Nevin Manimala

Brain Stimul. 2024 Aug 10:S1935-861X(24)00139-6. doi: 10.1016/j.brs.2024.08.002. Online ahead of print.

ABSTRACT

BACKGROUND: Deep brain stimulation of central thalamus (CT-DBS) has potential for modulating states of consciousness, but it can also trigger electrographic seizures, including poly-spike-wave trains (PSWT).

OBJECTIVES: To report the probability of inducing PSWTs during CT-DBS in awake, freely-moving mice.

METHODS: Mice were implanted with electrodes to deliver unilateral and bilateral CT-DBS at different frequencies while recording EEG. We titrated stimulation current by gradually increasing it at each frequency until a PSWT appeared. Subsequent stimulations to test arousal modulation were performed at the current one step below the current that caused a PSWT during titration.

RESULTS: In 2.21% of the test stimulations (10 out of 12 mice), CT-DBS caused PSWTs at currents lower than the titrated current, at currents as low as 20 μA.

CONCLUSION: Our study found a small but significant probability of inducing PSWTs even after titration and at relatively low currents. EEG should be closely monitored for electrographic seizures when performing CT-DBS in both research and clinical settings.

PMID:39134207 | DOI:10.1016/j.brs.2024.08.002

Brain Behav Immun. 2024 Aug 10:S0889-1591(24)00539-7. doi: 10.1016/j.bbi.2024.08.017. Online ahead of print.

ABSTRACT

BACKGROUND: Childhood maltreatment (CM) has long-term consequences for the regulation of stress biology which are particularly pronounced when mental and physical health sequelae have manifested. C-reactive protein (CRP) has been shown to be elevated in the non-pregnant state in association with CM as well as in the setting of CM-associated mental and physical health sequelae. In pregnancy, however, the association between CM and CRP is less clear. We sought to examine this association and consider the moderating role of four common health sequelae of CM (maternal depressive symptoms, overweight/obesity, smoking, and hypertensive disorders during pregnancy).

METHODS: A prospective, longitudinal study of 744 healthy pregnant participants was conducted, with analyses focusing on a sample of 643 participants. CM was assessed with the Childhood Trauma Questionnaire (CTQ) and categorized by whether no vs. one or more moderate to severe CM experiences were reported. Blood serum concentrations of CRP, maternal depression severity (continuous scores of the Center for Epidemiologic Studies Depression Scale, CES-D) and smoking during pregnancy were assessed in early (16.52 ± 2.50 weeks gestation) and late (33.65 ± 1.18 weeks gestation) pregnancy. Pre-pregnancy body mass index (BMI) was obtained at the first study visit and hypertensive disorders diagnosed during pregnancy were obtained from the medical record. Linear mixed effects models were employed to assess main effects of CM as well as interactive effects of CM and four common CM-associated sequelae as well as a sum score of these sequelae on repeatedly measured CRP concentration. In secondary analyses, we conducted latent class analyses to classify participants based on their specific experiences of childhood abuse and/or neglect and to assess the association of these CM subgroups with CM sequelae and CRP. All analyses were adjusted for potential confounders (maternal race and ethnicity and education/income).

RESULTS: CRP concentration decreased from early to late pregnancy (B = -0.06, SE = 0.01, p < 0.001). While there was no main effect of CM on CRP (p = 0.49), the interaction of CM and depressive symptoms was associated with CRP concentration (B = 0.08, SE = 0.04, p < 0.05), indicating higher CRP across pregnancy with increasing levels of depressive symptoms during pregnancy in participants with CM experience. This interaction was mainly driven by participants with co-occurring physical and emotional maltreatment. For none of the other CM-associated sequelae a statistically significant interaction with CM on CRP concentration was observed.

CONCLUSIONS: These results add to the growing empirical evidence suggesting higher inflammation during pregnancy in participants exposed to CM who experience depressive symptoms and highlight the detrimental effects of multiple co-occurring experiences of maltreatment. Given the negative consequences of chronic inflammatory state for the mother and the developing fetus, monitoring and treating psychiatric sequelae during pregnancy among participants exposed to CM is potentially an important opportunity to dampen long-term detrimental effects of CM, serving at least two generations.

PMID:39134185 | DOI:10.1016/j.bbi.2024.08.017

Chest. 2024 Aug 10:S0012-3692(24)04904-3. doi: 10.1016/j.chest.2024.07.160. Online ahead of print.

ABSTRACT

BACKGROUND: Latino adults experience multiple barriers to healthcare access and treatment that result in tobacco-related disparities. Mobile interventions have the potential to deliver smoking cessation treatment among Latino adults, the highest users of mobile technologies.

RESEARCH QUESTION: Is Decídetexto, a culturally accommodated mobile health intervention, more effective for smoking cessation compared to standard care among Latino adults who smoke?

STUDY DESIGN AND METHODS: A two-arm parallel group randomized clinical trial (RCT) was conducted in Kansas, New Jersey, and New York between October 2018 and September 2021. Eligible Latino adults who smoke (n=457) were randomly assigned to Decídetexto or a standard care group. The primary outcome was biochemically verified 7-day smoking abstinence at week 24. Secondary outcomes included self-reported 7-day smoking abstinence at weeks 12 and 24, and uptake and adherence of nicotine replacement therapy (NRT).

RESULTS: Participants mean age was 48.7 (SD 11.1) years, 45.2% were female, and 50.3% smoked ≥10 cigarettes per day. Two hundred twenty-nine participants were assigned to Decídetexto and 228 to standard care. Treating those lost to follow-up as participants who continued smoking, 14.4% of participants in the Decídetexto group were biochemically verified abstinent at week 24 compared to 9.2% in the standard care group (OR 1.66 [95% CI, 0.93-2.97], p=0.09). Treating those lost to follow-up as participants who continued smoking, 34.1% of the participants in the Decídetexto group self-reported smoking abstinence at week 24 compared to 20.6% of participants in the standard care group (OR 1.99 [95%, 1.31-3.03]; p<0.001). Analyzing only participants who completed the assessment at week 24, 90.6% (174/192) of participants in the Decídetexto group self-reported using NRT for at least one day compared to 70.2% (139/198) of participants in standard care (OR 4.10 [95% CI, 2.31-7.28]; p<0.01).

INTERPRETATION: Among Latino adults who smoke, the Decídetexto intervention was not associated with a statistically significant increase in biochemically verified abstinence at week 24. However, the Decídetexto intervention was associated with a statistically significant increase in self-reported 7-day smoking abstinence at weeks 12 and 24, and uptake of NRT. This RCT provides encouragement for the use of Decídetexto for smoking cessation among Latino adults.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03586596.

PMID:39134144 | DOI:10.1016/j.chest.2024.07.160

J Acad Nutr Diet. 2024 Aug 10:S2212-2672(24)00751-2. doi: 10.1016/j.jand.2024.08.001. Online ahead of print.

ABSTRACT

BACKGROUND: The 2020-2025 Dietary Guidelines for Americans (DGA) includes a lacto-ovo vegetarian pattern (the Healthy Vegetarian Dietary Pattern; HVDP) as one recommended dietary patterns during pregnancy.

OBJECTIVE: To adapt the HVDP for vegan, ovo-vegetarian, lacto-vegetarian, and pescatarian diets during pregnancy.

DESIGN: Using food pattern modeling, four adaptations of the HVDP were developed at energy levels that may be appropriate during pregnancy (1800, 2000, 2200, 2400, and 2600 kcal/day). Models were run both with and without the addition of a composite prenatal supplement.

MAIN OUTCOME MEASURES: Main outcome measures were macro- and micronutrient adequacy without exceeding recommendations for saturated fat and added sugar.

STATISTICAL ANALYSIS PERFORMED: The 2020-2025 DGA Food Pattern Modeling Report was used to define food groups and nutrients in the HVDP. The HVDP was revised to remove dairy and/or eggs or to add seafood.

RESULTS: Across all examined energy levels (1800, 2000, 2200, 2400, and 2600 kcal per day), modeled dietary patterns provided sufficient macronutrients. Without prenatal supplements, each dietary pattern met most, but not all, micronutrient recommendations. Micronutrients that were below recommendations in patterns without supplements included vitamin D, iron, vitamin E, sodium, and choline. With the addition of an “composite” prenatal supplement to these patterns, the nutrients below 100% of recommendations were vitamin D, choline, and sodium.

CONCLUSIONS: Overall, these results show that a HVDP and similar diets without meat, eggs, dairy, and/or seafood can provide most nutrients needed during pregnancy, albeit with some micronutrient challenges similar to those diets that include meat and other animal products.

PMID:39134141 | DOI:10.1016/j.jand.2024.08.001

J Am Coll Radiol. 2024 Aug 10:S1546-1440(24)00690-2. doi: 10.1016/j.jacr.2024.07.024. Online ahead of print.

ABSTRACT

OBJECTIVE: Currently, computed tomographic pulmonary angiogram (CTPA) for evaluating acute pulmonary embolism (PE) in Emergency Departments (EDs) is overused and with low yields. The goal of this study is to assess the impact of an evidence-based clinical decision support (CDS) tool, aimed at optimizing appropriate use of CTPA for evaluating PE.

METHODS: The study was performed at EDs in a large healthcare system and included 9 academic and community hospitals. The primary outcome was the percent difference in utilization (number of CTPA performed/number of ED visits) and secondary outcome was yield (percentage of CTPA positive for acute PE), comparing 12 months before (6/1/2021-5/31/2022) vs. 12 months after (6/1/2022-5/31/2023) a system-wide implementation of the CDS. Univariate and multivariable analyses using logistic regression were performed to assess factors associated with diagnosis of acute PE. Statistical process control (SPC) charts were used to assess monthly trends in utilization and yield.

RESULTS: Among 931,677 visits to Emergency Departments, 28,101 CTPAs were performed on 24,675 patients. 14,825 CTPAs were performed among 455,038 visits (3.26%) pre-intervention; 13,276 among 476,639 visits (2.79%) post-intervention, a 14.51% relative decrease in CTPA utilization (chi-square, p<0.001). CTPA yield remained unchanged (1371/14825=9.25% pre- vs. 1184/13276=8.92% post-intervention; chi-square, p=0.34). Patients with COVID diagnosis prior to CTPA had higher probability of acute PE. SPC charts demonstrated seasonal variation in utilization (Friedman test, p=0.047).

DISCUSSION: Implementing a CDS based on validated decision rules was associated with a significant reduction in CTPA utilization. The change was immediate and sustained for 12 months post-intervention.

PMID:39134106 | DOI:10.1016/j.jacr.2024.07.024

Facial Plast Surg Aesthet Med. 2024 Aug 12. doi: 10.1089/fpsam.2024.0046. Online ahead of print.

ABSTRACT

Background: The distribution of lip shapes in young females and how morphological variation relates to attractiveness are poorly defined. Objectives: We hypothesized that among young female lip images generated by a statistical atlas model, those with more full lips compared with those with less full lips would be perceived as more attractive as measured by anonymous survey participants. Method: A statistical atlas of lip morphology was created using photographs of 700 women aged 18-35 years. The average lip shape was determined by coregistering and averaging images. Morphological variation was analyzed using principal component analysis. The relationship between attractiveness and observed lip morphologies was assessed using publicly distributed surveys. Results: In total, 428 survey responses were obtained. We developed a statistical model of variation of lip shape in the population and its relationship to attractiveness. The most attractive lips were significantly fuller than the average shape in the population, with greater vertical height and surface area. Conclusion: A statistical atlas can provide a visual guide to variation in lip shape in the population. The most attractive lip shapes vary significantly from the population average, lending support to procedures that increase lip height and surface area.

PMID:39134070 | DOI:10.1089/fpsam.2024.0046

J Public Health Dent. 2024 Aug 12. doi: 10.1111/jphd.12634. Online ahead of print.

ABSTRACT

OBJECTIVES: We aimed to evaluate the association between antibiotic prophylaxis and adverse outcomes following tooth extraction within the Veterans Affairs Healthcare System.

METHODS: We conducted a retrospective cohort study of patients undergoing dental extractions in 2015-2019. The primary exposure was antibiotic prophylaxis. The primary outcome was post-extraction complication within 7 days (e.g., alveolar osteitis and surgical site infection); the secondary outcome was subsequent medical care relating to a post-extraction oral complication within 7 days. Multivariable logistic regression models assessed the independent effect of antibiotic prophylaxis on each outcome.

RESULTS: Of 385,880 visits with a dental extraction, 122,810 (31.8%) received antibiotic prophylaxis. Overall, 3387 (0.9%) experienced a post-extraction complication and 350 (0.09%) received medical care relating to a post-extraction oral complication within 7 days. In multivariable regression, diabetes was a statistically significant (p = 0.01) effect modifier of the association between antibiotic prophylaxis and post-extraction complication. Among visits for patients without diabetes, antibiotic prophylaxis was significantly associated with an increased odds of post-extraction complication (odds ratio [OR] = 1.25, 95% confidence interval [CI]: 1.13-1.38), but among visits for patients with diabetes no significant effect was observed (OR = 1.03, 95% CI: 0.92-1.15). Antibiotic prophylaxis was not significantly associated with post-extraction medical care (OR = 1.04; 95% CI: 0.83-1.30).

CONCLUSIONS: In this large retrospective cohort, we observed no significant protective effect of antibiotic prophylaxis on post-extraction complications or subsequent medical care utilization in a setting with low complication rates. These data suggest that use of antibiotic prophylaxis in similar settings may need to be re-evaluated to minimize unnecessary antibiotic use.

PMID:39134053 | DOI:10.1111/jphd.12634

J Reconstr Microsurg. 2024 Aug 12. doi: 10.1055/a-2383-6916. Online ahead of print.

ABSTRACT

BACKGROUND: The rising clinical importance of assessing frailty is driven by its predictive capability for postoperative outcomes. This study assesses RAI-rev (Risk Analysis Index) effectiveness in predicting adverse outcomes in lower extremity (LE) flap reconstruction.

METHODS: Analyzing NSQIP data from 2015-2020, we compared demographics, perioperative factors, and 30-day outcomes in all locoregional and free flap cases. Frailty scores, calculated using RAI-rev, were categorized with <15 as non-frail and >35 as the most frail. Adjusted odds-ratios (aOR) for specific complications were calculated using non-frail as the reference group. Frailty scores in locoregional flaps were compared to those in free flaps.

RESULTS: We identified 270 locoregional and 107 free flap cases. Higher RAI-rev scores in locoregional flaps correlated with increased complications, such as deep surgical site infection (1% non-frail vs. 20% RAI 31-35), stroke (0% non-frail vs. 17% most-frail), and mortality (0% non-frail vs. 17% most-frail). Locoregional flap cases with RAI-rev scores in the most-frail group had a significantly elevated aOR for stroke (51.0, 95% CI: 1.8-1402.5, p=0.02), mortality (43.1, 95% CI: 1.6-1167.6, p=0.03), and any complication (6.8, 95% CI: 1.2-37.4, p=0.03). In free flap cases, higher RAI-rev scores were associated with increased complications, with only sepsis showing a statistically significant difference (6% non-frail vs. 100% most-frail; aOR 42.3, CI: 1.45 – 1245.3, p=0.03). Free flap cases had a significantly lower RAI-rev score compared to locoregional flap cases (14.91 vs. 17.64, p=0.01).

CONCLUSION: Elevated RAI-rev scores (>35) correlated with more complications in locoregional flaps, while free flap reconstruction patients had generally low RAI-rev scores. This suggests that free flaps are less commonly recommended for presumed higher-risk patients. The study demonstrates that RAI-rev may be able to serve as a risk calculator in lower extremity reconstruction, aiding in the assessment of candidates for limb salvage versus amputation.

PMID:39134048 | DOI:10.1055/a-2383-6916

Int J Epidemiol. 2024 Jun 12;53(4):dyae104. doi: 10.1093/ije/dyae104.

ABSTRACT

BACKGROUND: The impact of societal factors on the occurrence of head and neck cancers (HNCs) remains understudied, especially in the Nordic countries.

METHODS: To quantify the association between socio-economic status (SES) and the occurrence of HNCs, this cohort study uses data from the Nordic Occupational Cancer project that combine occupational and cancer registry data from 1961 to 2005 of 14.9 million individuals aged between 30 and 64 years. Occupational categories were combined into seven socio-economic categories. Standardized incidence ratio (SIR) analyses were conducted with the cancer incidence rates for the entire national study populations used as reference rates.

RESULTS: Altogether, 83 997 HNCs-72% in men and 28% in women-were recorded. Among men, a gradient of risk associated with SES was observed for cancers of the tongue, other oral cavity subsites, pharynx, oropharynx and larynx in groups with lower SES. Managers showed decreased SIRs of 0.50 to -0.90 also for cancers of the lip, tongue, other oral cavity subsites, oropharynx, nasopharynx, nose and larynx. In contrast, excess risks of tongue, other oral cavity subsites, pharyngeal, oropharyngeal and laryngeal cancers were observed among clerical (SIRs 1.05-1.16), skilled workers (1.04-1.14), unskilled workers (1.16-1.26) and economically inactive men (1.38-1.87). Among women, no risk gradient similar to that in men was revealed.

CONCLUSIONS: The current study underscores the influence of SES on the incidence of HNCs and highlights the need for targeted interventions, including tobacco and alcohol control policies, and improved access to healthcare services, particularly for socio-economically disadvantaged populations.

PMID:39133936 | DOI:10.1093/ije/dyae104

Nurs Ethics. 2024 Aug 12:9697330241268901. doi: 10.1177/09697330241268901. Online ahead of print.

ABSTRACT

BACKGROUND: Belonging to the clinical environment and the professional values of the performers play a role in forming a professional identity. Therefore, it is necessary to understand the degree of connection among these concepts.

AIM: This study aimed to examine the mediating effects of professional values on the relationship between nurses’ clinical environment belongingness and professional identity.

DESIGN: In the present study, a descriptive cross-sectional multicenter design was used.

PARTICIPANTS AND RESEARCH CONTEXT: A convenient sample of 635 nurses recruited from three hospitals in Fars Province, Southern Iran, from September 2023 to January 2024. Nurses Professional Values Scale-Revised, Clinical Environment Belongingness Scale, and Professional Identity Scale were used to collect the data. The mediation model was analyzed using SPSS v27 and the Process Macro 4.0.

ETHICAL CONSIDERATIONS: The protocol of this study was approved by the Research Ethics Committee of Fasa University of Medical Sciences, and informed consent was obtained from all nurses. The study conforms to the principles outlined in the Declaration of Helsinki.

RESULTS: Based on the results of regression analysis, clinical environment belongingness had a positive and significant impact on professional identity (β = 0.366, p < 0.001) and professional value (β = 0.676, p < 0.001). Professional value significantly predicted professional identity (β = 0.170, p < 0.001). The indirect effect of clinical environment belongingness on professional identity via professional values was statistically significant (β = 0.115, SE = 0.024, 95% CI = [0.068, 0.162]), and this effect was directly (β = 0.336, SE = 0.034, 95% CI = [0.297, 0.434]) significant.

CONCLUSIONS: The new theoretical framework for nurses developed in this study can contribute to professional development. It is further recommended that the promotion of professional value and clinical environment belongingness may be effective in enhancing the professional identity of the nursing staff, as indicated by the results.

PMID:39133934 | DOI:10.1177/09697330241268901