Nevin Manimala

Comput Biol Med. 2024 Nov 25;184:109368. doi: 10.1016/j.compbiomed.2024.109368. Online ahead of print.

ABSTRACT

This study addresses the characterization of normal gait and pathological deviations caused by neurological diseases. We focus on the angular knee kinematics in the sagittal plane and we propose to exploit Hidden Markov Models to build a statistical model of normal gait. Such model provides a log-likelihood score that quantifies gait quality. Hence allowing to assess deviations of pathological cycles from normal gait. Our approach allows a refined characterization of motor impairments of three different patients’ groups. In particular, it detects the affected lower limb in Hemiparetic patients. Comparatively to the Gait Variable Score and a Dynamic Time Warping-based metric, our results show that our statistical method is more effective for finely quantifying pathological deviations. Finally, we show the potential use of our methodology to assess therapeutic impacts during gait rehabilitation, which represents a promising avenue for improving patient care.

PMID:39591667 | DOI:10.1016/j.compbiomed.2024.109368

Rep Prog Phys. 2024 Nov 26. doi: 10.1088/1361-6633/ad9756. Online ahead of print.

ABSTRACT

Statistical mechanics provides a framework for describing the physics of large, complex many-body systems using only a few macroscopic parameters to determine the state of the system. For isolated quantum many-body systems, such a description is achieved via the eigenstate thermalization hypothesis (ETH), which links thermalization, ergodicity and quantum chaotic behavior. However, tendency towards thermalization is not observed at finite system sizes and evolution times in a robust many-body localization (MBL) regime found numerically and experimentally in the dynamics of interacting many-body systems at strong disorder. Although the phenomenology of the MBL regime is well-established, the central question remains unanswered: under what conditions does the MBL regime give rise to an MBL phase in which the thermalization does not occur even in the asymptotic limit of infinite system size and evolution time?

This review focuses on recent numerical investigations aiming to clarify the status of the MBL phase, and it establishes the critical open questions about the dynamics of disordered many-body systems. Persistent finite size drifts towards ergodicity consistently emerge in spectral properties of disordered many-body systems, excluding naive single-parameter scaling hypothesis and preventing comprehension of the status of the MBL phase. The drifts are related to tendencies towards thermalization and non-vanishing transport observed in the dynamics of many-body systems, even at strong disorder. These phenomena impede understanding of microscopic processes at the ETH-MBL crossover. Nevertheless, the abrupt slowdown of dynamics with increasing disorder strength suggests the proximity of the MBL phase. This review concludes that the questions about thermalization and its failure in disordered many-body systems remain a captivating area open for further explorations.

PMID:39591655 | DOI:10.1088/1361-6633/ad9756

J Interpers Violence. 2024 Nov 26:8862605241299445. doi: 10.1177/08862605241299445. Online ahead of print.

ABSTRACT

This study aimed to extend limited extant knowledge of female-perpetrated sexual offenses, including child sexual abuse material (CSAM) offenses, that enter the criminal justice system. Sexual offenses actioned by the police in one jurisdiction of Australia between 1 January 2012 and 30 June 2021 (N = 37,864) were analyzed to explore the prevalence of sexual offenses and types of sexual offenses perpetrated; the relationship between perpetrator gender, age, and offense type; and the relationship between perpetrator gender, age, offense type, and likelihood of law enforcement action (N = 34,835). Consistent with previous research, (predominantly adult) males were responsible for most sexual offenses before police. Females were responsible for 12.2% of all offenses over this period, with juvenile females (10-17 years) implicated in a significant proportion (10.2%) of all offenses. In fact, juvenile females were responsible for the majority of assaultive CSAM offenses, whereas juvenile males mostly perpetrated offline child sexual abuse offenses. Regarding adults, there was a minimal, statistically significant difference between gender and offense type. Odds of perpetrating an online assaultive CSAM offense were 20 times higher for juvenile females compared to both adult males and adult females, and 7.69 times higher for juvenile females compared to juvenile males. Finally, for the same offense type, gender and age differentially impacted law enforcement action. For all offense types, enforcement and gravity (e.g., arrest and referral to court) of further action, were significantly lower among all females and juvenile males compared to adult males. Juvenile females were least likely to have any serious action taken. These findings provide a seminal platform from which to expand much-needed research on female-perpetrated offending to inform policy and practice.

PMID:39591641 | DOI:10.1177/08862605241299445

Am J Trop Med Hyg. 2024 Nov 26:tpmd230732. doi: 10.4269/ajtmh.23-0732. Online ahead of print.

ABSTRACT

The rapid diagnosis of coronavirus disease 2019 (COVID-19) is critical for comprehensive public health response strategies, and self-testing with antigen rapid diagnostic tests (Ag-RDTs) presents opportunities to test in hard-to-reach communities. Therefore, we evaluated the acceptability, feasibility, and uptake of Ag-RDT self-testing at the community level in Tanzania. From June to October 2022, symptomatic individuals or those with recent contact with a known or suspected COVID-19 patient were offered assisted testing and self-testing within mining communities and at transport hubs. This study included a cross-sectional survey before and after implementation. Participants were assessed for their acceptability and uptake of the nasal Ag-RDT self-test and their preference for nasal Ag-RDT self-testing. The survey data were collected in Open Data Kit, whereas the Ag-RDT results in the community were recorded by using the COVISUSPECT Mobile Application. Data analysis was performed by using STATA and R Statistical Software. A total of 538 individuals were screened, and 454 (84.4%) consented to be tested. The preference for self-testing was relatively low (33%), and the majority of participants (67%) opted to be assisted by a healthcare professional. Of the participants who opted for testing, 149 (32.8%) were able to self-test. Generally, there was no major difference in the various assessed parameters between the baseline and end-line surveys. The results from fitting multiple logistic regression indicated that after controlling for age, participants living in Dodoma were significantly less likely to opt for self-testing (odds ratio = 0.54; P-value = 0.023) compared with those living in Dar es Salaam. There was no significant difference in self-testing between participants living in Mara and those living in Dar es Salaam (odds ratio = 0.7; P-value = 0.179). After controlling for region, older (≥40 years) participants were significantly less likely to self-test compared with participants aged 18 to <40 years (odds ratio = 0.47; P-value = 0.002). The intervention was well-accepted in all areas in which Ag-RDTs were deployed. Our findings can therefore support the Ministry of Health by increasing accessibility to severe acute respiratory syndrome coronavirus 2 testing in the hard-to-reach communities in response to the next COVID-19 wave.

PMID:39591640 | DOI:10.4269/ajtmh.23-0732

Adv Emerg Nurs J. 2024 Nov 26. doi: 10.1097/TME.0000000000000552. Online ahead of print.

ABSTRACT

Mass gathering events can greatly impact overburdened emergency medical service systems and emergency departments, which frequently experience staffing shortages and overcrowding. Nurse practitioners (NPs) were introduced into an event medicine team at mass gatherings to reduce emergency transports to local emergency departments as well as offering a “treat and release” disposition for patients presenting to medical tents. This study aimed to examine the impact of NPs at mass gathering events; 147 chart reviews were performed from 05/01/2023 to 09/30/2023 for all patients assessed by an NP at events staffed by an event medicine team; 60% of patients assessed by an NP were treated and released from the event, potentially reducing the number of patient transports and emergency department visits considerably. NPs can provide higher levels of care at events, treating common complaints such as heat-related illness, nausea, vomiting, minor trauma, and laceration repairs. Although this study did not compare data from events where NPs were not present versus when they were utilized to grasp the statistical impact their presence has had since their introduction to the team model, the study clearly shows the benefits NPs bring to mass gathering medical care. This is significant for emergency NPs as this research validates the need to include these providers in this new setting and role in which they can practice. More research is needed to compare patient outcomes with and without NPs present.

PMID:39591635 | DOI:10.1097/TME.0000000000000552

Ophthalmic Surg Lasers Imaging Retina. 2024 Nov 1:1-6. doi: 10.3928/23258160-20241114-01. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: This study compares the ability of resident ophthalmologists to identify neovascularization (NV) in patients with proliferative diabetic retinopathy (PDR) using widefield swept-source optical coherence tomography angiography (SS-OCTA) and fluorescein angiography (FA).

PATIENTS AND METHODS: Fluorescein angiography and SS-OCTA images were scrambled to create a grading set consisting of 1) early and late phase FA images, 2) B-scan videos, and 3) vitreoretinal interface (VRI) slab. Participants were asked to identify NV.

RESULTS: Twelve resident physicians participated in the study. Resident physicians correctly identified 75.6% of NV using FA, 65.3% of NV using SS-OCTA B-scans, and 90.7% of NV using the SSOCTA VRI slab. There was no statistically significant difference in participants’ ability to detect NV across imaging modalities (P = 0.08).

CONCLUSION: Detection rates of NV using SS-OCTA were comparable to that of using FA. Results suggest that SS-OCTA may be an appropriate imaging modality for detection of NV in PDR patients. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

PMID:39591626 | DOI:10.3928/23258160-20241114-01

JMIR Form Res. 2024 Nov 26;8:e60674. doi: 10.2196/60674.

ABSTRACT

BACKGROUND: Inexperienced adolescent drivers are particularly susceptible to engaging in distracted driving behaviors (DDBs) such as texting while driving (TWD). Traditional driver education approaches have shown limited success in reducing motor vehicle crashes among young drivers.

OBJECTIVE: We tested an innovative approach to help address the critical issue of DDB among teenagers. We investigated the effectiveness of using a novel virtual reality (VR) game “Distracted Navigator” to educate novice teenage drivers about DDB.

METHODS: The game consisted of maneuvering a spaceship around asteroids while engaging in simulated DDB (eg, inputting numbers into a keypad). A physician-facilitated discussion, based on the theory of planned behavior, linked gameplay to real-life driving. Teenagers were recruited for the in-person study and randomly assigned at the block level to intervention (VR gameplay or discussion) and control groups (discussion only), approximating a 2:1 ratio. Unblinded, bivariate statistical analyses (all 2-tailed t tests or chi-square tests) and regression analyses measured programming impact on TWD-related beliefs and intentions. Content analysis of focus group interviews identified thematic feedback on the programming.

RESULTS: Of the 24 participants, 15 (63%) were male; their ages ranged from 14 to 17 (mean 15.8, SD 0.92) years, and all owned cell phones. Compared to the control group (n=7, 29%), the intervention group (n=17, 71%) was more likely to report that the programming had positively changed how they felt about texting and driving (?²₁₈=-8.3; P=.02). However, specific TWD attitudes and intentions were not different by treatment status. Irrespective of treatment, pre- and postintervention scores indicated reduced confidence in safely TWD (ie, perceived behavioral control; β=-.78; t₄₆=-2.66; P=.01). Thematic analysis revealed the following: (1) the VR gameplay adeptly portrayed real-world consequences of texting and driving, (2) participants highly valued the interactive nature of the VR game and discussion, (3) both the VR game and facilitated discussion were deemed as integral and complementary components, and (4) feedback for improving the VR game and discussion.

CONCLUSIONS: Our findings show that the novel use of immersive VR experiences with interactive discussions can raise awareness of DDB consequences and is a promising method to enhance driving safety education. The widespread accessibility of VR technology allows for scalable integration into driver training programs, warranting a larger, prospective, randomized study.

PMID:39591605 | DOI:10.2196/60674

Arch Cardiol Mex. 2024;94(4):403-411. doi: 10.24875/ACM.23000203.

ABSTRACT

OBJECTIVES: Ebstein’s anomaly is a congenital defect characterized by a lack of delamination and apical displacement of the tricuspid valve, tricuspid insufficiency, right atrial enlargement, and ventricular dysfunction. To analyze the results and evolution of the different surgical strategies, data were collected from 45 patients operated on during 1990-2018. Twenty-six patients were included with a median age at initial surgery of 11.3 years (range: 13 days-18.6 years).

METHOD: Procedures were plastic 10 patients (38%), cone technique reconstruction 11 (42%), and replacement 5 (19%). Additional interventions were required in 7 patients: cavo-pulmonary anastomosis 4 and Cox-maze 4. Nine patients (34.6%) required reoperation due to severe tricuspid insufficiency. Six had previous plastic, two bioprothesis, and one, cone.

RESULTS: Overall mortality was 11.5% (3) at a median of 10.1 years post-surgery (range: 5.7-10.12) associated with arrhythmias (p = 0.05), right (p = 0.008), left (p = 0.0001) ventricular dysfunction and reoperations (p = 0.03). None were previous conus. Median follow-up was 6.5 years (range: 1-29.1). Ninety-one-point-six percent were in functional class I/II and 79.2% in sinus rhythm.

CONCLUSIONS: The results of the different classic techniques were similar, although not free of complications and reoperations. Cone reconstruction proved to be effective, with low surgical mortality, less need for reoperations, and durability in the medium term.

PMID:39591595 | DOI:10.24875/ACM.23000203

Cir Cir. 2024;92(6):751-757. doi: 10.24875/CIRU.23000024.

ABSTRACT

OBJECTIVE: To compare the costs of care and the opportunity of care for the management of grade I-II ankle sprain in two Family Medicine Units, one with rehabilitation service (FMU 13) and one without rehabilitation service (FMU 41).

METHOD: Observational analytical study, records with diagnosis of grade I-II ankle sprain attended at the FMU were included January-November 2021. Consultations were recorded in the emergency department, family medicine, rehabilitation, cabinet studies and time to grant the appointment in the rehabilitation service (opportunity of care), the Mann-Whitney U test was used to compare costs of care and timeliness of care.

RESULTS: In FMU 41, care costs were higher compared to FMU 13 ($13,990 vs $8,063); however, this difference was not significant, as was the cost of care in family medicine, rehabilitation, and opportunity of care.

CONCLUSIONS: The costs of care and the opportunity of care were similar in both models of care (FMU 13-FMU 41) of grade I-II ankle sprain.

PMID:39591581 | DOI:10.24875/CIRU.23000024

Cir Cir. 2024;92(6):741-750. doi: 10.24875/CIRU.24000184.

ABSTRACT

OBJECTIVE: Reviewing available literature regarding extranodal Rosai-Dorfman disease in the breast to explore the clinical characteristics of this disease, the described therapeutic options, and their outcomes.

METHOD: In January 2024, the PubMed, SpringerOpen, and Scopus databases were searched with the keywords “Rosai,” “Dorfman,” and “Breast.” Forty-two studies were included in the final analysis, obtaining a total of 70 reported cases of extranodal Rosai-Dorfman disease affecting the breast. Patient characteristics, mammogram descriptions, therapeutic management, and outcomes were reviewed for statistical analysis.

RESULTS: The main population consisted of females in their sixth decade of life (93%), presenting with a firm, non-tender nodule (65.7%), generally localized to one breast (72%). About 18.6% of patients had nodal or extranodal disease in other areas. Excisional biopsy was the main treatment strategy (63%) and surgical excision showed a lesser association with recurrence than incisional biopsy (p = 0.049). Most instances of disease recurrence or progression were diagnosed within the first 2 years.

CONCLUSIONS: This study revealed that surgical excision showed less association with disease recurrence or progression than expectant management. Follow-up can be conducted with a mammogram and physical examination since recurrence tends to occur locally within 2 years.

PMID:39591578 | DOI:10.24875/CIRU.24000184