Nevin Manimala

JAMA Netw Open. 2024 Oct 1;7(10):e2442091. doi: 10.1001/jamanetworkopen.2024.42091.

ABSTRACT

IMPORTANCE: Suicide is a leading cause of death among young people. Accurate detection of self-injurious thoughts and behaviors (SITB) underpins equity in youth suicide prevention.

OBJECTIVES: To compare methods of detecting SITB using structured electronic health information and measure algorithmic performance across demographics.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used medical records among youths aged 6 to 17 years with at least 1 mental health-related emergency department (ED) visit in 2017 to 2019 to an academic health system in Southern California serving 787 000 unique individuals each year. Analyses were conducted between January and September 2023.

EXPOSURES: Multiexpert electronic health record review ascertained the presence of SITB using the Columbia Classification Algorithm of Suicide Assessment. Random forest classifiers with nested cross-validation were developed using (1) International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for nonfatal suicide attempt and self-harm and chief concern and (2) all available structured data, including diagnoses, medications, and laboratory tests.

MAIN OUTCOME AND MEASURES: Detection performance was assessed overall and stratified by age group, sex, and race and ethnicity.

RESULTS: The sample comprised 2702 unique youths with an MH-related ED visit (1384 youths who identified as female [51.2%]; 131 Asian [4.8%], 266 Black [9.8%], 719 Hispanic [26.6%], 1319 White [48.8%], and 233 other race [8.6%]; median [IQR] age, 14 [12-16] years), including 898 children and 1804 adolescents. Approximately half of visits were related to SITB (1286 visits [47.6%]). Sensitivity of SITB detection using only codes and chief concern varied by age group and increased until age 15 years (6-9 years: 59.3% [95% CI, 48.5%-69.5%]; 10-12 years: 69.0% [95% CI, 63.8%-73.9%]; 13-15 years: 88.4% [95% CI, 85.1%-91.2%]; 16-17 years: 83.1% [95% CI, 79.1%-86.6%]), while specificity remained constant. The area under the receiver operating characteristic curve (AUROC) was lower among preadolescents (0.841 [95% CI, 0.815-0.867]) and male (0.869 [95% CI, 0.848-0.890]), Black (0.859 [95% CI, 0.813-0.905]), and Hispanic (0.861 [95% CI, 0.831-0.891]) youths compared with adolescents (0.925 [95% CI, 0.912-0.938]), female youths (0.923 [95% CI, 0.909-0.937]), and youths of other races and ethnicities (eg, White: 0.901 [95% CI, 0.884-0.918]). Augmented classification (ie, using all available structured data) outperformed classification with codes and chief concern alone (AUROC, 0.975 [95% CI, 0.968-0.980] vs 0.894 [95% CI, 0.882-0.905]; P < .001).

CONCLUSIONS AND RELEVANCE: In this study, diagnostic codes and chief concern underestimated SITB prevalence, particularly among minoritized youths. These results suggest that priority on algorithmic fairness in suicide prevention strategies must extend to accurate detection of youths with suicide-related emergencies.

PMID:39470636 | DOI:10.1001/jamanetworkopen.2024.42091

JAMA Netw Open. 2024 Oct 1;7(10):e2442204. doi: 10.1001/jamanetworkopen.2024.42204.

ABSTRACT

IMPORTANCE: Having diverse participants in clinical trials ensures new drug products work well across different demographic groups, making health care safer and more effective for everyone. Information on the extent of Native Hawaiian and Pacific Islander participation in clinical trials is limited.

OBJECTIVE: To examine representation of Native Hawaiian and Pacific Islanders in clinical trials leading to the first US Food and Drug Administration (FDA) approvals for the 10 drug products with the top worldwide sales forecasts in 2024.

DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional secondary analysis of existing data from clinical trials that took place from 2006 to 2021 in the US. All clinical trials that were included in the FDA first approval application for the 10 drug products were evaluated in this study. Data were analyzed from February to August 2024.

EXPOSURE: Participation in a clinical drug trial.

MAIN OUTCOMES AND MEASURES: Comparison of the proportion of Native Hawaiian and Pacific Islander participation in clinical trials for the 10 drug products with top sales forecasts in 2024 to the Native Hawaiian and Pacific Islander population proportion.

RESULTS: In this cross-sectional study of 139 062 individuals, Native Hawaiian and Pacific Islander participation in clinical trials for the 10 drug products with top sales forecasts was either unknown or low. For 6 of the 10 drug products (60%), the number of Native Hawaiian and Pacific Islander participants was not documented. All trials that reported Native Hawaiian and Pacific Islander participation had fewer Native Hawaiian and Pacific Islander participants than would be expected based on their US population proportion, with 2 of the differences being statistically significant. Of the trials that disaggregated Native Hawaiian and Pacific Islander participants from other racial groups, the number of Native Hawaiian and Pacific Islander participants was 8 for risankizumab-rzaa (0.38% of participants vs 0.49% of the population; percentage point difference, -0.11%; 95% CI, -0.37% to -0.15%), 7 for bictegravir/emtricitabine/tenofovir alafenamide (0.38% of participants vs 0.49% of the population; percentage point difference, -0.10%; 95% CI, -0.39% to 0.18%), 27 for 4vHPV/9vHPV (0.15% of participants vs 0.46% of the population; percentage point difference, -0.31%; 95% CI, -0.37% to -0.26%), and 90 for BNT162B2 COVID-19 vaccine (0.20% of participants vs 0.52% of the population; percentage point difference, -0.32; 95% CI, -0.36% to -0.27%).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, limited documentation and participation of Native Hawaiian and Pacific Islander individuals in clinical trials for drug products with top sales forecasts was found. This is especially concerning because Native Hawaiian and Pacific Islander individuals have a higher risk than other racial groups for type 2 diabetes, cancer, and several other conditions the products examined in this study treat. Given the importance of enrolling Native Hawaiian and Pacific Islander participants in clinical trials, sites should be established in key geographic regions, such as Hawai’i, and postmarket studies should be conducted within Native Hawaiian and Pacific Islander populations.

PMID:39470635 | DOI:10.1001/jamanetworkopen.2024.42204

Chaos. 2024 Oct 1;34(10):103124. doi: 10.1063/5.0219848.

ABSTRACT

Resonance and synchronized rhythm are significant phenomena observed in dynamical systems in nature, particularly in biological contexts. These phenomena can either enhance or disrupt system functioning. Numerous examples illustrate the necessity for organs within the human body to maintain their rhythmic patterns for proper operation. For instance, in the brain, synchronized or desynchronized electrical activities can contribute to neurodegenerative conditions like Huntington’s disease. In this paper, we utilize the well-established Hodgkin-Huxley (HH) model, which describes the propagation of action potentials in neurons through conductance-based mechanisms. Employing a “data-driven” approach alongside the outputs of the HH model, we introduce an innovative technique termed “dynamic entrainment.” This technique leverages deep learning methodologies to dynamically sustain the system within its entrainment regime. Our findings show that the results of the dynamic entrainment technique match with the outputs of the mechanistic (HH) model.

PMID:39470595 | DOI:10.1063/5.0219848

Chaos. 2024 Oct 1;34(10):103148. doi: 10.1063/5.0219799.

ABSTRACT

Recently, we developed a theory of a geometrically growing system. Here, we show that the theory can explain some phenomena of power-law distribution, including classical demographic and economic and novel instances of the COVID-19 pandemic, without introduction of delicate economic or pandemic propagation models but only on a statistical way. A convexity in the low-size part of the distribution diagram is one peculiarity of the theory, which is absent in the power-law distribution. We found that the distribution of the geometrically growing system in the diagram could have a trend to flatten in the evolution of the system so that the relative ratio between the biggest and smallest sizes within the system increases. The system can act as a reverse machine to convert the diffusion in parametric space to a concentration in size.

PMID:39470594 | DOI:10.1063/5.0219799

Minerva Dent Oral Sci. 2024 Oct 29. doi: 10.23736/S2724-6329.24.04961-1. Online ahead of print.

ABSTRACT

BACKGROUND: Following an episode of hereditary angioedema (HAE), dental anxiety commonly arises, and many patients find it challenging to access proper care. While the use of virtual reality (VR) for pain and anxiety management in dentistry is on the rise, its application in individuals with angioedema remains largely unexplored. In a case series conducted at a specialized dental clinic, three patients with a history of acute angioedema attacks and dental anxiety engaged with 360° VR videos while seated in the dental chair, utilizing a virtual reality device.

METHODS: Three patients with hereditary angioedema were treated by subjecting them to virtual immersion using VR glasses. Intraoperative reactions were analyzed using VAS scales in order to report the patients’ level of anxiety and pain.

RESULTS: The outcomes, evaluated through a standard observation tool, surveys, and interviews, encompass the assessment of patient anxiety and pain, responses to VR, and the evaluation of system usability along with its impact on the dental team’s workflow Three individuals underwent examination, from which three reliable questionnaires were obtained, demonstrating a success rate of 99.9%. The group included one male and two females, with their ages spanning from 6 to 58 years. The findings revealed an average anxiety score of 1.80 with a standard deviation of 0.6 points, and an average pain score of 1.98 with a standard deviation of 0.3, thus validating full immersion in distraction. Statistical analysis using independent-sample t-tests and ANOVA indicated no significant differences in anxiety levels among the patients based on gender. Both patients wore the VR device throughout the procedure, expressing that it was comfortable, diverting, and held the potential to alleviate anxiety and pain. The dentist noted a positive influence on patient anxiety levels and procedure completion times, expressing an intention to continue employing VR with other angioedema patients and across diverse clinical populations.

CONCLUSIONS: Virtual reality can be an excellent distraction tool in patients with hereditary angioedema who present at least one acute attack per year.

PMID:39470592 | DOI:10.23736/S2724-6329.24.04961-1

Acta Otolaryngol. 2024 Oct 29:1-5. doi: 10.1080/00016489.2024.2411350. Online ahead of print.

ABSTRACT

BACKGROUND: Hematopoietic stem cell transplantation (HSCT) is a critical treatment for various hematologic malignancies but can lead to complications, including ototoxicity.

AIM/OBJECTIVES: This study aims to explore the relationship between patient-specific factors and ototoxicity in adult HSCT patients.

MATERIAL AND METHODS: We conducted a retrospective analysis of 129 adult patients who underwent HSCT between 2003 and 2020. Age, gender, transplant indications, conditioning regimens, and pre- and post-transplant audiometry thresholds data were collected from patient files. A hearing loss of 10 decibels or more at two consecutive frequencies or a hearing loss of 20 decibels or more at a single frequency was considered as significant hearing loss (SHL). Statistical analyses were performed to describe factors associated with SHL.

RESULTS: SHL occurred in 16.3% of patients. Older age was significantly associated with an increased risk of SHL (p = .035). Poorer pretransplant hearing thresholds at 4000 Hz and 6000 Hz were also significant predictors of SHL (p = .039 and p = .014, respectively). There was no significant relationship between the donor type of HSCT (autologous vs. allogeneic) and ototoxicity (p = .45), and between conditioning regimens and ototoxicity (p = .860).

CONCLUSIONS: Age and pre-existing hearing levels are significant predictors of ototoxicity post-HSCT. Careful management and monitoring are essential to prevent and address hearing loss in HSCT patients to improve hearing-related quality of life.

PMID:39470587 | DOI:10.1080/00016489.2024.2411350

Medicine (Baltimore). 2024 Oct 25;103(43):e39710. doi: 10.1097/MD.0000000000039710.

ABSTRACT

BACKGROUND: Recently, magnetic resonance imaging (MRI) has emerged as a leading technique for investigating schizophrenia (SZ) pathological mechanisms, prompting an increase in related studies. This study aims to examine the field’s research status and trends via bibliometric analysis.

METHOD: The publications on SZ and MRI over the past decade were retrieved from the Web of Science Core Collection (WOSCC) On October 15, 2023. CiteSpace and VOSviewer were used to conduct scientometric and visualized analysis, covering countries, institutions, authors, journals, co-cited literature, and keywords.

RESULTS: A total of 4840 publications were retrieved from 2014 to 2023. The United States leads with 1863 articles, followed by China with 1127 articles. King’s College London had the highest number of publications, with 332 articles. Schizophrenia Research ranks first in the journal that published the research on schizophrenia and MRI, the most published journal, Neuroimage is the most cited journal. Calhoun is the most prolific author with 145 articles, and Fischl is the most cited author, receiving 1188 citations. The literature co-citation network (2014 to 2023) revealed 16 clusters with robust structure (Q = 0.8719) and high confidence (S = 0.9421) involving MRI studies of SZ, genetic imaging and treatment of schizophrenia. Keywords include MRI, psychosis and functional magnetic resonance imaging (fMRI), MRI and neuroimaging, MRI and neuroimaging and white matter and diffusion tensor imaging.

CONCLUSION: This study offers an overview of the research status and trends of publications on SZ and MRI, aiming to inspire future research directions.

PMID:39470568 | DOI:10.1097/MD.0000000000039710

Medicine (Baltimore). 2024 Oct 25;103(43):e40093. doi: 10.1097/MD.0000000000040093.

ABSTRACT

Erectile dysfunction (ED) is a common male sexual health problem that can be associated with obesity. This study aimed to identify serum metabolic differences and pathways related to ED in obese men using non-targeted metabolomics techniques. We included 54 obese male patients with (n = 27) and without (n = 27) ED. We collected 5 mL of fasting elbow vein blood and analyzed serum metabolites using ultra-high-performance liquid chromatography-mass spectrometry. Multivariate statistical methods (principal component analysis and orthogonal partial least squares discriminant analysis) were used to identify differential metabolites between the groups. Finally, pathway analysis using the Kyoto encyclopedia of genes and genomes database identified 4 differential metabolic pathways in obese men with ED compared to obese men without ED. A total of 77 differential metabolites were identified in obese men with ED compared to the control group (obese men without ED) using a threshold of variable importance in the projection > 1 and P < .05. Pathway analysis revealed 4 main differences: glycine, serine and threonine metabolism, glycerophospholipid metabolism, aminoacyl-tRNA biosynthesis, and D-glutamine and D-glutamate metabolism. Specific metabolites associated with these pathways included betaine aldehyde, choline, L-threonine, phosphatidylcholine, L-serine, and D-glutamine. Our findings suggest abnormalities in fatty acid metabolism, phospholipid metabolism, and amino acid metabolism between obese men with and without ED. Metabolites such as betaine aldehyde, choline, L-threonine, phosphatidylcholine, L-serine, and D-glutamine may be potential biomarkers for distinguishing obese men with ED.

PMID:39470567 | DOI:10.1097/MD.0000000000040093

Medicine (Baltimore). 2024 Oct 25;103(43):e40147. doi: 10.1097/MD.0000000000040147.

ABSTRACT

Given the need to measure parents’ perceptions of their children’s exposure to tobacco smoke, the Parental Perceptions of Children’s Exposure to Tobacco Smoke (PPE) instrument was developed and validated in Hebrew and later translated into English and Portuguese. The PPE has already been translated and adapted to the Brazilian context but a more robust sample is necessary to investigate the measurement properties. Thus, this study evaluated the measurement properties of the Brazilian version of the PPE instrument. Reliability and validity study were conducted with 161 parents with children up to 18 years of age. Perception of parental smoking status was investigated using analysis of variance. The instrument showed excellent reliability (Cronbach α = 0.92 and intraclass correlation coefficient = 0.91). The exploratory factor analysis identified 4 factors with a total accumulated variance of 71.6%. Confirmatory factor analysis validated this structure with 4 factors. It was necessary to exclude a question that presented low commonality. Analysis of variance demonstrated that nonsmoking and former smoking parents have similar scores, although they are higher than those of current smokers. Our findings provide evidence that the PPE version translated and adapted for the Brazilian context is a reliable and valid instrument. Thus, it can help us understand how parents cope with exposure to tobacco smoke.

PMID:39470565 | DOI:10.1097/MD.0000000000040147

Waste Manag Res. 2024 Oct 29:734242X241291939. doi: 10.1177/0734242X241291939. Online ahead of print.

ABSTRACT

Zimbabwe’s tourism industry, renowned for its natural wonders and cultural heritage, faces a looming energy crisis rooted in the detrimental over-reliance on fossil fuels and the underutilization of substantial waste resources that lie dormant. The article investigates multifaceted relationship between six independent variables: landfill gas recovery and anaerobic digestion, pyrolysis and gasification, incineration, biogas production, biodiesel production, ethanol production and syngas fermentation and one dependent variable: energy development and sustainability. In this study, a quantitative methodology was adopted, involving the gathering of data from 519 stakeholders in the tourism supply chain through a simple random sampling technique, with the sample size determined using the Krejcie and Morgan table. The distribution of questionnaires was facilitated through Google Forms, and the data analysis was conducted using Smart PLS. Statistical findings indicate direct significant relationship between variables, and t-statistic values all hypotheses were all greater than the threshold of 1.96, ranging from a minimum of 2.911 to a maximum of 9.431. These findings underscore the robustness of the relationships between the waste-to-energy technologies and energy development and sustainability within Zimbabwe’s tourism sector. This empirical evidence highlights the substantial potential for these innovative technologies to play a pivotal role in mitigating the energy crisis and fostering sustainable energy development.

PMID:39469843 | DOI:10.1177/0734242X241291939