Nevin Manimala

Int J Prosthodont. 2024 Feb 21;37(7):187-193. doi: 10.11607/ijp.8905.

ABSTRACT

PURPOSE: To characterize material changes that may occur in virgin cobalt-chromium (Co-Cr) alloy powder when it is blended with alloy powders that have been reused multiple times.

MATERIALS AND METHODS: Initially, 20 kg of virgin Co-Cr powder was loaded into a laser-sintering device. The tensile test specimens were fabricated in the first (Group 1), fourth (Group 2), seventh (Group 3), tenth (Group 4), and thirteenth (Group 5) production cycles (N = 15). Prior to fabricating the specimens, powder alloy samples were collected from the powder bed for analysis. The tensile strength, elastic modulus, and percent elongation were calculated with tensile testing. Scanning electron microscopy and energy dispersive x-ray spectroscopy (SEM/EDS) and laser particle size distribution (LPSD) were used to analyze the alloy powder samples. The fracture surface of one tensile test specimen from each group was examined via SEM/EDS. One-way ANOVA followed by Dunnett T3 test was used for statistical analysis (α = .05).

RESULTS: No difference was observed between groups in terms of tensile strength. A statistically significant difference was observed between Groups 1 and 2 in terms of percent elongation. Groups 2 and 4 were statistically significantly different in terms of both elastic modulus and percent elongation (P ≤ .05). SEM images of the powder alloy showed noticeable differences with increasing numbers of cycles. SEM images and the EDS analysis of the fractured specimens were in accordance with the strength data.

CONCLUSIONS: Reusing Co-Cr alloy powder increased the particle size distribution. However, there was no correlation between increased cycle number and the mechanical properties of the powder.

PMID:38787583 | DOI:10.11607/ijp.8905

Health Phys. 2024 May 24. doi: 10.1097/HP.0000000000001830. Online ahead of print.

ABSTRACT

The aim of this study was to investigate the effects of tube current and tube voltage choices on patient dose in adult and pediatric CT protocols by qualitative analysis using Principal Component Analysis (PCA), cluster analysis, and statistical analysis.Dose length product (DLP), Effective mAs (Eff. mAs), and volume-weighted CT dose index (CTDIvol) dose descriptors were obtained from 16 adult and pediatric head phantom CT examinations. Different tube voltage and tube current values were selected in both pediatric head and adult head CT imaging protocols, and PCA and cluster analysis were applied to the data obtained for qualitative analysis of the relationship between CTDIvol, Eff. mAs and Total DLP values. The two principial components (PC) with the highest values among those obtained as a result of the PCA method were used. PC1 was 70.97%, and PC2 was 28.03%. In the cluster analysis, it was observed that the values obtained from pediatric and adult phantom CT scans were classified into two different clusters. The correlation coefficient for adult patients was r = 0.998, and for pediatric patients, the correlation coefficient was r = 0.947. When the obtained clusters were examined, the degree of closeness or distance of the variables could be observed. In the study, as a result of the analysis of CTDIvol, Eff. mAs and Total DLP data based on manufacturer data at different kV and mA values with PCA and cluster analysis, it was shown that pediatric patients could be exposed to more radiation than the adult patients.

PMID:38787573 | DOI:10.1097/HP.0000000000001830

J Vis. 2024 May 1;24(5):12. doi: 10.1167/jov.24.5.12.

ABSTRACT

Materials exhibit an extraordinary range of visual appearances. Characterizing and quantifying appearance is important not only for basic research on perceptual mechanisms but also for computer graphics and a wide range of industrial applications. Although methods exist for capturing and representing the optical properties of materials and how they vary across surfaces (Haindl & Filip, 2013), the representations are typically very high-dimensional, and how these representations relate to subjective perceptual impressions of material appearance remains poorly understood. Here, we used a data-driven approach to characterizing the perceived appearance characteristics of 30 samples of wood veneer using a “visual fingerprint” that describes each sample as a multidimensional feature vector, with each dimension capturing a different aspect of the appearance. Fifty-six crowd-sourced participants viewed triplets of movies depicting different wood samples as the sample rotated. Their task was to report which of the two match samples was subjectively most similar to the test sample. In another online experiment, 45 participants rated 10 wood-related appearance characteristics for each of the samples. The results reveal a consistent embedding of the samples across both experiments and a set of nine perceptual dimensions capturing aspects including the roughness, directionality, and spatial scale of the surface patterns. We also showed that a weighted linear combination of 11 image statistics, inspired by the rating characteristics, predicts perceptual dimensions well.

PMID:38787569 | DOI:10.1167/jov.24.5.12

JAMA Netw Open. 2024 May 1;7(5):e2410994. doi: 10.1001/jamanetworkopen.2024.10994.

ABSTRACT

IMPORTANCE: The health care workforce continues to experience high rates of depression and anxiety. Finding ways to effectively support the mental health and well-being of health care workers is challenging.

OBJECTIVE: To test the effectiveness of remote, pushed digital assessments and engagement to improve depression and anxiety among health care workers compared with usual care.

DESIGN, SETTING, AND PARTICIPANTS: This was a 9-month randomized clinical trial with a 6-month intervention period. Participants were health care workers with self-reported daily access to a smartphone and at least 4 clinical hours per week. Participants were randomized to usual care or the intervention between January 2022 and March 2023. Data analyses were conducted between May and July 2023.

INTERVENTIONS: All participants completed baseline, 6-month, and 9-month mental health, well-being, and burnout assessments. The control group had open access to a web-based mental health platform. Participants in the intervention group received monthly text messaging about mental health, mental health assessments, and linkages to care.

MAIN OUTCOMES AND MEASURES: The primary outcomes were mean change in depression and anxiety scores at 6 months from baseline. Secondary outcomes include mean change in well-being, burnout, and self-reported workplace productivity.

RESULTS: In this study, 1275 participants were randomized (642 [50.4%] to the intervention group and 633 [49.6%] to control group). Participants had a mean (SD) age of 38.6 (10.9) years, 1063 participants (83.4%) were female, 320 (25.1%) self-identified as Black, and 793 (62.2%) self-identified as White. Across the groups, the mean difference in depression score was significantly different at 6 months (-0.96 [95% CI, -1.52 to -0.40]) and at 9 months (-1.14 [95% CI, -1.69 to -0.58]). The mean difference in anxiety score from baseline to 6 months was statistically significantly larger for those in the intervention group vs usual care (-0.71 [95% CI, -1.25 to -0.17]) and held true at 9 months (-1.06 [95% CI, -1.59 to -0.52]).

CONCLUSIONS AND RELEVANCE: In a trial of health care workers, a proactive digital engagement strategy, including pushed text messaging, mobile mental health assessments, and connection to care, improved depression and anxiety over a 6-month period compared with simply making the same resources available for individuals to find and use.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05028075.

PMID:38787562 | DOI:10.1001/jamanetworkopen.2024.10994

JAMA Netw Open. 2024 May 1;7(5):e2411717. doi: 10.1001/jamanetworkopen.2024.11717.

ABSTRACT

IMPORTANCE: For patients with nonspine bone metastases, short-course radiotherapy (RT) can reduce patient burden without sacrificing clinical benefit. However, there is great variation in uptake of short-course RT across practice settings.

OBJECTIVE: To evaluate whether a set of 3 implementation strategies facilitates increased adoption of a consensus recommendation to treat nonspine bone metastases with short-course RT (ie, ≤5 fractions).

DESIGN, SETTING, AND PARTICIPANTS: This prospective, stepped-wedge, cluster randomized quality improvement study was conducted at 3 community-based cancer centers within an existing academic-community partnership. Rollout was initiated in 3-month increments between October 2021 and May 2022. Participants included treating physicians and patients receiving RT for nonspine bone metastases. Data analysis was performed from October 2022 to May 2023.

EXPOSURES: Three implementation strategies-(1) dissemination of published consensus guidelines, (2) personalized audit-and-feedback reports, and (3) an email-based electronic consultation platform (eConsult)-were rolled out to physicians.

MAIN OUTCOMES AND MEASURES: The primary outcome was adherence to the consensus recommendation of short-course RT for nonspine bone metastases. Mixed-effects logistic regression at the bone metastasis level was used to model associations between the exposure of physicians to the set of strategies (preimplementation vs postimplementation) and short-course RT, while accounting for patient and physician characteristics and calendar time, with a random effect for physician. Physician surveys were administered before implementation and after implementation to assess feasibility, acceptability, and appropriateness of each strategy.

RESULTS: Forty-five physicians treated 714 patients (median [IQR] age at treatment start, 67 [59-75] years; 343 women [48%]) with 838 unique nonspine bone metastases during the study period. Implementing the set of strategies was not associated with use of short-course RT (odds ratio, 0.78; 95% CI, 0.45-1.34; P = .40), with unadjusted adherence rates of 53% (444 lesions) preimplementation vs 56% (469 lesions) postimplementation; however, the adjusted odds of adherence increased with calendar time (odds ratio, 1.68; 95% CI, 1.20-2.36; P = .003). All 3 implementation strategies were perceived as being feasible, acceptable, and appropriate; only the perception of audit-and-feedback appropriateness changed before vs after implementation (19 of 29 physicians [66%] vs 27 of 30 physicians [90%]; P = .03, Fisher exact test), with 20 physicians (67%) preferring reports quarterly.

CONCLUSIONS AND RELEVANCE: In this quality improvement study, a multicomponent set of implementation strategies was not associated with increased use of short-course RT within an academic-community partnership. However, practice improved with time, perhaps owing to secular trends or physician awareness of the study. Audit-and-feedback was more appropriate than anticipated. Findings support the need to investigate optimal approaches for promoting evidence-based radiation practice across settings.

PMID:38787561 | DOI:10.1001/jamanetworkopen.2024.11717

JAMA Netw Open. 2024 May 1;7(5):e2412055. doi: 10.1001/jamanetworkopen.2024.12055.

ABSTRACT

IMPORTANCE: Heat waves are increasing in frequency, intensity, and duration and may be acutely associated with pregnancy outcomes.

OBJECTIVE: To examine changes in daily rates of preterm and early-term birth after heat waves in a 25-year nationwide study.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study of singleton births used birth records from 1993 to 2017 from the 50 most populous US metropolitan statistical areas (MSAs). The study included 53 million births, covering 52.8% of US births over the period. Data were analyzed between October 2022 and March 2023 at the National Center for Health Statistics.

EXPOSURES: Daily temperature data from Daymet at 1-km2 resolution were averaged over each MSA using population weighting. Heat waves were defined in the 4 days (lag, 0-3 days) or 7 days (lag, 0-6 days) preceding birth.

MAIN OUTCOMES AND MEASURES: Daily counts of preterm birth (28 to <37 weeks), early-term birth (37 to <39 weeks), and ongoing pregnancies in each gestational week on each day were enumerated in each MSA. Rate ratios for heat wave metrics were obtained from time-series models restricted to the warm season (May to September) adjusting for MSA, year, day of season, and day of week, and offset by pregnancies at risk.

RESULTS: There were 53 154 816 eligible births in the 50 MSAs from 1993 to 2017; 2 153 609 preterm births and 5 795 313 early-term births occurring in the warm season were analyzed. A total of 30.0% of mothers were younger than 25 years, 53.8% were 25 to 34 years, and 16.3% were 35 years or older. Heat waves were positively associated with daily rates of preterm and early-term births, showing a dose-response association with heat wave duration and temperatures and stronger associations in the more acute 4-day window. After 4 consecutive days of mean temperatures exceeding the local 97.5th percentile, the rate ratio for preterm birth was 1.02 (95% CI, 1.00-1.03), and the rate ratio for early-term birth was 1.01 (95% CI, 1.01-1.02). For the same exposure, among those who were 29 years of age or younger, had a high school education or less, and belonged to a racial or ethnic minority group, the rate ratios were 1.04 (95% CI, 1.02-1.06) for preterm birth and 1.03 (95% CI, 1.02-1.05) for early-term birth. Results were robust to alternative heat wave definitions, excluding medically induced deliveries, and alternative statistical model specifications.

CONCLUSIONS AND RELEVANCE: In this cohort study, preterm and early-term birth rates increased after heat waves, particularly among socioeconomically disadvantaged subgroups. Extreme heat events have implications for perinatal health.

PMID:38787560 | DOI:10.1001/jamanetworkopen.2024.12055

JAMA Netw Open. 2024 May 1;7(5):e2413127. doi: 10.1001/jamanetworkopen.2024.13127.

ABSTRACT

IMPORTANCE: Unprecedented increases in hospital occupancy rates during COVID-19 surges in 2020 caused concern over hospital care quality for patients without COVID-19.

OBJECTIVE: To examine changes in hospital nonsurgical care quality for patients without COVID-19 during periods of high and low COVID-19 admissions.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the 2019 and 2020 Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project State Inpatient Databases. Data were obtained for all nonfederal, acute care hospitals in 36 states with admissions in 2019 and 2020, and patients without a diagnosis of COVID-19 or pneumonia who were at risk for selected quality indicators were included. The data analysis was performed between January 1, 2023, and March 15, 2024.

EXPOSURE: Each hospital and week in 2020 was categorized based on the number of COVID-19 admissions per 100 beds: less than 1.0, 1.0 to 4.9, 5.0 to 9.9, 10.0 to 14.9, and 15.0 or greater.

MAIN OUTCOMES AND MEASURES: The main outcomes were rates of adverse outcomes for selected quality indicators, including pressure ulcers and in-hospital mortality for acute myocardial infarction, heart failure, acute stroke, gastrointestinal hemorrhage, hip fracture, and percutaneous coronary intervention. Changes in 2020 compared with 2019 were calculated for each level of the weekly COVID-19 admission rate, adjusting for case-mix and hospital-month fixed effects. Changes during weeks with high COVID-19 admissions (≥15 per 100 beds) were compared with changes during weeks with low COVID-19 admissions (<1 per 100 beds).

RESULTS: The analysis included 19 111 629 discharges (50.3% female; mean [SD] age, 63.0 [18.0] years) from 3283 hospitals in 36 states. In weeks 18 to 48 of 2020, 35 851 hospital-weeks (36.7%) had low COVID-19 admission rates, and 8094 (8.3%) had high rates. Quality indicators for patients without COVID-19 significantly worsened in 2020 during weeks with high vs low COVID-19 admissions. Pressure ulcer rates increased by 0.09 per 1000 admissions (95% CI, 0.01-0.17 per 1000 admissions; relative change, 24.3%), heart failure mortality increased by 0.40 per 100 admissions (95% CI, 0.18-0.63 per 100 admissions; relative change, 21.1%), hip fracture mortality increased by 0.40 per 100 admissions (95% CI, 0.04-0.77 per 100 admissions; relative change, 29.4%), and a weighted mean of mortality for the selected indicators increased by 0.30 per 100 admissions (95% CI, 0.14-0.45 per 100 admissions; relative change, 10.6%).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, COVID-19 surges were associated with declines in hospital quality, highlighting the importance of identifying and implementing strategies to maintain care quality during periods of high hospital use.

PMID:38787558 | DOI:10.1001/jamanetworkopen.2024.13127

JAMA Netw Open. 2024 May 1;7(5):e2413157. doi: 10.1001/jamanetworkopen.2024.13157.

ABSTRACT

IMPORTANCE: Early-onset colorectal cancer (EOCRC), defined as a diagnosis at younger than age 50 years, is increasing, and so-called red flag signs and symptoms among these individuals are often missed, leading to diagnostic delays. Improved recognition of presenting signs and symptoms associated with EOCRC could facilitate more timely diagnosis and impact clinical outcomes.

OBJECTIVE: To report the frequency of presenting red flag signs and symptoms among individuals with EOCRC, to examine their association with EOCRC risk, and to measure variation in time to diagnosis from sign or symptom presentation.

DATA SOURCES: PubMed/MEDLINE, Embase, CINAHL, and Web of Science were searched from database inception through May 2023.

STUDY SELECTION: Studies that reported on sign and symptom presentation or time from sign and symptom presentation to diagnosis for patients younger than age 50 years diagnosed with nonhereditary CRC were included.

DATA EXTRACTION AND SYNTHESIS: Data extraction and quality assessment were performed independently in duplicate for all included studies using Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines. Joanna Briggs Institute Critical Appraisal tools were used to measure risk of bias. Data on frequency of signs and symptoms were pooled using a random-effects model.

MAIN OUTCOMES AND MEASURES: Outcomes of interest were pooled proportions of signs and symptoms in patients with EOCRC, estimates for association of signs and symptoms with EOCRC risk, and time from sign or symptom presentation to EOCRC diagnosis.

RESULTS: Of the 12 859 unique articles initially retrieved, 81 studies with 24 908 126 patients younger than 50 years were included. The most common presenting signs and symptoms, reported by 78 included studies, were hematochezia (pooled prevalence, 45% [95% CI, 40%-50%]), abdominal pain (pooled prevalence, 40% [95% CI, 35%-45%]), and altered bowel habits (pooled prevalence, 27% [95% CI, 22%-33%]). Hematochezia (estimate range, 5.2-54.0), abdominal pain (estimate range, 1.3-6.0), and anemia (estimate range, 2.1-10.8) were associated with higher EOCRC likelihood. Time from signs and symptoms presentation to EOCRC diagnosis was a mean (range) of 6.4 (1.8-13.7) months (23 studies) and a median (range) of 4 (2.0-8.7) months (16 studies).

CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis of patients with EOCRC, nearly half of individuals presented with hematochezia and abdominal pain and one-quarter with altered bowel habits. Hematochezia was associated with at least 5-fold increased EOCRC risk. Delays in diagnosis of 4 to 6 months were common. These findings highlight the need to identify concerning EOCRC signs and symptoms and complete timely diagnostic workup, particularly for individuals without an alternative diagnosis or sign or symptom resolution.

PMID:38787555 | DOI:10.1001/jamanetworkopen.2024.13157

JAMA Netw Open. 2024 May 1;7(5):e2413166. doi: 10.1001/jamanetworkopen.2024.13166.

ABSTRACT

IMPORTANCE: Frailty is associated with adverse outcomes after even minor physiologic stressors. The validated Risk Analysis Index (RAI) quantifies frailty; however, existing methods limit application to in-person interview (clinical RAI) and quality improvement datasets (administrative RAI).

OBJECTIVE: To expand the utility of the RAI utility to available International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) administrative data, using the National Inpatient Sample (NIS).

DESIGN, SETTING, AND PARTICIPANTS: RAI parameters were systematically adapted to ICD-10-CM codes (RAI-ICD) and were derived (NIS 2019) and validated (NIS 2020). The primary analysis included survey-weighed discharge data among adults undergoing major surgical procedures. Additional external validation occurred by including all operative and nonoperative hospitalizations in the NIS (2020) and in a multihospital health care system (UPMC, 2021-2022). Data analysis was conducted from January to May 2023.

EXPOSURES: RAI parameters and in-hospital mortality.

MAIN OUTCOMES AND MEASURES: The association of RAI parameters with in-hospital mortality was calculated and weighted using logistic regression, generating an integerized RAI-ICD score. After initial validation, thresholds defining categories of frailty were selected by a full complement of test statistics. Rates of elective admission, length of stay, hospital charges, and in-hospital mortality were compared across frailty categories. C statistics estimated model discrimination.

RESULTS: RAI-ICD parameters were weighted in the 9 548 206 patients who were hospitalized (mean [SE] age, 55.4 (0.1) years; 3 742 330 male [weighted percentage, 39.2%] and 5 804 431 female [weighted percentage, 60.8%]), modeling in-hospital mortality (2.1%; 95% CI, 2.1%-2.2%) with excellent derivation discrimination (C statistic, 0.810; 95% CI, 0.808-0.813). The 11 RAI-ICD parameters were adapted to 323 ICD-10-CM codes. The operative validation population of 8 113 950 patients (mean [SE] age, 54.4 (0.1) years; 3 148 273 male [weighted percentage, 38.8%] and 4 965 737 female [weighted percentage, 61.2%]; in-hospital mortality, 2.5% [95% CI, 2.4%-2.5%]) mirrored the derivation population. In validation, the weighted and integerized RAI-ICD yielded good to excellent discrimination in the NIS operative sample (C statistic, 0.784; 95% CI, 0.782-0.786), NIS operative and nonoperative sample (C statistic, 0.778; 95% CI, 0.777-0.779), and the UPMC operative and nonoperative sample (C statistic, 0.860; 95% CI, 0.857-0.862). Thresholds defining robust (RAI-ICD <27), normal (RAI-ICD, 27-35), frail (RAI-ICD, 36-45), and very frail (RAI-ICD >45) strata of frailty maximized precision (F1 = 0.33) and sensitivity and specificity (Matthews correlation coefficient = 0.26). Adverse outcomes increased with increasing frailty.

CONCLUSION AND RELEVANCE: In this cohort study of hospitalized adults, the RAI-ICD was rigorously adapted, derived, and validated. These findings suggest that the RAI-ICD can extend the quantification of frailty to inpatient adult ICD-10-CM-coded patient care datasets.

PMID:38787554 | DOI:10.1001/jamanetworkopen.2024.13166

Psychosom Med. 2024 May 13. doi: 10.1097/PSY.0000000000001321. Online ahead of print.

ABSTRACT

OBJECTIVE: Acute exercise elicits various biobehavioral and psychological responses, but results are mixed with regard to the magnitude of exercise-induced affective reactions. This meta-analysis examines the magnitude of general mood state, anxiety, and depressive symptom responses to acute exercise while exploring exercise protocol characteristics and background health behaviors that may play a role in the affective response.

METHODS: A total of 2,770 articles were identified from a MEDLINE/PubMed search and an additional 133 articles from reviews of reference sections. Studies had to have measured general mood before the acute exercise bout and within 30 minutes after exercise completion. Effect sizes were estimated using Hedges’ g, with larger values indicating improvement in the outcome measure.

RESULTS: A total of 103 studies were included presenting data from 4,671 participants. General mood state improved from pre-exercise to post-exercise (g = 0.336, 95%CI = 0.234,0.439). Anxiety (g = 0.497, 95%CI = 0.263,0.730) and depressive symptoms (g = 0.407, 95%CI = 0.249,0.564) also improved with exercise. There was substantial and statistically significant heterogeneity in each of these meta-analyses. This heterogeneity was not explained by differences in participants’ health status. Meta-regression analyses with potential moderators (intensity of exercise, mode of exercise, usual physical activity level, or weight status of participants) also did not reduce the heterogeneity.

CONCLUSION: This meta-analysis shows significantly improved general mood, decreased anxiety, and lower depressive symptoms in response to an acute bout of exercise. There was substantial heterogeneity in the magnitude of the effect sizes, indicating that additional research is needed to identify determinants of a positive affective response to acute exercise.

PMID:38787545 | DOI:10.1097/PSY.0000000000001321