Nevin Manimala

Int J Public Health. 2024 Feb 15;69:1606378. doi: 10.3389/ijph.2024.1606378. eCollection 2024.

ABSTRACT

Objectives: Socioeconomic disparities in obesity have been observed in both childhood and adulthood. However, it remains unclear how the role of risk factors influencing these inequalities has evolved over time. Methods: Longitudinal data on 2,866 children and adolescents (6-17 years old) from the China Health and Nutrition Survey were used to track their BMI during childhood, adolescence, and adulthood. Concentration Index was utilized to measure socioeconomic inequalities in obesity, while Oaxaca decomposition was employed to determine the share of different determinants of inequality. Results: The concentration index for obesity during childhood and adulthood were 0.107 (95% CI: 0.023, 0.211) and 0.279 (95% CI: 0.203, 0.355), respectively. Changes in baseline BMI (24.6%), parental BMI (10.4%) and socioeconomic factors (6.7%) were found to be largely responsible for the increasing inequality in obesity between childhood and adulthood. Additionally, mother’s education (-7.4%) was found to contribute the most to reducing these inequalities. Conclusion: Inequalities in obesity during childhood and adulthood are significant and growing. Interventions targeting individuals with higher BMI, especially those who are wealthy, can significantly reduce the gap.

PMID:38426185 | PMC:PMC10902784 | DOI:10.3389/ijph.2024.1606378

Front Neurol. 2024 Feb 15;15:1359775. doi: 10.3389/fneur.2024.1359775. eCollection 2024.

ABSTRACT

INTRODUCTION: In acute stroke, identifying early changes (parenchymal hypodensity) on non-contrast CT (NCCT) can be challenging. We aimed to identify whether the accuracy of clinicians in detecting acute hypodensity in ischaemic stroke patients on a non-contrast CT is improved with the use of an Artificial Intelligence (AI) based, automated hypodensity detection algorithm (HDT) using MRI-DWI as the gold standard.

METHODS: The study employed a case-crossover within-clinician design, where 32 clinicians were tasked with identifying hypodensity lesions on NCCT scans for five a priori selected patient cases, before and after viewing the AI-based HDT. The DICE similarity coefficient (DICE score) was the primary measure of accuracy. Statistical analysis compared DICE scores with and without AI-based HDT using mixed-effects linear regression, with individual NCCT scans and clinicians as nested random effects.

RESULTS: The AI-based HDT had a mean DICE score of 0.62 for detecting hypodensity across all NCCT scans. Clinicians’ overall mean DICE score was 0.33 (SD 0.31) before AI-based HDT implementation and 0.40 (SD 0.27) after implementation. AI-based HDT use was associated with an increase of 0.07 (95% CI: 0.02-0.11, p = 0.003) in DICE score accounting for individual scan and clinician effects. For scans with small lesions, clinicians achieved a mean increase in DICE score of 0.08 (95% CI: 0.02, 0.13, p = 0.004) following AI-based HDT use. In a subgroup of 15 trainees, DICE score improved with AI-based HDT implementation [mean difference in DICE 0.09 (95% CI: 0.03, 0.14, p = 0.004)].

DISCUSSION: AI-based automated hypodensity detection has potential to enhance clinician accuracy of detecting hypodensity in acute stroke diagnosis, especially for smaller lesions, and notably for less experienced clinicians.

PMID:38426177 | PMC:PMC10902446 | DOI:10.3389/fneur.2024.1359775

PeerJ. 2024 Feb 26;12:e16963. doi: 10.7717/peerj.16963. eCollection 2024.

ABSTRACT

Global biodiversity is declining at an ever-increasing rate. Yet effective policies to mitigate or reverse these declines require ecosystem condition data that are rarely available. Morphology-based bioassessment methods are difficult to scale, limited in scope, suffer prohibitive costs, require skilled taxonomists, and can be applied inconsistently between practitioners. Environmental DNA (eDNA) metabarcoding offers a powerful, reproducible and scalable solution that can survey across the tree-of-life with relatively low cost and minimal expertise for sample collection. However, there remains a need to condense the complex, multidimensional community information into simple, interpretable metrics of ecological health for environmental management purposes. We developed a riverine taxon-independent community index (TICI) that objectively assigns indicator values to amplicon sequence variants (ASVs), and significantly improves the statistical power and utility of eDNA-based bioassessments. The TICI model training step uses the Chessman iterative learning algorithm to assign health indicator scores to a large number of ASVs that are commonly encountered across a wide geographic range. New sites can then be evaluated for ecological health by averaging the indicator value of the ASVs present at the site. We trained a TICI model on an eDNA dataset from 53 well-studied riverine monitoring sites across New Zealand, each sampled with a high level of biological replication (n = 16). Eight short-amplicon metabarcoding assays were used to generate data from a broad taxonomic range, including bacteria, microeukaryotes, fungi, plants, and animals. Site-specific TICI scores were strongly correlated with historical stream condition scores from macroinvertebrate assessments (macroinvertebrate community index or MCI; R² = 0.82), and TICI variation between sample replicates was minimal (CV = 0.013). Taken together, this demonstrates the potential for taxon-independent eDNA analysis to provide a reliable, robust and low-cost assessment of ecological health that is accessible to environmental managers, decision makers, and the wider community.

PMID:38426140 | PMC:PMC10903356 | DOI:10.7717/peerj.16963

Behav Res Ther. 2024 Feb 24;175:104497. doi: 10.1016/j.brat.2024.104497. Online ahead of print.

ABSTRACT

The onset of the COVID-19 pandemic resulted in a dramatic increase in the salience and importance of information relating to both the risk of infection, and factors that could mitigate against such risk. This is likely to have contributed to elevated contamination fear concerns in the general population. Biased attention for contamination-related information has been proposed as a potential mechanism underlying contamination fear, though evidence regarding the presence of such biased attention has been inconsistent. A possible reason for this is that contamination fear may be characterised by variability in attention bias that has not yet been examined. The current study examined the potential association between attention bias variability for both contamination-related and mitigation-related stimuli, and contamination fear during the early stages of the COVID-19 pandemic. A final sample of 315 participants completed measures of attention bias and contamination fear. The measure of average attention bias for contamination-related stimuli and mitigation-related stimuli was not associated with contamination fear (r = 0.055 and r = 0.051, p > 0.10), though both attention bias variability measures did show a small but statistically significant relationship with contamination fear (r = 0.133, p < 0.05; r = 0.147, p < 0.01). These attention bias variability measures also accounted for significant additional variance in contamination fear above the average attention bias measure (and controlling for response time variability). These findings provide initial evidence for the association between attention bias variability and contamination fear, underscoring a potential target for cognitive bias interventions for clinical contamination fear.

PMID:38422560 | DOI:10.1016/j.brat.2024.104497

Am J Otolaryngol. 2024 Feb 23;45(3):104230. doi: 10.1016/j.amjoto.2024.104230. Online ahead of print.

ABSTRACT

OBJECTIVE: Previous studies have focused on the balance system’s involvement in sleep deprivation or disorders. This study investigated how daily routine sleep quality affects the balance system of people without sleep deprivation or diagnosed sleep disorders.

METHODS: The study included 45 participants with a BMI score of <25. The PSQI was used to determine sleep quality. The SOT, HS-SOT, and ADT evaluated the vestibular system’s functionality.

RESULTS: In SOT, condition 3, 4, 5, and 6 composite scores, VIS and VEST composite balance scores, and HS-SOT 5 scores were lower in the HPSQI group. At the same time, there is a statistically significant negative correlation between these scores and PSQI scores.

CONCLUSION: Poor sleep quality may be a factor influencing the balance system. Sleep quality affects the visual and vestibular systems rather than the somatosensory system. The population should be made aware of this issue, and clinicians should consider the potential impact of sleep quality when evaluating the balance system.

PMID:38422556 | DOI:10.1016/j.amjoto.2024.104230

Phys Med Biol. 2024 Feb 29. doi: 10.1088/1361-6560/ad2ee8. Online ahead of print.

ABSTRACT

OBJECTIVE: &#xD;An algorithm was developed for automated positioning of lattice points within volumetric modulated arc lattice radiation therapy (VMATLRT) planning. These points are strategically placed within the gross tumor volume(GTV) to receive high doses, adhering to specific separation rules from adjacent organs at risk(OARs). The study goals included enhancing planning safety, consistency, and efficiency while emulating human performance.

APPROACH: A Monte Carlo-based algorithm was designed to optimize the number and arrangement of lattice points within the GTV while considering placement constraints and objectives. These constraints encompassed minimum spacing between points, distance from OARs, and longitudinal separation along the z-axis. Additionally, the algorithm included an objective to permit, at the user’s discretion, solutions with more centrally placed lattice points within the GTV. To validate its effectiveness, the automated approach was compared with manually planned treatments for 24 previous patients. Prior to clinical implementation, a failure mode and effects analysis (FMEA) was conducted to identify potential shortcomings.&#xD;Main results.&#xD;The automated program successfully met all placement constraints with an average execution time of 0.29 ±0.07 minutes per lattice point. The average lattice point density(# points per cc of GTV) was similar for automated(0.00725) compared to manual placement(0.00704). The dosimetric differences between the automated and manual plans were minimal, with statistically significant differences in certain metrics like minimum dose(1.9% vs. 1.4%), D5%(52.8% vs. 49.4%), and Body-GTV V30%(20.7 cc vs. 19.7 cc).

SIGNIFICANCE: This study underscores the feasibility of employing a straightforward Monte Carlo-based algorithm to automate the creation of spherical target structures for VMAT LRT planning. The automated method yields similar dose metrics, enhances inter-planner consistency for larger targets, and requires fewer resources and less time compared to manual placement. This approach holds promise for standardizing treatment planning in prospective patient trials and facilitating its adoption across centers seeking to implement VMATLRT techniques.&#xD.

PMID:38422544 | DOI:10.1088/1361-6560/ad2ee8

Physiol Meas. 2024 Feb 29. doi: 10.1088/1361-6579/ad2eb4. Online ahead of print.

ABSTRACT

OBJECTIVE: Carotid ultrasound (US) has been studied as a non-invasive alternative for hemodynamic monitoring. A long-axis (LA) view is traditionally employed but is difficult to maintain and operator experience may impact the diameter estimates, making it unsuitable for monitoring. Preliminary results show that a new, i.e., rotated and tilted (RT) view is more robust to motion and less operator-dependent. This study aimed to quantitatively assess common carotid diameter estimates obtained in a clinical setting from an RT view and compare those to corresponding estimates obtained using other views.

APPROACH: Carotid US measurements were performed in 30 adult cardiac-surgery patients (26 males, 4 females) with short-axis (SA), LA, and RT probe orientations, the first being used as a reference for measuring the true vessel diameter. Per 30-s acquisition, the median and spread in diameter values were computed, the latter representing a measure of robustness, and were statistically compared between views.

MAIN RESULTS: The median (IQR) over all the patients of the median diameter per 30-s acquisition was 7.15 (1.15) mm for the SA view, 7.03 (1.51) mm for the LA view, and 6.99 (1.72) mm for the RT view. The median spread in diameter values was 0.18 mm for the SA view, 0.16 mm for the LA view, and 0.18 mm for the RT view. There were no statistically significant differences between views in the median diameter values (p=0.088) or spread (p=0.122).

SIGNIFICANCE: The RT view results in comparable and equally robust median carotid diameter values compared to the reference. These findings open the path for future studies investigating the use of the RT view in new applications, such as in wearable ultrasound devices.

PMID:38422517 | DOI:10.1088/1361-6579/ad2eb4

J Radiol Prot. 2024 Feb 29. doi: 10.1088/1361-6498/ad2ebc. Online ahead of print.

ABSTRACT

The purpose of this study was to provide benchmark data for discussing the tolerability of cancer risk associated with occupational radiation exposure. It focused on differences in cancer mortality risk by occupation among Japan’s working population and examined baseline cancer mortality risks and its variations from 1995 through 2020. Data were collected every five years from national vital statistics sources. By focusing on the same types of cancer among radiation induced effects, cumulative mortality risks were calculated for colorectal, lung, and breast cancer (females only) for those aged 15-74. The average cumulative mortality risk for the working population in Japan has decreased by 30-60% over the past 25 years. Service workers and male managers were at an average risk, among all workers, while clerical workers and transportation and manufacturing workers had about half the average risk. The risks were higher for professionals and female managers, about 1.5 to 2 times the average for professionals and up to 5 times the average for female managers. The decrease in the average cancer mortality risk in the working population as a baseline suggests that risk tolerance in society might have changed over time. Since differences in mortality by occupation were confirmed, the usefulness of occupational data as a benchmark needs further investigation, as high-risk/low-risk occupations vary by country and region. The results of this study contribute to put radiation risks into perspective with the background risk of cancer.

PMID:38422516 | DOI:10.1088/1361-6498/ad2ebc

J Am Acad Orthop Surg. 2024 Feb 28. doi: 10.5435/JAAOS-D-23-00806. Online ahead of print.

ABSTRACT

INTRODUCTION: Effective pain management is vital in orthopaedic care, impacting postoperative recovery and patient well-being. This study aimed to discern national and regional pain prescription trends among orthopaedic surgeons through Medicare claims data, using geospatial analysis to ascertain opioid and nonopioid usage patterns across the United States.

METHODS: Physician-level Medicare prescription databases from 2016 to 2020 were filtered to orthopaedic surgeons, and medications were categorized into opioids, muscle relaxants, anticonvulsants, and NSAIDs. Patient demographics were extracted from a Medicare provider demographic data set, while county-level socioeconomic metrics were obtained primarily from the American Community Survey. Geospatial analysis was conducted using Geoda software, using Moran I statistic for cluster analysis of pain medication metrics. Statistical trends were analyzed using linear regression, Mann-Whitney U test, and multivariate logistic regression, focusing on prescribing rates and hotspot/coldspot identification.

RESULTS: Analysis encompassed 16,505 orthopaedic surgeons, documenting more than 396 million days of pain medication prescriptions: 57.42% NSAIDs, 28.57% opioids, 9.84% anticonvulsants, and 4.17% muscle relaxants. Annually, opioid prescriptions declined by 4.43% (P < 0.01), while NSAIDs rose by 3.29% (P < 0.01). Opioid prescriptions dropped by 210.73 days yearly per surgeon (P < 0.005), whereas NSAIDs increased by 148.86 days (P < 0.005). Opioid prescriptions were most prevalent in the West Coast and Northern Midwest regions, and NSAID prescriptions were most prevalent in the Northeast and South regions. Regression pinpointed spine as the highest and hand as the lowest predictor for pain prescriptions.

DISCUSSION: On average, orthopaedic surgeons markedly decreased both the percentage of patients receiving opioids and the duration of prescription. Simultaneously, the fraction of patients receiving NSAIDs dramatically increased, without change in the average duration of prescription. Opioid hotspots were located in the West Coast, Utah, Colorado, Arizona, Idaho, the Northern Midwest, Vermont, New Hampshire, and Maine. Future directions could include similar examinations using non-Medicare databases.

PMID:38422494 | DOI:10.5435/JAAOS-D-23-00806

Can J Microbiol. 2024 Feb 29. doi: 10.1139/cjm-2023-0155. Online ahead of print.

ABSTRACT

Streptococcus pneumoniae is the major cause of invasive pneumococcal disease (IPD). However, the global population structure remains largely unexplored. In this study, we investigated the spatial and temporal patterns of genetic variation of S. pneumoniae based on archived multilocus sequence typing data from PubMLST.org. Our analyses demonstrated both shared and unique distributions of sequence types (STs) and allele types among regional populations. Among the 17,915 global STs, 36 representing 15,263 isolates were broadly shared among all six continents, consistent with recent clonal dispersal and expansion of this pathogen. The analysis of molecular variance revealed that >96% genetic variations were found within individual regional populations. However, though low (<4%), statistically significant genetic differentiation among regional populations were observed. Comparisons between non-clone-corrected and clone-corrected datasets showed that localized clonal expansion contributed significantly to the observed genetic differentiations among regions. Temporal analyses of the isolates showed that implementation of pneumococcal conjugate vaccine impacted the distributions of STs but the effect on population structure were relatively limited. Linkage disequilibrium analyses identified evidence for recombination in all continental populations, however, the inferred recombination was not random. We discussed the limitations and implications of our analyses to the global epidemiology and vaccine developments for S. pneumoniae.

PMID:38422492 | DOI:10.1139/cjm-2023-0155