Nevin Manimala

Sci Rep. 2023 Aug 21;13(1):13580. doi: 10.1038/s41598-023-40565-z.

ABSTRACT

Immune checkpoint inhibitors (ICIs) activate anti-tumor activity by inhibiting immune checkpoint molecules that suppress inflammatory T-cell activity. However, ICIs can initiate excessive immune responses, thereby causing immune-related adverse events (irAEs). ICI-associated uveitis (ICIU) is an irAE that affects the eyes. Although Vogt-Koyanagi-Harada disease (VKH)-like uveitis is a common form of ICIU, it is unclear which factors determine the ICIU form. We retrospectively reviewed the medical records of nine ICIU cases treated with ICIs for malignancies. We also performed HLA typing in seven cases to investigate the association between HLA and disease type. Fisher’s exact test was used for the statistical analysis. Five of the ICIU cases were VKH-like ICIUs, and four were non-VKH-like ICIUs. No association was found between mean age, sex, primary disease, ICI, time to onset, and disease type. Four patients with VKH-like uveitis underwent HLA genotyping and were all positive for HLA-DRB1*04:05. All 3 patients with non-VKH-like uveitis were negative for HLA-DRB1*04:05. Statistical analysis showed that HLA-DRB1*04:05 was significantly associated with developing VKH-like ICIU (P = 0.029). In ICIU, HLA-DRB1*04:05 was associated with the pathogenesis of VKH-like uveitis, suggesting that ICI-associated VKH-like uveitis has a similar pathogenesis to VKH.

PMID:37604934 | DOI:10.1038/s41598-023-40565-z

J Public Health Policy. 2023 Aug 21. doi: 10.1057/s41271-023-00433-6. Online ahead of print.

ABSTRACT

Inequalities in the accessibility and utilization of quality, safe, and effective coronavirus disease 2019 (COVID-19) vaccines across and within countries limited their value in protecting health during the COVID-19 pandemic. We quantified cross-country, income-associated inequality in COVID-19 vaccination using statistical models based on the data for 79 countries through December 2021. We found notable inequality in vaccinations per capita. At least 11.9% of doses administered in high-income countries could be redistributed to low-income countries to substantially reduce income-associated inequality in vaccinations. The results of this modeling study indicate that reliance on multiple doses of vaccine to attain optimal protection from COVID-19 is a significant contributor to inequality in vaccinations per capita. Dose-sharing mechanisms should account for and include efforts to optimize the capabilities of health systems to deliver vaccines.

PMID:37604927 | DOI:10.1057/s41271-023-00433-6

Br Dent J. 2023 Aug 21. doi: 10.1038/s41415-023-6182-1. Online ahead of print.

ABSTRACT

Introduction Supervised toothbrushing programmes (STPs) are a cost-effective public health intervention, reducing tooth decay and health inequalities in children. However, the uptake of STPs in England is unknown. This study aimed to establish the current provision of STPs across England and summarise the barriers and facilitators to their implementation.Methods An online survey was sent to dental public health consultants, local authority (LA) oral health leads, and public health practitioners across England. Quantitative data were analysed using descriptive statistics. Barriers and facilitators were analysed using the Consolidated Framework for Implementation Research.Results Information was received for 141 LAs across England. Approximately half implemented an STP (n = 68/141). Most STPs were commissioned by LAs (n = 44/68) and adopted a targeted approach (n = 54/68). Barriers to implementation were: 1) acquiring funding; 2) poor communication and engagement between LAs, oral health providers and settings; 3) oral health not a priority; 4) logistically challenging to implement; and 5) lack of capacity. Facilitators were: 1) an integrated and mandated public health approach; 2) collaboration and ongoing support between LAs, oral health providers, and settings; 3) clarity of guidance; 4) flexible approach to delivery; 5) adequate available resources; and 6) ownership and empowerment of setting staff.Conclusion The current provision of STPs is varied, and although there are challenges to their implementation, there are also areas of good practice where these challenges have been overcome.

PMID:37604921 | DOI:10.1038/s41415-023-6182-1

Sci Rep. 2023 Aug 21;13(1):13626. doi: 10.1038/s41598-023-39006-8.

ABSTRACT

Moving around in crowds is part of our daily lives, and we are used to the associated restriction of mobility. Nevertheless, little is known about how individuals experience these limitations. Such knowledge would, however, help to predict behavior, assess crowding, and improve measures for safety and comfort. To address this research gap, we conducted two studies on how constrained mobility affects physiological arousal as measured by mobile electrodermal activity (EDA) sensors. In study 1, we constrained walking speed by externally imposing a specific walking speed without physical proximity to another person, while, in study 2, we varied walking speed by increasing the number of people in a given area. In study 1, we confirmed previous findings showing that faster speeds led to statistically significantly higher levels of physiological arousal. The external limitations of walking speed, however, even if perceived as uncomfortable, did not increase physiological arousal. In the second study, subjects’ speed was gradually reduced by density in a single-lane experiment. This study shows that physiological arousal increased statistically significant with increasing density and decreasing speed, suggesting that people experience more stress when their movement is restricted by proximity to others. The result of study 2 is even more significant given the results of study 1: When there are no other people around, arousal increases with walking speed due to the physiology of walking. This effect reverses when the speed must be reduced due to other people. Then the arousal increases at lower speeds.

PMID:37604897 | DOI:10.1038/s41598-023-39006-8

NPJ Digit Med. 2023 Aug 21;6(1):155. doi: 10.1038/s41746-023-00903-x.

ABSTRACT

Electronic health records are often incomplete, reducing the power of genetic association studies. For some diseases, such as knee osteoarthritis where the routine course of diagnosis involves an X-ray, image-based phenotyping offers an alternate and unbiased way to ascertain disease cases. We investigated this by training a deep-learning model to ascertain knee osteoarthritis cases from knee DXA scans that achieved clinician-level performance. Using our model, we identified 1931 (178%) more cases than currently diagnosed in the health record. Individuals diagnosed as cases by our model had higher rates of self-reported knee pain, for longer durations and with increased severity compared to control individuals. We trained another deep-learning model to measure the knee joint space width, a quantitative phenotype linked to knee osteoarthritis severity. In performing genetic association analysis, we found that use of a quantitative measure improved the number of genome-wide significant loci we discovered by an order of magnitude compared with our binary model of cases and controls despite the two phenotypes being highly genetically correlated. In addition we discovered associations between our quantitative measure of knee osteoarthritis and increased risk of adult fractures- a leading cause of injury-related death in older individuals-, illustrating the capability of image-based phenotyping to reveal epidemiological associations not captured in the electronic health record. For diseases with radiographic diagnosis, our results demonstrate the potential for using deep learning to phenotype at biobank scale, improving power for both genetic and epidemiological association analysis.

PMID:37604895 | DOI:10.1038/s41746-023-00903-x

Sci Rep. 2023 Aug 21;13(1):13633. doi: 10.1038/s41598-023-40690-9.

ABSTRACT

This work explores the potential for achieving correlated disorder in electrical circuits by utilizing reactive elements. By establishing a direct correspondence between the tight-binding Hamiltonian and the admittance matrix of the circuit, a novel approach is presented. The localization phenomena within the circuit are investigated through the analysis of the two-port impedance. To introduce correlated disorder, the Aubry-André-Harper (AAH) model is employed. Both one-dimensional and quasi-one-dimensional AAH structures are examined and effectively mapped to their tight-binding counterparts. Notably, transitions from a high-conducting phase to a low-conducting phase are observed in these circuits, highlighting the impact of correlated disorder.

PMID:37604882 | DOI:10.1038/s41598-023-40690-9

Nat Ecol Evol. 2023 Aug 21. doi: 10.1038/s41559-023-02150-5. Online ahead of print.

ABSTRACT

Dispersal across biogeographic barriers is a key process determining global patterns of biodiversity as it allows lineages to colonize and diversify in new realms. Here we demonstrate that past biogeographic dispersal events often depended on species’ traits, by analysing 7,009 tetrapod species in 56 clades. Biogeographic models incorporating body size or life history accrued more statistical support than trait-independent models in 91% of clades. In these clades, dispersal rates increased by 28-32% for lineages with traits favouring successful biogeographic dispersal. Differences between clades in the effect magnitude of life history on dispersal rates are linked to the strength and type of biogeographic barriers and intra-clade trait variability. In many cases, large body sizes and fast life histories facilitate dispersal success. However, species with small bodies and/or slow life histories, or those with average traits, have an advantage in a minority of clades. Body size-dispersal relationships were related to a clade’s average body size and life history strategy. These results provide important new insight into how traits have shaped the historical biogeography of tetrapod lineages and may impact present-day and future biogeographic dispersal.

PMID:37604875 | DOI:10.1038/s41559-023-02150-5

Sci Rep. 2023 Aug 21;13(1):13582. doi: 10.1038/s41598-023-40848-5.

ABSTRACT

We demonstrate that isomorphically mapping gray-level medical image matrices onto energy spaces underlying the framework of fast data density functional transform (fDDFT) can achieve the unsupervised recognition of lesion morphology. By introducing the architecture of geometric deep learning and metrics of graph neural networks, gridized density functionals of the fDDFT establish an unsupervised feature-aware mechanism with global convolutional kernels to extract the most likely lesion boundaries and produce lesion segmentation. An AutoEncoder-assisted module reduces the computational complexity from [Formula: see text] to [Formula: see text], thus efficiently speeding up global convolutional operations. We validate their performance utilizing various open-access datasets and discuss limitations. The inference time of each object in large three-dimensional datasets is 1.76 s on average. The proposed gridized density functionals have activation capability synergized with gradient ascent operations, hence can be modularized and embedded in pipelines of modern deep neural networks. Algorithms of geometric stability and similarity convergence also raise the accuracy of unsupervised recognition and segmentation of lesion images. Their performance achieves the standard requirement for conventional deep neural networks; the median dice score is higher than 0.75. The experiment shows that the synergy of fDDFT and a naïve neural network improves the training and inference time by 58% and 51%, respectively, and the dice score raises to 0.9415. This advantage facilitates fast computational modeling in interdisciplinary applications and clinical investigation.

PMID:37604860 | DOI:10.1038/s41598-023-40848-5

J Clin Nurs. 2023 Aug 21. doi: 10.1111/jocn.16850. Online ahead of print.

ABSTRACT

OBJECTIVE: This study examined levels of self-reported dignity and explored factors expected to influence dignity experienced by older adults during acute hospitalisation in Ghana.

BACKGROUND: Dignified care has been recognised as inseparable from quality nursing care and maintaining patients’ dignity has been highlighted in professional codes of conduct for nurses. However, there is a lack of research on self-reported dignity and the factors that influence the dignity of older adults during acute hospitalisation in Africa.

SETTING: A large teaching hospital in the northern region of Ghana.

PARTICIPANTS: Hospitalised older adults.

METHODS: A cross-sectional survey was used to gather data from a convenience sample of 270 older inpatients, using the Hospitalized Older Adults’ Dignity Scale. Data were analysed using descriptive statistics and stepwise ordinal logistic regression to investigate stratified dignity outcomes. The study was reported following the STROBE checklist.

RESULTS: More than half of the older adults surveyed reported low to moderate levels of dignity. Demographic characteristics such as age, marital status, religious status, occupation, level of education and type of hospital ward did not show any significant associations with dignity levels. However, there was a significant association found between dignity levels and sex and the number of hospitalisations.

CONCLUSION: Most older adults in a Ghanian hospital experienced loss of dignity during their acute hospitalisation. Male older adults reported higher dignity levels during acute hospitalisation than their female counterparts. Further, older adults who were admitted to hospital for the second time reported less dignity compared to those admitted three or more times.

RELEVANCE TO CLINICAL PRACTICE: The results emphasise the importance of healthcare professionals having the necessary knowledge and skills to provide gender-sensitive care, which ultimately promotes the dignity of all patients. Additionally, the results underscore the urgency of implementing measures that guarantee patients’ dignity during all hospital admissions.

PATIENT OR PUBLIC CONTRIBUTION: Survey questionnaires were completed by hospitalised older adults at the study setting.

PMID:37604797 | DOI:10.1111/jocn.16850

Disabil Health J. 2023 Aug 2:101513. doi: 10.1016/j.dhjo.2023.101513. Online ahead of print.

ABSTRACT

BACKGROUND: Companies are increasingly attending to their Diversity, Equity, and Inclusion (DEI) statements in their public-facing documents, including job advertisements. Little is known about how various decisions about language type or placement within a job ad are received by marginalized populations, including those living with disabilities.

OBJECTIVE: This study aims to explore various options for DEI statements within job ads, to assess whether these choices have a measurable impact on potential job seekers living with disabilities.

METHODS: An experiment with a 2 × 2 × 2 design was used which varied the DEI language (legal/traditional or heartfelt), the placement at the top or the bottom of the job advertisement, and whether the company offered the opportunity to indicate a need for accommodations even before the interview. Quantitative and qualitative items measured general reactions to the statement, intent to apply to this company, willingness to disclose a need for accommodations, how supportive the company seemed, and impressions of the company’s level of trustworthiness. Statistical tests include t-tests, z-tests for proportions, and regression-based tests for mediation.

RESULTS: Heartfelt statements and upfront placement inspired more positive reactions from participants, with trust mediating these positive relationships. However, participants also expressed skepticism that, regardless of language, bias would still exist in the reality of the job.

CONCLUSIONS: These results suggest that job candidates with disabilities are not indifferent to a company’s DEI framing and prefer heartfelt language and earlier placement, though statements without direct evidence can raise suspicion about whether the actions would stay true to the words.

PMID:37604765 | DOI:10.1016/j.dhjo.2023.101513