Nevin Manimala

PLoS One. 2023 Oct 20;18(10):e0293095. doi: 10.1371/journal.pone.0293095. eCollection 2023.

ABSTRACT

This study aimed to explore the differences in playing style and technical performance according to the ranking level in Spanish football teams. The sample comprised 38 professional teams that competed in LaLiga from 2008/09 to 2020/21, with a total of 4940 matches. The teams were grouped by their final ranking position: Champion (1st); Champions League (2nd-4th); Europa League (5th-6th); middle teams (7th-17th); and relegated teams (18th-20th). Linear mixed models were used to examine the effects of the team ranking on variables related to playing style and technical performance. The F2 statistic was calculated as effect size (ES). Regarding the style of play, the Champion teams initiated offensive sequences from a more advanced field position than the remaining ranking groups with a descending effect as the ranking position decreased (p < 0.001; ES = medium). The sequence duration and passes per sequence showed a decreasing effect across ranking groups (both p < 0.001; ES = small). In contrast, the direct speed showed an increasing effect as the ranking position decreased (p < 0.001; ES = small). A decreasing effect was observed in the number of sequences ending in the final third as the ranking position decreased (p < 0.001; ES = large) while no effect was found for the sequences ending in a shot. There was a reduction effect in ball possession, passing accuracy, through balls and crosses as the teams’ ranking decreased (all p < 0.001; ES = small-to-large). In summary, higher-ranked teams had an advanced starting position, longer offensive sequences, slower progression speed, more ball possession, higher passing accuracy, and more crosses and through balls than lower-ranked teams. Football coaches should consider that adopting a playing style focused on regaining the ball possession in advanced field zones and using long passing sequences can be an effective tactical strategy to improve the teams’ ranking during the season.

PMID:37862370 | DOI:10.1371/journal.pone.0293095

Adv Neonatal Care. 2023 Oct 19. doi: 10.1097/ANC.0000000000001115. Online ahead of print.

ABSTRACT

BACKGROUND: Nursing assessment of milk flow regulation and associated apnea, bradycardia, and desaturation (ABD events) contribute to considerations for the discharge of newborns from the acute care setting. Research regarding infant feeding-related (FR) events (sucking and swallowing difficulties) and ABD events in moderate to late-preterm and full-term infants is lacking.

PURPOSE: This study observes the impact of FR and ABD events during feeding on hospital length of stay (LOS) and healthcare utilization (cost) in moderate-to-late preterm newborns, as well as full-term infants.

METHODS: In a retrospective study, bottle-fed infants admitted to the level II specialty care nursery of an academic community hospital in Southern California were observed for FR and ABD events. Statistical analyses were used to determine the impact of FR events on adjusted LOS, to evaluate the interaction between FR event status and adjusted LOS on total hospital charges, and to assess the statistical independence between FR events and diagnostic-related group severity.

RESULTS: The full sample of patient records included 308 infants born between 32- and 44-week gestational age between April 1, 2018, and October 31, 2022. LOS was twice as long in infants who had FR events. Total median charges were higher in the group with FR events at $160,165 versus $64,380 with non-FR events.

IMPLICATIONS FOR PRACTICE AND RESEARCH: Increased knowledge in the epidemiology and nursing care of infants experiencing milk flow regulation and associated ABD events is critical for informing practices and guidelines related to the prevention of related morbidities.

PMID:37862366 | DOI:10.1097/ANC.0000000000001115

PLoS One. 2023 Oct 20;18(10):e0292754. doi: 10.1371/journal.pone.0292754. eCollection 2023.

ABSTRACT

BACKGROUND: The burden of drowning among occupational boaters in low and middle-income countries is highest globally. In Uganda, over 95% of people who drowned from boating-related activities were not wearing lifejackets at the time of the incident. We implemented and evaluated a peer-led training program to improve lifejacket wear among occupational boaters on Lake Albert, Uganda.

METHODS: We conducted a two-arm cluster randomized controlled trial in which fourteen landing sites were randomized to the intervention and non-intervention arm with a 1:1 allocation ratio. In the intervention arm, a six-month peer-to-peer training program on lifejacket wear was implemented while the non-intervention arm continued to receive the routine Marine Police sensitizations on drowning prevention through its community policing program. The effect of the intervention was assessed on self-reported and observed lifejacket wear using a test of differences in proportions of wear following the intention to treat principle. The effect of contamination was assessed using mixed effect modified Poisson regression following the As Treated analysis principle at 95% CI. Results are reported according to the CONSORT statement-extension for cluster randomized trials.

RESULTS: Self-reported lifejacket wear increased markedly from 30.8% to 65.1% in the intervention arm compared to the non-intervention arm which rose from 29.9% to 43.2%. Observed wear increased from 1.0% to 26.8% in the intervention arm and from 0.6% to 8.8% in the non-intervention arm. The test of differences in proportions of self-reported lifejacket wear (65.1%- 43.2% = 21.9%, p-value <0.001) and observed wear (26.8%- 8.8% = 18%, p-value <0.001) showed statistically significant differences between the intervention and non-intervention arm. Self-reported lifejacket wear was higher among boaters who received peer training than those who did not (Adj. PR 1.78, 95% CI 1.38-2.30).

CONCLUSION: This study demonstrated that peer-led training significantly improves lifejacket wear among occupational boaters. The government of Uganda through the relevant ministries, and the Landing Site Management Committees should embrace and scale up peer-led training programs on lifejacket wear to reduce drowning deaths.

PMID:37862363 | DOI:10.1371/journal.pone.0292754

PLoS Genet. 2023 Oct 20;19(10):e1010983. doi: 10.1371/journal.pgen.1010983. Online ahead of print.

ABSTRACT

In high-throughput spatial transcriptomics (ST) studies, it is of great interest to identify the genes whose level of expression in a tissue covaries with the spatial location of cells/spots. Such genes, also known as spatially variable genes (SVGs), can be crucial to the biological understanding of both structural and functional characteristics of complex tissues. Existing methods for detecting SVGs either suffer from huge computational demand or significantly lack statistical power. We propose a non-parametric method termed SMASH that achieves a balance between the above two problems. We compare SMASH with other existing methods in varying simulation scenarios demonstrating its superior statistical power and robustness. We apply the method to four ST datasets from different platforms uncovering interesting biological insights.

PMID:37862362 | DOI:10.1371/journal.pgen.1010983

J Am Acad Orthop Surg. 2023 Oct 19. doi: 10.5435/JAAOS-D-21-00249. Online ahead of print.

ABSTRACT

BACKGROUND: Pavlik harness treatment is the standard of care for developmental dysplasia of the hip in infants younger than 6 months. The effect of Pavlik harness treatment on the achievement of motor milestones has not previously been reported.

METHODS: In this prospective cohort study, 35 patients were prospectively enrolled to participate and received questionnaires with sequential clinical visits monitoring treatment of their developmental dysplasia of the hip. One-sample Student t-tests assessed differences in milestone attainment age, and the Benjamini-Hochberg procedure was conducted to decrease the false discovery rate. Post hoc power analyses of each test were conducted. The age of achievement of eight early motor milestones were recorded and compared with a previously published cohort of healthy infants.

RESULTS: Infants treated with a Pavlik harness achieved four early motor milestones markedly later than the reported age of achievement in a historical control group. These milestones included “roll supine” (5.3 vs. 4.5 months; P = 0.039), “roll prone” (5.7 vs. 5.0 months; P = 0.039), “sit” (6.4 vs. 5.2 months; P < 0.001), and “crawl on stomach” (7.7 vs. 6.6 months; P = 0.039). However, there was no difference in time to achievement of later motor milestones of “crawl on knees,” “pull to stand,” and “independent walking.”

CONCLUSION: Several early motor milestones were achieved at a statistically significantly later time than historical control subjects not treated in a Pavlik harness. Despite statistical significance, the small delays in early motor milestones were not thought to be clinically significant. No differences were observed in the later motor milestones, including knee crawling, standing, and independent walking. Clinicians and parents may be reassured by these findings.

LEVEL OF EVIDENCE: Therapeutic Level II-prospective study.

PMID:37862341 | DOI:10.5435/JAAOS-D-21-00249

J Med Internet Res. 2023 Oct 20;25:e46552. doi: 10.2196/46552.

ABSTRACT

BACKGROUND: Elicitation of patients’ preferences is an integral part of shared decision-making, the recommended approach for prostate cancer decision-making. Existing decision aids for this population often do not specifically focus on patients’ preferences. Healium is a brief interactive web-based decision aid that aims to elicit patients’ treatment preferences and is designed for a low health literate population.

OBJECTIVE: This study used a randomized controlled trial to evaluate whether Healium, designed to target preference elicitation, is as efficacious as Healing Choices, a comprehensive education and decision tool, in improving outcomes for decision-making and emotional quality of life.

METHODS: Patients diagnosed with localized prostate cancer who had not yet made a treatment decision were randomly assigned to the brief Healium intervention or Healing Choices, a decision aid previously developed by our group that serves as a virtual information center on prostate cancer diagnosis and treatment. Assessments were completed at baseline, 6 weeks, and 3 months post baseline, and included decisional outcomes (decisional conflict, satisfaction with decision, and preparation for decision-making), and emotional quality of life (anxiety/tension and depression), along with demographics, comorbidities, and health literacy.

RESULTS: A total of 327 individuals consented to participate in the study (171 were randomized to the Healium intervention arm and 156 were randomized to Healing Choices). The majority of the sample was non-Hispanic (272/282, 96%), White (239/314, 76%), married (251/320, 78.4%), and was on average 62.4 (SD 6.9) years old. Within both arms, there was a significant decrease in decisional conflict from baseline to 6 weeks postbaseline (Healium, P≤.001; Healing Choices, P≤.001), and a significant increase in satisfaction with one’s decision from 6 weeks to 3 months (Healium, P=.04; Healing Choices, P=.01). Within both arms, anxiety/tension (Healium, P=.23; Healing Choices, P=.27) and depression (Healium, P=.001; Healing Choices, P≤.001) decreased from baseline to 6 weeks, but only in the case of depression was the decrease statistically significant.

CONCLUSIONS: Healium, our brief decision aid focusing on treatment preference elicitation, is as successful in reducing decisional conflict as our previously tested comprehensive decision aid, Healing Choices, and has the added benefit of brevity, making it the ideal tool for integration into the physician consultation and electronic medical record.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05800483; https://clinicaltrials.gov/study/NCT05800483.

PMID:37862103 | DOI:10.2196/46552

J Med Internet Res. 2023 Oct 20;25:e48093. doi: 10.2196/48093.

ABSTRACT

BACKGROUND: With the global rise in Alzheimer disease (AD), early screening for mild cognitive impairment (MCI), which is a preclinical stage of AD, is of paramount importance. Although biomarkers such as cerebrospinal fluid amyloid level and magnetic resonance imaging have been studied, they have limitations, such as high cost and invasiveness. Digital markers to assess cognitive impairment by analyzing behavioral data collected from digital devices in daily life can be a new alternative. In this context, we developed a “virtual kiosk test” for early screening of MCI by analyzing behavioral data collected when using a kiosk in a virtual environment.

OBJECTIVE: We aimed to investigate key behavioral features collected from a virtual kiosk test that could distinguish patients with MCI from healthy controls with high statistical significance. Also, we focused on developing a machine learning model capable of early screening of MCI based on these behavioral features.

METHODS: A total of 51 participants comprising 20 healthy controls and 31 patients with MCI were recruited by 2 neurologists from a university hospital. The participants performed a virtual kiosk test-developed by our group-where we recorded various behavioral data such as hand and eye movements. Based on these time series data, we computed the following 4 behavioral features: hand movement speed, proportion of fixation duration, time to completion, and the number of errors. To compare these behavioral features between healthy controls and patients with MCI, independent-samples 2-tailed t tests were used. Additionally, we used these behavioral features to train and validate a machine learning model for early screening of patients with MCI from healthy controls.

RESULTS: In the virtual kiosk test, all 4 behavioral features showed statistically significant differences between patients with MCI and healthy controls. Compared with healthy controls, patients with MCI had slower hand movement speed (t₄₉=3.45; P=.004), lower proportion of fixation duration (t₄₉=2.69; P=.04), longer time to completion (t₄₉=-3.44; P=.004), and a greater number of errors (t₄₉=-3.77; P=.001). All 4 features were then used to train a support vector machine to distinguish between healthy controls and patients with MCI. Our machine learning model achieved 93.3% accuracy, 100% sensitivity, 83.3% specificity, 90% precision, and 94.7% F₁-score.

CONCLUSIONS: Our research preliminarily suggests that analyzing hand and eye movements in the virtual kiosk test holds potential as a digital marker for early screening of MCI. In contrast to conventional biomarkers, this digital marker in virtual reality is advantageous as it can collect ecologically valid data at an affordable cost and in a short period (5-15 minutes), making it a suitable means for early screening of MCI. We call for further studies to confirm the reliability and validity of this approach.

PMID:37862101 | DOI:10.2196/48093

JMIR Public Health Surveill. 2023 Oct 20;9:e44155. doi: 10.2196/44155.

ABSTRACT

BACKGROUND: Patients recovering from COVID-19 often experience persistent problems in their daily activities related to limitations in physical, nutritional, cognitive, and mental functioning. To date, it is unknown what treatment is needed to support patients in their recovery from COVID-19.

OBJECTIVE: This study aimed to evaluate the primary allied health care of patients recovering from COVID-19 at 6-month follow-up and to explore which baseline characteristics are associated with changes in the scores of outcomes between baseline and 6-month follow-up.

METHODS: This Dutch nationwide prospective cohort study evaluated the recovery of patients receiving primary allied health care (ie, dietitians, exercise therapists, occupational therapists, physical therapists, and speech and language therapists) after COVID-19. All treatments offered by primary allied health professionals in daily practice were part of usual care. Patient-reported outcome measures on participation, health-related quality of life, fatigue, physical functioning, and psychological well-being were assessed at baseline and at 3- and 6-month follow-up. Linear mixed model analyses were used to evaluate recovery over time, and uni- and multivariable linear regression analyses were used to examine the association between baseline characteristics and recovery.

RESULTS: A total of 1451 adult patients recovering from COVID-19 and receiving treatment from 1 or more primary allied health professionals were included. For participation (Utrecht Scale for Evaluation of Rehabilitation-Participation range 0-100), estimated mean differences of at least 2.3 points were observed at all time points. For the health-related quality of life (EuroQol Visual Analog Scale, range 0-100), the mean increase was 12.3 (95% CI 11.1-13.6) points at 6 months. Significant improvements were found for fatigue (Fatigue Severity Scale, range 1-7): the mean decrease was -0.7 (95% CI -0.8 to -0.6) points at 6 months. However, severe fatigue was reported by 742/929 (79.9%) patients after 6 months. For physical functioning (Patient-Reported Outcomes Measurement Information System-Physical Function Short Form 10b, range 13.8-61.3), the mean increase was 5.9 (95% CI 5.9-6.4) points at 6 months. Mean differences of -0.8 (95% CI -1.0 to -0.5) points for anxiety (Hospital Anxiety and Depression Scale range 0-21) and -1.6 (95% CI -1.8 to -1.3) points for depression were found after 6 months. A worse baseline score, hospital admission, and male sex were associated with greater improvement between baseline and 6-month follow-up, whereas age, the BMI, comorbidities, and smoking status were not associated with mean changes in any outcome measures.

CONCLUSIONS: Patients recovering from COVID-19 who receive primary allied health care make progress in recovery but still experience many limitations in their daily activities after 6 months. Our findings provide reference values to health care providers and health care policy makers regarding what to expect from the recovery of patients who receive health care from 1 or more primary allied health professionals.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04735744; https://tinyurl.com/3vf337pn.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2340/jrm.v54.2506.

PMID:37862083 | DOI:10.2196/44155

Clin J Sport Med. 2023 Oct 19. doi: 10.1097/JSM.0000000000001195. Online ahead of print.

ABSTRACT

OBJECTIVES: Although physical trauma has been reported in boxing since its inception, boxing still appeals to athletes and spectators. This systematic review and meta-analysis assess both acute and chronic neurological and neuropsychological effects that boxing has on the brain. Further assessments in terms of comparisons of the concussion ratio in boxing to other combat sports, as well as the efficiency of wearing headguards, are also performed.

DATA SOURCES: This systematic review and meta-analysis used the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The outcomes incorporated included physical chronic abnormalities of the brain, neuropsychiatric, and neurological disorders sustained in amateur or professional boxing, in addition to the safety benefits of boxing headguards. Odds ratios, descriptive statistics, and inferential statistics are also reported.

MAIN RESULTS: From the 84 articles reviewed, the 35 included articles suggested that boxers have a significantly elevated risk of sustaining a concussion compared with other combat sports (risk ratio [RR]: 0.253 vs RR: 0.065, P < 0.001). From the 631 amateur and professional boxers analyzed, 147 (23.30%) had cavum septum pellucidum, whereas 125 of 411 amateur and professional boxers (30.41%) presented with some form of brain atrophy. Dementia or amnesia was observed in 46 of 71 boxers (61.79%), 36 of 70 (51.43%) had various forms and severities of cognitive disorders, and 57 of 109 (52.29%) displayed abnormal computed tomography or electroencephalogram scan results. Utilization of headguards significantly increased the risk for stoppages in amateur bouts, compared with boxers not wearing a headguard (OR: 1.75 vs 0.53, P < 0.050).

CONCLUSIONS: Boxing is a hazardous sport that has the potential to have fatal and negative life-changing results. Because of the limited reliable data regarding the efficiency of boxing headguards, future research should focus on the overall significance that headguards may have for reducing head trauma.

PMID:37862081 | DOI:10.1097/JSM.0000000000001195

Disabil Rehabil Assist Technol. 2023 Oct 20:1-8. doi: 10.1080/17483107.2023.2272849. Online ahead of print.

ABSTRACT

PURPOSE: Unmet needs for assistive technology (AT) contribute to health and quality of life disparities among people with intellectual and developmental disabilities (IDD) [1-4]. The biggest barrier people with IDD face accessing technology is affordability and a lack of funding [1,3-6]. The purpose of this study was to examine how AT were provided to people with IDD in Medicaid Home- and Community-Based Services (HCBS) in the United States, the largest funding source for Long-Term Services and Supports for people with IDD.

MATERIALS AND METHODS: We analysed Medicaid HCBS 1915(c) waivers for people with IDD from across the USA in fiscal year (FY) 2021 using content analysis and descriptive statistics.

RESULTS AND CONCLUSIONS: In FY2021, 31 states and the District of Columbia provided AT (stand-alone and combined services) through 68 waivers for people with IDD to improve functioning, communication, independence, and community integration. In total, $63.3 million was projected for the AT services for 23,753 people with IDD. Average spending per person on AT services was $2,663. We found significant variability in terms of how states allocated AT to people with IDD in their HCBS programs. Not only were less than 3% of people with IDD with HCBS projected to receive assistive technology services, there was also large variance across services and states. Assistive technology promotes the health, safety, quality of life, independence, and community integration of people with IDD – they align with the very aims of HCBS, and thus, should be expanded.

PMID:37862062 | DOI:10.1080/17483107.2023.2272849