Nevin Manimala

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

Eur Urol Oncol. 2023 Aug 19:S2588-9311(23)00161-X. doi: 10.1016/j.euo.2023.07.018. Online ahead of print.

ABSTRACT

BACKGROUND: The European Association of Urology guidelines include the lutetium-177 (¹⁷⁷Lu) PSMA-617 prostate-specific membrane antigen (PSMA) ligand as a therapy option for metastatic castration-resistant prostate cancer (mCRPC). A major challenge in clinical practice is to pursue a personalized treatment approach based on robust predictive biomarkers.

OBJECTIVE: To assess the performance of ¹⁷⁷Lu PSMA in real-world practice and to elaborate clinical biomarkers for evaluating treatment responses.

DESIGN, SETTING, AND PARTICIPANTS: We conducted a retrospective observational study including 233 patients with mCRPC treated with ¹⁷⁷Lu PSMA in eight high-volume European centers.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Baseline characteristics and clinical parameters during and after ¹⁷⁷Lu PSMA treatment were documented. Correlations to treatment response were analyzed using χ² and log-rank tests, with differences between groups with and without disease progression calculated using a Mann-Whitney U test. Univariate and multivariate-adjusted hazard ratios (HRs) were measured using Cox proportional hazards models.

RESULTS AND LIMITATIONS: A prostate-specific antigen (PSA) decrease of ≥30% was observed in 41.7%, 63.5%, and 77.8% of patients after the first, second, and third treatment cycle, respectively. Restaging performed via PSMA positron emission tomography-computed tomography revealed that 33.7% of patients had an imaging-based response, including two patients with a complete response, while 13.4% had stable disease. The median time to progression was 5 mo and the median time until the start of a consecutive antineoplastic therapy was 8.5 mo. Of importance, a PSA decrease ≥30% after the first two cycles of ¹⁷⁷Lu PSMA (1 cycle: p = 0.0003; 2 cycles: p = 0.004), absolute PSA after the first three cycles (1 cycle: p = 0.011; 2 cycles: p = 0.0005; 3 cycles: p = 0.002), and a PSA doubling time >6 mo (p = 0.009) were significantly correlated to treatment response. Furthermore, gamma-glutamyl transferase ≤31 U/L at the start of ¹⁷⁷Lu PSMA therapy was correlated with 1.5 times higher risk of progression for patients without but not with visceral metastases (p = 0.046).

CONCLUSIONS: ¹⁷⁷Lu PSMA is an effective treatment option in mCRPC in the real-world setting. A PSA decrease ≥30% after the first two cycles is an early marker of response that can be easily implemented in clinical practice.

PATIENT SUMMARY: ¹⁷⁷Lu PSMA is a radioactive agent approved for treatment of advanced prostate cancer. We reviewed its use outside of clinical trials for patients treated at eight European centers. We found that ¹⁷⁷Lu PSMA is an effective treatment option in real-world practice. A PSA (prostate-specific antigen) decrease of ≥30% after the first two therapy cycles is an early indicator of response to treatment and can be used in personalizing treatments for patients.

PMID:37604763 | DOI:10.1016/j.euo.2023.07.018

Parkinsonism Relat Disord. 2023 Aug 17:105809. doi: 10.1016/j.parkreldis.2023.105809. Online ahead of print.

ABSTRACT

INTRODUCTION: Deep Brain Stimulation (DBS) is an effective treatment for the motor symptoms of Parkinson’s Disease. The targeted physiological structure for lead location is commonly the subthalamic nucleus (STN). The efficacy of DBS for improving motor symptoms is assessed via the Unified Parkinson’s Disease Rating III Scale (UPDRS-III). In this study, we sought to compare the efficacy of frequency settings utilized for STN-DBS.

METHODS: Following PRISMA Guidelines, a search on PUBMED and MEDLINE was performed to include full-length randomized controlled trials evaluating STN-DBS. The frequency stimulation parameters and Unified Parkinson’s Disease Rating Scale (UPDRS-III) outcomes were extracted in the search. High-frequency stimulation (HFS) was defined as ≥100 Hz and low-frequency stimulation (LFS) was defined as <100 Hz. A frequentist network meta-analysis was performed with odds ratios (OR) and pooling performed using the Mantel-Haenszel method. Statistics are presented as OR [95% CI].

RESULTS: 15 studies consisting of 298 patients were included for analysis. Bilateral HFS -0.68 [-0.89; -0.46] was associated with better UPDRS-III scores compared to bilateral LFS. On the other hand, bilateral LFS with medications (MEDS) was favored over HFS with MEDS (-0.28 [-0.63; 0.07]). Bilateral LFS and MEDS, HFS and MEDS, stimulation (STIM) OFF MEDS ON, HFS, LFS, STIM OFF MEDS OFF UPDRS outcomes were ranked from best to worst outcomes.

DISCUSSION: The outcomes of this study suggest that bilateral HFS has better utility for those with no response to medication, while LFS has additive benefits to medication by improving unique symptoms via different neurophysiological mechanisms.

PMID:37604755 | DOI:10.1016/j.parkreldis.2023.105809

Br J Gen Pract. 2023 Jul 4:BJGP.2023.0007. doi: 10.3399/BJGP.2023.0007. Online ahead of print.

ABSTRACT

BACKGROUND: There are inequalities in the geographical distribution of the primary care workforce in England. Primary care networks (PCNs), and the associated Additional Roles Reimbursement Scheme (ARRS) funding, have stimulated employment of new healthcare roles. However, it is not clear whether this will impact inequalities.

AIM: To examine whether the ARRS impacted inequality in the distribution of the primary care workforce.

DESIGN AND SETTING: A retrospective before-and-after study of English PCNs in 2019 and 2022.

METHOD: The study combined workforce, population, and deprivation data at network level for March 2019 and March 2022. The change was estimated between 2019 and 2022 in the slope index of inequality (SII) across deprivation of full-time equivalent (FTE) GPs (total doctors, qualified GPs, and doctors-in-training), nurses, direct patient care, administrative, ARRS and non- ARRS, and total staff per 10 000 patients.

RESULTS: A total of 1255 networks were included. Nurses and qualified GPs decreased in number while all other staff roles increased, with ARRS staff having the greatest increase. There was a pro- rich change in the SII for administrative staff (-0.482, 95% confidence interval [CI] = -0.841 to -0.122, P<0.01) and a pro- poor change for doctors-in-training (0.161, 95% CI = 0.049 to 0.274, P<0.01). Changes in distribution of all other staff types were not statistically significant.

CONCLUSION: Between 2019 and 2022 the distribution of administrative staff became less pro-poor, and doctors-in-training became pro-poor. The changes in inequality in all other staff groups were mixed. The introduction of PCNs has not substantially changed the longstanding inequalities in the geographical distribution of the primary care workforce.

PMID:37604700 | DOI:10.3399/BJGP.2023.0007

Mult Scler Relat Disord. 2023 Aug 13;78:104931. doi: 10.1016/j.msard.2023.104931. Online ahead of print.

ABSTRACT

BACKGROUND: Multiple Sclerosis (MS) is a chronic disease with a high prevalence of neuropsychiatric symptoms. Mindfulness is a practice that encourages individuals to cultivate a present-focused, acceptance-based approach for managing psychological distress. Its positive effect on MS has been demonstrated, but learning such technique is expensive and time-consuming. In this study, we investigated the feasibility and efficacy of an 8-week, at-home, smart-device aided mindfulness program in a cohort of MS patients. Specifically, we explored the role of a brain-sensing headband providing real-time auditory feedback as supportive tool for meditation exercises.

METHODS: The study included two visits, one at baseline and another after the mindfulness program. We measured adherence to the proposed mindfulness treatment and its effect on questionnaires investigating different psychological domains, cognition, fatigue, quality of life and quantitative EEG parameters. All participants received a smart biofeedback device to be used during the therapeutic program consisting of daily meditative exercises.

RESULTS: Twenty-nine patients were recruited for the present study. Among them, 27 (93%) completed the entire program and 17 (63%) completed more than 80% of the scheduled sessions. We observed a statistically significant reduction of the Ruminative Response Scale score and a significant increase of the Digit Span Backward. Regarding neurophysiological data, we found a significant reduction of the whole-scalp beta and parieto-occipital theta power post intervention.

CONCLUSION: Our results show that an at-home, smart-device aided mindfulness program is feasible for people with MS. The efficacy in terms of reappraisals of stress, cognitive and emotional coping responses is also supported by our neurophysiological data. Further studies are warranted to better explore the role of such approaches in managing the psychological impact of MS diagnosis.

PMID:37603929 | DOI:10.1016/j.msard.2023.104931

Mult Scler Relat Disord. 2023 Jul 22;78:104909. doi: 10.1016/j.msard.2023.104909. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: disease-modifying treatments (DMT) for Multiple Sclerosis (MS) have expanded in recent years making the shared-decision process challenging. Moreover, no head-to-head studies are available within the first-line options. Our aim is to compare therapeutic persistence within first-line DMT: teriflunomide (TER), dimethyl fumarate (DMF), and injectable drugs (INJ) in a real-world setting.

METHODS: Retrospective observational study analyzing diagnosed with Relapsing-Remitting Multiple Sclerosis (RRMS) who started DMT between January 2015 and April 2022 (TER=117, DMF=117, INJ=123). Clinical, radiological, and demographic variables were collected. The primary outcome was the median time to discontinuation of any DMT. Dropout was defined as discontinuation for 6 months for any reason.

RESULTS: Of the total of 357 patients, 155 withdraw with a median time-to-discontinuation of 1.427 years (IQR 2.410). The discontinuation rate was higher in the injectable group, 49.6%; compared to teriflunomide 40.2%, and dimethyl fumarate 39.8% (p = 0.201). The most frequent reason of discontinuation differs within groups (lack of efficacy in TER, 63.8%, and adverse effects in DMF and INJ (40.4% and 40.9% respectively). No difference in persistence was observed between DMT (p = 0.30). After 2018 there has been a tendency to treat in a quick and early manner (lower EDSS; relapse rate and number of naïve patients), statistically significant for TER (p = 0.005, p = 0.010, and p = 0.045).

CONCLUSIONS: Our study demonstrated no differences in persistence between the actual first-line DMT in a real-world setting, although a trend to favor oral-DMT was seen. Reasons for discontinuation differs within groups.

PMID:37603928 | DOI:10.1016/j.msard.2023.104909

Ecotoxicol Environ Saf. 2023 Aug 19;263:115384. doi: 10.1016/j.ecoenv.2023.115384. Online ahead of print.

ABSTRACT

BACKGROUND: Ambient particulate matter with aerodynamic diameter ≤ 2.5 µm (PM_2.5) consists of various toxic constituents. However, the health effect of PM_2.5 may differ depending on its constituents, but the joint effect of PM_2.5 constituents remains incompletely understood.

OBJECTIVE: Our goal was to evaluate the joint effect of long-term PM_2.5 constituent exposures on dyslipidemia and identify the most hazardous chemical constituent.

METHODS: This study included 67,015 participants from the China Multi-Ethnic Cohort study. The average yearly levels of PM_2.5 constituents for all individuals at their residences were assessed through satellite remote sensing and chemical transport modeling. Dyslipidemia was defined as one or more following abnormal blood lipid concentrations: total cholesterol (TC) ≥ 6.22 mmol/L, triglycerides (TG) ≥ 2.26 mmol/L, high-density lipoprotein cholesterol (HDL-C) < 1.04 mmol/L, and low-density lipoprotein cholesterol (LDL-C) ≥ 4.14 mmol/L. The logistic regression model was utilized to examine the single effect of PM2.5 constituents on dyslipidemia, while the weighted quantile sum regression model for the joint effect.

RESULTS: The odds ratio with a 95 % confidence interval for dyslipidemia positively related to per-SD increase in the three-year average was 1.29 (1.20-1.38) for PM_2.5 mass, 1.25 (1.17-1.34) for black carbon, 1.24 (1.16-1.33) for ammonium, 1.33 (1.24-1.43) for nitrate, 1.34 (1.25-1.44) for organic matter, 1.15 (1.08-1.23) for sulfate, 1.30 (1.22-1.38) for soil particles, and 1.12 (1.05-1.92) for sea salt. Stronger associations were observed in individuals < 65 years of age, males, and those with low physical activity. Joint exposure to PM_2.5 constituents was positively related to dyslipidemia (OR: 1.09, 95 %CI: 1.05-1.14). Nitrate was identified as the constituent with the largest weight (weighted at 0.387).

CONCLUSIONS: Long-term exposure to PM_2.5 constituents poses a significant risk to dyslipidemia and nitrate might be the most responsible for the risk. These findings indicate that reducing PM_2.5 constituent exposures, especially nitrate, could be beneficial to alleviate the burden of disease attributed to PM_2.5-related dyslipidemia.

PMID:37603926 | DOI:10.1016/j.ecoenv.2023.115384