Nevin Manimala

Pediatr Emerg Care. 2023 Sep 5. doi: 10.1097/PEC.0000000000003034. Online ahead of print.

ABSTRACT

OBJECTIVE: We sought to investigate the disease outcomes and predictors of severe outcomes among children infected with the Delta variant of SARS-CoV-2 compared with pre-Delta strains.

METHODS: Single-center retrospective cohort study in an emergency department located within an urban academic children’s hospital. Patients included children (0-18 years) who tested positive for SARS-CoV-2. Main outcomes measured include need for hospital admission or COVID-directed therapies.

RESULTS: There was a trend toward decreased hospital admission and no significant difference in the severity of outcomes in the Delta cohort relative to the pre-Delta cohort. The Delta cohort had lower odds of hospital admission (odds ratio [OR], 0.79; 95% confidence interval [CI], 0.51-1.23), but the result was not statistically significant. Logistic regression analyses showed that overall, age 1 to 4 years (OR, 2.35; 95% CI, 1.23-4.57) and public insurance (OR, 1.80, 95% CI, 1.08-3.01) were predictors of hospital admission. Within the Delta cohort, the presence of any comorbidity increased the odds of admission (OR, 2.52; 95% CI, 1.09-6.04). Black children had lower odds of admission than white children (overall OR, 0.53; 95% CI, 0.31-0.90; pre-Delta OR, 0.50; 95% CI, 0.26-0.95).

CONCLUSIONS: The severity of measured disease outcomes was similar in pediatric patients when comparing children infected with the pre-Delta and Delta variants of SARS-CoV-2, even among children with comorbidities once adjusting for acuity.Ongoing research is essential to determine disease severity and risk for children with comorbidities because SARS-CoV-2 continues to mutate, including with Omicron subvariants.

PMID:37665790 | DOI:10.1097/PEC.0000000000003034

JMIR Public Health Surveill. 2023 Sep 4;9:e48630. doi: 10.2196/48630.

ABSTRACT

BACKGROUND: Pre-exposure prophylaxis (PrEP) is proven to prevent HIV infection. However, PrEP uptake to date has been limited and inequitable. Analyzing the readability of existing PrEP-related information is important to understand the potential impact of available PrEP information on PrEP uptake and identify opportunities to improve PrEP-related education and communication.

OBJECTIVE: We examined the readability of web-based PrEP information identified using search engines and on Twitter. We investigated the readability of web-based PrEP documents, stratified by how the PrEP document was obtained on the web, information source, document format and communication method, PrEP modality, and intended audience.

METHODS: Web-based PrEP information in English was systematically identified using search engines and the Twitter API. We manually verified and categorized results and described the method used to obtain information, information source, document format and communication method, PrEP modality, and intended audience. Documents were converted to plain text for the analysis and readability of the collected documents was assessed using 4 readability indices. We conducted pairwise comparisons of readability based on how the PrEP document was obtained on the web, information source, document format, communication method, PrEP modality, and intended audience, then adjusted for multiple comparisons.

RESULTS: A total of 463 documents were identified. Overall, the readability of web-based PrEP information was at a higher level (10.2-grade reading level) than what is recommended for health information provided to the general public (ninth-grade reading level, as suggested by the Department of Health and Human Services). Brochures (n=33, 7% of all identified resources) were the only type of PrEP materials that achieved the target of ninth-grade reading level.

CONCLUSIONS: Web-based PrEP information is often written at a complex level for potential and current PrEP users to understand. This may hinder PrEP uptake for some people who would benefit from it. The readability of PrEP-related information found on the web should be improved to align more closely with health communication guidelines for reading level to improve access to this important health information, facilitate informed decisions by those with a need for PrEP, and realize national prevention goals for PrEP uptake and reducing new HIV infections in the United States.

PMID:37665621 | DOI:10.2196/48630

JMIR Med Educ. 2023 Sep 4;9:e46482. doi: 10.2196/46482.

ABSTRACT

BACKGROUND: Large language models (LLMs) have demonstrated significant potential in diverse domains, including medicine. Nonetheless, there is a scarcity of studies examining their performance in medical examinations, especially those conducted in languages other than English, and in direct comparison with medical students. Analyzing the performance of LLMs in state medical examinations can provide insights into their capabilities and limitations and evaluate their potential role in medical education and examination preparation.

OBJECTIVE: This study aimed to assess and compare the performance of 3 LLMs, GPT-4, Bing, and GPT-3.5-Turbo, in the German Medical State Examinations of 2022 and to evaluate their performance relative to that of medical students.

METHODS: The LLMs were assessed on a total of 630 questions from the spring and fall German Medical State Examinations of 2022. The performance was evaluated with and without media-related questions. Statistical analyses included 1-way ANOVA and independent samples t tests for pairwise comparisons. The relative strength of the LLMs in comparison with that of the students was also evaluated.

RESULTS: GPT-4 achieved the highest overall performance, correctly answering 88.1% of questions, closely followed by Bing (86.0%) and GPT-3.5-Turbo (65.7%). The students had an average correct answer rate of 74.6%. Both GPT-4 and Bing significantly outperformed the students in both examinations. When media questions were excluded, Bing achieved the highest performance of 90.7%, closely followed by GPT-4 (90.4%), while GPT-3.5-Turbo lagged (68.2%). There was a significant decline in the performance of GPT-4 and Bing in the fall 2022 examination, which was attributed to a higher proportion of media-related questions and a potential increase in question difficulty.

CONCLUSIONS: LLMs, particularly GPT-4 and Bing, demonstrate potential as valuable tools in medical education and for pretesting examination questions. Their high performance, even relative to that of medical students, indicates promising avenues for further development and integration into the educational and clinical landscape.

PMID:37665620 | DOI:10.2196/46482

J Chem Inf Model. 2023 Sep 4. doi: 10.1021/acs.jcim.3c00526. Online ahead of print.

ABSTRACT

The basin-hopping algorithm (BHA) allows for the efficient exploration of atomic cluster potential energy surfaces by random perturbations in configuration space, followed by energy minimizations. Here, the taboo search method is incorporated to prevent the search from revisiting recently visited regions of the search space. Two taboo search modes are implemented, one mode resets the search to random coordinates upon encountering the taboo region, while the other simply rejects any proposed move into the taboo region. These two modes are tested and compared on a variety of potential energy surfaces─several clusters where atomic interactions are described by the Lennard-Jones potential, and Au₅₅ where a semi-empirical tight binding potential is used to describe atomic interactions. Some differences in performance between the two taboo search modes were noted for LJ₃₈ and Au₅₅, with the mode that rejects all hops into the taboo region performing better, offering a means to improve the efficiency of the BHA for multifunnel systems. However, both taboo search modes failed to significantly improve performance on multifunnel systems where more than two funnels were present in the system.

PMID:37665618 | DOI:10.1021/acs.jcim.3c00526

Phys Chem Chem Phys. 2023 Sep 4. doi: 10.1039/d3cp03092j. Online ahead of print.

ABSTRACT

The energy transfer pathways in light-harvesting complex II are complicated and the discovery of the energy transfer between the two luteins revealed an unelucidated important role of carotenoids in the energy flow. This energy transfer between the two S₂ states of luteins was for the first time investigated using Frenkel exciton models, using a hybrid scheme of molecular mechanics and quantum mechanics. The results show the energy flow between the two luteins under the Förster resonance energy transfer mechanism. The energy transfer caused by energy level resonance occurs in configurations with small energy gaps. This energy transfer pathway is particularly sensitive to conformation. Moreover, according to the statistical characteristics of the data of the energy gaps and coupling values between LUTs, we proposed stochastic exciton Hamiltonian models to facilitate clarification of the energy transfer among pigments in antenna complexes.

PMID:37665609 | DOI:10.1039/d3cp03092j

Arch Argent Pediatr. 2023 Sep 7:e202310083. doi: 10.5546/aap.2023-10083.eng. Online ahead of print.

ABSTRACT

Objectives: The purpose of this study was to compare breastfeeding and related factors (age, level of education, age at first pregnancy, etc.), and complementary feeding practices between Syrian refugee and native Turkish mothers. Material and methods: This descriptive-comparative study examined the nutritional characteristics of infants aged 9 to 60 months whose mothers were Turkish or Syrian refugees who attended Kızıltepe State Hospital between January 2022 and July 2022. Results: 204 mothers (126 Turkish and 78 Syrian) who had a child aged 9-60 months were included. The average age of the mothers was 27.60 ± 5.17 years for Turkish citizens and 28.91 ± 5.62 for Syrian refugees, without significant difference between the two groups (p: 0.091). Postpartum breastfeeding was 91.3% and breastfeeding duration was 12 (0-24) months in Turkish citizens; in Syrian refugees, breastfeeding was 84.6% and average breastfeeding time was 9 (0- 24) months (respectively, breast milk intake p: 0.144, uptake time p: 0.161; no statistical difference). Breastfeeding training was received by 23.8% of Turkish citizens and 5.1% of Syrian refugees; there was a significant difference between the two groups (p: 0.001). Conclusion: In refugee groups, infant and maternal nutrition practices are disrupted. Working in conjunction with local and international organizations and state agencies that give help to refugee groups, the appropriate interventions, initiatives, supports, and awareness-raising activities would strive to improve practices in mother and baby nutrition and narrow gaps.

PMID:37665607 | DOI:10.5546/aap.2023-10083.eng

Biomed Tech (Berl). 2023 Sep 5. doi: 10.1515/bmt-2022-0450. Online ahead of print.

ABSTRACT

OBJECTIVES: Novel noise reduction and QRS detection algorithms in Electrocardiogram (ECG) signal based on Empirical Mode Decomposition (EMD), Ensemble Empirical Mode Decomposition (EEMD) and the Modified Sigmoid Thresholding Function (MSTF) are proposed in this paper.

METHODS: EMD and EEMD algorithms are used to decompose the noisy ECG signal into series of Intrinsic Mode Functions (IMFs). Then, these IMFs are thresholded by the MSTF for reduction of noises and preservation of QRS complexes. After that, the thresholded IMFs are used to obtain the clean ECG signal. The characteristic points P, Q, R, S and T peaks are detected using peak detection algorithm.

RESULTS: The proposed methods are validated through experiments on the MIT-BIH arrhythmia database and Additive White Gaussian Noise (AWGN) is added to the clean ECG signal at different input SNR (SNR _in). Standard performance parameters output SNR (SNR _out), mean square error (MSE), root mean square error (RMSE), SNR improvement (SNR _imp) and percentage root mean square difference (PRD) are employed for evaluation of the efficacy of the proposed methods. The results showed that the proposed methods provide significant quantitative and qualitative improvements in denoising performance, compared with existing state-of-the-art methods such as wavelet denoising, conventional EMD (EMD-Conv), conventional EEMD (EEMD-Conv, Stockwell Transform (ST) and Complete EEMD with Adaptative Noise with hybrid interval thresholding and higher order statistic to select relevant modes (CEEMDAN-HIT).

CONCLUSIONS: A detail quantitative analysis demonstrate that for abnormal ECG records 207 m and 214 m at input SNR of -2 dB the SNR _imp value is 12.22 and 11.58 dB respectively, which indicates that the proposed algorithm can be used as an effective tool for denoising of ECG signals.

PMID:37665599 | DOI:10.1515/bmt-2022-0450

Cogn Neuropsychiatry. 2023 Sep 4:1-9. doi: 10.1080/13546805.2023.2255344. Online ahead of print.

ABSTRACT

Introduction: Patients with schizophrenia exhibit prospective memory (PM) impairment. Intraindividual reaction time variability (IIRTV) is an index of attentional control that is required for PM. This study examined the differences in IIRTV between patients with schizophrenia and healthy controls and the relationship between IIRTV and PM performance.Method: Thirty-nine patients with schizophrenia and forty-two healthy controls were recruited to complete a PM task and the Sustained Attention to Response Task. IIRTV was calculated as the coefficient of variation (mean/SD) of reaction time over correctly responded trials in these tasks.Results: Patients with schizophrenia showed lower PM accuracy and increased IIRTV, while the associations between PM accuracy and IIRTV were significant in healthy controls but not in patients with schizophrenia.Conclusion: These findings suggest impaired PM and relationship between PM and attentional control in patients with schizophrenia.

PMID:37665566 | DOI:10.1080/13546805.2023.2255344

J Addict Dis. 2023 Sep 4:1-6. doi: 10.1080/10550887.2023.2251856. Online ahead of print.

ABSTRACT

Introduction: Studies suggest that a large proportion of patients with substance use disorders (SUDs) also have underlying chronic pain. There is limited data on prevalence of chronic pain treatment as a component of residential substance use treatment. This initiative sought to investigate the prevalence and type of chronic pain services offered at these residential programs.Methods: This study was a retrospective review of information obtained from residential substance use treatment facility websites contained in SAMHSA’s treatment navigator. Nine hundred-fifty out of 2952 websites were randomly selected for analysis. The primary outcome was prevalence of facilities that had chronic pain programs. Services offered were specified as available. Descriptive statistics were used to summarize data.Results: Nine-hundred nine websites (95.7%, [94,97]) were accessible. Twenty-six facilities (2.9%,[1.9,4.2]) had a chronic pain program and of these 22 (84.6%, [64.3,95.0]) specified services offered. Common services included physical therapy (6, 27.3%), massage (12, 54.6%), and acupuncture (10, 45.5%). Of the remaining sites, 630 (69.3%, [66.2,72.3]) specified services offered, including yoga (122, 19.4%) and exercise (199, 31.6%).Conclusion: Our study demonstrated that despite most facilities offering adjunctive services, few had chronic pain programs. This suggests that there is a possible need for better updating of facility websites or possibly an area for improvement in residential substance use treatment settings.

PMID:37665562 | DOI:10.1080/10550887.2023.2251856

Immunol Res. 2023 Sep 4. doi: 10.1007/s12026-023-09419-8. Online ahead of print.

ABSTRACT

Ankylosing spondylitis (AS) is an autoinflammatory disease that affects the sacroiliac joints, causing stiffness and pain in the back. MICA is a ligand of the NKG2D receptor, and an increase in its expression affects the immune response in various diseases. NLRP3 is a multiprotein complex that promotes the release of IL-1β, but its role in AS has been minimally explored. The objective of this study was to analyze the association and interaction of polymorphic variants of the MICA and NLRP3 genes in patients with AS. In this case-control study, patients with AS were included and compared with healthy controls of Mexican origin. The polymorphisms rs4349859 and rs116488202 of MICA and rs3806268 and rs10754558 of NLRP3 were genotyped using TaqMan probes. Associations were determined using logistic regression models, while interactions were analyzed by the multifactorial dimensionality reduction (MDR) method. A P value < 0.05 was considered statistically significant. The minor allele of rs4349859 (A) and rs116488202 (T) of MICA polymorphisms showed risk associations with AS (OR = 9.22, 95% CI = 4.26-20.0, P < 0.001; OR = 9.36, 95% CI = 4.17-21.0, P < 0.001), while the minor allele of the rs3806268 (A) polymorphism of NLRP3 was associated with protection (OR = 0.55, 95% CI = 0.33-0.91, P = 0.019). MDR analysis revealed synergistic interactions between the MICA and NLRP3 polymorphisms (P = 0.012). In addition, high- and low-risk genotypes were identified among these variants. The study findings suggest that the MICA rs4349859 A allele and rs116488202 T allele are associated with AS risk. An interaction between MICA and NLRP3 was observed which could increase the genetic risk in AS.

PMID:37665559 | DOI:10.1007/s12026-023-09419-8