Nevin Manimala

Clin Spine Surg. 2023 Aug 15. doi: 10.1097/BSD.0000000000001506. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to show the correction maneuvers used in scoliosis surgery and give hints and tips on achieving optimal correction with the help of visual content.

MATERIALS AND METHODS: Seventy-two scoliosis patients with 96 major curves operated between 2011 and 2018 evaluated retrospectively. Seven different correction maneuvers (Ucar convex rod rotation technique, cantilever technique, convex double-rod rotation technique, convex double-rod translation technique, double-rod rotation with coronal bending, convex rod rotation with coronal bending, direct vertebral rotation) were used in these surgeries alone or together. Each method is explained with figures and videos. Type of scoliosis, follow-up time, age, preoperative and postoperative degree of curvature, amount of correction, surgical time, amount of transfusion, hemoglobin level, and hospital stay were evaluated.

RESULTS: The mean follow-up was 42.5 (24-108) months, and the mean age was 15.8 (12-29) years. The mean preoperative scoliosis angle of the patients was 75.9 (50-139) degrees, and the final follow-up was 15.6 (5-40) degrees. The scoliotic deformity correction rate was 79.3%. The mean preoperative thoracic kyphosis of the patients was 58.7 (12-110) degrees, and the final follow-up was 41.2 (25-62) degrees. The mean surgical time was 293 (160-440) minutes. The mean hospitalization length was 5.8 (2-21) days. The blood delivered to patients during surgery and postoperative was 715 (300-1800) mL. There was a statistically significant difference between the preoperative and final follow-up scoliosis angle (P=0.000).

CONCLUSIONS: Providing an ideal correction without damaging the spinal cord depends on correctly applying the correction maneuvers. The use of correction maneuvers alone or in combination in the appropriate order will shorten the duration of the case, decrease the amount of bleeding, shorten the hospital stay, increase the amount of correction, and reduce complications.

PMID:37651561 | DOI:10.1097/BSD.0000000000001506

J Bone Joint Surg Am. 2023 Aug 31. doi: 10.2106/JBJS.22.01278. Online ahead of print.

ABSTRACT

BACKGROUND: We hypothesized that an opioid-free (OF), multimodal pain management pathway for thumb carpometacarpal (CMC) joint arthroplasty would not have inferior pain control compared with that of a standard opioid-containing (OC) pathway.

METHODS: This was a single-center, randomized controlled clinical trial of patients undergoing primary thumb CMC joint arthroplasty. Patients were randomly allocated to either a completely OF analgesic pathway or a standard OC analgesic pathway. Patients in both cohorts received a preoperative brachial plexus block utilizing 30 mL of 0.5% ropivacaine that was administered via ultrasound guidance. The OF group was given a combination of cryotherapy, anti-inflammatory medications, acetaminophen, and gabapentin. The OC group was only given cryotherapy and opioid-containing medication for analgesia. Patient-reported pain was assessed with use of a 0 to 10 numeric rating scale at 24 hours, 2 weeks, and 6 weeks postoperatively. We compared the demographics, opioid-related side effects, patient satisfaction, and Veterans RAND 12-Item Health Survey (VR-12) results between these 2 groups.

RESULTS: At 24 hours postoperatively, pain scores in the OF group were statistically noninferior to, and lower than, those in the OC group (median, 2 versus 4; p = 0.008). Pain scores continued to differ significantly at 2 weeks postoperatively (median, 2 versus 4; p = 0.001) before becoming more similar at 6 weeks (p > 0.05). No difference was found between groups with respect to opioid-related side effects, patient satisfaction, or VR-12 results.

CONCLUSIONS: A completely opioid-free perioperative protocol is effective for the treatment of pain following thumb CMC joint arthroplasty in properly selected patients.

LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

PMID:37651550 | DOI:10.2106/JBJS.22.01278

Science. 2023 Sep;381(6661):995-998. doi: 10.1126/science.ade9803. Epub 2023 Aug 31.

ABSTRACT

Calculus, the study of change in processes and systems, serves as the foundation for many STEM disciplines. Traditional, lecture-based calculus instruction may present a barrier for students seeking STEM degrees, limit their access to STEM professions, and block their potential to address society’s challenges. A large-scale pragmatic trial with randomized student allocation was conducted to compare two calculus instruction styles: active student engagement (treatment condition) versus traditional, lecture-based instruction (control condition). A sample of 811 university students were studied across 32 sections taught by 19 instructors over three semesters at a large, US-based Hispanic-serving institution. Large effect sizes were consistently measured for student learning outcomes in the treatment condition, which demonstrates a new standard for calculus instruction and increased opportunities for completion of STEM degrees.

PMID:37651531 | DOI:10.1126/science.ade9803

IEEE Trans Neural Netw Learn Syst. 2023 Aug 31;PP. doi: 10.1109/TNNLS.2023.3259149. Online ahead of print.

ABSTRACT

Short-term load forecasting (STLF) is challenging due to complex time series (TS) which express three seasonal patterns and a nonlinear trend. This article proposes a novel hybrid hierarchical deep-learning (DL) model that deals with multiple seasonality and produces both point forecasts and predictive intervals (PIs). It combines exponential smoothing (ES) and a recurrent neural network (RNN). ES extracts dynamically the main components of each individual TS and enables on-the-fly deseasonalization, which is particularly useful when operating on a relatively small dataset. A multilayer RNN is equipped with a new type of dilated recurrent cell designed to efficiently model both short and long-term dependencies in TS. To improve the internal TS representation and thus the model’s performance, RNN learns simultaneously both the ES parameters and the main mapping function transforming inputs into forecasts. We compare our approach against several baseline methods, including classical statistical methods and machine learning (ML) approaches, on STLF problems for 35 European countries. The empirical study clearly shows that the proposed model has high expressive power to solve nonlinear stochastic forecasting problems with TS including multiple seasonality and significant random fluctuations. In fact, it outperforms both statistical and state-of-the-art ML models in terms of accuracy.

PMID:37651485 | DOI:10.1109/TNNLS.2023.3259149

PLoS One. 2023 Aug 31;18(8):e0290663. doi: 10.1371/journal.pone.0290663. eCollection 2023.

ABSTRACT

BACKGROUND: Serotonergic brain signaling is considered critical for an appropriate and dynamic adaptation to stress, seemingly through modulating limbic system functions, such as the hypothalamic-pituitary-adrenal (HPA)-axis. This interplay is of great interest since it holds promise as a target for preventing stress-related brain disorders, e.g., major depression. Our group has previously observed that prefrontal serotonin transporter (5-HTT) binding, imaged with positron emission tomography (PET), is positively associated with the cortisol awakening response (CAR), an index of HPA axis stress hormone dynamics. The aim of this cross-sectional study was to replicate the previous finding in a larger independent group of healthy individuals.

METHODS: Molecular imaging and cortisol data were available for 90 healthy individuals. Prefrontal 5-HTT binding was imaged with [11C]DASB brain PET. Non-displaceable 5-HTT binding potential (BPND) was quantified using the Multilinear Reference Tissue Model 2 (MRTM2) with cerebellum as the reference region. CAR was based on five serial salivary cortisol samples within the first hour upon awakening. The association between CAR and prefrontal 5-HTT BPND was evaluated using a multiple linear regression model adjusted for age and sex. Further, we tested for sex differences in the association. Finally, an exploratory analysis of the association, was performed in 8 additional brain regions.

RESULTS: We observed no statistically significant association between 5-HTT binding and CAR corrected for age and sex in the prefrontal cortex (β = -0.28, p = 0.26). We saw no interaction with sex on the association (p = 0.99).

CONCLUSION: We could not confirm a positive association between CAR and prefrontal 5-HTT BPND in this independent dataset. Also, sex differences in the association were not apparent. Our data do not exclude that the serotonin transporter system is involved in the regulation of stress responses in at-risk or manifest depressed states.

PMID:37651457 | DOI:10.1371/journal.pone.0290663

PLoS One. 2023 Aug 31;18(8):e0290819. doi: 10.1371/journal.pone.0290819. eCollection 2023.

ABSTRACT

Anthropogenic activities can lead to changes in animal behavior. Predicting population consequences of these behavioral changes requires integrating short-term individual responses into models that forecast population dynamics across multiple generations. This is especially challenging for long-lived animals, because of the different time scales involved. Beaked whales are a group of deep-diving odontocete whales that respond behaviorally when exposed to military mid-frequency active sonar (MFAS), but the effect of these nonlethal responses on beaked whale populations is unknown. Population consequences of aggregate exposure to MFAS was assessed for two beaked whale populations that are regularly present on U.S. Navy training ranges where MFAS is frequently used. Our approach integrates a wide range of data sources, including telemetry data, information on spatial variation in habitat quality, passive acoustic data on the temporal pattern of sonar use and its relationship to beaked whale foraging activity, into an individual-based model with a dynamic bioenergetic module that governs individual life history. The predicted effect of disturbance from MFAS on population abundance ranged between population extinction to a slight increase in population abundance. These effects were driven by the interaction between the temporal pattern of MFAS use, baseline movement patterns, the spatial distribution of prey, the nature of beaked whale behavioral response to MFAS and the top-down impact of whale foraging on prey abundance. Based on these findings, we provide recommendations for monitoring of marine mammal populations and highlight key uncertainties to help guide future directions for assessing population impacts of nonlethal disturbance for these and other long-lived animals.

PMID:37651444 | DOI:10.1371/journal.pone.0290819

PLoS One. 2023 Aug 31;18(8):e0291046. doi: 10.1371/journal.pone.0291046. eCollection 2023.

ABSTRACT

BACKGROUND: Hand grip strength (HGS) is related to arthritis and all-cause mortality. Many studies have examined the association between HGS and arthritis, but these studies did not consider relative HGS indices. The objectives of this study were to examine the association between arthritis and HGS indices in an older Korean population and to compare an absolute HGS index and a relative HGS indices.

METHODS: In a large-scale cross-sectional study, a total of 16,860 subjects older than 50 years from the Korea National Health and Nutrition Survey from 2014 to 2019 were included for statistical analysis. A binary logistic regression model was used to examine the association between arthritis and HGS indices in crude and covariate-adjusted models.

RESULTS: In the crude analysis, all anthropometric and HGS indices were associated with arthritis except for weight in men. In adjusted models 1 and 2, among the anthropometric indices, waist circumference (WC) and waist-to-height ratio (WHtR) were associated with arthritis in men but not in women. Absolute HGS and all relative HGS indices showed a negative association with arthritis among both men and women, and the magnitude of the association of arthritis with the absolute HGS index and the relative HGS indices was similar. However, the magnitude of the association between all HGS indices and arthritis was higher for men than for women except in the crude analysis.

DISCUSSION: Absolute and relative HGS indices had negative associations with arthritis, and the magnitude of the association between the absolute HGS index and arthritis and between the relative HGS indices and arthritis was similar in all models. To our knowledge, this is the first report of an association between arthritis and relative HGS indices, which was not observed in previous studies.

PMID:37651431 | DOI:10.1371/journal.pone.0291046

PLoS One. 2023 Aug 31;18(8):e0290334. doi: 10.1371/journal.pone.0290334. eCollection 2023.

ABSTRACT

BACKGROUND: Oral healthcare behavior leads to oral health status. Factors associated with oral healthcare behavior might affect oral hygiene in pregnant women, who are at high risk for gingivitis and dental caries. This study aimed to explore factors associated with oral healthcare behaviors during pregnancy among pregnant women in a northeastern province of Thailand.

METHOD: A total of 405 pregnant women who attended antenatal care clinics at one of the government hospitals in the province were invited to participate in this cross-sectional study. Dentists in the hospitals measured pregnant women’s gingivitis and dental calculus status using mouth mirrors and explorers. A structured questionnaire was used to obtain variables of interest. Linear regression analysis, Beta and 95% confidence interval (CI) were applied.

RESULTS: The majority were 20-24 years old (33.6%). Most of the participants had received upper secondary education (37.6%). Majority had gingivitis (88.1%) and dental calculus (88.6%). The findings revealed that age (Beta = -0.129, 95%CI = -0.269, -0.016), educational level (Beta = 0.118, 95% CI = 0.110, 0.183), and oral health literacy (Beta = 0.283, 95% CI = 0.156, 0.319) were statistically significant factors associated with oral healthcare behaviors.

CONCLUSION: Younger pregnant women had better oral healthcare behaviors than older pregnant women and pregnant women had better oral healthcare behaviors due to higher educational levels and oral health literacy. Oral health promotion should be improved through oral health literacy, and interventions should be added to improve oral care skills particularly in older pregnant women as they are at a greater risk for poor oral healthcare behaviors.

PMID:37651430 | DOI:10.1371/journal.pone.0290334

PLoS One. 2023 Aug 31;18(8):e0288383. doi: 10.1371/journal.pone.0288383. eCollection 2023.

ABSTRACT

BACKGROUND: COVID-19 has had a disproportionate impact on racial and ethnic minorities compared to White people. Studies have not sufficiently examined how sex and age interact with race/ethnicity, and potentially shape COVID-19 outcomes. We sought to examine disparities in COVID-19 outcomes by race, sex and age over time, leveraging data from Michigan, the only state whose Department of Health and Human Services (DHSS) publishes cross-sectional race, sex and age data on COVID-19.

METHODS: This is an observational study using publicly available COVID-19 data (weekly cases, deaths, and vaccinations) from August 31 2020 to June 9 2021. Outcomes for descriptive analysis were age-standardized COVID-19 incidence and mortality rates, case-fatality rates by race, sex, and age, and within-gender and within-race incidence rate ratios and mortality rate ratios. We used descriptive statistics and linear regressions with age, race, and sex as independent variables.

RESULTS: The within-sex Black-White racial gap in COVID-19 incidence and mortality decreased at a similar rate among men and women but the remained wider among men. As of June 2021, compared to White people, incidence was lower among Asian American and Pacific Islander people by 2644 cases per 100,000 people and higher among Black people by 1464 cases per 100,000 people. Mortality was higher among those aged 60 or greater by 743.6 deaths per 100,000 people vs those 0-39. The interaction between race and age was significant between Black race and age 60 or greater, with an additional 708.5 deaths per 100,000 people vs White people aged 60 or greater. Black people had a higher case fatality rate than White people.

CONCLUSION: COVID-19 incidence, mortality and vaccination patterns varied over time by race, age and sex. Black-White disparities decreased over time, with a larger effect on Black men, and Older Black people were particularly more vulnerable to COVID-19 in terms of mortality. Considering different individual characteristics such as age may further help elucidate the mechanisms behind racial and gender health disparities.

PMID:37651422 | DOI:10.1371/journal.pone.0288383

JMIR Form Res. 2023 Aug 31;7:e50346. doi: 10.2196/50346.

ABSTRACT

BACKGROUND: On December 20, 2019, the US “Tobacco 21” law raised the minimum legal sales age of tobacco products to 21 years. Initial research suggests that misinformation about Tobacco 21 circulated via news sources on Twitter and that sentiment about the law was associated with particular types of tobacco products and included discussions about other age-related behaviors. However, underlying themes about this sentiment as well as temporal trends leading up to enactment of the law have not been explored.

OBJECTIVE: This study sought to examine (1) sentiment (pro-, anti-, and neutral policy) about Tobacco 21 on Twitter and (2) volume patterns (number of tweets) of Twitter discussions leading up to the enactment of the federal law.

METHODS: We collected tweets related to Tobacco 21 posted between September 4, 2019, and December 31, 2019. A 2% subsample of tweets (4628/231,447) was annotated by 2 experienced, trained coders for policy-related information and sentiment. To do this, a codebook was developed using an inductive procedure that outlined the operational definitions and examples for the human coders to annotate sentiment (pro-, anti-, and neutral policy). Following the annotation of the data, the researchers used a thematic analysis to determine emergent themes per sentiment category. The data were then annotated again to capture frequencies of emergent themes. Concurrently, we examined trends in the volume of Tobacco 21-related tweets (weekly rhythms and total number of tweets over the time data were collected) and analyzed the qualitative discussions occurring at those peak times.

RESULTS: The most prevalent category of tweets related to Tobacco 21 was neutral policy (514/1113, 46.2%), followed by antipolicy (432/1113, 38.8%); 167 of 1113 (15%) were propolicy or supportive of the law. Key themes identified among neutral tweets were news reports and discussion of political figures, parties, or government involvement in general. Most discussions were generated from news sources and surfaced in the final days before enactment. Tweets opposing Tobacco 21 mentioned that the law was unfair to young audiences who were addicted to nicotine and were skeptical of the law’s efficacy and importance. Methods used to evade the law were found to be represented in both neutral and antipolicy tweets. Propolicy tweets focused on the protection of youth and described the law as a sensible regulatory approach rather than a complete ban of all products or flavored products. Four spikes in daily volume were noted, 2 of which corresponded with political speeches and 2 with the preparation and passage of the legislation.

CONCLUSIONS: Understanding themes of public sentiment-as well as when Twitter activity is most active-will help public health professionals to optimize health promotion activities to increase community readiness and respond to enforcement needs including education for retailers and the general public.

PMID:37651169 | DOI:10.2196/50346