Nevin Manimala

JAMA Netw Open. 2023 Aug 1;6(8):e2328159. doi: 10.1001/jamanetworkopen.2023.28159.

ABSTRACT

IMPORTANCE: There are known risks of using opioids for extended periods. However, less is known about the long-term trajectories of opioid use following initiation.

OBJECTIVE: To identify 5-year trajectories of prescription opioid use, and to examine the characteristics of each trajectory group.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study conducted in New South Wales, Australia, linked national pharmaceutical claims data to 10 national and state data sets to determine sociodemographic characteristics, clinical characteristics, drug use, and health services use. The cohort included adult residents (aged ≥18 years) of New South Wales who initiated a prescription opioid between July 1, 2003, and December 31, 2018. Statistical analyses were conducted from February to September 2022.

EXPOSURE: Dispensing of a prescription opioid, with no evidence of opioid dispensing in the preceding 365 days, identified from pharmaceutical claims data.

MAIN OUTCOMES AND MEASURES: The main outcome was the trajectories of monthly opioid use over 60 months from opioid initiation. Group-based trajectory modeling was used to classify these trajectories. Linked health care data sets were used to examine characteristics of individuals in different trajectory groups.

RESULTS: Among 3 474 490 individuals who initiated a prescription opioid (1 831 230 females [52.7%]; mean [SD] age, 49.7 [19.3] years), 5 trajectories of long-term opioid use were identified: very low use (75.4%), low use (16.6%), moderate decreasing to low use (2.6%), low increasing to moderate use (2.6%), and sustained use (2.8%). Compared with individuals in the very low use trajectory group, those in the sustained use trajectory group were older (age ≥65 years: 22.0% vs 58.4%); had more comorbidities, including cancer (4.1% vs 22.2%); had increased health services contact, including hospital admissions (36.9% vs 51.6%); had higher use of psychotropic (16.4% vs 42.4%) and other analgesic drugs (22.9% vs 47.3%) prior to opioid initiation, and were initiated on stronger opioids (20.0% vs 50.2%).

CONCLUSIONS AND RELEVANCE: Results of this cohort study suggest that most individuals commencing treatment with prescription opioids had relatively low and time-limited exposure to opioids over a 5-year period. The small proportion of individuals with sustained or increasing use was older with more comorbidities and use of psychotropic and other analgesic drugs, likely reflecting a higher prevalence of pain and treatment needs in these individuals.

PMID:37561463 | DOI:10.1001/jamanetworkopen.2023.28159

JAMA Netw Open. 2023 Aug 1;6(8):e2328343. doi: 10.1001/jamanetworkopen.2023.28343.

ABSTRACT

IMPORTANCE: In 2018, Medicare removed total knee arthroplasty from the list of inpatient-only procedures, resulting in a new pool of patients eligible for outpatient total knee arthroplasty. How this change was associated with the characteristics of patients undergoing outpatient knee arthroplasty at hospital-owned surgery centers (HOSCs) vs freestanding ambulatory surgery centers (FASCs) is unknown.

OBJECTIVES: To describe the characteristics of patients undergoing outpatient, elective total and partial knee arthroplasty in 2017 and 2018 and to compare the cohorts receiving treatment at FASCs and HOSCs.

DESIGN, SETTING, AND PARTICIPANTS: This observational retrospective cohort study included 5657 patients having elective, outpatient partial and total knee arthroplasty in the Florida and Wisconsin State Ambulatory Surgery Databases in 2017 and 2018. Prior admissions were identified in the State Inpatient Database. Statistical analysis was performed from March to June 2022.

MAIN OUTCOMES AND MEASURES: Characteristics of patients undergoing surgery at a FASC vs a HOSC in 2017 and 2018 were compared.

RESULTS: A total of 5657 patients (mean [SD] age, 64.2 [9.9] years; 2907 women [51.4%]) were included in the study. Outpatient knee arthroplasties increased from 1910 in 2017 to 3747 in 2018 and were associated with an increase in total knee arthroplasties (474 in 2017 vs 2065 in 2018). The influx of patients undergoing outpatient knee arthroplasty was associated with an amplification of differences between the patients treated at FASCs and the patients treated at HOSCs. Patients with private payer insurance seen at FASCs increased from 63.4% in 2017 (550 of 867) to 72.7% in 2018 (1272 of 1749) (P < .001), while the percentage of patients with private payer insurance seen at HOSCs increased, but to a lesser extent (41.6% [427 of 1027] in 2017 vs 46.4% [625 of 1346] in 2018; P < .001). In 2017, the percentages of White patients seen at FASCs and HOSCs were similar (85.0% [737 of 867] vs 88.2% [906 of 1027], respectively); in 2018, the percentage of White patients seen at FASCs had increased and was significantly different from the percentage of White patients seen at HOSCs (90.6% [1585 of 1749] vs 87.9% [1183 of 1346]; P = .01). Both types of facilities saw an increase from 2017 to 2018 in the percentage of patients from communities of low social vulnerability, but this increase was greater for FASCs (FASCs: 6.7% [58 of 867] in 2017 vs 33.9% [593 of 1749] in 2018; HOSCs: 7.6% [78 of 1027] in 2017 vs 21.2% [285 of 1346] in 2018). Finally, while FASCs and HOSCs had cared for a similar portion of patients with prior admissions in 2017 (7.8% [68 of 867] vs 9.4% [97 of 1027], respectively; P = .25), in 2018, FASCs cared for fewer patients with prior admissions than HOSCs (4.0% [70 of 1749] vs 8.1% [109 of 1346]; P < .001).

CONCLUSIONS: This study suggests that the increase in the number of patients undergoing outpatient knee arthroplasty in 2018 corresponded to FASCs treating a greater share of patients who were White, covered by private payer insurance, and healthier. These findings raise a concern that as more operations transition to the outpatient setting, variability in access to FASCs may increase, leaving hospital-owned centers to bear a greater share of the burden of caring for more vulnerable patients with more severe illness.

PMID:37561458 | DOI:10.1001/jamanetworkopen.2023.28343

Br J Radiol. 2023 Aug 10:20230143. doi: 10.1259/bjr.20230143. Online ahead of print.

ABSTRACT

OBJECTIVE: To validate selection criteria for sublobar resection in patients with lung cancer with respect to recurrence, and to investigate predictors for recurrence in patients for whom the criteria are not suitable.

METHODS: Patients who underwent sublobar resection for lung cancer between July 2010 and December 2018 were retrospectively included. The criteria for curative sublobar resection were consolidation-to-tumor ratio ≤0.50 and size ≤3.0 cm in tumors with a ground-glass opacity (GGO) component (GGO group), and size of ≤2.0 cm and volume doubling time ≥400 days in solid tumors (solid group). Cox regression was used to identify predictors for time-to-recurrence (TTR) in tumors outside of these criteria (non-curative group).

RESULTS: Out of 530 patients, 353 were classified into the GGO group and 177 into the solid group. In the GGO group, the 2-year recurrence rates in curative and non-curative groups were 2.1 and 7.7%, respectively (p = 0.054). In the solid group, the 2-year recurrence rates in curative and non-curative groups were 0.0 and 28.6%, respectively (p = 0.03). Predictors of 2-year TTR after non-curative sublobar resection were pathological nodal metastasis (hazard ratio [HR], 6.63; p = 0.02) and lymphovascular invasion (LVI; HR, 3.28; p = 0.03) in the GGO group, and LVI (HR, 4.37; p < 0.001) and fibrosis (HR, 3.18; p = 0.006) in the solid group.

CONCLUSION: The current patient selection criteria for sublobar resection are satisfactory. LVI was a predictor for recurrence after non-curative resection.

ADVANCES IN KNOWLEDGE: This result supports selection criteria of patients for sublobar resection. LVI may help predict recurrence after non-curative sublobar resection.

PMID:37561432 | DOI:10.1259/bjr.20230143

Sch Psychol. 2023 Aug 10. doi: 10.1037/spq0000573. Online ahead of print.

ABSTRACT

This study explored the relationship between 391 third-grade students’ writing productivity and the amount of intervention dosage received over a 6-week period. In addition, the association between gender and the amount of intervention dosage received was examined. Results indicated that intervention dosage had a statistically significant relationship with students’ writing productivity at the conclusion of intervention implementation. In addition, there was not a statistically significant difference in the amount of intervention dose received between female and male students. Notably, less intervention dosage may be indicative of higher rates of school absenteeism, which is associated with adverse academic outcomes. Implications and future research directions are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:37561428 | DOI:10.1037/spq0000573

J Travel Med. 2023 Aug 10:taad107. doi: 10.1093/jtm/taad107. Online ahead of print.

ABSTRACT

BACKGROUND: Giardiasis is a common gastrointestinal illness in travellers. Data on the actual giardiasis risk of travellers to different travel destinations is scarce. We aim to estimate the risk of giardiasis in travellers from Germany by destination country and region.

METHODS: We analysed travel-related giardiasis cases, their countries and regions of exposure and the age and sex distribution of cases reported in 2014-2019 in Germany. We defined a travel-related giardiasis case as a laboratory-confirmed (i.e. positive microscopy, antigen test or nucleic acid test) symptomatic individual with outbound travel abroad within 3-25 days before symptom onset. Based on the number of reported cases per exposure country and UNWTO travel data for Germany, we calculated the number of travel-related giardiasis cases per 100 000 travellers and compared the incidence in 2014-2016 and 2017-2019 to identify potential trends.

RESULTS: In 2014-2019, 21 172 giardiasis cases were reported in Germany, corresponding to an overall incidence of 4.3 per 100 000 population. Of all cases, 6879 (32%) were travel-related with a median age of 34 (interquartile range (IQR): 25-50), 51% were male. Southern Asia was the most frequently reported exposure region and had the highest incidence in travellers (64.1 per 100 000 returning travellers) in 2017-2019, followed by Latin America (19.2) and Sub-Saharan Africa (12.9). We observed statistically significant decreasing trends for Southern Asia and Sub-Saharan Africa. Latin America was the only region with a statistically significant increasing trend.

CONCLUSIONS: Almost one-third of recent giardiasis cases in Germany were travel-related. Giardiasis incidence in travellers differs greatly depending on the destination region. Decreasing trends in many regions might be due to improvements in food hygiene or travel conditions. Our results may inform medical consultation pre and post patient’s travel.

PMID:37561417 | DOI:10.1093/jtm/taad107

Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2023 Aug 10:1-15. doi: 10.1080/19440049.2023.2240437. Online ahead of print.

ABSTRACT

In this study, direct analysis in real time high resolution mass spectrometry (DART-HRMS) was used to investigate the accurate characterisation of feed additive formulations containing coccidiostats or carotenoids. The study demonstrates the efficacy of DART-HRMS in identifying the active substances in these formulations and distinguishing between feed additives with the same active substance. The protocol for this method involves two simple steps that are extracting samples with organic solvents and measuring the extracts with DART-HRMS. The study also employs various statistical tools, including a factorial design approach, to optimise the DART-HRMS settings, and multivariate statistics, to establish classification models for feed additive formulations using nominal mass spectra. Our study demonstrates the potential of DART-HRMS in ensuring the correct identification of feed additives containing various coccidiostats or carotenoids and proposes this tool as an additional means for compliance checks with EU regulations.

PMID:37561415 | DOI:10.1080/19440049.2023.2240437

J Anim Sci. 2023 Aug 10:skad269. doi: 10.1093/jas/skad269. Online ahead of print.

ABSTRACT

Technology that facilitates estimations of individual animal dry matter intake rates in group-housed settings will improve production and management efficiencies. Estimating dry matter intake in pasture settings or facilities where feed intake cannot be monitored may benefit from predictive algorithms that use other variables as proxies. This study examined the relationships between dry matter intake (DMI), animal performance, and environmental variables. Here we determined whether a machine learning approach can predict DMI from measured water intake variables, age, sex, full body weight, and average daily gain (ADG). Two hundred and five animals were studied in a drylot setting (152 bulls for 88 days and 53 steers for 50 days). Collected data included daily DMI, water intake, daily predicted full body weights, and average daily gain using In-Pen-Weighing Positions and Feed Intake Nodes. After exclusion of 26 bulls of low-frequency breeds and one severe (greater than 3 standard deviations) outlier, the final number of animals used for modeling were 178 (125 bulls, 53 steers). Climate data were recorded at 30-minute intervals throughout the study period. Random Forest Regression (RFR) and Repeated Measures Random Forest (RMRF) were used as a machine learning approaches to develop a predictive algorithm. Repeated Measures ANOVA (RMANOVA)was used as the traditional approach. Using the RMRF method, an algorithm was constructed that predicts an animal’s DMI within 0.75 kg. Evaluation and refining of algorithms used to predict DMI in drylot by adding more representative data will allow for future extrapolation to controlled small plot grazing and, ultimately, more extensive group field settings.

PMID:37561392 | DOI:10.1093/jas/skad269

Sports Med. 2023 Aug 10. doi: 10.1007/s40279-023-01880-7. Online ahead of print.

ABSTRACT

The literature on high-intensity interval training (HIIT) contains claims that, if true, could revolutionize the science and practice of exercise. This critical analysis examines two varieties of claims: (i) HIIT is effective in improving various indices of fitness and health, and (ii) HIIT is as effective as more time-consuming moderate-intensity continuous exercise. Using data from two recent systematic reviews as working examples, we show that studies in both categories exhibit considerable weaknesses when judged through the prism of fundamental statistical principles. Predominantly, small-to-medium effects are investigated in severely underpowered studies, thus greatly increasing the risk of both type I and type II errors of statistical inference. Studies in the first category combine the volatility of estimates associated with small samples with numerous dependent variables analyzed without consideration of the inflation of the type I error rate. Studies in the second category inappropriately use the p > 0.05 criterion from small studies to support claims of ‘similar’ or ‘comparable’ effects. It is concluded that the situation in the HIIT literature is reminiscent of the research climate that led to the replication crisis in psychology. As in psychology, this could be an opportunity to reform statistical practices in exercise science.

PMID:37561389 | DOI:10.1007/s40279-023-01880-7

Ir J Med Sci. 2023 Aug 10. doi: 10.1007/s11845-023-03485-5. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Early neurological deterioration (END) in acute ischemic stroke (AIS), patients is defined as clinical worsening or recurrence during first 72 h after onset of AIS. We have conducted this study to determine the association between END and functional outcome at 3 months of onset of AIS along with associated risk factors of END in AIS cases.

METHODOLOGY: This study was conducted after approval of Institute Ethics Committee. Two hundred three consecutive patients were admitted from September 2020 to January 2022 at a tertiary care hospital. One hundred ninety patients were included in the study; patients were divided into two groups: (1) early neurological deterioration (END) and (2) non-early neurological deterioration (non-END). Patients were followed-up either telephonically or in person at approximately 3 months using modified Rankin Scale 0-6. All the clinically significant prognostic markers and p < 0.10 variables were considered significant in univariate analysis; P < 0.05 were considered statistically significant for the multivariate analysis.

RESULTS: Out of 190 cases included in the cohort 34/190 (17.8%) cases showed END with mean age (56.56 (± 16.6)) and males (20/34 (58.8%)). END was independently associated with high blood glucose at admission (OR = 1.015; P = 0.002; 95%CI = 1.005-1.024) and low serum albumin (OR = 0.208; P = 0.002; 95%CI = 0.077-0.562). Patients with END showed poor functional outcome (mRS > 2) at end of 3 months (32 (94.1%); P < 0.001) and death was also statistically significant (22 (64.7%); P < 0.001) as compared to AIS cases having non-END.

CONCLUSION: Our study showed END may be associated with poor functional outcome in AIS patients. Higher blood glucose at admission and low serum albumin may be statistically significant causing END. Future prospective cohort with larger sample size may confirm the findings.

PMID:37561387 | DOI:10.1007/s11845-023-03485-5

Bull Exp Biol Med. 2023 Aug 10. doi: 10.1007/s10517-023-05876-1. Online ahead of print.

ABSTRACT

We studied the possibility of conductometric measurement of myelokaryocyte content in the red bone marrow of mice using a hematological Abacus Junior 5 Vet analyzer (Diatron). Statistical, correlation, and regression analyses were performed to assess of the results of myelokaryocyte counting in the suspensions of mouse red bone marrow by a direct method in cytometers and by using Abacus Junior 5 Vet analyzer. It was shown that in both intact mice and animals with modelled red bone marrow hypoplasia, irrespectively of the state of hematopoiesis in representative samples, conductometric measurements of myelokaryocyte content on the Abacus analyzer with high confidence reproduced direct counting results (in different tests p=0.64-0.82, p=0.83-0.98). This indicates that myelokaryocyte counting on the Abacus Junior 5 Vet analyzer can be an acceptable alternative to counting chamber measurements in mouse samplings. However, the variability of single measurements with the Abacus Junior 5 Vet in red bone marrow suspensions is high (5%) and this has to be considered in small samples.

PMID:37561375 | DOI:10.1007/s10517-023-05876-1