Nevin Manimala

Accid Anal Prev. 2023 Sep 30;193:107307. doi: 10.1016/j.aap.2023.107307. Online ahead of print.

ABSTRACT

Identifying critical safety management drivers with high driver-level risks is essential for traffic safety improvement. Previous studies commonly evaluated driver-level risks based upon aggregated statistical characteristics (e.g., driving exposure and driving behavior), which were obtained from long-period driving monitoring data. However, given the great advancements of the connected vehicle and in-vehicle data instrumentation technologies, there has been a notable increase in the collection of short-period driving data, which has emerged as a prominent data source for analysis. In this data environment, traditionally employed aggregated behavior characteristics are unstable due to the time-varying feature of driving behavior coupled with insufficient data sampling periods. Thus, traditional modeling methods based upon aggregated statistical characteristics are no longer feasible. Instead of utilizing such unreliable statistical information to represent driver-level risks, this study employed temporal variation characteristics of driving behavior to identify critical safety management drivers in the short-period driving data environment. Specifically, the relationships between driving behavior temporal variation characteristics and individual crash occurrence probability were developed. To eliminate the impacts of drivers’ driving behavior heterogeneity on model performance, “traffic entropy” index that could quantify the abnormal degrees of driving behavior was proposed. Deep learning models including convolutional neural network (CNN) and long short-term memory (LSTM) were employed to conduct the temporal variation feature mining. Empirical analyses were conducted using data obtained from online ride-hailing services. Experiment results showed that temporal variation characteristics based models outperformed traditional aggregated statistical characteristics based models. The area under the curve (AUC) index was improved by 4.1%. And the proposed traffic entropy index further enhanced the model performance by 5.3%. The best model achieved an AUC of 0.754, comparable to existing approaches utilizing long-period driving data. Finally, applications of the proposed method in driver management program development and its further investigations have been discussed.

PMID:37783160 | DOI:10.1016/j.aap.2023.107307

Ann Diagn Pathol. 2023 Sep 28;67:152214. doi: 10.1016/j.anndiagpath.2023.152214. Online ahead of print.

ABSTRACT

There are immunohistochemistry (IHC) and immunofluorescence (IF) panels described in the literature and established by personal and institutional experiences that are in common use by pathologists in their daily practice. Stewardship is a difficult discussion because IHC utilization is influenced by many factors including the pathologist’s experience, background, practice setting, personal bias, and medicolegal culture. We developed the methodology to audit the IHC/IF utilization in our academic subspecialty practice. We aim to share this methodology and to provide our data that can be used for consideration by other subspecialized academic practices. This analysis included a total of 63,157 specimens that were accessioned during 2022, representing 38,612 cases. The likelihood of ordering IHC/IF ranged from 1 % (in genitourinary pathology) to 59 % (in renal pathology). The average percentage of specimens with IHC/IF was 21 % for the entire practice. In cases where IHC/IF was ordered, the number of stained slides averaged 4.9 per specimen for the entire practice. The number of IHC/IF slides per specimen ranged from 1.9 (in gastrointestinal pathology) to 12.2 (in renal pathology). The highest number of antibodies ordered for a single specimen by subspecialty ranged from 11 (in cardiac pathology) to 63 (in dermatopathology). Renal pathology was the only subspecialty that had an average number of IHC/IF slides that was statistically significantly different from all other subspecialties. We described the various patterns of utilization by subspecialty and rationalized their subtle differences. We also analyzed the types of cases that exceeded the reimbursement limits set by the Centers for Medicare and Medicaid Services (CMS).

PMID:37783147 | DOI:10.1016/j.anndiagpath.2023.152214

Eur J Radiol. 2023 Sep 27;168:111112. doi: 10.1016/j.ejrad.2023.111112. Online ahead of print.

ABSTRACT

PURPOSE: To assess hepatocellular carcinoma (HCC) risk after sustained virologic response (SVR) through clinical data analyses, including evaluation of liver fibrosis using the extracellular volume fraction (ECV) obtained from dual-energy computed tomography (DECT).

METHODS: Ninety-two patients (52 men and 40 women; mean age, 69.9 years) with hepatitis C virus infection after SVR underwent DECT of the liver (3-minute equilibrium-phase images) between January 2020 and March 2022. The ECV was calculated by measuring iodine density; fibrous markers, including ECV, fibrosis-4 index, aspartate aminotransferase to platelet ratio index, and platelet count, were statistically analyzed (p < 0.05). The risk factors associated with HCC were analyzed using univariate and multivariate logistic regression analyses.

RESULTS: The ECV (26.1 ± 4.6 %) in patients with HCC (n,21) was significantly larger than the ECV (20.7 ± 3.3 %) in patients without HCC (n = 71) (p < 0.001). The cutoff value for the ECV was 24.3 %. The area under the operating characteristic curve of the ECV was 0.857, which was higher than that of the serum fibrosis markers. Older age, SVR achieved with interferon, alpha-fetoprotein level (>5 ng/mL), advanced fibrosis before treatment (>F3), and ECV were associated with HCC according to the univariate analysis. Multivariate analyses showed that ECV was the only factor independently associated with HCC (odds ratio 0.619, 95 % confidence interval 0.482-0.795, p < 0.001).

CONCLUSION: Liver fibrosis estimated using ECV can be a predictive marker in patients with HCC after SVR.

PMID:37783146 | DOI:10.1016/j.ejrad.2023.111112

J Stroke Cerebrovasc Dis. 2023 Sep 30;32(11):107348. doi: 10.1016/j.jstrokecerebrovasdis.2023.107348. Online ahead of print.

ABSTRACT

BACKGROUND: Air pollutant concentrations in South Korea vary greatly by region and time. To assess temporal and spatial associations of stroke subtypes with long-term air pollution effects on stroke mortality, we studied ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH).

METHODS: This was an observational study conducted in South Korea from 2001-2018. Concentrations of carbon monoxide (CO), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), and particulate matter ≤10 µm in diameter (PM₁₀) were determined from 332 stations. Average air pollutant concentrations in each district were determined by distance-weighted linear interpolation. The nationwide stroke mortality rates in 249 districts were obtained from the Korean Statistical Information Service. Time intervals were divided into three consecutive 6-year periods: 2001-2006, 2007-2012, and 2013-2018.

RESULTS: The concentrations of air pollutants gradually decreased from 2001-2018, along with decreases in IS and ICH mortality rates. However, mortality rates associated with SAH remained constant. From 2001-2006, NO₂ (adjusted odds ratio [aOR]:1.13, 95% confidence interval: 1.08-1.19), SO₂ (aOR: 1.10, 1.07-1.13), and PM₁₀ (aOR: 1.12, 1.06-1.18) concentrations were associated with IS mortality, and SO₂ (aOR: 1.07, 1.02-1.13) and PM₁₀ (aOR:1.11,1.06-1.22) concentrations were associated with SAH-associated mortality. Air pollution was no longer associated with stroke mortality from 2007 onward, as the air pollution concentration continued to decline. Throughout the entire 18-year period, ICH-associated mortality was not associated with air pollution.

CONCLUSIONS: Considering temporal and spatial trends, high concentrations of air pollutants were most likely to be associated with IS mortality. Our results strengthen the existing evidence of the deleterious effects of air pollution on IS mortality.

PMID:37783139 | DOI:10.1016/j.jstrokecerebrovasdis.2023.107348

Environ Int. 2023 Sep 28;180:108238. doi: 10.1016/j.envint.2023.108238. Online ahead of print.

ABSTRACT

BACKGROUND: Prenatal exposure to per- and polyfluoroalkyl substances (PFAS) has been linked to low birth weight but higher childhood weight and obesity. However, little is known regarding the associations between PFAS exposure and dynamic body mass index (BMI) trajectories, particularly from birth through preadolescence.

OBJECTIVE: To evaluate the associations of cord serum PFAS concentrations with BMI trajectories from birth to age 10 years and longitudinal BMI in different periods.

METHODS: Based on 887 mother-child pairs in the longitudinal prospective birth cohort, we measured 12 PFAS congeners in cord serum and calculated BMI with anthropometric indicators at 9 follow-up time points from birth to age 10 years. The BMI trajectories were identified using group-based trajectory model (GBTM). To estimate the associations of cord serum PFAS levels with BMI trajectories and longitudinal changes in BMI, logistic regression models, linear mixed models, Bayesian kernel machine regression, and quantile-based g-computation models (QGC) were used.

RESULTS: The median concentrations of 10 PFAS congeners included in statistical analysis ranged from 0.047 to 3.623 μg/L. Two BMI trajectory classes were identified by GBTM, characterized by high group and low group. In logistic regression models, five PFAS congeners (PFBA, PFHpA, PFHxS, PFHpS, and PFDoDA) were associated with the higher probability of being in high BMI trajectory group (odds ratio, OR: 1.21 to 1.74, p < 0.05). Meanwhile, higher PFAS mixture were related to elevated odds for the high group in both BKMR models and QGC models, with PFHpA and PFHpS being the two most important drivers jointly. In the sex-stratified analysis, the positive associations remained significant exclusively among males. In the longitudinal analysis, PFUnDA and PFDoDA were associated with increased BMI from birth to age 10 years. Furthermore, PFBS and PFHpA were negatively related to BMI throughout infancy and toddlerhood (from birth to age 3 years), whereas PFDoDA confirmed a positive association with mid-childhood (from age 6 to 10 years) BMI.

CONCLUSIONS: Prenatal PFAS exposure was positively associated with BMI trajectories from birth to preadolescence and longitudinal BMI in various periods. Future research could use better trajectory modeling strategies to shape more complete growth trajectories and explore the relationship between BMI trajectories and adulthood health.

PMID:37783122 | DOI:10.1016/j.envint.2023.108238

Psychiatry Res. 2023 Sep 22;329:115483. doi: 10.1016/j.psychres.2023.115483. Online ahead of print.

ABSTRACT

Evidence on the impact of the COVID-19 pandemic on psychotic disorders is so far scarce. We conducted an incidence study to ascertain rates of first-episode psychosis (FEP) before and during the COVID-19 pandemic in South London. We screened clinical records of individuals living in the London boroughs of Southwark and Lambeth who were referred to the early intervention services before (from 1/3/2019 to 28/2/2020) and during (from 1/3/2020 to 28/2/2021) the COVID-19 pandemic. We used the Office for National Statistics to determine the population at risk. We computed crude and sex-age standardised FEP incidence per 100,000 person-years. We used Poisson regression to calculate the incidence rate ratio (IRR) across the COVID-19 pandemic. A total of 321 incident cases of FEP were identified during the COVID-19 pandemic, accounting for a crude rate of 69.8 (95% CI 62.1-77.4) per 100,000 person-years. The crude rate for the year before was 47.5 (95% CI 41.2-53.8). The incidence variation between the two years accounted for an adjusted IRR of 1.45 (95% CI 1.22-1.72). The pandemic was accompanied by a 45% spike in the rates of first-episode psychosis. This finding should inform public health research and demonstrate the need for adequate resources for secondary care.

PMID:37783096 | DOI:10.1016/j.psychres.2023.115483

J Environ Manage. 2023 Sep 30;347:119093. doi: 10.1016/j.jenvman.2023.119093. Online ahead of print.

ABSTRACT

Eutrophic lakes are a major source of the atmospheric greenhouse gas methane (CH₄), and CH₄ ebullition emissions from inland lakes have important implications for the carbon cycle. However, the spatio-temporal heterogeneity of CH₄ ebullition emission and its influencing factors in shallow eutrophic lakes of arid and semi-arid regions remain unclear. This study aimed to determine the mechanism of CH₄ emission via eutrophication in Lake Ulansuhai, a large shallow eutrophic lake in a semi-arid region of China.To this end, monthly field surveys were conducted from May to October 2021, and gas chromatography was applied using the headspace equilibrium technique with an inverted funnel arrangement. The total CH₄ fluxes ranged from 0.102 mmol m^-2 d^-1 to 59.296 mmol m^-2 d^-1 with an average value of 4.984 ± 1.82 mmol m^-2 d^-1. CH₄ ebullition emissions showed significant temporal and spatial variations. The highest CH₄ ebullition emission was observed in July with a grand mean of 9.299 mmol m^-2 d^-1, and the lowest CH₄ ebullition emissions occurred in October with an average of 0.235 mmol m^-2 d^-1. Among seven sites (S1-S7), the maximum (3.657 mmol m^-2 d^-1) and minimum (1.297 mmol m^-2 d^-1). CH₄ ebullition emissions were observed at S2 and S7, respectively. As the main route of CH₄ emission to the atmosphere in Lake Ulansuhai, the CH₄ ebullition flux during May to October accounted for 69% of the total CH₄ flux. Statistical analysis showed that CH₄ ebullition was positively correlated with temperature (R = 0.391, P < 0.01) and negatively correlated with air pressure (R = 0.286, P < 0.00). Temperature and air pressure were found to strongly regulate the production and oxidation of CH₄. Moreover, nutritional status indicators such as TP and NH₄⁺-N significantly affect CH₄ ebullition emissions (R = 0.232, P < 0.01; R = -0.241, P < 0.01). This study reveals the influencing factors of CH₄ ebullition emission in Lake Ulansuhai, and provides theoretical reference and data support for carbon emission from eutrophic lakes. Nevertheless, research on eutrophic shallow lakes needs to be further strengthened. Future research should incorporate improved flux measurement techniques with process-based models to improve the accuracy from regional to large-scale estimation of CH₄ emissions and clarify the carbon budget of aquatic ecosystems. In this manner, the understanding and predictability of CH₄ ebullition emission from shallow lakes can be improved.

PMID:37783080 | DOI:10.1016/j.jenvman.2023.119093

Epilepsy Behav. 2023 Sep 30;148:109451. doi: 10.1016/j.yebeh.2023.109451. Online ahead of print.

ABSTRACT

OBJECTIVES: Lennox-Gastaut Syndrome (LGS) and other drug-resistant epilepsy (DRE) can impact behavior, communication, and quality of life (QoL). In collaboration with community engagement efforts with the Lennox-Gastaut Syndrome Foundation (LGSF), we aimed to gain an initial snapshot of patient and family perspectives and experiences with evaluation of behavior, communication, and QoL.

METHODS: A cross-sectional survey was conducted to collect self-reported information from caregivers of children with LGS and other DRE regarding their perspectives and experiences with healthcare providers’ evaluation of behavior, communication, and QoL. The survey tool was developed by the study investigators in partnership with the LGS Foundation and had diffused to caregivers online by epilepsy advocacy groups including the Pediatric Epilepsy Surgery Alliance (PESA). Responses were analyzed. Descriptive statistics were calculated. The survey asked for caregiver perspectives and assessed which instruments the caregivers had previously been given for measuring these domains.

RESULTS: Responses from 245 caregivers were included, with 132 (54%) caregivers of an individual with LGS and 113 (46%) caregivers of an individual with non-LGS related DRE. Respondents reported that 66% of their loved ones had undergone epilepsy-related surgery. Over 90% agreed that measuring behavior, communication, and QoL was important, but fewer than half felt that their healthcare providers evaluated these domains well. LGS caregivers largely shared non-LGS caregivers’ perspectives; however, they reported more frequently that communication was not evaluated enough. Barriers to measuring these domains included a lack of good surveys (developmentally appropriate and specific to the type of epilepsy) or not receiving any survey instruments for these domains during clinic appointments. Caregivers play a crucial role for individuals with DRE, and their input is essential in identifying challenges and needs. Caregivers believe that measuring behavior, communication, and quality of life is important, and most of them feel that their loved ones are not adequately evaluated during their healthcare encounters. There is a need for appropriately scaled survey instruments to measure areas of importance for patients and caregivers, as well as incorporation of these outcomes in the healthcare discussion.

PMID:37783029 | DOI:10.1016/j.yebeh.2023.109451

Braz J Otorhinolaryngol. 2023 Sep 18;89(6):101331. doi: 10.1016/j.bjorl.2023.101331. Online ahead of print.

ABSTRACT

OBJECTIVE(S): In this study, the laryngopharynx microbiome alterations were characterized after proton pump inhibitor treatment in patients with Laryngopharyngeal Reflux Disease (LPRD) and healthy people. The potential outcome-predictive biomarker was explored.

METHODS: Patients with LPRD and healthy controls were enrolled. The composition of their laryngopharynx microbiota was analyzed both by traditional plate count of the main bacterial groups and PCR amplification followed by denaturing gradient gel electrophoresis. Shannon-Wiener index and evenness index based on Dice index were used to assess the bacterial diversity. Droplet digital PCR was used to determine the total bacterial RNA and relative abundance of Klebsiella oxytoca. Receiver operating characteristic curve was plotted to explore the potential of Klebsiella oxytoca as an outcome-predictive biomarker.

RESULTS: A total of 29 LPRD cases and 28 healthy subjects were enrolled. The composition of the laryngopharynx microbiota was almost similar, except Klebsiella oxytoca. The cluster analysis showed that the similarity between healthy and treatment-effective groups, as well as pretreatment and treatment-invalid groups, was close. Statistical analysis showed that there were differences in the diversity index and richness among the healthy, treatment-effective, pretreatment and treatment-invalid groups. The abundance of Klebsiella oxytoca in the treatment-effective LPRD group was lower than that of the treatment-invalid LPRD group. The abundance of Klebsiella oxytoca can distinguish treatment-effective and -invalid groups (AUC=0.859) with a sensitivity of 77.78% and specificity of 90.91%.

CONCLUSION: There were differences in the diversity of cecal contents microbial community between treatment-invalid and treatment-effective LPRD groups. Klebsiella oxytoca has potential to distinguish treatment outcomes.

LEVEL OF EVIDENCE: How common is the problem? Level 1. Is this diagnostic or monitoring test accurate? (Diagnosis) Level 4. What will happen if we do not add a therapy? (Prognosis) Level 5. Does this intervention help? (Treatment Benefits) Level 4. What are the COMMON harms? (Treatment Harms) Level 4. What are the RARE harms? (Treatment Harms) Level 4. Is this (early detection) test worthwhile?(Screening) Level 4.

PMID:37782990 | DOI:10.1016/j.bjorl.2023.101331

Geriatr Nurs. 2023 Sep 30;54:144-147. doi: 10.1016/j.gerinurse.2023.08.026. Online ahead of print.

ABSTRACT

PROBLEM: Acute care nurses are the front line of hospital care for persons with dementia (PwD), yet many have inadequate dementia education and lack the confidence to appropriately manage PwD in the hospital setting.

IMPLEMENTATION: Two acute care units with high rates of PwD in a large tertiary-care hospital were provided an education intervention involving interactive case-based discussion of the challenges of inpatient dementia care.

RESULTS: Out of 190 nurses, 171 completed a one-hour virtual educational session, 142 completed pre/post-session confidence surveys, and 123 completed pre/post-session knowledge tests. There was a statistically significant improvement in knowledge scores from 75.8% pre-session to 88.4% post-session (p < 0.001), and pre/post-session dementia care confidence increased from 3.49 to 4.44 ( + 27.22%; p < 0.001) CONCLUSION: An interactive virtual education intervention improves acute care nurses’ confidence and knowledge in managing PwD in the acute care setting and may improve hospital outcomes for this population.

PMID:37782977 | DOI:10.1016/j.gerinurse.2023.08.026