Nevin Manimala

Plast Surg Nurs. 2021 Jan-Mar 01;41(1):6-17. doi: 10.1097/PSN.0000000000000360.

ABSTRACT

There is no quantitative evidence as to how plastic and aesthetic nurses perceive the value of certification. The aim of this study was to determine how certified and noncertified plastic and aesthetic registered nurses (RNs), who are members of the International Society of Plastic and Aesthetic Nurses (ISPAN), perceive the value of certification. A secondary study aim was to compare perceptions of nurses who hold a CPSN (Certified Plastic Surgical Nurse), CANS (Certified Aesthetic Nurse Specialist), or both certifications with nurses who do not hold these certifications. Upon approval of the ISPAN Board of Directors, the researchers prepared a survey. The survey collected demographic information sufficient to capture a picture of the nurses participating in the survey and to compare profiles of certified and noncertified nurses. The Perceived Value of Certification Tool (PVCT)-12 was used to obtain information about the nurses’ perceived extrinsic and intrinsic values of certification. Overall, the highest level of agreement was found with the intrinsic value statements. Across all 12 items of the PVCT-12, participants who held a CPSN and/or CANS certification reported greater perceptions of the value of the CPSN and CANS certifications than participants who did not hold a CPSN or CANS certification. Certified participants’ intrinsic and extrinsic value scores were found to be significantly higher than noncertified participants’ scores. The extrinsic value statements of the PVCT-12 were the least endorsed. Extrinsic rewards in combination with added support and recognition for nurses may be what is necessary to increase the proportion of certified nurses.

PMID:33626555 | DOI:10.1097/PSN.0000000000000360

Audiol Neurootol. 2021 Feb 24:1-8. doi: 10.1159/000512004. Online ahead of print.

ABSTRACT

BACKGROUND: In this study, optic coherence tomography (OCT) examination was performed to check whether there was any interaction between ophthalmic axonal structures in unilateral tinnitus patients, and the relationship between optic nerve thickness and cochlear nerve thickness was evaluated.

OBJECTIVE: The aim of the study was to evaluate the relatioship between hearing loss, tinnitus, and nerve thicknesses.

STUDY DESIGN: Prospective study.

SETTING: Tertiary referral university hospital.

PATIENTS: The study included 88 patients with unilateral tinnitus, for which no organic cause could be found in physical examination, psychiatric evaluation, or with imaging methods. Study groups were formed of the tinnitus side and control groups were formed of the healthy side as follows: Group 1 (Non-tinnitus side normal hearing values – n = 30), Group 2 (non-tinnitus side minimal hearing loss – n = 27), Group 3 (non-tinnitus side moderate hearing loss – n = 31), Group 4 (tinnitus side normal hearing values – n = 25), Group 5 (tinnitus side minimal hearing loss – n = 25), and Group 6 (tinnitus side moderate hearing loss – n = 38).

INTERVENTION: Retinal nerve fiber layer (RNFL) thickness was evaluated with OCT, and the cochlear nerve cross-sectional area was evaluated with MRI.

MAIN OUTCOME MEASURES: RNFL measurements were taken with OCT from the subfoveal area (RNFL-SF) and 1.5 mm temporal to the fovea (RNFL-T µm) and nasal (RNFL-N µm) sectors. On MRI, 3 measurements were taken along the nerve from the cerebellopontine angle as far as the internal auditory canal, and the mean value of these 3 measurements was calculated.

RESULTS: When the groups were evaluated in respect of cochlear nerve thickness, a significant difference was seen between Group 1 and both the groups with hearing loss and the tinnitus groups. In the subgroup analysis, a statistically significant difference was determined between Group 1 and Groups 3, 4, 5, and 6 (p = 0.013, p = 0.003, p < 0.001, and p < 0.001, respectively). When the groups were evaluated in respect of the RNFL-SF (µm), RNFL-T (µm), and RNFL-N (µm) values, the differences were determined to be statistically significant (p < 0.001 for all). In the correlation analysis, a negative correlation was determined between hearing loss and cochlear nerve diameter (r: -0.184, p = 0.014), and RNFL-N (r: -0.272, p < 0.001) and between tinnitus and cochlear nerve diameter (r: -0.536, p < 0.001), and RNFL-T (r: -0.222, p < 0.009).

CONCLUSION: The study results clearly showed a relationship between cochlear nerve fiber thickness and hearing loss and the severity of tinnitus in cases with unilateral tinnitus and that there could be neurodegenerative factors in the disease etiology. A similar relationship seen with the RNFL supports the study hypothesis.

PMID:33626543 | DOI:10.1159/000512004

Phys Med Biol. 2021 Feb 24. doi: 10.1088/1361-6560/abe956. Online ahead of print.

ABSTRACT

Integrated-type proton computed tomography (pCT) measures proton stopping power ratio (SPR) images for proton therapy treatment planning, but its image quality is degraded due to noise and scatter. Although several correction methods have been proposed, techniques that include estimation of uncertainty are limited. This study proposes a novel uncertainty-aware pCT image correction method using a Bayesian convolutional neural network (BCNN). A DenseNet-based BCNN was constructed to predict both a corrected SPR image and its uncertainty from a noisy SPR image. A total 432 noisy SPR images of 6 non-anthropomorphic and 3 head phantoms were collected with Monte Carlo simulations, while true noise-free images were calculated with known geometric and chemical components. Heteroscedastic loss and deep ensemble techniques were performed to estimate aleatoric and epistemic uncertainties by training 25 unique BCNN models. 200-epoch end-to-end training was performed for each model independently. Feasibility of the predicted uncertainty was demonstrated after applying two post-hoc calibrations and calculating spot-specific path length uncertainty distribution. For evaluation, accuracy of head SPR images and water-equivalent thickness (WET) corrected by the trained BCNN models was compared with a conventional method and non-Bayesian CNN model. BCNN-corrected SPR images represent noise-free images with high accuracy. Mean absolute error in test data was improved from 0.263 for uncorrected images to 0.0538 for BCNN-corrected images. Moreover, the calibrated uncertainty represents accurate confidence levels, and the BCNN-corrected calibrated WET was more accurate than non-Bayesian CNN with high statistical significance. Computation time for calculating one image and its uncertainties with 25 BCNN models is 0.7 seconds with a consumer grade GPU. Our model is able to predict accurate pCT images as well as two types of uncertainty. These uncertainties will be useful to identify potential cause of SPR errors and develop a spot-specific range margin criterion, toward elaboration of uncertainty-guided proton therapy.

PMID:33626513 | DOI:10.1088/1361-6560/abe956

Int J Sports Physiol Perform. 2021 Feb 24:1-8. doi: 10.1123/ijspp.2020-0029. Online ahead of print.

ABSTRACT

PURPOSE: To statistically evaluate the internal and external load metrics in different types of lacrosse drills.

METHODS: A total of 25 Division I collegiate female lacrosse players wore a heart rate monitor and a global positioning system during preseason training sessions. Seven measures determined training load, 2 internal measures and 5 external measures, across 5 different types of drills: stickwork, small-sided games, individual skills, conditioning, and team drills. Principal component analysis was used to determine which internal and external load variables were most associated with each drill type.

RESULTS: Stickwork extracted 2 principal components, explaining 45% and 17% of the variance. Small-sided games extracted 1 principal component, explaining 51% of the variance. Individual skills extracted 2 components, explaining 39% and 22% of the variance. Conditioning extracted 2 components, explaining 44% and 24% of the variance. Team drills extracted 2 components, explaining 52% and 18% of the variance.

CONCLUSIONS: In 4 out of 5 training modes, the inclusion of both internal and external training-load measures was necessary to accurately decipher training load. For most drills, the first component is related to measures of external load, and the second component described the balance between internal and external load measures. Small-sided games extracted only external measures including the following: accelerations, total distance, and average speed. These results show that a combination of internal and external load measures is required to determine training load during certain training modes. This information can help coaches make decisions about desired training load for practice sessions.

PMID:33626504 | DOI:10.1123/ijspp.2020-0029

J Sport Rehabil. 2021 Feb 24:1-6. doi: 10.1123/jsr.2020-0166. Online ahead of print.

ABSTRACT

CONTEXT: Myofascial self-release is performed using a roller to exert pressure on the soft tissues and to promote effects similar to those of traditional massage. However, there is no standardization regarding its application, mainly in relation to time.

OBJECTIVE: To evaluate the effects of myofascial self-release with a rigid roller on range of motion (ROM), pressure pain threshold (PPT), and hamstring strength in asymptomatic individuals following 2 different times of intervention.

DESIGN: Randomized, controlled, blind, clinical trial comparing preintervention and immediately postintervention within 2 groups.

SETTING: Institutional physiotherapy clinic.

PARTICIPANTS: A total of 40 university students (18-30 y), who had no symptoms, participated.

INTERVENTION: Foam roller for 30 seconds and 2 minutes for group 2.

MAIN OUTCOME MEASURES: Hamstring PPT, knee-extension ROM, and peak knee-flexion torque measured before and immediately after the intervention.

RESULTS: Both groups experienced a statistically significant increase in ROM compared with baseline (30 s and 2 min for group 2 P < .024). There were no statistically significant differences comparing peak knee-flexion torque or PPT.

CONCLUSIONS: Hamstring myofascial self-release using a roller for 30 seconds or 2 minutes produced an increase in ROM in healthy individuals. PPT and peak knee-flexion isometric torque showed no effects.

PMID:33626501 | DOI:10.1123/jsr.2020-0166

Diagn Microbiol Infect Dis. 2021 Jan 22;100(2):115308. doi: 10.1016/j.diagmicrobio.2021.115308. Online ahead of print.

ABSTRACT

In 2018, we demonstrated a decreased prevalence of the hypervirulent Clostridioides difficile BI/NAP1/027 strain across the United States (US) Veterans Health Administration (VHA) from 2011 through 2016. The objective of this retrospective study was to update the prevalence of the BI/NAP1/027 strain within the VHA from 2017 through 2020. Patients with positive tests for the presence of toxigenic C. difficile at any Veterans Affairs Medical Center found to also routinely test for BI/NAP1/027 strain presence were included between July 1, 2016 and June 30, 2020. In total, 7490 patients had 8148 positive C. difficile tests that had a corresponding BI/NAP1/027 test. Of those, there were 1031 (12.6%) presumptive positive tests for the BI/NAP1/027 strain. The overall prevalence of BI/NAP1/027 decreased from a high of 15.4% in 2017 to 8.21% in 2020. Statistically significant reductions in rates from 2017 to 2020 occurred in 4 of 9 US Census Bureau regions.

PMID:33626478 | DOI:10.1016/j.diagmicrobio.2021.115308

J Contam Hydrol. 2021 Jan 22;238:103774. doi: 10.1016/j.jconhyd.2021.103774. Online ahead of print.

ABSTRACT

In the densely urbanised Milan Metropolitan area (northern Italy), the long history of anthropogenic activities still exerts a significant pressure on groundwater resource. One of the most serious threats to the water quality of urban aquifers is attributed to diffuse contamination, which is caused by a series of unknown small sources (i.e., multiple point sources) distributed over large areas. In the study area and in many industrialised regions of the world, tetrachloroethylene [PCE], trichloroethylene [TCE] and hexavalent chromium [Cr(VI)] represent the common example of long-standing and persistent pollution in groundwater. In the Milan Metropolitan area, high levels of PCE + TCE and Cr(VI) were detected in the shallow aquifer as well as in the deep aquifer. To assess and map the shallow and deep aquifers susceptibility to PCE + TCE and Cr(VI) contamination at a regional scale, the Weights of Evidence modelling technique has been applied. This method has been used to objectively evaluate the spatial correlation between the high presence of these pollutants in each aquifer and hydrogeological and land use factors that can potentially influence the contamination. Moreover, the results allowed us to quantify on a large scale the effect that preferential flowpaths, due to both thickness variation in the aquitard and the areal density of multi aquifer wells, have in reducing the protection of the underlying deep aquifer. The end-products of the study constitute a key tool to be used by water-resource managers and decision-makers for the improvement of groundwater management and protection strategies.

PMID:33626464 | DOI:10.1016/j.jconhyd.2021.103774

Gait Posture. 2021 Feb 13;85:258-265. doi: 10.1016/j.gaitpost.2021.02.004. Online ahead of print.

ABSTRACT

BACKGROUND: Several multi-segment foot models have been developed to evaluate foot and ankle motion using skin-marker motion analysis. However, few multi-segment models have been evaluated against a reference standard to establish kinematic accuracy.

RESEARCH QUESTION: How accurately do skin-markers estimate foot and ankle motion for the modified Shriners Hospitals for Children Greenville (mSHCG) multi-segment foot model when compared against the reference standard, dual fluoroscopy (DF), during gait, in asymptomatic participants?

METHODS: Five participants walked overground as full-body skin-marker trajectory data and DF images of the foot and shank were simultaneously acquired. Using the mSHCG model, ankle and midfoot angles were calculated throughout stance for both motion analysis techniques. Statistical parametric mapping assessed differences in joint angles and marker positions between skin-marker and DF motion analysis techniques. Paired t tests, and linear regression models were used to compare joint angles and range of motion (ROM) calculated from the two techniques.

RESULTS: In the coronal plane, the skin-marker model significantly overestimated ROM (p = 0.028). Further, the DF model midfoot ROM was significantly positively related to differences between DF and skin-marker midfoot angles (p = 0.035, adjusted R² = 0.76). In the sagittal plane, skin-markers underestimated ankle angles by as much as 7.26°, while midfoot angles were overestimated by as much as 9.01°. However, DF and skin-marker joint angles were not significantly different over stance. Skin-markers on the tibia, calcaneus, and fifth metatarsal had significantly different positions than the DF markers along the direction of walking for isolated portions that were less than 10 % of stance. Euclidean distances between DF and skin-markers positions were less than 9.36 mm.

SIGNIFICANCE: As the accuracy of the mSHCG model was formerly unknown, the results of this study provide ranges of confidence for key angles calculated by this model.

PMID:33626450 | DOI:10.1016/j.gaitpost.2021.02.004

J Pharm Biomed Anal. 2021 Feb 10;197:113961. doi: 10.1016/j.jpba.2021.113961. Online ahead of print.

ABSTRACT

Epilepsy is one of the most prevalent neurological disorders, affecting approximately 1% of the world population. Despite the availability of dozens of antiepileptic drugs (AEDs) in clinical practice, the number of patients who do not respond to treatment and/or exhibit high pharmacokinetic variability remains significant, highlighting the importance of therapeutic drug monitoring (TDM). Plasma and serum are the main biological matrices applied for the TDM of AEDs, but the necessity of a specialized professional has been an obstacle to sample collection in ambulatory. Thus, drug quantification in saliva arises as a promising alternative. Herein, a novel highperformance liquid chromatographic (HPLC) technique with diode-array detection (DAD) was developed and fully validated, in order to simultaneously quantify carbamazepine, carbamazepine-10,11-epoxide, S-licarbazepine, lacosamide and levetiracetam in human saliva. The technique was linear in the following concentration ranges: 0.2-6 mg L^-1 for carbamazepine and carbamazepine-10,11-epoxide; 0.3-9 mg L^-1 for S- licarbazepine; 1-30 mg L^-1 for lacosamide; and 0.8-24 mg L^-1 for levetiracetam. The lower limits of the established calibration ranges are below therapeutic margins, attesting a sensitive drug quantification. Accuracy values ranged from -14.76 to 9.35 % and -12.87 and 11.18 % in intra-day and inter-day analysis, respectively. Intra-day values of precision varied between 3.45-10.76% and inter-day values ranged from 3.85 to 13.05 %. This method was subsequently applied to saliva samples of epileptic patients admitted to the Refractory Epilepsy Centre of Centro Hospitalar e Universitário de Coimbra (CHUC EPE, Coimbra). The results of saliva samples were correlated with drug concentrations in plasma from the same patients. Statistically significant correlations were observed (p < 0.05) for carbamazepine (r² = 0.6887; r = 0.8299), carbamazepine-10,11-epoxide (r² = 0.8633; r = 0.9291), S-licarbazepine (r² = 0.5266; r = 0.7257) and levetiracetam (r² = 0.7103; r = 0.8428). Our data support that this method can be used in TDM of AEDs using human saliva samples, constituting a new approach to establish individual therapeutic ranges and assess patient’s adherence to treatment.

PMID:33626445 | DOI:10.1016/j.jpba.2021.113961

Pregnancy Hypertens. 2021 Feb 14;24:13-21. doi: 10.1016/j.preghy.2021.02.001. Online ahead of print.

ABSTRACT

Hypertensive disorders in pregnancy (HDP) are associated with various maternal and fetal adverse outcomes and become an increasingly significant threat to Chinese pregnant women. Yet, the prevalence of HDP in China is not clear. We conducted this meta-analysis to estimate the prevalence of HDP and specific subtypes in China. We searched PubMed, Embase, Web of Science, CNKI, Wangfang, and CMB for studies on prevalence of HDP and specific subtypes, published from 1990 to Jan 21, 2020, without language restrictions. We included all studies reported the prevalence of HDP and specific subtypes in Chinese pregnant women. We excluded qualitative studies, case reports, reviews, conference presentations, and studies only provided abstracts. We using a standard self-developed form to extract information from eligible studies. We did meta-analyses by random-effect models and estimated the pooled prevalence of HDP and specific subtypes. In order to explore potential sources of heterogeneity and subgroup effects, we did and meta-regression and subgroup analyses by pre-specified covariates. This study is registered with PROSPERO, number CRD42020166001. We initially identified 4179 records, of which 92 studies with 1,377,448 participants were eligible in the final systematic review and meta-analyses. The pooled prevalence (95% CI) of HDP, gestational hypertension, preeclampsia, mild preeclampsia, severe preeclampsia, eclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia were 7.30% (6.60%-8.00%), 3.30% (2.90%-3.70%), 4.50% (4.00%-5.00%), 2.00% (1.70%-2.30%), 2.60% (2.10%-3.00%), 0.11% (0.08%-0.15%), 0.60% (0.30%-0.90%), and 0.60% (0.40%-0.80%), respectively. No publication bias was identified, although heterogeneity was high (I² statistics: 92.0%-99.3%). High prevalence of HDP and the subtypes frequently reported in Western and Northern China. Pregnant women who were aged 35 years and above had high prevalence of HDP and subtypes; women who were overweight or obese had high prevalence of HDP, gestational hypertension and preeclampsia. The prevalence of HDP and the subtypes vary in different areas in China. Given to increasingly prevalent of the risk factors, such as overweight, obesity, and advance maternal age, strategies to prevent and manage HDP need to be improved, especially for women living in Western and Northern China.

PMID:33626437 | DOI:10.1016/j.preghy.2021.02.001