Nevin Manimala

Sci Adv. 2023 Apr 14;9(15):eade4083. doi: 10.1126/sciadv.ade4083. Epub 2023 Apr 12.

ABSTRACT

In language, grammatical dependencies often hold between items that are not immediately adjacent to each other. Acquiring these nonadjacent dependencies is crucial for learning grammar. However, there are potentially infinitely many dependencies in the language input. How does the infant brain solve this computational learning problem? Here, we demonstrate that while rudimentary sensitivity to nonadjacent regularities may be present relatively early, robust and reliable learning can only be achieved when convergent statistical and perceptual, specifically prosodic cues, are both present, helping the infant brain detect the building blocks that form a nonadjacent dependency. This study contributes to our understanding of the neural foundations of rule learning that pave the way for language acquisition.

PMID:37043570 | DOI:10.1126/sciadv.ade4083

Clin Orthop Relat Res. 2023 Apr 12. doi: 10.1097/CORR.0000000000002649. Online ahead of print.

ABSTRACT

BACKGROUND: Advanced practice professionals, including physician assistants (PAs) and nurse practitioners (NPs), play an important role in providing high-quality orthopaedic care. This role has been highlighted by projections of nationwide shortages in orthopaedic surgeons, with rural areas expected to be most affected. Given that approximately half of rural counties have no practicing orthopaedic surgeons and that advanced practice professionals have been shown to be more likely to practice in rural areas compared to physicians in other medical disciplines, orthopaedic advanced practice professionals may be poised to address orthopaedic care shortages in rural areas, but the degree to which this is true has not been well characterized.

QUESTIONS/PURPOSES: (1) What percentage of rural counties have no orthopaedic caregivers, including surgeons and advanced practice professionals? (2) Is the density of advanced practice professionals greater than that of orthopaedic surgeons in rural counties? (3) Do orthopaedic advanced practice professionals only practice in counties that also have practicing orthopaedic surgeons? (4) Are NPs in states with full practice authority more likely to practice in rural counties compared with NPs in restricted practice authority states?

METHODS: We identified orthopaedic surgeons and advanced practice professionals using the 2019 Medicare Provider Utilization and Payment Data, as this large dataset has been shown to be the most complete source of claims data nationwide. Each professional’s ZIP Code was matched to counties per the US Postal Service ZIP Code Crosswalk Files. The total number and density of physician and advanced practice professionals per 100,000 residents were calculated per county nationwide. Counties were categorized as urban (large central metropolitan, large fringe metropolitan, medium metropolitan, and small metropolitan) or rural (micropolitan and noncore) using the National Center for Health Statistics Urban-Rural Classification Scheme. Comparisons between rural and urban county caregivers were conducted with the chi-square test and odds ratios. Population densities were compared with the Wilcoxon rank sum test. A bivariate density map was made to visualize the nationwide distribution of orthopaedic caregivers and determine the percentage of rural counties with no orthopaedic caregivers as well as whether orthopaedic advanced practice professionals practiced in counties not containing any surgeons. Additionally, to compare states with NP’s full versus restricted practice authority, each NP was grouped based on their state to determine whether NPs in states with full practice authority were more likely to practice in rural counties. We identified a group of 31,091 orthopaedic caregivers, which was comprised of 23,728 physicians, 964 NPs, and 6399 PAs (7363 advanced practice professionals). A total of 88% (20,879 of 23,728) of physicians and 87% (6427 of 7363) of advanced practice professionals were in urban counties, which is comparable to nationwide population distributions.

RESULTS: A total of 39% (1237 of 3139) of counties had no orthopaedic professionals (defined as orthopaedic surgeons or advanced practice professionals) in 2019. Among these counties, 82% (1015 of 1237) were rural and 18% (222 of 1237) were urban. The density of advanced practice professionals providing orthopaedic services compared with the density of orthopaedic surgeons was higher in rural counties (18 ± 70 versus 8 ± 40 per 100,000 residents; p = 0.001). Additionally, 3% (57 of 1974) of rural and 1% (13 of 1165) of urban counties had at least one orthopaedic advanced practice professional, but no orthopaedic surgeons concurrently practicing in the county. There was no difference between the percentage of rural counties with an NP in states with full versus restricted practice authority for NPs (19% [157 of 823] versus 26% [36 of 141], OR 1.45 [95% CI 0.99 to 2.2]; p = 0.08).

CONCLUSION: As advanced practice professionals tended to only practice in counties which contain orthopaedic surgeons, our analysis suggests that plans to increase the number of advanced practice professionals alone in rural counties may not be sufficient to fully address the demand for orthopaedic care in rural areas that currently do not have orthopaedic surgeons in practice. Rather, interventions are needed to encourage more orthopaedic surgeons to practice in rural counties in collaborative partnerships with advanced practice professionals. In turn, rural orthopaedic advanced practice professionals may serve to further extend the accessibility of these surgeons, but it remains to be determined what the total number and ratio of advanced practice professionals and surgeons is needed to serve rural counties adequately.

CLINICAL RELEVANCE: To increase rural orthopaedic outreach, state legislatures may consider providing financial incentives to hospitals who adopt traveling clinic models, incorporating advanced practice professionals in these models as physician-extenders to further increase the coverage of orthopaedic care. Furthermore, the creation of more widespread financial incentives and programs aimed at expanding the experience of trainees in serving rural populations are longer-term investments to foster interest and retention of orthopaedic caregivers in rural settings.

PMID:37043552 | DOI:10.1097/CORR.0000000000002649

Health Promot Chronic Dis Prev Can. 2023 Apr;43(4):191-198. doi: 10.24095/hpcdp.43.4.04.

ABSTRACT

INTRODUCTION: In adults, chronic exposure to air pollution is associated with elevated blood pressure, but few studies have examined this relationship in youth. We investigated the association between annual ambient concentrations of air pollutants (fine particulate matter [PM2.5] and nitrogen dioxide [NO2]) and systolic blood pressure (SBP) among adolescents in Montréal, Canada.

METHODS: Participants were students aged 15 to 17 years who provided SBP and residential postal code data in 2004/05 through their enrolment in the Nicotine Dependence in Teens study. Annual estimates for 2004 of residential exposure to NO2 and PM2.5 were provided by the Canadian Urban Environmental Health Research Consortium and linked to participants’ residential postal code. Elevated SBP was defined as SBP ≥ 90th percentile adjusted for age, sex and height. Logistic regression was used to estimate odds ratios and 95% confidence intervals (CIs) for each pollutant with respect to elevated SBP, adjusted for relevant confounders.

RESULTS: The sample consisted of 508 adolescents (mean age: 16.9, 46% male); 4% had elevated SBP. Although estimates were not statistically significant, there were generally modest positive associations between pollutant levels and SBP. The adjusted prevalence odds ratio of elevated SBP was 1.33 (95% CI: 0.64, 3.05) for every interquartile range (IQR) increase in residential PM2.5 levels (2.1μg/m3). Similarly, the adjusted prevalence odds ratio of elevated SBP was 1.17 (95% CI: 0.47, 2.70) for every IQR increase in residential NO2 levels (10.2 ppb).

CONCLUSION: Findings support a possible relationship between exposure to air pollutants and increased SBP in adolescents, warranting further investigation for this important public health concern.

PMID:37043547 | DOI:10.24095/hpcdp.43.4.04

Proc Natl Acad Sci U S A. 2023 Apr 18;120(16):e2218329120. doi: 10.1073/pnas.2218329120. Epub 2023 Apr 12.

ABSTRACT

Coevolution at the gene level, as reflected by correlated events of gene loss or gain, can be revealed by phylogenetic profile analysis. The optimal method and metric for comparing phylogenetic profiles, especially in eukaryotic genomes, are not yet established. Here, we describe a procedure suitable for large-scale analysis, which can reveal coevolution based on the assessment of the statistical significance of correlated presence/absence transitions between gene pairs. This metric can identify coevolution in profiles with low overall similarities and is not affected by similarities lacking coevolutionary information. We applied the procedure to a large collection of 60,912 orthologous gene groups (orthogroups) in 1,264 eukaryotic genomes extracted from OrthoDB. We found significant cotransition scores for 7,825 orthogroups associated in 2,401 coevolving modules linking known and unknown genes in protein complexes and biological pathways. To demonstrate the ability of the method to predict hidden gene associations, we validated through experiments the involvement of vertebrate malate synthase-like genes in the conversion of (S)-ureidoglycolate into glyoxylate and urea, the last step of purine catabolism. This identification explains the presence of glyoxylate cycle genes in metazoa and suggests an anaplerotic role of purine degradation in early eukaryotes.

PMID:37043529 | DOI:10.1073/pnas.2218329120

PLoS One. 2023 Apr 12;18(4):e0284339. doi: 10.1371/journal.pone.0284339. eCollection 2023.

ABSTRACT

Efforts to develop a range of HIV prevention products that can serve as behaviorally congruent viable alternatives to consistent condom use and oral pre-exposure prophylaxis (PrEP) remain crucial. MTN-035 was a randomized crossover trial seeking to evaluate the safety, acceptability, and adherence to three placebo modalities (insert, suppository, enema) prior to receptive anal intercourse (RAI). If participants had no RAI in a week, they were asked to use their assigned product without sex. We hypothesized that the modalities would be acceptable and safe for use prior to RAI, and that participants would report high adherence given their behavioral congruence with cleansing practices (e.g., douches and/or enemas) and their existing use to deliver medications (e.g., suppositories; fast-dissolving inserts) via the rectum. Participants (N = 217) were sexual and gender minorities enrolled in five different countries (Malawi, Peru, South Africa, Thailand, and the United States of America). Mean age was 24.9 years (range 18-35 years). 204 adverse events were reported by 98 participants (45.2%); 37 (18.1%) were deemed related to the study products. The proportion of participants reporting “high acceptability” was 72% (95%CI: 65% – 78%) for inserts, 66% (95%CI: 59% – 73%) for suppositories, and 73% (95%CI: 66% – 79%) for enemas. The proportion of participants reporting fully adherent per protocol (i.e., at least one use per week) was 75% (95%CI: 69% – 81%) for inserts, 74% (95%CI: 68% – 80%) for suppositories, and 83% (95%CI: 77% – 88%) for enemas. Participants fully adherent per RAI-act was similar among the three products: insert (n = 99; 58.9%), suppository (n = 101; 58.0%) and enema (n = 107; 58.8%). The efficacy and effectiveness of emerging HIV prevention drug depends on safe and acceptable delivery modalities that are easy to use consistently. Our findings demonstrate the safety and acceptability of, and adherence to, enemas, inserts, and suppositories as potential modalities through which to deliver a rectal microbicide.

PMID:37043527 | DOI:10.1371/journal.pone.0284339

PLoS One. 2023 Apr 12;18(4):e0284252. doi: 10.1371/journal.pone.0284252. eCollection 2023.

ABSTRACT

BACKGROUND: Household food insecurity is a major public health problem in Ethiopia despite the presence of various interventions implemented by the government. However, there is a dearth of evidence regarding the prevalence and responsible factors in Ethiopia, specifically in the South Ari district. This study, therefore, aimed to assess household food insecurity and associated factors in South Ari district, Southern Ethiopia.

METHODS: A community-based cross-sectional study was employed from March 11 to April 11, 2021, at South Ari district, Southern Ethiopia. A two-stage sampling technique was used to draw a sample of 717 households. Data were checked and entered into Epi-Data V3.2., and exported to SPSS V25.0 for data exploration and analysis. Variables with a p-value <0.25 in bivariable logistic regression were candidates for multivariable logistic regression. Multivariable logistic regression analysis was fitted to determine factors associated with household food insecurity. Hosmer-Lemeshow goodness-of-fit statistic was used to check model fitness and was satisfied. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to determine the strength of association. P-value <0.05 was used to declare statistical significance.

RESULT: The prevalence of household food insecurity was 44.8% (95% CI: 41.1%, 48.5%). Larger family size (8 and above) (AOR = 1.91, 95% CI: 1.10, 3.30), high dependency ratio (AOR = 2.71, 95% CI: 1.67, 4.40), medium dependency ratio (AOR = 1.72, 95% CI: 1.13, 2.62), poor wealth index (AOR = 2.30, 95% CI: 1.53, 3.46), not using agricultural extension service (AOR = 2.25, 95% CI: 1.57, 3.23), and non-beneficiary of productive safety net program (AOR = 1.71, 95% CI: 1.01, 2.87) were factors significantly associated with household food insecurity.

CONCLUSIONS: The findings of this study showed a significant proportion of households were food insecure in South Ari District. Larger family size, high and medium dependency ratio, poor wealth index, not using agricultural extension service, and non-beneficiary of productive safety net program were significant risk factors associated with household food insecurity. Therefore, rigorous work is highly needed to enhance income-generating activities, strengthen agricultural productivity, expand the productive safety net program, and limit population pressure through improved family planning use.

PMID:37043521 | DOI:10.1371/journal.pone.0284252

PLoS One. 2023 Apr 12;18(4):e0281043. doi: 10.1371/journal.pone.0281043. eCollection 2023.

ABSTRACT

Smart contracts (SC) are software programs that reside and run over a blockchain. The code can be written in different languages with the common purpose of implementing various kinds of transactions onto the hosting blockchain. They are ruled by the blockchain infrastructure with the intent to automatically implement the typical conditions of traditional contracts. Programs must satisfy context-dependent constraints which are quite different from traditional software code. In particular, since the bytecode is uploaded in the hosting blockchain, the size, computational resources, interaction between different parts of the program are all limited. This is true even if the specific programming languages implement more or less the same constructs as that of traditional languages: there is not the same freedom as in normal software development. The working hypothesis used in this article is that Smart Contract specific constraints should be captured by specific software metrics (that may differ from traditional software metrics). We tested this hypothesis on 85K Smart Contracts written in Solidity and uploaded on the Ethereum blockchain. We analyzed Smart Contracts from two repositories “Etherscan” and “Smart Corpus” and we computed the statistics of a set of software metrics related to Smart Contracts and compared them to the metrics extracted from more traditional software projects. Our results show that generally, Smart Contract metrics have more restricted ranges than the corresponding metrics in traditional software systems. Some of the stylized facts, like power law in the tail of the distribution of some metrics, are only approximate but the lines of code follow a log-normal distribution which reminds us of the same behaviour already found in traditional software systems.

PMID:37043512 | DOI:10.1371/journal.pone.0281043

PLoS One. 2023 Apr 12;18(4):e0282240. doi: 10.1371/journal.pone.0282240. eCollection 2023.

ABSTRACT

BACKGROUND: As adolescence is a transition period from childhood to adulthood malnutrition occurring at this age resonates through generations. Although there were many individual studies in Ethiopia about different form of malnutrition among adolescent, their results are inconclusive indicating the need for generating a pooled estimate of adolescent nutritional status and associated factors. This review and meta-analyses aimed at estimating the pooled prevalence of different forms of malnutrition and associated factors among adolescents in Ethiopia.

METHOD AND MATERIALS: We searched data bases from Pub Med, Cochrane Library, Health Inter Network Access to Research Initiative (HINARI), Science Direct and search engines; Google and Google Scholar and other sources; Reference of References and expert contact which were used to select the studies. Joanna Briggs Institute (JBI) quality appraisal tool was applied to identify eligible studies. STATA/SE V.14 was used to analyze the data. Effect size with 95% Confidence Interval (CI) and heterogeneity were estimated. Heterogeneity of studies was quantified with I2 statistic >50% used as an indicator of heterogeneity. Potential publication bias was assessed using Funnel plots and Egger’s regression test. Trim and fill analysis was also performed. The presences of a statistical association between independent and dependent variables were declared at P <0.05. The PROSPERO registration number for the review is CRD42020159734.

RESULTS: The pooled prevalence of overweight/obesity, stunting and thinness were 10.63% (95% CI: 8.86, 12.40), 20.06% (95% CI: 15.61, 24.51) and 21.68% (95% CI: 9.56, 33.81), respectively. Being female (OR: 2.02, CI: 1.22-3.34), low dietary diversity score (OR: 2.26 CI: 1.28-3.99) and high physical activity (OR: 0.36, 95%CI: 0.14-0.88) were significantly associated with adolescent overweight/obesity. Urban residence (OR: 0.82, 95%CI: 0.68-0.99), protected drinking water source (OR: 0.50, CI: 0.27-0.90) and having family size<5 people (OR: 0.54, CI: 0.44-0.66) were independent predictors of adolescent stunting. Early adolescent age (10-14 years) (OR: 2.38, CI: 1.70-3.34), protected water source for drinking (OR: 0.36, CI: 0.21-0.61), low wealth index (OR: 1.80, CI: 1.01-3.19) and family size <5 people (OR: 0.50, CI: 0.28-0.89) were significantly (P < 0.05) associated with adolescent thinness.

CONCLUSION: The prevalence of overweight/obesity, stunting and thinness are high in Ethiopian adolescents indicating the upcoming challenge of double burden of malnutrition. The results imply the presence of double burden of malnutrition among adolescents which heralds the need for programmatic and policy response in terms of addressing modifiable risk factors including: dietary practices, physical activity, water source and economic status of these adolescents.

PMID:37043492 | DOI:10.1371/journal.pone.0282240

PLoS One. 2023 Apr 12;18(4):e0283327. doi: 10.1371/journal.pone.0283327. eCollection 2023.

ABSTRACT

BACKGROUND: Parentally bereaved children are at increased risk of negative consequences, and the mediating factors most consistently identified are found to be related to family function after the loss, including cohesion. However, existing evidence is limited, especially with respect to children and youths’ own perception of family cohesion and its long-term effects on health and well-being. Therefore, the aim of this study was to investigate self-reported family cohesion the first year after the loss of a parent to cancer and its association to long-term psychological health and well-being among young adults that were bereaved during their teenage years.

METHOD AND PARTICIPANTS: In this nationwide population-based study, 622 of 851 (73%) young adults (aged 18-26) responded to a study-specific questionnaire six to nine years after losing a parent to cancer at the age of 13 to 16. Associations were assessed with modified Poisson regression.

RESULTS: Bereaved youth that reported poor family cohesion the first year after losing a parent to cancer had a higher risk of reporting symptoms of moderate to severe depression six to nine years after the loss compared to those reporting good family cohesion. They also had a higher risk of reporting low levels of well-being, symptoms of anxiety, problematic sleeping and emotional numbness once a week or more at the time of the survey. These results remained statistically significant after adjusting for a variety of possible confounding factors.

CONCLUSION: Self-reported poor family cohesion the first year after the loss of a parent to cancer was strongly associated with long-term negative psychological health-related outcomes among bereaved youth. To pay attention to family cohesion and, if needed, to provide support to strengthen family cohesion in families facing bereavement might prevent long-term suffering for their teenage children.

PMID:37043474 | DOI:10.1371/journal.pone.0283327

PLoS One. 2023 Apr 12;18(4):e0284171. doi: 10.1371/journal.pone.0284171. eCollection 2023.

ABSTRACT

This study calls into question the default computation of the disposition effect that uses the average purchase price as a reference point. We show, through a lab experiment, that the reference price of participants can change depending on the experimental behavioral design that is used. Our results show that for the control group, different reference prices do not show significant differences in the computation of the disposition effect, thus supporting the use of the average purchase price as a reference. However, this is not the case for participants in the treatment group. With the addition of experimental treatment concerning the disclosure of the final balance of the participants, the reference prices to compute the disposition effect showed statistically significant differences. The need to display their results caused these participants to use the first purchase price as a reference point when selling their assets.

PMID:37043473 | DOI:10.1371/journal.pone.0284171