Nevin Manimala

Int J Numer Method Biomed Eng. 2021 Dec 4:e3560. doi: 10.1002/cnm.3560. Online ahead of print.

ABSTRACT

Because of retina abnormalities of diabetic patients, the most common vision-threatening disease is Diabetic retinopathy (DR). The diabetic retinopathy diagnosis and prevention is the challenging task it may lead to vision loss. According to the literature analysis, the shortcomings in existing studies such as failed to reduce the feature dimension, higher execution time and higher computational cost, unable to tune the hyper-parameters such as a number of hidden layers and learning rate, more computational complexities, higher cost and etc during DR classification. To tackle these problems, we proposed a Deep long and short term memory (LSTM) in a neural network with Red Fox Optimization (Deep LSTM-RFO) algorithm for DR classification. The four major components involved in the proposed methods are image pre-processing, segmentation, feature extraction and classification. At first, an adaptive histogram equalization (CLAHE) and histogram equalization (HE) model performs the fundus image pre-processing thereby neglecting the noise and improving the contrast level of an image. Next, an adaptive watershed segmentation model effectively segments the lesion region based on the optic disc color and size of hemorrhages. At the third stage, we have extracted statistical, intensity, color and shape features. Finally, the single normal class with three abnormal classes such as mild Non-proliferative diabetic retinopathy (M-NPDR), moderate NPDR (Mo-NPDR) and severe NPDR (S-NPDR) are accurately classified using the Deep LSTM-RFO algorithm. Experimentally, the MESSIDOR, STARE and DRIVE datasets are the datasets used for both training and validation. MATLAB software performs the implementation process with respect to various evaluation criteria used. However, the proposed method accomplished superior performance such as 98.45% specificity, 96.78% sensitivity, 97.92% precision, 96.89% recall, 97.93% F-score results in terms of DR classification than previous methods. This article is protected by copyright. All rights reserved.

PMID:34865312 | DOI:10.1002/cnm.3560

J Cosmet Dermatol. 2021 Dec 5. doi: 10.1111/jocd.14643. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this investigation was to create and validate 5-point photonumeric scales for the assessment of dynamic crow’s feet, static crow’s feet, and infraorbital hollows.

MATERIAL AND METHODS: Three novel 5-point photonumeric scales were created by a medical team. A total of 12 raters from all over the world performed a digital validation, and a total of 5 raters a live validation of the created scale.

RESULTS: The statistical analysis revealed almost perfect intra-rater and inter-rater reliability in the digital validation of the scales for the assessment of static and dynamic crow’s feet as well as infraorbital hollows. In the live validation, both crow’s feet scales showed almost perfect intra-rater reliability, while the Croma Infraorbital Hollow Assessment Scale showed substantial intra-rater reliability. Inter-rater reliability was substantial for all three scales in the live validation. All three scales, the Croma Dynamic Crow’s Feet Assessment Scale, Croma Static Crow’s Feet Assessment Scale, and Croma Infraorbital Hollow Assessment Scale, were validated digitally and in a live setting.

CONCLUSION: The created scales to assess infraorbital hollowing, dynamic and static crow’s feet have been shown to provide substantial to almost perfect agreement in the digital and live validation and can thus be considered as helpful tools in the clinical and research setting. While technical methods and appliances to assess the degrees of severity of age-dependent features are advancing, validated scales are of great importance due to their ease of use and, as shown by the validations, reliability, and reproducibility.

PMID:34865301 | DOI:10.1111/jocd.14643

J Eval Clin Pract. 2021 Dec 5. doi: 10.1111/jep.13642. Online ahead of print.

ABSTRACT

RATIONALE, AIMS AND OBJECTIVES: Increased incidence of chronic illnesses coupled with physician shortages have yielded strain on primary care provider (PCP) to meet care demands. Interdisciplinary providers have increasingly been embedded into primary care teams to alleviate some workload demand. Little evidence exists about the impact of interdisciplinary PCP care delivery models on provider strain in primary care. To determine the impact of interdisciplinary PCP care delivery on burnout, job satisfaction and intention to leave current position.

METHODS: We conducted a cross-sectional mail survey using Dillman methodology of primary care practices (e.g., internal medicine) across New York State. A random sample of interdisciplinary PCPs (physicians, nurse practitioners, and physician assistants) (n = 333) responded. The Provider Comanagement Index (α = 0.85) was used to measure how well interdisciplinary dyads comanagement care delivery attributes (effective communication; mutual respect and trust; shared philosophy of care). Provider outcomes were measured with validated Agency for Healthcare Research and Quality and Health Resources and Services Administration items for burnout, job satisfaction and intention to leave position. Descriptive statistics, logistic regression models, crude and adjusted odds ratios were calculated, controlling for participant and practice characteristics.

RESULTS: Almost 30% of participants reported burnout with three times the odds of intending to leave their current position within 1 year. With each unit increase in effective comanagement between interdisciplinary dyads there was 15% less burnout and 10% less odds of intention to leave position.

CONCLUSION: Incorporating interdisciplinary specialties in primary care appears promising to alleviate some adverse provider outcomes. Organizations contemplating delivery models to promote well-being and retention may consider comanagement. Cost effectiveness research is needed to determine financial sustainability of interdisciplinary care delivery.

PMID:34865285 | DOI:10.1111/jep.13642

Trop Med Int Health. 2021 Dec 5. doi: 10.1111/tmi.13701. Online ahead of print.

ABSTRACT

OBJECTIVE: High-quality healthcare is essential to ensuring maternal and newborn survival. Efficient measurement requires knowing how long measures of quality provide consistent insight for intended uses.

METHODS: We used a repeated health facility assessment in Senegal to calculate structural and process quality of antenatal care (ANC), delivery, and child health services in facilities assessed 2 years apart. We tested agreement of quality measures within facilities and regions. We estimated how much input-adjusted and process quality-adjusted coverage measures changed for each service when calculated using quality measurements from the same facilities measured 2 years apart.

RESULTS: Over 6 waves of continuous surveys, 628 paired assessments were completed. Changes at the facility level were substantial and often positive, but inconsistent. Structural quality measures were moderately correlated (0.40 – 0.69) within facilities over time, more so in hospitals; correlation was <0.20 for process measures based on direct observation of ANC and child visits. Most measures were more strongly correlated once averaged to regions; process quality of child services was not (-0.32). Median relative difference in national adjusted coverage estimates was 6.0%; differences in subnational estimates were largest for process quality of child services (19.6%).

CONCLUSION: Continuous measures of structural quality demonstrated consistency at regional levels and in higher-level facilities over 2 years; results for process measures were mixed. Direct observation of child visits provided inconsistent measures over time. For other measures, linking population data with health facility assessments from up to 2 years prior is likely to introduce modest measurement error in adjusted coverage estimates.

PMID:34865274 | DOI:10.1111/tmi.13701

Eur J Oral Sci. 2021 Dec 5. doi: 10.1111/eos.12837. Online ahead of print.

ABSTRACT

Endogenous dentin proteases contribute to the degradation of collagen fibrils in the hybrid layer. Recently, inhibition of host-derived proteases by curcuminoids has shown promising results. The aim of this study was to evaluate the effect of curcuminoid treatment on the microtensile bond strength (μTBS) after 24 h or 12 months of storage. Fifty-four extracted sound human molars were flattened to mid-coronal dentin and divided into nine groups. After phosphoric acid-etching for 15 s, the dentin was experimentally treated for 60 s using 100 μM or 200 μM of curcumin, diflourobenzocurcumin, or demethoxycurcumin dissolved in 1% and 2% dimethyl sulfoxide (DMSO)/water solutions. Untreated and DMSO-treated groups served as controls. After bonding agent application, each tooth was restored with dental composite. The molars were sectioned into 0.9 × 0.9 × 6 mm beams. The μTBS testing was performed after 24 h and 12 months of storage in artificial saliva. Data were analyzed using regression analyses. Failure patterns were evaluated using scanning electron microscopy. Dentin treatment with curcuminoids did not adversely affect 24-h μTBS compared to controls. After 12 months, the μTBS of curcuminoid groups was statistically significantly higher than the controls. This study indicates the feasibility of using curcuminoids as protease inhibitors.

PMID:34865272 | DOI:10.1111/eos.12837

J Clin Periodontol. 2021 Dec 5. doi: 10.1111/jcpe.13578. Online ahead of print.

ABSTRACT

AIM: This study aimed to determine whether periodontitis in early pregnancy and periodontal therapy during gestation affect the incidence of gestational diabetes mellitus (GDM) through a population-based clinical study.

MATERIALS AND METHODS: Subjects without periodontitis at 1-4 weeks of gestation who met our inclusion criteria were enrolled in the Nonperiodontitis group. Periodontitis patients who agreed or refused to receive periodontal therapy during pregnancy were enrolled in the Periodontitis Treated or Untreated group, respectively. At 12-16 weeks of gestation, gingival crevicular fluid (GCF) and venous blood were collected for analyses of bacterial species and serum inflammatory mediators, respectively. At 24-28 weeks of gestation, GDM patients were identified by oral glucose tolerance tests. The association tests were performed using chi-squared statistics and regression analyses.

RESULTS: The complete data of 3523 pregnant women were recorded during the study period. The GDM incidence among the untreated periodontitis participants (84/749, 11.21%) was significantly higher than that among the nonperiodontitis participants (108/2255, 4.79%) (P < 0.05), and periodontal treatment during gestation reduced the incidence from 11.21% (untreated group) to 7.32% (38/519, treated group) (P < 0.05). Based on the multiple logistic regression analyses, periodontitis in early pregnancy was associated with GDM, and the three-step regression analyses showed that Porphyromonas gingivalis (P. gingivalis) and the serum TNF-α and IL-8 levels played roles in the association between untreated periodontitis and GDM. Furthermore, Pearson’s correlation test indicated that the existence of P. gingivalis in GCF was positively correlated with high serum levels of these two inflammatory mediators.

CONCLUSION: This study establishes a connection between periodontitis in early pregnancy and GDM and demonstrates that the presence of P. gingivalis is associated with high serum levels of inflammatory mediators, thereby may contribute to the development of GDM. In-depth mechanistic studies are needed to further support these findings. This article is protected by copyright. All rights reserved.

PMID:34865247 | DOI:10.1111/jcpe.13578

Am J Ind Med. 2021 Dec 5. doi: 10.1002/ajim.23318. Online ahead of print.

ABSTRACT

BACKGROUND: General population job-exposure matrices (JEMs) based on expert assessments of physical exposures may be valuable tools for studying occupation-related musculoskeletal disorders. Wrist-hand JEMs are few and the reliability and validity of expert assessments of wrist-hand exposures is uncertain.

METHODS: We examined intra- and inter-rater reliability of ratings of five experts of hand-wrist repetition, deviation, force, vibration, and computer work in 33 jobs selected to represent a large exposure variation. The validity of ratings of hand-wrist repetition was examined by comparison with electro-goniometer measurements of wrist angular velocity and mean power frequency (MPF), and the validity of hand-wrist deviation by comparison with goniometer measurements of range of motion (ROM).

RESULTS: Intra-rater test-retest and inter-rater Spearman correlation coefficients controlling for rater effects, varied between 0.70 and 0.87. Corresponding kappa statistics of overall agreement showed similar high values, except for wrist deviation (kappa = 0.50). Regression analyses showed strong positive associations between expert assessments of repetition and goniometer measurements of wrist angular velocity (R² = 0.56, p < 0.0001) and MPF (R² = 0.37, p < 0.0003), while expert ratings of wrist deviation showed a weak statistically nonsignificant association with goniometer measurements of ROM (R² = 0.032, p = 0.34).

CONCLUSION: The reliability of expert assessments of wrist-hand physical exposures was high. Compared to goniometer measurements, the validity of assessments of wrist-hand repetition was also high, but it was low for assessments of wrist-hand deviation. The results are encouraging for establishing a hand-wrist JEM, but the results for wrist deviation emphasize that expert assessments should be validated against objective measurements.

PMID:34865239 | DOI:10.1002/ajim.23318

Bull Math Biol. 2021 Dec 4;84(1):13. doi: 10.1007/s11538-021-00955-8.

NO ABSTRACT

PMID:34865189 | DOI:10.1007/s11538-021-00955-8

J Clin Monit Comput. 2021 Dec 5. doi: 10.1007/s10877-021-00789-8. Online ahead of print.

ABSTRACT

The accuracy of pulse pressure variation (PPV) to predict fluid responsiveness using pressure-controlled (PC) instead of volume-controlled modes is under debate. To specifically address this issue, we designed a study to evaluate the accuracy of PPV to predict fluid responsiveness in severe septic patients who were mechanically ventilated with biphasic positive airway pressure (BIPAP) PC-ventilation mode. 45 patients with sepsis or septic shock and who were mechanically ventilated with BIPAP mode and a target tidal volume of 7-8 ml/kg were included. PPV was automatically assessed at baseline and after a standard fluid challenge (Ringer’s lactate 500 ml). A 15% increase in stroke volume (SV) defined fluid responsiveness. The predictive value of PPV was evaluated through a receiver operating characteristic (ROC) curve analysis and “gray zone” statistical approach. 20 (44%) patients were considered fluid responders. We identified a significant relationship between PPV decrease after volume expansion and SV increase (spearman ρ = – 0.5, p < 0.001). The area under ROC curve for PPV was 0.71 (95%CI 0.56-0.87, p = 0.007). The best cut-off (based on Youden’s index) was 8%, with a sensitivity of 80% and specificity of 60%. Using a gray zone approach, we identified that PPV values comprised between 5 and 15% do not allow a reliable fluid responsiveness prediction. In critically ill septic patients ventilated under BIPAP mode, PPV appears to be an accurate method for fluid responsiveness prediction. However, PPV values comprised between 5 and 15% constitute a gray zone that does not allow a reliable fluid responsiveness prediction.

PMID:34865181 | DOI:10.1007/s10877-021-00789-8

Occup Med (Lond). 2021 Dec 2:kqab159. doi: 10.1093/occmed/kqab159. Online ahead of print.

ABSTRACT

BACKGROUND: Physical activity of resident physicians (RPs) during on-call shifts is difficult to objectively evaluate. The integration of smartphones in our daily routines may allow quantitative assessment, employing pedometric assessment.

AIMS: To evaluate the number of steps that RPs walk during on-call shifts as a marker of physical activity by using smartphone-based pedometers.

METHODS: Step counts were collected from 100 RPs’ smartphones who volunteered to participate in the study between January 2018 and May 2019. The conversion rate was 1400 steps = 1 km (application’s default). A shift was defined as regular morning work followed by an in-house on-call stay, totalling 26 hours. Statistical analyses included univariate and multivariate linear mixed models, and Fisher exact test. A P-value < 0.05 was considered statistically significant.

RESULTS: The average walking distance was 12 118 steps (8.6 km/RP/shift). Paediatric intensive care unit and neurosurgery residents recorded the longest walking distances 16 347 and 15 630 steps (11.67 and 11.16 km/shift), respectively. Radiology residents walked the shortest distances 4718 steps (3.37 km/shift). Physically active RPs walked significantly longer distances during their shifts than non-physically active RPs: 12 527 steps versus 11 384 steps (8.95 versus 8.13 km/shift, P < 0.05), respectively. Distances covered during weekday shifts were longer than weekend shifts: 12 092 steps versus 11 570 steps (8.63 versus 8.26 km/shift, P < 0.05), respectively.

CONCLUSIONS: Smartphone-based pedometers can aid in analysing physical activity and workload during on-call shifts; such information can be valuable for human resource department, occupational health authorities and medical students with impaired physical mobility when choosing a speciality.

PMID:34865160 | DOI:10.1093/occmed/kqab159