Nevin Manimala

Mil Med. 2022 Apr 13:usac102. doi: 10.1093/milmed/usac102. Online ahead of print.

ABSTRACT

INTRODUCTION: In modern conflicts, deployed members are more vulnerable to craniomaxillofacial (CMF) injury than in previous conflicts. Patients presenting with CMF trauma are susceptible to post-trauma dental malocclusion and may require lengthy rehabilitation to achieve pre-injury function. This study surveyed military health care professionals who are potential contributors to CMF trauma rehabilitation teams to evaluate the orthodontist’s inclusion in treating to the final outcome.

METHODS: Following approval from the Defense Health Agency Information Management Collections Office (Control Number: 9-DHA-1031-E) and the Air Force 59th Medical Wing Institutional Review Board (Reference Number: FWH20210061E), a survey study was conducted from April 2021 to July 2021. Volunteer participants were recruited from orthodontists, oral maxillofacial surgeons, medical specialists, and other dental specialists who have worked in military healthcare. Respondents reported their current practice treating CMF trauma, self-evaluated their knowledge of different aspects of the process, and submitted their perceptions on system and patient-limiting factors which affect outcomes. Descriptive statistics were conducted for ordinal data and chi-square tests for categorical data. Kruskal-Wallis analyses of variance compared cohorts with further Mann-Whitney U tests to distinguish the difference in cohorts.

RESULTS: Valid responses were collected from 171 participants. The responses were mostly from active duty military (93%) and well distributed among orthodontists, oral maxillofacial surgeons, other dental specialists, and medical specialists. When reporting current CMF trauma treatment practices, the majority of dental specialists stated they most commonly participate in a multidisciplinary team that addresses any CMF trauma case (68.4%) whereas medical specialists most commonly act as solo independent provider practice (53.6%). Dental specialists reported follow-up with post-trauma patients greater than 1 year and medical specialists reported the shortest post-trauma follow-up time with a median of 0 to 3 months. The majority of participants selected at least one system factor limiting CMF trauma care (78.7%) and at least one patient factor limiting CMF trauma care (86.3%). When asked about orthodontic participation in multidisciplinary teams, the responses showed a great range with orthodontists never included in CMF trauma care 23.1% of the time and always consulted regarding trauma cases 10.7% of the time. Other survey data collected allows the investigators to draw conclusions regarding specific limitations to treatment and recommendations for improvement, along with qualitative responses from survey participants.

CONCLUSIONS: Orthodontics, while available in the military, is underutilized in treating post-warfare or other CMF trauma. There are both system- and patient-limiting factors in the treatment of battlefield and non-battlefield CMF trauma. In addition, there are limitations to the inclusion of orthodontists in CMF trauma care which include the physical distance from primary treating specialists and the absence of standard referral protocols. Oral maxillofacial surgeons reported the highest understanding of the military orthodontist’s contribution to a CMF trauma treatment team and medical specialists reported the lowest understanding. Advanced technology tools could help improve outcomes and multidisciplinary interactions. Further research is needed to study the complete CMF trauma rehabilitation process in military treatment facilities, evaluate the efficiency of cross-specialty referrals, and highlight best practices and protocols of functioning multidisciplinary teams.

PMID:35415744 | DOI:10.1093/milmed/usac102

Faraday Discuss. 2022 Apr 13. doi: 10.1039/d1fd00090j. Online ahead of print.

ABSTRACT

Induction time, a measure of how long one will wait for nucleation to occur, is an important parameter in quantifying nucleation kinetics and its underlying mechanisms. Due to the stochastic nature of nucleation, efficient methods for measuring large numbers of independent induction times are needed to ensure statistical reproducibility. In this work, we present a novel approach for measuring and analyzing induction times in sessile arrays of microdroplets via deliquescence/recrystallization cycling. With the help of a recently developed image analysis protocol, we show that the interfering diffusion-mediated interactions between microdroplets can be eliminated by controlling the relative humidity, thereby ensuring independent nucleation events. Moreover, possible influence of heterogeneities, impurities, and memory effect appear negligible as suggested by our 2-cycle experiment. Further statistical analysis (k-sample Anderson-Darling test) reveals that upon identifying possible outliers, the dimensionless induction times obtained from different datasets (microdroplet lines) obey the same distribution and thus can be pooled together to form a much larger dataset. The pooled dataset showed an excellent fit with the Weibull function, giving a mean supersaturation at nucleation of 1.61 and 1.85 for the 60 pL and 4 pL microdroplets respectively. This confirms the effect of confinement where smaller systems require higher supersaturations to nucleate. Both the experimental method and the data-treatment procedure presented herein offer promising routes in the study of fundamental aspects of nucleation kinetics, particularly confinement effects, and are adaptable to other salts, pharmaceuticals, or biological crystals of interest.

PMID:35415724 | DOI:10.1039/d1fd00090j

Palliat Med Rep. 2022 Mar 30;3(1):26-35. doi: 10.1089/pmr.2021.0036. eCollection 2022.

ABSTRACT

BACKGROUND: Empathic communication skills have a growing presence in graduate medical education to empower trainees in serious illness communication.

OBJECTIVE: Evaluate the impact, feasibility, and acceptability of a shared communication training intervention for residents of different specialties.

DESIGN: A randomized controlled study of standard education v. our empathic communication skills-building intervention: VitalTalk-powered workshop and formative bedside feedback using a validated observable behavioral checklist.

SETTING/SUBJECTS: During the 2018-2019 academic year, our intervention was implemented at a large single-academic medical center in the United States involving 149 internal medicine and general surgery residents.

MEASUREMENTS: Impact outcomes included observable communication skills measured in standardized patient encounters (SPEs), and self-reported communication confidence and burnout collected by surveys. Analyses included descriptive and inferential statistics, including independent and paired t tests and multiple regression model to predict post-SPE performance.

RESULTS: Of residents randomized to the intervention, 96% (n = 71/74) completed the VitalTalk-powered workshop and 42% (n = 30/71) of those residents completed the formative bedside feedback. The intervention demonstrated a 33% increase of observable behaviors (p < 0.001) with improvement in all eight skill categories, compared with the control who only showed improvement in five. Intervention residents demonstrated improved confidence in performing all elicited communication skills such as express empathy, elicit values, and manage uncertainty (p < 0.001).

CONCLUSIONS: Our educational intervention increased residents’ confidence and use of essential communication skills. Facilitating a VitalTalk-powered workshop for medical and surgical specialties was feasible and offered a shared learning experience for trainees to benefit from expert palliative care learning outside their field.

PMID:35415720 | PMC:PMC8994435 | DOI:10.1089/pmr.2021.0036

Womens Health Rep (New Rochelle). 2022 Mar 28;3(1):385-394. doi: 10.1089/whr.2021.0027. eCollection 2022.

ABSTRACT

BACKGROUND: Despite the prevalence of abortion stigma in the United States, few studies have examined the relationship between stigma and psychological well-being postabortion among women who undergo abortion for fetal anomalies.

MATERIALS AND METHODS: We conducted a cross-sectional study of women who underwent second-trimester abortion for pregnancy complications to assess the association between abortion stigma and psychological outcomes. We asked women to retrospectively report self-judgment and perceived community condemnation at the time of their abortion and evaluated present-day grief, post-traumatic stress, and self-reported mental health. We recruited participants using Facebook, Craigslist, and other public online forums. We used multivariable linear regression to evaluate relationships between abortion stigma and psychological outcomes. In adjusted models, we controlled for covariates that were associated with the outcome at a level of p < 0.1.

RESULTS: Adjusted models, including 80 women, revealed that higher self-judgment at the time of abortion was significantly associated with increased postabortion grief (β = 2.5 and p = 0.02). Self-judgment was not associated with statistically significant differences in post-traumatic stress or mental health. There was no association between perceived community condemnation and psychological outcomes.

DISCUSSION: Abortion stigma may be associated with increased postabortion grief, but does not appear to be associated with differences in post-traumatic stress or mental health. Investigating how different preprocedure counseling methods can impact self-judgment might inform future interventions aimed at improving psychological outcomes postabortion.

IMPLICATIONS FOR PRACTICE AND/OR POLICY: Abortion providers should consider that women who display signs of self-judgment may be at higher risk for increased grief after pregnancy termination for fetal anomalies or maternal complications.

PMID:35415714 | PMC:PMC8994429 | DOI:10.1089/whr.2021.0027

J Hand Surg Glob Online. 2021 Nov 8;4(1):25-31. doi: 10.1016/j.jhsg.2021.08.007. eCollection 2022 Jan.

ABSTRACT

PURPOSE: We evaluated the literature on complications associated with different positions used for immobilizing the upper extremity during conservative treatment of distal radius fractures (DRF).

METHODS: A search of PubMed, Embase, and Medline was conducted to identify original research on the effects that upper extremity positioning during the treatment of DRFs has on complication rates. Treatment groups were categorized by wrist positioning in flexion, extension, or neutral, as well as forearm positioning in pronation, supination, or neutral. The primary endpoints examined included the loss of reduction, recasting/refabricating an orthosis, and functional limitations.

RESULTS: A total of 1,655 articles were identified through an initial database search. Ultimately, 8 studies, with 786 total patients, met the inclusion criteria for this systematic review. A qualitative analysis determined that immobilizing DRFs with the wrist in extension results in better functional and radiographic outcomes with lower rates of complications, such as pain, recasting, and the need for operation. The 2 studies that compared forearm pronation versus supination revealed contradictory results regarding which position was associated with superior outcomes. A meta-analysis comparing the various wrist and forearm positions failed to demonstrate statistically significant differences in the rates of loss of reduction or recasting/refabricating an orthosis between the groups. This analysis was limited by considerable heterogeneity in the data from the different studies.

CONCLUSIONS: Despite the high incidence of DRFs, there is limited research on the optimal position of immobilization for conservative treatment of them. Available evidence suggests that the wrist should be immobilized in extension, as these patients had improved functional and radiographic outcomes. No conclusion can be drawn from the existing literature on ideal forearm position during immobilization. This review also suggests better data reporting practices for studies researching DRFs, so that future meta-analyses can be more comprehensive.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

PMID:35415593 | PMC:PMC8991451 | DOI:10.1016/j.jhsg.2021.08.007

J Hand Surg Glob Online. 2021 Aug 11;3(6):348-351. doi: 10.1016/j.jhsg.2021.06.010. eCollection 2021 Nov.

ABSTRACT

PURPOSE: The use of self-tapping cortical screws is indicated in patients with metacarpal and phalangeal fractures requiring formal stabilization. The aim of this study was to systematically compare and evaluate the design parameters of 4 commercially available self-tapping screw systems.

METHODS: We measured various design parameters of self-tapping cortical screws of different lengths from several manufactures using scanning electron microscopy. Screws were obtained in 8, 12, 16, and 20 mm lengths. The measured parameters included screw length, head height, pitch, outer diameter, inner diameter, terminal thread diameter, terminal thread-to-tip distance, thread-to-tip distance of 1 full revolution, and crest width. Data were assessed statistically using 1- and 2-way analysis of variance (ANOVA) tests, and the significance level was set at a P value < .05.

RESULTS: There was variability in advertised screw lengths compared with measured screw lengths with 2 manufacturers. There was a statistically significant difference between the thread-to-tip distance and head height between screws while controlling for diameter.

CONCLUSIONS: Screw sizes and dimensions are critical in order to avoid complications such as prominent hardware and postoperative stiffness. Knowledge of the design parameters presented for each of the different manufacturers may prove useful to hand surgeons when selecting screws for fixation of metacarpal and phalangeal fractures.

CLINICAL RELEVANCE: Specific design characteristics of commonly used screws in hand surgery vary slightly by manufacturer and may have clinically relevant implications in fixation of metacarpal and phalangeal fractures.

PMID:35415582 | PMC:PMC8991776 | DOI:10.1016/j.jhsg.2021.06.010

Horm Res Paediatr. 2022 Apr 12. doi: 10.1159/000524573. Online ahead of print.

ABSTRACT

INTRODUCTION: Turner syndrome (TS) is associated with a high risk of primary ovarian insufficiency. Current guidelines recommend early fertility counseling for affected youth and their families. This study assessed pediatric endocrinologists’ fertility counseling practices for girls with TS.

METHODS: TS providers were invited to complete a survey via the Pediatric Endocrine Society listserv. Descriptive statistics summarized variables of interest. Correlations were used to identify associations between barriers/practice characteristics and fertility preservation (FP) referral. Thematic analysis was used to examine qualitative responses.

RESULTS: 119 providers completed the survey. Seventy percent of providers reported discussing fertility implications of TS routinely in pediatric care. Fifty-six percent of providers reported often or always referring patients with spontaneous menarche to FP specialists, whereas only 19% reported often or always referring their patients without spontaneous menarche (p<0.001). Barriers associated with FP referral frequency included unfamiliarity with FP options, belief that FP is not a possible goal for their patients and absence of a local reproductive endocrinologist. Qualitatively, four referral barrier themes were identified: (1) Questionable utility of referral, (2) Lack of perceived interest among patients/families, (3) Provider barriers (e.g. lack of knowledge), (4) Logistical/structural barriers to accessing fertility-related care.

DISCUSSION/CONCLUSION: Providers report inconsistently discussing fertility implications of TS. The frequency of referral to a FP specialist and factors/barriers affecting the decision to refer remain variable. Future research should focus on expanding provider education, addressing barriers to high quality fertility counseling and referral for patients with TS, and investigating FP outcomes in TS.

PMID:35413716 | DOI:10.1159/000524573

J Neural Eng. 2022 Apr 12. doi: 10.1088/1741-2552/ac669a. Online ahead of print.

ABSTRACT

OBJECTIVE: Fast neural Electrical Impedance Tomography (FnEIT) is an imaging technique that has been successful in visualising electrically evoked activity of myelinated fibres in peripheral nerves by measurement of the impedance changes (dZ) accompanying excitation. However, imaging of unmyelinated fibres is challenging due to temporal dispersion (TP) which occurs due to variability in conduction velocities of the fibres and leads to a decrease of the signal below the noise with distance from the stimulus. To overcome TP and allow EIT imaging in unmyelinated nerves, a new experimental and signal processing paradigm is required allowing dZ measurement further from the site of stimulation than compound neural activity is visible. The development of such a paradigm was the main objective of this study.

APPROACH: A FEM-based statistical model of temporal dispersion in porcine subdiaphragmatic nerve was developed and experimentally validated ex-vivo. Two paradigms for nerve stimulation and processing of the resulting data – continuous stimulation and trains of stimuli, were implemented; the optimal paradigm for recording dispersed dZ in unmyelinated nerves was determined.

MAIN RESULTS: While continuous stimulation and coherent spikes averaging led to higher signal-to-noise ratios (SNR) at close distances from the stimulus, stimulation by trains was more consistent across distances and allowed dZ measurement at up to 15 cm from the stimulus (SNR = 1.8±0.8) if averaged for 30 minutes.

SIGNIFICANCE: The study develops a method that for the first time allows measurement of dZ in unmyelinated nerves in simulation and experiment, at the distances where compound action potentials are fully dispersed.

PMID:35413701 | DOI:10.1088/1741-2552/ac669a

Am J Emerg Med. 2022 Apr 6;56:188-195. doi: 10.1016/j.ajem.2022.03.060. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study was to compare and determine whether there were any differences in clinical outcomes between pregnant and non-pregnant women who had been infected with COVID-19.

METHODS: A literature search was performed in 9 databases on November 20, 2021. The relative risk (RR) with 95% confidence interval (95% CI) was used to estimate the effect of pregnancy on COVID-19 outcomes. The I square value was used to assess heterogeneity, and the random or the fixed-effects model were adopted. Sensitivity and publication bias analyses were performed.

RESULTS: This study included 8 published studies with 859,278 COVID-19 female patients. The incidences of fever and cough among pregnant women with COVID-19 were 19.07% and 28.79%, respectively. Pregnancy was associated with significantly increased risks of intensive care unit (ICU) admission (RR = 2.23, 95% CI = 1.58-3.16) and ventilation (RR = 2.13, 95% CI = 1.06-4.28), but was not associated with a statistically significant increase in mortality.

CONCLUSIONS: Our results suggest that pregnant women with COVID-19 have a significantly higher probability of being hospitalized to the ICU and ventilation than non-pregnant women with COVID-19. To avoid these adverse outcomes, pregnant women should take precautions (for example, reduce going out, maintain social distance, and wear a mask) to avoid COVID-19 infection. Finally, additional research into the fetal outcomes is required to better investigate the impact of COVID-19 on pregnancy.

PMID:35413655 | DOI:10.1016/j.ajem.2022.03.060

Neuroimage Clin. 2022 Apr 6;34:103003. doi: 10.1016/j.nicl.2022.103003. Online ahead of print.

ABSTRACT

Conceptualizing mental disorders as deviations from normative functioning provides a statistical perspective for understanding the individual heterogeneity underlying psychiatric disorders. To broaden the understanding of the idiosyncrasy of brain aging in schizophrenia, we introduced an imaging-derived brain age paradigm combined with normative modeling as novel brain age metrics. We constructed brain age models based on GM, WM, and their combination (multimodality) features of 482 normal participants. The normalized predicted age difference (nPAD) was estimated in 147 individuals with schizophrenia and their 130 demographically matched controls through normative models of brain age metrics and compared between the groups. Regression analyses were also performed to investigate the associations of nPAD with illness duration, onset age, symptom severity, and intelligence quotient. Finally, regional contributions to advanced brain aging in schizophrenia were investigated. The results showed that the individuals exhibited significantly higher nPAD (P < 0.001), indicating advanced normative brain age than the normal controls in GM, WM, and multimodality models. The nPAD measure based on WM was positively associated with the negative symptom score (P = 0.009), and negatively associated with the intelligence quotient (P = 0.039) and onset age (P = 0.006). The imaging features that contributed to nPAD mostly involved the prefrontal, temporal, and parietal lobes, especially the precuneus and uncinate fasciculus. This study demonstrates that normative brain age metrics could detect advanced brain aging and associated clinical and neuroanatomical features in schizophrenia. The proposed nPAD measures may be useful to investigate aberrant brain aging in mental disorders and their brain-phenotype relationships.

PMID:35413648 | DOI:10.1016/j.nicl.2022.103003