Nevin Manimala

Clin Orthop Relat Res. 2022 Jun 20. doi: 10.1097/CORR.0000000000002276. Online ahead of print.

ABSTRACT

BACKGROUND: Aseptic revision THA and TKA are associated with an increased risk of adverse outcomes compared with primary THA and TKA. Understanding the risk profiles for patients undergoing aseptic revision THA or TKA may provide an opportunity to decrease the risk of postsurgical complications. There are risk stratification tools for postoperative complications after aseptic revision TKA or THA; however, current tools only include nonmodifiable risk factors, such as medical comorbidities, and do not include modifiable risk factors.

QUESTIONS/PURPOSES: (1) Can machine learning predict 30-day mortality and complications for patients undergoing aseptic revision THA or TKA using a cohort from the American College of Surgeons National Surgical Quality Improvement Program database? (2) Which patient variables are the most relevant in predicting complications?

METHODS: This was a temporally validated, retrospective study analyzing the 2014 to 2019 National Surgical Quality Improvement Program database, as this database captures a large cohort of aseptic revision THA and TKA patients across a broad range of clinical settings and includes preoperative laboratory values. The training data set was 2014 to 2018, and 2019 was the validation data set. Given that predictive models learn expected prevalence of outcomes, this split allows assessment of model performance in contemporary patients. Between 2014 and 2019, a total of 24,682 patients underwent aseptic revision TKA and 17,871 patients underwent aseptic revision THA. Of those, patients with CPT codes corresponding to aseptic revision TKA or THA were considered as potentially eligible. Based on excluding procedures involving unclean wounds, 78% (19,345 of 24,682) of aseptic revision TKA procedures and 82% (14,711 of 17,871) of aseptic revision THA procedures were eligible. Ten percent of patients in each of the training and validation cohorts had missing predictor variables. Most of these missing data were preoperative sodium or hematocrit (8% in both the training and validation cohorts). No patients had missing outcome data. No patients were excluded due to missing data. The mean patient was age 66 ± 12 years, the mean BMI was 32 ± 7 kg/m2, and the mean American Society of Anesthesiologists (ASA) Physical Score was 3 (56%). XGBoost was then used to create a scoring tool for 30-day adverse outcomes. XGBoost was chosen because it can handle missing data, it is nonlinear, it can assess nuanced relationships between variables, it incorporates techniques to reduce model complexity, and it has a demonstrated record of producing highly accurate machine-learning models. Performance metrics included discrimination and calibration. Discrimination was assessed by c-statistics, which describe the area under the receiver operating characteristic curve. This quantifies how well a predictive model discriminates between patients who have the outcome of interest versus those who do not. Relevant ranges for c-statistics include good (0.70 to 0.79), excellent (0.80 to 0.89), and outstanding (> 0.90). We estimated 95% confidence intervals (CIs) for c-statistics by 500-sample bootstrapping. Calibration curves quantify reliability of model predictions. Reliable models produce prediction probabilities for outcomes that are similar to observed probabilities of those outcomes, so a well-calibrated model should demonstrate a calibration curve that does not deviate substantially from a line of slope 1 and intercept 0. Calibration curves were generated on the 2019 validation data. Shapley Additive Explanations (SHAP) visualizations were used to investigate feature importance to gain insight into how models made predictions. The models were built into an online calculator for ongoing testing and validation. The risk calculator, which is freely available (http://nb-group.org/rev2/), allows a user to input patient data to calculate postoperative risk of 30-day mortality, cardiac, and respiratory complications after aseptic revision TKA or THA. A post hoc analysis was performed to assess whether using data from 2020 would improve calibration on 2019 data.

RESULTS: The model accurately predicted mortality, cardiac complications, and respiratory complications after aseptic revision THA or TKA, with c-statistics of 0.88 (95% CI 0.83 to 0.93), 0.80 (95% CI 0.75 to 0.84), and 0.78 (95% CI 0.74 to 0.82), respectively, on internal validation and 0.87 (95% CI 0.77 to 0.96), 0.70 (95% CI 0.61 to 0.78), and 0.82 (95% CI 0.75 to 0.88), respectively, on temporal validation. Calibration curves demonstrated slight over-confidence in predictions (most predicted probabilities were higher than observed probabilities). Post hoc analysis of 2020 data did not yield improved calibration on the 2019 validation set. Important risk factors for all models included increased age and higher ASA, BMI, hematocrit level, and sodium level. Hematocrit and ASA were in the top three most important features for all models. The factor with the strongest association for mortality and cardiac complication models was age, and for the respiratory model, chronic obstructive pulmonary disease. Risk related to sodium followed a U-shaped curve. Preoperative hyponatremia and hypernatremia predicted an increased risk of mortality and respiratory complications, with a nadir of 138 mmol/L; hyponatremia was more strongly associated with mortality than hypernatremia. A hematocrit level less than 36% predicted an increased risk of all three adverse outcomes. A BMI less than 24 kg/m2-and especially less than 20 kg/m2-predicted an increased risk of all three adverse outcomes, with little to no effect for higher BMI.

CONCLUSION: This temporally validated model predicted 30-day mortality, cardiac complications, and respiratory complications after aseptic revision THA or TKA with c-statistics ranging from 0.78 to 0.88. This freely available risk calculator can be used preoperatively by surgeons to educate patients on their individual postoperative risk of these specific adverse outcomes. Unanswered questions that remain include whether altering the studied preoperative patient variables, such as sodium or hematocrit, would affect postoperative risk of adverse outcomes; however, a prospective cohort study is needed to answer this question.

LEVEL OF EVIDENCE: Level III, therapeutic study.

PMID:35767804 | DOI:10.1097/CORR.0000000000002276

J Clin Oncol. 2022 Jun 29:JCO2101811. doi: 10.1200/JCO.21.01811. Online ahead of print.

ABSTRACT

A statistical test for the presence of treatment effects on survival will be based on a null hypothesis (absence of effects) and an alternative (presence of effects). The null is very simply expressed. The most common alternative, also simply expressed, is that of proportional hazards. For this situation, not only do we have a very powerful test in the log-rank test but also the outcome is readily interpreted. However, many modern treatments fall outside this relatively straightforward paradigm and, as such, have attracted attention from statisticians eager to do their best to avoid losing power as well as to maintain interpretability when the alternative hypothesis is less simple. Examples include trials where the treatment effect decays with time, immunotherapy trials where treatment effects may be slow to manifest themselves as well as the so-called crossing hazards problem. We review some of the solutions that have been proposed to deal with these issues. We pay particular attention to the integrated log-rank test and how it can be combined with the log-rank test itself to obtain powerful tests for these more complex situations.

PMID:35767775 | DOI:10.1200/JCO.21.01811

Ann Agric Environ Med. 2022 Jun 24;29(2):316-320. doi: 10.26444/aaem/150522. Epub 2022 Jun 9.

ABSTRACT

INTRODUCTION: Between 2015-2020, the concentrations and diversity of filamentous fungi as well as the levels of mycotoxins in 4 classes of vegetables and fruits were studied in samples from farms located in eastern Poland. The short communication summarizes the results with the use of statistical analysis and indicates the potential health hazards associated with the consumption of the produce contaminated with fungi and/or mycotoxins. The concentrations of filamentous fungi in all examined samples were moderate (2.813 – 4.146 log₁₀ CFU g ^-1). The highest values were noted in root vegetables, whereas the lowest values in fruit vegetables. The mycobiota revealed a marked biodiversity (67 species and 33 genera). Penicillium and Fusarium prevailed in the mycobiota of root vegetables, whereas Cladosporium and Alternaria in the remaining classes. Most of identified species (88.1%) were described as potentially pathogenic. The importance of mycotoxins as a potential health risk factor for vegetable consumers, was confirmed by the detection of a high prevalence (>55%) of total aflatoxin (AFT). The level of AFT in berry fruits was significantly higher than in other classes. The high prevalence (58.5%) of deoxynivalenol was noted in raspberries.

CONCLUSIONS: Filamentous fungi present in the examined vegetables and fruits may pose a potential health risk for consumers due to a high prevalence of potentially pathogenic species, mostly those producing mycotoxins.

PMID:35767771 | DOI:10.26444/aaem/150522

J Dual Diagn. 2022 Jun 29:1-9. doi: 10.1080/15504263.2022.2090650. Online ahead of print.

ABSTRACT

Objective: It is well-established that Bipolar Disorder (BD) has comorbidity with Alcohol Use Disorder (AUD) and could present the same symptoms of an underlying diagnosis of BD, therefore delaying the proper relevant treatment. Recent studies show the occurrence of alterations in the circulating levels of inflammatory mediators in patients dealing with AUD as well as those with BD. The objective of this study is to get an assessment of whether patients with AUD and BD comorbidity [BD(+)] would present different ratios of the Complete Blood Count (CBC) in comparison with patients with AUD but without a BD comorbidity [BD(-)]. Methods: This is a retrospective study, conducted through a selection of patients files who were admitted to the psychiatric department at Hôtel-Dieu de France University Hospital in Beirut, Lebanon, between January of the year 2016 and May of the year 2021. Overall, 83 files of patients dealing with AUD were included in this study. Results: Patients with BD(+) showed a higher Eosinophils to Lymphocytes Ratio (ELR) in comparison to those with BD(-). The Receiver Operation Characteristic (ROC) analysis had an area under the curve at 0.719 with a p = .001. The cutoff value of ELR that best differentiates BD(-) from BD(+) was 0.087 (Sensitivity = 81.3%; Specificity = 63.6%). The logistic regression analysis showed that an ELR superior to 0.087 presented a statistically significant difference, exposing patients belonging to the BD(+) group (OR = 11.66; p < .001). Conclusions: Our data suggest that ELR may be a valuable, reproducible, easily accessible, and cost-effective inflammatory marker, pointing at the presence of a BD comorbidity with AUD.

PMID:35767724 | DOI:10.1080/15504263.2022.2090650

JMIR Form Res. 2022 Jun 27. doi: 10.2196/39217. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has required restrictive measures put in place to mitigate transmission of the coronavirus COVID-19. Evidence has demonstrated an increased generalized anxiety and depression within young adults due to COVID-19 pandemic. However, little research has examined the longitudinal effect of COVID-19 over the course of time and its impact of anxiety and depression. Additionally, as it relates to incidences and severity of depression and anxiety. Age age and gender have been found to play a significant on individual’s mental health with young adults and females particularly at risk.

OBJECTIVE: This study sought to examine the impact of the COVID-19 pandemic on anxiety and depression upon admissions to treatment.

METHODS: The current study is an observational study that was completed longitudinally in which, the grouping variable split the time interval into five equal groups and assessed over that period of time. 112 young adults (aged 18-25) were recruited for the study. Participants completed assessments online through Qualtrics link.

RESULTS: Psychometric properties of the admission assessments were uniformly highly statistically significant. There was a significant difference for generalized anxiety between group 1 interval and group 3 interval. No significant difference was noted across the time intervals for depression. Differences were noted to predict the impact of the psychometrics scores on gender. Only the ability to participate and the quality-of-life sub-factor of the FACIT assessment were significant.

CONCLUSIONS: The current study sought to understand the impact that COVID had on young adults seeking mental health services during the pandemic. It was apparent that gender was a significant factor for increased anxiety in young adults seeking mental health services during the pandemic. The findings have critical importance to potential treatment success rate of the clients, while providing an overarching understanding of the impact of the pandemic and establishing clinical recommendations for the treatment of the individuals who are seeking out treatment..

PMID:35767688 | DOI:10.2196/39217

Aust J Rural Health. 2022 Jun 29. doi: 10.1111/ajr.12894. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to investigate the perceptions and beliefs of rural high school teachers about student suicide completion in their school and their perceived self-efficacy in identification of suicidality in students (suicidal ideation, plans and behaviours).

DESIGN: A cross-sectional survey methodology.

SETTING: Gippsland and the Loddon Mallee regions of Victoria, Australia.

PARTICIPANTS: Rural high school teachers.

OUTCOME MEASURE: A survey that aimed to obtain participants’ perceptions and self-reports about students who had died by suicide in their school within the last 5 years, their perceived self-efficacy in identifying suicidal students and barriers to helping students at risk.

RESULTS: Two hundred and seventy-seven rural high school teachers participated and 86% reported that a student from their school had died by suicide within the last 5 years. Sixty-five per cent believed that more than one student had died by suicide and 70% perceived they were currently aware of students experiencing suicidality in their class. Receiving professional development about suicide and obtaining help from mental health clinicians predicted perceived self-efficacy in identification of suicidality in students. Participants perceived the barriers to help students at risk included insufficient numbers of school-based mental health professionals and community mental health services.

CONCLUSIONS: Many rural high school teachers perceive they are at the front line of the youth suicide crisis due to unmet service need in youth mental ill health. Increased access to effective services immediately after teachers become aware of suicidality may assist in reducing youth suicide in rural areas.

PMID:35767662 | DOI:10.1111/ajr.12894

Proc Natl Acad Sci U S A. 2022 Jul 5;119(27):e2115047119. doi: 10.1073/pnas.2115047119. Epub 2022 Jun 29.

ABSTRACT

Human vision is attuned to the subtle differences between individual faces. Yet we lack a quantitative way of predicting how similar two face images look and whether they appear to show the same person. Principal component-based three-dimensional (3D) morphable models are widely used to generate stimuli in face perception research. These models capture the distribution of real human faces in terms of dimensions of physical shape and texture. How well does a “face space” based on these dimensions capture the similarity relationships humans perceive among faces? To answer this, we designed a behavioral task to collect dissimilarity and same/different identity judgments for 232 pairs of realistic faces. Stimuli sampled geometric relationships in a face space derived from principal components of 3D shape and texture (Basel face model [BFM]). We then compared a wide range of models in their ability to predict the data, including the BFM from which faces were generated, an active appearance model derived from face photographs, and image-computable models of visual perception. Euclidean distance in the BFM explained both dissimilarity and identity judgments surprisingly well. In a comparison against 16 diverse models, BFM distance was competitive with representational distances in state-of-the-art deep neural networks (DNNs), including novel DNNs trained on BFM synthetic identities or BFM latents. Models capturing the distribution of face shape and texture across individuals are not only useful tools for stimulus generation. They also capture important information about how faces are perceived, suggesting that human face representations are tuned to the statistical distribution of faces.

PMID:35767642 | DOI:10.1073/pnas.2115047119

Sci Adv. 2022 Jul;8(26):eabm6185. doi: 10.1126/sciadv.abm6185. Epub 2022 Jun 29.

ABSTRACT

An accurate record of preindustrial (pre-1900 CE) sea level is necessary to contextualize modern global mean sea level (GMSL) rise with respect to natural variability. Precisely dated phreatic overgrowths on speleothems (POS) provide detailed rates of Late Holocene sea-level rise in Mallorca. Statistical analysis indicates that sea level rose locally by 0.12 to 0.31 m (95% confidence) from 3.26 to 2.84 thousand years (ka) ago (2σ) and remained within 0.08 m (95% confidence) of preindustrial levels from 2.84 ka to 1900 CE. This sea-level history is consistent with glacial isostatic adjustment models adopting relatively weak upper mantle viscosities of ~10²⁰ Pa s. There is virtual certainty (>0.999 probability) that the average GMSL rise since 1900 CE has exceeded even the high average rate of sea-level rise between 3.26 and 2.84 ka inferred from the POS record. We conclude that modern GMSL rise is anomalous relative to any natural variability in ice volumes over the past 4000 years.

PMID:35767617 | DOI:10.1126/sciadv.abm6185

PLoS One. 2022 Jun 29;17(6):e0270108. doi: 10.1371/journal.pone.0270108. eCollection 2022.

ABSTRACT

BACKGROUND: Inappropriate Anti-diabetic Medication Therapy (IADT) refers to a drug-related problem and includes ‘ineffective drug therapy’, ‘unnecessary drug therapy’, ‘dosage too high’, and ‘dosage too low’. This study aimed to determine the prevalence and factors associated with IADT among T2DM patients at Mbarara Regional Referral Hospital, Uganda (MRRH).

METHOD: A prospective cross-sectional study was conducted at the medical and surgical wards of MRRH from November 2021 to January 2022. One hundred and thirty-eight adult patients aged 18 years and above, with T2DM, were recruited using consecutive sampling. Patient file reviews and interviewer-administered questionnaire was used for data collection. The data were entered into and analyzed using SPSS version 25. Descriptive analysis was employed to describe the population and determine the prevalence of IADT. Types of IADTs were identified using Cipolle’s DRP classification tool. A univariate and multivariate logistic regression analysis was used to identify factors significantly associated with IADT. The P-value of < 0.05 was considered statistically significant at 95% confidence interval.

RESULTS: A total of 138 hospitalized T2DM patients were studied. Eighty (58.0%) were females, and 70 (50.7%) were ≥ 60 years of age. Out of a total of 138 participants, 97 experienced at least one IADT, with an estimated prevalence of 70.3%. ‘Dosage too high’ (29.2%) and ‘dosage too low’ (27.9%) were the most common type of IADTs. Age ≥ 60 years (AOR, 8.44; 95% CI, 2.09-10.90; P-value = 0.003), T2DM duration of < 1 year (AOR, 0.37; 95% CI, 0.11-0.35; P-value = 0.019), and HbA1c of < 7% (AOR, 9.97; 95% CI, 2.34-13.57; P-value = 0.002) were found to be factors significantly associated with the occurrence of IADTs.

CONCLUSION: The overall prevalence of inappropriate anti-diabetic medication therapy among T2DM patients admitted to medical and surgical wards of MRRH was 70.3%. The most common type of IADT in this study was ‘dosage too high’, accounting for almost one-third followed by ‘dosage too low’ accounting for a quarter of total IADTs. Age greater or equal to 60 years, T2DM duration of < 1 year, and HbA1c of < 7% during the current admission were found to be factors significantly associated with the occurrence of IADTs in hospitalized T2DM patients.

PMID:35767589 | DOI:10.1371/journal.pone.0270108

PLoS One. 2022 Jun 29;17(6):e0270378. doi: 10.1371/journal.pone.0270378. eCollection 2022.

ABSTRACT

BACKGROUND: Intestinal parasitic infection (IPIs) is one of the major health problems in Sub -Saharan Africa where water, sanitation and hygiene practices are inadequate. Taking into account the national level implementation of intensive hand hygiene against COVID-19 pandemic and general protective effect this study assessed its effect on intestinal parasite.

OBJECTIVE: This study aim to investigate the effect of compliance to hand hygiene practice on the prevalence of intestinal parasitic infection (IPIs) and intensity of Soil transmitted helminthes (STH) among patients attending tertiary care hospital in southern Ethiopia.

METHODS: Observational study was conducted from June to September 2021. Data on socio demographic, hand hygiene practice and intestinal parasite (prevalence and intensity of helminthic infection) was collected from randomly selected and consented patients. Compliance to hand hygiene practice was assessed using pre-tested questionnaire. Fresh stool sample from each participant was examined by direct wet mount, concentration and Ziehl-Neelson (ZN) staining technique to detect intestinal parasite. Intensity of STH measurements was done through direct egg-count per gram using Kato Katz methods. Data analysis was done using SPSS version 25. Odds ratio with 95% confidence interval was used to measure association and p-value <0.05 was considered as statistically significant.

RESULTS: The study population (N = 264) consisted of 139(52.65%) male and 125 (47.34%) female with the mean ages of 36 ±16.12(±SD). The proportion of good compliance to hand hygiene during COVID-19 to was 43.93% (95%CI: 37% to 47) and prevalence of intestinal parasite was 26.14% (95%CI:21.2% to 31.75) comprising 23.48% intestinal protozoa and 6.43% of soil transmitted helminthic infection. Gardia lamblia, Entamoeba histolytica/dispar, Ascaris lumbricoides were the common parasite in the study area with prevalence of 15.53%, 6.44%, and 1.52% respectively. Prevalence of intestinal parasite among participants with good compliance to hand hygiene group and poor compliance to hand hygiene were (14.65% vs. 35.13%)(AOR: 0.48,95%CI:0.13 to 0.68) (p = 0.002) implying that good compliance to hand hygiene can reduce the risk of IPIs by 52%. Moreover significantly lower odds of intestinal protozoa among good compliance to hand hygiene group than the control (OR:0.38; (95%CI: 0.20 to 0.71);P = 0.001. However, no significant difference in the odds of intensity of STH infection in good compliance hand hygiene and poor compliance group. The result of this study also confirmed the association between intestinal parasitic infections and younger /adolescent age, education status, habit of eating raw vegetable and figure nail status.

CONCLUSION: Good hand hygiene compliance during COVID-19 significantly associated with reduction of intestinal parasitic infection. This finding highlights the secondary protective effect of improved hand hygiene against IPIs and suggest it can used in augmenting the existing parasitic control strategies in the study setting.

PMID:35767582 | DOI:10.1371/journal.pone.0270378