Nevin Manimala

J Health Care Poor Underserved. 2022;33(4):1925-1948. doi: 10.1353/hpu.2022.0146.

ABSTRACT

OBJECTIVE: To explore parent perspectives on barriers, facilitators, and priorities related to coordinating care for children and youth with special health care needs (CYSHCN).

METHODS: Thirty-nine parents of Medicaid-eligible CYSHCN participated in focus groups and completed a brief survey about their child’s health insurance coverage, access to specialized services, and need for support with service coordination. Survey data were analyzed using descriptive statistics. Focus group data were analyzed by multiple independent coders using an approach that combines inductive reasoning with predetermined coding strategies.

RESULTS: Sixty-seven percent of parents reported that they needed care coordination support. Qualitative data were organized into three main themes: the work of caregiving; the impact of caregiving on multiple aspects of parents’ lives; and caregivers’ needs related to emotional acceptance, service referrals and navigation, and developmental transitions.

CONCLUSIONS: Findings support importance of services such as medical homes, care coordinators, peer navigators, respite care, and transition planning.

PMID:36341671 | DOI:10.1353/hpu.2022.0146

J Health Care Poor Underserved. 2022;33(4):1879-1890. doi: 10.1353/hpu.2022.0143.

ABSTRACT

BACKGROUND: Clinical medical students are exposed to COVID-19 infection, thus it is imperative to achieve a high COVID-19 vaccination rate among this group of people.

OBJECTIVE: To determine the level of acceptance of COVID-19 vaccine and possible reasons for COVID-19 vaccine hesitance among medical students in Enugu, Nigeria.

METHODS: A cross-sectional study of 420 medical students at the two university teaching hospitals in Enugu. A p-value of less than .05 was considered statistically significant.

RESULTS: Only 36.1% of the respondents were willing to take the COVID-19 vaccine. Extra source of income was significantly associated with the acceptability of the COVID-19 vaccine among the students (p = .012).

CONCLUSION: COVID-19 vaccine acceptance rate among medical students in Enugu appears to be very low. There is an urgent need for more advocacy and enlightenment to address the misconceptions and fears fueling the high vaccine hesitance rate seen in the study.

PMID:36341668 | DOI:10.1353/hpu.2022.0143

Tissue Eng Part A. 2022 Nov 7. doi: 10.1089/ten.TEA.2022.0149. Online ahead of print.

ABSTRACT

The aim of this study is to investigate if a high dose of the SDF -1 plasmid improves outcome in a minipig model of chronic anal sphincter injury.

METHODS: Twenty two female minipigs underwent excision of the posterior hemi-circumference of the anal sphincter complex and were allowed to recover for 6 weeks. They were randomly allocated (n=6) to receive either 5% dextrose (sham), or 2, 4 or 8 mg of SDF-1 plasmid at the defect site. Two control pigs received no surgery/treatment. Outcome measures included anal manometry at pre-injury/pre-treatment and 2, 4 and 8 weeks after treatment, recording the mean of 8 pressure channels and the posterior channel alone, histopathology using Masson’s trichrome and immunohistochemistry using PGP9.5 for staining of neural structures and CY3 staining for blood vessels. Data is expressed as mean±standard error. Manometry analysis used two-way ANOVA followed by the Holm-Sidak test. Quantification of muscle/fibrosis was analyzed with a Kruskal-Wallis One Way Analysis of Variance on Ranks.

RESULTS: Posterior anal pressures were significantly decreased in sham treated animals compared to controls (p=0.04). In contrast, mean anal pressures at the 4 time points were not significantly different between groups. (p>0.05) The defect area of the sham treated group showed irregular muscle bundles while all three SDF-1 treatment groups show organized muscle bundles with the most organization in the higher dose groups. Quantification of Masson stained slides showed no statistically significant differences between groups but did show increased muscle volume in the area of defect in the treatment groups compared to sham. PGP9.5 and CY3 staining showed increased fluorescence in the higher dose groups compared to sham treatment.

CONCLUSION: A single higher dose of the plasmid encoding SDF-1 may increase muscle volume in the area of a chronic defect.

PMID:36341592 | DOI:10.1089/ten.TEA.2022.0149

Assessment. 2022 Nov 5:10731911221134599. doi: 10.1177/10731911221134599. Online ahead of print.

ABSTRACT

Rating scales are commonly used in psychological research and practice. It is important to consider how different item response options used on rating scales, such as those based on frequency or severity, may affect how they measure psychological constructs. In this study, participants were randomly assigned to conditions where they completed two depression and two generalized anxiety rating scales that used either frequency or severity item response options. Descriptive statistics and reliability estimates across depression and generalized anxiety scales using different item response options were similar. Measurement invariance tests indicated that depression and generalized anxiety scales with different item response options could be considered practically invariant. Finally, depression and generalized anxiety scales with different item response options had similar correlations with measures of impairment and other psychological constructs. There were essentially no differences in psychometric and measurement properties of these depression and generalized anxiety scales when using different item response options, suggesting this may not substantially affect the measurement of these constructs.

PMID:36341537 | DOI:10.1177/10731911221134599

Interspeech. 2022;2022:2018-2022. doi: 10.21437/interspeech.2022-10814.

ABSTRACT

Major Depressive Disorder (MDD) is a severe illness that affects millions of people, and it is critical to diagnose this disorder as early as possible. Detecting depression from voice signals can be of great help to physicians and can be done without any invasive procedure. Since relevant labelled data are scarce, we propose a modified Instance Discriminative Learning (IDL) method, an unsupervised pre-training technique, to extract augment-invariant and instance-spread-out embeddings. In terms of learning augment-invariant embeddings, various data augmentation methods for speech are investigated, and time-masking yields the best performance. To learn instance-spreadout embeddings, we explore methods for sampling instances for a training batch (distinct speaker-based and random sampling). It is found that the distinct speaker-based sampling provides better performance than the random one, and we hypothesize that this result is because relevant speaker information is preserved in the embedding. Additionally, we propose a novel sampling strategy, Pseudo Instance-based Sampling (PIS), based on clustering algorithms, to enhance spread-out characteristics of the embeddings. Experiments are conducted with DepAudioNet on DAIC-WOZ (English) and CONVERGE (Mandarin) datasets, and statistically significant improvements, with p-value 0.0015 and 0.05, respectively, are observed using PIS in the detection of MDD relative to the baseline without pre-training.

PMID:36341466 | PMC:PMC9634944 | DOI:10.21437/interspeech.2022-10814

Front Immunol. 2022 Oct 20;13:965550. doi: 10.3389/fimmu.2022.965550. eCollection 2022.

ABSTRACT

BACKGROUND: Although immune checkpoint inhibitors (ICIs) have become the frontline treatment option for patients with various advanced cancers due to improved survival, they can be associated with a spectrum of cutaneous immune-related adverse events (cirAEs). However, little is known regarding the occurrence and patterns of cirAE-related ICI therapy in patients of different races other than white populations. Therefore, we investigated the incidence and associated factors of cirAEs among cancer patients in northern Thailand.

METHODS: A referral-center-based ambispective cohort study was conducted from January 1, 2017, to March 31, 2021. Based on a linked database and merged patient-level data, adult patients with pathologically confirmed cancer who were diagnosed and received ICI therapy regardless of cancer type and followed up through August 31, 2021, were included. All cirAE-related ICI therapy was based on clinical evaluation and ascertainment by a board-certified dermatologist. The incidence of cirAE-related ICI therapy with confidence intervals (CIs) across cancer- and ICI therapy-specific groups was estimated. Factors associated with cirAEs were evaluated using multivariable modified Poisson regression to estimate risk ratios (RRs) and 95% CIs.

RESULTS: The study included 112 patients (67 men [59.8%]; mean age, 65.0 [range, 31.0-88.0] years), who were mainly diagnosed with lung cancer (56.3%), followed by liver cancer (19.6%). The overall incidence of cirAE-related ICI therapy was 32.1% (95% CI, 24.1-41.4); however, there was no substantial difference in sex, cancer type, or individual ICI therapy. The two identified prognostic risk factors of cirAE-related ICI therapy were age >75 years (adjusted RR, 2.13; 95% CI, 1.09-4.15; P=0.027) and pre-existing chronic kidney disease stages 3-4 (adjusted RR, 3.52; 95% CI, 2.33-5.31; P<0.001).

CONCLUSIONS: The incidence of cirAE-related ICI therapy among Thai cancer patients was comparable to that in white populations. Early identification, particularly in elderly patients and those with CKD, should be implemented in clinical practice to help optimize therapeutic decision-making and patient health outcomes.

PMID:36341419 | PMC:PMC9630333 | DOI:10.3389/fimmu.2022.965550

Front Immunol. 2022 Oct 20;13:972161. doi: 10.3389/fimmu.2022.972161. eCollection 2022.

ABSTRACT

Autoantibodies (Abs) are biomarkers for many disease conditions and are increasingly used to facilitate diagnosis and treatment decisions. To guarantee high sensitivity and specificity, the choice of their detection method is crucial. Via cell-based assays, we recently found 21 patients with neurological diseases positive for antibodies against argonaute (AGO), 10 of which having a neuropathy (NP). Here, we established a simple and conformation-sensitive ELISA with the aim to distinguish between AGO1 Abs against conformational epitopes and non-conformational epitopes and to reveal further characteristics of AGO1 antibodies in NP and autoimmune disease (AID). In a retrospective multicenter case/control and observational study, we tested 434 patients with NP, 274 disease controls with AID, and 116 healthy controls (HC) for AGO1 Abs via conformation-stabilizing ELISA. Seropositive patients were also tested for conformation-specificity via comparative denaturing/stabilizing ELISA (CODES-ELISA), CBA positivity, AGO1 titers and IgG subclasses, and AGO2 reactivity. These parameters were statistically compared among different epitope-specific patient groups. We found Abs in 44 patients, including 28/434 (6.5%) NP, 16/274 (5.8%) AID, and 0/116 (0%) HC. Serum reactivity was consistently higher for AGO1 than AGO2. Globally among the 44 AGO1 Abs-positive patients, 42 were also tested in CBA for AGO1 Abs positivity and 15 (35.7%) were positive. Furthermore, 43 were tested for conformation-specificity and 32 (74.4%) bound a conformational epitope. Among the subgroups of highly positive patients (ELISA z-score >14) with sera binding conformational epitopes (n=23), 14 patient sera were also CBA positive and 9 bound a second conformational but CBA-inaccessible epitope. A third, non-conformational epitope was bound by 11/43 (15.6%). Among the epitope-specific patient subgroups, we found significant differences regarding the Abs titers, IgG subclass, and AGO2 reactivity. When comparing AGO1 Abs-positive NP versus AID patients, we found the conformation-specific and CBA inaccessible epitope significantly more frequently in AID patients. We conclude that 1) conformational ELISA was more sensitive than CBA in detecting AGO1 Abs, 2) serum reactivity is higher for AGO1 than for AGO2 at least for NP patients, 3) AGO1 Abs might be a marker-of-interest in 6.5% of NP patients, 4) distinguishing epitopes might help finding different patient subgroups.

PMID:36341350 | PMC:PMC9630334 | DOI:10.3389/fimmu.2022.972161

Ann Stat. 2022 Oct;50(5):2793-2815. doi: 10.1214/22-aos2210. Epub 2022 Oct 27.

ABSTRACT

Multiple biomarkers are often combined to improve disease diagnosis. The uniformly optimal combination, i.e., with respect to all reasonable performance metrics, unfortunately requires excessive distributional modeling, to which the estimation can be sensitive. An alternative strategy is rather to pursue local optimality with respect to a specific performance metric. Nevertheless, existing methods may not target clinical utility of the intended medical test, which usually needs to operate above a certain sensitivity or specificity level, or do not have their statistical properties well studied and understood. In this article, we develop and investigate a linear combination method to maximize the clinical utility empirically for such a constrained classification. The combination coefficient is shown to have cube root asymptotics. The convergence rate and limiting distribution of the predictive performance are subsequently established, exhibiting robustness of the method in comparison with others. An algorithm with sound statistical justification is devised for efficient and high-quality computation. Simulations corroborate the theoretical results, and demonstrate good statistical and computational performance. Illustration with a clinical study on aggressive prostate cancer detection is provided.

PMID:36341282 | PMC:PMC9635489 | DOI:10.1214/22-aos2210

Front Med (Lausanne). 2022 Oct 20;9:994308. doi: 10.3389/fmed.2022.994308. eCollection 2022.

ABSTRACT

OBJECTIVE: This study aimed to identify trajectories of radiographic progression of the spine over time and use them, along with associated clinical factors, to develop a prediction model for patients with ankylosing spondylitis (AS).

METHODS: Data from the medical records of patients diagnosed with AS in a single center were extracted between 2001 and 2018. Modified Stoke Ankylosing Spondylitis Spinal Scores (mSASSS) were estimated from cervical and lumbar radiographs. Group-based trajectory modeling classified patients into trajectory subgroups using longitudinal mSASSS data. In multivariate analysis, significant clinical factors associated with trajectories were selected and used to develop a decision tree for prediction of radiographic progression. The most appropriate group for each patient was then predicted using decision tree analysis.

RESULTS: We identified three trajectory classes: class 1 had a uniformly increasing slope of mSASSS, class 2 showed sustained low mSASSS, and class 3 showed little change in the slope of mSASSS but highest mSASSS from time of diagnosis to after progression. In multivariate analysis for predictive factors, female sex, younger age at diagnosis, lack of eye involvement, presence of peripheral joint involvement, and low baseline erythrocyte sedimentation rate (log) were significantly associated with class 2. Class 3 was significantly associated with male sex, older age at diagnosis, presence of ocular involvement, and lack of peripheral joint involvement when compared with class 1. Six clinical factors from multivariate analysis were used for the decision tree for classifying patients into three trajectories of radiographic progression.

CONCLUSION: We identified three patterns of radiographic progression over time and developed a decision tree based on clinical factors to classify patients according to their trajectories of radiographic progression. Clinically, this model holds promise for predicting prognosis in patients with AS.

PMID:36341272 | PMC:PMC9631932 | DOI:10.3389/fmed.2022.994308

Front Med (Lausanne). 2022 Oct 19;9:1042101. doi: 10.3389/fmed.2022.1042101. eCollection 2022.

ABSTRACT

PURPOSE: To compare stereopsis and visual acuity (VA) between bilateral implantation of trifocal intraocular lenses (IOL) and blended implantation of an extended depth of focus (EDOF) IOL with a bifocal IOL.

METHODS: This is a non-randomized, prospective comparative study included 74 eyes of 37 patients who underwent phacoemulsification and bilateral implantation of AT LISA tri 839MP IOL (bilateral group; 21 patients) or blended implantation of Tecnis Symfony ZXR00 and Tecnis ZLB00 IOL (blended group; 16 patients). The primary outcomes were stereoacuity and binocular VA. The secondary outcomes were visual defocus curve, quality of life, and patient satisfaction. Follow-up was performed 3 months after the surgery.

RESULTS: The mean near stereoacuity was 49.76 ± 22.67 and 120.63 ± 90.94 seconds of arc (arcsec) in the bilateral and blended groups, respectively (P < 0.001). Near stereoacuity was positively correlated with VA difference of two eyes (r = 0.896, P < 0.001). The mean binocular uncorrected visual acuity at 40 cm, 80 cm, 5 m, and corrected distance visual acuity at 5 m of the bilateral and blended groups was not statistically significant different. The bilateral group had better VA at a vergence from -2.5 to -4.0 D. Both groups obtained high quality of life and patient satisfaction scores.

CONCLUSION: The bilateral and blended groups achieved good binocular VA, quality of life, and high patient satisfaction. However, the near stereoacuity of the blended group was worse.

PMID:36341263 | PMC:PMC9629615 | DOI:10.3389/fmed.2022.1042101