Nevin Manimala

Acad Emerg Med. 2021 Nov 5. doi: 10.1111/acem.14412. Online ahead of print.

ABSTRACT

BACKGROUND: Emergency Department (ED) visits are known to be anxiety-ridden and stress-provoking experiences especially in the pediatric population. Distraction techniques have been used as a means to reduce anxiety and stress thereby facilitating care in the ED and making the visit less unpleasant. Our study aimed to evaluate the effectiveness of an active and immersive distraction technique, using a mindfulness-based virtual reality (VR) program (Take-Pause), to alleviate anxiety in pediatric ED patients.

METHODS: A prospective, randomized, single-blinded study, evaluating ED patients aged 13-17 years with a chief complaint of acute pain was conducted. Patients were randomized to either the active distraction intervention (VR group), utilizing the VR headset for 5 minutes; or to the passive distraction intervention (iPad group), playing on an iPad for 5 minutes. The primary outcome was a difference in the change in anxiety scores on the Spielberger State-Trait Anxiety Inventory between the two groups. Secondary outcomes included a difference in pain scores, respiratory rate (RR) and heart rate (HR) between the groups.

RESULTS: A total of 110 subjects were enrolled. At 15 minutes, the mean anxiety score for the VR group improved by 10 points vs. 6 points in the iPad group (P<.001; 95% CI: .44 to 7.6). There was no statistical significance in the reduction of pain scores (p=.953) and RR’s (p= .776) between the groups. Patients enrolled in both groups did not experience any adverse effects.

CONCLUSION: Take-Pause, offering an active and immersive distraction technique, is more effective than a passive distraction approach to lower anxiety levels in adolescent ED patients.

PMID:34741370 | DOI:10.1111/acem.14412

J Sleep Res. 2021 Nov 6:e13512. doi: 10.1111/jsr.13512. Online ahead of print.

ABSTRACT

Previous work has shown that both long and short sleep duration is associated with increased mortality, with lowest risk around 7 hr. This has had widespread impact on views on the optimal sleep duration. However, age, being employed/retired, and blue-/white-collar status, may influence the time available for sleep and thus, confound the association. We investigated the role of these factors on the association between sleep duration and mortality. We used employed and retired participants (N = 25,430) from the Swedish National March Cohort and Cox proportional hazards regression to model the shape of the association. We found a significant U-shaped association in a multivariable model with a hazard ratio (HR) of 1.24 (95% confidence interval [CI] 1.10, 1.39) for <5-hr sleep duration, and a HR of 1.30 (95% CI 1.12, 1.51) for ≥9-hr sleep duration, with the lowest HR for 7 hr, but with a span of low HRs from 5 to 8 hr. Unadjusted values showed a pronounced U-shape. Adjusting for age accounted for most of the attenuation in the multivariable model. Stratification into five age groups showed a significant U-shape only in those aged >60.3 years at baseline. The shape of the association did not differ between blue-/white-collar workers, nor between employed and retired groups. We conclude that the U-shaped association between sleep duration and mortality is present only in older individuals.

PMID:34741361 | DOI:10.1111/jsr.13512

Med Phys. 2021 Nov 6. doi: 10.1002/mp.15325. Online ahead of print.

ABSTRACT

PURPOSE: Gadolinium-based contrast agents (GBCAs) may add value to Magnetic Resonance (MR)-only radiotherapy workflows including on hybrid machines such as the MR Linac. The impact of GBCAs on radiotherapy dose distributions however have not been well studied. This work used retrospective GBCA-enhanced datasets to assess the dosimetric effect of GBCAs on head and neck plans.

METHODS: Ten patients with oropharyngeal SCC receiving radiotherapy from November 2018-April 2020 were included in this study. Radiotherapy planning included contrast-enhanced CT and MR scans. A contrast agent ‘contour’ was defined by delineating GBCA-enhanced regions using an agreed window/level threshold, transferred to the planning CT and given a standardised electron density (ED) of 1.149 in the Monaco treatment planning system (Elekta AB). Four plans were per patient calculated and compared using two methods: (1) optimised without contrast (Plan A) then recalculated with ED (Plan B), and (2) optimised with contrast ED (Plan C) then without (Plan D). For target parameters minimum and maximum doses to 1cc of PTVs, D₉₅ values, and percent dose differences were calculated. Dose differences for OARs were calculated as a percentage of the clinical tolerance value. For the purposes of this study, ±2% over the whole treatment course was considered to be a clinically acceptable dose deviation. Wilcoxon-signed rank tests were used to determine any dose differences within and between the two methods of optimisation and recalculation (p < 0.05). Pearson’s correlations were used to establish the relationship between gadolinium uptake volume in a structure (i.e. proportion of structure covered by a density override) and the resulting dose difference.

RESULTS: The median percent dose differences for key reportable dosimetric parameters between non-contrast and simulated contrast plans were <1.2% over all fractions over all patients for reportable target parameters (mean 0.34%, range 0.22-1.02%). The percent dose differences for max dose to 1cc of both PTV1 and PTV2 were significantly different after application of density override (p < 0.05) but only in method 2 (Plan C vs Plan D). For D₉₅ PTV1 there was a statistically significant effect of density override (p < 0.01), however only in method 1 (Plan A vs Plan B). There were no significant differences between calculation methods of the impact of contrast in most target parameters with the exception of D₉₅ PTV1 (p < 0.01), and for D₉₅ PTV2 (p < 0.05). The median percent dose differences for reportable OAR parameters as a percentage of clinical planning tolerances were <2.0% over a full treatment course (mean 0.65%, range 0.27-1.62%). There were no significant differences in dose to OARs within or between methods for contrast impact assessment.

CONCLUSIONS: Dose differences to targets and OARs in oropharyngeal cancer treatment due to a presence of GBCA were minimal and this work suggests that prospective in vivo evaluations of impact may not be necessary in this clinical site. Accounting for GBCAs may not be needed in daily adaptive workflows on the MR Linac. This article is protected by copyright. All rights reserved.

PMID:34741308 | DOI:10.1002/mp.15325

Psychon Bull Rev. 2021 Nov 5. doi: 10.3758/s13423-021-02010-y. Online ahead of print.

ABSTRACT

Research on visual word identification has extensively investigated the role of morphemes, recurrent letter chunks that convey a fairly regular meaning (e.g., lead-er-ship). Masked priming studies highlighted morpheme identification in complex (e.g., sing-er) and pseudo-complex (corn-er) words, as well as in nonwords (e.g., basket-y). The present study investigated whether such sensitivity to morphemes could be rooted in the visual system sensitivity to statistics of letter (co)occurrence. To this aim, we assessed masked priming as induced by nonword primes obtained by combining a stem (e.g., bulb) with (i) naturally frequent, derivational suffixes (e.g., -ment), (ii) non-morphological, equally frequent word-endings (e.g., -idge), and (iii) non-morphological, infrequent word-endings (e.g., -kle). In two additional tasks, we collected interpretability and word-likeness measures for morphologically-structured nonwords, to assess whether priming is modulated by such factors. Results indicate that masked priming is not affected by either the frequency or the morphological status of word-endings, a pattern that was replicated in a second experiment including also lexical primes. Our findings are in line with models of early visual processing based on automatic stem/word extraction, and rule out letter chunk frequency as a main player in the early stages of visual word identification. Nonword interpretability and word-likeness do not affect this pattern.

PMID:34741277 | DOI:10.3758/s13423-021-02010-y

Brain Imaging Behav. 2021 Nov 5. doi: 10.1007/s11682-021-00562-0. Online ahead of print.

ABSTRACT

The locus coeruleus is the main noradrenergic nucleus of the brain and is often affected in neurodegenerative diseases. Recently, magnetic resonance imaging with specific T1-weighted sequences for neuromelanin has been used to evaluate locus coeruleus integrity in patients with these conditions. In some of these studies, abnormalities in locus coeruleus signal have also been found in healthy controls and related to ageing. However, this would be at variance with recent post-mortem studies showing that the nucleus is not affected during normal ageing. The present study aimed at evaluating locus coeruleus features in a well-defined cohort of cognitively healthy subjects who remained cognitively intact on a one-year follow-up. An ad-hoc semiautomatic analysis of locus coeruleus magnetic resonance was applied. Sixty-two cognitively intact subjects aged 60-80 years, without significant comorbidities, underwent 3 T magnetic resonance with specific sequences for locus coeruleus. A semi-automatic tool was used to estimate the number of voxels belonging to locus coeruleus and its intensity was obtained for each subject. Each subject underwent extensive neuropsychological testing at baseline and 12 months after magnetic resonance scan. Based on neuropsychological testing 53 subjects were cognitively normal at baseline and follow up. No significant age-related differences in locus coeruleus parameters were found in this cohort. In line with recent post-mortem studies, our in vivo study confirms that locus coeruleus magnetic resonance features are not statistically significantly affected by age between 60 and 80 years, the age range usually evaluated in studies on neurodegenerative diseases. A significant alteration of locus coeruleus features in a cognitively intact elderly subject might be an early sign of pathology.

PMID:34741273 | DOI:10.1007/s11682-021-00562-0

Environ Sci Pollut Res Int. 2021 Nov 5. doi: 10.1007/s11356-021-16937-1. Online ahead of print.

ABSTRACT

The groundwater environment changes under the influence of anthropogenic activities. Because of the construction of the Da’an irrigation area, the amount of irrigation and fertilizer there has changed. Achieving the coordinated development of groundwater resources and economic benefits requires a deeper understanding of the impact of the construction of irrigation areas on groundwater chemistry. In this study, the variations in groundwater chemistry characteristics were studied using statistics and hydrogeochemical methods. Further, the groundwater quality was assessed using the support vector machine method. The results show that the primary water chemistry type was the HCO₃ – Ca – Mg type, with local Fe³⁺ and F^– pollution. After the construction of irrigation area, the SO₄^2-, HCO₃^–, K⁺ + Na⁺, and Ca²⁺ contents decreased, but the Cl^– and Mg²⁺ contents increased. The main nitrogen source in phreatic water was anthropogenic activities, and the main pollution component was NH₄⁺. After the construction of the irrigation area, the NH₄⁺ concentration increased significantly, and the ratio of samples exceeding the standard increased by 37.5%. The over-standard regions spread to the northwest, east, and southeast of Da’an City and east and southeast of the irrigation area. The groundwater quality was predominantly grade IV and V, which accounted for an increase of 16.35%, widely distributed in the south, east, and southwest of the irrigation area and urban areas. The construction of the irrigation area reduced the suitability of phreatic water for agricultural irrigation in the southeast but increased in the west and north.

PMID:34741265 | DOI:10.1007/s11356-021-16937-1

Sleep Breath. 2021 Nov 5. doi: 10.1007/s11325-021-02493-y. Online ahead of print.

ABSTRACT

PURPOSE: Although polysomnography (PSG) is the gold standard for monitoring sleep, it has many limitations. We aimed to prospectively determine the validity of wearable sleep-tracking devices and smartphone applications by comparing the data to that of PSGs.

METHODS: Patients who underwent one night of attended PSG at a single institution from January, 2015 to July 2019 were recruited. Either a sleep application or wearable device was used simultaneously while undergoing PSG. Nine smartphone applications and three wearable devices were assessed.

RESULTS: We analyzed the results of 495 cases of smartphone applications and 170 cases of wearables by comparing each against PSG. None of the tested applications were able to show a statistically significant correlation between sleep efficiency, durations of wake time, light sleep or deep sleep with PSG. Snore time correlated well in both of the two applications which provided such information. Deep sleep duration and WASO measured by two of the three wearable devices correlated significantly with PSG. Even after controlling for transition count and moving count, the correlation indices of the wearables did not increase, suggesting that the algorithms used by the wearables were not largely affected by tossing and turning.

CONCLUSIONS: Most of the applications tested in this study showed poor validity, while wearable devices mildly correlated with PSG. An effective use for these devices may be as a tool to identify the change seen in an individual’s sleep patterns on a day-to-day basis, instead of as a method of detecting absolute measurements.

PMID:34741243 | DOI:10.1007/s11325-021-02493-y

J Neurol. 2021 Nov 5. doi: 10.1007/s00415-021-10881-3. Online ahead of print.

ABSTRACT

Pandemic restrictions have led to changes in therapy plans and disrupted rehabilitation services for people with multiple sclerosis. CogEx is an international, multicentre MS dual-intervention (cognitive rehabilitation, aerobic exercise) randomized, controlled rehabilitation trial confined to people with progressive disease. The primary outcome is cognition (processing speed).There are 11 treatment sites in six countries with participants required to make 27 site visits over 12 weeks. Collectively, the large, in-person demands of the trial, and the varying international policies for the containment of COVID-19, might disproportionately impact the administration of CogEx. During the first lockdown, all centres closed on average for 82.9 (SD = 24.3) days. One site was required to lockdown on two further occasions. One site remained closed for 16 months. Ten staff (19.2%) were required to quarantine and eight staff (15.4%) tested positive for COVID. 10 of 264 (3.8%) participants acquired COVID-19. All survived. The mean duration of enrollment delay has been [236.7 (SD = 214.5) days]. Restarting participants whose interventions were interrupted by the pandemic meant recalculating the intervention prescriptions for these individuals. While the impact of the pandemic on CogEx has been considerable, all study sites are again open. Participants and staff have shown considerable flexibility and resilience in keeping a complex, international endeavour running. The future in general remains uncertain in the midst of a pandemic, but there is cautious optimism the study will be completed with sufficient sample size to robustly evaluate our hypothesis and provide meaningful results to the MS community on the impact of these interventions on people with progressive MS.Trial registration: The trial was registered on September 20th 2018 at www.clinicaltrials.gov having identifier NCT03679468. Registration was performed before recruitment was initiated.

PMID:34741240 | DOI:10.1007/s00415-021-10881-3

Lung. 2021 Nov 6. doi: 10.1007/s00408-021-00490-2. Online ahead of print.

ABSTRACT

Pulmonary hypertension (PH) is associated with decreased survival in patients with pulmonary fibrosis and combined pulmonary fibrosis and emphysema. Main pulmonary artery (PA) diameter and PA diameter/ascending aortic diameter (PA/AA) ratio, as measured on CT, have recently emerged as specific markers for PH. Our single-center retrospective study found that PA/AA ratio > 1 is associated with decreased survival in individuals with pulmonary fibrosis, with or without emphysema. Our study also describes markers of cardiac remodeling, and the echocardiographic diagnosis of PH in this patient population.

PMID:34741227 | DOI:10.1007/s00408-021-00490-2

J Clin Pediatr Dent. 2021 Nov 1;45(5):298-305. doi: 10.17796/1053-4625-45.5.2.

ABSTRACT

OBJECTIVE: The aim of this study is to evaluate the relationship between packaged product label and medication package insert reading habits of parents and their children’s oral/dental health.

STUDY DESIGN: A questionnaire including demographic characteristics and label/insert reading habits was filled by parents of 301 children who referred to the Pediatric Dentistry Department. The children were examined intraorally and dmft/DMFT and ICDAS II scores were recorded. The data were evaluated statistically.

RESULTS: Label and medication package insert reading were found in 71.4% and 88.4% of the parents, respectively. Label reading increased as the age of the child and the number of children in the family increased. Medical package insert reading increased as the mother’s education and SLS/paraben knowledge increased. Decrease of 1 point in ICDAS II resulted in the 1.410 times increase in the rate of medical package insert reading of the parents.

CONCLUSION: It is concluded that improving the label and medical insert reading rate of the parents would be effective for providing better oral and dental health for their children.

PMID:34740268 | DOI:10.17796/1053-4625-45.5.2