Nevin Manimala

Complement Ther Clin Pract. 2022 Mar 5;47:101571. doi: 10.1016/j.ctcp.2022.101571. Online ahead of print.

ABSTRACT

AIM: To investigate the effectiveness of dry-needling(DN) together with exercise therapy on pain, ultrasonographic parameters of myofascial trigger points(MTrPs), and upper trapezius(UT) muscles, and neck disability in patients with myofascial pain syndrome.

MATERIAL AND METHODS: This was a single-blind, prospective, randomized, and controlled trial. Participants aged 18-45 years with persistent neck pain for >3 months caused by the active MTrPs in the UT muscles were included. The exercise therapy was performed 3 times/week for 3 months. DN therapy was applied once a week, for a total of three sessions. The pain intensity, ultrasonographic measurements of the thickness of the UT muscle, and diameter of the MTrPs in the UT muscle were the primary outcomes. The secondary outcome was the neck disability.

RESULTS: Seventy participants were randomized into two groups: the dry-needling together with exercise group(DNG, n = 35) and the exercise-only group(EG, n = 35). A total of 8 participants dropped out of the study, and the study was completed with 62 participants(DNG = 33; EG = 29). There was a significant difference in terms of VAS(at night, at rest, and during activity)(p < 0.001) at post-treatment and after 3 months, the thickness of UT muscle(p = 0.004), and diameter of MTrP(p = 0.021) at post-treatment between the groups. No statistical differences were identified in terms of NDI(p = 0.065).

CONCLUSION: This study demonstrated the effects of DN applied together with exercise therapy on reduction of the pain intensity at short(post-treatment) and mid-term(after 3 months), and the ultrasonographic parameters of MTrPs and UT muscles at short-term(post-treatment).

PMID:35272249 | DOI:10.1016/j.ctcp.2022.101571

Anat Sci Educ. 2022 Mar 10. doi: 10.1002/ase.2177. Online ahead of print.

ABSTRACT

Health concerns during the Covid-19 pandemic required the adaptation of a lecture-laboratory course in ultrasound imaging for graduate students from an in-person to a live, remote learning format. The adaptation of in-person lectures to live, remote delivery was achieved by using videoconferencing. The adaptation of in-person laboratory sessions to live, remote instruction was achieved in the first half of the course by providing a hand-held ultrasound instrument to each student who performed self-scanning at their remote locations, while the instructor provided live instruction using videoconferencing. In the second half of the course, the students transitioned to using cart-based, hospital-type instruments and self-scanning in the ultrasound laboratory on campus. The aim of this study was to measure the success of this adaptation to the course by comparing assessment scores of students in the live, remote course with assessment scores of students in the in-person course offered in the previous year. There were no statistically significant differences in the assessment scores of students in the two courses. The adaptation of a course in ultrasound imaging from an in-person to a live, remote learning format during the Covid-19 pandemic described here suggests that contrary to the prevailing view, ultrasound imaging can be taught to students without in-person instruction. The adapted course can serve as a model for teaching ultrasound where instructors and learners are physically separated by constraints other than health concerns during a pandemic.

PMID:35271761 | DOI:10.1002/ase.2177

Med Phys. 2022 Mar 10. doi: 10.1002/mp.15596. Online ahead of print.

ABSTRACT

PURPOSE: A novel phantom-imaging platform, a set of software tools, for automated and high precision imaging of the American College of Radiology (ACR) PET phantom for PET/MR and PET/CT systems is proposed.

METHODS: The key feature of this platform is the vector graphics design which facilitates the automated measurement of the knife-edge response function and hence image resolution, using composite volume of interest (VOI) templates in a 0.5 mm resolution grid applied to all inserts of the phantom. Furthermore, the proposed platform enables the generation of an accurate μ-map for PET/MR systems with a robust alignment based on two-stage image registration using specifically designed PET templates. The proposed platform is based on the open-source NiftyPET software package used to generate multiple list-mode data bootstrap realisations and image reconstructions to determine the precision of the two-stage registration and any image-derived statistics. For all the analyses, iterative image reconstruction was employed with and without modelled shift-invariant point spread function (PSF) and with varying iterations of the ordered subsets expectation maximisation (OSEM) algorithm. The impact of the activity outside the field of view (FOV) was assessed using two acquisitions of 30 minutes each, with and without the activity outside the FOV.

RESULTS: The utility of the platform has been demonstrated by providing a standard and an advanced phantom analysis including the estimation of spatial resolution using all cylindrical inserts. In the imaging planes close to the edge of the axial FOV, we observed deterioration in the quantitative accuracy, reduced resolution (FWHM increased by 1 – 2 mm), reduced contrast and background uniformity due to the activity outside the FOV. Although it slows convergence, the PSF reconstruction had a positive impact on resolution and contrast recovery, but the degree of improvement depended on the regions. The uncertainty analysis based on bootstrap resampling of raw PET data indicated high precision of the two-stage registration.

CONCLUSIONS: We demonstrated that phantom imaging using the proposed methodology with the metric of spatial resolution and multiple bootstrap realisations may be helpful in more accurate evaluation of PET systems as well as in facilitating fine tuning for optimal imaging parameters in PET/MR and PET/CT clinical research studies. This article is protected by copyright. All rights reserved.

PMID:35271742 | DOI:10.1002/mp.15596

Clin Pharmacol Ther. 2022 Mar 10. doi: 10.1002/cpt.2578. Online ahead of print.

ABSTRACT

Asthma is a chronic disease of the lungs characterized by airway inflammation, bronchoconstriction, and increased airway responsiveness. Forced Expiratory Volume in the first second (FEV1) is used as a measure of lung function and to help diagnose and monitor lung diseases including asthma. An exponential longitudinal model has been previously developed to adequately describe the FEV1 response in asthma patients with placebo. This model was the basis of a longitudinal model-based meta-analysis which was undertaken to describe the trough FEV1 responses ranging up to 1 year from nine clinical studies in asthma population (N=3896), following placebo, dual (Fluticasone Furoate/Vilanterol) and triple combinations (Fluticasone Furoate/ Umeclidinium /Vilanterol) given via inhalation. Numerical, graphical and simulation-based diagnostics showed that a Weibull model adequately characterized the longitudinal trough FEV1 response with time. Automatic covariate selection supported by statistically based regression models identified a range of patient characteristics influencing the model parameters. Race was a significant covariate on baseline but not on the parameters that impact the FEV1 trajectory. Based on the trough FEV1, all active treatments were found to be significantly different when compared to placebo and showed clinically meaningful improvement in FEV1. The model was able to predict the longitudinal FEV1 response in Chinese patients with inadequately controlled asthma and was used to provide additional support with respect to the design for a shorter duration Phase 3 study to China National Medical Products Administration (NMPA).

PMID:35271735 | DOI:10.1002/cpt.2578

J Am Med Inform Assoc. 2022 Mar 10:ocac034. doi: 10.1093/jamia/ocac034. Online ahead of print.

ABSTRACT

OBJECTIVE: Clinicians spend significant time working in the electronic health record (EHR). The US is an outlier in EHR time, suggesting that EHR-related work may be driven in part by the legal environment and threat of malpractice. To assess this, we evaluate the association between state-level malpractice climate and clinician time spent in the EHR.

MATERIALS AND METHODS: We use EHR metadata from 351 ambulatory care health systems in the United States using Epic from January-August 2019 combined with state-level data on malpractice incidence and payouts. We used descriptive statistics to measure variation in clinician EHR time, including total EHR time, documentation time per day, and after-hours EHR time per day. Multi-variable regression evaluated the association between clinicians in high malpractice states and EHR use.

RESULTS: We found no association between location in a state in the top-quartile of malpractice payouts and time spent in the EHR per day, time spent in the EHR outside of scheduled hours, or time spent documenting per day, except for a subgroup of the clinicians in the highest malpractice specialties, where there was a small increase in EHR time per day (B = 6.08 min, P < 0.001) and time spent documenting notes (B = 2.77 min, P < 0.001).

DISCUSSION: State-level differences in malpractice incidence are unlikely to be a significant driver of EHR work for most clinicians.

CONCLUSION: Policymakers seeking to address EHR documentation burden should examine burden driven by other socio-technical demands on clinician time, such as billing or quality measurement.

PMID:35271723 | DOI:10.1093/jamia/ocac034

Arch Pathol Lab Med. 2022 Mar 10. doi: 10.5858/arpa.2021-0223-CP. Online ahead of print.

ABSTRACT

CONTEXT.—: The College of American Pathologists (CAP) updated the Laboratory Accreditation Program Cytopathology Checklist to assist laboratories in meeting and exceeding the Clinical Laboratory Improvement Amendments standards for gynecologic cytologic-histologic correlation (CHC).

OBJECTIVE.—: To survey the current CHC practices.

DESIGN.—: Data were analyzed from a survey developed by the committee and distributed to participants in the CAP Gynecologic Cytopathology PAP Education Program mailing.

RESULTS.—: Worldwide, CHC practice is nearly universally adopted, with an overall rate of 87.0% (568 of 653). CHC material was highly accessible. CHC was commonly performed real time/concurrently at the time the corresponding surgical pathology was reviewed. Investigation of CHC discordances varied with North American laboratories usually having a single pathologist review all discrepant histology and cytology slides to determine the reason for discordance, while international laboratories have a second pathologist review histology slides to determine the reason for discordance. The cause of CHC discordance was primarily sampling issues. The more common statistical metrics for CHC monitoring were the total percentage of cases that correlated with subsequent biopsies, screening error rate by cytotechnologist, and interpretative error rate by cytotechnologist.

CONCLUSIONS.—: Many laboratories have adopted and implemented the CHC guidelines with identifiable differences in practices between North American and international laboratories. We identify the commonalities and differences between North American and international institutional practices including where CHC is performed, how CHC cases are identified and their accessibility, when CHC is performed, who investigates discordances, what discordances are identified, and how the findings affect quality improvement.

PMID:35271691 | DOI:10.5858/arpa.2021-0223-CP

PLoS One. 2022 Mar 10;17(3):e0265063. doi: 10.1371/journal.pone.0265063. eCollection 2022.

ABSTRACT

BACKGROUND: Considering perinatal transmission and the high rate of chronic hepatitis B virus (HBV) infection in infants, diagnosis of HBV infection during pregnancy and timely interventions are of great importance. Therefore, this study was performed to investigate the prevalence and genotype distribution of HBV infection and the associated risk factors among pregnant women in the northern shores of the Persian Gulf, South of Iran.

METHODS: Serum samples of 1425 pregnant women were tested for the presence of HBsAg and HBcAb by ELISA (HBsAg one-Version ULTRA and HBc Ab ELISA kits, DIA.PRO, Milan, Italy). The seropositive samples were tested for the presence of HBV DNA by nested PCR, targeting S, X, pre-core (pre-C), and basal core promoter (BCP) regions of the HBV genome. The amplified fragments were sequenced by Sanger dideoxy sequencing technology to evaluate the genotype distribution and mutations of HBV infection by using the MEGA 7 software. The HBV seropositive pregnant women were tested for HCV and HIV coinfections by ELISA (HCV Ab and HIV Ab/Ag ELISA kits, DIA.PRO, Milan, Italy).

RESULTS: Of 1425 participants, 15 pregnant women (1.05%, 95% CI: 0.64%-1.73%) were positive for HBsAg, 41 women (2.88%, 95% CI: 2.10%-3.88%) were positive for HBcAb, and 5 women (0.35%, 95% CI: 0.15% -0.82%) had HBV viremia with genotype D, sub-genotype D3 and subtype ayw2. One of the viremic samples was positive for HBcAb but negative for HBsAg, which is indicative of an occult HBV infection. HBsAg seroprevalence was higher among pregnant women aged 20 to 29 years, women in the third trimester of pregnancy, residents of Khormuj city, Afghan immigrants, illiterate women, and pregnant women with a history of tattoo and HBV vaccination. The highest rate of HBcAb seroprevalence was observed in residents of Borazjan city, Turk ethnicity, the age group >39 years, and those women with more parities and a history of abortion. Nevertheless, HBV seroprevalence among pregnant women was not statistically associated with these variables. In contrast, HBcAb seropositivity was significantly associated with the history of tattoo (P = 0.018). According to mutations analyses, seven amino acid substitutions in the HBsAg, one point mutation in the pre-C region, and five points mutations in the BCP region were detected. Besides, the BCP mutations caused amino acid substitutions in the X protein. Of note, the conversion of Ala → Val at amino acid 168 (A168V) and Thr → Pro at amino acid 127 (T127P) were detected in HBsAg of the occult HBV strain.

CONCLUSION: These results indicate a relatively low prevalence of HBV infection among pregnant women in the South of Iran, while tattooing is a risk factor for exposure to HBV infection. Moreover, all of the HBV-positive pregnant women were asymptomatic and unaware of their infection. Therefore, routine screening for HBV markers during pregnancy, appropriate treatment of HBV-infected women, and HBV vaccination are recommended to decrease mother-to-child transmission of HBV.

PMID:35271684 | DOI:10.1371/journal.pone.0265063

PLoS One. 2022 Mar 10;17(3):e0265255. doi: 10.1371/journal.pone.0265255. eCollection 2022.

ABSTRACT

Traditional body measurement techniques are commonly used to assess physical health; however, these approaches do not fully represent the complex shape of the human body. Three-dimensional (3D) imaging systems capture rich point cloud data that provides a representation of the surface of 3D objects and have been shown to be a potential anthropometric tool for use within health applications. Previous studies utilising 3D imaging have only assessed body shape based on combinations and relative proportions of traditional body measures, such as lengths, widths and girths. Geometric morphometrics (GM) is an established framework used for the statistical analysis of biological shape variation. These methods quantify biological shape variation after the effects of non-shape variation-location, rotation and scale-have been mathematically held constant, otherwise known as the Procrustes paradigm. The aim of this study was to determine whether shape measures, identified using geometric morphometrics, can provide additional information about the complexity of human morphology and underlying mass distribution compared to traditional body measures. Scale-invariant features of torso shape were extracted from 3D imaging data of 9,209 participants form the LIFE-Adult study. Partial least squares regression (PLSR) models were created to determine the extent to which variations in human torso shape are explained by existing techniques. The results of this investigation suggest that linear combinations of body measures can explain 49.92% and 47.46% of the total variation in male and female body shape features, respectively. However, there are also significant amounts of variation in human morphology which cannot be identified by current methods. These results indicate that Geometric morphometric methods can identify measures of human body shape which provide complementary information about the human body. The aim of future studies will be to investigate the utility of these measures in clinical epidemiology and the assessment of health risk.

PMID:35271672 | DOI:10.1371/journal.pone.0265255

PLoS One. 2022 Mar 10;17(3):e0265262. doi: 10.1371/journal.pone.0265262. eCollection 2022.

ABSTRACT

BACKGROUND: Due to the effectiveness of insecticide-treated nets (ITNs), most malaria-endemic countries resort to free distributions in the population with particular attention to pregnant women, a more vulnerable group. However, the mere issuance of ITNs does not usually translate to proper utilization. This study aimed to examine the utilization of ITNs and its associated factors among pregnant women in Myanmar.

METHODS: The data analyzed in this cross-sectional study were extracted from available survey datasets of the 2015-16 Myanmar Demographic Health Survey. The secondary data were presented using a chart, descriptive statistics and inferential statistics including simple and multiple logistic regression models. All analyses were performed using STATA, Version 15. A p-value <0.05 was considered statistically significant.

RESULTS: Of 466 currently pregnant women, the majority (96%) possessed bed nets for sleeping. Among them, 15.9% slept without a bed net the night before the survey, while 65.7% slept with untreated nets. Only about 1 in 5 (18.4%) slept under ITNs. In the multivariate logistic regression analysis, pregnant women residing in delta and lowland regions [adjusted odds ratio (aOR) = 7.70, 95% confidence interval (CI): 3.62, 16.38], plains (aOR = 7.09, 95%CI: 3.09, 16.25) or hilly areas (aOR = 4.26, 95%CI: 1.91, 9.52) were more likely to report non-utilization of ITNs than those residing in coastal regions.

CONCLUSION: Relatively poor ITN utilization was observed among pregnant women in Myanmar. Health promotion activities for ITN utilization should be implemented especially for pregnant women residing in the delta, lowland, plain and hilly regions. Other social-behavioral factors including perceived susceptibility to malaria, knowledge of ITNs, and attitude towards ITN that might favor the non-utilization of ITNs need to be further explored.

PMID:35271668 | DOI:10.1371/journal.pone.0265262