Nevin Manimala

JMIR Form Res. 2022 Jul 21;6(7):e35197. doi: 10.2196/35197.

ABSTRACT

BACKGROUND: Adolescents’ consumption of healthy foods is suboptimal in low- and middle-income countries. Adolescents’ fondness for games and social media and the increasing access to smartphones make apps suitable for collecting dietary data and influencing their food choices. Little is known about how adolescents use phones to track and shape their food choices.

OBJECTIVE: This study aimed to examine the acceptability, usability, and likability of a mobile phone app prototype developed to collect dietary data using artificial intelligence-based image recognition of foods, provide feedback, and motivate users to make healthier food choices. The findings were used to improve the design of the app.

METHODS: A total of 4 focus group discussions (n=32 girls, aged 15-17 years) were conducted in Vietnam. Qualitative data were collected and analyzed by grouping ideas into common themes based on content analysis and ground theory.

RESULTS: Adolescents accepted most of the individual- and team-based dietary goals presented in the app prototype to help them make healthier food choices. They deemed the overall app wireframes, interface, and graphic design as acceptable, likable, and usable but suggested the following modifications: tailored feedback based on users’ medical history, anthropometric characteristics, and fitness goals; new language on dietary goals; provision of information about each of the food group dietary goals; wider camera frame to fit the whole family food tray, as meals are shared in Vietnam; possibility of digitally separating food consumption on shared meals; and more appealing graphic design, including unique badge designs for each food group. Participants also liked the app’s feedback on food choices in the form of badges, notifications, and statistics. A new version of the app was designed incorporating adolescent’s feedback to improve its acceptability, usability, and likability.

CONCLUSIONS: A phone app prototype designed to track food choice and help adolescent girls from low- and middle-income countries make healthier food choices was found to be acceptable, likable, and usable. Further research is needed to examine the feasibility of using this technology at scale.

PMID:35862147 | DOI:10.2196/35197

Hypertension. 2022 Jul 18:101161HYPERTENSIONAHA12219568. doi: 10.1161/HYPERTENSIONAHA.122.19568. Online ahead of print.

ABSTRACT

BACKGROUND: Poorly controlled hypertension is a great challenge to global public health. Incentive approaches, based on behavioral and economic concepts, may improve patients’ adherence to treatment.

METHODS: We conducted a 2-arm randomized controlled trial to test whether financial incentives can help patients with poorly controlled hypertension in China reduce their blood pressure (BP). Participants were randomized 1:1 to the control and intervention groups. All participants received WeChat-based standard education and support for hypertension management. The intervention group received financial incentives, including process- and outcome-based incentives.

RESULTS: No statistically significant differences in BP reduction and hypertension control rates were found between the two groups from baseline to 12-month follow-up. Mean systolic BP decreased from 158.7 to 149.8 mm Hg in the intervention group and 159.7 to 149.5 mm Hg in the control group (P=0.639). Mean diastolic BP decreased from 93.7 to 86.6 mm Hg in the intervention group and 93.9 to 86.3 mm Hg in the control group (P=0.667). Hypertension control rates in the intervention and control groups were 20.8% and 15.8%, respectively (P=0.318). Medication adherence was 84.2% in the intervention group and 86.2% in the control group (P=0.705).

CONCLUSIONS: Financial incentives were effective in the short term for BP control, but a sustained effect of incentive-based BP control was not identified beyond 3 months of intervention. Future studies that focus on identifying the appropriate amount and structure of financial incentives for BP control are warranted.

REGISTRATION: URL: xxx; Unique identifier: ISRCTN13467677.

PMID:35862120 | DOI:10.1161/HYPERTENSIONAHA.122.19568

Am Psychol. 2022 Jul 21. doi: 10.1037/amp0001033. Online ahead of print.

ABSTRACT

Memorializes Jim Sidanius (née James Brown [1945-2021]), one of the the foremost social and political psychologists of his generation. His theory of social dominance redefined the scientific study of intergroup relations, advancing novel hypotheses regarding the causes and consequences of intergroup conflict and inequality by integrating insights across the social and biological sciences. Jim’s theoretical insights were matched only by his empirical prowess; he was a master at analyzing large data sets with advanced statistical methods, methods that he taught to hundreds of doctoral students over the years in his notoriously challenging but rewarding graduate statistics courses at the University of California, Los Angeles (UCLA), and Harvard. Beyond his teaching of statistics and advanced topics in social psychology and African American studies, Jim mentored dozens of aspiring intergroup relations scholars over a 44-year career. As one of few Black social psychologists, he served as a role model for young Black scholars in particular. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PMID:35862108 | DOI:10.1037/amp0001033

Plast Reconstr Surg. 2022 Jul 22. doi: 10.1097/PRS.0000000000009537. Online ahead of print.

ABSTRACT

BACKGROUND: Implant-based breast reconstruction has evolved, with a recent resurgence of prepectoral techniques. Comparative reconstructive outcomes and complications have not been fully elucidated among the total submuscular (TSM), dual-plane (DP), and prepectoral planes of implant placement.

METHODS: All immediate implant-based breast reconstructions from March 2017 through August 2019 were retrospectively reviewed. Cases were divided into TSM, DP, and prepectoral cohorts. Demographics, operative techniques, and reconstructive outcomes and complications were compared among groups.

RESULTS: 826 cases (510 patients) were identified and divided into TSM (n=392), DP (n=358), and prepectoral (n=76) cohorts. Average follow-up for all patients was 27 months. The prepectoral cohort had a higher average BMI and rate of prior reduction/mastopexy. Overall complications were lowest in the TSM group, though this difference was not statistically significant. Major infection occurred more frequently in the DP group compared to the TSM cohort. The prepectoral cohort had a significantly increased incidence of wound dehiscence than the TSM group, while both the dual-plane and prepectoral groups had higher rates of seroma formation and explantation compared to TSM.

CONCLUSIONS: Overall reconstructive complication rates were comparable among the cohorts. Compared to those undergoing TSM reconstruction, the DP cohort was more likely to develop a major infection or require explantation, while the prepectoral group had significantly higher rates of isolated dehiscence, seroma formation, and explantation. This suggest that the absence of overlying vascularized muscle may lead to an inherent inability to tolerate wound healing complications, though further research is needed to clarify these observations.

PMID:35862095 | DOI:10.1097/PRS.0000000000009537

Plast Reconstr Surg. 2022 Jul 22. doi: 10.1097/PRS.0000000000009532. Online ahead of print.

ABSTRACT

BACKGROUND: Multiple studies have analyzed the impact of co-morbidities on breast reduction surgery with mixed results. The purpose of this investigation was to perform a statistical analysis of all complications by a single surgeon, using a single technique for breast reduction.

METHODS: Records of patients undergoing breast reduction from 1984 to 2019 with an inferior pedicle were reviewed. Co-morbidities analyzed included hypertension, diabetes, nicotine use, weight of breast tissue resected, pedicle length and basal metabolic index. The literature on the effects of comorbidities on outcomes for breast reconstruction were also reviewed.

RESULTS: Although increasing BMI significantly increased the rate of fat necrosis, it did not impact those patients requiring reoperation for this complication. BMI greater than 35, weight of tissue resection greater than 1000gm, and nipple to inframammary fold distance greater than 20cm all increased the odds ratio of having a breast with some fat necrosis. Increasing BMI increased the risk of wound healing problems (both major and minor), but not for patients requiring reoperation. BMI greater than 35, breast tissue resection greater than 1000gm, and nipple to fold distance greater than 20 only minimally increased the odds ratio for a major wound complication.

CONCLUSIONS: Patients with increased BMI are at greater risk for fat necrosis and wound healing complications. However, these usually can be managed conservatively in patients undergoing inferior pedicle breast reduction. Patients do not require free nipple grafting. The use of nicotine, presence of diabetes or hypertension does not impact outcome.

PMID:35862089 | DOI:10.1097/PRS.0000000000009532

Psychol Trauma. 2022 Jul 21. doi: 10.1037/tra0001316. Online ahead of print.

ABSTRACT

OBJECTIVE: Bayesian meta-analyses offer several advantages over traditional approaches, including improved accuracy when using a small number of studies and enhanced estimation of heterogeneity. However, psychological trauma research has yet to see widespread adoption of these statistical methods, potentially due to researchers’ unfamiliarity with the processes involved. The purpose of this article is to provide a practical tutorial for conducting random-effects Bayesian meta-analyses.

METHOD: Explanations and recommendations are provided for completing the primary steps of a Bayesian meta-analysis, ranging from model specification to interpretation of results. Furthermore, an illustrative example is used to demonstrate the application of each step. In the example, results are synthesized from six studies included in a previously published systematic review (Holliday et al., 2020), with a combined sample size of 21,244,109, examining the association between posttraumatic stress disorder and risk of suicide in veterans and military personnel.

RESULTS: The posterior distributions for each model estimate, such as the pooled effect size and the heterogeneity parameter, are discussed and interpreted with regard to the probability of increased suicide risk.

CONCLUSIONS: Our hope is that this tutorial, along with the provided data and code, facilitate the use of Bayesian meta-analyses in the study of psychological trauma. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PMID:35862085 | DOI:10.1037/tra0001316

Hypertension. 2022 Jul 7:101161YPERTENSIONAHA12118794. doi: 10.1161/HYPERTENSIONAHA.121.18794. Online ahead of print.

ABSTRACT

BACKGROUND: Ambulatory blood pressure monitoring (ABPM) is routinely performed in children with chronic kidney disease to identify masked hypertension, a risk factor for accelerated chronic kidney disease progression. However, ABPM is burdensome, and developing an accurate prediction of masked hypertension may allow using ABPM selectively rather than routinely.

METHODS: To create a prediction model for masked hypertension using clinic blood pressure (BP) and other clinical characteristics, we analyzed 809 ABPM studies with nonhypertensive clinic BP among the participants of the Chronic Kidney Disease in Children study.

RESULTS: Masked hypertension was identified in 170 (21.0%) observations. We created prediction models for masked hypertension via gradient boosting, random forests, and logistic regression using 109 candidate predictors and evaluated its performance using bootstrap validation. The models showed C statistics from 0.660 (95% CI, 0.595-0.707) to 0.732 (95% CI, 0.695-0.786) and Brier scores from 0.148 (95% CI, 0.141-0.154) to 0.167 (95% CI, 0.152-0.183). Using the possible thresholds identified from this model, we stratified the dataset by clinic systolic/diastolic BP percentiles. The prevalence of masked hypertension was the lowest (4.8%) when clinic systolic/diastolic BP were both <20th percentile, and relatively low (9.0%) with clinic systolic BP<20th and diastolic BP<80th percentiles. Above these thresholds, the prevalence was higher with no discernable pattern.

CONCLUSIONS: ABPM could be used selectively in those with low clinic BP, for example, systolic BP<20th and diastolic BP<80th percentiles, although careful assessment is warranted as masked hypertension was not completely absent even in this subgroup. Above these clinic BP levels, routine ABPM remains recommended.

PMID:35862083 | DOI:10.1161/HYPERTENSIONAHA.121.18794

Health Rep. 2022 Jul 20;33(7):24-35. doi: 10.25318/82-003-x202200700003-eng.

ABSTRACT

BACKGROUND: Vaping is more prevalent among younger than older Canadians. While vaping is less harmful than combustible tobacco, it is not without health risk.

DATA AND METHODS: Data from the 2019 Canadian Health Survey on Children and Youth were used to estimate vaping prevalence. Logistic regression models assessed the association of sociodemographic, youth, parenting and peer factors with vaping. The 2020 Canadian Community Health Survey identified adolescents who reported vaping before tobacco smoking. Data from the 2019 Canadian Tobacco and Nicotine Survey were used to examine vaping of e-liquids containing nicotine and flavours.

RESULTS: Vaping rates for 15- to 17-year-olds were nearly four times (21.3%) higher than those of 12- to 14-year-olds (5.4%). Two-thirds (66.1%) of 12- to 17-year-olds who had used both tobacco and e-cigarettes reported trying e-cigarettes first. E-liquids containing nicotine were used by 89.3% of 15- to 19-year-olds who reported vaping in the past 30 days; comparable with older adults. For both younger and older adolescents, having friends who engaged in negative behaviours, having been employed, and having consumed alcohol increased the odds. For 12- to 14-year-olds, attention deficit hyperactivity disorder was a risk factor, whereas having parents who usually knew who they were with and higher relatedness scores were protective. Among older adolescents, being male, being Canadian-born, having lower grades, and using tobacco or cannabis increased the odds of vaping.

INTERPRETATION: An adolescent’s risk of vaping was most strongly correlated with other substance use, although other youth, parenting and peer characteristics also mattered. Because most of the data presented were collected before the COVID-19 pandemic and new vaping regulations, ongoing monitoring remains important.

PMID:35862070 | DOI:10.25318/82-003-x202200700003-eng

Math Med Biol. 2022 Jul 21:dqac009. doi: 10.1093/imammb/dqac009. Online ahead of print.

ABSTRACT

We focus on modelling of cancer hyperthermia driven by the application of the magnetic field to iron oxide nanoparticles. We assume that the particles are interacting with the tumour environment by extravasating from the vessels into the interstitial space. We start from Darcy’s and Stokes’ problems in the interstitial and fluid vessels compartments. Advection-diffusion of nanoparticles takes place in both compartments (as well as uptake in the tumour interstitium), and a heat source proportional to the concentration of nanoparticles drives heat diffusion and convection in the system. The system under consideration is intrinsically multi-scale. The distance between adjacent vessels (the micro-scale) is much smaller than the average tumour size (the macro-scale). We then apply the asymptotic homogenisation technique to retain the influence of the micro-structure on the tissue scale distribution of heat and particles. We derive a new system of homogenised partial differential equations (PDEs) describing blood transport, delivery of nanoparticles and heat transport. The new model comprises a double Darcy’s law, coupled with two double advection-diffusion-reaction systems of PDEs describing fluid, particles and heat transport and mass, drug and heat exchange. The role of the micro-structure is encoded in the coefficients of the model, which are to be computed solving appropriate periodic problems. We show that the heat distribution is impaired by increasing vessels’ tortuosity and that regularization of the micro-vessels can produce a significant increase (1-2 degrees) in the maximum temperature. We quantify the impact of modifying the properties of the magnetic field depending on the vessels’ tortuosity.

PMID:35862063 | DOI:10.1093/imammb/dqac009

JAMA Netw Open. 2022 Jul 1;5(7):e2219416. doi: 10.1001/jamanetworkopen.2022.19416.

ABSTRACT

IMPORTANCE: Patients with acute ischemic stroke often undergo magnetic resonance imaging (MRI) in addition to computed tomography (CT), but its association with clinical outcomes is uncertain.

OBJECTIVE: To assess whether clinical outcomes of patients with acute ischemic stroke with initial CT alone were noninferior to those with additional MRI.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective observational propensity score-matched cohort study of clinical outcomes at discharge and 1 year for patients hospitalized with acute ischemic stroke was conducted at an academic medical center between January 2015 and December 2017. Data collection from an electronic medical record system performed from May 2020 through January 2022 was not completely blinded. Noninferiority margins were based on the designs of previous randomized clinical trials of ischemic stroke treatments. Statistical analysis was performed in January 2022. Participants were adults hospitalized with acute ischemic stroke with admission diagnosis based on CT. Exclusion criteria were primarily missing data. From 508 eligible patients, all 123 cases with additional MRI were propensity-score matched to 123 controls without.

EXPOSURE: MRI after initial diagnosis.

MAIN OUTCOMES AND MEASURES: Death or dependence at hospital discharge (modified Rankin Scale score of 3-6) and stroke or death occurring in survivors within 1 year after discharge.

RESULTS: Among 246 participants, the median age was 68 years (IQR, 58-78.8 years) and 131 (53.0%) were men. Death or dependence at discharge occurred more often in patients with additional MRI (59 of 123 [48.0%]) than in those with CT alone (52 of 123 [42.3%]; absolute difference, 5.7%; 95% CI, -6.7% to 18.1%), meeting the -7.50% criterion for noninferiority. Stroke or death within 1 year after discharge determined for 225 of 235 (96%) survivors occurred more often in patients with additional MRI (22 of 113 [19.5%]) than in those with CT alone (14 of 112 [12.5%]; relative risk, 1.14; 95% CI, 0.86-1.50), meeting the 0.725 relative risk criterion for noninferiority.

CONCLUSIONS AND RELEVANCE: This propensity score-matched cohort study of patients hospitalized with acute ischemic stroke found that a diagnostic imaging strategy of initial CT alone was noninferior to initial CT plus additional MRI with regard to clinical outcomes at discharge and at 1 year. Further research is needed to determine which patients hospitalized with acute ischemic stroke benefit from MRI.

PMID:35862046 | DOI:10.1001/jamanetworkopen.2022.19416