Nevin Manimala

Ophthalmic Physiol Opt. 2022 Mar 3. doi: 10.1111/opo.12971. Online ahead of print.

ABSTRACT

PURPOSE: To compare accommodative and binocular vision performance between young diabetic subjects and normal controls, and to investigate the correlation of accommodative/binocular indices with the severity of diabetes.

METHODS: Thirty young subjects with diabetes mellitus (DM) and 30 age-matched normal controls were recruited in this hospital-based cross-sectional study. DM was diagnosed by a haemoglobin A1c (HbA1c) higher than 6.5%. The status of vision-related symptoms was examined by the convergence insufficiency symptoms survey (CISS). All participants underwent a complete optometric examination including visual acuity measurement, objective and subjective refraction, accommodative and binocular vision assessments.

RESULTS: All study participants were between 18 and 40 years of age. There were no statistically significant differences in best-corrected visual acuity (BCVA), sphere, cylinder and spherical equivalent refraction (SE) between the diabetes and control groups. The median near point of convergence (NPC) was significantly more remote in diabetics compared with the control group. Mean accommodative amplitude (AA) and vergence facility (VF) and the median monocular accommodative facility (AF) were significantly lower in diabetic subjects compared with normal controls. In addition, the median accommodative lag in the diabetic group was significantly higher than the control group. A significantly higher percentage of the diabetic group were symptomatic (26.6%), compared with the controls (6.6%). The NPC and accommodative lag showed a significant positive correlation with the HbA1c level, while VF, AA and AF exhibited a significant negative correlation with HbA1c.

CONCLUSION: Aspects of accommodative and binocular vision performance are strongly affected by DM. There is also a significant correlation between accommodative and binocular disorders with the severity of DM. A significant percentage of young subjects with DM have severe vision-related symptoms.

PMID:35238412 | DOI:10.1111/opo.12971

Mass Spectrom Rev. 2022 Mar 3. doi: 10.1002/mas.21773. Online ahead of print.

ABSTRACT

Metabolomics is an area of intriguing and growing interest. Since the late 1990s, when the first Omic applications appeared to study metabolite’s pool (“metabolome”), to understand new aspects of the global regulation of cellular metabolism in biology, there have been many evolutions. Currently, there are many applications in different fields such as clinical, medical, agricultural and food. In our opinion, it is clear that developments in metabolomics analysis have also been driven by advances in mass spectrometry (MS) technology. As natural complex products (NCPs) are increasingly used around the world as medicines, food supplements, and substance-based medical devices, their analysis using metabolomic approaches will help to bring more and more rigor to scientific studies and industrial production monitoring. This review is intended to emphasize the importance of metabolomics as a powerful tool for studying NCPs, by which significant advantages can be obtained in terms of elucidation of their composition, biological effects and quality control. The different approaches of metabolomic analysis, the main and basic techniques of multivariate statistical analysis are also briefly illustrated, in order to allow an overview of the workflow associated with the metabolomic studies of NCPs. Therefore, various articles and reviews are illustrated and commented as examples of the application of MS-based metabolomics to NCPs. This article is protected by copyright. All rights reserved.

PMID:35238411 | DOI:10.1002/mas.21773

Anaesthesia. 2022 Mar 3. doi: 10.1111/anae.15684. Online ahead of print.

ABSTRACT

The aim of our study was to clarify the association between glycated haemoglobin (HbA_1c ) and postoperative outcomes in people without an existing diagnosis of diabetes. Half a million adults were recruited into the UK Biobank prospective cohort study between March 2006 and October 2010. We divided participants into three groups: no diagnosis of diabetes and HbA_1c < 42 mmol.mol^-1 ; no diagnosis of diabetes and elevated HbA_1c (≥ 42 mmol.mol^-1 with no upper limit); and prevalent diabetes (regardless of HbA_1c concentration) at recruitment. We followed up participants by linkage with routinely collected hospital data to determine any surgical procedures undertaken after recruitment and the associated postoperative outcomes. Our main outcome measure was a composite primary outcome of 30-day major postoperative complications and 90-day all-cause mortality. We used logistic regression to estimate the odds of the primary outcome by group. We limited analyses to those who underwent surgery within one year of recruitment (n = 26,653). In a combined effects logistic regression model, participants not known to have diabetes with HbA_1c ≥ 42 mmol.mol^-1 had increased odds of the primary outcome (OR [95% CI] 1.43 [1.02-2.02]; p = 0.04), when compared with those without diabetes and HbA_1c < 42 mmol.mol^-1 . This effect was attenuated and no longer statistically significant in a direct effects model with adjustment for hyperglycaemia-related comorbidity (OR [95% CI] 1.37 [0.97-1.93]; p = 0.07). Elevated pre-operative HbA_1c in people without diabetes may be associated with an increased risk of complications, but the association is likely confounded by end-organ comorbidity. In contrast to previous evidence, our findings suggest that to prevent adverse postoperative outcomes, optimisation of pre-existing morbidity should take precedence over reducing HbA_1c in people without diabetes.

PMID:35238399 | DOI:10.1111/anae.15684

Health Serv Res. 2022 Mar 3. doi: 10.1111/1475-6773.13966. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine whether the Comprehensive Care for Joint Replacement (CJR) model, a mandatory episode-based payment program for knee and hip replacement surgery, affected patient-reported measures of quality.

DATA SOURCES: Surveys of Medicare fee-for-service beneficiaries who had hip or knee replacement surgery, collected between July 2018 and March 2019, secondary Medicare administrative data, the Provider of Services file, CJR and Bundled Payments for Care Improvement participant lists from the Centers for Medicare & Medicaid Services, and the Area Health Resource Files.

STUDY DESIGN: In 2018, participation in the CJR model was mandatory for nearly all hospitals in 34 randomly-selected, metropolitan statistical areas (MSAs) that had high historical Medicare payments for lower-extremity joint replacements surgery. The control group included 47 high-payment MSAs randomly assigned as controls. We estimated risk-adjusted differences in self-reported measures of functional status and pain, satisfaction with care, and caregiver help between respondents in CJR hospitals and respondents in hospitals located in the control group.

DATA COLLECTION: We selected a census of CJR patients and an equal number of control patients to survey. We fielded two waves of surveys using a mail and phone protocol, yielding 8433 CJR and 9014 control respondents.

PRINCIPAL FINDINGS: CJR respondents were slightly more likely to depend on caregivers for certain activities of daily living when they got home (either directly from the hospital or after an institutional post-acute care stay). On a 100-point scale, differences ranged from -2.6 points (p <0.01) for help needed bathing to -1.7 points (p <0.05) for help needed using the toilet. However, differences in eight measures of self-reported functional status approximately 90-120 days after hospital discharge were not statistically significant, ranging from -1.1% (p = 0.087) to 0.7% (p = 0.437).

CONCLUSIONS: CJR did not harm patient health or affect patient satisfaction on average but did increase reliance on caregivers during recovery.

PMID:35238397 | DOI:10.1111/1475-6773.13966

J Infect Dis. 2021 Nov 23;224(Supplement_5):S475-S483. doi: 10.1093/infdis/jiab187.

ABSTRACT

BACKGROUND: Typhoid fever remains a major public health problem in India. Recently, the Surveillance for Enteric Fever in India program completed a multisite surveillance study. However, data on subnational variation in typhoid fever are needed to guide the introduction of the new typhoid conjugate vaccine in India.

METHODS: We applied a geospatial statistical model to estimate typhoid fever incidence across India, using data from 4 cohort studies and 6 hybrid surveillance sites from October 2017 to March 2020. We collected geocoded data from the Demographic and Health Survey in India as predictors of typhoid fever incidence. We used a log linear regression model to predict a primary outcome of typhoid incidence.

RESULTS: We estimated a national incidence of typhoid fever in India of 360 cases (95% confidence interval [CI], 297-494) per 100 000 person-years, with an annual estimate of 4.5 million cases (95% CI, 3.7-6.1 million) and 8930 deaths (95% CI, 7360-12 260), assuming a 0.2% case-fatality rate. We found substantial geographic variation of typhoid incidence across the country, with higher incidence in southwestern states and urban centers in the north.

CONCLUSIONS: There is a large burden of typhoid fever in India with substantial heterogeneity across the country, with higher burden in urban centers.

PMID:35238365 | DOI:10.1093/infdis/jiab187

Hum Reprod. 2022 Mar 3:deac036. doi: 10.1093/humrep/deac036. Online ahead of print.

ABSTRACT

STUDY QUESTION: What are the intentions of men and women of reproductive age in the UK regarding reproduction and family building?

SUMMARY ANSWER: We identified six main categories of people; Avoiders, Betweeners, Completers, Desirers, Expectants and Flexers, for whom reproduction education strategies should be tailored differently to suit intentions.

WHAT IS KNOWN ALREADY: Several studies have highlighted poor fertility awareness across men and women of reproductive age. As the average age of first-time parents continues to rise, there has been a concerted effort from educators, healthcare professionals, charities, reproductive health groups and government policymakers, to improve fertility awareness. In order to ensure that these messages are effective and to deploy the best strategies, it is important to understand people’s reproductive health needs. This study therefore aimed to explore different reproductive intentions to aid tailoring of information to help individuals and couples achieve their family building desires.

STUDY DESIGN, SIZE, DURATION: We conducted a mixed-method study via a UK-wide cross-sectional survey with 1082 participants and semi-structured interviews of 20 women and 15 men who agreed to follow-up interviews. Interviews lasted an hour on average. Ethics approval from UCL Research Ethics Committee.

PARTICIPANTS/MATERIALS, SETTING, METHODS: Survey participants were recruited nationwide via online newspaper and social media adverts. Interviewees were purposely sampled to include men and women from the reproductive age range (18-45 years), varying ethnicity and education background. Survey data were analysed using the Minitab statistical software package. Interview data were transcribed and analysed using the framework method.

MAIN RESULTS AND THE ROLE OF CHANCE: From the survey and interviews, we identified six key categories of people, grouped alphabetically, in a user-friendly manner to highlight a spectrum of reproductive intentions: Avoiders describes respondents who have no children and do not want to have children in the future; Betweeners describes those who already have child(ren) and want more in the future but are not actively trying to conceive; Completers describes those who have child(ren) but do not want more; Desirers describes those who are actively trying to conceive or plan to have child(ren) in the future; Expectants describes those who were pregnant at the time of the study; and Flexers describes those who may or may not already have and are unsure but or open to having child(ren) in the future. Analysis of survey data identified the following proportions in our study: Avoiders, 4.7%; Betweeners, 11.3%; Completers, 13.6%; Desirers, 36.9%; Expectants, 4.1%; and Flexers 28.4% and 2.4% preferring not to answer. There was one ‘other’ group from qualitative analysis, who would like to have children in the future but were unsure whether they could or had changing views. We recommend classifying as ‘Desirers’ or ‘Flexers’ for the purposes of fertility education. A majority of the survey population were trying to get pregnant; were pregnant; or planning to have a child in the future-whether actively, passively or simply open to the idea, with interviews providing deep insights into their family building decision-making.

LIMITATIONS, REASONS FOR CAUTION: Due to the online recruitment method, there may be a bias towards more educated respondents.

WIDER IMPLICATIONS OF THE FINDINGS: We developed a user-friendly, alphabetical categorization of reproductive intentions, which may be used by individuals, healthcare professionals, educators, special interest groups, charities and policymakers to support and enable individuals and couples in making informed choices to achieve their desired intentions, if and when they choose to start a family.

STUDY FUNDING/COMPETING INTEREST(S): There was no external funding for this study. The authors report no competing interests.

TRIAL REGISTRATION NUMBER: N/A.

PMID:35238351 | DOI:10.1093/humrep/deac036

Cereb Cortex. 2022 Mar 3:bhac077. doi: 10.1093/cercor/bhac077. Online ahead of print.

ABSTRACT

Goal-directed behavior is dependent upon the ability to detect errors and implement appropriate posterror adjustments. Accordingly, several studies have explored the neural activity underlying error-monitoring processes, identifying the insula cortex as crucial for error awareness and reporting mixed findings with respect to the anterior cingulate cortex (ACC). Variable patterns of activation have previously been attributed to insufficient statistical power. We therefore sought to clarify the neural correlates of error awareness in a large event-related functional magnetic resonance imaging (fMRI) study. Four hundred and two healthy participants undertook the error awareness task, a motor Go/No-Go response inhibition paradigm in which participants were required to indicate their awareness of commission errors. Compared to unaware errors, aware errors were accompanied by significantly greater activity in a network of regions, including the insula cortex, supramarginal gyrus (SMG), and midline structures, such as the ACC and supplementary motor area (SMA). Error awareness activity was related to indices of task performance and dimensional measures of psychopathology in selected regions, including the insula, SMG, and SMA. Taken together, we identified a robust and reliable neural network associated with error awareness.

PMID:35238340 | DOI:10.1093/cercor/bhac077

J AOAC Int. 2022 Mar 3:qsac029. doi: 10.1093/jaoacint/qsac029. Online ahead of print.

ABSTRACT

BACKGROUND: PathogenDx family of assays use microarray technology to simultaneously detect the presence of bacterial and fungal pathogens in food products, environmental surfaces and cannabis products.

OBJECTIVE: The Detectx Combined assay, was validated for the detection of Aspergillus, (Aspergillus flavus, Aspergillus fumigatus, Aspergillus niger and Aspergillus terreus), Salmonella, and a broad range of STEC (stx1 and/or 2) species. The validation consisted of two matrix studies in dried hemp flower and dried cannabis flower (> 0.3% delta-9 tetrahydrocannabinol) flower, product consistency, stability, robustness and inclusivity and exclusivity for two targets: Aspergillus and STEC.

METHODS: The PathogenDx Detectx Combined assay was evaluated with 30 replicates in each matrix and confirmed according to the instructions outlined in this study.

RESULTS: Results of the validation study met the requirements of AOAC SMPR 2020.002 and 2020.012. In the inclusivity and exclusivity study, all target isolates (Aspergillus and STEC) were correctly detected. For the exclusivity study, 26 out of 30 Aspergillus and 30 out of 30 STEC non-target strains were correctly excluded. In the matrix study, the PathogenDx Detectx Combined assay showed no significant statistical differences between confirmed results for dried hemp and cannabis flower. Robustness testing indicated small changes to the method parameters did not impact the performance of the assay. Stability and consistency studies verified the assay’s shelf-life claims were appropriate and manufacturing of the assay was consistent.

CONCLUSIONS: The validation study indicated that the PathogenDx Detectx Combined assay was successful in detection of the new target analytes (Aspergillus flavus, Aspergillus fumigatus, Aspergillus niger and Aspergillus terreus, and STEC containing stx1 and/or 2) and could successfully recover these organisms and Salmonella from dried hemp flower and dried cannabis flower (> 0.3% delta-9 tetrahydrocannabinol).

PMID:35238337 | DOI:10.1093/jaoacint/qsac029

Am J Epidemiol. 2022 Mar 3:kwac040. doi: 10.1093/aje/kwac040. Online ahead of print.

ABSTRACT

Dietary copper intake may be associated with cognitive decline and dementia. We used data from 10,269 participants of the Atherosclerosis Risks in Communities Study to study the associations of dietary copper intake with 20-year cognitive decline and incident dementia. Dietary copper intake from food and supplements was quantified using food frequency questionnaires. Cognition was assessed using three cognitive tests at study visits; dementia was ascertained at study visits and via surveillance. Multiple imputation by chained equations was applied to account for the missing information of cognitive function during follow-up. Survival analysis with parametric models and mixed-effect models were used to estimate the associations for incident dementia and cognitive decline, respectively. During 20 years of follow-up (1996-1998 to 2016-2017), 1,862 incident cases of dementia occurred. Higher intake of dietary copper from food was associated with higher risk of incident dementia among those with high intake of saturated fat (hazards ratio: 1.49, 95% confidence interval (CI): 1.04, 1.95). Higher intake of dietary copper from food was associated with greater decline in language overall (beta: -0.12, 95% CI: -0.23, -0.02). Therefore, a diet high in copper, particularly when combined with a diet high in saturated fat, may increase the risk of cognitive impairment.

PMID:35238336 | DOI:10.1093/aje/kwac040

Am J Epidemiol. 2022 Mar 3:kwac043. doi: 10.1093/aje/kwac043. Online ahead of print.

ABSTRACT

The inverse probability of treatment weighting (IPTW) approach is popular for evaluating causal effects in observational studies, but extreme propensity scores could bias the estimator and induce excessive variance. Recently, the overlap weighting approach has been proposed to alleviate this problem, which smoothly down-weights the subjects with extreme propensity scores. Although advantages of overlap weighting have been extensively demonstrated in literature with continuous and binary outcomes, research on its performance with time-to-event or survival outcomes is limited. In this article, we propose estimators that combine propensity score weighting and inverse probability of censoring weighting to estimate the counterfactual survival functions. These estimators are applicable to the general class of balancing weights, which includes IPTW, trimming, and overlap weighting as special cases. We conduct simulations to examine the empirical performance of these estimators with different propensity score weighting schemes in terms of bias, variance, and 95% confidence interval coverage, under various degree of covariate overlap between treatment groups and censoring rate. We demonstrate that overlap weighting consistently outperforms IPTW and associated trimming methods in bias, variance, and coverage for time-to-event outcomes, and the advantages increase as the degree of covariate overlap between the treatment groups decreases.

PMID:35238335 | DOI:10.1093/aje/kwac043