Nevin Manimala

ANZ J Surg. 2022 Apr 3. doi: 10.1111/ans.17669. Online ahead of print.

ABSTRACT

BACKGROUND: Interhospital transfers in Australia facilitate access to acute surgical services, however transfer delays can occur. The aims of this study were to examine Australian mortality audit data on acute surgical patients who were transferred after presenting with a surgical emergency, and to identify modifiable predictors of transfer delay.

METHODS: Surgical admissions between 1 January 2001 and 18 August 2020 were retrospectively extracted from the Australian and New Zealand Audit of Surgical Mortality database. Relevant factors and themes of interest were collated. Results were presented as odds ratios (OR) and 95% confidence intervals (CI), with statistical significance defined as P <0.05.

RESULTS: After exclusion, a final 8270 cases were analysed. Non-modifiable predictors identified were female gender (OR 1.34, 95% CI 1.05-1.70, P = 0.0184), comorbidities (OR 1.50, 95% CI 1.40-161, P <0.0001) and major non-trauma non-vascular specialty (OR 1.54 to 7.77, depending on specialty, P < 0.05). Modifiable predictors were inadequate clinical assessment (OR 49.48, 95% CI 32.91-74.38, P <0.0001), poor communication (OR 6.62, 95% CI 3.70-11.85, P <0.0001) and multiple transfers (OR 6.30, OR 95% 4.31-9.21, P <0.0001). Age, lack of bed and after-hours transfer did not predict transfer delays. Metropolitan transfers was protective against transfer delays (OR 0.64, 95% CI 0.47-0.86, P = 0.0035).

CONCLUSION: In the view of the receiving surgeon or assessor, all transfer delays potentially contributed to patient deaths, and may have been preventable. Strategies directed at modifiable factors could minimize delays. Increased surgical services in non-metropolitan regions could reduce need for transfer. Prospective data is required to examine if the same predictors are observed in surgical patients who survive.

PMID:35373494 | DOI:10.1111/ans.17669

Mol Inform. 2022 Apr 3. doi: 10.1002/minf.202200026. Online ahead of print.

ABSTRACT

A quantitative structure-property relationship (QSPR) modeling was carried out for predicting drug and drug-like compounds solubility in supercritical carbon dioxide. For the first time, a dataset of 148 drugdrug-like compounds, accounting for 3971 experimental data points (EDPs), was collected and used for modelling the relationship between selected molecular descriptors and solubility fraction data achieved by a nonlinear approached (Artificial neural network, ANN) based on molecular descriptors. Experimental solubility data for a given drug are published as a function of temperature and pressure. In this study, 11 significant PaDEL descriptors (AATS3v, MATS2e, GATS4c, GATS3v, GATS4e, GATS3s, nBondsM, AVP-0, SHBd, MLogP, and MLFER_S), the temperature and the pressure were statistically proved to be sufficient inputs. The architecture of the optimised model was found to be {13,10,1}. Validation of the model was checked using several recommended statistical metrics, including Average absolute relative deviation (AARD=3.7748%), Root Mean Square Error (RMSE=0.5162), Coefficient of Correlation (r=0.9761), Coefficient of Determination (R²=0.9528), and Robustise (Q²=0.9528). The model was also subjected to an external test by using 143 EDPs. Sensitivity analysis and domain of application were examined. The overall results confirm that the optimised ANN-QSPR model can be used reliably for the correlation and prediction of this property.

PMID:35373477 | DOI:10.1002/minf.202200026

Acad Emerg Med. 2022 Apr 3. doi: 10.1111/acem.14497. Online ahead of print.

ABSTRACT

BACKGROUND: Although more guideline-adherent care has been described in pediatric compared to adult trauma centers, we aimed to provide a more detailed characterization of management and resource utilization of children with intra-abdominal injury (IAI) within pediatric centers. Our primary objective was to describe the epidemiology, diagnostic evaluation, and management of children with IAI across U.S. children’s hospitals. Our secondary objective was to describe the inter-hospital variation in surgical management of children with IAI.

METHODS: We conducted a cross-sectional study of 33 hospitals in the Pediatric Health Information System. We included children aged <18 years evaluated in the emergency department from 2010-2019 with IAI, as defined by ICD coding, and who underwent an abdominal computed tomography (CT). Our primary outcome was abdominal surgery. We categorized IAI by organ system and described resource utilization data. We used generalized linear regression to calculate adjusted hospital-level proportions of abdominal surgery, with a random effect for hospital.

RESULTS: We studied 9,265 children with IAI. Median (IQR) age was 9.0 years (IQR: 6.0, 13.0). Abdominal surgery was performed in 16% (n=1,479) of children, with the lowest proportion of abdominal surgery observed in children aged <5 years. Liver (38.6%) and spleen (32.1%) were the most common organs injured. 3.1% of children with liver injuries and 2.8% with splenic injuries underwent abdominal surgery. Although there was variation in rates of surgery across hospitals (p<0.001), only 3 of 33 hospitals had rates that were statistically different from the aggregate mean of 16%.

CONCLUSIONS: Most children with IAI are managed non-operatively, and most children’s hospitals manage children with IAI similarly. These data can be used to inform future benchmarking efforts across hospitals to assess concordance with guidelines for the management of children with IAI.

PMID:35373473 | DOI:10.1111/acem.14497

Integr Environ Assess Manag. 2022 Apr 4. doi: 10.1002/ieam.4614. Online ahead of print.

ABSTRACT

As health-based drinking water standards for per- and polyfluorinated alkyl substances (PFAS) continue to evolve, public health and environmental protection decision-makers must assess exposure risks associated with all public drinking water systems in the United States (US). Unfortunately, current knowledge regarding the presence of PFAS in environmental systems is limited. In this study a screening approach was established to: 1) identify and direct attention toward potential PFAS hot-spots in drinking water sources; 2) prioritize sampling locations; and 3) provide insights regarding the potential PFAS sources that contaminate groundwater and surface water. Our approach incorporates geospatial data from public sources, including the U.S. Environmental Protection Agency’s (US EPA) Toxic Release Inventory (TRI), to identify locations where PFAS may be present in drinking water sources. An indicator factor (e.g. “risk factor” was developed as a function of distance between potential past and/or present PFAS-users (e.g., military bases, industrial sites, and airports) and the public water system, and generates a heat map that visualizes potential exposure risks. A binomial logistic regression model indicates whether PFAS is likely to be detected in public water systems. The results obtained using the developed screening approach aligned well (with a 76% overall model accuracy) with PFAS sampling and chemical analysis data from 81 public drinking water systems in the state of Kentucky. This study proposes this screening model as an effective decision aid to assist key decision-makers in identifying and prioritizing sampling locations for potential PFAS exposure risks in the public drinking water sources in their service areas. This article is protected by copyright. All rights reserved. © 2022 SETAC.

PMID:35373458 | DOI:10.1002/ieam.4614

Pharm Stat. 2022 Apr 3. doi: 10.1002/pst.2212. Online ahead of print.

ABSTRACT

Pharmaceutical companies regularly need to make decisions about drug development programs based on the limited knowledge from early stage clinical trials. In this situation, eliciting the judgements of experts is an attractive approach for synthesising evidence on the unknown quantities of interest. When calculating the probability of success for a drug development program, multiple quantities of interest-such as the effect of a drug on different endpoints-should not be treated as unrelated. We discuss two approaches for establishing a multivariate distribution for several related quantities within the SHeffield ELicitation Framework (SHELF). The first approach elicits experts’ judgements about a quantity of interest conditional on knowledge about another one. For the second approach, we first elicit marginal distributions for each quantity of interest. Then, for each pair of quantities, we elicit the concordance probability that both lie on the same side of their respective elicited medians. This allows us to specify a copula to obtain the joint distribution of the quantities of interest. We show how these approaches were used in an elicitation workshop that was performed to assess the probability of success of the registrational program of an asthma drug. The judgements of the experts, which were obtained prior to completion of the pivotal studies, were well aligned with the final trial results.

PMID:35373454 | DOI:10.1002/pst.2212

Int Wound J. 2022 Apr 3. doi: 10.1111/iwj.13811. Online ahead of print.

ABSTRACT

This study examined the relationship between the personal predisposing factors of patients and the severity of pressure injuries (PIs) developed during surgery. This retrospective cohort study collected 439 cases of peri-operative PIs. Using binary logistic regression to identify the variables associated with PI severity, the effects of interactions between associated variables were then tested. The results of this study revealed that among the personal predisposing factors, only higher patient age (P = .001) and higher body mass index (P < .001) posed a greater risk of stage 2 PIs or higher. Among the surgery-related facilitating factors, only patients who were placed in the prone position during surgery and patients who lost ≥1000 mL of blood during surgery were at greater risk of stage 2 PIs or higher, compared, respectively, to those placed in the supine position and those who lost ≤100 mL of blood. Furthermore, the amount of blood lost during surgery moderated the influence of age on PI severity. For elderly patients who are expected to lose a large blood volume during surgery or lose an immeasurable amount of blood due to the use of cardiopulmonary bypass, taking more precautionary measures to prevent PIs is recommended.

PMID:35373448 | DOI:10.1111/iwj.13811

J Clin Nurs. 2022 Apr 3. doi: 10.1111/jocn.16312. Online ahead of print.

ABSTRACT

AIMS AND OBJECTIVES: The aim of this study was to discover the nature of the adverse events in Finnish long-term professional homecare reported by professionals, and to identify the circumstances in which adverse events occur and their consequences.

BACKGROUND: Adverse events are incidents causing unintended and unnecessary harm to older people at home. Safety is a basic human right and a fundamental prerequisite for independent living among older people at home. Few studies have focused on both long-term professional homecare environment and the safety of older people.

DESIGN: The research was a descriptive registry-based study.

METHODS: This study consisted of adverse events (N = 61248) in Finnish public long-term professional homecare (2009-2019). Data were described using frequencies and percentages. STROBE statement checklist was chosen for reporting the study process.

RESULTS: By profession, practical nurses and registered nurses reported the most of adverse events (89.8%). These were either critical incidents (78.3%) or near misses (20.0%) and concerned medicine, injuries and accidents, information flow or management. Consequences for older people were usually rated from no-harm to moderate harm. For long-term professional homecare, image harm, extra financial costs, no-harm and prolonged care for older people were among the consequences. Personnel frequently observed the older people afterwards and informed older people of adverse events, yet some of actions were unknown.

CONCLUSIONS: Many harmful adverse events are considered harmless for older people. Sometimes this can lead to unmet care needs or missed care. The degree of harm needs to be assessed in terms of physical, mental and social health with the HaiPro reporting system for homecare.

RELEVANCE TO CLINICAL PRACTICE: An understanding and a comprehensive view of the situation and holistic assessment of care needs includes safety and safety risks to increase safety and feeling of safety for older people at home.

PMID:35373401 | DOI:10.1111/jocn.16312

Br J Clin Pharmacol. 2022 Apr 3. doi: 10.1111/bcp.15342. Online ahead of print.

ABSTRACT

AIMS: To assess the appropriateness of the bodyweight or fixed dosing regimen, population pharmacokinetic (PopPK) model of kukoamine B has been built in sepsis patients.

METHODS: Plasma Concentrations of kukoamine B and the covariates information were from 30 sepsis patients assigned into 0.06 mg/kg, 0.12 mg/kg and 0.24 mg/kg groups in Phase IIa clinical trial. PopPK model was built using nonlinear mixed-effect (NLME) modelling approach. Based on the final model, PK profiles were respectively simulated for 500 times applying the bodyweight and renal function information of 12 sepsis patients from 0.24 mg/kg group on the bodyweight or the fixed dosing regimen. For each dosing regimen, PK profiles of 6000 virtual patients were obtained. Statistical analyses for C_max and C_min were performed. If the biases of C_max and C_min can all meet the criteria of ±15%, the fixed dosing regimen can substitute the bodyweight dosing regimen.

RESULTS: PopPK model was successfully developed by NLME approach. Bi-compartmental model was selected as the basic model. Renal function was identified as a statistically significant covariate about systemic clearance with OFV decreasing 8.6, resulting in a 5.2% decrease inter-individual variability (IIV) of systemic clearance. Body weight was not identified as a statistically significant covariate. Simulation results demonstrated two methods had a bias of 8.1% for C_max , and 8.6% for C_min . Furthermore, PK variability was lower on the fixed dosing regimen than the body weight regimen.

CONCLUSIONS: Based on simulation results, fixed dosing regimen was recommended in the following clinical trials.

PMID:35373389 | DOI:10.1111/bcp.15342

Magn Reson Med. 2022 Apr 3. doi: 10.1002/mrm.29227. Online ahead of print.

ABSTRACT

PURPOSE: To improve reconstruction fidelity of fine structures and textures in deep learning- (DL) based reconstructions.

METHODS: A novel patch-based Unsupervised Feature Loss (UFLoss) is proposed and incorporated into the training of DL-based reconstruction frameworks in order to preserve perceptual similarity and high-order statistics. The UFLoss provides instance-level discrimination by mapping similar instances to similar low-dimensional feature vectors and is trained without any human annotation. By adding an additional loss function on the low-dimensional feature space during training, the reconstruction frameworks from under-sampled or corrupted data can reproduce more realistic images that are closer to the original with finer textures, sharper edges, and improved overall image quality. The performance of the proposed UFLoss is demonstrated on unrolled networks for accelerated two- (2D) and three-dimensional (3D) knee MRI reconstruction with retrospective under-sampling. Quantitative metrics including normalized root mean squared error (NRMSE), structural similarity index (SSIM), and our proposed UFLoss were used to evaluate the performance of the proposed method and compare it with others.

RESULTS: In vivo experiments indicate that adding the UFLoss encourages sharper edges and more faithful contrasts compared to traditional and learning-based methods with pure ℓ2$$ {ell}_2 $$ loss. More detailed textures can be seen in both 2D and 3D knee MR images. Quantitative results indicate that reconstruction with UFLoss can provide comparable NRMSE and a higher SSIM while achieving a much lower UFLoss value.

CONCLUSION: We present UFLoss, a patch-based unsupervised learned feature loss, which allows the training of DL-based reconstruction to obtain more detailed texture, finer features, and sharper edges with higher overall image quality under DL-based reconstruction frameworks. (Code available at: https://github.com/mikgroup/UFLoss).

PMID:35373388 | DOI:10.1002/mrm.29227

Int J Health Plann Manage. 2022 Apr 3. doi: 10.1002/hpm.3468. Online ahead of print.

ABSTRACT

In 1945 the Food and Agricultural Organization (FAO) chose its Latin motto ‘fiat panis’ which translates as ‘let there be bread’ to prevent an unprecedented health catastrophe as a result of endemic hunger and poor nutritional health. Despite the long standing effort in this regard, for so many people, especially in developing economies in sub-Saharan Africa, access to enough, good quality, and constant supply of food and water remains an affront to good nutritional health. Globally, the FAO reports that 815 million people representing 10% of the population worldwide are currently undernourished. Our study investigates the effect of sustainable food production on malnutrition across sub-Saharan African countries. An ensemble of more sophisticated econometric models is applied to dynamic cross-country panel data from 16 countries in the 4 regions in Sub-Saharan African. Our study is innovative because it makes a pioneering contribution to the available stock of literature on indicators of sustainable food production and malnutrition which is still at an embryonic stage. We note that even though sub-Sahara African has a large tract of arable land, it negatively contributes towards malnutrition. We observed a positive and statistically significant relationship between food production (crop and livestock) and agricultural labour on malnutrition. Policy recommendations have been proposed to improve higher nutritional health through food production.

PMID:35373366 | DOI:10.1002/hpm.3468