Nevin Manimala

ACS Sens. 2024 Apr 10. doi: 10.1021/acssensors.4c00252. Online ahead of print.

ABSTRACT

Arrays of cross-reactive sensors, combined with statistical or machine learning analysis of their multivariate outputs, have enabled the holistic analysis of complex samples in biomedicine, environmental science, and consumer products. Comparisons are frequently made to the mammalian nose or tongue and this perspective examines the role of sensing arrays in analyzing food and beverages for quality, veracity, and safety. I focus on optical sensor arrays as low-cost, easy-to-measure tools for use in the field, on the factory floor, or even by the consumer. Novel materials and approaches are highlighted and challenges in the research field are discussed, including sample processing/handling and access to significant sample sets to train and test arrays to tackle real issues in the industry. Finally, I examine whether the comparison of sensing arrays to noses and tongues is helpful in an industry defined by human taste.

PMID:38598846 | DOI:10.1021/acssensors.4c00252

J Neurosci Nurs. 2024 Apr 9. doi: 10.1097/JNN.0000000000000753. Online ahead of print.

ABSTRACT

BACKGROUND: Despite the negative consequences of falls among neurosurgery patients in acute care settings, there is a lack of high-quality evidence for successful fall prevention programs. This study was conducted to evaluate the effectiveness of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) program on falling prevention compared with routine falling protocol in neurosurgical patients in Jordan. METHODS: A prospective quasi-experimental design was used in this study. The sample comprised 70 neurosurgical patients from a major university-affiliated hospital in Jordan. The study sample was assigned into a control group (35 patients) and an intervention group (35 patients). A demographics questionnaire, and different fall risk screening tools and tests were used in this study as recommended by the STEADI program. RESULTS: Multivariate analysis of variance results showed a significant effect (P = .001) of the STEADI program on the linear combination of outcome measures. Independent samples t tests further confirmed the program’s effectiveness, with statistically significant mean differences in most outcome measures between the intervention and control groups post intervention. After implementing the study intervention, participants in the intervention group had a statistically significant lower risk for falls. CONCLUSION: The findings indicate potential effectiveness in improving neurosurgery patients’ outcomes and reducing the risk of falls. Implementing the study recommendations can enhance patient safety and promote evidence-based fall prevention interventions in neurosurgery patients.

PMID:38598842 | DOI:10.1097/JNN.0000000000000753

N Engl J Med. 2024 Apr 11;390(14):1265-1276. doi: 10.1056/NEJMoa2310532.

ABSTRACT

BACKGROUND: Platinum-based chemotherapy is the recommended adjuvant treatment for patients with resectable, ALK-positive non-small-cell lung cancer (NSCLC). Data on the efficacy and safety of adjuvant alectinib as compared with chemotherapy in patients with resected ALK-positive NSCLC are lacking.

METHODS: We conducted a global, phase 3, open-label, randomized trial in which patients with completely resected, ALK-positive NSCLC of stage IB (tumors ≥4 cm), II, or IIIA (as classified according to the seventh edition of the Cancer Staging Manual of the American Joint Committee on Cancer and Union for International Cancer Control) were randomly assigned in a 1:1 ratio to receive oral alectinib (600 mg twice daily) for 24 months or intravenous platinum-based chemotherapy in four 21-day cycles. The primary end point was disease-free survival, tested hierarchically among patients with stage II or IIIA disease and then in the intention-to-treat population. Other end points included central nervous system (CNS) disease-free survival, overall survival, and safety.

RESULTS: In total, 257 patients were randomly assigned to receive alectinib (130 patients) or chemotherapy (127 patients). The percentage of patients alive and disease-free at 2 years was 93.8% in the alectinib group and 63.0% in the chemotherapy group among patients with stage II or IIIA disease (hazard ratio for disease recurrence or death, 0.24; 95% confidence interval [CI], 0.13 to 0.45; P<0.001) and 93.6% and 63.7%, respectively, in the intention-to-treat population (hazard ratio, 0.24; 95% CI, 0.13 to 0.43; P<0.001). Alectinib was associated with a clinically meaningful benefit with respect to CNS disease-free survival as compared with chemotherapy (hazard ratio for CNS disease recurrence or death, 0.22; 95% CI, 0.08 to 0.58). Data for overall survival were immature. No unexpected safety findings were observed.

CONCLUSIONS: Among patients with resected ALK-positive NSCLC of stage IB, II, or IIIA, adjuvant alectinib significantly improved disease-free survival as compared with platinum-based chemotherapy. (Funded by F. Hoffmann-La Roche; ALINA ClinicalTrials.gov number, NCT03456076.).

PMID:38598794 | DOI:10.1056/NEJMoa2310532

Cancer Nurs. 2024 Apr 10. doi: 10.1097/NCC.0000000000001350. Online ahead of print.

ABSTRACT

BACKGROUND: Demoralization is a psychological syndrome that is highly prevalent in patients with cancer and detrimental to individuals’ physical and mental health. To explore effective intervention, we first determined the relationships between locus of control, coping strategies, symptom burden, and demoralization.

OBJECTIVE: The aim of this study was to determine the relationship between symptom burden, locus of control, coping strategies, and demoralization in patients with cancer.

METHODS: In this descriptive-correlational study, 273 valid patients were selected with convenience sampling method from a hospital in China. Data were collected using the Chinese version of the M.D. Anderson Symptom Inventory, the Chinese version of the Multidimensional Health Locus of Control Scale, the Chinese version of the Medical Coping Modes Questionnaire, and the Mandarin version of the Demoralization Scale. Data were analyzed using descriptive and inferential statistics using SPSS and AMOS.

RESULTS: A total of 115 patients (42.12%) experienced clinical demoralization (Mandarin version of the Demoralization Scale > 30). Symptom burden (β = 0.295, P < .001), confrontation (β = -0.117, P = .028), and resignation (β = 0.456, P < .001) had direct effects on demoralization. Symptom burden also had an indirect effect on demoralization through the mediating role of resignation (β = 0.026, P = .002). Meanwhile, locus of control can affect demoralization entirely through the indirect mediating role of coping strategies (chance locus of control via resignation [β = 0.138, P < .01], powerful locus of control via confrontation [β = -0.017, P < .05]).

CONCLUSIONS: Symptom burden affects demoralization not only directly but also indirectly. Coping strategies play an important mediating role between symptom burden, locus of control, and demoralization in patients with cancer.

IMPLICATIONS FOR PRACTICE: It is urgent to screen demoralization and identify patients with high symptom burden, maladaptive locus of control, or coping strategies. For the patients targeted, a more comprehensive and systematic approach to symptom management and more appropriate guidance related to adaptive coping strategies are needed.

PMID:38598755 | DOI:10.1097/NCC.0000000000001350

Neurology. 2024 May 14;102(9):e209244. doi: 10.1212/WNL.0000000000209244. Epub 2024 Apr 10.

ABSTRACT

BACKGROUND AND OBJECTIVES: The time taken to achieve blood pressure (BP) control could be pivotal in the benefits of reducing BP in acute intracerebral hemorrhage (ICH). We aimed to assess the relationship between the rapid achievement and sustained maintenance of an intensive systolic BP (SBP) target with radiologic, clinical, and functional outcomes.

METHODS: Rapid, Intensive, and Sustained BP lowering in Acute ICH (RAINS) was a multicenter, prospective, observational cohort study of adult patients with ICH <6 hours and SBP ≥150 mm Hg at 4 Comprehensive Stroke Centers during a 4.5-year period. Patients underwent baseline and 24-hour CT scans and 24-hour noninvasive BP monitoring. BP was managed under a rapid (target achievement ≤60 minutes), intensive (target SBP <140 mm Hg), and sustained (target stability for 24 hours) BP protocol. SBP target achievement ≤60 minutes and 24-hour SBP variability were recorded. Outcomes included hematoma expansion (>6 mL or >33%) at 24 hours (primary outcome), early neurologic deterioration (END, 24-hour increase in NIH Stroke Scale score ≥4), and 90-day ordinal modified Rankin scale (mRS) score. Analyses were adjusted by age, sex, anticoagulation, onset-to-imaging time, ICH volume, and intraventricular extension.

RESULTS: We included 312 patients (mean age 70.2 ± 13.3 years, 202 [64.7%] male). Hematoma expansion occurred in 70/274 (25.6%) patients, END in 58/291 (19.9%), and the median 90-day mRS score was 4 (interquartile range, 2-5). SBP target achievement ≤60 minutes (178/312 [57.1%]) associated with a lower risk of hematoma expansion (adjusted odds ratio [aOR] 0.43, 95% confidence interval [CI] 0.23-0.77), lower END rate (aOR 0.43, 95% CI 0.23-0.80), and lower 90-day mRS scores (aOR 0.48, 95% CI 0.32-0.74). The mean 24-hour SBP variability was 21.0 ± 7.6 mm Hg. Higher 24-hour SBP variability was not related to expansion (aOR 0.99, 95% CI 0.95-1.04) but associated with higher END rate (aOR 1.15, 95% CI 1.09-1.21) and 90-day mRS scores (aOR 1.06, 95% CI 1.04-1.10).

DISCUSSION: Among patients with acute ICH, achieving an intensive SBP target within 60 minutes was associated with lower hematoma expansion risk. Rapid SBP reduction and stable sustention within 24 hours were related to improved clinical and functional outcomes. These findings warrant the design of randomized clinical trials examining the impact of effectively achieving rapid, intensive, and sustained BP control on hematoma expansion.

CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that in adults with spontaneous ICH and initial SBP ≥150 mm Hg, lowering SBP to <140 mm Hg within the first hour and maintaining this for 24 hours is associated with decreased hematoma expansion.

PMID:38598746 | DOI:10.1212/WNL.0000000000209244

J Nerv Ment Dis. 2024 May 1;212(5):284-288. doi: 10.1097/NMD.0000000000001729.

ABSTRACT

Our aim is to reveal the interaction of cultural and religious influences with professional equipment by determining the level of knowledge, sexual attitudes, and homophobia of medical students about LGBTI+ individuals. The study included 324 students from our faculty of medicine. The Hudson and Ricketts Homophobia scale, the Attitudes Towards Lesbians and Gay Men scale, and the Hendrick Sexual Attitudes scale were used with the sociodemograpic data form. Data were collected and analyzed using descriptive and inferential statistical tests. The mean score of the students from the Hudson and Ricketts Homophobia scale was 58.50. The findings of our study support that medical students consider that the education they receive in this regard is inadequate. One of the goals of undergraduate medical education is the provision of health services to all segments of society; therefore, it is recommended to make improvements in the curriculum in this regard.

PMID:38598728 | DOI:10.1097/NMD.0000000000001729

Z Psychosom Med Psychother. 2024 Feb;70(1):24-34. doi: 10.13109/zptm.2024.70.1.24.

ABSTRACT

To investigate macular and peripapillary vascular density (VD) in patients with anorexia nervosa (AN) compared to healthy controls. Methods:Whole face scans of the superficial and deep macular layers and whole face and peripapillary scans of the radial peripapillary capillaries (RPC) were obtained using optical coherence tomography angiography (OCTA, AngioVueR, Optovue) in ten patients with AN and ten age-matched controls.The primary objective was to determine whether there was a difference between the vessel density (VD) in the above areas in AN and controls. P-values ≤ 0.0125 were considered statistically significant. Results: VD in the superficialmacular en-face OCTA image was significantly lower in the study group compared to the control group. Neither the deepmacula nor the radial peripapillary capillary (RPC) in the whole-face image nor the RPC-peripapillary imaging appeared to be significantly different. Conclusion: Patients with AN showed reduced VD in the superficialmacular layers compared to healthy controls, which can be discussed as a consequence of the malnutrition. OCTA could be a useful non- invasive tool to detect reduced peripheral blood supply to show vascular changes that occur before ocular symptoms.

PMID:38598705 | DOI:10.13109/zptm.2024.70.1.24

Chaos. 2024 Apr 1;34(4):043129. doi: 10.1063/5.0200335.

ABSTRACT

In this paper, the dynamical properties of soliton interactions in the focusing Gardner equation are analyzed by the conventional two-soliton solution and its degenerate cases. Using the asymptotic expressions of interacting solitons, it is shown that the soliton polarities depend on the signs of phase parameters, and that the degenerate solitons in the mixed and rational forms have variable velocities with the time dependence of attenuation. By means of extreme value analysis, the interaction points in different interaction scenarios are presented with exact determination of positions and occurrence times of high transient waves generated in the bipolar soliton interactions. Next, with all types of two-soliton interaction scenarios considered, the interactions of two solitons with different polarities are quantitatively shown to have a greater contribution to the skewness and kurtosis than those with the same polarity. Specifically, the ratios of spectral parameters (or soliton amplitudes) are determined when the bipolar soliton interactions have the strongest effects on the skewness and kurtosis. In addition, numerical simulations are conducted to examine the properties of multi-soliton interactions and their influence on higher statistical moments, especially confirming the emergence of the soliton interactions described by the mixed and rational solutions in a denser soliton ensemble.

PMID:38598677 | DOI:10.1063/5.0200335

Chaos. 2024 Apr 1;34(4):043130. doi: 10.1063/5.0200029.

ABSTRACT

Developing reliable methodologies to decode brain state information from electroencephalogram (EEG) signals is an open challenge, crucial to implementing EEG-based brain-computer interfaces (BCIs). For example, signal processing methods that identify brain states could allow motor-impaired patients to communicate via non-invasive, EEG-based BCIs. In this work, we focus on the problem of distinguishing between the states of eyes closed (EC) and eyes open (EO), employing quantities based on permutation entropy (PE). An advantage of PE analysis is that it uses symbols (ordinal patterns) defined by the ordering of the data points (disregarding the actual values), hence providing robustness to noise and outliers due to motion artifacts. However, we show that for the analysis of multichannel EEG recordings, the performance of PE in discriminating the EO and EC states depends on the symbols’ definition and how their probabilities are estimated. Here, we study the performance of PE-based features for EC/EO state classification in a dataset of N=107 subjects with one-minute 64-channel EEG recordings in each state. We analyze features obtained from patterns encoding temporal or spatial information, and we compare different approaches to estimate their probabilities (by averaging over time, over channels, or by “pooling”). We find that some PE-based features provide about 75% classification accuracy, comparable to the performance of features extracted with other statistical analysis techniques. Our work highlights the limitations of PE methods in distinguishing the eyes’ state, but, at the same time, it points to the possibility that subject-specific training could overcome these limitations.

PMID:38598676 | DOI:10.1063/5.0200029

Med Care. 2024 Apr 10. doi: 10.1097/MLR.0000000000001999. Online ahead of print.

ABSTRACT

BACKGROUND: The provision of high-quality hospital care requires adequate space, buildings, and equipment, although redundant infrastructure could also drive service overprovision.

OBJECTIVE: To explore the distribution of physical hospital resources-that is, capital assets-in the United States; its correlation with indicators of community health and nonhealth factors; and the association between hospital capital density and regional hospital utilization and costs.

RESEARCH DESIGN: We created a dataset of n=1733 US counties by analyzing the 2019 Medicare Cost Reports; 2019 State Inpatient Database Community Inpatient Statistics; 2020-2021 Area Health Resource File; 2016-2020 American Community Survey; 2022 PLACES; and 2019 CDC WONDER. We first calculated aggregate hospital capital assets and investment at the county level. Next, we examined the correlation between community’s medical need (eg, chronic disease prevalence), ability to pay (eg, insurance), and supply factors with 4 metrics of capital availability. Finally, we examined the association between capital assets and hospital utilization/costs, adjusted for confounders.

RESULTS: Counties with older and sicker populations generally had less aggregate hospital capital per capita, per hospital day, and per hospital discharge, while counties with higher income or insurance coverage had more hospital capital. In linear regressions controlling for medical need and ability to pay, capital assets were associated with greater hospital utilization and costs, for example, an additional $1000 in capital assets per capita was associated with 73 additional discharges per 100,000 population (95% CI: 45-102) and $19 in spending per bed day (95% CI: 12-26).

CONCLUSIONS: The level of investment in hospitals is linked to community wealth but not population health needs, and may drive use and costs.

PMID:38598671 | DOI:10.1097/MLR.0000000000001999