Nevin Manimala

J Forensic Sci. 2021 Nov 19. doi: 10.1111/1556-4029.14946. Online ahead of print.

ABSTRACT

Aluminum (Al) powder is commonly encountered in improvised explosive devices (IEDs) as a metallic fuel due to its availability and low cost. Although available commercially in powder form, amateur bomb-makers also produce their own Al powder via simple methods found online. In order to provide investigative leads and forensic intelligence, it is important to evaluate not only the composition of homemade devices, but also to distinguish between the various forms of Al powder they contain. To achieve this goal, a method using automated microscopy in combination with statistical techniques has been demonstrated to have the potential to provide source discrimination and investigative leads in source attribution of Al powders in IEDs. The present research refined this method and investigated 59 industrially and amateurly produced Al powder sources with seven subsamples per source using two traditional linear discriminant analyses (LDA), one with a standard data split for training and testing, and another using leave-one-out cross-validation. Averaging the classification accuracies for the two LDA-based analyses, LDA has the ability to correctly classify 59.26%, 83.35%, and 80.69% of the samples based on their powder source, type, and production method, respectively. This classification accuracy represents a 3407%, 317%, and 61.38% increase in accuracy from random class assignment, respectively. Further, in most instances of incorrect data attribution to a particular source, the subsample has been misidentified with another sample of the same powder type or production method.

PMID:34799855 | DOI:10.1111/1556-4029.14946

Risk Anal. 2021 Nov 19. doi: 10.1111/risa.13858. Online ahead of print.

ABSTRACT

In this study, we propose a time-dependent susceptible-exposed-infected-recovered (SEIR) model for the analysis of the SARS-CoV-2 epidemic outbreak in three different countries, the United States, Italy, and Iceland using public data inherent the numbers of the epidemic wave. Since several types and grades of actions were adopted by the governments, including travel restrictions, social distancing, or limitation of movement, we want to investigate how these measures can affect the epidemic curve of the infectious population. The parameters of interest for the SEIR model were estimated employing a composite likelihood approach. Moreover, standard errors have been corrected for temporal dependence. The adoption of restrictive measures results in flatten epidemic curves, and the future evolution indicated a decrease in the number of cases.

PMID:34799850 | DOI:10.1111/risa.13858

Eur Arch Paediatr Dent. 2021 Nov 20. doi: 10.1007/s40368-021-00664-9. Online ahead of print.

ABSTRACT

PURPOSE: Osteogenesis imperfecta (OI) results from mutations in the genes involved in the modification or biosynthesis of collagen. This study aimed to assess the oral health-related quality of life (OHRQoL) in children with OI.

METHODOLOGY: Participants were recruited from a highly specialised OI centre for children. The Child Oral-Health Impact Profile-Short Form (COHIP-SF) was used, adding demographic and qualitative questions. Children aged 8-16 years participated between January and October 2019. Statistical analysis was carried out. A higher COHIP-SF score indicates better OHRQoL (maximum score, 76).

RESULTS: One hundred and six (106) children participated (44 female, mean age 11.93 years). COHIP-SF median score was 59. Children reporting mild OI (n = 55) had higher median scores (62) compared to severe OI (n = 7) with median scores of 55 (P = 0.087). When comparing mixed (< 12 years, n = 46) and permanent dentition (≥ 12, n = 60), no significant difference in OHRQoL was seen (P = 0.977). There was no significant difference between severities for each COHIP-SF domain. Limited data on the presence of dentinogenesis imperfecta did not impact overall score (P = 0.109), but was significant in the oral-health domain (P = 0.033).

QUALITATIVE: Common themes were the need for braces, discolouration, pain and function.

CONCLUSION: This study confirmed that children with OI have dental concerns in areas including oral health, functional well-being and socio-emotional well-being. This was related to severity of OI.

PMID:34799841 | DOI:10.1007/s40368-021-00664-9

Diabetes Ther. 2021 Nov 19. doi: 10.1007/s13300-021-01174-z. Online ahead of print.

ABSTRACT

Limiting postprandial glycemic response (PPGR) is an important intervention in reducing the risk of chronic metabolic diseases and has been shown to impart significant health benefits in people with elevated levels of blood sugar. In this study, we collected gut microbiome activity data by assessing the metatranscriptome, and we measured the glycemic responses of 550 adults who consumed more than 30,000 meals, collectively, from omnivore or vegetarian/gluten-free diets. We demonstrate that gut microbiome activity, anthropometric factors, and food macronutrients modulate individual variation in glycemic response. We employ two predictive models, including a mixed-effects linear regression model (R = 0.77) and a gradient boosting machine model (R_train = 0.80/R²_train = 0.64; R_test = 0.64/R²_test = 0.40), which demonstrate variation in PPGR between individuals when ingesting the same foods. All features in the final mixed-effects linear regression model were significant (p < 0.05) except for two features which were retained as suggestive: glutamine production pathways (p = 0.08) and the interaction between tyrosine metabolizers and carbs (p = 0.06). We introduce molecular functions as features in these two models, aggregated from microbial activity data, and show their statistically significant contributions to glycemic control. In summary, we demonstrate for the first time that metatranscriptomic activity of the gut microbiome is correlated with PPGR among adults.

PMID:34799839 | DOI:10.1007/s13300-021-01174-z

Klin Padiatr. 2021 Nov 19. doi: 10.1055/a-1662-5336. Online ahead of print.

ABSTRACT

BACKGROUND: The number of long term cancer survivors during childhood or adolescence is increasing steadily. Survivors often suffer from physical or psychosocial long term effects. There is currently little data on the arrangement of long term aftercare in the field of psychosocial care.

METHODS: In November 2017 a questionnaire was sent to 1900 cancer survivors aged between 18 and 35 years whose diagnosis dated at least five years prior. The obtained data serve as a condition and needs assessment, how the (psychosocial) long-term aftercare is perceived by the survivors and what else is desired. The analysis was conducted using descriptive statistics as well as the calculation of bivariate correlations.

RESULTS: The response rate was 54.9% (n=1.043). The median interval from the first diagnosis was 20 years. In total 666 survivors (63.9%) stated that they suffered from at least one long term effect. Within this, especially neurocognitive themes played a role. 87.2% of the respondents had the feeling that they had overcome the illness/therapy well.

CONCLUSION: Through a stronger patient-focussed orientation concerning the current care and advisory services, the situation of long term survivors could be improved. This especially includes access to relevant information that focuses on the available psychosocial and welfare services, as well as to advisory and care services. Additionally, the development and expansion of care structures in the areas of neurocognition and psychotherapy is important to ensure long term participation attendance.

HINTERGRUND: Die Zahl der Langzeitüberlebenden nach einer Krebserkrankung im Kindes- oder Jugendalter (Survivor) steigt stetig. Survivor leiden nicht selten unter körperlichen oder psychosozialen Spätfolgen. Für die Gestaltung der Langzeitnachsorge im Bereich der psychosozialen Versorgung liegen bislang kaum Daten vor.

METHODE: 11/2017 wurde deutschlandweit ein Fragebogen an 1.900 Survivor im Alter von 18 bis 35 Jahren versandt, deren Erstdiagnose zum Befragungszeitpunkt mindestens fünf Jahre zurücklag. Die erhobenen Daten dienen als Zustands- und Bedarfserhebung, wie die (psychosozialen) Langzeitnachsorge von den Survivorn wahrgenommen und was darüber hinaus gewünscht wird. Die Auswertung erfolgte mittels deskriptiver Statistik sowie der Berechnung bivariater Korrelationen.

ERGEBNISSE: Der Rücklauf betrug 54,9% (n=1.043). Der mediane Abstand zur Erst-Diagnose betrug 20 Jahre. Insgesamt gaben 666 Survivor (63,9%) an, mindestens eines der abgefragten Items/Symptome bei sich zu beobachten. Hierbei spielen besonders neurokognitive Themen eine Rolle. Viele Angebote der Langzeitnachsorge sind den Survivorn nicht bekannt. 87,2% der Befragten haben das Gefühl, die Erkrankung/Therapie gut gemeistert zu haben.

SCHLUSSFOLGERUNG: Eine stärkere patientenorientierte Ausrichtung der derzeitigen Versorgungs- und Beratungsangebote könnte die Situation von Langzeitüberlebenden noch verbessern. Zentral sind hierbei der Zugang zu gezielten Informationen, eine psychosoziale und sozialrechtliche Betreuung sowie der Zugang zu Beratungs- und Versorgungsangeboten. Auch der Auf- und Ausbau von Versorgungsstrukturen im Bereich der Neurokognition und Psychotherapie ist für die langfristige Sicherstellung von Partizipation wünschenswert.

PMID:34798671 | DOI:10.1055/a-1662-5336

Gesundheitswesen. 2021 Nov 19. doi: 10.1055/a-1665-6874. Online ahead of print.

ABSTRACT

BACKGROUND: In Germany, the Diagnosis-Related Group Statistics (DRG Statistics) represent an almost complete discharge data-based registry of inpatient services in acute care hospitals. However, services of hospitals owned by workers’ compensation funds and financed through the statutory insurance for occupational accidents are excluded from the obligation of submitting hospital discharge data. Hence, the DRG statistics might be incomplete regarding inpatient services for trauma care.

METHODS: In order to illustrate trauma and post-trauma care in acute care hospitals, groups of specific inpatient services were defined. Numbers of cases according to these groups were identified in the microdata of the DRG statistics, as well as in the inpatient data of all nine workers’ compensation funds hospitals in Germany. By dividing cases financed through the statutory insurance for occupational accidents from cases financed through other payers, the overlap of both databases as well as the share of cases not recorded in the DRG statistics were quantified. The analysis comprised data of 2016-2018.

RESULTS: Depending on the type of service, the share of cases not recorded in the DRG statistics varied between 0.1% and more than 60% (accumulated 2016 to 2018). There was under-recording of early-stage rehabilitation for traumatic brain injury (61%), treatment for traumatic paraplegia (14% for initial treatment and 23% for subsequent treatment), treatment for amputation injury (13%) and treatment for severe hand injury (5%).

CONCLUSION: Regarding inpatient services that are not covered by the statutory insurance for occupational accidents, the microdata of the DRG statistics can be considered as virtually complete. However, inpatient services for trauma care are not completely recorded because discharge data are not submitted by hospitals run by workers’ compensation funds when services are financed through the statutory insurance for occupational accidents. Analyses of trauma care can only be complete if data of hospitals financed by workers’ compensation funds are included.

PMID:34798663 | DOI:10.1055/a-1665-6874

J Low Genit Tract Dis. 2021 Nov 17. doi: 10.1097/LGT.0000000000000633. Online ahead of print.

ABSTRACT

OBJECTIVES: Vulvar cancer is a gynecological cancer for which posttreatment morbidity must be known to propose the appropriate medical strategy. The objectives of this article were to review and to summarize the available studies evaluating the impact of vulvar surgery on the quality of sex life.

MATERIALS AND METHODS: We searched MEDLINE abstracts (source PubMed) and included all studies published between 1990 and 2020 that evaluated the impact of vulvar surgery on the patients’ sex life. Articles were selected in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. We evaluated the quality of the studies using the “study quality assessment tools” established by the National Heart Lung and Blood Institute and the health-related quality-of-life score. Summary statistics were used to report the results of the studies selected.

RESULTS: A total of 41 articles were screened, and 15 studies were included in this review. Two questionnaires, that is, European Organization for Research and Treatment of Cancer QLC C30 and Female Sexual Function Index, were used in 60% of the studies. The quality of the studies was heterogeneous. None of them had a high level of evidence. Eleven of the 16 studies reported an impairment of quality of sex life, mainly related to the size of the initial lesion and the type of surgery performed. Preoperative sexual status, that is, active sex life, age, and morbidity seemed to be important factors.

CONCLUSIONS: None of the studies had a high level of evidence, and their methodological quality was heterogeneous. More powerful studies using validated questionnaires are necessary. Because this is essential surgery, patients should be informed that if it impacts their sexual life, management strategies will be part of their postoperative care.

PMID:34798652 | DOI:10.1097/LGT.0000000000000633

Spine (Phila Pa 1976). 2021 Nov 18. doi: 10.1097/BRS.0000000000004277. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective review.

OBJECTIVE: Assess measures of spinal-pelvic balance in predicting functional outcome in patients who underwent posterior spinal fusion for adolescent idiopathic scoliosis (AIS) at minimum 40-year follow-up.

SUMMARY OF BACKGROUND DATA: Back pain and long-term function are considered when choosing levels for surgery in AIS patients. Three hundred and fourteen patients underwent fusion for AIS between 1961 and 1977. One hundred and thirty-four patients were located for potential long-term follow-up.

METHODS: With IRB approval, medical records and public resources were used to locate patients. Patients completed health related quality of life instruments, and returned for assessment including full radiographs. Radiographs were analyzed for scoliosis measures, and recognized spinal-pelvic measures including the lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI) and pelvic tilt (PT). Bivariate and multivariable analyses were performed to assess the association between spinal-pelvic measures and patient-reported outcomes (PROs).

RESULTS: Thirty-five of 134 patients agreed to return for complete health related quality of life (HRQoL) and radiographic follow-up. There were no differences at baseline between those agreeing and declining participation. The cohort was 94% female, had an average age of 60.5 years, and average follow-up of 46 years. In bivariate analysis, PI-LL was the only spinal-pelvic parameter which statistically discriminated between patients doing well and not, as assessed by the Oswestry Disability Index and the PROMIS Pain Interference and Fatigue instruments. In multivariable analysis, (PI-LL > 9°) was associated with worse scores in PROMIS-Pain Interference, Physical Function, Depression, Fatigue, Social Function as well as the total Oswestry score. An SVA > 50 mm was associated with worse scores in the SRS-7.

CONCLUSIONS: In a cohort of 35 patients with average follow-up of 46 years after posterior spinal instrumentation with Harrington rods (PSIF) for adolescent idiopathic scoliosis, spinal-pelvic mismatch as identified by (PI-LL > 9°) was associated with inferior HRQoL outcomes. Other spinal-pelvic measures (SVA and PT) were not reliably associated with inferior HRQol.Level of Evidence: 4.

PMID:34798644 | DOI:10.1097/BRS.0000000000004277

J Neurosurg. 2021 Nov 19:1-2. doi: 10.3171/2021.8.JNS211708. Online ahead of print.

NO ABSTRACT

PMID:34798609 | DOI:10.3171/2021.8.JNS211708

J Neurosurg. 2021 Nov 19:1-11. doi: 10.3171/2021.9.JNS211698. Online ahead of print.

ABSTRACT

OBJECTIVE: Microsurgery for cerebral aneurysms is called definitive, yet some patients undergo a craniotomy that results in noncurative treatment. Furthermore, the overall rate of noncurative microsurgery for cerebral aneurysms is unclear. The objective of this study was to complete a systematic review and meta-analysis to quantify three scenarios of noncurative treatment: aneurysm wrapping, postclipping remnants, and late regrowth of completely obliterated aneurysms.

METHODS: A PRISMA-guided systematic literature review of the MEDLINE and Cochrane Library databases and meta-analysis was completed. Studies were included that detailed rates of aneurysm wrapping, residua confirmed with imaging, and regrowth after confirmed total occlusion. Pooled rates were subsequently calculated using a random-effects model. An assessment of statistical heterogeneity and publication bias among the included studies was also completed for each analysis, with resultant I2 values and p values determined with Egger’s test.

RESULTS: Sixty-four studies met the inclusion criteria for final analysis. In 41 studies, 573/15,715 aneurysms were wrapped, for a rate of 3.5% (95% CI 2.7%-4.2%, I2 = 88%). In 43 studies, 906/13,902 aneurysms had residual neck or dome filling, for a rate of 6.4% (95% CI 5.2%-7.6%, I2 = 93%). In 15 studies, 71/2568 originally fully occluded aneurysms showed regrowth, for a rate of 2.1% (95% CI 1.2%-3.1%, I2 = 58%). Together, there was a total rate of noncurative surgery of 12.0% (95% CI 11.5%-12.5%). Egger’s test suggested no significant publication bias among the studies. Meta-regression analysis revealed that the reported rate of aneurysm wrapping has significantly declined over time, whereas the rates of aneurysm residua and recurrence have not significantly changed.

CONCLUSIONS: Open microsurgery for cerebral aneurysm results in noncurative treatment approximately 12% of the time. This metric may be used to counsel patients and as a benchmark for other treatment modalities. This investigation is limited by the high degree of heterogeneity among the included studies.

PMID:34798602 | DOI:10.3171/2021.9.JNS211698