Nevin Manimala

Diving Hyperb Med. 2021 Mar 31;51(1):72-77. doi: 10.28920/dhm51.1.72-77.

ABSTRACT

INTRODUCTION: This paper presents a quantitative and qualitative study exploring patients’ knowledge and experience of hyperbaric oxygen treatment (HBOT).

METHODS: Participants included 29 patients with appropriate indications who were undertaking HBOT at facilities in two different locations: Hobart, Australia, and Plymouth, United Kingdom. Participants completed surveys prior to commencing HBOT, after five sessions, and on completion of HBOT. Semi-structured one-to-one interviews were conducted with each individual on conclusion of their course. Data were analysed using descriptive statistics and interpretive description.

RESULTS: Prior to referral, 15/29 (52%) of participants knew HBOT was used to treat divers, and of these, 9/15 (60%) were familiar with its use for non-divers. Only one third sought additional information about the process between referral for HBOT and attending their medical assessment. Anxiety was a pre-treatment concern amongst participants. However, when re-measured after five sessions and upon completion of the HBOT course, anxiety was reduced. The interview data revealed themes based around the physical, emotional and social aspects of HBOT: (1) anxiety within self; (2) naivety to normalisation; (3) enjoyment being a ‘diver’; and (4) burdens of HBOT.

CONCLUSIONS: Many patients experienced anxiety prior to commencing HBOT but, with support, quickly adjusted to treatment, transitioning from a state of naivety to normalisation in their experience of the hyperbaric chamber. They enjoyed feeling like a ‘diver’ and considered aspects of the burdens of treatment, such as finances or logistics, a minor inconvenience. These results highlight the need for psychosocial support during treatment by identifying gaps in patient preparation for HBOT.

PMID:33761544 | DOI:10.28920/dhm51.1.72-77

Diving Hyperb Med. 2021 Mar 31;51(1):53-62. doi: 10.28920/dhm51.1.53-62.

ABSTRACT

INTRODUCTION: This study identified characteristics and diving practices of victims of fatal surface supplied breathing apparatus (SSBA) incidents in Australia from 1965-2019 to determine underlying factors and risks associated with these activities, better educate the diving community and prevent such deaths.

METHODS: A hand search was made of ‘Project Stickybeak’ reports from 1965-2000 and SSBA fatality data were compared to the Australasian Diving Safety Foundation fatality database. The National Coronial Information System was searched to identify SSBA diving deaths for 2001-2019. Extracted data were collated and analysed using descriptive statistics and Poisson Regression. A chain of events analysis was used to determine the likely sequence of events.

RESULTS: There were 84 identified SSBA-related deaths during the study period. Most victims were relatively young, healthy males (median age 33 years). At least 50% of victims were undertaking work-related diving, and 37% were recreational diving. Equipment issues, mainly compressor-related, were the main contributor, identified as a predisposing factor in 48% of incidents and as triggers in 24%.

CONCLUSIONS: Preventable surface-supplied diving deaths still occur in both occupational and recreational diving, often from poor equipment maintenance and oversight. Incorrect configuration of the SSBA and lack of training remain on-going problems in recreational users. These could be addressed by improved education, and, failing this, regulatory oversight. The increase in health-related incidents in older participants may be controlled to some extent by greater medical oversight, especially in recreational and non-certified occupational divers who should be encouraged to undergo regular diving medical assessments.

PMID:33761541 | DOI:10.28920/dhm51.1.53-62

Plast Reconstr Surg. 2021 Mar 19. doi: 10.1097/PRS.0000000000007780. Online ahead of print.

ABSTRACT

BACKGROUND: The accepted “one-size-fits-all” dose strategy for prophylactic enoxaparin may not optimize the medication’s risks and benefits after surgical procedures. The authors hypothesized that weight-based administration might improve the pharmacokinetics of prophylactic enoxaparin when compared to fixed-dose administration.

METHODS: The FIxed or Variable Enoxaparin (FIVE) trial was a randomized, double-blind trial that compared the pharmacokinetic and clinical outcomes of patients assigned randomly to postoperative venous thromboembolism prophylaxis using enoxaparin 40 mg twice daily or enoxaparin 0.5 mg/kg twice daily. Patients were randomized after surgery and received the first enoxaparin dose at 8 hours after surgery. Primary hypotheses were (1) weight-based administration is noninferior to a fixed dose for avoiding underanticoagulation (anti-factor Xa <0.2 IU/ml) and (2) weight-based administration is superior to fixed-dose administration for avoiding overanticoagulation (anti-factor Xa >0.4 IU/ml). Secondary endpoints were 90-day venous thromboembolism and bleeding.

RESULTS: In total, 295 patients were randomized, with 151 assigned to fixed-dose and 144 to weight-based administration of enoxaparin. For avoidance of underanticoagulation, weight-based administration had a greater effectiveness (79.9 percent versus 76.6 percent); the 3.3 percent (95 percent CI, -7.5 to 12.5 percent) greater effectiveness achieved statistically significant noninferiority relative to the a priori specified -12 percent noninferiority margin (p = 0.004). For avoidance of overanticoagulation, weight-based enoxaparin administration was superior to fixed-dose administration (90.6 percent versus 82.2 percent); the 8.4 percent (95 percent CI, 0.1 to 16.6 percent) greater effectiveness showed significant safety superiority (p = 0.046). Ninety-day venous thromboembolism and major bleeding were not different between fixed-dose and weight-based cohorts (0.66 percent versus 0.69 percent, p = 0.98; 3.3 percent versus 4.2 percent, p = 0.72, respectively).

CONCLUSION: Weight-based administration showed superior pharmacokinetics for avoidance of underanticoagulation and overanticoagulation in postoperative patients receiving prophylactic enoxaparin.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

PMID:33761517 | DOI:10.1097/PRS.0000000000007780

Med Princ Pract. 2021 Mar 24. doi: 10.1159/000516067. Online ahead of print.

ABSTRACT

A significant number of studies suggests that coffee consumption reduces cancer risk. This beneficial effect is usually ascribed to the presence of polyphenolic antioxidants and anti- inflammatory agents, including caffeine, cafestol, kahweol and chlorogenic acids. To summarize recent literature on this subject we performed a bibliographic search in PubMed and Embase over the period January 2005 to December 2020 to identify cohort studies and meta-analysis (with data collection ensuring quality of selected reports) that could provide quantitative data on the relationship between coffee consumption and common cancers. The totality of eligible scientific papers support the evidence that coffee intake is inversely associated with hepatocellular cancer risk and to a – slight extent- breast cancer risk among postmenopausal women. As to the association with other organs, including esophagus, pancreas, colorectum, kidneys, bladder, ovaries and prostate, the results are less clear as reports reveal conflicting results or statistically non- significant data. Therefore this overview does not allow broad- based conclusions. Important uncertainties include general study design, inhomogeneous patient sampling, different statistical analysis, (deliberate) misreporting of socio- economic status, education, coffee brewing methods, consumption caffeinated or decaffeinated coffee, smoking habits and alcohol intake. Obviously, more epidemiological research needs to be conducted before solid science- based recommendations can be made with regard to coffee consumption.

PMID:33761499 | DOI:10.1159/000516067

Phys Med Biol. 2021 Mar 24. doi: 10.1088/1361-6560/abf1b8. Online ahead of print.

ABSTRACT

Respiration-induced motion introduces significant positioning uncertainties in radiotherapy treatments for thoracic sites. Accounting for this motion is a non-trivial task commonly addressed with surrogate-based strategies and latency compensating techniques. This study investigates the potential of a new unified probabilistic framework to predict both future target motion in real-time from a surrogate signal and associated uncertainty A Bayesian approach is developed, based on a Kalman filter theory adapted specifically for surrogate measurements. Breathing motions are collected simultaneously from a lung target, two external surrogates (abdominal and thoracic markers) and an internal surrogate (liver structure) for 9 volunteers during 4 minutes, in which severe breathing changes occur to assess the robustness of the method. A comparison with an artificial non-linear neural network (NN) is performed, although no confidence interval prediction is provided. A static worst-case scenario and a simple static design are investigated. Although the NN can reduce the prediction errors from thoracic surrogate in some cases, the Bayesian framework outperforms in most cases the NN when using the other surrogates: bias on predictions is reduced by 38% and 16% on average when using respectively the liver and the abdomen for the simple scenario, and by respectively 40% and 31% for the worst-case scenario. The standard deviation of residuals is reduced on average by up to 42%. The Bayesian method is also found to be more robust to increasing latencies. The thoracic marker appears to be less reliable to predict the target position, while the liver shows to be a better surrogate. A statistical test confirms the significance of both observations. The proposed framework predicts both the future target position and the associated uncertainty, which can be valuably used to further assist motion management decisions. Further investigation is required to improve the predictions by using an adaptive version of the proposed framework.

PMID:33761479 | DOI:10.1088/1361-6560/abf1b8

Physiol Meas. 2021 Mar 24. doi: 10.1088/1361-6579/abf1b0. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop a sleep staging method from wrist-worn accelerometry and the photoplethysmogram (PPG) by leveraging transfer learning from a large electrocardiogram (ECG) database.

APPROACH: In previous work, we developed a deep convolutional neural network for sleep staging from ECG using the cross-spectrogram of ECG-derived respiration and instantaneous beat intervals, heart rate variability metrics, spectral characteristics, and signal quality measures derived from 5,793 subjects in Sleep Heart Health Study (SHHS). We updated the weights of this model by transfer learning using PPG data derived from the Empatica E4 wristwatch worn by 105 subjects in the `Emory Twin Study Follow-up’ (ETSF) database, for whom overnight polysomnographic (PSG) scoring was available. The relative performance of PPG, and actigraphy (Act), plus combinations of these two signals, with and without transfer learning was assessed.

MAIN RESULTS: The performance of our model with transfer learning showed higher accuracy (1-9 percentage points) and Cohen’s Kappa (0.01-0.13) than those without transfer learning for every classification category. Statistically significant, though relatively small, incremental differences in accuracy occurred for every classification category as tested with the McNemar test. The out-of-sample classification performance using features from PPG and actigraphy for four-class classification was Accuracy (Acc)=68.62% and Kappa=0.44. For two-class classification, the performance was Acc=81.49% and Kappa=0.58.

SIGNIFICANCE: We proposed a combined PPG and actigraphy-based sleep stage classification approach using transfer learning from a large ECG sleep database. Results demonstrate that the transfer learning approach improves estimates of sleep state. The use of automated beat detectors and quality metrics means human over-reading is not required, and the approach can be scaled for large cross-sectional or longitudinal studies using wrist-worn devices for sleep-staging.

PMID:33761477 | DOI:10.1088/1361-6579/abf1b0

Int J Sports Physiol Perform. 2021 Mar 23:1-8. doi: 10.1123/ijspp.2020-0264. Online ahead of print.

ABSTRACT

PURPOSE: To analyze the acute effect of photobiomodulation (PBM) on swimming critical velocity (CV).

METHODS: A total of 15 male federated swimmers (20.9 [2.4] y old) participated in this study. Three sets of front crawl were performed at distances of 100, 200, and 400 m to determine the CV under 3 experimental conditions: PBM (420 J), placebo (PLA), and control (C) in this randomized, crossover, double-blind, and placebo-controlled study. One-way analysis of variance for repeated measurements was used for statistical analyses.

RESULTS: The results showed that the prior application of PBM did not have ergogenic effects on CV and front crawl swimming performance: CV (PBM = 1.15 [0.15]; PLA = 1.20 [0.25]; C = 1.15 [0.14] m·s-1), swim time (ST) 100 m (PBM = 65.5 [6.3]; PLA = 65.2 [5.6]; C = 66.0 [5.9] s), ST 200 m (PBM = 148.5 [17.9]; PLA = 149.4 [16.4]; C = 150.1 [17.9] s), and ST 400 m (PBM = 327.7 [38.2]; PLA = 321.6 [47.7]; C = 329.5 [41.2] s).

CONCLUSIONS: A PBM application prior to front crawl swimming test did not significantly modify the CV, ST, physiological factors of metabolic fatigue, perceptual, and front crawl stroke efficiency parameters in competition swimmers covering distances of 100, 200, and 400 m.

PMID:33761459 | DOI:10.1123/ijspp.2020-0264

Comput Med Imaging Graph. 2021 Mar 11;89:101899. doi: 10.1016/j.compmedimag.2021.101899. Online ahead of print.

ABSTRACT

Computed tomography (CT) screening is essential for early lung cancer detection. With the development of artificial intelligence techniques, it is particularly desirable to explore the ability of current state-of-the-art methods and to analyze nodule features in terms of a large population. In this paper, we present an artificial-intelligence lung image analysis system (ALIAS) for nodule detection and segmentation. And after segmenting the nodules, the locations, sizes, as well as imaging features are computed at the population level for studying the differences between benign and malignant nodules. The results provide better understanding of the underlying imaging features and their ability for early lung cancer diagnosis.

PMID:33761446 | DOI:10.1016/j.compmedimag.2021.101899

Int J Law Psychiatry. 2021 Mar 21;76:101684. doi: 10.1016/j.ijlp.2021.101684. Online ahead of print.

ABSTRACT

Clinical impressions suggest that forensic patients in Belgium have more complex needs regarding care and risk in recent years than before. In this article, we analyzed psychometric data regarding patients’ symptoms, risk estimates, antisocial personality traits, and functional capabilities over a 10-year span in a medium-security unit for rehabilitation of forensic patients. Data from a total of 129 patients with a main diagnosis of psychosis were analyzed. Results confirmed that patients had higher risk assessment estimates, more psychopathic/antisocial personality traits, and lower cognitive and functional capabilities. The average psychotic symptom levels and protective factors did not statistically change over the ten-year period. The changes are thought to be due to a new forensic law and the creation of new high- and medium-risk beds.

PMID:33761440 | DOI:10.1016/j.ijlp.2021.101684

J Clin Virol. 2021 Mar 16;137:104795. doi: 10.1016/j.jcv.2021.104795. Online ahead of print.

ABSTRACT

BACKGROUND: Since the worldwide spread of SARS-CoV-2, different European countries reacted with temporary national lockdowns with the aim to limit the virus transmission in the population. Also Austria started a lockdown of public life in March 2020.

OBJECTIVES: In this study we investigated whether the circulation of different respiratory virus infections in Austria, as assessed by the established respiratory virus surveillance system, is affected by these measures as well and may reflect the success of the lockdown in limiting respiratory virus transmission.

STUDY DESIGN: Sentinel data obtained for influenza virus, respiratory syncytial virus, human metapneumovirus and rhinovirus cases were analyzed and compared between the season 2019/2020 and the five previous seasons.

RESULTS: We observed a rapid and statistically significant reduction of cumulative cases for all these viruses within short time after the lockdown in March 2020, compared to previous seasons (each p < 0.001). Also, sentinel screening for SARS-CoV-2 infections was performed and a decrease of SARS-CoV-2 was seen after the lockdown. While for the seasonally occurring viruses as influenza, respiratory syncytial virus or human metapneumovirus the lockdown led to the end of the annual epidemics, a re-increase of rhinovirus infections was observed after liberalization of numerous lockdown measures.

CONCLUSIONS: Our data provide evidence that occurrence of different respiratory virus infections reflect not only the efficiency of lockdown measures taken against SARS-CoV-2 but it shows also the effects of lockdown releases on the transmission of respiratory viruses.

PMID:33761423 | DOI:10.1016/j.jcv.2021.104795