Nevin Manimala

PLoS Negl Trop Dis. 2021 May 24;15(5):e0009372. doi: 10.1371/journal.pntd.0009372. eCollection 2021 May.

ABSTRACT

BACKGROUND: Burkholderia pseudomallei is a Gram-negative bacterium found in soil and water in many tropical countries. It causes melioidosis, a potentially fatal infection first described in 1911 in Myanmar. Melioidosis is a common cause of sepsis and death in South and South-east Asia, but it is rarely diagnosed in Myanmar. We conducted a nationwide soil study to identify areas where B. pseudomallei is present.

METHODOLOGY/PRINCIPAL FINDINGS: We collected soil samples from 387 locations in all 15 states and regions of Myanmar between September 2017 and June 2019. At each site, three samples were taken at each of three different depths (30, 60 and 90 cm) and were cultured for B. pseudomallei separately, along with a pooled sample from each site (i.e. 10 cultures per site). We used a negative binomial regression model to assess associations between isolation of B. pseudomallei and environmental factors (season, soil depth, soil type, land use and climate zones). B. pseudomallei was isolated in 7 of 15 states and regions. Of the 387 sites, 31 (8%) had one or more positive samples and of the 3,870 samples cultured, 103 (2.7%) tested positive for B. pseudomallei. B. pseudomallei was isolated more frequently during the monsoon season [RR-2.28 (95% CI: 0.70-7.38)] and less in the hot dry season [RR-0.70 (95% CI: 0.19-2.56)] compared to the cool dry season, and in the tropical monsoon climate zone [RR-2.26; 95% CI (0.21-6.21)] compared to the tropical dry winter climate zone. However, these associations were not statistically significant. B. pseudomallei was detected at all three depths and from various soil types (clay, silt and sand). Isolation was higher in agricultural land (2.2%), pasture land (8.5%) and disused land (5.8%) than in residential land (0.4%), but these differences were also not significant.

CONCLUSION/SIGNIFICANCE: This study confirms a widespread distribution of B. pseudomallei in Myanmar. Clinical studies should follow to obtain a better picture of the burden of melioidosis in Myanmar.

PMID:34029325 | DOI:10.1371/journal.pntd.0009372

PLoS One. 2021 May 24;16(5):e0251839. doi: 10.1371/journal.pone.0251839. eCollection 2021.

ABSTRACT

BACKGROUND: Soccer players incur injuries that typically affect their performance. Injuries are caused by intrinsic and extrinsic factors that call for multifactorial preventive interventions. The study examines the impact of the FIFA 11+ warm up programme on the incidence and severity of injuries in second division soccer players in Rwanda.

METHODS: Twelve teams (309 players) were randomised in the intervention group and 12 teams (317 players) in the control group using a cluster randomized controlled trial with teams as the unit of randomization. Intervention group teams implemented the FIFA 11+ soccer specific warm-up programme during training and matches at least three times a week over seven months of the Rwandan soccer season. Control group teams continued with usual warm up exercises. The primary outcome of this study was the overall incidence of training and match injuries. Injuries, training and match exposure as well as severity categories were recorded per the F-MARC guidelines.

RESULTS: A lower proportion of players sustained injuries in the intervention group (52%) compared to the control group (63%) (Odd ratio: 0.7; 95%CI: 0.5-0.9). A significantly lower rate ratio was observed in the intervention group for overall (RR = 0.6; 95%CI: 0.5-0.8) and match (RR = 0.6; 95%CI: 0.5-0.8) injuries. Compliance to the injury prevention programme was 77%. In the intervention group, the incidence of injury was similar across all teams and across the medium and highly compliant teams. There was a statistically significant 55% and 71% reduction of the rate of moderate and severe injuries in the intervention group respectively.

CONCLUSION: The 11+ warm up injury prevention programme resulted in a significant reduction in the odds of sustaining injuries. In addition, injuries sustained were less severe. The programme should be rolled out to all teams in Rwanda and may well result in a decrease in the incidence and severity of injury in similar contexts.

TRIAL REGISTRATION: Pan African Clinical Trial Registry (PACTR201505001045388).

PMID:34029321 | DOI:10.1371/journal.pone.0251839

PLoS Comput Biol. 2021 May 24;17(5):e1008957. doi: 10.1371/journal.pcbi.1008957. Online ahead of print.

ABSTRACT

Coevolution-based contact prediction, either directly by coevolutionary couplings resulting from global statistical sequence models or using structural supervision and deep learning, has found widespread application in protein-structure prediction from sequence. However, one of the basic assumptions in global statistical modeling is that sequences form an at least approximately independent sample of an unknown probability distribution, which is to be learned from data. In the case of protein families, this assumption is obviously violated by phylogenetic relations between protein sequences. It has turned out to be notoriously difficult to take phylogenetic correlations into account in coevolutionary model learning. Here, we propose a complementary approach: we develop strategies to randomize or resample sequence data, such that conservation patterns and phylogenetic relations are preserved, while intrinsic (i.e. structure- or function-based) coevolutionary couplings are removed. A comparison between the results of Direct Coupling Analysis applied to real and to resampled data shows that the largest coevolutionary couplings, i.e. those used for contact prediction, are only weakly influenced by phylogeny. However, the phylogeny-induced spurious couplings in the resampled data are compatible in size with the first false-positive contact predictions from real data. Dissecting functional from phylogeny-induced couplings might therefore extend accurate contact predictions to the range of intermediate-size couplings.

PMID:34029316 | DOI:10.1371/journal.pcbi.1008957

PLoS Comput Biol. 2021 May 24;17(5):e1008969. doi: 10.1371/journal.pcbi.1008969. Online ahead of print.

ABSTRACT

We contrast two computational models of sequence learning. The associative learner posits that learning proceeds by strengthening existing association weights. Alternatively, recoding posits that learning creates new and more efficient representations of the learned sequences. Importantly, both models propose that humans act as optimal learners but capture different statistics of the stimuli in their internal model. Furthermore, these models make dissociable predictions as to how learning changes the neural representation of sequences. We tested these predictions by using fMRI to extract neural activity patters from the dorsal visual processing stream during a sequence recall task. We observed that only the recoding account can explain the similarity of neural activity patterns, suggesting that participants recode the learned sequences using chunks. We show that associative learning can theoretically store only very limited number of overlapping sequences, such as common in ecological working memory tasks, and hence an efficient learner should recode initial sequence representations.

PMID:34029315 | DOI:10.1371/journal.pcbi.1008969

J ECT. 2021 Jun 1;37(2):e9-e12. doi: 10.1097/YCT.0000000000000744.

ABSTRACT

OBJECTIVES: Electroconvulsive therapy (ECT) is an effective and safe treatment of certain severe mental disorders, but there are some barriers to the implementation of continuation/maintenance ECT courses in some cases. Repeated difficulties in achieving intravenous access before each session may contribute to premature ECT discontinuation. The placement of a totally implantable venous-access device (TIVAD) could be an alternative to overcome these difficulties in certain subjects.

METHODS: For the present study we retrospectively identified all patients treated with continuation/maintenance ECT in our facilities during a 13-year period to which a TIVAD was implanted, paying attention to specific factors related to clinical characteristics, treatment course, and ECT technique.

RESULTS: We identified a TIVAD in 16 (3.33%) of 481 patients receiving ECT in our unit, of whom 87.5% were female. Half of the cases met the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for schizophrenia, 6 for bipolar disorder, and 2 for major depression disorder. Age of the study cases ranged from 17 to 87 years. A total of 1957 ECT sessions were registered in this group of cases during the observation period. Patients had undergone a mean of 124.06 ± 132.41 ECT sessions before the TIVAD was implanted, with the device mean time of utilization being 5.39 ± 3.46 years. In 2 cases, the device was removed after ECT discontinuation. Few incidents associated with the implantation and operation of the TIVAD were registered, comparable to the use of this device in other clinical contexts.

CONCLUSIONS: This case series suggest that a TIVAD placement can be an effective and safe solution for patients in continuation/maintenance ECT courses with difficult intravenous access. Future studies will need to carefully monitor the benefit and the potential complications of TIVAD placement in patients undergoing continuation/maintenance ECT programs.

PMID:34029306 | DOI:10.1097/YCT.0000000000000744

J ECT. 2021 Jun 1;37(2):84-87. doi: 10.1097/YCT.0000000000000724.

ABSTRACT

OBJECTIVES: Electroconvulsive therapy (ECT) is a mainstay in both acute and long-term management of difficult-to-treat depression. However, frequent acute courses of ECT or prolonged maintenance ECT treatment may increase adverse-effect burden and/or reduce patient acceptability. Therefore, we investigated the effectiveness of adjunctive vagus nerve stimulation (VNS) therapy as an alternative strategy for long-term maintenance treatment in ECT-responsive patients.

METHODS: This retrospective chart review identified maintenance ECT patients with unipolar (n = 5) and bipolar depression (n = 5) from 2 large hospital systems who had a history of ECT response, but the patients had significant residual incapacitating symptoms or increasing concerns regarding the burden associated with ECT and opted to receive adjunctive VNS therapy. The patients were followed for 2 years after VNS implantation. Response and remission were defined as Clinical Global Impression-Severity scale scores of ≤2 and 1, respectively, obtained at 1- and 2-year postimplantation compared with just before VNS implantation.

RESULTS: One-year postimplantation, 6 of 10 had responded of which 5 met remission criteria. All 10 patients benefited from adjunctive VNS therapy with either fewer hospitalizations and/or ECT sessions. Seven of 10 stopped maintenance ECT by the end of year 1; an additional patient stopped maintenance ECT by year 2. No patients required an acute course of ECT during the 2-year follow-up. There was a statistically significant reduction (P < 0.0001) in mean (SD) Clinical Global Impression-Severity scale scores between baseline (5.4 [0.51]) and the 1-year postimplantation (2.1 [1.37]) time points, and between baseline and the 2-year postimplantation (2.3 [1.16]) time points, whereas no difference existed between the 1- and 2-year postimplantation time points.

CONCLUSIONS: Vagus nerve stimulation therapy may be a useful maintenance strategy in patients with difficult-to-treat depression receiving maintenance ECT.

PMID:34029305 | DOI:10.1097/YCT.0000000000000724

J Occup Environ Med. 2021 May 21. doi: 10.1097/JOM.0000000000002273. Online ahead of print.

NO ABSTRACT

PMID:34029298 | DOI:10.1097/JOM.0000000000002273

Comput Inform Nurs. 2021 May 24. doi: 10.1097/CIN.0000000000000763. Online ahead of print.

ABSTRACT

We examined the association between symptoms (ie, dyspnea and pain) and patient outcomes (ie, length of stay, 30-day readmission, and death in hospital) among patients with heart failure using EMRs. This was a descriptive study that was conducted from July 1, 2014, to November 30, 2017. Participants were 754 hospitalized patients with heart failure (mean age, 70.62 ± 14.78 years; male-to-female ratio, 1:1.1). Data were analyzed using descriptive statistics, χ2 tests, and logistic regression analyses. Patients’ average length of stay was 8.92 ± 13.12 days. Thirty-two patients (4.2%) were readmitted, and 100 patients (13.3%) died during hospitalization. Two-thirds (67.7%) experienced dyspnea, and 367 (48.7%) experienced pain. Symptoms and ICU admission were significantly related to patient outcomes. In the regression analyses, dyspnea, pain, and ICU admission were significantly related to higher-than-average lengths of stay. Dyspnea and ICU admission were related to death in hospital. Information regarding patients’ symptoms, which was extracted from records, was a valuable resource in examining the relationship between symptoms and patient outcomes. The use of EMRs may be more advantageous than self-reported surveys when examining patients’ symptom and utilizing big data.

PMID:34029266 | DOI:10.1097/CIN.0000000000000763

Comput Inform Nurs. 2021 May 24. doi: 10.1097/CIN.0000000000000757. Online ahead of print.

ABSTRACT

This project piloted an educational intervention focused on use and management of EHR data by Doctor of Nursing Practice students in quality improvement initiatives. Recommendations from academic and clinical nursing promote the integration of EHR data findings into practice. Nursing’s general lack of understanding about how to use and manage data is a barrier to using EHR data to guide quality improvement initiatives. Doctor of Nursing Practice students at a hospital-affiliated university participated in a pre-test, training, and post-test through an online learning management system. Training content and assessments focused on data and planning for its use in quality improvement initiatives. Sixteen students experienced a median of 17.6% increase in scores after completing the post-test. There was a statistically significant increase in scores between the pre-test and post-test (P = .0006). These results suggest educational content included in the Doctor of Nursing Practice Quality Improvement Toolkit increases knowledge about use and management of EHR data. Future considerations include use for educating a variety of students and healthcare staff.

PMID:34029265 | DOI:10.1097/CIN.0000000000000757

Cornea. 2021 May 21. doi: 10.1097/ICO.0000000000002751. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to evaluate the safety and efficacy of tacrolimus 0.1% eye drops in a large population of pediatric patients affected by a severe form of vernal keratoconjunctivitis (VKC) who responded poorly to cyclosporine eye drops.

METHODS: This is a retrospective study based on standardized clinical charts and data collection of consecutive patients affected by severe VKC who responded poorly to cyclosporine eye drops topical treatment but treated with tacrolimus 0.1% eye drops with a follow-up of 18 months. Four clinical signs were graded for analysis: hyperemia, tarsal papillae, giant papillae, and limbal papillae. The blood tests for kidney and liver function and the tacrolimus level were studied. Visits were scheduled at baseline and at 3, 6, 12, and 18 months. Patients received tacrolimus 0.1% eye drops in both eyes 2 times daily.

RESULTS: Four hundred thirty-one patients were included. Three hundred twenty-five patients were affected by a seasonal form, whereas the remaining 106 by a perennial form. Statistical analysis on each single score showed a positive relevance (P < 0.001) from baseline to all other visits. No local or systemic complications were recorded.

CONCLUSIONS: Tacrolimus has been proposed as a treatment for severe forms of VKC. This study has confirmed the safety and efficacy of tacrolimus 0.1% eye drops in a large pediatric population of patients affected by a severe form of VKC who responded poorly to cyclosporine eye drops.

PMID:34029239 | DOI:10.1097/ICO.0000000000002751