Nevin Manimala

J Sport Rehabil. 2021 Mar 3:1-4. doi: 10.1123/jsr.2020-0275. Online ahead of print.

ABSTRACT

CONTEXT: Total Motion Release® (TMR®) is a novel treatment paradigm used to restore asymmetries in the body (eg, pain, tightness, limited range of motion). Six primary movements, known as the Fab 6, are performed by the patient and scored using a 0 to 100 scale. Clinicians currently utilize the TMR® scale to modify treatment, assess patient progress, and measure treatment effectiveness; however, the reliability of the TMR® scale has not been determined. It is imperative to assess scale reliability and establish minimal detectable change (MDC) values to guide clinical practice.

OBJECTIVE: To assess the reliability of the TMR® scale and establish MDC values for each motion in healthy individuals in a group setting.

DESIGN: Retrospective analysis of group TMR® assessments.

SETTING: University classroom.

PARTICIPANTS: A convenience sample of 61 students (23 males and 38 females; 25.48 [5.73] y), with (n = 31) and without (n = 30) previous exposure to TMR®.

INTERVENTION: The TMR® Fab 6 movements were tested at 2 time points, 2 hours apart. A clinician with previous training in TMR® led participant groups through both sessions while participants recorded individual motion scores using the 0 to 100 TMR® scale. Test-retest reliability was calculated using an intraclass correlation coefficient (2,1) for inexperienced, experienced, and combined student groups. Standard error of measurement and MDC values were also assessed for each intraclass correlation coefficient.

OUTCOME MEASURE: Self-reported scores on the TMR® scale.

RESULTS: Test-retest reliability ranged from 0.57 to 0.95 across the Fab 6 movements, standard error of measurement values ranged from 4.85 to 11.77, and MDC values ranged from 13.45 to 32.62.

CONCLUSION: The results indicate moderate to excellent reliability across the Fab 6 movements and a range of MDC values. Although this study is the first step in assessing the reliability of the TMR® scale for clinical practice, caution is warranted until further research is completed to establish reliability and MDC values of the TMR® scale in various settings to better guide patient care.

PMID:33662931 | DOI:10.1123/jsr.2020-0275

Forensic Sci Int. 2021 Feb 20;321:110739. doi: 10.1016/j.forsciint.2021.110739. Online ahead of print.

ABSTRACT

Sex estimation is a crucial component of the biological profile. Stull et al. (2017) have proposed a promising juvenile sex estimation method using long bone measurements taken from a South African sample, providing relatively high classification accuracies and made easy to use via the KidStats web-based app. In this study, we test the models developed by Stull et al. (2017) on an external historic population from Lisbon, Portugal, in order to determine whether the models can be reliably applied to archeological and forensic populations outside of the original population sample. The study sample consisted of 102 individuals (45 females and 57 males) aged under 13 years at death from the Lisbon identified skeletal collection. Measurements from these individuals were used to test the flexible discriminant analysis (FDA) models given by Stull et al. (2017). Allocation accuracies were calculated for boys and girls and children over and under 2 years separately and combined. Our findings show that the models developed by Stull et al. (2017) yield poor accuracy when applied to our external population and thus can potentially be misapplied on archeological skeletal remains or forensic remains of unknown origin. A number of statistical issues may explain why models fail to be transportable or even generalizable, namely multicollinearity, model overfitting and overly optimist bootstrapped cross-validation rates. It is also likely that population differences in size and sexual size dimorphism also affected the applicability of the models. We emphasize the importance of externally validating prediction models, particularly if they are intended to be applied across populations. Our study addresses Stull and co-worker’s request for further validation of the method on populations outside of South Africa, as the models cannot be confidently applied in the field until it has been externally validated.

PMID:33662898 | DOI:10.1016/j.forsciint.2021.110739

Environ Int. 2021 Mar 1;151:106456. doi: 10.1016/j.envint.2021.106456. Online ahead of print.

ABSTRACT

The understanding of sources and controlling factors of potentially toxic elements (PTEs) in soils plays an important role in the improvement of environmental management. With the rapid growth of data volume, effective methods are required for data analytics for the large geochemical data sets. In recent years, spatial machine learning technologies have been proven to have the potential to reveal hidden spatial patterns in order to extract geochemical information. In this study, two spatial clustering techniques of Getis-Ord G_i* statistic and K-means clustering analysis were performed on 15 PTEs in 6,862 topsoil samples from the Tellus datasets of Northern Ireland to investigate the hidden spatial patterns and association with their controlling factors. The spatial clustering patterns of hot spots (high values) and cold spots (low values) for the 15 PTEs were revealed, showing clear association with geological features, especially peat and basalt. Peat was associated with high concentrations of Bi, Pb, Sb and Sn, while basalt was associated with high concentrations of Co, Cr, Cu, Mn, Ni, V and Zn. The high concentrations of As, Ba, Mo and U were associated with mixture of various lithologies, indicating the complicated influences on them. In addition, three hidden patterns in the 6,862 soil samples were revealed by K-means clustering analysis. The soil samples in the first and second clusters were overlaid on the peatland and basalt formation, respectively, while the samples in the third cluster were overlaid on the mixture of the other lithologies. These hidden patterns of soil samples were consistent with the spatial clustering patterns for PTEs, highlighting the dominant control of peat and basalt in the topsoil of Northern Ireland. This study demonstrates the power of spatial machine learning techniques in identifying hidden spatial patterns, providing evidences to extract geochemical knowledge in environmental studies.

PMID:33662887 | DOI:10.1016/j.envint.2021.106456

Phys Med. 2021 Mar 1;82:185-191. doi: 10.1016/j.ejmp.2021.01.080. Online ahead of print.

NO ABSTRACT

PMID:33662882 | DOI:10.1016/j.ejmp.2021.01.080

Nurse Educ Today. 2021 Feb 11;99:104816. doi: 10.1016/j.nedt.2021.104816. Online ahead of print.

ABSTRACT

BACKGROUND: Collaboration and teamwork are vitally important for safe patient care. Experiential learning through interprofessional simulation helps prepare students for the expansive requirements of today’s complex healthcare environment.

PURPOSE: To develop and evaluate an interprofessional simulation educational activity to promote teamwork and communication between respiratory therapy and nursing students.

DESIGN: A mixed method design employing surveys, observation, and focus groups with educators and students was used. Thirty-six students from two institutions in Western Canada participated in this study. Data was analyzed using descriptive statistics and content analysis.

RESULTS: Baseline assessment revealed students were most familiar and comfortable with team functioning and communication interprofessional competencies, familiar but uncomfortable with collaborative leadership, conflict resolution, patient-centered care, and role clarification competencies. Correlation between communication and teamwork and collaborative leadership suggests these competencies play an important role in students’ ability to enact more complex skills, such as conflict resolution competency. Overall, participants were highly satisfied and shared invaluable insights for improving this simulation experience in the future.

CONCLUSION: This evaluation study demonstrated feasibility of interprofessional simulation and its potential to enhance acquisition of interprofessional competencies. A future study will incorporate additional disciplines, such as medicine and pharmacy, applying a controlled evaluation design.

PMID:33662866 | DOI:10.1016/j.nedt.2021.104816

Psychiatry Res. 2021 Feb 23;298:113821. doi: 10.1016/j.psychres.2021.113821. Online ahead of print.

ABSTRACT

The Coronavirus disease 2019 (COVID-19) pandemic has contributed to over 500,000 deaths, and hospitalization of thousands of individuals worldwide. Cross-sectional data indicate that anxiety and depression levels are greater during the pandemic, yet no known prospective studies have tested this assertion. Further, individuals with elevated trait anxiety prior to a global pandemic may theoretically be more apt to experience greater pandemic-related anxiety and/or impairment. The current study tested whether anxiety and depression increased from the month before the state’s Stay-At-Home order to the period of the Stay-At-Home order among 120 young adults in Louisiana, a state with especially high rates of COVID-19 related infections and deaths. We also tested whether pre-pandemic social anxiety was related to greater pandemic related anxiety, depression, and COVID-related worry and impairment. Depression but not anxiety increased during the Stay-At-Home order. Further, pre-pandemic trait anxiety, social anxiety, and depression were statistically significant predictors of anxiety and depression during the Stay-At-Home order, although only social anxiety was robustly related to COVID-related worry and impairment. Emotional distress increased during the COVID-19 pandemic Stay-At-Home order and this is especially the case among individuals with pre-pandemic elevations in trait anxiety (especially social anxiety) and depression.

PMID:33662840 | DOI:10.1016/j.psychres.2021.113821

Value Health Reg Issues. 2021 Mar 1;24:157-166. doi: 10.1016/j.vhri.2020.10.006. Online ahead of print.

ABSTRACT

OBJECTIVES: The objective of this study was to investigate predictors and develop risk equations for stage-3 chronic kidney disease (CKD) in Thai patients with type 2 diabetes mellitus (DM).

METHODS: A retrospective cohort study was conducted in patients with type 2 DM. The outcome was the development of stage-3 CKD. The data set was randomly split into training and validation data sets. Cox proportional hazard regression was used for model development. Discrimination (Harrell’s C statistic) and calibration (the Hosmer-Lemeshow chi-square test and survival probability curve) were applied to evaluate model performance.

RESULTS: In total, 2178 type 2 DM patients without stage-3 CKD, visiting the hospital from January 1, 2008, to December 31, 2017, were recruited, with median follow-up time of 1.29 years (interquartile range, 0.5-2.5 years); 385 (17.68%) subjects had developed stage-3 CKD. The final predictors included age, male sex, urinary albumin to creatinine ratio, estimated glomerular filtration rate, and hemoglobin A1c. Two 3-year stage-3 CKD risk models, model 1 (laboratory model) and model 2 (simplified model), had the C statistic in validation data sets of 0.890 and 0.812, respectively.

CONCLUSIONS: Two 3-year stage-3 CKD risk models were developed for Thai patients with type 2 DM. Both models have good discrimination and calibration. These stage-3 CKD prediction models could equip health providers with tools for clinical management and supporting patient education.

PMID:33662821 | DOI:10.1016/j.vhri.2020.10.006

Clin Res Hepatol Gastroenterol. 2021 Mar 1;45(6):101625. doi: 10.1016/j.clinre.2021.101625. Online ahead of print.

ABSTRACT

BACKGROUND: The prevalence and significance of cytomegalovirus (CMV) colitis in pediatric acute severe colitis is unknown. The aim of this study was to determine the prevalence of CMV in colonic mucosa of children with acute severe refractory colitis and compare the clinical characteristics and outcomes of CMV positive and negative patients.

METHODS: In a case-control study, colonic biopsy specimens from children with severe refractory colitis were tested for CMV, and matched with non-refractory IBD controls. We characterized CMV positive patients by assessing laboratory values, concurrent medications, and need for surgery as compared with CMV negative refractory colitis patients.

RESULTS: Colonic biopsies from 96 patients were evaluated for CMV; 48 with severe refractory colitis, and 48 non-refractory controls. There was an increased prevalence of CMV in severe refractory colitis [7/48 (14.6%), P < 0.0001]; all were previously CMV negative. Viral DNA burden on immunohistochemistry was not predictive of response to antiviral therapy or need for surgery at 12 months. Lymphopenia was seen in all CMV positive patients, but this did not demonstrate statistical significance (P = 0.09). We did not see an association between azathioprine or infliximab use and the need for surgery at 12 months.

CONCLUSIONS: There is an increased prevalence of CMV in colonic biopsies of pediatric patients with severe refractory colitis. Viral burden does not predict clinical outcomes or subsequent need for colectomy.

PMID:33662784 | DOI:10.1016/j.clinre.2021.101625

Clin Res Hepatol Gastroenterol. 2021 Mar 1;45(6):101603. doi: 10.1016/j.clinre.2020.101603. Online ahead of print.

ABSTRACT

PURPOSE: We showed in a previous study that the PG-SGA score is associated with survival and chemotherapy-related toxicities in metastatic colorectal cancer (mCRC) patients. The objective was to evaluate the association between pretherapeutic sarcopenia and variation in skeletal muscle index (SMI) during treatment with these outcomes in the same population.

METHODS: This prospective, multicenter, observational study enrolled non-pretreated mCRC patients. SMI was measured on routine CT scan at day 0 (D0) and day 60 (D60). Nutritional factors were collected at D0. Progression-free survival (PFS) and overall survival (OS) were calculated from treatment start.

RESULTS: 149 patients were included from 7/2013 to 11/2016. Pretherapeutic sarcopenia was not significantly associated with survival or chemotherapy-related toxicities. The decrease in SMI > 14% was significantly associated with shorter PFS (6 vs 9 mo; HR 1.8, 95% CI 1.1-3.1, p = 0.02) and OS (8.5 vs 26 mo; HR 2.6, 95% CI 1.4-4.8, p = 0.002), independently of hypoalbuminemia and malnutrition defined by PG-SGA. Patients with a SMI decrease > 14% had a higher rate of grade ≥ 2 clinical toxicities (40% vs 22%, OR 3.0, 95% CI 1.2-7.7, p = 0.02), but the difference was not statistically significant in multivariable analysis.

CONCLUSION: To our knowledge, this is the first study to assess prospectively the association of skeletal muscle loss with survival and treatment toxicities in non-pretreated patients with mCRC. Pretherapeutic sarcopenia was not associated with poor outcomes, but the loss of skeletal muscle mass within 60 days from treatment start was highly prognostic, independently of other prognostic and nutritional factors.

PMID:33662782 | DOI:10.1016/j.clinre.2020.101603

Clin Res Hepatol Gastroenterol. 2021 Mar 1;45(6):101623. doi: 10.1016/j.clinre.2021.101623. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Few studies have focused on the treatment failure of zinc monotherapy for oligosymptomatic Wilson disease (WD) patients. Therefore, we aimed to evaluate the long-term efficacy of zinc monotherapy in oligosymptomatic patients and to analyze the possible factors that may influence the outcome of this treatment.

METHODS: We retrospectively reviewed the medical records of oligosymptomatic WD patients who received zinc monotherapy from the time of diagnosis. Then, the characteristics of patients who were treated with zinc monotherapy successfully and those who experienced treatment failure were investigated.

RESULTS: Forty oligosymptomatic WD patients were identified that have received zinc monotherapy as initial treatment, with a median age of 3.83 years at the time of diagnosis. 36 (90%) patients had abnormal alanine transaminase/aspartate transaminase levels at baseline. None of the patients became symptomatic during zinc monotherapy. 28 (70%, Group 1) patients were treated with zinc monotherapy successfully for a median period of 2.4 years. In Group 1, serum aminotransferase levels significantly decreased 6 and 12 months after zinc therapy compared to the baseline levels (P < 0.05). 12 (30%, Group 2) patients experienced treatment failure with zinc monotherapy due to uncontrolled serum liver enzyme levels, and d-penicillamine was combined. The baseline 24-hour urine copper levels before treatment were significantly higher in Group 2 compared to that in Group 1 (182.5 vs 90.92 μg /day, P = 0.018). Comparing the age at onset; ceruloplasmin, serum copper, ALT, and AST levels; and proportions of abdominal ultrasonography abnormality at baseline between Group 1 and 2 revealed no statistically significant differences.

CONCLUSIONS: We found that high initial 24 -h urinary copper levels may lead to treatment failure of zinc monotherapy in oligosymptomatic WD patients. It might be reasonable to follow up liver function tests more closely during zinc monotherapy and to begin combination treatment with chelators early in patients with high level of 24 -h urinary copper.

PMID:33662781 | DOI:10.1016/j.clinre.2021.101623