Nevin Manimala

Am J Phys Med Rehabil. 2021 Feb 27. doi: 10.1097/PHM.0000000000001740. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate and compare the efficacy of an online and a traditionally delivered undergraduate elective courses in improving medical students’ disability related knowledge and attitudes.

METHODS: A randomized controlled design was implemented. Participants were medical students randomly assigned into summer 8-week disability and the society (OT100) online course, OT100 traditional course, or Wellness and Life Styles (PT100) control. Demographics were collected in addition to participants’ level disability knowledge and Attitudes Toward People with Disability scale scores (ATDP) one week prior to the semester and one week after it. Multivariate analysis of covariance (MANCOVA) using general linear model (GLM) was conducted to evaluate groups’ differences in main outcome measures.

RESULTS: In total, 198 undergraduate medical students successfully completed the study conditions; OT100 online (n = 74), OT100 traditional (n = 59), and PT100 (n = 65). OT100 groups (traditional and online) change scores were statistical similar for disability knowledge (p = 0.966) and attitudes (p = 0.705) but significantly better (p < 0.001) than the control group.

CONCLUSIONS: OT100 course delivered traditionally or regular appeared effective in improving medical students’ disability knowledge and ATDP. More studies are needed to create effective methods improving healthcare professionals’ disability related knowledge and attitudes.

PMID:33657029 | DOI:10.1097/PHM.0000000000001740

Br J Gen Pract. 2021 Mar 2:BJGP.2020.0178. doi: 10.3399/BJGP.2020.0178. Online ahead of print.

ABSTRACT

BACKGROUND: In England, general practitioners (GPs) are independent contractors working to a national contract. Since 2017 the contract requires GPs to use electronic tools to proactively identify moderate and severe frailty in people aged 65 and over and offer interventions to help those identified to stay well and maintain independent living. Little is currently known about GPs’ views of this contractual requirement.

AIM: To explore GPs’ views of identifying frailty and offering interventions for those living with moderate or severe frailty.

DESIGN AND SETTING: Sequential mixed-methods study of GPs in the East Midlands region of England (Derbyshire, Leicestershire, Lincolnshire, Nottinghamshire, Northamptonshire) between January and May 2019.

METHODS: Survey of GPs by online questionnaire, followed by semi-structured interview. Based on survey responses GPs with a range of views on identifying frailty, GP and practice characteristics, were selected for interview. Questionnaires were analysed using descriptive statistics. Interview transcripts were analysed using framework analysis.

RESULTS: 188 (6.1%) GPs responded to the survey and 18 GPs were interviewed. GPs were broadly supportive of identifying frailty, but felt risk-stratification tools lacked sensitivity and specificity and wanted evidence showing clinical benefit. Frailty identification increased workload and was under-resourced, with limited time for, and access to necessary interventions. GPs felt they lacked knowledge about frailty and more education was required.

CONCLUSION: Proactively identifying and responding to frailty in primary care requires GP education, highly sensitive and specific risk-stratification tools, access to interventions to lessen the impact of frailty and adequate resourcing to achieve its potential clinical impact.

PMID:33657008 | DOI:10.3399/BJGP.2020.0178

Adv Exp Med Biol. 2021;1321:253-260. doi: 10.1007/978-3-030-59261-5_22.

ABSTRACT

Aim The ongoing COVID-19 outbreak has not only had an impact on physical health but also on psychological health. The aim of this study was to measure the prevalence and severity of psychological distress in the community due to the COVID-19 pandemic. Methods This cross-sectional survey was conducted in February and March 2020 in Tehran, Iran. We analyzed demographic characteristics and assessed depression, anxiety, and stress levels in 241 people using convenience sampling and the DASS-21 questionnaire. All statistical analyses were performed using R. Results The study population included 241 community-dwelling participants, of whom 145 were women and 96 were males. The mean age was 49.16 ± 8.01 years. Approximately two-thirds of participants (n = 158) reported no history of comorbid illness. The mean scores of depression and stress were at a “severe” level, while anxiety levels were at an “extremely severe” level. The prevalence of severe and extremely severe depression readings was 51.45 and 38.17%, respectively. In the anxiety subscale, the prevalence of severe and extremely severe depression was 95.90 and 4.1%, and in the stress subscale the prevalence was 48.97 and 4.98%, respectively. Conclusion In this study, people reported experiencing severe and extremely severe psychological distress. Therefore, there is an urgent need to implement mental health intervention policies to cope with this ongoing challenge. We suggest that the incorporation of molecular biomarker tests into the algorithm could aid in assessment of patients and guide the most appropriate therapeutic response.

PMID:33656730 | DOI:10.1007/978-3-030-59261-5_22

Adv Exp Med Biol. 2021;1321:245-251. doi: 10.1007/978-3-030-59261-5_21.

ABSTRACT

Aim The COVID-19 was declared a pandemic in early 2020 and is associated with high public anxiety all over the world. The healthcare community is at the highest risk of infection and thereby prone to most distress. The aim of this study was to explore and evaluate the degree of depression, anxiety, and stress levels among medical college students during the COVID-19 epidemic in Iran. Methods A cross-sectional study was conducted in February and March 2020, 3 weeks after the first reported COVID-19 infection was identified in Iran. All medical college students who entered clinical courses were eligible for the study. Depression, stress, and anxiety were evaluated in these students using the DASS-21 questionnaire. Participants were selected by using availability sampling. All statistical analyses were performed using R version 3.5.1. Results The total number of participants was 207, with 143 males and 64 females. More than half of the participants (57.97%) were married. The mean duration of working experience among students with COVID-19 infection and experience in a medical ward was 3.00 ± 1.27 days and 17.40 ± 7.26 months, respectively. The majority of students had 2 or 3 days working experience with COVID-19 infection. The mean anxiety score of participants was 28.56 ± 4.68, the depression score was 29.36 ± 4.42, and the stress score was 28.99 ± 4.53. Our findings indicated that the mean scores of depression were at an “extremely severe” level, while stress and anxiety were at “severe” levels. The prevalence of “severe” symptoms of depression, stress, and anxiety was 69.57%, 60.87%, and 99.04%, respectively. Conclusions There is a high prevalence of anxiety and depression among medical students who were exposed to COVID-19-infected patients. Our results highlight the need to establish psychological support programs, training, and self-care for medical college students in relation to mental health. We recommend incorporation of molecular biomarker tests into an algorithm to aid in assessments and consideration of the appropriate therapeutic responses.

PMID:33656729 | DOI:10.1007/978-3-030-59261-5_21

Adv Exp Med Biol. 2021;1321:237-243. doi: 10.1007/978-3-030-59261-5_20.

ABSTRACT

AIM: The outbreak of COVID-19 has laid unprecedented psychological stress on healthcare workers (HCWs). We aimed to assess the immediate psychological impact of COVID-19 epidemic on the HCWs at Baqiyatallah Hospital in Tehran, Iran.

MATERIAL AND METHODS: We conducted a cross-sectional survey of HCWs using questionnaires in February and March 2020 in Baqiyatallah Hospital, Tehran. We evaluated depression, stress, and anxiety levels using the DASS-21 questionnaire. Participants were selected by using census sampling. All statistical analyses were performed using R version 3.5.1.

RESULTS: The study population included 217 HCWs (111 male, 116 female) and the mean age of the study group was 39.6 years old. Approximately two-thirds of the HCWs stayed in the hospital for 2-3 weeks. The mean scores of depression and stress were at a “severe” level, while anxiety scores were at an “extremely severe” level. The prevalence of severe scores was 38.71%, 2.30%, and 48.97% for depression, anxiety, and stress, and the prevalence of extremely severe scores was 46.54%, 97.24%, and 4.98% depression, anxiety, and stress, respectively. In stress subscale, moderate stress was 47.46%. Female HCWs reported higher levels of depression compared with males.

CONCLUSION: In this study, HCWs reported experiencing severe and extremely severe psychological burdens. Timely interventions to promote mental health in HCWs exposed to patients with COVID-19 need to be immediately implemented, with female nurses requiring particular attention. This process could be facilitated via tests for molecular biomarkers in accessible body fluids, such as saliva, plasma, and serum.

PMID:33656728 | DOI:10.1007/978-3-030-59261-5_20

Adv Exp Med Biol. 2021;1321:229-236. doi: 10.1007/978-3-030-59261-5_19.

ABSTRACT

AIM: Patients with confirmed COVID-19 infection can develop several psychological consequences. Epidemiological data on mental health and psychological disorder inpatients infected with COVID-19 pneumonia are not available in Iranian patients. The purpose of this study was to evaluate the anxiety, stress, and depression of patients with COVID-19.

MATERIAL AND METHODS: This cross-sectional survey was conducted in 2020. All confirmed patients with COVID-19 were included in the study by census sampling. Assessment of depression, stress, and anxiety was performed using the DASS-21 questionnaire. All statistical analyses were performed using R version 3.5.1.

RESULTS: The questionnaires were completed by 221 patients with COVID-19 infection (204 males, 17 females). The mean age was 45.90 ± 7.73 years. Our results indicated that the mean scores of depression and anxiety were at “extremely severe” levels, while stress levels were “severe.” The prevalence of “extremely severe” symptoms of depression and anxiety was 54.29% and 97.29%, respectively. The prevalence of severe stress was 46.61%.

CONCLUSION: In this study, patients infected with COVID-19 reported severe and extremely severe experience psychological distress. Further studies should focus on the combined use of psychological and molecular biomarker testing to increase accuracy. Overall, the findings demonstrate the necessity of special intervention programs for the confirmed patients with emerging infectious disease COVID-19 to promote mental health needs.

PMID:33656727 | DOI:10.1007/978-3-030-59261-5_19

J Assist Reprod Genet. 2021 Mar 3. doi: 10.1007/s10815-021-02131-2. Online ahead of print.

ABSTRACT

OBJECTIVE: The primary objective of this study was to test the hypotheses that compared to IVF cycles undergoing preimplantation genetic testing for aneuploidy (PGT-A) with or without testing for monogenic disorders (PGT-M), IVF cycles undergoing PGT for structural rearrangements (PGT-SR) will have (1) a poorer blastocyst conversion rate and (2) fewer usable blastocysts available for transfer. Secondarily, the study aimed to compare pregnancy outcomes among PGT groups.

PATIENTS: Retrospective cohort study including cycles started from January 1, 2012, to March 30, 2020, with the intent of pursuing PGT-A, PGT-A with PGT-M, and PGT-SR, with trophectoderm biopsy on days 5 or 6.

RESULTS: A total of 658 women underwent 902 cycles, including 607 PGT-A, 216 PGT-A&M, and 79 PGT-SR cycles. When compared with the blastocyst conversion rate for the PGT-A group (59.4%), and after adjustment for patient age, total number of mature oocytes, BMI, and ICSI, there were no significant differences for either the PGT-A&M (69.7%, aRR 1.03, 95% CI 0.96-1.10) or PGT-SR (63.2%, aRR1.04, 95% CI 0.96-1.13) groups. Compared to the PGT-A group, the proportion of usable blastocysts was statistically significantly lower in the PGT-SR group: 35.1% versus 24.4% (aRR 0.57, 95% CI 0.46-0.71) and the PGT-A&M group: 35.1% versus 31.5% (aRR 0.68, 95% CI 0.58-0.81). Implantation, pregnancy, and miscarriage rates were equivalent for all groups.

CONCLUSION: Patients with structural rearrangements have similar blastocyst development but significantly fewer usable blastocysts available for transfer compared to PGT-A testers. Nevertheless, with the transfer of a usable embryo, PGT-SR testers perform as well as those testing for PGT-A.

PMID:33656620 | DOI:10.1007/s10815-021-02131-2

Biol Cybern. 2021 Mar 3. doi: 10.1007/s00422-021-00864-y. Online ahead of print.

ABSTRACT

We investigate a simple model for motor pattern generation that combines central pattern generator (CPG) dynamics with a sensory feedback (FB) mechanism. Our CPG comprises a half-center oscillator with conductance-based Morris-Lecar model neurons. Output from the CPG drives a push-pull motor system with biomechanics based on experimental data. A sensory feedback conductance from the muscles allows modulation of the CPG activity. We consider parameters under which the isolated CPG system has either “escape” or “release” dynamics, and we study both inhibitory and excitatory feedback conductances. We find that increasing the FB conductance relative to the CPG conductance makes the system more robust against external perturbations, but more susceptible to internal noise. Conversely, increasing the CPG conductance relative to the FB conductance has the opposite effects. We find that the “closed-loop” system, with sensory feedback in place, exhibits a richer repertoire of behaviors than the “open-loop” system, with motion determined entirely by the CPG dynamics. Moreover, we find that purely feedback-driven motor patterns, analogous to a chain reflex, occur only in the inhibition-mediated system. Finally, for pattern generation systems with inhibition-mediated sensory feedback, we find that the distinction between escape- and release-mediated CPG mechanisms is diminished in the presence of internal noise. Our observations support an anti-reductionist view of neuromotor physiology: Understanding mechanisms of robust motor control requires studying not only the central pattern generator circuit in isolation, but the intact closed-loop system as a whole.

PMID:33656573 | DOI:10.1007/s00422-021-00864-y

Invest Ophthalmol Vis Sci. 2021 Mar 1;62(3):5. doi: 10.1167/iovs.62.3.5.

ABSTRACT

PURPOSE: The purpose of this paper was to study the bilateral choroidal thickness (CT) symmetry and differences in healthy individuals using wide-field swept-source optical coherence tomography (SS-OCT).

METHODS: All participants underwent a wide-field 16-mm 1-line scan using SS-OCT. CTs were measured at the following 12 points: 3 points at 900 µm, 1800 µm, and 2700 µm away from the nasal optic disc margin (nasal peripapillary area), 1 point at the subfovea, 6 points at 900 µm, 1800 µm, and 2700 µm away from the subfovea to the nasal and temporal areas (macular area), and 2 peripheral points at 2700 and 5400 µm from temporal point 3 (peripheral area). Bilateral CTs were measured; their correlations and differences in the corresponding regions were analyzed.

RESULTS: There were no statistically significant differences in CTs between the right and left eyes in all corresponding areas (all P > 0.05); they all showed significant positive correlation coefficients (r) (all P < 0.001). However, the nasal peripapillary and peripheral areas had relatively low correlation coefficients, compared to the macular areas. In addition, the bilateral CT differences were 32.60 ± 25.80 µm in the macular area, 40.67 ± 30.58 µm in the nasal peripapillary area, and 56.03 ± 45.73 µm in the peripheral area (all P < 0.001).

CONCLUSIONS: Overall, the CTs of each region were bilaterally symmetrical. However, the differences in CTs increased from the center to the periphery, which indicated that the anatomic variation of the nasal peripapillary and peripheral choroid was greater than that of the macula.

PMID:33656554 | DOI:10.1167/iovs.62.3.5

Plant Cell. 2021 Feb 2:koab029. doi: 10.1093/plcell/koab029. Online ahead of print.

ABSTRACT

The phenotypic consequences of the addition or subtraction of part of a chromosome is more severe than changing the dosage of the whole genome. By crossing diploid trisomies to a haploid inducer, we identified 17 distal segmental haploid disomies that cover ∼80% of the maize genome. Disomic haploids provide a level of genomic imbalance that is not ordinarily achievable in multicellular eukaryotes, allowing the impact to be stronger and more easily studied. Transcriptome size estimates revealed that a few disomies inversely modulate most of the transcriptome. Based on RNA sequencing, the expression levels of genes located on the varied chromosome arms (cis) in disomies ranged from being proportional to chromosomal dosage (dosage effect) to showing dosage compensation with no expression change with dosage. For genes not located on the varied chromosome arm (trans), an obvious trans-acting effect can be observed, with the majority showing a decreased modulation (inverse effect). The extent of dosage compensation of varied cis genes correlates with the extent of trans inverse effects across the 17 genomic regions studied. The results also have implications for the role of stoichiometry in gene expression, the control of quantitative traits, and the evolution of dosage-sensitive genes.

PMID:33656551 | DOI:10.1093/plcell/koab029