Nevin Manimala

Int J Med Inform. 2021 Sep 27;156:104595. doi: 10.1016/j.ijmedinf.2021.104595. Online ahead of print.

ABSTRACT

BACKGROUND: Clinical decision support systems and telemedicine for remote monitoring can together support clinicians’ intraoperative decision-making and management of surgical patients’ care. However, there has been limited investigation on patient perspectives about advanced health information technology use in intraoperative settings, especially an electronic OR (eOR) for remote monitoring and management of surgical patients.

PURPOSE: Our study objectives were: (1) to identify participant-rated items contributing to patient attitudes, beliefs, and level of comfort with eOR monitoring; and (2) to highlight barriers and facilitators to eOR use.

METHODS: We surveyed 324 individuals representing surgical patients across the United States using Amazon Mechanical Turk, an online platform supporting internet-based work. The structured survey questions examined the level of agreement and comfort with eOR for remote patient monitoring. We calculated descriptive statistics for demographic variables and performed a Wilcoxon matched-pairs signed-rank test to assess whether participants were more comfortable with familiar clinicians from local hospitals or health systems monitoring their health and safety status during surgery than clinicians from hospitals or health systems in other regions or countries. We also analyzed open-ended survey responses using a thematic approach informed by an eight-dimensional socio-technical model.

RESULTS: Participants’ average age was 34.07 (SD = 10.11). Most were white (80.9%), male (57.1%), and had a high school degree or more (88.3%). Participants reported a higher level of comfort with clinicians they knew monitoring their health and safety than clinicians they did not know, even within the same healthcare system (z = -4.012, p < .001). They reported significantly higher comfort levels with clinicians within the same hospital or health system in the United States than those in a different country (z = -10.230, p < .001). Facilitators and barriers to eOR remote monitoring were prevalent across four socio-technical dimensions: 1) organizational policies, procedures, environment, and culture; 2) people; 3) workflow and communication; and 4) hardware and software. Facilitators to eOR use included perceptions of improved patient safety through a safeguard system and perceptions of streamlined care. Barriers included fears of incorrect eOR patient assessments, decision-making conflicts between care teams, and technological malfunctions.

CONCLUSIONS: Participants expressed significant support for intraoperative telemedicine use and greater comfort with local telemedicine systems instead of long-distance telemedicine systems. Reservations centered on organizational policies, procedures, environment, culture; people; workflow and communication; and hardware and software. To improve the buy-in and acceptability of remote monitoring by an eOR team, we offer a few evidence-based guidelines applicable to telemedicine use within the context of OR workflow. Guidelines include backup plans for technical challenges, rigid care, and privacy standards, and patient education to increase understanding of telemedicine’s potential to improve patient care.

PMID:34627112 | DOI:10.1016/j.ijmedinf.2021.104595

Food Chem. 2021 Sep 27;372:131237. doi: 10.1016/j.foodchem.2021.131237. Online ahead of print.

ABSTRACT

Food fraud is still a recurrent practice throughout food supply chains. In the case of seafood, misidentification of species and products repackaging constitute the most common frauds. Therefore, the development of appropriate analytical approaches to be used against food fraud is necessary. The present study goal is to explore for the first time, the possibility to differentiate between Sparus aurata from two different mariculture farms located in Madeira Island (Caniçal and Ribeira Brava), using the mass fingerprint of fish mucus obtained from MALDI-TOF MS and analyzed using Mass-UP software for multivariate statistical analysis and biomarker identification. It was possible to establish, from the mucus protein fraction, a set of potential biomarkers for each location in a total of 35 peaks, being 17 peaks specific to Caniçal located farm and 18 to Ribeira Brava. The proposed analytical approach revealed a useful strategy providing accurate and fast results for fish geographical origin discrimination.

PMID:34627094 | DOI:10.1016/j.foodchem.2021.131237

Food Chem. 2021 Sep 25;372:131227. doi: 10.1016/j.foodchem.2021.131227. Online ahead of print.

ABSTRACT

To investigate the specific difference in aroma characteristics of Huangjiu (Chinese rice wine) in Shaoxing region fermented with different brewing water, descriptive sensory analysis, comprehensive two-dimensional gas chromatography-quadrupole mass spectrometry (GC × GC-qMS) and multivariate statistical analysis were employed. The descriptive sensory analysis proved that Huangjiu fermented with Jianhu water had higher overall aroma intensity, and was more prominent in ester, sweet and alcoholic aroma than those fermented with deionized water and Nenjiang water. The results of aroma components analysis by GC × GC-qMS showed that the Huangjiu fermented with Jianhu water had higher concentration of some key aroma compounds, such as ethyl butyrate (OAV: 29-196), isoamyl acetate (OAV: 11-18) and ethyl hexanoate (OAV: 38-47). The multivariate statistical analysis further confirmed that 14 compounds could be used as key markers to distinguish the Huangjiu samples fermented with different brewing water. The correlation network between the volatile compounds in Huangjiu and the inorganic components in water indicated that the ions played an important role in the formation of the difference in aroma characteristics among the samples.

PMID:34627089 | DOI:10.1016/j.foodchem.2021.131227

Clin Biomech (Bristol, Avon). 2021 Sep 25;90:105492. doi: 10.1016/j.clinbiomech.2021.105492. Online ahead of print.

ABSTRACT

BACKGROUND: Ground reaction forces are the gold standard for detecting gait events, but they are not always applicable in cerebral palsy. Ghoussayni’s algorithm is an event detection method based on the sagittal plane velocity of heel and toe markers. We aimed to evaluate whether Ghoussayni’s algorithm, using two different thresholds, was a valid event detection method in children with bilateral spastic cerebral palsy. We also aimed to define a new adaptation of Ghoussayni’s algorithm for detecting foot strike in cerebral palsy, and study the effect of event detection methods on spatiotemporal parameters.

METHODS: Synchronized kinematic and kinetic data were collected retrospectively from 16 children with bilateral spastic cerebral palsy (7 males and 9 females; age 8.9 ± 2.7 years) walking barefoot at self-selected speed. Gait events were detected using methods: 1) ground reaction forces, 2) Ghoussayni’s algorithm with a threshold of 0.5 m/s, and 3) Ghoussayni’s algorithm with a walking speed dependent threshold. The new adaptation distinguished how foot strikes were performed (heel and/or toe) comparing the timing when the foot markers velocities fell below the threshold. Differences between the three methods, and between spatiotemporal parameters calculated from the two Ghoussayni’s thresholds were analyzed.

FINDINGS: There were statistically significant (P < 0.05) differences between methods 1 and 3, and between some spatiotemporal parameters calculated from methods 2 and 3. Ghoussayni’s algorithm showed better performance for foot strike than for toe off.

INTERPRETATION: Ghoussayni’s algorithm using 0.5 m/s is valid in children with bilateral spastic cerebral palsy. Event detection methods affect spatiotemporal parameters.

PMID:34627071 | DOI:10.1016/j.clinbiomech.2021.105492

Epilepsy Behav. 2021 Oct 6;124:108327. doi: 10.1016/j.yebeh.2021.108327. Online ahead of print.

ABSTRACT

BACKGROUND: Sleep disorders are common in drug-resistant children with epilepsy and their mothers. Ketogenic diet therapy (KDT) may have positive effects on sleep quality. The aim of this study was to evaluate the sleep quality of children with epilepsy and their mothers after starting KDT.

METHODS: Using a prospective cross-sectional model, pre- and post-KDT questionnaires were given to the study subjects. A children’s sleep habits questionnaire was administered to children with epilepsy, and the Pittsburgh sleep questionnaire was administered to their mothers. Sociodemographic and some clinical categorical variables of the patient group were evaluated using descriptive statistics. Evaluation of the data was conducted using the Wilcoxon and paired t-tests as parametric and non-parametric tests.

RESULTS: Of 24 patients scheduled to begin KDT between January 2019 and January 2020, 14 were included in the study. Regarding sleep quality, improvement was reported in 7 (50%) of 14 patients, deterioration in 5 (35.7%) patients, and no change was seen in 2 (14.3%) patients. Sleep quality was reported to improve in all working mothers. Seven (50%) patients reported no seizures and 6 (42.9%) patients reported more than 50% seizure reduction. Although there were improvements in sleep scores in both groups, these improvements were not statistically significant. A significant decrease in sleep anxiety was reported in children after the third month of the KDT (p = 0.09).

CONCLUSIONS: The results of this study determined that three months of KDT offered significant improvement on the sleep anxiety of children with epilepsy. It was thought that paying attention to patient selection may lead to better sleep quality by increasing compliance to KDT. However, a larger scale study and longer term follow-up should be done.

PMID:34627070 | DOI:10.1016/j.yebeh.2021.108327

J Infect Public Health. 2021 Sep 23;14(11):1679-1685. doi: 10.1016/j.jiph.2021.09.015. Online ahead of print.

ABSTRACT

BACKGROUND: The upgrowth and rapid prevalence of pandrug-resistant Acinetobacter baumannii strains that have a pathogenic activity to cause several infections are of considerable influence on the health of communities worldwide. No infections by these bacterial strains were recorded before 1998, and currently, the numbers are on the rise.

METHODS: The A. baumannii strains were isolated from male and female patients in Medical Microbiology Department, King Fahd Medical City (KFMC) in Riyadh, Saudi Arabia between 1/1/2020 to 29/12/2020. The statistical analysis was performed base on sex, age, source of samples, and response to commercially available antibiotics. The A. baumannii strains that resisted all the antibiotics including colistin and imipenem were selected for the synergic test.

RESULTS: The data showed that 62.28%, 77.07% of 342 A. baumannii strains were isolated from males and patients over 35 years of age. A. baumannii strains (pandrug-A. baumannii) that can resist all tested antibiotics were 8.19%. The major source of the A. baumannii isolates was the respiratory system (>50%). Among all isolates (N = 342), azidothymidine-resistant A. baumannii strains were more than 85%. There is a statistically significant difference (P < 0.05) in the number of colistin-resistant A. baumannii strains isolated from males comparing with the female. The combinations of colistin and silver nanoparticles or imipenem and silver nanoparticles resulted in synergistic action led to reduction of MICs of colistin, imipenem, and silver nanoparticles (more than four-fold reduction). Also, the combinations of colistin and imipenem had high synergistic action.

CONCLUSION: The pandrug-resistant A. baumannii strains may represent a current and future threat that must be fought, and the synergy action of antibiotics and nanoparticles may be one of the available, rapid, and easy strategies to confront this global problem.

PMID:34627065 | DOI:10.1016/j.jiph.2021.09.015

J Infect Public Health. 2021 Sep 23;14(11):1642-1649. doi: 10.1016/j.jiph.2021.09.016. Online ahead of print.

ABSTRACT

BACKGROUND: Diarrhea and pseudomembranous colitis associated with Clostridioides difficile – a spore-forming anaerobic Gram-positive bacillus – is a major infection in hospitalized patients with a profound impact on clinical and economic outcomes. Recurrence (rCDI) is common and predisposes to further episodes with poor outcomes.

METHOD: We aimed to identify a wide range of risk factors for recurrence to guide stewardship initiatives. After ethical approval, we commenced collecting demographic and clinical data of patients older than 18 years with clinically and microbiologically confirmed C. difficile infection. Data were statistically analyzed using R software.

RESULTS: Of 204 patients included in the analysis, 36 (18%) suffered 90-day recurrence, rCDI was higher among females (23%) compared to males (13%), overall age median (IQR) was 66 (51-77), and for rCDI cases 81 (69-86) years. Among 26 variables analyzed to evaluate their association with rCDI, prior clindamycin exposure, concurrent use of aztreonam, patients >76 years, total hospital length of stay, and LOS before diagnosis ≤7 days, WBC ≤ 9.85 × 10³ at discharge were more likely to experience rCDI.

CONCLUSION: As identified in this analysis, patients with risk factors for rCDI could be candidates for close monitoring, a high index of suspicion, and risk mitigation interventions to avoid rCDI and improve clinical outcomes.

PMID:34627059 | DOI:10.1016/j.jiph.2021.09.016

J Infect Public Health. 2021 Sep 15;14(11):1590-1594. doi: 10.1016/j.jiph.2021.09.008. Online ahead of print.

ABSTRACT

BACKGROUND: In Oman, many extended families tend to live in one household. Some families can include 20-30 individuals with the majority of them being children. This study investigates the role of children in spreading SARS-CoV-2 causing COVID-19 within family clusters in Oman.

METHODS: This retrospective study includes data of 1026 SARS-CoV-2 positive children (≤18 years) collected from the national surveillance database for COVID-19 between 1 February 2020 and 30 May 2020.

RESULTS: We included 1026 patients. Most, 842 were Omani (82%), 52% male, and 28.5% asymptomatic. Close to the half of symptomatic 419 (40%), patients presented with fever associated with other respiratory symptoms. Fifty pediatric patients were index cases who transmitted the virus to 107 patients in total (86 adults and 21 children) with a mode of 1. There is no statistical significance of all studied risk factors in the transmission of the SARS-CoV-2 virus including age, gender, and cycle threshold (CT) value.

CONCLUSIONS: According to this study, children are not to be considered a significant driver of transmission of SARS-CoV-2 in Oman.

PMID:34627056 | DOI:10.1016/j.jiph.2021.09.008

Phys Med. 2021 Oct 6;90:115-122. doi: 10.1016/j.ejmp.2021.09.015. Online ahead of print.

ABSTRACT

PURPOSE: The present work aims to guide the physicist in order to start automated planning for the VMAT treatment of glioblastoma multiforme (GBM) by giving a recipe that was set up and tested during a long-term (two years) evaluation.

METHODS: An automatic technique in AutoPlanning module of the Pinnacle3 (Philips Medical Systems, Fitchburg, WI) treatment planning system was created and validated by comparing dose distributions of automatic plans (APs) and manual plans (MPs) and by performing a blind AP-MP comparison on a cohort of 20 patients. Automatic technique was then applied to 145 patients and failures were recorded i.e. the number of times for which dose distributions produced by the automatic module were not suitable for treatment.

RESULTS: Each of the 20 APs considered in the validation step was clinically acceptable and proved to be better (15 cases) or equal (5 cases) respect to MPs. A statistically significant improvement in brain stem, optic pathways, cochleae, pituitary gland and scalp sparing was observed for APs, while no statistically significant differences were recorded in target coverage or plan parameters. For only 5 cases out of the 145 plans the operator intervention was needed in order to obtain a clinical acceptable plan, while for the remaining 140 plans the automatic created solution was suitable.

CONCLUSIONS: A straightforward automatic procedure has been created and tested in our clinic. The AutoPlanning technique proposed represents a reliable tool to improve treatment planning efficiency and the recipe, here presented, could be simply imported to every radiotherapy center.

PMID:34627029 | DOI:10.1016/j.ejmp.2021.09.015

Environ Int. 2021 Oct 6;158:106898. doi: 10.1016/j.envint.2021.106898. Online ahead of print.

ABSTRACT

IMPORTANCE: Previous studies have reported associations between in utero exposure to regional air pollution and autism spectrum disorders (ASD). In utero exposure to components of near-roadway air pollution (NRAP) has been linked to adverse neurodevelopment in animal models, but few studies have investigated NRAP association with ASD risk.

OBJECTIVE: To identify ASD risk associated with in utero exposure to NRAP in a large, representative birth cohort.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective pregnancy cohort study included 314,391 mother-child pairs of singletons born between 2001 and 2014 at Kaiser Permanente Southern California (KPSC) hospitals. Maternal and child data were extracted from KPSC electronic medical records. Children were followed until: clinical diagnosis of ASD, non-KPSC membership, death, or December 31, 2019, whichever came first. Exposure to the complex NRAP mixture during pregnancy was assessed using line-source dispersion models to estimate fresh vehicle emissions from freeway and non-freeway sources at maternal addresses during pregnancy. Vehicular traffic load exposure was characterized using advanced telematic models combining traditional traffic counts and travel-demand models with cell phone and vehicle GPS data. Cox proportional-hazard models estimated hazard ratios (HR) of ASD associated with near-roadway traffic load and dispersion-modeled NRAP during pregnancy, adjusted for covariates. Non-freeway NRAP was analyzed using quintile distribution due to nonlinear associations with ASD.

EXPOSURES: Average NRAP and traffic load exposure during pregnancy at maternal residential addresses.

MAIN OUTCOMES: Clinical diagnosis of ASD.

RESULTS: A total of 6,291 children (5,114 boys, 1,177 girls) were diagnosed with ASD. The risk of ASD was associated with pregnancy-average exposure to total NRAP [HR(95% CI): 1.03(1.00,1.05) per 5 ppb increase in dispersion-modeled NOx] and to non-freeway NRAP [HR(95% CI) comparing the highest to the lowest quintile: 1.19(1.11, 1.27)]. Total NRAP had a stronger association in boys than in girls, but the association with non-freeway NRAP did not differ by sex. The association of freeway NRAP with ASD risk was not statistically significant. Non-freeway traffic load exposure demonstrated associations with ASD consistent with those of NRAP and ASD.

CONCLUSIONS: In utero exposure to near-roadway air pollution, particularly from non-freeway sources, may increase ASD risk in children.

PMID:34627014 | DOI:10.1016/j.envint.2021.106898