Nevin Manimala

J Affect Disord. 2021 Jun 11;292:708-713. doi: 10.1016/j.jad.2021.06.009. Online ahead of print.

ABSTRACT

BACKGROUND: In a recent issue in the journal, Humpston, Bebbington, and Marwaha (2021) reported the results of the first large epidemiological study of bipolar disorder in England. The prevalence estimate of bipolar disorder was based on the Mood Disorders Questionnaire (MDQ), a self-administered screening scale for a lifetime history of mania/hypomania. Humpston and colleagues found that the prevalence of bipolar disorder in England was similar to the rates in other parts of the world, and they stated that most individuals with bipolar disorder in England did not receive treatment for the disorder in the past year. A better understanding of the statistics of screening and the performance of the MDQ would indicate that the conclusions drawn from the epidemiological study are not justified.

METHODS: I review the principles and statistics of diagnostic screening and how screening is distinguished from case-finding. I then review the performance of the MDQ in the general population and calculate the positive predictive value of the MDQ in the study by Humpston and colleagues.

RESULTS: The developers of the MDQ reported a sensitivity of 28.1% and specificity of 97.2% in the general population based on a cutoff score of 7. Using this same cutoff, Humpston and colleagues reported the prevalence of “probable” bipolar disorder was 1.7%. Based on these data, the positive predictive value of the MDQ would be only 14.8%.

LIMITATIONS: Humpson et al. did not compare the MDQ to a diagnostic interview in their study; thus, the performance of the MDQ was estimated from another general population study.

CONCLUSIONS: When studying a disorder with a relatively low prevalence, it is near impossible for a screening test to have sufficient positive predictive value to be used to validly compare the individuals who do and do not screen positive. Most of the individuals whom Humpston et al. considered to have “probable” bipolar disorder would not have received the diagnosis had they been directly interviewed. Thus, the results of the Humpston et al. study are not a valid indicator of the correlates of bipolar disorder in the general population of England.

PMID:34161888 | DOI:10.1016/j.jad.2021.06.009

Diagn Microbiol Infect Dis. 2021 Apr 21;101(2):115392. doi: 10.1016/j.diagmicrobio.2021.115392. Online ahead of print.

ABSTRACT

Real-time reverse transcription-polymerase chain reaction (RT-PCR) on upper respiratory tract (URT) samples is the primary method to diagnose SARS-CoV-2 infections and guide public health measures, with a supportive role for serology. We reinforce previous findings on limited sensitivity of PCR testing, and solidify this fact by statistically utilizing a firm basis of multiple tests per individual. We integrate stratifications with respect to several patient characteristics such as severity of disease and time since onset of symptoms. Bayesian statistical modelling was used to retrospectively determine the sensitivity of RT-PCR using SARS-CoV-2 serology in 644 COVID-19-suspected patients with varying degrees of disease severity and duration. The sensitivity of RT-PCR ranged between 80% – 95%; increasing with disease severity, it decreased rapidly over time in mild COVID-19 cases. Negative URT RT-PCR results should be interpreted in the context of clinical characteristics, especially with regard to containment of viral transmission based on ‘test, trace and isolate’. Keywords: SARS-CoV-2, RT-PCR, serology, sensitivity, public health.

PMID:34161880 | DOI:10.1016/j.diagmicrobio.2021.115392

Water Res. 2021 Jun 4;201:117329. doi: 10.1016/j.watres.2021.117329. Online ahead of print.

ABSTRACT

Sea level rise has increased the frequency of tidal flooding even without accompanying precipitation in many coastal areas worldwide. As the tide rises, inundates the landscape, and then recedes, it can transport organic and inorganic matter between terrestrial systems and adjacent aquatic environments. However, the chemical and biological effects of tidal flooding on urban estuarine systems remain poorly constrained. Here, we provide the first extensive quantification of floodwater nutrient concentrations during a tidal flooding event and estimate the nitrogen (N) loading to the Lafayette River, an urban tidal sub-tributary of the lower Chesapeake Bay (USA). To enable the scale of synoptic sampling necessary to accomplish this, we trained citizen-scientist volunteers to collect 190 flood water samples during a perigean spring tide to measure total dissolved N (TDN), dissolved inorganic N (DIN) and phosphate concentrations, and Enterococcus abundance from the retreating ebb tide while using a phone application to measure the extent of tidal inundation. Almost 95% of Enterococcus results had concentrations that exceeded the standard established for recreational waters (104 MPN 100 mL^-1). Floodwater dissolved nutrient concentrations were higher than concentrations measured in natural estuarine waters, suggesting floodwater as a source of dissolved nutrients to the estuary. However, only DIN concentrations were statistically higher in floodwater samples than in the estuary. Using a hydrodynamic model to calculate the volume of water inundating the landscape, and the differences between the median DIN concentrations in floodwaters and the estuary, we estimate that 1,145 kg of DIN entered the Lafayette River during this single, blue sky, tidal flooding event. This amount exceeds the annual N load allocation for overland flow established by federal regulations for this segment of the Chesapeake Bay by 30%. Because tidal flooding is projected to increase in the future as sea levels continue to rise, it is crucial we quantify nutrient loading from tidal flooding in order to set realistic water quality restoration targets for tidally influenced water bodies.

PMID:34161874 | DOI:10.1016/j.watres.2021.117329

Public Health. 2021 Jun 20;196:74-81. doi: 10.1016/j.puhe.2021.05.021. Online ahead of print.

ABSTRACT

OBJECTIVES: Breast cancer survivors have reported worse health-related quality of life (HRQoL) outcomes on some subscales when compared with members of the general population. However, the increased attention to breast cancer survivorship should have improved the HRQoL of these survivors. Our aim was to examine whether physical and mental component scores (PCS-12 and MCS-12) using the Short Form (SF-12) questionnaire were different for racial/ethnic minorities, specifically for Black and Hispanic women relative to White women. Furthermore, we stratified the data by age group to evaluate these racial/ethnic differences in HRQoL of breast cancer survivors.

STUDY DESIGN: Cross-sectional study.

METHODS: Pooled cross-sectional analyses using data from the Medical Expenditure Panel Survey between 2008 and 2016 were conducted. Pooled ordinary least squares (OLS) regression was used to examine the racial/ethnic differences in PCS-12 and MCS-12 scores of breast cancer survivors. Furthermore, stratified analyses by age group were conducted to evaluate racial/ethnic differences in HRQoL by the age of breast cancer survivors.

RESULTS: After adjusting for confounders, there was no association between race/ethnicity and PCS-12 scores. However, Hispanic breast cancer survivors had statistically significantly lower MCS-12 scores (by 1.9 points [95% confidence interval {CI}: -3.53 to -0.37]) when compared with White breast cancer survivors. For PCS-12, after stratifying by age, the adjusted analyses showed no significant differences in PCS-12 scores when White female breast cancer survivors were compared with the other racial/ethnic categories. On the other hand, Black female survivors aged <50 years had 4.3 points (95% CI: 0.46-8.13) higher MCS-12 scores when compared with their White counterparts, while Hispanic breast cancer survivors aged <50 years had 3.1 points (95% CI: -0.40-6.69) higher MCS-12 scores relative to White women. Furthermore, among female breast cancer survivors aged ≥50 years, Hispanic women had 3.2 points (95% CI: -4.98 to -1.40) lower MCS-12 scores than White women.

CONCLUSION: Our study generated findings showing the racial/ethnic differences in HRQoL of breast cancer survivors and presented results stratified by age group. These findings provide the much-needed rationale for targeted and racial/ethnic-specific HRQoL improvement strategies among breast cancer survivors.

PMID:34161858 | DOI:10.1016/j.puhe.2021.05.021

Spine J. 2021 Jun 20:S1529-9430(21)00778-6. doi: 10.1016/j.spinee.2021.06.014. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: There is growing interest among payers in profiling hospital value and quality-of-care, including both the cost and safety of common surgeries, such as lumbar fusion. Nonetheless, there is sparse evidence describing the statistical reliability of such measures when applied to lumbar fusion for spondylolisthesis.

PURPOSE: To evaluate the reliability of 90-day inpatient hospital costs, overall complications, and rates of serious complications for profiling hospital performance in lumbar fusion surgery for spondylolisthesis.

STUDY DESIGN/SETTING: Data for this analysis came from State Inpatient Databases from nine states made available through the Healthcare Cost and Utilization Project.

PATIENT SAMPLE: Patients undergoing elective lumbar spine fusion for spondylolisthesis from 2010-2017 in participating states.

OUTCOME MEASURES: Statistical reliability, defined as the ability to distinguish true performance differences across hospitals relative to statistical noise. Reliability was assessed separately for 90-day inpatient costs (standardized across years to 2019 dollars), overall complications, and serious complication rates.

METHODS: Statistical reliability was measured as the amount of variation between hospitals relative to the total amount of variation for each measure. Total variation includes both between-hospital variation (“signal”) and within-hospital variation (“statistical noise”). Thus, reliability equals signal over (signal plus noise) and ranges from 0 to 1. To adjust for differences in patient-level risk and procedural characteristics, hierarchical linear and logistic regression models were created for the cost and complication outcomes. Random hospital intercepts were used to assess between-hospital variation. We evaluated the reliability of each measure by study year and examined the number of hospitals meeting different thresholds of reliability by year.

RESULTS: We included a total of 66,571 elective lumbar fusion surgeries for spondylolisthesis performed at 244 hospitals during the study period. The mean 90-day hospital cost was $30,827 (2019 dollars). 12.0% of patients experienced a complication within 90 days of surgery, including 7.8% who had a serious complication. The median reliability of 90-day cost ranged from 0.97-0.99 across study years, and there was a narrow distribution of reliability values. By comparison, the median reliability for the overall complication metric ranged from 0.22 to 0.44, and the reliability of the serious complication measure ranged from 0.30 to 0.49 across the study years. At least 96% of hospitals had high (> 0.7) reliability for cost in any year, whereas only 0-9% and 0-11% of hospitals reached this cutoff for the overall and serious complication rate in any year, respectively. By comparison, 10-69% of hospitals per year achieved a more moderate threshold of 0.4 reliability for overall complications, compared to 21-80% of hospitals who achieved this lower reliability threshold for serious complications.

CONCLUSIONS: 90-day inpatient costs are highly reliable for assessing variation across hospitals, whereas overall and serious complications are only moderately reliable for profiling performance. These results support the viability of emerging bundled payment programs that assume true differences in costs of care exist across hospitals.

PMID:34161844 | DOI:10.1016/j.spinee.2021.06.014

J Surg Res. 2021 Jun 20;267:260-266. doi: 10.1016/j.jss.2021.04.025. Online ahead of print.

ABSTRACT

BACKGROUND: Morbidity and Mortality Conference (MMC) is a traditional quality assessment tool among surgical residencies to evaluate complications within their care and to integrate and educate best practices. Unfortunately, it is difficult to validate and measure loop closure as a result of MMC. This may result in repeating past mistakes or worse, becoming a meeting of anecdotal experiences. The goal of this study is to present results from a morbidity and mortality assessment tool (MMAT) which provides a means of measuring and tracking factors related to those surgical complications discussed within the MMC.

MATERIALS AND METHODS: Three years of MMC presentations were organized into a database and further divided and organized into variables which included case by the class year of the presenting resident, service line, month the case was presented, and potential contributing factors. Contributing factors considered for each case were categorized as: Systems-Based, Direct Patient Care, and Interpersonal Communication. Contributing factors were assigned to cases by a review committee consisting of residents and faculty members.

RESULTS: The lack of knowledge, technical error, lack of experience, lack of supervision, failure to communicate with team members were present in greater than 10% of the presented cases. There was a “July Effect” in the Trauma service, where there was a statistically significant difference between the percentage of cases presented that involved Failure to Communicate errors when compared with the remainder of the year.

CONCLUSIONS: MMAT allows longitudinal collection of data from each MMC to recognize patterns that facilitate improvements in systems of care and institutional memory.

PMID:34161841 | DOI:10.1016/j.jss.2021.04.025

Am J Med Sci. 2021 Jun 20:S0002-9629(21)00240-8. doi: 10.1016/j.amjms.2021.06.009. Online ahead of print.

ABSTRACT

BACKGROUND: The therapeutic benefits and rationale for treating fevers with external cooling methods remain unclear. We aimed to describe the clinical settings in which cooling blankets (CBs) are used.

DESIGN: We conducted a retrospective chart review of CB use in adult patients admitted to our tertiary care center over a one-year period. We measured how they are used and correlations between clinical variables and their duration of use.

RESULTS: 561 patients were included in our study. The mean highest temperature during hospitalization was 39.35°C (SD, 0.67). Shivering occurred in 176 patients (31.4%) while on a CB although 303 patients (54%) had no data regarding shivering. Discontinuation of CBs was recorded in only 177 (30.5%) cases. Among these, the median duration of use was 33.37 hours (IQR: 18.13-80.38) while the median duration of fever was 22.13 hours (IQR 6.67-51.98). Duration of CB use was highly correlated with fever duration (Spearman’s rho, 0.771, p<.001), moderately with length of stay (LOS) (rho, 0.425, p<.001), LOS after CB initiation (rho, 0.475, p<.001) and antipyretic use (rho, 0.506, p<.001). No other statistically significant correlations were observed.

CONCLUSION: Documentation of CB use including temperature set points, time of discontinuation and duration in EMRs was poor. We could not establish benefits of CB use in this study but observed that almost a third of patients developed adverse effects in the form of shivering. Thus, adverse effects of CB use may outweigh potential benefits. Their use should be reevaluated and institutional protocols developed for their use.

PMID:34161829 | DOI:10.1016/j.amjms.2021.06.009

Exp Eye Res. 2021 Jun 20:108680. doi: 10.1016/j.exer.2021.108680. Online ahead of print.

ABSTRACT

Accumulation of bisretinoids such as A2E and its isomer iso-A2E is thought to mediate blue light-induced oxidative damage associated with age-related macular degeneration (AMD) and autosomal recessive Stargardt disease (STGD1). We hypothesize that increasing dietary intake of the macular carotenoids lutein and zeaxanthin in individuals at risk of AMD and STGD1 can inhibit the formation of bisretinoids A2E and iso-A2E, which can potentially ameliorate macular degenerative diseases. To study the beneficial effect of macular carotenoids in a retinal degenerative diseases model, we used ATP-binding cassette, sub-family A member 4 (Abca4^-/-)/β,β-carotene-9′,10′-oxygenase 2 (Bco2^-/-) double knockout (KO) mice that accumulate elevated levels of A2E and iso-A2E in the retinal pigment epithelium (RPE) and macular carotenoids in the retina. Abca4^-/-/Bco2^-/- and Abca4^-/- mice were fed a lutein-supplemented chow, zeaxanthin-supplemented chow or placebo chow (∼2.6 mg of carotenoid/mouse/day) for three months. Visual function and electroretinography (ERG) were measured after one month and three months of carotenoid supplementation. The lutein and zeaxanthin supplemented Abca4^-/-/Bco2^-/- mice had significantly lower levels of RPE/choroid A2E and iso-A2E compared to control mice fed with placebo chow and improved visual performance. Carotenoid supplementation in Abca4^-/- mice minimally raised retinal carotenoid levels and did not show much difference in bisretinoid levels or visual function compared to the control diet group. There was a statistically significant inverse correlation between carotenoid levels in the retina and A2E and iso-A2E levels in the RPE/choroid. Supplementation with retinal carotenoids, especially zeaxanthin, effectively inhibits bisretinoid formation in a mouse model of STGD1 genetically enhanced to accumulate carotenoids in the retina. These results provide further impetus to pursue oral carotenoids as therapeutic interventions for STGD1 and AMD.

PMID:34161819 | DOI:10.1016/j.exer.2021.108680

J Oral Maxillofac Surg. 2021 May 19:S0278-2391(21)00518-8. doi: 10.1016/j.joms.2021.05.019. Online ahead of print.

ABSTRACT

PURPOSE: We aim to reveal postoperative morphological correlations between the nasolabial components in patients with unilateral cleft lip (UCL). The hypothetical correlations are first, a correlation between the vertical height of the cleft-side alar base and the length of the cleft-side red lip, and second, a correlation between the length of the cleft-side red lip and the vertical position of the cleft-side oral commissure. We explain how these morphological balances are controlled by surgery.

METHODS: Three-dimensional bilateral measurements of the length of the red lip, vertical height of the nasal alar base, and vertical height of the oral commissure were conducted retrospectively on 31 patients with UCL and palate (complete UCL: 26; incomplete UCL: 5) who underwent primary lip plasty at Osaka Women’s and Children’s Hospital from 2017 to 2019.

RESULTS: We found a statistically significant correlation between the vertical height of the cleft-side alar base and cleft-side red lip length (P = .012, r = 0.45); thus, the longer the red lip, the lower was the nasal alar base. The correlation between the cleft-side red lip length and the vertical height of the cleft-side oral commissure also showed a statistically significant (P = .00074, r = 0.57); thus, the shorter the red lip, the higher was the oral commissure.

CONCLUSIONS: The present results provided objective evidence showing basic morphological relationships between the postoperative nasolabial features of patients with UCL. The results lead to a reasonable approach to define the proposed peak of the Cupid’s bow, an unsettled major controversy in cleft lip surgery.

PMID:34161809 | DOI:10.1016/j.joms.2021.05.019

Ann Epidemiol. 2021 Jun 20:S1047-2797(21)00154-X. doi: 10.1016/j.annepidem.2021.06.003. Online ahead of print.

NO ABSTRACT

PMID:34161794 | DOI:10.1016/j.annepidem.2021.06.003