Nevin Manimala

Arch Pathol Lab Med. 2021 Feb 26. doi: 10.5858/arpa.2020-0441-OA. Online ahead of print.

ABSTRACT

CONTEXT.—: In laboratory testing for monoclonal gammopathies, paraproteins are identified via serum immunofixation or serum immunosubtraction and immunoturbidimetric quantitation of serum immunoglobulins is often used.

OBJECTIVE.—: To evaluate methodic differences between serum immunofixation and serum immunosubtraction as well as in the quantitation of serum immunoglobulins on different clinical chemical platforms.

DESIGN.—: Three hundred twenty-two unique routine patient samples were blinded and used for comparison between serum immunofixation on Sebia’s HYDRASIS 2 and serum immunosubtraction on Sebia’s CAPILLARYS 2 as well as between quantitation results of immunoglobulin A, G, and M on Abbott’s ARCHITECT c16000PLUS and Roche’s Cobas c 502 module. Microsoft Excel 2019 with the add-on Abacus 2.0 and MedCalc were used for statistical analysis and graphic depiction via bubble diagram, Passing-Bablok regressions, and Bland-Altman plots.

RESULTS.—: The median age of patients was 75 years and samples with paraproteinemia were nearly evenly split between sexes. Paraprotein identification differed remarkably between immunofixation and immunosubtraction. Quantitation of serum immunoglobulins showed higher values on Abbott’s ARCHITECT c16000PLUS when compared with Roche’s Cobas c 502 module.

CONCLUSIONS.—: Identification of paraproteins via serum immunosubtraction is inferior to serum immunofixation, which can have implications on the diagnosis and monitoring of patients with monoclonal gammopathy. If immunoturbidimetric quantitation of immunoglobulins is used for follow-up, the same clinical-chemical platform should be used consistently.

PMID:33635966 | DOI:10.5858/arpa.2020-0441-OA

J Am Osteopath Assoc. 2021 Mar 1;121(3):247-253. doi: 10.1515/jom-2020-0280.

ABSTRACT

CONTEXT: Research has been scarce on health professionals’ knowledge about guidelines regulating service dogs in a clinical setting. Gaining insight into health professionals’ understanding of Americans with Disabilities Act (ADA) regulations concerning service dogs is critical for navigating compliance and reducing risk. Misinformation about service dogs could influence decisions affecting policy and care, leading to poor treatment and suboptimal health outcomes for patients with service animals.

OBJECTIVES: To assess health professionals’ knowledge about ADA regulations and beliefs about workplace protocols and training related to service dogs.

METHODS: The study used snowball sampling to distribute surveys to health professionals from around the United States. Initial outreach occurred using mailing lists, investigators’ personal networks, and social media. The survey contained 24 items. True and false questions were used to test ADA knowledge and then coded as correct or incorrect. Most closed-end questions were measured on a 5-point Likert scale using frequencies and descriptive statistics. A one-way analysis of variance (ANOVA) was conducted to test whether variables, such as encounters to service dogs, affected knowledge of ADA requirements.

RESULTS: The survey was completed by 441 health professionals from around the country. Most (234; 53.1%) worked in a hospital and came from a range of professional backgrounds (nurses, 155 [35.2%]; physicians, 71 [16.1%]). While nearly three-quarters (318 [73.1%]) of participants said their workplace had a policy on service animals, 113 (34.9%) of those said they were unfamiliar with the policy and 236 (54.5%) said they had not received adequate training on the topic. Most participants did not know basic ADA policy requirements related to service dogs. Only those who were extremely familiar with policy (F=4.613; p=0.001) and those who strongly agreed that they knew the differences between service dogs and other classes of animals (F=5.906; p=0.000) scored higher on the knowledge test than those who disagreed.

CONCLUSIONS: Our results suggest that increased familiarity and training leads to higher knowledge about service dogs and ADA policy. Health professionals need additional education on ADA service dog regulations and hospital policy in order to minimize risk and ensure patients with service dogs receive optimal care.

PMID:33635961 | DOI:10.1515/jom-2020-0280

J Am Osteopath Assoc. 2021 Mar 1;121(3):281-286. doi: 10.1515/jom-2020-0202.

ABSTRACT

CONTEXT: There has been a steady increase in the number of osteopathic (DO) medical students in the United States without a corresponding increase in DO representation in competitive specialties.

OBJECTIVES: To investigate the trends and impact of the Accreditation Council for Graduate Medical Education (ACGME) single accreditation system on DO match rates into dermatology and other competitive specialty programs.

METHODS: Information was collected through public databases (Electronic Residency Application Service [ERAS]; National Resident Matching Program [NRMP]; Association of American Medical Colleges [AAMC]; National Match Service, Inc. [NMS]; and the ACGME) to evaluate the match statistics of competitive specialties, including dermatology, otolaryngology, orthopedic surgery, neurosurgery, and plastic surgery. Residency program and medical school websites and residency communications were used to confirm whether the match placements were to programs that had traditionally been ACGME-accredited or former American Osteopathic Association (AOA) programs.

RESULTS: From 2012 to 2016 (pre-unification), osteopathic graduates comprised only 0.5% of the matches the specific specialties studied here and only 0.9% of ACGME dermatology positions. Post-unification (2017-2019), DOs comprised 2.0% of the matches into these specialties and 4.4% of the total ACGME dermatology positions. This apparent increase is misleading, as it is solely due to the transition of formerly AOA programs to ACGME status. The true post-unification DO match rate to traditionally ACGME programs is actually 0.6% for all competitive specialties and 0.4% for dermatology. Post-unification, 27.6% of formerly AOA positions in these competitive specialties were filled by allopathic (MD) applicants.

CONCLUSIONS: DO match rates into dermatology and other competitive specialties were poor prior to GME unification and continue to remain low. This situation, when coupled with the closing of many AOA programs and MDs matching into former AOA positions, threatens the future of osteopathic physicians in competitive specialties. Osteopathic recognition is one way to potentially help preserve osteopathic representation and philosophy in the single accreditation system era. Programs should not be hesitant to consider osteopathic applicants for competitive specialties.

PMID:33635959 | DOI:10.1515/jom-2020-0202

J Am Osteopath Assoc. 2021 Mar 1;121(3):255-263. doi: 10.1515/jom-2020-0020.

ABSTRACT

CONTEXT: With the advent of increasingly accessible three-dimensional (3D) printing, the possibility to efficiently design and generate prototype innovations is also increasing. This type of manufacturing can potentially enhance medical education by allowing design of models specific to osteopathic manipulative medicine (OMM).

OBJECTIVES: To determine the viability of a 3D-printed mechanically moveable rib cage in enhancing the teaching of rib osteopathic principles.

METHODS: A single-blind, qualitative study was conducted to evaluate the use of educating students with this novel 3D-printed, movable rib model vs. a traditional static rib model. A total of 237 first-year medical students participated in the study and received the same standardized lecture on the rib dysfunction. Students were also assigned at random to either a comparison group, which would utilize the 3D printed rib model, or the control group, which would utilize the traditional static model. Students would also complete an entrance and exit surveys assessing subjective scores of overall student satisfaction and objective scores for knowledge of OMM rib dysfunction and treatment. An independent samples t-test was applied to assess potential differences between select student evaluation scores (those with continuous variables) of the rib model in the comparison and experiment groups. Chi-square goodness of fit test was conducted to determine if there were any significant differences in entry and exit survey responses between the two groups. Descriptive statistics of the mean and standard deviation were also reported.

RESULTS: For both comparison and control groups, the mean score on an 11-point scale for the evaluation question, “Please rank on a scale of 0-10 how helpful you thought the rib models were to your education,” was 9.08 (SD, 1.397). Independent t-test results showed that the comparison group had higher scores than the control group when queried about whether they felt the model accurately depicted the material presented (comparison group mean, 9.55 [SD, 978] vs. control group mean, 9.06 [SD, 1.33; t(235) = 3.253; p=0.01). Chi-square test of goodness-of-fit showed that the differences between the number of correct answers chosen by participants for Item 3 (a case-based question asking students which rib they would treat for a patient presenting to an OMT clinic) was statistically significantly higher for the comparison group (51.9% correct in comparison group vs. 48.1% in control group), even though both groups scored similarly on this item during the entry survey.

CONCLUSIONS: The results of this study suggest that utilizing 3D printing to demonstrate somatic dysfunctions of the rib cage may improve understanding and student satisfaction for diagnosis and treatment.

PMID:33635955 | DOI:10.1515/jom-2020-0020

Anesthesiology. 2021 Feb 26. doi: 10.1097/ALN.0000000000003713. Online ahead of print.

ABSTRACT

BACKGROUND: Cholinergic drugs are known to modulate general anesthesia, but anesthesia responses in acetylcholine-deficient mice have not been studied. It was hypothesized that mice with genetic deficiency of forebrain acetylcholine show increased anesthetic sensitivity to isoflurane and ketamine and decreased gamma-frequency brain activity.

METHODS: Male adult mice with heterozygous knockdown of vesicular acetylcholine transporter in the brain or homozygous knockout of the transporter in the basal forebrain were compared with wild-type mice. Hippocampal and frontal cortical electrographic activity and righting reflex were studied in response to isoflurane and ketamine doses.

RESULTS: The loss-of-righting-reflex dose for isoflurane was lower in knockout (mean ± SD, 0.76 ± 0.08%, n = 18, P = 0.005) but not knockdown (0.78 ± 0.07%, n = 24, P = 0.021), as compared to wild-type mice (0.83 ± 0.07%, n = 23), using a significance criterion of P = 0.017 for three planned comparisons. Loss-of-righting-reflex dose for ketamine was lower in knockout (144 ± 39 mg/kg, n = 14, P = 0.006) but not knockdown (162 ± 32 mg/kg, n = 20, P = 0.602) as compared to wild-type mice (168 ± 24 mg/kg, n = 21). Hippocampal high-gamma (63 to 100 Hz) power after isoflurane was significantly lower in knockout and knockdown mice compared to wild-type mice (isoflurane-dose and mouse-group interaction effect, F[8,56] = 2.87, P = 0.010; n = 5 to 6 mice per group). Hippocampal high-gamma power after ketamine was significantly lower in both knockout and knockdown mice when compared to wild-type mice (interaction effect F[2,13] = 6.06, P = 0.014). The change in frontal cortical gamma power with isoflurane or ketamine was not statistically different among knockout, knockdown, and wild-type mice.

CONCLUSIONS: These findings suggest that forebrain cholinergic neurons modulate behavioral sensitivity and hippocampal gamma activity during isoflurane and ketamine anesthesia.

PMID:33635947 | DOI:10.1097/ALN.0000000000003713

PLoS One. 2021 Feb 26;16(2):e0247862. doi: 10.1371/journal.pone.0247862. eCollection 2021.

ABSTRACT

INTRODUCTION: The aim of this study is to analyse the impact of vaccination of infants with pneumococcal conjugate vaccine (PCV) on the incidence of invasive pneumococcal disease (IPD) in children under 5 years of age in the Czech Republic.

MATERIAL AND METHODS: The present study includes all IPD cases reported in children aged 0-4 years within the surveillance program in 2007-2017. The impact of PCV is analysed for five categories of IPD: cases caused by all serotypes, cases caused by PCV7 serotypes (4, 6B, 9V, 14, 18C, 19F, and 23F), cases caused by three additional PCV10 serotypes (1, 5, and 7F), cases caused by three additional PCV13 serotypes (3, 6A, and 19A), and cases caused by non-PCV serotypes. To assess the impact of PCV, the study period was divided into the pre-vaccination period 2007-2008 and post-vaccination period 2009-2017, which was divided into three three-year parts: 2009-2011, 2012-2014, and 2015-2017. Analysis of differences between periods was based on the Poisson regression model where the population numbers were handled as an offset.

RESULTS: The annual incidence of IPD in children under 5 years of age caused by all serotypes has had a downward trend since 2007: it dropped from 8.52/100 000 in 2007 to 2.67/100 000 in 2017, with slight increases in 2010 and 2013. All three post-vaccination periods show significantly lower (p<0.001) incidences in comparison to the pre-vaccination period, but they do not statistically significantly differ from each other.

CONCLUSIONS: IPD surveillance data in the Czech Republic show that after the introduction of PCV vaccination of infants, there has been a significant decrease in the IPD incidence of children under 5 years of age. Continued IPD surveillance is essential to monitor for possible post-vaccination serotype replacement.

PMID:33635933 | DOI:10.1371/journal.pone.0247862

PLoS One. 2021 Feb 26;16(2):e0247415. doi: 10.1371/journal.pone.0247415. eCollection 2021.

ABSTRACT

In 2015, the World Health Organization substantially revised its guidance for vaccination coverage cluster surveys (revisions were finalized in 2018) and has since developed a set of accompanying resources, including definitions for standardized coverage indicators and software (named the Vaccination Coverage Quality Indicators-VCQI) to calculate them.-The current WHO vaccination coverage survey manual was used to design and conduct two nationally representative vaccination coverage surveys in Nigeria-one to assess routine immunization and one to measure post-measles campaign coverage. The primary analysis for both surveys was conducted using VCQI. In this paper, we describe those surveys and highlight some of the analyses that are facilitated by the new resources. In addition to calculating coverage of each vaccine-dose by age group, VCQI analyses provide insight into several indicators of program quality such as crude coverage versus valid doses, vaccination timeliness, missed opportunities for simultaneous vaccination, and, where relevant, vaccination campaign coverage stratified by several parameters, including the number of previous doses received. The VCQI software furnishes several helpful ways to visualize survey results. We show that routine coverage of all vaccines is far below targets in Nigeria and especially low in northeast and northwest zones, which also have highest rates of dropout and missed opportunities for vaccination. Coverage in the 2017 measles campaign was higher and showed less geospatial variation than routine coverage. Nonetheless, substantial improvement in both routine program performance and campaign implementation will be needed to achieve disease control goals.

PMID:33635913 | DOI:10.1371/journal.pone.0247415

PLoS Genet. 2021 Feb 26;17(2):e1009373. doi: 10.1371/journal.pgen.1009373. Online ahead of print.

ABSTRACT

Whether hard sweeps or soft sweeps dominate adaptation has been a matter of much debate. Recently, we developed haplotype homozygosity statistics that (i) can detect both hard and soft sweeps with similar power and (ii) can classify the detected sweeps as hard or soft. The application of our method to population genomic data from a natural population of Drosophila melanogaster (DGRP) allowed us to rediscover three known cases of adaptation at the loci Ace, Cyp6g1, and CHKov1 known to be driven by soft sweeps, and detected additional candidate loci for recent and strong sweeps. Surprisingly, all of the top 50 candidates showed patterns much more consistent with soft rather than hard sweeps. Recently, Harris et al. 2018 criticized this work, suggesting that all the candidate loci detected by our haplotype statistics, including the positive controls, are unlikely to be sweeps at all and that instead these haplotype patterns can be more easily explained by complex neutral demographic models. They also claim that these neutral non-sweeps are likely to be hard instead of soft sweeps. Here, we reanalyze the DGRP data using a range of complex admixture demographic models and reconfirm our original published results suggesting that the majority of recent and strong sweeps in D. melanogaster are first likely to be true sweeps, and second, that they do appear to be soft. Furthermore, we discuss ways to take this work forward given that most demographic models employed in such analyses are necessarily too simple to capture the full demographic complexity, while more realistic models are unlikely to be inferred correctly because they require a large number of free parameters.

PMID:33635910 | DOI:10.1371/journal.pgen.1009373

Jpn J Nurs Sci. 2021 Feb 26:e12410. doi: 10.1111/jjns.12410. Online ahead of print.

ABSTRACT

AIM: For successful simulation-based learning (SBL), a structured interactive and bidirectional debriefing should be a prerequisite. The purpose of this study is to identify the effects of instructor-led hot debriefing (debriefing immediately after simulation) and cold debriefing (debriefing occurring after a certain period following simulation) in simulation with case-based learning (CBL).

METHOD: This study used a nonequivalent control group pretest-posttest design. A sample of 59 fourth-year nursing students in South Korea were invited and randomly divided into two groups, a post-simulation hot debriefing (PSHD, male = 4, female = 26), and cold debriefing (PSCD, male = 3, female = 26). We used clinical performance competency, satisfaction with CBL and SBL, and debriefing tools. The study period was from October to December of 2019. We analyzed the data with SPSS 23.0 software, using descriptive statistics and the t test.

RESULTS: Clinical performance competency means that the scores of both groups were significantly improved in the posttest (PSHD = 33.13 ± 5.11, PSCD = 34.10 ± 4.15) as compared to those in the pretest (t = -7.010, p < .001). The knowledge (t = -12.689, p < .001) and skill (t = -5.338, p = .001) scores of clinical performance competency in the PSCD were higher than those in the PSHD. The mean satisfaction scores of the PSHD group with CBL (4.53 ± 0.60) and debriefing (4.66 ± 0.55) was higher than for those in the PSCD group.

CONCLUSION: As a result of this study, PSHD and PSCD led by an instructor improved student clinical performance competency. The PSHD method, in particular, might be a positive influence on learner satisfaction with CBL, SBL, and debriefing.

PMID:33634592 | DOI:10.1111/jjns.12410

Pediatr Obes. 2021 Feb 25:e12778. doi: 10.1111/ijpo.12778. Online ahead of print.

ABSTRACT

BACKGROUND: Weight loss in children and adolescents with type 2 diabetes (T2D) is associated with improved glycaemic control.

OBJECTIVES: To assess the effects of liraglutide vs placebo on body mass index (BMI) and weight parameters in children and adolescents with T2D using data from the ellipse trial (NCT01541215).

METHODS: The ellipse trial randomized participants (10-<17 years old, BMI >85th percentile, T2D, glycated haemoglobin [HbA_1c ] 7.0%-11.0% [if diet- and exercise-treated] or 6.5% to 11.0% [if treated with metformin, basal insulin or both]) to liraglutide or placebo. This post-hoc analysis evaluated changes from baseline to weeks 26 and 52 in absolute BMI, percent change in BMI and other weight-related parameters. Changes were assessed by liraglutide overall (all doses) and liraglutide by dose (0.6, 1.2 and 1.8 mg/day) vs placebo using a pattern mixture model of observed data, with missing observations imputed from each treatment group.

RESULTS: In total, 134 participants were included. There were statistically significant differences between groups in certain parameters, including absolute BMI (estimated treatment difference [ETD] -0.89 kg/m² ; 95% confidence interval [CI] -1.71,-0.06) and percent change in BMI (ETD -2.73%; 95% CI -5.15,-0.30) at week 52, but none at week 26. Dose-dependent effects were not observed for liraglutide vs placebo for all BMI/weight parameters.

CONCLUSIONS: Compared with placebo, liraglutide was associated with statistically significant reductions in BMI/weight parameters at week 52, but not week 26, in children and adolescents with T2D.

PMID:33634589 | DOI:10.1111/ijpo.12778