Nevin Manimala

Acta Paediatr. 2021 Jun 6. doi: 10.1111/apa.15969. Online ahead of print.

ABSTRACT

Very preterm infants (≤ 32 weeks gestational age; GA) are at high risk of developing late-onset sepsis (LOS; onset after 72 hours of age), which is associated with increased mortality and short- and long-term morbidity. The early symptoms of suspected LOS are non-specific and are managed with empiric broad-spectrum antibiotics, with well-documented adverse effects, including mortality. Microbial blood culture, with adjunctive diagnostic biomarker(s) (e.g. C-reactive protein (CRP) and interleukin (IL)-6), are commonly used for LOS diagnosis, but have sub-optimal sensitivity and specificity, and median time to positivity of 12 – 36 hours for blood culture.

PMID:34091943 | DOI:10.1111/apa.15969

Lett Appl Microbiol. 2021 Jun 5. doi: 10.1111/lam.13519. Online ahead of print.

ABSTRACT

The development of microalgae culture technology has been an integral part to produce biomass feedstock to biofuel production. Due to this, numerous attempts have been made to improve some operational parameters of microalgae production. Despite this, specialized research in cell growth monitoring, considered as a fundamental parameter to achieve profitable applications of microalgae for biofuels production, presents some opportunity areas mainly related to the development of specific and accurate methodologies for growth monitoring. In this work, predictive models were developed through statistical tools that correlate a specific microalgal absorbance with cell density measured by cell count (cells∙mL^-1 ), for three species of interest for biofuels production. The results allow the precise prediction of cell density through a logistic model based on spectrophotometry, valid for all the kinetics analyzed. The adjusted determination coefficients (r²_adj ) for the developed models were 0.993, 0.995 and 0.994 for Dunaliella tertiolecta, Nannochloropsis oculata and Chaetoceros muelleri, respectively. The results showed that the equations obtained here can be used with an extremely low error (≤ 2%) for all the cell growth ranges analyzed, with low operational cost and high potential of automation. Finally, a user-friendly software was designed to give practical use to the developed predictive models.

PMID:34091927 | DOI:10.1111/lam.13519

J Dent Educ. 2021 Jun 6. doi: 10.1002/jdd.12696. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to assess the impact of a full-day workshop on increasing cultural awareness among incoming first-year (DDS-I) and post-doctoral (PGY-I) dental students at the Columbia University College of Dental Medicine.

METHODS: The workshop focused on developing students’ cultural awareness regarding dimensions of identity, recognition of power and privilege, importance of cross-cultural understanding and communication, and the role of self-reflection through direct teaching, interactive discussions, and reflective writing. A convenience sample of 83 DDS-I and 30 PGY-I students from the 2019 enrollment class were recruited. Assessments included pre- and post-workshop surveys, facilitator interviews, and a formal workshop evaluation. Descriptive and bivariate analyses of students’ responses were performed to assess cultural awareness within and between student groups. Facilitator interviews and student feedback were analyzed qualitatively to identify emerging themes.

RESULTS: Global cultural awareness among both student groups was higher in the post-workshop survey (for DDS-I, mean = 3.46, SD = 0.38; for PGY-I, mean = 3.47, SD = 0.30) than in the pre-workshop survey (for DDS-I, mean = 2.98, SD = 0.34; for PGY-I, mean = 2.90, SD = 0.47), which represented a statistically significant difference (p < 0.001 for both comparisons). Quantitative analysis revealed that the workshop provided a platform to discuss sensitive topics, increased cultural awareness among students and faculty, and provided faculty with different perspectives about culture awareness.

CONCLUSIONS: The full-day workshop achieved its goals of increasing dental students’ self-perceived cultural awareness and capacity to establish cross-cultural professional relationships.

PMID:34091910 | DOI:10.1002/jdd.12696

Med J Aust. 2021 Jun 5. doi: 10.5694/mja2.51117. Online ahead of print.

ABSTRACT

OBJECTIVE: To quantify the burden of invasive group A Streptococcus (GAS) disease in Western Australia during 2000-2018.

DESIGN, SETTING: Population-based data linkage study: Hospital Morbidity Data Collection (HMDC; all WA public and private hospital records), PathWest pathology data (government-owned pathology services provider), and death registrations.

PARTICIPANTS: People with invasive GAS disease, defined by an isolate from a normally sterile site (PathWest) or a hospital-based principal ICD-10-AM diagnosis code (HMDC).

MAIN OUTCOME MEASURES: Incidence of invasive GAS disease; median length of hospital stay; all-cause mortality.

RESULTS: We identified 2237 cases of GAS disease during 2000-2018; 1283 were in male patients (57%). 1950 cases had been confirmed by GAS isolates from normally sterile tissues (87%; including 1089 from blood [56% of cases] and 750 from tissue [38%]). The age-standardised incidence increased from 2.0 (95% CI, 1.4-2.7) cases per 100 000 population in 2000 to 9.1 (95% CI, 7.9-10.2) cases per 100 000 in 2017 (by year, adjusted for age group and sex: incidence rate ratio [IRR], 1.09; 95% CI, 1.08-1.10). Incidence was consistently higher among Indigenous than non-Indigenous Australians (year-adjusted IRR, 13.1; 95% CI, 11.3-15.1). All-cause 30-day mortality was 5% (116 deaths), and 90-day mortality 7% (156 deaths); 30-day mortality, adjusted for age group and sex, was not statistically significantly different for cases involving Indigenous or non-Indigenous patients (adjusted odds ratio, 0.8; 95% CI, 0.6-1.1).

CONCLUSIONS: The incidence of invasive GAS disease in WA increased between 2000 and 2018, particularly among Indigenous Australians. Mandatory notification of invasive GAS disease would therefore be appropriate. The social determinants of differences in incidence should be addressed, and other relevant host, pathogen, and health system factors investigated.

PMID:34091892 | DOI:10.5694/mja2.51117

Ecology. 2021 Jun 5:e03425. doi: 10.1002/ecy.3425. Online ahead of print.

ABSTRACT

Climate change is expected to alter the distribution and abundance of tree species, impacting ecosystem structure and function. Yet, anticipating where this will occur is often hampered by a lack of understanding of how demographic rates, most notably recruitment, vary in response to climate and competition across a species range. Using large-scale monitoring data on two dry woodland tree species (Pinus edulis and Juniperus osteosperma), we develop an approach to infer recruitment, survival, and growth of both species across their range. In doing so, we account for ecological and statistical dependencies inherent in large-scale monitoring data. We find that drying and warming conditions generally lead to declines in recruitment and survival, but the strength of responses varied between species. These climate conditions point to geographic regions of high vulnerability for particular species, such as Pinus edulis in N. Arizona, where both survival and recruitment are low. Our approach provides a path forward for leveraging emerging large-scale monitoring and remotely sensed data to anticipate the impacts of global change on species distributions.

PMID:34091890 | DOI:10.1002/ecy.3425

Biol Trace Elem Res. 2021 Jun 6. doi: 10.1007/s12011-021-02744-9. Online ahead of print.

ABSTRACT

Honey is a highly valued product due to its nutritional value, pro-health and healing properties. Pollutants from the environment penetrate into nectar, honeydew, pollen and next into bee products and can cause human exposure after ingestion. Mercury (Hg) is a toxic metal to living organisms. This is why it was important to determine the level of Hg in consumed honey.The aim of this manuscript is to analyse mercury concentration in honeys collected on the territory of Poland. A total of 108 samples of honey purchased in regional apiaries and hypermarkets were tested. The concentration of Hg was analysed in various types of honey (multifloral, honeydew, linden, goldenrod, acacia, buckwheat, rapeseed, sunflower, heather, dandelion, phacelia). The values of the Estimated Daily Intake (EDI), Estimated Weekly Intake (EWI) and % Provisional Tolerable Weekly Intake (% PTWI) were calculated. This allowed estimating the amount of Hg taken during consumption of the tested honeys.The concentration of Hg ranged from 0.01 to 1.71 µg/kg and was 0.43 µg/kg on average. A higher concentration of Hg, which was statistically significant, was recorded in honeydew honey, then in compound honeys. Honeys produced from one raw material had the lowest concentration of Hg. There were no significant differences in the concentration of Hg depending on the origin of honey. The calculations have shown that consumption of a portion (19 g) of the tested honey per week is safe for both adults and children according to the applicable standards.

PMID:34091870 | DOI:10.1007/s12011-021-02744-9

Ir J Med Sci. 2021 Jun 5. doi: 10.1007/s11845-021-02657-5. Online ahead of print.

ABSTRACT

AIM: To evaluate the nephro-ureteric stent (NUS) insertion and exchange practice in a tertiary referral cancer centre, and determine the safety and compliance with current guidelines. We also reviewed if increasing exchange time interval from 6 to 12 weeks was safe, and if this could be adopted into our local guidelines.

METHODS: A retrospective review was performed covering 24 months from January 2017 to December 2018. All NUS insertions and exchanges performed in that period were analysed, including the number of exchanges the patient underwent, the time between subsequent exchanges, and the screening time. We also reviewed the indications for stent insertion, possible causes for failed stent exchange, and factors which led to significant delays in stent exchanges for some patients. A scatterplot of screening time versus time in situ was derived and correlation analysis performed using the Pearson coefficient.

RESULTS: Thirty-two patients underwent de novo NUS insertion during the period, and 102 NUS exchanges were performed. The interval between stent exchanges ranged from 1 to 40 weeks, with a mean of 12.3 weeks (SD = 8.96 weeks). Screening time ranged from 33 s to 17 min, with a mean of 3 min 50 s (SD = 3 min 35 s). There were 100 successful exchanges, and two failed exchanges, accounting for 1.9% of total exchanges. In both failed cases, the reason for failed exchange was due to a prolonged period between exchanges (6 months in both cases). The reason for delay for stent exchange was due to non-attendance for scheduled appointments. There was a weakly positive correlation coefficient of 0.06 (screening time versus time period between insertions); however, this was not statistically significant (p = 0.81).

CONCLUSION: In this retrospective review, we have demonstrated that the recommended 6-week period between stent exchanges is unnecessary in the vast majority of cases, and that a longer interval between NUS exchanges, e.g. 8-12 weeks, is safe for the patient, and reduces screening time. This reduction in procedures also provides a significant potential saving to the radiology department in both monetary expense and limited angiography suite time.

PMID:34091859 | DOI:10.1007/s11845-021-02657-5

MAGMA. 2021 Jun 6. doi: 10.1007/s10334-021-00930-3. Online ahead of print.

ABSTRACT

OBJECT: To develop new imaging biomarkers of therapeutic efficacy through the quantification of intratumoral microvascular heterogeneity.

MATERIALS AND METHODS: The described method was a combination of non-supervised clustering and extraction of intratumoral complexity features (ICF): number of non-connected objects, volume fraction. It was applied to a set of 3D DCE-MRI K^trans maps acquired previously on tumor bearing mice prior to and on day 4 of anti-angiogenic treatment. Evolutions of ICF were compared to conventional summary statistics (CSS) and to heterogeneity related whole tumor texture features (TF) on treated (n = 9) and control (n = 6) mice.

RESULTS: Computed optimal number of clusters per tumor was 4. Several intratumoral features extracted from the clusters were able to monitor a therapy effect. Whereas no feature significantly changed for the control group, 6 features significantly changed for the treated group (4 ICF, 2 CSS). Among these, 5 also significantly differentiated the two groups (3 ICF, 2 CSS). TF failed in demonstrating differences within and between the two groups.

DISCUSSION: ICF are potential imaging biomarkers for anti-angiogenic therapy assessment. The presented method may be expected to have advantages with respect to texture analysis-based methods regarding interpretability of results and setup of standardized image analysis protocols.

PMID:34091826 | DOI:10.1007/s10334-021-00930-3

Pain Ther. 2021 Jun 6. doi: 10.1007/s40122-021-00268-7. Online ahead of print.

ABSTRACT

INTRODUCTION: Multicenter, randomized, double-blinded crossover study. The Netherlands (ClinicalTrials.gov NCT02112474). We hypothesized that the pain suppressive effects of 1000 Hz and 30 Hz spinal cord stimulation (SCS) strategies are equally effective in patients with chronic, neuropathic, unilateral leg pain after back surgery.

METHODS: Thirty-two patients (18-70 years, minimum leg pain 50 mm on 100 mm visual analog scale (VAS), minimal back pain) were randomized (1:1) to start 1000 Hz or 30 Hz neurostimulation for 9 days. After a 5-day washout, they crossed over, for another 9 days. Primary outcome was pain suppression (mean of VAS scores 4×/day) during the crossover period. The main investigators were blinded to strategy allocation, patients were blinded to the outcome, a blinded assessor analyzed the primary outcome.

RESULTS: The primary outcome was analyzed in 26 patients. There was no period effect (delta 4 mm, p = 0.42, 95% CI [- 5, 13]), allowing direct intrapatient comparison of the treatment effect (delta 1 mm, p = 0.92, 95% CI [- 13, 14]). Ninety-two percent of patients in both periods experienced greater than 34% pain suppression (minimal clinically important difference, MCID). Secondary outcomes (22 patients): pain suppression and improved quality of life were sustained at 12 months; both were statistically significant and clinically relevant. Fifty percent of patients had greater than 80% pain suppression (p < 0.001). At study termination, all events were resolved; no unanticipated events were reported. Medtronic provided a grant for additional study costs.

CONCLUSION: We conclude that our hypothesis regarding the effect of 1000 Hz and 30 Hz stimulation strategies on pain suppression was confirmed. Both stimulation strategies led to a large, sustainable, clinically relevant pain suppression and improvement in quality of life.

PMID:34091818 | DOI:10.1007/s40122-021-00268-7

Insights Imaging. 2021 Jun 5;12(1):72. doi: 10.1186/s13244-021-01016-3.

ABSTRACT

OBJECTIVES: To investigate the incremental value of Sestamibi SPECT combined with a non-enhanced and contrast-enhanced CT, using SPECT/CT, for the preoperative localisation of small parathyroid adenomas (PTA).

METHODS: Retrospectively, 147 patients surgically cured from primary hyperparathyroidism, as verified by biochemistry 6 months postoperatively, were included. All patients had preoperatively undergone a dual time ^99mTechnetium-Sestamibi SPECT (S) with multiphase CT including native (N), arterial (A) and venous (V) phases. Independently, two radiologists blinded from both the surgical and the preoperative imaging reports, sequentially performed PTA localisation starting with either [A] or [V], thereafter [A + N] or [V + N] and finally with the complete [A + N + S] or [V + N + S]. PTA localisation was reported for each image-set. The readers results were combined and the diagnostic performance for each image set was determined. Sensitivity was also calculated for the different quartiles of PTA weight distribution.

RESULTS: The median adenoma weight was 315 mg. No statistically significant differences in diagnostic performance between arterial and venous based image sets were found. The net effect of adding [N] was to increase specificity. Sestamibi SPECT significantly increased the overall diagnostic accuracy for arterial- and venous-based image sets, p = 0.0008 and p = 0.001, respectively. [A + N + S] was found to have the highest diagnostic performance with 86.5% sensitivity and 94.9% overall accuracy. [A + N + S] was particularly advantageous for locating PTA in the lower weight quartiles.

CONCLUSIONS: Native CT-phase and dual time point Sestamibi SPECT increase specificity and sensitivity, respectively. These, in combination with a single contrast-enhanced CT-phase is the most optimal examination protocol for preoperative localisation of PTA using SPECT/CT.

PMID:34091801 | DOI:10.1186/s13244-021-01016-3