Nevin Manimala

Mil Med. 2021 May 3:usab168. doi: 10.1093/milmed/usab168. Online ahead of print.

ABSTRACT

INTRODUCTION: Special Weapons and Tactics (SWAT) personnel who practice breaching with blast exposure are at risk for blast-related head trauma. We aimed to investigate the impact of low-level blast exposure on underlying white matter (WM) microstructure based on diffusion tensor imaging (DTI) and neurite orientation and density imaging (NODDI) in SWAT personnel before and after breacher training. Diffusion tensor imaging is an advanced MRI technique sensitive to underlying WM alterations. NODDI is a novel MRI technique emerged recently that acquires diffusion weighted data from multiple shells modeling for different compartments in the microstructural environment in the brain. We also aimed to evaluate the effect of a jugular vein compression collar device in mitigating the alteration of the diffusion properties in the WM as well as its role as a moderator on the association between the diffusion property changes and the blast exposure.

MATERIALS AND METHODS: Twenty-one SWAT personnel (10 non-collar and 11 collar) completed the breacher training and underwent MRI at both baseline and after blast exposure. Diffusion weighted data were acquired with two shells (b = 1,000, 2,000 s/mm2) on 3T Phillips scanners. Diffusion tensor imaging metrices, including fractional anisotropy, mean, axial, and radial diffusivity, and NODDI metrics, including neurite density index (NDI), isotropic volume fraction (fiso), and orientation dispersion index, were calculated. Tract-based spatial statistics was used in the voxel-wise statistical analysis. Post hoc analyses were performed for the quantification of the pre- to post-blast exposure diffusion percentage change in the WM regions with significant group difference and for the assessment of the interaction of the relationship between blast exposure and diffusion alteration.

RESULTS: The non-collar group exhibited significant pre- to post-blast increase in NDI (corrected P < .05) in the WM involving the right internal capsule, the right posterior corona radiation, the right posterior thalamic radiation, and the right sagittal stratum. A subset of these regions showed significantly greater alteration in NDI and fiso in the non-collar group when compared with those in the collar group (corrected P < .05). In addition, collar wearing exhibited a significant moderating effect for the alteration of fiso for its association with average peak pulse pressure.

CONCLUSIONS: Our data provided initial evidence of the impact of blast exposure on WM diffusion alteration based on both DTI and NODDI. The mitigating effect of WM diffusivity changes and the moderating effect of collar wearing suggest that the device may serve as a promising solution to protect WM against blast exposure.

PMID:33939823 | DOI:10.1093/milmed/usab168

Mil Med. 2021 May 3:usab176. doi: 10.1093/milmed/usab176. Online ahead of print.

ABSTRACT

INTRODUCTION: Ultrasound guidance is now widely available in military treatment facilities and civilian hospitals alike, both in the USA and in forward-deployed military environments. Technical mastery of ultrasound-guided peripheral intravenous (USGPIV) catheter insertion can be easily achieved through a short training course. Mastery can be achieved even when trainees have a limited medical background before course attendance. An evidence-based practice project team sought to improve the knowledge, confidence, and skills in the placement of USGPIV catheters by clinicians at Naval Hospital Jacksonville. Completion of an USGPIV training program can equip healthcare providers with knowledge and confidence for placement of peripheral access necessary in critical situations such as those requiring medications or blood products.

MATERIALS AND METHODS: The project team conducted a literature review to evaluate the appropriateness of USGPIV training for the nurses and military medical technicians in this setting. The team developed and delivered a USGPIV training program based on adaptations from the literature. During the training period, knowledge and confidence scores were reported by each trainee to evaluate the perceptions of the quality of training. The number of attempted catheter placements and ultrasound utilization was recorded in the pre- and post-implementation periods to evaluate the project’s effect on the delivery of patient care. Statistical analysis was conducted to evaluate project outcomes.

RESULTS: In the pre-intervention period, none of the 252 intravenous catheters were placed with the USGPIV technique, compared to 50 of 267 in the post-intervention period. These results demonstrate an 18.7% increase in the USGPIV access approach by nursing staff. Mean knowledge scores significantly increased following the delivery of the training, 60% versus 80% in the pre- and post-training assessments, respectively (P < .001). Mean self-reported skill confidence scores also significantly improved (P < .001).

CONCLUSION: Knowledge and self-reported confidence in USGPIV access improved for the trainees. Mean knowledge improved from 60% to 80%, while mean confidence scores increased from 2.74 to 3.79 for corpsman and from 3.0 to 3.88 for nurses. Utilization of the USGPIV technique increased by 18.7% in the post-intervention period. These results demonstrate that implementing this training program can improve knowledge, confidence, and use of ultrasound during the placement of PIV catheters.

PMID:33939820 | DOI:10.1093/milmed/usab176

J Anim Sci. 2021 May 3:skab133. doi: 10.1093/jas/skab133. Online ahead of print.

ABSTRACT

The interest and demand for healthy and less processed foods for people has been mirrored in the pet industry, with an explosion of alternative diets available. Several non-traditional feeding methodologies including raw meat based diets (RMBD) are believed by many dog owners to be superior to traditional extruded commercial dog foods. Despite the strong opinions, limited data are available comparing objective health measures among healthy dogs fed using different methods of diet preparation. Therefore, we compared health markers in client owned dogs fed a RMBD to markers in dogs fed a high quality, extruded kibble. We hypothesized that healthy adult dogs fed RMBD would show differences in biochemical and hematological parameters and improved clinical health scores (e.g.,dental, external ear canal and integument scores) compared to dogs fed a kibble diet. A cross-sectional observational study was performed comparing hematology, serum biochemistry, urinalysis management history and clinical health scores in healthy client-owned dogs reported as fed RMBD (n=28) or kibble (n=27) for > 1 year. Dental, external ear canal and integument health scores were assigned by a single veterinary evaluator blinded to feed group, using a scale where 0 was normal and 3 was most severely affected. Spearman correlation coefficient (rs) was calculated to assess the strength and direction of the relationship of biochemical outcomes with age and BCS, while analysis of variance was used to determine if biochemical analytes differed by breed or gender. Biochemical data were analyzed using multiple linear regression models, adjusting for the covariates gender, breed, age and BCS. A composite clinical health score, CCS= 9- (dental score + otitis score + integument score), was compared between feeding groups using Mann Whitney test. Serum alkaline phosphatase activity (P<0.001) and globulin concentration (P<0.001) was lower, while lymphocyte count (P<0.05) was higher in dogs fed RMBD. No differences were found in urinalysis between diet groups. Dogs fed RMBD showed a slight improvement in CCS compared to kibble fed dogs (CCS: P=0.03). Owner management significantly differed with greater likelihood of management interventions including dietary supplements and sporting activities in the RMBD group. Further work is needed to specifically determine the impact of diet processing and nutrient content on canine health.

PMID:33939804 | DOI:10.1093/jas/skab133

PLoS One. 2021 May 3;16(5):e0250963. doi: 10.1371/journal.pone.0250963. eCollection 2021.

ABSTRACT

Time-to-event analysis is a common occurrence in political science. In recent years, there has been an increased usage of machine learning methods in quantitative political science research. This article advocates for the implementation of machine learning duration models to assist in a sound model selection process. We provide a brief tutorial introduction to the random survival forest (RSF) algorithm and contrast it to a popular predecessor, the Cox proportional hazards model, with emphasis on methodological utility for political science researchers. We implement both methods for simulated time-to-event data and the Power-Sharing Event Dataset (PSED) to assist researchers in evaluating the merits of machine learning duration models. We provide evidence of significantly higher survival probabilities for peace agreements with 3rd party mediated design and implementation. We also detect increased survival probabilities for peace agreements that incorporate territorial power-sharing and avoid multiple rebel party signatories. Further, the RSF, a previously under-used method for analyzing political science time-to event data, provides a novel approach for ranking of peace agreement criteria importance in predicting peace agreement duration. Our findings demonstrate a scenario exhibiting the interpretability and performance of RSF for political science time-to-event data. These findings justify the robust interpretability and competitive performance of the random survival forest algorithm in numerous circumstances, in addition to promoting a diverse, holistic model-selection process for time-to-event political science data.

PMID:33939757 | DOI:10.1371/journal.pone.0250963

PLoS One. 2021 May 3;16(5):e0251029. doi: 10.1371/journal.pone.0251029. eCollection 2021.

ABSTRACT

Assisting patients with upper gastrointestinal bleeding is a crucial role for nurses, and as future nurses, students should demonstrate sound clinical judgment. Well-structured, high-quality simulations are useful alternatives to prepare students for clinical practice. However, nursing simulation scenarios focused on enhancing clinical judgment in managing upper gastrointestinal bleeding are limited. This study aims to develop, apply, and evaluate an effective nursing simulation scenario for patients with upper gastrointestinal bleeding based on Tanner’s clinical judgment model using a mixed methods study design. A high-fidelity patient simulation was conducted among 80 undergraduate nursing students divided into a simulated control group (n = 39) and an experimental group (n = 41). Subsequent student performance evaluations used questionnaires and video recordings. After scenario simulations, the students showed a statistically significant increase in theoretical knowledge (p = 0.001) and clinical performance skills (p < 0.001), but there was no significant increase in self-confidence (p = 0.291). According to the video analysis, the “noticing” clinical judgment phase was the most frequently observed phase, while “reflection” was the least frequently observed phase. Additionally, “education” was the most frequently observed nursing domain, and “anxiety” was the least frequently observed domain. Although further simulation repetitions are required to reinforce students’ self-confidence when caring for patients with upper gastrointestinal bleeding, the scenario was deemed effective. Moreover, emphasis should be placed on developing various scenarios to strengthen students’ clinical judgment skills, especially “reflecting” and “emotional care.”

PMID:33939752 | DOI:10.1371/journal.pone.0251029

PLoS One. 2021 May 3;16(5):e0250927. doi: 10.1371/journal.pone.0250927. eCollection 2021.

ABSTRACT

OBJECTIVES: To determine the prevalence and socio-demographic and parental-related factors of depression among school adolescents in Jimma town, southwest Ethiopia.

METHODS: Using a cross-sectional survey, 546 school adolescents were screened for depression using the patient health questionnaire (PHQ-9) from five randomly selected public and private schools. Oslo social support scale, adverse childhood experience tool, and socio-demographic questionnaire were used to gather data on risk factors. Linear regression analysis was used, and unstandardized beta (β) coefficients with 95% confidence intervals (CI) were reported to declare statistical significance.

RESULTS: A total of 546 adolescents participated in the study, with a response rate of 97.3%. The mean (±SD) age of participants was 16.8 ± 1.3 years. The majority (81%) of the adolescents were attending day classes at public schools. The prevalence of depression was found to be 28% using the patient health questionnaire. Based on the PHQ-9 depression severity scale, 18.5% and 8.2% of the adolescent had moderate and moderate to severe depression while 1.3% had severe depression. In the final multivariate linear regression analysis, it was found that sex, rural residence, low social support, being in higher grade level, and adverse childhood experience were found to be independently associated with a higher score of depression.

CONCLUSION: One in three adolescents was found to have a depressive syndrome. We recommend schools to integrate school mental health service that contains routine screening and intervention services. Moreover, efforts are needed to sensitize and educate the communities on child protection, social support, and safeguarding to effectively tackle the magnitude of adolescent depression.

PMID:33939748 | DOI:10.1371/journal.pone.0250927

PLoS One. 2021 May 3;16(5):e0250641. doi: 10.1371/journal.pone.0250641. eCollection 2021.

ABSTRACT

Instagram has more than one billion monthly users, which presents a unique research opportunity particularly in rare diseases or hard to reach populations. This study focuses on acute myeloid leukaemia, a rare haematological malignancy and aims to characterise who posts acute myeloid leukaemia-related content and the type of content created. The findings can provide information and a method for future studies, particularly those focused on online or social media based interventions. Acute myeloid leukaemia-related Instagram posts were identified by searching specific and relevant hashtags (#). A content analysis systematically classified themes in the data. A convenience sample of 100 posts (138 photos) were manually extracted and coded. Data are described using descriptive statistics and demonstrated by qualitative examples. The most frequent users in our sample were patients (66%), patient support networks (24%) and professional organisations (10%). Patients who were communicating their health update (31%) were the most frequently posted content and 25% of these posts described a symptom experience. Our findings demonstrate that patients and their support networks are frequenting Instagram and therefore may be able to receive and benefit from tailored intervention, however there is an identified gap in health-organisations participating in this virtual online community.

PMID:33939746 | DOI:10.1371/journal.pone.0250641

PLoS One. 2021 May 3;16(5):e0250105. doi: 10.1371/journal.pone.0250105. eCollection 2021.

ABSTRACT

Previous research has shown that behavioural mimicry fosters affiliation, and can be used to infer whether people belong to the same social unit. However, we still know very little about the generalizability of these findings and the individual factors involved. The present study intends to disentangle two important variables and assess their importance for affiliation: the matching in time of the behaviours versus their matching in form. In order to address this issue, we presented participants with short videos in which two actors displayed a set of small movements (e.g. crossing their legs, folding their arms, tapping their fingers) arranged to be either contingent in time or in form. A dark filter was used to eliminate ostensive group marks, such us phenotype or clothing. Participants attributed the highest degree of affiliation to the actors when their subsequent movements matched in form, but were delayed by 4-5 seconds, and the lowest degree when the timing of their movements matched, but they differed in form. To assess the generalizability of our findings, we took our study outside the usual Western context and tested a matching sample of participants from a traditional small-scale society in Kenya. In all, our results suggest that movements are used to judge the degree of affiliation between two individuals in both large- and small-scale societies. While moving in different ways at the same time seems to increase the perceived distance between two individuals, movements which match in form seem to invoke closeness.

PMID:33939734 | DOI:10.1371/journal.pone.0250105

PLoS One. 2021 May 3;16(5):e0250602. doi: 10.1371/journal.pone.0250602. eCollection 2021.

ABSTRACT

OBJECTIVE: We aimed to systematically identify the possible risk factors responsible for severe cases.

METHODS: We searched PubMed, Embase, Web of science and Cochrane Library for epidemiological studies of confirmed COVID-19, which include information about clinical characteristics and severity of patients’ disease. We analyzed the potential associations between clinical characteristics and severe cases.

RESULTS: We identified a total of 41 eligible studies including 21060 patients with COVID-19. Severe cases were potentially associated with advanced age (Standard Mean Difference (SMD) = 1.73, 95% CI: 1.34-2.12), male gender (Odds Ratio (OR) = 1.51, 95% CI:1.33-1.71), obesity (OR = 1.89, 95% CI: 1.44-2.46), history of smoking (OR = 1.40, 95% CI:1.06-1.85), hypertension (OR = 2.42, 95% CI: 2.03-2.88), diabetes (OR = 2.40, 95% CI: 1.98-2.91), coronary heart disease (OR: 2.87, 95% CI: 2.22-3.71), chronic kidney disease (CKD) (OR = 2.97, 95% CI: 1.63-5.41), cerebrovascular disease (OR = 2.47, 95% CI: 1.54-3.97), chronic obstructive pulmonary disease (COPD) (OR = 2.88, 95% CI: 1.89-4.38), malignancy (OR = 2.60, 95% CI: 2.00-3.40), and chronic liver disease (OR = 1.51, 95% CI: 1.06-2.17). Acute respiratory distress syndrome (ARDS) (OR = 39.59, 95% CI: 19.99-78.41), shock (OR = 21.50, 95% CI: 10.49-44.06) and acute kidney injury (AKI) (OR = 8.84, 95% CI: 4.34-18.00) were most likely to prevent recovery. In summary, patients with severe conditions had a higher rate of comorbidities and complications than patients with non-severe conditions.

CONCLUSION: Patients who were male, with advanced age, obesity, a history of smoking, hypertension, diabetes, malignancy, coronary heart disease, hypertension, chronic liver disease, COPD, or CKD are more likely to develop severe COVID-19 symptoms. ARDS, shock and AKI were thought to be the main hinderances to recovery.

PMID:33939733 | DOI:10.1371/journal.pone.0250602

PLoS One. 2021 May 3;16(5):e0250420. doi: 10.1371/journal.pone.0250420. eCollection 2021.

ABSTRACT

INTRODUCTION: Cognitive difficulties and neuropsychological alterations in Duchenne and Becker muscular dystrophy (DMD, BMD) boys are not yet sufficiently explored, although this topic could have a relevant impact, finding novel biomarkers of disease both at genetics and neuroimaging point of view. The current study aims to: 1) analyze the neuropsychological profile of a group of DMD and BMD boys without cognitive impairment with an assessment of their executive functions; 2) explore the structural connectivity in DMD, BMD, and age-matched controls focusing on cortico-subcortical tracts that connect frontal cortex, basal ganglia, and cerebellum via the thalamus; 3) explore possible correlations between altered structural connectivity and clinical neuropsychological measures.

MATERIALS AND METHODS: This pilot study included 15 boys (5 DMD subjects, 5 BMD subjects, and 5 age-matched typically developing, TD). They were assessed using a neuropsychological assessment protocol including cognitive and executive functioning assessment and performed a 1.5T MRI brain exam including advance Diffusion Weighted Imaging (DWI) method for tractography. Structural connectivity measurements were extracted along three specific tracts: Cortico-Ponto-Cerebellar Tract (CPCT), Cerebellar-Thalamic Tract (CTT), and Superior Longitudinal Fasciculus (SLF). Cortical-Spinal Tract (CST) was selected for reference, as control tract.

RESULTS: Regarding intellectual functioning, a major impairment in executive functions compared to the general intellectual functioning was observed both for DMD (mean score = 86.20; SD = 11.54) and for BMD children (mean score = 88; SD = 3.67). Mean FA resulted tendentially always lower in DMD compared to both BMD and TD groups for all the examined tracts. The differences in FA were statistically significant for the right CTT (DMD vs BMD, p = 0.002, and DMD vs TD, p = 0.0015) and the right CPCT (DMD vs TD, p = 0.008). Concerning DMD, significant correlations emerged between FA-R-CTT and intellectual quotients (FIQ, p = 0.044; ρs = 0.821), and executive functions (Denomination Total, p = 0.044, ρs = 0.821; Inhibition Total, p = 0.019, ρs = 0.900). BMD showed a significant correlation between FA-R-CPCT and working memory index (p = 0.007; ρs = 0.949).

DISCUSSION AND CONCLUSION: In this pilot study, despite the limitation of sample size, the findings support the hypothesis of the involvement of a cerebellar-thalamo-cortical loop for the neuropsychological profile of DMD, as the CTT and the CPCT are involved in the network and the related brain structures are known to be implied in executive functions. Our results suggest that altered WM connectivity and reduced fibre organization in cerebellar tracts, probably due to the lack of dystrophin in the brain, may render less efficient some neuropsychological functions in children affected by dystrophinopathies. The wider multicentric study could help to better establish the role of cerebellar connectivity in neuropsychological profile for dystrophinopathies, identifying possible novel diagnostic and prognostic biomarkers.

PMID:33939732 | DOI:10.1371/journal.pone.0250420