Nevin Manimala

Br J Gen Pract. 2020 Dec 9:bjgp20X713489. doi: 10.3399/bjgp20X713489. Online ahead of print.

ABSTRACT

BACKGROUND: For some common cancers, survival is lower in the UK than in comparable high-income countries.

AIM: To assess the effectiveness of a targeted postal intervention (to promote awareness of cancer symptoms and earlier help seeking) on patient consultation rates.

DESIGN AND SETTING: A two-arm randomised controlled trial was carried out on patients aged 50-84 years registered at 23 general practices in rural and urban areas of Greater London, Greater Manchester, and the North East of England.

METHOD: Patients who had not had a consultation at their general practice in the previous 12 months and had at least two other risk factors for late presentation with cancer were randomised to intervention and control arms. The intervention consisted of a posted letter and leaflet. Primary outcome was the number of consultations at the practice with patients randomised to each arm in the 6 months subsequent to posting the intervention. All patients with outcome data were included in the intention-to-treat analyses.

RESULTS: In total, 1513 patients were individually randomised to the intervention (n = 783) and control (n = 730) arms between Nov 2016 – May 2017; outcome data were available for 749 and 705 patients, respectively, with a statistically significantly higher rate of consultation in the intervention arm compared with the control arm: 436 versus 335 consultations (relative risk 1.40, 95% confidence interval = 1.11 to 1.77, P = 0.004). There was, however, no difference in the numbers of patients consulting.

CONCLUSION: Targeted interventions of this nature can change behaviour; there is a need to develop interventions that can be more effective at engaging patients with primary care. This study demonstrates that targeted interventions promoting both awareness of possible cancer symptoms and earlier health seeking, can change behaviour. There is a need to develop and test interventions that can be more effective at engaging the most at-risk patients.

PMID:33875418 | DOI:10.3399/bjgp20X713489

Cogn Sci. 2021 Apr;45(4):e12972. doi: 10.1111/cogs.12972.

ABSTRACT

A fundamental question in the study of human cognition is how people learn to predict the category membership of an example from its properties. Leading approaches account for a wide range of data in terms of comparison to stored examples, abstractions capturing statistical regularities, or logical rules. Across three experiments, participants learned a category structure in a low-dimension, continuous-valued space consisting of regularly alternating regions of class membership (A B A B). The dependent measure was generalization performance for novel items outside the range of the training space. Human learners often extended the alternation pattern–a finding of critical interest given that leading theories of categorization based on similarity or dimensional rules fail to predict this behavior. In addition, we provide novel theoretical interpretations of the observed phenomenon.

PMID:33873244 | DOI:10.1111/cogs.12972

J Am Acad Audiol. 2021 Apr 19. doi: 10.1055/s-0041-1723039. Online ahead of print.

ABSTRACT

BACKGROUND: How significant asymmetries in otolith organ function in the presence of symmetrical and asymmetrical semicircular canal function influence skull vibration-induced nystagmus testing (SVINT) has not been well described.

PURPOSE: The aim of the study is to examine the agreement between SVINT and caloric testing, ocular vestibular-evoked myogenic potentials (oVEMP), and cervical vestibular-evoked myogenic potentials (cVEMP) for detecting asymmetric vestibular function.

RESEARCH DESIGN: This is a retrospective study of patients presenting with the chief complaint of vertigo, dizziness, or imbalance.

STUDY SAMPLE: A total of 812 patients were studied with a median age at testing of 59 years (interquartile range 46-70; range 18-93) and included 475 (59%) women.

INTERVENTION: Either the monothermal warm caloric test or alternate binaural bithermal caloric test, oVEMP, and cVEMP tests were administered to all patients. All patients underwent the SVINT prior to vestibular laboratory testing.

DATA COLLECTION AND ANALYSIS: Agreement between tests categorized as normal versus abnormal was summarized using percent concordance (PC). Sensitivity and specificity values were calculated for SVINT compared with other tests of vestibular function.

RESULTS: There was higher agreement between ipsilateral and contralateral SVINT with the caloric test (PC = 80% and 81%, respectively) compared with oVEMP (PC = 63% and 64%, respectively) and cVEMP (PC = 76% and 78%, respectively). Ipsilateral and contralateral SVINT showed higher sensitivity for the caloric test (sensitivity = 47% and 36%, respectively) compared with oVEMP (sensitivity = 26% and 21%, respectively), or cVEMP (sensitivity = 33% vs. 27%, respectively). Specificity of SVINT was high (>80%) for all assessments of vestibular function.

CONCLUSION: The presence of SVIN is a useful indicator of the asymmetry of vestibular function between the two ears when making judgments about semicircular canal asymmetry but is less sensitive to asymmetries in otolith organ function.

PMID:33873220 | DOI:10.1055/s-0041-1723039

J Am Acad Audiol. 2021 Apr 19. doi: 10.1055/s-0041-1722983. Online ahead of print.

ABSTRACT

BACKGROUND: Temporal resolution is essential to speech acoustic perception. However, it may alter in individuals with auditory disorders, impairing the development of spoken and written language. The envelope of speech signals contains amplitude modulation (AM) that has critical information. Any problem reducing the listener’s sensitivity to these amplitude variations (auditory temporal acuity) is likely to cause speech comprehension problems. The modulation detection threshold (MDT) test is a measure for evaluating temporal resolution. However, this test cannot be used for patients with poor cooperation; therefore, objective evaluation of MDT is essential.

PURPOSE: The main aim of this study is to find the association between the auditory steady-state response (ASSR) and psychoacoustic measurement of MDT at different intensity levels and to assess the amplitude and phase of ASSR as a function of modulation depth.

DESIGN: This was a correlational research.

STUDY SAMPLE: Eighteen individuals (nine males and nine females) with normal hearing sensitivity, aged between 18 and 23 years, participated in this study.

DATA COLLECTION AND ANALYSIS: ASSR was recorded at fixed AM rates and variable AM depths for carrier frequencies of 1,000 and 2,000 Hz with varying intensities. The least AM depth, efficient to evoke an ASSR response, was interpreted as the physiological detection threshold of AM. The ASSR amplitude and phase, as a function of AM depth, were also evaluated at an intensity level of 60 dB hearing level (HL) with modulation rates of 40 and 100 Hz. Moreover, the Natus instrument (Biologic Systems) was used for the electrophysiological measurements. An AC40 clinical audiometer (Intra-acoustic, Denmark) was also used for the psychoacoustic measurement of MDT in a similar setting to ASSR, using the two-alternative forced choice method. Pearson’s correlation test and linear regression model and paired t-test were used for statistical analyses.

RESULTS: A significant positive correlation was found between psychoacoustic and electrophysiological measurements at a carrier frequency of 1000 Hz, with a modulation rate of 40 Hz at intensity levels of 60 dB HL (r = 0.63, p = 0.004), 50 dB HL (r = 0.52, p = 0.02). A significant positive correlation was also found at a carrier frequency of 2000 Hz, with a modulation rate of 47 Hz at 60 dB HL (r = 0.55, p = 0.01) and 50 dB HL (r = 0.67, p = 0.002) and a modulation rate of 97 Hz at 60 dB HL (r = 0.65, p = 0.003). Moreover, a significant association was found between the modulation depth and ASSR amplitude and phase increment at carrier frequencies of 1,000 and 2000 Hz, with modulation rates of 40 and 100 Hz.

CONCLUSION: There was a significant correlation between ASSR and behavioral measurement of MDT, even at low intensities with low modulation rates of 40 and 47 Hz. The ASSR amplitude and phase increment was a function of modulation depth increase. The findings of this study can be used as a basis for evaluating the relationship between two approaches in the clinical population.

PMID:33873218 | DOI:10.1055/s-0041-1722983

Adv Nutr. 2021 Apr 19:nmab037. doi: 10.1093/advances/nmab037. Online ahead of print.

ABSTRACT

Numerous observational studies have investigated the role of the Dietary Inflammatory Index (DII®) in chronic disease risk. The aims of this umbrella review and integrated meta-analyses were to systematically synthesize the observational evidence reporting on the associations between the DII and health outcomes based on meta-analyses, and to assess the quality and strength of the evidence for each associated outcome. This umbrella review with integrated meta-analyses investigated the association between the DII and a range of health outcomes based on meta-analyses of observational data. A credibility assessment was conducted for each outcome using the following criteria: statistical heterogeneity, 95% prediction intervals, evidence for small-study effect and/or excess significance bias, as well as effect sizes and P values using calculated random effects meta-analyses. In total, 15 meta-analyses reporting on 38 chronic disease-related outcomes were included, incorporating a total population of 4,360,111 subjects. Outcomes (n = 38) were examined through various study designs including case-control (n = 8), cross-sectional (n = 5), prospective (n = 5), and combination (n = 20) study designs. Adherence to a pro-inflammatory dietary pattern had a significant positive association with 27 (71%) of the included health outcomes (P value < 0.05). Using the credibility assessment, Class I (Convincing) evidence was identified for myocardial infarction only, Class II (Highly suggestive) evidence was identified for increased risk of all-cause mortality, overall risk of incident cancer, and risk of incident site-specific cancers (colorectal, pancreatic, respiratory, and oral cancers) with increasing (more pro-inflammatory) DII score. Most outcomes (n = 31) presented Class III (Suggestive) or lower evidence (Weak or No association). Pro-inflammatory dietary patterns were nominally associated with an increased risk of many chronic disease outcomes. However, the strength of evidence for most outcomes was limited. Further prospective studies are required to improve the precision of the effect size.

PMID:33873204 | DOI:10.1093/advances/nmab037

Urol Int. 2021 Apr 19:1-6. doi: 10.1159/000515652. Online ahead of print.

ABSTRACT

INTRODUCTION: The aim of our study is to evaluate the predictive factors affecting the success of treatment with nephrectomy in patients with poorly functioning kidney and nephrogenic hypertension.

METHODS: Data for patients who underwent nephrectomy with a diagnosis of nephrogenic hypertension in 3 centers between May 2010 and January 2020 were analyzed. In the postoperative period, if the blood pressure (BP) was below 140/90 mm Hg without medical treatment, it was accepted as complete response; if the arterial BP was below 140/90 mm Hg with medical treatment or less medication, it was accepted as partial response; and if BP did not decrease to normal values, it was accepted as unresponsive. Demographic characteristics, duration of hypertension, preoperative and postoperative BP values, and presence of metabolic syndrome were statistically evaluated.

RESULTS: Our study consisted of 91 patients with a mean preoperative hypertension duration of 23.3 ± 12.1 months. Among patients, 42 (46.2%) had complete response, 18 (19.8%) had partial response, and 31 (34.0%) had no response. Preoperative systolic and diastolic BP values were not effective on treatment success (p = 0.071, p = 0.973, respectively), but the increase in age and hypertension duration (p = 0.030 and p < 0.001, respectively) and the presence of metabolic syndrome (p = 0.002) significantly decreased the complete response rates.

CONCLUSIONS: Preoperative hypertension duration, advanced age, and presence of metabolic syndrome are predictive factors affecting the response to treatment in patients who undergo nephrectomy due to nephrogenic hypertension.

PMID:33873196 | DOI:10.1159/000515652

J Neural Eng. 2021 Apr 19. doi: 10.1088/1741-2552/abf97c. Online ahead of print.

ABSTRACT

OBJECTIVE: Transcranial photobiomodulation (tPBM) is a recently proposed non-invasive brain stimulation approach with various effects on the nervous system from the cells to the whole brain networks. Specially in the neural network level, tPBM may alter the topology and synchronizability of functional brain networks. However, the functional properties of the neural networks after tPBM are still poorly clarified.

APPROACH: Here, we employed electroencephalography (EEG) and different methods (conventional and spectral) in the graph theory analysis to track the significant effects of tPBM on the resting state brain networks. The non-parametric statistical analysis showed that just one short-term tPBM session over right medial frontal pole can significantly change both topological (i.e., clustering coefficient, global efficiency, local efficiency, eigenvector centrality) and dynamical (i.e., energy, largest eigenvalue, and entropy) features of resting state brain networks.

MAIN RESULTS: The topological results revealed that tPBM can reduce local processing, centrality, and laterality. Furthermore, the increased centrality of central electrode (Cz) was observed.

SIGNIFICANCE: These results suggested that tPBM may alter topology of resting state brain network to facilitate the neural information processing. However, the reduction of local processing after tPBM can be assumed as a negative point for this approach. On the other hand, the dynamical results showed that tPBM reduced stability of synchronizability but increased complexity in the resting state brain networks. These effects can be considered in association with the increased complexity of connectivity patterns among brain regions and the enhanced information propagation in the resting state brain networks. Overall, both topological and dynamical features of brain networks suggest that although tPBM decreases local processing and disrupts synchronizability of network, but it can increase the level of information transferring and processing in the brain network.

PMID:33873167 | DOI:10.1088/1741-2552/abf97c

Accid Anal Prev. 2021 Apr 16;156:106141. doi: 10.1016/j.aap.2021.106141. Online ahead of print.

ABSTRACT

Drivers age 65 and over have higher rates of crashes and crash-related fatalities than other adult drivers and are especially over-represented in crashes during left turns at intersections. This research investigated the use of SHRP2 Naturalistic Driving Study (NDS) data to assess infrastructure and other factors contributing to left turn crashes at signalized intersections, and how to improve older driver safety during such turns. NDS data for trips involving signalized intersections and crash or near-crash events were obtained for two driver age groups: drivers age 65 and over (older drivers) and a sample of drivers age 30-49, along with NDS pre-screening and questionnaire data. Video scoring of all trips was performed to collect additional information on intersection and trip conditions. To identify the most influential factors of crash risk during left turns at signalized intersections, machine learning and regression models were used. The results found that in the obtained NDS dataset, there was a relatively small volume of crashes during left turns at signalized intersections. Further, model results found the statistically significant variables of crash risk for older drivers were associated more with health and cognitive factors rather than the infrastructure or design of the intersections. The results suggest that a study using only SHRP2 NDS data will not lead to definitive findings or recommendations for infrastructure changes to increase safety for older drivers at signalized intersections and during left turns. Moreover, the findings of this study indicates the need to consider other data sources and data collection methods to address this critical literature gap in older driver safety.

PMID:33873135 | DOI:10.1016/j.aap.2021.106141

Clin Neurol Neurosurg. 2021 Apr 1;205:106626. doi: 10.1016/j.clineuro.2021.106626. Online ahead of print.

ABSTRACT

OBJECTIVE: A pragmatic tool for the early and reliable prediction of recovery in patients with acute ischemic stroke is needed. We aimed to test the addition of brain eloquent areas involvement in variables predicting poor outcome, using a simple scoring system.

METHODS: Retrospective study of patients with anterior circulation acute ischemic stroke treated with best medical treatment and/or endovascular reperfusion. Primary outcome measure was 3-months poor outcome (mRs 3-6). We developed a prognostic model based on clinical data and a quantitative scoring system of the main eloquent brain areas involved on early follow-up CT, and analyzed its accuracy to predict poor outcome comparatively to three other prognostic models. The final model was used to develop a score for outcome prediction based on the multivariable analysis.

RESULTS: A total of 197 patients were included (poor outcome = 62; mean age 67 ± 15.1 years; 44% females). Independent predictors of poor outcome were increasing age (p < 0.001), baseline NIHSS (p = 0.03), and the involvement of two brain areas: posterior limb of internal capsule (p < 0.001) and postero-superior corona radiata (p < 0.001). This model showed to be the most accurate to predict poor outcome (Balance Accuracy = 77.74%; C-Statistic = 0.891). The derived risk score attributing points for each of these variables (EASY score) showed similar performances (Balance Accuracy = 82.11%; C-Statistic = 0.90).

CONCLUSION: The EASY score is an easy-to-apply and accurate tool to predict the 3-months functional outcome after ischemic stroke, relying on simple clinical features and the assessment of two key eloquent brain areas on early follow-up CT.

PMID:33873121 | DOI:10.1016/j.clineuro.2021.106626

Phys Life Rev. 2021 Apr 14;37:100-102. doi: 10.1016/j.plrev.2021.04.003. Online ahead of print.

NO ABSTRACT

PMID:33873119 | DOI:10.1016/j.plrev.2021.04.003