Nevin Manimala

Pain Pract. 2021 Jul 3. doi: 10.1111/papr.13055. Online ahead of print.

ABSTRACT

The objective of this prospective, multicenter study is to characterize responses to percutaneous medial branch peripheral nerve stimulation (PNS) to determine if results from earlier, smaller single-center studies and reports were generalizable when performed at a larger number and wider variety of centers in patients recalcitrant to non-surgical treatments. Participants with chronic axial low back pain were implanted with percutaneous PNS leads targeting the lumbar medial branch nerves for up to 60 days, after which the leads were removed. Participants were followed long-term for 12 months after the 2-month PNS treatment. Data collection is complete for visits through end of treatment with PNS (Primary Endpoint) and 6 months after lead removal (8 months after start of treatment), with some participant follow-up visits thereafter in progress. Clinically and statistically significant reductions in pain intensity, disability, and pain interference were reported by a majority of participants. Seventy-three percent of participants were successes for the Primary Endpoint, reporting clinically significant (≥30%) reductions in back pain intensity after the 2-month percutaneous PNS treatment (n=54/74). While prospective follow up is ongoing, among those who had already completed the long-term follow up visits (n=51), reductions in pain intensity, disability, and pain interference were sustained in a majority of participants through 14 months after the start of treatment. Given the minimally invasive, non-destructive nature of percutaneous PNS and the significant benefits experienced by participants who were recalcitrant to non-surgical treatments, percutaneous PNS may provide a promising first-line neurostimulation treatment option for patients with chronic axial back pain.

PMID:34216103 | DOI:10.1111/papr.13055

Diabetes Metab Res Rev. 2021 Jul 3:e3482. doi: 10.1002/dmrr.3482. Online ahead of print.

ABSTRACT

AIMS: The study aimed to elucidate the effects of rare genetic variants on the risk of type 2 diabetes (T2D).

MATERIALS AND METHODS: Weighted burden analysis of rare variants was applied to a sample of 200,000 exome-sequenced participants in the UK Biobank project, of whom over 13,000 were identified as having T2D. Variant weights were allocated based on allele frequency and predicted effect, as informed by a previous analysis of hyperlipidaemia.

RESULTS: There was an exome-wide significant increased burden of rare, functional variants in three genes, GCK, HNF4A and GIGYF1. GIGYF1 has not previously been identified as a diabetes risk gene and its product appears to be involved in the modification of insulin signalling. A number of other genes did not attain exome-wide significance but were highly ranked and potentially of interest, including ALAD, PPARG, GYG1 and GHRL. Loss of function (LOF) variants were associated with T2D in GCK and GIGYF1 whereas nonsynonymous variants annotated as probably damaging were associated in GCK and HNF4A. Overall, fewer than 1% of T2D cases carried one of these variants. In HNF1A and HNF1B there was an excess of LOF variants among cases but the small numbers of these fell short of statistical significance.

CONCLUSIONS: Rare genetic variants make an identifiable contribution to T2D in a small number of cases but these may provide valuable insights into disease mechanisms. As larger samples become available it is likely that additional genetic factors will be identified. This research has been conducted using the UK Biobank Resource. This article is protected by copyright. All rights reserved.

PMID:34216101 | DOI:10.1002/dmrr.3482

Health Econ. 2021 Jul 2. doi: 10.1002/hec.4372. Online ahead of print.

ABSTRACT

Prior to the Affordable Care Act (ACA), insurance companies could charge higher premiums, or outright deny coverage, to people with preexisting health problems. But the ACA’s “guaranteed issue” provision forbids such price discrimination and denials of coverage. This paper seeks to determine whether, after implementation of the ACA, nongroup private insurance plans have experienced adverse selection. Our empirical approach employs a copula-based hurdle regression model, with dependence modeled as a function of dimensions along which adverse selection might occur. Our main finding is that, after implementation of the ACA, nongroup insurance enrollees with preexisting health problems do not appear to exhibit adverse selection. This finding suggests that the ACA’s mandate that everyone acquire coverage might have attracted enough healthy enrollees to offset any adverse selection.

PMID:34216065 | DOI:10.1002/hec.4372

J Aquat Anim Health. 2021 Jul 2. doi: 10.1002/aah.10130. Online ahead of print.

ABSTRACT

In this case study, phage therapy was applied to treat a multidrug-resistant case of septicemic cutaneous ulcerative disease (SCUD) caused by Citrobacter freundii in a loggerhead sea turtle Caretta caretta. Phages were applied topically, intravenously, into the carapace, and into the exhibit water using various phage cocktails specific to the causative agent over an 8-month period. This was performed in conjunction with antimicrobial therapy. The animal was monitored through weekly cultures, photographs, and complete blood cell counts, as well as immune assays (phagocytosis, plasma lysozyme and superoxide dismutase activity, and plasma electrophoresis profiles). The animal, in comparison to an untreated, unaffected control, had elevated antibody titers to the administered phages, which persisted for at least 35 weeks. Although cultures were clear of C. freundii after phage treatment, the infection did return over time and immune assays confirmed deficiencies when compared to a healthy loggerhead sea turtle. Immune parameters with statistically significant changes over the study period included the following: decreased phagocytosis, increased alpha- and gamma-globulin protein components, and an increased albumin : globulin ratio. When C. freundii appeared again, the multidrug-resistant status had reverted back to normal susceptibility patterns. Although not completely known whether it was another subspecies of bacteria, the therapy did resolve the multidrug-resistant challenge. Phage therapy in combination with antimicrobial agents may be an effective treatment for sea turtles with normally functioning immune systems or less-severe infections. Additional research is needed to better understand and quantify sea turtle immunology.

PMID:34216060 | DOI:10.1002/aah.10130

Int J Geriatr Psychiatry. 2021 Jul 3. doi: 10.1002/gps.5596. Online ahead of print.

ABSTRACT

OBJECTIVES: The Covid-19 pandemic has had a significant impact on older adults mental health care. Our study aimed to explore staff perspectives on key challenges and innovations in order to help inform the delivery of older adults mental health care in subsequent waves of the pandemic.

METHODS: A mixed methods online questionnaire developed by NIHR Mental Health Policy Research Unit (PRU) was used to gather staff perspectives on their challenges at work, problems faced by service users and their carers, and sources of help and support. Descriptive statistics were used for quantitative analysis and descriptive content analysis for qualitative analysis.

RESULTS: 158 participants, working in either community or inpatient settings, and from a range of professional disciplines, were included. For inpatient staff, a significant challenge was infection control. In the community, staff identified a lack of access to physical and social care as well as reduced contact with friends and families as being challenges for patients. Remote working was seen as a positive innovation along with Covid-19 related guidance from various sources and peer support.

CONCLUSION: Our study, with a focus on staff and patient well-being, helps to inform service development for future waves of the pandemic. We discuss measures to improve infection control in inpatient settings, the role of voluntary organisations in supporting socially isolated community patients, the need for better integration of physical and mental health services at an organisational level, and the importance of training staff to support patients and their families with end of life planning. This article is protected by copyright. All rights reserved.

PMID:34216045 | DOI:10.1002/gps.5596

Perspect Psychiatr Care. 2021 Jul 2. doi: 10.1111/ppc.12898. Online ahead of print.

ABSTRACT

PURPOSE: This study was carried out to determine the effect of mindfulness levels on the life satisfaction of nursing students.

DESIGN AND METHODS: A descriptive correlational study was conducted on 333 nursing students enrolled at a state university in Turkey.

FINDINGS: The statistical analysis of the data indicated that students’ mindfulness levels had a significantly positive impact on their satisfaction with life.

IMPLICATIONS FOR PRACTICE: Activities that include exercises, meditation and training geared to raise the level of mindfulness can also be beneficial in terms of increasing satisfaction with life.

PMID:34216042 | DOI:10.1111/ppc.12898

Stat Med. 2021 Jul 2. doi: 10.1002/sim.9127. Online ahead of print.

ABSTRACT

We propose a ridge-penalized adaptive Mantel test (AdaMant) for evaluating the association of two high-dimensional sets of features. By introducing a ridge penalty, AdaMant tests the association across many metrics simultaneously. We demonstrate how ridge penalization bridges Euclidean and Mahalanobis distances and their corresponding linear models from the perspective of association measurement and testing. This result is not only theoretically interesting but also has important implications in penalized hypothesis testing, especially in high-dimensional settings such as imaging genetics. Applying the proposed method to an imaging genetic study of visual working memory in healthy adults, we identified interesting associations of brain connectivity (measured by electroencephalogram coherence) with selected genetic features.

PMID:34216035 | DOI:10.1002/sim.9127

J Dent Educ. 2021 Jul 2. doi: 10.1002/jdd.12736. Online ahead of print.

ABSTRACT

PURPOSE/OBJECTIVES: To assess student perceptions on learning dental anatomy using natural extracted teeth, 3D printed models, 3D virtual models, and augmented reality (AR) technology. METHODS: Eighty first-year dental students enrolled in the dental anatomy course were instructed to examine four stations. The stations included four versions of a mandibular first molar: an extracted natural tooth, a 3D printed model, a 3D virtual model, and a model displayed on a novel AR device. After examining all stations, the students were asked to complete an electronic survey. Bivariate analysis was performed to determine whether students’ perceptions are related to their demographic characteristics and technological experience with computer use, 3D modeling, and video games. RESULTS: Seventy students completed the survey (87.5% response rate). Students rated natural teeth to have the highest educational value, the 3D printed tooth to be the most accessible, and the AR application to be the most interesting modality. Students who played little to no video games were more likely to rate AR as high educational value (48.8% vs. 10.3%; p < 0.001), while students with little 3D modeling experience were more likely to rate high accessibility of the 3D Model (78.1% vs. 48.3%; p < 0.001). No statistically significant associations between the perceptions and students’ demographic characteristics or use of computer were noted.

CONCLUSION: The natural extracted tooth was rated highest in educational value, while the 3D printed model was rated easiest to use, and the AR model was the most interesting to the students.

PMID:34216032 | DOI:10.1002/jdd.12736

J Community Genet. 2021 Jul 2. doi: 10.1007/s12687-021-00534-3. Online ahead of print.

ABSTRACT

The aim of the study was to provide accurate information regarding live-born infant survival after diagnosis of fatal fetal anomaly (FFA) to aid decision-making in respect of pregnancy management, and to ascertain the natural history of live-born infants with FFAs via a retrospective analysis of death records (2006-2018), from the National Paediatric Mortality Registry (source Central Statistics Office 2019). Diagnoses and survival times were ascertained from narrative records with further ascertainment and reconciliation of trisomies 13 and 18 cases by review of cytogenetic test records, the National Death Events Register and National Perinatal Epidemiology Centre data. During the study period, termination of pregnancy was not permitted under the Irish Constitution. Patients are live-born babies with fatal fetal anomalies whose deaths were registered in the Republic of Ireland. The main outcome measure was construction of anomaly-specific survival curves, or survival time range and median for those anomalies with rare occurrence. Survival curves for anencephaly, bilateral renal agenesis, thanatophoric dysplasia, trisomy 13, and trisomy 18 show that 90% (n = 95), 93% (n = 60), 100% (n = 14), 37% (n = 92) and 33% (n = 162), respectively, were deceased by 24 h and 98%, 100%, 100%, 73%, and 53%, respectively, by 1 week post-delivery. Survival time range and median were calculated for triploidy (3.5 h-20 days; 10.5 days), whose occurrence was rare. Anhydramnios, craniorachischisis, hydranencephaly and severe hydrocephalus were extremely rare and all deaths were neonatal deaths. Our results provide 13 years of national natural history data of live birth FFA survival. This provides objective information to aid obstetric counselling of couples upon diagnosis of an FFA.

PMID:34215991 | DOI:10.1007/s12687-021-00534-3

Environ Sci Pollut Res Int. 2021 Jul 2. doi: 10.1007/s11356-021-15074-z. Online ahead of print.

ABSTRACT

In the twenty-first century, the increasing demand for electrical and electronic equipment (EEE) has caused its quick update and the shortening of its service life span. As a consequence, a large number of waste electrical and electronic equipment (WEEE) needs to be processed and recycled. As an environmentally friendly method, biometallurgy has received extensive attention in the disposal of WEEE in recent years. Aspergillus niger is an acid-producing fungus with a potential applicability to improve metals’ recycling efficiency. This review article describes the latest statistical status of WEEE and presents the latest progress of various metallurgical methods involved in WEEE recycling for metal recovery. Moreover, based on the summary and comparison towards studies have been reported for bioleaching metals from WEEE by A. niger, the bioleaching mechanisms and the bioleaching methods are explained, as well as the effects of process parameters on the performance of the bioleaching process are also discussed. Some insights and perspectives are provided for A. niger to be applied to industrial processing scale.

PMID:34215982 | DOI:10.1007/s11356-021-15074-z