Nevin Manimala

J Nurs Scholarsh. 2021 Apr 20. doi: 10.1111/jnu.12649. Online ahead of print.

ABSTRACT

PURPOSE: To identify which patient and hospital characteristics are related to nurse staffing levels in acute care hospital settings.

DESIGN: A cross-sectional design was used for this study.

METHODS: The sample comprised 1,004 patients across 10 hospitals in the Andalucian Health Care System (southern Spain) in 2015. The sampling was carried out in a stratified, consecutive manner on the basis of (a) hospital size by geographical location, (b) type of hospital unit, and (c) patients’ sex and age group. Random criteria were used to select patients based on their user identification in the electronic health record system. The variables were grouped into two categories, patient and hospital characteristics. Multilevel linear regression models (MLMs) with random intercepts were used. Two models were fitted: the first was the null model, which contained no explanatory variables except the intercepts (fixed and random), and the second (explanatory) model included selected independent variables. Independent variables were allowed to enter the explanatory model if their univariate association with the nurse staffing level in the MLM was significant at p < .05.

RESULTS: Two hierarchical levels were established to control variance (patients and hospital). The model variables explained 63.4% of the variance at level 1 (patients) and 71.8% at level 2 (hospital). Statistically significant factors were the type of hospital unit (p = .002), shift (p < .001), and season (p < .001). None of the variables associated with patient characteristics obtained statistical significance in the model.

CONCLUSIONS: Nurse staffing levels were associated with hospital characteristics rather than patient characteristics.

CLINICAL RELEVANCE: This study provides evidence about factors that impact on nurse staffing levels in the settings studied. Further studies should determine the influence of patient characteristics in determining optimal nurse staffing levels.

PMID:33876892 | DOI:10.1111/jnu.12649

Stem Cells Transl Med. 2021 Apr 20. doi: 10.1002/sctm.20-0330. Online ahead of print.

ABSTRACT

We previously demonstrated the safety and feasibility of mesenchymal stem cell (MSC) transplantation for bronchopulmonary dysplasia (BPD) in preterm infants in a phase I clinical trial. We thus investigated the therapeutic efficacy of MSCs for BPD in premature infants. A phase II double-blind, randomized, placebo-controlled clinical trial was conducted on preterm infants at 23 to 28 gestational weeks (GW) receiving mechanical ventilator support with respiratory deterioration between postnatal days 5 and 14. Infants were stratified by 23 to 24 GW and 25 to 28 GW and randomly allocated (1:1) to receive stem cells (1 × 10⁷ cells/kg, n = 33) or placebo (n = 33). Although the inflammatory cytokines in the tracheal aspirate fluid were significantly reduced with MSCs, the primary outcome of death or severe/moderate BPD in the control group (18/33, 55%) was not significantly improved with MSC transplantation (17/33, 52%). In the subgroup analysis, the secondary outcome of severe BPD was significantly improved from 53% (8/15) to 19% (3/16) with MSC transplantation in the 23 to 24 GW group but not in the 25 to 28 GW subgroup. In summary, although MSC transplantation might be safe and feasible, this small study was underpowered to detect its therapeutic efficacy in preterm infants at 23 to 28 GW. Accordingly, we are now conducting an additional larger and controlled phase II clinical trial focusing on infants at 23 to 24 GW (NCT03392467). ClinicalTrials.gov identifier: NCT01828957.

PMID:33876883 | DOI:10.1002/sctm.20-0330

Australas J Ageing. 2021 Apr 20. doi: 10.1111/ajag.12951. Online ahead of print.

ABSTRACT

OBJECTIVE: To summarise frailty measures and outcomes reported in trials involving frail older inpatients.

METHODS: Databases were searched for randomised controlled trials enrolling frail older inpatients.

RESULTS: Twenty-four articles describing twelve trials were included. Seven trials applied six tools to measure frailty, whilst five trials employed ad hoc measures. Eighty outcomes were examined with survival and functional status reported most commonly. Nine studies trialled multidisciplinary, geriatrician-led interventions. Statistically significant between-group differences were detected for at least one outcome in ten trials. All studies represented high risk of bias within at least one domain.

CONCLUSIONS: Heterogeneity of interventions, measurement of frailty and outcomes reported limit generalisability of findings. Many articles purport to study frail patients, yet do not enrol patients using any frailty measurement tool. Utilising validated instruments to measure frailty and a standard set of health outcomes relevant to older people would assist consistent reporting and evaluation of future studies.

PMID:33876880 | DOI:10.1111/ajag.12951

Acta Paediatr. 2021 Apr 20. doi: 10.1111/apa.15881. Online ahead of print.

ABSTRACT

AIM: Treatment of childhood obesity is often insufficient and may be aggravated by high co-occurrence of attention-deficit/hyperactivity disorder (ADHD). We aimed to investigate whether children with overweight or obesity normalised in weight when receiving stimulant treatment for ADHD.

METHODS: Growth data of 118 children were obtained from medical records at outpatient paediatric and children’s psychiatric services in the Gothenburg area, Sweden. The children were diagnosed with ADHD and were between 6-17 years at the start of stimulant treatment. The pre-treatment data act as an internal control where every child is their own control.

RESULTS: At the start of treatment 74 children had normal weight and 44 had either overweight or obesity. During the year with stimulants, the mean (SD) body mass index (BMI) in standard deviation score (SDS) decreased significantly: -0.72 (0.66) compared to 0.17 (0.43) during the year before treatment (p<0.01). After one year with treatment 43% of those with overweight or obesity had reached normal weight.

CONCLUSIONS: Stimulant treatment for ADHD yield significant weight loss. In children with overweight or obesity and ADHD, this is an important finding showing additional benefit in terms of weight management.

PMID:33876865 | DOI:10.1111/apa.15881

J Prosthodont. 2021 Apr 20. doi: 10.1111/jopr.13366. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the trueness and precision of virtual facebow records using a smartphone as a 3D face scanner.

MATERIAL AND METHODS: Twenty repeated virtual facebow records were performed on two subjects using a smartphone as a 3D face scanner. For each subject, a virtual facebow was attached to his/her maxillary arch, and a face scan was performed using a smartphone with a 3D scan application. The subject’s maxillary arch intraoral scan was aligned to the face scan by the virtual facebow fork. This procedure was repeated 10 times for each subject. To investigate if the maxillary scan is located at the right position to the face, these virtual facebow records were superimposed to a cone-beam computed tomography (CBCT) head scan from the same subject by matching the face scan to the face 3D reconstruction from CBCT images. The location of maxillary arch in virtual facebow records was compared with its position in CBCT. The “trueness” of the proposed procedure is defined as the deviation between maxilla arch position in virtual facebow records and the CBCT images. The “precision” is defined as the deviation between each virtual facebow record. The linear deviation at left central incisor (#9), left first molar (#14), and right first molar (#3), as well as angular deviation of occlusal plane were analyzed with descriptive statistics. Differences between two objects were also explored with Mann Whitney U test.

RESULTS: The 20 virtual facebow records using the smartphone 3D scanner deviated from the CBCT measurements (trueness) by 1.14 ±0.40 mm at #9, 1.20 ±0.50 mm at #14, 1.12 ±0.51 mm at the #3, and 1.48 ±0.56° in the occlusal plane. The VFTs deviated from each other by 1.06 ±0.50 mm at #9, 1.09 ±0.49 mm at #14, 1.11 ±0.58 mm at #3, and 0.81 ±0.58° in the occlusal plane. When all sites combined, the trueness was 1.14 ±0.40 mm, and the precision was 1.08 ±0.52 mm. Out of eight measurements, three measurements were significantly different between subjects. Nevertheless, the mean difference was small.

CONCLUSIONS: Virtual facebow records made using smartphone-based face scan can capture the maxilla position with high trueness and precision. The deviation can be anticipated as around 1 mm in linear distance and 1° in angulation. This article is protected by copyright. All rights reserved.

PMID:33876857 | DOI:10.1111/jopr.13366

J Cosmet Dermatol. 2021 Apr 20. doi: 10.1111/jocd.14163. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the effectiveness of injection of autologous keratin gel and fibroblast for static forehead rhytides rectification as new soft tissue filler.

MATERIALS AND METHODS: Totally 48 volunteers suffering static forehead rhytides received the injection of autologous keratin and fibroblast and 6 volunteers received botulinum toxin type A (BTX-A) and hyaluronic acid(HA) treatment as parallel control. The follow-up study was carried out 1,3, 6, 12 and 24 months after treatment, photographs and satisfactions questionnaire were collected and assessed. All volunteers were independently assessed by blinded evaluators using global aesthetic improvement scores(GAIS). One-way-Anova was used for statistical analysis, and the significant level was α=0.05).

RESULTS: The static forehead rhytides was improved observably after the treatment. It still showed good result even at month 24 after the injection. There is no severe adverse effects observed in the whole procedure.

CONCLUSION: Autologous fibroblast and keratin combined injection might be an ideal therapy in mini-invasiveplastic injection area, which is safe and effective for static forehead rhytides correction, and has a long-term efficacy.

PMID:33876856 | DOI:10.1111/jocd.14163

Chemistry. 2021 Apr 20. doi: 10.1002/chem.202100922. Online ahead of print.

ABSTRACT

Heavy-atom-free sensitizers forming long-living triplet excited states via the spin-orbit charge transfer intersystem crossing (SOCT-ISC) process have potential to replace transition metal complexes in photonic applications. The efficiency of SOCT-ISC in BODIPY donor-acceptor dyads can be tuned by structural modification. Predicting the triplet state yields and reactive oxygen species generation quantum yields in a particular solvent is challenging due to a lack of quantitative structure-property relationship (QSPR) models. We analyzed data on 1 O 2 generation quantum yields (Φ Δ ) for >70 heavy-atom-free BODIPY in toluene, acetonitrile, and THF. To build reliable QSPR models, we synthesized new BODIPYs containing different electron donating groups, studied their optical and structural properties and the solvent dependence of 1 O2 , which confirmed the formation of triplet states via SOCT-ISC. More than 5000 quantum-chemical descriptors were calculated including descriptors using DFT, namely M06-2X functional. QSPR models predicting ΦΔ values were developed using multiple linear regression (MLR), which perform significantly better than other machine learning methods and show sufficient statistical parameters (R = 0.88 ̶ 0.91 and q 2 = 0.62 ̶ 0.69) for all three solvents. A small root mean squared error of 8.2% was obtained for ΦΔ values predicted using MLR model in toluene. QSPR and machine learning techniques can be useful for predicting ΦΔ values in different media and virtual screening of new heavy-atom-free BODIPYs with improved photosensitizing ability.

PMID:33876842 | DOI:10.1002/chem.202100922

Biometrics. 2021 Apr 20. doi: 10.1111/biom.13476. Online ahead of print.

ABSTRACT

In many studies, related individuals are phenotyped in order to infer how their genotype contributes to their phenotype, through the estimation of parameters such as breeding values or locus effects. When it is not possible to phenotype all the individuals, it is important to properly sample the population to improve the precision of the statistical analysis. This article studies how to optimize such sampling designs for pedigrees and association studies. Two sampling methods are developed, stratified sampling and D optimality. It is found that it is important to take account of mutation when sampling pedigrees with many generations: as the size of mutation effects increases, optimized designs sample more individuals in late generations. Optimized designs for association studies tend to improve the joint estimation of breeding values and locus effects, all the more as sample size is low and the genetic architecture of the trait is simple. When the trait is determined by few loci, they are reminiscent of classical experimental designs for regression models and tend to select homozygous individuals. When the trait is determined by many loci, locus effects may be difficult to estimate, even if an optimized design is used.

PMID:33876835 | DOI:10.1111/biom.13476

Pain Med. 2021 Apr 20:pnab144. doi: 10.1093/pm/pnab144. Online ahead of print.

ABSTRACT

OBJECTIVE: Pain catastrophizing is an important psychological predictor of pain. Recent evidence suggests the relationship between catastrophizing and pain intensity could be bidirectional, but most studies have been conducted on chronic pain patients and using criticized statistical methods. The present study aimed to examine if the relationship between pain intensity and catastrophizing was bidirectional in the context of childbirth.

METHODS: A total of 504 women without chronic pain were recruited on their 32-37 gestational week. They completed measures of catastrophizing and pain intensity on the first encounter and then again at 1, 3, and 6 months postpartum. The temporal relationship between the variables was assessed using a random intercept cross-lagged panel model.

RESULTS: The hypothesis of reciprocal association did not receive support, as pain intensity predicted catastrophizing during the postpartum period, but catastrophizing did not show an effect over pain intensity at any moment.

CONCLUSIONS: Pain intensity predicting catastrophizing is consistent with previous literature, while the lack of effect of catastrophizing over pain intensity is an unexpected result, which may suggest that catastrophizing plays a different role in the postpartum period. These results highlight the importance of timely efforts for pain management during the postpartum period and contribute to the theoretical conceptualization of catastrophizing.

PMID:33876826 | DOI:10.1093/pm/pnab144

Sci Rep. 2021 Apr 19;11(1):8435. doi: 10.1038/s41598-021-87713-x.

ABSTRACT

Expansion of COVID-19 worldwide increases interest in unraveling genomic variations of novel SARS-CoV-2 virus. Metadata of 408,493 SARS-CoV-2 genomes submitted to GISAID database were analyzed with respect to genomic clades and their geographic, age, and gender distributions. Of the currently known SARS-CoV-2 clades, clade GR was the most prevalent worldwide followed by GV then GH. Chronological analysis revealed expansion in SARS-CoV-2 clades carrying D614G mutations with the predominance of the newest clade, GV, in the last three months. D614G clades prevail in countries with more COVID-19 cases. Of them, the clades GH and GR were more frequently recovered from severe or deceased COVID-19 cases. In contrast, G and GV clades showed a significantly higher prevalence among asymptomatic patients or those with mild disease. Metadata analysis showed higher (p < 0.05) prevalence of severe/deceased cases among males than females and predominance of GR clade in female patients. Furthermore, severe disease/death was more prevalent (p < 0.05) in elderly than in adults/children. Higher prevalence of the GV clade in children compared to other age groups was also evident. These findings uniquely provide a statistical evidence on the adaptation-driven evolution of SARS-CoV-2 leading to altered infectivity, virulence, and mortality.

PMID:33875719 | DOI:10.1038/s41598-021-87713-x