Tag: nevin manimala

Transplant Proc. 2025 Mar 17:S0041-1345(25)00151-4. doi: 10.1016/j.transproceed.2025.02.038. Online ahead of print.

ABSTRACT

BACKGROUND: Determining effective ways to make prognostic predictions after kidney transplantation of patients is essential for the management of patients. This study examines how the PNI score affects renal outcomes after kidney transplantation. The potential impact of PNI on renal function beyond the overall nutritional status was also examined.

METHODS: In this retrospective study, 100 kidney transplant patients were divided into three groups according to PNI scores: low (<40), intermediate (40-45) and high (>45). Demographic characteristics, clinical parameters, serum creatinine levels, estimated glomerular filtration rate (eGFR) and parenchymal thickness were evaluated. Logistic regression analysis was applied for the risk of graft rejection. Patients who were followed up for at least 6 months after kidney transplantation and had complete clinical data were included in the study. The mean follow-up period was 36 months (range: 6-60 months).

RESULTS: There was no statistically significant correlation between PNI scores and renal function (P > .05). The mean creatinine level was 1.73 ± 1.11 mg/dL in the low PNI group and 1.37 ± 0.52 mg/dL in the high PNI group. Although this difference was close to the limit of statistical significance, it was not significant (P = .083). In logistic regression analysis, no significant effect of PNI score on graft rejection was observed (OR: 1.0015, 95% CI: 0.7975-1.2576, P = .9899). However, age (OR: 0.9247, P = .0347) and serum creatinine levels (OR: 2.8396, P = .0151) significantly affected the risk of graft rejection. No significant effect of PNI score on complication rates was observed.

CONCLUSIONS: This study demonstrated that PNI score alone is not a sufficient predictor of renal prognosis and graft rejection risk after kidney transplantation. Factors such as age and serum creatinine levels were found to be more predictive of the risk of graft rejection.

PMID:40102127 | DOI:10.1016/j.transproceed.2025.02.038

Ann Rheum Dis. 2025 Mar 17:S0003-4967(25)00240-7. doi: 10.1016/j.ard.2025.02.011. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess construct validity, including known-group discrimination, of the currently available disease activity instruments assessing peripheral arthritis in spondyloarthritis (SpA).

METHODS: In this analysis from the Assessment of SpondyloArthritis International Society (ASAS)-PerSpA study, patients with a diagnosis of axial SpA, peripheral SpA, or psoriatic arthritis (PsA) were included. The disease activity instruments evaluated were the Patient Global Assessment (PGA), Bath Ankylosing Spondylitis Disease Activity Index, Axial Spondyloarthritis Disease Activity Score, Disease Activity Index for PsA (DAPSA), Swollen Joint Count (SJC), Tender Joint Count, Disease Activity Score (DAS) 28, DAS44, and C-reactive protein (CRP). Construct validity was assessed through correlations with external constructs (Bath Ankylosing Spondylitis Functional Index, ASAS Health Index, and Euro Quality of Life 5 Dimensions) and known-group discrimination (active/inactive disease based on a combination of PGA [≥5/<5]), and SJC (≥1/0 and ≥2/<2) was analysed using standardised mean differences (SMDs).

RESULTS: In total, 4121 patients were included (mean age 45 [SD, 14] years, 61% males). When assessing the construct validity through correlations with external constructs, all instruments performed excellently (100% hypotheses confirmed). When assessing known-group discrimination, all disease activity measures, except CRP, presented SMDs ≥ 0.8 (good discrimination), with higher SMDs observed for DAS28 followed by DAPSA. Results were similar across disease phenotypes. Considering all combinations of PGA and SJC to discriminate between active/inactive disease, a better performance was observed for the composite scores, including joint counts.

CONCLUSIONS: In our construct validity analysis, all disease activity instruments assessing peripheral arthritis had a good performance as reflected in the correlations with external constructs and the known-group discrimination. The highest discriminatory capacity to distinguish between ‘active/inactive disease’ was observed for composite scores, including joint counts, like DAS28 and DAPSA.

PMID:40102118 | DOI:10.1016/j.ard.2025.02.011

ISA Trans. 2025 Mar 11:S0019-0578(25)00145-4. doi: 10.1016/j.isatra.2025.03.004. Online ahead of print.

ABSTRACT

Deep learning has significantly advanced bearing fault diagnosis. Traditional models rely on the assumption of independent and identically distributed, which is frequently violated due to variations in rotational speeds and loads during bearing fault diagnosis. The fault diagnosis of the bearing based on representation learning lacks the consideration of spectrum knowledge and representation diversity under multiple working conditions. Therefore, this study presents a domain-invariant representation learning strategy (DIRLs) for diagnosing bearing faults across differing working conditions. DIRLs, by leveraging envelope spectrum knowledge distillation, captures the Fourier characteristics as domain-invariant features and secures robust health state representations by aligning high-order statistics of the samples under different working conditions. Moreover, an innovative loss function, which maximizes the two-paradigm metric of the health state representation, is designed to enrich representation diversity. Experimental results demonstrate an average AUC improvement of 28.6 % on the Paderborn-bearing dataset and an overall diagnostic accuracy of 88.7 % on a private bearing dataset, validating the effectiveness of the proposed method.

PMID:40102111 | DOI:10.1016/j.isatra.2025.03.004

Z Med Phys. 2025 Mar 17:S0939-3889(25)00034-0. doi: 10.1016/j.zemedi.2025.02.004. Online ahead of print.

ABSTRACT

This work demonstrated the development of a fast, deep-learning framework (DeepSMCP) to mitigate noise in Monte Carlo dose distributions (MC-DDs) of photon treatment plans with high statistical uncertainty (SU) and its integration into the Swiss Monte Carlo Plan (SMCP). To this end, a two-channel input (MC-DD and computed tomography (CT) scan) 3D U-net was trained, validated and tested (80%/10%/10%) on high/low-SU MC-DD-pairs of 106 clinically-motivated VMAT arcs for 29 available CTs, augmented to 3074 pairs. The model was integrated into SMCP to enable a “one-click” workflow of calculating and denoising MC-DDs of high SU to obtain MC-DDs of low SU. The model accuracy was evaluated on the test set using Gamma passing rate (2% global, 2 mm, 10% threshold) comparing denoised and low-SU MC-DD. Calculation time for the whole workflow was recorded. Denoised MC-DDs match low-SU MC-DDs with average (standard deviation) Gamma passing rate of 82.9% (4.7%). Additional application of DeepSMCP to 12 unseen clinically-motivated cases of different treatment sites, including treatment sites not present during training, resulted in an average Gamma passing rate of 91.0%. Denoised DDs were obtained on average in 35.1 s, a 340-fold efficiency gain compared to low-SU MC-DD calculation. DeepSMCP presented a first seamlessly integrated promising denoising framework for MC-DDs.

PMID:40102103 | DOI:10.1016/j.zemedi.2025.02.004

Farm Hosp. 2025 Mar 17:S1130-6343(25)00018-2. doi: 10.1016/j.farma.2025.02.011. Online ahead of print.

NO ABSTRACT

PMID:40102084 | DOI:10.1016/j.farma.2025.02.011

Dent Mater. 2025 Mar 18:S0109-5641(25)00287-8. doi: 10.1016/j.dental.2025.03.004. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare the impact of neutral and acidic environments on wear resistance of lithium silicate glass-ceramics (LSGCs), with and without crystallization firing after manufacturing.

MATERIALS AND METHODS: Fifty-six specimens were tested in a two-body wear simulator and divided into seven groups. Four groups consisted of commercially available LSGC materials, each opposed to steatite antagonists. A fifth group included an LSGC material tested additionally in its fired state. A sixth group involved another LSGC material opposed to zirconia antagonists. A seventh group comprised zirconia specimens, opposed to steatite antagonists. All specimens underwent a two-body wear test with 250,000 cycles, a 5 kg load, and 1 mm lateral movement, while immersed in either neutral (pH 7) or acidic (pH 3) buffer solutions. Laser scanning microscopy, optical profilometry, and scanning electron microscopy were used to quantify and/or investigate the wear. Data were analyzed using one-way ANOVA.

RESULTS: LSGC materials exhibited significantly higher wear at pH 7 compared to pH 3 (p < 0.001). The greatest volume loss was observed in an unfired LSGC material (0.138 ± 0.039 mm³ at pH 3 vs. 0.495 ± 0.092 mm³ at pH 7). Steatite antagonists also suffered significantly greater wear at pH 7, with the highest antagonist wear recorded at 1.718 ± 0.068 mm³ . The wear mechanism caused by steatite antagonists differed from zirconia antagonists.

SIGNIFICANCE: Environmental conditions play a major role in the wear performance of LSGCs. Fully crystallized LSGC materials show similar susceptibility to environmental changes compared to LSGC materials requiring crystallization firing.

PMID:40102078 | DOI:10.1016/j.dental.2025.03.004

Womens Health Issues. 2025 Mar 17:S1049-3867(25)00029-5. doi: 10.1016/j.whi.2025.02.004. Online ahead of print.

ABSTRACT

OBJECTIVES: Georgia Title X sites serve over 160,000 patients per year, providing critical contraceptive access. The U.S. Medical Eligibility Criteria and Selected Practice Recommendations for Contraceptive Use (U.S. MEC SPR) are meant to increase contraception access, but few studies have explored U.S. MEC SPR implementation. This qualitative study aimed to understand Georgia Title X providers’ experiences with and attitudes toward U.S. MEC SPR implementation.

STUDY DESIGN: From March 2023 to December 2023, we conducted semi-structured interviews with 20 Georgia Title X providers. Participants also completed a short demographic survey. Transcripts were first assessed using rapid analysis techniques in Google Sheets, then analyzed more thoroughly with a thematic analysis approach in Dedoose. We calculated demographic descriptive statistics using SAS.

RESULTS: The sample was diverse in race but not gender; all participants identified as cisgender women. Interviews revealed that most participants learned about the guidelines in medical or nursing school. Notable benefits of using the U.S. MEC SPR included facilitating patient contraceptive education and building providers’ confidence in their prescribing skills. The only reported challenges were limited user-friendliness and limited information about certain medical conditions in the U.S. MEC. Participants had mixed experiences with clinic leadership prioritizing U.S. MEC SPR use but reported similar perceived patient barriers to care.

CONCLUSIONS: This study suggests that the U.S. MEC SPR can help Title X providers serve clients seeking contraception, but barriers to widespread implementation remain. Efforts to increase guidelines use should consider providers’ needs and preferences along with factors impacting patient access to contraceptive care.

PMID:40102077 | DOI:10.1016/j.whi.2025.02.004

Res Social Adm Pharm. 2025 Mar 6:S1551-7411(25)00072-5. doi: 10.1016/j.sapharm.2025.03.005. Online ahead of print.

ABSTRACT

BACKGROUND: Time to assessment and treatment of atrial fibrillation (AF) is critical for reducing stroke risk. However, Australian data have shown low uptake of timely anticoagulation, with people in regional areas having a greater risk of low uptake compared to people in metropolitan areas.

OBJECTIVE: To conduct a retrospective, mixed methods evaluation of a pharmacist-physician model of care for a rapid access atrial fibrillation (RAAF) clinic in a large regional centre in Victoria, Australia.

METHODS: The RAAF clinic involved telehealth pharmacist appointments and face-to-face physician consults and aimed to see patients within 14 days of referral. A retrospective mixed-methods evaluation was adopted. Quantitative methods included time-based analysis of appointment statistics, analyses of the proportion of patients meeting known quality indicators for risk assessment and treatment for AF. Qualitative analysis included conventional content analysis of patient feedback and net promoter scoring to understand patient acceptability.

RESULTS: There were 312 patients referred to the service during 2022-2023, 274 (88 %) patients participated in 268 pharmacist and 421 physician appointments. Median days from referral to first clinic consultation were 14 (inter quartile range 9-20). Proportion of high-risk patients (CHADSVA >1) who received anticoagulation for stroke prevention increased from 88 % pre-clinic to 97 % post-clinic. Anti-arrhythmic therapies were used by 76 % of patient’s pre-clinic and 73 % post-clinic, with changes to therapy occurring in 35 % of patients. Patients were highly accepting of the service, with a mean patient acceptability score of 9 out of 10. Qualitative analysis illustrated that positive patient experience was linked to clinician performance, as well as the organisational structure and workflow of the clinic itself.

CONCLUSIONS: A pharmacist-physician model of care was successfully implemented in a regional health setting, leading to improved access and medication management, with high levels of patient acceptance.

PMID:40102069 | DOI:10.1016/j.sapharm.2025.03.005

Curr Probl Cancer. 2025 Mar 17:101198. doi: 10.1016/j.currproblcancer.2025.101198. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Naïve non-muscle invasive bladder cancer (NMIBC) is commonly treated with transurethral resection (TURBT), but recurrence and progression remain concerns. This meta-analysis, the first we have conducted on this topic, compared recurrence and progression rates between patients treated with neoadjuvant Mitomycin C (MMC) and the control group (TURBT alone).

METHODS: Relevant articles were identified and appraised through a structured literature assessment. Databases searched included PubMed, Medline, Scopus, and Science Direct. Duplicate publications, book sections, conference papers, encyclopedias, case reports, magazine articles, presentations, theses, protocols, systematic reviews, and meta-analyses were excluded. Heterogeneity was assessed using the I².

KEY FINDINGS AND LIMITATIONS: The meta-analysis evaluated recurrence rates, progression rates, and adverse events. No heterogeneity was observed (I²=0 %). The pooled odd ratio (OR) for recurrence was 2.554 (95 % CI: 1.637-3.986), indicating a significant decrease in recurrence for the MMC group (P < 0.001). For progression rates, the overall pooled OR was 1.508 (95 % CI: 0.832-2.734), suggesting that the MMC group showed a lower progression rate. However, this difference was not statistically significant (P = 0.176).Adverse events varied, with the MMC group showing fewer cases of hematuria (8.4 % vs. 34 %) but more irritative bladder symptoms.

CONCLUSIONS AND CLINICAL IMPLICATIONS: The meta-analysis suggests lower recurrence and progression rates in the neoadjuvant MMC group compared to the control group. Both groups experienced a comparable range of adverse events, suggesting that both treatment approaches exhibit a similar safety profile. Larger and more randomized controlled trials (RCT) are needed to confirm MMC’s effectiveness in NIMBC treatment and establish its role in clinical practice.

PMID:40102068 | DOI:10.1016/j.currproblcancer.2025.101198

BMJ Open Qual. 2025 Mar 18;14(1):e003122. doi: 10.1136/bmjoq-2024-003122.

ABSTRACT

BACKGROUND: Violence and aggression (V&A) are commonplace on mental-health wards and may lead to restrictive practice interventions (RPI), having a detrimental impact on patients and staff. In the 12 months preceding this quality improvement (QI) project, there was a mean V&A incidence of 52.7±113.0 and RPI of 37.6±84.1 per 1000 bed days.

METHODS: Using QI methodology, a project involving creative practitioners was codeveloped to provide a range of activities delivered via a 7-day service, across 13 inpatient mental-health wards in five hospital settings, using levels of V&A and RPI as outcome measures. The creative practices used drew on successful projects arising from a linked charity, Creative Minds. Three plan-do-study-act cycles were completed. (1) Coproduction with ward staff, patients and creative practitioners of 4-week session plans, including an induction training package for creative practitioners. (2) Streamlined and centralised communication between creative practitioners and participating wards using a project coordinator. (3) Implementation of a creative-practitioner Rota to better support ward activity planning, staff and patient expectation setting.

RESULTS: During the 12-month project wards with creative practitioners experienced statistically significant reduction in V&A levels (F (1, 168)=5.72, p=0.017) and RPI (F (1, 168)=8.40, p=0.0042). Wards not involved in the project, V&A levels (F (1, 142) =3.34, p<0.069) and RPI (F (132, 142)=0.99, p=0.52) remained unchanged. Ward length-of-stay was used as a balancing measure with no difference pre 45.0±4.9 days and post 46.9±5.0 days intervention (p=0.18). At the project peak, creative practitioners delivered around 300 hours per week of creative activity, which appears to be associated with reduced number of V&A/RPI incidents.

CONCLUSIONS: Recommendations for the project’s next steps are to secure sustained funding for creative practitioners to further enhance patients/staff well-being, as well as the coproduction of a creative-practitioner implementation guide to be tested in other mental-health inpatient settings as a part of a research study to better understand the impact of the type/timing of activities (ie, day/evening/weekends) on important patient outcomes and staff well-being.

PMID:40102040 | DOI:10.1136/bmjoq-2024-003122