Tag: nevin manimala

Learn Mem. 2024 Mar 25;31(3):a053901. doi: 10.1101/lm.053901.123. Print 2024 Mar.

ABSTRACT

From early in life, we encounter both controllable environments, in which our actions can causally influence the reward outcomes we experience, and uncontrollable environments, in which they cannot. Environmental controllability is theoretically proposed to organize our behavior. In controllable contexts, we can learn to proactively select instrumental actions that bring about desired outcomes. In uncontrollable environments, Pavlovian learning enables hard-wired, reflexive reactions to anticipated, motivationally salient events, providing “default” behavioral responses. Previous studies characterizing the balance between Pavlovian and instrumental learning systems across development have yielded divergent findings, with some studies observing heightened expression of Pavlovian learning during adolescence and others observing a reduced influence of Pavlovian learning during this developmental stage. In this study, we aimed to investigate whether a theoretical model of controllability-dependent arbitration between learning systems might explain these seemingly divergent findings in the developmental literature, with the specific hypothesis that adolescents’ action selection might be particularly sensitive to environmental controllability. To test this hypothesis, 90 participants, aged 8-27, performed a probabilistic-learning task that enables estimation of Pavlovian influence on instrumental learning, across both controllable and uncontrollable conditions. We fit participants’ data with a reinforcement-learning model in which controllability inferences adaptively modulate the dominance of Pavlovian versus instrumental control. Relative to children and adults, adolescents exhibited greater flexibility in calibrating the expression of Pavlovian bias to the degree of environmental controllability. These findings suggest that sensitivity to environmental reward statistics that organize motivated behavior may be heightened during adolescence.

PMID:38527752 | DOI:10.1101/lm.053901.123

CMAJ. 2024 Mar 24;196(11):E369-E376. doi: 10.1503/cmaj.231166.

ABSTRACT

BACKGROUND: Physician work hours directly influence patient access to health care services and play a vital role in physician human resource planning. We sought to evaluate long-term trends in hours worked by physicians in Canada, overall and by subgroup.

METHODS: We used Statistics Canada’s Labour Force Survey to identify physicians via occupation and industry coding information. We estimated descriptive statistics and performed graphical analysis of the average weekly hours worked by physicians over the 1987-2021 period.

RESULTS: Overall, weekly physician work hours remained stable from 1987 until 1997, after which they declined. Average weekly hours decreased by 6.9 hours (p < 0.001), from 52.8 in 1987-1991 to 45.9 in 2017-2021. Among male physicians, work hours declined notably after 1997, while those of female physicians remained relatively stable at around 45 per week. Hours worked by married physicians declined significantly, amounting to 7.4 fewer hours per week (p = 0.001). In contrast, unmarried physicians displayed a statistically insignificant decline of 2.2 hours (p = 0.3). The COVID-19 pandemic was associated with a sharp but brief disruption in weekly hours; by the end of 2020, physicians’ work hours had returned to prepandemic levels.

INTERPRETATION: These findings may indicate a long-term shift in work preferences among Canadian physicians; male physicians may be seeking a better work-life balance, which, in turn, has narrowed the gap in hours worked by sex, with potential implications for pay equity. Policymakers and planners should carefully consider changes in hours worked, rather than just the total number of physicians, to ensure an accurate evaluation of the physician workforce.

PMID:38527745 | DOI:10.1503/cmaj.231166

J Nutr. 2024 Mar 23:S0022-3166(24)00165-2. doi: 10.1016/j.tjnut.2024.03.016. Online ahead of print.

ABSTRACT

INTRODUCTION: In Canada, nutrition policy as outlined in the Nutrition for Healthy Term Infants recommendations, includes a daily vitamin D supplement of 10 μg (400 IU) for breastfed infants and young children to support adequate vitamin D status.

OBJECTIVES: To report on adherence to vitamin D supplementation recommendations for breastfed infants (≤12 months); and for children breastfed >12 months.

METHODS: Canadian Community Health Survey (paired-cycles 2015/2016 and 2017/2018) maternal experiences data for infants born 2012-2018 who received any breastmilk formed the sample (n=7079). Whether the infant was given a vitamin D supplement (yes/no), and the frequency (daily/almost everyday, 1-2/week, or <1/week) were surveyed. Weighted data (95%CI) were summarized according to breastfeeding history (exclusive to 6 months and continuing; partial to 6 months and continuing; stopped ≤6 months). Correlates of supplement adherence were explored using logistic regression.

RESULTS: Overall, 87.1% (95%CI: 85.9, 88.3) of participants reported giving their infant (≤12 months) a vitamin D supplement, and of these 83.3% (95%CI: 81.9, 84.7) did so daily/almost everyday, 12.4% (95%CI: 11.1, 13.7) did so 1-2/week, and 4.3% (95%CI: 3.6, 5.0) did so <1/week. Lower adjusted odds of adherence were observed among participants reporting: stopped breastfeeding ≤6 months, lower education or income, recent immigration, and overweight pre-pregnancy body mass index; higher odds of adherence were observed in the western provinces. Mothers of children >12 months and breastfed (n=2312), 58.0% (95%CI: 54.9, 61.1) gave a vitamin D supplement daily/almost everyday.

CONCLUSION: Adherence to providing a vitamin D supplement to breastfed infants is high in Canada. Nonetheless, we estimate that ∼27% of mothers are non-adherent to daily/almost everyday administration of a vitamin D supplement; and that adherence declines in children breastfed >12 months. Further promotion to support uptake of the current guidance may be necessary, particularly for parents of recent immigration or lower socioeconomic status.

PMID:38527736 | DOI:10.1016/j.tjnut.2024.03.016

Nurs Womens Health. 2024 Mar 22:S1751-4851(24)00046-1. doi: 10.1016/j.nwh.2024.01.004. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the knowledge and perceptions of midwifery students regarding a midwifery-led model of care.

DESIGN: Cross-sectional study.

SETTING: A nursing college in North Karnataka, India. The midwifery-led care model is a relatively new concept in India. In 2018, guidelines on midwifery services in India were released during the Partners Forum held in New Delhi as the initiation of the model and with the support of the Ministry of Health and Family Welfare. The initiative began with the training of nurse practitioners in midwifery and is progressing.

PARTICIPANTS: Final-year diploma and bachelor’s degree students.

METHODS: Participants completed an online survey, which consisted of a 20-item questionnaire with a 5-point Likert scale to collect their knowledge and perceptions of the midwifery-led model of care. Descriptive statistics were used to describe the knowledge and perceptions of the students, including the mean, standard deviation, frequency, and percentage. Chi-square analysis and the Pearson’s correlation coefficient were used to assess relationships between variables of interest.

RESULTS: Among the 165 participants, 85.5% (n = 141) had a poor level of knowledge of the midwifery-led care model, and only 14.5% (n = 24) showed average knowledge, with none possessing adequate knowledge. Notably, gender was significantly associated with knowledge (p < .05), with female participants demonstrating lower knowledge levels compared to male participants. A substantial portion (76.4%, n = 126) had a negative perception of the midwifery-led care model, 23.6% (n = 39) had a neutral perception, and none had a positive perception. There was no significant correlation between students’ knowledge and perceptions of the midwifery-led model of care.

CONCLUSION: These results suggest that there is an urgent need for awareness, knowledge, and educational initiatives to help nursing students in India better comprehend the midwifery-led model of care and to strengthen the midwifery training in nursing colleges.

PMID:38527734 | DOI:10.1016/j.nwh.2024.01.004

J Am Pharm Assoc (2003). 2024 Mar 23:102076. doi: 10.1016/j.japh.2024.102076. Online ahead of print.

ABSTRACT

BACKGROUND: Transitions of care (TOC) is the coordination and continuity of healthcare as a patient transfers between different settings.¹ This can include a wide range of services, such as medication reconciliation, patient counseling, bedside delivery of medications, and others that meet individual patient needs.² In the pediatric population, patients are at increased risk of potential medication errors and subsequent harm due to reduced patient and/or caregiver health literacy, limited dosage form availability, and errors in medication administration.⁵ The use of TOC services at the time of hospital discharge in this population has the potential to make a positive impact on patient safety and the treatment of medical conditions.

OBJECTIVES: The primary objective of this study was to determine if patient-perceived understanding of home-going medications was greater in patients and/or caregivers that received medication bedside delivery and education from a pharmacy-led TOC service at a large, pediatric academic medical center. The secondary objective was to determine if the primary practice area of the pharmacist providing medication education led to changes in understanding of home-going medication(s).

METHODS: Using institution-wide, patient satisfaction surveys from January 1, 2021, through December 31, 2021, patient and/or caregiver responses were queried for two questions about home-going medications, relating to the understanding of administration and the potential side effects. Patients were divided into two groups depending on TOC services received, as documented in the electronic medical record (EMR). Survey responses for each of the two questions were categorized as top-box percentage by study group. Hypothesis testing between study groups for the primary and secondary outcomes were conducted using chi-squared tests at an alpha of 0.05. Statistical analyses were conducted using SAS version 9.4.

RESULTS: Of the 1,159 patients included in the study, 441 received TOC services, deemed the intervention group, and 718 did not receive TOC services, deemed the control group. When the intervention and control group were asked about understanding of medication administration, 96.37% versus 93.18% (p=0.007) of patients gave the most favorable response of “yes, definitely,” respectively. Further, 78.51% versus 77.44% (p=0.053) of patients gave the most favorable response when asked about understanding potential medication side effects, respectively.

CONCLUSION: Patients receiving TOC services by a member of the pharmacy team had a greater score for understanding of both medication administration and side effects. Furthermore, this greater score was consistent among the education provided by the inpatient and outpatient pharmacist.

PMID:38527733 | DOI:10.1016/j.japh.2024.102076

Rev Esp Med Nucl Imagen Mol (Engl Ed). 2024 Mar 23:500002. doi: 10.1016/j.remnie.2024.500002. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of our study was to evaluate the contribution of 18Fluorine-Fluorodeoxyglucose Positron Emission Tomography (18F-FDG PET) radiomic data obtained from both the tumoral and peritumoral area in predicting pathological complete response (pCR) in patients with locally advanced breast cancer receiving neoadjuvant chemotherapy (NAC).

METHODS: Female patients with a diagnosis of invasive ductal carcinoma who received NAC were evaluated retrospectively. The volume of interest (VOI) of the primary tumor (VOI-_T) was manually segmented, then a voxel-thick VOI was added around VOI-_T to define the peritumoral area (VOI-_PT). Morphological, intensity-based, histogram and texture parameters were obtained from VOIs. The patients were divided into two groups as pCR and non-complete pathological response (npCR). A “radiomic model” was created with only radiomic features, and a “patho-radiomic model” was created using radiomic features and immunohistochemical data.

RESULTS: Of the 66 patients included in the study, 21 were in the pCR group. The only statistically significant feature from the primary tumor among patients with pCR and npCR was Morphological_Compacity-_T (AUC: 0.666). Between response groups, a significant difference was detected in 2 morphological, 1 intensity, 4 texture features from VOI-_PT; no correlation was found between Morphological_Compacity-_PT and NGTDM_contrast-_PT. The obtained radiomic model’s sensitivity and accuracy values were calculated as 61.9% and 75.8%, respectively (AUC: 0.786). When HER2 status was added, sensitivity and accuracy values of the patho-radiomic model increased to 85.7% and 81.8%, respectively (AUC: 0.903).

CONCLUSIONS: Evaluation of PET peritumoral radiomic features together with the primary tumor, rather than just the primary tumor, provides a better prediction of the pCR to NAC in patients with breast cancer.

PMID:38527731 | DOI:10.1016/j.remnie.2024.500002

J Oral Maxillofac Surg. 2024 Mar 9:S0278-2391(24)00132-0. doi: 10.1016/j.joms.2024.03.001. Online ahead of print.

ABSTRACT

BACKGROUND: Artificial Intelligence, by answering questions about disease prevention strategies, can contribute to making diseases more treatable in their early stages.

PURPOSE: This study aims to evaluate the quality of patient information by assessing the responses of the Chat Generative Pretrained Transformer (ChatGPT, Open AI, USA) artificial intelligence model to questions related to medication-related osteonecrosis of the jaw (MRONJ).

STUDY DESIGN, SETTING, SAMPLE: The study was prospective cross-sectional design. The study was conducted within the Department of Oral and Maxillofacial Surgery. The study’s questions were prepared by an experienced oral and maxillofacial surgeon and directed to the artificial intelligence platform. The responses were evaluated by oral and maxillofacial surgeons using the Global Quality Scale (GQS).

PREDICTOR VARIABLE: The predictor variable is question type. A total of 120 questions were categorized into six groups, which encompassed general information about MRONJ (Group 1), queries from patients about to initiate medication therapy (Group 2), questions from patients currently undergoing medication treatment (Group 3), inquiries from patients who had completed medication usage (Group 4), general treatment-related information (Group 5), and case scenarios (Group 6).

MAIN OUTCOME VARIABLES: The main variable is the GQS score. The GQS rates the quality of information and its utility for the patients. The scores are as follows: Score 1: Poor quality, Score 2: Generally poor quality, Score 3: Moderate quality, Score 4: Good quality, Score 5: Excellent quality.

COVARIATES: Not applicable.

ANALYSES: Kruskal-Wallis and Mann-Whitney U tests were applied for intragroup and intergroup analyses. The statistical significance level was determined as P < .05 and P < .01.

RESULTS: The average score for all questions was calculated to be 3.9 ± 0.8, which is above the “moderate quality” threshold. Group 1 had a mean score of 3.4 ± 1.1; group 2 had 4.1 ± 0.7; group 3 had 3.8 ± 0.8; group 4 had 4.3 ± 0.6; group 5 had 4.2 ± 0.7; and group 6 had 4.1 ± 0.5. The variations in mean scores among these groups did not exhibit statistical significance (P > .05).

CONCLUSION AND RELEVANCE: The artificial intelligence model has generated responses of moderate quality to questions about MRONJ. The use of the artificial intelligence platform may assist in patients gaining a fundamental understanding of MRONJ.

PMID:38527729 | DOI:10.1016/j.joms.2024.03.001

J Oral Maxillofac Surg. 2024 Mar 6:S0278-2391(24)00133-2. doi: 10.1016/j.joms.2024.03.002. Online ahead of print.

ABSTRACT

BACKGROUND: Though the epidemiology of craniomaxillofacial (CMF) fractures has been well documented at urban hospitals, the characteristics of these fractures in rural hospitals have not been well studied.

PURPOSE: The purpose of this study is to report on the epidemiology of CMF fractures at a regional Level 1 trauma center serving a large rural population in central Illinois.

STUDY DESIGN, SETTING, SAMPLE: This is a retrospective cohort study at a community-based regional tertiary referral center that serves a predominantly rural population. Inclusion criteria comprised patients with radiologically confirmed CMF fractures between 2015 and 2019. Patients with incomplete medical records were excluded.

PREDICTOR VARIABLE: Predictor variables included demographics (age, admission source, race, and sex) and etiology of CMF fracture (assault/domestic violence, all-terrain vehicle/off-road, falls, farm-related, motor vehicle collisions, gunshot wound, and others).

MAIN OUTCOME VARIABLE: The primary outcome variable was the CMF anatomic location including nasal bone, orbit, mandible, malar/maxillary, and other CMF fractures.

COVARIATES: The covariates are not applicable.

ANALYSES: Descriptive statistics were used to summarize a sample of the population characteristics. Wilcoxon ranked sign tests and χ² tests of independence were used to assess for statistically significant associations between select variables of interest. Statistical significance was defined as P < .05.

RESULTS: Between 2015 and 2019, a total of 2,334 patients presented to the emergency department with a CMF fracture. After applying the inclusion/exclusion criteria, the final sample was composed of 1,844 patients for the management of 2,405 CMF fractures. The majority of patients were male(62.0%) and young adults (aged 18-39) had the highest number of CMF fractures (819) relative to all other age groups. The most common fracture etiology was fall(37.3%), and nasal bone fractures represented the most common fracture location(41.6%). χ² analyses revealed statistically significant associations between the anatomic location of CMF fracture incurred, and differing categories of age, admission source, race, sex, and etiology.

CONCLUSION AND RELEVANCE: Our study shows that patients seen at our Midwestern Level 1 trauma center are more likely to present with nasal bone and malar/maxillary fractures due to falls. In studies based in urban centers, patients are likely to present with orbital and mandibular fractures due to falls and assault.

PMID:38527728 | DOI:10.1016/j.joms.2024.03.002

J Oral Maxillofac Surg. 2024 Mar 7:S0278-2391(24)00134-4. doi: 10.1016/j.joms.2024.03.003. Online ahead of print.

ABSTRACT

BACKGROUND: Vascularized fibula free flap (VFFF) remains gold standard for reconstruction of bony defects of the maxilla or mandible. Research and publications in recent years essentially focused on the evolution and improvement of the recipient reconstructed area but very few concerning the donor site morbidity.

PURPOSE: The aim of this study was to analyze walking ability of patients following VFFF operation and to determine if there are long term walking disabilities.

STUDY DESIGN, SETTING, SAMPLE: The retrospective cohort study involved healthy controls and patients who had undergone VFFF between 2012 and 2019 at the oral and maxillo-facial department of the University Hospital in Lausanne, Switzerland. Patients with cardiovascular, pulmonary, neuromuscular or musculoskeletal pathologies that could impair walking were excluded from the study.

PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: Primary predictor is the reconstruction status, VFFF versus healthy patients (controls).

MAIN OUTCOME VARIABLES: Main outcomes were gait parameters. Objective evaluation of walking abilities was assessed using the Gait up system (Gait Up SA, EPFL Innov’Park-C, Lausanne, Switzerland), which are wearable motion sensors that provides 3D analytics of the gait.

COVARIATES: Covariates implied patient characteristics such as age, sex, time after surgery and subjective evaluation of the gait obtained with two orthopedic validated questionnaires.

RESULTS: This study implied 10 healthy controls and 11 patients who had undergone VFFF. Results showed statistically significant differences in the speed [m/s] (1.3 vs 1.1 for a P value of .001), the stride length [m] (1.4 vs 1.2 for a P value of 0.003), the flat foot phase [%] (55.0 vs 63.3 for a P value of .006) and the pushing phase [%] (34.1 vs 25.1 for a P value of .008).

CONCLUSION AND RELEVANCE: Reconstruction using vascularized autograft in maxillofacial surgery is substantial and well described. Our attention focusing on donor site morbidity has demonstrated subjective and objective long-term alterations. These results will have to be confirmed with gait analysis in a prospective project including preoperative and postoperative analysis of the gait of the patient acting himself as his own control, with a larger scale of patients.

PMID:38527727 | DOI:10.1016/j.joms.2024.03.003

Environ Res. 2024 Mar 23:118764. doi: 10.1016/j.envres.2024.118764. Online ahead of print.

ABSTRACT

The primary aim of this research is to comprehensively assess the applicability of chitosan biopolymer towards water treatment application and to enhance its adsorption capacity towards Remazol brilliant blue R-19 dye. This has been achieved through physical modification to obtain the material in hydrogel form and chemical modification by crosslinking it with barbituric acid. The characterization of the resulting Chitosan-barbituric acid hydrogel (CBH) was carried out using various analytical techniques such as SEM-EDX, FT-IR, TGA-DTA, XRD, and BET. CBH was employed as the adsorbent to eliminate R-19 dye from aqueous media. Utilizing response surface methodology (RSM), the parameters were fine-tuned, leading to the achievement of more than a 95% removal for R-19 dye. The adsorption behavior closely adhered to the Langmuir isotherm and pseudo-second-order kinetics. An interesting observation indicated that the rise in temperature leads to rise in adsorption capacity of CBH. The maximum adsorption capacities evaluated at 301.15 K, 313.15 K, 318.15 K, and 323.15 K were 566.6 mg g^-1, 624.7 mg g^-1, 671.3 mg g^-1, and 713.5 mg g^-1 respectively, in accordance with the Langmuir isotherm model. Examining the thermodynamics of the adsorption process revealed its spontaneous nature (ΔG = -21.14 to -27.09 kJ mol^-1) across the entire temperature range. Furthermore, the assessment of the isosteric heat of adsorption (ΔH_ads) was conducted using the Clausius-Clapeyron equation, with results indicating an increase in ΔH_ads from 1.85 to 2.16 kJ mol^-1 with temperature rise from 301.15 K to 323.15 K due to augmented surface loading. This suggested the existence of lateral interactions between the adsorbed dye molecules. The potential of adsorbent for regeneration was investigated, demonstrating the ability to reuse the material. Sustainability parameter calculated for synthesis process reflected a notably low E-factor value of 0.32 demonstrated the synthesis is environment friendly.

PMID:38527722 | DOI:10.1016/j.envres.2024.118764