Tag: nevin manimala

Artif Intell Med. 2023 Oct;144:102644. doi: 10.1016/j.artmed.2023.102644. Epub 2023 Sep 1.

ABSTRACT

The proliferation of wearable devices has allowed the collection of electrocardiogram (ECG) recordings daily to monitor heart rhythm and rate. For example, 24-hour Holter monitors, cardiac patches, and smartwatches are widely used for ECG gathering and application. An automatic atrial fibrillation (AF) detector is required for timely ECG interpretation. Deep learning models can accurately identify AFs if large amounts of annotated data are available for model training. However, it is impractical to request sufficient labels for ECG recordings for an individual patient to train a personalized model. We propose a Siamese-network-based approach for transfer learning to address this issue. A pre-trained Siamese convolutional neural network is created by comparing two labeled ECG segments from the same patient. We sampled 30-second ECG segments with a 50% overlapping window from the ECG recordings of patients in the MIT-BIH Atrial Fibrillation Database. Subsequently, we independently detected the occurrence of AF in each patient in the Long-Term AF Database. By fine-tuning the model with the 1, 3, 5, 7, 9, or 11 ECG segments ranging from 30 to 180 s, our method achieved macro-F1 scores of 96.84%, 96.91%, 96.97%, 97.02%, 97.05%, and 97.07%, respectively.

PMID:37783539 | DOI:10.1016/j.artmed.2023.102644

Artif Intell Med. 2023 Oct;144:102666. doi: 10.1016/j.artmed.2023.102666. Epub 2023 Sep 20.

ABSTRACT

The COVID-19 pandemic highlights the need for effective and non-intrusive methods to monitor the well-being of elderly individuals in their homes, especially for early detection of potential viral infections. Conspicuously, the present paper develops a Multi-scaled Long Short Term Memory (Ms-LSTM) model for the routine health monitoring of elderly patients to detect COVID-19. The proposed method offers home-based health diagnostics through urine analysis by leveraging the IoT-Fog-Cloud paradigm. Mainly, the proposed model constitutes a four-layered architecture: data acquisition, fog layer, cloud layer, and interface layer. Each layer serves distinct functionalities and provides specific services, thereby collectively enhancing the overall effectiveness of the model. The statistical results of the study demonstrate the superior performance of the proposed Ms-LSTM model in comparison to state-of-the-art methods, including Artificial Neural Networks (ANN), K-Nearest Neighbors (K-NN), Support Vector Machine (SVM), Random Forest, and LSTM. Further, the proposed model attains a mean temporal efficiency of 39.23 seconds. It exhibits high reliability (92.97%), stability (70.06%), and predictive accuracy (93.25%).

PMID:37783534 | DOI:10.1016/j.artmed.2023.102666

BMJ Open Qual. 2023 Sep;12(Suppl 2):e002242. doi: 10.1136/bmjoq-2022-002242.

ABSTRACT

BACKGROUND: Neck of femur fractures are common with associated high morbidity and mortality rates. National standards include provision of orthogeriatric care to any patient with a hip fracture. This study assessed the outcomes at 5 years following implementation of a collaborative orthogeriatric service at Southland Hospital in 2012.

METHODS: Retrospective data were collected for patients aged 65 years and older admitted with a fragility hip fracture. Data were collated for 2011 (preimplementation) and 2017 (postimplementation). Demographic data and American Society of Anesthesiologists (ASA) scores were recorded to ensure comparability of the patient groups. Length of stay, postoperative complications and 30-day and 1-year mortality were assessed.

RESULTS: 74 admissions with mean age at surgery of 84.2 years in 2011 and 107 admissions with mean age of 82.6 years in 2017. There was a higher proportion of ASA 2 and ASA 3 patients in 2017 compared with 2011 (p=0.036). The median length of stay in the orthopaedic ward was unchanged in the two cohorts but there was a shorter median length of stay by 6.5 days and mean length of stay by 11 days in 2017 in the rehabilitation ward (p<0.001 for both median and mean). Through logistic regression controlling for age, sex and ASA score, there was a reduction in the odds of having a complication by 12% (p<0.001). The study was too small to undertake statistical testing to calculate significant difference in overall 30-day and 1-year mortality between the groups.

CONCLUSION: The orthogeriatric service has reduced the frequency of complications and length of stay on the rehabilitation ward 5 years following implementation.

PMID:37783522 | DOI:10.1136/bmjoq-2022-002242

BMJ Open Qual. 2023 Sep;12(Suppl 2):e002303. doi: 10.1136/bmjoq-2023-002303.

ABSTRACT

Osteoporosis is a global health concern and a major contributor to worldwide mortality rates. Vertebral fractures due to osteoporosis are common and often undetected. Since vertebral fractures are often missed, evidence and guidelines suggest that vertebral fracture assessment (VFA) may optimise current approaches to bone density tests. We aimed to integrate VFA into an Australian Fracture Liaison Service (FLS) and measure the impact it had on osteoporosis treatment initiation.A retrospective case note review was undertaken to determine the number of clinic patients receiving VFA before the change in practice. Proctor’s seven domains of implementation strategy were used to facilitate quality improvement outcomes.The percentage of eligible patients receiving a routine VFA at the FLS imaging centre increased from 0% to 90%. The remaining 10% of patients did not receive a scan due to the patient not being able to assume the correct position, skilled staff being unavailable to perform the scan, or the patient declining. Post implementation, almost half (41%) of patients who underwent a VFA displayed abnormalities and 16 (4%) of these recorded a normal bone measure density score but abnormal VFA. Despite the successful adoption of the new screening protocol, there was no statistically significant increase in treatment initiation rates for patients with normal bone mass density scores.The FLS successfully integrated routine VFA into the osteoporosis care pathway. However, the introduction of VFA did not significantly increase treatment initiation. It may be more effective to offer VFAs to a proportion of patients based on a tailored approach rather than offering them routinely to all patients who access the FLS.

PMID:37783515 | DOI:10.1136/bmjoq-2023-002303

Br J Gen Pract. 2023 Jun 6:BJGP.2022.0150. doi: 10.3399/BJGP.2022.0150. Online ahead of print.

ABSTRACT

BACKGROUND: Technological advances have led to the use of patient portals that give people digital access to their personal health information. The NHS App was launched in January 2019 as a ‘front door’ to digitally enabled health services.

AIM: To evaluate patterns of uptake of the NHS App, subgroup differences in registration, and the impact of COVID-19.

DESIGN AND SETTING: An observational study using monthly NHS App user data at general-practice level in England was conducted.

METHOD: Descriptive statistics and time-series analysis explored monthly NHS App use from January 2019-May 2021. Interrupted time-series models were used to identify changes in the level and trend of use of different functionalities, before and after the first COVID-19 lockdown. Negative binomial regression assessed differences in app registration by markers of general-practice level sociodemographic variables.

RESULT: Between January 2019 and May 2021, there were 8 524 882 NHS App downloads and 4 449 869 registrations, with a 4-fold increase in App downloads when the COVID Pass feature was introduced. Analyses by sociodemographic data found 25% lower registrations in the most deprived practices (P<0.001), and 44% more registrations in the largest sized practices (P<0.001). Registration rates were 36% higher in practices with the highest proportion of registered White patients (P<0.001), 23% higher in practices with the largest proportion of 15-34-year-olds (P<0.001) and 2% lower in practices with highest proportion of people with long-term care needs (P<0.001).

CONCLUSION: The uptake of the NHS App substantially increased post-lockdown, most significantly after the NHS COVID Pass feature was introduced. An unequal pattern of app registration was identified, and the use of different functions varied. Further research is needed to understand these patterns of inequalities and their impact on patient experience.

PMID:37783512 | DOI:10.3399/BJGP.2022.0150

Emerg Med Australas. 2023 Oct 2. doi: 10.1111/1742-6723.14320. Online ahead of print.

ABSTRACT

OBJECTIVES: Despite significant treatment advances in paediatric diabetes management, ED presentations for potentially preventable (PP) complications such as diabetic ketoacidosis (DKA) remains a major issue. We aimed to examine the characteristics, rates and trends of diabetes-related ED presentations and subsequent admissions in youth aged 0-19 years from 2008 to 2018.

METHODS: Data were obtained from the Victorian Emergency Minimum Dataset and the National Diabetes Register. A diabetes-related ED presentation is defined using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification diagnosis codes. ‘Non-preventable’ presentations were the number of youths with newly diagnosed diabetes, and the remaining are classified as PP diabetes-related presentations. Poisson regression model was used to examine the trends in incidence rate and prevalence.

RESULTS: Four thousand eight hundred and seventy-two (59%) of 8220 presentations were PP, 4683 (57%) were for DKA whereas 6200 (82%) required hospital admission. Diabetes-related ED presentations decreased from 38.4 to 27.5 per 100 youth with diabetes per year between 2008 and 2018 (β = -0.04; confidence interval [CI] -0.04 to -0.03; P < 0.001). Females, those aged 0-4 years and rural youth had higher rates of ED presentations than males, older age groups and metropolitan youth. DKA presentations decreased from 20.1 presentations per 100 youth with diabetes in 2008-2009 to 14.9 presentations per 100 youth with diabetes in 2017-2018. The rate of DKA presentations was 68% higher in rural areas compared to metropolitan areas (incidence rate ratio 1.68; CI 1.59-1.78; P < 0.001).

CONCLUSIONS: Although the rates of diabetes-related ED presentations declined, PP diabetes-related presentations and subsequent hospitalisation remain high. Patient level research is required to understand the increased DKA presentations in rural youth.

PMID:37783473 | DOI:10.1111/1742-6723.14320

Am J Trop Med Hyg. 2023 Oct 2:tpmd230048. doi: 10.4269/ajtmh.23-0048. Online ahead of print.

ABSTRACT

Tuberculosis (TB) is the leading cause of death among people living with HIV (PLWH). Limited TB knowledge has been associated with delayed TB diagnosis and low adherence to TB treatment. A cross-sectional study was conducted among PLWH at the largest HIV-referral center in Lima, Peru, to describe TB knowledge among PLWH and potential associated sociodemographic factors. Participants answered a self-administered survey on TB knowledge, which consisted of five questions about TB cure, transmission, treatment, symptoms, and prevention. Of 179 PLWH enrolled, most participants did not know that isoniazid (85%) and antiretrovirals (78%) are preventive measures for TB, and 56 (31.3%) knew that TB can be asymptomatic in PLWH. We did not find statistical differences in TB knowledge based on gender, education, marital status, and time on HIV care. We identified important gaps in TB knowledge among PLWH. Addressing these gaps could empower PLWH to reduce their TB risk.

PMID:37783463 | DOI:10.4269/ajtmh.23-0048

Sci Total Environ. 2023 Sep 30:167514. doi: 10.1016/j.scitotenv.2023.167514. Online ahead of print.

ABSTRACT

Acrylamide is an organic compound classified as probably carcinogenic to humans because of sufficient evidence in animals but not in humans. Other health risks associated with acrylamide intake are still not fully elucidated. We aimed to study the relationship between acrylamide dietary intake and mortality in the E3N (Etude Epidémiologique auprès de femmes de l’Education Nationale) French cohort. We studied 72,585 women of the E3N prospective cohort, which completed a food frequency questionnaire in 1993. The E3N food consumption database and the food contamination database obtained from the second French total diet study were used to estimate participants’ average daily acrylamide dietary intake. We estimated the associations between acrylamide dietary intake and all-cause or cause-specific mortality using Cox proportional hazard models. During follow-up (1993-2014), we identified 6441 deaths. The mean acrylamide dietary intake was 32.6 μg/day, with coffee consumption as principal contributor (48.6 %). In the fully adjusted model, we found a non-linear association between acrylamide dietary intake and all-cause mortality and a linear positive association with cardiovascular disease (HR per one STD increment [95%CI]: 1.11 [1.02; 1.21]), all-cancer (HR [95%CI]: 1.05 [1.01; 1.10]) and lung cancer (HR [95%CI]: 1.22 [1.09; 1.38]) mortality, while we observed no association with breast (HR [95%CI]: 0.94 [0.86; 1.03]) and colorectal (HR [95%CI]: 1.12 [0.97; 1.29]) cancer mortality. We highlighted an interaction between acrylamide dietary intake and smoking status in the models for all-cause and all-cancer mortality: when stratifying on smoking status, statistically significant positive associations were observed only in current smokers. This study on a large prospective cohort following >70,000 women for over 20 years suggests that higher acrylamide dietary intakes are associated with an increased risk of mortality. Therefore, it is essential to keep reducing acrylamide contamination and prevent dietary intake of acrylamide, especially among smokers.

PMID:37783439 | DOI:10.1016/j.scitotenv.2023.167514

Orthop Traumatol Surg Res. 2023 Sep 30:103695. doi: 10.1016/j.otsr.2023.103695. Online ahead of print.

ABSTRACT

INTRODUCTION: Clinical studies have indicated reduced reliance on blocking screws with the introduction of polyaxial locking nails, yet the biomechanical superiority of polyaxial locking over blocking screws remains unverified, specifically for distal dia-metaphyseal femur fractures.

HYPOTHESIS: We hypothesized that the combination of multiaxial locking using three screws and parallel locking reinforced by two blocking screws would result in superior outcomes compared to utilizing only parallel locking with two screws and one blocking screw.

MATERIALS AND METHODS: Third-generation custom-made femur models representing AO/OTA 32 A1.2 dia-metaphyseal comminuted oblique fractures were divided into four groups (n=10/group). Group A employed distal fixation with three 4.5-mm polyaxial screws. Group B used two parallel locking screws and two blocking screws, Group C used two parallel locking screws and one blocking screw, and Group D used only two parallel screws. Specimens underwent axial and torsional load testing to assess fatigue strength, ultimate strength, axial stiffness (N/mm), torsional stiffness (N·mm/deg), axial load to failure (N), torsional load to failure (N·mm), coronal and sagittal angulations, and fracture site collapse.

RESULTS: Group C exhibited statistically superior torsional stiffness compared to Groups B and D (P=0.039 and P=0.034, respectively). Axial load to failure was highest in Group B and lowest in Group D (P=0.032). Group C demonstrated the highest torsional strength, while Group B exhibited the lowest (P=0.006). Coronal displacement was greatest in Group B, while Group A showed the highest resistance (P=0.009). Group A demonstrated the greatest resistance to fracture site collapse, with the weakest specimens observed in Groups B and C (P=0.01).

DISCUSSION: The performance of a single laterally positioned blocking screw is comparable to using two blocking screws. Medial positioning of a second blocking screw is unnecessary for stability enhancement. Multiaxial locking prevents fracture site collapse and coronal plane angulation more effectively than other methods. Multiaxial locking and/or parallel screws with a single laterally positioned blocking screw provide superior stiffness and stability for treating unstable dia-metaphyseal distal femoral fractures.

LEVEL OF EVIDENCE: N/A.

PMID:37783426 | DOI:10.1016/j.otsr.2023.103695

Eur J Pharm Sci. 2023 Sep 30:106601. doi: 10.1016/j.ejps.2023.106601. Online ahead of print.

ABSTRACT

The aim of this work is to develop a novel simultaneous in vitro dissolution – in situ perfusion system (SDPS) as a potential tool to evaluate the in vivo performance of solid oral formulation in rat. The innovative nitrendipine (NTD) tablet of Bayotensin mite® made in Germany was used as reference listed drug (RLD), and five generic products from Chinese market were compared with RLD using the in vitro dissolution test method specified by the orange book and the SDPS method developed in this study. Four self-prepared NTD tablets with different proportions of microcrystalline cellulose/starch were employed to investigate the discriminatory ability of the SDPS for formulation. In addition, the predictivity of the SDPS in relation to data from in vivo pharmaceutics studies was evaluated. The 45-min dissolution test and multiple-pH dissolution profiles of generic product 1 and 2 have no difference compared with the RLD, but their dissolution profiles from the SDPS showed statistically significant differences. A biexponential formula successfully described the concentration profiles of self-prepared formulations in SDPS experiments. The k_dis (0.08 ± 0.01 ∼ 0.2 ± 0.03 min^-1) and k_a (about 2.30 × 10^-3 min^-1) values calculated by the formulas of F1-F3 suggested that the used excipients had no effect on the intestinal absorption of NTD, and it might be the property of active pharmaceutical ingredient that led to the difference among the generics. Furthermore, the in vivo rat pharmacokinetics study results of F1-F3 showed a good correlation (R² = 0.99) with the SDPS data. In summary, the SDPS is a promising tool to detect the unexpected quality changes of pharmaceutical products in weakly regulated markets, facilitate formulation screening, and potentially reduce animal testing for estimating the in vivo absorption behavior of solid oral formulations. The absorption performance of generic drugs in vivo should be further investigated.

PMID:37783379 | DOI:10.1016/j.ejps.2023.106601