Tag: nevin manimala

Carbohydr Polym. 2023 Sep 1;315:120966. doi: 10.1016/j.carbpol.2023.120966. Epub 2023 Apr 29.

ABSTRACT

Deciphering the determinants of starch digestion from multiple interrelated properties is a challenge that can benefit from multifactorial data analysis. The present study investigated the digestion kinetic parameters (rate, final extent) of size-fractions from four commercial wheat starches with different amylose contents. Each size-fraction was isolated and characterized comprehensively using a large range of analytic techniques (FACE, XRD, CP-MAS NMR, time-domain NMR, DSC…). A statistical clustering analysis applied on the results revealed that the mobility of water and starch protons measured by time-domain NMR was consistently related to the macromolecular composition of the glucan chains and to the ultrastructure of the granule. The final extent of starch digestion was determined by the granule structural features. The digestion rate coefficient dependencies, on the other hand, changed significantly with the range of granule size, i.e. the accessible surface for initial binding of α-amylase. The study particularly showed the molecular order and the chains mobility predominantly limiting or accelerating the digestion rate depending on the accessible surface. This result confirmed the need to differentiate between the surface and the inner-granule related mechanisms in starch digestion studies.

PMID:37230611 | DOI:10.1016/j.carbpol.2023.120966

AJNR Am J Neuroradiol. 2023 May 25. doi: 10.3174/ajnr.A7886. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Endovascular treatment of acute ischemic stroke is now performed more frequently in the late window in radiologically selected patients. However, little is known about whether the frequency and clinical impact of incomplete recanalization and postprocedural cerebrovascular complications differ between early and late windows in the real world.

MATERIALS AND METHODS: We retrospectively reviewed all patients with acute ischemic stroke receiving endovascular treatment within 24 hours from 2015 to 2019 and included in the Acute STroke Registry and Analysis of Lausanne. We compared rates of incomplete recanalization and postprocedural cerebrovascular complications (parenchymal hematoma, ischemic mass effect, and 24-hour re-occlusion) in the early (<6 hours) versus late window (6-24 hours, including patients with unknown onset) populations and correlated them with the 3-month clinical outcome.

RESULTS: Among 701 patients with acute ischemic stroke receiving endovascular treatment, 29.2% had late endovascular treatment. Overall, incomplete recanalization occurred in 56 patients (8%), and 126 patients (18%) had at least 1 postprocedural cerebrovascular complication. The frequency of incomplete recanalization was similar in early and late endovascular treatment (7.5% versus 9.3%, adjusted P =.66), as was the occurrence of any postprocedural cerebrovascular complication (16.9% versus 20.5%, adjusted P = .36). When analyzing single postprocedural cerebrovascular complications, rates of parenchymal hematoma and ischemic mass effect were similar (adjusted P = .71, adjusted P = .79, respectively), but 24-hour re-occlusion seemed somewhat more frequent in late endovascular treatment (4% versus 8.3%, unadjusted P = .02, adjusted P = .40). The adjusted 3-month clinical outcome in patients with incomplete recanalization or postprocedural cerebrovascular complications was comparable between early and late groups (adjusted P = .67, adjusted P = .23, respectively).

CONCLUSIONS: The frequency of incomplete recanalization and of cerebrovascular complications occurring after endovascular treatment is similar in early and well-selected late patients receiving endovascular treatment. Our results demonstrate the technical success and safety of endovascular treatment in well-selected late patients with acute ischemic stroke.

PMID:37230542 | DOI:10.3174/ajnr.A7886

J Nucl Med. 2023 May 25:265077. doi: 10.2967/jnumed.122.265077. Online ahead of print.

ABSTRACT

⁶⁸Ga-gozetotide (⁶⁸Ga-PSMA-11) is used to identify prostate-specific membrane antigen (PSMA)-positive tumors on PET scans. In the VISION study, ⁶⁸Ga-PSMA-11 was used to determine the eligibility of patients with metastatic castration-resistant prostate cancer for treatment with ¹⁷⁷Lu-vipivotide tetraxetan (¹⁷⁷Lu-PSMA-617), based on predefined read criteria. This substudy aimed to investigate the interreader variability and intrareader reproducibility of visual assessments of ⁶⁸Ga-PSMA-11 PET/CT scans using the VISION read criteria and evaluate the agreement between read results for this and the VISION study. Methods: In VISION, ⁶⁸Ga-PSMA-11 PET/CT scans were centrally read as inclusion cases if they had at least 1 PSMA-positive lesion and no PSMA-negative lesions that fulfilled the exclusion criteria. In this substudy, 125 PET/CT scans (75 inclusion and 50 exclusion cases) were randomly selected from VISION and retrospectively assessed by 3 independent central readers. A random subset of 20 cases (12 inclusion and 8 exclusion cases) was recoded for assessment of intrareader reproducibility. Classification of cases as inclusion or exclusion cases was based on the VISION read criteria. Overall interreader variability was assessed by Fleiss κ-statistics, and pairwise variability and intrareader reproducibility were assessed by Cohen κ-statistics. Results: For interreader variability, the readers agreed on 77% of cases (overall average agreement rate, 0.85; Fleiss κ, 0.60 [95% CI, 0.50-0.70]). The pairwise agreement rate was 0.82, 0.88, and 0.84, and the corresponding Cohen κ was 0.54 (95% CI, 0.38-0.71), 0.67 (95% CI, 0.52-0.83), and 0.59 (95% CI, 0.43-0.75), respectively. For intrareader reproducibility, the agreement rate was 0.90, 0.90, and 0.95, and the corresponding Cohen κ was 0.78 (95% CI, 0.49-0.99), 0.76 (95% CI, 0.46-0.99), and 0.89 (95% CI, 0.67-0.99), respectively. The number of actual VISION inclusion cases out of the total number of cases scored as inclusion in this substudy was 71 of 93 (agreement rate, 0.76; 95% CI, 0.66-0.85) for reader 1, 70 of 88 (0.80; 0.70-0.87) for reader 2, and 73 of 96 (0.76; 0.66-0.84) for reader 3. All readers agreed on 66 of 75 VISION inclusion cases. Conclusion: Moderate-to-substantial interreader agreement and substantial-to-almost perfect intrareader reproducibility for ⁶⁸Ga-PSMA-11 PET/CT scan assessment using the VISION read criteria were observed. The read rules applied in VISION can be readily learned and demonstrate good reproducibility.

PMID:37230533 | DOI:10.2967/jnumed.122.265077

BMJ Open. 2023 May 25;13(5):e065068. doi: 10.1136/bmjopen-2022-065068.

ABSTRACT

OBJECTIVES: Respiratory protective equipment is critical to protect healthcare workers from COVID-19 infection, which includes filtering facepiece respirators (FFP3). There are reports of fitting issues within healthcare workers, although the factors affecting fitting outcomes are largely unknown. This study aimed to evaluate factors affecting respirator fitting outcomes.

DESIGN: This is a retrospective evaluation study. We conducted a secondary analysis of a national database of fit testing outcomes in England between July and August 2020.

SETTINGS: The study involves National Health Service (NHS) hospitals in England.

PARTICIPANTS: A total of 9592 observations regarding fit test outcomes from 5604 healthcare workers were included in the analysis.

INTERVENTION: Fit testing of FFP3 on a cohort of healthcare workers in England, working in the NHS.

PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome measure was the fit testing result, that is, pass or fail with a specific respirator. Key demographics, including age, gender, ethnicity and face measurements of 5604 healthcare workers, were used to compare fitting outcomes.

RESULTS: A total of 9592 observations from 5604 healthcare workers were included in the analysis. A mixed-effects logistic regression model was used to determine the factors which affected fit testing outcome. Results showed that males experienced a significantly (p<0.05) higher fit test success than females (OR 1.51; 95% CI 1.27 to 1.81). Those with non-white ethnicities demonstrated significantly lower odds of successful respirator fitting; black (OR 0.65; 95% CI 0.51 to 0.83), Asian (OR 0.62; 95% CI 0.52 to 0.74) and mixed (OR 0.60; 95% CI 0.45 to 0.79.

CONCLUSION: During the early phase of COVID-19, females and non-white ethnicities were less likely to have a successful respirator fitting. Further research is needed to design new respirators which provide equal opportunity for comfortable, effective fitting of these devices.

PMID:37230519 | DOI:10.1136/bmjopen-2022-065068

Res Synth Methods. 2023 May 25. doi: 10.1002/jrsm.1636. Online ahead of print.

ABSTRACT

The laborious and time-consuming nature of systematic review production hinders the dissemination of up-to-date evidence synthesis. Well-performing natural language processing (NLP) tools for systematic reviews have been developed, showing promise to improve efficiency. However, the feasibility and value of these technologies have not been comprehensively demonstrated in a real-world review. We developed an NLP-assisted abstract screening tool that provides text inclusion recommendations, keyword highlights, and visual context cues. We evaluated this tool in a living systematic review on SARS-CoV-2 seroprevalence, conducting a quality improvement assessment of screening with and without the tool. We evaluated changes to abstract screening speed, screening accuracy, characteristics of included texts, and user satisfaction. The tool improved efficiency, reducing screening time per abstract by 45.9% and decreasing inter-reviewer conflict rates. The tool conserved precision of article inclusion (positive predictive value; 0.92 with tool vs. 0.88 without) and recall (sensitivity; 0.90 vs. 0.81). The summary statistics of included studies were similar with and without the tool. Users were satisfied with the tool (mean satisfaction score of 4.2/5). We evaluated an abstract screening process where one human reviewer was replaced with the tool’s votes, finding that this maintained recall (0.92 one-person, one-tool vs. 0.90 two tool-assisted humans) and precision (0.91 vs. 0.92) while reducing screening time by 70%. Implementing an NLP tool in this living systematic review improved efficiency, maintained accuracy, and was well-received by researchers, demonstrating the real-world effectiveness of NLP in expediting evidence synthesis.

PMID:37230483 | DOI:10.1002/jrsm.1636

Am J Perinatol. 2023 May 25. doi: 10.1055/a-2099-8611. Online ahead of print.

ABSTRACT

OBJECTIVE: To date, there is limited information about medical student duty hours, shelf scores, and overall clerkship performance in Obstetrics and Gynecology. As a result, we were curious to know whether spending more time in the clinical environment translated to an improved learning experience or, in contrast, translated to decreased study time and worse overall clerkship performance.

STUDY DESIGN: A retrospective cohort analysis was performed at a single academic medical center of all medical students on the Obstetrics and Gynecology clerkship from August 2018 to June 2019. Recorded student duty hours were tabulated per day and per week, by student. National Board of Medical Examiners (NBME) Subject Exam (Shelf) equated percentile scores for the quarter of year were used.

RESULTS: Our statistical analysis showed that working long hours did not translate to higher or lower shelf score, or higher overall clerkship grade. However, working longer hours in the last two weeks of the clerkship was associated with high shelf score.

CONCLUSION: Longer medical student duty hours did not correlate to higher shelf scores or overall clerkship grades. Future multi-center studies are necessary to evaluate the importance of medical student duty hours and continue optimizing the educational experience of the OB/GYN clerkship.

PMID:37230478 | DOI:10.1055/a-2099-8611

Am J Perinatol. 2023 May 25. doi: 10.1055/a-2099-8662. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to determine health care disparities in evaluation and admission among underserved racial and ethnic minority groups presenting with cardiovascular complaints during the first postpartum year according to patient and provider demographics.

STUDY DESIGN: A retrospective cohort study was performed of all postpartum patients who sought emergency care between 2/2012 and 10/2020 in a large urban care center in Southeastern Texas. Patient information was collected by ICD-10 codes and individual chart analysis. Race, ethnicity, and gender information was self-reported for both patients on hospital enrollment forms and ED providers on their employment records. Statistical analysis was performed with logistic regression and Pearson’s Chi-squared test.

RESULTS: Of 47,976 patients who delivered during the study period, 41,237 (85.9%) were Black, Hispanic or Latina and 490 (1.1%) presented to the ED with cardiovascular complaints. Baseline characteristics were similar between groups; however, Hispanic or Latina patients were more likely to have had GDM during the index pregnancy (6.2% vs 18.3%). There was no difference in hospital admission between groups (17.9% Black vs 16.2% Latina or Hispanic patients). There was no difference in hospital admission rate by provider race or ethnicity overall (p =0.82). There was no difference in hospital admission rate when a patient was evaluated by a provider of a different race or ethnicity (RR= 1.08, CI 0.6-1.97). There was no difference in rate of admission according to self-reported gender of the provider (RR= 0.97, CI 0.66-1.44).

CONCLUSION: This study illustrates that disparities did not exist in the management of racial and ethnic minority groups who presented to the ED with cardiovascular complaints during the first postpartum year. Patient-provider discordance in race or gender was not a significant source of bias or discrimination during the evaluation and treatment of these patients.

PMID:37230477 | DOI:10.1055/a-2099-8662

Am J Perinatol. 2023 May 25. doi: 10.1055/a-2099-8494. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to examine the relationship between obesity and risk of stillbirth among pregnant women with obesity in the United States, with a focus on racial and ethnic disparities.

STUDY DESIGN: We conducted a retrospective cross-sectional analysis of birth and fetal data from the 2014-2019 National Vital Statistics System (N=14,938,384 total births), to examine associations of maternal body mass index (BMI) and risk of stillbirth. Cox proportional-hazards regression model was used to compute adjusted hazard ratios (HR) as a measure of risk of stillbirth in relation to maternal BMI.

RESULTS: The stillbirth rate was 6.70 per 1,000 births among women with a pre-pregnancy obesity, while the stillbirth rate among women with a normal (non-obese) pre-pregnancy BMI was 3.85 per 1,000 births. The risk of stillbirth was greater among women with obesity compared to women without obesity (HR 1.39; 95% CI: 1.37-1.41). Compared to Non-Hispanic (NH) Whites, women identifying as NH-other (HR 1.66; 95% CI: 1.61-1.72) and NH-Black (HR 1.31; 95% CI: 1.26-1.35) were at higher risk of stillbirth, while Hispanic women had a decreased likelihood of stillbirth (HR 0.38; 95% CI: 0.37-0.40).

CONCLUSION: Obesity is a modifiable risk factor for stillbirth. Public health awareness campaigns and strategies targeting weight management in women of reproductive age and racial/ethnic populations at highest risk for stillbirth are needed.

PMID:37230474 | DOI:10.1055/a-2099-8494

J Equine Vet Sci. 2023 May 23:104823. doi: 10.1016/j.jevs.2023.104823. Online ahead of print.

ABSTRACT

This study aimed to analyze effect of physical exercise in hemogasometric and electrolytic profiles of young Mangalarga Marchador horses beginning training for gait competitions. Six Mangalarga Marchador gaited horses with 6 months of training were evaluated. The ages ranged from three and a half to five years and included four stallions and two mares, with mean (±S.D.) body weight of 435±30Kg. Venous blood samples were collected from the horses, rectal temperature and HR were measured before and immediately after the gait test, and blood samples were used for hemogasometric and laboratory analyses. The Wilcoxon signed-rank test was used in the statistical analysis, assigning statistical significance for values of (p≤0.05). Physical effort significantly affected HR (p≤0.027), temperature (T) (p≤0.028), oxygen pressure (pO₂) (p≤0.027), oxygen saturation (sO₂) (p≤0.046), calcium (Ca²⁺) (p≤0.046), and glucose levels (GLI) (p≤0.028). The heart rate, temperature, and pO_2, sO₂, Ca²⁺, and glucose levels were affected by exercise. There was no considerable dehydration in these horses, making it clear that, at this level of effort, they did not enter a state of, indicating that the animals, even young horses, were well conditioned to the submaximal effort required in gaiting tests. The horses showed good adaptation to exercise and did not enter a state of fatigue with the effort made, indicating that the animals in this study received adequate training and could perform the type of exercise proposed, characterized by a submaximal effort.

PMID:37230434 | DOI:10.1016/j.jevs.2023.104823

Int J Cardiol. 2023 May 23:S0167-5273(23)00731-3. doi: 10.1016/j.ijcard.2023.05.038. Online ahead of print.

ABSTRACT

BACKGROUND: HFA-PEFF and cardiopulmonary exercise testing (CPET) are comprehensive diagnostic tools for heart failure with preserved ejection fraction (HFpEF). We aimed to investigate the incremental prognostic value of CPET for the HFA-PEFF score among patients with unexplained dyspnea with preserved ejection fraction (EF).

METHODS: Consecutive patients with dyspnea and preserved EF (n = 292) were enrolled between August 2019 and July 2021. All patients underwent CPET and comprehensive echocardiography, including two-dimensional speckle tracking echocardiography in the left ventricle, left atrium and right ventricle. The primary outcome was defined as a composite cardiovascular event including cardiovascular-related mortality, acute recurrent heart failure hospitalization, urgent repeat revascularization/myocardial infarction or any hospitalization due to cardiovascular events.

RESULTS: The mean age was 58 ± 14.5 years, and 166 (56.8%) participants were male. The study population was divided into three groups based on the HFA-PEFF score: < 2 (n = 81), 2-4 (n = 159), and ≥ 5 (n = 52). HFA-PEFF score ≥ 5, VE/VCO₂ slope, peak systolic strain rate of the left atrium and resting diastolic blood pressure were independently associated with composite cardiovascular events. Furthermore, the addition of VE/VCO₂ and HFA-PEFF to the base model showed incremental prognostic value for predicting composite cardiovascular events (C-statistic 0.898; integrated discrimination improvement 0.129, p = 0.032; net reclassification improvement 1.043, p ≤0.001).

CONCLUSIONS: CPET could be exploited for the HFA-PEFF approach in terms of incremental prognostic value and diagnosis among patients with unexplained dyspnea with preserved EF.

PMID:37230429 | DOI:10.1016/j.ijcard.2023.05.038