Tag: nevin manimala

J Magn Reson Imaging. 2023 Sep 14. doi: 10.1002/jmri.29013. Online ahead of print.

ABSTRACT

BACKGROUND: Carotid webs (CaWs) are fibromuscular projections in the internal carotid artery (ICA) that cause mild luminal narrowing (<50%), but may be causative in up to one-third of seemingly cryptogenic strokes. Understanding hemodynamic alterations caused by CaWs is imperative to assessing stroke risk. Time-Average Wall Shear Stress (TAWSS) and Oscillatory Shear Index (OSI) are hemodynamic parameters linked to vascular dysfunction and thrombosis.

PURPOSE: To test the hypothesis: “CaWs are associated with lower TAWSS and higher OSI than mild atherosclerosis or healthy carotid bifurcation.”

STUDY TYPE: Prospective study.

POPULATION: A total of 35 subjects (N = 14 bifurcations with CaW, 11F, age: 49 ± 10, 10 mild atherosclerosis 6F, age: 72 ± 9, 11 healthy 9F, age: 42 ± 13).

FIELD STRENGTH/SEQUENCE: 4D flow/STAR-MATCH/3D TOF/3T MRI, CTA.

ASSESSMENT: 4D Flow velocity data were analyzed in two ways: 1) 3D ROI in the ICA bulbar segment (complex flow patterns are expected) was used to quantify the regions with low TAWSS and high OSI. 2) 2D planes were placed perpendicular to the centerline of the carotid bifurcation for detailed analysis of TAWSS and OSI.

STATISTICAL TESTS: Independent-samples Kruskal-Wallis-H test with 0.05 used for statistical significance.

RESULTS: The percent surface area where low TAWSS was present in the ICA bulb was 12.3 ± 8.0% (95% CI: 7.6-16.9) in CaW subjects, 1.6 ± 1.9% (95% CI: 0.2-2.9) in atherosclerosis, and 8.5 ± 7.7% (95% CI: 3.6-13.4) in healthy subjects, all differences were statistically significant (ƞ² = 0.3 [95% CI: 0.05-0.5], P-value CaW vs. healthy = 0.2). OSI had similar values in the CCA between groups (ƞ² = 0.07 [95% CI: 0.0-0.2], P-value = 0.5), but OSI was significantly higher downstream of the bifurcation in CaW subjects compared to atherosclerosis and normal subjects. OSI returned to similar values between groups 1.5 diameters distal to the bifurcation (ƞ² = 0.03 [95% CI: 0.0-0.2], P-value = 0.7).

CONCLUSION: Lower TAWSS and higher OSI are present in the ICA bulb in patients with CaW when compared to patients with atherosclerotic or healthy subjects.

EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 2.

PMID:37706274 | DOI:10.1002/jmri.29013

Pediatrics. 2023 Sep 14:e2022061011. doi: 10.1542/peds.2022-061011. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 vaccine is important for children with sickle cell disease (SCD). This quality improvement project’s objective was to increase the proportion of children with SCD receiving ≥2 COVID-19 vaccine doses to ≥70% by June 2022.

METHODS: We used the Model for Improvement framework. We assessed COVID-19 vaccination rates biweekly. Three plan-do-study-act cycles focusing on patient education, provider awareness, and access were performed. Process measures included the outcome of outreach calls and educational video views. Missed clinic appointments was our balancing measure. Line graphs and statistical process control charts were used to track changes. Interrupted time series was used to model implementation rates while accounting for preexisting trends.

RESULTS: A total of 243 patients were included. During the preintervention (September 2021-January 2022) and intervention periods (February 2022-June 2022), overall vaccination rates increased from 33% to 41% and 41% to 64%, respectively. Mean vaccination rate in eligible children in each 2-week period increased from 2.1% to 7.2%. The achieved vaccination rate was 11% greater than predicted for patients with SCD. For the general population the achieved vaccination rate was 23% lower than predicted. The proportion of missed visits did not change (9.0% vs. 9.6%). During outreach calls, 10 patients (13.5%) booked a vaccine. Forty percent of patients watched the promotional video.

CONCLUSIONS: A significant number of patients with SCD are not vaccinated against COVID-19. Targeting misinformation and improving vaccine access aided in increasing vaccination. Additional interventions are needed as a large number of patients remain unvaccinated.

PMID:37706252 | DOI:10.1542/peds.2022-061011

J Neurophysiol. 2023 Sep 14. doi: 10.1152/jn.00194.2023. Online ahead of print.

ABSTRACT

Attention and divisive normalization both contribute to making visual processing more efficient. Attention selectively increases the neural gain of relevant information in early visual cortex, resulting in stronger perceived salience for attended regions or features. Divisive normalization improves processing efficiency by suppressing responses to homogeneous inputs and highlighting salient boundaries, facilitating sparse coding of inputs. Theoretical and empirical research suggest a tight link between attention and normalization, wherein attending to a stimulus results in a release from normalization, thereby allowing for an increase in neural response gain. In the present study, we address whether attention alters the qualitative properties of normalization. Specifically, we examine how attention influences the feature-tuned nature of normalization, whereby suppression is stronger between visual stimuli whose orientation contents are similar, and weaker when the orientations are different. Ten human observers viewed stimuli that varied in orientation content while we acquired fMRI BOLD responses under two attentional states: attending towards or attending away from the stimulus. Our results indicate that attention does not alter the specificity of feature-tuned normalization. Instead, attention seems to enhance visuocortical responses evenly, regardless of the degree of orientation similarity within the stimulus. Since visuocortical responses exhibit adaptation to statistical regularities in natural scenes, we conclude that while attention can selectively increase the gain of responses to attended items, it does not appear to alter the ecologically relevant correspondence between orientation differences and strength of tuned normalization.

PMID:37706234 | DOI:10.1152/jn.00194.2023

J Neurophysiol. 2023 Sep 14. doi: 10.1152/jn.00069.2023. Online ahead of print.

ABSTRACT

INTRODUCTION: Despite being studied for >50 years, the neurophysiological mechanisms underlying vibration(VIB)-induced kinesthetic illusions are still unclear. The aim of this study was to investigate how corticospinal excitability tested by transcranial magnetic stimulation (TMS) is modulated during VIB-induced illusions.

METHODS: Twenty healthy adults received vibration over wrist flexor muscles (80 Hz, 1 mm, 10 seconds). TMS was applied over the primary motor cortex representation of wrist extensors at 120% of resting motor threshold in four random conditions (10 trials/condition) : baseline (without VIB), 1s, 5s and 10s after VIB onset. Means of motor evoked potentiels (MEP) amplitudes and latencies were calculated.

RESULTS: Statistical analysis found a significant effect of conditions (stimulation timings) on MEP amplitudes (p=0.035). Paired-comparisons demonstrated lower corticospinal excitability during VIB at 1s compared to 5s (p=0.025) and 10s (p=0.003), although none of them differed to baseline values.

DISCUSSION: Results suggest a time-specific modulation of corticospinal excitability in muscles antagonistic to those vibrated, i.e. muscles involved in the perceived movement. An early decrease of excitability was observed at 1s followed by a stabilization of values near baseline at subsequent time-points. At 1s, the illusion is not yet perceived or not strong enough to up-regulate corticospinal networks coherent with the proprioceptive input. Spinal mechanisms, as reciprocal inhibition, could also contribute to lower the corticospinal drive of non-vibrated muscles in short period before the illusion emerges.

CONCLUSION: Our results suggest that neuromodulatory effects of VIB are likely time-dependent, and that future work is needed to further investigate underlying mechanisms.

PMID:37706230 | DOI:10.1152/jn.00069.2023

Milbank Q. 2023 Sep 14. doi: 10.1111/1468-0009.12672. Online ahead of print.

ABSTRACT

Policy Points The increasing political polarization of states reached new heights during the COVID-19 pandemic, when response plans differed sharply across party lines. This study found that states with Republican governors and larger Republican majorities in legislatures experienced higher death rates during the COVID-19 pandemic-and in preceding years-but these associations often lost statistical significance after adjusting for the average income and health status of state populations and for the policy orientations of the states. Future research may help clarify whether the higher death rates in these states result from policy choices or have other explanations, such as the tendency of voters with lower incomes or poorer health to elect Republican candidates.

CONTEXT: Increasing polarization of states reached a high point during the COVID-19 pandemic, when the party affiliation of elected officials often predicted their policy response. The health consequences of these divisions are unclear. Prior studies compared mortality rates based on presidential voting patterns, but few considered the partisan orientation of state officials. This study examined whether the partisan orientation of governors or legislatures was associated with mortality outcomes during the COVID-19 pandemic.

METHODS: Data on deaths and the partisan orientation of governors and legislators were obtained from the Centers for Disease Control and Prevention and the National Conference of State Legislatures, respectively. Linear regression was used to measure the association between Republican representation (percentage of seats held) in legislatures and (1) age-adjusted, all-cause mortality rates (AAMRs) in 2015-2021 and (2) excess death rates during three phases of the COVID-19 pandemic, controlling for median household income, the prevalence of four risk factors (obesity, chronic obstructive pulmonary disease, heart attack, stroke), and state policy orientation. Associations between excess death rates and the governor’s party were also examined.

FINDINGS: States with Republican governors or greater Republican representation in legislatures experienced higher AAMRs during 2015-2021, lower excess death rates during Phase 1 of the COVID-19 pandemic (weeks ending March 28, 2020, through June 13, 2020), and higher excess death rates in Phases 2 and 3 (weeks ending June 20, 2020, through April 30, 2022; p < 0.05). Most associations lost statistical significance after adjustment for control variables.

CONCLUSIONS: Mortality was higher in states with Republican governors and greater Republican legislative representation before and during much of the pandemic. Observed associations could be explained by the adverse effects of policy choices, reverse causality (e.g., popularity of Republican candidates in states with lower socioeconomic and health status), or unmeasured factors that predominate in states with Republican leaders.

PMID:37706227 | DOI:10.1111/1468-0009.12672

Cancer Med. 2023 Sep 14. doi: 10.1002/cam4.6493. Online ahead of print.

ABSTRACT

BACKGROUND: The National Comprehensive Cancer Network suggested that older women with low-risk breast cancer (LRBC; i.e., early-stage, node-negative, and estrogen receptor-positive) could omit adjuvant radiation treatment (RT) after breast-conserving surgery (BCS) if they were treated with hormone therapy. However, the association between RT omission and breast cancer-specific mortality among older women with comorbidity is not fully known.

METHODS: 1105 older women (≥65 years) with LRBC in 1998-2012 were queried from the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey data resource and were followed up through July 2018. Latent class analysis was performed to identify comorbidity burden classes. A propensity score-based inverse probability of treatment weighting (IPTW) was applied to Cox regression models to obtain subdistribution hazard ratios (HRs) and 95% CI for cancer-specific mortality considering other causes of death as competing risks, overall and separately by comorbidity burden class.

RESULTS: Three comorbidity burden (low, moderate, and high) groups were identified. A total of 318 deaths (47 cancer-related) occurred. The IPTW-adjusted Cox regression analysis showed that RT omission was not associated with short-term, 5- and 10-year cancer-specific death (p = 0.202 and p = 0.536, respectively), regardless of comorbidity burden. However, RT omission could increase the risk of long-term cancer-specific death in women with low comorbidity burden (HR = 1.98, 95% CI = 1.17, 3.33), which warrants further study.

CONCLUSIONS: Omission of RT after BCS is not associated with an increased risk of cancer-specific death and is deemed a reasonable treatment option for older women with moderate to high comorbidity burden.

PMID:37706222 | DOI:10.1002/cam4.6493

Patient Prefer Adherence. 2023 Sep 8;17:2249-2262. doi: 10.2147/PPA.S421875. eCollection 2023.

ABSTRACT

PURPOSE: In Romania, after reaching the age of 18, teenage girls can make an informed decision about vaccination. The aim of the study was to evaluate both knowledge and attitudes related to HPV infection, HPV vaccination, cervical cancer, as well as intentions, reservations, reasons that could influence the decision related to vaccination.

PATIENTS AND METHODS: We applied an anonymized questionnaire to 690 teenage girls in the 18-19 age group, recruited from 15 high schools in Bihor County. Based on the answers to the question corresponding to item 14 of subscale 3, 2 groups were identified: the group with a hesitant behavior called the non-vaccine group (GNV) and the group with a positive behavior called the pro-vaccine group (GPV). The statistical analysis was processed by using IBM-SPSS 22.

RESULTS: The analysis revealed significant differences between the groups in terms of the level of knowledge and attitudes related to vaccination, the adolescent girls in the GPV being more aware of the role and importance of HPV vaccination and more open to the idea of vaccination. For the GNV, the behavior can be explained by the fact that even if they have heard about the HPV infection being transmitted through unprotected sex and they think that vaccination in general is necessary to prevent certain diseases, they do not know if HPV vaccination would be effective in protecting them in the future. Adolescents from GPV declare they would accept HPV vaccination if it would be offered to them or they are already vaccinated.

CONCLUSION: Alongside interventions targeting parents and health-care professionals, it is necessary to improve the level of knowledge of adolescents about HPV infection, HPV vaccination and cervical cancer, by organizing information campaigns in schools, campaigns in which professionals in the field should be involved, but also by implementing education programs addressed to them.

PMID:37706209 | PMC:PMC10497041 | DOI:10.2147/PPA.S421875

J Med Educ Curric Dev. 2023 Sep 11;10:23821205231192335. doi: 10.1177/23821205231192335. eCollection 2023 Jan-Dec.

ABSTRACT

OBJECTIVE: Teaching procedural skills via digital platforms is challenging. There is a paucity of literature on the feasibility of implementing an online asynchronous web-based learning (WBL) module for endotracheal intubation in Emergency Medicine. Learners completed a pre-test questionnaire prior to reviewing the module to assess their current knowledge. After completion of the online module, another assessment on airway management competency was completed. The purpose of our pilot study was to determine the feasibility of implementing an online airway module and investigate knowledge acquisition among learners who completed it. Additionally, we compared the relationship between pre-module confidence and knowledge between various training levels of those who completed the module.

METHODS: The study was IRB exempt. We conducted a quasi-experimental pre- and post-test study, where learners took a multiple-choice question-based test before watching content module, and after completion of modules, they went on to complete post-test questions. All responses were collected using Google survey and the data were collected over a period of 6 months. We performed descriptive statistics for the pre- and post-module. Frequency distribution was used for data summarization and chi-square test was used to assess the difference between variables.

RESULTS: We received 366 responses in the pre-test module and 105 in post-test module. Responses were summarized into 5 broad categories which assessed knowledge about airway technique, anatomical landmarks, formulas for selecting blade size, tube size, depth of tube, and case-based scenarios. All questions showed a higher percentage of correct answers in the post-assessment compared to the pre-assessment.

CONCLUSION: The results demonstrated that this WBL airway module resulted in significant knowledge acquisition, as well as increased confidence when approaching airway management. The study demonstrated that a WBL airway module is a feasible method of asynchronous education for healthcare providers in all levels of training.

PMID:37706174 | PMC:PMC10496465 | DOI:10.1177/23821205231192335

Front Hum Neurosci. 2023 Aug 29;17:1225976. doi: 10.3389/fnhum.2023.1225976. eCollection 2023.

ABSTRACT

INTRODUCTION: To perceive speech, our brains process information from different sensory modalities. Previous electroencephalography (EEG) research has established that audio-visual information provides an advantage compared to auditory-only information during early auditory processing. In addition, behavioral research showed that auditory speech perception is not only enhanced by visual information but also by tactile information, transmitted by puffs of air arriving at the skin and aligned with speech. The current EEG study aimed to investigate whether the behavioral benefits of bimodal audio-aerotactile and trimodal audio-visual-aerotactile speech presentation are reflected in cortical auditory event-related neurophysiological responses.

METHODS: To examine the influence of multimodal information on speech perception, 20 listeners conducted a two-alternative forced-choice syllable identification task at three different signal-to-noise levels.

RESULTS: Behavioral results showed increased syllable identification accuracy when auditory information was complemented with visual information, but did not show the same effect for the addition of tactile information. Similarly, EEG results showed an amplitude suppression for the auditory N1 and P2 event-related potentials for the audio-visual and audio-visual-aerotactile modalities compared to auditory and audio-aerotactile presentations of the syllable/pa/. No statistically significant difference was present between audio-aerotactile and auditory-only modalities.

DISCUSSION: Current findings are consistent with past EEG research showing a visually induced amplitude suppression during early auditory processing. In addition, the significant neurophysiological effect of audio-visual but not audio-aerotactile presentation is in line with the large benefit of visual information but comparatively much smaller effect of aerotactile information on auditory speech perception previously identified in behavioral research.

PMID:37706173 | PMC:PMC10495990 | DOI:10.3389/fnhum.2023.1225976

Front Neurosci. 2023 Aug 29;17:1229155. doi: 10.3389/fnins.2023.1229155. eCollection 2023.

ABSTRACT

INTRODUCTION: Previous studies have investigated predictive factors for parenting stress in caregivers of autism spectrum disorder (ASD) patients using traditional statistical approaches, but their study settings and results were inconsistent. Herein, this study aimed to identify major predictors for parenting stress in this population by developing explainable machine learning models.

METHODS: Study participants were collected from the Department of Child and Adolescent Psychiatry, Severance Hospital, Yonsei University College of Medicine, Seoul, the Republic of Korea between March 2016 and October 2020. A total of 36 model features were used, which include subscales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) for caregivers’ psychopathology, Social Responsiveness Scale-2 for core symptoms, and Child Behavior Checklist (CBCL) for behavioral problems. Machine learning classifiers [eXtreme Gradient Boosting (XGBoost), random forest (RF), logistic regression, and support vector machine (SVM) classifier] were generated to predict severe total parenting stress and its subscales (parental distress, parent-child dysfunctional interaction, and difficult child). Model performance was assessed by area under the receiver operating curve (AUC), sensitivity, specificity, accuracy, positive predictive value, and negative predictive value. We utilized the SHapley Additive exPlanations tree explainer to investigate major predictors.

RESULTS: A total of 496 participants were included [mean age of ASD patients 6.39 (SD 2.24); 413 men (83.3%)]. The best-performing models achieved an AUC of 0.831 (RF model; 95% CI 0.740-0.910) for parental distress, 0.814 (SVM model; 95% CI 0.720-0.896) for parent-child dysfunctional interaction, 0.813 (RF model; 95% CI 0.724-0.891) for difficult child, and 0.862 (RF model; 95% CI 0.783-0.930) for total parenting stress on the test set. For the total parenting stress, ASD patients’ aggressive behavior and anxious/depressed, and caregivers’ depression, social introversion, and psychasthenia were the top 5 leading predictors.

CONCLUSION: By using explainable machine learning models (XGBoost and RF), we investigated major predictors for each subscale of the parenting stress index in caregivers of ASD patients. Identified predictors for parenting stress in this population might help alert clinicians whether a caregiver is at a high risk of experiencing severe parenting stress and if so, providing timely interventions, which could eventually improve the treatment outcome for ASD patients.

PMID:37706158 | PMC:PMC10495987 | DOI:10.3389/fnins.2023.1229155