Tag: nevin manimala

Environ Sci Pollut Res Int. 2023 Aug 2. doi: 10.1007/s11356-023-28934-7. Online ahead of print.

ABSTRACT

Recently, several urban areas are trying to mitigate the environmental impacts of traffic, where noise pollution is one of the main consequences. Thus, studying the determinants of traffic-related noise generation and developing a model that predicts the level of noise by controlling the influencing factors are crucial for transportation planning purposes. This research aims at utilizing the response surface method (RSM) to develop a robust statistical prediction model of traffic-related noise levels and optimize different traffic characteristics’ ranges to reduce the expected noise levels. The results indicate that the rate of L_eq increase is higher at traffic flow values less than the 1204 veh/h. The interaction effect of flow-speed and flow-heavy vehicle percentage pairs shows that L_eq has peak values around 45.8 km/h and 28.71%, respectively, with almost symmetric value distribution about those center points. The main effects study indicates a direct effect of traffic flow, speed, density, and traffic composition on roadside noise levels. The prediction model has good representativeness of observed noise levels by predicted noise levels as the model has a high coefficient of determination (R² = 95.87% and R² adj = 92.26%) with a significance level of 0.0036. Then, the research presents a methodology to perform an optimization of the roadside noise level by defining traffic characteristics that can keep the noise level below 65 dB(A) or minimize noise level. Decision-makers could use the proposed method to control the roadside noise level.

PMID:37531052 | DOI:10.1007/s11356-023-28934-7

Environ Sci Pollut Res Int. 2023 Aug 2. doi: 10.1007/s11356-023-28935-6. Online ahead of print.

ABSTRACT

Biochemical oxygen demand (BOD) is one of the most important parameters used for water quality assessment. Alternative methods are essential for accurately prediction of this parameter because the traditional method in predicting the BOD is time-consuming and it is inaccurate due to inconstancies in microbial multiplicity. In this study, the applicability of four hybrid neuro-fuzzy (ANFIS) methods, ANFIS with genetic algorithm (GA), ANFIS with particle swarm optimization (PSO), ANFIS with sine cosine algorithm (SCA), and ANFIS with marine predators algorithm (MPA), was investigated in predicting BOD using distinct input combinations such as potential of hydrogen (pH), dissolved oxygen (DO), electrical conductivity (EC), water temperature (WT), suspended solids (SS), chemical oxygen demand (COD), total nitrogen (TN), and total phosphorus (T-P) acquired from two river stations, Gongreung and Gyeongan, South Korea. The applicability of multi-variate adaptive regression spline (MARS) in determination of the best input combination was examined. The ANFIS-MPA was found to be the best model with the lowest root mean square error and mean absolute error and the highest determination coefficient. It improved the root mean square error of ANFIS-PSO, ANFIS-GA, and ANFIS-SCA models by 13.8%, 12.1%, and 6.3% for Gongreung Station and by 33%, 25%, and 6.3% for Gyeongan Station in the test stage, respectively.

PMID:37531049 | DOI:10.1007/s11356-023-28935-6

Updates Surg. 2023 Aug 2. doi: 10.1007/s13304-023-01619-z. Online ahead of print.

ABSTRACT

Robot-assisted transaxillary thyroidectomy is widely performed in Asian countries, although it is still under discussion in the Western World. However, there have been few studies reporting on the learning curve of robot-assisted transaxillary thyroidectomy. We used the cumulative sum (CUSUM) analysis to assess the learning curve of gasless robot-assisted transaxillary thyroidectomy at a third-level institution in Europe. We included all consecutive patients operated by a single surgeon without previous experience of robotic surgery from February 2012 to January 2023. The primary endpoint of the study was the learning curve extracted from the median operative time using the CUSUM method for the quantitative assessment. Overall, 583 patients were enrolled. The median operative time for thyroid lobectomy and total thyroidectomy was 70 and 90 min, respectively. The CUSUM analysis showed that the learning curve for thyroid lobectomy and total thyroidectomy is 66 and 56 cases, respectively. Moreover, the presence of thyroiditis resulted associated with shorter operative time for total thyroidectomy (p = 0.044), whereas no factors resulted associated with surgical complications. The learning curve for performing robotic transaxillary thyroid lobectomy for a surgeon without previous robotic experience is 66 cases. After that, 56 cases must be performed to acquire proficiency in robotic transaxillary total thyroidectomy. Training programs may reduce the slope of the learning curve.

PMID:37531041 | DOI:10.1007/s13304-023-01619-z

Eur Arch Paediatr Dent. 2023 Aug 2. doi: 10.1007/s40368-023-00826-x. Online ahead of print.

ABSTRACT

PURPOSE: The aims of this study were to: (1) examine the psychometric properties of the Greek version of JSE-HP and (2) explore empathy among Greek dental postgraduate students.

METHODS: The JSE-HP scale was translated into Greek using the back translation method. The questionnaire was given to 111 dental postgraduate students between November 2017 and February 2018. A random sample of 25% was retested to assess test-retest reliability. The reliability of the Greek version of JSE-HP was measured with Cronbach’s alpha (α) and Discrimination Indices (DIs). Exploratory Factor Analysis, with varimax rotation of the factorial axes, was used to examine the dimensionality and the factorial validity of the Greek version of the JSE-HP. Comparisons between groups of postgraduate students were performed as appropriate with the Kruskal-Wallis or the Mann-Whitney U test.

RESULTS: The response rate was 100%. The mean age was 28.9 years. The reliability, in the sense of internal consistency of the questionnaire was considered satisfactory (Cronbach’s alpha: 0.76, average DI: 0.33.) The test-retest reliability was satisfactory (Pearson’s r = 0.77, p < 0.001). Factor Analysis revealed 7 significant factors. No statistically significant differences in empathy scores were found among groups of postgraduate students.

CONCLUSIONS: The Greek version of the JSE-HP shows good psychometric properties. Empathy scores do not differ among Greek dental postgraduate students.

PMID:37531023 | DOI:10.1007/s40368-023-00826-x

J Racial Ethn Health Disparities. 2023 Aug 2. doi: 10.1007/s40615-023-01698-z. Online ahead of print.

ABSTRACT

A complex interplay of social, economic, and environmental factors drove the COVID-19 epidemic. Understanding these factors is crucial in explaining the racial disparities observed in COVID-19 deaths. This research investigated various hypotheses, including ecological, racial, demographic, economic, and political party factors, to determine their impact on COVID-19 deaths. The study utilized data from the National Center for Health Statistics (NCHS), specifically focusing on COVID-19 deaths categorized by race and Hispanic origin in US counties, with over 100 recorded deaths as of July 11, 2022.

METHOD: To analyze the data, the study employed partial least squares (PLS) as the statistical approach, considering the presence of multicollinearity in the county-level socioeconomic data. SmartPLS4 software was utilized to illustrate paths depicting variance and covariance and to conduct significance tests. The analysis encompassed overall COVID-19 deaths and deaths among White, Black, and Hispanic Americans, utilizing the same latent variables and paths.

RESULTS: The results revealed that the number of residents aged 65 years or older in a county was the most influential predictor of COVID-19 deaths, irrespective of race. Economic factors emerged as the second strongest predictors. However, when considering each racial group separately, distinct factors aligned with the five hypotheses emerged as significant contributors to COVID-19 deaths. Furthermore, the diagrams illustrating the relationships between these factors (covariates) varied among racial groups, indicating that the underlying social influences differed across races.

DISCUSSION: In light of these findings, it becomes evident that a “one-size-fits-all” approach to prevention strategies is suboptimal. Instead, targeted prevention efforts tailored to specific racial and social classes at high risk of COVID-19 death could have provided more precise messaging and necessitate direct engagement.

PMID:37531017 | DOI:10.1007/s40615-023-01698-z

Ultrasound J. 2023 Aug 2;15(1):33. doi: 10.1186/s13089-023-00331-8.

ABSTRACT

BACKGROUND: Measurement of the optic nerve sheath diameter (ONSD) via ultrasonography has been proposed as a non-invasive metric of intracranial pressure that may be employed during in-field patient triage. However, first responders are not typically trained to conduct sonographic exams and/or do not have access to an expensive ultrasound device. Therefore, for successful deployment of ONSD measurement in-field, we believe that first responders must have access to low-cost, portable ultrasound and be assisted by artificial intelligence (AI) systems that can automatically interpret the optic nerve sheath ultrasound scan. We examine the suitability of five commercially available, low-cost, portable ultrasound devices that can be combined with future artificial intelligence algorithms to reduce the training required for and cost of in-field optic nerve sheath diameter measurement. This paper is focused on the quality of the images generated by these low-cost probes. We report results of a clinician preference survey and compare with a lab analysis of three quantitative image quality metrics across devices. We also examine the suitability of the devices in a hypothetical far-forward deployment using operators unskilled in ultrasound, with the assumption of a future onboard AI video interpreter.

RESULTS: We find statistically significant differences in clinician ranking of the devices in the following categories: “Image Quality”, “Ease of Acquisition”, “Software”, and “Overall ONSD”. We show differences in signal-to-noise ratio, generalized contrast-to-noise ratio, point-spread function across the devices. These differences in image quality result in a statistically significant difference in manual ONSD measurement. Finally, we show that sufficiently wide transducers can capture the optic nerve sheath during blind (no visible B-mode) scans performed by operators unskilled in sonography.

CONCLUSIONS: Ultrasound of the optic nerve sheath has the potential to be a convenient, non-invasive, point-of-injury or triage measure for elevated intracranial pressure in cases of traumatic brain injury. When transducer width is sufficient, briefly trained operators may obtain video sequences of the optic nerve sheath without guidance. This data suggest that unskilled operators are able to achieve the images needed for AI interpretation. However, we also show that image quality differences between ultrasound probes may influence manual ONSD measurements.

PMID:37530991 | DOI:10.1186/s13089-023-00331-8

Int J Cardiovasc Imaging. 2023 Aug 2. doi: 10.1007/s10554-023-02920-z. Online ahead of print.

ABSTRACT

PURPOSE: A novel conceptual framework was introduced to enhance the quantitative assessment of functional mitral regurgitation (FMR) and improve risk stratification. However, the data was derived from a single-center cohort and lack external validation. We aimed to validate the proposed algorithm using a different patient population.

METHODS: Patients with at least mild FMR and reduced left ventricular ejection fraction (< 50%) were retrospectively identified at a single-center. The cohort was stratified in low, intermediate and high-risk according to the proposed framework, on the basis of effective regurgitant orifice area (EROA) and regurgitant volume (RegVol). Patients within the intermediate-risk group were subsequently reclassified into either the low-risk category (Regurgitant Fraction, RegFrac < 50%) or the high-risk category (RegFrac ≥ 50%) based on their regurgitant fraction. The primary endpoint was all-cause mortality.

RESULTS: A total of 572 patients were included. During a median follow-up of 3.8 years there were 254 deaths (44%). On multivariable analysis, the proposed thresholds for FMR severity remained independently associated with all-cause mortality (adjusted hazard ratio: 1.488; 95% confidence interval [CI]: 1.110-2.013; p-value = 0.010). This algorithm demonstrated superior discriminative ability (C-statistic: 0.664) compared to contemporary guidelines (C-statistic: 0.522; p-value for comparison < 0.001). Additionally, it resulted in a significant improvement in the net reclassification index (0.162; p-value < 0.001).

CONCLUSIONS: Within our cohort, the application of the proposed concept demonstrated a significant association with a higher risk of all-cause mortality. Moreover, this conceptual framework showcased the potential to improve the accuracy of risk prediction beyond current guidelines.

PMID:37530972 | DOI:10.1007/s10554-023-02920-z

Int J Cardiovasc Imaging. 2023 Aug 2. doi: 10.1007/s10554-023-02923-w. Online ahead of print.

ABSTRACT

Right ventricular (RV) function is a determining factor for clinical outcomes in patients undergoing tricuspid valve surgery (TVS). Our aim was to investigate the importance of the function of the right ventricular outflow tract (RVOT), which is an important anatomical region of the RV, in patients underwent TVS. 104 patients who underwent TVS were analyzed retrospectively. Patients with previous cardiac surgery, congenital heart disease, or heart failure were excluded. The parasternal short-axis view at the level of the aortic root was used to measure RVOT dimensions and RVOT fractional shortening (RVOT-FS). The effect of RVOT diameter and function on major adverse cardiac events (MACE) after TVS was investigated. In our study, MACE, consisting of pacemaker implantation, acute kidney injury, postoperative atrial fibrillation and mortality, was developed at 44 (42.3%) patients.We compared the predictive performances of RVOT end-systolic (RVOTs) diameter, RVOT end-diastolic (RVOTd) diameter, RVOT-FS and RV diameters in prediction of MACE. The model including the RVOTs had higher AUC, R2 and likelihood ratio X2 values (0.775, 0.287 and 25.0, respectively) than RVOTd (0.770, 0.279 and 24.2, respectively) and RVOT-FS (0.750, 0.215 and 18.1, respectively). RVOT diameters showed better performance in predicting MACE than RV diameters. Moreover, there was statistically significant association between RVOTs, RVOTd and MACE (p value were 0.014 and 0.027, respectively), while no association between RVOT-FS and MACE (p value was 0.177). In summary, we determined that the RVOT diameters are important predictors for the in-hospital clinical outcomes of patients who underwent TVS.

PMID:37530971 | DOI:10.1007/s10554-023-02923-w

Adv Health Sci Educ Theory Pract. 2023 Aug 2. doi: 10.1007/s10459-023-10269-0. Online ahead of print.

ABSTRACT

Education in Doctor of Medicine programs has moved towards an emphasis on clinical competency, with entrustable professional activities providing a framework of learning objectives and outcomes to be assessed within the clinical environment. While the identification and structured definition of objectives and outcomes have evolved, many methods employed to assess clerkship students’ clinical skills remain relatively unchanged. There is a paucity of medical education research applying advanced statistical design and analytic techniques to investigate the validity of clinical skills assessment. One robust statistical method, multitrait-multimethod matrix analysis, can be applied to investigate construct validity across multiple assessment instruments and settings. Four traits were operationalized to represent the construct of critical clinical skills (professionalism, data gathering, data synthesis, and data delivery). The traits were assessed using three methods (direct observations by faculty coaches, clinical workplace-based evaluations, and objective structured clinical examination type clinical practice examinations). The four traits and three methods were intercorrelated for the multitrait-multimethod matrix analysis. The results indicated reliability values in the adequate to good range across the three methods with the majority of the validity coefficients demonstrating statistical significance. The clearest evidence for convergent and divergent validity was with the professionalism trait. The correlations on the same method/different traits analyses indicated substantial method effect; particularly on clinical workplace-based assessments. The multitrait-multimethod matrix approach, currently underutilized in medical education, could be employed to explore validity evidence of complex constructs such as clinical skills. These results can inform faculty development programs to improve the reliability and validity of assessments within the clinical environment.

PMID:37530967 | DOI:10.1007/s10459-023-10269-0

Qual Life Res. 2023 Aug 2. doi: 10.1007/s11136-023-03484-0. Online ahead of print.

ABSTRACT

PURPOSE: To determine if video-based educational intervention compared to the standard verbal guidelines, provided to caregivers on home-based palliative care could enhance the quality of life (QoL) in advanced head and neck cancer (HNC) patients.

METHODS: The study employed a prospective, two-arm parallel-group, randomized controlled trial design. Investigators prepared a real-world demonstrational video of ten minutes duration regarding home-based care for family caregivers, with voice-over in Odia language (Eastern India). The contents of the video addressed the management of common problems in palliative care among HNC patients. This study included 180 participants, 90 patient & caregiver dyads randomized to interventional (video-based education) or control (verbal instruction) groups. Patients’ QoL was measured at baseline and 3 weeks follow-up using EORTC QLQ C30. Data were analyzed descriptively, and the Chi-square, Mann-Whitney U, T-test, spearman correlation, and multiple hierarchical regression analyses were employed for statistical analysis, with a significance level of p < 0.05.

RESULTS: Seventy participant dyads completed the planned two assessments: baseline and at the end of 3rd week (Intervention = 37; Control = 33). The intervention group showed a significant improvement in the patient’s health-related QoL, physical, emotional, and social functioning. Symptom burden reduction was observed for pain, nausea, and fatigue. A significant increase in the change in QoL with the video-based education group (VBE) compared to the verbal instruction (VI) group after adjusting for age, gender, physical functioning, and pain symptomology (adjusted R² = 0.402) was noted.

CONCLUSION: VBE intervention using smart-phone may offer caregivers a viable means of enhancing self-management while improving patients’ QoL within the socio-cultural challenges for home-based palliative care in India. Further research on training caregivers using digital interventions and home-based visits is recommended.

TRIAL REGISTRATION NUMBER: CTRI/2021/06/034473 [Registered on: 30/06/2021].

PMID:37530959 | DOI:10.1007/s11136-023-03484-0