Tag: nevin manimala

Nat Commun. 2023 Jul 25;14(1):4254. doi: 10.1038/s41467-023-39810-w.

ABSTRACT

The Atlantic meridional overturning circulation (AMOC) is a major tipping element in the climate system and a future collapse would have severe impacts on the climate in the North Atlantic region. In recent years weakening in circulation has been reported, but assessments by the Intergovernmental Panel on Climate Change (IPCC), based on the Climate Model Intercomparison Project (CMIP) model simulations suggest that a full collapse is unlikely within the 21st century. Tipping to an undesired state in the climate is, however, a growing concern with increasing greenhouse gas concentrations. Predictions based on observations rely on detecting early-warning signals, primarily an increase in variance (loss of resilience) and increased autocorrelation (critical slowing down), which have recently been reported for the AMOC. Here we provide statistical significance and data-driven estimators for the time of tipping. We estimate a collapse of the AMOC to occur around mid-century under the current scenario of future emissions.

PMID:37491344 | DOI:10.1038/s41467-023-39810-w

Orphanet J Rare Dis. 2023 Jul 25;18(1):211. doi: 10.1186/s13023-023-02811-5.

ABSTRACT

BACKGROUND: The natural history of skeletal complications in achondroplasia (ACH) is well-described. However, it remains unclear how the rates of non-skeletal complications, surgical procedures, healthcare needs and mortality differ between individuals with ACH and the general population. This study aimed to contextualise the extent of these outcomes by comparing event rates across the lifespan, between those with ACH and matched controls in a United Kingdom (UK) population.

METHODS: This retrospective, matched cohort study used data from national UK databases: the Clinical Practice Research Database (CPRD) GOLD from primary care, the secondary care Hospital Episode Statistics (HES) databases and the Office of National Statistics mortality records. ACH cases were identified using disorder-specific Read Codes or International Classification of Diseases 10th Revision codes. For each ACH case, up to four age- and sex-matched controls (defined as those without evidence of skeletal/growth disorders) were included. Event rates per 100 person-years were calculated for a pre-defined set of complications (informed by reviews of existing ACH literature and discussion with clinical authors), healthcare visits and mortality. Rate ratios (RRs) with 95% confidence intervals (CIs) were used to compare case and control cohorts.

RESULTS: 541 ACH cases and 2052 controls were identified for the CPRD cohort; of these, 275 cases and 1064 matched controls had linkage to HES data. Approximately twice as many non-skeletal complications were reported among individuals with ACH versus controls (RR [95% CI] 1.80 [1.59-2.03]). Among ACH cases, a U-shaped distribution of complications was observed across age groups, whereby the highest complication rates occurred at < 11 and > 60 years of age. Individuals with ACH had greater needs for medication, GP referrals to specialist care, medical imaging, surgical procedures and healthcare visits versus controls, as well as a mortality rate of almost twice as high.

CONCLUSIONS: Patients with ACH experience high rates of a range of both skeletal and non-skeletal complications across their lifespan. To manage these complications, individuals with ACH have significantly increased healthcare needs compared to the general population. These results underscore the need for more coordinated and multidisciplinary management of people with ACH to improve health outcomes across the lifespan.

PMID:37491331 | DOI:10.1186/s13023-023-02811-5

Nat Commun. 2023 Jul 25;14(1):4473. doi: 10.1038/s41467-023-40069-4.

ABSTRACT

Measurement error in polygenic indices (PGIs) attenuates the estimation of their effects in regression models. We analyze and compare two approaches addressing this attenuation bias: Obviously Related Instrumental Variables (ORIV) and the PGI Repository Correction (PGI-RC). Through simulations, we show that the PGI-RC performs slightly better than ORIV, unless the prediction sample is very small (N < 1000) or when there is considerable assortative mating. Within families, ORIV is the best choice since the PGI-RC correction factor is generally not available. We verify the empirical validity of the simulations by predicting educational attainment and height in a sample of siblings from the UK Biobank. We show that applying ORIV between families increases the standardized effect of the PGI by 12% (height) and by 22% (educational attainment) compared to a meta-analysis-based PGI, yet estimates remain slightly below the PGI-RC estimates. Furthermore, within-family ORIV regression provides the tightest lower bound for the direct genetic effect, increasing the lower bound for the standardized direct genetic effect on educational attainment from 0.14 to 0.18 (+29%), and for height from 0.54 to 0.61 (+13%) compared to a meta-analysis-based PGI.

PMID:37491308 | DOI:10.1038/s41467-023-40069-4

BMC Med Educ. 2023 Jul 25;23(1):530. doi: 10.1186/s12909-023-04479-8.

ABSTRACT

BACKGROUND: The traditional Chinese dentistry classroom teaching model focuses on the instruction of knowledge details, but less on the frameworks and learners’ motivation. Here, we introduced a combination of mind mapping and PBL instruction (MBL)into the prosthodontics course for Chinese dental students. This study aimed to evaluate the effectiveness and efficiency of MBL in prosthodontics and make observations from the students’ perspectives, based on their response with the learning process.

METHODS: We prospectively enrolled 56 fourth-year undergraduates of stomatology, and these participants were randomly allocated into either the combined mind map teaching group (MBL) or the problem-based learning group (PBL) to attend the prosthodontics course. An anonymous questionnaire was also administered to both groups to evaluate the students’ perceptions and experiences, using closed and open-ended items. Data were analyzed using descriptive statistics and thematic analysis.

RESULTS: The students’ responses to closed items indicate their experience in PBL and MBL to be positive, including increased motivation, improved memory of knowledge, enhanced discipline connection and raised teamwork, with fairly higher ratings for the MBL group. However, the tutor-guided competence scores including the memory and framework part, were significantly higher for MBL group than PBL group (two-way ANOVA, p < 0.01, p < 0.001, respectively). Meanwhile, the self-perceived competence scores including the motivation, framework and teamwork part, were significantly higher for MBL group than PBL group (two-way ANOVA, p < 0.01, p < 0.001, p < 0.05, respectively).

CONCLUSION: Our findings suggest that MBL teaching approach can help in integration of knowledge structure and enhance clinical reasoning. MBL is an effective and well-organized method in prosthodontics course for dental students.

PMID:37491283 | DOI:10.1186/s12909-023-04479-8

Appl Ergon. 2023 Jul 23;113:104096. doi: 10.1016/j.apergo.2023.104096. Online ahead of print.

ABSTRACT

Marksmanship performance while moving is a critical skill among tactical athletes due to the high demands of their occupational duties. Qualifications for dynamic marksmanship performance are not standardized across tactical athlete groups, which may limit comprehensive assessment of tactical athlete performance for situational awareness and adaptability to an unpredictable environment. Although static marksmanship performance provides foundational information on skills and level of ability, research is lacking on factors that influence dynamic marksmanship performance to best prepare tactical athletes for duties. The purpose of this study was to identify whether static marksmanship performance, speed of movement, load carriage, and biomechanical factors while ‘shooting on the move’ influenced dynamic marksmanship performance. Twenty-four male tactical athletes (22 active-duty Army Soldiers, two civilian SWAT operators; age: 23.83 ± 5.47 years; height: 1.80 ± 0.08 m; weight: 81.04 ± 7.87 kg) participated; final analyses did not include data from the two civilian operators to maintain sample homogeneity. Tactical athletes completed static and dynamic (‘shoot on the move’) marksmanship tasks under three load conditions: (1) no load (NL), (2) half kit (HK) of 11.34 kg, and (3) full kit (KIT) of 22.68 kg. Dynamic marksmanship was completed under three speed conditions: (1) self-selected slow speed, (2) standard speed, and (3) self-selected fast speed. Hip, knee, and ankle kinematics were collected via wireless inertial measurement units. Spatiotemporal parameters were collected via optical detection system. Marksmanship performance (accuracy) was collected via open-air acoustic target scoring and mean radial error (MRE) was calculated for both static and dynamic marksmanship tasks. Linear mixed-effects models were fit with dynamic MRE as the outcome variable with fixed effects of static MRE, load condition, speed condition, kinematics, and spatiotemporal parameters, adjusting for body mass. Alpha level was set a priori at p ≤ 0.10. The final statistical model included fixed effects of static MRE, load condition, speed condition, and time spent in double limb support. Static MRE (p < 0.01) and time spent in double limb support (p = 0.01) were significant factors. For each 1 cm increase in static MRE there was a 0.66 cm increase in dynamic MRE. For every 1% increase in time spent in double limb support while ‘shooting on the move’ there was a 0.13 cm increase in dynamic MRE. Findings from this study highlight that tactical athletes who have larger static stance MRE and spend a longer time in double limb support during a gait cycle exhibit an increase in MRE during ‘shoot on the move’ trials. Overall, dynamic shooting accuracy is not affected by lower extremity joint angles, load carriage, or speed of movement. Although strong relationships are known between gait speed, load, and lower extremity kinematics, the differences in tactical gait compared to normal gait and multi-task paradigm that likely favors marksmanship accuracy seem to present novel movement characteristics unique to occupational gait. Further investigation is warranted to identify other potential factors that may improve or worsen dynamic marksmanship performance.

PMID:37490790 | DOI:10.1016/j.apergo.2023.104096

Int J Food Microbiol. 2023 Jul 18;404:110320. doi: 10.1016/j.ijfoodmicro.2023.110320. Online ahead of print.

ABSTRACT

The Gram-positive bacteria lactic acid bacteria (LAB) are used in the food industry but are also known for inhibiting certain food spoilage microorganisms, especially fungi. Sources of nitrogen (N) for culture media are generally organic and expensive. Many attempts have been made to formulate economical culture media with alternative N sources obtained from agricultural and industrial byproducts. This study describes the design and optimization of an inexpensive culture medium for Lactiplantibacillus plantarum (formerly Lactobacillus plantarum) MZ809351 strain B31. The culture medium was optimized using statistical experimental designs to identify the factors with the most significant effects on biomass concentration to reduce the overall cost, aiming to obtain a biomass concentration similar to that obtained with the reference LAB culture medium (de Man, Rogosa and Sharpe; MRS). Sodium acetate and magnesium sulfate were the most significant factors (p < 0.005), and their contents were reduced by 22 % and 40 %, respectively, without affecting biomass concentration. Malt germ extract (MGE) was used as an alternative nitrogen source to replace meat extract (ME) and proteose peptone (PP). Through these experiments, the composition of a culture medium that is less expensive than MRS broth was defined, which produced a biomass concentration (3.8 g/L) similar to that obtained with MRS medium. The inhibitory effects of two LAB strains isolated from the Ivory Coast and Mexico on the growth and production of ochratoxin A (OTA) in an ochratoxigenic fungus was tested. The minimum cellular concentration of the LAB to prevent the development of Aspergillus carbonarius Ac 089 and the production of OTA was determined in a model assay in Petri dishes. The conditions to inhibit the germination of A. carbonarius Ac 089 and the production of OTA were found. Using the optimized medium and a ratio of 2 × 10⁴ LAB/spore (1 × 10⁸ CFU/mL) strain B7 (L. plantarum MZ809351) and 2 × 10³ LAB/spore (1 × 10⁷ CFU/mL) strain B31 (L. plantarum MN922335) completely inhibited the growth of the fungus. A ratio of 2 × 10⁵ LAB/spore (1 × 10⁹ CFU/mL) was required to inhibit OTA production with strains B7 and B31. This study indicates the potential of cultivating LAB in an optimized and inexpensive culture medium for use as a biological control agent against ochratoxigenic fungi in food.

PMID:37490784 | DOI:10.1016/j.ijfoodmicro.2023.110320

Eur J Prev Cardiol. 2023 Jul 25:zwad245. doi: 10.1093/eurjpc/zwad245. Online ahead of print.

ABSTRACT

AIM: We aimed to perform a systematic review and meta-analysis of randomised controlled trials (RCTs) to determine the impact of a polypill-based strategy (PBS) on therapeutic adherence and cardiovascular outcomes compared with usual care for secondary prevention of cardiovascular diseases (CVD).

METHODS: We systematically searched PubMed, Cochrane, and Scopus databases from inception to January 2023, including RCTs comparing PBS to usual care in patients with prior CVD. We assessed efficacy outcomes of therapeutic adherence, systolic blood pressure (SBP) and low-density lipoprotein-cholesterol (LDL-C), and safety outcomes of all-cause and cardiovascular mortality. Statistical analysis was performed with Review Manager 5.4.1 and R Version 4.2.1.

RESULTS: A total of eight RCTs with a population of 6,541 individuals were included, of whom 3,318 (50.7%) were treated with PBS. Follow-up ranged from 6 to 60 months. PBS was associated with a significantly increased therapeutic adherence (risk ratio [RR] 1.22; 95% CI 1.10 to 1.34; p<0.001). Cardiovascular mortality (RR 0.61; 95% CI 0.44 to 0.85; p=0.004), SBP (mean difference [MD] -1.47 mmHg; 95% CI -2.86 to -0.09; p=0.04), and LDL-C (MD -3.83 mg/dL; 95% CI -6.99 to -0.67; p=0.02) were significantly lower in PBS group. The incidence of all-cause mortality was similar between groups (RR 0.83; 95% CI 0.54 to 1.29; p=0.41).

CONCLUSIONS: In patients with pre-existing CVD, a PBS is associated with lower cardiovascular mortality and improved therapeutic adherence, along with a modest decrease in SBP and LDL-C compared with usual care. Thus, PBS may be considered a preferred option for this patient population.

PMID:37490769 | DOI:10.1093/eurjpc/zwad245

Clin Infect Dis. 2023 Jul 25;77(Supplement_2):S156-S170. doi: 10.1093/cid/ciad341.

ABSTRACT

BACKGROUND: Increasing trends of antimicrobial resistance are observed around the world, driven in part by excessive use of antimicrobials. Limited access to diagnostics, particularly in low- and middle-income countries, contributes to diagnostic uncertainty, which may promote unnecessary antibiotic use. We investigated whether introducing a package of diagnostic tools, clinical algorithm, and training-and-communication messages could safely reduce antibiotic prescribing compared with current standard-of-care for febrile patients presenting to outpatient clinics in Uganda.

METHODS: This was an open-label, multicenter, 2-arm randomized controlled trial conducted at 3 public health facilities (Aduku, Nagongera, and Kihihi health center IVs) comparing the proportions of antibiotic prescriptions and clinical outcomes for febrile outpatients aged ≥1 year. The intervention arm included a package of point-of-care tests, a diagnostic and treatment algorithm, and training-and-communication messages. Standard-of-care was provided to patients in the control arm.

RESULTS: A total of 2400 patients were enrolled, with 49.5% in the intervention arm. Overall, there was no significant difference in antibiotic prescriptions between the study arms (relative risk [RR]: 1.03; 95% CI: .96-1.11). In the intervention arm, patients with positive malaria test results (313/500 [62.6%] vs 170/473 [35.9%]) had a higher RR of being prescribed antibiotics (1.74; 1.52-2.00), while those with negative malaria results (348/688 [50.6%] vs 376/508 [74.0%]) had a lower RR (.68; .63-.75). There was no significant difference in clinical outcomes.

CONCLUSIONS: This study found that a diagnostic intervention for management of febrile outpatients did not achieve the desired impact on antibiotic prescribing at 3 diverse and representative health facility sites in Uganda.

PMID:37490746 | DOI:10.1093/cid/ciad341

Clin Infect Dis. 2023 Jul 25;77(Supplement_2):S199-S205. doi: 10.1093/cid/ciad324.

NO ABSTRACT

PMID:37490743 | DOI:10.1093/cid/ciad324

AIDS Care. 2023 Jul 25:1-8. doi: 10.1080/13548506.2023.2229236. Online ahead of print.

ABSTRACT

In Mozambique, women are the most affected by HIV/AIDS and heterosexual encounters remain the main route for HIV/AIDS. Condom use is the most effective method of HIV/AIDS prevention, and the intention to use and buy/get condoms has a significant role in safe sex behavior. This study aimed to evaluate the efficacy of two psychosocial interventions – the Didactic and ACCENT Interventions – to prevent HIV/AIDS among Mozambican Women. Participants were Mozambican women (n = 150), users of the gynecology clinic of the Central Hospital of Beira. The study design was a randomized controlled trial (RCT) with assignment to three groups: Didactic intervention, ACCENT intervention, and Control group. Measures were from an adaption of the Women’s Health Questionnaire, which includes questions about sociodemographic, clinical, and behavioral variables related to HIV prevention/risk. There was a significant group effect on condom use and safer sex preparatory behaviors, F(2, 146) = 6.45, p = .002, with Bonferroni post-hoc tests showing differences between the ACCENT vs. Control groups and ACCENT vs. Didactic groups (all p = .022). There were no statistically significant time effects on both condom use and safer sex preparatory behaviors. Results are promising for HIV/AIDS prevention in Mozambican women at sexual risk, but replication is needed for generalizability of findings.

PMID:37490699 | DOI:10.1080/13548506.2023.2229236