Tag: nevin manimala

Physiother Theory Pract. 2023 Aug 31:1-8. doi: 10.1080/09593985.2023.2253313. Online ahead of print.

ABSTRACT

BACKGROUND: Poststroke shoulder pain (PSSP) is a common poststroke complication. Even though it is a common phenomenon, it is unclear how it impacts the patient’s life.

OBJECTIVE: To investigate the differences in upper extremity function, sleep quality, and functional independence between patients with and without PSSP.

METHODS: This cross-sectional study included 63 participants with stroke (32 patients with PSSP and 31 patients without PSSP). Shoulder pain was evaluated with a Visual Analog Scale and the participants were divided into two groups as those with and without PSSP. The upper extremity function was assessed with the Disabilities of the Arm, Shoulder, and Hand Questionnaire, the Arm Motor Ability Test, and the Nine Hole Peg Test. Sleep quality was assessed with Pittsburgh Sleep Quality Index and the functional independence was assessed with the Functional Independence Measure. All data were analyzed using the program IBM SPSS Statistics 22.0. The Mann-Whitney U test was used to compare the non-normally distributed parameters, and the Chi-square test was used to compare the ordinal variables. The Spearman correlation test was used for the relationship and a linear regression test was used for regression.

RESULTS: Upper extremity function decreased (p < .05), only the sleep disturbance sub-parameter of sleep quality increased (p = .01), and functional independence increased in patients with PSSP (p < .001). There was a moderate relationship between pain and upper extremity function and a fair relationship between pain and sleep quality (use of sleep medications, daytime dysfunction sub-parameters) (p < .05).

CONCLUSIONS: PSSP impairs upper extremity functions, which play an important role in activities of daily living, and reduces functional independence. These results suggest that it is important to evaluate shoulder pain and examine the factors affecting pain in the rehabilitation of patients with stroke.

PMID:37651602 | DOI:10.1080/09593985.2023.2253313

Clin Spine Surg. 2023 Aug 22. doi: 10.1097/BSD.0000000000001512. Online ahead of print.

ABSTRACT

STUDY DESIGN: A retrospective cohort.

OBJECTIVE: We utilize big data and modeling techniques to create optimized comorbidity indices for predicting postoperative outcomes following cervical spine fusion surgery.

SUMMARY OF BACKGROUND DATA: Cervical spine decompression and fusion surgery are commonly used to treat degenerative cervical spine pathologies. However, there is a paucity of high-quality data defining the optimal comorbidity indices specifically in patients undergoing cervical spine fusion surgery.

METHODS: Using data from 2016 to 2019, we queried the Nationwide Readmissions Database (NRD) to identify individuals who had received cervical spine fusion surgery. The Johns Hopkins Adjusted Clinical Groups (JHACG) frailty-defining indicator was used to assess frailty. To measure the level of comorbidity, Elixhauser Comorbidity Index (ECI) scores were queried. Receiver operating characteristic curves were developed utilizing comorbidity indices as predictor variables for pertinent complications such as mortality, nonroutine discharge, top-quartile cost, top-quartile length of stay, and 1-year readmission.

RESULTS: A total of 453,717 patients were eligible. Nonroutine discharges occurred in 93,961 (20.7%) patients. The mean adjusted all-payer cost for the procedure was $22,573.14±18,274.86 (top quartile: $26,775.80) and the mean length of stay was 2.7±4.4 days (top quartile: 4.7 d). There were 703 (0.15%) mortalities and 58,254 (12.8%) readmissions within 1 year postoperatively. Models using frailty+ECI as primary predictors consistently outperformed the ECI-only model with statistically significant P-values for most of the complications assessed. Cost and mortality were the only outcomes for which this was not the case, as frailty outperformed both ECI and frailty+ECI in cost (P<0.0001 for all) and frailty+ECI performed as well as ECI alone in mortality (P=0.10).

CONCLUSIONS: Our data suggest that frailty+ECI may most accurately predict clinical outcomes in patients receiving cervical spine fusion surgery. These models may be used to identify high-risk populations and patients who may necessitate greater resource utilization following elective cervical spinal fusion.

PMID:37651572 | DOI:10.1097/BSD.0000000000001512

Ther Drug Monit. 2023 Aug 24. doi: 10.1097/FTD.0000000000001137. Online ahead of print.

NO ABSTRACT

PMID:37651569 | DOI:10.1097/FTD.0000000000001137

Clin Spine Surg. 2023 Aug 15. doi: 10.1097/BSD.0000000000001506. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to show the correction maneuvers used in scoliosis surgery and give hints and tips on achieving optimal correction with the help of visual content.

MATERIALS AND METHODS: Seventy-two scoliosis patients with 96 major curves operated between 2011 and 2018 evaluated retrospectively. Seven different correction maneuvers (Ucar convex rod rotation technique, cantilever technique, convex double-rod rotation technique, convex double-rod translation technique, double-rod rotation with coronal bending, convex rod rotation with coronal bending, direct vertebral rotation) were used in these surgeries alone or together. Each method is explained with figures and videos. Type of scoliosis, follow-up time, age, preoperative and postoperative degree of curvature, amount of correction, surgical time, amount of transfusion, hemoglobin level, and hospital stay were evaluated.

RESULTS: The mean follow-up was 42.5 (24-108) months, and the mean age was 15.8 (12-29) years. The mean preoperative scoliosis angle of the patients was 75.9 (50-139) degrees, and the final follow-up was 15.6 (5-40) degrees. The scoliotic deformity correction rate was 79.3%. The mean preoperative thoracic kyphosis of the patients was 58.7 (12-110) degrees, and the final follow-up was 41.2 (25-62) degrees. The mean surgical time was 293 (160-440) minutes. The mean hospitalization length was 5.8 (2-21) days. The blood delivered to patients during surgery and postoperative was 715 (300-1800) mL. There was a statistically significant difference between the preoperative and final follow-up scoliosis angle (P=0.000).

CONCLUSIONS: Providing an ideal correction without damaging the spinal cord depends on correctly applying the correction maneuvers. The use of correction maneuvers alone or in combination in the appropriate order will shorten the duration of the case, decrease the amount of bleeding, shorten the hospital stay, increase the amount of correction, and reduce complications.

PMID:37651561 | DOI:10.1097/BSD.0000000000001506

J Bone Joint Surg Am. 2023 Aug 31. doi: 10.2106/JBJS.22.01278. Online ahead of print.

ABSTRACT

BACKGROUND: We hypothesized that an opioid-free (OF), multimodal pain management pathway for thumb carpometacarpal (CMC) joint arthroplasty would not have inferior pain control compared with that of a standard opioid-containing (OC) pathway.

METHODS: This was a single-center, randomized controlled clinical trial of patients undergoing primary thumb CMC joint arthroplasty. Patients were randomly allocated to either a completely OF analgesic pathway or a standard OC analgesic pathway. Patients in both cohorts received a preoperative brachial plexus block utilizing 30 mL of 0.5% ropivacaine that was administered via ultrasound guidance. The OF group was given a combination of cryotherapy, anti-inflammatory medications, acetaminophen, and gabapentin. The OC group was only given cryotherapy and opioid-containing medication for analgesia. Patient-reported pain was assessed with use of a 0 to 10 numeric rating scale at 24 hours, 2 weeks, and 6 weeks postoperatively. We compared the demographics, opioid-related side effects, patient satisfaction, and Veterans RAND 12-Item Health Survey (VR-12) results between these 2 groups.

RESULTS: At 24 hours postoperatively, pain scores in the OF group were statistically noninferior to, and lower than, those in the OC group (median, 2 versus 4; p = 0.008). Pain scores continued to differ significantly at 2 weeks postoperatively (median, 2 versus 4; p = 0.001) before becoming more similar at 6 weeks (p > 0.05). No difference was found between groups with respect to opioid-related side effects, patient satisfaction, or VR-12 results.

CONCLUSIONS: A completely opioid-free perioperative protocol is effective for the treatment of pain following thumb CMC joint arthroplasty in properly selected patients.

LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

PMID:37651550 | DOI:10.2106/JBJS.22.01278

Science. 2023 Sep;381(6661):995-998. doi: 10.1126/science.ade9803. Epub 2023 Aug 31.

ABSTRACT

Calculus, the study of change in processes and systems, serves as the foundation for many STEM disciplines. Traditional, lecture-based calculus instruction may present a barrier for students seeking STEM degrees, limit their access to STEM professions, and block their potential to address society’s challenges. A large-scale pragmatic trial with randomized student allocation was conducted to compare two calculus instruction styles: active student engagement (treatment condition) versus traditional, lecture-based instruction (control condition). A sample of 811 university students were studied across 32 sections taught by 19 instructors over three semesters at a large, US-based Hispanic-serving institution. Large effect sizes were consistently measured for student learning outcomes in the treatment condition, which demonstrates a new standard for calculus instruction and increased opportunities for completion of STEM degrees.

PMID:37651531 | DOI:10.1126/science.ade9803

IEEE Trans Neural Netw Learn Syst. 2023 Aug 31;PP. doi: 10.1109/TNNLS.2023.3259149. Online ahead of print.

ABSTRACT

Short-term load forecasting (STLF) is challenging due to complex time series (TS) which express three seasonal patterns and a nonlinear trend. This article proposes a novel hybrid hierarchical deep-learning (DL) model that deals with multiple seasonality and produces both point forecasts and predictive intervals (PIs). It combines exponential smoothing (ES) and a recurrent neural network (RNN). ES extracts dynamically the main components of each individual TS and enables on-the-fly deseasonalization, which is particularly useful when operating on a relatively small dataset. A multilayer RNN is equipped with a new type of dilated recurrent cell designed to efficiently model both short and long-term dependencies in TS. To improve the internal TS representation and thus the model’s performance, RNN learns simultaneously both the ES parameters and the main mapping function transforming inputs into forecasts. We compare our approach against several baseline methods, including classical statistical methods and machine learning (ML) approaches, on STLF problems for 35 European countries. The empirical study clearly shows that the proposed model has high expressive power to solve nonlinear stochastic forecasting problems with TS including multiple seasonality and significant random fluctuations. In fact, it outperforms both statistical and state-of-the-art ML models in terms of accuracy.

PMID:37651485 | DOI:10.1109/TNNLS.2023.3259149

PLoS One. 2023 Aug 31;18(8):e0290663. doi: 10.1371/journal.pone.0290663. eCollection 2023.

ABSTRACT

BACKGROUND: Serotonergic brain signaling is considered critical for an appropriate and dynamic adaptation to stress, seemingly through modulating limbic system functions, such as the hypothalamic-pituitary-adrenal (HPA)-axis. This interplay is of great interest since it holds promise as a target for preventing stress-related brain disorders, e.g., major depression. Our group has previously observed that prefrontal serotonin transporter (5-HTT) binding, imaged with positron emission tomography (PET), is positively associated with the cortisol awakening response (CAR), an index of HPA axis stress hormone dynamics. The aim of this cross-sectional study was to replicate the previous finding in a larger independent group of healthy individuals.

METHODS: Molecular imaging and cortisol data were available for 90 healthy individuals. Prefrontal 5-HTT binding was imaged with [11C]DASB brain PET. Non-displaceable 5-HTT binding potential (BPND) was quantified using the Multilinear Reference Tissue Model 2 (MRTM2) with cerebellum as the reference region. CAR was based on five serial salivary cortisol samples within the first hour upon awakening. The association between CAR and prefrontal 5-HTT BPND was evaluated using a multiple linear regression model adjusted for age and sex. Further, we tested for sex differences in the association. Finally, an exploratory analysis of the association, was performed in 8 additional brain regions.

RESULTS: We observed no statistically significant association between 5-HTT binding and CAR corrected for age and sex in the prefrontal cortex (β = -0.28, p = 0.26). We saw no interaction with sex on the association (p = 0.99).

CONCLUSION: We could not confirm a positive association between CAR and prefrontal 5-HTT BPND in this independent dataset. Also, sex differences in the association were not apparent. Our data do not exclude that the serotonin transporter system is involved in the regulation of stress responses in at-risk or manifest depressed states.

PMID:37651457 | DOI:10.1371/journal.pone.0290663

PLoS One. 2023 Aug 31;18(8):e0290819. doi: 10.1371/journal.pone.0290819. eCollection 2023.

ABSTRACT

Anthropogenic activities can lead to changes in animal behavior. Predicting population consequences of these behavioral changes requires integrating short-term individual responses into models that forecast population dynamics across multiple generations. This is especially challenging for long-lived animals, because of the different time scales involved. Beaked whales are a group of deep-diving odontocete whales that respond behaviorally when exposed to military mid-frequency active sonar (MFAS), but the effect of these nonlethal responses on beaked whale populations is unknown. Population consequences of aggregate exposure to MFAS was assessed for two beaked whale populations that are regularly present on U.S. Navy training ranges where MFAS is frequently used. Our approach integrates a wide range of data sources, including telemetry data, information on spatial variation in habitat quality, passive acoustic data on the temporal pattern of sonar use and its relationship to beaked whale foraging activity, into an individual-based model with a dynamic bioenergetic module that governs individual life history. The predicted effect of disturbance from MFAS on population abundance ranged between population extinction to a slight increase in population abundance. These effects were driven by the interaction between the temporal pattern of MFAS use, baseline movement patterns, the spatial distribution of prey, the nature of beaked whale behavioral response to MFAS and the top-down impact of whale foraging on prey abundance. Based on these findings, we provide recommendations for monitoring of marine mammal populations and highlight key uncertainties to help guide future directions for assessing population impacts of nonlethal disturbance for these and other long-lived animals.

PMID:37651444 | DOI:10.1371/journal.pone.0290819

PLoS One. 2023 Aug 31;18(8):e0291046. doi: 10.1371/journal.pone.0291046. eCollection 2023.

ABSTRACT

BACKGROUND: Hand grip strength (HGS) is related to arthritis and all-cause mortality. Many studies have examined the association between HGS and arthritis, but these studies did not consider relative HGS indices. The objectives of this study were to examine the association between arthritis and HGS indices in an older Korean population and to compare an absolute HGS index and a relative HGS indices.

METHODS: In a large-scale cross-sectional study, a total of 16,860 subjects older than 50 years from the Korea National Health and Nutrition Survey from 2014 to 2019 were included for statistical analysis. A binary logistic regression model was used to examine the association between arthritis and HGS indices in crude and covariate-adjusted models.

RESULTS: In the crude analysis, all anthropometric and HGS indices were associated with arthritis except for weight in men. In adjusted models 1 and 2, among the anthropometric indices, waist circumference (WC) and waist-to-height ratio (WHtR) were associated with arthritis in men but not in women. Absolute HGS and all relative HGS indices showed a negative association with arthritis among both men and women, and the magnitude of the association of arthritis with the absolute HGS index and the relative HGS indices was similar. However, the magnitude of the association between all HGS indices and arthritis was higher for men than for women except in the crude analysis.

DISCUSSION: Absolute and relative HGS indices had negative associations with arthritis, and the magnitude of the association between the absolute HGS index and arthritis and between the relative HGS indices and arthritis was similar in all models. To our knowledge, this is the first report of an association between arthritis and relative HGS indices, which was not observed in previous studies.

PMID:37651431 | DOI:10.1371/journal.pone.0291046