Tag: nevin manimala

Proc Natl Acad Sci U S A. 2023 Jun 20;120(25):e2217322120. doi: 10.1073/pnas.2217322120. Epub 2023 Jun 13.

ABSTRACT

Congressional district lines in many US states are drawn by partisan actors, raising concerns about gerrymandering. To separate the partisan effects of redistricting from the effects of other factors including geography and redistricting rules, we compare possible party compositions of the US House under the enacted plan to those under a set of alternative simulated plans that serve as a nonpartisan baseline. We find that partisan gerrymandering is widespread in the 2020 redistricting cycle, but most of the electoral bias it creates cancels at the national level, giving Republicans two additional seats on average. Geography and redistricting rules separately contribute a moderate pro-Republican bias. Finally, we find that partisan gerrymandering reduces electoral competition and makes the partisan composition of the US House less responsive to shifts in the national vote.

PMID:37310996 | DOI:10.1073/pnas.2217322120

JMIR Res Protoc. 2023 Jun 13;12:e41981. doi: 10.2196/41981.

ABSTRACT

BACKGROUND: Psychosocial interventions delivered by nonspecialists can be effective at reducing common adolescent mental health problems in low-resource settings. However, there is a lack of evidence on resource-efficient methods for building capacity to deliver these interventions.

OBJECTIVE: The objective of this study is to evaluate the effects of a digital training (DT) course, delivered in a self-guided format or with coaching, on nonspecialists’ competency to deliver a problem-solving intervention intended for adolescents with common mental health problems in India.

METHODS: We will conduct a pre-post study with a nested parallel, 2-arm, individually randomized controlled trial. The study aims to recruit 262 participants, randomized 1:1 to receive either a self-guided DT course or a DT course with weekly individualized coaching provided remotely by telephone. In both arms, the DT will be accessed over 4 to 6 weeks. Participants will be nonspecialists (ie, without prior practice-based training in psychological therapies) recruited from among university students and affiliates of nongovernmental organizations in Delhi and Mumbai, India.

RESULTS: Outcomes will be assessed at baseline and 6 weeks post randomization using a knowledge-based competency measure that incorporates a multiple-choice quiz format. The primary hypothesis is that self-guided DT will lead to increased competency scores among novices with no prior experience of delivering psychotherapies. The secondary hypothesis is that digital training with coaching will have an incremental effect on competency scores compared with DT alone. The first participant was enrolled on April 4, 2022.

CONCLUSIONS: The study will address an evidence gap on the effectiveness of training methods for nonspecialist providers of adolescent mental health interventions in low-resource settings. The findings from this study will be used to support wider efforts to scale up evidence-based mental health interventions for young people.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05290142; https://clinicaltrials.gov/ct2/show/NCT05290142.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/41981.

PMID:37310781 | DOI:10.2196/41981

Acta Obstet Gynecol Scand. 2023 Jun 13. doi: 10.1111/aogs.14591. Online ahead of print.

ABSTRACT

INTRODUCTION: Fetal heart rate (FHR) monitoring is routine in intrapartum care worldwide and one of the most common obstetrical procedures. Intrapartum FHR monitoring helps assess fetal wellbeing and interpretation of the FHR help form decisions for clinical management and intervention. It relies on the observers’ subjective assessments, with variation in interpretations leading to variations in intrapartum care. The purpose of this systematic review was to summarize and evaluate extant inter- and intrarater reliability research on the human interpretation of intrapartum FHR monitoring.

MATERIAL AND METHODS: We searched for the terms “fetal heart rate monitoring,” “interpretation agreement” and related concepts on Embase, Medline, Maternity and Infant Care Database and CINAHL. The last search was made on January 31, 2022. The protocol for the study was prospectively registered in PROSPERO (CRD42021260937). Studies that assess inter- and intrarater reliability and agreement of health professionals’ intrapartum FHR monitoring were included and studies including other assessment of fetal wellbeing excluded. We extracted data in reviewer pairs using quality appraisal tool for studies of diagnostic reliability (QAREL) forms. The data retrieved from the studies are presented as narrative synthesis and in additional tables.

RESULTS: Forty-nine articles concerning continuous FHR monitoring were included in the study. For interrater reliability and agreement, in total 577 raters assessed 6315 CTG tracings. There was considerable heterogeneity in quality and measures across the included articles. We found higher reliability and agreement for the basic FHR features than for overall classification and higher agreement for intrarater reliability and agreement than for their interrater counterparts.

CONCLUSIONS: There is great variation in reliability and agreement measures for continuous intrapartum FHR monitoring, implying that intrapartum CTG should be used with caution for clinical decision making given its questionable reliability. We found few high-quality studies and noted methodological concerns in the studies. We recommend a more standardized approach to future reliability studies on FHR monitoring.

PMID:37310765 | DOI:10.1111/aogs.14591

Ophthalmic Surg Lasers Imaging Retina. 2023 Jun 1:1-3. doi: 10.3928/23258160-20230522-01. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Characteristics of vitreoretinal surgery fellowship program directors (PDs) in North America are not well described. This study reports on the gender and research productivity of vitreoretinal surgery PDs in the United States and Canada.

MATERIALS AND METHODS: We reviewed demographics, total number of Scopus-indexed publications, h-index, and m-quotient for vitreoretinal surgery fellowship PDs in 2022. Descriptive statistics, student t-tests, χ² tests, and logistic regression analyses were performed.

RESULTS: Information was obtained on 83/89 (93%) PDs; 86% were male, and 84% did not have an additional graduate degree. The mean publication count was 81.54 (SD: 90.33) and mean h-index was 20.61 (SD: 16.49). There were no significant differences between female and male fellowship PDs with respect to number of publications, h-indices, and m-quotients.

CONCLUSION: Women were underrepresented among vitreoretinal fellowship PDs although they had similar research productivity as their male colleagues. [Ophthalmic Surg Lasers Imaging Retina 2023;54:xx-xx.].

PMID:37310752 | DOI:10.3928/23258160-20230522-01

Am J Occup Ther. 2023 May 1;77(3):7703205080. doi: 10.5014/ajot.2023.050089.

ABSTRACT

IMPORTANCE: To fulfill their societal role, occupational therapists need to exist in sufficient supply, be equitably distributed, and meet competency standards. Occupational therapy workforce research is instrumental in reaching these aims, but its global status is unknown.

OBJECTIVE: To map the volume and nature (topics, methods, geography, funding) of occupational therapy workforce research worldwide.

DATA SOURCES: Six scientific databases (MEDLINE/PubMed, Scopus, CINAHL, Web of Science Core Collection, PDQ-Evidence for Informed Health Policymaking, OTseeker), institutional websites, snowballing, and key informants.

STUDY SELECTION AND DATA COLLECTION: Research articles of any kind were included if they involved data regarding occupational therapists and addressed 1 of 10 predefined workforce research categories. Two reviewers were used throughout study selection. No language or time restrictions applied, but the synthesis excluded publications before 1996. A linear regression examined the publications’ yearly growth.

FINDINGS: Seventy-eight studies met the inclusion criteria, 57 of which had been published since 1996. Although significant (p < .01), annual publication growth was weak (0.07 publications/yr). “Attractiveness and retention” was a common topic (27%), and cross-sectional surveys were frequent study designs (53%). Few studies used inferential statistics (39%), focused on resource-poor countries (11%), used standardized instruments (10%), or tested a hypothesis (2%). Only 30% reported funding; these studies had stronger methodology: 65% used inferential statistics, and just 6% used exploratory cross-sectional surveys.

CONCLUSIONS AND RELEVANCE: Worldwide occupational therapy workforce research is scant and inequitably distributed, uses suboptimal methods, and is underfunded. Funded studies used stronger methods. Concerted efforts are needed to strengthen occupational therapy workforce research. What This Article Adds: This review highlights the opportunity to develop a stronger, evidence-based strategy for workforce development and professional advocacy.

PMID:37310749 | DOI:10.5014/ajot.2023.050089

Am J Occup Ther. 2023 May 1;77(3):7703205040. doi: 10.5014/ajot.2023.050109.

ABSTRACT

IMPORTANCE: The Integrative Medication Self-Management Intervention (IMedS) is a manualized occupational therapy intervention designed to improve adherence to medications. The intervention influences medication adherence and facilitates new medication habits and routines; however, it has not been tested in a community clinical setting.

OBJECTIVE: To test the efficacy of the IMedS to address medication adherence rates among community-dwelling adults with hypertension (HTN), Type 2 diabetes mellitus (T2DM), or both.

DESIGN: Randomized controlled trial using a pretest-posttest control group design.

SETTING: Primary care clinic in a large federally qualified health center.

PARTICIPANTS: Adults with uncontrolled HTN, T2DM, or both.

INTERVENTION: Participants were divided into two groups: The control group received treatment as usual (TAU) per the primary care protocol, and the intervention IMedS group received TAU and the IMedS intervention.

OUTCOMES AND MEASURES: Primary outcome: seven-item version of the Adherence to Refills and Medication Scale (ARMS-7), pill count, blood pressure, hemoglobin A1c, or all of these.

RESULTS: The proportion of adherent participants increased in both groups, but between groups, changes were not statistically significant. Post hoc comparisons of the results of a mixed analysis of variance for ARMS-7 measurements indicated that the occupational therapy intervention had a unique effect, compared with that for the TAU control group (dc = 0.65). Effect scores for pill count (d = 0.55) also suggested that the occupational therapy intervention positively affected adherence.

CONCLUSIONS AND RELEVANCE: Occupational therapists can provide assessment and intervention to positively influence medication adherence in a primary care setting. What This Article Adds: This article provides a better understanding of the occupational therapist’s role in addressing medication management and adherence on the interdisciplinary primary care medical team.

PMID:37310747 | DOI:10.5014/ajot.2023.050109

JAMA Netw Open. 2023 Jun 1;6(6):e2318132. doi: 10.1001/jamanetworkopen.2023.18132.

ABSTRACT

IMPORTANCE: The clinical value of current multifactorial algorithms for individualized assessment of dementia risk remains unclear.

OBJECTIVE: To evaluate the clinical value associated with 4 widely used dementia risk scores in estimating 10-year dementia risk.

DESIGN, SETTING, AND PARTICIPANTS: This prospective population-based UK Biobank cohort study assessed 4 dementia risk scores at baseline (2006-2010) and ascertained incident dementia during the following 10 years. Replication with a 20-year follow-up was based on the British Whitehall II study. For both analyses, participants who had no dementia at baseline, had complete data on at least 1 dementia risk score, and were linked to electronic health records from hospitalizations or mortality were included. Data analysis was conducted from July 5, 2022, to April 20, 2023.

EXPOSURES: Four existing dementia risk scores: the Cardiovascular Risk Factors, Aging and Dementia (CAIDE)-Clinical score, the CAIDE-APOE-supplemented score, the Brief Dementia Screening Indicator (BDSI), and the Australian National University Alzheimer Disease Risk Index (ANU-ADRI).

MAIN OUTCOMES AND MEASURES: Dementia was ascertained from linked electronic health records. To evaluate how well each score predicted the 10-year risk of dementia, concordance (C) statistics, detection rate, false-positive rate, and the ratio of true to false positives were calculated for each risk score and for a model including age alone.

RESULTS: Of 465 929 UK Biobank participants without dementia at baseline (mean [SD] age, 56.5 [8.1] years; range, 38-73 years; 252 778 [54.3%] female participants), 3421 were diagnosed with dementia at follow-up (7.5 per 10 000 person-years). If the threshold for a positive test result was calibrated to achieve a 5% false-positive rate, all 4 risk scores detected 9% to 16% of incident dementia and therefore missed 84% to 91% (failure rate). The corresponding failure rate was 84% for a model that included age only. For a positive test result calibrated to detect at least half of future incident dementia, the ratio of true to false positives ranged between 1 to 66 (for CAIDE-APOE-supplemented) and 1 to 116 (for ANU-ADRI). For age alone, the ratio was 1 to 43. The C statistic was 0.66 (95% CI, 0.65-0.67) for the CAIDE clinical version, 0.73 (95% CI, 0.72-0.73) for the CAIDE-APOE-supplemented, 0.68 (95% CI, 0.67-0.69) for BDSI, 0.59 (95% CI, 0.58-0.60) for ANU-ADRI, and 0.79 (95% CI, 0.79-0.80) for age alone. Similar C statistics were seen for 20-year dementia risk in the Whitehall II study cohort, which included 4865 participants (mean [SD] age, 54.9 [5.9] years; 1342 [27.6%] female participants). In a subgroup analysis of same-aged participants aged 65 (±1) years, discriminatory capacity of risk scores was low (C statistics between 0.52 and 0.60).

CONCLUSIONS AND RELEVANCE: In these cohort studies, individualized assessments of dementia risk using existing risk prediction scores had high error rates. These findings suggest that the scores were of limited value in targeting people for dementia prevention. Further research is needed to develop more accurate algorithms for estimation of dementia risk.

PMID:37310738 | DOI:10.1001/jamanetworkopen.2023.18132

J Women Aging. 2023 Jun 13:1-19. doi: 10.1080/08952841.2023.2222638. Online ahead of print.

ABSTRACT

AIMS: The overarching goal of the present study was to examine the contribution of various sources of empowerment to mental health during retirement with an added emphasis on gender differences. The empowerment sources that were examined corresponded with three distinct ecological systems: (1) Chronosystem-resource gains from the pre- to post-retirement period and satisfaction with the prior working period; (2) Microsystem-marital power dynamics (measured by the division of household labor and decision-making in the marital relationship) and the presence of a confidant; (3) Ontogenetic system-a sense of meaning in one’s life during the retirement period and an assessment of absolute resources.

METHOD: The research sample consisted of 160 Israeli retirees (78 women and 82 men) who had retired within the previous eight years. Data were collected by the Panels Research Institute in Israel using the institute’s database of members. Participants completed an online questionnaire accessible via a website link. Statistical processing was performed using ANOVA and hierarchical regression analysis.

RESULTS: The results indicated that retirees’ reports of resource gains after retirement, their sense of meaning in life, their satisfaction with their working period prior to retirement, and their perceived level of absolute resources were all associated with mental health. Additionally, the more participants (both men and women) rated that the husband was involved in household labor, the better retirees reported their mental health to be. Gender differences were found in regard to some empowerment sources during retirement: retired women reported lower levels of mental health and prior work satisfaction compared to retired men, and men’s assessments of their participation in household labor and decision-making were higher than women’s assessments of their husbands’ involvement. The proportion of men who reported that their wives were their confidants was higher than the proportion of women who reported that their husbands were their confidants.

SUMMARY AND CONCLUSIONS: Overall, men experienced more sources of empowerment than women during retirement, but findings suggest that men’s emotional dependence on their wives is greater than women’s emotional dependence on their husbands. Based on the study’s findings, recommendations are offered to professionals who work with retirees.

PMID:37310726 | DOI:10.1080/08952841.2023.2222638

Fam Med. 2023 May;55(5):339-344. doi: 10.22454/FamMed.2023.788985. Epub 2023 Feb 21.

ABSTRACT

BACKGROUND AND OBJECTIVES: The family medicine residency application process is arduous and competitive. An important part of the application is the in-person interview process, which was affected during the last two interview cycles (2021-2022) due to restrictions imposed by the COVID-19 pandemic. Virtual interviews eliminate traveling costs associated with applications, potentially improving underrepresented minorities’ access to interviewing opportunities. Our goal was to assess if virtual interviews at our institution have negative or positive effects on access for underrepresented in medicine (URiM) applicants and our residency match results. Methods: We analyzed data from 2019-2022 to compare application volumes, applicant demographics, and match results between two in-person cycles (2019 and 2020) and two virtual cycles (2021-2022). Data were analyzed using Pearson χ2 criteria and P=.05 defined significance. Differences between years for expected counts were determined using single sample χ2 tests. Results: No statistical significance was noted on number of applications by URiM to our program despite decrease costs associated with virtual interview process. The number of URiM applicants matching to our program did not improve by simply implementing virtual interviews when compared to in-person interview seasons in the past.

CONCLUSIONS: Virtual interviews at our institution did not increase URiM applications to our program from substantial equivalent medical schools. Further research in this area from programs in other states may enhance our understanding of the impact of virtual interviews on URiM applications to residency and match results.

PMID:37310680 | DOI:10.22454/FamMed.2023.788985

Ther Innov Regul Sci. 2023 Jun 13. doi: 10.1007/s43441-023-00541-1. Online ahead of print.

ABSTRACT

Artificial Intelligence (AI) and Machine Learning (ML) are making headlines in medical research, especially in drug discovery, digital imaging, disease diagnostics, genetic testing, and optimal care pathway (personalized care). However, the potential uses and benefits of AI/ML applications need to be distinguished from hype. In the 2022 American Statistical Association Biopharmaceutical Section Regulatory-Industry Statistical Workshop, we convened a panel of experts from FDA and industry to talk about the challenges of successfully applying AI/ML in precision medicine and how to overcome those challenges. This paper provides a summary and expansion on the topics discussed in the panel: the application of AI/ML, bias, and data quality.

PMID:37310669 | DOI:10.1007/s43441-023-00541-1