Tag: nevin manimala

BMC Health Serv Res. 2023 Jun 7;23(1):588. doi: 10.1186/s12913-023-09569-3.

ABSTRACT

BACKGROUND: In 2015, the Australian government froze the Medicare Benefits Schedule Rebate (MBSR) for General Practitioner (GP) service use. This paper aimed to explore the impact of the MBSR freeze on the demand for GP services in Victoria, Australia, for three years, from 2014 to 2016.

METHOD: Annual data on GP service utilisation by the Victorian State Statistical Area Level 3 (SA3) were analysed using 2015 as the reference year (MBSR freeze year). We compared annual per-person GP service use before and after the MBSR freeze for each SA3. Socioeconomic Indexes for Areas (SEIFA) scores and regions of Victoria (Greater Melbourne and the Rest of Victoria) were used to identify the most disadvantaged SA3s in Victoria. We conducted a multivariable regression analysis for the number of GP services per patient by SA3, controlling for regions of Victoria, the number of GP services, the proportion of bulk-billed visits, age group, gender and year.

FINDINGS: After adjusting for age group, gender, region, SEIFA, the number of GPs and the proportion of bulk-billed GP visits, mean GP services per person per year declined steadily between 2014 and 2016, with a 3% or 0.11 visit (-0.114, 95%CI: -0.134; -0.094, P = < 0.001) reduction in mean utilisation in 2016 compared to 2014. In disadvantaged SA3s, there was a fall in the number of GP services that were bulk-billed during and after the MBSR freeze compared to 2014, and this fall was large in LOW SEIFA SA3s, with a reduction in 17% of mean bulk-billed GP services.

CONCLUSION: The MBSR freeze for GP consultations in 2015 resulted in a reduction in the annual per capita demand for GP visits, with the impact of reduced demand more significant in lower socioeconomic and regional/rural areas. The GP funding policies must consider the demand differences by social-economic status and location.

PMID:37286961 | DOI:10.1186/s12913-023-09569-3

BMC Nephrol. 2023 Jun 7;24(1):161. doi: 10.1186/s12882-023-03225-y.

ABSTRACT

PURPOSE: Continuous kidney replacement therapy (CKRT) is an increasingly common intervention for critically ill patients with kidney failure. Because CKRT affects body temperature, detecting infections in patients on CKRT is challenging. Understanding the relation between CKRT and body temperature may facilitate earlier detection of infection.

METHODS: We retrospectively reviewed adult patients (≥ 18 years) admitted to the intensive care unit at Mayo Clinic in Rochester, Minnesota, from December 1, 2006, through November 31, 2015, who required CKRT. We summarized central body temperatures for these patients according to the presence or absence of infection.

RESULTS: We identified 587 patients who underwent CKRT during the study period, of whom 365 had infections, and 222 did not have infections. We observed no statistically significant differences in minimum (P = .70), maximum (P = .22), or mean (P = .55) central body temperature for patients on CKRT with infection vs. those without infection. While not on CKRT (before CKRT initiation and after cessation), all three body temperature measurements were significantly higher in patients with infection than in those without infection (all P < .02).

CONCLUSION: Body temperature is insufficient to indicate an infection in critically ill patients on CKRT. Clinicians should remain watchful for other signs, symptoms, and indications of infection in patients on CKRT because of expected high infection rates.

PMID:37286960 | DOI:10.1186/s12882-023-03225-y

Am J Physiol Endocrinol Metab. 2023 Jun 7. doi: 10.1152/ajpendo.00043.2023. Online ahead of print.

ABSTRACT

OBJECTIVE: Elevated fasting free fatty acids (FFA) are associated with Impaired Glucose Tolerance (IGT) and decreased β-cell function (quantified as Disposition Index (DI)). We sought to examine how changes in fasting FFA and glucose alter islet function.

METHODS: We studied 10 subjects with Normal Fasting Glucose (NFG) and Normal Glucose Tolerance (NGT) on 2 occasions. On one occasion, Intralipid^® and glucose were infused overnight to mimic conditions present in IFG/IGT. In addition, we studied 7 subjects with IFG/IGT on 2 occasions. On one occasion insulin was infused to lower overnight FFA and glucose concentrations to those observed in people with NFG/NGT. The following morning, a labeled mixed meal was used to measure postprandial glucose metabolism and β-cell function.

RESULTS: Elevation of overnight fasting FFA and glucose in NFG/NGT did not alter peak or integrated glucose concentrations (2.0 ± 0.1 vs 2.0 ± 0.1 Mol per 5 h, Saline vs. Intralipid^® / glucose, p = 0.55). While overall β-cell function quantified by the Disposition Index was unchanged, the dynamic component of β-cell responsivity (f_d) was decreased by Intralipid^® and glucose infusion (9 ± 1 vs. 16 ± 3 10^-9, p = 0.02). In people with IFG/IGT, insulin did not alter postprandial glucose concentrations or indices of β-cell function. Endogenous glucose production and glucose disappearance was also unchanged in both groups.

CONCLUSIONS: We conclude that acute, overnight changes in FFA and glucose concentrations do not alter islet function or glucose metabolism in prediabetes.

PMID:37285600 | DOI:10.1152/ajpendo.00043.2023

JCO Precis Oncol. 2023 Jun;7:e2200668. doi: 10.1200/PO.22.00668.

ABSTRACT

PURPOSE: Accurately distinguishing renal cell carcinoma (RCC) from normal kidney tissue is critical for identifying positive surgical margins (PSMs) during partial and radical nephrectomy, which remains the primary intervention for localized RCC. Techniques that detect PSM with higher accuracy and faster turnaround time than intraoperative frozen section (IFS) analysis can help decrease reoperation rates, relieve patient anxiety and costs, and potentially improve patient outcomes.

MATERIALS AND METHODS: Here, we extended our combined desorption electrospray ionization mass spectrometry imaging (DESI-MSI) and machine learning methodology to identify metabolite and lipid species from tissue surfaces that can distinguish normal tissues from clear cell RCC (ccRCC), papillary RCC (pRCC), and chromophobe RCC (chRCC) tissues.

RESULTS: From 24 normal and 40 renal cancer (23 ccRCC, 13 pRCC, and 4 chRCC) tissues, we developed a multinomial lasso classifier that selects 281 total analytes from over 27,000 detected molecular species that distinguishes all histological subtypes of RCC from normal kidney tissues with 84.5% accuracy. On the basis of independent test data reflecting distinct patient populations, the classifier achieves 85.4% and 91.2% accuracy on a Stanford test set (20 normal and 28 RCC) and a Baylor-UT Austin test set (16 normal and 41 RCC), respectively. The majority of the model’s selected features show consistent trends across data sets affirming its stable performance, where the suppression of arachidonic acid metabolism is identified as a shared molecular feature of ccRCC and pRCC.

CONCLUSION: Together, these results indicate that signatures derived from DESI-MSI combined with machine learning may be used to rapidly determine surgical margin status with accuracies that meet or exceed those reported for IFS.

PMID:37285559 | DOI:10.1200/PO.22.00668

J Clin Endocrinol Metab. 2023 Jun 7:dgad344. doi: 10.1210/clinem/dgad344. Online ahead of print.

ABSTRACT

INTRODUCTION: Many observational studies have been reported the association between educational attainment (EA) and thyroid function, but the causal relationship remains unclear. We aimed to obtain causal effects of EA on thyroid function and to quantify the mediating effects of modifiable risk factors.

METHODS: Two-sample Mendelian randomization (MR) was performed by using summary statistics from large genome-wide association studies (GWAS) to assess the effect of EA on thyroid function, including hypothyroidism, hyperthyroidism, thyroid stimulating hormone (TSH) and free thyroxine (FT4). A multivariable analysis was conducted to assess the mediating role of smoking and help to explain the association between EA and thyroid function. Similar analysis was further performed using data from the National Health and Nutrition Examination Survey (NHANES) 1999-2002.

RESULTS: In MR analysis, EA was causally associated with TSH (β=0.046, 95% CI: 0.015-0.077; p = 4.00 × 10-3), rather than hypothyroidism, hyperthyroidism and FT4. Importantly, smoking could serve as a mediator in the association between EA and TSH, in which the mediating proportion was estimated to be 10.38%. After adjusting for smoking in the multivariable MR analysis, the β value of EA on TSH was attenuated to 0.030 (95% CI: 0.016-0.045; p = 9.32 × 10-3). Multivariable logistic regression model in NHANES suggested a dose-response relationship between TSH (Q4 vs. Q1: OR = 1.33, 95% CI: 1.05-1.68; P for trend = 0.023) and EA. Smoking, systolic blood pressure (SBP) and body mass index (BMI) partially mediated the association between EA and TSH, with the proportion of the mediation effects being 43.82%, 12.28% and 6.81%, respectively.

CONCLUSION: There is a potentially causal association between EA and TSH, which could be mediated by several risk factors, such as smoking.

PMID:37285488 | DOI:10.1210/clinem/dgad344

J Infect Dis. 2023 Jun 7:jiad212. doi: 10.1093/infdis/jiad212. Online ahead of print.

ABSTRACT

BACKGROUND: To reduce the risk of pertussis related morbidity and mortality in early life, an increasing number of countries recommend maternal pertussis vaccination. Hence, there is limited knowledge about half-lives of vaccine-induced pertussis-specific maternal antibodies, especially in preterm infants and factors potentially influencing them.

METHODS: We compared two different approaches to provide estimates of the half-lives of pertussis-specific maternal antibodies in infants and explored potential effects on the half-life for two studies. In the first approach, we estimated the half-lives per child and used these estimates as responses in linear models. In the second approach, we used linear mixed effect models on a log-2 transformed scale of the longitudinal data to use the inverse of the time parameter as an estimate for the half-lives.

RESULTS: Both approaches provided similar results. The identified covariates partly explain differences in half-life estimates. The strongest evidence we observed was a difference between term and preterm infants, with the preterm showing a higher half-life. Among others, a longer interval between vaccination and delivery increases the half-life.

CONCLUSION: Several variables influence the decay speed of maternal antibodies. Both approaches have (dis)advantages, while the choice is secondary when assessing the half-life of pertussis-specific antibodies. Brief summary: We compared two approaches for estimating the half-life of vaccine-induced pertussis-specific maternal antibodies, focusing on the difference between preterm and term born infants, while also examining other variables. Both approaches yielded similar results, with preterm infants showing a higher half-life.

PMID:37285482 | DOI:10.1093/infdis/jiad212

J Oral Pathol Med. 2023 Jun 7. doi: 10.1111/jop.13451. Online ahead of print.

ABSTRACT

BACKGROUND: MicroRNAs (miRNAs) play crucial regulatory roles in cancer progression, including oral cancer (OC). However, the biological mechanisms of miRNA-15a-5p in OC remain unclear. This study aimed to evaluate the expression of miRNA-15a-5p and the YAP1 gene in OC.

METHODS: A total of 22 clinically and histologically confirmed oral squamous cell carcinoma (OSCC) patients were recruited, and their tissues were stored in a stabilizing solution. Later, RT-PCR was performed to evaluate miRNA-15a-5p and the targeting gene YAP1. The results of OSCC samples were compared with unpaired normal tissues.

RESULTS: The normality tests, Kolmogorov-Smirnov and Shapiro-Wilk, revealed a normal distribution. Inferential statistics were performed using an independent sample t-test/unpaired t-test among the study intervals to compare the expression of miR-15a and YAP1. SPSS (IBM SPSS Statistics for Windows, Version 26.0, Armonk, NY: IBM Corp. Released 2019) was used to analyse the data. The significance level was set at 5% (α = 0.05), and a p-value <0.05 was considered statistically significant. The expression of miRNA-15a-5p was lower in OSCC than in normal tissue, whereas the opposite was observed for YAP1 levels.

CONCLUSION: In conclusion, this study demonstrated that miRNA-15a-5p was downregulated and YAP1 was overexpressed, which had a statistically significant difference between the normal and OSCC groups. Therefore, miRNA-15a-5p may serve as a novel biomarker to better understand the pathology and as a potential target in OSCC therapy.

PMID:37285474 | DOI:10.1111/jop.13451

JBJS Rev. 2023 Jun 7;11(6). doi: 10.2106/JBJS.RVW.23.00077. eCollection 2023 Jun 1.

ABSTRACT

» Data continue to accumulate indicating that many systematic reviews are methodologically flawed, biased, redundant, or uninformative. Some improvements have occurred in recent years based on empirical methods research and standardization of appraisal tools; however, many authors do not routinely or consistently apply these updated methods. In addition, guideline developers, peer reviewers, and journal editors often disregard current methodological standards. Although extensively acknowledged and explored in the methodological literature, most clinicians seem unaware of these issues and may automatically accept evidence syntheses (and clinical practice guidelines based on their conclusions) as trustworthy.» A plethora of methods and tools are recommended for the development and evaluation of evidence syntheses. It is important to understand what these are intended to do (and cannot do) and how they can be utilized. Our objective is to distill this sprawling information into a format that is understandable and readily accessible to authors, peer reviewers, and editors. In doing so, we aim to promote appreciation and understanding of the demanding science of evidence synthesis among stakeholders. We focus on well-documented deficiencies in key components of evidence syntheses to elucidate the rationale for current standards. The constructs underlying the tools developed to assess reporting, risk of bias, and methodological quality of evidence syntheses are distinguished from those involved in determining overall certainty of a body of evidence. Another important distinction is made between those tools used by authors to develop their syntheses as opposed to those used to ultimately judge their work.» Exemplar methods and research practices are described, complemented by novel pragmatic strategies to improve evidence syntheses. The latter include preferred terminology and a scheme to characterize types of research evidence. We organize best practice resources in a Concise Guide that can be widely adopted and adapted for routine implementation by authors and journals. Appropriate, informed use of these is encouraged, but we caution against their superficial application and emphasize their endorsement does not substitute for in-depth methodological training. By highlighting best practices with their rationale, we hope this guidance will inspire further evolution of methods and tools that can advance the field.

PMID:37285444 | DOI:10.2106/JBJS.RVW.23.00077

Sci Adv. 2023 Jun 9;9(23):eadi1405. doi: 10.1126/sciadv.adi1405. Epub 2023 Jun 7.

ABSTRACT

Long-duration gamma-ray bursts (GRBs) are powerful cosmic explosions, signaling the death of massive stars. Among them, GRB 221009A is by far the brightest burst ever observed. Because of its enormous energy (E_iso ≈ 10⁵⁵ erg) and proximity (z ≈ 0.15), GRB 221009A is an exceptionally rare event that pushes the limits of our theories. We present multiwavelength observations covering the first 3 months of its afterglow evolution. The x-ray brightness decays as a power law with slope ≈t^-1.66, which is not consistent with standard predictions for jetted emission. We attribute this behavior to a shallow energy profile of the relativistic jet. A similar trend is observed in other energetic GRBs, suggesting that the most extreme explosions may be powered by structured jets launched by a common central engine.

PMID:37285439 | DOI:10.1126/sciadv.adi1405

Sci Adv. 2023 Jun 9;9(23):eade6350. doi: 10.1126/sciadv.ade6350. Epub 2023 Jun 7.

ABSTRACT

Global warming has shifted phenological traits in many species, but whether species are able to track further increasing temperatures depends on the fitness consequences of additional shifts in phenological traits. To test this, we measured phenology and fitness of great tits (Parus major) with genotypes for extremely early and late egg lay dates, obtained from a genomic selection experiment. Females with early genotypes advanced lay dates relative to females with late genotypes, but not relative to nonselected females. Females with early and late genotypes did not differ in the number of fledglings produced, in line with the weak effect of lay date on the number of fledglings produced by nonselected females in the years of the experiment. Our study is the first application of genomic selection in the wild and led to an asymmetric phenotypic response that indicates the presence of constraints toward early, but not late, lay dates.

PMID:37285433 | DOI:10.1126/sciadv.ade6350