Tag: nevin manimala

JCO Oncol Pract. 2023 May 26:OP2200782. doi: 10.1200/OP.22.00782. Online ahead of print.

ABSTRACT

PURPOSE: Burnout is a psychological occupational syndrome defined by the Maslach Burnout Inventory (MBI) as emotional exhaustion, depersonalization, and a low sense of personal accomplishment. We sought to characterize the prevalence of burnout among early-career medical oncologists at The University of Texas MD Anderson Cancer Center (MDACC).

METHODS: For this institutional review board-approved study, an electronic survey was developed for Assistant Professors in the MDACC Division of Cancer Medicine. All participants were involved directly in patient care. Our survey included questions assessing self-reported burnout, nine questions validated in the abbreviated MBI, and 31 questions to assess potential contributors to burnout. Each question was scaled 1-5, with higher scores associated with higher burnout. Descriptive statistics were used to estimate the prevalence of burnout, and logistic regression analyses were performed to identify contributing factors.

RESULTS: Among 86 Assistant Professors, 56 (65%) responded to the survey. The mean duration on faculty was 3.1 years. The mean clinical effort was 67% (range, 19-95). Fifty-four percent of respondents self-reported symptoms of burnout including 21% indicating severe burnout. Using the MBI, sentiments of being emotionally drained (54%), fatigued facing another day on the job (45%), and becoming more callous (30%) were especially notable. Twenty-five percent of respondents exhibited severe emotional exhaustion, which was more prevalent (P < .0001) than depersonalization (6%) or lack of personal accomplishment (17%).

CONCLUSION: Burnout exists with high prevalence among early-career medical oncologists, with emotional exhaustion being the most common manifestation of burnout. Interventions focusing on reducing emotional exhaustion are needed to reduce burnout among early-career medical oncologists.

PMID:37235818 | DOI:10.1200/OP.22.00782

Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2023 May 26:1-13. doi: 10.1080/19440049.2023.2217273. Online ahead of print.

ABSTRACT

Lupin seeds have a high potential as an alternative for animal proteins in feed and food. However, the possible presence of alkaloids hinders the usage of lupins in human diets. This review aims to identify the main factors that influence the presence of alkaloids in lupins. A literature study covering English-published scientific papers in Scopus from 1980 to 2022 was performed. Biotic, abiotic, and genotypic factors influence the production of these toxic secondary metabolites by lupines. In particular, sweet cultivars with high 13-hydroxylupanine and 13-tigloyloxylupanine concentrations, abundant light exposure and standard diurnal cycles, well-watering procedures, relatively cold environment, N-deficient fertilizer with 240 mg K kg^-1 and 60 mg P kg^-1, high soil pH, and organic growing system conditions, are the best options to avoid high global alkaloid content. Results of this study can be used to develop predictive mechanistic models, although there is still the necessity to collect additional data by performing multi-variate studies.

PMID:37235811 | DOI:10.1080/19440049.2023.2217273

Urogynecology (Phila). 2023 Jun 1;29(6):314-322. doi: 10.1097/SPV.0000000000001362. Epub 2023 May 19.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the 3- to 5-year retreatment outcomes for conservatively and surgically treated urinary incontinence (UI) in a population of women 66 years and older.

METHODS: This retrospective cohort study used 5% Medicare data to evaluate UI retreatment outcomes of women undergoing physical therapy (PT), pessary treatment, or sling surgery. The data set used inpatient, outpatient, and carrier claims from 2008 to 2016 in women 66 years and older with fee-for-service coverage. Treatment failure was defined as receiving another UI treatment (pessary, PT, sling, Burch urethropexy, or urethral bulking) or repeat sling. A secondary analysis was performed where additional treatment courses of PT or pessary were also considered a treatment failure. Survival analysis was used to evaluate the time from treatment initiation to retreatment.

RESULTS: Between 2008 and 2013, 13,417 women were included with an index UI treatment, and follow-up continued through 2016. In this cohort, 41.4% received pessary treatment, 31.8% received PT, and 26.8% underwent sling surgery. In the primary analysis, pessaries had the lowest treatment failure rate compared with PT (P<0.001) and sling surgery (P<0.001; survival probability, 0.94 [pessary], 0.90 [PT], 0.88 [sling]). In the analysis where retreatment with PT or a pessary was considered a failure, sling surgery had the lowest retreatment rate (survival probability, 0.58 [pessary], 0.81 [PT], 0.88 [sling]; P<0.001 for all comparisons).

CONCLUSIONS: In this administrative database analysis, there was a small but statistically significant difference in treatment failure among women undergoing sling surgery, PT, or pessary treatment, but pessary use was commonly associated with the need for repeat pessary fittings.

PMID:37235803 | DOI:10.1097/SPV.0000000000001362

Spine (Phila Pa 1976). 2023 May 22. doi: 10.1097/BRS.0000000000004598. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective cohort study.

OBJECTIVE: To determine prognostic factors for the progression of osteoporotic vertebral fracture (OVF) following conservative treatment.

SUMMARY OF BACKGROUND DATA: Few studies have evaluated factors associated with progressive collapse of OVFs. Furthermore, machine learning has not been applied in this context.

METHODS: The study involved the progression of collapse (PC) and non-PC groups based on a compression rate of 15%. Clinical data, fracture site, OVF shape, Cobb angle, and anterior wedge angle of the fractured vertebra were evaluated. The presence of intravertebral cleft and the type of bone marrow signal change were analyzed using magnetic resonance imaging. Multivariate logistic regression analysis was performed to identify prognostic factors. In machine learning methods, decision tree (DT) and random forest (RF) models were used.

RESULTS: There were no significant differences in clinical data between the groups. The proportion of fracture shape (P<0.001) and bone marrow signal change (P=0.01) were significantly different between the groups. Moderate wedge shape was frequently observed in the non-PC group (31.7%), whereas the normative shape was most common in the PC group (54.7%). The Cobb angle and anterior wedge angle at diagnosis of OVFs were higher in the non-PC group (13.2±10.9; P=0.001, 14.3±6.6; P<0.001) than in the PC group (10.3±11.8, 10.4±5.5). The bone marrow signal change at the superior aspect of the vertebra was more frequently found in the PC group (42.5%) than in the non-PC group (34.9%). Machine learning revealed that vertebral shape at initial diagnosis was a main predictor of progressive vertebral collapse.

CONCLUSION: The initial shape of the vertebra and bone edema pattern on MRI appear to be useful prognostic factors for the progression of collapse in OVFs.

PMID:37235792 | DOI:10.1097/BRS.0000000000004598

J Clin Endocrinol Metab. 2023 May 26:dgad290. doi: 10.1210/clinem/dgad290. Online ahead of print.

ABSTRACT

CONTEXT: Impact of lost GLP-1 receptor function in human physiology.

OBJECTIVE: Identify coding nonsynonymous GLP1R variants in Danish individuals to link their in vitro phenotypes and clinical phenotypic associations.

METHODS: We sequenced GLP1R in 8,642 Danish individuals with type 2 diabetes or normal glucose tolerance and examined the ability of nonsynonymous variants to bind GLP-1 and to signal in transfected cells via cAMP formation and beta-arrestin recruitment. We performed a cross-sectional study between the burden of loss-of-signalling (LoS) variants and cardiometabolic phenotypes in 2,930 patients with type 2 diabetes and 5,712 participants in a population-based cohort. Furthermore, we studied the association between cardiometabolic phenotypes and the burden of the LoS variants and 60 partly overlapping predicted loss-of-function (pLoF) GLP1R variants found in 330,566 unrelated Caucasian exome-sequenced participants in the UK Biobank cohort.

RESULTS: We identified 36 nonsynonymous variants in GLP1R of which 10 had a statistically significant loss in GLP-1-induced cAMP signalling compared to wildtype. However, no association was observed between the LoS variants and type 2 diabetes, although LoS variant carriers had a minor increased fasting plasma glucose level. Moreover, pLoF variants from the UK Biobank also did not reveal substantial cardiometabolic associations, despite a small effect on HbA1c.

CONCLUSION: Since no homozygous LoS nor pLoF variants were identified and heterozygous carriers had similar cardiometabolic phenotype as non-carriers, we conclude that GLP-1R may be of particular importance in human physiology, due to a potential evolutionary intolerance of harmful homozygous GLP1R variants.

PMID:37235780 | DOI:10.1210/clinem/dgad290

J Clin Endocrinol Metab. 2023 May 26:dgad289. doi: 10.1210/clinem/dgad289. Online ahead of print.

ABSTRACT

INTRODUCTION: Secondary hyperparathyroidism (SHPT) is a complication of chronic kidney disease (CKD) affecting mineral and bone metabolism and characterized by excessive parathyroid hormone (PTH) production and parathyroid hyperplasia. The objective of this analysis was to compare the efficacy and adverse effects of extended release calcifediol (ERC) and paricalcitol (PCT) by assessing their effect on biomarkers PTH, calcium and Phosphate in patients with non-dialysis CKD (ND CKD).

METHODS: A systematic literature research (SLR) was performed in PubMed to identify randomized control trials (RCTs). Quality assessment was done with the GRADE method. The effects of ERC vs PCT were compared using random effects in a frequentist setting.

RESULTS: Nine RCTs comprising 1426 patients were included in the analyses. The analyses were performed on two overlapping networks, due to non-reporting of outcomes in some of the included studies. No head-to-head trials were identified. No statistically significant differences in PTH reduction were found between PCT and ERC. Treatment with PCT showed statistically significant increases in calcium compared to ERC (0.2 mg/dl increase, 95% CI: -0.37 to -0.05 mg/dl). No differences in effects on phosphate were observed.

CONCLUSION: This NMA showed that ERC is comparable in lowering PTH levels vs PCT. ERC displayed avoidance of potentially clinically relevant increases in serum calcium, offering an effective and well tolerated treatment option for the management of SHPT in patients with ND CKD.

PMID:37235771 | DOI:10.1210/clinem/dgad289

J Burn Care Res. 2023 May 26:irad079. doi: 10.1093/jbcr/irad079. Online ahead of print.

ABSTRACT

The coronavirus disease and the subsequent pandemic that followed drastically changed human civilization with disruptive effects on health and overall wellbeing of mankind. This disruptive effect has been shown to include changes in epidemiology of burn injuries. This study therefore aimed to determine the impact of COVID-19 on acute burn presentation at the University College Hospital, Ibadan. This was a retrospective study carried out between April 1st 2019 and March 31st 2021. The period was divided into two: April 1st 2019 to March 31st 2020 and April 1st 2020 to March 31st 2021. Data obtained from the burn unit registry was analyzed using the scientific package for social sciences (SPSS) version 25. The only statistically significant finding from this study was the marked reduction in burn ICU admission during the pandemic (p<0.001). A total of 144 patients presented to the burn intensive care unit at UCH Ibadan during the period under review with 92 patients in the pre-pandemic year, and 52 patients in the pandemic year. 0-9 years representing 42% in pre-pandemic, and 30.8% in the pandemic period was the most affected age group. Scald was predominantly among the pediatric age group in both groups. Males were more likely to suffer flame burn in both study periods with a near gender equilibration during the pandemic. Burn injury during the pandemic resulted in more total body surface area burned. Conclusion: The lockdown effect of the pandemic resulted in a significant reduction in acute burn admissions at the University College Hospital, Ibadan.

PMID:37235751 | DOI:10.1093/jbcr/irad079

Am J Speech Lang Pathol. 2023 May 26:1-24. doi: 10.1044/2023_AJSLP-22-00314. Online ahead of print.

ABSTRACT

PURPOSE: This article provides a systematic review and analysis of group and single-case studies addressing augmentative and alternative communication (AAC) intervention with school-aged persons having autism spectrum disorder (ASD) and/or intellectual/developmental disabilities resulting in complex communication needs (CCNs). Specifically, we examined participant characteristics in group-design studies reporting AAC intervention outcomes and how these compared to those reported in single-case experimental designs (SCEDs). In addition, we compared the status of intervention features reported in group and SCED studies with respect to instructional strategies utilized.

PARTICIPANTS: Participants included school-aged individuals with CCNs who also experienced ASD or ASD with an intellectual delay who utilized aided or unaided AAC.

METHOD: A systematic review using descriptive statistics and effect sizes was implemented.

RESULTS: Findings revealed that participant features such as race, ethnicity, and home language continue to be underreported in both SCED and group-design studies. Participants in SCED investigations more frequently used multiple communication modes when compared to participants in group studies. The status of pivotal skills such as imitation was sparsely reported in both types of studies. With respect to instructional features, group-design studies were more apt to utilize clinical rather than educational or home settings when compared with SCED studies. In addition, SCED studies were more apt to utilize instructional methods that closely adhered to instructional features more typically characterized as being associated with behavioral approaches.

CONCLUSION: The authors discuss future research needs, practice implications, and a more detailed specification of treatment intensity parameters for future research.

PMID:37235744 | DOI:10.1044/2023_AJSLP-22-00314

Surg Laparosc Endosc Percutan Tech. 2023 May 18. doi: 10.1097/SLE.0000000000001177. Online ahead of print.

ABSTRACT

BACKGROUND: We aim to evaluate how new robotic skills are acquired and retained by having participants train and retest using exercises on the robotic platform. We hypothesized that participants with a 3-month break from the robotic platform will have less learning decay and increased retention compared with those with a 6-month break.

METHODS: This was a prospective randomized trial in which participants voluntarily enrolled and completed an initial training phase to reach proficiency in 9 robot simulator exercises. They were then instructed to refrain from practicing until they retested either 3 or 6 months later. This study was completed at an academic medical center within the general surgery department. Participants were medical students, and junior-level residents with minimal experience in robotic surgery were enrolled. A total of 27 enrolled, and 13 participants completed the study due to attrition.

RESULTS: Overall, intragroup analysis revealed that participants performed better in their retest phase compared with their initial training in terms of attempts to reach proficiency, time for completion, penalty score, and overall score. Specifically, during the first attempt in the retesting phase, the 3-month group did not deviate far from their final attempt in the training phase, whereas the 6-month group experienced significantly worse time to complete and overall score in interrupted suturing {[-4 (-18 to 20) seconds vs. 109 (55 to 118) seconds, P=0.02] [-1.3 (-8 to 1.9) vs. -18.9 (-19.5 to (-15.0)], P=0.04} and 3-arm relay {[3 (-4 to 23) seconds vs. 43 (30 to 50) seconds, P=0.02] [0.4 (-4.6 to 3.1) vs. -24.8 (-30.6 to (-20.3)], P=0.01] exercises. In addition, the 6-month group had a significant increase in penalty score in retesting compared with the 3-month group, which performed similarly to their training phase [3.3 (2.7 to 3.3) vs. 0 (-0.8 to 1.7), P=0.03].

CONCLUSIONS: This study identified statistically significant differences in learning decay, skills retention, and proficiency between 3-month and 6-month retesting intervals on a robotic simulation platform.

PMID:37235716 | DOI:10.1097/SLE.0000000000001177

Proc Natl Acad Sci U S A. 2023 May 30;120(22):e2220033120. doi: 10.1073/pnas.2220033120. Epub 2023 May 26.

ABSTRACT

The complex motility of bacteria, ranging from single-swimmer behaviors such as chemotaxis to collective dynamics, including biofilm formation and active matter phenomena, is driven by their microscale propellers. Despite extensive study of swimming flagellated bacteria, the hydrodynamic properties of their helical-shaped propellers have never been directly measured. The primary challenges to directly studying microscale propellers are 1) their small size and fast, correlated motion, 2) the necessity of controlling fluid flow at the microscale, and 3) isolating the influence of a single propeller from a propeller bundle. To solve the outstanding problem of characterizing the hydrodynamic properties of these propellers, we adopt a dual statistical viewpoint that connects to the hydrodynamics through the fluctuation-dissipation theorem (FDT). We regard the propellers as colloidal particles and characterize their Brownian fluctuations, described by 21 diffusion coefficients for translation, rotation, and correlated translation-rotation in a static fluid. To perform this measurement, we applied recent advances in high-resolution oblique plane microscopy to generate high-speed volumetric movies of fluorophore-labeled, freely diffusing Escherichia coli flagella. Analyzing these movies with a bespoke helical single-particle tracking algorithm, we extracted trajectories, calculated the full set of diffusion coefficients, and inferred the average propulsion matrix using a generalized Einstein relation. Our results provide a direct measurement of a microhelix’s propulsion matrix and validate proposals that the flagella are highly inefficient propellers, with a maximum propulsion efficiency of less than 3%. Our approach opens broad avenues for studying the motility of particles in complex environments where direct hydrodynamic approaches are not feasible.

PMID:37235635 | DOI:10.1073/pnas.2220033120