Tag: nevin manimala

J Robot Surg. 2023 May 23. doi: 10.1007/s11701-023-01625-8. Online ahead of print.

ABSTRACT

While laparoscopic simulation-based training is a well-established component of general surgery training, no such requirement or standardized curriculum exists for robotic surgery. Furthermore, there is a lack of high-fidelity electrocautery simulation training exercises in the literature. Using Messick’s validity framework, we sought to determine the content, response process, internal content and construct validity of a novel inanimate tissue model that utilizes electrocautery for potential incorporation in such curricula. A multi-institutional, prospective study involving medical students (MS) and general surgery residents (PGY1-3) was conducted. Participants performed an exercise using a biotissue bowel model on the da Vinci Xi robotic console during which they created an enterotomy using electrocautery, followed by approximation with interrupted sutures. Participant performance was recorded and then scored by crowd-sourced assessors of technical skill, along with three of the authors. Construct validity was determined via difference in Global Evaluative Assessment of Robotic Skills (GEARS) score, time to completion, and total number of errors between the two cohorts. Upon completion of the exercise, participants were surveyed on their perception of the exercise and its impact on their robotic training to determine content validity. 31 participants were enrolled and separated into two cohorts: MS + PGY1 vs. PGY2-3. Time spent on the robotic trainer (0.8 vs. 8.13 h, p = 0.002), number of bedside robotic assists (5.7 vs. 14.8, p < 0.001), and number of robotic cases as primary surgeon (0.3 vs. 13.1, p < 0.001) were statistically significant between the two groups. Differences in GEARS scores (18.5 vs. 19.9, p = 0.001), time to completion (26.1 vs. 14.4 min, p < 0.001), and total errors (21.5 vs. 11.9, p = 0.018) between the groups were statistically significant as well. Of the 23 participants that completed the post-exercise survey, 87% and 91.3% reported improvement in robotic surgical ability and confidence, respectively. On a 10-point Likert scale, respondents rated the realism of the exercise 7.5, educational benefit 9.1, and effectiveness in teaching robotic skills 8.7. Controlling for the upfront investment of certain training materials, each exercise iteration cost ~ $30. This study confirmed the content, response process, internal structure and construct validity of a novel, high-fidelity and cost-effective inanimate tissue exercise which successfully incorporates electrocautery. Consideration should be given to its addition to robotic surgery training programs.

PMID:37219784 | DOI:10.1007/s11701-023-01625-8

Environ Sci Pollut Res Int. 2023 May 23. doi: 10.1007/s11356-023-27606-w. Online ahead of print.

ABSTRACT

Streams are pristine natural life-thriving water sources for people living in the mountainous proximity of NE India, where water scarcity is a common occurrence in most villages and towns. In the last few decades, factors like coal mining had drastically reduced the usability of stream water in the region; as such, an attempt has been made to assess the spatiotemporal variation of stream water chemistry affected by acid mine drainage (AMD) at Jaintia Hills, Meghalaya. The water variables were subjected to a multivariate statistical technique of principal component analysis (PCA) to understand their condition at each sampling point while comprehensive pollution index (CPI) and water quality index (WQI) was incorporated to assess the quality status. Maximum WQI was recorded in S4 (541.14) during summer, while minimum value was estimated in winter at S1 (14.65). Throughout the seasons, the WQI revealed “Good” quality in S1 (unimpacted stream), while the impacted streams (S2, S3, and S4) exhibited a “Very poor” to “Water unsuitable for drinking” status. Similarly, in S1, the CPI showed a ranged value of 0.20 to 0.37, presenting a water quality status of “Clean to Sub-Clean,” whereas, CPI of the impacted streams indicated “Severely polluted” status. In addition, PCA bi-plot presented higher affinity of free CO₂, Pb, SO₄^2-, EC, Fe, and Zn in AMD-impacted streams than in unimpacted streams. The result demonstrates the environmental issues induced by coal mine waste and in particular, stream water being severely affected by AMD in mining areas of Jaintia Hills. Thus, measures to stabilized the mine repercussions and cumulative effects on the water bodies need to be formulated by the government, as stream water will remain the primary water source for the tribal communities in this region.

PMID:37219781 | DOI:10.1007/s11356-023-27606-w

Environ Sci Pollut Res Int. 2023 May 23. doi: 10.1007/s11356-023-27659-x. Online ahead of print.

ABSTRACT

Monitoring air contaminants has become essential to exposure science, toxicology, and public health research. However, missing values are common while monitoring air contaminants, especially in resource-constrained settings such as power cuts, calibration, and sensor failure. In contaminants monitoring, evaluating existing imputation techniques for dealing with recurrent periods of missing and unobserved data are limited. The proposed study aims to perform a statistical evaluation of six univariate and four multivariate time series imputation methods. The univariate methods are based on inter-time correlation characteristics, and the multivariate approach considers muti-site to impute missing data. The present study retrieved data from 38 ground-based monitoring stations for particulate pollutants in Delhi for 4 years. For univariate methods, missing values were simulated under 0-20% (5%, 10%, 15%, and 20%), and high 40%, 60%, and 80% missing levels having long gaps. Before evaluating multivariate methods, input data underwent pre-processing steps: selecting the target station to be imputed, choosing covariates based on the spatial correlation between multiple sites, and framing a combination of target and neighbouring stations (covariates) under 20%, 40%, 60%, and 80%. Next, the particulate pollutants data of 1480 days is provided as input to four multivariate techniques. Finally, the performance of each algorithm was evaluated using error metrics. The results show that the long interval time series data and spatial correlation of multiple stations significantly improved outcomes for univariate and multivariate time series methods. The univariate Kalman_arima performs well for long-missing gaps and all missing levels (except for 60-80%), yielding low error and high R² and d values. In contrast, multivariate MIPCA performed better than Kalman-arima for all target stations with the highest missing percentage.

PMID:37219777 | DOI:10.1007/s11356-023-27659-x

J Racial Ethn Health Disparities. 2023 May 23. doi: 10.1007/s40615-023-01634-1. Online ahead of print.

ABSTRACT

BACKGROUND: This study examined racial/ethnic differences in comorbidity burden and health-related quality of life (HRQOL) among older women before breast cancer diagnosis.

METHODS: From Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey (SEER-MHOS) linked data resource, 2513 women diagnosed with breast cancer at ≥ 65 years between 1998 and 2012 were identified and grouped based on comorbidity burden using latent class analysis. Pre-diagnosis HRQOL was measured using SF-36/VR-12 and summarized to physical (PCS) and mental component summary (MCS) scores. The adjusted least-square means and 95% confidence intervals were obtained according to comorbidity burden and race/ethnicity. The interactions were examined with 2-way ANOVA.

RESULTS: The latent class analysis revealed four comorbid burden classes, with Class 1 being the most healthy and Class 4 being the least healthy. African American (AA) and Hispanic women were more likely to be in Class 4 than non-Hispanic white (NHW) women (18.6%, 14.8%, and 8.3%, respectively). The mean PCS was 39.3 and differed by comorbidity burden and race/ethnicity (P_interaction < 0.001). There were no racial/ethnic differences in Classes 1 and 2, while NHW women reported significantly lower PCS scores than AA women in Classes 3 and 4. The mean MCS was 51.4 and differed by comorbidity burden and race/ethnicity (P_interaction < 0.001). There was no racial/ethnic difference in Class 3; however, AA women reported lower MCS scores than Asian/Pacific Islander women in Class 1, and AA and Hispanic women reported lower MCS scores than NHW women in Classes 2 and 4.

CONCLUSION: Comorbidity burden negatively affected HRQOL but differentially for racial/ethnic groups. As the comorbidity burden increases, NHW women are more concerned with physical HRQOL, while AA and Hispanic women are more concerned with mental HRQOL.

PMID:37219735 | DOI:10.1007/s40615-023-01634-1

Qual Life Res. 2023 May 23. doi: 10.1007/s11136-023-03435-9. Online ahead of print.

ABSTRACT

PURPOSE: This unselected, population-based cohort study aimed to determine the level of health-related quality of life (HRQoL) in patients with Crohn’s disease (CD) and ulcerative colitis (UC) at the time of diagnosis compared with a reference population and identify the demographic factors, psychosocial measures, and disease activity markers associated with HRQoL.

METHODS: Adult patients newly diagnosed with CD or UC were prospectively enrolled. HRQoL was measured using the Short Form 36 (SF-36) and Norwegian Inflammatory Bowel Disease Questionnaires. Clinical significance was assessed using Cohen’s d effect size and further compared with a Norwegian reference population. Associations between HRQoL and symptom scores, demographic factors, psychosocial measures, and disease activity markers were analyzed.

RESULTS: Compared with the Norwegian reference population, patients with CD and UC reported significantly lower scores in all SF-36 dimensions, except for physical functioning. Cohen’s d effect sizes for men and women in all SF-36 dimensions were at least moderate, except for bodily pain and emotional role for men with UC and physical functioning for both sexes and diagnoses. In the multivariate regression analysis, depression subscale scores ≥ 8 on the Hospital Anxiety and Depression Scale, substantial fatigue, and high symptom scores were associated with reduced HRQoL.

CONCLUSION: Patients newly diagnosed with CD and UC reported statistically and clinically significantly lower scores in seven of the eight SF-36 dimensions than the reference population. Symptoms of depression, fatigue, and elevated symptom scores were associated with poorer HRQoL.

PMID:37219727 | DOI:10.1007/s11136-023-03435-9

Ultrasound J. 2023 May 23;15(1):25. doi: 10.1186/s13089-023-00326-5.

ABSTRACT

BACKGROUND: Although lung sliding seen by point-of-care ultrasound (POCUS) is known to be affected to varying degrees by different physiologic and pathologic processes, it is typically only reported qualitatively in the critical care setting. Lung sliding amplitude quantitatively expresses the amount of pleural movement seen by POCUS but its determinants in mechanically ventilated patients are largely unknown.

METHODS: This was a single-center, prospective, observational pilot study examining 40 hemithoraces in 20 adult patients receiving mechanical ventilation. Each subject had lung sliding amplitude measured in both B-mode and by pulsed wave Doppler at their bilateral lung apices and bases. Differences in lung sliding amplitude were correlated with anatomical location (apex vs base) as well as physiologic parameters including positive end expiratory pressure (PEEP), driving pressure, tidal volume and the ratio of arterial partial pressure of oxygen (PaO₂) to fraction of inspired oxygen (FiO₂).

RESULTS: POCUS lung sliding amplitude was significantly lower at the lung apex compared to the lung base in both B-mode (3.6 ± 2.0 mm vs 8.6 ± 4.3 mm; p < 0.001) and the pulsed wave Doppler mode (10.3 ± 4.6 cm/s vs 13.9 ± 5.5 cm/s; p < 0.001) corresponding to expected distribution of ventilation to the lung bases. Inter-rater reliability of B-mode measurements was excellent (ICC = 0.91) and distance traversed in B-mode had a significant positive correlation with pleural line velocity (r² = 0.32; p < 0.001). There was a non-statistically significant trend towards lower lung sliding amplitude for PEEP ≥ 10 cmH₂O, as well as for driving pressure ≥ 15 cmH₂O in both ultrasound modes.

CONCLUSION: POCUS lung sliding amplitude was significantly lower at the lung apex than the lung base in mechanically ventilated patients. This was true when using both B-mode and pulsed wave Doppler. Lung sliding amplitude did not correlate with PEEP, driving pressure, tidal volume or PaO₂:FiO₂ ratio. Our findings suggest that lung sliding amplitude can be quantified in mechanically ventilated patients in a physiologically predictable way and with high inter-rater reliability. A better understanding of POCUS derived lung sliding amplitude and its determinants may aid in the more accurate diagnosis of lung pathologies, including pneumothorax, and could serve as a means of further reducing radiation exposure and improving outcomes in critically ill patients.

PMID:37219721 | DOI:10.1186/s13089-023-00326-5

Mem Cognit. 2023 May 23. doi: 10.3758/s13421-023-01432-4. Online ahead of print.

ABSTRACT

Assigning stress to polysyllabic words is a crucial aspect of reading aloud in English. Previous research demonstrated that native English speakers are sensitive to word endings as probabilistic orthographic cues to stress assignment. However, little is known about if second language (L2) learners of English are sensitive to word endings as cues to lexical stress. The current study investigated whether native Chinese-speakers learning English as a second language (ESL) are sensitive to word endings as probabilistic orthographic cues to lexical stress. Our ESL learners demonstrated sensitivity to word endings as cues in a stress-assignment task and a naming task. With the increase in language proficiency, ESL learners responded more accurately in the stress-assignment task. Moreover, stress position and language proficiency moderated the strength of the sensitivity, with a trochaic bias and better proficiency leading to better sensitivity in the stress-assignment task. However, as language proficiency increased, participants’ naming speed became faster in iambic but slower in trochaic patterns, reflecting the learners’ fledgling knowledge about the specific stress patterns associated with varying orthographic cues, especially in a demanding naming task. Taken together, the evidence from our ESL learners fits in the proposed statistical learning mechanism, that is, L2 learners are able to implicitly extract statistical regularities from linguistic materials, the orthographic cues to lexical stress in our study. Stress position and language proficiency both play a role in developing this sensitivity.

PMID:37219718 | DOI:10.3758/s13421-023-01432-4

Clin Exp Optom. 2023 May 23:1-6. doi: 10.1080/08164622.2023.2215381. Online ahead of print.

ABSTRACT

CLINICAL RELEVANCE: Increased serum cystatin C may play a role in the pathogenesis of idiopathic epiretinal membrane (IERM). Physicians should be aware of this relationship and should refer patients to the ophthalmology clinic for screening.

BACKGROUND: To evaluate the serum cystatin C level in patients with IERM, and its associations with visual acuity.

METHODS: Sixty-eight patients with IERM and sixty-nine controls were enrolled in this cross-sectional study. Based on the results of optical coherence tomography, patients with IERM were divided into four stages (I, II, III and IV). Serum cystatin C was measured in all participants. Serum cystatin C levels were compared between the control group and IERM group and between the IERM group with different optical coherence tomography stages. Multiple linear regression was used to evaluate the relationship between serum cystatin C and IERM stages and best corrected visual acuity.

RESULTS: Serum cystatin C level was higher in the IERM group than in the control group (P < 0.001). There were statistically significant differences in serum cystatin C among different stages of IERM (P_{I vs II} = 0.011, P_{I vs IV} < 0.001 and P_{III vs IV} = 0.040, respectively). There were significant differences in best corrected visual acuity among different stages of IERM (P_{I vs III} = 0.018, P_{I vs IV} < 0.001, P_{II vs IV} < 0.001 and P_{III vs IV} < 0.001, respectively). Regression analysis showed a positive correlation between serum cystatin C and best corrected visual acuity (t = 2.238 P = 0.029). The cut-off value of receiver operation characteristic curve of serum cystatin C for IERM was 0.775.

CONCLUSION: This study revealed that serum cystatin C may be involved in the pathogenesis of IERM and can predict its occurrence. Elevated serum cystatin C appears to be associated with the severity of the disease and relatively poor vision acuity in IERM patients.

PMID:37218573 | DOI:10.1080/08164622.2023.2215381

J Comp Eff Res. 2023 May 23:e220188. doi: 10.57264/cer-2022-0188. Online ahead of print.

ABSTRACT

Aim: With no head-to-head studies comparing the effectiveness of lanadelumab and berotralstat for prevention of hereditary angioedema (HAE) attacks, this network meta-analysis (NMA) aimed to indirectly compare the effectiveness of these treatments. Materials & methods: The NMA, using the published data from Phase III trials, was performed using a frequentist weighted regression-based approach following Rücker et al. Efficacy outcomes of interest were HAE attack rate per 28 days and ≥90% reduction in monthly HAE attacks [24]. Results & conclusion: In this NMA, lanadelumab 300 mg administered every 2 weeks or every 4 weeks was associated with statistically significantly higher effectiveness versus berotralstat 150 mg once daily (q.d.) or 110 mg q.d. for both efficacy outcomes assessed.

PMID:37218553 | DOI:10.57264/cer-2022-0188

Analyst. 2023 May 23. doi: 10.1039/d2an01035f. Online ahead of print.

ABSTRACT

Mid-infrared spectroscopic imaging (MIRSI) is an emerging class of label-free techniques being leveraged for digital histopathology. Modern histopathologic identification of ovarian cancer involves tissue staining followed by morphological pattern recognition. This process is time-consuming and subjective and requires extensive expertise. This paper presents the first label-free, quantitative, and automated histological recognition of ovarian tissue subtypes using a new MIRSI technique. This optical photothermal infrared (O-PTIR) imaging technique provides a 10× enhancement in spatial resolution relative to prior instruments. It enables sub-cellular spectroscopic investigation of tissue at biochemically important fingerprint wavelengths. We demonstrate that the enhanced resolution of sub-cellular features, combined with spectroscopic information, enables reliable classification of ovarian cell subtypes achieving a classification accuracy of 0.98. Moreover, we present a statistically robust analysis from 78 patient samples with over 60 million data points. We show that sub-cellular resolution from five wavenumbers is sufficient to outperform state-of-the-art diffraction-limited techniques with up to 235 wavenumbers. We also propose two quantitative biomarkers based on the relative quantities of epithelia and stroma that exhibit efficacy in early cancer diagnosis. This paper demonstrates that combining deep learning with intrinsic biochemical MIRSI measurements enables quantitative evaluation of cancerous tissue, improving the rigor and reproducibility of histopathology.

PMID:37218522 | DOI:10.1039/d2an01035f