Tag: nevin manimala

PLoS One. 2023 May 2;18(5):e0284117. doi: 10.1371/journal.pone.0284117. eCollection 2023.

ABSTRACT

BACKGROUND: Chronic diseases are considered one of the major causes of illness, disability, and death worldwide. Chronic illness leads to a huge health and economic burden, especially in low- and middle-income countries. This study examined disease-stratified healthcare utilisation (HCU) among Bangladesh patients with chronic diseases from a gender perspective.

METHODS: Data from the nationally representative Household Income and Expenditure Survey 2016-2017 consisting of 12,005 patients with diagnosed chronic diseases was used. Gender differentiated chronic disease stratified-analytical exploration was performed to identify the potential factors to higher or lower utilisation of healthcare services. Logistic regression with step-by-step adjustment for independent confounding factors was the method used.

RESULTS: The five most prevalent chronic diseases among patients were gastric/ulcer (Male/Female, M/F: 16.77%/16.40%), arthritis/rheumatism (M/F: 13.70%/ 13.86%), respiratory diseases/asthma/bronchitis (M/F: 12.09% / 12.55%), chronic heart disease (M/F: 8.30% / 7.41%), and blood pressure (M/F: 8.20% / 8.87%). Eighty-six percent of patients with chronic diseases utilised health care services during the previous 30 days. Although most patients received outpatient healthcare services, a substantial difference in HCU among employed male (53%) and female (8%) patients were observed. Chronic heart disease patients were more likely to utilise health care than other disease types, which held true for both genders while the magnitude of HCU was significantly higher in males (OR = 2.22; 95% CI:1.51-3.26) than their female counterparts (OR = 1.44; 1.02-2.04). A similar association was observed among patients with diabetes and respiratory diseases.

CONCLUSION: A burden of chronic diseases was observed in Bangladesh. Patients with chronic heart disease utilised more healthcare services than patients experiencing other chronic diseases. The distribution of HCU varied by patient’s gender as well as their employment status. Risk-pooling mechanisms and access to free or low-cost healthcare services among the most disadvantaged people in society might enhance reaching universal health coverage.

PMID:37130132 | DOI:10.1371/journal.pone.0284117

PLoS Comput Biol. 2023 May 2;19(5):e1010989. doi: 10.1371/journal.pcbi.1010989. eCollection 2023 May.

ABSTRACT

Animals rely on different decision strategies when faced with ambiguous or uncertain cues. Depending on the context, decisions may be biased towards events that were most frequently experienced in the past, or be more explorative. A particular type of decision making central to cognition is sequential memory recall in response to ambiguous cues. A previously developed spiking neuronal network implementation of sequence prediction and recall learns complex, high-order sequences in an unsupervised manner by local, biologically inspired plasticity rules. In response to an ambiguous cue, the model deterministically recalls the sequence shown most frequently during training. Here, we present an extension of the model enabling a range of different decision strategies. In this model, explorative behavior is generated by supplying neurons with noise. As the model relies on population encoding, uncorrelated noise averages out, and the recall dynamics remain effectively deterministic. In the presence of locally correlated noise, the averaging effect is avoided without impairing the model performance, and without the need for large noise amplitudes. We investigate two forms of correlated noise occurring in nature: shared synaptic background inputs, and random locking of the stimulus to spatiotemporal oscillations in the network activity. Depending on the noise characteristics, the network adopts various recall strategies. This study thereby provides potential mechanisms explaining how the statistics of learned sequences affect decision making, and how decision strategies can be adjusted after learning.

PMID:37130121 | DOI:10.1371/journal.pcbi.1010989

Int J Soc Determinants Health Health Serv. 2023 May 2:27551938231170834. doi: 10.1177/27551938231170834. Online ahead of print.

ABSTRACT

This study aimed to assess the coverage of essential postnatal maternal care services among women residing in the slums of Islamabad. A community-based, cross-sectional study was conducted to assess the coverage of essential postnatal care (PNC) services. Using random sampling, 416 women living in the squatter settlements of Islamabad Capital Territory were selected as study participants. Data was analyzed by using SPSS version 22. Descriptive statistics were employed to display frequencies for categorical variables, whereas mean, median, and standard deviation were calculated for continuous variables. The analysis of data showed that 93.5 percent of the women utilized postnatal services at least once after delivery. Approximately 9 percent and 4 percent of women received all eight recommended services within 24 h of birth and beyond 24 h of birth, respectively. Effective PNC services were received by only 1 percent of the women. The study revealed that the utilization of effective PNC was very low. The majority of the women delivered in health institutions and received their first PNC checkups, but follow-up for the recommended checkups was very low. These results can help health professionals and policymakers in designing programs and developing efficient strategies that would improve PNC service utilization in Pakistan.

PMID:37130119 | DOI:10.1177/27551938231170834

PLoS One. 2023 May 2;18(5):e0285168. doi: 10.1371/journal.pone.0285168. eCollection 2023.

ABSTRACT

Prediction of virus-host protein-protein interactions (PPI) is a broad research area where various machine-learning-based classifiers are developed. Transforming biological data into machine-usable features is a preliminary step in constructing these virus-host PPI prediction tools. In this study, we have adopted a virus-host PPI dataset and a reduced amino acids alphabet to create tripeptide features and introduced a correlation coefficient-based feature selection. We applied feature selection across several correlation coefficient metrics and statistically tested their relevance in a structural context. We compared the performance of feature-selection models against that of the baseline virus-host PPI prediction models created using different classification algorithms without the feature selection. We also tested the performance of these baseline models against the previously available tools to ensure their predictive power is acceptable. Here, the Pearson coefficient provides the best performance with respect to the baseline model as measured by AUPR; a drop of 0.003 in AUPR while achieving a 73.3% (from 686 to 183) reduction in the number of tripeptides features for random forest. The results suggest our correlation coefficient-based feature selection approach, while decreasing the computation time and space complexity, has a limited impact on the prediction performance of virus-host PPI prediction tools.

PMID:37130110 | DOI:10.1371/journal.pone.0285168

PLoS One. 2023 May 2;18(5):e0285087. doi: 10.1371/journal.pone.0285087. eCollection 2023.

ABSTRACT

OBJECTIVES: Plasma leakage, a hallmark of disease in Dengue virus (DENV) infection, is an important clinical manifestation and is often associated with numerous factors such as viral factors. The aim of this study is to investigate the association of virus serotype, viral load kinetics, history of infection, and NS1 protein with plasma leakage.

METHODS: Subjects with fever ≤ 48 hours and positive DENV infection were included. Serial laboratory tests, viral load measurements, and ultrasonography examination to assess plasma leakage were performed.

RESULTS: DENV-3 was the most common serotype found in the plasma leakage group (35%). Patients with plasma leakage demonstrated a trend of higher viral load and a longer duration of viremia compared to those without. This was significantly observed on the fourth day of fever (p = 0.037). We found higher viral loads on specific days in patients with plasma leakage in both primary and secondary infections compared to those without. In addition, we also observed more rapid viral clearance in patients with secondary infection. NS1 protein, especially after 4 days of fever, was associated with higher peak viral load level, even though it was not statistically significant (p = 0.470). However, pairwise comparison demonstrated that peak viral load level in the group of patients with circulating NS1 detected for 7 days was significantly higher than the 5-day group (p = 0.037).

CONCLUSION: DENV-3 was the most common serotype to cause plasma leakage. Patients with plasma leakage showed a trend of higher viral load and a longer duration of viremia. Higher level of viral load was observed significantly on day 5 in patients with primary infection and more rapid viral clearance was observed in patients with secondary infection. Longer duration of circulating NS1 protein was also seen to be positively correlated with higher peak viral load level although not statistically significant.

PMID:37130105 | DOI:10.1371/journal.pone.0285087

J Clin Anesth. 2023 Aug;87:111088. doi: 10.1016/j.jclinane.2023.111088. Epub 2023 Mar 1.

ABSTRACT

STUDY OBJECTIVE: To investigate if an erector spinae plane (ESP) block decreases postoperative opioid consumption, pain and postoperative nausea and vomiting in patients undergoing robotically-assisted minimally invasive direct coronary artery bypass surgery (RAMIDCAB).

DESIGN: A single-center, double-blind, prospective, randomized, placebo-controlled trial.

SETTING: Postoperative period; operating room, post-anesthesia care unit (PACU) and hospital ward in a university hospital.

PATIENTS: Sixty-four patients undergoing RAMIDCAB surgery via left-sided mini-thoracotomy and enrolled in the institutional enhanced recovery after cardiac surgery program.

INTERVENTIONS: At the end of surgery, patients received an ESP catheter at vertebra T5 under ultrasound guidance and were randomized to the administration of either ropivacaine 0.5% (loading dose of 30 ml and three additional doses of 20 ml each, interspersed with a 6 h interval) or normal saline 0.9% (with an identical administration scheme). In addition, patients received multimodal analgesia including acetaminophen, dexamethasone and patient-controlled analgesia with morphine. Following the final ESP bolus and before catheter removal, the position of the catheter was re-evaluated by ultrasound. Patients, investigators and medical personnel were blinded for the group allocation during the entire trial.

MEASUREMENTS: Primary outcome was cumulative morphine consumption during the first 24 h after extubation. Secondary outcomes included location and severity of pain, presence/extent of sensory block, duration of postoperative ventilation and hospital length of stay. Safety outcomes comprised the incidence of adverse events.

MAIN RESULTS: Median (IQR) 24-h morphine consumption was not different between the intervention- and control-groups, 67 mg (35-84) versus 71 mg (52-90) (p = 0.25), respectively. Likewise, no differences were detected in secondary and safety endpoints.

CONCLUSIONS: Following RAMIDCAB surgery, adding an ESP block to a standard multimodal analgesia regimen did not reduce opioid consumption and pain scores.

PMID:37129976 | DOI:10.1016/j.jclinane.2023.111088

J Environ Manage. 2023 Aug 1;339:117856. doi: 10.1016/j.jenvman.2023.117856. Epub 2023 Apr 5.

ABSTRACT

With increasing human impacts on the ecosystem in natural protected areas, there is an urgent need to undertake an assessment of ecological carrying capacity taken as a benchmark for assessing regional sustainability. Based on satellite remote sensing and socio-economic statistical data from 2000 to 2019, this study distinguished the controlling factors for the spatial and temporal patterns of ecological carrying capacity in the Qilian Mountain National Park, one of the 10 pilot national parks in China. The ecological carrying capacity index (ECCI) was developed by using the Driver-Pressure-State-Impact-Response framework and a comprehensive weight method. The results showed that the multiyear averaged ECCI was low in the south and west but was high in central and eastern regions. The spatial distribution of the ECCI was constrained by soil resources, ecosystem quality, land use/cover and water environment. At the regional scale, the ECCI decreased from 2000 to 2014, especially in Tianzhu, where farmland expansion and severe droughts reduced habitat quality and ecosystem function. However, the ECCI increased significantly from 2014 to 2019, which was attributed to a warm moist climate and the implementation of eco-environmental protection policies. Forest and grassland coverage, soil and water conservation, waste water treatment amount and terrestrial water reserves accounted for 35%, 26%, 20% and 8%, respectively, of the temporal variability in the ECCI. Concurrent with national park development, the ECCI is predicted to increase in most areas from 2020 to 2029 by back-propagation artificial neural networks, except for Sunan, Shandan and Menyuan, possibly owing to increasing conflicts between humans and the environment. The findings of this study provide evidence about the effectiveness of government policies in promoting regional sustainability by altering ecosystem composition and function. In addition, the dominant drivers for the temporal variability of ecological carrying capacity varied in space according to stepwise regression analysis, calling for region-specific management strategies in mountain protected areas and their surroundings.

PMID:37129968 | DOI:10.1016/j.jenvman.2023.117856

Nurse Educ. 2023 Apr 28. doi: 10.1097/NNE.0000000000001432. Online ahead of print.

ABSTRACT

BACKGROUND: Several definitions and guiding principles for nursing academic-practice partnerships exist.

PROBLEM: There remains a gap between academic-practice partnership definitions and practical operational models, thereby limiting schools of nursing ability to engage in productive partnerships. This article describes the development and validation of a novel Operational Model for Nursing Academic-Practice Partnerships.

APPROACH: An email survey of all nursing faculty (n = 228) identified quantity and types of faculty-led academic-practice partnerships. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed via thematic analysis conducted by 2 members of the project team and validated by the full project team.

OUTCOMES: The Operational Model for Academic-Practice Partnerships was created and is comprised of 8 partnership strategies: innovation, embedded faculty, joint appointment, consultant, independent practice, volunteer, scholarship, and clinical site development.

CONCLUSION: We offer this model as a framework to structure the development, implementation, and evaluation of academic-practice partnerships at nursing schools.

PMID:37129964 | DOI:10.1097/NNE.0000000000001432

Biometrics. 2023 May 2. doi: 10.1111/biom.13872. Online ahead of print.

ABSTRACT

Q-learning has been one of the most commonly used methods for optimizing dynamic treatment regimes (DTRs) in multi-stage decision making. Right-censored survival outcome poses a significant challenge to Q-Learning due to its reliance on parametric models for counterfactual estimation which are subject to misspecification and sensitive to missing covariates. In this paper we propose an imputation-based Q-learning (IQ-learning) where flexible nonparametric or semiparametric models are employed to estimate optimal treatment rules for each stage and then weighted hot-deck multiple imputation (MI) and direct-draw MI are used to predict optimal potential survival times. Missing data are handled using inverse probability weighting and MI, and the non-random treatment assignment among the observed is accounted for using a propensity-score approach. We investigate the performance of IQ-learning via extensive simulations and show that it is more robust to model misspecification than existing Q-Learning methods, imputes only plausible potential survival times contrary to parametric models, and provides more flexibility in terms of baseline hazard shape. Using IQ-learning we developed an optimal DTR for leukemia treatment based on a randomized trial with observational follow-up that motivated this study. This article is protected by copyright. All rights reserved.

PMID:37129942 | DOI:10.1111/biom.13872

J Med Internet Res. 2023 May 2;25:e44840. doi: 10.2196/44840.

ABSTRACT

BACKGROUND: Randomized controlled trials on text message interventions for smoking cessation have shown they are effective and recommended for tobacco control. However, the effectiveness in real-world settings is largely unknown, especially in low- and middle-income countries.

OBJECTIVE: This study aimed to provide real-world evidence about the utilization and effectiveness of a message-based tobacco cessation program (mCessation) in China.

METHODS: From May 2021 to September 2022, 16,746 people from the general population participated in the mCessation program provided by the World Health Organization. All participants received text messages on smoking cessation via instant messaging for 6 months, and they were also required to report smoking status. We randomly selected 2500 participants and interviewed them by telephone to determine the 7-day point prevalence abstinence rate at 6 months. Descriptive statistics were used to analyze population characteristics and abstinence rate. Logistic regression analysis was performed to explore risk factors for the abstinence rate.

RESULTS: Among the 2500 participants, the mean age was 35 years, and most (2407/2500, 96.20%) were male. The prevalence of tobacco dependence and light degree of tobacco dependence were 85.70% (2142/2500) and 89.10% (2228/2500), respectively. For respondents (953/2500, 38.10%), the 7-day point prevalence abstinence rate at 6 months was 21.90% (209/953). Participants older than 40 years or with tobacco dependence had significantly higher abstinence rates than those who were younger than 30 years old (odds ratio [OR] 1.77, 95% CI 1.06-3.29) or without dependence (OR 1.64, 95% CI 1.08-2.51), respectively. However, married people or heavily dependent smokers tended to find it more difficult to successfully quit smoking compared with unmarried people (OR 0.57, 95% CI 0.34-0.93) or lightly dependent smokers (OR 0.16, 95% CI 0.02-0.98), respectively.

CONCLUSIONS: In a real-world setting, mCessation China was generally acceptable to men and lightly dependent smokers, and it could help 1 in 5 smokers aged 18 years to 67 years quit smoking. However, strategies to increase awareness of young and married adults may improve implementation and abstinence rates.

PMID:37129934 | DOI:10.2196/44840