Tag: nevin manimala

Methods Mol Biol. 2023;2590:127-138. doi: 10.1007/978-1-0716-2819-5_8.

ABSTRACT

WhatsHap is a command-line tool for phasing and phasing-related tasks. It allows to infer haplotypes in diploid and polyploid samples based on (preferably long) reads covering at least two heterozygous variants. It offers additional tools for working with phased variant calls such as computing statistics, comparing different phasings and assigning reads in alignment files to their haplotype.

PMID:36335496 | DOI:10.1007/978-1-0716-2819-5_8

Circulation. 2022 Nov 6. doi: 10.1161/CIRCULATIONAHA.122.062949. Online ahead of print.

ABSTRACT

Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly being used for circulatory support in cardiogenic shock patients, although the evidence supporting its use in this context remains insufficient. The aim of the Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock (ECMO-CS) trial was to compare immediate implementation of VA-ECMO vs. an initially conservative therapy (allowing downstream use of VA-ECMO) in patients with rapidly deteriorating or severe cardiogenic shock. Methods: This multicenter, randomized, investigator-initiated, academic clinical trial included patients with either rapidly deteriorating or severe cardiogenic shock. Patients were randomly assigned to immediate VA-ECMO or no immediate VA-ECMO. Other diagnostic and therapeutic procedures were performed as per current standard(s) of care. In the early conservative group, VA-ECMO could be used downstream in case of worsening hemodynamic status. The primary endpoint was the composite of death from any cause, resuscitated circulatory arrest, and implementation of another mechanical circulatory support device at 30 days. Results: A total of 122 patients were randomized; after excluding 5 patients due to the absence of informed consent, 117 subjects were included in the analysis, of whom 58 randomized to immediate VA-ECMO and 59 to no immediate VA-ECMO. The composite primary endpoint occurred in 37 (63.8%) and 42 (71.2%) of patients in the immediate VA-ECMO and the no early VA-ECMO groups, respectively (hazard ratio, 0.72; 95% confidence intervals [CI], 0.46 to 1.12; P=0.21). VA-ECMO was used in 23 (39%) of no early VA-ECMO patients. The 30-day incidence of resuscitated cardiac arrest (10.3. % vs. 13.6%; risk difference [RD], -3.2; 95% CI, -15.0 to 8.5), all-cause mortality (50.0% versus 47.5%; RD, 2.5; 95% CI, -15.6 to 20.7), serious adverse events (60.3% vs. 61.0%; RD, -0.7; 95% CI, -18.4 to 17.0), sepsis, pneumonia, stroke, leg ischemia, and bleeding was not statistically different between the immediate VA-ECMO and the no immediate VA-ECMO groups. Conclusions: Immediate implementation of VA-ECMO in patients with rapidly deteriorating or severe cardiogenic shock did not improve clinical outcomes compared with an early conservative strategy that permitted downstream use of VA-ECMO in case of worsening hemodynamic status. Clinical Trial Registration: URL: https://www.clinicaltrials.gov; Unique identifier NCT02301819.

PMID:36335478 | DOI:10.1161/CIRCULATIONAHA.122.062949

Knee Surg Sports Traumatol Arthrosc. 2022 Nov 6. doi: 10.1007/s00167-022-07216-8. Online ahead of print.

ABSTRACT

PURPOSE: There is a paucity of data available on total knee prostheses combining dual-radius, ultra-congruency, posterior-stabilization and mobile-bearing insert. This prospective cohort study aimed to assess the clinical evolution of the FIRST^® prosthesis (Symbios Orthopédie, Yverdon, CH), the earliest prosthesis with this particular design. It was hypothesized that the primary outcomes, evaluating pain, stiffness, function and stability, would improve following arthroplasty and remain improved during the follow-up period of 10 years.

METHODS: All patients programmed for a total knee arthroplasty using a FIRST^® prosthesis at our university hospital between 2006 and 2008 were invited to participate. Study knees were evaluated pre-operatively as well as one, five and ten years post-operatively. Patients filled out questionnaires at each evaluation point and had a radiographic assessment at the five-year and ten-year follow-ups. Primary outcomes were the total, pain, stiffness and function measures of the Western Ontario and McMaster Universities Osteoarthritis questionnaire (WOMAC) and the knee and function measures of the Knee Society Score (KSS). Friedman and Wilcoxon’s rank-sum tests were used to compare measures across time points.

RESULTS: Hundred and twenty four prostheses were included (baseline demographics: 69.9 ± 8.3 years old, 28.1 ± 4.3 kg/m², 54% male) and 68 could be followed during ten years. Five prostheses underwent a revision. All other prostheses lost at follow-up were lost for reasons unrelated to the prosthesis. All primary measures reported statistically and clinically significant improvements between baseline and the three follow-up evaluations. Statistically significant improvements at the three follow-up evaluations were also observed for most secondary measures. There was no implant loosening. At ten-year follow-up, radiolucent lines were observed in 2.9% femoral implants and 1.5% tibial implants.

CONCLUSION: The positive results observed in all domains of assessment and the small revision rate demonstrated an effective functioning of the FIRST^® prosthesis during the ten-year follow-up period. The results, globally similar to those previously published for other prosthesis designs, encourage the development of assistive methods to select the most appropriate designs on an individual basis.

LEVEL OF EVIDENCE: IV, prospective cohort study.

PMID:36335473 | DOI:10.1007/s00167-022-07216-8

Soc Psychiatry Psychiatr Epidemiol. 2022 Nov 6. doi: 10.1007/s00127-022-02380-1. Online ahead of print.

ABSTRACT

PURPOSE: The associations of duration of subjective poverty and poverty status with mortality among older people remains inconclusive, and the underlying mechanisms of mental health on them are rarely discussed in population-based epidemiological studies.

METHODS: We used the data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) (2008-2018). The Cox regression model was used to estimate hazard ratio (HR) and 95% confidence intervals (CIs) for mortality. Mediation analysis was applied to assess the effect of mental health.

RESULTS: When compared with participants without subjective poverty, those who reported subjective poverty at one time point (2008 or 2011) or two time points (2008 and 2011) had a higher risk of death, with multivariable-adjusted HR (95% CIs) of 1.08 (1.00-1.16) and 1.22 (1.06-1.39), respectively. For poverty status, the multivariable-adjusted HR (95% CIs) of mortality were 0.81 (0.66-0.98) for “just objective poverty” and 0.78 (0.62-0.98) for “neither subjective nor objective poverty” compared with participants who reported “just subjective poverty”, while there was no statistically significant association between “poverty subjectively and objectively” and mortality (HR = 0.88, 95% CI 0.72-1.07). Besides, we found that the proportion mediated by mental health was 26.6%, and age was a significant effect modifier.

CONCLUSIONS: Subjective poverty may be associated with a higher risk of death among Chinese older people. This study showed that promoting mental health alone may not substantially reduce socioeconomic inequality in health. Further explorations of measures to tackle the social determinants of health are still needed.

PMID:36335472 | DOI:10.1007/s00127-022-02380-1

J Public Health (Oxf). 2022 Nov 3:fdac122. doi: 10.1093/pubmed/fdac122. Online ahead of print.

ABSTRACT

BACKGROUND: Differential attainment has been widely observed in United Kingdom (UK) medical training, with minority ethnicity being associated with reduced success in recruitment and progression through training. Specialty training in Public Health in the UK recruits candidates with medical as well as non-medical backgrounds. At the request of the UK Faculty of Public Health and Health Education England, we sought to examine whether differential attainment may or may not be occurring in the multi-stage recruitment process.

METHODS: We analysed 3 years of national recruitment data into Public Health specialty training to identify whether demographic characteristics including age, sex, ethnicity and professional background were associated with successful recruitment.

RESULTS: In total 2252 applications between 2018 and 2020 were analysed. Candidates who were older, Asian, black or from backgrounds other than medicine were significantly less likely to progress from the psychometric testing stage than the white British group. Fewer statistically significant differences were observed at the final stage of recruitment involving interviews, group work and a written task.

CONCLUSIONS: The findings suggest that older candidates those from some ethnic minority backgrounds and those from backgrounds other than medicine are disadvantaged by the current recruitment process, with differential attainment associated with the psychometric testing stage.

PMID:36335426 | DOI:10.1093/pubmed/fdac122

Allergy Asthma Proc. 2022 Nov 1;43(6):543-545. doi: 10.2500/aap.2022.43.220067.

ABSTRACT

Background: Curcumin has been shown to decrease allergic symptoms and biomarkers in some animal and human studies. Objective: Our study aimed to determine if curcumin affects immediate skin-prick testing. Methods: We enrolled 34 participants sensitized to select antigens. The participants were randomized to treatment with curcumin or placebo in a double-blind fashion. The participants underwent titrated skin-prick testing before and after 1 week of treatment, and the pre- and posttreatment skin test wheals and flares were compared. Results: Curcumin did not have a statistically significant effect on immediate skin-prick test wheal or flare size. Conclusion: Although curcumin may attenuate allergic symptoms and biomarkers, it does not have a significant effect on immediate skin-prick test results and does not need to be discontinued before testing.

PMID:36335415 | DOI:10.2500/aap.2022.43.220067

Trials. 2022 Nov 5;23(1):924. doi: 10.1186/s13063-022-06790-z.

ABSTRACT

BACKGROUND: The HemiSPAIRE trial is being conducted to determine whether a modified muscle sparing technique (SPAIRE-“Save Piriformis and Internus, Repairing Externus”) in hip hemiarthroplasty brings clinical benefits compared to the standard lateral technique in adults aged 60 years or older, with a displaced intracapsular hip fracture. This article describes the detailed statistical analysis plan for the trial. METHODS AND DESIGN: HemiSPAIRE is a definitive, pragmatic, superiority, multicentre, randomised controlled trial (with internal pilot) with two parallel groups. Participants, ward staff and all research staff involved in post-operative assessments are blinded to allocation. This article describes in detail (1) the primary and secondary outcomes; (2) the statistical analysis principles, including a survivor average causal effect (SACE) method chosen specifically to address the issue of potential bias from differential survival between trial arms, which was seen from data review by the Trial Steering Committee, the participants that will be included in each analysis, the covariates that will be included in each analysis, and how the results will be presented; (3) planned main analysis of the primary outcome; (4) planned analyses of the secondary outcomes; and (5) planned additional analyses of the primary and secondary outcomes.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04095611. Registered on 19 September 2019.

PMID:36335403 | DOI:10.1186/s13063-022-06790-z

Addict Sci Clin Pract. 2022 Nov 5;17(1):60. doi: 10.1186/s13722-022-00342-1.

ABSTRACT

BACKGROUND: Medication for opioid use disorder (MOUD) reduces mortality, but few patients access MOUD. At a Federally Qualified Health Center (FQHC), we implemented a low barrier model of MOUD, including same-day MOUD initiation and a harm reduction philosophy.

OBJECTIVE: To investigate whether low barrier MOUD improved retention in care compared to traditional treatment.

DESIGN AND PARTICIPANTS: Retrospective cohort study of patients with at least one visit seeking MOUD at the FQHC during a historical control period (3/1/2018-3/31/2019) and a low barrier intervention period (11/1/2019-7/31/2020).

MAIN MEASURES: Primary outcomes were any MOUD prescription within 6 months of the index visit and 3- and 6-month retention in treatment without care gap, with care gap defined as 60 consecutive days without a visit or prescription. Secondary outcomes were all-cause hospitalization and emergency department visit within 6 months of the index visit.

KEY RESULTS: Baseline characteristics were similar between the intervention (n = 113) and control (n = 90) groups, except the intervention group had higher rates of uninsured, public insurance and diabetes. Any MOUD prescription within 6 months of index visit was higher in the intervention group (97.3% vs 70%), with higher adjusted odds of MOUD prescription (OR = 4.01, 95% CI 2.08-7.71). Retention in care was similar between groups at 3 months (61.9% vs 60%, aOR = 1.06, 95% CI 0.78-1.44). At 6 months, a higher proportion of the intervention group was retained in care, but the difference was not statistically significant (53.1% vs 45.6%, aOR 1.27, 95% CI 0.93-1.73). There was no significant difference in adjusted odds of 6-month hospitalization or ED visit between groups.

CONCLUSIONS: Low barrier MOUD engaged a higher risk population and did not result in any statistically significant difference in retention in care compared with a historical control. Future research should determine what interventions improve retention of patients engaged through low barrier care. Primary care clinics can implement low barrier treatment to make MOUD accessible to a broader population.

PMID:36335381 | DOI:10.1186/s13722-022-00342-1

Pilot Feasibility Stud. 2022 Nov 5;8(1):237. doi: 10.1186/s40814-022-01192-z.

ABSTRACT

INTRODUCTION: Postoperative infections represent a significant burden of disease, demanding antibiotic prescriptions, and are contributing to antimicrobial resistance. The burden of infection as a surgical complication is greater in low- and middle-income countries (LMICs). We report the protocol of a pilot study for the co-design, implementation and evaluation of two infection prevention and control (IPC) and antimicrobial stewardship (AMS) interventions across the surgical pathway in a teaching hospital in India.

METHODS AND ANALYSIS: The two interventions developed following in-depth qualitative enquiry are (i) surveillance and feedback of postoperative infections to optimise the use of antibiotics in two surgical departments (gastrointestinal and cardiovascular and thoracic surgery) and (ii) raising awareness amongst patients, carers and members of public about IPC and AMS. We will conduct a prospective study, formatively evaluating the implementation process of delivering the two co-designed interventions using implementation science frameworks. The study will systematically assess the context of intervention delivery, so that implementation support for the interventions may be adapted to the needs of stakeholders throughout the study. Analysis of implementation logs and interviews with stakeholders upon completion of the implementation period, will offer insights into the perceived acceptability, appropriateness, feasibility and sustainability of the interventions and their implementation support. Implementation costs will be captured descriptively. Feasibility of clinical data collection to investigate effectiveness of interventions will also be assessed for a future larger study. Thematic framework analysis and descriptive statistics will be used to report the qualitative and quantitative data, respectively.

STRENGTHS AND LIMITATIONS OF THIS STUDY: • The paired interventions have been co-designed from their inception with involvement of stakeholders at different stages in the surgical pathway. • Simultaneous evaluation of implementation and clinical outcomes will inform the development of a future larger study to enable/assess the scalability of interventions • The study offers a novel combination of implementation theory-informed, stakeholder-driven and clinically relevant evaluation, carried out in the context of a middle-income country hospital. • The project may not be applicable to every low-resource setting and surgical context due to differences in healthcare systems and cultures. However, the application of implementation science concepts may facilitate transferability and adaptation to other settings.

PMID:36335367 | DOI:10.1186/s40814-022-01192-z

BMC Public Health. 2022 Nov 5;22(1):2027. doi: 10.1186/s12889-022-14392-2.

ABSTRACT

BACKGROUND: It is difficult to accurately assess the health literacy(HL) level of Mongolians by using Chinese conventional HL questionnaire, due to their particularity in language, culture and living environment. Therefore, it is very important to design an exclusive HL questionnaire for them. In addition, the existing statistical models cannot meet the requirement of HL assessment with high precision, so it is necessary to study a new HL assessment model.

METHODS: A HL questionnaire with 68 questions is designed by combing the HLS-EU-Q47and the characteristics of Mongolians in China. 742 Mongolians aged 18 to 87 in Inner Mongolia of China answered the questionnaire. A data set with 742 samples is constructed, where each sample has 68 features and 1 target. Based on it, the XGB and LGBM regression models are respectively constructed to assess the HL levels of respondents, and their evaluation effects are compared. The impact of each question on the HL level is quantitatively analyzed by using the feature-importance function in LGBM model to verify the effectiveness of the questionnaire and to find the key factors for affecting HL.

RESULTS: The HL questionnaire has the high reliability, which is reflected by the high internal consistency (Cronbach’s coefficient=0.807) and test-retest reliability (Mutual Information Score= 0.803). The validity of the HL questionnaire is obtained by solving KMO and Bartlett Spherical Test Chi-square Value, which are 0.765 and 2486 ([Formula: see text]), respectively. [Formula: see text] index and the absolute error obtained by using the HL assessment model based on LGBM are 0.98347 and 11, which are better than ones by applying the model based-XGB, respectively. The quantitative analysis results show that all 68 questions have influence on HL level, but their degree are different. The first three factors are age, salary level, the judgment ability for the HL information in media, respectively. The HL level distribution of the respondents was 66.71[Formula: see text] excellent, 25.74[Formula: see text] good and 7.54[Formula: see text] poor, respectively.

CONCLUSIONS: The presented HL questionnaire with 68 questions and LGBM regression model can obtain the HL level assessment results with high precision for Mongolians in China. The impact of each question in the questionnaire on the final assessment results can be quantified by using the feature-importance function in LGBM model, which is better than the existing qualitative analysis methods.

PMID:36335364 | DOI:10.1186/s12889-022-14392-2