Tag: nevin manimala

J Pediatr Gastroenterol Nutr. 2021 Sep 1;73(3):325-328. doi: 10.1097/MPG.0000000000003178.

ABSTRACT

OBJECTIVES: Inadequate bowel preparation (IBP) for colonoscopy leads to missed diagnosis, longer anesthesia time, higher chance of complications and increased costs. Adult studies have demonstrated that patient characteristics such as male gender and obesity are associated with IBP. Little is known about factors affecting bowel preparation in children. Our aim was to determine factors associated with IBP in children.

METHODS: We prospectively enrolled children undergoing outpatient colonoscopy. Quality of bowel preparation was assessed using Boston Bowel Preparation Scale (BBPS) score (range 0-9). Data collected included patient demographics, indication, and type of insurance. Patients were divided into two groups based on BBPS score-adequate (BBPS score > 5) and inadequate (BBPS score < 5) and groups were compared using Student t-test and chi-square test. Possible predictors were analyzed using multivariate logistic regression models.

RESULTS: A total of 334 children were prospectively enrolled of whom 321 were studied further (age range 2-18 years; mean age 12.4 years; 60.4% female; 85.9% Caucasian). The mean BBPS score was 6.8 (standard deviation of ±2). IBP was reported in 12.8% (41/321). Multivariable logistic regression analysis did not show statistical differences between the groups in studied patient factors including age, gender, obesity, race, insurance type, and indication for colonoscopy.

CONCLUSION: Contrary to several adult studies, the results of our prospective study did not show any relationship between examined patient factors and IBP in children. Interestingly, IBP was less prevalent in our pediatric study compared to published adult data (12.8% vs 20-40%).

PMID:34415261 | DOI:10.1097/MPG.0000000000003178

J Obstet Gynaecol. 2021 Aug 20:1-7. doi: 10.1080/01443615.2021.1929116. Online ahead of print.

ABSTRACT

This study examines the relationship between the age at menarche and gestational diabetes mellitus (GDM). This retrospective study included subjects who were diagnosed with GDM at a pregnancy polyclinic in Kocaeli, Turkey between 2014 and 2018. The mean ages at menarche were 12.6 and 13.03 years in the GDM group and control group, respectively. The analysis results showed that pre-pregnancy cycle duration, age at menarche and pre-pregnancy BMI are statistically significant in terms of the development of gestational diabetes. (p < .05).In our study showed that the risk of GDM was found to be 2.3 times higher in pregnant women with a menarche age of <12 years. If the pre-pregnancy BMI value is more than 25 kg/cm², the risk of GDM was found to be approximately 2 times higher. The study indicated that age at menarche, cycle duration, and BMI were risk factors for GDM. IMPACT STATEMENTWhat is already known on this subject? GDM has a lasting health impact on both the mother and the foetus. While several risk factors have previously been identified for GDM such as family history, obesity, advanced maternal age, significant gaps remain in our understanding of the risk factor and pathogenesis. Recent studies suggested that earlier menarche was significantly associated with an increased risk of GDM.What do the results of this study add? There might be ethnic differences on the relationship between the GDM and menarche age. There is no study examining the relationship between the age of menarche and GDM in Turkey. In presented study, we determined the risk factors of GDM including the age of menarche, cycle duration and BMI.What are the implications of these findings for clinical practice and / or further research? Therefore, a comprehensive evaluation of the menstrual history by healthcare professionals is important for future pregnancy risks. It is important to understand risk factors for GDM and to establish preventive strategies among high-risk populations. In addition, this study will shed light on future epidemiological and cohort studies.

PMID:34415226 | DOI:10.1080/01443615.2021.1929116

Int J Circumpolar Health. 2021 Dec;80(1):1969745. doi: 10.1080/22423982.2021.1969745.

ABSTRACT

The primary aim of this study was to determine if self-reported occupational noise exposure was associated with Raynaud’s phenomenon. In northern Sweden, a nested case-control study was performed on subjects reporting Raynaud’s phenomenon (N=461), and controls (N=763) matched by age, sex and geographical location. The response rate to the exposure questionnaire was 79.2%. The study showed no statistically significant association between occupational noise exposure and reporting Raynaud’s phenomenon (OR 1.10; 95% CI 0.83-1.46) in simple analyses. However, there was a trend towards increasing OR for Raynaud’s phenomenon with increasing noise exposure, although not statistically significant. Also, there was a significant association between noise exposure and hearing loss (OR 2.76; 95% CI 2.00-3.81), and hearing loss was associated with reporting Raynaud’s phenomenon (OR 1.52; 95% CI 1.03-2.23) in a multiple regression model. In conclusion, self-reported occupational noise exposure was not statistically significantly associated with Raynaud’s phenomenon, but there was a dose-effect trend. In addition, the multiple model showed a robust association between hearing loss and Raynaud’s phenomenon. These findings offer some support for a common pathophysiological background for Raynaud’s phenomenon and hearing loss among noise-exposed workers, possibly through noise-induced vasoconstriction.

PMID:34415235 | DOI:10.1080/22423982.2021.1969745

J Neurointerv Surg. 2021 Aug 19:neurintsurg-2021-017867. doi: 10.1136/neurintsurg-2021-017867. Online ahead of print.

ABSTRACT

BACKGROUND: Despite constant improvements in recent years, sufficient reperfusion after mechanical thrombectomy (MT) is not reached in up to 15% of patients with large vessel occlusion stroke (LVOS). The outcome of patients with unsuccessful reperfusion after MT especially after intravenous thrombolysis (IVT) use is not known. We investigated the influence of initial IVT in this particular group of patients with failed intracranial recanalization.

METHODS: We conducted a retrospective analysis of the Endovascular Treatment in Ischemic Stroke (ETIS) registry from January 2015 to December 2019. Patients presenting with LVOS of the anterior circulation and final modified Thrombolysis in Cerebral Infarction score (mTICI) of 0, 1 or 2a were included. Posterior circulation, isolated cervical carotid occlusions and successful reperfusions (mTICI 2b, 2c or 3) were excluded. The primary endpoint was favorable outcome (modified Rankin Scale score of 0-2) after 3 months. Secondary endpoints were safety outcomes including mortality, any intracranial hemorrhage (ICH), parenchymal hematoma (PH) and symptomatic intracranial hemorrhage (sICH) rates.

RESULTS: Among 5076 patients with LVOS treated with MT, 524 patients with insufficient recanalization met inclusion criteria, of which 242 received IVT and 282 did not. Functional outcome was improved in the MT+IVT group compared with the MT alone group, although the difference did not reach statistical significance (23.0% vs 12.9%; adjusted OR=1.82; 95% CI 0.98 to 3.38; p=0.058). However, 3 month mRS shift analysis showed a significant benefit of IVT (adjusted OR=1.68; 95% CI 1.56 to 6.54). ICH and sICH rates were similar in both groups, although PH rate was higher in the MT+IVT group (adjusted OR=3.20; 95% CI 1.56 to 6.54).

CONCLUSIONS: Among patients with LVOS in the anterior circulation and unsuccessful MT, IVT was associated with improved functional outcome even after unsuccessful MT. Despite recent trials questioning the place of IVT in the LVOS reperfusion strategy, these findings emphasize a subgroup of patients still benefiting from IVT.

PMID:34413246 | DOI:10.1136/neurintsurg-2021-017867

Proc Natl Acad Sci U S A. 2021 Aug 24;118(34):e2100761118. doi: 10.1073/pnas.2100761118.

ABSTRACT

Binary classification is one of the central problems in machine-learning research and, as such, investigations of its general statistical properties are of interest. We studied the ranking statistics of items in binary classification problems and observed that there is a formal and surprising relationship between the probability of a sample belonging to one of the two classes and the Fermi-Dirac distribution determining the probability that a fermion occupies a given single-particle quantum state in a physical system of noninteracting fermions. Using this equivalence, it is possible to compute a calibrated probabilistic output for binary classifiers. We show that the area under the receiver operating characteristics curve (AUC) in a classification problem is related to the temperature of an equivalent physical system. In a similar manner, the optimal decision threshold between the two classes is associated with the chemical potential of an equivalent physical system. Using our framework, we also derive a closed-form expression to calculate the variance for the AUC of a classifier. Finally, we introduce FiDEL (Fermi-Dirac-based ensemble learning), an ensemble learning algorithm that uses the calibrated nature of the classifier’s output probability to combine possibly very different classifiers.

PMID:34413191 | DOI:10.1073/pnas.2100761118

BMJ Open. 2021 Aug 19;11(8):e047575. doi: 10.1136/bmjopen-2020-047575.

ABSTRACT

BACKGROUND: We can improve healthcare services by better understanding current provision. One way to understand this is by linking data sets from clinical and national audits, national registries and other National Health Service (NHS) encounter data. However, getting to the point of having linked national data sets is challenging.

OBJECTIVE: We describe our experience of the data application and linkage process for our study ‘LAUNCHES QI’, and the time, processes and resource requirements involved. To help others planning similar projects, we highlight challenges encountered and advice for applications in the current system as well as suggestions for system improvements.

FINDINGS: The study set up for LAUNCHES QI began in March 2018, and the process through to data acquisition took 2.5 years. Several challenges were encountered, including the amount of information required (often duplicate information in different formats across applications), lack of clarity on processes, resource constraints that limit an audit’s capacity to fulfil requests and the unexpected amount of time required from the study team. It is incredibly difficult to estimate the resources needed ahead of time, and yet necessary to do so as early on as funding applications. Early decisions can have a significant impact during latter stages and be hard to change, yet it is difficult to get specific information at the beginning of the process.

CONCLUSIONS: The current system is incredibly complex, arduous and slow, stifling innovation and delaying scientific progress. NHS data can inform and improve health services and we believe there is an ethical responsibility to use it to do so. Streamlining the number of applications required for accessing data for health services research and providing clarity to data controllers could facilitate the maintenance of stringent governance, while accelerating scientific studies and progress, leading to swifter application of findings and improvements in healthcare.

PMID:34413101 | DOI:10.1136/bmjopen-2020-047575

Eur Respir J. 2021 Aug 19:2101796. doi: 10.1183/13993003.01796-2021. Online ahead of print.

NO ABSTRACT

PMID:34413149 | DOI:10.1183/13993003.01796-2021

Postgrad Med J. 2021 Aug 19:postgradmedj-2021-140852. doi: 10.1136/postgradmedj-2021-140852. Online ahead of print.

NO ABSTRACT

PMID:34413176 | DOI:10.1136/postgradmedj-2021-140852

eNeuro. 2021 Aug 19:ENEURO.0032-21.2021. doi: 10.1523/ENEURO.0032-21.2021. Online ahead of print.

ABSTRACT

Humans can use their previous experience in form of statistical priors to improve decisions. It is however unclear how such priors are learned and represented. Importantly, it has remained elusive whether prior learning is independent of the sensorimotor system involved in the learning process or not, as both modality-specific and modality-general learning have been reported in the past. Here, we used a saccadic eye movement task to probe the learning and representation of a spatial prior across a few trials. In this task, learning occurs in an unsupervised manner and through encountering trial-by-trial visual hints drawn from a distribution centered on the target location. Using a model-comparison approach, we found that participants’ prior knowledge is largely represented in the form of their previous motor actions, with minimal influence from the previously seen visual hints. By using two different motor contexts for response (looking either at the estimated target location, or exactly opposite to it), we could further compare whether prior experience obtained in one motor context can be transferred to the other. Although learning curves were highly similar, and participants seemed to use the same strategy for both response types, they could not fully transfer their knowledge between contexts, as performance and confidence ratings dropped after a switch of the required response. Together, our results suggest that humans preferably use the internal representations of their previous motor actions, rather than past incoming sensory information, to form statistical sensorimotor priors on the timescale of a few trials.Significance StatementHumans can learn statistical regularities and later use them as priors to inform decisions. It remains unclear what type of representation is used to store and integrate past experience. We designed an experiment where humans had to combine visual information over multiple trials to locate a hidden target location. Using computational modelling, we found that participants represented past experience in the form of their previous decisions, and not directly by memorizing the visual cues. As a consequence of overweighing past decisions relative to the veridical visual information, gained experience did not generalize across two different contexts, albeit they differed minimally with respect to the prior. Hence, the process through which past experience is learned determines its influence on our decisions.

PMID:34413084 | DOI:10.1523/ENEURO.0032-21.2021

BMJ Open. 2021 Aug 19;11(8):e045574. doi: 10.1136/bmjopen-2020-045574.

ABSTRACT

INTRODUCTION: In 2013, the WHO published the first global and regional estimates on physical and sexual intimate partner violence (IPV) and non-partner sexual violence (NPSV) based on a systematic review of population-based prevalence studies. In this protocol, we describe a new systematic review for the production of updated estimates for IPV and NPSV for global monitoring of violence against women, including providing the baseline for measuring Sustainable Development Goal to eliminate all forms of violence against women and girls.

METHODS AND ANALYSIS: The systematic review will update and extend the previous search for population-based surveys (either nationally or subnationally representative) conducted among women aged 15+ years that measured the prevalence of physical, sexual, psychological and physical and/or sexual IPV, NPSV or sexual violence by any perpetrator up to December 2019. Data will be extracted separately for all age groups, setting (urban/rural), partnership status (currently partnered/ever partnered/all women) and recall period (lifetime prevalence/past 12 months). Studies will be identified from electronic searches of online databases of EMBASE, MEDLINE, Global Health and PsycInfo. A search of national statistics office homepages will be conducted for each country to identify reports on population-based, national or subnational studies that include data on IPV or NPSV published outside academic journals. Two reviewers will be involved in quality assessment and data extraction of the review. The review is planned to be updated on a continuous basis. All findings will undergo a country consultation process.

ETHICS AND DISSEMINATION: Formal ethical approval is not required, as primary data will not be collected. This systematic review will provide a basis and a follow-up tool for global monitoring of the Sustainable Development Goal Target 5.2 on the elimination of all forms of violence against women and girls.

PROSPERO REGISTRATION NUMBER: CRD42017054100.

PMID:34413098 | DOI:10.1136/bmjopen-2020-045574