Tag: nevin manimala

Mil Med. 2022 Jul 26:usac234. doi: 10.1093/milmed/usac234. Online ahead of print.

ABSTRACT

INTRODUCTION: The National Defense Authorization Act of 2017 indicated the need for a national strategy to improve trauma care among military treatment facilities (MTFs). Part of the proposed strategy to improve trauma outcomes was to convert identified MTFs into verified trauma centers. The American College of Surgeons (ACS) verifies trauma centers through an evaluation process based on available resources at a facility. It has been proven that trauma centers, specifically those verified by the ACS, have improved trauma outcomes. In 2017, we implemented steps to become a level III trauma program, according to the standards for designation by the state and verification through the ACS. The goal of this retrospective review is to evaluate the impact of this implementation with regard to both patient care and the MTF.

MATERIALS AND METHODS: Data from a single-MTF trauma registry from 2018, at the initiation of the trauma program, to present were reviewed. Outcomes were selected based upon the ACS verification criteria. Specifically, emergency department length of stay (ED LOS), nonsurgical admissions, injury severity score, diversion rates, and time to operating room were reviewed. Statistical analyses were performed using Student’s t-tests. Institutional review board (IRB) approval was not required for this study as it was performed as a quality improvement project using deidentified data.

RESULTS: ED LOS decreased significantly after implementation of the trauma program from an average of 6.43 h in 2018 to 4.73 h in 2019 and 4.6 h in 2020 (P < .04). Nonsurgical admissions decreased significantly from 57.8% in 2018, with rates of <20% in all subsequent years (P < .01). The average injury severity score increased from 5.61 in 2018 to 7.52 in 2020 (P < .01) and 7.27 in 2021 (P < .01). Diversion rates also decreased from >5% in 2018 to 0% in 2021.

CONCLUSIONS: The establishment of a trauma program in accordance with the standards of the ACS for verification improved metrics of care for trauma patients at our MTF. This implementation as part of the local trauma system also led to increased injury severity seen by the MTF, which enhances readiness for its providers.

PMID:36177765 | DOI:10.1093/milmed/usac234

Am J Sports Med. 2022 Oct;50(12):3198-3209. doi: 10.1177/03635465221120388. Epub 2022 Sep 13.

ABSTRACT

BACKGROUND: Femoroacetabular impingement syndrome is characterized by chondrolabral damage and hip pain. The specific biomechanics used by people with femoroacetabular impingement syndrome during daily activities may exacerbate their symptoms. Femoroacetabular impingement syndrome can be treated nonoperatively or surgically; however, differential treatment effects on walking biomechanics have not been examined.

PURPOSE: To compare the 12-month effects of physical therapist-led care or arthroscopy on trunk, pelvis, and hip kinematics as well as hip moments during walking.

STUDY DESIGN: Secondary analysis of multi-centre, pragmatic, two-arm superiority randomized controlled trial subsample; Level of evidence, 1.

METHODS: A subsample of 43 participants from the Australian Full randomised controlled trial of Arthroscopic Surgery for Hip Impingement versus best cONventional (FASHIoN trial) underwent gait analysis and completed the International Hip Outcome Tool (iHOT-33) at both baseline and 12 months after random allocation to physical therapist-led care (personalized hip therapy; n = 22; mean age 35; 41% female) or arthroscopy (n = 21; mean age 36; 48% female). Changes in trunk, pelvis, and hip biomechanics were compared between treatment groups across the gait cycle using statistical parametric mapping. Associations between changes in iHOT-33 and changes in hip kinematics across 3 planes of motion were examined.

RESULTS: As compared with the arthroscopy group, the personalized hip therapy group increased its peak hip adduction moments (mean difference = 0.35 N·m/body weight·height [%] [95% CI, 0.05-0.65]; effect size = 0.72; P = .02). Hip adduction moments in the arthroscopy group were unchanged in response to treatment. No other between-group differences were detected. Improvements in iHOT-33 were not associated with changes in hip kinematics.

CONCLUSION: Peak hip adduction moments were increased in the personalized hip therapy group and unchanged in the arthroscopy group. No biomechanical changes favoring arthroscopy were detected, suggesting that personalized hip therapy elicits greater changes in hip moments during walking at 12-month follow-up. Twelve-month changes in hip-related quality of life were not associated with changes in hip kinematics.

PMID:36177759 | DOI:10.1177/03635465221120388

Stat Med. 2022 Sep 30. doi: 10.1002/sim.9575. Online ahead of print.

ABSTRACT

The safety of medical products due to adverse events (AE) from drugs, therapeutic biologics, and medical devices is a major public health concern worldwide. Likelihood ratio test (LRT) approaches to pharmacovigilance constitute a class of rigorous statistical tools that permit objective identification of AEs of a specific drug and/or a class of drugs cataloged in spontaneous reporting system databases. However, the existing LRT approaches encounter certain theoretical and computational challenges when an underlying Poisson model assumption is violated, including in cases of zero-inflated data. We briefly review existing LRT approaches and propose a novel class of (pseudo-) LRT methods to address these challenges. Our approach uses an alternative parametrization to formulate a unified framework with a common test statistic that can handle both Poisson and zero-inflated Poisson (ZIP) models. The proposed framework is computationally efficient, and it reveals deeper insights into the comparative behaviors of the Poisson and the ZIP models for handling AE data. Our extensive simulation studies document notably superior performances of the proposed methods over existing approaches particularly under zero-inflation, both in terms of statistical (eg, much better control of the nominal level and false discovery rate with substantially enhanced power) and computational ( $\sim$ 100-500-fold gains in average running times) performance metrics. An application of our method on the statin drug class from the FDA FAERS database reveals interesting insights on potential AEs. An R package, pvLRT, implementing our methods has been released in the public domain.

PMID:36177750 | DOI:10.1002/sim.9575

Acta Psychiatr Scand. 2022 Sep 30. doi: 10.1111/acps.13506. Online ahead of print.

ABSTRACT

INTRODUCTION: Alcohol, tobacco and coffee are commonly used substances and use in adolescence has previously been linked to mood disorders. However, few large prospective studies have investigated adolescent use in relation to mental health outcomes in adulthood. The main aim of this study was to examine the prospective associations between alcohol use, cigarette smoking and coffee consumption at age 16 and subsequent mood disorders up to 33 years of age.

METHODS: Data from The Northern Finland Birth Cohort 1986 Study were used and a total of 7,660 participants (49.9% male) were included. Associations between alcohol use, cigarette smoking and coffee consumption at age 16 and later diagnoses of major depression and bipolar disorder were examined using multinomial logistic regression analyses.

RESULTS: Mean number of cigarettes/day (OR=1.23 (95% CI 1.01-1.50)) and mean volume of alcohol consumption (OR = 1.22 (95% CI 1.01-1.47)), but not frequency of excessive drinking, in adolescence were associated with increased risk for subsequent bipolar disorder after adjustment for sex, parental psychiatric disorders, family structure, illicit substance use, and emotional and behavioral problems at age 16. An association between cigarette smoking and major depression attenuated to statistically non-significant when adjusted for emotional and behavioral problems. No associations were observed between adolescent coffee consumption and subsequent mood disorders.

CONCLUSIONS: This is the first study to report an association of adolescent cigarette smoking and subsequent bipolar disorder diagnosis providing grounds for further research and pointing to a place for preventive measures among adolescents.

PMID:36177725 | DOI:10.1111/acps.13506

Biometrics. 2022 Sep 30. doi: 10.1111/biom.13766. Online ahead of print.

ABSTRACT

In the COVID-19 pandemic, workplace transmission plays an important role. For this type of transmission, the longitudinal 14-day incidence curve of SARS-CoV-2 infections per economic sector is a proxy. In Belgium, a census of confirmed 14-day incidences per NACE-BEL sector level three is available from September 2020 until June 2021, encompassing two waves of infections. However, these high-dimensional data, with a relatively small number of NACE-BEL sectors, are challenging to analyze. We propose a non-linear Gaussian-Gaussian model that combines parametric and semi-parametric elements to describe the incidence curves with a small set of meaningful parameters. These parameters are further analyzed with conventional statistical methods, such as canonical correlation analysis and linear models, to provide insight into predictive characteristics of the first wave for the second wave. Those non-linear models classify economic sectors into three groups: sectors with two regular waves of infections, sectors with only a first wave and sectors with a more irregular profile, which may indicate a clear effect of COVID-19 vaccination. The Gaussian-Gaussian model thus allows for analyzing and comparing incidence curves and to bring out key characteristics of such curves. Finally, we consider in which other settings the proposed approach could be applied, together with possible pitfalls. This article is protected by copyright. All rights reserved.

PMID:36177715 | DOI:10.1111/biom.13766

J Cardiovasc Electrophysiol. 2022 Sep 30. doi: 10.1111/jce.15697. Online ahead of print.

ABSTRACT

AIM: We conducted a systematic review and meta-analysis of randomized and observational studies with a control group to evaluate the effectiveness and safety of a time to isolation (TTI)-based strategy of cryoballoon ablation (CBA) in the treatment of atrial fibrillation (AF).

METHODS: Three electronic databases (MEDLINE, Cochrane Central Register of Controlled Trials and Embase) without language restrictions were searched. The intervention assessed was a TTI-based strategy of CBA in the treatment of AF. TTI was defined as the time from the start of freezing to the last recorded pulmonary veins’ potential. The comparison of interest was intended conventional protocol of CBA. The primary end point was freedom from atrial arrhythmia.

RESULTS: Nine studies were deemed eligible (N= 2289 patients). Eight studies reported freedom from atrial arrhythmia and pooled results showed a marginally similar success rate between two protocols (OR: 1.24; 95% CI: 0.98 – 1.56). A prespecified subgroup analysis verified that a high dose TTI strategy (with >120s duration of cryotherapy post TTI) compared to conventional protocol could significantly increase the patients without atrial arrhythmia during follow-up (OR: 1.39; 95% CI: 1.05 – 1.83). TTI strategy could also significantly decrease total procedure time (SMD: – 26.24 minutes; 95% CI: – 36.90 to – 15.57) and phrenic nerve palsy incidence (OR: 0.49; 95% CI 0.29 – 0.84).

CONCLUSION: Moderate confidence evidence suggests that an individualized CBA dosing strategy based on TTI and extended (> 2 minutes post TTI) duration of CBA is accompanied by fewer recurrences post AF ablation. This article is protected by copyright. All rights reserved.

PMID:36177697 | DOI:10.1111/jce.15697

J Exp Psychol Gen. 2022 Sep 29. doi: 10.1037/xge0001304. Online ahead of print.

ABSTRACT

Nonarbitrary phenomena in language, such as systematic association in the form-meaning interface, have been widely reported in the literature. Exploiting such systematic associations previous studies have demonstrated that pseudowords can be indicative of meaning. However, whether semantic activation from words and pseudowords is supported by the very same processes, activating a common semantic memory system, is currently not known. Here, we take advantage of recent progresses from computational linguistics models allowing to induce meaning representations for out-of-vocabulary strings of letters via domain-general associative-learning mechanisms applied to natural language. We combined these models with data from priming tasks, in which participants are showed two strings of letters presented sequentially one after the other and are then asked to indicate if the latter is a word or a pseudoword. In Experiment 1 we reanalyzed the data of the largest behavioral database on semantic priming, while in Experiment 2 we ran an independent replication on a new language, Italian, controlling for a series of possible confounds. Results were consistent across the two experiments and showed that the prime-word meaning interferes with the semantic pattern elicited by the target pseudoword (i.e., at increasing estimated semantic relatedness between prime word and target pseudoword, participants’ reaction times increased and accuracy decreased). These findings indicate that the same associative mechanisms governing word meaning also subserve the processing of pseudowords, suggesting in turn that human semantic memory can be conceived as a distributional system that builds upon a general-purpose capacity of extracting knowledge from complex statistical patterns. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PMID:36174173 | DOI:10.1037/xge0001304

Psychol Assess. 2022 Sep 29. doi: 10.1037/pas0001167. Online ahead of print.

ABSTRACT

Increasing research uses intensive longitudinal designs to examine antecedents and consequences associated with dynamic affective processes. These studies often rely on the Positive and Negative Affect Schedule (PANAS) to measure affect. Studies assessing the structure of the PANAS are largely cross-sectional in nature and cannot always disentangle within-person variability from between-person differences in affect. A paucity of studies examines structural similarities and differences in affect at the between- and within-person levels, and few have done so with short-form versions of the PANAS. This study investigates the multilevel factor structure of the 10-item PANAS-short-form in a sample of young adults (n = 272) measured daily consecutively over 1 month. Additionally, dynamic relations between positive and negative affect, depressive symptoms, stress, and physical symptoms were examined. Results support a three factors within and two factors between multilevel structural model. Distinct dynamic relations were observed among positive affect, negative affect, stress, and physical symptoms at the within level. Positive and negative affect were correlated with depressive symptoms, stress, and physical symptoms at the between level. Findings indicate the need to disentangle structural components of positive and negative affect when conducting intensive longitudinal studies to examine correlates linked to dynamic affective processes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PMID:36174167 | DOI:10.1037/pas0001167

Psychol Assess. 2022 Sep 29. doi: 10.1037/pas0001183. Online ahead of print.

ABSTRACT

For decades, the Home Observation for Measurement of the Environment (HOME) has been the most widely used measure of children’s home environments. This report provides a revised version of the HOME-Short Form, the HOME-21, reflecting historical changes in family composition and caregiver roles, norms about the acceptability of different forms of discipline, and children’s digital environments. Using data from two samples of parents of children ages 0-17 (Fast Track [FT], N = 553, age = 33.8, 49.2% female, 48.1% Black, 51.9% White/other; Great Smoky Mountains Study [GSMS], N = 722, age = 37.2, 54.7% female, 67.6% White, 6.6% Black, 25.8% American Indian), we assess the utility of the HOME-21 with descriptive statistics and correlations with a range of demographic, family context, parenting, and child adjustment measures. Higher HOME-21 scores were correlated with obtaining a high school diploma or equivalency diploma (in GSMS only), having 4 or more years of college, and household income. HOME-21 was also correlated with having a more favorable family context indexed by fewer stressful life events (in FT only), less household food insecurity, lower household chaos, and more perceived social support. Higher HOME-21 scores were correlated with better parenting in the form of parental acceptance, positive parenting, warm involvement, appropriate and consistent discipline, verbal discussion, less physical aggression, and greater parental self-efficacy. Higher HOME-21 scores were correlated with better child adjustment in terms of fewer emotional and conduct problems, less hyperactivity, and more prosocial behavior. The HOME-21 has utility for use in future studies of children’s home environments in the 21st century. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PMID:36174166 | DOI:10.1037/pas0001183

Exp Clin Psychopharmacol. 2022 Sep 29. doi: 10.1037/pha0000603. Online ahead of print.

ABSTRACT

Alcohol and tobacco use are interrelated. This study examined response to very low nicotine content (VLNC) and moderate nicotine content (MNC) cigarettes by problematic drinking. We utilized a double-blind, randomized, within-subjects crossover design of VLNC and MNC cigarettes in two groups of adult cigarette smokers: with at-risk drinking (ARD; n = 23) and without ARD (n = 24). Participants smoked only their assigned experimental cigarette in their home environment for 7 days, and completed laboratory visits, including ad libitum smoking of the assigned experimental cigarette, at the beginning and end of each experimental week. Participants smoked their usual cigarettes for 7 days between conditions. Participants provided daily reports of alcohol and cigarette consumption. Current Diagnostic and Statistical Manual of Mental Disorders-5th edition (DSM-5) alcohol use disorder (AUD) was assessed at baseline and the end of each experimental week. Compliance with smoking of experimental cigarettes was good. Adjusting for baseline drinking, there was no significant effect of experimental cigarette or ARD group on drinks per day or alcohol urges. There was no effect of experimental cigarette or ARD group on cigarettes per day, or on any puff topography outcome or postsmoking exhaled carbon monoxide during laboratory smoking. No participant had a change in AUD status or AUD severity. After 7 days of exposure to VLNC cigarettes, adult cigarette smokers with ARD did not show compensatory drinking or compensatory smoking behavior. A future policy change in the United States to reduce nicotine content in cigarettes may not produce unintended compensatory drinking or smoking among this vulnerable and prevalent population of smokers. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PMID:36174143 | DOI:10.1037/pha0000603