Tag: nevin manimala

Prehosp Disaster Med. 2022 Sep 12:1-18. doi: 10.1017/S1049023X22001273. Online ahead of print.

ABSTRACT

BACKGROUND: Tracheal intubation is a high-risk intervention for exposure to airborne infective pathogens, including the novel coronavirus disease 2019 (COVID-19). During the recent pandemic, personal protective equipment (PPE) was essential to protect staff during intubation but is recognized to make the practical conduct of anesthesia and intubation more difficult. In the early phase of the coronavirus pandemic, some simple alterations were made to the emergency anesthesia standard operating procedure (SOP) of a prehospital critical care service to attempt to maintain high intubation success rates despite the challenges posed by wearing PPE. This retrospective observational cohort study aims to compare first-pass intubation success rates before and after the introduction of PPE and an altered SOP.

METHODOLOGY: A retrospective observational cohort study was conducted from January 1, 2019 through August 30, 2021. The retrospective analysis used prospectively collected data using prehospital electronic patient records. Anonymized data were held in Excel (v16.54) and analyzed using IBM SPSS Statistics (v28). Patient inclusion criteria were those of all ages who received a primary tracheal intubation attempt outside the hospital by critical care teams. March 27, 2020 was the date from which the SOP changed to mandatory COVID-19 SOP including Level 3 PPE – this date is used to separate the cohort groups.

RESULTS: Data were analyzed from 1,266 patients who received primary intubations by the service. The overall first-pass intubation success rate was 89.7% and the overall intubation success rate was 99.9%. There was no statistically significant difference in first-pass success rate between the two groups: 90.3% in the pre-COVID-19 group (n = 546) and 89.3% in the COVID-19 group (n = 720); Pearson chi-square 0.329; P = .566. In addition, there was no statistical difference in overall intubation success rate between groups: 99.8% in the pre-COVID-19 group and 100.0% in the COVID-19 group; Pearson chi-square 1.32; P = .251.Non-drug-assisted intubations were more than twice as likely to require multiple attempts in both the pre-COVID-19 group (n = 546; OR = 2.15; 95% CI, 1.19-3.90; P = .01) and in the COVID-19 group (n = 720; OR = 2.5; 95% CI, 1.5-4.1; P = <.001).

CONCLUSION: This study presents simple changes to a prehospital intubation SOP in response to COVID-19 which included mandatory use of PPE, the first intubator always being the most experienced clinician, and routine first use of video laryngoscopy (VL). These changes allowed protection of the clinical team while successfully maintaining the first-pass and overall success rates for prehospital tracheal intubation.

PMID:36093838 | DOI:10.1017/S1049023X22001273

Libyan J Med. 2022 Dec;17(1):2122159. doi: 10.1080/19932820.2022.2122159.

ABSTRACT

Health care delivery continues to be unsafe despite major patient safety (PS) improvement efforts over the past decade. Medical school education plays an important role in promoting this culture during initial training. To determine undergraduate medical students’ attitudes toward PS at a Tunisian medical school. We carried out a cross-sectional study among undergraduate medical students at Ibn Al Jazzar Medical School in Sousse, Tunisia, using a self-administered questionnaire inspired from the valid tool: Attitudes to Patient Safety Questionnaire (APSQ III). A total of 178 medical students responded to the questionnaire. Medical students tend to have an overall positive perceptions of PS culture with a global mean score 5.33 ± 0.5. Among the individual domains ‘Working hours as a cause of error’ earned the highest score (6.38 ± 1.0) followed in order by ‘Team functioning’ (6.24 ± 0.8), ‘Error inevitability’ (5.91 ± 1.0) and ‘Patient involvement in reducing error’ (5.50 ± 1.0). The lowest score was for ‘Professional incompetence as a cause of error’ (4.01 ± 1.0). A PS domain’s mean scores comparison based on socio-demographic variables: gender, age, academic year and on PS training revealed a statistically significant difference (p < 0.05) for five PS key dimensions: ‘ Error reporting confidence ‘, ‘ Working hours as a cause of error ‘, ‘ Professional incompetence as a cause of error ‘, ‘ Team functioning ‘ and ‘PS training received’. Tunisian medical students showed positive attitude towards PS. Nevermore, intensive in terms of frequency and duration sessions, based on various teaching methods may be needed to fulfill students’ educational needs.

PMID:36093793 | DOI:10.1080/19932820.2022.2122159

Prim Health Care Res Dev. 2022 Sep 12;23:e56. doi: 10.1017/S1463423622000445.

ABSTRACT

INTRODUCTION: The coronavirus (COVID-19) pandemic has impacted healthcare worldwide. It has altered service delivery and posed challenges to practitioners in relation to workload, well-being and support. Within primary care, changes in physicians’ activities have been identified and innovative work solutions implemented. However, evidence is lacking regarding the impact of the pandemic on pharmacy personnel who work in primary care.

AIM: To explore the impact of the pandemic on the working practice (including the type of services provided) and job satisfaction of pharmacists and pharmacy technicians within Scottish general practice. Due to the stressful nature of the pandemic, we hypothesise that job satisfaction will have been negatively affected.

METHODS: An online questionnaire was distributed in May-July 2021, approximately 15 months since initial lockdown measures in the UK. The questionnaire was informed by previous literature and underwent expert review and piloting. Analysis involved descriptive statistics, non-parametric statistical tests and thematic analysis.

RESULTS: 180 participants responded (approximated 16.1% response rate): 134 pharmacists (74.4%) and 46 technicians (25.6%). Responses indicated greater involvement with administrative tasks and a reduction in the provision of clinical services, which was negatively perceived by pharmacists. There was an increase in remote working, although most participants continued to have a physical presence within general practices. Face-to-face interactions with patients reduced, which was negatively perceived by participants, and telephone consults were considered efficient yet less effective. Professional development activities were challenged by increased workloads and reduced support available. Although workplace stress was apparent, there was no indication of widespread job dissatisfaction.

CONCLUSION: The pandemic has impacted pharmacists and technicians, but it is unknown if changes will be permanent, and there is a need to understand which changes should continue. Future research should explore the impact of altered service delivery, including remote working, on patient care.

PMID:36093791 | DOI:10.1017/S1463423622000445

Comput Methods Biomech Biomed Engin. 2022 Sep 10:1-12. doi: 10.1080/10255842.2022.2117547. Online ahead of print.

ABSTRACT

To assess the severity and progression of adolescents with idiopathic scoliosis (AIS), radiography with X-rays is usually used. The methods based on statistical observations have been developed from 3D reconstruction of the trunk or topography. Machine learning has shown great potential to classify the severity of scoliosis on imaging data, generally on X-ray measurements. It is also known that AIS leads to the development of gait disorder. To our knowledge, machine learning has never been tested on spine intervertebral efforts during gait as a radiation-free method to classify the severity of spinal deformity in AIS. Develop automated machine learning algorithms in lumbar/thoracolumbar scoliosis to classify the severity of spinal deformity of AIS based on the lumbosacral joint (L5-S1) efforts during gait. The lumbosacral joint efforts of 30 individuals with lumbar/thoracolumbar AIS were used as distinctive features fed to the machine learning algorithms. Several tests were run using various classification algorithms. The labeling consisted of three classes reflecting the severity of scoliosis i.e. mild, moderate and severe. The ensemble classifier algorithm including k-nearest neighbors, support vector machine, random forest and multilayer perceptron achieved the most promising results, with accuracy scores of 91.4%. This preliminary study shows lumbosacral joint efforts can be used to classify the severity of spinal deformity in lumbar/thoracolumbar AIS. This method showed the potential of being used as an assessment tool to follow-up the progression of AIS as a radiation-free method, alternative to radiography. Future studies should be performed to test the method on other categories of AIS.

PMID:36093771 | DOI:10.1080/10255842.2022.2117547

Prep Biochem Biotechnol. 2022 Sep 10:1-12. doi: 10.1080/10826068.2022.2119577. Online ahead of print.

ABSTRACT

Livestock blood is a protein-rich waste byproduct produced during meat production processes in slaughterhouses. Its utilization through conversion into value-added products is an intriguing management strategy. In this study, bovine blood was used to obtain the protein hydrolysate for use as a peptone for microbial growth medium. Lyophilized bovine blood was heat treated to make it susceptible to enzymic hydrolysis, and then enzymatically treated with trypsin (bovine pancreas protease) to produce protein hydrolysate. Physico-chemical features were determined for protein hydrolysate and compared to commercial Merck peptone from meat. Amino acid compositions of bovine blood and commercial peptones were subjected to multivariate analysis based on Euclidean similarity matrix using software PAST. Strains of Staphylococcus aureus 25,923, Pseudomonas aeruginosa 27,853, Staphylococcus aureus 6538 P, Enterococcus faecalis 11,700, Escherichia coli 8739, Klebsiella pneumoniae 13,883, Salmonella typhimurium 14,028 and Listeria monocytogenes 13,932 were used as test microbial strains. Growth of bacteria in culture media based on the peptone from bovine protein hydrolysate was compared to that in corresponding reference media based on commercial peptone. The results of these growth tests were comparable. Growth data were depicted and statistically analyzed using R packages ggplot2 and growthcurver, respectively, providing data fitting a standard form of logistic equation.

PMID:36093752 | DOI:10.1080/10826068.2022.2119577

J Comp Eff Res. 2022 Sep 12. doi: 10.2217/cer-2022-0044. Online ahead of print.

ABSTRACT

Aim: Technical Support Document 21 discusses trial-based, flexible relative survival models. The authors generalized flexible relative survival models to the network meta-analysis (NMA) setting while accounting for different treatment-effect specifications. Methods: The authors compared the standard parametric model with mixture, mixture cure and nonmixture cure, piecewise, splines and fractional polynomial models. The optimal treatment-effect parametrization was defined in two steps. First, all models were run with treatment effects on all parameters and subsequently the optimal model was defined by removing uncertain treatment effects, for which the parameter was smaller than its standard deviation. The authors used a network in previously treated advanced non-small-cell lung cancer. Results: Flexible model-based NMAs impact fit and incremental mean survival and they increase corresponding uncertainty. Treatment-effect specification impacts incremental survival, reduces uncertainty and improves the fit statistic. Conclusion: Extrapolation techniques already available for individual trials can now be used for NMAs to ensure that the most plausible extrapolations are being used for health technology assessment submissions.

PMID:36093741 | DOI:10.2217/cer-2022-0044

Phys Chem Chem Phys. 2022 Sep 12. doi: 10.1039/d2cp02110b. Online ahead of print.

ABSTRACT

Ionanofluids (INFs), nanoparticles dispersed into a base fluid, e.g. an ionic liquid, are a novel class of alternative heat transfer fluids. Addition of nanoparticles to a base ionic liquid is the prime reason for an enhancement in the thermophysical properties of ionanofluids. However, due to very limited research on ionanofluids, further studies are required to understand changes in the isobaric heat capacity of ionanofluids as a function of size of cations of the base ionic liquid structure and concentration of nanoparticles. Herein, isobaric heat capacity was measured as a function of temperature for the prepared ionanofluid samples from a series of imidazolium ionic liquids and multi walled carbon nanotubes (MWCNTs). Moreover, the influence of the size of cations on the isobaric heat capacity enhancement mechanism and the stability of ionanofluid samples was studied. Furthermore, experimental isobaric heat capacity data were assessed by a novel non-statistical data analysis method named mathematical gnostics (MG). MG marginal analysis was used to evaluate the most probable values from the measured data set. A robust linear regression along a gnostic influence function was also used to find the best fit to correlate the measured data.

PMID:36093723 | DOI:10.1039/d2cp02110b

J Alzheimers Dis. 2022 Sep 7. doi: 10.3233/JAD-220610. Online ahead of print.

ABSTRACT

BACKGROUND: Dysregulated glucose metabolism in the brain is considered to be one of the key causes of Alzheimer’s disease (AD). Abnormal glucose uptake in AD is tightly associated with decreased levels of glucose transporter 1 (GLUT1) and GLUT3 in the brain, but the underlying mechanisms remain unclear.

OBJECTIVE: We aimed to explore the cause and mechanism of impaired glucose uptake in AD.

METHODS: N2a/WT and N2a/APP695swe cells were cultured in vitro, and cellular glucose uptake and ATP content, as well as the expression of GLUT1, GLUT3, and PI3K/Akt pathway members, were detected. Intracellular reactive oxygen species (ROS) levels were detected by flow cytometry. After treatment with the ROS scavenger N-acetyl-L-cysteine (NAC), the above indicators were detected again.

RESULTS: GLUT1 expression was significantly decreased (p = 0.0138) in N2a/APP695swe cells, while GLUT3 expression was no statistical difference (p > 0.05). After NAC treatment, PI3K and Akt phosphorylation levels, GLUT1 expression, glucose uptake and ATP levels were remarkably increased (p = 0.0006, p = 0.0008, p = 0.0009, p = 0.0001, p = 0.0013), while Aβ levels were significantly decreased (p = 0.0058, p = 0.0066). After addition of the PI3K inhibitor LY29004, GLUT1 expression was reduced (p = 0.0008), and Aβ levels were increased (p = 0.0009, p = 0.0117). In addition, increases in glucose uptake and ATP levels induced by the Akt activator SC79 were hindered by the GLUT1 inhibitor WZB117 (p = 0.0002, p = 0.0005). Aβ levels were decreased after SC79 treatment and increased after WZB117 treatment (p = 0.0212, p = 0.0006).

CONCLUSION: Taken together, scavenging of ROS prevents from Aβ deposition via activation of the PI3K/Akt/GLUT1 pathway, and improved the impaired glucose uptake in N2a/APP695swe cells.

PMID:36093707 | DOI:10.3233/JAD-220610

J Alzheimers Dis. 2022 Sep 9. doi: 10.3233/JAD-220556. Online ahead of print.

ABSTRACT

BACKGROUND: Preliminary work by our center has reported behavior and functional benefits in patients with Alzheimer’s disease (AD) following targeted micronutritional supplementation.

OBJECTIVE: To build on the existing exploratory research and investigate the impact of these micronutrients on the natural progression of AD in a randomized controlled trial.

METHODS: Patients with mild-moderate AD consumed daily 1 g fish oil (of which 500 mg DHA, 150 mg EPA), 22 mg carotenoids (10 mg lutein, 10 mg meso-zeaxanthin, 2 mg zeaxanthin), and 15 mg vitamin E or placebo for 12 months in a double-blind, placebo-controlled, randomized clinical trial. Carotenoids, ω-3FAs, and vitamin E were quantified in blood. Carotenoids were also measured in skin. AD severity was measured using the mini-mental state examination and dementia severity rating scale tools. Behavior, mood, and memory were measured using an informant-based questionnaire.

RESULTS: Following 12 months of supplementation, the active group (n = 50) compared to the placebo group (n = 27), demonstrated statistically significant improvements in skin carotenoid measurements, blood carotenoids, ω-3FAs, and vitamin E concentrations (p < 0.05, for all). The active group also performed better in objective measures of AD severity (i.e., memory and mood), with a statistically significant difference reported in the clinical collateral for memory (p < 0.001).

CONCLUSION: Exponential increases in the prevalence of AD and its relentless progressive nature is driving the need for interventions that help to ameliorate symptoms and improve quality of life in AD patients. Given the positive outcomes demonstrated in this trial, this combined micronutrient dietary supplement should be considered in the overall management of AD.

PMID:36093704 | DOI:10.3233/JAD-220556

J Alzheimers Dis. 2022 Sep 6. doi: 10.3233/JAD-220385. Online ahead of print.

ABSTRACT

BACKGROUND: Eye-movement behavior has been used as a reliable tool to identify cognitive and behavioral patterns in individuals with different neuropsychiatric disorders including Alzheimer’s disease (AD). Most studies in the field have been dedicated to evaluating eye-movement behavior during cognitive tasks in different protocols using multiple parameters.

OBJECTIVE: We aimed to evaluate the differences of eye-movement behavior in healthy subjects, subjects with mild cognitive impairment (MCI), and those with AD in a simple color task with and without cognitive demand.

METHODS: 91 subjects: 18 AD, 47 MCI, and 26 healthy controls had their oculomotor parameters assessed during baseline (no cognitive demand involved) and during a simple computational color memory task using an eye-tracker.

RESULTS: Baseline showed statistically different and heterogeneous results between normal cognition and MCI groups. Familiarization phase of the task could not discriminate between groups in any of the analyzed parameters. AD subjects made longer fixations and visits on distractors, and more frequent fixations and visits on the target areas than other groups during the response phase.

CONCLUSION: Eye-tracking time-related parameters differentiate AD subjects from other groups under cognitive demand even in a simple color memory task.

PMID:36093694 | DOI:10.3233/JAD-220385