Tag: nevin manimala

Philos Trans A Math Phys Eng Sci. 2022 Sep 5;380(2231):20210382. doi: 10.1098/rsta.2021.0382. Epub 2022 Jul 18.

ABSTRACT

This paper uses three-dimensional grain-scale finite-element (FE) simulations to appraise the classical scattering theory of plane longitudinal wave propagation in untextured polycrystals with statistically equiaxed grains belonging to the seven crystal symmetries. As revealed from the results of 10 390 materials, the classical theory has a linear relationship with the elastic scattering factor at the quasi-static velocity limit, whereas the reference FE and self-consistent (SC) results generally exhibit a quadratic relationship. As supported by the results of 90 materials, such order difference also extends to the attenuation and phase velocity, leading to larger differences between the classical theory and the FE results for more strongly scattering materials. Alternatively, two approximate models are proposed to achieve more accurate calculations by including an additional quadratic term. One model uses quadratic coefficients from quasi-static SC velocity fits and is thus symmetry-specific, while the other uses theoretically determined coefficients and is valid for any individual material. These simple models generally deliver more accurate attenuation and phase velocity (particularly the second model) than the classical theory, especially for strongly scattering materials. However, the models are invalid for the attenuation of materials with negative quadratic coefficients. This article is part of the theme issue ‘Wave generation and transmission in multi-scale complex media and structured metamaterials (part 1)’.

PMID:35858092 | DOI:10.1098/rsta.2021.0382

Clin Orthop Relat Res. 2022 Jul 19. doi: 10.1097/CORR.0000000000002326. Online ahead of print.

ABSTRACT

BACKGROUND: The subscapularis muscle, which is part of the rotator cuff, is located anterior to the shoulder. In anterior approaches to the shoulder, its supplying nerves are at risk of iatrogenic injury, which may cause postoperative complications. It is unclear whether there is any nerve-free zone in which a subscapularis split can be performed without risking nerve damage.

QUESTIONS/PURPOSES: In an anatomical study, we asked: (1) With the arm abducted 60° and externally rotated, what are the median and shortest distances between the entrance point of the subscapular nerves into subscapularis muscle and the myotendinous junction of this muscle? (2) What are those distances in other positions of the shoulder? (3) Did those measurements differ between specimen sexes or sides?

METHODS: In 84 shoulders of 66 embalmed anatomic specimens, the distance from the myotendinous junction of the subscapularis muscle to the entrance points of the subscapular nerves into the subscapularis muscle was measured using an inelastic thread and a millimeter gauge with the arm abducted 60° and rotated externally. In 16 of 84 shoulders, which were selected randomly, after taking the measurements with the arm abducted 60° and rotated externally, arm positions were changed and further measurements were taken with the arm abducted 60° and rotated neutrally, abducted 60° and rotated internally, and abducted 90° and rotated externally. The positions of the entrance points were described with statistical parameters and compared between different sides, sexes, and joint positions. Measurements were verified using eight fresh-frozen shoulders, showing no difference in distances compared with embalmed specimens and confirming reproducibility of measurements. Absolute distances were used to minimize possible distortion when using correlations and for straightforwardness and clinical applicability.

RESULTS: The median (range) distance was 43 mm (24 to 64) for the upper subscapular nerve and 38 mm (23 to 59) for the lower subscapular nerve with the arm rotated externally and abducted 60°. In the 16 subsamples, internal rotation decreased the distance to 34 mm (24 to 49) and 31 mm (15 to 43), respectively, and maximal external rotation and 90° of abduction increased it up to 49 mm (30 to 64) and 41 mm (27 to 56). Comparison of left and right sides yielded no difference. Comparison of sexes showed distances for the lower subscapular nerve of 36 mm (23 to 54) in females versus 39 mm (24 to 60) in males.

CONCLUSION: In no specimen did the nerve come closer than 23 mm medial to the myotendinous junction with the arm rotated externally and abducted. Therefore, not exceeding a distance of 20 mm medial to the myotendinous junction with the arm rotated externally seems to provide sufficient protection from nerve injury during surgery.

CLINICAL RELEVANCE: Based on the described zone of 20 mm medial to the myotendinous junction, the risk of nerve injury in a subscapularis split approach can be minimized.

PMID:35857337 | DOI:10.1097/CORR.0000000000002326

Inflamm Bowel Dis. 2022 Jul 20:izac131. doi: 10.1093/ibd/izac131. Online ahead of print.

ABSTRACT

BACKGROUND: We sought to review Crohn’s disease (CD) case definitions that use diagnosis, procedure, and medication claims.

METHODS: We searched PubMed and Embase from inception through January 31, 2022, using terms related to CD, inflammatory bowel disease, administrative claims, or validity. Each article was scrutinized by 2 authors independently screening and abstracting data. Collected data included participant characteristics, case definition characteristics, and case definition validity. When diagnostic accuracy was provided for multiple case definitions, we extracted the case definition selected by the authors. All diagnostic accuracy characteristics were captured.

RESULTS: We identified 30 studies that evaluated a case definition using claims data to identify CD patients. The most common case definition included counts of diagnosis codes (57%) followed by a combination of diagnosis codes and medications (20%). All but 1 study validated the case definition with a medical chart review. In 2 studies, the patient’s primary care provider completed a survey to confirm disease status. The positive predictive value of the case definitions ranged from 18% (≥1 code at a single U.S. health plan) to 100% (≥1 code plus a relevant prescription at a U.S. hospital). More complex case definitions (eg, ≥1 code + prescription or ≥2 codes) had lower variability in positive predictive value (≥80%) and specificity (≥85%) than the ≥1 code requirement.

CONCLUSIONS: Health services researchers should validate case definitions in their research cohorts. When such validation cannot be performed, we recommend using a more complex case definition. Studies without a validated CD case definition should use sensitivity analyses to confirm the robustness of their results.

PMID:35857336 | DOI:10.1093/ibd/izac131

JAMA Netw Open. 2022 Jul 1;5(7):e2222385. doi: 10.1001/jamanetworkopen.2022.22385.

ABSTRACT

IMPORTANCE: Programs that provide affordable and stable housing, such as federal rental assistance, may be associated with improved mean blood glucose levels and related diabetes outcomes.

OBJECTIVE: To assess whether 2 different types of federal rental assistance programs are associated with glycated hemoglobin A1c (HbA1c) levels among middle-aged and older US adults.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the National Health and Nutrition Examination Survey (NHANES) linked with US Department of Housing and Urban Development records of rental assistance participation. Adults aged 45 years or older who were receiving 2 types of rental assistance (project-based housing or housing vouchers) at the time of the NHANES interview and those who would receive rental assistance within the subsequent 2 years (waitlist group) were included. Data were collected from January 1999 to December 2016 and analyzed in October 2021.

EXPOSURES: Rental assistance participation, including project-based housing (subsidized housing developments including public housing) and housing vouchers (tenant-based subsidies for private market housing).

MAIN OUTCOMES AND MEASURES: The primary outcome was continuous HbA1c level, a common measure of blood glucose reflecting diabetes control. Linear regression was used to estimate the association between the 2 rental assistance programs and HbA1c level. Logistic regression was used to assess the association between rental assistance programs and HbA1c cut points (prediabetes: 5.7% to ≤6.5%; diabetes: >6.5%; uncontrolled diabetes: ≥9% [to convert to proportion of total Hb, multiply by 0.01]). Analyses used weights created by the National Center for Health Statistics that adjust for linkage eligibility.

RESULTS: Among 1050 adults in the study (41.6% aged ≥65 years; 70.1% female), 795 were receiving rental assistance at time of the NHANES interview (450 lived in project-based housing, and 345 had housing vouchers), and 255 received rental assistance within 2 years after the interview. Participants in project-based housing had lower HbA1c levels compared with individuals in the waitlist group (β, -0.290; 95% CI, -0.599 to 0.020), but the difference was not significant. No significant differences in HbA1c levels were found between those receiving housing vouchers and those in the waitlist group (β, 0.051; 95% CI, -0.182 to 0.284). Receiving project-based housing was associated with a reduced likelihood of uncontrolled diabetes (-3.7 percentage points; 95% CI, -7.0 to -0.0 percentage points) compared with being in the waitlist group.

CONCLUSIONS AND RELEVANCE: In this cohort study of a nationally representative sample of US adults, living in project-based, federally subsidized housing was associated with a reduced likelihood of uncontrolled diabetes. The findings suggest that affordable housing programs may be associated with improved diabetes outcomes.

PMID:35857325 | DOI:10.1001/jamanetworkopen.2022.22385

JAMA Surg. 2022 Jul 20. doi: 10.1001/jamasurg.2022.2804. Online ahead of print.

ABSTRACT

IMPORTANCE: Recent studies have investigated the effect of overlapping surgeon responsibilities or nurse to patient staffing ratios on patient outcomes, but the association of overlapping anesthesiologist responsibilities with patient outcomes remains unexplored to our knowledge.

OBJECTIVE: To examine the association between different levels of anesthesiologist staffing ratios and surgical patient morbidity and mortality.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective, matched cohort study consisting of major noncardiac inpatient surgical procedures performed from January 1, 2010, to October 31, 2017, was conducted in 23 US academic and private hospitals. A total of 866 453 adult patients (aged ≥18 years) undergoing major inpatient surgery within the Multicenter Perioperative Outcomes Group electronic health record registry were included. Anesthesiologist sign-in and sign-out times were used to calculate a continuous time-weighted average staffing ratio variable for each operation. Propensity score-matching methods were applied to create balanced sample groups with respect to patient-, operative-, and hospital-level confounders and resulted in 4 groups based on anesthesiologist staffing ratio. Groups consisted of patients receiving care from an anesthesiologist covering 1 operation (group 1), more than 1 to no more than 2 overlapping operations (group 1-2), more than 2 to no more than 3 overlapping operations (group 2-3), and more than 3 to no more than 4 overlapping operations (group 3-4). Data analysis was performed from October 2019 to October 2021.

EXPOSURE: Undergoing a major inpatient surgical operation that involved an anesthesiologist providing care for up to 4 overlapping operations.

MAIN OUTCOMES AND MEASURES: The primary composite outcome was 30-day mortality and 6 major surgical morbidities (cardiac, respiratory, gastrointestinal, urinary, bleeding, and infectious complications) derived from International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision discharge diagnosis codes.

RESULTS: In all, 578 815 adult patients (mean [SD] age, 55.7 [16.2] years; 55.1% female) were analyzed. After matching operations according to anesthesiologist staffing ratio, 48 555 patients were in group 1; 247 057, group 1-2; 216 193, group 2-3; and 67 010, group 3-4. Increasing anesthesiologist coverage responsibilities was associated with an increase in risk-adjusted surgical patient morbidity and mortality. Compared with patients in group 1-2, those in group 2-3 had a 4% relative increase in risk-adjusted mortality and morbidity (5.06% vs 5.25%; adjusted odds ratio [AOR], 1.04; 95% CI, 1.01-1.08; P = .02) and those in group 3-4 had a 14% increase in risk-adjusted mortality and morbidity (5.06% vs 5.75%; AOR, 1.15; 95% CI, 1.09-1.21; P < .001).

CONCLUSIONS AND RELEVANCE: This study’s findings suggest that increasing overlapping coverage by anesthesiologists is associated with increased surgical patient morbidity and mortality. Therefore, the potential effects of staffing ratios in perioperative team models should be considered in clinical coverage efforts.

PMID:35857304 | DOI:10.1001/jamasurg.2022.2804

JAMA Netw Open. 2022 Jul 1;5(7):e2222973. doi: 10.1001/jamanetworkopen.2022.22973.

ABSTRACT

IMPORTANCE: Overprescription of opioid medications following surgery is well documented. Current prescribing models have been proposed in narrow patient populations, which limits their generalizability.

OBJECTIVE: To develop and validate a model for predicting outpatient opioid use following a range of gynecological surgical procedures.

DESIGN, SETTING, AND PARTICIPANTS: In this prognostic study, statistical models were explored using data from a training cohort of participants undergoing gynecological surgery for benign and malignant indications enrolled prospectively at a single institution’s academic gynecologic oncology practice from February 2018 to March 2019 (cohort 1) and considering 39 candidate predictors of opioid use. Final models were internally validated using a separate testing cohort enrolled from May 2019 to February 2020 (cohort 2). The best final model was updated by combining cohorts, and an online calculator was created. Data analysis was performed from March to May 2020.

EXPOSURES: Participants completed a preoperative survey and weekly postoperative assessments (up to 6 weeks) following gynecological surgery. Pain management was at the discretion of clinical practitioners.

MAIN OUTCOMES AND MEASURES: The response variable used in model development was number of pills used postoperatively, and the primary outcome was model performance using ordinal concordance and Brier score.

RESULTS: Data from 382 female adult participants (mean age, 56 years; range, 18-87 years) undergoing gynecological surgery (minimally invasive procedures, 158 patients [73%] in cohort 1 and 118 patients [71%] in cohort 2; open surgical procedures, 58 patients [27%] in cohort 1 and 48 patients [29%] in cohort 2) were included in model development. One hundred forty-seven patients (38%) used 0 pills after hospital discharge, and the mean (SD) number of pills used was 7 (10) (median [IQR], 3 [0-10] pills). The model used 7 predictors: age, educational attainment, smoking history, anticipated pain medication use, anxiety regarding surgery, operative time, and preoperative pregabalin administration. The ordinal concordance was 0.65 (95% CI, 0.62-0.68) for predicting 5 or more pills (Brier score, 0.22), 0.65 (95% CI, 0.62-0.68) for predicting 10 or more pills (Brier score, 0.18), and 0.65 (95% CI, 0.62-0.68) for predicting 15 or more pills (Brier score, 0.14).

CONCLUSIONS AND RELEVANCE: This model provides individualized estimates of outpatient opioid use following a range of gynecological surgical procedures for benign and malignant indications with all model inputs available at the time of procedure closing. Implementation of this model into the clinical setting is currently ongoing, with plans for additional validation in other surgical populations.

PMID:35857323 | DOI:10.1001/jamanetworkopen.2022.22973

ASAIO J. 2022 Jul 20. doi: 10.1097/MAT.0000000000001788. Online ahead of print.

ABSTRACT

Extracorporeal hemoadsorption with the CytoSorb adsorber is increasingly being used during the past years. The use in combination with extracorporeal membrane oxygenation (ECMO) is feasible, but frequency of its use and outcomes have not been assessed in larger cohorts. We analyzed all patients treated with veno-venous (VV) ECMO either with or without CytoSorb in Germany from 2017 to 2019. Data were retrieved from a nationwide claim dataset collected by the Research Data Center of the Federal Bureau of Statistics. During this three-year episode, 7,699 patients were treated with VV ECMO. Among these, the number of CytoSorb-treated patients constantly increased from 156 (6.6%) in 2017 to 299 (11.8%) in 2019. In this large cohort hemoadsorption with the CytoSorb adsorber was associated with higher mortality and increased treatment costs. Due to limited information in the dataset about the severity of disease comparison of outcomes of patients treated with and without CytoSorb has to be interpreted with caution. Further studies have to examine if this finding is due to a negative effect of hemoadsorption with the CytoSorb device or is rather to be attributed to disease severity.

PMID:35857288 | DOI:10.1097/MAT.0000000000001788

Biometals. 2022 Jul 20. doi: 10.1007/s10534-022-00415-3. Online ahead of print.

ABSTRACT

To investigate the metabolic changes in type C hepatic encephalopathy (CHE) rats after reducing manganese (Mn) intake. A total of 80 Sprague-Dawley rats were divided into control group and CHE groups (induced by intraperitoneal injection of thioacetamide at a dose of 250 mg/kg of body weight twice a week for 6 weeks). CHE rats were subdivided into 1Mn group (fed a standard diet, with 10 mg Mn/kg feed), 0.5Mn group (half-Mn diet), 0.25Mn group (quarter-Mn diet) and 0Mn group (no-Mn diet) for 4 to 8 weeks. Morris water maze (MWM), Y maze and narrow beam test (NBT) were used to evaluate cognitive and motor functions. Blood ammonia, brain Mn content, the number of GS-positive cells, and glutamine synthetase (GS) activity were measured. The metabolic changes of CHE rats were investigated using hydrogen-nuclear magnetic resonance and mass spectrometry. Multivariate statistical analysis was used to analyze the results. Significantly decreased numbers of entries in target area of MWM and Y maze, longer NBT latency and total time, higher blood ammonia, brain Mn content and GS activity were found in CHE rats. After reducing Mn intake, CHE rats had better behavioral performance, significantly lower blood ammonia, brain Mn content and GS activity. The main up-regulated metabolites were Ala, GABA, Glu, Gln, Lac, Tyr, Phe in 1Mn rats. After reducing Mn intake, metabolites returned to normal level at different degrees. Reducing Mn intake could reduce brain Mn content and blood ammonia, regulate GS activity and amino acid metabolism, ultimately improve behavioral performance in CHE rats.

PMID:35857253 | DOI:10.1007/s10534-022-00415-3

J Neurooncol. 2022 Jul 20. doi: 10.1007/s11060-022-04095-4. Online ahead of print.

ABSTRACT

INTRODUCTION: As lifespans for persons living with HIV (PLWH) have improved over the last decade, there has been a simultaneous increase in non-AIDS-related cancer in that group. However, there is a paucity of data regarding the incidence of glioblastoma multiforme (GBM) in PLWH. Better understanding of the oncogenesis, natural history, and treatment outcomes of GBM in PLWH should lead to improved treatment strategies.

METHODS: We performed a comprehensive literature search of six electronic databases to identify eligible cases of GBM among PLWH. Kaplan-Meier estimates, Fisher’s exact test, and logistic regression were used to interrogate the data. Epidemiologic data on global HIV prevalence was obtained from the 2016 UNAIDS incidence report, and CNS cancer incidence was obtained from the GDB 2016 Brain and Other CNS Cancer Collaborators.

RESULTS: There is an inverse relationship between the incidence of HIV and CNS cancer globally. Median overall survival (OS) from GBM diagnosis was 8 months. Estimates for survival at 1 and 2 years were 28 and 5%, respectively. There were no statistically significant predictors of OS in this setting. There was a significant difference (p < 0.01) in OS in PLWH and GBM when compared to TCGA age matched cohorts.

CONCLUSION: The diagnosis of GBM in PLWH is severely underreported in the literature. Despite maximal treatment, OS in this patient population is significantly less than in HIV-negative people. There was a poor prognosis of GBM in PLWH, which is inconsistent with previous reports. Further investigation is required for PLWH and concomitant GBM. Analyses must consider if HAART is maintained in PLWH during GBM treatment.

PMID:35857248 | DOI:10.1007/s11060-022-04095-4

Bull Math Biol. 2022 Jul 20;84(9):90. doi: 10.1007/s11538-022-01047-x.

ABSTRACT

Understanding the joint impact of vaccination and non-pharmaceutical interventions on COVID-19 development is important for making public health decisions that control the pandemic. Recently, we created a method in forecasting the daily number of confirmed cases of infectious diseases by combining a mechanistic ordinary differential equation (ODE) model for infectious classes and a generalized boosting machine learning model (GBM) for predicting how public health policies and mobility data affect the transmission rate in the ODE model (Wang et al. in Bull Math Biol 84:57, 2022). In this paper, we extend the method to the post-vaccination period, accordingly obtain a retrospective forecast of COVID-19 daily confirmed cases in the US, and identify the relative influence of the policies used as the predictor variables. In particular, our ODE model contains both partially and fully vaccinated compartments and accounts for the breakthrough cases, that is, vaccinated individuals can still get infected. Our results indicate that the inclusion of data on non-pharmaceutical interventions can significantly improve the accuracy of the predictions. With the use of policy data, the model predicts the number of daily infected cases up to 35 days in the future, with an average mean absolute percentage error of [Formula: see text], which is further improved to [Formula: see text] if combined with human mobility data. Moreover, the most influential predictor variables are the policies of restrictions on gatherings, testing and school closing. The modeling approach used in this work can help policymakers design control measures as variant strains threaten public health in the future.

PMID:35857207 | DOI:10.1007/s11538-022-01047-x