Tag: nevin manimala

Ann Epidemiol. 2022 Mar 27:S1047-2797(22)00044-8. doi: 10.1016/j.annepidem.2022.03.010. Online ahead of print.

ABSTRACT

PURPOSE: The use of predictive models in epidemiology is relatively narrow as most of the studies report results of traditional statistical models such as Linear, Logistic, or Cox regressions. In this study, a high-dimensional epidemiological cohort, collected within the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD) in 1984-1989, was used to investigate the predictive ability of models with embedded variable selection.

METHODS: Simple Logistic Regression with seven preselected risk factors was compared to k-Nearest Neighbors, Logistic Lasso Regression, Decision Tree, Random Forest, and Multilayer Perceptron in predicting cardiovascular death for the aged men from KIHD for the long horizon of 30±3 years: 746 predictor variables were available for 2682 men (705 cardiovascular deaths were registered and 1977 men stayed alive). We considered two scenarios of handling competing risks (removing subjects and treating them as non-cases).

RESULTS: The best average AUC on the test sample was 0.8075 (95%CI, 0.8051-0.8099) in scenario 1 and 0.7155 (95%CI, 0.7128-0.7183) in scenario 2 achieved with Logistic Lasso Regression, which was 6.04% and 5.50% higher than the baseline AUC provided by Logistic Regression with manually preselected predictors.

CONCLUSIONS: In both scenarios Logistic Lasso Regression, Random Forest, and Multilayer Perceptron outperformed Simple Logistic Regression.

PMID:35354081 | DOI:10.1016/j.annepidem.2022.03.010

Behav Processes. 2022 Mar 27:104628. doi: 10.1016/j.beproc.2022.104628. Online ahead of print.

ABSTRACT

In this paper, we introduce discrete choice experiments (DCEs) and provide foundational knowledge on the topic. DCEs are one of the most popular methods within econometrics to study the distribution of choices within a population. DCEs are particularly useful when studying the effects of categorical variables on choice. Procedurally, a DCE involves recruiting a large sample of individuals exposed to a set of choice arrays. The factors that are suspected to affect choice are varied systematically across the choice arrays. Most commonly, DCE data are analyzed with a multinomial logit statistical model with a goal of determining the relative utility of each relevant factor. We also discuss DCEs in comparison with behavioral choice models, such as those based on the matching law, and we show an example of a DCE to illustrate how a DCE can be used to understand choice with behavioral, social, and organizational factors.

PMID:35354088 | DOI:10.1016/j.beproc.2022.104628

Cell Rep. 2022 Mar 29;38(13):110576. doi: 10.1016/j.celrep.2022.110576.

ABSTRACT

The functions of the human brain are metabolically expensive and reliant on coupling between cerebral blood flow (CBF) and neural activity, yet how this coupling evolves over development remains unexplored. Here, we examine the relationship between CBF, measured by arterial spin labeling, and the amplitude of low-frequency fluctuations (ALFF) from resting-state magnetic resonance imaging across a sample of 831 children (478 females, aged 8-22 years) from the Philadelphia Neurodevelopmental Cohort. We first use locally weighted regressions on the cortical surface to quantify CBF-ALFF coupling. We relate coupling to age, sex, and executive functioning with generalized additive models and assess network enrichment via spin testing. We demonstrate regionally specific changes in coupling over age and show that variations in coupling are related to biological sex and executive function. Our results highlight the importance of CBF-ALFF coupling throughout development; we discuss its potential as a future target for the study of neuropsychiatric diseases.

PMID:35354053 | DOI:10.1016/j.celrep.2022.110576

West J Emerg Med. 2021 Jul 14;22(4):911-918. doi: 10.5811/westjem.2021.3.50981.

ABSTRACT

INTRODUCTION: Emergency department (ED) patients have higher than average levels of food insecurity. We examined the association between multiple measures of food insecurity and frequent ED use in a random sample of ED patients.

METHODS: We completed survey questionnaires with randomly sampled adult patients from an urban public hospital ED (n = 2,312). We assessed food insecurity using four questions from the United States Department of Agriculture Household Food Security Survey. The primary independent variable was any food insecurity, defined as an affirmative response to any of the four items. Frequent ED use was defined as self-report of ≥4 ED visits in the past year. We examined the relationship between patient food insecurity and frequent ED use using bivariate and multivariable analyses and examined possible mediation by anxiety/depression and overall health status.

RESULTS: One-third (30.9%) of study participants reported frequent ED use, and half (50.8%) reported any food insecurity. Prevalence of food insecurity was higher among frequent vs. non-frequent ED users, 62.8% vs 45.4% (P <0.001). After controlling for potential confounders, food insecurity remained significantly associated with frequent ED use (adjusted odds ratio 1.48, 95% confidence interval, 1.20-1.83). This observed association was partially attenuated when anxiety/depression and overall health status were added to models.

CONCLUSION: The high observed prevalence of food insecurity suggests that efforts to improve care of ED patients should assess and address this need. Further research is needed to assess whether addressing food insecurity may play an important role in efforts to reduce frequent ED use for some patients.

PMID:35354018 | DOI:10.5811/westjem.2021.3.50981

Cell Rep. 2022 Mar 29;38(13):110606. doi: 10.1016/j.celrep.2022.110606.

ABSTRACT

The visual system processes sensory inputs sequentially, perceiving coarse information before fine details. Here we study the neural basis of coarse-to-fine processing and its computational benefits in natural vision. We find that primary visual cortical neurons in awake mice respond to natural scenes in a coarse-to-fine manner, primarily driven by individual neurons rapidly shifting their spatial frequency preference from low to high over a brief response period. This shift transforms the population response in a way that counteracts the statistical regularities of natural scenes, thereby reducing redundancy and generating a more efficient neural representation. The increase in representational efficiency does not occur in either dark-reared or anesthetized mice, which show significantly attenuated coarse-to-fine spatial processing. Collectively, these results illustrate that coarse-to-fine processing is state dependent, develops postnatally via visual experience, and provides a computational advantage by generating more efficient representations of the complex spatial statistics of ethologically relevant natural scenes.

PMID:35354030 | DOI:10.1016/j.celrep.2022.110606

West J Emerg Med. 2021 Jul 15;22(4):937-942. doi: 10.5811/westjem.2021.4.50135.

ABSTRACT

INTRODUCTION: Most emergency medicine (EM) applicants use the internet as a source of information when evaluating residency programs. Previous studies have analyzed the components of residency program websites; however, there is a paucity of information regarding EM program websites. The purpose of our study was to analyze information on EM residency program websites.

METHODS: In April-May 2020, we evaluated 249 United States EM residency program websites for presence or absence of 38 items relevant to EM applicants. Descriptive statistics were performed, including means and standard deviations.

RESULTS: Of the 249 EM websites evaluated, the websites contained a mean of 20 of 38 items (53%). Only 16 programs (6%) contained at least three-quarters of the items of interest, and no programs contained all 38 items. The general categories with the least amount of items were social media use (9%), research (46%), and lifestyle (49%), compared to the other general categories such as application process (58%), resident information (63%), general program information (67%), and facility information (69%). The items provided by programs most often included program description (98%), blocks and rotations (91%), and faculty listing (88%). The items provided least often included housing/neighborhood information (17%) and social media links (19%).

CONCLUSION: Our comprehensive review of EM residency websites in the US revealed the absence of many variables on most programs’ websites. Use of this information to enhance accessibility of desired information stands to benefit both applicants and programs in the increasingly competitive specialty of EM.

PMID:35354009 | DOI:10.5811/westjem.2021.4.50135

West J Emerg Med. 2021 Jul 20;22(4):979-987. doi: 10.5811/westjem.2021.3.50116.

ABSTRACT

INTRODUCTION: Patients with coronavirus disease 2019 (COVID-19) can develop rapidly progressive respiratory failure. Ventilation strategies during the COVID-19 pandemic seek to minimize patient mortality. In this study we examine associations between the availability of emergency department (ED)-initiated high-flow nasal cannula (HFNC) for patients presenting with COVID-19 respiratory distress and outcomes, including rates of endotracheal intubation (ETT), mortality, and hospital length of stay.

METHODS: We performed a retrospective, non-concurrent cohort study of patients with COVID-19 respiratory distress presenting to the ED who required HFNC or ETT in the ED or within 24 hours following ED departure. Comparisons were made between patients presenting before and after the introduction of an ED-HFNC protocol.

RESULTS: Use of HFNC was associated with a reduced rate of ETT in the ED (46.4% vs 26.3%, P <0.001) and decreased the cumulative proportion of patients who required ETT within 24 hours of ED departure (85.7% vs 32.6%, P <0.001) or during their entire hospitalization (89.3% vs 48.4%, P <0.001). Using HFNC was also associated with a trend toward increased survival to hospital discharge; however, this was not statistically significant (50.0% vs 68.4%, P = 0.115). There was no impact on intensive care unit or hospital length of stay. Demographics, comorbidities, and illness severity were similar in both cohorts.

CONCLUSIONS: The institution of an ED-HFNC protocol for patients with COVID-19 respiratory distress was associated with reductions in the rate of ETT. Early initiation of HFNC is a promising strategy for avoiding ETT and improving outcomes in patients with COVID-19.

PMID:35354003 | DOI:10.5811/westjem.2021.3.50116

West J Emerg Med. 2021 Jul 19;22(4):810-819. doi: 10.5811/westjem.2021.3.50932.

ABSTRACT

INTRODUCTION: Our goal was to systematically review contemporary literature comparing the relative effectiveness of two mechanical compression devices (LUCAS and AutoPulse) to manual compression for achieving return of spontaneous circulation (ROSC) in patients undergoing cardiopulmonary resuscitation (CPR) after an out-of-hospital cardiac arrest (OHCA).

METHODS: We searched medical databases systematically for randomized controlled trials (RCT) and observational studies published between January 1, 2000-October 1, 2020 that compared mechanical chest compression (using any device) with manual chest compression following OHCA. We only included studies in the English language that reported ROSC outcomes in adult patients in non-trauma settings to conduct random-effects metanalysis and trial sequence analysis (TSA). Multivariate meta-regression was performed using preselected covariates to account for heterogeneity. We assessed for risk of biases in randomization, allocation sequence concealment, blinding, incomplete outcome data, and selective outcome reporting.

RESULTS: A total of 15 studies (n = 18474), including six RCTs, two cluster RCTs, five retrospective case-control, and two phased prospective cohort studies, were pooled for analysis. The pooled estimates’ summary effect did not indicate a significant difference (Mantel-Haenszel odds ratio = 1.16, 95% confidence interval, 0.97 to 1.39, P = 0.11, I2 = 0.83) between mechanical and manual compressions during CPR for ROSC. The TSA showed firm evidence supporting the lack of improvement in ROSC using mechanical compression devices. The Z-curves successfully crossed the TSA futility boundary for ROSC, indicating sufficient evidence to draw firm conclusions regarding these outcomes. Multivariate meta-regression demonstrated that 100% of the between-study variation could be explained by differences in average age, the proportion of females, cardiac arrests with shockable rhythms, witnessed cardiac arrest, bystander CPR, and the average time for emergency medical services (EMS) arrival in the study samples, with the latter three attaining statistical significance.

CONCLUSION: Mechanical compression devices for resuscitation in cardiac arrests are not associated with improved rates of ROSC. Their use may be more beneficial in non-ideal situations such as lack of bystander CPR, unwitnessed arrest, and delayed EMS response times. Studies done to date have enough power to render further studies on this comparison futile.

PMID:35353993 | DOI:10.5811/westjem.2021.3.50932

West J Emerg Med. 2021 Jul 19;22(4):919-930. doi: 10.5811/westjem.2021.3.49770.

ABSTRACT

INTRODUCTION: The role of gender in interprofessional interactions is poorly understood. This mixed-methods study explored perceptions of gender bias in interactions between emergency medicine (EM) residents and nurses.

METHODS: We analyzed qualitative interviews and focus groups with residents and nurses from two hospitals for dominant themes. An electronic survey, developed through an inductive-deductive approach informed by qualitative data, was administered to EM residents and nurses. Quantitative analyses included descriptive statistics and between-group comparisons.

RESULTS: Six nurses and 14 residents participated in interviews and focus groups. Key qualitative themes included gender differences in interprofessional communication, specific examples of, and responses to, gender bias. Female nurses perceived female residents as more approachable and collaborative than male residents, while female residents perceived nurses’ questions as doubting their clinical judgment. A total of 134 individuals (32%) completed the survey. Females more frequently perceived interprofessional gender bias (mean 30.9; 95% confidence interval {CI}, 25.6, 36.2; vs 17.6 [95% CI, 10.3, 24.9). Residents reported witnessing interprofessional gender bias more frequently than nurses (58.7 (95% CI, 48.6, 68.7 vs 23.9 (95% CI, 19.4, 28.4). Residents reported that gender bias affected job satisfaction (P = 0.002), patient care (P = 0.001), wellness (P = 0.003), burnout (P = 0.002), and self-doubt (P = 0.017) more frequently than nurses.

CONCLUSION: Perceived interprofessional gender bias negatively impacts personal wellbeing and workplace satisfaction, particularly among female residents. Key institutional stakeholders including residency, nursing, and hospital leadership should invest the resources necessary to develop and integrate evidence-based strategies to improve interprofessional relationships that will ultimately enhance residency training, work climate, and patient care.

PMID:35353996 | DOI:10.5811/westjem.2021.3.49770

West J Emerg Med. 2021 Jul 20;22(4):882-889. doi: 10.5811/westjem.2021.2.50249.

ABSTRACT

INTRODUCTION: Increases in emergency department (ED) crowding and boarding are a nationwide issue resulting in worsening patient care and throughput. To compensate, ED administrators often look to modifying staffing models to improve efficiencies.

METHODS: This study evaluates the impact of implementing the waterfall model of physician staffing on door-to-doctor time (DDOC), door-to-disposition time (DDIS), left without being seen (LWBS) rate, elopement rate, and the number of patient sign-outs. We examined 9,082 pre-intervention ED visits and 8,983 post-intervention ED visits.

RESULTS: The change in DDOC, LWBS rate, and elopement rate demonstrated statistically significant improvement from a mean of 65.1 to 35 minutes (P <0.001), 1.12% to 0.92% (P = 0.004), and 3.96% to 1.95% (P <0.001), respectively. The change in DDIS from 312 to 324.7 minutes was not statistically significant (P = 0.310). The number of patient sign-outs increased after the implementation of a waterfall schedule (P <0.001).

CONCLUSION: Implementing a waterfall schedule improved DDOC time while decreasing the percentage of patients who LWBS and eloped. The DDIS and number of patient sign-outs appears to have increased post implementation, although this may have been confounded by the increase in patient volumes and ED boarding from the pre- to post-intervention period.

PMID:35353992 | DOI:10.5811/westjem.2021.2.50249