Tag: nevin manimala

PLoS One. 2021 Dec 22;16(12):e0260110. doi: 10.1371/journal.pone.0260110. eCollection 2021.

ABSTRACT

To quickly and efficiently recognize abnormal patterns from large-scale time series and pathological signals in epilepsy, this paper presents here a preliminary RSW&TST framework for Multiple Change-Points (MCPs) detection based on the Random Slide Window (RSW) and Trigeminal Search Tree (TST) methods. To avoid the remaining local optima, the proposed framework applies a random strategy for selecting the size of each slide window from a predefined collection, in terms of data feature and experimental knowledge. For each data segment to be diagnosed in a current slide window, an optimal path towards a potential change point is detected by TST methods from the top root to leaf nodes with O(log3(N)). Then, the resulting MCPs vector is assembled by means of TST-based single CP detection on data segments within each of the slide windows. In our experiments, the RSW&TST framework was tested by using large-scale synthetic time series, and then its performance was evaluated by comparing it with existing binary search tree (BST), Kolmogorov-Smirnov (KS)-statistics, and T-test under the fixed slide window (FSW) approach, as well as the integrated method of wild binary segmentation and CUSUM test (WBS&CUSUM). The simulation results indicate that our RSW&TST is both more efficient and effective, with a higher hit rate, shorter computing time, and lower missed, error and redundancy rates. When the proposed RSW&TST framework is executed for MCPs detection on pathological ECG (electrocardiogram)/EEG (electroencephalogram) recordings of people in epileptic states, the abnormal patterns are roughly recognized in terms of the number and position of the resultant MCPs. Furthermore, the severity of epilepsy is roughly analyzed based on the strength and period of signal fluctuations among multiple change points in the stage of a sudden epileptic attack. The purpose of our RSW&TST framework is to provide an encouraging platform for abnormal pattern recognition through MCPs detection on large-scale time series quickly and efficiently.

PMID:34936654 | DOI:10.1371/journal.pone.0260110

PLoS One. 2021 Dec 22;16(12):e0258348. doi: 10.1371/journal.pone.0258348. eCollection 2021.

ABSTRACT

BACKGROUND: Since the COVID-19 pandemic began, there have been concerns related to the preparedness of healthcare workers (HCWs). This study aimed to describe the level of awareness and preparedness of hospital HCWs at the time of the first wave.

METHODS: This multinational, multicenter, cross-sectional survey was conducted among hospital HCWs from February to May 2020. We used a hierarchical logistic regression multivariate analysis to adjust the influence of variables based on awareness and preparedness. We then used association rule mining to identify relationships between HCW confidence in handling suspected COVID-19 patients and prior COVID-19 case-management training.

RESULTS: We surveyed 24,653 HCWs from 371 hospitals across 57 countries and received 17,302 responses from 70.2% HCWs overall. The median COVID-19 preparedness score was 11.0 (interquartile range [IQR] = 6.0-14.0) and the median awareness score was 29.6 (IQR = 26.6-32.6). HCWs at COVID-19 designated facilities with previous outbreak experience, or HCWs who were trained for dealing with the SARS-CoV-2 outbreak, had significantly higher levels of preparedness and awareness (p<0.001). Association rule mining suggests that nurses and doctors who had a ‘great-extent-of-confidence’ in handling suspected COVID-19 patients had participated in COVID-19 training courses. Male participants (mean difference = 0.34; 95% CI = 0.22, 0.46; p<0.001) and nurses (mean difference = 0.67; 95% CI = 0.53, 0.81; p<0.001) had higher preparedness scores compared to women participants and doctors.

INTERPRETATION: There was an unsurprising high level of awareness and preparedness among HCWs who participated in COVID-19 training courses. However, disparity existed along the lines of gender and type of HCW. It is unknown whether the difference in COVID-19 preparedness that we detected early in the pandemic may have translated into disproportionate SARS-CoV-2 burden of disease by gender or HCW type.

PMID:34936646 | DOI:10.1371/journal.pone.0258348

Plast Reconstr Surg. 2022 Jan 1;149(1):95e-103e. doi: 10.1097/PRS.0000000000008666.

ABSTRACT

BACKGROUND: Antiplatelet agents are typically withheld perioperatively because of bleeding concerns. Dual antiplatelet therapy, such as aspirin and clopidogrel, has significant morbidity and mortality benefits in patients with ischemic heart disease or peripheral vascular disease. This study aims to evaluate the impact of perioperative dual antiplatelet therapy in the lower extremity free tissue transfer population.

METHODS: Lower extremity free tissue transfers performed by the senior author (K.K.E.) from 2011 to 2019 were retrospectively reviewed. Demographics, comorbidities, perioperative dual antiplatelet therapy, and free tissue transfer characteristics were recorded. Outcomes of interest included flap success, hematoma formation, blood transfusion requirements, and cardiac event occurrence.

RESULTS: One hundred ninety-five free tissue transfers were included. Median age at the time of free tissue transfer was 56.5 years. Median Charlson Comorbidity Index was 3. Thirty-four patients were on clopidogrel, which was either withheld (n = 20) or continued (n = 14) on the day of free tissue transfer. Incidence of blood transfusion was significantly higher in both the withheld and continued versus nonclopidogrel groups. Flap success was statistically equivalent between groups (withheld, 90.0 percent; continued, 92.9 percent; nonclopidogrel, 95.0 percent; p = 0.346). Cardiac events occurred most often in the continued group (21.4 percent) compared to the withheld (5.0 percent) and nonclopidogrel (0.6 percent) groups. On multivariate analysis, holding clopidogrel remained significant for increased odds of postoperative transfusion. The clopidogrel group was no longer significant for intraoperative transfusion.

CONCLUSIONS: Despite increases in volume of blood products transfused, free tissue transfer can be performed safely with perioperative dual antiplatelet therapy. Withholding dual antiplatelet therapy on the day of free tissue transfer was not associated with decreased intraoperative transfusion; thus, dual antiplatelet therapy can safely be continued throughout the operative course to minimize cardiovascular risk.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

PMID:34936629 | DOI:10.1097/PRS.0000000000008666

Plast Reconstr Surg. 2022 Jan 1;149(1):253-261. doi: 10.1097/PRS.0000000000008678.

ABSTRACT

BACKGROUND: The Open Payments database was created to increase transparency of industry payment relationships within medicine. The current literature often examines only 1 year of the database. In this study, the authors use 5 years of data to show trends among industry payments to plastic surgeons from 2014 to 2018. In addition, the authors lay out the basics of conflict-of-interest reporting for the new plastic surgeon. Finally, the authors suggest an algorithm for the responsible management of industry relationships.

METHODS: This study analyzed nonresearch payments made to plastic surgeons from January 1, 2014, to December 31, 2018. Descriptive statistics were calculated using R Statistical Software and visualized using Tableau.

RESULTS: A total of 304,663 payments totaling $140,889,747 were made to 8148 plastic surgeons; 41 percent ($58.28 million) was paid to 50 plastic surgeons in the form of royalty or license payments. With royalties excluded, average and median payments were $276 and $25. The average yearly total per physician was $2028. Of the 14 payment categories, 95 percent of the total amount paid was attributable payments in one of six categories. Seven hundred thirty companies reported payments to plastic surgeons from 2014 to 2018; 15 companies (2 percent) were responsible for 80 percent ($66.34 million) of the total sum paid. Allergan was responsible for $24.45 million (29.6 percent) of this amount.

CONCLUSIONS: Although discussions on the proper management of industry relationships continue to evolve, the data in this study illustrate the importance of managing industry relationships. The simple guidelines suggested create a basis for managing industry relationships in the career of the everyday plastic surgeon.

PMID:34936632 | DOI:10.1097/PRS.0000000000008678

Plast Reconstr Surg. 2022 Jan 1;149(1):183-195. doi: 10.1097/PRS.0000000000008645.

ABSTRACT

BACKGROUND: Despite its increasing use in craniofacial surgery, the evidence for piezosurgery over conventional bone-cutting techniques has not been critically appraised. The purpose of this systematic review and meta-analysis was to identify and assess the evidence that exists for the use of piezosurgery in craniofacial surgery.

METHODS: A systematic review was undertaken using a computerized search. Publication descriptors, methodologic details, and outcomes were extracted. Articles were assessed using the methodologic index for nonrandomized studies and Cochrane instruments. Random effects meta-analysis was completed.

RESULTS: Thirty-nine studies were included. Most studies were published within the past 5 years (51.3 percent) and were randomized controlled trials (56.4 percent). The mean age of patients was 27 years (range, 0.2 to 57 years), and the mean sample size was 44 (range, 12 to 180). Meta-analysis revealed that compared to conventional instruments, piezosurgery had a lower postoperative incidence of sensory disturbance, principally in mandibular procedures (OR, 0.29; 95 percent CI, 0.11 to 0.77; p = 0.01) and pain at postoperative day 3 (mean difference, -0.86; 95 percent CI, -1.20 to -0.53; p < 0.01). There was no statistically significant difference in operating room time (mean difference, 8.60; 95 percent CI, -1.27 to 18.47; p = 0.80) or osteotomy time (mean difference, 0.35; 95 percent CI, -2.99 to 3.68; p = 0.84). Most studies were clinically homogenous (92 percent) and of high quality based on the methodologic index for nonrandomized studies instrument (84 percent). Few studies had domains at high risk of bias based on the Cochrane instrument (28.6 percent).

CONCLUSIONS: Piezosurgery has considerable benefits when compared to conventional instruments. Future studies should investigate its cost-effectiveness and benefits in terms of blood loss, edema/ecchymosis, and patient satisfaction.

PMID:34936620 | DOI:10.1097/PRS.0000000000008645

Plast Reconstr Surg. 2022 Jan 1;149(1):15-27. doi: 10.1097/PRS.0000000000008633.

ABSTRACT

BACKGROUND: Racial disparities are evident in multiple aspects of the perioperative care of breast cancer patients, but data examining whether such differences translate to clinical and patient-reported outcomes are limited. This study examined the impact of race on perioperative outcomes in autologous breast reconstruction.

METHODS: A retrospective cohort study including all breast cancer patients who underwent immediate autologous breast reconstruction at a single institution from 2010 to 2017 was conducted. Self-reported race was used to classify patients into three groups: white, African American, and other. The primary and secondary endpoints were occurrence of any major complications within 30 days of surgery and patient-reported outcomes (measured with the BREAST-Q), respectively. Regression models were constructed to identify factors associated with the outcomes.

RESULTS: Overall, 404 patients, including 259 white (64 percent), 63 African American (16 percent), and 82 patients from other minority groups (20 percent), were included. African American patients had a significantly higher proportion of preoperative comorbidities. Postoperatively, African American patients had a higher incidence of 30-day major complications (p = 0.004) and were more likely to return to the operating room (p = 0.006). Univariable analyses examining complications demonstrated that race was the only factor associated with 30-day major complications (p = 0.001). Patient-reported outcomes were not statistically different at each time point through 3 years postoperatively.

CONCLUSIONS: African American patients continue to present with increased comorbidities and may be more likely to experience major complications following immediate autologous breast reconstruction. However, patient-reported satisfaction or physical well-being outcomes may not differ between groups.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

PMID:34936598 | DOI:10.1097/PRS.0000000000008633

Plast Reconstr Surg. 2022 Jan 1;149(1):151-161. doi: 10.1097/PRS.0000000000008670.

ABSTRACT

BACKGROUND: Lymphaticovenous anastomosis, a supermicrosurgical technique, creates bypasses between the lymphatic and venous systems. The quality of lymphaticovenous anastomosis depends on the surgeon’s dexterity and precision, and is subject to imperfections caused by the physiologic tremor of the human hand. A dedicated robot for microsurgery has been created to overcome these limitations (MUSA, MicroSure, Eindhoven, The Netherlands). This study describes 1-year clinical outcomes of the first-in-human trial of robot-assisted and manual lymphaticovenous anastomosis in patients with breast cancer-related lymphedema.

METHODS: In this prospective pilot study, women with breast cancer-related lymphedema were randomized into the robot-assisted or manual lymphaticovenous anastomosis group. Outcomes were quality of life, arm circumference, conservative treatment frequency, arm dermal backflow stage, and anastomosis patency.

RESULTS: Twenty women were included, of whom eight underwent robot-assisted lymphaticovenous anastomosis surgery and 12 underwent manual surgery. In both groups, quality of life significantly improved at 12 months (robot-assisted surgery, p = 0.045; manual surgery, p = 0.001). Arm circumference did not decrease (robot-assisted surgery, p = 0.094; manual surgery, p = 0.240). Daily use of compression garments decreased by 61.9 percent (robot-assisted surgery) and 70.2 percent (manual surgery). The frequency of manual lymphatic drainage remained similar compared with baseline. Arm dermal backflow stage was reduced in one patient in the robot-assisted group and in five cases in the manual group. Overall, 76.5 percent of the anastomoses were patent (robot-assisted surgery, 66.6 percent; manual surgery, 81.8 percent).

CONCLUSIONS: After evaluating 1-year follow-up data, this study confirms the feasibility of robot-assisted lymphaticovenous anastomosis surgery. Clinical outcomes were comparable between robot-assisted and manual lymphaticovenous anastomosis. This encourages further research using the new microsurgical robot MUSA for lymphaticovenous anastomosis and other (super)microsurgical procedures.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

PMID:34936615 | DOI:10.1097/PRS.0000000000008670

IEEE Trans Ultrason Ferroelectr Freq Control. 2021 Dec 22;PP. doi: 10.1109/TUFFC.2021.3137425. Online ahead of print.

ABSTRACT

Time series measurements with data gaps (dead times) prevent accurate computations of frequency stability variances such as the Allan variance (AVAR) and its square-root the Allan deviation (ADEV). To extract frequency distributions, time series data must be sequentially ordered and equally spaced. Data gaps, particularly large ones, make ADEV estimates unreliable. Gap imputation by interpolation, zero-padding, or adjoining live segments, all fail in various ways. We have devised an algorithm that fills gaps by imputing an extension of preceding live data and explain its advantages. To demonstrate the effectiveness of the algorithm, we have implemented it on 513-length original datasets and have removed 30% (150 values). The resulting data is consistent with the original in all three major criteria: the noise characteristic, the distribution, and the ADEV levels and slopes. Of special importance is that all ADEV measurements on the imputed data set lie within 90% confidence of the statistic for the original dataset.

PMID:34936554 | DOI:10.1109/TUFFC.2021.3137425

Traffic Inj Prev. 2021 Dec 22:1-6. doi: 10.1080/15389588.2021.2004311. Online ahead of print.

ABSTRACT

OBJECTIVE: Motorcycles, moped scooters and bicycles are commonly involved in traffic accidents and riders often suffer significant morbidity and mortality. The aim of this study is to compare and categorize the different injury patterns and fractures suffered by riders of each vehicle type after a traffic accident.

METHODS: Data from a level 1 trauma center in Las Vegas, Nevada were analyzed. Traffic accident victims riding a motorcycle, moped, or bicycle from 2013 to 2017 were included. Injury location and fracture location were assigned to six and sixteen categorical locations, respectively. Descriptive statistics, including frequency counts for categorical data and mean for continuous data, were calculated for the full sample and for each of the vehicle types. Logistic regression was performed on race, categorized age, vehicle type and helmet use to calculate adjusted odds ratios for injury type between the three groups.

RESULTS: Of the 2115 patients, 1372 were motorcyclists, 356 were moped scooter riders and 387 were bicyclists. Overall the vast majority of injuries reported were of the extremities or pelvic girdle (62.2%), and this was true regardless of vehicle type. Head and neck injuries were significantly more common in bicyclists (39.5%) and moped riders (34.6%), than in motorcyclists (22.7%). Helmet use was substantially lower in the moped (34%) and bicycle (20%) groups compared to the motorcycle group (85%). The most common fractures regardless of vehicle type were of the skull/face, rib, vertebral, and tibia/fibula with slight variations between vehicle groups.

CONCLUSION: Similarities were seen in the most common fracture and injury patterns between the three groups. Head and neck injuries were much more common in moped and bicycle riders compared to motorcyclists. This is most likely due to the significantly higher percentage of motorcycle riders who wore a helmet. Counseling regarding helmet and protective equipment use, especially among moped and bicycle riders is essential to reduce head injuries.

PMID:34936538 | DOI:10.1080/15389588.2021.2004311

Clin Exp Rheumatol. 2021 Dec 22. Online ahead of print.

ABSTRACT

OBJECTIVES: Systemic lupus erythematosus (SLE) has been associated with insulin resistance and beta-cell dysfunction. Apolipoprotein C3 (ApoC3) is a component of very low-density lipoproteins. Since ApoC3 has been linked to beta-cell impairment in the general population, in this study we aimed to discover if this lipoprotein is related to glucose homeostasis disturbance in patients with SLE.

METHODS: One hundred and forty non diabetic patients with SLE who had a glycaemia lower than 110 mg/dl were recruited. Insulin, C-peptide, and ApoC3 were assessed. Insulin resistance and beta-cell function were calculated using the Homeostasis Model Assessment (HOMA2) indices. A multivariable regression analysis was performed to study the relationship of ApoC3 to those molecules and indices adjusting for classical factors associated with insulin resistance that included glucocorticoids.

RESULTS: In the multivariable regression analysis that included prednisone intake, a significant relation of ApoC3 to C-peptide was found (beta coef. 0.27 [95%CI 0.03-0.51) ng/ml, p=0.030). Similarly, ApoCa3 was associated with higher degree of beta-cell dysfunction (HOMA2-%B) although in this case statistical significance was not achieved (beta coef. 8 [95%CI-1-18], p=0.086). This relationship was not found with serum insulin levels or IR indices. Furthermore, in the univariable analysis, but not after multivariable adjustment, the disease damage score was found to significantly mediate the effect of ApoC3 on circulating C-peptide. and HOMA2-%B.

CONCLUSIONS: Beta-cell dysfunction and ApoC3 are linked in patients with SLE.

PMID:34936546