Tag: nevin manimala

Clin Exp Pharmacol Physiol. 2021 Mar 30. doi: 10.1111/1440-1681.13501. Online ahead of print.

ABSTRACT

Colorectal surgery is associated with an above-average mortality rate of ~15%. During surgery, maintenance of vital organ perfusion is essential in order to reduce postoperative mortality and morbidity, with renal perfusion of particular importance. Oesophageal Doppler monitors (ODM) are commonly used to try and provide accurate measures of fluid depletion during surgery, however it is unclear to what extent they reflect organ perfusion. In addition, it is not known whether macro- and/ or microvascular perfusion indices are associated with renal complications following colorectal surgery. Thirty-two participants scheduled for colorectal surgery had three measures of macro- and microvascular renal blood flow via contrast enhanced ultrasound (CEUS), and simultaneous measures of cardiac output indicies via ODM: i) pre-operatively; ii) intra-operatively at the mid-point of operation, and iii) after the conclusion of surgery. The Postoperative Morbidity Survey (POMS) was used to assess postoperative complications. Intra-operatively, there was a significant correlation between renal microvascular flow (RT) and renal macrovascular flow (TTI) (rho=0.52; p=0.003). Intra-operative TTI, but not RT, was associated with cardiac index (rho= -0.50; p=0.0003). Intra-operative RT predicted increases in renal complications (OR 1.46; 95% CI 1.03 to 2.09) with good discrimination (C-statistic, 0.85). Complications were not predicted by TTI or ODM-derived indices. There was no relationship between RT and TTI before or after surgery. ODM measures of haemodynamic status do not correlate with renal microvascular blood flow, and as such are likely not suitable to determine vital organ perfusion. Only CEUS-derived measures of microvascular perfusion were predictive of postoperative renal complications.

PMID:33783024 | DOI:10.1111/1440-1681.13501

Clin Transplant. 2021 Mar 30:e14301. doi: 10.1111/ctr.14301. Online ahead of print.

ABSTRACT

BACKGROUND: The coupling of increased life expectancy and improvements in both quality and access to chronic liver disease care, is culminating in an expanding population of septuagenarians (≥ 70 years) in need of liver transplantation (LT). The objective of this study is to partially alleviate this knowledge deficit and to add clarity to the current status and role of LDLT in this recipient population.

METHODS: 295 adult patients underwent LDLT between January 1, 2011 and December 31, 2016. Twelve (4%) of these patients were septuagenarians and this group was compared to younger cohort (n=283) .

RESULTS: Comorbidity profiles between the two groups were similar and no statistically significant differences were noted in warm/cold ischemia times, operative duration, or blood product utilization. ICU and total hospital stays were comparable. Septuagenarian 1-and 5-year graft and patient survivals were identical at 91.7%. Their younger counterparts had 1-and 5-year patient survivals of 91.1% and 84.0 % accompanied by 1-and 5-year graft survivals of 89.8% and 82.7%, respectively.

CONCLUSION: our study highlights a recognition that LDLT can afford highly-selected elderly patients to access to transplant with equivalent outcomes to those realized by younger recipients.

PMID:33783041 | DOI:10.1111/ctr.14301

Stat Med. 2021 Mar 29. doi: 10.1002/sim.8962. Online ahead of print.

ABSTRACT

Interval-censored failure time data commonly arise in epidemiological and biomedical studies where the occurrence of an event or a disease is determined via periodic examinations. Subject to interval-censoring, available information on the failure time can be quite limited. Cost-effective sampling designs are desirable to enhance the study power, especially when the disease rate is low and the covariates are expensive to obtain. In this work, we formulate the case-cohort design with multiple interval-censored disease outcomes and also generalize it to nonrare diseases where only a portion of diseased subjects are sampled. We develop a marginal sieve weighted likelihood approach, which assumes that the failure times marginally follow the proportional hazards model. We consider two types of weights to account for the sampling bias, and adopt a sieve method with Bernstein polynomials to handle the unknown baseline functions. We employ a weighted bootstrap procedure to obtain a variance estimate that is robust to the dependence structure between failure times. The proposed method is examined via simulation studies and illustrated with a dataset on incident diabetes and hypertension from the Atherosclerosis Risk in Communities study.

PMID:33783001 | DOI:10.1002/sim.8962

J Card Surg. 2021 Mar 30. doi: 10.1111/jocs.15516. Online ahead of print.

ABSTRACT

OBJECTIVES: Some patients who undergo transcatheter aortic valve replacement (TAVR) have a concomitant diverse aortic pathologies (AP). They are usually considered high-risk candidates for the procedure and require further assessment to determine the best vascular approach. The impact of these AP on TAVR is not well known as the information is scarce. We aimed to evaluate midterm clinical impact of different AP after transapical (TA)-TAVR.

METHODS: Twenty patients with atherosclerotic/occluding aortic diseases (A/OAD) (porcelain aorta, Leriche Syndrome, penetrating aortic ulcer, and aortic thrombus), 24 patients with aortic morphologic diseases (AMD) (thoracic/abdominal aortic aneurysms, aortic kinking, aortic type B dissection, aortic elongation/tortuosity, and previous aortic intervention), and 11 patients with combined aortic diseases (CAD) underwent TA-TAVR treatment between January 2011 and November 2019 at our center. We conducted up to 5-years clinical follow-up.

RESULTS: All patients were classified in the heart team as a high interventional risk. The 30-day mortality and stroke were 5% and 10% in the A/OAD, 8.3% and 0% in the AMD, and 0% and 0% in the CAD, respectively. The median time of freedom from a composite of death and cardio-cerebral adverse events was 22.1 months [95% confidence interval [CI]: 9.9-34.3] in A/OAD versus 34.3 months [95% CI: 15.6-53] in AMD versus 17 months [95% CI: 0-39.4] in CAD; p = .525. We registered neither procedural aortic injury nor aortic syndrome at follow-up. The moderate/severe paravalvular leakage rates were 5%, 0% and 0% in the A/OAD, AMD and CAD, respectively.

CONCLUSION: Independent of underlying AP, the TA-TAVR is a safe method and shows very promising early and midterm outcomes in patients with various AP.

PMID:33783007 | DOI:10.1111/jocs.15516

Nurs Forum. 2021 Mar 29. doi: 10.1111/nuf.12573. Online ahead of print.

ABSTRACT

BACKGROUND: Modern innovative education approaches are crucial for nursing education, which leads to improving evidence-based teaching strategies and preparing nursing students for their future workplaces. The primary aim of the study was a comparison of the effectiveness of the flipped classroom and traditional educational methods on the attainment of knowledge regarding venous thromboembolism (VTE) prevention among nursing students. In addition, investigation of the opinions of the nursing students regarding the advantages and disadvantages flipped classroom educational method was the secondary aim of the study.

METHODS: This study was implemented with a randomized controlled design in the Faculty of Nursing in September and October 2019, with 118 first- and second-semester undergraduate nursing students (58 students in the flipped classroom, 60 students in the traditional lecture) who had not taken the Adult Health Nursing course. Implementation of the study was conducted in three phases: pretest, educational intervention, and posttest for both groups.

RESULTS: The study findings demonstrated no statistically significant difference in any of the mean scores of VTE domains between the two groups in the pretest. However, the flipped classroom group had higher mean scores of all VTE domains compared with the traditional lecture group in the posttest. Mostly, students highlighted four advantages of the flipped classroom, including “Deep motive,” “Engagement,” “Cost-effectiveness,” and “Self-confidence.”

CONCLUSIONS: The flipped classroom method proved to have positive effects in VTE domains in terms of knowledge, risk assessment, and prophylaxis among nursing students. This method can be recommended as an innovative and student-centered method in the teaching of evidence-based nursing practices.

PMID:33782992 | DOI:10.1111/nuf.12573

Psychophysiology. 2021 Mar 29:e13793. doi: 10.1111/psyp.13793. Online ahead of print.

ABSTRACT

Event-related potentials (ERPs) can be very noisy, and yet, there is no widely accepted metric of ERP data quality. Here, we propose a universal measure of data quality for ERP research-the standardized measurement error (SME)-which is a special case of the standard error of measurement. Whereas some existing metrics provide a generic quantification of the noise level, the SME quantifies the data quality (precision) for the specific amplitude or latency value being measured in a given study (e.g., the peak latency of the P3 wave). It can be applied to virtually any value that is derived from averaged ERP waveforms, making it a universal measure of data quality. In addition, the SME quantifies the data quality for each individual participant, making it possible to identify participants with low-quality data and “bad” channels. When appropriately aggregated across individuals, SME values can be used to quantify the combined impact of the single-trial EEG noise and the number of trials being averaged together on the effect size and statistical power in a given experiment. If SME values were regularly included in published articles, researchers could identify the recording and analysis procedures that produce the highest data quality, which could ultimately lead to increased effect sizes and greater replicability across the field.

PMID:33782996 | DOI:10.1111/psyp.13793

J Public Health Dent. 2021 Mar 29. doi: 10.1111/jphd.12452. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate the prevalence and factors associated with dental pain and its impact on the quality of life of adult and elderly homeless people in Midwest Brazil.

METHODS: A cross-sectional study was conducted with 353 individuals aged ≥18 attending a public homeless shelter in a Brazilian state capital (Goiânia). Data on sociodemographic, psychosocial, drug use and oral health-related factors, and quality of life [Oral Impact on Daily Performance scale (OIDP)] were collected through interviews. Pearson’s Chi-square tests and robust Poisson regression were used for statistical analysis.

RESULTS: The prevalence of dental pain in the past 6 months was 50 percent. Most of the respondents reported very severe pain and self-management including medication and tooth extraction. In the adjusted regression, the prevalence of pain was 1.48 times higher among individuals who last visited the dentist within the past 2 years, compared to those who had visited more than 2 years ago; and nearly five times higher among those with a perceived need for dental treatment, compared to those with no need. The prevalence of oral impact on daily performance was 80.1 percent and the most affected activities were “difficulty eating” and “feeling ashamed to smile or speak.” The adjusted prevalence of impact was higher among individuals who had dental pain, regardless of their sociodemographic characteristics.

CONCLUSIONS: The prevalence, intensity, and self-management of dental pain were high among the Brazilian homeless people studied. Reporting of pain was associated with factors related to dental care and negatively affected their quality of life.

PMID:33782969 | DOI:10.1111/jphd.12452

Stat Med. 2021 Mar 29. doi: 10.1002/sim.8960. Online ahead of print.

ABSTRACT

Clinical studies on periodontal disease (PD) often lead to data collected which are clustered in nature (viz. clinical attachment level, or CAL, measured at tooth-sites and clustered within subjects) that are routinely analyzed under a linear mixed model framework, with underlying normality assumptions of the random effects and random errors. However, a careful look reveals that these data might exhibit skewness and tail behavior, and hence the usual normality assumptions might be questionable. Besides, PD progression is often hypothesized to be spatially associated, that is, a diseased tooth-site may influence the disease status of a set of neighboring sites. Also, the presence/absence of a tooth is informative, as the number and location of missing teeth informs about the periodontal health in that region. In this paper, we develop a (shared) random effects model for site-level CAL and binary presence/absence status of a tooth under a Bayesian paradigm. The random effects are modeled using a spatial skew-normal/independent (S-SNI) distribution, whose dependence structure is conditionally autoregressive (CAR). Our S-SNI density presents an attractive parametric tool to model spatially referenced asymmetric thick-tailed structures. Both simulation studies and application to a clinical dataset recording PD status reveal the advantages of our proposition in providing a significantly improved fit, over models that do not consider these features in a unified way.

PMID:33782991 | DOI:10.1002/sim.8960

Biotechnol Bioeng. 2021 Mar 30. doi: 10.1002/bit.27767. Online ahead of print.

ABSTRACT

Straight-through chromatography, wherein the eluate from one column passes directly onto another column without adjustment, is one strategy to integrate and intensify manufacturing processes for biologics. Development and optimization of such straight-through chromatographic processes is a challenge, however. Conventional high-throughput screening methods optimize each chromatographic step independently, with limited consideration for the connectivity of steps. Here, we demonstrate a method for the development and optimization of fully integrated, multi-column processes for straight-through purification. Selection of resins was performed using an in-silico tool for the prediction of processes for straight-through purification based on a one-time characterization of host-cell proteins combined with the chromatographic behavior of the product. A two-step optimization was then conducted to determine the buffer conditions that maximized yield while minimizing process- and product-related impurities. This optimization of buffer conditions included a series of range-finding experiments on each individual column, similar to conventional screening, followed by the development of a statistical model for the fully integrated, multi-column process using design of experiments (DoE). We used this methodology to develop and optimize integrated purification processes for a single-domain antibody and a cytokine, obtaining yields of 88% and 86%, respectively, with process- and product-related variants reduced to phase-appropriate levels for nonclinical material. This article is protected by copyright. All rights reserved.

PMID:33782945 | DOI:10.1002/bit.27767

Child Dev. 2021 Mar 29. doi: 10.1111/cdev.13552. Online ahead of print.

ABSTRACT

This study examines whether changes in classroom quality predict within-child changes in achievement and behavioral problems in elementary school (ages spanning approximately 6-11 years old). Drawing on data from a longitudinal study of children in predominantly low-income, nonurban communities (n = 1,078), we relied on child fixed effects modeling, which controlled for stable factors that could bias the effects of classroom quality. In general, we found that changes in classroom quality had small and statistically nonsignificant effects on achievement and behavior. However, we found that moving into a high-quality classroom, particularly those rated as high in Classroom Organization, had positive effects on achievement and behavior for children with significant exposure to poverty in early life.

PMID:33782953 | DOI:10.1111/cdev.13552