Tag: nevin manimala

PLoS One. 2022 Apr 4;17(4):e0265381. doi: 10.1371/journal.pone.0265381. eCollection 2022.

ABSTRACT

Article-level measures of publication impact (alternative metrics or altmetrics) can help authors and other stakeholders assess engagement with their research and the success of their communication efforts. The wide variety of altmetrics can make interpretation and comparative assessment difficult; available summary tools are either narrowly focused or do not reflect the differing values of metrics from a stakeholder perspective. We created the EMPIRE (EMpirical Publication Impact and Reach Evaluation) Index, a value-based, multi-component metric framework for medical publications. Metric weighting and grouping were informed by a statistical analysis of 2891 Phase III clinical trial publications and by a panel of stakeholders who provided value assessments. The EMPIRE Index comprises three component scores (social, scholarly, and societal impact), each incorporating related altmetrics indicating a different aspect of engagement with the publication. These are averaged to provide a total impact score and benchmarked so that a score of 100 equals the mean scores of Phase III clinical trial publications in the New England Journal of Medicine (NEJM) in 2016. Predictor metrics are defined to estimate likely long-term impact. The social impact component correlated strongly with the Altmetric Attention Score and the scholarly impact component correlated modestly with CiteScore, with the societal impact component providing unique insights. Analysis of fresh metrics collected 1 year after the initial dataset, including an independent sample, showed that scholarly and societal impact scores continued to increase, whereas social impact scores did not. Analysis of NEJM ‘notable articles’ showed that observational studies had the highest total impact and component scores, except for societal impact, for which surgical studies had the highest score. The EMPIRE Index provides a richer assessment of publication value than standalone traditional and alternative metrics and may enable medical researchers to assess the impact of publications easily and to understand what characterizes impactful research.

PMID:35377894 | DOI:10.1371/journal.pone.0265381

PLoS One. 2022 Apr 4;17(4):e0266570. doi: 10.1371/journal.pone.0266570. eCollection 2022.

ABSTRACT

BACKGROUND: Healthcare workers, including residents, are prone to various mental health disorders especially given the context of the COVID-19 pandemic. Residents, particularly, are already under undue stress due to their respective training program demands.

METHODS: This cross-sectional, online survey-based study from August to November 2020 collected demographic and mental health measurements from all residents at the Aga Khan University Hospital, Nairobi. The questionnaire investigated demographic variables, information regarding direct care of COVID-19 patients, prior history of mental health and mental health outcomes using the Patient Health Questionnaire, Generalized Anxiety Disorder scale, Insomnia Severity Index, Impact of Event Scale-Revised Questionnaire and Stanford Professional Fulfillment Index Questionnaire.

RESULTS: A total of 100 residents completed the survey (participation rate 77.5%). Participants were about equal in gender (women [53%]), with a median age of 31.28 years, and majority were single (66.7%). A total of 66 participants (66%) were directly engaged in COVID-19 care. Depression: 64.3%, anxiety: 51.5%, insomnia: 40.5%, distress: 35.4%, and burnout: 51.0% were reported in all participants. Statistical significance was found in median depression, professional fulfillment and interpersonal disengagement when comparing frontline resident directly involved in care of COVID-19 patient versus second line residents.

CONCLUSION: Residents directly involved with caring for COVID-19 patients had statistically higher incidences of depression and interpersonal disengagement and lower professional fulfillment compared to second line residents. Keeping in mind the limited resources in sub-Saharan Africa, urgent and geographically specific strategies are needed to help combat mental health disorders in this specific population.

PMID:35377909 | DOI:10.1371/journal.pone.0266570

PLoS Negl Trop Dis. 2022 Apr 4;16(4):e0010297. doi: 10.1371/journal.pntd.0010297. eCollection 2022 Apr.

ABSTRACT

Dengue, a mosquito transmitted febrile viral disease, is a serious public health concern in Bangladesh. Despite significant number of incidences and reported deaths each year, there are inadequate number of studies relating the temporal trends of the clinical parameters as well as socio-demographic factors with the clinical course of the disease. Therefore, this study aims to associate the clinical parameters, demographic and behavioral factors of the dengue patients admitted in a tertiary care hospital in Dhaka, Bangladesh during the 2019 outbreak of dengue with the clinical course of the disease. Data were collected from the 336 confirmed dengue in-patients and analyzed using SPSS 26.0 software. Majority of the patients were male (2.2 times higher than female) who required longer time to recover compared to females (p < 0.01), urban resident (54.35%) and belonged to the age group of 18-40 years (73.33%). Dengue fever (90.77%) and dengue hemorrhagic fever (5.95%) were reported in most of the dengue patients while fever (98%) was the most frequently observed symptom. A significantly positive association was found between patient’s age and number of manifested symptoms (p = 0.013). Average duration of stay in the hospital was 4.9 days (SD = 1.652) and patient’s recovery time was positively correlated with delayed hospitalization (p < 0.01). Additionally, recovery time was negatively correlated with initial blood pressure (both systolic (p = 0.001, and diastolic (p = 0.023)) and platelet count (p = 0.003) of the patients recorded on the first day of hospitalization. Finally, a statistical model was developed which predicted that, hospital stay could be positively associated with an increasing trend of temperature, systolic blood pressure and reduced platelets count. Findings of this study may be beneficial to better understand the clinical course of the disease, identify the potential risk factors and ensure improved patient management during future dengue outbreaks.

PMID:35377886 | DOI:10.1371/journal.pntd.0010297

PLoS Comput Biol. 2022 Apr 4;18(4):e1009309. doi: 10.1371/journal.pcbi.1009309. Online ahead of print.

ABSTRACT

For de novo mutational signature analysis, the critical first step is to decide how many signatures should be expected in a cancer genomics study. An incorrect number could mislead downstream analyses. Here we present SUITOR (Selecting the nUmber of mutatIonal signaTures thrOugh cRoss-validation), an unsupervised cross-validation method that requires little assumptions and no numerical approximations to select the optimal number of signatures without overfitting the data. In vitro studies and in silico simulations demonstrated that SUITOR can correctly identify signatures, some of which were missed by other widely used methods. Applied to 2,540 whole-genome sequenced tumors across 22 cancer types, SUITOR selected signatures with the smallest prediction errors and almost all signatures of breast cancer selected by SUITOR were validated in an independent breast cancer study. SUITOR is a powerful tool to select the optimal number of mutational signatures, facilitating downstream analyses with etiological or therapeutic importance.

PMID:35377867 | DOI:10.1371/journal.pcbi.1009309

PLoS One. 2022 Apr 4;17(4):e0262204. doi: 10.1371/journal.pone.0262204. eCollection 2022.

ABSTRACT

BACKGROUND: Washington, DC, and sub-Saharan Africa are both affected by generalized HIV epidemics. However, care for persons living with HIV (PLWH) and clinical outcomes may differ in these geographically and culturally diverse areas. We compared patient and clinical site characteristics among adult persons living with HIV (PLWH) enrolled in two longitudinal HIV cohort studies-the African Cohort Study (AFRICOS) and the DC Cohort.

METHODS: The DC Cohort is a clinic-based city-wide longitudinal cohort comprised of PLWH attending 15 HIV clinics in Washington, DC. Patients’ socio-demographic characteristics, clinical evaluations, and laboratory data are retrospectively collected from electronic medical records and limited manual chart abstraction. AFRICOS is a prospective observational cohort of PLWH and uninfected volunteers attending 12 select HIV care and treatment facilities in Nigeria, Kenya, Uganda and Tanzania. AFRICOS study participants are a subset of clinic patients who complete protocol-specific visits every 6 months with history and physical examination, questionnaire administration, and blood/sputum collection for ascertainment of HIV outcomes and comorbidities, and neurocognitive and functional assessments. Among participants aged ≥ 18 years, we generated descriptive statistics for demographic and clinical characteristics at enrollment and follow up and compared them using bivariable analyses.

RESULTS: The study sample included 2,774 AFRICOS and 8,420 DC Cohort participants who enrolled from January 2013 (AFRICOS)/January 2011 (DC Cohort) through March 2018. AFRICOS participants were significantly more likely to be women (58.8% vs 27.1%) and younger (83.3% vs 61.1% aged < 50 years old) and significantly less likely to be MSM (only 0.1% of AFRICOS population reported MSM risk factor) than DC Cohort. Similar rates of current viral suppression (about 75% of both samples), hypertension, hepatitis B coinfection and alcohol use were observed. However, AFRICOS participants had significantly higher rates of CD4<200 and tuberculosis and significantly lower rates of obesity, DM, hepatitis C coinfection and syphilis.

CONCLUSIONS: With similar viral suppression outcomes, but many differences between our cohorts noted, the combined sample provides unique opportunities to assess and compare HIV care and treatment outcomes in the U.S. and sub-Saharan Africa. Comparing these two cohorts may inform care and treatment practices and may pave the way for future pathophysiologic analyses.

PMID:35377881 | DOI:10.1371/journal.pone.0262204

IEEE J Biomed Health Inform. 2022 Apr 4;PP. doi: 10.1109/JBHI.2022.3164570. Online ahead of print.

ABSTRACT

Positron Emission Tomography (PET) has become a preferred imaging modality for cancer diagnosis, radiotherapy planning, and treatment responses monitoring. Accurate and automatic tumor segmentation is the fundamental requirement for these clinical applications. Deep convolutional neural networks have become the state-of-the-art in PET tumor segmentation. The normalization process is one of the key components for accelerating network training and improving the performance of the network. However, existing normalization methods either introduce batch noise into the instance PET image by calculating statistics on batch level or introduce background noise into every single pixel by sharing the same learnable parameters spatially. In this paper, we proposed an attentive transformation (AT)-based normalization method for PET tumor segmentation. We exploit the distinguishability of breast tumor in PET images and dynamically generate dedicated and pixel-dependent learnable parameters in normalization via the transformation on a combination of channel-wise and spatial-wise attentive responses. The attentive learnable parameters allow to re-calibrate features pixel-by-pixel to focus on the high-uptake area while attenuating the background noise of PET images. Our experimental results on two real clinical datasets show that the AT-based normalization method improves breast tumor segmentation performance when compared with the existing normalization methods.

PMID:35377850 | DOI:10.1109/JBHI.2022.3164570

Proc Natl Acad Sci U S A. 2022 Apr 12;119(15):e2114914119. doi: 10.1073/pnas.2114914119. Epub 2022 Apr 4.

ABSTRACT

SignificanceA large body of research in the social and behavioral sciences studies the impact of behavioral interventions (or “nudges”) on decisions. Although this work has been extremely influential, we currently lack an overarching theoretical framework for behavioral interventions that provides a systematic account of their behavioral consequences, cognitive and neurobiological mechanisms, and statistical interpretations. In this paper, we propose such a theoretical framework using the diffusion decision model, a quantitative theory of decision-making whose parameters offer a theoretically compelling characterization of choice underpinnings. Our results not only reveal insights about how context-based interventions alter behavior but also offer practitioners a model-based method for choosing between behavioral interventions based on different goals.

PMID:35377794 | DOI:10.1073/pnas.2114914119

Health Aff (Millwood). 2022 Apr;41(4):549-556. doi: 10.1377/hlthaff.2021.00440.

ABSTRACT

Despite reports of a physician burnout epidemic, there is little research on the relationship between burnout and objective measures of care outcomes and no research on the relationship between burnout and costs of care. Linking survey data from 1,064 family physicians to Medicare claims, we found no consistent statistically significant relationship between seven categories of self-reported burnout and measures of ambulatory care-sensitive admissions, ambulatory care-sensitive emergency department visits, readmissions, or costs. The coefficients for ambulatory care-sensitive admissions and readmissions for all burnout levels, compared with never being burned out, were consistently negative (fewer ambulatory care-sensitive admissions and readmissions), suggesting that, counterintuitively, physicians who report burnout may nevertheless be able to create better outcomes for their patients. Even if true, this hypothesis should not indicate that physician burnout is beneficial or that efforts to reduce physician burnout are unimportant. Our findings suggest that the relationship between burnout and outcomes is complex and requires further investigation.

PMID:35377764 | DOI:10.1377/hlthaff.2021.00440

J Urol. 2022 Apr 4:101097JU0000000000002688. doi: 10.1097/JU.0000000000002688. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the incidence of 90-day complications after urethroplasty and identify factors associated with them.

METHODS: A single-institution, two-surgeon retrospective review was performed on patients undergoing urethroplasty from 08/2003-06/2020. Variables included the incidence, type and Clavien-Dindo grade of complications, patient age, individual comorbidities, comorbidity component of the Charlson comorbidity index (CCI), smoking status, obesity (BMI ≥35), bacteriuria, type of urethroplasty, stricture etiology, length, location, prior endoscopic procedures, previous urethroplasty, and pre-operative suprapubic catheterization. The primary outcome was the incidence of significant 90-day complications defined as Clavien grade ≥2. Descriptive statistics were used to summarize the results and binary logistic regression was used to examine the factors associated with 90-day complications.

RESULTS: Of the 1611 patients included in the analysis, 90-day complications (Clavien ≥2) occurred in 7.9% (128/1611) and were wound-related (3.5%), urinary tract infection (3.4%), cardiovascular (0.4%), catheter-related (0.2%), hematuria (0.1%), or retention (0.1%). On univariable binary logistic regression stricture location (p=0.04), stricture length (p=0.009), CCI (p<0.0001), prior urethroplasty (p=0.01) and bacteriuria (p=0.002) were associated with complications while age (p=0.3), etiology (p=0.2), smoking (p=0.2), obesity (p=0.3), failed endoscopic treatment (p=0.8), indwelling suprapubic catheter (p=0.7) and type of urethroplasty (p=0.09) were not. On multivariable analysis, increasing CCI (Odds Ratio 1.31, 95%CI 1.10-1.56; p=0.003), prior urethroplasty (O.R.1.86, 95%CI 1.09-3.17; p=0.02) and pre-operative bacteriuria (O.R.1.67, 95%CI 1.14-2.45; p=0.009) remained associated with 90-day complications.

CONCLUSION: Patients with increased comorbidities, prior urethroplasty and pre-operative bacteriuria are at higher risk for complications after urethroplasty and should be counselled accordingly in a shared decision-making model of care.

PMID:35377776 | DOI:10.1097/JU.0000000000002688

JCO Glob Oncol. 2022 Mar;8:e2100246. doi: 10.1200/GO.21.00246.

ABSTRACT

PURPOSE: Currently, limited information is available on care provided to breast cancer survivors in Singapore. This study aims to assess the quality of post-treatment cancer survivorship care among breast cancer survivors on the basis of compliance with international guidelines up to 5 years post-primary treatment.

METHODS: This study analyzed a cohort of 189 nonmetastatic breast cancer survivors recruited from the National Cancer Centre Singapore, Changi General Hospital, and KK Women’s and Children’s Hospital between November 2011 and September 2015. Data were retrieved from electronic medical records in 6-month intervals. Adherence to guidelines was assessed in four areas: (1) recurrent cancer surveillance, (2) monitoring and detecting late effects, (3) health care resource utilization, and (4) preventive care. Descriptive statistics, Kaplan-Meier, and regression analyses were conducted.

RESULTS: Annual surveillance mammogram adherence rates were ≥ 83% consistently. The most common new diagnosis was osteoporosis at an incidence rate of 102 (95% CI, 77.6 to 135) cases per 1,000 person-years. Overall, ≤ 10.1% of survivors had an emergency department or hospitalization visit. Oncologist services were overutilized, with a median of 6 (interquartile range: 4-10) visits in the first 6 months before reducing to a median of 2 (interquartile range: 1-3) visits biannually 3 years post-treatment. Bone mineral density test utilization rate adhered to guidelines for 92.2% of aromatase inhibitor recipients but only for 36.4% of premenopausal tamoxifen recipients.

CONCLUSION: Overall, adherence rates to surveillance and osteoporosis preventive care were high. Extensive utilization of oncologist services up to 5 years post-primary treatment could be reversed with strategies to engage and coordinate survivorship care with primary care providers, leveraging their strengths to improve adherence to health promotion and chronic disease management.

PMID:35377727 | DOI:10.1200/GO.21.00246