Tag: nevin manimala

Ann Intern Med. 2022 Apr 5. doi: 10.7326/M21-2812. Online ahead of print.

ABSTRACT

BACKGROUND: Despite increasing awareness of firearm-related deaths, evidence on the clinical and economic implications of nonfatal firearm injuries is limited.

OBJECTIVE: To measure changes in clinical and economic outcomes after nonfatal firearm injuries among survivors and their family members.

DESIGN: Cohort study.

SETTING: MarketScan Medicare and commercial claims data, 2008 to 2018.

PARTICIPANTS: 6498 survivors of firearm injuries matched to 32 490 control participants and 12 489 family members of survivors matched to 62 445 control participants.

INTERVENTION: Exposure to nonfatal firearm injury as a survivor or family member of a survivor.

MEASUREMENTS: Changes in health care spending, use, and morbidity from preinjury through 1 year postinjury relative to control participants, on average and by type and severity of firearm injury.

RESULTS: After nonfatal firearm injury, medical spending increased $2495 per person per month (402%) and cost sharing increased $102 per person per month (176%) among survivors relative to control participants (P < 0.001) in the first year after injury, driven by an increase in the first month of $25 554 (4122%) in spending and $1112 (1917%) in cost sharing per survivor (P < 0.001). All categories of health care use increased relative to the control group. Survivors had a 40% increase in pain diagnoses, a 51% increase in psychiatric disorders, and an 85% increase in substance use disorders after firearm injury relative to control participants (P < 0.001), accompanied by increased pain and psychiatric medications. Family members had a 12% increase in psychiatric disorders relative to their control participants (P = 0.003). These overall clinical and economic changes were driven by intentional firearm injuries and more severe firearm injuries.

LIMITATION: Precision of diagnostic codes and generalizability to other patient populations, including Medicaid and uninsured patients.

CONCLUSION: In survivors, nonfatal firearm injuries led to increases in psychiatric disorders, substance use disorders, and pain diagnoses, alongside substantial increases in health care spending and use. In addition, mental health worsened among family members.

PRIMARY FUNDING SOURCE: National Institutes of Health.

PMID:35377713 | DOI:10.7326/M21-2812

Neuropsychology. 2022 Apr 4. doi: 10.1037/neu0000809. Online ahead of print.

ABSTRACT

OBJECTIVE: Cognitive impairment is common among individuals with Parkinson’s disease (PD). Intraindividual variability (IIV) is a measure of variability across multiple tasks of cognitive functioning. Due to the limited amount of research, particularly among individuals with PD, IIV has been an underutilized metric of cognitive functioning both in research and clinical practice. Previous research demonstrated that individuals with PD have greater variability in cognitive performance relative to controls, and that IIV is predictive of future cognitive impairments. The aim of this study is to investigate the association between baseline IIV and change in cortical and subcortical volumes among individuals with PD.

METHOD: The present study used data from 80 newly diagnosed PD patients who were part of a longitudinal cohort study (Parkinson progression marker initiative [PPMI]). Participants completed neuropsychological measures and underwent T1 structural magnetic resonance imaging (MRI) at baseline and the first annual follow-up. Neuropsychological tests assessed attention, processing speed, visuospatial functioning, verbal fluency learning, and memory. T1 scans were processed using standard Freesurfer protocols for extraction of regional volumes.

RESULTS: Greater IIV at baseline was predictive of change in cortical volume in posterior temporal/parietal regions over the 1-year period. Baseline IIV predicted cortical volume changes above and beyond the main effect of motor severity and the baseline statistical mean/global cognition score.

CONCLUSION: Our results provide initial evidence that IIV is a marker of longitudinal cortical volume loss. Evidence is building that IIV is a sensitive marker of cognitive impairment and the underlying neurodegeneration among individuals with PD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PMID:35377683 | DOI:10.1037/neu0000809

Personal Disord. 2022 Apr 4. doi: 10.1037/per0000560. Online ahead of print.

ABSTRACT

Maternal borderline personality disorder (BPD) symptoms have been found to relate to parenting difficulties that subsequently predict children’s maladjustment. One specific area of difficulty for mothers with BPD symptoms surrounds responses to infant distress. Based in mentalization theories of BPD, the current study tested the relation between BPD symptom severity and maternal accuracy in predicting infant distress. Infant biological sex was also tested as a moderator. Participants included 101 mothers, varying in self-reported BPD symptom severity, and their 12- to 23-month-old infants. At a laboratory visit, mothers responded to structured questions about their predictions for infant distress behaviors in fear- and anger-eliciting tasks, which were then observed. Maternal accuracy represented the statistical association between maternal predictions and infant distress behaviors. Maternal accuracy did not differ between infant fear and anger. For male infants, mothers’ higher BPD symptom severity related to lower accuracy across fear and anger contexts. For female infants, BPD symptom severity did not influence maternal accuracy. Results are discussed in relation to existing theories of emotional disruption in the relationships between mothers with BPD symptoms and their infants. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PMID:35377691 | DOI:10.1037/per0000560

Arch Orthop Trauma Surg. 2022 Apr 4. doi: 10.1007/s00402-022-04419-z. Online ahead of print.

ABSTRACT

BACKGROUND: Recurrent hip dislocation after multiple revision total hip arthroplasty is a severe complication. Therefore, constrained acetabular liners (CL) have been used during salvage procedures. We report our experience of constrained liners in a re-revision setting with focus on re-dislocation. We also evaluated acetabular and femoral bone loss as potential risk factor.

METHODS: Between January 2013 and December 2016, 65 patients were treated in a single institution for revision and re-revision hip arthroplasty using CL. The indication for using a CL was a high risk of re-redislocation after multiple recurrent hip dislocation including failed Dual Mobility Cups (DMC). Compromising soft tissue defects as well as severe bone defect were therefore regarded as high risks. Thirty-eight patients (77.6%) underwent a minimum of three surgical procedures before the index revision procedure. Sixteen patients (24.6%) were excluded as they were lost to follow-up, expired before minimum follow-up or refused study participation, leaving 49 patients in the analysis (75.4%). The mean follow-up was 62 months (44-74; SD = 7.7). We assessed the following potential risk factors for revision or dislocation: type of surgical setting (septic/aseptic), BMI, cup inclination angle, size of liner used and acetabular and femoral bone loss according to Paprosky classification. The primary endpoints were dislocation or repeat revision for any reason.

RESULTS: Of the 49 patients, we found an overall re-revision rate of 40.8% (20/49) and a dislocation rate of 30.6% (15/49). There were no significant differences among the surgical re-revision rate or dislocation rate as a factor of patient characteristics. In terms of bone loss, there was a trend towards higher revision rates for increasing acetabular and femoral bone loss, but without statistical significance.

CONCLUSIONS: We found the use of a constrained liner in a re-revision setting still bears a high risk of re-revision and re-dislocation. Therefore we restrained from using constrained liners in favour of Dual mobility cups. In this study there was no significant higher dislocation rate in the subgroup of periprosthetic infection. Furthermore the rigid design of a constrained liner bears the known risk of structural failure of acetabular reconstruction implants. Severe acetabular or femoral bone defects seem to have an impact on the revision rate, but not on the dislocation rate with regards to the restored offset and center of the hip. Results have to be taken into context such that the study population inherently has a predisposition for poorer outcomes. Indications should be strongly filtered for patients at high risk for recurrent hip joint dislocation including failed DMCs with only limited bone loss and moderate soft tissue defects. Our modification to the existing classification with a high inter and intraobserver reliability will make future studies more comparable regarding revisions and bone stock loss. Still further research using objective and reproducible parameters is needed to better analyze data especially in the background of complex revision hip arthroplasty.

PMID:35377048 | DOI:10.1007/s00402-022-04419-z

Biomech Model Mechanobiol. 2022 Apr 4. doi: 10.1007/s10237-022-01571-8. Online ahead of print.

ABSTRACT

Personalized computational cardiac models are considered to be a unique and powerful tool in modern cardiology, integrating the knowledge of physiology, pathology and fundamental laws of mechanics in one framework. They have the potential to improve risk prediction in cardiac patients and assist in the development of new treatments. However, in order to use these models for clinical decision support, it is important that both the impact of model parameter perturbations on the predicted quantities of interest as well as the uncertainty of parameter estimation are properly quantified, where the first task is a priori in nature (meaning independent of any specific clinical data), while the second task is carried out a posteriori (meaning after specific clinical data have been obtained). The present study addresses these challenges for a widely used constitutive law of passive myocardium (the Holzapfel-Ogden model), using global sensitivity analysis (SA) to address the first challenge, and inverse-uncertainty quantification (I-UQ) for the second challenge. The SA is carried out on a range of different input parameters to a left ventricle (LV) model, making use of computationally efficient Gaussian process (GP) surrogate models in place of the numerical forward simulator. The results of the SA are then used to inform a low-order reparametrization of the constitutive law for passive myocardium under consideration. The quality of this parameterization in the context of an inverse problem having observed noisy experimental data is then quantified with an I-UQ study, which again makes use of GP surrogate models. The I-UQ is carried out in a Bayesian manner using Markov Chain Monte Carlo, which allows for full uncertainty quantification of the material parameter estimates. Our study reveals insights into the relation between SA and I-UQ, elucidates the dependence of parameter sensitivity and estimation uncertainty on external factors, like LV cavity pressure, and sheds new light on cardio-mechanic model formulation, with particular focus on the Holzapfel-Ogden myocardial model.

PMID:35377030 | DOI:10.1007/s10237-022-01571-8

Arch Virol. 2022 Apr 2. doi: 10.1007/s00705-022-05422-w. Online ahead of print.

ABSTRACT

With the widespread use of coronavirus disease 2019 (COVID-19) vaccines, a rapid and reliable method to detect SARS-CoV-2 neutralizing antibodies (NAbs) is extremely important for monitoring vaccine effectiveness and immunity in the population. The purpose of this study was to evaluate the performance of the RapiRead™ reader and the TestNOW™ COVID-19 NAb rapid point-of-care (POC) test for quantitative measurement of antibodies against the spike protein receptor-binding domain of severe respiratory syndrome coronavirus 2 (SARS-CoV-2) in different biological matrices compared to chemiluminescence immunoassay (CLIA) methods. Ninety-four samples were collected and analyzed using a RapiRead™ reader and TestNOW™ COVID-19 NAb kits for detecting neutralizing antibodies, and then using two CLIAs. The data were compared statistically using the Kruskal-Wallis test for more than two groups or the Mann-Whitney test for two groups. Specificity and sensitivity were evaluated using a receiver operating characteristic (ROC) curve. Good correlation was observed between the rapid lateral flow immunoassay (LFIA) test system and both CLIA methods. RapiRead™ reader/TestNOW™ COVID-19 NAb vs. Maglumi: correlation coefficient (r) = 0.728 for all patients; r = 0.841 for vaccinated patients. RapiRead™ reader/TestNOW™ COVID-19 NAb vs. Mindray: r = 0.6394 in all patients; r = 0.8724 in vaccinated patients. The time stability of the POC serological test was also assessed considering two times of reading, 12 and 14 minutes. The data revealed no significant differences. The use of a RapiRead™ reader and TestNOW™ COVID-19 NAb assay is a quantitative, rapid, and valid method for detecting SARS-CoV-2 neutralizing antibodies and could be a useful tool for screening studies of SARS-CoV-2 infection and assessing the efficacy of vaccines in a non-laboratory context.

PMID:35377034 | DOI:10.1007/s00705-022-05422-w

Trop Anim Health Prod. 2022 Apr 4;54(3):156. doi: 10.1007/s11250-022-03150-6.

ABSTRACT

The seroprevalence of Coxiella burnetii in goats and sheep in the UAE was evaluated by ELISA testing of 437 small ruminant sera samples from livestock farms (LivF) and 478 from the Al Ain livestock market (AALM), and the data from the pilot serosurvey were analyzed using the z-test of two proportions and Fisher’s method. The overall proportion of C. burnetii-seropositive goats of 32.1% was significantly higher than 24.7% for seropositive sheep (p < 0.05). On the other hand, the difference in the proportions of C. burnetii-seropositive sheep from the LivF (27.9%) and AALM (21.7%) was not statistically significant (p > 0.05). By comparison, the proportion of C. burnetii-seropositive goats from LivFs was 31.6% compared to 32.5% for the goats from the AALM (p > 0.05). In addition, there was variability in the proportions of C. burnetii-seropositive goats and sheep from the different Emirates, but none of differences was statistically significant (p > 0.05). These data provide the first evidence of apparent C. burnetii infections in goat and sheep herds in the UAE with seropositivity rate that is significantly higher in goats than sheep. The epidemiology and animal and public health implications of this pathogen need to be thoroughly evaluated in the UAE.

PMID:35377029 | DOI:10.1007/s11250-022-03150-6

Eur Spine J. 2022 Apr 4. doi: 10.1007/s00586-022-07165-3. Online ahead of print.

ABSTRACT

PURPOSE: In-brace radiograph of adolescents with idiopathic scoliosis (AIS) has been shown to reflect brace efficacy and the possibility of achieving curve correction. Conversely, the first out-of-brace radiograph could demonstrate the patient’s ability to maintain the correction. We aimed to determine which of the two radiographs is the best predictor of the Cobb angle at the end of treatment (final radiograph).

DESIGN: Retrospective cohort study of a prospective dataset.

METHODS: The population was selected based on the following inclusion criteria: AIS, age 10-18 years; Risser score 0-2; Cobb angle 25-40°; brace treatment; availability of all radiographs.

STATISTICS: Pearson correlations provide a first exploration of data. The univariate and multivariate logistic regression model tested the predictors. Finally ROC curve provided a check of model accuracy.

RESULTS: A total of 131 patients were included (mean age 13.0 ± 1.3, Cobb angle 33.2 ± 5.5°; 78% females). At the end of treatment, 56% had stabilised, 9% had progressed, and 44% had improved. The difference between the in-brace and final radiographs was 8.0 ± 6.0°, while the difference between the first out-of-brace and final radiographs was 1.8 ± 5.2°. The best predictor of final outcome was the first out-of-brace radiograph (0.80), compared to in-brace (0.68) and baseline (0.59) radiographs. The best cut-offs to predict avoidance of progression were 30% and 10% of the correction rates for the in-brace and first out-of-brace radiographs, respectively.

CONCLUSION: The first out-of-brace radiograph predicts end results better than the in-brace radiograph. It offers an excellent clinical reference for clinicians and patients. The first out-of-brace radiograph should be considered an essential element of future predictive models. LEVEL OF EVIDENCE 1: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

PMID:35376983 | DOI:10.1007/s00586-022-07165-3

Minerva Pediatr (Torino). 2022 Apr 4. doi: 10.23736/S2724-5276.22.06683-6. Online ahead of print.

ABSTRACT

BACKGROUND: One of the possible adverse outcomes of magnesium sulfate (MgSO4) administration for preterm fetal neuroprotection is hypermagnesemia in the newborn. The objectives of this study were to evaluate the association between antenatal MgSO4 administration for neuroprotection and neonatal serum magnesium levels in the first days of life.

METHODS: A single-center retrospective case-control study was conducted on preterm neonates born in our institution between January 2017 and December 2019. Prenatal, perinatal, and postnatal parameters were recorded, and demographic information was collected. Comparative analysis between the group of neonates exposed to antenatal MgSO4 and the control group was performed.

RESULTS: A total of 98 patients were enrolled in the study, 49 of them were exposed to antenatal MgSO4 for neuroprotection. The serum magnesium levels in the 5 first days of life were higher in the case group, and higher than the normal range of serum magnesium levels (>2.4 mg/dL), with a statistical significance. The number of days needed to normalize serum magnesium levels was higher in the case group compared to the control group (median of 7 days [1-8] versus 2 days [1-5]).

CONCLUSIONS: Our findings show that antenatal administration of MgSO4 is associated with high serum magnesium levels in neonates. This group of patients needs close electrolyte monitoring during the first days of life. Parenteral nutrition supplemented with magnesium should only be considered after evaluation of serum magnesium levels.

PMID:35373935 | DOI:10.23736/S2724-5276.22.06683-6

J Biomed Mater Res B Appl Biomater. 2022 Apr 4. doi: 10.1002/jbm.b.35066. Online ahead of print.

ABSTRACT

The study aims to compare the way modern resin-based composites (RBCs) respond to mechanical stress related to the tooth structure they are designed to replace. Eight representative light-cured RBCs, including ormocers, giomers, RBCs with nano and agglomerated nanoparticles, prepolymerized, or compact fillers, were selected. Flexural strength, FS and modulus/E, were measured in a three-point bending test. A fractographic analysis determined the origin of fracture. The quasi-static (indentation hardness/H_IT , indentation modulus/E_IT ) and viscoelastic (storage modulus/E’, loss modulus/E″, loss factor/tan δ) behavior was assessed by a depth-sensing indentation test equipped with a dynamic-mechanical analysis module. One and multiple-way analysis of variance (ANOVA), Tukey honestly significant difference (HSD) post-hoc tests (α = 0.05), and Weibull statistics were applied. Parameter material exhibited the highest effect on E (p < .001, η_P² = .857), followed by FS (η_P² = .729), and the strain (η_P² = .553). Highest material reliability was identified in the RBCs with nano and agglomerated nanoparticles. The most frequent type of failure originated from volume (81.3%), followed by edge (10.6%), and corner (8.1%) flaws. Enamel evidenced three times higher H_IT , E_IT , and E’ values as RBCs and dentin, and the smallest deviation from ideal elasticity. Ormocers exhibited the highest damping capacity, followed by the RBCs with prepolymerized fillers. Damping capacity and static mechanical properties are mutually exclusive. Analyzed RBCs and the tooth structure are better adapted to the relevant frequency for chewing than for higher frequencies. RBCs are comparable to dentin in terms of their mechanical performance, but apart from the damping behavior, they are far inferior to enamel. Damping ability of analyzed material could be exploited for correlation with the clinical behavior.

PMID:35373907 | DOI:10.1002/jbm.b.35066