Tag: nevin manimala

Anesth Prog. 2021 Oct 1;68(3):141-145. doi: 10.2344/anpr-68-02-01.

ABSTRACT

OBJECTIVE: Antipsychotic drugs exhibit α-1 adrenergic receptor-blocking activity. When epinephrine and antipsychotic drugs are administered in combination, β-2 adrenergic effects are thought to predominate and induce hypotension. This study aimed to assess hemodynamic parameters in patients regularly taking antipsychotics who were administered epinephrine-containing lidocaine under general anesthesia in a dental setting.

METHODS: Thirty patients taking typical and/or atypical antipsychotics and scheduled for dental procedures under general anesthesia were enrolled. Five minutes after tracheal intubation, baseline systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and percutaneous oxygen saturation (SpO2) measurements were taken. The SBP, DBP, HR, and SpO2 measurements were repeated 2, 4, 6, 8, and 10 minutes after the injection of 1.8 mL of 2% lidocaine (36 mg) with 1:80,000 epinephrine (22.5 mcg) via buccal infiltration.

RESULTS: Differences between the baseline measurements and those of each time point were analyzed using Dunnett test, and no statistically significant changes were observed.

CONCLUSIONS: Our findings demonstrate that the use of epinephrine at a clinically relevant dose of 22.5 mcg for dental treatment under general anesthesia is unlikely to affect the hemodynamic parameters of patients taking antipsychotic medications.

PMID:34606571 | DOI:10.2344/anpr-68-02-01

J Gerontol A Biol Sci Med Sci. 2021 Oct 4:glab285. doi: 10.1093/gerona/glab285. Online ahead of print.

ABSTRACT

BACKGROUND: Dysregulation of some metabolic factors increases the risk of dementia. It remains unclear if overall metabolic dysregulation, or only certain components, contribute to cognitive aging and if these associations are sex-specific.

METHODS: Data from the 2006-2016 waves of the Health and Retirement Study (HRS) was used to analyze 7,103 participants aged 65+ at baseline (58% women). We created a metabolic-dysregulation risk score (MDRS) composed of blood pressure/hypertension status, HbA1c/diabetes status, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and waist circumference, and assessed cognitive trajectories from repeated measures of the HRS-Telephone Interview for Cognitive Status (HRS-TICS) over 10 years of follow-up. Linear mixed-effects models estimated associations between MDRS or individual metabolic factors (biomarkers) with mean and change in HRS-TICS scores and assessed sex-modification of these associations.

RESULTS: Participants with higher MDRSs had lower mean HRS-TICS scores, but there were no statistically significant differences in rate of decline. Sex-stratification showed this association was present for women only. MDRS biomarkers revealed heterogeneity in the strength and direction of associations with HRS-TICS. Lower HRS-TICS levels were associated with hypertension, higher HbA1c/diabetes, and lower HDL-C and TC; while faster rate of cognitive decline was associated with hypertension, higher HbA1c/diabetes and higher TC. Participants with higher HbA1c/diabetes presented worse cognitive trajectories. Sex-differences indicated women with higher HbA1c/diabetes to have lower HRS-TICS levels while hypertensive males presented better cognitive trajectory.

CONCLUSIONS: Our results demonstrate that metabolic dysregulation is more strongly associated with cognition in women compared to men, though sex-differences vary by individual biomarker.

PMID:34606593 | DOI:10.1093/gerona/glab285

PLoS One. 2021 Oct 4;16(10):e0258179. doi: 10.1371/journal.pone.0258179. eCollection 2021.

ABSTRACT

OBJECTIVES: The aim of this paper was to provide evidence for the impact of prenatal sex steroid exposure on prenatal and postnatal body size parameters, and muscle strength in children.

METHODS: The following anthropometric data were studied in a group of 1148 children (536 boys and 612 girls) aged 6-13 years: the 2D:4D digit ratio, birth weight and length, and birth head and chest circumference. Postnatal parameters (6-13 years) included body weight and height, BMI, waist and hip circumference, WHR, as well as grip strength in both hands. All parameters that required it were adjusted for sex and gestational or chronological age. A general linear model, Pearson’s correlation, t-statistics and Cohen’s Δ were used in statistical analysis.

RESULTS: Among birth size parameters, only birth weight was significantly negatively correlated with the 2D:4D digit ratio in children. Higher (feminized) digit ratios were significantly correlated with postnatal parameters such as body weight, BMI, and waist and hip circumference (positively), as well as hand grip strength-a proxy for muscular strength (negatively).

CONCLUSION: Problems with maintaining adequate body size parameters and muscle strength may be programmed in fetal life and predicted on the basis of the 2D:4D digit ratio. Body weight at birth and in early ontogenesis are additive correlates of the 2D:4D ratio. The present findings suggest that the 2D:4D digit ratio is related to postnatal phenotypes such as birth weight, overweight, and obesity as well as muscle strength in 6-13-year-old children of both sexes.

PMID:34606496 | DOI:10.1371/journal.pone.0258179

PLoS Med. 2021 Oct 4;18(10):e1003808. doi: 10.1371/journal.pmed.1003808. eCollection 2021 Oct.

ABSTRACT

BACKGROUND: School-based violence prevention interventions offer enormous potential to reduce children’s experience of violence perpetrated by teachers, but few have been rigorously evaluated globally and, to the best of our knowledge, none in humanitarian settings. We tested whether the EmpaTeach intervention could reduce physical violence from teachers to students in Nyarugusu Refugee Camp, Tanzania.

METHODS AND FINDINGS: We conducted a 2-arm cluster-randomised controlled trial with parallel assignment. A complete sample of all 27 primary and secondary schools in Nyarugusu Refugee Camp were approached and agreed to participate in the study. Eligible students and teachers participated in cross-sectional baseline, midline, and endline surveys in November/December 2018, May/June 2019, and January/February 2020, respectively. Fourteen schools were randomly assigned to receive a violence prevention intervention targeted at teachers implemented in January-March 2019; 13 formed a wait-list control group. The EmpaTeach intervention used empathy-building exercises and group work to equip teachers with self-regulation, alternative discipline techniques, and classroom management strategies. Allocation was not concealed due to the nature of the intervention. The primary outcome was students’ self-reported experience of physical violence from teachers, assessed at midline using a modified version of the ISPCAN Child Abuse Screening Tool-Child Institutional. Secondary outcomes included student reports of emotional violence, depressive symptoms, and school attendance. Analyses were by intention to treat, using generalised estimating equations adjusted for stratification factors. No schools left the study. In total, 1,493 of the 1,866 (80%) randomly sampled students approached for participation took part in the baseline survey; at baseline 54.1% of students reported past-week physical violence from school staff. In total, 1,619 of 1,978 students (81.9%) took part in the midline survey, and 1,617 of 2,032 students (79.6%) participated at endline. Prevalence of past-week violence at midline was not statistically different in intervention (408 of 839 students, 48.6%) and control schools (412 of 777 students, 53.0%; risk ratio = 0.91, 95% CI 0.80 to 1.02, p = 0.106). No effect was detected on secondary outcomes. A camp-wide educational policy change during intervention implementation resulted in 14.7% of teachers in the intervention arm receiving a compressed version of the intervention, but exploratory analyses showed no difference in our primary outcome by school-level adherence to the intervention. Main study limitations included the small number of schools in the camp, which limited statistical power to detect small differences between intervention and control groups. We also did not assess the test-retest reliability of our outcome measures, and interviewers were unmasked to intervention allocation.

CONCLUSIONS: There was no evidence that the EmpaTeach intervention effectively reduced physical violence from teachers towards primary or secondary school students in Nyarugusu Refugee Camp. Further research is needed to develop and test interventions to prevent teacher violence in humanitarian settings.

TRIAL REGISTRATION: clinicaltrials.gov (NCT03745573).

PMID:34606500 | DOI:10.1371/journal.pmed.1003808

IEEE Trans Vis Comput Graph. 2021 Oct 4;PP. doi: 10.1109/TVCG.2021.3114786. Online ahead of print.

ABSTRACT

Inspection of tissues using a light microscope is the primary method of diagnosing many diseases, notably cancer. Highly multiplexed tissue imaging builds on this foundation, enabling the collection of up to 60 channels of molecular information plus cell and tissue morphology using antibody staining. This provides unique insight into disease biology and promises to help with the design of patient-specific therapies. However, a substantial gap remains with respect to visualizing the resulting multivariate image data and effectively supporting pathology workflows in digital environments on screen. We, therefore, developed Scope2Screen, a scalable software system for focus+context exploration and annotation of whole-slide, high-plex, tissue images. Our approach scales to analyzing 100GB images of 109 or more pixels per channel, containing millions of individual cells. A multidisciplinary team of visualization experts, microscopists, and pathologists identified key image exploration and annotation tasks involving finding, magnifying, quantifying, and organizing regions of interest (ROIs) in an intuitive and cohesive manner. Building on a scope-to-screen metaphor, we present interactive lensing techniques that operate at single-cell and tissue levels. Lenses are equipped with task-specific functionality and descriptive statistics, making it possible to analyze image features, cell types, and spatial arrangements (neighborhoods) across image channels and scales. A fast sliding-window search guides users to regions similar to those under the lens; these regions can be analyzed and considered either separately or as part of a larger image collection. A novel snapshot method enables linked lens configurations and image statistics to be saved, restored, and shared with these regions. We validate our designs with domain experts and apply Scope2Screen in two case studies involving lung and colorectal cancers to discover cancer-relevant image features.

PMID:34606456 | DOI:10.1109/TVCG.2021.3114786

PLoS Comput Biol. 2021 Oct 4;17(10):e1009452. doi: 10.1371/journal.pcbi.1009452. Online ahead of print.

ABSTRACT

Choice history effects describe how future choices depend on the history of past choices. In experimental tasks this is typically framed as a bias because it often diminishes the experienced reward rates. However, in natural habitats, choices made in the past constrain choices that can be made in the future. For foraging animals, the probability of earning a reward in a given patch depends on the degree to which the animals have exploited the patch in the past. One problem with many experimental tasks that show choice history effects is that such tasks artificially decouple choice history from its consequences on reward availability over time. To circumvent this, we use a variable interval (VI) reward schedule that reinstates a more natural contingency between past choices and future reward availability. By examining the behavior of optimal agents in the VI task we discover that choice history effects observed in animals serve to maximize reward harvesting efficiency. We further distil the function of choice history effects by manipulating first- and second-order statistics of the environment. We find that choice history effects primarily reflect the growth rate of the reward probability of the unchosen option, whereas reward history effects primarily reflect environmental volatility. Based on observed choice history effects in animals, we develop a reinforcement learning model that explicitly incorporates choice history over multiple time scales into the decision process, and we assess its predictive adequacy in accounting for the associated behavior. We show that this new variant, known as the double trace model, has a higher performance in predicting choice data, and shows near optimal reward harvesting efficiency in simulated environments. These results suggests that choice history effects may be adaptive for natural contingencies between consumption and reward availability. This concept lends credence to a normative account of choice history effects that extends beyond its description as a bias.

PMID:34606493 | DOI:10.1371/journal.pcbi.1009452

J Clin Sleep Med. 2021 Oct 1;17(10):2009-2018. doi: 10.5664/jcsm.9382.

ABSTRACT

STUDY OBJECTIVES: Short sleep duration (SD) is associated with cardiovascular disease. We investigated the relationship between objective SD and subclinical atherosclerosis employing hybrid positron emission tomography/magnetic resonance imaging with ¹⁸F-FDG tracer in the MESA cohort.

METHODS: We utilized data from Multi-Ethnic Study of Atherosclerosis-SLEEP and Multi-Ethnic Study of Atherosclerosis-PET ancillary studies. SD and sleep fragmentation index (SFI) were assessed using 7-day actigraphy. The primary and secondary outcomes were carotid inflammation, defined using target-to-background ratios, and measures of carotid wall remodeling (carotid wall thickness), summarized by SD category. Multivariable linear regression was performed to assess the association between SD and SFI with the primary/secondary outcomes, adjusting for several covariates including apnea-hypopnea index, and cardiovascular disease risk.

RESULTS: Our analytical sample (n = 58) was 62% female (mean age 68 ± 8.4 years). Average SD was 5.1 ± 0.9 hours in the short SD group (≤ 6 h/night, 31%), and 7.1 ± 0.8 hours in the normal SD group (69%). Prevalence of pathologic vascular inflammation (maximal target-to-background ratio > 1.6) was higher in the short SD group (89% vs 53%, P = .01). Those with short SD had a higher maximal target-to-background ratio (1.77 vs 1.71), although this was not statistically significant (P = .39). Carotid wall thickness was positively associated with SFI even after adjusting for covariates (Beta [standard error] = 0.073 ± [0.032], P = .03).

CONCLUSIONS: Prevalence of pathologic vascular inflammation was higher among those who slept ≤ 6 hours, and vascular inflammation was higher among those with a SD of ≤ 6 hours. Interestingly, SFI was positively associated with carotid wall thickness even after adjustment for covariates. Our results are hypothesis generating but suggest that both habitual SD and SFI should be investigated in future studies as potential risk factors for subclinical atherosclerosis.

CITATION: Kundel V, Reid M, Fayad Z, et al. Sleep duration and vascular inflammation using hybrid positron emission tomography/magnetic resonance imaging: results from the Multi-Ethnic Study of Atherosclerosis. J Clin Sleep Med. 2021;17(10):2009-2018.

PMID:34606438 | DOI:10.5664/jcsm.9382

IEEE Trans Biomed Eng. 2021 Oct 4;PP. doi: 10.1109/TBME.2021.3117516. Online ahead of print.

ABSTRACT

OBJECTIVE: Ankle joint stiffness is known to be modulated by co-contraction of the ankle muscles; however, it is unclear to what extent changes in agonist muscle activation alone affect ankle joint stiffness. This study tested the effects of varying levels of ankle muscle activation on ankle joint mechanical stiffness in standing and during the late stance phase of walking.

METHODS: Dorsiflexion perturbations were applied at various levels of ankle muscle activation via a robotic platform in standing and walking conditions. In standing, muscle activation was modulated by having participants perform an EMG target matching task that required varying levels of plantarflexor activation. In walking, muscle activation was modulated by changing walking speeds through metronome-based auditory feedback. Ankle stiffness was evaluated by performing a Least-squares system identification using a parametric model consisting of stiffness, damping, and inertia. The association between ankle muscle activation and joint stiffness was evaluated using correlation analyses. Linear regression models were used to determine the extent to which muscle activation contributed to ankle stiffness. An inclusive statistical approach (both classical and Bayesian analyses) was adopted to measure the statistical significance (p-value) and Bayes Factor (BF10).

RESULTS: Results indicate that plantarflexor activity was positively correlated with ankle stiffness in both standing and walking (p<0.001, BF10>1000), whereas dorsiflexor activity was negatively correlated with ankle stiffness in walking (p=0.014, BF10=5.1) but not in standing (p=0.725). Regression analyses indicated that ankle muscle activation predicted about 84% of the variation in ankle stiffness in standing and 45% in walking (p<0.001, BF10>100).

CONCLUSION: Ankle muscle activation significantly contributes to ankle stiffness during standing and walking.

SIGNIFICANCE: The results highlight the role of muscle activation on maintaining joint stiffness and underscore the importance of accounting for muscle activation when measuring ankle stiffness in healthy as well as patient populations.

PMID:34606446 | DOI:10.1109/TBME.2021.3117516

J Biopharm Stat. 2021 Oct 4:1-14. doi: 10.1080/10543406.2021.1979575. Online ahead of print.

ABSTRACT

This paper investigates the use of a general multi-arm multi-stage (MAMS) approach for time-to-event outcomes that would streamline simultaneous comparison of a large number of promising therapies in clinical trials, thus significantly reducing the time and the number of patients needed to evaluate the treatment. Controlling type I error in this setting is different than regular clinical trials as this approach incorporates both multiple comparison between arms and multiple stages. Historically, pairwise (PWER) and familywise (FWER) type I error rates have been primarily used to regulate the type I error in such designs. This paper will focus on constructing the efficacy and futility boundaries for a MAMS clinical trial in two different scenarios. In the first, it is assumed that the same outcome is used throughout the clinical trial for both intermediate and final assessments. In this scenario, we propose using the generalized Dunnett procedure that controls FWER. In the latter scenario, where intermediate and final outcomes are different in nature, we propose modifications to the existing method that originally concentrated on controlling PWER and extend the method to include FWER in the design. We also explore the performance of the proposed MAMS design in a setting where the proportional hazard assumption is violated in the presence of a delayed treatment effect and demonstrate the loss of power because of that. An alternative test statistic that can help circumvent this problem to maintain the desired power is also suggested.

PMID:34606418 | DOI:10.1080/10543406.2021.1979575

Prague Med Rep. 2021;122(3):201-211. doi: 10.14712/23362936.2021.17.

ABSTRACT

The aim of this study was to evaluate the stomatognathic system of individuals with controlled systemic hypertension through comparison with a disease-free control group. Seventy individuals (44 female and 26 male) were divided into two groups: a controlled systemic hypertension (n=35) and a disease-free control (n=35). The individuals were evaluated on the basis of masticatory cycle efficiency of the value of the ensemble-averaged integrated linear envelope to the electromyographic signal of the masseter and temporalis muscles in the habitual (peanuts and raisins) and non-habitual chewing (Parafilm M); molar bite force (right and left) and ultrasound images from the bilateral masseter and temporal muscles at rest and maximum voluntary contraction. The data obtained were tabulated and submitted to statistical analysis (p&lt;0.05). There was a significant difference between groups in the habitual (peanuts and raisins) and non-habitual (Parafilm M) chewing with reduced muscle activity to controlled systemic hypertension group. Muscle thickness occurred significant difference between groups at rest and maximum voluntary contraction of the temporalis muscles. There was no significant difference between groups in maximum molar bite force. The present study findings indicate that the controlled systemic hypertension promotes functional changes of the masticatory system, especially with respect to its masticatory efficiency and muscle thickness.

PMID:34606432 | DOI:10.14712/23362936.2021.17