Tag: nevin manimala

Clin Transl Sci. 2021 Jul 3. doi: 10.1111/cts.13088. Online ahead of print.

ABSTRACT

Sepsis-induced metabolic dysfunction contributes to organ failure and death. L-carnitine has shown promise for septic shock, but a recent phase II study of patients with vasopressor-dependent septic shock demonstrated a non-significant reduction in mortality. We undertook a pharmacometabolomics study of these patients (n = 250) to identify metabolic profiles predictive of a 90-day mortality benefit from L-carnitine. The independent predictive value of each pretreatment metabolite concentration, adjusted for L-carnitine dose, on 90-day mortality was determined by logistic regression. A grid-search analysis maximizing the Z-statistic from a binomial proportion test identified specific metabolite threshold levels that discriminated L-carnitine responsive patients. Threshold concentrations were further assessed by hazard ratio and Kaplan-Meier estimate. Accounting for L-carnitine treatment and dose, 11 ¹ H-NMR metabolites and 12 acylcarnitines were independent predictors of 90-day mortality. Based on the grid-search analysis numerous acylcarnitines and valine were identified as candidate metabolites of drug response. Acetylcarnitine emerged as highly viable for the prediction of an L-carnitine mortality benefit due to its abundance and biological relevance. Using its most statistically significant threshold concentration, patients with pretreatment acetylcarnitine greater than or equal to 35 µM were less likely to die at 90 days if treated with L-carnitine (18 g) versus placebo (p = 0.01 by log rank test). Metabolomics also identified independent predictors of 90-day sepsis mortality. Our proof-of-concept approach shows how pharmacometabolomics could be useful for tackling the heterogeneity of sepsis and informing clinical trial design. In addition, metabolomics can help understand mechanisms of sepsis heterogeneity and variable drug response, because sepsis induces alterations in numerous metabolite concentrations.

PMID:34216108 | DOI:10.1111/cts.13088

J Aquat Anim Health. 2021 Jul 2. doi: 10.1002/aah.10130. Online ahead of print.

ABSTRACT

In this case study, phage therapy was applied to treat a multidrug-resistant case of septicemic cutaneous ulcerative disease (SCUD) caused by Citrobacter freundii in a loggerhead sea turtle Caretta caretta. Phages were applied topically, intravenously, into the carapace, and into the exhibit water using various phage cocktails specific to the causative agent over an 8-month period. This was performed in conjunction with antimicrobial therapy. The animal was monitored through weekly cultures, photographs, and complete blood cell counts, as well as immune assays (phagocytosis, plasma lysozyme and superoxide dismutase activity, and plasma electrophoresis profiles). The animal, in comparison to an untreated, unaffected control, had elevated antibody titers to the administered phages, which persisted for at least 35 weeks. Although cultures were clear of C. freundii after phage treatment, the infection did return over time and immune assays confirmed deficiencies when compared to a healthy loggerhead sea turtle. Immune parameters with statistically significant changes over the study period included the following: decreased phagocytosis, increased alpha- and gamma-globulin protein components, and an increased albumin : globulin ratio. When C. freundii appeared again, the multidrug-resistant status had reverted back to normal susceptibility patterns. Although not completely known whether it was another subspecies of bacteria, the therapy did resolve the multidrug-resistant challenge. Phage therapy in combination with antimicrobial agents may be an effective treatment for sea turtles with normally functioning immune systems or less-severe infections. Additional research is needed to better understand and quantify sea turtle immunology.

PMID:34216060 | DOI:10.1002/aah.10130

Health Econ. 2021 Jul 2. doi: 10.1002/hec.4372. Online ahead of print.

ABSTRACT

Prior to the Affordable Care Act (ACA), insurance companies could charge higher premiums, or outright deny coverage, to people with preexisting health problems. But the ACA’s “guaranteed issue” provision forbids such price discrimination and denials of coverage. This paper seeks to determine whether, after implementation of the ACA, nongroup private insurance plans have experienced adverse selection. Our empirical approach employs a copula-based hurdle regression model, with dependence modeled as a function of dimensions along which adverse selection might occur. Our main finding is that, after implementation of the ACA, nongroup insurance enrollees with preexisting health problems do not appear to exhibit adverse selection. This finding suggests that the ACA’s mandate that everyone acquire coverage might have attracted enough healthy enrollees to offset any adverse selection.

PMID:34216065 | DOI:10.1002/hec.4372

Perspect Psychiatr Care. 2021 Jul 2. doi: 10.1111/ppc.12898. Online ahead of print.

ABSTRACT

PURPOSE: This study was carried out to determine the effect of mindfulness levels on the life satisfaction of nursing students.

DESIGN AND METHODS: A descriptive correlational study was conducted on 333 nursing students enrolled at a state university in Turkey.

FINDINGS: The statistical analysis of the data indicated that students’ mindfulness levels had a significantly positive impact on their satisfaction with life.

IMPLICATIONS FOR PRACTICE: Activities that include exercises, meditation and training geared to raise the level of mindfulness can also be beneficial in terms of increasing satisfaction with life.

PMID:34216042 | DOI:10.1111/ppc.12898

Int J Geriatr Psychiatry. 2021 Jul 3. doi: 10.1002/gps.5596. Online ahead of print.

ABSTRACT

OBJECTIVES: The Covid-19 pandemic has had a significant impact on older adults mental health care. Our study aimed to explore staff perspectives on key challenges and innovations in order to help inform the delivery of older adults mental health care in subsequent waves of the pandemic.

METHODS: A mixed methods online questionnaire developed by NIHR Mental Health Policy Research Unit (PRU) was used to gather staff perspectives on their challenges at work, problems faced by service users and their carers, and sources of help and support. Descriptive statistics were used for quantitative analysis and descriptive content analysis for qualitative analysis.

RESULTS: 158 participants, working in either community or inpatient settings, and from a range of professional disciplines, were included. For inpatient staff, a significant challenge was infection control. In the community, staff identified a lack of access to physical and social care as well as reduced contact with friends and families as being challenges for patients. Remote working was seen as a positive innovation along with Covid-19 related guidance from various sources and peer support.

CONCLUSION: Our study, with a focus on staff and patient well-being, helps to inform service development for future waves of the pandemic. We discuss measures to improve infection control in inpatient settings, the role of voluntary organisations in supporting socially isolated community patients, the need for better integration of physical and mental health services at an organisational level, and the importance of training staff to support patients and their families with end of life planning. This article is protected by copyright. All rights reserved.

PMID:34216045 | DOI:10.1002/gps.5596

J Community Genet. 2021 Jul 2. doi: 10.1007/s12687-021-00534-3. Online ahead of print.

ABSTRACT

The aim of the study was to provide accurate information regarding live-born infant survival after diagnosis of fatal fetal anomaly (FFA) to aid decision-making in respect of pregnancy management, and to ascertain the natural history of live-born infants with FFAs via a retrospective analysis of death records (2006-2018), from the National Paediatric Mortality Registry (source Central Statistics Office 2019). Diagnoses and survival times were ascertained from narrative records with further ascertainment and reconciliation of trisomies 13 and 18 cases by review of cytogenetic test records, the National Death Events Register and National Perinatal Epidemiology Centre data. During the study period, termination of pregnancy was not permitted under the Irish Constitution. Patients are live-born babies with fatal fetal anomalies whose deaths were registered in the Republic of Ireland. The main outcome measure was construction of anomaly-specific survival curves, or survival time range and median for those anomalies with rare occurrence. Survival curves for anencephaly, bilateral renal agenesis, thanatophoric dysplasia, trisomy 13, and trisomy 18 show that 90% (n = 95), 93% (n = 60), 100% (n = 14), 37% (n = 92) and 33% (n = 162), respectively, were deceased by 24 h and 98%, 100%, 100%, 73%, and 53%, respectively, by 1 week post-delivery. Survival time range and median were calculated for triploidy (3.5 h-20 days; 10.5 days), whose occurrence was rare. Anhydramnios, craniorachischisis, hydranencephaly and severe hydrocephalus were extremely rare and all deaths were neonatal deaths. Our results provide 13 years of national natural history data of live birth FFA survival. This provides objective information to aid obstetric counselling of couples upon diagnosis of an FFA.

PMID:34215991 | DOI:10.1007/s12687-021-00534-3

J Dent Educ. 2021 Jul 2. doi: 10.1002/jdd.12736. Online ahead of print.

ABSTRACT

PURPOSE/OBJECTIVES: To assess student perceptions on learning dental anatomy using natural extracted teeth, 3D printed models, 3D virtual models, and augmented reality (AR) technology. METHODS: Eighty first-year dental students enrolled in the dental anatomy course were instructed to examine four stations. The stations included four versions of a mandibular first molar: an extracted natural tooth, a 3D printed model, a 3D virtual model, and a model displayed on a novel AR device. After examining all stations, the students were asked to complete an electronic survey. Bivariate analysis was performed to determine whether students’ perceptions are related to their demographic characteristics and technological experience with computer use, 3D modeling, and video games. RESULTS: Seventy students completed the survey (87.5% response rate). Students rated natural teeth to have the highest educational value, the 3D printed tooth to be the most accessible, and the AR application to be the most interesting modality. Students who played little to no video games were more likely to rate AR as high educational value (48.8% vs. 10.3%; p < 0.001), while students with little 3D modeling experience were more likely to rate high accessibility of the 3D Model (78.1% vs. 48.3%; p < 0.001). No statistically significant associations between the perceptions and students’ demographic characteristics or use of computer were noted.

CONCLUSION: The natural extracted tooth was rated highest in educational value, while the 3D printed model was rated easiest to use, and the AR model was the most interesting to the students.

PMID:34216032 | DOI:10.1002/jdd.12736

Stat Med. 2021 Jul 2. doi: 10.1002/sim.9127. Online ahead of print.

ABSTRACT

We propose a ridge-penalized adaptive Mantel test (AdaMant) for evaluating the association of two high-dimensional sets of features. By introducing a ridge penalty, AdaMant tests the association across many metrics simultaneously. We demonstrate how ridge penalization bridges Euclidean and Mahalanobis distances and their corresponding linear models from the perspective of association measurement and testing. This result is not only theoretically interesting but also has important implications in penalized hypothesis testing, especially in high-dimensional settings such as imaging genetics. Applying the proposed method to an imaging genetic study of visual working memory in healthy adults, we identified interesting associations of brain connectivity (measured by electroencephalogram coherence) with selected genetic features.

PMID:34216035 | DOI:10.1002/sim.9127

Obes Surg. 2021 Jul 2. doi: 10.1007/s11695-021-05533-4. Online ahead of print.

ABSTRACT

BACKGROUND: Grazing behavior is common in patients undergoing bariatric surgery (BS); however, little is known about grazing behavior in operated patients in the long term. We aimed to estimate grazing frequency and its association with weight loss and surgery response in patients who had undergone BS.

METHODS: This cross-sectional study included 109 patients who had undergone Roux-en-Y gastric bypass at least 5 years previously. They answered questions about socioeconomic factors, surgical information, and adherence to treatment/follow-up. The Rep(eat) questionnaire was used for grazing assessment. Student’s t-test and Pearson’s chi-square test were used to evaluate differences between groups. Analysis of covariance and partial correlation were used to investigate grazing behavior, and weight loss outcomes were controlled for the elapsed time since BS, healthcare service type, current psychologist care status, and the presence of a constriction ring.

RESULTS: The mean elapsed time since BS was 9.97 ± 2.39 years. Patients with grazing behavior (67%) comprised fewer surgery responders (p = 0.019), had lower total (%TWL, p = 0.005) and excess weight loss (%EWL, p = 0.029), and received less psychological counseling (45.5% vs. 54.5%, p = 0.042). Correlations were found between the presence of grazing and its subtypes and %EWL and %TWL (T = – 0.382, T = – 0.361, p < 0.001; compulsive grazing: T = – 0.358, T = – 0.342, p < 0.001, p = 0.001; non-compulsive grazing: T = – 0.333, T = – 0.311, p = 0.001, p = 0.003). No significant difference between patients with and without grazing behavior was found for previous/current diagnoses of psychological diseases or dietitian counseling.

CONCLUSION: Grazing behavior is common in the long-term among patients who have undergone BS and is negatively related to weight loss parameters.

PMID:34215973 | DOI:10.1007/s11695-021-05533-4

Environ Sci Pollut Res Int. 2021 Jul 2. doi: 10.1007/s11356-021-15135-3. Online ahead of print.

ABSTRACT

The ecosystem and water quality of Terme River, an essential drinking and irrigation water source in the region, are at risk due to anthropogenic pressures. Therefore, the present study aim to present a comprehensive overview of the water quality state and pollution sources of the river. Some physicochemical water quality parameters were analyzed by standard methods along the surface water of river spatiotemporally. The concentrations of major elements and heavy metals (Na, Mg, K, Ca, Al, Cr, Fe, Co, Mn, Ni, Zn, Cd, Cu, Pb, As) were measured in water samples. Relationships between physicochemical data were assessed by using multivariate statistical analysis (MSA) methods. The order of the mean values of cations were as follow: Ca²⁺ > Mg²⁺ > Na⁺ > K⁺ > NH₄⁺ (32.66, 26.82, 13.29, 6.45, 0.305; mg/L), and order of anions: SO₄^2- > NO₃^– >F^– > NO₂^– (7.88, 3.988, 1.01, 0.0316; mg/L). Increases in ion concentrations in the downstream zone have been monitored in the summer and autumn months. Average water quality index (WQI) 22, heavy metal pollution index (HPI) 15.61, heavy metal evaluation index (HEI) 0.78, and nutrient pollution index (NPI) 0.404 values indicated that the general water quality of Terme River was fine. All hazard quotient (HQ) and hazard index (HI) values in this study were calculated below the risk threshold (<1). HI-total values (2.48E-01) in children were higher than in adults (2.14E-01). This suggests that children’s health is at higher risk than adults. Principal component analysis (PCA) data formed four principal components (PCs) explaining 85.22% of the total variance. These PCs revealed that the significant changes in water quality occurred from point and diffuse sources, including rock types of the basin, soil erosion, domestic wastewater discharges, and agricultural flow of inorganic fertilizers.

PMID:34215978 | DOI:10.1007/s11356-021-15135-3