Tag: nevin manimala

BMJ Open. 2024 Aug 21;14(8):e081776. doi: 10.1136/bmjopen-2023-081776.

ABSTRACT

OBJECTIVE: This study aims to further explore the relevant influencing factors of depression and explore the correlation between multimorbidity coexistence and depression to find the goals and methods of early intervention of depression in the elderly.

DESIGN: This study adopts a cross-sectional approach.

SETTING: The study population of this project came from the China Health and Retirement Longitudinal Study. Depression was grouped according to the 10-item version of Centre for Epidemiological Research Depression Scale. Chronic diseases, height, weight, grip strength, education, marital status, alcohol consumption, exercise and other indicators were included in the analysis.

PARTICIPANTS: 2239 adults over 60 years of age were included.

RESULTS: The proportion of women in the depression group was higher (p<0.001). The depression group had a lower grip strength than the control group (p<0.05). The sleep duration was shorter in the depression group (p<0.001). There were differences in education, marital status and alcohol consumption in the depression group (p<0.05). The depression group might have more types of coexisting chronic diseases (p<0.001). The depression group was more likely to have hypertension, dyslipidaemia, chronic lung diseases, heart attack, stroke, stomach disease and memory-related disease. Grip strength was connected with the risk of depression in the elderly (0.971 (95% CI 0.959 to 0.984)). Sleep (0.827 (95% CI 0.785 to 0.872) and education level (0.790 (95% CI 0.662 to 0.942) were related to the risk of depression in the elderly. Concomitant chronic diseases could affect the risk of depression in the elderly (1.455 (95% CI 1.243 to 1.703)).

CONCLUSION: The coexistence of multiple chronic diseases and depression is very common in the elderly. The coexistence of multiple chronic diseases is more common in older women and older depressed people. With the increase in the number of chronic diseases, the risk of depression in the elderly is significantly increased.

PMID:39174069 | DOI:10.1136/bmjopen-2023-081776

BMJ Open. 2024 Aug 21;14(8):e085819. doi: 10.1136/bmjopen-2024-085819.

ABSTRACT

INTRODUCTION: HIV drug resistance poses a challenge to the United Nation’s goal of ending the HIV/AIDS epidemic. The integrase strand transfer inhibitor (InSTI) dolutegravir, which has a higher resistance barrier, was endorsed by the WHO in 2019 for first-line, second-line and third-line antiretroviral therapy (ART). This multiplicity of roles of dolutegravir in ART may facilitate the emergence of dolutegravir resistance.

METHODS AND ANALYSIS: Nested within the International epidemiology Databases to Evaluate AIDS (IeDEA), DTG RESIST is a multicentre study of adults and adolescents living with HIV in sub-Saharan Africa, Asia, and South and Central America who experienced virological failure on dolutegravir-based ART. At the time of virological failure, whole blood will be collected and processed to prepare plasma or dried blood spots. Laboratories in Durban, Mexico City and Bangkok will perform genotyping. Analyses will focus on (1) individuals who experienced virological failure on dolutegravir and (2) those who started or switched to such a regimen and were at risk of virological failure. For population (1), the outcome will be any InSTI drug resistance mutations, and for population (2) virological failure is defined as a viral load >1000 copies/mL. Phenotypic testing will focus on non-B subtype viruses with major InSTI resistance mutations. Bayesian evolutionary models will explore and predict treatment failure genotypes. The study will have intermediate statistical power to detect differences in resistance mutation prevalence between major HIV-1 subtypes; ample power to identify risk factors for virological failure and limited power for analysing factors associated with individual InSTI drug resistance mutations.

ETHICS AND DISSEMINATION: The research protocol was approved by the Biomedical Research Ethics Committee at the University of KwaZulu-Natal, South Africa and the Ethics Committee of the Canton of Bern, Switzerland. All sites participate in International epidemiology Databases to Evaluate AIDS and have obtained ethics approval from their local ethics committee to collect additional data.

TRIAL REGISTRATION NUMBER: NCT06285110.

PMID:39174068 | DOI:10.1136/bmjopen-2024-085819

BMJ Open. 2024 Aug 21;14(8):e082495. doi: 10.1136/bmjopen-2023-082495.

ABSTRACT

OBJECTIVES: To investigate the role of comorbid chronic obstructive pulmonary disease (COPD) and symptom type on general practitioners’ (GP’s) symptom attribution and clinical decision-making in relation to lung cancer diagnosis.

DESIGN: Vignette survey with a 2×2 mixed factorial design.

SETTING: A nationwide online survey exploring clinical decision-making in primary care.

PARTICIPANTS: 109 GPs based in the United Kingdom (UK) who were registered as responders on Dynata (an online survey platform).

INTERVENTIONS: GPs were presented with four vignettes which described a patient aged 75 with a smoking history presenting with worsening symptoms (either general or respiratory) and with or without a pre-existing diagnosis of COPD.

PRIMARY AND SECONDARY OUTCOME MEASURES: GPs indicated the three most likely diagnoses (free-text) and selected four management approaches (20 pre-coded options). Attribution of symptoms to lung cancer and referral for urgent chest X-ray were primary outcomes. Alternative diagnoses and management approaches were explored as secondary outcomes. Multivariable mixed-effects logistic regression was used, including random intercepts for individual GPs.

RESULTS: 422 vignettes were completed. There was no evidence for COPD status as a predictor of lung cancer attribution (OR=1.1, 95% CI=0.5-2.4, p=0.914). There was no evidence for COPD status as a predictor of urgent chest X-ray referral (OR=0.6, 95% CI=0.3-1.2, p=0.12) or as a predictor when in combination with symptom type (OR=0.9, 95% CI=0.5-1.8, p=0.767).

CONCLUSIONS: Lung cancer was identified as a possible diagnosis for persistent respiratory by only one out of five GPs, irrespective of the patients’ COPD status. Increasing awareness among GPs of the link between COPD and lung cancer may increase the propensity for performing chest X-rays and referral for diagnostic testing for symptomatic patients.

PMID:39174063 | DOI:10.1136/bmjopen-2023-082495

BMJ Open. 2024 Aug 21;14(8):e080607. doi: 10.1136/bmjopen-2023-080607.

ABSTRACT

INTRODUCTION: Sepsis, a condition of global public health concern, is a major cause of morbidity and mortality, especially in patients with underlying HIV infection. This study aims to determine outcomes, aetiology and antibiotic resistance patterns among children with HIV exposure or infection admitted with a clinical presentation suggestive of sepsis who have confirmed bloodstream infections at Arthur Davison Children’s Hospital (ADCH) in Ndola, Zambia.

METHODS AND ANALYSIS: This will be a prospective longitudinal study of 200 children aged <2 years admitted with sepsis at ADCH with two of the following conditions: temperature of 38.0°C, respiratory rate ≥20 breaths per minute and pulse rate ≥90 beats per minute. About 2-5 mL of blood collected from each participant will be inoculated into BACTEC culture bottles and incubated for 5-7 days. Positive cultures will be inoculated onto culture media for subculture followed by species identification followed by antibiotic susceptibility testing. Time-to-event outcomes such as hospital readmission and mortality will be analysed using Kaplan-Meier and Cox proportional hazards. Predictors will be identified using regression methods. All statistical tests will use a 5% significance level with a 95% confidence level. STATA V.16 will be used for statistical analysis.

ETHICS AND DISSEMINATION: Ethical clearance and approval have been granted by the Tropical Diseases Research Centre Ethics Committee (TDRC-EC 092/07/23). Caregiver consent will be obtained verbally for participants presenting as medical emergencies, and written informed consent will be obtained once stable. Findings from this study will be shared with the Ministry of Health Zambia and will be disseminated to the scientific community through peer-reviewed scientific journals.

PMID:39174062 | DOI:10.1136/bmjopen-2023-080607

BMJ Open. 2024 Aug 21;14(8):e078108. doi: 10.1136/bmjopen-2023-078108.

ABSTRACT

OBJECTIVES: Our aim was to identify which patients are likely to stay in hospital longer following total hip replacement surgery.

DESIGN: Longitudinal, observational study used routinely collected data.

SETTING: Data were collected from an NHS Trust in South-West England between 2016 and 2019.

PARTICIPANTS: 2352 hip replacement patients had complete data and were included in analysis.

PRIMARY AND SECONDARY OUTCOME MEASURES: Three measures of length of stay were used: a count measure of number of days spent in hospital, a binary measure of ≤7 days/>7 days in hospital and a binary measure of remaining in hospital when medically fit for discharge.

RESULTS: The mean length of stay was 5.4 days following surgery, with 18% in hospital for more than 7 days, and 11% staying in hospital when medically fit for discharge. Longer hospital stay was associated with older age (OR=1.06, 95% CI 1.05 to 1.08), being female (OR=1.42, 95% CI 1.12 to 1.81) and more comorbidities (OR=3.52, 95% CI 1.45 to 8.55) and shorter length of stay with not having had a recent hospital admission (OR=0.44, 95% CI 0.32 to 0.60). Results were similar for remaining in hospital when medically fit for discharge, with the addition of an association with highest socioeconomic deprivation (OR=2.08, 95% CI 1.37 to 3.16).

CONCLUSIONS: Older, female patients with more comorbidities and from more socioeconomically deprived areas are likely to remain in hospital for longer following surgery. This study produced regression models demonstrating consistent results across three measures of prolonged hospital stay following hip replacement surgery. These findings could be used to inform surgery planning and when supporting patient discharge following surgery.

PMID:39174061 | DOI:10.1136/bmjopen-2023-078108

Neural Netw. 2024 Aug 7;180:106598. doi: 10.1016/j.neunet.2024.106598. Online ahead of print.

ABSTRACT

Multiview learning (MVL) seeks to leverage the benefits of diverse perspectives to complement each other, effectively extracting and utilizing the latent information within the dataset. Several twin support vector machine-based MVL (MvTSVM) models have been introduced and demonstrated outstanding performance in various learning tasks. However, MvTSVM-based models face significant challenges in the form of computational complexity due to four matrix inversions, the need to reformulate optimization problems in order to employ kernel-generated surfaces for handling non-linear cases, and the constraint of uniform noise assumption in the training data. Particularly in cases where the data possesses a heteroscedastic error structure, these challenges become even more pronounced. In view of the aforementioned challenges, we propose multiview twin parametric margin support vector machine (MvTPMSVM). MvTPMSVM constructs parametric margin hyperplanes corresponding to both classes, aiming to regulate and manage the impact of the heteroscedastic noise structure existing within the data. The proposed MvTPMSVM model avoids the explicit computation of matrix inversions in the dual formulation, leading to enhanced computational efficiency. We perform an extensive assessment of the MvTPMSVM model using benchmark datasets such as UCI, KEEL, synthetic, and Animals with Attributes (AwA). Our experimental results, coupled with rigorous statistical analyses, confirm the superior generalization capabilities of the proposed MvTPMSVM model compared to the baseline models. The source code of the proposed MvTPMSVM model is available at https://github.com/mtanveer1/MvTPMSVM.

PMID:39173204 | DOI:10.1016/j.neunet.2024.106598

Neural Netw. 2024 Aug 8;180:106572. doi: 10.1016/j.neunet.2024.106572. Online ahead of print.

ABSTRACT

Person Re-identification (Re-ID) aims to match person images across non-overlapping cameras. The existing approaches formulate this task as fine-grained representation learning with deep neural networks, which involves extracting image features using a deep convolutional network, followed by mapping the features into a discriminative space through another smaller network, in order to make full use of all possible cues. However, recent Re-ID methods that strive to capture every cue and make the space more discriminative have resulted in longer features, ranging from 1024 to 14336, leading to higher time (distance computation) and space (feature storage) complexities. There are two potential solutions: reduction-after-training methods (such as Principal Component Analysis and Linear Discriminant Analysis) and reduction-during-training methods (such as 1 × 1 Convolution). The former utilizes a statistical approach aiming for a global optimum but lacking end-to-end optimization of large data and deep neural networks. The latter lacks theoretical guarantees and may be vulnerable to training noise such as dataset noise or initialization seed. To address these limitations, we propose a method called Euclidean-Distance-Preserving Feature Reduction (EDPFR) that combines the strengths of both reduction-after-training and reduction-during-training methods. EDPFR first formulates the feature reduction process as a matrix decomposition and derives a condition to preserve the Euclidean distance between features, thus ensuring accuracy in theory. Furthermore, the method integrates the matrix decomposition process into a deep neural network to enable end-to-end optimization and batch training, while maintaining the theoretical guarantee. The result of the EDPFR is a reduction of the feature dimensions from f_a and f_b to f_a^‘ and f_b^‘, while preserving their Euclidean distance, i.e.L₂(f_a,f_b)=L₂(f_a^‘,f_b^‘). In addition to its Euclidean-Distance-Preserving capability, EDPFR also features a novel feature-level distillation loss. One of the main challenges in knowledge distillation is dimension mismatch. While previous distillation losses, usually project the mismatched features to matched class-level, spatial-level, or similarity-level spaces, this can result in a loss of information and decrease the flexibility and efficiency of distillation. Our proposed feature-level distillation leverages the benefits of the Euclidean-Distance-Preserving property and performs distillation directly in the feature space, resulting in a more flexible and efficient approach. Extensive on three Re-ID datasets, Market-1501, DukeMTMC-reID and MSMT demonstrate the effectiveness of our proposed Euclidean-Distance-Preserving Feature Reduction.

PMID:39173200 | DOI:10.1016/j.neunet.2024.106572

Obstet Gynecol. 2024 Aug 22. doi: 10.1097/AOG.0000000000005708. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the utility, success, and safety of ovarian tissue cryopreservation and autologous cryopreserved ovarian tissue transplantation for fertility preservation in patients with gynecologic cancers.

DATA SOURCES: A comprehensive search was performed of the MEDLINE, EMBASE, ClinicalTrials.gov, and Cochrane Library databases to identify relevant studies on the utility and outcomes of ovarian tissue cryopreservation and autologous cryopreserved ovarian tissue transplantation for gynecologic cancers from inception until January 23, 2024.

METHODS OF STUDY SELECTION: Two reviewers independently performed the study selection, data extraction, and risk-of-bias assessment, and the results were then reviewed together. Twenty-three studies were included in the current systematic review.

TABULATION, INTEGRATION, AND RESULTS: The resultant data were meta-analyzed to produce a pooled-effect estimate of the utility of ovarian tissue cryopreservation and autologous transplantation in gynecologic cancers as a proportion of all indications. We found that 7.5% and 9.6% of women undergoing ovarian tissue cryopreservation and autologous transplantation, respectively, had gynecologic cancers. In comparison, hematologic malignancies and breast cancer accounted for approximately 66.0% of all indications for these procedures. The return rate for autologous cryopreserved ovarian tissue transplantation in gynecologic cancers (6.0%) was not statistically different from those for other indications. Among women with gynecologic cancer who underwent ovarian stimulation, 27.3% had at least one child, and the ovarian endocrine function was restored in 78.1% of the women after autologous transplantation. The median graft longevity was 32 months, and no graft-site recurrence was reported after autologous transplantation in women with gynecologic cancer.

CONCLUSION: Our results suggest that ovarian tissue cryopreservation and autologous transplantation are feasible options for preserving ovarian function in women with gynecologic cancers, although ovarian tissue cryopreservation is underutilized, and further studies are needed to determine the longer-term outcomes of autologous transplantation.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42024498522.

PMID:39173181 | DOI:10.1097/AOG.0000000000005708

MMWR Morb Mortal Wkly Rep. 2024 Aug 22;73(33):722-730. doi: 10.15585/mmwr.mm7333e1.

ABSTRACT

INTRODUCTION: The Vaccines for Children (VFC) program was established in 1994 to provide recommended vaccines at no cost to eligible children and help ensure that all U.S. children are protected from life-threatening vaccine-preventable diseases.

METHODS: CDC analyzed data from the 2012-2022 National Immunization Survey-Child (NIS-Child) to assess trends in vaccination coverage with ≥1 dose of measles, mumps, and rubella vaccine (MMR), 2-3 doses of rotavirus vaccine, and a combined 7-vaccine series, by VFC program eligibility status, and to examine differences in coverage among VFC-eligible children by sociodemographic characteristics. VFC eligibility was defined as meeting at least one of the following criteria: 1) American Indian or Alaska Native; 2) insured by Medicaid, Indian Health Service (IHS), or uninsured; or 3) ever received at least one vaccination at an IHS-operated center, Tribal health center, or urban Indian health care facility.

RESULTS: Overall, approximately 52.2% of U.S. children were VFC eligible. Among VFC-eligible children born during 2011-2020, coverage by age 24 months was stable for ≥1 MMR dose (88.0%-89.9%) and the combined 7-vaccine series (61.4%-65.3%). Rotavirus vaccination coverage by age 8 months was 64.8%-71.1%, increasing by an average of 0.7 percentage points annually. Among all children born in 2020, coverage was 3.8 (≥1 MMR dose), 11.5 (2-3 doses of rotavirus vaccine), and 13.8 (combined 7-vaccine series) percentage points lower among VFC-eligible than among non-VFC-eligible children.

CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Although the VFC program has played a vital role in increasing and maintaining high levels of childhood vaccination coverage for 30 years, gaps remain. Enhanced efforts must ensure that parents and guardians of VFC-eligible children are aware of, have confidence in, and are able to obtain all recommended vaccines for their children.

PMID:39173180 | DOI:10.15585/mmwr.mm7333e1

Medwave. 2024 Aug 21;24(7):e2929. doi: 10.5867/medwave.2024.07.2929.

ABSTRACT

High-energy trauma is defined as severe organic injuries resulting from events that generate a large amount of kinetic, electrical, or thermal energy. It represents a significant public health concern, accounting for 10% of global mortality. This article aims to describe the epidemiology of high-energy trauma in Chile. Specifically, it seeks to compare the mortality rate per 100 000 inhabitants among member countries of the World Health Organization (WHO), provide a descriptive analysis of notifications under the Explicit Health Guarantees (GES) for the health issue of polytraumatized patients, and analyze the trend in the mortality rate due to external causes in Chile. This study employs an ecological design using three open-access databases. First, the WHO database on deaths from traffic accidents in 2019 was used. Then, the GES database was consulted for the “Polytraumatized” issue between 2018 and 2022. Finally, the Chilean Department of Health Statistics database on causes of death between 1997 and 2020 was utilized. In 2019, Chile ranked in the middle regarding the mortality rate per 100 000 inhabitants due to traffic accidents. GES notifications for polytrauma predominantly involved men aged 20 to 40 years and those affiliated with the public health system, highlighting a primary focus for prevention efforts. Mortality from accidents showed a decreasing trend, with significant structural changes identified in 2000 and 2007.

PMID:39173171 | DOI:10.5867/medwave.2024.07.2929