Tag: nevin manimala

BMJ. 2024 Aug 21;386:e078964. doi: 10.1136/bmj-2023-078964.

ABSTRACT

OBJECTIVES: To estimate age standardised suicide rate ratios in male and female physicians compared with the general population, and to examine heterogeneity across study results.

DESIGN: Systematic review and meta-analysis.

DATA SOURCES: Studies published between 1960 and 31 March 2024 were retrieved from Embase, Medline, and PsycINFO. There were no language restrictions. Forward and backwards reference screening was performed for selected studies using Google Scholar.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Observational studies with directly or indirectly age standardised mortality ratios for physician deaths by suicide, or suicide rates per 100 000 person years of physicians and a reference group similar to the general population, or extractable data on physician deaths by suicide suitable for the calculation of ratios. Two independent reviewers extracted data and assessed the risk of bias using an adapted version of the Joanna Briggs Institute checklist for prevalence studies. Mean effect estimates for male and female physicians were calculated based on random effects models, with subgroup analyses for geographical region and a secondary analysis of deaths by suicide in physicians compared with other professions.

RESULTS: Among 39 included studies, 38 studies for male physicians and 26 for female physicians were eligible for analyses, with a total of 3303 suicides in male physicians and 587 in female physicians (observation periods 1935-2020 and 1960-2020, respectively). Across all studies, the suicide rate ratio for male physicians was 1.05 (95% confidence interval 0.90 to 1.22). For female physicians, the rate ratio was significantly higher at 1.76 (1.40 to 2.21). Heterogeneity was high for both analyses. Meta-regression revealed a significant effect of the midpoint of study observation period, indicating decreasing effect sizes over time. The suicide rate ratio for male physicians compared with other professions was 1.81 (1.55 to 2.12).

CONCLUSION: Standardised suicide rate ratios for male and female physicians decreased over time. However, the rates remained increased for female physicians. The findings of this meta-analysis are limited by a scarcity of studies from regions outside of Europe, the United States, and Australasia. These results call for continued efforts in research and prevention of physician deaths by suicide, particularly among female physicians and at risk subgroups.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019118956.

PMID:39168499 | DOI:10.1136/bmj-2023-078964

ESC Heart Fail. 2024 Aug 21. doi: 10.1002/ehf2.15033. Online ahead of print.

ABSTRACT

AIMS: Certain critical risk factors of heart failure with preserved ejection fraction (HFpEF) patients were significantly different from those of heart failure with reduced ejection fraction (HFrEF) patients, resulting in the limitations of existing predictive models in real-world situations. This study aimed to develop a machine learning model for predicting 90 day readmission for HFpEF patients.

METHODS AND RESULTS: Data were extracted from electronic health records from 1 August 2020 to 1 August 2021 and follow-up records of patients with HFpEF within 3 months after discharge. Feature extraction was performed by univariate analysis combined with the least absolute shrinkage and selection operator (LASSO) algorithms. Machine learning models like eXtreme Gradient Boosting (XGBoost), random forest, neural network and logistic regression were adopted to construct models. The discrimination and calibration of each model were compared, and the Shapley Additive exPlanations (SHAP) method was used to explore the interpretability of the model. The cohort included 746 patients, of whom 103 (13.8%) were readmitted within 90 days. XGBoost owned the best performance [area under the curve (AUC) = 0.896, precision-recall area under the curve (PR-AUC) = 0.868, sensitivity = 0.817, specificity = 0.837, balanced accuracy = 0.827]. The Kolmogorov-Smirnov (KS) statistic was 0.694 at 0.468 in the XGBoost model. SHAP identified the top 12 risk features, including activities of daily living (ADL), left atrial dimension (LAD), left ventricular end-diastolic diameter (LVDD), shortness, nitrates, length of stay, nutritional risk, fall risk, accompanied by other symptoms, educational level, anticoagulants and edema.

CONCLUSIONS: Our model could help medical agencies achieve the early identification of 90 day readmission risk in HFpEF patients and reveal risk factors that provide valuable insights for treatments.

PMID:39168476 | DOI:10.1002/ehf2.15033

J Am Pharm Assoc (2003). 2024 Aug 19:102215. doi: 10.1016/j.japh.2024.102215. Online ahead of print.

ABSTRACT

BACKGROUND: Pharmacy deserts represent areas where residents face significant challenges to accessing pharmacies. North Carolina (NC) presents an intriguing case study due to its diverse geographic landscape yet lacks extensive research regarding its pharmacy deserts.

OBJECTIVES: This study aims to map pharmacy deserts in NC using pharmacy location and Social Determinants of Health (SDOH) data measured using the Social Vulnerability Index (SVI) and descriptively characterize healthcare utilization statistics for University of North Carolina (UNC) Health’s catchment population.

METHODS: Pharmacy location data was compiled from the NC Board of Pharmacy. Pharmacy deserts were defined based on SVI >0.75 and distance thresholds aligned to United States Department of Agriculture (USDA) standards. Residential characteristics were retrieved from PolicyMap and Social Explorer databases. UNC Health patient utilization data were collected by UNC Pharmacy Data Analytics group for three NC counties.

RESULTS: 2,002 NC pharmacies met inclusion criteria. 17.2% urban tracts (1.3M residents) and 4.25% rural tracts (0.14M residents) were identified as pharmacy deserts (adj. p<0.001). Those residing in deserts had significantly less internet access, annual medical cost per capita, and access to homeless relief services as well as significantly higher food insecurity rates and Medicare cost per capita (adj. p <0.001). UNC specific healthcare utilization statistics for the three assessed counties were all poorer in deserts compared to non-deserts within the same counties (p>0.05).

CONCLUSION: A geospatial map with the location of pharmacy deserts in NC was created to highlight differences in patient healthcare utilization, affecting rural and urban areas. By incorporating SDOH predictors, this study provides a more nuanced map of NC pharmacy deserts compared to reviewing distance to pharmacies alone. Higher rates of emergency room and inpatient visits in counties with more residents in pharmacy deserts suggests potential health outcomes associated with limited pharmacy access.

PMID:39168448 | DOI:10.1016/j.japh.2024.102215

J Shoulder Elbow Surg. 2024 Aug 19:S1058-2746(24)00582-2. doi: 10.1016/j.jse.2024.07.010. Online ahead of print.

ABSTRACT

BACKGROUND: As orthopedic surgery becomes increasingly competitive, orthopedic surgeons are now pursuing advanced degrees more frequently to enhance their resumes or gain additional expertise. The specific impact of this additional training and education on a surgeon’s career trajectory is not well defined. The purpose of this study was to understand the impact of an advanced degree on the academic career of orthopedic shoulder and elbow surgeons.

METHODS: Orthopedic shoulder and elbow fellowship-trained surgeons were identified using the directory listed on the American Shoulder and Elbow Surgeons website. Demographics, education, and current professional roles were obtained. Research productivity was obtained using SCOPUS and Google Scholar. Advanced degrees were defined as those additional to the primary medical degree (Doctor of Medicine [MD] or Doctor of Osteopathic Medicine [DO]). Outcome measures collected included timing of advanced degree obtainment, current academic and leadership roles, leadership on journal editorial boards, and research productivity. Statistical analysis was performed using the chi-square test and Mann-Whitney U test to determine the association of advanced degrees on outcome measures.

RESULTS: In total, 893 orthopedic shoulder and elbow surgeons were identified, of whom 129 had advanced degrees. Most common advanced degrees included Master of Science (MS/MSc; 43%), Master of Business Administration (MBA; 23%), and Doctor of Philosophy (PhD; 13%). The most common period of degree obtainment was before medical school (35%) with the least common times being after medical school/before residency (0.9%) and between residency and fellowship training (0.9%). Surgeons who held advanced degrees demonstrated greater research productivity, with a higher h-index (p < 0.001), a greater number of citations (p < 0.001), and more publications (p < 0.001). Of the 523 shoulder and elbow surgeons who worked at an academic institution, those holding advanced degrees were more likely to serve as orthopedic department chair (p < 0.001) and serve an editorial board position (< 0.001).

CONCLUSION: This study found that having an advanced degree as an orthopedic shoulder and elbow surgeon was linked to higher research impact and productivity and an increased likelihood of becoming a department chair and holding an editorial position. These significant findings can help future trainees and department leadership in understanding the importance and impact of additional training on career trajectories for academic faculty.

PMID:39168444 | DOI:10.1016/j.jse.2024.07.010

Environ Res. 2024 Aug 19:119818. doi: 10.1016/j.envres.2024.119818. Online ahead of print.

ABSTRACT

Contamination by neonicotinoid (NEO) insecticides in surface waters is a global problem. Nevertheless, the occurrence of NEOs in lakes is not well known. Hongze Lake, the largest impounded lake on the Eastern Route of the South-to-North Water Diversion Project, was selected to investigate the distribution, ecological risks, and health risks of NEOs. Water samples from the lake and nearby rivers were collected and analyzed for 8 widely used NEOs in three seasons. The results indicated the average total NEO concentration in summer, winter, and spring was 222, 211, and 244 ng L^-1 for the river water, and 265, 213, and 181 ng L^-1 for the lake water, respectively, with no statistical seasonal difference. For the river water, the highest total NEO concentration in the three seasons was observed in the Andong River. For the lake water, the total NEO concentrations in summer were relatively high in sites near the inflow river estuaries due to the high riverine inputs during the flood period. The spatial difference in NEO concentration was relatively low in winter, which may be related to the wind-driven lake current. The seasonal variation in NEO compositions in the lake was generally similar to that in the river, indicating riverine input was the important source for the lake. Huai River was the largest contributor to the NEO inputs to the lake, and Sanhe Gate was the major output pathway. Clothianidin and imidacloprid in the river and lake water would produce moderate acute ecological risks in summer. Thus, the usage of the above two NEOs should be decreased or restricted. For integral NEO risks, 53% and 58% of the river and lake water sites exceeded the acute ecological threshold, respectively. Health risk assessment suggested drinking the water obtained from the lake would not produce a negative impact on public health.

PMID:39168430 | DOI:10.1016/j.envres.2024.119818

J Stroke Cerebrovasc Dis. 2024 Aug 20;33(11):107776. doi: 10.1016/j.jstrokecerebrovasdis.2024.107776. Online ahead of print.

ABSTRACT

OBJECTIVE: This study mainly observed the changes in Intersectin-1 (ITSN-1) expression in rat brain tissue after ischemia-reperfusion intervened by Dicyclopentadiene.

METHODS: SD rats were randomly divided into non-middle Cerebral Artery Occlusion model group (normal group, sham operation group) and Middle Cerebral Artery Occlusion (MCAO) model group [Ischemia reperfusion (cerebral ischemia reperfusion)] reperfusion,IR) (6h, 24h, 72h, 1w, 2w) group, butylphthalein intervention group], First of all, Use Western The expression of ITSN-1 in the cerebral tissue of infarction side after ischemia-reperfusion injury in each group was measured by blotting, and then the loss and degree of nerve function after ischemia-reperfusion injury in each group was evaluated by Zea-Longa scoring method. The morphological changes of cells in the ischemic penumbra region in the normal group and the MCAO model group for 24h were observed by HE staining. Next, 24h was selected as the reperfusion point for intervention with butylphthalein sodium chloride injection. Finally, Zea-Longa scoring method was used to evaluate whether the rats had neurological impairment and its degree, TTC (Triphenyltetrazolium chloride) staining was used to determine whether the rats had cerebral infarction and its extent, and Western The expression of ITSN-1 in the cerebral tissue of infarcted rats after ischemia-reperfusion injury was measured by blotting.

RESULTS: 1. Zea-Longa scoring: Scores, except for the normal group and sham operation group (which scored 0), ranged between 2.75 ± 0.46 in the ischemia-reperfusion 24h group and 1.88 ± 0.35 in the Dicyclopentadiene intervention group, showing statistically significant decreases (P<0.05). 2. HE staining results: The cell structures in the brain tissues of normal group rats were normal with regular nuclear shapes and sizes. There were no obvious abnormal changes. Rats in the ischemia-reperfusion 24h group showed obviously swollen cells, reduced and aggregated nucleus, and cell necrosis in the ischemic penumbra. 3. TTC staining results: Except for the normal group and the sham operation group, which had no infarcts, the ischemia-reperfusion 24h group had the largest volume ratio of cerebral infarction. The volume ratio of cerebral infarction in the Dicyclopentadiene intervention group relatively reduced, making a difference with statistical significance (P<0.05). 4. Western blotting results: After cerebral ischemia-reperfusion in rats, ITSN-1 expression in the infarction-side brain tissue dynamically changed. ITSN-1 expression in the ischemia-reperfusion 24h group was significantly lower among other groups compared to the normal group (P<0.05). After 24 hours, the expression gradually increased after using Dicyclopentadiene intervention, the difference was statistically significant (P<0.05).

CONCLUSION: After cerebral ischemia-reperfusion in rats, ITSN-1 expression dynamically changed in the infarction-side brain tissue. Dicyclopentadiene can alleviate ischemia-reperfusion injuries in rats, which might be related to the regulation of ITSN-1 expression.

PMID:39167849 | DOI:10.1016/j.jstrokecerebrovasdis.2024.107776

Appl Physiol Nutr Metab. 2024 Aug 21. doi: 10.1139/apnm-2024-0228. Online ahead of print.

ABSTRACT

Carbohydrate (CHO) and caffeine (CAF) mouth rinsing have been independently reported to benefit sport performance. The proposed mechanisms by which mouth rinsing CHO exerts an influence are reported to be different to those for mouth rinsing CAF. However, the potential ergogenic effects of combining CHO and CAF in a single mouth rinse solution, are unclear. This study aimed to review the available evidence of CHO-CAF combined mouth rinse on exercise and cognitive performance in human participants. A systematic literature search was conducted using five databases until April 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Among the nine randomized crossover studies included, only one study showed significant improvements in lower-body muscular endurance with CHO-CAF mouth rinse (effect size [ES]: 0.48; p<0.05), while two studies reported non-statistically significant improvements in repeated sprint performance compared to other mouth rinse and placebo conditions (ES: 0.20-0.81;p=0.07-0.18). However, for other performance measures including repeated jumps, upper-body strength and endurance, endurance cycling, and intermittent recovery run, most evidence (five studies) did not demonstrate significant ergogenic effects. Notably, of the two studies that examined cognitive performance, both reported significant improvements with CHO-CAF mouth rinse compared with the placebo condition (ES: 0.45-3.45; p<0.05). Overall, a synergistic influence of CHO-CAF mouth rinse on physical exercise performance is not evident, but preliminary evidence suggests potential benefits on cognitive performance. Future studies are required to address various methodological issues identified in this review, while practitioners and athletes should exercise caution when considering this novel nutritional strategy.

PMID:39167825 | DOI:10.1139/apnm-2024-0228

Ann Am Thorac Soc. 2024 Aug 21. doi: 10.1513/AnnalsATS.202311-955OC. Online ahead of print.

ABSTRACT

Rationale: Growing evidence suggests that air pollution exposure is a major risk factor in chronic obstructive pulmonary disease (COPD) that is associated with an increased prothrombotic state and adverse cardiovascular outcomes. However, much of this work is based on observational data or human exposure studies involving younger participants. The biological causality and mechanism of air pollution-induced prothrombotic response in patients with COPD remain to be explored. Objective: The main aim of this work was to investigate the impact of short-term diesel exhaust (DE) exposure on circulating prothrombotic markers-fibrinogen and plasminogen activator inhibitor-1 (PAI-1)-and urinary eicosanoids in patients with COPD. Methods: Twenty-nine research participants were recruited in this randomized, double-blinded, crossover, controlled human exposure study to DE. Participants included former smokers with and without mild or moderate COPD (ES and COPD group) and healthy never-smokers without COPD (NS group). Each participant was exposed to DE (300 µg/m³ of PM_2.5) and filtered air (FA) for 2 hours on different occasions, in randomized order, separated by a 4-week washout. Blood and urine samples were collected prior to and 24 hours after each exposure. Plasma fibrinogen and serum PAI-1 concentrations were quantified using ELISAs. Urinary eicosanoid concentrations were quantified using ultra- performance liquid chromatography coupled to tandem mass spectrometry. Linear mixed-effects models were used for statistical comparisons. Results: Participants with COPD showed an increase in plasma fibrinogen (effect estimate: 1.27 [1.06 to 1.53], p=0.01) after DE relative to FA, but no significant DE-associated change in serum PAI-1 (0.95 [0.87 to 1.04], p=0.26). In never-smokers and ex-smokers without COPD, fibrinogen (NS group: 1.10 [0.99 to 1.23], p=0.08; ES group: 0.86 [0.68 to 1.09], p=0.08] and PAI-1 (NS group: 1.12 [ 0.96 to 1.32], p=0.15; ES group: 0.90 [0.79 to 1.03], p=0.13) were not changed after DE exposure. COPD participants showed a DE-attributable increase in urinary thromboxane B₂ (TXB₂) metabolites concentrations as follows: 11-dehydro TXB₂ (1.45 [1.02 to 2.08], p=0.04); 2,3-dinor-TXB₂ (1.45 [1.05 to 2.00], p=0.03). Conclusions: Participants with COPD had increased plasma fibrinogen and urinary TXB₂ metabolites after short-term DE exposure, suggesting they may be more susceptible to pollution-attributable prothrombotic response compared to healthy controls or ex-smokers without COPD. Clinical trial registration available at www.clinicaltrials.gov, ID: NCT02236039.

PMID:39167788 | DOI:10.1513/AnnalsATS.202311-955OC

J Med Internet Res. 2024 Aug 21;26:e56500. doi: 10.2196/56500.

ABSTRACT

BACKGROUND: Large language models including GPT-4 (OpenAI) have opened new avenues in health care and qualitative research. Traditional qualitative methods are time-consuming and require expertise to capture nuance. Although large language models have demonstrated enhanced contextual understanding and inferencing compared with traditional natural language processing, their performance in qualitative analysis versus that of humans remains unexplored.

OBJECTIVE: We evaluated the effectiveness of GPT-4 versus human researchers in qualitative analysis of interviews with patients with adult-acquired buried penis (AABP).

METHODS: Qualitative data were obtained from semistructured interviews with 20 patients with AABP. Human analysis involved a structured 3-stage process-initial observations, line-by-line coding, and consensus discussions to refine themes. In contrast, artificial intelligence (AI) analysis with GPT-4 underwent two phases: (1) a naïve phase, where GPT-4 outputs were independently evaluated by a blinded reviewer to identify themes and subthemes and (2) a comparison phase, where AI-generated themes were compared with human-identified themes to assess agreement. We used a general qualitative description approach.

RESULTS: The study population (N=20) comprised predominantly White (17/20, 85%), married (12/20, 60%), heterosexual (19/20, 95%) men, with a mean age of 58.8 years and BMI of 41.1 kg/m². Human qualitative analysis identified “urinary issues” in 95% (19/20) and GPT-4 in 75% (15/20) of interviews, with the subtheme “spray or stream” noted in 60% (12/20) and 35% (7/20), respectively. “Sexual issues” were prominent (19/20, 95% humans vs 16/20, 80% GPT-4), although humans identified a wider range of subthemes, including “pain with sex or masturbation” (7/20, 35%) and “difficulty with sex or masturbation” (4/20, 20%). Both analyses similarly highlighted “mental health issues” (11/20, 55%, both), although humans coded “depression” more frequently (10/20, 50% humans vs 4/20, 20% GPT-4). Humans frequently cited “issues using public restrooms” (12/20, 60%) as impacting social life, whereas GPT-4 emphasized “struggles with romantic relationships” (9/20, 45%). “Hygiene issues” were consistently recognized (14/20, 70% humans vs 13/20, 65% GPT-4). Humans uniquely identified “contributing factors” as a theme in all interviews. There was moderate agreement between human and GPT-4 coding (κ=0.401). Reliability assessments of GPT-4’s analyses showed consistent coding for themes including “body image struggles,” “chronic pain” (10/10, 100%), and “depression” (9/10, 90%). Other themes like “motivation for surgery” and “weight challenges” were reliably coded (8/10, 80%), while less frequent themes were variably identified across multiple iterations.

CONCLUSIONS: Large language models including GPT-4 can effectively identify key themes in analyzing qualitative health care data, showing moderate agreement with human analysis. While human analysis provided a richer diversity of subthemes, the consistency of AI suggests its use as a complementary tool in qualitative research. With AI rapidly advancing, future studies should iterate analyses and circumvent token limitations by segmenting data, furthering the breadth and depth of large language model-driven qualitative analyses.

PMID:39167785 | DOI:10.2196/56500

Blood Adv. 2024 Aug 21:bloodadvances.2024013746. doi: 10.1182/bloodadvances.2024013746. Online ahead of print.

ABSTRACT

BMT CTN 1506 was a phase III randomized trial comparing gilteritinib versus placebo after allogeneic HCT for FLT3-ITD-positive AML. The primary analysis comparing relapse-free survival (RFS) was not statistically significant, however, patients with detectable FLT3-ITD MRD peri-HCT had significantly longer RFS with gilteritinib. The aim of this analysis is to describe the effect of post-HCT gilteritinib versus placebo on health-related quality of life (HRQOL). HRQOL was measured using the Functional Assessment of Cancer Therapy (FACT)-BMT, FACT-Leukemia (-Leu), and EQ-5D-5L at post-HCT randomization, day 29, month 3, 6, 12, 18, 24, and/or end of therapy. HRQOL and clinically meaningful differences were summarized using descriptive statistics and compared using mixed model repeated measures to evaluate longitudinal change from baseline and stratified Cox model to evaluate time to improvement. Between 8/2017 and 7/2020, 356 patients were randomized. HRQOL completion rate was acceptable (>70%) across all time points and measures. There were no differences in FACT-BMT, FACT-Leu, or EQ-5D-5L scores at any time point between cohorts. There was an increase in scores over time, indicating improvement in HRQOL post-HCT. Clinically meaningful improvement and time to improvement in HRQOL was similar in both arms. Despite higher TEAEs with gilteritinib, response to the question of being “bothered by side effects of treatment” did not differ between groups. Subgroup analysis of MRD detectable and negative patients demonstrated no differences in HRQOL between arms. For FLT3-ITD+ AML patients undergoing HCT, gilteritinib maintenance was not associated with any difference in HRQOL or patient-reported impact of side effects. Trial Registration: NCT02997202.

PMID:39167766 | DOI:10.1182/bloodadvances.2024013746