Tag: nevin manimala

JMIR Form Res. 2023 Oct 10;7:e48946. doi: 10.2196/48946.

ABSTRACT

BACKGROUND: In resource-limited countries, access to specialized health care services such as dermatology is limited. Clinical decision support systems (CDSSs) offer innovative solutions to address this challenge. However, the implementation of CDSSs is commonly associated with unique challenges. VisualDx-an exemplar CDSS-was recently implemented in Botswana to provide reference materials in support of the diagnosis and management of dermatological conditions. To inform the sustainable implementation of VisualDx in Botswana, it is important to evaluate the intended users’ perceptions about the technology.

OBJECTIVE: This study aims to determine health care workers’ acceptance of VisualDx to gauge the feasibility of future adoption in Botswana and other similar health care systems.

METHODS: The study’s design was informed by constructs of the Technology Acceptance Model. An explanatory, sequential, mixed methods study involving surveys and semistructured interviews was conducted. The REDCap (Research Electronic Data Capture; Vanderbilt University) platform supported web-based data capture from March 2021 through August 2021. In total, 28 health care workers participated in the study. Descriptive statistics were generated and analyzed using Excel (Microsoft Corp), and thematic analysis of interview transcripts was performed using Delve software.

RESULTS: All survey respondents (N=28) expressed interest in using mobile health technology to support their work. Before VisualDx, participants referenced textbooks, journal articles, and Google search engines. Overall, participants’ survey responses showed their confidence in VisualDx (18/19, 95%); however, some barriers were noted. Frequently used VisualDx features included generating a differential diagnosis through manual entry of patient symptoms (330/681, 48.5% of total uses) or using the artificial intelligence feature to analyze skin conditions (150/681, 22% of total uses). Overall, 61% (17/28) of the survey respondents were also interviewed, and 4 thematic areas were derived.

CONCLUSIONS: Participants’ responses indicated their willingness to accept VisualDx. The ability to access information quickly without internet connection is crucial in resource-constrained environments. Selected enhancements to VisualDx may further increase its feasibility in Botswana. Study findings can serve as the basis for improving future CDSS studies and innovations in Botswana and similar resource-limited countries.

PMID:37815861 | DOI:10.2196/48946

JAMA Netw Open. 2023 Oct 2;6(10):e2337192. doi: 10.1001/jamanetworkopen.2023.37192.

ABSTRACT

IMPORTANCE: Current Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) diagnoses of substance use disorders rely on criterion count-based approaches, disregarding severity grading indexed by individual criteria.

OBJECTIVE: To examine correlates of alcohol use disorder (AUD) across count-based severity groups (ie, mild, moderate, mild-to-moderate, severe), identify specific diagnostic criteria indicative of greater severity, and evaluate whether specific criteria within mild-to-moderate AUD differentiate across relevant correlates and manifest in greater hazards of severe AUD development.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study involved 2 cohorts from the family-based Collaborative Study on the Genetics of Alcoholism (COGA) with 7 sites across the United States: cross-sectional (assessed 1991-2005) and longitudinal (assessed 2004-2019). Statistical analyses were conducted from December 2022 to June 2023.

MAIN OUTCOMES AND MEASURES: Sociodemographic, alcohol-related, psychiatric comorbidity, brain electroencephalography (EEG), and AUD polygenic score measures as correlates of DSM-5 AUD levels (ie, mild, moderate, severe) and criterion severity-defined mild-to-moderate AUD diagnostic groups (ie, low-risk vs high-risk mild-to-moderate).

RESULTS: A total of 13 110 individuals from the cross-sectional COGA cohort (mean [SD] age, 37.8 [14.2] years) and 2818 individuals from the longitudinal COGA cohort (mean baseline [SD] age, 16.1 [3.2] years) were included. Associations with alcohol-related, psychiatric, EEG, and AUD polygenic score measures reinforced the role of increasing criterion counts as indexing severity. Yet within mild-to-moderate AUD (2-5 criteria), the presence of specific high-risk criteria (eg, withdrawal) identified a group reporting heavier drinking and greater psychiatric comorbidity even after accounting for criterion count differences. In longitudinal analyses, prior mild-to-moderate AUD characterized by endorsement of at least 1 high-risk criterion was associated with more accelerated progression to severe AUD (adjusted hazard ratio [aHR], 11.62; 95% CI, 7.54-17.92) compared with prior mild-to-moderate AUD without endorsement of high-risk criteria (aHR, 5.64; 95% CI, 3.28-9.70), independent of criterion count.

CONCLUSIONS AND RELEVANCE: In this cohort study of a combined 15 928 individuals, findings suggested that simple count-based AUD diagnostic approaches to estimating severe AUD vulnerability, which ignore heterogeneity among criteria, may be improved by emphasizing specific high-risk criteria. Such emphasis may allow better focus on individuals at the greatest risk and improve understanding of the development of AUD.

PMID:37815828 | DOI:10.1001/jamanetworkopen.2023.37192

J Periodontol. 2023 Oct 10. doi: 10.1002/JPER.23-0322. Online ahead of print.

ABSTRACT

BACKGROUND: Coffee is one of the world’s most popular beverages and is the main dietary source of caffeine for most people. The various molecular effects of caffeine suggest that it may enhance bone loss. The purpose of the present study was to investigate the relationship of coffee, coffee types, and caffeine metabolites with periodontitis.

METHODS: Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2009-2014. Total coffee and different types of coffee consumption were acquired through a 24-h dietary recall. Urinary caffeine metabolites were quantified using high-performance liquid chromatography-electrospray ionization-tandem quadrupole mass spectrometry (HPLC-ESI-MS/MS). The association of coffee, coffee types, and caffeine metabolites with periodontitis and its severity were assessed using multivariable logistic regression.

RESULTS: A total of 3309 eligible participants were included. After adjusting for potential confounding variables, a positive association was observed between coffee consumption (particularly certain types of coffee) and periodontitis. Notably, a positive correlation was also found between total coffee intake and the severity of periodontitis. Additionally, for urinary caffeine metabolites, there was a significant positive association between 1-methyluric acid (1-MU), 1,3-dimethyluric acid (1,3-DMU), 3,7-dimethyluric acid (3,7-DMU), 1,7-dimethylxanthine (1,7-DMX), or 5-actlyamino-6-amino-3-methyluracil (AAMU) and periodontitis, with adjusted odds ratios and 95% confidence intervals of 1.10 (1.02, 1.19), 1.86 (1.05, 3.29), 0.94 (0.90, 0.98), 1.29 (1.03, 1.62), and 1.15 (1.05, 1.26), respectively.

CONCLUSIONS: The present study suggests a positive association of coffee intake (especially certain coffee types) and caffeine metabolites (1-MU, 1,3-DMU, 3,7-DMU, 1,7-DMX, and AAMU) with periodontitis and its severity.

PMID:37815812 | DOI:10.1002/JPER.23-0322

Int Endod J. 2023 Oct 10. doi: 10.1111/iej.13986. Online ahead of print.

ABSTRACT

AIM: This study aimed to investigate 2-year changes in periapical trabecular patterns in single-rooted teeth with apical periodontitis using fractal analysis and periapical index (PAI) after root canal treatment performed with or without BioPure MTAD solution.

METHODOLOGY: In this randomized clinical trial, 100 patients were selected and randomized to either the BioPure MTAD or the control groups. Initial periapical radiographs were obtained for each participant before and 2 years after root canal treatment. The region of interest in the periapical lesion around the root apex was selected from the paired periapical radiographs, and then, the fractal dimension (FD) was calculated. With regards to the classification of periapical status, PAI was labelled as “healed” (PAI ≤ 2) or “unhealed” (PAI ≥ 3).

RESULTS: After 24 months, 28 patients did not comply with the follow-up and the data of 72 patients were compared. When the initial and the follow-up PAI scores were compared, the decrease was statistically significant in 33 of 37 teeth (89.2%) and 32 of 35 teeth (91.4%) in the BioPure MTAD and control group, respectively. In both groups, statistically significant increases were observed in FD values after 2 years in all patients (p < .001). No significant difference was found between the two groups amongst decreased PAI scores and increased FD values.

CONCLUSIONS: Root canal treatments with or without BioPure MTAD irrigation contributed to periapical healing in single-visit root canal treatment. Two years after root canal treatment, the extent of the periapical trabecular bone radiographically increased, as the FD and PAI data revealed.

PMID:37815804 | DOI:10.1111/iej.13986

Int J Lang Commun Disord. 2023 Oct 10. doi: 10.1111/1460-6984.12959. Online ahead of print.

ABSTRACT

BACKGROUND: Supporting psychosocial well-being in aphasia is necessarily person-centred, interdisciplinary and coordinated. Shortcomings in such support are described in Ireland and elsewhere. Speech and language therapists (SLTs) are integral; and describing current practice and barriers they experience is important for enhancing service delivery.

AIMS: To understand how SLTs enact, and are supported to enact, aphasia psychosocial care in Ireland.

METHODS & PROCEDURES: This is a cross-sectional, online, self-administered clinician survey targeting SLTs working minimally 1 year post-qualification with persons with aphasia of any aetiology in Ireland. The survey questions were charted against key constructs of the implementation science framework, normalization process theory (NPT), and descriptive statistics were applied.

OUTCOMES & RESULTS: A total of 54 eligible datasets were included. SLTs believed psychosocial support to be part of their role, but perceived multiple barriers in enacting it. These included a lack of training, clinical supervision, management support, role recognition, and access to and joint working with mental health professionals and services.

CONCLUSIONS & IMPLICATIONS: SLTs in Ireland face a range of individual and structural barriers, including care coordination and resourcing. There is a clear need not only for training, upskilling and mentorship, but also for wider changes around access to mental health professionals and clarity around the processes of referral, coordination and integration of aphasia care across settings. These findings comprise preliminary insights into current practices. Further research is needed as well as clarity on best-practice pathways for different aetiologies of aphasia. Articulating current practices using NPT may have utility for developing empirically informed and principled interventions to improve service delivery.

WHAT THIS PAPER ADDS: What is already known on this subject People with aphasia of all aetiologies are at risk of psychosocial problems. Shortcomings in access and the availability of appropriate support have been documented both internationally and in Ireland. To address this issue, an important first step is to understand how SLTs in Ireland currently enact and are supported to enact aphasia psychosocial care. What this study adds to the existing knowledge The findings describe the potential levers and barriers to progressing aphasia psychosocial care in Ireland. A range of individual, team and structural factors were identified. These were locally contextualized but similar issues are reported in other countries. Linking attitudes with NPT constructs provides a first step for further principled implementation projects. What are the practical and clinical implications of this study? Addressing psychosocial problems is perceived as a legitimate part of the speech and language therapy role. SLTs in Ireland enact a range of therapeutic approaches but may need opportunities for formal training and supervision, and for better coordination and integration with other mental health services and disciplines. Understanding differences in care pathways across the range of aphasia aetiologies is additionally important given the emphasis on post-stroke aphasia in the literature.

PMID:37815803 | DOI:10.1111/1460-6984.12959

Am J Orthod Dentofacial Orthop. 2023 Oct 9:S0889-5406(23)00510-3. doi: 10.1016/j.ajodo.2023.08.013. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aimed to longitudinally examine the changes in craniofacial and dentoalveolar regions during the third and fourth decades of life.

METHODS: The data from this study constitute the cephalometric films and plaster models of 8 female and 8 male dental students or dentists. The mean chronological ages of the subjects at the first observation period was 22.09 years for females and 22.64 years for males. The material was collected over 3 intervals: 1985-1989, 1998-2000, and 2016-2017. The observation period was approximately 28 years. Acquired cephalometric recordings and dental models were assessed for subjects in their 20s (baseline), 30s, and 40s. Maxillary, mandibular, maxillomandibular, soft-tissue, and dentoalveolar cephalometric variables were measured with a cephalometric analysis software, and dental cast measurements were made with a digital caliper. Changes in the cephalometric films and dental casts were evaluated statistically.

RESULTS: Statistical analysis showed that the length of the midfacial region increased with age. The height of the lower face increased significantly in females and the mandible can be seen mildly rotating to the posterior as it increased in length. The nose moved slightly forward and downward in males and females. Upper lip height was significantly increased in females; however, there was a significant reduction in upper lip thickness for males and females. Soft-tissue pogonion measurements showed a significant forward and downward chin movement in females. Overjet was significantly increased in females, whereas the mandibular arch length was significantly decreased for both sexes, although it was more prominent in females. There was a loss of space in the anterior segments of males and females, resulting in increased crowding. However, the loss of space was only significant in the mandible.

CONCLUSIONS: We observed significant changes in skeletal, soft-tissue, and dentoalveolar variables of subjects in their third and fourth decades of life. The fact that many changes have occurred throughout this study demonstrates that the process of maturation and aging is ongoing.

PMID:37815780 | DOI:10.1016/j.ajodo.2023.08.013

Am J Orthod Dentofacial Orthop. 2023 Oct 8:S0889-5406(23)00491-2. doi: 10.1016/j.ajodo.2023.07.018. Online ahead of print.

ABSTRACT

INTRODUCTION: This study performed a 3-dimensional analysis of tooth movement during orthodontic retention to assess the effectiveness of double retention (fixed and removable) in preventing undesired tooth movement.

METHODS: One hundred randomly selected patients were included at the initiation of double orthodontic retention with fixed retainers and vacuum-formed splints (recommended to be worn 22 h/d) in both arches. Intraoral scans were performed directly (T0), 1 month (n = 88), 3 months (T2) (n = 78), and 6 months (T3) (n = 66) after retainer bonding. Nine reference points were marked on each tooth in every patient. Subsequent scans were superimposed, and point displacement was calculated. Statistical analysis was performed using the R statistical software (version 4.2.2; R Core Team, Vienna, Austria).

RESULTS: Sample size calculation determined at least 55 patients were needed. The total dropout between T0 and T3 was 34 patients (did not show up for appointment). The median absolute displacement value of a single point between T0 and T3 was 0.015 mm. The most stable teeth were mandibular central incisors, whereas the least stable were mandibular molars. Most tooth displacements occurred between T0 and T2, then slowed down significantly.

CONCLUSIONS: Double orthodontic retention prevents major tooth displacements in most patients during the first 6 months of retention; however, larger, unpredictable single-tooth displacement may occur in individual patients.

PMID:37815779 | DOI:10.1016/j.ajodo.2023.07.018

Am J Orthod Dentofacial Orthop. 2023 Oct 10:S0889-5406(23)00511-5. doi: 10.1016/j.ajodo.2023.08.014. Online ahead of print.

ABSTRACT

INTRODUCTION: The American Association of Orthodontists (AAO) Annual Session aims to educate members using expert speakers in the field. Selection to speak is an honor and can help further an orthodontist’s career and credibility. A European study found a significant gender discrepancy in selected speakers at their orthodontic meeting. This has not been investigated in the United States.

METHODS: Speaker names from the 2015-2023 AAO Annual Sessions were obtained and analyzed for gender and then compared with active membership and orthodontic faculty percentages. In addition, the gender of each General Chair and Doctors’ Program Chair was analyzed and then compared with the female speaker and membership percentages. Because AAO research award winners are selected blindly, show expertise in the field, and are provided an opportunity to speak at the Annual Session, their gender was also confirmed and compared with membership percentage and female speaker percentage. Two-way chi-square tests were used, and P values of <0.05 were considered statistically significant. Mann-Kendall trend tests analyzed any potential changes in gender representation among AAO active memberships and AAO Annual Session speakers.

RESULTS: Female doctors were underrepresented as speakers (P values ranged from <0.001 to <0.05) in every year studied except 2020 compared with active membership and female faculty percentages. Female doctors were also significantly underrepresented as Annual Session General Chairs and Doctors’ Program Chairs (P <0.01). The difference in female doctor representation among research awards winners (63%) compared with the Annual Session speakers (19%) was highly significant. Female representation in AAO active membership shows a significant increase from 2015 to 2023. The ratio of female-to-male speakers appears to be increasing but did not reach statistical significance.

CONCLUSIONS: Female doctors are underrepresented as selected speakers at the AAO Annual Session but comprise the majority of research award recipients. Efforts to provide opportunities for women to showcase their knowledge should be implemented.

PMID:37815778 | DOI:10.1016/j.ajodo.2023.08.014

J Adolesc Health. 2023 Oct 9:S1054-139X(23)00441-X. doi: 10.1016/j.jadohealth.2023.08.031. Online ahead of print.

ABSTRACT

PURPOSE: Single-visit long-acting reversible contraception (LARC) is cost-effective and convenient. Our objective was to compare incidence of single-visit LARC placement and associated factors during the year before the COVID-19 pandemic (March 15, 2020) and the first year of the pandemic.

METHODS: This retrospective cohort study analyzed electronic health records from a large healthcare system. Eligible adolescents were aged 10-19 years and received outpatient LARC from March 15, 2019 to March 14, 2021. Logistic regression models determined the relationship of patient and provider characteristics on single-visit LARC before and during COVID-19.

RESULTS: One thousand six adolescents initiated LARC during the study period. Fewer adolescents received single-visit LARC during COVID-19 (289/506, 57.1%) compared to before (315/500, 63.0%), although changes in odds of single-visit LARC were not statistically significant. Concordance between county of patient residence and the location of the LARC placement facility was associated with single-visit LARC before (adjusted odds ratio [aOR] = 2.75) and during (aOR = 1.74) the pandemic (both p < .05). During the pandemic, a few factors were associated with reduced odds of single-visit LARC: (1) public insurance (aOR = 0.49, p < .01), (2) nonobstetricians/nongynecologists providers (pediatrics [aOR = 0.35, p < .01], family medicine [aOR = 0.53, p < .01], or internal medicine [aOR = 0.14, p < .05]), and (3) advanced practice practitioners (aOR = 0.49, p < .01).

DISCUSSION: Incidence of single-visit LARC was similar before and during the pandemic. Certain factors were associated with lower odds of single-visit LARC insertion, suggesting differential access during the pandemic for subgroups of adolescents. Our findings may guide policy and programmatic interventions to improve access to single-visit LARC for all adolescent populations.

PMID:37815761 | DOI:10.1016/j.jadohealth.2023.08.031

Mol Biotechnol. 2023 Oct 10. doi: 10.1007/s12033-023-00916-7. Online ahead of print.

ABSTRACT

Plastic pollution has threatened biodiversity and human health by shrinking habitats, reducing food quality, and limiting the activities of organisms. Therefore, global interest in discovering novel enzymes capable of degrading plastics has increased considerably. Within this context, the functional metagenomic approach, which allows for unlocking the functional potential of uncultivable microbial biodiversity, was used to discover a plastic-degrading enzyme. First, metagenomic libraries derived from microplastic-associated microbiota were screened for esterases capable of degrading both tributyrin and polycaprolactone. Clone KAD01 produced esterase highly active against p-nitrophenyl esters (C2-C16). The gene corresponding to the enzyme activity showed moderate identity (≤ 55.94%) to any known esterases/cutinases. The gene was extracellularly expressed with a 6× histidine tag in E. coli BL21(DE3), extracellularly. Titer of the enzyme (CEstKAD01) was raised from 21.32 to 35.17 U/mL by the statistical optimization of expression conditions and media components. CEstKAD01 was most active at pH 7.0 and 30 °C. It was noteworthy stable over a wide pH (6.0-10.0) and temperature (20-50 °C). The enzyme was active and stable in elevated NaCl concentrations up to 12% (w/v). Pre-incubation of CEstKAD01 with Mg²⁺, Mn²⁺, and Ca²⁺ increased the enzyme activity. CEstKAD01 displayed an excellent tolerance against various chemicals and solvents. It was determined that 1 mg of the enzyme caused the release of 5.39 ± 0.18 mM fatty acids from 1 g apple cutin in 120 min. K_m and V_max values of CEstKAD01 against p-nitrophenyl butyrate were calculated to be 1.48 mM and 20.37 µmol/min, respectively. The enzyme caused 6.94 ± 0.55, 8.71 ± 0.56, 7.47 ± 0.47, and 9.22 ± 0.18% of weight loss in polystyrene, high-density polyethylene, low-density polyethylene, and polyvinyl chloride after 30-day incubation. The scanning electron microscopy (SEM) analysis indicated the formation of holes and pits on the plastic surfaces supporting the degradation. In addition, the change in chemical structure in plastics treated with the enzyme was determined by Fourier Transform Infrared Spectroscopy (FTIR) analysis. Finally, the degradation products were found to have no genotoxic potential. To our knowledge, no cutinolytic esterase with the potential to degrade polystyrene (PS), high-density polyethylene (HDPE), low-density polyethylene (LDPE), and polyvinyl chloride (PVC) has been identified from metagenomes derived from microplastic-associated microbiota.

PMID:37815749 | DOI:10.1007/s12033-023-00916-7