Tag: pubmed

Neurology. 2024 Nov 12;103(9):e209951. doi: 10.1212/WNL.0000000000209951. Epub 2024 Oct 16.

ABSTRACT

BACKGROUND AND OBJECTIVES: Social determinants of health (SDOH) are important contributors to poor stroke-related outcomes. While some have suggested that this association is driven by the increased incidence of stroke observed with poor SDOH, others have raised concerns regarding disparities in acute stroke care. This study aimed to determine the association between SDOH and the administration of thrombolytic therapy and mechanical thrombectomy among patients with acute ischemic stroke.

METHODS: A retrospective cohort analysis was conducted using Texas Emergency Department Public Use Data (2016-2019), including adult patients diagnosed with acute ischemic stroke. The risk ratios (RRs) of administering thrombolysis and thrombectomy based on variables representing SDOH and a collective measure (Social Vulnerability Index [SVI]) were computed using mixed-effects Poisson regression models accounting for the nested nature of patients in hospitals and neighborhoods. The Charlson comorbidity score was considered as a covariate.

RESULTS: Of the 139,852 patients with ischemic stroke (female, 51.7%; White, 67.2%; Black, 16.6%; Hispanic, 25.1%), 16,831 (12.3%) received thrombolytic therapy and 5,951 (4.3%) received mechanical thrombectomy. Age older than 65 years (RR 0.578 [0.537-0.621]) vs 18-45 years, Black (RR 0.801 [0.761-0.844]) vs White, Hispanic (RR 0.936 [0.895-0.98]) vs non-Hispanic, Medicare/Medicaid/Veterans Affairs (VA) (RR 0.917 [0.882-0.954]) or uninsured (RR 0.883 [0.833-0.935]) vs private insurance, and rural (RR 0.782 [0.723-0.845]) vs urban dwelling were less likely to be associated with thrombolysis. Patients in the highest quintile based on the SVI were less likely to receive thrombolysis than those in the lowest quintile (RR 0.926 [0.867-0.989]). Patients were less likely to receive thrombectomy if they were 65 years and older (RR 0.787 [0.691-0.895]), belonged to the Black race (RR 0.745 [0.679-0.818]) or Hispanic ethnicity (RR 0.919 [0.851-0.992]), had Medicare/Medicaid/VA insurance (RR 0.909 [0.851-0.971]), or were from a rural area (RR 0.909 [0.851-0.971]). Similarly, SVI decreased the likelihood of undergoing mechanical thrombectomy (RR 0.842 [0.747-0.95]).

DISCUSSION: Despite many improvements in stroke management, SDOH continue to be a significant driver of treatment access for acute ischemic stroke. While our findings are limited to Texas, our results should raise awareness and promote more studies regarding the effects of these SDOH at the national and international levels.

PMID:39413335 | DOI:10.1212/WNL.0000000000209951

Med Phys. 2024 Oct 16. doi: 10.1002/mp.17454. Online ahead of print.

ABSTRACT

BACKGROUND: Proton beam therapy, when integrated with MRI guidance, presents complex dosimetric challenges due to interactions with magnetic fields. Prior research has emphasized the nuanced impact of magnetic fields on dosimetry. For thermoluminescent dosimeters (TLDs) the electron-return effect, alongside small air cavities surrounding the pellets, can lead to nonuniform dose distributions. Future MR-guided proton therapy will require reliable methods for end-to-end tests and dosimetric audits, which so far are often performed using TLDs equipped with phantoms. This implicates the necessity of accounting for these interactions.

PURPOSE: This study investigates the influence of magnetic fields on TLDs at two proton energies, using magnetic field strengths of 0, 0.25, and $1T$ , aiming to clarify their impact on dose measurement accuracy.

METHODS: The study was conducted at a synchrotron-based ion beam therapy beam line, enhanced by a resistive dipole magnet for creating magnetic fields up to $1T$ to simulate MR-guided proton therapy. Individual correction factors were applied for TLD measurements. The impact of air gaps on the TLD signal was evaluated using three dedicated TLD holders with air gaps of 0.1, 0.25, and 0.5 mm surrounding the TLD pellets using the highest available proton energy of $252.7MeV$ . Additionally, the influence of the magnetic field strength on the TLD response was evaluated for two proton energies of $97.4MeV$ and $252.7MeV$ .

RESULTS: The study found no statistically significant variation in TLD dose response attributable to changes in the air gap or the presence of magnetic fields. A power analysis indicated an upper limit on a potential change in dose-response as small as 1.5%.

CONCLUSIONS: The findings suggested that the impact of air gap variations and magnetic field strengths on the TLD response was below the detection threshold of TLD sensitivity. This emphasizes the suitability of TLDs for dose measurement in MR-guided proton therapy, indicating that additional correction factors may not be necessary despite the influence of magnetic fields.

PMID:39413314 | DOI:10.1002/mp.17454

J Dev Behav Pediatr. 2024 Sep-Oct 01;45(5):e483-e491. doi: 10.1097/DBP.0000000000001294. Epub 2024 Jun 21.

ABSTRACT

OBJECTIVE: To identify the impact of social determinants on the experiences of children with disabilities and their families during the COVID-19 pandemic from the perspective of parents/guardians.

METHODS: A mixed-methods study engaged parents/guardians of children with Individualized Education Programs (IEPs) in July to August 2021 at a developmental/behavioral pediatrics clinic in 1 urban academic medical center. All parents/guardians completed study-specific surveys on experiences and impact of COVID-19. A subset completed semi-structured interviews. Analysis included descriptive statistics and Fisher exact tests for survey questions and thematic analysis to code interviews and identify themes. Results were corroborated by experts in developmental/behavioral pediatrics and special education.

RESULTS: Participants included 24 parents/guardians representing 27 children (mean = 7.37 years). A majority attended public school (78%) and identified as non-White (78%). Most commonly, the children’s disabilities were autism (52%), attention-deficit hyperactivity disorder (37%), and speech/language impairment (33%). The services received by children most commonly were speech/language (89%) and physical/occupational (70%) therapies. Five themes emerged about the impact of social determinants on experiences during COVID-19 related to: adapting to disruption of routines, attendance/engagement in learning, interruption of IEP services, support for children and families, and challenges with technology.

CONCLUSION: Social determinants, such as housing, income, insurance, and quality of education, affected the experiences of families and their ability to adapt to the needs of children with disabilities in the setting of COVID-19 pandemic-related changes.

PMID:39413306 | DOI:10.1097/DBP.0000000000001294

J Dev Behav Pediatr. 2024 Sep-Oct 01;45(5):e422-e430. doi: 10.1097/DBP.0000000000001306. Epub 2024 Aug 13.

ABSTRACT

OBJECTIVE: An expert commission has proposed the term “profound” autism for children on the spectrum who are minimally verbal or nonverbal and have intellectual disability (ID), behavioral challenges, and co-occurring conditions. It is unknown whether parents’ rating of “severe” autism aligns with the definition of “profound” autism. Using the National Survey of Children’s Health, we sought to (1) estimate the prevalence of parent-reported severe autism, (2) identify child characteristics that are associated with severe autism, (3) compare health care utilization, and (4) compare caregiver stress and resilience between families of children with severe versus mild/moderate autism.

METHODS: Parent responses on the 2018 to 2019 NSCH were used to compare school-age children with parent-reported severe autism and those with mild/moderate autism. Descriptive statistics, χ 2 tests, and logistic regression were used for statistical analysis.

RESULTS: Among parents of 1,368 US children with autism, 10.1% characterized their child’s autism as severe, a prevalence of 1 in 333. Parents of children with severe autism were more likely to report ID (45% vs 12.1%, p < 0.001), language delay (88% vs 58.7%, p < 0.001), and difficulties in dressing and bathing (67% vs 19.2%, p < 0.001). Children with severe autism had more behavioral problems and co-occurring conditions but were no more likely to see specialists or receive autism-specific behavioral therapy. Their caregivers reported more stress and less resilience.

CONCLUSION: The characteristics of “profound” autism and parent-reported “severe” autism significantly overlap, allowing the use of the NSCH for studies of this vulnerable population. Children with profound/severe autism could benefit from more behavioral therapy, specialty care, and family support.

PMID:39413304 | DOI:10.1097/DBP.0000000000001306

J Orthop Trauma. 2024 Oct 15. doi: 10.1097/BOT.0000000000002927. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study was to investigate whether HWR after Lisfranc ORIF resulted in significant impact via PROMIS physical function (PF) and pain intensity (PI) scores.

METHODS: Design: Retrospective cohort.

SETTING: Level-1 trauma center.

PATIENT SELECTION CRITERIA: Adult patients with isolated Lisfranc injuries who were treated via ORIF between 2002-2023 that had PROMIS PF and PI scores through 6 months follow-up were included. Patients were excluded if they received index treatment other than ORIF or underwent secondary surgical intervention prior to HWR. A sub analysis was performed at 1 year follow- up.

OUTCOME MEASURES AND COMPARISONS: Primary outcomes were PROMIS PF and PI scores. The Wilcoxon signed-rank test compared differences between PROMIS scores within the HWR group. The Wilcoxon ranked-sum test compared differences between HWR vs no HWR. Distributive MCID was calculated using the 0.5 SD method.

RESULTS: There were 482 patients (489 feet) identified with isolated Lisfranc injuries. Seventy-seven feet underwent ORIF followed by HWR. Thirty feet underwent ORIF without HWR. The average age of the no HWR group was 45.8 (18.0-81.3) versus the HWR group which was 38.7 (18.3-74.1) (p=0.053). Nineteen (63.3%) were female in the no HWR group compared to 33 (42.9%) in the HWR group (p=0.084). HWR occurred an average of 4.43 months after ORIF. Patients who underwent HWR had a statistically significant increase in average PF scores (39.7 to 45.9, p<0.001) at their standard 6 week (1.5 month) postoperative visit. HWR patients had a non-significant decrease in average PI scores (56.5 to 53.9, p=0.24). Compared to those with retained hardware, the HWR group demonstrated a statistically significant net improvement in PF and PI scores from surgery, with an average improvement of 5.6 and 1.7, respectively (P=0.002, 0.008).

CONCLUSIONS: Patients experienced significant improvement in PROMIS PF scores for Lisfranc ORIF at 6 weeks after HWR. Compared to patients with retained hardware, they also experienced significant improvement in PROMIS PF and PI scores.

LEVEL OF EVIDENCE: III.

PMID:39413293 | DOI:10.1097/BOT.0000000000002927

MSMR. 2024 Sep 20;31(9):12-15.

ABSTRACT

This study aimed to determine the incidence of hair loss among U.S. active component service women, describe the types of hair loss, and summarize potential racial and ethnic disparities of hair loss among service women over the last 12 years. Estimates of traction alopecia among service members have been difficult, as there are no specific diagnosis codes for traction alopecia in the International Classification of Diseases, 9th and 10th revisions (ICD-9/ICD-10). A prior study on the prevalence of alopecia among female active component service women between 2010 and 2019 reported that 2.7% had traction alopecia diagnoses. That estimate may not be accurate, as the previous study used the ICD-9 code 704.01 (alopecia areata) and ICD-10 code Q84.0 (congenital alopecia), which are not fully representative of traction alopecia cases in administrative health records. This study used ICD-9/ICD-10 diagnostic codes 704.0 (ICD-9), L63, L64, L65, and L66 (ICD-10) to define cases of alopecia. The study population included female active component service members in the U.S. Army, Navy, Air Force, and Marine Corps between January 1, 2010 and December 31, 2022. The overall incidence rate of alopecia was 804.4 per 100,000 person-years. Non-Hispanic Black and Hispanic female active component service members had the highest incidence rates among all races and ethnicities, at 1,138.7 and 1,013.6 per 100,000 person-years, respectively. Non-Hispanic Black female active component service members were more than twice as likely to be diagnosed with alopecia compared to non-Hispanic White female active component service members.

PMID:39413275

Cancer Control. 2024 Jan-Dec;31:10732748241293640. doi: 10.1177/10732748241293640.

ABSTRACT

BACKGROUND: This case-control study investigated the relationship between sleep duration and quality with the occurrence of breast cancer among women, both pre- and post-menopausal, in the northwest Khyber Pakhtunkhwa (KP) region of Pakistan.

METHOD: This case-control research was carried in multiple tertiary care facilities. Newly diagnosed primary breast cancer patients were recruited as cases (n = 408), and 5+ years age-matched controls (n = 408) were randomly selected from the general population. Participants completed a Pittsburg sleeping quality index (PSQI) questionnaire that included questions on sleep characteristics. Statistical analysis included independent t-tests to compare mean sleep durations and quality scores between groups, and logistic regression to adjust for potential confounders.

RESULTS: Sleep onset latency between cases and controls was not significantly associated with health outcomes, with a P-value of .142. However, sleep duration showed a significant association (P = .049). For sleep duration, the adjusted odds ratio for ≤6 h was 1.02 (95% CI: .5-2.1), while for 7-8 h the adjusted odds ratio was 1.0 (95% CI: .6-1.6). Self-reported sleep quality did not demonstrate significant associations, with the P-value for “very good” sleep quality being .561. Sleep duration of less than 6 h among women with triple-negative breast cancer (TNBC) was found to be strongly associated with a more aggressive type of breast cancer, with an adjusted odds ratio of 1.5 (95% CI: 1.02-2.3, P < .05).

CONCLUSION: This study does not provide evidence to support an association between sleep duration or quality and the risk of breast cancer. However, it reports a significant association, with shorter sleep durations linked to an increased risk particularly in the context of aggressive breast cancer types such as TNBC.

PMID:39413266 | DOI:10.1177/10732748241293640

Chaos. 2024 Oct 1;34(10):103126. doi: 10.1063/5.0212322.

ABSTRACT

This study presents a modified stochastic diffusion particle tracking model (MSDPTM) that incorporates energy cascade theory to more accurately simulate suspended sediment transport. The impact of turbulent eddies on sediment particles is an intermittent process, which is also considered in this study. The study examines the time correlation between eddies using eddy turnover time and finds that closer-scale eddies exhibit higher correlations than those farther apart. The statistical properties of particle movement, such as the ensemble mean and variance of particle trajectories, have been calculated and compared with the stochastic diffusion particle tracking model (SDPTM) results. Notably, MSDPTM with intermittency demonstrates a significantly larger ensemble mean of particle trajectories in the streamwise direction than other particle tracking models. The proposed model is validated through comparison with available data, showing its enhanced performance. The results of the simulation indicate that MSDPTM outperforms SDPTM, especially when the intermittency effect of eddies is considered.

PMID:39413263 | DOI:10.1063/5.0212322

Chaos. 2024 Oct 1;34(10):101102. doi: 10.1063/5.0238827.

ABSTRACT

Understanding how species interactions shape biodiversity is a core challenge in ecology. While much focus has been on long-term stability, there is rising interest in transient dynamics-the short-lived periods when ecosystems respond to disturbances and adjust toward stability. These transitions are crucial for predicting ecosystem reactions and guiding effective conservation. Our study introduces a model that uses convex combinations to blend pairwise and higher-order interactions (HOIs), offering a more realistic view of natural ecosystems. We find that pairwise interactions slow the journey to stability, while HOIs speed it up. Employing global stability analysis and numerical simulations, we establish that as the proportion of HOIs increases, mean transient times exhibit a significant reduction, thereby underscoring the essential role of HOIs in enhancing biodiversity stabilization. Our results reveal a robust correlation between the most negative real part of the eigenvalues of the Jacobian matrix associated with the linearized system at the coexistence equilibrium and the mean transient times. This indicates that a more negative leading eigenvalue correlates with accelerated convergence to stable coexistence abundances. This insight is vital for comprehending ecosystem resilience and recovery, emphasizing the key role of HOIs in promoting stabilization. Amid growing interest in transient dynamics and its implications for biodiversity and ecological stability, our study enhances the understanding of how species interactions affect both transient and long-term ecosystem behavior. By addressing a critical gap in ecological theory and offering a practical framework for ecosystem management, our work advances knowledge of transient dynamics, ultimately informing effective conservation strategies.

PMID:39413260 | DOI:10.1063/5.0238827

MSMR. 2024 Sep 20;31(9):7-11.

ABSTRACT

In May 2022, cases of mpox emerged beyond its historically endemic parts of Central and West Africa, primarily affecting men who have sex with men (MSM), and spreading via sexual networks. During this global outbreak the novel clinical and epidemiological characteristics of mpox disease were thoroughly documented in civilian populations but comparable data have not been reported for Military Health System (MHS) populations including beneficiaries. MHS cases were identified through a variety of data sources, including the Disease Reporting System internet (DRSi) and a customized query of ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) encounter codes. Contemporaneous chart reviews of patients’ electronic health records in the Armed Forces Health Longitudinal Technology Application (AHLTA) and MHS GENESIS were performed to characterize cases. A total of 146 confirmed and probable MHS cases were identified from May 2022 through April 2024. Most cases occurred among MSM, with the majority developing classic prodromal symptoms and some experiencing anogenital and urinary symptoms.

PMID:39413256