Tag: pubmed

JAMA Netw Open. 2022 May 2;5(5):e2213945. doi: 10.1001/jamanetworkopen.2022.13945.

ABSTRACT

IMPORTANCE: New-onset atrial fibrillation (AF) is commonly reported in patients with severe infections. However, the absolute risk of thromboembolic events without anticoagulation remains unknown.

OBJECTIVE: To investigate the thromboembolic risks associated with AF in patients with pneumonia, assess the risk of recurrent AF, and examine the association of initiation of anticoagulation therapy with new-onset AF.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used linked Danish nationwide registries. Participants included patients hospitalized with incident community-acquired pneumonia in Denmark from 1998 to 2018. Statistical analysis was performed from August 15, 2021, to March 12, 2022.

EXPOSURES: New-onset AF.

MAIN OUTCOMES AND MEASURES: Thromboembolic events, recurrent AF, and all-cause death. Estimated risks were calculated for thromboembolism without anticoagulation therapy, new hospital or outpatient clinic contact with AF, initiation of anticoagulation therapy, and all-cause death at 1 and 3 years of follow-up. Death was treated as a competing risk, and inverse probability of censoring weights was used to account for patient censoring if they initiated anticoagulation therapy conditioned on AF.

RESULTS: Among 274 196 patients hospitalized for community-acquired pneumonia, 6553 patients (mean age [SD], 79.1 [11.0] years; 3405 women [52.0%]) developed new-onset AF. The 1-year risk of thromboembolism was 0.8% (95% CI, 0.8%-0.8%) in patients without AF vs 2.1% (95% CI, 1.8%-2.5%) in patients with new-onset AF without anticoagulation; this risk was 1.4% (95% CI, 1.0%-2.0%) among patients with AF with intermediate stroke risk and 2.8% (95% CI, 2.3%-3.4%) in patients with AF with high stroke risk. Three-year risks were 3.5% (95% CI, 2.8%-4.3%) among patients with intermediate stroke risk and 5.3% (95% CI, 4.4%-6.5%) among patients with high stroke risk. Among patients with new-onset AF, 32.9% (95% CI, 31.8%-34.1%) had a new hospital contact with AF, and 14.0% (95% CI, 13.2%-14.9%) initiated anticoagulation therapy during the 3 years after incident AF diagnosis. At 3 years, the all-cause mortality rate was 25.7% (95% CI, 25.6%-25.9%) in patients with pneumonia without AF vs 49.8% (95% CI, 48.6%-51.1%) in patients with new-onset AF.

CONCLUSIONS AND RELEVANCE: This cohort study found that new-onset AF after community-acquired pneumonia was associated with an increased risk of thromboembolism, which may warrant anticoagulation therapy. Approximately one-third of patients had a new hospital or outpatient clinic contact for AF during the 3-year follow-up, suggesting that AF triggered by acute infections is not a transient, self-terminating condition that reverses with resolution of the infection.

PMID:35616941 | DOI:10.1001/jamanetworkopen.2022.13945

JAMA Netw Open. 2022 May 2;5(5):e2214171. doi: 10.1001/jamanetworkopen.2022.14171.

ABSTRACT

IMPORTANCE: In emergency epidemic and pandemic settings, public health agencies need to be able to measure the population-level attack rate, defined as the total percentage of the population infected thus far. During vaccination campaigns in such settings, public health agencies need to be able to assess how much the vaccination campaign is contributing to population immunity; specifically, the proportion of vaccines being administered to individuals who are already seropositive must be estimated.

OBJECTIVE: To estimate population-level immunity to SARS-CoV-2 through May 31, 2021, in Rhode Island, Massachusetts, and Connecticut.

DESIGN, SETTING, AND PARTICIPANTS: This observational case series assessed cases, hospitalizations, intensive care unit occupancy, ventilator occupancy, and deaths from March 1, 2020, to May 31, 2021, in Rhode Island, Massachusetts, and Connecticut. Data were analyzed from July 2021 to November 2021.

EXPOSURES: COVID-19-positive test result reported to state department of health.

MAIN OUTCOMES AND MEASURES: The main outcomes were statistical estimates, from a bayesian inference framework, of the percentage of individuals as of May 31, 2021, who were (1) previously infected and vaccinated, (2) previously uninfected and vaccinated, and (3) previously infected but not vaccinated.

RESULTS: At the state level, there were a total of 1 160 435 confirmed COVID-19 cases in Rhode Island, Massachusetts, and Connecticut. The median age among individuals with confirmed COVID-19 was 38 years. In autumn 2020, SARS-CoV-2 population immunity (equal to the attack rate at that point) in these states was less than 15%, setting the stage for a large epidemic wave during winter 2020 to 2021. Population immunity estimates for May 31, 2021, were 73.4% (95% credible interval [CrI], 72.9%-74.1%) for Rhode Island, 64.1% (95% CrI, 64.0%-64.4%) for Connecticut, and 66.3% (95% CrI, 65.9%-66.9%) for Massachusetts, indicating that more than 33% of residents in these states were fully susceptible to infection when the Delta variant began spreading in July 2021. Despite high vaccine coverage in these states, population immunity in summer 2021 was lower than planned owing to an estimated 34.1% (95% CrI, 32.9%-35.2%) of vaccines in Rhode Island, 24.6% (95% CrI, 24.3%-25.1%) of vaccines in Connecticut, and 27.6% (95% CrI, 26.8%-28.6%) of vaccines in Massachusetts being distributed to individuals who were already seropositive.

CONCLUSIONS AND RELEVANCE: These findings suggest that future emergency-setting vaccination planning may have to prioritize high vaccine coverage over optimized vaccine distribution to ensure that sufficient levels of population immunity are reached during the course of an ongoing epidemic or pandemic.

PMID:35616938 | DOI:10.1001/jamanetworkopen.2022.14171

Dermatol Ther (Heidelb). 2022 May 26. doi: 10.1007/s13555-022-00745-7. Online ahead of print.

ABSTRACT

INTRODUCTION: The tuberculosis (TB) positive conversion rate among psoriasis patients who received biologics has been reported worldwide, particularly in regions with low TB risk. Nonetheless, the TB-related safety of biologics such as adalimumab and secukinumab remains elusive in areas with high TB risk. According to the World Tuberculosis Report 2021, China is the country with the second highest TB burden, but data on TB conversion are also limited. Thus, we performed a retrospective, single-center study to profile the TB infection status conversion ratio among psoriasis patients treated with adalimumab and secukinumab in China.

METHODS: Patients were enrolled between April 2019 and February 2021 from West China Hospital, Sichuan University. Baseline and relevant clinical information were summarized, and proper statistical analysis was used under different conditions.

RESULTS: Five (5.43%) patients suffered TB conversion in the adalimumab group, two of whom developed active TB within the first 6 months. In the secukinumab group, four (5.26%) patients had TB positive conversion with no reports of active TB.

CONCLUSION: Our data show a relatively high rate of TB conversion among these psoriasis patients after mean treatment duration of 17.13 months. We recommend that, in patients who receive adalimumab, TB be reevaluated after the first 3 months and then monitored semiannually for the next 2 years. For patients treated with secukinumab, annual examination is sufficient.

PMID:35616884 | DOI:10.1007/s13555-022-00745-7

Ann Med. 2022 Dec;54(1):1538-1547. doi: 10.1080/07853890.2022.2076900.

ABSTRACT

BACKGROUND: Throughout the years significant progress has been observed in all medical fields. It was possible to achieve thanks to a wide range of scientists, including physician-scientists. However, in recent years their number is significantly declining. Thus we have aimed to explore the attitudes of medical students towards research.

METHODS: The cross-sectional study was conducted among medical students of Medical University of Warsaw between the 1st and 23rd of December 2019. Survey examining scientific interests and activities, opinions on selected research issues, and perception of potential barriers to research activities has been distributed to 838 students and collected from 695 (391 students of the 2nd year and 304 of the 5th year) with a response rate of 82.9%. Descriptive statistics, the Chi-squared test, U-Mann-Whitney, and Kruskal-Wallis tests were used for between-group comparisons. The differences were considered statistically significant if the p values were <.05.

RESULTS: 55.2% of responders rated their scientific interests in high school as high, with no significant differences between 2nd and 5th-year students. 33.8% (n = 233) of all students plan to pursue research activity after graduation, and 52.8% (n = 360) plan to obtain PhD title. Students who presented higher scientific interests in high school more often were involved in research projects at the university (24.7% vs 17.5%, p = .044), and showed higher interest in pursuing a research career (37.9% vs 28.9%, p = .02). Lack of time and knowledge on starting a research project were perceived as the main barriers to scientific work.

CONCLUSIONS: Many medical students express research interests, are involved in scientific projects, and plan to pursue their careers in this direction. There is a majority of students with lower attitudes towards research. Medical universities should consider adapting their curricula accordingly to accommodate the needs of both groups and respond to the shortage of physicians working in clinics and research.KEY MESSAGESOne-third of medical students plan to pursue career in medical research after graduation.Students who presented higher scientific interests in the high school are more often involved in research projects at the university and show higher interest in pursuing a research career.According to medical students, lack of time, resources and funding and insufficient knowledge how to start a research project are the most important barriers to research activity.

PMID:35616902 | DOI:10.1080/07853890.2022.2076900

Methods Mol Biol. 2022;2480:295-310. doi: 10.1007/978-1-0716-2241-4_16.

ABSTRACT

The efficient extraction and purification of recombinant proteins from leaf and seed tissues is often a challenging task, involving multiple steps that must be optimized by identifying and accommodating complex parameter interactions. Conventional one-factor-at-a-time approaches fail to reveal these complex interactions and often result in sub-optimal processes with unnecessary costs. Here, we describe generic considerations to identify global optima for the extraction and purification of recombinant proteins from complex plant matrices. The corresponding experiments can help to streamline downstream processing by reducing the time, costs, and number of unit operations. The procedure involves the knowledge-based selection of factors for screening, the systematic design and analysis of experiments, and the iterative refinement of suitable conditions. The resulting descriptive models can be used to guide process scale-up and offer scientific justifications for process development decisions in negotiations with regulatory authorities.

PMID:35616869 | DOI:10.1007/978-1-0716-2241-4_16

Environ Sci Pollut Res Int. 2022 May 26. doi: 10.1007/s11356-022-20989-2. Online ahead of print.

ABSTRACT

Three artificial intelligence (AI) data-driven techniques, including artificial neural network (ANN), support vector regression (SVR), and adaptive neuro-fuzzy inference system (ANFIS), were applied for modeling and predicting turbidity removal from water using graphene oxide (GO). Based on partial mutual information (PIM) algorithm, pH, GO dosage, and initial turbidity were selected as the input variables for developing the models. The prediction performance of the AI-based models was compared with each other and with the response surface methodology (RSM) model, previously reported by the authors, as well. The models’ estimation accuracy was assessed through statistical measures, including mean-squared error (MSE), root-mean-square error (RMSE), mean absolute error (MAE), and coefficient of determination (R²). Among the evaluated models, ANN had the highest estimation accuracy as it showed the highest R² for the validation data (0.949) and the lowest MSE, RMSE, and MAE values. Furthermore, ANN predicted 76.1% of data points with relative errors (RE) less than 10%. In contrast, the weakest prediction performance belonged to the SVR model with the lowest R² for both calibration (0.712) and validation (0.864) data. Besides, only 57.1% of the SVR’s predictions were characterized by RE < 10%. The ANFIS and RSM models exhibited a more or less similar performance in terms of R² for the validation data (0.877 and 0.871, respectively) and other statistical parameters. According to the results, the ANN technique is proposed as the best option for modeling the process. Nevertheless, as the RSM technique provides valuable information about the contribution of the independent operational parameters and their complex interaction effects using the least number of experiments, simulating the process by this technique before modeling by ANN is inevitable.

PMID:35616836 | DOI:10.1007/s11356-022-20989-2

J Assist Reprod Genet. 2022 May 26. doi: 10.1007/s10815-022-02500-5. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the cytogenetic risk of assisted reproductive technology (ART) by comparing the incidence of de novo chromosomal abnormalities between fetuses conceived via in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and natural conception.

MATERIALS AND METHODS: Prenatal invasive diagnostic testing (amniocentesis and cytogenetic analysis) was performed on 1496 fetuses conceived via IVF/ICSI (IVF/ICSI group) and 1396 fetuses from natural conception (NC group). The incidence of de novo chromosomal abnormalities (including aneuploidy and chromosomal structure abnormalities) was used to evaluate the cytogenetic risk of ART. For statistical analysis, χ²-test was used for binary dependent variable. The significance level was P < 0.05 and confidence interval was 95%.

RESULT(S): The IVF/ICSI group displayed a modest increase in the overall de novo chromosomal abnormality rate compared with that in the NC group but with no statistical significance (6.75% vs. 6.16%; χ² = 0.42, P > 0.05). The incidence of abnormal karyotypes was also not significantly different between the IVF/ICSI and NC groups in different maternal ages, including ≥ 35 years group (7.55% vs. 9.60%, χ² = 1.40, P > 0.05) and < 35 years group (6.20% vs. 4.54%, χ² = 2.51, P > 0.05). Moreover, there was no difference in the proportion of aneuploid and structural abnormalities in detected karyotypes between the IVF/ICSI and NC groups. Logistic regression analysis showed no significant association between the method of pregnancy and de novo chromosomal abnormalities (odds ratio (OR) 1.03; 95% CI 0.71-1.50; P = 0.86) after adjusting for other confounding factors.

CONCLUSION(S): Fetuses conceived via IVF/ICSI had a slight but not statistically significant increase in de novo abnormal karyotypes compared to those in naturally conceived fetuses. Our findings indicate no significant association between de novo fetal chromosomal abnormalities and the pregnancy method in high-risk pregnancies in the second trimester. For these pregnancies with a high risk but with a normal karyotype, further genetic testing is required for diagnosis.

PMID:35616756 | DOI:10.1007/s10815-022-02500-5

Graefes Arch Clin Exp Ophthalmol. 2022 May 26. doi: 10.1007/s00417-022-05709-3. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to investigate the effect of day-long face mask wearing on non-invasive tear break-up time (NI-BUT) in health care staff due to working schedules.

METHODS: Seventy-four right eyes of 74 participants were included in the study. Participants completed the Ocular Surface Disease Index (OSDI) questionnaire, and NI-BUT measurements were performed between 08.30-09.00 and 16.30-17.00 h. Participants with an initial NI-BUT measurement below 17 s were classified as group-1, and those over 17 s were classified as group-2. NI-BUT changes during the day and correlation to age, gender, and OSDI results were evaluated.

RESULTS: Thirty-eight women and 36 men, with a mean age of 30.9 ± 8.5 years, were included in the study. The mean OSDI score of the participants was 28.6 ± 17.1. NI-BUT means of group-1 at baseline and 8th hour were 11.4 ± 3.3 and 7.9 ± 3.6 s, respectively, and the mean NI-BUT at the 8th hour was statistically significantly lower than the baseline (p < 0.0001). Also, 24.2% (8 people) of those in group-2 had the 8th-hour NI-BUT value fallen into the measurable range (below 17 s). No significant correlation was found between the decrease in NI-BUT value and age, gender, and OSDI (p = 0.08, p = 0.3, and p = 0.2, respectively).

CONCLUSION: The use of face masks throughout the day leads to a significant reduction in NI-BUT, regardless of age, gender, and OSDI score. Prolonged use of face masks should be considered as a risk factor for evaporative dry eye disease.

PMID:35616726 | DOI:10.1007/s00417-022-05709-3

J Physician Assist Educ. 2022 Jun 1;33(2):122-126. doi: 10.1097/JPA.0000000000000429.

ABSTRACT

PURPOSE: Physician assistant (PA) graduates should be prepared to care for patients with substance use disorders. Medication-assisted therapy (MAT) allows PA graduates to provide that care by becoming licensed to prescribe buprenorphine. However, it is unclear how feasible and effective it is to implement online MAT waiver training during PA school. This study examined student knowledge and attitudes after training to assess its impact and perceived value.

METHODS: We conducted a 15-question survey after one class of students completed training during clinical rotations. Students self-reported pre/post change in awareness, knowledge, interest, comfort and confidence, perceived usefulness to practice, and assessed quality using 5-point Likert scale (higher scores = more positive) and narrative responses. Data analysis was performed using the Wilcoxon signed rank test and descriptive statistics. Free text comments were analyzed for themes using constant comparison.

RESULTS: Fifty-five (100%) students completed training within 6 weeks. The survey response rate was 49/55 (89%). Pre-to-post score changes were significant (p < .05) from +0.39 to +1.35 with the greatest changes seen in knowledge (+1.35), comfort (+1.14), awareness (+1.06), and confidence (+1.08); the lowest change was in interest (score change +0.39). Students reported being satisfied with content organization and quality (mean 3.82) and recommended training to colleagues (3.98); 82% reported they would have preferred 3 months to complete training; 46% would have preferred training prior to the start of clinical rotations. Major themes indicated a desire for better preparation and flexibility of platform, with ambivalence about relevance to practice.

CONCLUSION: Online MAT waiver training is feasible and effective. However, students may not be convinced of its relevance to future practice. Faculty should offer adequate preparation and optimize integration into existing curricula.

PMID:35616689 | DOI:10.1097/JPA.0000000000000429

Eur J Trauma Emerg Surg. 2022 May 26. doi: 10.1007/s00068-022-02002-0. Online ahead of print.

ABSTRACT

PURPOSE: Hybrid operating rooms benefit patients with severe trauma but have a prerequisite of significant resources. This paper proposes a practical triage method to determine patients that should enter the hybrid operating room considering a limited availability of medical resources.

METHODS: This retrospective observational study was conducted using the database from the Japan Trauma Data Bank comprising information collected between January 2004 and December 2018. A machine-learning-based triage algorithm was developed using the baseline demographics, injury mechanisms, and vital signs obtained from the database. The analysis dataset comprised information regarding 117,771 trauma patients with an abbreviated injury scale (AIS) > 3. The performance of the proposed model was compared against those of other statistical models [logistic regression and classification and regression tree (CART) models] while considering the status quo entry condition (systolic blood pressure < 90 mmHg).

RESULTS: The proposed trauma hybrid-suite entry algorithm (THETA) outperformed other pre-existing algorithms [precision-recall area under the curve: THETA (0.59), logistic regression model (0.22), and classification and regression tree (0.20)].

CONCLUSION: A machine-learning-based algorithm was developed to triage patient entry into hybrid operating rooms. Although the validation in a prospective multicentre arrangement is warranted, the proposed algorithm could be a potentially useful tool in clinical practice.

PMID:35616704 | DOI:10.1007/s00068-022-02002-0