Tag: pubmed

Epidemiology. 2022 Oct 18. doi: 10.1097/EDE.0000000000001561. Online ahead of print.

ABSTRACT

BACKGROUND: Traditional surveillance of adverse infant outcomes following maternal medication exposures relies on pregnancy exposure registries, which are often underpowered. We characterize the statistical power of TreeScan™, a data mining tool, to identify potential signals in the setting of perinatal medication exposures and infant outcomes.

METHODS: We used empirical data to inform background incidence of major congenital malformations and other birth conditions. Statistical power was calculated using two probability models compatible with TreeScan, Bernoulli, and Poisson, while varying the sample size, magnitude of the risk increase, and incidence of a specified outcome. We also simulated larger exposure to referent matching ratios when using the Bernoulli model in the setting of fixed N:1 propensity score matching. Finally, we assessed the impact of outcome misclassification on power.

RESULTS: The Poisson model demonstrated greater power to detect signals than the Bernoulli model across all scenarios and suggested a sample size of 4,000 exposed pregnancies is needed to detect a twofold increase in risk of a common outcome (approximately 8 per 1,000) with 85% power. Increasing the fixed matching ratio with the Bernoulli model did not reliably increase power. An outcome definition with high sensitivity is expected to have somewhat greater power to detect signals than an outcome definition with high positive predictive value.

CONCLUSIONS: Use of the Poisson model with an outcome definition that prioritizes sensitivity may be optimal for signal detection. TreeScan is a viable method for surveillance of adverse infant outcomes following maternal medication use.

PMID:36252086 | DOI:10.1097/EDE.0000000000001561

Proc Natl Acad Sci U S A. 2022 Oct 25;119(43):e2212114119. doi: 10.1073/pnas.2212114119. Epub 2022 Oct 17.

ABSTRACT

Quantum mechanics revolutionized chemists’ understanding of molecular structure. In contrast, the kinetics of molecular reactions in solution are well described by classical, statistical theories. To reveal how the dynamics of chemical systems transition from quantum to classical, we study femtosecond proton transfer in a symmetric molecule with two identical reactant sites that are spatially apart. With the reaction launched from a superposition of two local basis states, we hypothesize that the ensuing motions of the electrons and nuclei will proceed, conceptually, in lockstep as a superposition of probability amplitudes until decoherence collapses the system to a product. Using ultrafast spectroscopy, we observe that the initial superposition state affects the reaction kinetics by an interference mechanism. With the aid of a quantum dynamics model, we propose how the evolution of nuclear wavepackets manifests the unusual intersite quantum correlations during the reaction.

PMID:36252025 | DOI:10.1073/pnas.2212114119

Diabetes Care. 2022 Oct 17:dc221267. doi: 10.2337/dc22-1267. Online ahead of print.

NO ABSTRACT

PMID:36251985 | DOI:10.2337/dc22-1267

Surg Infect (Larchmt). 2022 Oct 13. doi: 10.1089/sur.2022.238. Online ahead of print.

ABSTRACT

Background: The Study to Optimize Peritoneal Infection Therapy (STOP-IT) Trial identified an association between prolonged antibiotic therapy and delayed identification of recurrent intra-abdominal infection (IAI). However, this association has not been observed in other studies. The purpose of this study was to evaluate the association between recurrent IAIs and the duration of antibiotic agents. Patients and Methods: Adult patients from 2016 to 2020 who underwent a source control procedure for a colon-related complicated IAI were identified. Patients not meeting the inclusion criteria were excluded. Demographics, comorbidities, post-operative antibiotic duration, and presence of secondary intra-abdominal infection were recorded. The primary outcome was the time to identification of secondary IAI. Delayed identification of recurrent infection was identified as 10 or more days following source control procedure. Statistical analysis using χ², Fisher exact, and Wilcoxon rank sum were used where appropriate. Results: Seventy-six of the patients identified met inclusion criteria, and 17 (22.4%) of those patients had a recurrent IAI. Patients with recurrent infections were slightly younger (64 vs. 60 years; p = 0.01) and had lower rates of pre-operative anticoagulation (50.8% vs. 17.6%). There were no differences in the initial length of antibiotic therapy after source control between the recurrent infection and non-recurrent groups (p = 0.6). There was a difference in total days of antibiotic use between the two groups, with the recurrent infection group averaging 10 more days of antibiotic use than the non-recurrence group (p < 0.0001). In those patients with a recurrence, there were no differences in median days to identification (9 vs. 11.5 days; p = 0.29) or the rate of those with delayed identification of recurrent infection (44.4% vs. 75%; p = 0.33). Conclusions: Similar to the STOP-IT Trial we failed to identify an association between the duration of post-operative antibiotic agents and recurrent infection. However, we further failed to identify an association between the prolonged post-operative courses and the timing of identification of the recurrent infection. Further evaluation is needed to determine if prolonged therapy delays the identification of recurrent infection.

PMID:36251958 | DOI:10.1089/sur.2022.238

Surg Infect (Larchmt). 2022 Oct 14. doi: 10.1089/sur.2022.217. Online ahead of print.

ABSTRACT

Background: International guidelines advise against prophylactic antimicrobial agents for primarily closed surgical incisions, but most oculoplastic surgeons report using chloramphenicol ointment. We evaluated baseline surgical site infection (SSI) rates in patients undergoing eyelid surgery who received prophylactic chloramphenicol ointment post-operatively. Withdrawal of prophylaxis was then prospectively audited to establish whether infection rates changed in a clinically meaningful way. This article reports the early findings. Patients and Methods: A single-center retrospective audit was undertaken; electronic medical records were reviewed for consecutive patients who underwent eyelid surgery with primary incision closure. All patients received post-operative prophylactic chloramphenicol. Those with histopathologic evidence of malignancy were excluded. Patient demographics, surgical details, evidence of post-operative SSI and other complications were recorded. Local policy was changed in accordance with national guidelines; prophylactic chloramphenicol ointment was withheld, and the above information collected prospectively. Our policy excluded skin malignancies, full thickness skin grafts, patients on systemic immunosuppression, and diabetes mellitus because of potential increased infection risk. Results: There were no statistically significant differences between the groups, except seniority of surgeon. Surgical site infection was identified in 14 of 872 eyes (1.6%) receiving post-operative chloramphenicol, and three of 133 eyes (2.25%) without antibiotic agents, which was not statistically significant. Conclusions: Post-operative SSI rates in eyelid surgery are low. Routine use of prophylactic antibiotic agents in primarily closed surgical eyelid incisions does not adhere to international standards and may contribute to antimicrobial resistance. Early results suggest infection rates remain low without prophylactic chloramphenicol; clinicians should consider withdrawing it from routine practice in suitable patients.

PMID:36251956 | DOI:10.1089/sur.2022.217

J Womens Health (Larchmt). 2022 Oct 11. doi: 10.1089/jwh.2022.0205. Online ahead of print.

ABSTRACT

Introduction: Most women take medication during pregnancy despite limited scientific evidence on safety. We investigated medication use, including changes in and reasons for changes in use during pregnancy, with attention to medication use in pregnant women with chronic conditions. Materials and Methods: We conducted an online survey of pregnant women aged ≥18 years (n = 1,226). We calculated descriptive statistics for aspects of medication use and performed multivariable logistic regression to examine associations between change in use and chronic conditions. Results: Seventy-nine percent of women took at least one medication during pregnancy. Among those, 63.2% made at least one medication change: 42.0% started, 34.9% stopped, 30.0% missed dose(s), and 18.1% lowered dose(s) from that originally prescribed or recommended. More than a third (36.5%) of women who stopped, lowered, or missed medication did so independent of health care provider advice; 54.0% cited concern about birth or developmental defects as reasons for change. Odds of medication change were higher for women with chronic conditions: digestive conditions-starting (adjusted odds ratio [AOR] = 1.8, 95% confidence interval [CI] = 1.1-2.7), stopping (AOR = 2.1, 95% CI = 1.4-3.3), and lowering (AOR = 2.4, 95% CI = 1.7-3.3) medication; mental health conditions-starting (AOR = 1.6, 95% CI = 1.2-2.2), stopping (AOR = 3.0, 95% CI = 2.3-4.0), or missing (AOR = 2.1, 95% CI = 1.6-2.8) medication; pain conditions-stopping (AOR = 2.9, 95% CI = 2.0-4.2); and respiratory conditions-starting (AOR = 2.0, 95% CI = 1.3-3.1), stopping (AOR = 1.7, 95% CI = 1.1-2.6), and missing (AOR = 2.2, 95% CI = 1.4-3.4) medication. Conclusions: Most pregnant women take medication and many, including those with chronic conditions, change their medication use during pregnancy. Medication change may occur independent of health care provider advice and due to women’s safety concerns.

PMID:36251939 | DOI:10.1089/jwh.2022.0205

J Speech Lang Hear Res. 2022 Oct 12:1-11. doi: 10.1044/2022_JSLHR-21-00572. Online ahead of print.

ABSTRACT

PURPOSE: Augmentative and alternative communication (AAC) systems are important to support communication for individuals with complex communication needs. A recent addition to AAC system options is the brain-computer interface (BCI). This study aimed to compare the clinical application of the P300 speller BCI with two more common AAC systems, the EyeLink board, and an eye-tracking camera.

METHOD: Ten participants without communication impairment (18-35 years of age) used each of the three AAC systems to spell three-letter words in one session. Accuracy and speed of letter selection were measured, and questionnaires were administered to evaluate usability, cognitive workload, and user preferences.

RESULTS: The results showed that the BCI was significantly less accurate, slower, and with lower usability and higher cognitive workload compared to the eye-tracking camera and EyeLink board. Participants rated the eye-tracking camera as the most favorable AAC system on all measures.

CONCLUSIONS: The results demonstrated that while the P300 speller BCI was usable by most participants, it did not function as well as the eye-tracking camera and EyeLink board. The clinical use of the BCI is, therefore, currently difficult to justify for most individuals, particularly when considering the substantial cost and setup resourcing needed.

SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21291384.

PMID:36251867 | DOI:10.1044/2022_JSLHR-21-00572

IEEE Trans Pattern Anal Mach Intell. 2022 Oct 17;PP. doi: 10.1109/TPAMI.2022.3214832. Online ahead of print.

ABSTRACT

Graphs are important data representations for describing objects and their relationships, which appear in a wide diversity of real-world scenarios. As one of a critical problem in this area, graph generation considers learning the distributions of given graphs and generating more novel graphs. Owing to their wide range of applications, generative models for graphs, which have a rich history, however, are traditionally hand-crafted and only capable of modeling a few statistical properties of graphs. Recent advances in deep generative models for graph generation is an important step towards improving the fidelity of generated graphs and paves the way for new kinds of applications. This article provides an extensive overview of the literature in the field of deep generative models for graph generation. Firstly, the formal definition of deep generative models for the graph generation and the preliminary knowledge are provided. Secondly, taxonomies of deep generative models for both unconditional and conditional graph generation are proposed respectively; the existing works of each are compared and analyzed. After that, an overview of the evaluation metrics in this specific domain is provided. Finally, the applications that deep graph generation enables are summarized and five promising future research directions are highlighted.

PMID:36251910 | DOI:10.1109/TPAMI.2022.3214832

Plast Reconstr Surg. 2022 Oct 18. doi: 10.1097/PRS.0000000000009783. Online ahead of print.

ABSTRACT

BACKGROUD: Despite clinical concerns associated with pediatric traumatic brain injuries (TBIs), they remain grossly underreported. This is the first retrospective study to characterize concomitant pediatric TBI and CMF trauma patients, including frequency, presentation, documentation, and outcomes.

METHODS: An IRB-approved retrospective cohort study was performed to identify all pediatric patients presenting with CMF fractures at a high volume, tertiary trauma center between the years 1990 and 2010. Patient charts were reviewed for demographic information, presentation, operative management, length of stay, mortality at two years, dentition, CMF fracture patterns, and concomitant TBIs. Data was analyzed using two-tailed Student’s t-tests and chi square analysis. A P value ≤ 0.05 was considered statistically significant.

RESULTS: Of the 2966 pediatric CMF trauma patients identified and included for analysis (mean age of 7 ± 4.7 years old, predominantly Caucasian [59.8%], and male [64.0%]), 809 had concomitant TBI (frequency of 27.3%). Only 1.6% of the TBI cases were documented in charts. Mortality at two years, length of stay in hospital, and time to follow up significantly increased from mild to severe TBIs. Concomitant TBI were more common with skull & upper third fractures than CMF trauma without TBI (81.8% vs 61.1%, P < 0.05).

CONCLUSIONS: Concomitant TBI injuries were present in a significant number of pediatric CMF trauma cases but was not documented for most cases. Craniomaxillofacial surgeons should survey all pediatric CMF trauma patients for TBI and manage with neurology and/or neurosurgery teams. Future prospective studies are necessary to characterize and generate practice guiding recommendations.

PMID:36251865 | DOI:10.1097/PRS.0000000000009783

Adv Clin Exp Med. 2022 Oct 17. doi: 10.17219/acem/153417. Online ahead of print.

ABSTRACT

INTRODUCTION: The kangaroo mother care (KMC) technique for preterm and low-birthweight (LBW) neonates, which consists of skin-to-skin contact, is thought to have a beneficial impact on clinical outcomes. Hence, the current meta-analysis aims to evaluate the influence of KMC on neonatal mortality and length of hospitalization compared with conventional care.

MATERIAL AND METHODS: A systematic literature search of studies published between 1988 and 2021 found 24 trials involving 19,980 participants, of which 10,354 received KMC and 9626 were controls under conventional care. To measure the impact of applying KMC in preterm LBW neonates on mortality and the length of hospital stay, statistical analysis using dichotomous and continuous analysis methods was performed employing fixed and random models to calculate odds ratios (ORs) with 95% confidence intervals (95% CIs).

RESULTS: Compared to the control group, the application of KMC in preterm LBW neonates resulted in significantly lower mortality (OR: 0.65, 95% CI: 0.44-0.97, p = 0.03) in a short term (within 2 months, I2 = 71%) and long term (3-12 months) (OR: 0.72, 95% CI: 0.59-0.87, p = 0.0007, I2 = 0%), and had no significant impact on the length of hospital stay (OR: -1.43, 95% CI: -2.88-0.02, p = 0.05, I2 = 86%).

CONCLUSION: In comparison with the control group, the implementation of KMC in preterm LBW neonates resulted in significantly lower mortality but had no significant impact on the length of hospitalization. More studies are needed to confirm the current findings.

PMID:36251794 | DOI:10.17219/acem/153417