Tag: pubmed

Radiat Res. 2022 Apr 22. doi: 10.1667/RADE-20-00269.1. Online ahead of print.

ABSTRACT

Radiation worker studies provide direct estimates of cancer risk after protracted low-dose exposures to external X-ray and gamma-ray irradiations. The National Registry for Radiation Workers (NRRW) started in 1976 and has become the largest epidemiological program of research on nuclear workers in the UK. Here, we report on the relationship between solid cancer incidence and external radiation at the low-dose levels in 172,452 NRRW cohort members of whom (90%) were men. This study is based on 5.25 million person-years of follow-up from 1955 through the end of 2011. In the range of accumulated low doses two-thirds of workers have doses of less than 10 mSv. This study is an updated analysis of solid cancer incidence data with an additional 10 years of follow-up over the previous analysis of the NRRW cohort (NRRW-3). A total of 18,310 cases of solid cancers based on a 10-year lag were registered and of these 43% of the solid cancer cases occurred during the latest 10 years. Poisson regression was used to investigate the relationship between solid cancers risk and protracted chronic low-dose radiation exposure. This study demonstrated for solid cancers a rapid decrease of risk at high external doses that appeared to be driven by the workers who were monitored for potential exposure to internal emitters and who had also received relatively high external doses. Among cohort members only exposed to external radiation, a strong association was found between external dose and solid cancers (ERR/Sv = 0.52, 95% CI: 0.11; 0.96, based on 13,199 cases). A similar pattern is also seen for lung cancer. Excluding lung cancer from the grouping of all solid cancers resulted in evidence of a linear association with external radiation dose (ERR/Sv = 0.24, 95% CI: 0.01; 0.49, based on 15,035 cases), so suggesting some degree of confounding by smoking. Statistically significantly increasing trends with dose were seen for cancers of the colorectal, bladder and pleura cancer. Some of these results should be treated with caution because of the limited corroborating evidence from other published studies. Information on internal doses as well as non-radiation factors such smoking would be helpful to make more definitive inferences.

PMID:35452522 | DOI:10.1667/RADE-20-00269.1

PLoS One. 2022 Apr 22;17(4):e0267534. doi: 10.1371/journal.pone.0267534. eCollection 2022.

ABSTRACT

BACKGROUND: Recruitment plays a vital role in conducting randomized control trials (RCTs). Challenges and failure of proper recruitment lead to early termination of trials. Monetary incentives have been suggested as a potential solution to these challenges. Therefore, we aimed to do a systematic review and analysis to evaluate the effect of incentives on the number of participants willing to consent to and participate in RCTs.

METHODS: Electronic databases were systematically searched from inception to September 23rd, 2021, using the following keywords: payments, incentive, response, participation, enrollment, randomized, randomization, and RCT. The Cochrane Risk of Bias tool was used to assess the quality of the included trials. Risk ratios (RRs) were calculated with their corresponding 95% confidence interval (CI). All analyses were done with the random-effects model. We used Revman software to perform the analysis.

RESULTS: Six RCTs with 6,253 Participants met the inclusion criteria. Our analysis showed significant improvement in response rate (RR: 1.27; 95% CI: 1.04, 1.55; P = 0.02) and consent rates (RR: 1.44; 95% CI: 1.11, 1.85; P = 0.006) when an incentive payment was offered to participants. Even a small amount of incentive showed significant improvement in both consent (RR: 1.33; 95% CI: 1.03, 1.73; P = 0.03) and response rates (RR: 1.26; 95% CI: 1.08, 1.47; P = 0.004).

CONCLUSION: In conclusion, our meta-analysis demonstrated statistically significant increases in the rate of consent and responses from participants when offered even small monetary value incentives. These findings suggest that incentives may be used to reduce the rate of recruitment failure and subsequent study termination. However, further RCTs are needed to establish a critical threshold beyond which incentive amount does not alter response rates further and the types of RCTs in which financial incentives are likely to be effective.

PMID:35452488 | DOI:10.1371/journal.pone.0267534

PLoS One. 2022 Apr 22;17(4):e0267340. doi: 10.1371/journal.pone.0267340. eCollection 2022.

ABSTRACT

BACKGROUND: Individuals who undergo total knee arthroplasty (TKA) for treatment of knee osteoarthritis often experience suboptimal outcomes. Investigation of neuromuscular control strategies in these individuals may reveal factors that contribute to these functional deficits. The purpose of this pilot study was to determine the relationship between patient function and modular control during gait before and after TKA.

METHODS: Electromyography data from 36 participants (38 knees) were collected from 8 lower extremity muscles on the TKA-involved limb during ≥5 over-ground walking trials before (n = 30), 6-months after (n = 26), and 24-months after (n = 13) surgery. Muscle modules were estimated using non-negative matrix factorization. The number of modules was determined from 500 resampled trials.

RESULTS: A higher number of modules was related to better performance-based and patient-reported function before and 6-months after surgery. Participants with organization similar to healthy, age-matched controls trended toward better function 24-months after surgery, though these results were not statistically significant. We also observed plasticity in the participants’ modular control strategies, with 100% of participants who were present before and 24-months after surgery (10/10) demonstrating changes in the number of modules and/or organization of at least 1 module.

CONCLUSIONS: This pilot work suggests that functional improvements following TKA may initially present as increases in the number of modules recruited during gait. Subsequent improvements in function may present as improved module organization.

NOTEWORTHY: This work is the first to characterize motor modules in TKA both before and after surgery and to demonstrate changes in the number and organization of modules over the time course of recovery, which may be related to changes in patient function. The plasticity of modular control following TKA is a key finding which has not been previously documented and may be useful in predicting or improving surgical outcomes through novel rehabilitation protocols.

PMID:35452480 | DOI:10.1371/journal.pone.0267340

PLoS One. 2022 Apr 22;17(4):e0267240. doi: 10.1371/journal.pone.0267240. eCollection 2022.

ABSTRACT

OBJECTIVE: The Stress Management and Resilience Training (SMART) program is an evidence-based intervention designed to build resilience in physicians in clinical practice. The objective of the current study was to assess the impact of the SMART program on academic physicians’ levels of resilience, subjective happiness, stress, and anxiety, and specifically during the implementation of a new hospital-wide Health Information System (HIS).

METHODS: A total of 40 physicians in a tertiary care academic hospital were randomized (allocation ratio 1:1) to either the SMART intervention or the control condition. The SMART intervention consisted of one mandatory two-hour in-person workshop and an optional 24-week online program, designed to support the materials delivered in the workshop. Outcome measures were assessed using validated scales administered online at baseline and at 3-months and 6-months follow-up.

RESULTS: After adjusting for baseline levels of each outcome, no statistically significant intervention effect was observed for resilience, subjective happiness, stress or anxiety at 3-months or 6-months follow-up. However, physicians in the intervention group demonstrated improvements in resilience, stress and anxiety at follow-up that were within the range of clinically relevant differences.

CONCLUSIONS: The findings of this exploratory study provide modest support that the SMART intervention may be beneficial for proactively addressing physician wellness during the implementation of a new HIS and that larger randomized trials are warranted.

TRIAL REGISTRATION: NCT04384861.

PMID:35452478 | DOI:10.1371/journal.pone.0267240

PLoS One. 2022 Apr 22;17(4):e0266823. doi: 10.1371/journal.pone.0266823. eCollection 2022.

ABSTRACT

In this contribution, we present an innovative data-driven model to reconstruct a reliable temporal pattern for time-lagged statistical monetary figures. Our research cuts across several domains regarding the production of robust economic inferences and the bridging of top-down aggregated information from central databases with disaggregated information obtained from local sources or national statistical offices. Our test bed case study is the European Regional Development Fund (ERDF). The application we discuss deals with the reported time lag between the local expenditures of ERDF by beneficiaries in Italian regions and the corresponding payments reported in the European Commission database. Our model reconstructs the timing of these local expenditures by back-dating the observed European Commission reimbursements. The inferred estimates are then validated against the expenditures reported from the Italian National Managing Authorities (NMAs) in terms of cumulative monetary difference. The lower cumulative yearly distance of our modelled expenditures compared to the official European Commission payments confirms the robustness of our model. Using sensitivity analysis, we also analyse the relative importance of the modelling parameters on the cumulative distance between the modelled and reported expenditures. The parameters with the greatest influence on the uncertainty of this distance are the following: first, how the non-clearly regionalised expenditures are attributed to individual regions; and second, the number of backward years that the residuals of the yearly payments are spread onto. In general, the distance between the modelled and reported expenditures can be further reduced by fixing these parameters. However, the gain is only marginal for some regions. The present study paves the way for modelling exercises that are aimed at more reliable estimates of the expenditures on the ground by the ultimate beneficiaries of European funds. Additionally, the output databases can contribute to enhancing the reliability of econometric studies on the effectiveness of European Union (EU) funds.

PMID:35452469 | DOI:10.1371/journal.pone.0266823

PLoS One. 2022 Apr 22;17(4):e0266077. doi: 10.1371/journal.pone.0266077. eCollection 2022.

ABSTRACT

Access to low-frequency acoustic information in cochlear implant patients leads to better speech understanding in noise. Electrocochleography (ECochG) can provide real-time feedback about the health of the cochlea during the insertion process with the potential to reduce insertion trauma. We describe our experiences of using this technique. Data from 47 adult subjects with measurable residual hearing and an Advanced Bionics (Valencia, CA) SlimJ (46) or MidScala (1) electrode array were analyzed. ECochGs were recorded intraoperatively via the implant. The surgeon adjusted the course of the electrode insertion based on drops in the ECochG. The final array position was assessed using postoperative imaging and pure tone thresholds were measured before and after surgery. Three different patterns of ECochG response amplitude were observed: Growth, Fluctuating and Total Loss. Subjects in the growth group showed the smallest postoperative hearing loss. However, the group with fluctuating amplitudes showed no meaningful correlation between the ECochG responses and the postoperative hearing loss, indicating that amplitude alone is insufficient for detecting damage. Considering the phase of the signal additionally to the amplitude and reclassifying the data by both the phase and amplitude of the response into three groups Type I-Type III produced statistically significant correlations between postoperative hearing loss and the grouping based on amplitude and phase respectively. We showed significantly better hearing preservation for Type I (no drop in amplitude) and Type II (drop with a concurrent phase shift), while Type III (drop without concurrent phase shift) had more surgery induced hearing loss. ECochG potentials measured through the implant could provide valuable feedback during the electrode insertion. Both the amplitude and phase of the ECochG response are important to consider. More data needs to be evaluated to better understand the impact of the different signal components to design an automated system to alert the surgeon ahead of damaging the cochlea.

PMID:35452461 | DOI:10.1371/journal.pone.0266077

PLoS One. 2022 Apr 22;17(4):e0267400. doi: 10.1371/journal.pone.0267400. eCollection 2022.

ABSTRACT

A variety of oxytocin regimens are used for labor induction and augmentation. Considering the increasing rates of labor induction, it is important to assess the most optimal oxytocin regimen without compromising maternal and fetal safety. The aim of this study was to compare delivery outcomes of low-dose and high-dose oxytocin induction protocols. This retrospective cohort study of 487 women comparing low-dose oxytocin protocol (n = 280) and high-dose oxytocin protocol (n = 207) in labor induction following cervical ripening by balloon catheter was performed in Helsinki University Hospital after implementation of a new oxytocin induction protocol. The study included two six-month cohorts from 2016 and 2019. Women with vital singleton pregnancies ≥37 gestational weeks, cephalic presentation, and intact amniotic membranes were included. The primary outcome was the rate of vaginal delivery. The secondary outcomes were the rates of maternal and neonatal infections, postpartum hemorrhage, umbilical artery blood pH-value, admission to neonatal intensive care, and induction-to-delivery interval. Statistical analyses were performed by using IBM SPSS Statistics for Windows (Armonk, NY, USA). The rate of vaginal delivery was higher [69.9% (n = 144) vs. 47.9% (n = 134); p<0.004] and the rates of maternal and neonatal infection were lower during the new high-dose oxytocin protocol [maternal infections 13.6% (n = 28) vs. 22.1% (n = 62); p = 0.02 and neonatal infection 2.9% (n = 6) vs. 14.6% (n = 41); p<0.001, respectively]. The rates of post-partum hemorrhage, umbilical artery blood pH-value <7.05 or neonatal intensive care admissions did not differ between the cohorts. The median induction-to-delivery interval was shorter in the new protocol [32.0 h (IQR 18.5-42.7) vs. 37.9 h (IQR 27.8-52.8); p<0.001]. In conclusion, implementation of the new continuous high-dose oxytocin protocol resulted in higher rate of vaginal delivery and lower rate of maternal and neonatal infections. Our experience supports the use of high-dose continuous oxytocin induction regimen with a practice of stopping oxytocin once active labor is achieved, and a 15-18-hour maximum duration for oxytocin induction in the latent phase of labor following cervical ripening with a balloon catheter.

PMID:35452451 | DOI:10.1371/journal.pone.0267400

PLoS Med. 2022 Apr 22;19(4):e1003967. doi: 10.1371/journal.pmed.1003967. eCollection 2022 Apr.

ABSTRACT

BACKGROUND: Taller adult height is associated with lower risks of ischemic heart disease in mendelian randomization (MR) studies, but little is known about the causal relevance of height for different subtypes of ischemic stroke. The present study examined the causal relevance of height for different subtypes of ischemic stroke.

METHODS AND FINDINGS: Height-associated genetic variants (up to 2,337) from previous genome-wide association studies (GWASs) were used to construct genetic instruments in different ancestral populations. Two-sample MR approaches were used to examine the associations of genetically determined height with ischemic stroke and its subtypes (cardioembolic stroke, large-artery stroke, and small-vessel stroke) in multiple ancestries (the MEGASTROKE consortium, which included genome-wide studies of stroke and stroke subtypes: 60,341 ischemic stroke cases) supported by additional cases in individuals of white British ancestry (UK Biobank [UKB]: 4,055 cases) and Chinese ancestry (China Kadoorie Biobank [CKB]: 10,297 cases). The associations of genetically determined height with established cardiovascular and other risk factors were examined in 336,750 participants from UKB and 58,277 participants from CKB. In MEGASTROKE, genetically determined height was associated with a 4% lower risk (odds ratio [OR] 0.96; 95% confidence interval [CI] 0.94, 0.99; p = 0.007) of ischemic stroke per 1 standard deviation (SD) taller height, but this masked a much stronger positive association of height with cardioembolic stroke (13% higher risk, OR 1.13 [95% CI 1.07, 1.19], p < 0.001) and stronger inverse associations with large-artery stroke (11% lower risk, OR 0.89 [0.84, 0.95], p < 0.001) and small-vessel stroke (13% lower risk, OR 0.87 [0.83, 0.92], p < 0.001). The findings in both UKB and CKB were directionally concordant with those observed in MEGASTROKE, but did not reach statistical significance: For presumed cardioembolic stroke, the ORs were 1.08 (95% CI 0.86, 1.35; p = 0.53) in UKB and 1.20 (0.77, 1.85; p = 0.43) in CKB; for other subtypes of ischemic stroke in UKB, the OR was 0.97 (95% CI 0.90, 1.05; p = 0.49); and for other nonlacunar stroke and lacunar stroke in CKB, the ORs were 0.89 (0.80, 1.00; p = 0.06) and 0.99 (0.88, 1.12; p = 0.85), respectively. In addition, genetically determined height was also positively associated with atrial fibrillation (available only in UKB), and with lean body mass and lung function, and inversely associated with low-density lipoprotein (LDL) cholesterol in both British and Chinese ancestries. Limitations of this study include potential bias from assortative mating or pleiotropic effects of genetic variants and incomplete generalizability of genetic instruments to different populations.

CONCLUSIONS: The findings provide support for a causal association of taller adult height with higher risk of cardioembolic stroke and lower risk of other ischemic stroke subtypes in diverse ancestries. Further research is needed to understand the shared biological and physical pathways underlying the associations between height and stroke risks, which could identify potential targets for treatments to prevent stroke.

PMID:35452448 | DOI:10.1371/journal.pmed.1003967

Aging (Albany NY). 2022 Apr 22;14(undefined). doi: 10.18632/aging.204022. Online ahead of print.

ABSTRACT

Lymphoma is accompanied by the impairment of multiple immune functions. Cytokines play an important role in a variety of immune-related functions and affect the tumor microenvironment. However, the exact regulatory mechanisms between them remain unclear. This study aimed to explore the cytokines expression and function in Hodgkin’s lymphoma (HL), diffuse large B-cell lymphoma (DLBCL), and mantle cell lymphoma (MCL). We performed a transcriptome integration analysis of 14 lymphoma datasets including 240 Hodgkin’s lymphoma, 891 diffuse large B-cell lymphoma, 216 mantle cell lymphoma, and 64 health samples. The results showed that multiple immune functions and signal pathway damage were shared by all three types of lymphoma, and these functions were related to cytokines. Furthermore, through co-expression network and functional interaction network analysis, we identified CXCL14 as a key regulator and it affects cell chemotaxis and migration functions. The functional experiment showed that CXCL14 knockdown inhibited cell migration in MCL cell lines. This study suggested that high expression of CXCL14 may aggravate MCL via promoting cell migration. Our findings provide novel insights into the biology of this disease and would be helpful for the pathogenesis study and drug discovery of lymphomas.

PMID:35452413 | DOI:10.18632/aging.204022

Hum Vaccin Immunother. 2022 Apr 22:1-7. doi: 10.1080/21645515.2022.2064134. Online ahead of print.

ABSTRACT

Mass vaccination is critical to control the pandemic of coronavirus disease 2019 (COVID-19). Fear of adverse events (AEs) after COVID-19 vaccination is a main factor associated with vaccination hesitancy. We aimed to analyze AEs in healthcare workers (HCWs) vaccinated with COVID-19 vaccines (Aikewei or CoronaVac) composed of inactivated virus. We used a structured self-administered questionnaire to conduct two surveys on COVID-19 vaccination among HCWs in perinatal medicine and obstetrics/gynecology from April 5 to April 21, 2021. In total, 1392 HCWs who had received at least one vaccine dose were included. Of them, 1264 (90.8%) were females and 1047 (75.2%) received two doses. The overall incidence of any AEs after the first and second dose was 38.2% (532/1392) and 31.0% (325/1047) respectively (χ2 = 13.506, P = .0002). Female and HCWs aged 18-30 y were more likely to report AEs. The most common AEs were local reaction, accounting for 48.1% and 67.4% of all AEs after the first and second dose respectively. The systemic AEs were mainly neurological (9.8% and 4.8% after the first and second injection respectively) and flu-like symptoms (6.3% and 3.2%). Overall, most of AEs were mild, only 5.1% (after the first dose) and 2.8% (after the second dose) of individuals with AEs received symptomatic treatment or sick leaves, and none of them required hospitalization. Our data added more evidence that inactivated COVID-19 vaccines are highly safe. The data are valuable to overcome vaccine hesitancy associated with concerns about the safety of COVID-19 vaccines.

PMID:35452357 | DOI:10.1080/21645515.2022.2064134