Tag: pubmed

J Anat. 2022 Apr 4. doi: 10.1111/joa.13662. Online ahead of print.

ABSTRACT

The relationship between the sagittal shape of the cervical spine and that of the thoracolumbar spine is established in the normal spine. Adolescent idiopathic scoliosis (AIS) is recognised as a change in the shape of the spine in both the coronal and sagittal planes. The effects of AIS on the alignment of the cervical spine, including the effects of surgery, has been less well studied. The objective of this study was to identify, using regression analysis, the significant relationships between the alignment of the thoracolumbar spine, in both the coronal and sagittal planes, and the sagittal alignment of the cervical spine in AIS. This study used coronal and sagittal radiographic measures from a group with AIS, both pre and post-operatively, which were analysed using multiple linear regression methods to identify significant parameters that explain the sagittal shape of the cervical spine. There were 51 pairs of pre and post-operative radiographs analysed, 40 of which were Lenke 1 curves and 11 Lenke 3 curves. Posterior spinal fusion was performed for all. The significant parameters pre-operatively were T1 slope, thoracic kyphosis, lumbar lordosis and SVA with an R² value of 78%. Post-operatively, the significant parameters were T1 slope, thoracic kyphosis, lumbar lordosis and thoracolumbar scoliosis with an R² of 63%. The sagittal alignment of the cervical spine in AIS is related to the shape of key parameters in the rest of the spine. Changes in the cervical sagittal shape occur to compensate for changes in shape to the rest of the spine that occur as a consequence of surgery. This has implications for the understanding of how the compensatory mechanisms of the spine are used to maintain a horizontal gaze, along with prediction of the effects of surgery on the shape of the spine.

PMID:35373348 | DOI:10.1111/joa.13662

Med J (Ft Sam Houst Tex). 2022 Apr-Jun;(Per 22-04/05/06):32-39.

ABSTRACT

BACKGROUND: Uncontested air movement and advances for medical care of combat casualties have resulted in a decreased case fatality rate. However, in future large-scale combat operations, the military has established a plan for multidomain operations to defeat near-peer adversaries. Prolonged casualty care and mass casualty scenarios will become more prevalent. Prehospital friendly scoring systems such as the shock index (SI) and revised trauma score (RTS) may provide useful triage data. Development of accurate, data-driven, triage systems will be key to optimize management of resources, care, and transport of combat casualties.

METHODS: We included data from the Department of Defense Trauma Registry between 01 January 2007 to 17 March 2020. Data comprised of adult US military or coalition service members for analysis as the baseline cohort, and those who died within 24 hours were included in the early death cohort. We performed statistical analysis on demographics and injury data, SI and RTS to measure the receiver operating characteristics (ROC) of each value to predict early death.

RESULTS: The early death cohort had a significantly higher injury severity score (25 vs. 5) and a higher percentage of serious injuries in every body region than the baseline cohort. The early death cohort sustained serious injuries to the head and neck at a rate five times that of the baseline cohort (43.4% vs 8.1%) with odds ratio (OR) of death 8.0 (95% confidence interval 5.7-11.1) followed by skin (13.6% versus 1.9%) with an OR of 6.3 (95% CI 3.8-10.3). The mean SI was 1.21 versus 0.80. The revised trauma score (RTS) was 4.18 versus 7.34. The RTS had a higher area under the receiver operating characteristic (0.896 versus 0.716 for SI).

CONCLUSIONS: Serious injuries to the head and skin were most strongly associated with death within the first 24 hours. The RTS appears to be a more accurate tool than SI alone for assessing injury mortality. Military medical personnel should consider these factors when triaging casualties during future conflicts in resource limited settings with delayed evacuation.

PMID:35373319

Eur J Public Health. 2022 Apr 4:ckac032. doi: 10.1093/eurpub/ckac032. Online ahead of print.

ABSTRACT

BACKGROUND: Low response rates in health surveys may affect the representativeness and generalizability of results if non-response is systematically related to the indicator of interest. To account for such potential bias, weighting procedures are widely used with an overall aim to obtain less biased estimates. The aim of this study was to assess the impact of applying calibrated weights on prevalence estimates of primary health care utilization among respondents compared to the entire sample of a representative Danish survey of adults aged ≥16 years.

METHODS: Registry-based 1-year prevalence data on health care utilization of chiropractor/physiotherapist, dentist and psychologist in 2016 were linked to the entire sample (n = 312 349), including respondents (n = 183 372), from the Danish National Health Survey in 2017. Calibrated weights, which applied information on e.g. sex, age, ethnic background, education and overall health service use were used to assess their impact on prevalence estimates among respondents.

RESULTS: Across all included types of health care, weighting for non-response decreased prevalence estimates among respondents, which resulted in less biased estimates. For example, the overall 1-year prevalence of chiropractor/physiotherapist, dentist and psychologist utilization decreased from 19.1% to 16.9%, 68.4% to 62.5% and 1.9% to 1.8%, respectively. The corresponding prevalence in the entire sample was 16.5%, 59.4% and 1.7%.

CONCLUSIONS: Applying calibrated weights to survey data to account for non-response reduces bias in primary health care utilization estimates. Future studies are needed to explore the possible impact of weighting on other health estimates.

PMID:35373254 | DOI:10.1093/eurpub/ckac032

Eur Heart J Acute Cardiovasc Care. 2022 Apr 4:zuac036. doi: 10.1093/ehjacc/zuac036. Online ahead of print.

NO ABSTRACT

PMID:35373250 | DOI:10.1093/ehjacc/zuac036

Ann Acad Med Singap. 2022 Mar;51(3):170-179.

ABSTRACT

INTRODUCTION: Adults aged ≥60 years contribute to disproportionately higher visits to the emergency departments (ED). We performed a systematic review to examine the reasons why older persons visit the ED in Singapore.

METHODS: We searched Medline, Embase and Scopus from January 2000 to December 2021 for studies reporting on ED utilisation by older adults in Singapore, and included studies that investigated determinants of ED utilisation. Statistically significant determinants and their effect sizes were extracted. Determinants of ED utilisation were organised using Andersen and Newman’s model. Quality of studies was evaluated using Newcastle Ottawa Scale and Critical Appraisal Skills Programme.

RESULTS: The search yielded 138 articles, of which 7 were used for analysis. Among the significant individual determinants were predisposing (staying in public rental housing, religiosity, loneliness, poorer coping), enabling (caregiver distress from behavioural and psychological symptoms of dementia) and health factors (multimorbidity in patients with dementia, frailty, primary care visit in last 6 months, better treatment adherence). The 7 included studies are of moderate quality and none of them employed conceptual frameworks to organise determinants of ED utilisation.

CONCLUSION: The major determinants of ED utilisation by older adults in Singapore were largely individual factors. Evaluation of societal determinants of ED utilisation was lacking in the included studies. There is a need for a more holistic examination of determinants of ED utilisation locally based on conceptual models of health seeking behaviours.

PMID:35373240

Front Digit Health. 2022 Mar 18;4:798895. doi: 10.3389/fdgth.2022.798895. eCollection 2022.

ABSTRACT

INTRODUCTION: Self-regulation has been implicated in health risk behaviors and is a target of many health behavior interventions. Despite most prior research focusing on self-regulation as an individual-level trait, we hypothesize that self-regulation is a time-varying mechanism of health and risk behavior that may be influenced by momentary contexts to a substantial degree. Because most health behaviors (e.g., eating, drinking, smoking) occur in the context of everyday activities, digital technologies may help us better understand and influence these behaviors in real time. Using a momentary self-regulation measure, the current study (which was part of a larger multi-year research project on the science of behavior change) used ecological momentary assessment (EMA) to assess if self-regulation can be engaged and manipulated on a momentary basis in naturalistic, non-laboratory settings.

METHODS: This one-arm, open-label exploratory study prospectively collected momentary data for 14 days from 104 participants who smoked regularly and 81 participants who were overweight and had binge-eating disorder. Four times per day, participants were queried about momentary self-regulation, emotional state, and social and environmental context; recent smoking and exposure to smoking cues (smoking sample only); and recent eating, binge eating, and exposure to binge-eating cues (binge-eating sample only). This study used a novel, momentary self-regulation measure comprised of four subscales: momentary perseverance, momentary sensation seeking, momentary self-judgment, and momentary mindfulness. Participants were also instructed to engage with Laddr, a mobile application that provides evidence-based health behavior change tools via an integrated platform. The association between momentary context and momentary self-regulation was explored via mixed-effects models. Exploratory assessments of whether recent Laddr use (defined as use within 12 h of momentary responses) modified the association between momentary context and momentary self-regulation were performed via mixed-effects models.

RESULTS: Participants (mean age 35.2; 78% female) in the smoking and binge-eating samples contributed a total of 3,233 and 3,481 momentary questionnaires, respectively. Momentary self-regulation subscales were associated with several momentary contexts, in the combined as well as smoking and binge-eating samples. For example, in the combined sample momentary perseverance was associated with location, positively associated with positive affect, and negatively associated with negative affect, stress, and tiredness. In the smoking sample, momentary perseverance was positively associated with momentary difficulty in accessing cigarettes, caffeine intake, and momentary restraint in smoking, and negatively associated with temptation and urge to smoke. In the binge-eating sample, momentary perseverance was positively associated with difficulty in accessing food and restraint in eating, and negatively associated with urge to binge eat. While recent Laddr use was not associated directly with momentary self-regulation subscales, it did modify several of the contextual associations, including challenging contexts.

CONCLUSIONS: Overall, this study provides preliminary evidence that momentary self-regulation may vary in response to differing momentary contexts in samples from two exemplar populations with risk behaviors. In addition, the Laddr application may modify some of these relationships. These findings demonstrate the possibility of measuring momentary self-regulation in a trans-diagnostic way and assessing the effects of momentary, mobile interventions in context. Health behavior change interventions may consider measuring and targeting momentary self-regulation in addition to trait-level self-regulation to better understand and improve health risk behaviors. This work will be used to inform a later stage of research focused on assessing the transdiagnostic mediating effect of momentary self-regulation on medical regimen adherence and health outcomes.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, Identifier: NCT03352713.

PMID:35373179 | PMC:PMC8971561 | DOI:10.3389/fdgth.2022.798895

Ann Acad Med Singap. 2022 Mar;51(3):143-148.

ABSTRACT

INTRODUCTION: Identifying peripheral arterial disease (PAD) during diabetic foot screening (DFS) is crucial in reducing the risk of diabetic foot ulcerations and lower limb amputations. Screening assessments commonly used include absolute systolic toe pressure (ASTP) and toe-brachial index (TBI). There is a lack of research defining the threshold values of both assessment methods. We aimed to compare the accuracy of ASTP and TBI and establish optimal threshold values of ASTP and TBI with reference to the internationally accepted ankle-brachial pressure index (ABPI) screening test, for a multiethnic diabetic population in Singapore.

METHODS: A retrospective, observational study of DFS results from January 2017 to December 2017 was conducted. Receiver operating characteristic analysis was conducted for ASTP and TBI using the internationally accepted ABPI cut-off value of ≤0.9 to indicate PAD.

RESULTS: A total of 1,454 patients with mean (standard deviation) age of 63.1 (12.4) years old were included. There were 50.8% men and 49.2% women, comprising 69.7% Chinese, 13.5% Indian, 10.1% Malay and 6.7% other ethnicities. Areas under the curve for ASTP and TBI were 0.89 (95% confidence interval [Cl] 0.85-0.94) and 0.94 (95% Cl 0.90-0.98), respectively, and the difference was statistically significant (P<0.001). Derived optimal threshold values to indicate ABPI≤0.9 for ASTP and TBI were <95.5mmHg (specificity 0.86, sensitivity 0.84) and <0.7 (specificity 0.89, sensitivity 0.95), respectively.

CONCLUSION: ASTP or TBI may be used to detect ABPI-determined PAD in DFS. The optimal threshold values derived from a multiethnic Asian diabetic population were <95.5mmHg for ASTP and <0.7 for TBI.

PMID:35373237

Zhonghua Kou Qiang Yi Xue Za Zhi. 2022 Apr 9;57(4):346-351. doi: 10.3760/cma.j.cn112144-20220207-00046. Online ahead of print.

ABSTRACT

Objective: To evaluate the pink and white esthetics of conventional and socket shield technique (SST) immediate implant restoration. Methods: Thirty volunteers were recruited according to preset criteria, and were assigned to 3 groups. Natural teeth group (ten undergraduates or postgraduates from Peking University School and Hospital of Stomatology in January 2020, n=10): all volunteers’ maxillary anterior teeth were natural teeth with healthy gingiva, and none of the teeth were restored by crowns or composite. Conventional group and SST group (patients had a maxillary central incisor immediate implant placed in Department of Prosthodontics, Peking University School and Hospital of Stomatology during October 2016 to January 2021, n=10 for each group): the volunteer had an unrestored natural maxillary central incisor, and the contralateral maxillary central incisor was restored by conventional or SST immediate implant placement, temporization and all ceramic final restoration, photos were taken 12 months post-surgery. Three groups of evaluators namely layperson (staff from Second Clinical Division of Peking University School and Hospital of Stomatology and 2 family members, n=10), dental students (class 2015 undergraduates from Peking University School and Hospital of Stomatology, n=10) and prosthodontists (from Department of Prosthodontics, Peking University School and Hospital of Stomatology, n=10) were invited to assess the esthetics using pink esthetic score (PES) and white esthetic score (WES). The results were statistically analyzed. Results: PES and WES of natural teeth group [9(8, 10) and 8(7, 10)] were significantly higher than conventional group [7(6,8) and 7(6,9)] (H=287.08, 132.79,P<0.01) and SST group [7(6, 9) and 8(7, 9)] (H=216.01, 101.21, P<0.01). SST group yielded higher PES than the conventional group (H=-71.06, P=0.002), yet had similar WES (H=-31.57, P=0.391). Dental students had significant lower PES and WES than prosthodontists (H=-120.90, -218.86, P<0.01) and layperson (H=-109.55, 134.97, P<0.01). Prosthodontists and layperson got similar PES (H=-11.36, P=0.587), however yielded different WES (H=-83.89, P<0.01). Conclusions: SST immediate implant placement obtained better pink esthetics than conventional protocol 12-month after implant surgery, profession may have significant impact on evaluators during pink and white esthetic evaluation.

PMID:35368160 | DOI:10.3760/cma.j.cn112144-20220207-00046

Adv Healthc Mater. 2022 Apr 3:e2102800. doi: 10.1002/adhm.202102800. Online ahead of print.

ABSTRACT

Secreted proteins provide abundant functional information on living cells and can be used as important tumor diagnostic markers, of which profiling at the single-cell level is helpful for accurate tumor cell classification. Currently, achieving living single-cell multi-index, high-sensitivity and quantitative secretion biomarker profiling remains a great challenge. Here, a high-throughput living single-cell multi-index secreted biomarker profiling platform is proposed, combined with machine learning, to achieve accurate tumor cell classification. A single-cell culture microfluidic chip with self-assembled graphene oxide quantum dots (GOQDs) enables high-activity single-cell culture, ensuring normal secretion of biomarkers and high-throughput single-cell separation, providing sufficient statistical data for machine learning. At the same time, the antibody barcode chip with self-assembled GOQDs performs multi-index, highly sensitive and quantitative detection of secreted biomarkers, in which each cell culture chamber covers a whole barcode array. Importantly, by combining the K-means strategy with machine learning, thousands of single tumor cell secretion data are analyzed, enabling tumor cell classification with a recognition accuracy of 95.0%. In addition, further profiling of the grouping results reveals the unique secretion characteristics of subgroups. This work provides an intelligent platform for high-throughput living single-cell multiple secretion biomarker profiling, which has broad implications for cancer investigation and biomedical research. This article is protected by copyright. All rights reserved.

PMID:35368151 | DOI:10.1002/adhm.202102800

Ecol Appl. 2022 Apr 3:e2616. doi: 10.1002/eap.2616. Online ahead of print.

ABSTRACT

Regime shifts have large consequences for ecosystems and the services they provide. However, understanding the potential for, causes of, proximity to, and thresholds for regimes shifts in nearly all settings is difficult. Generic statistical indicators of resilience have been proposed and studied in a wide range of ecosystems as a method to detect when regime shifts are becoming more likely without direct knowledge of underlying system dynamics or thresholds. These early warning statistics (EWS) have been studied separately but there have been few examples that directly compare temporal and spatial EWS in ecosystem-scale empirical data. To test these methods, we collected high-frequency time series and high-resolution spatial data during a whole-lake fertilization experiment while also monitoring an adjacent reference lake. We calculated two common EWS, standard deviation and autocorrelation, in both time series and spatial data to evaluate their performance prior to the resulting algal bloom. We also applied the quickest detection method to generate binary alarms of resilience change from temporal EWS. One temporal EWS, rolling window standard deviation, provided advanced warning in most variables prior to the bloom, showing trends and between-lake patterns consistent with theory. In contrast, temporal autocorrelation and both measures of spatial EWS (spatial SD, Moran’s I) provided little or no warning. By compiling time series data from this and past experiments with and without nutrient additions, we were able to evaluate temporal EWS performance for both constant and changing resilience conditions. True positive alarm rates were 2.5 – 8.3 times higher for rolling window standard deviation when a lake was being pushed towards a bloom than the rate of false positives when it was not. For rolling window autocorrelation, alarm rates were much lower and no variable had a higher true positive than false positive alarm rate. Our findings suggest temporal EWS provide advanced warning of algal blooms and that this approach could help managers prepare for and/or minimize negative bloom impacts.

PMID:35368134 | DOI:10.1002/eap.2616