Tag: pubmed

Sci Total Environ. 2021 Jul 9;796:148943. doi: 10.1016/j.scitotenv.2021.148943. Online ahead of print.

ABSTRACT

Environmental factor-driven bacterial diversity could be an indicator for evaluating ecosystem multifunctionality (EMF). However, little is known about interconnections between EMF and the community diversity of rare and abundant phoD-harboring bacteria responsible for organic phosphorus mineralization. Illumina MiSeq sequencing and multiple statistical analyses were used to evaluate diversity maintenance of rare and abundant phoD-harboring bacteria at both taxonomic and phylogenetic levels and their contributions to soil EMF in the subtropical Shennongjia primeval forest. We found that rare phoD-harboring bacteria exhibited higher community diversity and broader environmental breadths than abundant ones, while abundant phoD-harboring bacteria showed closer phylogenetic clustering and stronger phylogenetic signals of ecological preferences than rare ones. Stochastic processes dominated community assemblies of rare and abundant phoD-harboring bacteria, and temperature was an important environmental variable adjusting the balance between stochastic and deterministic processes. The taxonomic α-diversity of rare phoD-harboring bacteria showed larger contribution to soil EMF than that of abundant ones, while the phylogenetic α-diversity of abundant phoD-harboring bacteria contributed significantly more than that of rare ones. Our findings enrich knowledge of the environmental adaptation of rare and abundant phoD-harboring bacteria, and highlight linkages between soil EMF and the diversity of rare and abundant phoD-harboring bacteria at both the taxonomic and phylogenetic levels.

PMID:34265611 | DOI:10.1016/j.scitotenv.2021.148943

Int J Nurs Stud. 2021 Jun 26;121:104012. doi: 10.1016/j.ijnurstu.2021.104012. Online ahead of print.

ABSTRACT

BACKGROUND: Case management has been developed and suggested as a method for improving the quality of dementia care by optimising care service and delivery using a feasible and cost-effective approach. However, the effects of case management for improving dementia care remain inconclusive.

AIM: To analyse the efficacy of case management interventions for people with dementia and their carers.

DESIGN: Systematic review and meta-analysis.

METHODS: This study conducted a systematic review of the literature from January 1, 2002, to March 15, 2021, indexed in the following databases: Academic Search Complete, CINAHL, Cochrane Library, EMBASE, MEDLINE, PubMed, OVID, and Web of Science. Intervention studies examining patients with dementia and their carers published in the English language were included. The methodological quality of included studies was evaluated using the PEDro scale. The meta-analysis was performed using a random-effects model to calculate the pooled standardised mean difference (SMD) of case management intervention outcomes for both people with dementia (cognitive function, neuropsychiatric symptoms, and quality of life) and their carers (carer burden). Stata 16.0 was used for statistical analysis.

RESULTS: A total of eight studies met the eligibility criteria for this study. The results of the quantitative analysis, ranging from 6 to 18 months, showed no significant effect on cognitive function, quality of life over 12 months and longer, and carer burden over time between groups with and without intervention. However, significant improvements were observed for neuropsychiatric symptoms over 12 months and longer and quality of life at six months in the case management group.

CONCLUSION: Case management appears to have the potential to improve the health outcomes among people with dementia. However, these conclusions are limited due to the lack of conducted studies. Future work examining intervention outcomes remains necessary to explore the effects of interventions on the mental and physical wellbeing of carers.

PMID:34265500 | DOI:10.1016/j.ijnurstu.2021.104012

Gait Posture. 2021 Jul 12;89:102-108. doi: 10.1016/j.gaitpost.2021.07.003. Online ahead of print.

ABSTRACT

BACKGROUND: Although foot orthoses are often used in the management of lower limb musculoskeletal conditions, their effects on muscle activation is unclear, especially in more proximal segments of the lower limb.

RESEARCH QUESTION: Primary aim: Is there an immediate effect of foot orthoses on gluteal muscle activity during overground walking in healthy young adults? Secondary aim: Is there an immediate effect of foot orthoses on the activity of hamstring, quadriceps and calf muscles?

METHODS: In eighteen healthy young adults, muscle activity was recorded using fine wire electrodes for gluteus minimus (GMin; anterior, posterior) and gluteus medius (GMed; anterior, middle, posterior); and surface electrodes for gluteus maximus (GMax), hamstring, quadriceps and calf muscles. Participants completed six walking trials for two conditions; shoe and shoe with prefabricated foot orthoses. Muscle activity was normalised to the peak activity of the shoe condition and analysed using one-dimensional statistical non-parametric mapping to identify differences across the gait cycle.

RESULTS: Activity of GMed (anterior, middle, posterior) and GMin (posterior) was reduced in early stance phase when the orthosis was worn in the shoe (p < 0.05). GMin (anterior) activity was significantly reduced during swing (p < 0.05). Muscle activity was also significantly reduced during the orthoses condition for the lateral hamstrings and calf muscles (p < 0.05).

SIGNIFICANCE: Using foot orthoses may provide a strategy to reduce demand on GMin, GMed, lateral hamstring and calf muscles while walking.

PMID:34265525 | DOI:10.1016/j.gaitpost.2021.07.003

Clin Pharmacol Drug Dev. 2021 Jul 15. doi: 10.1002/cpdd.996. Online ahead of print.

ABSTRACT

Pharmacokinetics, safety, and tolerability of abacavir 600 mg/dolutegravir 50 mg/lamivudine 300 mg were assessed in this phase 1, single-arm, open-label, single-dose study in fasted healthy male (n = 4) and female (n = 8) participants of Japanese heritage. Participants received a single dose of abacavir 600 mg/dolutegravir 50 mg/lamivudine 300 mg after an 8-hour fast, with safety assessments and blood samples for pharmacokinetic parameters collected through 72 hours after dosing. Geometric mean maximum plasma concentrations were 5.22 μg/mL (time to maximum concentration [t_max ], 1.01 hours) for abacavir, 4.13 μg/mL (t_max , 3.50 hours) for dolutegravir, and 3.35 μg/mL (t_max , 2.98 hours) for lamivudine. Geometric mean area under the concentration-time curve values were 18.20, 71.60, and 16.60 μg • h/mL for abacavir, dolutegravir, and lamivudine, respectively. No adverse events were reported, and no clinically significant findings were observed in laboratory values, physical examinations, or 12-lead electrocardiographic parameters. Single-tablet administration of abacavir 600 mg/dolutegravir 50 mg/lamivudine 300 mg was well tolerated in Japanese participants. Exposure to abacavir and lamivudine was comparable with that seen in previous studies. A modest increase in exposure to dolutegravir vs previous clinical studies was observed but is not expected to impact the clinical management of HIV-1 or increase the risk for adverse events.

PMID:34265164 | DOI:10.1002/cpdd.996

Liver Transpl. 2021 Jul 15. doi: 10.1002/lt.26231. Online ahead of print.

ABSTRACT

With advances in computing and information technology, large healthcare research databases are becoming increasingly accessible to investigators across the world. These rich, population-level data sources can serve many purposes, such as to generate ‘Real World Evidence’, to enhance disease phenotyping, or to identify unmet clinical needs, among others. This is of particular relevance to the study of patients with end-stage liver disease (ESLD) – a socioeconomically and clinically heterogeneous population that is frequently under-represented in clinical trials. This review describes the recommended ‘best practices’ in the execution, reporting and interpretation of large database clinical epidemiology research in hepatology. The advantages and limitations of selected data sources are reviewed, as well as important concepts on data linkages. The appropriate classification of exposures and outcomes is addressed, and the strategies needed to overcome limitations of the data and minimize bias are explained as they pertain to patients with ESLD and/or liver transplant (LT) recipients. Lastly, selected statistical concepts are reviewed, from model building to analytic decision-making and hypothesis testing. The purpose of this review is to provide the practical insights and knowledge needed to ensure successful and impactful research using large clinical databases in the modern era, and advance the study of ESLD and LT.

PMID:34265178 | DOI:10.1002/lt.26231

Med Phys. 2021 Jul 15. doi: 10.1002/mp.15098. Online ahead of print.

ABSTRACT

PURPOSE: We propose a general framework for quantifying predictive uncertainties of dose-related quantities and leveraging this information in a dose mimicking problem in the context of automated radiation therapy treatment planning.

METHODS: A three-step pipeline, comprising feature extraction, dose statistic prediction and dose mimicking, is employed. In particular, the features are produced by a convolutional variational autoencoder and used as inputs in a previously developed nonparametric Bayesian statistical method, estimating the multivariate predictive distribution of a collection of predefined dose statistics. Specially developed objective functions are then used to construct a probabilistic dose mimicking problem based on the produced distributions, creating deliverable treatment plans.

RESULTS: The numerical experiments are performed using a dataset of 94 retrospective treatment plans of prostate cancer patients. We show that the features extracted by the variational autoencoder capture geometric information of substantial relevance to the dose statistic prediction problem and are related to dose statistics in a more regularized fashion than hand-crafted features. The estimated predictive distributions are reasonable and outperforms a non-input-dependent benchmark method, and the deliverable plans produced by the probabilistic dose mimicking agree better with their clinical counterparts than for a non-probabilistic formulation.

CONCLUSIONS: We demonstrate that prediction of dose-related quantities may be extended to include uncertainty estimation and that such probabilistic information may be leveraged in a dose mimicking problem. The treatment plans produced by the proposed pipeline resemble their original counterparts well, illustrating the merits of a holistic approach to automated planning based on probabilistic modeling.

PMID:34265105 | DOI:10.1002/mp.15098

Acta Paediatr. 2021 Jul 15. doi: 10.1111/apa.16032. Online ahead of print.

ABSTRACT

AIM: To examine the factors associated with the risk of neonatal mortality following caesarean births at country-level in sub-Saharan Africa.

METHODS: We used meta-analytic procedure to synthesize the results of most recent nationally representative cross-sectional Demographic and Health Survey (DHS) datasets for 33 sub-Saharan Africa countries conducted between 2010 and 2018. Pooled odds ratio (OR) and 95% confidence intervals (CI) were computed for all countries.

RESULTS: The overall caesarean section (CS) rate was 4.9%, neonatal mortality was 2.8% and Post-CS neonatal mortality was 4.3%. The rates of CS were generally low and only 5 countries had CS rates at or above 10%. The overall pooled result showed a statistically significant increase in the odds of neonatal mortality after a caesarean section (CS) OR 1.7 (95% CI 1.53 – 1.89; I² = 39.3%, p<0.012); such that children delivered via CS were 70% more likely not to survive beyond the first 30 days. Geographical variations existed in the measure of association between caesarean section and neonatal mortality.

CONCLUSION: This paper has provided evidence on the low rates of CS and the associated neonatal mortality risk compared to normal deliveries in sub-Saharan Africa.

PMID:34265122 | DOI:10.1111/apa.16032

J Genet Couns. 2021 Jul 15. doi: 10.1002/jgc4.1444. Online ahead of print.

ABSTRACT

In recent years, it has become apparent that patients expect genetic counselors to be able to address questions about insurance coverage for genetic testing and perform ‘genesurance’ tasks in and out of genetic counseling sessions. Anecdotally, many genetic counseling graduate programs have begun to incorporate genesurance training in some capacity. However, the amount, modality, and potential barriers to this training had not been previously studied; therefore, this study aimed to elucidate current graduate program practice regarding genesurance. Program Directors of Accreditation Council for Genetic Counseling (ACGC) accredited programs who had students enrolled as of July 2019 (n = 50) were recruited through the Association of Genetic Counseling Program Directors (AGCPD) listserv and invited to complete an anonymous electronic survey via Qualtrics. Program Directors (PDs) from 25 ACGC accredited programs located in the United States completed the survey and were included in the analysis, responses from two ACGC Canadian programs were excluded due to small sample size and differences in healthcare systems. Responses were analyzed using descriptive statistics and open-ended responses were coded utilizing latent qualitative content analysis. The majority of respondents from the United States, 96.0% (24/25), report incorporating genesurance training into their curriculum utilizing a variety of training modalities including classroom, clinical, and online experiences. Most (81.0%) felt their trainees were adequately or very prepared to discuss genesurance issues. Despite varied methods of teaching modalities, PDs identified barriers to providing this training, including time constraints within the curriculum, lack of interest in the subject, as well as acknowledging the constantly changing landscape of billing and insurance. Despite these barriers, a baseline understanding of the impact of insurance on offering genetic testing and insight into how insurance impacts clinical practice may be beneficial to genetic counseling trainees, as it reflects the current genetic counselor’s workflow and practice patterns.

PMID:34265129 | DOI:10.1002/jgc4.1444

Cancer. 2021 Jul 15. doi: 10.1002/cncr.33801. Online ahead of print.

ABSTRACT

BACKGROUND: Breast cancer is the most common cancer among women in the United States. However, data on spatial disparities in survival for breast cancer are limited in the country. This study estimated 5-year relative survival (RS) of female breast cancer and examined the spatial variations across the contiguous United States.

METHODS: Women newly diagnosed with breast cancer in 2003-2010 in the United States were identified from the National Cancer Database and followed up through 2016. The crude 5-year RS at the county level was estimated and adjusted for patients’ key sociodemographic and clinical factors. To account for spatial effects, the RS estimates were smoothed using the Bayesian spatial survival model. A local spatial autocorrelation analysis with the Getis-Ord Gi* statistics was applied to identify geographic clusters of low or high RS.

RESULTS: Clusters of low RS were identified in more than 15 states covering 671 counties, mostly in the southeast and southwest regions, including Georgia, Alabama, Mississippi, Louisiana, Arkansas, Oklahoma, and Texas. Approximately 30% of these clusters can be explained by patients’ characteristics: Race, insurance, and stage at diagnosis appeared to be the major attributable factors.

CONCLUSIONS: Significant spatial disparity in female breast cancer survival was found, with low RS clusters identified in Georgia, Alabama, Mississippi, Louisiana, Arkansas, Oklahoma, and Texas. Policies and interventions that focus on serving Black women, improvements in insurance coverage, and early detection in these areas could potentially mitigate the spatial disparities.

PMID:34265081 | DOI:10.1002/cncr.33801

Br J Clin Pharmacol. 2021 Jul 15. doi: 10.1111/bcp.14985. Online ahead of print.

ABSTRACT

AIM: The Norwegian Association for Clinical Pharmacology in their National Guidelines decreased therapeutic range (TR) of topiramate (TPM) from 5-20 mg/L to 2-10 mg/L. The objective of this study is to ascertain which TR produces better clinical outcomes.

METHODS: Data source were request forms for routine therapeutic drug monitoring of TPM. Concentration dependent adverse drug reactions (ADRs) were evaluated in 1,721 samples taken pre-dose. Seizure frequency analysis was performed in 294 samples of monotherapy.

STATISTICS: Prism 5.0, GraphPad Instatt: One-way Anova with Bonferroni correction for median plasma level (PL). χ2-test with Bonferroni correction for seizure frequency and for distribution of PL according to TR 5-20 mg/L and intervals <2, 2-5, 5-10, 10-20, >20 mg/L.

RESULTS: Better seizure control was found in children both in whole cohort (without seizure 49% vs 37% adults), as well as in monotherapy (56% vs 44%), in children with PL 5-20 mg/L vs <5 mg/L (65% vs 44%) and in children with PL 5-10 mg/L vs <2 mg/L (63 vs 14%). PL in seizure-free patients did not differ from those with seizure. Seizure control was poorer in the period 2003-2005 compared to 2006-2011. ADRs reported in 38 samples (2.8%) were without relation to PL.

CONCLUSIONS: Change of TR is not recommended.

PMID:34265104 | DOI:10.1111/bcp.14985