Tag: pubmed

Brief Funct Genomics. 2021 Aug 9:elab034. doi: 10.1093/bfgp/elab034. Online ahead of print.

ABSTRACT

We propose the hierarchical Projective Adaptive Resonance Theory (PART) algorithm for classification of gene expression data. This algorithm is realized by combing transposed quasi-supervised PART and unsupervised PART. We develop the corresponding validation statistics for each process and compare it with other clustering algorithms in a case study of tuberculosis (TB). First, we use sample-based transposed quasi-supervised PART to obtain optimal clustering results of samples distinguished by time post-infection and the representative genes for each cluster including up-regulated, down-regulated and stable genes. The up- and down-regulated genes show more than 90% similarity to the result derived from Linear Models for Microarray Data and are verified by weighted k-nearest neighbor model on TB projection. Second, we use gene-based unsupervised PART algorithm to cluster these representative genes where functional enrichment analysis is conducted in each cluster. We further confirm the main immune response of human macrophage-like THP-1 cells against TB within 2 days is type I interferon-mediated innate immunity. This study demonstrates how hierarchical PART algorithm analyzes microarray data. The sample-based quasi-supervised PART extracts representative genes and narrows down the shortlist of disease-relevant genes and gene-based unsupervised PART classifies representative genes that help to interpret immune response against TB.

PMID:34369558 | DOI:10.1093/bfgp/elab034

East Mediterr Health J. 2021 Jul 29;27(7):656-664. doi: 10.26719/2021.27.7.656.

ABSTRACT

BACKGROUND: Efforts to reduce inappropriate hospital stay, including alternatives such as homecare, are important to improve patient care and reduce health care costs.

AIMS: This study evaluated inappropriate hospital stay in Shiraz, Islamic Republic of Iran and the extent to which these stays were due to lack of homecare services and others factors needed for homecare.

METHODS: This cross-sectional study was conducted between January 2018 and September 2019 at two public hospitals in Shiraz. All adult patients hospitalized in these two hospitals in the study period were included, except patients in mental care wards. Appropriateness of patients’ hospital stay was assessed on a daily basis using the Iranian version of the Appropriateness Evaluation Protocol. The chi-squared test was used to assess association between need for homecare and patient characteristics.

RESULTS: Of 6458 hospitalization days assessed (for 1954 patients), 710 (11.0%) days were inappropriate. The greatest proportion of causes of inappropriate stay were physician-related (32.9%). Of the 710 inappropriate hospitalization days, 231 were due to lack of homecare services. Most patients who were inappropriately hospitalized because of lack of homecare services were insured through Salamat insurance (64.0%). A statistically significant relationship was found between the need for homecare services and the type of health insurance (P = 0.01). Of the patients admitted to hospital because of lack of homecare services, 36.8% had endocrine diseases, especially diabetes, and 21.8% needed oxygen services.

CONCLUSION: Institutionalizing home health care in the Iranian health system could encourage more home health care referral and reduce inappropriate hospitalization, especially for diabetes.

PMID:34369579 | DOI:10.26719/2021.27.7.656

J Neurol Phys Ther. 2021 Aug 6. doi: 10.1097/NPT.0000000000000368. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Falls are a major health concern after stroke. Spatial and temporal gait asymmetry and variability can contribute to instability and increased fall risk in persons with stroke (PwS). We aimed to quantify gait spatiotemporal symmetry and variability parameters in PwS undergoing rehabilitation in the subacute stage of the disease, by comparison to healthy participants, and to examine the associations between these parameters and patients’ reactive and proactive balance capacity.

METHODS: Twenty-two PwS and 12 healthy adults walked over a computerized treadmill system at their self-selected walking speed. Symmetry and variability of gait parameters (step length, swing time, and stance time) as well as upper extremity and lower extremity angular range of motion in the sagittal plane were extracted. In addition, the Berg Balance Scale (BBS) and the fall threshold in response to sudden surface translations at increasing intensities were assessed.

RESULTS: PwS demonstrated significantly higher asymmetry in all gait parameters in comparison to controls. Also, PwS demonstrated increased stance time variability in comparison to healthy controls and increased swing time variability in the paretic lower extremity. Significant negative associations were found between fall threshold and stance time asymmetry in PwS (r = -0.48, P = 0.022), between the BBS and swing time asymmetry (r = -0.50, P = 0.018), and between the BBS and stance time variability of the paretic lower extremity (r = -0.56, P = 0.006).

DISCUSSION AND CONCLUSIONS: Findings highlight the importance of gait temporal symmetry and variability measures for dynamic balance control after stroke. These parameters should be considered when assessing gait recovery and safety in PwS.Video Abstract available for more insight from the authors (see the Supplementary Video, available at: http://links.lww.com/JNPT/A355).

PMID:34369447 | DOI:10.1097/NPT.0000000000000368

J Craniofac Surg. 2021 Aug 6. doi: 10.1097/SCS.0000000000008077. Online ahead of print.

ABSTRACT

We aimed to recommend an efficient algorithm to detect the presence of specific pathologies of the lacrimal sac (LS). The charts of 296 patients who had undergone LS biopsy were reviewed retrospectively. The age, gender, history, examination and radiological findings, sac appearance, and pathology results of the patients were recorded. The power of our data to predict the presence of potential specific pathology was identified by regression analysis. After the causality evaluation of the statistical results, an algorithm was created to differentiate specific LS pathologies from chronic dacryocystitis. Our algorithm was mainly formed by deciding on radiological examination and biopsy according to the risk scoring created by the examination findings. A specific LS pathology was observed in 11 (3.7%) patients. When we applied the recommended algorithm to cases with a suspicion of specific pathology and/or found to have a specific pathology, 36.4% of the patients would not require radiological examination and 29.6% of them would not require a biopsy. On the other hand, 80% of the frozen biopsies had been conducted on cases without a specific pathology. Managing the cases according to our algorithm would mean that frozen biopsy would be recommended in only 1 (12.5%) case without a specific pathology. Besides, the detection of cases with a specific pathology would not be prevented and the necessary diagnostic procedures would continue to be performed. Specific LS pathologies can be detected adequately, whereas decreasing unnecessary examinations and procedures in cases without a specific pathology by using our algorithm.

PMID:34369466 | DOI:10.1097/SCS.0000000000008077

Demography. 2021 Aug 9:9420322. doi: 10.1215/00703370-9420322. Online ahead of print.

ABSTRACT

The literature suggests a positive link between homeownership and the transition to parenthood. However, in recent decades, couples’ preference for becoming homeowners before having their first child has been undermined by rising housing unaffordability and housing uncertainty. An archetypal example is Britain, where homeownership rates among young adults have fallen substantially as a result of low wages, unemployment, reductions in the availability of mortgage credit, and rising house prices. This situation has produced a housing crisis. Using longitudinal data from the British Household Panel Survey (1991-2008) and the United Kingdom Household Longitudinal Study (2009-2016), we apply multilevel, discrete-time event-history techniques to a sample of women aged 18-42. We investigate whether and how the link between homeownership and entering parenthood has changed in Britain in recent decades. Our findings reveal that in comparison with the 1990s, the likelihood of becoming a parent has declined among homeowners, whereas childbearing rates among private renters have remained stable. Thus, owner-occupiers and private renters have become more similar in terms of their likelihood of entering parenthood. Overall, our findings question the classical micro-level assumption of a positive link between homeownership and transition to parenthood, at least among Britain’s “Generation Rent.” These findings are subsequently interpreted in terms of increased housing uncertainty.

PMID:34369553 | DOI:10.1215/00703370-9420322

J Hosp Palliat Nurs. 2021 Aug 4. doi: 10.1097/NJH.0000000000000778. Online ahead of print.

ABSTRACT

Chronic obstructive pulmonary disease (COPD) is a progressive, life-limiting illness. Despite significant symptom burden, access to advance care planning (ACP) and palliative care are limited. Early initiation of ACP enables patients to articulate the values that underpin the decisions they would make if, in the future, they are unable to speak for themselves. Nurses constitute the majority of health care workforce and are well placed to initiate these discussions. This study explored knowledge, attitudes, and practice regarding ACP for patients with COPD among Australian and New Zealand respiratory nurses. A cross-sectional online survey tested knowledge about ACP and canvassed attitudes about current practice. Data were analyzed using descriptive statistics and content analysis of text data. The 112 participating respiratory nurses had substantial knowledge and positive attitudes regarding ACP in COPD; however, they lacked confidence and clarity regarding their role. Despite advances in end-of-life care provision for chronic disease, well-established barriers remained (inadequate training, fear of distressing patients, and time), and discussion triggers were still linked to acute deterioration, diagnosis of severe disease, and patient initiation. Better articulating the role of the respiratory nurse in ACP and building capacity and confidence within this workforce may improve ACP access for people living with COPD.

PMID:34369423 | DOI:10.1097/NJH.0000000000000778

J Neurosci Nurs. 2021 Aug 6. doi: 10.1097/JNN.0000000000000608. Online ahead of print.

ABSTRACT

BACKGROUND: The sexuality of people with spinal cord injury (SCI) is a subject often neglected by healthcare professionals because of their lack of knowledge or understanding of how to proceed in this context. Different teaching strategies can be used to fill this knowledge gap, such as clinical simulation and peer-assisted learning. This study evaluates the effects of an educational intervention on nursing students’ knowledge acquisition about the sexuality of individuals with SCI and on the students’ self-confidence and satisfaction with the experience. METHODS: Quasi-experimental, pretest-posttest design was conducted with nursing students (N = 54). The intervention was the application by a senior-level nursing student of 2 scenarios of high-fidelity clinical simulation. The primary outcome was the knowledge about the sexuality of people with SCI. The secondary outcome was the satisfaction and self-confidence in learning. We performed descriptive and inferential statistics and built multiple linear regression models. RESULTS: The effect of the intervention on knowledge acquisition ranged from the mean of 1.26 in the pretest to 3.10 in the posttest. The means in the scores of satisfaction and self-confidence were considered excellent and correlated with knowledge acquisition. Previous attendance of a class on SCI positively interfered in the scale of knowledge acquisition. CONCLUSION: We verified an effect size ranging from medium to large magnitude for knowledge acquisition, and great satisfaction and self-confidence in learning through the use of simulated experience and peer-assisted learning.

PMID:34369432 | DOI:10.1097/JNN.0000000000000608

J Bronchology Interv Pulmonol. 2021 Aug 9. doi: 10.1097/LBR.0000000000000801. Online ahead of print.

ABSTRACT

RATIONALE: The benefit from applying suction during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is unclear.

BACKGROUND: The purpose of this study was to evaluate the impact of applying suction during EBUS-TBNA of lymph nodes (LN) on the diagnostic yield and specimen quality of EBUS-TBNA smears and cellblocks.

METHODS: We conducted a randomized blinded cross-over trial comparing the diagnostic yield and quality of EBUS-TBNA samples obtained with suction (S+) and without suction (S-) from suspected malignant mediastinal LN. Each LN was aspirated 4 times in a randomly assigned alternating order: S+/S-/S+/S- or S-/S+/S-/S+, resulting in 2 matched S+/S- smears pairs and 1 matched S+/S- cellblocks pairs. Specimen were assessed by a blinded cytopathologist. The primary outcome was the diagnostic yield of EBUS-TBNA smears and cellblocks. Secondary analyses accounted for LN size (≤2 vs. >2 cm) and station (mediastinal vs. hilar).

RESULTS: Of 234 EBUS-TBNA smears and 114 cellblocks were obtained from 59 LN. The concordance of S+ and S- cellblocks diagnostic yield was low (43.8%; 95% confidence interval: 30.7-57.6) with a significantly higher diagnostic yield among S+ compared with S- cellblocks (56.1% vs. 10.5%, respectively, P<0.001), regardless of LN station and size. However, S+ and S- smears were moderately concordant (66.7%; 95% confidence interval: 57.4-75.1) with no overall difference in their respective diagnostic yield. Numerically higher diagnostic yield among S+ smears in LN≤2 cm or hilar LN was not statistically significant. Results were similar for specimen adequacy, sensitivity and diagnosis of malignancy.

CONCLUSION: Applying suction during EBUS-TBNA of suspected malignant LN enhanced the diagnostic yield of cellblocks regardless of mediastinal LN station or size, but not of smears.

PMID:34369402 | DOI:10.1097/LBR.0000000000000801

Ear Hear. 2021 Aug 6. doi: 10.1097/AUD.0000000000001110. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study was to investigate the effect of a small change in reverberation time (from 0.57 to 0.69 s) in a classroom on children’s performance and listening effort. Aiming for ecological listening conditions, the change in reverberation time was combined with the presence or absence of classroom noise. In three academic tasks, the study examined whether the effect of reverberation was modulated by the presence of noise and depended on the children’s age.

DESIGN: A total of 302 children (aged 11-13 years, grades 6-8) with normal hearing participated in the study. Three typical tasks of daily classroom activities (speech perception, sentence comprehension, and mental calculation) were administered to groups of children in two listening conditions (quiet and classroom noise). The experiment was conducted inside real classrooms, where reverberation time was controlled. The outcomes considered were task accuracy and response times (RTs), the latter taken as a behavioral proxy for listening effort. Participants were also assessed on reading comprehension and math fluency. To investigate the impact of noise and/or reverberation, these two scores were entered in the statistical model to control for individual child’s general academic abilities.

RESULTS: While the longer reverberation time did not significantly affect accuracy or RTs under the quiet condition, it had several effects when in combination with classroom noise, depending on the task measured. A significant drop in accuracy with a longer reverberation time emerged for the speech perception task, but only for the grade 6 children. The effect on accuracy of a longer reverberation time was nonsignificant for sentence comprehension (always at ceiling), and depended on the children’s age in the mental calculation task. RTs were longer for moderate than for short reverberation times in the speech perception and sentence comprehension tasks, while there was no significant effect of the different reverberation times on RTs in the mental calculation task.

CONCLUSIONS: The results indicate small, but statistically significant, effects of a small change in reverberation time on listening effort as well as accuracy for children aged 11 to 13 performing typical tasks of daily classroom activities. Thus, the results extend previous findings in adults to children as well. The findings also contribute to a better understanding of the practical implications and importance of optimal ranges of reverberation time in classrooms. A comparison with previous studies underscored the importance of early reflections as well as reverberation times in classrooms.

PMID:34369418 | DOI:10.1097/AUD.0000000000001110

Cornea. 2021 Aug 6. doi: 10.1097/ICO.0000000000002803. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to describe demographics, predisposing factors, clinical features, treatment, and outcomes of microbial keratitis cases resistant to antimicrobials.

METHODS: A retrospective case series was conducted. All patients with microbial keratitis resistant to antimicrobials who underwent a corneal scrape and culture from 2012 to December 2016 at the Sydney Eye Hospital were included. Cases were identified from pathology and hospital coding data. Coagulase-negative staphylococci (CoNS), Staphylococcus aureus (S. aureus), and Corynebacterium spp. resistant to cefalotin, chloramphenicol, ciprofloxacin, or gentamicin were analyzed.

RESULTS: One hundred fifteen episodes had a resistant CoNS, 24 S. aureus, and 12 Corynebacterium spp. Antimicrobial resistance was associated with older women (67%, median age 83 years) with Corynebacterium spp. (P < 0.001), corneal graft, and previous topical steroid use. Larger epithelial defects (P = 0.203) and infiltrates (P = 0.180) were more likely to be associated with Corynebacterium spp., but not statistically significant. At the initial and final visits, resistant S. aureus (75% vs. 67%) and Corynebacterium spp. (78% vs. 80%) cases were more likely to be classified as blind (>3/60) compared with CoNS (45% vs. 28%) (P = 0.011 vs. P = 0.004). Corneal perforation occurred more often in resistant S. aureus cases (P < 0.001), whereas slow and nonhealing epithelial defects needing other procedures were more likely to occur with resistant Corynebacterium spp. (P < 0.001).

CONCLUSIONS: Patients with resistant CoNS were younger and presented with smaller ulcers and moderate vision loss. Visual and clinical outcomes were significantly better for resistant CoNS than for those with resistant S. aureus or Corynebacterium spp.

PMID:34369390 | DOI:10.1097/ICO.0000000000002803