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BMJ Health & Care Informatics Dec 2023Accurate identification of medical conditions within a real-time inpatient setting is crucial for health systems. Current inpatient comorbidity algorithms rely on...
INTRODUCTION
Accurate identification of medical conditions within a real-time inpatient setting is crucial for health systems. Current inpatient comorbidity algorithms rely on integrating various sources of administrative data, but at times, there is a considerable lag in obtaining and linking these data. Our study objective was to develop electronic medical records (EMR) data-based inpatient diabetes phenotyping algorithms.
MATERIALS AND METHODS
A chart review on 3040 individuals was completed, and 583 had diabetes. We linked EMR data on these individuals to the International Classification of Disease (ICD) administrative databases. The following EMR-data-based diabetes algorithms were developed: (1) laboratory data, (2) medication data, (3) laboratory and medications data, (4) diabetes concept keywords and (5) diabetes free-text algorithm. Combined algorithms used statements between the above algorithms. Algorithm performances were measured using chart review as a gold standard. We determined the best-performing algorithm as the one that showed the high performance of sensitivity (SN), and positive predictive value (PPV).
RESULTS
The algorithms tested generally performed well: ICD-coded data, SN 0.84, specificity (SP) 0.98, PPV 0.93 and negative predictive value (NPV) 0.96; medication and laboratory algorithm, SN 0.90, SP 0.95, PPV 0.80 and NPV 0.97; all document types algorithm, SN 0.95, SP 0.98, PPV 0.94 and NPV 0.99.
DISCUSSION
Free-text data-based diabetes algorithm can yield comparable or superior performance to a commonly used ICD-coded algorithm and could supplement existing methods. These types of inpatient EMR-based algorithms for case identification may become a key method for timely resource planning and care delivery.
Topics: Humans; Electronic Health Records; Inpatients; Reproducibility of Results; Algorithms; Diabetes Mellitus
PubMed: 38123357
DOI: 10.1136/bmjhci-2023-100894 -
Plants (Basel, Switzerland) Jul 2023Breeding of high-yielding and stable durum wheat varieties with improved kernel characteristics is needed for dry regions around the globe. The aim of this study was to...
Breeding of high-yielding and stable durum wheat varieties with improved kernel characteristics is needed for dry regions around the globe. The aim of this study was to investigate the performance and stability of eight durum wheat genotypes varying in their kernel characteristics across 15 contrasting environments. The tested material included three recombinant inbred lines (NUR-072, NUR-106 and NUR-238) derived from a cross between Norsi, a Jordanian landrace with special kernel characteristics and UC1113 , an elite line from USA. Field trials were carried out for three constitutive growing seasons under rainfed conditions, except for three environments where supplementary irrigation was provided. After the harvest, grain yield (GY), total yield (TW), and harvest index (HI) were recorded. Additionally, several kernel-related traits, including thousand kernel weight (TKW), kernel area (KA), kernel width (KW), kernel length (KL), kernel circularity (KC), and kernel length-width ratio (KL:KW) were evaluated. Analysis of variance for all tested traits revealed high significant variations () between the genotype (except for TW) and the genotype × environment (G × E) interaction. Genotype effect contributed to substantial percentage of variation (>75%) for KA, KL, KC and KL:KW, whereas KW showed a lower percentage similar to GY. Regarding the G × E effect, explained variation was highest for the TW (67.79%), and lowest for KL (6.47%). For GY, Norsi produced significantly the lowest mean value (249.99 g.m) while, Bolenga produced the highest mean value (377.85 g.m) although no significant differences were observed with the remaining genotypes. On the other hand, Norsi, NUR-072 and NUR-106 showed best performance for TKW and kernel-related traits with NUR-106 producing the highest mean value for KL (9.07 mm). The GGE biplot and AMMI analysis of GY identified Bolenga, Um Qais and NUR-106 as good performers across several environments, while Norsi exhibited the poorest performance. For TKW, Norsi was the best performer across different environments followed by NUR-106, which showed excellent performance under irrigated and saline conditions. For stability analysis, NUR-106 emerged as the most stable genotype in this study for GY and several kernel-related traits, particularly for KL and KC. In conclusion, the results of this study offer valuable insights for durum wheat breeders seeking to develop high-yielding and stable varieties with special kernel characteristics suitable for cultivation in dry areas.
PubMed: 37514278
DOI: 10.3390/plants12142664 -
Cureus Jul 2023The concept of standardized patients (SPs) was first introduced in the 1960s by Dr. Howard Barrows of the University of Southern California and has been applied in... (Review)
Review
The concept of standardized patients (SPs) was first introduced in the 1960s by Dr. Howard Barrows of the University of Southern California and has been applied in medical school education since that time. This practice has allowed medical students to practice skills on live persons who are teachers rather than on real patients, who may be endangered by their emerging skills. Previous studies supported the use of SPs but did not measure whether they improved clinical competence or students' confidence in their skills. This literature review evaluated whether current medical education literature supports or refutes the use of SPs compared to other modalities such as simulated patients (SiPs) and virtual reality (VR) in the improvement of student confidence, clinical performance, and interpersonal communication skills. The research questions posed for this review were as follows: do medical students in their first two years of education who have practiced skills using SPs have more self-confidence in their ability to perform skills on real patients than those students who did not use SPs, do medical students in their third and fourth years of medical school have higher clinical competency with sensitive patient examinations after using SPs in their first two years of medical education than those students who did not use SPs, and do medical students who have used SPs for discussing sensitive issues have better interpersonal skills when they encounter real patients in the clinical setting than those who have not used SPs? The methodology for this descriptive, systematic review of the literature was organized using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart to describe how articles were collected and synthesized to evaluate the variables under study. The results of this study revealed that students learned the most when SPs were used because they were able to teach students the skills that they needed in a safe learning environment. Medical students performing sensitive patient examinations with SPs learned not only how to perform the examinations but also how to improve their communication with patients. Students and residents reported increased confidence and clinical competence when performing new skills with SPs rather than with peer practice, virtual reality, or real patients in a clinical setting. Although the utilization of SPs has been studied in multiple ways and found to be a powerful tool in the education of undergraduate medical students and interns, there is still much study to be done to address the human needs of real patients. Gaps in this literature included small sample sizes, a lack of standardized assessment tools, and the need to include a multidisciplinary approach that addresses cultural awareness and appreciation. The authors found limited studies analyzing the effect the coronavirus disease 2019 (COVID-19) pandemic had on the use of SPs in medical school education. Continued scientific inquiry in post-pandemic medical education is an essential component for dissemination as most schools have reintroduced the use of SPs, which strengthens the concept that their use is superior to the other simulation methods used when SPs were not available.
PubMed: 37593270
DOI: 10.7759/cureus.42027 -
Nutrients Aug 2023The aim of this investigation was to determine whether, after Ramadan, pre-exercise caffeine intake can reduce any possible negative effects of this month on short-term... (Randomized Controlled Trial)
Randomized Controlled Trial
Pre-Exercise Caffeine Intake Attenuates the Negative Effects of Ramadan Fasting on Several Aspects of High-Intensity Short-Term Maximal Performances in Adolescent Female Handball Players.
The aim of this investigation was to determine whether, after Ramadan, pre-exercise caffeine intake can reduce any possible negative effects of this month on short-term maximal performances in young female handball players. A randomized study involved thirteen young female handball players. Participants performed a squat jump (SJ), Illinois agility test (AG), and 5 m run shuttles test (total (TD) and peak (PD) distances) at 08:00 AM and 06:00 PM on three different occasions: one week before Ramadan (Pre-R), the last week of Ramadan (R), and the week after Ramadan (Post-R). A placebo (Pla) or caffeine (Caff) (6 mg·kg) was administered 60 min before exercise test sessions at two distinct times of day (08:00 AM and 06:00 PM) during the two periods: Pre and Post-R. The PSQI and dietary intake were assessed during all testing periods. The results revealed that Pre-R, (SJ, AG, TD, and PD) test performances were greater in the evening (PM) than in the morning (AM) (all < 0.001). However, compared with Pre-R, PM performances declined significantly during R (all < 0.001) and Post-R ( < 0.05, < 0.01, < 0.01 and < 0.001, respectively). In addition, Pre-R, AM Caff produced moderate significant improvements compared with AM Pla, with small-to-no beneficial effects observed with PM Caff in SJ (4.8% vs. 1%), AG (1.8% vs. 0.8%), TD (2.8% vs. 0.3%), and PD (6% vs. 0.9%). Nevertheless, Caff produced moderate ergogenic effects during both AM and PM sessions during Post-R in SJ (4.4% vs. 2.4%), AG (1.7% vs. 1.5%), TD (2.9% vs. 1.3%), and PD (5.8% vs. 3%) with values approaching those of Pre-R Pla within the same time of day ( > 0.05, > 0.05, < 0.05, and < 0.05, respectively). In summary, pre-exercise Caff intake with a dose equivalent to 6 mg·kg reduced the negative effects of Ramadan fasting in several aspects of short-term maximal performances in young female handball players at both times of the day.
Topics: Adolescent; Female; Humans; Athletic Performance; Caffeine; Eating; Fasting; Sports; Time
PubMed: 37571369
DOI: 10.3390/nu15153432 -
Nanomaterials (Basel, Switzerland) Dec 2023Owing to their remarkable success in photocatalytic applications, multiferroic BiFeO and its derivatives have gained a highly promising position as electrode materials... (Review)
Review
Owing to their remarkable success in photocatalytic applications, multiferroic BiFeO and its derivatives have gained a highly promising position as electrode materials for future developments of efficient catalysts. In addition to their appropriate band gaps, these materials exhibit inherent intrinsic polarizations enabling efficient charge carrier separation and their high mobility without the need for additional co-catalysts. Here, we review the existing strategies for enhancing the photocatalytic performances of BiFeO-based materials and we describe the physico-chemical properties at the origin of their exceptional photocatalytic behavior. A special focus is paid to the degradation of organic pollutants and water splitting, both driven through photocatalysis to unveil the correlation between BiFeO size, substitution, and doping on the one hand and the photocatalytic performances on the other hand. Finally, we provide practical recommendations for future developments of high-performing BiFeO-based electrodes.
PubMed: 38202506
DOI: 10.3390/nano14010051 -
BMC Medical Education Aug 2023Cricothyrotomy is a procedure performed to establish an airway in critical airway events. It is performed only rarely and anesthesiologists are often unprepared when...
BACKGROUND
Cricothyrotomy is a procedure performed to establish an airway in critical airway events. It is performed only rarely and anesthesiologists are often unprepared when called upon to perform it. This study aimed to simulate cricothyrotomy using pig larynx and trachea models to help anesthesiologists master cricothyrotomy and improve the ability to establish cricothyrotomy quickly.
METHODS
The porcine larynx and trachea were dissected and covered with pigskin to simulate the structure of the anterior neck of a human patient. An animal model of cricothyrotomy was established. Forty anesthesiologists were randomly divided into four groups. Each physician performed three rounds of cricothyrotomy, and recorded the time to accomplish each successful operation. After training the cricothyrotomy procedure, a questionnaire survey was conducted for the participating residents using a Likert scale. The participants were asked to score the utility of the training course on a scale of 1 ((minimum) to 5 ((maximum).
RESULTS
Through repeated practice, compared with the time spent in the first round of the operation (67 ± 29 s), the time spent in the second round of the operation (47 ± 21 s) and the time spent in the third round of the operation (36 ± 11 s) were significantly shortened (P < 0.05). Results of the survey after training were quite satisfied, reflecting increased the ability of proficiency in locating the cricothyroid membrane and performing a surgical cricothyrotomy.
CONCLUSION
The porcine larynx and trachea model is an excellent animal model for simulating and practicing cricothyrotomy, helping anesthesiologists to master cricothyrotomy and to perform it proficiently when required.
Topics: Animals; Humans; Swine; Trachea; Airway Management
PubMed: 37550664
DOI: 10.1186/s12909-023-04558-w -
CoDAS 2023Dynamic vocal analysis (DVA) is an auditory-perceptual and acoustic vocal assessment strategy that provides estimates on the biomechanics and aerodynamics of vocal...
Dynamic vocal analysis (DVA) is an auditory-perceptual and acoustic vocal assessment strategy that provides estimates on the biomechanics and aerodynamics of vocal production by performing frequency and intensity variation tasks and using voice acoustic spectrography. The objective of this experience report is to demonstrate the use of DVA in the assessment of vocal functionality of dysphonic and non-dysphonic individuals, with a special focus on the laryngeal musculature. Phonatory tasks consisted of sustained vowel, "a" or "é", and/or connected speech, in three intensities (habitual, soft, and loud) and three frequencies (habitual, high, and low), as well as ascending and descending glissando. The adjustments of the laryngeal and paralaryngeal muscles can be inferred from the different DVA tasks. The main characteristics of the laryngeal muscles analyzed are control of glottic adduction, stretching, and shortening of the vocal folds; the main characteristics of the paralaryngeal musculature are mainly related to the vertical laryngeal position in the neck. While the sustained vowel evaluates the vocal functionality with a focus on the larynx, connected speech allows the evaluation of the articulatory adjustments employed. An acoustic spectrographic software can be used to visualize the performance of such tasks. The clinical application of the DVA will be exemplified using acoustic spectrography plates from normal and dysphonic voices, taken from a voice bank. Individuals who perform the DVA tasks in a balanced way, with adequate vocal quality and without phonatory effort, demonstrate good vocal functionality. On the other hand, difficulties in performing these tasks with worsening vocal quality and/or increased muscle tension may be indications of altered vocal functionality.
Topics: Humans; Voice; Speech; Phonation; Voice Quality; Larynx
PubMed: 37729254
DOI: 10.1590/2317-1782/20232021083pt -
Journal of the American Association For... Nov 2023Small animal physiology studies are often complicated, but the level of complexity is greatly increased when performing live-animal X-ray imaging studies at synchrotron...
Small animal physiology studies are often complicated, but the level of complexity is greatly increased when performing live-animal X-ray imaging studies at synchrotron radiation facilities. This is because these facilities are typically not designed specifically for biomedical research, and the animals and image detectors are located away from the researchers in a radiation enclosure. In respiratory X-ray imaging studies one challenge is the detection of respiration in free-breathing anaesthetised rodents, to enable images to be acquired at specific phases of the breath and for detecting changes in respiratory rate. We have previously used a Philtec RC60 sensor interfaced to a PowerLab data acquisition system and custom-designed timing hub to perform this task. Here we evaluated the Panasonic HL-G108 for respiratory sensing. The performance of the two sensors for accurate and reliable breath detection was directly compared using a single anesthetized rat. We also assessed how an infrared heat lamp used to maintain body temperature affected sensor performance. Based on positive results from these comparisons, the HL-G108 sensor was then used for respiratory motion detection in tracheal X-ray imaging studies of 21 rats at the SPring-8 Synchrotron, including its use for gated image acquisition. The results of that test were compared to a similar imaging study that used the RC60 for respiratory detection in 19 rats. Finally, the HL-G108 sensor was tested on 5 mice to determine its effectiveness on smaller species. The results showed that the HL-G108 is much more robust and easier to configure than the RC60 sensor and produces an analog signal that is amenable to stable peak detection. Furthermore, gated image acquisition produced sequences with substantially reduced motion artefacts, enabling the additional benefit of reduced radiation dose through the application of shuttering. Finally, the mouse experiments showed that the HL-G108 is equally capable of detecting respiration in this smaller species.
Topics: Rats; Mice; Animals; Respiratory Rate; Rodentia; Respiration; Motion; Artifacts
PubMed: 37816589
DOI: 10.30802/AALAS-JAALAS-23-000018 -
Frontiers in Physiology 2023The present study strived to gain a more profound understanding of the distinctions in development between swimmers who are considered to be on track to the senior elite...
The present study strived to gain a more profound understanding of the distinctions in development between swimmers who are considered to be on track to the senior elite level compared to those who are not. Longitudinal data of 29 talented sprint and middle-distance swimmers (12 males; 17 females) on season best performances (season best times) and underlying performance characteristics (anthropometrics, starts, turns, maximal swimming velocity, stroke index [SI, an indirect measure of swimming efficiency] and lower body power) were collected over four swimming seasons (median of = 3 seasons per swimmer). Based on their season best performance at early senior age (males aged 18-19; females aged 17-18), some swimmers were considered to be on track to reach the elite level (referred to as high-performing seniors; 6 males and 10 females), whereas others were not (referred to as lower-performing seniors; 6 males and 7 females). Retrospectively studying these swimmers (males and females separately), we found that all high-performing seniors were already on track to the elite level at late junior age (males aged 17; females aged 16), evidenced with faster season best performances throughout their transition compared to their lower-performing peers ( < 0.05). Independent sample -tests revealed that high-performing seniors significantly outscored their lower-performing peers on maximal swimming velocity (males and females), starts and turns (males), SI (females) and lower body power (females) at late junior age ( < 0.05). Additionally, multilevel models showed faster rates of development for high-performing seniors on turns and maximal swimming velocity (males), and SI (females) compared to lower-performing peers during the junior-to-senior transition ( < 0.05). Particularly, the higher initial levels of swim performance and underlying characteristics at late junior age as well as the ability to keep progressing on season best performances (males and females), turns and maximal swimming velocity (males), and SI (females) during the junior-to-senior transition, may be crucial factors in the attainment of swimming expertise.
PubMed: 37621763
DOI: 10.3389/fphys.2023.1221567