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BMC Medical Research Methodology Apr 2024Epidemiological studies in refugee settings are often challenged by the denominator problem, i.e. lack of population at risk data. We develop an empirical approach to...
BACKGROUND
Epidemiological studies in refugee settings are often challenged by the denominator problem, i.e. lack of population at risk data. We develop an empirical approach to address this problem by assessing relationships between occupancy data in refugee centres, number of refugee patients in walk-in clinics, and diseases of the digestive system.
METHODS
Individual-level patient data from a primary care surveillance system (PriCarenet) was matched with occupancy data retrieved from immigration authorities. The three relationships were analysed using regression models, considering age, sex, and type of centre. Then predictions for the respective data category not available in each of the relationships were made. Twenty-one German on-site health care facilities in state-level registration and reception centres participated in the study, covering the time period from November 2017 to July 2021.
RESULTS
445 observations ("centre-months") for patient data from electronic health records (EHR, 230 mean walk-in clinics visiting refugee patients per month and centre; standard deviation sd: 202) of a total of 47.617 refugee patients were available, 215 for occupancy data (OCC, mean occupancy of 348 residents, sd: 287), 147 for both (matched), leaving 270 observations without occupancy (EHR-unmatched) and 40 without patient data (OCC-unmatched). The incidence of diseases of the digestive system, using patients as denominators in the different sub-data sets were 9.2% (sd: 5.9) in EHR, 8.8% (sd: 5.1) when matched, 9.6% (sd: 6.4) in EHR- and 12% (sd 2.9) in OCC-unmatched. Using the available or predicted occupancy as denominator yielded average incidence estimates (per centre and month) of 4.7% (sd: 3.2) in matched data, 4.8% (sd: 3.3) in EHR- and 7.4% (sd: 2.7) in OCC-unmatched.
CONCLUSIONS
By modelling the ratio between patient and occupancy numbers in refugee centres depending on sex and age, as well as on the total number of patients or occupancy, the denominator problem in health monitoring systems could be mitigated. The approach helped to estimate the missing component of the denominator, and to compare disease frequency across time and refugee centres more accurately using an empirically grounded prediction of disease frequency based on demographic and centre typology. This avoided over-estimation of disease frequency as opposed to the use of patients as denominators.
Topics: Humans; Refugees; Electronic Health Records; Emigration and Immigration; Risk Factors; Electronics
PubMed: 38561661
DOI: 10.1186/s12874-024-02204-7 -
Medical Teacher Mar 2024Teams and the promotion of teamwork for both faculty and for students can be key components of integrated curriculum and 'flipped classroom' active learning approaches...
Teams and the promotion of teamwork for both faculty and for students can be key components of integrated curriculum and 'flipped classroom' active learning approaches for medical education. The benefits of teams and teamwork are presented to faculty and students, sometimes indoctrination, but the costs of the team approach, balanced against the purported benefits, are typically not discussed. This unbalanced presentation creates the need for a statement of a contrarian view. I posit that among the problems of teams and teamwork in education are diminishment of individual initiative and individual responsibility, lowering standards to the least common denominator, creating excess obligations with respect toward weaker team members, negative effects on academic freedom, inconsistency with respect to how faculty and students are evaluated, and giving students a somewhat false view of their accountability as a medical professional. Possible ideological considerations and attitudes toward individualism with respect to teams need to be understood as well.
PubMed: 38555864
DOI: 10.1080/0142159X.2024.2331050 -
The Journal of Pediatrics Mar 2024To determine which groups of children with cancer for whom to apply the newly developed quality measures (QMs) for end-of-life (EOL) care.
OBJECTIVE
To determine which groups of children with cancer for whom to apply the newly developed quality measures (QMs) for end-of-life (EOL) care.
STUDY DESIGN
In a series of nominal groups, panelists answered the question: "Which children, diagnoses, conditions, or prognoses should be included when examining the quality of EOL care for children with cancer?" In each group, individual panelists proposed answers to the question. After collating individual responses, each panelist ranked their 5 top answers and points were assigned (5 pts for the best answer, 4 pts the second best, etc.). A team of pediatric oncology and palliative care clinician-scientists developed and applied a coding structure for responses and associated themes and subthemes for responses.
RESULTS
We conducted 5 nominal groups with a total of 44 participants. Most participants identified as female (88%) and non-Hispanic White (86%). Seventy-nine percent were clinicians, mainly in pediatric palliative care, pediatric oncology, or hospice; 40% were researchers and 12% were bereaved parents. Responses fell into 5 themes: (1) poor prognosis cancer; (2) specific treatment scenarios; (3) certain populations; (4) certain symptoms; and (5) specific utilization scenarios. Poor prognosis cancer and specific treatment scenarios received the most points (320 pts [49%] and 147 pts [23%], respectively).
CONCLUSIONS
Participants developed a framework to identify which children should be included in EOL QMs for children with cancer. The deliberate identification of the denominator for pediatric QMs serves as a potent tool for enhancing quality, conducting research, and developing clinical programs.
PubMed: 38554745
DOI: 10.1016/j.jpeds.2024.114038 -
ISA Transactions May 2024A three-stage decentralized controller design algorithm is developed to achieve setpoint tracking and disturbance rejection in MIMO systems with communication time...
Development of a novel model matching decentralized controller design algorithm and its experimental validation through load frequency controller implementation in restructured power system using TMS320F28379D controlCARD.
A three-stage decentralized controller design algorithm is developed to achieve setpoint tracking and disturbance rejection in MIMO systems with communication time delay, and nonlinearities such as saturation and dead band. The first stage involves reference model formulation. The second stage comprises equating approximate generalized time moments/approximate generalized Markov parameters of closed-loop system model with reference model at certain expansion points in s-plane to obtain synthesis-like equation, concerning products of unknown controller numerator and denominator polynomials. This process yields simultaneous linear equations, whose solution provides the coefficients of the product polynomials. In the third stage, the controller parameters are extracted from the product polynomials using exact model matching. The proposed method is illustrated by designing load frequency controller in traditional and restructured power systems under scenarios like system parameter uncertainties, random load variation, and time-varying communication delays. Simulation studies reveal the efficacy of the proposed technique over existing techniques. Furthermore, the practical implementation feasibility of the decentralized controller designed for the restructured power system is validated using the TMS320F28379D controlCARD.
PubMed: 38553408
DOI: 10.1016/j.isatra.2024.03.027 -
Echocardiography (Mount Kisco, N.Y.) Apr 2024Survey of four ratio-based metrics, commonly used to evaluate left ventricular performance. The numerator of each ratio is plotted against the corresponding denominator,...
Survey of four ratio-based metrics, commonly used to evaluate left ventricular performance. The numerator of each ratio is plotted against the corresponding denominator, implying that the slope of the colored line reflects the value of the ratio. Similar graphs can be constructed for the other cardiac compartments. Data sets obtained at various altitudes and defined with reference to sea level, based on Rao et al. Acronyms: E/A unitless ratio of the early (E) and late (A) diastolic wave peak velocities (cm/s); EDD, end-diastolic diameter (mm); EDV, end-diastolic volume (mL); EF, ejection fraction (%); ESD, end-systolic diameter (mm); ESV, end-systolic volume (mL); FS, fractional shortening (%).
Topics: Humans; Altitude; Heart Ventricles; Diastole; Stroke Volume; Ventricular Function, Left
PubMed: 38549393
DOI: 10.1111/echo.15797 -
Alcohol, Clinical & Experimental... May 2024South Africa has the highest reported prevalence of fetal alcohol spectrum disorders (FASD) globally. The most recent study reported a weighted, estimated FASD...
BACKGROUND
South Africa has the highest reported prevalence of fetal alcohol spectrum disorders (FASD) globally. The most recent study reported a weighted, estimated FASD prevalence of 310 per 1000 in a community in the Western Cape Province. Because there is as yet no reliable estimate of the national burden of FASD in South Africa, further epidemiological studies are needed in diverse settings. This paper reports on a multiyear, multisite FASD epidemiological study that took place from 2015 to 2022 at eight study sites in four provinces.
METHODS
The cross-sectional epidemiological study used an active case-ascertainment method, specifically in primary schools. All children were recruited when they were enrolled in Grade 1 at a participating school. All consented participants progressed through a tiered-screening recruitment and diagnostic process.
RESULTS
Overall, 3033 children were included in the study. A total of 3001 children were screened for FASD in the first tier, with 1086 progressing to the second and 495 to the third tier. Of the 495 children referred, 475 were discussed during the final case conference. A total of 309 participants were diagnosed with FAS across the eight study sites. The highest reported prevalence was in the Northern Cape Province, with a rate of 199.3/1000 (95% CI, 147.6-251) using all eligible participants as the denominator. The lowest prevalence was in the Eastern Cape Province, with a rate of 57.4/1000 (95% CI, 36.5-78.3). The pooled FAS prevalence for the eight study sites was 80.2/1000 (95% CI, 70.4-89.9).
CONCLUSIONS
As with previous studies, we found a concerningly high prevalence of FASD in South Africa. Given the scope of the problem it should be a high priority for health and welfare services to address.
PubMed: 38548386
DOI: 10.1111/acer.15306 -
Viruses Mar 2024Dolutegravir (DTG) is a cornerstone of global antiretroviral (ARV) therapy (ART) due to its high efficacy and favorable tolerability. However, limited data exist... (Review)
Review
BACKGROUND
Dolutegravir (DTG) is a cornerstone of global antiretroviral (ARV) therapy (ART) due to its high efficacy and favorable tolerability. However, limited data exist regarding the risk of emergent integrase strand transfer inhibitor (INSTI) drug-resistance mutations (DRMs) in individuals receiving DTG-containing ART.
METHODS
We performed a PubMed search using the term "Dolutegravir", last updated 18 December 2023, to estimate the prevalence of VF with emergent INSTI DRMs in people living with HIV (PLWH) without previous VF on an INSTI who received DTG-containing ART.
RESULTS
Of 2131 retrieved records, 43 clinical trials, 39 cohorts, and 6 cross-sectional studies provided data across 6 clinical scenarios based on ART history, virological status, and co-administered ARVs: (1) ART-naïve PLWH receiving DTG plus two NRTIs; (2) ART-naïve PLWH receiving DTG plus lamivudine; (3) ART-experienced PLWH with VF on a previous regimen receiving DTG plus two NRTIs; (4) ART-experienced PLWH with virological suppression receiving DTG plus two NRTIs; (5) ART-experienced PLWH with virological suppression receiving DTG and a second ARV; and (6) ART-experienced PLWH with virological suppression receiving DTG monotherapy. The median proportion of PLWH in clinical trials with emergent INSTI DRMs was 1.5% for scenario 3 and 3.4% for scenario 6. In the remaining four trial scenarios, VF prevalence with emergent INSTI DRMs was ≤0.1%. Data from cohort studies minimally influenced prevalence estimates from clinical trials, whereas cross-sectional studies yielded prevalence data lacking denominator details.
CONCLUSIONS
In clinical trials, the prevalence of VF with emergent INSTI DRMs in PLWH receiving DTG-containing regimens has been low. Novel approaches are required to assess VF prevalence with emergent INSTI DRMs in PLWH receiving DTG in real-world settings.
Topics: Humans; Cross-Sectional Studies; Prevalence; Lamivudine; HIV Infections; Heterocyclic Compounds, 3-Ring; Mutation; HIV Integrase Inhibitors; Anti-HIV Agents; Oxazines; Piperazines; Pyridones
PubMed: 38543764
DOI: 10.3390/v16030399 -
Journal of Clinical Medicine Mar 2024This prospective, multicenter observational cohort study was carried out in 12 trauma centers in Germany and Switzerland. Its purpose was to evaluate the rate of...
This prospective, multicenter observational cohort study was carried out in 12 trauma centers in Germany and Switzerland. Its purpose was to evaluate the rate of undertriage, as well as potential consequences, and relate these with different Trauma Team Activation Protocols (TTA-Protocols), as this has not been done before in Germany. : Each trauma center collected the data during a three-month period between December 2019 and February 2021. All 12 participating hospitals are certified as supra-regional trauma centers. Here, we report a subgroup analysis of undertriaged patients. Those included in the study were all consecutive adult patients (age ≥ 18 years) with acute trauma admitted to the emergency department of one of the participating hospitals by the prehospital emergency medical service (EMS) within 6 h after trauma. The data contained information on age, sex, trauma mechanism, pre- and in-hospital physiology, emergency interventions, emergency surgical interventions, intensive care unit (ICU) stay, and death within 48 h. Trauma team activation (TTA) was initiated by the emergency medical services. This should follow the national guidelines for severe trauma using established field triage criteria. We used various denominators, such as ISS, and criteria for the appropriateness of TTA to evaluate the undertriage in four groups. : This study included a total of 3754 patients. The average injury severity score was 5.1 points, and 7.0% of cases ( = 261) presented with an injury severity score (ISS) of 16+. TTA was initiated for a total of 974 (26%) patients. In group 1, we evaluated how successful the actual practice in the EMS was in identifying patients with ISS 16+. The undertriage rate was 15.3%, but mortality was lower in the undertriage cohort compared to those with a TTA (5% vs. 10%). In group 2, we evaluated the actual practice of EMS in terms of identifying patients meeting the appropriateness of TTA criteria; this showed a higher undertriage rate of 35.9%, but as seen in group 1, the mortality was lower (5.9% vs. 3.3%). In group 3, we showed that, if the EMS were to strictly follow guideline criteria, the rate of undertriage would be even higher (26.2%) regarding ISS 16+. Using the appropriateness of TTA criteria to define the gold standard for TTA (group 4), 764 cases (20.4%) fulfilled at least one condition for retrospective definition of TTA requirement. : Regarding ISS 16+, the rate of undertriage in actual practice was 15.3%, but those patients did not have a higher mortality.
PubMed: 38541939
DOI: 10.3390/jcm13061714 -
Journal of Clinical Medicine Mar 2024Forensic hospitals throughout the country house individuals with severe mental illness and history of criminal violations. Insomnia affects 67.4% of hospitalized... (Review)
Review
Forensic hospitals throughout the country house individuals with severe mental illness and history of criminal violations. Insomnia affects 67.4% of hospitalized patients with chronic neuropsychiatric disorders, indicating that these conditions may hijack human somnogenic pathways. Conversely, somnolence is a common adverse effect of many antipsychotic drugs, further highlighting a common etiopathogenesis. Since the brain salience network is likely the common denominator for insomnia, neuropsychiatric and neurodegenerative disorders, here, we focus on the pathology of this neuronal assembly and its likely driver, the dysfunctional neuronal and mitochondrial membrane. We also discuss potential treatment strategies ranging from membrane lipid replacement to mitochondrial transplantation. The aims of this review are threefold: 1. Examining the causes of insomnia in forensic detainees with severe mental illness, as well as its role in predisposing them to neurodegenerative disorders. 2. Educating State hospital and prison clinicians on frontotemporal dementia behavioral variant, a condition increasingly diagnosed in older first offenders which is often missed due to the absence of memory impairment. 3. Introducing clinicians to natural compounds that are potentially beneficial for insomnia and severe mental illness.
PubMed: 38541916
DOI: 10.3390/jcm13061691 -
Entropy (Basel, Switzerland) Feb 2024Machine learning (ML) methods are increasingly being applied to analyze biological signals. For example, ML methods have been successfully applied to the human...
Machine learning (ML) methods are increasingly being applied to analyze biological signals. For example, ML methods have been successfully applied to the human electroencephalogram (EEG) to classify neural signals as pathological or non-pathological and to predict working memory performance in healthy and psychiatric patients. ML approaches can quickly process large volumes of data to reveal patterns that may be missed by humans. This study investigated the accuracy of ML methods at classifying the brain's electrical activity to cognitive events, i.e., event-related brain potentials (ERPs). ERPs are extracted from the ongoing EEG and represent electrical potentials in response to specific events. ERPs were evoked during a visual Go/NoGo task. The Go/NoGo task requires a button press on Go trials and response withholding on NoGo trials. NoGo trials elicit neural activity associated with inhibitory control processes. We compared the accuracy of six ML algorithms at classifying the ERPs associated with each trial type. The raw electrical signals were fed to all ML algorithms to build predictive models. The same raw data were then truncated in length and fitted to multiple dynamic state space models of order nx using a continuous-time subspace-based system identification algorithm. The 4nx numerator and denominator parameters of the transfer function of the state space model were then used as substitutes for the data. Dimensionality reduction simplifies classification, reduces noise, and may ultimately improve the predictive power of ML models. Our findings revealed that all ML methods correctly classified the electrical signal associated with each trial type with a high degree of accuracy, and accuracy remained high after parameterization was applied. We discuss the models and the usefulness of the parameterization.
PubMed: 38539732
DOI: 10.3390/e26030220