Lung ultrasound for prediction of surfactant requirement in Indian preterm neonates: a diagnostic accuracy study.

Surfactant replacement for respiratory distress syndrome (RDS) is currently guided by oxygen (FiO2) requirement in preterm neonates. Lung ultrasound (LUS) has emerged as an important predictive tool; however, there is a paucity of evidence from developing countries. The objective of this study was to determine the diagnostic accuracy of the LUS score in comparison to standard criteria based on FiO2 requirement for prediction of surfactant requirement. In this prospective study, preterm neonates of < 34 weeks' gestation with RDS were included within 2 h of life. Surfactant was administered if the FiO2 requirement exceeded 30%. Baseline characteristics, respiratory parameters, and LUS clips were recorded soon after birth and compared between the surfactant and non-surfactant groups. LUS scoring was later performed by masked assessors which was not used in the management of neonates. Among 82 neonates (mean gestation 30.6 weeks and weight 1375 g) included in the study, 33 (40.2%) received surfactant. The surfactant group had a higher Silverman score, required higher FiO2 and mean airway pressure, and needed invasive ventilation more frequently. The mean (± SD) LUS score was significantly higher in the surfactant (9.4 ± 3.2) compared to the non-surfactant group (5.1 ± 2.1). The diagnostic accuracy of LUS scoring was determined by ROC curve analysis (AUC (95% CI): 0.83 (0.74-0.92), p < 0.01). A cutoff score of ≥ 8 for LUS was considered optimal for the prediction of surfactant requirement (sensitivity and specificity (95% CI) of 70% (51-84) and 80% (66-90), respectively).    Conclusion: Lung ultrasound is a valid diagnostic tool for the prediction of surfactant requirements in resource-limited settings. What is Known: • Lung ultrasound has a good diagnostic accuracy in predicting the need for surfactant administration in preterm neonates in developed countries, but its role in developing countries is unclear. What is New: • Lung ultrasound proved to be a valid diagnostic tool in predicting surfactant replacement therapy in resource-limited settings. • The diagnostic performance of lung ultrasound was better in neonates on non-invasive ventilation, compared to invasive ventilation.

Understanding the Role of a Technology and EMR-based Social Determinants of Health Screening Tool and Community-based Resource Connections in Health Care Resource Utilization.

BACKGROUND: Health systems are increasingly investing in social determinants of health (SDoH), but there is limited research on how such efforts impact health care resource use. This study presents pilot work on an SDoH screening and referral platform recently implemented in South Carolina's largest private nonprofit health system. OBJECTIVES: To assess the feasibility and sustainability of SDoH screening and SDoH-related referrals in a large health system and examine how they affect health resource use. RESEARCH DESIGN: Observational study using electronic medical records and SDoH screening data from June 1, 2019 to December 31, 2020. SUBJECTS: Patients (18 y+) engaged in community health, inpatient case management, or ambulatory care and condition management programs. MEASURES: We describe the use of SDoH screening by providers (community health workers, nurse case managers, and social workers) and SDoH referral volumes among patients. We use multivariate analyses to predict changes in emergency department visits, inpatient admission s (length of stay and volume), and primary care visits from referral volume, SDoH screening question responses, and patient characteristics (eg, comorbidities). RESULTS: Of 2687 patients, 662 (24.6%) screened positive for 1 or more SDoH domains. SDoH screening performance remained consistent among providers over time. Six hundred fifty-eight (24.5%) patients received SDoH referrals. Patients receiving an increasing volume of referrals had decreasing primary care visits but their comorbidities moderated this effect. CONCLUSIONS: The study provides initial descriptive information on SDoH needs, implementation of referrals and resource use, guiding SDoH screening implementation in population health, and care management programs.

Emergency department use and geospatial variation in social determinants of health: a pilot study from South Carolina.

BACKGROUND: Health systems are increasingly addressing patients' social determinants of health (SDoH)-related needs and investigating their effects on health resource use. SDoH needs vary geographically; however, little is known about how this geographic variation in SDoH needs impacts the relationship between SDoH needs and health resource use. METHODS: This study uses data from a SDoH survey administered to a pilot patient population in a single health system and the electronic medical records of the surveyed patients to determine if the impact of SDoH needs on emergency department use varies geospatially at the US Census block group level. A Bayesian zero-inflated negative binomial model was used to determine if emergency department visits after SDoH screening varied across block groups. Additionally, the relationships between the number of emergency department visits and the response to each SDoH screening question was assessed using Bayesian negative binomial hurdle models with spatially varying coefficients following a conditional autoregressive (CAR) model at the census block group level. RESULTS: Statistically important differences in emergency department visits after screening were found between block groups. Statistically important spatial variation was found in the association between patient responses to the questions concerning unhealthy home environments (e.g. mold, bugs/rodents, not enough air conditioning/heat) or domestic violence/abuse and the mean number of emergency department visits after the screen. CONCLUSIONS: Notable spatial variation was found in the relationships between screening positive for unhealthy home environments or domestic violence/abuse and emergency department use. Despite the limitation of a relatively small sample size, sensitivity analyses suggest spatially varying relationships between other SDoH-related needs and emergency department use.

The use of concentrated growth factor in dental implantology: A systematic review.

In the era of evidence based dentistry, a well-documented consolidated data about improvements in dentistry is a necessity. Concentrated growth factor (CGF) is an emerging trend in periodontology and now in implant dentistry. Various studies have been published in the literature evaluating the effect of CGF on implant osseointegration, implant stability, survival rate, sinus augmentation, and peri-implant defects. However, no systematic review has yet been documented. The present systematic review, being first of its kind, aimed to evaluate the potential outcomes of employing CGF in implant treatment. A literature search was carried out in PubMed and Google scholar for articles published between 2001 and 2019, with various keywords such as "CGF," "dental implant," "bone regeneration," "CGF," and "osseointegration." The screening of studies was done according to PRISMA guidelines. A total of eleven studies were included in this review. Majority of the included studies pointed toward the beneficial effects of CGF in implant treatment. CGF was seen to promote osseointegration and enhance bone regeneration. Although more clinical studies are required to validate the potential merits of CGF in the long run, the preliminary results seem promising.

Timing of preventive behavior in the case of a new and evolving health risk: the case of COVID-19 vaccination.

BACKGROUND: Time preferences for preventive behavior under novel risks and uncertain contexts may differ from timing preferences related to familiar risks. Therefore, it is crucial to examine drivers of preventative health behavior timing in light of new health risks. Using the case of COVID-19, we examine factors affecting vaccination timing plans when vaccines were widely available in the European Union (EU). METHODS: We use data from the Flash Eurobarometer 494 survey (May 21-26, 2021), which collected information on EU residents' attitudes towards COVID-19 vaccinations. We also use the 'Our World in Data' vaccination database for country-level COVID-19 vaccination rates. Probit regressions were conducted to determine how local vaccination rates, trust in information sources, social norms, vaccine safety beliefs, and risk understanding affected the probability of COVID-19 vaccination delay. RESULTS: Of total participants (n = 26,106), 9,063 (34.7%) were vaccinated, 7,114 (27.3%) wanted to get vaccinated as soon as possible, 5,168 (19.8%) wanted to delay vaccination and 2,962 (11.4%) resisted vaccination. Participants were more likely to delay COVID-19 vaccination if they lived in a country with lower vaccination prevalence, trusted online social networks, family, friends, and colleagues for vaccination information, were eager to follow vaccination-related social norms, expressed vaccine safety concerns, and understood the risk of catching COVID-19 without a vaccine to be lower. CONCLUSIONS: Results from the study contribute to understanding important factors that predict timing of vaccination plans. These findings can also contribute to the wider knowledge base about timing of preventive behavior uptake in novel risk contexts.

An assessment of preclinical removable prosthodontics based on multiple-choice questions: Stakeholders' perceptions.

PURPOSE: Item analysis of multiple-choice questions (MCQs) is an essential tool for identifying items that can be stored, revised, or discarded to build a quality MCQ bank. This study analyzed MCQs based on item analysis to develop a pool of valid and reliable items and investigate stakeholders' perceptions regarding MCQs in a written summative assessment (WSA) based on this item analysis. METHODS: In this descriptive study, 55 questions each from 2016 to 2019 of WSA in preclinical removable prosthodontics for fourth-year undergraduate dentistry students were analyzed for item analysis. Items were categorized according to their difficulty index (DIF I) and discrimination index (DI). Students (2021-2022) were assessed using this question bank. Students' perceptions of and feedback from faculty members concerning this assessment were collected using a questionnaire with a five-point Likert scale. RESULTS: Of 220 items when both indices (DIF I and DI) were combined, 144 (65.5%) were retained in the question bank, 66 (30%) required revision before incorporation into the question bank, and only 10 (4.5%) were discarded. The mean DIF I and DI values were 69% (standard deviation [Std.Dev] = 19) and 0.22 (Std.Dev = 0.16), respectively, for 220 MCQs. The mean scores from the questionnaire for students and feedback from faculty members ranged from 3.50 to 4.04 and from 4 to 5, respectively, indicating that stakeholders tended to agree and strongly agree, respectively, with the proposed statements. CONCLUSION: This study assisted the prosthodontics department in creating a set of prevalidated questions with known difficulty and discrimination capacity.

Development and Validation of Single-Optimization Knowledge-Based Volumetric Modulated Arc Therapy Model Plan in Nasopharyngeal Carcinomas.

Purpose: Knowledge-based planning (KBP) has evolved to standardize and expedite the complex process of radiation therapy planning for nasopharyngeal cancer (NPC). Herein, we aim to develop and validate the suitability of a single-optimization KBP for NPC. Methods and Materials: Volumetric modulated arc therapy plans of 103 patients with NPC treated between 2016 and 2020 were reviewed and used to generate a KBP model. A validation set of 15 patients was employed to compare the quality of single optimization KBP and clinical plans using the paired t test and the Wilcoxon signed rank test. The time required for either planning was also analyzed. Results: Most patients (86.7%) were of locally advanced stage (III/IV). The median dose received by 95% of the high-risk planning target volume was significantly higher for the KBP (97.1% vs 96.4%; P = .017). The median homogeneity (0.09 vs 0.1) and conformity (0.98 vs 0.97) indices for high-risk planning target volume and sparing of the normal tissues like optic structures, spinal cord, and uninvolved dysphagia and aspiration-related structures were better with the KBP (P < .05). In the blinded evaluation, the physician preferred the KBP plan in 13 out of 15 patients. The median time required to generate the KBP and manual plans was 53 and 77 minutes, respectively. Conclusions: KBP with a single optimization is an efficient and time saving alternative for manual planning in NPC.

A case report on implant retained auricular prosthesis: Bringing back hope and smile.

Long-term success of a facial prosthesis mainly depends on retention. Most articles relate tissue health to long-term success, not retention. Anatomic undercuts, skin adhesives and implants are important factors to provide sufficient retention. Extra oral implant retained prosthesis have been proven to be a predictable treatment option for maxillofacial rehabilitation. This case report describes the clinical and laboratory procedures for fabricating implant-retained auricular prosthesis using magnets for retention. It describes how an initial planning for implant placement with Hader-bar retentive system was opted out due to intra-surgical situation. The use of craniofacial implants for retention of extra oral prosthesis, such as ears, offers excellent support and retentive abilities and improves a patient's appearance and quality of life. It has been shown in clinical and biomechanical studies that two implants are sufficient to retain an auricular prosthesis. Judicial treatment planning and implant placement according to the available remaining structures is prudent for a successful prosthesis.

Patient and Care Team Perspectives on Social Determinants of Health Screening in Primary Care: A Qualitative Study.

Importance: Health systems in the US are increasingly screening for social determinants of health (SDOH). However, guidance incorporating stakeholder feedback is limited. Objective: To examine patient and care team experiences in early implementation of SDOH screening in primary care. Design, Setting, and Participants: This qualitative study included cross-sectional analysis of SDOH screenings during primary care visits from February 22 to May 10, 2022, primary care team member interviews from July 6, 2022, to March 8, 2023, and patient stakeholder engagement on June 30, 2022. The setting was a large southeastern US health care system. Eligible patients were aged 18 years or older with completed visits in primary care. Exposure: Screening for SDOH in primary care. Main outcomes and Measures: Multivariable logistic regression evaluated patient (eg, age, race and ethnicity) and care team characteristics (eg, practice type), and screening completeness. Interviews contextualized the quantitative analysis. Results: There were 78 928 visits in practices conducting any SDOH screening. The population with visits had a mean (SD) age of 57.6 (18.1) years; 48 086 (60.9%) were female, 12 569 (15.9%) Black, 60 578 (76.8%) White, and 3088 (3.9%) Hispanic. A total of 54 611 visits (69.2%) were with a doctor of medicine and 13 035 (16.5%) with a nurse practitioner. Most had no SDOH questions answered (75 298 [95.4%]) followed by all questions (2976 [3.77%]). Logistic regression analysis found that clinician type, patient race, and primary payer were associated with screening likelihood: for clinician type, nurse practitioner (odds ratio [OR], 0.13; 95% CI, 0.03-0.62; P = .01) and physician assistant (OR, 3.11; 95% CI, 1.19-8.10; P = .02); for patient race, Asian (OR, 1.69; 95% CI, 1.25-2.28; P = .001); Black (OR, 1.49; 95% CI, 1.10-2.01; P = .009); or 2 or more races (OR, 1.48; 95% CI, 1.12-1.94; P = .006); and for primary payer, Medicaid (OR, 0.62; 95% CI, 0.48-0.80; P < .001); managed care (OR, 1.17; 95% CI, 1.07-1.29; P = .001); uninsured or with Access Health (OR, 0.26; 95% CI, 0.10-0.67; P = .005), and Tricare (OR, 0.71; 95% CI, 0.55-0.92; P = .01). Interview themes included barriers (patient hesitancy, time and resources for screening and referrals, and number of questions/content overlap) and facilitators (communication, practice champions, and support for patient needs). Conclusions and Relevance: This qualitative study presents potential guidance regarding factors that could improve SDOH screening within busy clinical workflows.

Diet, Fluid Intake, Urine Output and Urinary Sodium/Potassium Ratios in Children With Urolithiasis.

We performed a cross-sectional study on 25 children (17 boys) with urolithiasis with normal glomerular functions at a tertiary care teaching hospital between March, 2018 to March, 2019. Dietary assessment showed that caloric intake was below recommended dietary allowance (RDA) in 68% patients while the median protein intake was 34.3% more. The fluid intake was below the recommended standards in 56%, and 48% of the children had urine output below 1.5 mL/kg/hour. The urinary sodium was elevated in 96% of the children, urinary potassium was low in 40%, and hypercalciuria was seen in 28%. While metabolic causes predominate in childhood urolithiasis, other factors like dietary changes, liberal fluid and low sodium intake are advised for prevention of recurrences as they have a contributory role too.

Simultaneous spectrophotometric determination of drug components from their dosage formulations.

Spectrophotometry is a quick and reliable method for determining the composition of a variety of complex drug mixtures. Several mathematical models are available for the resolution of complex multicomponent UV spectra. UV spectrophotometric methods have the inherent capacity to resolve the interlaced spectra of complex mixtures quickly and appropriately, particularly for quantitative determination of components of mixture where several costly tools are not available. These methods also have the benefit of lower operational costs as they are operated using lesser amounts of analytical grade solvents and generate less waste. In this review, we discussed the theoretical background of different UV spectrometric methods for quantitative analysis of drug mixtures. The main focus of this review is to describe and report applications of extended Beer's law-based multicomponent analysis and to highlight the recent developments in the simultaneous determination of drug components from their complex mixtures.

A strategy towards the synthesis of superhydrophobic/superoleophilic non-fluorinated polypyrrole nanotubes for oil-water separation.

Superhydrophobic/superoleophilic materials have shown great potential for applications in oil/water separation. However, practical applications of these materials are restricted due to their toxicity and complicated, expensive, and non-eco-friendly fabrication procedures. Here, we have successfully developed an easy, simple, cost-effective, and environmentally friendly strategy towards the synthesis of superhydrophobic and superoleophilic porous polypyrrole nanotubes. Such wettability has been introduced into polypyrrole by co-doping with sodium dodecylbenzenesulfonate, a surfactant for lowering surface energy and controlling the morphology of the nanotubes. These non toxic and environment friendly polymer nanotubes exhibit oil absorption capability from oil/water mixtures with a reasonable efficiency with good reusability.

Sacrificial amphiphiles: Eco-friendly chemical herders as oil spill mitigation chemicals.

Crude oil spills are a major threat to marine biota and the environment. When light crude oil spills on water, it forms a thin layer that is difficult to clean by any methods of oil spill response. Under these circumstances, a special type of amphiphile termed as "chemical herder" is sprayed onto the water surrounding the spilled oil. The amphiphile forms a monomolecular layer on the water surface, reducing the air-sea surface tension and causing the oil slick to retract into a thick mass that can be burnt in situ. The current best-known chemical herders are chemically stable and nonbiodegradable, and hence remain in the marine ecosystem for years. We architect an eco-friendly, sacrificial, and effective green herder derived from the plant-based small-molecule phytol, which is abundant in the marine environment, as an alternative to the current chemical herders. Phytol consists of a regularly branched chain of isoprene units that form the hydrophobe of the amphiphile; the chain is esterified to cationic groups to form the polar group. The ester linkage is proximal to an allyl bond in phytol, which facilitates the hydrolysis of the amphiphile after adsorption to the sea surface into the phytol hydrophobic tail, which along with the unhydrolyzed herder, remains on the surface to maintain herding action, and the cationic group, which dissolves into the water column. Eventual degradation of the phytol tail and dilution of the cation make these sacrificial amphiphiles eco-friendly. The herding behavior of phytol-based amphiphiles is evaluated as a function of time, temperature, and water salinity to examine their versatility under different conditions, ranging from ice-cold water to hot water. The green chemical herder retracted oil slicks by up to ~500, 700, and 2500% at 5°, 20°, and 35°C, respectively, during the first 10 min of the experiment, which is on a par with the current best chemical herders in practice.