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Nevin Manimala Statistics

Surgical Outcome Measures in a Cohort of Patients at High Risk of Breast Cancer Treated by Bilateral Risk Reducing Mastectomy and Breast Reconstruction

Plast Reconstr Surg. 2022 Jun 24. doi: 10.1097/PRS.0000000000009383. Online ahead of print.

ABSTRACT

INTRODUCTION: Women with breast cancer related genetic pathogenic variants (e.g. BRCA1, BRCA2) or with a strong family history carry lifetime risks of developing breast cancer of up to 80-90%. A significant proportion of these women proceed to bilateral risk reducing mastectomy (RRM). We aimed to document the surgical morbidity of RRM and establish whether a diagnosis of breast cancer at the time of surgery impacted on outcomes.

METHODS: Clinical details of 445 women identified as having >25% lifetime risk of developing breast cancer who underwent RRM and breast reconstruction were interrogated for surgical outcomes such as planned, unplanned and emergency procedures, complication rates, length of stay and longevity of breast reconstruction. These outcome measures were recorded in women diagnosed with breast cancer perioperatively (cancer group, CG) and those without malignancy (benign group, BG).

RESULTS: Median follow up was similar in both groups (BG, 70months; CG 73 months). Patients were older in the CG than BG (43y v 39y; p<0.001). Women in the CG required more planned procedures to complete reconstruction than those in the BG (4 v 2; p=0.002). Emergency procedures, unplanned surgical interventions (e.g. capsulectomy) and post reconstruction complication rates were similar between groups.One in five women overall required revisional surgery. Patients with autologous reconstructions had a revision rate of 1.24/1000 person years compared with 2.52 in the implant reconstruction group.

CONCLUSION: Women contemplating RRM can be reassured that this a safe and effective procedure but will likely take multiple interventions. This knowledge should be integral to obtaining informed consent.

PMID:35749222 | DOI:10.1097/PRS.0000000000009383

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Nevin Manimala Statistics

Scaling of Acceleration Statistics in High Reynolds Number Turbulence

Phys Rev Lett. 2022 Jun 10;128(23):234502. doi: 10.1103/PhysRevLett.128.234502.

ABSTRACT

The scaling of acceleration statistics in turbulence is examined by combining data from the literature with new data from well-resolved direct numerical simulations of isotropic turbulence, significantly extending the Reynolds number range. The acceleration variance at higher Reynolds numbers departs from previous predictions based on multifractal models, which characterize Lagrangian intermittency as an extension of Eulerian intermittency. The disagreement is even more prominent for higher-order moments of the acceleration. Instead, starting from a known exact relation, we relate the scaling of acceleration variance to that of Eulerian fourth-order velocity gradient and velocity increment statistics. This prediction is in excellent agreement with the variance data. Our Letter highlights the need for models that consider Lagrangian intermittency independent of the Eulerian counterpart.

PMID:35749192 | DOI:10.1103/PhysRevLett.128.234502

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Nevin Manimala Statistics

Two-sample t α -test for testing hypotheses in small-sample experiments

Int J Biostat. 2022 Jun 24. doi: 10.1515/ijb-2021-0047. Online ahead of print.

ABSTRACT

It has been reported that about half of biological discoveries are irreproducible. These irreproducible discoveries were partially attributed to poor statistical power. The poor powers are majorly owned to small sample sizes. However, in molecular biology and medicine, due to the limit of biological resources and budget, most molecular biological experiments have been conducted with small samples. Two-sample t-test controls bias by using a degree of freedom. However, this also implicates that t-test has low power in small samples. A discovery found with low statistical power suggests that it has a poor reproducibility. So, promotion of statistical power is not a feasible way to enhance reproducibility in small-sample experiments. An alternative way is to reduce type I error rate. For doing so, a so-called t α -test was developed. Both theoretical analysis and simulation study demonstrate that t α -test much outperforms t-test. However, t α -test is reduced to t-test when sample sizes are over 15. Large-scale simulation studies and real experiment data show that t α -test significantly reduced type I error rate compared to t-test and Wilcoxon test in small-sample experiments. t α -test had almost the same empirical power with t-test. Null p-value density distribution explains why t α -test had so lower type I error rate than t-test. One real experimental dataset provides a typical example to show that t α -test outperforms t-test and a microarray dataset showed that t α -test had the best performance among five statistical methods. In addition, the density distribution and probability cumulative function of t α -statistic were given in mathematics and the theoretical and observed distributions are well matched.

PMID:35749155 | DOI:10.1515/ijb-2021-0047

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Nevin Manimala Statistics

Clinical, radiographic, and biochemical evaluation of two-piece versus one-piece single implants with a laser-microgrooved collar surface after 5 years of functional loading

Clin Implant Dent Relat Res. 2022 Jun 24. doi: 10.1111/cid.13118. Online ahead of print.

ABSTRACT

AIM: To compare the clinical and radiographic conditions and the expression of pro-inflammatory cytokines in peri-implant crevicular fluid (PICF) at two-piece/bone level (TP/BL) versus one-piece/tissue level (OP/TL) single implants with a laser-microgrooved collar after at least 5 years of loading.

MATERIALS AND METHODS: In total, 20 single TP/BL implants and 20 contralateral OP/TL implants, both with a laser-microgrooved collar surface, in 20 systemically and periodontally healthy subjects (12 males and 8 females, between the age of 36 and 64 [mean age of 49.7 ± 12.3 years]), were examined. Levels of IL-1β, IL-1RA, IL-6, IL-8, IL-17, b-FGF, G-CSF, GM-CSF, IFN, MIP-1β, TNF-α, and VEGF were assessed in PICF using the Bio-Plex 200 Suspension Array System. Plaque index (PI), probing depth (PD), bleeding on probing (BOP), and gingival recession (REC) were recorded. Radiographic crestal bone levels (CBL) were assessed at the mesial and distal aspects of the implant sites.

RESULTS: The mean PI, PD, BOP, and REC values had no significant differences in either group. A higher mean value of CBL with statistical difference was detected for TP/BL compared with OP/TL implants. The levels of IL-1β, IL-6, IL-8, GM-CSF, and MIP-1β and TNF-α were higher at TP/BL implants than at OP/TL implants. However, only IL-1β, IL-6, and TNF-α values presented significant differences between the groups.

CONCLUSIONS: Although after 5 years of loading single TP/BL and OP/TL implants with a laser-microgrooved collar surface presented similar good clinical conditions, a higher proinflammatory state and higher crestal bone loss were detected for TP/BL implants.

PMID:35749154 | DOI:10.1111/cid.13118

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Nevin Manimala Statistics

Sharing Rewards Undermines Coordinated Hunting

J Comput Biol. 2022 Jun 24. doi: 10.1089/cmb.2021.0549. Online ahead of print.

ABSTRACT

Coordinated hunting is widely observed in animals, and sharing rewards is often considered a major incentive for its success. While current theories about the role played by sharing in coordinated hunting are based on correlational evidence, we reveal the causal roles of sharing rewards through computational modeling with a state-of-the-art Multi-agent Reinforcement Learning (MARL) algorithm. We show that counterintuitively, while selfish agents reach robust coordination, sharing rewards undermines coordination. Hunting coordination modeled through sharing rewards (1) suffers from the free-rider problem, (2) plateaus at a small group size, and (3) is not a Nash equilibrium. Moreover, individually rewarded predators outperform predators that share rewards, especially when the hunting is difficult, the group size is large, and the action cost is high. Our results shed new light on the actual importance of prosocial motives for successful coordination in nonhuman animals and suggest that sharing rewards might simply be a byproduct of hunting, instead of a design strategy aimed at facilitating group coordination. This also highlights that current artificial intelligence modeling of human-like coordination in a group setting that assumes rewards sharing as a motivator (e.g., MARL) might not be adequately capturing what is truly necessary for successful coordination.

PMID:35749149 | DOI:10.1089/cmb.2021.0549

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Nevin Manimala Statistics

Placental location and obstetrical-neonatal outcomes – A retrospective study

Int J Gynaecol Obstet. 2022 Jun 24. doi: 10.1002/ijgo.14316. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore the potential association of lateral placentation with pregnancy outcome.

METHODS: The database of a tertiary medical center was searched for women who gave birth to a singleton infant in 2012-2020 for whom placental location was documented during antepartum sonographic examination. Clinical data were compared between patients with a central (anterior/posterior/fundal) or lateral placenta using standard statistics. The primary outcome measure was neonatal birthweight; secondary outcome measures were pregnancy complications and mode of delivery.

RESULTS: The cohort included 12,306 women: 11,608 (94%) with a central placenta and 698 (5.6%) with a lateral placenta. The lateral placenta group had higher rates (P <0.05) of prior and current cesarean delivery, assisted delivery, and preterm birth. On multivariate regression analyses, placental location (aOR 1.36, 95% CI 1.11-1.66) and maternal age (aOR 1.02, 95% CI 1.01-1.03) were associated with risk of preterm birth; lateral placenta (aOR 1.22, 95% CI 1.02-1.47), maternal age (aOR 1.07, 95% CI 1.06-1.08), parity (aOR 0.32, 95% CI 0.28-0.35), and prior cesarean delivery (aOR 12.00, 95% CI 10.60-13.60) were associated with risk of current cesarean delivery.

CONCLUSION: The findings suggest that lateral placentation may pose a risk of preterm birth and cesarean delivery compared to central placentation.

PMID:35749141 | DOI:10.1002/ijgo.14316

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Nevin Manimala Statistics

Hospital Costs and Fatality Rates of Traumatic Assaults by Mechanism in the US, 2016-2018

JAMA Netw Open. 2022 Jun 1;5(6):e2218496. doi: 10.1001/jamanetworkopen.2022.18496.

ABSTRACT

IMPORTANCE: Estimates of the total economic cost of firearm violence are important in drawing attention to this public health issue; however, studies that consider violence more broadly are needed to further the understanding of the extent to which such costs can be avoided.

OBJECTIVES: To estimate the association of firearm assaults with US hospital costs and deaths compared with other assault types.

DESIGN, SETTING, AND PARTICIPANTS: The 2016-2018 US Nationwide Emergency Department Sample and National Inpatient Sample, Healthcare Cost and Utilization Project were used in this cross-sectional study of emergency department (ED) and inpatient admissions for assaults involving a firearm, sharp object, blunt object, or bodily force identified using International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes. Differences in ED and inpatient costs (2020 US dollars) across mechanisms were estimated using ordinary least-squares regression with and without adjustments for year and hospital, patient, and injury characteristics. The Centers for Disease Control and Prevention underlying cause of death data were used to estimate national death rates and hospital case-fatality rates across mechanisms. Cost analysis used a weighted sample. National death rates and hospital case-fatality rates used US resident death certificates, covering 976 million person-years. Hospital case-fatality rates also used nationally weighted ED records covering 2.7 million admissions. Data analysis was conducted from March 1, 2021, to March 31, 2022.

EXPOSURE: The primary exposure was the mechanism used in the assault.

MAIN OUTCOMES AND MEASURES: Emergency department and inpatient costs per record. National death rates and hospital case-fatality rates.

RESULTS: Overall, 2.4 million ED visits and 184 040 inpatient admissions for assault were included. Across all mechanisms, the mean age of the population was 32.7 (95% CI, 32.6-32.9) years in the ED and 36.4 (95% CI, 36.2-36.7) years in the inpatient setting; 41.9% (95% CI, 41.2%-42.5%) were female in the ED, and 19.1% (95% CI, 18.6%-19.6%) of inpatients were female. Most assaults recorded in the ED involved publicly insured or uninsured patients and hospitals in the Southern US. Emergency department costs were $678 (95% CI, $657-$699) for bodily force, $861 (95% CI, $813-$910) for blunt object, $996 (95% CI, $925-$1067) for sharp object, and $1388 (95% CI, $1254-$1522) for firearm assaults. Corresponding inpatient costs were $14 702 (95% CI, $14 178-$15 227) for bodily force, $17 906 (95% CI, $16 888-$18 923) for blunt object, $19 265 (95% CI, $18 475-$20 055) for sharp object, and $34 949 (95% CI, $33 654-$36 244) for firearm assaults. National death rates per 100 000 were 0.04 (95% CI, 0.03-0.04) for bodily force, 0.03 (95% CI, 0.03-0.03) for blunt object, 0.54 (95% CI, 0.52-0.55) for sharp object, and 4.40 (95% CI, 4.36-4.44) for firearm assaults. Hospital case fatality rates were 0.01% (95% CI, 0.009%-0.012%) for bodily force, 0.05% (95% CI, 0.04%-0.06%) for blunt object, 1.05% (95% CI, 1.00%-1.09%) for sharp object, and 15.26% (95% CI, 15.04%-15.49%) for firearm assaults. In regression analysis, ED costs for firearm assaults were 59% to 99% higher than costs for nonfirearm assaults, and inpatient costs were 67% to 118% higher.

CONCLUSIONS AND RELEVANCE: The findings of this study suggest that it may be useful for policies aimed at reducing the costs of firearm violence to consider violence more broadly to understand the extent to which costs can be avoided.

PMID:35749116 | DOI:10.1001/jamanetworkopen.2022.18496

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Nevin Manimala Statistics

Effect of Automated Telephone Infectious Disease Consultations to Nonacademic Hospitals on 30-Day Mortality Among Patients With Staphylococcus aureus Bacteremia: The SUPPORT Cluster Randomized Clinical Trial

JAMA Netw Open. 2022 Jun 1;5(6):e2218515. doi: 10.1001/jamanetworkopen.2022.18515.

ABSTRACT

IMPORTANCE: Staphylococcus aureus bacteremia (SAB) is a common and potentially severe infectious disease (ID). Retrospective studies and derived meta-analyses suggest that bedside infectious disease consultation (IDC) for SAB is associated with improved survival; however, such IDCs might not always be possible because of the lack of ID specialists, particularly at nonacademic hospitals.

OBJECTIVES: To investigate whether unsolicited telephone IDCs (triggered by an automated blood stream infection reporting system) to nonacademic hospitals improved 30-day all-cause mortality in patients with SAB.

DESIGN, SETTING, AND PARTICIPANTS: This patient-blinded, multicenter, interventional, cluster randomized, controlled, crossover clinical trial was conducted in 21 rural, nonacademic hospitals in Thuringia, Germany. From July 1, 2016, to December 31, 2018, 1029 blood culture reports were assessed for eligibility. A total of 386 patients were enrolled, whereas 643 patients were not enrolled for the following reasons: death before enrollment (n = 59); palliative care (n = 41); recurrence of SAB (n = 9); discharge from the hospital before enrollment (n = 77); age younger than 18 years (n = 5); duplicate report from a single patient (n = 26); late report (n = 17); blood culture reported during the washout phase (n = 48); and no signed informed consent for other or unknown reasons (n = 361).

INTERVENTIONS: During the ID intervention phase, ID specialists from Jena University Hospital provided unsolicited telephone IDCs to physicians treating patients with SAB. During the control phase, patients were treated according to local standards. Crossover was performed after including 15 patients or, at the latest, 1 year after the first patient was included.

MAIN OUTCOMES AND MEASURES: Thirty-day all-cause mortality.

RESULTS: A total of 386 patients (median [IQR] age, 75 [63-82] years; 261 [67.6%] male) were included, with 177 randomized to the IDC group and 209 to the control group. The 30-day all-cause mortality rate did not differ between the IDC and control groups (relative risk reduction [RRR], 0.12; 95% CI, -2.17 to 0.76; P = .81). No evidence was found of a difference in secondary outcomes, including 90-day mortality (RRR, 0.17; 95% CI, -0.59 to 0.57; P = .62), 90-day recurrence (RRR, 0.10; 95% CI, -2.51 to 0.89; P = .89), and hospital readmission (RRR, 0.04; 95% CI, -0.63 to 0.48; P = .90). Exploratory evidence suggested that indicators of quality of care were potentially realized more often in the IDC group than in the control group (relative quality improvement, 0.16; 95% CI, 0.08-0.26; P = .01).

CONCLUSIONS AND RELEVANCE: In this cluster randomized clinical trial, unsolicited telephone IDC, although potentially enhancing quality of care, did not improve 30-day all-cause mortality in patients with SAB.

TRIAL REGISTRATION: drks.de Identifier: DRKS00010135.

PMID:35749114 | DOI:10.1001/jamanetworkopen.2022.18515

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Nevin Manimala Statistics

Prevalence of Perinatal Depression and Anxiety in Both Parents: A Systematic Review and Meta-analysis

JAMA Netw Open. 2022 Jun 1;5(6):e2218969. doi: 10.1001/jamanetworkopen.2022.18969.

ABSTRACT

IMPORTANCE: New and expectant parents experience perinatal mood disorders, with consequences to parenting ability, bonding with the neonate, interpersonal relationships, and health and well-being of parents. Research shows that maternal and paternal perinatal mood disorders are associated, but no recent systematic review has addressed the prevalence of perinatal mood disorders in both mothers and fathers (parental dyad).

OBJECTIVE: To examine the prevalence of perinatal mood disorders in parental dyads and identify factors associated with perinatal mood disorders in parental dyads.

DATA SOURCES: Ovid (MEDLINE, Embase, and PsycINFO) and Web of Science were searched from January 1, 1990, to June 8, 2021, for observational studies reporting on the prevalence of perinatal depression or anxiety in a parental dyad.

STUDY SELECTION: Studies reporting the prevalence of anxiety or depression in both members of a parental dyad were included, with diagnosis according to established criteria (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition], International Classification of Diseases, 11th Revision) or use of validated screening tools.

DATA EXTRACTION AND SYNTHESIS: Prevalence data were extracted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were analyzed in subgroups: antenatal depression, early postnatal depression (0-12 weeks), late postnatal depression (3-12 months), and perinatal anxiety. Pooled prevalence was calculated using a random-effects meta-analysis model. Quality assessment was performed using Joanna Briggs Institute Appraisal Checklist for Studies Reporting Prevalence Data. Data were analyzed in June 2021.

MAIN OUTCOMES AND MEASURES: Prevalence of perinatal anxiety and perinatal depression in parental dyads.

RESULTS: Twenty-three studies were included, with data from 29 286 couples. The pooled prevalence of antenatal depression in both parents was 1.72% (95% CI, 0.96%-2.48%; P < .001). The prevalence of early postnatal depression (up to 12 weeks post partum) was 2.37% (95% CI, 1.66%-3.08%; P < .001) and the prevalence of late postnatal depression (3-12 months post partum) was 3.18% (95% CI, 2.3-4.05; P < .001). Only 3 studies reported on perinatal anxiety in both parents, precluding a quantitative analysis.

CONCLUSIONS AND RELEVANCE: In up to 3.18% of couples, both parents may concurrently experience perinatal depression. Perinatal health care must consider the mental health needs of parents, both as individuals and as a parental dyad. Further research is needed to examine outcomes in families where both parents experience perinatal mood disorders.

PMID:35749112 | DOI:10.1001/jamanetworkopen.2022.18969

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Effects of feed deprivation on physical and blood parameters of horses

Rev Bras Med Vet. 2021 Jul 22;43:e000321. doi: 10.29374/2527-2179.bjvm000321. eCollection 2021.

ABSTRACT

The objective of this study was to evaluate the effect of feed restriction on some physical and blood parameters in horses kept outdoors under natural conditions. Twenty horses were deprived of food for 48 h. They were closely monitored and examined, and blood samples were taken at the beginning (0) of the experiment and 6, 12, 18, 24, 30, 36, 42 and 48 hours afterward. During the experimental period, the control group (12 animals) had free access to water and hay, while the restricted group had free access to water only. Data were submitted to two-way analysis of variance with repeated measures, and statistical significance was P ≤ 0.05. The horses tolerated feed restriction without complications. Feed restriction had no effect on body mass and body condition score, heart rate, respiratory rate, capillary filling time and body temperature. However, feed restriction decreased the intensity of gastrointestinal sounds (P<0.05) compared to the control horses. Feed restriction did not cause any changes in erythrocyte variables and gamma glutamyl transferase, creatinine, total protein, and albumin concentrations. During fasting, there was a reduction in the leukocyte response (P<0.05). Feed restriction significantly raised the levels of blood urea nitrogen (24 to 48 hours), aspartate aminotransferase (36 to 48 hours) and total cholesterol (42 to 48 hours). During 48 hours of fasting, there was a continuous increase in triglyceride concentration. Feed restriction for 48 h had a marked effect on the intensity of gastrointestinal sounds and was responsible for important metabolic changes in the healthy horses of our sample.

PMID:35749104 | PMC:PMC9179197 | DOI:10.29374/2527-2179.bjvm000321