Category: Statistics

J Insur Med. 2024 Nov 1;51(3):138-142. doi: 10.1029/AAIMEDICINE-D-24-00014.1.

ABSTRACT

Universal Health Insurance does not exist in the United States for two reasons: (1) there is a general unwillingness to dismantle the historically grown framework of the world’s most complex mix of public and private sector health coverage and (2) mere cost considerations. The first concern can be abated by establishing a Universal Health Insurance system which retains many or most of the historically grown infrastructure. Cost containment of such a reform is addressed herein in that the two proposed pathways comprise either (1) a leveled solution through Medicare-expansion for the uninsured only or (2) a more complex solution through a national, 2-tier healthcare system for all Americans. Both pathways are based on solid financing without major tax increases by using existing and/or yet untapped funding sources. The insurance consequences for both options are assessable. They are minor for the Medicare-expansion and more wide-ranging, yet also achievable, for a national, 2-tier healthcare system. Universal Health Insurance must no longer be an illusion that continues to haunt our society in the 21st century.

PMID:39586063 | DOI:10.1029/AAIMEDICINE-D-24-00014.1

Neurology. 2024 Dec 24;103(12):e210102. doi: 10.1212/WNL.0000000000210102. Epub 2024 Nov 25.

ABSTRACT

BACKGROUND AND OBJECTIVES: Multiple studies found a higher ischemic stroke incidence in rural areas compared with urbanized areas, often explained by a low socioeconomic status (SES). However, this has rarely been investigated specifically in younger adults. We aimed to investigate the age-specific (15-49 years vs 50+ years) incidence of ischemic stroke in rural and urbanized municipalities within the Netherlands.

METHODS: Patients with a first-ever ischemic stroke (15 years or older) between 1998 and 2018 were included in this registry-based study through linkage of Dutch national hospital administrative registries. Ischemic stroke was defined through ICD-9 and ICD-10 codes. The urbanization grade of the municipality was defined by the address density in 5 subgroups (from most urban ≥2,500 addresses per km² to rural <500 addresses per km²). The urbanization grade-specific incidence rate per 100,000 person-years, standardized for age and sex, and incidence rate ratios (IRRs) were calculated. In addition, we performed stratified analyses for young age groups (15-39 and 40-49 years) and neighborhood SES (nSES), which was calculated using welfare, level of education, and recent labor participation.

RESULTS: In total, 23,720 patients aged 15-49 years (median age 44.7 years [interquartile range (IQR) 40.6-48.8], 51.6% women) and 369,107 patients aged older than 50 years (median age 76.7 years [IQR 68.8-84.7], 50.8% women) were included. Patients aged 15-49 years living in rural areas showed a 5% higher risk of ischemic stroke (IRR 1.05 [99% CI 0.98-1.13]) compared with patients in urbanized areas, whereas for persons aged 50 years and older, this risk was decreased by 3% (IRR 0.97 [99% CI 0.95-0.98]). For patients aged 15-39 years, this risk was 20% higher (IRR 1.20 [99% CI 1.05-1.37]), and for patients aged 40-49 years, the risk did not differ (IRR 1.01 [99% CI 0.93-1.09]). The rural-urban disparities in all age groups remained similar when stratified for nSES.

DISCUSSION: The incidence of ischemic stroke is higher among persons aged 15-49 years living in rural areas compared with urban areas, which was driven by a risk-increase in patients 15-39 years. This was reversed among persons aged 50 years and older. Our findings were not fully explained by differences in nSES. This suggests that different age-specific predictors might play a role in rural-urban disparities in ischemic stroke incidence.

PMID:39586044 | DOI:10.1212/WNL.0000000000210102

J Occup Environ Hyg. 2024 Nov 25:1-15. doi: 10.1080/15459624.2024.2420994. Online ahead of print.

ABSTRACT

Several recent studies have examined the role of intermediate/semi-volatile organic compound emissions from paving and roofing asphalts in the formation of secondary organic aerosols (SOAs), which constitute a portion of fine atmospheric particulate matter. These studies have yielded divergent results. Building upon this research, this study aims to develop more representative emission factors for estimating the contribution of roofing materials to SOA formation. This was accomplished by investigating the impact on SOA formation of variables such as rooftop temperatures, solar insolation values, study durations, and the physical and chemical properties of the roofing materials tested. To quantify the influence of these variables, data from existing literature were drawn, and limited experimental lab work was conducted. Monte Carlo-based quantitative uncertainty and sensitivity analyses were completed to estimate more representative emission factors, generate accompanying uncertainty ranges, and rank critical parameters driving emissions that should be considered in any follow-up research. The emission factors developed in this study resulted in a central tendency estimate of 1.7 × 10^-4 Gg/yr SOA for the 720 hottest hours in Southern California, with a 90% confidence interval of 6.0 × 10^-5 to 3.4 × 10^-4 Gg/yr. For the 4,320 annual daylight hours, the central tendency estimate is 2.1 × 10^-5 Gg/yr, with a 90% confidence interval of 4.7 × 10^-6 to 5.1 × 10^-5 Gg/yr. To provide perspective, the results of this study indicate that the SOA contribution to in-service emissions from asphalt roofing surfaces is four to five orders of magnitude lower than that reported for mobile diesel and gasoline sources.

PMID:39586037 | DOI:10.1080/15459624.2024.2420994

Environ Sci Technol. 2024 Nov 25. doi: 10.1021/acs.est.4c09523. Online ahead of print.

ABSTRACT

Chlorine (Cl) radicals strongly affect atmospheric oxidation and the fate of pollutants. Despite several observations, the potential impacts of nitrogen chemistry associated with NO₂ on Cl chemistry are poorly understood. Here, we provided direct field evidence that the nitrogen chemistry enhancements triggered by the increased NO₂ drove daytime nitrate (NO₃^–) photolysis and nighttime NO₃-N₂O₅ reactions, significantly promoting the increases in the concentrations of ClNO₂ and Cl₂ after the Chinese Spring Festival. The enhancement in the Cl chemistry facilitated the elevations of both O₃ and atmospheric oxidation capacity during the winter daytime. Our findings highlighted the importance of nitrogen chemistry induced by the increased NO₂ in enhanced Cl chemistry.

PMID:39586026 | DOI:10.1021/acs.est.4c09523

J Bras Nefrol. 2024 Oct-Dec;46(4):e20230035. doi: 10.1590/2175-8239-JBN-2023-0035en.

ABSTRACT

INTRODUCTION: The benefit of prenatal steroids in fetal lung maturation is well established, but their effect on the kidney has not been studied in detail in humans. Animal models have shown an increase in the expression of Na+/H+ exchangers, Na+-K+-ATPase pumps and aquaporin-1. This study aims to assess the effect of prenatal steroids on the maturation of renal tubules in preterms.

METHODS: 21 preterms born between 24 and 34 weeks were included. Participants were divided into two groups according to their exposure to prenatal steroids. The maturation of tubular function was evaluated through the change of the fractional excretion of Na+, K+ and beta 2-microglobulin, the transtubular gradient of K+, urine pH, and osmolality.

RESULTS: The mean age was 30.57 ± 1.8 weeks and the mean weight was 1415 ± 267.8 grams. Baseline differences were not observed, except for a significant difference in the change in urinary excretion of beta 2-microglobulin (Group 1: 1 980 ± 9 075 ng/mL and Group 2: -7 274 ± 10 006 ng/mL, p = 0.04).

CONCLUSIONS: Prenatal steroids showed no statistically significant difference on renal tubule maturation in preterms.

PMID:39586011 | DOI:10.1590/2175-8239-JBN-2023-0035en

Proc Natl Acad Sci U S A. 2024 Dec 3;121(49):e2412551121. doi: 10.1073/pnas.2412551121. Epub 2024 Nov 25.

ABSTRACT

Sea surface salinity ([Formula: see text]) is a key parameter in the thermohaline circulation of global oceans. Near the megadeltas, inland streamflow through large catchments plays a crucial role in mediating salinity. While some regional studies have investigated how [Formula: see text] is impacted through water cycle and climate components, a global scale quantification of inland streamflow contribution on [Formula: see text] variability is lacking. Here, we utilized remote sensing and observation-driven datasets to quantify the statistical associations between [Formula: see text] and streamflow ([Formula: see text]) at 48 megadeltas worldwide. This study uncovers a robust negative association between [Formula: see text] and [Formula: see text], with correlation coefficients [Formula: see text] less than [Formula: see text] for seasonal data found in 26 of the 48 megadeltas, and less than [Formula: see text] for deseasoned data in 21 megadeltas. The anticorrelation relationship is more pronounced in large deltas, particularly near tropical climates and in river-influenced deltas. The study also underscores the significant roles of climate, morphological, and anthropogenic stratification in impacting the natural influence of freshwater discharge on SSS. By highlighting the interconnected impacts of alterations in terrestrial water cycle upstream and [Formula: see text], this work contributes to enhancing our understanding of global ocean and climate circulation patterns and in tackling environmental issues pertaining to marine ecosystems.

PMID:39585992 | DOI:10.1073/pnas.2412551121

Proc Natl Acad Sci U S A. 2024 Dec 3;121(49):e2404313121. doi: 10.1073/pnas.2404313121. Epub 2024 Nov 25.

ABSTRACT

In Europe, the tendency among immigrants and descendants to seek out and interact with other coethnics has raised concern for their integration as it can reduce contact with the ethnic majority. Though policymakers implement large-scale integration programs to counteract these trends, it remains empirically and theoretically ambiguous whether exposure to coethnic peers impedes integration, and causal evidence is more limited for the growing population of migrant children. In this article, I use high-quality Danish administrative panel data over 28 y to investigate whether the ethnic composition experienced in childhood among immigrants and descendants with a non-EU background affects a core behavioral indicator of integration: naturalization. To isolate the causal effect of the childhood ethnic composition, I use the quasi-experimental assignment of siblings into different school grades in the same school. I find that being exposed to coethnic peers in the school grade increases the probability of naturalizing later in life. The main explanation is that exposure to some coethnic peers improves academic skills which are positively correlated with citizenship acquisition. These findings demonstrate the causal importance of non-EU migrant children’s social environment for their later integration into the national community showing that the modest presence of coethnic peers can be a precondition for, not a barrier to, integration.

PMID:39585976 | DOI:10.1073/pnas.2404313121

Stroke. 2024 Dec;55(12):2776-2785. doi: 10.1161/STROKEAHA.124.047210. Epub 2024 Nov 25.

ABSTRACT

BACKGROUND: Restenosis after carotid artery stenting (CAS) is associated with the risk of developing ischemic stroke. We aimed to evaluate the inhibitory effect of cilostazol addition on in-stent restenosis (ISR) in patients treated with CAS.

METHODS: In a randomized, open-label, blind-end point trial, patients with symptomatic and asymptomatic carotid artery stenosis and scheduled for CAS were randomly assigned to adding cilostazol (50 or 100 mg, twice per day) on other antiplatelets from 3 days before CAS or not adding cilostazol. Concomitant use of other antiplatelets was unrestricted. ISR was diagnosed by a peak systolic velocity of at least 1.75 m/s on duplex ultrasonography. The primary outcome was incidence of ISR within 2 years after CAS. Secondary outcomes included occurrences of cardiovascular events or any death and hemorrhagic events.

RESULTS: Participants were recruited from December 2010 to September 2015. Although the sample size was initially set to be 900 (450 in each group), 631 patients (mean age 69.9 years, 558 men, 325 in the cilostazol, and 306 in the noncilostazol group) were included in the primary analysis. Within 2 years’ follow-up, ISR occurred in 31 of 325 patients (cumulative incidence 10.8%) in the cilostazol group and 46 of 306 patients (19.6%) in the noncilostazol group (hazard ratio, 0.64 [95% CI, 0.41-1.0]; P=0.056). In the exploratory analysis, incidence of ISR beyond 30 days after CAS was lower in the cilostazol group than in the noncilostazol group (10.3% versus 19.3%; P=0.040). Incidences of cardiovascular events or any death and hemorrhagic events were similar between the groups (6.2% versus 6.7% and 2.3% versus 1.4%, respectively).

CONCLUSIONS: The addition of cilostazol to other antiplatelet agents could contribute to the reduction of ISR in the chronic stage of patients who underwent CAS, the authenticity of which depends on further studies with sufficient statistical power.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01261234.

PMID:39585936 | DOI:10.1161/STROKEAHA.124.047210

PLoS One. 2024 Nov 25;19(11):e0313496. doi: 10.1371/journal.pone.0313496. eCollection 2024.

ABSTRACT

PURPOSE: This study aims to quantitatively analyze the impact of split times on overall performance in standard distance triathlon events. It also examines how environmental factors such as water type, temperature, and altitude affect overall race outcomes.

METHODS: Quantile regression was employed to analyze the race records of 1,580 triathletes participating in 46 standard distance events in China.

RESULTS: Swim time significantly influences race performance among the top 50% of elite athletes (p < 0.05). For slower elite athletes, bike time is more critical. Temperature has a positive effect on race times, while altitude also shows a significant positive impact, with race times decreasing as altitude increases (up to 1,600 meters in this study’s dataset). River water enhances race times compared to still water, whereas sea water generally slows athletes down.

CONCLUSION: The influence of split times and environmental factors on overall race rime varies according to the athletes’ performance levels. To optimize results, training plans and race strategies should be tailored to each athlete’s capabilities. Additionally, understanding and adapting to environmental conditions in advance is crucial.

PMID:39585923 | DOI:10.1371/journal.pone.0313496

PLoS Pathog. 2024 Nov 25;20(11):e1012740. doi: 10.1371/journal.ppat.1012740. Online ahead of print.

ABSTRACT

The molecular clock hypothesis assumes that mutations accumulate on an organism’s genome at a constant rate over time, but this assumption does not always hold true. While modelling approaches exist to accommodate deviations from a strict molecular clock, assumptions about rate variation may not fully represent the underlying evolutionary processes. There is considerable variability in rabies virus (RABV) incubation periods, ranging from days to over a year, during which viral replication may be reduced. This prompts the question of whether modelling RABV on a per infection generation basis might be more appropriate. We investigate how variable incubation periods affect root-to-tip divergence under per-unit time and per-generation models of mutation. Additionally, we assess how well these models represent root-to-tip divergence in time-stamped RABV sequences. We find that at low substitution rates (<1 substitution per genome per generation) divergence patterns between these models are difficult to distinguish, while above this threshold differences become apparent across a range of sampling rates. Using a Tanzanian RABV dataset, we calculate the mean substitution rate to be 0.17 substitutions per genome per generation. At RABV’s substitution rate, the per-generation substitution model is unlikely to represent rabies evolution substantially differently than the molecular clock model when examining contemporary outbreaks; over enough generations for any divergence to accumulate, extreme incubation periods average out. However, measuring substitution rates per-generation holds potential in applications such as inferring transmission trees and predicting lineage emergence.

PMID:39585914 | DOI:10.1371/journal.ppat.1012740