Category: Statistics

Eur J Health Econ. 2024 Aug 27. doi: 10.1007/s10198-024-01718-7. Online ahead of print.

ABSTRACT

BACKGROUND: Evidence on the cost effectiveness of deprescribing in multimorbidity is limited.

OBJECTIVE: To investigate the cost effectiveness of a general practitioner (GP) delivered, individualised medication review to reduce polypharmacy and potentially inappropriate prescribing in older patients with multimorbidity in Irish primary care.

METHODS: Within trial economic evaluation, from a healthcare perspective and based on a cluster randomised controlled trial with a 6 month follow up and 403 patients (208 Intervention and 195 Control) recruited between April 2017 and December 2019. Intervention GPs used the SPPiRE website which contained educational materials and a template to support a web-based individualised medication review. Control GPs delivered usual care. Incremental costs, quality adjusted life years (QALYs) generated using the EQ-5D-5L instrument, and expected cost effectiveness were estimated using multilevel modelling and multiple imputation techniques. Uncertainty was explored using parametric, deterministic and probabilistic methods.

RESULTS: On average, the SPPiRE intervention was dominant over usual care, with non-statistically significant mean cost savings of €410 (95% confidence interval (CI): – 2211, 1409) and mean health gains of 0.014 QALYs (95% CI – 0.011, 0.039). At cost effectiveness threshold values of €20,000 and €45,000 per QALY, the probability of SPPiRE being cost effective was 0.993 and 0.988. Results were sensitive to missing data and data collection period.

CONCLUSIONS: The study observed a pattern towards dominance for the SPPiRE intervention, with high expected cost effectiveness. Notably, observed differences in costs and outcomes were consistent with chance, and missing data and related uncertainty was non trivial. The cost effectiveness evidence may be considered promising but equivocal.

TRIAL REGISTRATION: ISRCTN: 12752680, 20th October 2016.

PMID:39190222 | DOI:10.1007/s10198-024-01718-7

Environ Monit Assess. 2024 Aug 27;196(9):849. doi: 10.1007/s10661-024-13041-y.

ABSTRACT

Climate change has a significant impact on the Ganga-Brahmaputra (GB) basin, the major food belt of India, which frequently experiences flooding and varied incidences of drought. The current study examines the changing trend of rainfall and temperature in the GB basin over a period of 30 years to identify areas at risk with an emphasis on the Paris Agreement’s mandate to keep increasing temperatures below 2 °C. The maximum temperature anomaly in the middle Ganga plains recorded an increase of more than 1.5 °C year^-1 in 1999, 2005, and 2009. Some extreme events were observed in the Brahmaputra basin during 1999, 2009, and 2010, where a prominent temperature increase of 1.5 °C year^-1 was observed. The minimum temperature revealed an increasing trend for the G-B basin with an anomalous increase of 0.04 to 0.06 °C year^-1. The rainfall variability across the Ganga basin shows a rising tendency over the lower Ganga region while the Brahmaputra basin showed a downward trend. To identify the statistical relation between the Global climatic oscillations and regional climate, Standardized Precipitation Index (SPI) and Niño 3.4 were used. The wet and dry period estimation shows a rise in flood conditions in the Ganga basin whereas, in the Brahmaputra basin, an increase in drought frequency was observed. The correlation based on Niño 3.4 and SPI3 presents a negative relation for the monsoon season in the G-B basin revealing a situation of drought occurrence (SPI3 below 0) with increased Nino 3.4 values (El Niño above + 0.4C).

PMID:39190210 | DOI:10.1007/s10661-024-13041-y

Rheumatol Int. 2024 Aug 27. doi: 10.1007/s00296-024-05683-5. Online ahead of print.

ABSTRACT

Since the introduction of mRNA vaccines against SARS-CoV-2, the induction of autoimmunity by mRNA vaccination has been discussed. Several cases of dermatomyositis (DM) associated with mRNA vaccination against SARS-CoV-2 infection have been reported. The question is whether there is a common pathomechanism for the induction of DM by this mRNA vaccination. The aim of this review is to analyse the sample of previously published case reports of DM following COVID-19 mRNA vaccination for common indicators of a possible immune pathomechanism.In this review, we summarised case reports of DM following mRNA vaccination against COVID-19. We considered this case report landscape as a cumulative sample (n = 32) and identified common clinical and molecular parameters in the intersection of case reports and statistically analysed the effect of these parameters on the development of DM.MDA-5 antibodies seem to play a role in the autoantibody signature after mRNA vaccination. MDA-5-positive DM is statistically more strongly associated with mRNA vaccination and interstitial lung disease/rapidly progressive interstitial lung disease (ILD/RP-ILD) than MDA-5-negative DM. MDA-5-positive DM seems not to be associated with an increased risk of malignancy, whereas MDA-5-negative DM is more strongly associated with malignancy.Our findings emphasize the potential role of innate antiviral signalling pathways in connecting DM to mRNA vaccination. MDA-5 autoantibodies appear to be predictive of a severe DM progression following mRNA vaccination. There seems to be an association between MDA-5 autoantibodies and paraneoplastic DM post-vaccination. Further studies are required to uncover the underlying mechanisms of autoimmunity triggered by mRNA vaccination.

PMID:39190200 | DOI:10.1007/s00296-024-05683-5

Environ Monit Assess. 2024 Aug 27;196(9):848. doi: 10.1007/s10661-024-13033-y.

ABSTRACT

Wodyetia bifurcata, also known as foxtail palm tree leaves, was tested for highly effective methylene blue (MB) removal from commercial and artificial effluent. BET surface area measurement, FESEM, FTIR, and pH_zpc were used to get information on the shape and structure of the particles. Several important factors were used to determine its adsorption activity, including intake concentration, contact duration, and pH level. Accelerated adsorption is seen in the experimental results, with more than 94% adsorption occurring successfully in the initial 12 min and reaching equilibrium within 15 min (% removal = 97.45%) at neutral pH. It was discovered that the maximum adsorption capacity was 58.74 mg g^-1 at 308 K. The adsorption procedure confirms an active adsorption process of linear and non-linear kinetics of pseudo-second order, and the adsorption path is well addressed by the Freundlich model both in linear and non-linear form, having an R² value close to unity. Thermodynamic characteristics point to an exothermic, viable, spontaneous reaction with higher entropy. Utilizing a 1:1 MeOH/H₂O ratio, spent adsorbent may be readily regenerated by as much as 75% with a possible three-cycle usage. The practical application of biosorbents was confirmed by real-time effectiveness testing using MB-carrying industrial wastewater, and up to 45.75% adsorption was shown. A relative standard deviation confirmed statistical dependability. All things considered, the current material provides a clean and environmentally friendly way to remove MB dye from various wastewater types.

PMID:39190194 | DOI:10.1007/s10661-024-13033-y

Can Urol Assoc J. 2024 May 21. doi: 10.5489/cuaj.8709. Online ahead of print.

ABSTRACT

INTRODUCTION: Robotic surgery for localized prostate cancer offers a greater range of motion attributed to the EndoWrist instruments. Postoperative outcomes are linked to the quality of vesico-urethral anastomosis. Trainees frequently complain of suturing difficulty in a back-handed fashion. We aimed to analyze wrist motion using the DaVinci simulator. We hypothesized that using the thumb and index finger would allow superior surgical proficiency when compared to the middle finger.

METHODS: After institutional review board approval, we recruited 42 medical students in one academic medical center. Students were randomly assigned to start with their thumb and index finger (1&2) or thumb and middle finger (1&3). Three standardized modules were used with nine metrics calculated, including: score, total time, economy of motion, efficiency score, collisions, inaccurate puncture, wound approximation, out of view, and penalty subtotal. Statistical analysis of the metrics was calculated using SPSS.

RESULTS: Three metrics were found to have differences between the finger placement of 1&3compared to 1&2. The number of collisions, wound approximation, and penalty score where 1&3 were used had a lower score in each. The number of collisions was 5.7 less in the 1&3 finger placement (p=0.046). This metric was found to have statistically significant differences between finger placement where 1&3 had a lower score compared to 1&2. The wound approximation score was 0.2 points lower when using the 1&3 placement (p=0.075). Lastly, the penalty assigned was 6.5 points lower when using 1&3 (p=0.069).

CONCLUSIONS: Although finger placement did not affect the overall score of the completed simulation, instrument collisions and unnecessary wound complications may lead to adverse outcomes when using 1&2 despite offering a wider range of motion. This may be due to decreased comfort in hand position. Trainees may be able to improve the effectiveness of their vesico-urethral anastomosis during robotic-assisted radical prostatectomy.

PMID:39190174 | DOI:10.5489/cuaj.8709

Neuroradiology. 2024 Aug 27. doi: 10.1007/s00234-024-03452-6. Online ahead of print.

ABSTRACT

INTRODUCTION: Parkinson’s disease (PD) is a neurodegenerative disorder characterized by dopaminergic neurons’ degeneration of the substantia nigra, presenting with motor and non-motor symptoms. We hypothesized that altered diffusion metrics are associated with clinical symptoms in de novo PD patients.

METHODS: Fractional Anisotropy (FA) and Mean (MD), Axial (AD), and Radial Diffusivity (RD) were assessed in 55 de novo PD patients (58.62 ± 9.85 years, 37 men) and 55 age-matched healthy controls (59.92 ± 11.25 years, 34 men). Diffusion-weighted images and clinical variables were collected from the Parkinson’s Progression Markers Initiative study. Tract-based spatial statistics were used to identify white matter (WM) changes, and fiber tracts were localized using the JHU-WM tractography atlas. Motor and non-motor symptoms were evaluated in patients.

RESULTS: We observed higher FA values and lower RD values in patients than controls in various fiber tracts (p-TFCE < 0.05). No significant MD or AD difference was observed between groups. Diffusion metrics of several regions significantly correlated with non-motor (state and trait anxiety and daytime sleepiness) and axial motor symptoms in the de novo PD group. No correlations were observed between diffusion metrics and other clinical symptoms evaluated.

CONCLUSION: Our findings suggest microstructural changes in de novo PD fiber tracts; however, limited associations with clinical symptoms reveal the complexity of PD pathology. They may contribute to understanding the neurobiological changes underlying PD and have implications for developing targeted interventions. However, further longitudinal research with larger cohorts and consideration of confounding factors are necessary to elucidate the underlying mechanisms of these diffusion alterations in de novo PD.

PMID:39190159 | DOI:10.1007/s00234-024-03452-6

Epilepsy Behav. 2024 Aug 25;159:110010. doi: 10.1016/j.yebeh.2024.110010. Online ahead of print.

ABSTRACT

BACKGROUND: Epilepsy poses a significant public health problem in many parts of the world. The majority of people with epilepsy (PWE) are from low-income and middle-income countries (LMICs). Taenia solium neurocysticercosis (NCC) is estimated to cause 30% of preventable epilepsy in PWE in areas of T. solium endemicity. This study was conducted to assess the prevalence of NCC in PWE, evaluate the presence of cognitive impairment in PWE, and assess potential contributing factors.

METHODS: PWE were recruited within a mental health clinic-based cross-sectional study in rural Southern Tanzania. PWE underwent a detailed neurological examination, and a blood sample was collected for T. solium cysticercosis (CC) serology testing. Patients who were serologically positive for CC and those detected to have prominent neurological deficits apart from epilepsy were invited to receive a cerebral computed tomography (CT) examination.

RESULTS: Out of the 223 people with epilepsy (PWE) recruited, 221 underwent clinical examination. Among these, 26 (11.8 %) had cognitive impairment, and 2 had additional neurological signs or symptoms. Twenty-five of the 223 PWE (11.2 %) tested positive for CC. A total of 36 participants underwent CT scans, with 18 testing positives for CC and 18 negatives. Of the 36 who had CT scans, 8 (22.2 %) were diagnosed with NCC; 7 were CC positive, and 1 was CC negative. Multivariate logistic regression confirmed that cognitive impairment in PWE was 8.62 times higher for Kongwa participants compared to Chunya, with a statistically significant association (95 % CI: 1.75-156; P<0.037). Additionally, having an education was associated with a 91 % reduction in the odds of NCC (OR=0.09) compared to no education, which was also statistically significant (95 % CI: 0.01 to 0.33; P<0.002).

CONCLUSION: Our study found a 22.2% prevalence of neurocysticercosis (NCC) among PWE. Cognitive impairment was present in 11.8% of PWE but was not significantly associated with NCC. Socioeconomic and educational factors may play a larger role in cognitive impairment among PWE.

PMID:39186856 | DOI:10.1016/j.yebeh.2024.110010

J Environ Manage. 2024 Aug 25;368:122261. doi: 10.1016/j.jenvman.2024.122261. Online ahead of print.

ABSTRACT

The Sustainable Development Goals (SDGs) are essential measure for preserving the balance between human well-being and natural ecosystems. The benefit of preserving ecosystems health play a crucial role in promoting the SDGs by providing stable ecosystem services (ESs). However, the ecological health of mountainous cities is vulnerable, with relative low ecological resilience. To investigate the conflict between ecosystems and sustainable development, this study takes the Chengdu-Chongqing Urban Agglomeration as the study area. The major tasks and results in this study include: (1) using the entropy weighting method and the InVEST model, we combined remote sensing, geographic, and statistical data to quantify three types of SDGs (economic, social, environmental) and four ESs (water yield, soil conservation, habitat quality, carbon storage), and establish a localized sustainable development assessment framework that is applicable to the Chengdu-Chongqing Urban Agglomeration. The results show that from 2014 to 2020, the three types of SDGs exhibited an overall upward trend, with the lowest values occurring in 2016. The gap between different counties has narrowed, but significant regional differences still remain, indicating an unbalanced development status quo. Among the 142 counties, water yield and soil conservation values show a consistent downward trend but occupies significant interannual variations, while habitat quality and carbon storage values increases consistently each year. (2) using Spearman’s nonparametric correlation analysis and multiscale geographically weighted regression model to explore the temporal variation and spatial heterogeneity of correlations between county ESs and SDGs. The results showed significant heterogeneity in the spatial trade-offs and synergies between ESs and SDGs, with two pairs of synergies weakening, seven pairs of trade-offs increasing, and the strongest negative correlation between Economic Sustainable Development Goals and habitat quality. (3) we applied the self-organizing mapping neural networks to analyze the spatial clustering characteristics of ESs-SDGs. Based on the spatial clustering effects, we divides the Chengdu-Chongqing Urban Agglomeration into four zones, and different zones have different levels of ESs and SDGs. The targeted strategies should be adopted according to local conditions. This work is of great practical importance in maintaining the stability and sustainable development of the Chengdu-Chongqing Urban Agglomeration ecosystem and provides a scientific reference for the optimal regulation of mountainous cities.

PMID:39186853 | DOI:10.1016/j.jenvman.2024.122261

J Urol. 2024 Aug 26:101097JU0000000000004224. doi: 10.1097/JU.0000000000004224. Online ahead of print.

ABSTRACT

PURPOSE: Epididymal cyst lesions (ECL) include both spermatoceles and epididymal cysts, and are often incidentally found on physical exam or scrotal ultrasound (SUS). We aimed to determine the association of ECL and semen parameters among men presenting for fertility evaluation.

MATERIALS AND METHODS: We reviewed men at our institution who had at least one semen analysis (SA) and SUS available for review between 2002 to 2022. SUS data included testicular measurements, presence or absence of subclinical varicocele, and size and laterality of ECL, if present. Demographic and clinical information including serum testosterone and follicle-stimulating hormone (FSH) and semen parameters were compared between men with and without ECL.

RESULTS: Among 861 men, 164 (19%) had unilateral right ECL (median 4 mm, interquartile range [IQR] 3-8 mm), 189 (22%) had unilateral left ECL (4 mm, IQR 3-9 mm), and 113 (13%) had bilateral ECL. Patients with ECL were significantly older than men without ECL at the time of evaluation, but had no statistically significant difference in semen volume, sperm concentration, sperm motility, sperm morphology, total motile sperm count, or serum hormonal values. Analysis of men with unilateral and bilateral ECL showed that ECL size and laterality did not significantly correlate with any semen parameter evaluated.

CONCLUSION: We found no association between ECL and semen parameters. Patients should be counseled toward conservative management with observation for asymptomatic ECL in the setting of fertility evaluation.

PMID:39186830 | DOI:10.1097/JU.0000000000004224

J Appl Clin Med Phys. 2024 Aug 26:e14489. doi: 10.1002/acm2.14489. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the feasibility of an open-source, semi-automated, and reproducible vertex placement tool to improve the efficiency of lattice radiotherapy (LRT) planning. We used polymer gel dosimetry with a Cone Beam CT (CBCT) readout to commission this LRT technique.

MATERIAL AND METHODS: We generated a volumetric modulated arc therapy (VMAT)-based LRT plan on a 2 L NIPAM polymer gel dosimeter using our Eclipse Acuros version 15.6 AcurosXB beam model, and also recalculated the plan with a pre-clinical Acuros v18.0 dose calculation algorithm with the enhanced leaf modelling (ELM). With the assistance of the MAAS-SFRThelper software, a lattice vertex diameter of 1.5 cm and center-to-center spacing of 3 cm were used to place the spheres in a hexagonal, closed packed structure. The verification plan included four gantry arcs with 15°, 345°, 75°, 105° collimator angles. The spheres were prescribed 20 Gy to 50% of their combined volume. The 6 MV Flattening Filter Free beam energy was used to deliver the verification plan. The dosimetric accuracy of the LRT delivery was evaluated with 1D dose profiles, 2D isodose maps, and a 3D global gamma analysis.

RESULTS: Qualitative comparisons between the 1D dose profiles of the Eclipse plan and measured gel showed good consistency at the prescription dose mark. The average diameter measured 13.3 ± 0.2 mm (gel for v15.6), 12.6 mm (v15.6 plan), 13.1 ± 0.2 mm (gel for v18.0), and 12.3 mm (v18.0 plan). 3D gamma analysis showed that all gamma pass percent were > 95% except at 1% and 2% at the 1 mm distance to agreement criteria.

CONCLUSION: This study presents a novel application of gel dosimetry in verifying the dosimetric accuracy of LRT, achieving excellent 3D gamma results. The treatment planning was facilitated by publicly available software that automatically placed the vertices for consistency and efficiency.

PMID:39186819 | DOI:10.1002/acm2.14489