Category: Statistics

JMIR Aging. 2024 Oct 25;7:e60209. doi: 10.2196/60209.

ABSTRACT

BACKGROUND: Physical activity has emerged as a modifiable behavioral factor to improve cognitive function. However, research on adherence to remote monitoring of physical activity in older adults is limited.

OBJECTIVE: This study aimed to assess adherence to remote monitoring of physical activity in older adults within a pilot cohort from objective user data, providing insights for the scalability of such monitoring approaches in larger, more comprehensive future studies.

METHODS: This study included 22 participants from the Boston University Alzheimer’s Disease Research Center Clinical Core. These participants opted into wearing the Verisense watch as part of their everyday routine during 14-day intervals every 3 months. Eighteen continuous physical activity measures were assessed. Adherence was quantified daily and cumulatively across the follow-up period. The coefficient of variation was used as a key metric to assess data consistency across participants over multiple days. Day-to-day variability was estimated by calculating intraclass correlation coefficients using a 2-way random-effects model for the baseline, second, and third days.

RESULTS: Adherence to the study on a daily basis outperformed cumulative adherence levels. The median proportion of adherence days (wearing time surpassed 90% of the day) stood at 92.1%, with an IQR spanning from 86.9% to 98.4%. However, at the cumulative level, 32% (7/22) of participants in this study exhibited lower adherence, with the device worn on fewer than 4 days within the requested initial 14-day period. Five physical activity measures have high variability for some participants. Consistent activity data for 4 physical activity measures might be attainable with just a 3-day period of device use.

CONCLUSIONS: This study revealed that while older adults generally showed high daily adherence to the wearable device, consistent usage across consecutive days proved difficult. These findings underline the effectiveness of wearables in monitoring physical activity in older populations and emphasize the ongoing necessity to simplify usage protocols and enhance user engagement to guarantee the collection of precise and comprehensive data.

PMID:39454101 | DOI:10.2196/60209

J Cardiovasc Nurs. 2024 Oct 24. doi: 10.1097/JCN.0000000000001157. Online ahead of print.

ABSTRACT

BACKGROUND: Frailty is common in adults with end-stage heart failure receiving a left ventricular assist device (LVAD). Short-term studies show frailty reversal post-LVAD. Little is known about long-term frailty and how frailty relates to key LVAD outcomes, including depression, quality of life (QoL), and cognition beyond 6 months.

OBJECTIVE: The purpose of this study was to examine physical frailty, depression, QoL, and cognition from pre-LVAD implantation to 3, 6, and 12 months post-LVAD implantation.

METHODS: Clinical data and measures of physical frailty, depression, QoL, and cognition pre- and post-LVAD were extracted from an existing institutional database. Descriptive statistics and tests for statistical significance were used to describe and compare changes over time. Frailty trajectories were identified to describe physical frailty from pre-LVAD to 12 months post-LVAD.

RESULTS: The sample (n = 46) was predominantly male (76%), with a mean age of 64.7 ± 11 years, and over half (n = 25) were physically frail. Physical frailty was reduced by nearly half at 12 months. Frailty, depression, and QoL significantly improved at all time points (P < .001). Improvements in cognition did not reach statistical significance. Recipients of LVAD without improvement in frailty exhibited worse depression, QoL, and cognition scores at 12 months compared with those not frail pre-LVAD or no longer frail post-LVAD implantation.

CONCLUSION: Some recipients of LVADs experienced physical frailty reversal with benefits sustained long-term. Those without improvement recorded worse long-term patient-reported outcomes. Identifying factors that predict physical frailty response to LVAD implantation is a key area of future research.

PMID:39454087 | DOI:10.1097/JCN.0000000000001157

Retina. 2024 Oct 16. doi: 10.1097/IAE.0000000000004309. Online ahead of print.

ABSTRACT

PURPOSE: To compare functional and anatomical outcomes between posterior drainage of residual fluid using a 41G cannula, fluid tolerance (R-SRF), and conventional complete drainage methods, including removal through peripheral retinal breaks (PRB), perfluorocarbon liquid (PFCL), and posterior retinotomy (PR).

METHODS: In this retrospective, multicenter study, we evaluated cases for visual acuity (VA) at 3 months of follow-up. Secondary outcomes included surgical success, postoperative metamorphopsia, shifts, full-thickness folds (FTF), optical coherence tomography (OCT) parameters, and safety. Subgroup analyses were also conducted.

RESULTS: VA did not differ significantly between the three main groups. Subgroup analyses revealed worse VA for PR with 1.131 LogMAR (20/270 in Snellen conversion, p=0,002), with significantly more grade C proliferative vitreoretinopathy (PVR, 40.0%, p=0,003). R-SRF tended to offer better secondary outcomes, without statistical significance except for postoperative epiretinal membrane (ERM, 30.8%, p=0,041). Subgroup analyses found significantly more shifts with PFCL (91,7%, p=0,036). No cases of postoperative FTF or macular holes were observed with the 41G.

CONCLUSION: Our study introduced the 41G technique, indicating favourable outcomes for fovea-off retinal detachments. Nevertheless, fluid tolerance appeared to be the best option, offering a cost-effective and faster method, with an optimal microstructural profile and VA comparable to that of complete drainage techniques.

PMID:39454073 | DOI:10.1097/IAE.0000000000004309

J Forensic Nurs. 2024 Oct 23. doi: 10.1097/JFN.0000000000000510. Online ahead of print.

ABSTRACT

INTRODUCTION: Workplace violence (WPV) is a common experience among healthcare workers in the United States. Although WPV may affect workers physically, WPV can also affect workers’ mental health. Emergency department (ED) workers’ perceptions of available and necessary WPV support have not been previously reported.

METHODS: A cross-sectional survey design was used to examine ED workers’ perceived level of WPV support and emotional impact that WPV causes them. This study was conducted at six Midwestern U.S. EDs. Respondents confidentially completed an adapted version of the Survey of Violence Experienced by Staff. Data analysis included descriptive statistics, t test, and Kruskal-Wallis test.

RESULTS: Respondents (N = 206) who experienced WPV served as the analytical sample. Respondents predominantly agreed or strongly agreed that support was available after WPV (n = 129, 63.2%). The predominant source of support after WPV was another colleague from the department (n = 127, 62.3%). Less than half of respondents (n = 96, 47.1%) indicated they agreed/strongly agreed that managers were supportive after verbal abuse, but 63.6% (n = 126) indicated that managers were supportive after physical assault. There was no statistical difference between the emotional impact of verbal abuse compared with threats/assaults.

DISCUSSION: Forensic nurses and emergency nurses with forensic nursing training are situated to combine their expertise in trauma-informed care, evidence collection, and expert testimony to support victimized ED workers. Timely support should be offered regardless of the category of WPV experienced. Insight into why support is perceived as available and accessible but may not be used warrants further study.

PMID:39454070 | DOI:10.1097/JFN.0000000000000510

Retina. 2024 Oct 16. doi: 10.1097/IAE.0000000000004298. Online ahead of print.

ABSTRACT

PURPOSE: To characterize changes in macular structure and vascularity seen in premature-birth adults.

METHODS: Retrospective review of adult patients seen in our clinic from July 2018 to November 2020 with history of premature birth not requiring treatment for retinopathy of prematurity (ROP), as well as healthy controls. Swept-source OCT-angiography (OCT-A) scans were analyzed for various parameters related to macular structure and vascularity. Statistical analysis was performed using univariate linear regression.

RESULTS: Thirty-four eyes were included (17 eyes from 10 premature-birth adults, 17 eyes from 11 control patients). Prematurity was associated with vascular changes on OCT-A: decreased foveal avascular zone (FAZ) area (p=0.001), decreased FAZ circularity index (p<0.001), decreased superficial capillary plexus vessel (CPV) density (p=0.02), and decreased deep CPV density (p<0.001). Prematurity was also associated with structural changes: shallower foveal pit depth (p<0.001), decreased cube average thickness (CAT) (p=0.005), and increased central subfield thickness-to-CAT ratio (p=0.002).

CONCLUSIONS: This is the largest published series of OCT-A data for premature-birth adults. Even without a history of ROP treatment, premature birth is associated with multiple changes to macular structure and vascularity that persist into adulthood. These include a smaller, more irregularly shaped FAZ, decreased juxtafoveal vascular density, and a shallower foveal pit.

PMID:39454058 | DOI:10.1097/IAE.0000000000004298

Crit Care Explor. 2024 Oct 25;6(11):e1175. doi: 10.1097/CCE.0000000000001175. eCollection 2024 Nov 1.

ABSTRACT

IMPORTANCE: The U.S. pediatric acute care system has become more centralized, placing increasing importance on interhospital transfers.

OBJECTIVES: We conducted a geospatial analysis of critically ill children undergoing interfacility transfer with a specific focus on understanding travel distances between the patient’s residence and the hospitals in which they receive care.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective geospatial analysis using five U.S. state-level administrative databases; four states observed from 2016 to 2019 and one state from 2018 to 2019. Participants included 10,665 children who experienced 11,713 episodes of critical illness involving transfer between two hospitals.

MAIN OUTCOMES AND MEASURES: Travel distances and the incidence of “potentially suboptimal triage,” in which patients were transferred to a second hospital less than five miles further from their residence than the first hospital.

RESULTS: Patients typically present to hospitals near their residence (median distance from residence to first hospital, 4.2 miles; interquartile range [IQR], 1.8-9.6 miles). Transfer distances are relatively large (median distance between hospitals, 28.9 miles; IQR, 11.2-53.2 miles), taking patients relatively far away from their residences (median distance from residence to second hospital, 30.1 miles; IQR, 12.2-54.9 miles). Potentially suboptimal triage was frequent: 24.2 percent of patients were transferred to a hospital less than five miles further away from their residence than the first hospital. Potentially suboptimal triage was most common in children living in urban counties, and became less common with increasing medical complexity.

CONCLUSIONS AND RELEVANCE: The current pediatric critical care system is organized in a hub-and-spoke model, which requires large travel distances for some patients. Some transfers might be prevented by more efficient prehospital triage. Current transfer patterns suggest the choice of initial hospital is influenced by geography as well as by attempts to match hospital resources with perceived patient needs.

PMID:39454049 | DOI:10.1097/CCE.0000000000001175

J Chem Theory Comput. 2024 Oct 25. doi: 10.1021/acs.jctc.4c01096. Online ahead of print.

ABSTRACT

Crystal structure prediction (CSP) is an important field of material design. Herein, we propose a novel generative adversarial network model, guided by a data-driven approach and incorporating the real physical structure of crystals, to address the complexity of high-dimensional data and improve prediction accuracy in materials science. The model, termed GAN-DDLSF, introduces a novel sampling method called data-driven latent space fusion (DDLSF), which aims to optimize the latent space of generative adversarial networks (GANs) by combining the statistical properties of real data with a standard Gaussian distribution, effectively mitigating the “mode collapse” problem prevalent in GANs. Our approach introduces a more refined generation mechanism specifically for binary crystal structures such as gallium nitride (GaN). By optimizing for the specific crystallographic features of GaN while maintaining structural rationality, we achieve higher precision and efficiency in predicting and designing structures for this particular material system. The model generates 9321 GaN binary crystal structures, with 16.59% reaching a stable state and 24.21% found to be metastable. These results can significantly enhance the accuracy of crystal structure predictions and provide valuable insights into the potential of the GAN-DDLSF approach for the discovery and design of binary, ternary, and multinary materials, offering new perspectives and methods for materials science research and applications.

PMID:39454048 | DOI:10.1021/acs.jctc.4c01096

J Econ Entomol. 2024 Oct 25:toae253. doi: 10.1093/jee/toae253. Online ahead of print.

ABSTRACT

Previously developed behavioral approaches for controlling the apple maggot fly, Rhagoletis pomonella (Walsh) (Diptera: Tephritidae), include attract-and-kill (AK) systems such as perimeter trapping using either, odor-baited red sticky spheres or odor-baited, sticky-free attracticidal spheres with contoured tops that ensure the sustained release of both insecticide and feeding stimulant. Here, over a 3-year span in 26 commercial apple orchards across Massachusetts, New Hampshire, and Maine, we evaluated the effectiveness of a novel AK strategy for R. pomonella management. Synthetic apple blend lures were deployed on perimeter-row trees to attract the pest, while perimeter-row insecticide sprays blended with 2% sugar, a known phagostimulant, served as the lethal component. Comparatively, grower standard (GS) blocks received full-block insecticide sprays devoid of sugar and lures. Monitoring revealed that red sticky spheres in AK blocks captured significantly more R. pomonella adults than unbaited monitoring spheres in GS blocks. Penetration of R. pomonella into block interiors remained consistently low and statistically similar for both AK and GS blocks. Whole-block infestation levels showed no significant difference between the 2 management approaches. Notably, insecticide application in AK blocks was reduced by 75%, 64.7%, and 64.2% in 2019, 2020, and 2021, respectively, compared with GS blocks. This grower-friendly AK approach could be integral to a reduced insecticide spray-based strategy for apple cultivation in the northeastern United States.

PMID:39454040 | DOI:10.1093/jee/toae253

J Clin Gastroenterol. 2024 Oct 22. doi: 10.1097/MCG.0000000000002090. Online ahead of print.

ABSTRACT

OBJECTIVE: Endoscopic submucosal dissection (ESD) is a superior, minimally invasive technique compared with other snare-based endoscopic resection techniques for rectal neoplasms extending to the dentate line (RNDLs). However, performing a successful ESD in the anal canal can be challenging due to vascularity and limited scope stability. In this meta-analysis, we aim to evaluate the safety and efficacy of ESD for RNDLs.

METHODS: We performed a comprehensive electronic database search from January 2005 through January 2024 for studies evaluating outcomes of ESD performed for managing RNDLs. Pooled proportions were calculated using random-effect models. Heterogeneity was evaluated using I2 and Q statistics.

RESULTS: Data were extracted from 11 studies comprising 496 patients. The pooled en bloc resection rates were 93.60% (95% CI = 90.70-95.70). The pooled R0 resection rate was 80.60% (95% CI = 70.50-87.80). The pooled recurrence rate was 4.00% (95% CI = 2.40-6.50). There was no evidence of significant heterogeneity calculated using the Q test and I2 statistic. The main adverse events were anal pain, postprocedural bleeding, and anal stricture with pooled rates of 20.20% (95% CI = 14.80-26.90), 8.20% (95% CI = 4.70-14.0), and 3.50% (95% CI = 2.10-5.70), respectively.

CONCLUSIONS: ESD is a safe and effective option for managing RNDLs with a low recurrence rate. Adverse events such as postprocedural perianal pain, postprocedural bleeding, and anal stenosis seem to be more common compared with colorectal ESD done for more proximal lesions. However, these can typically be managed conservatively or with minimally invasive endoscopic techniques.

PMID:39453696 | DOI:10.1097/MCG.0000000000002090

J Clin Gastroenterol. 2024 Oct 22. doi: 10.1097/MCG.0000000000002088. Online ahead of print.

ABSTRACT

BACKGROUND: Inflammatory bowel disease (IBD) encompasses chronic gastrointestinal disorders characterized by recurrent inflammation. Achieving mucosal healing and preventing disease progression are primary treatment goals.

OBJECTIVES: This study aimed to compare disease characteristics, medication utilization, procedures performed, and hospitalizations between IBD patients treated in hospital and community settings using the Leumit Health Service database.

DESIGN: A retrospective cohort study was conducted using data from the Leumit Health Service, comprising 3020 patients diagnosed with IBD from January 2010 to December 2019.

METHODS: Patients were divided based on primary care setting: hospital-based or community-based. Data included demographic characteristics, disease type, medication usage, procedures, and outcomes. Statistical analyses assessed differences between groups.

RESULTS: Hospital-treated patients were significantly younger (49.4±18.4 vs. 40.4±18.7, P<0.001 ), had higher rates of Crohn’s disease (45.9% vs. 71.4%, P<0.001), exhibited higher inflammatory markers (calprotectin 768±2182 vs. 1305±2526, P<0.001), lower albumin (4.23±0.27 vs. 4.12±0.32, P<0.001), hemoglobin levels (13.4±1.6 vs. 12.9±1.6, P<0.001), and lower BMI (26.2±5.3 vs. 24.6±5.6, P<0.001) compared with community-treated patients. Hospital-treated patients had more endoscopic procedures, higher medication utilization rates, shorter treatment durations, and increased hospitalization occurrence (12.1% vs. 23.6%, P<0.001), length (0.67±3.34 vs. 1.45±5.88, P<0.001), and colectomies (4.73% vs. 15.8%, P<0.001).

CONCLUSIONS: Disparities exist in IBD management between hospital and community settings, influenced by disease severity and treatment approaches. Hospital-based care is associated with more aggressive disease and intensive interventions, while community-based care may reflect milder disease and conservative management. Integrating specialized care models and personalized approaches across settings can optimize patient outcomes and health care delivery for IBD management. Further research is needed to understand these disparities’ underlying mechanisms and develop comprehensive care strategies.

PMID:39453694 | DOI:10.1097/MCG.0000000000002088