Category: Statistics

Australas J Ageing. 2023 Apr 10. doi: 10.1111/ajag.13186. Online ahead of print.

ABSTRACT

OBJECTIVES: To quantify physical activity in patients prior to and during an acute general medical hospital admission and explore relationships between mobility, pre- and in-hospital physical activity.

METHODS: This was a prospective, single-site secondary observational study conducted on general medical wards at a tertiary hospital. Prehospital physical activity was measured via the Physical Activity Scale for the Elderly (PASE; scored 0-400); in-hospital physical activity was measured via accelerometry (time at metabolic equivalents [METs] > 1.5), and mobility was measured via the de Morton Mobility Index (DEMMI). Associations were determined via Spearman’s correlations.

RESULTS: Forty-six participants were included: median age 81 [76-85] years, 59% female, DEMMI on admission 39 [30-49]. Prehospital physical activity was low (PASE median 27.1 [1.6-61.9]). In-hospital physical activity was also low (0.5 [0.2-1.5] hours per day being physically active and 54 [16-194] steps per day taken). No statistically significant relationships existed between pre- and in-hospital physical activity (Spearman’s rho (ρ) 0.24, 95% CI -0.08-0.53, p = 0.07). However, physical activity levels in the pre- and in-hospital settings were positively associated with patients’ mobility in-hospital (Spearman’s ρ 0.44, 95% CI 0.15-0.67, p = 0.002; Spearman’s ρ 0.40, 95% CI 0.08-0.645, p = 0.011 respectively).

CONCLUSIONS: Physical activity is low both before and during a general medical admission. Assessment of usual physical activity patterns should be part of the clinical assessment of patients in general medicine; however, the low activity levels observed indicate a need for valid and reliable tools suitable for an older, frail cohort. Findings will inform the development of physical activity guidelines during hospitalisation.

PMID:37036825 | DOI:10.1111/ajag.13186

Anesth Analg. 2023 Apr 10. doi: 10.1213/ANE.0000000000006479. Online ahead of print.

ABSTRACT

BACKGROUND: Red blood cell (RBC) transfusions are used frequently in pediatric patients admitted to the intensive care unit (ICU) after cardiac surgery. To improve data-driven transfusion decision-making in the ICU, we conducted a retrospective analysis to assess the effect of RBC transfusion on cerebral and somatic regional oxygenation (rSO2).

METHODS: We evaluated post- versus pre-RBC transfusion cerebral rSO2 and somatic rSO2 in all consecutive pediatric patients (age >28 days to <18 years) who underwent biventricular cardiac surgery at a single center between July 2016 and April 2020.

RESULTS: The final data set included 263 RBC postoperative transfusion events in 75 patients who underwent 83 surgeries. The median pretransfusion hemoglobin was 10.6 g/dL (25th-75th percentile, 9.3-11.6). The median pretransfusion cerebral and somatic rSO2 were 63% (54-71) and 69% (55-80), which increased by a median of 3 percentage points (-2 to 6) and 2 percentage points (-3 to 6), respectively, after transfusion. After adjusting for pretransfusion hemoglobin, change in hemoglobin posttransfusion versus pretransfusion, and potential confounders (age, sex, and STAT surgical mortality risk score), the posttransfusion versus pretransfusion change in cerebral or somatic rSO2 was not statistically significant. Pretransfusion cerebral rSO2 (crSO2) was ≤50%, a previously described threshold for increased risk for unfavorable neurological outcome, for 22 of 138 (16%) transfusion events with complete pre- and post-crSO2 data. Sixteen of these 22 (73%) transfusions resulted in a posttransfusion crSO2 >50%. When restricting analysis to the first (index) transfusion after arrival to the ICU from the operating room (administered at a median of 1.15 postoperative days [25th-75th percentile, 0.84-1.93]), between-patient pretransfusion hemoglobin was not associated with pretransfusion crSO2 but within-patient posttransfusion versus pretransfusion hemoglobin difference was significantly associated with posttransfusion versus pretransfusion crSO2 difference (mean posttransfusion versus pretransfusion crSO2 difference, 2.54; 95% confidence interval, 0.50-4.48).

CONCLUSIONS: In this study, neither cerebral nor somatic rSO2 increased significantly post- versus pre-RBC transfusion in pediatric cardiac surgery patients admitted to the ICU after biventricular repairs. However, almost three-quarters of transfusions administered when pretransfusion crSO2 was below the critical threshold of 50% resulted in a posttransfusion crSO2 >50%. In addition, the significant within-patient change in crSO2 in relation to the change in posttransfusion versus pretransfusion hemoglobin in the immediate postoperative period suggests that a personalized approach to transfusion following within-patient trends of crSO2 rather than absolute between-patient values may be an important focus for future research.

PMID:37036824 | DOI:10.1213/ANE.0000000000006479

Telemed J E Health. 2023 Apr 10. doi: 10.1089/tmj.2022.0445. Online ahead of print.

ABSTRACT

Background: Telehealth and in-person behavioral health services have previously shown equal effectiveness, but cost studies have largely been limited to travel savings for telehealth cohorts. The purpose of this analysis was to compare telehealth and in-person cohorts, who received behavioral health services in a large multisite study of usual care treatment approaches to examine relative value units (RVUs) and payment. Methods: We used current procedural terminology codes for each encounter to identify RVUs and Medicare payment rates. Mixed linear regression models compared telehealth and in-person cohorts on RVUs, per-encounter payment rates, and total-episode payment rates. Results: We found the behavioral health services provided by telehealth to have modest, but statistically significantly lower RVUs (i.e., less provider work in time spent and case complexity), per-encounter payments, and total episode payments than the in-person cohort. Despite Medicare rates discounting payments for nonphysician providers and the in-person cohort using clinical social workers more frequently, the services provided by the telehealth cohort still had lower payments. Thus, the differences observed are due to the in-person cohort receiving higher payment RVU services than the telehealth cohort, which was more likely to receive briefer therapy sessions and other less expensive services. Conclusions: Behavioral health services provided by telehealth used services with lower RVUs than behavioral health services provided in-person, on average, even after adjusting for patient demographics and diagnosis. Observed differences in Medicare payments resulted from the provider type and services used by the two cohorts; thus, costs and insurance reimbursements may vary for others.

PMID:37036816 | DOI:10.1089/tmj.2022.0445

Percept Mot Skills. 2023 Apr 10:315125231169868. doi: 10.1177/00315125231169868. Online ahead of print.

ABSTRACT

We assessed the accuracy of intraset repetitions in reserve (RIR) predictions on single-joint machine-based movements of trained and untrained men and women. Participants were 27 men (M age = 22, SE = 0.6 years; M weight = 90.8, SE = 4.0 kg; M height = 182.3, SE = 1.4 cm; M training experience = 66, SE = 9 months) and 31 women (M age = 20, SE = 0.4 years; M weight = 67.8, SE = 2.3 kg; M height = 167.6, SE = 1.1 cm; M training experience = 22, SE = 4 months). In one session, participants performed a five-repetition maximum (5RM) test on biceps curl, triceps pushdown, and seated row exercises; we then estimated one repetition maximum (1RM). Participants then performed four sets of each exercise, in a randomized order, to the point of momentary muscular failure at 72.5% of 1RM. During each set, participants indicated when they first perceived 5RIR and then predicted RIR on every repetition thereafter until failure. The difference between actual repetitions performed and predicted repetitions at each intraset prediction was determined to be the RIR difference (RIRDIFF). A 3-way repeated measures ANCOVA found that a 3-way interaction was not statistically significant (p = 0.435) and no covariates of sex (p = 0.917), training experience (p = 0.462) nor experience rating RIR significantly affected RIRDIFF (p = 0.462-0.917). There were significant main effects for the proximity to failure of the prediction and the set number (p < 0.01) but not for exercise (p = 0.688). Thus, intraset RIR predictions were more accurate when closer to failure and in later sets, but sex, training experience, and experience rating RIR did not significantly influence RIR prediction accuracy on machine-based single-joint exercises.

PMID:37036795 | DOI:10.1177/00315125231169868

J Radiat Res. 2023 Apr 7:rrad015. doi: 10.1093/jrr/rrad015. Online ahead of print.

ABSTRACT

Particle beam therapy (PT) is a potentially promising approach to the treatment of extrahepatic biliary cancer (EBC) because of its unique dose distribution using the Bragg peak. However, the superiority of PT to photon radiotherapy (XT) remains unclear. Therefore, we conducted a systematic review and meta-analysis to compare PT and XT for the treatment of EBC. The primary endpoint was overall survival (OS), which was pooled using a random-effects model. Nine articles comprising a total of 1558 patients (seven XT articles, n = 1488 patients; two PT articles, n = 70 patients) were screened. In addition, we compared the outcomes of XT and PT with the outcomes available from a prospective data registry (proton-net). The 1-year OS probability rates were 55, 65 and 72% for the XT group, PT group and PT registry, respectively. The 2-year OS probability rates were 26, 38 and 38% for the XT group, PT group and PT registry, respectively. The 3-year OS probability rates were 12, 35 and 18% for the XT group, PT group and PT registry, respectively. Although the difference between the 1-year OS rates of the XT group and PT registry was statistically significant, no other significant superiority was observed among these groups. In conclusion, the efficacy of PT was not superior to that of XT during this meta-analysis.

PMID:37036780 | DOI:10.1093/jrr/rrad015

JAMA Intern Med. 2023 Apr 10. doi: 10.1001/jamainternmed.2023.0512. Online ahead of print.

ABSTRACT

IMPORTANCE: Medicaid supplemental insurance covers most cost sharing in Medicare. Among low-income Medicare beneficiaries, the loss of Medicaid eligibility above this program’s income eligibility threshold (100% of federal poverty level [FPL]) may exacerbate racial and ethnic disparities in Medicare beneficiaries’ ability to afford care.

OBJECTIVE: To examine whether exceeding the income threshold for Medicaid, which results in an abrupt loss of Medicaid eligibility, is associated with greater racial and ethnic disparities in access to and use of care.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used a regression discontinuity design to assess differences in access to and use of care associated with exceeding the income threshold for Medicaid eligibility. We analyzed Medicare beneficiaries with incomes 0% to 200% of FPL from the 2008 to 2018 biennial waves of the Health and Retirement Study linked to Medicare administrative data. To identify racial and ethnic disparities associated with the loss of Medicaid eligibility, we compared discontinuities in outcomes among Black and Hispanic beneficiaries (n = 2885) and White beneficiaries (n = 5259). Analyses were conducted between January 1, 2022, and October 1, 2022.

MAIN OUTCOME MEASURES: Patient-reported difficulty accessing care due to cost and outpatient service use, medication fills, and hospitalizations measured from Medicare administrative data.

RESULTS: This cross-sectional study included 8144 participants (38 805 person-years), who when weighted represented 151 282 957 person-years in the community-dwelling population of Medicare beneficiaries aged 50 years and older and incomes less than 200% FPL. In the weighted sample, the mean (SD) age was 75.4 (9.4) years, 66.1% of beneficiaries were women, 14.8% were non-Hispanic Black, 13.6% were Hispanic, and 71.6% were White. Findings suggest that exceeding the Medicaid eligibility threshold was associated with a 43.8 percentage point (pp) (95% CI, 37.8-49.8) lower probability of Medicaid enrollment among Black and Hispanic Medicare beneficiaries and a 31.0 pp (95% CI, 25.4-36.6) lower probability of Medicaid enrollment among White beneficiaries. Among Black and Hispanic beneficiaries, exceeding the threshold was associated with increased cost-related barriers to care (discontinuity: 5.7 pp; 95% CI, 2.0-9.4), lower outpatient use (-6.3 services per person-year; 95% CI, -10.4 to -2.2), and fewer medication fills (-6.9 fills per person-year; 95% CI, -11.4 to -2.5), but it was not associated with a statistically significant discontinuity in hospitalizations. Discontinuities in these outcomes were smaller or nonsignificant among White beneficiaries. Consequently, exceeding the threshold was associated with widened disparities, including greater reductions in outpatient service use (disparity: -6.2 services per person-year; 95% CI, -11.7 to -0.6; P = .03) and medication fills (disparity: -7.2 fills per person-year; 95% CI, -13.4 to -1.0; P = .02) among Black and Hispanic vs White beneficiaries.

CONCLUSIONS AND RELEVANCE: This cross-sectional study found that loss of eligibility for Medicaid supplemental insurance above the federal poverty level, which increases cost sharing in Medicare, was associated with increased racial and ethnic health care disparities among low-income Medicare beneficiaries. Expanding eligibility for Medicaid supplemental insurance may narrow these disparities.

PMID:37036727 | DOI:10.1001/jamainternmed.2023.0512

J Exp Psychol Hum Percept Perform. 2023 Mar;49(3):306-326. doi: 10.1037/xhp0001097.

ABSTRACT

Although group members may be diverse and have their own reasons for actions, people tend to generalize the actions of known members to unknown cases from the observer’s perspective. Nevertheless, it is unclear whether action generalization is entirely determined by statistical evidence or is additionally constrained by prior knowledge or beliefs toward group members’ actions. Given that people specifically believe that group members pursue common action goals, we hypothesized that action generalization is constrained by this belief. Accordingly, the extent of generalizing a goal underlying action does not always increase as the prevalence of the goal increases; instead, a strict monotonicity effect is observed for the action’s movement. We found that the common goal is generalized to a new group member only when all sampled group members have this target property, revealing that the relation between the prevalence of goals and the strength of their generalization violates strict monotonicity (Studies 1a and 1b). In contrast, the more group members perform the same movement, the more likely this movement is to be generalized to an unknown group member, showing monotonic generalization of movements (Studies 3a, 3b, and 3c). Importantly, these dissociative generalizations are specific to entitative social groups (Studies 2, 4, and 6) and not due to differences in experimental tasks between studies. In shared experimental paradigms, when the goal status is available, the monotonic generalization of actions is not found; however, when the goal status is unavailable and the movement is still accessed, the monotonic generalization of actions is observed (Study 5). Thus, our findings highlight that the belief that group members pursue a common goal constrains action generalization to a greater extent than statistical evidence. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:37036672 | DOI:10.1037/xhp0001097

Anal Chem. 2023 Apr 10. doi: 10.1021/acs.analchem.2c05292. Online ahead of print.

ABSTRACT

Plasmonic nanoparticles are finding applications within the single molecule sensing field in a “dimer” format, where interaction of the target with hairpin DNA causes a decrease in the interparticle distance, leading to a localized surface plasmon resonance shift. While this shift may be detected using spectroscopy, achieving statistical relevance requires the measurement of thousands of nanoparticle dimers and the timescales required for spectroscopic analysis are incompatible with point-of-care devices. However, using dark-field imaging of the dimer structures, simultaneous digital analysis of the plasmonic resonance shift after target interaction of thousands of dimer structures may be achieved in minutes. The main challenge of this digital analysis on the single-molecule scale was the occurrence of false signals caused by non-specifically bound clusters of nanoparticles. This effect may be reduced by digitally separating dimers from other nanoconjugate types. Variation in image intensity was observed to have a discernible impact on the color analysis of the nanoconjugate constructs and thus the accuracy of the digital separation. Color spaces wherein intensity may be uncoupled from the color information (hue, saturation, and value (HSV) and luminance, a* vector, and b* vector (LAB) were contrasted to a color space which cannot uncouple intensity (RGB) to train a classifier algorithm. Each classifier algorithm was validated to determine which color space produced the most accurate digital separation of the nanoconjugate types. The LAB-based learning classifier demonstrated the highest accuracy for digitally separating nanoparticles. Using this classifier, nanoparticle conjugates were monitored for their plasmonic color shift after interaction with a synthetic RNA target, resulting in a platform with a highly accurate yes/no response with a true positive rate of 88% and a true negative rate of 100%. The sensor response of tested single stranded RNA (ssRNA) samples was well above control responses for target concentrations in the range of 10 aM-1 pM.

PMID:37036670 | DOI:10.1021/acs.analchem.2c05292

Biochem Genet. 2023 Apr 10. doi: 10.1007/s10528-023-10372-2. Online ahead of print.

ABSTRACT

Previous studies found that the circadian clock gene participated in the genesis and development of breast cancer. However, research findings on the relationship between polymorphisms in the CLOCK gene and breast cancer risk were inconsistent. This study performed a meta-analysis of the association between CLOCK gene polymorphisms and breast cancer risk. PubMed, Cochrane Library, and Embase databases were electronically searched to collect studies on the association between CLOCK gene polymorphisms and breast cancer risk from inception to February 14, 2022. The quality of the included literature was assessed using the Newcastle-Ottawa Scale. For statistical analysis, odds ratio (OR) and 95% confidence intervals (CIs) were calculated using STATA 14.0. In addition, publication bias was performed by the funnel diagram and the Harbord’s regression test. And sensitivity analysis was assessed by the trim and fill method. A total of 6 eligible studies, including 10,164 subjects (5488 breast cancer cases and 4676 controls), were screened in this meta-analysis. Though we did not find a significant association between the polymorphisms in the overall CLOCK gene with breast cancer risk [OR (95%CI) = 0.98 (0.96, 1.01), P = 0.148], we found that compared with T/T types of rs3749474 in CLOCK, T/C and C/C types of rs3749474 were associated with lower risk of breast cancer [OR (95%CI) = 0.93 (0.88, 0.98), P = 0.003]. The sensitivity analysis confirmed the robustness of the results. The funnel plot showed no significant publication bias. Polymorphisms in the CLOCK gene might be associated with breast cancer risk. More studies are needed to confirm the conclusion.

PMID:37036639 | DOI:10.1007/s10528-023-10372-2

Environ Monit Assess. 2023 Apr 10;195(5):551. doi: 10.1007/s10661-023-11030-1.

ABSTRACT

This study compiles commonly available groundwater chemistry data from the Pearl Harbor Sole Source Aquifer (SSA), Hawai’i-O’ahu’s primary drinking water source-and applies hierarchical clustering analysis (HCA), principal component analyses (PCA), piper diagrams, and box plots with geospatial analysis to better define groundwater regions and correlate groundwater chemistry in those regions with land use. Groundwater in this aquifer recharges and flows through chemically similar soil and rocks, such that anthropogenic activities are a primary influence on the chemical variability of the aquifer’s differing regions. Our analyses link specific chemical species in groundwater to land use/cover categories: urban, agriculture, and natural and anthropogenically-induced saline water intrusion. To create distinct statistical groupings with different groundwater chemistry compositions, it was important that the suite of parameters used in the statistical analysis do not covary. In our case, Cl^– covaried with several major ions; however, by including F^–, alkalinity, and SiO_x that do not covary with Cl^– in the covariance matrix, we produced improved spatial grouping of HCA clusters and stronger affinities to land use designations. Results show that dominant groundwater chemistry changes with land use along flow paths. These results pertain to areas where groundwater flows from conservation land in high recharge areas of O’ahu’s mountain ranges to urban and agricultural land use regions: groundwater retains its source characteristics until about 3-6 km into agricultural and urban zoned lands. Ultimately, this study outlines a simple method for water quality regulators to use groundwater chemistry to identify risks of target contaminants based on land use.

PMID:37036575 | DOI:10.1007/s10661-023-11030-1