Category: Statistics

J Med Internet Res. 2024 Apr 25;26:e52646. doi: 10.2196/52646.

ABSTRACT

BACKGROUND: Patients using web-based health care communities for e-consultation services have the option to choose their service providers from an extensive digital market. To stand out in this crowded field, doctors in web-based health care communities often engage in prosocial behaviors, such as proactive and reactive actions, to attract more users. However, the effect of these behaviors on the volume of e-consultations remains unclear and warrants further exploration.

OBJECTIVE: This study investigates the impact of various prosocial behaviors on doctors’ e-consultation volume in web-based health care communities and the moderating effects of doctors’ digital and offline reputations.

METHODS: A panel data set containing information on 2880 doctors over a 22-month period was obtained from one of the largest web-based health care communities in China. Data analysis was conducted using a 2-way fixed effects model with robust clustered SEs. A series of robustness checks were also performed, including alternative measurements of independent variables and estimation methods.

RESULTS: Results indicated that both types of doctors’ prosocial behaviors, namely, proactive and reactive actions, positively impacted their e-consultation volume. In terms of the moderating effects of external reputation, doctors’ offline professional titles were found to negatively moderate the relationship between their proactive behaviors and their e-consultation volume. However, these titles did not significantly affect the relationship between doctors’ reactive behaviors and their e-consultation volume (P=.45). Additionally, doctors’ digital recommendations from patients negatively moderated both the relationship between doctors’ proactive behaviors and e-consultation volume and the relationship between doctors’ reactive behaviors and e-consultation volume.

CONCLUSIONS: Drawing upon functional motives theory and social exchange theory, this study categorizes doctors’ prosocial behaviors into proactive and reactive actions. It provides empirical evidence that prosocial behaviors can lead to an increase in e-consultation volume. This study also illuminates the moderating roles doctors’ digital and offline reputations play in the relationships between prosocial behaviors and e-consultation volume.

PMID:38663006 | DOI:10.2196/52646

J Am Anim Hosp Assoc. 2024 May 1;60(3):93-99. doi: 10.5326/JAAHA-MS-7388.

ABSTRACT

The objective of this study was to investigate the value of the lactate to albumin ratio (L:A) as a prognostic marker for mortality in septic dogs. A single-center retrospective case-control study based on clinical record review was conducted at an academic teaching hospital. All records were extracted for diagnoses of bacterial sepsis, septic peritonitis, septic shock, or septicemia between February 2012 and October 2021. The study included 143 dogs. The most commonly identified sepsis diagnoses in dogs were septic peritonitis (55%; 78/143), unclassified sepsis (20%), and sepsis secondary to wounds or dermatological conditions (10%; 15/143). Median lactate and albumin for all dogs at presentation were 2.80 mmol/L and 2.6 g/dL, respectively; the median L:A ratio was 1.22. No clinically or statistically significant differences in lactate (P = 0.631), albumin (P = 0.695), or L:A (P = 0.908) were found between survivors and nonsurvivors.

PMID:38662997 | DOI:10.5326/JAAHA-MS-7388

JCO Precis Oncol. 2024 Apr;8:e2300398. doi: 10.1200/PO.23.00398.

ABSTRACT

PURPOSE: Ethnic diversity in cancer research is crucial as race/ethnicity influences cancer incidence, survival, drug response, molecular pathways, and epigenetic phenomena. In 2018, we began a project to examine racial/ethnic diversity in cancer research, with a commitment to review these disparities every 4 years. This report is our second assessment, detailing the present state of racial/ethnic diversity in cancer genomics and clinical trials.

METHODS: To study racial/ethnic inclusion in cancer genomics, we extracted ethnic records from all data sets available at cBioPortal (n = 125,128 patients) and cancer-related genome-wide association studies (n = 28,011,282 patients) between 2018 and 2022. Concerning clinical trials, we selected studies related to breast cancer (n = 125,518 patients, 181 studies), lung cancer (n = 34,329 patients, 119 studies), and colorectal cancer (n = 40,808 patients, 105 studies).

RESULTS: In cancer genomics (N = 28,136,410), 3% of individuals lack racial/ethnic registries; tumor samples were collected predominantly from White patients (89.14%), followed by Asian (7%), African American (0.55%), and Hispanic (0.21%) patients and other populations (0.1%). In clinical trials (N = 200,655), data on race/ethnicity are missing for 60.14% of the participants; for individuals whose race/ethnicity was recorded, most were characterized as White (28.33%), followed by Asian (7.64%), African (1.79), other ethnicities (1.37), and Hispanic (0.73). Racial/ethnic representation significantly deviates from global ethnic proportions (P ≤ .001) across all data sets, with White patients outnumbering other ethnic groups by a factor of approximately 4-6.

CONCLUSION: Our second update on racial/ethnic representation in cancer research highlights the persistent overrepresentation of White populations in cancer genomics and a notable absence of racial/ethnic information across clinical trials. To ensure more equitable and effective precision oncology, future efforts should address the reasons behind the insufficient representation of ethnically diverse populations in cancer research.

PMID:38662980 | DOI:10.1200/PO.23.00398

Am J Public Health. 2024 Apr 25:e1-e4. doi: 10.2105/AJPH.2024.307646. Online ahead of print.

ABSTRACT

Objectives. To test the associations between local employment opportunities for the Black workforce and drug mortality among Black Americans, while examining the potential moderating effects of fentanyl seizure rates. Methods. We derived data from the National Center for Health Statistics’ restricted-access Multiple Cause of Death file, linked with county-level job counts, drug supply, and other characteristics from the US Census Bureau and the Centers for Disease Control and Prevention. After examining the characteristics of counties by the magnitudes of increases in drug mortality from 2010‒2013 to 2018-2021, we conducted a first-differenced regression analysis to test the associations between the job-to-Black workforce ratio and age-adjusted drug mortality rates among Black Americans in US counties and test the moderating effects of state-level fentanyl seizure rates. Results. One more job per 100 Black workers was associated with 0.29 fewer drug overdose deaths per 100 000 Black Americans in the county. This negative association was stronger in the counties of the states with higher increases in fentanyl seizure rates. Conclusions. Increasing employment opportunities can be an important strategy for preventing Black Americans’ drug mortality, especially among those living in areas with higher increases in fentanyl seizure rates. (Am J Public Health. Published online ahead of print April 25, 2024:e1-e4. https://doi.org/10.2105/AJPH.2024.307646).

PMID:38662973 | DOI:10.2105/AJPH.2024.307646

J Magn Reson Imaging. 2024 Apr 25. doi: 10.1002/jmri.29395. Online ahead of print.

ABSTRACT

BACKGROUND: Standard Cartesian time-of-flight (TOF) head magnetic resonance angiography (MRA) is routinely used to evaluate the intracranial arteries, but does not provide quantitative hemodynamic information that is useful for patient risk stratification as well as for monitoring treatment and tracking changes in blood flow over time. Quantitative TOF (qTOF) MRA represents a new and efficient method for simultaneous evaluating the intracranial arteries and quantifying blood flow velocity, but it has not yet been evaluated in patients with cerebrovascular disease.

PURPOSE: To evaluate qTOF for simultaneously evaluating the intracranial arteries and quantifying intracranial blood flow velocity in patients with cerebrovascular disease, without the need for a phase contrast (PC) scan.

STUDY TYPE: Prospective.

SUBJECTS: Twenty-four patients (18 female, 6 male) with cerebrovascular disease.

FIELD STRENGTH/SEQUENCES: Head MRA at 3 T using gradient-echo 3D qTOF, standard Cartesian TOF, and PC protocols.

ASSESSMENT: Three independent readers assessed arterial image quality using a 4-point scale (1: non-diagnostic, 4: excellent) and artifact presence. Total and component flow velocities obtained with qTOF and PC were measured.

STATISTICAL TESTS: Wilcoxon signed-rank tests, Gwet’s AC2, intraclass correlation coefficients (ICC) for absolute agreement, Bland-Altman analyses, tests of equal proportions. P values <0.05 were considered statistically significant.

RESULTS: Averaged across readers and compared to standard Cartesian TOF, qTOF significantly improved overall arterial image quality (3.8 ± 0.2 vs. 3.6 ± 0.5), image quality at locations of pathology (3.7 ± 0.5 vs. 3.4 ± 0.7), and increased the proportion of evaluations rated without artifacts (63.9% [46/72] vs. 37.5% [27/72]). qTOF significantly agreed with PC for total flow velocity (ICC = 0.71) and component flow velocity (ICC = 0.89).

DATA CONCLUSION: qTOF angiography of the head matched or improved upon the image quality of standard Cartesian TOF, reduced image artifacts, and provided quantitative hemodynamic data, without the need for a PC scan.

EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 2.

PMID:38662966 | DOI:10.1002/jmri.29395

Clin Orthop Relat Res. 2024 Apr 19. doi: 10.1097/CORR.0000000000003071. Online ahead of print.

ABSTRACT

BACKGROUND: Treatment of femoral neck fractures in patients who are nongeriatric (≤ 60 years) is challenging because of high failure rates. Anatomic parameters influence the biomechanical environment for fracture healing, but their associations with clinical prognosis remains unclear.

QUESTIONS/PURPOSES: (1) Which anatomic parameter that is identifiable on pelvic radiographs shows a statistical correlation with a higher risk of clinical failure defined as nonunion, avascular necrosis (AVN), reoperation, and functional failure (decrease in Harris hip score reaching the minimum clinically important difference) in the screw fixation of femoral neck fractures among nongeriatric patients? (2) How does the influence of anatomic parameters on clinical prognosis manifest: directly or mediated by additional mechanisms?

METHODS: This retrospective, multicenter study used a nationwide database in China. Between January 2014 and December 2020, we evaluated 1066 patients with femoral neck fractures with a median age of 53 years (interquartile range 46 to 56) and median follow-up period of 62 months. Anatomic parameters including femoral neck-shaft angle (NSA), femoral head radius, femoral neck width, femoral offset, acetabular center-edge angle, and acetabular sharp angle were variables of interest. The primary outcome was clinical failure including nonunion, AVN, reoperation, and functional failure (decrease in Harris hip score reaching the minimum clinically important difference). Risk factors for failure were first filtered using the Bayesian information criterion and then assessed with multiple regression adjusting for confounders. The mediation effect was further explored using model-based causal mediation analysis with a quasi-Bayesian Monte Carlo method.

RESULTS: Of all anatomic parameters we assessed, the contralateral NSA was associated with clinical failure, after adjusting for all potential covariates and confounding variables (adjusted odds ratio 0.92 [95% confidence interval 0.89 to 0.95]; p < 0.001). The optimal threshold for the NSA was 130°, with the highest Youden index of 0.27. Patients with an NSA < 130° (41% [441 of 1066]) demonstrated an increased occurrence of nonunion (15% [68 of 441] versus 5% [33 of 625]; p < 0.001), AVN (32% [141 of 441] versus 22% [136 of 625]; p < 0.001), functional failure (25% [110 of 441] versus 15% [93 of 625]), and reoperations (28% [122 of 441] versus 13% [79 of 625]). The impact of an NSA less than 130° on clinical failure was direct and substantially mediated by the type of displaced fracture (mediation proportion: 18.7%).

CONCLUSION: In our study of screw fixations for femoral neck fractures among nongeriatric patients, we identified that a contralateral NSA < 130° correlates with an increased risk of clinical failure including nonunion, AVN, functional failure, and reoperation. The effect is either direct or mediated through displaced fracture types. This is important for surgeons in order to recognize the elevated rate of clinical failure and nature of the challenging biomechanical environment, which should guide them in refining surgical details and selecting appropriate fixation and rehabilitation plans. Approaches to managing these fractures require further validation with large-scale clinical trials.

LEVEL OF EVIDENCE: Level III, prognostic study.

PMID:38662919 | DOI:10.1097/CORR.0000000000003071

J Strength Cond Res. 2024 May 1;38(5):e264-e272. doi: 10.1519/JSC.0000000000004727.

ABSTRACT

Harry, JR, Hurwitz, J, Agnew, C, and Bishop, C. Statistical tests for sports science practitioners: identifying performance gains in individual athletes. J Strength Cond Res 38(5): e264-e272, 2024-There is an ongoing surge of sports science professionals within sports organizations. However, when seeking to determine training-related adaptations, sports scientists have demonstrated continued reliance on group-style statistical analyses that are held to critical assumptions not achievable in smaller-sample team settings. There is justification that these team settings are better suited for replicated single-subject analyses, but there is a dearth of literature to guide sports science professionals seeking methods appropriate for their teams. In this report, we summarize 4 methods’ ability to detect performance adaptations at the replicated single-subject level and provide our assessment for the ideal methods. These methods included the model statistic, smallest worthwhile change, coefficient of variation (CV), and standard error of measurement (SEM), which were discussed alongside step-by-step guides for how to conduct each test. To contextualize the methods’ use in practice, real countermovement vertical jump (CMJ) test data were used from 4 (2 females and 2 males) athletes who complete 5 biweekly CMJ test sessions. Each athlete was competing in basketball at the NCAA Division 1 level. We concluded that the combined application of the model statistic and CV methods should be preferred when seeking to objectively detect meaningful training adaptations in individual athletes. This combined approach ensures that the differences between the tests are (a) not random and (b) reflect a worthwhile change. Ultimately, the use of simple and effective methods that are not restricted by group-based statistical assumptions can aid practitioners when conducting performance tests to determine athlete adaptations.

PMID:38662890 | DOI:10.1519/JSC.0000000000004727

J Strength Cond Res. 2024 May 1;38(5):951-956. doi: 10.1519/JSC.0000000000004697.

ABSTRACT

González-Cano, H, Martín-Olmedo, JJ, Baz-Valle, E, Contreras, C, Schoenfeld, BJ, García-Ramos, A, Jiménez-Martínez, P, and Alix-Fages, C. Do muscle mass and body fat differ between elite and amateur natural physique athletes on competition day? A preliminary, cross-sectional, anthropometric study. J Strength Cond Res 38(5): 951-956, 2024-Natural physique athletes strive to achieve low body fat levels while promoting muscle mass hypertrophy for competition day. This study aimed to compare the anthropometric characteristics of natural amateur (AMA) and professional (PRO) World Natural Bodybuilding Federation (WNBF) competitors. Eleven male natural physique athletes (6 PRO and 5 AMA; age = 24.8 ± 2.3 years) underwent a comprehensive anthropometric evaluation following the International Society for the Advancement of Kinanthropometry protocol within a 24-hour time frame surrounding the competition. The 5-component fractionation method was used to obtain the body composition profile of the muscle, adipose, bone, skin, and residual tissues. Five physique athletes exceeded the 5.2 cutoff point of muscle-to-bone ratio (MBR) for natural athletes. Professional physique athletes were older than AMA physique athletes (p = 0.05), and they also presented larger thigh girths (p = 0.005) and bone mass (p = 0.019) compared with AMA physique athletes. Although no statistically significant between-group differences were observed in body mass, height, or body fat levels, PRO physique athletes exhibited a higher body mass index (BMI; AMA: 24.45 ± 0.12; PRO: 25.52 ± 1.01; p = 0.048), lean body mass (LBM; AMA: 64.49 ± 2.35; PRO: 69.80 ± 3.78; p = 0.024), fat-free mass (FFM; AMA: 71.23 ± 3.21; PRO: 76.52 ± 4.31; p = 0.05), LBM index (LBMI; AMA: 20.65 ± 0.52; PRO: 21.74 ± 0.85; p = 0.034), and fat-free mass index index (FFMI; AMA: 22.80 ± 0.22; PRO: 23.83 ± 0.90; p = 0.037) compared with AMA physique athletes. These findings highlight the unique characteristics and anthropometric differences between PRO and AMA natural physique athletes on competition day, emphasizing the significance of age, thigh girth, bone mass, BMI, LBM, FFM, and FFMI in distinguishing these 2 groups. Based on our findings, the established boundaries for muscle mass in natural physique athletes, based on FFMI and MBR, warrant reconsideration.

PMID:38662887 | DOI:10.1519/JSC.0000000000004697

J Strength Cond Res. 2024 May 1;38(5):912-923. doi: 10.1519/JSC.0000000000004707.

ABSTRACT

Donnelly, S, Collins, K, Burns, C, O’Neill, C, and Mangan, S. A comparison of elite and sub-elite match-play running performance of Gaelic football players. J Strength Cond Res 38(5): 912-923, 2024-This research aimed to examine differences in match-play running performance between elite and sub-elite Gaelic football players. Global Positioning System devices were used to record the match-play running performance of sub-elite and elite players during the 2018 and 2019 seasons, respectively. In total, 783 samples were collected from 31 sub-elite and 30 elite players, from 1 elite and 1 sub-elite team. Comparisons were made on a team and positional level. Statistical significance was accepted at p ≤ 0.05. Significant positional differences were present between all positions with varying effect sizes (ESs) and p-values. Effect size was used to determine the magnitude of statistical difference. On a team level, the elite covered significantly more relative distance (p = 0.021, ES = 0.007) and elicited significantly higher average speed (p = 0.023, ES = 0.007) in quarters 2, 3, and 4 than the sub-elite. The elite covered significantly more relative distance high-intensity running (17-21.9 km·h-1; p = 0.002, ES = 0.012) in quarter 3 and performed significantly more power events per minute (p = 0.006, ES = 0.009) in quarter 4. In quarter 1, the sub-elite performed significantly more power events per minute (p = 0.006, ES = 0.009), relative high-speed running (≥17 km·h-1; p = 0.011, ES = 0.009), and relative distance high-intensity running (17-21.9 km·h-1; p = 0.002, ES = 0.012). Power events were defined as the estimation of the number of events that depend on anaerobic processes. The present study indicates that elite players possess superior conditioning, ability to read match-play, pacing, and anaerobic capacity. Sub-elite teams may use the present study to inform their training to potentially improve conditioning, pacing, and anaerobic capacity.

PMID:38662885 | DOI:10.1519/JSC.0000000000004707

J Bone Joint Surg Am. 2024 Apr 25. doi: 10.2106/JBJS.23.00555. Online ahead of print.

ABSTRACT

BACKGROUND: Recent evidence showing that computer-assisted total knee arthroplasty (TKA) is associated with better outcomes compared with conventional TKA for patients with end-stage knee osteoarthritis has not been included in economic evaluations of computer-assisted TKA, which are needed to support coverage decisions. This study evaluated the cost-effectiveness of computer-assisted TKA from a payer’s perspective, incorporating recent evidence.

METHODS: We compared computer-assisted TKA with conventional TKA with regard to costs (in 2022 U.S. dollars) and quality-adjusted life-years (QALYs) using Markov models for elderly patients (≥65 years of age) and patients who were not elderly (55 to 64 years of age). Costs and QALYs were estimated in the lifetime for elderly patients and in the short term for patients who were not elderly, under a bundled payment program and a Fee-for-Service program. Transition probabilities, costs, and QALYs were retrieved from the literature, a national knee arthroplasty registry, and the National Center for Health Statistics. Threshold and probabilistic sensitivity analyses were conducted to examine the robustness of key estimates used in the base-case analysis. Using projected estimates of TKA utilization, the total cost savings of performing computer-assisted TKA rather than conventional TKA were estimated.

RESULTS: Compared with conventional TKA, computer-assisted TKA was associated with higher QALYs and lower costs for both elderly patients and patients who were not elderly, regardless of payment programs, making computer-assisted TKA a favorable treatment option. Widespread adoption of computer-assisted TKA in all U.S. patients would result in an estimated total cost saving of $1 billion for payers.

CONCLUSIONS: Compared with conventional TKA, computer-assisted TKA reduces costs to payers while providing favorable outcomes. Payers may consider providing additional payment incentives to providers for performing computer-assisted TKA, to achieve outcome improvement and cost control by facilitating widespread adoption of computer-assisted TKA.

LEVEL OF EVIDENCE: Economic and Decision Analysis Level II. See Instructions for Authors for a complete description of levels of evidence.

PMID:38662805 | DOI:10.2106/JBJS.23.00555