Category: Statistics

Fr J Urol. 2024 Oct 25:102797. doi: 10.1016/j.fjurol.2024.102797. Online ahead of print.

ABSTRACT

Curative surgery for localized prostate cancer can lead to iatrogenic erectile dysfunction (ED), affecting couples. Sexuality remains influenced by social norms, often requiring men to provide pleasure through rigid erections. However, iatrogenic ED does not prevent male orgasm, although it can disrupt body image and self-esteem. This study aims to describe couples’ sexual repertoire and partners’ sexual satisfaction post radical prostatectomy at the Centre Hospitalier Universitaire de Martinique. A monocentric retrospective observational study was conducted with data collected from January 2021 to March 2024. The Valentin and ASEX questionnaires were administered to the partners of future vesiculo-prostatectomy patients at the start of the sex-rehabilitation program. Responses were analyzed anonymously using the Sphinx iQ2 application. The characteristics of the population were described in terms of proportions and means, with a significance threshold set at 0.05 for statistical tests.Of the 152 couples identified, 65 Valentine questionnaires were available. Respondents were heterosexual women, with an average age of 59, and their partners had an average age of 64. Non-penetrative sex was already part of the sexual repertoire for 52% of couples prior to prostate cancer diagnosis. After surgery, 32% of partners resumed penetrative sex, while 43% had not yet resumed sexual intimacy, and 14% had resumed non-penetrative sex. Mutual fondling (85%), vaginal penetration (70%), female oro-genital sex (70%) and male oro-genital sex (52%) were the most popular sexual stimuli. Surgery was therefore no obstacle to sexual satisfaction for our respondents, with a satisfaction level of 90% before and 86% after total prostatectomy. The same applies to orgasm before and after total prostatectomy.The results show that erectile dysfunction is not an obstacle to partners’ sexual satisfaction, with couples able to reinvent their sexuality around non-penetrative practices. Sexual satisfaction indicators before and after RA show a strong correlation, confirming that surgery does not negatively affect sexual satisfaction. The results show that men suffering from post-RP ED can free themselves from the dogma of penile erection by exploring female sexual pleasure to a greater extent. Couples practicing non-penetrative sexuality report satisfying, more playful, complicit and varied sexuality. Finally, ED has less of an impact on partners than future operators believe.

PMID:39490901 | DOI:10.1016/j.fjurol.2024.102797

Sci Total Environ. 2024 Oct 25:177191. doi: 10.1016/j.scitotenv.2024.177191. Online ahead of print.

ABSTRACT

To better characterize properties governing the sorption of per- and polyfluoroalkyl substances (PFAS) to biochar, twenty-three diverse biochars were characterized and evaluated as sorbents for perfluorooctanoic acid (PFOA). Biochars were produced at various temperatures, using two different technologies, and made from sewage sludge, food waste reject, wood wastes, and one reference substrate (wood pellets). The biochars were characterized in terms of surface area, pore volume and pore size distributions, elemental composition, leachable elements, ash content, pH, zeta potential, condensed aromatic carbon (ConAC) content (determined by benzenepolycarboxylic acid (BPCA) markers), and their -OH functional group content (infrared spectroscopy). PFOA sorption isotherms were determined using Polanyi-Dubinin-Manes (PDM) and Freundlich models. The sludge-based biochars [Freundlich coefficients (log K_F) between 2.56 ± 0.11 and 6.72 ± 0.22 (μg/kg)/(μg/L)^nF; fitted free energy of adsorption (E) and pore volume (V_o) from the PDM model between 13.27 and 17.26 kJ/mol, and 0.50 and 523.51 cm³/kg] outperformed wood biochars [log K_F between 1.02 and 4.56 ± 0.22 (μg/kg)/(μg/L)^nF; E between 9.87 and 17.44 kJ/mol; V_o between 0.21 and 6.52 cm³/kg] as PFOA sorbents. Multivariate statistical analysis revealed that the sorption capacity was mainly controlled by pore volume within the pore diameter region that could accommodate the molecular size of PFOA (3-6 nm). Hydrophobic interactions between PFOA and aromatic carbon rich regions controlled sorption affinity, especially in the wood biochars.

PMID:39490842 | DOI:10.1016/j.scitotenv.2024.177191

Sci Total Environ. 2024 Oct 25:177193. doi: 10.1016/j.scitotenv.2024.177193. Online ahead of print.

ABSTRACT

Accurate estimation of soil water content (SWC) is essential for effective agriculture and water resources management. While various methods have been developed for in-situ SWC measurement, practical limitations and the need for comprehensive water sensor networks make their use complicated. To overcome these challenges, heuristic data-driven models may provide a suitable alternative to practical methods for SWC simulation under different cultivation conditions. In this paper, the application of gene expression programming (GEP) methodology was proposed to simulate SWC at three different depths in rice fields using information related to weather and groundwater. A modeling study was conducted that applied the robust k-fold testing data assignment method, considering two different chronologic strategies of “k” defining to evaluate both strategies. The first one was based on the definition of the “k” values based on yearly data partitioning, while the second one considered growing stages as the “k” definition criterion. Besides evaluating the models using error statistics, a further uncertainty analysis was also conducted to check stability and confidence. The obtained results revealed that selection of “k” based on growing stages produced more accurate and stable results. Among the target parameters, water content at the third layer was predicted with higher accuracy.

PMID:39490826 | DOI:10.1016/j.scitotenv.2024.177193

Sci Total Environ. 2024 Oct 25:177120. doi: 10.1016/j.scitotenv.2024.177120. Online ahead of print.

ABSTRACT

Establishing natural background levels (NBLs) of nitrate‑nitrogen (NO₃-N) is crucial for groundwater resource management and pollution prevention. Traditional statistical methods for evaluating NO₃-N NBLs generally overlook the hydrogeochemical processes associated with NO₃-N pollution. We propose using a method that combines principal component factor analysis and K-means clustering (PCFA-KM) to identify NO₃-N anomalies in three typical areas of the Huaihe River Basin and evaluate the effectiveness of this method in comparison with the hydrochemical graphic method (Hydro) and the Gaussian mixture model (GMM). The results showed that PCFA-KM was the most robust and effective for identifying NO₃-N anomalies caused by human activities. This method not only considers the data’s discreteness but also combines the influencing factors of NO₃-N pollution to identify anomalies, thus avoiding the influence of non-homogeneous hydrogeological conditions. Moreover, 70 % of the identified anomalies were explained by sampling survey data, geochemical ratios, and pollution percentage indices, confirming the method’s effectiveness and reliability. The upper limits of NO₃-N NBLs obtained by PCFA-KM were 12.97 mg/L (CUs-I), 4.42 mg/L (CUs-V), and 5.57 mg/L (CUs-VI). This study provides a new approach for NO₃-N anomaly identification, which can guide future NO₃-N NBLs assessments and pollution prevention and control efforts.

PMID:39490819 | DOI:10.1016/j.scitotenv.2024.177120

J Arthroplasty. 2024 Oct 26:S0883-5403(24)01146-X. doi: 10.1016/j.arth.2024.10.106. Online ahead of print.

ABSTRACT

INTRODUCTION: The Area Deprivation Index (ADI) is a weighted index comprised of 17 census-based markers of material deprivation and poverty. The purpose of this study was to determine whether patients undergoing total hip arthroplasty (THA) in areas of high ADI (greater disadvantage) were associated with differences in 90-day: 1) medical complications; 2) emergency department (ED) utilizations; and 3) readmissions.

METHODS: A nationwide database was queried for primary THA patients from 2010 to 2020. The ADI is reported on a scale of 0 to 100, with higher numbers indicating greater disadvantage. Patients undergoing primary THA in regions associated with high ADI (90%+) were compared to those of lower ADI (0 to 89%). A total of 138,670 patients were evenly matched between the two cohorts following 1:1 propensity score matching by age, sex, and Elixhauser Comorbidity Index (ECI). Primary endpoints were 90-day medical complications, ED utilizations, and readmissions. Multivariable logistic regression models calculated the odds ratios (OR) and 95% confidence intervals (95% CI). P-values less than 0.01 were statistically significant.

RESULTS: Patients undergoing THA from high ADI had significantly higher rates and odds of developing any medical complications (13.00 versus 11.91%; OR: 1.09, P < 0.0001), including acute kidney injuries (1.83 versus 1.52%; OR: 1.20, P < 0.0001), myocardial infarctions (0.35 versus 0.24%; OR: 1.45, P = 0.0003), and surgical site infections (0.94 versus 0.76%; OR: 1.23, P = 0.0004). High ADI patients had significantly higher rates and odds of ED visits within 90 days (3.94 versus 3.67%; OR: 1.08, P = 0.008). There was no significant difference in readmissions (5.44 versus 5.69%; OR: 0.95, P = 0.034).

CONCLUSIONS: Socioeconomically disadvantaged patients have increased odds of 90-day medical complications and ED utilizations, despite comparable 90-day readmission rates. Measures of neighborhood disadvantage may be valuable metrics to inform healthcare policy and improve post-discharge care.

PMID:39490718 | DOI:10.1016/j.arth.2024.10.106

J Arthroplasty. 2024 Oct 26:S0883-5403(24)01015-5. doi: 10.1016/j.arth.2024.10.002. Online ahead of print.

ABSTRACT

BACKGROUND: Despite the prevalence of total hip arthroplasty (THA) as a treatment for hip-related conditions, there is limited research directly comparing the patient-reported outcome measures (PROMs) between primary and revision THA. This study compared the time to achieve minimal clinically important difference (MCID) between primary and revision THA.

METHODS: We conducted a retrospective analysis comparing 6,671 THAs (6,070 primary and 601 all-cause revision THAs) performed between 2016 and 2022. Patient-reported outcomes were evaluated using preoperative and postoperative scores of Patient-Reported Outcomes Measurement Information System (PROMIS) Global Physical, PROMIS Physical Function-10a (PF-10a), and Hip Injury and Osteoarthritis Outcome Score-Physical Function Short-form (HOOS-PS). The time to achieve MCID was assessed using survival curves with and without interval-censoring, and statistical comparisons were performed using log-rank and weighted log-rank tests.

RESULTS: Comparing the time to achieve MCID without interval-censoring, primary THA demonstrated significantly faster median times than revision THA for PROMIS Global Physical (3.3 versus 3.9 months, P < 0.001), PROMIS PF-10a (3.6 versus 6.2 months, P < 0.001), and HOOS-PS (3.1 versus 4.0 months, P < 0.001). Similarly, when using interval-censoring, primary THA continued to achieve MCID significantly faster than revision THA for PROMIS Global Physical (0.23 to 0.24 versus 0.50 to 0.51 months, P < 0.001), PROMIS PF-10a (1.43 to 1.44 versus 3.03 to 3.04 months, P < 0.001), and HOOS-PS (0.87 to 0.87 versus 1.20 to 1.21 months, P < 0.001).

CONCLUSION: Across all PROMs, primary THA achieved MCID significantly faster than revision THA, irrespective of interval-censoring. These findings underscore the importance of setting realistic postoperative recovery expectations during perioperative patient counseling. Future studies should investigate the factors influencing time to achieve MCID and explore how to enhance revision THA techniques and perioperative management for improved patient outcomes.

PMID:39490716 | DOI:10.1016/j.arth.2024.10.002

J Arthroplasty. 2024 Oct 26:S0883-5403(24)01160-4. doi: 10.1016/j.arth.2024.10.120. Online ahead of print.

ABSTRACT

BACKGROUND: Socioeconomic status (SES)-an individual or group’s social standing or class, as measured by education, income, and occupation-has been associated with poor surgical outcomes in orthopaedics. Total knee (TKA) and total hip (THA) arthroplasties are the most commonly investigated orthopaedic surgeries regarding SES and patient-reported outcome measures (PROMs), yet the results are contradictory. The aim of this systematic review was to assess the impact of SES on PROMs following total joint arthroplasty (TJA).

METHODS: We performed a literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines utilizing MEDLINE (Ovid), EMBASE (Ovid), and Cochrane Library from database inception (1971, 1974, and 1996, respectively) to August 2, 2023, to identify studies investigating SES and PROMs in adults undergoing primary elective TJA. Studies were included if they evaluated one of three SES variables (income, education, or employment status) and reported at least one-year scores using a validated PROM. There were two reviewers who independently screened studies and extracted data.

RESULTS: There were 16 studies included in this systematic review. A total of 55,875 arthroplasties, including 24,055 TKAs and 31,820 THAs, were analyzed. Of the studies, eight evaluated income, 15 evaluated education, and two evaluated employment status. The majority of studies investigating income found a statistically significant association between lower income and worse postoperative PROMs. There were ten studies, involving 90% of all patients from the included education studies, that found a statistically significant association between education and postoperative PROMs. There were two studies that found unemployed THA patients had lower improvements in PROMs compared to employed and retired patients.

CONCLUSION: Our systematic review found several significant associations between income, education, employment, and PROMs after TJA. Providers should pay special attention to lower-income, less educated, and unemployed patients. These patients may benefit from targeted interventions to achieve substantial clinical benefit after TJA.

PMID:39490715 | DOI:10.1016/j.arth.2024.10.120

Gastrointest Endosc. 2024 Oct 25:S0016-5107(24)03638-1. doi: 10.1016/j.gie.2024.10.039. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Individual randomized controlled trials (RCTs) and pairwise meta-analyses do not compare all commercially available endoscopic bariatric therapies (EBTs) head-to-head. Therefore, the choice among them is currently made by inference or indirect data. We aimed to assess the comparative efficacy and safety of EBTs through a network meta-analysis.

METHODS: We searched Medline, EMBASE, and Cochrane CENTRAL from inception for IGBs and from 2013 for ESG until May 2023. Only RCTs comparing any of the currently commercially available EBTs to controls were considered eligible. Outcomes included %total weight loss (%TWL), serious adverse events (SAEs), and intolerability.

RESULTS: We identified 821 citations, of which 10 and 8 were eligible for the qualitative and quantitative analysis, respectively. Considering %TWL at the time of IGB removal, all EBTs were associated with statistically higher %TWL than controls. There were no significant differences among EBTs. However, considering the %TWL at the follow-up closest to 12 months, both ESG and Spatz3 were more effective than Orbera, with no statistical difference between ESG and Spatz3. For both outcomes, p-score and ranking score suggested that ESG was probably associated with a greater weight loss (0.889272 and 0.899469 respectively), followed by Spatz3 (0.822894 and 0.842773 respectively), and Orbera (0.536968 and 0.507165 respectively).

CONCLUSIONS: All currently available FDA-approved EBTs are more effective than both diet plus lifestyle intervention and sham procedures with an acceptable safety profile. ESG seems the most effective and may be prioritized for patients fit for both ESG and IGB. Direct controlled trials between EBTs are warranted to confirm these findings.

PMID:39490693 | DOI:10.1016/j.gie.2024.10.039

Gastrointest Endosc. 2024 Oct 25:S0016-5107(24)03635-6. doi: 10.1016/j.gie.2024.10.036. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Refractory benign esophageal strictures (RBES) are defined by inadequate response to dilation. Early recognition of RBES allows for earlier initiation of aggressive therapy potentially leading to less morbidity and cost. We sought to establish a predictive model for RBES.

METHODS: Patients who underwent esophagogastroduodenoscopy (EGD) with esophageal dilation at Mayo Clinic Rochester were identified. In addition, a cohort of patients from a clinical database of patients with RBES managed with self-dilation was identified. Malignant strictures, Schatzki rings, and previously treated strictures were excluded. RBES was defined by inability to maintain a diameter ≥14mm over 5 dilation sessions. Multivariable logistic regression models were built to predict RBES.

RESULTS: 128 patients with index EGD and esophageal dilation were identified, with 25 meeting RBES criteria. An additional 63 RBES patients were identified from the self-dilation cohort for a total of 88 RBES and 103 non-RBES patients. Multivariable analysis yielded a strong predictive model, with a c-statistic of 0.85, identifying stricture length ≥ 2cm, diameter ≤ 7mm and proximal/diffuse stricture location as associated with a higher risk for RBES. Patients without any of these risk factors had a 2% risk of RBES while those with all 3 risk factors had a risk of 73% for RBES.

CONCLUSIONS: Risk of RBES can be predicted at index EGD based on stricture features. A predictive model for RBES was created based on readily available risk factors, which may guide an individualized therapeutic approach to patients with benign esophageal stricture, potentially reducing morbidity and cost.

PMID:39490691 | DOI:10.1016/j.gie.2024.10.036

Acad Pediatr. 2024 Oct 26:S1876-2859(24)00540-0. doi: 10.1016/j.acap.2024.10.010. Online ahead of print.

ABSTRACT

OBJECTIVE: To understand the association between food insecurity (FI) and housing insecurity (HI) risk, the effects of the COVID-19 pandemic on health-related activities among children with overweight or obesity, and caregivers’ and clinicians’ challenges and priorities related to pediatric weight management.

METHODS: We conducted surveys with caregivers of children with overweight and obesity and pediatric clinicians at two academic medical centers in the Greater Boston area. We used multivariable logistic regression models to examine associations between FI and HI risk and the effects of the COVID-19 pandemic on health-related activities and descriptive statistics to summarize caregivers’ and clinicians’ challenges and priorities related to pediatric weight management.

RESULTS: We analyzed data from surveys with 344 caregivers and 100 pediatric clinicians. Overall, 37% of caregivers endorsed both FI+HI, 18% FI alone, 10% HI alone, and 35% neither FI/HI. In the adjusted logistic regression models, combined FI+HI (reference: neither FI/HI) was significantly associated with higher odds of sleeping less (aOR 2.96 [95% confidence interval (CI): 1.46, 6.01]) and higher odds of spending less time outside (aOR 2.10 [95% CI: 1.06, 4.16]). Top priorities for pediatric weight management identified by both caregivers and clinicians were related to physical activity and availability of outdoor spaces.

CONCLUSIONS: Endorsement of both FI+HI was associated with children getting less sleep and spending less time outside during the COVID-19 pandemic. Future innovations in care plans for children with overweight and obesity should be adapted to a family’s social context and should incorporate caregivers’ and clinicians’ challenges and priorities.

PMID:39490687 | DOI:10.1016/j.acap.2024.10.010