Category: Statistics

J Vasc Access. 2023 Dec 23:11297298231214032. doi: 10.1177/11297298231214032. Online ahead of print.

ABSTRACT

BACKGROUND: Distal hand ischemia syndrome (DHIS) is a well reported adverse outcome in patients with upper arm AV access. 25%-40% of these patients have been reported to be due to primary arterial disease complicated with significant arterial calcification. The effectiveness of revascularization of the distal arterial circulation on symptom resolution has not been reported yet.

METHODS: Retrospective single center analysis of patients evaluated for hand/forearm pain in patients with upper arm AV access who had arterial revascularization between 01/2016 and 12/2020 were included for the analysis. Fifty-one patients met inclusion criteria. Stenotic lesions greater than 70% in the subclavian, axillary, brachial, radial, or ulnar artery were treated with balloon angioplasty. Institutional approval was obtained to review charts.

OUTCOMES: Successful revascularization, improvement in pain in 48 h, 1 month, and 3 months.

RESULTS: Seventy six percent of patients had an upper arm Arteriovenous Fistula (AVF) and 24% patients had an upper arm Arteriovenous Graft (AVG). Mean access flow was 1210 (556) ml/min. 55% of patients had radial or ulnar arterial stenosis, 45% had brachial/axillary or subclavian artery stenosis. 45% patients had lesions in both radial and ulnar arteries, 88% of patients were successfully revascularized. 76% (18) of patients had improvement in symptoms within 48 h and 68% remained symptom free in 3 months. Mean DHIS stage was 3.1 before intervention and improved to 1.1 post intervention (p < 0.001). Patient satisfaction with their AV access improved from 34% to 72% (p < 0.01). Multiple regression analysis did not reveal statistically significant correlations between time on dialysis vintage and other chronic medical conditions on post procedure symptom improvement.

CONCLUSIONS: DHIS with occlusive arterial disease can be successfully revascularized to improve symptoms. Complete evaluation of the inflow arterial segment and optimal endovascular revascularization could decrease the need for access revision procedures or access abandonment.

PMID:38142277 | DOI:10.1177/11297298231214032

Eur J Clin Nutr. 2023 Dec 23. doi: 10.1038/s41430-023-01396-3. Online ahead of print.

ABSTRACT

Currently available anthropometric body composition prediction equations were often developed on small participant samples, included only several measured predictor variables, or were prepared using conventional statistical regression methods. Machine learning approaches are increasingly publicly available and have key advantages over statistical modeling methods when developing prediction algorithms on large datasets with multiple complex covariates. This study aimed to test the feasibility of predicting DXA-measured appendicular lean mass (ALM) with a neural network (NN) algorithm developed on a sample of 576 participants using 10 demographic (sex, age, 7 ethnic groupings) and 43 anthropometric dimensions generated with a 3D optical scanner. NN-predicted and measured ALM were highly correlated (n = 116; R², 0.95, p < 0.001, non-significant bias) with small mean, absolute, and root-mean square errors (X ± SD, -0.17 ± 1.64 kg and 1.28 ± 1.04 kg; 1.64). These observations demonstrate the application of NN body composition prediction algorithms to rapidly emerging large and complex digital anthropometric datasets. Clinical Trial Registration: NCT03637855, NCT05217524, NCT03771417, and NCT03706612.

PMID:38142263 | DOI:10.1038/s41430-023-01396-3

Ann Work Expo Health. 2023 Dec 23:wxad078. doi: 10.1093/annweh/wxad078. Online ahead of print.

ABSTRACT

OBJECTIVES: Agriculture entered the discussions about safety climates late, despite being one of the most hazardous industries. We recently developed a safety climate scale in Bordeaux vineyards, for which we provided good evidence of reliability and construct validity (Grimbuhler and Viel 2019). In this study, we aimed to establish the external validity of this safety climate scale with the help of an independent national sample of vineyard professionals.

POPULATION AND METHODS: We approached vineyard managers and operators during compulsory training and certification procedures for pesticide-related activities. Trainees giving informed consent for participation in the study were asked to complete a safety climate questionnaire at the start and end of a training session. In total, 406 vineyard managers or operators completed the questionnaire at the start of the study, 37 of whom declined to complete the questionnaire at the end of the training session, leaving 369 subjects available for pretraining/post-training comparisons. Statistical comparisons were based on t-tests and mixed models for repeated measures.

RESULTS: A mean safety climate score of 82.91 (SD: 9.06) was obtained in the initial survey in the Bordeaux region, whereas the safety climate score was estimated at 83.78 (SD 10.39) in this nationwide survey (P = 0.23). A significant increase was observed after the training course, for the safety climate score (7.5%, P < 10-15) and for each of its 7 dimensions (P < 10-4 or less), in both univariate and multivariate analyses. However, the magnitude of these increases varied with dimension, ranging from 2.4% for rules and best practices to 15.5% for communication and feedback.

CONCLUSIONS: External validity was demonstrated by transferability and sensitivity to intervention. This safety climate scale can now be considered to provide a good inference of the safety culture, with a meaning generalizable across vineyards.

PMID:38142237 | DOI:10.1093/annweh/wxad078

Arch Pediatr. 2023 Dec 22:S0929-693X(23)00212-9. doi: 10.1016/j.arcped.2023.10.005. Online ahead of print.

ABSTRACT

BACKGROUND: Persons with achondroplasia develop early obesity, which is a comorbidity associated with other complications. Currently, there are no validated specific predictive equations to estimate resting energy expenditure in achondroplasia.

METHODS: We analyzed the influence of body composition on this parameter and determined whether predictive models used for children with standard height are adjusted to achondroplasia. In this cross-sectional study, we measured anthropometric parameters in children with achondroplasia. Fat mass was obtained using the Slaughter skinfold-thickness equation and resting energy expenditure was determined with a Fitmate-Cosmed calorimeter and with predictive models validated for children with average height (Schofield, Institute of Medicine, and Tverskaya).

RESULTS: All of the equations yielded a lower mean value than resting energy expenditure with indirect calorimetry (1256±200 kcal/day [mean±SD]) but the closest was the Tverskaya equation (1017 ± 64 kcal/day), although the difference remained statistically significant. We conclude that weight and height have the greatest influence on resting energy expenditure.

CONCLUSION: We recommend studying the relationship between body composition and energy expenditure in achondroplasia in more depth. In the absence of valid predictive models suitable for clinical use to estimate body composition and resting energy expenditure in achondroplasia, it is recommended to use the gold standard methods by taking into account certain anthropometric parameters.

PMID:38142205 | DOI:10.1016/j.arcped.2023.10.005

HPB (Oxford). 2023 Dec 10:S1365-182X(23)02011-7. doi: 10.1016/j.hpb.2023.12.004. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate tolerability, pathologic response, and disease outcomes utilizing pre-operative stereotactic body radiation therapy (SBRT) followed by consolidation chemotherapy (CHT) prior to orthotopic liver transplant (OLT) in unresectable cholangiocarcinoma (CCA).

METHODS: This was a retrospective chart review of patients treated on OLT protocol at a single tertiary center from 2012 to 2019. Patients received pre-operative SBRT (40-50 Gy in 5 fractions) followed by CHT until progression or OLT. Progression-free survival (PFS) and overall survival (OS) were compared via log-rank test and Cox proportional hazards regression.

RESULTS: 26 patients (84.6% hilar, 15.4% intrahepatic) were identified for analysis. Eight patients (30.8%) patients developed acute toxicity after SBRT, mostly grade 1 nausea. Nine (34.6%) patients underwent OLT of which 4 (44.4%) achieved a pathologic complete response (pCR). Five (55.6%) OLT patients, including 2 pCR, developed recurrence at a median time of 49.9 weeks after OLT. 3-year OS for the OLT and dropout cohort was 75% and 9%, respectively (p < 0.0001). OS in hilar tumors only was statistically different for those that achieved a pCR (p = 0.014).

CONCLUSIONS: Pre-operative SBRT is a well-tolerated and effective radiation technique as part of OLT protocol for unresectable CCA and conferred in a pCR rate of 44% within our cohort.

PMID:38142182 | DOI:10.1016/j.hpb.2023.12.004

J Surg Educ. 2023 Dec 22:S1931-7204(23)00421-X. doi: 10.1016/j.jsurg.2023.11.013. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the effects of single accreditation and pass/fail licensing exams on osteopathic (DO) medical students applying for surgical residency.

DESIGN: Electronic surveys were distributed to 1509 program directors (PD) in 10 surgical specialties. PDs were separated into 2categories based on their program’s accreditation status prior to single accreditation: formerly accredited by the American Osteopathic Association (AOA) or not accredited by the AOA. Separate chi-squared and binomial tests were used to determine statistical differences between PDs in each category and within each surgical specialty.

SETTING: Voluntary, anonymous, electronic survey.

PARTICIPANTS: Three hundred survey responses were received (response rate 19.8%) and 234 responses were included in statistical analyses. Sixty-six responses were excluded because the survey was incomplete, the survey was not completed by a PD, or the PD indicated disqualification of DO applicants from matching at that program.

RESULTS: The majority of PDs in both categories recommend or require that DO students take both United States Medical Licensing Examination (USMLE) Step1 [Χ² (2, N = 234) = 8.939, p = 0.011] and USMLE Step 2 CK [Χ² (2, N = 234) = 4.161, p = 0.125] despite pass/fail outcomes only on Step 1 and Level 1. When deciding whom to interview, PDs in both categories highly ranked USMLE Step 2 CK scores and letters of recommendation (LOR). Formerly-AOA-accredited programs highly ranked COMLEX-USA Level 2 scores (p = < 0.001) and completion of an audition rotation (p = 0.001). Non-AOA-accredited programs highly ranked the Medical Student Performance Evaluation (MSPE) (p = < 0.001) and clerkship grades/evaluations (p = 0.001).

CONCLUSIONS: Significant differences exist in programs despite single accreditation. DO applicants should take both USMLE Step 1 and Step 2 CK to be considered competitive for any surgical specialty. Additionally, DO students should prioritize formerly-AOA-accredited programs for audition rotations.

PMID:38142150 | DOI:10.1016/j.jsurg.2023.11.013

J Mol Graph Model. 2023 Dec 12;127:108692. doi: 10.1016/j.jmgm.2023.108692. Online ahead of print.

ABSTRACT

The solvation of K⁺ cation plays an important role in various phenomena such as biological procedures, geological time, and archaeological properties. Monte Carlo (MC) simulation and DFT method are employed to study the structural and energetic characteristics of the K ⁺ Ar_n (n = 1-14) clusters. The potential model (PM) and the Basin-Hopping (BH) method are the foundation of the MC simulation. The pairwise PM (PW-PM) is improved by introducing the N-body interactions via the polarizable potential model (PPM). On the other side, the DFT functional M05-2X, combined with the 6-311++G(3d2f,2p) basis set, and the Grimme dispersion correction GD3 was used to deeply investigate the geometrical properties and the relative stability of the K ⁺ Ar_n clusters. Starting from n = 12, a structural transition from square antiprism (SA) to icosahedron (ICOS) form is detected. Additionally, the PPM allows us to examine the largest sizes (n = 15-54). Herein, the first ICOS layers are found for n = 12 and 54 cluster sizes, respectively. The binding energy and the second energy difference as a function of cluster size are used to evaluate the relative stability of K ⁺ Ar_n clusters. The obtained data are in concordance with the available results in the literature.

PMID:38141268 | DOI:10.1016/j.jmgm.2023.108692

J Burn Care Res. 2023 Dec 23:irad199. doi: 10.1093/jbcr/irad199. Online ahead of print.

ABSTRACT

Marjolin’s ulcer is described as malignant lesions developed in the injured skin, which can cause several kinds of malignancies. Our results showed that no HER2 but p53 was detected in Majorlin’s ulcer samples. Meanwhile, by statistical analysis we found that the positive rate of p53 in Majorlin’s ulcer samples was associated with the pathological type of ulcer canceration and degree of tumor differentiation. The positive expression rate of VEGF was 62.5% in poorly differentiated SCC, 39.4% in moderately differentiated SCC, and 66.7% in well-differentiated SCC, respectively. Furthermore, some cases of Majorlin’s ulcer with positive P53 were negative for VEGF, while some cases with positive VEGF were negative for P53. Image superposition showed that VEGF expression was absent or minimal in p53-positive cases. However, P53 was not expressed or rarely expressed in VEGF positive cases. Our results of this study will suggest that P53 can be used as the mark of Marjolin’s ulcer differentiation and there may be some interaction between P53 and VEGF in Marjolin’s ulcer. The regulation of microenvironment in the oncogenesis, progression and differentiation of Marjolin’s ulcer is complex and needs further study.

PMID:38141261 | DOI:10.1093/jbcr/irad199

J Breast Imaging. 2023 Nov 30;5(6):675-684. doi: 10.1093/jbi/wbad075.

ABSTRACT

OBJECTIVE: To evaluate the ability of a long-term technologist coaching program to sustain gains in mammography quality made by a previously implemented quality improvement (QI) initiative.

METHODS: Mammography quality metrics from July 2014 to June 2020 were reviewed. Numbers of screening mammograms performed/audited, monthly average mammogram overall quality pass rates, changes in facilities/staffing, and technical recall rates were evaluated. Performance metrics at baseline (July 2013), during the improvement (July 2014 to January 2015), postimprovement (February 2015 to August 2015), and sustained coaching periods (after initiation of the technologist coaching model, from September 2015 to June 2020) were compared.

RESULTS: During the postimprovement and sustained coaching periods, 93% (501/541) and 90% (8902/9929) of audited mammograms, respectively, met overall passing criteria, achieving or exceeding the QI goal of 90%, and results for both periods were significantly higher than that during the improvement period (74%, 1098/1489), at P < 0.0001 and P < 0.0001, respectively. The technical recall rates during the improvement and postimprovement periods were 2.6% (85/3321) and 1.7% (54/3236), respectively; the rate during the sustained coaching period was significantly lower than these, at 1.2% (489/40 440) (P < 0.0001 and P = 0.0232, respectively). Sustained quality passing rates and lower technical recall rates were observed despite statistically significantly increases in screening volumes.

CONCLUSION: A technologist coaching program resulted in sustained high mammographic quality for almost 5 years.

PMID:38141238 | DOI:10.1093/jbi/wbad075

J Breast Imaging. 2023 Nov 30;5(6):658-665. doi: 10.1093/jbi/wbad063.

ABSTRACT

OBJECTIVE: To assess the impact of informing women about the presence of breast arterial calcification (BAC) on mammography by determining whether those notified about the presence of BAC would seek cardiovascular evaluation.

METHODS: This IRB-approved prospective study included 494 patients who underwent screening mammography between June 8, 2021, and April 22, 2022. Mammograms were reviewed by a radiologist, and patients were notified via e-mail about the presence or absence of BAC. Patients with BAC were advised to discuss the results with their physicians and were surveyed 3 months later. Frequencies and proportions were calculated for study participation, presence of BAC, survey participation, health actions, and perceptions. Confidence intervals were calculated for proportions of health actions and perceptions.

RESULTS: Of 494 study participants, 68/494 (13.8%; 95% CI: 10.9%-17.1%) had BAC detected on mammography and 42/68 (61.8%; 95% CI: 61.1%-62.1%) with BAC completed the follow-up survey at 3 months. Of these 42 survey respondents, 24/42 (57.1%; 95% CI: 41.1%-72.3%) reported discussing results with their primary care physician (PCP) or a cardiologist. In addition, 34/42 (81.0%; 95% CI: 65.9%-91.4%) reported finding it helpful to receive information about BAC and 32/42 (76.2%; 95% CI: 60.6%-88.0%) believed all women should be informed about BAC after mammography.

CONCLUSION: After notification about the presence of BAC on screening mammography, the majority (57.1%) of survey respondents reported discussing the results with a PCP or cardiologist. These results suggest that providing mammography patients with information about BAC may promote preventive cardiovascular health.

PMID:38141233 | DOI:10.1093/jbi/wbad063