Category: Statistics

Intern Emerg Med. 2023 Dec 21. doi: 10.1007/s11739-023-03487-2. Online ahead of print.

ABSTRACT

Out-of-hospital cardiac arrest (OHCA) is a major public health concern with low survival rates. First responders (FRs) and public access defibrillation (PAD) programs can significantly improve survival, although barriers to response activation persist. The Emilia Romagna region in Italy has introduced a new system, the DAE RespondER App, to improve the efficiency of FR dispatch in response to OHCA. The study aimed to evaluate the association between different logistic factors, FRs’ perceptions, and their decision to accept or decline dispatch to an OHCA scene using the DAE RespondER App. A cross-sectional web survey was conducted, querying 14,518 registered FRs using the DAE RespondER app in Emilia Romagna. The survey explored logistic and cognitive-emotional perceptions towards barriers in responding to OHCAs. Statistical analysis was conducted, with responses adjusted using non-response weights. 4,644 responses were obtained (32.0% response rate). Among these, 1,824 (39.3%) had received at least one dispatch request in the past year. Multivariable logistic regression showed that being male, having previous experience with OHCA situations, and having an automated external defibrillator (AED) available at the moment of the call were associated with a higher probability of accepting the dispatch. Regarding FRs’ perceptions, logistic obstacles were associated with mission rejection, while higher scores in cognitive-emotional obstacles were associated with acceptance. The study suggests that both logistical and cognitive-emotional factors are associated with FRs’ decision to accept a dispatch. Addressing these barriers and further refining the DAE RespondER App can enhance the effectiveness of PAD programs, potentially improving survival rates for OHCA. The insights from this study can guide the development of interventions to improve FR participation and enhance overall OHCA response systems.

PMID:38123905 | DOI:10.1007/s11739-023-03487-2

Jpn J Radiol. 2023 Dec 21. doi: 10.1007/s11604-023-01519-7. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to assess whether short repetition time (TR) diffusion-weighted imaging (DWI) could improve diffusion contrast in patients with prostate cancer (PCa) compared with long TR (conventional) reference standard DWI.

MATERIALS AND METHODS: Our Institutional Review Board approved this retrospective study and waived the need for informed consent. Twenty-five patients with suspected PCa underwent multiparametric magnetic resonance imaging (mp-MRI) using a 3.0-T system. DWI was performed with TR of 1850 ms (short) and 6000 ms (long) with b-values of 0, 1000, and 2000s/mm². Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), visual score, apparent diffusion coefficient (ADC), and diagnostic performance were compared between short and long TR DWI for both b-values. The statistical tests included paired t-test for SNR and CNR; Wilcoxon signed-rank test for VA; Pearson’s correlation and Bland-Altman plot analysis for ADC; and McNemar test and receiver operating characteristic analysis and Delong test for diagnostic performance.

RESULTS: Regarding b1000, CNR and visual score were significantly higher in short TR compared with long TR (P = .003 and P = .002, respectively), without significant difference in SNR (P = .21). Considering b2000, there was no significant difference in visual score between short and long TR (P = .07). However, SNR and CNR in long TR were higher (P = .01 and P = .04, respectively). ADC showed significant correlations, without apparent bias for ADC between short and long TR for both b-values. For diagnostic performance of DWI between short and long TR for both b-values, one out of five readers noted a significant difference, with the short TR for both b-values demonstrating superior performance.

CONCLUSIONS: Our data showed that the short TR DWI₁₀₀₀ may provide better image quality than did the long TR DWI₁₀₀₀ and may improve visualization and diagnostic performance of PCa for readers.

PMID:38123889 | DOI:10.1007/s11604-023-01519-7

Otolaryngol Head Neck Surg. 2023 Dec 20. doi: 10.1002/ohn.625. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the association of postoperative naloxone with the development of new substance use disorder (SUD), overdose, and death within 6 months of otolaryngologic surgery.

STUDY DESIGN: Retrospective cohort database study on TriNetX.

METHODS: Adult patients who underwent tonsil surgery (noncancerous), thyroid/parathyroid, septorhinoplasty, otology/neurotology, sinus/anterior skull base, and head and neck cancer surgeries between January 2003 and April 2023. Patients were excluded if they had an instance of SUD or overdose recorded in their charts prior to surgery, or had undergone another surgery within that 6-month time frame. We hypothesized that patients prescribed naloxone postoperatively would have decreased odds for experiencing new SUD, overdose, and/or death within 6 months of surgery compared to patients who did not receive naloxone. P < .01 was considered statistically significant.

RESULTS: There were 2,305,655 patients in this study. The average age was 36.7 ± 19.5 years old, with 46% female patients. Before matching, cohorts showed equivocal odds for developing new SUD, increased odds for overdose, and mixed odds for dying. After matching for demographic variables and comorbidities such as other substance use, opioid use for other pathologies, and psychiatric conditions, these effects diminished (P > .01).

CONCLUSION: Our results suggest that postoperative naloxone may not significantly affect development of new SUD and incident overdose and death in certain otolaryngologic surgeries after controlling for prior SUD and psychiatric conditions. Clinicians should be aware of these comorbidities when considering their postoperative pain management protocol, which may or may not include naloxone.

PMID:38123881 | DOI:10.1002/ohn.625

Clin Oral Investig. 2023 Dec 20;28(1):4. doi: 10.1007/s00784-023-05388-2.

ABSTRACT

OBJECTIVES: Skeletal class II malocclusion is one of the most common malocclusions. Among the functional appliances for skeletal class II malocclusion, the Twin-Block appliance with a maxillary expander is effective in repositioning the mandible forward. In this study, we focused our efforts on investigating the effects of Twin-Block appliances with maxillary expanders on the upper airway in growing children with skeletal class II malocclusion by tracing and measuring lateral cephalograms after evaluating the consistency of three-dimensional CBCT data and two-dimensional lateral cephalogram data.

MATERIALS AND METHODS: A total of 102 patients ranging from 9 to 15 years old (11.37 ± 2.80, male/female ratio = 1:1) with skeletal class II malocclusion were selected to evaluate the consistency of CBCT data and lateral cephalogram data. The strongly and moderately correlated segments were then selected to study the effects of Twin-Block with a maxillary expander on the upper airway in 66 growing children with skeletal class II malocclusion (11.31 ± 1.23 years old, male/female ratio = 1:1) by lateral cephalograms.

RESULTS: The results showed a strong significant correlation in the nasopharynx (r = 0.708) and moderate significant correlations in the overall upper airway (r = 0.641), palatopharynx (r = 0.553), and glossopharynx (r = 0.575) but a weak correlation in the hypopharynx (r = 0.323). The corresponding determination coefficient (R²) was also determined by scatter plot analysis. Moreover, compared with the pretreatment data (T1), the total area of the upper airway and the areas of the nasopharynx, palatopharynx, and glossopharynx after functional treatment (T2) increased statistically and significantly.

CONCLUSIONS: Lateral cephalograms can reflect the volume of the nasopharynx and oropharynx in skeletal class II children to a certain extent, while Twin-Block appliances with maxillary expanders can widen the volume of the nasopharynx and oropharynx significantly.

CLINICAL RELEVANCE: The lateral cephalogram is reliable for analyzing the nasopharynx, palatopharynx, and glossopharynx in orthodontic clinical practice. Twin-Block appliances with maxillary expanders have a positive effect on skeletal class II patients with airway stenosis.

PMID:38123880 | DOI:10.1007/s00784-023-05388-2

Dermatol Ther (Heidelb). 2023 Dec 21. doi: 10.1007/s13555-023-01068-x. Online ahead of print.

ABSTRACT

INTRODUCTION: Patients with psoriasis report pruritus as their most bothersome symptom. Tapinarof cream 1% once daily demonstrated significant efficacy versus vehicle and was well tolerated in adults with mild to severe plaque psoriasis in two 12-week trials: PSOARING 1 (NCT03956355) and PSOARING 2 (NCT03983980). Here, we present patient-reported pruritus outcomes from these trials.

METHODS: Outcomes included a Peak Pruritus Numerical Rating Scale (PP-NRS) score of 0 or 1 (itch-free state); Dermatology Life Quality Index (DLQI) itch item scores; and Psoriasis Symptom Diary (PSD) itch item scores.

RESULTS: Analyses included 683 tapinarof- and 342 vehicle-treated patients. At baseline, mean pruritus scores were similar across trials with only 7-11% of patients reporting an itch-free state. At week 12, the proportion of tapinarof-treated patients achieving an itch-free state was 50% in both trials compared with 32% (P = 0.0007) and 27% (P < 0.0001) in the vehicle groups. Improvements were apparent at the earliest assessments with continued improvement over the course of the trials. There were rapid and statistically significant improvements in the proportion of patients with a ≥ 4-point improvement in PP-NRS for tapinarof-treated patients versus vehicle from week 2 with 68% vs 46% (P = 0.0004) and 60% vs 31% (P = 0.0001) at week 12 achieving a response in each trial. Significantly greater reductions in itch with tapinarof versus vehicle were also demonstrated at week 12 for DLQI itch item 1 (P = 0.0026 and P < 0.0001), PSD item 1 (both P < 0.0001), and PSD item 2 (both P < 0.0001).

CONCLUSION: Tapinarof was highly efficacious in reducing pruritus across multiple patient-reported outcome measures, with rapid, statistically significant, and clinically meaningful improvements. The high proportion of patients achieving the treatment target of an itch-free state at week 12 (50%) is a noteworthy clinical outcome for a non-steroidal topical cream in the treatment of mild to severe plaque psoriasis.

TRIAL REGISTRATION: Clinical trial registration information: NCT03956355, NCT03983980.

PMID:38123875 | DOI:10.1007/s13555-023-01068-x

Environ Monit Assess. 2023 Dec 20;196(1):69. doi: 10.1007/s10661-023-12214-5.

ABSTRACT

Technology-driven population expansion is closely linked to land use change. Unregulated mining, urbanization, industrialization, and forest clearing threaten land use and cover. This study used GIS and statistical methods to examine land use and cover changes in eastern India’s Asansol-Durgapur Development Authority (ADDA). The Kappa coefficient was used to validate each year’s LULC map accuracy. This region is changing rapidly due to industrial and urban development, which might cause environmental issues. Thus, this area is ideal for a scientific land-use change study. The central hypothesis of this study is that the LULC of an industrial area is spatially heterogeneous and that the number of hotspots is gradually increasing in response to the dynamicity of land use change over time and space. Three years (1992, 2007, and 2022) were used to determine the estimated transition rate. Hotspots of land use change were identified using autocorrelation statistics for LULC clustering using Moron’s I and Gi Z statistics. The proportion of land encompassed by natural vegetation experienced a decline from 12% in 1992 to 4% in 2022. Similarly, the extent of land occupied by agricultural activities decreased from 47 to 38% during the period spanning from 1992 to 2022. The industrial and coal mining sectors experienced a modest growth rate of 1% during the period spanning from 1992 to 2022. If the current rate of land use change persists, it will gradually and consistently alter the existing landscape. This study’s findings can potentially inform strategies to mitigate the adverse impacts of industrialization and urbanization on the region’s natural resources.

PMID:38123872 | DOI:10.1007/s10661-023-12214-5

Eur Radiol Exp. 2023 Dec 21;7(1):82. doi: 10.1186/s41747-023-00395-0.

ABSTRACT

BACKGROUND: Abdominal aortic endoleaks after endovascular aneurysm repair might be position-dependent, therefore undetectable using supine imaging. We aimed to determine the feasibility and benefit of using a low-field tiltable magnetic resonance imaging (MRI) scanner allowing to study patients who can be imaged in both supine and upright positions of endoleaks.

METHODS: Ten EVAR patients suspected of endoleak based on ultrasound examination were prospectively included. MRI in upright and supine positions was compared with routine supine computed tomography angiography (CTA). Analysis was performed through (1) subjective image quality assessment by three observers, (2) landmark registration between MRI and CTA scans, (3) Euclidean distances between renal and endograft landmarks, and (4) evaluation of endoleak detection on MRI by a consensus panel. Statistical analysis was performed by one-way repeated measures analysis of variance.

RESULTS: The image quality of upright/supine MRI was inferior compared to CTA. Median differences in both renal and endograft landmarks were approximately 6-7 mm between upright and supine MRI and 5-6 mm between supine MRI and CTA. In the proximal sealing zone of the endograft, no differences were found among all three scan types (p = 0.264). Endoleak detection showed agreement between MRI and CTA in 50% of the cases, with potential added value in only one patient.

CONCLUSIONS: The benefit of low-field upright MRI for endoleak detection was limited. While MRI assessment was non-inferior to standard CTA in detecting endoleaks in selected cases, improved hardware and sequences are needed to explore the potential of upright MRI in patients with endoleaks.

RELEVANCE STATEMENT: Upright low-field MRI has limited clinical value in detecting position-dependent endoleaks; improvements are required to fulfil its potential as a complementary modality in this clinical setting.

KEY POINTS: • Upright MRI shows potential for imaging endoleaks in aortic aneurysm patients in different positions. • The image quality of upright MRI is inferior to current techniques. • Upright MRI complements CTA, but lacks accurate deformation measurements for clinical use. • Advancements in hardware and imaging sequences are needed to fully utilise upright MRI capabilities.

PMID:38123829 | DOI:10.1186/s41747-023-00395-0

Eur Phys J E Soft Matter. 2023 Dec 20;46(12):131. doi: 10.1140/epje/s10189-023-00389-1.

ABSTRACT

Non-equilibrium fluctuations caused by the rearrangement of hemoglobin molecules into an aggregate state under shear stress have been investigated experimentally. The flow response under the shear stress (σ) corroborates the presence of contrasting aggregate and rejuvenation states governed by entropy production and consumption events. From the time-dependent shear rate fluctuation studies of aggregate states, the probability distribution function (PDF) of the rate of work done is observed to be spread from negative to positive values with a net positive mean. The PDFs follow the steady-state fluctuation theorem, even at a smaller timescale than that desired by the theorem. The behavior of the effective temperature (T_eff) that emerges from a non-equilibrium fluctuation and interconnects with the structural restrictions of the aggregate state of our driven system is observed to be within the boundary of the thermodynamic uncertainty. The increase in T_eff with the applied σ illustrates a phenomenal nonlinear power flux-dependent aggregating behavior in a classic bio-molecular-driven system.

PMID:38123828 | DOI:10.1140/epje/s10189-023-00389-1

J Hazard Mater. 2023 Dec 11;465:133108. doi: 10.1016/j.jhazmat.2023.133108. Online ahead of print.

ABSTRACT

Due to the intervention of human activities, the background values of riverbed sediment exhibit spatiotemporal variability, which can affect the accuracy of risk assessment results. Using risk assessment that do not rely on background values is an executable alternative to avoid such problems. In this study, a relative pollution level assessment (RPLA) method which was based on the statistical results of relevant literatures was proposed. This method includes a four-step data processing procedure to extract the evaluation indexes of relative pollution degree of pollutants in environment and a series of relative pollution status assessment methods to evaluate the overall relative pollution level and regional difference of world-wide rivers. To demonstrate how to use RPLA method, 310 relevant literatures covering world-wide rivers were selected. And the ambient background value (x̅), the world-wide threshold values (WWTV) and the relative pollution grades (LEVEL I ∼ IV) of 9 target metals (Cr, Ni, Cu, Zn, As, Cd, Pb, Sb and Tl) in riverbed surface sediments of world-wide rivers were extracted and used for evaluation. Moreover, the stability and applicability of RPLA method were evaluated. Results show that the evaluation results of RPLA method are robust and comparable with traditional evaluation method.

PMID:38118195 | DOI:10.1016/j.jhazmat.2023.133108

Glob Public Health. 2024 Jan;19(1):2291703. doi: 10.1080/17441692.2023.2291703. Epub 2023 Dec 20.

ABSTRACT

One in five child deaths under age 5 are a result of severe wasting. Malnutrition at early ages is linked to lifelong consequences, such as reduced cognitive skills, reduced earnings in adulthood and chronic health conditions. Countries worldwide have committed to addressing child undernutrition, and ending hunger is foundational to the Millennium Development Goals. In this paper, we study the intergenerational effect of providing free tuition in secondary school on future children’s nutrition. We combined a novel longitudinal dataset that captures educational policies for 40 African countries from 1990 to 2019 with the Demographic and Health Survey (DHS). We identified three countries that introduced free secondary education several years after implementing free primary education. Exploiting this variation in timing we estimate the additional impact of providing free secondary education over free primary education. Using a difference-in-difference approach, we find that introducing free secondary education significantly reduced wasting. Cohorts exposed to free secondary had an 18% relative decrease in wasting. The impact on cohorts exposed only to free primary was smaller and not statistically significant. Expanding free secondary education has long-term, intergenerational benefits and is an effective path to reducing malnutrition. Results are robust to different specifications.

PMID:38118117 | DOI:10.1080/17441692.2023.2291703