Category: Statistics

JAMA Health Forum. 2023 Aug 4;4(8):e232320. doi: 10.1001/jamahealthforum.2023.2320.

ABSTRACT

IMPORTANCE: Down syndrome is the leading genetic cause of intellectual disability and automatically qualifies individuals for Social Security Insurance. Therefore, Medicaid is the major health insurance provider for a population at high risk for dementia, obesity, and premature mortality. Despite the importance of Medicaid for adults with Down syndrome, little is known about how this population uses Medicaid.

OBJECTIVE: To describe enrollment in, health care use in, and cost to Medicaid for adults with Down syndrome compared with adults with intellectual disability and a random sample of adults enrolled in Medicaid.

DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, the data are from a claims cohort of adults aged 18 years or older enrolled in Medicaid at any point between January 1, 2011, and December 31, 2019. Participants were enrollees with 1 or more inpatient claim or 2 or more other claims with an International Classification of Diseases, Ninth Revision code or an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code for Down syndrome or intellectual disability as well as a random sample of those without developmental disability. Analyses were conducted from June 2022 to February 2023.

MAIN OUTCOMES AND MEASURES: Data were linked across 2 data reporting systems. Main outcomes were enrollee demographic characteristics, enrollment characteristics, cost, and service use.

RESULTS: This cohort study included 123 024 individuals with Down syndrome (820 273 person-years of coverage; mean [SD] age, 35 [14.7] years; median age, 33 years [IQR, 21-48 years]; 51.6% men; 14.1% Black individuals; 16.7% Hispanic individuals; and 74.6% White individuals), 1 182 246 individuals with intellectual disability (mean [SD] age, 37.1 [16.8] years; median age, 33 years [IQR, 22-50 years]; 56.5% men; 22.0% Black individuals; 11.7% Hispanic individuals; and 69.5% White individuals), and 3 176 371 individuals with no developmental disabilities (mean [SD] age, 38 [18.6] years; median age, 33 years [IQR, 21-52 years]; 43.8% men; 23.7% Black individuals; 20.7% Hispanic individuals; and 61.3% White individuals). Median enrollment in Medicaid for a person with Down syndrome was 8.0 years (IQR, 5.0-9.0 years; mean [SD], 6.6 [2.6] years). Costs were higher for the Down syndrome group (median, $26 278 per person-year [IQR, $11 145-$55 928 per person-year]) relative to the group with no developmental disabilities (median, $6173 per person-year [IQR, $868-$58 390 per person-year]). Asian, Black, Hispanic, Native American, and Pacific Islander adults with Down syndrome had fewer costs and claims per person-year compared with White adults with Down syndrome.

CONCLUSION AND RELEVANCE: This cohort study of individuals with Down syndrome enrolled in Medicaid found consistent enrollment and high use of health care in a population with high health care needs. Results were similar comparing individuals with Down syndrome and those with intellectual disability, with both groups differing from a sample of Medicaid enrollees with no developmental disabilities. Medicaid data are a useful tool for understanding the health and well-being of individuals with Down syndrome.

PMID:37566429 | DOI:10.1001/jamahealthforum.2023.2320

JAMA Netw Open. 2023 Aug 1;6(8):e2328335. doi: 10.1001/jamanetworkopen.2023.28335.

ABSTRACT

IMPORTANCE: Despite the increased perinatal risks associated with pregnancies conceived with infertility treatment, there are no recommendations for timing of delivery among this at-risk population.

OBJECTIVE: To identify the gestational age at which the ongoing risks of stillbirth are optimally balanced with the risks of neonatal comorbidities and infant deaths in term singleton pregnancies conceived with infertility treatment.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used birth and death data from January 1, 2014, to December 31, 2018, in the US obtained from the National Center for Health Statistics. Singleton pregnancies conceived with infertility treatment delivered at term (37-42 weeks’ gestation) were eligible for inclusion. The exclusion criteria were deliveries at less than 37 weeks’ or at least 43 weeks’ gestation and pregnancies with unknown history of infertility treatment, congenital anomalies, pregestational diabetes, pregestational hypertension, gestational hypertension, and preeclampsia. Data were analyzed from July 22, 2022, to June 24, 2023.

EXPOSURE: Gestational age at delivery between 37 and 42 weeks.

MAIN OUTCOMES AND MEASURES: The primary outcome was optimal timing of delivery. To ascertain this timing, the risk of delivery (rate of neonatal morbidity and infant death) at a given gestational week was compared with the risk of delivery in the subsequent week of gestation for an additional week (rate of stillbirth during the given week per 10 000 ongoing pregnancies plus rate of neonatal morbidity and infant death in the subsequent week of gestation per 10 000 deliveries). The rates of stillbirth, neonatal morbidity, and infant death (within 1 year of life) were compared at each week. Neonatal morbidity included an Apgar score of 3 or lower at 5 minutes, requirement of ventilation for 6 hours or more, neonatal intensive care unit admission, and seizures.

RESULTS: Of the 178 448 singleton term pregnancies conceived with infertility treatment (maternal mean [SD] age, 34.2 [5.2] years; mean [SD] gestational age, 39.2 [1.2] weeks; 130 786 [73.5%] were non-Hispanic White patients). The risk of delivery in the subsequent week of gestation was lower than the risk of delivery at both 37 weeks (628 [95% CI, 601-656] vs 1005 [95% CI, 961-1050] per 10 000 live births) and 38 weeks (483 [95% CI, 467-500 vs 625 [95% CI, 598-652] per 10 000 live births). The risks of delivery in subsequent week of gestation significantly exceeded the risk of delivery at 39 weeks (599 [95% CI, 576-622] vs 479 [95% CI, 463-495] per 10 000 live births) and were not significant at 40 weeks (639 [95% CI, 605-675] vs 594 [95% CI, 572-617] per 10 000 live births) and 41 weeks (701 [95% CI, 628-781] vs 633 [95% CI, 599-669] per 10 000 live births).

CONCLUSIONS AND RELEVANCE: Results of this study suggest that, in pregnancies conceived with infertility treatment, delivery at 39 weeks provided the lowest perinatal risk when comparing risk of delivery at this week of gestation vs the subsequent week of gestation.

PMID:37566418 | DOI:10.1001/jamanetworkopen.2023.28335

Clin Chem. 2023 Aug 11:hvad104. doi: 10.1093/clinchem/hvad104. Online ahead of print.

ABSTRACT

A secondary higher-order calibrator is required to be commutable with clinical samples to be suitable for use in the calibration hierarchy of an end-user clinical laboratory in vitro diagnostic medical device (IVD-MD). Commutability is a property of a reference material that means results for a reference material and for clinical samples have the same numeric relationship, within specified limits, across the measurement procedures for which the reference material is intended to be used. Procedures for assessing commutability have been described in the literature. This report provides recommendations for establishing a quantitative criterion to assess the commutability of a certified reference material (CRM). The criterion is the maximum allowable noncommutability bias (MANCB) that allows a CRM to be used as a calibrator in a calibration hierarchy for an IVD-MD without exceeding the maximum allowable combined standard uncertainty for a clinical sample result (umaxCS). Consequently, the MANCB is derived as a fraction of the umaxCS for the measurand. The suitability of an MANCB for practical use in a commutability assessment is determined by estimating the number of measurements of clinical samples and CRMs required based on the precision performance and nonselectivity for the measurand of the measurement procedures in the assessment. Guidance is also provided for evaluating indeterminate commutability conclusions and how to report results of a commutability assessment.

PMID:37566391 | DOI:10.1093/clinchem/hvad104

Environ Sci Technol Lett. 2020 Nov 11;8(1):46-52. doi: 10.1021/acs.estlett.0c00764. eCollection 2021 Jan 12.

ABSTRACT

The COVID-19 pandemic is the single largest event in contemporary history in terms of the global restriction of mobility, with the majority of the world population experiencing various forms of “lockdown”. This phenomenon incurred increased amounts of teleworking and time spent at home, fewer trips to shops, closure of retail outlets selling non-essential goods, and the near disappearance of leisure and recreational activities. This paper presents a novel method for an economy-wide estimate of the emissions reductions caused by the restriction of movement. Using a global multiregional macro-economic model complemented by Google Community Mobility Reports (CMRs) and national transport data, we cover 129 individual countries and quantify direct and indirect global emissions reductions of greenhouse gases (GHG; 1173 Mt), PM_2.5 (0.23 Mt), SO₂ (1.57 Mt), and NO_x (3.69 Mt). A statistically significant correlation is observed between cross-country emission reductions and the stringency of mobility restriction policies. Due to the aggregated nature of the CMRs, we develop different scenarios linked to consumption, work, and lifestyle aspects. Global reductions are on the order of 1-3% (GHG), 1-2% (PM_2.5), 0.5-2.8% (SO₂), and 3-4% (NO_x). Our results can help support crucial decision making in the post-COVID world, with quantified information about how direct and indirect consequences of mobility changes benefit the environment.

PMID:37566352 | PMC:PMC7671098 | DOI:10.1021/acs.estlett.0c00764

ACS ES T Water. 2021 Sep 12;1(10):2174-2185. doi: 10.1021/acsestwater.1c00146. eCollection 2021 Oct 8.

ABSTRACT

A novel coronavirus (SARS-CoV-2) causing corona virus disease 2019 (COVID-19) has attracted global attention due to its highly infectious and pathogenic properties. Most of current studies focus on aerosols released from infected individuals, but the presence of SARS-CoV-2 in wastewater also should be examined. In this review, we used bibliometrics to statistically evaluate the importance of water-related issues in the context of COVID-19. The results show that the levels and transmission possibilities of SARS-CoV-2 in wastewater are the main concerns, followed by potential secondary pollution by the intensive use of disinfectants, sludge disposal, and the personal safety of workers. The presence of SARS-CoV-2 in wastewater requires more attention during the COVID-19 pandemic. Thus, the most effective techniques, i.e., wastewater-based epidemiology and quantitative microbial risk assessment, for virus surveillance in wastewater are systematically analyzed. We further explicitly review and analyze the successful operation of a sewage treatment plant in Huoshenshan Hospital in China as an example and reference for other sewage treatment systems to properly ensure discharge safety and tackle the COVID-19 pandemic. This review offers deeper insight into the prevention and control of SARS-CoV-2 and similar viruses in the post-COVID-19 era from a wastewater perspective.

PMID:37566346 | PMC:PMC8457323 | DOI:10.1021/acsestwater.1c00146

Clin Transl Oncol. 2023 Aug 11. doi: 10.1007/s12094-023-03300-8. Online ahead of print.

ABSTRACT

BACKGROUND: This review was implemented to examine the impact of bone metastasis on the prognosis of non-small cell lung cancer patients (NSCLC) treated with immune checkpoint inhibitors (ICIs).

METHODS: A literature search was conducted in the PubMed, CENTRAL, Web of Science, and Embase databases up to 4th September 2022. Multivariable adjusted data were pooled in a random-effects model.

RESULTS: 13 studies were included. On a combined analysis of 10 studies, it was noted that bony metastasis was associated with poor overall survival (OS) in NSCLC patients treated with ICIs (HR: 1.55 95% CI 1.24, 1.94 I² = 69% p = 0.001). Meta-analysis of seven studies showed that bony metastasis was not associated with poor progression-free survival (PFS) in NSCLC patients treated with ICIs (HR: 1.31 95% CI 0.85, 2.01 I² = 85% p = 0.22). Meta-regression analysis using the moderator’s age, male gender, smoking history, squamous histology, and ICI as 1st line therapy for the outcome OS was not statistically significant.

CONCLUSION: The presence of bone metastasis is a predictor of poor OS in NSCLC treated with ICIs. However, PFS does not seem to be influenced by the presence of bone metastasis. Clinicians should prioritize the management of NSCLC patients with bone metastasis and explore the use of combination therapies to achieve optimal results. Further studies taking into account different combination therapies for such patients would strengthen the evidence.

PMID:37566344 | DOI:10.1007/s12094-023-03300-8

Obes Surg. 2023 Aug 11. doi: 10.1007/s11695-023-06750-9. Online ahead of print.

ABSTRACT

INTRODUCTION: With the increase in life expectancy and a growing number of people suffering from obesity, bariatric and metabolic surgery is becoming a major concern in the elderly population. The study aimed to collect, systematize and present the available data on the surgical treatment of obesity among Polish patients over 65 years of age.

MATERIAL AND METHODS: A retrospective study analysed patients over 65 years who underwent laparoscopic bariatric procedures in Poland from 2008 to 2022. The efficacy endpoints were percentage of excess weight loss (EWL%), percentage of total weight loss (%TWL), improvement in obesity-related diseases.

RESULTS: The group consisted of 284 patients (173 women, 60.9%). The mean follow-up was 47.5 months. The mean BMI before surgery was 43.1 kg/m2. 146 (51.4%) patients had T2D, and 244 (85.9%) had HT. The most common procedure was sleeve gastrectomy (82.0%). The mean EWL% after surgery was 50.9%, and the mean TWL% after surgery was 20.6%. There was the statistically significant difference between AGB vs OAGB, SG vs OAGB in %EWL (p = 0.0116, p = 0.009, respectively) and RYGB vs OAGB in %TWL (p = 0.0291). After surgery, 93 patients (63.7%) had complete or partial remission of T2D, and 112 patients (45.9%) had complete or partial remission of HT.

CONCLUSION: Bariatric surgery appears to be a safe and effective method of treatment of obesity in patients over 65 years of age. OAGB seems to have better results in weight loss than SG, RYGB, and AGB in older patients.

PMID:37566339 | DOI:10.1007/s11695-023-06750-9

Behav Res Methods. 2023 Aug 11. doi: 10.3758/s13428-023-02198-y. Online ahead of print.

ABSTRACT

This article presents CPB-LEX, a large-scale database of lexical statistics derived from children’s picture books (age range 0-8 years). Such a database is essential for research in psychology, education and computational modelling, where rich details on the vocabulary of early print exposure are required. CPB-LEX was built through an innovative method of computationally extracting lexical information from automatic speech-to-text captions and subtitle tracks generated from social media channels dedicated to reading picture books aloud. It consists of approximately 25,585 types (wordforms) and their frequency norms (raw and Zipf-transformed), a lexicon of bigrams (two-word sequences and their transitional probabilities) and a document-term matrix (which shows the importance of each word in the corpus in each book). Several immediate contributions of CPB-LEX to behavioural science research are reported, including that the new CPB-LEX frequency norms strongly predict age of acquisition and outperform comparable child-input lexical databases. The database allows researchers and practitioners to extract lexical statistics for high-frequency words which can be used to develop word lists. The paper concludes with an investigation of how CPB-LEX can be used to extend recent modelling research on the lexical diversity children receive from picture books in addition to child-directed speech. Our model shows that the vocabulary input from a relatively small number of picture books can dramatically enrich vocabulary exposure from child-directed speech and potentially assist children with vocabulary input deficits. The database is freely available from the Open Science Framework repository: https://tinyurl.com/4este73c .

PMID:37566336 | DOI:10.3758/s13428-023-02198-y

Environ Sci Pollut Res Int. 2023 Aug 11. doi: 10.1007/s11356-023-28576-9. Online ahead of print.

ABSTRACT

Cancer disease is one of the main causes of death in the world, with million annual cases in the last decades. The need to find a cure has stimulated the search for efficient treatments and diagnostic procedures. One of the most promising tools that has emerged against cancer in recent years is machine learning (ML), which has raised a huge number of scientific papers published in a relatively short period of time. The present study analyzes global scientific production on ML applied to the most relevant cancer types through various bibliometric indicators. We find that over 30,000 studies have been published so far and observe that cancers with the highest number of published studies using ML (breast, lung, and colon cancer) are those with the highest incidence, being the USA and China the main scientific producers on the subject. Interestingly, the role of China and Japan in stomach cancer is correlated with the number of cases of this cancer type in Asia (78% of the worldwide cases). Knowing the countries and institutions that most study each area can be of great help for improving international collaborations between research groups and countries. Our analysis shows that medical and computer science journals lead the number of publications on the subject and could be useful for researchers in the field. Finally, keyword co-occurrence analysis suggests that ML-cancer research trends are focused not only on the use of ML as an effective diagnostic method, but also for the improvement of radiotherapy- and chemotherapy-based treatments.

PMID:37566331 | DOI:10.1007/s11356-023-28576-9

Environ Sci Pollut Res Int. 2023 Aug 11. doi: 10.1007/s11356-023-28988-7. Online ahead of print.

ABSTRACT

The increasing occurrence of micropollutants in natural water bodies has medium to long-term effects on both aquatic life and human health. The aim of this study is to optimize the degradation of two pharmaceutical pollutants of emerging concern: amoxicillin and acetaminophen in aqueous solution at laboratory and pilot scale, by solar photo-Fenton process carried out at neutral pH using ethylenediamine-N,N’-disuccinic acid (EDDS) as a complexing agent to maintain iron in solution. The initial concentration of each compound was set at 1 mg/L dissolved in a simulated effluent from a municipal wastewater treatment plant (MWTP). A factorial experimental design and its surface response analysis were used to optimize the operating parameters to achieve the highest initial degradation rate of each target. The evolution of the degradation process was measured by ultra-performance liquid chromatography (UPLC/UV), obtaining elimination rates above 90% for both contaminants. Statistical study showed the optimum concentrations of Fe(III) at 3 mg/L at an Fe-EDDS ratio of 1:2 and 2.75 mg/L H₂O₂ for the almost complete removal of the target compounds by solar photo-Fenton process. Validation of the experimental design was successfully carried out with actual MWTP effluent spiked with 100 μg/L of amoxicillin and acetaminophen, each at pilot plant scale.

PMID:37566324 | DOI:10.1007/s11356-023-28988-7