Category: Statistics

Otolaryngol Head Neck Surg. 2023 Jul 31. doi: 10.1002/ohn.419. Online ahead of print.

ABSTRACT

OBJECTIVE: Determine the ideal head position to optimize visualization of the subglottis using flexible laryngoscopy.

STUDY DESIGN: Prospective cohort study.

SETTING: Outpatient multidisciplinary airway clinic at a tertiary care center.

METHODS: Patients presenting to a multidisciplinary airway clinic undergoing nasoendoscopic airway examination were enrolled. Three head positions were utilized to examine the subglottis during laryngoscopy: “sniffing,” chin tuck, and stooping positions. In-office reviewers and blinded clinician participants evaluated views of the airway based on Cormack-Lehane (CL) scale, airway grade (AG), and visual analog scale (VAS). Demographic data were obtained. Statistical analysis compared head positions and demographic data using Student’s t test, analysis of variance, and Tukey’s post hoc analysis.

RESULTS: One hundred patients participated. No statistical differences existed among in-clinic or blinded reviewers for the CL score in any head position (p = .35, .5, respectively). For both AG and VAS, flexed and stooping positions were rated higher than the sniffing positions by both in-clinic and blinded reviewers (p < .01 for all analyses), but there was no statistical difference between these two positions (p = .28, .18, respectively). There was an inverse correlation between age and scores for AG and VAS in the flexed position for both sets of reviewers (p = .02, <.01 respectively), and a higher body mass index was significantly associated with the need to perform tracheoscopy for full airway evaluation (p < .01).

CONCLUSION: Both flexion and stoop postures can be implemented by an experienced endoscopist in awake, transnasal flexible laryngoscopy to enhance visualization of the subglottic airway.

PMID:37522249 | DOI:10.1002/ohn.419

BJOG. 2023 Jul 31. doi: 10.1111/1471-0528.17620. Online ahead of print.

ABSTRACT

OBJECTIVE: To identify vaginal morphology and position factors associated with prolapse recurrence following vaginal surgery.

DESIGN: Secondary analysis of magnetic resonance images (MRI) of the Defining Mechanisms of Anterior Vaginal Wall Descent cross-sectional study.

SETTING: Eight clinical sites in the US Pelvic Floor Disorders Network.

POPULATION OR SAMPLE: Women who underwent vaginal mesh hysteropexy (hysteropexy) with sacrospinous fixation or vaginal hysterectomy with uterosacral ligament suspension (hysterectomy) for uterovaginal prolapse between April 2013 and February 2015.

METHODS: The MRI (rest, strain) obtained 30-42 months after surgery, or earlier for participants with recurrence who desired reoperation before 30 months, were analysed. MRI-based prolapse recurrence was defined as prolapse beyond the hymen at strain on MRI. Vaginal segmentations (at rest) were used to create three-dimensional models placed in a morphometry algorithm to quantify and compare vaginal morphology (angulation, dimensions) and position.

MAIN OUTCOME MEASURES: Vaginal angulation (upper, lower and upper-lower vaginal angles in the sagittal and coronal plane), dimensions (length, maximum transverse width, surface area, volume) and position (apex, mid-vagina) at rest.

RESULTS: Of the 82 women analysed, 12/41 (29%) in the hysteropexy group and 22/41 (54%) in the hysterectomy group had prolapse recurrence. After hysteropexy, women with recurrence had a more laterally deviated upper vagina (p = 0.02) at rest than women with successful surgery. After hysterectomy, women with recurrence had a more inferiorly (lower) positioned vaginal apex (p = 0.01) and mid-vagina (p = 0.01) at rest than women with successful surgery.

CONCLUSIONS: Vaginal angulation and position were associated with prolapse recurrence and suggestive of vaginal support mechanisms related to surgical technique and potential unaddressed anatomical defects. Future prospective studies in women before and after prolapse surgery may distinguish these two factors.

PMID:37522240 | DOI:10.1111/1471-0528.17620

Technol Health Care. 2023 Jul 20. doi: 10.3233/THC-220732. Online ahead of print.

ABSTRACT

BACKGROUND: Recurrent acute pancreatitis is a common acute abdominal disease in surgery.

OBJECTIVE: To evaluate the radiographic features of pancreatic computed tomography (CT) imaging in the diagnosis of acute and chronic pancreatitis.

METHODS: 48 pancreatitis patients who met the criteria were selected in this retrospective study from 2010 to 2019. Each diagnosis was evaluated as functional abdominal pain, recurrent acute pancreatitis, or chronic pancreatitis. All clinical data were collected from the patient’s medical records. 54 radiological features were extracted from each region of interest in outline the pancreas and divided into five categories: first order statistics, the gray level co-occurrence matrix (GLCM), the gray level run-length matrix (GLRLM), the neighborhood gray level difference matrix (NGTDM), and morphological features by the MATLAB program.

RESULTS: Of the 48 patients, 16 had functional abdominal pain (33.3%), 18 had recurrent acute pancreatitis (37.5%), and 14 had chronic pancreatitis (29.2%). In the univariate analysis, nine radiological features, eight GLCM features and one NGTDM feature were significantly different between groups. Nine radiological characteristics had important reference values with AUC values ranging from 0.73-0.91.

CONCLUSION: Nine radiographic features of CT imaging demonstrate good evaluation efficiency in the diagnosis of pancreatitis and can distinguish patients with functional abdominal pain, recurrent acute pancreatitis, and chronic pancreatitis.

PMID:37522229 | DOI:10.3233/THC-220732

J Alzheimers Dis. 2023 Jul 26. doi: 10.3233/JAD-230159. Online ahead of print.

ABSTRACT

BACKGROUND: A connection between plasma levels of haptoglobin (Hp) and Alzheimer’s disease (AD) has been shown in several observational studies. It is debatable, nonetheless, how the two are related causally.

OBJECTIVE: To establish the causal relationship between Hp and AD using a two-sample Mendelian randomization (MR) study.

METHODS: From the extensive genome-wide association studies and FinnGen dataset, summaries and statistics pertaining to AD were gathered. We investigated the possibility of a causal link between Hp and AD using a two-sample MR study. Inverse variance weighting was used as the primary analytical technique, and it was supported by the joint application of complementary analyses and fixed effects meta-analysis to combine results from various sources.

RESULTS: Genetically determined Hp was causally associated with AD [odds ratio (OR), 1.05; 95% confidence interval (CI), 1.02 to 1.09; p = 8.96×10-4]; Inverse variance-weighted estimates coming from different data sources were combined in a meta-analysis with consistent findings (OR, 1.03; 95% CI, 1.01 to 1.05; p = 2.00×10-3). The outcomes of the inverse MR analysis showed that AD had no appreciable causal impact on Hp.

CONCLUSION: The present MR analysis shows that higher plasma Hp leads to an increased risk of AD. Strategies for plasma Hp testing may open up new doors for the early diagnosis and prevention of AD.

PMID:37522206 | DOI:10.3233/JAD-230159

Ir J Psychol Med. 2023 Jul 31:1-13. doi: 10.1017/ipm.2023.35. Online ahead of print.

ABSTRACT

OBJECTIVES: Despite a substantial epidemiological literature on the incidence of psychotic disorders in Ireland, no systematic review has previously been undertaken. Such evidence can help inform understanding of need for psychosis care.

METHODS: We conducted a prospectively registered systematic review (PROSPERO: CRD42021245891) following PRISMA guidelines. We searched four databases (Medline, PsycInfo, Web of Science, Embase) for papers containing incidence data on non-organic psychotic disorders, in people 16-64 years, published between 1950 and 2021 in the general adult population. We conducted duplicate screening, risk of bias assessments, and extracted data to a standardised template. We undertook a narrative synthesis for each major diagnostic outcome. Random effects meta-analyses were conducted for comparisons with ≥5 incidence rates.

RESULTS: Our search yielded 1975 non-duplicate citations, of which 23 met inclusion criteria, containing incidence data ascertained between 1974 and 2016 (median study quality: 5/8; interquartile range: 4-6). Incidence of all psychotic disorders (N = 4 studies) varied from 22.0 (95%CI: 17.3-28.0) in Dublin to 34.1 per 100,000 person-years (95%CI: 31.0-37.5) in Cavan and Monaghan. The pooled incidence of schizophrenia (N = 6 studies, N = 8 settings) was 20.0 per 100,000 person-years, though with imprecision around this estimate (95%CI: 10.6-37.5; I²: 97.6%). Higher rates of most outcomes were observed in men. There was consistent evidence of raised rates in more deprived and fragmented social environments, but no clear pattern by rural-urban status.

CONCLUSIONS: Patterns of incidence of psychotic disorders in Ireland are broadly consistent with the wider literature from the Global North. Findings could help identify populations at higher risk of psychosis in Ireland.

PMID:37522189 | DOI:10.1017/ipm.2023.35

J Am Heart Assoc. 2023 Jul 31:e029190. doi: 10.1161/JAHA.122.029190. Online ahead of print.

ABSTRACT

Background Epidemiologic studies have identified risk factors associated with pulmonary hypertension and right heart failure, but causative drivers of pulmonary hypertension and right heart adaptation are not well known. We sought to leverage unbiased genetic approaches to determine clinical conditions that share genetic architecture with pulmonary pressure and right ventricular dysfunction. Methods and Results We leveraged Vanderbilt University’s deidentified electronic health records and DNA biobank to identify 14 861 subjects of European ancestry who underwent at least 1 echocardiogram with available estimates of pulmonary pressure and right ventricular function. Analyses of the study were performed between 2020 and 2022. The final analytical sample included 14 861 participants (mean [SD] age, 63 [15] years and mean [SD] body mass index, 29 [7] kg/m²). An unbiased phenome-wide association study identified diabetes as the most statistically significant clinical International Classifications of Diseases, Ninth Revision (ICD-9) code associated with polygenic risk for increased pulmonary pressure. We validated this finding further by finding significant associations between genetic risk for diabetes and a related condition, obesity, with pulmonary pressure estimate. We then used 2-sample univariable Mendelian randomization and multivariable Mendelian randomization to show that diabetes, but not obesity, was independently associated with genetic risk for increased pulmonary pressure and decreased right ventricle load stress. Conclusions Our findings show that genetic risk for diabetes is the only significant independent causative driver of genetic risk for increased pulmonary pressure and decreased right ventricle load stress. These findings suggest that therapies targeting genetic risk for diabetes may also potentially be beneficial in treating pulmonary hypertension and right heart dysfunction.

PMID:37522172 | DOI:10.1161/JAHA.122.029190

Disabil Rehabil Assist Technol. 2023 Jul 31:1-16. doi: 10.1080/17483107.2023.2239293. Online ahead of print.

ABSTRACT

PURPOSE: College students with concussion experience academic, cognitive and psychosocial challenges, yet frequently lack supports necessary for successful reintegration into school. Success in College after Concussion with Effective Student Supports (SUCCESS) is a virtual peer mentoring program designed to provide education, support and connection through a mobile application. The purpose of this study was to describe use of personas as components of mobile app development and conduct preliminary testing of SUCCESS using personas.

METHODS: Personas were developed from case studies and portrayed by college students trained as fictitious mentees. Mentors were blinded to use of personas. Eleven mentors completed measures pre and post a 4-week mentoring cycle. Mentors and personas interacted in the app via chat, video calls and sharing of educational materials. Measures included the Post-Concussion Symptom Scale (PCSS); PROMIS Self-Efficacy; Depression, Anxiety and Stress Scale (DASS); and a series of focus groups.

RESULTS: Mentors suggested improvements to resolve instability of video calls, expand educational materials to address psychosocial functioning, and add structure to the mentoring relationship. Some preferences around communication, like groups chats and emoji keyboards, were not able to be addressed. As expected, PCSS scores were stable. DASS score (p = .04), especially depression (p = .03), decreased. PROMIS scores showed a trend towards growth (p = .057), although were not statistically significant.

CONCLUSIONS: Use of personas allowed technical challenges and program refinements to be addressed before including students with subacute concussion in testing. Although continued development will address enhancement of communication modalities preferred by students, future efficacy testing of SUCCESS is warranted.

PMID:37522162 | DOI:10.1080/17483107.2023.2239293

J Neurochem. 2023 Jul 31. doi: 10.1111/jnc.15919. Online ahead of print.

ABSTRACT

The molecular mechanisms underlying posttraumatic stress disorder (PTSD) are yet to be fully elucidated, especially in underrepresented population groups. Expression quantitative trait loci (eQTLs) are DNA sequence variants that influence gene expression, in a local (cis-) or distal (trans-) manner, and subsequently impact cellular, tissue, and system physiology. This study aims to identify genetic loci associated with gene expression changes in a South African PTSD cohort. Genome-wide genotype and RNA-sequencing data were obtained from 32 trauma-exposed controls and 35 PTSD cases of mixed-ancestry, as part of the SHARED ROOTS project. The first approach utilised 108 937 single-nucleotide polymorphisms (SNPs) (MAF > 10%) and 11 312 genes with Matrix eQTL to map potential eQTLs, while controlling for covariates as appropriate. The second analysis was focused on 5638 SNPs related to a previously calculated PTSD polygenic risk score for this cohort. SNP-gene pairs were considered eQTLs if they surpassed Bonferroni correction and had a false discovery rate <0.05. We did not identify eQTLs that significantly influenced gene expression in a PTSD-dependent manner. However, several known cis-eQTLs, independent of PTSD diagnosis, were observed. rs8521 (C > T) was associated with TAGLN and SIDT2 expression, and rs11085906 (C > T) was associated with ZNF333 expression. This exploratory study provides insight into the molecular mechanisms associated with PTSD in a non-European, admixed sample population. This study was limited by the cross-sectional design and insufficient statistical power. Overall, this study should encourage further multi-omics approaches towards investigating PTSD in diverse populations.

PMID:37522158 | DOI:10.1111/jnc.15919

Clin Epidemiol. 2023 Jul 24;15:881-890. doi: 10.2147/CLEP.S416028. eCollection 2023.

ABSTRACT

PURPOSE: A diagnostic model to differentiate multiple myeloma (MM) from bone metastasis (BM) in patients with destructive bone lesions (MM-BM DDx) was developed to promote timely and appropriate referral of patients with MM to hematologists. External validation has never been conducted. This study aims to externally validate the performance of the MM-BM DDx model.

PATIENTS AND METHODS: This multi-center external validation study was conducted using retrospective data of patients over 45 years old diagnosed with MM or BM at six university-affiliated hospitals in Thailand from 2016 to 2022. The MM-BM DDx development dataset, including patients from 2012 to 2015, was utilized during external validation. Diagnostic indicators for MM included in the MM-BM DDx model are serum creatinine, serum globulin, and serum alkaline phosphatase (ALP). MM and BM diagnosis was based on the documented International Classification of Diseases 10th Revision codes. Model performance was evaluated in terms of discrimination, calibration, and accuracy.

RESULTS: A total of 3018 patients were included in the validation dataset (586 with MM and 2432 with BM). Clinical characteristics were similar between the validation and development datasets. The MM-BM DDx model’s predictions showed an AUC of 0.89 (95% CI, 0.87, 0.90). The predicted probabilities of MM from the model increased concordantly with the observed proportion of MM within the validation dataset. The estimated sensitivity, specificity, and LR for each odds class in the validation dataset were similar to those of the development dataset.

CONCLUSION: The discriminative ability and calibration of the MM-BM DDx model were found to be preserved during external validation. These findings provide support for the practical use of the MM-BM DDx model to assist clinicians in identifying patients with destructive bone lesions who are likely to have MM and enable them to arrange timely referrals for further evaluation by hematologists.

PMID:37522153 | PMC:PMC10377591 | DOI:10.2147/CLEP.S416028

Environ Chall (Amst). 2021 Aug;4:100164. doi: 10.1016/j.envc.2021.100164. Epub 2021 May 30.

ABSTRACT

The emergence of the SARS-CoV-2 has affected several production services including the water production and delivery processes. This study considered sachet water quality during the advent of the SARS-CoV-2 pandemic using multivariate statistics and Water Quality Index, Water Pollution Index and, hygienic and sanitation practices of sixty-two (62) sachet water vendors using a panel assessment approach. The findings showed that vendors did not adhere to proper hygienic practices as ninety-four (94%) of them did not have health clearance, ninety (90%) did not frequently wash their receptacles for selling daily, and most of them stored and sold in unhygienic environments. Majority of the producers violated Food and Drugs Authority Regulations. The Empirical Orthogonal Function analysis showed that total iron, Total Heterotrophic Bacteria, Salmonella, Cl^–, E. coli, and fecal and total coliforms were the controlling elements in the water. All the brands were below threshold limits based on the physical water assessment. However, enteric bacteria were observed in all the brands. Water Quality and Water Pollution Indices (WQI and WPI) described all the sachet water brands (vendors and production sites) as excellent for drinking. The WQI computations for samples from the production and vending sites respectively ranged from 0.12 to 0.36 and 0.27-0.42 whereas WPI presented 0.22-0.31 and 0.23-0.32. Comparatively, samples from vendors had elevated elemental concentrations and loads. This suggests that besides sachet water contamination during production and transportation, vendors significantly impacted the quality of sachet water. Sensitization on proper hygienic practices for sachet water production and vending and routine assessment of the quality of sachet water produced or sold is recommended.

PMID:37522148 | PMC:PMC9767321 | DOI:10.1016/j.envc.2021.100164