Category: Statistics

Exp Parasitol. 2023 Aug 7:108591. doi: 10.1016/j.exppara.2023.108591. Online ahead of print.

ABSTRACT

Mass rearing of mosquitoes as required to fulfil research studies is a technically challenging endeavor. Blood meal source has been recognized as a key consideration in mass rearing of mosquitoes that affects colony health and fecundity. Four species of laboratory-colonized mosquitoes from the Department of Entomology, US Army Medical Directorate – Armed Forces Research Institute of Medical Sciences (USAMD-AFRIMS); Anopheles cracens, An. dirus, An. minimus and An. sawadwongporni were fed blood meals from human and rhesus macaque sources using an artificial membrane feeder. The effects of different blood meal sources were evaluated concerning blood-feeding, survival and reproduction (fecundity and hatching rates). Adult survival was monitored at days 7, 14 and 21 post blood-feeding. Although the mosquitoes fed on human blood exhibited higher rates of engorgement, there were no significant differences in blood-feeding rates in An. cracens (P = 0.08) and An. dirus (P = 0.91) between rhesus macaque and human blood sources. Twenty-one days post-feeding, no significant differences were observed in the survival rates of mosquitoes fed on human versus rhesus macaque blood. Except for An. dirus, which had better survival rates with human blood (97.5%) than after feeding on rhesus macaque blood (95.4%). All mosquito species fed on human blood produced significantly more eggs when compared to those fed on rhesus macaque blood. However, there was no statistical difference in hatching rates between blood sources, except for An. dirus, which had better hatching rates with human blood. These results indicate that human and rhesus macaque blood may be a viable alternative for maintaining Anopheles mosquitoes in colony.

PMID:37558194 | DOI:10.1016/j.exppara.2023.108591

J Endod. 2023 Aug 7:S0099-2399(23)00471-5. doi: 10.1016/j.joen.2023.07.026. Online ahead of print.

ABSTRACT

INTRODUCTION: A combination labial infiltration (1.8 mL) plus lingual infiltration (1.8 mL) of 4% articaine with 1:100,000 epinephrine in the mandibular lateral incisor was found superior to a labial infiltration of 1.8 mL of the same solution. However, it is not known whether the volume or the location had the greatest effect. Therefore, the purpose of this prospective, randomized crossover study was to determine the anesthetic efficacy of a labial infiltration of a 3.6 mL volume of 4% articaine with 1:100,000 epinephrine compared to labial infiltration (1.8 mL) plus lingual infiltration (1.8 mL) of 4% articaine with 1:100,000 epinephrine in the mandibular lateral incisor.

METHODS: One hundred subjects randomly received two sets of injections, using 4% articaine with 1:100,000 epinephrine, consisting of labial and lingual infiltrations of 1.8 mL (3.6 mL total) and two labial infiltrations of 1.8 mL (3.6 mL total) of the mandibular lateral incisor in two separate appointments. Electric pulp testing was used to determine anesthetic success (highest 80/80 reading). The data were analyzed statistically.

RESULTS: The labial and lingual combination exhibited a significantly higher anesthetic success rate (97%) when compared to the two labial infiltrations (74%) and had significantly higher 80/80s readings from 1 minute to 58 minutes.

CONCLUSIONS: Within the limitations of this clinical study, a combination labial plus lingual infiltration using a 3.6 mL volume of 4% articaine with 1:100,000 epinephrine significantly increased pulpal anesthetic success for the mandibular lateral incisor when compared to a labial infiltration using a 3.6 mL volume of articaine. Therefore, location of the infiltrations was more important than volume.

PMID:37558177 | DOI:10.1016/j.joen.2023.07.026

J Obstet Gynaecol Can. 2023 Aug 7:S1701-2163(23)00498-X. doi: 10.1016/j.jogc.2023.08.001. Online ahead of print.

ABSTRACT

OBJECTIVE: Our objective was to explore the workforce and clinical care of first and second trimester surgical abortion (FTSA, STSA) providers following the publication of updated Society of Obstetricians and Gynaecologists of Canada (SOGC) surgical abortion guidelines.

METHODS: We conducted a national, cross-sectional, online, self-administered survey of physicians who provided abortion care in 2019. This anonymized survey collected participant demographics, types of abortion services, and characteristics of FTSA and STSA clinical care. Through health care organizations using a modified Dillman technique, we recruited from July to December 2020. Descriptive statistics were generated by R Statistical Software.

RESULTS: We present the data of 222 surgical abortion provider respondents, of whom 219 provided FTSA, 109 STSA, and 106 both. Respondents practiced in every Canadian province and territory. Most were obstetrician-gynaecologists (56.8%) and family physicians (36.0%). The majority of FTSA and STSA respondents were located in urban settings, 64.8% and 79.8% respectively, and more than 80% practiced in hospitals. More than 1 in 4 respondents reported <5 years’ experience with surgical abortion care and 93.2% followed SOGC guidelines. Noted guideline deviations included that prophylactic antibiotic use was not universal, and more than half of respondents used sharp curettage in addition to suction. Fewer than 5% of STSA respondents used mifepristone for cervical preparation.

CONCLUSIONS: The surgical abortion workforce is multidisciplinary and rejuvenating. Education, training, and practice supports, including SOGC guideline implementation, are required to optimize care and to ensure equitable FTSA and STSA access in both rural and urban regions.

PMID:37558165 | DOI:10.1016/j.jogc.2023.08.001

J Sport Health Sci. 2023 Aug 7:S2095-2546(23)00074-1. doi: 10.1016/j.jshs.2023.08.001. Online ahead of print.

ABSTRACT

BACKGROUND: One of the pathological hallmarks distinguishing Alzheimer’s disease from other dementias is the accumulation of amyloid beta (Aβ). Higher physical activity is associated with decreased dementia risk, and one potential path could be through Aβ levels modulation. We aimed to explore the relationship between physical activity and Aβ in middle-aged and older adults.

METHODS: A systematic search of PubMed, Web of Science, PsycINFO, Cochrane Central Register of Controlled Trials, and SportDiscuss was performed from inception to the 28^th of April 2022. Studies were eligible if they included physical activity and Aβ data in adults aged 45 years or older. Multi-level meta-analyses of intervention and observational studies were performed to examine the role of physical activity in modulating Aβ levels.

RESULTS: In total, 37 articles were included (8 randomized controlled trials (RCTs), 3 non-RCTs, 4 prospective longitudinal studies, and 22 cross-sectional studies). The overall effect size of physical activity interventions on changes in blood Aβ was medium (pooled standardized mean difference (SMD) = -0.69, 95% confidence interval (95%CI): -1.41 to 0.03; I² = 74.6%). However, these results were not statistically significant, and there were not enough studies to explore the effects of physical activity on cerebrospinal fluid (CSF) and brain Aβ. Data from observational studies were examined based on measurements of Aβ in the brain using positron emission tomography scans, CSF, and blood. Higher physical activity was positively associated with Aβ only in the CSF (Estimate r = 0.12; 95%CI: 0.05 to 0.18; I² = 38%).

CONCLUSION: Physical activity might moderately reduce blood Aβ in middle-aged and older adults. However, results were only near statistical significance and might be interpreted with caution given the methodological limitations observed in some of the included studies. In observational studies, higher levels of physical activity were positively associated with Aβ only in CSF. Therefore, further research is needed to understand the modulating role of physical activity in the brain, CSF, and blood Aβ, as well as its implication for cognitive health.

PMID:37558161 | DOI:10.1016/j.jshs.2023.08.001

J Theor Biol. 2023 Aug 7:111592. doi: 10.1016/j.jtbi.2023.111592. Online ahead of print.

ABSTRACT

There has been an increasing recognition of the utility of models of the spatial dynamics of viral spread within tissues. Multicellular models, where cells are represented as discrete regions of space coupled to a virus density surface, are a popular approach to capture these dynamics. Conventionally, such models are simulated by discretising the viral surface and depending on the rate of viral diffusion and other considerations, a finer or coarser discretisation may be used. The impact that this choice may have on the behaviour of the system has not been studied. Here we demonstrate that under realistic parameter regimes – where viral diffusion is small enough to support the formation of familiar ring-shaped infection plaques – the choice of spatial discretisation of the viral surface can qualitatively change key model outcomes including the time scale of infection. Importantly, we show that the choice between implementing viral spread as a cell-scale process, or as a high-resolution converged PDE can generate distinct model outcomes, which raises important conceptual questions about the strength of assumptions underpinning the spatial structure of the model. We investigate the mechanisms driving these discretisation artefacts, the impacts they may have on model predictions, and provide guidance on the design and implementation of spatial and especially multicellular models of viral dynamics. We obtain our results using the simplest TIV construct for the viral dynamics, and therefore anticipate that the important effects we describe will also influence model predictions in more complex models of virus-cell-immune system interactions. This analysis will aid in the construction of models for robust and biologically realistic modelling and inference.

PMID:37558160 | DOI:10.1016/j.jtbi.2023.111592

Swiss Med Wkly. 2023 Aug 9;153:40098. doi: 10.57187/smw.2023.40098.

ABSTRACT

BACKGROUND: Addressing the current demographic development, the efficacy and safety of kidney transplantations from very senior donors needs to be carefully evaluated. The aim of this study was to analyse patient and graft outcomes of kidney allograft recipients stratified by donor age.

METHODS: We retrospectively investigated n = 491 patients from a prospective, observational renal transplant cohort. Patients with kidneys from very old donors (n = 75, aged >70 years), elderly donors (n = 158, between 60-70 years), and regular donors (n = 258, aged <60 years) were investigated. The primary outcome was death-censored graft survival within the predefined donor age groups.

RESULTS: Overall, n = 57 death-censored graft losses occurred. Graft loss was proportionally highest in the very old donor group (n = 11/75), but this did not reach statistical significance when compared to the elderly (14/158) and regular donor groups (32/258); (p = 0.37). Kaplan-Meier analysis demonstrated that 3-year/5-year death-censored graft survival in the very old donor group was 96%/86% and did not differ from the other age groups (p = 0.44). Median estimated glomerular filtration rate (eGFR), calculated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula (in ml/min/1.73 m2 of body surface) 12 months post-transplant did not differ between the elderly donor and very old donor groups (p = 0.53). However, patients who received regular donor kidneys had higher median eGFR compared to recipients in both the elderly and very old donor groups (p <0.0001). During follow-up, 31% of patients developed at least one acute rejection episode. Time-to-event analysis demonstrated no difference in occurrence of any acute rejection event across all three groups (p = 0.11).

CONCLUSIONS: This study demonstrates that kidney transplantation from carefully selected very old donors seems a valid option with reasonable short- and mid-term outcomes.

PMID:37556837 | DOI:10.57187/smw.2023.40098

Aesthet Surg J. 2023 Aug 10:sjad251. doi: 10.1093/asj/sjad251. Online ahead of print.

ABSTRACT

BACKGROUND: People of color (POC) are often underrepresented in clinical studies evaluating the safety and effectiveness of aesthetic products, including hyaluronic acid (HA) fillers, which to date have limited clinical data in POC.

OBJECTIVE: To assess the safety and effectiveness of a new line of dynamic HA fillers (RHA®, Revance, Nashville TN) for treating moderate-to-severe nasolabial folds (NLF) in POC versus non-POC.

METHODS: Post hoc subgroup analyses compared the efficacy and safety of POC versus non-POC subjects treated with RHA2, RHA3, or RHA4 for correction of moderate-to-severe nasolabial folds in the pooled Per Protocol population (N=217) in two clinical trials. Evaluated population cohorts were classified by Fitzpatrick Skin Type (FST) [high FST (IV-VI) versus low FST (I-III)] and by subject-reported race (non-White versus White) relative to baseline at 6, 9, 12, and 15 months.

RESULTS: POC consistently showed greater improvement in wrinkle severity and higher responder rates compared to non-POC, which reached statistical significance at several measured time points. Global aesthetic improvement scores (GAIS) and subject satisfaction were similar for POC and non-POC and remained high throughout the course of the study. Treatment-related adverse event rates were generally lower for high FSTs versus low FSTs, with no reported cases of keloidal scarring.

CONCLUSION: The RHA line of dynamic fillers is well tolerated and effective for the correction of moderate-to-severe nasolabial folds in POC and can be confidently used in this important and growing patient population.

PMID:37556827 | DOI:10.1093/asj/sjad251

Nurse Educ. 2023 Aug 9. doi: 10.1097/NNE.0000000000001486. Online ahead of print.

ABSTRACT

BACKGROUND: Although just culture is reportedly integrated across education and practice, little is known about how perceptions may change across time as students transition from prelicensure education to registered nurse in the practice setting.

PURPOSE: The purpose of this study was to describe and compare just culture perceptions of registered nurses at 2 time points: (1) as prelicensure students and (2) as new graduate nurses with a minimum of 6 months of experience.

METHODS: Utilizing the Just Culture Assessment Tool for Nursing Education (JCAT-NE) and the Just Culture Assessment Tool (JCAT), this within-subject, longitudinal study measured just culture perceptions across time.

RESULTS: Although there was no statistically significant change in total scores across time, 8 individual items demonstrated statistically significant change.

CONCLUSIONS: Students use the knowledge, skills, and attitudes about just culture taught in prelicensure education as new graduate nurses. However, findings reveal areas where the practice environment has altered perceptions of just culture.

PMID:37556826 | DOI:10.1097/NNE.0000000000001486

Acad Med. 2023 Aug 3. doi: 10.1097/ACM.0000000000005366. Online ahead of print.

ABSTRACT

PURPOSE: The developmental trajectory of learning during residency may be attributed to multiple factors, including variation in individual trainee performance, program-level factors, graduating medical school effects, and the learning environment. Understanding the relationship between medical school and learner performance during residency is important in prioritizing undergraduate curricular strategies and educational approaches for effective transition to residency and postgraduate training. This study explores factors contributing to longitudinal and developmental variability in resident milestones ratings, focusing on variability due to graduating medical school, training program, and learners using national cohort data from emergency medicine (EM) and family medicine (FM).

METHOD: Data from programs with residents entering training in July 2016 were used (EM: n = 1,645 residents, 178 residency programs; FM: n = 3,997 residents, 487 residency programs). Descriptive statistics were used to examine data trends. Cross-classified mixed-effects regression were used to decompose variance components in milestones ratings.

RESULTS: During postgraduate year (PGY)-1, graduating medical school accounted for 5% and 6% of the variability in milestones ratings, decreasing to 2% and 5% by PGY-3 for EM and FM, respectively. Residency program accounted for substantial variability during PGY-1 (EM=70%; FM=53%) but decreased during PGY-3 (EM=62%; FM=44%), with greater variability across training period in patient care (PC), medical knowledge (MK), and systems-based practice (SBP). Learner variance increased significantly between PGY-1 (EM=23%; FM=34%) and PGY-3 (EM=34%; FM=44%), with greater variability in practice-based learning and improvement (PBLI), professionalism (PROF), and interpersonal communication skills (ICS).

CONCLUSIONS: The greatest variance in milestone ratings can be attributed to the residency program, and to a lesser degree, learners and medical school. The dynamic impact of program-level factors on learners shift during the first-year and across the duration of residency training, highlighting the influence of curricular, instructional, and programmatic factors on resident performance throughout residency.

PMID:37556818 | DOI:10.1097/ACM.0000000000005366

Comput Inform Nurs. 2023 Aug 9. doi: 10.1097/CIN.0000000000001049. Online ahead of print.

ABSTRACT

The cross-sectional study enrolled 231 patients with heart failure (n = 115; 60.87% were men; mean age, 74.34 ± 12.70 years) and heart transplantation (n = 116; 72.41% were men; mean age, 56.85 ± 11.87 years) who self-reported their technology usage, physical activity, and source of motivation for exercise. Patients with heart failure were significantly older (P = .0001) than patients with heart transplantation. Physical activity levels in patients with heart failure decreased as the New York Heart Association classification increased. Patients with heart failure reported significantly lower physical activity than patients with heart transplantation (P = .0008). Smartphones were the most widely used electronic device to access the Internet in both groups. Patients with heart transplantation seemed to use more than one device to access the Internet. In both groups, patients reporting more technology usage also reported higher levels of physical activity. Patients who accessed the Internet daily reported lower levels of physical activity. Whereas patients with heart failure identified encouragement by family members as a source of motivation for exercise, patients with heart transplantation reported that they were likely to exercise if motivated by their healthcare provider. Patients with heart failure and heart transplantation have unique technological and motivational needs that need consideration for mobile health-driven interventions.

PMID:37556811 | DOI:10.1097/CIN.0000000000001049