Category: Statistics

J Am Med Dir Assoc. 2023 Jul 29:S1525-8610(23)00615-1. doi: 10.1016/j.jamda.2023.06.025. Online ahead of print.

ABSTRACT

OBJECTIVES: To better demonstrate the relationship between common eye diseases and the risk of dementia, we conducted a systematic review and meta-analysis of cohort studies to investigate the relationship between common eye diseases and dementia.

DESIGN: Systematic review and meta-analysis.

SETTING AND PARTICIPANTS: Patients with common eye diseases.

METHODS: We conducted a systematic search of articles published up to August 25, 2022, of online databases including PubMed, EMBASE, and Web of Science. We included cohort studies that evaluated the association of glaucoma, age-related macular degeneration (AMD), diabetic retinopathy (DR), and cataracts with all-cause dementia, Alzheimer’s disease (AD), and vascular dementia (VaD). Relative risks (RRs) and 95% CIs were pooled using random effects model, and heterogeneity was assessed by the I² statistic. Subgroup analysis and sensitivity analysis were also performed.

RESULTS: In total, 25 studies were included in the meta-analysis, with a total of 11,410,709 participants. Pooled estimates suggested an increased risk of all-cause dementia associated with AMD (RR, 1.29; 95% CI, 1.13-1.48), glaucoma (RR, 1.16; 95% CI, 1.03-1.32), DR (RR, 1.40; 95% CI, 1.21-1.63), and cataract (RR,1.23; 95% CI, 1.09-1.40); an increased risk of AD associated with AMD (RR, 1.27; 95% CI, 1.06-1.52), glaucoma (RR, 1.18; 95% CI, 1.02-1.38), DR (RR, 1.21; 95% CI, 1.04-1.41), and cataracts (RR,1.22; 95% CI, 1.07-1.38). No association was observed between incident VaD and any eye diseases. The results of subgroup analyses were consistent with those in meta-analysis of DR and risk of all-cause dementia. Meta-regressions suggested geographic regions as potential sources of heterogeneity for the association between AMD and all-cause dementia, AMD and AD, glaucoma and dementia, glaucoma, and AD, respectively.

CONCLUSIONS AND IMPLICATIONS: AMD, glaucoma, DR, and cataract may be associated with an increased risk of all-cause dementia and AD, but not VaD. However, the results should be interpreted cautiously because of the high heterogeneity and unstable findings in some subgroup analyses.

PMID:37527793 | DOI:10.1016/j.jamda.2023.06.025

Appl Clin Inform. 2023 Aug 1. doi: 10.1055/a-2145-6980. Online ahead of print.

ABSTRACT

OBJECTIVE: Few community pharmacies have access to health information exchange (HIE) data. We conducted a first-of-its-kind usability evaluation of a HIE interface prototype (referred to throughout as the “HIE-Pioneer mock-up”) developed with pharmacists and pharmacy technicians to aid future implementation in community pharmacies.

METHODS: Community pharmacists and pharmacy technicians were recruited to complete usability evaluations with the HIE-Pioneer mock-up. Each usability evaluation lasted up to 60 mins. System usability scale (SUS) scores were collected from each participant following each usability evaluation session and summarized with descriptive statistics. Usability evaluation videos were reviewed for common usability attributes, such as the impact of identified usability problems, learnability, and efficiency. Time on task, task success rates, and prototype utilization were also recorded.

RESULTS: Sixteen total participants completed usability testing across three community pharmacies. The average SUS score was 69.7 (scale 0 – 100, where 100 is the best), with pharmacists on average reporting higher satisfaction than technicians (74.1 vs. 65.3, respectively). Altogether, we identified 23 distinct usability problems. Key problems identified included needed clarification in tool label names and accessibility of HIE links within existing workflow. Overall, the usability of the HIE-Pioneer mock-up generally fostered pharmacy professionals’ ease of learning and efficiency.

CONCLUSION: Our study identified key areas, and potential solutions, to improve the usability of the HIE-Pioneer mock-up. Overall, pharmacy professionals viewed the HIE-Pioneer mock-up positively, with good satisfaction ratings. The HIE-Pioneer mock-up provides a blueprint for future HIE implementation in community pharmacy settings, which would increase community pharmacy teams’ access to HIE data nationwide. Community pharmacy access to bi-directional HIE is expected to improve communication amongst more healthcare professionals involved in patient care and equip pharmacy professionals with needed information for improved clinical decision making.

PMID:37527792 | DOI:10.1055/a-2145-6980

Am J Perinatol. 2023 Aug 1. doi: 10.1055/a-2145-7636. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the effect of non-reassuring fetal heart rate (NRFHR) patterns in labor on the postnatal renal function of neonates with a prenatal diagnosis of Congenital Anomalies of the Kidney and Urinary Tract (CAKUT).

STUDY DESIGN: A retrospective cohort study was conducted in a single tertiary referral center between 2012 and 2020. All cases with a prenatal diagnosis of CAKUT were extracted, and their fetal, maternal, obstetrical, and neonatal characteristics were analyzed. Cases of multiple gestations, preterm delivery, small for gestational age, major associated malformations or genetic aberrations, and pre-labor acute obstetrical events were excluded from the analysis. The study group was comprised of patients who experienced NRFHR during labor. The control groups included (1) patients who had a trial of labor with a normal fetal heart rate pattern and (2) patients who delivered by elective cesarean section (CS). The primary outcome was abnormal serum creatinine levels in the perinatal period. For statistical purposes, the CAKUT cases were classified into a low and high estimated risk for an abnormal postnatal renal outcome. A subgroup analysis of the results was performed accordingly.

RESULTS: 256 fetuses were diagnosed prenatally with CAKUT during the study period. Of them, 214 (83%) women underwent a trial of labor, and forty-two patients (17%) underwent an elective Cesarean Section. Of the patients who underwent a trial of labor, 21/214 (9.8%) experienced NRFHR during labor. No statistically significant between-group differences were found in maternal and fetal characteristics. NRFHR patterns were not associated with a deterioration in neonatal serum creatinine compared to those with normal fetal monitoring or those born by an elective CS.

CONCLUSION: NRFHR patterns during labor and delivery did not impair neonatal renal function status in fetuses diagnosed prenatally with low and high-risk CAKUT. Delivery can be managed according to standard obstetrical guidelines.

PMID:37527788 | DOI:10.1055/a-2145-7636

Thromb Haemost. 2023 Aug 1. doi: 10.1055/a-2145-7238. Online ahead of print.

ABSTRACT

BACKGROUND: Cancer associated venous thromboembolism (Ca-VTE) treatment with anticoagulation is associated with bleeding complications and there are limited data on risk factors. Current models do not provide accurate bleeding risk prediction.

METHODS: UK Clinical Practice Research Datalink data (2008-2020) was used to generate a cohort of patients with anticoagulant initiation for first Ca-VTE. Patients were observed up to 180 days for significant bleeding including major bleeding, and clinically relevant non-major bleeding requiring hospitalisation (CRNMB-H). A scoring scheme was developed from subdistribution hazard ratios, and its discrimination (expressed by the C-statistic) estimated from cross-validation.

RESULTS: 15,749 patients with Ca-VTE and anticoagulant treatment were included. In total, 537 significant bleeding events, 161 major bleeds and 376 CRNMB-H were identified after adjudicated review in 4914 person-years of observation. Incidence rates of 3.3 and 7.7 per 100 person-years were noted for major bleeding and CRNMB-H. Independent predictors of significant bleeding were cancer of the bladder, central nervous system, cervix, kidney, melanoma, prostate and upper gastrointestinal tract. Overall C-statistic for significant bleeding was 0.70, and 0.76 and 0.67 for major bleeding and for CRNMB-H, respectively.

CONCLUSIONS: This risk score may identify patients at risk of significant bleeding, while also helping to determine treatment duration.

PMID:37527782 | DOI:10.1055/a-2145-7238

J Gynecol Obstet Hum Reprod. 2023 Jul 30:102637. doi: 10.1016/j.jogoh.2023.102637. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the evolution of endometriomas with or without medical treatment.

METHODS: This retrospective observational study was performed at the Gynaecological Center, Hôpital La Conception (Assistance Publique Hopitaux de Marseille). We reviewed clinical data of patients with at least one endometrioma diagnosed by magnetic resonance imaging (MRI) and at least one other MRI exam after more than three months. Patients were divided into groups receiving medical treatment and without medical treatment (high-dose progestins, low-dose progestins or combined contraceptives). The primary objective was to evaluate the evolution of endometriomas with or without hormonal treatment. The primary evaluation criterion was the diameter of the endometriomas, and the secondary evaluation criterion was the number of endometriomas for each patient observed. The secondary objective was to evaluate whether different categories of hormonal treatment have different efficacity in the evolution of endometriomas.

RESULTS: We included 68 patients, 39 (57,4%) with hormonal treatment and 29 (42,6%) without hormonal treatment. There were 105 total endometriomas identified at the first MRI, 52 in patients with hormonal treatment and 53 in patients without treatment. The mean diameter of the endometriomas in patients with hormonal treatment was 31,48 ± 18,1 mm at the first MRI and 23,60 ± 15,3 mm at the second MRI. The mean diameter of the endometriomas in patients without treatment was 33,57 ± 19,7 mm at the first MRI and 40,11 ± 25,7 mm at the second MRI (statistically significant difference, p = 0.01). The mean number of endometriomas in patients with treatment was 1,79 ± 1,1 at the first MRI and 1,18 ± 0,9 at the second MRI, while the mean number of endometriomas in patients without hormonal treatment was 1,38 ± 0,6 at the first MRI and 1,97 ± 1,5 at the second MRI (difference not statistically significant, p = 0.38). The subgroup analysis differentiated by category of hormonal treatment did not show statistically significant results.

CONCLUSIONS: The present study shows that there is a positive effect of hormonal treatment on reducing the diameter of endometriomas and also a significative increase in endometrioma size in the absence of treatment. There is no evidence of an advantage of a single category of hormonal treatment on this effect on endometriomas. Thus, any medical treatment could be proposed as a first-line therapy for endometriomas that would reduce the size of the endometrioma and thereby help to avoid surgical intervention.

PMID:37527765 | DOI:10.1016/j.jogoh.2023.102637

Neuropsychologia. 2023 Jul 30:108652. doi: 10.1016/j.neuropsychologia.2023.108652. Online ahead of print.

ABSTRACT

The current study examined whether adults with Developmental Dyslexia are impaired in learning linguistic regularities in a novel language, and whether this may be explained by a domain general deficit in the effect of sleep on consolidation. We compared online learning and offline consolidation of morphological regularities in individuals with Developmental Dyslexia (N = 40) and typical readers (N = 38). Participants learned to apply plural inflections to novel words based on morpho-phonological rules embedded in the input and learned to execute a finger motor sequence task. To test the effects of time and sleep on consolidation, participants were assigned into one of two sleep-schedule groups, trained in the evening or in the morning and tested 12 and 24 h later. Unlike typical readers, Dyslexic readers did not extract the morpho-phonological regularities during training and as a group they did not show offline gains in inflecting trained items 24 h after training, suggesting that the deficit in extraction of regularities during training may be related to the deficit in consolidation. The offline gains in dyslexic readers, were correlated with their prior phonological abilities, and were less affected by sleep than those of typical readers. Although no deficit was found in the consolidation of the motor task, dyslexic readers were again less successful in generating an abstract representation of the motor sequence, reflected in a difficulty to generalize the motor sequence knowledge acquired using one hand to the untrained hand. The results suggest that individuals with Developmental Dyslexia have a domain general deficit in extracting statistical regularities from an input. Within the language domain this deficit is reflected in reduced benefits of consolidation, particularly during sleep, perhaps due to reduced prior phonological abilities, which may impede the individual’s ability to extract the linguistic regularities during and after training and thus constrain the consolidation process.

PMID:37527734 | DOI:10.1016/j.neuropsychologia.2023.108652

J Dent. 2023 Jul 30:104646. doi: 10.1016/j.jdent.2023.104646. Online ahead of print.

ABSTRACT

OBJECTIVES: Retaining and restoring severely compromised teeth with subcrestal defect extensions or removing and replacing them using implant-supported crowns (ISC) remains controversial, and economic analyses comparing both strategies remain scarce. We performed a cost-time analysis, comparing the expenditures for retaining “unrestorable” teeth using forced orthodontic extrusion and restoration (FOE) versus extraction and ISC, in a clinical prospective cohort study.

METHODS: Forty-two patients (n=21 per group) were enrolled from clinical routine at a university into this study. Direct medical and indirect costs (opportunity costs) were assessed for all relevant steps (initial care, active care, restorative care, supportive care) using the private payer’s perspective in German healthcare based on a micro-costing approach and/or national fee items. Statistical comparison was performed with Mann-Whitney-U-test.

RESULTS: Patients were followed up for at least one year after initial treatment (n=40). The drop-out rate was 5% (n=2). Total direct medical costs were higher for ISC (median: 3439.05€) than FOE (median: 1601.46€) with p<0.001. We observed a higher number of appointments (p=0.002) for ISC (median: 14.5) in comparison to FOE (median: 12), while cumulatively, FOE patients spent more time in treatment (median: 402.5 min) in comparison to ISC (median: 250 min) with p<0.001, resulting in comparable opportunity costs for both treatment groups (FOE: 304.50€; ISC: 328.98€).

CONCLUSIONS: ISC generated higher costs than FOE. More in-depth and long-term exploration of cost-effectiveness is warranted.

CLINICAL SIGNIFICANCE: ISCs were associated with higher initial medical costs and required more appointments than the restoration of severely compromised teeth after FOE. Treatment time was higher for patients with FOE, resulting in similar opportunity costs for both treatment approaches. Future research needs to investigate long-term cost-effectiveness.

PMID:37527727 | DOI:10.1016/j.jdent.2023.104646

J Therm Biol. 2023 Jul 27;116:103673. doi: 10.1016/j.jtherbio.2023.103673. Online ahead of print.

ABSTRACT

As temperatures rise, understanding how ectotherms will become impacted by thermal stress is of critical importance. In this context, many researchers quantify critical temperatures – these are the upper (CTmax) and lower (CTmin) thermal limits at which organisms can no longer function. Most studies estimate CTs using bath-based methods where organisms are submerged within a set thermal environment. Plate-based methods (i.e. hot plates), however, offer huge opportunity for automation and are readily available in many lab settings. Plates, however, generate a unidirectional thermal boundary layer above their surface which means that the temperatures experienced by organisms of different sizes is different. This boundary layer effect can bias estimates of critical temperatures. Here, we test the hypothesis that biases in critical temperature estimation on hot plates are driven by organism height. We also quantify the composition of the boundary layer in order to correct for these biases. We assayed four differently sized species of UK ants for their CTmax in dry baths (with no boundary layer) and on hot plates (with a boundary layer). We found that hot plates overestimated the CTmax values of the different ants, and that this overestimate was larger for taller species. By statistically modelling the thickness of the thermal boundary layer, and combining with estimates of species height, we were able to correct this overestimation and eliminate methodological differences. Our study provides two main findings. First, we provide evidence that organism height is positively related to the bias present in plate-based estimates of CTmax. Second, we show that a relatively simple statistical model can correct for this bias. By using simple corrections for boundary layer effects, as we have done here, researchers could open up a new possibility space in the design and implementation of thermal tolerance assays using plates rather than restrictive dry or water baths.

PMID:37527565 | DOI:10.1016/j.jtherbio.2023.103673

Lab Med. 2023 Aug 1:lmad069. doi: 10.1093/labmed/lmad069. Online ahead of print.

ABSTRACT

Nonlinear curve fitting is an important process in laboratory medicine, particularly with the increased use of highly sensitive antibody-based assays. Although the process is often automated in commercially available software, it is important that clinical scientists and physicians recognize the limitations of the various approaches used and are able to select the most appropriate model. This article summarizes the key nonlinear functions and demonstrates their application to common laboratory data. Following this, a basic overview of the statistical comparison of models is presented and then a discussion of important algorithms used in nonlinear curve fitting. An accompanying Microsoft Excel workbook is available that can be used to explore the content of this article.

PMID:37527550 | DOI:10.1093/labmed/lmad069

ACS Appl Mater Interfaces. 2023 Aug 1. doi: 10.1021/acsami.3c08118. Online ahead of print.

ABSTRACT

Hydrothermal synthesis is a highly efficient way to yield multiform Te nanosheets. However, the growth mechanisms and property discrepancies between different types of Te nanosheets are still unclear. In this paper, we perform an investigation on this issue by monitoring the hydrothermally synthesized Te nanosheets at different growth stages with transmission electron microscopy and electrical tests. Three main types of Te nanosheets and their variants are revealed including trapezoidal and “V”-shaped configurations. It is found that the different types of Te nanosheets dominate at different reaction stages, indicating a sequential growth scenario. Surfactants and surface energy co-determine the growth kinetics, while the crystallographic attachments lead to specifically included angles of 74° and 41° in the “V”-shaped Te nanosheets. The fractions of the three main types of Te nanosheets as a function of reaction time are statistically tracked, and their crystalline structures, interfaces, and preferential growth orientations are uncovered. Moreover, the electrical properties of the Te nanosheets are tested, and the results show an interface-related feature. These findings provide some new insights into the synthesis and property of low-dimensional Te functional materials.

PMID:37527542 | DOI:10.1021/acsami.3c08118