Category: Statistics

Invest Ophthalmol Vis Sci. 2023 Jan 3;64(1):2. doi: 10.1167/iovs.64.1.2.

ABSTRACT

PURPOSE: The purpose of this study was to investigate optical coherence tomography (OCT)-measured retinal thickness (RT) and best-corrected distance visual acuity (BCDVA) in eyes with different types of astigmatism.

METHODS: This is a case-control study of 101 participants stratified into With-The-Rule (WTR; n = 41), Against-The-Rule (ATR; n = 25), and control (n = 35) groups by noncycloplegic subjective refraction. Inclusion criteria were ages between 18 and 45 years, spherical-equivalent (SE) refraction ≥-10.00 diopters (D), negative cylindrical power (CYL) ≤-0.75 D with axes of 0 to 30 degrees/150 to 180 degrees for WTR and 60 to 120 degrees for ATR, or CYL ≥-0.25 D for controls. Participants suffering from ocular diseases related to retinal defects, having a history of ocular surgery, with BCDVA >0.10 LogMAR, or poor OCT imaging quality were excluded. Fovea-centered scans were performed using spectral-domain OCT (SD-OCT), and RT automatically measured by the inbuilt software. Only right eyes were analyzed. Groups were matched for age, gender, SE, axial length, and corneal curvature.

RESULTS: One-way ANOVA showed a significant difference in both BCDVA (P = 0.039) and macular RT (P = 0.028) among the three groups. Bonferroni’s post hoc test revealed statistically significant between-group differences in BCDVA (WTR vs. controls, P = 0.041), as well as in RT at inner-nasal (WTR vs. ATR, P = 0.034) and outer-temporal subfields (WTR vs. controls, P = 0.042). BCDVA was positively associated with macular RT (r = 0.206, P = 0.041) after adjusting for age, gender, and axial length.

CONCLUSIONS: Greater RT and poorer BCDVA were found in eyes with WTR astigmatism. Our findings suggest that the effect of astigmatism on retinal thickness and BCDVA may vary depending on not only magnitude, but also axis of astigmatism.

PMID:36595274 | DOI:10.1167/iovs.64.1.2

JAMA Intern Med. 2023 Jan 3. doi: 10.1001/jamainternmed.2022.6069. Online ahead of print.

ABSTRACT

IMPORTANCE: Testing for coronary heart disease (CHD) in asymptomatic kidney transplant candidates before transplant is widespread and endorsed by various professional societies, but its association with perioperative outcomes is unclear.

OBJECTIVE: To estimate the association of pretransplant CHD testing with rates of death and myocardial infarction (MI).

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included all adult, first-time kidney transplant recipients from January 2000 through December 2014 in the US Renal Data System with at least 1 year of Medicare enrollment before and after transplant. An instrumental variable (IV) analysis was used, with the program-level CHD testing rate in the year of the transplant as the IV. Analyses were stratified by study period, as the rate of CHD testing varied over time. A combination of US Renal Data System variables and Medicare claims was used to ascertain exposure, IV, covariates, and outcomes.

EXPOSURES: Receipt of nonurgent invasive or noninvasive CHD testing during the 12 months preceding kidney transplant.

MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of death or acute MI within 30 days of after kidney transplant.

RESULTS: The cohort comprised 79 334 adult, first-time kidney transplant recipients (30 147 women [38%]; 25 387 [21%] Black and 48 394 [61%] White individuals; mean [SD] age of 56 [14] years during 2012 to 2014). The primary outcome occurred in 4604 patients (244 [5.3%]; 120 [2.6%] death, 134 [2.9%] acute MI). During the most recent study period (2012-2014), the CHD testing rate was 56% in patients in the most test-intensive transplant programs (fifth IV quintile) and 24% in patients at the least test-intensive transplant program (first IV quintile, P < .001); this pattern was similar across other study periods. In the main IV analysis, compared with no testing, CHD testing was not associated with a change in the rate of primary outcome (rate difference, 1.9%; 95% CI, 0%-3.5%). The results were similar across study periods, except for 2000 to 2003, during which CHD testing was associated with a higher event rate (rate difference, 6.8%; 95% CI, 1.8%-12.0%).

CONCLUSIONS AND RELEVANCE: The results of this cohort study suggest that pretransplant CHD testing was not associated with a reduction in early posttransplant death or acute MI. The study findings potentially challenge the ubiquity of CHD testing before kidney transplant and should be confirmed in interventional studies.

PMID:36595271 | DOI:10.1001/jamainternmed.2022.6069

Phys Med Biol. 2022 Dec 9. doi: 10.1088/1361-6560/acaa85. Online ahead of print.

ABSTRACT

OBJECTIVE: In the field of radiation oncology, the benefit of MRI goes beyond that of providing high soft-tissue contrast images for staging and treatment planning. With the recent clinical introduction of hybrid MRI linear accelerators (MR-Linacs) it has become feasible to map physiological parameters describing diffusion, perfusion, and relaxation during the entire course of radiotherapy, for example. However, advanced data analysis tools are required for extracting qualified prognostic and predictive imaging biomarkers from longitudinal MRI data. In this study, we propose a new prediction framework tailored to exploit temporal dynamics of tissue features from repeated measurements. We demonstrate the framework using a newly developed decomposition method for tumor characterization.

APPROACH: Two previously published MRI datasets with multiple measurements during and after radiotherapy, were used for development and testing: T$_2$-weighted multi-echo images obtained for two mouse models of pancreatic cancer, and diffusion-weighted images for patients with brain metastases. Initially, the data was decomposed using the novel monotonous slope non-negative matrix factorization (msNMF) tailored for MR data. The following processing consisted of a tumor heterogeneity assessment using descriptive statistical measures, robust linear modelling to capture temporal changes of these, and finally logistic regression analysis for stratification of tumors and volumetric outcome.

MAIN RESULTS: The framework was able to classify the two pancreatic tumor types with an textit{area under curve} AUC of 0.999, $P<0.001$ and predict the tumor volume change with a correlation coefficient of 0.513, $P=0.034$. A classification of the human brain metastases into responders and non-responders resulted in an AUC of 0.74, $P=0.065$.

SIGNIFICANCE: A general data processing framework for analyses of longitudinal MRI data has been developed and applications were demonstrated by classification of tumor type and prediction of radiotherapy response. Further, as part of the assessment, the merits of msNMF for tumor tissue decomposition were demonstrated.

PMID:36595245 | DOI:10.1088/1361-6560/acaa85

Phys Med Biol. 2022 Dec 2. doi: 10.1088/1361-6560/aca875. Online ahead of print.

ABSTRACT

Regulators require that wireless power transfer (WPT) systems and other strong magnetic field sources are compliant with the basic restrictions (BR) defined as the limits of the fields induced in the human body, i.e., the induced electric field/current density/specific absorption rate limits. This can be achieved by demonstrating compliance with the reference levels (RL) defined in air without the human body, i.e., the incident electric/magnetic field limits. Local sources, such as WPT transmitters, generate non-uniform fields that can locally exceed the RL while the induced fields are still well below the BR. In these cases, robust compliance with BR can be demonstrated, generally requiring a large number of simulations. In this study, we proposed an efficient evaluation using a homogeneous phantom and applying a coverage factor to account for the local field enhancements caused by the dielectric contrasts of the highly inhomogeneous human tissues. The generally applicable coverage factors were derived from a statistical analysis of the field enhancements observed on four magnetic near-field sources placed at different separation distances (2-80 mm) and locations on the back of 12 anatomical models. The field enhancements were characterized by the ratios between the peak induced fields in the anatomical models and those in the homogeneous half-space phantom (ε_r= 55, σ = 0.75 S/m, ρ = 1,000 kg/m³) at the same distance. The resulting 99th percentile coverage factors range from 1 and 9 depending on the dosimetric quantity. The use of these coverage factors reduces the compliance testing effort from hundreds of simulations to only one, and makes experimental testing feasible without the support of simulations. The study also demonstrates that running only a few use-case simulations with anatomical models may underestimate the exposure by more than 10 dB.

PMID:36595233 | DOI:10.1088/1361-6560/aca875

J Pediatr Orthop B. 2022 Dec 16. doi: 10.1097/BPB.0000000000001045. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with a diagnosis of arthrogryposis often present with various orthopedic conditions, one of which is congenital vertical talus (CVT). This is the first study of this specific subset of syndromic patients to evaluate the medium-term outcomes of CVT correction using the minimally invasive Dobbs method.

METHODS: All patients with vertical talus and distal arthrogryposis who received treatment at our institution between January 2006 and June 2021 were identified. Radiographs, clinical notes and Patient-Reported Outcome Measurement Information System (PROMIS) scores (when available) were retrospectively reviewed. An alpha of 0.05 was used for all statistical analyses.

RESULTS: In total 12 patients (19 feet) met all inclusion criteria and were included in the final analysis. By the time of the most recent visit, the average lateral Talar-Axis First Metatarsal Base Angle of the entire cohort increased from 13.73 ± 9.75 degrees 2 weeks postoperatively to 28.75 ± 23.73 degrees (P = 0.0076). Radiographic recurrence of the talonavicular deformity was seen in nine feet (47.4%), 4 (21.1%) of which required additional unplanned surgery, The average PROMIS scores of the entire cohort in the pain interference, mobility and peer relationship domains were 48.97 ± 9.56, 47.9 ± 11.60 and 52.87 ± 8.31, respectively.

CONCLUSION: Despite a higher radiographic recurrence rate of talonavicular deformity in this specific subset of syndromic patients, these patients still report PROMIS scores near the population average in the pain interference, mobility and peer relationships domains. We believe that the minimally invasive Dobbs method should be recommended as the first-line treatment method for these patients. Level of evidence: Level III.

PMID:36595217 | DOI:10.1097/BPB.0000000000001045

Pain Ther. 2023 Jan 3. doi: 10.1007/s40122-022-00464-z. Online ahead of print.

ABSTRACT

INTRODUCTION: Globally, chronic pain affects more than 30% of people worldwide and is the leading cause of disability and health care utilisation. Access to timely, person-centred, cost-effective programs is unattainable for most. People living in regional, rural and remote areas are disproportionately affected due to scarcity of services and qualified, multidisciplinary health and medical professionals. Caring and supporting people with chronic pain involves a range of interventions that incorporate a multifaceted bio-psychosocial approach. Tertiary and primary chronic pain services are optimally placed to deliver integrated models of care. This pilot study explored the effectiveness of an integrated Guided Self-Help (GSH) program within a multidisciplinary tertiary pain unit in a public hospital in Australia.

METHODS: A service delivery evaluation was undertaken and a pilot study implemented to determine feasibility and useability of an integrated GSH program for people with chronic pain. A single-group pre-post evaluation was provided to a convenience sample of 42 people referred to the Flinders Medical Centre Pain Management Unit (FMC PMU). Delivered via telehealth or in person by postgraduate students, a manualised GSH workbook was utilised to support adherence and fidelity. Content included goal setting, pain conceptualisation, psychoeducation, activity scheduling, pacing and cognitive strategies. The purpose of the integrated GSH pilot program was to support participants in gaining increased pain literacy, knowledge of effective physical and psychological strategies and enhance self-management of their chronic pain. Levels of psychological distress (PHQ-9 and GAD-7), pain catastrophising (PCS), and pain severity/interference (BPI) were assessed at the beginning and end of support. Integrating the program within a multidisciplinary pain unit intended to facilitate and provide participants with an understanding of their pain through a psychosocial lens, build self-efficacy, and recognise the benefits of other non-medical supports to manage their chronic pain in the future. Outcome data were routinely collected as part of FMC PMU usual practice for clinical and quality assurance purposes, then analysed retrospectively. Thus, under the National Health and Medical Research Council (NHMRC) Ethical Considerations in Quality Assurance and Evaluation Activities guidelines (NHMRC, 2014), and verified by the Southern Adelaide Local Health Network (SALHN) Research Committee (our institutional review board) via email (dated 10/09/2020), ethical review and approval were not required for this project as it constituted a quality improvement activity – specifically, a service delivery evaluation. This project is registered with the SALHN Quality Library (for quality assurance activities that are exempt from ethical approval) (Quality Register ID 3390).

RESULTS: Participants showed statistically significant improvements on the PHQ-9 [i.e., mean drop of 2.85 (t = 3.16)], GAD [mean drop of 2.52 (t = 2.71)], and PCS [mean drop of 7.77 (t = 3.47)] with small-to-moderate effect sizes. BPI scores did not change. Results were similar when stratifying analyses by those who completed 2-5 versus 6-12 sessions.

CONCLUSION: Integrating a GSH program for people with chronic pain into a multidisciplinary tertiary pain clinic is an efficacious and scalable way to increase access to effective strategies that can increase self-efficacy and self-management. Novel, scalable, and effective solutions are needed to improve quality of life and address disparities for people with chronic pain. The psychological shifts and benefits observed support efficacy towards self-management strategies that can increase autonomy and quality of life.

PMID:36595182 | DOI:10.1007/s40122-022-00464-z

Environ Sci Pollut Res Int. 2023 Jan 3. doi: 10.1007/s11356-022-24907-4. Online ahead of print.

ABSTRACT

With rising global production and population, the globalized globe has also seen severe environmental damage. This is why renewable energy sources are important for the planet’s future and human progress. In order to fight climate change and decrease emissions, promoting energy efficiency is one of the most valuable strategies. Trade patterns across borders, however, have significantly evolved. This analysis provides new evidence regarding the influence of technological progress, and more specifically, industrial innovation, on the OECD countries’ international competitiveness. This article aims to analyse the effects of international commerce, FDI, and human capital on the development of renewable energy sources, energy efficiency measures, and cutting-edge technologies. In this analysis, we look at how different variables, including GDP per capita, trade, FDI, human capital, and urbanization, affect one another. To conduct the analysis, researchers used a pool of annual time series data from 2000 to 2019 for OECD economies. The long-term relationship between the variables is estimated using the AMG estimation, Cup-FM, and Cup-BC test. AMG estimation, Cup-FM estimation, and Cup-BC estimation were all used, providing valid results for the investigation. Research shows that energy efficiency, renewable energy, and technological innovation are negatively affected by FDI and urbanization but positively affected by GDP per capita, trade, and human capital. There is no statistically significant effect of human capital on the dependent variables. The estimated results also provide important policy consequences for the chosen and the other emerging economies in creating an adequate route ahead to sustainable development.

PMID:36595169 | DOI:10.1007/s11356-022-24907-4

Lasers Med Sci. 2023 Jan 3;38(1):30. doi: 10.1007/s10103-022-03697-8.

ABSTRACT

The aim of this study was to examine the effectiveness of different irrigation activation methods on smear layer removal and tubular penetration. One hundred-five distal roots of mandibular molar teeth in total; 50 for smear removal efficiency (n = 10) analysis using scanning electron microscopy (SEM), and 55 roots were used to examine tubular penetration using confocal laser scanning microscope (CLSM). Five different irrigation activation methods were used in this study; conventional needle irrigation (CNI), sonic irrigation device of EDDY, passive ultrasonic irrigation (PUI), PIPS and SWEEPS techniques, which are two different laser irrigation activation methods. The obtained data were statistically analyzed and the significance level was determined as p < 0.05. At the apical level, the cleanest canal walls were observed when laser methods PIPS and SWEEPS were used, while in the middle third, there was no difference in smear removal efficiencies between all groups except for the CNI (p > 0.05). Penetration depths and percentages increased from apically to coronally in all groups. The PUI and EDDY generally showed similar penetration depths and percentages to the CNI, except at the coronal root level (p > 0.05). In all groups, when PIPS was used, it showed greater penetration depth and percentage (p < 0.05). PIPS and SWEEPS techniques showed lowest and similar smear scores compared to PUI and EDDY in the apical area where access and effectiveness of the irrigation solution are difficult.

PMID:36595139 | DOI:10.1007/s10103-022-03697-8

Int J Clin Oncol. 2023 Jan 3. doi: 10.1007/s10147-022-02283-w. Online ahead of print.

ABSTRACT

BACKGROUND: Cabozantinib was established as the standard of care for the treatment of patients with renal cell carcinoma (RCC) whose disease had progressed after vascular endothelial growth factor receptor tyrosine kinase inhibitor (VEGFR-TKI) therapy in the global randomized trial METEOR. A phase 2 study was conducted to bridge the findings in METEOR to Japanese patients. Here, we report a biomarker analysis and update the efficacy and safety results of cabozantinib treatment.

METHODS: Japanese patients with RCC who received at least one prior VEGFR-TKI were enrolled and received cabozantinib 60 mg orally once daily. The primary endpoint was objective response rate. Secondary endpoints included progression-free survival, overall survival, and safety. Exploratory analyses included the relationship between plasma protein hepatocyte growth factor (HGF) levels and treatment responses.

RESULTS: In total, 35 patients were enrolled. The median treatment duration was 58.3 (range 5.1-131.4) weeks. The objective response rate was 25.7% (90% confidence interval [CI] 14.1-40.6). Kaplan-Meier estimate of median progression-free survival was 11.1 months (95% CI 7.4-18.4). The estimated progression-free survival proportion was 73.1% (95% CI 54.6-85.0) at 6 months. Median overall survival was not reached. Adverse events were consistent with those in METEOR and the safety profile was acceptable. Nonresponders to cabozantinib showed relatively higher HGF levels than responders at baseline.

CONCLUSIONS: Updated analyses demonstrate the long-term efficacy and safety of cabozantinib in Japanese patients with advanced RCC after at least one VEGFR-TKI therapy. Responders tended to show lower baseline HGF levels ClinicalTrials.gov Identifier: NCT03339219.

PMID:36595123 | DOI:10.1007/s10147-022-02283-w

Eur J Epidemiol. 2023 Jan 3. doi: 10.1007/s10654-022-00947-5. Online ahead of print.

ABSTRACT

Pregnancy-related factors are important for short- and long-term health in mothers and offspring. The nationwide population-based Swedish Medical Birth Register (MBR) was established in 1973. The present study describes the content and quality of the MBR, using original MBR data, Swedish-language and international publications based on the MBR.The MBR includes around 98% of all births in Sweden. From 1982 onwards, the MBR is based on prospectively recorded information in standardized antenatal, obstetric, and neonatal records. When the mother and infant are discharged from hospital, this information is forwarded to the MBR, which is updated annually. Maternal data include information from first antenatal visit on self-reported obstetric history, infertility, diseases, medication use, cohabitation status, smoking and snuff use, self-reported height and measured weight, allowing calculation of body mass index. Birth and neonatal data include date and time of birth, mode of delivery, singleton or multiple birth, gestational age, stillbirth, birth weight, birth length, head circumference, infant sex, Apgar scores, and maternal and infant diagnoses/procedures, including neonatal care. The overall quality of the MBR is very high, owing to the semi-automated data extraction from the standardized regional electronic health records, Sweden’s universal access to antenatal care, and the possibility to compare mothers and offspring to the Total Population Register in order to identify missing records. Through the unique personal identity numbers of mothers and live-born offspring, the MBR can be linked to other health registers. The Swedish MBR contains high-quality pregnancy-related information on more than 5 million births during five decades.

PMID:36595114 | DOI:10.1007/s10654-022-00947-5