Category: Statistics

J Laparoendosc Adv Surg Tech A. 2022 Dec 29. doi: 10.1089/lap.2022.0514. Online ahead of print.

ABSTRACT

Purpose: The aim of this study is to investigate the effect of bladder neck plication during transperitoneal robot-assisted radical prostatectomy (tRARP) on orgasm-related incontinence (climacturia) and the relationship between International Index of Erectile Function 5 (IIEF-5) scores and climacturia. Materials and Methods: We evaluated 118 patients who underwent nerve-sparing tRARP in our clinic and survived the first postoperative year. Patients were divided into two groups: those who underwent bladder neck plication (Group 1, n = 58) and those who did not (Group 2, n = 60). Our study investigated whether there is a difference between the groups in terms of climacturia or if there is a relationship between IIEF-5 scores and climacturia. Results: Of the patients in Group 1, 10.3% had incontinence and 13.8% had climacturia. Of the patients in Group 2 who did not have bladder neck plication, 10% had incontinence and 15% had climacturia. There was no difference between the groups in terms of climacturia (P > .825). Three patients (5.2%) in Group 1 and four patients (6.6%) in Group 2 requested treatment. There was no statistically significant correlation between IIEF-5 scores and climacturia in both groups (Group 1, P > .208; and Group 2, P > .508). Conclusions: In our study, the frequency of climacturia in patients who underwent bladder neck plication during tRARP was consistent with the literature and did not show a statistically significant difference from patients who did not undergo bladder neck plication. It has been observed that bladder neck plication, which has no effect on long-term continence, does not contribute to prevention of climacturia. No correlation was found between IIEF-5 scores and climacturia.

PMID:36580546 | DOI:10.1089/lap.2022.0514

J Palliat Med. 2022 Dec 29. doi: 10.1089/jpm.2022.0360. Online ahead of print.

ABSTRACT

Background: Potentially burdensome transitions at the end of life (e.g., repeated hospitalizations toward the end of life and/or health care transitions in the last three days of life) are common among residential care/assisted living (RC/AL) residents, and are associated with lower quality of end-of-life care reported by bereaved family members. We examined the association between state RC/AL regulations relevant to end-of-life care delivery and the likelihood of residents experiencing potentially burdensome transitions. Methods: Retrospective cohort study combining RC/AL registries of states’ regulations with Medicare claims data for residents in large RC/ALs (i.e., 25+ beds) in the United States on the 120th day before death (N = 129,153), 2017-2019. Independent variables were state RC/AL regulations relevant to end-of-life care, including third-party services, staffing, and medication management. Analyses included: (1) separate logistic regression models for each RC/AL regulation, adjusting for sociodemographic covariates; (2) separate logistic regression models with a Medicare fee-for-service (FFS) subgroup to control for comorbidities, and (3) multivariable regression analysis, including all regulations in both the overall sample and the Medicare FFS subgroup. Results: We found a lack of associations between potentially burdensome transitions and regulations regarding third-party services and staffing. There were small associations found between regulations related to medication management (i.e., requiring regular medication reviews, permitting direct care workers for injections, requiring/not requiring licensed nursing staff for injections) and potentially burdensome transitions. Conclusions: In this cross-sectional study, the associations of RC/AL regulations with potentially burdensome transitions were either small or not statistically significant, calling for more studies to explain the wide variation observed in end-of-life outcomes among RC/AL residents.

PMID:36580545 | DOI:10.1089/jpm.2022.0360

Med J (Ft Sam Houst Tex). 2023 Jan-Mar;(Per 23-1/2/3):97-102.

ABSTRACT

INTRODUCTION: Airway obstruction is the second leading cause of potentially survivable death on the battlefield. The Committee on Tactical Combat Casualty Care (CoTCCC) has evolving recommendations for the optimal supraglottic airway (SGA) device for inclusion to the medics’ aid bag.

METHODS: We convened an expert consensus panel consisting of a mix of 8 prehospital specialists, emergency medicine experts, and experienced combat medics, with the intent to offer recommendations for optimal SGA selection. Prior to meeting, we independently reviewed previously published studies conducted by our study team, conducted a virtual meeting, and summarized the findings to the panel. The studies included an analysis of end-user after action reviews, a market analysis, engineering testing, and prospective feedback from combat medics. The panel members then made recommendations regarding their top 3 choices of devices including the options of military custom design. Simple descriptive statistics were used to analyze panel recommendations.

RESULTS: The preponderance (7/8, 88%) of panel members recommended the gel-cuffed SGA, followed by the self-inflating-cuff SGA (5/8, 62%) and laryngeal tube SGA (5/8, 62%). Panel members expressed concerns primarily related to the (1) devices’ tolerance for the military environment, and (2) ability to effectively secure the gel-cuffed SGA and the self-inflating-cuff SGA during transport.

CONCLUSIONS: A preponderance of panel members selected the gel-cuff SGA with substantial feedback highlighting the need for military-specific customizations to support the combat environment needs.

PMID:36580532

Med J (Ft Sam Houst Tex). 2023 Jan-Mar;(Per 23-1/2/3):57-63.

ABSTRACT

BACKGROUND: Introduction: Military Role 1 practitioners have difficulty maintaining skill competency by working solely in military medical treatment facilities. Recognizing this, the Army Medical Department has renewed focus on physician specialty-specific Individual Critical Task Lists (ICTL) and is increasing the number of military-civilian partnerships, wherein small military treatment teams work full-time in civilian trauma centers. Yet, data to validate this approach is lacking. We hypothesize military Role 1 practitioners working full-time at a civilian Level 1 trauma center would attain similar resuscitation-specific procedural frequency to providers deployed to an active combat zone, and use the emergency medicine (EM) ICTL to compare select procedural frequency between a cohort of trauma patients from a civilian Level 1 trauma center and a cohort of combat casualties from the Department of Defense Trauma Registry (DODTR).

METHODS: We compared a selected subset of critically-injured, military-aged (18-35 years) trauma patients who were seen in a Level I Trauma Center emergency department (ED) between January 1, 2016 and December 31, 2017 and dispositioned directly either to the operating room, intensive care unit, or morgue to a selected cohort from the Department of Defense Trauma Registry (DODTR) who were seen in EDs in Iraq and Afghanistan between January 2007 and August 2016 using descriptive statistics. The primary outcome was the frequency of ICTL procedures performed, and the secondary outcome was injury severity.

RESULTS: We identified 843 civilian patients meeting inclusion criteria, of 1,719 military-aged patients captured by the trauma registry during the study. The selected cohort from the DODTR included 27,359 patients. Demographics were similar between the 2 groups, except the DODTR cohort included significantly more patients with blast trauma (55% versus 0.4%). We found similar ICTL procedural frequency (1 procedure for every 1.84 patients in the civilian cohort compared to one procedure/1.52 patients in the military cohort).

CONCLUSION: Role-1 ICTL trauma procedures were performed at similar frequencies between civilian patients seen at a Level 1 trauma center and combat casualties. With proper practice implementation, the opportunity exists for Role 1 practitioners to maintain their trauma resuscitation skills at civilian trauma centers.

PMID:36580525

Med J (Ft Sam Houst Tex). 2023 Jan-Mar;(Per 23-1/2/3):34-40.

ABSTRACT

INTRODUCTION: Approximately 1.7 million people sustain traumatic brain injuries (TBI) annually in the US. To reduce morbidity and mortality, management strategies aim to control progressive intracranial bleeding. This study analyzes the association between Tranexamic Acid (TXA) administration and mortality among casualties within the Department of Defense Trauma Registry, specifically focusing on subsets of patients with varying degree of head injury severities.

METHODS: Besides descriptive statistics, we used inverse probability weighted (for age, military service category, mechanism of injury, total units of blood units administered), and injury severity (ISS) and Abbreviated Injury Scale (AIS) head score adjusted generalized linear models to analyze the association between TXA and mortality. Specific subgroups of interest were increasing severities of head injury and further stratifying these by Glasgow Coma Score of 3-8 and severe overall bodily injuries (ISS>=15).

RESULTS: 25,866 patients were included in the analysis. 2,352 (9.1%) received TXA and 23,514 (90.9%) did not receive TXA. Among those with ISS>=15 (n=6,420), 21.2% received TXA. Among those with any head injury (AIS head injury severity score>=1; n=9,153), 7.2% received TXA. The median ISS scores were greater in the TXA versus no-TXA group (17 versus 6). Weighted and adjusted models showed overall, there was 25% lower mortality risk between those who received TXA at any point and those who did not (OR:0.75, 95% CI: 0.59, 0.95). Further, as the AIS severity score increased from >=1 (1.08; 0.80, 1.47) to >=5 (0.56; 0.33, 0.97), the odds of mortality decreased.

CONCLUSIONS: TXA may potentially be beneficial in patients with severe head injuries, especially those with severe overall injury profiles. There is a need of definitive studies to confirm this association.

PMID:36580522

Vestn Otorinolaringol. 2022;87(6):11-13. doi: 10.17116/otorino20228706111.

ABSTRACT

OBJECTIVE: To assess the state of the thresholds of sound perception at speech frequencies in users of cochlear implantation (CI) systems with developed speech skills.

MATERIAL AND METHODS: The study involved 30 patients – users of CI systems, of whom 17 girls, 13 boys aged 6 to 14 years. All patients underwent speech audiometry in a free sound field twice (at the beginning of the study and after adjusting the settings of the speech processor). The ASSR (auditory steady-state responses) thresholds were recorded as the second stage to assess the perception of non-speech stimuli after adjusting the settings of the speech processor.

RESULTS: Correlation analysis was carried out between the percentage of speech intelligibility and the average ASSR thresholds. There was no statistically significant relationship between lowering the ASSR thresholds and speech intelligibility. The absence of a relationship between speech intelligibility and user satisfaction with the speech processor settings was revealed. Improving the intelligibility of the user’s speech by the CI system did not affect the improvement on the response to the addressed speech.

PMID:36580503 | DOI:10.17116/otorino20228706111

PLoS Comput Biol. 2022 Dec 29;18(12):e1010730. doi: 10.1371/journal.pcbi.1010730. Online ahead of print.

ABSTRACT

Large-scale genotype-phenotype screens provide a wealth of data for identifying molecular alterations associated with a phenotype. Epistatic effects play an important role in such association studies. For example, siRNA perturbation screens can be used to identify combinatorial gene-silencing effects. In bacteria, epistasis has practical consequences in determining antimicrobial resistance as the genetic background of a strain plays an important role in determining resistance. Recently developed tools scale to human exome-wide screens for pairwise interactions, but none to date have included the possibility of three-way interactions. Expanding upon recent state-of-the-art methods, we make a number of improvements to the performance on large-scale data, making consideration of three-way interactions possible. We demonstrate our proposed method, Pint, on both simulated and real data sets, including antibiotic resistance testing and siRNA perturbation screens. Pint outperforms known methods in simulated data, and identifies a number of biologically plausible gene effects in both the antibiotic and siRNA models. For example, we have identified a combination of known tumour suppressor genes that is predicted (using Pint) to cause a significant increase in cell proliferation.

PMID:36580499 | DOI:10.1371/journal.pcbi.1010730

J Infect Dis. 2022 Dec 29:jiac496. doi: 10.1093/infdis/jiac496. Online ahead of print.

ABSTRACT

BACKGROUND: There is an incompletely understood increased risk for cardiovascular disease (CVD) among people living with HIV (PLWH). We investigated if a collection of biomarkers were associated with CVD among PLWH. Mendelian randomization (MR) was used to identify potentially causal associations.

METHODS: Data from follow-up in 4 large trials among PLWH were used to identify 131 incident CVD cases and they were matched to 259 participants without incident CVD (controls). Tests of associations between 460 baseline protein levels and case status were conducted.

RESULTS: Univariate analysis found CLEC6A, HGF, IL6, IL10RB, and IGFBP7 as being associated with case status and a multivariate model identified 3 of these: CLEC6A (OR = 1.48, p = 0.037), HGF (OR = 1.83, p = 0.012) and IL6 (OR = 1.45, p = 0.016). MR methods identified 5 significantly associated proteins: AXL, CHI3L1, GAS6, IL6RA, and SCGB3A2.

CONCLUSIONS: These results implicate inflammatory and fibrotic processes as contributing to CVD. While some of these biomarkers are well established in the general population and in PLWH (IL6 and its receptor), some are novel to PLWH (HGF, AXL and GAS6) and some are novel overall (CLEC6A). Further investigation into; 1.) the uniqueness of these biomarkers in PLWH and 2.) the role of these biomarkers as targets among PLWH, is warranted.

PMID:36580481 | DOI:10.1093/infdis/jiac496

PLoS One. 2022 Dec 29;17(12):e0276726. doi: 10.1371/journal.pone.0276726. eCollection 2022.

ABSTRACT

Identification of small objects in fluorescence microscopy is a non-trivial task burdened by parameter-sensitive algorithms, for which there is a clear need for an approach that adapts dynamically to changing imaging conditions. Here, we introduce an adaptive object detection method that, given a microscopy image and an image level label, uses kurtosis-based matching of the distribution of the image differential to express operator intent in terms of recall or precision. We show how a theoretical upper bound of the statistical distance in feature space enables application of belief theory to obtain statistical support for each detected object, capturing those aspects of the image that support the label, and to what extent. We validate our method on 2 datasets: distinguishing sub-diffraction limit caveolae and scaffold by stimulated emission depletion (STED) super-resolution microscopy; and detecting amyloid-β deposits in confocal microscopy retinal cross-sections of neuropathologically confirmed Alzheimer’s disease donor tissue. Our results are consistent with biological ground truth and with previous subcellular object classification results, and add insight into more nuanced class transition dynamics. We illustrate the novel application of belief theory to object detection in heterogeneous microscopy datasets and the quantification of conflict of evidence in a joint belief function. By applying our method successfully to diffraction-limited confocal imaging of tissue sections and super-resolution microscopy of subcellular structures, we demonstrate multi-scale applicability.

PMID:36580473 | DOI:10.1371/journal.pone.0276726

PLoS One. 2022 Dec 29;17(12):e0279580. doi: 10.1371/journal.pone.0279580. eCollection 2022.

ABSTRACT

INTRODUCTION: Metabolic syndrome is a group of metabolic risk factors which are associated with an increased risk of cardiovascular disease and type2 diabetes. Nowadays, several studies have shown that the burden of metabolic syndrome is increasing among epileptic patients, and leads to MS-associated complications, including cardiovascular disease. However, getting published documents has been limited in Ethiopia and the study area. Therefore, we aimed to analyze the magnitude and associated factors of metabolic syndrome among epileptic patients in Dessie Comprehensive Specialized Hospital in compression with respective controls.

METHODS: Hospital-based comparative cross-sectional study design was implemented from June 25 to August 20, 2021. A total of 204 participants with an equal number of cases and controls (n = 102 each) were included. The data was collected through face-to-face interviews and biochemical analyses such as fasting blood glucose and lipid profiles were done through the enzymatic technique. The magnitude of metabolic syndrome was determined using both National Cholesterol Education Program Adult Treatment Panel III and International Diabetes Federation definition criteria. The STATA version 14 was used for statistical data analysis, and a comparison of categorical and continuous variables was done with χ2 and an independent t-test, respectively. The multivariable binary logistic regression analysis was used to identify factors associated with metabolic syndrome, and variables having a P-value of <0.05 were considered statistically significant.

RESULT: The prevalence of metabolic syndrome among the epileptic group was (25.5% in National Cholesterol Education Program Adult Treatment Panel III and 23.5% in International Diabetes Federation criteria), whereas it was 13.7% in National Cholesterol Education Program Adult Treatment Panel III and 14.7% in International Diabetes Federation criteria among control groups. According to the International Diabetes Federation criteria, low physical activity (adjusted odds ratio = 4.73, 95% CI: 1.08-20.68), taking multiple antiepileptic drugs (adjusted odds ratio = 8.08, 95% CI: 1.52-42.74), having a total cholesterol level of ≥ 200 mg/dl (adjusted odds ratio = 5.81, 95%: 1.32-41.13) and body mass index (adjusted odds ratio = 1.57, 95% CI = 1.16-2.11) were significantly associated with metabolic syndrome among epileptic participants. Applying National Cholesterol Education Program Adult Treatment Panel III criteria, taking multiple antiepileptic drugs (adjusted odds ratio = 6.81, 95% CI: 1.29-35.92), having a total cholesterol level > 200 mg/dl (adjusted odds ratio = 7.37, 95% CI: 1.32-41.13) and body mass index (adjusted odds ratio = 1.53, 96% CI: 1.16-2.01) were also significantly associated.

CONCLUSION: The prevalence of metabolic syndrome among epileptic patients was higher than that of control groups and reaches statistically significant by National Cholesterol Education Program Adult Treatment Panel III. Being on multiple antiepileptic drugs, body mass index, having low physical activity and raised total cholesterol were significantly associated with metabolic syndrome among the epileptic group. Therefore, it is better to focus on controlling weight, having sufficient physical exercise, and regular monitoring of total cholesterol levels in epileptic patients.

PMID:36580471 | DOI:10.1371/journal.pone.0279580