Category: Statistics

Sud Med Ekspert. 2023;66(3):24-28. doi: 10.17116/sudmed20236603124.

ABSTRACT

The aim of this study is to estimate the variability limits of craniometric skull parameters, revealed in Kazakhstan, and find out significant criteria for forensic medical identification of the local population. The investigation included 25 standard craniometric skull parameters, revealed in Kazakhstan. Standard antropometric tests and tools were used. Current study confirm that the craniometrics indicators of Kazakhstan population have specific regional features. The skulls, revealed in Kazakhstan, are well craniometrically differentiated. Statistically significant differences were found out in 6 craniometric parameters in men (width of skull base, frontal chord, full face height, condylar and bigonial width, mandibular height) and in 4 parameters in women (transverse diameter, width of skull base, mastoid width, width of occipital foramen). The usage of updated data according to the regional features of the craniometrics parameters allow to significantly improve the forensic identification accuracy, study more completely the biological regularities of population formation and assess the comparative efficacy of individual features in the population reconstructions.

PMID:37192455 | DOI:10.17116/sudmed20236603124

Sud Med Ekspert. 2023;66(3):14-17. doi: 10.17116/sudmed20236603114.

ABSTRACT

The aim of this study was to establish the degree of projectile incidence angle with obstacle on forensic medical characteristic of gunshot injuries arising from smoothbore weapon fire and bullet ricochet. Based on the comprehensive forensic study results of experimental entry gunshot injuries, statistically significant differences in the following morphological signs were found for two ranges of incidence angle values (10-20° and 30-50°): «Number of MD», «Length 1 MD», «Length 2 MD», «Width 1 MD», «Orientation of AD to the conventional clock face relative to MD 1 or to the group of largest MD (max. value)». The medians and limits of 99% confidence intervals of these features values were observed depending on the range of incidence angle values. The revealed patterns can be used in expert practice during forensic medical examination of gunshot injuries formed as a result of a projectile ricochet after smoothbore weapon fire, as well as to develop a methodology for conducting a forensic study of this gunshot injury type.

PMID:37192453 | DOI:10.17116/sudmed20236603114

Am J Respir Crit Care Med. 2023 May 16. doi: 10.1164/rccm.202301-0071OC. Online ahead of print.

ABSTRACT

RATIONALE: Phosphodiesterase-4 inhibitors (PDE4i) have demonstrated increased efficacy in COPD patients with chronic bronchitis or higher blood eosinophil counts. Further characterization of patients most likely to benefit is warranted.

OBJECTIVE: To identify determinants of response to the PDE4-inhibitor tanimilast .

METHODS: A PDE4-gene-expression signature in blood was developed by unsupervised clustering of the ECLIPSE study dataset (ClinTrial.gov: NCT00292552; Gene-Expression Series: GSE76705). The signature was further evaluated using blood and sputum transcriptome data from the BIOMARKER study (NCT03004417; GSE133513), enabling validation of the association between PDE4-signaling and target biomarkers. Predictivity of the associated biomarkers against clinical response was then tested in the phase-2b PIONEER tanimilast study (NCT02986321).

MEASUREMENTS AND MAIN RESULTS: The PDE4-gene-expression signature developed in the ECLIPSE dataset classified subgroups of patients associated to different PDE4-signaling in the BIOMARKER cohort with Area-Under the Receiver-Operated-Curve of 98%. In the BIOMARKER study, serum interleukin-8 was the only variable consistently associated to PDE4-signaling, with lower levels associated to higher PDE4-activity. In the PIONEER study the exacerbation rate reduction mediated by tanimilast treatment increased up to 2-fold in patients with lower interleukin-8 levels; 36% vs 18%, reaching statistically significance ≤20pg/mL (p=0.035). The combination with blood eosinophils ≥150µL-1 or chronic bronchitis provided further additive exacerbation rate reduction: 45% (p=0.013) and 47% (p=0.027), respectively.

CONCLUSIONS: This analysis using selected heterogeneous datasets identifies interleukin-8 as an independent predictor of PDE4 inhibition, as tanimilast had a greater effect on exacerbation prevention in COPD patients with lower baseline serum interleukin-8. Testing of this biomarker in other datasets is warranted.

PMID:37192443 | DOI:10.1164/rccm.202301-0071OC

J Am Acad Orthop Surg. 2023 May 16. doi: 10.5435/JAAOS-D-22-00878. Online ahead of print.

ABSTRACT

INTRODUCTION: Posterior lumbar fusion surgery has become more common amid an aging population, with degenerative disease as its most common indication. Historically, postoperative pain control for spine surgery has relied on opioids. However, opioid use is associated with adverse effects such as dependence, respiratory depression, and altered cognition. Our study aimed to determine whether an opioid-sparing multimodal analgesia regimen (ketorolac, orphenadrine, and gabapentin) could be a viable alternative to diminish opioid use compared with a standard opioid-based regimen in Hispanic patients undergoing posterior lumbar spinal fusion.

METHODS: This was a randomized controlled trial of Hispanic patients scheduled to undergo elective posterior spinal fusion. Inclusion criteria included age 30 to 85 years, Hispanic ethnicity, lumbar stenosis between L1 and S1, elective posterior spinal fusion with instrumentation, American Society of Anesthesiologists Score <2, and consent to participate in the study. Patients were randomized into two groups, an experimental multimodal analgesia and control (opioid-based) treatment groups, and outcomes such as morphine milligram equivalents used, visual analog scale score, and length of hospital stay were compared between the groups.

RESULTS: The MMA experimental group used significantly lower amounts of opioid (measured with morphine milligram equivalent) than the opioid-based group during the 12-hour and 24-hour postoperative periods (P-value = 0.023 and P-value = 0.033, respectively). No statistically significant difference was observed in opioid use in the 48-hour postoperative period between both groups (P-value = 0.066). The MMA group had significantly lower VAS scores reported at the 12-hour, 24-hour, and 48-hour postoperative periods compared with the opioid-based group (P-values = 0.016, 0.020, and 0.020, respectively). No difference was observed in the length of hospital stay between groups (P-value = 0.169).

DISCUSSION: Implementing an MMA protocol in Hispanic patients undergoing posterior lumbar fusion resulted in decreased overall opioid use and decreased pain intensity compared with the opioid-based group. MMA is an effective alternative for pain control in patients who want to avoid opioid use.

CLINICAL TRIAL REGISTRATION: Identifier: NCT05413902.

PMID:37192425 | DOI:10.5435/JAAOS-D-22-00878

J Am Acad Orthop Surg. 2023 May 16. doi: 10.5435/JAAOS-D-22-00800. Online ahead of print.

ABSTRACT

INTRODUCTION: Sacroiliac joint (SIJ) fusion is a surgical treatment option for SIJ pathology in select patients who have failed conservative management. More recently, minimally invasive surgical (MIS) techniques have been developed. This study aimed to determine the trends in procedure volume and reimbursement rates for SIJ fusion.

METHODS: Publicly available Medicare databases were assessed using the National Summary Data Files for 2010 to 2020. Files were organized according to current procedural terminology (CPT) codes. CPT codes specific to open and MIS SI joint fusion (27279 and 27280) were identified and tracked. To track surgeon reimbursements, the CMS Medicare Physician Fee Schedule Look-Up Tool was used to extract facility prices. Descriptive statistics and linear regression were used to evaluate trends in procedure volume, utilization, and reimbursement rates. Compound annual growth rates were calculated, and discrepancies in inflation were corrected for using the Consumer Price Index.

RESULTS: A total of 33,963 SIJ fusions were conducted in the Medicare population between 2010 and 2020, with an overall increase in procedure volume of 2,350.9% from 318 cases in 2010 to 7,794 in 2020. Since the introduction of the 27279 CPT code in 2015, 8,806 cases (31.5%) have been open and 19,120 (68.5%) have been MIS. Surgeon reimbursement for open fusions increased nominally by 42.8% (inflation-adjusted increase of 20%) from $998 in 2010 to $1,425 in 2020. Meanwhile, reimbursement for MIS fusion experienced a nominal increase of 58.4% (inflation-adjusted increase of 44.9%) from $582 in 2015 to $922 in 2020.

CONCLUSION: SIJ fusion volume in the Medicare population has increased substantially in the past 10 years, with MIS SIJ fusion accounting for most of the procedures since the introduction of the 27279 CPT code in 2015. Reimbursement rates for surgeons have also increased for both open and MIS procedures, even after adjusting for inflation.

PMID:37192412 | DOI:10.5435/JAAOS-D-22-00800

J Am Assoc Nurse Pract. 2023 May 16. doi: 10.1097/JXX.0000000000000893. Online ahead of print.

ABSTRACT

BACKGROUND: The human papilloma virus (HPV) is the leading cause of cervical cancer worldwide and is responsible for genital warts and five other types of cancers. The HPV vaccine was introduced in 2006 and demonstrated to be safe and more effective than expected, yet adolescent rates of immunization in the United States remain low.

LOCAL PROBLEM: Adolescent HPV vaccine rates were below the national average, and effective vaccine recommendation strategies were not used at an urban pediatric primary care office in southern Florida.

METHODS: The percentage of HPV vaccine rates in this primary care office were measured among adolescents ages 13-17 years using data obtained from Florida’s state vaccine registry before implementation of the intervention, after the intervention, and monthly over a 90-day period.

INTERVENTIONS: Interventions aimed to improve vaccine rates included implementing an HPV protocol consisting of education on providing a strong bundled recommendation, appointing a vaccine champion, implementing standing vaccine orders, and educational materials.

RESULTS: The vaccine rates among adolescents increased by 11% for the initial dose, 7% for the second dose, and 6% for the vaccine completion rate. Chi-square test demonstrated statistical significance, for the initial vaccine.

CONCLUSION: A nurse practitioner-led application of an evidenced-based HPV vaccine protocol positively affected the care of adolescents in this primary care setting.

PMID:37192408 | DOI:10.1097/JXX.0000000000000893

Swiss Med Wkly. 2023 May 15;153:40072. doi: 10.57187/smw.2023.40072.

ABSTRACT

INTRODUCTION: The combined use of intraoperative MRI and awake surgery is a tailored microsurgical resection to respect functional neural networks (mainly the language and motor ones). Intraoperative MRI has been classically considered to increase the extent of resection for gliomas, thereby reducing neurological deficits. Herein, we evaluated the combined technique of awake microsurgical resection and intraoperative MRI for primary brain tumours (gliomas, metastasis) and epilepsy (cortical dysplasia, non-lesional, cavernomas).

PATIENTS AND METHODS: Eighteen patients were treated with the commonly used “asleep awake asleep” (AAA) approach at Lille University Hospital, France, from November 2016 until May 2020. The exact anatomical location was insular with various extensions, frontal, temporal or fronto-temporal in 8 (44.4%), parietal in 3 (16.7%), fronto-opercular in 4 (22.2%), Rolandic in two (11.1%), and the supplementary motor area (SMA) in one (5.6%).

RESULTS: The patients had a mean age of 38.4 years (median 37.1, range 20.8-66.9). The mean surgical duration was 4.1 hours (median 4.2, range 2.6-6.4) with a mean duration of intraoperative MRI of 28.8 minutes (median 25, range 13-55). Overall, 61% (11/18) of patients underwent further resection, while 39% had no additional resection after intraoperative MRI. The mean preoperative and postoperative tumour volumes of the primary brain tumours were 34.7 cc (median 10.7, range 0.534-130.25) and 3.5 cc (median 0.5, range 0-17.4), respectively. Moreover, the proportion of the initially resected tumour volume at the time of intraoperative MRI (expressed as 100% from preoperative volume) and the final resected tumour volume were statistically significant (p= 0.01, Mann-Whitney test). The tumour remnants were commonly found posterior (5/9) or anterior (2/9) insular and in proximity with the motor strip (1/9) or language areas (e.g. Broca, 1/9). Further resection was not required in seven patients because there were no remnants (3/7), cortical stimulation approaching eloquent areas (3/7) and non-lesional epilepsy (1/7). The mean overall follow-up period was 15.8 months (median 12, range 3-36).

CONCLUSION: The intraoperative MRI and awake microsurgical resection approach is feasible with extensive planning and multidisciplinary collaboration, as these methods are complementary and synergic rather than competitive to improve patient oncological outcomes and quality of life.

PMID:37192405 | DOI:10.57187/smw.2023.40072

Adv Gerontol. 2023;36(1):83-88.

ABSTRACT

The object of the study was senile people, who sought dental orthopedic care in municipal healthcare institutions of the town of Cheboksary, the Chuvash Republic. The sample size was 1 000 people. The obtained quantitative indicators were subjected to statistical processing using parametric and nonparametric statistical methods. The analysis of mounted orthopedic dent prosthetic structures manufactured and installed in elderly and senile patients shows that the choice of material and method of manufacture is largely determined by such a social factor as the average monthly income. This, in turn, largely depends on income-generating employment and the possibility of obtaining additional financial support from family members in which the patient lives. Social factors have a significant impact on the quality of life in elderly and senile people.

PMID:37192359

Environ Sci Technol. 2023 May 16. doi: 10.1021/acs.est.3c00845. Online ahead of print.

ABSTRACT

There are widespread policy assumptions that the phase-out of gasoline and diesel internal combustion engines will over time lead to much reduced emissions of Volatile Organic Compounds (VOCs) from road transport and related fuels. However, the use of real-world emissions measurements from a new mobile air quality monitoring station demonstrated a large underestimation of alcohol-based species in road transport emissions inventories. Scaling of industry sales statistics enabled the discrepancy to be attributed to the use of ancillary solvent products such as screenwash and deicer which are not included in internationally applied vehicle emission methodologies. A fleet average nonfuel nonexhaust VOC emission factor of 58 ± 39 mg veh^-1 km^-1 was calculated for the missing source, which is greater than the total of all VOCs emitted from vehicle exhausts and their associated evaporative fuel losses. These emissions are independent of the vehicle energy/propulsion system and therefore applicable to all road vehicle types including those with battery-electric powertrains. In contrast to predictions, vehicle VOC emissions may actually increase given a predicted growth in total vehicle kilometers driven in a future electrified fleet and will undergo a complete VOC respeciation due to the source change.

PMID:37191998 | DOI:10.1021/acs.est.3c00845

JMIR Serious Games. 2023 May 16;11:e40931. doi: 10.2196/40931.

ABSTRACT

BACKGROUND: Cognitive assessment using tangible objects can measure fine motor and hand-eye coordination skills along with other cognitive domains. Administering such tests is often expensive, labor-intensive, and error prone owing to manual recording and potential subjectivity. Automating the administration and scoring processes can address these difficulties while reducing time and cost. e-Cube is a new vision-based, computerized cognitive assessment tool that integrates computational measures of play complexity and item generators to enable automated and adaptive testing. The e-Cube games use a set of cubes, and the system tracks the movements and locations of these cubes as manipulated by the player.

OBJECTIVE: The primary objectives of the study were to validate the play complexity measures that form the basis of developing the adaptive assessment system and evaluate the preliminary utility and usability of the e-Cube system as an automated cognitive assessment tool.

METHODS: This study used 6 e-Cube games, namely, Assembly, Shape-Matching, Sequence-Memory, Spatial-Memory, Path-Tracking, and Maze, each targeting different cognitive domains. In total, 2 versions of the games, the fixed version with predetermined sets of items and the adaptive version using the autonomous item generators, were prepared for comparative evaluation. Enrolled participants (N=80; aged 18-60 years) were divided into 2 groups: 48% (38/80) of the participants in the fixed group and 52% (42/80) in the adaptive group. Each was administered the 6 e-Cube games; 3 subtests of the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV; Block Design, Digit Span, and Matrix Reasoning); and the System Usability Scale (SUS). Statistical analyses at the 95% significance level were applied.

RESULTS: The play complexity values were correlated with the performance indicators (ie, correctness and completion time). The adaptive e-Cube games were correlated with the WAIS-IV subtests (r=0.49, 95% CI 0.21-0.70; P<.001 for Assembly and Block Design; r=0.34, 95% CI 0.03-0.59; P=.03 for Shape-Matching and Matrix Reasoning; r=0.51, 95% CI 0.24-0.72; P<.001 for Spatial-Memory and Digit Span; r=0.45, 95% CI 0.16-0.67; P=.003 for Path-Tracking and Block Design; and r=0.45, 95% CI 0.16-0.67; P=.003 for Path-Tracking and Matrix Reasoning). The fixed version showed weaker correlations with the WAIS-IV subtests. The e-Cube system showed a low false detection rate (6/5990, 0.1%) and was determined to be usable, with an average SUS score of 86.01 (SD 8.75).

CONCLUSIONS: The correlations between the play complexity values and performance indicators supported the validity of the play complexity measures. Correlations between the adaptive e-Cube games and the WAIS-IV subtests demonstrated the potential utility of the e-Cube games for cognitive assessment, but a further validation study is needed to confirm this. The low false detection rate and high SUS scores indicated that e-Cube is technically reliable and usable.

PMID:37191993 | DOI:10.2196/40931