Category: Statistics

Clin Rheumatol. 2022 May 2. doi: 10.1007/s10067-022-06167-2. Online ahead of print.

ABSTRACT

Homelessness is a public health crisis and there is a paucity of information about patients with rheumatic disease experiencing homelessness. We sought to develop approaches to improve care for this unique patient population. We previously reported observations on 17 homeless patients with inflammatory arthritis (15 rheumatoid arthritis (RA), 2 psoriatic arthritis (PsA)). We obtained follow-up information from our original 17 patients and compared this to data summarized and published about them from 12 months previously. We also created and administered a 100-question needs assessment survey. Follow-up 12-month clinical information was available from 13/17 homeless and 13/17 non-homeless controls. Homeless patients remained less well with more disease than non-homeless patients-poorer access to clinic appointments (80% vs 91%, p < 0.05), more emergency services use (20 vs 5 ED visits), less DMARDs use (43% vs 100%, p < 0.01), and more steroid use (29% vs 0%, p < 0.01). Homeless patients also had higher inflammatory markers than non-homeless patients (ESR 32 vs 26 mm/h and CRP 17 vs 5 mg/L), although these findings were not statistically significantly different. Seventy-eight percent of homeless patients were stable, 14% improved, and 7% worse; 21% had stable controlled and 57% stable active disease vs 62% and 0% of non-homeless (p < 0.01). Among the homeless, 6 (4 RA, 2 PsA) completed the survey, 2 declined, and 9 could not be reached. All 6 had found housing although all still had housing insecurity; 4 (67%) were homeless in the past. Three out of six (50%) obtained housing from social assistance during hospitalization following disease exacerbation while homeless. The average monthly income was $873. 5/6 (83.3%), were unable to work due to health, and were in considerable pain that adversely impacted their physical and mental health and ability to perform ADLs. Their perceived “greatest need” included dental care, physical therapy, knee surgery, employment, socialization secondary to isolation, and stable housing. Our understanding of the unique challenges of patients with rheumatic disease experiencing homelessness is improved, but not complete. Strengthened collaboration between street medicine providers and rheumatologists is necessary to improve care for homeless patients, especially given poorer outcomes compared with non-homeless counterparts. Key Points • We report 12-month follow-up information from our original 17 homeless patients with inflammatory arthritis (related in this journal in 2021) and their responses to an extensive needs assessment survey designed to identify barriers to care. • Homeless patients with inflammatory arthritis continued to have worse disease outcomes, use more corticosteroids and less DMARDs, and be seen less often in rheumatology clinics and more frequently in emergency departments than their non-homeless counterparts. • Survey data indicated that social assistance during hospitalization was a key area where healthcare providers could intervene to provide housing security for homeless patients and improve outcomes. Patients perceived “greatest needs” went beyond housing and rheumatological care and critically included access to social/specialty services. • Street medicine is the direct delivery of healthcare to people experiencing homelessness wherever they reside. Our observations, obtained in collaboration with street medicine colleagues, suggest important and salutary opportunities for this partnership to improve care for these particular patients.

PMID:35499771 | DOI:10.1007/s10067-022-06167-2

Environ Sci Pollut Res Int. 2022 Apr 30. doi: 10.1007/s11356-022-19761-3. Online ahead of print.

ABSTRACT

Rapid urbanisation has had a significant negative influence on the water bodies that flow through and around urban areas. This study aims to evaluate the water quality and analyse the suitability for drinking and irrigation uses. This study envisaged assessing the water quality status of the groundwater using the pollution index of groundwater (PIG), ecological risk index (ERI) and multivariate statistical techniques, namely cluster analysis (CA) and principal component analysis (PCA), that were applied to differentiate the sources of water quality variation and determine the cause of pollution in the study area. Most groundwater is unsuitable for drinking and irrigation consumption, depending on analyses. PIG values indicated high pollution levels in the studied water body, rendering it unsuitable for any practical purpose. CA results showed the impact of surface water and treatment plant on groundwater. PCA was used to identify four important factors in the groundwater, including mineral and nutrient pollution, heavy metal pollution, organic pollution and faecal contamination. The deteriorating water quality of the groundwater was demonstrated to originate from vast sources of anthropogenic activities, especially municipal sewage discharge. Study wells had greater concentrations of Cl^– and Na⁺ in their water because seawater flows into the aquifer system and mixes with the marine aquifer matrix. Thus, the current work reveals how to employ the PIG and multivariate statistical approaches to obtain more accessible and more meaningful information about the water quality of groundwater and to identify the sources of pollution.

PMID:35499738 | DOI:10.1007/s11356-022-19761-3

Environ Sci Pollut Res Int. 2022 Apr 30. doi: 10.1007/s11356-022-20362-3. Online ahead of print.

ABSTRACT

Over the period 1980-2016, this study looks into the causal relations between carbon dioxide (CO₂) emissions, energy consumption (EC), foreign direct investment (FDI), and gross domestic product (GDP) in five South Asian countries (Bangladesh, India, Nepal, Pakistan, and Sri Lanka). To achieve the research objectives, panel unit root tests, panel co-integration, autoregressive distributed lag model, and Granger causality tests are used. In the long run, GDP has a positive impact on CO₂ emissions, while squared GDP has a negative impact, confirming the framework of the environmental Kuznets curve (EKC) in Pakistan and Sri Lanka. However, in the short run along with these two countries, Bangladesh also confirms the EKC hypothesis. Among these five countries, Bangladesh and Nepal support the pollution haven hypothesis, but India, Pakistan, and Sri Lanka support the FDI halo hypothesis. The EC has a large positive impact on CO₂ emissions across five countries. In the long run, the Granger causality test confirms one-way causation from EC to CO₂ emissions and bidirectional causality of FDI and CO₂. These countries might encourage clean energy technology through FDI without jeopardizing GDP and environmental quality. The findings of the study provide a guideline for these countries to reduce CO₂ emissions, achieve a long-term green GDP, and combat global warming.

PMID:35499737 | DOI:10.1007/s11356-022-20362-3

Appl Biochem Biotechnol. 2022 May 2. doi: 10.1007/s12010-022-03945-1. Online ahead of print.

ABSTRACT

Batch experiments were performed to evaluate the biohydrogen and biomethane production by co-digestion of chicken manure and food waste in a two-stage mesophilic fermentation process. Results showed that no hydrogen was produced in the first stage of sole chicken manure fermentation, while methane yield was 247.3 mL·g^-1-VS. By comparison, the co-digestion process with food waste proportions of 50-85% obtained hydrogen yields of 15.5-57.5 mL·g^-1-VS, and the methane yields and maximum specific methane production rates were also improved by 7.0-16.7% and 80%, respectively. Moreover, the highest hydrogen and methane yields were achieved during sole food waste fermentation process. The acetate was the main volatile fatty acid (VFA) produced during sole chicken manure fermentation process in the first stage. Statistical analysis revealed that hydrogen production from co-digestion process and sole food waste fermentation process followed the n-butyrate-type pathway. Meanwhile, it should be noticed that the co-fermentation of chicken manure and food waste had antagonistic effects on the hydrogen fermentation, implying that there might be some inhibition factors existing in chicken manure or produced during the co-fermentation process. At the beginning of methane fermentation, the VFA profiles were similar to those at the end of hydrogen fermentation, and the main VFA compositions changed to acetate and propionate in the latter period of methane production. The volatile solid removal efficiencies were also promoted in co-digestion process compared with sole chicken manure digestion, which were increased by 9.7-14.4% with food waste proportions of 50-80%.

PMID:35499692 | DOI:10.1007/s12010-022-03945-1

J Math Biol. 2022 May 2;84(6):46. doi: 10.1007/s00285-022-01756-w.

ABSTRACT

This paper deals with a system of reaction-diffusion-advection equations for a generalist predator-prey model in open advective environments, subject to an unidirectional flow. In contrast to the specialist predator-prey model, the dynamics of this system is more complex. It turns out that there exist some critical advection rates and predation rates, which classify the global dynamics of the generalist predator-prey system into three or four scenarios: (1) coexistence; (2) persistence of prey only; (3) persistence of predators only; and (4) extinction of both species. Moreover, the results reveal significant differences between the specialist predator-prey system and the generalist predator-prey system, including the evolution of the critical predation rates with respect to the ratio of the flow speeds; the take-over of the generalist predator; and the reduction in parameter range for the persistence of prey species alone. These findings may have important biological implications on the invasion of generalist predators in open advective environments.

PMID:35499718 | DOI:10.1007/s00285-022-01756-w

Clin Oral Investig. 2022 May 2. doi: 10.1007/s00784-022-04514-w. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this randomized clinical trial (RCT) was to explore the clinical survival of a new, Bis-GMA-free pit and fissure sealant (Helioseal F Plus) in comparison to an established control material (Helioseal F).

MATERIAL AND METHODS: This in vivo study was designed as a prospective, 2-year, two-centre RCT with a split-mouth design. The initial study population consisted of 92 adolescents who were followed up 1 month (N = 89), 6 months (N = 88), 1 year (N = 85) and 2 years (N = 82) after sealant application. The attrition rate was 10.9% after 2 years. At each examination, the sealant retention and presence of caries were recorded. The statistical analysis included the calculation of Kaplan-Meier survival curves, log-rank tests and a Cox proportional hazard regression model.

RESULTS: No adverse events during the application or any of the follow-up visits were documented. The proportion of completely intact sealants and those with minimal loss was almost identical in both groups at 85.9% (Helioseal F Plus) and 86.5% Helioseal F) after 2 years of observation. The regression analysis revealed operator dependency; no significant differences were found between the materials, the study centres, the chosen isolation technique and patient age or sex.

CONCLUSION: The newly developed sealant can be evaluated as at least equivalent in terms of survival and retention behaviour compared to the established control material.

CLINICAL RELEVANCE: The new sealant can be recommended for clinical use. With respect to the material properties (Bis-GMA-free, less light polymerisation time and better thixotropic behaviour), it offers additional advantages with clinical relevance.

PMID:35499655 | DOI:10.1007/s00784-022-04514-w

Mov Disord. 2022 May 2. doi: 10.1002/mds.29033. Online ahead of print.

ABSTRACT

BACKGROUND: Early diagnosis in patients with neurodegenerative disorders is crucial to initiate disease-modifying therapies at a time point where progressive neurodegeneration can still be modified.

OBJECTIVES: The objective of this study was to determine whether motor or non-motor signs of the disease occur as indicators of a prodromal phase of X-linked dystonia-parkinsonism (XDP), a highly-penetrant monogenic movement disorder with striking basal ganglia pathology.

METHODS: In addition to a comprehensive clinical assessment, sensor-based balance and gait analyses were performed in non-manifesting mutation carriers (NMCs), healthy controls (HCs), and patients with XDP. Gradient-boosted trees (GBT) methodology was utilized to classify groups of interest.

RESULTS: There were no clinically overt disease manifestations in the NMCs. Balance analysis, however, revealed a classification accuracy of 90% for the comparison of NMC versus HC. For the gait analysis, the best-performing GBT-based model showed a balanced accuracy of 95% (NMC vs. HC; walking at maximum speed). Using a separate analysis of genetic modifiers, several gait parameters correlated strongly with the estimated age at disease onset in the NMC group.

CONCLUSIONS: Our study unraveled balance and gait abnormalities in NMCs that preceded the onset of XDP. These findings demonstrate prodromal motor changes among NMCs who will develop XDP with a very high likelihood in the future. Gait abnormalities had a predictive value for the estimated age at onset highlighting the impact of genetic modifiers in personalized treatment in monogenic neurodegenerative disorders. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

PMID:35491955 | DOI:10.1002/mds.29033

Scand J Public Health. 2022 May 1:14034948221089769. doi: 10.1177/14034948221089769. Online ahead of print.

ABSTRACT

AIM: To analyse the associations between bullying victimisation, disability, and self-reported psychosomatic complaints in adolescents, and to investigate the role of support from parents and teachers in such associations.

METHODS: The study was based on Finnish and Swedish data from two waves (2013/2014 and 2017/2018) of the Health Behaviour in School-aged Children survey (n=16,057). Descriptive statistics were produced for four groups of adolescents: (a) bullied with disabilities; (b) not bullied with disabilities; (c) bullied without disabilities; and (d) not bullied without disabilities (reference group). Two multilevel multinomial logistic regression models were performed for the Finnish and Swedish samples separately. The first model analysed associations between psychosomatic complaints and bullying victimisation, controlling for a range of confounders. The second model analysed associations between psychosomatic complaints and social support from parents and teachers.

RESULTS: Across both countries, bullied adolescents with disabilities were more likely to self-report psychosomatic complaints than the reference group, even after adjusting for other potential confounders. Teacher support was identified as a potential protective factor as the odds ratio for psychosomatic complaints decreased when including teacher support as a factor in the model. The association with parent support showed mixed findings in Finland and Sweden.

CONCLUSIONS: Disability in combination with bullying victimisation generated the highest levels of self-reported psychosomatic complaints compared to adolescents that were not bullied nor had disabilities. High teacher support may be a protective factor against psychosomatic complaints for bullied and/or disabled adolescents.

PMID:35491912 | DOI:10.1177/14034948221089769

Vascular. 2022 Apr 30:17085381221094943. doi: 10.1177/17085381221094943. Online ahead of print.

ABSTRACT

BACKGROUND: Acute peripheral arterial ischemia (APAI) is an acute ischemic condition that develops as a result of embolism or thrombosis, and its morbidity and mortality are still high today. The objective of this study is to determine the effect of preoperative Neutrophil-to-Lymphocyte ratio (NLR) on mortality in patients admitted with the diagnosis of APAI.

METHODS: 178 patients who were diagnosed with acute peripheral arterial occlusion and underwent emergency embolectomy were evaluated retrospectively over a 7-year period. Patient demographics, clinical history, risk factors, comorbidity, and hemogram sub-parameters were documented. The endpoint of the patients was determined as death.

RESULTS: A total of 178 patients were identified with a mean age 74.29±14.71 (range 28-111) years; among them, 105 (59%) were female. 18% patients (32/178) died within 30 days. Lower extremity involvement was present in 124 (69.7%) of the patients. A statistically significant difference was found between the mortality rates and blood parameters of the patients included in the study in terms of white blood count C-reactive protein (CRP), and age among those with normal distribution. Neutrophil, NLR, procalcitonin, lactate, aspartate aminotransferase, and urea; It was statistically significant in terms of mortality in our patients with APAI. NLR values of the deceased were determined as 7.98 ± 6.85.

CONCLUSIONS: APAI patients with high NLRs had significantly higher risks of 30-day mortality. The NLR can be used as a prognostic marker in these patients and warrants further investigation.

PMID:35491879 | DOI:10.1177/17085381221094943

Circ Arrhythm Electrophysiol. 2022 May 2:CIRCEP121010075. doi: 10.1161/CIRCEP.121.010075. Online ahead of print.

ABSTRACT

BACKGROUND: Maximal left ventricular wall thickness (MLVWT) is a risk factor for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). In adults, the severity of left ventricular hypertrophy has a nonlinear relationship with SCD, but it is not known whether the same complex relationship is seen in childhood. The aim of this study was to describe the relationship between left ventricular hypertrophy and SCD risk in a large international pediatric HCM cohort.

METHODS: The study cohort comprised 1075 children (mean age, 10.2 years [±4.4]) diagnosed with HCM (1-16 years) from the International Paediatric Hypertrophic Cardiomyopathy Consortium. Anonymized, noninvasive clinical data were collected from baseline evaluation and follow-up, and 5-year estimated SCD risk was calculated (HCM Risk-Kids).

RESULTS: MLVWT Z score was <10 in 598 (58.1%), ≥10 to <20 in 334 (31.1%), and ≥20 in 143 (13.3%). Higher MLVWT Z scores were associated with heart failure symptoms, unexplained syncope, left ventricular outflow tract obstruction, left atrial dilatation, and nonsustained ventricular tachycardia. One hundred twenty-two patients (71.3%) with MLVWT Z score ≥20 had coexisting risk factors for SCD. Over a median follow-up of 4.9 years (interquartile range, 2.3-9.3), 115 (10.7%) had an SCD event. Freedom from SCD event at 5 years for those with MLVWT Z scores <10, ≥10 to <20, and ≥20 was 95.6%, 87.4%, and 86.0, respectively. The estimated SCD risk at 5 years had a nonlinear, inverted U-shaped relationship with MLVWT Z score, peaking at Z score +23. The presence of coexisting risk factors had a summative effect on risk.

CONCLUSIONS: In children with HCM, an inverted U-shaped relationship exists between left ventricular hypertrophy and estimated SCD risk. The presence of additional risk factors has a summative effect on risk. While MLVWT is important for risk stratification, it should not be used either as a binary variable or in isolation to guide implantable cardioverter defibrillator implantation decisions in children with HCM.

PMID:35491873 | DOI:10.1161/CIRCEP.121.010075