Category: Statistics

Clin Oral Implants Res. 2021 Sep 29. doi: 10.1111/clr.13858. Online ahead of print.

ABSTRACT

AIM: The aim of this retrospective clinical study was to compare the accuracy of static Computer-Assisted Implant Surgery (sCAIS) in posterior single edentulous patients using different surgical guide designs.

MATERIALS & METHODS: Thirty-seven partially edentulous patients with a total of 54 implants were included in the study. Seventeen implants were included in Group 1 – Unbounded Tooth-Mucosa Supported; 18 implants in Group 2 – Unbounded Tooth Supported; and 19 implants in Group 3 (Control) – Bounded Tooth Supported. All partially edentulous patients were treated with fully guided implant surgery using the corresponding surgical guide. Discrepancies between the pre-planned and post-operative implant position were evaluated.

RESULTS: The mean angular deviation ± standard deviation (SD) was 2.91 ± 1.56°, 3.33 ± 1.72° and 2.25 ± 1.13° for Groups 1, 2 and 3, respectively. The mean ± SD 3D offset at base was 0.66 ± 0.29 mm, 0.77 ± 0.24 mm and 0.49 ± 0.22 mm; and 3D offset at tip was 0.84 ± 0.45 mm, 1.07 ± 0.38 mm and 0.75 ± 0.25 mm for Groups 1, 2 and 3, respectively. No statistically significant differences between groups were found for angular deviation. There were statistically significant differences between Groups 2 and 3 for 3D offset at base (p = 0.002) and 3D offset at tip (p = 0.010).

CONCLUSIONS: Different surgical guide designs for posterior single edentulous areas appear to be associated with the accuracy level of sCAIS. In unbounded sites, having additional posterior attached soft tissue support is preferable.

PMID:34587320 | DOI:10.1111/clr.13858

Med Phys. 2021 Sep 29. doi: 10.1002/mp.15255. Online ahead of print.

ABSTRACT

PURPOSE: Radiomics, the objective study of non-visual features in clinical imaging, has been useful in informing decisions in clinical oncology. However, radiomics currently lacks the ability to characterize the overall topological structure of the data. This niche can be filled by persistent homology, a form of topological data analysis that analyzes high-level structure. We hypothesized that persistent homology features quantified using cubical complexes could be extracted from lung tumor scans and related to survival.

METHODS: We obtained segmented computed tomography (CT) lung scans (n = 565) from the NSCLC-Radiomics and NSCLC-Radiogenomics datasets in The Cancer Imaging Archive. These scans are three dimensional images whose pixel intensity corresponds to a number of Hounsfield units (HU). Cubical complexes are a topological image analysis method that effectively analyze the number of topological features in an image as the image is thresholded at different intensities. We calculated a novel output called a feature curve by plotting the number of 0 dimensional topological features counted from the cubical complex filtration against each Hounsfield value. This curve’s first moment of distribution was utilized as a summary statistic to show association with survival in a Cox proportional hazards model. We hypothesized that persistent homology features quantified using cubical complexes could be extracted from lung tumor scans and related to survival Results: After controlling for tumor image size, age, and stage, the first moment of the 0D topological feature curve was associated with poorer survival (HR = 1.118; 95% CI = 1.026-1.218; p = 0.01). The patients in our study with the lowest first moment scores had significantly better survival (1238 days; 95% CI = 936-1599) compared to the patients with the highest first moment scores (429 days; 95% CI = 326-601; p = .0015).

CONCLUSIONS: We have shown that persistent homology can generate useful clinical correlates from tumor CT scans. Our 0-dimensional topological feature curve statistic predicts survival in lung cancer patients. This novel statistic may be used in tandem with standard radiomics variables to better inform clinical oncology decisions.

PMID:34587294 | DOI:10.1002/mp.15255

Biom J. 2021 Sep 29. doi: 10.1002/bimj.202000336. Online ahead of print.

ABSTRACT

In statistical research, variable selection and feature extraction are a typical issue. Variable selection in linear models has been fully developed, while it has received relatively little attention for longitudinal data. Since a longitudinal study involves within-subject correlations, the likelihood function of discrete longitudinal responses generally cannot be expressed in analytically closed form, and standard variable selection methods cannot be directly applied. As an alternative, the penalized generalized estimating equation (PGEE) is helpful but very likely results in incorrect variable selection if the working correlation matrix is misspecified. In many circumstances, the within-subject correlations are of interest and need to be modeled together with the mean. For longitudinal binary data, it becomes more challenging because the within-subject correlation coefficients have the so-called Fréchet-Hoeffding upper bound. In this paper, we proposed smoothly clipped absolute deviation (SCAD)-based and least absolute shrinkage and selection operator (LASSO)-based penalized joint generalized estimating equation (PJGEE) methods to simultaneously model the mean and correlations for longitudinal binary data, together with variable selection in the mean model. The estimated correlation coefficients satisfy the upper bound constraints. Simulation studies under different scenarios are made to assess the performance of the proposed method. Compared to existing PGEE methods that specify a working correlation matrix for longitudinal binary data, the proposed PJGEE method works much better in terms of variable selection consistency and parameter estimation accuracy. A real data set on Clinical Global Impression is analyzed for illustration.

PMID:34587284 | DOI:10.1002/bimj.202000336

Pharmacotherapy. 2021 Sep 29. doi: 10.1002/phar.2628. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare associations between individual antidepressants and newborn outcomes.

DESIGN: Retrospective cohort study.

SETTING: Deliveries in a large, US medical system.

POPULATION: Women who received at least one antidepressant prescription 3 months prior to conception through delivery.

METHODS: Eligible women had maternal characteristics and newborn outcomes extracted from medical record data. Exposure was defined by the timing of the prescription during pregnancy.

MAIN OUTCOME MEASURES: Newborn outcomes (any adaptation syndrome, neonatal intensive care unit (NICU) admission) were analyzed for each antidepressant and compared using standard statistics and multivariable regression compared to exposure to bupropion. Odds of outcomes based on timing of exposure were also explored.

RESULTS: A total of 3,694 women were analyzed. Rates of any adaptation syndrome (p<0.001), NICU admission (p<0.001), and transient tachypnea of newborn (TTN) (p=0.006) were significantly different between drugs. Infants exposed to duloxetine had the highest rates of NICU admissions (39.6%) and adaptation syndromes (15.1%). Venlafaxine-exposed infants had the highest rates of TTN (18.2%). Controlling for maternal age, race, insurance, and gestational age at delivery, early pregnancy antidepressant exposure was associated with adaptation syndrome and NICU admission for both duloxetine (adjusted odds ratio (aOR) 2.31 [95% Confidence Interval (CI) 1.11-4.80] and aOR 2.47 [95% CI 1.40-4.34], respectively) and escitalopram (aOR 1.72 [95% CI 1.09-2.70] and aOR 1.64 [95% CI 1.21-2.22], respectively). Exposure in the third trimester was associated with any adaptation syndrome for citalopram, duloxetine, escitalopram, fluoxetine, sertraline, and venlafaxine and NICU admission for bupropion, citalopram, duloxetine, escitalopram, and fluoxetine.

CONCLUSION: Duloxetine and escitalopram appear to have the strongest associations with any adaptation syndrome and NICU admission whereas bupropion and sertraline tended to have among the lowest risks of these outcomes. These results can help providers and patients discuss choice of individual antidepressant drugs during pregnancy.

PMID:34587291 | DOI:10.1002/phar.2628

J Nutr. 2021 Sep 29:nxab314. doi: 10.1093/jn/nxab314. Online ahead of print.

ABSTRACT

BACKGROUND: High meat consumption might play a role in promoting low-grade systemic inflammation, but evidence is limited.

OBJECTIVES: We examined cross-sectional associations of habitual meat consumption with serum C-reactive protein (CRP) and total white blood cell count (WBCC) in British adults.

METHODS: We included 403,886 men and women (aged 38-73 y) participating in the UK Biobank who provided information on meat intake (via touchscreen questionnaire) and a nonfasting blood sample at recruitment (2006-2010). For a subset of participants (∼5%), an additional blood sample was collected (median 4.4 y later). We used multivariable linear regression models to estimate associations of meat intake (total meat, unprocessed red meat, processed meat, and poultry) with logCRP and logWBCC.

RESULTS: The difference in the serum CRP (mg/L) for each 50-g/d higher intake for total meat was 11.6% (95% CI: 11.1, 12.0%), for processed meat was 38.3% (95% CI: 36.0, 40.7%), for unprocessed red meat was 14.4% (95% CI: 13.6, 15.1%), and for poultry was 12.8% (95% CI: 12.0, 13.5%). The difference in the WBCC (×10-9L) for each 50 g/d higher intake of total meat was 1.5% (95% CI: 1.4, 1.6%), for processed meat was 6.5% (95% CI: 6.1, 6.9%), for unprocessed red meat was 1.6% (95% CI: 1.4, 1.7%), and for poultry was 1.6% (95% CI: 1.4, 1.7%). All associations were attenuated after adjustment for adiposity; by 67% with BMI (in kg/m2) and by 58% with waist circumference for total meat and CRP, and by 53% and 47%, respectively, for WBCC, although associations remained statistically significant. Findings of sensitivity analyses in 15,420 participants were similar prospectively, except there were no associations between unprocessed red meat and WBCC.

CONCLUSIONS: Higher meat consumption, particularly of processed meat, was positively associated with inflammatory markers in these British adults; however, the magnitudes of associations are small and predominantly due to higher adiposity.

PMID:34587250 | DOI:10.1093/jn/nxab314

Fam Med. 2021 Sep;53(8):712-716. doi: 10.22454/FamMed.2021.175818.

ABSTRACT

BACKGROUND AND OBJECTIVES: In the United States, 89% of counties have no clinics providing abortion care. Though training residents increases intention to provide abortion care, rates of postresidency abortion provision are low. This study, conducted at one family medicine residency program in the Southwest United States, examines graduates’ postresidency practice of abortion care in the context of their intent to provide during residency training.

METHODS: We collected cross-sectional data from a survey of graduates of University of New Mexico Family Medicine Residency from 2005 to 2017. We performed a mixed-methods analysis using descriptive statistics and conceptual content analysis, including a new methodology of performing content analysis of four subgroups based on intention to provide abortion care at different time points.

RESULTS: The response rate was 46%, with 54 responses to 115 surveys. Only 35% residents who intended to provide abortion care had done so after graduation from residency. Barrier analysis revealed that the three most frequent barriers were structural, with 52% of respondents saying that their workplace would not allow abortion care. The two most frequent themes affecting intention were “competence” and feeling that abortion care was “medically necessary.” However, the two most common themes affecting actual practice were “workplace support” and local “patient access.”

CONCLUSIONS: This study provides information about the themes associated with changing intentions and practice of abortion care, which may help elucidate new strategies for training residents to anticipate and address challenges to postresidency provision. The study also provides some insight into residents with no intention to provide abortion care in residency who develop an intention to provide abortion care after graduation, which is a group of people for whom there is little information.

PMID:34587268 | DOI:10.22454/FamMed.2021.175818

PLoS One. 2021 Sep 29;16(9):e0257890. doi: 10.1371/journal.pone.0257890. eCollection 2021.

ABSTRACT

BACKGROUND: In disease control, the program officers are vital to the successful implementation of control strategies. However, poor knowledge of the disease and its control, staff attrition, and lack of intentional training for new staff can lead to under-performance and ineffectiveness of interventions. Thus, the Nigeria Field Epidemiology and Laboratory Training Program, in collaboration with National Malaria Elimination Program, planned a malaria short course (MSC) to strengthen the capacity of current program managers and incoming staff. To guide the development of the curriculum for the MSC, we conducted a needs assessment survey to ascertain the perceived usefulness of the MSC, the priority rating of MSC thematic domains and associated factors.

METHODS: Overall, 384 purposively selected respondents across ten states and the Federal Capital Territory in Nigeria were interviewed. These comprised malaria and non-malaria control program staff at state, local government area (LGA) and ward levels. We administered a structured questionnaire to elicit information on socio-demographics, training needs, priority malaria thematic domains, perceived course usefulness and willingness of ministries/organizations to release staff to attend the MSC. Data were analyzed using descriptive and inferential statistics at p<0.05.

RESULTS: Mean age was 43.9 (standard deviation: 7.6 years), 172 (44.8%) were females. Of the 384 respondents, 181 (47.1%), 144 (37.5%) and 59 (15.4%) were at the ward, LGA and state levels, respectively. Seventy-two (18.8%) had never worked in malaria control program. Majority (98.7%, n = 379) reported the need for further training, 382 (99.5%) opined that the course would be useful, and all affirmed their employers’ willingness towards their participation at the training. Respondents rated high the domains of basic malariology, malaria treatment, malaria prevention, surveillance/data management, use of computers, leadership skills, program management and basic statistics. Predictors of malaria topical domains’ high rating were gender (odds ratio (OR) = 6.77; 95% CI:3.55-12.93) and educational qualifications (OR = 0.48; 95% CI:0.26-0.89).

CONCLUSIONS: A malaria short course is a necessity and appropriate for program officers at different levels of health administration in Nigeria to achieve malaria elimination, taking into consideration the challenges of human resource retention. The outcome of this study should inform the curriculum and the delivery of the MSC.

PMID:34587210 | DOI:10.1371/journal.pone.0257890

Angle Orthod. 2021 Sep 29. doi: 10.2319/071221-549.1. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate stability and satisfaction in adult anterior open bite (AOB) patients at least 9 months post-treatment, as well as patient and practitioner factors that may be associated with stability and satisfaction.

MATERIALS AND METHODS: Practitioners and their adult AOB patients were recruited through the National Dental Practice-Based Research Network. Data on patient and practitioner characteristics, treatment recommendations and factors were previously collected. Treatment stability was determined by assessing post-treatment intraoral photographs. Patient satisfaction was determined from post-treatment questionnaires. Treatment was categorized into aligners, fixed appliances, temporary anchorage devices, and orthognathic surgery. Extractions were also investigated. Retention type was categorized into vacuum-formed, Hawley-style, or bonded retainers, and regimens were classified as full-time or part-time wear.

RESULTS: Retention data collected from 112 patients had a mean post-treatment time of 1.21 years. There were no statistically significant differences in stability between treatment groups. Depending on whether a qualitative index or a millimetric measure was employed, stability ranged from 65% to 89%. Extractions and less initial lower incisor proclination were associated with higher stability in patients treated with fixed appliances only. High satisfaction was reported by patients at retention. There were no clear differences in stability or satisfaction among retention types or regimens.

CONCLUSIONS: The stability of adult AOB orthodontic treatment was high, regardless of treatment or retainer modality. Satisfaction in adult AOB patients was high, regardless of retention type or regimen.

PMID:34587249 | DOI:10.2319/071221-549.1

PLoS One. 2021 Sep 29;16(9):e0257546. doi: 10.1371/journal.pone.0257546. eCollection 2021.

ABSTRACT

OBJECTIVE: To analyze trends in urinary tract infection hospitalization (cystitis, pyelonephritis, prostatitis and non-specified UTI) among patients over 65 years in Spain from 2000-2015.

METHODS: We conducted a retrospective observational study using the Spanish Hospitalization Minimum Data Set (CMBD), with codifications by the International Classification of Diseases (ICD-9). We collected data on sex, age, type of discharge, main diagnosis, comorbid diagnosis, length of stay, and global cost. All the hospitalizations were grouped by age into three categories: 65-74 years old, 75-84 years old, and 85 years old and above. In the descriptive statistical analysis, crude rates were defined as hospitalizations per 1,000 inhabitants aged ≥65. To identify trends over time, we performed a Joinpoint regression.

RESULTS: From 2000-2015, we found 387,010 hospitalizations coded as UTIs (54,427 pyelonephritis, 15,869 prostatitis, 2643 cystitis and 314,071 non-specified UTI). The crude rate of hospitalization for UTIs between 2000 and 2015 ranged from 2.09 in 2000 to 4.33 in 2015 Rates of hospitalization were higher in men than in women, except with pyelonephritis. By age group, higher rates were observed in patients aged 85 years or older, barring prostatitis-related hospitalizations. Joinpoint analyses showed an average annual percentage increase (AAPC) in incidence rates of 4.9% (95% CI 3.2;6.1) in UTI hospitalizations. We observed two joinpoints, in 2010 and 2013, that found trends of 5.5% between 2000 and 2010 (95% CI 4.7;6.4), 1.5% between 2010 and 2013 (95% CI -6.0;9.6) and 6.8% between 2013 and 2015 (95% CI -0.3;14.4).

CONCLUSIONS: The urinary infection-related hospitalization rate in Spain doubled during the period 2000-2015. The highest hospitalization rates occurred in men, in the ≥85 years old age group, and in non-specified UTIs. There were increases in all types of urinary tract infection, with non-specified UTIs having the greatest growth. Understanding these changing trends can be useful for health planning.

PMID:34587191 | DOI:10.1371/journal.pone.0257546

PLoS One. 2021 Sep 29;16(9):e0256216. doi: 10.1371/journal.pone.0256216. eCollection 2021.

ABSTRACT

Cancer is a life-threatening disease, and the challenges in accepting the diagnosis can bring a devastating emotional impact on the patient’s mental and psychological wellbeing. Issues related to illness acceptance among cancer patients are not well studied in Malaysia. To date, the Acceptance of Illness Scale has not been translated to the Malay language (Bahasa Malaysia) nor validated for use in the oncology setting. The objective of the study is to translate, validate and determine the reliability of the Bahasa Malaysia version of the Acceptance of Illness Scale among Malaysian patients with cancer. A total of 129 patients newly diagnosed with cancer were consecutively sampled and the scale was administered via face-to-face interviews. A pilot test (n = 30) was conducted and test-retest reliability was determined. The Bartlett Test of Sphericity was statistically significantly (p<0.001), while the Kaiser-Mayer-Olkin (KMO) measure of sampling adequacy was adequate at 0.84. Scale item mean scores ranged between 3.02 and 4.33, while the item-total correlation ranged between 0.50 to 0.66 (p<0.05). The internal reliability coefficient was 0.84. The test-retest reliability indicated a high correlation, r = 0.94 with p = 0.001. The Bahasa Malaysia version of the Acceptance of Illness Scale is a valid and reliable instrument that is appropriate for use in Malaysian patients with cancer. Use of this scale to assess illness acceptance among the Malay-speaking patients with cancer can act as a guide for delivery of psycho-oncological services to help patients have a better mental wellbeing and life adjustment in living with cancer.

PMID:34587199 | DOI:10.1371/journal.pone.0256216