Category: Statistics

Magn Reson Med. 2022 Jan 26. doi: 10.1002/mrm.29171. Online ahead of print.

ABSTRACT

PURPOSE: Develop a novel 2D cardiac MR fingerprinting (MRF) approach to enable simultaneous T1, T2, T2*, and fat fraction (FF) myocardial tissue characterization in a single breath-hold scan.

METHODS: Simultaneous, co-registered, multi-parametric mapping of T1, T2, and FF has been recently achieved with cardiac MRF. Here, we further incorporate T2* quantification within this approach, enabling simultaneous T1, T2, T2*, and FF myocardial tissue characterization in a single breath-hold scan. T2* quantification is achieved with an eight-echo readout that requires a long cardiac acquisition window. A novel low-rank motion-corrected (LRMC) reconstruction is exploited to correct for cardiac motion within the long acquisition window. The proposed T1/T2/T2*/FF cardiac MRF was evaluated in phantom and in 10 healthy subjects in comparison to conventional mapping techniques.

RESULTS: The proposed approach achieved high quality parametric mapping of T1, T2, T2*, and FF with corresponding normalized RMS error (RMSE) T1 = 5.9%, T2 = 9.6% (T2 values <100 ms), T2* = 3.3% (T2* values <100 ms), and FF = 0.8% observed in phantom scans. In vivo, the proposed approach produced higher left-ventricular myocardial T1 values than MOLLI (1148 vs 1056 ms), lower T2 values than T2-GraSE (42.8 vs 50.6 ms), lower T2* values than eight-echo gradient echo (GRE) (35.0 vs 39.4 ms), and higher FF values than six-echo GRE (0.8 vs 0.3 %) reference techniques. The proposed approach achieved considerable reduction in motion artifacts compared to cardiac MRF without motion correction, improved spatial uniformity, and statistically higher apparent precision relative to conventional mapping for all parameters.

CONCLUSION: The proposed cardiac MRF approach enables simultaneous, co-registered mapping of T1, T2, T2*, and FF in a single breath-hold for comprehensive myocardial tissue characterization, achieving higher apparent precision than conventional methods.

PMID:35081260 | DOI:10.1002/mrm.29171

Braz Oral Res. 2022 Jan 14;36:e014. doi: 10.1590/1807-3107bor-2022.vol36.0014. eCollection 2022.

ABSTRACT

Oral leukoplakia is a potentially malignant disorder, defined as a white plaque that cannot be diagnosed as another known disease or disorder, and has an increased risk of malignancy. The aim of the present study was to evaluate the results of CO2 laser treatment in a well-defined cohort of patients with oral leukoplakia in order to identify the occurrence of clinical outcomes of relapse, resolution, or malignancy after treatment. The study group comprised 37 patients. Before treatment, clinical photographs and incisional biopsies were obtained in all cases. In addition, the post-treatment results were documented using photographs. Evaluation of treatment results was performed by an independent researcher who had not performed the surgery. The minimum, maximum, and mean values of continuous variables were calculated. Statistically significant relationships were tested using the Cox regression analysis. A survival curve was constructed according to the Kaplan-Meier method to analyze the malignant transformation and recurrence of oral leukoplakia. The clinical outcomes analyzed were resolution, recurrence, and malignancy. The mean follow-up period was 36 months (range, 6-239 months). In 13/37 patients, leukoplakia recurred between 6 and 93 months (mean, 38.2 months). In 8/37 patients, a malignant transformation occurred (mean, 50.6 months). In 16/37 patients, lesion resolution occurred. No risk factor was statistically significant for malignancy or recurrence of lesions. The treatment of the lesions by CO2 laser was efficient in the removal of the lesions; however, it did not avoid the clinical outcomes of recurrence or malignancy.

PMID:35081231 | DOI:10.1590/1807-3107bor-2022.vol36.0014

Braz Oral Res. 2022 Jan 14;36:e001. doi: 10.1590/1807-3107bor-2022.vol36.0001. eCollection 2022.

ABSTRACT

Limited research attention has been paid to Turkish dentists’ perceptions of child abuse and neglect (CA/N). This study aimed to examine Turkish dentists’ knowledge about, attitudes toward, and perceptions of CA/N. A total of 229 Turkish dentists responded to the self-administered, valid and reliable questionnaire. It consisted of 34 questions that could be classified into the following conceptual categories: a) sociodemographic data, b) knowledge about legal procedures and the orofacial characteristics and findings that are indicative of CA/N, and c) self-efficacy and attitudes toward CA/N. Multivariate analysis of variance was conducted and partial eta squared coefficients were used statistically. Knowledge about legal obligations was associated with occupational experience, highest CA/N education, frequency of child dental treatment. Prior experience with case of suspected CA/N demonstrated the greatest effects. Knowledge about the orofacial characteristics and findings that are indicative of CA/N was associated with prior experience with at least one case of suspected CA/N. The most frequently provided reasons for failure to report cases of suspected CA/N were fear that the child would be harmed. Turkish dentists demonstrated moderate levels of knowledge about their legal obligations and the orofacial characteristics and findings that are indicative of CA/N. Dentists should receive detailed education on CA/N in their undergraduate and postgraduate education. In addition, it is necessary to increase awareness and knowledge about CA/N by providing in-service trainings at the institutions where they work.

PMID:35081219 | DOI:10.1590/1807-3107bor-2022.vol36.0001

Braz Oral Res. 2022 Jan 14;36:e002. doi: 10.1590/1807-3107bor-2022.vol36.0002. eCollection 2022.

ABSTRACT

The objective of this study was to analyze possible associations between antibiotic dental prescriptions in the public health service, health service characteristics, and social characteristics of the municipalities. Using the register of dispensing in the public health service of a state in the Southeast region of Brazil, in 2017 we analyzed patterns of antibiotic prescriptions by dentists. Data were obtained from the Integrated Pharmaceutical Services Management System (SIGAF, in Portuguese). The outcome variable was the number of Daily Defined Doses (DDD) per 1,000 residents/year in each municipality. CART (Classification and Regression Tree) technique was used to determine the influence of the following variables: populational social characteristics (Human Development Index, Gini Index, the proportion of rural population and proportion of families benefiting from the Bolsa Família Program) and oral health services characteristics (access to individual dental care, number of dentists and oral health teams per 1,000 residents, and percentage of preventive and restorative individual dental procedures. Data analysis was performed using IBM SPSS Statistics 21.0. Antibiotics were the medications most prescribed by dentists in the public health service, with penicillin being the most frequently prescribed class. The average DDD/1,000 residents/year for the 421 municipalities surveyed was 96.54 (range 0.008 and 619.660). Select factors were associated with antibiotic prescriptions including access to individual dental care (Adjusted p-value ≤0.001), a number of oral health teams/1,000 inhabitants (Adjusted p-value=0.001), and Gini Index (Adjusted p-value = 0.046). Access to oral health services and inequality were associated with the use of antibiotics.

PMID:35081220 | DOI:10.1590/1807-3107bor-2022.vol36.0002

R I Med J (2013). 2022 Feb 1;105(1):37-41.

ABSTRACT

BACKGROUND: During the initial wave of the COVID-19, there was uncertainty related to whether the pandemic would affect pregnancy delivery outcomes. We sought to identify whether changes in hospital policies and provider practices, driven by COVID-19, would influence delivery outcomes in nulliparous, term, singleton, vertex (NTSV) pregnancies in Rhode Island.

OBJECTIVE: We compare the delivery outcomes and associated factors for NTSV deliveries during the first wave of the COVID-19 pandemic in Rhode Island compared to patients who delivered the year prior.

STUDY DESIGN: This is a retrospective cohort study of patients who presented to Women & Infants Hospital for NTSV deliveries during April 2019, pre-COVID-19, and April 2020, during COVID-19.

RESULTS: During COVID-19, patients were more likely to have abnormal electronic fetal monitoring (AEFM) as an indication for cesarean section (p<.02) and less likely to have an elective cesarean delivery (p<.01). Patients during COVID-19 were more likely to have a midwife involved in their care compared to pre-COVID-19 (p<.001). The cesarean section rate was not statistically different between the two time periods.

CONCLUSION: Those delivering during the pandemic were more likely to have AEFM as an indication for cesarean delivery and less likely to have elective cesareans. They were more likely to have a midwife involved in their care. Further investigation into factors associated with changes in NTSV cesarean rates is warranted.

PMID:35081187

Cad Saude Publica. 2022 Jan 7;38(1):e00037021. doi: 10.1590/0102-311X00037021. eCollection 2022.

ABSTRACT

The objective of this study was to analyze factors associated with cases of congenital anomalies from the perspective of social determinants of health in the State of Rio Grande do Sul, Brazil. This is a case-control study with all the pairs of mothers and liveborn infants from 2012 to 2015 in the state, based on the total number of liveborn infants with congenital anomalies (5,250) and a random sample of 21,000 without congenital anomalies, according to data on the live birth certificates. The statistical analyses included chi-square tests and logistic regression models with SPSS. The Dahlgren & Whitehead model was used as the basis for grouping and discussing the variables. In the multivariate model, all the variables that were significantly associated with the outcome were in the sense of increasing the odds of births with congenital anomalies: black women had 20% higher odds than white women (OR = 1.20; p-value = 0.013); age over 40 years increased the odds by 97% when compared to women 18 to 29 years of age; women with less than four years of schooling showed 50% higher odds when compared to women with 12 or more years of schooling (OR = 1.50; p-value = 0.001); women with no prenatal visits had 97% higher odds than women with seven or more prenatal visits (OR = 1.97; p-value = 0.001); and prior history of miscarriages/stillbirths increased the odds by 17% (OR = 1.17; p-value = 0.001). The results raise the issue of racial and social inequalities, related to health inequities.

PMID:35081200 | DOI:10.1590/0102-311X00037021

PLoS One. 2022 Jan 26;17(1):e0263015. doi: 10.1371/journal.pone.0263015. eCollection 2022.

ABSTRACT

Problem-based learning (PBL) allows students to learn medical statistics through problem solving experience. The aim of this study was to assess the efficiency of PBL modules implemented in the blended learning courses in medical statistics through knowledge outcomes and student satisfaction. The pilot study was designed as a randomized controlled trial that included 53 medical students who had completed all course activities. The students were randomized in two groups: the group with access to PBL modules within the blended learning course (hPBL group) and the group without access to PBL modules-only blended learning course (BL group). There were no significant differences between the groups concerning socio-demographic characteristics, previous academic success and modality of access to course materials. Students from hPBL group had a significantly higher problem solving score (p = 0.012; effect size 0.69) and the total medical statistics score (p = 0,046; effect size 0.57). Multivariate regression analysis with problem solving as an outcome variable showed that problem solving was associated with being in hPBL group (p = 0.010) and having higher grade point average (p = 0.037). Multivariate regression analysis with the medical statistics score as an outcome variable showed the association between a higher score on medical statistics with access to PBL modules (p = 0.045) and a higher grade point average (p = 0.021). All students in hPBL group (100.0%) considered PBL modules useful for learning medical statistics. PBL modules can be easily implemented in the existing courses within medical statistics using the Moodle platform, they have high applicability and can complement, but not replace other forms of teaching. These modules were shown to be efficient in learning, to be well accepted among students and to be a potential missing link between teaching and learning medical statistics. The authors of this study are planning to create PBL modules for advanced courses in medical statistics and to conduct this study on other universities with a more representative study sample, with the aim to overcome the limitations of the existing study and confirm its results.

PMID:35081161 | DOI:10.1371/journal.pone.0263015

PLoS One. 2022 Jan 26;17(1):e0262908. doi: 10.1371/journal.pone.0262908. eCollection 2022.

ABSTRACT

OBJECTIVE: The aim of this retrospective observational study is to analyse clinical, serological and radiological predictors of outcome in patients with COVID-19 pneumonia treated with tocilizumab, providing clinical guidance to its use in real-life.

METHOD: This is a retrospective, monocentric observational cohort study. All consecutive patients hospitalized between February the 11th and April 14th 2020 for severe COVID-19 pneumonia at Reggio Emilia AUSL and treated with tocilizumab were enrolled. The patient’s clinical status was recorded every day using the WHO ordinal scale for clinical improvement. Response to treatment was defined as an improvement of one point (from the status at the beginning of tocilizumab treatment) during the follow-up on this scale. Bivariate association of main patients’ characteristics with outcomes was explored by descriptive statistics and Fisher or Kruskal Wallis tests (respectively for qualitative or quantitative variables). Each clinically significant predictor was checked by a loglikelihood ratio test (in univariate logistic models for each of the considered outcomes) against the null model.

RESULTS: A total of 173 patients were included. Only hypertension, the use of angiotensin-converting enzyme inhibitors, PaO2/FiO2, respiratory rate and C-reactive protein were selected for the multivariate analysis. In the multivariable model, none of them was significantly associated with response.

CONCLUSIONS: Evaluating a large number of clinical variables, our study did not find new predictors of outcome in COVID19 patients treated with tocilizumab. Further studies are needed to investigate the use of tocilizumab in COVID-19 and to better identify clinical phenotypes which could benefit from this treatment.

PMID:35081151 | DOI:10.1371/journal.pone.0262908

PLoS One. 2022 Jan 26;17(1):e0262387. doi: 10.1371/journal.pone.0262387. eCollection 2022.

ABSTRACT

OBJECTIVE: To evaluate the association between transvaginal ultrasound scan of cervix and Bishop’s score in predicting successful induction of labour, cut-off points and patients’ tolerability and acceptance for both procedures.

DESIGN: A comparative clinical trial.

SETTING: A tertiary hospital in Selangor, Malaysia.

PARTICIPANTS: 294 women planned for elective induction of labour for various indications were included. All women had transvaginal ultrasound to assess the cervical length and digital vaginal examination to assess the Bishop cervical scoring by separate investigators before induction of labour.

PRIMARY OUTCOME MEASURE: To evaluate the association of the cervical length by transvaginal ultrasound scan and Bishop score in predicting successful induction of labour.

SECONDARY OUTCOME MEASURE: Variables associated with successful induction of labour and patients’ tolerability and acceptance for transvaginal ultrasound scan of cervix.

RESULTS: There was no statistically significant difference among the vaginal and Caesarean delivery groups in terms of mean maternal age, height, weight, body mass index, ethnicity and gestational age at induction. Vaginal delivery occurred in 207 women (70.4%) and 87 women (29.6%) delivered via Caesarean section. There was a high degree of correlation between the cervical length and Bishop score (r-value 0.745; p <0.001). Sonographic assessment of cervical length demonstrated a comparable accuracy in comparison to Bishop score. Analysis using ROC curves noted an optimal cut-off value of ≤27mm for cervical length and Bishop score of ≥ 4, with a sensitivity of 69.1% vs 67%, specificity 60.9% vs 55%, and area under the curves (AUCs) of 0.672 and 0.643 respectively (p <0.001). Multivariate logistic regression analysis demonstrated that parity (OR 2.70), cervical length (OR 0.925), Bishop score (OR 1.272) and presence of funnelling (OR 3.292) were highly significant as independent predictors of success labour induction. Women also expressed significantly less discomfort with transvaginal ultrasound compared with digital vaginal examination.

CONCLUSION: Sonographic assessment of cervical measurement predicts the success of induction of labour with similar diagnostic accuracy with conventional Bishop score.

PMID:35081157 | DOI:10.1371/journal.pone.0262387

PLoS One. 2022 Jan 26;17(1):e0262607. doi: 10.1371/journal.pone.0262607. eCollection 2022.

ABSTRACT

Despite advancements in the study of brain maturation at different developmental epochs, no work has linked the significant neural changes occurring just after birth to the subtler refinements in the brain occurring in childhood and adolescence. We aimed to provide a comprehensive picture regarding foundational neurodevelopment and examine systematic differences by family income. Using a nationally representative longitudinal sample of 486 infants, children, and adolescents (age 5 months to 20 years) from the NIH MRI Study of Normal Brain Development and leveraging advances in statistical modeling, we mapped developmental trajectories for the four major cortical lobes and constructed charts that show the statistical distribution of gray matter and reveal the considerable variability in regional volumes and structural change, even among healthy, typically developing children. Further, the data reveal that significant structural differences in gray matter development for children living in or near poverty, first detected during childhood (age 2.5-6.5 years), evolve throughout adolescence.

PMID:35081147 | DOI:10.1371/journal.pone.0262607