Category: Statistics

J Orofac Orthop. 2021 Apr 14. doi: 10.1007/s00056-021-00292-4. Online ahead of print.

ABSTRACT

PURPOSE: Main goal of the study was the identification and quantitative analysis of monomer elution from materials commonly used in fixed orthodontic therapy. Studies have shown severe health effects of monomers including cytotoxic, allergenic or mutagenic potential and endocrine changes. This in vitro study focusses primarily on five resins which are usually processed intraorally and remain in the oral cavity long-term.

METHODS: We tested the elution of monomers from specimens (7.5 mm × 1.5 mm) immersed in artificial saliva at body temperature (37 °C) for 30 min to 5 weeks. The used method is in accordance with DIN EN ISO 10993-13. The five tested materials were BrackFix® (Voco GmbH, Cuxhaven, Germany), Triad®Gel (DeguDent GmbH, Hanau, Germany), and Transbond™ XT, LR and Plus (3M Unitek, Monrovia, CA, USA). All aliquots were analyzed using high performance liquid chromatography (HPLC). Data were statistically analyzed.

RESULTS: All five analyzed materials eluted substances over a period of 5 weeks. Identified substances included bisphenol A (BPA), triethylene glycol dimethacrylate (TEGDMA) and urethane dimethacrylate (UDMA). BPA eluted from Transbond™ Plus, XT, LR and BrackFix®. The cumulated mean values after 35 days ranged from 16.04 to 64.83 ppm, depending on the material. TEGDMA eluted with a mean of 688.61 ppm from Transbond™ LR. UDMA with a mean of 1682.00 ppm from Triad®Gel. For each material the highest concentrations of all these substances were found in the first elution period. Other substances that were not equivocally identified or of low concentration also eluted.

CONCLUSION: Using the described method, it is possible to qualitatively and quantitatively determine the in vitro elution of monomers from orthodontic materials. The concentrations of the substances identified were below the current maximum recommended intake. However, a cumulative effect and low-dose effects should be considered for both patients and dental professionals, especially for young patients. Measures to reduce exposure patients and practitioners are suggested.

PMID:33852039 | DOI:10.1007/s00056-021-00292-4

Eur Radiol. 2021 Apr 14. doi: 10.1007/s00330-021-07918-6. Online ahead of print.

ABSTRACT

OBJECTIVES: To develop an objective quantitative method to characterize and visualize meningioma-brain adhesion using MR elastography (MRE)-based slip interface imaging (SII).

METHODS: This retrospective study included 47 meningiomas (training dataset: n = 35; testing dataset: n = 12) with MRE/SII examinations. Normalized octahedral shear strain (NOSS) values were calculated from the acquired MRE displacement data. The change in NOSS at the tumor boundary (ΔNOSS_bdy) was computed, from which a 3D ΔNOSS_bdy map of the tumor surface was created and the probability distribution of ΔNOSS_bdy over the entire tumor surface was calculated. Statistical features were calculated from the probability histogram. After eliminating highly correlated features, the capability of the remaining feature for tumor adhesion classification was assessed using a one-way ANOVA and ROC analysis.

RESULTS: The magnitude and location of the tumor adhesion can be visualized by the reconstructed 3D ΔNOSS_bdy surface map. The entropy of the ΔNOSS_bdy histogram was significantly different between adherent tumors and partially/completely non-adherent tumors in both the training (AUC: 0.971) and testing datasets (AUC: 0.900). Based on the cutoff values obtained from the training set, the ΔNOSS_bdy entropy in the testing dataset yielded an accuracy of 0.83 for distinguishing adherent versus partially/non-adherent tumors, and 0.67 for distinguishing non-adherent versus completely/partially adherent tumors.

CONCLUSIONS: SII-derived ΔNOSS_bdy values are useful for quantification and classification of meningioma-brain adhesion. The reconstructed 3D ΔNOSS_bdy surface map presents the state and location of tumor adhesion in a “clinician-friendly” manner, and can identify meningiomas with a high risk of adhesion to adjacent brain parenchyma.

KEY POINTS: • MR elastography (MRE)-based slip interface imaging shows promise as an objective tool to preoperatively discriminate meningiomas with a high risk of intraoperative adhesion. • Measurement of the change of shear strain at meningioma boundaries can provide quantitative metrics depicting the state of adhesion at the tumor-brain interface. • The surface map of tumor adhesion shows promise in assisting precise adhesion localization, using a comprehensible, “clinician-friendly” 3D visualization.

PMID:33852045 | DOI:10.1007/s00330-021-07918-6

Eur Radiol. 2021 Apr 14. doi: 10.1007/s00330-021-07943-5. Online ahead of print.

ABSTRACT

OBJECTIVES: Quantum noise is a random process in X-ray-based imaging systems. We addressed and measured the uncertainty of radiomics features against this quantum noise in computed tomography (CT) images.

METHODS: A clinical multi-detector CT scanner, two homogeneous phantom sets, and four heterogeneous samples were used. A solid tumor tissue removed from a male BALB/c mouse was included. We the placed phantom sets on the CT scanning table and repeated 20 acquisitions with identical imaging settings. Regions of interest were delineated for feature extraction. Statistical quantities-average, standard deviation, and percentage uncertainty-were calculated from these 20 repeated scans. Percentage uncertainty was used to measure and quantify feature stability against quantum noise. Twelve radiomics features were measured. Random noise was added to study the robustness of machine learning classifiers against feature uncertainty.

RESULTS: We found the ranges of percentage uncertainties from homogeneous soft tissue phantoms, homogeneous bone phantoms, and solid tumor tissue to be 0.01-2138%, 0.02-15%, and 0.18-16%, respectively. Overall, it was found that the CT features ShortRunHighGrayLevelEmpha (SRHGE) (0.01-0.18%), ShortRunLowGrayLevelEmpha (SRLGE) (0.01-0.41%), LowGrayLevelRunEmpha (LGRE) (0.01-0.39%), and LongRunLowGrayLevelEmpha (LRLGE) (0.02-0.66%) were the most stable features against the inherent quantum noise. The most unstable features were cluster shade (1-2138%) and max probability (1-16%). The impact of random noise to the prediction accuracy by different machine learning classifiers was found to be between 0 and 12%.

CONCLUSIONS: Twelve features were used for uncertainty measurements. The upper and lower bounds of percentage uncertainties were determined. The quantum noise effect on machine learning classifiers is model dependent.

KEY POINTS: • Quantum noise is a random process and is intrinsic to X-ray-based imaging systems. This inherent quantum noise creates unpredictable fluctuations in the gray-level intensities of image pixels. Extra cautions and further validations are strongly recommended when unstable radiomics features are selected by a predictive model for disease classification or treatment outcome prognosis. • We addressed and used the statistical quantity of percentage uncertainty to measure the uncertainty of radiomics features against the inherent quantum noise in computed tomography (CT) images. • A clinical multi-detector CT scanner, two homogeneous phantom sets, and four heterogeneous samples were used in the stability measurement. A solid tumor tissue removed from a male BALB/c mouse was included in the heterogeneous sample.

PMID:33852047 | DOI:10.1007/s00330-021-07943-5

JAMA Netw Open. 2021 Apr 1;4(4):e215902. doi: 10.1001/jamanetworkopen.2021.5902.

ABSTRACT

IMPORTANCE: Psychiatric emergency department (ED) visits may be avoidable if individuals have access to adequate outpatient care, but the extent to which individuals use the ED itself as a key point of access is largely unknown.

OBJECTIVE: To describe the extent to which the ED is a first point of contact for mental health care among adults, and identify key factors associated with this outcome.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted from 2010 to 2018 in Ontario, Canada. Using health care administrative data, all individuals aged 16 years and older with an incident psychiatric ED visit were included. Statistical analysis was performed from September 2019 to February 2021.

MAIN OUTCOMES AND MEASURES: The primary outcome was no outpatient mental health or addictions contact in the 2 years preceding the incident ED visit. The study also measured predisposing (age, sex, immigrant status, comorbidity), enabling (neighborhood income, rurality, continuity of primary care), and need factors (diagnosis from incident ED visit) associated with the so-called first-contact ED visits, generating adjusted odds ratios (aORs) and 95% CIs.

RESULTS: The cohort included 659 084 patients who visited the ED. Among these patients, 340 354 were female individuals (51.6%), and the mean (SD) age was 39.1 (18.5) years. The incident ED visit was a first contact for 298 924 individuals (45.4%). Patients who had increased odds of first-contact ED visits included older individuals (aged 65-84 years vs 16-24 years; aOR, 1.13; 95% CI, 1.12-1.14), male individuals (aOR, 1.14; 95% CI, 1.13-1.15), immigrants (eg, economic class immigrant vs nonimmigrant status: aOR, 1.20; 95% CI, 1.18-1.21), rural residents (aOR, 1.21; 95% CI, 1.20-1.21), and in those with minimal primary care (aOR, 1.68; 95% CI, 1.67-1.69). All diagnoses had a higher likelihood of first-contact ED visits than mood disorders, particularly substance and alcohol use disorders (aOR, 1.66; 95% CI, 1.65-1.68).

CONCLUSIONS AND RELEVANCE: This study’s results suggest that nearly half of incident psychiatric ED visits were first-contact visits, which may be avoidable. Targeted efforts to improve outpatient access should focus on populations with risk factors for first-contact ED presentations, including men, older adults, rural residents, those with poor primary care connectivity, and those with substance-related diagnoses.

PMID:33852001 | DOI:10.1001/jamanetworkopen.2021.5902

JAMA Netw Open. 2021 Apr 1;4(4):e215832. doi: 10.1001/jamanetworkopen.2021.5832.

ABSTRACT

IMPORTANCE: Bruising caused by physical abuse is the most common antecedent injury to be overlooked or misdiagnosed as nonabusive before an abuse-related fatality or near-fatality in a young child. Bruising occurs from both nonabuse and abuse, but differences identified by a clinical decision rule may allow improved and earlier recognition of the abused child.

OBJECTIVE: To refine and validate a previously derived bruising clinical decision rule (BCDR), the TEN-4 (bruising to torso, ear, or neck or any bruising on an infant <4.99 months of age), for identifying children at risk of having been physically abused.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cross-sectional study was conducted from December 1, 2011, to March 31, 2016, at emergency departments of 5 urban children’s hospitals. Children younger than 4 years with bruising were identified through deliberate examination. Statistical analysis was completed in June 2020.

EXPOSURES: Bruising characteristics in 34 discrete body regions, patterned bruising, cumulative bruise counts, and patient’s age. The BCDR was refined and validated based on these variables using binary recursive partitioning analysis.

MAIN OUTCOMES AND MEASURES: Injury from abusive vs nonabusive trauma was determined by the consensus judgment of a multidisciplinary expert panel.

RESULTS: A total of 21 123 children were consecutively screened for bruising, and 2161 patients (mean [SD] age, 2.1 [1.1] years; 1296 [60%] male; 1785 [83%] White; 1484 [69%] non-Hispanic/Latino) were enrolled. The expert panel achieved consensus on 2123 patients (98%), classifying 410 (19%) as abuse and 1713 (79%) as nonabuse. A classification tree was fit to refine the rule and validated via bootstrap resampling. The resulting BCDR was 95.6% (95% CI, 93.0%-97.3%) sensitive and 87.1% (95% CI, 85.4%-88.6%) specific for distinguishing abuse from nonabusive trauma based on body region bruised (torso, ear, neck, frenulum, angle of jaw, cheeks [fleshy], eyelids, and subconjunctivae), bruising anywhere on an infant 4.99 months and younger, or patterned bruising (TEN-4-FACESp).

CONCLUSIONS AND RELEVANCE: In this study, an affirmative finding for any of the 3 BCDR TEN-4-FACESp components in children younger than 4 years indicated a potential risk for abuse; these results warrant further evaluation. Clinical application of this tool has the potential to improve recognition of abuse in young children with bruising.

PMID:33852003 | DOI:10.1001/jamanetworkopen.2021.5832

JAMA Psychiatry. 2021 Apr 14. doi: 10.1001/jamapsychiatry.2021.0154. Online ahead of print.

ABSTRACT

IMPORTANCE: Nurses are the largest component of the US health care workforce. Recent research suggests that nurses may be at high risk for suicide; however, few studies on this topic exist.

OBJECTIVES: To estimate the national incidence of suicide among nurses and examine characteristics of nurse suicides compared with physicians and the general population.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used US data from 159 372 suicides reported in the National Violent Death Reporting System from 2007 to 2018. With the use of workforce denominators, sex-specific suicide incidence estimates were generated among nurses, physicians, and the general population (age, ≥30 years). Associations between clinician type and method of suicide and results of toxicology examination at death were calculated, adjusted for sociodemographic characteristics. Statistical analysis was performed from October 16, 2020, to January 10, 2021.

EXPOSURE: Occupation as a nurse or physician.

MAIN OUTCOME AND MEASURES: Suicide incidence and characteristics associated with suicides.

RESULTS: A total of 2374 suicides among nurses (1912 women [80.5%]; mean [SD] age, 52.8 [11.8] years), 857 suicides among physicians (723 men [84.4%]; mean [SD] age, 59.8 [15.3] years), and 156 141 suicides in the general population (121 483 men [77.8%]; mean [SD] age, 53.1 [14.7] years) were identified. Overall, suicide was more common among nurses compared with the general population (sex-adjusted incidence in 2017-2018, 23.8 per 100 000 vs 20.1 per 100 000; relative risk, 1.18 [95% CI, 1.03-1.36]). Among women in 2017-2018, the suicide incidence among nurses was 17.1 per 100 000 (506 among 2 966 048) vs 8.6 per 100 000 (8879 among 103 731 387) in the general female population (relative risk, 1.99 [95% CI, 1.82-2.18]). In absolute terms, being a female nurse was associated with an additional 8.5 suicides per 100 000 (95% CI, 7.0-10.0 per 100 000) compared with the general population of women. By sex, physician suicide rates were not statistically different from the general population other than among female physicians in 2011-2012 (11.7 per 100 000 [95% CI, 6.6-16.8 per 100 000] female physicians vs 7.5 per 100 000 [95% CI, 7.2-7.7 per 100 000] general population; P = .04). In terms of the characteristics of suicides, clinicians were more likely to use poisoning than the general population; for example, 24.9% (95% CI, 23.5%-26.4%) of nurses used poisoning compared with 16.8% (95% CI, 16.6%-17.0%) of the general suicide population. The presence of antidepressants, benzodiazepines, barbiturates, and opiates was more common among clinician suicides than suicides in the general population.

CONCLUSION AND RELEVANCE: This study suggests that, in the US, the risk of suicide compared with the general population was significantly greater for nurses but not for physicians. Further research is needed to assess whether interventions would be associated with benefit in reducing suicide risk among nurses.

PMID:33851982 | DOI:10.1001/jamapsychiatry.2021.0154

JBI Evid Synth. 2021 Apr 12. doi: 10.11124/JBIES-20-00223. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this systematic review is to identify, appraise, and synthesize the best available evidence on the effectiveness of opioid substitution treatment in reducing HIV risk behavior among African, Caribbean, and Black people.

INTRODUCTION: Substance use plays an important role in HIV transmission among Black people by increasing risky sexual behavior and the risk of HIV acquisition. Opioid substitution treatment, such as methadone maintenance treatment and buprenorphine therapy, has been found to be an effective measure to minimize HIV transmission attributable to opioid addiction.

INCLUSION CRITERIA: The current review considered studies that included African Caribbean and Black adult patients, aged 18 years or over, who have used methadone maintenance treatment or buprenorphine therapies as part of the intervention for opioid use disorders and have been evaluated for sex- and drug-related HIV risk behaviors. This review considered studies that have evaluated the impact of methadone maintenance treatment or buprenorphine therapy on sex- and drug-related HIV risk behaviors.

METHODS: Multiple databases were searched, including Embase, MEDLINE, PsycINFO, Cochrane Central Register of Controlled Trials, Open Grey, Grey Matters, New York Academy of Medicine Grey Literature Report, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform. Two reviewers independently assessed all titles and abstracts, and potentially relevant studies were retrieved in full. Papers selected for retrieval were assessed by two independent reviewers for methodological validity. Data were then extracted from papers. Statistical pooling of quantitative data and meta-analysis was not possible due to heterogeneity of data.

RESULTS: In total, 565 articles were retrieved from databases and unpublished/gray literature searches; 150 duplicates were removed, leaving 415 records. After reviewing titles and abstracts, 368 did not meet our eligibility criteria. Thus, 47 articles were retrieved for full-text assessment of which 42 were excluded, leaving five articles to be included in this review: three randomized control trials, one cohort, and one quasi-experimental study. Four studies focused on methadone maintenance treatment.and one study discussed the effectiveness of buprenorphine intervention. All studies were from the USA. One study enrolled participants in methadone maintenance treatment for heroin injectors, of which 10% of the sample was HIV positive. These papers included studies that reported a significant reduction in sex-related HIV behavior, including having multiple sexual partners, frequency of sexual intercourse, condom use, prostitution and sex trade. Of the five studies, two reported on drug-related HIV risk behaviors, citing a reduction in drug-related HIV risk behaviors. Also, these papers showed unexpected outcomes relating to frequency of sexual intercourse, prostitution, and sex trade. One study reported a significantly higher number of sexual encounters among those not participating in treatment. One study reported decreasing prostitution and sex trade among individuals receiving methadone maintenance treatment intervention.

CONCLUSION: Methadone maintenance treatment or buprenorphine therapy can be effective in reducing sex- and drug-related HIV risk among African, Caribbean, and Black people. However, due to the weaknesses in the body of evidence and the quality of evidence, it is not possible to make strong conclusions about these interventions. Rigorous studies are necessary to generate more findings and reinforce the body of literature.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019126954.

PMID:33851941 | DOI:10.11124/JBIES-20-00223

J Am Acad Orthop Surg. 2021 Apr 13. doi: 10.5435/JAAOS-D-20-01345. Online ahead of print.

ABSTRACT

Personality plays an important role in performance in medical education and mentorship. Personality assessment can aid in the ability to identify strengths and areas for development by understanding how one’s personality influences their learning and interpersonal relationships. We sought to evaluate personality assessment as an effective tool in mentoring during orthopaedic residency in this prospective, cross-sectional study from two orthopaedic surgery residency programs using the Hogan Personality Inventory (HPI). Participants completed a survey regarding their experience with the assessment. Descriptive statistics were calculated, and two-sample t-tests were used to examine differences between groups. In total, thirty-four individuals completed the survey. Our results showed 82.4% reported that the HPI very accurately represented them and 58.8% reported better understanding potentially perceived strengths and weaknesses. In total, 75.7% and 72.7% were satisfied with their mentorship about development as a clinician and researcher, respectively. Significant differences were seen between participants who did and did not re-review their results, and participants who did and did-not believe their results profile was accurate. We conclude that personality assessments can be valuable in promoting introspection and strengthening relationships within orthopaedic surgery, particularly when they are valued and emphasized by the user. Our results suggest that use of the HPI provided participants with a better understanding of their perceived strengths and weaknesses as they progress through their orthopaedic residency training.

PMID:33851949 | DOI:10.5435/JAAOS-D-20-01345

Nat Commun. 2021 Apr 13;12(1):1947. doi: 10.1038/s41467-021-22249-2.

ABSTRACT

Superfund sites could affect life expectancy (LE) via increasing the likelihood of exposure to toxic chemicals. Here, we assess to what extent such presence could alter the LE independently and in the context of sociodemographic determinants. A nationwide geocoded statistical modeling at the census tract level was undertaken to estimate the magnitude of impact. Results showed a significant difference in LE among census tracts with at least one Superfund site and their neighboring tracts with no sites. The presence of a Superfund site could cause a decrease of -0.186 ± 0.027 years in LE. This adverse effect could be as high as -1.22 years in tracts with Superfund sites and high sociodemographic disadvantage. Specific characteristics of Superfund sites such as being prone to flooding and the absence of a cleanup strategy could amplify the adverse effect. Furthermore, the presence of Superfund sites amplifies the negative influence of sociodemographic factors at lower LEs.

PMID:33850131 | DOI:10.1038/s41467-021-22249-2

Neuroreport. 2021 May 5;32(7):636-642. doi: 10.1097/WNR.0000000000001641.

ABSTRACT

This study aimed to investigate the relationship between levodopa responsiveness and white matter alterations in Parkinson’s disease patients using diffusion tensor imaging (DTI). Twenty-six recruited Parkinson’s disease patients were evaluated using the Mini-Mental State Examination, Hoehn and Yahr scale (H&Y) and Unified Parkinson’s Disease Rating Scale (UPDRS). Each patient underwent a DTI scan and an acute levodopa challenge test. The improvement rate of UPDRS-III was calculated, Parkinson’s disease patients were grouped into a responsive group (improvement rate ≥30%) and a nonresponsive group (improvement rate <30%). The differences in fractional anisotropy, mean diffusivity, axial diffusivity and radial diffusivity between the two groups were measured using tract-based spatial statistics. There was no difference in demographic features or baseline evaluations between groups. The UPDRS-III score after the challenge was higher in the nonresponsive group than that in the responsive group. Compared to the responsive group, patients in the nonresponsive group exhibited decreased fractional anisotropy in the corpus callosum; cingulum; left corona radiata; left internal capsule; left middle frontal gyrus; left superior longitudinal fasciculus and right somatosensory cortex. Mean diffusivity and radial diffusivity were increased in wide-ranging areas in the nonresponsive group. No difference was observed in axial diffusivity. White matter alterations in the abovementioned areas may affect the function of the dopaminergic network and thus may be associated with the levodopa response in Parkinson’s disease patients. Further studies are needed to analyze the specific mechanism and pathological changes underlying these effects.

PMID:33850092 | DOI:10.1097/WNR.0000000000001641