Category: Statistics

Eur J Paediatr Neurol. 2021 Aug 24;34:99-104. doi: 10.1016/j.ejpn.2021.08.004. Online ahead of print.

ABSTRACT

AIM: To describe factors affecting eligibility for, and rates of utilization of, hyperacute therapy in children with acute ischemic stroke (AIS) following establishment of our institutional acute stroke treatment pathway in 2005.

METHODS: A retrospective analysis of a prospectively enrolled, single-center cohort was performed including children age 2 – <18 years with acute AIS from 2005 through 2017. Descriptive statistics were used to summarize clinical characteristics, presentation data, and Pediatric NIH Stroke Scale (PedNIHSS) scores that were abstracted from medical records. Assessment for eligibility and administration of hyperacute therapy was determined at the time of presentation according to the institutional stroke pathway.

RESULTS: Of 90 children (median age at presentation 11.3 years, 36% female) with acute AIS, 5 (6%) received hyperacute therapy: 3 received intravenous tissue plasminogen activator (IV-tPA) alone, 1 received endovascular therapy (EVT) alone, and 1 received IV-tPA and EVT. Of 54 children (60%) who presented within 4.5 h of time last seen well, 6 had PedNIHSS scores 6-24, no medical contraindication to IV-tPA, and a partial or complete vessel occlusion. Of 7 children >3 years old who presented after EVT became available at our hospital and within 6 h of time last seen well with a PedNIHSS score 6-24, 3 (43%) had a large vessel occlusion (LVO). Two patients underwent EVT and the other patient was not transferred until >6 h from time last seen well.

CONCLUSIONS: Delay to presentation and diagnosis of childhood acute AIS, mild neurologic deficits at presentation, medical contraindications to IV-tPA, and lack of vessel occlusion on acute neuroimaging contribute to low rates of hyperacute treatment in children with acute AIS.

PMID:34454335 | DOI:10.1016/j.ejpn.2021.08.004

Chemosphere. 2021 Aug 19;287(Pt 1):131931. doi: 10.1016/j.chemosphere.2021.131931. Online ahead of print.

ABSTRACT

As part of the global monitoring plan on persistent organic pollutants (GMP) under the Stockholm Convention passive air samplers equipped with polyurethane foam disks (PUFs) were applied to monitor dioxin-like POPs. For sampling, toluene-pretreated PUFs were exposed for three months during two years. Chemical analysis was performed in one accredited expert laboratory using internationally accepted methods; for comparison, all results were normalized to one PUF and 3 month exposure. Total TEQs, using WHO₂₀₀₅-TEFs, were lowest in the Pacific Islands countries (PAC) and had similar mean values in Africa (16.8 pg TEQ/PUF), Asia (16.9 pg TEQ/PUF), and Latin American and Caribbean countries (GRULAC, 13.3 pg TEQ/PUF). Using median values, Asia (13.4 pg TEQ/PUF) and GRULAC (13.1 pg TEQ/PUF) had higher amounts than Africa (6.1 pg TEQ/PUF) and PAC (2.1 pg TEQ/PUF). The contribution of PCDD/PCDF to the total TEQ was 2-3-times higher than from the dl-PCB. Mono-ortho PCB did not play a role in any of the samples. The previous 40 samples during 2010/2011 and the present 195 samples from 2017/2018 did not show a statistical difference (p value = 0.3), only for GRULAC, a downward trend was identified. It is recommended combining 4 PUFs to ‘annual’ samples.

PMID:34454223 | DOI:10.1016/j.chemosphere.2021.131931

Clin Neurophysiol. 2021 Jul 24;132(10):2416-2421. doi: 10.1016/j.clinph.2021.07.011. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the prognostic value of needle electromyography (EMG) genioglossus involvement in patients with amyotrophic lateral sclerosis (ALS) at diagnosis.

METHODS: We separately explored the prognostic value of clinical bulbar lower motor neuron (LMN) signs and EMG genioglossus involvement using Cox proportional hazard models adjusted for age, gender, diagnostic delay, presence of bulbar upper motor neuron (UMN) signs, EMG cervical and lumbosacral region involvement, ALSFRS-R score and C9Orf72 gene status. Then, we compared the prognostic value of EMG masseter and genioglossus abnormalities in a subset of patients in whom both muscles were analysed.

RESULTS: 103 ALS patients were included in the study. Neurophysiological genioglossus involvement was associated with a shorter survival (p = 0.002), a shorter time to moderate dysphagia (p = 0.0001) and to severe dysarthria (p = 0.012). Its prognostic value was still evident in patients without clinical bulbar LMN signs. Bulbar clinical LMN signs were only associated with an earlier onset of moderate dysphagia (p = 0.0001). EMG masseter abnormalities did not reach statistical significance with regard to all the clinical milestones.

CONCLUSIONS: Genioglossus EMG at diagnosis could provide important information about ALS progression rate. The masseter muscle seems to be less involved in ALS.

SIGNIFICANCE: EMG genioglossus involvement is a prognostic factor in ALS.

PMID:34454268 | DOI:10.1016/j.clinph.2021.07.011

J Environ Manage. 2021 Aug 25;299:113505. doi: 10.1016/j.jenvman.2021.113505. Online ahead of print.

ABSTRACT

The biorefinery approach must be boosted in the management of agro-residues in the future. The present study aims to investigate the valorization of tomato production residues, namely rotten tomato (unfit for consumption – RT), green tomato (GT), and tomato branches (TB). The assessment involves the recovery of value-added compounds through the extraction process followed by biogas production through anaerobic digestion. A thorough characterization of the three residues (RT, GT, and TB) was carried out, including the identification of volatile compounds by solid-phase microextraction (SPME) and gas chromatography/mass spectrometry (GC/MS). The volatiles analysis revealed the presence of flavor enhancer compounds and molecules with insecticidal properties. A solid-liquid extraction with ethanol allowed the recovery of value-added compounds in the extracts, in particular phenolic compounds, β-carotene, and lycopene, which contributed to the antioxidant activity. RT and TB extracts were found to be richer in total phenolic compounds (~27 mg GAE/g_db dry basis) and exhibited higher antioxidant activity (IC₅₀ = 0.911 and 0.745 mg/mL). The tomato branches extract had the highest concentration of carotenoids with 37.23 and 3.08 mg/kg_db of β-carotene and lycopene, respectively. The biochemical methane potential (BMP) was assessed in sealed reactors operating in anaerobic conditions for all the raw (RT, GT, and TB) and extracted substrates waste (RTe, GTe, and TBe). While the BMP of RT and GT was in the range of 232-285 mL CH₄/g VS, a lower value of 141 mL CH₄/g VS was obtained for TB. The methane production for each pair of raw and extracted substrates (RT/RTe, GT/GTe, and TB/TBe) was considered statistically similar at a 95 % confidence level. Overall, the value-added compounds recovery through ethanolic extraction did not compromise the methane production of the materials.

PMID:34454202 | DOI:10.1016/j.jenvman.2021.113505

Clin Neurol Neurosurg. 2021 Aug 19;208:106900. doi: 10.1016/j.clineuro.2021.106900. Online ahead of print.

ABSTRACT

BACKGROUND & PURPOSE: The safety and efficacy of the Woven EndoBridge (WEB) device has been proven in recent multicenter trials. This study investigated whether operator experience influences WEB treatment-related outcomes.

MATERIAL AND METHODS: This was a retrospective analysis of a prospectively collected multicenter database. The data of all patients who underwent WEB treatment for an intracranial aneurysm from March 2014 to June 2020 in two high-volume centers were pooled. Operator experience was indexed by the number of WEB treatments performed previously. The primary endpoint was the overall complication rate. Secondary endpoints were long-term adequate (Raymond-Roy classification of 1-2.) angiographic occlusion, WEB-related complications, number of WEB not deployed, procedure duration, and radiation exposure (air kerma).

RESULTS: Among 237 patients (mean age 59.4 +/- 11.5 years) treated with WEB (median aneurysm diameter, 5.8 mm; interquartile range 4.5-7 mm), WEB-related complications occurred in 28 patients (11.8%) and adequate long-term occlusion was achieved for 154 aneurysms (86%). The median number of WEB treatment performed previously per operator was 20 (IQR, 9-41). The overall complication rate, WEB-related complication rate and aneurysm occlusion rate were not significantly correlated with WEB operator experience. There were also no significant correlations between the WEB operator experience and the number of WEB not deployed, procedure duration or radiation exposure.

CONCLUSION: There was no significant association between the number of WEB treatments previously performed per operator and any technical or clinical results after intracranial aneurysm treatment with WEB. These results imply a relatively short learning curve for this device in high-volume neurovascular centers.

PMID:34454205 | DOI:10.1016/j.clineuro.2021.106900

Sleep Med. 2021 Aug 13;86:19-24. doi: 10.1016/j.sleep.2021.08.008. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore the influence of loneliness on sleep behavior and sleep quality based on propensity score-matched samples in Southwest China.

METHODS: Individual-level data were obtained from a Southwest China cohort study. Participants who felt lonely were matched with those who did not with propensity scores on the basis of age, gender, socioeconomic factors, physical exercise and social connection level. Sleep behavior (onset and offset timing), sleep quality (sleep latency, nocturnal awakenings and subjective sleep quality), and daytime function (daytime sleepiness and fatigue) were assessed with the Pittsburgh Sleep Index Scale (PSQI) and compared between the two groups. The data were collected between May 2019 and December 2019, and data analyses were completed in April 2021.

RESULTS: A total of 11,696 participants were included, and 824 out of 839 participants who felt loneliness were statistically matched with 824 participants who did not. Analyses of the matched samples showed that sleep onset and offset timing were similar between those who felt lonely and those who did not (p = 0.110 and p = 0.751, respectively). Sleep latency was longer in those who felt lonely (26.84 [0.9] vs. 35.52 [1.2] min, p < 0.001) than in those who did not. Furthermore, participants who felt lonely tended to have poor subjective sleep, a higher frequency of nocturnal awakenings, daytime sleepiness and fatigue (all p < 0.001).

CONCLUSIONS: Loneliness was associated with extended sleep latency, increased nocturnal awakenings, and reduced subjective sleep quality and daytime function but was not associated with sleep behavior, including sleep onset and offset timings.

PMID:34454179 | DOI:10.1016/j.sleep.2021.08.008

J Environ Manage. 2021 Aug 25;299:113586. doi: 10.1016/j.jenvman.2021.113586. Online ahead of print.

ABSTRACT

Anthropogenic activities responsible for modifying climatic regimes and land use and land cover (LULC) have been altering fire behavior even in regions with natural occurrences, such as the Pantanal. This biome was highlighted in 2020 due to the record number of fire foci and burned areas registered. Thus, this study aimed to understand how changes in LULC and climate affect the spatial, temporal and magnitude dynamics of fire foci. The Earth Trends Modeler (ETM) was used to identify trends in spatiotemporal bases of environmental and climatic variables. No trend was identified in the historical series of precipitation data. However, an increasing trend was observed for evapotranspiration, normalized difference vegetation index (NDVI) and temperature. For soil moisture, a decreasing trend was observed. The comparison between the mean of the historical series and the year 2020 showed that the variables precipitation, temperature, soil moisture and evapotranspiration had atypical behavior. Such behavior may have contributed to creating a drier environment with available combustible material, leading to a record number of burned areas, about three million hectares (248%) higher than the historical average. The 2020 fire foci data were used in two types of spatial statistical analyses: Grouping, showing that 76% of the registered fire foci were at high risk of fire and; Hot and Cold Spots, indicating high concentrations of Hot Spots in the northern region of the Pantanal, close to Cerrado and Amazon biomes agricultural frontier. The results of the Land Change Modeler (LCM) tool evidenced a strong transition potential from the natural vegetation to agriculture and pasture in the eastern region of the Pantanal, indicating that this could be, in the future, a region of high concentration of fire foci and possibly high risk of fire. This tool also allowed the prediction of a scenario for 2030 that showed that if measures for environmental protection and combating fires are not adopted, in this year, 20% of the Pantanal areas will be for agricultural and pasture use. Finally, the results suggest that the advance of agriculture in the Pantanal and changes in climatic and environmental variables boosted the increase in fire foci and burned areas in the year 2020.

PMID:34454200 | DOI:10.1016/j.jenvman.2021.113586

Am J Obstet Gynecol MFM. 2021 Aug 25:100472. doi: 10.1016/j.ajogmf.2021.100472. Online ahead of print.

ABSTRACT

BACKGROUND: Women who undergo cesarean delivery report that they are less satisfied with their child birthing experience and have later skin-to-skin contact. As cesarean deliveries account for nearly one-fifth of all births globally, improving the child birthing experience is imperative. One delivery technique that may improve the child birthing experience, termed the family-centered cesarean, allows the mother to view the birth of her baby and to have the baby immediately placed on her chest following delivery.

OBJECTIVE(S): Our primary outcome was to compare satisfaction with birthing experiences between women who underwent either a family-centered or traditional cesarean delivery. Our secondary outcomes compared timing of skin-to-skin contact, and maternal and neonatal outcomes between the two methods of cesarean delivery.

STUDY DESIGN: Pregnant women aged ≥ 18 years who had been admitted to Labor and Delivery with a planned cesarean delivery at one of two delivery units were prospectively enrolled. Women were randomized 1:1, but not blinded, to either the family-centered cesarean (Method 1; N=68) or traditional cesarean (Method 2; N=61). Time to skin-to-skin interactions and newborn vitals were recorded by a nurse at time of delivery. A self-administered questionnaire was provided to participants in the hospital on postpartum to obtain satisfaction with the birthing experience using a modified Likert scale, ranging from 1 (lowest) to 5 (highest). Baseline characteristics and all other variables of interest were abstracted from the electronic medical record. Baseline characteristics, maternal satisfaction, and maternal/neonatal outcomes between methods of delivery were compared using t tests and Pearson’s chi-squared (or Fisher’s exact), as appropriate.

RESULTS: Between June 2016-July 2018, women who were randomized to either Method 1 or Method 2 did not significantly differ by baseline characteristics. This study was unable to detect a difference in satisfaction (4.6 Method 1 vs. 4.4 Method 2; p=0.27). However, mean time to skin-to-skin contact was significantly different. Patients in Method 1 established skin-to-skin contact on average 11.2 minutes earlier than those in Method 2 (5.1 vs 16.3; p<0.01). No other differences in maternal and neonatal outcomes were identified.

CONCLUSION(S): While our study did not find statistical differences in maternal/newborn outcomes, including maternal satisfaction, the family-centered cesarean was significantly associated with earlier skin-to-skin contact. Given known benefits of earlier skin-to-skin contact without associated harm, women should be allowed to choose either method of cesarean delivery based on their personal preference.

PMID:34454161 | DOI:10.1016/j.ajogmf.2021.100472

Hand Surg Rehabil. 2021 Aug 25:S2468-1229(21)00247-4. doi: 10.1016/j.hansur.2021.08.009. Online ahead of print.

ABSTRACT

The aim of this study was to investigate the effect of hand deformity on upper-limb function and health-related quality of life (HRQOL) in children with hemiplegic cerebral palsy (CP). The study included 44 children with hemiplegic CP between the ages of 6 and 14 years (mean age, 10.04 years; SD, 3.1; 23 males, 21 females). The Manual Ability Classification System (MACS) and Gross Motor Function Classification System (GMFCS) were used, with the Zancolli classification to characterize hand deformities on the more affected side. Upper-limb function was assessed in terms of unilateral capacity (Quality of Upper Extremity Skills Test: QUEST) and bimanual performance (Children’s Hand-use Experience Questionnaire: CHEQ), while HRQOL was evaluated on the KIDSCREEN-27 questionnaire. Comparison of bimanual performance and unilateral capacity in children with Zancolli level I and II hemiplegic CP found statistically significant differences (p < 0.01). There was also a significant difference on the HRQOL ‘physical activities and health’ subdomain, in favor of Zancolli level I deformity (P = 0.003), but not on the other HRQOL domains (p > 0.05). Upper-limb function and the HRQOL physical health domain were poorer with greater hand deformity in children with hemiplegic CP.

PMID:34454162 | DOI:10.1016/j.hansur.2021.08.009

Sci Total Environ. 2021 Aug 21;802:149721. doi: 10.1016/j.scitotenv.2021.149721. Online ahead of print.

ABSTRACT

The natural flow regime (i.e. magnitude, frequency, duration, timing and rate of change of flow events) is crucial for maintaining freshwater biodiversity and ecosystem services. Protecting instream flow from anthropogenic alterations first requires an understanding of the relationship between aquatic organisms and the flow regime. In this study, we used a unique framework based on random forest modeling to quantify effects of natural flow regime metrics on fish and macroinvertebrate assemblages across ecoregions and flow regime types in the state of South Carolina, USA. We found that all components of the natural flow regime affected both fish and benthic macroinvertebrate assemblages, suggesting that maintaining natural aspects of all flow regime components is critical for protecting freshwater diversity. We identified hydrologic metrics and flow regime components such as magnitude, frequency, and duration of flow events, that were associated with the greatest ecological responses for individual stream classes to help managers prioritize hydrologic and biological metrics of interest during environmental flow standard development. The response of aquatic organisms to hydrologic metrics varied across stream classifications and ecoregions, highlighting the importance of accounting for differences in flow regime and ecoregion when designing environmental flow standards. We provide a flexible framework based on statistical flow-ecology relationships that can be used to inform instream flow management and assess effects of flow alteration on riverine assemblages.

PMID:34454154 | DOI:10.1016/j.scitotenv.2021.149721