Category: Statistics

Forensic Sci Int. 2021 Sep 14;328:110998. doi: 10.1016/j.forsciint.2021.110998. Online ahead of print.

ABSTRACT

Near Infrared (NIR) is a type of vibrational spectroscopy widely used in different areas to characterize substances. NIR datasets are comprised of absorbance measures on a range of wavelengths (λ). Typically noisy and correlated, the use of such datasets tend to compromise the performance of several statistical techniques; one way to overcome that is to select portions of the spectra in which wavelengths are more informative. In this paper we investigate the performance of the Random Forest (RF) classifier associated with several wavelength importance ranking approaches on the task of classifying product samples into categories, such as quality levels or authenticity. Our propositions are tested using six NIR datasets comprised of two or more classes of food and pharmaceutical products, as well as illegal drugs. Our proposed classification model, an integration of the χ² ranking score and the RF classifier, substantially reduced the number of wavelengths in the dataset, while increasing the classification accuracy when compared to the use of complete datasets. Our propositions also presented good performance when compared to competing methods available in the literature.

PMID:34551367 | DOI:10.1016/j.forsciint.2021.110998

Int J Nurs Stud. 2021 Sep 5;124:104084. doi: 10.1016/j.ijnurstu.2021.104084. Online ahead of print.

ABSTRACT

BACKGROUND: Nurses play a vitally important role in promoting equitable and essential care. China undertook bold reforms in its education and healthcare systems since 1990s. The effect of these reforms on the nursing workforce has not been assessed systematically.

OBJECTIVE: This study aims to assess the changing trends and the underlying challenges of the nursing workforce in Mainland China in the period of 1998-2018.

DESIGN: Retrospective data analysis.

METHODS: Data were acquired from the National Health Statistics Yearbook from 1999 to 2019. Descriptive statistics were used to analyze the nature of the nursing workforce in terms of quantity, quality, and structure. Non-parametric tests were used to compare doctors and nurses in terms of number and work experiences. Global Moran’s I index and hotspot analysis were applied to compare the equity in distribution of nurses at national and provincial levels.

RESULTS: From 1998 to 2018, the number of nurses increased from 1.22 to 4.10 million with an average rate of increase of 6.3% per annum. The ratio of doctors to nurses changed from 1: 0.61 to 1: 1.14, reaching 1: 1 in 2013. The main educational level of registered nurses elevated to associated degree (48.9%), and nurses with advanced titles increased at the most rapid rate. In 2018, 60.3% of nurses were younger than 35 years old. The Global Moran’s I index ranged from 0.211 to 0.198 (Z > 1.96, P < 0.05). Hotspot analysis showed the distribution of nurses was unequally concentrated in the northern region and with the highest distribution in Beijing.

CONCLUSIONS: Great improvement on the scale and the quality of nursing workforce over the past 20 years has been witnessed in China. However, the shortage of nurses, outflow of younger nurses and the imbalance distribution of nursing workforce among the country are emerging challenges. Plans should not be ignored on continuously cultivating more qualified nurses, retaining younger nurses, attracting nurses to work in rural areas and the northeast region. Tweetable abstract: The number of nurses in Mainland China increased greatly in the period of 1998-2018, with its improvement in quality, structure, and distribution. However, the shortage of nurses, nurse outflow and the imbalance in the distribution are underlying risks that influence nurse development.

PMID:34551370 | DOI:10.1016/j.ijnurstu.2021.104084

Am J Med Sci. 2021 Sep 19:S0002-9629(21)00318-9. doi: 10.1016/j.amjms.2021.06.021. Online ahead of print.

ABSTRACT

BACKGROUND: Dysregulation of the circadian rhythm is linked to immune response deficiencies. Diurnal temperature variation-a surrogate for the circadian rhythm, exists in humans, yet its preservation during illness is not well understood.

METHODS: Temperatures measured within one-half hour of 8 am, 12 pm, 4 pm, 8 pm, 12 am, and 4 am from 16,245 hospitalized patients were statistically analyzed.

RESULTS: Although we found a diurnal pattern when analyzing the ensemble of temperatures from all patients, stratified by measurement site, the trough-to-peak difference was only 0.2°F, while that for healthy volunteers had been in the 0.5°F to 1.9°F range. The peaks occurred at 8 pm for all patients, regardless of age or sex, which is similar to healthy people. However, the troughs were shifted to later times compared with the 6 am in healthy people-for young patients (age 20-30 years) the trough was at 8 am and for elderly patients (age 70-80 years), at 12 pm, again regardless of patients’ sex. Analysis of individual patients showed that less than 20% of patients exhibited diurnal variation and among those showing variation, the trend was present only on the minority of hospitalization days. The presence or absence of an infectious process or fever did not influence the proportion of patients showing diurnal variation.

CONCLUSIONS: Hospitalization is associated with disruption in the circadian rhythm as reflected by patients’ body temperature. Since abnormality in body temperature is known to affect patient outcomes, an understanding of the diurnal cycle during hospitalization is the first step towards devising approaches to re-establish the circadian rhythm.

PMID:34551353 | DOI:10.1016/j.amjms.2021.06.021

Seizure. 2021 Sep 14;92:195-199. doi: 10.1016/j.seizure.2021.09.003. Online ahead of print.

ABSTRACT

OBJECTIVE: Results of observational investigations have demonstrated that the risk of a traffic accident is independent of use of AEDs. However, no reports of driving tests conducted with patients administered AEDs have been presented. This study examined this scenario in a simulated driving setting.

METHODS: Driving performance of 43 patients with epilepsy (PWE) and prescribed an AED, who were licensed to drive and drove regularly (subject group), was assessed, with the results compared to 40 age- and gender-matched healthy volunteers (control group). Daily driving skills associated with a traffic accident were examined using two different tests provided by a driving simulator software package, road-tracking and car-following. Standard deviation of lateral position (SDLP) and distance coefficient of variation (DCV) were determined as primary and exploratory outcomes, respectively.

RESULTS: There was no statistically significant difference for primary outcome shown by SDLP between the subject and control groups (p = 0.906), nor for exploratory outcome shown by DCV (p = 0.063). Multiple regression analysis revealed that age (ß=0.967, p = 0.001), female gender (ß=0.469, p<0.001), and duration of driving experience (ß=-0.583, p = 0.038) were correlated with SDLP.

SIGNIFICANCE: The present results demonstrated that the driving performance of PWE taking AEDs was not different from that of healthy volunteers.

PMID:34551366 | DOI:10.1016/j.seizure.2021.09.003

Cell Rep. 2021 Sep 21;36(12):109748. doi: 10.1016/j.celrep.2021.109748.

ABSTRACT

Obesity-induced inflammation is a major driving force in the development of insulin resistance, type 2 diabetes (T2D), and related metabolic disorders. During obesity, macrophages accumulate in the visceral adipose tissue, creating a low-grade inflammatory environment. Nuclear factor κB (NF-κB) signaling is a central coordinator of inflammatory responses and is tightly regulated by the anti-inflammatory protein A20. Here, we find that myeloid-specific A20-deficient mice are protected from diet-induced obesity and insulin resistance despite an inflammatory environment in their metabolic tissues. Macrophages lacking A20 show impaired mitochondrial respiratory function and metabolize more palmitate both in vitro and in vivo. We hypothesize that A20-deficient macrophages rely more on palmitate oxidation and metabolize the fat present in the diet, resulting in a lean phenotype and protection from metabolic disease. These findings reveal a role for A20 in regulating macrophage immunometabolism.

PMID:34551300 | DOI:10.1016/j.celrep.2021.109748

Spine J. 2021 Sep 19:S1529-9430(21)00906-2. doi: 10.1016/j.spinee.2021.09.007. Online ahead of print.

ABSTRACT

BACKGROUD CONTEXT: Low back pain can be difficult to diagnose, leaving patients frustrated and confused after medical visits.

PURPOSE: To evaluate the importance of reasons for seeking care in patients with back pain, and to compare this to physicians’ assumptions about these patients’ reasons.

STUDY DESIGN/SETTING: Prospective survey study carried out at two Academic Spine Centers.

PATIENT SAMPLE: 419 patients with back pain upon initial presentation to a spine clinic, and 198 physicians; all volunteered to complete a survey.

OUTCOME MEASURES: Variance in mean values between patient and physician responders with significance determined by non-overlapping 95% confidence intervals.

METHODS: Patients were asked to “rate each of the following with regard to their importance to you” (answering between 0 “not important” to 4 “extremely important”): improvement in level of pain, improvement in ability to perform daily tasks, explanation of what is causing your problem, thorough physical examination, diagnostic testing, medication, physical therapy, surgery. Physicians were asked to rate each of these “with regard to their importance to your patients.”

RESULTS: Patients indicated the following items were the most important (mean values): explanation of what is causing your problem (3.27), improvement in level of pain (3.48) and improvement in ability to perform daily tasks (3.31). Patients attributed the least importance and lowest scores to: surgery (1.07) and medication (1.89). Comparing the mean values to each item by patient and physician responders revealed statistically significant differences in certain items. Specifically, physicians underestimated the importance of an explanation of what is causing the problem (2.78 ± 0.119 vs. 3.28 ± 0.098, 95% CI) and overvalued diagnostic tests (2.64 ± 0.120 vs. 2.30 ± 0.147, 95% CI), medications (2.38 ± 0.118 vs. 1.89 ± 0.143, 95% CI) and surgery (1.60 ± 0.126 vs 1.07 ± 0.140, 95% CI).

CONCLUSION: Patients did not place as much importance on diagnostic tests, medications and surgery as the physicians assumed. Physicians understand that back pain patients want improvement in both pain and function, but they underestimate the importance of an explanation for the pain.

PMID:34551322 | DOI:10.1016/j.spinee.2021.09.007

Cell Rep. 2021 Sep 21;36(12):109722. doi: 10.1016/j.celrep.2021.109722.

ABSTRACT

DNA replication timing and three-dimensional (3D) genome organization are associated with distinct epigenome patterns across large domains. However, whether alterations in the epigenome, in particular cancer-related DNA hypomethylation, affects higher-order levels of genome architecture is still unclear. Here, using Repli-Seq, single-cell Repli-Seq, and Hi-C, we show that genome-wide methylation loss is associated with both concordant loss of replication timing precision and deregulation of 3D genome organization. Notably, we find distinct disruption in 3D genome compartmentalization, striking gains in cell-to-cell replication timing heterogeneity and loss of allelic replication timing in cancer hypomethylation models, potentially through the gene deregulation of DNA replication and genome organization pathways. Finally, we identify ectopic H3K4me3-H3K9me3 domains from across large hypomethylated domains, where late replication is maintained, which we purport serves to protect against catastrophic genome reorganization and aberrant gene transcription. Our results highlight a potential role for the methylome in the maintenance of 3D genome regulation.

PMID:34551299 | DOI:10.1016/j.celrep.2021.109722

J Med Radiat Sci. 2021 Sep 22. doi: 10.1002/jmrs.530. Online ahead of print.

ABSTRACT

INTRODUCTION: Adjuvant radiation therapy (RT) following primary surgery in women affected by early breast cancer (EBC) plays a central role in reducing local recurrences and overall mortality. The FAST-FORWARD trial recently demonstrated that 1-week hypofractionated adjuvant RT is not inferior to the standard schedule in terms of local relapse, cosmetic outcomes and toxicity. The aim of this in silico study was to evaluate the dosimetric aspects of a 1-week RT course, administered through volumetric modulated arc therapy (VMAT), compared with traditional three-dimensional conformal radiation therapy (3D-CRT) with tangential fields.

METHODS: Patients affected by left-side EBC undergoing adjuvant RT were selected. ESTRO guidelines for the clinical target volume (CTV) delineation and FAST-FORWARD protocol for CTV to planning target volume (PTV) margin definition were followed. Total prescribed dose was 26 Gy in five fractions. The homogeneity index (HI) and the global conformity index (GCI) were taken into account for planning and dose distribution optimisation purposes. Both 3D-CRT tangential fields and VMAT plans were generated for each patient.

RESULTS: The analysis included 21 patients. PTV coverage comparison between 3D-CRT and VMAT plans showed significant increases for GCI (P < 0.05) in VMAT technique; no statistically significant differences were observed regarding HI. For organs at risks (OAR), statistically significant increases were observed in terms of skin V103% (P < 0.002) and ipsilateral lung V30% (P < 0.05) with 3D-CRT and of heart V5% (P < 0.05) with VMAT technique.

CONCLUSIONS: This in silico study showed that both 3D-CRT and VMAT are dosimetrically feasible techniques in the framework of 1-week hypofractionated treatments for left EBC.

PMID:34551211 | DOI:10.1002/jmrs.530

Clin Oral Implants Res. 2021 Sep 22. doi: 10.1111/clr.13841. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim was to evaluate the role of resorbable membranes applied over customized titanium meshes related to soft tissue healing and bone regeneration after vertical/horizontal bone augmentation.

MATERIALS AND METHODS: Thirty patients with partial edentulism of the maxilla/mandible, with vertical/horizontal reabsorption of the alveolar bone, and needing implant-supported restorations, were randomly divided into two groups: Group A was treated using only custom-made meshes (Mesh-); Group B using custom-made meshes with cross-linked collagen membranes (Mesh+). Data collection included: surgical and healing complications, “pseudo-periosteum” thickness, bone density, planned bone volume (PBV), regenerated bone volume (RBV), regeneration rate (RR), vertical bone gain (VBG), and implant survival in regenerated areas. Statistical analysis was performed between the 2 study groups using a significance level of α=0.05.

RESULTS: Regarding the healing complications, the non-inferiority analysis proved to be inconclusive despite the better results of group Mesh+ (13%) compared to group Mesh- (33%); Estimated value -1.13 CI-95% from -0.44 to 0.17. Superiority approach confirmed the absence of significant differences (p=0.39). RBV were 803.27mm³ and 843.13mm³ , respectively; and higher RR was observed in group Mesh+ (82.3%) compared to Mesh- (74.3%), although this value didn’t reach a statistical significance (p=0.44). All 30 patients completed the study, receiving 71 implants; 68 out of them were clinically stable and in function.

CONCLUSION: the results showed that customized meshes alone don’t appear to be inferior to customized meshes covered by cross-linked collagen membranes in terms of healing complication rates and regeneration rates, although superior results were observed in group Mesh+ compared to group Mesh- for all variables.

PMID:34551168 | DOI:10.1111/clr.13841

Int J Clin Pract. 2021 Sep 22:e14915. doi: 10.1111/ijcp.14915. Online ahead of print.

ABSTRACT

BACKGROUND: Although biologic agents are very effective, solid data proving they are safer than other therapies in psoriasis are still lacking.

METHODS: A total of 289 psoriatic patients were followed for 30 months; of which number 118 were treated with topical agents alone, 112 received biologic agents, and the remaining 59 patients were on non-biologic systemic agents. The rates of adverse events in these groups were recorded and statistically analyzed.

RESULTS: Patients treated with biologic agents had higher rates of adverse events (p=0.017), including overall infections (p=0.003), respiratory infections (p<0.001), renal, urinary (p<0.001), musculoskeletal, connective tissue (p<0.001, and p=0.021) and oral cavity-related (p=0.046) disorders. Except for the incidence of infections, all the above adverse events occurred more often in our study than in clinical trials. The occurrence of serious adverse events was p=0.066, with the incidence of serious infections being p=0.164. Unlike patients on topical therapy and non-biologic systemic agents, patients treated with biologic agents were forced to discontinue their therapies (p=0.001). The Psoriasis Area Severity Index (PASI) and Body Surface Area (BSA) scores were the lowest among patients on biologic agents.

CONCLUSION: While biologic agents were the most effective therapies, they were associated with higher rates of treatment discontinuation and adverse events in comparison with other forms of therapy.

PMID:34551188 | DOI:10.1111/ijcp.14915