Category: Statistics

Mil Med. 2021 Aug 28:usab353. doi: 10.1093/milmed/usab353. Online ahead of print.

ABSTRACT

INTRODUCTION: We aimed to evaluate the effect of the SARS-COV2 pandemic on chaplain utilization at Brooke Army Medical Center. Our hypothesis was that multiple pandemic-related factors led to a care environment with increased mental and spiritual stress for patients and their families, leading to an increased need for adjunct services such as chaplaincy.

MATERIALS AND METHODS: This was a single-institution retrospective chart review study that evaluated the records of 10,698 patients admitted between July 1, 2019, and January 31, 2020, or between July 1, 2020, and January 31, 2021. Our primary study outcomes included the number of chaplain consultations, the number of visits per consultation, and the time of visits between the two study cohorts. Secondary outcomes included inpatient mortality and the number of end-of-life visits. We also isolated a subgroup of patients admitted with COVID-19 and compared their outcomes with the two larger cohorts. Statistical analysis included t-test or chi-squared test, based on the variable. This study was reviewed and approved by the Brooke Army Medical Center Institutional Review Board (IRB ID C.2021.010e).

RESULTS: Fewer consults were performed during the study period affected by the SARS-COV2 pandemic (4814 vs. 5884, P-value <.01). There were fewer individual visits per consult during the study period affected by the SARS-COV2 pandemic (1.44 vs. 1.64, P-value <.01), which led to fewer overall time spent per consult (37.41 vs. 41.19 minutes, P-value <.01). The 2020 cohort (without COVID-19 cases) demonstrated a higher mortality rate than the 2019 cohort (2.8% vs. 1.9%, P-value <.01). The COVID-19 diagnosis cohort demonstrated a much higher mortality rate compared to other patients in the 2020 cohort (19.3% vs. 2.8%, P-value <.01). We demonstrated the relative need for EOL consults by presenting the ratio of EOL consults to inpatient deaths. This ratio was highest for the COVID-19 diagnosis cohort (0.76) compared to the 2020 cohort (0.50) and the 2019 cohort (0.60).

CONCLUSIONS: This study demonstrates that factors related to the SARS-COV2 pandemic resulted in fewer chaplaincy consults in our inpatient setting. We did not find other reports of a change in the rate of chaplaincy consultation, but available reports suggest that many centers have had difficulty balancing the spiritual needs of patients with local exposure guidelines. Although fewer individual chaplain consults occurred during the SARS-COV2 pandemic, our chaplain service innovated by utilizing various phone, video, and web-based platforms to deliver spiritual support to our community. Our study also suggests that the patients most greatly affected by the pandemic have an increased need for spiritual support, especially at the end of life. Future studies in this subject should examine the effect of various types of chaplain services as they relate to the health and well-being of hospitalized patients.

PMID:34453171 | DOI:10.1093/milmed/usab353

Mil Med. 2021 Aug 28:usab325. doi: 10.1093/milmed/usab325. Online ahead of print.

ABSTRACT

INTRODUCTION: Brachytherapy, with external beam radiation, increases survival in the treatment of locally advanced cervical cancer (LACC). In 2016, Robin et al. reported only 44% of patients received standard-of-care (SOC) brachytherapy in the USA. The Pacific Island Health Care Project has provided humanitarian medical care to women from the U.S. Associated Pacific Islands (USAPI) for three decades at Tripler Army Medical Center (TAMC), a military health care system (MHS) facility. We evaluated whether this underserved and understudied patient population received SOC treatment for LACC at TAMC.

MATERIALS AND METHODS: The TAMC tumor registry was searched for all cervical cancer cases from 1997 to 2019. Subjects were excluded if they did not have stage IB2-IVA disease and were not from USAPI. The primary outcome was the overall utilization of brachytherapy, and statistical analysis was performed using the chi-square test.

RESULTS: We identified 214 women with cervical cancer treated at TAMC, of which 67 met the study criteria. Ninety-two percent had squamous cell carcinoma on histology. Of the patients identified, 48 (71.6%, P < .001) were treated with brachytherapy. Fifteen (22.4%) patients received external radiation alone, and four (6.0%) received chemoradiation without brachytherapy. A post-hoc power analysis was conducted with a power of 91.3%.

CONCLUSIONS: Women with cervical cancer from USAPI in the PIHCP program treated at TAMC received significantly higher rates of SOC radiation treatment than the U.S. population on average. This highlights the ability of PIHCP, through the MHS, to deliver SOC treatment for cervical cancer to an otherwise underserved patient population.

PMID:34453178 | DOI:10.1093/milmed/usab325

Ann Work Expo Health. 2021 Aug 28:wxab071. doi: 10.1093/annweh/wxab071. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to construct, validate, and calibrate an exposure matrix that would be used to estimate personal airborne exposures to total dust, manganese, nickel, chromium, and aluminum for welders in the WHAT-ME cohort. The Workers’ Health in Apprenticeship Trades: metal and electrical (WHAT-ME) study established a cohort of women and men welders to investigate pregnancy and other birth outcomes along with health issues related to welding. To construct the matrix, data were extracted and assembled from the literature and analyzed to produce exposure models. Final models derived in this first step were then compared with external data gathered under controlled conditions and later combined to form calibrated models.

METHODS: A systematic literature search was conducted to identify and extract all relevant data from published journal articles appearing in selected databases. Summary data were extracted that represented airborne personal exposures to total, inhalable and respirable dusts along with metal concentrations for manganese, nickel, chromium, and aluminum. Mathematical exposure models were derived and a validation of the models undertaken in the second part of this study. The most common welding combinations of welding process, base metal, and consumable (welding scenarios) for welders taking part in the WHAT-ME study were identified through detailed welding questionnaires completed by WHAT-ME participants. These were replicated under controlled conditions with a welder equipped with a personal air sampling pump to gather samples. A gravimetric analysis was performed to determine total dust exposures followed by a metals analysis using ICP-MS. Predictions were made for these welding scenarios replicated in the laboratory, using the exposure models derived in the literature and the predictions correlated against the results from the welding laboratory replications.

RESULTS: The systematic review yielded 92 published articles from which 737 summary statistics were extracted representing 4620 personal samples of total dust, 4762 of manganese, 4679 of nickel, 3972 of chromium, and 676 of aluminum. The highest total dust exposures were for flux-core arc welding (FCAW) while the highest manganese producing base metal was mild steel. For nickel, the highest emissions were from high alloyed steel using gas metal arc welding while chromium emissions were most abundant in manual metal arc welding on stainless steel. Aluminum exposures were highest in FCAW welding and on aluminum as a base metal. The replication of 21 scenarios covered more than 90% of the scenarios in the WHAT-ME study. Sixty-one laboratory welding sessions took place with a minimum of two replications per scenario. Spearman rank correlations between predicted exposures and mean measured exposures yielded a rho of 0.93 (P < 0.001) for total dust, 0.87 (P < 0.001) for manganese, 0.54 (P < 0.024) for nickel, 0.43 (P = 0.055) for chromium, and 0.29 (P = 0.210) for aluminum.

CONCLUSIONS: This study produced the first welding exposure matrix composed of process, base metal, and consumable. This model was able to predict exposures observed under controlled conditions and could be used by any researcher to estimate welding exposures in a wide range of occupational contexts.

PMID:34453157 | DOI:10.1093/annweh/wxab071

Brief Bioinform. 2021 Aug 27:bbab347. doi: 10.1093/bib/bbab347. Online ahead of print.

ABSTRACT

Continuous evaluation of drug safety is needed following approval to determine adverse events (AEs) in patient populations with diverse backgrounds. Spontaneous reporting systems are an important source of information for the detection of AEs not identified in clinical trials and for safety assessments that reflect the real-world use of drugs in specific populations and clinical settings. The use of spontaneous reporting systems is expected to detect drug-related AEs early after the launch of a new drug. Spontaneous reporting systems do not contain data on the total number of patients that use a drug; therefore, signal detection by disproportionality analysis, focusing on differences in the ratio of AE reports, is frequently used. In recent years, new analyses have been devised, including signal detection methods focused on the difference in the time to onset of an AE, methods that consider the patient background and those that identify drug-drug interactions. However, unlike commonly used statistics, the results of these analyses are open to misinterpretation if the method and the characteristics of the spontaneous reporting system cannot be evaluated properly. Therefore, this review describes signal detection using data mining, considering traditional methods and the latest knowledge, and their limitations.

PMID:34453158 | DOI:10.1093/bib/bbab347

Spinal Cord. 2021 Aug 27. doi: 10.1038/s41393-021-00695-5. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective descriptive study.

OBJECTIVES: To summarize epidemiologic data on nontraumatic spinal cord injury (NTSCI) for the last 30 years and compare these findings to data from individuals with traumatic spinal cord injury (TSCI).

SETTING: National Rehabilitation Center affiliated with the Ministry of Health and Welfare in Korea.

METHODS: The medical records of 948 individuals with NTSCIs were retrospectively reviewed. Three groups were created based on onset period (1990-1999, 2000-2009, 2010-2019) and six groups based on age (≤15, 16-30, 31-45, 46-60, 61-75, and ≥76 years). Pearson’s chi-square and analysis of variance tests were used for statistical analysis.

RESULTS: The male-to-female ratio was 1.30:1 for NTSCI individuals and 3.47:1 for TSCI individuals. The mean age (standard deviation [SD]) at the time of injury increased from 38.7 (SD = 18.1) years in the 1990s to 55.5 (SD = 16.6) years in the 2010s (F = 44.597, p ≤ 0.001). Vertebral column degenerative disorder was the primary cause of injury in 28.9% of the cases, and the most common neurologic level was T12-L2. Paraplegia occurred in 74.6% of cases, and tetraplegia in 25.4% of cases. The proportion of NTSCI individuals increased from 11.2% to 29.3% during the observation period.

CONCLUSIONS: The proportion of NTSCI among total spinal cord injuries has increased in Korea over the last 30 years (1990-2019). Compared to individuals with TSCI, those with NTSCI had a higher age at onset, with different male-to-female ratios. Our study is the most comprehensive investigation of NTSCI in Korea, and our findings can inform research directions and medical guidelines.

PMID:34453110 | DOI:10.1038/s41393-021-00695-5

Br J Cancer. 2021 Aug 27. doi: 10.1038/s41416-021-01524-5. Online ahead of print.

ABSTRACT

BACKGROUND: Cancer outcomes are poor in socioeconomically deprived communities, with low symptom awareness contributing to prolonged help-seeking and advanced disease. Targeted cancer awareness interventions require evaluation.

METHODS: This is a randomised controlled trial involving adults aged 40+ years recruited in community and healthcare settings in deprived areas of South Yorkshire and South-East Wales.

INTERVENTION: personalised behavioural advice facilitated by a trained lay advisor.

CONTROL: usual care. Follow-up at two weeks and six months post-randomisation.

PRIMARY OUTCOME: total cancer symptom recognition score two weeks post-randomisation.

RESULTS: Two hundred and thirty-four participants were randomised. The difference in total symptom recognition at two weeks [adjusted mean difference (AMD) 0.6, 95% CI: -0.03, 1.17, p = 0.06] was not statistically significant. Intervention participants reported increased symptom recognition (AMD 0.8, 95% CI: 0.18, 1.37, p = 0.01) and earlier intended presentation (AMD -2.0, 95% CI: -3.02, -0.91, p < 0.001) at six months. “Lesser known” symptom recognition was higher in the intervention arm (2 weeks AMD 0.5, 95% CI: 0.03, 0.97 and six months AMD 0.7, 95% CI: 0.16, 1.17). Implementation cost per participant was £91.34, with no significant between-group differences in healthcare resource use post-intervention.

CONCLUSIONS: Improved symptom recognition and earlier anticipated presentation occurred at longer-term follow-up. The ABACus Health Check is a viable low-cost intervention to increase cancer awareness in socioeconomically deprived communities.

CLINICAL TRIAL REGISTRATION: ISRCTN16872545.

PMID:34453114 | DOI:10.1038/s41416-021-01524-5

Sci Rep. 2021 Aug 27;11(1):17554. doi: 10.1038/s41598-021-96120-1.

NO ABSTRACT

PMID:34453078 | DOI:10.1038/s41598-021-96120-1

Sci Rep. 2021 Aug 27;11(1):17290. doi: 10.1038/s41598-021-96690-0.

ABSTRACT

A survey of Acanthamoeba in 100 public freshwater sources in 28 provinces across Thailand has identified 9 genotypes comprising T2/6, T3-T5, T9, T11, T12, T18 and a novel ‘T23’ among 131 isolates. Sequencing of the near complete 18S rRNA gene of Acanthamoeba of all isolates has shown that the most predominant genotype T4 found in 87 isolates (66.4%) contained 4 subtypes, i.e. T4A, T4B, T4C and T4F, while all isolates assigned to genotype T2/6 belonged to subtype B. Among intron-bearing genotypes, most isolates harbouring genotype T3 contained S516 introns, characterised by 3 distinct variants whilst all genotypes T4A and T5 were intronless. Identical 18S rRNA sequences of Acanthamoeba were identified across regions of the country and four isolates in this study shared the same sequences with those from remote nations, suggesting that some strains have reproductive success in diverse ecological niche. Nucleotide diversity of genotypes T2/6B, T3, T4, T9 and T11 in this study was significantly less than that among global isolates outside Thailand, implying that limited sequence diversity occurred within local populations. A remarkably higher level of nucleotide diversity in genotype T11 than those of other genotypes (0.041 vs. 0.012-0.024) could be due to cryptic subtypes. Recombination breakpoints have been detected within genotypes and subtypes as well as within isolates despite no evidence for sexual and parasexual cycles in the genus Acanthamoeba. Tajima’s D, Fu & Li’s D* and F* statistics revealed significantly negative deviation from neutrality across genotypes and subtypes, implying purifying selection in this locus. The 18S rRNA gene of the novel genotype ‘T23’ displayed 7.82% to 28.44% sequence differences in comparison with all known genotypes. Both Bayesian and maximum likelihood phylogenetic trees have placed genotype T23 as sister to the clade comprising genotypes T10, T12 and T14, all of these possess cyst structure belonging to morphological group III. Hence, Acanthamoeba bangkokensis sp. nov. is proposed for this novel genotype. It is likely that more genotypes of Acanthamoeba remain to be discovered while the evolution of the 18S rRNA gene of this pathogenic-free living amoeba seems to be ongoing.

PMID:34453084 | DOI:10.1038/s41598-021-96690-0

Sci Data. 2021 Aug 27;8(1):228. doi: 10.1038/s41597-021-01009-3.

ABSTRACT

Curated global climate data have been generated from climate model outputs for the last 120,000 years, whereas reconstructions going back even further have been lacking due to the high computational cost of climate simulations. Here, we present a statistically-derived global terrestrial climate dataset for every 1,000 years of the last 800,000 years. It is based on a set of linear regressions between 72 existing HadCM3 climate simulations of the last 120,000 years and external forcings consisting of CO₂, orbital parameters, and land type. The estimated climatologies were interpolated to 0.5° resolution and bias-corrected using present-day climate. The data compare well with the original HadCM3 simulations and with long-term proxy records. Our dataset includes monthly temperature, precipitation, cloud cover, and 17 bioclimatic variables. In addition, we derived net primary productivity and global biome distributions using the BIOME4 vegetation model. The data are a relevant source for different research areas, such as archaeology or ecology, to study the long-term effect of glacial-interglacial climate cycles for periods beyond the last 120,000 years.

PMID:34453060 | DOI:10.1038/s41597-021-01009-3

J Cosmet Dermatol. 2021 Aug 27. doi: 10.1111/jocd.14430. Online ahead of print.

ABSTRACT

BACKGROUND: In many cases, human papillomavirus (HPV) infection is self-limiting, as innate and adaptive cell-mediated immunity are needed for infection elimination; however, the inability of the immune system in some patients to clear the infection is a matter of debate. The interleukin-17 (IL-17) family cytokines play an important protective role in host immune response to infections, through maintaining immunity against specific pathogens, induction of antimicrobial proteins, and recruitment of neutrophils to sites of invasion. Galectin-3 (Gal-3) may be considered as a marker of viral infection as many studies reported its increased serum level in viral infections.

AIMS: To evaluate levels of serum Gal-3 and IL-17 in patients with verrucas, and to explore the potential role of these markers in the pathogenesis of the disease.

METHODS: Fifty patients suffering from HPV Infection, and fifty healthy controls were included in this study. Serum levels of Gal-3 and IL-17 were assessed using enzyme-linked immunosorbent assay.

RESULTS: The patients’ serum Gal-3 was significantly higher while IL 17 was significantly lower than that of the healthy controls (p-value < 0.001). Moreover, a statistically significant positive correlation was found between Gal-3 serum level and disease duration and number of warts. Significant negative correlation exists between IL-17 and Gal-3 levels.

CONCLUSION: Our results indicate a potential role of both IL-17 and Gal-3 in the pathogenesis of warts and open a new opportunity in targeting these markers in the future in treating warts.

PMID:34449950 | DOI:10.1111/jocd.14430