Category: Statistics

Clin Infect Dis. 2021 Sep 15:ciab808. doi: 10.1093/cid/ciab808. Online ahead of print.

ABSTRACT

BACKGROUND: In the US, norovirus is the leading cause of healthcare-associated gastroenteritis outbreaks. To inform prevention efforts, we describe the epidemiology of norovirus outbreaks in long-term care facilities (LTCFs).

METHODS: CDC collects epidemiologic and laboratory data on norovirus outbreaks from U.S. health departments through the National Outbreak Reporting System (NORS) and CaliciNet. Reports from both systems were merged, and norovirus outbreaks in nursing homes, assisted living, and other LTCFs occurring in 2009-2018 were analyzed. Data from the Centers for Medicare and Medicaid Services and the National Center for Health Statistics were used to estimate state LTCF counts.

RESULTS: During 2009-2018, 50 states, Washington D.C., and Puerto Rico reported 13,092 norovirus outbreaks and 416,284 outbreak-associated cases in LTCFs. Participation in NORS and CaliciNet increased from 2009-2014 and median reporting of LTCF norovirus outbreaks stabilized at 4.1 outbreaks per 100 LTCFs (IQR: 1.0-7.1) annually since 2014. Most outbreaks were spread via person-to-person transmission (90.4%) and 75% occurred during December-March. Genogroup was reported for 7,292 outbreaks with 862 (11.8%) positive for GI and 6,370 (87.3%) for GII. Among 4,425 GII outbreaks with typing data, 3,618 (81.8%) were GII.4. LTCF residents had higher attack rates than staff (median 29.0% versus 10.9%; p<0.001). For every 1,000 cases, there were 21.6 hospitalizations and 2.3 deaths.

CONCLUSIONS: LTCFs have a high burden of norovirus outbreaks. Most LTCF norovirus outbreaks occurred during winter months and were spread person-to-person. Outbreak surveillance can inform development of interventions for this vulnerable population, such as vaccines targeting GII.4 norovirus strains.

PMID:34523674 | DOI:10.1093/cid/ciab808

Am J Epidemiol. 2021 Sep 14:kwab227. doi: 10.1093/aje/kwab227. Online ahead of print.

ABSTRACT

The sex/gender and aging-related cognitive decline association remains poorly understood due to inconsistencies in findings. Such heterogeneity could be attributable to the cognitive functions studied and study population characteristics, but also to a differential selection by drop-out and death between men and women. This work aims to evaluate the impact of selection by drop-out and death on the association between sex/gender and cognitive decline. We first compared the most frequently used statistical methods for longitudinal data, targeting either population estimands (marginal models estimated by Generalized Estimating Equations) or subject-specific estimands (mixed/joint models estimated by likelihood maximization) on eight aging studies: six population-based (ACTIVE(1996-2009), Paquid(1988-2014), REGARDS(2003-2016), 3-City(1999-2016), WHICAP(1992-2017), Whitehall II(2007-2016)) and two clinic-based (ADNI(2004-2017), MEMENTO(2011-2016)) studies. We illustrated the differences in the estimands of the sex/gender association with cognitive decline in selected examples and highlighted the critical role of differential selection by drop-out and death. By using the same estimand, we then contrasted the sex/gender association across cohorts and cognitive measures suggesting residual differential sex/gender association depending on the targeted cognitive measure (memory or animal fluency) and the initial cohort selection. We recommend focusing on subject-specific estimands in the alive population for assessing sex/gender differences while handling differential selection over time.

PMID:34521111 | DOI:10.1093/aje/kwab227

Brain Behav. 2021 Sep 14:e32349. doi: 10.1002/brb3.2349. Online ahead of print.

ABSTRACT

OBJECTIVES: There are controversies about the role of zinc in the development of both types 1 and 2 diabetes. The aim of this study was to assess serum zinc level in diabetic patients with and without peripheral neuropathy in comparison to healthy controls and to explore the possible relationship between serum zinc level and severity of peripheral neuropathy.

METHODS: This case control study was conducted on 120 subjects: 40 patients fulfilled the criteria for diagnosis of probable diabetic polyneuropathy (DPN), 40 diabetic patients without polyneuropathy (N-DPN) and 40 healthy controls. DPN patients were submitted to clinical assessment of diabetic neuropathy using neuropathy symptom and change (NSC) scale, Michigan Neuropathy Screening Instrument Physical Assessment (MNSI) scale and electrophysiological assessment using nerve conduction study. Zinc serum level was measured in all subjects included in this study using direct colorimetric test method.

RESULTS: Diabetic patients with and without neuropathy were found to have significantly lower mean values of serum zinc than healthy controls (p = .025, .03 respectively). There is a statistically significant negative correlation between zinc serum level and hemoglobin A1C (HA1C) (p ˂ .001), NSC score (p = .001) and MNSI score (p = .003) in DPN group. There were also statistically significant correlations between zinc serum level and nerve conduction study values.

CONCLUSION: Zinc deficiency significantly correlates with the severity of DPN and glycemic control.

PMID:34521153 | DOI:10.1002/brb3.2349

Forensic Sci Int. 2021 Sep 2;327:110988. doi: 10.1016/j.forsciint.2021.110988. Online ahead of print.

ABSTRACT

The development of fingermarks on reflective surfaces is often a challenge regarding the photography of images with overlapping lines, low contrast and reflections, especially considering that many forensic laboratories are supplied only with basic instrumentation for fingerprint analysis. The present study overviews these difficulties and proposes a combination of chemical and optical procedures, using low-cost products and equipment, to develop fingermarks on silver mirror surfaces. The chemical treatment promotes the delimitation of the substrate, transforming the reflective surface into a transparent surface. The results were statistically analyzed, indicating quality improvement of natural fingermarks pictures taken with standard digital camera on transparent surface. There was good observation of details and minutiae, even for samples recovered several days or weeks after deposition. The suggested method substantially modifies the composition of the substrate without any contact with the fingermark, preserving its characteristics and properties. Like other nondestructive methodologies, this approach could be prioritized over methods that directly change the evidence itself and allows for the photography of the fingermark in unaltered condition. Lastly, it does not impact on the efficiency of subsequent exams.

PMID:34521020 | DOI:10.1016/j.forsciint.2021.110988

Comput Biol Med. 2021 Aug 26;137:104802. doi: 10.1016/j.compbiomed.2021.104802. Online ahead of print.

ABSTRACT

An in silico trial simulates a disease and its corresponding therapies on a cohort of virtual patients to support the development and evaluation of medical devices, drugs, and treatment. In silico trials have the potential to refine, reduce cost, and partially replace current in vivo studies, namely clinical trials and animal testing. We present the design and implementation of an in silico trial for treatment of acute ischemic stroke. We propose an event-based modelling approach for the simulation of a disease and injury, where changes to the state of the system (the events) are assumed to be instantaneous. Using this approach we are able to combine a diverse set of models, spanning multiple time scales, to model acute ischemic stroke, treatment, and resulting brain tissue injury. The in silico trial is designed to be modular to aid development and reproducibility. It provides a comprehensive framework for application to any potential in silico trial. A statistical population model is used to generate cohorts of virtual patients. Patient functional outcomes are also predicted with a statistical model, using treatment and injury results and the patient’s clinical parameters. We demonstrate the functionality of the event-based modelling approach and trial framework by running proof of concept in silico trials. The proof of concept trials simulate the same cohort of patients twice: once with successful treatment (successful recanalisation) and once with unsuccessful treatment (unsuccessful treatment). Ways to overcome some of the challenges and difficulties in setting up such an in silico trial are discussed, such as validation and computational limitations.

PMID:34520989 | DOI:10.1016/j.compbiomed.2021.104802

J Environ Manage. 2021 Sep 11;300:113719. doi: 10.1016/j.jenvman.2021.113719. Online ahead of print.

ABSTRACT

Shrimp are one of the fastest growing commodities in aquaculture and have a considerable land footprint. Here, we explored the impact of utilizing different production methods (extensive vs intensive) for expanding shrimp production on the cumulative land footprint of shrimp aquaculture. A meta-analytic approach was utilized to simultaneously estimate model coefficients to explore three relationships: production intensity and total land burden, production intensity and the proportion of land at the farm, and production intensity and the farmland burden. A literature review was conducted and a total of 7 datasets, 22 subsets, and 973 individual farms were included in this study. The global models were as follows: model 1 → ln (total land burden) = 0.1165-0.3863 * ln (production intensity), model 2 → proportion of direct (farm) land use:total land use = 0.7592-0.1737 * ln (production intensity), model 3 → ln (direct land use) = 0.1991-0.9674 * ln (production intensity). Production expansion was modeled under different scenarios. The most land intensive projections involved using only extensive systems to increase production when compared to a business-as-usual scenario. The least land intensive scenario involved utilizing intensive systems. A scenario where farmland was not expanded used 17% less land and 28% less land to produce 7.5 and 10 million tons of shrimp, respectively, when compared to business-as-usual scenarios. These estimates are limited by uncertainty in shrimp feed composition but demonstrate the effect of production intensity on the overall land footprint of shrimp production.

PMID:34521002 | DOI:10.1016/j.jenvman.2021.113719

Int Emerg Nurs. 2021 Sep 11;58:101050. doi: 10.1016/j.ienj.2021.101050. Online ahead of print.

ABSTRACT

BACKGROUND: There is a strong biomedical focus within emergency care. However, while failure to meet patients’ fundamental care needs has severe consequences for the patient, there is limited knowledge on how nursing care is provided in emergency rooms and the related implications for patients.

AIM: This study aims to explore how fundamental care needs of critically ill patients are met in emergency rooms.

METHODS: Non-participant observations at an emergency department in Sweden included 108 observations and field notes (150 h). Data were analysed using descriptive statistics.

RESULTS: Observations showed that registered nurses (RN) identified patients’ fundamental care needs and provided nursing care. However, the RNs’ focus on the patient decreased over time. When the RN communicated with the patient, the patients’ physical needs were met to a greater extent. The organisational structure and physical environment of emergency rooms limit RNs’ ability to meet patients’ fundamental care needs.

CONCLUSION: Not all patients had their fundamental care needs optimally met. This study highlights the importance of RNs working in an integrated manner; an RN working bedside is crucial for establishing a patient-nurse relationship to meet the patient’s physical, psychosocial, and relational needs.

PMID:34520964 | DOI:10.1016/j.ienj.2021.101050

Am J Otolaryngol. 2021 Sep 3;43(1):103195. doi: 10.1016/j.amjoto.2021.103195. Online ahead of print.

ABSTRACT

OBJECTIVES: Adenotonsillectomy (T&A) is one of the most common surgical procedures performed in the United States. Several studies have defined the safety of laryngeal mask airway (LMA) during this surgery, and conflicting evidence exists describing the role it plays in reducing intraoperative times. Our objective is to describe the role LMA and operating on a stretcher have on reducing intraoperative time during pediatric T&A.

METHODS: This is a retrospective review between October 2017 and January 2020. We included patients between the ages of 4-18 years old undergoing T&A. We excluded medically complex patients with chromosomal, craniofacial, and metabolic abnormalities, patients with cerebral palsy, and those who were tracheostomy dependent. Patient demographics included surgical indication, age, sex, obesity, use of preoperative midazolam, type of airway used, use of traditional operating room (OR) bed versus transport stretcher, surgeon type, and intraoperative times. Data was analyzed with univariate t-test and multivariate linear regression.

RESULTS: One hundred seventy-nine patients were included with an average age of 7.2 years. LMA and stretcher were used on 46.4% and 40.2% of patients, respectively. On multivariate linear regression LMA reduced emergence time by 4.4 min (p ≤ 0.001, 95% CI -6.7 to -2.1) and transport stretcher reduced induction time by 2.5 min (p = 0.04, 95% CI -4.9 to -0.1). Use of LMA and stretcher did not have a statistically significant difference on actual procedure time.

CONCLUSION: Our study further supports the role LMA has in reducing intraoperative times in addition to describing a novel method of reducing intraoperative time by operating on a transport stretcher for healthy children undergoing T&A.

LEVEL OF EVIDENCE: 3.

PMID:34520971 | DOI:10.1016/j.amjoto.2021.103195

Respir Med. 2021 Sep 10;188:106609. doi: 10.1016/j.rmed.2021.106609. Online ahead of print.

ABSTRACT

BACKGROUND: Radial endobronchial ultrasound-guided transbronchial biopsy (rEBUS-TBB) facilitates the diagnosis of peripheral lung lesions. However, methods to prevent infectious complications afterwards have not been well established. Therefore, we analyzed the efficacy of short-term oral antibiotics for preventing infectious complications.

METHODS: We retrospectively analyzed 484 patients. Patients who underwent rEBUS-TBB from March 2018 to March 2019 did not receive prophylactic antibiotics (“no prophylactic” group, n = 233), while patients who underwent rEBUS-TBB from April 2019 to March 2020 did receive prophylactics (oral amoxicillin/clavulanate for 3 days; “prophylactic” group, n = 251). Multivariable logistic regression was used to identify independent factors for infectious complications.

RESULTS: The median age was 66 years (IQR: 59-74 years), and 58.9% were male. Slightly over half of the patients (54.4%) were previous or current smokers. In 13% (n = 63) of patients, the procedure was performed using a guide sheath. Infectious complications occurred in 12 (5.2%) and 2 (0.8%) cases in the no prophylactic and prophylactic groups, respectively. In multivariable analysis, infectious complications were significantly associated with a cavity or low-density attenuation (LDA) of the lesion, and with obstructive pneumonic consolidation, but not with prophylactic antibiotics. In subgroup analysis, infectious complications occurred less often when prophylactic antibiotics were used in patients with at least one risk factor (22.4% vs. 0%, p = 0.005).

CONCLUSIONS: The risk factors for infectious complications were cavities, LDA in the lesion, and obstructive pneumonic consolidation. Use prophylactic antibiotics might reduce incidence of infectious complications in the presence of these risk factors.

PMID:34520893 | DOI:10.1016/j.rmed.2021.106609

Soc Sci Med. 2021 Sep 8;287:114379. doi: 10.1016/j.socscimed.2021.114379. Online ahead of print.

ABSTRACT

Efforts to mitigate the spread of COVID-19 rely on trust in public health organizations and practices. These practices include contact tracing, which requires people to share personal information with public health organizations. The central role of trust in these practices has gained more attention during the pandemic, resurfacing endemic questions about public trust and potential racial trust disparities, especially as they relate to participation in public health efforts. Using an explanatory mixed methods design, we conducted quantitative analysis of state-level survey data in the United States from a representative sample of Michigan residents (n = 1000) in May 2020. We used unadjusted and adjusted linear regressions to examine differences in trust in public health information and willingness to participate in public health efforts by race. From July to September 2020, we conducted qualitative interviews (n = 26) to further explain quantitative results. Using unadjusted linear regression, we observed higher willingness to participate in COVID-19 public health efforts among Black survey respondents compared to White respondents. In adjusted analysis, that difference disappeared, yielding no statistically significant difference between Black and White respondents in either trust in public health information sources or willingness to participate. Qualitative interviews were conducted to explain these findings, considering their contrast with assumptions that Black people would exhibit lower trust in public health organizations during COVID-19. Altruism, risk acknowledgement, trust in public health organizations during COVID-19, and belief in efficacy of public health efforts contributed to willingness to participate in public health efforts among interviewees. Our findings underscore the contextual nature of trust, and the importance of this context when analyzing protective health behaviors among communities disproportionately affected by COVID-19. Assumptions about mistrust among Black individuals and communities may be inaccurate because they overlook the specific context of the public health crisis. These findings are important because they indicate that Black respondents are exhibiting strategic trust during COVID-19 despite systemic, contemporary, and historic barriers to trust. Conceptual specificity rather than blanket generalizations is warranted, especially given the harms of stereotyping and discrimination.

PMID:34520940 | DOI:10.1016/j.socscimed.2021.114379