Category: Statistics

J Osteopath Med. 2021 Aug 17. doi: 10.1515/jom-2021-0124. Online ahead of print.

ABSTRACT

CONTEXT: Healthcare delivery was dramatically affected during the coronavirus disease 2019 (COVID-19) pandemic. Many outpatient visits were cancelled or forgone for fear of exposure to the virus, allowing telemedicine to take on a much larger role in healthcare. The delivery of manual therapies, such as osteopathic manipulative treatment (OMT), via telehealth posed a unique challenge as these are typically provided in-person by a trained osteopathic physician. This study provides a description of one osteopathic pediatrician’s experience in delivering osteopathic interventions to pediatric patients via telehealth. To our knowledge, these techniques have not previously been described in the literature.

OBJECTIVES: To detail the experience of one osteopathic pediatrician’s experience in delivering osteopathic interventions via telehealth.

METHODS: Patients were offered the option of converting their existing OMT appointment to a telehealth visit. Prior to the appointment, instructions were emailed to the patient’s parent or guardian along with a voluntary survey to provide feedback. Thirty-minute telehealth visits were conducted during which the provider gave verbal and visual instructions to a parent or guardian over a video platform to guide them in providing treatment to the patient based on osteopathic principles. Patients aged 3 and older rated their pain before and after the appointment using the Wong-Baker FACES scale. Deidentified patient demographics, chief complaints, treatments, anatomic locations, and pain scores were recorded in a REDcap database. Descriptive statistics were analyzed and paired samples t-tests were used with a p-value of <0.05 used to determine significance.

RESULTS: Eighteen patients ranging from 6 months to 19 years of age were treated utilizing osteopathic interventions via telehealth during 54 distinct visits. The most common chief complaints treated were back (n=31; 26.3%) and neck (n=28; 23.7%) pain. The most common osteopathic techniques upon which instruction was based were inhibition (n=131; 29.7%) soft tissue (n=127; 28.8%) and counterstrain (n=78; 17.7%). The average post-treatment pain score (2.57) was significantly lower than the average pre-treatment pain score (6.77) p<0.01. No serious complications were observed.

CONCLUSIONS: In our small retrospective case series, osteopathic interventions via telehealth resulted in decreased average pain scores following treatment while minimizing risk of viral exposure and transmission. Further study is needed to determine if such treatment methods could be effective on a larger scale when distance or illness preclude an in-person OMT visit.

PMID:34411468 | DOI:10.1515/jom-2021-0124

Aust N Z J Public Health. 2021 Aug 19. doi: 10.1111/1753-6405.13143. Online ahead of print.

ABSTRACT

OBJECTIVE: In June 2020, the Australian Government announced that personal importation of nicotine vaping products (NVP) would be prohibited, pending a 12-month classification and regulation review by the Therapeutic Goods Administration. This brief report examines the themes of responses on Twitter to this announcement.

METHODS: Simple random sampling was used to retrieve tweets containing keywords from 19 to 26 June 2020. Tweets were manually coded and descriptive statistics calculated for themes and policy position.

RESULTS: The vast majority of the 1,168 tweets were anti-policy. Themes included: criticism towards government (59.8%), activism against NVP restriction (38%), potential adverse consequences (30.8%) and support for NVP restriction (1.4%). Tweets that identified potential adverse consequences of NVP restriction cited: smoking relapse for individuals currently using NVPs (75.6%); the impact of policy enforcement (8.6%); illicit market (8.3%); panic buying (3.6%); difficulty obtaining prescriptions (2.8%); and impacts on NVP businesses (2.8%).

CONCLUSION: Tweets predominately objected to the policy announcement. Approximately three-quarters of tweets that cited potential adverse consequences of the policy mentioned smoking relapse as their primary concern. Implications for public health: User-generated content on Twitter was primarily used to lobby against the proposed policy, which was subsequently amended.

PMID:34411375 | DOI:10.1111/1753-6405.13143

Eur J Neurol. 2021 Aug 19. doi: 10.1111/ene.15074. Online ahead of print.

ABSTRACT

PURPOSE: To validate a clinical score of vascular origin in patients with acute transient visual disturbances (TVD) without diplopia.

METHODS: We conducted a prospective study in an ophthalmology emergency department and a TIA clinic. Patients underwent clinical evaluation including a tailored questionnaire, brain, vascular, and ophthalmic investigations, and 3-month follow-up. TVD were classified according to vascular or nonvascular origin by three independent experts based on all clinical, cerebrovascular, and ophthalmologic investigations, but blind to the questionnaire results. A clinical score was derived based on clinical variables independently associated with a vascular origin, and was externally validated in an independent cohort.

RESULTS: An ischemic origin of TVD was found in 45% (67/149) of patients in the derivation cohort. Age and six questions were independently associated with an ischemic origin. A nine-point score (≥70 years=2; monocular visual loss=2; black or white vision=1; single episode=1; lack of headache=2; diffuse, constricted, altitudinal or lateralized visual loss pattern on drawings=1) showed good discriminative power in identifying ischemic origin (c-statistic 0.82) and was replicated in the validation cohort (n=130; 25% of ischemic origin; c-statistic 0.75). With a score ≥4, sensitivity was 85% (95% confidence interval 68-95) and specificity was 52% (95% confidence interval 41-62). In both cohorts, ophthalmic evaluation found a vascular cause in 4% and was noncontributive in 85%. After 3 months, no patients had a stroke, TIA, or retinal infarct.

CONCLUSION: Our score may assist in predicting a nonvascular origin of TVD. Ophthalmic evaluation, when not readily available, should not delay the neurovascular evaluation.

PMID:34411384 | DOI:10.1111/ene.15074

Am J Addict. 2021 Aug 19. doi: 10.1111/ajad.13209. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: The adverse impact of chronic methamphetamine (MA) use on cognitive function has been described in previous studies, but limited evidence is available for abstinent users from prospective longitudinal studies. The aim of the present study was to assess cognitive function of varying abstinent duration.

METHODS: This prospective longitudinal study was conducted with baseline and four follow-up interviews every 6 months over 2 years in 358 MA users in Guangdong province, China. The Montreal Cognitive Assessment (MoCA) was used to measure cognitive function. Generalized estimating equation (GEE) analysis was used to examine within-subjects relationships between abstinence and cognitive consequences over time.

RESULTS: The repeated measure analysis of variance showed significant differences in the total MoCA score and all subscale scores (except Orientation) in the 24 months follow-up. The GEE model showed that abstinence from MA in the past 6 months predicted an increase of 0.66 (95% confidence interval [CI] = 0.29 to 1.05, p = .002) in MoCA score changes compared with the nonabstinence MA users. Abstinence in the past 12, 18, and 24 months predicted an increase in MoCA total score changes of 1.25 (95% CI = -0.23 to 2.74), 2.15 (95% CI = -0.79 to 5.09), and 5.28 (95% CI = -2.01 to 12.58), respectively, but none of these was statistically significant.

DISCUSSION AND CONCLUSIONS: Cognitive function was potentially improved following 6 months of MA abstinence.

SCIENTIFIC SIGNIFICANCE: This study extends prior research by long-term follow-up in big sample MA abstinence users. Findings from study support the need for a comprehensive measure to decrease MA use and promote the recovery of cognitive impairment.

PMID:34411367 | DOI:10.1111/ajad.13209

Skin Res Technol. 2021 Aug 19. doi: 10.1111/srt.13082. Online ahead of print.

ABSTRACT

BACKGROUND: Skin pores are structural features of the skin, which tend to change as the skin ages. Since previous studies measured pores two-dimensionally, precise measurements using three-dimensional imaging were needed to comprehensively understand skin pores. This study aimed to determine the patterns behind the changes in skin pores during one’s lifetime and to identify new characteristics of the pores in aged.

MATERIALS AND METHODS: Skin surface profiles were measured three-dimensionally from the cheeks of 101 Korean women from February to March 2020 to analyze the exact state of their pores. The researchers performed K-means clustering to classify the skin pores, and topographical features of pores were analyzed as well. Statistical analyses were performed to verify the differences in the skin pore characteristics among clusters and the correlation between clusters and ages.

RESULTS: Skin pores were classified into five groups based on size, density, and elongation. The skin conditions of the cluster groups were well correlated with aging, despite excluding age as a factor in pore classification. Adjacent skin pores tend to connect in the elderly.

CONCLUSION: Skin pores become larger and longer over time. Skin pores connect together in the elderly, which might be related to wrinkle formation. This phenomenon strongly suggests skin pores as a characteristic of aging skin and as a potential target for anti-aging treatment.

PMID:34411370 | DOI:10.1111/srt.13082

Transpl Int. 2021 Aug 19. doi: 10.1111/tri.14012. Online ahead of print.

ABSTRACT

Post-transplant malignancy is diagnosed in approximately 18% of heart transplant patients and is a leading cause of death post-transplant. One modifiable risk factor is the type and amount of immunosuppression received. Contemporary rabbit anti-thymocyte globulin (rATG) dosing strategy using T-cell-guided dosing, and its effect on malignancy in heart transplant patients is unclear. This was a single-center, retrospective chart review of heart transplant recipients receiving rATG for induction. Patients diagnosed with malignancy post-transplant were matched 1:2 to controls using a nested case-control design. The primary endpoint was to determine the relative risk of rATG exposure with the actual incidence of malignancy post-transplant. The secondary endpoint was the impact of maintenance immunosuppression on malignancy risk. Of the 126 patients included in the study, 25 developed malignancy and were matched to 50 control patients. The median cumulative rATG dose in milligrams (mg) between groups was 365mg in malignancy cases and 480mg in controls (OR 0.90, 95% CI 0.75 – 1.08, p=0.28). In both the univariate and multivariable analysis, there was no statistically significant difference in malignancy risk found with any maintenance immunosuppressant. The results of this study showed that patient-tailored rATG dosing strategies may not be associated with malignancy development as previously thought.

PMID:34411345 | DOI:10.1111/tri.14012

Acta Paediatr. 2021 Aug 19. doi: 10.1111/apa.16076. Online ahead of print.

ABSTRACT

AIM: This study examined trends in absolute and relative socioeconomic, gender and geographical inequalities in the coverage of polio immunisation in Guinea, West Africa, from 1999-2016.

METHODS: Data from the 1999, 2005 and 2012 Guinea Demographic and Health Survey and the 2016 Guinea Multiple Indicator Cluster Survey were analysed using the World Health Organization’s health equity assessment toolkit. We disaggregated polio immunisation coverage using five equity stratifiers: household economic status, maternal educational level, place of residence, child’s gender and region. The four summary measures used were the difference, ratio, population attributable risk and population attributable fraction. A 95% confidence interval (CI) was constructed around point estimates to measure statistical significance.

RESULTS: A total of 4,778 one-year-old children were included. Polio immunisation coverage in 1999, 2005, 2012 and 2016 were 43.4%, 50.7%, 51.2% and 38.6%, respectively. Socioeconomic and geographical inequalities in polio immunisation favoured children with educated mothers who came from richer families living in urban areas. There were also differences in the eight regions over the 1999-2016 study period.

CONCLUSION: Targeting children from disadvantaged subgroups must be prioritised to ensure equitable immunisation services that help to eradicate polio in Guinea.

PMID:34411347 | DOI:10.1111/apa.16076

Neural Comput. 2021 Jun 11;33(7):1751-1817. doi: 10.1162/neco_a_01389.

ABSTRACT

Time series data sets often contain heterogeneous signals, composed of both continuously changing quantities and discretely occurring events. The coupling between these measurements may provide insights into key underlying mechanisms of the systems under study. To better extract this information, we investigate the asymptotic statistical properties of coupling measures between continuous signals and point processes. We first introduce martingale stochastic integration theory as a mathematical model for a family of statistical quantities that include the phase locking value, a classical coupling measure to characterize complex dynamics. Based on the martingale central limit theorem, we can then derive the asymptotic gaussian distribution of estimates of such coupling measure that can be exploited for statistical testing. Second, based on multivariate extensions of this result and random matrix theory, we establish a principled way to analyze the low-rank coupling between a large number of point processes and continuous signals. For a null hypothesis of no coupling, we establish sufficient conditions for the empirical distribution of squared singular values of the matrix to converge, as the number of measured signals increases, to the well-known Marchenko-Pastur (MP) law, and the largest squared singular value converges to the upper end of the MP support. This justifies a simple thresholding approach to assess the significance of multivariate coupling. Finally, we illustrate with simulations the relevance of our univariate and multivariate results in the context of neural time series, addressing how to reliably quantify the interplay between multichannel local field potential signals and the spiking activity of a large population of neurons.

PMID:34411270 | DOI:10.1162/neco_a_01389

Neural Comput. 2021 Jun 11;33(7):1993-2032. doi: 10.1162/neco_a_01400.

ABSTRACT

The Potjans-Diesmann cortical microcircuit model is a widely used model originally implemented in NEST. Here, we reimplemented the model using NetPyNE, a high-level Python interface to the NEURON simulator, and reproduced the findings of the original publication. We also implemented a method for scaling the network size that preserves first- and second-order statistics, building on existing work on network theory. Our new implementation enabled the use of more detailed neuron models with multicompartmental morphologies and multiple biophysically realistic ion channels. This opens the model to new research, including the study of dendritic processing, the influence of individual channel parameters, the relation to local field potentials, and other multiscale interactions. The scaling method we used provides flexibility to increase or decrease the network size as needed when running these CPU-intensive detailed simulations. Finally, NetPyNE facilitates modifying or extending the model using its declarative language; optimizing model parameters; running efficient, large-scale parallelized simulations; and analyzing the model through built-in methods, including local field potential calculation and information flow measures.

PMID:34411272 | DOI:10.1162/neco_a_01400

J Clin Apher. 2021 Aug 19. doi: 10.1002/jca.21932. Online ahead of print.

ABSTRACT

BACKGROUND: Optimization of platelet (PLT) apheresis collection is a priority to satisfy the increasing demand of hemato-oncology patients. We assessed the performance of a plateletpheresis unit supporting hematology patients.

STUDY DESIGN AND METHODS: This descriptive retrospective study included 561 plateletpheresis collections from 2013 to 2018. For data analysis, descriptive statistics and receiver operating characteristic (ROC) curve were used. A 5-item satisfaction questionnaire was analyzed.

RESULTS: Ninety percent of the donors were males. The median plateletpheresis time was 89 minutes; its success rate was 92.5%; median donor PLT count was 232 × 10⁹ /L, women median PLT count was 247 × 10⁹ /L vs 231×10⁹ /L in men (P = .017). Seventy-seven percent donors were candidates for a double product and 24.5% were processed; 20.8% of these donors had a weight ≤75 and 79.2% >75 kg, P = .003, and 6.6% were women and 93.4% men, P = .161. Thirty-six of donors had ≥250 × 10⁹ /L and 16.8% was processed as a triple product. ROC analysis showed that with donor PLT counts ≥200 × 10⁹ /L the sensitivity for obtaining double products was 0.981 and specificity 0.714, with an area under the curve (AUC) = 0.877. The adverse effect rate was 4.3%. Of the potential donors, 6.3% were rejected. The cost of processing single or double products was 430 USD. Comfort and time spent during plateletpheresis were areas for improvement.

CONCLUSION: Platelet count and donor weight predicted PLT yield and obtaining double products. Women had higher PLT counts, but no significant difference was found between donor gender and processed products. Assessment of the apheresis unit can help to improve its performance.

PMID:34411330 | DOI:10.1002/jca.21932