Category: Statistics

J Hazard Mater. 2021 Jul 27;422:126724. doi: 10.1016/j.jhazmat.2021.126724. Online ahead of print.

ABSTRACT

Improper healthcare waste (HCW) management poses significant risks to the environment, human health, and socio-economic sustainability due to the infectious and hazardous nature of HCW. This research aims at rendering a comprehensive landscape of the body of research on HCW management by (i) mapping the scientific development of HCW research, (ii) identifying the prominent HCW research themes and trends, and (iii) providing a research agenda for HCW management towards a circular economy (CE) transition and sustainable environment. The analysis revealed four dominant HCW research themes: (1) HCW minimization, sustainable management, and policy-making; (2) HCW incineration and its associated environmental impacts; (3) hazardous HCW management practices; and (4) HCW handling and occupational safety and training. The results showed that the healthcare industry, despite its potential to contribute to the CE transition, has been overlooked in the CE discourse due to the single-use mindset of the healthcare industry in the wake of the infectious, toxic, and hazardous nature of HCW streams. The findings shed light on the HCW management domain by uncovering the current status of HCW research, highlighting the existing gaps and challenges, and providing potential avenues for further research towards a CE transition in the healthcare industry and HCW management.

PMID:34399217 | DOI:10.1016/j.jhazmat.2021.126724

J Hazard Mater. 2021 Aug 8;422:126857. doi: 10.1016/j.jhazmat.2021.126857. Online ahead of print.

ABSTRACT

Nowadays, the global spreading of hazardous heavy metals becomes a top-priority environmental challenge, owing to its serious detrimental health outcomes. Herein, a novel cysteine-doped polyaniline@faujasite hybrid composite (Cys-PANi@FAU-50) was synthesized via a facile in-situ polymerization route for the effective detoxification of Cr(VI)-bearing wastewaters. The Cys-PANi@FAU-50 composite displayed an open mesoporous structure richly decorated with nitrogen/oxygen-containing functional groups, which consequently boosted the diffusion, adsorption and reduction of Cr(VI) oxyanions. The Cr(VI) adsorption behavior was satisfactorily tailored via pseudo-second-order law and Langmuir model with a maximum uptake capacity of 384.6 mg/g. Based on the advanced statistical physics theory, the monolayer model with two distinct receptor sites provided a reliable microscopic and macroscopic prediction of the Cr(VI) adsorption process. Stereographically, the Cr(VI) ions were adsorbed through horizontal multi-anchorage and vertical multi-molecular mechanisms on the amine and hydroxyl groups of Cys-PANi@FAU-50, respectively. The thermodynamic functions evidenced that the Cr(VI) adsorption was an endothermic spontaneous process. XPS analysis proved that Cr(VI) ions were electrostatically adsorbed, and subsequently reduced to Cr(III), which were in turn immobilized by chelation with imine/sulfonate groups and electrostatic interactions with carboxylate groups. The Cys-PANi@FAU-50 featured an effortless regenerability and good reusability. Overall, the Cys-PANi@FAU-50 composite owns outstanding potentiality for detoxifying Cr(VI)-laden effluents.

PMID:34399223 | DOI:10.1016/j.jhazmat.2021.126857

Ultrasonics. 2021 Aug 11;117:106550. doi: 10.1016/j.ultras.2021.106550. Online ahead of print.

ABSTRACT

This paper aims at dealing with the dilemma of examining the existence of a defect in ultrasonic detection of coarse grain materials. In such cases, defect echoes can be drowned in a strong noise background resulting from intricate coarse grain scattering, that is, grain noise. To this end, we develop an innovative signal reconstruction methodology from polluted measurements which combines basic statistical analysis with a series of machine learning algorithms. The proposed methodology analyzes abundant information from numerous raw signals to distinguish the desired signal from grain noise, avoiding the limitation of information provided only by a single signal. The technique is achieved by collecting similar signals together through a clustering algorithm and subsequently inputting these similar signals to a denoising autoencoder to suppress the grain noise. It is successfully employed to ultrasonic signals obtained from an as-cast stainless steel specimen with coarse equiaxed grains, a stainless steel specimen with relatively homogeneous dendrite fabricated by additive manufacturing and a stainless steel weld with heterogeneous columnar grains having variation of grain sizes in various locations. The influence of material microstructure and probe frequency on denoising performance is investigated in detail. Based on this, the proposed methodology is applied to defect detection. Desired A-scan results and B-scan imaging are achieved by the proposed method, where defects are well revealed. The experimental results demonstrate the developed methodology has stable excellent performance and superior denoising capabilities for defect detection with respect to conventional techniques, especially in the case where the noise is almost the same as the desired signal.

PMID:34399134 | DOI:10.1016/j.ultras.2021.106550

Lung Cancer. 2021 Aug 3;160:36-43. doi: 10.1016/j.lungcan.2021.07.017. Online ahead of print.

ABSTRACT

OBJECTIVES: Exhaled breath analysis by electronic nose (eNose) has shown to be a potential predictive biomarker before start of anti-PD-1 therapy in patients with non-small cell lung carcinoma (NSCLC). We hypothesized that the eNose could also be used as an early monitoring tool to identify responders more accurately at early stage of treatment when compared to baseline. In this proof-of-concept study we aimed to definitely discriminate responders from non-responders after six weeks of treatment.

MATERIALS AND METHODS: This was a prospective observational study in patients with advanced NSCLC eligible for anti-PD-1 treatment. The efficacy of treatment was assessed by the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 at 3-month follow-up. We analyzed SpiroNose exhaled breath data of 94 patients (training cohort n = 62, validation cohort n = 32). Data analysis involved signal processing and statistics based on Independent Samples T-tests and Linear Discriminant Analysis (LDA) followed by Receiver Operating Characteristic (ROC) analysis.

RESULTS: In the training cohort, a specificity of 73% was obtained at a 100% sensitivity level to identify objective responders. The Area Under the Curve (AUC) was 0.95 (CI: 0.89-1.00). In the validation cohort, these results were confirmed with an AUC of 0.97 (CI: 0.91-1.00).

CONCLUSION: Exhaled breath analysis by eNose early during treatment allows for a highly accurate, non-invasive and low-cost identification of advanced NSCLC patients who benefit from anti-PD-1 therapy.

PMID:34399166 | DOI:10.1016/j.lungcan.2021.07.017

Ann Intern Med. 2021 Aug 17. doi: 10.7326/M21-1814. Online ahead of print.

ABSTRACT

BACKGROUND: Acupuncture has promising effects on chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), but high-quality evidence is scarce.

OBJECTIVE: To assess the long-term efficacy of acupuncture for CP/CPPS.

DESIGN: Multicenter, randomized, sham-controlled trial. (ClinicalTrials.gov: NCT03213938).

SETTING: Ten tertiary hospitals in China.

PARTICIPANTS: Men with moderate to severe CP/CPPS, regardless of prior exposure to acupuncture.

INTERVENTION: Twenty sessions of acupuncture or sham acupuncture over 8 weeks, with 24-week follow-up after treatment.

MEASUREMENTS: The primary outcome was the proportion of responders, defined as participants who achieved a clinically important reduction of at least 6 points from baseline on the National Institutes of Health Chronic Prostatitis Symptom Index at weeks 8 and 32. Ascertainment of sustained efficacy required the between-group difference to be statistically significant at both time points.

RESULTS: A total of 440 men (220 in each group) were recruited. At week 8, the proportions of responders were 60.6% (95% CI, 53.7% to 67.1%) in the acupuncture group and 36.8% (CI, 30.4% to 43.7%) in the sham acupuncture group (adjusted difference, 21.6 percentage points [CI, 12.8 to 30.4 percentage points]; adjusted odds ratio, 2.6 [CI, 1.8 to 4.0]; P < 0.001). At week 32, the proportions were 61.5% (CI, 54.5% to 68.1%) in the acupuncture group and 38.3% (CI, 31.7% to 45.4%) in the sham acupuncture group (adjusted difference, 21.1 percentage points [CI, 12.2 to 30.1 percentage points]; adjusted odds ratio, 2.6 [CI, 1.7 to 3.9]; P < 0.001). Twenty (9.1%) and 14 (6.4%) adverse events were reported in the acupuncture and sham acupuncture groups, respectively. No serious adverse events were reported.

LIMITATION: Sham acupuncture might have had certain physiologic effects.

CONCLUSION: Compared with sham therapy, 20 sessions of acupuncture over 8 weeks resulted in greater improvement in symptoms of moderate to severe CP/CPPS, with durable effects 24 weeks after treatment.

PRIMARY FUNDING SOURCE: China Academy of Chinese Medical Sciences and the National Administration of Traditional Chinese Medicine.

PMID:34399062 | DOI:10.7326/M21-1814

Pediatr Neurol. 2021 Jun 26;123:43-49. doi: 10.1016/j.pediatrneurol.2021.06.009. Online ahead of print.

ABSTRACT

BACKGROUND: The neurodevelopmental impairment in tuberous sclerosis complex (TSC) has a multifactorial origin. Various factors have been proposed as predictors of neurological outcome such as tuber load, seizure onset, and TSC2 mutation. Cerebellar lesions have been associated with worse neuroradiological phenotype, but their contribution is not well understood.

METHODS: A partly retrospective and partly prospective pediatric cohort study was conducted at three hospitals in Greece between 2015 and 2020. Patients aged ≤ 18 years with a confirmed TSC daignosis were included and underwent brain imaging, a semistructured interview (authorized Greek version of the tuberous sclerosis-associated neuropsychiatric disorders, or TAND, checklist), and intellectual ability assessment.

RESULTS: The study populations consisted of 45 patients with TSC (22 females, 23 males; mean age 9.53 years). Twenty patients (44.4%) had cerebellar lesions. Cerebellar involvement was the most powerful predictor of tuber load (P = 0.03). Cerebellar lesions were associated with giant cell astrocytomas (SEGAs) (P = 0.01) and severe neurological outcome (P = 0.01). Even though in the univariate analysis early seizure onset, tuber load, and cerebellar involvement were associated with intellectual impairment and neurological severity, none of them was an independent predictor of cognitive outcome and neurological severity.

CONCLUSIONS: Cerebellar lesions are common among individuals with TSC. Cerebellar involvement correlates with supratentorial derangement and the development of SEGAs, which is suggestive of a more severe clinical and neuroradiological phenotype. Cerebellar involvement and early seizure onset were not independent predictors of either neurological severity or intellectual disability or neurobehavioral outcome; their role in TSC clinical phenotype should be further investigated.

PMID:34399109 | DOI:10.1016/j.pediatrneurol.2021.06.009

Ann Intern Med. 2021 Aug 17. doi: 10.7326/M20-7003. Online ahead of print.

ABSTRACT

BACKGROUND: Despite expected initial universal susceptibility to a novel pandemic pathogen like SARS-CoV-2, the pandemic has been characterized by higher observed incidence in older persons and lower incidence in children and adolescents.

OBJECTIVE: To determine whether differential testing by age group explains observed variation in incidence.

DESIGN: Population-based cohort study.

SETTING: Ontario, Canada.

PARTICIPANTS: Persons diagnosed with SARS-CoV-2 and those tested for SARS-CoV-2.

MEASUREMENTS: Test volumes from the Ontario Laboratories Information System, number of laboratory-confirmed SARS-CoV-2 cases from the Integrated Public Health Information System, and population figures from Statistics Canada. Demographic and temporal patterns in incidence, testing rates, and test positivity were explored using negative binomial regression models and standardization. Sources of variation in standardized ratios were identified and test-adjusted standardized infection ratios (SIRs) were estimated by metaregression.

RESULTS: Observed disease incidence and testing rates were highest in the oldest age group and markedly lower in those younger than 20 years; no differences in incidence were seen by sex. After adjustment for testing frequency, SIRs were lowest in children and in adults aged 70 years or older and markedly higher in adolescents and in males aged 20 to 49 years compared with the overall population. Test-adjusted SIRs were highly correlated with standardized positivity ratios (Pearson correlation coefficient, 0.87 [95% CI, 0.68 to 0.95]; P < 0.001) and provided a case identification fraction similar to that estimated with serologic testing (26.7% vs. 17.2%).

LIMITATIONS: The novel methodology requires external validation. Case and testing data were not linkable at the individual level.

CONCLUSION: Adjustment for testing frequency provides a different picture of SARS-CoV-2 infection risk by age, suggesting that younger males are an underrecognized group at high risk for SARS-CoV-2 infection.

PRIMARY FUNDING SOURCE: Canadian Institutes of Health Research.

PMID:34399059 | DOI:10.7326/M20-7003

J Drugs Dermatol. 2021 Aug 1;20(8):880-887. doi: 10.36849/JDD.6101.

ABSTRACT

BACKGROUND: Long-term efficacy, safety, and quality of life with ixekizumab (IXE) through 5 years in UNCOVER-1 and UNCOVER-2 patients with baseline scalp, nail, or palmoplantar psoriasis were assessed.

METHODS: Patients included in this intent-to-treat subanalysis had baseline involvement in at least one of the three anatomic areas (scalp, fingernail, or palmoplantar locations) and 1) received IXE through week 60, with a 160-mg starting dose 80 mg Q2W through week 12 and Q4W thereafter, 2) achieved a static Physician&rsquo;s Global Assessment score of 0 or 1 at week 12, and 3) completed week 60 and continued treatment with IXE Q4W or were escalated to Q2W during the long-term extension. Efficacy outcomes (e.g., percent improvement in Psoriasis Scalp Severity Index [PSSI], Nail Psoriasis Severity Index [NAPSI], Palmoplantar Psoriasis Area and Severity [PPASI], and Dermatology Life Quality Index [DLQI]) were summarized by descriptive statistics through week 264.

RESULTS: Patients rapidly achieved and sustained improvements in scalp, nail, and palmoplantar psoriasis for up to 5 years with IXE. Patients achieved complete clearance at year 5: observed (scalp, 82%; nail, 73%; palmoplantar, 96%) and mNRI (scalp, 77%; nail, 67%; palmoplantar, 85%). Up to 80% of patients reported DLQI 0,1 responses at week 12, which were sustained through week 264. No increases in the number of annual treatment-emergent adverse events were observed from years 1&ndash;5.

CONCLUSION: Patients receiving IXE for 5 years sustained high rates of improvement in scalp, nail, and palmoplantar psoriasis, with a long-term quality of life benefit with no unexpected safety signals. J Drugs Dermatol. 2021;20(8):880-887. doi:10.36849/JDD.6101.

PMID:34397207 | DOI:10.36849/JDD.6101

J Drugs Dermatol. 2021 Aug 1;20(8):865-867. doi: 10.36849/JDD.6037.

ABSTRACT

BACKGROUND: New development of cell-targeted therapies to enable site-specific skin tissue drug delivery may reduce off-target effects, decrease unwanted toxicities, and enhance drug efficacy. These efforts have led to several targeting strategies that modulate active product delivery to include small molecule-, nucleic acid-, peptide-, antibody-, and cell-based strategies. Tissue specific cell-targeting strategies such as these may be useful in cosmetic dermatologic applications.

OBJECTIVE: The aim of this 16-week clinical trial of a skin brightening composition containing melanocyte cell-targeted biodelivery was to assess its effectiveness in restoring the skin complexion evenness by modulating melanocyte activity in a cohort of 50 Fitzpatrick type I&ndash;VI subjects with moderate to severe dyspigmentation.

RESULTS: Data from expert grading, skin surface colorimetry, and subject self-assessments reflected significant improvement in facial skin tone as early as 2 weeks after treatment initiation, with continual improvement through week 16. The most dramatic pigmentation improvement, based on investigator assessments, was a statistically significant improvement in skin brightness at week 2 that progressed to week 8 with significant improvement in skin evenness and brightness. By weeks 12 and 16, progressive levels of significant improvement in skin evenness and brightening became apparent. Colorimetry demonstrated progressive improvement in skin dyspigmentation starting at 2 weeks and continuing to week 16. Subject self-assessment data supported similar improvements in skin dyspigmentation.

CONCLUSION: These results demonstrate the ability of a cell-targeted topical therapy to achieve improvements in skin pigmentation through site-specific suppression of melanocyte activity. J Drugs Dermatol. 2021;20(8):865-867. oi:10.36849/JDD.6037 THIS ARTICLE HAD BEEN MADE AVAILABLE FREE OF CHARGE. PLEASE SCROLL DOWN TO ACCESS THE FULL fTEXT OF THIS ARTICLE WITHOUT LOGGING IN. NO PURCHASE NECESSARY. PLEASE CONTACT THE PUBLISHER WITH ANY QUESTIONS.

PMID:34397200 | DOI:10.36849/JDD.6037

Arthritis Care Res (Hoboken). 2021 Aug 16. doi: 10.1002/acr.24768. Online ahead of print.

ABSTRACT

OBJECTIVES: Changes of routine disease management associated with COVID-19 lockdown might have potentially affected the clinical course of juvenile idiopathic arthritis (JIA). Aim of our study was to assess the rate of disease flare before and during COVID-19 lockdown to investigate its impact on disease course in JIA children.

METHODS: A single-center retrospective study was conducted, including patients presenting inactive JIA between September 1^st , 2018 and March 9^th , 2019 (group A) and between September 1^st , 2019 and March 9^th , 2020 (group B). For each patient, demographic and clinical data were collected. The rate of JIA flare from March 10^th , 2019 to June 30^th , 2019 for group A and from March 10^th , 2020 to June 30^th , 2020 for group B was compared.

RESULTS: Group A included 126 patients and group B 124 patients. Statistical analysis did not show significant differences among the two cohorts with respect to age, sex, age of JIA onset, JIA subtype, co-occurrence of uveitis, ANA positivity and past or ongoing medications. The rate of disease flare during lockdown at time of first COVID-19 pandemic wave, was significantly higher in comparison to the previous year (16.9% vs 6.3%, p=0.009).

CONCLUSION: Our study showed that COVID-19 lockdown was associated with a higher rate of joint inflammation in JIA children. This finding has a considerable clinical implication, since restrictive measures may be necessary in order to contain pandemics. Our data highlight the need for rearrangement in the home and healthcare management of JIA children during lockdowns.

PMID:34397168 | DOI:10.1002/acr.24768