Category: Statistics

PLoS One. 2021 Aug 12;16(8):e0255992. doi: 10.1371/journal.pone.0255992. eCollection 2021.

ABSTRACT

PURPOSE: We aimed to determine the degree to which reasons for primary care visits changed during the COVID-19 pandemic.

METHODS: We used data from the University of Toronto Practice Based Research Network (UTOPIAN) to compare the most common reasons for primary care visits before and after the onset of the COVID-19 pandemic, focusing on the number of visits and the number of patients seen for each of the 25 most common diagnostic codes. The proportion of visits involving virtual care was assessed as a secondary outcome.

RESULTS: UTOPIAN family physicians (N = 379) conducted 702,093 visits, involving 264,942 patients between March 14 and December 31, 2019 (pre-pandemic period), and 667,612 visits, involving 218,335 patients between March 14 and December 31, 2020 (pandemic period). Anxiety was the most common reason for visit, accounting for 9.2% of the total visit volume during the pandemic compared to 6.5% the year before. Diabetes and hypertension remained among the top 5 reasons for visit during the pandemic, but there were 23.7% and 26.2% fewer visits and 19.5% and 28.8% fewer individual patients accessing care for diabetes and hypertension, respectively. Preventive care visits were substantially reduced, with 89.0% fewer periodic health exams and 16.2% fewer well-baby visits. During the pandemic, virtual care became the dominant care format (77.5% virtual visits). Visits for anxiety and depression were the most common reasons for a virtual visit (90.6% virtual visits).

CONCLUSION: The decrease in primary care visit volumes during the COVID-19 pandemic varied based on the reason for the visit, with increases in visits for anxiety and decreases for preventive care and visits for chronic diseases. Implications of increased demands for mental health services and gaps in preventive care and chronic disease management may require focused efforts in primary care.

PMID:34383844 | DOI:10.1371/journal.pone.0255992

PLoS One. 2021 Aug 12;16(8):e0256185. doi: 10.1371/journal.pone.0256185. eCollection 2021.

ABSTRACT

Prisons are the epicenter of the COVID-19 pandemic. Media reports have focused on whether transfers of incarcerated people between prisons have been the source of outbreaks. Our objective was to examine the relationship between intersystem prison transfers and COVID-19 incidence in a state prison system. We assessed the change in the means of the time-series of prison transfers and their cross-correlation with the time-series of COVID-19 tests and cases. Regression with automatic detection of multiple change-points was used to identify important changes to transfers. There were over 20,000 transfers between the state’s prisons from January through October 2020. Most who were transferred (82%), experienced a single transfer. Transfers between prisons are positively related to future COVID-19 case rates but transfers are not reactive to current case rates. To mitigate the spread of COVID-19 in carceral settings, it is crucial for transfers of individuals between facilities to be limited.

PMID:34383854 | DOI:10.1371/journal.pone.0256185

PLoS One. 2021 Aug 12;16(8):e0255944. doi: 10.1371/journal.pone.0255944. eCollection 2021.

ABSTRACT

In this paper, we propose a hierarchical statistical model for a single repairable system subject to several failure modes (competing risks). The paper describes how complex engineered systems may be modelled hierarchically by use of Bayesian methods. It is also assumed that repairs are minimal and each failure mode has a power-law intensity. Our proposed model generalizes another one already presented in the literature and continues the study initiated by us in another published paper. Some properties of the new model are discussed. We conduct statistical inference under an objective Bayesian framework. A simulation study is carried out to investigate the efficiency of the proposed methods. Finally, our methodology is illustrated by two practical situations currently addressed in a project under development arising from a partnership between Petrobras and six research institutes.

PMID:34383829 | DOI:10.1371/journal.pone.0255944

PLoS One. 2021 Aug 12;16(8):e0256138. doi: 10.1371/journal.pone.0256138. eCollection 2021.

ABSTRACT

It is critical to understand the role feed manufacturing may have regarding potential African swine fever virus (ASFV) transmission, especially given the evidence that feed and/or ingredients may be potential vectors. The objective of the study was to evaluate the distribution of ASFV in a feed mill following manufacture of contaminated feed. To accomplish this, a pilot-scale feed mill consisting of a mixer, bucket elevator, and spouting was constructed in a BSL-3Ag facility. First, a batch of ASFV-free feed was manufactured, followed by a batch of feed that had an ASFV-contaminated ingredient added to feed, which was then mixed and discharged from the equipment. Subsequently, four additional ASFV-free batches of feed were manufactured using the same equipment. Environmental swabs from 18 locations within the BSL-3Ag room were collected after each batch of feed was discharged. The locations of the swabs were categorized into four zones: 1) feed contact surface, 2) non-feed contact surface < 1 meter away from feed, 3) non-feed contact surface > 1 meter from feed, and 4) transient surfaces. Environmental swabs were analyzed using a qPCR specific for the ASFV p72 gene and reported as genomic copy number (CN)/mL of environmental swab processing buffer. Genomic copies were transformed with a log10 function for statistical analysis. There was no evidence of a zone × batch interaction for log10 genomic CN/mL (P = 0.625) or cycle threshold (Ct) value (P = 0.608). Sampling zone impacted the log10 p72 genomic CN/mL (P < 0.0001) and Ct values (P < 0.0001), with a greater amount of viral genome detected on transient surfaces compared to other surfaces (P < 0.05). This study illustrates that once ASFV enters the feed mill environment it becomes widespread and movement of people can significantly contribute to the spread of ASFV in a feed mill environment.

PMID:34383843 | DOI:10.1371/journal.pone.0256138

PLoS One. 2021 Aug 12;16(8):e0255602. doi: 10.1371/journal.pone.0255602. eCollection 2021.

ABSTRACT

BACKGROUND: The risk of mortality following elective total hip (THR) and knee replacements (KR) may be influenced by patients’ pre-existing comorbidities. There are a variety of scores derived from individual comorbidities that can be used in an attempt to quantify this. The aims of this study were to a) identify which comorbidity score best predicts risk of mortality within 90 days or b) determine which comorbidity score best predicts risk of mortality at other relevant timepoints (30, 45, 120 and 365 days).

PATIENTS AND METHODS: We linked data from the National Joint Registry (NJR) on primary elective hip and knee replacements performed between 2011-2015 with pre-existing conditions recorded in the Hospital Episodes Statistics. We derived comorbidity scores (Charlson Comorbidity Index-CCI, Elixhauser, Hospital Frailty Risk Score-HFRS). We used binary logistic regression models of all-cause mortality within 90-days and within 30, 45, 120 and 365-days of the primary operation using, adjusted for age and gender. We compared the performance of these models in predicting all-cause mortality using the area under the Receiver-operator characteristics curve (AUROC) and the Index of Prediction Accuracy (IPA).

RESULTS: We included 276,594 elective primary THRs and 338,287 elective primary KRs for any indication. Mortality within 90-days was 0.34% (N = 939) after THR and 0.26% (N = 865) after KR. The AUROC for the CCI and Elixhauser scores in models of mortality ranged from 0.78-0.81 after THR and KR, which slightly outperformed models with ASA grade (AUROC = 0.77-0.78). HFRS performed similarly to ASA grade (AUROC = 0.76-0.78). The inclusion of comorbidities prior to the primary operation offers no improvement beyond models with comorbidities at the time of the primary. The discriminative ability of all prediction models was best for mortality within 30 days and worst for mortality within 365 days.

CONCLUSIONS: Comorbidity scores add little improvement beyond simpler models with age, gender and ASA grade for predicting mortality within one year after elective hip or knee replacement. The additional patient-specific information required to construct comorbidity scores must be balanced against their prediction gain when considering their utility.

PMID:34383814 | DOI:10.1371/journal.pone.0255602

PLoS One. 2021 Aug 12;16(8):e0255988. doi: 10.1371/journal.pone.0255988. eCollection 2021.

ABSTRACT

Epiphora and dermatochalasis are common presentations in the ophthalmology clinic. To evaluate the change of epiphora before and after functional blepharoplasty, this retrospective cohort study reviewed 39 medical records of epiphora patients who underwent upper blepharoplasty. Severity of epiphora using MUNK score was collected and compared between before and at 6 months after blepharoplasty. The analysis model was performed to measure tear breakup time (TBUT) and frequency of artificial tears use. Subgroups of subjects before blepharoplasty to short baseline TBUT (≤ 10 seconds) and long TBUT (≥ 10 seconds) were also evaluated for the MUNK score change. From the analysis of 39 patients, the results showed a statistically significant decrease in post blepharoplasty MUNK score compared to the baseline (all P < 0.001). There was no significant difference between baseline and post-operative TBUT (P > 0.05). Twenty patients were in the short TBUT group and 19 in the long TBUT group. The reduction of MUNK score after blepharoplasty in the short TBUT group was not different to the long TBUT group (P = 0.50, 95% CI -0.84 to 0.41). However, in short TBUT group, frequency of artificial tears use after surgery was less than pre-operation. From the study, upper eyelid blepharoplasty might be one technique reducing the bothersome epiphora in dermatochalasis patients.

PMID:34383823 | DOI:10.1371/journal.pone.0255988

PLoS One. 2021 Aug 12;16(8):e0255372. doi: 10.1371/journal.pone.0255372. eCollection 2021.

ABSTRACT

This study was conducted in Farta district, south Gondar from 2019 to 2020 cropping years to identify rodent pest species and estimate damage caused on barley crops. Four independent barley crop fields (40 x 40 m each) were sampled randomly to estimate the loss. Two were located near Alemsaga Priority State Forest and the other two were away from the forest. Four (2 x 2 m) rodent exclusion plots were established at 10 m interval as control units in each selected experimental barley fields using fine wire mesh. Rodent pest species were collected using both Sherman and snap traps throughout the different crop growing stages. The damaged and undamaged barley tillers by pest rodents were counted on five 1 x 1 m randomly sampled quadrats for each selected experimental fields. Variations on pest rodent population between cropping years and sites were analyzed using Chi square test. The mean crop damages between cropping years and experimental field sites were analyzed using two way ANOVA. Arvicanthis abyssinicus, Mastomys natalensis, Arvicanthis dembeensis, Mus musculus, Lophuromys simensis, Tachyoryctes splendens and Hystrix cristata were identified as pest rodents in the study area. A total of 968 individual rodents (427 in 2019 and 541 in 2020) were trapped during the study period. There was a statistical variation (χ2 = 13.42, df = 1 and P<0.05) between trapped individuals of the two successive years. The crop fields near the forest were more vulnerable than away from the forest during both cropping years. Statistical variations was observed on mean crop losses between cropping years and experimental barley crop sites. The highest crop damage was seen at maturity stage and the lowest during sowing in all experimental plots and cropping years. The percentage of barley yield loss due to rodent pests was 21.7 kg ha-1. The monetary value of this yield loss was equivalent to 4875 Birr (121.9 US$ h-1). Alemsaga Forest as shelter and conservation strategies like free of farmland from livestock and terracing for soil conservation have great role for the high rodent pest populations in the study area. Field sanitation, trapping and using restricted rodenticides like zinc phosphide are the possible recommendation to local farmers against rodent pests.

PMID:34383810 | DOI:10.1371/journal.pone.0255372

Asian J Endosc Surg. 2021 Aug 11. doi: 10.1111/ases.12976. Online ahead of print.

ABSTRACT

PURPOSE: Of the various methods used, the laparoscopic surgical repair of inguinal hernias is widely performed. We aimed to estimate the incidence of bilateral and contralateral occult inguinal hernias in our surgical population and to compare the results of total extraperitoneal repair (TEP) for bilateral and unilateral inguinal hernias, occult and non-occult hernias.

METHODS: We retrospectively reviewed data of patients who underwent TEP for the repair of adult inguinal hernias from January 2012 to November 2018 in our hospital.

RESULTS: Of the data of 259 patients included, 134 (51.7%) and 125 (48.3%) had unilateral and bilateral inguinal hernias, respectively, while 70 patients (27%) were found to have a contralateral occult inguinal hernia, intraoperatively. The mean operative time was 129 ± 48 minutes (range, 43-300 minutes) and 167 ± 55 minutes (range, 85-390 minutes) for the unilateral and bilateral groups, respectively, indicating a significantly longer duration of surgery for the bilateral group (P < .05). Recurrence occurred in 1.5% (5/134) and 0.4% (1/250) of the operated hernias in the unilateral and the bilateral groups, respectively, indicating a significantly lower rate of recurrence in the latter group (P < .05). The two groups showed no statistically significant differences with respect to the remaining perioperative data. The incidence of postoperative complications in occult hernias was not significantly different from that in non-occult hernias.

CONCLUSIONS: Our TEP method, involving a laparoscopic exploration from the intraperitoneal side, can be safely and effectively utilized for the repair of both bilateral and contralateral occult inguinal hernias.

PMID:34382753 | DOI:10.1111/ases.12976

Int J Rheum Dis. 2021 Aug 12. doi: 10.1111/1756-185X.14203. Online ahead of print.

ABSTRACT

Missing data in clinical epidemiological research violate the intention-to-treat principle, reduce the power of statistical analysis, and can introduce bias if the cause of missing data is related to a patient’s response to treatment. Multiple imputation provides a solution to predict the values of missing data. The main objective of this study is to estimate and impute missing values in patient records. The data from the Kuwait Registry for Rheumatic Diseases was used to deal with missing values among patient records. A number of methods were implemented to deal with missing data; however, choosing the best imputation method was judged by the lowest root mean square error (RMSE). Among 1735 rheumatoid arthritis patients, we found missing values vary from 5% to 65.5% of the total observations. The results show that sequential random forest method can estimate these missing values with a high level of accuracy. The RMSE varied between 2.5 and 5.0. missForest had the lowest imputation error for both continuous and categorical variables under each missing data rate (10%, 20%, and 30%) and had the smallest prediction error difference when the models used the imputed laboratory values.

PMID:34382756 | DOI:10.1111/1756-185X.14203

J Vet Intern Med. 2021 Aug 12. doi: 10.1111/jvim.16238. Online ahead of print.

ABSTRACT

BACKGROUND: Rates of detecting ≥1 potential enteric pathogens (PEP) or toxins (PEP-T) in feces, blood, or both of horses ≥6 months of age with enteric disease and impact of multiple detections on outcome of horses with colitis has not been reported.

OBJECTIVE: To determine detection rates of PEP/PEP-T in feces, blood, or both of horses with enteric disease and effect of detecting multiple agents on outcome of horses with colitis.

ANIMALS: Thirty-seven hundred fifty-three fecal samples submitted to IDEXX Laboratories and 239 fecal and blood samples submitted to Michigan State University’s Veterinary Diagnostic Laboratory (MSUVDL).

METHODS: Retrospective evaluation of PEP/PEP-T testing results was performed to determine rates of detection of 1 or more PEP/PEP-T. Impact of detecting multiple agents on outcome was assessed in 239 horses hospitalized for colitis.

RESULTS: One or more PEP/PEP-T was detected in 1175/3753 (31.3%) and 145/239 (60.7%) of samples submitted to IDEXX Laboratories and MSUVDL, respectively. In a hospitalized cohort, survival to discharge was lower (76%) in horses with 1 agent, compared to horses with either no (88%) or multiple (89%) agents. There was no difference (P = .78) in days of hospitalization between horses with 0 (1-17), 1 (1-33), and > 1 positive (1-20) result. There was no difference in cost of hospitalization (P = .25) between horses with 0 ($2357, $1110-15 553), 1 ($2742, $788-11 005), and >1 positive ($2560, $1091-10 895) result.

CONCLUSIONS AND CLINICAL IMPORTANCE: Detection rates of PEP/PEP-T in horses with colitis vary with cohorts and tests performed. Detection of more than 1 PEP or PEP-T did not affect outcome.

PMID:34382708 | DOI:10.1111/jvim.16238