Category: Statistics

J Adv Nurs. 2021 Feb 23. doi: 10.1111/jan.14805. Online ahead of print.

ABSTRACT

AIM: To test a theoretical model aiming to understand which characteristics of the professional nursing practice environment most affect patients, professionals and institution outcomes.

DESIGN: A cross-sectional and correlational study, using a structural equation model.

METHODS: One thousand seven hundred and seventy-three staff nurses were recruited using convenience sampling in five Brazilian hospitals from November 2017 to July 2018. Structural equation modelling was used to assess the relationship between the characteristics of the nursing work environment and patients (climate of safety and quality of care), nursing professionals (job satisfaction and emotional exhaustion) and institutions (intention to leave the job) outcomes. The model was tested using the partial least squares method, considering the bootstrapping technique to estimate the results. The path coefficients and their respective 95% confidence intervals were calculated. The quality of fit of the structural model was assessed by calculating the coefficient of determination (R² ), the predictive validity coefficient (Q² ) and the effect size (f² ).

RESULTS: The characteristics that most affected the outcomes for patients were Nurse manager ability, leadership and support of nurses (λ=0.27), and Staffing and resource adequacy (λ=0.26); for nursing professionals, Staffing and resource adequacy (λ=-0.19), and Collegial nurse-physician relations (λ=0.19); and for institutions, Nurse manager ability, leadership and support of nurses (λ=-0.10), and Collegial nurse-physician relations (λ=-0.10).

CONCLUSION: The characteristics of the professional nursing practice environment that most contribute to achieving better outcomes include nurse manager ability, leadership and support of nurses, staffing and resource adequacy, and collegial nurse-physician relations.

IMPACT: This study allowed us to assess which strategies should be prioritized in the professional nursing practice environment to achieve better results. Thus, investment in the training of leadership, in the adequacy of resources, and in physician-nurse relations will bring better results for patients, nursing professionals, and institutions.

PMID:33624302 | DOI:10.1111/jan.14805

Environ Sci Pollut Res Int. 2021 Feb 23. doi: 10.1007/s11356-021-12942-6. Online ahead of print.

ABSTRACT

Most studies focused on the temporal trend of mortality risk associated with temperature exposure. The relative role of heat, cold, and temperature variation (TV) on morbidity and its temporal trends are explored insufficiently. This study aims to investigate the temporal trends of emergency ambulance dispatch (EAD) risk and the attributable burden of heat, cold, and hourly temperature variation (HTV). We collected time-series data of daily EAD and ambient temperature in Shenzhen from 2010 to 2017. HTV was calculated as the standard deviation of the hourly temperatures between 2 consecutive days. Quasi-Poisson generalized additive models (GAM) with a time-varying distributed lag nonlinear model (DLNM) were applied to examine temporal trends of the HTV-, heat-, and cold-EAD association. The temporal variation of the attributable fraction (AF%) and attributable number (AN) for different temperature exposures was also calculated. The largest RR was observed in extreme cold [1.30 (95% CI: 1.18, 1.43)] and moderate cold [1.25 (95% CI: 1.17, 1.34)]. Significant increasing trends in HTV-related effects and burden were observed, especially for the extreme HTV effects (P for interaction < 0.05). Decreasing trends were observed in the heat-related effect and burden, though it showed no significance (P for interaction = 0.46). There was no clear change pattern of cold-related effects and burdens. Overall, the three temperature exposure caused 13.7% of EAD, of which 4.1%, 4.3%, and 5.3% were attributed to HTV, heat, and cold, respectively. All the temperature indexes in this study, especially the cold effect, are responsible for the increased risk of EAD. People have become more susceptible to HTV over the recent decade. However, there is no clear evidence to support the temporal change of the population’s susceptibility to heat and cold. Thus, in addition to heat and cold, the emergency ambulance service department should pay more attention to HTV under climate change.

PMID:33624238 | DOI:10.1007/s11356-021-12942-6

Environ Sci Pollut Res Int. 2021 Feb 23. doi: 10.1007/s11356-021-12896-9. Online ahead of print.

ABSTRACT

The defensibility of field sampling data collected in support of natural resource damage assessments and other environmental investigations depends on rigorous quality assurance and control both in the field and laboratory. One important step in field procedures is the cleaning of sampling equipment between samples to minimize the carryover of contaminants. Large-scale sampling efforts during the Deepwater Horizon oil spill event have highlighted the importance of understanding how multiple equipment cleaning protocols affect interstation cross-contamination and the resulting chemical data quality. In this study, six field cleaning techniques were tested on metal sampling equipment using two different sediment types spiked with crude oil in order to understand their relative and absolute effectiveness in reducing chemical carryover. The complexity of the cleaning protocols ranged from a simple water and scrub brush application to protocols that included soap and/or solvent. In this study, percent residual hydrocarbon transfer, relative to total loading in sediments, never exceeded 0.032%. The least labor-intensive protocol, water and scrub brush application, had the highest potential for hydrocarbon transfer (0.011-0.032%). Statistical differences were observed among treatments, and it was found that protocols containing a solvent step were more effective than protocols without solvents. Depending on the data quality objectives, the differences may not be meaningful, and choosing a cleaning technique should be governed by health, safety, and environmental factors. The residual hydrocarbons measured after equipment cleanings for all techniques in this study were negligible when compared with other variables that occur during routine sampling and laboratory activities.

PMID:33624247 | DOI:10.1007/s11356-021-12896-9

J Sleep Res. 2021 Feb 23:e13278. doi: 10.1111/jsr.13278. Online ahead of print.

ABSTRACT

Primary insomnia is often considered a disorder of 24-hr hyperarousal. Numerous attempts have been made to investigate nocturnal heart rate (HR) and its variability (HRV) as potential pathophysiological hallmarks of altered arousal levels in insomnia, with mixed results. We have aimed to overcome some of the pitfalls of previous studies by using a young, medication-free, age- and gender-matched population consisting of 43 students aged 18-30 years half with a subthreshold insomnia complaint. We employed at-home ambulatory polysomnography and compared this attenuated insomnia group to a good sleeping group. The poor sleepers had significantly higher wake after sleep onset, arousal count, mean HR in all sleep stages (with the exception of Stage 1) and lower sleep efficiency. Consistent with previous research, we also found a significant group-by-sleep stage interaction in the prediction of nocturnal HR, highlighting the insomnia group to have a lower wake-sleep HR reduction compared to good sleepers. When restricting our analyses to insomnia with objectively determined short sleep duration, we found significantly lower standard deviation of RR intervals (SDNN; a measure of HRV) compared to good sleepers. Taken together, this lends credence to the hyperarousal model of insomnia and may at least partially explain the increased prevalence of cardiovascular morbidity and mortality observed in patients with insomnia.

PMID:33622029 | DOI:10.1111/jsr.13278

Med J Aust. 2021 Feb 23. doi: 10.5694/mja2.50960. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess the efficacy of a pro-active, absolute cardiovascular risk-guided approach to opportunistically modifying cardiovascular risk factors in patients without coronary ischaemia attending a chest pain clinic.

DESIGN: Prospective, randomised, open label, blinded endpoint study.

SETTING: The rapid access chest pain clinic of Royal Hobart Hospital, a tertiary hospital.

PARTICIPANTS: Patients who presented to the chest pain clinic between 1 July 2014 and 31 December 2017 who had intermediate to high absolute cardiovascular risk scores (5-year risk ≥ 8%). Patients with known cardiac disease or from groups with clinically determined high risk of cardiovascular disease were excluded.

MAIN OUTCOME MEASURES: The primary endpoint was change in 5-year absolute risk score (Australian absolute risk calculator) at follow-up (at least 12 months after baseline assessment). Secondary endpoints were changes in lipid profile, blood pressure, smoking status, and body mass index, and major adverse cardiovascular events.

RESULTS: The mean change in risk at follow-up was +0.4 percentage points (95% CI, -0.8 to 1.5 percentage points) for the 98 control group patients and -2.4 percentage points (95% CI, -1.5 to -3.4 percentage points) for the 91 intervention group patients; the between-group difference in change was 2.7 percentage points (95% CI, 1.2-4.1 percentage points). Mean changes in lipid profile, systolic blood pressure, and smoking status were larger for the intervention group, but not statistically different from those for the control group.

CONCLUSIONS: An absolute cardiovascular risk-guided, pro-active risk factor management strategy employed opportunistically in a chest pain clinic significantly improved 5-year absolute cardiovascular risk scores.

TRIAL REGISTRATION: Australia New Zealand Clinical Trial Registry, ACTRN12617000615381 (retrospective).

PMID:33622026 | DOI:10.5694/mja2.50960

Vet Clin Pathol. 2021 Feb 23. doi: 10.1111/vcp.12980. Online ahead of print.

ABSTRACT

BACKGROUND: The accessibility of thromboelastography (TEG) to general practitioners is limited by short sample storage times (30 minutes) and storage temperatures (20-23°C).

OBJECTIVES: We aimed to evaluate the stability of canine and equine citrated blood samples when stored for extended periods of time, both at room temperature (RT) (20-23°C) and refrigerator temperature (FT) (2-7.5°C).

METHODS: Citrated whole blood samples from healthy dogs and horses (n = 10 for each) were stored for 30 minutes (baseline) at RT before TEG analysis. Baseline values for TEG variables R, K, α, MA, LY30, and LY60 were compared with those from samples stored for 2, 8, and 22.5 h, at RT and FT. Results were compared using an ANOVA (P < .05). Total allowable analytical error (TE_a ) based on biological variation data was used to evaluate stability.

RESULTS: In dogs, statistically significant differences included shorter R, longer K, decreased MA, and increased LY60 at various time points and storage temperatures from 2 h onward. Only samples stored for 2 h at FT showed acceptable stability compared with TE_a . In horses, statistically significant differences included shorter R and K, and decreased α, LY30, and LY60 at various time points and storage temperatures from 2 h onward. Samples were not stable at any time compared with TE_a , regardless of the temperature.

CONCLUSIONS: In this study, canine samples could be stored for up to 2 h at FT without affecting TEG results; equine samples should be stored for 30 minutes at RT.

PMID:33622027 | DOI:10.1111/vcp.12980

Eur J Dent. 2021 Feb 23. doi: 10.1055/s-0040-1722484. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to evaluate the effect of in-office bleaching on the enamel surface and the efficacy of calcium silicate-sodium phosphate-fluoride salt (CS) and NovaMin bioactive glass (NM) dentifrice in remineralizing bleached enamel.

MATERIALS AND METHODS: Forty extracted premolars were sectioned mesio-distally, and the facial and lingual enamel were flattened and polished. The samples were equally divided into nonbleached and bleached with 38% hydrogen peroxide (HP). Each group was further divided according to the remineralization protocol (n = 10); no remineralization treatment (nontreated), CS, or NM, applied for 3 minutes two times/day for 7 days, or CS combined with NR-5 boosting serum (CS+NR-5) applied for 3 minutes once/day for 3 days. The average Knoop hardness number (KHN) and surface roughness (utilizing atomic force microscopy) were measured. Surface topography/elemental analysis was analyzed by using scanning electron microscopy/energy dispersive X-ray analysis. All the tests were performed at baseline, after bleaching, and following each remineralization protocol. Data were statistically analyzed by two-way analysis of variance and Bonferroni post hoc multiple comparison tests (α = 0.05).

RESULTS: HP significantly reduced KHN and increased roughness (p < 0.05). All remineralization materials increased the hardness and reduced the surface roughness after bleaching except NM, which demonstrated significantly increased roughness (p < 0.05). Ca/P ratio decreased after bleaching (p < 0.05), and following treatment, CS and CS+NR-5 exhibited higher remineralization capacity in comparison to NM (p < 0.05).

CONCLUSION: Although none of the material tested was able to reverse the negative effect of high-concentration in-office HP on enamel completely, the remineralization efficacy of CS and CS+NR-5 was superior to that of NM.

PMID:33622008 | DOI:10.1055/s-0040-1722484

Eur J Dent. 2021 Feb 23. doi: 10.1055/s-0040-1722483. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study was to evaluate the short-term effect of active skeletonized sutural distractor (ASSD) appliance on temporomandibular joint morphology of class III malocclusion subjects.

MATERIALS AND METHODS: This was a prospective interventional study. Cone-beam computerized tomography (CBCT) images of 22 patients were taken before and after treatment by using Planmeca Promax 3D CBCT machine version 2.9.2 (Planmeca OY Helsinki, Finland). The condylar width, height, length, roof of glenoid fossa thickness, and all joint spaces were measured. The condylar position was determined based on Pullinger and Hollander formula. The condylar shape was determined as per Kinzinger et al. The condylar volume was calculated by using Mimics software (Materialize, Belgium).

STATISTICAL ANALYSIS: Data analysis was performed by using SPSS software version 24. Wilcoxon paired signed-rank test was used to compare the difference in temporomandibular joint morphology and condylar volume between pre- and post-treatment measurements. Chi-square test was used to compare the condylar position and shape.

RESULTS: The superior (p = 0.000 on the right side, p = 0.005 on the left side) and posterior joint spaces (p = 0.000 on both sides) were decreased after the treatment, respectively. The condyles were rotated upward and backward, thereby increasing the anterior joint spaces (p = 0.000 on both sides) after the treatment. The condylar volume increases after treatment, but no significant differences were observed (p = 0.903 on the right side, p = 0.062 on the left side).

CONCLUSION: The significant changes were observed in joint spaces. The condyles were more anteriorly placed before treatment. Condylar position and shape alter in response to ASSD treatment. The condylar volume did not show any significant change.

PMID:33622009 | DOI:10.1055/s-0040-1722483

Eur J Dent. 2021 Feb 23. doi: 10.1055/s-0041-1724158. Online ahead of print.

ABSTRACT

OBJECTIVE: The study aimed to evaluate the existence of possible correlations among root canal configuration, quality of filling, and its sealability.

MATERIALS AND METHODS: Sixty human mandibular central incisors were selected for this study. The teeth were prepared with the Profile 04 system up to instrument 35/0.04 and irrigated with 2.5 mL of 2.5% sodium hypochlorite at each instrument change. Root canal filling was performed by the lateral compaction technique, using gutta-percha and an epoxy resin-based sealer (AH Plus) labeled with 0.1% Rhodamine B dye. Afterward, the specimens were submitted to fluid filtration tests to assess the sealability of the filling. Cross-sections were obtained at -3, -6, and -8 mm from the root apex and submitted to a metallographic treatment to determine the root canal configuration and the percentage of gutta-percha filled areas. The data were statistically analyzed by the Grubbs test. Pairs of correlations were analyzed by applying the Spearman test at a level of significance of 5%.

RESULTS: No correlation was observed among the analyzed variables as follows: root canal configuration versus filling quality (Spearman’s rho = 0.031); filling quality versus sealability (Spearman’s rho = 0.219); and root canal configuration versus sealability (Spearman’s rho = 0.184).

CONCLUSION: The root canal configuration did not affect the quality of the filling and its sealability.

PMID:33622010 | DOI:10.1055/s-0041-1724158

Eur J Dent. 2021 Feb 23. doi: 10.1055/s-0041-1723065. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to investigate the effect of additional apical preparation using the ProDesign Logic (PDL) 50/.01 rotary heat-treated nickel-titanium (NiTi) file with a larger diameter and minimal taper for retreatment of curved root canals.

MATERIALS AND METHODS: Mesial curved root canals of 12 mandibular molars were prepared using PDL 25/.06 and filled using the continuous wave of condensation technique and AH Plus sealer. After retreatment using ProDesign S (PDS) 25/.08, PDL 25/.06 and PDL 35/05, a complementary procedure was performed with PDL 50/.01. Microcomputed tomography (micro-CT) scanning was performed before and after retreatment procedures. The cyclic fatigue resistance of unused PDS 25/.08, PDL 25/.06, PDL 35/.05 and PDL 50/.01 instruments (n = 12) was evaluated in a stainless-steel device.

STATISTICAL ANALYSIS: Data on the volumes of the root canals and the remaining filling materials were submitted to the paired t-test. Cyclic fatigue resistance data was submitted to one-way ANOVA and Tukey’s tests (α = 0.05).

RESULTS: Use of PDL 50/.01 decreased the remaining filling materials in the apical third (p < 0.05). The root canal volume was similar in the cervical and middle thirds before and after preparation using PDL 50/.01 (p > 0.05). PDL 50/.01 presented the highest cyclic fatigue resistance (p < 0.05).

CONCLUSIONS: Use of the PDL 50/.01 instrument as an additional apical preparation for retreatment of curved root canals improved filling material removal in the apical third, while maintaining the dentin in the cervical and middle thirds. In addition, PDL 50/.01 presented high-flexural resistance.

PMID:33622011 | DOI:10.1055/s-0041-1723065