Category: Statistics

PLoS One. 2021 Oct 26;16(10):e0259127. doi: 10.1371/journal.pone.0259127. eCollection 2021.

ABSTRACT

INTRODUCTION: Port implantations at the forearm are associated with an increased risk of relevant vein thrombosis. Therefore, with this study we sought to identify the responsible risk factors to improve technical quality of the method.

METHODS: This is a retrospective analysis of 313 patients with port implantation at the forearm in 2019. Then, exploratory statistics were conducted comprising Cox-Regression and Kaplan-Meier-Analyses.

RESULTS: Mean age was 60 ± 14 years. 232 (74%) of the patients were female. No early infection was observed. 29 late infections and 57 cases of thrombosis occurred. In only 9% of the patients with thrombosis hospital admission was necessary for treatment. Median interval to the diagnosis of thrombosis was 23 days; inter-quartile-range: 16-75. Mean interval to elective port explantation was 227 ± 128 days. There was no effect of occurrence of thrombosis of the interventionalist, the assistance nor of several technical aspects. However, there was a significantly lower risk of thrombosis for primary implanted port system compared to replacement ports, Hazard-ratio: 0.34 [Confidence interval: 0.172, 0.674], p = 0.002. Age was a significant risk factor for late infections, Hazard-ratio: 3.35 [Confidence interval:1.84, 6.07], p < 0.0001.

CONCLUSION: The main risk factor for adverse outcome after radiographically guided port implantation at the forearm is the type of the implanted port system. The reason for that might not be the material itself but the experience of a team with a certain port system. Age is a risk factor for late complications.

PMID:34699565 | DOI:10.1371/journal.pone.0259127

PLoS One. 2021 Oct 26;16(10):e0258940. doi: 10.1371/journal.pone.0258940. eCollection 2021.

ABSTRACT

BACKGROUND: The use of cannabis for symptoms of endometriosis was investigated utilising retrospective archival data from Strainprint Technologies Ltd., a Canadian data technology company with a mobile phone application that tracks a range of data including dose, mode of administration, chemovar and their effects on various self-reported outcomes, including pelvic pain.

METHODS: A retrospective, electronic record-based cohort study of StrainprintTM users with self-reported endometriosis was conducted. Self-rated cannabis efficacy, defined as a function of initial and final symptom ratings, was investigated across the included symptom clusters of cramps, pelvic pain, gastrointestinal pain, nausea, depression, and low libido. Cannabis dosage form, dose and cannabinoid ratio information was also recorded.

RESULTS: A total number of 252 participants identifying as suffering endometriosis recorded 16193 sessions using cannabis between April 2017 and February 2020. The most common method of ingestion was inhalation (n = 10914, 67.4%), with pain as the most common reported symptom being treated by cannabis (n = 9281, 57.3%). Gastrointestinal symptoms, though a less common reason for cannabis usage (15.2%), had the greatest self-reported improvement after use. Inhaled forms had higher efficacy for pain, while oral forms were superior for mood and gastrointestinal symptoms. Dosage varied across ingestion methods, with a median dose of 9 inhalations (IQR 5 to 11) for inhaled dosage forms and 1 mg/mL (IQR 0.5 to 2) for other ingested dosage forms. The ratio of THC to CBD had a statistically significant, yet clinically small, differential effect on efficacy, depending on method of ingestion.

CONCLUSIONS: Cannabis appears to be effective for pelvic pain, gastrointestinal issues and mood, with effectiveness differing based on method of ingestion. The greater propensity for use of an inhaled dosage delivery may be due to the rapid onset of pain-relieving effects versus the slower onset of oral products. Oral forms appeared to be superior compared to inhaled forms in the less commonly reported mood or gastrointestinal categories. Clinical trials investigating the tolerability and effectiveness of cannabis for endometriosis pain and associated symptoms are urgently required.

PMID:34699540 | DOI:10.1371/journal.pone.0258940

PLoS One. 2021 Oct 26;16(10):e0258496. doi: 10.1371/journal.pone.0258496. eCollection 2021.

ABSTRACT

Lack of precipitation and groundwater for irrigation limits crop production in semi-arid regions, such as the Southern High Plains (SHP). Advanced technologies, such as variable rate irrigation (VRI), can conserve water and improve water use efficiency for sustainable agriculture. However, the adoption of VRI is hindered by the lack of on-farm research focusing on the feasibility of VRI. The objective of this study was to assess the effect of irrigation rates on cotton yield as affected by soil physical properties and topography in the Southern High Plains. This study was conducted in two fields within a 194-ha commercially managed farm in Hale County, Texas, in 2017. An irrigation treatment with three rates was implemented in a randomized complete block design with two replications as separate blocks in each field. A total of 230 composite soil samples were collected from the farm in spring 2017 and analyzed for texture. Information on apparent soil electrical conductivity (ECa), elevation, and final yield were collected from the fields. A statistical model showed that the effect of irrigation rates on cotton yield depended on its interaction with soil physical properties and topography. For example, areas with slope >2% and sand content >50% had no significant response to higher irrigation rates. This model suggests that applying irrigation amounts based on the yield response can be a basis for VRI. This study provides valuable information for site-specific irrigation to optimize crop production in fields with significant variability in soil physical properties and topography.

PMID:34699534 | DOI:10.1371/journal.pone.0258496

PLoS One. 2021 Oct 26;16(10):e0258867. doi: 10.1371/journal.pone.0258867. eCollection 2021.

ABSTRACT

Cyber insurance is a risk management option to cover financial losses caused by cyberattacks. Researchers have focused their attention on cyber insurance during the last decade. One of the primary issues related to cyber insurance is estimating the premium. The effect of network topology has been heavily explored in the previous three years in cyber risk modeling. However, none of the approaches has assessed the influence of clustering structures. Numerous earlier investigations have indicated that internal links within a cluster reduce transmission speed or efficacy. As a result, the clustering coefficient metric becomes crucial in understanding the effectiveness of viral transmission. We provide a modified Markov-based dynamic model in this paper that incorporates the influence of the clustering structure on calculating cyber insurance premiums. The objective is to create less expensive and less homogenous premiums by combining criteria other than degrees. This research proposes a novel method for calculating premiums that gives a competitive market price. We integrated the epidemic inhibition function into the Markov-based model by considering three functions: quadratic, linear, and exponential. Theoretical and numerical evaluations of regular networks suggested that premiums were more realistic than premiums without clustering. Validation on a real network showed a significant improvement in premiums compared to premiums without the clustering structure component despite some variations. Furthermore, the three functions demonstrated very high correlations between the premium, the total inhibition function of neighbors, and the speed of the inhibition function. Thus, the proposed method can provide application flexibility by adapting to specific company requirements and network configurations.

PMID:34699537 | DOI:10.1371/journal.pone.0258867

Ann Plast Surg. 2021 Nov 1;87(5):600-605. doi: 10.1097/SAP.0000000000002735.

ABSTRACT

INTRODUCTION: Panniculectomy is a common procedure in plastic surgery, often performed after massive weight loss and in morbidly obese patients. It is also performed in combination with various gynecologic procedures based on the rational that it will reduce complication rates and benefit the patient (Am J Obstet Gynecol, 2000. 182, 1502-1505; J Gynecol Technol, 1997;3:9-16; J Am Coll Surg, 1995). These and other studies fail to provide proof of these claims for a number of reasons, including study design, lack of a control group and the inclusion of nonmorbidly obese patients (J Am Coll Surg, 1995; Gynecol Oncol, 1998, 70, 80-86; Int J Gynecol Cancer, 2015;25(8):1503-1512). Recent medical practice has focused increasingly on minimizing patient morbidity and trends in reimbursement are moving toward penalizing practices, which increase complications. The aim of this study was to evaluate the premise that the addition of panniculectomy to gynecologic surgery in the obese and morbidly obese patient population results in a statistically significant improvement in measureable outcomes.

METHODS/RESULTS: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was reviewed to assess the association of complications with panniculectomy combined with gynecologic surgery in the morbidly obese patient population. The query identified 296 patients with a body mass index greater than 30 who had panniculectomy concomitant with gynecologic surgery. The results demonstrated a statistically significant relationship (P < 0.05) of these concomitant procedures with superficial infection, wound infection, pulmonary embolism, systemic sepsis, return to operating room, length of operation and length of stay. A systematic review of the literature was then performed which identified only 5 studies that included comparative cohorts of those with gynecologic surgery, with and without panniculectomy. There was no significant benefit across the studies in measured paramters.

CONCLUSIONS: This NSQIP study and systematic review of the existing literature does not support the premise that there is a statistically significant benefit associated with performing panniculectomy in conjunction with gynecologic surgery in the morbidly obese patient population. The NSQIP data demonstrate significant elevation of negative outcomes in morbidly obese patients undergoing combined procedures. In the light of the risks to patients and current direction of medical practice the addition of elective panniculectomy to gynecologic surgery should be reevaluated in the a patient population with a body mass index greater than 30.

PMID:34699436 | DOI:10.1097/SAP.0000000000002735

JAAPA. 2021 Nov 1;34(11):1-9. doi: 10.1097/01.JAA.0000800020.12927.8c.

ABSTRACT

This economic analysis of physician assistant/associate (PA) career earnings sought to assess the increasing effect of student debt, its potential effect on job selection, and whether such financial obligations may influence graduates to select higher-paying specialties. The model was a 30-year-old newly graduated PA who begins working in family medicine. A simulation included wages, student debt, national household expenditures, and real estate statistics. The scenario consisted of a high and middle cost of living in two geographic areas, a family of four, and an average life expectancy. Using a validated economic program, a series of calculations produced the financial effect on moderate-income levels and expenditures based on median PA earnings. On the deficit side is education debt, loan repayment, financing a house, college for children, retirement, and discretionary spending. Weighted variables were used to maximize the sensitivity effect of the simulation. A Monte Carlo probabilistic program predicted the likely outcome of income, expenses, inflation, and investments. Furthermore, the lifetime earnings of a PA who retires at age 67 years and lives to age 85 years falls in the 75th percentile of income of all Americans. The conclusion is that a full-time PA career in any clinical role is as economically rewarding as it is satisfying.

PMID:34699456 | DOI:10.1097/01.JAA.0000800020.12927.8c

Ann Plast Surg. 2021 Nov 1;87(5):493-500. doi: 10.1097/SAP.0000000000003022.

ABSTRACT

INTRODUCTION: The safety of combined augmentation-mastopexy is controversial. This study evaluates a national database to analyze the perioperative safety of combined augmentation-mastopexy to either augmentation or mastopexy alone.

METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients undergoing augmentation mammaplasty and mastopexy from 2005 to 2018. The patients were divided into the following groups: group I, augmentation; group II, mastopexy; group III, combined augmentation-mastopexy. Baseline characteristics and outcomes were compared. Outcomes were 30-day complications, reoperation, and readmission.

RESULTS: We found 5868 (74.2%) augmentation only, 1508 (19.1%) mastopexy only and 534 (6.6%) combined augmentation-mastopexy cases. Mean operative time was highest among the combined group at 129 minutes compared with 127 minutes for mastopexy alone and 66 minutes for augmentation alone (P < 0.01). Rates of any complications and readmission were different among groups (0.8% vs 2.5% vs 1.5% respectively, P < 0.01 and 0.7% vs 1.5% vs 1.5% respectively, P = 0.049), whereas reoperation was not statistically different (1.2% vs 1.4% vs 1.5%, P = 0.75). The incidence of dehiscence (0.6%; P < 0.01) was highest in the combined group. Multivariable logistic regression analysis did not reveal an increased odds of complications, reoperation, or readmission with combined augmentation-mastopexy.

CONCLUSIONS: An evaluation of the nationwide cohort suggests that combined augmentation-mastopexy is a safe procedure in the perioperative period.

PMID:34699429 | DOI:10.1097/SAP.0000000000003022

Ann Plast Surg. 2021 Nov 1;87(5):533-536. doi: 10.1097/SAP.0000000000002887.

ABSTRACT

BACKGROUND: Linear scleroderma is a rare connective tissue disease characterized by thickening of the skin due to excess collagen deposit. It is the most frequent type of localized scleroderma in the pediatric population (40%-70%), and it usually affects the extremities and head. Linear scleroderma can cause growth disturbances, extremity length discrepancy, and debilitating joint contractures. The aim of this study was to describe the surgical outcomes of microsurgical flap reconstruction of linear scleroderma in the pediatric population.

METHODS: A retrospective review of all children with linear scleroderma was performed at our institution. Patients less than 18 years of age with clinical diagnosis of linear scleroderma and who underwent microsurgical flap reconstruction for correction of their scleroderma were included. Fat grafting procedures were excluded. Patient demographics and surgical outcomes were collected.

RESULTS: A total 7 patients underwent microsurgical flap reconstruction for treatment of their linear scleroderma producing debilitating soft tissue contractures and preventing ambulation or elbow extension. Six patients had scleroderma involving the lower extremity and 1 involving the upper extremity. Three anterolateral thigh and 4 latissimus dorsi flaps were performed. The median age at surgery was 7 years (Q1-Q3, 5-11), and the median body mass index was 21.3 kg/m2 (Q1-Q3, 16.5-22.1). The median follow-up was 121.1 months (Q1-Q3, 43.2-187.4). All flaps survived, and no donor site complications were reported. Perioperative complications included wound infection that required debridement (n = 1), immediate postoperative bleeding requiring surgical intervention (n = 1), intraoperative venous congestion (n = 1), and scleroderma recurrence outside the flap (n = 2). When comparing anterolateral thigh and latissimus dorsi flaps, there was no statistically significant difference in the development of surgical complications, number of surgical revisions per patient [median, 4 (Q1-Q3, 4-7) vs 2.5 (Q1-Q3, 1.3, 3), P = 0.0916], or unplanned surgical interventions [median, 0 (Q1-Q3, 0-1) vs 1 (Q1-Q3, 0-1), P = 0.7228]. The reconstruction was successful in improving range of motion in 6 patients, 5 of which reached full weight-bearing. However, all patients had residual limb deformity, and 4 had remaining extremity length discrepancy.

CONCLUSIONS: Microsurgical flaps are a good option for functional improvement of severe pediatric linear scleroderma affecting the extremities. However, residual limb deformity is common, and patients are often required to undergo additional surgical revisions.

PMID:34699432 | DOI:10.1097/SAP.0000000000002887

Clin J Pain. 2021 Oct 26. doi: 10.1097/AJP.0000000000000998. Online ahead of print.

ABSTRACT

OBJECTIVES: High-quality evidence demonstrates analgesic effects of sweet tasting solutions for infants during painful procedures. However, evidence of the analgesic effects of sucrose beyond 12 months of age is less certain. The aim of this study was to ascertain the efficacy of oral sucrose in hospitalized toddlers (ages 12 to 36▒mo) compared to placebo (water) during venipuncture.

METHODS: Blinded, two-armed randomized controlled trial (RCT) including hospitalized toddlers aged 12-36 months. Toddlers were randomized to either 25% sucrose or water prior to venipuncture, stratified by age (12-24▒mo and >24-36▒mo). Standard of care included topical anesthetics for both groups. Pain assessment included cry duration and FLACC (Face, Legs, Activity, Cry, Consolability) scores. Descriptive statistics and linear models were used to report the percentage of time crying and mean differences in FLACC scores. Data analysis was performed using R version 3.6.3.

RESULTS: A total of 95 toddlers were randomized and 85 subsequently studied. The median percentage of time spent crying between insertion of the first needle and 30s after the end of procedure in both groups was 81% (IQR=66). There was no significant difference in crying time and FLACC scores between groups (P>0.05). When examining effects of sucrose for the younger toddlers (less than 24 months of age) there was a reduction in crying time of 10% and a 1.2-point reduction in mean FLACC scores compared to the toddlers older than 24 months.

DISCUSSION: Findings highlight that toddlers become highly distressed during venipuncture, despite the standard care of topical anesthetics. In addition, sucrose does not effectively reduce distress especially in the older group of toddlers.

PMID:34699407 | DOI:10.1097/AJP.0000000000000998

Blood Press Monit. 2021 Oct 25. doi: 10.1097/MBP.0000000000000572. Online ahead of print.

ABSTRACT

OBJECTIVES: To characterize the blood pressure (BP) profile of the new β3-adrenergic receptor agonist, vibegron, in patients with overactive bladder.

METHODS: Patients were randomized to once-daily vibegron 75 mg or placebo for 28 days and underwent ambulatory BP monitoring. The primary endpoint was change from baseline (CFB) to day 28 in mean daytime ambulatory systolic BP (SBP). Secondary endpoints were CFB in mean 24-h SBP and in mean daytime and mean 24-h ambulatory diastolic BP (DBP) and heart rate (HR). Safety was assessed through adverse event reporting.

RESULTS: Of 214 patients randomized, 96 receiving vibegron and 101 receiving placebo had evaluable baseline and day 28 measurements. Overall, 39.6 and 30.7% of patients receiving vibegron and placebo, respectively, had preexisting hypertension. The least squares mean difference (LSMD; 90% confidence interval) between vibegron and placebo in CFB in mean daytime SBP was 0.8 (-0.9, 2.5) mmHg. LSMD in CFB in mean daytime DBP and HR was 0.0 mmHg and 0.9 bpm, respectively. No significant differences between treatments were seen in CFB in mean 24-h SBP (LSMD, 0.6 mmHg), DBP (-0.2 mmHg) or HR (1.0 bpm). The most common treatment-emergent adverse event was hypertension, with rates comparable between groups [vibegron: n = 5 (4.7%); placebo: n = 4 (3.7%)]. One patient receiving vibegron took a prohibited medication (phentermine) known to increase BP.

CONCLUSIONS: Once-daily vibegron had no statistically significant or clinically relevant effects on BP or HR.

PMID:34699409 | DOI:10.1097/MBP.0000000000000572