Category: Statistics

Integr Environ Assess Manag. 2022 Apr 4. doi: 10.1002/ieam.4614. Online ahead of print.

ABSTRACT

As health-based drinking water standards for per- and polyfluorinated alkyl substances (PFAS) continue to evolve, public health and environmental protection decision-makers must assess exposure risks associated with all public drinking water systems in the United States (US). Unfortunately, current knowledge regarding the presence of PFAS in environmental systems is limited. In this study a screening approach was established to: 1) identify and direct attention toward potential PFAS hot-spots in drinking water sources; 2) prioritize sampling locations; and 3) provide insights regarding the potential PFAS sources that contaminate groundwater and surface water. Our approach incorporates geospatial data from public sources, including the U.S. Environmental Protection Agency’s (US EPA) Toxic Release Inventory (TRI), to identify locations where PFAS may be present in drinking water sources. An indicator factor (e.g. “risk factor” was developed as a function of distance between potential past and/or present PFAS-users (e.g., military bases, industrial sites, and airports) and the public water system, and generates a heat map that visualizes potential exposure risks. A binomial logistic regression model indicates whether PFAS is likely to be detected in public water systems. The results obtained using the developed screening approach aligned well (with a 76% overall model accuracy) with PFAS sampling and chemical analysis data from 81 public drinking water systems in the state of Kentucky. This study proposes this screening model as an effective decision aid to assist key decision-makers in identifying and prioritizing sampling locations for potential PFAS exposure risks in the public drinking water sources in their service areas. This article is protected by copyright. All rights reserved. © 2022 SETAC.

PMID:35373458 | DOI:10.1002/ieam.4614

Pharm Stat. 2022 Apr 3. doi: 10.1002/pst.2212. Online ahead of print.

ABSTRACT

Pharmaceutical companies regularly need to make decisions about drug development programs based on the limited knowledge from early stage clinical trials. In this situation, eliciting the judgements of experts is an attractive approach for synthesising evidence on the unknown quantities of interest. When calculating the probability of success for a drug development program, multiple quantities of interest-such as the effect of a drug on different endpoints-should not be treated as unrelated. We discuss two approaches for establishing a multivariate distribution for several related quantities within the SHeffield ELicitation Framework (SHELF). The first approach elicits experts’ judgements about a quantity of interest conditional on knowledge about another one. For the second approach, we first elicit marginal distributions for each quantity of interest. Then, for each pair of quantities, we elicit the concordance probability that both lie on the same side of their respective elicited medians. This allows us to specify a copula to obtain the joint distribution of the quantities of interest. We show how these approaches were used in an elicitation workshop that was performed to assess the probability of success of the registrational program of an asthma drug. The judgements of the experts, which were obtained prior to completion of the pivotal studies, were well aligned with the final trial results.

PMID:35373454 | DOI:10.1002/pst.2212

J Clin Nurs. 2022 Apr 3. doi: 10.1111/jocn.16312. Online ahead of print.

ABSTRACT

AIMS AND OBJECTIVES: The aim of this study was to discover the nature of the adverse events in Finnish long-term professional homecare reported by professionals, and to identify the circumstances in which adverse events occur and their consequences.

BACKGROUND: Adverse events are incidents causing unintended and unnecessary harm to older people at home. Safety is a basic human right and a fundamental prerequisite for independent living among older people at home. Few studies have focused on both long-term professional homecare environment and the safety of older people.

DESIGN: The research was a descriptive registry-based study.

METHODS: This study consisted of adverse events (N = 61248) in Finnish public long-term professional homecare (2009-2019). Data were described using frequencies and percentages. STROBE statement checklist was chosen for reporting the study process.

RESULTS: By profession, practical nurses and registered nurses reported the most of adverse events (89.8%). These were either critical incidents (78.3%) or near misses (20.0%) and concerned medicine, injuries and accidents, information flow or management. Consequences for older people were usually rated from no-harm to moderate harm. For long-term professional homecare, image harm, extra financial costs, no-harm and prolonged care for older people were among the consequences. Personnel frequently observed the older people afterwards and informed older people of adverse events, yet some of actions were unknown.

CONCLUSIONS: Many harmful adverse events are considered harmless for older people. Sometimes this can lead to unmet care needs or missed care. The degree of harm needs to be assessed in terms of physical, mental and social health with the HaiPro reporting system for homecare.

RELEVANCE TO CLINICAL PRACTICE: An understanding and a comprehensive view of the situation and holistic assessment of care needs includes safety and safety risks to increase safety and feeling of safety for older people at home.

PMID:35373401 | DOI:10.1111/jocn.16312

Int Wound J. 2022 Apr 3. doi: 10.1111/iwj.13811. Online ahead of print.

ABSTRACT

This study examined the relationship between the personal predisposing factors of patients and the severity of pressure injuries (PIs) developed during surgery. This retrospective cohort study collected 439 cases of peri-operative PIs. Using binary logistic regression to identify the variables associated with PI severity, the effects of interactions between associated variables were then tested. The results of this study revealed that among the personal predisposing factors, only higher patient age (P = .001) and higher body mass index (P < .001) posed a greater risk of stage 2 PIs or higher. Among the surgery-related facilitating factors, only patients who were placed in the prone position during surgery and patients who lost ≥1000 mL of blood during surgery were at greater risk of stage 2 PIs or higher, compared, respectively, to those placed in the supine position and those who lost ≤100 mL of blood. Furthermore, the amount of blood lost during surgery moderated the influence of age on PI severity. For elderly patients who are expected to lose a large blood volume during surgery or lose an immeasurable amount of blood due to the use of cardiopulmonary bypass, taking more precautionary measures to prevent PIs is recommended.

PMID:35373448 | DOI:10.1111/iwj.13811

Br J Clin Pharmacol. 2022 Apr 3. doi: 10.1111/bcp.15342. Online ahead of print.

ABSTRACT

AIMS: To assess the appropriateness of the bodyweight or fixed dosing regimen, population pharmacokinetic (PopPK) model of kukoamine B has been built in sepsis patients.

METHODS: Plasma Concentrations of kukoamine B and the covariates information were from 30 sepsis patients assigned into 0.06 mg/kg, 0.12 mg/kg and 0.24 mg/kg groups in Phase IIa clinical trial. PopPK model was built using nonlinear mixed-effect (NLME) modelling approach. Based on the final model, PK profiles were respectively simulated for 500 times applying the bodyweight and renal function information of 12 sepsis patients from 0.24 mg/kg group on the bodyweight or the fixed dosing regimen. For each dosing regimen, PK profiles of 6000 virtual patients were obtained. Statistical analyses for C_max and C_min were performed. If the biases of C_max and C_min can all meet the criteria of ±15%, the fixed dosing regimen can substitute the bodyweight dosing regimen.

RESULTS: PopPK model was successfully developed by NLME approach. Bi-compartmental model was selected as the basic model. Renal function was identified as a statistically significant covariate about systemic clearance with OFV decreasing 8.6, resulting in a 5.2% decrease inter-individual variability (IIV) of systemic clearance. Body weight was not identified as a statistically significant covariate. Simulation results demonstrated two methods had a bias of 8.1% for C_max , and 8.6% for C_min . Furthermore, PK variability was lower on the fixed dosing regimen than the body weight regimen.

CONCLUSIONS: Based on simulation results, fixed dosing regimen was recommended in the following clinical trials.

PMID:35373389 | DOI:10.1111/bcp.15342

Magn Reson Med. 2022 Apr 3. doi: 10.1002/mrm.29227. Online ahead of print.

ABSTRACT

PURPOSE: To improve reconstruction fidelity of fine structures and textures in deep learning- (DL) based reconstructions.

METHODS: A novel patch-based Unsupervised Feature Loss (UFLoss) is proposed and incorporated into the training of DL-based reconstruction frameworks in order to preserve perceptual similarity and high-order statistics. The UFLoss provides instance-level discrimination by mapping similar instances to similar low-dimensional feature vectors and is trained without any human annotation. By adding an additional loss function on the low-dimensional feature space during training, the reconstruction frameworks from under-sampled or corrupted data can reproduce more realistic images that are closer to the original with finer textures, sharper edges, and improved overall image quality. The performance of the proposed UFLoss is demonstrated on unrolled networks for accelerated two- (2D) and three-dimensional (3D) knee MRI reconstruction with retrospective under-sampling. Quantitative metrics including normalized root mean squared error (NRMSE), structural similarity index (SSIM), and our proposed UFLoss were used to evaluate the performance of the proposed method and compare it with others.

RESULTS: In vivo experiments indicate that adding the UFLoss encourages sharper edges and more faithful contrasts compared to traditional and learning-based methods with pure ${\ell }_2$ loss. More detailed textures can be seen in both 2D and 3D knee MR images. Quantitative results indicate that reconstruction with UFLoss can provide comparable NRMSE and a higher SSIM while achieving a much lower UFLoss value.

CONCLUSION: We present UFLoss, a patch-based unsupervised learned feature loss, which allows the training of DL-based reconstruction to obtain more detailed texture, finer features, and sharper edges with higher overall image quality under DL-based reconstruction frameworks. (Code available at: https://github.com/mikgroup/UFLoss).

PMID:35373388 | DOI:10.1002/mrm.29227

Int J Health Plann Manage. 2022 Apr 3. doi: 10.1002/hpm.3468. Online ahead of print.

ABSTRACT

In 1945 the Food and Agricultural Organization (FAO) chose its Latin motto ‘fiat panis’ which translates as ‘let there be bread’ to prevent an unprecedented health catastrophe as a result of endemic hunger and poor nutritional health. Despite the long standing effort in this regard, for so many people, especially in developing economies in sub-Saharan Africa, access to enough, good quality, and constant supply of food and water remains an affront to good nutritional health. Globally, the FAO reports that 815 million people representing 10% of the population worldwide are currently undernourished. Our study investigates the effect of sustainable food production on malnutrition across sub-Saharan African countries. An ensemble of more sophisticated econometric models is applied to dynamic cross-country panel data from 16 countries in the 4 regions in Sub-Saharan African. Our study is innovative because it makes a pioneering contribution to the available stock of literature on indicators of sustainable food production and malnutrition which is still at an embryonic stage. We note that even though sub-Sahara African has a large tract of arable land, it negatively contributes towards malnutrition. We observed a positive and statistically significant relationship between food production (crop and livestock) and agricultural labour on malnutrition. Policy recommendations have been proposed to improve higher nutritional health through food production.

PMID:35373366 | DOI:10.1002/hpm.3468

J Clin Periodontol. 2022 Apr 3. doi: 10.1111/jcpe.13623. Online ahead of print.

ABSTRACT

The aim of this study was to assess the efficacy of the adjunct use of a subgingival erythritol powder air-polishing device (EPAP) in comparison to conventional subgingival instrumentation alone during initial non-surgical periodontal therapy. 21 patients with generalised Stage 2 and 3 grade B periodontitis were included in this single centre, single blinded, split-mouth randomised clinical trial. Teeth on the control side were treated with conventional hand and ultrasonic instrumentation while the contralateral test side was treated using EPAP as adjunct to conventional subgingival instrumentation with hand and ultrasonic instruments. Three months after initial instrumentation, persisting pockets of ≥4 mm were retreated, in both control and test side, again with the respective treatment approach: Subgingival instrumentation alone on control and subgingival instrumentation + EPAP on test side. Clinical parameters such as probing pocket depth (PPD), bleeding on probing (BOP) and relative attachment level (RAL) were recorded at baseline, 3 and 6 months following the initial instrumentation. Subgingival plaque samples were collected at baseline, immediately post-operative as well as 1 week, 1 month, 3 months and 6 months after initial instrumentation. In the test group after 6 months, a significantly greater number of initially deep pockets (PPD ≥5.5 mm) were reduced to shallow (PPD ≤3.4 mm) and a greater attachment gain was observed. No statistically significant microbiological differences could be found between test and control group. The results of the present study indicate that the adjunct use of subgingival airflow therapy with EPAP during initial non-surgical periodontal therapy might be beneficial in initially deep pockets (PPD≥5.5 mm). This article is protected by copyright. All rights reserved.

PMID:35373340 | DOI:10.1111/jcpe.13623

J Anat. 2022 Apr 4. doi: 10.1111/joa.13662. Online ahead of print.

ABSTRACT

The relationship between the sagittal shape of the cervical spine and that of the thoracolumbar spine is established in the normal spine. Adolescent idiopathic scoliosis (AIS) is recognised as a change in the shape of the spine in both the coronal and sagittal planes. The effects of AIS on the alignment of the cervical spine, including the effects of surgery, has been less well studied. The objective of this study was to identify, using regression analysis, the significant relationships between the alignment of the thoracolumbar spine, in both the coronal and sagittal planes, and the sagittal alignment of the cervical spine in AIS. This study used coronal and sagittal radiographic measures from a group with AIS, both pre and post-operatively, which were analysed using multiple linear regression methods to identify significant parameters that explain the sagittal shape of the cervical spine. There were 51 pairs of pre and post-operative radiographs analysed, 40 of which were Lenke 1 curves and 11 Lenke 3 curves. Posterior spinal fusion was performed for all. The significant parameters pre-operatively were T1 slope, thoracic kyphosis, lumbar lordosis and SVA with an R² value of 78%. Post-operatively, the significant parameters were T1 slope, thoracic kyphosis, lumbar lordosis and thoracolumbar scoliosis with an R² of 63%. The sagittal alignment of the cervical spine in AIS is related to the shape of key parameters in the rest of the spine. Changes in the cervical sagittal shape occur to compensate for changes in shape to the rest of the spine that occur as a consequence of surgery. This has implications for the understanding of how the compensatory mechanisms of the spine are used to maintain a horizontal gaze, along with prediction of the effects of surgery on the shape of the spine.

PMID:35373348 | DOI:10.1111/joa.13662

Med J (Ft Sam Houst Tex). 2022 Apr-Jun;(Per 22-04/05/06):32-39.

ABSTRACT

BACKGROUND: Uncontested air movement and advances for medical care of combat casualties have resulted in a decreased case fatality rate. However, in future large-scale combat operations, the military has established a plan for multidomain operations to defeat near-peer adversaries. Prolonged casualty care and mass casualty scenarios will become more prevalent. Prehospital friendly scoring systems such as the shock index (SI) and revised trauma score (RTS) may provide useful triage data. Development of accurate, data-driven, triage systems will be key to optimize management of resources, care, and transport of combat casualties.

METHODS: We included data from the Department of Defense Trauma Registry between 01 January 2007 to 17 March 2020. Data comprised of adult US military or coalition service members for analysis as the baseline cohort, and those who died within 24 hours were included in the early death cohort. We performed statistical analysis on demographics and injury data, SI and RTS to measure the receiver operating characteristics (ROC) of each value to predict early death.

RESULTS: The early death cohort had a significantly higher injury severity score (25 vs. 5) and a higher percentage of serious injuries in every body region than the baseline cohort. The early death cohort sustained serious injuries to the head and neck at a rate five times that of the baseline cohort (43.4% vs 8.1%) with odds ratio (OR) of death 8.0 (95% confidence interval 5.7-11.1) followed by skin (13.6% versus 1.9%) with an OR of 6.3 (95% CI 3.8-10.3). The mean SI was 1.21 versus 0.80. The revised trauma score (RTS) was 4.18 versus 7.34. The RTS had a higher area under the receiver operating characteristic (0.896 versus 0.716 for SI).

CONCLUSIONS: Serious injuries to the head and skin were most strongly associated with death within the first 24 hours. The RTS appears to be a more accurate tool than SI alone for assessing injury mortality. Military medical personnel should consider these factors when triaging casualties during future conflicts in resource limited settings with delayed evacuation.

PMID:35373319