Category: Statistics

J Pediatr Orthop. 2021 May 13. doi: 10.1097/BPO.0000000000001844. Online ahead of print.

ABSTRACT

INTRODUCTION: Orthopaedic surgery remains a male-dominated specialty. To date there has not been a focused analysis of gender in authorship within the pediatric orthopaedic literature.

METHODS: The electronic table of contents from 2011 to 2020 of 3 major pediatric orthopaedic journals [Journal of Children’s Orthopedics (JCO), Journal of Pediatric Orthopedics (JPO), and Journal of Pediatric Orthopedics Part B (JPO-B)] were reviewed. Publications were reviewed for the number of articles with at least 1 female author and the number of articles with women listed as first authors. These were compared over the 10-year study period, and by individual year of publication. Statistical analysis included a general linear model with factorial one-way anslysis of variance and Bonferroni post hoc testing.

RESULTS: A total of 4097 articles were reviewed. In 2020, there was a significantly higher percentage of articles with a female author when compared with 2011 (64% to 42%, P=0.010). A female was listed as first author in significantly more publications in 2020 as compared with 2011 (23% to 10%, P=0.031). During the 10-year study period, the highest mean proportion of articles with at least 1 female author was seen in JPO (60%), with similar findings in JCO (55%). Significantly fewer articles in JPO-B contained a female author (37%, P=0.001). The highest percentage of publications with a female first author across 10 years was in JCO (22%), followed by JPO (20%). Significantly fewer articles with a female first author were found in JPO-B (9%, P=0.001).

CONCLUSION: There is an increasing proportion of publications in the pediatric orthopaedic literature with female authors and female first authors from 2011 to 2020. In addition, there was a statistical difference in female authorship when comparing specific publications, which should be investigated further.

LEVEL OF EVIDENCE: Level IV.

PMID:33989256 | DOI:10.1097/BPO.0000000000001844

J Pediatr Orthop. 2021 May 13. doi: 10.1097/BPO.0000000000001845. Online ahead of print.

ABSTRACT

BACKGROUND: Transverse myelitis (TM) is a rare inflammatory disorder of the spinal cord. It can have a heterogeneous presentation with sensory, motor, and autonomic dysfunction. Neurological sequelae of TM include autonomic dysfunction, motor weakness, and/or spasticity. Studies describing orthopaedic deformities and treatments associated with TM are nonexistent. This purpose of this study was to describe the orthopaedic manifestations of TM in children.

METHODS: A multicenter retrospective review was conducted of patients, 0 to 21 years of age, with TM presenting over a 15-year period at 4 academic children’s hospitals. Those with confirmed diagnosis of TM and referred to an orthopaedic surgeon were included. Demographics, orthopaedic manifestations, operative/nonoperative treatments, and complications were recorded. Descriptive statistics were used for data reporting.

RESULTS: Of 119 patients identified with TM, 37 saw an orthopaedic surgeon. By etiology, 23 were idiopathic (62%), 10 infectious (27%), 3 (8%) inflammatory/autoimmune, and 1 (3%) vascular. The mean age at diagnosis was 6.7 (SD: 5.5) years and at orthopaedic presentation was 8.4 (SD: 5.2) years. Orthopaedic manifestations included scoliosis in 13 (35%), gait abnormalities in 7 (19%), foot deformities in 7 (19%), upper extremity issues in 7 (19%), symptomatic spasticity in 6 (16%), lower extremity muscle contractures in 6 (16%), fractures in 6 (16%), hip displacement in 3 (8%), pain in 2 (5%), and limb length discrepancy in 2 (5%) patients. Seven children (19%) were seen for establishment of care. In all, 14 (38%) underwent operative intervention, mainly for soft-tissue and scoliosis management. Four patients had baclofen pump placement for spasticity management. Postoperative complications occurred in 36% of cases, most commonly because of infection. Neither topographic pattern nor location of lesion had a significant relationship with need for hip or spine surgery.

CONCLUSIONS: This report describes the orthopaedic manifestations associated with TM in children, nearly 40% of whom required operative intervention(s). Understanding the breadth of musculoskeletal burden incurred in TM can help develop surveillance programs to identify and treat these deformities in a timely manner.

LEVEL OF EVIDENCE: Level IV.

PMID:33989257 | DOI:10.1097/BPO.0000000000001845

PLoS One. 2021 May 14;16(5):e0250071. doi: 10.1371/journal.pone.0250071. eCollection 2021.

ABSTRACT

BACKGROUND: In Neonatal Intensive Care Units (NICUs) premature infants are exposed to various acoustic, environmental and emotional stressors which have a negative impact on their development and the mental health of their parents. Family-centred music therapy bears the potential to positively influence these stressors. The few existing studies indicate that interactive live-improvised music therapy interventions both reduce parental stress factors and support preterm infants’ development.

METHODS: The present randomized controlled longitudinal study (RCT) with very low and extremely low birth weight infants (born <30+0 weeks of gestation) and their parents analyzed the influence of music therapy on both the physiological development of premature infants and parental stress factors. In addition, possible interrelations between infant development and parental stress were explored. 65 parent-infant-pairs were enrolled in the study. The treatment group received music therapy twice a week from the 21st day of life till discharge from hospital. The control group received treatment as usual.

RESULTS: Compared to the control group, infants in the treatment group showed a 11.1 days shortening of caffeine therapy, 12.1 days shortening of nasogastric/ orogastric tube feed and 15.5 days shortening of hospitalization, on average. While these differences were not statistically significant, a factor-analytical compound measure of all three therapy durations was. From pre-to-post-intervention, parents showed a significant reduction in stress factors. However, there were no differences between control and treatment group. A regression analysis showed links between parental stress factors and physiological development of the infants.

CONCLUSION: This pilot study suggests that a live-improvised interactive music therapy intervention for extremely and very preterm infants and their parents may have a beneficial effect on the therapy duration needed for premature infants before discharge from hospital is possible. The study identified components of the original physiological variables of the infants as appropriate endpoints and suggested a slight change in study design to capture possible effects of music therapy on infants’ development as well. Further studies should assess both short-term and long-term effects on premature infants as well as on maternal and paternal health outcomes, to determine whether a family-centered music therapy, actually experienced as an added value to developmental care, should be part of routine care at the NICU.

PMID:33989286 | DOI:10.1371/journal.pone.0250071

J Assoc Nurses AIDS Care. 2021 May 13. doi: 10.1097/JNC.0000000000000254. Online ahead of print.

ABSTRACT

The aim of this study was to use data from the United Nations Global Indicators Database to analyze the trends in the HIV incidence rate among women in sub-Saharan African countries between 2000 and 2017. The HIV incidence rate is defined as the number of new HIV infections per 1,000 uninfected population, aged 15 to 49 years old. Joinpoint regression analysis was applied to identify periods when there were significant changes in the HIV incidence rate. The results show that there was a global decrease trend in the HIV incidence rates among women in sub-Saharan Africa, decreasing in all sub-Saharan African countries, except in Angola, Equatorial Guinea, and Sudan, which have remained the same, and Madagascar, where the overall trend is increasing. The joinpoint regression statistical method offers an in-depth analysis of the incidence of HIV among women in sub-Saharan Africa.

PMID:33989245 | DOI:10.1097/JNC.0000000000000254

Med Care. 2021 May 13. doi: 10.1097/MLR.0000000000001570. Online ahead of print.

ABSTRACT

BACKGROUND: The Risk Stratification Index (RSI) is superior to Hierarchical Conditions Categories (HCC) in patient-level regressions but has not been applied to assess hospital effects.

OBJECTIVE: The objective of this study was to measure the accuracy of RSI in modeling 30-day hospital mortality across all conditions using multilevel logistic regression.

SUBJECTS AND DATA SOURCES: A 100% sample of Medicare inpatient stays from 2009 to 2014, restricted to patients greater than 65 years of age in general hospitals, resulting in 64 million stays at 3504 hospitals.

RESEARCH DESIGN: We calculated RSI and HCC scores for patient stays using multilevel logistic regression in 3 populations: all inpatients, surgical, and nonsurgical. Correlations of risk-standardized mortality rates with rates of specific case types assessed case-mix balance. Patient stay volume was included to assess smaller hospitals.

RESULTS: We found a negligible correlation of all-conditions risk-standardized mortality rates with hospitals’ proportions of orthopedic, cardiac, or pneumonia cases. RSI outperformed HCC in multilevel regressions containing both patient and hospital-level effects. C-statistics using RSI were 0.87 for the all-inpatients group, 0.87 for surgical, and 0.86 for nonsurgical stays. With HCC they were 0.82, 0.82, and 0.81. Akaike Information Criteria and Bayesian Information Criteria values were higher with HCC. RSI shifted 41% of hospitals’ rankings by >1 decile. Hospitals with smaller volumes had higher 30-day observed and standardized mortality: 11.2% in the lowest volume quintile versus 8.5% in the highest volume quintile.

CONCLUSION: RSI has superior accuracy and results in a significant shift in rankings compared with HCC in multilevel models of 30-day hospital mortality across all conditions.

PMID:33989249 | DOI:10.1097/MLR.0000000000001570

BJOG. 2021 May 14. doi: 10.1111/1471-0528.16753. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the Large Uterus Classification System (LUCS) ability to predict surgical outcomes and complications in total laparoscopic hysterectomies (TLHs) for large uteri.

DESIGN: Prospective observational study.

SETTING: Two referral centres.

POPULATION OR SAMPLE: 392 women who underwent TLH for a large uterus (uterine fundus at or over the transverse umbilical line).

METHODS: Between 2004 and 2019, the intraoperative LUCS was estimated in all patients. The LUCS considers the uterine and adnexal vascular pedicles displacement. Type 1 is without vascular pedicles displacement. Type 2 has the cephalad displacement of adnexal vascular pedicles. The uterine vessels displacement regardless of adnexal pedicles defines Type 3.

MAIN OUTCOME MEASURES: Patients’ characteristics with perioperative outcomes were prospectively collected and compared between the three types of large uteri.

RESULTS: 251 (64%), 82 (20.9%) and 59 (15.1%) women had Type 1, Type 2, and Type 3 uteri, respectively. Women with Type 1 uteri had a lower uterine weight, shorter operative time, less blood loss, and less complication rates than Type 2 and 3. The conversion rate to laparotomy in Type 1 was similar to Type 2 (OR:0.98;95%CI:0.32-3.56) but lower than Type 3 (OR:0.35;95%CI:0.14-0.97); in Type 2 it was lower than Type 3, although without the conventional statistical significance (OR:0.36;95%CI:0.13-1.13;p=0.07). Multivariable analysis showed that the uterine Type (1 vs. 2-3) was independently associated with the total complications rate (OR:2.00;95%CI:1.09-3.68;p=0.02).

CONCLUSIONS: The LUCS appears associated with surgical outcomes and complications, potentially stratifying the surgical risk and guiding the surgical technique in TLHs for large uteri.

PMID:33988895 | DOI:10.1111/1471-0528.16753

J Clin Psychiatry. 2021 Feb 23;82(2):20m13356. doi: 10.4088/JCP.20m13356.

ABSTRACT

OBJECTIVE: To examine the efficacy and safety of paliperidone palmitate once-monthly (PP1M) versus oral antipsychotics (OAPs) in Black/African American patients with schizophrenia and a history of criminal justice system involvement.

METHODS: This was a post hoc analysis of a 15-month prospective, randomized, open-label, parallel-group, multicenter US study conducted from May 2010 to December 2013 that examined a subpopulation of Black/African American patients with schizophrenia (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria). The primary objective was to compare time to first treatment failure in patients treated with PP1M versus OAPs. Secondary objectives were to compare time to first institutionalization (psychiatric hospitalization or arrest/incarceration) and mean number of treatment failure events and institutionalizations over 15 months in PP1M-treated and OAP-treated patients.

RESULTS: The intention-to-treat population included 275 Black/African American patients (PP1M, n = 145; OAPs, n = 130). Median time to first treatment failure was not reached for PP1M-treated patients and was 270 days for OAP-treated patients; hazard ratio (HR) was 1.39 (95% CI, 0.97-1.99; P = .075). Median time to first institutionalization was not reached for PP1M-treated patients and was 304 days for OAP-treated patients; HR was 1.49 (95% CI, 1.01-2.19; P = .043). Mean numbers of treatment failure events and institutionalizations were lower with PP1M than OAPs. The safety profile of PP1M was consistent with that of previous PP1M studies.

CONCLUSIONS: In a Black/African American subpopulation of patients with schizophrenia and prior criminal justice system involvement, PP1M reduced the number of treatment failures, thereby reducing the number of psychiatric hospitalizations and/or arrests/incarcerations compared with daily OAPs.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01157351.

PMID:33988924 | DOI:10.4088/JCP.20m13356

J Clin Psychiatry. 2021 Feb 23;82(2):20m13288. doi: 10.4088/JCP.20m13288.

ABSTRACT

OBJECTIVE: Previous research shows elevated disability in psychotic disorders. However, co-occurring symptomatology has been increasingly highlighted as predictive of clinical outcomes in the psychotic spectrum. The current study investigates how both psychotic and nonpsychotic symptom domains predict functioning across psychotic disorders.

METHODS: Outpatients (N = 128) with psychotic spectrum diagnoses participated in the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) Field Trials at the Centre for Addiction and Mental Health in Toronto, Canada, in 2011, including the repeated administration of “cross-cutting” brief screening measures that assessed internalizing (eg, anxiety, depression), substance use (eg, alcohol, psychoactive drug use), and psychotic symptoms. Level of functioning was also assessed by self-report and clinician-rated World Health Organization Disability Assessment Schedule 2.0 (WHO-DAS-II). The relation between symptom domains and disability was examined concurrently and prospectively via hierarchical regression.

RESULTS: Psychosis was strongly linked to self-reported disability when considered in isolation (β = 0.22, P < .001; R2 = 0.11). However, when all 3 symptom domains were included in analyses, internalizing symptoms were the strongest concurrent (β = 0.31, P < .001; R2 = 0.17) and prospective (β = 0.29, P < .001; R2 = 0.15) predictor of disability. In the concurrent model, an interaction between internalizing and substance use emerged, wherein high internalizing symptoms were particularly detrimental in persons with high levels of substance use (β = 0.08, P < .05; R2 = 0.014). Results were similar for clinician-rated WHO-DAS-II.

CONCLUSIONS: This research supports the potential clinical utility of rapid screening tools available in the newest psychiatric diagnostic manual. The internalizing symptom domain was the strongest predictor of functional outcome for outpatients with psychotic disorders. The results highlight the relevance of a broad range of symptoms, including those that fall outside the primary psychiatric concern, in recovery-oriented clinical work in psychosis.

PMID:33988932 | DOI:10.4088/JCP.20m13288

Environ Sci Pollut Res Int. 2021 May 14. doi: 10.1007/s11356-021-14071-6. Online ahead of print.

ABSTRACT

The electric energy mainly comes from thermal power generation fueled by electric coal, and the selection of electric coal supplier is of great practical significance for the development of electric power enterprises. In this paper, the mechanism of supplier selection in electric coal procurement is designed from a perspective of sustainability. Concretely, eleven evaluation indexes from three aspects of economy, environment, and society are selected to construct a new evaluation index system for selecting sustainable electric coal suppliers. Based on this index system, a new method of supplier selection in electric coal procurement based on 2-tuple correlation coefficient analysis is proposed. In this method, considering that the evaluation index values have the features of multi-source heterogeneous data, i.e., precise real number, interval number, and fuzzy linguistic variables coexist, all index values are converted into 2-tuples. Then, a 2-tuple deviation maximization method is proposed to determine the weight of each evaluation index, and a new method of 2-tuple correlation coefficient analysis is proposed to select sustainable electric coal suppliers. Moreover, the effectiveness and feasibility of the model are highlighted by an application example of selecting the electric coal suppliers. Combined with the development status of electric power industry and the research results of this paper, several countermeasures and suggestions are provided on how to formulate the optimal procurement strategy of electric coal for electric power enterprises and how to improve the competitiveness for electric coal suppliers.

PMID:33988842 | DOI:10.1007/s11356-021-14071-6

Environ Sci Pollut Res Int. 2021 May 14. doi: 10.1007/s11356-021-14315-5. Online ahead of print.

ABSTRACT

The optimal design and performance monitoring of wind farms depend on the precise assessment of spatial and temporal distribution of wind speed. The aim of this research is to investigate the appropriateness of nine popular probability distribution models (exponential, gamma, generalised extreme value, inverse Gaussian, Kumaraswamy, log-logistic, lognormal, Nakagami, and Weibull) for the assessment of wind speed distribution (WSD) at 10 sites situated at topographically distinct locations in Tamil Nadu, India, based on 39 years of data. The results suggest that a single distribution cannot produce best fit for all the stations. On an individual level, the generalised extreme value distribution provided the most suitable fit for majority of the stations, followed by the Kumaraswamy distribution. The Kumaraswamy distribution has performed well even if the WSD of the station is negatively skewed. Hence, based on the ranking and performance consistency, the Kumaraswamy distribution can be preferred irrespective of the topographical heterogeneity of the stations.

PMID:33988843 | DOI:10.1007/s11356-021-14315-5