Nevin Manimala

Am J Public Health. 2022 Aug;112(8):1151-1160. doi: 10.2105/AJPH.2022.306805.

ABSTRACT

Life expectancy figures for countries and population segments are increasingly being reported to more decimal places and used as indicators of the strengths or failings of countries’ health and social systems. Reports seldom quantify their intrinsic statistical imprecision or the age-specific numbers of deaths that determine them. The SE formulas available to compute imprecision are all model based. This note adds a more intuitive data-based SE method and extends the jackknife to the analysis of event rates more generally. It also describes the relationships between the magnitude of the SE and the numbers of person-years and deaths on which it is based. These relationships can help quantify the statistical noise present in published year-to-year differences in life expectancies, as well as in same-year differences between or within countries. Agencies and investigators are encouraged to use one of these SEs to report the imprecision of life expectancy numbers and to tailor the number of decimal places accordingly. (Am J Public Health. 2022;112(8):1151-1160. https://doi.org/10.2105/AJPH.2022.306805).

PMID:35830672 | DOI:10.2105/AJPH.2022.306805

Sex Transm Dis. 2022 Jul 14. doi: 10.1097/OLQ.0000000000001675. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has coincided with an explosion of on-line platforms for sexually transmitted infections (STIs) testing using self-collected, mail-in specimens. Reports on the effect of COVID-19-associated restrictions on sexual behaviors have been mixed, but STI transmissions have continued during the pandemic. We sought to understand the pandemic impact on sexual habits associated with STIs among IWantTheKit (IWTK) users.

METHODS: Users of IWTK, a free, on-line STI testing platform, were invited to complete an anonymous questionnaire. Descriptive statistics were used to describe survey responses. Associations with reports of new sex partnerships were explored as a marker of STI risk. Descriptive statistics, univariate and multivariate logistic regression models were used to analyze individual characteristics and reported behaviors associated with self-reported new sexual partnerships during the first two COVID-19 pandemic waves.

RESULTS: Of the 3,462 users of the on-line STI testing platform between June 2020 and February 2021, 1,088 (31.4%) completed the on-line survey; 705 (66.2%) of 1,065 reported a new sex partner. One-quarter met their sex partners using Apps. Overall, 10% were symptomatic and almost 18% were concerned that their partner had an STI. White race in males (OR 1.81 [95%CI:1.04, 3.16]), female age < 25 years (OR 1.85 [95%CI:1.09, 3.14]), and increased condom use in both men and women were significantly associated with reports of new sexual partnerships in adjusted analysis.

CONCLUSIONS: Despite pandemic restrictions on social gatherings, new sexual partnerships were common in this population, associated with common risk factors, and may help to explain ongoing STI transmission.

PMID:35830655 | DOI:10.1097/OLQ.0000000000001675

J Clin Pediatr Dent. 2022 May 1;46(3):211-218. doi: 10.17796/1053-4625-46.3.7.

ABSTRACT

OBJECTIVES: With the recent improvements in technology, the expectation of minimal invasion and maximal comfort in caries removal techniques is increasing. This study aims to examine the effectiveness of six caries removal methods in primary teeth.

STUDY DESIGN: Sixty primary molars (10 teeth in each groups) were used. The groups were: Group I (Tungsten Carbide Bur), Group II (Sono abrasion), Group III (Air abrasion), Group IV (Carisolv), Group V (Er:YAG Laser), Group VI (ART). In micro-CT scanning, mineral density at the cavity floor was examined before and after caries removal. After caries removal, the patency of the dentinal tubules was examined in two teeth from each group on SEM images. Statistical analyses were performed using Kruskal-Wallis, Wilcoxon tests.

RESULTS: For six different caries removal methods, tooth mineral (inorganic, total) densities at cavity floors were compared among the groups after the procedures, and no statistically significant difference was found (p>0.05). On the SEM images, it was seen that the dentinal tubules were exposed and no smear layer was formed in the Carisolv group. Significant rough surfaces were exposed in the laser group.

CONCLUSION: It was observed that alternative caries removal methods are at least as effective as the traditional method in primary teeth for clinical applications.

PMID:35830639 | DOI:10.17796/1053-4625-46.3.7

Haemophilia. 2022 Jul 13. doi: 10.1111/hae.14624. Online ahead of print.

ABSTRACT

INTRODUCTION: Measurement of physical activity (PA) using commercial activity trackers such as Fitbit devices has become increasingly popular, also for people with haemophilia (PWH). The accuracy of the Fitbit model Charge 3 has not yet been examined.

AIMS: To compare the Fitbit Charge 3 against the research-grade accelerometer ActiGraph GT3X-BT in measuring average daily steps and minutes spent in different PA intensities.

METHODS: Twenty-four young PWH wore a wrist-worn Fitbit Charge 3 and hip-worn ActiGraph GT3X-BT simultaneously for seven consecutive days in free-living conditions. Correlation of and differences between the devices for daily averages of PA parameters were assessed using Pearson’s correlation coefficient and paired t-test, respectively. Agreement between devices was assessed using Bland-Altman plots.

RESULTS: Twenty participants (mean age 21.8) were included in the analyses. We found moderate to high correlations between Fitbit and ActiGraph measured daily averages for all PA variables, but statistically significant differences between devices for all variables except daily minutes of moderate PA. Fitbit overestimated average daily steps, minutes of light, vigorous and moderate-to-vigorous PA. Bland-Altman plots showed a measurement bias between devices for all parameters with increasing overestimation by the Fitbit for higher volumes of PA.

CONCLUSION: The Fitbit Charge 3 overestimated steps and minutes of light, moderate and moderate-to-vigorous PA as compared to the ActiGraph GT3X-BT, and this bias increased with PA volume. The Fitbit should therefore be used with caution in research, and we advise users of the device to be cognizant of this overestimation.

PMID:35830613 | DOI:10.1111/hae.14624

Perfusion. 2022 Jul 13:2676591221115267. doi: 10.1177/02676591221115267. Online ahead of print.

ABSTRACT

BACKGROUND: Extracorporeal Membrane Oxygenation (ECMO) therapy for respiratory failure is an increasingly popular modality of support. Patient selection is an important aspect of outcome success. This review assesses the efficacy of the popular prognostic tools Respiratory ECMO Survival Prediction Score (RESP) and Predicting Death for Severe ARDS on VV-ECMO score (PRESERVE) for ECMO patient selection.

METHODS: A literature search was performed. Six publications were found to match the specified selection criteria. These publications were assessed and compared using the area under the receiver operating characteristic (AUROC) curve statistical method to ascertain the discriminatory ability of the models to predict treatment outcome.

RESULTS: Six articles were included in this review from 306 screened, of which all were retrospective cohort studies. Data was generated over a period of 3-9 years from 13 referring hospitals. Studies consisted of 467 male and 221 female (30 unknown) participants in total with a high heterogeneity. The PRESERVE prognostic model was found to have a higher AUROC score than the RESP model, however both models were found to be sub-optimal in their discriminatory ability. A high chance of bias was seen across all included studies.

CONCLUSION: It was the findings of this review, indicated by analysis using the AUROC measures, that the prognostic model PRESERVE performed better than RESP for predicting post ECMO therapy outcomes, for patients presenting with Acute Respiratory Distress Syndrome within their respective validated time frames, i.e., RESP at Intensive care unit (ICU) discharge and PRESERVE at 6 months post ICU discharge. However, It was recognized that comparator groups were small thereby introducing bias into the study. Further prospective, randomized studies would be necessary to effectively assess the utility of these predictive survival scores.

PMID:35830605 | DOI:10.1177/02676591221115267

Ann Am Thorac Soc. 2022 Jul 13. doi: 10.1513/AnnalsATS.202110-1127OC. Online ahead of print.

ABSTRACT

RATIONALE: Chronic obstructive pulmonary disease (COPD) is a heterogeneous syndrome, with phenotypic manifestations that tend to be distributed along a continuum. Unsupervised machine learning based on broad selection of imaging and clinical phenotypes may be used to identify primary variables that define disease axes and stratify patients with COPD.

OBJECTIVES: To identify primary variables driving COPD heterogeneity using principal component analysis (PCA), and to define disease axes and assess the prognostic value of these axes across three outcomes: progression, exacerbation, and mortality.

METHODS: We included 7331 patients between 39 and 85 years, of which 40.3% are black and 45.8% are female smokers with a mean of 44.6 pack years from the COPDGene Phase 1 cohort (2008-2011) in our analysis. Out of a total of 916 phenotypes, 147 continuous clinical, spirometric, and CT features were selected. For each component (PC), we computed a principal component score (PCS) based on feature weights. We used PCS distributions to define disease axes along which we divided the patients into quartiles. To assess the prognostic value of these axes, we applied logistic regression analyses to estimate 5-year (n=4159) and 10-year (n=1487) odds of progression. Cox regression and Kaplan-Meier analyses were performed to estimate 5-year and 10-year risk of exacerbation (n=6532) and all-cause mortality (n=7331).

RESULTS: The first PC, accounting for 43.7% of variance, was defined by CT measures of air trapping and emphysema. The second PC, accounting for 13.7% of variance, was defined by spirometric and CT measures of vital capacity and lung volume. The third PC, accounting for 7.9% of the variance, was defined by CT measures of lung mass, airway thickening, and body habitus. Stratification of patients across each disease axis revealed up to 3.2-fold [2.4, 4.3] greater odds of 5-year progression, 5.4-fold [4.6, 6.3] greater risk of 5-year exacerbation, and 5.0-fold [4.2, 6.0] greater risk of 10-year mortality between the highest and lowest quartiles.

CONCLUSIONS: Unsupervised learning analysis of the COPDGene cohort reveals CT measurements may bolster patient stratification along the continuum of COPD phenotypes. Each of the disease axes also individually demonstrate prognostic potential, predictive of future FEV1 decline, exacerbation, and mortality.

PMID:35830591 | DOI:10.1513/AnnalsATS.202110-1127OC

Female Pelvic Med Reconstr Surg. 2022 Jun 29. doi: 10.1097/SPV.0000000000001222. Online ahead of print.

ABSTRACT

IMPORTANCE: Surgical site infection (SSI) is a common and costly complication. Targeted interventions in high-risk patients may lead to a reduction in SSI; at present, there is no method to consistently identify patients at increased risk of SSI.

OBJECTIVE: The aim of this study was to develop and validate a model for predicting risk of SSI after pelvic organ prolapse surgery.

STUDY DESIGN: Women undergoing surgery between 2011 and 2017 were identified using Current Procedural Terminology codes from the Centers for Medicare and Medicaid Services 5% Limited Data Set. Surgical site infection ≤90 days of surgery was the primary outcome, with 41 candidate predictors identified, including demographics, comorbidities, and perioperative variables. Generalized linear regression was used to fit a full specified model, including all predictors and a reduced penalized model approximating the full model. Model performance was measured using the c-statistic, Brier score, and calibration curves. Accuracy measures were internally validated using bootstrapping to correct for bias and overfitting. Decision curves were used to determine the net benefit of using the model.

RESULTS: Of 12,334 women, 4.7% experienced SSI. The approximated model included 10 predictors. Model accuracy was acceptable (bias-corrected c-statistic [95% confidence interval], 0.603 [0.578-0.624]; Brier score, 0.045). The model was moderately calibrated when predicting up to 5-6 times the average risk of SSI between 0 and 25-30%. There was a net benefit for clinical use when risk thresholds for intervention were between 3% and 12%.

CONCLUSIONS: This model provides estimates of probability of SSI within 90 days after pelvic organ prolapse surgery and demonstrates net benefit when considering prevention strategies to reduce SSI.

PMID:35830590 | DOI:10.1097/SPV.0000000000001222

J Morphol. 2022 Jul 13. doi: 10.1002/jmor.21496. Online ahead of print.

ABSTRACT

Muroid rodents mostly have a complex stomach: one part is lined with a cornified (non-glandular) epithelium, referred to as a ‘forestomach,’ whereas the rest is lined with glandular epithelium. Numerous functions for the forestomach have been proposed. We collated a catalog of anatomical depictions of the stomach of 174 muroid species from which the respective non-glandular and glandular areas could be digitally measured, yielding a ‘stomach ratio’ (non-glandular:glandular area) as a scale-independent variable. Stomach ratios ranged from 0.13 to 20.15, and the coefficient of intraspecific variation if more than one picture was available for a species averaged at 29.7% (± 21.5). We tested relationships of the ratio with body mass and various anatomical and ecological variables, including diet. There was a consistent phylogenetic signal, suggesting that closely related species share a similar anatomy. Apart from classifying stomachs into hemiglandular and discoglandular, no anatomical or ecological measure showed a consistent relationship to the stomach ratio. In particular, irrespective of statistical method or the source of dietary information, dietary proxies did not significantly correlate with the stomach ratio, except for a trend towards significance for invertivory (insectivory). Yet, even this relationship was not convincing: whereas highly insectivorous species had high but no low stomach ratios, herbivorous species had both low and high stomach ratios. Thus, the statistical effect is not due to a systematic increase in the relative forestomach size with invertivory. The most plausible hypotheses so far associate the muroid forestomach and its microbiome with a generic protective role against microbial or fungal toxins and diseases, without evident correlates of a peculiar need for this function under specific ecological conditions. Yet, this function remains to be confirmed. While providing a catalog of published depictions and hypotheses, this study highlights that the function of the muroid rodent forestomach remains enigmatic to date. This article is protected by copyright. All rights reserved.

PMID:35830587 | DOI:10.1002/jmor.21496

Cornea. 2022 Aug 1;41(8):1029-1034. doi: 10.1097/ICO.0000000000003030. Epub 2022 Mar 30.

ABSTRACT

PURPOSE: The scrolling properties of the Descemet membrane endothelial keratoplasty (DMEK) graft are essential for surgical success. Currently, there is limited knowledge on what dictates the tightness of the DMEK scroll. The purpose of this study was to determine the impact of temperature and protein digestion on DMEK graft scroll tightness.

METHODS: For the temperature experiment, a total of 28 eyes were used for this study. Scrolls in the cold group were kept at 4°C while scrolls in the hot group were kept at 37°C. Scroll width was recorded at the 5-, 15-, and 30-minute mark. For the protein digestion experiment, a total of 18 eyes were exposed to collagenase A (10 CDU/mL) in Optisol solution. Scroll width was recorded at the time points of 1, 3, 5, 10, and 20 minutes.

RESULTS: The results of the temperature experiment did not yield any statistically significant changes in the mean scroll width of the DMEK scrolls across both temperature ranges and observation times. For the protein digestion experiment, the mean scroll width grew from 1.85 mm to 2.13 mm from the beginning of the experiment until the final observation at 20 minutes. This is a 14.7% change over 20 minutes with a P value (<0.001), exemplifying a statistically significant change in scroll width.

CONCLUSIONS: Temperature did not have any significant effect over scroll tightness, but scroll tightness decreased with collagenase exposure.

PMID:35830580 | DOI:10.1097/ICO.0000000000003030

Int J Med Robot. 2022 Jul 13:e2439. doi: 10.1002/rcs.2439. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study was to evaluate the long-term results of robot-assisted (RATS) thymectomy in the treatment of large thymomas, defined as larger than 5 cm.

METHODS: We retrospectively reviewed 106 thymectomies from 2010 to 2020, creating two groups based on the surgical approach (open or RATS) and size. Kaplan-Meier and Cox-regression were used to estimate and identify risk factors of oncological outcomes. To perform a well-balanced analysis, a propensity score matched (PSM) analysis was conducted for large thymomas.

RESULTS: From 2015, we performed 54 RATS thymectomies: 53.7% (n=29) for small and 46.3% (n=25) for large thymomas. Conversions were similar and all patients had a complete resection. The overall (82% vs 92%, p=0.57) and disease-free survival were comparable between RATS and open (92.5% vs 93%, p=0.67), outcomes confirmed after PSM for large thymomas.

CONCLUSIONS: RATS thymectomy could be considered a valid option in selected patients with large thymomas.

PMID:35830541 | DOI:10.1002/rcs.2439