Tag: nevin manimala

Breast Cancer Res Treat. 2023 Feb 24. doi: 10.1007/s10549-023-06875-6. Online ahead of print.

ABSTRACT

PURPOSE: Among women with non-metastatic breast cancer, marked disparities in stage at presentation, receipt of guideline-concordant treatment and stage-specific survival have been shown in national cohorts based on race, ethnicity, insurance and language. Little is published on the performance of safety-net hospitals to achieve equitable care. We evaluate differences in treatment and survival by race, ethnicity, language and insurance status among women with non-metastatic invasive breast cancer at a single, urban academic safety-net hospital.

METHODS: We conducted a retrospective study of patients with invasive ductal or lobular breast cancer, diagnosed and treated between 2009 and 2014 at an urban, academic safety-net hospital. Demographic, tumor and treatment characteristics were obtained. Stage at presentation, stage-specific overall survival, and receipt of guideline-concordant surgical and adjuvant therapies were analyzed. Chi-square analysis and ANOVA were used for statistical analysis. Unadjusted survival analysis was conducted by Kaplan-Meier method using log-rank test; adjusted 5 year survival analysis was completed stratified by early and late stage, using flexible parametric survival models incorporating age, race, primary language and insurance status.

RESULTS: 520 women with stage 1-3 invasive breast cancer were identified. Median age was 58.5 years, 56.1% were non-white, 31.7% were non-English-speaking, 16.4% were Hispanic, and 50.1% were Medicaid/uninsured patients. There were no statistically significant differences in stage at presentation between age group, race, ethnicity, language or insurance. The rate of breast conserving surgery (BCS) among stage 1-2 patients did not vary by race, insurance or language. Among patients indicated for adjuvant therapies, the rates of recommendation and completion of therapy did not vary by race, ethnicity, insurance or language. Unadjusted survival at 5 years was 93.7% for stage 1-2 and 73.5% for stage 3. Adjusting for age, race, insurance status and primary language, overall survival at 5 years was 93.8% (95% CI 86.3-97.2%) for stage 1-2 and 83.4% (95% CI 35.5-96.9%) for stage 3 disease. Independently, for patients with early- and late-stage disease, age, race, language and insurance were not associated with survival at 5-years.

CONCLUSION: Among patients diagnosed and treated at an academic safety-net hospital, there were no differences in the stage at presentation or receipt of guideline-concordant treatment by race, ethnicity, insurance or language. Overall survival did not vary by race, insurance or language. Additional research is needed to assess how hospitals and healthcare systems mitigate breast cancer disparities.

PMID:36826701 | DOI:10.1007/s10549-023-06875-6

Health Econ Rev. 2023 Feb 24;13(1):15. doi: 10.1186/s13561-022-00416-5.

ABSTRACT

The Capitation Payment Unit (CPU) financing mechanism constitutes more than 70% of health spending in Colombia, with a budget allocation of close to 60 trillion Colombian pesos for the year 2022 (approximately 15.7 billion US dollars). This article estimates actuarially, using modern techniques, the CPU for the contributory regime of the General System of Social Security in Health in Colombia, and compares it with what is estimated by the Ministry of Health and Social Protection. Using freely available information systems, by means of statistical copulas functions and artificial neural networks, pure risk premiums are calculated between 2015 and 2021. The study concludes that the weights by risk category are systematically different, showing historical pure premiums surpluses in the group of 0-1 years and deficits (for the regions normal and cities) in the groups over 54 years of age.

PMID:36826699 | DOI:10.1186/s13561-022-00416-5

Int J Comput Dent. 2023 Feb 24;26(1):37-47. doi: 10.3290/j.ijcd.b3818305.

ABSTRACT

AIM: The present study aimed to evaluate the marginal and internal fit of lithium disilicate crowns at various locations.

MATERIALS AND METHODS: A typodont maxillary left first molar was prepared for a lithium disilicate crown, scanned, and a master die fabricated. Three groups were created according to fabrication method (n = 10): conventional impression and press method (group C); scanning of definitive cast and milling method (group D); and intraoral scanning and milling method (group I). Assessment was performed using the triple-scan protocol. At the buccopalatal and mesiodistal sections, the absolute marginal discrepancy (AMD), marginal gap (MG), axial internal gap (AI), and line angle internal gap (LI) were measured. One-way analysis of variance (ANOVA) and post hoc Tukey HSD tests were used for statistical analysis (α = 0.05).

RESULTS: AMD values were significantly lower in group C than in groups D and I (P < 0.05). MG values in group C were significantly lower than those in the buccal and distal areas in group D and all areas in group I (P < 0.05). AI values in the buccal and palatal areas in group D were significantly lower than those in the mesial and distal areas in group D and all areas in groups C and I (P < 0.05). LI values were significantly lower in group C than in groups D and I (P < 0.05).

CONCLUSION: All three methods were clinically acceptable except for the marginal fit of the intraoral scanning and milling method, which was on the borderline of a clinically acceptable fit. (Int J Comput Dent 2023;26(1): 37-0; doi: 10.3290/j.ijcd.b3818305).

PMID:36825566 | DOI:10.3290/j.ijcd.b3818305

Int J Comput Dent. 2023 Feb 24;26(1):31-36. doi: 10.3290/j.ijcd.b3818295.

ABSTRACT

AIM: The present study aimed to investigate the effect of pulp chamber depth on the failure load and mode of failure of CAD/CAM endocrowns.

MATERIALS AND METHODS: Thirty mandibular molars were sectioned above the cementoenamel junction (CEJ), followed by root canal treatment. Teeth were sectioned at a level of 1.5 mm above the CEJ, arranged from the lowest to the highest depths, and divided into three groups (n = 10): group SE: Shallow pulp chamber (1.42 to 2.17 mm); group IE: Intermediate pulp chamber (2.25 to 3.17 mm); group DE: Deep pulp chamber (3.33 to 5.17 mm). CAD/CAM endocrowns were fabricated by milling lithium disilicate ceramic blocks and were cemented using resin cement. Teeth were embedded in acrylic resin at 2 mm below the CEJ, and a compressive load was applied to create a 45-degree angled functional loading simulation until the occurrence of failure.

RESULTS: The mean failure loads were highest in group DE (1893.75 ± 496.08 N) compared with groups IE (1103.71 ± 254.59 N) and SE (1084.63 ± 240.92 N), with statistically significant differences between group DE and both groups IE and SE (P < 0.001). Pearson correlation coefficient (PCC) revealed a strong positive correlation between the pulp chamber depth and failure load of the endocrowns. The failure mode for all samples was catastrophic failure.

CONCLUSION: The pulp chamber depth affected the failure load of the teeth restored with endocrowns. The failure loads were higher in teeth with a greater pulp chamber depth. (Int J Comput Dent 2023;26(1): 31-0; doi: 10.3290/j.ijcd.b3818295).

PMID:36825565 | DOI:10.3290/j.ijcd.b3818295

Clin Transl Allergy. 2023 Feb;13(2):e12220. doi: 10.1002/clt2.12220.

ABSTRACT

BACKGROUND: As extract-based skin testing as well as in vitro tests for major allergens have their own advantages, both procedures are usually performed in routine settings. In times of shortages in medical staff and supplies, we asked ourselves, how many patients would be underdiagnosed, if only one test could be used.

METHODS: In a retrospective analysis, we investigated a cohort of 2646 patients seen by a single physician in a large Austrian outpatient allergy clinic in 2018. Only patients with an allergen source-specific history and pairs of extract-based skin prick (SPT) and in vitro molecular allergy tests to major allergens were included.

RESULTS: For all tested allergen sources, sensitivity was higher for SPT than for sIgE-based molecular allergy testing. Concerning 1006 birch pollen-allergic patients, 791 (78.6%) had positive results with both tests, while 153 (15.2%) only with the SPT and 62 (6.2%) only with the sIgE to Bet v1. The other allergen sources showed similar results: For house dust mite 816/1120 (72.9%), grass pollen 1077/1416 (76.1%) and cat 433/622 (69.6%) remained test-positive with both procedures, whereas in 276 (24.6%), 224 (15.8%) and 173 (27.8%) times only the SPT and 28 (2.5%), 115 (8.1%) and 16 (2.6%) times only the sIgE to Der p1/2/23, Phl p1/5 and Fel d1 showed a positive result. Each comparison was statistically significant (each p < 0.0001, Chi-squared test).

CONCLUSIONS: Screening for allergy with major molecular allergens has lower sensitivity when compared with extract-based skin tests. A combination of both is required for an optimal sensitivity.

PMID:36825518 | DOI:10.1002/clt2.12220

Clin Trials. 2023 Feb 24:17407745231154260. doi: 10.1177/17407745231154260. Online ahead of print.

ABSTRACT

BACKGROUND/AIMS: The stepped-wedge design has been extensively studied in the setting of the cluster randomized trial, but less so for the individually randomized trial. This article derives the optimal allocation of individuals to treatment sequences. The focus is on designs where all individuals start in the control condition and at the beginning of each time period some of them cross over to the intervention, so that at the end of the trial all of them receive the intervention.

METHODS: The statistical model that takes into account the nesting of repeated measurements within subjects is presented. It is also shown how possible attrition is taken into account. The effect of the intervention is assumed to be sustained so that it does not change after the treatment switch. An exponential decay correlation structure is assumed, implying that the correlation between any two time point decreases with the time lag. Matrix algebra is used to derive the relation between the allocation of units to treatment sequences and the variance of the treatment effect estimator. The optimal allocation is the one that results in smallest variance.

RESULTS: Results are presented for three to six treatment sequences. It is shown that the optimal allocation highly depends on the correlation parameter ρ and attrition rate r between any two adjacent time points. The uniform allocation, where each treatment sequence has the same number of individuals, is often not the most efficient. For 0.1≤ρ≤0.9 and r=0,0.05,0.2, its efficiency relative to the optimal allocation is at least 0.8. It is furthermore shown how a constrained optimal allocation can be derived in case the optimal allocation is not feasible from a practical point of view.

CONCLUSION: This article provides the methodology for designing individually randomized stepped-wedge designs, taking into account the possibility of attrition. As such it helps researchers to plan their trial in an efficient way. To use the methodology, prior estimates of the degree of attrition and intraclass correlation coefficient are needed. It is advocated that researchers clearly report the estimates of these quantities to help facilitate planning future trials.

PMID:36825509 | DOI:10.1177/17407745231154260

Biochem Mol Biol Educ. 2023 Feb 24. doi: 10.1002/bmb.21716. Online ahead of print.

ABSTRACT

This study aimed to investigate the teaching effect of the blended BOPPPS based on an online and offline mixed teaching model (“B + BOPPPS”) in the course of fermentation engineering in applied universities. The participants were 142 undergraduates majoring from the course of fermentation engineering in Food Science and Engineering in 2019 and 2020 in Huanghuai University, Zhumadian city, Henan province, China. The students in the control group (68 students) were taught in 2019, and the students in the experimental group (74 students) were taught in 2020. The traditional teaching method and “B + BOPPPS” were implemented, respectively. The teaching effect was evaluated using the questionnaire survey of course satisfaction and theoretical knowledge test. The results showed that the scores of the theoretical knowledge test in the experimental group adopting “B + BOPPPS” were significantly higher than those in the control group, and the difference was statistically significant (p < 0.01). The students had a good evaluation of the “B + BOPPPS” in many aspects, which included achieving learning goals, providing in-depth understanding of knowledge points, stimulating interest in learning, training in the ability to analyze and think about problems, and so on. The results suggested that “B + BOPPPS” could stimulate students’ interest in learning and improve their subjective initiative. They could also improve students’ ability to master and apply knowledge, which was conducive to improving the theoretical teaching quality of the course of fermentation engineering.

PMID:36825497 | DOI:10.1002/bmb.21716

J Sch Health. 2023 Feb 24. doi: 10.1111/josh.13299. Online ahead of print.

ABSTRACT

BACKGROUND: The public health policies and school closures in response to the Covid-19 pandemic have created disruptions in school meal programs. Research is needed to understand the changes in school food service revenue before and during the initial Covid-19-related school shutdowns.

METHODS: A longitudinal cohort study examining federal and state reimbursements as well as sales revenues for all public local education agencies (LEAs) in Maryland from school years (SY) 2018-2019 and 2019-2020 was conducted. Monthly changes in federal and state reimbursements for Child Nutrition Programs, including the National School Lunch Program (NSLP), School Breakfast Program (SBP), Summer Food Service Program (SFSP), and Child and Adult Care Food Program (CACFP) were examined.

RESULTS: In the SY 2018-2019, the total revenues from federal and state reimbursements for SBP, NSLP, SFSP, and at-risk CACFP were $272.9 million; in comparison, for the SY 2019-2020, the total revenues were $241.8 million (11.4% reduction from SY 2018-2019). On average, the school shutdown (during March to June 2020) was associated with a $450,385 (p-value < .01) reduction in federal and state reimbursements per LEA-month (41% reduction).

CONCLUSIONS: The school shutdown during the Covid-19 pandemic was associated with a statistically significant reduction in school food service revenues across Maryland’s public LEAs.

PMID:36825481 | DOI:10.1111/josh.13299

Hum Reprod. 2023 Feb 24:dead034. doi: 10.1093/humrep/dead034. Online ahead of print.

ABSTRACT

STUDY QUESTION: Are machine learning methods superior to traditional statistics in predicting blastocyst ploidy status using morphokinetic and clinical biodata?

SUMMARY ANSWER: Mixed effects logistic regression performed better than all machine learning methods for ploidy prediction using our dataset of 8147 embryos.

WHAT IS KNOWN ALREADY: Morphokinetic timings have been demonstrated to be delayed in aneuploid embryos. Machine learning and statistical models are increasingly being built, however, until now they have been limited by data insufficiency.

STUDY DESIGN, SIZE, DURATION: This is a multicentre cohort study. Data were obtained from 8147 biopsied blastocysts from 1725 patients, treated from 2012 to 2020.

PARTICIPANTS/MATERIALS, SETTING, METHODS: All embryos were cultured in a time-lapse system at nine IVF clinics in the UK. A total of 3004 euploid embryos and 5023 aneuploid embryos were included in the final verified dataset. We developed a total of 12 models using four different approaches: mixed effects multivariable logistic regression, random forest classifiers, extreme gradient boosting, and deep learning. For each of the four algorithms, two models were created, the first consisting of 22 covariates using 8027 embryos (Dataset 1) and the second, a dataset of 2373 embryos and 26 covariates (Dataset 2). Four final models were created by switching the target outcome from euploid to aneuploid for each algorithm (Dataset 1). Models were validated using internal-external cross-validation and external validation.

MAIN RESULTS AND THE ROLE OF CHANCE: All morphokinetic variables were significantly delayed in aneuploid embryos. The likelihood of euploidy was significantly increased the more expanded the blastocyst (P < 0.001) and the better the trophectoderm grade (P < 0.01). Univariable analysis showed no association with ploidy status for morula or cleavage stage fragmentation, morula grade, fertilization method, sperm concentration, or progressive motility. Male age did not correlate with the percentage of euploid embryos when stratified for female age. Multinucleation at the two-cell or four-cell stage was not associated with ploidy status. The best-performing model was logistic regression built using the larger dataset with 22 predictors (F1 score 0.59 for predicting euploidy; F1 score 0.77 for predicting aneuploidy; AUC 0.71; 95% CI 0.67-0.73). The best-performing models using the algorithms from random forest, extreme gradient boosting, and deep learning achieved an AUC of 0.68, 0.63, and 0.63, respectively. When using only morphokinetic predictors the AUC was 0.61 for predicting ploidy status, whereas a model incorporating only embryo grading was unable to discriminate aneuploid embryos (AUC = 0.52). The ploidy prediction model’s performance improved with increasing age of the egg provider.

LIMITATIONS, REASONS FOR CAUTION: The models have not been validated in a prospective study design or yet been used to determine whether they improve clinical outcomes.

WIDER IMPLICATIONS OF THE FINDINGS: This model may aid decision-making, particularly where pre-implantation genetic testing for aneuploidy is not permitted or for prioritizing embryos for biopsy.

STUDY FUNDING/COMPETING INTEREST(S): No specific funding was sought for this study; university funds supported the first author. A.Ca. is a minor shareholder of participating centres.

TRIAL REGISTRATION NUMBER: N/A.

PMID:36825452 | DOI:10.1093/humrep/dead034

Zhongguo Gu Shang. 2023 Feb 25;36(2):165-71. doi: 10.12200/j.issn.1003-0034.2023.02.014.

ABSTRACT

OBJECTIVE: To compare the long-term follow-up effect and complications of ceramic on ceramic (CoC) interface and ceramic on polyethyleneon ceramic (CoP) interface in primary total hip arthroplasty, and provide clinical evidence.

METHODS: Search PubMed, EMBase, the CoChrane Library databases, Web of science, Wanfang database, and CNKI from January 2000 to September 2021, screening and inclusion of randomized controlled trials (RCTs) comparing the long-term efficacy and complications of CoC interface and CoP interface in total hip arthroplasty. Literature screening, quality evaluation and data extraction were carried out according to the inclusion and exclusion criteria, using Review Manager 5.3 statistical software. The software was used to perform statistical analysis on joint function, revision, prosthesis fracture, abnormal joint noise, and prosthesis wear rate after CoC or CoP.

RESULTS: Seven RCTs studies were included, including 390 cases of hips with CoC artificial joints and 384 cases of hips with CoP artificial joints. The long-term joint function improvement of CoC and CoP artificial joints was similar and there was no significant differences, with an average difference was MD=0.63, 95%CI=(-1.81, 3.07), P=0.61. About the postoperative complications, CoC artificial joints have higher incidence rate of abnormal joint noise, with odds ratio (OR)=11.05, 95%CI=(2.04, 59.84), P=0.005. CoP artificial joints wear faster, with an average MD=-87.11, 95%CI=(-114.40, -59.82), P<0.000 1. There was no significant difference between the two groups in the replacement-related complications such as joint dislocation, prosthesis loosening, osteolysis, and the rate of prosthesis revision caused by various reasons.

CONCLUSION: The clinical function results and complications of CoC artificial joints are comparable to those of CoP artificial joints. Although CoP artificial joint prosthesis has a faster wear rate, it does not affect joint function and increase complications, and there is no abnormal joint noise. CoC is expensive and the long-term efficacy is equivalent to CoP. Clinicians should consider cost performance when choosing CoC.

PMID:36825419 | DOI:10.12200/j.issn.1003-0034.2023.02.014