Tag: pubmed

PLoS One. 2022 Mar 23;17(3):e0265875. doi: 10.1371/journal.pone.0265875. eCollection 2022.

ABSTRACT

Rainfall fluctuation is directly affected by the Earth’s climate change. It can be described using the coefficient of variation (CV). Similarly, the ratio of CVs can be used to compare the rainfall variation between two regions. The ratio of CVs has been widely used in statistical inference in a number of applications. Meanwhile, the confidence interval constructed with this statistic is also of interest. In this paper, confidence intervals for the ratio of two independent CVs of lognormal distributions with excess zeros using the fiducial generalized confidence interval (FGCI), Bayesian methods based on the left-invariant Jeffreys, Jeffreys rule, and uniform priors, and the Wald and Fieller log-likelihood methods are proposed. The results of a simulation study reveal that the highest posterior density (HPD) Bayesian using the Jeffreys rule prior method performed the best in terms of the coverage probability and the average length for almost all cases of small sample size and a large sample size together with a large variance and a small proportion of non-zero values. The performance of the statistic is demonstrated on two rainfall datasets from the central and southern regions in Thailand.

PMID:35320313 | DOI:10.1371/journal.pone.0265875

PLoS One. 2022 Mar 23;17(3):e0265342. doi: 10.1371/journal.pone.0265342. eCollection 2022.

ABSTRACT

INTRODUCTION: Sickle cell disease (SCD) is an inherited hemoglobinopathy that predominantly affects African Americans in the United States. The disease is associated with complications leading to high healthcare utilization rates, including emergency department (ED) visits and hospitalizations. Optimal SCD care requires a multidisciplinary approach involving SCD specialists to ensure preventive care, minimize complications and prevent unnecessary ED visits and hospitalizations. However, most individuals with SCD receive sub-optimal care or are unaffiliated with care (have not seen an SCD specialist). We aimed to identify barriers to care from the perspective of individuals with SCD in a multi-state sample.

METHODS: We performed a multiple methods study consisting of surveys and interviews in three comprehensive SCD centers from March to June 2018. Interviews were transcribed and coded, exploring themes around barriers to care. Survey questions on the specific themes identified in the interviews were analyzed using summary statistics.

RESULTS: We administered surveys to 208 individuals and conducted 44 in-depth interviews. Barriers to care were identified and classified according to ecological level (i.e., individual, family/interpersonal, provider, and socio-environmental/organizational level). Individual-level barriers included lack of knowledge in self-management and disease severity. Family/interpersonal level barriers were inadequate caregiver support and competing life demands. Provider level barriers were limited provider knowledge, provider inexperience, poor provider-patient relationship, being treated differently, and the provider’s lack of appreciation of the patient’s SCD knowledge. Socio-environmental/organizational level barriers included limited transportation, lack of insurance, administrative barriers, poor care coordination, and reduced access to care due to limited clinic availability, services provided or clinic refusal to provide SCD care.

CONCLUSION: Participants reported several multilevel barriers to SCD care. Strategies tailored towards reducing these barriers are warranted. Our findings may also inform interventions aiming to locate and link unaffiliated individuals to care.

PMID:35320302 | DOI:10.1371/journal.pone.0265342

PLoS One. 2022 Mar 23;17(3):e0265624. doi: 10.1371/journal.pone.0265624. eCollection 2022.

ABSTRACT

BACKGROUND: Data on health status outcomes after spontaneous coronary artery dissection (SCAD) are limited.

METHODS AND FINDINGS: Using the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study we compared patients with SCAD and other acute myocardial infarction (AMI) at presentation (baseline), 1-month, and-12 months using standardized health status instruments. Among 3572 AMI patients ≤ 55 years, 67 had SCAD. SCAD patients were younger (median age (IQR) 45 (40.5-51) years vs. 48 (44-52) in other AMI, p = 0.003), more often female (92.5% vs. 66.6%), have college education (73.1% vs. 51.7%) and household income >$100,000 (43.3% vs. 17.7% (All p<0.001). SCAD patients at baseline had higher mean ± SD Short Form-12 [SF-12] physical component scores [PCS] (48.7±10.2 vs. 43.8±12.1, p<0.001) and mental component scores [MCS] (49.6±12.4 vs. 45.4±12.5, p = 0.008), and at 12-months [PCS (50.1±9.0 vs. 44.3±12.3, p<0.001) and MCS (53±10.1 vs 50.2±11.0, p = 0.045)]. The Euro-Quality of Life Scale [EQ-5D] VAS and EQ-5D index scores were similar at baseline, but higher at 12-months for SCAD (EQ-5D VAS: 82.2±10.2 vs. 72.3±21.0, p<0.001; EQ-5D index scores; 90.2±15.3 vs. 83.7±19.8, p = 0.012). SCAD patients had better baseline Seattle Angina Questionnaire [SAQ] physical limitation (88.8±20.1 vs. 81.2±25.4, p = 0.017). At 12-months SCAD patients had better physical limitation (98.0±8.5 vs. 91.4±18.8, p = 0.007), angina frequency (96.4±8.8 vs. 91.3±16.8, p = 0.018) and quality of life scores (80.7±14.7 vs 72.2±23.2, p = 0.005). Magnitude of change in health status from baseline to 12-months was not statistically different between the groups. After adjustment for time and comorbidities there remained no difference in most health status outcomes.

CONCLUSIONS: SCAD patients fare marginally better than other AMI patients on most health status instruments and have similar 12-month health status recovery. Better pre-event health status suggests a need to modify exercise prescriptions and cardiac rehabilitation protocols to better assist this physically active population to recover.

PMID:35320296 | DOI:10.1371/journal.pone.0265624

J Magn Reson Imaging. 2022 Mar 23. doi: 10.1002/jmri.28168. Online ahead of print.

ABSTRACT

BACKGROUND: The relationship of tissue chemistry to breast density and cancer risk has not been documented despite breast density being a known risk factor.

PURPOSE: To investigate whether distinct chemical profiles associated with breast density and cancer risk are identified in healthy breast tissue using in vivo two-dimensional correlated spectroscopy (2D COSY).

STUDY TYPE: Prospective.

POPULATION: One-hundred-seven participants including 55 at low risk and 52 at high risk of developing breast cancer.

FIELD STRENGTH/SEQUENCE: 3 T/ axial/ T1, T2, 2D COSY.

ASSESSMENT: Two radiologists defined breast density on T2. Interobserver variability assessed. Peak volumes normalized to methylene at (1.30, 1.30) ppm as internal shift reference.

STATISTICAL TESTS: Chi-squared/Mann-Whitney/Kappa statistics/Kruskal Wallis/pairwise analyses. Significance level 0.05.

RESULTS: Ten percentage were fatty breasts, 39% scattered fibroglandular, 35% heterogeneously dense, and 16% extremely dense. Interobserver variability was excellent (kappa = 0.817). Sixty percentage (64/107) were premenopausal. Four distinct tissue chemistry categories were identified: low-density (LD)/premenopausal, high-density (HD)/premenopausal, LD/postmenopausal, and HD/postmenopausal. Compared to LD, HD breast chemistry showed significant increases of cholesterol (235%) and lipid unsaturation (33%). In the low-risk category, postmenopausal women with dense breasts recorded the largest significant changes including cholesterol methyl 540%, lipid unsaturation 207%, glutamine/glutamate 900%, and choline/phosphocholine 800%. In the high-risk cohort, premenopausal women with HD recorded a more active chemical profile with significant increases in choline/phosphocholine 1100%, taurine/glucose 550% and cholesterol sterol 250%.

DATA CONCLUSION: Four distinct chemical profiles were identified in healthy breast tissue based on breast density and menopausal status in participants at low and high risk. Gradual increase in neutral lipid content and metabolites was noted in both risk groups across categories in different order. In low risk, the HD postmenopausal category exhibited the highest metabolic activity, while women at high risk exhibited the highest lipid content and metabolic activity in the HD premenopausal category.

LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY STAGE: 3.

PMID:35319148 | DOI:10.1002/jmri.28168

Head Neck. 2022 Mar 23. doi: 10.1002/hed.27038. Online ahead of print.

ABSTRACT

BACKGROUND: To assess the efficacy and safety of preoperative embolization (PE) in patients with carotid body tumor (CBTs).

METHODS: In a single-center retrospective cohort study, 127 patients underwent surgical resection of CBTs from January 2003 to December 2019. One-to-one propensity score matching was conducted between patients with or without PE.

RESULTS: Thirty-two (25.2%) patients received PE. After propensity score matching, no statistically significant differences were found in the baseline characteristics of 28 patients in each group. Compared with NPE group, operative time and estimated blood loss (EBL) were significantly reduced in the PE group. The incidence of stroke, perioperative complications, intraoperative blood transfusion, vascular reconstruction, hospital stay, tumor recurrence, and all-cause mortality were not different between the PE and NPE group.

CONCLUSIONS: Preoperative embolization was efficient and safe with a reduction of intraoperative blood loss and operative time during CBT resection.

PMID:35319144 | DOI:10.1002/hed.27038

J Magn Reson Imaging. 2022 Mar 23. doi: 10.1002/jmri.28172. Online ahead of print.

ABSTRACT

BACKGROUND: Advanced diffusion-based MRI biomarkers may provide insight into microstructural and perfusion changes associated with neurodegeneration and cognitive decline.

PURPOSE: To assess longitudinal microstructural and perfusion changes using apparent diffusion coefficient (ADC) and intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) parameters in cognitively impaired (CI) and healthy control (HC) groups.

STUDY TYPE: Prospective/longitudinal.

POPULATION: Twelve CI patients (75% female) and 13 HC subjects (69% female).

FIELD STRENGTH/SEQUENCE: 3 T; Spin-Echo-IVIM-DWI.

ASSESSMENT: Two MRI scans were performed with a 12-month interval. ADC and IVIM-DWI metrics (diffusion coefficient [D] and perfusion fraction [f]) were generated from monoexponential and biexponential fits, respectively. Additionally, voxel-based correlations were evaluated between change in Montreal Cognitive Assessment (ΔMoCA) and baseline imaging parameters.

STATISTICAL TESTS: Analysis of covariance with sex and age as covariates was performed for main effects of group and time (false discovery rate [FDR] corrected) with post hoc comparisons using Bonferroni correction. Partial-η² and Hedges’ g were used for effect-size analysis. Spearman’s correlations (FDR corrected) were used for the relationship between ΔMoCA score and imaging. P < 0.05 was considered statistically significant.

RESULTS: Significant differences were found for the main effects of group (HC vs. CI) and time. For group effects, higher ADC, IVIM-D, and IVIM-f were observed in the CI group compared to HC (ADC: 1.23 ± 0.08^. 10^-3 vs. 1.09 ± 0.07^. 10^-3 mm² /sec; IVIM-D: 0.82 ± 0.01^. 10^-3 vs. 0.73 ± 0.01^. 10^-3 mm² /sec; and IVIM-f: 0.317 ± 0.008 vs. 0.253 ± 0.009). Significantly higher ADC, IVIM-D, and IVIM-f values were observed in the CI group after 12 months (ADC: 1.45 ± 0.05^. 10^-3 vs. 1.50 ± 0.07^. 10^-3 mm² /sec; IVIM-D: 0.87 ± 0.01^. 10^-3 vs. 0.94 ± 0.02^. 10^-3 mm² /sec; and IVIM-f: 0.303 ± 0.007 vs. 0.332 ± 0.008), but not in the HC group at large effect size. ADC, IVIM-D, and IVIM-f negatively correlated with ΔMoCA score (ρ = -0.49, -0.51, and -0.50, respectively).

DATA CONCLUSION: These findings demonstrate that longitudinal differences between CI and HC cohorts can be measured using IVIM-based metrics.

LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY STAGE: 2.

PMID:35319142 | DOI:10.1002/jmri.28172

J Surg Oncol. 2022 Mar 23. doi: 10.1002/jso.26863. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Fluorescence from adrenal tumors can be detected with near-infrared imaging after injection with indocyanine green. However, it is unknown if adrenal tumors exhibit autofluorescence. The aim of this study was to determine whether adrenal tumors emit near-infrared autofluorescence (NIRAF).

METHODS: This was a prospective study of patients who underwent minimally invasive adrenalectomy at a tertiary center. Intraoperative images were analyzed to detect NIRAF with a 750 nm camera. Descriptive and comparative statistical analyses were performed.

RESULTS: Twenty-five adrenalectomies were examined. Only 11 tumors (44%), that originated from the cortex exhibited autofluorescence. A contrast distinction between the tumor and retroperitoneum was observed in 23 patients, whereas a contrast distinction between the tumor and normal adrenocortical tissue was seen in 12 patients. The overall fluorescence intensity of adrenal tumors was found to be variable and ranging between 0.3 and 5.6 times that of the background tissue. Pheochromocytoma, malignancy and adrenal cyst did not demonstrate NIRAF.

CONCLUSION: This is the first study to show that adrenocortical tissue can demonstrate NIRAF. The pattern of fluorescence was similar to that observed after indocyanine green injection in our historical experience. NIRAF has a potential to be used as an intraoperative optical adjunct during adrenalectomy.

PMID:35319103 | DOI:10.1002/jso.26863

Laryngoscope. 2022 Mar 23. doi: 10.1002/lary.30102. Online ahead of print.

ABSTRACT

OBJECTIVES: Assess current frenotomy practice patterns of pediatric otolaryngologists via a cross-sectional survey.

STUDY DESIGN: Survey study.

METHODS: A 31-question electronic survey assessing frenotomy practice patterns was distributed to all American Society of Pediatric Otolaryngology (ASPO) members. Descriptive statistics were used to summarize responses and demographics of respondents.

RESULTS: Of all ASPO members, 41% (240/588) completed the survey. Most respondents, 185 (77%), reported increased frenotomy referrals over the last 5 years and 144 (60%) described the current number of referrals as “too many.” The two primary lingual frenotomy indications identified in infants were: breastfeeding/nipple pain (92%) and inability to latch (83%). For older children, speech difficulty (87%) was the primary indication. Maxillary frenotomy indications in infants varied amongst respondents. For analgesia during in-office frenotomy procedures, respondents used glucose/sucrose drops (48%), topical lidocaine (29%), or no pain control measure (27%). For post-procedure care, respondents recommended continuing lactation support (45%), massaging/stretching the wound (38%), or none (40%). Most respondents, 143 (60%), reported having seen a complication from frenotomy, and the most reported frenotomy complications were frenulum re-attachment and excessive bleeding.

CONCLUSIONS: In the last 5 years, otolaryngologists have seen an increase in referrals for frenotomy. Pediatric otolaryngologists have varying practice patterns with regards to ankyloglossia diagnosis and treatment. The reported indications for frenotomy varied amongst pediatric otolaryngologists especially with respect to maxillary frenotomy. Practice patterns also varied with respect to procedural pain control and frenotomy aftercare recommendations. More frenotomy research is needed to establish a standard of care for patients with ankyloglossia.

LEVEL OF EVIDENCE: 4 Laryngoscope, 2022.

PMID:35319112 | DOI:10.1002/lary.30102

Aust Occup Ther J. 2022 Mar 23. doi: 10.1111/1440-1630.12799. Online ahead of print.

ABSTRACT

INTRODUCTION: Occupational therapists are key members of the multidisciplinary team and regularly work with people of higher weight across age groups and practice settings. There is limited existing research regarding the occupational therapy role with this client group. The aim of this study was to explore occupational therapy practice and barriers to service provision for Australian occupational therapists working with clients of higher weight.

METHODS: A cross-sectional study design using a self-administered online survey was distributed to members of the national occupational therapy professional association. The survey was designed to identify common assessments and interventions used with clients of higher weight and explore occupational therapists’ perspectives on their knowledge and confidence and the barriers to service delivery. Descriptive statistics were used to summarise rating scales, and open-ended responses were analysed using thematic analysis.

RESULTS: Eighty Australian occupational therapists working in a range of settings and with varied experience levels participated in the study. Participants described the most common areas of occupational therapy assessment and intervention when working with clients of higher weight to be self-care, equipment prescription, home modifications and pressure care. Respondents were least confident in interventions related to psychosocial, leisure and employment interventions. Barriers to service delivery included accessibility and cost of equipment, lack of training and weight stigma.

CONCLUSION: Occupational therapy practice promotes and enables participation in everyday occupations with people of higher weight. This study highlights not only the occupational therapy skills and unique approach to the person, their environment and occupations but also the challenges faced by occupational therapists when working with people of higher weight. Occupational therapists could consider utilising the weight-inclusive paradigm to broaden their contribution from self-care to other important aspects of participation and well-being.

PMID:35319102 | DOI:10.1111/1440-1630.12799

Stat Med. 2022 Mar 23. doi: 10.1002/sim.9374. Online ahead of print.

ABSTRACT

In randomized clinical trials, incorporating baseline covariates can improve the power in hypothesis testing for treatment effects. For survival endpoints, the Cox proportional hazards model with baseline covariates as explanatory variables can improve the standard logrank test in power. Although this has long been recognized, this adjustment is not commonly used as the primary analysis and instead the logrank test followed by the estimation of the hazard ratio between treatment groups is often used. By projecting the score function for the Cox proportional hazards model onto a space of covariates, the logrank test can be more powerful. We derive a power formula for this augmented logrank test under the same setting as the widely used power formula for the logrank test and propose a simple strategy for sizing randomized clinical trials utilizing historical data of the control treatment. Through numerical studies, the proposed procedure was found to have the potential to reduce the sample size substantially as compared to the standard logrank test. A concern to utilize historical data is that those might not reflect well the data structure of the study to design and then the sample size calculated might not be accurate. Since our power formula is applicable to datasets pooled across the treatment arms, the validity of the power calculation at the design stage can be checked in blind reviews.

PMID:35319100 | DOI:10.1002/sim.9374