Tag: pubmed

JAMA Health Forum. 2023 Aug 4;4(8):e232517. doi: 10.1001/jamahealthforum.2023.2517.

ABSTRACT

IMPORTANCE: Better evidence is needed on whether Medicare Advantage (MA) plans can control the use of postacute care services while achieving excellent outcomes.

OBJECTIVE: To compare self-reported use of postacute care services and outcomes among traditional Medicare (TM) beneficiaries and MA enrollees.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the National Health and Aging Trends Study (NHATS) with linked Medicare enrollment data from 2015 to 2017. Participants were community-dwelling MA or TM beneficiaries 70 years and older; those with dual Medicare and Medicaid eligibility were also identified. Analyses were conducted from May 2022 to February 2023 and were weighted to account for the complex survey design.

EXPOSURES: Enrollment in MA and dual eligibility for Medicare and Medicaid.

MAIN OUTCOMES AND MEASURES: Postacute care service use including site of use, duration, primary indication, and whether participants met their goals or experienced improved functional status during or after services.

RESULTS: Included in the analysis were 2357 Medicare beneficiaries who used postacute care. Of these beneficiaries, 815 (32.6%; 62.0% were females [weighted percentages]) had MA and 1542 (67.4%; 59.5% were females [weighted percentages]) had TM. Enrollees in MA reported using postacute care services across all NHATS survey rounds: between 16.2% (95% CI, 14.3%-18.4%) and 17.7% (95% CI, 15.4%-20.4%) of MA enrollees reported using postacute care services each round, vs 22.4% (95% CI, 20.9%-24.1%) to 24.1% (95% CI, 21.8%-26.6%) of TM beneficiaries (P for all rounds <.002). Enrollees in MA reported less functional improvement during postacute care use (63.1% [95% CI, 59.2%-66.8%] vs 71.7% [95% CI, 68.9%-74.3%], P < .001). Among beneficiaries who ended postacute service use, fewer MA enrollees than TM enrollees reported that they met their goals (70.5% [95% CI, 65.1%-75.3%] vs 76.2% [95% CI, 73.1%-79.1%]; P = .053) or had improved functional status (43.9% [95% CI, 38.9%-49.1%] vs 46.0% [95% CI, 42.5%-49.5%]; P = .42), but differences were not statistically significant. Differences in postacute care use and functional improvement were not statistically significant between MA and TM enrollees with dual eligibility.

CONCLUSIONS AND RELEVANCE: In this cohort study of Medicare beneficiaries, we found that MA enrollees overall used less postacute care services than their TM counterparts. Among users of postacute care services, MA enrollees reported less favorable outcomes compared with TM enrollees. These findings highlight the importance of assessing patient-reported outcomes, especially as MA and other payment models seek to reduce inefficient use of postacute care services.

PMID:37594745 | DOI:10.1001/jamahealthforum.2023.2517

Environ Sci Pollut Res Int. 2023 Aug 18. doi: 10.1007/s11356-023-29250-w. Online ahead of print.

ABSTRACT

This study uses the difference-in-difference (DID) method to explore the relative effectiveness and mechanism of the “Ten Measures on Air Pollution Prevention and Control” (TMAPPC) policy and the “carbon trading” pilot (CTP) policy on the digital transformation of enterprises. The research results show that the incentive effect of market-incentive environmental regulation on the digital transformation of enterprises is better than that of command-control environmental regulation. In addition, there are differences in the mechanism of action; the level of digital economy development and market competition can strengthen the incentive effect of market-incentive environmental regulation on the digital transformation of enterprises; the government support and media attention can strengthen the incentive effect of command-control environmental regulation on enterprises’ digital transformation. The results of heterogeneity analysis show that, compared with the TMAPPC policy, the CTP policy can better drive the digital transformation of enterprises in the eastern region, enterprises in regions with low to medium digital development levels, and enterprises in regions with low environmental regulation intensity, as well as high-tech enterprises. Moreover, the two environmental regulation policies have more significant driving effects on large enterprises and enterprises with low financing constraints. Based on the research conclusions, this study puts forward relevant policy recommendations for further improving environmental regulation policies and promoting the digital transformation of enterprises.

PMID:37594714 | DOI:10.1007/s11356-023-29250-w

Environ Sci Pollut Res Int. 2023 Aug 18. doi: 10.1007/s11356-023-29049-9. Online ahead of print.

ABSTRACT

Flooding events are determining a significant amount of damages, in terms of economic loss and also casualties in Asia and Pacific areas. Due to complexity and ferocity of severe flooding, predicting flood-prone areas is a difficult task. Thus, creating flood susceptibility maps at local level is though challenging but an inevitable task. In order to implement a flood management plan for the Balrampur district, an agricultural dominant landscape of India, and strengthen its resilience, flood susceptibility modeling and mapping are carried out. In the present study, three hybrid machine learning (ML) models, namely, fuzzy-ANN (artificial neural network), fuzzy-RBF (radial basis function), and fuzzy-SVM (support vector machine) with 12 topographic, hydrological, and other flood influencing factors were used to determine flood-susceptible zones. To ascertain the relationship between the occurrences and flood influencing factors, correlation attribute evaluation (CAE) and multicollinearity diagnostic tests were used. The predictive power of these models was validated and compared using a variety of statistical techniques, including Wilcoxon signed-rank, t-paired tests and receiver operating characteristic (ROC) curves. Results show that fuzzy-RBF model outperformed other hybrid ML models for modeling flood susceptibility, followed by fuzzy-ANN and fuzzy-SVM. Overall, these models have shown promise in identifying flood-prone areas in the basin and other basins around the world. The outcomes of the work would benefit policymakers and government bodies to capture the flood-affected areas for necessary planning, action, and implementation.

PMID:37594709 | DOI:10.1007/s11356-023-29049-9

Int Endod J. 2023 Aug 18. doi: 10.1111/iej.13960. Online ahead of print.

ABSTRACT

AIM: To assess the influence of a flat-side design on the geometry, metallurgy, mechanical performance and shaping ability of a novel nickel-titanium rotary instrument.

METHODOLOGY: Sixty-five new 25-mm flat-side rotary instruments (size 25, taper 0.04) and their nonflat-side prototypes (n = 65) were assessed for major deformations and examined regarding macroscopic and microscopic design, determination of nickel and titanium elements ratio, measurement of phase transformation temperature and evaluation of mechanical performance parameters including time/cycles to fracture, maximum torque, angle of rotation, maximum bending and buckling strengths and cutting ability. Additionally, unprepared canal areas, volume of hard tissue debris and percentage reduction of dentine thickness were calculated for each tested instrument after preparing mesial canals of mandibular molars (n = 12), using micro-CT imaging. Statistical analyses were performed using the U-Mann-Whitney test and independent Student t-test (α = 5%).

RESULTS: The number of spirals (n = 8) and blade direction (clockwise) were similar between both flat and nonflat instruments, whilst the helical angles were equivalent (⁓25°). Flat-instruments showed inconsistencies in the homogeneity of the gold colour on the flat-side surface, blade discontinuity, and incomplete and variable S-shaped cross-sections. The titanium-to-nickel ratios were equivalent, but significant differences in the R-phase finish and austenitic start phase transformation temperatures were observed between the flat and nonflat-side instruments. The flat-side instruments demonstrated superior cutting ability compared to the nonflat instruments, as well as, significantly lower values for time to fracture, rotation to fracture and maximum torque to fracture (p < .001). No statistical difference was observed between tested instruments regarding angle of rotation (p = .437), maximum bending (p = .152) and buckling load (p = .411). Preparation protocols using flat and nonflat instruments did not show any statistically significant differences (p > .05). All flat-side instruments exhibited deformation after shaping procedures.

CONCLUSIONS: The flat-side instrument showcased enhanced cutting ability compared to its nonflat counterpart. However, it exhibited inferior performance in terms of time, rotation and maximum torque to fracture, along with distinct phase transformation temperatures. No differences were observed in the titanium-to-nickel ratios, angle of rotation, maximum bending, buckling load, preparation time, percentage of untouched canal walls, volume of hard tissue debris and percentage reduction of dentine thickness.

PMID:37594701 | DOI:10.1111/iej.13960

Neuropsychol Rev. 2023 Aug 18. doi: 10.1007/s11065-023-09604-4. Online ahead of print.

ABSTRACT

Dr. Leonhard presents a comprehensive and insightful critique of the existing malingering research literature and its implications for neuropsychological practice. Their statistical critique primarily focuses on the crucial issue of diagnostic inference when multiple tests are involved. While Leonhard effectively addresses certain misunderstandings, there are some overlooked misconceptions within the literature and a few new confusions were introduced. In order to provide a balanced commentary, this evaluation considers both Leonhard’s critiques and the malingering research literature. Furthermore, a concise introduction to Bayesian diagnostic inference, utilizing the results of multiple tests, is provided. Misunderstandings regarding Bayesian inference are clarified, and a valid approach to Bayesian inference is elucidated. The assumptions underlying the simple Bayes model are thoroughly discussed, and it is demonstrated that the chained likelihood ratios method is an inappropriate application of this model due to one reason identified by Leonhard and another reason that has not been previously recognized. Leonhard’s conclusions regarding the primary dependence of incremental validity on unconditional correlations and the alleged mathematical incorrectness of the simple Bayes model are refuted. Finally, potential directions for future research and practice in this field are explored and discussed.

PMID:37594692 | DOI:10.1007/s11065-023-09604-4

Neuropsychol Rev. 2023 Aug 18. doi: 10.1007/s11065-023-09606-2. Online ahead of print.

ABSTRACT

The thoughtful commentaries in this volume of Drs. Bush, Jewsbury, and Faust add to the impact of the two reviews in this volume of statistical and methodological issues in the forensic neuropsychological determination of malingering based on performance and symptom validity tests (PVTs and SVTs). In his commentary, Dr. Bush raises, among others, the important question of whether such malingering determinations can still be considered as meeting the legal Daubert standard which is the basis for neuropsychological expert testimony. Dr. Jewsbury focuses mostly on statistical issues and agrees with two key points of the statistical review: Positive likelihood chaining is not a mathematically tenable method to combine findings of multiple PVTs and SVTs, and the Simple Bayes method is not applicable to malingering determinations. Dr. Faust adds important narrative texture to the implications for forensic neuropsychological practice and points to a need for research into factors other than malingering that may explain PVT and SVT failures. These commentaries put into even sharper focus the serious questions raised in the reviews about the scientific basis of present practices in the forensic neuropsychological determination of malingering.

PMID:37594691 | DOI:10.1007/s11065-023-09606-2

Neuropsychol Rev. 2023 Aug 18. doi: 10.1007/s11065-023-09602-6. Online ahead of print.

ABSTRACT

Forensic neuropsychological examinations to detect malingering in patients with neurocognitive, physical, and psychological dysfunction have tremendous social, legal, and economic importance. Thousands of studies have been published to develop and validate methods to forensically detect malingering based largely on approximately 50 validity tests, including embedded and stand-alone performance and symptom validity tests. This is Part II of a two-part review of statistical and methodological issues in the forensic prediction of malingering based on validity tests. The Part I companion paper explored key statistical issues. Part II examines related methodological issues through conceptual analysis, statistical simulations, and reanalysis of findings from prior validity test validation studies. Methodological issues examined include the distinction between analog simulation and forensic studies, the effect of excluding too-close-to-call (TCTC) cases from analyses, the distinction between criterion-related and construct validation studies, and the application of the Revised Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) in all Test of Memory Malingering (TOMM) validation studies published within approximately the first 20 years following its initial publication to assess risk of bias. Findings include that analog studies are commonly confused for forensic validation studies, and that construct validation studies are routinely presented as if they were criterion-reference validation studies. After accounting for the exclusion of TCTC cases, actual classification accuracy was found to be well below claimed levels. QUADAS-2 results revealed that extant TOMM validation studies all had a high risk of bias, with not a single TOMM validation study with low risk of bias. Recommendations include adoption of well-established guidelines from the biomedical diagnostics literature for good quality criterion-referenced validation studies and examination of implications for malingering determination practices. Design of future studies may hinge on the availability of an incontrovertible reference standard of the malingering status of examinees.

PMID:37594690 | DOI:10.1007/s11065-023-09602-6

J Community Genet. 2023 Aug 18. doi: 10.1007/s12687-023-00660-0. Online ahead of print.

ABSTRACT

This study aimed to assess the Family Quality of Life (FQoL) of Brazilian families with male children with Fragile X syndrome (FXS). Data from 53 families were collected using forms that included sociodemographic and clinical information, as well as the Beach Center Family Quality of Life Scale, a 5-point Likert scale ranging from “very dissatisfied” (1) to “very satisfied” (5). The mean overall FQoL score was 3.56 ± 0.79; the emotional well-being domain had the lowest score (2.98 ± 1.11) and showed significant differences between the other domains: family interaction (3.81 ± 0.89; p < 0.001), parenting (3.66 ± 0.89; p < 0.001), physical and material well-being (3.48 ± 0.83; p < 0.001), and disability-related support (3.75 ± 0.98; p < 0.001). Physical and material well-being was the second-lowest domain and was statistically different from the family interaction domain (p = 0.013). Lower FQoL satisfaction ratings were found in families with children who had difficulty getting along with people of the same age (t(51) = -3.193, p = 0.002; d = 1.019) and difficulty in living together on a day-to-day basis (t(51) = -3.060, p = 0.004; d = 0.888). These results highlight the importance of proper emotional support for the family, emphasizing the need to provide assistance not only for individuals with FXS but also for other family members. Besides, we advocate for the adoption of public policies that provide financial assistance to families and the implementation of the Brazilian Policy of Comprehensive Care for People with Rare Diseases.

PMID:37594660 | DOI:10.1007/s12687-023-00660-0

Updates Surg. 2023 Aug 18. doi: 10.1007/s13304-023-01630-4. Online ahead of print.

ABSTRACT

PURPOSE: The current pooling up analysis aimed to evaluate whether aortic calcification (AC) was a potential risk factor for anastomotic leakage (AL) after colorectal surgery.

METHODS: In this study, we searched studies in three databases including PubMed, Embase, and the Cochrane Library on April 20, 2022. In order to investigate the association between AC and AL, the hazard ratios (HRs) and 95% confidence intervals (CIs) of AC were pooled up. Our study was performed with RevMan 5.3 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

RESULTS: We finally enrolled eight studies involving 1955 patients for statistical analysis. As for all patients, we found that AC could significantly increase the risk of AL after surgery (HR = 2.31, I² = 0%, 95%CI = 1.58 to 3.38, P < 0.01). In five studies including patients undergoing colorectal surgery (benign diseases and cancers), AC was also a risk factor for AL (HR = 3.30, I² = 2%; 95%CI = 1.83 to 5.95, P < 0.01). In terms of the other three studies that only included CRC patients, there was still a correction between AC and AL (HR = 1.80, I² = 0%, 95%CI = 1.10 to 2.96, P = 0.02).

CONCLUSION: Patients with AC were more likely to develop AL after colorectal surgery. Moreover, subgroup analysis suggested that AC was a predictor for AL after CRC surgery.

PMID:37594659 | DOI:10.1007/s13304-023-01630-4

Sports Med. 2023 Aug 18. doi: 10.1007/s40279-023-01902-4. Online ahead of print.

ABSTRACT

BACKGROUND: According to the principle of specific adaptations to imposed demands, training induces specific adaptations that predominantly transfer towards performance tasks of similar physiological and/or biomechanical characteristics. Functional performance improvements secondary to resistance and plyometric training have been hypothesized to be force-vector specific; however, the literature pertaining to this matter appears somewhat equivocal.

OBJECTIVE: The objective of the present systematic review with meta-analysis was to synthesize the available body of literature regarding the performance implications of vertically and horizontally oriented resistance- and plyometric training.

DATA SOURCES: The review drew from the following sources: PubMed, Web of Science, Scopus, Physiotherapy Evidence Database (PEDro), Cochrane Library, Cumulative Index of Nursing and Allied Health Literature (CINAHL), SPORTDiscus and Google Scholar.

STUDY ELIGIBILITY CRITERIA: To qualify for inclusion, studies had to compare the efficacy of vertically and horizontally oriented resistance and/or plyometric training, with one or multiple outcome measures related to vertical/horizontal jumping, sprinting and/or change of direction speed (CODS).

STUDY APPRAISAL AND SYNTHESIS: For each outcome measure, an inverse-variance random effects model was applied, with between-treatment effects quantified by the standardized mean difference (SMD) and associated 95% confidence- and prediction intervals.

RESULTS: Between-treatment effects were of trivial magnitude for vertical jumping (SMD = – 0.04, P = 0.69) and long-distance (≥ 20 m) sprinting (0.03, P = 0.83), whereas small to moderate effects in favor of horizontal training were observed for horizontal jumping (0.25, P = 0.07), short-distance (≤ 10 m) sprinting (0.72, P = 0.01) and CODS (0.31, P = 0.06), although only the short-distance sprint outcome reached statistical significance.

CONCLUSIONS: In conclusion, our meta-analysis reveals a potential superiority of horizontally oriented training for horizontal jumping, short-distance sprinting and CODS, whereas vertically oriented training is equally efficacious for vertical jumping and long-distance sprinting. From an applied perspective, the present analysis provides an advanced basis for weighting of vertical and horizontal force-vector exercises as an integrated component for optimizing sport-specific performances. The present systematic review with meta-analysis was not a priori registered.

PMID:37594654 | DOI:10.1007/s40279-023-01902-4