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Nevin Manimala Statistics

Examining the equity and diversity characteristics of academic general surgeons hired in Canada

Can J Surg. 2023 Sep 6;66(5):E458-E466. doi: 10.1503/cjs.006122. Print 2023 Sep-Oct.

ABSTRACT

BACKGROUND: Job competition and underemployment among surgeons emphasize the importance of equitable hiring practices. The purpose of this study was to describe some of the demographic characteristics of academic general surgeons and to evaluate the gender and visible minority (VM) status of those recently hired.

METHODS: Demographic information about academic general surgeons across Canada including gender, VM status, practice location and graduate degree status was collected. Location of residency was collected for recently hired general surgeons (hired between 2013 and 2020). Descriptive statistics were performed on the demographic characteristics at each institution. Pearson correlation coefficients and hypothesis testing were used to determine the correlation between various metrics and gender and VM status.

RESULTS: A total of 393 general surgeons from 30 academic hospitals affiliated with 14 universities were included. The percentage of female general surgeons ranged from 0% to 47.4% and the percentage of VM general surgeons ranged from 0% to 66.7% at the hospitals. This heterogeneity did not correlate with city population (gender: r = 0.06, p = 0.77; VM: r = 0.04, p = 0.83). The percentage of VM general surgeons at each hospital did not correlate with the percentage of VM population in the city (r = 0.13, p = 0.49). Only 34 of 120 recently hired academic general surgeons (28.3%) did not have a graduate degree. The percentage of recently hired academic general surgeons who did not have a graduate degree was approximately 1.5 times higher among male hirees than female hirees. With respect to academic promotion, the percentage of female full professors ranged from 0% to 40.0% and did not correlate with the percentage of female general surgeons at each institution (r = 0.11, p = 0.70). The percentage of VM full professors ranged from 0% to 44.4% and was moderately correlated with the percentage of VM surgeons at each institution (r = 0.40, p = 0.16).

CONCLUSION: The academic general surgery workforce appears to be somewhat diverse. However, there was substantial heterogeneity in diversity between hospitals, leaving room for improvement. We must be willing to examine our hiring processes and be transparent about them to build an equitable surgical workforce.

PMID:37673438 | DOI:10.1503/cjs.006122

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Nevin Manimala Statistics

Continuity of primary care and emergency department visits following knee and hip replacement surgery: a retrospective cohort study

Can J Surg. 2023 Sep 6;66(5):E451-E457. doi: 10.1503/cjs.016622. Print 2023 Sep-Oct.

ABSTRACT

BACKGROUND: Continuity of primary care (CPC) improves patient well-being, but the association between CPC and surgical outcomes has not been well studied. The numbers of joint replacement procedures are expected to rise considerably in the coming years, so it is crucial to identify factors related to successful outcomes. The purpose of this study was to examine the association between CPC and emergency department (ED) visits after knee and hip replacement surgery.

METHODS: Physician claims and hospital data from 2005 to 2020 in Nova Scotia were used in this retrospective study. To measure CPC, we used the Modified Modified Continuity Index (MMCI), which is the number of primary care providers adjusted for the total number of visits. The outcome was ED visits within 90 days of discharge. Logistic regression was used to test for associations between MMCI and the probability of an ED visit.

RESULTS: There were 28 574 knee and 16 767 hip procedures in the data set; 13.9% (95% confidence interval [CI] 13.5%-14.3%) and 13.5% (95% CI 13.0%-14.0%) of the patients, respectively, had an ED visit within 90 days. For patients who underwent knee procedures, the mean MMCI was 0.868 (95% CI 0.867-0.870); 10.7% (95% CI 10.4 %-11.1 %) had perfect continuity of care. For patients who underwent hip procedures, the corresponding measures were 0.864 (95% CI 0.862-0.866) and 13.5% (95% CI 13.0%-14.0%). There was a statistically significant negative association between greater continuity of care and the probability of an ED visit after controlling for confounders.

CONCLUSION: Having multiple primary care providers before surgery increased the likelihood of negative outcomes following knee or hip replacement surgery compared with having a single provider. Presurgical conversations should include primary care history to improve postsurgical outcomes.

PMID:37673437 | DOI:10.1503/cjs.016622

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Nevin Manimala Statistics

Food additive emulsifiers and risk of cardiovascular disease in the NutriNet-Santé cohort: prospective cohort study

BMJ. 2023 Sep 6;382:e076058. doi: 10.1136/bmj-2023-076058.

ABSTRACT

OBJECTIVE: To assess the associations between exposure to food additive emulsifiers and risk of cardiovascular disease (CVD).

DESIGN: Prospective cohort study.

SETTING: French NutriNet-Santé study, 2009-21.

PARTICIPANTS: 95 442 adults (>18 years) without prevalent CVD who completed at least three 24 hour dietary records during the first two years of follow-up.

MAIN OUTCOME MEASURES: Associations between intake of food additive emulsifiers (continuous (mg/day)) and risk of CVD, coronary heart disease, and cerebrovascular disease characterised using multivariable proportional hazard Cox models to compute hazard ratios for each additional standard deviation (SD) of emulsifier intake, along with 95% confidence intervals.

RESULTS: Mean age was 43.1 (SD 14.5) years, and 79.0% (n=75 390) of participants were women. During follow-up (median 7.4 years), 1995 incident CVD, 1044 coronary heart disease, and 974 cerebrovascular disease events were diagnosed. Higher intake of celluloses (E460-E468) was found to be positively associated with higher risks of CVD (hazard ratio for an increase of 1 standard deviation 1.05, 95% confidence interval 1.02 to 1.09, P=0.003) and coronary heart disease (1.07, 1.02 to 1.12, P=0.004). Specifically, higher cellulose E460 intake was linked to higher risks of CVD (1.05, 1.01 to 1.09, P=0.007) and coronary heart disease (1.07, 1.02 to 1.12, P=0.005), and higher intake of carboxymethylcellulose (E466) was associated with higher risks of CVD (1.03, 1.01 to 1.05, P=0.004) and coronary heart disease (1.04, 1.02 to 1.06, P=0.001). Additionally, higher intakes of monoglycerides and diglycerides of fatty acids (E471 and E472) were associated with higher risks of all outcomes. Among these emulsifiers, lactic ester of monoglycerides and diglycerides of fatty acids (E472b) was associated with higher risks of CVD (1.06, 1.02 to 1.10, P=0.002) and cerebrovascular disease (1.11, 1.06 to 1.16, P<0.001), and citric acid ester of monoglycerides and diglycerides of fatty acids (E472c) was associated with higher risks of CVD (1.04, 1.02 to 1.07, P=0.004) and coronary heart disease (1.06, 1.03 to 1.09, P<0.001). High intake of trisodium phosphate (E339) was associated with an increased risk of coronary heart disease (1.06, 1.00 to 1.12, P=0.03). Sensitivity analyses showed consistent associations.

CONCLUSION: This study found positive associations between risk of CVD and intake of five individual and two groups of food additive emulsifiers widely used in industrial foods.

TRIAL REGISTRATION: ClinicalTrials.gov NCT03335644.

PMID:37673430 | DOI:10.1136/bmj-2023-076058

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Nevin Manimala Statistics

Unsupervised home spirometry versus supervised clinic spirometry for respiratory disease: a systematic methodology review and meta-analysis

Eur Respir Rev. 2023 Sep 6;32(169):220248. doi: 10.1183/16000617.0248-2022. Print 2023 Sep 30.

ABSTRACT

BACKGROUND: The number of patients completing unsupervised home spirometry has recently increased due to more widely available portable technology and the COVID-19 pandemic, despite a lack of solid evidence to support it. This systematic methodology review and meta-analysis explores quantitative differences in unsupervised spirometry compared with spirometry completed under professional supervision.

METHODS: We searched four databases to find studies that directly compared unsupervised home spirometry with supervised clinic spirometry using a quantitative comparison (e.g. Bland-Altman). There were no restrictions on clinical condition. The primary outcome was measurement differences in common lung function parameters (forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC)), which were pooled to calculate overall mean differences with associated limits of agreement (LoA) and confidence intervals (CI). We used the I2 statistic to assess heterogeneity, the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess evidence certainty for the meta-analyses. The review has been registered with PROSPERO (CRD42021272816).

RESULTS: 3607 records were identified and screened, with 155 full texts assessed for eligibility. We included 28 studies that quantitatively compared spirometry measurements, 17 of which reported a Bland-Altman analysis for FEV1 and FVC. Overall, unsupervised spirometry produced lower values than supervised spirometry for both FEV1 with wide variability (mean difference -107 mL; LoA= -509, 296; I2=95.8%; p<0.001; very low certainty) and FVC (mean difference -184 mL, LoA= -1028, 660; I2=96%; p<0.001; very low certainty).

CONCLUSIONS: Analysis under the conditions of the included studies indicated that unsupervised spirometry is not interchangeable with supervised spirometry for individual patients owing to variability and underestimation.

PMID:37673426 | DOI:10.1183/16000617.0248-2022

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Nevin Manimala Statistics

Safety and Immunogenicity of the Heterologous 2-Dose Ad26.ZEBOV, MVA-BN-Filo Vaccine Regimen in Health Care Providers and Frontliners of the Democratic Republic of the Congo

J Infect Dis. 2023 Aug 24:jiad350. doi: 10.1093/infdis/jiad350. Online ahead of print.

ABSTRACT

BACKGROUND: In response to recent Ebola epidemics, vaccine development against the Zaire ebolavirus (EBOV) has been fast-tracked in the past decade. Health care providers and frontliners working in Ebola-endemic areas are at high risk of contracting and spreading the virus.

METHODS: This study assessed the safety and immunogenicity of the 2-dose heterologous Ad26.ZEBOV, MVA-BN-Filo vaccine regimen (administered at a 56-day interval) among 699 health care providers and frontliners taking part in a phase 2, monocentric, randomized vaccine trial in Boende, the Democratic Republic of Congo. The first participant was enrolled and vaccinated on 18 December 2019. Serious adverse events were collected up to 6 months after the last received dose. The EBOV glycoprotein FANG ELISA (Filovirus Animal Nonclinical Group enzyme-linked immunosorbent assay) was used to measure the immunoglobulin G-binding antibody response to the EBOV glycoprotein.

RESULTS: The vaccine regimen was well tolerated with no vaccine-related serious adverse events reported. Twenty-one days after the second dose, an EBOV glycoprotein-specific binding antibody response was observed in 95.2% of participants.

CONCLUSIONS: The 2-dose vaccine regimen was well tolerated and led to a high antibody response among fully vaccinated health care providers and frontliners in Boende.

PMID:37673423 | DOI:10.1093/infdis/jiad350

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Nevin Manimala Statistics

Bland and Altman agreement method: to plot differences against means or differences against standard? An endless tale?

Clin Chem Lab Med. 2023 Sep 6. doi: 10.1515/cclm-2023-0306. Online ahead of print.

ABSTRACT

OBJECTIVES: In the Bland and Altman analysis of agreement studies, there is some controversy whether “to plot the differences between the Standard/actual measurement method and the test/new measurement method against their mean” or “to plot the differences against the standard method”. Of course, this is not just a “graphic dispute” as a regression model is inherent in the graphical choice to test the proportional and systematic biases.

METHODS: We revised two relevant papers claiming to plot the differences against the standard and outlined their pitfalls taking into account the underlying statistical methodology. Furthermore, we have considered the conditions (correlation between the two measurement methods and ratio of their variances) leading correlation coefficient and regression slope between differences and means or differences and standard different from zero.

RESULTS: We have shown the situations in which the regression slope and the correlation coefficient calculated from the differences and means according to Bland and Altman approach or calculated from the differences and standard are closer to zero giving the minimum possible value of spurious proportional error between the two methods.

CONCLUSIONS: We highlighted how the calculation of the expected values of the correlation coefficients and, above all, of the regression slope can be very useful for choosing the statistical model in the context of an agreement study between two measurement methods. Finally, we outlined some recommendations for understanding the real possibility of carrying out agreement or calibration studies.

PMID:37673419 | DOI:10.1515/cclm-2023-0306

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Nevin Manimala Statistics

Biomaterials Text Mining: A Hands-On Comparative Study of Methods on Polydioxanone Biocompatibility

N Biotechnol. 2023 Sep 4:S1871-6784(23)00044-4. doi: 10.1016/j.nbt.2023.09.001. Online ahead of print.

ABSTRACT

Scientific information extraction is fundamental for research and innovation, but is currently mostly a manual, time-consuming process. Text Mining tools (TMTs) enable automated, accurate and quick information extraction from text, but there is little precedent of their use in the biomaterials field. Here, we compare the ability of various TMTs to extract useful information from biomaterials abstracts. Focusing on the biocompatibility of polydioxanone, a biodegradable polymer for which there are relatively few scientific publications, we have tested several tools ranging from machine learning approaches and statistical text analysis to MeSH indexing and domain-specific semantic tools for Named Entity Recognition. We have evaluated their output alongside a manual review of systematic reviews and meta-analyses. The findings show that TMTs can be highly efficient and powerful for mapping biomaterials texts and rapidly yield up-to-date information. Here, they enable one to identify dominating themes, see the evolution of specific terms and topics, and learn about key medical applications in biomaterials literature over the years. The analysis also shows that heterogeneous polymer naming is a significant challenge in mining biomedical literature that is yet to be tackled. This research showcases the potential value of using Natural Language Processing and domain-specific tools to extract and organize biomaterials data.

PMID:37673372 | DOI:10.1016/j.nbt.2023.09.001

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Nevin Manimala Statistics

Impact of New Abortion Restrictions on People in Prison: Estimated Number of Incarcerated People without Abortion Access and Distance to Abortion Providers

Contraception. 2023 Sep 4:110278. doi: 10.1016/j.contraception.2023.110278. Online ahead of print.

ABSTRACT

OBJECTIVE: To estimate the annual number of incarcerated pregnant people in state and federal prisons needing an abortion.

STUDY DESIGN: We used 2021 Bureau of Justice Statistics data and prior studies’ findings to estimate the number of pregnant incarcerated people, then calculated state-specific abortion ratios to determine the number potentially needing an abortion.

RESULTS: Out of 638 pregnant people incarcerated in prisons annually, 110 would be expected to need an abortion, including 55 in states where abortion is currently banned or restricted.

CONCLUSIONS: Under Dobbs, many incarcerated pregnant people will be forced to continue unwanted pregnancies to term.

PMID:37673362 | DOI:10.1016/j.contraception.2023.110278

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Nevin Manimala Statistics

The ability of nutrition warning labels to improve understanding and choice outcomes among consumers demonstrating preferences for unhealthy foods

J Acad Nutr Diet. 2023 Sep 4:S2212-2672(23)01514-9. doi: 10.1016/j.jand.2023.08.135. Online ahead of print.

ABSTRACT

BACKGROUND: Given growing interest in warning labels as a form of front-of-pack nutrition label, it is important to better understand the mechanisms via which these labels may exert their effects, especially among those making suboptimal food choices.

OBJECTIVE: To assess the extent to which consumers with the weakest outcomes for objective understanding and choice in no-label conditions were able to improve their understanding/choices after exposure to warning labels on food product options.

DESIGN: Post-hoc analyses of the cross-sectional FOP-ICE study data generated from an online survey that included simulated food choice and nutritional quality ranking scenarios.

PARTICIPANTS/SETTING: 3680 adults from 18 countries: Argentina, Australia, Belgium, Bulgaria, Canada, Denmark, France, Germany, Italy, Mexico, Netherlands, Poland, Portugal, Singapore, Spain, Switzerland, the UK, and the USA.

INTERVENTION: Survey respondents selected their preferred product options and ranked foods according to their healthiness before and after exposure to mock breakfast cereal, cake, and pizza products displaying warning labels.

MAIN OUTCOME MEASURES: Objective understanding and food choice.

STATISTICAL ANALYSES PERFORMED: Within each product category, analyses were conducted on those who initially (i) incorrectly identified the healthiest option and/or (ii) selected the unhealthiest option as their preferred choice. Significant differences between proportions selecting each understanding and choice response option were assessed using two sample z-tests for proportions.

RESULTS: Salience of the warning labels was low: 46% reported noticing the labels while completing the survey. Just over one-third of those aware of the presence of warning labels were able to identify the least healthy option in the post-exposure condition. Around one-half re-selected the least healthy option post-exposure, and just over one-quarter switched to the healthiest option.

CONCLUSIONS: The results indicate warning labels can assist some consumers to improve their food quality assessments and choices. However, design improvements could enhance the salience and interpretability of this label format.

PMID:37673335 | DOI:10.1016/j.jand.2023.08.135

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Nevin Manimala Statistics

Effectiveness and safety of different postoperative adjuvant regimens in patients with low-grade gliomas:A network meta-analysis

World Neurosurg. 2023 Sep 4:S1878-8750(23)01237-8. doi: 10.1016/j.wneu.2023.08.125. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to investigate the effectiveness and safety of various adjuvant regimens in patients with low-grade gliomas, and to further explore the optimal adjuvant treatment for patients with low-grade gliomas and the differences in the efficacy of each treatment regimens in different tumor types.

METHODS: A comprehensive search of the PubMed, Cochrane Library, Ovid, Embase, and Web of Science databases was conducted to screen randomized and nonrandomized controlled trials related to adjuvant therapy in patients with low-grade gliomas. The Cochrane quality assessment method and the Newcastle-Ottawa scale were used to assess the quality of the included randomized and nonrandomized controlled trials, respectively. The data from previous studies were extracted using Excel and GetData Graph Digitizer 2.26 software, and network meta-analysis was performed using RevMan 5.3 and Stata 16.0 statistical software.

RESULTS: The specific ranking of 5-year progression-free survival (PFS) for each treatment regimen from best to the worst in patients with low-grade gliomas was surgery combined with procarbazine, lomustine, and vincristine (S + PCV), surgery combined with standard radiotherapy and PVC multidrug chemotherapy (S + RT + PCV), surgery combined with standard radiotherapy and temozolomide monotherapy (S + RT + TMZ), surgery combined with enhanced radiotherapy (S + H-RT), surgery combined with standard radiotherapy (S + RT), surgery combined with TMZ (S + TMZ), and S. The 5-year overall survival (OS) ranking was S + RT + TMZ, S + RT + PCV, S + H-RT + TMZ, S + H-RT, S + RT, and S. The 2-year PFS ranking was S + RT + TMZ, S + PCV, S + RT, S + RT + PCV, S + TMZ, S + H -RT, and S. The 2-year OS ranking was S + RT + TMZ, S + H-RT + TMZ, S + RT, S + RT + PCV, S + H – RT, and S. The incidence of adverse events (AEs ≥ 3) was ranked from highest to lowest as follows: S + RT + PCV, S + RT + TMZ, S + PCV, S + H-RT, S + TMZ, and S + RT. In the IDHmt/noncoder group, the S + RT + PCV and S + H – RT regimens had better 5-year PFS and 5-year OS. In the IDHmt/coder group, the 5-year PFS of each treatment regimen ranked from the best to the worst was S + RT + TMZ, S + RT + PCV, S + H-RT, S + RT, S + TMZ, and S. The order of 5-year OS from best to worst was S + H-RT, S + RT + TMZ, S + RT + PCV, S + RT, and S. In the IDHwt group, the S + H-RT and S + TMZ regimens had better 5-year PFS.

CONCLUSIONS: This study revealed that both the S + RT + TMZ and S + RT + PCV regimens might be effective therapies for treating patients with low-grade gliomas. Among these, the S + RT + TMZ regimen seemed to be safer, but might lead to tumor deterioration. In the IDHmt/coder type, the S + RT + TMZ scheme might have a significant advantage. In the IDHmt/noncoder type, the S + RT + PCV scheme might be more dominant, while in the IDHwt type, the S + H – RT and S + TMZ schemes also might be good treatment options.

PMID:37673325 | DOI:10.1016/j.wneu.2023.08.125