Tag: statistics

Proc Natl Acad Sci U S A. 2024 Jun 11;121(24):e2402375121. doi: 10.1073/pnas.2402375121. Epub 2024 Jun 3.

ABSTRACT

Recent work has emphasized the disproportionate bias faced by minorities when interacting with law enforcement. However, research on the topic has been hampered by biased sampling in administrative data, namely that records of police interactions with citizens only reflect information on the civilians that police elect to investigate, and not civilians that police observe but do not investigate. In this work, we address a related bias in administrative police data which has received less empirical attention, namely reporting biases around investigations that have taken place. Further, we investigate whether digital monitoring tools help mitigate this reporting bias. To do so, we examine changes in reports of interactions between law enforcement and citizens in the wake of the New York City Police Department’s replacement of analog memo books with mobile smartphones. Results from a staggered difference in differences estimation indicate a significant increase in reports of citizen stops once the new smartphones are deployed. Importantly, we observe that the rise is driven by increased reports of “unproductive” stops, stops involving non-White citizens, and stops occurring in areas characterized by a greater concentration of crime and non-White residents. These results reinforce the recent observation that prior work has likely underestimated the extent of racial bias in policing. Further, they highlight that the implementation of digital monitoring tools can mitigate the issue to some extent.

PMID:38830090 | DOI:10.1073/pnas.2402375121

Continuum (Minneap Minn). 2024 Jun 1;30(3):878-903. doi: 10.1212/CON.0000000000001433.

ABSTRACT

OBJECTIVE: This article synthesizes the current literature on prognostication in neurocritical care, identifies existing challenges, and proposes future research directions to reduce variability and enhance scientific and patient-centered approaches to neuroprognostication.

LATEST DEVELOPMENTS: Patients with severe acute brain injury often lack the capacity to make their own medical decisions, leaving surrogate decision makers responsible for life-or-death choices. These decisions heavily rely on clinicians’ prognostication, which is still considered an art because of the previous lack of specific guidelines. Consequently, there is significant variability in neuroprognostication practices. This article examines various aspects of neuroprognostication. It explores the cognitive approach to prognostication, highlights the use of statistical modeling such as Bayesian models and machine learning, emphasizes the importance of clinician-family communication during prognostic disclosures, and proposes shared decision making for more patient-centered care.

ESSENTIAL POINTS: This article identifies ongoing challenges in the field and emphasizes the need for future research to ameliorate variability in neuroprognostication. By focusing on scientific methodologies and patient-centered approaches, this research aims to provide guidance and tools that may enhance neuroprognostication in neurocritical care.

PMID:38830074 | DOI:10.1212/CON.0000000000001433

J Craniofac Surg. 2024 Jun 3. doi: 10.1097/SCS.0000000000010385. Online ahead of print.

ABSTRACT

The purpose of this study was to compare speech outcomes in patients with submucous cleft palate (SMCP) between speech therapy alone and double-opposing Z-plasty (DOZ) combined with speech therapy. The subjects were 67 patients with SMCP (overt type, 45 males, 22 females), who were divided into the observation group (n=18), the speech therapy group (n=24; duration, 17.8 mo), and the DOZ and speech therapy (DOZ-speech therapy) group (n=25; median age at DOZ, 5.3 years, duration, 18.6 mo). The median age at initial and final speech assessments were 3 and 5 years. After age, sex, syndromic status, duration of speech therapy, surgery timing, and speech outcomes were investigated, statistical analysis was performed. After tailored interventions, both isolated and non-isolated SMCP patients experienced significant improvements in speech outcomes, including nasal emission, hypernasality, compensatory articulation, and unintelligible speech. Since comparable improvements were observed, there were no significant differences in the final assessments regardless of initial speech issues between the speech therapy group and the DOZ-speech therapy group (all P>0.05). In the DOZ-speech therapy group, the rate of achieving “socially acceptable” speech was 92.3% in isolated cases and 90% in non-isolated cases. Multivariate analysis revealed that DOZ showed a tendency to reduce hypernasality, compensatory articulation, and “unintelligible” speech; syndromic or developmental conditions influenced outcomes in nasal emission and hypernasality; and initial hypernasality and compensatory articulation were correlated with outcomes. Therefore, DOZ surgery could be recommended to resolve hypernasality and compensatory articulation in SMCP patients before speech issues worsen.

PMID:38830053 | DOI:10.1097/SCS.0000000000010385

Ann Med. 2024 Dec;56(1):2362880. doi: 10.1080/07853890.2024.2362880. Epub 2024 Jun 3.

ABSTRACT

BACKGROUND: Nocturnal blood pressure (BP) is correlated with an increased risk of cardiovascular events and is an important predictor of cardiovascular death in hypertensive patients.

OBJECTIVE: Nocturnal BP control is of great importance for cardiovascular risk reduction. This systematic review and meta-analysis aimed to explore the efficacy of angiotensin receptor blockers (ARBs) for nocturnal BP reduction in patients with mild to moderate hypertension.

METHODS: PICOS design structure was used to formulate the data extraction. All statistical calculations and analyses were performed with R.

RESULTS: Seventy-seven studies with 13,314 participants were included. The overall analysis indicated that nocturnal BP drop varied considerably among different ARBs. Allisartan (13.04 [95% CI (-18.41, -7.68)] mmHg), olmesartan (11.67 [95% CI (-14.12, -9.21)] mmHg), telmisartan (11.11 [95% CI (-12.12, -10.11)] mmHg) were associated with greater reduction in nocturnal systolic BP. In the aspect of the nocturnal-diurnal BP drop ratio, only allisartan was greater than 1. While, the variation tendency of last 4-6 h ambulatory BP was basically consistent with nocturnal BP. Additionally, allisartan showed improvement effect in the proportion of patients with dipping BP pattern.

CONCLUSIONS: This study demonstrates that for patients with mild to moderate hypertension, allisartan, olmesartan and telmisartan have more advantages in nocturnal BP reduction among the ARBs, while allisartan can reduce nighttime BP more than daytime BP and improve the dipping pattern.

PMID:38830046 | DOI:10.1080/07853890.2024.2362880

JNCI Cancer Spectr. 2024 Jun 3:pkae043. doi: 10.1093/jncics/pkae043. Online ahead of print.

ABSTRACT

BACKGROUND: Socioeconomic inequalities in the uptake of colorectal cancer screening are well documented, but the implications on health inequity remain unclear.

METHODS: Sixty-year-olds were randomly recruited from the Swedish population between March, 2014, and March, 2020, and invited to either fecal immunochemical testing (FIT) 2 years apart (n = 60,137) or once-only primary colonoscopy (PCOL; n = 30,400). By linkage to Statistics Sweden’s registries, we obtained socioeconomic data. In each defined socioeconomic group, we estimated the cumulative yield of advanced neoplasia (AN) in each screening arm (intention-to-screen analysis). We predicted the probability of exceeding the yield in the PCOL arm after a third round of FIT: Pr{AN_FIT3>AN_PCOL}.

RESULTS: In the lowest income group, the yield of AN was 1.63% (95% confidence interval [CI] = 1.35% to 1.93%) after two rounds of FIT, in relation to 1.93% (95% CI = 1.49% to 2.40%) in the PCOL arm. We predicted Pr{AN_FIT3>AN_PCOL} = 0.86. In the highest income group, we found a more pronounced yield gap between the two screening strategies, 2.32% (95% CI = 2.15% to 2.49%) vs 3.71% (95% CI = 3.41% to 4.02%), and a very low Pr{AN_FIT3>AN_PCOL} (= 0.02).

CONCLUSIONS: Yields of AN from FIT 2 years apart and PCOL, respectively, were poorer, but differed lesser, in lower socioeconomic groups. The results are valuable for evaluations of health equity in organized screening for colorectal cancer.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov number NCT02078804.

PMID:38830030 | DOI:10.1093/jncics/pkae043

J Pediatr Endocrinol Metab. 2024 Jun 4. doi: 10.1515/jpem-2024-0144. Online ahead of print.

ABSTRACT

OBJECTIVES: This study is aimed to explore the correlation between bisphenol A (BPA) and phthalates, including diethylhexylphthalate (DEHP) and dibutylphthalate (DBP), and precocious puberty (PP).

METHODS: A case-control study was conducted in Ho Chi Minh City, Vietnam, from November 2021 to April 2022, involving 250 children, with 124 of them diagnosed with PP and 126 serving as controls. We assessed the levels of urinary BPA, DEHP, and DBP in all participants and examined their association with the risk of PP.

RESULTS: BPA was detected in 11.3 % of PP cases but was not found in any individuals in the control group (p<0.001). Diethylhexylphthalate metabolite (MEHP) was not detected in any of the samples. Positive urinary results for dibutylphthalate metabolite (MBP) were observed in 8.1 % of PP cases and 2.4 % in the control group, with an odds ratio of 3.6 (95 % confidence interval: 0.97-13.4, p=0.03).

CONCLUSIONS: The PP group exhibited a higher prevalence of positive urinary BPA and DBP levels compared to the control group.

PMID:38829694 | DOI:10.1515/jpem-2024-0144

Invest Ophthalmol Vis Sci. 2024 Jun 3;65(6):3. doi: 10.1167/iovs.65.6.3.

ABSTRACT

PURPOSE: Investigating influencing factors on the pupillary light response (PLR) as a biomarker for local retinal function by providing epidemiological data of a large normative collective and to establish a normative database for the evaluation of chromatic pupil campimetry (CPC).

METHODS: Demographic and ophthalmologic characteristics were captured and PLR parameters of 150 healthy participants (94 women) aged 18 to 79 years (median = 46 years) were measured with L-cone- and rod-favoring CPC protocols. Linear-mixed effects models were performed to determine factors influencing the PLR and optical coherence tomography (OCT) data were correlated with the pupillary function volume.

RESULTS: Relative maximal constriction amplitude (relMCA) and latency under L-cone- and rod-favoring stimulation were statistically significantly affected by the stimulus eccentricity (P < 0.0001, respectively). Iris color and gender did not affect relMCA or latency significantly; visual hemifield, season, and daytime showed only minor influence under few stimulus conditions. Age had a statistically significant effect on latency under rod-specific stimulation with a latency prolongation ≥60 years. Under photopic and scotopic conditions, baseline pupil diameter declined significantly with increasing age (P < 0.0001, respectively). Pupillary function volume and OCT data were not correlated relevantly.

CONCLUSIONS: Stimulus eccentricity had the most relevant impact on relMCA and latency of the PLR during L-cone- and rod-favoring stimulation. Latency is prolonged ≥60 years under scotopic conditions. Considering the large study collective, a representative normative database for relMCA and latency as valid readout parameters for L-cone- and rod-favoring stimulation could be established. This further validates the usability of the PLR in CPC as a biomarker for local retinal function.

PMID:38829669 | DOI:10.1167/iovs.65.6.3

JAMA. 2024 Jun 3. doi: 10.1001/jama.2024.4088. Online ahead of print.

ABSTRACT

IMPORTANCE: Optimal health care delivery, both now and in the future, requires a continuous loop of knowledge generation, dissemination, and uptake on how best to provide care, not just determining what interventions work but also how best to ensure they are provided to those who need them. The randomized clinical trial (RCT) is the most rigorous instrument to determine what works in health care. However, major issues with both the clinical trials enterprise and the lack of integration of clinical trials with health care delivery compromise medicine’s ability to best serve society.

OBSERVATIONS: In most resource-rich countries, the clinical trials and health care delivery enterprises function as separate entities, with siloed goals, infrastructure, and incentives. Consequently, RCTs are often poorly relevant and responsive to the needs of patients and those responsible for care delivery. At the same time, health care delivery systems are often disengaged from clinical trials and fail to rapidly incorporate knowledge generated from RCTs into practice. Though longstanding, these issues are more pressing given the lessons learned from the COVID-19 pandemic, heightened awareness of the disproportionate impact of poor access to optimal care on vulnerable populations, and the unprecedented opportunity for improvement offered by the digital revolution in health care. Four major areas must be improved. First, especially in the US, greater clarity is required to ensure appropriate regulation and oversight of implementation science, quality improvement, embedded clinical trials, and learning health systems. Second, greater adoption is required of study designs that improve statistical and logistical efficiency and lower the burden on participants and clinicians, allowing trials to be smarter, safer, and faster. Third, RCTs could be considerably more responsive and efficient if they were better integrated with electronic health records. However, this advance first requires greater adoption of standards and processes designed to ensure health data are adequately reliable and accurate and capable of being transferred responsibly and efficiently across platforms and organizations. Fourth, tackling the problems described above requires alignment of stakeholders in the clinical trials and health care delivery enterprises through financial and nonfinancial incentives, which could be enabled by new legislation. Solutions exist for each of these problems, and there are examples of success for each, but there is a failure to implement at adequate scale.

CONCLUSIONS AND RELEVANCE: The gulf between current care and that which could be delivered has arguably never been wider. A key contributor is that the 2 limbs of knowledge generation and implementation-the clinical trials and health care delivery enterprises-operate as a house divided. Better integration of these 2 worlds is key to accelerated improvement in health care delivery.

PMID:38829654 | DOI:10.1001/jama.2024.4088

Turk Kardiyol Dern Ars. 2024 Jun;52(4):269-273. doi: 10.5543/tkda.2024.55484.

ABSTRACT

OBJECTIVE: Individuals across all age groups may experience elevated blood pressure due to a combination of internal and environmental factors. Factors influencing arterial pressure include diet, stress, sleep patterns, and lifestyle. This study aims to investigate the susceptibility to high blood pressure among occupational groups working night shifts.

METHOD: The study included healthcare worker participants who had at least six night shifts per month. A control group consisted of participants performing the same roles during daytime. Participants with chronic diseases or those taking blood pressure-affecting medication were excluded. Holter recordings were made over a minimum of 48 hours, including both a free day and a work day.

RESULTS: The study involved 114 participants-55 in the study group and 59 in the control group. Statistically significant differences were noted between the groups in the daylight-night ratios of systolic and diastolic pressures, with P values of 0.006 and 0.005, respectively. The systolic daylight-night difference was -5.7 ± 5.5% in the study group and -9.0 ± 7.0% in the control group. The diastolic daylight-night difference was -7.9 ± 9.6% in the study group and -12.7 ± 8.2% in the control group.

CONCLUSION: Occupations with nighttime work schedules are often associated with non-dipping blood pressure patterns due to sleep disturbances. It is crucial to consider the blunted dipping of blood pressure induced by night shift work when assessing and monitoring hypertension and related medical conditions.

PMID:38829641 | DOI:10.5543/tkda.2024.55484

Turk Kardiyol Dern Ars. 2024 Jun;52(4):237-243. doi: 10.5543/tkda.2024.27546.

ABSTRACT

OBJECTIVE: This study aims to explore the impact of sodium-glucose cotransporter-2 (SGLT-2) inhibitors, a newer class of oral antidiabetic drugs, on atrial electromechanical delay (EMD) in patients with type 2 diabetes mellitus (DM). This is particularly relevant given the significantly higher incidence of atrial fibrillation (AF) in diabetic patients compared to the general population. Atrial electromechanical delay is recognized as an important factor influencing the development of atrial fibrillation.

METHODS: This study included 30 type 2 DM patients (53.3% female, mean age 60.07 ± 10.03 years), initiating treatment with SGLT-2 inhibitors. The patients were assessed using echocardiography at baseline and again at 6 months, focusing on basic echocardiographic parameters and atrial electromechanical delay times (EMD) measured via tissue Doppler imaging.

RESULTS: No significant changes were observed in intra-atrial EMD times. However, significant reductions were noted in interatrial EMD times, decreasing from 15.13 ± 5.87 ms to 13.20 ± 6.12 ms (P = 0.029). Statistically significant shortening occurred in lateral pulmonary acceleration (PA) times (from 58.73 ± 6.41 ms to 54.37 ± 6.97 ms, P < 0.001), septal PA times (from 50.90 ± 6.02 ms to 48.23 ± 5), and tricuspid PA times (from 43.60 ± 6.28 ms to 41.30 ± 5.60 ms, P = 0.003). Additionally, there was a significant reduction in the E/e’ ratio from 8.13 ± 4.0 to 6.50 ± 2.37 (P = 0.003).

CONCLUSION: SGLT-2 inhibitors might positively influence atrial electromechanical conduction, reducing DM-related functional impairments and the risk of arrhythmias, particularly AF.

PMID:38829634 | DOI:10.5543/tkda.2024.27546