Tag: statistics

JMIR Form Res. 2022 Sep 19;6(9):e36805. doi: 10.2196/36805.

ABSTRACT

BACKGROUND: To empower healthy aging, digital solutions embed multiple modules for physical activity, cognitive health promotion, and social engagement. Integrating new empowering technologies such as digital exercise monitoring requires assessment measures and analysis procedures, considering variable compliance of users with different modules.

OBJECTIVE: This study aims to assess the influence of a tablet-based and a feedback system-based exercise module on balance and leg strength by considering use adherence instead of the use of the entire multimodular system.

METHODS: In the prospective cohort study within the fit4AAL project, 83 users (n=67, 81% women; n=16, 19% men; mean age 66.2, SD 2.3 years) used the 2 digital exercise modules of a multimodular physical activity promotion system for >18 weeks. A data-driven clustering method based on the average use frequency of the exercise modules determined the number of user types that met the World Health Organization-recommended training frequency of at least twice per week. On the basis of this use adherence, statistical analysis was performed with features of functional performance tests (unipedal stance, 30-second chair rise, Y-balance, and hurdle step tests). The tests were conducted 6 months before the intervention, immediately before the intervention, and after the intervention, comparing the baseline phase with the 3 feedback use groups of the study (using only the tablet, the tablet and the feedback system, or only the feedback system).

RESULTS: Of the 83 users, 43 (52%) met the World Health Organization-recommended frequency of muscle-strengthening activities. Overall, the feedback use groups achieved, on average, more chair rises in 30 seconds than the baseline group (P=.01; moderate effect size of 0.07). Of the 43 users, 26 (60%) additionally used the feedback system-based exercise module. They improved in balance compared with the users using either the tablet or the feedback system (P=.02). In addition, they improved their leg strength within the group (P=.04) and compared with the baseline (P=.01).

CONCLUSIONS: The additional use of a feedback system showed a tendency to positively maintain and influence the already exceptionally high functional performance of older adults. Considering use adherence in future multimodular system studies is crucial to assess the influence of single and combined use of exercise modules on functional performance.

PMID:36121691 | DOI:10.2196/36805

JMIR Form Res. 2022 Sep 19;6(9):e40703. doi: 10.2196/40703.

ABSTRACT

BACKGROUND: Surgery can sometimes be the best solution for chronic musculoskeletal pain, but presurgical preparation and postsurgical rehabilitation are often required to achieve the maximum benefits. A digital musculoskeletal surgical care program was developed to support the population of patients undergoing total knee arthroplasty.

OBJECTIVE: We aimed to demonstrate safety, engagement, and acceptability and explore clinical outcomes, health care use, and satisfaction among participants of a digital musculoskeletal surgical care program who were undergoing total knee arthroplasty.

METHODS: A retrospective, observational feasibility study comparing digital musculoskeletal surgical care program participants to a comparison group was conducted. The intervention group registered for a digital musculoskeletal surgical care program, which included health coaches, physical therapists, and tailored exercises and educational articles to provide preoperative and postoperative support to patients who had recently undergone total knee arthroplasty. Comparison group members received standard-of-care treatment. Engagement (number of exercise therapy sessions and educational articles accessed per week) and acceptability (Net Promoter Score) were examined among intervention group participants. Descriptive statistics for postoperative outcomes, including safety (postoperative complications), clinical improvement (pain, function, anxiety, and depression), and health care use and experiences (length of hospital stay, surgery satisfaction, and physical therapy adherence), were reported for both groups. Differences among postoperative results were compared by using the independent samples 2-tailed t test or Mann-Whitney test for continuous outcomes and the Fisher exact test or chi-square test for categorical outcomes.

RESULTS: Of the 53 participants (intervention group: n=22; comparison group: n=31) who were included in this study, 35 (66%) were female and 25 (47%) were aged from 45 to 60 years. On average, the intervention group completed 23 exercise sessions, read 2.7 educational articles, sent 45.5 texts to their health coaches, and were actively engaged for 6 weeks after their operation. Among 21 participants, 14 (67%) self-reported as promoters on the Net Promoter Score scale. Intervention group members reported fewer postoperative complications (6/22, 27%) than the comparison group (15/31, 48%), and they experienced better outcomes with regard to function (Knee Injury and Osteoarthritis Outcome Score-Physical Function Short Form-intervention group: mean 23.0; comparison group: mean 32.5), depression (Patient Health Questionnaire 2-Item-intervention group: mean 0.4; comparison group: mean 1.6), anxiety (General Anxiety Disorder 2-Item-intervention group: mean 0.6; comparison group: mean 1.5), and impressions of change (Patient Global Impression of Change-intervention group: median 7.0; comparison group: median 6.0). Intervention group participants also reported less health care use, better adherence to their physical therapy exercises, and higher surgery satisfaction.

CONCLUSIONS: Our digital musculoskeletal surgical care program shows promising levels of engagement and acceptability among those who recently underwent total knee arthroplasty. The surgical care program may also help with improving postsurgical complications and clinical outcomes and lowering health care use.

PMID:36121690 | DOI:10.2196/40703

J Air Waste Manag Assoc. 2022 Sep 19. doi: 10.1080/10962247.2022.2126558. Online ahead of print.

ABSTRACT

In order to get well understanding of the production trend of plastic waste in Chengdu, as well as its compositions and environmental impacts, based on the statistical data from 2005 to 2019, the back propagation (BP) neural network model was used to predict the production amount of plastic waste in Chengdu. Compositions of plastic waste were analyzed by sampling. In addition, inhale particles and greenhouse gas emissions (GHGs) from plastic waste incineration, bisphenol A (BPA) from plastic waste landfill were evaluated. Results indicated that, (1) economic development, urban construction level, residents’ consumption ability and plastic waste production were positively correlated to different degrees. (2) The production of plastic waste in Chengdu in 2025 and 2030 will reach 865.3 and 931 kiloton (Kt) respectively. (3) High density polyethylene (HDPE) and polypropylene (PP) are the two main components of plastic waste in Chengdu, accounted for 40.17% and 24.96%, respectively. (4) Different degrees of environmental impacts occurred during plastic waste incineration and landfill, taking the year of 2019 as an example, the incineration of plastic waste in Chengdu produced 2874.82-4711.73 tons of inhalable particulate matter (PM) and emitted 725.4-867.4 Kt of CO₂, about 65.02-910.27 kg of bisphenol A (BPA) leached from sanitary landfill. (5) positive policies and measures from the beginning to the end-of-life of plastics should be carried out in the future, which will improve plastic waste management level in Chengdu, and mitigate the side-impacts from plastic waste treatment and disposal.

PMID:36121689 | DOI:10.1080/10962247.2022.2126558

JAMA Netw Open. 2022 Sep 1;5(9):e2231903. doi: 10.1001/jamanetworkopen.2022.31903.

ABSTRACT

IMPORTANCE: The prevalence of obesity has increased substantially among emerging adults, yet no previous large-scale behavioral weight loss trials have been conducted among this age group.

OBJECTIVE: To test the effect of 2 theory-based motivational enhancements on weight loss within a primarily digital lifestyle intervention designed for emerging adults.

DESIGN, SETTING, AND PARTICIPANTS: In this randomized clinical trial conducted at an academic medical research center, 382 participants aged 18 to 25 years with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 25 to 45 were enrolled between February 2, 2016, and February 6, 2019. Data collection was completed February 8, 2020. Analysis was performed on an intention-to-treat basis.

INTERVENTIONS: Participants were randomized to 1 of 3 groups: developmentally adapted behavioral weight loss (aBWL), aBWL plus behavioral economics (aBWL + BE), or aBWL plus self-determination theory (aBWL + SDT). All groups received a 6-month intervention with 1 group session, 1 individual session, and a digital platform (digital tools for self-monitoring, weekly lessons, tailored feedback, text messages, and optional social media). The aBWL + BE group received modest financial incentives for self-monitoring and weight loss; the aBWL + SDT group received optional experiential classes. Coaching and message framing varied by group.

MAIN OUTCOMES AND MEASURES: The primary outcome was mean (SE) weight change (in kilograms) at 6 months. Secondary outcomes included proportion of participants achieving weight loss of 5% or more, percentage weight change, waist circumference, body composition, and blood pressure.

RESULTS: Among the 382 participants (mean [SD] age, 21.9 [2.2] years), 316 (82.7%) were female, mean (SD) BMI was 33.5 (4.9), 222 (58.1%) were of underrepresented race and/or ethnicity, and 320 (83.8%) were retained at the primary end point. There was a significant time effect for mean (SE) weight loss (-3.22 [0.55] kg in the aBWL group; -3.47 [0.55] kg in the aBWL + BE group; and -3.40 [0.53] kg in the aBWL + SDT group; all P < .001), but no between-group differences were observed (aBWL vs aBWL + BE: difference, -0.25 kg [95% CI, -1.79 to 1.29 kg]; P = .75; aBWL vs aBWL + SDT: difference, -0.18 kg [95% CI, -1.67 to 1.31 kg]; P = .81; and aBWL + SDT vs aBWL + BE: difference, 0.07 kg [95% CI, -1.45 to 1.59 kg]; P = .93). The proportion of participants achieving a weight loss of 5% or more was 40.0% in the aBWL group (50 of 125), 39.8% in the aBWL + BE group (51 of 128), and 44.2% in the aBWL + SDT group (57 of 129), which was not statistically different across groups (aBWL vs aBWL + BE, P = .89; aBWL vs aBWL + SDT, P = .45; aBWL + SDT vs aBWL + BE, P = .54). Parallel findings were observed for all secondary outcomes-clinically and statistically significant improvements with no differences between groups.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, all interventions produced clinically significant benefit, but neither of the motivational enhancements promoted greater reductions in adiposity compared with the developmentally adapted standard group. Continued efforts are needed to optimize lifestyle interventions for this high-risk population and determine which intervention works best for specific individuals based on sociodemographic and/or psychosocial characteristics.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02736981.

PMID:36121656 | DOI:10.1001/jamanetworkopen.2022.31903

JAMA Netw Open. 2022 Sep 1;5(9):e2231917. doi: 10.1001/jamanetworkopen.2022.31917.

ABSTRACT

IMPORTANCE: Health care workers (HCWs) have been experiencing substantial stress and burnout, and evidence-based mitigation strategies are needed. Transcendental Meditation (TM) is a mantra meditation practice with potential efficacy in reducing stress.

OBJECTIVE: To assess the efficacy of TM practice in reducing stress among HCWs over a 3-month period.

DESIGN, SETTING, AND PARTICIPANTS: This single-center open-label randomized clinical trial was conducted among HCWs at an academic medical center from November 19, 2020, to August 31, 2021. Inclusion criteria comprised a score of 6 points or greater on the Subjective Units of Distress Scale and an increase of 5% or greater in baseline heart rate or an increase of 33% or greater in galvanic skin response after exposure to a stressful script. Exclusion criteria included the use of antipsychotic or β blocker medications, current suicidal ideation, or previous TM training. Of 213 HCWs who participated in prescreening, 95 attended in-person visits, resulting in 80 eligible participants who were randomized to receive a TM intervention (TM group) or usual treatment (control group).

INTERVENTIONS: The TM group practiced TM for 20 minutes twice daily over a 3-month period. The control group received usual treatment, which consisted of access to wellness resources.

MAIN OUTCOMES AND MEASURES: The primary outcome was change in acute psychological distress measured by the Global Severity Index. Secondary outcomes included changes in burnout (measured by the Maslach Burnout Inventory), insomnia (measured by the Insomnia Severity Index), and anxiety (measured by the Generalized Anxiety Disorder-7 scale).

RESULTS: Among 80 participants, 66 (82.5%) were women, with a mean (SD) age of 40 (11) years. One participant (1.3%) was American Indian or Alaska Native, 5 (6.3%) were Asian, 12 (15.0%) were Black, 59 (73.8%) were White, and 3 (3.8%) were of unknown or unreported race; 4 participants (5.0%) were Hispanic, and 76 (95.0%) were non-Hispanic. A total of 41 participants were randomized to the TM group, and 39 were randomized to the control group. Participants in the TM group did not show a statistically significant decrease in psychological distress on the Global Severity Index compared with those in the control group (-5.6 points vs -3.8 points; between-group difference, -1.8 points; 95% CI, -4.2 to 0.6 points; P = .13). Compared with the control group, the TM group had significantly greater reductions in the secondary end points of emotional exhaustion (Maslach Burnout Inventory subscore: -8.0 points vs -2.6 points; between-group difference, -5.4 points; 95% CI, -9.2 to -1.6 points; P = .006), insomnia (Insomnia Severity Scale score: -4.1 points vs -1.9 points; between-group difference, -2.2 points; 95% CI, -4.4 to 0 points; P = .05), and anxiety (Generalized Anxiety Disorder-7 score: -3.1 points vs -0.9 points; between-group difference, -2.2 points; 95% CI, -3.8 to -0.5; P = .01) at 3 months. A total of 38 participants (92.7%) in the TM group adhered to home practice.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, TM practice among HCWs over a 3-month period did not result in a statistically significant reduction in the primary outcome of acute psychological distress compared with usual treatment but significantly improved the secondary outcomes of burnout, anxiety, and insomnia. These findings suggest that TM may be a safe and effective strategy to alleviate chronic stress among HCWs.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04632368.

PMID:36121655 | DOI:10.1001/jamanetworkopen.2022.31917

JAMA Netw Open. 2022 Sep 1;5(9):e2231973. doi: 10.1001/jamanetworkopen.2022.31973.

ABSTRACT

IMPORTANCE: For some patients receiving warfarin, adding aspirin (acetylsalicylic acid) increases bleeding risk with unclear treatment benefit. Reducing excess aspirin use could be associated with improved clinical outcomes.

OBJECTIVE: To assess changes in aspirin use, bleeding, and thrombosis event rates among patients treated with warfarin.

DESIGN, SETTING, AND PARTICIPANTS: This pre-post observational quality improvement study was conducted from January 1, 2010, to December 31, 2019, at a 6-center quality improvement collaborative in Michigan among 6738 adults taking warfarin for atrial fibrillation and/or venous thromboembolism without an apparent indication for concomitant aspirin. Statistical analysis was conducted from November 26, 2020, to June 14, 2021.

INTERVENTION: Primary care professionals for patients taking aspirin were asked whether an ongoing combination aspirin and warfarin treatment was indicated. If not, then aspirin was discontinued with the approval of the managing clinician.

MAIN OUTCOMES AND MEASURES: Outcomes were assessed before and after intervention for the primary analysis and before and after 24 months before the intervention (when rates of aspirin use first began to decrease) for the secondary analysis. Outcomes included the rate of aspirin use, bleeding, and thrombotic outcomes. An interrupted time series analysis assessed cumulative monthly event rates over time.

RESULTS: A total of 6738 patients treated with warfarin (3160 men [46.9%]; mean [SD] age, 62.8 [16.2] years) were followed up for a median of 6.7 months (IQR, 3.2-19.3 months). Aspirin use decreased slightly from a baseline mean use of 29.4% (95% CI, 28.9%-29.9%) to 27.1% (95% CI, 26.1%-28.0%) during the 24 months before the intervention (P < .001 for slope before and after 24 months before the intervention) with an accelerated decrease after the intervention (mean aspirin use, 15.7%; 95% CI, 14.8%-16.8%; P = .001 for slope before and after intervention). In the primary analysis, the intervention was associated with a significant decrease in major bleeding events per month (preintervention, 0.31%; 95% CI, 0.27%-0.34%; postintervention, 0.21%; 95% CI, 0.14%-0.28%; P = .03 for difference in slope before and after intervention). No change was observed in mean percentage of patients having a thrombotic event from before to after the intervention (0.21% vs 0.24%; P = .34 for difference in slope). In the secondary analysis, reducing aspirin use (starting 24 months before the intervention) was associated with decreases in mean percentage of patients having any bleeding event (2.3% vs 1.5%; P = .02 for change in slope before and after 24 months before the intervention), mean percentage of patients having a major bleeding event (0.31% vs 0.25%; P = .001 for change in slope before and after 24 months before the intervention), and mean percentage of patients with an emergency department visit for bleeding (0.99% vs 0.67%; P = .04 for change in slope before and after 24 months before the intervention), with no change in mean percentage of patients with a thrombotic event (0.20% vs 0.23%; P = .36 for change in slope before and after 24 months before the intervention).

CONCLUSIONS AND RELEVANCE: This quality improvement intervention was associated with an acceleration of a preexisting decrease in aspirin use among patients taking warfarin for atrial fibrillation and/or venous thromboembolism without a clear indication for aspirin therapy. Reductions in aspirin use were associated with reduced bleeding. This study suggests that an anticoagulation clinic-based aspirin deimplementation intervention can improve guideline-concordant aspirin use.

PMID:36121653 | DOI:10.1001/jamanetworkopen.2022.31973

Environ Sci Pollut Res Int. 2022 Sep 19. doi: 10.1007/s11356-022-22734-1. Online ahead of print.

ABSTRACT

Fastest growing population, rapid urbanization, and growth in the disciplines of science and technology cause continually development in the amount and diversity of solid waste. In modern world, evaluation of an appropriate solid waste disposal method (SWDM) can be referred as multi-criteria decision-making (MCDM) problem due to involvement of several conflicting quantitative and qualitative sustainability indicators. The imprecision and ambiguity are usually arisen in SWDM assessment problem, and the q-rung orthopair fuzzy set (q-ROFS) has been recognized as one of the adaptable and valuable ways to tackle the complex uncertain information arisen in realistic problems. In the context of q-ROFSs, entropy is a significant measure for depicting fuzziness and uncertain information of q-ROFS and the discrimination measure is generally used to quantify the distance between two q-ROFSs by evaluating the amount of their discrimination. Thus, the aim of this study is to propose a novel integrated framework based on multi-attribute multi-objective optimization with the ratio analysis (MULTIMOORA) method with q-rung orthopair fuzzy information (q-ROFI). In this approach, an integrated weighting process is presented by combining objective and subjective weights of criteria with q-ROFI. Inspired by the q-rung orthopair fuzzy entropy and discrimination measure, objective weights of criteria are estimated by entropy and discrimination measure-based model. Whereas, the subjective weights are derived based on aggregation operator and the score function under q-ROFS environment. In this respect, novel entropy and discrimination measure are proposed for q-ROFSs. Furthermore, to display the feasibility and usefulness of the introduced approach, a case study related to SWD method selection is presented under q-ROFS perspective. Finally, comparison and sensitivity investigation are presented to confirm the robustness and solidity of the introduced approach.

PMID:36121629 | DOI:10.1007/s11356-022-22734-1

Jpn J Radiol. 2022 Sep 19. doi: 10.1007/s11604-022-01336-4. Online ahead of print.

ABSTRACT

PURPOSE: The present study aims to investigate the occurrence and severity of HRCT abnormalities in symptomatic never-smokers, passively exposed to cigarette smoke.

MATERIALS AND METHODS: A total of 135 never-smokers with respiratory symptoms, without underlying lung disease, underwent paired inspiratory-expiratory HRCT and completed the secondhand smoking (SHS) exposure scale questionnaire. Individuals passively exposed to tobacco consisted the secondhand smoking group (SHS group) (n = 68); the remaining 67 controls were never exposed to SHS. Statistical analysis was performed using the Kolmogorov-Smirnov, x² and Pearson Point-Biserial correlation tests. P < 0.05 was statistically significant.

RESULTS: HRCT findings in SHS group included bronchial wall thickening (98.5%), mild cylindrical bronchiectasis (44%), ground-glass opacities (17.6%), and mosaic attenuation pattern (53%). Air trapping occurred in 65% of expiratory scans. Differences in occurrence of findings between SHS group participants and controls were statistically significant (p < 0.0001). There was significant correlation between exposure to tobacco smoke in hours/day and in number of cigarettes/day and the presence of mosaic attenuation pattern, ground-glass opacities, cylindrical bronchiectasis and air trapping, respectively (p < 0.05). Cumulative SHS exposure in years was also strongly correlated with the presence of ground-glass opacities, mosaic attenuation pattern, cylindrical bronchiectasis, and air trapping, as well as with the frequency of respiratory symptoms (p < 0.05).

CONCLUSION: HRCT findings attributed to SHS are mostly related to airway involvement and are correlated with the duration and grade of exposure to environmental tobacco smoke. SHS followed by lifestyle adjustments should be considered in symptomatic non-smokers with such HRCT findings.

PMID:36121625 | DOI:10.1007/s11604-022-01336-4

Drugs. 2022 Sep 19. doi: 10.1007/s40265-022-01769-1. Online ahead of print.

ABSTRACT

Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegenerative disorder involving loss of upper and lower motor neurons, with most cases ending in death within 3-5 years of onset. Several molecular and cellular pathways have been identified to cause ALS; however, treatments to stop or reverse disease progression are yet to be found. Riluzole, a neuroprotective agent offering only a modest survival benefit, has long been the sole disease-modifying therapy for ALS. Edaravone, which demonstrated statistically significant slowing of ALS disease progression, is gaining approval in an increasing number of countries since its first approval in 2015. Sodium phenylbutyrate and taurursodiol (PB-TURSO) was conditionally approved in Canada in 2022, having shown significant slowing of disease progression and prolonged survival. Most clinical trials have focused on testing small molecules affecting common cellular pathways in ALS: targeting glutamatergic, apoptotic, inflammatory, and oxidative stress mechanisms among others. More recently, clinical trials utilizing stem cell transplantation and other biologics have emerged. This rich and ever-growing pipeline of investigational products, along with innovative clinical trial designs, collaborative trial networks, and an engaged ALS community’, provide renewed hope to finding a cure for ALS. This article reviews existing ALS therapies and the current clinical drug development pipeline.

PMID:36121612 | DOI:10.1007/s40265-022-01769-1

Photochem Photobiol Sci. 2022 Sep 19. doi: 10.1007/s43630-022-00303-2. Online ahead of print.

ABSTRACT

In the current study, the application of fluorescence spectroscopy along with the advanced statistical technique and confocal microscopy was investigated for the early detection of stripe rust infection in wheat grown under field conditions. The indigenously developed Fluorosensor fitted with LED, emitting monochromatic light was used that covered comparatively larger leaf area for recording fluorescence data thus presenting more reliable current status of the leaf. The examined leaf samples covered the entire range of stripe rust disease infection from no visible symptoms to the complete disease prevalence. The molecular changes were also assessed in the leaves as the disease progresses. The emission spectra mainly produce two fluorescence emission classes, namely the blue-green fluorescence (400-600 nm range) and chlorophyll fluorescence (650-800 nm range). The chlorophyll fluorescence region showed lower chlorophyll bands both at 685 and 735 nm in the asymptomatic (early diseased) and symptomatic (diseased) leaf samples than the healthy ones as a result of partial deactivation of PSII reaction centers. The 735 nm chlorophyll fluorescence band was either slight or completely absent in the leaf samples with lower to higher disease incidence and thus differentiate between the healthy and the infected leaf samples. The Hydroxycinnamic acids (caffeic and sinapic acids) showed decreasing trend, whereas the ferulic acid increased with the rise in disease infection. Peak broadening/shifting has been observed in case of ferulic acid and carotenes/carotenoids, with the increase in the disease intensity. While using the LEDs (365 nm), the peak broadening and the decline in the chlorophyll fluorescence bands could be used for the early prediction of stripe rust disease in wheat crop. The PLSR statistical techniques discriminated well between the healthy and the diseased samples, thus showed promise in early disease detection. Confocal microscopy confirmed the early prevalence of stripe rust disease infection in a susceptible variety at a stage when the disease is not detectable visually. It is inferred that fluorescence emission spectroscopy along with the chemometrics aided in the effective and timely diagnosis of plant diseases and the detected signatures provide the basis for remote sensing.

PMID:36121603 | DOI:10.1007/s43630-022-00303-2