Tag: statistics

JMIR Form Res. 2023 Jun 19;7:e42573. doi: 10.2196/42573.

ABSTRACT

BACKGROUND: Farmers have higher rates of depression than nonfarmers and higher rates of suicide than the general population. Several barriers to help seeking have been identified in farmers, which may be overcome by offering web-based mental health support. Computerized cognitive behavioral therapy (cCBT) is an effective intervention used to prevent and treat mild to moderate depression but has not been evaluated in the farming community.

OBJECTIVE: This study explored the feasibility of delivering a cCBT course tailored to farmers using a mixed methods approach.

METHODS: Farmers (aged ≥18 years) with no, minimal, or moderately severe depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score <20) were recruited using web-based and offline advertisements and given access to a cCBT course consisting of 5 core modules and automated and personalized email support. Depression (PHQ-9), anxiety (General Anxiety Disorder-7), and social functioning (Work and Social Adjustment Scale) were measured at baseline and the 8-week follow-up. Wilcoxon signed rank tests assessed changes in scores for all outcome measures over time. Telephone interviews focusing on participant use and satisfaction with the course were analyzed using thematic analysis.

RESULTS: Overall, 56 participants were recruited; 27 (48%) through social media. Overall, 62% (35/56) of participants logged into the course. At baseline, almost half of the participants reported experiencing minimal depressive symptoms (25/56, 45%) and mild anxiety (25/56, 45%), and just over half (30/56, 54%) reported mild to moderate functional impairment. Posttreatment data were available for 27% (15/56) of participants (41/56, 73% attrition rate). On average, participants experienced fewer depressive symptoms (P=.38) and less functional impairment (P=.26) at the 8-week follow-up; these results were not statistically significant. Participants experienced significantly fewer symptoms of anxiety at the 8-week follow-up (P=.02). Most participants (13/14, 93%) found the course helpful and easy to access (10/13, 77%) and the email support helpful (12/14, 86%). Qualitative interviews identified heavy workloads and mental health stigma within the farming community as barriers to help seeking. Participants thought that web-based support would be helpful, being convenient and anonymous. There were concerns that older farmers and those with limited internet connections may have difficulty accessing the course. Improvements regarding the layout and content of the course were suggested. Dedicated support from someone with farming knowledge was recommended to improve retention.

CONCLUSIONS: cCBT may be a convenient way of supporting mental health within farming communities. However, challenges in recruiting and retaining farmers may indicate that cCBT supported only by email may not be an acceptable mode of mental health care delivery for many; however, it was valued by respondents. Involving farming organizations in planning, recruitment, and support may address these issues. Mental health awareness campaigns targeting farming communities may also help reduce stigma and improve recruitment and retention.

PMID:37335597 | DOI:10.2196/42573

Plast Reconstr Surg. 2023 Jun 19. doi: 10.1097/PRS.0000000000010840. Online ahead of print.

ABSTRACT

BACKGROUND: Benign masseteric hypertrophy (BMH) is a condition in which the thickness of the masseter muscle is increased, resulting in jawline prominence with undesirable aesthetic appearance. Botulinum toxin type A (BTA) injection is a promising treatment option, but its effective dose remains debated.

METHODS: Adults over 19 diagnosed with BMH through visual examination and palpation related to a masseter muscle prominence were selected; 80 patients were randomly assigned into five groups (placebo group and 4 groups with different doses of BTA – 24U, 48U, 72U, 96U on both sides of the jaw) and treated with placebo or BTA once at their baseline visit. During each follow-up, the treatment efficacy was evaluated via ultrasound examination of the masseter muscle, 3D facial contour analysis, visual evaluation by the investigator, and patient satisfaction evaluation.

RESULTS: The mean age of the 80 patients was 42.7±9.98 years; 68.75% were women. The mean change of the MMT during the maximum clenching state after 12 weeks of drug administration compared to the baseline in the 24U, 48U, 72U, and 96U groups were -2.33±0.41 mm, -3.35±0.42 mm, -2.86±0.42 mm, and -3.79±0.42 mm. All treatment groups showed a statistically significant decrease compared to placebo. Regarding subjective satisfaction, all treatment groups, except the 24U group at 4 weeks, showed higher satisfaction than the placebo group during all visits. No significant adverse events were noted.

CONCLUSIONS: BTA administration of at least 48U for BMH is more cost-effective than high-dose units and has a low possibility of side effects.

PMID:37335589 | DOI:10.1097/PRS.0000000000010840

Plast Reconstr Surg. 2023 Jun 19. doi: 10.1097/PRS.0000000000010822. Online ahead of print.

ABSTRACT

BACKGROUND: Patients undergoing immediate breast reconstruction with tissue expanders are frequently admitted after surgery for monitoring and pain control, which introduces additional costs and risks of nosocomial infection. Same-day discharge could conserve resources, mitigate risk, and return patients home for faster recovery. We used large data sets to investigate the safety of same day discharge after mastectomy with immediate postoperative expander placement.

METHODS: A retrospective review of patients in the National Surgical Quality Improvement Program NSQIP database who underwent tissue expander breast reconstruction between 2005 and 2019 was performed. Patients were grouped based on date of discharge. Demographic information, medical comorbidities, and outcomes were recorded. Statistical analysis was performed to determine efficacy of same-day discharge and identify factors that predict safety.

RESULTS: Of the 14,387 included patients, 10% were discharged same-day, 70% postoperative day one, and 20% later. Most common complications were infection, reoperation, and readmission and trended upward with length of stay (6.4% v 9.3% v 16.8%), though statistically equivalent between same-day and next-day discharge. The complication rate for later-day discharge was statistically higher. Patients discharged later had significantly more comorbidities than same or next-day discharge counterparts. Predictors of complication included hypertension, smoking, diabetes, and obesity.

CONCLUSIONS: Immediate tissue expander reconstruction patients are usually admitted overnight. However, we demonstrate same-day discharge has equivalent risk of perioperative complications as next-day discharge. For the otherwise healthy patient, going home the day of surgery is a safe and cost-effective option, though the decision should be made in the context of each patient.

PMID:37335577 | DOI:10.1097/PRS.0000000000010822

J Vis. 2023 Jun 1;23(6):11. doi: 10.1167/jov.23.6.11.

ABSTRACT

The human spatial orientation system is well designed on the ground but is imperfect in the aeronautical three-dimensional (3D) environment. However, human perception systems perform Bayesian statistics based on encountered environments and form shortcuts to improve perceptual efficiency. It is unknown whether our perception of spatial orientation is modified by flying experience and forms perceptual biases. The current study tested pilot perceptual biases on ambiguous visual stimuli, the bistable point-light walkers, and found that flying experiences increased the pilot’s tendency to perceive himself as higher than the target and the target as farther away from them. Such perceptual effects due to flight are likely to be attributed to experience of variable vestibular state in a higher position in 3D space, rather than the experience of a higher viewpoint. Our findings suggest that flying experience will modifies our visual perceptual biases, and that more attention should be paid to the enhanced viewing from above bias when flying to avoid overestimating altitude or viewing angle when the visual conditions are ambiguous.

PMID:37335570 | DOI:10.1167/jov.23.6.11

Plast Reconstr Surg. 2023 Jun 19. doi: 10.1097/PRS.0000000000010824. Online ahead of print.

ABSTRACT

INTRODUCTION: Intensity modulated radiation therapy (IMRT) and other modifiable radiation factors have been associated with decreased radiation toxicity. These factors could allow for improved reconstructive outcomes in patients requiring post-mastectomy radiation therapy (PMRT). However, they have not yet been well-studied in implant-based breast reconstruction (IBBR).

METHODS: We performed a retrospective chart review of patients who underwent mastectomy with immediate tissue expander placement followed by PMRT. Radiation characteristics were collected, including radiation technique, bolus regimen, X-ray energy, fractionation, maximum radiation hot spot (DMax), and tissue volume receiving >105% (V105%) or >107% (V107%) of the prescription dose. Reconstructive complications occurring after initiation of PMRT were analyzed with respect to these radiation characteristics.

RESULTS: 68 patients (70 breasts) were included in this study. The overall complication rate was 28.6%, with infection being the most common complication (24.3%), requiring removal of the tissue expander or implant in greater than half of infections (15.7%). DMax was greater in patients who required explant after PMRT, and this approached statistical significance (114.5+/-7.2% v. 111.4+/-4.4%, p=0.059). V105% and V107% were also greater in patients who required explant after PMRT (42.1+/-17.1% v. 33.0+/-20.9% and 16.4+/-14.5% v. 11.3+/-14.6%, respectively), however this was not statistically significant (p=0.176 and p=0.313, respectively). There were no significant differences in complication rates between patients with respect to radiation technique or other radiation characteristics studied.

CONCLUSIONS: Minimizing the radiation hot spots and volumes of tissue receiving greater than the prescription dose of radiation may improve reconstructive outcomes in patients undergoing IBBR followed by PMRT.

PMID:37335545 | DOI:10.1097/PRS.0000000000010824

Ecol Appl. 2023 Jun 19:e2900. doi: 10.1002/eap.2900. Online ahead of print.

ABSTRACT

Exposure to pesticides can profoundly alter community dynamics. It is expected that dominance patterns will be enhanced or reduced depending on whether the dominant species is less or more sensitive to the pesticide than the subdominant species. Community dynamics are, however, also determined by processes linked to population growth as well as competition at carrying capacity. Here, we used a mesocosm experiment to quantify the effect of chlorpyrifos exposure on the population dynamics of four cladoceran species (Daphnia magna, D. pulicaria, D. galeata and Scapholeberis mucronata) in mixed cultures, testing for direct effects of chlorpyrifos and indirect effects mediated by interactions with other species on timing of population growth and dominance at carrying capacity. We also quantified whether the pesticide-induced changes in community dynamics affect top-down control of phytoplankton. By adding a treatment in which we used different genotype combinations of each species, we also tested to what extent genetic composition affects community responses to pesticide exposure. Immobilization tests showed that D. magna is the least sensitive to chlorpyrifos of the tested species. Chlorpyrifos exposure first lead to a reduction in the abundance of D. galeata to the benefit of D. pulicaria, and subsequently to a reduction in densities of D. pulicaria to the benefit of D. magna. This resulted in D. magna being more dominant in the pesticide than in the control treatment by the end of the experiment. There was no effect of genotypic differences on community patterns, and top-down control of phytoplankton was high in all treatments. Our results suggest that in this community dominance patterns are enhanced in line with the observed among-species differences in sensitivity to the pesticide. Our results also show that the development of the community in the pesticide treatment is a complex interaction between direct and indirect effects of the pesticide.

PMID:37335538 | DOI:10.1002/eap.2900

BJOG. 2023 Jun 19. doi: 10.1111/1471-0528.17558. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the effect of treatment with neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS), versus primary debulking surgery (PDS), on quality of life (QoL) in patients with advanced epithelial ovarian cancer (EOC).

DESIGN: Randomised trial conducted in a single institution.

SETTING: Division of Gynaecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

SAMPLE: Patients with stage-IIIC/IV EOC and high tumour load.

METHODS: Patients were randomised (1:1) to undergo either PDS (PDS group) or NACT followed by IDS (NACT/IDS group).

MAIN OUTCOME MEASURES: Quality-of-life (QoL) data, assessed using the European Organization for Research and Treatment of Cancer core QoL questionnaire (QLQ-C30) and ovarian cancer module (OV28); co-primary outcomes were the QLQ-C30 global health score at 12 months (cross-sectional analysis) and the difference in mean QLQ-C30 global health score over time between treatment groups (longitudinal analysis).

RESULTS: From October 2011 to May 2016, 171 patients were enrolled (PDS = 84; NACT/IDS = 87). We observed no clinical or statistically significant difference between treatment groups in any of the QoL functioning scales at 12 months, including QLQ-C30 global health score (NACT/IDS group vs PDS group, mean difference 4.7, 95% CI -4.99 to 14.4, p = 0.340). Over time, we found lower global health scores for those undergoing PDS than for those receiving NACT (difference in mean score 6.27, 95% CI 0.440-12.11, p = 0.035), albeit this was not clinically relevant.

CONCLUSIONS: We found no difference in global QoL related to treatment approach at 12 months, even though patients in the NACT/IDS group reported better global health scores across the 12-month period compared with the PDS group; these findings further confirm that NACT/IDS might be a feasible option for patients unsuitable for PDS.

PMID:37334772 | DOI:10.1111/1471-0528.17558

Microsc Res Tech. 2023 Jun 19. doi: 10.1002/jemt.24369. Online ahead of print.

ABSTRACT

Medicinal plants are richest source of chemical compounds that can be used to evolve novel drugs. According to World Health Organization (WHO), in developing countries more than 3.5 billion people relay on herbal drugs for their primary health care. In the present study, an attempt was carried out to authenticate some selected medicinal plants (Fagonia cretica L., Peganum harmala L., Tribulus terrestris L., Chrozophora tinctoria L. Raf. and Ricinus communis L.) from family Zygophyllaceae and Euphorbiaceae using light and scanning electron macroscopic techniques. Macroscopic evaluation and comparative anatomy (Light Microscopy) of the root and fruits revealed great diversity in macro and microscopic features. Scanning electron microscopy (SEM) of root powder showed non-glandular trichomes, stellate trichomes, parenchyma cells and vessels. Fruits SEM exhibited non-glandular trichomes, glandular trichomes, stellate trichomes, peltate trichomes and mesocarp cells. Both macroscopic and microscopic evaluation plays a crucial role in the correct substantiation and validation of novel sources. These findings can serve as an essential source of information to accomplish the authenticity and to appraise the quality and purity of the herbal drugs in accordance to WHO guidelines. These parameters can be used to distinguish the selected plants from their commonly used adulterants. RESEARCH HIGHLIGHTS: In the current work, five plants (Fagonia cretica L., Peganum harmala L., Tribulus terrestris L., Chrozophora tinctoria L. Raf. and Ricinus communis L.) from Zygophyllaceae and Euphorbiaceae were investigated for macroscopy and microscopy (LM & SEM) for the first time. Macroscopic and microscopic evaluation disclosed great diversity in morphology and histology. Microscopy is the backbone of standardization process. Current study helped in correct identification and quality assurance of the plant materials. Their statistical investigation may possess great potency for plant taxonomists to further appraise the vegetative growth and tissue development which is requisite especially for fruit to enhance the yield of herbal drugs and their formulation. Further molecular studies, compounds isolation and characterization are required to deepen the knowledge of these herbal drugs.

PMID:37334760 | DOI:10.1002/jemt.24369

J Appl Clin Med Phys. 2023 Jun 19:e14065. doi: 10.1002/acm2.14065. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study is to investigate the use of a deep learning architecture for automated treatment planning for proton pencil beam scanning (PBS).

METHODS: A 3-dimensional (3D) U-Net model has been implemented in a commercial treatment planning system (TPS) that uses contoured regions of interest (ROI) binary masks as model inputs with a predicted dose distribution as the model output. Predicted dose distributions were converted to deliverable PBS treatment plans using a voxel-wise robust dose mimicking optimization algorithm. This model was leveraged to generate machine learning (ML) optimized plans for patients receiving proton PBS irradiation of the chest wall. Model training was carried out on a retrospective set of 48 previously-treated chest wall patient treatment plans. Model evaluation was carried out by generating ML-optimized plans on a hold-out set of 12 contoured chest wall patient CT datasets from previously treated patients. Clinical goal criteria and gamma analysis were used to compare dose distributions of the ML-optimized plans against the clinically approved plans across the test patients.

RESULTS: Statistical analysis of mean clinical goal criteria indicates that compared to the clinical plans, the ML optimization workflow generated robust plans with similar dose to the heart, lungs, and esophagus while achieving superior dosimetric coverage to the PTV chest wall (clinical mean V95 = 97.6% vs. ML mean V95 = 99.1%, p < 0.001) across the 12 test patients.

CONCLUSIONS: ML-based automated treatment plan optimization using the 3D U-Net model can generate treatment plans of similar clinical quality compared to human-driven optimization.

PMID:37334746 | DOI:10.1002/acm2.14065

J Clin Hypertens (Greenwich). 2023 Jun 19. doi: 10.1111/jch.14687. Online ahead of print.

ABSTRACT

To compare the predictive value of mortality between left ventricular hypertrophy (LVH) defined by Chinese thresholds and defined by international guidelines in hypertension individuals and investigate better indexation methods for LVH in Chinese population. We included 2454 community hypertensive patients with Left ventricular mass (LVM) and relative wall thickness. LVM was indexed to body surface area (BSA), height^{2 7} and height ^{1 7} . The outcomes were all-cause and cardiovascular mortality. Cox proportional hazards models were used to explore the association between LVH and the outcomes. C-statistics and time-dependent receiver operating characteristic curve (ROC) was used to evaluate the value of those indicators. During a median follow-up of 49 months (interquartile range 2-54 months), 174 participants (7.1%) died from any cause (n = 174), with 71 died of cardiovascular disease. LVM/BSA defined by the Chinese thresholds was significantly associated with cardiovascular mortality (HR: 1.63; 95%CI: 1.00-2.64). LVM/BSA was significantly associated with all-cause mortality using Chinese thresholds (HR: 1.56; 95%CI: 1.14-2.14) and using Guideline thresholds (HR: 1.52; 95%CI: 1.08-2.15). LVM/Height^1.7 was significantly associated with all-cause mortality using Chinese thresholds (HR: 1.60; 95%CI: 1.17-2.20) and using Guideline thresholds (HR: 1.54; 95%CI: 1.04-2.27). LVM/Height^2.7 was not significantly associated with all-cause mortality. C-statistics indicated that LVM/BSA and LVM/Height^1.7 by Chinese thresholds had better predictive ability for mortality. Time-ROC indicated that only LVM/Height^1.7 defined by Chinese threshold had incremental value for predicting mortality. We found that in community hypertensive populations, race-specific thresholds should be used to classify LV hypertrophy related to mortality risk stratification. LVM/BSA and LVM/Height^1.7 are acceptable normalization method in Chinese hypertension.

PMID:37334744 | DOI:10.1111/jch.14687