Tag: statistics

J Basic Clin Physiol Pharmacol. 2023 Mar 24. doi: 10.1515/jbcpp-2023-0040. Online ahead of print.

ABSTRACT

Moderate-to-vigorous physical activity (MVPA) has been shown to have a favorable effect on many diseases as a complementary therapy and is a critical component of healthy living. During the pandemic era, physical activity has been promoted for resistance against coronavirus disease 2019 (COVID-19). However, there is scarce evidence on whether MVPA could reduce the infectivity and susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The objective of this meta-analysis was to determine the effect of MVPA on morbidity, mortality, and duration of hospitalization in COVID-19 patients. We performed a comprehensive search of five online databases for eligible studies up to September 9, 2021. Meta-analyses were conducted to determine the association between MVPA and COVID-19-related morbidity, hospitalization, and mortality. The odds ratio (OR) was applied as the summary statistic for the primary outcomes. Secondary analyses were conducted to evaluate the difference in the metabolic equivalent of tasks (METs) between the outcome and non-outcome groups with the mean difference as the pooled effect. This meta-analysis included eight observational studies. We found that MVPA significantly reduced the odds of contracting SARS-CoV-2 infection (OR=0.88; 95% confidence interval [CI] = 0.85-0.92), hospitalization (OR=0.56; 95% CI=0.35-0.92), and mortality (OR=0.42; 95% CI=0.21-0.81) due to COVID-19 compared to no physical activity. METs≥500 min/week were linked to decreased morbidity and mortality of COVID-19 (OR=0.94 [95% CI=0.90-0.98]; OR=0.56 [95% CI=0.38-0.83]). COVID-19 patients with MVPA demonstrated a lower risk of COVID-19-related morbidity, hospitalization, and mortality compared to those who were less active, highlighting the importance of an active lifestyle despite the pandemic situation where such activities are limited.

PMID:36957989 | DOI:10.1515/jbcpp-2023-0040

J Am Acad Orthop Surg. 2023 Mar 23. doi: 10.5435/JAAOS-D-22-00764. Online ahead of print.

ABSTRACT

INTRODUCTION: Acetabular fractures requiring an anterior approach have historically been delayed, allowing a stable clot to form before creating large surgical exposures. The purpose of this study was to determine whether immediate fixation of acetabular fractures within 24 hours using an anterior approach demonstrates notable difference in blood loss, length of stay (LOS), complications, or mortality compared with acetabular fractures treated after 24 hours.

METHODS: Ninety-three patients were optimized for surgery within 24 hours of injury. Thirty-two patients underwent fixation within 24 hours using an anterior approach to the acetabulum. Demographics, hours from injury to operating room, fracture classification, embolization, surgical approach, intraoperative cell salvage use, Charlson Comorbidity Index, American Society of Anesthesiologists class, Injury Severity Score, and Abbreviated Chest Injury Score were recorded. Estimated blood loss, transfusions, intensive care unit stay, total hospital LOS, complications, and mortality rates were compared.

RESULTS: No statistically significant differences were observed in fracture classification, blood loss, or intraoperative transfusions between the immediate and delayed fixation groups. Six patients in the delayed group (9.8%) returned to the operating room for a complication compared with one patient (3.1%) in the immediate group (P = 0.42). Three patients in the delayed group (4.9%) developed a surgical site infection compared with none (0%) in the immediate group (P = 0.55). The immediate group had an average LOS of 7 days compared with 11 days in the delayed fixation group (P = 0.01). No notable differences were observed in 30- or 90-day mortality rates.

DISCUSSION: Medically optimized patients with acetabular fractures who undergo immediate fixation through an anterior approach do not seem to have an associated increase in blood loss, transfusions, or mortality. Prompt surgical management may also be associated with a shorter preoperative and postoperative LOS.

LEVEL OF EVIDENCE: Therapeutic level III.

PMID:36952666 | DOI:10.5435/JAAOS-D-22-00764

J Clin Oncol. 2023 Mar 23:JCO2201649. doi: 10.1200/JCO.22.01649. Online ahead of print.

ABSTRACT

PURPOSE: Metastatic castration-resistant prostate cancer (mCRPC) remains a lethal disease with current standard-of-care therapies. Homologous recombination repair (HRR) gene alterations, including BRCA1/2 alterations, can sensitize cancer cells to poly (ADP-ribose) polymerase inhibition, which may improve outcomes in treatment-naïve mCRPC when combined with androgen receptor signaling inhibition.

METHODS: MAGNITUDE (ClinicalTrials.gov identifier: NCT03748641) is a phase III, randomized, double-blinded study that evaluates niraparib and abiraterone acetate plus prednisone (niraparib + AAP) in patients with (HRR+, n = 423) or without (HRR-, n = 247) HRR-associated gene alterations, as prospectively determined by tissue/plasma-based assays. Patients were assigned 1:1 to receive niraparib + AAP or placebo + AAP. The primary end point, radiographic progression-free survival (rPFS) assessed by central review, was evaluated first in the BRCA1/2 subgroup and then in the full HRR+ cohort, with secondary end points analyzed for the full HRR+ cohort if rPFS was statistically significant. A futility analysis was preplanned in the HRR- cohort.

RESULTS: Median rPFS in the BRCA1/2 subgroup was significantly longer in the niraparib + AAP group compared with the placebo + AAP group (16.6 v 10.9 months; hazard ratio [HR], 0.53; 95% CI, 0.36 to 0.79; P = .001). In the overall HRR+ cohort, rPFS was significantly longer in the niraparib + AAP group compared with the placebo + AAP group (16.5 v 13.7 months; HR, 0.73; 95% CI, 0.56 to 0.96; P = .022). These findings were supported by improvement in the secondary end points of time to symptomatic progression and time to initiation of cytotoxic chemotherapy. In the HRR- cohort, futility was declared per the prespecified criteria. Treatment with niraparib + AAP was tolerable, with anemia and hypertension as the most reported grade ≥ 3 adverse events.

CONCLUSION: Combination treatment with niraparib + AAP significantly lengthened rPFS in patients with HRR+ mCRPC compared with standard-of-care AAP.

PMID:36952634 | DOI:10.1200/JCO.22.01649

Int J Epidemiol. 2023 Mar 23:dyad038. doi: 10.1093/ije/dyad038. Online ahead of print.

ABSTRACT

MOTIVATION: Directed acyclic graphs (DAGs) are used in epidemiological research to communicate causal assumptions and guide the selection of covariate adjustment sets when estimating causal effects. For any given DAG, a set of graphical rules can be applied to identify minimally sufficient adjustment sets that can be used to adjust for bias due to confounding when estimating the causal effect of an exposure on an outcome. The daggle app is a web-based application that aims to assist in the learning and teaching of adjustment set identification using DAGs.

GENERAL FEATURES: The application offers two modes: tutorial and random. The tutorial mode presents a guided introduction to how common causal structures can be presented using DAGs and how graphical rules can be used to identify minimally sufficient adjustment sets for causal estimation. The random mode tests this understanding by presenting the user with a randomly generated DAG-a daggle. To solve the daggle, users must correctly identify a valid minimally sufficient adjustment set.

IMPLEMENTATION: The daggle app is implemented as an R shiny application using the golem framework. The application builds upon existing R libraries including pcalg to generate reproducible random DAGs, dagitty to identify all valid minimal adjustment sets and ggdag to visualize DAGs.

AVAILABILITY: The daggle app can be accessed online at [http://cbdrh.shinyapps.io/daggle]. The source code is available on GitHub [https://github.com/CBDRH/daggle] and is released under a Creative Commons CC BY-NC-SA 4.0 licence.

PMID:36952629 | DOI:10.1093/ije/dyad038

Int J Radiat Biol. 2023 Mar 23:1-16. doi: 10.1080/09553002.2023.2194405. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to evaluate if the micronucleus test using oral epithelial cells is a suitable biomarker for biomonitoring children exposed to X-ray.

MATERIAL AND METHODS: A search was performed through the electronic databases PubMed/Medline, Scopus and Web of Science, all studies published up to February 2022 that examined the relationship between exposure of children to radiographic examinations and micronucleus.

RESULTS: The initial search in the electronic databases identified 108 records. 91 records were excluded because they were repeated or not related to the study. A total of 17 full-text manuscripts were screened for eligibility. Finally, a total of nine manuscripts met the inclusion criteria in the SR and six were included in the meta-analysis. Only two studies found a difference in micronucleus labeling. On the other hand, all studies showed that X-ray was able to induce cellular death in oral mucosa cells. Following the parameters of the Effective Practices in Public Health Project (EPHPP), five manuscripts reached moderate and strong scores, and four studies were categorized as weak at final rating. In the meta-analysis, the diamond advanced more towards the increase of micronuclei after the radiographic examination. With a statistically significant difference in micronucleated cells in children before and after radiographic examinations (SMD = 0.96, 95% CI, 0.07 to 1.84, p = 0.04), with Tau²=1.09; Chi²=53.37, and p < 0.001.

CONCLUSION: Radiographic examinations in children can cause genotoxic and cytotoxic damage in the oral epithelium with a large effect size.

PMID:36952616 | DOI:10.1080/09553002.2023.2194405

J Orthop Trauma. 2023 Mar 23. doi: 10.1097/BOT.0000000000002602. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine the infection and non-union rates for open tibia fracture treatment over the last four decades since the introduction of the Gustilo-Anderson (GA) open fracture classification.

DATA SOURCES: PubMed, Scopus, CINAHL, and Cochrane databases were reviewed using the PRISMA checklist for articles between 1977 and September 2018.

STUDY SELECTION: 161 articles meeting the following inclusion criteria: English language, published between 1977-2018, reported infection rates, reported nonunion rates and fractures classified by the GA open fracture criteria were selected.

DATA EXTRACTION: All articles were thoroughly evaluated to extract infection and nonunion data for open tibia fractures.Data Synthesis Due to variability in the data reviewed, statistical evaluation could not be reliably done.

RESULTS: 11,326 open tibia fractures were reported with 17% type I, 25.2% type II, 25.3% type IIIA, and 32.5% type IIIB/C. The average infection rate over four decades was 18.3%, with 24.3% superficial, 61% deep, and 14.7% pin tract. The infection rate by decade was: 14% for 1977-1986, 16.2% for 1987-1996, 20.5% for 1997-2006, and 18.1% from 2007-2017. The overall non-union rate was 14.1%. The non-union rate was 13% for 1977-1986, 17% for 1987-1996, 12.8% for 1997-2006, and 12.3% for 2007-2017.

CONCLUSIONS: This in-depth summary has demonstrated that the percentage rate for infections and nonunion has remained similar over the past forty years.

LEVEL OF EVIDENCE: Level IV. See Instructions for Authors for a complete description of levels of evidence.

PMID:36952593 | DOI:10.1097/BOT.0000000000002602

PLoS Comput Biol. 2023 Mar 23;19(3):e1010953. doi: 10.1371/journal.pcbi.1010953. Online ahead of print.

ABSTRACT

Mitochondria are highly dynamic organelles, containing vital populations of mitochondrial DNA (mtDNA) distributed throughout the cell. Mitochondria form diverse physical structures in different cells, from cell-wide reticulated networks to fragmented individual organelles. These physical structures are known to influence the genetic makeup of mtDNA populations between cell divisions, but their influence on the inheritance of mtDNA at divisions remains less understood. Here, we use statistical and computational models of mtDNA content inside and outside the reticulated network to quantify how mitochondrial network structure can control the variances of inherited mtDNA copy number and mutant load. We assess the use of moment-based approximations to describe heteroplasmy variance and identify several cases where such an approach has shortcomings. We show that biased inclusion of one mtDNA type in the network can substantially increase heteroplasmy variance (acting as a genetic bottleneck), and controlled distribution of network mass and mtDNA through the cell can conversely reduce heteroplasmy variance below a binomial inheritance picture. Network structure also allows the generation of heteroplasmy variance while controlling copy number inheritance to sub-binomial levels, reconciling several observations from the experimental literature. Overall, different network structures and mtDNA arrangements within them can control the variances of key variables to suit a palette of different inheritance priorities.

PMID:36952562 | DOI:10.1371/journal.pcbi.1010953

PLoS One. 2023 Mar 23;18(3):e0276673. doi: 10.1371/journal.pone.0276673. eCollection 2023.

ABSTRACT

Poverty is a big threat to prosperity in developing countries like Pakistan. Alleviating poverty needs concerted efforts including how to measure and analyze poverty. Therefore, this paper employs synthetic panel technique and uses repeated cross-sections household survey dataset (Household Integrated and Economic Survey (HIES)) of Pakistan for 2010-11 and 2015-16, to derive poverty bounds for Pakistan. The findings of the paper suggest that 17% of population still remains in poverty in 2015-16 as they were in 2010-11. They don’t move in or out of poverty. In the same periods 19% population affected by poverty. The 2.5% poor’s of 2010-11 moves out of poverty in 2015-16. This constitutes the first attempt to provide an insight into poverty dynamics in Pakistan using the available survey data.

PMID:36952554 | DOI:10.1371/journal.pone.0276673

PLoS One. 2023 Mar 23;18(3):e0283334. doi: 10.1371/journal.pone.0283334. eCollection 2023.

ABSTRACT

An in-depth analysis of the epidemiological patterns of TB/HIV co-infection is essential since it helps to target high-risk areas with effective control measures. The main objective of this study was to assess the spatial clustering of TB/HIV co-infection prevalence in Ethiopia for the year 2018 using district-level aggregated TB and HIV data obtained from the Ethiopian Federal Ministry of Health. The global Moran’s index, Getis-Ord [Formula: see text] local statistic, and Bayesian spatial modeling techniques were applied to analyse the data. The result of the study shows that TB among people living with HIV (PLHIV) and HIV among TB patients prevalence were geographically heterogeneous. The highest prevalence of TB among PLHIV in 2018 was reported in the Gambella region (1.44%). The overall prevalence of TB among PLHIV in Ethiopia in the same year was 0.38% while the prevalence of HIV among TB patients was 6.88%. Both district-level prevalences of HIV among TB patients and TB among PLHIV were positively spatially autocorrelated, but the latter was not statistically significant. The local indicators of spatial analysis using the Getis-Ord statistic also identified hot-spots districts for both types of TB/HIV co-infection data. The results of Bayesian spatial logistic regression with spatially structured and unstructured random effects using the Besag, York, and Mollié prior showed that not all the heterogeneities in the prevalence of HIV among TB patients and TB among PLHIV were explained by the spatially structured random effects. This study expanded knowledge about the spatial clustering of TB among PLHIV and HIV among TB patients in Ethiopia at the district level in 2018. The findings provide information to health policymakers in the country to plan geographically targeted and integrated interventions to jointly control TB and HIV.

PMID:36952538 | DOI:10.1371/journal.pone.0283334

PLoS One. 2023 Mar 23;18(3):e0283593. doi: 10.1371/journal.pone.0283593. eCollection 2023.

ABSTRACT

Early proper nutritional support is important to critically ill patients. Nutritional support is also associated with clinical outcomes of neurocritically ill patients. We investigate whether early nutrition is associated with clinical outcomes in neurocritically ill patients. This was a retrospective, single-center, observational study including neurosurgical patients who were admitted to the intensive care unit (ICU) from January 2013 to December 2019. Patients who started enteral nutrition or parenteral nutrition within 72 hours after ICU admission were defined as the early nutrition group. The primary endpoint was in-hospital mortality. The secondary endpoint was an infectious complication. Propensity score matching (PSM) and propensity score weighting overlap weights (PSOW) were used to control selection bias and confounding factors. Among 1,353 patients, early nutrition was performed in 384 (28.4%) patients: 152 (11.2%) early enteral nutrition (EEN) and 232 (17.1%) early parenteral nutrition (EPN). In the overall study population, the rate of in-hospital mortality was higher in patients with late nutrition than in those with early nutrition (P<0.001). However, there was no significant difference in in-hospital mortality and infectious complications incidence between the late and the early nutrition groups in the PSM and PSOW adjusted population (all P>0.05). In the overall study population, EEN patients had a low rate of in-hospital mortality and infectious complications compared with those with EPN and late nutrition (P<0.001 and P = 0.001, respectively). In the multivariable analysis of the overall, PSM adjusted, and PSOW adjusted population, there was no significant association between early nutrition and in-hospital mortality and infectious complications (all P>0.05), but EEN was significantly associated with in-hospital mortality and infectious complications (all P<0.05). Eventually, early enteral nutrition may reduce the risk of in-hospital mortality and infectious complications in neurocritically ill patients.

PMID:36952527 | DOI:10.1371/journal.pone.0283593