Tag: statistics

Arch Pathol Lab Med. 2022 Oct 3. doi: 10.5858/arpa.2022-0032-OA. Online ahead of print.

ABSTRACT

CONTEXT.—: Although several neuroendocrine cell types constitute gastroenteropancreatic neuroendocrine tumors (NETs), the clinical and prognostic implications of the expression of multiple peptide hormones have not been comprehensively evaluated in rectal NETs.

OBJECTIVE.—: To identify the clinicopathologic characteristics and prognostic impact of peptide hormone expression.

DESIGN.—: We evaluated the expression of peptide YY (PYY), glucagon, somatostatin, serotonin, insulin, and gastrin using immunolabeling in 446 endoscopically or surgically resected rectal NETs.

RESULTS.—: PYY, glucagon, serotonin, somatostatin, insulin, and gastrin were expressed in 261 of 389 (67.1%), 205 of 446 (46.0%), 36 of 446 (8.1%), 33 of 446 (7.4%), 2 of 446 (0.4%), and 1 of 446 cases (0.2%), respectively. Immunoreactivity to any peptide hormone was present in 345 of 446 cases (77.4%). Tumors expressing serotonin or somatostatin were associated with lymphovascular invasion, chromogranin A expression, and shorter disease-free survival (DFS). Rectal NETs were classified as L-cell, enterochromaffin-cell, D-cell, null-expression, or mixed-expression type based on peptide hormonal expression status. Patients with D-cell NET had the shortest DFS (10-year DFS, 54.5%), followed by those with enterochromaffin-cell NET (89.5%), null expression (97.0%), L-cell NET (99.6%), and mixed-expression NET (100%; P < .001). Multivariable analyses revealed that somatostatin expression was an independent indicator of poor prognosis with respect to DFS in rectal NETs (P = .001).

CONCLUSIONS.—: Somatostatin expression is a poor prognostic indicator in patients with rectal NETs. Therefore, additional peptide hormonal immunolabeling, including somatostatin, serotonin, and PYY, in rectal NETs can provide more information regarding DFS.

PMID:36191342 | DOI:10.5858/arpa.2022-0032-OA

J Nerv Ment Dis. 2022 Oct 3. doi: 10.1097/NMD.0000000000001598. Online ahead of print.

ABSTRACT

We investigated insight and its relationship with the clinical characteristics in eating disorders (EDs). Thirty anorexia nervosa (AN) and 30 bulimia nervosa (BN) patients, diagnosed based on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria, were evaluated with Eating Disorder Examination Questionnaire (EDE-Q), the Body Image Satisfaction Questionnaire (BISQ), Rosenberg Self-Esteem Scale (RSES), and the Brown Assessment of Beliefs Scale (BABS). There was no statistically significant difference between the AN and the BN group in clinical scale scores. Thirty percent of AN and 23.3% of BN patients showed “poor insight” according to BABS. In the whole sample, BABS scores were significantly positively correlated with the EDE-Q eating, shape, weight concern subscales, and global scores, and the RSES scores; and negatively correlated with the BISQ general appearance and trunk subscale scores. Manifestation of “poor insight” is frequent in EDs. Poor insight in EDs is associated with eating, shape and weight concerns, body dissatisfaction, and low self-esteem.

PMID:36191337 | DOI:10.1097/NMD.0000000000001598

Prehosp Emerg Care. 2022 Oct 3:1-9. doi: 10.1080/10903127.2022.2132565. Online ahead of print.

ABSTRACT

Objective: Disparities have been observed in the treatment of pain in emergency department patients. However, few studies have evaluated such disparities in emergency medical services (EMS). We describe pain medication administration for trauma indications in an urban EMS system and how it varies with patient demographics.Methods: We performed a retrospective review of the electronic medical records of adult patients transported for isolated trauma (without accompanying medical complaint) from 1/1/18 to 6/30/2020 by a third service EMS agency in a major United States metropolitan area. We performed descriptive statistics on epidemiology, type of pain medications administered, and pain scores. Kruskall-Wallis and chi-square or Fisher’s exact tests were used to compare continuous and categorical variables, respectively. We constructed a logistic regression model to estimate the odds of nontreatment of pain by age, race, sex, transport interval, pain score, and Glasgow Coma Scale (GCS) score for patients with pain scores of at least four on a one to ten scale, the threshold for pain treatment per the EMS protocol.Results: Of 32,463 EMS patients with traumatic injuries included in the analysis, 40% (12,881/32,463) were African American, 50% (16,284/32,463) were female, the median age was 27 years (IQR 45-64), and the median initial pain score was 5 (IQR 2-8). Fifteen percent (4,989/32,463) received any analgesic. Initial pain scores were significantly higher for African American and female patients. African American patients were less likely to receive analgesia compared to White and Hispanic patients (19% versus 25% and 23%, respectively, p < 0.0001). Adjusting for age, pain score, transport interval, and GCS, African American compared to White, and female compared to male patients were less likely to be treated for pain, OR 1.59 (95% CI 1.47-1.72) and OR 1.20 (95% CI 1.11-1.28), respectively.Conclusion: Among patients with isolated traumatic injuries treated in a single, urban EMS system, African American and female patients were less likely to receive analgesia than White or male patients. Analgesics were given to a small percentage of patients who were eligible for treatment by protocol, and intravenous opioids were used in the vast majority patients who received treatment.

PMID:36191334 | DOI:10.1080/10903127.2022.2132565

Scand J Work Environ Health. 2022 Oct 3:4060. doi: 10.5271/sjweh.4060. Online ahead of print.

ABSTRACT

OBJECTIVES: Workplace bullying has been suggested to increase symptoms of anxiety. A reverse relationship has also been proposed. However, so far only few earlier studies have investigated this topic and the reported associations might partly be explained by unmeasured individual characteristics. In this study, we aim to examine the temporality and directionality between workplace bullying and anxiety symptoms, taking time-invariant characteristics into account. Furthermore, we aim to examine whether leadership quality modifies these associations.

METHODS: We included 13 491 individuals from two nationwide cohort studies in Sweden and Denmark. Using cross-lagged structural equation models (SEM) and dynamic panel models with fixed effects, we examined contemporaneous and lagged associations between self-reported workplace bullying and anxiety. Cohort-specific results were estimated and combined using fixed-effect meta-analysis.

RESULTS: The cross-lagged SEM models supported contemporaneous and lagged relationships in both directions (from workplace bullying to symptoms of anxiety and vice versa). In contrast, only contemporaneous relationships remained statistically significant and of considerable magnitude in the dynamic panel models with fixed effects. Specifically, exposure to workplace bullying was related to a concurrent increase in anxiety symptoms (b=0.61, 95% confidence interval 0.32-0.90). No support of interaction with leadership quality was found.

CONCLUSIONS: The results indicate that onset of workplace bullying is associated with an immediate or short-term increase in anxiety symptoms. This study provides novel insights regarding temporal aspects and causal inference of the bullying-anxiety relationship useful for managing psychological hazards and preventing mental illness at work.

PMID:36191297 | DOI:10.5271/sjweh.4060

J Clin Oncol. 2022 Oct 3:JCO2201874. doi: 10.1200/JCO.22.01874. Online ahead of print.

NO ABSTRACT

PMID:36191279 | DOI:10.1200/JCO.22.01874

PLoS One. 2022 Oct 3;17(10):e0271240. doi: 10.1371/journal.pone.0271240. eCollection 2022.

ABSTRACT

In low-dimensional data and within the framework of a classical linear regression model, we intend to compare variable selection methods and investigate the role of shrinkage of regression estimates in a simulation study. Our primary aim is to build descriptive models that capture the data structure parsimoniously, while our secondary aim is to derive a prediction model. Simulation studies are an important tool in statistical methodology research if they are well designed, executed, and reported. However, bias in favor of an “own” preferred method is prevalent in most simulation studies in which a new method is proposed and compared with existing methods. To overcome such bias, neutral comparison studies, which disregard the superiority or inferiority of a particular method, have been proposed. In this paper, we designed a simulation study with key principles of neutral comparison studies in mind, though certain unintentional biases cannot be ruled out. To improve the design and reporting of a simulation study, we followed the recently proposed ADEMP structure, which entails defining the aims (A), data-generating mechanisms (D), estimand/target of analysis (E), methods (M), and performance measures (P). To ensure the reproducibility of results, we published the protocol before conducting the study. In addition, we presented earlier versions of the design to several experts whose feedback influenced certain aspects of the design. We will compare popular penalized regression methods (lasso, adaptive lasso, relaxed lasso, and nonnegative garrote) that combine variable selection and shrinkage with classical variable selection methods (best subset selection and backward elimination) with and without post-estimation shrinkage of parameter estimates.

PMID:36191290 | DOI:10.1371/journal.pone.0271240

Cancer. 2022 Oct 3. doi: 10.1002/cncr.34440. Online ahead of print.

ABSTRACT

Despite high mortality rates from gastric cancer, surgical management remains critical for curative potential. Optimal outcomes of gastric cancer resection depend on a multitude of variables, including the extent of resection, scope of lymphadenectomy, method of reconstruction, and potential for a minimally invasive approach. Laparoscopic gastrectomy, compared with open gastrectomy, has been analyzed in numerous randomized control trials. Generally, those trials demonstrated statistically similar postoperative complication rates, mortality, and oncologic outcomes between the two approaches. Although laparoscopic gastrectomy requires longer operative times, significant improvements in estimated blood loss, postoperative length of stay, and return of bowel function have been noted in patients who undergo laparoscopic gastrectomy. These short-term benefits, along with equivalent oncologic results, have influenced national guidelines in both Eastern and Western countries to recommend laparoscopy, especially for early stage disease. Although robotic gastrectomy has not been as widely validated in effective trials, studies have reported equivalent oncologic outcomes and similar or improved postoperative complication and recovery rates after robotic gastrectomy compared with open gastrectomy. Comparing the two minimally invasive gastrectomy approaches, robotic surgery was associated with improved estimated blood loss, incidence of pancreatic sequela, and lymph node harvests in some studies, whereas laparoscopy resulted in lower operative times and hospital costs. Ultimately, when applying outcomes from the literature to clinical patient care decisions, it is imperative to recognize these studies’ range of inclusion criteria, delineating between patients originating from Eastern or Western countries, the use of neoadjuvant chemotherapy, the volume of surgeon experience, and the extent of gastrectomy, among others.

PMID:36191278 | DOI:10.1002/cncr.34440

Environ Sci Technol. 2022 Oct 3. doi: 10.1021/acs.est.2c02099. Online ahead of print.

ABSTRACT

As the climate warms, wildfire activity is increasing, posing a risk to human health. Studies have reported on particulate matter (PM) in wildfire smoke, yet the chemicals associated with PM have received considerably less attention. Here, we analyzed 13 years (2006-2018) of PM_2.5 chemical composition data from monitors in California on smoke-impacted days. Select chemicals (e.g., aluminum and sulfate) were statistically elevated on smoke-impacted days in over half of the years studied. Other chemicals, mostly trace metals harmful to human health (e.g., copper and lead), were elevated during particular fires only. For instance, in 2018, lead was more than 40 times higher on smoke days on average at the Point Reyes monitoring station, due mostly to the Camp Fire, burning approximately 200 km away. There was an association between these metals and the combustion of anthropogenic material (e.g., the burning of houses and vehicles). Although still currently rare, these infrastructure fires are likely becoming more common and can mobilize trace metals in smoke far downwind, at levels generally unseen except in the most polluted areas of the country. We hope a better understanding of the chemicals in wildfire smoke will assist in the communication and reduction of public health risks.

PMID:36191257 | DOI:10.1021/acs.est.2c02099

Dev Neurorehabil. 2022 Oct 3:1-9. doi: 10.1080/17518423.2022.2131922. Online ahead of print.

ABSTRACT

This study aimed to examine the acute changes in dynamic balance Postural Control experienced by children with Autism Spectrum Disorder (ASD) who undertook a 6-month extracurricular Service-Learning Physical Education (PE) program. The study used a quasi-experimental design with 23 participants divided into an experimental group and a control group. Limits of Stability protocol was used to measure the children’s postural control. The results showed that the experimental group achieved statistically significant improvements. To conclude, this study provides substantial input about how extracurricular PE activities aimed at developing the general motor proficiency of ASD children can improve their dynamic balance.

PMID:36191252 | DOI:10.1080/17518423.2022.2131922

Ultrasound Obstet Gynecol. 2022 Oct 3. doi: 10.1002/uog.26089. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop a model based on factors available at diagnosis of twin-twin transfusion syndrome (TTTS) that predicts chance of dual twin survival following fetoscopic laser photocoagulation (FLPC) using machine learning algorithm.

METHODS: A retrospective analysis of data collected from two university-affiliated tertiary fetal centers between 2012 and 2021. The cohort included monochorionic twin pregnancies complicated by TTTS who underwent FLPC. Data were stratified based on survival rates 30 days after delivery, dual survival cases were compared to the rest. Following random forest, as an ensemble machine-learning algorithm, relative importance value was calculated for each parameter that presented statistically significant difference. Holdout method was applied to check overfitting of the random forest algorithm. A prediction model for having dual twin survival 30 days after delivery was constructed to a graphic nomogram based on the testing set.

RESULTS: The study included 537 women, of them 346 (64.4%) had dual twin survival at 30 days and were compared to 191 (35.6%) that had one or no survivors. Univariate analysis demonstrated no differences in demographic parameters between the groups. At time of diagnosis, the dual survival groups presented lower rates of donor’s estimated fetal weight below 10^th centile for gestational age (56.4% vs. 69.4% p=0.004), intertwin growth discordance above 25% (40.8% vs. 56.5%, p=0.001), and anterior placenta (40.5% vs. 50%, p=0.034). Doppler differences between the groups demonstrated lower rates of elevated pulsatility index (PI) above 95^th centile, measured in the donor’s umbilical artery and ductus venosus, as well as lower rates of decreased PI below 5^th centile, measured in the donor’s middle cerebral artery. Importance value for each of these 6 parameters was calculated allowing the construction of a prediction model with area under ROC curve (AUC=0.916, 95% CI= 0.887-0.946).

CONCLUSIONS: Incorporating six variables: donor’s estimated fetal weight below 10^th centile, intertwin growth discordance above 25%, anterior placenta, pulsatility index in the umbilical artery, ductus venosus and middle cerebral artery, obtained at time of diagnosis of TTTS into a predictive model for dual twin survival following FLPC has been developed. This clinically applicable tool may allow improved treatment plans and patient counseling. This article is protected by copyright. All rights reserved.

PMID:36191157 | DOI:10.1002/uog.26089