Tag: statistics

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

Arch Sex Behav. 2022 Sep 19. doi: 10.1007/s10508-022-02384-7. Online ahead of print.

ABSTRACT

Sensation seeking (SS)-the seeking of novel and intense sensations or experiences and the willingness to take risks for the sake of such experiences-has been shown to be related to various risky sexual behaviors (RSBs) in areas such as multiple sexual partners, condom use, and sexual initiation. The aims of the current meta-analysis were to examine (1) how SS relates to specific RSBs in adolescents and (2) how the overall relationship between SS and RSB differs across sex, race, and age. Overall, a total of 40 studies met the inclusion criteria for our meta-analysis examining the relationship between SS and RSB, contributing 102 effect sizes. RSB variables included unprotected sex; multiple sexual partners; hazardous sexual activity; sexual initiation; virginity status; and history of sexually transmitted disease (STD) diagnosis. Moderating effects of sex, race, and age were also examined. The overall mean effect size of the correlational relationship between adolescent SS and RSB was statistically significant, as were the mean effect sizes of the relationships between SS and RSB subgroups, except for history of STD diagnosis. Race and age did not significantly moderate the overall relationship between SS and RSB; however, results indicated that SS and RSB relations were stronger in females compared to males. Our findings suggest that adolescents with elevations in SS tendencies tend to engage in more RSBs compared to their peers with lower levels of SS, increasing their risk of unplanned pregnancy and STD acquisition.

PMID:36121585 | DOI:10.1007/s10508-022-02384-7

Int Urol Nephrol. 2022 Sep 19. doi: 10.1007/s11255-022-03318-x. Online ahead of print.

ABSTRACT

PURPOSE: Concomitant kidney diseases raise the mortality rate due to the SARS-CoV-2 virus as an independent factor. Although a qualitative PCR test’s result is sufficient for diagnosis, Cycle threshold value may present relevant information to the physicians in providing faster treatment in patients with chronic conditions, including kidney diseases, to prevent morbidity and subsequent mortality. Thus, the present study was conducted to determine the relationship between the Cycle threshold value and clinical outcomes in renal patients with the coronavirus 2019.

METHODS: This retrospective study was conducted on renal patients with the coronavirus 2019 infection admitted to Labbafinejad Hospital in Tehran, the capital of Iran, within a period of one year, from late February 2020 to February 2021. Data were collected per the prepared checklist. Cycle threshold values were measured by performing PCR on nasopharynx and oropharynx swab samples of patients.

RESULTS: According to the adjusted analysis, having high viral load increased the odds of in-hospital mortality (aOR = 11.65, 95% CI 3.93-34.54), ICU admission (aOR = 5.49, 95% CI 2.16-13.97), and invasive ventilation (aOR = 7.18, 95% CI 2.61-19.74). Having high viral load also increased the odds of O₂ therapy (aOR = 3.08, 95% CI 0.79-12.01), although the difference was not statistically significant (P = 0.105).

CONCLUSION: Cycle threshold value was a significant predictor of mortality in renal patients. Nevertheless, further studies are required on how to render optimal use of the Cycle threshold value, given that the quality of the test sample and the different groups of patients under study affect the effectiveness of this marker in predicting disease severity.

PMID:36121573 | DOI:10.1007/s11255-022-03318-x

Dysphagia. 2022 Sep 19. doi: 10.1007/s00455-022-10513-6. Online ahead of print.

ABSTRACT

BACKGROUND: Prophylactic swallowing exercises (PSE) during radiotherapy can significantly reduce dysphagia after radiotherapy in head and neck cancer (HNC). However, its positive effects are hampered by low adherence rates during the burdensome therapy period. Hence, the main goal of this multicenter randomized controlled trial (RCT) was to investigate the effect of 3 different service-delivery modes on actual patients’ adherence.

METHODS: A total of 148 oropharyngeal cancer patients treated with primary (chemo)radiotherapy were randomly assigned to a 4 weeks PSE program, either diary-supported (paper group; n = 49), app-supported (app group; n = 49) or therapist-supported (therapist group; n = 50). Participants practiced 5 days/week, daily alternating tongue strengthening exercises with chin tuck against resistance exercises. Adherence was measured as the percentage of completed exercise repetitions per week (%reps). Statistical analysis was performed by means of SPSSv27, using Linear Mixed-effects Models with post hoc pairwise testing and Bonferroni-Holm correction.

RESULTS: Adherence and evolution of adherence over time was significantly different between the three groups (p < .001). Adherence rates decreased in all three groups during the 4 training weeks (p < .001). During all 4 weeks, the therapist group achieved the highest adherence rates, whilst the app group showed the lowest adherence rates.

CONCLUSIONS: PSE adherence decreased during the first 4 radiotherapy weeks regardless of group, but with a significant difference between groups. The therapist group achieved the highest adherence rates with a rather limited decline, therefore, increasing the face-to-face contact with a speech-language therapist can overcome the well-known problem of low adherence to PSE in this population.

TRIAL REGISTRATION: Trial registration: ISRCTN, ISRCTN98243550. Registered December 21, 2018 – retrospectively registered, https://www.isrctn.com/ISRCTN98243550?q=gwen%20van%20nuffelen&filters=&sort=&offset=1&totalResults=2&page=1&pageSize=10&searchType=basic-search .

PMID:36121560 | DOI:10.1007/s00455-022-10513-6

Eur J Orthop Surg Traumatol. 2022 Sep 19. doi: 10.1007/s00590-022-03386-w. Online ahead of print.

ABSTRACT

BACKGROUND: Although periprosthetic joint infection (PJI) is a serious complication following a total joint arthroplasty procedure, there remains uncertainty regarding the diagnosis of PJI due to the lack of a globally accepted, standardized definition. The goal of this review is to critically analyze the quality of the evidence used for the novel 2018 MSIS PJI definition and identify gaps and limitations with using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool.

METHODS: References from the modified 2018 MSIS definition for PJI by Parvizi et al. were retrieved and manually reviewed. A total of 11 studies were assessed using a validated QUADAS-2 tool.

RESULTS: Many included studies had an unclear or high risk of bias for the Index Test domain due to a lack of blinding and lack of prespecified thresholds. A majority of studies utilized Youden’s J statistic to optimize the thresholds which may diminish external validity. Likewise, several studies were assessed to have an unclear and high risk of bias for the Flow and Timing domain primarily due to a lack of reporting and a large number of exclusions. Overall, there was a low risk of bias for the choice of reference standard, its conduct and interpretation, as well as for the Patient Selection domain.

CONCLUSION: Although the literature used for the MSIS 2018 PJI definition is fraught with potential sources of bias, there may be a trend toward an improvement in the quality of evidence when compared to the earlier definition of PJI.

PMID:36121542 | DOI:10.1007/s00590-022-03386-w

Biomech Model Mechanobiol. 2022 Sep 19. doi: 10.1007/s10237-022-01636-8. Online ahead of print.

ABSTRACT

Spinal fixation and fusion are surgical procedures undertaken to restore stability in the spine and restrict painful or degenerative motion. Malpositioning of pedicle screws during these procedures can result in major neurological and vascular damage. Patient-specific surgical guides offer clear benefits, reducing malposition rates by up to 25%. However, they suffer from long lead times and the manufacturing process is dependent on third-party specialists. The development of a standard set of surgical guides may eliminate the issues with the manufacturing process. To evaluate the feasibility of this option, a statistical shape model (SSM) was created and used to analyse the morphological variations of the T4-T6 vertebrae in a population of 90 specimens from the Visible Korean Human dataset (50 females and 40 males). The first three principal components, representing 39.7% of the variance within the population, were analysed. The model showed high variability in the transverse process (~ 4 mm) and spinous process (~ 4 mm) and relatively low variation (< 1 mm) in the vertebral lamina. For a Korean population, a standardised set of surgical guides would likely need to align with the lamina where the variance in the population is lower. It is recommended that this standard set of surgical guides should accommodate pedicle screw diameters of 3.5-6 mm and transverse pedicle screw angles of 3.5°-12.4°.

PMID:36121529 | DOI:10.1007/s10237-022-01636-8