Tag: statistics

J Travel Med. 2021 Oct 8:taab150. doi: 10.1093/jtm/taab150. Online ahead of print.

ABSTRACT

BACKGROUND: Typhoid fever is a notifiable disease within Australia. Although studies in endemic regions give an indication of acquisition risk, many countries lack reliable data, and little is known of the absolute or relative risk in Australian travellers. By combining notified case data with travel statistics provided by the Australian Bureau of Statistics, the aim of this study was to give an indication of risk for typhoid acquisition among Australian travellers.

METHODS: Australian typhoid notifications between 1st January 2010 and 30th June 2017 were grouped by country of acquisition and age category (<15 or ≥15 years). Australian travel data were used to inform time at risk and incidence rate of Australian typhoid notifications pertaining to country and region of acquisition. Infections, though notifiable, were excluded as the focus was vaccine preventable illness. Data from New South Wales and Victoria were used to examine the incidence in those acquiring infection in their country of birth (COB) against travellers who did not.

RESULTS: Nine hundred twenty-three cases of typhoid were notified over the period of review, 96% of which were acquired overseas. The greatest determinant of risk was travel destination, with countries in south Asia associated with highest crude incidence rate (252 per 100 000 person-years), particularly Bangladesh. Younger age and immigrants returning to their COB were generally associated with higher risk of acquisition.

CONCLUSIONS: The risk of typhoid fever in Australian travellers to endemic regions is considerable. Immigrants returning to their COB appear to be at higher risk and it is likely that this risk extends to their traveling dependents. These findings help clinicians and public health officials to plan and advise pre-travel vaccination strategies with at-risk individuals and groups. Additional sociodemographic data collection with Australian typhoid notifications would enhance the surveillance of differing international travel risk groups leaving Australia.

PMID:34619766 | DOI:10.1093/jtm/taab150

Cytopathology. 2021 Oct 7. doi: 10.1111/cyt.13066. Online ahead of print.

ABSTRACT

INTRODUCTION: Uterine clear cell adenocarcinoma (CCC) is a rare, aggressive malignancy with a poor prognosis. The present study was conducted to study and describe the characteristic morphologic features of uterine clear cell carcinoma (CCC) in cervical cytology.

METHODS: This was a 3-year retrospective case-control study. Cervical samples of women with histopathologically proven endometrial and cervical clear cell carcinoma were included as cases. Controls included cervical samples from histopathologically proven endometrial serous carcinoma(n=15), endometrioid adenocarcinoma(n=20) and endocervical adenocarcinoma(n=15). Twenty-eight cytomorphologic features were evaluated; the strength of association was determined by Odds ratio (OR), and Cramer’s V. Diagnostic accuracy of statistically significant features was also determined.

RESULTS: A total of 72 CCCs of the female genital tract, including 25(34.7%) endometrial CCC and 13(18.0%) cervical CCC, were reported on histopathology during the study period. Corresponding cervical samples were available for a total of 14(36.8%) patients, of which 13(92.8%) were found to be positive for epithelial cell abnormality. On univariate analysis, 3/28 cytomorphologic variables were found to be significant predictors of uterine CCC, viz. presence of dense cytoplasm(OR=88;V=0.72), deep nuclear membrane irregularities(OR=17.5;V=0.55) and coarse chromatin(OR=21.3;V=0.46). The presence of dense cytoplasm was noted to have the highest positive predictive value(92%) and high specificity(97.8%). In contrast, coarse chromatin was noted to have the highest sensitivity(92.3%) and negative predictive value(96.7%).

CONCLUSIONS: The presence of dense cytoplasm and deep nuclear membrane irregularities in the tumor cells were found to be strong predictors and coarse chromatin, a moderate predictor of uterine CCC compared to its close cytologic mimics.

PMID:34619807 | DOI:10.1111/cyt.13066

Arch Cardiol Mex. 2021 Oct 7. doi: 10.24875/ACM.21000108. Online ahead of print.

ABSTRACT

BACKGROUND: Pulmonary thromboendarterectomy is the current treatment of choice in patients with chronic thromboembolic pulmonary hypertension. The objective of the present study was to analyze the clinical and hemodynamic outcomes and the risk factors for mortality in a cardiovascular center in Colombia.

METHODS: Cohort study, conducted between 2001 and 2019. All operated patients were included in the study. Risk factors associated with mortality were established by means of a multivariate regression using the COX method and survival was established using the Kaplan-Meier method. p < 0.05 was considered statistically significant.

RESULTS: Seventy-three patients were operated. Median age was 51 years, 55% of females, 79% had functional Class III and IV. The mean pulmonary arterial pressure was 50 mmHg and 640 dyn.s.cm-5 for pulmonary vascular resistance (PVR). After the intervention, there was a decrease in mean pulmonary artery pressure (p ≤ 0.001) and in PVR (p = 0.357); 21% had evidence of residual pulmonary hypertension. Only 8% and 6% continued with functional Class III and IV at 6 and 12 months, respectively. There were 15 deaths (19.1%; 12% at 30 days). The factors associated with mortality were the diastolic diameter of the right ventricle measured postoperatively (hazard ratio [HR] 10.88 95% confidence interval [CI] 1.97-62, p = 0.007), time of invasive mechanical ventilation (HR 1.06 95% CI 1.02-1.09 p = 0.004), and the presence of complications during the surgical procedure (HR 5.62 95% CI 1.94-16.22 p = 0.001).

CONCLUSIONS: Pulmonary thromboendarterectomy is associated with excellent clinical and hemodynamic outcomes. The mortality risk factors found are not those usually described in the literature.

PMID:34619746 | DOI:10.24875/ACM.21000108

Brief Bioinform. 2021 Oct 8:bbab405. doi: 10.1093/bib/bbab405. Online ahead of print.

ABSTRACT

Long-read sequencing technology enables significant progress in de novo genome assembly. However, the high error rate and the wide error distribution of raw reads result in a large number of errors in the assembly. Polishing is a procedure to fix errors in the draft assembly and improve the reliability of genomic analysis. However, existing methods treat all the regions of the assembly equally while there are fundamental differences between the error distributions of these regions. How to achieve very high accuracy in genome assembly is still a challenging problem. Motivated by the uneven errors in different regions of the assembly, we propose a novel polishing workflow named BlockPolish. In this method, we divide contigs into blocks with low complexity and high complexity according to statistics of aligned nucleotide bases. Multiple sequence alignment is applied to realign raw reads in complex blocks and optimize the alignment result. Due to the different distributions of error rates in trivial and complex blocks, two multitask bidirectional Long short-term memory (LSTM) networks are proposed to predict the consensus sequences. In the whole-genome assemblies of NA12878 assembled by Wtdbg2 and Flye using Nanopore data, BlockPolish has a higher polishing accuracy than other state-of-the-arts including Racon, Medaka and MarginPolish & HELEN. In all assemblies, errors are predominantly indels and BlockPolish has a good performance in correcting them. In addition to the Nanopore assemblies, we further demonstrate that BlockPolish can also reduce the errors in the PacBio assemblies. The source code of BlockPolish is freely available on Github (https://github.com/huangnengCSU/BlockPolish).

PMID:34619757 | DOI:10.1093/bib/bbab405

Obstet Gynecol. 2021 Oct 7. doi: 10.1097/AOG.0000000000004567. Online ahead of print.

ABSTRACT

OBJECTIVE: To estimate the national pregnancy-associated homicide mortality ratio, characterize pregnancy-associated homicide victims, and compare the risk of homicide in the perinatal period (pregnancy and up to 1 year postpartum) with risk among nonpregnant, nonpostpartum females aged 10-44 years.

METHODS: Data from the National Center for Health Statistics 2018 and 2019 mortality files were used to identify all female decedents aged 10-44 in the United States. These data were used to estimate 2-year pregnancy-associated homicide mortality ratios (deaths/100,000 live births) for comparison with homicide mortality among nonpregnant, nonpostpartum females (deaths/100,000 population) and to mortality ratios for direct maternal causes of death. We compared characteristics and estimated homicide mortality rate ratios and 95% CIs between pregnant or postpartum and nonpregnant, nonpostpartum victims for the total population and with stratification by race and ethnicity and age.

RESULTS: There were 3.62 homicides per 100,000 live births among females who were pregnant or within 1 year postpartum, 16% higher than homicide prevalence among nonpregnant and nonpostpartum females of reproductive age (3.12 deaths/100,000 population, P<.05). Homicide during pregnancy or within 42 days of the end of pregnancy exceeded all the leading causes of maternal mortality by more than twofold. Pregnancy was associated with a significantly elevated homicide risk in the Black population and among girls and younger women (age 10-24 years) across racial and ethnic subgroups.

CONCLUSION: Homicide is a leading cause of death during pregnancy and the postpartum period in the United States. Pregnancy and the postpartum period are times of elevated risk for homicide among all females of reproductive age.

PMID:34619735 | DOI:10.1097/AOG.0000000000004567

Obstet Gynecol. 2021 Oct 7. doi: 10.1097/AOG.0000000000004574. Online ahead of print.

ABSTRACT

OBJECTIVE: To test the ability of a hospital-wide, bundled quality-improvement initiative to improve postpartum maternal blood pressure control and adherence to postpartum follow-up among patients with hypertensive disorders of pregnancy.

METHODS: This quality-improvement initiative consisted of a bundle of clinical interventions including health care professional and patient education, a dedicated nurse educator, and protocols for postpartum hypertensive disorders of pregnancy care in the inpatient, outpatient and readmission setting. We implemented this initiative in patients with hypertensive disorders of pregnancy starting in January 2019 at the University of Chicago. The study period was divided into four periods, which correspond to preintervention, distinct bundle roll outs, and postintervention. Our primary outcome was postpartum hypertension visit adherence. Secondary outcomes included blood pressure values and antihypertensive medication use in the immediate postpartum and outpatient postpartum time periods. We then stratified our outcomes by race to assess whether the effect size differed.

RESULTS: A total of 926 patients who delivered between September 2018 and November 2019 were included. Postpartum hypertension visit adherence improved from preintervention period compared with the full implementation period (33.5% vs 59.4%, P<.001). Blood pressure in the first 24 hours postpartum decreased from preintervention compared with full implementation (preintervention median [interquartile range] systolic blood pressure 149 mm Hg [138, 159] vs 137 [131, 146] in postimplementation; P<.001). After implementation, fewer patients experienced a blood pressure of 140/90 mm Hg or higher at the first postpartum blood pressure check, when compared with preintervention (39.1% vs 18.5%, P=.004). The effect size did not differ by race.

CONCLUSION: A bundled quality-improvement initiative for patients with hypertensive disorders of pregnancy was associated with improved postpartum visit adherence and blood pressure control in the postpartum period.

PMID:34619718 | DOI:10.1097/AOG.0000000000004574

Otol Neurotol. 2021 Oct 6. doi: 10.1097/MAO.0000000000003315. Online ahead of print.

ABSTRACT

OBJECTIVE: To describe the audiological results and complications following active middle ear implant (AMEI) surgery in users with bilateral ear atresia.

STUDY DESIGN: Observational and retrospective longitudinal follow-up.

SETTING: A tertiary referral hospital for hearing rehabilitation and craniofacial malformations.

PATIENTS: Medical records of 27 patients with bilateral congenital aural atresia (34 ears) who underwent surgery for AMEI were reviewed. Data were analyzed using descriptive and inferential statistics. The alpha error was assumed to be 5%.

OUTCOME MEASURES: Medical and technical complications and audiological results were observed during follow-up.

RESULTS: The median postoperative follow-up was 37.5 months (27.7-75.5 mo). Medical or technical complications occurred in 35.3% (n = 12) of patients during follow-up, 14.7% (n = 5) required surgical revision. The auditory thresholds in the free field improved from 53.75 dB (46.87-56.25) to 25 dB (21.25-32.5) after 6 months using the AMEI (p < 0.001) and remained stable till the last audiological evaluation (22.5: 21.25 26.25). Compared with the preoperative results, all speech perception tests also showed the benefits of AMEI at 6 months postoperatively and in the last audiological evaluation.

CONCLUSIONS: Monitoring the use of AMEI in this sample demonstrated the safety of these implants compared with data available in the literature. The rates of medical and technical complications were consistent with data published by other groups. Finally, the audiological results remained stable during follow-up.

PMID:34619727 | DOI:10.1097/MAO.0000000000003315

Clin Nucl Med. 2021 Oct 4. doi: 10.1097/RLU.0000000000003909. Online ahead of print.

ABSTRACT

PURPOSE: We evaluated the prognostic value of metabolic parameters measured on pretreatment FDG PET/CT in patients with cervical neuroendocrine carcinomas (NECs).

METHODS: A total of 22 patients with cervical NECs who underwent pretreatment FDG PET/CT were retrospectively reviewed. The SUVmax, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary lesion were measured. The associations between prognostic factors and progression-free survival (PFS) and overall survival (OS) were investigated using the Kaplan-Meier method, log-rank test, and univariate and multivariate Cox proportional hazards model.

RESULTS: Of the 22 patients, 12 developed disease progression, and 5 died during the follow-up period. Univariate analyses revealed that MTV, TLG, and the International Federation of Gynecology and Obstetrics stage were significantly associated with PFS (all P < 0.05), whereas SUVmax did not show a significant correlation with PFS. Kaplan-Meier survival curves revealed that patients with MTV >31.9 cm3 (log-rank, P < 0.001), TLG >154.3 (log-rank, P < 0.001), and higher International Federation of Gynecology and Obstetrics stage (log-rank, P = 0.026) had significantly shorter PFS. In the multivariate analyses, MTV (P = 0.017; hazard ratio [HR], 7.298; 95% confidence interval [CI], 1.427-37.316) and TLG (P = 0.003; HR, 15.175; 95% CI, 2.470-93.244) were independent prognostic factors, whereas for OS, the univariate analysis revealed that only TLG >154.3 showed statistical significance (P = 0.043; HR, 9.821; 95% CI, 1.080-89.290).

CONCLUSIONS: Metabolic tumor volume and TLG on FDG PET/CT were the significant prognostic factors of PFS in patients with cervical NECs. Patients with high MTV and TLG had worse clinical outcomes. In addition, TLG may also be a predictor of OS.

PMID:34619703 | DOI:10.1097/RLU.0000000000003909

Obstet Gynecol. 2021 Oct 7. doi: 10.1097/AOG.0000000000004570. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the association between adverse childhood experiences and adverse pregnancy outcomes.

METHODS: This cohort study included individuals who enrolled in a perinatal collaborative mental health care program (COMPASS [the Collaborative Care Model for Perinatal Depression Support Services]) between 2017 and 2021. Participants completed psychosocial self-assessments, including an adverse childhood experiences screen. The primary exposure was adverse childhood experiences measured by the ACE (adverse childhood experience) score, which was evaluated as a dichotomized variable, with a high ACE score defined as greater than three. Secondary analyses used the ACE score as a continuous variable. Adverse pregnancy outcomes including gestational diabetes, hypertensive disorders of pregnancy, preterm birth, and small-for-gestational-age (SGA) births were abstracted from the electronic health record. Bivariable and multivariable analyses were performed, including mediation analyses.

RESULTS: Of the 1,274 women with a completed adverse childhood experiences screen, 904 (71%) reported one or more adverse childhood experiences, and 290 (23%) reported a high ACE score (more than three adverse childhood experiences). Adverse childhood experience scores were not associated with gestational diabetes or SGA births. After controlling for potential confounders, individuals with high ACE score had 1.55-fold (95% CI 1.06-2.26) increased odds of having hypertensive disorders of pregnancy and 2.03-fold (95% CI 1.38-2.99) increased odds of preterm birth. Each point increase in ACE score was not associated with a statistically increased odds of hypertensive disorders of pregnancy (adjusted odds ratio [aOR] 1.07, 95% CI 0.99-1.15); however, each additional point on the adverse childhood experiences screen was associated with increased odds of preterm birth (aOR 1.13, 95% CI 1.05-1.22). Mediation analyses demonstrated tobacco use, chronic medical problems, and obesity each partially mediated the observed association between high ACE scores and hypertensive disorders of pregnancy. Having chronic medical comorbidities partially mediated the observed association between high ACE scores and preterm birth.

CONCLUSION: One in four individuals referred to a perinatal mental health program who were pregnant or postpartum had a high ACE score. Having a high ACE score was associated with an increased risk of hypertensive disorders of pregnancy and preterm birth. These results underscore how remote events may reverberate through the life course.

PMID:34619717 | DOI:10.1097/AOG.0000000000004570

Ear Hear. 2021 Oct 6. doi: 10.1097/AUD.0000000000001127. Online ahead of print.

ABSTRACT

OBJECTIVE: Hearing impairment may lead to an increased need to recover from fatigue and distress after a day of work. Also, hearing impairment may negatively affect the balance between workload and control over it (job demand and job control). The uptake of hearing solutions may have a positive effect on these outcomes. We aimed to assess the longitudinal relationship between change in speech recognition in noise and changes in need for recovery after work and job demand and job control, and the influence of hearing solutions on these relationships over a period of 5 years. Research questions (RQs) were as follows: (1) Is a 5-year change in speech recognition in noise associated with a change in need for recovery after work over that same 5-year period?; (2) Is a 5-year change in speech recognition in noise associated with a change in job demand and job control over that same 5-year period?; (3) What is the effect of hearing solution uptake in the 5-year period on the change in these outcomes in that same 5-year period?

METHOD: Data of the Netherlands Longitudinal Study on Hearing, collected between 2006 and January 2019, were divided into two 5-year follow-up intervals: T0 (baseline) to T1 (5-year follow-up) and T1 (5-year follow-up) to T2 (10-year follow-up). An online digit-triplet in noise test was used to assess speech recognition in noise. Online questionnaires on demographic, socioeconomic, and work-related characteristics were administered. For RQ1-RQ2, the study sample included adults working ≥12 hours per week, with at least two consecutive measurements (n = 783). For RQ3, employees who had not yet obtained hearing solutions at baseline, but who would be eligible based on a speech reception threshold in noise ≥ -5.5 dB signal-to-noise ratio (SNR), were included (n = 147). Longitudinal linear regression analyses using mixed models were performed to assess RQ1-RQ3.

RESULTS: After adjusting for baseline values, 5-year change in speech recognition in noise showed a statistically significant association with 5-year change in need for recovery. A worsening of 1 dB SNR in speech recognition in noise in an individual was associated with an increase of 0.72 units in need for recovery (scale range 0 to 100). A 5-year change in speech recognition in noise was not significantly associated with a 5-year change in job demand or job control. The uptake of hearing solutions in the 5-year period did not have a significant effect on change in need for recovery in that same 5-year period.

CONCLUSION: The significant longitudinal association between 5-year worsening in speech recognition in noise and increase in need for recovery over the same time period strengthens the evidence for the importance of early detection of a worsening in speech recognition in noise to identify employees with an increase in need for recovery. The absence of an effect of the uptake of a hearing solution on need for recovery indicates that additional alternative interventions may be needed to foster beneficial use of hearing solutions as well as to mitigate the increased need for recovery in case of worsening speech recognition in noise.

PMID:34619688 | DOI:10.1097/AUD.0000000000001127