Tag: statistics

JAMA Pediatr. 2022 May 23. doi: 10.1001/jamapediatrics.2022.1516. Online ahead of print.

NO ABSTRACT

PMID:35604677 | DOI:10.1001/jamapediatrics.2022.1516

JAMA Intern Med. 2022 May 23. doi: 10.1001/jamainternmed.2022.1563. Online ahead of print.

ABSTRACT

IMPORTANCE: The association between physician fatigue and patient outcomes is important to understand but has been difficult to examine given methodological and data limitations. Surgeons frequently perform urgent procedures overnight and perform additional procedures the following day, which could adversely affect outcomes for those daytime operations.

OBJECTIVE: To examine the association between an attending surgeon operating overnight and outcomes for operations performed by that surgeon the next day.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, a retrospective analysis of a large multicenter registry of surgical procedures was done using a within-surgeon analysis to address confounding, with data from 20 high-volume US institutions. This study included 498 234 patients who underwent a surgical procedure during the day (between 7 am and 5 pm) between January 1, 2010, and August 30, 2020.

EXPOSURES: Whether the attending surgeon for the current day’s procedures operated between 11 pm and 7 am the previous night. Two exposure measures were examined: whether the surgeon operated at all the previous night and the number of hours spent operating the previous night (including having performed no work at all).

MAIN OUTCOMES AND MEASURES: The primary composite outcome was in-hospital death or major complication (sepsis, pneumonia, myocardial infarction, thromboembolic event, or stroke). Secondary outcomes included operation length and individual outcomes of death, major complications, and minor complications (surgical site infection or urinary tract infection).

RESULTS: Among 498 234 daytime operations performed by 1131 surgeons, 13 098 (2.6%) involved an attending surgeon who operated the night before. The mean (SD) age of the patients who underwent an operation was 55.3 (16.4) years, and 264 740 (53.1%) were female. After adjusting for operation type, surgeon fixed effects, and observable patient characteristics (ie, age and comorbidities), the adjusted incidence of in-hospital death or major complications was 5.89% (95% CI, 5.41%-6.36%) among daytime operations when the attending surgeon operated the night before compared with 5.87% (95% CI, 5.85%-5.89%) among daytime operations when the same surgeon did not (absolute adjusted difference, 0.02%; 95% CI, -0.47% to 0.51%; P = .93). No significant associations were found between overnight work and secondary outcomes except for operation length. Operating the previous night was associated with a statistically significant decrease in length of daytime operations (adjusted length, 112.7 vs 117.4 minutes; adjusted difference, -4.7 minutes; 95% CI, -8.7 to -0.8, P = .02), although this difference is unlikely to be meaningful.

CONCLUSIONS AND RELEVANCE: The findings of this cross-sectional study suggest that operating overnight was not associated with worse outcomes for operations performed by surgeons the subsequent day. These results provide reassurance concerning the practice of having attending surgeons take overnight call and still perform operations the following morning.

PMID:35604661 | DOI:10.1001/jamainternmed.2022.1563

Eur J Pain. 2022 May 23. doi: 10.1002/ejp.1975. Online ahead of print.

ABSTRACT

BACKGROUND: There is limited research on the long-term effectiveness of epidural steroid injections (ESI) in older adults despite the high prevalence of back and leg pain in this age group. We tested the hypotheses that older adults undergoing ESI, compared to patients not receiving ESI: 1) have worse pain, disability and quality of life (“outcomes”) pre-ESI, 2) have improved outcomes after ESI, and 3) have improved outcomes due to a specific ESI effect.

METHODS: We prospectively studied patients ≥65 years old presenting to primary care with new episodes of back pain in three US healthcare systems (BOLD registry). Outcomes were leg and back pain intensity, disability and quality of life, assessed at baseline and 3-, 6-, 12- and 24-month follow-ups. We categorized participants as: 1) ESI within 6 months from the index visit (n=295); 2) no ESI within 6 months (n=4,809); 3) no ESI within 6 months, propensity-score matched to group 1 (n=483). We analyzed the data using linear regression and Generalized Estimating Equations.

RESULTS: Pain intensity, disability and quality of life at baseline were significantly worse at baseline in ESI patients (group 1) than in group 2. The improvement from baseline to 24 months in all outcomes was statistically significant for group 1. However, no statistically significant differences were observed between outcome trajectories for the propensity-score matched groups 1 and 3.

CONCLUSIONS: Older adults treated with ESI have long-term improvement. However, the improvement is unlikely the result of a specific ESI effect.

PMID:35604636 | DOI:10.1002/ejp.1975

J Anim Sci. 2022 May 23:skac191. doi: 10.1093/jas/skac191. Online ahead of print.

ABSTRACT

Treats are offered to dogs to reinforce the animal-owner bond and as rewards. Wheat, which contains gluten (gliadin and glutenin proteins), is often used in treats. The US is a leading producer of sorghum which might be an alternative; however, it does not have functional properties to form viscoelastic doughs, because is mainly composed of kafirin protein. Therefore, the objectives of this study were to determine the effects of supplementing soluble animal proteins in whole sorghum rotary molded baked dog treats on dog preference, sensory attributes, and oxidation rate. The treats were produced in triplicate in a 2×4 + 1 augmented factorial arrangement of treatments. Two whole sorghum flours (WWS and WRS), four protein sources [none (NC), spray-dried plasma (SDP), egg protein (EP), and gelatin (GL)], and a positive control with wheat (WWF-GTN) were evaluated. A preference ranking test with twelve dogs was performed. Additionally, five trained panelists scored the intensity of appearance, aroma, flavor, texture/mouthfeel, and aftertaste attributes. Finally, the treats were stored at 30°C and 60% RH, and hexanal concentrations were measured on days 0, 28, 56, and 112. The data was analyzed using the statistical software SAS for the animal and oxidation rate evaluations with significance considered at P<0.05. The descriptive sensory evaluation data was analyzed using multivariate analysis (XLSTAT). The dogs did not detect differences among WWF-GTN, WWS, or WRS treats when evaluated together. However, the WWF-GTN, WWS-SDP and WWS-EP treatments were preferred among the white sorghum treatments. The EP treatments led to some consumption difficulties by dogs because of their hard texture. The panelists reported a high degree of variation in the appearance and texture across treatments. The WRS and WWS treats with SDP or EP were darker, while NC treats had more surface cracks. Initial crispness, hardness, and fracturability were higher in EP treatments compared to all other sorghum treatments. The predominant flavor and aftertaste identified were “grainy.” The hexanal values for all treats were <1.0 mg/kg except for the EP treatments that had higher values (2.0-19.3 mg/kg) across the shelf-life test. This work indicated that the replacement of WWF-GTN by WWS and WRS, along with soluble animal proteins like SDP or GL would produce comparable preference by dogs, oxidation rates, product aromatics, flavor, aftertaste attributes, and, at a lower degree, product texture.

PMID:35604642 | DOI:10.1093/jas/skac191

Circulation. 2022 May 23. doi: 10.1161/CIRCULATIONAHA.122.060402. Online ahead of print.

ABSTRACT

Background: Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are foundational therapy in patients with heart failure with reduced ejection fraction (HFrEF), yet underlying mechanisms of benefit are not well defined. We sought to investigate the relationships between SGLT2i treatment, changes in metabolic pathways, and outcomes using targeted metabolomics. Methods: Dapagliflozin Effects on Biomarkers, Symptoms and Functional Status in Patients with HF with Reduced Ejection Fraction (DEFINE-HF) was a placebo-controlled trial of dapagliflozin in HFrEF. We performed targeted mass spectrometry-based profiling of 63 metabolites (45 acylcarnitines [markers of fatty acid oxidation], 15 amino acids, and 3 conventional metabolites) in plasma samples at randomization and 12 weeks. Using mixed models, we identified principal components analysis (PCA)-defined metabolite clusters that changed differentially with treatment, and also examined the relationship between change in metabolite clusters with change in Kansas City Cardiomyopathy Questionnaire (KCCQ) Scores and N-terminal pro-B-type natriuretic peptide (NT-proBNP). Models were adjusted for relevant clinical covariates, and nominal p<0.05 with FDR-adjusted p-value<0.10 were used to determine statistical significance. Results: Among the 234 DEFINE-HF participants with targeted metabolomic data, the mean age was 62.0±11.1 years, 25% were women, 38% were Black, and mean ejection fraction was 27±8%. Dapagliflozin increased ketone-related and short/medium-chain acylcarnitine PCA metabolite clusters compared with placebo (nominal p=0.01, FDR-adjusted p-value=0.08 for both clusters). However, ketosis (Β-hydroxybutyrate levels > 500 μM), was infrequently achieved (3 [2.5%] in dapagliflozin arm vs. 1 [0.9%] in placebo arm), and supraphysiologic levels were not observed. Conversely, increases in long-chain acylcarnitine, long-chain dicarboxylacylcarnitine, and aromatic amino acid metabolite clusters were associated with decreases in KCCQ scores (i.e. worse quality of life) and increases in NT-proBNP levels, without interaction by treatment group. Conclusions: In this study of targeted metabolomics in a placebo-controlled trial of SGLT2i in HFrEF, we observed effects of dapagliflozin on key metabolic pathways, supporting a role for altered ketone and fatty acid biology with SGLT2i in patients with HFrEF. Reassuringly, only physiologic levels of ketosis were observed. Additionally, we identified several metabolic biomarkers associated with adverse HFrEF outcomes.

PMID:35603596 | DOI:10.1161/CIRCULATIONAHA.122.060402

Women Health. 2022 May 22:1-9. doi: 10.1080/03630242.2022.2077508. Online ahead of print.

ABSTRACT

This study purposed to assess the mediating role of social support between stress, depressive symptoms, and self-esteem among Jordanian pregnant women. Across-sectional study recruited a total of 538 pregnant Jordanian women using a cluster stratified random sampling technique, during the period from September 2019 to February 2020. The study used the following measures: The Perceived Stress Scale (PSS), Beck’s Depression Inventory (BDI), Rosenberg Self-Esteem Scale, and Multidimensional Social Support Scale (MSPSS). Descriptive statistics and inferential statistics were used to test the mediating effect of social support in terms of the association between depression and self-esteem. The results were considered significant if p ≤ .05. The findings showed that 75.6% of participants had moderate-to-high stress levels. High levels of stress, depressive symptoms, and low self-esteem were highly correlated with low social support (p < .05). Depressive symptoms predict the self-esteem (F_{(2, 537)} = 158.631 p < .05). Social support significantly mediates the relationship between the depressive symptoms and self-esteem with p = .01. Thus, during the antenatal care, administration of screening tools to identify pregnant women with low social support levels and at risk of developing psychological difficulties would allow primary healthcare to promote for positive health outcomes for the mothers and the babies.

PMID:35603571 | DOI:10.1080/03630242.2022.2077508

Inquiry. 2022 Jan-Dec;59:469580221092132. doi: 10.1177/00469580221092132.

ABSTRACT

Introduction. Musculoskeletal disorders (MSD) remain a substantial burden to society and to workplaces worldwide. Evidence-based practice approaches may be helpful; however, current research evidence is not consistently strong. Workplaces must address MSD regardless of the state of the research evidence. The study objective was to describe workplace MSD prevention practices experiences and perspectives of workers, managers, and occupational health and safety practitioners. Methods. This descriptive study used a convenience sample from Newfoundland and Labrador workplaces. Data were collected via survey and interviews. The survey data was analyzed using descriptive statistics and the interview data was analyzed using thematic analysis. Results. Results were examined from 645 survey respondents and 17 interviewees. Survey findings revealed that about half of respondents reported MSD policies existed in their workplace. Many MSD practices (such as ergonomics and force reduction) were considered available by most respondents. Over fifty percent of respondents received some training on MSD. The person most often endorsed as responsible to support workers with MSD was a manager. Interview findings showed that MSD prevention practices related to awareness, training, and hazard reduction are considered important and effective. Facilitators of MSD prevention include practices that are proactive and customized and increase knowledge about MSD prevention. Barriers concerning lack of resources and poor implementation were consistently mentioned. Conclusions. Evidence from current practices may help workplaces reduce MSD burden. However, with only about fifty percent of respondents reporting that MSD policies exist in the workplace, further work to address MSD is required. Future research should examine workplace practices as an important source of evidence. OHS professionals can use the study findings and adapt it to their context(s) to guide their design and implementation of MSD prevention practices. Improved MSD prevention practices and interventions can lead to decreases in MSD in workplaces across all industrial sectors.

PMID:35603566 | DOI:10.1177/00469580221092132

Drug Test Anal. 2022 May 23. doi: 10.1002/dta.3326. Online ahead of print.

ABSTRACT

A method using innovative sample preparation was developed for determination of cocaine on banknotes. Aqueous extraction of cocaine from banknotes was performed using a sonication-enhanced technique. Quantitation of cocaine was achieved using high performance liquid chromatography (HPLC) with UV detection at 230 nm, while identification was accomplished utilizing gas chromatography with mass spectrometry (GC-MS). Multiple calibration techniques, including the external calibration method (ECM), internal standard method (ISM), and standard addition method (SAM) were incorporated into the experimental design to simultaneously determine cocaine contents and assess matrix effects. Statistical paired t tests confirmed that matrix effects were not significant with the sample preparation employed. No damage to the features of the banknotes was observed from the extraction procedure. Extraction efficiency, spike recovery, and detection limit were also determined. The unique experimental design allowed for ECM, ISM, and SAM to concurrently determine the contents of cocaine on banknotes collected around Metro-Detroit. The concentration range of cocaine was from 1.58 to 14.7 mg per note, with an average of 6.96 mg per note. The method is simple and suitable for drug analysis and forensic science applications.

PMID:35603522 | DOI:10.1002/dta.3326

J Vis Commun Med. 2022 May 23:1-7. doi: 10.1080/17453054.2022.2071686. Online ahead of print.

ABSTRACT

This study aimed to evaluate the use of medical photography among dermatologists and plastic surgeons in Saudi Arabia. This cross-sectional study was conducted on 63 physicians (43 dermatologists, 20 plastic surgeons) using 36-item multiple choice questionnaire on the use of medical photography. Data were analysed using descriptive statistics, and two-tailed, Chi-square and Exact tests. Medical photography was used by most of dermatologists (90.7%) and plastic surgeons (95%). More than three-fourths of them agreed that medical photography aids in enhancing clinical effectiveness and standard of care. Photography was done mostly to track disease progression for dermatologists (87.2%), and for research and/or future publications for plastic surgeons (89.5%). The primary reason for exchange of photographs via email or text messages was for seeking second opinion and further recommendations from colleagues. Consent from patients before photographing was obtained by majority of both groups. Medical photography is commonly used both in clinical and academic practices for diagnostic, treatment and teaching purposes. Its value in enhancing medical care is agreed upon and the existence of workplace medical photography protocol is important. Consent from patients must be always acquired and stressed upon even with the absence of clear grounding regulations and protocols.

PMID:35603507 | DOI:10.1080/17453054.2022.2071686

Plant J. 2022 May 23. doi: 10.1111/tpj.15840. Online ahead of print.

ABSTRACT

Peroxisomes are universal eukaryotic organelles essential to plants and animals. Most peroxisomal matrix proteins carry Peroxisome Targeting Signal type 1 (PTS1), a C-terminal tripeptide. Studies from various kingdoms have revealed influences from sequence upstream of the tripeptide on peroxisome targeting, supporting the view that positive charges in the upstream region are the major enhancing elements. However, a systematic approach to better define the upstream elements influencing PTS1 targeting capability is needed. Here, we used protein sequences from 177 plant genomes to perform large-scale and in-depth analysis of the PTS1 domain, which includes the PTS1 tripeptide and upstream sequence elements. We identified and verified 12 low-frequency PTS1 tripeptides and revealed upstream enhancing and inhibiting sequence patterns for peroxisome targeting, which were later validated in vivo. Follow-up analysis revealed that nonpolar and acidic residues have relatively strong enhancing and inhibiting effects respectively, on peroxisome targeting. However, in contrast to the previous understanding, positive charges alone do not show the anticipated enhancing effect and that both the position and property of the residues within these patterns are important for peroxisome targeting. We further demonstrated that the three residues immediately upstream of the tripeptide are the core influencers, with a “basic-nonpolar-basic” pattern serving as a strong and universal enhancing pattern for peroxisome targeting. These findings have significantly advanced our knowledge of the PTS1 domain in plants and likely other eukaryotic species as well. The principles and strategies employed in this study may also be applied to deciphering auxiliary targeting signals for other organelles.

PMID:35603488 | DOI:10.1111/tpj.15840