Tag: statistics

Chemistry. 2022 Mar 31. doi: 10.1002/chem.202200115. Online ahead of print.

ABSTRACT

We discuss in this CONCEPT mini-review the fundamental and polymerization chemistry of inverse vulcanization for the preparation of statistical and segmented sulfur copolymers, which have been actively developed and advanced in various applications over the past decade. We explicitly delve into a discussion of step-growth polymerization constructs to describe the inverse vulcanization process and discuss prepolymer approaches for the synthesis of segmented sulfur polyurethanes. We further discuss the advantages of inverse vulcanization in conjunction with dynamic covalent polymerization and post-polymerization modifications to prepare segmented block copolymers with enhanced thermomechanical and flame retardant properties of these materials.

PMID:35362205 | DOI:10.1002/chem.202200115

Adv Mater. 2022 Mar 31:e2202168. doi: 10.1002/adma.202202168. Online ahead of print.

ABSTRACT

Nanovaccines have emerged as promising alternatives or complements to conventional cancer treatments. Despite the progresses, specific co-delivery of antigen and adjuvant to their corresponding intracellular destinations for maximizing the activation of antitumor immune responses remains a challenge. Herein, we developed a lipid-coated iron oxide nanoparticle as nanovaccine (IONP-C/O@LP) that could co-deliver peptide antigen and adjuvant (CpG DNA) into cytosol and lysosomes of dendritic cells (DCs) through both membrane fusion and endosome-mediated endocytosis. Such two-pronged cellular uptake pattern enabled IONP-C/O@LP to synergistically activate immature DCs. Iron oxide nanoparticle also exhibited adjuvant effects by generating intracellular reactive oxygen species, which further promoted DC maturation. IONP-C/O@LP accumulated in the DCs of draining lymph nodes effectively increased the antigen-specific T cells in both tumor and spleen, inhibited tumor growth, and improved animal survival. Moreover, we have demonstrated that this nanovaccine is a general platform of delivering clinically relevant peptide antigens derived from human papilloma virus 16 to trigger antigen-specific immune responses in vivo. This article is protected by copyright. All rights reserved.

PMID:35362203 | DOI:10.1002/adma.202202168

J Gastroenterol Hepatol. 2022 Mar 31. doi: 10.1111/jgh.15844. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: Endoscopic retrograde cholangiopancreatography (ERCP) requires radiation. This study aimed to assess the clinical factors influencing radiation exposure and devise a scoring model for predicting high-dose radiation exposure.

METHODS: ERCP cases recorded between 2016 and 2019 in a single tertiary teaching hospital were retrospectively reviewed. A scoring model was created by bootstrap method in a derivation cohort (2016-2018) and was assessed in a validation cohort (2019).

RESULTS: Out of 4,223 ERCPs, 2,983 and 1,240 cases were included in the deviation and validation cohorts, respectively. In the derivation cohort, 746 cases (top 25%) comprised the high-dose exposure group, and 2,237 cases (bottom 75%) comprised the low-dose exposure group. Nine clinical parameters associated with high-dose exposure were male, pancreatic sphincterotomy, balloon dilatation, biliary or pancreatic drainage, procedures with contrast dye, endoscopist, in hospital ERCP, and spot image. Stone removal was included by bootstrap analysis. As presented in a nomogram, the weight score of each variable was as follows: male, 1; pancreatic sphincterotomy, 3; balloon dilatation, 7; stone removal, 3; biliary or pancreatic drainage, 5; procedures with contrast dye, 1; endoscopist B, 4; endoscopist C, 5; in hospital procedure, 3; and spot image, 3. A total score ≥15 suggested a high-dose radiation exposure. The sensitivity and specificity of the model for high-dose exposure were 0.562 and 0.813, respectively. In the validation cohort, the model showed reasonable predictability.

CONCLUSIONS: Various factors were associated with radiation exposure. The simple scoring system in this study could guide endoscopists in predicting the risk of high-dose radiation exposure.

PMID:35362155 | DOI:10.1111/jgh.15844

J Adv Nurs. 2022 Apr 1. doi: 10.1111/jan.15207. Online ahead of print.

ABSTRACT

AIMS: Reproductive coercion is associated with poor health outcomes in women. This study examined exposure to and use of reproductive coercion and care seeking among college students.

DESIGN: A cross-sectional survey was administered to 2291 college students of all genders seeking care in college health and counselling centres as baseline data for a cluster-randomized controlled trial.

METHODS: Online surveys were collected (9/2015-3/2017). Descriptive statistics, chi-square, Fisher’s exact and t-tests were analysed.

RESULTS: Among female participants, 3.1% experienced reproductive coercion in the prior 4 months. Experience was associated with older age (p = .041), younger age at first intercourse (p = .004), Black/African American race (p < .001), behaviourally bisexual (p = .005), more lifetime sexual partners (p < .001) and ever pregnant (p = .010). Sexually transmitted infection (p < .001), recent drug use or smoking (p = .018; p = .001), requiring special health equipment (p = .049), poor school performance (p < .001) and all categories of violence (p = <.001-.015) were associated with women’s reproductive coercion experience. Participants who experienced reproductive coercion were more likely to seek care for both counselling and healthcare, (p = .022) and sexually transmitted infection (p = .004). Among males, 2.3% reported recent use of reproductive coercion; these participants reported sexual violence perpetration (p = .005), less condom use (p = .003) and more sexual partners than non-perpetrators (p < .001).

CONCLUSION: Although reproductive coercion was reported infrequently among college students, those students experiencing it appear to be at risk for poor health and academic outcomes. Health and counselling centres are promising settings to address RC and related health behaviours.

PMID:35362185 | DOI:10.1111/jan.15207

Cytopathology. 2022 Apr 1. doi: 10.1111/cyt.13123. Online ahead of print.

ABSTRACT

OBJECTIVE: The effect of rapid on-site evaluation (ROSE) combined with computed tomography-guided transthoracic core needle biopsy (CT-guided TCNB) is rarely investigated. This study aimed to evaluate the diagnostic efficiency and safety of ROSE combined with CT-guided TCNB for suspected lung cancer patients.

MATERIALS AND METHODS: Clinical data from 285 patients who received CT-guided TCNB for suspected lung cancer in Huashan Hospital from 2015 to 2018 were retrospectively analyzed. 163 of these patients underwent CT-guided TCNB combined with ROSE (ROSE group), while the remaining 122 patients underwent without ROSE (non-ROSE group). The smears obtained from TCNB were quickly processed with Diff-Quick staining and analyzed by one skilled cytologist on-site. The consistency of ROSE with the final clinicopathological diagnosis and the diagnostic efficiency and safety of ROSE combined with CT-guided TCNB in suspected lung cancer patients were evaluated.

RESULTS: ROSE was highly concordant with pathological diagnosis (κ = 0.791; p < 0.001), with the accuracy of 95.7%. The diagnostic accuracy was significantly higher in ROSE group compared with that in non-ROSE group (96.3% vs. 86.1%; p = 0.002), with overall incidences of complications of 36.8% and 23.8%, respectively. Minor pneumothorax without drainage was slightly increased in ROSE group compared with non-ROSE group (14.1% vs. 6.6%; p = 0.046). However, there was no significant difference in serious complications between the two groups.

CONCLUSION: ROSE was highly consistent with the final clinicopathological diagnosis for suspected lung cancer. ROSE further improved the diagnostic efficiency of CT-guided TCNB with no increased incidence of serious complications.

PMID:35362154 | DOI:10.1111/cyt.13123

Br J Clin Psychol. 2022 Apr 1. doi: 10.1111/bjc.12366. Online ahead of print.

ABSTRACT

OBJECTIVES: This study examined whether ‘personality vulnerability’ (i.e., self-critical perfectionism or dependency) predicts the trajectory of change, as well as variability and instability (i.e., entropy) of symptoms, during cognitive behaviour therapy (CBT) for depression.

DESIGN: Study participants were outpatients (N = 312) experiencing a primary mood disorder. Participants received CBT for depression group sessions over 15 weeks. Self-report measures of self-critical perfectionism, dependency, and depression were collected longitudinally.

METHODS: A latent growth mixture modelling (LGMM) statistical approach was used to evaluate the presence of latent classes of individuals based on their longitudinal pattern of symptom change during CBT and to evaluate whether baseline self-critical perfectionism or dependency predicts class membership. A Latent Acceleration Score (LAS) model evaluated whether perfectionism or dependency led to variability in depression symptom change (e.g., velocity) by considering changes in velocity (e.g., acceleration and/or deceleration).

RESULTS: LGMM indicated the presence of two latent classes that represent symptom improvement (N = 239) or minimal symptom improvement over time (N = 73). Elevated baseline self-critical perfectionism, but not dependency, predicted a greater likelihood of membership in the class of participants who demonstrated minimal symptom improvement over time. The second analysis examined whether baseline self-critical perfectionism also predicts depression symptom variability and instability. The LAS perfectionism model demonstrated that perfectionism accelerates depression symptom change during the first seven sessions of treatment, then has a decelerating effect on depression symptom change.

CONCLUSIONS: Results indicated that higher baseline self-critical perfectionism predicted higher variability and instability in depression symptoms and variability in acceleration and deceleration, over the course of treatment.

PMID:35362112 | DOI:10.1111/bjc.12366

J Trauma Stress. 2022 Mar 31. doi: 10.1002/jts.22819. Online ahead of print.

ABSTRACT

Refugees are disproportionately affected by extreme traumatic events that can violate core beliefs and life goals (i.e., global meaning) and cause significant distress. This mixed-methods study used an exploratory sequential design to assess meaning violations in a sample of Syrian refugees living in Portugal. For this purpose, we cross-culturally adapted the Global Meaning Violations Scale (GMVS) for use with Arabic-speaking refugees. In total, 43 war-affected Syrian adults participated in the two-phase study. Participants completed measures of trauma and narrated violations as they filled out the newly adapted GMVS-ArabV. GMVS-ArabV validity evidence based on response processes was investigated through Phase 1 focus groups (FGs; n = 2), whereas data from Phase 2 cognitive interviews (n = 38) were used to preliminarily explore the measure’s internal structure through descriptive statistics as well as culture- and trauma-informed content evidence through thematic analysis. The results suggested highest goal (M = 3.51, SD = 1.46) and lowest belief (M = 2.38, SD = 1.59) violations of educational goals and religious beliefs, respectively. Themes related to stressors, item formulation, response scale, and the global meaning construct suggested that (a) beliefs and goals can be differentially violated by different stressors; (b) much like war trauma, including torture, daily stressors can additionally shatter pretrauma global meaning; and (c) refugees reappraise meaning and suffer violations anew throughout their migration journeys. The GMVS-ArabV offers a promising tool for exploring shattered cognitions in refugees and informs evidence-based approaches to trauma recovery and psychological adjustment in postmigration settings (the Arabic abstract and keywords are available in the Supplementary Materials).

PMID:35362149 | DOI:10.1002/jts.22819

Surg Technol Int. 2022 Mar 31;40:sti40/1556. Online ahead of print.

ABSTRACT

BACKGROUND: Low-intensity shockwave therapy (Li-SWT) is a promising option for the treatment of erectile dysfunction (ED). Many devices with different characteristics in terms of generators, shockwaves, set-up parameters and procedure protocols are commercially available. In this report, we present our experience with the main shockwave technologies currently in use in clinical practice for ED treatment.

METHODS: A retrospective national, multi-institutional study was performed to compare the effects of different shockwave technologies in ED patients. All of the subjects underwent 8 consecutive weekly physical treatments with SWT under either a focused or non-focused regimen: 3,000 shocks per session at 0.09 mJ/mm2 and 10,000 shocks per session at 15 Hz and 90 mJ, respectively. Efficacy was evaluated by comparing pre- and post-treatment Sexual Health Inventory in Men (SHIM) scores, International Index of Erectile Function (IIEF-5) and Erection Hardness Score (EHS). Possible relationships between type of shockwave generator, source, morphology and type of ED were investigated.

RESULTS: A total of 94 men were included in the analysis. There were no significant differences in the baseline clinical characteristics or demographics. The mean (SD) increase in the scores from questionnaires evaluated at 8 weeks was clinically and statistically significant, with overall improvements of +5.49, +5.47 and +1.18 (p<0.0001) in the IIEF-5, SHIM, and EHS scores, respectively. The increases in these scores were evaluated by a multiple regression analysis, in relation to the shockwave generator, type of ED, shockwave source and morphology, but none of the factors examined predicted improvement. No side effects were reported with any device.

CONCLUSIONS: SWT is a clinically effective and safe treatment for ED that is independent of the generator type, source, shockwave morphology emitted, type of ED and perhaps treatment protocol.

PMID:35362088

Crit Care Nurse. 2022 Apr 1;42(2):23-31. doi: 10.4037/ccn2022385.

ABSTRACT

BACKGROUND: Intensive care unit early mobility programs improve patients’ functional status and outcomes. An electronic health record-based communication tool improved interprofessional communication within an early mobility program. Long-term sustainability of this communication tool has not been evaluated.

LOCAL PROBLEM: Ineffective interprofessional communication was perceived as a barrier to success of an intensive care unit early mobility program at the project institution. An electronic health record-based communication tool was successfully implemented to improve communication. Sustaining the intervention is of continued importance.

METHODS: Longitudinal data were collected 2 years after initial implementation of the communication tool to evaluate its continued impact on patient outcomes and staff engagement with an intensive care unit early mobility program.

RESULTS: Initial implementation of the electronic health record-based communication tool resulted in statistically and clinically significant improvements in patient and staff metrics. Compared with postimplementation data, 2-year longitudinal follow-up data revealed nonsignificant changes in patient outcomes (time from admission to mobility goal, mechanical ventilation duration, length of intensive care unit stay, and discharge disposition recommendations to higher independence levels). Staff reported continued use of the communication tool and positive perceptions of its impact on the intensive care unit early mobility program.

CONCLUSIONS: Nonsignificant changes in patient outcomes may indicate sustainment of the effect of the communication tool’s original implementation. Employing appropriate sustainment techniques is essential to maintain practice change. The electronic health record-based communication tool can improve interprofessional communication within an intensive care unit early mobility program, improving patient outcomes and staff teamwork.

PMID:35362081 | DOI:10.4037/ccn2022385

Pediatrics. 2022 Apr 1;149(4):e2021052165. doi: 10.1542/peds.2021-052165.

ABSTRACT

BACKGROUND AND OBJECTIVES: Inappropriate vancomycin use is common in children’s hospitals. We report a quality improvement (QI) intervention to reduce vancomycin use in our tertiary care PICU.

METHODS: We retrospectively quantified the prevalence of infections caused by organisms requiring vancomycin therapy, including methicillin-resistant Staphylococcus aureus (MRSA), among patients with suspected bacterial infections. Guided by these data, we performed 3 QI interventions over a 3-year period, including (1) stakeholder education, (2) generation of a consensus-based guideline for empiric vancomycin use, and (3) implementation of this guideline through clinical decision support. Vancomycin use in days of therapy (DOT) per 1000 patient days was measured by using statistical process control charts. Balancing measures included frequency of bacteremia due to an organism requiring vancomycin not covered with empiric therapy, 30-day mortality, and cardiovascular, respiratory, and renal organ dysfunction.

RESULTS: Among 1276 episodes of suspected bacterial infection, a total of 19 cases of bacteremia (1.5%) due to organisms requiring vancomycin therapy were identified, including 6 MRSA bacteremias (0.5%). During the 3-year QI project, overall vancomycin DOT per 1000 patient days in the PICU decreased from a baseline mean of 182 DOT per 1000 patient days to 109 DOT per 1000 patient days (a 40% reduction). All balancing measures were unchanged, and all cases of MRSA bacteremia were treated empirically with vancomycin.

CONCLUSION: Our interventions reduced overall vancomycin use in the PICU without evidence of harm. Provider education and consensus building surrounding indications for empiric vancomycin use were key strategies.

PMID:35362066 | DOI:10.1542/peds.2021-052165