Tag: statistics

Cell Rep. 2022 Mar 29;38(13):110606. doi: 10.1016/j.celrep.2022.110606.

ABSTRACT

The visual system processes sensory inputs sequentially, perceiving coarse information before fine details. Here we study the neural basis of coarse-to-fine processing and its computational benefits in natural vision. We find that primary visual cortical neurons in awake mice respond to natural scenes in a coarse-to-fine manner, primarily driven by individual neurons rapidly shifting their spatial frequency preference from low to high over a brief response period. This shift transforms the population response in a way that counteracts the statistical regularities of natural scenes, thereby reducing redundancy and generating a more efficient neural representation. The increase in representational efficiency does not occur in either dark-reared or anesthetized mice, which show significantly attenuated coarse-to-fine spatial processing. Collectively, these results illustrate that coarse-to-fine processing is state dependent, develops postnatally via visual experience, and provides a computational advantage by generating more efficient representations of the complex spatial statistics of ethologically relevant natural scenes.

PMID:35354030 | DOI:10.1016/j.celrep.2022.110606

West J Emerg Med. 2021 Jul 15;22(4):937-942. doi: 10.5811/westjem.2021.4.50135.

ABSTRACT

INTRODUCTION: Most emergency medicine (EM) applicants use the internet as a source of information when evaluating residency programs. Previous studies have analyzed the components of residency program websites; however, there is a paucity of information regarding EM program websites. The purpose of our study was to analyze information on EM residency program websites.

METHODS: In April-May 2020, we evaluated 249 United States EM residency program websites for presence or absence of 38 items relevant to EM applicants. Descriptive statistics were performed, including means and standard deviations.

RESULTS: Of the 249 EM websites evaluated, the websites contained a mean of 20 of 38 items (53%). Only 16 programs (6%) contained at least three-quarters of the items of interest, and no programs contained all 38 items. The general categories with the least amount of items were social media use (9%), research (46%), and lifestyle (49%), compared to the other general categories such as application process (58%), resident information (63%), general program information (67%), and facility information (69%). The items provided by programs most often included program description (98%), blocks and rotations (91%), and faculty listing (88%). The items provided least often included housing/neighborhood information (17%) and social media links (19%).

CONCLUSION: Our comprehensive review of EM residency websites in the US revealed the absence of many variables on most programs’ websites. Use of this information to enhance accessibility of desired information stands to benefit both applicants and programs in the increasingly competitive specialty of EM.

PMID:35354009 | DOI:10.5811/westjem.2021.4.50135

West J Emerg Med. 2021 Jul 20;22(4):979-987. doi: 10.5811/westjem.2021.3.50116.

ABSTRACT

INTRODUCTION: Patients with coronavirus disease 2019 (COVID-19) can develop rapidly progressive respiratory failure. Ventilation strategies during the COVID-19 pandemic seek to minimize patient mortality. In this study we examine associations between the availability of emergency department (ED)-initiated high-flow nasal cannula (HFNC) for patients presenting with COVID-19 respiratory distress and outcomes, including rates of endotracheal intubation (ETT), mortality, and hospital length of stay.

METHODS: We performed a retrospective, non-concurrent cohort study of patients with COVID-19 respiratory distress presenting to the ED who required HFNC or ETT in the ED or within 24 hours following ED departure. Comparisons were made between patients presenting before and after the introduction of an ED-HFNC protocol.

RESULTS: Use of HFNC was associated with a reduced rate of ETT in the ED (46.4% vs 26.3%, P <0.001) and decreased the cumulative proportion of patients who required ETT within 24 hours of ED departure (85.7% vs 32.6%, P <0.001) or during their entire hospitalization (89.3% vs 48.4%, P <0.001). Using HFNC was also associated with a trend toward increased survival to hospital discharge; however, this was not statistically significant (50.0% vs 68.4%, P = 0.115). There was no impact on intensive care unit or hospital length of stay. Demographics, comorbidities, and illness severity were similar in both cohorts.

CONCLUSIONS: The institution of an ED-HFNC protocol for patients with COVID-19 respiratory distress was associated with reductions in the rate of ETT. Early initiation of HFNC is a promising strategy for avoiding ETT and improving outcomes in patients with COVID-19.

PMID:35354003 | DOI:10.5811/westjem.2021.3.50116

West J Emerg Med. 2021 Jul 19;22(4):810-819. doi: 10.5811/westjem.2021.3.50932.

ABSTRACT

INTRODUCTION: Our goal was to systematically review contemporary literature comparing the relative effectiveness of two mechanical compression devices (LUCAS and AutoPulse) to manual compression for achieving return of spontaneous circulation (ROSC) in patients undergoing cardiopulmonary resuscitation (CPR) after an out-of-hospital cardiac arrest (OHCA).

METHODS: We searched medical databases systematically for randomized controlled trials (RCT) and observational studies published between January 1, 2000-October 1, 2020 that compared mechanical chest compression (using any device) with manual chest compression following OHCA. We only included studies in the English language that reported ROSC outcomes in adult patients in non-trauma settings to conduct random-effects metanalysis and trial sequence analysis (TSA). Multivariate meta-regression was performed using preselected covariates to account for heterogeneity. We assessed for risk of biases in randomization, allocation sequence concealment, blinding, incomplete outcome data, and selective outcome reporting.

RESULTS: A total of 15 studies (n = 18474), including six RCTs, two cluster RCTs, five retrospective case-control, and two phased prospective cohort studies, were pooled for analysis. The pooled estimates’ summary effect did not indicate a significant difference (Mantel-Haenszel odds ratio = 1.16, 95% confidence interval, 0.97 to 1.39, P = 0.11, I2 = 0.83) between mechanical and manual compressions during CPR for ROSC. The TSA showed firm evidence supporting the lack of improvement in ROSC using mechanical compression devices. The Z-curves successfully crossed the TSA futility boundary for ROSC, indicating sufficient evidence to draw firm conclusions regarding these outcomes. Multivariate meta-regression demonstrated that 100% of the between-study variation could be explained by differences in average age, the proportion of females, cardiac arrests with shockable rhythms, witnessed cardiac arrest, bystander CPR, and the average time for emergency medical services (EMS) arrival in the study samples, with the latter three attaining statistical significance.

CONCLUSION: Mechanical compression devices for resuscitation in cardiac arrests are not associated with improved rates of ROSC. Their use may be more beneficial in non-ideal situations such as lack of bystander CPR, unwitnessed arrest, and delayed EMS response times. Studies done to date have enough power to render further studies on this comparison futile.

PMID:35353993 | DOI:10.5811/westjem.2021.3.50932

West J Emerg Med. 2021 Jul 19;22(4):919-930. doi: 10.5811/westjem.2021.3.49770.

ABSTRACT

INTRODUCTION: The role of gender in interprofessional interactions is poorly understood. This mixed-methods study explored perceptions of gender bias in interactions between emergency medicine (EM) residents and nurses.

METHODS: We analyzed qualitative interviews and focus groups with residents and nurses from two hospitals for dominant themes. An electronic survey, developed through an inductive-deductive approach informed by qualitative data, was administered to EM residents and nurses. Quantitative analyses included descriptive statistics and between-group comparisons.

RESULTS: Six nurses and 14 residents participated in interviews and focus groups. Key qualitative themes included gender differences in interprofessional communication, specific examples of, and responses to, gender bias. Female nurses perceived female residents as more approachable and collaborative than male residents, while female residents perceived nurses’ questions as doubting their clinical judgment. A total of 134 individuals (32%) completed the survey. Females more frequently perceived interprofessional gender bias (mean 30.9; 95% confidence interval {CI}, 25.6, 36.2; vs 17.6 [95% CI, 10.3, 24.9). Residents reported witnessing interprofessional gender bias more frequently than nurses (58.7 (95% CI, 48.6, 68.7 vs 23.9 (95% CI, 19.4, 28.4). Residents reported that gender bias affected job satisfaction (P = 0.002), patient care (P = 0.001), wellness (P = 0.003), burnout (P = 0.002), and self-doubt (P = 0.017) more frequently than nurses.

CONCLUSION: Perceived interprofessional gender bias negatively impacts personal wellbeing and workplace satisfaction, particularly among female residents. Key institutional stakeholders including residency, nursing, and hospital leadership should invest the resources necessary to develop and integrate evidence-based strategies to improve interprofessional relationships that will ultimately enhance residency training, work climate, and patient care.

PMID:35353996 | DOI:10.5811/westjem.2021.3.49770

West J Emerg Med. 2021 Jul 20;22(4):882-889. doi: 10.5811/westjem.2021.2.50249.

ABSTRACT

INTRODUCTION: Increases in emergency department (ED) crowding and boarding are a nationwide issue resulting in worsening patient care and throughput. To compensate, ED administrators often look to modifying staffing models to improve efficiencies.

METHODS: This study evaluates the impact of implementing the waterfall model of physician staffing on door-to-doctor time (DDOC), door-to-disposition time (DDIS), left without being seen (LWBS) rate, elopement rate, and the number of patient sign-outs. We examined 9,082 pre-intervention ED visits and 8,983 post-intervention ED visits.

RESULTS: The change in DDOC, LWBS rate, and elopement rate demonstrated statistically significant improvement from a mean of 65.1 to 35 minutes (P <0.001), 1.12% to 0.92% (P = 0.004), and 3.96% to 1.95% (P <0.001), respectively. The change in DDIS from 312 to 324.7 minutes was not statistically significant (P = 0.310). The number of patient sign-outs increased after the implementation of a waterfall schedule (P <0.001).

CONCLUSION: Implementing a waterfall schedule improved DDOC time while decreasing the percentage of patients who LWBS and eloped. The DDIS and number of patient sign-outs appears to have increased post implementation, although this may have been confounded by the increase in patient volumes and ED boarding from the pre- to post-intervention period.

PMID:35353992 | DOI:10.5811/westjem.2021.2.50249

Sci Total Environ. 2022 Mar 27:154867. doi: 10.1016/j.scitotenv.2022.154867. Online ahead of print.

ABSTRACT

Climatology and trends in different types of aerosols with focus on absorbing aerosols over Kanpur located in Indo-Gangetic Plain (IGP) in South Asia and Beijing in North China Plain (NCP) in East Asia are investigated. We perform a first analysis of high-quality time series of columnar aerosols observations over a period of nearly two-decades, along with satellite observations to provide a broader regional perspective. Satellite retrieved aerosol Ångström exponent (AE) values have increased (10-20%) suggesting an increasing contribution of fine aerosols to aerosol optical depth (AOD) over Asia in last 2-decades. Among three aerosol types [urban-industrial (UI), biomass burning (BB), and dust (DU)], only UI and BB aerosols are present over Kanpur throughout the year, while DU is present along with UI and BB aerosols only during pre-monsoon and monsoon. Overall, there is a positive trend in BB aerosols over both Kanpur and Beijing, a positive (negative) trend in UI aerosols over Kanpur (Beijing), and positive (negative) trend in dust over Beijing (Kanpur). Positive trend in BB aerosols over Kanpur is statistically significant. Among three absorbing aerosol types [mostly black carbon (MBC), mostly dust (MDU), and mixed (MIX) containing BC and dust], only MBC and MIX are present in post-monsoon and winter over IGP, and MDU is present along with MBC and MIX only during pre-monsoon and monsoon, in agreement with aerosol types found. Trends in MBC, MIX and MDU over Kanpur in IGP and in MIX over Beijing are statistically significant. These trends are attributed mainly to changes in anthropogenic aerosol emissions, and not to natural and climatic factors as their changes are relatively small. These findings on hitherto unavailable climatology and trends in aerosols and absorbing aerosols over two global aerosol hotspots and identified contrasts will be crucial in model simulations to better decipher aerosol-climate interactions over Asia.

PMID:35353982 | DOI:10.1016/j.scitotenv.2022.154867

J Clin Lab Anal. 2022 Mar 30:e24379. doi: 10.1002/jcla.24379. Online ahead of print.

ABSTRACT

BACKGROUND: Mucosa-associated lymphoid tissue lymphoma translocation protein 1 (MALT1) participates in the immune-related allergic response and inflammation flare, while its clinical role in asthma children is still unknown. Herein, this study aimed to investigate MALT1 expression, and its correlation with exacerbation risk, T helper (Th)1, Th2 cells (and their secreted cytokines), as well as inflammatory cytokines in asthma children.

METHODS: Sixty children with asthma exacerbation and 60 children with remission asthma were enrolled in this study; then their blood MALT1, Th1, Th2 cells, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interferon-gamma (IFN-γ), and interleukin-4 (IL-4) were detected. Besides, blood MALT1 in another 20 health controls was also determined.

RESULTS: Mucosa-associated lymphoid tissue lymphoma translocation protein 1 was highest in children with asthma exacerbation, followed by children with remission asthma, and lowest in health controls (p < 0.001). MALT1 could distinguish children with asthma exacerbation from children with remission asthma (area under the curve (AUC): 0.757, 95% CI: 0.670-0.843). In children with asthma exacerbation, MALT1 was negatively linked with IFN-γ (p = 0.002) and Th1 cells (p = 0.050), but positively related to Th2 cells (p = 0.027) and exhibited a positive correlation trend (without statistical significance) with IL-4 (p = 0.066); meanwhile, MALT1 was positively correlated with exacerbation severity (p = 0.010) and TNF-α (p = 0.003), but not linked with IL-6 (p = 0.096). In children with remission asthma, MALT1 only was negatively associated with Th1 cells (p = 0.023), but positively linked with TNF-α (p = 0.023).

CONCLUSION: Mucosa-associated lymphoid tissue lymphoma translocation protein 1 serves as a potential biomarker for monitoring exacerbation risk and Th1/Th2 imbalance-mediated inflammation of asthma children.

PMID:35353938 | DOI:10.1002/jcla.24379

Ultrasound Obstet Gynecol. 2022 Mar 30. doi: 10.1002/uog.24906. Online ahead of print.

ABSTRACT

OBJECTIVES: To report the causative relationship of maternal COVID-19 with intrauterine fetal death, describe the specific placental pathology, findings of fetal autopsy and clinical characteristics, and identify potential risk factors.

METHODS: This is a prospective case series. A cohort of 165 placentas of non-vaccinated pregnant women affected by COVID-19 in Greece were histologically examined and six cases of intrauterine fetal death associated with SARS-COV-2 placentitis were retrieved. Complete fetal autopsy was performed in three cases. Gross, histopathological, immunohistochemical, molecular, and electron microscopy examinations were carried out in the stillbirth placentas and fetal organs. The histological findings of SARS-COV-2 placentitis were compared with the 159 cases, in which maternal COVID-19 resulted in livebirth. Regression analysis was used to identify predisposing factors for SARS-COV-2 placentitis.

RESULTS: All six stillbirth placentas showed severe and extensive histological changes of SARS-COV-2 placentitis, i.e. a combination of marked intervillositis with a mixed inflammatory infiltrate and massive perivillous fibrinoid deposition with trophoblast damage, associated with intensely positive immunostaining for SARS-COV-2 spike protein, the presence of virions on electron microscopy and a positive RT-PCR test in placental tissues. The histological lesions obliterated over 75% of the maternal intervillous space, accounting for intrauterine fetal death. Similar histological lesions affecting less than 25% of the placenta were recorded in 7 liveborn neonates, while the remaining 152 placentas of COVID-19-affected pregnancies with livebirths did not show similar findings. Complete fetal autopsy showed evidence of an asphyctic mode of death without evidence of viral transmission to the fetus. The mothers had mild clinical symptoms or were asymptomatic and the interval between maternal COVID-19 diagnosis and fetal death ranged from 3 to 15 days. Statistically significant predisposing factors for SARS-COV-2-placentitis included thrombophilia and IUGR. Multiple sclerosis was seen in one case.

CONCLUSIONS: SARS-COV-2 placentits occurred uncommonly in COVID-19-affected pregnancies of non-vaccinated mothers and, when extensive, caused fetal demise, with no evidence of transplacental fetal infection. Thrombophilia and prenatally detected IUGR emerged as independent predisposing factors for the potentially lethal SARS-COV-2 placentitis. This article is protected by copyright. All rights reserved.

PMID:35353936 | DOI:10.1002/uog.24906