Tag: statistics

Spine (Phila Pa 1976). 2021 Jul 7. doi: 10.1097/BRS.0000000000004163. Online ahead of print.

ABSTRACT

STUDY DESIGN: Michigan Spine Surgery Improvement Collaborative (MSSIC) prospectively collects data on all patients undergoing operations for degenerative and/or deformity indications.

OBJECTIVE: We aimed to identify which factors are significantly associated with return-to-work after lumbar surgery at long-term follow-up.

SUMMARY OF BACKGROUND DATA: Prior publications have created a clinically relevant predictive model for return-to-work, wherein education, gender, race, comorbidities, and preoperative symptoms increased likelihood of return-to-work at 3 months after lumbar surgery. We sought to determine if these trends 1) persisted at 1 year and 2 years postoperatively; or 2) differed among preoperatively employed versus unemployed patients.

METHODS: MSSIC was queried for all patients undergoing lumbar operations (2014-2019). All patients intended to return-to-work postoperatively. Patients were followed for up to 2 years postoperatively. Measures of association were calculated with multivariable generalized estimating equations (GEE).

RESULTS: Return-to-work increased from 63% (3542/5591) at 90 days postoperatively to 75% (3143/4147) at 1 year and 74% (2133/2866) at 2 years postoperatively. Following GEE, neither clinical nor surgical variables predicted return-to-work at all three time intervals: 90 days, 1 year, and 2 years postoperatively. Only socioeconomic factors reached statistical significance at all follow-up points. Preoperative employment followed by insurance status had the greatest associations with return-to-work. In a sub-analysis of patients who were preoperatively employed, insurance was the only factor with significant associations with return-to-work at all three follow-up intervals. The return-to-work rates among unemployed patients at baseline increased from 29% (455/1100) at 90 days, 44% (495/608) at 1 year, and 46% (366/426) at 2 years postoperatively. The only two significant factors associated with return-to-work at all three follow-up intervals were Medicaid, as compared to private insurance, and male gender.

CONCLUSION: In patients inquiring about long-term return-to-work after lumbar surgery, insurance status represents the important determinant of employment status.Level of Evidence: 2.

PMID:34265812 | DOI:10.1097/BRS.0000000000004163

J Strength Cond Res. 2021 Jul 13. doi: 10.1519/JSC.0000000000004019. Online ahead of print.

ABSTRACT

Figueiredo, PS, Looney, DP, Pryor, JL, Doughty, EM, McClung, HL, Vangala, SV, Santee, WR, Beidleman, BA, and Potter, AW. Verification of maximal oxygen uptake in active military personnel during treadmill running. J Strength Cond Res XX(X): 000-000, 2021-It is unclear whether verification tests are required to confirm “true” maximal oxygen uptake (V[Combining Dot Above]O2max) in modern warfighter populations. Our study investigated the prevalence of V[Combining Dot Above]O2max attainment in U.S. Army soldiers performing a traditional incremental running test. In addition, we examined the utility of supramaximal verification testing as well as repeated trials for familiarization for accurate V[Combining Dot Above]O2max assessment. Sixteen U.S. Army soldiers (1 woman, 15 men; age, 21 ± 2 years; height, 1.73 ± 0.06 m; body mass, 71.6 ± 10.1 kg) completed 2 laboratory visits, each with an incremental running test (modified Astrand protocol) and a verification test (110% maximal incremental test speed) on a motorized treadmill. We evaluated V[Combining Dot Above]O2max attainment during incremental testing by testing for the definitive V[Combining Dot Above]O2 plateau using a linear least-squares regression approach. Peak oxygen uptake (V[Combining Dot Above]O2peak) was considered statistically equivalent between tests if the 90% confidence interval around the mean difference was within ±2.1 ml·kg-1·min-1. Oxygen uptake plateaus were identified in 14 of 16 volunteers for visit 1 (87.5%) and all 16 volunteers for visit 2 (100%). Peak oxygen uptake was not statistically equivalent, apparent from the mean difference in V[Combining Dot Above]O2peak measures between the incremental test and verification test on visit 1 (2.3 ml·kg-1·min-1, [1.3-3.2]) or visit 2 (1.1 ml·kg-1·min-1 [0.2-2.1]). Interestingly, V[Combining Dot Above]O2peak was equivalent, apparent from the mean difference in V[Combining Dot Above]O2peak measures between visits for the incremental tests (0.0 ml·kg-1·min-1 [-0.8 to 0.9]) but not the verification tests (-1.2 ml·kg-1·min-1 [-2.2 to -0.2]). Modern U.S. Army soldiers can attain V[Combining Dot Above]O2max by performing a modified Astrand treadmill running test. Additional familiarization and verification tests for confirming V[Combining Dot Above]O2max in healthy active military personnel may be unnecessary.

PMID:34265816 | DOI:10.1519/JSC.0000000000004019

Am J Clin Oncol. 2021 Jul 16. doi: 10.1097/COC.0000000000000851. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study was to compare survival endpoints between women with uterine carcinosarcoma and those with uterine serous carcinoma utilizing matching analysis.

METHODS: Patients with stages I to II who underwent hysterectomy at our institution were included in this analysis. Patients with carcinosarcoma were then matched to patients with serous carcinoma based on stage, and adjuvant management received (observation, radiation treatment alone, chemotherapy alone, or combined modality with radiotherapy and chemotherapy. Recurrence-free survival, disease-specific survival, and overall survival were calculated for the 2 groups.

RESULTS: A total of 134 women were included (67 women with carcinosarcoma and 67 with serous carcinoma, matched 1:1). There was no statistically significant difference between the 2 groups regarding 5-year recurrence-free survival (59% vs. 62%), disease-specific survival (66% vs. 67%), or overall survival (53% vs. 57%), respectively. The only independent predictor of shorter recurrence-free survival for the entire cohort was the lack of adjuvant combined modality therapy, while lower uterine segment involvement was the only independent predictor for shorter disease-specific survival. Lack of lymph node dissection and lack of adjuvant combined modality therapy were independent predictors of shorter overall survival.

DISCUSSION: When matched based on stage and adjuvant treatment, our study suggests that there is no statistically significant difference in survival endpoints between women with early-stage carcinosarcoma and serous carcinoma. Adjuvant combined modality treatment is an independent predictor of longer recurrence-free survival and overall survival.

PMID:34265785 | DOI:10.1097/COC.0000000000000851

Clin J Pain. 2021 Jul 9. doi: 10.1097/AJP.0000000000000959. Online ahead of print.

ABSTRACT

CONTEXT AND OBJECTIVES: Although opioids play an indispensable role in the management of cancer-related pain, inadequate pain relief still occurs. The primary objective of this study was to evaluate whether the combination of a low dose of methadone with morphine promotes a reduction in opioid consumption; the secondary objectives were if the association promotes lower pain intensity, and adverse effects.

METHODS: There were studied 41 patients with cancer-related pain in palliative setting. They were starting the third step of the analgesic ladder, and one group achieve methadone (2.5▒mg/12▒h) in combination with morphine (MM), and another group received morphine (M) alone. Both groups could use morphine (5▒mg) as needed to maintain pain intensity <4, and adjuvant in stable dose. The following outcomes were evaluated: total morphine dose, pain intensity, and adverse effects.

RESULTS: There was no difference in the number of adjuvants, and the dose of morphine used. Pain intensity was lower in the MM group after 2 weeks, with no statistically significant difference at other time points. There was no difference in the adverse effects.

CONCLUSIONS: Low dose of methadone in combination with morphine provided faster pain control as compared to morphine alone, and although this study was not powered to show differences in adverse effects, we did not notice a difference.

PMID:34265791 | DOI:10.1097/AJP.0000000000000959

Am J Emerg Med. 2021 Jul 2;50:1-4. doi: 10.1016/j.ajem.2021.06.068. Online ahead of print.

ABSTRACT

BACKGROUND: The restraint chair is a tool used by law enforcement and correction personnel to control aggressive, agitated individuals. When initiating its use, subjects are often placed in a hip-flexed/head-down (HFHD) position to remove handcuffs. Usually, this period of time is less than two minutes but can become more prolonged in particularly agitated patients. Some have proposed this positioning limits ventilation and can result in asphyxia. The aim of this study is to evaluate if a prolonged HFHD restraint position causes significant ventilatory compromise.

METHODS: Subjects exercised on a stationary bicycle until they reached 85% of their predicted maximal heart rate. They were then handcuffed with their hands behind their back and placed into a HFHD seated position for five minutes. The primary outcome measurement was maximal voluntary ventilation (MVV). This was measured at baseline, after initial placement into the HFHD position, and after five minutes of being in the position while still maintaining the HFHD position. Baseline measurements were compared with final measurements for statistically significant differences.

RESULTS: We analyzed data for 15 subjects. Subjects had a mean MVV of 165.3 L/min at baseline, 157.8 L/min after initially being placed into the HFHD position, and a mean of 138.7 L/min after 5 min in the position. The mean baseline % predicted MVV was 115%; after 5 min in the HFHD position the mean was 96%. This 19% absolute difference was statistically significant (p = 0.001).

CONCLUSIONS: In healthy seated male subjects with recent exertion, up to five minutes in a HFHD position results in a small decrease in MVV compared with baseline MVV levels. Even with this decrease, mean MVV levels were still 96% of predicted after five minutes. Though a measurable decrease was found, there was no clinically significant change that would support that this positioning would lead to asphyxia over a five-minute time period.

PMID:34265730 | DOI:10.1016/j.ajem.2021.06.068

Biomed Phys Eng Express. 2021 Jul 15. doi: 10.1088/2057-1976/ac14d1. Online ahead of print.

ABSTRACT

Head and neck (H&N) cancer patients often present anatomical and geometrical changes in tumors and organs at risk (OARs) during radiotherapy treatment. These changes may result in the need to adapt the existing treatment planning, using an expert’s subjective opinion, for offline adaptive radiotherapy and a new treatment planning before each treatment, for online adaptive radiotherapy. In the present study, a fast methodology is proposed to assist in planning adaptation clinical decision using tumor and parotid glands percentage volume changes during treatment. The proposed approach was applied to 40 Η&Ν cases, with one planning Computed Tomography (pCT) image and CBCT scans for 6 weeks of treatment per case. Deformable registration was used for each patient’s pCT image alignment to its weekly CBCT. The calculated transformations were used to align each patient’s anatomical structures to the weekly anatomy. Clinical target volume (CTV) and parotid gland volume percentage changes were calculated in each case. The accuracy of the achieved image alignment was validated qualitatively and quantitatively. Furthermore, statistical analysis was performed to test if there is a statistically significant correlation between CTV and parotid glands volume percentage changes. Average MDA for CTV and parotid glands between corresponding structures defined by an expert in CBCTs and automatically calculated through registration was 1.4±0.1 mm and 1.5±0.1 mm, respectively. The mean registration time of the first CBCT image registration for 40 cases was lower than 3.4 min. Five patients show more than 20% tumor volume change. Six patients show more than 30% parotid glands volume change. Ten out of 40 patients proposed for planning adaptation. All the statistical tests performed showed no correlation between CTV/parotid glands percentage volume changes. The aim to assist in clinical decision making on a fast and automatic way was achieved using the proposed methodology, thereby reducing workload in clinical practice.

PMID:34265756 | DOI:10.1088/2057-1976/ac14d1

Eur Addict Res. 2021 Jul 15:1-8. doi: 10.1159/000517302. Online ahead of print.

ABSTRACT

INTRODUCTION: There is a need to strengthen the standard surveillance of the opioid overdose crisis in the USA. The role of Google Trends (GT) was explored in this context.

METHODS: In this study, a systemic GT search was done for a period from January 2004 to December 2018. “Naloxone” and “drug overdose” were chosen as search inputs. By using locally weighted scatterplot smoothing, we locally regressed and smoothed the relative search data generated by the GT search. We conducted a changepoint analysis (CPA) to detect significant statistical changes in the “naloxone” trend from 2004 to 2018. Cross-correlation function analyses were done to examine the correlation between 2 time series: year-wise relative search volume (RSV) for “naloxone” and “drug overdose” with the age-adjusted drug overdose mortality rate. Pearson’s correlation was performed for the state-wise age-adjusted mortality rate due to drug overdose and RSV for “naloxone” and “drug overdose.”

RESULTS: Smoothed and regressed GT of “naloxone” were similar to the “opioid overdose” trend published by the National Center for Health Statistics. The CPA showed 2 statistically significant points in 2011 and 2015. CPA of year-wise RSV for “naloxone” and “drug overdose” showed significantly positive correlation with the age-adjusted drug overdose mortality at lag zero. State-wise RSV for “naloxone” and “drug overdose” too showed a strong and significant positive correlation with the state-wise mortality data.

DISCUSSION/CONCLUSION: Inexpensive, publicly accessible, real-time GT data could supplement and strengthen the monitoring of opioid overdose epidemic if used in conjunction with the existing official data sources.

PMID:34265773 | DOI:10.1159/000517302

Int J Paleopathol. 2021 Jul 12;34:142-146. doi: 10.1016/j.ijpp.2021.07.002. Online ahead of print.

ABSTRACT

OBJECTIVE: Skeletal collections of immature individuals identified by age and sex serve as reference material for studying development in past populations. Several of these collections were established during the Industrial Revolution (IR), a period known for its difficult living conditions in industrial cities. We question if these collections represent useful comparisons from which to explore the natural history of human growth.

MATERIALS: Immature individuals from two skeletal collections contemporaneous to the IR period were studied: 71 children from the Spitalfields (UK) and 108 from the Strasbourg (F) collections. Among them we selected mandibles of individuals aged from 0 to 30 months, representing 32 and 52 individuals, respectively.

METHODS: We scored the dental development of first and second left deciduous molars according to (Moorrees et al., 1963) stages, from X-rays (Spitalfields) or CT-scans (Strasbourg) data and compared it with the modern reference pattern from the Lewis Growth Records by covariance analysis (ANCOVA).

RESULTS: Statistical differences exist in the dental development timeline between the 3 samples. This mainly concerns a delay in the root formation in IR samples that related to post-natal living conditions.

CONCLUSIONS: The delay in dental development timeline suggests that growth processes were impacted during IR in England and France, probably due to stressful living conditions.

SIGNIFICANCE: keletal collections dating from the IR period in Europe might be not the most appropriate referencesl for studying the natural history of human growth.

LIMITATIONS: This study focus on dental development only.

SUGGESTIONS FOR FURTHER RESEARCH: Exploring the skeletal growth pattern in other skeletal collections, pre or post-dating the IR, is advised.

PMID:34265668 | DOI:10.1016/j.ijpp.2021.07.002

Chemosphere. 2021 Jul 9;285:131504. doi: 10.1016/j.chemosphere.2021.131504. Online ahead of print.

ABSTRACT

Denitrification can be enhanced in the Integrated Fixed Film Activated System (IFAS) system by integrating media into the anoxic or aerobic zone. The simultaneous nitrification and denitrification (SND) in the biofilm layers has been reported in the aerobic zone of the IFAS system. In this study, two IFAS systems with Bioweb® media installed in the anoxic or aerobic reactor were operated in parallel to evaluate both anoxic denitrification or aerobic SND in the biofilm layers enhanced by fixed film media at three different nitrite and nitrate recirculation (NR) ratios of 75%, 100%, and 125%. The results revealed that both IFAS systems achieved the same organic and nitrogen removal efficiencies without statistically significant difference. The NR ratio of 125% enhanced slightly the denitrification in the anoxic zones of both systems. The media increased the anoxic denitrification at the NR ratio of 100%. The SND in the biofilm was found insignificant in both systems. It was evident that suspended-growth microorganisms stored substrates internally in the cells under anoxic conditions due to insufficient retention time. The aerobic denitrifiers including Chryseobacterium sp., Klebsiella pneumonia, and Pseudomonas aeruginosa were abundant in both IFAS systems providing aerobic denitrification with storage products as carbon sources. In summary, the denitrification in the anoxic zone and SND in the biofilm of the aerobic zone, both were enhanced by the fixed film media, did not contribute significantly to the IFAS system for the biological nitrogen removal because of microbial storage products and aerobic denitrification of several aerobic denitrifiers.

PMID:34265722 | DOI:10.1016/j.chemosphere.2021.131504

Sci Total Environ. 2021 Jul 9;796:148819. doi: 10.1016/j.scitotenv.2021.148819. Online ahead of print.

ABSTRACT

The global spatiotemporal pattern of the COPD burden attributable to ambient PM2.5 is unknown in the context of the continuing increase in exposure to ambient PM2.5. Data on COPD burden attributable to ambient PM2.5 from 1990 to 2019 were retrieved from the Global Burden of Disease Study 2019. Cases and age-standardized rates of COPD mortality (ASMR) and disability-adjusted life years (ASDR) were estimated by age, sex, region, and country. The estimated annual percentage change (EAPC) was calculated to quantify the secular trends of ASMR and ASDR from 1990 to 2019. Globally, the number of COPD deaths and DALYs attributable to ambient PM2.5 both increased by over 90% from 1990 to 2019, but ASMR and ASDR both slightly decreased, with EAPC of -0.58 (95% CI: -0.72, -0.44) and -0.40 (95% CI: -0.51, -0.29), respectively. Most COPD deaths and DALYs attributable to PM2.5 occurred in the middle sociodemographic index (SDI) region, but the fastest growth of ASMR and ASDR occurred in the low SDI region, with EAPCs of 2.41 (95% CI: 2.23, 2.59) and 2.34 (95% CI: 2.16, 2.52), respectively. East Asia and South Asia were the high-risk areas of COPD deaths and DALYs attributable to PM2.5, among which China and India were the countries with the heaviest burden. COPD deaths and DALYs attributable to PM2.5 mainly occurred in individuals 70-89 years old and 60-84 years old, respectively. The age-specific rates of mortality and DALYs had a rapid increase in low and low-middle SDI regions from 1990 to 2019. The ASMR or ASDR had a reverse V-shaped relationship with SDI. In summary, the ambient PM2.5-attributable COPD burden is socioeconomic- and age-dependent, and it mediates the heterogeneity of spatial and temporal distribution. Low- and middle-income countries endure the highest ambient PM2.5-attributable COPD burden due to the high exposure to PM2.5 and poor availability and affordability of medicines and diagnostic tests.

PMID:34265615 | DOI:10.1016/j.scitotenv.2021.148819