Tag: statistics

Med Care. 2021 May 13. doi: 10.1097/MLR.0000000000001570. Online ahead of print.

ABSTRACT

BACKGROUND: The Risk Stratification Index (RSI) is superior to Hierarchical Conditions Categories (HCC) in patient-level regressions but has not been applied to assess hospital effects.

OBJECTIVE: The objective of this study was to measure the accuracy of RSI in modeling 30-day hospital mortality across all conditions using multilevel logistic regression.

SUBJECTS AND DATA SOURCES: A 100% sample of Medicare inpatient stays from 2009 to 2014, restricted to patients greater than 65 years of age in general hospitals, resulting in 64 million stays at 3504 hospitals.

RESEARCH DESIGN: We calculated RSI and HCC scores for patient stays using multilevel logistic regression in 3 populations: all inpatients, surgical, and nonsurgical. Correlations of risk-standardized mortality rates with rates of specific case types assessed case-mix balance. Patient stay volume was included to assess smaller hospitals.

RESULTS: We found a negligible correlation of all-conditions risk-standardized mortality rates with hospitals’ proportions of orthopedic, cardiac, or pneumonia cases. RSI outperformed HCC in multilevel regressions containing both patient and hospital-level effects. C-statistics using RSI were 0.87 for the all-inpatients group, 0.87 for surgical, and 0.86 for nonsurgical stays. With HCC they were 0.82, 0.82, and 0.81. Akaike Information Criteria and Bayesian Information Criteria values were higher with HCC. RSI shifted 41% of hospitals’ rankings by >1 decile. Hospitals with smaller volumes had higher 30-day observed and standardized mortality: 11.2% in the lowest volume quintile versus 8.5% in the highest volume quintile.

CONCLUSION: RSI has superior accuracy and results in a significant shift in rankings compared with HCC in multilevel models of 30-day hospital mortality across all conditions.

PMID:33989249 | DOI:10.1097/MLR.0000000000001570

BJOG. 2021 May 14. doi: 10.1111/1471-0528.16753. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the Large Uterus Classification System (LUCS) ability to predict surgical outcomes and complications in total laparoscopic hysterectomies (TLHs) for large uteri.

DESIGN: Prospective observational study.

SETTING: Two referral centres.

POPULATION OR SAMPLE: 392 women who underwent TLH for a large uterus (uterine fundus at or over the transverse umbilical line).

METHODS: Between 2004 and 2019, the intraoperative LUCS was estimated in all patients. The LUCS considers the uterine and adnexal vascular pedicles displacement. Type 1 is without vascular pedicles displacement. Type 2 has the cephalad displacement of adnexal vascular pedicles. The uterine vessels displacement regardless of adnexal pedicles defines Type 3.

MAIN OUTCOME MEASURES: Patients’ characteristics with perioperative outcomes were prospectively collected and compared between the three types of large uteri.

RESULTS: 251 (64%), 82 (20.9%) and 59 (15.1%) women had Type 1, Type 2, and Type 3 uteri, respectively. Women with Type 1 uteri had a lower uterine weight, shorter operative time, less blood loss, and less complication rates than Type 2 and 3. The conversion rate to laparotomy in Type 1 was similar to Type 2 (OR:0.98;95%CI:0.32-3.56) but lower than Type 3 (OR:0.35;95%CI:0.14-0.97); in Type 2 it was lower than Type 3, although without the conventional statistical significance (OR:0.36;95%CI:0.13-1.13;p=0.07). Multivariable analysis showed that the uterine Type (1 vs. 2-3) was independently associated with the total complications rate (OR:2.00;95%CI:1.09-3.68;p=0.02).

CONCLUSIONS: The LUCS appears associated with surgical outcomes and complications, potentially stratifying the surgical risk and guiding the surgical technique in TLHs for large uteri.

PMID:33988895 | DOI:10.1111/1471-0528.16753

J Clin Psychiatry. 2021 Feb 23;82(2):20m13356. doi: 10.4088/JCP.20m13356.

ABSTRACT

OBJECTIVE: To examine the efficacy and safety of paliperidone palmitate once-monthly (PP1M) versus oral antipsychotics (OAPs) in Black/African American patients with schizophrenia and a history of criminal justice system involvement.

METHODS: This was a post hoc analysis of a 15-month prospective, randomized, open-label, parallel-group, multicenter US study conducted from May 2010 to December 2013 that examined a subpopulation of Black/African American patients with schizophrenia (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria). The primary objective was to compare time to first treatment failure in patients treated with PP1M versus OAPs. Secondary objectives were to compare time to first institutionalization (psychiatric hospitalization or arrest/incarceration) and mean number of treatment failure events and institutionalizations over 15 months in PP1M-treated and OAP-treated patients.

RESULTS: The intention-to-treat population included 275 Black/African American patients (PP1M, n = 145; OAPs, n = 130). Median time to first treatment failure was not reached for PP1M-treated patients and was 270 days for OAP-treated patients; hazard ratio (HR) was 1.39 (95% CI, 0.97-1.99; P = .075). Median time to first institutionalization was not reached for PP1M-treated patients and was 304 days for OAP-treated patients; HR was 1.49 (95% CI, 1.01-2.19; P = .043). Mean numbers of treatment failure events and institutionalizations were lower with PP1M than OAPs. The safety profile of PP1M was consistent with that of previous PP1M studies.

CONCLUSIONS: In a Black/African American subpopulation of patients with schizophrenia and prior criminal justice system involvement, PP1M reduced the number of treatment failures, thereby reducing the number of psychiatric hospitalizations and/or arrests/incarcerations compared with daily OAPs.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01157351.

PMID:33988924 | DOI:10.4088/JCP.20m13356

J Clin Psychiatry. 2021 Feb 23;82(2):20m13288. doi: 10.4088/JCP.20m13288.

ABSTRACT

OBJECTIVE: Previous research shows elevated disability in psychotic disorders. However, co-occurring symptomatology has been increasingly highlighted as predictive of clinical outcomes in the psychotic spectrum. The current study investigates how both psychotic and nonpsychotic symptom domains predict functioning across psychotic disorders.

METHODS: Outpatients (N = 128) with psychotic spectrum diagnoses participated in the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) Field Trials at the Centre for Addiction and Mental Health in Toronto, Canada, in 2011, including the repeated administration of “cross-cutting” brief screening measures that assessed internalizing (eg, anxiety, depression), substance use (eg, alcohol, psychoactive drug use), and psychotic symptoms. Level of functioning was also assessed by self-report and clinician-rated World Health Organization Disability Assessment Schedule 2.0 (WHO-DAS-II). The relation between symptom domains and disability was examined concurrently and prospectively via hierarchical regression.

RESULTS: Psychosis was strongly linked to self-reported disability when considered in isolation (β = 0.22, P < .001; R2 = 0.11). However, when all 3 symptom domains were included in analyses, internalizing symptoms were the strongest concurrent (β = 0.31, P < .001; R2 = 0.17) and prospective (β = 0.29, P < .001; R2 = 0.15) predictor of disability. In the concurrent model, an interaction between internalizing and substance use emerged, wherein high internalizing symptoms were particularly detrimental in persons with high levels of substance use (β = 0.08, P < .05; R2 = 0.014). Results were similar for clinician-rated WHO-DAS-II.

CONCLUSIONS: This research supports the potential clinical utility of rapid screening tools available in the newest psychiatric diagnostic manual. The internalizing symptom domain was the strongest predictor of functional outcome for outpatients with psychotic disorders. The results highlight the relevance of a broad range of symptoms, including those that fall outside the primary psychiatric concern, in recovery-oriented clinical work in psychosis.

PMID:33988932 | DOI:10.4088/JCP.20m13288

Environ Sci Pollut Res Int. 2021 May 14. doi: 10.1007/s11356-021-14071-6. Online ahead of print.

ABSTRACT

The electric energy mainly comes from thermal power generation fueled by electric coal, and the selection of electric coal supplier is of great practical significance for the development of electric power enterprises. In this paper, the mechanism of supplier selection in electric coal procurement is designed from a perspective of sustainability. Concretely, eleven evaluation indexes from three aspects of economy, environment, and society are selected to construct a new evaluation index system for selecting sustainable electric coal suppliers. Based on this index system, a new method of supplier selection in electric coal procurement based on 2-tuple correlation coefficient analysis is proposed. In this method, considering that the evaluation index values have the features of multi-source heterogeneous data, i.e., precise real number, interval number, and fuzzy linguistic variables coexist, all index values are converted into 2-tuples. Then, a 2-tuple deviation maximization method is proposed to determine the weight of each evaluation index, and a new method of 2-tuple correlation coefficient analysis is proposed to select sustainable electric coal suppliers. Moreover, the effectiveness and feasibility of the model are highlighted by an application example of selecting the electric coal suppliers. Combined with the development status of electric power industry and the research results of this paper, several countermeasures and suggestions are provided on how to formulate the optimal procurement strategy of electric coal for electric power enterprises and how to improve the competitiveness for electric coal suppliers.

PMID:33988842 | DOI:10.1007/s11356-021-14071-6

Environ Sci Pollut Res Int. 2021 May 14. doi: 10.1007/s11356-021-14315-5. Online ahead of print.

ABSTRACT

The optimal design and performance monitoring of wind farms depend on the precise assessment of spatial and temporal distribution of wind speed. The aim of this research is to investigate the appropriateness of nine popular probability distribution models (exponential, gamma, generalised extreme value, inverse Gaussian, Kumaraswamy, log-logistic, lognormal, Nakagami, and Weibull) for the assessment of wind speed distribution (WSD) at 10 sites situated at topographically distinct locations in Tamil Nadu, India, based on 39 years of data. The results suggest that a single distribution cannot produce best fit for all the stations. On an individual level, the generalised extreme value distribution provided the most suitable fit for majority of the stations, followed by the Kumaraswamy distribution. The Kumaraswamy distribution has performed well even if the WSD of the station is negatively skewed. Hence, based on the ranking and performance consistency, the Kumaraswamy distribution can be preferred irrespective of the topographical heterogeneity of the stations.

PMID:33988843 | DOI:10.1007/s11356-021-14315-5

Acta Anaesthesiol Scand. 2021 May 14. doi: 10.1111/aas.13852. Online ahead of print.

ABSTRACT

Systematic review methodology with meta-analyses have long been regarded as one of the highest forms of research methodology and a cornerstone in many clinical guidelines. A common criticism of this methodology is the handling of the clinical and/or statistical heterogeneity which arises when pooling heterogenous data from different trials, settings and interventions.

PMID:33988875 | DOI:10.1111/aas.13852

Infection. 2021 May 14. doi: 10.1007/s15010-021-01626-5. Online ahead of print.

ABSTRACT

PURPOSE: Studies have demonstrated improvements in hand hygiene (HH) compliance through interventions, noting the negative association of HH and healthcare associated infections (HAIs), but how to sustain long-term improvement is still unknown in the Chinese population. This study sought to determine the extent of change in HH compliance after multimodal HH interventions, and to evaluate the relationship between that change and HAI incidence.

METHODS: We conducted a longitudinal study in a general teaching hospital in China from 2017 to 2020. Trained investigators observed HH practices based on the World Health Organization’s 5 moments for HH. We identified the incidence of HAIs using semi-automated constant surveillance software. We used the Cochran-Mantel-Haenszel test to assess the secular trend of HH compliance and HAIs. The Spearman correlation coefficient (r_s) was used to evaluate the relationship between the incidence of HAIs and compliance with HH.

RESULTS: The study made 480,943 observations, where HH was occurring between 2017 and 2020. HH compliance increased from 68.90 to 91.76% during that period (P_trend < 0.01), while the incidence of HAIs decreased from 1.10 to 0.91%. Compliance also increased for each moment type and for each healthcare worker (P_trend < 0.01). Lower HH compliance was observed in before-patient contact and after contact with patient surroundings, and among interns and cleaners. We also observed a weak but statistically significant negative correlation between the monthly HH compliance and incidence of HAIs (r_s = – 0.27; P = 0.037).

CONCLUSIONS: The multimodal HH implementation delivered sustained improvement in HH compliance, and this change was associated with a decline in the incidence of HAIs.

PMID:33988829 | DOI:10.1007/s15010-021-01626-5

Exp Appl Acarol. 2021 May 14. doi: 10.1007/s10493-021-00625-3. Online ahead of print.

ABSTRACT

Cheliceral chelal design in free-living astigmatid mites (Arthropoda: Acari) is reviewed within a mechanical model. Trophic access (body size and cheliceral reach) and food morsel handling (chelal gape and estimated static adductive crushing force) are morphologically investigated. Forty-seven commonly occurring astigmatid mite species from 20 genera (covering the Acaridae, Aeroglyphidae, Carpoglyphidae, Chortoglyphidae, Glycyphagidae, Lardoglyphidae, Pyroglyphidae, Suidasiidae, and Winterschmidtiidae) are categorised into functional groups using heuristics. Conclusions are confirmed with statistical tests and multivariate morphometrics. Despite these saprophagous acarines in general being simple ‘shrunken/swollen’ versions of each other, clear statistical correlations in the specifics of their mechanical design (cheliceral and chelal scale and general shape) with the type of habitat and food consumed (their ‘biome’) are found. Using multivariate analyses, macro- and microsaprophagous subtypes are delineated. Relative ratios of sizes on their own are not highly informative of adaptive syndromes. Sympatric resource competition is examined. Evidence for a maximum doubling of approximate body volume within nominal taxa is detected but larger mites are not more ‘generalist’ feeding types. Two contrasting types of basic ‘Bauplan’ are found differing in general scale: (i) a large, chunk-crunching, ‘demolition’-feeding omnivore design (comprising 10 macrosaprophagous astigmatid species), and (ii) a small selective picking, squashing/slicing or fragmentary/’plankton’ feeding design (which may indicate obligate fungivory/microbivory) comprising 20 microsaprophagous acarid-shaped species. Seventeen other species appear to be specialists. Eleven of these are either: small (interstitial/burrowing) omnivores-or a derived form designed for processing large hard food morsels (debris durophagy, typified by the pyroglyphid Dermatophagoides farinae), or a specialist sub-type of particular surface gleaning/scraping fragmentary feeding. Six possible other minor specialist gleaning/scraping fragmentary feeders types each comprising one to two species are described. Details of these astigmatid trophic-processing functional groups need field validation and more corroborative comparative enzymology. Chelal velocity ratio in itself is not highly predictive of habitat but with cheliceral aspect ratio (or chelal adductive force) is indicative of life-style. Herbivores and pest species are typified by a predicted large chelal adductive force. Pest species may be ‘shredders’ derived from protein-seeking necrophages. Carpoglyphus lactis typifies a mite with tweezer-like chelae of very feeble adductive force. It is suggested that possible zoophagy (hypocarnivory) is associated with low chelal adductive force together with a small or large gape depending upon the size of the nematode being consumed. Kuzinia laevis typifies an oophagous durophage. Functional form is correlated with taxonomic position within the Astigmata-pyroglyphids and glycyphagids being distinct from acarids. A synthesis with mesostigmatid and oribatid feeding types is offered together with clarification of terminologies. The chelal lyrifissure in the daintiest chelicerae of these astigmatids is located similar to where the action of the chelal moveable digit folds the cheliceral shaft in uropodoids, suggesting mechanical similarities of function. Acarid astigmatids are trophically structured like microphytophagous/fragmentary feeding oribatids. Some larger astigmatids (Aleuroglyphus ovatus, Kuzinia laevis, Tyroborus lini) approximate, and Neosuidasia sp. matches, the design of macrophytophagous oribatids. Most astigmatid species reviewed appear to be positioned with other oribatid secondary decomposers. Only Dermatophagoides microceras might be a primary decomposer approximating a lichenivorous oribatid (Austrachipteria sp.) in trophic form. Astigmatid differences are consilient with the morphological trend from micro- to macrophytophagy in oribatids. The key competency in these actinotrichid mites is a type of ‘gnathosomisation’ through increased chelal and cheliceral height (i.e., a shape change that adjusts the chelal input effort arm and input adductive force) unrestricted by the dorsal constraint of a mesostigmatid-like gnathotectum. A predictive nomogram for ecologists to use on field samples is included. Future work is proposed in detail.

PMID:33988815 | DOI:10.1007/s10493-021-00625-3

Neurol Sci. 2021 May 14. doi: 10.1007/s10072-021-05303-1. Online ahead of print.

ABSTRACT

Neurodegenerative disorders like Alzheimer’s, Parkinson’s, and associated dementia typically originate with altered protein folding and aggregation of their β structures in the neurons. This self-aggregation leads to glial activation in the brain, causing neuroinflammation and leads to neuronal death. According to statistics provided by WHO, there are around 50 million people with dementia worldwide and every year, 10 million more cases are projected to increase. Also, around 5-8 percentage of people who are aged above 60 globally has dementia or associated disorders. Over 82 million in 2030 and 152 in 2050 are expected to have dementia. Most of these patients fall into low-middle-income countries which makes it even more essential to find an affordable and effective treatment method. Polyphenols of different origin are studied for their potential role as anti-neuro-inflammatory molecules. This review would summarize recent advances in three widely researched dietary polyphenols projected as potential therapeutic agents for disorders like Alzheimer’s, Parkinson’s, etc. They are Resveratrol, Catechins, and Tannins. The review would discuss the recent advances and challenges in using these polyphenols using specific examples as potential therapeutic agents against neuroinflammation associated disorders. An abstract of neuroinflammation-associated events and the effects by selected polyphenols.

PMID:33988799 | DOI:10.1007/s10072-021-05303-1