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This paper studies second-order properties of the many instruments robust t -ratios based on the limited information maximum likelihood and Fuller estimators for instrumental variable regression models with homoskedastic errors under the many instruments asymptotics, where the number of instruments may increase proportionally with the sample size n , and proposes second-order refinements to the t -ratios to improve the size and power properties. Based on asymptotic expansions of the null and non-null distributions of the t -ratios derived under the many instruments asymptotics, we show that the second-order terms of those expansions may have non-trivial impacts on the size as well as the power properties. Furthermore, we propose adjusted t -ratios whose approximation errors for the null rejection probabilities are of order O ( n − 1 ) in contrast to the ones for the unadjusted t -ratios of order O ( n − 1 / 2 ) , and show that these adjustments induce some desirable power properties in terms of the local maximinity. Although these results are derived under homoskedastic errors, we also establish a stochastic expansion for a heteroskedasticity robust t -ratio, and propose an analogous adjustment under slight deviations from homoskedasticity.

Summary Objectives The vocal tract discomfort scale is a self-rating seven-point Likert scale that quantifies frequency and severity of eight qualitative descriptors including burning, tight, dry, aching, tickling, sore, irritable, and lump in the throat, and ranges from 0 (never/none) to 6 (always/extreme; Mathieson et al. 2009). The objectives of the current study were to compare the vocal tract discomfort scale results between elementary school teachers and high school teachers and between male and female teachers using the Persian vocal tract discomfort scale. Also, teachers in different age ranges and with different experiences were compared regarding vocal tract discomfort symptoms. Methods The researchers chose 20 elementary and high schools by simple random sampling in Khorramabad, Iran. The survey was given to available teachers of the selected schools. Considering the inclusion criteria, required sample size, and after excluding questionnaires that were not correctly answered, 120 were selected such that 30 were chosen for each subgroup. Subjects consisted of 60 elementary school teachers (30 females and 30 males) with the mean age of 40.92 years (standard deviation = 6.07) and 60 high school teachers (30 females and 30 males) with the mean age of 40.67 years (standard deviation = 6.00). SPSS 25 was used for analyzing the data. Results Results indicated that the frequency and severity of the vocal tract discomfort in elementary school teachers were significantly higher than for the high school teachers with a medium to large effect size. Although the frequency and severity of the symptoms were higher in female compared with male teachers, those differences were not significantly different. Younger teachers had lower frequency and severity ratings of vocal tract discomfort symptoms than older teachers. Teaching experience was not an important factor in predicting vocal tract discomfort symptoms in teachers. Conclusions The results of this study suggest that there is higher frequency, greater severity, and higher percentages of vocal tract discomfort symptoms in elementary compared with high school teachers. In addition, although the mean frequency and severity of vocal tract discomfort symptoms were not significantly different between females and males, females reported higher percentages of the symptoms. Because each of the eight vocal tract symptoms was experienced at the time of testing by between 42% (tightness) and 68% (dryness) of the participants, it is suggested that an educational program regarding vocal tract discomfort may be helpful for this profession.

COVID-19 is a worldwide public health threat. Diagnosis by RT-PCR has been employed as the standard method to confirm viral infection. Sample pooling testing can optimize the resources by reducing the workload and reagents shortage, and be useful in laboratories and countries with limited resources. This study aims to evaluate SARS-CoV-2 detection by sample pooling testing in comparison with individual sample testing.We created 210 pools out of 245 samples, varying from 4 to 10 samples per pool, each containing a positive sample. We conducted detection of SARS-CoV-2-specific RdRp/E target sites.Pooling of three samples for SARS-CoV-2 detection might be an efficient strategy to perform without losing RT-PCR sensitivity.Considering the positivity rate in Dominican Republic and that larger sample pools have higher probabilities of obtaining false negative results, the optimal sample size to perform a pooling strategy shall be three samples.La COVID-19 es una amenaza de salud pública mundial. La RT-PCR es el método estándar para confirmar la infección. La estrategia de pruebas de muestras agrupadas puede reducir la carga de trabajo y la escasez de reactivos, y ser útil en países con escasos recursos. Evaluamos la detección del SARS-CoV-2 mediante esta estrategia en comparación con pruebas individuales.Creamos 210 grupos de 245 muestras, de 4 a 10 muestras por grupo, cada uno con una muestra positiva. Realizamos extracción de ARN y qRT-PCR para detectar la presencia de la diana RdRp/E.La combinación de hasta 3 muestras para la detección del SARS-CoV-2 podría ser una estrategia eficaz sin perder la sensibilidad.Considerando la tasa de positividad en República Dominicana y que los grupos con más muestras tienen mayor probabilidad de obtener resultados falsos negativos, el tamaño óptimo para realizar esta estrategia es de 3 muestras.

Background Course of Alcohol Dependence Syndrome (ADS) is studded with multiple relapses. Personality factors are implicated as one of the influencing factors in the course of this disorder. Keeping in view of scarcity of Indian data available, the study was planned with the aim to find Personality traits more commonly associated with ADS patients, and identify specific traits, associated with relapses of ADS. Method With sample size of 100 consecutive cases and 100 controls, socio-demographic data was collected. Alcohol Use Disorder Identification Test (AUDIT) and Severity of Alcohol Use Disorder Test (SAD-Q) were administered to each of these patient. Personality dimensions were assessed with NEO-five factor inventory (NEO-FFI) (Costa and McCrae), for both groups and further compared for differences in the dimensions in each of its subscale. Results The NEO scores, showed statistically significant difference with Cases having higher scores in Neuroticism and control group in Openness and Conscientiousness. Neuroticism linked to higher scores of AUDIT and SADQ and also associated with relapses. Other traits also showed statistically significant association which are discussed. Conclusion As new factors are being explored for effective management, routine personality profiling is easily accomplished and can give delightful insight into focused and designed management plan.

Summary Introduction Vocal cord vibration after transoral CO2 LASER-guided thyroarytenoid (TA) myoneurectomy in adductor spasmodic dysphonia (AdSD) patients is unclear to date. The precise vibratory patterns in AdSD patients are difficult to evaluate with routine videolaryngostroboscopy. High-speed videolaryngoscopy (HSV) is an ideal choice to evaluate such patients. This study was performed to compare pre- and postoperative, after 6 months, vocal fold vibratory onset delay (VFVOD) and closed phase glottal cycle (CPGC) in AdSD patients following transoral CO2 LASER-guided TA myoneurectomy using the HSV. Materials and methods Retrospective study, conducted from January, 2016 to January, 2019, of the AdSD patients who underwent transoral CO2 LASER-guided TA myoneurectomy using the HSV. Patient data were acquired from the hospital database to evaluate VFVOD and CPGC from HSV recordings of the patients. VFVOD was calculated as sum of prephonatory delay (PPD) and steady-state delay (SSD). The PPD and SSD were evaluated and compared separately for each patient. The MedCal Version 19.2.6 was used for data analysis. Paired sample t test was performed to compute the significance of the difference between the mean of the dataset. A P value less than 0.05 was considered significant. Results A total of nine patients were included in the study, out of which three were females and six were males. The average age was 45.5 ± 6.9 years. The mean of postoperative PPD (166.8 ± 22.1), SSD (76.5 ± 8.6), and CPGC (62.6 ± 4.8) were significantly less than mean of preoperative PPD (222.6 ± 22.1), SSD (97.7 ± 9.5), and CPGC (71.6 ± 5 %), with P values of 0.0007, 0.0001, and 0.0001, respectively. Conclusions There was a significant decrease in VFVOD and CPGC posttransoral CO2 LASER-guided TA myoneurectomy in AdSD patients after 6 months follow-up. This study also establishes efficiency of the HSV to measure the vocal cord vibration in the patients with AdSD. The primary limitations of the study were the small sample size and its retrospective nature. Future prospective studies with increased sample size can further substantiate the findings of the work performed here.

Newton-step approximations to pseudo maximum likelihood estimates of spatial autoregressive models with a large number of parameters are examined, in the sense that the parameter space grows slowly as a function of sample size. These have the same asymptotic efficiency properties as maximum likelihood under Gaussianity but are of closed form. Hence they are computationally simple and free from compactness assumptions, thereby avoiding two notorious pitfalls of implicitly defined estimates of large spatial autoregressions. For an initial least squares estimate, the Newton step can also lead to weaker regularity conditions for a central limit theorem than those extant in the literature. A simulation study demonstrates excellent finite sample gains from Newton iterations, especially in large multiparameter models for which grid search is costly. A small empirical illustration shows improvements in estimation precision with real data., 36 pages

Summary Introduction Prehabilitation is defined as preoperative conditioning of patients in order to improve post-operative outcomes. Some studies showed an increase in functional recovery following colorectal surgery, but its effect in hepato-pancreato-biliary (HPB) surgery is unclear. The aim of this study was to realize a systematic literature review and meta-analysis on the current available evidence on prehabilitation in HPB surgery. Materials and methods A systematic review and a metanalysis were carried out on prehabilitation (physical, nutritional and psychological interventions) in HPB surgery (2009-2019). Assessed outcomes were postoperative complications, length of stay (LOS), 30-day readmission, and mortality. Main results Four studies among the 191 screened were included in this systematic review (3 randomized controlled trials, 1 case-control propensity score study), involving 419 patients (prehabilitation group, n = 139; control group, n = 280). After pooling, no difference was observed on LOS ((−4.37 days [95% CI: −8.86; 0.13]) or postoperative complications (RR 0.83 [95%CI: 0.62; 1.10]), reported by all the included studies. Two trials reported on readmission rate, but given the high heterogeneity, a meta-analysis was not realized. No deaths were reported among the included studies. Conclusion No effect of prehabilitation programs in HPB surgery was observed on LOS or postoperative complications rate. Future trials with standardized outcomes of measure, and adequately powered samples calculations are thus required. PROSPERO registration CRD42020165218.

This paper develops generalized method of moments (GMM) estimation and inference procedures for quantile regression models. We propose a GMM estimator for simultaneous estimation across multiple quantiles. This estimator allows us to model quantile regression coefficients using flexible parametric restrictions across quantiles. The restrictions and simultaneous estimation lead to efficiency gains compared to standard methods. We establish the asymptotic properties of the GMM estimators when the number of quantiles used is fixed and when it diverges to infinity jointly with the sample size. As an alternative to GMM, we also propose a minimum distance estimator over a given subset of quantiles. Moreover, we provide specification tests for the imposed restrictions. The estimators and tests we propose are simple to implement in practice. Monte Carlo simulations provide numerical evidence of the finite sample properties of the methods. Finally, we apply the proposed methods to estimate the effects of smoking on birthweight of live infants at the extreme bottom of the conditional distribution.

Many statistical and econometric learning methods rely on Bayesian ideas, often applied or reinterpreted in a frequentist setting. Two leading examples are shrinkage estimators and model averaging estimators, such as weighted-average least squares (WALS). In many instances, the accuracy of these learning methods in repeated samples is assessed using the variance of the posterior distribution of the parameters of interest given the data. This may be permissible when the sample size is large because, under the conditions of the Bernstein--von Mises theorem, the posterior variance agrees asymptotically with the frequentist variance. In finite samples, however, things are less clear. In this paper we explore this issue by first considering the frequentist properties (bias and variance) of the posterior mean in the important case of the normal location model, which consists of a single observation on a univariate Gaussian distribution with unknown mean and known variance. Based on these results, we derive new estimators of the frequentist bias and variance of the WALS estimator in finite samples. We then study the finite-sample performance of the proposed estimators by a Monte Carlo experiment with design derived from a real data application about the effect of abortion on crime rates.

A number of powerful demographic inference methods have been developed in recent years, with the goal of fitting rich evolutionary models to genetic data obtained from many populations. In this paper we investigate the statistical performance of these methods in the specific case where there is continuous migration between populations. Compared with earlier work, migration significantly complicates the theoretical analysis and requires new techniques. We employ the theories of phase-type distributions and concentration of measure in order to study the two-island and isolation-with-migration models, resulting in both upper and lower bounds on rates of convergence for parametric estimators in migration models. For the upper bounds, we consider inferring rates of coalescent and migration on the basis of directly observing pairwise coalescent times, and, more realistically, when (conditionally) Poisson-distributed mutations dropped on latent trees are observed. We complement these upper bounds with information-theoretic lower bounds which establish a limit, in terms of sample size, below which inference is effectively impossible.

Background Three-dimensional (3D) models improve the comprehension of renal anatomy. Objective To evaluate the impact of novel 3D-derived parameters, to predict surgical outcomes after robot-assisted partial nephrectomy (RAPN). Design, setting, and participants Sixty-nine patients with cT1-T2 renal mass scheduled for RAPN were included. Three-dimensional virtual modeling was achieved from computed tomography. The following volumetric and morphological 3D parameters were calculated: VT (volume of the tumor); VT/VK (ratio between tumor volume and kidney volume); CSA3D (ie, contact surface area); UCS3D (contact to the urinary collecting system); Tumor-Artery3D: tumor’s blood supply by tertiary segmental arteries (score = 1), secondary segmental artery (score = 2), or primary segmental/main renal artery (scoren = 3); ST (tumor’s sphericity); ConvT (tumor’s convexity); and Endophyticity3D (ratio between the CSA3D and the global tumor surface). Intervention RAPN with a 3D model. Outcome measurements and statistical analysis Three-dimensional parameters were compared between patients with and without complications. Univariate logistic regression was used to predict overall complications and type of clamping; linear regression was used to predict operative time, warm ischemia time, and estimated blood loss. Results and limitations Overall, 11 (15%) individuals experienced overall complications (7.2% had Clavien ≥3 complications). Patients with urinary collecting system (UCS) involvement at 3D model (UCS3D = 2), tumor with blood supply by primary or secondary segmentary arteries (Tumor-Artery3D = 1 and 2), and high Endophyticity3D values had significantly higher rates of overall complications (all p ≤ 0.03). At univariate analysis, UCS3D, Tumor-Artery3D, and Endophyticity3D are significantly associated with overall complications; CSA3D and Endophyticity3D were associated with warm ischemia time; and CSA3D was associated with selective clamping (all p ≤ 0.03). Sample size and the lack of interobserver variability are the main limits. Conclusions Three-dimensional modeling provides novel volumetric and morphological parameters to predict surgical outcomes after RAPN. Patient summary Novel morphological and volumetric parameters can be derived from a three-dimensional model to describe surgical complexity of renal mass and to predict surgical outcomes after robot-assisted partial nephrectomy.

We study the rapidly growing literature on the causal effects of financial education programs in a meta-analysis of 76 randomized experiments with a total sample size of over 160,000 individuals. Many of these experiments are published in top economics and finance journals. The evidence shows that financial education programs have, on average, positive causal treatment effects on financial knowledge and downstream financial behaviors. Treatment effects are economically meaningful in size, similar to those realized by educational interventions in other domains, and robust to accounting for publication bias in the literature. We also discuss the cost-effectiveness of financial education interventions.

High-dimensional linear regression has been intensively studied in the community of statistics in the last two decades. For the convenience of theoretical analyses, classical methods usually assume independent observations and sub-Gaussian-tailed errors. However, neither of them hold in many real high-dimensional time-series data. Recently [Sun, Zhou, Fan, 2019, J. Amer. Stat. Assoc., in press] proposed Adaptive Huber Regression (AHR) to address the issue of heavy-tailed errors. They discover that the robustification parameter of the Huber loss should adapt to the sample size, the dimensionality, and the moments of the heavy-tailed errors. We progress in a vertical direction and justify AHR on dependent observations. Specifically, we consider an important dependence structure -- Markov dependence. Our results show that the Markov dependence impacts on the adaption of the robustification parameter and the estimation of regression coefficients in the way that the sample size should be discounted by a factor depending on the spectral gap of the underlying Markov chain.

BACKGROUND Donepezil had been recognized to have impact on sleep quality in demented patients. However, there was insufficient evidences about the actual effect of donepezil in the sleep architectures. Our meta-analysis aimed to evaluate the changes of sleep architectures related to donepezil use. METHODS Followed the PRISMA2020 and AMSTAR2 guidelines, electronic search had been performed on the databases of PubMed, Embase, ScienceDirect, ClinicalKey, Cochrane CENTRAL, ProQuest, Web of Science, and ClinicalTrials.gov. The outcome measurement was changes of sleep parameters detected by polysomnography. A random-effects meta-analysis was conducted. RESULTS Total twelve studies had been involved. The percentage of REM sleep would significantly increase after donepezil treatment (Hedges' g = 0.694, p

Voting rules can be assessed from quite different perspectives: the axiomatic, the pragmatic, in terms of computational or conceptual simplicity, susceptibility to manipulation, and many others aspects. In this paper, we take the machine learning perspective and ask how prominent voting rules compare in terms of their learnability by a neural network. To address this question, we train the neural network to choosing Condorcet, Borda, and plurality winners, respectively. Remarkably, our statistical results show that, when trained on a limited (but still reasonably large) sample, the neural network mimics most closely the Borda rule, no matter on which rule it was previously trained. The main overall conclusion is that the necessary training sample size for a neural network varies significantly with the voting rule, and we rank a number of popular voting rules in terms of the sample size required.

Introduction and objectives Most of the studies evaluating the effect of cross links on spinal stability are performed in vitro on porcine or human spine segments and there is limited data regarding clinical benefits of cross link augmentation in traumatic injuries. In this study we aimed to evaluate the effects of cross-links insertion between rods on the fusion rates and post-surgical patients’ satisfaction among patients with traumatic thoracolumbar fractures who underwent posterior spinal fixation with pedicle screws. Materials and methods This study was conducted as a randomized clinical trial on 60 patients suffering from traumatic thoracolumbar vertebrae fractures. Patients were randomized into three groups: A (without any cross-link), B (One cross-link insertion) and C (two cross-links insertion). Six months after surgery outcomes were evaluated: fusion rates (plain X-ray and CT scan), Back pain (Visual Analog Scale) and patient satisfaction (fair, good, excellent). Results In group A 13 (65%) patients had structured bone fusion, but in 7 (35%) patients bone fusion was not observed. In both groups B and C, 19 patients (95%) had bone fusion, but only in 1 patient (5%) fusion failed (p = 0.009). In group A, fair satisfaction has the highest rate (8 patients (40%)) compared to the other groups. The highest reported severity of back pain was observed in group A while the lowest reported intensity of back pain was related to group B (p = 0.001). Conclusions Adding cross link to posterior spinal fixations of patients with traumatic thoracolumbar fractures can be associated with better final fusion results and patients’ satisfaction. However it is necessary to design studies with greater sample sizes to confirm this theory. Trial registration number: IRCT20120527009878N3.

Conditional value at risk (CVaR) is a popular measure for quantifying portfolio risk. Sensitivity analysis of CVaR is common in risk management and gradient-based optimization algorithms. In this paper, we study the infinitesimal perturbation analysis estimator for CVaR sensitivity using randomized quasi-Monte Carlo (RQMC) simulation. RQMC has proved valuable in financial option pricing with a better rate of convergence compared to Monte Carlo sampling, but theoretical guarantees for this new application of RQMC shall be studied. To this end, we first prove that the RQMC-based estimator is strongly consistent under very mild conditions. Under some technical conditions, RQMC yields a mean error rate of O ( n − 1 / 2 − 1 / ( 4 d − 2 ) + ϵ ) for arbitrarily small ϵ > 0 , where d represents the dimension of RQMC points and n is the sample size. Some typical applications of CVaR sensitivity estimation are conducted to both show how the theoretical results can be applied, as well as to provide numerical results documenting the superiority of the RQMC estimator.

The key statistical properties of the Root Mean Square Error (RMSE) and the Mean Absolute Error (MAE) estimators were derived in this study for zero mean symmetric error distributions. A density function, named the Approximate Root Normal Distribution (ARND), was developed to approximate the distribution of a square root of a normal random variable. This enabled approximating the distribution of the RMSE estimator. The theoretical derivations and the demonstrations on common distributions, a benchmark time series, and a real world data set (with prediction errors generated from ANN and ARIMA models) lead to the following practically useful findings. When comparing errors having the same distribution type, RMSE was shown to be preferred for platykurtic distributions, MAE for leptokurtic distributions, and either RMSE or MAE for mesokurtic distributions. For different distribution types, however, using the two estimators alone was shown to lead to erroneous conclusions. The revelation that the estimated RMSE/MSE ratio could identify whether the errors came from platykurtic/mesokurtic/leptokurtic distributions was a useful complementary result. Comparison of errors based on, error distributions, sample size and the standard errors of the estimators, was discussed. The proposed procedure for deriving the statistical properties of the two estimators has scope for extension for other distribution types.

Physical activity (PA) and exercise have numerous benefits in Cystic Fibrosis (CF) including improved lung function, exercise capacity and quality of life. Despite these benefits, the effectiveness of interventions to promote PA in this population are still largely unknown. The objective of this review was to synthesise existing research and determine whether exercise interventions are effective in promoting PA in people with CF. Using the PRISMA guidelines, a comprehensive search was conducted. Fifteen studies (463 participants) met the inclusion criteria. Eleven studies demonstrated improvements in PA in both short- and long-term interventions. However, the interventions were variable across the included studies, with a large inconsistency in PA assessment tools used. Aerobic training and activity counselling were the two elements identified in this review which most consistently improved PA. Future research should consider larger sample sizes and the use of accurate instruments to assess and track PA levels longitudinally.

Objectives To investigate the general population’s view on artificial intelligence (AI) in medicine with specific emphasis on 3 areas that have experienced major progress in AI research in the past few years, namely radiology, robotic surgery, and dermatology. Methods For this prospective study, the April 2020 Online Longitudinal Internet Studies for the Social Sciences Panel Wave was used. Of the 3117 Longitudinal Internet Studies For The Social Sciences panel members contacted, 2411 completed the full questionnaire (77.4% response rate), after combining data from earlier waves, the final sample size was 1909. A total of 3 scales focusing on trust in the implementation of AI in radiology, robotic surgery, and dermatology were used. Repeated-measures analysis of variance and multivariate analysis of variance was used for comparison. Results The overall means show that respondents have slightly more trust in AI in dermatology than in radiology and surgery. The means show that higher educated males, employed or student, of Western background, and those not admitted to a hospital in the past 12 months have more trust in AI. The trust in AI in radiology, robotic surgery, and dermatology is positively associated with belief in the efficiency of AI and these specific domains were negatively associated with distrust and accountability in AI in general. Conclusions The general population is more distrustful of AI in medicine unlike the overall optimistic views posed in the media. The level of trust is dependent on what medical area is subject to scrutiny. Certain demographic characteristics and individuals with a generally positive view on AI and its efficiency are significantly associated with higher levels of trust in AI.

Assisting end users to identify desired results from a large dataset is an important problem for multi-criteria decision making. To address this problem, top-k and skyline queries have been widely adopted, but they both have inherent drawbacks, i.e., the user either has to provide a specific utility function or faces many results. The k-regret minimization query is proposed, which integrates the merits of top-k and skyline queries. Due to the NP-hardness of the problem, the k-regret minimization query is time consuming and the greedy framework is widely adopted. However, formal theoretical analysis of the greedy approaches for the quality of the returned results is still lacking. In this paper, we first fill this gap by conducting a nontrivial theoretical analysis of the approximation ratio of the returned results. To speed up query processing, a sampling-based method, S toc P res G reed , is developed to reduce the evaluation cost. In addition, a theoretical analysis of the required sample size is conducted to bound the quality of the returned results. Finally, comprehensive experiments are conducted on both real and synthetic datasets to demonstrate the efficiency and effectiveness of the proposed methods.

Atrial fibrillation after cardiac surgery (AFACS) is a serious postoperative complication. There is significant research interest in this field but also relevant heterogeneity in reported AFACS definitions and approaches used for its identification. Few data exist on the extent of this variation in clinical studies. The authors reviewed the literature since 2001 and included manuscripts reporting outcomes of AFACS in adults. They excluded smaller studies and studies in which patients did not undergo a sternotomy. The documented protocol in each manuscript was analyzed according to six different categories to determine how AFACS was defined, which techniques were used to identify it, and the inclusion and/or exclusion criteria. They also noted when a category was not described in the documented protocol. The authors identified 302 studies, of which 92 were included. Sixty-two percent of studies were randomized controlled trials. There was significant heterogeneity in the manuscripts, including the exclusion of patients with preoperative AF, the definition and duration of AF needed to meet the primary endpoint, the type of screening approach (continuous, episodic, or opportunistic), the duration of monitoring during the study period in days, the diagnosis with predefined electrocardiogram criteria, and the requirement for independent confirmation by study investigators. Furthermore, the definitions of these criteria frequently were not described. Consistent reporting standards for AFACS research are needed to advance scientific progress in the field. The authors here propose pragmatic standards for trial design and reporting standards. These include adequate sample size estimation, a clear definition of the AFACS endpoints, and a protocol for AFACS detection.

We propose a locality preserving partial least squares discriminant analysis (LPPLSDA) which adds a locality preserving feature to the conventional partial least squares discriminant analysis(PLS-DA). The locality preserving feature captures the within group structural information via a similarity graph. The ability of LPPLS-DA to capture local structures allows it to be better suited for face recognition. We evaluate the performance of our proposed method on several benchmarked face databases which offer different levels of complexity in terms of sample size as well as image acquisition conditions. The experimental results indicate that, for each database used, the proposed method consistently outperformed the conventional PLS-DA method.

Accurate diagnosis of a disease is essential in healthcare. Prediction models, based on classical regression techniques, are widely used in clinical practice. Machine Learning (ML) techniques might be preferred in case of a large amount of data per patient and relatively limited numbers of subjects. However, this increases the risk of overfitting, and external validation is imperative. However, in the field of ML, new and more efficient techniques are developed rapidly, and if recruiting patients for a validation study is time consuming, the ML technique used to develop the first model might have been surpassed by more efficient ML techniques, rendering this original model no longer relevant. We demonstrate a stepwise design for simultaneous development and validation of prediction models based on ML techniques. The design enables - in one study - evaluation of the stability and robustness of a prediction model over increasing sample size as well as assessment of the stability of sensitivity/specificity at a chosen cut-off. This will shorten the time to introduction of a new test in health care. We finally describe how to use regular clinical parameters in conjunction with ML based predictions, to further enhance differentiation between subjects with and without a disease.

PURPOSE To compare Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) with traditional ("legacy") patient-reported outcome measures (PROMs) in regard to correlations, ease of use, and quality criteria for upper (UE) and lower extremity (LE) orthopaedic conditions. METHODS A systematic search of the PubMed/MEDLINE database was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify published articles that referenced the various PROMIS PF measures. Two authors independently reviewed selected studies. The search returned 857 studies, 85 of which were selected for independent review by 2 authors. Of these, 54 were selected for inclusion. Mixed linear models were performed to assess for differences between legacy PROMs and PROMIS measures. RESULTS The combined sample size of all included studies yielded 6,074 UE and 9,366 LE patients. Overall, PROMIS PF measures demonstrated strong correlations with legacy PROMs among UE (weighted Pearson correlation, 0.624, standard error [SE] = 0.042; weighted Spearman correlation, 0.566, SE = 0.042) and LE patients (weighted Pearson correlation, 0.645, SE = 0.062; weighted Spearman correlation, 0.631, SE = 0.041). PROMIS PF questionnaires completed by UE patients had fewer questions than legacy PROMs (5.9 vs 17.7, P = .0093) and were completed in less time (90.5 vs 223.8 seconds, P = .084). PROMIS PF questionnaires completed by LE patients had fewer questions than legacy PROMs (4.81 vs 15.33, P < .001) and were completed in less time (63.6 vs 203.2 seconds, P = .0063). The differences for the reliability measures were not significant. CONCLUSIONS PROMIS PF scores correlate strongly with commonly used legacy PROMs in orthopaedics, particularly in UE and LE patients. PROMIS PF forms can be administered efficiently and to a broad patient population while remaining highly reliable. Therefore, they can be justified for standardized use among orthopaedic patients with UE and LE conditions, improving the ability to aggregate and compare outcomes in orthopaedic research. LEVEL OF EVIDENCE Level IV, systematic review of Level I-IV evidence.

Summary: To compare the clinical efficacy and safety of Thulium laser enucleation of prostate (ThuLEP) and Holmium laser enucleation of prostate (HoLEP). We systematically searched PubMed, Embase, and Cochrane Library databases within a period from the date of database establishment to October 2020. RevMan 5.4. was used for calculation and statistical analyses. 8 studies of 2125 patients were included. ThuLEP provided less hemoglobin decrease (MD: −0.37, 95%CI -0.61 to −0.14, P = 0.002) and shorter length of hospital stay (MD: −0.41, 95%CI -0.72 to −0.10, P = 0.01). During the postoperative follow-ups, statistically significant differences only were found in IPSS (MD: −0.96; 95%CI -1.27 to −0.65; P

Metabolic and bariatric surgery helps women achieve a healthier weight, reduce co-morbid conditions, increase fertility rates, and improve pregnancy outcomes compared with counterparts who are obese. Breastfeeding is known to provide both infant and maternal health benefits as well. Less is known about the impact of bariatric surgery on breastfeeding. The objective of this study was to review the impact of bariatric surgery on breastfeeding following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. PubMed and Medline databases were searched using terms such as “bariatric surgery,” “postnatal care,” “lactation,” and “breastfeeding.” Reference lists were also used to find relevant articles. A total of 49 records were identified. Abstracts were screened, and 11 observational studies were identified after meeting inclusion criteria, which included the use of original research on breastfeeding and women who have had bariatric surgery. The available research shows that breast milk after bariatric surgery is adequate in nutrients and that no long-term effects were reported in cases studies when nutrient deficiencies were corrected. Limitations include observational study design and small sample sizes. This systematic review suggests that breastfeeding after bariatric surgery should be recommended along with monitoring and micronutrient supplementation. However, additional research and increased sample sizes are needed to further examine the relationship, and such studies should be conducted to strengthen the evidence and explore ways to improve breastfeeding rates in this population.

Background Sarcopenia is defined as either low pre-operative muscle mass or low muscle density on abdominal CT imaging. It has been associated with worse short-term outcomes after surgery for colorectal liver metastases. This study aimed to evaluate whether sarcopenia also impacts long-term survival outcomes in these patients. Methods A random-effects meta-analysis was conducted following the PRISMA guidelines. Overall survival (OS) and disease-free survival (DFS) outcomes were evaluated. Results Eleven studies were included, ten reporting on the impact of low muscle mass and four on low muscle density. Sample sizes ranged between 47 and 539 (2124 patients in total). Altogether, 897 (42%) patients were considered sarcopenic, although definitions varied between studies. Median follow-up was 21–74 months. Low muscle mass (hazard ration (HR) 1.35, 95%CI 1.08–1.68) and low muscle density (HR 1.97, 95%CI 1.07–3.62) were associated with impaired OS. Low muscle mass (pooled HR 1.17, 95%CI 0.94–1.46) and low muscle density (pooled HR 1.13, 95%CI 0.85–1.50) were not associated with impaired RFS. Discussion Sarcopenia is associated with poorer OS, but not RFS, in patients with CRLM. Additional studies with standardized sarcopenia definitions are needed to better assess the impact of sarcopenia in patients with CRLM.

Background The diagnosis of subclinical depression (SD) currently relies exclusively on subjective clinical scores and structured interviews, which shares great similarities with major depression (MD) and increases the risk of misdiagnosis of SD and MD. This study aimed to develop a method of disease classification for SD and MD by resting-state functional features using radiomics strategy. Methods Twenty-six SD, 36 MD subjects and 33 well-matched healthy controls (HC) were recruited and underwent resting-state functional magnetic resonance imaging (rs-fMRI). A novel radiomics analysis was proposed to discriminate SD from MD. Multi-scale brain functional features were extracted to explore a comprehensive representation of functional characteristics. A two-level feature selection strategy and support vector machine (SVM) were employed for classification. Results The overall classification accuracy among SD, MD and HC groups was 84.21%. Particularly, the model excellently distinguished SD from MD with 96.77% accuracy, 100% sensitivity, and 92.31% specificity. Moreover, features with high discriminative power to distinguish SD from MD showed a strong association with default mode network, frontoparietal network, affective network, and visual network regions. Limitation The sample size was relatively small, which may limit the application in clinical translation to some extent. Conclusion These findings demonstrated that a valid radiomics approach based on functional measures can discriminate SD from MD with a high classification performance, facilitating an objective and reliable diagnosis individually in clinical practice. Features with high discriminative power may provide insight into a profound understanding of the brain functional impairments and pathophysiology of SD and MD.

Background Childhood anxiety and depression lead to great distress and impairment. Preventing them simultaneously in early life is critically important. We evaluated the long-term efficacy of an emotion regulation-based (ER) and a behavioural activation-based (BA) program. Both aimed to build resilience to prevent worry, a transdiagnostic feature across anxiety and depression. Methods Participants were 316 students (52.2% female; 8–13 years) from six South Australian primary schools. Schools were randomised to the ER, BA or a control condition. Measures of resilience, worry, anxiety, and depression were taken at pre- and post- program, and at 6- and 12-month follow-up. In addition, levels of emotion regulation, behavioural activation and resilience were measured as potential mediators of changes in anxiety and depression. Results No significant condition × time interactions were observed. However, the percentage of children who met the clinical cut-offs for generalised anxiety disorder and major depressive disorder decreased significantly in the BA condition at 12-month follow-up, as well as the percentage of children who met the clinical cut-off for obsessive compulsive disorder in the ER condition. Furthermore, emotion regulation mediated the relationship between condition and worry at post-program in the ER condition. Limitations The sample size is relatively small. Reliance on child self-report may have resulted in inaccurate responses. Conclusion The ER and BA transdiagnostic prevention programs for childhood anxiety and depression showed promising results for certain anxiety disorders not otherwise observed in universal school-based studies. Future research should consider evaluating the programs with a larger sample using alternative outcome measures.

This meta-analysis was conducted to determine the effect of animal-assistant therapy on the quality of life of older adults. This research systematically searched electronic databases (CINAHL, Cochrane Central, Medline/ PubMed, Web of Science, Science Direct, and the National Thesis Centre and ULAKBI_M of the Council of Higher Education) for studies published between April June 2021. Seven studies with experimental design were used, three were quasi-experimental and four were randomly controlled studies. The total sample size in the meta-analysis was 375 (experimental group: 177 and control group: 198). The mean duration of animal-assistant therapy was 38.5 12.4 min. Animal-assistant therapy had a significant effect on the quality of life of older adults (mean difference:-4.59 p: 0.03, Z:2.23). Therefore, animal assistant therapy is an effective method to improve older adults' quality of life. (c) 2021 Elsevier Inc. All rights reserved.

Background Instability constitutes over 20% of revisions after total hip arthroplasty (THA). Dual mobility (DM) designs were introduced as a solution to this problem. However, the few publications that have reported promising results for monobloc DM constructs have been limited by sample size or length of follow-up. The purpose of this study is to evaluate mid-term outcomes (minimum 5-year follow-up) of a single-surgeon series utilizing a monobloc DM acetabular component in patients with high risk for dislocation. Methods This is a single-surgeon consecutive series of 207 primary THAs implanted with a monobloc DM component in patients who were considered at high risk for dislocation. Patient demographics and case-specific data were collected retrospectively. All patients had a minimum of 5-year follow-up. The Mann-Whitney U test was used to assess continuous variables, whereas categorical variables were analyzed using the chi-square test. Survival probability was calculated using the Kaplan-Meier method. Results Radiographic analysis did not reveal acetabular radiolucency in any patients, and there were no revisions for aseptic loosening. In addition, there were no dislocations. Seven of 205 patients (3.4%) were revised, 5 on the femoral side due to periprosthetic fracture and the remaining two for infection. Survivorship of the acetabular component from revision was 99%. The mean Veteran RAND (VR-12) physical score improved from 7 (standard deviation [SD]: 13.7) preoperatively to 9.5 (SD: 17.6) at the final follow-up. Similarly, the hip disability osteoarthritis score improved from 8 (SD: 17.9) preoperatively to 21.2 (SD: 37). Conclusion Monobloc DM components reliably prevent dislocation after primary THA in high-risk patients. At mid-term follow-up, this DM monobloc component demonstrates excellent implant survivorship, radiographic fixation, and improved functional outcomes.

A key goal of orthodontic treatment with fixed appliances is alignment of the dentition, and this remains a commonly selected outcome in clinical studies investigating orthodontic tooth movement. This systematic review has evaluated treatment duration to achieve alignment of the mandibular dentition using fixed appliances.Systematic literature searches without restrictions were undertaken in 9 databases for randomized clinical trials (RCTs) assessing duration and rate of tooth alignment using fixed appliances with or without treatment adjuncts published up to January 2021. After duplicate study selection, data extraction, and risk of bias assessment according to Cochrane, random-effects meta-analyses of aggregate data, and individual patient data were conducted.Thirty-five trials were included with 2258 participants (39% male; mean age 17.8 years), giving a pooled duration to achieve whole-arch alignment of the mandibular dentition of 263.0 days (4 trials; 95% confidence interval [CI], 186.7-339.4 days) and incisor alignment in the mandibular arch of 100.7 days (9 trials; 95% CI, 84.1-117.4 days). Surgical-assisted orthodontics was associated with reduced duration of incisor alignment: mean difference of 44.3 days less (4 trials; 95% CI, 20.0-68.9 days; P 0.001; high quality of evidence), whereas subgroup and meta-regression analyses indicated significant effects of baseline crowding and premolar extractions. Individual patient data analysis from 3 RCTs indicated that for each additional participant age year, whole-arch alignment of the mandibular dentition took 13.7 days longer (3 trials; 95% CI, 7.7-17.7 days; P 0.001) and for each additional mm of irregularity, 17.5 days more were needed (2 trials; 95% CI, 9.8-25.2 days; P 0.001).Patient and treatment-related characteristics can significantly affect the duration of tooth alignment and should be taken into account both clinically and when designing trial outcomes. Future research studies investigating rates of orthodontic tooth alignment would benefit from adequate sample sizes and a more consistent methodology in outcome assessment. Data in this systematic review provides a basis for appropriate trial design for future RCTs investigating the rate of orthodontic tooth alignment with fixed appliances.

Objectives Recent advancements in high-resolution imaging have improved the diagnostic assessment of magnetic resonance imaging (MRI) for intralabyrinthine schwannoma (ILS). This systematic review aimed to evaluate the diagnostic performance of MRI for patients with ILS. Methods Ovid-MEDLINE and EMBASE databases were searched for related studies on the diagnostic performance of MRI for patients with ILS published up to February 10, 2020. The primary endpoint was the diagnostic performance of MRI for ILS. The quality of the enrolled studies was assessed using tailored questionnaires and the Quality Assessment of Diagnostic Accuracy Studies-2 criteria. Results Overall, 6 retrospective studies that included 122 patients with ILS from a parent population of 364 were included. The sample size, parent population and its composition, reference standard, detailed parameters of MRI, and even the diagnostic methods varied between the studies. The studies had moderate quality. The sensitivity of combination of T2WI and CE-T1WI was over 90%. Relative sensitivity of T2WI comparative to CE-T1WI ranged from 62% to 100%, and the specificity were 100%. Conclusions MRI has acceptable diagnostic performance for ILS. There is a need for well-organized research to reduce the factors causing heterogeneity.

European journal of cancer 160, 80-91 (2022). doi:10.1016/j.ejca.2021.10.007, Published by Elsevier, Amsterdam [u.a.]

Abnormalities of the brain network organization in focal epilepsy have been extensively quantified. However, the extent and directionality of abnormalities are highly variable and subtype insensitive. We conducted meta-analyses to obtain a more accurate and epilepsy type-specific quantification of the interictal global brain network organization in focal epilepsy. By using random-effects models, we estimated differences in average clustering coefficient, average path length, and modularity between patients with focal epilepsy and controls, based on 45 studies with a total sample size of 1,468 patients and 1,021 controls. Structural networks had a significant lower level of integration in patients with epilepsy as compared to controls, with a standardized mean difference of -0.334 (95 % confidence interval -0.631 to -0.038; p-value 0.027). Functional networks did not differ between patients and controls, except for the beta band clustering coefficient. Our meta-analyses show that differences in the brain network organization are not as well defined as individual studies often propose. We discuss potential pitfalls and suggestions to enhance the yield and clinical value of network studies.

Logistics capability is an essential capacity for transport and logistics firm to convey the value and services to the client. However, supply chain uncertainty and risk establish the obstacle while achieving operational excellence. The main objective of this research is to examine the impact of logistic capabilities on mitigating supply chain uncertainty and risk in courier firms in Pakistan. Research identified that operational flexibility, innovation and process optimization has a significant positive impact on company side risk and uncertainties whereas process optimization also positively impacted on customer’s side risk and uncertainties. An online survey was conducted and data were obtained from sample size of 150 employees from Pakistani logistics companies. We performed multiple regression analysis to indicate the impact of logistics capability in mitigation of supply chain uncertainty and risk.

To evaluate the tensile behavior of metal foils by resistance heating (RH) assisted tensile testing system accurately, this study proposed to embed a digital image correlation (DIC) system with laser speckles for the measurement of full-field strain distribution. Furthermore, the sample structures were optimized to achieve uniform temperature and strain distribution. An infrared camera was used to monitor the temperature distribution. Rectangular samples instead of dog-bone shaped samples were proposed. A model for calculating the temperature distribution was established to optimize the sample structure. The parameters that influence the temperature distribution and tensile behavior were studied. As results, compared to the strain measured by a non-contact extensometer, the maximum deviation of the strain measured by DIC was less than 6% when the nominal strain was larger than 0.013. It is confirmed that the proposed tensile testing system is reliable for measuring the temperature and full-field strain distributions. Sample shape influenced temperature distributions of smaller samples while it almost had no influence on the temperature distributions of larger samples. The temperature difference was not affected by the material type but by the sample size. The proposed rectangular shape was validated to be feasible for RH assisted tensile testing. The sample length was successfully optimized for a more uniform temperature distribution by the established model. Although the tensile deformation was not influenced by the sample shape, the temperature distribution resulted in a non-uniform strain distribution before achieving ultimate tensile strength. Longer effective sample length between two clamping jigs contributed to a more uniform temperature distribution and material deformation. A more accurate evaluation of high-temperature tensile behavior for metal foils can be achieved by the proposed RH assisted tensile testing system using rectangular samples with an optimized structure.

A coalescent model of a sample of size n is derived from a birth–death process that originates at a random time in the past from a single founder individual. Over time, the descendants of the founder evolve into a population of large (infinite) size from which a sample of size n is taken. The parameters and time of the birth–death process are scaled in N 0 , the size of the present-day population, while letting N 0 → ∞ , similarly to how the standard Kingman coalescent process arises from the Wright-Fisher model. The model is named the Limit Birth-Death (LBD) coalescent model. Simulations from the LBD coalescent model with sample size n are computationally slow compared to standard coalescent models. Therefore, we suggest different approximations to the LBD coalescent model assuming the population size is a deterministic function of time rather than a stochastic process. Furthermore, we introduce a hybrid LBD coalescent model, that combines the exactness of the LBD coalescent model model with the speed of the approximations.

Phase II clinical trials in oncology are used to initially evaluate the therapeutic efficacy of a new treatment. In the past, the total response was a frequently used endpoint to access the effectiveness of the treatment. When the total response is modest, clinicians may also be interested in disease control (defined as the total response or stable disease) since it may better predict clinical outcomes. Thus, formally testing both the total response and disease control in a phase II trial has an important clinical implication. In this paper, we propose a new method to construct optimal subset designs for one-stage and two-stage phase II clinical trials with two binary endpoints, i.e. the total response and disease control. A new set of hypotheses under the framework of intersection-union tests is provided in which the treatment is considered promising if both the total response and disease control are good. We show that the power function for each test in a large family of tests is nondecreasing in both the total response rate and disease control rate; identify the parameter configurations at which the maximum Type I error rate and minimum power are achieved and derive level- α tests. We also provide optimal one-stage designs with the minimum sample size and optimal two-stage designs with the least expected total sample size.

Background The number of randomized clinical trials (RCTs) for manual therapy (MT) has increased exponentially in recent years but the quality of reporting is heterogeneous. Objective To assess the quality of the reporting of results in RCTs manual therapy, both in the text and in the graphs. Study design Methodological review. Methods We reviewed a random sample of 120 RCTs in MT published between 2000 and 2020 in indexed journals. We identified the primary outcome for each trial, and evaluated the completeness and correctness of reporting of results in the text and in the graphs. Results Forty per cent of the RCTs explicitly identified the primary outcome and 47.5% reported a sample size calculation. In 46.7% of the trials, the reporting of between groups comparisons was complete (including effect size and precision). Only 29.2% used the confidence interval as a measure of precision. Fifty-eight per cent of the trials reported significant differences in the results, and 30.8% reported a value of clinical relevance for at least one variable of the study. Forty-seven per cent reported the primary outcome graphically but only 19.6% of the graphs were self explanatory and 66.1% had problems of visual clarity. Conclusions Our findings suggest that the reporting of the results in MT trials is generally incomplete and graphics are often poor. These shortcomings could affect the interpretation of the results and their application in clinical practice. Improvements are needed in the reporting of results in order to advance clinical practice and research in manual therapy.

Summary Background The conduct and reporting of pilot studies is important to assess the feasibility of future randomized controlled trials (RCT). The Consolidated Standards of Reporting Trials (CONSORT) statement extension to pilot/feasibility studies addresses the reporting quality of the pilot studies (Summary Table 1). The aims of this systematic review are (1) to assess the reporting quality of pilot studies in pediatric urology and (2) to explore the factors that are associated with the reporting quality of these studies. Methods A comprehensive search was conducted through MEDLINE® and EMBASE® to identify pilot RCTs from 2005 to 2018. Two reviewers independently performed title and abstract screening and full text review, with discrepancies resolved by consensus. CONSORT extension reported items were summarized and overall proportion of reported items for each article was estimated. A linear regression model was conducted to determine factors associated with higher reporting quality. Publication year, biostatistician/epidemiologist support, sample size justification and journal impact factor were collected. Results Of the 1463 titles duplicates were removed and 1347 were screened, 36 studies were included. Overall, 36 pilot studies reported about 8–9 of 17 items [51% (95% CI: 46 – 56%)]. The most reported items were contact details for the corresponding author (97%), title identification of study as randomised pilot or feasibility trial (95%), eligibility criteria and setting (81%), both interventions (78%), and specific objectives of the pilot trial (75%). Less fulfilled items were blinding (11%), registration of the trial (11%), randomization details (28%), detailing recruitment status in the pilot study (19%), trial design (31%), and source of funding for pilot trial (34%). Interpretation of the results of pilot trial and their implications for the future definitive trial was reported by 34% of the studies. Factors associated with higher reporting quality were the presence of biostatistician or epidemiologist (P = 0.004), and if the sample size for the pilot study was justified (P = 0.002). Discussion Overall reporting quality of pilot studies in pediatric urology literature from 2005-2018 was suboptimal. The quality of pilot RCTs included in the present review were lower than that observed in the orthopedic literature, however, it appears to be consistent with the trends regarding OQS in chronic kidney disease and allopathic medicine. While we endeavoured to maintain utmost rigidity of this systematic review, there are inherent limitations. The CONSORT 2010 extension for pilot RCTs was published in 2016. Clinical trials can take several years, many pilot studies published pre-2016 would not have had the guidance of the extension during designing phases. Not all pilot RCTs are published, so this could potentially reduce the generalizability of the findings from this review. Only studies in English, published in full peer-reviewed journals were included, and this review only addressed the reporting quality of pilot studies in pediatric urology. Conclusion This review demonstrated that reporting quality of pilot studies in pediatric urology is currently suboptimal. Including biostatistician and/or epidemiologist, can ameliorate the quality of future pilot studies. Implementing CONSORT 2010 extension by journals as a prerequisite for submission of pilot or feasibility trials is recommended to improve the robustness and transparency of future pilot studies.

Background Metabolic and bariatric surgery (MBS) has demonstrated improvements in diabetes and cardiovascular health. The effect of MBS on the risk of ischemic stroke remains unclear. Objectives The goal of this study was to determine the risk of stroke following MBS compared with patients with obesity who qualified for but did not undergo MBS. Setting The Mariner Database, a national claims database. Methods We identified patients with body mass index (BMI) ≥40 or those with a BMI and a qualifying co-morbidity, who underwent MBS between 2010 to 2019. Similar patients who did not undergo MBS served as controls. Coarsened exact matching was performed followed by logistic regression analysis to determine the effect of BMS on stroke risk. Results A total of 70 622 BMS patients and 1 320 182 MBS-eligible controls were identified. After matching, the 1-year stroke risk among MBS patients (n = 56 514) versus controls (n = 56 514) was .6% versus 1.2% (OR .54, 95% CI .47–.61). The 5-year stroke risk for MBS (n = 27619) versus control (n = 27619) was 2.8% versus 3.6% (OR .78, 95% CI .65–.90). Conclusion MBS appears to reduce the risk of stroke following surgery. To our knowledge, this is the largest sample size in a study of ischemic cerebrovascular disease in bariatric surgery.

Introduction Over the last 2 decades, several minimally invasive surgical techniques and approaches have been introduced for hip arthroplasty, including anterolateral minimally invasive surgery (ALMIS) introduced by Rottinger in 2004. As described, this muscle sparing approach promises faster recovery and lower dislocation rates. Although there has been a peaked recent interest in minimally invasive surgery (MIS) hip arthroplasty, few studies support the superiority of ALMIS compared to the more traditional posterior approach. The present study examines the safety and early complications of elderly patients undergoing ALMIS compared to a posterior approach for hemiarthroplasty of displaced femoral neck fractures. Methods In a retrograde level III case-control study, 100 consecutive elderly patients with primary hip arthroplasty were divided into two groups. The first group consisted of 50 consecutive cases operated with the ALMIS approach and the second group of 50 consecutive cases operated through a posterior approach. Operative time, postoperative complication rates, length of hospitalization, blood loss, and leg-length discrepancy, were reviewed retrospectively. Results No differences were observed in post-operative complications. Overall, the operative time was significantly greater in the ALMIS group compared to the posterior approach group (75 ± 12 vs 67.5 ± 16 min, respectively; p ≤ 0.01). However, the operating time of the second half of the ALMIS cohort (N = 25), did not differ from the posterior approach group (72.7 ± 10.5 vs 67.5 ± 16, respectively; p = 0.19). Leg length discrepancy was significantly less in the ALMIS group compared to the posterior exposure group (1.5 ± 3.2 vs 3.2 ± 3.3, respectively; P≤0.1). Conclusions The results of the retrograde analysis, although limited in sample size, shows no major differences in ALMIS compared to a more traditional posterior approach in terms of immediate post-operative complications. Although the overall operating time was longer in the patients treated with ALMIS, the second cohort of patients treated with this method had an operating time that was similar to that observed with posterior approach. Leg-length discrepancies were significantly less in patients treated with ALMIS.

During radiation therapy treatments patients may require medications to manage radiation toxicities. Since patients are assessed daily by Radiation Therapists (RTs) it would be optimal and timely for patients to receive medication prescriptions for relief of common radiation side effects from the RTs.The purpose of this study was to determine the perceptions that RTs and Radiation Oncologists (ROs) have of frontline treatment RTs prescribing medications to patients for treatment-related side effects.A qualitative and quantitative survey consisting of twenty-five questions on a five-point Likert scale, one open-ended question, and three demographic questions was designed. While the survey sought to examine the perceptions that RTs and ROs have of RTs prescribing medications, the survey also proposed eight different medications that RTs could potentially prescribe. The medications that were proposed are commonly prescribed to radiation therapy patients and included anti-emetic, topical anti-bacterial, hydrocortisone cream, topical anaesthetic, anti-diarrheal, anti-spasmodic, urinary analgesic and anti-fungal medications. After the survey was approved by the Research Ethics Board, RTs and ROs at a large, academic cancer centre were invited to complete the survey. To analyze the survey results, several statistical tests were performed separately for the RTs' surveys and the ROs' surveys. The chi-squared test was used to determine if the sample RT and RO populations were representative of the actual RT and RO populations (p0.05). Additionally, the Sign test for medians was used to analyze statistically the responses to the Likert scale questions (p0.05), while the Kruskal-Wallis test was used to compare the responses to the Likert scale questions across the demographic groups identified in the demographic questions (p0.05).The response rate was 34% (31/90) for the RT population and 42% (10/24) for the RO population. The statistical analysis of the RT population's surveys showed that the majority of the RTs shared positive perceptions towards having RTs prescribe medications, while some respondents highlighted negative perceptions in the open-ended qualitative question. The majority of the RTs agreed that RTs should prescribe five of the eight proposed medications, excluding anti-spasmodic, urinary analgesic, and anti-fungal medications. In contrast to the RTs, there was no statistically significant consensus from the ROs on RTs prescribing medications. Furthermore, the ROs had varying opinions on RTs prescribing the eight proposed medications.Although the sample size in this study was small, the results from the RT population's surveys supported RTs prescribing medications. The positive results from the RTs and the equivocal response from the ROs suggest that future research should be conducted. Additionally, a future pilot study could be implemented where RTs prescribe one or more of the five medications that were supported to prescribe by the RTs. By having RTs prescribe medications to patients in a pilot study, the effectiveness on patient care could be measured.

Background Under-triage in trauma remains prevalent, in part because of decisions made by physicians at non-trauma centers. We developed two digital behavior change interventions to recalibrate physician heuristics (pattern recognition), and randomized 688 emergency medicine physicians to use the interventions or to a control. In this observational follow-up, we evaluated whether exposure to the interventions changed physician performance in practice. Methods We obtained 2016 – 2018 Medicare claims for severely injured patients, linked the names of trial participants to National Provider Identifiers (NPIs), and identified claims filed by trial participants for injured patients presenting to non-trauma centers in the year before and after their trial. The primary outcome measure was the triage status of severely injured patients. Results We linked 670 (97%) participants to NPIs, identified claims filed for severely injured patients by 520 (76%) participants, and claims filed at non-trauma centers by 228 (33%). Most participants were white (64%), male (67%), and had more than three years of experience (91%). Patients had a median Injury Severity Score of 16 (IQR 16 – 17), and primarily sustained neuro-trauma. After adjustment, patients treated by physicians randomized to the interventions experienced less under-triage in the year after the trial than before (41% versus 58% [-17%], P = 0.015); patients treated by physicians randomized to the control experienced no difference in under-triage (49% versus 56% [-7%], P = 0.35). The difference-in-the-difference was non-significant (10%, P = 0.18). Conclusions It was feasible to track trial participants’ performance in national claims. Sample size limitations constrained causal inference about the effect of the interventions.

Background Cocaine abuse is a public health burden. Cocaine is known to cause vasospasm and acute myocardial infarction (AMI). The prevalence of AMI in patients presenting with chest pain and concurrent cocaine use (CPCC) varies among studies. We performed a systemic review and meta-analysis to assess the current literature for the prevalence of AMI in patients with CPCC. Methods We performed a literature search of PubMed, EMBASE, and Scopus from its beginning to May 18, 2020 and updated this search on February 18, 2021. Full-text studies that assessed the primary outcome (AMI) specifically among patients with CPCC who presented to the emergency department (ED) were included. We excluded studies that were not in English, did not take place in the ED, and case reports, which only reported positive cases and not incidence of AMI. Random effect meta-analysis was performed to assess the prevalence of primary outcome and to examine correlations between risk factors and AMI. Heterogeneity was assessed by I-square value. We also performed subgroup analysis to identify potential sources of heterogeneity. Results We identified 2178 studies and screened 102 full-text studies to include 16 studies (3269 patients) in our final analysis. The pooled prevalence of AMI was 4.7% (95% CI 0.8–23), I-square of 84%. However, rates among studies of low risk patients were lower (1.1% 95% CI 0.2–5) compared to studies of mixed risk patients (7.7%, 95% 5–11). A meta-regression was used to look at correlation between risk factors and AMI and found that AMI was positively correlated in patients with a history of CAD (correlation coefficient [Corr. Coeff.] 5.6, 96% CI 2.3–8.7), HTN (Corr. Coeff. 2.9, 95% CI 0.9–4.9), DM (Corr. Coeff. 8.0, 95% CI 2.4–14), HLD (Corr. Coeff. 5.9, 95% CI 2.4, 9). Sources of potential heterogeneity included patients' risk as defined by the authors, study designs, publication year, and study sample size. Conclusion The overall prevalence of AMI and death among patients with cocaine-associated chest pain was relatively low, although high risk patients were still associated with high prevalence of AMI. Clinicians should consider risk-stratify these patients and treat them accordingly.

Summary Background Excessive use of digital smart devices, including smartphones and tablet computers, could be a risk factor for myopia. We aimed to review the literature on the association between digital smart device use and myopia. Methods In this systematic review and meta-analysis we searched MEDLINE and Embase, and manually searched reference lists for primary research articles investigating smart device (ie, smartphones and tablets) exposure and myopia in children and young adults (aged 3 months to 33 years) from database inception to June 2 (MEDLINE) and June 3 (Embase), 2020. We included studies that investigated myopia-related outcomes of prevalent or incident myopia, myopia progression rate, axial length, or spherical equivalent. Studies were excluded if they were reviews or case reports, did not investigate myopia-related outcomes, or did not investigate risk factors for myopia. Bias was assessed with the Joanna Briggs Institute Critical Appraisal Checklists for analytical cross-sectional and cohort studies. We categorised studies as follows: category one studies investigated smart device use independently; category two studies investigated smart device use in combination with computer use; and category three studies investigated smart device use with other near-vision tasks that were not screen-based. We extracted unadjusted and adjusted odds ratios (ORs), β coefficients, prevalence ratios, Spearman's correlation coefficients, and p values for associations between screen time and incident or prevalent myopia. We did a meta-analysis of the association between screen time and prevalent or incident myopia for category one articles alone and for category one and two articles combined. Random-effects models were used when study heterogeneity was high (I2>50%) and fixed-effects models were used when heterogeneity was low (I2≤50%). Findings 3325 articles were identified, of which 33 were included in the systematic review and 11 were included in the meta-analysis. Four (40%) of ten category one articles, eight (80%) of ten category two articles, and all 13 category three articles used objective measures to identify myopia (refraction), whereas the remaining studies used questionnaires to identify myopia. Screen exposure was measured by use of questionnaires in all studies, with one also measuring device-recorded network data consumption. Associations between screen exposure and prevalent or incident myopia, an increased myopic spherical equivalent, and longer axial length were reported in five (50%) category one and six (60%) category two articles. Smart device screen time alone (OR 1·26 [95% CI 1·00–1·60]; I2=77%) or in combination with computer use (1·77 [1·28–2·45]; I2=87%) was significantly associated with myopia. The most common sources of risk of bias were that all 33 studies did not include reliable measures of screen time, seven (21%) did not objectively measure myopia, and nine (27%) did not identify or adjust for confounders in the analysis. The high heterogeneity between studies included in the meta-analysis resulted from variability in sample size (range 155–19 934 participants), the mean age of participants (3–16 years), the standard error of the estimated odds of prevalent or incident myopia (0·02–2·21), and the use of continuous (six [55%] of 11) versus categorical (five [46%]) screen time variables Interpretation Smart device exposure might be associated with an increased risk of myopia. Research with objective measures of screen time and myopia-related outcomes that investigates smart device exposure as an independent risk factor is required. Funding None.

Numerous clinical trials are being conducted in the field of spinal cord injury (SCI). These trials are typically registered on ClinicalTrials.gov. The objective of this study was to identify the characteristics of the completed SCI trials and characterize the potential factors associated with publication. ClinicalTrials.gov database was queried for all the completed trials on patients with SCI. Baseline characteristics of the completed trials were assessed. The publication status of these trials was identified using PubMed or Google Scholar. The secondary and primary outcomes reported in the publication were then compared to the outcomes registered in ClinicalTrial.gov. Multivariable logistic regression analysis was performed to determine the characteristics associated with publication status and time to publication. A total of 457 of 1,061 trials on SCI were completed. Of those, 60% were ultimately published. Trials that had received funding from sources besides the NIH, private industries, or the federal government were more likely to remain unpublished. The median time to publish was three years, with larger trials taking a longer time. The median sample size for completed trials was 30. Assessment of mismatch rates in primary outcomes of published data to registered outcomes was 8.9%. In SCI trials, outcomes registered on ClinicalTrial.gov often matched published results. Additionally, sample size and funding source play a significant role in the publication rate of these trials. Published data represents a reliable source for clinicians, researchers, and patients; efforts to curb publication bias and reporting bias are paramount for implementing evidence-based practices and ensure proper scientific conduct.