PURPOSE: To compare the outcomes of mitomycin-C (MMC) delivered by intra-Tenon injection vs sponge application during trabeculectomy surgery. METHODS: We retrospectively reviewed 566 patients with primary and secondary glaucoma diagnoses who received trabeculectomy surgery with MMC in an academic medical center. Exclusion criteria were age less than 18 years, no light perception vision, combined surgery, previous glaucoma incisional surgery, intraoperative 5-fluorouracil, or follow-up < 1 month. Subjects were divided into 2 cohorts: MMC delivered by sponge application or by intra-Tenon injection. Main outcome measures were postoperative intraocular pressure (IOP) level and secondary measures were survival rate for IOP control, glaucoma medication use, complication rate, and vision. RESULTS: After inclusion/exclusion criteria, 316 eyes were available for analysis; 131 eyes had MMC delivered via sponge and 185 eyes via injection. Mean postoperative IOP was not significantly different between treatment groups but change in IOP from baseline was lower in the sponge vs the injection group 24 months after surgery (P = .038). The MMC sponge group had significantly more tense, vascularized, or encapsulated blebs as a late complication (P = .046). Time to failure for postoperative IOP control was not significantly different between MMC treatment groups, but older patient age and limbus-based conjunctival incision were associated with significantly longer time to fail. CONCLUSIONS: The application of MMC by injection was similar to application by sponge in lowering IOP in patients with glaucoma and the safety of both techniques appears to be comparable. Limbus-based conjunctival incision had longer time to failure for postoperative IOP control vs fornix-based incision. NOTE: Publication of this article is sponsored by the American Ophthalmological Society. (C) 2020 Elsevier Inc. All rights reserved.

Purpose. To examine financial and clinical work productivity outcomes associated with the use of the electronic health record (EHR). Methods. 191,360 billable clinical encounters were analyzed for 12 clinical providers over a 9-year study period during which an EHR was implemented. Main outcome measures were clinical revenues collected per provider and secondary outcomes were charge capture, patient visit coding levels, transcription costs, patient visit volume per provider, digital drawing, and digital imaging volume. Results. The difference in inflation adjusted net clinical revenue per provider per year did not change significantly in the period after EHR implementation (mean = $404,198; SD = $17,912) than before (mean = $411,420; SD = $39,366) (P = 0.746). Charge capture, the proportion of higher- and lower-level visit codes for new and established patients, and patient visits per provider remained stable. A total savings of $188,951 in transcription costs occurred over a 4-year time period post-EHR implementation. The rate of drawing the ophthalmic exam in the EHR was low (mean = 2.28%; SD = 0.05%) for all providers. Conclusions. This study did not show a clear financial gain after EHR implementation in an academic ophthalmology practice. Ophthalmologists do not rely on drawings to document the ophthalmic exam; instead, the ophthalmic exam becomes text-driven in a paperless world.

Purpose: To determine whether multiple interventions influence adherence to glaucoma medication and to study the relationship between personality type and adherence.Methods: Eighty patients with glaucoma using prostaglandin monotherapy were prospectively randomized to an intervention or a nonintervention group. Over a 5-month period, the intervention group received monthly automated telephone calls reminding them to take their glaucoma medications. At month 3, the intervention group had an office visit with their physician and received education regarding their disease and treatment. The nonintervention group returned at the end of the study period. Adherence was directly measured with an electronic monitoring cap. Outcome measures were adherence rate and therapeutic coverage. Patients completed the Minnesota Multiphasic Personality Inventory-2.Results: Thirty-eight patients were randomized to the intervention group and 42 were randomized to the nonintervention group. Mean adherence rate for the intervention group over 5 months was 76% and for the nonintervention group, 81%. For the intervention group, adherence did not change significantly after the midstudy visit (P=0.233). No difference existed between the intervention and nonintervention groups before (P=0.456) or after (P=0.134) the midstudy intervention visit. The Minnesota Multiphasic Personality Inventory-2 personality scales for depression (P=0.01) and hypochondriasis (P>0.0001) were significantly associated with poorer adherence.Conclusions: Monthly automated telephone reminders, a 1-time educational session, and increased contact with a physician did not improve adherence rate with glaucoma medications. Depression and hypochondriasis personality types were related to poor adherence and highlight the role of psychosocial factors in medication adherence.

teams are by now used to the argument “we need a new stadium to be competitive” from owners (Neil deMause in his Field of Schemes website calls this “leveling the playing field”). The validity of this claim may be considered rhetorically (see again deMause’s Field of Schemes or a take by Doug Pappas at baseballprospectus.com); we do not engage in that herein. Rather, we take the claim at face value and statistically test whether new stadiums are associated with “more competitiveness” in Major League Baseball. We first measure “competitiveness” the way the team owners implicitly claim: wins. However, since one if We build it, Will they compete?

I consider the beginnings of computational and empirical statistics, particularly emphasizing the contributions to these by the scientists at Los Alamos National Laboratory during and after World War II. The timeline considered herein begins with preparations for the 1890 U.S. Census and concludes with Tukey's introduction of the jackknife.

The southern part of Central Valley of California in winter has long had high PM10 mass, which until about 1990 included sulfate, vanadium, and nickel from the burning of crude oil used to generate steam to enhance heavy petroleum recovery. In roughly 1990, natural gas became the major energy source used for steam generation. In 1989–1991, data were collected throughout California on the mortality from strokes and ischemic heart disease (IHD). Although no spatial variability was seen for strokes, the southern San Joaquin Valley was found to have IHD mortality rates roughly 60% greater than the rest of the valley. PM10 was statistically identified as the major factor associated with the IHD mortality. However, when the rate of IHD was reexamined in the 2003–2007 period, a sharp reduction, about 30%, was seen in the relative rates for southern San Joaquin Valley as compared with the northern Sacramento Valley. We have measured very fine and ultrafine vanadium and nickel aerosols in a winter experiment in 2009, which shows an order of magnitude reduction in vanadium and nickel aerosols as compared with the pre-1990 data, which is a consequence of the switch from burning crude oil to natural gas to generate the steam. The inference of a causal relationship between the reduced vanadium and nickel and the improved IHD rate is supported by a growing body of laboratory and epidemiological work on the toxicity of vanadium and nickel, including from oceangoing ships burning crude or residual oil.

Purpose To characterize the personality profile of glaucoma subjects. Patients and Methods One hundred eight subjects including 56 open-angle glaucoma (OAG) and 52 controls were given the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) test and all performed automated perimetry. Clinical and demographic information which could relate to personality type was collected. Results OAG subjects had significantly higher Hypochondriasis (Hs; P=0.0082), Hysteria (Hy; P=0.0056), and Health Concerns (HEA; P=0.0025) mean scores than the control group. OAG subjects also had a significantly greater frequency of clinically abnormal score for hysteria (P=0.0262), and health concerns (P=0.0018). Multivariate analysis of variance revealed that Hypochondriasis, Hysteria, and Health Concerns scores were related to number of systemic medications used and to diagnostic group. Other potential explanatory variables such as sex, ethnicity, number of medical problems, length of glaucoma diagnosis, occurrence of glaucoma surgery, intraocular pressure, and visual status (logMAR, visual field indices) were not related to these personality scores. Conclusions Patients with a diagnosis of OAG had more abnormal MMPI-2 scores in areas that focus upon concerns of somatic complaints and poor health. The use of systemic medications, which may be a constant reminder of illness, is a factor that may contribute to higher MMPI-2 scores.

Primary biliary cirrhosis (PBC) is generally a slowly progressive disease that may lead to cirrhosis and liver failure. However, patients with PBC often suffer from a variety of symptoms long before the development of cirrhosis that include issues of daily living that have an impact on their work environment and their individual quality of life. We therefore examined multiple parameters by taking advantage of the database of our cohort of 1032 patients with PBC and 1041 matched controls. The data were obtained from patients from 23 tertiary referral centers throughout the United States and from rigorously matched controls by age, sex, ethnicity, and random-digit dialing. The data showed that patients with PBC were more likely than controls to have significant articular symptoms, a reduced ability to perform household chores, and the need for help with routine activities. Patients with PBC rated their overall activity similar or superior to that of controls; however, more of them reported limitations in their ability to carry out activities at work or at home and difficulties in everyday activities. PBC cases also more frequently reported limitations in participating in certain sports or exercises and pursuing various hobbies; however, they did not report significant limitations in social activities. In a multivariable analysis, household income, a diagnosis of systemic lupus erythematosus, limitations in work activities, a reduction in work secondary to disability, and church attendance were independently increased in PBC cases with respect to controls. Conclusion: Our data indicate that the quality of life of patients with PBC in the United States is generally well preserved. Nevertheless, patients with PBC suffer significantly more than controls from a variety of symptoms that are beyond the immediate impact of liver failure and affect their lifestyle, personal relationships, and work activities.

Abstract : Systemic lupus erythematosus (SLE) is a systemic autoimmune disease, predominantly occurring in women of childbearing age. SLE, like several other autoimmune diseases, is characterized by a striking female predominance and, although sex hormone influences have been suggested as an explanation for this phenomenon, definitive data are still unavailable. Our group recently reported an increased X monosomy in lymphocytes of women, affected with primary biliary cirrhosis (PBC), systemic sclerosis (SSc), and autoimmune thyroiditis (AITD) in comparison to healthy women, thus suggesting the involvement of this chromosome in female predominance and in the deregulation of the immune system that characterizes autoimmunity. We have now evaluated X monosomy rates in SLE using fluorescence in situ hybridization (FISH) on peripheral mononuclear white blood cells (PBMCs) from female patients compared to healthy age-matched controls. In addition, because of a previous finding of microchimerism as a pathogenetic cause of a number of autoimmune diseases, we investigated the presence of cells carrying the Y chromosome. We did not identify an increased X monosomy in women with SLE compared to controls ( P = 0.3960, SLE vs. HCs, Student's t -test), thus suggesting that a different mechanism of immune deregulation might be predominant in the female population of patients with SLE.

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease, predominantly occurring in women of childbearing age. SLE, like several other autoimmune diseases, is characterized by a striking female predominance and, although sex hormone influences have been suggested as an explanation for this phenomenon, definitive data are still unavailable. Our group recently reported an increased X monosomy in lymphocytes of women, affected with primary biliary cirrhosis (PBC), systemic sclerosis (SSc), and autoimmune thyroiditis (AITD) in comparison to healthy women, thus suggesting the involvement of this chromosome in female predominance and in the deregulation of the immune system that characterizes autoimmunity. We have now evaluated X monosomy rates in SLE using fluorescence in situ hybridization (FISH) on peripheral mononuclear white blood cells (PBMCs) from female patients compared to healthy age-matched controls. In addition, because of a previous finding of microchimerism as a pathogenetic cause of a number of autoimmune diseases, we investigated the presence of cells carrying the Y chromosome. We did not identify an increased X monosomy in women with SLE compared to controls (P = 0.3960, SLE vs. HCs, Student's t-test), thus suggesting that a different mechanism of immune deregulation might be predominant in the female population of patients with SLE.

Organically grown products experienced a doubling in percent penetration of organic sales into retail markets during the period from 1997 to 2003; however, there is still a debate over the perceived quality advantage of organically grown fruits and vegetables. In a study focusing on commercial production of processing tomatoes, samples were analyzed from 4 growers with matched organic and conventional fields. For the 4 growers studied, individual analysis of variance results indicated that tomato juice prepared from organically produced tomatoes on some farms was significantly higher in soluble solids ( degrees Brix), higher in consistency, and titratable acidity, but lower in red color, ascorbic acid, and total phenolics content in the microwaved juice. Results were significantly different among specific growers, and this may be attributed to differences in soil type and soil nutrients, tomato cultivar, environmental conditions, or other production-related factors. Higher levels of soluble solids, titratable acidity, and consistency are desirable for the production of tomato paste, in that tomatoes with these attributes may be more flavorful and require less thermal treatment. This has the potential to result both in cost savings from less energy required in paste manufacture and potentially a higher quality product due to less thermal degradation of color, flavor, and nutrients. Future work may involve a larger number of commercial growers and correlation to controlled university research plots.

"Advanced Statistics From an Elementary Point of View." Journal of the American Statistical Association, 102(478), pp. 766–767

Background This study examines the portrayals of soft drinks in popular American movies as a potential vehicle for global marketing and an indicator of covert product placement. Methods We conducted a content analysis of America's top-ten grossing films from 1991 through 2000 that included portrayals of beverages (95 movies total). Coding reliabilities were assessed with Cohen's kappa, and exceeded 0.80. If there was at least one instance of branding for a beverage, the film was considered having branded beverages. Fisher's exact test was used to determine if soft drink portrayals were related to audience rating or genre. Data on the amount of time soft drinks appeared onscreen was log transformed to satisfy the assumption of normality, and analyzed using a repeated measures ANOVA model. McNemar's test of agreement was used to test whether branded soft drinks are as likely to appear or to be actor-endorsed compared to other branded beverages. Results Rating was not associated with portrayals of branded soft drinks, but comedies were most likely to include a branded soft drink (p = 0.0136). Branded soft drinks appeared more commonly than other branded non-alcoholic beverages (p = 0.0001), branded beer (p = 0.0004), and other branded alcoholic beverages (p = 0.0006). Actors consumed branded soft drinks in five times the number of movies compared to their consumption of other branded non-alcoholic beverages (p = 0.0126). About half the revenue from the films with portrayals of branded soft drinks come from film sales outside the U.S. Conclusion The frequent appearance of branded soft drinks provides indirect evidence that product placement is a common practice for American-produced films shown in the U.S. and other countries.

Tomato processors are increasingly interested in being able to predict whether tomatoes will peel well, and therefore, yield high-value processed tomatoes. We describe two statistical models for peeling applied to multiple years of data. One model is appropriate for perfect or defect-free tomatoes, and the second model is valid for the normal population of tomatoes obtained following mechanical harvesting. The ability to peel perfect tomatoes was significantly affected by exposure of tomatoes to temperatures greater than 100F, by fruit weight and by pericarp wall thickness. The peelability of a normal population of tomatoes was influenced by tomato weight and width as well as degree-days and exposure to temperatures greater than 90F. Thickness of the pericarp walls and red layer positively affected the peelability of normal tomatoes. The ability to predict tomato peelability using statistical models may improve the quality of processed tomatoes and may result in more efficient commercial peeling operations.

Objective: To determine the safety and efficacy of a dietary supplement with a low dose of ephedra and caffeine in overweight/obese premenopausal female subjects.Design: A 9-month, double-blind, randomized control study compared the efficacy and safety of a dietary supplement with ephedra and caffeine to a control supplement.Subjects: Sixty-one healthy, premenopausal women with body mass index (BMI) from 27 to 39 kg/m(2) were randomly assigned and received a dietary supplement (40 mg/day ephedra alkaloids, 100 mg/day caffeine, high potency mixture of vitamins, minerals, omega-3 fatty acids) or a control supplement for 9 months.Measurements: Efficacy: changes in body weight, body composition, lipids, insulin, leptin, adiponectin, ghrelin, and self-reports of physical activity, diet and quality of life indices. Safety: blood pressure, heart rate, electrocardiograms, urinalysis, blood histology, serum chemistry measures and self-reported symptoms.Results: Forty-one women completed the study. The treatment group lost significantly more body weight (-7.18 kg) and body fat (-5.33 kg) than the control group (-2.25 and -0.99 kg, respectively), and showed significant declines in heart rate, serum cholesterol, triglycerides, cholesterol to high-density lipoprotein ratio, glucose, fasting insulin, and leptin. Blood pressure, electrocardiograms, other clinical chemistry measures, blood histology, urinalysis, and self- reported physical activity were similar in the groups. Minor symptoms included dry mouth, insomnia, nervousness and palpitations. The treatment group reported more energy and decreased appetite compared to controls and scored higher on a quality of life domain assessing vitality.Conclusion: A dietary supplement containing a low potency ephedra/caffeine mixture appeared safe and effective in causing loss of weight and body fat, and improving several metabolic parameters, including insulin sensitivity and lipid profiles when tested under physician supervision. Such supplements could be a useful tool to assist with weight loss.

Primary biliary cirrhosis (PBC) is an autoimmune disease of unknown etiology, often associated with other autoimmune conditions. Controlled studies have so far provided conflicting data on risk factors and comorbidity rates in PBC. We enrolled patients with PBC (n = 1032) from 23 tertiary referral centers for liver diseases in the United States and random-digit-dialed controls (n = 1041) matched for sex, age, race, and geographical location. Patients and controls were administered a modified version of the US National Health and Nutrition Examination Study (NHANES III) questionnaire by trained personnel to evaluate associations between PBC and social, demographic, personal and family medical histories, lifestyle, and reproductive factors and the rates of comorbidity in affected individuals. Data indicate that having a first-degree relative with PBC (adjusted odds ratio [AOR] 10.736; 95% confidence interval 4.227-27.268), history of urinary tract infections (AOR 1.511, 95% CI 1.192-1.915), past smoking (AOR 1.569, 95% CI 1.292-1.905), or use of hormone replacement therapies (AOR 1.548, 95% CI 1.273-1.882) were significantly associated with increased risk of PBC. The frequent use of nail polish slightly increased the risk of having PBC. Other autoimmune diseases were found in 32% of cases and 13% of controls (P<0.0001). In conclusion, environmental factors, possibly including infectious agents through urinary tract infections or chemicals contained in cigarette smoke, may induce PBC in genetically susceptible individuals. Exogenous estrogens may also contribute to explain the female predominance of the disease.

OBJECTIVE:To determine the effect of a community hospital-wide program enabling nurses and prehospital personnel to mobilize institutional resources for the treatment of patients with nontraumatic shock.DESIGN:Historically controlled single-center study.SETTING:A 180-bed community hospital.PATIENTS:Patients in shock who were candidates for aggressive therapy.INTERVENTIONS:From January 1998 to May 31, 2000, patients in shock received standard therapy (control group). During the month of June 2000, intensive education of all health-care providers (ie, prehospital personnel, nurses, and physicians) took place. From July 1, 2000, through June 30, 2001, patients in shock (protocol group) were managed with a hospital-wide shock program. The program included early recognition of shock and the initiation of therapy by nonphysicians. Frontline personnel mobilized a shock team, which used goal-directed resuscitation protocols, early intensivist involvement, and rapid transfer to the ICU where protocols specific to shock etiology were implemented.MEASUREMENTS AND MAIN RESULTS:Eighty-six and 103 patients, respectively, were enrolled in the control and protocol groups. Baseline characteristics were similar. The protocol group had significant reductions in the median times to interventions, as follows: intensivist arrival, 2:00 h to 50 min (p < 0.002); ICU/operating room admission, 2 h 47 min to 1 h 30 min (p < 0.002); 2 L fluid infused, 3 h 52 min to 1 h 45 min (p < 0.0001); and pulmonary artery catheter placement, 3 h 50 min to 2 h 10 min (p 0.02). Good outcomes (ie, discharged to home or to a rehabilitation center) were more likely in the protocol group than in the control group (p = 0.02). The hospital mortality rate was 40.7% in the control group and 28.2% in the protocol group (p = 0.035).CONCLUSION:Similar to current practice in patients who have experienced trauma or cardiac arrest, the empowerment of nonphysician providers to mobilize hospital resources for the care of patients with shock is effective. A community hospital program incorporating the education of providers, the activation of a coordinated team response, and early goal-directed therapy expedited appropriate treatment and was temporally associated with improved outcomes. Randomized multicenter trials are needed to further assess the impact of the shock program on outcomes.