Statistical examination to determine whether only 48-h value for serum concentration during high-dose methotrexate therapy is a predictor for clinical adverse events using ordered logistic regression analysis

Abstract Background and Aims High dose Methotrexate (HDMTX) is an important component of several modern oncological/haematological treatment protocols due to its central nervous system penetrance. Nephrotoxicity represents a significant adverse effect and can limit therapeutic options. Therefore, strategies to prevent this are paramount. Urinary alkalinisation and large volume resuscitation to maintain adequate hydration and urine output are the typical strategies. Urinary alkalinisation prevents tubular precipitation of methotrexate and therefore, a strict urinary pH target of 7 is maintained via a continuous bicarbonate infusion. Method We describe a case report, of Iatrogenic metabolic alkalosis leading to respiratory compromise in a patient receiving HDMTX from Mayo Clinic, Rochester. Results We present the case of a 76-year-old woman with a Diffuse Large B-Cell Lymphoma with CNS involvement who presented for elective admission for her 1st cycle of HDMTX. She received 7g of Methotrexate at dosing of 8 g/m2. She received the standard urinary alkalinisation with pre- and post-hydration. Her baseline HCO3- was 28 mEq/L. Her 48 hour MTX level was elevated at 1.2 so the urinary alkalinisation protocol was continued until <0.1 mcmol/L. On day 4, she developed frequent episodes of apnoea. Her ABG demonstrated a metabolic alkalaemia pH 7.54, pCO 53, pO2 91, HCO3 45. She was transferred to the ICU for close monitoring. Her bicarbonate infusion was discontinued and she received acetazolamide. Her bicarbonate improved to 31 after 12 hours. She had a significant improvement in her respiratory status with no further episodes of apnoea. Her bicarbonate infusion was restarted due to elevated MTX levels. She was discharged home with no further complications. Conclusion Iatrogenic Metabolic alkalosis leading to respiratory compromise represents a rare but important complication of urinary alkalinsation protocols for High-dose Methotrexate therapy.

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Trust in police as an influencing factor on trust in government: 2SLS analysis using perception of safety

Policing An International Journal of Police Strategies and Management ◽

10.1108/pijpsm-11-2019-0172 ◽

2020 ◽

Vol 43 (4) ◽

pp. 541-558

Author(s):

Jisu Jeong ◽

Seunghui Han

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Trust In Government ◽

Content Type ◽

Perception Of Safety ◽

Ordered Logistic Regression ◽

The Impact ◽

The Relationship ◽

Trust In Police

PurposeCitizen trust in police is important in terms of citizen consent to government policies and of police achieving their organizational goals. In the previous study, improvements in police policy, organizational operation and policing activities were developed to clarify which factors influence trust in police and how trust can be improved. This research raises the question, would changes in trust in police have an impact on trust in government? In this paper, this research question is discussed theoretically and the causal relationship analyzed empirically by applying OLS, ordered logistic, 2SLS and logistic regressions.Design/methodology/approachThe basic analysis methods are to apply the OLS and the ordered logistic regression. OLS regression analysis is an analytical method that minimizes an error range of a regression line. The assumptions for OLS are: linearity, independence, equilibrium, extrapolation and multicollinearity issues. These problems were statistically verified and analyzed, in order to confirm the robustness of the analysis results by comparing the results of the ordered logistic regression because of the sequence characteristic of the dependent variable. The data to be used in this study is the Asia Barometer Survey in 2013.FindingsTrust in police and citizen perception of safety are analyzed as important factors to increase trust in the government. The effects of trust in police are more significant than the effects of control variables, and the direction and strength of the results are stable. The effect of trust in police on trust in government is strengthened by the perception of safety (IV). In addition, OLS, ordered logistic regression analysis, which analyzed trust in central government and local government, and logistic regression analysis categorized by trust and distrust show the stability.Research limitations/implicationsThis paper has implications in terms of theoretical and empirical analysis of the relationship between trust in police and trust in government. In addition, the impact of perception of safety on trust in police can be provided to police officers, policymakers and governors who are seeking to increase trust in government. This paper is also meaningful in that it is the microscopic research based on the citizens' survey. One of the limitations of macroscopic research is that it does not consider the individual perceptions of citizens.Practical implicationsThe results of this paper can confirm the relationship of the virtuous cycle, which is perception of safety – trust in police – trust in government. The police will need to provide security services to improve citizens' perception of safety and make great efforts to create safer communities and society. Trust in police formed through this process can be an important component of trust in government. By making citizens feel safer and achieving trust in police, ultimately, trust in government will be improved.Originality/valueThe police perform one of the essential roles of government and are one of the major components of trust in government, but the police sector has been neglected compared to the roles of the economic and political sectors. These influences of macro factors are too abstract to allow specific policy directions to be suggested. If we consider trust in police, and factors that can improve trust in government, we can suggest practical policy alternatives.

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