Transition to Independent Surgical Practice and Burnout Among Early Career General Surgeons

Background: The transition from surgical residency to independent practice is a challenging period that has not been well studied. Methods: An email invitation to complete a 55-item survey and the Maslach Burnout Inventory–Human Services Survey (MBI-HSS) was sent to early career general surgeons across Canada. The chi-square test or Fisher’s exact test was used to compare demographic and survey characteristics with burnout. Multivariable logistic regression was performed. Results: Of the 586 surgeons contacted, 88 responded (15%); 51/88 surgeons (58.0%) were classified as burnt out according to the MBI-HSS. Most surgeons (68.2%) were not confident in their abilities to handle the business aspect of practice. The majority (60.2%) believed that a transition to independent practice program would be beneficial to recent surgical graduates. Conclusions: Our data showed high prevalence of burnout among recently graduated general surgeons across Canada. Further, respondents were not confident in their managerial and administrative skills required to run a successful independent practice.

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Abstract W MP61: Prevalence of Echocardiographic Abnormalities in Acute Ischemic Stroke

Stroke ◽

10.1161/str.45.suppl_1.wmp61 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Bryan Eckerle ◽

Heidi Sucharew ◽

Kathleen Alwell ◽

Charles J Moomaw ◽

Matthew Flaherty ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Clinical Decision Making ◽

Retrospective Chart Review ◽

Clinical Decision ◽

Imaging Method ◽

Chi Square ◽

Exact Test ◽

High Prevalence ◽

Chi Square Test

Introduction: Non-invasive cardiac imaging is an important tool in evaluation of acute ischemic stroke, as a cardiac source can be implicated in approximately 20% of cases. However, the preferred imaging method is unclear due in part to the lack of consistent data regarding the yield of the two most commonly employed modalities, transthoracic and transesophageal echocardiography (TTE and TEE). Here we examine, in a large, biracial population, the prevalence of abnormalities detected by echocardiography during evaluation of acute ischemic stroke. Methods: Acute ischemic stroke cases were identified from a population of 1.3 million in the Greater Cincinnati area in 2005. Medical history and echocardiography results were determined by retrospective chart review. Echocardiographic abnormalities were pre-defined based on possibility of change in clinical decision making. All cases were abstracted by study nurses and subsequently verified by study physicians. Results were stratified by cardiac history and choice of echocardiographic technique; groups were compared using chi-square test or Fisher’s Exact test. Results: There were 2197 hospital-ascertained ischemic stroke cases in 2005. Median age was 73 (IQR 61-81), 22% were black, and 55% were female. TTE was performed in 68% of cases; TEE was performed in 7%. TEE revealed at least one abnormality in 55% of cases with cardiac history and 32% of cases without (Table). Yield of TTE was 20% in cases with cardiac history and 3% in cases without. Discussion: TEE is of considerable yield in selected patients, irrespective of cardiac history. This is in keeping with prior cost-effectiveness analyses recommending TEE alone for patients in whom suspicion of occult source of cardiac embolism is high. Prevalence of abnormalities on TTE in this population is similar to that of previously published series.

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Comparison of Clinical Outcomes With Drug Coated Balloons Versus Plain Balloon Angioplasty In Chronic Limb-Threatening Ischemia

Vascular and Endovascular Surgery ◽

10.1177/15385744211022598 ◽

2021 ◽

pp. 153857442110225

Author(s):

Joel Mathew John ◽

Vimalin Samuel ◽

Dheepak Selvaraj ◽

Prabhu Premkumar ◽

Albert A Kota ◽

...

Keyword(s):

Clinical Outcomes ◽

Interventional Procedure ◽

Tertiary Care ◽

Arterial Disease ◽

Multivariable Logistic Regression Analysis ◽

Tertiary Care Centre ◽

Chi Square ◽

Exact Test ◽

Institutional Review ◽

Chi Square Test

Objective: The use of drug coated balloon (DCB) for angioplasty has shown superior efficacy against plain balloons for treating complex infrainguinal arterial disease. We report and compare the clinical outcomes following application of DCB(Paclitaxel) and plain angioplasty (POBA) in our tertiary care centre. Methods: A retrospective, single centre analysis of 301 patients with chronic limb-threatening ischemia involving the infrainguinal segment was conducted between September 2014 and September 2018, after approval from the Institutional review board. We analyzed clinical outcomes by measuring postoperative ABI improvement, restenosis requiring reintervention procedure, minor and major amputations at the end of 18 months. . To find the association between the group variables (POBA and DCB) and other risk variables, Chi-square test/Fisher’s exact test was used. Multivariable logistic regression analysis was used. Results: Patients who underwent treatment with plain balloon (POBA) and DCB(Paclitaxel) angioplasty were 246(81.7%) and 55(18.3%) respectively. Our study group was predominantly male (Male: Female = 6.7:1), most patients were more than 50 years of age (n = 251, 83.4%). Smoking (n = 199, 66.1%) and diabetes (n = 210, 69.8%) were the most common atherosclerotic risk factors. Postoperative Ankle Brachial Pressure Index (ABI) improvement were similar in both groups (POBA = 57.7%; DCB = 69.8%; p = 0.103). Minor and major amputations following POBA were 26% and 22%; and DCB were 12.7% and 16.4% respectively. Re-stenosis requiring a re-interventional procedure within 18 months was 15%, (n = 37) following POBA; and 12.7% (n = 7) following DCB (p = 0.661). Conclusions: This retrospective study shows similar clinical limb related outcomes following POBA and DCB at 18 months. However, our comparative analysis between the POBA and DCB groups was totally unadjusted and not adjusted for common confounders such as age and sex. Hence, for one to draw definitive conclusions leading to changes in clinical practice; a randomized, prospective study with a larger patient cohort is needed.

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MRI of the Entire Spinal Cord—Worth the While or Waste of Time? A Retrospective Study of 74 Patients with Multiple Sclerosis

Diagnostics ◽

10.3390/diagnostics11081424 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1424

Author(s):

Esben Nyborg Poulsen ◽

Anna Olsson ◽

Stefan Gustavsen ◽

Annika Reynberg Langkilde ◽

Annette Bang Oturai ◽

...

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Cervical Spinal Cord ◽

Brain Mri ◽

Anatomical Location ◽

Spinal Cord Lesions ◽

Chi Square ◽

Exact Test ◽

Mcdonald Criteria ◽

Chi Square Test

Spinal cord lesions are included in the diagnosis of multiple sclerosis (MS), yet spinal cord MRI is not mandatory for diagnosis according to the latest revisions of the McDonald Criteria. We investigated the distribution of spinal cord lesions in MS patients and examined how it influences the fulfillment of the 2017 McDonald Criteria. Seventy-four patients with relapsing-remitting MS were examined with brain and entire spinal cord MRI. Sixty-five patients received contrast. The number and anatomical location of MS lesions were assessed along with the Expanded Disability Status Scale (EDSS). A Chi-square test, Fischer’s exact test, and one-sided McNemar’s test were used to test distributions. MS lesions were distributed throughout the spinal cord. Diagnosis of dissemination in space (DIS) was increased from 58/74 (78.4%) to 67/74 (90.5%) when adding cervical spinal cord MRI to brain MRI alone (p = 0.004). Diagnosis of dissemination in time (DIT) was not significantly increased when adding entire spinal cord MRI to brain MRI alone (p = 0.04). There was no association between the number of spinal cord lesions and the EDSS score (p = 0.71). MS lesions are present throughout the spinal cord, and spinal cord MRI may play an important role in the diagnosis and follow-up of MS patients.

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1591. Antibiotic Utilization Trends in Veterans Affairs (VA) Patients with Carbapenem Resistant Enterobacteriaceae (CRE) Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1771 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S792-S792

Author(s):

Alfredo Traversa ◽

Linda Poggensee ◽

Geneva M Wilson ◽

Katie J Suda ◽

Charlesnika T Evans ◽

...

Keyword(s):

Treatment Options ◽

Blood Stream ◽

Chi Square ◽

Blood Stream Infections ◽

Exact Test ◽

Carbapenem Resistant ◽

Extended Spectrum ◽

New Antibiotics ◽

Chi Square Test ◽

Carbapenem Resistant Enterobacteriaceae

Abstract Background Carbapenem-resistant Enterobacteriaceae (CRE) are classified as an “urgent threat” to public health. Historically, colistin and tigecycline had been considered the drugs of choice for CRE infections, while other agents such as aminoglycosides and carbapenems had been used as adjunctive therapy. However, the FDA approval of ceftazidime-avibactam in 2015, meropenem-vaborbactam in 2017, and plazomicin in 2018 has expanded treatment options. Our purpose was to assess trends in CRE treatment for “new” antibiotics (ceftazidime-avibactam, meropenem-vaborbactam, plazomicin) as compared with other antibiotics with CRE activity. Methods This was a retrospective cohort study describing treatment of CRE blood stream infections (BSI) across 134 VA facilities from 2012-2018. Patients were censored at their first positive blood culture with CRE. Categorical data was assessed with a Fisher’s exact test or chi-square test. Trends test and logistic regression were used to describe changes in CRE treatment over time. Results 724 patients with positive blood cultures for CRE were identified during the study period. Most patients were male (94%), white (32%) or Hispanic (38%), and the mean age was 71.5+11.9. Of those patients that received antibiotics (N=697), 53.4% carbapenems, 40.3% received aminoglycosides, 39.3% received polymyxins, 32.9% penicillins, 32.6% extended spectrum cephalosporins, 26.1% fluoroquinolones, 11.6% ceftazidime/avibactam, and 0.4% ceftolazone/tazobactam. Over the study period, there was decreased utilization of aminoglycosides (P < 0.0026) and colistin (P< 0.002) and increases in extended spectrum cephalosporins (P < 0.001) and ceftazidime/avibactam (P < 0.001). Conclusion Utilization of “older” agents such as aminoglycosides and polymyxins for the treatment of CRE blood stream infections is decreasing in the VA. Treating CRE with ceftazidime/avibactam, a newly approved antibiotic, and extended spectrum cephalosporins are increasing. Disclosures All Authors: No reported disclosures

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Association of cervical carcinogenesis risk with HPV16 E6 and E7 variants in the Taizhou area, China

BMC Cancer ◽

10.1186/s12885-021-08531-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mei-Zhen Dai ◽

Yi Qiu ◽

Xing-Hong Di ◽

Wei-Wu Shi ◽

Hui-Hui Xu

Keyword(s):

Cervical Cancer ◽

Cervical Carcinogenesis ◽

Chi Square ◽

Major Health Problem ◽

Hpv16 E6 ◽

Exact Test ◽

Chi Square Test ◽

E6 And E7

Abstract Background Human papillomavirus (HPV) type 16 accounts for a larger share of cervical cancer and has been a major health problem worldwide for decades. The progression of initial infection to cervical cancer has been linked to viral sequence properties; however, the role of HPV16 variants in the risk of cervical carcinogenesis, especially with longitudinal follow-up, is not fully understood in China. Methods We aimed to investigate the genetic variability of HPV16 E6 and E7 oncogenes in isolates from cervical exfoliated cells. Between December 2012 and December 2014, a total of 310 single HPV16-positive samples were selected from women living in the Taizhou area, China. Sequences of all E6 and E7 oncogenes were analysed by PCR-sequencing assay. Detailed sequence comparison, genetic heterogeneity analyses and maximum-likelihood phylogenetic tree construction were performed with BioEdit Sequence Alignment Editor and MEGA X software. Data for cytology tests and histological diagnoses were obtained from our Taizhou Area Study with longitudinal follow-up for at least 5 years. The relationship between HPV16 variants and cervical carcinogenesis risk was analysed by the chi-square test or Fisher’s exact test. Results In this study, we obtained 64 distinct variation patterns with the accession GenBank numbers MT681266-MT681329. Phylogenetic analysis revealed that 98.3% of HPV16 variants belong to lineage A, in which the A4 (Asian) sublineage was dominant (64.8%), followed by A2 (12.1%), A1 (11.4%), and A3 (10.0%). The A4 (Asian) sublineage had a higher risk of CIN2+ than the A1–3 (European) sublineages (OR = 2.69, 95% CI = 1.04–6.97, P < 0.05). Furthermore, nucleotide variation in HPV16 E6 T178G is associated with the development of cervical cancer. Conclusion These data could provide novel insights into the role of HPV16 variants in cervical carcinogenesis risk in China.

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Hardy-Weinberg Testing for Continuous Data

Genetics ◽

10.1093/genetics/147.4.1965 ◽

1997 ◽

Vol 147 (4) ◽

pp. 1965-1975

Author(s):

Lauren M McIntyre ◽

B S Weir

Keyword(s):

Intraclass Correlation ◽

Kernel Density ◽

Variable Number ◽

Continuous Data ◽

Test Statistic ◽

Test Procedures ◽

Chi Square ◽

Exact Test ◽

Chi Square Test ◽

The Many

Abstract Estimation of allelic and genotypic distributions for continuous data using kernel density estimation is discussed and illustrated for some variable number of tandem repeat data. These kernel density estimates provide a useful representation of data when only some of the many variants at a locus are present in a sample. Two Hardy-Weinberg test procedures are introduced for continuous data: a continuous chi-square test with test statistic TCCS and a test based on Hellinger's distance with test statistic TCCS. Simulations are used to compare the powers of these tests to each other and to the powers of a test of intraclass correlation TIC, as well as to the power of Fisher's exact test TFET applied to discretized data. Results indicate that the power of TCCS is better than that of THD but neither is as powerful as TFET. The intraclass correlation test does not perform as well as the other tests examined in this article.

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Leadership and Motivation as Important Aspects of the International Company’s Corporate Culture

Sustainability ◽

10.3390/su13073916 ◽

2021 ◽

Vol 13 (7) ◽

pp. 3916

Author(s):

Ingrida Košičiarová ◽

Zdenka Kádeková ◽

Peter Štarchoň

Keyword(s):

Corporate Culture ◽

Rank Correlation ◽

Chi Square ◽

Exact Test ◽

Main Research ◽

Leadership Motivation ◽

Kendall Rank Correlation ◽

Friedman's Test ◽

Chi Square Test

Although the issue of corporate culture has been taken over and addressed in the literature from various perspectives, there are very few researchers about the role of leadership and motivation in it, respectively very few researchers have addressed them as important components of the international company’s corporate culture. The present paper aims to point out that leadership and motivation can be perceived as important aspects of the international company’s corporate culture. The object of the investigation was an international company (situated in Italy) and its five subsidiaries (situated in Italy, Czech Republic, Germany, and Turkey). As the main research method, there was chosen the method of the questionnaire survey, which was attempted by all the company’s employees (totally 270 respondents). The questionnaire was divided into three separate, but logically related parts—leadership, motivation, and corporate culture, and submitted to two groups of respondents—the company’s management and its employees. In total 11 hypotheses were formulated and further evaluated by the methods of Pearson Chi-square Test, Fisher’s Exact Test, Cramer’s V coefficient, Kendall rank correlation coefficient, Eta coefficient, Spearman coefficient, Mann–Whitney U test and Wilcoxon W statistics, Kruskal–Wallis test, and Friedman’s test. The results of the research have proven that leadership and motivation are important parts of the corporate culture.

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F-Test Alternatives to Fisher’s Exact Test and to the Chi-Square Test of Homogeneity in 2 × 2 Tables

Journal of Educational Statistics ◽

10.3102/10769986008001059 ◽

1983 ◽

Vol 8 (1) ◽

pp. 59-73 ◽

Cited By ~ 1

Author(s):

John E. Overall ◽

Robert R. Starbuck

Keyword(s):

Beta Distribution ◽

Binary Response ◽

Binomial Model ◽

Chi Square ◽

Exact Probability ◽

Exact Test ◽

Mutual Dependence ◽

Treatment Groups ◽

Test Of Homogeneity ◽

Chi Square Test

A binomial model is proposed for testing the significance of differences in binary response probabilities in two independent treatment groups. Without correction for continuity, the binomial statistic is essentially equivalent to Fisher’s exact probability. With correction for continuity, the binomial statistic approaches Pearson’s chi-square. Due to mutual dependence of the binomial and F distributions on the beta distribution, a simple F statistic can be used for computation instead of the binomial.

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Association between tumor mutational burden (TMB) and immune-related adverse events (irAEs) in patients (pts) with metastatic urothelial carcinoma (mUC) during checkpoint immunotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.6_suppl.489 ◽

2021 ◽

Vol 39 (6_suppl) ◽

pp. 489-489

Author(s):

Elie W. Akl ◽

Pier Vitale Nuzzo ◽

Elio Adib ◽

Amin Nassar ◽

Sarah Abou Alaiwi ◽

...

Keyword(s):

Sequencing Data ◽

Chi Square ◽

P Values ◽

Exact Test ◽

Radiological Data ◽

Tumor Mutational Burden ◽

Chi Square Test ◽

Metastatic Urothelial Carcinoma ◽

Multivariable Regression ◽

The Relationship

489 Background: Immune checkpoint inhibition (ICI) has greatly improved clinical outcomes for pts with mUC and other cancers. ICI is associated with a class of AEs, deemed irAEs due to immune activation. Nonetheless, biomarkers associated with irAE are still lacking. We hypothesized that the immune response against neoantigens is partly responsible for irAEs and investigated the association between irAEs, TMB and response to ICI. Methods: We identified patients with mUC at Dana Farber Cancer Institute who were treated with ICI (monotherapy or combination) and had available tumor sequencing data through Oncopanel. TMB was calculated using the number of non-synonymous exonic mutations per megabase. The severity of irAEs was graded using CTCAE v.5.0. Mann-Whitney U test was performed to identify association between TMB, incidence and grade of irAEs. A cut-off of 10/mb was assigned for TMB. Fisher’s exact test was used to evaluate the radiologic response between pts with and without irAEs and low vs. high TMB. Multivariable linear regression was used to assess the relationship between TMB, irAEs and response. p-values were adjusted using Benjamini-Hochberg method. Results: Of 101 pts with mUC who met the inclusion criteria, 32 (32%) reported irAEs. 6 (6%) were grade (G)1, 20 (20%) were G2, and 6 (6%) were G3. Median(m) time on therapy was 84 days for pts without irAEs and 88 days for pts with irAEs. Pts with irAEs had higher mTMB (15.4/mb) compared to pts with no irAEs (9.8) ( p = 0.01). In pts on monotherapy (93), those with irAEs (n=27) had a higher mTMB (15.13/mb) compared to pts with no irAEs (n=66) (mTMB = 10.20/mb) ( p = 0.01). Out of 94 pts with radiological data, response was achieved in 16 (50%) pts with irAE vs 10 (16%) pts with no irAE ( p < 0.001). When both irAE and response were included in a multivariable regression, the association between irAE and TMB was not significant ( p = 0.4). Pts with both irAE and high TMB had a response rate of 56% which was significantly higher than those with either irAE but low TMB (28.6%) or high TMB but no irAE (21.2 %) or low TMB and no irAE (10.3%) (Chi-square test p = 0.002; FDR corrected p-values for individual comparisons in Table). There was no association between TMB and irAE grade. Conclusions: Higher TMB was associated with higher incidence of irAEs in pts with mUC on ICIs. Moreover, pts with both high TMB and irAEs exhibited better response rates than those with only high TMB or irAEs, suggesting that they may provide complementary tumor and host characteristics. Further evaluation in mUC is needed to confirm this relationship between TMB, irAEs and response in a larger cohort and explore specific mutational signatures that may be associated with irAEs. [Table: see text]

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Association between Food Intake and Overweight in Children Assisted by Primary Care

The Open Nursing Journal ◽

10.2174/1874434602115010305 ◽

2021 ◽

Vol 15 (1) ◽

pp. 305-312

Author(s):

Erivelton Sousa Lima ◽

Amanda de Castro Amorim Serpa Brandão ◽

Antonio Luiz Gomes Junior ◽

Luana kelle Batista Moura ◽

Gerardo Vasconcelos Mesquita ◽

...

Keyword(s):

Primary Care ◽

Food Intake ◽

Food Consumption ◽

Cross Sectional Study ◽

Processed Foods ◽

Food Groups ◽

Chi Square ◽

Cross Sectional ◽

Exact Test ◽

Chi Square Test

Background: The child feed in the first two years of life is of fundamental importance for a healthy growth and development. Aims: To verify the association between food consumption indicators and overweight in children under the age of two, followed up by primary care health professionals. Methods: A cross-sectional study was conducted on 232 children assisted by primary care. A structured questionnaire was used with questions on sociodemographic data of mothers or guardians and food intake and anthropometric data of children. The analysis of the association between excess weight and food intake indicators was performed using the Pearson’s chi-square test (χ2) and Fisher’s exact test (f ˂ 5). Results: Regarding food intake in children under 6 months of age, 35.1% of the children were exclusively breastfed. Among children at the age of 6 to 23 months: 66.3% were on continued breastfeeding; 16.7% consumed adequate foods at the age of 6 to 8 months; 90.4% consumed foods that belonged to the six food groups; 76.3% consumed food at the minimum frequency and with adequate consistency; 88.9% consumed iron-rich and vitamin A-rich foods, and 59.3% consumed ultra-processed foods. Regarding nutritional status, 24.5% of the children were overweight. Conclusion: There was no statistically significant association between overweight and food consumption indicators among the surveyed children. However, exclusive breastfeeding was below the recommended level, a low percentage of the introduction of complementary foods at the appropriate age and high consumption of ultra-processed foods reveal the need to improve the assistance provided by primary care to this group.

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