scholarly journals 1111 Do Sleep Disorder Symptom Endorsements Differ Between ADHD Subtypes?

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A422-A423
Author(s):  
M Seewald ◽  
A Muench ◽  
C Alio ◽  
B Rosenfield ◽  
R DiTomasso ◽  
...  
Keyword(s):  
Sleep Disorders ◽  
Sleep Disorder ◽  
Small Sample ◽  
Surveillance Study ◽  
Statistical Control ◽  
Chi Square ◽  
Sleep Complaints ◽  
Disorder Symptom ◽  
Small Sample Sizes ◽  
Age Range

Abstract Introduction To date, research on differences in sleep complaints between patients with different subtypes of ADHD has been mixed. On balance, the evidence tends towards ADHD-Combined Presentation (ADHD-C) being associated with more severe sleep and sleep-related daytime complaints than ADHD-Primarily Inattentive (ADHD-I). In order to further assess this issue a surveillance study was undertaken in an active ADHD clinic by adding a comprehensive sleep disorders screener (SDS-CL-25) to the clinical intake procedures. These data were used to ascertain whether the two subtypes differ for any of 13 sleep disorders symptoms. Methods Subjects (n = 132; 83 male, 49 female, mean age 32.8, age range 18-79), presenting to the clinic for evaluation for ADHD were given the SDS-CL-25. The SDS-CL-25 is a 25-item instrument developed to screen for multiple sleep disorders at one time (problems are endorsed on a Likert-scale; 0 = never and 4 = more than 5x/week). Endorsements greater than 3x/week were counted as positive for the symptom and less than three days per week was considered negative. Percent per group was compared using Chi Square Analyses. Cumulative morbidity means were also analyzed using t-tests. The subtype, ADHD-I (n=71) and ADHD-C (N=61), was established using EMR records. Results No significant differences between patients with ADHD-I and ADHD-C were detected. Conclusion The lack of finding in the present analysis may reflect a lack of difference or a failure to detect differences based on the small sample sizes or lack of statistical control for likely confounders (age, sex, illness severity or chronicity, SES status, etc.). Analyses are ongoing. Support No support was provided for this abstract.

Characterization of microsatellite instability (dMMR/MSI-H) and mutational landscape in a large contemporary cohort of upper tract urothelial cancer (UTUC) patients.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 465-465
Author(s):  
Arpit Rao ◽  
Julie Elaine McGrath ◽  
Joanne Xiu ◽  
Andre Luiz De Souza ◽  
Shuchi Gulati ◽  
...  
Keyword(s):  
Microsatellite Instability ◽  
Chromatin Remodeling ◽  
Statistical Significance ◽  
Small Sample ◽  
Biological Pathways ◽  
High Rate ◽  
Chi Square ◽  
Mutational Landscape ◽  
Comparison Results ◽  
Small Sample Sizes

465 Background: UTUC is a rare genitourinary malignancy and a number of studies, limited by small sample sizes, have attempted to characterize its mutational landscape. Because immunotherapy is commonly used for this disease type, we evaluated the prevalence of microsatellite instability and characterized the mutational landscapes of UTUC in a large contemporary patient cohort. Methods: UTUC tumor samples were analyzed using next generation sequencing (NGS) (NextSeq, 592 gene panel) or whole exome sequencing (WES) (NovaSeq) (Caris Life Sciences, Phoenix, AZ). Mismatch repair status (deficient [dMMR] or proficient [pMMR]) and microsatellite instability status (MSI-high or stable [MSS]) were detected by immunohistochemistry (IHC), fragment analysis, and NGS. Tumor mutational burden (TMB) was measured by counting all somatic mutations found per tumor (high cutoff ≥ 10 mutations per MB). PD-L1 expression was tested by IHC using PD-L1 antibody clones 22c3 (Agilent; positive cutoff CPS ≥ 10) and SP142 (Ventana; positive cutoff ≥ 5% IC). Pathogenic fusion events were detected using whole transcriptome sequencing (NovaSeq). Statistical significance was determined using the Chi-square test and adjusted for multiple comparison. Results: 538 patients with included – median (range) age 71.5 (30-89) years and 37.5% female/62.5% male. Prevalence of dMMR/MSI-H was 3.9% (21/538) and TMB-high was 22.7% (96/423). Significant molecular differences were not detected in primary vs metastatic disease or in male vs female cases. dMMR/MSI-H tumors had higher frequency of TMB-high compared to MSS tumors (100% vs. 19%, p = 0.00003). dMMR/MSI-H tumors also had a higher frequency than MSS tumors for mutations in genes involved in chromatin remodeling (ASXL 82.4%, CREBBP 60%, SMARCA4 40%, KMT2D 95%, ARIDIA 100%, KMT2A 20%, KMT2C 35.3%, NSD1 20%), DNA-damage repair (FANCG 10%, ATM 45%, ATRX 40%) and other biological pathways (RNF43 10%, PTCH1 21.4%, ERBB3 30%, CDKN2A 25%, TSC2 15%, FLNC 15%, HNF1A 20%, CIC 15%, DNMT3A 17.6%); all adjusted p < 0.05. Pathogenic fusions were detected in 3.8% (17/443) cases, with FGFR3 fusion being the most common, occurring in 2.7% (12/443) cases. PD-L1 positivity was identified in 33.2% (133/400) cases tested by 22c3 antibody and 28.4% (89/313) cases tested by SP142 antibody. No difference was seen in PD-L1 positivity between MSI-H/dMMR vs. MSS tumors. Conclusions: In the largest analysis to date, we found a 3.9% prevalence of dMMR/MSI-high rate in UTUC. All dMMR/MSI-H tumors displayed TMB-high. PD-L1 positivity was comparable between dMMR/MSI-H and MSS tumors. dMMR/MSI-H tumors had a significantly higher rate of mutations in genes involved in chromatin remodeling and DDR biological pathways. These results could inform design of targeted therapy trials in UTUC.

On the use of chi-square analyses in studies of resource utilization

1991 ◽  
Vol 21 (1) ◽  
pp. 58-65 ◽  
Author(s):  
Dennis E. Jelinski
Keyword(s):  
Resource Utilization ◽  
Goodness Of Fit ◽  
Small Sample ◽  
Homogeneity Test ◽  
Type I ◽  
Sample Sizes ◽  
Goodness Of Fit Test ◽  
Chi Square ◽  
Test Of Homogeneity ◽  
Small Sample Sizes

Chi-square (χ2) tests are analytic procedures that are often used to test the hypothesis that animals use a particular food item or habitat in proportion to its availability. Unfortunately, several sources of error are common to the use of χ2 analysis in studies of resource utilization. Both the goodness-of-fit and homogeneity tests have been incorrectly used interchangeably when resource availabilities are estimated or known apriori. An empirical comparison of the two methods demonstrates that the χ2 test of homogeneity may generate results contrary to the χ2 goodness-of-fit test. Failure to recognize the conservative nature of the χ2 homogeneity test, when "expected" values are known apriori, may lead to erroneous conclusions owing to the increased possibility of committing a type II error. Conversely, proper use of the goodness-of-fit method is predicated on the availability of accurate maps of resource abundance, or on estimates of resource availability based on very large sample sizes. Where resource availabilities have been estimated from small sample sizes, the use of the χ2 goodness-of-fit test may lead to type I errors beyond the nominal level of α. Both tests require adherence to specific critical assumptions that often have been violated, and accordingly, these assumptions are reviewed here. Alternatives to the Pearson χ2 statistic are also discussed.

scholarly journals 1183 Board-certified Sleep Medicine Physicians See A Greater Proportion Of Complex Sleep Patients Than Non-specialist Providers

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A452-A452
Author(s):  
S L Jobe ◽  
J S Albrecht ◽  
S M Scharf ◽  
A M Johnson ◽  
S Parthasarathy ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Sleep Disorders ◽  
Sleep Disorder ◽  
Sleep Medicine ◽  
Board Certification ◽  
Administrative Claims ◽  
Medicare Beneficiaries ◽  
Sleep Complaints ◽  
Obstructive Sleep ◽  
The Impact

Abstract Introduction Despite a growing literature regarding the impact of board-certification in sleep medicine, little is known about the complexity of patients seen by board-certified sleep medicine physicians (BCSMPs) relative to non-specialists. To address this gap, the purpose of the current study was to evaluate the differences in sleep complaints among Medicare beneficiaries seen by BCSMPs relative to individuals seen by non-specialists. Methods Our data source was a random 5% sample of Medicare administrative claims data from 2006-2013. Sleep disorders were operationalized using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Descriptive analyses were performed to estimate the number of sleep disorder diagnoses patients received by provider status. BCSMPs were identified using a cross-matching procedure based on National Provider Identifier (NPI). Results A total of 57,209 Medicare beneficiaries received a sleep disorder diagnosis between 2006-2013. Of these, only 2.2% were seen by BCSMPs. Relative to beneficiaries seen by non-specialists, those seen by BCSMPs were more likely to be diagnosed with more than one sleep disorder (p&lt;0.001). Specifically, 91.0% of individuals seen by non-specialists received only one sleep disorder diagnosis, whereas 75.9% of individuals seen by BCSMPs received only one sleep disorder diagnosis. Among beneficiaries seen by non-specialists, the most common sleep disorders were insomnia (48.2%; n=26,967), obstructive sleep apnea (OSA; 31.4%; n=17,554), and restless legs syndrome (8.7%; n=4,871). Among those seen by BCSMPs, the most common sleep disorders were OSA, (70.4%; n=901), sleep apnea with hypersomnia (16.5%; n=211), and insomnia (11.7%; n=150). Conclusion BCSMPs see more complex sleep patients than do non-specialists. These results suggest the possibility that more complex patients are referred for sleep specialty care. Further, these results demonstrate the value of board certification in sleep medicine in caring for complex sleep patients. Support This research was supported by an AASM Strategic Research Award from the AASM Foundation to the University of Maryland, Baltimore (PI: EMW).

scholarly journals 1109 Broadly Assessing Sleep Complaints In A Sample Of Patients With ADHD

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A422-A422
Author(s):  
M Seewald ◽  
C Alio ◽  
B Rosenfield ◽  
R DiTomasso ◽  
A L Muench ◽  
...  
Keyword(s):  
Sleep Disorders ◽  
Sleep Disturbances ◽  
A Priori ◽  
Sleep Onset ◽  
Sleep Complaints ◽  
Insomnia Disorder ◽  
Delayed Sleep Phase Disorder ◽  
Delayed Sleep Phase ◽  
Delayed Sleep ◽  
Age Range

Abstract Introduction It is commonly observed in clinical settings that patients with ADHD regularly present with comorbid “sleep disturbances”. In the absence of broad based sleep disorders assessments, it is thought that this represents Delayed Sleep Phase Disorder (DSPD). Recently, a surveillance study was undertaken in a university-based, outpatient specialty clinic for adults with ADHD, by adding a comprehensive sleep disorders screener (SDS-CL-25) to the clinical intake procedures. These data were used to ascertain which sleep disorders symptoms are common in this clinical cohort. Methods SDS-CL-25 data were collected in 150 subjects (93/57 male/female, mean age 32.8, age range 18-79). The SDS-CL-25 is a 25 item instrument developed to screen for 13 sleep disorders at one time (Sleep Dx symptoms are endorsed on Likert-scales; 0 [never] 4 [&gt;5x/week]). For the purposes of this study, the percentage of subjects endorsing frequent symptomatology (sum of the percent of endorsements for columns 3 & 4)was calculated per symptom. Sums of &gt;20% were considered, a priori, to be of clinical significance. Results Patients endorsed: increased fatigue (59%); SL or WASO or EMA’s &gt;30 minutes (40%; 26%; 21%, respectively); late preferred time to bed (31%); work & school limits sleep opportunity (30%); variable time to and out of bed (27%); and snoring (21%). The average percent endorsement was 15% (range 0-59%). Conclusion These results suggest that, consistent with clinical observations, adult patients diagnosed with ADHD frequently endorse late preferred time to bed, variable sleep wake schedules, work/school limitations on sleep opportunity, and sleep onset problems that are accompanied by daytime fatigue. This constellation of symptoms is consistent with the notion that patients with ADHD tend to have comorbid DSPD. The high prevalence of middle and late insomnia was unexpected and suggests that Insomnia Disorder (proper) may also be a feature of ADHD. Support No support was provided for this abstract.

scholarly journals Primary Monosymptomatic Nocturnal Enuresis in Children and Correlation with Sleep Disorders in Arak, Iran

2021 ◽  
Vol 19 (3) ◽  
Author(s):  
Maryam Khalajmehri ◽  
Parsa Yousefichaijan ◽  
Masoud Rezagholizamenjany ◽  
Bahman Salehi ◽  
Bahman Sadeghi-Sedeh ◽  
...  
Keyword(s):  
Sleep Disorders ◽  
Sleep Disorder ◽  
Nocturnal Enuresis ◽  
Sleep Disturbances ◽  
Control Group ◽  
Case Group ◽  
Healthy Children ◽  
Chi Square ◽  
Monosymptomatic Nocturnal Enuresis ◽  
Primary Monosymptomatic Nocturnal Enuresis

Background: Nocturnal enuresis is a symptom defined as enuresis in children over 5 years of age that might have mutual connection to sleep disturbances. This condition might be a stressful factor for children and their families. Objectives: This study aimed to find the correlation between primary monosymptomatic nocturnal enuresis (PMNE), as a stressful factor and sleep disorders. Methods: This case-control study was conducted on 132 children, including 66 children with nocturnal enuresis as the case group and 66 healthy children as the control group. The two groups were homogenous in age, gender, and other demographic characteristics. The organized sleep disorder questionnaire based on sleep disorder diagnostic criteria (using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) was used in this study. The correlation between PMNE and sleep disorders was investigated based on the Chi-square test on SPSS software (version 23). Results: The mean scores of the subjects with sleep disorders in the control and case groups were 0.38 ± 0.78 and 2.24 ± 1.73, respectively. Therefore, there were significant differences between the two groups in sleep disorders (P = 0.001). In addition, primary insomnia, hypersomnia, circadian sleep rhythm, and sleep terror disorders in the case group were higher than the control group (P = 0.001). Conclusions: The PMNE has been defined as a risk factor for sleep disorders.

Alternatives to the Chi-Square Test for Evaluating Rank Histograms from Ensemble Forecasts

2005 ◽  
Vol 20 (5) ◽  
pp. 789-795 ◽  
Author(s):  
Kimberly L. Elmore
Keyword(s):  
Goodness Of Fit ◽  
Small Sample ◽  
Chi Square ◽  
Ensemble Forecasts ◽  
Statistical Fluctuations ◽  
Rank Histogram ◽  
Anderson Darling ◽  
Discrete Uniform ◽  
Small Sample Sizes ◽  
Von Mises

Abstract Rank histograms are a commonly used tool for evaluating an ensemble forecasting system’s performance. Because the sample size is finite, the rank histogram is subject to statistical fluctuations, so a goodness-of-fit (GOF) test is employed to determine if the rank histogram is uniform to within some statistical certainty. Most often, the χ2 test is used to test whether the rank histogram is indistinguishable from a discrete uniform distribution. However, the χ2 test is insensitive to order and so suffers from troubling deficiencies that may render it unsuitable for rank histogram evaluation. As shown by examples in this paper, more powerful tests, suitable for small sample sizes, and very sensitive to the particular deficiencies that appear in rank histograms are available from the order-dependent Cramér–von Mises family of statistics, in particular, the Watson and Anderson–Darling statistics.

scholarly journals A-208 The Effect of Language on Invalid Baselines in ImPACT

2020 ◽  
Vol 35 (6) ◽  
pp. 1003-1003
Author(s):  
Kuwabara H ◽  
Grant K ◽  
Moore S ◽  
Maietta J ◽  
Kinsora T ◽  
...  
Keyword(s):  
Cognitive Abilities ◽  
Small Sample ◽  
Cognitive Testing ◽  
English Speakers ◽  
Group Differences ◽  
Language Abilities ◽  
Chi Square ◽  
Impact Performance ◽  
Baseline Testing ◽  
Small Sample Sizes

Abstract Objective The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a computerized assessment of cognitive abilities used for management of sport-concussion that has been translated into 22 languages. Research suggests that language of administration may affect ImPACT performance in bilingual individuals. This study examined the rate of invalid baselines in bilingual/monolingual athletes and in different languages of administrations to explore any potential language biases in ImPACT’s validity index. Methods Participants included 47,677 athletes (Mage = 15.11; 57.37% male) from across Nevada who completed a baseline assessment. There were 90 different languages reported among 10,798 bilingual athletes (22.65%). Chi-square analyses were conducted to examine group differences in rate of invalid baselines by language (monolingual/bilingual) and administration language. Results Overall, 6.2% of athletes produced invalid baselines. There were no significant differences in the rate of invalid baselines in self-reported monolingual (6.1%) and bilingual athletes (6.4%; p &gt; .05). There were 12 different languages of administration; however, due to small sample sizes of some administration languages, further analyses were only conducted with English and Spanish administrations. There were no significant differences in invalid baselines in English (6.2%) and Spanish administrations (7.3%; p &gt; .05). Additionally, among the bilingual Spanish/English speakers, there were no significant differences in invalid baselines in English (6.4%) and Spanish administrations (6.5%; p &gt; .05). Conclusion The current study demonstrates that rates of invalid baselines do not differ based on monolingualism/bilingualism or administration language. This is promising given the high demand for baseline testing, an increase in athletes’ diverse language abilities, and various available languages of ImPACT administration.

scholarly journals Medical Advisability of Youth Pitching Recommendations on the Internet

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110366
Author(s):  
David F. Painter ◽  
James H. Dove ◽  
Kristina Monteiro ◽  
Peter K. Kriz ◽  
Brett D. Owens
Keyword(s):  
Cross Sectional Study ◽  
Small Sample ◽  
Chi Square ◽  
Cross Sectional ◽  
Exact Test ◽  
Content Quality ◽  
Internet Information ◽  
Small Sample Sizes ◽  
Website Content ◽  
Google Search

Background: As the incidence of youth pitching injuries and surgical procedures attributed to overuse has drastically increased, there are quality concerns about popular internet resources regarding arm care for youth pitchers. Purpose/Hypothesis: To assess the medical advisability of online arm care recommendations for youth pitchers. It was hypothesized that websites contain misleading arm-care information that is discordant with medical advice. Study Design: Cross-sectional study. Methods: We reviewed the first 100 websites populated after a Google search for youth pitching recommendations. Websites were categorized by type (athletic organization, commercial, or educational) and content quality (medically advisable, discordant, or neutral), the latter with respect to the Pitch Smart guidelines used by Major League Baseball. Chi-square tests of independence and z tests of independent proportions were used to compare column proportions among categories of website content quality for each type of website source. Given the small sample sizes in some instances, the Fisher-Freeman-Halton exact test was performed to assess the relationship between website source type and quality of information. Results Of the 99 qualifying websites, 76 were categorized as medically advisable, 16 as discordant, and 7 as neutral. In addition, 92% of educational websites and 94.7% of athletic organization websites featured exclusively advisable content, whereas only 54.8% of commercial websites were advisable. Of the 16 discordant websites, 15 were commercial sites. Educational websites were significantly more advisable and neutral in content when compared with discordant information, while commercial websites were significantly predictive of discordant content. Among the first 50 websites populated according to Google, 42 (84%) were advisable, 6 (12%) discordant, and 2 (4%) neutral. The remaining websites (n = 49) featured 34 (69.4%) that were advisable, 10 (20.4%) discordant, and 5 (10.2%) neutral. Conclusion: Study findings indicated that websites of an educational nature are predictive of medically advisable content, while commercial websites (eg, blogs) are associated with discordant information. The abundance and availability of inaccurate internet information should be appreciated by medical professionals and parents/coaches of youth baseball players.

scholarly journals Prevalence of Sleep Disorders among Epileptic Children Referring To Emam-Reza Clinic and Comparing With Non-Epileptic Group during 2013-2014

2021 ◽  
Author(s):  
Sorour Inaloo ◽  
Zahra GHanavatipour
Keyword(s):  
Sleep Disorders ◽  
Case Control Study ◽  
Linear Regression Analysis ◽  
World Population ◽  
Seizure Duration ◽  
Chi Square ◽  
Epileptic Children ◽  
Chi Square Test ◽  
Age Range ◽  
Control Study

Introduction: The prevalence of sleep disorders are 15-42 percent in world population. Sleep disorders can be the result of physical, psychological and environmental factors. The prevalence of these disorders is higher in epileptic children. The aim of this study was identifying the rapid diagnosis of sleep disorders in epileptic children in order to reduce the disease problems. Methods: In this case-control study, 160 children in the age range of 4-16 with epilepsy and sleep disorders were evaluated. In order to data analysis SPSS version 16, chi-square test; quantitative data, Mann-Whitney non-parametric test were used. Linear regression analysis was used to determine the effect of seizure variables on the severity of sleep disorders criteria. Results: Our results indicated that the incidence of sleep disorders are significantly higher among epileptic children compared to non-epileptic ones (p<0.05). In addition, we observed a significant correlation among some seizure variables such as etiology (p<0.003), response (p<0.01), abnormal EEG (p<0.003), abnormal MRI and CT (p<0.003), age (p<0.003), seizure duration (p<0.002) and sex (p<0.04) with the incidence of sleep disorders. Conclusion: Some of the epileptic variables, which have a significant correlation with the prevalence of sleep disorders can be considered as the possible parameters for predicting faster sleep disorders in children with epilepsy. Detection of sleep disorders in these children can reduce their problems.

Comparison of the Mantel-Haenszel Test With a Randomized and a Jackknife Test for Detecting Biased Items

1990 ◽  
Vol 15 (1) ◽  
pp. 53-67 ◽  
Author(s):  
Gregory Camilli ◽  
Jeffrey K. Smith
Keyword(s):  
Total Sample ◽  
Randomization Test ◽  
Small Sample ◽  
Reference Groups ◽  
Chi Square ◽  
Jackknife Test ◽  
Significance Levels ◽  
Chi Square Test ◽  
Small Sample Sizes ◽  
Haenszel Test

The Mantel-Haenszel (MH) chi-square test has been shown to have desirable statistical properties in detecting biased items. However, small sample sizes are still of concern, especially when large differences in ability exist between the focal and reference groups. This is because the accuracy and power of the MH test depends on the range of overlap between the focal and reference groups on raw scores, as well as the total sample size at any particular raw score. The MH procedure is compared with (a) a randomization test and (b) a jackknife test, which make weaker distributional assumptions. The MH chi-square significance levels were found to be extremely robust.

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