Category: Nevin Manimala

BMC Med Res Methodol. 2023 Jan 25;23(1):23. doi: 10.1186/s12874-023-01845-4.

ABSTRACT

BACKGROUND: Multivariate longitudinal data are under-utilized for survival analysis compared to cross-sectional data (CS – data collected once across cohort). Particularly in cardiovascular risk prediction, despite available methods of longitudinal data analysis, the value of longitudinal information has not been established in terms of improved predictive accuracy and clinical applicability.

METHODS: We investigated the value of longitudinal data over and above the use of cross-sectional data via 6 distinct modeling strategies from statistics, machine learning, and deep learning that incorporate repeated measures for survival analysis of the time-to-cardiovascular event in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort. We then examined and compared the use of model-specific interpretability methods (Random Survival Forest Variable Importance) and model-agnostic methods (SHapley Additive exPlanation (SHAP) and Temporal Importance Model Explanation (TIME)) in cardiovascular risk prediction using the top-performing models.

RESULTS: In a cohort of 3539 participants, longitudinal information from 35 variables that were repeatedly collected in 6 exam visits over 15 years improved subsequent long-term (17 years after) risk prediction by up to 8.3% in C-index compared to using baseline data (0.78 vs. 0.72), and up to approximately 4% compared to using the last observed CS data (0.75). Time-varying AUC was also higher in models using longitudinal data (0.86-0.87 at 5 years, 0.79-0.81 at 10 years) than using baseline or last observed CS data (0.80-0.86 at 5 years, 0.73-0.77 at 10 years). Comparative model interpretability analysis revealed the impact of longitudinal variables on model prediction on both the individual and global scales among different modeling strategies, as well as identifying the best time windows and best timing within that window for event prediction. The best strategy to incorporate longitudinal data for accuracy was time series massive feature extraction, and the easiest interpretable strategy was trajectory clustering.

CONCLUSION: Our analysis demonstrates the added value of longitudinal data in predictive accuracy and epidemiological utility in cardiovascular risk survival analysis in young adults via a unified, scalable framework that compares model performance and explainability. The framework can be extended to a larger number of variables and other longitudinal modeling methods.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00005130, Registration Date: 26/05/2000.

PMID:36698064 | DOI:10.1186/s12874-023-01845-4

J Digit Imaging. 2023 Jan 25. doi: 10.1007/s10278-023-00781-5. Online ahead of print.

ABSTRACT

Oncotype Dx Recurrence Score (RS) has been validated in patients with ER + /HER2 – invasive breast carcinoma to estimate patient risk of recurrence and guide the use of adjuvant chemotherapy. We investigated the role of MRI-based radiomics features extracted from the tumor and the peritumoral tissues to predict the risk of tumor recurrence. A total of 62 patients with biopsy-proved ER + /HER2 – breast cancer who underwent pre-treatment MRI and Oncotype Dx were included. An RS > 25 was considered discriminant between low-intermediate and high risk of tumor recurrence. Two readers segmented each tumor. Radiomics features were extracted from the tumor and the peritumoral tissues. Partial least square (PLS) regression was used as the multivariate machine learning algorithm. PLS β-weights of radiomics features included the 5% features with the largest β-weights in magnitude (top 5%). Leave-one-out nested cross-validation (nCV) was used to achieve hyperparameter optimization and evaluate the generalizable performance of the procedure. The diagnostic performance of the radiomics model was assessed through receiver operating characteristic (ROC) analysis. A null hypothesis probability threshold of 5% was chosen (p < 0.05). The exploratory analysis for the complete dataset revealed an average absolute correlation among features of 0.51. The nCV framework delivered an AUC of 0.76 (p = 1.1∙10^-3). When combining “early” and “peak” DCE images of only T or TST, a tendency toward statistical significance was obtained for TST with an AUC of 0.61 (p = 0.05). The 47 features included in the top 5% were balanced between T and TST (23 and 24, respectively). Moreover, 33/47 (70%) were texture-related, and 25/47 (53%) were derived from high-resolution images (1 mm). A radiomics-based machine learning approach shows the potential to accurately predict the recurrence risk in early ER + /HER2 – breast cancer patients.

PMID:36698037 | DOI:10.1007/s10278-023-00781-5

Int J Colorectal Dis. 2023 Jan 26;38(1):24. doi: 10.1007/s00384-023-04318-8.

ABSTRACT

AIM: To investigate whether patients with endoscopically untraversable rectal cancer may benefit from a defunctioning stoma created before neoadjuvant therapy or resectional surgery.

METHODS: This retrospective study comprise patients diagnosed with rectal cancer during 2007-2020 in Region Västerbotten, Sweden. The primary outcome was time between diagnosis and any treatment, while survival and the incidence of complications were secondary outcomes. Excluded were patients without endoscopic obstruction, patients already having a stoma, patients with recurrent disease, palliative patients, and patients receiving a stoma shortly after diagnosis due to any urgent bowel-related complication. Data were obtained from the Swedish Colorectal Cancer Registry and medical records. Kaplan-Meier failure curves were drawn, and a multivariable Cox regression model was employed for confounding adjustment.

RESULTS: Out of 843 patients, 57 remained after applying exclusion criteria. Some 12/57 (21%) patients received a planned stoma before treatment, and the remainder received upfront neoadjuvant therapy or surgery. Median time to any treatment was 51 days for the planned stoma group and 36 days for the control group, with an adjusted hazard ratio of 0.28 (95% confidence interval: 0.12-0.64). Complications occurred at a rate of 5/12 (42%) and 7/45 (16%) in the planned stoma group and control group, respectively. Survival was similar between groups.

CONCLUSION: A planned stoma results in treatment delay, but it remains unclear whether this is clinically relevant. Complications were more common in the planned stoma group, although the data are limited. While larger studies are needed, it seems feasible to avoid defunctioning stomas even in endoscopically obstructing rectal cancers.

PMID:36698033 | DOI:10.1007/s00384-023-04318-8

Commun Chem. 2022 Apr 19;5(1):55. doi: 10.1038/s42004-022-00669-5.

ABSTRACT

Although important for atmospheric processes and gas-phase catalysis, very little is known about the hydration state of ions in the vapor phase. Here we study the evaporation energetics and kinetics of a chloride ion from liquid water by molecular dynamics simulations. As chloride permeates the interface, a water finger forms and breaks at a chloride separation of ≈ 2.8 nm from the Gibbs dividing surface. For larger separations from the interface, about 7 water molecules are estimated to stay bound to chloride in saturated water vapor, as corroborated by continuum dielectrics and statistical mechanics models. This ion hydration significantly reduces the free-energy barrier for evaporation. The effective chloride diffusivity in the transition state is found to be about 6 times higher than in bulk, which reflects the highly mobile hydration dynamics as the water finger breaks. Both effects significantly increase the chloride evaporation flux from the quiescent interface of an electrolyte solution, which is predicted from reaction kinetic theory.

PMID:36698011 | DOI:10.1038/s42004-022-00669-5

Environ Sci Pollut Res Int. 2023 Jan 26. doi: 10.1007/s11356-023-25454-2. Online ahead of print.

ABSTRACT

The reasonable selection of non-geological disaster samples is of great significance to improve the accuracy of geological disaster assessment, reduce the cost of disaster management, and maintain the sustainable development of ecological environment. Liulin County was selected as the study area. This paper creatively divided non-geological disaster sampling areas by macro-geomorphology, and carried out susceptibility mapping based on random forest (RF) and frequency ratio-random forest (FR-RF) models. The accuracy of each model was evaluated by receiver operating characteristic curve (ROC) combined with the distribution characteristics of geological disasters and the actual urban construction in the study area. The results show that the FR-RF model constructed by selecting non-geological disaster samples in hilly area is most suitable for the susceptibility mapping of this study area. The different results in different sampling areas are mainly due to the great changes in the representativeness of non-geological disaster samples. The distance from the roads is the most important factor affecting the occurrence of disasters in the study area. The statistical results of disaster management cost estimation and gross domestic product (GDP) value show that the disaster management cost of HFR-RF model decreases by 13.45% on average compared with other models, and the ratio of GDP to disaster management cost is relatively high. These research results promote the progress of geological disaster prevention technology, maintain the stability of geological environment, and are of great significance to the stable and sustainable development of local economy.

PMID:36697985 | DOI:10.1007/s11356-023-25454-2

Environ Sci Pollut Res Int. 2023 Jan 26. doi: 10.1007/s11356-023-25478-8. Online ahead of print.

ABSTRACT

Human activities and climate change are recognized as two of the most important drivers of hydrologic variability and have attracted the interest of researchers over the past decade. Changes in land use, dam construction, agricultural development, and global warming are forces that directly or indirectly impact the global and local hydrologic regime. This study examines the effects of these drivers on streamflow and sediment transport in the Gorganroud watershed, located in the north of Iran. In addition, the most sensitive land use patterns are detected using statistical approaches and a hydrologic model. The current study’s principal argument is based on the variability of land use patterns during the modeling procedure (2007-2019). The Soil and Water Assessment Tool (SWAT) model is used to consider the land use dynamics during the simulation period based on the hydrological regime of the reference period. The Simple Differential Method (SDM) and Climate Elasticity Method (CEM) are utilized to estimate the contribution rates of land use and climate change in streamflow and sediment transport changes. The results indicate that changes in land use have contributed more than 60% to streamflow and sediment regime changes in all subbasins. A sensitivity analysis of land uses and the spatial distribution of the Human Contribution Rate (HCR) over the study area reveal that an increase in orchard land use (8.7% during the computational period) is primarily responsible for these significant changes.

PMID:36697980 | DOI:10.1007/s11356-023-25478-8

Amino Acids. 2023 Jan 25. doi: 10.1007/s00726-023-03236-x. Online ahead of print.

ABSTRACT

We developed a hollow fiber centrifugal ultrafiltration (HFCF-UF) method to study the change of plasma levels of free glycine (Gly) in patients with acute ischemic stroke (AIS). Twenty-four patients with AIS confirmed by diffusion-weighted imaging (DWI) were enrolled. During the study period, the patients did not receive any supplemental amino acids therapy that could affect the obtained results. Our results showed that although AIS patients adopted different methods of treatment (thrombolytic and non-thrombolytic), the clinical NIHSS score of AIS showed a downward trend whereas Gly concentration showed increased trend. Moreover, plasma free Gly concentration was positively correlated with ASPECTS score. The correlation between Gly levels and infarct volume showed a statistical significance. That is to say, higher Gly level predicted smaller infarct size. Thus, the change of free Gly level in plasma could be considered as a potential biomarker of AIS.

PMID:36697969 | DOI:10.1007/s00726-023-03236-x

Ann Fam Med. 2022 Apr 1;(20 Suppl 1). doi: 10.1370/afm.20.s1.3098.

ABSTRACT

Context: In the midst of the COVID-19 pandemic- with undulating statistics of new cases and deaths and with schools set to reopen in the fall of 2020 after a long hiatus- the objective was to address the needs and methods of preparing children for a safe return to school. Objective: To educate 1st – 5th grade elementary school children about proper health and safety precautions during the COVID-19 pandemic. Study Design and Setting: Three monthly virtual sessions via zoom were implemented with focuses on hygiene, physical activity, and healthy coping mechanisms during a pandemic. The hygiene lecture included interactive demonstrations on handwashing, coughing/sneezing precautions, and appropriate mask-wearing behavior. During the coping mechanisms session, children were asked to use art or free text to answer the question “How has COVID-19 changed my feelings?” The physical activity session discussed safe ways for children to stay active during the pandemic. Both quantitative (pre and post-knowledge assessment quizzes) and qualitative (free text, drawings) data were collected through electronic surveys. Quizzes were designed for the appropriate grade level and used a combination of multiple choice, free text, checkboxes, and pictures to address common themes. Population studied and Intervention: School-aged children (1st-5th grade) at the Raindrop Foundation of San Antonio participated in educational sessions about maintaining proper COVID-19 hygiene. Outcome Measures and Results: Final results show six 1st – 2nd graders and nine 3rd – 5th graders consistently participated in the project. The children involved could identify proper mask-wearing etiquette, safe coughing habits, and when and how to wash their hands. Emotions reported were both positive (ex. happy) and negative (ex. Sad, bored). Reported activities were indoor electronic games and work. Children reported missing friends and going to parks. Conclusions: These educational sessions were organized to teach children safe practices for their return to school, develop coping skills, and also help them adapt to physical activity while maintaining social distancing. Participant 1st – 5th graders answered most questions correctly and displayed the basics of COVID-19 safety knowledge. The children surveyed are experiencing mixed emotions during the pandemic due to feelings of social isolation.

PMID:36696676 | DOI:10.1370/afm.20.s1.3098

J Healthc Qual. 2023 Jan 25. doi: 10.1097/JHQ.0000000000000378. Online ahead of print.

ABSTRACT

The National Quality Forum (NQF) evaluates healthcare performance measures for endorsement based on a broad set of criteria. We extracted data from NQF technical reports released between spring 2018 and spring 2019. Measures were commonly stewarded by federal agencies (44.29%), evaluated for maintenance (67.14%), classified as outcome (42.14%) or process (39.29%) measures, and used a statistical model for risk adjustment (48.57%). For 80% of the measures reviewed, a patient advocate was present on the reviewing committee. Validity was evaluated using face validity (65.00%) or score-level empirical validity (67.14%), and reliability was frequently evaluated using score-level testing (71.43%). Although 91.56% of all reviewed measures were endorsed, most standing committee members voted moderate rather than high support on key assessment criteria like measure validity, measure reliability, feasibility of use, and whether the measure addresses a key performance gap. Results show that although the Consensus Development Process includes multidisciplinary stakeholder input and thorough evaluations of measures, continued work to identify and describe appropriate and robust methods for reliability and validity testing is needed. Further work is needed to study the extent to which stakeholder input is truly representative of diverse viewpoints and improve processes for considering social factors when risk adjusting.

PMID:36696671 | DOI:10.1097/JHQ.0000000000000378

Menopause. 2023 Feb 1;30(2):218-224. doi: 10.1097/GME.0000000000002107. Epub 2022 Nov 7.

ABSTRACT

IMPORTANCE AND OBJECTIVE: Hot flashes (HFs) are a prevalent feature of menopause. Hot flashes can be bothersome and affect quality of life. However, HFs have also been associated with the risk for cardiovascular disease. Therefore, providing current evidence on the effect of therapies to reduce HFs can help patients and providers with decision making. This review provides details on the scientific evidence to date related to the effect of physical activity (PA) and exercise to alter the HF experience in women.

METHODS: The PubMed database was searched between June 2020 and June 2022 for currently available evidence regarding the relation between PA and exercise and HFs. Our analysis included randomized control trials on exercise training, epidemiological studies, and studies evaluating acute exercise on the self-reported and objectively measured HF experience in addition to systematic reviews on the topic published as of June 2022.

DISCUSSION AND CONCLUSIONS: The majority of evidence from randomized control trials indicates that aerobic and resistance exercise training lead to a decrease in subjectively experienced HFs. The limited available studies on acute exercise indicate that a bout of moderate-intensity exercise may decrease objectively measured and self-reported HFs but acute increases in PA intensity above accustomed levels may influence subjective HF experience. Some evidence suggests that for those with depression, habitual PA may be an effective way to reduce HF symptoms. Weighing the available evidence, for people who experience HFs, engaging in regular moderate-intensity PA, including aerobic and resistance exercise, may be an effective therapy to reduce HFs and women should be counseled on the benefits of regular, moderate exercise. However, significant gaps in knowledge remain about the optimal exercise prescription, effectiveness for a diverse population, meaning of differences between objective and subjective experience, and mechanisms that lead to changes in HFs.

PMID:36696647 | DOI:10.1097/GME.0000000000002107