Category: Nevin Manimala

PLoS Negl Trop Dis. 2022 Jun 9;16(6):e0010441. doi: 10.1371/journal.pntd.0010441. eCollection 2022 Jun.

ABSTRACT

Chikungunya, a mosquito-borne disease, is a growing threat in Brazil, where over 640,000 cases have been reported since 2017. However, there are often long delays between diagnoses of chikungunya cases and their entry in the national monitoring system, leaving policymakers without the up-to-date case count statistics they need. In contrast, weekly data on Google searches for chikungunya is available with no delay. Here, we analyse whether Google search data can help improve rapid estimates of chikungunya case counts in Rio de Janeiro, Brazil. We build on a Bayesian approach suitable for data that is subject to long and varied delays, and find that including Google search data reduces both model error and uncertainty. These improvements are largest during epidemics, which are particularly important periods for policymakers. Including Google search data in chikungunya surveillance systems may therefore help policymakers respond to future epidemics more quickly.

PMID:35679262 | DOI:10.1371/journal.pntd.0010441

PLoS One. 2022 Jun 9;17(6):e0269605. doi: 10.1371/journal.pone.0269605. eCollection 2022.

ABSTRACT

BACKGROUND & OBJECTIVE: Heterozygous familial hypercholesterolemia (FHeH) is important risk factor for premature coronary artery disease (CAD). Strategies for its diagnosis and prevalence have not been well studied in India. We performed healthcare worker-based opportunistic screening to assess feasibility for determining its prevalence.

METHODS: A healthcare worker was trained in use of Dutch Lipid Clinic Network (DLCN) criteria for diagnosis of FHeH. Successive eligible individuals (n = 3000 of 3450 screened) presenting to biochemistry laboratories of two hospitals for blood lipid measurements were evaluated for FHeH. Cascade screening or genetic studies were not performed. Descriptive statistics are reported.

RESULTS: We included 2549 participants (men 1870, women 679) not on statin therapy. Health worker screened 25-30 individuals/day in 6-10 minutes each. The mean age was 46.2±11y. Variables of DLCN criteria were more in women vs men: family history 51.1 vs 35.6%, past CAD 48.2 vs 20.1%, arcus cornealis 1.1 vs 0.3%, tendon xanthoma 0.3 vs 0.1%, and LDL cholesterol 190-249 mg/dl in 8.5 vs 2.4%, 250-329 mg/dl in 0.7 vs 0% and ≥330 mg/dl in 0.3 vs 0% (p<0.01). Definite FHeH (DLCN score >8) was in 15 (0.59%, frequency 1:170) and probable FHeH (score 6-8) in 87 (3.4%, frequency 1:29). The prevalence was significantly greater in women, age <50y and in those with hypertension, diabetes and known CAD.

CONCLUSIONS: Healthcare worker-led opportunistic screening for diagnosis of FHeH using DLCN criteria is feasible in low-resource settings. The results show significant prevalence of clinically detected definite and probable FHeH in the population studied.

PMID:35679249 | DOI:10.1371/journal.pone.0269605

Multivariate Behav Res. 2022 Jun 9:1-21. doi: 10.1080/00273171.2022.2077287. Online ahead of print.

ABSTRACT

Researchers with mediation hypotheses must consider which design to use: within-subject or between-subject? In this paper, I argue that three factors should influence design choice: validity, causality, and statistical power. Threats to validity include carry-over effects, participant awareness, measurement, and more. Causality is a core element of mediation, and the assumptions required for causal inference differ between the two designs. Between-subject designs require more restrictive no-confounder assumptions, but within-subject designs require the assumption of no carry-over effects. Statistical power should be higher in within-subject designs, but the degree and conditions of this advantage are unknown for mediation analysis. A Monte Carlo simulation compares designs under a broad range of sample sizes, effect sizes, and correlations among repeated measurements. The results show within-subject designs require about half the sample size of between-subject designs to detect indirect effects of the same size, but this difference can vary with population parameters. I provide an empirical example and R script for conducting power analysis for within-subject mediation analysis. Researchers interested in conducting mediation analysis should not select within-subject designs merely because of higher power, but they should also consider validity and causality in their decision, both of which can favor between-subject designs.

PMID:35679239 | DOI:10.1080/00273171.2022.2077287

PLoS Comput Biol. 2022 Jun 9;18(6):e1010101. doi: 10.1371/journal.pcbi.1010101. eCollection 2022 Jun.

ABSTRACT

Undergraduate students from underrepresented backgrounds (e.g., Black, Indigenous, and people of color [BIPOC], members of the Deaf community, people with disabilities, members of the 2SLGBTQIA+ community, from low-income backgrounds, or underrepresented genders) continue to face exclusion and marginalization in higher education. In this piece, authored and edited by a diverse group of Science, Technology, Engineering, and Mathematics (STEM) scholars, we present 10 simple rules for succeeding as an underrepresented STEM undergraduate student, illuminating the “hidden curriculum” of STEM specifically as it relates to the underrepresented undergraduate experience. Our rules begin by encouraging students to embrace their own distinct identities and scientific voices and explain how students can overcome challenges unique to underrepresented students throughout their undergraduate degrees. These rules are derived from a combination of our own experiences navigating our undergraduate STEM degrees and the growing body of literature on improving success for underrepresented students.

PMID:35679237 | DOI:10.1371/journal.pcbi.1010101

J Comp Eff Res. 2022 Jun 9. doi: 10.2217/cer-2022-0070. Online ahead of print.

ABSTRACT

Background: Relative overall survival (OS) estimates reported in the MAVORIC trial are potentially confounded by a high proportion of patients randomized to vorinostat switching to mogamulizumab; furthermore, vorinostat is not used in clinical practice in the UK. Methods: Three methods were considered for crossover adjustment. Survival post-crossover adjustment was compared with data from the Hospital Episode Statistics (HES) to contextualize estimates. Results: Following adjustment, the OS hazard ratio for mogamulizumab versus vorinostat was 0.42 (95% CI: 0.18, 0.98) using the method considered most appropriate based on an assessment of assumptions and comparison with HES. Conclusions: OS of mogamulizumab relative to vorinostat may be underestimated in MAVORIC due to the presence of crossover. The HES database was used to validate this adjustment.

PMID:35678206 | DOI:10.2217/cer-2022-0070

Med Phys. 2022 Jun 9. doi: 10.1002/mp.15799. Online ahead of print.

ABSTRACT

PURPOSE: Deep neural networks (DNNs) have been widely applied in medical image classification, benefiting from its powerful mapping capability among medical images. However, these existing deep learning-based methods depend on an enormous amount of carefully labeled images. Meanwhile, noise is inevitably introduced in the labeling process, degrading the performance of models. Hence, it is significant to devise robust training strategies to mitigate label noise in the medical image classification tasks.

METHODS: In this work, we propose a novel Bayesian statistics guided label refurbishment mechanism (BLRM) for DNNs to prevent overfitting noisy images. BLRM utilizes maximum a posteriori probability (MAP) in the Bayesian statistics and the exponentially time-weighted technique to selectively correct the labels of noisy images. The training images are purified gradually with the training epochs when BLRM is activated, further improving classification performance.

RESULTS: Comprehensive experiments on both synthetic noisy images (public OCT & Messidor datasets) and real-world noisy images (ANIMAL-10N) demonstrate that BLRM refurbishes the noisy labels selectively, curbing the adverse effects of noisy data. Also, the anti-noise BLRM integrated with DNNs are effective at different noise ratio and are independent of backbone DNN architectures. In addition, BLRM is superior to state-of-the-art comparative methods of anti-noise.

CONCLUSIONS: These investigations indicate that the proposed BLRM is well capable of mitigating label noise in medical image classification tasks. This article is protected by copyright. All rights reserved.

PMID:35678232 | DOI:10.1002/mp.15799

Photodermatol Photoimmunol Photomed. 2022 Jun 9. doi: 10.1111/phpp.12811. Online ahead of print.

ABSTRACT

PURPOSE: To assess the clinical periodontal, bacterial, and immunological outcomes of chloro-aluminum phthalocyanine-mediated-photodynamic therapy (PDT) as an adjunct to dental scaling (DS) versus DS alone among cigarette smokers (CS) and never-smokers (NS).

METHODS: A total of 26 patients (13 CS and 13 NS) with clinical and radiographic diagnosis of stage II chronic periodontitis were recruited. Each patient from both groups were subjected with two parallel therapies (split-mouth): PDT + DS (test side) and DS alone (control side). Periodontal parameters were investigated by evaluating plaque scores (PS), bleeding on probing (BOP), probing depth (PD), clinical attachment loss (CAL) and alveolar bone loss (ABL). Subgingival plaque was collected to detect and quantify Porphyromonas gingivalis and Tannerella forsythia using real-time quantitative polymerase chain reaction (RT-qPCR) assay. Gingival crevicular fluid was sampled for the quantification of interleukin (IL)-1β and tumor necrosis factor-alpha (TNF-α) using enzyme linked immunosorbent assay. All assessments were performed at baseline, 3 months, and 6 months.

RESULTS: BOP was significantly reduced at 6 months after PDT+DS in CS groups (p<0.05). Mean PD and CAL significantly reduced after both PDT+DS and DS subgroups and among NS and CS groups (p<0.05). At 6 months follow up, the copy number of both P. gingivalis and T. forsythia remained significantly high in CS group (p<0.01). Only PDT+DS subgroup in CS significantly reduced the counts of P. gingivalis and T. forsythia at 3 months and 6 months (p<0.05). Only at 6 months did PDT+DS showed statistically significantly reduced IL-1β levels in the NS group (p<0.01). TNF-α levels significantly reduced in CS group with PDT+DS and DS alone at both 3 months and 6 months follow up (p<0.01).

CONCLUSION: Chloro-aluminum phthalocyanine-mediated PDT helped to improve the non-surgical periodontal therapy outcomes among stage II chronic periodontitis patients among smokers and never-smokers.

PMID:35678189 | DOI:10.1111/phpp.12811

Palliat Support Care. 2022 Jun 9:1-7. doi: 10.1017/S1478951522000694. Online ahead of print.

ABSTRACT

OBJECTIVES: A meta-analysis has explored the effect of psychotherapy on the quality of life (QOL) but has not explored the effect on advanced cancer patients’ survival, which is highly debated. Therefore, we consider the survival days and QOL as the primary outcomes in our analysis.

METHODS: Eligible studies were collected from four databases (PubMed, Embase, Cochrane Library, and Web of Science) until February 20, 2021. The pooled effect sizes were presented as weighted mean difference (WMD) or relative risk (RR) with 95% confidence intervals (CIs). Publication bias was evaluated by Egger’s test, and I² statistics was used to assess the heterogeneity.

RESULTS: Thirty-three studies were finally included, containing 2,159 patients in the psychotherapy group and 2,170 patients in the control group. McGill Quality of Life Questionnaire (MQOL) and European Organization for Research and Treatment of Cancer Quality of Life-C15-Palliative (EORTC-QLQ-C15-Pal) supported that QOL of the psychotherapy group was significantly higher than that of the control group, and WMD value was 0.42 (95% CI: 0.12-0.71) and 17.26 (95% CI: 11.08-23.44), respectively. No significant difference was observed between the two groups regarding to the survival time (WMD: 17.85, 95% CI: -8.79, 44.49, P = 0.189). Moreover, the levels of anxiety, depression, confusion, pain, and suffering were lowered in psychotherapy group (all P < 0.05).

SIGNIFICANCE OF RESULTS: Psychotherapy could improve the QOL of advanced cancer patients but not affect the survival time.

PMID:35678169 | DOI:10.1017/S1478951522000694

JDR Clin Trans Res. 2022 Jun 9:23800844221101800. doi: 10.1177/23800844221101800. Online ahead of print.

ABSTRACT

INTRODUCTION: Early childhood caries (ECC) is a complex oral disease that is prevalent in US children.

OBJECTIVES: The purpose of this 2-y prospective cohort study was to examine baseline and time-dependent risk factors for ECC onset in initially caries-free preschool children.

METHODS: A cohort of 189 initially caries-free children aged 1 to 3 y was recruited. At each 6-mo study visit, children were examined using the ICDAS index; salivary samples were collected to assess mutans streptococci (MS), lactobacilli, Candida species, salivary cortisol (prior and after a stressor), and salivary IgA. Diet and oral health behavior were assessed from parent report. Child and family stress exposure was assessed from measures of psychological symptoms, stressful life event exposure, family organization and violence exposure, and social support. Sociodemographic factors were also considered. A Kaplan-Meier estimator of survival function of time to ECC and a Cox proportional hazards model were used to identify predictors of ECC onset.

RESULTS: Onset of ECC was associated with high salivary MS levels at baseline (log-rank test, P < 0.0001). Cox proportional hazards regression showed that the risk of dental caries significantly increased with salivary MS in log scale over the 6-mo period (hazard ratio, 1.08; P = 0.01). Other risk factors in the model did not reach statistical significance.

CONCLUSION: Our results provide prospective evidence that an increase in salivary MS predicts ECC onset in young, initially caries-free children, confirming that a high salivary MS count likely plays a causal role in ECC onset, independent of covariates.

KNOWLEDGE TRANSFER STATEMENT: These results suggest that we must focus on reducing salivary MS counts in young children and preventing or delaying MS colonization in infants and young children determined to be at risk for ECC.

PMID:35678084 | DOI:10.1177/23800844221101800

Cochrane Database Syst Rev. 2022 Jun 9;6:CD013609. doi: 10.1002/14651858.CD013609.pub2.

ABSTRACT

BACKGROUND: Elbow supracondylar fractures are common, with treatment decisions based on fracture displacement. However, there remains controversy regarding the best treatments for this injury.

OBJECTIVES: To assess the effects (benefits and harms) of interventions for treating supracondylar elbow fractures in children.

SEARCH METHODS: We searched CENTRAL, MEDLINE, and Embase in March 2021. We also searched trial registers and reference lists. We applied no language or publication restrictions.

SELECTION CRITERIA: We included randomised and quasi-randomised controlled trials comparing different interventions for the treatment of supracondylar elbow fractures in children. We included studies investigating surgical interventions (different fixation techniques and different reduction techniques), surgical versus non-surgical treatment, traction types, methods of non-surgical intervention, and timing and location of treatment.

DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We collected data and conducted GRADE assessment for five critical outcomes: functional outcomes, treatment failure (requiring re-intervention), nerve injury, major complications (pin site infection in most studies), and cosmetic deformity (cubitus varus). MAIN RESULTS: We included 52 trials with 3594 children who had supracondylar elbow fractures; most were Gartland 2 and 3 fractures. The mean ages of children ranged from 4.9 to 8.4 years and the majority of participants were boys. Most studies (33) were conducted in countries in South-East Asia. We identified 12 different comparisons of interventions: retrograde lateral wires versus retrograde crossed wires; lateral crossed (Dorgan) wires versus retrograde crossed wires; retrograde lateral wires versus lateral crossed (Dorgan) wires; retrograde crossed wires versus posterior intrafocal wires; retrograde lateral wires in a parallel versus divergent configuration; retrograde crossed wires using a mini-open technique or inserted percutaneously; buried versus non-buried wires; external versus internal fixation; open versus closed reduction; surgical fixation versus non-surgical immobilisation; skeletal versus skin traction; and collar and cuff versus backslab. We report here the findings of four comparisons that represent the most substantial body of evidence for the most clinically relevant comparisons. All studies in these four comparisons had unclear risks of bias in at least one domain. We downgraded the certainty of all outcomes for serious risks of bias, for imprecision when evidence was derived from a small sample size or had a wide confidence interval (CI) that included the possibility of benefits or harms for both treatments, and when we detected the possibility of publication bias. Retrograde lateral wires versus retrograde crossed wires (29 studies, 2068 children) There was low-certainty evidence of less nerve injury with retrograde lateral wires (RR 0.65, 95% CI 0.46 to 0.90; 28 studies, 1653 children). In a post hoc subgroup analysis, we noted a greater difference in the number of children with nerve injuries when lateral wires were compared to crossed wires inserted with a percutaneous medial wire technique (RR 0.41, 95% CI 0.20 to 0.81, favours lateral wires; 10 studies, 552 children), but little difference when an open technique was used (RR 0.91, 95% CI 0.59 to 1.40, favours lateral wires; 11 studies, 656 children). Although we noted a statistically significant difference between these subgroups from the interaction test (P = 0.05), we could not rule out the possibility that other factors could account for this difference. We found little or no difference between the interventions in major complications, which were described as pin site infections in all studies (RR 1.08, 95% CI 0.65 to 1.79; 19 studies, 1126 children; low-certainty evidence). For functional status (1 study, 35 children), treatment failure requiring re-intervention (1 study, 60 children), and cosmetic deformity (2 studies, 95 children), there was very low-certainty evidence showing no evidence of a difference between interventions. Open reduction versus closed reduction (4 studies, 295 children) Type of reduction method may make little or no difference to nerve injuries (RR 0.30, 95% CI 0.09 to 1.01, favours open reduction; 3 studies, 163 children). However, there may be fewer major complications (pin site infections) when closed reduction is used (RR 4.15, 95% CI 1.07 to 16.20; 4 studies, 253 children). The certainty of the evidence for these outcomes is low. No studies reported functional outcome, treatment failure requiring re-intervention, or cosmetic deformity. The four studies in this comparison used direct visualisation during surgery. One additional study used a joystick technique for reduction, and we did not combine data from this study in analyses. Surgical fixation using wires versus non-surgical immobilisation using a cast (3 studies, 140 children) There was very low-certainty evidence showing little or no difference between interventions for treatment failure requiring re-intervention (1 study, 60 children), nerve injury (3 studies, 140 children), major complications (3 studies, 126 children), and cosmetic deformity (2 studies, 80 children). No studies reported functional outcome. Backslab versus sling (1 study, 50 children) No nerve injuries or major complications were experienced by children in either group; this evidence is of very low certainty. Functional outcome, treatment failure, and cosmetic deformity were not reported. AUTHORS’ CONCLUSIONS: We found insufficient evidence for many treatments of supracondylar fractures. Fixation of displaced supracondylar fractures with retrograde lateral wires compared with crossed wires provided the most substantial body of evidence in this review, and our findings indicate that there may be a lower risk of nerve injury with retrograde lateral wires. In future trials of treatments, we would encourage the adoption of a core outcome set, which includes patient-reported measures. Evaluation of the effectiveness of traction compared with surgical fixation would provide a valuable addition to this clinical field.

PMID:35678077 | DOI:10.1002/14651858.CD013609.pub2