Category: Statistics

BMC Ecol Evol. 2024 Nov 19;24(1):143. doi: 10.1186/s12862-024-02330-2.

ABSTRACT

BACKGROUND: The invasion of non-native species into ecosystems is a growing human-induced problem. To control their spread and population growth, knowledge is needed on the factors that facilitate or impede their invasions. In animals, traits often associated with invasion success are high activity, boldness, and aggression. However, these traits also make individuals susceptible to predation, which could curb population growth. We investigated if a recent invader into the Baltic Sea, the shrimp Palaemon elegans, differs in risk-taking from a native shrimp, P. adspersus. We recorded activity, habitat choice, and response to perceived predation threat of both species.

RESULTS: We found the invading shrimp to take greater risks than the native one; while the native shrimp adjusted its behaviour to habitat structure and exposure to a perceived predator, the non-native shrimp did not, and it resumed normal activity sooner after a perceived predation threat. Despite the greater risk taking by the non-native shrimp, its population has grown rapidly during the last two decades in the investigated area and is now larger than that of the native shrimp.

CONCLUSIONS: We discuss plausible explanations for the population growth of the invader, including the recent decline in predatory fishes that could have reduced the cost of risk-taking, and anthropogenic eutrophication that has increased food abundance could have allowed the population growth. These results stress the need to assess the optimality of the behaviours of both native and non-native species when investigating the factors that influence invasion success in human-disturbed environments.

PMID:39558248 | DOI:10.1186/s12862-024-02330-2

BMC Med Imaging. 2024 Nov 18;24(1):313. doi: 10.1186/s12880-024-01473-4.

ABSTRACT

BACKGROUND: Esophageal fistula (EF), a rare and potentially fatal complication, can be better managed with predictive models for personalized treatment plans in esophageal cancers. We aim to develop a clinical-deep learning radiomics model for effectively predicting the occurrence of EF.

METHODS: The study involved esophageal cancer patients undergoing radiotherapy or chemoradiotherapy. Arterial phase enhanced CT images were used to extract handcrafted and deep learning radiomic features. Along with clinical information, a 3-step feature selection method (statistical tests, Least Absolute Shrinkage and Selection Operator, and Recursive Feature Elimination) was used to identify five feature sets in training cohort for constructing random forest EF prediction models. Model performance was compared and validated in both retrospective and prospective test cohorts.

RESULTS: One hundred seventy five patients (122 in training and 53 in test cohort)were retrospectively collected from April 2018 to June 2022. An additional 27 patients were enrolled as a prospective test cohort from June 2022 to December 2023. Post-selection in the training cohort, five feature sets were used for model construction: clinical, handcrafted radiomic, deep learning radiomic, clinical-handcrafted radiomic, and clinical-deep learning radiomic. The clinical-deep learning radiomic model excelled with AUC of 0.89 (95% Confidence Interval: 0.83-0.95) in the training cohort, 0.81 (0.65-0.94) in the test cohort, and 0.85 (0.71-0.97) in the prospective test cohort. Brier-score and calibration curve analyses validated its predictive ability.

CONCLUSIONS: The clinical-deep learning radiomic model can effectively predict EF in patients with advanced esophageal cancer undergoing radiotherapy or chemoradiotherapy.

PMID:39558242 | DOI:10.1186/s12880-024-01473-4

BMC Geriatr. 2024 Nov 18;24(1):958. doi: 10.1186/s12877-024-05551-8.

ABSTRACT

OBJECTIVE: To investigate the efficacy of both multicomponent exercise and nutritional interventions on frailty by conducting a systematic review and meta-analysis to examine changes in frailty incidence.

DESIGN: A systematic review and meta-analysis.

ELIGIBLE CRITERIA: The included studies were limited to original controlled trials focused on frailty interventions in older adults aged 65 years and over. The studies involved only participants with specific diseases, and those recovering from surgery or being hospitalized were excluded.

INFORMATION SOURCES: A systematic search was performed on three databases: PUBMED, EMBASE, and Cumulative Index to Nursing and Allied Health, with the latest search in October 2024. Three authors independently extracted the data using a standardized data collection form. Relative risks were used as a summary measure. Pooled-effect estimates of each outcome were calculated by the random-effects meta-analysis.

RESULTS: After searching three databases, 5327 records were identified. After removing duplicates and screening the titles and abstracts, 19 multicomponent exercise studies and 7 nutritional intervention studies were eligible. In a pooled analysis of 18 multicomponent exercise RCTs, including a total of 3457 older adults, the multicomponent exercises showed a clinically significant reduction in frailty risk by relative change 55% times (95% CI 45% to 67%, p value < 0.001). The subgroup analysis of combinations of macronutrients and micronutrients also demonstrated statistically significant decrease in frailty risk by relative change 28% times (95% CI 11% to 72%, p value = 0.008).

CONCLUSION: Multicomponent exercises can effectively improve physical frailty, regardless of the duration and types of the activities, whereas the efficacy of nutritional supplements remains unclear. Personalized multicomponent approaches that incorporate both exercises and nutritional supplements have promised to enhance effectiveness in reducing frailty, thus warranting further investigation.

TRIAL REGISTRATION: The study was registered on 12 September 2022, under PROSPERO registration number CRD42022357357.

PMID:39558234 | DOI:10.1186/s12877-024-05551-8

Arch Oral Biol. 2024 Nov 10;170:106126. doi: 10.1016/j.archoralbio.2024.106126. Online ahead of print.

ABSTRACT

OBJECTIVE: This systematic review and meta-analysis (SRMA) aimed to determine whether the presence of H. pylori in dental plaque is associated with gastric H. pylori infection.

DESIGN: Search for the relevant literature was done in various databases: PubMed, Embase, Web of Science and Cochrane till September 21, 2023. The studies were screened for outcome of interest i.e. gastric H. pylori infection and exposure of interest i.e. H. pylori positivity in dental plaque. The pooled results of the study outcomes were evaluated using Odds Ratio (OR), accompanied by a 95 % confidence interval (CI). To evaluate the heterogeneity among studies, I² statistics were utilized, with an I² exceeding 50 % indicating a significant to high variation. In cases where I² was greater than 50 %, a random-effects model (specifically, the Der Simonian and Laird method) was employed.

RESULTS: Data from 27 observational studies and 2408 participants were included. The pooled OR of the H. pylori positivity in dental plaque among the patients with H. pylori positivity in stomach was 3.80 (95 % CI 2.24; 6.43), with high heterogeneity (I²= 69 %, p<0.01). Sensitivity analysis after removing the outliers reduced the heterogeneity significantly (I²=22 %, p=0.16). Meta-regression revealed that the strength of association did not vary according to the year of study or the sample size included in the studies. Overall certainty of the evidence was low.

CONCLUSIONS: The present meta-analysis showed that the presence of gastric H. pylori infection was higher among patients with H. pylori in dental plaque compared to patients without H. pylori in dental plaque. Presence of H. pylori infection in dental plaque can have implications in the management of H. pylori infection as dental plaque can serve as a reservoir from which the microorganism can recolonize the gastric mucosa.

PMID:39556904 | DOI:10.1016/j.archoralbio.2024.106126

Int Braz J Urol. 2025 Jan-Feb;51(1):e20240311. doi: 10.1590/S1677-5538.IBJU.2024.0311.

ABSTRACT

PURPOSE: Currently, detethering surgery (DS) is the modality most extensively utilized to treat primary Tethered cord syndrome (TCS). Disappointingly, some children without bladder impairment showed a deterioration of bladder function after surgery, which critically influences the health-related quality of life. It was hypothesized that the DS might have a significant effect on bladder function and psychology. Therefore, the purpose of this study was to investigate the effect of DS on bladder function and quality of life in children with primary TCS.

MATERIALS AND METHODS: A retrospective study of 83 patients aged 6 to 10 years who were diagnosed with TCS and underwent DS between 2022 and 2023. The urodynamic parameters and score, psychological-behavioral profile, and lower urinary tract symptoms were compared before and after DS. Additionally, the patients were divided into the normal group and the abnormal group according to the preoperative urodynamics parameters.

RESULTS: A total of 66 children fulfilled the criteria, with a mean age at surgery of 89.5 ± 13.7 months. There were statistically significant differences in bladder detrusor sphincter synergy and urodynamic score and no statistically significant difference in the remaining urodynamic parameters and psychological-behavioral items before and after DS. The proportion of bladder dysfunction that improved or did not worsen after surgery was higher in the Abnormal group than in the Normal group. Nevertheless, the detection rate of each psychological behavior abnormality in children with TCS was higher compared with that of normal children, both preoperatively and postoperatively.

CONCLUSIONS: DS could not considerably ameliorate pre-existing bladder dysfunction and patients exhibiting non-progressive bladder dysfunction could be treated conservatively with close observation. TCS plagues patients all the time even if detethering. Psychological counseling for children with TCS should be strengthened after DS.

PMID:39556851 | DOI:10.1590/S1677-5538.IBJU.2024.0311

Interact J Med Res. 2024 Nov 18;13:e57265. doi: 10.2196/57265.

ABSTRACT

BACKGROUND: The World Health Organization recommends a daily sodium intake of less than 2000 mg for adults; however, the Mexican population, like many others globally, consumes more sodium than this recommended amount. Excessive sodium intake is often accompanied by inadequate potassium intake. The association between knowledge, attitudes, and behaviors (KAB) and actual sodium intake has yielded mixed results across various populations. In Mexico, however, salt/sodium-related KAB and its relationship with sodium and potassium intake have not been evaluated.

OBJECTIVE: This study primarily aims to describe salt/sodium-related KAB in a Mexican population and, secondarily, to explore the association between KAB and 24-hour urinary sodium and potassium excretion.

METHODS: We conducted a cross-sectional study in an adult population from Mexico City and the surrounding metropolitan area. Self-reported KAB related to salt/sodium intake was assessed using a survey developed by the Pan American Health Organization. Anthropometric measurements were taken, and 24-hour urinary sodium and potassium excretion levels were determined. Descriptive statistics were stratified by sex and presented as means (SD) or median (25th-75th percentiles) for continuous variables, and as absolute and relative frequencies for categorical variables. The associations between KAB and sodium and potassium excretion were assessed using analysis of covariance, adjusting for age, sex, BMI, and daily energy intake as covariates, with the Šidák correction applied for multiple comparisons.

RESULTS: Overall, 232 participants were recruited (women, n=184, 79.3%). The mean urinary sodium and potassium excretion were estimated to be 2582.5 and 1493.5 mg/day, respectively. A higher proportion of men did not know the amount of sodium they consumed compared with women (12/48, 25%, vs 15/184, 8.2%, P=.01). More women reported knowing that there is a recommended amount for daily sodium intake than men (46/184, 25%, vs 10/48, 20.8%, P=.02). Additionally, more than half of men (30/48, 62.5%) reported never or rarely reading food labels, compared with women (96/184, 52.1%, P=.04). Better salt/sodium-related KAB was associated with higher adjusted mean sodium and potassium excretion. For example, mean sodium excretion was 3011.5 (95% CI 2640.1-3382.9) mg/day among participants who reported knowing the difference between salt and sodium, compared with 2592.8 (95% CI 2417.2-2768.3) mg/day in those who reported not knowing this difference (P=.049). Similarly, potassium excretion was 1864.9 (95% CI 1669.6-2060.3) mg/day for those who knew the difference, compared with 1512.5 (95% CI 1420.1-1604.8) mg/day for those who did not (P=.002). Additionally, higher urinary sodium excretion was observed among participants who reported consuming too much sodium (3216.0 mg/day, 95% CI 2867.1-3565.0 mg/day) compared with those who claimed to eat just the right amount (2584.3 mg/day, 95% CI 2384.9-2783.7 mg/day, P=.01).

CONCLUSIONS: Salt/sodium-related KAB was poor in this study sample. Moreover, KAB had a greater impact on potassium excretion than on sodium excretion, highlighting the need for more strategies to improve KAB related to salt/sodium intake. Additionally, it is important to consider other strategies aimed at modifying the sodium content of foods.

PMID:39556832 | DOI:10.2196/57265

JMIR Res Protoc. 2024 Nov 18;13:e56522. doi: 10.2196/56522.

ABSTRACT

BACKGROUND: There is an increasing need for evidence-based postoperative rehabilitation strategies to optimize patient outcome. Knowledge of potential prognostic factors could steer the development of rehabilitation protocols and could result in better treatment outcomes and higher patient satisfaction.

OBJECTIVE: This study aimed to investigate which potential prognostic factors predict baseline shoulder pain and function and its evolution in the first 2 years following surgery, in patients with total shoulder arthroplasty. The secondary objective is to investigate which potential prognostic factors predict baseline quality of life and its evolution in the first two years following surgery.

METHODS: To reach the aims of this project, a prospective longitudinal study, running from January 2020 to March 2025, will be carried out with a follow-up of 48 months. Patients will be randomized based on sling wear. We will study factors such as shoulder function, patient expectations, psychosocial factors, lifestyle factors, sling wear, soft tissue integrity, and physiotherapy treatment. Test moments will take place preoperatively, at 6 weeks, 12 weeks, 6 months, 12 months, and 24 months. Descriptive statistics will be used to describe the patient population characteristics. Based on literature review, expert opinion, and univariate analyses, potential prognostic factors will be chosen as covariates. A mixed regression model for repeated measures will be used to assess both the evolution of the Shoulder Pain and Disability Index within persons from baseline over time and the differences in evolution between participants. Correlation analyses will be used to investigate associations between the other outcome measures such as the Constant and Murley Score, shoulder range of motion, shoulder muscle strength, and proprioception, and the primary outcome measure, the Shoulder Pain and Disability Index score. Potential prognostic factors not included in the model will be presented in a descriptive manner.

RESULTS: Data collection started in January 2020. In April 2023 the sample size was reached. Data collection will end in April 2025. Analyses will follow when data collection is completed.

CONCLUSIONS: Knowledge of potential prognostic factors will have implications toward better rehabilitation strategies of patients after total shoulder arthroplasty.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04258267; https://clinicaltrials.gov/study/NCT04258267.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56522.

PMID:39556824 | DOI:10.2196/56522

J Med Internet Res. 2024 Nov 18;26:e57641. doi: 10.2196/57641.

ABSTRACT

BACKGROUND: Kawasaki disease (KD) is an acute pediatric vasculitis that can lead to coronary artery aneurysms and severe cardiovascular complications, often presenting with obvious fever in the early stages. In current clinical practice, distinguishing KD from other febrile illnesses remains a significant challenge. In recent years, some researchers have explored the potential of machine learning (ML) methods for the differential diagnosis of KD versus other febrile illnesses, as well as for predicting coronary artery lesions (CALs) in people with KD. However, there is still a lack of systematic evidence to validate their effectiveness. Therefore, we have conducted the first systematic review and meta-analysis to evaluate the accuracy of ML in differentiating KD from other febrile illnesses and in predicting CALs in people with KD, so as to provide evidence-based support for the application of ML in the diagnosis and treatment of KD.

OBJECTIVE: This study aimed to summarize the accuracy of ML in differentiating KD from other febrile illnesses and predicting CALs in people with KD.

METHODS: PubMed, Cochrane Library, Embase, and Web of Science were systematically searched until September 26, 2023. The risk of bias in the included original studies was appraised using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Stata (version 15.0; StataCorp) was used for the statistical analysis.

RESULTS: A total of 29 studies were incorporated. Of them, 20 used ML to differentiate KD from other febrile illnesses. These studies involved a total of 103,882 participants, including 12,541 people with KD. In the validation set, the pooled concordance index, sensitivity, and specificity were 0.898 (95% CI 0.874-0.922), 0.91 (95% CI 0.83-0.95), and 0.86 (95% CI 0.80-0.90), respectively. Meanwhile, 9 studies used ML for early prediction of the risk of CALs in children with KD. These studies involved a total of 6503 people with KD, of whom 986 had CALs. The pooled concordance index in the validation set was 0.787 (95% CI 0.738-0.835).

CONCLUSIONS: The diagnostic and predictive factors used in the studies we included were primarily derived from common clinical data. The ML models constructed based on these clinical data demonstrated promising effectiveness in differentiating KD from other febrile illnesses and in predicting coronary artery lesions. Therefore, in future research, we can explore the use of ML methods to identify more efficient predictors and develop tools that can be applied on a broader scale for the differentiation of KD and the prediction of CALs.

PMID:39556821 | DOI:10.2196/57641

J Med Internet Res. 2024 Nov 18;26:e52435. doi: 10.2196/52435.

ABSTRACT

BACKGROUND: The wearable monitoring device (WMD) is emerging as a promising tool for community-dwelling older adults to monitor personal health, enhance awareness of their activities, and promote healthy behaviors. However, the sustained use of WMDs among this population remains a significant challenge.

OBJECTIVE: This study aims to implement an interventional program that promotes and motivates the continued use of WMDs among older adults through a peer and professional support approach. This program will facilitate the integration of WMDs into their daily lives.

METHODS: This feasibility trial examined the following: (1) the usability of the WMD from the users’ perspectives; (2) the feasibility of the Live With Wearable Monitoring Device program; and (3) the effectiveness of the Live With Wearable Monitoring Device program among community-dwelling older adults. The intervention, based on Self-Determination Theory, involved using the Live With Wearable Monitoring Device program over a 3-month period, with ongoing professional and peer support provided by community health workers, aided by a nurse and social workers. This support included 1 home visit and biweekly communication via WhatsApp. Data were collected at baseline and at 1, 3, and 6 months.

RESULTS: A total of 39 participants were enrolled in the intervention group, while 37 participants were in the control group. The recruitment rate was high (76/89, 85%), and the attrition rate was low (8/76, 11%), indicating that the program is feasible for older adults. Participants in the intervention group exhibited higher self-efficacy, lower anxiety levels, and used the smartwatch more frequently, in terms of both days and hours, compared with the control group. A between-group difference was observed in self-efficacy between the intervention and control groups (β=3.31, 95% CI 0.36-6.25, P=.03), with statistically significant higher mean values recorded at all 4 time points.

CONCLUSIONS: It is clear that merely providing a WMD to older adults does not guarantee its usage, particularly for those unfamiliar with how to utilize its health-related functions in their daily routines. This study implemented a theory-based program aimed at enhancing the ongoing use of WMDs among older adults, suggesting that continuous professional and peer support may significantly influence WMD usage.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05269303; https://clinicaltrials.gov/ct2/show/NCT05269303.

PMID:39556810 | DOI:10.2196/52435

JMIR Rehabil Assist Technol. 2024 Nov 18;11:e55776. doi: 10.2196/55776.

ABSTRACT

BACKGROUND: Visual disability is a growing problem for many middle-aged and older adults. Conventional mobility aids, such as white canes and guide dogs, have notable limitations that have led to increasing interest in electronic travel aids (ETAs). Despite remarkable progress, current ETAs lack empirical evidence and realistic testing environments and often focus on the substitution or augmentation of a single sense.

OBJECTIVE: This study aims to (1) establish a novel virtual reality (VR) environment to test the efficacy of ETAs in complex urban environments for a simulated visual impairment (VI) and (2) evaluate the impact of haptic and audio feedback, individually and combined, on navigation performance, movement behavior, and perception. Through this study, we aim to address gaps to advance the pragmatic development of assistive technologies (ATs) for persons with VI.

METHODS: The VR platform was designed to resemble a subway station environment with the most common challenges faced by persons with VI during navigation. This environment was used to test our multisensory, AT-integrated VR platform among 72 healthy participants performing an obstacle avoidance task while experiencing symptoms of VI. Each participant performed the task 4 times: once with haptic feedback, once with audio feedback, once with both feedback types, and once without any feedback. Data analysis encompassed metrics such as completion time, head and body orientation, and trajectory length and smoothness. To evaluate the effectiveness and interaction of the 2 feedback modalities, we conducted a 2-way repeated measures ANOVA on continuous metrics and a Scheirer-Ray-Hare test on discrete ones. We also conducted a descriptive statistical analysis of participants’ answers to a questionnaire, assessing their experience and preference for feedback modalities.

RESULTS: Results from our study showed that haptic feedback significantly reduced collisions (P=.05) and the variability of the pitch angle of the head (P=.02). Audio feedback improved trajectory smoothness (P=.006) and mitigated the increase in the trajectory length from haptic feedback alone (P=.04). Participants reported a high level of engagement during the experiment (52/72, 72%) and found it interesting (42/72, 58%). However, when it came to feedback preferences, less than half of the participants (29/72, 40%) favored combined feedback modalities. This indicates that a majority preferred dedicated single modalities over combined ones.

CONCLUSIONS: AT is crucial for individuals with VI; however, it often lacks user-centered design principles. Research should prioritize consumer-oriented methodologies, testing devices in a staged manner with progression toward more realistic, ecologically valid settings to ensure safety. Our multisensory, AT-integrated VR system takes a holistic approach, offering a first step toward enhancing users’ spatial awareness, promoting safer mobility, and holds potential for applications in medical treatment, training, and rehabilitation. Technological advancements can further refine such devices, significantly improving independence and quality of life for those with VI.

PMID:39556804 | DOI:10.2196/55776