Category: Statistics

Health Mark Q. 2024 Oct 30:1-19. doi: 10.1080/07359683.2024.2422202. Online ahead of print.

ABSTRACT

Sustaining telehealth uptake hinges on people’s desire and ability to effectively engage with it. We explored trust and confidence in telehealth delivered by medical and allied health using cross-sectional survey of 1,116 Australians. Descriptive analysis presented factors that would improve trust and confidence in telehealth cross-tabulated with video consultation experience. Inferential statistics compared levels of trust in medical and allied health telehealth with user-related variables. Trust in medical telehealth was higher than in allied health, but practice with video calls, experience with high-quality telehealth, and good internet were associated with greater levels of trust in both groups. Telehealth with a known health professional and no additional costs were top-ranked factors to improve trust and confidence. Participants confident in troubleshooting trusted telehealth more. This first cross-sectional study on trust and confidence in telehealth suggests that digital upskilling and promoting quality video consultations can potentially enhance telehealth adoption.

PMID:39475427 | DOI:10.1080/07359683.2024.2422202

Sports Biomech. 2024 Oct 30:1-32. doi: 10.1080/14763141.2024.2398508. Online ahead of print.

ABSTRACT

Functional data analysis (FDA) is a contemporary area of statistics designed for analysis of functions or curves. FDA has grown in human movement applications over the last three decades, with it being applied across a range of sport applications including rowing, weightlifting, diving, race-walking, jumping and running. Functional principal components analysis (fPCA) has been the most commonly used technique in sports biomechanics, often being applied to better understand characteristics of variability present in curves from biomechanical variables sampled from sporting movements. Given that FDA is an area of statistics with specific techniques for processing and analysing data, it provides one valuable platform for biomechanists to understand and think about their data more holistically. Further, the visual interpretability that FDA techniques provide, there is great potential for FDA to be used beyond research contexts, as a suite of practical tools to assist practical sports biomechanists in making decisions in sport. This review aims to demonstrate some methods yet to be applied in sports biomechanics, with simple sports biomechanics data applications taken from rowing. This article aims to showcase the value that FDA may have in assisting practitioners as they make decisions with athletes regarding their movement characteristics.

PMID:39475398 | DOI:10.1080/14763141.2024.2398508

Am J Clin Nutr. 2024 Jul 23:S0002-9165(24)00598-7. doi: 10.1016/j.ajcnut.2024.07.003. Online ahead of print.

ABSTRACT

BACKGROUND: Maternal obesity increases risk of infant mortality. Because obesity is highly inheritable, grandmaternal obesity could also play a role. However, it is unknown whether grandmaternal obesity is related to grandoffspring infant mortality risk.

OBJECTIVES: We investigated the associations of grandmaternal early pregnancy body mass index [BMI (in kg/m²)] and grandoffspring infant mortality risk.

METHODS: Using Swedish nationwide registers, we estimated infant mortality hazard ratios (HRs) by levels of maternal grandmaternal early pregnancy BMI among 315,461 singleton live-born grandoffspring. We examined whether the association was mediated through maternal body size. In a subset of 164,095 grandsoffspring we evaluated the role of paternal grandmaternal BMI. To explore whether factors shared within families explained these associations, we studied the relations of maternal or paternal full sisters’ BMI and infant mortality.

RESULTS: Maternal grandmaternal overweight or obesity (BMI ≥ 25.0) was associated with increased grandoffspring infant mortality risk. Compared with the population median BMI (21.7), estimated adjusted hazard ratios [HRs (95% confidence interval [CI])] of grandoffspring mortality for BMI 25.0 and 30.0 were, respectively, 1.60 (1.14, 2.23) and 1.61 (1.13, 2.27). Maternal high birth weight-for-gestational age and early pregnancy obesity (BMI ≥ 30.0) were also associated with increased infant mortality risk. The association between maternal grandmaternal overweight or obesity and grandoffspring infant mortality was mostly (62%) mediated through maternal overweight or obesity. Maternal sisters’ BMI was unrelated to infant mortality. Paternal grandmaternal obesity was associated with increased infant mortality risk (HR [95% CI] for BMI 30.0 compared with 21.7: 1.65 [1.02, 2.67]); associations with paternal sisters’ BMI were not statistically significant.

CONCLUSIONS: Maternal grandmaternal overweight or obesity is associated with increased risk of grandoffspring infant mortality; factors shared within families may not play a major role. The association is mediated through the maternal early pregnancy BMI. Whether the association with paternal grandmaternal BMI is explained by shared familial factors warrants future confirmation.

PMID:39475386 | DOI:10.1016/j.ajcnut.2024.07.003

Biomarkers. 2024 Oct 30:1-15. doi: 10.1080/1354750X.2024.2421884. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study was to compare the levels of cathepsin B and pentraxin 3 in maternal serum of pregnant women with preeclampsia in the second trimester, to ascertain the impact of these levels on maternal and fetal outcomes, and to present a comprehensive analysis of the combined effects of cathepsin B and pentraxin 3 levels.

METHODS: This prospective case-control study was conducted at Bursa Yuksek Ihtisas Training and Research Hospital between 1 January 2022 and 31 December 2022. The study included 78 pregnant women diagnosed with preeclampsia and 78 healthy pregnant women in the second trimester, between the ages of 18 and 45. Once a diagnosis of preeclampsia was established, maternal serum samples were obtained from the pregnant women prior to the initiation of any therapeutic intervention. Once all samples had been collected, the values for cathepsin B and pentraxin 3 were determined using the ELISA method.

RESULTS: The results demonstrated a statistically significant elevation in the levels of pentraxin 3 (p = 0.008) and cathepsin B (p = 0.005) in pregnancies affected by preeclampsia when compared to those deemed healthy. Moreover, pentraxin-3 (p = 0.007) and cathepsin B (p = 0.002) were found to be significantly elevated in severe preeclampsia compared to mild preeclampsia. A comparison of the groups with and without HELLP syndrome revealed no statistically significant difference between the two groups. The ROC analysis revealed that the Cathepsin B 7.04 cut-off value was statistically significantly associated with the prediction of preeclampsia in all cases, with a sensitivity of 78.2% and a specificity of 47.4% (p = 0.005, AUC = 0.631).

CONCLUSION: The levels of CB and PTX3 may be employed as biomarkers to facilitate the early diagnosis of PE during the second trimester. Furthermore, these biomarkers may prove to be promising for the prediction of PE severity.

PMID:39475373 | DOI:10.1080/1354750X.2024.2421884

Eur Stroke J. 2024 Oct 30:23969873241293566. doi: 10.1177/23969873241293566. Online ahead of print.

ABSTRACT

PURPOSE: Secondhand smoke significantly increases the risk of cerebrovascular diseases, prompting recent public smoking bans. We aimed to ascertain the effects of smoke-free legislation on stroke incidence and mortality.

METHODS: We systematically searched Medline, Embase, Cochrane Library, and Scopus up to August 13, 2023, for studies reporting changes in stroke incidence following partial or comprehensive smoking bans. A random-effects meta-analysis was conducted on hospital admissions and mortality for stroke, stratified based on comprehensiveness of the ban ((i) workplaces-only, (ii) workplaces and restaurants, (iii) workplaces, restaurants and bars). The effect of post-ban follow-up duration was assessed visually by a forest plot, while meta-regression was employed to evaluate for any dose-response relationship between ban comprehensiveness and stroke risk.

FINDINGS: Of 3987 records identified, 15 studies analysing bans across a median follow-up time of 24 months (range: 3-67) were included. WRB bans were associated with reductions in the rates of hospital admissions for stroke (nine studies; RR, 0.918; 95% CI, 0.872-0.967) and stroke mortality (three studies; RR, 0.987; 95% CI, 0.952-1.022), although the latter did not reach statistical significance. There was no significant difference in the risk of stroke admissions for studies with increased ban comprehensiveness and no minimum duration for significant post-ban effects to be observed.

DISCUSSION AND CONCLUSION: Legislative smoking bans were associated with significant reductions in stroke-related hospital admissions, providing evidence for its utility as a public health intervention.

PMID:39475361 | DOI:10.1177/23969873241293566

Med Phys. 2024 Oct 30. doi: 10.1002/mp.17498. Online ahead of print.

ABSTRACT

BACKGROUND: Accurate preoperative prediction of cervical lymph node metastasis (LNM) for papillary thyroid carcinoma (PTC) patients is essential for disease staging and individualized treatment planning, which can improve prognosis and facilitate better management.

PURPOSE: To establish a fully automated deep learning-enabled model (FADLM) for automated tumor segmentation and cervical LNM prediction in PTC using ultrasound (US) video keyframes.

METHODS: The bicentral study retrospective enrolled 518 PTC patients, who were then randomly divided into the training (Hospital 1, n = 340), internal test (Hospital 1, n = 83), and external test cohorts (Hospital 2, n = 95). The FADLM integrated mask region-based convolutional neural network (Mask R-CNN) for automatic thyroid primary tumor segmentation and ResNet34 with Bayes strategy for cervical LNM diagnosis. A radiomics model (RM) using the same automated segmentation method, a traditional radiomics model (TRM) using manual segmentation, and a clinical-semantic model (CSM) were developed for comparison. The dice similarity coefficient (DSC) was used to evaluate segmentation performance. The prediction performance of the models was validated in terms of discrimination and clinical utility with the area under the receiver operator characteristic curve (AUC), heatmap analysis, and decision curve analysis (DCA). The comparison of the predictive performance among different models was conducted by DeLong test. The performances of two radiologists compared with FADLM and the diagnostic augmentation with FADLM’s assistance were analyzed in terms of accuracy, sensitivity and specificity using McNemar’s x² test. The p-value less than 0.05 was defined as a statistically significant difference. The Benjamini-Hochberg procedure was applied for multiple comparisons to deal with Type I error.

RESULTS: The FADLM yielded promising segmentation results in training (DSC: 0.88 ± 0.23), internal test (DSC: 0.88 ± 0.23), and external test cohorts (DSC: 0.85 ± 0.24). The AUCs of FADLM for cervical LNM prediction were 0.78 (95% CI: 0.73, 0.83), 0.83 (95% CI: 0.74, 0.92), and 0.83 (95% CI: 0.75, 0.92), respectively. It all significantly outperformed the RM (AUCs: 0.78 vs. 0.72; 0.83 vs. 0.65; 0.83 vs. 0.68, all adjusted p-values < 0.05) and CSM (AUCs: 0.78 vs. 0.71; 0.83 vs. 0.62; 0.83 vs. 0.68, all adjusted p-values < 0.05) across the three cohorts. The RM offered similar performance to that of TRM (AUCs: 0.61 vs. 0.63, adjusted p-value = 0.60) while significantly reducing the segmentation time (3.3 ± 3.8 vs. 14.1 ± 4.2 s, p-value < 0.001). Under the assistance of FADLM, the accuracies of junior and senior radiologists were improved by 18% and 15% (all adjusted p-values < 0.05) and the sensitivities by 25% and 21% (all adjusted p-values < 0.05) in the external test cohort.

CONCLUSION: The FADLM with elaborately designed automated strategy using US video keyframes holds good potential to provide an efficient and consistent prediction of cervical LNM in PTC. The FADLM displays superior performance to RM, CSM, and radiologists with promising efficacy.

PMID:39475358 | DOI:10.1002/mp.17498

Am J Speech Lang Pathol. 2024 Oct 30:1-19. doi: 10.1044/2024_AJSLP-23-00346. Online ahead of print.

ABSTRACT

PURPOSE: In this study, we evaluated the feasibility and efficacy of language plus goal management training program for individuals with aphasia. The intervention targeted expressive language, while concurrently integrating tasks designed to improve executive function and error awareness.

METHOD: A single-subject repeated-measures design was utilized to determine whether a combined treatment (Multi-Modal Aphasia Therapy PLUS Goal Management Training [M-MAT Meta]) would be efficacious for individuals with aphasia. This article reports on two participants with severe Wernicke’s aphasia, who comprised one of the four dyads of the study. Treatment was administered in a small group setting (N = 2) for 2 hr per day, 3 days per week for 4 weeks. Individual video feedback sessions were conducted once a week. Analysis of outcomes included visual inspection and calculation of Tau-U effect sizes of probed treatment data as well as statistical analysis of standardized language and executive function assessments.

RESULTS: Visual inspection indicated improvements in naming and discourse skills, which were maintained at the 1-month follow-up. Both participants’ standardized scores indicated a significant decrease in aphasia severity, which was maintained 1 month posttreatment. Error awareness improved for one of the two participants, but this improvement was not maintained. Participants demonstrated increased inhibition of unwanted responses and took longer on the planning and problem-solving time required to complete the assessment, indicating a decrease in impulsivity.

CONCLUSION: The results of this preliminary study suggest that M-MAT Meta may be an effective way to increase self-awareness and communication in individuals with severe Wernicke’s aphasia.

PMID:39475344 | DOI:10.1044/2024_AJSLP-23-00346

Pediatr Emerg Care. 2024 Oct 30. doi: 10.1097/PEC.0000000000003293. Online ahead of print.

ABSTRACT

OBJECTIVE: Subconjunctival hemorrhages (SCHs) are uncommon injuries in young children beyond the neonatal period and have been associated with abuse. In otherwise well infants, they are sometimes attributed to commonly observed symptoms that invoke Valsalva maneuvers, such as cough, vomiting, and constipation. Our study aims to ascertain the prevalence of SCH among children presenting to emergency care with cough, vomiting, and constipation.

METHODS: We conducted a cross-sectional secondary analysis of a prospectively collected dataset of children aged 1 month to 3 years presenting to a tertiary pediatric emergency department (ED). Children with and without SCH were identified at the time of their examination by ED providers. Children were assigned to Valsalva symptom groups of cough, vomiting, and/or constipation based on review of the ICD-10 codes associated with the ED encounter. Descriptive statistics and prevalence were calculated for each group. Chi-square testing of proportions was used to compare the prevalence of SCH based on the presence or absence of the 3 symptoms of interest.

RESULTS: Four thousand seven hundred seventeen qualifying ED encounters were captured, with 2 total cases of SCH identified (0.4 per 1000). SCHs were uncommonly observed in patients with cough (0.5 per 1000), vomiting (0 per 1000), and constipation (0 per 1000). We found no significant differences in the prevalence of SCH based on the presence or absence of cough (P = 0.87), vomiting (P = 0.52), or constipation (P = 0.82).

CONCLUSION: SCH is an uncommon finding in children under 3 years and is similarly uncommon among children with cough, vomiting, or constipation. It should not be attributed to uncomplicated presentations of cough, vomiting, or constipation, and alternative diagnoses, including abuse, should be carefully considered in the differential diagnosis of SCH.

PMID:39475329 | DOI:10.1097/PEC.0000000000003293

Int J Methods Psychiatr Res. 2024 Dec;33(4):e70006. doi: 10.1002/mpr.70006.

ABSTRACT

OBJECTIVES: To develop a composite score for differential resilience to effects of combat-related stressors (CRS) on persistent DSM-IV post-traumatic stress disorder (PTSD) among US Army combat arms soldiers using survey data collected before deployment.

METHODS: A sample of n = 2542 US Army combat arms soldiers completed a survey shortly before deployment to Afghanistan and then again two to three and 8-9 months after redeployment. Retrospective self-reports were obtained about CRS. Precision treatment methods were used to determine whether differential resilience to persistent PTSD in the follow-up surveys could be developed from pre-deployment survey data in a 60% training sample and validated in a 40% test sample.

RESULTS: 40.8% of respondents experienced high CRS and 5.4% developed persistent PTSD. Significant test sample heterogeneity was found in resilience (t = 2.1, p = 0.032), with average treatment effect (ATE) of high CRS in the 20% least resilient soldiers of 17.1% (SE = 5.5%) compared to ATE = 3.8% (SE = 1.2%) in the remaining 80%. The most important predictors involved recent and lifetime pre-deployment distress disorders.

CONCLUSIONS: A reliable pre-deployment resilience score can be constructed to predict variation in the effects of high CRS on persistent PTSD among combat arms soldiers. Such a score could be used to target preventive interventions to reduce PTSD or other resilience-related outcomes.

PMID:39475323 | DOI:10.1002/mpr.70006

Pharm Stat. 2024 Oct 30. doi: 10.1002/pst.2446. Online ahead of print.

ABSTRACT

An informed estimate of subject-level variance is a key determinate for accurate estimation of the required sample size for clinical trials. Evaluating completed adult Type 2 diabetes studies submitted to the FDA for accuracy of the variance estimate at the planning stage provides insights to inform the sample size requirements for future studies. From the U.S. Food and Drug Administration (FDA) database of new drug applications containing 14,106 subjects from 26 phase 3 randomized studies submitted to the FDA in support of drug approvals in adult type 2 diabetes studies reviewed between 2013 and 2017, we obtained estimates of subject-level variance for the primary endpoint-change in glycated hemoglobin (HbA1c) from baseline to 6 months. In addition, we used nine additional studies to examine the impact of clinically meaningful covariates on residual standard deviation and sample size re-estimation. Our analyses show that reduced sample sizes can be used without interfering with the validity of efficacy results for adult type 2 diabetes drug trials. This finding has implications for future research involving the adult type 2 diabetes population, including the potential to reduce recruitment period length and improve the timeliness of results. Furthermore, our findings could be utilized in the design of future endocrinology clinical trials.

PMID:39475306 | DOI:10.1002/pst.2446