Category: Statistics

J Med Internet Res. 2024 Oct 25;26:e58257. doi: 10.2196/58257.

ABSTRACT

BACKGROUND: Most studies assessing the impact of online media and social media use on COVID-19 vaccine hesitancy predominantly rely on survey data, which often fail to capture the clustering of health opinions and behaviors within real-world networks. In contrast, research using social network analysis aims to uncover the diverse communities and discourse themes related to vaccine support and hesitancy within social media platforms. Despite these advancements, there is a gap in the literature on how a person’s social circle affects vaccine acceptance, wherein an important part of social influence stems from offline interactions.

OBJECTIVE: We aimed to examine how online media consumption influences vaccination decisions within real-world social networks by analyzing unique quantitative network data collected from Romania, an Eastern European state and member of the European Union.

METHODS: We conducted 83 face-to-face interviews with participants from a living lab in Lerești, a small rural community in Romania, using a personal network analysis framework. This approach involved gathering data on both the respondents and individuals within their social circles (referred to as alters). After excluding cases with missing data, our analysis proceeded with 73% (61/83) of the complete personal networks. To examine the hierarchical structure of alters nested within ego networks, we used a mixed multilevel logistic regression model with random intercepts. The model aimed to predict vaccination status among alters, with the focal independent variable being the respondents’ preferred source of health and prevention information. This variable was categorized into 3 types: traditional media, online media (including social media), and a combination of both, with traditional media as the reference category.

RESULTS: In this study, we analyzed 61 personal networks, encompassing between 15 and 25 alters each, totaling 1280 alters with valid data across all variables of interest. Our primary findings indicate that alters within personal networks, whose respondents rely solely on online media for health information, exhibit lower vaccination rates (odds ratio [OR] 0.37, 95% CI 0.15-0.92; P=.03). Conversely, the transition from exclusive traditional media use to a combination of both traditional and online media does not significantly impact vaccination rate odds (OR 0.75, 95% CI 0.32-1.78; P=.52). In addition, our analysis revealed that alters in personal networks of respondents who received the vaccine are more likely to have received the vaccine themselves (OR 3.75, 95% CI 1.79-7.85; P<.001).

CONCLUSIONS: Real-world networks combine diverse human interactions and attributes along with consequences on health opinions and behaviors. As individuals’ vaccination status is influenced by how their social alters use online media and vaccination behavior, further insights are needed to create tailored communication campaigns and interventions regarding vaccination in areas with low levels of digital health literacy and vaccination rates, as Romania exposes.

PMID:39454189 | DOI:10.2196/58257

JMIR Res Protoc. 2024 Oct 25;13:e59894. doi: 10.2196/59894.

ABSTRACT

BACKGROUND: With the aging of society, the prevalence of hearing loss (HL) is increasing. Currently, approximately 5% of the global population has HL, and this number is projected to reach 7 million by 2050. Although hearing aids (HAs) are the primary treatment for HL, their use is limited by barriers such as high costs and social stigma. To address these limitations, over-the-counter (OTC) HAs have been introduced, but their effectiveness and drawbacks require further investigation.

OBJECTIVE: This study aims to conduct a noninferiority randomized controlled trial comparing OTC HAs with traditional HAs to assess the clinical effectiveness of OTC HAs.

METHODS: We designed a noninferiority randomized controlled trial comparing OTC HAs and traditional HAs in adults with mild-to-moderate HL. A total of 64 participants (32 per group) will be recruited. Randomization will be performed using block randomization (block sizes of 2 or 4) with an equal allocation ratio. The study will include 2 types of HAs: an OTC HA (Jabra Enhance Pro) and a traditional HA (LiNX Quattro LE561-DRW) by GN ReSound A/S. OTC HAs will be self-fitted using a smartphone app, while traditional HAs will be fitted by a licensed audiologist using the National Acoustics Laboratories-Non-Linear Prescription, second generation. Assessments, including functional gain, real-ear measurement, speech audiometry, and questionnaires, will be conducted at 6-month intervals over the course of 3 visits. Statistical analysis will compare the 2 outcomes, focusing on functional gain, to determine noninferiority.

RESULTS: This study is scheduled to begin in August 2024 and has not yet recruited any participants. The study will be conducted over 2 years, from August 2024 to July 2026. Each participant will have 2 follow-up visits at 6-month intervals, making the total follow-up period 1 year.

CONCLUSIONS: Since 2022, the introduction of OTC HAs has revolutionized access to these devices. Researchers, clinicians, and the general public are keen to evaluate the clinical effectiveness of OTC HAs, as more individuals will likely use them for HL. This increased usage will provide valuable real-world data to understand the benefits and limitations of OTC HAs. Monitoring the outcomes and user feedback will provide insights into their effectiveness and impact on hearing rehabilitation.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/59894.

PMID:39454188 | DOI:10.2196/59894

Mol Pharm. 2024 Oct 25. doi: 10.1021/acs.molpharmaceut.4c00686. Online ahead of print.

ABSTRACT

Spray drying is one of the leading manufacturing methods for active pharmaceutical ingredients (APIs) owing to its rapid, single-step, and cost-effective nature. It also has the capacity to generate microspheres capable of controlled release of APIs including biomolecules and vaccines. However, one of the key challenges of spray-dried formulations especially with poly(lactic-co-glycolic acid) (PLGA)-based controlled-release injectables is burst release, where a significant fraction of the API is released prematurely within a short period of time following administration, leading to detrimental impact on the performance and quality of end products. This study uses a model API, bovine serum albumin (BSA) protein, to identify the sources of burst release that may affect the kinetics and performance of long-acting injectable microsphere formulations. Spray-dried microspheres with various formulations (i.e., variable BSA/PLGA ratios) were characterized in terms of their morphology, particle size, surface area, thermal properties, moisture content, as well as chemical compositions and their distributions to investigate the impact of spray drying on the burst release phenomenon. The results suggest that a relatively high initial release (85%) observed is mainly attributed to the protein distribution close to the particle surface. Morphology analysis provided evidence that the microspheres retained their spherical structure during the burst release phase. X-ray photoelectron spectroscopy, hard X-ray photoelectron spectroscopy, and argon cluster sputtering-assisted time-of-flight secondary ion mass spectrometry analysis suggest an enrichment of PLGA on particle surfaces with buried BSA protein. The statistically significant difference in particle size and surface area between three different formulations may be responsible for an initial variation in release but did not seem to alter the overall burst release profile. Considering the suggested source of burst release, the two-fluid spray-drying method, characterized by a single liquid feed delivering a preprepared emulsion, generated matrix-type microspheres with a surface layer of PLGA, as evidenced by surface analysis. The PLGA surface layer proved to be prone to degradation and pore formation, allowing for faster diffusion of BSA out of the microspheres, resulting in a burst release. Increasing the polymer concentration did not seem to halt this process.

PMID:39454183 | DOI:10.1021/acs.molpharmaceut.4c00686

Phys Rev Lett. 2024 Oct 11;133(15):158302. doi: 10.1103/PhysRevLett.133.158302.

ABSTRACT

We discover an instability mechanism in suspensions of self-propelled particles that does not involve active stress. Instead, it is driven by a subtle interplay of inertia, swimmer motility, and concentration fluctuations, through a crucial time lag between the velocity and the concentration field. The resulting time-persistent state seen in our high-resolution numerical simulations consists of self-sustained waves of concentration and orientation, transiting from regular oscillations to wave turbulence. We analyze the statistical features of this active turbulence, including an intriguing connection to the Batchelor spectrum of passive scalars.

PMID:39454139 | DOI:10.1103/PhysRevLett.133.158302

J Clin Oncol. 2024 Oct 25:JCO2400965. doi: 10.1200/JCO.24.00965. Online ahead of print.

ABSTRACT

PURPOSE: Fatigue is a highly prevalent and disabling symptom for patients with metastatic breast cancer (MBC). Evidence-based interventions for managing fatigue in advanced cancer populations are lacking. This phase II randomized controlled trial tested the effect of acceptance and commitment therapy (ACT) on fatigue interference with functioning in patients with MBC.

METHODS: Eligible patients were women with stage IV breast cancer who had moderate to severe fatigue interference. Patients completed a baseline assessment that included self-report measures of fatigue interference with activities, mood, and cognition (primary outcome) and sleep interference with functioning, engagement in daily activities, and quality of life (QOL; secondary outcomes). Then patients were randomly assigned to six weekly telephone-delivered sessions of either ACT (n = 116) or education/support (n = 120). Follow-up assessments occurred at 2 weeks, 3 months, and 6 months postintervention (means, 9.69, 20.51, and 33.59 weeks postbaseline, respectively).

RESULTS: Linear mixed model analyses showed that compared with patients in the education/support condition, patients in the ACT condition reported significantly less fatigue interference (P = .018). These results were significant at 2 weeks and 6 months postintervention. ACT’s effect on sleep interference was not statistically significant after the Sidak adjustment for multiple comparisons (P = .037). ACT patients showed a steady decline in sleep interference, a trend that was not found for education/support patients. Engagement in daily activities and QOL did not significantly differ between study groups, except for functional QOL (P = .006). Compared with education/support patients, ACT patients showed significantly better functional QOL at 2 weeks and 6 months postintervention.

CONCLUSION: Results suggest that a brief, telephone-delivered ACT intervention can reduce fatigue interference with functioning in patients with MBC.

PMID:39454125 | DOI:10.1200/JCO.24.00965

PLoS One. 2024 Oct 25;19(10):e0306180. doi: 10.1371/journal.pone.0306180. eCollection 2024.

ABSTRACT

This study examines the effects of relative household income on individual well-being, mental health, and physical health in Germany. Consistent with previous studies, we document a dip in the distribution of households in which the wife out-earns the husband. Using a regression discontinuity design, we show that husbands in couples in which the wife earns just more exhibit lower satisfaction with life, work, and health, and report worse physical health. Women in these couples report lower satisfaction with life and health, and worse mental health. Results on life, work, and health satisfaction among women are more pronounced in West Germany, consistent with previous evidence of gender norm differences between East and West Germany.

PMID:39454115 | DOI:10.1371/journal.pone.0306180

JMIR Aging. 2024 Oct 25;7:e60209. doi: 10.2196/60209.

ABSTRACT

BACKGROUND: Physical activity has emerged as a modifiable behavioral factor to improve cognitive function. However, research on adherence to remote monitoring of physical activity in older adults is limited.

OBJECTIVE: This study aimed to assess adherence to remote monitoring of physical activity in older adults within a pilot cohort from objective user data, providing insights for the scalability of such monitoring approaches in larger, more comprehensive future studies.

METHODS: This study included 22 participants from the Boston University Alzheimer’s Disease Research Center Clinical Core. These participants opted into wearing the Verisense watch as part of their everyday routine during 14-day intervals every 3 months. Eighteen continuous physical activity measures were assessed. Adherence was quantified daily and cumulatively across the follow-up period. The coefficient of variation was used as a key metric to assess data consistency across participants over multiple days. Day-to-day variability was estimated by calculating intraclass correlation coefficients using a 2-way random-effects model for the baseline, second, and third days.

RESULTS: Adherence to the study on a daily basis outperformed cumulative adherence levels. The median proportion of adherence days (wearing time surpassed 90% of the day) stood at 92.1%, with an IQR spanning from 86.9% to 98.4%. However, at the cumulative level, 32% (7/22) of participants in this study exhibited lower adherence, with the device worn on fewer than 4 days within the requested initial 14-day period. Five physical activity measures have high variability for some participants. Consistent activity data for 4 physical activity measures might be attainable with just a 3-day period of device use.

CONCLUSIONS: This study revealed that while older adults generally showed high daily adherence to the wearable device, consistent usage across consecutive days proved difficult. These findings underline the effectiveness of wearables in monitoring physical activity in older populations and emphasize the ongoing necessity to simplify usage protocols and enhance user engagement to guarantee the collection of precise and comprehensive data.

PMID:39454101 | DOI:10.2196/60209

J Cardiovasc Nurs. 2024 Oct 24. doi: 10.1097/JCN.0000000000001157. Online ahead of print.

ABSTRACT

BACKGROUND: Frailty is common in adults with end-stage heart failure receiving a left ventricular assist device (LVAD). Short-term studies show frailty reversal post-LVAD. Little is known about long-term frailty and how frailty relates to key LVAD outcomes, including depression, quality of life (QoL), and cognition beyond 6 months.

OBJECTIVE: The purpose of this study was to examine physical frailty, depression, QoL, and cognition from pre-LVAD implantation to 3, 6, and 12 months post-LVAD implantation.

METHODS: Clinical data and measures of physical frailty, depression, QoL, and cognition pre- and post-LVAD were extracted from an existing institutional database. Descriptive statistics and tests for statistical significance were used to describe and compare changes over time. Frailty trajectories were identified to describe physical frailty from pre-LVAD to 12 months post-LVAD.

RESULTS: The sample (n = 46) was predominantly male (76%), with a mean age of 64.7 ± 11 years, and over half (n = 25) were physically frail. Physical frailty was reduced by nearly half at 12 months. Frailty, depression, and QoL significantly improved at all time points (P < .001). Improvements in cognition did not reach statistical significance. Recipients of LVAD without improvement in frailty exhibited worse depression, QoL, and cognition scores at 12 months compared with those not frail pre-LVAD or no longer frail post-LVAD implantation.

CONCLUSION: Some recipients of LVADs experienced physical frailty reversal with benefits sustained long-term. Those without improvement recorded worse long-term patient-reported outcomes. Identifying factors that predict physical frailty response to LVAD implantation is a key area of future research.

PMID:39454087 | DOI:10.1097/JCN.0000000000001157

Retina. 2024 Oct 16. doi: 10.1097/IAE.0000000000004309. Online ahead of print.

ABSTRACT

PURPOSE: To compare functional and anatomical outcomes between posterior drainage of residual fluid using a 41G cannula, fluid tolerance (R-SRF), and conventional complete drainage methods, including removal through peripheral retinal breaks (PRB), perfluorocarbon liquid (PFCL), and posterior retinotomy (PR).

METHODS: In this retrospective, multicenter study, we evaluated cases for visual acuity (VA) at 3 months of follow-up. Secondary outcomes included surgical success, postoperative metamorphopsia, shifts, full-thickness folds (FTF), optical coherence tomography (OCT) parameters, and safety. Subgroup analyses were also conducted.

RESULTS: VA did not differ significantly between the three main groups. Subgroup analyses revealed worse VA for PR with 1.131 LogMAR (20/270 in Snellen conversion, p=0,002), with significantly more grade C proliferative vitreoretinopathy (PVR, 40.0%, p=0,003). R-SRF tended to offer better secondary outcomes, without statistical significance except for postoperative epiretinal membrane (ERM, 30.8%, p=0,041). Subgroup analyses found significantly more shifts with PFCL (91,7%, p=0,036). No cases of postoperative FTF or macular holes were observed with the 41G.

CONCLUSION: Our study introduced the 41G technique, indicating favourable outcomes for fovea-off retinal detachments. Nevertheless, fluid tolerance appeared to be the best option, offering a cost-effective and faster method, with an optimal microstructural profile and VA comparable to that of complete drainage techniques.

PMID:39454073 | DOI:10.1097/IAE.0000000000004309

J Forensic Nurs. 2024 Oct 23. doi: 10.1097/JFN.0000000000000510. Online ahead of print.

ABSTRACT

INTRODUCTION: Workplace violence (WPV) is a common experience among healthcare workers in the United States. Although WPV may affect workers physically, WPV can also affect workers’ mental health. Emergency department (ED) workers’ perceptions of available and necessary WPV support have not been previously reported.

METHODS: A cross-sectional survey design was used to examine ED workers’ perceived level of WPV support and emotional impact that WPV causes them. This study was conducted at six Midwestern U.S. EDs. Respondents confidentially completed an adapted version of the Survey of Violence Experienced by Staff. Data analysis included descriptive statistics, t test, and Kruskal-Wallis test.

RESULTS: Respondents (N = 206) who experienced WPV served as the analytical sample. Respondents predominantly agreed or strongly agreed that support was available after WPV (n = 129, 63.2%). The predominant source of support after WPV was another colleague from the department (n = 127, 62.3%). Less than half of respondents (n = 96, 47.1%) indicated they agreed/strongly agreed that managers were supportive after verbal abuse, but 63.6% (n = 126) indicated that managers were supportive after physical assault. There was no statistical difference between the emotional impact of verbal abuse compared with threats/assaults.

DISCUSSION: Forensic nurses and emergency nurses with forensic nursing training are situated to combine their expertise in trauma-informed care, evidence collection, and expert testimony to support victimized ED workers. Timely support should be offered regardless of the category of WPV experienced. Insight into why support is perceived as available and accessible but may not be used warrants further study.

PMID:39454070 | DOI:10.1097/JFN.0000000000000510