Category: Statistics

Retina. 2024 Oct 16. doi: 10.1097/IAE.0000000000004298. Online ahead of print.

ABSTRACT

PURPOSE: To characterize changes in macular structure and vascularity seen in premature-birth adults.

METHODS: Retrospective review of adult patients seen in our clinic from July 2018 to November 2020 with history of premature birth not requiring treatment for retinopathy of prematurity (ROP), as well as healthy controls. Swept-source OCT-angiography (OCT-A) scans were analyzed for various parameters related to macular structure and vascularity. Statistical analysis was performed using univariate linear regression.

RESULTS: Thirty-four eyes were included (17 eyes from 10 premature-birth adults, 17 eyes from 11 control patients). Prematurity was associated with vascular changes on OCT-A: decreased foveal avascular zone (FAZ) area (p=0.001), decreased FAZ circularity index (p<0.001), decreased superficial capillary plexus vessel (CPV) density (p=0.02), and decreased deep CPV density (p<0.001). Prematurity was also associated with structural changes: shallower foveal pit depth (p<0.001), decreased cube average thickness (CAT) (p=0.005), and increased central subfield thickness-to-CAT ratio (p=0.002).

CONCLUSIONS: This is the largest published series of OCT-A data for premature-birth adults. Even without a history of ROP treatment, premature birth is associated with multiple changes to macular structure and vascularity that persist into adulthood. These include a smaller, more irregularly shaped FAZ, decreased juxtafoveal vascular density, and a shallower foveal pit.

PMID:39454058 | DOI:10.1097/IAE.0000000000004298

Crit Care Explor. 2024 Oct 25;6(11):e1175. doi: 10.1097/CCE.0000000000001175. eCollection 2024 Nov 1.

ABSTRACT

IMPORTANCE: The U.S. pediatric acute care system has become more centralized, placing increasing importance on interhospital transfers.

OBJECTIVES: We conducted a geospatial analysis of critically ill children undergoing interfacility transfer with a specific focus on understanding travel distances between the patient’s residence and the hospitals in which they receive care.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective geospatial analysis using five U.S. state-level administrative databases; four states observed from 2016 to 2019 and one state from 2018 to 2019. Participants included 10,665 children who experienced 11,713 episodes of critical illness involving transfer between two hospitals.

MAIN OUTCOMES AND MEASURES: Travel distances and the incidence of “potentially suboptimal triage,” in which patients were transferred to a second hospital less than five miles further from their residence than the first hospital.

RESULTS: Patients typically present to hospitals near their residence (median distance from residence to first hospital, 4.2 miles; interquartile range [IQR], 1.8-9.6 miles). Transfer distances are relatively large (median distance between hospitals, 28.9 miles; IQR, 11.2-53.2 miles), taking patients relatively far away from their residences (median distance from residence to second hospital, 30.1 miles; IQR, 12.2-54.9 miles). Potentially suboptimal triage was frequent: 24.2 percent of patients were transferred to a hospital less than five miles further away from their residence than the first hospital. Potentially suboptimal triage was most common in children living in urban counties, and became less common with increasing medical complexity.

CONCLUSIONS AND RELEVANCE: The current pediatric critical care system is organized in a hub-and-spoke model, which requires large travel distances for some patients. Some transfers might be prevented by more efficient prehospital triage. Current transfer patterns suggest the choice of initial hospital is influenced by geography as well as by attempts to match hospital resources with perceived patient needs.

PMID:39454049 | DOI:10.1097/CCE.0000000000001175

J Chem Theory Comput. 2024 Oct 25. doi: 10.1021/acs.jctc.4c01096. Online ahead of print.

ABSTRACT

Crystal structure prediction (CSP) is an important field of material design. Herein, we propose a novel generative adversarial network model, guided by a data-driven approach and incorporating the real physical structure of crystals, to address the complexity of high-dimensional data and improve prediction accuracy in materials science. The model, termed GAN-DDLSF, introduces a novel sampling method called data-driven latent space fusion (DDLSF), which aims to optimize the latent space of generative adversarial networks (GANs) by combining the statistical properties of real data with a standard Gaussian distribution, effectively mitigating the “mode collapse” problem prevalent in GANs. Our approach introduces a more refined generation mechanism specifically for binary crystal structures such as gallium nitride (GaN). By optimizing for the specific crystallographic features of GaN while maintaining structural rationality, we achieve higher precision and efficiency in predicting and designing structures for this particular material system. The model generates 9321 GaN binary crystal structures, with 16.59% reaching a stable state and 24.21% found to be metastable. These results can significantly enhance the accuracy of crystal structure predictions and provide valuable insights into the potential of the GAN-DDLSF approach for the discovery and design of binary, ternary, and multinary materials, offering new perspectives and methods for materials science research and applications.

PMID:39454048 | DOI:10.1021/acs.jctc.4c01096

J Econ Entomol. 2024 Oct 25:toae253. doi: 10.1093/jee/toae253. Online ahead of print.

ABSTRACT

Previously developed behavioral approaches for controlling the apple maggot fly, Rhagoletis pomonella (Walsh) (Diptera: Tephritidae), include attract-and-kill (AK) systems such as perimeter trapping using either, odor-baited red sticky spheres or odor-baited, sticky-free attracticidal spheres with contoured tops that ensure the sustained release of both insecticide and feeding stimulant. Here, over a 3-year span in 26 commercial apple orchards across Massachusetts, New Hampshire, and Maine, we evaluated the effectiveness of a novel AK strategy for R. pomonella management. Synthetic apple blend lures were deployed on perimeter-row trees to attract the pest, while perimeter-row insecticide sprays blended with 2% sugar, a known phagostimulant, served as the lethal component. Comparatively, grower standard (GS) blocks received full-block insecticide sprays devoid of sugar and lures. Monitoring revealed that red sticky spheres in AK blocks captured significantly more R. pomonella adults than unbaited monitoring spheres in GS blocks. Penetration of R. pomonella into block interiors remained consistently low and statistically similar for both AK and GS blocks. Whole-block infestation levels showed no significant difference between the 2 management approaches. Notably, insecticide application in AK blocks was reduced by 75%, 64.7%, and 64.2% in 2019, 2020, and 2021, respectively, compared with GS blocks. This grower-friendly AK approach could be integral to a reduced insecticide spray-based strategy for apple cultivation in the northeastern United States.

PMID:39454040 | DOI:10.1093/jee/toae253

J Clin Gastroenterol. 2024 Oct 22. doi: 10.1097/MCG.0000000000002090. Online ahead of print.

ABSTRACT

OBJECTIVE: Endoscopic submucosal dissection (ESD) is a superior, minimally invasive technique compared with other snare-based endoscopic resection techniques for rectal neoplasms extending to the dentate line (RNDLs). However, performing a successful ESD in the anal canal can be challenging due to vascularity and limited scope stability. In this meta-analysis, we aim to evaluate the safety and efficacy of ESD for RNDLs.

METHODS: We performed a comprehensive electronic database search from January 2005 through January 2024 for studies evaluating outcomes of ESD performed for managing RNDLs. Pooled proportions were calculated using random-effect models. Heterogeneity was evaluated using I2 and Q statistics.

RESULTS: Data were extracted from 11 studies comprising 496 patients. The pooled en bloc resection rates were 93.60% (95% CI = 90.70-95.70). The pooled R0 resection rate was 80.60% (95% CI = 70.50-87.80). The pooled recurrence rate was 4.00% (95% CI = 2.40-6.50). There was no evidence of significant heterogeneity calculated using the Q test and I2 statistic. The main adverse events were anal pain, postprocedural bleeding, and anal stricture with pooled rates of 20.20% (95% CI = 14.80-26.90), 8.20% (95% CI = 4.70-14.0), and 3.50% (95% CI = 2.10-5.70), respectively.

CONCLUSIONS: ESD is a safe and effective option for managing RNDLs with a low recurrence rate. Adverse events such as postprocedural perianal pain, postprocedural bleeding, and anal stenosis seem to be more common compared with colorectal ESD done for more proximal lesions. However, these can typically be managed conservatively or with minimally invasive endoscopic techniques.

PMID:39453696 | DOI:10.1097/MCG.0000000000002090

J Clin Gastroenterol. 2024 Oct 22. doi: 10.1097/MCG.0000000000002088. Online ahead of print.

ABSTRACT

BACKGROUND: Inflammatory bowel disease (IBD) encompasses chronic gastrointestinal disorders characterized by recurrent inflammation. Achieving mucosal healing and preventing disease progression are primary treatment goals.

OBJECTIVES: This study aimed to compare disease characteristics, medication utilization, procedures performed, and hospitalizations between IBD patients treated in hospital and community settings using the Leumit Health Service database.

DESIGN: A retrospective cohort study was conducted using data from the Leumit Health Service, comprising 3020 patients diagnosed with IBD from January 2010 to December 2019.

METHODS: Patients were divided based on primary care setting: hospital-based or community-based. Data included demographic characteristics, disease type, medication usage, procedures, and outcomes. Statistical analyses assessed differences between groups.

RESULTS: Hospital-treated patients were significantly younger (49.4±18.4 vs. 40.4±18.7, P<0.001 ), had higher rates of Crohn’s disease (45.9% vs. 71.4%, P<0.001), exhibited higher inflammatory markers (calprotectin 768±2182 vs. 1305±2526, P<0.001), lower albumin (4.23±0.27 vs. 4.12±0.32, P<0.001), hemoglobin levels (13.4±1.6 vs. 12.9±1.6, P<0.001), and lower BMI (26.2±5.3 vs. 24.6±5.6, P<0.001) compared with community-treated patients. Hospital-treated patients had more endoscopic procedures, higher medication utilization rates, shorter treatment durations, and increased hospitalization occurrence (12.1% vs. 23.6%, P<0.001), length (0.67±3.34 vs. 1.45±5.88, P<0.001), and colectomies (4.73% vs. 15.8%, P<0.001).

CONCLUSIONS: Disparities exist in IBD management between hospital and community settings, influenced by disease severity and treatment approaches. Hospital-based care is associated with more aggressive disease and intensive interventions, while community-based care may reflect milder disease and conservative management. Integrating specialized care models and personalized approaches across settings can optimize patient outcomes and health care delivery for IBD management. Further research is needed to understand these disparities’ underlying mechanisms and develop comprehensive care strategies.

PMID:39453694 | DOI:10.1097/MCG.0000000000002088

JMIR Form Res. 2024 Oct 25;8:e59501. doi: 10.2196/59501.

ABSTRACT

BACKGROUND: Older adults have a high rate of loneliness, which contributes to increased psychosocial risk, medical morbidity, and mortality. Digital emotional support interventions provide a convenient and rapid avenue for additional support. Digital peer support interventions for emotional struggles contrast the usual provider-based clinical care models because they offer more accessible, direct support for empowerment, highlighting the users’ autonomy, competence, and relatedness.

OBJECTIVE: This study aims to examine a novel anonymous and synchronous peer-to-peer digital chat service facilitated by trained human moderators. The experience of a cohort of 699 adults aged ≥65 years was analyzed to determine (1) if participation, alone, led to measurable aggregate change in momentary loneliness and optimism and (2) the impact of peers on momentary loneliness and optimism.

METHODS: Participants were each prompted with a single question: “What’s your struggle?” Using a proprietary artificial intelligence model, the free-text response automatched the respondent based on their self-expressed emotional struggle to peers and a chat moderator. Exchanged messages were analyzed to quantitatively measure the change in momentary loneliness and optimism using a third-party, public, natural language processing model (GPT-4 [OpenAI]). The sentiment change analysis was initially performed at the individual level and then averaged across all users with similar emotion types to produce a statistically significant (P<.05) collective trend per emotion. To evaluate the peer impact on momentary loneliness and optimism, we performed propensity matching to align the moderator+single user and moderator+small group chat cohorts and then compare the emotion trends between the matched cohorts.

RESULTS: Loneliness and optimism trends significantly improved after 8 (P=.02) to 9 minutes (P=.03) into the chat. We observed a significant improvement in the momentary loneliness and optimism trends between the moderator+small group compared to the moderator+single user chat cohort after 19 (P=.049) and 21 minutes (P=.04) for optimism and loneliness, respectively.

CONCLUSIONS: Chat-based peer support may be a viable intervention to help address momentary loneliness in older adults and present an alternative to traditional care. The promising results support the need for further study to expand the evidence for such cost-effective options.

PMID:39453688 | DOI:10.2196/59501

J Child Adolesc Psychopharmacol. 2024 Oct 25. doi: 10.1089/cap.2024.0085. Online ahead of print.

ABSTRACT

Introduction: Despite advances in obstetric care, postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide. Prior reviews of studies published through 2016 suggest an association of antidepressant use during late pregnancy and increased risk of PPH. However, a causal link between prenatal antidepressants and PPH remains controversial. Objectives: This systematic literature review aimed to synthesize the empirical evidence on the association of antidepressant exposure in late pregnancy with the risk of PPH, including studies published before and after 2016. Methods: A systematic literature search was conducted using PubMed, OVID Medline, EMBASE, SCOPUS, PsycINFO, and CINAHL from inception to September 9, 2023. Original, peer-reviewed studies (published in English) that reported on the frequency or risk of PPH in women with evidence of antidepressant use during pregnancy and included at least one control group were included. Results: Twenty studies (eight published after 2016) met inclusion criteria, most of which focused on the risks of PPH associated with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). The main findings from the individual studies were mixed, but the majority documented statistically significant associations of PPH with late prenatal exposure, especially for exposures occurring within 30 days of delivery, compared with unexposed deliveries. Fourteen studies addressed underlying antidepressant indications or their correlates. Few studies focused on prenatal antidepressants and the risk of well-defined severe PPH or on antidepressant dose changes and general PPH risk. None examined competing risks of antidepressant discontinuation on mental health outcomes. Conclusions: Late pregnancy exposure to antidepressants may be a minor risk factor for PPH, but it is unclear to what extent reported associations are causal in nature, as opposed to correlational (effects related to nonpharmacological factors including maternal indication). For patients needing antidepressants during pregnancy, current evidence does not favor routinely discontinuing antidepressants specifically to reduce the risk of PPH.

PMID:39453674 | DOI:10.1089/cap.2024.0085

JAMA Netw Open. 2024 Oct 1;7(10):e2441615. doi: 10.1001/jamanetworkopen.2024.41615.

NO ABSTRACT

PMID:39453659 | DOI:10.1001/jamanetworkopen.2024.41615

JAMA Netw Open. 2024 Oct 1;7(10):e2438657. doi: 10.1001/jamanetworkopen.2024.38657.

ABSTRACT

IMPORTANCE: Hepatitis C virus (HCV) microelimination aims to detect and treat hidden infections, especially in at-risk groups, like people experiencing homelessness (PEH) with alcohol or drug use disorders. Point-of-care HCV RNA testing and peer support workers are crucial for identifying and preventing HCV infection among marginalized populations, contributing to overall elimination goals.

OBJECTIVE: To assess risk factors, prevalence, and trends of active HCV infection among PEH in Madrid, Spain (2019-2023).

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted between 2019 and 2023 in PEH, defined as people who lacked a fixed, regular, and adequate night residence, screened on the street or in homeless shelters via mobile unit using rapid HCV antibody testing, followed by HCV-RNA testing in Madrid, Spain. Data were analyzed from January to June 2024.

MAIN OUTCOMES AND MEASURES: Active HCV infection among PEH was the main outcome. Risk factors analyzed included being born outside of Spain, alcohol misuse, lacking financial income, benzodiazepine use, injection drug use (IDU; including nonactive IDU and active IDU within the last year), opioid substitution therapy participation, and sexual behavior patterns. Data were analyzed using logistic regression. P values were adjusted for multiple testing using the false discovery rate (q-values).

RESULTS: A total of 4741 individuals were screened for HCV infection, of whom 2709 (mean [SD] age, 42.2 [12.7]; 1953 [72.2%] men) were PEH and included in analysis. A total of 363 PEH (13.4%) had test results positive for HCV antibodies, of whom 172 (47.4%) had test results positive for HCV-RNA, and 148 of these (91.9%) started HCV treatment. Overall, active HCV infection prevalence was 6.3%, and the main risk factors associated with active HCV infection included IDU, encompassing both nonactive IDU (adjusted odds ratio [aOR], 10.9; 95% CI, 6.1-19.4; q < .001) and active IDU in the last year (aOR, 27.0; 95% CI, 15.2-48.0; q < .001); a lack of financial income (aOR, 1.8; 95% CI, 1.1-2.9; q = .03); and alcohol misuse (aOR, 1.8; 95% CI, 1.3-2.6; q = .008). There was a significant decrease between 2019 and 2023 in active HCV infection prevalence across the entire population, from 7.2% to 3.4% (P = .04).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of PEH in Madrid, IDU, lack of income, and alcohol misuse were primary risk factors associated with HCV infection. The significant decline in HCV rates observed across all risk groups during the study period suggests preventive policies were effective in reducing HCV prevalence among the homeless population.

PMID:39453657 | DOI:10.1001/jamanetworkopen.2024.38657