Category: Statistics

JAMA Pediatr. 2024 Oct 21. doi: 10.1001/jamapediatrics.2024.3967. Online ahead of print.

ABSTRACT

IMPORTANCE: Childhood asthma is characterized by pervasive disparities, including 3-fold higher hospitalization rates and 7-fold higher death rates for Black children compared with White children. To address asthma disparities, one must intervene in all lived environments.

OBJECTIVE: To determine if a community health worker (CHW) intervention to connect the primary care, home, and school for low-income minoritized school-aged children with asthma and their caregivers improves asthma control.

DESIGN, SETTING, AND PARTICIPANTS: This study was a hybrid effectiveness/implementation trial using a 2 × 2 factorial, cluster randomized clinical trial design of 36 schools crossed with participant-level randomization into a clinic-based CHW intervention. The study was conducted from May 2018 to June 2022. The intervention took place in primary care offices, homes, and 36 West Philadelphia, Pennsylvania, public and charter schools. Children aged 5 to 13 years with uncontrolled asthma were recruited from local primary care practices.

INTERVENTIONS: Asthma management, trigger remediation, and care coordination occurred in school, home, and primary care settings. Children were followed up for 12 months. The Yes We Can Children’s Asthma Program, Open Airways For Schools Plus, and school-based asthma therapy were implemented.

MAIN OUTCOMES AND MEASURES: Improvement in asthma control, as measured by the Asthma Control Questionnaire, comparing the mean difference between groups 1 year after randomization with their baseline (difference in differences). Both primary care and school interventions were dramatically disrupted by the COVID-19 pandemic; therefore, stratified analyses were performed to assess per-protocol intervention efficacy before the pandemic disruptions.

RESULTS: A total of 1875 participants were approached, 1248 were excluded, and 1 was withdrawn. The 626 analyzed study participants (mean [SD] age, 8.7 [2.4] years; 363 male [58%]) self-identified as Black race (96%) and non-Hispanic ethnicity (98%). Although all groups had statistically significant improvements in asthma control from baseline to 12 months (P- group: -0.46; 95% CI, -0.58 to -0.33; P+ group: -0.57; 95% CI, -0.74 to -0.44; S- group: -0.47; 95% CI, -0.58 to -0.35; S+ group: -0.59; 95% CI, -0.74 to -0.44), none of the difference-in-differences estimates from the primary prespecified models showed a clinically meaningful improvement in asthma control. Analysis from the prepandemic interval, however, demonstrated that children in the combined clinic-school intervention had a statistically significant improvement in asthma control scores compared with control (-0.79; 95% CI, -1.40 to -0.18).

CONCLUSIONS AND RELEVANCE: This randomized clinical trial provides preliminary evidence that connecting all lived environments for care of children can be accomplished through linkages with CHWs.

PMID:39432292 | DOI:10.1001/jamapediatrics.2024.3967

JAMA Neurol. 2024 Oct 21. doi: 10.1001/jamaneurol.2024.3481. Online ahead of print.

ABSTRACT

IMPORTANCE: One of 10 patients develop epilepsy in the late phase after cerebral venous thrombosis (CVT) diagnosis but predicting the individual risk is difficult.

OBJECTIVE: To develop and externally validate a prognostic score to estimate the individual risk of post-CVT epilepsy.

DESIGN, SETTING, AND PARTICIPANTS: This observational cohort study included both retrospective and prospective patients enrolled from 1994 through 2022. For development of the DIAS3 score, data from the International CVT Consortium (n = 1128), a large international hospital-based multicenter CVT cohort, were used. For validation, data from 2 independent multicenter cohorts, the ACTION-CVT (n = 543) and the Israel CVT study (n = 556), were used. Of 2937 eligible, consecutively enrolled adult patients with radiologically verified CVT, 710 patients with a history of epilepsy prior to CVT, follow-up less than 8 days, and missing late seizure status were excluded.

EXPOSURE: The prediction score (DIAS3) was developed based on available literature and clinical plausibility and consisted of 6 readily available clinical variables collected during the acute phase: decompressive hemicraniectomy, intracerebral hemorrhage at presentation, age, seizure(s) in the acute phase (excluding status epilepticus), status epilepticus in the acute phase, and subdural hematoma at presentation.

MAIN OUTCOME AND MEASURE: Time to a first late seizure, defined as occurring more than 7 days after diagnosis of CVT.

RESULTS: Of 1128 patients included in the derivation cohort (median age, 41 [IQR, 30-53] years; 805 women [71%]), 128 (11%) developed post-CVT epilepsy during a median follow-up of 12 (IQR, 3-26) months. According to the DIAS3 score, the predicted 1-year and 3-year risk of epilepsy in individual patients ranged from 7% to 68% and 10% to 83%, respectively. Internal and external validation showed adequate discrimination in the derivation cohort (1 year and 3 years: C statistic, 0.74; 95% CI, 0.70-0.79) and the 2 independent validation cohorts, (ACTION-CVT) 1 year: C statistic, 0.76; 95% CI, 0.67-0.84; 3 years: C statistic, 0.77; 95% CI, 0.66-0.84; and Israel CVT study 1 year: C statistic, 0.80; 95% CI, 0.75-0.86. Calibration plots indicated adequate agreement between predicted and observed risks.

CONCLUSIONS AND RELEVANCE: The DIAS3 score (freely available online) is a simple tool that can help predict the risk of post-CVT epilepsy in individual patients. The model can improve opportunities for personalized medicine and may aid in decision-making regarding antiseizure medication, patient counseling, and facilitation of research on epileptogenesis in CVT.

PMID:39432281 | DOI:10.1001/jamaneurol.2024.3481

Acta Otolaryngol. 2024 Oct 21:1-6. doi: 10.1080/00016489.2024.2415493. Online ahead of print.

ABSTRACT

BACKGROUND: Facial paralysis patients with normal hearing often require ossicular chain dislocation throughout the entire process of facial nerve decompression surgery, and their hearing tends to be slightly impaired after surgery. There is not detailed explanation of hearing changes after facial nerve decompression with preserving intact ossicular chain.

PURPOSE: This study aimed to determine the efficacy and hearing outcomes of facial nerve decompression with preserving ossicular chain intact transmastoid supralabyrinthine recess pathway in Bell’s palsy.

METHODS: A retrospective study comparing the pre- and post-operative facial nerve HB functional grades and hearing results of 12 patients with Bell’s palsy who underwent facial nerve decompression.

RESULTS: Preoperative and postoperative mean House-Brackmann (HB) scores respectively were 4.41 ± 0.67 and 1.58 ± 0.79 grades; The recovery rate to HB grade I, II was 100% or to grade III or lower was 83.3% (10/12). The pre- and post-operative mean PTAs (0.125, 0.25, 0.5, 1, 2, 4, 8KHz) were 19.1 ± 1.9 dB and 36.8 ± 4.1 dB; The pre- and postoperative low frequencies (0.125, 0.25KHz) were 18.5 ± 2.3 dB and 26 ± 3.8 dB; The pre- and postoperative speech frequencies (0.5, 1, 2KHz) mean PTAs were 18.5 ± 1.9 dB and 21.5 ± 2.9 dB; Comparison of pre- and post-operative hearing outcomes at all frequencies, low frequencies, and speech frequencies showed no statistically significant differences (p < 0.05); The pre- and postoperative high frequencies (4, 8KHz) were 20.6 ± 4.7 dB and 70.4 ± 11.6 dB and the hearing outcomes were statistically significant (p >0.05).

CONCLUSION: Subtotal facial nerve decompression with preserving ossicular chain intact transmastoid supralabyrinthine recess pathway does not cause the verbal frequency hearing loss of Bell’s palsy, but it has high frequency sensorineural hearing loss, which tend to be unavoidable and independent of the skill of the surgical operator.

PMID:39432250 | DOI:10.1080/00016489.2024.2415493

Acta Otolaryngol. 2024 Oct 21:1-5. doi: 10.1080/00016489.2024.2416934. Online ahead of print.

ABSTRACT

BACKGROUND: Systemic lupus erythematosus (SLE) is a chronic, inflammatory, autoimmune disease, characterized by multiple organ involvement, which is seen more often in young females.

OBJECTIVES: To evaluate the hearing and balance functions in SLE patients.

MATERIALS AND METHODS: Twenty-four SLE patients, 24 healthy controls underwent pure tone audiometry (0.125-16 kHz), VNG, vestibular evoked myogenic potential (VEMP), and video head impulse test (vHIT).

RESULTS: A statistically significant difference was determined between the control group and the SLE group at 0.125, 0.25, 0.5, 1.0, 6.0, 8.0, 10, 12, 14, and 16 kHz frequencies. Sensorineural hearing loss was observed in 37.5% of the SLE group. The pursuit test was pathological at the rate of 25% in the SLE group. No response was obtained in six SLE patients in the oVEMP test and four SLE patients in the cVEMP test. The mean posterior SCC VOR gain values were 0.64 ± 0.2 in the SLE group. A significant difference was determined between the groups with respect to posterior SCC VOR gains.

CONCLUSIONS AND SIGNIFICANCE: Our findings show that SLE disease may negatively affect the hearing system and the vestibular system as well. The current study is the first study to comprehensively evaluate SLE patients with VNG, VEMP, and vHIT tests.

PMID:39432242 | DOI:10.1080/00016489.2024.2416934

Cardiovasc Drugs Ther. 2024 Oct 21. doi: 10.1007/s10557-024-07620-x. Online ahead of print.

ABSTRACT

PURPOSE: Cancer patients face a four- to sevenfold higher risk of venous thromboembolism (VTE) than the general population. Novel oral anticoagulants (NOACs) provide convenient alternatives to traditional therapies.

METHODS: We performed a systematic literature search across PubMed, Embase, and the Cochrane Library, targeting studies that examined the use of NOACs in cancer-associated VTE. The search included randomized controlled trials (RCTs). Selected studies compared NOACs with low-molecular-weight heparin (LMWH) or vitamin K antagonists (VKA) in cancer patients diagnosed with VTE. A meta-analysis using a random-effects model was applied to estimate pooled effect sizes for outcomes.

RESULTS: In this meta-analysis, we included 12 RCTs. Results showed NOACs were more effective than LMWH in preventing VTE recurrence (RR 0.66, 95% CI 0.52-0.83, p = 0.0004). Compared with VKAs, NOACs showed no significant difference (RR 0.63, 95% CI 0.34-1.15, p = 0.13). However, this finding is limited by the small patient sample. Major bleeding outcomes were similar between NOACs and LMWH/VKAs (RR 1.24, 95% CI 0.85-1.80, p = 0.28; RR 0.77, 95% CI 0.39-1.53, p = 0.46, respectively). Meta-regression analysis indicated a statistically significant positive correlation between mortality and major bleeding events when comparing NOACs with LMWH (p = 0.049). There was no significant difference in all-cause mortality between patients treated with NOACs and those treated with LMWH (RR 1.04, 95% CI 0.92-1.18, p = 0.54) or VKAs (RR 0.94, 95% CI 0.72-1.23, p = 0.65).

CONCLUSION: Meta-analysis shows NOACs, especially factor Xa inhibitors, reduce VTE recurrence in cancer patients more effectively than LMWH. Comparison between NOACs and VKAs is inconclusive due to limited patient data. Further research is needed to assess NOACs’ efficacy and safety against VKAs.

PMID:39432236 | DOI:10.1007/s10557-024-07620-x

Environ Sci Pollut Res Int. 2024 Oct 21. doi: 10.1007/s11356-024-35316-0. Online ahead of print.

ABSTRACT

The carbon emission trading market is crucial for reducing emissions, conserving energy, and enhancing the climate and environment. Studying carbon price forecasting can encourage China’s involvement in international carbon financial instruments trading and promote the development of China’s pilot carbon markets. This study employs ensemble empirical mode decomposition (EEDM) to convert the initial carbon price, which is a non-stationary signal, into several intrinsic mode functions and residual terms. Subsequently, hybrid machine learning methods are used to estimate the carbon price. For empirical analysis, the three main carbon markets with large trading volumes, Guangdong, Hubei, and Shenzhen, are selected from the eight pilot carbon markets. To achieve short-term carbon price prediction, a hybrid model combining a genetic algorithm (GA) and back propagation (BP) neural network is used. This model effectively addresses the issue of neural networks falling into local optimization. The results indicate that the hybrid algorithm is significantly superior to other algorithms for short-term prediction. Additionally, another hybrid model, combining the least squares support vector machine (LSSVM) and particle swarm optimization (PSO) algorithms, is employed to reduce forecast error while minimizing search parameters, which is not possible with traditional neural network models.

PMID:39432218 | DOI:10.1007/s11356-024-35316-0

Environ Sci Pollut Res Int. 2024 Oct 21. doi: 10.1007/s11356-024-35315-1. Online ahead of print.

ABSTRACT

Several efforts have been made to explore the income inequality influence on environmental degradation, but the query regarding the nexus of income inequality and renewable energy consumption (REC) is still unanswered. This vacuum in existing literature has raised the need to inspect the relationship between income inequality and REC. Thus, this study purposes to investigate the asymmetric effect of income inequality on REC for emerging Asian economies over the period 1990-2019 by adopting the nonlinear autoregressive distributed lag (NARDL) approach. The panel-wise long-run results infer that positive shock in income inequality exerts a significant negative effect on REC, while negative shock in income inequality has an insignificant effect on REC. Likewise, economy-wise long-run findings reveal that a positive shock in income inequality brings a negative and statistically significant influence on REC in the case of China, India, and Iran, while a negative shock in income inequality brings a positive influence on REC only in case of Russia.

PMID:39432217 | DOI:10.1007/s11356-024-35315-1

Environ Sci Pollut Res Int. 2024 Oct 21. doi: 10.1007/s11356-024-35288-1. Online ahead of print.

ABSTRACT

CO₂ emissions in Belt and Road Initiative (BRI) countries are precisely influenced by economic determinants, requiring a comprehensive perspective. The BRI can augment its prospects for sustainable development by acknowledging the obstacles it faces and promoting global collaboration. Examining the CO₂ emission (CO₂e) in BRI countries in response to economic determinants such as financial development (FD), income distribution (ID), foreign direct investment (FDI), economic complexity index (ECI), and economic growth (EG) will determine the study’s long-term and short-term impacts. This study introduces a novel concept of CO₂es by employing panel data from 1991 to 2020. Thus, the CD, Kao, Pedroni, FMOLS, and pooled mean group-autoregressive distributed lag (PMG-ARDL) tests are utilized to assess cointegration. According to empirical findings, economic determinants (ECI, EG, FDI, and ID) have a statistically significant short-run and long-run impact on CO₂e in BRI countries. Policymakers in BRI countries should integrate monetary development, FDI, and CO₂es to foster EG, attract FDI, and promote sustainable development through regulatory frameworks.

PMID:39432216 | DOI:10.1007/s11356-024-35288-1

Indian J Gastroenterol. 2024 Oct 21. doi: 10.1007/s12664-024-01697-w. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Dyssynergic defecation (DD) is a disorder of anorectal function characterized by impaired relaxation or inappropriate contraction of pelvic floor muscles on attempted defecation. Based on previous Indian studies, we devised a symptom score (bleeding per rectum, excessive straining for stools, digitation, sense of incomplete evacuation/blockage-BEDS) and tried to determine if it can identify which patients with chronic constipation are more likely to have DD.

METHODS: This is a prospective observational cohort study in which consecutive adult patients (> 18 years) with chronic constipation who were referred to our centre for anorectal manometry (ARM) between 2019 and 2023 were included. Prior to tests, patients were asked in detail regarding their symptoms and scoring was done. ARM was done by a single observer. Diagnosis of DD was based on standard criteria. Statistical tests used were median, range and percentages, Chi-square test and Mann-Whitney U-test. The data was analyzed for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Agreement of symptom-based scoring and DD diagnosis as per criteria was calculated using Cohen’s κ coefficient. A p value of < 0.05 was considered statistically significant.

RESULTS: As many as 244 patients (males 140, median age 42 years) formed the study cohort. Of these, 104 (42.6%) have DD. Sense of incomplete evacuation/sense of blockage (72.1% vs. 40%, p < 0.0001), excessive straining (73.1% vs. 22.1%, p < 0.0001) and digitation (28.8% vs. 13.5%, p 0.003) were more commonly reported in patients with DD. Taking a cut-off score of > / = 2, sensitivity of 69.2%, specificity 81.4% and positive likelihood ratio of 3.73 were noted. Similarly, if the score of > / = 3 was considered, the likelihood ratio increased to 4.71 with an increase in specificity (94.29%) and fall in sensitivity (26.92%).

CONCLUSION: Symptom-based BEDS score of > / = 2 is useful in identifying patients with DD.

PMID:39432213 | DOI:10.1007/s12664-024-01697-w

Sci China Life Sci. 2024 Oct 18. doi: 10.1007/s11427-024-2734-6. Online ahead of print.

NO ABSTRACT

PMID:39432206 | DOI:10.1007/s11427-024-2734-6