Category: Statistics

PLOS Glob Public Health. 2024 Jan 3;4(1):e0002064. doi: 10.1371/journal.pgph.0002064. eCollection 2024.

ABSTRACT

In Australia, there is a high burden of acute rheumatic fever (ARF) among Aboriginal and Torres Strait Islander peoples. Clinical diagnostic criteria can result in a diagnosis of ‘definite’, ‘probable’ or ‘possible’ ARF and outcomes range from recovery to severe rheumatic heart disease (RHD). We compared outcomes by ARF diagnosis, where the main outcome was defined as disease progression from: possible to probable ARF, definite ARF or RHD; probable to definite ARF or RHD; or definite ARF to definite ARF recurrence or RHD. Data were extracted from the Northern Territory RHD register for Indigenous Australians with an initial diagnosis of ARF during the 5.5-year study period (01/01/2013-30/06/2019). Descriptive statistics were used to describe cohort characteristics, probability of survival, and cumulative incidence risk of disease progression. Cox proportional hazards regression was used to determine whether time to disease progression differed according to ARF diagnosis. Sub-analyses on RHD outcome, clinical manifestations, and antibiotic adherence were also performed. In total there were 913 cases with an initial ARF diagnosis. Of these, 92 (13%) experienced disease progression. The probability of disease progression significantly differed between ARF diagnoses (p = 0.0043; log rank test). Cumulative incidence risk of disease progression at 5.5 years was 33.6% (95% CI 23.6-46.2) for definite, 13.5% (95% CI 8.8-20.6) for probable and 11.4% (95% CI 6.0-21.3) for possible ARF. Disease progression was 2.19 times more likely in those with definite ARF than those with possible ARF (p = 0.026). Progression to RHD was reported in 52/732 (7%) of ARF cases with normal baseline echocardiography. There was a significantly higher risk of progression from no RHD to RHD if the initial diagnosis was definite compared to possible ARF (p<0.001). These data provide a useful way to stratify risk and guide prognosis for people diagnosed with ARF and can help inform practice.

PMID:38170692 | DOI:10.1371/journal.pgph.0002064

IEEE Trans Vis Comput Graph. 2024 Jan 3;PP. doi: 10.1109/TVCG.2024.3349428. Online ahead of print.

ABSTRACT

Alphanumeric and special characters are essential during text entry. Text entry in virtual reality (VR) is usually performed on a virtual Qwerty keyboard to minimize the need to learn new layouts. As such, entering capitals, symbols, and numbers in VR is often a direct migration from a physical/touchscreen Qwerty keyboard-that is, using the mode-switching keys to switch between different types of characters and symbols. However, there are inherent differences between a keyboard in VR and a physical/touchscreen keyboard, and as such, a direct adaptation of mode-switching via switch keys may not be suitable for VR. The high flexibility afforded by VR opens up more possibilities for entering alphanumeric and special characters using the Qwerty layout. In this work, we designed two controller-based raycasting text entry methods for alphanumeric and special characters input (Layer-ButtonSwitch and Key-ButtonSwitch) and compared them with two other methods (Standard Qwerty Keyboard and Layer-PointSwitch) that were derived from physical and soft Qwerty keyboards. We explored the performance and user preference of these four methods via two user studies (one short-term and one prolonged use), where participants were instructed to input text containing alphanumeric and special characters. Our results show that Layer-ButtonSwitch led to the highest statistically significant performance, followed by Key-ButtonSwitch and Standard Qwerty Keyboard, while Layer-PointSwitch had the slowest speed. With continuous practice, participants’ performance using Key-ButtonSwitch reached that of Layer-ButtonSwitch. Further, the results show that the key-level layout used in Key-ButtonSwitch led users to parallel mode switching and character input operations because this layout showed all characters on one layer. We distill three recommendations from th results that can help guide the design of text entry techniques for alphanumeric and special characters in VR.

PMID:38170655 | DOI:10.1109/TVCG.2024.3349428

J Am Podiatr Med Assoc. 2023 Nov-Dec;113(6):22-128. doi: 10.7547/22-128.

ABSTRACT

BACKGROUND: Syndesmosis injuries occur in approximately 10% of all ankle fractures. The integrity of the deltoid ligament is important in the decision of surgical treatment of lateral malleolus fractures.

METHODS: Patients who were operated on for Weber B ankle fracture were evaluated retrospectively, and the relationship between tenderness around the medial malleolus and syndesmosis injury was investigated. Patients with visual analog scale, Foot and Ankle Ability Measure daily living, and sports activity scores in their files were included. This study enrolled 38 patients. The patients were divided into two groups. Group 1 consisted of patients with a medial space greater than 4 mm on preoperative radiographs and a positive intraoperative Cotton test, in which a syndesmosis screw was used. Group 2 consisted of patients with a medial space less than 4 mm on preoperative radiographs and negative intraoperative Cotton test, for whom no syndesmosis screw was used.

RESULTS: In 17 of 38 patients, syndesmosis screws were used because of intraopeative positive Cotton test. In 21 patients, the Cotton test was negative and the syndesmosis screw was not used. Comparing the groups statistically revealed no statistically significant difference in all scores. Tenderness around the medial malleolus was detected in two patients in group 2 and nine patients in group 1. A statistically significant difference was detected in terms of medial clear space values and tenderness around the medial malleolus between both groups.

CONCLUSIONS: The absence of tenderness around the medial malleolus in Weber B ankle fractures indicates no syndesmosis injury, whereas the presence of tenderness around the medial malleolus does not mean that there is a syndesmosis injury.

PMID:38170597 | DOI:10.7547/22-128

Mol Biol Cell. 2024 Jan 3:mbcE23080298. doi: 10.1091/mbc.E23-08-0298. Online ahead of print.

ABSTRACT

Cell Painting assays generate morphological profiles that are versatile descriptors of biological systems and have been used to predict in vitro and in vivo drug effects. However, Cell Painting features extracted from classical software such as CellProfiler are based on statistical calculations and often not readily biologically interpretable. In this study, we propose a new feature space, which we call BioMorph, that maps these Cell Painting features with readouts from comprehensive Cell Health assays. We validated that the resulting BioMorph space effectively connected compounds not only with the morphological features associated with their bioactivity but with deeper insights into phenotypic characteristics and cellular processes associated with the given bioactivity. The BioMorph space revealed the mechanism of action for individual compounds, including dual-acting compounds such as emetine, an inhibitor of both protein synthesis and DNA replication. Overall, BioMorph space offers a biologically relevant way to interpret the cell morphological features derived using software such as CellProfiler and to generate hypotheses for experimental validation.

PMID:38170589 | DOI:10.1091/mbc.E23-08-0298

JMIR Form Res. 2024 Jan 3;8:e45998. doi: 10.2196/45998.

ABSTRACT

BACKGROUND: Psychological inflexibility is a core concept of acceptance and commitment therapy (ACT), which is a comprehensive, transdiagnostic interpretation of mental health symptoms. Erectile dysfunction (ED) is a condition that affects male sexual performance, involving the inability to achieve and maintain a penile erection sufficient for satisfactory sexual activity. Psychosocial factors primarily influence ED in men younger than 40 years, whereas biological factors are more likely to be the underlying cause in older men.

OBJECTIVE: This web-based cross-sectional study examined differences in depression, anxiety, and psychological inflexibility among men with ED younger and older than 40 years in a Japanese population.

METHODS: We used a web-based survey to gather data from various community samples. ED was assessed by the International Index of Erectile Function-5 (IIEF-5) questionnaire, while depression, anxiety, and psychological inflexibility were evaluated by the Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), Acceptance and Action Questionnaire-II (AAQ-II), Cognitive Fusion Questionnaire (CFQ), and Valuing Questionnaire-Obstacle Subscale (VQ-OB) questionnaires. The chi-square test estimated the scores of PHQ-9 and GAD-7 among men with ED, comparing those younger than 40 years and those older than 40 years. Additionally, a two-way ANOVA was conducted with ED severity and age group as independent variables, assessing psychological inflexibility.

RESULTS: Valid responses from 643 individuals (mean age 36.19, SD 7.54 years) were obtained. Of these, 422 were younger than 40 years (mean age 31.76, SD 5.00 years), and 221 were older than 40 years (mean age 44.67, SD 2.88 years). There was a statistical difference in the prevalence of depression as judged by PHQ≥10 between men with ED younger and older than 40 years (P<.001). On the other hand, there was no difference in the prevalence of anxiety as judged by GAD≥10 (P=.12). The two-way ANOVA revealed that the interactions for CFQ (P=.04) and VQ-OB (P=.01) were significant. The simple main effect was that men with ED younger than 40 years had significantly higher CFQ (P=.01; d=0.62) and VQ-OB (P<.001; d=0.87) scores compared to those older than 40 years in moderate ED and severe ED. Additionally, it was found that men younger than 40 years with moderate to severe ED had significantly higher CFQ (P=.01; d=0.42) and VQ-OB (P=.02; d=0.38) scores compared to men younger than 40 years without ED. On the other hand, no interaction was found for AAQ-II (P=.16) scores.

CONCLUSIONS: To the best of our knowledge, this web-based cross-sectional study is the first to examine the relationship between psychological inflexibility and ED. We conclude that men with moderate and severe ED younger than 40 years have higher psychological inflexibility and might be eligible for ACT.

PMID:38170587 | DOI:10.2196/45998

JMIR Pediatr Parent. 2024 Jan 3;7:e47361. doi: 10.2196/47361.

ABSTRACT

BACKGROUND: Falls are the most common hospitalized injury mechanism in children aged ≤1 years, and currently, there are no targeted prevention interventions. The prevention of falls in children of this age requires changes in the behavior of their caregivers, and theoretically informed digital behavior change interventions (DBCIs) may provide a unique mechanism for achieving effective intervention. However, user acceptance and the ability of DBCIs to effect the required changes in behavior are critical to their likelihood of success.

OBJECTIVE: This study aims to evaluate a behavior theory-informed digital intervention developed following a user-centered approach for user experience, the potential for this intervention to prevent infant falls, and its impact on behavioral drivers underpinning fall risk in young children.

METHODS: Parents of infants aged <1 year were recruited and asked to use the intervention for 3 months. A pre-post longitudinal design was used to examine the change in the potential to reduce the risk of falls after a 3-month exposure to the intervention. Postintervention data on behavioral drivers for fall prevention, user acceptability, and engagement with the app were also collected. Interviews were conducted to explore user experiences and identify areas for further improvement of the intervention.

RESULTS: A total of 62 parents participated in the study. A statistically significant effect on the potential to reduce falls was observed after the intervention. This effect was higher for new parents. Parents agreed that the intervention targeted most of the target behavior drivers. The impact of behavior drivers and intervention on the potential for fall prevention had a positive correlation. The intervention demonstrated good levels of acceptability. Feedback from participants was mostly positive, and the primary area identified for further improvement was widening the scope of the intervention.

CONCLUSIONS: This study demonstrated the promise of a newly developed digital intervention to reduce the risk of infant falls, particularly among new parents. It also showed a positive influence of the DBCI on the drivers of parental behaviors that are important for fall reduction among infants. The acceptability of the app was high, and important insights were gained from users about how to further improve the app.

PMID:38170580 | DOI:10.2196/47361

J Gerontol A Biol Sci Med Sci. 2024 Jan 3:glad288. doi: 10.1093/gerona/glad288. Online ahead of print.

ABSTRACT

BACKGROUNDS: To examine the association between cumulative cognitive function and subsequent mortality among patients hospitalized for acute heart failure (AHF).

METHODS: Based on a prospective cohort of patients hospitalized for AHF, cognitive function was measured by using Mini-Cog test at admission, 1- and 12-month following discharge. Cumulative cognitive function was interpreted by cumulative Mini-Cog score and cumulative times of cognitive impairment. Outcomes included subsequent all-cause and cardiovascular mortality.

RESULTS: 1454 patients hospitalized for AHF with median follow-up of 4.76 (interquartile range [IQR]: 4.18-5.07) years were included. Tertile 1 of cumulative Mini-Cog score had the highest risk of all-cause (hazard ratio [HR]: 1.52, 95% confidence interval [CI]: 1.14-2.03) and cardiovascular mortality (HR: 1.40, 95% CI: 1.02-1.93) compared with Tertile 3; patients with ≥ 2 times of cognitive impairment had the highest risk of all-cause (HR: 1.34, 95% CI: 1.03-1.73) and cardiovascular mortality (HR: 1.25, 95% CI: 0.93-1.67) compared with patients without any cognitive impairment. Cumulative Mini-Cog score provided the highest incremental prognostic ability in predicting all-cause (C-statistics: 0.64, 95% CI: 0.61-0.66) and cardiovascular mortality (C-statistics: 0.63, 95% CI: 0.60-0.67) risk on the basis of Get With The Guidelines-Heart Failure score.

CONCLUSION: Poor cumulative cognitive function was associated with increased risk of subsequent mortality and provided incremental prognostic ability for the outcomes among patients with AHF. Longitudinal assessment and monitoring of cognitive function among patients with AHF would be of great importance in identifying patients at greater risk of self-care absence for optimizing personal disease management in clinical practice.

PMID:38170569 | DOI:10.1093/gerona/glad288

JAMA Psychiatry. 2024 Jan 3. doi: 10.1001/jamapsychiatry.2023.4948. Online ahead of print.

ABSTRACT

IMPORTANCE: Transcranial direct current stimulation (tDCS) is moderately effective for depression when applied by trained staff. It is not known whether self-applied tDCS, combined or not with a digital psychological intervention, is also effective.

OBJECTIVE: To determine whether fully unsupervised home-use tDCS, combined with a digital psychological intervention or digital placebo, is effective for a major depressive episode.

DESIGN, SETTING, AND PARTICIPANTS: This was a double-blinded, sham-controlled, randomized clinical trial with 3 arms: (1) home-use tDCS plus a digital psychological intervention (double active); (2) home-use tDCS plus digital placebo (tDCS only), and (3) sham home-use tDCS plus digital placebo (double sham). The study was conducted between April 2021 and October 2022 at participants’ homes and at Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil. Included participants were aged 18 to 59 years with major depression and a Hamilton Depression Rating Scale, 17-item version (HDRS-17), score above 16, a minimum of 8 years of education, and access to a smartphone and internet at home. Exclusion criteria were other psychiatric disorders, except for anxiety; neurologic or clinical disorders; and tDCS contraindications.

INTERVENTIONS: tDCS was administered in 2-mA, 30-minute prefrontal sessions for 15 consecutive weekdays (1-mA, 90-second duration for sham) and twice-weekly sessions for 3 weeks. The digital intervention consisted of 46 sessions based on behavioral therapy. Digital placebo was internet browsing.

MAIN OUTCOMES AND MEASURES: Change in HDRS-17 score at week 6.

RESULTS: Of 837 volunteers screened, 210 participants were enrolled (180 [86%] female; mean [SD] age, 38.9 [9.3] years) and allocated to double active (n = 64), tDCS only (n = 73), or double sham (n = 73). Of the 210 participants enrolled, 199 finished the trial. Linear mixed-effects models did not reveal statistically significant group differences in treatment by time interactions for HDRS-17 scores, and the estimated effect sizes between groups were as follows: double active vs tDCS only (Cohen d, 0.05; 95% CI, -0.48 to 0.58; P = .86), double active vs double sham (Cohen d, -0.20; 95% CI, -0.73 to 0.34; P = .47), and tDCS only vs double sham (Cohen d, -0.25; 95% CI, -0.76 to 0.27; P = .35). Skin redness and heat or burning sensations were more frequent in the double active and tDCS only groups. One nonfatal suicide attempt occurred in the tDCS only group.

CONCLUSIONS AND RELEVANCE: Unsupervised home-use tDCS combined with a digital psychological intervention or digital placebo was not found to be superior to sham for treatment of a major depressive episode in this trial.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04889976.

PMID:38170541 | DOI:10.1001/jamapsychiatry.2023.4948

JAMA Surg. 2024 Jan 3. doi: 10.1001/jamasurg.2023.6699. Online ahead of print.

NO ABSTRACT

PMID:38170534 | DOI:10.1001/jamasurg.2023.6699

JAMA Netw Open. 2024 Jan 2;7(1):e2350044. doi: 10.1001/jamanetworkopen.2023.50044.

ABSTRACT

IMPORTANCE: Investigations into the association of antepartum maternal infections with the pathogenesis of biliary atresia (BA) in human offspring are insufficient.

OBJECTIVE: To examine the association between prenatal infections in mothers and the development of BA in their offspring.

DESIGN, SETTING, AND PARTICIPANTS: This population-based case-control study obtained administrative data from the Taiwan National Health Insurance Research Database with linkage to the Taiwan Maternal and Child Health Database, capturing demographic and medical information on nearly all 23 million of the Taiwan population. The cohort comprised 2 905 978 singleton live births among mother-infant dyads between January 1, 2004, and December 31, 2020, in Taiwan. The case group of infants with BA was identified from use of International Classification of Diseases diagnostic codes for BA and subsequent Kasai procedure or liver transplant. The control group was randomly selected from infants without BA, representing approximately 1 in 1000 study population. Data analyses were performed from May 1 to October 31, 2023.

EXPOSURE: Prenatal maternal infections, including intestinal infection, influenza, upper airway infection, pneumonia, soft-tissue infection, and genitourinary tract infection.

MAIN OUTCOMES AND MEASURES: The main outcome was exposure to prenatal maternal infections. Inverse probability weighting analysis was performed by building a logistic regression model to estimate the probability of the exposure observed for a particular infant and using the estimated probability as a weight in subsequent analyses. The weighted odds ratio (OR) estimated by logistic regressions was then used to assess the risk of BA in offspring after prenatal maternal infections.

RESULTS: Among the mother-infant dyads included, 447 infants with BA were cases (232 females [51.9%]) and 2912 infants without BA were controls (1514 males [52.0%]). The mean (SD) maternal age at childbirth was 30.7 (4.9) years. Offspring exposed to prenatal intestinal infection (weighted OR, 1.46; 95% CI, 1.17-1.82) and genitourinary tract infection (weighted OR, 1.22; 95% CI, 1.05-1.41) in mothers exhibited a significantly higher risk of BA. Furthermore, maternal intestinal infection (weighted OR, 6.05; 95% CI, 3.80-9.63) and genitourinary tract infection (weighted OR, 1.55; 95% CI, 1.13-2.11) that occurred during the third trimester were associated with an increased risk of BA in offspring.

CONCLUSIONS AND RELEVANCE: Results of this case-control study indicate an association between prenatal intestinal infection and genitourinary tract infection in mothers and BA occurrence in their offspring. Further studies are warranted to explore the underlying mechanisms of this association.

PMID:38170523 | DOI:10.1001/jamanetworkopen.2023.50044