Category: Statistics

PLoS One. 2023 Jun 7;18(6):e0276032. doi: 10.1371/journal.pone.0276032. eCollection 2023.

ABSTRACT

Intimate partner violence against women (IPVW) is a pressing social issue which poses a challenge in terms of prevention, legal action, and reporting the abuse once it has occurred. However, a significant number of female victims who file a complaint against their abuser and initiate legal proceedings, subsequently, withdraw charges for different reasons. Research in this field has been focusing on identifying the factors underlying women victims’ decision to disengage from the legal process to enable intervention before this occurs. Previous studies have applied statistical models to use input variables and make a prediction of withdrawal. However, none have used machine learning models to predict disengagement from legal proceedings in IPVW cases. This could represent a more accurate way of detecting these events. This study applied machine learning (ML) techniques to predict the decision of IPVW victims to withdraw from prosecution. Three different ML algorithms were optimized and tested with the original dataset to assess the performance of ML models against non-linear input data. Once the best models had been obtained, explainable artificial intelligence (xAI) techniques were applied to search for the most informative input features and reduce the original dataset to the most important variables. Finally, these results were compared to those obtained in the previous work that used statistical techniques, and the set of most informative parameters was combined with the variables of the previous study, showing that ML-based models had a better predictive accuracy in all cases and that by adding one new variable to the previous work’s predictive model, the accuracy to detect withdrawal improved by 7.5%.

PMID:37285361 | DOI:10.1371/journal.pone.0276032

PLoS One. 2023 Jun 7;18(6):e0286401. doi: 10.1371/journal.pone.0286401. eCollection 2023.

ABSTRACT

The relationship between lifestyles and multimorbidity is well established, but previous studies have often neglected the role of spatial heterogeneity. Thus, this study is the first to explore this association in Chinese adults from a spatial perspective using a geographically weighted logistic regression (GWLR) model and describe the geographical characteristics across different regions. According to 2018 China Health and Retirement Longitudinal Study (CHARLS) database, a total of 7101 subjects were finally included, with 124 prefecture-level administrative regions in China. Non-spatial and GWLR model were used for analysis, and gender stratification analysis was also performed. Data were visualized through ArcGIS 10.7. The results showed that a total prevalence of approximately 5.13% of multimorbidity, and among participants with multimorbidity, the separate prevalence of hypertension, diabetes or high blood sugar, heart disease, and stroke were 4.45%, 2.32%, 3.02%, and 1.41%, respectively. The GWLR model indicated that current (OR: 1.202-1.220) and former smokers (OR: 1.168-1.206) may be important risk factors for multimorbidity in adults, especially in north and west among male. Past drinkers (OR: 1.233-1.240), especially in eastern China, contribute to the development of the multimorbidity in men but not in women. Vigorous-intensity activities (OR: 0.761-0.799) were negatively associated with multimorbidity in the west, with no gender difference. Depression (OR: 1.266-1.293) appeared to increase the risk for multimorbidity, with the weakest effects in central China and no gender difference. There was an interaction between light activities and gender (P = 0.024). The prevalence of multimorbidity differed across various areas of the province. The role of geographical variations in lifestyles and multimorbidity may provide valuable information for developing site-specific intervention strategies.

PMID:37285342 | DOI:10.1371/journal.pone.0286401

PLoS Comput Biol. 2023 Jun 7;19(6):e1011147. doi: 10.1371/journal.pcbi.1011147. eCollection 2023 Jun.

ABSTRACT

Aquatic systems worldwide can exist in multiple ecosystem states (i.e., a recurring collection of biological and chemical attributes), and effectively characterizing multidimensionality will aid protection of desirable states and guide rehabilitation. The Upper Mississippi River System is composed of a large floodplain river system spanning 2200 km and multiple federal, state, tribal and local governmental units. Multiple ecosystem states may occur within the system, and characterization of the variables that define these ecosystem states could guide river rehabilitation. We coupled a long-term (30-year) highly dimensional water quality monitoring dataset with multiple topological data analysis (TDA) techniques to classify ecosystem states, identify state variables, and detect state transitions over 30 years in the river to guide conservation. Across the entire system, TDA identified five ecosystem states. State 1 was characterized by exceptionally clear, clean, and cold-water conditions typical of winter (i.e., a clear-water state); State 2 had the greatest range of environmental conditions and contained most the data (i.e., a status-quo state); and States 3, 4, and 5 had extremely high concentrations of suspended solids (i.e., turbid states, with State 5 as the most turbid). The TDA mapped clear patterns of the ecosystem states across several riverine navigation reaches and seasons that furthered ecological understanding. State variables were identified as suspended solids, chlorophyll a, and total phosphorus, which are also state variables of shallow lakes worldwide. The TDA change detection function showed short-term state transitions based on seasonality and episodic events, and provided evidence of gradual, long-term changes due to water quality improvements over three decades. These results can inform decision making and guide actions for regulatory and restoration agencies by assessing the status and trends of this important river and provide quantitative targets for state variables. The TDA change detection function may serve as a new tool for predicting the vulnerability to undesirable state transitions in this system and other ecosystems with sufficient data. Coupling ecosystem state concepts and TDA tools can be transferred to any ecosystem with large data to help classify states and understand their vulnerability to state transitions.

PMID:37285341 | DOI:10.1371/journal.pcbi.1011147

JNCI Cancer Spectr. 2023 Jun 7:pkad039. doi: 10.1093/jncics/pkad039. Online ahead of print.

ABSTRACT

BACKGROUND: Genetic predispositions may modulate risk for developing neurocognitive late effects in childhood acute lymphoblastic leukemia (ALL) survivors.

METHODS: Long-term ALL survivors (n = 212; 14.3[4.77] years, mean[SD]; 49% female) treated with chemotherapy completed neurocognitive testing and task-based functional neuroimaging (fMRI). Based on previous work from our team, genetic variants related to the folate pathway, glucocorticoid regulation, drug metabolism, oxidative stress, and attention were included as predictors of neurocognitive performance, using multivariable models adjusted for age, race, and sex. Subsequent analyses evaluated the impact of these variants on task-based fMRI. Statistical tests were two-sided.

RESULTS: Survivors exhibited higher rates of impaired attention(20.8%), motor skills(42.2%), visuo-spatial memory(49.3-58.3%), processing speed(20.1%), and executive function(24.3-26.1%) relative to population norms (10%; p’s < 0.001). Genetic variants implicated in attention deficit phenotypes predicted impaired attention span (synaptosome associated protein 25 [SNAP25rs3746544], F(2,172)=4.07, p = 0.019) and motor skills (monoamine oxidase A, [MAOArs1137070], F(2,125)=5.25, p = 0.007). Visuo-spatial memory and processing speed varied as a function of genetic variants in the folate pathway (methylenetetrahydrofolate reductase [MTHFRrs1801133], F(2,165)=3.48, p = 0.033; methylenetetrahydrofolate dehydrogenase 1 [MTHFD1rs2236225], F(2,135)=3.8, p = 0.025; respectively). Executive function performance was modulated by genetic variants in the folate pathway (MTHFD1rs2236225, F(2,158)=3.95, p = 0.021; MTHFD1rs1950902, F(2,154)=5.55, p = 0.005) and glucocorticoid regulation (vitamin D receptor [VDRrs154410], F(2,158)=3.29, p = 0.039; FKBP prolyl isomerase 5 [FKBP5rs1360780], F(2,154)=5.6, p = 0.005). Additionally, MTHFD1rs2236225 and FKBP5rs1360780 were associated with altered brain function during attention and working memory (p < 0.05; FWE corrected).

CONCLUSION: Results extend previous findings of genetic risk of neurocognitive impairment following ALL therapy and highlight the importance of examining genetic modulators in relation to neurocognitive deficits.

PMID:37285328 | DOI:10.1093/jncics/pkad039

PLoS One. 2023 Jun 7;18(6):e0283947. doi: 10.1371/journal.pone.0283947. eCollection 2023.

ABSTRACT

BACKGROUND: Communicating well with patients is a competence central to everyday clinical practice, and communicating statistical information, especially in Bayesian reasoning tasks, can be challenging. In Bayesian reasoning tasks, information can be communicated in two different ways (which we call directions of information): The direction of Bayesian information (e.g., proportion of people tested positive among those with the disease) and the direction of diagnostic information (e.g., the proportion of people having the disease among those tested positive). The purpose of this study was to analyze the impact of both the direction of the information presented and whether a visualization (frequency net) is presented with it on patient’s ability to quantify a positive predictive value.

MATERIAL AND METHODS: 109 participants completed four different medical cases (2⨯2⨯4 design) that were presented in a video; a physician communicated frequencies using different directions of information (Bayesian information vs. diagnostic information). In half of the cases for each direction, participants were given a frequency net. After watching the video, participants stated a positive predictive value. Accuracy and speed of response were analyzed.

RESULTS: Communicating with Bayesian information led to participant performance of only 10% (without frequency net) and 37% (with frequency net) accuracy. The tasks communicated with diagnostic information but without a frequency net were correctly solved by 72% of participants, but accuracy rate decreased to 61% when participants were given a frequency net. Participants with correct responses in the Bayesian information version without visualization took longest to complete the tasks (median of 106 seconds; median of 13.5, 14.0, and 14.5 seconds in other versions).

DISCUSSION: Communicating with diagnostic information rather than Bayesian information helps patients to understand specific information better and more quickly. Patients’ understanding of the relevance of test results is strongly dependent on the way the information is presented.

PMID:37285320 | DOI:10.1371/journal.pone.0283947

Plast Reconstr Surg. 2023 Jun 6. doi: 10.1097/PRS.0000000000010799. Online ahead of print.

ABSTRACT

BACKGROUND: To investigate the postoperative effect of dental arch changes in cleft palate patients with modified Sommerlad palatoplasty by intraoral scanning technique in early deciduous dentition children.

METHODS: Patients (n=60) with non-syndromic unilateral complete cleft lip with palate (UCLP) or cleft palate only (CPO) treated by modified Sommerlad palatoplasty without relaxed excision before 18 months old and 95 healthy controls without cleft were included. Three-dimension images of the maxillary dental arches of all subjects aged 3 to 4 years were obtained by intraoral scanning (IOS) technique. Seven parameters including anterior dental arch width (Ar-Al), middle dental arch width (Fr-Fl), posterior dental arch width (Sr-Sl), anterior palatal arch width (Cr-Cl), posterior palatal arch width (Mr-Ml), anterior dental arch length (IP-D) and entire dental arch length (IP-O) were measured.

RESULTS: Compared with male group, the Mr-Ml distance of controls in female group statistically decreased (p=0.039) and the Fr-Fl, Sr-Sl, Mr-Ml distance of female patients decreased (p=0.013, p=0.002, p=0.005). The IP-D, IP-O distance of children in UCLP group was shorter than those of CPO children (p＜0.0001, p＜0.0001). Patient group showed decreased distance of Ar-Al, Cr-Cl, IP-D and IP-O and increased distance of Sr-Sl and Mr-Ml compared with control group (p=0.0002, p=0.002, p<0.0001, p<0.0001, p=0.007, p=0.027).

CONCLUSION: The results indicated that the modified palatoplasty showed no growth inhibition in the middle, posterior dental arch width, and palatal arch width, though slightly but significantly inhibition in the length of anterior and entire dental arch.

CLINICAL QUESTION/ LEVEL OF EVIDNCE: Risk, III.

PMID:37285204 | DOI:10.1097/PRS.0000000000010799

Breastfeed Med. 2023 Jun 6. doi: 10.1089/bfm.2022.0237. Online ahead of print.

ABSTRACT

Background: Although the beneficial effects of exclusive breastfeeding (EBF) on infants and mothers have been identified, EBF rates remain unsatisfactory. Co-parenting interventions for perinatal couples have not been systematically evaluated and analyzed for their effects on breastfeeding outcomes. Aims and Objectives: To systematically evaluate the effects of co-parenting interventions on the rate of EBF, breastfeeding knowledge, breastfeeding attitude, breastfeeding self-efficacy, parental relationship, and partner support. Methods: Randomized controlled trials and quasi-experimental studies were systematically screened in eight online databases from inception to November 2022. Trials included in this review were assessed using the Cochrane Risk of Bias Assessment Tool. Eligible trials were used to conduct a meta-analysis using Review Manager software. The I² statistic was used to assess heterogeneity between studies. When it was not possible to conduct a meta-analysis, a descriptive analysis was used to present the findings due to insufficient data from the included studies. Results: Fifteen of the 1,869 articles reviewed met the inclusion criteria. Co-parenting interventions significantly improved the EBF rate at 16 weeks (odds ratio [OR] = 3.85, 95% confidence interval, CI [1.84 to 8.03], p < 0.001, I² = 69%) and 6 months (OR = 2.82, 95% CI [1.47 to 5.41], p = 0.002, I² = 85%). This study revealed that co-parenting interventions made statistically significant improvements in parental relationship (standardized mean difference [SMD] = 0.26, 95% CI [0.13 to 0.38], p < 0.001, I² = 80%). There was no evidence of the effectiveness of interventions in terms of overall parental support (SMD = 0.75, 95% CI [-0.46 to 1.97], p < 0.001, I² = 96%). Given the discrepant and limited research data, findings on breastfeeding knowledge, breastfeeding attitudes, and breastfeeding self-efficacy were presented descriptively. Conclusion: Co-parenting interventions effectively increase EBF rates at 16 weeks and 6 months postpartum, and improve breastfeeding knowledge, breastfeeding attitude, and parental relationships.

PMID:37285199 | DOI:10.1089/bfm.2022.0237

Plast Reconstr Surg. 2023 Jun 6. doi: 10.1097/PRS.0000000000010807. Online ahead of print.

ABSTRACT

BACKGROUND: Many options for free tissue transfer have been described for head and neck reconstruction. While functional outcomes remain paramount, aesthetic considerations like color match can be equally consequential for patient quality of life. It is important to understand differences in color match based on flap donor site for head and neck reconstruction.

METHODS: A retrospective review was performed of patients who underwent head and neck reconstruction with free tissue transfer at a tertiary care academic medical center between November 2012 and November 2020. Patients with documented pictures of their reconstruction and external skin paddles were considered. Patient demographics and surgery specific factors were recorded. Objective differences in color match were obtained by calculating the International Commission on Illumination Delta E 2000 (dE2000) score. Standard univariate descriptive statistics and multivariable statistical analyses were performed.

RESULTS: Lateral arm, parascapular, and medial sural artery perforator (MSAP) free tissue transfer performed favorably compared to other donor sites, whereas anterolateral thigh flaps had the highest average dE2000 scores. Differences in dE2000 scores were mitigated by post-operative radiation to the flap site and with increasing time beyond 6 months post-operatively.

CONCLUSIONS: We provide an objective assessment of external skin color match in patients undergoing free tissue transfer for head and neck cancer by donor site. MSAP, lateral arm, and parascapular free flaps performed well compared to traditional donor sites. These differences are more significant at the face and mandible when compared to the neck, but diminish 6 months after surgery and with post-operative radiation to the free flap skin paddle.

PMID:37285194 | DOI:10.1097/PRS.0000000000010807

JMIR Hum Factors. 2023 Jun 7;10:e40111. doi: 10.2196/40111.

ABSTRACT

BACKGROUND: Despite young First Nations Australians being typically healthy, happy, and connected to family and culture, high rates of emotional distress, suicide, and self-harm are also observed. Differing worldviews of service providers and First Nations young people regarding illness and treatment practices, language differences, culturally inappropriate service models, geographical remoteness, and stigma can all inhibit access to appropriate mental health support. Mental health treatments delivered digitally (digital mental health; dMH) offer flexible access to evidence-based, nonstigmatizing, low-cost treatment and early intervention on a broad scale. There is a rapidly growing use and acceptance of these technologies among young First Nations people.

OBJECTIVE: The objective was to assess the feasibility, acceptability, and use of the newly developed Aboriginal and Islander Mental Health Initiative for Youth (AIMhi-Y) app and determine the feasibility of study procedures in preparation for future assessments of effectiveness.

METHODS: This was a nonrandomized pre-post study using mixed methods. First Nations young people aged 12-25 years who provided consent (with parental consent where appropriate) and possessed the ability to navigate a simple app with basic English literacy were included. Researchers conducted one face-to-face 20-minute session with participants to introduce and orient them to the AIMhi-Y app. The app integrates culturally adapted low-intensity cognitive behavioral therapy (CBT), psychoeducation, and mindfulness-based activities. Participants received supportive text messages weekly throughout the 4-week intervention period and completed assessments of psychological distress, depression, anxiety, substance misuse, help-seeking, service use, and parent-rated strengths and difficulties at baseline and 4 weeks. Qualitative interviews and rating scales were completed at 4 weeks to gain feedback on subjective experience, look and style, content, overall rating, check-ins, and involvement in the study. App use data were collected.

RESULTS: Thirty young people (17 males and 13 females) aged between 12 and 18 (mean 14.0, SD 1.55) years were assessed at baseline and 4 weeks. Repeated measures 2-tailed t tests showed improvements in well-being measures that were statistically and clinically significant for psychological distress (Kessler Psychological Distress Scale, 10-item) and depressive symptoms (Patient Health Questionnaire, 2-item). Participants spent on average 37 minutes in the app. The app was rated positively, with mean ratings of 4 out of 5 points (on scales of 1-5). Participants reported that they found the app easy to use, culturally relevant, and useful. The feasibility of the study was demonstrated with a 62% recruitment rate, a 90% retention rate, and high study acceptability ratings.

CONCLUSIONS: This study supports earlier research suggesting that dMH apps that are appropriately designed with and for the target populations are a feasible and acceptable means of lowering symptoms for mental health disorders among First Nations youth.

PMID:37285184 | DOI:10.2196/40111

Cardiovasc J Afr. 2023 Jun 7;34:1-5. doi: 10.5830/CVJA-2023-017. Online ahead of print.

ABSTRACT

AIM: Empagliflozin (EMPA) is a sodium-glucose transporter-2 inhibitor used in the treatment of type 2 diabetes and has positive effects on cardiovascular outcomes. Amitriptyline (AMT) can be used in many clinical indications but leads to cardiotoxicity by causing QT prolongation. Our aim in this study was to determine how the effects of the concomitant use of empagliflozin and amitriptyline, which have been shown to have effects on sodium and calcium metabolism in cardiomyocytes, would cause an effect on QT and QTc intervals in clinical practice.

METHODS: Twenty-four male Wistar albino rats were randomised into four groups. The control group received only physiological serum (1 ml) via orogastric gavage (OG). The EMPA group received empagliflozin (10 mg/kg) via OG. The AMT group received amitriptyline (100 mg/kg) via OG. The AMT + EMPA group (n = 6) received amitriptyline (100 mg/kg) and empagliflozin (10 mg/kg). Under anaesthesia, QT and QTc intervals were measured at baseline, and in the first and second hours.

RESULTS: In the AMT group, QT intervals and QTc values were found to be statistically longer than in the control group (p ≤ 0.001). Empagliflozin significantly ameliorated amitriptyline-induced QT and QTc prolongation. In the AMT + EMPA group, QT and QTc intervals were significantly lower compared to that in the AMT group (p < 0.01).

CONCLUSION: In this study, we determined that empagliflozin significantly ameliorated amitriptyline-induced QT and QTc prolongation. This effect was probably due to the opposite effects of these two agents in the intracellular calcium balance. With more clinical trials, the routine use of empagliflozin may be suggested to prevent QT and QTc prolongation in diabetic patients receiving amitriptyline.

PMID:37285169 | DOI:10.5830/CVJA-2023-017