Category: Statistics

J Med Internet Res. 2023 Oct 10. doi: 10.2196/47112. Online ahead of print.

ABSTRACT

BACKGROUND: Recent studies have linked a low Heart Rate Variability (HRV) with COVID-19 infection, indicating that this parameter can be a marker of the onset of the disease, its severity, and predictor of mortality in infected people. Given the large offer of wearable devices that capture physiological signals of the human body easily and non-invasive, several studies used this equipment to measure the HRV of individuals and related these measures to the infection by COVID-19.

OBJECTIVE: The objective of this study was to assess the utility of HRV measurements obtained from wearable devices as predictive indicators for COVID-19 infection, as well as the onset and worsening of symptoms in affected individuals.

METHODS: A systematic review was conducted, searching the following databases up to the end of January 2023: Embase, PubMed, Web of Science, Scopus, and IEEE. Studies had to include (I) measures of HRV in patients with COVID-19 and (II) measurements involving the use of wearable devices. We also conducted a meta-analysis of these measures to reduce the possible biases and increase the statistical power of the primary research.

RESULTS: The main result was the association between low HRV and the onset and worsening of COVID-19 symptoms. In some cases, it was possible to predict the onset of COVID-19 before a positive clinical test. The meta-analysis of studies reported shows that a reduction in HRV parameters is associated with COVID-19 infection. Individuals with COVID-19 presented a reduction in the SDNN and RMSSD indices compared to healthy individuals. The decrease in the SDNN index (Standard Deviation of the Normal-to-Normal interbeat interval) was 3.25 ms (95% CI -5.34 to -1.16), and the decrease in the RMSSD index (Root Mean Square Successive Difference) was 1.24 ms (95% CI -3.71 to 1.23).

CONCLUSIONS: Wearable devices that measure changes in HRV, such as smart watches, rings, and bracelets, provide information that allows identifying the COVID-19 infection during the presymptomatic period as well as its worsening, through an indirect and non-invasive self-diagnosis.

CLINICALTRIAL: International Prospective Register of Systematic Reviews (PROSPERO; CRD42023399705).

PMID:37820372 | DOI:10.2196/47112

J Chem Inf Model. 2023 Oct 11. doi: 10.1021/acs.jcim.3c00761. Online ahead of print.

ABSTRACT

Raman spectra are examples of high dimensional data that can often be limited in the number of samples. This is a primary concern when Deep Learning frameworks are developed for tasks such as chemical species identification, quantification, and diagnostics. Open-source data are difficult to obtain and often sparse; furthermore, the collecting and curating of new spectra require expertise and resources. Deep generative modeling utilizes Deep Learning architectures to approximate high dimensional distributions and aims to generate realistic synthetic data. The evaluation of the data and the performance of the deep models is usually conducted on a per-task basis and provides no indication of an increase to robustness, or generalization, on a wider scale. In this study, we compare the benefits and limitations of a standard statistical approach to data synthesis (weighted blending) with a popular deep generative model, the Variational Autoencoder. Two binary data sets are divided into 3-fold to simulate small, limited samples. Synthetic data distributions are created per fold using the two methods and then augmented into the training of two Deep Learning algorithms, a Convolutional Neural Network and a Fully-Connected Neural Network. The goal of this study is to observe the trends in learning as synthetic data are continually augmented to the training data in increasing batches. To determine the impact of each synthetic method, Principal Component Analysis and the discrete Fréchet distance are implemented to visualize and measure the distance between the source and synthetic distributions along with the Machine Learning metric balanced accuracy for evaluating performance on imbalanced data.

PMID:37820361 | DOI:10.1021/acs.jcim.3c00761

Am J Respir Crit Care Med. 2023 Oct 11. doi: 10.1164/rccm.202305-0854OC. Online ahead of print.

ABSTRACT

RATIONALE: Assessing the early use of video-assisted thoracoscopic surgery (VATS) or intrapleural enzyme therapy (IET) in pleural infection requires a phase III randomized controlled trial (RCT).

OBJECTIVES: To establish the feasibility of randomization in a surgery versus non-surgery trial as well as the key outcome measures which are important to identify relevant patient-centered outcomes in a RCT.

METHODS: MIST-3 was a prospective multicenter RCT. All-comers with a confirmed diagnosis of pleural infection were enrolled and those with ongoing pleural sepsis after up to 24-hours of standard care were randomized to one of 3 arms; continued standard care, IET, or surgical opinion for VATS. The analysis was by intention to treat, despite some participants in the VATS arm not being fit enough to undergo surgical intervention.

MAIN RESULTS: Of 97 eligible patients, 60 (62%) participants were randomized. Despite a difference in time-to-intervention, length of stay was similar in both arms. There were no significant inter-group differences in 2-month readmission and further intervention. Compared to VATS, IET demonstrated a greater improvement in mean EQ-5D-5L health utility index at 2 months from baseline.

CONCLUSION: This is the first multicenter RCT of early IET vs early surgery in pleural infection. Despite logistical challenges posed by the COVID-19 pandemic, the study met its predefined feasibility criteria. Potential shortening of LOS with early surgery, and signals toward earlier resolution of pain and shortened recovery with IET were demonstrated. The study findings suggest that a definitive study is feasible and required to assess optimal initial management. Clinical trial registration available at www.isrctn.com, ID: ISRCTN18192121.

PMID:37820359 | DOI:10.1164/rccm.202305-0854OC

J Dev Behav Pediatr. 2023 Oct 11. doi: 10.1097/DBP.0000000000001221. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to understand health care experiences among a sample of caregivers of children with TDs to inform future directions for improving the health care system.

METHODS: We conducted a survey of caregivers of youth with TDs and used descriptive statistics and quantitative analyses to characterize the health care utilization practices of the sample.

RESULTS: The majority (70%) of families first consulted their pediatrician/primary care provider, and caregivers reported receiving care in line with current best practice guidelines. However, caregivers in the current sample perceived a lack of knowledgeability on the part of their first providers, which significantly predicted more providers seen and also reported difficulty finding specialty providers (63% of the sample reported difficulty finding a treatment provider who understood tics).

CONCLUSION: Results suggest that improving caregiver satisfaction with early health care experiences for their child’s TD may help to relieve the burden on families and the health care system more broadly, along with continued efforts to increase the number of specialty providers available.

PMID:37820348 | DOI:10.1097/DBP.0000000000001221

Pediatr Infect Dis J. 2023 Oct 9. doi: 10.1097/INF.0000000000004082. Online ahead of print.

ABSTRACT

OBJECTIVE: To identify the difference in clinical characteristics between viral pneumonia and Mycoplasma pneumoniae, providing cues on their differential diagnosis for primary hospitals with the insufficient pathogen detection capacity.

METHODS: We retrospectively reviewed the medical records of hospitalized children with acute respiratory tract infections, and pathogenic microbes test results were analyzed. Clinical characteristics, routine blood parameters and hospitalization duration and fee were compared between M. pneumoniae and viral pneumonia. We used in the multivariable logistic regression to predict the probability of children with M. pneumoniae and graphically represented by a dynamic nomogram. The discrimination and clinical utility of the model were confirmed by receiver operating characteristic and decision curve analysis curves.

RESULT: A total of 375 children with community-acquired pneumonia were included. Mycoplasma infection accounted for the largest proportion (22.13%). The incidence of both hypothermia and vomiting was lower in M. pneumoniae compared to viral pneumonia (hypothermia: 10.50% vs. 0.00%; vomiting: 7.90% vs. 0.00%). The prevalence of hyperthermia was higher in M. pneumoniae (hyperthermia: 89.5% vs. 100%). Procalcitonin, peripheral blood white blood cell count and lymphocyte levels were higher in the viral pneumonia group, and eosinophil levels were conversely lower. As for the duration of illness, the mean length of stay was 5.20 ± 2.12 (viral pneumonia) and 6.27 ± 2.48 days (M. pneumoniae). Children with M. pneumoniae had higher overall hospital costs and required more medical treatment. The above were all statistically significant with a P < 0.05. The scoring system was established based on the above results. Receiver operating characteristic curves showed good model-discrimination ability with 0.844 of the area under the curve in the training set and 0.778 in the test set. Decision curve analysis curves demonstrated the discriminative superiority of this model. The web-based dynamic nomogram calculator is accessible at https://zhxylxy0160128.shinyapps.io/Nomogram/.

CONCLUSION: Nomograms have satisfactory discrimination, and clinical utility may benefit in predicting the probability of developing M. pneumoniae in children. Children with M. pneumoniae have a higher burden than those with viral pneumonia and may require more intensive in-hospital monitoring.

PMID:37820276 | DOI:10.1097/INF.0000000000004082

Pediatr Infect Dis J. 2023 Oct 5. doi: 10.1097/INF.0000000000004128. Online ahead of print.

ABSTRACT

BACKGROUND: Doxycycline is considered the first-line treatment of Lyme disease in adolescents and adults, but largely disproven concerns of permanent tooth staining prevented its use and evaluation in children <8 years old. We sought to describe short-term adverse effects and treatment failures among young children receiving oral doxycycline for Lyme disease.

METHODS: We completed a 2-pronged evaluation of children with Lyme disease treated with doxycycline. We performed a retrospective case series of patients <8 years old who were diagnosed with Lyme disease and treated with doxycycline. We then performed a telephone follow-up survey study of the patients’ parents to gather additional details regarding clinical outcomes and adverse reactions to doxycycline. Descriptive statistics were calculated.

RESULTS: A total of 32 patients were identified through the retrospective case series and 18 participated in the follow-up survey. The most common clinical diagnosis (22/32; 69%) was single erythema migrans. Seven (22%) had neurological Lyme disease. Three patients (9%) stopped doxycycline treatment prematurely due to adverse effects. During telephone follow-up, 2 children were reported to have dental staining. No patients were identified with treatment failure during the retrospective case series. On telephone follow-up, 3 patients had residual symptoms after treatment, though none were convincing of treatment failure.

CONCLUSIONS: Our study suggests that doxycycline is generally well-tolerated and an effective treatment of Lyme disease in young children. Prospective, observational studies with long-term assessment of dental staining and clinical outcomes are needed. Alternative antibiotics, principally amoxicillin, remain the preferred treatment of non-neurological Lyme disease manifestations in young children, but doxycycline is likely a safe and effective alternative when needed.

PMID:37820258 | DOI:10.1097/INF.0000000000004128

Braz Oral Res. 2023 Oct 9;37:e091. doi: 10.1590/1807-3107bor-2023.vol37.0091. eCollection 2023.

ABSTRACT

Maternal mental health affects their children’s oral health. This study assessed the associations between maternal mental health and dental anxiety level, dental caries experience, oral hygiene, and gingival status among 6- to 12-year-old children in Nigeria. This was a cross-sectional study that recruited mother-child dyad participants through a household survey conducted in Ile-Ife, Nigeria. Data collected included the independent (maternal mental health risk, depressive symptoms, and child’s dental anxiety), and dependent (caries experience, oral hygiene status, and gingival health status) variables. Multivariate logistic regression analysis was conducted to determine the associations between dependent and independent variables after adjusting for confounders (mothers’ age, child’s age, sex, and socioeconomic status). Statistical significance was set at p < 0.05. Of the 1411 mothers recruited, 1248 (88.4%) had low mental health risk, and 896 (63.5%) had mild depressive symptoms. As for the children, 53 (3.8%) had caries, 745 (52.8%) had moderate to high dental anxiety, 953 (63.0%) had gingivitis and 36 (2.6%) had poor oral hygiene. The maternal mental health risk was not significantly associated with the child’s caries experience (AOR: 1.012; 95%CI: 0.860-1.190; p = 0.886), poor oral hygiene (AOR:1.037; 95%CI: 0.975-1.104; p=0.250), and moderate/severe gingivitis (AOR:0.887; 95%CI: 0.764-1.030; p = 0.115). Maternal depression status was not significantly associated with the child’s caries experience (AOR: 0.910; 95%CI: 0.802-1.033; p = 0.145), poor oral hygiene (AOR: 1.016; 95%CI: 0.976-1.057; p = 0.439), and moderate/severe gingivitis (AOR: 0.963; 95%CI: 0.861-1.077; p = 0.509). Maternal mental health risk and depression do not seem to be risk factors for schoolchildren’s oral health in Nigeria. Further studies are needed to understand these findings.

PMID:37820250 | DOI:10.1590/1807-3107bor-2023.vol37.0091

Cad Saude Publica. 2023 Oct 9;39(8):e00138122. doi: 10.1590/0102-311XPT138122. eCollection 2023.

ABSTRACT

This study evaluates the association of birth conditions with attention deficit/hyperactivity disorders (ADHD) in adults using data from two birth cohorts in the city of Pelotas Rio Grande do Sul State, Brazil. In 1982 and 1993 all births in the city were identified and have been prospectively monitored. In the follow-ups at 30 and 22 years of the 1982 (n = 3,574) and 1993 (n = 3,780) cohorts, respectively, participants were examined, and trained psychologists applied the Mini-International Neuropsychiatric Interview (M.I.N.I.). Those individuals who met the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria were defined as positive for ADHD. Poisson regression with robust variance adjustment was used to estimate the prevalence ratio (PR) adjusted for sex, maternal skin color, family income, maternal age, maternal schooling during pregnancy, maternal marital status, parity, and maternal smoking during pregnancy. The prevalence of adult ADHD was 4.4% and 4.5% in the 1982 and 1993 cohorts, respectively. The prevalence of ADHD was higher in those born with lower weight, but no linear trend was observed, and those born with weight between 3,000 and 3,499 grams (PR = 1.40; 95%CI: 1.05-1.86) had the highest risk. For gestational age, we observed an inversely proportional relationship for the presence of ADHD: preterm infants had a 33% higher risk (95%CI: 0.90-1.96) of being considered as having ADHD than those born at 39 or more weeks, but as the confidence interval included nullity, this association may have occurred at random. These results indicate that birth weight and gestational age may be associated with adult ADHD.

PMID:37820233 | DOI:10.1590/0102-311XPT138122

Dental Press J Orthod. 2023 Oct 9;28(4):e232333. doi: 10.1590/2177-6709.28.4.e232333.oar. eCollection 2023.

ABSTRACT

INTRODUCTION: Superposing 3D models is an imminent need. However, current methods rely on marking multiple points on the maxilla and mandible, which could increase point marking and overlapping errors.

OBJECTIVE: This study aimed at developing a method for superimposing 3D models of the maxillary and mandibular arches with Autodesk Inventor® engineering software, using a single universal coordinate system (UCS) point superposition.

METHODS: A total of 104 STL (stereolithography) models of the maxillary and mandibular arches exported from My iTero® platform were retrospectively selected, in which T0 and T1 were the initial and refinement periods, respectively (n=26 per group). The X, Y, and Z coordinates associated with a single point in each arch were inserted into the models with SlicerCMF® software for model orientation. The arch models with UCS registration were transferred to Autodesk Inventor® for superimposition and to measure tooth movements performed during Invisalign® treatment. Arch expansion, intrusion and rotation were analyzed by two examiners. The statistics were performed using intraclass correlation coefficients (ICC), Dahlberg’s formula, and t-test (p<0.05).

RESULTS: A reliable method of superimposing 3D digital models using a single UCS point in the maxilla and mandible was developed. ICC showed excellent intra- and inter-examiner correlation (ICC>0.90). A systematic error was not found concerning linear and angular measurements (<1mm and <1.5°, respectively). Digital dental movements could be analyzed, including arch expansion, dental intrusion, and tooth rotation.

CONCLUSIONS: The developed method was proven reliable and reproducible for superimposing 3D models of the maxillary and mandibular arches by using UCS system.

PMID:37820226 | DOI:10.1590/2177-6709.28.4.e232333.oar

Clin Orthop Relat Res. 2023 Oct 11. doi: 10.1097/CORR.0000000000002888. Online ahead of print.

ABSTRACT

BACKGROUND: Obesity-based cutoffs in TKA are premised on higher rates of postoperative complications. However, operative time may be associated with postoperative complications, leading to an unnecessary restriction of TKA in patients with obesity. If operative time is associated with these obesity-related outcomes, it should be accounted for in order to ensure all measurable factors associated with negative outcomes are examined for patients with obesity after TKA.

QUESTIONS/PURPOSES: We asked: (1) Is operative time, controlling for BMI class, associated with readmission, reoperation, and postoperative major and minor complications? (2) Is operative time associated with a difference in the direction or strength of obesity-related adverse outcomes?

METHODS: In this comparative study, we extracted all records on elective, unilateral TKA between January 2014 and December 2020 in the American College of Surgeons National Surgical Quality Improvement Program database, resulting in an initial sample of 394,381 TKAs. Patients with emergency procedures (0.1% [270]) and simultaneous bilateral TKAs (2% [8736]), missing or null data (1% [4834]), and those with operative times less than 25 minutes (0.1% [548]) were excluded, leaving 96% (379,993) of our original sample size. The National Surgical Quality Improvement Program database was selected because of its inclusion of operative time, which is not found in any other national database. BMI was subdivided into underweight (BMI < 18.5 kg/m2, < 1% [719]), normal weight (BMI 18.5 to 24.9 kg/m2, 9% [34,513]), overweight (BMI 25.0 to 29.9 kg/m2, 27% [101,538]), Class I obesity (BMI 30.0 to 34.9 kg/m2, 29% [111,712]), Class II obesity (BMI 35.0 to 39.9 kg/m2, 20% [76,605]), and Class III obesity (BMI ≥ 40.0 kg/m2, 14% [54,906]). The mean operative time was 91 ± 36 minutes, 61% of patients were women (233,062 of 379,993), and the mean age was 67 ± 9 years. Patients with obesity tended to be younger and more likely to have preoperative comorbidities and longer operative times than patients with normal weight. Multivariable logistic regression models examined the main effects of operative time with respect to 30-day readmission, reoperation, and major and minor medical complications, while adjusting for BMI class and other covariates including age, sex, race, smoking status, and number of preoperative comorbidities. We then evaluated the potential interaction effect of BMI class and operative time. This interaction term helps determine whether the association of BMI with postoperative outcomes changes based on the duration of the surgery, and vice versa. If the interaction term is statistically significant, it implies the association of BMI with adverse postoperative outcomes is inconsistent across all patients. Instead, it varies with the operative time. Adjusted odds ratios and 95% confidence intervals were calculated, and interaction effects were plotted.

RESULTS: After controlling for obesity, longer procedure duration was independently associated with higher odds of all outcomes (30-minute estimates; adjusted ORs are per minute), including readmission (9% per half-hour of surgical duration; adjusted OR 1.003 [95% CI 1.003 to 1.004]; p < 0.001), reoperation (15% per half-hour of surgical duration; adjusted OR 1.005 [95% CI 1.004 to 1.005]; p < 0.001), postoperative major complications (9% per half-hour of surgical duration; adjusted OR 1.003 [95% CI 1.003 to 1.004]; p < 0.001), and postoperative minor complications (18% per half-hour of surgical duration; adjusted OR 1.006 [95% CI 1.006 to 1.007]; p < 0.001). The interaction effect indicates that patients with obesity had lower odds of reoperation than patients with normal weight when operative times were shorter, but higher odds of reoperation with a longer operative duration.

CONCLUSION: We found that operative time, a proxy for surgical complexity, had a moderate, differential association with obesity over a 30-minute period. Perioperative modification of surgical complexity such as surgical techniques, training, and team dynamics may make safe TKA possible for certain patients who might have otherwise been denied surgery. Decisions to refuse TKA to patients with obesity should be based on a holistic assessment of a patient’s operative complexity, rather than strictly assessing a patient’s weight or their ability to lose weight. Future studies should assess patient-specific characteristics that are associated with operative time, which can further push the development of techniques and strategies that reduce surgical complexity and improve TKA outcomes.

LEVEL OF EVIDENCE: Level III, therapeutic study.

PMID:37820225 | DOI:10.1097/CORR.0000000000002888