Category: Statistics

PLOS Digit Health. 2023 Sep 15;2(9):e0000339. doi: 10.1371/journal.pdig.0000339. eCollection 2023 Sep.

ABSTRACT

Timely interventions have a proven benefit for people experiencing psychotic illness. One bottleneck to accessing timely interventions is the referral process to the specialist team for early psychosis (STEP). Many general practitioners lack awareness or confidence in recognising psychotic symptoms or state. Additionally, referrals for people without apparent psychotic symptoms, although beneficial at a population level, lead to excessive workload for STEPs. There is a clear unmet need for accurate stratification of STEPs users and healthy cohorts. Here we propose a new approach to addressing this need via the application of digital behavioural tests. To demonstrate that digital behavioural tests can be used to discriminate between the STEPs users (SU; n = 32) and controls (n = 32, age and sex matched), we compared performance of five different classifiers applied to objective, quantitative and interpretable features derived from the ‘mirror game’ (MG) and trail making task (TMT). The MG is a movement coordination task shown to be a potential socio-motor biomarker of schizophrenia, while TMT is a neuropsychiatric test of cognitive function. All classifiers had AUC in the range of 0.84-0.92. The best of the five classifiers (linear discriminant classifier) achieved an outstanding performance, AUC = 0.92 (95%CI 0.75-1), Sensitivity = 0.75 (95%CI 0.5-1), Specificity = 1 (95%CI 0.75-1), evaluated on 25% hold-out and 1000 folds. Performance of all analysed classifiers is underpinned by the large effect sizes of the differences between the cohorts in terms of the features used for classification what ensures generalisability of the results. We also found that MG and TMT are unsuitable in isolation to successfully differentiate between SU with and without at-risk-mental-state or first episode psychosis with sufficient level of performance. Our findings show that standardised batteries of digital behavioural tests could benefit both clinical and research practice. Including digital behavioural tests into healthcare practice could allow precise phenotyping and stratification of the highly heterogenous population of people referred to STEPs resulting in quicker and more personalised diagnosis. Moreover, the high specificity of digital behavioural tests could facilitate the identification of more homogeneous clinical high-risk populations, benefiting research on prognostic instruments for psychosis. In summary, our study demonstrates that cheap off-the-shelf equipment (laptop computer and a leap motion sensor) can be used to record clinically relevant behavioural data that could be utilised in digital mental health applications.

PMID:37713385 | DOI:10.1371/journal.pdig.0000339

PLoS One. 2023 Sep 15;18(9):e0291139. doi: 10.1371/journal.pone.0291139. eCollection 2023.

ABSTRACT

BACKGROUND: The cancer registry system is an important part of the cancer control program. Improper coding of cancers leads to misclassification and incorrect statistical information about cancer. Therefore, in this study, the main objective of the qualitative analysis was the accuracy in assigning the codes to the pathological reports in the centers responsible for cancer registry.

METHODS: This study was descriptive, retrospective and applied. The data source in this study included 15,659 pathology reports received during the years 2017-2019 in the population-based cancer registry centers of Mazandaran province. Out of 1800 reports, 1765 samples of reports were selected and analysis was done on them by stratified random sampling method. A researcher-made checklist was used to collect data, and the Kappa agreement coefficient and Cohen’s agreement percentage were presented to check the accuracy of the reports. STATA13 was used for data analysis.

RESULTS: 1150 of 1765 pathology reports (65.0%), did not have a topographic, morphological and behavioral codes and 410 (23.2%) had grade codes. The Kappa coefficient in reports with a topography code was 0.916 and with a morphology code it was 0.929, respectively. In behavior coding, the highest agreement is in the category of benign cancers at 65.2% and in grade coding in the category without grade is 100%.

CONCLUSION: The most reports were on carcinoma morphology, and the Kappa coefficient in morphology codes has almost complete reliability. In terms of behavior coding, there was the most agreement in the category of benign cancers. The Kappa coefficient in given behavior codes has low reliability.

PMID:37713374 | DOI:10.1371/journal.pone.0291139

PLoS One. 2023 Sep 15;18(9):e0290838. doi: 10.1371/journal.pone.0290838. eCollection 2023.

ABSTRACT

Climate change is one of the most relevant challenges that the world has to deal with. Studies that aim to understand the behavior of environmental and atmospheric variables and the way they relate to each other can provide helpful insights into how the climate is changing. However, such studies are complex and rarely found in the literature, especially in dealing with data from the Brazilian territory. In this paper, we analyze four environmental and atmospheric variables, namely, wind speed, radiation, temperature, and humidity, measured in 27 Weather Stations (the capital of each of the 26 Brazilian states plus the federal district). We use the detrended fluctuation analysis to evaluate the statistical self-affinity of the time series, as well as the cross-correlation coefficient ρDCCA to quantify the long-range cross-correlation between stations, and a network analysis that considers the top 10% ρDCCA values to represent the cross-correlations between stations better. The methodology used in this paper represents a step forward in the field of hybrid methodologies, combining time series and network analysis that can be applied to other regions, other environmental variables, and also to other fields of research. The application results are of great importance to better understand the behavior of environmental and atmospheric variables in the Brazilian territory and to provide helpful insights about climate change and renewable energy production.

PMID:37713368 | DOI:10.1371/journal.pone.0290838

PLoS One. 2023 Sep 15;18(9):e0290727. doi: 10.1371/journal.pone.0290727. eCollection 2023.

ABSTRACT

Quality control (QC) is a systematic approach to ensuring that products and services meet customer requirements. It is an essential part of manufacturing and industry, as it helps to improve product quality, customer satisfaction, and profitability. Quality practitioners generally apply control charts to monitor the industrial process, among many other statistical process control tools, and to detect changes. New developments in control charting schemes for high-quality monitoring are the need of the hour. In this paper, we have enhanced the performance of the mixed homogeneously weighted moving average (HWMA)-cumulative sum (CUSUM) control chart by using the auxiliary information-based (AIB) regression estimator and named it MHCAIB. The proposed MHCAIB chart provided an unbiased and more efficient estimator of the process location. The various measures of the run length are used to judge the performance of the proposed MHCAIB and to compare it with existing AIB charts like CUSUMAIB, EWMAAIB, MECAIB (mixed AIB EWMA-CUSUM), and HWMAAIB. The Run length (RL) based performance comparisons indicate that the MHCAIB chart performs relatively better in monitoring small to moderate shifts over its competitor’s charts. It is shown that the chart’s performance improves with the increase in correlation between the study variable and the auxiliary variable. An illustrative application of the proposed MHCAIB chart is also provided to show its implementation in practical situations.

PMID:37713367 | DOI:10.1371/journal.pone.0290727

Anesth Analg. 2023 Sep 15. doi: 10.1213/ANE.0000000000006661. Online ahead of print.

ABSTRACT

BACKGROUND: Preoperative anemia is an established risk factor for morbidity and mortality after surgery. Men and women have different hemoglobin concentrations and are at different risks of postoperative complications. However, sex-stratified analysis on the association between preoperative hemoglobin and outcomes after noncardiac surgery has been limited in previous studies.

METHODS: This was a retrospective cohort study of adult patients undergoing elective major noncardiac surgery in a large academic hospital. The primary outcome was a collapsed composite of postoperative mortality or cardiovascular, renal, pulmonary, and infectious complications during hospitalization. Sex-specific univariable associations between preoperative hemoglobin and the composite outcome were visualized using moving-average and cubic-spline smoothing plots. Multivariable regression models adjusting for patient demographics, comorbidities, medication uses, laboratory tests, and anesthesia/surgery features were used to estimate confounder-adjusted associations. Restricted cubic spline and piecewise linear functions were used to assess the possible nonlinear relationships between preoperative hemoglobin and the outcomes. The interaction between patient sex and hemoglobin on outcomes was assessed using a likelihood-ratio test.

RESULTS: We included 22,550 patients, with 6.7% (622 of 9268) of women and 9.7% (1293 of 13,282) of men developing the primary outcome. Lower preoperative hemoglobin was associated with a higher incidence of the primary composite outcome in both men and women. Nonlinearity for the association was not statistically significant in either women (P = .539) or men (P = .165). The multivariable-adjusted odds ratios per 1 g/dL increase in hemoglobin were 0.93 (95% confidence interval [CI], 0.87-0.98; P = .013) for women and 0.94 (95% CI, 0.90-0.97; P < .001) for men, with no interaction by sex (Pinteraction = .923). No hemoglobin thresholds were confirmed at which the associations with the primary outcome changed significantly.

CONCLUSIONS: Low preoperative hemoglobin was associated with a higher risk of complications or mortality after elective noncardiac surgery in both men and women. No differences in the strength of associations between sexes were found. Further studies are needed to assess whether these associations are linear or there are sex-specific thresholds of preoperative hemoglobin concentrations below which postoperative risks begin to increase.

PMID:37713328 | DOI:10.1213/ANE.0000000000006661

J Clin Endocrinol Metab. 2023 Sep 15:dgad550. doi: 10.1210/clinem/dgad550. Online ahead of print.

ABSTRACT

BACKGROUND: The severity of visceral adipose tissue (VAT) inflammation in individuals with obesity is thought to signify obesity sub-phenotype(s) associated with higher cardiometabolic risk. Yet, this tissue is not accessible for direct sampling in the non-surgical patient. We hypothesized that circulating miRNAs (circ-miRs) could serve as biomarkers to distinguish human obesity subgroups with high or low extent of VAT-inflammation.

METHODS: Discovery and validation cohorts of patients living with obesity undergoing bariatric surgery (n = 35 and 51, respectively) were included. VAT inflammation was classified into low/high based on an expression score derived from the mRNA levels of TNFA, IL6 and CCL2 (determined by rtPCR). Differentially-expressed circ-miRs were identified, and their discriminative power to detect low/high VAT inflammation was assessed by ROC-AUC analysis.

RESULTS: Fifty three out of 263 circ-miRs (20%) were associated with high VAT inflammation according to Mann-Whitney analysis in the discovery cohort. Of those, 12 (12/53 = 23%) were differentially expressed according to Deseq2, and 6 significantly discriminated between high and low VAT inflammation with ROC-AUC > 0.8. Of the resulting 5 circ-miRs that were differentially abundant in all three statistical approaches, 3 were unaffected by hemolysis and validated in an independent cohort. Circ-miRs 181b-5p, 1306-3p, and 3138 combined with HOMA-IR exhibited ROC-AUC of 0.951 (95%CI:0.865-1) and 0.808 (95%CI:0.654-0.963) in the discovery and validation cohorts, respectively, providing strong discriminative power between participants with low versus high VAT inflammation. Predicted target genes of these miRNAs are enriched in pathways of insulin and inflammatory signaling, circadian entrainment, and cellular senescence.

CONCLUSIONS: Circ-miRs that identify patients with low versus high VAT inflammation constitute a putative tool to improve personalized care of patients with obesity.

PMID:37713174 | DOI:10.1210/clinem/dgad550

J Autism Dev Disord. 2023 Sep 15. doi: 10.1007/s10803-023-06124-1. Online ahead of print.

ABSTRACT

Psychology originally defined parent-child conflict in terms of interpersonal relationships, where parent-child conflict is a process of inconsistent attitudes between parents and children that occurs in a family setting. For this end, we aims to investigate the influence of parental awareness on preschoolers’ perception of parent-child conflict and the mediating role of preschoolers’ self-esteem. This paper proposes a dynamic parent-child relationship discovery algorithm based on the impact of parent-child cooperation activities on preschool children’s development. We applied SPSS and Mplus statistical software for data processing and analysis, and Nvivo 11.0 qualitative software for validation and analysis. The reliability of preschool children’s perceived parent-child conflict and sub-dimensions were: 0.901, 0.799, 0.791, 0.811, 0.729; the total scale and the retest reliability of each dimension were: 0.914, 0.837, 0.836, 0.792, 0.711. Validated factor analysis using Mplus: RMSEA = 0.075, TLI = 0.856, CFI = 0.876, SRMR = 0.064.

PMID:37713171 | DOI:10.1007/s10803-023-06124-1

J Contin Educ Health Prof. 2023 Sep 15. doi: 10.1097/CEH.0000000000000530. Online ahead of print.

ABSTRACT

INTRODUCTION: The purpose of this program evaluation was to investigate the efficacy of simulation-based primary care procedural skills training to increase participant confidence, knowledge, and skill in performing the procedures included in the training and to evaluate the cost-effectiveness of the training.

METHODS: A retrospective, within-subjects analysis of the change in perceived confidence, skill, and knowledge in procedure performance after the simulation-based primary care procedural skills training program measured by pretraining and post-training Likert scale surveys and change in clinical procedure performance frequency for abscess incision and drainage and laceration repair up to 6 months before and 6 months after the training in the outpatient setting was performed.

RESULTS: Participants self-reported higher median confidence, perceived skill, and perceived knowledge of all procedures included in the training course, with statistically significant increases for all procedures. A mean increase in laceration repairs in the clinical setting of 10% after training was found. Higher median performance of abscess incision and drainage after training (median = 20.00%, n = 25) compared with before training (median = 0.00%, n = 25) and a mean increase in performance of abscess incision and drainage in the clinical setting of 6% after training was found, but increases were not statistically significant.

DISCUSSION: Participation in a 2-day simulation-based primary care procedural skills training program was an effective method to increase confidence, perceived skill, and knowledge of outpatient procedures among practicing providers. Further evaluation to establish return on investment is needed, because statistically significant increases in clinical procedure performance were unable to be demonstrated.

PMID:37713161 | DOI:10.1097/CEH.0000000000000530

Ann Plast Surg. 2023 Oct 1;91(4):409-412. doi: 10.1097/SAP.0000000000003634.

ABSTRACT

INTRODUCTION: Improving patient education materials may improve patient outcomes. This study aims to explore the possibility of generating patient education materials with the assistance of a large language model, Chat Generative Pre-Trained Transformer (ChatGPT). In addition, we compare the accuracy and readability of ChatGPT-generated materials versus expert-generated materials.

METHODS: Patient education materials in implant-based breast reconstruction were generated by experts and ChatGPT independently. Readability and accuracy of the materials are the main outcomes. Readability of the materials was compared using Flesch-Kincaid score. Accuracy of the materials generated by ChatGPT was evaluated by 2 independent reviewers. Content errors are categorized into information errors, statistical errors, and multiple errors (errors more than 2 types).

RESULTS: The content generated by experts had higher readability. The Flesch-Kincaid score is at the 7.5 grade for expert-generated materials, whereas the content generated by ChatGPT is at the 10.5 grade (despite ChatGPT being asked to generate content at the seventh grade level). The accuracy of ChatGPT-generated content is 50%, with most errors being information errors. ChatGPT often provides information about breast reduction or breast augmentation, despite being asked specifically about breast reconstruction. Despite its limitation, ChatGPT significantly reduced the time required to generate patient education materials. Although it takes experts 1 month to generate patient education materials, ChatGPT generates materials within 30 minutes.

CONCLUSIONS: ChatGPT can be a powerful starting tool to generate patient education materials. However, its readability and accuracy still require improvements.

PMID:37713147 | DOI:10.1097/SAP.0000000000003634

J Pharm Pract. 2023 Sep 15:8971900231202643. doi: 10.1177/08971900231202643. Online ahead of print.

ABSTRACT

Background: Contemporary guidelines for managing nonvalvular atrial fibrillation (NVAF) include apixaban and rivaroxaban as first-line anticoagulation treatment options. Minimal guidance is available regarding selecting anticoagulants for patients with class I-III obesity. Objective: This study aims to evaluate the comparative effectiveness and safety of apixaban and rivaroxaban in both obese and morbidly obese patients with NVAF. Methods: A retrospective cohort study was conducted at an outpatient cardiovascular clinic after Institutional Review Board approval. Patients were eligible if they were ≥18 years of age, had a BMI ≥30 kg/m², and took apixaban or rivaroxaban for NVAF for ≥3 months. The primary endpoint was the composite rate of stroke, transient ischemic attack (TIA), myocardial infarction (MI), or presence of atrial thrombosis. Bleeding events were evaluated as the primary safety endpoint. Results: Combined, the cohorts consisted of 303 obese or morbidly obese patients. The primary composite endpoint occurred in 3.8% of patients taking apixaban and 1.7% of patients taking rivaroxaban (P = .28). Both clinically relevant, non-major and major bleeding occurred more often in the apixaban arm, but this difference was not statistically significant; however, bleeding risk may have been skewed due to differences in baseline characteristics. Conclusion and Relevance: For obese and morbidly obese patients prescribed either apixaban or rivaroxaban for NVAF, rates of stroke, TIA, MI, and atrial thrombosis did not differ. The preferred DOAC for patients with class I-III obesity remains elusive, but current data points to a patient-centered approach for anticoagulant selection.

PMID:37713139 | DOI:10.1177/08971900231202643