Category: Statistics

J Am Mosq Control Assoc. 2023 Jun 1;39(2):138-141. doi: 10.2987/23-2116.

ABSTRACT

Neuroinvasive La Crosse virus disease remains the primary cause of pediatric arboviral encephalitis in the USA. In spite of the persistent public health burden, there are limited entomologic surveillance options that target both native and invasive La Crosse virus (LACV) vectors. In this study we used Reiter/Cummings tacklebox gravid traps to compare white oak (Quercus alba) and hay (predominately Festuca arundinacea) infusions within a LACV-endemic area of western North Carolina. Paired gravid traps (approximately 1,728 total trap-hours for each infusion) yielded 485 mosquitoes, with 3 species (Aedes japonicus [n = 265], Ae. triseriatus [n = 156], and Culex restuans [n = 45]) accounting for 96.1% of the total collection. The hay-infusion traps collected 2.5 times more Ae. triseriatus and 1.3 times more Ae. japonicus than the oak-infusion traps. The sum differences in overall collections for these 2 species by infusion type were statistically significant (χ2 = 9.61, df = 1, P = 0.0019). Poisson ratio tests to compare capture rates suggest that hay infusions were more effective for capturing Ae. triseriatus, but that hay and white oak leaf infusions had equivocal capture rates for Ae. japonicus (an invasive LACV accessory vector) and Cx. restuans (an enzootic West Nile virus vector). These results are discussed in the context of operational considerations for LACV vector surveillance.

PMID:37364182 | DOI:10.2987/23-2116

J Med Entomol. 2023 Jun 26:tjad067. doi: 10.1093/jme/tjad067. Online ahead of print.

ABSTRACT

Age-grading mosquitoes are significant because only older mosquitoes are competent to transmit pathogens to humans. However, we lack effective tools to do so, especially at the critical point where mosquitoes become a risk to humans. In this study, we demonstrated the capability of using surface-enhanced Raman spectroscopy and artificial neural networks to accurately age-grade field-aged low-generation (F2) female Aedes aegypti mosquitoes held under ambient conditions (error was 1.9 chronological days, in the range 0-22 days). When degree days were used for model calibration, the accuracy was further improved to 20.8 degree days (approximately equal to 1.4 chronological days), which indicates the impact of temperature fluctuation on prediction accuracy. This performance is a significant advancement over binary classification. The great accuracy of this method outperforms traditional age-grading methods and will facilitate effective epidemiological studies, risk assessment, vector intervention monitoring, and evaluation.

PMID:37364175 | DOI:10.1093/jme/tjad067

J Pediatr Gastroenterol Nutr. 2023 Jun 27. doi: 10.1097/MPG.0000000000003864. Online ahead of print.

ABSTRACT

BACKGROUND AIMS: Pediatric advanced endoscopy consists primarily of Endoscopic Retrograde Cholangiopancreatography (ERCP) and Endoscopic Ultrasound (EUS) and is becoming more common in pediatrics. This study aims to characterize the current landscape of pediatric advanced endoscopy training and practice by directly surveying independently practicing pediatric advanced endoscopists (PAEs). We also aim to ascertain expert opinion on competency in pediatric ERCP and EUS.

METHODS: A 66-question REDCap survey and a 73-question Qualtrics survey were distributed to members of the ERCP Special Interest Group of North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition. Respondents currently performing ERCP or EUS independently in children were included. Statistical analysis was performed using Mann-Whitney U test.

RESULTS: Of 41 PAEs surveyed, 38 (92.7%) responded and 27 independent practitioners were included. 13 respondents performed EUS. PAEs who completed an advanced endoscopy fellowship (AEF) were more comfortable performing ASGE grade 3/4 ERCPs (p<0.0008) and felt more prepared to practice EUS independently than other trainees. Expert opinion of PAEs felt a threshold of 200 procedures was needed to attain competency in either ERCP or EUS. Pediatric duodenoscope exposure improved comfort in performing ERCP in children <10kg (p=0.009).

CONCLUSIONS: Training of pediatric gastroenterologists in ERCP and EUS are highly variable, though the skills attained are similar. AEF-trained specialists reported greater training volumes and felt more prepared to practice independently than those who did not. Competency thresholds determined by expert PAEs for ERCP and EUS agree with American Society for Gastrointestinal Endoscopy guidelines for adult advanced endoscopy trainees.

PMID:37364161 | DOI:10.1097/MPG.0000000000003864

Arch Endocrinol Metab. 2023 Jun 19;67(6):e000650. doi: 10.20945/2359-3997000000650.

ABSTRACT

OBJECTIVE: The primary aim is to analyze the endoscopic endonasal surgical results in short-term and two-year follow-ups according to the 11th Acromegaly Consensus statement (2018). Indeed, prognostic factors and complications were analyzed.

SUBJECTS AND METHODS: 40 patients who underwent endoscopic endonasal surgery by acromegaly between 2013 to 2020 was analyzed. Patients were considered in remission if an upper limit of normal (ULN) IGF-1 was less than 1.0 at the six-month and two-year follow-ups. Moreover, we assessed the Knosp grade, tumor volumetry, ULN, T2 signal in MRI, reoperation, and complications.

RESULTS: The mean age of admission was 46.7 years. Thirty-two patients were in remission after six months of surgery (80%), decreasing to 76.32% at the two-year follow-up. All microadenomas presented remission (n = 6). Regarding the complications, three patients had permanent panhypopituitarism (7.5%); postoperative cerebrospinal fluid (CSF) leaks did not occur in this series. The hyperintense signal on the T2 MRI and a higher tumor volumetry were the single predictor’s factors of non-emission in a multivariate regression logistic analysis (p < 0.05). Preoperative hormone levels (GH and IGF-1) were not a prognostic factor for remission. The re-operated patients who presented hypersignal already had a high predictor of clinical-operative failure.

CONCLUSION: The endoscopic endonasal surgery promotes high short-term and two-year remission rates in acromegaly; the tumor’s volumetry and the T2 hypersignal were statistically significant prognostic factors in non-remission – the complications presented at similar rates in comparison to the literature. In invasive GH-secreting tumors, we should offer these patients a multi-disciplinary approach to improve acromegalic patients’ remission rates.

PMID:37364152 | DOI:10.20945/2359-3997000000650

Inflamm Bowel Dis. 2023 Jun 26:izad115. doi: 10.1093/ibd/izad115. Online ahead of print.

ABSTRACT

BACKGROUND: Antitumor necrosis factor (anti-TNF) inhibitors are first-line treatment among patients with ulcerative colitis (UC). With time, patients tend to lose response or become intolerant, necessitating switching to small cell biologics such as tofacitinib or vedolizumab. In this real-world study of a large, geographically diverse US population of TNF-experienced patients with UC, we evaluated the effectiveness and safety of newly initiating treatment with tofacitinib vs vedolizumab.

METHODS: We conducted a cohort study using secondary data from a large US insurer (Anthem, Inc.). Our cohort included patients with UC newly initiating treatment with tofacitinib or vedolizumab. Patients were required to have evidence of treatment with anti-TNF inhibitors in the 6 months prior to cohort entry. The primary outcome was treatment persistence >52 weeks. Additionally, we evaluated the following secondary outcomes as additional measures of effectiveness and safety: (1) all-cause hospitalization; (2) total abdominal colectomy; (3) hospitalization for infection; (4) hospitalization for malignancy; (5) hospitalization for cardiac events; and (6) hospitalization for thromboembolic events. We used fine stratification by propensity scores to control for confounding by demographics, clinical factors, and treatment history at baseline.

RESULTS: Our primary cohort included 168 new users of tofacitinib and 568 new users of vedolizumab. Tofacitinib was associated with lower treatment persistence (adjusted risked ratio, 0.77; 95% CI, 0.60 -0.99). Differences in secondary measures of effectiveness or safety between tofacitinib initiators vs vedolizumab initiators were not statistically significant (all-cause hospitalization, adjusted hazard ratio, 1.23; 95% CI, 0.83-1.84; total abdominal colectomy, adjusted HR, 1.79; 95% CI, 0.93-3.44;and hospitalization for any infection, adjusted HR, 1.94; 95% CI, 0.83-4.52).

DISCUSSION: Ulcerative colitis patients with prior anti-TNF experience initiating tofacitinib demonstrated lower treatment persistence compared with those initiating vedolizumab. This finding is in contrast to other recent studies suggesting superior effectiveness of tofacitinib. Ultimately, head-to-head randomized, controlled trials that focus on directly measured end points may be needed to best inform clinical practice.

PMID:37358904 | DOI:10.1093/ibd/izad115

J Med Internet Res. 2023 Jun 26;25:e46771. doi: 10.2196/46771.

ABSTRACT

BACKGROUND: Suicide is a global public health problem. Digital interventions are considered a low-threshold treatment option for people with suicidal ideation or behaviors. Internet-based cognitive behavioral therapy (iCBT) targeting suicidal ideation has demonstrated effectiveness in reducing suicidal ideation. However, suicidal ideation often is related to additional mental health problems, which should be addressed for optimal care. Yet, the effects of iCBT on related symptoms, such as depression, anxiety, and hopelessness, remain unclear.

OBJECTIVE: We aimed to analyze whether digital interventions targeting suicidal ideation had an effect on related mental health symptoms (depression, anxiety, and hopelessness).

METHODS: We systematically searched CENTRAL, PsycInfo, Embase, and PubMed for randomized controlled trials that investigated guided or unguided iCBT for suicidal ideation or behaviors. Participants reporting baseline suicidal ideation were eligible. Individual participant data (IPD) were collected from eligible trials. We conducted a 1-stage IPD meta-analysis on the effects on depression, anxiety, and hopelessness-analyzed as 2 indices: symptom severity and treatment response.

RESULTS: We included IPD from 8 out of 9 eligible trials comprising 1980 participants with suicidal ideation. iCBT was associated with significant reductions in depression severity (b=-0.17; 95% CI -0.25 to -0.09; P<.001) and higher treatment response (ie, 50% reduction of depressive symptoms; b=0.36; 95% CI 0.12-0.60; P=.008) after treatment. We did not find significant effects on anxiety and hopelessness.

CONCLUSIONS: iCBT for people with suicidal ideation revealed significant effects on depression outcomes but only minor or no effects on anxiety and hopelessness. Therefore, individuals with comorbid symptoms of anxiety or hopelessness may require additional treatment components to optimize care. Studies that monitor symptoms with higher temporal resolution and consider a broader spectrum of factors influencing suicidal ideation are needed to understand the complex interaction of suicidality and related mental health symptoms.

PMID:37358893 | DOI:10.2196/46771

JMIR Res Protoc. 2023 Jun 26;12:e46816. doi: 10.2196/46816.

ABSTRACT

BACKGROUND: Allergic diseases affect around 40% of the pediatric population worldwide. The coexistence of asthma, allergic rhinitis, eczema, and food allergy renders allergy treatment and prevention challenging. Infant feeding strategies recommend avoiding allergenic foods to prevent allergy development and anaphylaxis. However, recent evidence suggests that early consumption of food allergens during weaning in infants aged 4-6 months could result in food tolerance, thus reducing the risk of developing allergies.

OBJECTIVE: The aim of this study is to systematically review and carry out a meta-analysis of evidence on the outcome of early food introduction for preventing childhood allergic diseases.

METHODS: We will conduct a systematic review of interventions through a comprehensive search of various databases including PubMed, Embase, Scopus, CENTRAL, PsycINFO, CINAHL, and Google Scholar to identify potential studies. The search will be performed for any eligible articles from the earliest published articles up to the latest available studies in 2023. We will include randomized controlled trials (RCTs), cluster RCTs, non-RCTs, and other observational studies that assess the effect of early food introduction to prevent childhood allergic diseases.

RESULTS: Primary outcomes will include measures related to the effect of childhood allergic diseases (ie, asthma, allergic rhinitis, eczema, and food allergy). PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines will be followed for study selection. All data will be extracted using a standardized data extraction form and the quality of the studies will be assessed using the Cochrane Risk of Bias tool. A summary of findings table will be generated for the following outcomes: (1) total number of allergic diseases, (2) rate of sensitization, (3) total number of adverse events, (4) improvement of health-related quality of life, and (5) all-cause mortality. Descriptive and meta-analyses will be performed using a random-effects model in Review Manager (Cochrane). Heterogeneity among selected studies will be assessed using the I² statistic and explored through meta-regression and subgroup analyses. Data collection is expected to start in June 2023.

CONCLUSIONS: The results acquired from this study will contribute to the existing literature and harmonize recommendations for infant feeding with regard to the prevention of childhood allergic diseases.

TRIAL REGISTRATION: PROSPERO CRD42021256776; https://tinyurl.com/4j272y8a.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/46816.

PMID:37358892 | DOI:10.2196/46816

J Med Internet Res. 2023 Jun 26;25:e43633. doi: 10.2196/43633.

ABSTRACT

BACKGROUND: Engagement is key to interventions that achieve successful behavior change and improvements in health. There is limited literature on the application of predictive machine learning (ML) models to data from commercially available weight loss programs to predict disengagement. Such data could help participants achieve their goals.

OBJECTIVE: This study aimed to use explainable ML to predict the risk of member disengagement week by week over 12 weeks on a commercially available web-based weight loss program.

METHODS: Data were available from 59,686 adults who participated in the weight loss program between October 2014 and September 2019. Data included year of birth, sex, height, weight, motivation to join the program, use statistics (eg, weight entries, entries into the food diary, views of the menu, and program content), program type, and weight loss. Random forest, extreme gradient boosting, and logistic regression with L1 regularization models were developed and validated using a 10-fold cross-validation approach. In addition, temporal validation was performed on a test cohort of 16,947 members who participated in the program between April 2018 and September 2019, and the remaining data were used for model development. Shapley values were used to identify globally relevant features and explain individual predictions.

RESULTS: The average age of the participants was 49.60 (SD 12.54) years, the average starting BMI was 32.43 (SD 6.19), and 81.46% (39,594/48,604) of the participants were female. The class distributions (active and inactive members) changed from 39,369 and 9235 in week 2 to 31,602 and 17,002 in week 12, respectively. With 10-fold-cross-validation, extreme gradient boosting models had the best predictive performance, which ranged from 0.85 (95% CI 0.84-0.85) to 0.93 (95% CI 0.93-0.93) for area under the receiver operating characteristic curve and from 0.57 (95% CI 0.56-0.58) to 0.95 (95% CI 0.95-0.96) for area under the precision-recall curve (across 12 weeks of the program). They also presented a good calibration. Results obtained with temporal validation ranged from 0.51 to 0.95 for area under a precision-recall curve and 0.84 to 0.93 for area under the receiver operating characteristic curve across the 12 weeks. There was a considerable improvement in area under a precision-recall curve of 20% in week 3 of the program. On the basis of the computed Shapley values, the most important features for predicting disengagement in the following week were those related to the total activity on the platform and entering a weight in the previous weeks.

CONCLUSIONS: This study showed the potential of applying ML predictive algorithms to help predict and understand participants’ disengagement with a web-based weight loss program. Given the association between engagement and health outcomes, these findings can prove valuable in providing better support to individuals to enhance their engagement and potentially achieve greater weight loss.

PMID:37358890 | DOI:10.2196/43633

Oncologist. 2023 Jun 26:oyad170. doi: 10.1093/oncolo/oyad170. Online ahead of print.

ABSTRACT

BACKGROUND: This retrospective, real-world study evaluated the prevalence of brain metastases, clinicodemographic characteristics, systemic treatments, and factors associated with overall survival among patients with advanced non-small cell lung cancer (aNSCLC) in the US. We also described the genomic characterization of 180 brain metastatic specimens and frequency of clinically actionable genes.

MATERIALS AND METHODS: De-identified electronic health records-derived data of adult patients diagnosed with aNSCLC between 2011 and 2017 were analyzed from a US-nationwide clinicogenomic database.

RESULTS: Of 3257 adult patients with aNSCLC included in the study, approximately 31% (n = 1018) had brain metastases. Of these 1018 patients, 71% (n = 726) were diagnosed with brain metastases at initial NSCLC diagnosis; 57% (n = 583) of patients with brain metastases received systemic treatment. Platinum-based chemotherapy combinations were the most common first-line therapy; single-agent chemotherapies, epidermal growth factor receptor tyrosine kinase inhibitors, and platinum-based chemotherapy combinations were used in second line. Patients with brain metastases had a 1.56 times greater risk of death versus those with no brain metastases. In the brain metastatic specimens (n = 180), a high frequency of genomic alterations in the p53, MAPK, PI3K, mTOR, and cell-cycle associated pathways was observed.

CONCLUSION: The frequency of brain metastases at initial clinical presentation and associated poor prognosis for patients in this cohort underscores the importance of early screening for brain metastasis in NSCLC. Genomic alterations frequently identified in this study emphasize the continued need for genomic research and investigation of targeted therapies in patients with brain metastases.

PMID:37358877 | DOI:10.1093/oncolo/oyad170

Appl Immunohistochem Mol Morphol. 2023 Jun 26. doi: 10.1097/PAI.0000000000001139. Online ahead of print.

ABSTRACT

Breast cancer is a heterogenous disease at the molecular level thus, it can be hypothesized that different molecular subtypes differ in their tumor microenvironment (TME) also. Understanding the TME heterogeneity may provide new prognostic biomarkers and new targets for cancer therapy. For deciphering heterogeneity in the TME, immunohistochemistry for immune markers (CD3, CD4, CD8, CD68, CD163, and programmed death-ligand 1), Cancer-associated fibroblast markers [anti-fibroblast activating protein α (FAP-α), platelet-derived growth factor receptor α (PDGFR-α), S100A4, Neuron-glial antigen 2, and Caveolin-1], and angiogenesis (CD31) was performed on tissue microarrays of different molecular subtypes of breast cancer. High CD3+ T cells were noted in the Luminal B subtype (P=0.002) of which the majority were CD8+ cytotoxic T cells. Programmed death-ligand 1 expression in immune cells was highest in the human epidermal growth factor receptor 2 (Her-2)-positive and Luminal B subtypes compared with the triple-negative breast cancer (TNBC) subtype (P=0.003). Her-2 subtype is rich in M2 tumor-associated macrophages (P=0.000) compared with TNBC and Luminal B subtypes. M2 immune microenvironment correlated with high tumor grade and high Ki-67. Her-2 and TNBC subtypes are rich in extracellular matrix remodeling (FAP-α, P=0.003), angiogenesis-promoting (PDGFR-α; P=0.000) and invasion markers (Neuron-glial antigen 2, P=0.000; S100A4, P=0.07) compared with Luminal subtypes. Mean Microvessel density showed an increasing trend: Luminal A>Luminal B>Her-2 positive>TNBC; however, this difference was not statistically significant. The cancer-associated fibroblasts (FAP-α, PDGFR-α, and Neuron-glial antigen 2) showed a positive correlation with lymph node metastasis in specific subtypes. Immune cells, tumor-associated macrophage, and cancer-associated fibroblast-related stromal markers showed higher expression in Luminal B, Her-2 positive, and TNBC respectively. This differential expression of different components of TME indicates heterogeneity of the TME across molecular subtypes of breast cancer.

PMID:37358863 | DOI:10.1097/PAI.0000000000001139