Category: Statistics

Int Endod J. 2021 Nov 12. doi: 10.1111/iej.13662. Online ahead of print.

ABSTRACT

AIM: This prospective in vivo study aimed to optimize the assessment of pulpal contrast-enhancement (PCE) on dental magnetic resonance imaging (dMRI) and investigate physiological PCE-patterns.

METHODOLOGY: In 70 study participants, 1585 healthy teeth were examined using 3-Tesla dMRI before and after contrast administration. For all teeth, the quotient of post- and pre-contrast pulp signal intensity (Q-PSI) was calculated to quantify PCE. First, pulp chambers were analyzed in 10 participants to compare the coefficient of variation of mean vs. maximum Q-PSI-values (Q-PSI_mean vs. Q-PSI_max ). Second, dynamic pulpal contrast-enhancement was evaluated in 10 subjects to optimize the time interval between contrast application and image acquisition. Finally, 50 participants (age groups: 20-29, 30-39, 40-49, 50-59, and 60-69 years) were examined to analyze age, gender, tooth types and maxilla vs. mandible as independent factors of PCE. Statistical analysis was performed using Wilcoxon signed rank test and linear mixed models.

RESULTS: PCE-assessment based on Q-PSI_max was associated with a significantly smaller coefficient of variation compared Q-PSI_mean , with median values of 0.17 vs. 0.21 (p=0.002). Analysis of dynamic PCE revealed an optimal timing interval for image acquisition 4 minutes after contrast media application. No significant differences in PCE were observed by comparing age groups, female vs. male participants and maxillary vs. mandibular teeth (p>0.05). Differences between tooth types were small (median Q-PSI_max values of 2.52 / 2.32 / 2.30 / 2.20 for molars / premolars / canines / incisors), but significant (p<0.05), except for the comparison of canines vs. premolars (p=0.80).

CONCLUSIONS: PCE in dMRI is a stable intra-individual marker with only minor differences between different tooth types, thus forming an important basis for intra-individual controls when assessing teeth with suspected endodontic pathology. Furthermore, it was demonstrated that PCE is independent of age, gender and jaw type. These findings indicate that dMRI-based PCE analysis could be a valuable diagnostic tool for the identification of various pulp diseases in future patient studies.

PMID:34767640 | DOI:10.1111/iej.13662

PLoS One. 2021 Nov 12;16(11):e0259817. doi: 10.1371/journal.pone.0259817. eCollection 2021.

ABSTRACT

PURPOSE: Understanding what constitutes normal walking mechanics across the adult lifespan is crucial to the identification and intervention of early decline in walking function. Existing research has assumed a simple linear alteration in peak joint powers between young and older adults. The aim of the present study was to quantify the potential (non)linear relationship between age and the joint power waveforms of the lower limb during walking.

METHODS: This was a pooled secondary analysis of the authors’ (MT, KD, JJ) and three publicly available datasets, resulting in a dataset of 278 adults between the ages of 19 to 86 years old. Three-dimensional motion capture with synchronised force plate assessment was performed during self-paced walking. Inverse dynamics were used to quantity joint power of the ankle, knee, and hip, which were time-normalized to 100 stride cycle points. Generalized Additive Models for location, scale and shape (GAMLSS) was used to model the effect of cycle points, age, walking speed, stride length, height, and their interaction on the outcome of each joint’s power.

RESULTS: At both 1m/s and 1.5 m/s, A2 peaked at the age of 60 years old with a value of 3.09 (95% confidence interval [CI] 2.95 to 3.23) W/kg and 3.05 (95%CI 2.94 to 3.16), respectively. For H1, joint power peaked with a value of 0.40 (95%CI 0.31 to 0.49) W/kg at 1m/s, and with a value of 0.78 (95%CI 0.72 to 0.84) W/kg at 1.5m/s, at the age of 20 years old. For H3, joint power peaked with a value of 0.69 (95%CI 0.62 to 0.76) W/kg at 1m/s, and with a value of 1.38 (95%CI 1.32 to 1.44) W/kg at 1.5m/s, at the age of 70 years old.

CONCLUSIONS: Findings from this study do not support a simple linear relationship between joint power and ageing. A more in-depth understanding of walking mechanics across the lifespan may provide more opportunities to develop early clinical diagnostic and therapeutic strategies for impaired walking function. We anticipate that the present methodology of pooling data across multiple studies, is a novel and useful research method to understand motor development across the lifespan.

PMID:34767611 | DOI:10.1371/journal.pone.0259817

PLoS One. 2021 Nov 12;16(11):e0259822. doi: 10.1371/journal.pone.0259822. eCollection 2021.

ABSTRACT

BACKGROUND: Clinical outcomes among COVID-19 patients vary greatly with age and underlying comorbidities. We aimed to determine the demographic and clinical factors, particularly baseline chronic conditions, associated with an increased risk of severity in COVID-19 patients from a population-based perspective and using data from electronic health records (EHR).

METHODS: Retrospective, observational study in an open cohort analyzing all 68,913 individuals (mean age 44.4 years, 53.2% women) with SARS-CoV-2 infection between 15 June and 19 December 2020 using exhaustive electronic health registries. Patients were followed for 30 days from inclusion or until the date of death within that period. We performed multivariate logistic regression to analyze the association between each chronic disease and severe infection, based on hospitalization and all-cause mortality.

RESULTS: 5885 (8.5%) individuals showed severe infection and old age was the most influencing factor. Congestive heart failure (odds ratio -OR- men: 1.28, OR women: 1.39), diabetes (1.37, 1.24), chronic renal failure (1.31, 1.22) and obesity (1.21, 1.26) increased the likelihood of severe infection in both sexes. Chronic skin ulcers (1.32), acute cerebrovascular disease (1.34), chronic obstructive pulmonary disease (1.21), urinary incontinence (1.17) and neoplasms (1.26) in men, and infertility (1.87), obstructive sleep apnea (1.43), hepatic steatosis (1.43), rheumatoid arthritis (1.39) and menstrual disorders (1.18) in women were also associated with more severe outcomes.

CONCLUSIONS: Age and specific cardiovascular and metabolic diseases increased the risk of severe SARS-CoV-2 infections in men and women, whereas the effects of certain comorbidities are sex specific. Future studies in different settings are encouraged to analyze which profiles of chronic patients are at higher risk of poor prognosis and should therefore be the targets of prevention and shielding strategies.

PMID:34767594 | DOI:10.1371/journal.pone.0259822

PLoS One. 2021 Nov 12;16(11):e0259687. doi: 10.1371/journal.pone.0259687. eCollection 2021.

ABSTRACT

Listeria monocytogenes and Salmonella spp. are considered important foodborne pathogens that are commonly associated with foods of animal origin. The aim of this study was to perform molecular characterization of L. monocytogenes and Salmonella spp. isolated from biofilms of cattle and poultry slaughterhouses located in the Federal District and State of Goiás, Brazil. Fourteen L. monocytogenes isolates and one Salmonella sp. were detected in poultry slaughterhouses. No isolates were detected in cattle slaughterhouses. All L. monocytogenes isolates belonged to lineage II, and 11 different pulsotypes were detected. Pulsed-field gel electrophoresis analysis revealed the dissemination of two strains within one plant, in addition to the regional dissemination of one of them. The Salmonella isolate was identified via whole genome sequencing as Salmonella enterica serovar Minnesota ST548. In the sequence analysis, no premature stop codons were detected in the inlA gene of Listeria. All isolates demonstrated the ability to adhere to Caco-2 cells, while 50% were capable of invading them. Antimicrobial resistance was detected in 57.1% of the L. monocytogenes isolates, and resistance to sulfonamide was the most common feature. The tetC, ermB, and tetM genes were detected, and four isolates were classified as multidrug-resistant. Salmonella sp. was resistant to nine antimicrobials and was classified as multidrug-resistant. Resistance genes qnrB19, blaCMY-2, aac(6′)-Iaa, sul2, and tetA, and a mutation in the parC gene were detected. The majority (78.5%) of the L. monocytogenes isolates were capable of forming biofilms after incubation at 37°C for 24 h, and 64.3% were capable of forming biofilms after incubation at 12°C for 168 h. There was no statistical difference in the biofilm-forming capacity under the different evaluated conditions. Salmonella sp. was capable of forming biofilms at both tested temperatures. Biofilm characterization was confirmed by collecting the samples consistently, at the same sampling points, and by assessing biofilm formation in vitro. These results highlight the potential risk of cross-contamination in poultry slaughterhouses and the importance of surveillance and pathogen control maintenance programs within the meat production industry.

PMID:34767604 | DOI:10.1371/journal.pone.0259687

PLoS One. 2021 Nov 12;16(11):e0258785. doi: 10.1371/journal.pone.0258785. eCollection 2021.

ABSTRACT

BACKGROUND: Rupture of the deltoid ligament (DL) in acute ankle fracture is very common. However, there is still insufficient evidence on whether to repair the DL in acute ankle fracture. Therefore, a systematic review and meta-analysis of comparative studies was performed to report the outcome of DL repair in acute ankle fracture.

METHODS: The PubMed, Cochrane Library, EMBASE and Web of Science databases were searched from the inception dates to October 31, 2020, for comparative studies. The methodological quality was evaluated based on the risk-of-bias tool of the Cochrane Collaboration for Randomized Controlled Trials (RCTs) or the Risk-of-Bias Assessment Tool for Non-randomized Studies (RoBANS). The post-operative medial clear space (MCS), final MCS, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS) score and incidence of complications were analysed.

RESULTS: A total of 8 comparative studies involving 388 participants who suffered Weber type B or C ankle fractures were included in this meta-analysis. The results showed that the post-operative MCS, final MCS, AOFAS score and rate of complications were statistically superior in the DL repair group. For the VAS score, there was no significant difference between the DL repair group and the DL non-repair group.

CONCLUSIONS: In this meta-analysis of comparative studies, DL repair offered great advantages in terms of the post-operative MCS, final MCS, AOFAS score and rate of complications compared with non-repair. The repair of the DL in patients with acute ankle fractures might be beneficial to ankle joint stability and assist in improving the quality of ankle reduction. More high-quality and prospective studies with long follow-up durations are needed to further demonstrate the superiority of DL repair over non-repair.

PMID:34767584 | DOI:10.1371/journal.pone.0258785

PLoS One. 2021 Nov 12;16(11):e0259633. doi: 10.1371/journal.pone.0259633. eCollection 2021.

ABSTRACT

Antimicrobial stewardship for outpatients with acute respiratory tract infections (ARTIs) should be urgently promoted in this era of antimicrobial resistance. Previous large-sample studies were based on administrative data and had limited reliability. We aimed to identify current antimicrobial prescription practices for ARTIs by directly basing on medical records. This multicenter retrospective study was performed from January to December in 2018, at five medical institutes in Japan. We targeted outpatients aged ≥18 years whose medical records revealed International Classification of Diseases (ICD-10) codes suggesting ARTIs. We divided the eligible cases into three age groups (18-64 years, 65-74 years, and ≥75 years). We defined broad-spectrum antimicrobials as third-generation cephalosporins, macrolides, fluoroquinolones, and faropenem. Primary and secondary outcomes were defined as the proportion of antimicrobial prescriptions for the common cold and other respiratory tract infections, respectively. Totally, data of 3,940 patients were collected. Of 2,914 patients with the common cold, 369 (12.7%) were prescribed antimicrobials. Overall, compared to patients aged ≥75 years (8.5%), those aged 18-64 years (16.6%) and those aged 65-74 years (12.1%) were frequently prescribed antimicrobials for the common cold (odds ratio [95% confidential interval]; 2.15 [1.64-2.82] and 1.49 [1.06-2.09], respectively). However, when limited to cases with a valid diagnosis of the common cold by incorporating clinical data, no statistical difference was observed among the age groups. Broad-spectrum antimicrobials accounted for 90.2% of the antimicrobials used for the common cold. Of 1,026 patients with other respiratory infections, 1,018 (99.2%) were bronchitis, of which antimicrobials were prescribed in 49.9% of the cases. Broad-spectrum antimicrobials were the main agents prescribed, accounting for nearly 90% of prescriptions in all age groups. Our data suggested a favorable practice of antimicrobial prescription for outpatients with ARTIs in terms of prescribing proportions, or quantitative aspect. However, the prescriptions were biased towards broad-spectrum antimicrobials, highlighting the need for further antimicrobial stewardship in the outpatient setting from a qualitative perspective.

PMID:34767587 | DOI:10.1371/journal.pone.0259633

PLoS One. 2021 Nov 12;16(11):e0259442. doi: 10.1371/journal.pone.0259442. eCollection 2021.

ABSTRACT

BACKGROUND: Children need good nutrition to develop proper immune mechanisms and psychosocial maturity, but malnutrition can affect their ability to realize this. Apart from the national demographic and health survey, which is carried out every 5 years, there have not been enough documented studies on child breastfeeding and weaning practices of caregivers in the Volta Region. We, therefore, examined child breastfeeding and weaning practices of mothers in the Volta Region of Ghana.

METHODS: A sub-national survey method was adopted and a semi-structured questionnaire was used to collect data from 396 mothers and their children. Descriptive and inferential statistics comprising frequency, percentage, chi-square, and logistic regression were employed in analysing the data. We defined exclusive breastfeeding as given only breast milk to an infant from a mother or a wet nurse for six months of life except drops or syrups consisting of vitamins, minerals, supplements, or medicines on medical advice, and prolonged breastfeeding as breastfeeding up to 24 months of age.

RESULTS: The prevalence of exclusive breastfeeding (EBF) was 43.7%. Mothers constituting 61.1% started breastfeeding within an hour of giving birth. In addition to breast milk, 5.1% gave fluids to their children on the first day of birth. About 66.4% started complementary feeding at 6 months, 22.0% breastfed for 24 months or beyond, while 40.4% fed their children on-demand. Child’s age (AOR: 0.23, 95% CI:0.12-0.43, p<0.0001), prolonged breastfeeding (AOR: 0.41, 95%CI: 0.12-0.87, p = 0.001), mother’s religion (AOR: 3.92, 95%CI: 1.23-12.61, p = 0.021), feeding practices counselled on (AOR: 1.72, 95%CI: 1.96-3.09, p = 0.023), mother ever heard about EBF (AOR: 0.43, 95%CI: 1.45-2.41, p = 0.039), child being fed from the bottle with a nipple (AOR: 1.53, 95%CI: 1.94-2.48, p = 0.003), and age at which complementary feeding was started (AOR: 17.43, 95%CI: 3.47-87.55, p = 0.008) were statistically associated with EBF.

CONCLUSION: Breastfeeding education has been ongoing for decades, yet there are still gaps in the breastfeeding practices of mothers. To accelerate progress towards attainment of the sustainable development goal 3 of ensuring healthy lives and promoting well-being for all at all ages by the year 2030, we recommend innovative policies that include extensive public education to improve upon the breastfeeding and weaning practices of mothers.

PMID:34767566 | DOI:10.1371/journal.pone.0259442

IEEE Trans Pattern Anal Mach Intell. 2021 Nov 12;PP. doi: 10.1109/TPAMI.2021.3127870. Online ahead of print.

ABSTRACT

Correspondence analysis (CA) is a multivariate statistical tool used to visualize and interpret data dependencies by finding maximally correlated embeddings of pairs of random variables. CA has found applications in fields ranging from epidemiology to social sciences; however, current methods do not scale to large, high-dimensional datasets. In this paper, we provide a novel interpretation of CA in terms of an information-theoretic quantity called the principal inertia components. We show that estimating the principal inertia components, which consists in solving a functional optimization problem over the space of finite variance functions of two random variable, is equivalent to performing CA. We then leverage this insight to design novel algorithms to perform CA at an unprecedented scale. Particularly, we demonstrate how the principal inertia components can be reliably approximated from data using deep neural networks. Finally, we show how these maximally correlated embeddings of pairs of random variables in CA further play a central role in several learning problems including visualization of classification boundary and training process, and underlying recent multi-view and multi-modal learning methods.

PMID:34767505 | DOI:10.1109/TPAMI.2021.3127870

IEEE Trans Neural Netw Learn Syst. 2021 Nov 12;PP. doi: 10.1109/TNNLS.2021.3124052. Online ahead of print.

ABSTRACT

Comparing competing mathematical models of complex processes is a shared goal among many branches of science. The Bayesian probabilistic framework offers a principled way to perform model comparison and extract useful metrics for guiding decisions. However, many interesting models are intractable with standard Bayesian methods, as they lack a closed-form likelihood function or the likelihood is computationally too expensive to evaluate. In this work, we propose a novel method for performing Bayesian model comparison using specialized deep learning architectures. Our method is purely simulation-based and circumvents the step of explicitly fitting all alternative models under consideration to each observed dataset. Moreover, it requires no hand-crafted summary statistics of the data and is designed to amortize the cost of simulation over multiple models, datasets, and dataset sizes. This makes the method especially effective in scenarios where model fit needs to be assessed for a large number of datasets, so that case-based inference is practically infeasible. Finally, we propose a novel way to measure epistemic uncertainty in model comparison problems. We demonstrate the utility of our method on toy examples and simulated data from nontrivial models from cognitive science and single-cell neuroscience. We show that our method achieves excellent results in terms of accuracy, calibration, and efficiency across the examples considered in this work. We argue that our framework can enhance and enrich model-based analysis and inference in many fields dealing with computational models of natural processes. We further argue that the proposed measure of epistemic uncertainty provides a unique proxy to quantify absolute evidence even in a framework which assumes that the true data-generating model is within a finite set of candidate models.

PMID:34767511 | DOI:10.1109/TNNLS.2021.3124052

Circulation. 2021 Nov 12. doi: 10.1161/CIRCULATIONAHA.121.056012. Online ahead of print.

ABSTRACT

Background: Despite the acknowledged importance of socioeconomic factors as regards cardiovascular-disease onset, and survival, the relationship between individual-level socioeconomic factors and survival after out-of-hospital cardiac arrest (OHCA) is not fully established. Our aim was to investigate whether socioeconomic variables are associated with 30-day survival after OHCA. Methods: We linked data from the Swedish Registry for Cardiopulmonary Resuscitation with individual-level data on socioeconomic factors (i.e. educational level and disposable income) from Statistics Sweden. Confounding and mediating variables included demographic factors, comorbidity and Utstein resuscitation variables. Outcome was 30-day survival. Multiple modified Poisson regression was used for the main analyses. Results: A total of 31,373 OHCAs occurring in 2010-2017 were included. Crude 30-day survival rates by income quintiles were: Q1 (low) 414/6277 (6.6%), Q2=339/6276 (5.4%), Q3=423/6275 (6.7%), Q4=652/6273 (10.4%) and Q5 (high) 928/6272 (14.8%). In adjusted analysis, the chance of survival by income level followed a gradient-like increase, with a risk ratio (RR) of 1.86 (95% CI 1.65-2.09) in the highest-income quintile vs. the lowest. This association remained after adjusting for comorbidity, resuscitation factors and initial rhythm. A higher educational level was associated with improved 30-day survival, the RR associated with post-secondary education ≥ 4 years being 1.51 (95% CI 1.30-1.74). Survival disparities by income and educational level were observed in both men and women. Conclusions: In this nationwide observational study using individual-level socioeconomic data, higher income and higher educational level were associated with better 30-day survival following OHCA, in both sexes.

PMID:34767462 | DOI:10.1161/CIRCULATIONAHA.121.056012