Category: Statistics

Am J Perinatol. 2021 Apr 20. doi: 10.1055/s-0041-1727229. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to assess the use of a standardized prenatal genetic testing educational video and its effects on patient uptake of prenatal testing, patient knowledge, decisional conflict, and decisional regret.

STUDY DESIGN: This was an IRB-approved randomized controlled trial. Patients were randomized to intervention (standardized video education) or control (no video education). The video education group viewed a 5-minute educational video on genetic testing options, and the control group did not review the video. Both groups answered validated questionnaires to assess maternal knowledge (Maternal Serum Screening Knowledge Questionnaire [MSSK]), conflict (Decisional Conflict Scale [DCS]), and regret (Decisional Regret Scale [DRS]). The primary outcome was genetic testing uptake; secondary outcomes were knowledge-based test score, and level of decisional conflict and regret.

RESULTS: We enrolled 210 patients between 2016 and 2020, with 208 patients randomized, 103 patients in the video education group and 105 patients in the control group. Four patients were excluded from the video education group for missing data. Video education was associated with a 39% lower chance of prenatal testing compared with patients who did not receive video education, (odds ratio 0.39, 95% confidence interval 0.16-0.92). Patients in the video education group had higher mean MSSKQ scores by 2.9 points (8.5 vs. 5.7, p < 0.001), lower Decisional Conflict Scores by 7.3 points (31.5 vs. 38.8, p < 0.001), lower Decisional Regret Scores by 5.4 points (23.8 vs. 29.2, p < 0.001).

CONCLUSION: We found that video education on prenatal genetic testing improved patients’ knowledge, decreased testing and decisional conflict and regret regarding testing. This may indicate improved understanding of testing options and more informed decisions that align with their personal values and beliefs. This standardized video can be easily implemented in clinical practice to increase patient understanding and support decisions that align with patient’s values.

KEY POINTS: · A standardized educational video improves patient knowledge about prenatal testing options in pregnancy.. · Video education decreases testing and decisional conflict and decisional regret in pregnancy.. · A standardized educational video may be used in the clinical setting to educate patients on testing options and help them make informed decisions about testing..

PMID:33878774 | DOI:10.1055/s-0041-1727229

Am J Perinatol. 2021 Apr 20. doi: 10.1055/s-0041-1727168. Online ahead of print.

ABSTRACT

OBJECTIVE: This study was aimed to review 4 weeks of universal novel coronavirus disease 2019 (COVID-19) screening among delivery hospitalizations, at two hospitals in March and April 2020 in New York City, to compare outcomes between patients based on COVID-19 status and to determine whether demographic risk factors and symptoms predicted screening positive for COVID-19.

STUDY DESIGN: This retrospective cohort study evaluated all patients admitted for delivery from March 22 to April 18, 2020, at two New York City hospitals. Obstetrical and neonatal outcomes were collected. The relationship between COVID-19 and demographic, clinical, and maternal and neonatal outcome data was evaluated. Demographic data included the number of COVID-19 cases ascertained by ZIP code of residence. Adjusted logistic regression models were performed to determine predictability of demographic risk factors for COVID-19.

RESULTS: Of 454 women delivered, 79 (17%) had COVID-19. Of those, 27.9% (n = 22) had symptoms such as cough (13.9%), fever (10.1%), chest pain (5.1%), and myalgia (5.1%). While women with COVID-19 were more likely to live in the ZIP codes quartile with the most cases (47 vs. 41%) and less likely to live in the ZIP code quartile with the fewest cases (6 vs. 14%), these comparisons were not statistically significant (p = 0.18). Women with COVID-19 were less likely to have a vaginal delivery (55.2 vs. 51.9%, p = 0.04) and had a significantly longer postpartum length of stay with cesarean (2.00 vs. 2.67days, p < 0.01). COVID-19 was associated with higher risk for diagnoses of chorioamnionitis and pneumonia and fevers without a focal diagnosis. In adjusted analyses, including demographic factors, logistic regression demonstrated a c-statistic of 0.71 (95% confidence interval [CI]: 0.69, 0.80).

CONCLUSION: COVID-19 symptoms were present in a minority of COVID-19-positive women admitted for delivery. Significant differences in obstetrical outcomes were found. While demographic risk factors demonstrated acceptable discrimination, risk prediction does not capture a significant portion of COVID-19-positive patients.

KEY POINTS: · COVID-19 symptoms were present in a minority of COVID-19-positive women admitted.. · COVID-19 symptomatology did not appear to differ before or after the apex of infection in New York.. · Demographic risk factors are unlikely to capture a significant portion of COVID-19-positive patients..

PMID:33878775 | DOI:10.1055/s-0041-1727168

Chemosphere. 2021 Apr 14;279:130573. doi: 10.1016/j.chemosphere.2021.130573. Online ahead of print.

ABSTRACT

BACKGROUND: Bisphenol S (BPS) and bisphenol F (BPF), as substitutes for bisphenol A (BPA), are synthetic compounds detected increasingly frequently in plastics and resins. BPA, BPS, and BPF are endocrine disruptors with unclear effects on depressive symptoms. This study aims to evaluate the effects of these compounds on depressive symptoms in adults.

METHODS: We used data from the U.S. National Health and Nutrition Examination Survey (NHANES) 2007-2016 for BPA (N = 7,085) and NHANES 2013-2016 for BPS and BPF (N = 2,707). BPA, BPS and BPF were detected in urine samples. Depressive symptoms were assessed with a nine-item patient health questionnaire (PHQ-9). Logistic regression models were used to investigate the effects of urinary BPA, BPS, and BPF concentrations on depressive symptoms.

RESULTS: In the general population, no significant association was observed between urinary BPA, BPS, and BPF and depressive symptoms. However, in stratified analyses, urinary BPS was positively associated with depressive symptoms in men (odds ratio [OR], 2.90; 95% confidence interval [CI], 1.13-7.47). In elderly men (≥60 years old), urinary BPA and BPS were positively correlated with depressive symptoms with ORs (95% CIs) of 5.53 (1.55-19.70) and 28.89 (4.23-192.75), respectively. In addition, urinary BPS was negatively associated with depressive symptoms (OR, 0.16; 95% CI, 0.04-0.59) in elderly women (≥60 years old).

CONCLUSIONS: This study indicated that exposure to BPA and BPS was positively associated with depressive symptoms, especially in men. However, BPS was negatively associated with depressive symptoms in elderly women.

PMID:33878692 | DOI:10.1016/j.chemosphere.2021.130573

J Environ Manage. 2021 Apr 17;289:112498. doi: 10.1016/j.jenvman.2021.112498. Online ahead of print.

ABSTRACT

This study presents a novel landscape classification map of the Republic of Ireland and is the first to identify broad landscape classes by incorporating physiographic and land cover data. The landscape classification responds to commitments to identify and classify the Irish landscape as a signatory to the European Landscape Convention. The methodology applied a series of clustering iterations to determine an objective multivariate classification of physiographic landscape units and land cover datasets. The classification results determined nine statistically significant landscape classes and the development of a landscape classification map at a national scale. A statistical breakdown of land cover area and diversity of each class was interpreted, and a comparison was extended using independent descriptive variables including farmland use intensity, elevation, and dominant soil type. Each class depicts unique spatial and composition characteristics, from coastal, lowland and elevated, to distinct and dominating land cover types, further explained by the descriptive variables. The significance of individual classes and success of the classification is discussed with particular reference to the wider applicability of the map. The transferability of the methodology to other existing physiographic maps and environmental datasets to generate new landscape classifications is also considered. This novel work facilitates the development of a strategic framework to efficiently monitor, compare and analyse ecological and other land use data that is spatially representative of the distribution and extent of land cover in the Irish countryside.

PMID:33878703 | DOI:10.1016/j.jenvman.2021.112498

Physiol Meas. 2021 Apr 20. doi: 10.1088/1361-6579/abf9f3. Online ahead of print.

ABSTRACT

OBJECTIVE: A proof-of-concept study to assess the potential of a Deep Learning (DL) based photoplethysmography PPG (‘DLPPG’) classification method to detect peripheral arterial disease (PAD) using toe PPG signals.

APPROACH: PPG spectrogram images derived from our previously published multi-site PPG datasets (214 participants; 31.3% legs with PAD by Ankle Brachial Pressure Index (ABPI)) were input into a pretrained 8-layer (5 Convolutional Layers + 3 Fully Connected Layers) AlexNet as tailored to the 2-class problem with transfer learning to fine tune the Convolutional Neural Network (CNN). k-fold random cross validation (CV) was performed [for k=5 and k=10], with each evaluated over k training / validation runs. Overall test sensitivity, specificity, accuracy, and Cohen’s Kappa statistic with 95% confidence interval ranges were calculated and compared, as well as sensitivities in detecting mild-moderate (0.5≤ABPI<0.9) and major (ABPI<0.5) levels of PAD.

MAIN RESULTS: Cross validation with either k = 5 or 10 folds gave similar diagnostic performances. The overall test sensitivity was 86.6%, specificity 90.2% and accuracy 88.9% (Kappa: 0.76 [0.70-0.82]) (at k=5). The sensitivity to mild-moderate disease was 83.0% (75.5-88.9%) and to major disease was 100.0% (90.5-100.0%).

SIGNIFICANCE: Substantial agreements have been demonstrated between the DL-based PPG classification technique and the ABPI PAD diagnostic reference. This novel automatic approach, requiring minimal pre-processing of the pulse waveforms before PPG trace classification, could offer significant benefits for the diagnosis of PAD in a variety of clinical settings where low-cost, portable and easy-to-use diagnostics are desirable.

PMID:33878743 | DOI:10.1088/1361-6579/abf9f3

Diabetes Metab Syndr. 2021 Apr 14;15(3):863-868. doi: 10.1016/j.dsx.2021.04.011. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Reduction of atherogenic lipoproteins is often the ultimate goal of nutritional interventions, however this is complicated given that hypolipidemia is frequently observed in coronavirus disease 2019 (COVID-19) patients. We aimed to explore the association of hypolipidemia with patient outcomes in terms of immunothrombosis and multiorgan injury, focusing on specialized apolipoproteins apo A1 and apo B.

METHODS: Lipid profiles of 50 COVID-19 patients and 30 sick controls presenting to the Emergency Department (ED) were measured in this prospective observational study. The primary outcome was development of severe acute kidney injury (AKI). Need for hospitalization and ICU admission were secondary outcomes. Lipoproteins were analyzed for independent association with serum creatinine (SCr) increase ratio and correlated with a wide panel of biomarkers.

RESULTS: COVID-19 cohort had significantly lower apo A1 (p = 0.006), and higher apo B/apo A1 ratio (p = 0.041). Patients developing severe AKI had significantly lower LDL-C (p = 0.021). Apo B/apo A1 was associated with 2.25-fold decrease in serum SCr increase ratio, while LDL-C with a 1.5% decrease. Hypolipidemia correlated with low plasminogen, ADAMTS13 activity/VWF:Ag, and high inflammatory biomarkers (CRP, IL-6, IL-8, IL-10), plasminogen activator inhibitor-1 (PAI-1), ED creatinine, and SCr increase ratio.

CONCLUSION: Although favored in dietetics, findings of a low LDL-C in COVID-19 patients should be alarming in light of our observations. Low apo B/apo A1 ratio and LDL-C are predictive of renal deterioration in COVID-19 patients, and low LDL-C in particular may potentially serve to indicate COVID-19 related AKI driven by disrupted fibrinolysis and a secondary thrombotic microangiopathy-like process.

PMID:33878674 | DOI:10.1016/j.dsx.2021.04.011

J Photochem Photobiol B. 2021 Apr 15;219:112189. doi: 10.1016/j.jphotobiol.2021.112189. Online ahead of print.

ABSTRACT

The increasing demand for aesthetics, together with advancements in technology, have contributed to the rise in popularity of all-ceramic restorations. In the last two decades, the continuous progression in ceramic materials science for dental applications has permitted the fabrication of high-strength materials. Amongst these, zirconia-based ceramics have improved in terms of fracture resistance and long-term viability in comparison with other silica-based materials. Unfortunately, while bonding of resin cement-silica ceramics can be strengthened through creation of a porous surface by applying hydrofluoric acid (5%-9.5%) and a subsequent silane coupling agent, the glass-free polycrystalline microstructure of zirconia ceramics does not allow such a reaction. The aim of the present in vitro study was to observe the effect of 1070 nm fiber nanosecond pulse laser irradiation on zirconia samples through morphological analysis (profilometry, SEM), thermal recording with Fiber Bragg Gratings (FBGs), elemental composition analysis (EDX) and bond strength testing (mechanical tests) in order to evaluate the possible advantages of this kind of treatment on zirconia surfaces, as well as to show the potential side effects and changes in chemical composition. Despite laser irradiation with a 1070 nm wavelength fiber laser and correct process parameters demonstrating suitable outcomes in terms of improved surface roughness and minimal thermal damage, comparison between irradiated and unirradiated samples did not exhibit statistically significant differences in terms of bonding strength.

PMID:33878686 | DOI:10.1016/j.jphotobiol.2021.112189

J Affect Disord. 2021 Mar 31;288:129-135. doi: 10.1016/j.jad.2021.03.074. Online ahead of print.

ABSTRACT

BACKGROUND: This study aims to explore the mediational effects of emotional and behavioral problems on the association between childhood emotional abuse and depressive symptoms among college students.

METHODS: Data were drawn from 60 universities from 10 provinces in China (n=30,374). Information about childhood maltreatment, depressive symptoms, emotional and behavioral problems were gathered through the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Center for Epidemiologic Studies Depression Scale (CES-D) and the Strengths and Difficulties Questionnaire (SDQ), respectively. Univariable and multivariable logistic regression models and mediating models were used.

RESULTS: After controlling for demographic factors, childhood emotional abuse was the strongest risk factor for depressive symptoms (adjusted odds ratio (aOR)=2.54, 95%CI=2.27-2.85). The relationship between childhood emotional abuse and depressive symptoms was partially mediated by emotional and behavioral problems with 68.7% total indirect effect. Among the 5 identified subtypes of emotional and behavioral problems, the mediating effects of emotional problems (57.3%) and hyperactivity (28.6%) were higher than peer problems (7.8%) and prosocial behavior (3.6%). Conduct problems did not show a significant mediating effect (p>0.05).

LIMITATIONS: The cross-sectional design is limited to make inferences about causality.

CONCLUSIONS: Childhood emotional abuse was strongly associated with depressive symptoms in college students. Of the five identified subtypes of emotional and behavioral problems, four subtypes mediated the relationship between childhood emotional abuse and depressive symptoms, including emotional problems, hyperactivity, peer problems and prosocial behavior.

PMID:33878646 | DOI:10.1016/j.jad.2021.03.074

J Neurol Sci. 2021 Apr 17;425:117447. doi: 10.1016/j.jns.2021.117447. Online ahead of print.

ABSTRACT

Data regarding the risk of tuberculosis (TB) in myasthenia gravis (MG) patients receiving immunosuppressive therapy is limited, and the benefit of TB preventative therapy in these patients is uncertain. We audited observational data collected at an MG clinic in South Africa over a ~ 10-year period, of cases who received immunosuppressive therapy. The total time that the cohort was at risk (patient-years) was used as the denominator to calculate TB incidence after immunosuppressive therapy initiation. Multivariate logistic regression analysis was performed to identify differences between patients who did, and those who did not, develop TB. Of 480 cases, only two received TB preventative therapy when starting immunotherapy. Seventeen of 282 (6%) patients tested, were HIV-infected. With a median follow-up of 3.6 years (interquartile range 1;7.5), 13 (3%) patients (all HIV-uninfected) developed TB (38% within 12 months of starting immunosuppressive therapy). The incidence rate of TB in the study population (≤401/100000 person-years) was not higher than that for the hospital’s catchment area during the same period (>500/100000 population). The maximum dose of prescribed prednisone was higher in patients who developed TB compared to those who did not (median: 0.6 mg/kg/day vs 0.4; 0.002); Odds ratio for TB increased 1.26-fold for every 0.1 mg/kg/day increase in maximum dose (p = 0.001). In our TB endemic setting, receiving immunosuppressive therapy was not associated with excess TB in MG patients. Preventative therapy may be considered in those who are at greatest risk of developing TB and receiving high-dose prednisone.

PMID:33878657 | DOI:10.1016/j.jns.2021.117447

Neural Netw. 2021 Feb 16;141:98-106. doi: 10.1016/j.neunet.2021.01.013. Online ahead of print.

ABSTRACT

Firstly, an intermittent event-triggered control (IETC), as a combination of intermittent control and event-triggered control, is proposed. Then, the quasi-synchronization problem of coupled memristive neural networks with time-varying delays (CDMNN) is discussed under this IETC. To include more of the existing work, aperiodic intermittent control and event-triggered control with combined measurement errors are adopted in the IETC. Under the IETC, it is shown that Zeno behavior cannot be exhibited for CDMNN. At the same time, two new differential inequalities are established, and some simple and practical criteria for CDMNN quasi-synchronization and synchronization are obtained by using these inequalities. In the obtained results, synchronization is a spatial case of quasi-synchronization, and the activation functions of DMNN do not need to be bounded. Finally, a numerical example and some simulations are provided to test the results in theoretical analysis.

PMID:33878659 | DOI:10.1016/j.neunet.2021.01.013