Category: Statistics

J Magn Reson Imaging. 2021 Nov 19. doi: 10.1002/jmri.28000. Online ahead of print.

ABSTRACT

BACKGROUND: The majority of heart failure (HF) in hypertrophic cardiomyopathy (HCM) manifests as a phenotype with preserved left ventricular (LV) ejection fraction; however, the exact contribution of left atrial (LA) phasic function to HF with preserved ejection fraction (HFpEF) in HCM remains unresolved.

PURPOSE: To define the association between LA function and HFpEF in HCM patients using cardiac magnetic resonance imaging (MRI) feature tracking.

STUDY TYPE: Retrospective.

POPULATION: One hundred and fifty-four HCM patients (HFpEF vs. non-HF: 55 [34 females] vs. 99 [43 females]).

FIELD STRENGTH/SEQUENCE: 3.0 T/balanced steady-state free precession.

ASSESSMENT: LA reservoir function (reservoir strain [ε_s ], total ejection fraction [EF]), conduit function (conduit strain [ε_e ], passive EF), booster-pump function (booster strain [ε_a ] and active EF), LA volume index, and LV global longitudinal strain (LV GLS) were evaluated in HCM patients.

STATISTICAL TESTS: Chi-square test, Student’s t-test, Mann-Whitney U test, multivariate linear regression, logistic regression, and net reclassification analysis were used. Two-sided P < 0.05 was considered statistically significant.

RESULTS: No significant difference was found in LV GLS between the non-HF and HFpEF group (-10.67 ± 3.14% vs. -10.14 ± 4.01%, P = 0.397), whereas the HFpEF group had more severely impaired LA phasic strain (ε_s : 27.40 [22.60, 35.80] vs. 18.15 [11.98, 25.90]; ε_e : 13.80 [9.20, 18.90] vs. 7.95 [4.30, 14.35]; ε_a : 13.50 [9.90, 17.10] vs. 7.90 [5.40, 14.15]). LA total EF (37.91 [29.54, 47.94] vs. 47.49 [39.18, 55.01]), passive EF (14.70 [7.41, 21.49] vs. 18.07 [9.32, 24.78]), and active EF (27.19 [17.79, 36.60] vs. 36.64 [26.63, 42.71]) were all significantly decreased in HFpEF patients compared with non-HF patients. LA reservoir (β = 0.90 [0.85, 0.96]), conduit (β = 0.93 [0.87, 0.99]), and booster (β = 0.86 [0.78, 0.95]) strain were independently associated with HFpEF in HCM patients. The model including reservoir strain (Net Reclassification Index [NRI]: 0.260) or booster strain (NRI: 0.325) improved the reclassification of HFpEF based on LV GLS and minimum left atrial volume index (LAVI_min ).

DATA CONCLUSION: LA phasic function was severely impaired in HCM patients with HFpEF, whereas LV function was not further impaired compared with non-HF patients.

LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 3.

PMID:34799953 | DOI:10.1002/jmri.28000

Child Care Health Dev. 2021 Nov 20. doi: 10.1111/cch.12932. Online ahead of print.

ABSTRACT

BACKGROUND: Developmental delay (DD) indicates a failure to meet the developmental milestones of most children of the same age. Studies based solely on the ICD coding manual may underestimate the prevalence of DD. Real-world use of rehabilitation data may be useful in the identification of more DD children previously undiagnosed with DD.

AIMS: To estimate the prevalence of DD among children aged 0-6 by age and sex in Taiwan based on modified ICD codes.

METHODS: A list of ICD codes specific to DD (including delays and disabilities requiring early intervention) was generated from the existing ICD codebook and modified based on National Health Insurance (NHI) claims data pertaining to developmental rehabilitation of children aged 0-6. The validity of the codes was subsequently assessed by DD experts in various fields using the consensus development technique. The resulting list was used to estimate the prevalence of DD among children in Taiwan from 2000 to 2015 based on analysis of longitudinal NHI data.

RESULT: Between 2000 and 2015, the prevalence of DD among children aged 0 to 6 years increased from 2.0% to 5.7 % and the sex ratio was 181-197 males per 100 females. The prevalence estimate obtained in this study (5.6%) was 229% higher than existing government statistics (1.6%) published in 2014.

CONCLUSIONS: The codes developed using claims data in this study can be used to estimate the prevalence of DD among children and evaluate the effectiveness of intervention programs. Consistent increases in the prevalence of DD indicate that efforts to promote early intervention have been effective. Nonetheless, the low prevalence rate among 0-2y children with developmental delay and low prevalence rate of female CWDD means that the policy should notice the lack of access to healthcare services for infants and female children, and produce a more equitable or fair distribution of healthcare resources.

PMID:34799877 | DOI:10.1111/cch.12932

J Magn Reson Imaging. 2021 Nov 19. doi: 10.1002/jmri.28002. Online ahead of print.

ABSTRACT

BACKGROUND: Advanced magnetic resonance imaging (MRI) methods are increasingly being used to assess the human placenta. Yet, the structure-function interplay in normal placentas and their associations with pregnancy risks are not fully understood.

PURPOSE: To characterize the normal human placental structure (volume and umbilical cord centricity index (CI)) and function (perfusion) ex-vivo using MRI, to assess their association with birth weight (BW), and identify imaging-markers for placentas at risk for dysfunction.

STUDY TYPE: Prospective.

POPULATION: Twenty normal term ex-vivo placentas.

FIELD STRENGTH/SEQUENCE: 3 T/ T₁ and T₂ weighted (T₁ W, T₂ W) turbo spin-echo, three-dimensional susceptibility-weighted image, and time-resolved angiography with interleaved stochastic trajectories (TWIST), during passage of a contrast agent using MRI compatible perfusion system that mimics placental flow.

ASSESSMENT: Placental volume and CI were manually extracted from the T₁ W images by a fetal-placental MRI scientist (D.L., 7 years of experience). Perfusion maps including bolus arrival-time and full-width at half maximum were calculated from the TWIST data. Mean values, entropy, and asymmetries were calculated from each perfusion map, relating to both the whole placenta and volumes of interest (VOIs) within the umbilical cord and its daughter blood vessels.

STATISTICAL TESTS: Pearson correlations with correction for multiple comparisons using false discovery rate were performed between structural and functional parameters, and with BW, with P < 0.05 considered significant.

RESULTS: All placentas were successfully perfused and scanned. Significant correlations were found between whole placenta and VOIs perfusion parameters (mean R = 0.76 ± 0.06, range = 0.67-0.89), which were also significantly correlated with CI (mean R = 0.72 ± 0.05, range = 0.65-0.79). BW was correlated with placental volume (R = 0.62), but not with CI (P = 0.40). BW was also correlated with local perfusion asymmetry (R = -0.71).

DATA CONCLUSION: Results demonstrate a gradient of placental function, associated with CI and suggest several ex-vivo imaging-markers that might indicate an increased risk for placental dysfunction.

LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 1.

PMID:34799945 | DOI:10.1002/jmri.28002

J Forensic Sci. 2021 Nov 19. doi: 10.1111/1556-4029.14946. Online ahead of print.

ABSTRACT

Aluminum (Al) powder is commonly encountered in improvised explosive devices (IEDs) as a metallic fuel due to its availability and low cost. Although available commercially in powder form, amateur bomb-makers also produce their own Al powder via simple methods found online. In order to provide investigative leads and forensic intelligence, it is important to evaluate not only the composition of homemade devices, but also to distinguish between the various forms of Al powder they contain. To achieve this goal, a method using automated microscopy in combination with statistical techniques has been demonstrated to have the potential to provide source discrimination and investigative leads in source attribution of Al powders in IEDs. The present research refined this method and investigated 59 industrially and amateurly produced Al powder sources with seven subsamples per source using two traditional linear discriminant analyses (LDA), one with a standard data split for training and testing, and another using leave-one-out cross-validation. Averaging the classification accuracies for the two LDA-based analyses, LDA has the ability to correctly classify 59.26%, 83.35%, and 80.69% of the samples based on their powder source, type, and production method, respectively. This classification accuracy represents a 3407%, 317%, and 61.38% increase in accuracy from random class assignment, respectively. Further, in most instances of incorrect data attribution to a particular source, the subsample has been misidentified with another sample of the same powder type or production method.

PMID:34799855 | DOI:10.1111/1556-4029.14946

J Forensic Sci. 2021 Nov 19. doi: 10.1111/1556-4029.14947. Online ahead of print.

ABSTRACT

Sex estimation methods using traditional cranial nonmetric traits utilize predictive models to produce a final sex estimation, using the resulting model’s score to classify the individual. When sex estimations are assigned from discriminant scoring alone, statistical confidence in the resultant estimate is not always assessed or reported. Although some forensic anthropologists may qualitatively report their confidence in the assessment (e.g., “probable male”), these statements are subjective, not standardized, and not necessarily based on statistical results in a uniform way. The goals of this study were to evaluate how posterior probability-informed thresholds (PPITs) impacted accuracy rates, assess the balance between sample inclusion and accuracy for the proposed PPIT approach, and make recommendations for the use and interpretation of specific thresholds in casework. Using a sample of U.S. Black and White females and males (n = 292), we examined how PPITs can standardize the decision-making process of inferring sex for two methods using nonmetric cranial traits. We found that using PPITs of at least 0.85 increased accuracy (over 92% for some PPITs) yet remained highly inclusive of the sample. PPITs < 0.75 did not produce classification accuracy rates significantly higher than chance, and when using these cranial trait sex estimation methods, cases with posterior probabilities (PPs) <0.75 should be reported as “indeterminate.” The 0.75-0.84 PPIT interval had an accuracy rate of 76%, which was both statistically significantly different from chance as well as from the higher (>0.85) groups, suggesting that although sex estimation at this level may be acceptable, the results hold lower confidence.

PMID:34799862 | DOI:10.1111/1556-4029.14947

Eur Arch Paediatr Dent. 2021 Nov 20. doi: 10.1007/s40368-021-00664-9. Online ahead of print.

ABSTRACT

PURPOSE: Osteogenesis imperfecta (OI) results from mutations in the genes involved in the modification or biosynthesis of collagen. This study aimed to assess the oral health-related quality of life (OHRQoL) in children with OI.

METHODOLOGY: Participants were recruited from a highly specialised OI centre for children. The Child Oral-Health Impact Profile-Short Form (COHIP-SF) was used, adding demographic and qualitative questions. Children aged 8-16 years participated between January and October 2019. Statistical analysis was carried out. A higher COHIP-SF score indicates better OHRQoL (maximum score, 76).

RESULTS: One hundred and six (106) children participated (44 female, mean age 11.93 years). COHIP-SF median score was 59. Children reporting mild OI (n = 55) had higher median scores (62) compared to severe OI (n = 7) with median scores of 55 (P = 0.087). When comparing mixed (< 12 years, n = 46) and permanent dentition (≥ 12, n = 60), no significant difference in OHRQoL was seen (P = 0.977). There was no significant difference between severities for each COHIP-SF domain. Limited data on the presence of dentinogenesis imperfecta did not impact overall score (P = 0.109), but was significant in the oral-health domain (P = 0.033).

QUALITATIVE: Common themes were the need for braces, discolouration, pain and function.

CONCLUSION: This study confirmed that children with OI have dental concerns in areas including oral health, functional well-being and socio-emotional well-being. This was related to severity of OI.

PMID:34799841 | DOI:10.1007/s40368-021-00664-9

Risk Anal. 2021 Nov 19. doi: 10.1111/risa.13858. Online ahead of print.

ABSTRACT

In this study, we propose a time-dependent susceptible-exposed-infected-recovered (SEIR) model for the analysis of the SARS-CoV-2 epidemic outbreak in three different countries, the United States, Italy, and Iceland using public data inherent the numbers of the epidemic wave. Since several types and grades of actions were adopted by the governments, including travel restrictions, social distancing, or limitation of movement, we want to investigate how these measures can affect the epidemic curve of the infectious population. The parameters of interest for the SEIR model were estimated employing a composite likelihood approach. Moreover, standard errors have been corrected for temporal dependence. The adoption of restrictive measures results in flatten epidemic curves, and the future evolution indicated a decrease in the number of cases.

PMID:34799850 | DOI:10.1111/risa.13858

Diabetes Ther. 2021 Nov 19. doi: 10.1007/s13300-021-01174-z. Online ahead of print.

ABSTRACT

Limiting postprandial glycemic response (PPGR) is an important intervention in reducing the risk of chronic metabolic diseases and has been shown to impart significant health benefits in people with elevated levels of blood sugar. In this study, we collected gut microbiome activity data by assessing the metatranscriptome, and we measured the glycemic responses of 550 adults who consumed more than 30,000 meals, collectively, from omnivore or vegetarian/gluten-free diets. We demonstrate that gut microbiome activity, anthropometric factors, and food macronutrients modulate individual variation in glycemic response. We employ two predictive models, including a mixed-effects linear regression model (R = 0.77) and a gradient boosting machine model (R_train = 0.80/R²_train = 0.64; R_test = 0.64/R²_test = 0.40), which demonstrate variation in PPGR between individuals when ingesting the same foods. All features in the final mixed-effects linear regression model were significant (p < 0.05) except for two features which were retained as suggestive: glutamine production pathways (p = 0.08) and the interaction between tyrosine metabolizers and carbs (p = 0.06). We introduce molecular functions as features in these two models, aggregated from microbial activity data, and show their statistically significant contributions to glycemic control. In summary, we demonstrate for the first time that metatranscriptomic activity of the gut microbiome is correlated with PPGR among adults.

PMID:34799839 | DOI:10.1007/s13300-021-01174-z

Gesundheitswesen. 2021 Nov 19. doi: 10.1055/a-1665-6874. Online ahead of print.

ABSTRACT

BACKGROUND: In Germany, the Diagnosis-Related Group Statistics (DRG Statistics) represent an almost complete discharge data-based registry of inpatient services in acute care hospitals. However, services of hospitals owned by workers’ compensation funds and financed through the statutory insurance for occupational accidents are excluded from the obligation of submitting hospital discharge data. Hence, the DRG statistics might be incomplete regarding inpatient services for trauma care.

METHODS: In order to illustrate trauma and post-trauma care in acute care hospitals, groups of specific inpatient services were defined. Numbers of cases according to these groups were identified in the microdata of the DRG statistics, as well as in the inpatient data of all nine workers’ compensation funds hospitals in Germany. By dividing cases financed through the statutory insurance for occupational accidents from cases financed through other payers, the overlap of both databases as well as the share of cases not recorded in the DRG statistics were quantified. The analysis comprised data of 2016-2018.

RESULTS: Depending on the type of service, the share of cases not recorded in the DRG statistics varied between 0.1% and more than 60% (accumulated 2016 to 2018). There was under-recording of early-stage rehabilitation for traumatic brain injury (61%), treatment for traumatic paraplegia (14% for initial treatment and 23% for subsequent treatment), treatment for amputation injury (13%) and treatment for severe hand injury (5%).

CONCLUSION: Regarding inpatient services that are not covered by the statutory insurance for occupational accidents, the microdata of the DRG statistics can be considered as virtually complete. However, inpatient services for trauma care are not completely recorded because discharge data are not submitted by hospitals run by workers’ compensation funds when services are financed through the statutory insurance for occupational accidents. Analyses of trauma care can only be complete if data of hospitals financed by workers’ compensation funds are included.

PMID:34798663 | DOI:10.1055/a-1665-6874

Klin Padiatr. 2021 Nov 19. doi: 10.1055/a-1662-5336. Online ahead of print.

ABSTRACT

BACKGROUND: The number of long term cancer survivors during childhood or adolescence is increasing steadily. Survivors often suffer from physical or psychosocial long term effects. There is currently little data on the arrangement of long term aftercare in the field of psychosocial care.

METHODS: In November 2017 a questionnaire was sent to 1900 cancer survivors aged between 18 and 35 years whose diagnosis dated at least five years prior. The obtained data serve as a condition and needs assessment, how the (psychosocial) long-term aftercare is perceived by the survivors and what else is desired. The analysis was conducted using descriptive statistics as well as the calculation of bivariate correlations.

RESULTS: The response rate was 54.9% (n=1.043). The median interval from the first diagnosis was 20 years. In total 666 survivors (63.9%) stated that they suffered from at least one long term effect. Within this, especially neurocognitive themes played a role. 87.2% of the respondents had the feeling that they had overcome the illness/therapy well.

CONCLUSION: Through a stronger patient-focussed orientation concerning the current care and advisory services, the situation of long term survivors could be improved. This especially includes access to relevant information that focuses on the available psychosocial and welfare services, as well as to advisory and care services. Additionally, the development and expansion of care structures in the areas of neurocognition and psychotherapy is important to ensure long term participation attendance.

HINTERGRUND: Die Zahl der Langzeitüberlebenden nach einer Krebserkrankung im Kindes- oder Jugendalter (Survivor) steigt stetig. Survivor leiden nicht selten unter körperlichen oder psychosozialen Spätfolgen. Für die Gestaltung der Langzeitnachsorge im Bereich der psychosozialen Versorgung liegen bislang kaum Daten vor.

METHODE: 11/2017 wurde deutschlandweit ein Fragebogen an 1.900 Survivor im Alter von 18 bis 35 Jahren versandt, deren Erstdiagnose zum Befragungszeitpunkt mindestens fünf Jahre zurücklag. Die erhobenen Daten dienen als Zustands- und Bedarfserhebung, wie die (psychosozialen) Langzeitnachsorge von den Survivorn wahrgenommen und was darüber hinaus gewünscht wird. Die Auswertung erfolgte mittels deskriptiver Statistik sowie der Berechnung bivariater Korrelationen.

ERGEBNISSE: Der Rücklauf betrug 54,9% (n=1.043). Der mediane Abstand zur Erst-Diagnose betrug 20 Jahre. Insgesamt gaben 666 Survivor (63,9%) an, mindestens eines der abgefragten Items/Symptome bei sich zu beobachten. Hierbei spielen besonders neurokognitive Themen eine Rolle. Viele Angebote der Langzeitnachsorge sind den Survivorn nicht bekannt. 87,2% der Befragten haben das Gefühl, die Erkrankung/Therapie gut gemeistert zu haben.

SCHLUSSFOLGERUNG: Eine stärkere patientenorientierte Ausrichtung der derzeitigen Versorgungs- und Beratungsangebote könnte die Situation von Langzeitüberlebenden noch verbessern. Zentral sind hierbei der Zugang zu gezielten Informationen, eine psychosoziale und sozialrechtliche Betreuung sowie der Zugang zu Beratungs- und Versorgungsangeboten. Auch der Auf- und Ausbau von Versorgungsstrukturen im Bereich der Neurokognition und Psychotherapie ist für die langfristige Sicherstellung von Partizipation wünschenswert.

PMID:34798671 | DOI:10.1055/a-1662-5336