Category: Statistics

Knee. 2021 May 9;30:267-274. doi: 10.1016/j.knee.2021.04.007. Online ahead of print.

ABSTRACT

BACKGROUND: Delays to diagnosis of anterior cruciate ligament (ACL) injury and specialist consultation continue to place patients at risk of early onset osteoarthritis. Incorporating acute knee clinics within a streamlined accident and emergency (A&E) pathway have shown potential in reducing delay but specific evaluative research is lacking. The aim of this service evaluation was to investigate the effectiveness of an acute knee clinic at one NHS Trust in the United Kingdom (UK), on reducing the delay to diagnosis of ACL injury and specialist consultation compared to a standard A&E pathway.

METHODS: An uncontrolled before and after design was utilised for this service evaluation. Data were collected from historical electronic patient records over a 1-year period with analysed results compared against previously collected data from the same NHS Trust.

RESULTS: 81 records met the criteria for the streamlined A&E pathway and were compared against 50 from the standard A&E pathway. For the streamlined A&E pathway median delay to diagnosis reduced from 97 to 14 days and delay to specialist consultation reduced from 158.5 to 45 days and were of statistical significance. The incorporation of an acute knee clinic was identified as the most influential factor on delay in addition to the location of presentation and mechanism of injury.

CONCLUSIONS: Introducing an acute knee clinic within a streamlined A&E pathway has a clinically relevant effect on reducing delay to diagnosis and specialist consultation and allows findings to be extrapolated and implemented to all UK based NHS Trust A&E departments.

PMID:33979729 | DOI:10.1016/j.knee.2021.04.007

Cell Rep. 2021 May 11;35(6):109110. doi: 10.1016/j.celrep.2021.109110.

ABSTRACT

Antibody repertoire sequencing enables researchers to acquire millions of B cell receptors and investigate these molecules at the single-nucleotide level. This power and resolution in studying humoral responses have led to its wide applications. However, most of these studies were conducted with a limited number of samples. Given the extraordinary diversity, assessment of these key features with a large sample set is demanded. Thus, we collect and systematically analyze 2,152 high-quality heavy-chain antibody repertoires. Our study reveals that 52 core variable genes universally contribute to more than 99% of each individual’s repertoire; a distal interspersed preferences characterize V gene recombination; the number of public clones between two repertoires follows a linear model, and the positive selection dominates at RGYW motif in somatic hypermutations. Thus, this population-level analysis resolves some critical features of the antibody repertoire and may have significant value to the large cadre of scientists.

PMID:33979623 | DOI:10.1016/j.celrep.2021.109110

Cell Rep. 2021 May 11;35(6):109114. doi: 10.1016/j.celrep.2021.109114.

ABSTRACT

How genes interact with the environment to shape phenotypic variation and evolution is a fundamental question intriguing to biologists from various fields. Existing linear models built on single genes are inadequate to reveal the complexity of genotype-environment (G-E) interactions. Here, we develop a conceptual model for mechanistically dissecting G-E interplay by integrating previously disconnected theories and methods. Under this integration, evolutionary game theory, developmental modularity theory, and a variable selection method allow us to reconstruct environment-induced, maximally informative, sparse, and casual multilayer genetic networks. We design and conduct two mapping experiments by using a desert-adapted tree species to validate the biological application of the model proposed. The model identifies previously uncharacterized molecular mechanisms that mediate trees’ response to saline stress. Our model provides a tool to comprehend the genetic architecture of trait variation and evolution and trace the information flow of each gene toward phenotypes within omnigenic networks.

PMID:33979624 | DOI:10.1016/j.celrep.2021.109114

Compr Psychiatry. 2021 Apr 30;108:152242. doi: 10.1016/j.comppsych.2021.152242. Online ahead of print.

ABSTRACT

BACKGROUND: Several studies have shown that interpersonal dependency is a risk factor for prolonged grief disorder (PGD), a disorder that has been recently approved by the American Psychiatric Association Assembly for inclusion in the Diagnostic and Statistical Manual of Mental Disorders-5-Text Revision (DSM-5-TR). Nevertheless, it remains unclear whether this relationship is independent of depression, which may also be related to both loss and interpersonal dependency. Furthermore, anaclitic dependency (maladaptive and immature) compared to relatedness (more adaptive and mature) dependency, and the relationships between these types of dependency and PGD, have not been examined. The aim of the present study was to determine how anaclitic and relatedness dependency are associated with PGD symptom severity, controlling for depressive symptom severity, over and above potential sociodemographic and loss-related confounder variables.

METHODS: Participants (N = 241) bereaved after the death of a family member from 0.5 to 8 years before the survey (M = 3.36, SD = 2.02) completed the Depressive Experiences Questionnaire, the Patient Health Questionnaire-9, and the Prolonged Grief Disorder-13 scale (PG-13).

RESULTS: A hierarchical regression analysis confirmed that anaclitic dependency is positively associated with PGD symptom severity, even when controlling for depression severity and other potential confounder variables. There was no significant association between relatedness dependency and PGD.

CONCLUSIONS: To assess the risk of PGD in individuals bereaved after the death of a family member, it is important to assess anaclitic dependency.

PMID:33979631 | DOI:10.1016/j.comppsych.2021.152242

Hypertens Pregnancy. 2021 May 12:1-9. doi: 10.1080/10641955.2021.1921791. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to assess the accuracy of The Fetal Medicine Foundation (FMF) screening algorithm for the prediction of preeclampsia.METHODS: Out of 138 women with high-risk pregnancies prospectively followed, 30 developed preeclampsia. The clinical examination and biochemical measurements were performed at first, second, early and late third trimester.RESULTS: A lower PAPP-A levels were found in the first trimester, while sFlt/PlGF was increased in the second and early third trimester in preeclampsia (p>0.05). FMF algorithm presented higher specificity (>70%), but had a drawback of lower sensitivity (35-77%).CONCLUSION: FMF algorithm had modest performance in the prediction of preeclampsia for high-risk pregnancies.

PMID:33979553 | DOI:10.1080/10641955.2021.1921791

Curr Eye Res. 2021 May 12. doi: 10.1080/02713683.2021.1929330. Online ahead of print.

ABSTRACT

PURPOSE: Cystoid macular edema (CME) following cataract surgery is a well-known entity. Less is known regarding the risk factors of developing CME following repair of rhegmatogenous retinal detachments (RRD).

METHODS: This was a multi-institutional study of primary RRD surgeries from 1/1/2015 through 12/31/2015. The primary outcome was development of post-operative CME following RRD surgery. Post-operative optical coherence tomography imaging and 3 months of follow up following RRD repair were required.

RESULTS: There were 1,466 eyes that met the inclusion criteria, and 140 (9.6%) developed post-operative CME following primary RRD repair. On multivariate analysis the statistically significant metrics were older patient age (OR 1.03 per year, 95% CI 1.01 to 1.05), pre-operative proliferative vitreoretinopathy (PVR, OR 1.74, 95% 1.03 to 2.95), and cataract surgery following RRD repair (OR 2.18, 95% CI 1.47 to 3.25). Single surgery success was protective against CME (OR 0.20 (95% CI 0.14 – 0.30). Seventy-six (9.0%) of the phakic eyes and 60 (9.9%) of the pseudophakic eyes, developed post-operative CME. Multivariate analysis showed that cataract surgery following RRD repair (p < 0.0001) for phakic eyes and older age (p = 0.0075) for pseudophakic eyes were risk factors. In eyes that underwent successful retinal re-attachment with one surgery, post-operative cataract surgery (p = 0.0005) and pre-operative PVR (p = 0.0011) were risk factors for CME in this subgroup.

CONCLUSION: CME occurred in nearly 10% of eyes following RRD repair. The biggest risk factors were recurrent RRD, preexisting PVR, older age, and cataract surgery following RRD repair.

PMID:33979556 | DOI:10.1080/02713683.2021.1929330

PLoS One. 2021 May 12;16(5):e0251491. doi: 10.1371/journal.pone.0251491. eCollection 2021.

ABSTRACT

Alternative pigment sources that are harmless to human health and can be produced in an eco-responsible way are of great research interest. The experiments undertaken in this study were conducted using autumn leaves of Aesculus hippocastanum as potential novel colorant sources. This study focused on improving the Gauss-peak spectra method (a less expensive alternative to high-pressure liquid chromatography) in combination with thin-layer chromatography, leading to the development of a new methodology. The collected leaves were stored at two different temperatures: 20°C and -20°C. The data obtained by spectrophotometric scanning of the samples were analyzed using the Gauss-peak spectra method in the R program with three wavelength ranges: 350-750 nm, 390-710 nm, and 400-700 nm. The results were then assessed for statistically significant differences in the estimated concentrations for the different wavelength ranges regarding (1) total pigment, carotenoid, and chlorophyll concentration (two-sample t-test) and (2) concentration of each indicated pigment (two-way analysis of variance). The results were also tested for differences between the estimated concentrations of samples stored under the different conditions. The Gauss-peak spectra results with and without thin-layer chromatography were statistically compared using a paired t-test. The results showed that thin-layer chromatography greatly enhanced the efficiency of the Gauss-peak spectra method for estimating the major and minor pigment composition without generating high additional costs. A wavelength range of 400-700 nm was optimal for all Gauss-peak spectra methods. In conclusion, the proposed method is a more successful, inexpensive alternative to high-pressure liquid chromatography.

PMID:33979411 | DOI:10.1371/journal.pone.0251491

PLoS One. 2021 May 12;16(5):e0251605. doi: 10.1371/journal.pone.0251605. eCollection 2021.

ABSTRACT

INTRODUCTION: Rumors and conspiracy theories, can contribute to vaccine hesitancy. Monitoring online data related to COVID-19 vaccine candidates can track vaccine misinformation in real-time and assist in negating its impact. This study aimed to examine COVID-19 vaccine rumors and conspiracy theories circulating on online platforms, understand their context, and then review interventions to manage this misinformation and increase vaccine acceptance.

METHOD: In June 2020, a multi-disciplinary team was formed to review and collect online rumors and conspiracy theories between 31 December 2019-30 November 2020. Sources included Google, Google Fact Check, Facebook, YouTube, Twitter, fact-checking agency websites, and television and newspaper websites. Quantitative data were extracted, entered in an Excel spreadsheet, and analyzed descriptively using the statistical package R version 4.0.3. We conducted a content analysis of the qualitative information from news articles, online reports and blogs and compared with findings from quantitative data. Based on the fact-checking agency ratings, information was categorized as true, false, misleading, or exaggerated.

RESULTS: We identified 637 COVID-19 vaccine-related items: 91% were rumors and 9% were conspiracy theories from 52 countries. Of the 578 rumors, 36% were related to vaccine development, availability, and access, 20% related to morbidity and mortality, 8% to safety, efficacy, and acceptance, and the rest were other categories. Of the 637 items, 5% (30/) were true, 83% (528/637) were false, 10% (66/637) were misleading, and 2% (13/637) were exaggerated.

CONCLUSIONS: Rumors and conspiracy theories may lead to mistrust contributing to vaccine hesitancy. Tracking COVID-19 vaccine misinformation in real-time and engaging with social media to disseminate correct information could help safeguard the public against misinformation.

PMID:33979412 | DOI:10.1371/journal.pone.0251605

J Magn Reson Imaging. 2021 May 12. doi: 10.1002/jmri.27637. Online ahead of print.

ABSTRACT

BACKGROUND: Radiomics has shown promising results in the diagnosis, efficacy, and prognostic assessments of multiple myeloma (MM). However, little evidence exists on the utility of radiomics in predicting a high-risk cytogenetic (HRC) status in MM.

PURPOSE: To develop and test a magnetic resonance imaging (MRI)-based radiomics model for predicting an HRC status in MM patients.

STUDY TYPE: Retrospective.

POPULATION: Eighty-nine MM patients (HRC [n: 37] and non-HRC [n: 52]).

FIELD STRENGTH/SEQUENCE: A 3.0 T; fast spin-echo (FSE): T1-weighted image (T1WI) and fat-suppression T2WI (FS-T2WI).

ASSESSMENT: Overall, 1409 radiomics features were extracted from each volume of interest drawn by radiologists. Three sequential feature selection steps-variance threshold, SelectKBest, and least absolute shrinkage selection operator-were repeated 10 times with 5-fold cross-validation. Radiomics models were constructed with the top three frequency features of T₁ WI/T₂ WI/two-sequence MRI (T₁ WI and FS-T₂ WI). Radiomics models, clinical data (age and visually assessed MRI pattern), or radiomics combined with clinical data were used with six classifiers to distinguish between HRC and non-HRC statuses. Six classifiers used were support vector machine, random forest, logistic regression (LR), decision tree, k-nearest neighbor, and XGBoost. Model performance was evaluated with area under the curve (AUC) values.

STATISTICAL TESTS: Mann-Whitney U-test, Chi-squared test, Z test, and DeLong method.

RESULTS: The LR classifier performed better than the other classifiers based on different data (AUC: 0.65-0.82; P < 0.05). The two-sequence MRI models performed better than the other data models using different classifiers (AUC: 0.68-0.82; P < 0.05). Thus, the LR two-sequence model yielded the best performance (AUC: 0.82 ± 0.02; sensitivity: 84.1%; specificity: 68.1%; accuracy: 74.7%; P < 0.05).

CONCLUSION: The LR-based machine learning method appears superior to other classifier methods for assessing HRC in MM. Radiomics features based on two-sequence MRI showed good performance in differentiating HRC and non-HRC statuses in MM.

EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 2.

PMID:33979466 | DOI:10.1002/jmri.27637

PLoS One. 2021 May 12;16(5):e0250894. doi: 10.1371/journal.pone.0250894. eCollection 2021.

ABSTRACT

Medically underserved areas (MUA) or health professional shortage areas (HPSA) designations are based on primary care health services availability. These designations are used in recruiting international medical graduates (IMGs) trained in primary care or subspecialty (e.g., oncology) to areas of need. Whether the MUA/HPSA designation correlates with Oncologist Density (OD) and supports IMG oncologists’ recruitment to areas of need is unknown. We evaluated the concordance of OD with the designation of MUAs/HPSAs and evaluated the impact of OD and MUA/HPSA status on overall survival. We conducted a retrospective cohort study of patients diagnosed with hematological malignancies or metastatic solid tumors in 2011 from the Surveillance Epidemiology and End Results (SEER) database. SEER was linked to the American Medical Association Masterfile to calculate OD, defined as the number of oncologists per 100,000 population at the county level. We calculated the proportion of counties with MUA or HPSA designation for each OD category. Overall survival was estimated using the Kaplan-Meier method and compared between the OD category using a log-rank test. We identified 68,699 adult patients with hematologic malignancies or metastatic solid cancers in 609 counties. The proportion of MUA/HPSA designation was similar across counties categorized by OD (93.2%, 95.4%, 90.3%, and 91.7% in counties with <2.9, 2.9-6.5, 6.5-8.4 and >8.4 oncologists per 100K population, p = 0.7). Patients’ median survival in counties with the lowest OD was significantly lower compared to counties with the highest OD (8 vs. 11 months, p<0.0001). The difference remained statistically significant in multivariate and subgroup analysis. MUA/HPSA status was not associated with survival (HR 1.03, 95%CI 0.97-1.09, p = 0.3). MUA/HPSA designation based on primary care services is not concordant with OD. Patients in counties with lower OD correlated with inferior survival. Federal programs designed to recruit physicians in high-need areas should consider the availability of health care services beyond primary care.

PMID:33979399 | DOI:10.1371/journal.pone.0250894