Category: Statistics

PLoS One. 2021 Aug 2;16(8):e0255566. doi: 10.1371/journal.pone.0255566. eCollection 2021.

ABSTRACT

BACKGROUND: Closing the gap of unmet for family planning is crucial to eliminate new pediatric HIV infections likewise to improve maternal and child health among reproductive-age women living with HIV. However, studies conducted on unmet need for family planning among reproductive-age women living with HIV showed inconsistent and non-conclusive findings on the magnitude of the problem. Moreover, there was no meta-analysis conducted in this area. So this systematic review and meta-analysis were conducted to estimate the pooled prevalence unmet need for family planning among reproductive-age women living with HIV in Ethiopia.

METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed to review both published and unpublished studies in Ethiopia. All studies in PubMed, Cochrane Library, Hinari, Google Scholar, CINAHL, and Global Health databases were searched. Meta-analysis was performed using STATA 14 software. The heterogeneity and publication bias were assessed using the I2 statistics and Egger regression asymmetry test, respectively. Forest plots were used to present the pooled prevalence with a 95% confidence interval (CI).

RESULTS: This review included 7 studies, and 3333 study participants. The pooled prevalence of unmet need for family planning among reproductive-age women living with HIV in Ethiopia was 25.13% (95%CI: 19.97, 30.29). The pooled prevalence of unmet need for spacing and limiting was 13.91% (95%CI: 10.11, 17.72) and 9.11% (95%CI: 6.43, 11.78), respectively.

CONCLUSIONS: One-fourths of reproductive-age women living with HIV had an unmet need for family planning. A variety of programmatic investments are needed to achieve more meaningful progress toward the reduction of unmet need for family planning among reproductive-age women living with HIV.

PMID:34339464 | DOI:10.1371/journal.pone.0255566

PLoS One. 2021 Aug 2;16(8):e0254774. doi: 10.1371/journal.pone.0254774. eCollection 2021.

ABSTRACT

BACKGROUND: Over the years, sanitation programs over the world have focused more on household sanitation, with limited attention towards the disposal of children’s stools. This lack of attention could be due to the misconception that children’s stools are harmless. The current study examined the individual and contextual predictors of safe disposal of children’s faeces among women in sub-Saharan Africa (SSA).

METHODS: The study used secondary data involving 128,096 mother-child pairs of under-five children from the current Demographic and Health Surveys (DHS) in 15 sub-Saharan African countries from 2015 to 2018. Multilevel logistic analysis was used to assess the individual and contextual factors associated with the practice of safe disposal of children’s faeces. We presented the results as adjusted odds ratios (aOR) at a statistical significance of p< 0.05.

RESULTS: The results show that 58.73% (57.79-59.68) of childbearing women in the 15 countries in SSA included in our study safely disposed off their children’s stools. This varied from as high as 85.90% (84.57-87.14) in Rwanda to as low as 26.38% (24.01-28.91) in Chad. At the individual level, the practice of safe disposal of children’s stools was more likely to occur among children aged 1, compared to those aged 0 [aOR = 1.74; 95% CI: 1.68-1.80] and those with diarrhoea compared to those without diarrhoea [aOR = 1.17, 95% CI: 1.13-1.21]. Mothers with primary level of education [aOR = 1.42, 95% CI: 1.30-1.5], those aged 35-39 [aOR = 1.20, 95% CI: 1.12-1.28], and those exposed to radio [aOR = 1.23, 95% CI: 1.20-1.27] were more likely to practice safe disposal of children’s stools. Conversely, the odds of safe disposal of children’s stool were lower among mothers who were married [aOR = 0.74, 95% CI: 0.69-0.80] and those who belonged to the Traditional African Religion [aOR = 0.64, 95% CI: 0.51-0.80]. With the contextual factors, women with improved water [aOR = 1.13, 95% CI: 1.10-1.16] and improved toilet facility [aOR = 5.75 95% CI: 5.55-5.95] had higher odds of safe disposal of children’s stool. On the other hand, mothers who lived in households with 5 or more children [aOR = 0.89, 95% CI: 0.86-0.93], those in rural areas [aOR = 0.86, 95% CI: 0.82-0.89], and those who lived in Central Africa [aOR = 0.19, 95% CI: 0.18-0.21] were less likely to practice safe disposal of children’s stools.

CONCLUSION: The findings indicate that between- and within-country contextual variations and commonalities need to be acknowledged in designing interventions to enhance safe disposal of children’s faeces. Audio-visual education on safe faecal disposal among rural women and large households can help enhance safe disposal. In light of the strong association between safe stool disposal and improved latrine use in SSA, governments need to develop feasible and cost-effective strategies to increase the number of households with access to improved toilet facilities.

PMID:34339451 | DOI:10.1371/journal.pone.0254774

PLoS One. 2021 Aug 2;16(8):e0255395. doi: 10.1371/journal.pone.0255395. eCollection 2021.

ABSTRACT

With the development of urbanisation and the increasing number of modern vehicles, traffic contamination has become an important source of environmental pollution. Most previous studies have focused on using roadside soil or plants to determine the spatial pattern of traffic pollutants along roads and the factors that influence this pattern, whereas few studies have reconstructed pollution histories caused by traffic using suitable methods. In this study, two gravity cores were obtained from Qianhu Lake, which is in the Zhongshan tourist area of Nanjing City and is distant from industrial areas. An accurate chronological framework covering the period from 1994 to 2014 was established using the correlation between the variation in grain size of the sediment cores and the variation in annual rainfall in Nanjing City. Moreover, magnetic and chemical parameters were also measured, and the results demonstrated that concentration-related magnetic parameters exhibited different correlations with different heavy metal concentrations. These correlations were significantly positive for Zn, Pb, and Co; weakly positive for Ni; absent for Cr; and negative for V. Combined with statistical data on industrial emissions and private cars in Nanjing City since 1994, the observed variations in magnetic susceptibility, anhysteretic remanent magnetisation, saturation isothermal remanent magnetisation, Zn, Pb, and Co, were controlled by traffic activities in the tourist area but not by industry. Therefore, the variations in these parameters record the traffic pollution history of the study area. Combined with the obtained chronological framework, the traffic-related pollution history could be divided into two stages: 1) from 1994 to 2003, when traffic-related pollution became increasingly serious because of the exponential increase in the number of private cars and the prosperity of tourism; 2) from 2003 to 2014, when traffic-related pollution continuously increased but at a much slower rate than in stage 1. This slower rate of increase was probably related to the maximum carrying capacity of the tourist area and technological innovations in automobile manufacturing, as well as improvements in fuels.

PMID:34339452 | DOI:10.1371/journal.pone.0255395

PLoS One. 2021 Aug 2;16(8):e0255115. doi: 10.1371/journal.pone.0255115. eCollection 2021.

ABSTRACT

This research aims to identify, rank, and create an interplay among the psychological barriers to adopting Industry 4.0 technologies in the manufacturing sector. A comprehensive literature review tracked by a discussion with industry and academic experts recognized 20 barriers. Based on three widely acclaimed statistical techniques, hybrid AHP-TOPSIS (Analytical Hierarchy Process-Technique for Order Performance by Similarity to Ideal Solution) and ISM (Interpretative Structural Modeling), critical psychological barriers have been investigated. A group of 8 experts from industry and academia with at least 10 years of experience was consulted for AHP and ISM techniques. Whereas TOPSIS was conducted by 443 operational-level users, including managers and supervisors of different functional areas of the manufacturing industry located in Pakistan. The findings reveal that ‘Fear of job losses’, ‘Fear of data loss/Risk of security breaches, ‘Lack of advanced & continued education of employees’ and ‘Lack of standards and reference architecture’, with highest importance weights, emerged as the most prominent psychological barriers in developing economies. Then the interrelations among these barriers resulted in a four-layered structural model. The driver barriers identified in the final model advocate that development in ‘advanced & continued education of employees’, ‘standards & reference architecture’ and ‘minimization of fear of job & data loss’ can expedite the adoption of industry 4.0 (i4.0) technologies. The study uniquely develops hierarchical relationships among the psychological barriers for adopting i4.0 in the manufacturing context using AHP-TOPSIS and ISM techniques. The study would be valuable for practitioners, decision-makers and companies that wish to focus their efforts and resources on removing the most critical barriers and challenges for the seamless implementation of Industry 4.0.

PMID:34339448 | DOI:10.1371/journal.pone.0255115

PLoS One. 2021 Aug 2;16(8):e0253294. doi: 10.1371/journal.pone.0253294. eCollection 2021.

ABSTRACT

Due to various human activities, soil quality under different land use patterns is deteriorating all over the world. This deterioration is very complex in the river irrigation area and is caused by multi-point and non-point source pollution and seasonal variation. Therefore, the characteristics and sources of soil metal pollution in river irrigation area of Baoji city were analyzed. The contents of 8 metals were given by ICP-MS, in the soil samples. Statistical methods, geo-accumulation index (Igeo) and potential ecological risk index (RI) were conducted to evaluate the spatial distribution features, sources and ecological risks of metal contamination from the study area soil. Principal component analysis and cluster analysis were used to analyze the pollution sources of metal. The analysis showed that Cd is the most polluted, and human activities represented a great impact on the contents of Zn, Ni, Cu and Cd in soil, Cd post moderate-strong pollution and strong risk, Cd has a maximum Igeo value of 3.17. All rivers were at risk of moderate pollution levels in study. Among them, some rivers had even reached strong pollution level. Pollution caused by human activities was the most significant pollution source of metal in the research area soil.

PMID:34339446 | DOI:10.1371/journal.pone.0253294

PLoS One. 2021 Aug 2;16(8):e0234286. doi: 10.1371/journal.pone.0234286. eCollection 2021.

ABSTRACT

Foot-and-mouth disease (FMD) is endemic in Kenya affecting cloven-hoofed ruminants. The epidemiology of the disease in small ruminants (SR) in Kenya is not documented. We carried out a cross-sectional study, the first in Kenya, to estimate the sero-prevalence of FMD in SR and the associated risk factors nationally. Selection of animals to be sampled used a multistage cluster sampling approach. Serum samples totaling 7564 were screened for FMD antibodies of non-structural-proteins using ID Screen® NSP Competition ELISA kit. To identify the risk factors, generalized linear mixed effects (GLMM) logistic regression analysis with county and villages as random effect variables was used. The country animal level sero-prevalence was 22.5% (95% CI: 22.3%-24.3%) while herd level sero-prevalence was 77.6% (95% CI: 73.9%-80.9%). The risk factor that was significantly positively associated with FMD sero-positivity in SR was multipurpose production type (OR = 1.307; p = 0.042). The risk factors that were significantly negatively associated with FMD sero-positivity were male sex (OR = 0.796; p = 0.007), young age (OR = 0.470; p = 0.010), and sedentary production zone (OR = 0.324; p<0.001). There were no statistically significant intra class correlations among the random effect variables but interactions between age and sex variables among the studied animals were statistically significant (p = 0.019). This study showed that there may be widespread undetected virus circulation in SR indicated by the near ubiquitous spatial distribution of significant FMD sero-positivity in the country. Strengthening of risk-based FMD surveillance in small ruminants is recommended. Adjustment of husbandry practices to control FMD in SR and in-contact species is suggested. Cross-transmission of FMD and more risk factors need to be researched.

PMID:34339447 | DOI:10.1371/journal.pone.0234286

PLoS One. 2021 Aug 2;16(8):e0253873. doi: 10.1371/journal.pone.0253873. eCollection 2021.

ABSTRACT

Online social networks like Twitter and Facebook are among the most popular sites on the Internet. Most online social networks involve some specific features, including reciprocity, transitivity and degree heterogeneity. Such networks are so called scale-free networks and have drawn lots of attention in research. The aim of this paper is to develop a novel methodology for directed network embedding within the latent space model (LSM) framework. It is known, the link probability between two individuals may increase as the features of each become similar, which is referred to as homophily attributes. To this end, penalized pair-specific attributes, acting as a distance measure, are introduced to provide with more powerful interpretation and improve link prediction accuracy, named penalized homophily latent space models (PHLSM). The proposed models also involve in-degree heterogeneity of directed scale-free networks by embedding with the popularity scales. We also introduce LASSO-based PHLSM to produce an accurate and sparse model for high-dimensional covariates. We make Bayesian inference using MCMC algorithms. The finite sample performance of the proposed models is evaluated by three benchmark simulation datasets and two real data examples. Our methods are competitive and interpretable, they outperform existing approaches for fitting directed networks.

PMID:34339437 | DOI:10.1371/journal.pone.0253873

PLoS One. 2021 Aug 2;16(8):e0255261. doi: 10.1371/journal.pone.0255261. eCollection 2021.

ABSTRACT

RATIONALE: Clinical decision support (CDS) tools leveraging electronic health records (EHRs) have been an approach for addressing challenges in asthma care but remain under-studied through clinical trials.

OBJECTIVES: To assess the effectiveness and efficiency of Asthma-Guidance and Prediction System (A-GPS), an Artificial Intelligence (AI)-assisted CDS tool, in optimizing asthma management through a randomized clinical trial (RCT).

METHODS: This was a single-center pragmatic RCT with a stratified randomization design conducted for one year in the primary care pediatric practice of the Mayo Clinic, MN. Children (<18 years) diagnosed with asthma receiving care at the study site were enrolled along with their 42 primary care providers. Study subjects were stratified into three strata (based on asthma severity, asthma care status, and asthma diagnosis) and were blinded to the assigned groups.

MEASUREMENTS: Intervention was a quarterly A-GPS report to clinicians including relevant clinical information for asthma management from EHRs and machine learning-based prediction for risk of asthma exacerbation (AE). Primary endpoint was the occurrence of AE within 1 year and secondary outcomes included time required for clinicians to review EHRs for asthma management.

MAIN RESULTS: Out of 555 participants invited to the study, 184 consented for the study and were randomized (90 in intervention and 94 in control group). Median age of 184 participants was 8.5 years. While the proportion of children with AE in both groups decreased from the baseline (P = 0.042), there was no difference in AE frequency between the two groups (12% for the intervention group vs. 15% for the control group, Odds Ratio: 0.82; 95%CI 0.374-1.96; P = 0.626) during the study period. For the secondary end points, A-GPS intervention, however, significantly reduced time for reviewing EHRs for asthma management of each participant (median: 3.5 min, IQR: 2-5), compared to usual care without A-GPS (median: 11.3 min, IQR: 6.3-15); p<0.001). Mean health care costs with 95%CI of children during the trial (compared to before the trial) in the intervention group were lower than those in the control group (-$1,036 [-$2177, $44] for the intervention group vs. +$80 [-$841, $1000] for the control group), though there was no significant difference (p = 0.12). Among those who experienced the first AE during the study period (n = 25), those in the intervention group had timelier follow up by the clinical care team compared to those in the control group but no significant difference was found (HR = 1.93; 95% CI: 0.82-1.45, P = 0.10). There was no difference in the proportion of duration when patients had well-controlled asthma during the study period between the intervention and the control groups.

CONCLUSIONS: While A-GPS-based intervention showed similar reduction in AE events to usual care, it might reduce clinicians’ burden for EHRs review resulting in efficient asthma management. A larger RCT is needed for further studying the findings.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02865967.

PMID:34339438 | DOI:10.1371/journal.pone.0255261

PLoS Comput Biol. 2021 Aug 2;17(8):e1009266. doi: 10.1371/journal.pcbi.1009266. Online ahead of print.

ABSTRACT

It is of great interest and potential to discover causal relationships between pairs of exposures and outcomes using genetic variants as instrumental variables (IVs) to deal with hidden confounding in observational studies. Two most popular approaches are Mendelian randomization (MR), which usually use independent genetic variants/SNPs across the genome, and transcriptome-wide association studies (TWAS) (or their generalizations) using cis-SNPs local to a gene (or some genome-wide and likely dependent SNPs), as IVs. In spite of their many promising applications, both approaches face a major challenge: the validity of their causal conclusions depends on three critical assumptions on valid IVs, and more generally on other modeling assumptions, which however may not hold in practice. The most likely as well as challenging situation is due to the wide-spread horizontal pleiotropy, leading to two of the three IV assumptions being violated and thus to biased statistical inference. More generally, we’d like to conduct a goodness-of-fit (GOF) test to check the model being used. Although some methods have been proposed as being robust to various degrees to the violation of some modeling assumptions, they often give different and even conflicting results due to their own modeling assumptions and possibly lower statistical efficiency, imposing difficulties to the practitioner in choosing and interpreting varying results across different methods. Hence, it would help to directly test whether any assumption is violated or not. In particular, there is a lack of such tests for TWAS. We propose a new and general GOF test, called TEDE (TEsting Direct Effects), applicable to both correlated and independent SNPs/IVs (as commonly used in TWAS and MR respectively). Through simulation studies and real data examples, we demonstrate high statistical power and advantages of our new method, while confirming the frequent violation of modeling (including valid IV) assumptions in practice and thus the importance of model checking by applying such a test in MR/TWAS analysis.

PMID:34339418 | DOI:10.1371/journal.pcbi.1009266

PLoS One. 2021 Aug 2;16(8):e0255128. doi: 10.1371/journal.pone.0255128. eCollection 2021.

ABSTRACT

OBJECTIVE: To assess the effectiveness of mindfulness-based interventions on people with dementia and mild cognitive impairment.

METHODS: We searched several electronic databases, namely Cochrane Library, EMBASE, and MEDLINE with no limitations for language or document type (last search: 1 February 2020). Randomized controlled trials of mindfulness-based interventions for people with dementia and mild cognitive impairment compared to active-control interventions, waiting lists, or treatment as usual were included. Predefined outcomes were anxiety symptoms, depressive symptoms, cognitive function, quality of life, mindfulness, ADL and attrition. We used the random effects model (DerSimonian-Laird method) for meta-analysis, reporting effect sizes as Standardized Mean Difference. Heterogeneity was assessed with the I2 statistics.

RESULTS: Eight randomized controlled trials, involving 276 patients, met the eligibility criteria and were included in the meta-analysis. We found no significant effects for mindfulness-based interventions in either the short-term or the medium- to long-term on any outcomes, when compared with control conditions. The number of included studies and sample sizes were too small. Additionally, the quality of evidence was low for each randomized controlled trial included in the analysis. This is primarily due to lack of intent-to-treat analysis, high risk of bias, and imprecise study results. The limited statistical power and weak body of evidence prevented us from reaching firm conclusions.

CONCLUSIONS: We found no significant effects of mindfulness-based interventions on any of the outcomes when compared with control conditions. The evidence concerning the efficacy of mindfulness-based interventions in this population is scarce in terms of both quality and quantity. More well-designed, rigorous, and large-scale randomized controlled trials are needed.

PMID:34339428 | DOI:10.1371/journal.pone.0255128