Nevin Manimala

Med Phys. 2022 Oct 17. doi: 10.1002/mp.16046. Online ahead of print.

ABSTRACT

PURPOSE: Determination of reliable change of radiomics feature over time is essential and vital in delta-radiomics, but has not yet been rigorously examined. This study attempts to propose a methodological approach of using reliable change index (RCI), a statistical metric to determine the reliability of quantitative biomarker changes by accounting for the baseline measurement standard error, in delta-radiomics. The use of RCI was demonstrated with the MRI data acquired from a group of prostate cancer (PCa) patients treated by 1.5 Tesla MRI-guided radiotherapy (MRgRT).

METHODS: Fifty consecutive PCa patients who underwent five-fractionated MRgRT were retrospectively included, and 1023 radiomics features were extracted from the clinical target volume (CTV) and planning target volume (PTV). The two MRI datasets acquired at the first fraction (MRI11 and MRI21) were used to calculate the baseline feature reliability against image acquisition using intraclass correlation coefficient (ICC). The RCI was constructed based on the baseline feature measurement standard deviation, ICC and feature value differences at two time points between the fifth (MRI51) and the first fraction MRI (MRI11). The reliable change of features was determined in each patient only if the calculated RCI was over 1.96 or smaller than -1.96. The feature changes between MRI51 and MRI11 were correlated to two patient-reported quality-of-life clinical endpoints of urinary domain summary score (UDSS) and bowel domain summary score (BDSS) in 35 patients using the Spearman correlation test. Only the significant correlations between a feature that was reliably changed in ≥7 patients (20%) by RCI and an endpoint were considered as true significant correlations.

RESULTS: 352 (34.4%) and 386 (37.7%) features among all 1023 features were determined by RCI to be reliably changed in more than five (10%) patients in the CTV and PTV, respectively. Nineteen features were found reliably changed in the CTV and 31 features in the PTV, respectively, in ten (20%) or more patients. These features were not necessarily associated with significantly different longitudinal feature values (group p-value <0.05). Most reliably changed features in more than 10 patients had excellent or good baseline test-retest reliability ICC, while none showed poor reliability. The RCI method ruled out the features to be reliably changed when substantial feature measurement bias was presented. After applying the RCI criterion, only four and five true significant correlations were confirmed with UDSS and BDSS in the CTV respectively, with low true significance correlation rates of 10.8% (4/37) and 17.9% (5/28). No true significant correlations were found in the PTV.

CONCLUSIONS: The RCI method was proposed for delta-radiomics and demonstrated using PCa MRgRT data. The RCI has advantages over some other statistical metrics commonly used in the previous delta-radiomics studies, and is useful to reliably identify the longitudinal radiomics feature change on an individual basis. This proposed RCI method should be helpful for the development of essential feature selection methodology in delta-radiomics. This article is protected by copyright. All rights reserved.

PMID:36251320 | DOI:10.1002/mp.16046

Transl Vis Sci Technol. 2022 Oct 3;11(10):24. doi: 10.1167/tvst.11.10.24.

ABSTRACT

PURPOSE: The purpose of this study was to develop a model, based on initial optic nerve head (ONH) characteristics, predictive of long-term rapid retinal nerve fiber layer (RNFL) thinning in patients with open-angle glaucoma (OAG).

METHODS: This study evaluated 712 eyes with OAG that had been followed up for >5 years with annual evaluation of RNFL thickness. Baseline ophthalmic features were incorporated into the machine learning models for prediction of faster RNFL thinning. The model was trained and tested using a random forest (RF) method, and was interpreted using Shapley additive explanations. Factors associated with faster rate of RNFL thinning were statistically evaluated using a decision tree.

RESULTS: The RF model showed that greater lamina cribrosa (LC) curvature, higher intraocular pressure (IOP), visual field mean deviation converging towards -5 dB, and thinner peripapillary choroid at baseline were the four most significant features predicting faster RNFL thinning. Partial interaction between the features showed that larger LC curvature was a strong factor for faster RNFL thinning when it exceeded approximately 12.0. When the LC curvature was ≤12, higher initial IOP and thinner peripapillary choroid played a role in the rapid RNFL thinning. Based on the decision tree, higher IOP (>26.5 mm Hg), greater laminar curvature (>13.95), and thinner peripapillary choroid (≤117.5 µm) were the 3 most important determinants affecting the rate of RNFL thinning.

CONCLUSIONS: Baseline ophthalmic data and ONH characteristics of patients with OAG were predictive of eyes at risk of faster progression. Combinations of important characteristics, such as IOP, LC curvature, and choroidal thickness, could stratify eyes into groups with different rates of RNFL thinning.

TRANSLATIONAL RELEVANCE: This work lays the foundations for developing prediction models to estimate glaucoma prognosis based on initial ONH characteristics.

PMID:36251319 | DOI:10.1167/tvst.11.10.24

JAMA Netw Open. 2022 Oct 3;5(10):e2236676. doi: 10.1001/jamanetworkopen.2022.36676.

ABSTRACT

IMPORTANCE: Loneliness and social isolation are public health concerns faced by older adults due to physical, cognitive, and psychosocial changes that develop with aging. Loneliness and social isolation are associated with increased morbidity and mortality.

OBJECTIVE: To evaluate interventions, targeting older adults, associated with a reduction in loneliness and social isolation.

DATA SOURCES: OVID, CINAHL, CENTRAL, Embase, PsychINFO, Web of Science, and Scopus were searched from inception to March 2020.

STUDY SELECTION: Peer-reviewed randomized clinical trials measuring loneliness and social isolation or support in adults aged 65 years or older. Only English language articles were included.

DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened studies, extracted data, and assessed risk of bias. Random-effects models were performed to pool the overall effect size by intervention. Statistical heterogeneity was evaluated with the I2 statistic and by estimating prediction intervals. Data were analyzed from November 2021 to September 2022.

MAIN OUTCOMES AND MEASURES: Quantitative measures of loneliness, social isolation, or social support based on an effect size of standardized mean differences.

RESULTS: Seventy studies were included in the systematic review (8259 participants); 44 studies were included in the loneliness meta-analysis (33 in the community with 3535 participants; 11 in long-term care with 1057 participants), with participants’ ages ranging from 55 to 100 years. Study sizes ranged from 8 to 741 participants. Interventions included animal therapy, psychotherapy or cognitive behavioral therapy, multicomponent, counseling, exercise, music therapy, occupational therapy, reminiscence therapy, social interventions, and technological interventions. Most interventions had a small effect size. Animal therapy in long-term care, when accounting for studies with no active controls, had the largest effect size on loneliness reduction (-1.86; 95% CI, -3.14 to -0.59; I2 = 86%) followed by technological interventions (videoconferencing) in long-term care (-1.40; 95% CI, -2.37 to -0.44; I2 = 70%).

CONCLUSIONS AND RELEVANCE: In this study, animal therapy and technology in long-term care had large effect sizes, but also high heterogeneity, so the effect size’s magnitude should be interpreted with caution. The small number of studies per intervention limits conclusions on sources of heterogeneity. Overall quality of evidence was very low. Future studies should consider measures of social isolation in long-term care and identify the contextual components that are associated with a reduction in loneliness.

PMID:36251294 | DOI:10.1001/jamanetworkopen.2022.36676

JAMA Netw Open. 2022 Oct 3;5(10):e2236904. doi: 10.1001/jamanetworkopen.2022.36904.

ABSTRACT

IMPORTANCE: Medications for addiction treatment (MAT) are inconsistently offered in HIV clinics.

OBJECTIVE: To evaluate the impact of implementation facilitation (hereafter referred to as “facilitation”), a multicomponent implementation strategy, on increasing provision of MAT for opioid use disorder (MOUD), alcohol use disorder (MAUD), and tobacco use disorder (MTUD).

DESIGN, SETTING, AND PARTICIPANTS: Conducted from July 26, 2016, through July 25, 2020, the Working with HIV Clinics to adopt Addiction Treatment using Implementation Facilitation (WHAT-IF?) study used an unblinded, stepped wedge design to sequentially assign each of 4 HIV clinics in the northeastern US to cross over from control (ie, baseline practices) to facilitation (ie, intervention) and then evaluation and maintenance periods every 6 months. Participants were adult patients with opioid, alcohol, or tobacco use disorder. Data analysis was performed from August 2020 to September 2022.

INTERVENTIONS: Multicomponent facilitation.

MAIN OUTCOMES AND MEASURES: Outcomes, assessed using electronic health record data, were provision of MAT among patients with opioid, alcohol, or tobacco use disorder during the evaluation (primary outcome) and maintenance periods compared with the control period.

RESULTS: Among 3647 patients, the mean (SD) age was 49 (12) years, 1814 (50%) were Black, 781 (22%) were Hispanic, and 1407 (39%) were female; 121 (3%) had opioid use disorder, 126 (3%) had alcohol use disorder, and 420 (12%) had tobacco use disorder. Compared with the control period, there was no increase in provision of MOUD with facilitation during the evaluation period (243 patients [27%; 95% CI, 22%-32%] vs 135 patients [28%; 95% CI, 22%-35%]; P = .59) or maintenance period (198 patients [29%; 95% CI, 22%-36%]; P = .48). The change in provision of MAUD from the control period to the evaluation period was not statistically significant (251 patients [8%; 95% CI, 5%-12%] vs 112 patients [13%; 95% CI, 8%-21%]; P = .11); however, the difference increased and became significant during the maintenance period (180 patients [17%; 95% CI, 12%-24%]; P = .009). There were significant increases in provision of MTUD with facilitation during both the evaluation (810 patients [33%; 95% CI, 30%-36%] vs 471 patients [40%; 95% CI, 36%-45%]; P = .005) and maintenance (643 patients [38%; 95% CI, 34%-41%]; P = .047) periods.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, facilitation led to increased provision of MTUD, delayed improvements in MAUD, and no improvements in MOUD in HIV clinics. Enhanced strategies, potentially including clinic and patient incentives, especially for MOUD, may be needed to further increase provision of MAT in HIV clinics.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02907944.

PMID:36251291 | DOI:10.1001/jamanetworkopen.2022.36904

JAMA Pediatr. 2022 Oct 17. doi: 10.1001/jamapediatrics.2022.3756. Online ahead of print.

ABSTRACT

IMPORTANCE: Global studies have reported that the incidence of Kawasaki disease (KD) declined during the COVID-19 pandemic. These studies suggest that the global pandemic and its accompanying mitigation measures may provide an important opportunity to explore the hypothesis of a KD pathogenesis.

OBJECTIVE: To compare changes in KD incidence in Japan before and after the start of the COVID-19 pandemic.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted using the data set from Japan’s 26th nationwide KD survey that obtained information on patients who were diagnosed with KD in Japan from January 1, 2019, through December 31, 2020.

MAIN OUTCOMES AND MEASURES: Kawasaki disease incidence rates were calculated by referring to the national population data in the vital statistics data for Japan.

RESULTS: A total of 28 520 patients were identified (16 236 male individuals [56.9%]; median [IQR] age, 26 [14-44] months). A total of 17 347 patients were diagnosed with KD in 2019 and 11 173 were diagnosed in 2020, representing a 35.6% reduction in the number of patients diagnosed in 2020 compared with the previous year. Patient distributions for days of illness at the first hospital visit were almost identical in 2019 and 2020, suggesting that the decrease in KD incidence likely was not associated with pandemic-related delays in seeking treatment. The proportion of patients diagnosed with KD who were younger than 12 months was significantly larger in 2020 than in 2019 (21.6% vs 19.4%; P < .001). Compared with KD incidence among younger patients, the incidence among those 24 months and older declined rapidly after initiation of COVID-19 special mitigation measures, with a greater percentage reduction (58.3% reduction in July), but rebounded faster after the end of the special mitigation period. By contrast, the incidence among patients younger than 12 months declined moderately after the initiation of the special mitigation period, with a lower percentage reduction (40.3% reduction in October), and rebounded at a later phase.

CONCLUSIONS AND RELEVANCE: In this cohort study, the number of patients diagnosed with KD decreased by approximately one-third across Japan in 2020, with no indication that parents avoided a hospital visit. Differences in KD incidence reduction patterns before and after the initiation of COVID-19 pandemic mitigation measures were found in patients with KD aged younger than 12 months compared with those 24 months or older, suggesting a potential KD pathogenesis involving transmission among children.

PMID:36251290 | DOI:10.1001/jamapediatrics.2022.3756

Ear Nose Throat J. 2022 Oct 17:1455613221134860. doi: 10.1177/01455613221134860. Online ahead of print.

ABSTRACT

This study aimed to identify the association between different cochlear metrics, including the basal turn diameter (A-value), the basal turn width (B-value), and the height of the cochlea (H-value). We also reported an association between H-value and hearing outcomes with cochlear implants (CI). This is a retrospective study that included all patients who underwent CI procedures between 2012 and 2018 at a tertiary center and have; preoperative high-resolution computed tomography (CT), normal cochlea, postoperative follow-up duration of at least 2 years, scores of the category auditory performance II (CAP-II), and speech intelligibility rating (SIR) scales. A total of 65 ears implanted with CI in 46 patients (24 boys and 20 girls; mean age of 7 (±10) years) fulfilled the inclusion criteria. We found significant positive correlations between A vs B, A vs H, and B vs H (P-value = 0.008, 0.018, and 0.0039, respectively). We also found a significant positive relationship between A, B, and H values and cochlear duct length (CDL) (P-value < 0.0001, 0.008, and 0.018, respectively). Finally, the H-value was significantly correlated with the SIR (P-value = 0.027). However, its correlation with the CAP score was not statistically significant (P-value = 0.62). Cochlear height significantly correlated with CDL and the other cochlear parameters. The variation in cochlear height can also affect speech outcomes in patients undergoing CI. Therefore, the H-value together with the other cochlear metrics should be adequately assessed preoperatively in CI patients.

PMID:36251258 | DOI:10.1177/01455613221134860

J Gastrointest Cancer. 2022 Oct 17. doi: 10.1007/s12029-022-00871-7. Online ahead of print.

ABSTRACT

PURPOSE: Historically, reported incidence of brain metastasis secondary to esophageal carcinoma is low. We sought to determine the incidence of brain metastasis in a contemporary cohort of patients with carcinoma of the esophagus.

METHODS: Data from patients with localized esophageal carcinoma prospectively enrolled on three curative intent Alliance treatment trials (N0044, N0342, N044E) were reviewed including time to diagnosis of first progression event (brain versus other site) and overall survival.

RESULTS: Eighty-five patients comprised the cohort of which 85% were male and 86% had adenocarcinoma primary tumor histology. Thirty-nine of the 85 patients had documented progression to any site, and of those, brain metastasis occurred as the first event in 15% (6 of 39). Adenocarcinoma was the primary histology in all 6 patients and tumor grade was high (3 or 4) in 5 of the 6 patients (one not documented). Median time to brain metastasis (9.6 months) versus non-brain metastasis (12.4 months) and median survival after first progression (5.4 months versus 8.1 months, respectively) were not statistically different.

CONCLUSION: In this prospective cohort of patients with esophageal carcinoma, those with high-grade adenocarcinoma appear to have a higher incidence of brain metastasis than historically reported. The pattern of brain metastases corroborates recent findings in terms of incidence, predominance of adenocarcinoma primary tumor histology, timing after diagnosis, and overall survival. Further study to confirm these findings, as well as the value of baseline, restaging and follow-up cranial imaging for brain metastasis is recommended.

GOV IDENTIFIERS: NCT00022139 (NCCTG N0044), NCT00100945 (NCCTG N0342), and NCT00100945 (NCCTG N044E).

PMID:36251211 | DOI:10.1007/s12029-022-00871-7

Environ Sci Pollut Res Int. 2022 Oct 17. doi: 10.1007/s11356-022-23631-3. Online ahead of print.

ABSTRACT

Lung cancer is one of the primary causes of death with poor life expectancy after diagnosis. History of past respiratory diseases such as asthma, chronic obstructive lung disease (COPD), emphysema, and chronic bronchitis can increase the risk of lung cancer. Very few studies are available to simultaneously assess multiple respiratory diseases and lung cancer. The objective of this study was to investigate correlations between asthma, emphysema, chronic bronchitis, and chronic obstructive lung disease with lung cancer in the US adult population. This was a cross-sectional study using data from a total of 23,523 adult participants from the National Health Examination and Nutrition Survey (NHANES) datasets for seven cycles ranging from 2003-2004 to 2015-2016. To analyze the data, specialized weighted complex survey logit regressions were conducted. Linear logit regression models using only main-effects were constructed first to assess the correlation between the selected demographic and lifestyle variables and asthma, emphysema, chronic bronchitis, and COPD. A second set of linear, main-effects logit regression models were constructed to examine the correlation between lung cancer and asthma, emphysema, chronic bronchitis, COPD when corrected for the selected covariates. The study identified positive correlations between emphysema, chronic bronchitis, COPD, and lung cancer. No correlation between asthma and lung cancer was established. Of the covariates studied, race/ethnicity, marital status, highest educational level, age, family income to poverty ratio, and lifetime smoking were also found to be correlated with the presence of lung cancer. Correlations between the covariates gender, body mass index, alcohol consumption, and country of birth and lung cancer were not found. The study established statistically significant correlations between lung cancer and the lung diseases emphysema, chronic bronchitis, and COPD. The lack of association between asthma and lung cancer may arise from the timeline of diagnosis asthma or type of lung cancer. The study also established significant correlations between lung cancer and several of the covariates included in the analysis. It also established correlations between the covariates and the lung diseases asthma, emphysema, chronic bronchitis, and COPD.

PMID:36251191 | DOI:10.1007/s11356-022-23631-3

Eur J Health Econ. 2022 Oct 17. doi: 10.1007/s10198-022-01532-z. Online ahead of print.

ABSTRACT

Becoming divorced or widowed are stressful life events experienced by a substantial part of the population. While marital status is a significant predictor in many studies on healthcare expenditures, effects of a change in marital status, specifically becoming divorced or widowed, are less investigated. This study combines individual health claims data and registered sociodemographic characteristics from all Dutch inhabitants (about 17 million) to estimate the differences in healthcare expenditure for individuals whose marital status changed (n = 469,901) compared to individuals who remained married, using propensity score matching and generalized linear models. We found that individuals who were (long-term) divorced or widowed had 12-27% higher healthcare expenditures (RR = 1.12, 95% CI 1.11-1.14; RR = 1.27, 95% CI 1.26-1.29) than individuals who remained married. Foremost, this could be attributed to higher spending on mental healthcare and home care. Higher healthcare expenditures are observed for both divorced and widowed individuals, both recently and long-term divorced/widowed individuals, and across all age groups, income levels and educational levels.

PMID:36251142 | DOI:10.1007/s10198-022-01532-z

J Patient Rep Outcomes. 2022 Oct 17;6(1):113. doi: 10.1186/s41687-022-00514-2.

ABSTRACT

BACKGROUND: The impact of the coronavirus disease 2019 (COVID) is worse among those with fewer financial resources, in jobs not amenable to remote work, and in denser living conditions. People of color are more likely to be among these vulnerable groups. Although race itself is a social construction and not based on underlying genetic/biological differences, this study investigated race/ethnicity differences in the negative repercussions of COVID and in the benefits of psychological and social resources.

METHODS: This cross-sectional, web-based study (n = 4817) was administered to a heterogeneous United States sample in Spring/Summer 2020. Information was gathered on the following COVID-specific variables: Infection Status, Coping with Lockdown, Social Support, Post-traumatic Growth, Interpersonal Conflict, Worry about Self, Financial Impact on Family, Lack of Money, Inadequate Access to Healthcare, and Housing Instability. Resilience was operationalized as the ability to maintain a sense of wellness in the face of the pandemic, using the DeltaQuest Wellness measure. Multivariate linear regression (adjusting for demographics) and propensity-matched cohort analysis (matched on demographics) evaluated the impact of COVID-specific variables on Wellness in separate models for Whites and Non-Whites.

FINDINGS: Both sets of models retained the same COVID-specific variables and explained about half of the variance in wellness. Coping with Lockdown, Social Support, and Post-traumatic Growth were associated with higher levels of Wellness in both Whites and Non-Whites, while Interpersonal Conflict and Worry about Self were associated with lower levels of Wellness. While these associations are similar, Non-Whites reported worse levels of some positive resources (e.g., social support) and more challenging levels of negative stressors (e.g., interpersonal, worry, financial). Non-Whites also reported much higher levels of post-traumatic growth.

CONCLUSION: COVID was a source of worry and even conflict, but also unlocked people’s resources in use of health-enhancing behavioral strategies, social support, and renewed gratitude for sources of personal meaning and value. The similar relationships between Whites and Non-Whites on wellness and COVID-specific stressors across racial groups underscore that race is a social construction, not a biological fact. Focusing on a renewed appreciation for sources of personal meaning, and particularly faith, seemed to buffer much of the COVID-related stress for Non-Whites.

PMID:36251138 | DOI:10.1186/s41687-022-00514-2