Nevin Manimala

Stat Med. 2022 Nov 27. doi: 10.1002/sim.9615. Online ahead of print.

ABSTRACT

The mean residual life (MRL) function is an important and attractive alternative to the hazard function for characterizing the distribution of a time-to-event variable. In this article, we study the modeling and inference of a family of generalized MRL models for right-censored survival data with censoring indicators missing at random. To estimate the model parameters, augmented inverse probability weighted estimating equation approaches are developed, in which the non-missingness probability and the conditional probability of an uncensored observation are estimated by parametric methods or nonparametric kernel smoothing techniques. Asymptotic properties of the proposed estimators are established and finite sample performance is evaluated by extensive simulation studies. An application to brain cancer data is presented to illustrate the proposed methods.

PMID:36437483 | DOI:10.1002/sim.9615

BMC Med Inform Decis Mak. 2022 Nov 28;22(1):309. doi: 10.1186/s12911-022-02057-4.

ABSTRACT

BACKGROUND: Machine learning (ML) algorithms have been trained to early predict critical in-hospital events from COVID-19 using patient data at admission, but little is known on how their performance compares with each other and/or with statistical logistic regression (LR). This prospective multicentre cohort study compares the performance of a LR and five ML models on the contribution of influencing predictors and predictor-to-event relationships on prediction model´s performance.

METHODS: We used 25 baseline variables of 490 COVID-19 patients admitted to 8 hospitals in Germany (March-November 2020) to develop and validate (75/25 random-split) 3 linear (L1 and L2 penalty, elastic net [EN]) and 2 non-linear (support vector machine [SVM] with radial kernel, random forest [RF]) ML approaches for predicting critical events defined by intensive care unit transfer, invasive ventilation and/or death (composite end-point: 181 patients). Models were compared for performance (area-under-the-receiver-operating characteristic-curve [AUC], Brier score) and predictor importance (performance-loss metrics, partial-dependence profiles).

RESULTS: Models performed close with a small benefit for LR (utilizing restricted cubic splines for non-linearity) and RF (AUC means: 0.763-0.731 [RF-L1]); Brier scores: 0.184-0.197 [LR-L1]). Top ranked predictor variables (consistently highest importance: C-reactive protein) were largely identical across models, except creatinine, which exhibited marginal (L1, L2, EN, SVM) or high/non-linear effects (LR, RF) on events.

CONCLUSIONS: Although the LR and ML models analysed showed no strong differences in performance and the most influencing predictors for COVID-19-related event prediction, our results indicate a predictive benefit from taking account for non-linear predictor-to-event relationships and effects. Future efforts should focus on leveraging data-driven ML technologies from static towards dynamic modelling solutions that continuously learn and adapt to changes in data environments during the evolving pandemic.

TRIAL REGISTRATION NUMBER: NCT04659187.

PMID:36437469 | DOI:10.1186/s12911-022-02057-4

BMC Nurs. 2022 Nov 28;21(1):327. doi: 10.1186/s12912-022-01111-w.

ABSTRACT

BACKGROUND: In the recent era, nursing needs employees with moral intelligence, cultural competence, and self-compassion skills more than ever. This study aimed to determine the predictors of moral intelligence and its relationship with self-compassion and cultural competence in nursing students.

METHODS: This cross-sectional and multi-center descriptive study was conducted in 2022. With convenience sampling, 250 nursing students from three Iranian universities participated in this study. Data gathering included the Moral Intelligence Questionnaire, Self-Compassion Scale (short form), and Cultural Competency Questionnaire. The data were analyzed using descriptive statistics, the correlation between variables, and hierarchical regression.

RESULTS: The results showed that nursing students had good moral intelligence (72.63 ± 11.38), moderate self-compassion (37.19 ± 5.02), and poor cultural competence (50.06 ± 13.15). No statistically significant relationship was observed between self-compassion and cultural competence (r = 0.11, p = 0.07). Moral intelligence with marital status (r = 0.16, p = 0.01), academic year (r = 0.14, p = 0.03) and self-compassion (r = 0.33, p < 0.001) had a significant relationship in such a way that these variables explained 15% of moral intelligence and self-compassion had the highest impact (p < 0.001).

CONCLUSION: Considering the moderate level of self-compassion and the poor level of cultural competence reported in the undergraduate nursing students, and also that self-compassion was known to be a predictive factor for moral intelligence, planners and educators must pay more attention to promoting self-compassion and cultural competency in the curriculum and conduct studies to find ways to improve them.

PMID:36437448 | DOI:10.1186/s12912-022-01111-w

Biol Trace Elem Res. 2022 Nov 28. doi: 10.1007/s12011-022-03486-y. Online ahead of print.

ABSTRACT

Arsenic (As) is a toxic metalloid that affects many organs through drinking water. This study aims to examine the efficacy of ozone therapy on chronic arsenic toxicity. Twenty-four male Wistar albino rats were housed in individual cages and grouped as control, As, O₃, and As + O_3. As was applied by adding 5 mg/kg/day in drinking water for 60 days. Ozone therapy was applied at 0.5 mg/kg/day (i.p.) O₃ in the last 5 days of the experimental period. Tissues were harvested and analyzed for histopathological injury and apoptotic markers. There was no significant difference between the As + O₃ and O₃ groups (p = 0.186 and p = 0.599) for light microscopic criteria: inflammatory cell infiltration and hydropic degeneration in liver tissue.In TUNEL assessments, similar outcomes were obtained in the control and As + O₃ groups. A statistically significant increase was observed in p53 and Caspase 3 (Casp-3) expression levels in the As group compared to the O₃ and As + O₃ groups. There was no significant difference between the As + O₃ and O₃ groups on peritubular hemorrhage and desquamation parameters in kidneys (p = 0.147 and p = 0.094). The KIM-1 expression level was significantly increased in the As group compared to the As + O₃ group (p = 0.01), and the Casp-3 expression level was not significantly changed in the O₃ group compared to the As + O₃ group (p = 0.59). In conclusion, it is determined that ozone therapy has ameliorative effects on the microscopic injury of liver and kidney tissues. In addition to microscopic improvement, KIM-1 gene expression levels were ameliorated in the kidneys. The apoptotic cell counts and the Casp-3 and p53 gene expression levels were decreased by O₃ administration. Thus, ozone therapy can be a treatment choice for As toxicity.

PMID:36437433 | DOI:10.1007/s12011-022-03486-y

Eur Arch Paediatr Dent. 2022 Nov 28. doi: 10.1007/s40368-022-00769-9. Online ahead of print.

ABSTRACT

INTRODUCTION: The aim of this study is to evaluate the knowledge of infant oral health in mothers who have breastfeeding for a period longer than 6 months.

METHODS: A descriptive, observational and cross-sectional study was carried out in 1126 mothers who had breastfed for more than 6 months, using a validated questionnaire.

RESULTS: 57% of the mothers surveyed had a high or very high level of knowledge about oral health during pregnancy and breastfeeding; a statistically significant association (p < 0.05) was found between this and the variables of mother’s age, duration of breastfeeding, level of education and previous information received about oral health.

CONCLUSIONS: The age of the mothers is positively related to the level of oral health knowledge, the elder the mothers the higher the knowledge. Mothers with a longer duration of breastfeeding beyond 24 months have a higher degree of oral health knowledge compared to the rest of the respondents, while their level of educations was also positively related to their degree of knowledge. There is a direct relationship between mothers having received previous information on oral hygiene and their surveyed degree of knowledge.

PMID:36437430 | DOI:10.1007/s40368-022-00769-9

Diabetes Ther. 2022 Nov 27. doi: 10.1007/s13300-022-01343-8. Online ahead of print.

ABSTRACT

AIMS: Severe acute respiratory syndrome coronavirus type 2 (SARS-COV-2) infection may increase the risk of developing dangerous symptoms among the elderly with underlying medical conditions. The aim of this study was to evaluate the safety and immunogenicity of the SARS-CoV-2 inactivated vaccine (Vero) in patients over 60 years of age with hypertension and/or diabetes.

METHODS: An open-label, multi-center, prospective clinical trial was conducted at three medical sites in Fujian, China. Participants aged 60 years and above with hypertension, diabetes, and healthy controls were included in four groups: hypertension, diabetes, combined disease, and healthy controls. Volunteers received two doses of the inactivated SARS-COV-2 vaccine (BBIBP-CorV) on days 0 and 21. Adverse events were recorded for 21 days after each dose. Blood samples were taken before the first vaccination and 28 days after the second vaccination to detect the serum conversion rate and geometric mean titer (GMT) of neutralizing antibodies.

RESULTS: A total of 480 participants (110 hypertension, 110 diabetes, 100 combined hypertension and diabetes, and 160 healthy controls) were recruited. The incidences of adverse events in the four groups were 10 (9.1%) in the hypertension group, 19 (17.3%) in the diabetes group, 11 (11.0%) in the combined disease group, and 11 (6.9%) in healthy controls, with no statistical significance (P > 0.05). At 28 days after the second vaccination, the positive conversion rates of serum neutralizing antibody in the four groups were 97.3%(107/110), 97.3% (107/110), 100.0% (99/99),and 98.7%(155/157), respectively, and the GMTs were 75.28 (95% CI 64.03-88.50), 69.4 (95% CI 59-81.63), 77.21 (95% CI 66.68-89.41), and 78.64 (95% CI 69.87-88.50), respectively. There was no significant difference in neutralizing antibody responses among the four groups (P > 0.05). Additionally, the GMT after immunization was higher in females than in males (OR = 2.59, 95% CI 1.31-5.12).

CONCLUSIONS: The BBIBP-CorV vaccine is safe and elicits an adequate antibody response in patients over 60 years of age with hypertension and/or diabetes.

TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT05065879.

PMID:36437418 | DOI:10.1007/s13300-022-01343-8

J Sleep Res. 2022 Nov 27:e13795. doi: 10.1111/jsr.13795. Online ahead of print.

ABSTRACT

Recently an association between blood glucose dysregulation and sleep disruption was suggested. The association between sleep disordered breathing, most of which is due to obstructive sleep apnea (OSA) in the general population, and diabetic severity, as well as the impact of antidiabetic treatment, remains unclear. This study aimed to investigate these associations as well as age and sex differences. This cross-sectional study evaluated 7,680 community participants as the main cohort (population-based cohort). OSA was assessed by the 3% oxygen desaturation index from pulse oximetry, which was corrected for sleep duration obtained by wrist actigraphy. For arguing the limitations for using pulse oximetry, 597 hospitalised patients, who were assessed by the apnea-hypopnea index from attended polysomnography, were also evaluated as the validation cohort (hospital-based cohort). Moderate-to-severe OSA was more prevalent as haemoglobin A1c (HbA1c) levels increased (<5.6%/5.6%-<6.5%/6.5%-<7.5%/≥7.5%, respectively) in both cohorts (p < 0.001), but only in those without antidiabetic treatment. The HbA1c level was an independent factor for moderate-to-severe OSA (population-based cohort, odds ratio [OR] 1.26, 95% confidence interval [CI] 1.10-1.45; hospital-based cohort, OR 1.69, 95% CI 1.22-2.33, per 1% increase). These associations were more prominent in the middle-aged (aged <60 years) than in the elderly (aged ≥60 years) and in women than in men in both cohorts. The prevalence of moderate-to-severe OSA in patients with antidiabetic treatment in the hospital-based cohort was ≥75% regardless of HbA1c levels. In conclusion, an association between the prevalence of OSA and HbA1c level even within or over the normal range was found only in patients without antidiabetic treatment and was more prominent in the middle-aged and in women.

PMID:36437403 | DOI:10.1111/jsr.13795

Prog Orthod. 2022 Nov 28;23(1):43. doi: 10.1186/s40510-022-00438-z.

ABSTRACT

BACKGROUND: To assess the predictability of crowding resolution and the efficacy of different strategies to gain space during clear aligners treatment.

METHODS: A total of 10 clinicians were randomly recruited using the Doctor Locator by Align Technology (California). For each clinician, four consecutive patients treated with aligners and manual stripping were selected for a total of 40 subjects. Thus, 80 arches were collected and uploaded on the Orthoanalyzer software for arch measurements. The data were gained on the starting arch form (T0), on the virtual arch developed with digital planning (vT1), and on the arch form achieved at the end of the aligner sequences (T1). The following parameters were scored: Little’s Irregularity Index, transversal arch diameters, (intercuspid, interpremolar, and intermolar width), incisor position/arch length, and enamel interproximal reduction (IPR).

RESULTS: For all the measurements, statistically significant differences were found at different stages. The predictability of crowding resolution was very high, ranging from 87% in the upper arch and 81% in the lower one. Among the different strategies to gain space, variations in sagittal incisor position were predictable, with a value of 70% both in the upper and lower arch. Conversely, changes in arch diameters were less reliable varying between 49 and 67% in the lower arch and 59-83% in the upper one. Moreover, IPR was the least accurate procedure, wavering at 49% in the upper arch and 42% in the lower arch.

CONCLUSIONS: The predictability of crowding resolution during treatment with aligners was high. However, the virtual arch forms obtained at the end of digital planning (vT1) did not correspond with the arch forms at the end of the aligner sequences (T1). The IPR was the least predictable strategy to gain space, being, perhaps, an operator-dependent procedure.

PMID:36437397 | DOI:10.1186/s40510-022-00438-z

Int J Legal Med. 2022 Nov 28. doi: 10.1007/s00414-022-02920-z. Online ahead of print.

ABSTRACT

PURPOSE: Several studies tried to discuss and clarify the so-called Mellanby effect: Similar blood alcohol concentrations (BACs) supposedly lead to more signs of impairment in the phase of alcohol resorption than elimination. To assess this effect for alcoholised e-scooter driving, results of a real-driving fitness study were subanalysed.

METHODS: Sixteen subjects (9 females; 7 males) who completed runs at comparable BACs in the phases of alcohol resorption and elimination were chosen to assess a possible “Mellanby effect”. The data of the subjects was taken from a prior e-scooter study by Zube et al., which included 63 subjects in total.

RESULTS: In the phase of alcohol resorption, the relative driving performance was approx. 92% of the phase of elimination (p value 0.21). Statistically significant more demerits were allocated to the obstacle “narrowing track” in the phase of resorption than elimination. Subjects also needed significantly more time to pass the obstacles “narrowing track”, “driving in circles counterclockwise” and “thresholds” in the phase of resorption than elimination.

DISCUSSION: The most relevant obstacle to discriminate between the two different states of alcoholisation was the narrowing track. Insofar, measurements of the standard deviation of the lateral position (SDLP) might also be a sensitive component for the detection of central nervous driving impairment during shorter trips with an e-scooter. Additionally, driving slower during the phase of alcohol resorption seems to be the attempt to compensate alcohol-related deficits.

CONCLUSION: The results of the study suggest a slight Mellanby effect in e-scooter drivers.

PMID:36437382 | DOI:10.1007/s00414-022-02920-z

Bioprocess Biosyst Eng. 2022 Nov 28. doi: 10.1007/s00449-022-02819-4. Online ahead of print.

ABSTRACT

Consumer choice is typically influenced by color, leading to an increase in the use of artificial colorants by industry. However, several artificial colorants have been banned due to their harmful effects on human health and the environment, leading to increased interest in colorants from natural sources. Natural colorants can be found in plants, insects, and microorganisms. The importance of evaluating the technical and cost feasibility for the production of natural colorants are important factors for the replacement of artificial counterpart. Therefore, it is highly beneficial to predict the productivity of microbial colorants. The use of statistical methods that generate polynomial models through multiple regressions can provide information of interest about a bioprocess. However, modeling and control of biological processes require complex systems models, because they are nonlinear and non-deterministic systems. In this regard, artificial neural networks are suitable for estimating bioprocess variables with systems modeling. In this work, two different strategies were developed to predict the production of red colorants by Talaromyces amestolkiae, namely simulation by artificial neural networks (ANN) and response surface methodology (RSM). The results showed that the colorant concentration predicted by ANN is closer to the experimental data than that predicted by polynomial models fitted by multiple regression. Thus, this work suggests that the use of ANN can identify the initial conditions of the culture parameters that have the greatest influence on colorant production and can be a tool to be employed to improve the production of biotechnological products, such as microbial colorants.

PMID:36437377 | DOI:10.1007/s00449-022-02819-4