Nevin Manimala

BJOG. 2022 Aug 25. doi: 10.1111/1471-0528.17284. Online ahead of print.

ABSTRACT

OBJECTIVE: To understand the effect of changing from cytology-based to primary HPV screening on the positive predictive value (PPV) of colposcopy referrals for cervical intraepithelial neoplasia (CIN) in a cohort offered HPV vaccination.

DESIGN: Retrospective pre/post observational cohort study.

SETTING: Scotland POPULATION OR SAMPLE: 2193 women referred to colposcopy between September 2019 – February 2020 from cytology-based screening and September 2020 – February 2021 from primary high-risk HPV (hrHPV) screening.

METHODS: Calculating Positive Predictive Values (PPVs) for 2 cohorts of women; one having liquid-based cytology screening and the subsequent high-risk HPV hrHPV cervical screening as a pre/post observational study.

MAIN OUTCOME MEASURES: Positive predictive values of LBC and hrHPV cut-offs for colposcopy referral for CIN at colposcopy.

RESULTS: Narrative review: Three papers fitted our criteria; these reported results only for cytology-based screening. The PPV was lower for women in HPV vaccinated cohorts indicating the lower prevalence of disease. Vaccination underage of 17 had the lowest PPV reported. Scottish colposcopy data: hrHPV and cytology showed a non-significant difference between PPV (17.5%, CI 95%=14.3-20.7; 20.6, CI 95%=16.7-24.5) for referrals with a cut-off of low grade dyskaryosis (LGD); both met the standard set of 8-25%. hrHPV PPV (66.7, CI 95%=56.8-76.6) was comparable to cytology (64.1, CI 95%=55.8-72.4) for referrals with a cut-off of high grade dyskaryosis (HGD) but neither met the standard set of 77-92%.

CONCLUSIONS: Current literature only provided PPVs for LBC and overall, the vaccinated cohort had lower PPVs. Only LG dyskaryosis met PHE criteria. The PPV for HPV vaccinated women undergoing either LBC or HR-HPV screening were not statistically different. However, similar to the papers in current literature, HG dyskaryosis (HGD) PPVs of both techniques did not meet the PHE threshold of 76.6-91.6% outlined in the cervical standards data report..

PMID:36054732 | DOI:10.1111/1471-0528.17284

Int J Cancer. 2022 Aug 10. doi: 10.1002/ijc.34237. Online ahead of print.

ABSTRACT

Colon cancer is the second most frequently diagnosed cancer in women in Norway, where incidence rates of colon cancer increased 3-fold between 1955 and 2014, for unknown reasons. We aimed to assess the burden of colon cancer attributable to modifiable risk factors in Norwegian women using the data from the Norwegian Women and Cancer (NOWAC) study. Self-reported information from 35 525 women from the NOWAC study were available. These included the following exposures: smoking status, alcohol consumption, body mass index, physical activity, intake of calcium, fibers, and red and processed meat. Colon cancer cases were identified from the Cancer Registry of Norway. A parametric piecewise constant hazards model was used to estimate the strength of exposure-cancer associations. Population attributable fractions with 95% confidence intervals (CIs) were calculated considering competing risk of death. The fraction of incident colon cancer attributable to ever smoking was 18.7% (95% CI 4.7%-30.6%), low physical activity 10.8% (95% CI -0.7% to 21.0%), alcohol consumption 14.5% (95% CI -2.8% to 28.9%), and low intake of calcium 10.0% (95% CI -7.8% to 24.8%). A small proportion of colon cancer cases was attributable to combined intake of red and processed meat over 500 g/week, overweight/obesity, and low intake of fibers. Jointly, these seven risk factors could explain 46.0% (95% CI 23.0%-62.4%) of the colon cancer incidence burden. Between 23% and 62% of the colon cancer burden among women in Norway was attributable to modifiable risk factors, indicating an important preventive potential of a healthy lifestyle.

PMID:36054722 | DOI:10.1002/ijc.34237

J Genet Couns. 2022 Aug 25. doi: 10.1002/jgc4.1625. Online ahead of print.

ABSTRACT

Bullying is reported in around 20% of children according to the US Department of Education and has been reported in the histories of individuals with genetic disorders. To our knowledge, there has never been a study surveying whether genetic counselors screen their pediatric patients for bullying. This is despite guidelines that pediatric healthcare providers should screen for bullying. The purpose of this study was to assess North American genetic counselors who see pediatric patients and enquire about their practices, attitudes, self-confidence, knowledge, and potential training needs in relation to bullying screening. In an anonymous online survey, 139 genetic counselors from the United States and Canada completed a modified version of the previously validated Healthcare Providers Practices, Attitudes, Self-Confidence, and Knowledge (HCP-PACK) instrument. Among our participant population, 85% reported they did not screen for bullying. This is despite no statistically significant difference in the amount of reported time spent on either initial or follow-up appointments between those who did or did not screen. Those who screened for bullying among their pediatric patients were more likely to view bullying as a healthcare problem (as measured on the attitude subscale) (t[135] = -2.07, p = 0.04) and had greater confidence in their ability to know how to assess for bullying (as measured on the self-confidence subscale) (t[135] = -2.90, p = 0.004) compared with participants who did not screen for bullying. Responses from genetic counselors who screened their patients for bullying demonstrated how screening for bullying can be aligned with the American Board of Genetic Counseling practice-based competencies. Even though the majority of participants did not view screening for bullying as a genetic counselor’s role, 82.5% agreed that bullying was a healthcare problem and 63.6% thought genetic counselors should have additional educational opportunities to learn about bullying. Evidence-based guidance is needed to help genetic counselors interested in including screening for bullying in their practice.

PMID:36054701 | DOI:10.1002/jgc4.1625

J Biophotonics. 2022 Aug 27:e202200187. doi: 10.1002/jbio.202200187. Online ahead of print.

ABSTRACT

Photoplethysmography (PPG) is a noninvasive optical technology, with applications including vital sign extraction and patient monitoring. The PPG acquisition skin type may be of importance. Skin is either non-glabrous (~90%) or glabrous (~10%). Clinical PPG collection is typically from glabrous (fingerpad), while proliferating wearables collecting PPG, which may perform critical functions like arrythmia detection, often acquire from atypical sites. Glabrous skin has significant differences from non-glabrous, including microcirculation, yet comparisons between their PPG signals have not been well reported. Using a smartphone-based remote/contactless PPG, a pilot dataset was collected from the hands (palmar/dorsal) of 5 healthy volunteers. The data shows statistically significant lead time (52±36ms) of glabrous over non-glabrous. Further, a trend of glabrous amplitude increase over non-glabrous (31%) was found. Although our study has a small number of participants, these results further the characterization of PPG skin differences, and can be used to inform development of PPG-based devices. This article is protected by copyright. All rights reserved.

PMID:36054679 | DOI:10.1002/jbio.202200187

Autism Res. 2022 Sep 2. doi: 10.1002/aur.2801. Online ahead of print.

ABSTRACT

The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) has been widely used for ASD assessment. While prior studies investigated sensitivity and specificity of ADOS-2 Modules 1-3, there has been limited research addressing algorithm cut-off scores to optimize ADOS-2 classification. The goal of this study was to assess algorithm cut-off scores for diagnosing ASD with Modules 1-3, and to evaluate alignment of the ADOS-2 classification with the best estimate clinical diagnosis. Participants included 3144 children aged 31 months or older who received ADOS-2 Modules 1-3, as well as the best estimate clinical diagnosis. Five classification statistics were reported for each module: sensitivity, specificity, positive predictive value, negative predictive value, and accuracy (i.e., Receiver Operator Classification Statistic), and these statistics were calculated for the optimal cut-off score. Frequency tables were used to compare ADOS-2 classification and the best estimate clinical diagnosis. Half of the sample received Module 3, 21% received Module 2, and 29% received Module 1. The overall prevalence of ASD was 60%; the male-to-female ratio was 4:1, and half of the sample was non-White. Across all modules, the autism spectrum cut-off score from the ADOS-2 manual resulted in high sensitivity (95%+) and low specificity (63%-73%). The autism cut-off score resulted in better specificity (76%-86%) with favorable sensitivity (81%-94%). The optimal cut-off scores for all modules based on the current sample were within the autism spectrum classification range except Module 2 Algorithm 2. In the No ASD group, 29% had false positives (ADOS-2 autism spectrum classification or autism classification). The ADOS-2 autism spectrum classification did not indicate directionality for diagnostic outcome (ASD 56% vs. No ASD 44%). While cut-off scores of ADOS-2 Modules 1-3 in the manual yielded good clinical utility in ASD assessment, false positives and low predictability of the autism spectrum classification remain challenging for clinicians. LAY SUMMARY: ADOS-2 Modules 1-3 have been widely used for ASD assessment, but there has been limited research on algorithm cut-off scores to optimize ADOS-2 clinical performance. Using a large independent sample, we examined alignment of the ADOS-2 classification with clinicians’ best estimate clinical diagnosis, assessing algorithm cut-off scores. Cut-off scores of ADOS-2 Modules 1-3 in the manual yielded good clinical utility in ASD classification. The optimal cut-off scores based on the current sample were generally within the autism spectrum classification range.

PMID:36054678 | DOI:10.1002/aur.2801

J Sleep Res. 2022 Aug 24. doi: 10.1111/jsr.13715. Online ahead of print.

ABSTRACT

There have been studies in the literature regarding the effect of obstructive sleep apnea syndrome on hearing function, but studies on the effect of obstructive sleep apnea syndrome on the peripheral vestibular system are limited. The aim of the present study was to determine whether obstructive sleep apnea syndrome causes functional neurological changes, particularly in the peripheral vestibular system, using the video head impulse test. Overall, 57 patients with obstructive sleep apnea syndrome were included; the ‘Snorers’ group comprised 20 volunteers diagnosed with simple snoring in the polysomnography test. The severity of apnea was assessed by monitoring cardiac and respiratory functions during sleep in both groups. The video head impulse test and audiological evaluations were performed in both groups. Statistically significant differences were found in the cochlea and semicircular canals of our patients in the video head impulse test and audiological battery tests. It may be assumed that decreased blood oxygen concentrations and chronic hypoxaemia have negative effects on the vestibule, cochlear sensory epithelium, and the auditory pathways. We think that inner ear structures and pathways may be affected due to hypoxia in obstructive sleep apnea syndrome. Therefore, screening patients with obstructive sleep apnea syndrome with an audiometry battery may help to detect inner ear pathologies early.

PMID:36054674 | DOI:10.1111/jsr.13715

Stat Med. 2022 Aug 26. doi: 10.1002/sim.9562. Online ahead of print.

ABSTRACT

Network meta-analysis (NMA) of rare events has attracted little attention in the literature. Until recently, networks of interventions with rare events were analyzed using the inverse-variance NMA approach. However, when events are rare the normal approximations made by this model can be poor and effect estimates are potentially biased. Other methods for the synthesis of such data are the recent extension of the Mantel-Haenszel approach to NMA or the use of the noncentral hypergeometric distribution. In this article, we suggest a new common-effect NMA approach that can be applied even in networks of interventions with extremely low or even zero number of events without requiring study exclusion or arbitrary imputations. Our method is based on the implementation of the penalized likelihood function proposed by Firth for bias reduction of the maximum likelihood estimate to the logistic expression of the NMA model. A limitation of our method is that heterogeneity cannot be taken into account as an additive parameter as in most meta-analytical models. However, we account for heterogeneity by incorporating a multiplicative overdispersion term using a two-stage approach. We show through simulation that our method performs consistently well across all tested scenarios and most often results in smaller bias than other available methods. We also illustrate the use of our method through two clinical examples. We conclude that our “penalized likelihood NMA” approach is promising for the analysis of binary outcomes with rare events especially for networks with very few studies per comparison and very low control group risks.

PMID:36054668 | DOI:10.1002/sim.9562

Am J Hematol. 2022 Aug 28. doi: 10.1002/ajh.26703. Online ahead of print.

ABSTRACT

It is well established that splenic dysfunction occurs in early childhood in sickle cell anemia (SCA), although the determinants and consequences of splenic injury are not fully understood. In this study, we examined spleen size and splenic function in 100 children with SCA aged 0 to 16 years at King’s College Hospital in London. Spleen size was assessed by abdominal ultrasound and splenic function by pitted red blood cells (PIT counts). In our cohort, 5.6% of children aged 6 to 10 years and 19.4% of children aged 11 to 16 years had no visible spleen on ultrasound (autosplenectomy). Splenomegaly was common in all age groups, with 28% of children overall having larger spleens than the average for their age. Only one child had a PIT count suggesting preserved splenic function. We found no correlation between hemoglobin F levels and spleen size, nor was there any difference in spleen size between children treated with or without hydroxyurea. Although there was a trend towards increased spleen length in children with co-inherited α-thalassemia, this did not reach statistical significance. Finally, we found a strong association between erythrocyte deformability measured with oxygen gradient ektacytometry, spleen size, and PIT counts. In conclusion, our results do not agree with the general perception that most children with SCA undergo autosplenectomy within the first decade of life and indicate that loss of erythrocyte deformability contributes to loss of splenic filtration capacity in SCA, as well as phenotypical variations in spleen size. This article is protected by copyright. All rights reserved.

PMID:36054667 | DOI:10.1002/ajh.26703

J Dent Educ. 2022 Sep 2. doi: 10.1002/jdd.13087. Online ahead of print.

ABSTRACT

PURPOSE: In 2021, the American Dental Association (ADA) announced the intention to develop a standardized dental hygiene licensure objective structured clinical examination (DHLOSCE). The purpose of this study was to measure the United States (US) dental hygiene (DH) educators’ foundational knowledge of OSCE development and delivery in light of the impending development of the DHLOSCE by the ADA’s Testing Services.

METHODS: The study was determined to be exempt from Institutional Review Board oversight. A 21-question survey was developed, pilot tested, and electronically disseminated through Qualtrics. The survey recruitment was emailed to the directors of all entry-level DH education programs in the US (n = 328), asking them to participate in the survey and to forward it to the clinical faculty in their institutions. Descriptive and inferential statistics were utilized to analyze the data.

RESULTS: There were 143 study participants, for a completion rate of 45%. Over two-thirds of respondents (64%) were unaware of the plans to develop the DHLOSCE, while 13% reported utilizing OSCEs to meet accreditation standards. Only 3% reported receiving a formal education in OSCE development compared to 29% who learned through a colleague or peer. Nearly half reported a lack of faculty experience as a barrier to OSCE implementation. Over three-quarters, 76% reported a lack of OCSE development committees within their program and only 14% had experience developing an OSCE station.

CONCLUSION: The study results suggest an urgent need for the development of OSCE training resources specific to DH education, as programs across the US prepare for the impending DHLOSCE.

PMID:36052838 | DOI:10.1002/jdd.13087

Crit Rev Food Sci Nutr. 2022 Sep 2:1-19. doi: 10.1080/10408398.2022.2117786. Online ahead of print.

ABSTRACT

Various methodologies including genetic analyses, morphometrics, proteomics, lipidomics, metabolomics, etc. are now used or being developed to authenticate fish and seafood. Such techniques usually lead to the generation of enormous amounts of data. The analysis and interpretation of this information can be particularly challenging. Statistical techniques are therefore commonly used to assist in analyzing these data, visualizing trends and differences and extracting conclusions. This review article aims at presenting and discussing statistical methods used in studies on fish and seafood authenticity and adulteration, allowing researchers to consider their options based on previous successes/failures but also offering some recommendations about the future of such techniques. Techniques such as PCA, AMOVA and F_ST statistics, that allow the differentiation of genetic groups, or techniques such as MANOVA that allow large data sets of morphometric characteristics or elemental differences to be analyzed are discussed. Furthermore, methods such as cluster analysis, DFA, CVA, CDA and heatmaps/Circos plots that allow samples to be differentiated based on their geographical origin are also reviewed and their advantages and disadvantages as found in past studies are given. Finally, mathematical simulations and modeling are presented in a detailed review of studies using them, together with their advantages and limitations.

PMID:36052815 | DOI:10.1080/10408398.2022.2117786