Nevin Manimala

Health Aff (Millwood). 2022 Jun;41(6):893-900. doi: 10.1377/hlthaff.2021.01856.

ABSTRACT

The Comprehensive End-Stage Renal Disease (ESRD) Care (CEC) Model was the first Medicare specialty-oriented accountable care organization (ACO) model. We examined whether this model provided better results for beneficiaries with ESRD than primary care-based ACO models. We found significant decreases in Medicare payments ($126 per beneficiary per month), hospitalizations (5 percent), and likelihood of readmissions (8 percent) among beneficiaries with ESRD during the first year of alignment with the CEC Model and no impacts on these measures among beneficiaries with ESRD who were aligned with primary care-based ACOs, relative to fee-for-service Medicare beneficiaries. Neither the CEC nor primary care-based ACO models significantly reduced the likelihood of catheter use, but fistula use increased for CEC Model beneficiaries to levels just above statistical significance. Other populations with chronic conditions may benefit from the testing of a specialty-oriented ACO model. In addition, primary care-based ACOs may benefit from applying CEC Model strategies to high-need subpopulations. Last, the strategies that enabled ESRD Seamless Care Organizations to achieve reductions in hospitalizations and readmissions even without hospital participation as owners could inform physician-led ACOs’ efforts to coordinate with hospitals in their areas.

PMID:35666977 | DOI:10.1377/hlthaff.2021.01856

J Clin Oncol. 2022 Jun 6:JCO2101365. doi: 10.1200/JCO.21.01365. Online ahead of print.

ABSTRACT

PURPOSE: Patients with multiple myeloma (MM) may show patchy bone marrow (BM) infiltration and extramedullary disease. Notwithstanding, quantification of plasma cells (PCs) continues to be performed in BM since the clinical translation of circulating tumor cells (CTCs) remains undefined.

PATIENTS AND METHODS: CTCs were measured in peripheral blood (PB) of 374 patients with newly diagnosed MM enrolled in the GEM2012MENOS65 and GEM2014MAIN trials. Treatment included bortezomib, lenalidomide, and dexamethasone induction followed by autologous transplant, consolidation, and maintenance. Next-generation flow cytometry was used to evaluate CTCs in PB at diagnosis and measurable residual disease (MRD) in BM throughout treatment.

RESULTS: CTCs were detected in 92% (344 of 374) of patients with newly diagnosed MM. The correlation between the percentages of CTCs and BM PCs was modest. Increasing logarithmic percentages of CTCs were associated with inferior progression-free survival (PFS). A cutoff of 0.01% CTCs showed an independent prognostic value (hazard ratio: 2.02; 95% CI, 1.3 to 3.1; P = .001) in multivariable PFS analysis including the International Staging System, lactate dehydrogenase levels, and cytogenetics. The combination of the four prognostic factors significantly improved risk stratification. Outcomes according to the percentage of CTCs and depth of response to treatment showed that patients with undetectable CTCs had exceptional PFS regardless of complete remission and MRD status. In all other cases with detectable CTCs, only achieving MRD negativity (and not complete remission) demonstrated a statistically significant increase in PFS.

CONCLUSION: Evaluation of CTCs in PB outperformed quantification of BM PCs. The detection of ≥ 0.01% CTCs could be a new risk factor in novel staging systems for patients with transplant-eligible MM.

PMID:35666958 | DOI:10.1200/JCO.21.01365

J Exp Psychol Anim Learn Cogn. 2022 Jun 6. doi: 10.1037/xan0000322. Online ahead of print.

ABSTRACT

Bridging associative and normative theories of animal learning, I show that an associative system can behave as if performing probabilistic inference by using the function f(V) = 1 – e^-cV to transform associative strengths (V) into response probabilities. For example, using this function, an associative system can respond normatively to a compound stimulus AB, given previous separate experiences with the components A and B. The CR probability formulae that result from the proposed function have a normative interpretation in terms of statistical decision theory. The formulae also suggest a normative interpretation of stimulus generalization as a heuristic to infer whether different stimuli are likely to convey redundant or independent information about reinforcement. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PMID:35666932 | DOI:10.1037/xan0000322

J Exp Psychol Gen. 2022 Jun 6. doi: 10.1037/xge0001225. Online ahead of print.

ABSTRACT

Previous studies showed a bilingual advantage in metacognitive processing (tracking one’s own cognitive performance) in linguistic tasks. However, bilinguals do not constitute a homogeneous population, and it was unclear which aspects of bilingualism affect metacognition. In this project, we tested the hypothesis that simultaneous acquisition and use of typologically different languages leads to development of diverse processing strategies and enhances metacognition. The hypothesis was tested in the visual and auditory modalities in language and nonlanguage domains, in an artificial language learning task. In the auditory modality, the hypothesis was confirmed for linguistic stimuli, with no between-domain transfer of metacognitive abilities was observed at the individual level. In the visual modality, no differences in metacognitive efficiency were observed. Moreover, we found that bilingualism per se and the use of typologically different languages modulated separate metacognitive processes engaged in monitoring cognitive performance in statistical learning task. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

PMID:35666891 | DOI:10.1037/xge0001225

J Pediatr Gastroenterol Nutr. 2022 Jun 6. doi: 10.1097/MPG.0000000000003510. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine how the use of biological therapy is associated with surgical intervention for paediatric inflammatory bowel disease (PIBD) at population level.

METHODS: Hospital Episode Statistics data were obtained for all admissions within England, (1997-2015), in children aged 0-18 years, with an ICD-10 code for diagnosis of Crohn’s disease (CD), ulcerative colitis (UC) or inflammatory bowel disease-unclassified (IBD-U). OPCS codes for major surgical resection associated with PIBD and for biological therapy were also obtained. Data are presented as median values (interquartile range).

RESULTS: In total, 22,645 children had a diagnosis of PIBD of which 13,722 (61%) had CD, 7,604 (34%) UC and 1,319 (5.8%) cases IBD-U. Biological therapy was used in 4,054 (17.9%) cases. Surgical resection was undertaken in 3,212 (14%) cases, more commonly for CD than UC (17.5 vs 10.3%, p<0.0001). Time from diagnosis to major surgical resection was 8.3 (1.2-28.2) months in CD and 8.2 (0.8-21.3) months in UC. As the time-frame of the data-set progressed, there was a decreased rate of surgical intervention (p=0.04) and an increased use of biological therapy (p<0.0001). Additionally, the number of new diagnoses of PIBD increased.

CONCLUSION: The introduction of biologic agents has been associated with a reduction in cases undergoing surgery in children with a known diagnosis of PIBD. As time progresses we will be able to determine whether biological therapies prevent the need for surgery altogether or just delay this until adulthood.An infographic is available for this article at: http://links.lww.com/MPG/C846.

PMID:35666884 | DOI:10.1097/MPG.0000000000003510

J Pediatr Gastroenterol Nutr. 2022 Jun 6. doi: 10.1097/MPG.0000000000003493. Online ahead of print.

ABSTRACT

OBJECTIVES: We aimed to determine the growth and safety parameters in newborns fed a goat milk based infant formula (GMF) using a randomized double-blind trial, in which a cow milk formula (CMF) served as a control and a breast fed (BF) group as a reference.

METHODS: Healthy term infants (n=218) aged up to 14 days old were recruited from 25 European study centers and randomized to GMF or CMF. Weight, length, head circumference were measured at baseline, and at 14, 28, 56, 84, and 112 days at the study clinics. Adverse events were recorded and stool characteristics, reflux, fussiness, colic, and flatulence were self-reported by parents in 3-day diaries. Anthropometric measurements were transformed to WHO standardized age- and sex adjusted z-scores. Analyses of covariance and linear mixed modeling were used to statistically analyze growth, while adjusting for potential confounders when studying the breast-fed group (n=86).

RESULTS: Comparing the GMF to the CMF group, weight gain [mean difference 227.8 g (95% CI -16.6-439.0)] and z-scores for anthropometric measurements were similar after 112 days intervention. Infant formula groups showed greater mean (SD) weight z-scores than the BF group from 84 days onwards (GMF: 0.28 (0.84), CMF: 0.12 (0.88), BF -0.19 (1.02), p<0.05), whereas length and head circumference z-scores were similar. Incidences of serious adverse events and reflux, fussiness, colic, and flatulence were similar among the three groups.

CONCLUSION: Our data demonstrate that GMF provides adequate growth, has a good tolerability, and is safe to use in infants.

PMID:35666856 | DOI:10.1097/MPG.0000000000003493

Circ Genom Precis Med. 2022 Jun 6:101161CIRCGEN121003612. doi: 10.1161/CIRCGEN.121.003612. Online ahead of print.

ABSTRACT

BACKGROUND: Although many polygenic risk scores (PRS) for cardiovascular traits have been developed in European populations, it is an urgent task to construct a PRS and to evaluate its ability in non-European populations. We developed a genome-wide PRS for blood pressure in a Japanese population and examined the associations between this PRS and hypertension prevalence.

METHODS: We performed a cross-sectional study in 11 252 Japanese individuals who participated in the J-MICC (Japan Multi-Institutional Collaborative Cohort) study. Using publicly available GWAS summary statistics from Biobank Japan, we developed the PRS in the target data (n=7876). With >30 000 single nucleotide polymorphisms, we evaluated PRS performance in the test data (n=3376). Hypertension was defined as systolic blood pressure of 130 mm Hg or more, or diastolic blood pressure of 85 mm Hg or more, or taking an antihypertensive drug.

RESULTS: Compared with the middle PRS quintile, the prevalence of hypertension at the top PRS quintile was higher independently from traditional risk factors (odds ratio, 1.73 [95% CI, 1.32-2.27]). The difference of mean systolic blood pressure and diastolic blood pressure between the middle and the top PRS quintile was 4.55 (95% CI, 2.26-6.85) and 2.32 (95% CI, 0.86-3.78) mm Hg, respectively. Subgroups reflecting combinations of Japanese PRS and modifiable lifestyles and factors (smoking, alcohol intake, sedentary time, and obesity) were associated with the prevalence of hypertension. A European-derived PRS was not associated with hypertension in our participants.

CONCLUSIONS: A PRS for blood pressure was significantly associated with hypertension and BP traits in a general Japanese population. Our findings also highlighted the importance of a combination of PRS and risk factors for identifying high-risk subgroups.

PMID:35666837 | DOI:10.1161/CIRCGEN.121.003612

Int J Med Robot. 2022 Jun 6:e2431. doi: 10.1002/rcs.2431. Online ahead of print.

ABSTRACT

INTRODUCTION: The purpose of this study was to evaluate outcomes in elderly patients (age≥65 years) undergoing robotic colorectal surgery (RCRS) in comparison with non-elderly patients.

MATERIALS AND METHODS: Data was collected on elderly and non-elderly patients who underwent RCRS from a prospectively maintained database.

RESULTS: A total of 89 elderly and 73 non-elderly patients were identified. No statistically significant differences in postoperative complication, reoperation, wound infection, anastomotic leak or mortality were observed. The median length of stay was 1 day longer in elderly patients (p=0.007). Subgroup analysis of octogenarians demonstrated outcomes that compared favourably with younger patients.

CONCLUSION: RCRS in elderly patients is safe and effective, with outcomes that do not differ significantly with younger patients. Older age should not be considered to be a specific exclusion criteria for RCRS. To our knowledge, this study represents the largest in the literature to examine outcomes specifically in elderly patients undergoing RCRS. This article is protected by copyright. All rights reserved.

PMID:35666815 | DOI:10.1002/rcs.2431

IEEE/ACM Trans Comput Biol Bioinform. 2022 Jun 6;PP. doi: 10.1109/TCBB.2022.3178446. Online ahead of print.

ABSTRACT

Statistical analysis on genomic data can explore the relationship between gene sequence and phenotype. Particularly, counting the genomic mutation samples and associating with related phenotypes for statistical analysis can annotate the variation sites and help to diagnose genovariation. Expansion of the size of variation sample data helps to increase the accuracy of statistical analysis. It is feasible to securely share data from genomic databases on cloud platforms. In this paper, we design a secure counting query protocol that can securely share genomic data on cloud platforms. Our protocol supports statistical analysis of the genomic data in VCF (Variant Call Format) files by counting query. There are three participants of data owner, cloud platform and query party. Firstly, the genomic data is preprocessed to reduce the data size. Secondly, Paillier homomorphic is used so that genomic data can be securely shared and calculated on cloud platform. Finally, the results which be decrypted is used to implement counting function of the protocol. Experimental results show that the protocol can implement the query counting function after homomorphic encryption. The query time is less than 1 second, which provide a feasible solution to share genomic data securely on cloud platform for statistical analysis.

PMID:35666798 | DOI:10.1109/TCBB.2022.3178446

IEEE Trans Cybern. 2022 Jun 6;PP. doi: 10.1109/TCYB.2022.3172790. Online ahead of print.

ABSTRACT

Due to the frequent changes in operating conditions, time-varying behaviors, including slow-varying dynamics and switching modes, commonly exist in industrial processes, resulting in different degrees of shifting in the process data distribution. When the data distribution shifts in a relatively wide range, conventional adaptive methods become ineffective since they are unable to distinguish normal shifts from real faults, leading to false alarms. In this study, an incremental variational Bayesian Gaussian mixture model (IncVBGMM) is proposed for developing a fine-scale adaptive monitoring scheme to efficiently accommodate the shifting data distribution caused by different degrees of time-varying behaviors. First, IncVBGMM with decremental optimization is proposed to adapt to the changing data distribution via the automatic complement of local models while reducing redundancy to optimize the mixture model. Then, a fine-scale adaptive monitoring scheme is built with physical interpretations to discern between normal shifts and real faults by joint analysis of the static and dynamic information. In addition, a novel monitoring statistic called the expectation of variational Bayesian inference distance (EVBID) is proposed, which can quantify the distance from samples to the variational monitoring model and indicate the fault effects. Case studies involving a real-world three-phase flow facility reveal that the proposed method can accurately differentiate various types of faults from normal shifts and effectively adapt to the time-varying dynamics.

PMID:35666782 | DOI:10.1109/TCYB.2022.3172790