Nevin Manimala

Otol Neurotol. 2024 Nov 29. doi: 10.1097/MAO.0000000000004378. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the difference in overall, hospital, and out-of-hospital cost difference of day-case stapes surgery, compared with inpatient stapes surgery, while maintaining equal hearing outcomes and quality of life (QoL).

STUDY DESIGN: A single-center, nonblinded, randomized controlled trial in a tertiary referral center.

METHODS: A total of 112 adult patients planned for primary or revision stapes surgery for clinically suspected otosclerosis were randomly assigned to either the day-case or inpatient treatment group. An evaluation was performed of the difference in total health care-related costs (hospital and out-of-hospital costs) from a hospital and patient perspective over the course of 1 year. Audiometric measurements included pure-tone audiometric measurements and speech audiometry measured at 2 months and 1 year postoperatively. QoL was assessed at 3 months and 1 year postoperatively, using the EQ-5D and HUI3 questionnaires.

RESULTS: A total of 109 cases (100 patients) were analyzed due to three dropouts. The total health care-related costs were €16,586 in the inpatient group (n = 54) and €16,904 in the day-case group (n = 55). The mean postoperative hospital stay was 0.9 days (mean costs of €854) in the inpatient group and 0.5 days (mean costs of €561) in the day-case group (both mean differences statistically significant), with a crossover rate from day-case to the inpatient group of 36% (n = 20) and a crossover rate from inpatient to the day-case group of 11% (n = 6). There were no differences in postoperative complications and objective hearing outcomes. Besides an increased number (0.2) of postoperative telephone consultations in the day-case group, there were no statistically significant differences in postoperative hospital and out-of-hospital costs or visits. The QoL showed no statistically significant differences.

CONCLUSION: A day-case approach in primary or revision stapes surgery does not result in a statistically significant reduction of health care-related hospital and out-of-hospital costs compared with an inpatient approach. It also does not affect the surgical outcome (objective audiometric measurements and complication rate), QoL, and postoperative course (number of postoperative hospital and out-of-hospital visits).Level of evidence: 1.

PMID:39627898 | DOI:10.1097/MAO.0000000000004378

Clin Diabetes Endocrinol. 2024 Dec 4;10(1):41. doi: 10.1186/s40842-024-00208-2.

ABSTRACT

BACKGROUND: Effective diabetic retinopathy screening (DRS) programmes are important in preventing vision impairment and blindness caused by diabetes. This study focuses on identifying the factors affecting attendance or non-adherence to DRS among children and young adults with diabetes mellitus (DM) in Bangladesh.

METHODS: A mixed-methods approach was used, which included patients diagnosed with DM aged 12-26 years from Bangladesh who were registered at BIRDEM Women and Children hospital in Dhaka. Data collection occurred between July 2019 and July 2020, mainly through telephone and email due to restrictions imposed by the COVID-19 pandemic. Statistical analyses, including chi-squared tests, t-tests, and logistic regression, were used to assess the demographic and clinical factors influencing attendance at DRS.

RESULTS: The study reported a high 88% attendance rate for DRS among children and young adults in Bangladesh. However, some barriers to attendance were identified. Children under 15 years of age showed a higher tendency to attend their last DRS appointment when compared to older age participants (16-26 years), P < 0.05. Male participants demonstrated a lower likelihood of attending their DRS appointments than females (OR 0.29, CI: 0.17 to 0.50), P < 0.001. Additionally, participants with higher HbA1c levels (mean 9.1%, IQR 2.5) attended their last DRS appointment compared to those with lower levels (mean 8.0%) (p < 0.05). The primary barriers leading to missed DRS appointments were distance to the hospital (15, 31.9%), financial limitations (19, 40.4%), and busy schedules (14, 29.8%).

CONCLUSIONS: Compliance with DRS was high in this setting especially among younger patients, females, and those with higher HbA1c levels, highlighting the effectiveness of current DRS initiatives in Bangladesh. Addressing barriers such as cost, service accessibility and transportation could improve attendance rates further, and strategies such as flexible scheduling, transport subsidies, telemedicine, and use of artificial intelligence may help overcome these challenges.

PMID:39627896 | DOI:10.1186/s40842-024-00208-2

BMC Med. 2024 Dec 3;22(1):574. doi: 10.1186/s12916-024-03802-4.

ABSTRACT

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is associated with an increased incidence of hepatic and extrahepatic cancers, in particular those linked to obesity. In people with chronic liver disease, aspirin may confer protection against hepatocellular carcinoma (HCC). We explore the potential chemoprotective effect of aspirin/other anti-platelet agents on obesity-related cancers, including HCC in people with NAFLD.

METHODS: We performed a retrospective cohort study of anonymised electronic medical records using the TriNetX network (Cambridge, MA, USA), a global federated database. We identified adults aged 18 or over with a diagnosis of NAFLD, prior to commencing antiplatelet agents. Two groups were created: antiplatelet (1) versus no antiplatelet use (2). We propensity score matched for nine variables. Antiplatelet use was defined as aspirin, ticagrelor, cangrelor, clopidogrel or prasugrel use for at least 1 year. The outcomes of interest were incidence of HCC and other obesity-related cancers. Follow-up was for 5 years. We performed subgroup analyses on aspirin users only and stratified findings for sex and age. Sensitivity analysis was conducted on individuals with 3- and 5-year aspirin exposure.

RESULTS: Post matching, there were 42,192 people per group. Antiplatelet use in people with NAFLD was associated with statistically significant reduction in all obesity-related cancers (HR 0.71, 95% CI 0.65-0.78, p < 0.001) and individually for HCC (HR 0.52, 95% CI 0.40-0.68, p < 0.001), breast carcinoma (HR 0.78, 95% CI 0.66-0.92, p = 0.003), pancreatic carcinoma (HR 0.61, 95% CI 0.47-0.78, p < 0.001) and colorectal carcinoma (HR 0.68, 95% CI 0.56-0.84, p < 0.001). For women, there was a significant reduction in risk of ovarian carcinoma (HR 0.75, 95% CI 0.57-0.98, p = 0.034). Aspirin monotherapy was similarly associated with reduced incidence of HCC (HR 0.46, 95% CI 0.32-0.64, p < 0.001) and all obesity-related cancers (HR 0.71, 95% CI, 0.56-0.90, p = 0.004), with benefits observed in males (HR 0.71, 95% CI 0.56-0.90, p = 0.004), females (HR 0.77, 95% CI 0.67-0.88, p < 0.001) and in older (HR 0.72, 95% CI 0.63-0.82, p < 0.001) but not younger people (HR 0.78, 95% CI 0.60-1.03, p = 0.589).

CONCLUSIONS: Aspirin/antiplatelet agents may have a role in primary cancer prevention in people living with NAFLD.

PMID:39627877 | DOI:10.1186/s12916-024-03802-4

Mov Ecol. 2024 Dec 3;12(1):75. doi: 10.1186/s40462-024-00519-0.

ABSTRACT

BACKGROUND: Wildfires can have complex effects on wildlife populations. Understanding how post-fire conditions affect the movement ecology of threatened species can assist in better conservation and management, including informing the release of rescued and rehabilitated animals. The 2019-2020 megafires in Australia resulted in thousands of animals coming into care due to injury or concerns over habitat degradation. This included hundreds of koalas (Phascolarctos cinereus), for which relatively little was known about how fire affected habitat suitability, or when rehabilitated animals could be returned to burnt areas.

METHODS: We compared the movements of koalas across three experimental groups-non-rehabilitated koalas in burnt habitat, non-rehabilitated koalas in nearby unburnt habitat, and rehabilitated koalas returned to their rescue location in burnt habitat in New South Wales, Australia. We GPS-tracked 32 koalas for up to nine months and compared, across treatment groups, home ranges, mean nightly distance moved, the farthest distance moved from their release site and total displacement distance.

RESULTS: We found no differences in koala movements and home range size between non-rehabilitated koalas in burnt and unburnt habitat. However, rehabilitated koalas moved farther from their release site, had larger displacement distances, and larger home ranges than non-rehabilitated individuals. Regardless of their experimental group, we also found that males moved further than females each night. Additionally, our resource selection analysis showed that, koalas preferred low and moderately burnt habitats over all other fire severity classes.

CONCLUSIONS: Experimental frameworks that incorporate “treatment” and “control” groups can help isolate disturbance effects on animal movements. Encouragingly, despite catastrophic wildfires, burnt woodlands provided adequate resources for koalas to persist and recover. Furthermore, rehabilitated koalas re-integrated into the burnt landscape despite moving farther from their release sites than non-rehabilitated individuals. Studies like this improve our understanding of the ecological impacts of fire on species and their habitats, and will be instrumental in informing wildlife management and conservation efforts as wildfires increase in frequency and severity worldwide in response to climate change.

PMID:39627876 | DOI:10.1186/s40462-024-00519-0

Mol Autism. 2024 Dec 3;15(1):51. doi: 10.1186/s13229-024-00630-4.

ABSTRACT

BACKGROUND: Very large sample sizes are often needed to capture heterogeneity in autism, necessitating data sharing across multiple studies with diverse assessment instruments. In these cases, data harmonization can be a critical tool for deriving a single dataset for analysis. This can be done through computational approaches that enable the conversion of scores across various instruments. To this end, our study examined the use of analytical approaches for mapping scores on two measures of adaptive functioning, namely predicting the scores on the vineland adaptive behavior scales II (VABS) from the scores on the adaptive behavior assessment system II (ABAS).

METHODS: Data from the province of Ontario neurodevelopmental disorders network were used. The dataset included scores VABS and the ABAS for 720 participants (autism n = 547, 433 male, age: 11.31 ± 3.63 years; neurotypical n = 173, 95 male, age: 12.53 ± 4.05 years). Six regression approaches (ordinary least squares (OLS) linear regression, ridge regression, ElasticNet, LASSO, AdaBoost, random forest) were used to predict VABS total scores from the ABAS scores, demographic variables (age, sex), and phenotypic measures (diagnosis; core and co-occurring features; IQ; internalizing and externalizing symptoms).

RESULTS: The VABS scores were significantly higher than the ABAS scores in the autism group, but not the neurotypical group (median difference: 8, 95% CI = (7,9)). The difference was negatively associated with age (beta = -1.2 ± 0.12, t = -10.6, p < 0.0001). All estimators demonstrated similar performance, with no statistically significant differences in mean absolute error (MAE) values across estimators (MAE range: 4.96-6.91). The highest contributing features to the prediction model were ABAS composite score, diagnosis, and age.

LIMITATIONS: This study has several strengths, including the large sample. We did not examine the conversion of domain scores across the two measures of adaptive functioning and suggest this as a future area of investigation.

CONCLUSION: Overall, our results supported the feasibility of harmonization. Our results suggest that a linear regression model trained on the ABAS composite score, the ABAS raw domain scores, and age, sex, and diagnosis would provide an acceptable trade-off between accuracy, parsimony, and data collection and processing complexity.

PMID:39627866 | DOI:10.1186/s13229-024-00630-4

Genome Med. 2024 Dec 3;16(1):143. doi: 10.1186/s13073-024-01392-7.

ABSTRACT

BACKGROUND: Multiplexed Assays of Variant Effects (MAVEs) can test all possible single variants in a gene of interest. The resulting saturation-style functional data may help resolve variant classification disparities between populations, especially for Variants of Uncertain Significance (VUS).

METHODS: We analyzed clinical significance classifications in 213,663 individuals of European-like genetic ancestry versus 206,975 individuals of non-European-like genetic ancestry from All of Us and the Genome Aggregation Database. Then, we incorporated clinically calibrated MAVE data into the Clinical Genome Resource’s Variant Curation Expert Panel rules to automate VUS reclassification for BRCA1, TP53, and PTEN.

RESULTS: Using two orthogonal statistical approaches, we show a higher prevalence (p ≤ 5.95e – 06) of VUS in individuals of non-European-like genetic ancestry across all medical specialties assessed in all three databases. Further, in the non-European-like genetic ancestry group, higher rates of Benign or Likely Benign and variants with no clinical designation (p ≤ 2.5e – 05) were found across many medical specialties, whereas Pathogenic or Likely Pathogenic assignments were increased in individuals of European-like genetic ancestry (p ≤ 2.5e – 05). Using MAVE data, we reclassified VUS in individuals of non-European-like genetic ancestry at a significantly higher rate in comparison to reclassified VUS from European-like genetic ancestry (p = 9.1e – 03) effectively compensating for the VUS disparity. Further, essential code analysis showed equitable impact of MAVE evidence codes but inequitable impact of allele frequency (p = 7.47e – 06) and computational predictor (p = 6.92e – 05) evidence codes for individuals of non-European-like genetic ancestry.

CONCLUSIONS: Generation of saturation-style MAVE data should be a priority to reduce VUS disparities and produce equitable training data for future computational predictors.

PMID:39627863 | DOI:10.1186/s13073-024-01392-7

J Cheminform. 2024 Dec 3;16(1):135. doi: 10.1186/s13321-024-00932-y.

ABSTRACT

Extended-connectivity fingerprints (ECFPs) are a ubiquitous tool in current cheminformatics and molecular machine learning, and one of the most prevalent molecular feature extraction techniques used for chemical prediction. Atom features learned by graph neural networks can be aggregated to compound-level representations using a large spectrum of graph pooling methods. In contrast, sets of detected ECFP substructures are by default transformed into bit vectors using only a simple hash-based folding procedure. We introduce a general mathematical framework for the vectorisation of structural fingerprints via a formal operation called substructure pooling that encompasses hash-based folding, algorithmic substructure selection, and a wide variety of other potential techniques. We go on to describe Sort & Slice, an easy-to-implement and bit-collision-free alternative to hash-based folding for the pooling of ECFP substructures. Sort & Slice first sorts ECFP substructures according to their relative prevalence in a given set of training compounds and then slices away all but the L most frequent substructures which are subsequently used to generate a binary fingerprint of desired length, L. We computationally compare the performance of hash-based folding, Sort & Slice, and two advanced supervised substructure-selection schemes (filtering and mutual-information maximisation) for ECFP-based molecular property prediction. Our results indicate that, despite its technical simplicity, Sort & Slice robustly (and at times substantially) outperforms traditional hash-based folding as well as the other investigated substructure-pooling methods across distinct prediction tasks, data splitting techniques, machine-learning models and ECFP hyperparameters. We thus recommend that Sort & Slice canonically replace hash-based folding as the default substructure-pooling technique to vectorise ECFPs for supervised molecular machine learning. Scientific contribution A general mathematical framework for the vectorisation of structural fingerprints called substructure pooling; and the technical description and computational evaluation of Sort & Slice, a conceptually simple and bit-collision-free method for the pooling of ECFP substructures that robustly and markedly outperforms classical hash-based folding at molecular property prediction.

PMID:39627861 | DOI:10.1186/s13321-024-00932-y

BMC Health Serv Res. 2024 Dec 3;24(1):1533. doi: 10.1186/s12913-024-12014-8.

ABSTRACT

BACKGROUND: There are more than 4 million breast cancer survivors in the United States. With continuing improvements in early detection and treatment, the number of breast cancer survivors will only continue to increase. Breast cancer survivors face a lifetime risk of long-term or late-effects from cancer treatments, thus post-cancer treatment care, referred to as survivorship care, is critical. Social determinants of health, including where a breast cancer survivor lives, may impact cancer survivorship care. Our purpose was to evaluate the relationship between rural/urban status and receipt of cancer survivorship care and instructions for Missouri breast cancer survivors using state-level data from a nationwide telephone survey-the Behavioral Risk Factor Surveillance System (BRFSS).

METHODS: Missouri included the BRFSS Cancer Survivorship Module in 2014, 2016, 2018, and 2020. Module items ask cancer survivors about receipt of a “post-cancer-treatment summary” and “follow-up instructions.” We hypothesized chances of receipt of both components would differ among four level Rural-Urban Commuting Area (RUCA) Code groups (Rural, Small-Town, Micropolitan, Metropolitan). Data from 430 breast cancer survivors over four survey years were combined and grouped according to RUCA status. Using a logistic model with a multilevel approach (after sampling weights calibration), the relationship between receipt of survivorship instructions and RUCA group was examined.

RESULTS: 46% of Missouri breast cancer survivors reported receipt of complete survivorship instructions. Compared to rural breast cancer survivors, micropolitan breast cancer survivors had 5.9 times higher odds of receiving survivorship instructions (p < 0.0001).

CONCLUSIONS: Less than half of respondents reported receiving complete post-cancer treatment instructions. More urban respondents were more likely to receive instructions than their rural counterparts which raises questions about the quality of post-treatment care between rural and urban survivors. A sophisticated and purposeful approach to mitigating potential disparities is warranted. Receipt of cancer survivorship care plans may be impacted by rurality/urbanicity. Clinicians caring for cancer survivors living in rural or urban settings must continue to be diligent with providing personalized survivorship care.

PMID:39627855 | DOI:10.1186/s12913-024-12014-8

BMC Nurs. 2024 Dec 3;23(1):880. doi: 10.1186/s12912-024-02535-2.

ABSTRACT

OBJECTIVE: To develop an empathy scale to measure the empathy in nurses.

MATERIALS AND METHODS: The sample of the study were collected between March and May in 2023 from 720 nurses working in private and state hospitals in İstanbul. Both exploratory factor analysis and confirmatory factor analysis were carried out. IBM SPSS and AMOS were utilized for statistical analyses.

RESULTS: KMO and Bartlett’s test values of scale showed that the dataset was convenient for factor analyses (KMO = 0.94, Chi-Square = 9683.89, df = 595). In exploratory factor analysis, the 16 items comprising scale were distributed in three subscales. The confirmatory factor analysis revealed that the scale was in sufficient model fit. Cronbach’s alpha of the total scale was 0.91.

CONCLUSION: Empathy scale is a valid and reliable measurement tool to evaluate the empathy levels of nurses in three subscales: Emotional Empathy, Cognitive Empathy and Compassionate Empathy. The scale is a valuable tool for quality nursing care and contributes to the definition of strategies that advance the quality of nursing care.

PMID:39627839 | DOI:10.1186/s12912-024-02535-2

Trials. 2024 Dec 4;25(1):809. doi: 10.1186/s13063-024-08651-3.

ABSTRACT

BACKGROUND: The number of non-inferiority (NI) trials, those aiming to show a new treatment is no worse than a comparator, is increasing. However, their added complexity over superiority trials can create confusion. Most guidance and reviews to date have an industry focus with research suggesting these trials may differ from publicly funded NI trials. The aim of this work is to review the design and reporting characteristics of UK publicly funded NI trials. This assessment will show how well recommendations from industry are translating to publicly funded trials.

METHODS: The International Standard Randomised Controlled Trial Number web registry and the National Institute for Health and Care Research’s Funding and Awards Library and Journals Library were searched using the term non-inferiority and logical synonyms. Inclusion requirements were a UK publicly funded NI randomised controlled trial. Characteristics of the design, analyses and results as available were recorded on a dedicated data extraction spreadsheet. Appropriate summary statistics were used to present the results.

RESULTS: Searches completed on the 14th of January 2022 identified 477 potential trials which after exclusions resulted in a database of 114 NI trials to be summarised. Non-inferiority margins were defined for most trials with a median of 8% (IQR: 3-10%) used for risk differences (n = 58) and 0.35 (IQR: 0.26-0.43) standardised mean difference for continuous outcomes (n = 30). Justifications for the margin chosen (n = 62) were more commonly based on the clinical importance (49/62) and less commonly using statistical considerations (13/62). The most prevalent primary analysis population was solely on an intention-to-treat basis (49/114). The superiority of the treatment was well described but not always included as an outcome and only powered for in about a third of cases.

CONCLUSIONS: Aspects of NI trial design are well described but not always in line with current recommendations. Of particular note, is the absence of statistical considerations when setting the non-inferiority margin, which eliminates the ability to confirm indirect superiority over placebo for the new treatment. Additionally, despite suggestions that it can increase the type 1 error in NI trials, the use of the intention-to-treat alone is the most common analysis population.

TRIAL REGISTRATION: Research on Research ID: 3171 (registration date: 31st May 2023).

PMID:39627838 | DOI:10.1186/s13063-024-08651-3