Tag: nevin manimala

Sci Rep. 2022 Nov 21;12(1):20005. doi: 10.1038/s41598-022-20991-1.

ABSTRACT

Modern datasets are characterized by numerous features related by complex dependency structures. To deal with these data, dimensionality reduction techniques are essential. Many of these techniques rely on the concept of intrinsic dimension (id), a measure of the complexity of the dataset. However, the estimation of this quantity is not trivial: often, the id depends rather dramatically on the scale of the distances among data points. At short distances, the id can be grossly overestimated due to the presence of noise, becoming smaller and approximately scale-independent only at large distances. An immediate approach to examining the scale dependence consists in decimating the dataset, which unavoidably induces non-negligible statistical errors at large scale. This article introduces a novel statistical method, Gride, that allows estimating the id as an explicit function of the scale without performing any decimation. Our approach is based on rigorous distributional results that enable the quantification of uncertainty of the estimates. Moreover, our method is simple and computationally efficient since it relies only on the distances among data points. Through simulation studies, we show that Gride is asymptotically unbiased, provides comparable estimates to other state-of-the-art methods, and is more robust to short-scale noise than other likelihood-based approaches.

PMID:36411305 | DOI:10.1038/s41598-022-20991-1

J Feline Med Surg. 2022 Nov 21:1098612X221125573. doi: 10.1177/1098612X221125573. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study was to evaluate the association between meningeal enhancement (MgE) and cerebrospinal fluid (CSF) analysis results, their individual association with bacteriology results from affected ear samples and whether these test results influenced clinicians’ therapeutic choice in cats with otitis media and interna (OMI).

METHODS: This was a multicentre retrospective study carried out over an 8-year period. Cats diagnosed with OMI, with or without a nasopharyngeal polyp, leading to peripheral vestibular signs were included. Only cats for which MRI with postcontrast T1-weighted sequences and CSF analyses available were included. Cats with intra-axial MRI lesions or empyema were excluded.

RESULTS: Fifty-eight cats met the inclusion criteria. MgE was reported in 26/58 cases, of which nine had an abnormal CSF result (increased total nucleated cell count [TNCC] or total protein); 32/58 cases had no MgE, of which 10 showed abnormal CSF results. There was no association between bacteriology results (external ear canal or bulla) and MgE or abnormal CSF results. CSF abnormalities were statistically significantly more common in acute cases (n = 16/37) than in chronic cases (n = 3/21; Fischer’s test P = 0.04). Prednisolone was prescribed in 10/16 cases with increased TNCC. Among the 42 cases with normal TNCC, 15 received prednisolone and 13 received non-steroidal anti-inflammatory drugs. Various antimicrobial drugs were prescribed in 53/58 cats. Duration of antimicrobial treatment was similar, regardless of positive bacterial culture (5.58 vs 4.22 weeks), abnormal CSF (5.83 vs 4.76 weeks) or MgE (5.33 vs 4.90 weeks).

CONCLUSIONS AND RELEVANCE: No association was found between the CSF and MgE results. Furthermore, no association was found between MgE, CSF or bacteriology findings. In addition, abnormal CSF results might lead the clinician to treat with corticosteroids, but they did not have any impact on duration of antimicrobial treatment. CSF abnormalities were seen significantly less frequently in chronic cases. The outcome tended to be poorer when MgE was detected on MRI.

PMID:36409551 | DOI:10.1177/1098612X221125573

JMIR Res Protoc. 2022 Nov 21;11(11):e37663. doi: 10.2196/37663.

ABSTRACT

BACKGROUND: Antimicrobial resistance is a known global public health threat. In addition, it brings serious economic consequences to agriculture. Antibiotic resistance in humans, animals, and environment is interconnected, as proposed in the tricycle surveillance by the World Health Organization. In Malaysia, research and surveillance of antimicrobial resistance are mainly performed in clinical samples, agricultural settings, and surface waters, but no surveillance of the drinking water systems has been performed yet. Hence, this policy-driven study is a combined effort of microbiologists and engineers to provide baseline data on the magnitude of antimicrobial resistance in the drinking water systems of Malaysia.

OBJECTIVE: The aim of this study was to study the baseline level of antibiotic-resistant bacteria in the drinking water distribution systems of Malaysia by collecting samples from the pretreatment and posttreatment outlets of water treatment plants in a selected state of Malaysia. We aimed to determine the prevalence of antibiotic-resistant bacteria, the occurrence of antibiotic-resistant genes, and the level of antibiotics present in the drinking water systems.

METHODS: This is a laboratory-based, cross-sectional study in a selected state of Malaysia. Water samples from 6 drinking water treatment plants were collected. Samples were collected at 3 sampling points, that is, the intake sampling station, service reservoir outlet station, and the distribution system sampling station. These were tested against 7 types of antibiotics in triplicates. Samples were screened for antibiotic-resistant bacteria and antibiotic-resistant genes and quantified for the level of antibiotics present in the drinking water treatment plants.

RESULTS: We will show the descriptive statistics of the number of bacterial colonies harvested from water samples grown on Reasoner’s 2A agar with or without antibiotics, the occurrence of antibiotic-resistant genes, and the level of antibiotics detected in the water samples. The sampling frame was scheduled to start from November 2021 and continue until December 2022. Data analysis is expected to be completed by early 2023, and the results are expected to be published in mid-2023.

CONCLUSIONS: This study provides baseline information on the status of the antimicrobial-resistant bacteria, the presence of resistance genes as contaminants, and the level of antibiotics present in the drinking water systems of Malaysia, with the aim of demonstrating to policymakers the need to consider antimicrobial resistance as a parameter in drinking water surveillance.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/37663.

PMID:36409546 | DOI:10.2196/37663

Vital Health Stat 1. 2022 Nov;(196):1-20.

ABSTRACT

To evaluate the quality of web surveys, the National Center for Health Statistics’ Division of Research and Methodology has been conducting a series of studies with survey data from commercially recruited panels,referred to as the Research and Development Survey (RANDS). This report describes the propensity-score adjusted estimates from the second round of RANDS (RANDS 2) using the 2016 National Health Interview Survey (NHIS).

PMID:36409516

JAMA Netw Open. 2022 Nov 1;5(11):e2243127. doi: 10.1001/jamanetworkopen.2022.43127.

ABSTRACT

IMPORTANCE: New York City, an early epicenter of the pandemic, invested heavily in its COVID-19 vaccination campaign to mitigate the burden of disease outbreaks. Understanding the return on investment (ROI) of this campaign would provide insights into vaccination programs to curb future COVID-19 outbreaks.

OBJECTIVE: To estimate the ROI of the New York City COVID-19 vaccination campaign by estimating the tangible direct and indirect costs from a societal perspective.

DESIGN, SETTING, AND PARTICIPANTS: This decision analytical model of disease transmission was calibrated to confirmed and probable cases of COVID-19 in New York City between December 14, 2020, and January 31, 2022. This simulation model was validated with observed patterns of reported hospitalizations and deaths during the same period.

EXPOSURES: An agent-based counterfactual scenario without vaccination was simulated using the calibrated model.

MAIN OUTCOMES AND MEASURES: Costs of health care and deaths were estimated in the actual pandemic trajectory with vaccination and in the counterfactual scenario without vaccination. The savings achieved by vaccination, which were associated with fewer outpatient visits, emergency department visits, emergency medical services, hospitalizations, and intensive care unit admissions, were also estimated. The value of a statistical life (VSL) lost due to COVID-19 death and the productivity loss from illness were accounted for in calculating the ROI.

RESULTS: During the study period, the vaccination campaign averted an estimated $27.96 (95% credible interval [CrI], $26.19-$29.84) billion in health care expenditures and 315 724 (95% CrI, 292 143-340 420) potential years of life lost, averting VSL loss of $26.27 (95% CrI, $24.39-$28.21) billion. The estimated net savings attributable to vaccination were $51.77 (95% CrI, $48.50-$55.85) billion. Every $1 invested in vaccination yielded estimated savings of $10.19 (95% CrI, $9.39-$10.87) in direct and indirect costs of health outcomes that would have been incurred without vaccination.

CONCLUSIONS AND RELEVANCE: Results of this modeling study showed an association of the New York City COVID-19 vaccination campaign with reduction in severe outcomes and avoidance of substantial economic losses. This significant ROI supports continued investment in improving vaccine uptake during the ongoing pandemic.

PMID:36409495 | DOI:10.1001/jamanetworkopen.2022.43127

JAMA Netw Open. 2022 Nov 1;5(11):e2243134. doi: 10.1001/jamanetworkopen.2022.43134.

ABSTRACT

IMPORTANCE: Prior studies have revealed gender differences in the milestone and clinical competency committee assessment of emergency medicine (EM) residents.

OBJECTIVE: To explore gender disparities and the reasons for such disparities in the narrative comments from EM attending physicians to EM residents.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter qualitative analysis examined 10 488 narrative comments among EM faculty and EM residents between 2015 to 2018 in 5 EM training programs in the US. Data were analyzed from 2019 to 2021.

MAIN OUTCOMES AND MEASURES: Differences in narrative comments by gender and study site. Qualitative analysis included deidentification and iterative coding of the data set using an axial coding approach, with double coding of 20% of the comments at random to assess intercoder reliability (κ, 0.84). The authors reviewed the unmasked coded data set to identify emerging themes. Summary statistics were calculated for the number of narrative comments and their coded themes by gender and study site. χ2 tests were used to determine differences in the proportion of narrative comments by gender of faculty and resident.

RESULTS: In this study of 283 EM residents, of whom 113 (40%) identified as women, and 277 EM attending physicians, of whom 95 (34%) identified as women, there were notable gender differences in the content of the narrative comments from faculty to residents. Men faculty, compared with women faculty, were more likely to provide either nonspecific comments (115 of 182 [63.2%] vs 40 of 95 [42.1%]), or no comments (3387 of 10 496 [32.3%] vs 1169 of 4548 [25.7%]; P < .001) to men and women residents. Compared with men residents, more women residents were told that they were performing below level by men and women faculty (36 of 113 [31.9%] vs 43 of 170 [25.3%]), with the most common theme including lack of confidence with procedural skills.

CONCLUSIONS AND RELEVANCE: In this qualitative study of narrative comments provided by EM attending physicians to residents, multiple modifiable contributors to gender disparities in assessment were identified, including the presence, content, and specificity of comments. Among women residents, procedural competency was associated with being conflated with procedural confidence. These findings can inform interventions to improve parity in assessment across graduate medical education.

PMID:36409494 | DOI:10.1001/jamanetworkopen.2022.43134

JAMA Netw Open. 2022 Nov 1;5(11):e2243201. doi: 10.1001/jamanetworkopen.2022.43201.

ABSTRACT

IMPORTANCE: In the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial, there was a significant reduction in the adjudicated primary outcome among patients with stable atherosclerotic vascular disease randomized to dual pathway inhibition (rivaroxaban 2.5 mg twice daily plus aspirin 100 mg daily) vs aspirin monotherapy, but not with rivaroxaban 5 mg twice daily vs aspirin monotherapy. Whether the results are similar without adjudication is unknown.

OBJECTIVE: To examine the impact of dual pathway inhibition (with rivaroxaban plus aspirin) or rivaroxaban monotherapy compared with aspirin monotherapy on investigator-reported CV events and to understand the extent of concordance between investigator-reported and centrally adjudicated clinical events.

DESIGN, SETTING, AND PARTICIPANTS: This is a secondary analysis of the COMPASS trial, an international, double-blind, double-dummy, randomized clinical trial with a 3-by-2 partial factorial design that evaluated participants with stable atherosclerotic vascular disease receiving rivaroxaban plus aspirin, rivaroxaban monotherapy, or aspirin monotherapy. End points were collected by blinded site investigators and adjudicated by a blinded clinical end point committee. Data were analyzed from March 2013 through February 2017.

INTERVENTIONS: Participants received dual inhibition pathway (2.5 mg rivaroxaban twice daily plus 100 mg aspirin once daily), rivaroxaban monotherapy (5 mg twice daily), or aspirin monotherapy (100 mg once daily).

MAIN OUTCOMES AND MEASURES: The primary efficacy outcome was a composite of cardiovascular (CV) death, stroke, or myocardial infarction (MI). Adjudicated and investigator-reported end points were compared.

RESULTS: A total of 27 395 patients (mean [SD] age, 68.2 [7.9] years; 78.0% men) were assessed, including 9152 patients randomized to dual pathway inhibition, 9117 patients randomized to rivaroxaban monotherapy, and 9126 patients randomized to aspirin monotherapy. Adjudication reduced the number of events by 10% to 15% for most end points. Among investigator-reported end points, dual pathway inhibition significantly reduced the rate of the primary efficacy outcome compared with aspirin alone (411 patients [4.5%] vs 542 patients [5.9%]; hazard ratio [HR], 0.75 [95% CI, 0.66-0.85]; P < .001), with similar reduction in adjudicated end points, (379 patients [4.1%] vs 496 patients [5.4%]; HR, 0.76 [95% CI, 0.66-0.86]; P < .001). Likewise, effects on ischemic end points were highly concordant (κ statistic = 0.94 [95% CI, 0.93-0.95] for the primary composite end point). Unlike with adjudicated outcomes, there was a significant reduction in the primary end point with rivaroxaban monotherapy vs aspirin monotherapy using investigator-reported events (477 patients [5.2%] vs 542 patients [5.9%]; HR, 0.88 [95% CI, 0.78-0.99]; P = .04) compared with adjudicated events (448 patients [4.9%] vs 496 patients [5.4%]; HR, 0.90 [95% CI, 0.79-1.03]; P = .12).

CONCLUSIONS AND RELEVANCE: This secondary analysis of the COMPASS trial found that whether assessed by blinded site investigators or adjudicators, dual pathway inhibition significantly reduced CV events among patients with stable atherosclerotic disease compared with aspirin plus placebo. These findings suggest that using investigator-reported events in blinded clinical trials may be a more efficient alternative to adjudication.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01776424.

PMID:36409491 | DOI:10.1001/jamanetworkopen.2022.43201

Diabetes Technol Ther. 2022 Nov 21. doi: 10.1089/dia.2022.0419. Online ahead of print.

ABSTRACT

BACKGROUND: The majority of individuals referred to diabetes self-management education and support (DSMES) programs do not access this resource. Of those who do, attrition is high, with anecdotal reports pointing to the didactic and impersonal nature of these programs contributing to low utilization and completion rates. In an effort to develop a more engaging form of DSMES for adults with type 2 diabetes (T2D), we constructed a non-didactic, “discovery learning”-based DSMES program centered on real-time flash glucose monitoring (FGM).

METHODS: In this single-arm pilot study, 35 adults with T2D duration 1 – 5 years, ages 21 – 75 years, not using insulin and HbA1c >8.0% were introduced to FGM and participated in five weekly group sessions. DSMES content was personalized, emerging from the concerns and questions arising from participants’ FGM discoveries. The primary outcome was glycemic change as assessed by blinded FGM at baseline and month 3. Secondary outcomes included psychosocial and behavioral measures.

RESULTS: There was a significant gain in % TIR 70 -180 mg/dL from baseline (55%) to month 3 (74%), and a parallel drop in TAR > 180 mg/dL from 44% to 25% (ps = 0.01). Overall well-being rose significantly (p = 0.04), while diabetes distress showed a non-significant drop. Participants reported improvements in healthy eating (p < 0.001) and physical activity, though the latter did not reach statistical significance.

CONCLUSIONS: These findings support a new approach to DSMES, a method that integrates FGM with a highly interactive and engaging, patient-driven, “discovery learning” approach to education.

PMID:36409486 | DOI:10.1089/dia.2022.0419

JAMA Intern Med. 2022 Nov 21. doi: 10.1001/jamainternmed.2022.5268. Online ahead of print.

NO ABSTRACT

PMID:36409473 | DOI:10.1001/jamainternmed.2022.5268

CJEM. 2022 Nov 21. doi: 10.1007/s43678-022-00411-z. Online ahead of print.

NO ABSTRACT

PMID:36409448 | DOI:10.1007/s43678-022-00411-z