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Nevin Manimala Statistics

Differences in target estimands between different propensity score-based weights

Pharmacoepidemiol Drug Saf. 2023 May 19. doi: 10.1002/pds.5639. Online ahead of print.

ABSTRACT

PURPOSE: Propensity score weighting is a popular approach for estimating treatment effects using observational data. Different sets of propensity score-based weights have proposed, including inverse probability of treatment (IPT) weights whose target estimand is the average treatment effect (ATE), weights whose target estimand is the average treatment effect in the treated (ATT), and, more recently, matching weights, overlap weights, and entropy weights. These latter three sets of weights focus on estimating the effect of treatment in those subjects for whom there is clinical equipoise. We conducted a series of simulations to explore differences in the value of the target estimands for these five sets of weights when the difference in means is the measure of treatment effect.

METHODS: We considered 648 scenarios defined by different values of the prevalence of treatment, the c-statistic of the propensity score model, the correlation between the linear predictors for treatment selection and the outcome, and by the magnitude of the interaction between treatment status and the linear predictor for the outcome in the absence of treatment.

RESULTS: We found that, when the prevalence of treatment was low or high and the c-statistic of the propensity score model was moderate to high, that matching weights, overlap weights, and entropy weights had target estimands that differed meaningfully from the target estimand of the ATE weights.

CONCLUSIONS: Researchers using matching weights, overlap weights, and entropy weights should not assume that the estimated treatment effect is comparable to the ATE. This article is protected by copyright. All rights reserved.

PMID:37208837 | DOI:10.1002/pds.5639

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Nevin Manimala Statistics

Developing time management with preclinical dental students via a preclinical exercise in an organization

J Dent Educ. 2023 May 19. doi: 10.1002/jdd.13246. Online ahead of print.

ABSTRACT

PURPOSE/OBJECTIVES: Developing time management is an important aspect of a dental student’s passage to clinical care and in their growth as a professional. Suitable time management and preparedness can potentially impact the prognosis of a successful dental appointment. The objective of this study was to determine if a time management exercise could be effective to increase students’ preparedness, organization, time management, and reflection during simulated clinical care prior to transitioning to the dental clinic.

METHODS: Students completed five-time management exercises during the term preceding their entrance into the predoctoral restorative clinic which included appointment planning and organization, and reflection once finished. Pre- and post-term surveys were used to determine the impact of the experience. Quantitative data was analyzed using a paired t-test and the qualitative data was thematically coded by the researchers.

RESULTS: Students reported a statistically significant increase in their self-confidence of clinical readiness after completion of the time management series, and all students completed the surveys. The themes indicated by students through their comments in the post-survey question regarding the experience were as follows: planning and preparation, time management, the practice of procedures, concern about workload, faculty encouragement, and unclear. Most students also reported the exercise to be beneficial for their predoctoral clinical appointments.

CONCLUSIONS: It was determined that the time management exercises were effective for the students as they transitioned to treating patients in the predoctoral clinic and can be used for future classes to increase their success.

PMID:37208799 | DOI:10.1002/jdd.13246

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Nevin Manimala Statistics

Interpretable Machine Learning Models for Phase Prediction in Polymerization-Induced Self-Assembly

J Chem Inf Model. 2023 May 19. doi: 10.1021/acs.jcim.3c00460. Online ahead of print.

ABSTRACT

While polymerization-induced self-assembly (PISA) has become a preferred synthetic route toward amphiphilic block copolymer self-assemblies, predicting their phase behavior from experimental design is extremely challenging, requiring time and work-intensive creation of empirical phase diagrams whenever self-assemblies of novel monomer pairs are sought for specific applications. To alleviate this burden, we develop here the first framework for a data-driven methodology for the probabilistic modeling of PISA morphologies based on a selection and suitable adaption of statistical machine learning methods. As the complexity of PISA precludes generating large volumes of training data with in silico simulations, we focus on interpretable low variance methods that can be interrogated for conformity with chemical intuition and that promise to work well with only 592 training data points which we curated from the PISA literature. We found that among the evaluated linear models, generalized additive models, and rule and tree ensembles, all but the linear models show a decent interpolation performance with around 0.2 estimated error rate and 1 bit expected cross entropy loss (surprisal) when predicting the mixture of morphologies formed from monomer pairs already encountered in the training data. When considering extrapolation to new monomer combinations, the model performance is weaker but the best model (random forest) still achieves highly nontrivial prediction performance (0.27 error rate, 1.6 bit surprisal), which renders it a good candidate to support the creation of empirical phase diagrams for new monomers and conditions. Indeed, we find in three case studies that, when used to actively learn phase diagrams, the model is able to select a smart set of experiments that lead to satisfactory phase diagrams after observing only relatively few data points (5-16) for the targeted conditions. The data set as well as all model training and evaluation codes are publicly available through the GitHub repository of the last author.

PMID:37208794 | DOI:10.1021/acs.jcim.3c00460

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Nevin Manimala Statistics

Measuring cognitively demanding activities in pediatric out-of-hospital cardiac arrest

Adv Simul (Lond). 2023 May 19;8(1):15. doi: 10.1186/s41077-023-00253-4.

ABSTRACT

BACKGROUND: This methodological intersection article demonstrates a method to measure cognitive load in clinical simulations. Researchers have hypothesized that high levels of cognitive load reduce performance and increase errors. This phenomenon has been studied primarily by experimental designs that measure responses to predetermined stimuli and self-reports that reduce the experience to a summative value. Our goal was to develop a method to identify clinical activities with high cognitive burden using physiologic measures.

METHODS: Teams of emergency medical responders were recruited from local fire departments to participate in a scenario with a shockable pediatric out-of-hospital cardiac arrest (POHCA) patient. The scenario was standardized with the patient being resuscitated after receiving high-quality CPR and 3 defibrillations. Each team had a person in charge (PIC) who wore a functional near-infrared spectroscopy (fNIRS) device that recorded changes in oxygenated and deoxygenated hemoglobin concentration in their prefrontal cortex (PFC), which was interpreted as cognitive activity. We developed a data processing pipeline to remove nonneural noise (e.g., motion artifacts, heart rate, respiration, and blood pressure) and detect statistically significant changes in cognitive activity. Two researchers independently watched videos and coded clinical tasks corresponding to detected events. Disagreements were resolved through consensus, and results were validated by clinicians.

RESULTS: We conducted 18 simulations with 122 participants. Participants arrived in teams of 4 to 7 members, including one PIC. We recorded the PIC’s fNIRS signals and identified 173 events associated with increased cognitive activity. [Defibrillation] (N = 34); [medication] dosing (N = 33); and [rhythm checks] (N = 28) coincided most frequently with detected elevations in cognitive activity. [Defibrillations] had affinity with the right PFC, while [medication] dosing and [rhythm checks] had affinity with the left PFC.

CONCLUSIONS: FNIRS is a promising tool for physiologically measuring cognitive load. We describe a novel approach to scan the signal for statistically significant events with no a priori assumptions of when they occur. The events corresponded to key resuscitation tasks and appeared to be specific to the type of task based on activated regions in the PFC. Identifying and understanding the clinical tasks that require high cognitive load can suggest targets for interventions to decrease cognitive load and errors in care.

PMID:37208778 | DOI:10.1186/s41077-023-00253-4

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Nevin Manimala Statistics

The association of QTc prolongation with cardiovascular events in cancer patients taking tyrosine kinase inhibitors (TKIs)

Cardiooncology. 2023 May 19;9(1):25. doi: 10.1186/s40959-023-00178-x.

ABSTRACT

OBJECTIVE: To investigate the association between stages of QTc prolongation and the risk of cardiac events among patients on TKIs.

METHODS: This was a retrospective cohort study performed at an academic tertiary care center of cancer patients who were taking TKIs or not taking TKIs. Patients with two recorded ECGs between January 1, 2009, and December 31, 2019, were selected from an electronic database. The QTc duration > 450ms was determined as prolonged. The association between QTc prolongation progression and events of cardiovascular disease were compared.

RESULTS: This study included a total of 451 patients with 41.2% of patients taking TKIs. During a median follow up period of 3.1 years, 49.5% subjects developed CVD and 5.4% subjects suffered cardiac death in patient using TKIs (n = 186); the corresponding rates are 64.2% and 1.2% for patients not on TKIs (n = 265), respectively. Among patient on TKIs, 4.8% of subjects developed stroke, 20.4% of subjects suffered from heart failure (HF) and 24.2% of subjects had myocardial infarction (MI); corresponding incidence are 6.8%, 26.8% and 30.6% in non-TKIs. When patients were regrouped to TKIs versus non-TKIs with and without diabetes, there was no significant difference in the incidence of cardiac events among all groups. Adjusted Cox proportional hazards models were applied to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). There is a significant increased risk of HF events (HR, 95% CI: 2.12, 1.36-3.32) and MI events (HR, 95% CI: 1.78, 1.16-2.73) during the 1st visit. There are also trends for an increased incidence of cardiac adverse events associated with QTc prolongation among patient with QTc > 450ms, however the difference is not statistically significant. Increased cardiac adverse events in patients with QTc prolongation were reproduced during the 2nd visit and the incidence of heart failure was significantly associated with QTc prolongation(HR, 95% CI: 2.94, 1.73-5.0).

CONCLUSION: There is a significant increased QTc prolongation in patients taking TKIs. QTc prolongation caused by TKIs is associated with an increased risk of cardiac events.

PMID:37208762 | DOI:10.1186/s40959-023-00178-x

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Nevin Manimala Statistics

A short-term bioreactor assay to assess the effect of essential oils on a microbiota derived from piglet’s intestinal content

Acta Vet Scand. 2023 May 19;65(1):17. doi: 10.1186/s13028-023-00679-w.

ABSTRACT

BACKGROUND: Modulating the microbiota is an emerging way to improve pig health. In-vitro bioreactor systems can be used to reproduce intestinal microbiota to study modulating avenues. In this study, a continuous feeding system to support a microbiota derived from piglet colonic contents, over 72 h, was developed. The microbiota from piglets was collected and used as inoculum. The culture media was derived from an artificial digestion of piglet feed. The microbiota diversity in time, the reproducibility between replicates and the diversity of the bioreactor microbiota compared to the inoculum was assessed. Essential oils were used as a proof of concept to assess the in vitro microbiota modulation. The microbiota diversity was assessed by 16S rRNA amplicon sequencing. Quantitative PCR was also used for total bacteria, lactobacilli and Enterobacteria.

RESULTS: At the start of the assay, the bioreactor microbiota diversity was similar to the inoculum. Time and replication affected the bioreactor microbiota diversity. Between 48 and 72 h, no statistical variation of the microbiota diversity was observable. After a 48 h running period, thymol and carvacrol were added at 200 ppm or 1000 ppm for 24 h. No microbiota modification was observed by sequencing. Quantitative PCR results showed a significant growth of lactobacilli when thymol was used at 1000 ppm, where only a trend was observed with the 16S analysis.

CONCLUSIONS: This study presents a bioreactor assay that can be used as a tool for rapid screening of additives and suggests that the effects of essential oils on the microbiota are subtle, acting against a few bacterial genera.

PMID:37208761 | DOI:10.1186/s13028-023-00679-w

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Nevin Manimala Statistics

Assessing the role of Piscine orthoreovirus in disease and the associated risk for wild Pacific salmon

BMC Biol. 2023 May 19;21(1):114. doi: 10.1186/s12915-023-01548-8.

ABSTRACT

This paper is a response to Polinski, M. P. et al. Innate antiviral defense demonstrates high energetic efficiency in a bony fish. BMC Biology 19, 138 (2021). https://doi.org/10.1186/s12915-021-01069-2.

PMID:37208758 | DOI:10.1186/s12915-023-01548-8

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Nevin Manimala Statistics

Identifying facilitators and barriers to integrated and equitable care for community-dwelling older adults with high emergency department use from historically marginalized groups

Int J Equity Health. 2023 May 19;22(1):97. doi: 10.1186/s12939-023-01900-y.

ABSTRACT

BACKGROUND: High rates of emergency department (ED) use by older adults persist despite attempts to improve accessibility of appropriate and comprehensive care. Understanding the drivers of ED visits from the perspective of older adults from historically marginalized groups could help reduce ED use by patients with needs that are preventable or could have been treated in a more appropriate setting. This interpretivist, feminist study aims to explore the unmet care needs of older adults (age 65 +) with high ED use and belonging to historically marginalized groups to better understand how social and structural inequities reinforced by neoliberalism; federal and provincial governance structures and policy frameworks; and regional processes and local institutional practices, shape the experiences of these older adults, particularly those at risk of poor health outcomes based on the social determinants of health (SDH).

METHODS/DESIGN: This mixed methods study will employ an integrated knowledge translation (iKT) approach, starting with a quantitative phase followed by a qualitative phase. Older adults self-identifying as belonging to a historically marginalized group, having visited an ED three or more times in the past 12 months, and living in a private dwelling, will be recruited using flyers posted at two emergency care sites and by an on-site research assistant. Data obtained through surveys, short answer questions, and chart review will be used to compile case profiles of patients from historically marginalized groups with potentially avoidable ED visits. Descriptive and inferential statistical analyses and inductive thematic analysis will be conducted. Findings will be interpreted using the Intersectionality-Based Policy Analysis Framework to identify the interconnections between unmet care needs, potentially avoidable ED admissions, structural inequalities, and the SDH. Semi-structured interviews will be conducted with a subset of older adults at risk of poor health outcomes based on SDH, family care partners, and health care professionals to validate preliminary findings and collect additional data on perceived facilitators and barriers to integrated and accessible care.

DISCUSSION: Exploring the linkages between potentially avoidable ED visits by older adults from marginalized groups and how their care experiences have been shaped by inequities in the systems, policies, and institutions that structure health and social care provision will enable researchers to offer recommendations for equity-focused policy and clinical practice reforms to improve patient outcomes and system integration.

PMID:37208757 | DOI:10.1186/s12939-023-01900-y

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Nevin Manimala Statistics

“In some clinics, they said it’s elective, and then they would refuse”: A Mixed-Methods Study on the impact of the COVID-19 pandemic on access to abortion services in Germany

Sex Reprod Healthc. 2023 May 5;36:100854. doi: 10.1016/j.srhc.2023.100854. Online ahead of print.

ABSTRACT

OBJECTIVE: The World Health Organization recognizes abortion as essential health care and has encouraged governments to ensure access to abortion services throughout the COVID-19 pandemic. However, the threat of infection combined with government responses to COVID-19 have impacted access to abortion services globally. This study explores access to abortion in Germany during the pandemic.

METHODS: This study used a mixed-methods design. An analysis of data collected by Women on Web (WoW) was carried out to assess women’s reasons for choosing telemedicine abortion outside the formal health system in Germany during the pandemic. Descriptive statistics were generated for 2057 requests for telemedicine abortion received by WoW between March 2020-March 2021. Semi-structured interviews were conducted with eight healthcare professionals involved in the provision of abortion services to explore how they perceive of women’s access to abortion services in Germany during the pandemic.

RESULTS: The quantitative analysis found that preferences and needs for privacy (47.3%), secrecy (44.4%) and comfort (43.9%) were the most common reasons for choosing telemedicine abortion. COVID-19 was another important reason (38.8%). The thematic analysis of the interviews was organized into two overarching themes: service provision, and axes of difference.

CONCLUSIONS: The pandemic affected the provision of abortion services as well as the circumstances of women seeking abortion. The main barriers to access were financial constraints, privacy issues, and lack of abortion providers. Throughout the pandemic, accessing abortion services was more difficult for many women in Germany, especially women experiencing multiple and overlapping forms of discrimination.

PMID:37207395 | DOI:10.1016/j.srhc.2023.100854

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Nevin Manimala Statistics

Ask questions (ASQ): Implementation of a question prompt list communication intervention in a network of outpatient medical oncology clinics

Patient Educ Couns. 2023 May 12;113:107793. doi: 10.1016/j.pec.2023.107793. Online ahead of print.

ABSTRACT

OBJECTIVE: This descriptive, single-arm study assessed the implementation and patient perceptions of an evidence-based Question Prompt List (QPL), the ASQ brochure, across a network of oncology clinics in a diverse patient population.

METHOD: The QPL was revised in collaboration with stakeholders. Implementation was assessed using the RE-AIM framework. Eligible patients were scheduled for a first appointment with an oncologist at any of eight participating clinics. All participants received the ASQ brochure and completed three surveys: one at baseline, one immediately before, and one following their appointment. Surveys assessed sociodemographic characteristics; communication-related outcomes (perceived knowledge, self-efficacy in interacting with physicians, trust in physicians, distress); and perceptions of the ASQ brochure. Analyses included descriptive statistics and linear mixed-effects models.

RESULTS: Reach: Participants (n = 81) represented the diverse population served by the clinic network.

EFFICACY: All outcomes improved significantly, with no significant differences by clinic site or patient race. Adoption: All eight invited clinics participated and recruited patients. Patient perceptions of the ASQ brochure were overwhelmingly positive.

CONCLUSION: Implementation of the ASQ brochure was successful in this oncology clinic network providing care to a diverse patient population.

PRACTICAL IMPLICATIONS: This evidence-based communication intervention can be implemented widely in similar medical contexts and populations.

PMID:37207383 | DOI:10.1016/j.pec.2023.107793