Tag: statistics

JAMA Pediatr. 2024 Dec 2. doi: 10.1001/jamapediatrics.2024.5049. Online ahead of print.

ABSTRACT

IMPORTANCE: Particulate matter exposure has been linked to impaired respiratory health in children, but the respiratory benefits of air purification have not been fully elucidated.

OBJECTIVES: To assess the respiratory health outcomes among children exposed to multisetting air purification vs sham purification.

DESIGN, SETTING, AND PARTICIPANTS: This cluster randomized, double-blind, crossover trial was conducted among healthy school-aged children (10-12 years) in China from April to December 2021. Data were analyzed from December 2021 to July 2024.

INTERVENTIONS: A multisetting (both in classrooms and bedrooms) air purification intervention compared with sham purification in a 2-stage intervention with more than 2 months (76 days) for each period and a washout period (88 days) to estimate the respiratory benefits of air purification.

MAIN OUTCOMES AND MEASURES: The primary outcomes were pulmonary function, airway inflammation markers, and metabolites in exhaled breath condensate (EBC) before and after the air purification intervention. Linear mixed-effects models were used to estimate the respiratory benefits of children related to air purification. Differential metabolites in EBC were identified using metabolomics analysis to explore their possible mediation roles.

RESULTS: A total of 79 children (38 male [48%]; mean [SD] age, 10.3 [0.5] years) were included in the statistical analyses. During the study period, the mean (SD) concentration of outdoor fine particulate matter (PM2.5) at the school site was 32.53 (24.06) μg/m3. The time-weighted personal PM2.5 concentration decreased by 45.14% during the true air purification period (mean [SD], 21.49 [8.72] μg/m3) compared with the sham air purification period (mean [SD], 39.17 [14.25] μg/m3). Air purification improved forced expiratory volume in 1 second by 8.04% (95% CI, 2.15%-13.93%), peak expiratory flow by 16.52% (95% CI, 2.76%-30.28%), forced vital capacity (FVC) by 5.73% (95% CI, 0.48%-10.98%), forced expiratory flow at 25% to 75% of FVC by 17.22% (95% CI, 3.78%-30.67%), maximal expiratory flow at 75% of FVC by 14.60% (95% CI, 0.35%-28.85%), maximal expiratory flow at 50% of FVC by 17.86% (95% CI, 3.65%-32.06%), and maximal expiratory flow at 25% of FVC by 18.22% (95% CI, 1.73%-34.70%). Fractional exhaled nitric oxide in the true air purification group decreased by 22.38% (95% CI, 2.27%-42.48%). Several metabolites in EBC (eg, L-tyrosine and β-alanine) were identified to mediate the effect of air purification on respiratory health.

CONCLUSIONS AND RELEVANCE: This randomized clinical trial provides robust and holistic evidence that indoor air purification notably improved pulmonary health in children, highlighting the importance of intensified indoor air purification in regions with high air pollution levels.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04835337.

PMID:39621320 | DOI:10.1001/jamapediatrics.2024.5049

Folia Microbiol (Praha). 2024 Dec 2. doi: 10.1007/s12223-024-01227-3. Online ahead of print.

ABSTRACT

The physicochemistry, metabolic properties, and microbial community structure of a tropical estuary persistently inundated with anthropogenic pollutants were elucidated using diverse analytical tools and a shotgun metagenomics approach. The physicochemistry of the Awoye estuary surface water (AEW) and sediment (AES) revealed higher values in the sediment for most of the parameters analyzed, while aside from copper and zinc, the concentrations of the detected heavy metals (Cd, Cr, Pb, Fe, As, Ni, Hg, Mn, Se) in the water and sediment were higher than the acceptable thresholds. Hydrocarbon content analysis revealed increasingly high concentrations of high molecular weight polycyclic aromatic hydrocarbons (HMW PAHs) in the sediment. Structurally, the predominant taxa in the AEW metagenome are Proteobacteria (50.35%), Alphaproteobacteria (43.31%), Brevundimonas (49.96%), and Leptolyngbya boryana (14.93%), while in the sediment (AES) metagenome, Proteobacteria (53.03%), Gammaproteobacteria (28.66%), Azospirillum (6.51%), and Acidihalobacter prosperus (7.56%) were preponderant. Statistical analysis of the two microbiomes (AEW, AES) revealed significant statistical differences (P < 0.05) at all the hierarchical levels. Functional characterization of the two metagenomes revealed extensive adaptations of the sediment microbiome to various environmental stressors as evident in the high numbers of putative genes involved in the degradation of diverse classes of aromatic hydrocarbons, efflux, detoxification, and transport of heavy metals, and metabolism of organic/inorganic nutrients. Findings from this study revealed that the estuary sediment is the sink for most of the anthropogenic pollutants and harbors the more adapted microbiome that could serve as a potential bioresource for the bioremediation of the perturbed estuary.

PMID:39621289 | DOI:10.1007/s12223-024-01227-3

Methods Mol Biol. 2025;2860:65-82. doi: 10.1007/978-1-0716-4160-6_5.

ABSTRACT

Poxviruses are large, complex viruses, and their host species are widespread across the tree of life. As a result, the bioinformatics analysis of their genomes can be complex. Here we show how a few helpful tools and strategies can be used to inform the analysis, leading to a better understanding of the structural properties of poxvirus genomes and to a more accurate quality control of, or comparison between, assembled sequences.

PMID:39621261 | DOI:10.1007/978-1-0716-4160-6_5

J Epidemiol Glob Health. 2024 Dec 2. doi: 10.1007/s44197-024-00332-3. Online ahead of print.

ABSTRACT

INTRODUCTION: Potentially Inappropriate Prescribing (PIP) poses a significant risk to patient safety and associated with poor healthcare outcomes in Gulf Cooperation Council (GCC) countries. This study aimed to assess PIP prevalence and patterns in older adults across all care settings in GCC.

METHODS: A comprehensive search was conducted on six medical databases to identify studies assessing the PIP prevalence in older adults using validated criteria in GCC. Pooled prevalence estimates and odds ratios were calculated using STATA Software (version 16). Statistical heterogeneity was evaluated with the I² statistic, and publication bias was assessed using funnel plot symmetry and Egger’s regression test. The risk of bias was assessed using the JBI Prevalence Critical Appraisal Tool.

RESULTS: Fourteen eligible studies conducted over ten years included 18,647 patients. The median prevalence of PIP was 54.4% (IQR: 37.6-62.1%), higher in hospital settings (59.5%; IQR: 53.7-65.3%) compared to primary care (44.2%; IQR: 18.5-54.4%). Cardiovascular medications were the most common PIP (15,353 occurrences). Polypharmacy was significantly associated with PIP exposure (OR: 5.26; 95% CI: 2.33-11.84). The odds of PIP exposure were significantly increased among older individuals with chronic kidney disease (OR: 1.87; 95% CI: 1.19-2.54) and diabetes (OR: 1.74; 95% CI: 1.18-2.30).

CONCLUSION: This study highlights high PIP prevalence among older adults in GCC countries, particularly in hospital settings. Polypharmacy and certain chronic conditions were significantly associated with PIP exposure. These findings emphasize the need for targeted interventions to improve prescribing practices and medication safety.

PMID:39621251 | DOI:10.1007/s44197-024-00332-3

Fish Physiol Biochem. 2025 Feb;51(1):1-13. doi: 10.1007/s10695-024-01431-5. Epub 2024 Dec 2.

ABSTRACT

The negative effects of global warming also directly affect aquatic populations. Consequences such as evaporation due to chronic temperature increase, increase in salinity, and increase in stock density per unit volume are potential stress factors. While creating the trial design, an attempt was made to simulate the effects of global warming, especially on species living in salty and brackish water biotopes. In this study, changes in the gills of rainbow trout (Oncorhynchus mykiss) acclimated to 0, 20, and 38 ‰ of saline in the laboratory were examined histologically and immunohistochemically and blood serum osmolarity. In addition, the water temperature was changed, and experiments were carried out at 16, 19, and 22 °C for each salinity group in parallel with the increase in salinity. However, to simulate the decrease in water volume and intensive stocking due to the potential impact of climate change, the study was carried out using 15 fishes in low-volume aquariums (45 L). Tap water that had been kept for at least 3 days was used in the aquariums. To protect the water quality, independent aquariums with sponge filters were used, and since the aim was to keep dissolved oxygen low, no ventilation system other than the sponge filter was used. In order to minimize the deterioration in water quality during the trial, a 15% water change was performed by performing a bottom flush every 4 days and water of the same temperature and salinity was added as much as the reduced volume. In addition, since increasing stock density due to temperature increase and water decrease will cause the amount of dissolved oxygen to decrease, pure oxygen was not entered into any tank throughout the experiment, and the concentration was requested to be at a low level (7 ± 0.13 mg/L) in all groups. The trials were terminated at the end of the 71st day. Increased serum osmolarity values were observed due to the increase in salinity, and the highest serum osmolarity value was measured at 644 mOsm/kg in the 38 ‰ salinity group. Differences between the groups were found to be statistically significant (p < 0.05). It was observed that the number of cells containing Na⁺/K⁺-ATPase increased depending on salinity. Also, the number of chloride cells reached the maximum level in the 38 ‰ salinity group. Due to increasing salt levels, an increase in mucus cells, limited onset hyperplasia, aneurysm, lamellar separation, and necrosis were observed in the gill tissue.

PMID:39621246 | DOI:10.1007/s10695-024-01431-5

Emerg Radiol. 2024 Dec 2. doi: 10.1007/s10140-024-02302-5. Online ahead of print.

ABSTRACT

PURPOSE: To assess whether adult trauma center status influences radiology resident performance on trauma cases in the Emergent/Critical Care Imaging SIMulation (WIDI SIM) exam.

MATERIALS AND METHODS: This retrospective study analyzed 29,290 WIDI SIM exam scores from 110 adult trauma cases across 55 radiology residency programs. Residents were categorized by training level-R1 (n = 17,801), R2 (n = 9,136), R3 (n = 1,826), R4 (n = 527)-and by their program’s adult trauma center designation: Level 1 (n = 20,121), Level 2 (n = 1,870), Level 3 (n = 1,029), Level 4 (n = 487), and no trauma designation (n = 5,834). A Generalized Linear Mixed Model with a negative binomial distribution was used to evaluate the effect of trauma center status on resident performance, adjusting for resident level, imaging modality, and case specialty.

RESULTS: After adjusting for confounding variables, there was no statistically significant difference in resident scores based on adult trauma center status (p > 0.05 for all trauma levels compared to no trauma designation). Resident level significantly influenced performance, with higher-level residents scoring better than R1 residents (p < 0.001 for R2-R4). Imaging modality and case specialty also significantly affected scores. Residents performed better on MR, US, and XR modalities compared to CT (p ≤ 0.002), and scored lower on chest, cardiovascular, musculoskeletal, and neuro cases compared to abdominopelvic cases (p < 0.001).

CONCLUSION: Adult trauma center status did not significantly impact radiology resident performance on trauma cases in the WIDI SIM exam. Resident training level, imaging modality, and case specialty were significant factors influencing performance. These findings suggest that resident education and exposure to diverse imaging modalities and specialties are more critical determinants of diagnostic accuracy than the trauma center designation of their training program.

PMID:39621241 | DOI:10.1007/s10140-024-02302-5

Health Care Manag Sci. 2024 Dec 2. doi: 10.1007/s10729-024-09694-3. Online ahead of print.

ABSTRACT

As social and economic conditions are key determinants of HIV, the United States ‘National HIV/AIDS Strategy (NHAS)’, in addition to care and treatment, aims to address mental health, unemployment, food insecurity, and housing instability, as part of its strategic plan for the ‘Ending the HIV Epidemic’ initiative. Although mechanistic models of HIV play a key role in evaluating intervention strategies, social conditions are typically not part of the modeling framework. Challenges include the unavailability of coherent statistical data for social conditions and behaviors. We developed a method, combining undirected graphical modeling with copula methods, to integrate disparate data sources, to estimate joint probability distributions for social conditions and behaviors. We incorporated these in a national-level network model, Progression and Transmission of HIV (PATH 4.0), to simulate behaviors as functions of social conditions and HIV transmissions as a function of behaviors. As a demonstration for the potential applications of such a model, we conducted two hypothetical what-if intervention analyses to estimate the impact of an ideal 100% efficacious intervention strategy. The first analysis modeled care behavior (using viral suppression as proxy) as a function of depression, neighborhood, housing, poverty, education, insurance, and employment status. The second modeled sexual behaviors (number of partners and condom-use) as functions of employment, housing, poverty, and education status, among persons who exchange sex. HIV transmissions and disease progression were then simulated as functions of behaviors to estimate incidence reductions. Social determinants are key drivers of many infectious and non-infectious diseases. Our work enables the development of decision support tools to holistically evaluate the syndemics of health and social inequity.

PMID:39621234 | DOI:10.1007/s10729-024-09694-3

Adv Ther. 2024 Dec 2. doi: 10.1007/s12325-024-03042-1. Online ahead of print.

ABSTRACT

INTRODUCTION: Psoriatic arthritis (PsA) is a chronic, multidomain, inflammatory disease requiring long-term treatment. Guselkumab, a fully human interleukin [IL]-23p19-subunit inhibitor, and the IL-17A inhibitors (IL-17Ai) ixekizumab and secukinumab are approved by the US Food and Drug Administration (FDA) for adults with active PsA. Real-world data evaluating on-label treatment persistence is an important consideration for patients.

METHODS: This retrospective claim-based analysis (IQVIA PharMetrics® Plus) included adults with PsA receiving guselkumab or their first subcutaneous (SC) IL-17Ai (ixekizumab/secukinumab) per FDA label (“on-label”) between July 14, 2020, and June 30, 2022. Baseline demographic and disease characteristics were collected in the 12 months preceding the index date (date of first guselkumab or SC IL-17Ai claim); follow-up extended through the earlier of the end of continuous insurance eligibility or end of data availability. Baseline characteristics were balanced between the cohorts by propensity score weighting (standardized mortality ratio [SMR]). Discontinuation was defined as a gap 2 × the FDA-approved maintenance dosing interval (guselkumab:112 days; SC IL-17Ai: 56 days); on-label persistence in the weighted cohorts was assessed using Kaplan-Meier curves and compared with a Cox proportional hazards model.

RESULTS: Weighted demographic and disease characteristics were well balanced between the cohorts (guselkumab: N = 910, mean age = 50.4 years, 60.4% female; SC IL-17Ai: N = 2740, mean age = 50.2, 59.4% female). At 12 months, the guselkumab cohort was 1.85 × more likely to remain persistent with on-label therapy vs the SC IL-17Ai cohort (p < 0.001); median time to discontinuation was not reached for guselkumab and was 12.3 months for SC IL-17Ai. At 3, 6, 9, and 12 months, persistence rates in the weighted cohorts were higher with guselkumab than with SC IL-17Ai (p < 0.001).

CONCLUSION: In this real-world claims data analysis in adults with PsA, on-label persistence rates were statistically significantly higher with guselkumab, as early as 3 months, with ~ 2 × greater likelihood of persistence at 12 months relative to SC IL-17Ai.

PMID:39621228 | DOI:10.1007/s12325-024-03042-1

Am J Cardiovasc Drugs. 2024 Dec 2. doi: 10.1007/s40256-024-00697-7. Online ahead of print.

ABSTRACT

BACKGROUND: Sodium-glucose cotransporter 2 inhibitors (SGLT2is) have become a first-line therapy for heart failure (HF) in adults. However, data on their use in HF associated with adult congenital heart disease (ACHD) are limited. This systematic review and meta-analysis evaluated the safety, tolerability, and efficacy of SGLT2is in ACHD HF patients, supplementing guideline-directed medical therapy.

METHODS: A comprehensive systematic search and meta-analysis were conducted on studies examining SGLT2i use in ACHD HF patients. The primary endpoint was the change in the New York Heart Association (NYHA) functional class (FC), with secondary endpoints including changes in ventricular function and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels. Additionally, the safety and tolerability of SGLT2is were evaluated.

RESULTS: The meta-analysis included eight studies with 287 patients aged 19-67 years (median age 37.5 years). Adding SGLT2is to combined therapies significantly improved NYHA FC (log odds ratio 1.3, 95% confidence interval [CI] 0.37-2.23, p = 0.01) and reduced NT-proBNP levels (mean difference [MD] -0.43, 95% CI -0.70 to -0.16, p < 0.001). A notable decrease in systolic blood pressure was observed (MD -0.32, 95% CI -0.51 to -0.14, p = 0.00). The adverse effect profile was comparable to that seen in routine HF, with fewer HF hospitalizations post-SGLT2i initiation. Urinary tract infections occurred in 14 patients (5%), with no instances of hypoglycemia or ketoacidosis reported. Medication withdrawal due to adverse effects was noted in 19 patients (7%).

CONCLUSIONS: SGLT2is are well tolerated in ACHD HF patients. Notably, SGLT2is improved NYHA FC and reduced NT-proBNP levels across a diverse ACHD HF patient cohort. However, further prospective, multicenter studies are needed to confirm the safety and efficacy of SGLT2is in this unique patient population.

PMID:39621203 | DOI:10.1007/s40256-024-00697-7

Arch Dermatol Res. 2024 Dec 2;317(1):63. doi: 10.1007/s00403-024-03575-z.

ABSTRACT

Pityriasis versicolor (PV) is a common skin condition associated with Malassezia species. Factors influencing PV development, such as sebum and skin hydration levels, are not fully understood, especially among adolescents. This study aimed to determine Malassezia speciation and assess sebum and hydration levels in secondary school students with PV in Ibadan, Nigeria. A cross-sectional study was conducted among secondary school students with PV and a control group. Sebum and hydration levels were measured using a sebumeter and corneometer, respectively. Malassezia speciation was determined through KOH microscopy and PCR-RFLP. Sebum levels were significantly higher in PV patients compared to controls. Skin hydration was lower in PV patients. Malassezia globosa was the predominant species, followed by Malassezia restricta and Malassezia sympodialis. No significant correlations were found between Malassezia species and clinical features. Increased sebum levels and decreased skin hydration are associated with PV in adolescents. Malassezia globosa is the primary species involved. Further research is needed to elucidate the complex relationship between these factors and PV pathogenesis. Clinical trial number Not applicable.

PMID:39621191 | DOI:10.1007/s00403-024-03575-z