Tag: statistics

Glob Health Sci Pract. 2024 Mar 11. doi: 10.9745/GHSP-D-23-00229. Online ahead of print.

ABSTRACT

BACKGROUND: We describe a 3-tier approach involving a gap analysis, root cause analysis, and pre-exposure prophylaxis (PrEP) collaborative to understand the gap and identify and address the main barriers to oral PrEP uptake and continuity in Uganda.

METHODS: We used a mixed methods design with retrospective, cross-sectional, and prospective components. The gap analysis involved descriptive analysis of PrEP uptake and continuity. The RCA identified the main barriers to initiation and continuity on PrEP among 1,334 clients who declined to start PrEP and 1,266 who missed their appointment but were at risk. The PrEP collaborative tested changes mapped onto specific barriers to optimize the PrEP clinical service delivery. A trend analysis of routinely collected data of the PrEP cascade determined significant shifts and trends in PrEP uptake and continuity.

RESULTS: Only 60% of the high-risk population eligible for PrEP were enrolled, while fewer than 30% of the cumulative number of PrEP users were refilled each quarter. Uncertainty and fear of side effects, perceptions about the harmfulness of the medication, perceived inability to adhere to PrEP, and stigma were the main reasons why clients rejected PrEP. Lack of access to the facility, side effects, pill burden, stigma, perceived low-risk exposure to HIV, and preference of staying at work as opposed to picking up refills affected continuity on PrEP. The collaborative registered statistically significant shifts in PrEP enrollment from 64% to 89% and continuity from 51% to 78% between July 21 and November 22 following the collaborative intervention.

CONCLUSIONS: We recommend using a 3-tier approach for other similar implementation contexts to strengthen PrEP programming, given the marked statistical shift in PrEP uptake and continuity. This begins with understanding the gap and barriers to use among clients, followed by mapping interventions to specific barriers through a quality improvement collaborative.

PMID:38467398 | DOI:10.9745/GHSP-D-23-00229

Neuroimage. 2024 Mar 9:120570. doi: 10.1016/j.neuroimage.2024.120570. Online ahead of print.

ABSTRACT

The brain is a complex, dynamic organ that shows differences in the same subject at various periods. Understanding how brain activity changes across age as a function of the brain networks has been greatly abetted by fMRI. Canonical analysis consists of determining how alterations in connectivity patterns (CPs) of certain regions are affected. An alternative approach is taken here by not considering connectivity but rather features computed from recordings at the regions of interest (ROIs). Using machine learning (ML) we assess how neural signals are altered by and prospectively predictive of age and sex via a methodology that is novel in drawing upon pairwise classification across six decades of subjects’ chronological ages. ML is used to answer the equally important questions of what properties of the computed features are most predictive as well as which brain networks are most affected by aging. It was found that there is decreased differentiation among the neural signals of older subjects that are separated in age by the same number of years as younger subjects. Furthermore, the burstiness of the signals change at different rates between males and females. The findings provide insight into brain aging via an ROI-based analysis, the consideration of several feature groups, and a novel classification-based ML pipeline. There is also a contribution to understanding the effects of data aggregated from different recording centers on the conclusions of fMRI studies.

PMID:38467344 | DOI:10.1016/j.neuroimage.2024.120570

Radiother Oncol. 2024 Mar 9:110220. doi: 10.1016/j.radonc.2024.110220. Online ahead of print.

ABSTRACT

INTRODUCTION: We prospectively evaluated morphologic and functional changes in the carotid arteries of patients treated with unilateral neck radiation therapy (RT) for head and neck cancer.

METHODS: Bilateral carotid artery duplex studies were performed at 0, 3, 6, 12, 18 months and 2, 3, 4, and 5 years following RT. Intima media thickness (IMT); global and regional circumferential, as well as radial strain, arterial elasticity, stiffness, and distensibility were calculated.

RESULTS: Thirty-eight patients were included. A significant difference in the IMT from baseline between irradiated and unirradiated carotid arteries was detected at 18 months (median, 0.073 mm vs -0.003 mm; P = 0.014), which increased at 3 and 4 years (0.128 mm vs 0.013 mm, P = 0.016, and 0.177 mm vs 0.023 mm, P = 0.0002, respectively). A significant transient change was noted in global circumferential strain between the irradiated and unirradiated arteries at 6 months (median difference, -0.89, P = 0.023), which did not persist. No significant differences were detected in the other measures of elasticity, stiffness, and distensibility.

CONCLUSIONS: Functional and morphologic changes of the carotid arteries detected by carotid ultrasound, such as changes in global circumferential strain at 6 months and carotid IMT at 18 months, may be useful for the early detection of radiation-induced carotid artery injury, can guide future research aiming to mitigate carotid artery stenosis, and should be considered for clinical surveillance survivorship recommendations after head and neck RT.

PMID:38467343 | DOI:10.1016/j.radonc.2024.110220

Photodiagnosis Photodyn Ther. 2024 Mar 9:104046. doi: 10.1016/j.pdpdt.2024.104046. Online ahead of print.

ABSTRACT

BACKGROUND: This study explores the intricate connections between choroidal vascular index (CVI) and non-invasive ultrasonographic atherosclerosis predictors, shedding light on the potential links between ocular vascular dynamics and systemic cardiovascular health.

METHODS: We conducted a cross-sectional analysis of 81 participants, assessing CVI, intima-media thickness (IMT), extra-media thickness (EMT), and the PATIMA index. The presence of coronary artery disease (CAD) was also evaluated. Statistical methods included descriptive statistics, t-tests for group comparisons, Spearman correlation analysis, and receiver operating characteristic (ROC) curve analysis.

RESULTS: Our findings revealed that patients with CAD had lower CVI values compared to those without CAD, underscoring a potential association between CVI and CAD. Significant negative correlations were observed between CVI and IMT, EMT, PATIMA, and CAD. ROC curve analysis identified optimal CVI cutoff values for hypertension and CAD detection, showcasing its potential as a diagnostic marker.

DISCUSSION: Our results align with existing literature on ocular vascular changes, supporting the notion that CVI may be a promising indicator of systemic vascular conditions. The study contributes to the broader understanding of the relationships between ocular and cardiovascular health, providing a foundation for future research and clinical applications.

CONCLUSION: The study suggests that CVI holds clinical relevance as a non-invasive marker for identifying systemic conditions, offering insights into the fields of neurology, physical therapy, and rehabilitation. Addressing its limitations, this research encourages further investigation into the multifaceted connections between CVI and atherosclerosis predictors.

PMID:38467337 | DOI:10.1016/j.pdpdt.2024.104046

Math Biosci. 2024 Mar 9:109170. doi: 10.1016/j.mbs.2024.109170. Online ahead of print.

ABSTRACT

Drug resistance is one of the most intractable issues to the targeted therapy for cancer diseases. To explore effective combination therapy schemes, we propose a mathematical model to study the effects of different treatment schemes on the dynamics of cancer cells. Then we characterize the dynamical behavior of the model by finding the equilibrium points and exploring their local stability. Lyapunov functions are constructed to investigate the global asymptotic stability of the model equilibria. Numerical simulations are carried out to verify the stability of equilibria and treatment outcomes using a set of collected model parameters and experimental data on murine colon carcinoma. Simulation results suggest that immunotherapy combined with chemotherapy contributes significantly to the control of tumor growth compared to monotherapy. Sensitivity analysis is performed to identify the importance of model parameters on the variations of model outcomes.

PMID:38467302 | DOI:10.1016/j.mbs.2024.109170

Food Chem Toxicol. 2024 Mar 9:114550. doi: 10.1016/j.fct.2024.114550. Online ahead of print.

ABSTRACT

BACKGROUND: The effect of human 8-Oxoguanine DNA Glycosylase (hOGG1) on exogenous chemicals in esophageal squamous cell carcinoma (ESCC) remain unclear. The study plans to determine hOGG1 expression levels in ESCC and possible interactions with known environmental risk factors in ESCC.

MATERIAL AND METHODS: We analyzed levels of exposure to urinary nitrosamines in volunteers from high and low prevalence areas by GC-MS. And we performed the interaction between hOGG1 gene and nitrosamine disinfection by-products by analyzing hOGG1 gene expression in esophageal tissues.

RESULTS: In ESCC, nitrosamine levels were significantly increased and hOGG1 mRNA expression levels were significantly decreased. There was a statistically significant interaction between reduced hOGG1 mRNA levels and non-tap drinking water sources in ESCC. The apparent indirect association between ESCC and NMEA indicated that 33.4% of the association between ESCC and NMEA was mediated by hOGG1.

CONCLUSION: In populations which exposed to high levels of environmental pollutants NDMA, low expression of hOGG1 may promote the high incidence of esophageal cancer in Huai’an. hOGG1 may be a novel mediator in nitrosamine-induced esophageal tumorigenesis.

PMID:38467300 | DOI:10.1016/j.fct.2024.114550

Urology. 2024 Mar 9:S0090-4295(24)00141-9. doi: 10.1016/j.urology.2023.11.043. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the impact of the recent changes to the urology residency application process on the criteria utilized by residency program directors (PDs) for interview invitations and their perspectives concerning these changes.

METHODS: One hundred thirty-seven urology residency PDs were invited to participate in an anonymous survey to explore interview selection criteria and the impact of the increase in preference signals (PS) per applicant.

RESULTS: Fifty-eight PDs (42.8%) completed the survey. The highest-ranked criteria were letters of recommendation (LoR) and successful sub-internship (sub-I) at the PD’s institution, without statistically significant differences between these two. Gender, ethnicity and medical school prestige were the lowest rated criteria, without significant differences between these three. Compared to before the increase in the number of PS per applicant, 80.7% of PDs reported that not receiving a PS from an applicant this cycle would more negatively impact the chances of offering an interview to that applicant. Moreover, 12.2% stated they would not interview any applicants who did not send a PS. Finally, 62.1% of PDs believed recent changes worsened the process.

CONCLUSION: Recent changes impacted PDs applicant evaluation, with the highest ranked criteria being LoRs and sub-I. Paradoxically, the increase in the number of PS per applicant has increased their importance as applicants are much less likely to receive interview offers from programs they have not signaled. Lastly, most PDs believe changes have worsened the evaluation process.

PMID:38467286 | DOI:10.1016/j.urology.2023.11.043

Clin Res Hepatol Gastroenterol. 2024 Mar 9:102315. doi: 10.1016/j.clinre.2024.102315. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to perform a meta-analysis to evaluate the safety and efficacy of dexmedetomidine versus midazolam for complex digestive endoscopy procedures, with the goal of offering comprehensive clinical evidence.

METHODS: Following predefined inclusion criteria, five databases were systematically searched, with a focus on identifying randomized controlled trials (RCTs) that compared the administration of dexmedetomidine and midazolam during complex digestive endoscopy procedures. The statistical software Stata 15.1 was employed for meticulous data analysis.

RESULTS: Sixteen RCTs were encompassed, involving a total of 1,218 patients. In comparison to the midazolam group, dexmedetomidine administration was associated with a reduced risk of respiratory depression (RR=0.25, 95%CI: 0.11-0.56) and hypoxemia (RR=0.22, 95%CI: 0.12-0.39). Additionally, the dexmedetomidine group exhibited lower incidence rates of choking (RR=0.27, 95%CI: 0.16-0.47), physical movement (RR=0.16, 95%CI: 0.09-0.27), and postoperative nausea and vomiting (RR=0.56,95%CI: 0.34-0.92). Patients and endoscopists in the dexmedetomidine group reported higher levels of satisfaction (patient satisfaction: SMD=0.73, 95%CI: 0.26-1.21; endoscopist satisfaction: SMD=0.84, 95%CI: 0.24-1.44). The incidence of hypotension and anesthesia recovery time did not significantly differ between the two groups (hypotension: RR=1.73,95%CI:0.94-3.20; anesthesia recovery time: SMD=0.02, 95%Cl: 0.44-0.49). It is noteworthy that the administration of dexmedetomidine was associated with a significant increase in the incidence of bradycardia in patients.

CONCLUSION: Compared to midazolam, dexmedetomidine exhibits a favorable safety profile for use in complex gastrointestinal endoscopy by significantly reducing the risk of respiratory depression and hypoxemia. Despite this, dexmedetomidine is associated with a higher incidence of bradycardia. These findings underscore the need for further research through larger, multi-center studies to thoroughly investigate dexmedetomidine’s safety and efficacy.

PMID:38467278 | DOI:10.1016/j.clinre.2024.102315

Magn Reson Imaging. 2024 Mar 9:S0730-725X(24)00064-X. doi: 10.1016/j.mri.2024.03.008. Online ahead of print.

ABSTRACT

OBJECTIVE: This study intended to investigate the feasibility and effectiveness of using clinical magnetic resonance imaging (MRI) radiomics features to predict lymphovascular invasion (LVI) status in breast cancer (BC) patients.

METHODS: A total of 182 BCE patients were retrospectively collected and randomly divided into a training set (n = 127) and a validation set (n = 55) in a 7:3 ratio. Based on pathological examination results, the training set was further divided into LVI group (n = 60) and non-LVI group (n = 67), and the validation set was divided into LVI group (n = 24) and non-LVI group (n = 31). General data and MRI examination indicators were compared. Multivariate logistic regression was utilized to analyze MRI radiomics features and clinically relevant indicators that were significant in the baseline information of patients in training set, independent risk factors were identified, and a logistic regression model was built. The accuracy of logistic model was validated using ROC curves in training and validation sets.

RESULTS: Age, pathohistological classification, tumor length, tumor width, presence or absence of Magnetic Resonance Spectroscopy (MRS) cho peak, presence or absence of spicule sign, peritumoral enhancement, and peritumoral edema were statistically significant (P < 0.05) between the two groups. Multivariate logistic regression analysis presented that spicule and peritumoral edema were independent risk factors for LVI in BC patients (P < 0.05). The ROC curve illustrated that AUC of the logistic regression model in the training set was 0.807 (95%CI: 0.730-0.885) and that in the validation set was 0.837 (95%CI: 0.731-0.944).

CONCLUSION: Radiomics features of spicule sign and peritumoral edema were independent risk factors for LVI in BC patients. A logistic regression model based on these factors, along with age, could accurately predict LVI occurrence in BC patients, providing data support for diagnosis and modeling of LVI in BC patients.

PMID:38467265 | DOI:10.1016/j.mri.2024.03.008

Acta Trop. 2024 Mar 9:107170. doi: 10.1016/j.actatropica.2024.107170. Online ahead of print.

ABSTRACT

Spatial analysis of infectious diseases can play an important role in mapping the spread of diseases and can support policy making at local level. Moreover, identification of disease clusters based on local geography and landscape forms the basis for disease control and prevention. Therefore, this study aimed to examine the spatial-temporal variations, hotspot areas, and potential risk factors of infectious diseases (including Viral Hepatitis, Typhoid and Diarrhea) in Ahmedabad city of India. We used Moran’s I and Local Indicators of Spatial Association (LISA) mapping to detect spatial clustering of diseases. Spatial and temporal regression analysis was used to identify the association between disease incidence and spatial risk factors. The Moran’s I statistics identified presence of positive spatial autocorrelation within the considered diseases, with Moran’s I from 0.09 for typhoid to 0.21 for diarrhea (p<0.001). This indicates a clustering of affected wards for each disease, suggesting that cases were not randomly distributed across the city. LISA mapping demonstrated the clustering of hotspots in central regions of the city, especially towards the east of the river Sabarmati, highlighting key geographical areas with elevated disease risk. The spatial clusters of infectious diseases were consistently associated with slum population density and illiteracy. Furthermore, temporal analysis suggested illiteracy rates could increase risk of viral hepatitis by 13% (95% Confidence Interval (CI): 1.01-1.26) and of diarrhea by 18% (95% CI: 1.07-1.31). Significant inverse association was also seen between viral hepatitis incidence and the distance of wards from rivers. Conclusively, the study highlight the impact of socio-economic gradients, such as slum population density (indicative of poverty) and illiteracy, on the localized transmission of water and foodborne infections. The evident social stratification between impoverished and affluent households emerges as a notable contributing factor and a potential source of differences in the dynamics of infectious diseases in Ahmedabad.

PMID:38467234 | DOI:10.1016/j.actatropica.2024.107170