Tag: statistics

PLoS One. 2023 Jun 29;18(6):e0279610. doi: 10.1371/journal.pone.0279610. eCollection 2023.

ABSTRACT

BACKGROUND: Sub-Saharan Africa faces prolonged COVID-19 related impacts on economic activity, livelihoods and nutrition, with recovery slowed down by lagging vaccination progress.

OBJECTIVE: This study investigated the economic impacts of COVID-19 on food prices, consumption and dietary quality in Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania.

METHODS: We conducted a repeated cross-sectional study using a mobile platform to collect data from July-December, 2021 (round 2). We assessed participants’ dietary intake of 20 food groups over the previous seven days and computed the primary outcome, the Prime Diet Quality Score (PDQS), and Dietary Diversity Score (DDS), with higher scores indicating better quality diets. We used generalized estimating equation (GEE) linear regression models to assess factors associated with diet quality during COVID-19.

RESULTS: Most of the respondents were male and the mean age was 42.4 (±12.5) years. Mean PDQS (±SD) was low at 19.4(±3.8), out of a maximum score of 40 in this study. Respondents (80%) reported higher than expected prices for all food groups. Secondary education or higher (estimate: 0.73, 95% CI: 0.32, 1.15), medium wealth status (estimate: 0.48, 95% CI: 0.14, 0.81), and older age were associated with higher PDQS. Farmers and casual laborers (estimate: -0.60, 95% CI: -1.11, -0.09), lower crop production (estimate: -0.87, 95% CI: -1.28, -0.46) and not engaged in farming (estimate: -1.38, 95% CI: -1.74, -1.02) were associated with lower PDQS.

CONCLUSION: Higher food prices and lower diet quality persisted during the COVID-19 pandemic. Economic and social vulnerability and reliance on markets (and lower agriculture production) were negatively associated with diet quality. Although recovery was evident, consumption of healthy diets remained low. Systematic efforts to address the underlying causes of poor diet quality through transforming food system value chains, and mitigation measures, including social protection programs and national policies are critical.

PMID:37384715 | DOI:10.1371/journal.pone.0279610

PLoS One. 2023 Jun 29;18(6):e0287811. doi: 10.1371/journal.pone.0287811. eCollection 2023.

ABSTRACT

BACKGROUND: Unplanned readmissions after colorectal cancer (CRC) surgery are common, expensive, and result from failure to progress in postoperative recovery. The context of their preventability and extent of predictability remains undefined. This study aimed to define the 30-day unplanned readmission (UR) rate after CRC surgery, identify risk factors, and develop a prediction model with external validation.

METHODS: Consecutive patients who underwent CRC surgery between 2012 and 2017 at Christchurch Hospital were retrospectively identified. The primary outcome was UR within 30 days after index discharge. Statistically significant risk factors were identified and incorporated into a predictive model. The model was then externally evaluated on a prospectively recruited dataset from 2018 to 2019.

RESULTS: Of the 701 patients identified, 15.1% were readmitted within 30 days of discharge. Stoma formation (OR 2.45, 95% CI 1.59-3.81), any postoperative complications (PoCs) (OR 2.27, 95% CI 1.48-3.52), high-grade PoCs (OR 2.52, 95% CI 1.18-5.11), and rectal cancer (OR 2.11, 95% CI 1.48-3.52) were statistically significant risk factors for UR. A clinical prediction model comprised of rectal cancer and high-grade PoCs predicted UR with an AUC of 0.64 and 0.62 on internal and external validation, respectively.

CONCLUSIONS: URs after CRC surgery are predictable and occur within 2 weeks of discharge. They are driven by PoCs, most of which are of low severity and develop after discharge. Atleast 16% of readmissions are preventable by management in an outpatient setting with appropriate surgical expertise. Targeted outpatient follow-up within two weeks of discharge is therefore the most effective transitional-care strategy for prevention.

PMID:37384713 | DOI:10.1371/journal.pone.0287811

PLoS One. 2023 Jun 29;18(6):e0287722. doi: 10.1371/journal.pone.0287722. eCollection 2023.

ABSTRACT

INTRODUCTION: Great improvements in the health of newborns, children, and women in Pakistan are needed. A large body of literature has demonstrated that the majority of maternal, newborn, and child deaths are preventable with essential health strategies including immunization, nutrition interventions, and child health interventions. Despite the importance of these interventions for the health of women and children, access to services continues to be a barrier. Furthermore, demand for services also contributes to low coverage of essential health interventions. Given the emerging threat of COVID-19 coupled with already weak maternal and child health, delivering effective and feasible nutrition and immunization services to communities, and increasing demand and uptake of services is a pressing and important need.

METHODS AND ANALYSIS: This quasi-experimental study aims to improve health service delivery and increase uptake. The study included four main intervention strategies including community mobilization, mobile health teams offering MNCH and immunization services, engagement of the private sector, and testing of a comprehensive health, nutrition, growth, and immunization app, Sehat Nishani, for a period of 12 months. The target group of the project were women of reproductive age (15-49 years) and children under-five. The project was implemented in three union councils (UCs) in Pakistan including Kharotabad-1(Quetta District, Balochistan), Bhana Mari (Peshawar District, Khyber Pakhtunkhwa) and Bakhmal Ahmedzai (Lakki Marwat district, Khyber Pakhtunkhwa). Propensity score matching based on size, location, health facilities, and key health indicators of UC was conducted to identify three matched UCs. A household baseline, midline, endline and close-out assessment will be conducted for evaluating coverage of interventions as well as the knowledge, attitude, and practices of the community in the MNCH and COVID-19 context. Descriptive and inferential statistics will be used to test hypotheses. As well, a detailed cost-effectiveness analysis will be conducted to generate costing data for these interventions to effectively inform policymakers and stakeholder on feasibility of the model. Trial registration: NCT05135637.

PMID:37384671 | DOI:10.1371/journal.pone.0287722

PLoS One. 2023 Jun 29;18(6):e0287567. doi: 10.1371/journal.pone.0287567. eCollection 2023.

ABSTRACT

Analyzing temporal and spatial distributions of airborne particles of biological origins is vital for the assessment and monitoring of air quality, especially with regard to public health, environmental ecology, and atmospheric chemistry. However, the analysis is frequently impeded by the low levels of biomass in the air, especially with metagenomic DNA analysis to explore diversity and composition of living organisms and their components in the air. To obtain sufficient amounts of metagenomic DNA from bioaerosols, researchers usually need a long sampling time with an expensive high-volume air sampler. This work shows the utilization of an air sampling device containing an economical, high-volume portable ventilation fan in combination with customized multi-sheet filter holders to effectively obtain high yields of genomic DNA in a relatively short time. The device, named ‘AirDNA’ sampler, performed better than other commercial air samplers, including MD8 Airport and Coriolis compact air samplers. Using the AirDNA sampler, an average DNA yield of 40.49 ng (12.47-23.24 ng at 95% CI) was obtained in only 1 hour of air sampling with a 0.85 probability of obtaining ≥10 ng of genomic DNA. The genomic DNA obtained by the AirDNA system is of suitable quantity and quality to be further used for amplicon metabarcoding sequencing of 16S, 18S, and cytochrome c oxidase I (COI) regions, indicating that it can be used to detect various prokaryotes and eukaryotes. Our results showed the effectiveness of our AirDNA sampling apparatus with a simple setup and affordable devices to obtain metagenomic DNA for short-term or long-term spatiotemporal analysis. The technique is well suited for monitoring air in built environments, especially monitoring bioaerosols for health purposes and for fine-scale spatiotemporal environmental studies.

PMID:37384659 | DOI:10.1371/journal.pone.0287567

PLoS One. 2023 Jun 29;18(6):e0287286. doi: 10.1371/journal.pone.0287286. eCollection 2023.

ABSTRACT

In today’s society, citizens’ ecological literacy (ecoliteracy) is critical for their understanding of sustainable development. This study used a questionnaire designed to quantitatively assess ecoliteracy from a linguistic ecology perspective. First, an underlying mechanism model for ecoliteracy was designed based on the results of previous studies. Then, the ecoliteracy level assessment scores of Guiyang inhabitants were combined with the respondents’ corresponding lifestyle characteristics to explore the effectiveness of interventions in affecting the participants’ ecoliteracy levels. The results showed that the formation and development of ecoliteracy is a dynamic and circular process that revolves around variables of independent, dependent, mediating, moderating and control. The various factors in the model interact and operate evenly along a particular path. As for the level of lifestyle characteristics, participants’ ecoliteracy levels had a statistically significant relationship with their attitudes regarding the importance of nature, participating in outdoor activities, and improving their ecoliteracy levels; as well as the frequencies regarding daily outdoor activity, the main activities in ecological areas, participation in volunteer activities, and use of ecological knowledge. The respondents with the highest levels of ecoliteracy had the most positive attitudes and engaged in ecological actions with the highest frequency. The lifestyle intervention features here are of great significance to the harmonious coexistence between humans and the natural environment and are also helpful for improving human health.

PMID:37384656 | DOI:10.1371/journal.pone.0287286

PLoS One. 2023 Jun 29;18(6):e0288054. doi: 10.1371/journal.pone.0288054. eCollection 2023.

ABSTRACT

OBJECTIVE: Lateral temporal lobe epilepsy (LTLE) has been diagnosed in only a small number of patients; therefore, its surgical outcome is not as well-known as that of mesial temporal lobe epilepsy. We aimed to evaluate the long-term (5 years) and short-term (2 years) surgical outcomes and identify possible prognostic factors in patients with LTLE.

METHODS: This retrospective cohort study was conducted between January 1995 and December 2018 among patients who underwent resective surgery in a university-affiliated hospital. Patients were classified as LTLE if ictal onset zone was in lateral temporal area. Surgical outcomes were evaluated at 2 and 5 years. We subdivided based on outcomes and compared clinical and neuroimaging data including cortical thickness between two groups.

RESULTS: Sixty-four patients were included in the study. The mean follow-up duration after the surgery was 8.4 years. Five years after surgery, 45 of the 63 (71.4%) patients achieved seizure freedom. Clinically and statistically significant prognostic factors for postsurgical outcomes were the duration of epilepsy before surgery and focal cortical dysplasia on postoperative histopathology at the 5-year follow-up. Optimal cut-off point for epilepsy duration was eight years after the seizure onset (odds ratio 4.375, p-value = 0.0214). Furthermore, we propose a model for predicting seizure outcomes 5 years after surgery using the receiver operating characteristic curve and nomogram (area under the curve = 0.733; 95% confidence interval, 0.588-0.879). Cortical thinning was observed in ipsilateral cingulate gyrus and contralateral parietal lobe in poor surgical group compared to good surgical group (p-value < 0.01, uncorrected).

CONCLUSIONS: The identified predictors of unfavorable surgical outcomes may help in selecting optimal candidates and identifying the optimal timing for surgery among patients with LTLE. Additionally, cortical thinning was more extensive in the poor surgical group.

PMID:37384651 | DOI:10.1371/journal.pone.0288054

PLoS One. 2023 Jun 29;18(6):e0287301. doi: 10.1371/journal.pone.0287301. eCollection 2023.

ABSTRACT

Recent advancements in computer vision and neural networks have facilitated the medical imaging survival analysis for various medical applications. However, challenges arise when patients have multiple images from multiple lesions, as current deep learning methods provide multiple survival predictions for each patient, complicating result interpretation. To address this issue, we developed a deep learning survival model that can provide accurate predictions at the patient level. We propose a deep attention long short-term memory embedded aggregation network (DALAN) for histopathology images, designed to simultaneously perform feature extraction and aggregation of lesion images. This design enables the model to efficiently learn imaging features from lesions and aggregate lesion-level information to the patient level. DALAN comprises a weight-shared CNN, attention layers, and LSTM layers. The attention layer calculates the significance of each lesion image, while the LSTM layer combines the weighted information to produce an all-encompassing representation of the patient’s lesion data. Our proposed method performed better on both simulated and real data than other competing methods in terms of prediction accuracy. We evaluated DALAN against several naive aggregation methods on simulated and real datasets. Our results showed that DALAN outperformed the competing methods in terms of c-index on the MNIST and Cancer dataset simulations. On the real TCGA dataset, DALAN also achieved a higher c-index of 0.803±0.006 compared to the naive methods and the competing models. Our DALAN effectively aggregates multiple histopathology images, demonstrating a comprehensive survival model using attention and LSTM mechanisms.

PMID:37384648 | DOI:10.1371/journal.pone.0287301

JMIR Mhealth Uhealth. 2023 Jun 29;11:e44585. doi: 10.2196/44585.

ABSTRACT

BACKGROUND: Digital therapeutic care (DTC) programs are unsupervised app-based treatments that provide video exercises and educational material to patients with nonspecific low back pain during episodes of pain and functional disability. German statutory health insurance can reimburse DTC programs since 2019, but evidence on efficacy and reasonable pricing remains scarce. This paper presents a probabilistic sensitivity analysis (PSA) to evaluate the efficacy and cost-utility of a DTC app against treatment as usual (TAU) in Germany.

OBJECTIVE: The aim of this study was to perform a PSA in the form of a Monte Carlo simulation based on the deterministic base case analysis to account for model assumptions and parameter uncertainty. We also intend to explore to what extent the results in this probabilistic analysis differ from the results in the base case analysis and to what extent a shortage of outcome data concerning quality-of-life (QoL) metrics impacts the overall results.

METHODS: The PSA builds upon a state-transition Markov chain with a 4-week cycle length over a model time horizon of 3 years from a recently published deterministic cost-utility analysis. A Monte Carlo simulation with 10,000 iterations and a cohort size of 10,000 was employed to evaluate the cost-utility from a societal perspective. Quality-adjusted life years (QALYs) were derived from Veterans RAND 6-Dimension (VR-6D) and Short-Form 6-Dimension (SF-6D) single utility scores. Finally, we also simulated reducing the price for a 3-month app prescription to analyze at which price threshold DTC would result in being the dominant strategy over TAU in Germany.

RESULTS: The Monte Carlo simulation yielded on average a €135.97 (a currency exchange rate of EUR €1=US $1.069 is applicable) incremental cost and 0.004 incremental QALYs per person and year for the unsupervised DTC app strategy compared to in-person physiotherapy in Germany. The corresponding incremental cost-utility ratio (ICUR) amounts to an additional €34,315.19 per additional QALY. DTC yielded more QALYs in 54.96% of the iterations. DTC dominates TAU in 24.04% of the iterations for QALYs. Reducing the app price in the simulation from currently €239.96 to €164.61 for a 3-month prescription could yield a negative ICUR and thus make DTC the dominant strategy, even though the estimated probability of DTC being more effective than TAU is only 54.96%.

CONCLUSIONS: Decision-makers should be cautious when considering the reimbursement of DTC apps since no significant treatment effect was found, and the probability of cost-effectiveness remains below 60% even for an infinite willingness-to-pay threshold. More app-based studies involving the utilization of QoL outcome parameters are urgently needed to account for the low and limited precision of the available QoL input parameters, which are crucial to making profound recommendations concerning the cost-utility of novel apps.

PMID:37384379 | DOI:10.2196/44585

Am J Respir Crit Care Med. 2023 Jun 29. doi: 10.1164/rccm.202210-1947OC. Online ahead of print.

ABSTRACT

RATIONALE: Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease for which novel therapies are needed. External controls (ECs) could enhance IPF trial efficiency, though the direct comparability of ECs to concurrent controls is unknown.

OBJECTIVES: To develop IPF ECs by fit for purpose data standards to historical randomized clinical trial (RCT), multicenter registry (Pulmonary Fibrosis Foundation Patient Registry [PFF-PR]), and electronic health record (EHR) data and to evaluate endpoint comparability among ECs and the BMS-986020 phase 2 RCT.

METHODS: After data curation, the rate of change in forced vital capacity (FVC) from baseline to 26 weeks among participants receiving BMS-986020 600 mg twice daily was compared with the BMS-placebo arm and ECs using mixed effects models with inverse probability weights.

MEASUREMENTS AND MAIN RESULTS: At 26 weeks, the rate of change in FVC was -32.71 mL (BMS-986020) versus -130.09 mL (BMS-placebo; difference, 97.4 mL, 95% CI, 24.6, 170.2), replicating the original BMS-986020 RCT. RCT-ECs showed treatment effect point estimates within the 95% CI of the original BMS-986020 RCT. Both PFF-PR-ECs and EHR-ECs experienced a slower rate of FVC decline compared with the BMS-placebo arm, resulting in treatment effect point estimates outside of the 95% CI of the original BMS-986020 RCT.

CONCLUSIONS: IPF ECs generated from historical RCT placebo arms result in comparable primary treatment effects to that of the original clinical trial, while ECs from real-world data sources, including registry or EHR data, do not. RCT-ECs may serve as a potentially useful supplement to future IPF RCTs.

PMID:37384378 | DOI:10.1164/rccm.202210-1947OC