Tag: statistics

RMD Open. 2023 May;9(2):e003120. doi: 10.1136/rmdopen-2023-003120.

ABSTRACT

BACKGROUND: Ongoing education of health professionals in rheumatology (HPR) is critical for high-quality care. An essential factor is education readiness and a high quality of educational offerings. We explored which factors contributed to education readiness and investigated currently offered postgraduate education, including the European Alliance of Associations for Rheumatology (EULAR) offerings.

METHODS AND PARTICIPANTS: We developed an online questionnaire, translated it into 24 languages and distributed it in 30 European countries. We used natural language processing and the Latent Dirichlet Allocation to analyse the qualitative experiences of the participants as well as descriptive statistics and multiple logistic regression to determine factors influencing postgraduate educational readiness. Reporting followed the Checklist for Reporting Results of Internet E-Surveys guideline.

RESULTS: The questionnaire was accessed 3589 times, and 667 complete responses from 34 European countries were recorded. The highest educational needs were ‘professional development’, ‘prevention and lifestyle intervention’. Older age, more working experience in rheumatology and higher education levels were positively associated with higher postgraduate educational readiness. While more than half of the HPR were familiar with EULAR as an association and the respondents reported an increased interest in the content of the educational offerings, the courses and the annual congress were poorly attended due to a lack of awareness, comparatively high costs and language barriers.

CONCLUSIONS: To promote the uptake of EULAR educational offerings, attention is needed to increase awareness among national organisations, offer accessible participation costs, and address language barriers.

PMID:37230762 | DOI:10.1136/rmdopen-2023-003120

J Neurointerv Surg. 2023 May 25:jnis-2023-020241. doi: 10.1136/jnis-2023-020241. Online ahead of print.

ABSTRACT

BACKGROUND: The presence of blebs increases the rupture risk of intracranial aneurysms (IAs).

OBJECTIVE: To evaluate whether cross-sectional bleb formation models can identify aneurysms with focalized enlargement in longitudinal series.

METHODS: Hemodynamic, geometric, and anatomical variables derived from computational fluid dynamics models of 2265 IAs from a cross-sectional dataset were used to train machine learning (ML) models for bleb development. ML algorithms, including logistic regression, random forest, bagging method, support vector machine, and K-nearest neighbors, were validated using an independent cross-sectional dataset of 266 IAs. The models’ ability to identify aneurysms with focalized enlargement was evaluated using a separate longitudinal dataset of 174 IAs. Model performance was quantified by the area under the receiving operating characteristic curve (AUC), the sensitivity and specificity, positive predictive value, negative predictive value, F1 score, balanced accuracy, and misclassification error.

RESULTS: The final model, with three hemodynamic and four geometrical variables, along with aneurysm location and morphology, identified strong inflow jets, non-uniform wall shear stress with high peaks, larger sizes, and elongated shapes as indicators of a higher risk of focal growth over time. The logistic regression model demonstrated the best performance on the longitudinal series, achieving an AUC of 0.9, sensitivity of 85%, specificity of 75%, balanced accuracy of 80%, and a misclassification error of 21%.

CONCLUSIONS: Models trained with cross-sectional data can identify aneurysms prone to future focalized growth with good accuracy. These models could potentially be used as early indicators of future risk in clinical practice.

PMID:37230750 | DOI:10.1136/jnis-2023-020241

Soc Sci Res. 2023 Jul;113:102829. doi: 10.1016/j.ssresearch.2022.102829. Epub 2022 Nov 18.

ABSTRACT

The question of whether economic recessions increase or decrease the earnings gap between the working and upper-middle class is debated. We study this issue and examine the Great Recession period using two different analytical strategies: three-level multilevel models and multivariate analysis over time. Based on EU Statistics on Income and Living Conditions (EU-SILC) data in 23 countries from 2004 to 2017, our results under both analytical strategies provide robust evidence that, by and large, the Great Recession widened the earnings gap between the working and upper-middle class. The effect magnitude is sizable; an increase of 5 percentage points in the unemployment rate is associated with an increase in the class earnings gap of approximately 0.10 log points.

PMID:37230715 | DOI:10.1016/j.ssresearch.2022.102829

J Nutr. 2022 Dec;152(12):2956-2965. doi: 10.1093/jn/nxac195. Epub 2023 Feb 10.

ABSTRACT

BACKGROUND: The fecal metabolome is affected by diet and includes metabolites generated by human and microbial metabolism. Advances in -omics technologies and analytic approaches have allowed researchers to identify metabolites and better utilize large data sets to generate usable information. One promising aspect of these advancements is the ability to determine objective biomarkers of food intake.

OBJECTIVES: We aimed to utilize a multivariate, machine learning approach to identify metabolite biomarkers that accurately predict food intake.

METHODS: Data were aggregated from 5 controlled feeding studies in adults that tested the impact of specific foods (almonds, avocados, broccoli, walnuts, barley, and oats) on the gastrointestinal microbiota. Fecal samples underwent GC-MS metabolomic analysis; 344 metabolites were detected in preintervention samples, whereas 307 metabolites were detected postintervention. After removing metabolites that were only detected in either pre- or postintervention and those undetectable in ≥80% of samples in all study groups, changes in 96 metabolites relative concentrations (treatment postintervention minus preintervention) were utilized in random forest models to 1) examine the relation between food consumption and fecal metabolome changes and 2) rank the fecal metabolites by their predictive power (i.e., feature importance score).

RESULTS: Using the change in relative concentration of 96 fecal metabolites, 6 single-food random forest models for almond, avocado, broccoli, walnuts, whole-grain barley, and whole-grain oats revealed prediction accuracies between 47% and 89%. When comparing foods with one another, almond intake was differentiated from walnut intake with 91% classification accuracy.

CONCLUSIONS: Our findings reveal promise in utilizing fecal metabolites as objective complements to certain self-reported food intake estimates. Future research on other foods at different doses and dietary patterns is needed to identify biomarkers that can be applied in feeding study compliance and clinical settings.

PMID:37230693 | DOI:10.1093/jn/nxac195

J Nutr. 2022 Dec;152(12):2865-2876. doi: 10.1093/jn/nxac230. Epub 2023 Feb 10.

ABSTRACT

BACKGROUND: Two indexes have been used to describe dietary inflammatory potential: the experiment-based dietary total antioxidant capacity (TAC) and the literature-derived dietary inflammatory index (DII). How robustly each index represents dietary inflammatory potential and the risk of nonalcoholic fatty liver disease (NAFLD) has not yet been established.

OBJECTIVES: We investigated the relation between dietary inflammatory potential and NAFLD, and compared the abilities of the TAC and DII scores to predict NAFLD in US adults.

METHODS: Cross-sectional data from 12,410 participants aged 20-80 y in the NHANES from 2011 to 2018 were identified. TAC and DII scores were calculated using 2 d of 24-h dietary recall data. We examined the association between dietary index and risk of NAFLD using linear and logistic regression models.

RESULTS: Higher energy-adjusted TAC (E-TAC) and inversely energy-adjusted DII (IE-DII) scores (both representing more anti-inflammatory diets) were associated with lower hepatic steatosis index (HSI) and US fatty liver index (USFLI) values after adjusting for potential covariates, and the association for each SD increase in the IE-DII was stronger than the E-TAC (β estimates for HSI: -0.39 compared with -0.25; P-difference = 0.036). In modeling the risk of NAFLD, we observed that participants with IE-DII scores in the highest quartile had the lowest ORs for NAFLD as assessed by either the HSI (OR: 0.77; 95% CI: 0.62, 0.96; P-trend = 0.023) or USFLI (OR: 0.48; 95% CI: 0.35, 0.68; P-trend <0.0001). TAC scores were also associated with NAFLD as assessed by the USFLI.

CONCLUSIONS: An anti-inflammatory diet is beneficial for reducing the risk of NAFLD in US adults. The DII is a stronger predictor of hepatic measures than the TAC, and we recommend that future hepatic health studies use the DII to estimate dietary inflammatory potential.

PMID:37230684 | DOI:10.1093/jn/nxac230

J Nutr. 2022 Dec;152(12):2802-2807. doi: 10.1093/jn/nxac187. Epub 2023 Feb 10.

ABSTRACT

BACKGROUND: Nonesterified fatty acids (NEFAs) play key roles in the pathophysiology of diabetes and cardiovascular disease.

OBJECTIVES: We sought to determine whether macronutrient content differences affect NEFA concentrations in a randomized crossover trial.

METHODS: Total NEFAs were measured from postintervention specimens of participants in the OMNI Heart trial (Optimal Macronutrient Intake Trial to Prevent Heart Disease). OMNI Heart compared 3 healthful diets to evaluate their effect on systolic blood pressure and serum LDL cholesterol: carbohydrate-rich diet (58% carbohydrate); protein-rich diet (25% protein), about half from plant sources; and a diet rich in unsaturated fatty acids (21% unsaturated fat), predominantly monounsaturated. The trial included 164 participants who consumed the 3 diets, each for 6 wk. Data were analyzed from the 156 participants with unthawed serum available from the week 6 visit for all diet periods. We used ANCOVA and generalized estimating equations (GEEs) to compare serum NEFA concentrations across the 3 diet periods.

RESULTS: The mean ± SD age of study participants was 52.9 ± 10.6 y and mean BMI was 30.3 ± 6.1 kg/m². Fifty-five percent of participants were women and 55% were African American. Comparisons of adjusted mean serum NEFA concentrations after each diet intervention identified no statistically significant differences (58% carbohydrate: 0.144 ± 0.083 mEq/L; 25% protein: 0.143 ± 0.076 mEq/L; 21% unsaturated fat: 0.143 ± 0.084 mEq/L; ANCOVA, P = 0.99). Likewise, we observed no significant serum NEFA concentration difference by diet in adjusted GEE models. In adjusted models, serum NEFA concentrations were positively associated, as anticipated, with female sex and higher BMI.

CONCLUSIONS: In this randomized crossover trial, we observed nearly identical serum NEFA concentrations after each of 3 healthful diets, regardless of macronutrient content.

PMID:37230677 | DOI:10.1093/jn/nxac187

J Nutr. 2022 Dec;152(12):2789-2801. doi: 10.1093/jn/nxac168. Epub 2023 Feb 10.

ABSTRACT

BACKGROUND: Dietary supplement (DS) use is widespread in the United States and contributes large amounts of micronutrients to users. Most studies have relied on data from 1 assessment method to characterize the prevalence of DS use. Combining multiple methods enhances the ability to capture nutrient exposures from DSs and examine trends over time.

OBJECTIVES: The objective of this study was to characterize DS use and examine trends in any DS as well as micronutrient-containing (MN) DS use in a nationally representative sample of the US population (≥1 y) from the 2007-2018 NHANES using a combined approach.

METHODS: NHANES obtains an in-home inventory with a frequency-based dietary supplement and prescription medicine questionnaire (DSMQ), and two 24-h dietary recalls (24HRs). Trends in the prevalence of use and selected types of products used were estimated for the population and by sex, age, race/Hispanic origin, family income [poverty-to-income ratio (PIR)], and household food security (food-secure vs. food-insecure) using the DSMQ or ≥ 1 24HR. Linear trends were tested using orthogonal polynomials (significance set at P < 0.05).

RESULTS: DS use increased from 50% in 2007 to 56% in 2018 (P = 0.001); use of MN products increased from 46% to 49% (P = 0.03), and single-nutrient DS (e.g., magnesium, vitamins B-12 and D) use also increased (all P < 0.001). In contrast, multivitamin-mineral use decreased (70% to 56%; P < 0.001). In adults (≥19 y), any (54% to 61%) and MN (49% to 54%) DS use increased, especially in men, non-Hispanic blacks and Hispanics, and low-income adults (PIR ≤130%). In children (1-18 y), any DS use remained stable (∼38%), as did MN use, except for food-insecure children, whose use increased from 24% to 31% over the decade (P = 0.03).

CONCLUSIONS: The prevalence of any and MN DS use increased over time in the United States. This may be partially attributed to increased use of single-nutrient products. Population subgroups differed in their DS use.

PMID:37230676 | DOI:10.1093/jn/nxac168

Carbohydr Polym. 2023 Sep 1;315:120966. doi: 10.1016/j.carbpol.2023.120966. Epub 2023 Apr 29.

ABSTRACT

Deciphering the determinants of starch digestion from multiple interrelated properties is a challenge that can benefit from multifactorial data analysis. The present study investigated the digestion kinetic parameters (rate, final extent) of size-fractions from four commercial wheat starches with different amylose contents. Each size-fraction was isolated and characterized comprehensively using a large range of analytic techniques (FACE, XRD, CP-MAS NMR, time-domain NMR, DSC…). A statistical clustering analysis applied on the results revealed that the mobility of water and starch protons measured by time-domain NMR was consistently related to the macromolecular composition of the glucan chains and to the ultrastructure of the granule. The final extent of starch digestion was determined by the granule structural features. The digestion rate coefficient dependencies, on the other hand, changed significantly with the range of granule size, i.e. the accessible surface for initial binding of α-amylase. The study particularly showed the molecular order and the chains mobility predominantly limiting or accelerating the digestion rate depending on the accessible surface. This result confirmed the need to differentiate between the surface and the inner-granule related mechanisms in starch digestion studies.

PMID:37230611 | DOI:10.1016/j.carbpol.2023.120966

AJNR Am J Neuroradiol. 2023 May 25. doi: 10.3174/ajnr.A7886. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Endovascular treatment of acute ischemic stroke is now performed more frequently in the late window in radiologically selected patients. However, little is known about whether the frequency and clinical impact of incomplete recanalization and postprocedural cerebrovascular complications differ between early and late windows in the real world.

MATERIALS AND METHODS: We retrospectively reviewed all patients with acute ischemic stroke receiving endovascular treatment within 24 hours from 2015 to 2019 and included in the Acute STroke Registry and Analysis of Lausanne. We compared rates of incomplete recanalization and postprocedural cerebrovascular complications (parenchymal hematoma, ischemic mass effect, and 24-hour re-occlusion) in the early (<6 hours) versus late window (6-24 hours, including patients with unknown onset) populations and correlated them with the 3-month clinical outcome.

RESULTS: Among 701 patients with acute ischemic stroke receiving endovascular treatment, 29.2% had late endovascular treatment. Overall, incomplete recanalization occurred in 56 patients (8%), and 126 patients (18%) had at least 1 postprocedural cerebrovascular complication. The frequency of incomplete recanalization was similar in early and late endovascular treatment (7.5% versus 9.3%, adjusted P =.66), as was the occurrence of any postprocedural cerebrovascular complication (16.9% versus 20.5%, adjusted P = .36). When analyzing single postprocedural cerebrovascular complications, rates of parenchymal hematoma and ischemic mass effect were similar (adjusted P = .71, adjusted P = .79, respectively), but 24-hour re-occlusion seemed somewhat more frequent in late endovascular treatment (4% versus 8.3%, unadjusted P = .02, adjusted P = .40). The adjusted 3-month clinical outcome in patients with incomplete recanalization or postprocedural cerebrovascular complications was comparable between early and late groups (adjusted P = .67, adjusted P = .23, respectively).

CONCLUSIONS: The frequency of incomplete recanalization and of cerebrovascular complications occurring after endovascular treatment is similar in early and well-selected late patients receiving endovascular treatment. Our results demonstrate the technical success and safety of endovascular treatment in well-selected late patients with acute ischemic stroke.

PMID:37230542 | DOI:10.3174/ajnr.A7886

J Nucl Med. 2023 May 25:265077. doi: 10.2967/jnumed.122.265077. Online ahead of print.

ABSTRACT

⁶⁸Ga-gozetotide (⁶⁸Ga-PSMA-11) is used to identify prostate-specific membrane antigen (PSMA)-positive tumors on PET scans. In the VISION study, ⁶⁸Ga-PSMA-11 was used to determine the eligibility of patients with metastatic castration-resistant prostate cancer for treatment with ¹⁷⁷Lu-vipivotide tetraxetan (¹⁷⁷Lu-PSMA-617), based on predefined read criteria. This substudy aimed to investigate the interreader variability and intrareader reproducibility of visual assessments of ⁶⁸Ga-PSMA-11 PET/CT scans using the VISION read criteria and evaluate the agreement between read results for this and the VISION study. Methods: In VISION, ⁶⁸Ga-PSMA-11 PET/CT scans were centrally read as inclusion cases if they had at least 1 PSMA-positive lesion and no PSMA-negative lesions that fulfilled the exclusion criteria. In this substudy, 125 PET/CT scans (75 inclusion and 50 exclusion cases) were randomly selected from VISION and retrospectively assessed by 3 independent central readers. A random subset of 20 cases (12 inclusion and 8 exclusion cases) was recoded for assessment of intrareader reproducibility. Classification of cases as inclusion or exclusion cases was based on the VISION read criteria. Overall interreader variability was assessed by Fleiss κ-statistics, and pairwise variability and intrareader reproducibility were assessed by Cohen κ-statistics. Results: For interreader variability, the readers agreed on 77% of cases (overall average agreement rate, 0.85; Fleiss κ, 0.60 [95% CI, 0.50-0.70]). The pairwise agreement rate was 0.82, 0.88, and 0.84, and the corresponding Cohen κ was 0.54 (95% CI, 0.38-0.71), 0.67 (95% CI, 0.52-0.83), and 0.59 (95% CI, 0.43-0.75), respectively. For intrareader reproducibility, the agreement rate was 0.90, 0.90, and 0.95, and the corresponding Cohen κ was 0.78 (95% CI, 0.49-0.99), 0.76 (95% CI, 0.46-0.99), and 0.89 (95% CI, 0.67-0.99), respectively. The number of actual VISION inclusion cases out of the total number of cases scored as inclusion in this substudy was 71 of 93 (agreement rate, 0.76; 95% CI, 0.66-0.85) for reader 1, 70 of 88 (0.80; 0.70-0.87) for reader 2, and 73 of 96 (0.76; 0.66-0.84) for reader 3. All readers agreed on 66 of 75 VISION inclusion cases. Conclusion: Moderate-to-substantial interreader agreement and substantial-to-almost perfect intrareader reproducibility for ⁶⁸Ga-PSMA-11 PET/CT scan assessment using the VISION read criteria were observed. The read rules applied in VISION can be readily learned and demonstrate good reproducibility.

PMID:37230533 | DOI:10.2967/jnumed.122.265077