Tag: statistics

Proc Natl Acad Sci U S A. 2023 Apr 25;120(17):e2206527120. doi: 10.1073/pnas.2206527120. Epub 2023 Apr 18.

ABSTRACT

The evolution of the mitochondria was a significant event that gave rise to the eukaryotic lineage and most large complex life. Central to the origins of the mitochondria was an endosymbiosis between prokaryotes. Yet, despite the potential benefits that can stem from a prokaryotic endosymbiosis, their modern occurrence is exceptionally rare. While many factors may contribute to their rarity, we lack methods for estimating the extent to which they constrain the appearance of a prokaryotic endosymbiosis. Here, we address this knowledge gap by examining the role of metabolic compatibility between a prokaryotic host and endosymbiont. We use genome-scale metabolic flux models from three different collections (AGORA, KBase, and CarveMe) to assess the viability, fitness, and evolvability of potential prokaryotic endosymbioses. We find that while more than half of host-endosymbiont pairings are metabolically viable, the resulting endosymbioses have reduced growth rates compared to their ancestral metabolisms and are unlikely to gain mutations to overcome these fitness differences. In spite of these challenges, we do find that they may be more robust in the face of environmental perturbations at least in comparison with the ancestral host metabolism lineages. Our results provide a critical set of null models and expectations for understanding the forces that shape the structure of prokaryotic life.

PMID:37071674 | DOI:10.1073/pnas.2206527120

Nurs Open. 2023 Apr 18. doi: 10.1002/nop2.1751. Online ahead of print.

ABSTRACT

AIMS: To explore the university students’ attitude and the potential influencing factors to receive the coronavirus disease 2019 (COVID-19) vaccine in Sichuan Province, China.

DESIGN: A cross-sectional study.

METHODS: The self-designed questionnaire was distributed among university students online in June 2021. SPSS software was used for statistical analysis of the data. Descriptive statistics, Chi-square, two independent samples t-tests, one-way analysis of variance (ANOVA), multivariate linear regression, and content analysis were performed.

RESULTS: A total of 397 questionnaires were analysed, involving 316 (79.6%) respondents have received at least one dose of a COVID-19 vaccine and 81 (20.4%) have not taken the vaccine. The total mean score of university students’ vaccination attitude was 25.97 (standard deviation [SD] = 3.720), and the total scoring rate was 74.2%. Main factors influencing students’ attitude included education level, major, living style, with chronic disease or not, self-reported vaccination status, and number of medical units that can provide vaccination within 3 km of residence. Students were more willing to choose Chinese-manufactured vaccines (66.8%) and participate in collective vaccination programs organized by the school (71.3%). The desired vaccine protection period was 5-10 years (42.1%). The top three reasons for refusing the vaccine or vaccine hesitancy were as follows: concern about the side effects of vaccine (44.8%), lack of information about vaccine (31.0%), and concern about the efficacy of vaccine (29.3%).

CONCLUSION: In general, most of the participants had relatively high level of positive attitude to receive the COVID-19 vaccine. Nevertheless, more attention should be paid to postgraduate students, non-medical students, those living alone, those with chronic disease, those have not received the COVID-19 vaccine, and those living far away from the vaccination medical units. Findings of this study can help educational institutions in developing effective interventions to improve the vaccination rate in the university student population.

PMID:37071667 | DOI:10.1002/nop2.1751

PLoS One. 2023 Apr 18;18(4):e0284474. doi: 10.1371/journal.pone.0284474. eCollection 2023.

ABSTRACT

BACKGROUND: Primary care patients with obesity seldom receive effective weight management treatment in primary care settings. This study aims to understand PCPs’ perspectives on obesity treatment barriers and opportunities to overcome them.

STUDY DESIGN: This is an explanatory sequential mixed methods study in which survey data was collected and used to inform subsequent qualitative interviews.

SETTINGS AND PARTICIPANTS: PCPs who provide care to adult patients in an academic medical center in the Midwestern US.

METHODOLOGY: PCPs (n = 350) were invited by email to participate in an online survey. PCPs were subsequently invited to participate in semi-structured interviews to further explore survey domains.

ANALYTIC APPROACH: Survey data were analyzed using descriptive statistics. Interviews were analyzed using directed content analysis.

RESULTS: Among 107 survey respondents, less than 10% (n = 8) used evidence-based guidelines to inform obesity treatment decisions. PCPs’ identified opportunities to improve obesity treatment including (1) education on local obesity treatment resources (n = 78, 73%), evidence-based dietary counseling strategies (n = 67, 63%), and effective self-help resources (n = 75, 70%) and (2) enhanced team-based care with support from clinic staff (n = 53, 46%), peers trained in obesity medicine (n = 47, 44%), and dietitians (n = 58, 54%). PCPs also desired increased reimbursement for obesity treatment. While 40% (n = 39) of survey respondents expressed interest in obesity medicine training and certification through the American Board of Obesity Medicine, qualitative interviewees felt that pursuing training would require dedicated time (i.e., reduced clinical effort) and financial support.

CONCLUSIONS: Opportunities to improve obesity treatment in primary care settings include educational initiatives, use of team-based care models, and policy changes to incentivize obesity treatment. Primary care clinics or health systems should be encouraged to identify PCPs with specific interests in obesity medicine and support their training and certification through ABOM by reimbursing training costs and reducing clinical effort to allow for study and board examination.

PMID:37071660 | DOI:10.1371/journal.pone.0284474

Clin J Am Soc Nephrol. 2023 Apr 18. doi: 10.2215/CJN.0000000000000173. Online ahead of print.

ABSTRACT

BACKGROUND: For patients who initiate dialysis during a hospital admission and continue to require dialysis after discharge, outpatient dialysis management could be improved by better understanding the future likelihood of recovery to dialysis-independence and the competing risk of death.

METHODS: We derived and validated linked models to predict the subsequent recovery to dialysis-independence and death within one year of hospital discharge using a population-based cohort of 7,657 patients in Ontario, Canada. Predictive variables included age, comorbidities, length of hospital admission, intensive care status, discharge disposition, and pre-hospital admission estimated glomerular filtration rate and random urine urine albumin to creatinine ratio. Models were externally validated in 1,503 contemporaneous patients from Alberta, Canada. Both models were created using proportional hazards survival analysis, with the ‘Recovery Model’ using Fine-Gray methods. Probabilities generated from both models were used to develop 16 distinct Recovery or Death Outcomes (ReDO) risk groups.

RESULTS: ReDO risk groups in the derivation group had significantly distinct 1-year probabilities for recovery to dialysis-independence (1st Quartile: 10% [95%CI 9-11]; 4th Quartile: 73% [70-77]) and for death (1st Quartile: 12% [11-13]; 4th Quartile: 46% [43-50]). In the validation group, model discrimination was modest (c-statistics [95%CI] for recovery and for death quartiles were 0.70 [0.67-0.73] and 0.66 [0.62-0.69], respectively) but calibration was excellent (integrated calibration index [95%CI] was 7% [5-9] and 4% [2-6] for recovery and death, respectively).

CONCLUSIONS: The ReDO models generated accurate expected probabilities of recovery to dialysis-independence and death in patients who continued outpatient dialysis after initiating dialysis in hospital. An online tool based on the models is available at: https://qxmd.com/calculate/calculator_874 Click to follow link.”>https://qxmd.com/calculate/calculator_874.

PMID:37071648 | DOI:10.2215/CJN.0000000000000173

Cyberpsychol Behav Soc Netw. 2023 Apr;26(4):288-299. doi: 10.1089/cyber.2022.0228.

ABSTRACT

Meta-analyses have found that social cognition training (SCT) has large effects on the emotion recognition ability of people with a psychotic disorder. Virtual reality (VR) could be a promising tool for delivering SCT. Presently, it is unknown how improvements in emotion recognition develop during (VR-)SCT, which factors impact improvement, and how improvements in VR relate to improvement outside VR. Data were extracted from task logs from a pilot study and randomized controlled trials on VR-SCT (n = 55). Using mixed-effects generalized linear models, we examined the: (a) effect of treatment session (1-5) on VR accuracy and VR response time for correct answers; (b) main effects and moderation of participant and treatment characteristics on VR accuracy; and (c) the association between baseline performance on the Ekman 60 Faces task and accuracy in VR, and the interaction of Ekman 60 Faces change scores (i.e., post-treatment – baseline) with treatment session. Accounting for the task difficulty level and the type of presented emotion, participants became more accurate at the VR task (b = 0.20, p < 0.001) and faster (b = -0.10, p < 0.001) at providing correct answers as treatment sessions progressed. Overall emotion recognition accuracy in VR decreased with age (b = -0.34, p = 0.009); however, no significant interactions between any of the moderator variables and treatment session were found. An association between baseline Ekman 60 Faces and VR accuracy was found (b = 0.04, p = 0.006), but no significant interaction between difference scores and treatment session. Emotion recognition accuracy improved during VR-SCT, but improvements in VR may not generalize to non-VR tasks and daily life.

PMID:37071641 | DOI:10.1089/cyber.2022.0228

Breastfeed Med. 2023 Apr;18(4):315-325. doi: 10.1089/bfm.2023.0036.

ABSTRACT

Introduction: Infants with single-ventricle (SV) congenital heart disease (CHD) undergo staged surgical and/or catheter-based palliation and commonly experience feeding challenges and poor growth. Little is known about human milk (HM) feeding or direct breastfeeding (BF) in this population. Aim: To determine (1) HM and BF prevalence for infants with SV CHD, and (2) whether BF at neonatal stage 1 palliation (S1P) discharge is associated with any HM at stage 2 palliation (S2P; ∼4-6 months old). Materials and Methods: Analysis of the National Pediatric Cardiology Quality Improvement Collaborative registry (2016-2021) using (1) descriptive statistics for prevalence, and (2) logistic regression adjusted for multiple variables (e.g., prematurity, insurance, length of stay) to examine early BF/later HM feeding. Results: Participants included 2,491 infants from 68 sites. HM prevalence ranged from 49.3% any/41.5% exclusive before S1P to 37.1% any/7.0% exclusive at S2P. Direct BF ranged from 16.1% any/7.9% exclusive before S1P to 9.2% any/3.2% exclusive at S2P discharge. Prevalence varied among sites; for example, 0-100% any HM before S1P. Infants BF at S1P discharge had greater odds of any HM (odds ratio = 4.11, 95% confidence interval [CI] = 2.79-6.07, p < 0.001) and exclusive HM (1.85, 95% CI 1.03-3.30, p = 0.039) at S2P. Conclusions: The prevalence of HM and BF for infants with SV CHD was low and declined over time. Direct BF at S1P discharge was associated with increased odds of any HM at S2P. Wide variation suggests that site-specific practices impact feeding outcomes. HM and BF prevalence are suboptimal in this population, and identification of supportive institutional practices is needed.

PMID:37071633 | DOI:10.1089/bfm.2023.0036

PLoS One. 2023 Apr 18;18(4):e0283328. doi: 10.1371/journal.pone.0283328. eCollection 2023.

ABSTRACT

BACKGROUND: Health care providers including pharmacists are often on the first line when dealing with COVID -19; they can be under threat of contracting and spreading the disease. We aimed to assess and compare their knowledge of hand sanitization during COVID-19 pandemic to improve quality of care.

METHODS: A cross-sectional study was conducted in Jordan, on healthcare providers in different settings from 27 October till 3 December 2020, using a pre-validated electronic questionnaire. Participants (n = 523) were healthcare providers practicing in different settings. Descriptive and association statistical analyses were produced on the data using SPSS 26. Chi square was used for the categorical variables, and One way ANOVA was used on the continuous and categorical variables.

RESULTS: A significant difference was recorded in total knowledge mean according to gender (59.78 vs 61.79 p = 0.030) in favor of men, and between pharmacists and other healthcare providers in favor of the latter (59.22 vs 61.45, p = 0.02). No significant difference was generally noticed between those who attended hand hygiene training and those who did not.

CONCLUSION: Healthcare providers’ knowledge of hand hygiene was generally good among participants, regardless of training and it was possibly increased because of fear of COVID-19 infection. Physicians were the most knowledgeable in regard of hand hygiene while pharmacists were the least among healthcare providers. Thus, structured, more frequent, and tailored training on hand sanitization in addition to new educational strategies are recommended for healthcare providers, in particular, pharmacists for better quality of care especially in pandemics.

PMID:37071629 | DOI:10.1371/journal.pone.0283328

PLoS One. 2023 Apr 18;18(4):e0282851. doi: 10.1371/journal.pone.0282851. eCollection 2023.

ABSTRACT

INTRODUCTION: There have been significant advancements in risk identification and treatment for ovarian cancer over the last decade. However, their impact on health services costs is unclear. This study estimated the direct health system costs (government perspective) for women diagnosed with ovarian cancer in Australia during 2006-2013, as a benchmark prior to opportunities for precision-medicine approaches to treatment, and for health care planning.

METHODS: Using cancer registry data, we identified 176 incident ovarian cancers (including fallopian tube and primary peritoneal cancer) in the Australian 45 and Up Study cohort. Each case was matched with four cancer-free controls on sex, age, geography, and smoking history. Costs were derived from linked health records on hospitalisations, subsidised prescription medicines and medical services to 2016. Excess costs for cancer cases were estimated for different phases of care relative to cancer diagnosis. Overall costs for prevalent ovarian cancers in Australia in 2013 were estimated based on 5-year prevalence statistics.

RESULTS: At diagnosis, 10% of women had localised disease, 15% regional spread and 70% distant metastasis (5% unknown). The mean excess cost per ovarian cancer case was $40,556 in the initial treatment phase (≤12 months post-diagnosis), $9,514 per annum in the continuing care phase and $49,208 in the terminal phase (up to 12 months before death). Hospital admissions accounted for the greatest proportion of costs during all phases (66%, 52% and 68% respectively). Excess costs were higher for patients diagnosed with distant metastatic disease, particularly during the continuing care phase ($13,814 versus $4,884 for localised/regional disease). The estimated overall direct health services cost of ovarian cancer in 2013 was AUD$99million (4,700 women nationally).

CONCLUSION: The excess health system costs of ovarian cancer are substantial. Continued investment in ovarian cancer research, particularly prevention, early detection and more effective personalised treatments is necessary to reduce the burden of disease.

PMID:37071628 | DOI:10.1371/journal.pone.0282851

PLoS One. 2023 Apr 18;18(4):e0284577. doi: 10.1371/journal.pone.0284577. eCollection 2023.

ABSTRACT

BACKGROUND: Implantable medical devices (IMDs) are medical instruments embedded inside the body. Well-informed and empowered patients living with IMDs are key players of improving IMD-related patient safety and health outcomes. However, little is known about IMD patients’ epidemiology, characteristics, and current awareness levels. Our primary aim was to investigate the point and lifetime prevalence of patients living with IMDs. Patients’ IMD-related knowledge and determinants of IMDs’ impact on their life were also explored.

METHODS: An online cross-sectional survey was conducted. Respondents’ IMD history, whether they received instructions for use and IMD’s overall impact on life were recorded by self-reports. Patients’ knowledge about living with IMDs was assessed on visual analogue scales (VAS, 0-10). Shared decision-making was analyzed by the 9-item Shared Decision Making Questionnaire (SDM-Q-9). Descriptive statistics and subgroup comparisons between IMD wearers were performed for statistical differences. Significant determinants of IMD’s overall impact on life were examined in linear regression analysis.

RESULTS: In the total sample (N = 1400, mean age 58.1 ±11.1; female 53.7%), nearly one third of respondents were living with IMD (30.9%; 433/1400). Among them, the most frequent IMDs were tooth implants (30.9%) and intraocular lens (26.8%). Mean knowledge VAS scores were similar (range: 5.5 ±3.8-6.5 ±3.2) but differences by IMD types were observed. Patients who received instructions for use or reported better impact on life indicated higher self-reported knowledge. Regression confirmed that patients’ knowledge was significant predictor of IMD’s impact on life, but this effect was overwritten by the SDM-Q-9.

CONCLUSIONS: This first comprehensive epidemiological study on IMDs provides basic data for public health strategy planning alongside the implementation of MDR. Improved self-perceived outcomes were associated with higher knowledge hence education of patients receiving IMD deserves consideration. We suggest to investigate further the role of shared decision-making on IMD’s overall impact on patients’ life in future prospective studies.

PMID:37071626 | DOI:10.1371/journal.pone.0284577

PLoS One. 2023 Apr 18;18(4):e0284425. doi: 10.1371/journal.pone.0284425. eCollection 2023.

ABSTRACT

BACKGROUND: Despite the fact that direct oral anticoagulants (DOACs) are favoured over warfarin for stroke prevention in patients with non-valvular atrial fibrillation (NVAF), physicians need to maintain competence in using and monitoring warfarin since many patients have contraindications or other barriers to using DOACs. Unlike DOACs, warfarin therapy requires regular blood testing to ensure that it is within a target range to ensure efficacy and safety. There is limited real-world data on the adequacy of warfarin control and the cost and burden of monitoring warfarin therapy in Canadian NVAF patients.

OBJECTIVES: In a large cohort of Canadian patients with NVAF on warfarin we assessed time in therapeutic range (TTR), determinants of TTR, process of care, direct costs, health related quality of life and loss of work time and productivity related to warfarin therapy.

METHODS: Five hundred and fifty one patients with NVAF, either newly initiated or stable on warfarin were prospectively enrolled across 9 Canadian provinces from primary care practices and anticoagulant clinics. Participating physicians provided baseline demographic and medical information. Patients completed diaries for 48 weeks, capturing information about International Normalized Ratio (INR) test results, test locations, process of INR monitoring, direct costs of travel, health-related quality of life and work productivity measures. TTR was estimated using linear interpolation of INR results and linear regression used to investigate associations between TTR and factors (defined a priori).

RESULTS: Four hundred and eighty (87.1%) patients had complete follow-up with an overall TTR of 74.4% based on 7,175 physician-reported INR values from 501 patients. 88% of this cohort were monitored through routine medical care (RMC). The average number of INRs per patient during the 48-week period was 14.1 (standard deviation (SD) = 8.3) tests with a mean duration of 23.8 (SD = 11.1) days between tests. We did not find a relationship between TTR and age, sex, presence of major comorbidities, patient’s province of residence or rural vs. urban residence. 12% of patients monitored through anticoagulant clinics had significantly better TTR than patients monitored through RMC (82% vs. 74%; 95% confidence interval: -13.8, -1.2; p = 0.02). Health related quality of life utility values were high and remained consistent throughout the study. The majority of patients reported no impact on either work productivity or impairment of regular activities due to being on long-term warfarin treatment.

CONCLUSIONS: We showed excellent overall TTR in an observed Canadian cohort, with monitoring through a dedicated anticoagulant clinic being associated with a statistically and clinically significant improvement in TTR. The burden of warfarin therapy on patients’ health related quality of life or daily work and activities was low.

PMID:37071625 | DOI:10.1371/journal.pone.0284425