Tag: statistics

PLoS One. 2021 Aug 24;16(8):e0256256. doi: 10.1371/journal.pone.0256256. eCollection 2021.

ABSTRACT

INTRODUCTION: A family-centered care model (FCCM) providing family-based HIV services, rather than separate adult/pediatric services, has been proposed to increase pediatric retention and treatment adherence.

MATERIALS AND METHODS: Eight health-care facilities in the Hhohho region of Eswatini were randomized to implement FCCM (n = 4) or continue standard-of-care (SOC) separate adult/pediatric clinics (n = 4). HIV-positive children and caregivers were enrolled; caregiver interview and child/caregiver chart abstraction were done at enrollment and every three months; pediatric viral load was evaluated at enrollment and every six months through 12 months. Because of study group differences in 12-month viral load data availability (89.4% FCCM and 72.0% SOC children had 12-month viral load), we used three separate analyses to evaluate the effects of FCCM on children’s viral suppression (<1,000 copies/mL) and undetectable virus (<400 copies/mL) at 12 months. In the first analysis, all children with missing viral outcome data were excluded from the analysis (modified intent to treat, mITT). The second analysis used inverse probability of missingness weighted logistic regression to estimate the effect of FCCM on 12-month viral outcomes compared to SOC (weighted mITT). For the third approach, missing virologic outcome data were imputed as virologic failure (imputed ITT). We also examined factors associated with viral suppression at 12 months using multivariable logistic regression.

RESULTS: We enrolled 379 HIV-positive children and 363 caregivers. Among all children at enrollment, viral suppression and undetectability was 78.4% and 73.9%, respectively, improving to 90.2% and 87.3% at 12 months. In mITT and weighted mITT analyses, there was no significant difference in children’s 12-month viral suppression between FCCM and SOC groups (89.2% and 91.6%, respectively). Using imputed ITT, there was a modest increase in 12-month viral suppression in FCCM versus SOC children (79.7% and 69.8%, respectively, p = 0.051) and 12-month undetectability (78.7% and 65.7%, respectively, p = 0.015). Among the 255 children suppressed at enrollment, more FCCM versus SOC children (98.0% versus 95.3%) were suppressed at 12-months, but this was not statistically significant in mITT or weighted mITT analyses, with a marginally significant difference using imputed mITT analysis (p = 0.042). A higher proportion of children suppressed at enrollment had undetectable viral load at 12 months in FCCM versus SOC children (98.0% versus 92.5%), a statistically significant difference across analytical methods. Among the 61 children unsuppressed at enrollment, achieving suppression was higher among SOC versus FCCM children, but this difference was not statistically significant and included only 38 children; and there were no significant differences in detectable viral load at 12 months. There were no significant differences between study groups in retention or ART adherence at 12 months for children or caregivers. Factors associated with lack of viral suppression/detectability at 12 months included lack of viral suppression at enrollment and having a younger caregiver (age <25 years).

CONCLUSIONS: FCCM in Eswatini was associated with a modest increase in viral suppression/undetectability at 12-months; 12-month retention and adherence did not differ by study group for children or caregivers. High levels of suppression and retention in both groups may have limited our ability to detect a difference.

TRIAL REGISTRATION: NCT03397420; ClinicalTrials.gov.

PMID:34428241 | DOI:10.1371/journal.pone.0256256

PLoS One. 2021 Aug 24;16(8):e0255703. doi: 10.1371/journal.pone.0255703. eCollection 2021.

ABSTRACT

The distributive power of the arithmetic operators: multiplication, division, addition, and subtraction, gives the arithmetic optimization algorithm (AOA) its unique ability to find the global optimum for optimization problems used to test its performance. Several other mathematical operators exist with the same or better distributive properties, which can be exploited to enhance the performance of the newly proposed AOA. In this paper, we propose an improved version of the AOA called nAOA algorithm, which uses the high-density values that the natural logarithm and exponential operators can generate, to enhance the exploratory ability of the AOA. The addition and subtraction operators carry out the exploitation. The candidate solutions are initialized using the beta distribution, and the random variables and adaptations used in the algorithm have beta distribution. We test the performance of the proposed nAOA with 30 benchmark functions (20 classical and 10 composite test functions) and three engineering design benchmarks. The performance of nAOA is compared with the original AOA and nine other state-of-the-art algorithms. The nAOA shows efficient performance for the benchmark functions and was second only to GWO for the welded beam design (WBD), compression spring design (CSD), and pressure vessel design (PVD).

PMID:34428219 | DOI:10.1371/journal.pone.0255703

PLoS Negl Trop Dis. 2021 Aug 24;15(8):e0009598. doi: 10.1371/journal.pntd.0009598. eCollection 2021 Aug.

ABSTRACT

BACKGROUND: Visceral leishmaniasis (VL), also known as kala-azar (KA), is a neglected vector-borne disease, targeted for elimination, but several affected blocks of Bihar are posing challenges with the high incidence of cases, and moreover, the disease is spreading in newer areas. High-quality kala-azar surveillance in India, always pose great concern. The complete and accurate patient level data is critical for the current kala-azar management information system (KMIS). On the other side, no accurate data on the burden of post kala-azar dermal leishmaniasis (PKDL) and co-infections are available under the current surveillance system, which might emerge as a serious concern. Additionally, in low case scenario, sentinel surveillance may be useful in addressing post-elimination activities and sustaining kala-azar (KA) elimination. Health facility-based sentinel site surveillance system has been proposed, first time to do a proper accounting of KA, PKDL and co-infection morbidity, mortality, diagnosis, case management, hotspot identification and monitoring the impact of elimination interventions.

METHODOLOGY/PRINCIPAL FINDINGS: Kala-azar sentinel site surveillance was established and activated in thirteen health facilities of Bihar, India, using stratified sampling technique during 2011 to 2014. Data were collected through specially designed performa from all patients attending the outpatient departments of sentinel sites. Among 20968 symptomatic cases attended sentinel sites, 2996 cases of KA and 53 cases of PKDL were registered from 889 endemic villages. Symptomatic cases meant a person with fever of more than 15 days, weight loss, fatigue, anemia, and substantial swelling of the liver and spleen (enlargement of spleen and liver).The proportion of new and old cases was 86.1% and 13.9% respectively. A statistically significant difference was observed for reduction in KA incidence from 4.13/10000 in 2011 to 1.75/10000 in 2014 (p<0.001). There were significant increase (0.08, 0.10 per 10 000 population) in the incidences of PKDL and co-infection respectively in the year 2014 as compared to that of 2011 (0.03, 0.06 per 10 000 population). The proportion of HIV-VL co-infection was significantly higher (1.6%; p<0.05) as compared to other co-infections. Proportions of male in all age groups were higher and found statistically significant (Chi-square test = 7.6; P = 0.026). Utilization of laboratory services was greatly improved. Friedman test showed statistically significant difference between response of different anti kala-azar drugs (F = 25.0, P = 0.004).The initial and final cure rate of AmBisome was found excellent (100%). The results of the signed rank sum test showed significant symmetry of unresponsiveness rate (P = 0.03). Similarly, relapse rate of sodium antimony gluconate (SAG) was also found significantly higher as compared to other drugs (95%CI 0.2165 to 19.7035; P = 0.03). A statistically significant difference was found (p<0.001) between villages having 1-2 cases (74%) and villages with 3-5 cases (15%). Significantly higher proportion (95%) of cases were captured by existing Govt. surveillance system (KMIS) (p<0.001), as compared to private providers (5%).

CONCLUSIONS/SIGNIFICANCE: Establishment of a sentinel site based kala-azar surveillance system in Bihar, India effectively detected the rising trend of PKDL and co-infections and captured complete and accurate patient level data. Further, this system may provide a model for improving laboratory services, KA, PKDL and co-infection case management in other health facilities of Bihar without further referral. Program managers may use these results for evaluating program’s effectiveness. It may provide an example for changing the practices of health care workers in Bihar and set a benchmark of high quality surveillance data in a resource limited setting. However, the generalizability of this sentinel surveillance finding to other context remains a major limitation of this study. The justifications for this; the sentinel sites were made in the traditionally high endemic PHC’s. The other conditions were Program commitment for diagnostic (rk-39) and the first line anti kala-azar drug i.e. miltefosine throughout the study period in the sentinel sites. In addition, there were clause of fulfillment of readiness criteria at each sentinel site (already described in the line no 171 to 180 at page no-8, 181-189 at page no-9 and 192-212 at page no-10). Rigorous efforts were taken to improve all the sentinel sites to meet the readiness criteria and research activities started only after meeting readiness criteria at the site. Therefore sentinel site surveillance described under the present study cannot be integrated into other set up (medium and low endemic areas). However, it can be integrated into highly endemic areas with program commitment and fulfillment of readiness criteria.

PMID:34428232 | DOI:10.1371/journal.pntd.0009598

Arch Cardiol Mex. 2021 Aug 24. doi: 10.24875/ACM.21000164. Online ahead of print.

ABSTRACT

INTRODUCTION: The coronavirus disease (COVID-19) pandemic has generated serious repercussions on the health system, reducing the number of all cardiology procedures worldwide.

OBJECTIVES: Describe the impact of the COVID-19 pandemic on the procedures performed by the electrophysiology department in a national referral center.

METHODS: We made a retrospective review of our data base and we compared procedures made in the past 3 years since 2017-2019 with the procedures made in the 2020. We divided the procedures into two large groups: Cardiac Implantable Electronic Devices (CIED) related procedures and electrophysiological procedures (EP) which included conventional and complex ablations.

RESULTS: There was a significant reduction in all the procedures, the average of procedures performed in the last 3 previous years was 467, while in 2020, we performed only 319 (p = 0.01); this represents a reduction of 33.4% in the total number of procedures. There was no statistical difference regarding the CIED related procedures, the average of procedures in the past 3 previous years was 174, and in 2020 we performed 190 procedures (p = 0.46). Regarding the EP, the average of the past 3 previous years was 293, while in 2020, we performed only 129 procedures (p < 0.01). The reduction in the EP was 55.97%. The most affected months were April, May, and June.

CONCLUSIONS: The COVID-19 pandemic considerably affected the number of the procedures in our center, reducing it by 33.4%. The reduction of procedures fundamentally affected the ablations, with a reduction of 55.97%. The number of CIED related procedures was not affected.

PMID:34428197 | DOI:10.24875/ACM.21000164

PLoS One. 2021 Aug 24;16(8):e0254379. doi: 10.1371/journal.pone.0254379. eCollection 2021.

ABSTRACT

PURPOSE: This cross-sectional observational study aims to report preliminary data from the first experience using tocilizumab for patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in three of Kuwait’s largest public hospitals City.

PATIENTS AND METHODS: This chart review study examined the benefits of tocilizumab treatment among 127 patients diagnosed with severe coronavirus disease of 2019 (COVID-19) pneumonia.

RESULTS: 90 of 127 patients (71%) survived. Mortality was highest in the elderly with multiple medical conditions.

CONCLUSION: Despite the small sample size and retrospective nature of the work, our findings are consistent with recent studies suggesting tocilizumab administration in patients presenting with severe COVID pneumonia with associated hyperinflammatory features conferred mortality benefit.

PMID:34428204 | DOI:10.1371/journal.pone.0254379

PLoS One. 2021 Aug 24;16(8):e0254223. doi: 10.1371/journal.pone.0254223. eCollection 2021.

ABSTRACT

Hand, foot and mouth (HFM) disease is a common childhood illness. The paper aims to capture the spatiotemporal characters, and investigate the influence factors of the HFM epidemic in 15 regions of Xinjiang province from 2008 to 2017, China. Descriptive statistical analysis shows that the children aged 0-5 years have a higher HFM incidence, mostly boys. The male-female ratio is 1.5:1. Through the scanning method, we obtain the first cluster high-risk areas. The cluster time is usually from May to August every year. A spatiotemporal model is proposed to analyze the impact of meteorological factors on HFM disease. Comparing with the spatial model, the model is more effective in terms of R2, AIC, deviation, and mean-square error. Among meteorological factors, the number of HFM cases generally increases with the intensity of rainfall. As the temperature increases, there are more HFM patients. Some regions are mostly influenced by wind speed. Further, another spatiotemporal model is introduced to investigate the relationship between HFM disease and socioeconomic factors. The results show that socioeconomic factors have significant influence on the disease. In most areas, the risk of HFM disease tends to rise with the increase of the gross domestic product, the ratios of urban population and tertiary industry. The incidence is closely related to the number of beds and population density in some regions. The higher the ratio of primary school, the lower the number of HFM cases. Based on the above analysis, it is the key measure to prevent and control the spread of the HFM epidemic in high-risk areas, and influence factors should not be ignored.

PMID:34428212 | DOI:10.1371/journal.pone.0254223

IEEE Trans Neural Netw Learn Syst. 2021 Aug 24;PP. doi: 10.1109/TNNLS.2021.3104974. Online ahead of print.

ABSTRACT

The entropy of the codes usually serves as the rate loss in the recent learned lossy image compression methods. Precise estimation of the probabilistic distribution of the codes plays a vital role in reducing the entropy and boosting the joint rate-distortion performance. However, existing deep learning based entropy models generally assume the latent codes are statistically independent or depend on some side information or local context, which fails to take the global similarity within the context into account and thus hinders the accurate entropy estimation. To address this issue, we propose a special nonlocal operation for context modeling by employing the global similarity within the context. Specifically, due to the constraint of context, nonlocal operation is incalculable in context modeling. We exploit the relationship between the code maps produced by deep neural networks and introduce the proxy similarity functions as a workaround. Then, we combine the local and the global context via a nonlocal attention block and employ it in masked convolutional networks for entropy modeling. Taking the consideration that the width of the transforms is essential in training low distortion models, we finally produce a U-net block in the transforms to increase the width with manageable memory consumption and time complexity. Experiments on Kodak and Tecnick datasets demonstrate the priority of the proposed context-based nonlocal attention block in entropy modeling and the U-net block in low distortion situations. On the whole, our model performs favorably against the existing image compression standards and recent deep image compression models.

PMID:34428157 | DOI:10.1109/TNNLS.2021.3104974

J Physician Assist Educ. 2021 Sep 1;32(3):164-170. doi: 10.1097/JPA.0000000000000372.

ABSTRACT

PURPOSE: Physician assistant (PA) programs aim to foster a collaborative culture that enables stakeholders to feel included, empowered, and valued. The purpose of this study was to explore the cultural climate of diversity and inclusion in one PA program to identify areas of strength and to serve as a baseline needs assessment for future program initiatives.

METHODS: The study used a cross-sectional, descriptive approach for PA survey data (N = 85) to assess perceptions of diversity and inclusion of PA program students, faculty, and staff.

RESULTS: The respondents largely agreed that the program created an inclusive learning environment (92%), the curriculum positively affected their understanding of diversity and cultural responsiveness (84.6%), and the program had an adequate amount of inclusivity for all program stakeholders (87%). Some faculty members (25%) and students (6.2%) disagreed that faculty were open to diverse political beliefs, and 35% of the respondents believed that more emphasis could be put on religious diversity. A few students (7.7%) perceived faculty as not supportive of non-native English language speakers; students of color (11.5%) were more likely than White students (5.1%) to have this perception.

CONCLUSIONS: This study largely met the goal to create a professional environment of mutual respect and, ultimately, a climate of inclusiveness. It also identified opportunities for new initiatives to meet the needs of all program stakeholders. Follow-up research that distinguishes faculty from students and a multicenter study to explore perspectives based on demographic differences would be timely and useful.

PMID:34428191 | DOI:10.1097/JPA.0000000000000372

Scand J Gastroenterol. 2021 Aug 24:1-5. doi: 10.1080/00365521.2021.1968485. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Non-cirrhotic portal hypertension (NCPH) comprise a group of diseases that cause portal hypertension without cirrhosis, leading to a high risk of hemorrhage from esophageal varices. There are no non-invasive predictors of high-risk varices (HRV) described in the literature for NCPH. This study aimed to evaluate whether transient splenic elastography (TSE) can predict HRV in patients with NCPH.

METHODS: Prospective study of patients with NCPH who underwent a single timepoint evaluation with transient liver and spleen elastography, ultrasonography, upper endoscopy, and laboratory tests. The study was performed from January to September 2020. Patients were divided into two groups based on the presence of HRV. The relation between TSE, transient liver elastography (TLE), spleen size, and platelet count to the presence of HRV was evaluated.

RESULTS: Of 42 patients with NCPH, 50% (21/42) presented HRV. In univariate analysis, TSE (median, 58.4 vs. 28.3, p = 0.009) and spleen size (median, 17.5 vs. 14.5 cm, p = 0.013) were associated with HRV. No statistically significant relationship was found between the presence of HRV and platelet count or TLE. In multivariate analysis, TSE was the only variable related to HRV (OR 1.21, 95% CI 1.02-1.38). TSE had a good performance in predicting HRV in our population (AUROC 0.878; 95% CI 0.751-1000). TSE > 35.4 kPa presents 93.3% sensitivity, 60.0% specificity, and 90.9% negative predictive value.

CONCLUSION: In our population of patients with NCPH, TSE is useful in predicting HRV. TLE, spleen size, and platelet count were not related to HRV.

PMID:34428123 | DOI:10.1080/00365521.2021.1968485

IEEE Trans Pattern Anal Mach Intell. 2021 Aug 24;PP. doi: 10.1109/TPAMI.2021.3107164. Online ahead of print.

ABSTRACT

Power Normalizations (PN) are useful non-linear operators which tackle feature imbalances in classification problems. We study PNs in deep learning via a novel PN layer that combines the feature vectors and their respective spatial locations in the feature maps produced by the last convolutional layer of CNN into a positive definite matrix with second-order statistics to which PN operators are applied, forming so-called Second-order Pooling (SOP). As the main goal of this paper is to study Power Normalizations, we investigate the role and meaning of MaxExp and Gamma, two popular PN functions. To this end, we provide probabilistic interpretations of such element-wise operators and discover surrogates with well-behaved derivatives for end-to-end training. Furthermore, we look at the spectral applicability of MaxExp and Gamma by studying Spectral Power Normalizations (SPN). We show that SPN on the autocorrelation/covariance matrix and the Heat Diffusion Process (HDP) on a graph Laplacian matrix are closely related, thus sharing their properties. Such a finding leads us to the culmination of our work, a fast spectral MaxExp which is a variant of HDP for covariances/autocorrelation matrices. We evaluate our ideas on fine-grained recognition, scene recognition, and material classification, as well as in few-shot learning and graph classification.

PMID:34428137 | DOI:10.1109/TPAMI.2021.3107164