Tag: statistics

Ecotoxicol Environ Saf. 2022 Apr 22;237:113542. doi: 10.1016/j.ecoenv.2022.113542. Online ahead of print.

ABSTRACT

Existing evidence has showed that exposure to polycyclic aromatic hydrocarbons (PAHs) increases the risk of many chronic diseases. Given the close connection between aging (a major risk factor) and chronic diseases, however, very few studies have evaluated the association between PAHs and aging. Furthermore, whether modifiable healthy lifestyle could attenuate the detrimental effect of PAHs on aging remains unknown. Therefore, we conducted this study, aiming to: (1) examine the associations of urinary monohydroxy polycyclic aromatic hydrocarbons (OH-PAHs) and lifestyle with Phenotypic Age Acceleration (PhenoAge.Accel), a novel aging measure that captures morbidity and mortality risk; and (2) evaluate the potential interaction effects of OH-PAHs and lifestyle on PhenoAge.Accel. Cross-sectional data of 2,579 participants (aged 20-84 years, n = 1,292 females) from the National Health and Nutrition Examination Survey for years 2001-2010 were analyzed. A lifestyle index was constructed based on five components (drinking, smoking, body mass index, physical activity, and diet), ranging from 0 to 5. We calculated PhenoAge.Accel using algorithms developed previously. General linear regression models were used to examine the associations. We observed strong associations of OH-PAHs and lifestyle with PhenoAge.Accel. For instance, one unit increase in ∑NAP (sum of 1- and 2-hydroxynaphthalene) was associated with 0.37 year (95% confidence interval [CI]: 0.26, 0.48) increase in PhenoAge.Accel. We did not observe statistically significant interaction effects between OH-PAHs and lifestyle on PhenoAge.Accel. After stratified by sex, we observed strong associations as well as statistically significant interactions of OH-PAHs and lifestyle with PhenoAge.Accel among females. In conclusion, both OH-PAHs and lifestyle were independently associated with phenotypic aging and there were statistically significant interactions between OH-PAHs and lifestyle on phenotypic aging among females. The findings highlight the importance of adherence to a healthy lifestyle to attenuate the detrimental effects of exposures to PAHs on phenotypic aging among females.

PMID:35468442 | DOI:10.1016/j.ecoenv.2022.113542

Ecotoxicol Environ Saf. 2022 Apr 22;237:113537. doi: 10.1016/j.ecoenv.2022.113537. Online ahead of print.

ABSTRACT

Both long-term exposure to air pollution and abnormal fasting blood glucose (FBG) are linked to dyslipidemia prevalence. However, the joint role of air pollution and FBG on dyslipidemia remains unknown clearly. In this study, we aimed to test whether abnormal FBG could enhance the risks of long-term exposure to air pollutants on dyslipidemia in general Chinese adult population. The present study recruited 8917 participants from 4 cities in Hebei province, China. Participants’ individual exposure to air pollutants was evaluated by the Empirical Bayesian Kriging statistical model in ArcGIS10.2 geographic information system. Dyslipidemia was defined according to Guidelines for the Prevention and Treatment of Dyslipidemia in Chinese Adults. Subjects were grouped into normal, prediabetes, diabetes according to FBG level. Generalized linear models were applied to analyze the interaction of air pollutants and FBG on dyslipidemia prevalence. The prevalence of dyslipidemia was 43.83% in our investigation. After adjusting all covariates, we found the risk of four air pollutants (PM_2.5, PM₁₀, NO₂, SO₂) on dyslipidemia prevalence was stronger as higher FBG level, and the adjusted odd ratio of interaction (OR_inter (95% CI)) between PM_2.5, PM₁₀, NO₂, SO₂ and FBG levels on dyslipidemia was 1.171 (1.162, 1.189), 1.119 (1.111, 1.127), 1.124 (1.115, 1.130), 1.107 (1.098, 1.115), respectively. Stratified analyses indicated the modifying effects of FBG on the association of air pollution with dyslipidemia were stronger among male, less than 65 years old, overweight/obesity (all P_inter<0.1). Our study concluded that high FBG levels strengthened the risk of long-term exposure to air pollution on dyslipidemia, especially more noticeable in male, less than 65 years old, overweight.

PMID:35468441 | DOI:10.1016/j.ecoenv.2022.113537

J Psychiatr Res. 2022 Apr 18;151:78-85. doi: 10.1016/j.jpsychires.2022.03.066. Online ahead of print.

ABSTRACT

Despite the established effectiveness of evidence-based PTSD treatments, not everyone responds the same. Specifically, some individuals respond early while others respond minimally throughout treatment. Our ability to predict these trajectories at baseline has been limited. Predicting which individuals will respond to a certain type of treatment can significantly reduce short- and long-term costs and increase the ability to preemptively match individuals with treatments to which they are most likely to respond. In the present study, we examined whether veterans’ responses to a 3-week Cognitive Processing Therapy-based intensive PTSD treatment program could be accurately predicted prior to the first session. Using a sample of 432 veterans, and a wide range of demographic and clinical data collected during intake, we assessed six machine learning and statistical methods and their ability to predict fast and minimal responders prior to treatment initiation. For fast response classification, gradient boosted models (GBM) had the highest AUC-PR (0.466). For minimal response classification, elastic net (EN) had the highest mean CV AUC-PR (0.628). Using the best performing classifiers, we were able to predict both fast and minimal responders prior to starting treatment with relatively high AUC-ROC of 0.765 (GBM) and 0.826 (EN), respectively. These results may inform treatment modifications, although the accuracy may not be sufficient for clinicians to base inclusion/exclusion decisions entirely on the classifiers. Future research should evaluate whether these classifiers can be expanded to predict to which treatment type(s) an individual is most likely to respond based on various clinical, circumstantial, and biological features.

PMID:35468429 | DOI:10.1016/j.jpsychires.2022.03.066

Arthritis Care Res (Hoboken). 2022 Apr 25. doi: 10.1002/acr.24903. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the cost-utility and cost-effectiveness of a group-based outpatient physical therapy intervention delivered six-weeks after primary total knee replacement (TKR) compared with usual care, alongside the Activity-orientated REhabilitation following kNee Arthroplasty (ARENA) multi-centre randomised controlled trial.

METHODS: The economic analyses were performed from the perspective of the health and social care payer. We collected resource use for health and social care and productivity losses, and patient outcomes for 12 months after surgery to derive costs and quality-adjusted life-years (QALYs). Results were expressed in incremental cost-effectiveness ratios (ICERs), and incremental net monetary benefit statistics (INMBs) for a society willing-to-pay £20,000 per QALY gained, with sensitivity analyses to model specification and perspective.

RESULTS: ARENA physical therapy classes cost, on average, £179 (SD=£39) per patient. Treatment in the year following surgery cost, on average, £1,739 (95%CI -£742, £4,221) per patient in the intervention group (n=89), an additional £346 (95%CI £38, £653) compared with usual care (n=91, £1,393;95%CI -£780, £3568). QALY benefits were 0.0506 higher (95%CI 0.009, 0.09) in the intervention group, corresponding to an additional 19 days in perfect health. The ICER for the intervention was £6,842 per QALY gained and the INMB was £665 (, 95%CI £139, £1,191) with a 92% probability of being cost-effective, and no less than 73% in all sensitivity analysis scenarios.

CONCLUSION: The addition of group-based outpatient physical therapy classes to usual care improves quality-of-life and is a cost-effective treatment option following TKR for a society willing-to-pay £20,000 per QALY gained.

PMID:35468266 | DOI:10.1002/acr.24903

Ultrasound Obstet Gynecol. 2022 Apr 25. doi: 10.1002/uog.24918. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess whether pregnancy associated plasma protein-A (PAPP-A) improves or provides equivalent screening performance as placental growth factor (PlGF) when screening for preterm preeclampsia (PE) at 11-13 weeks METHODS: This is a secondary analysis of a non-intervention screening study of 6546 singleton pregnancies prospectively screened for preterm PE in the first trimester between December 2016 and June 2018. Patient-specific risks for preterm PE were estimated by maternal history, mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), PlGF and PAPP-A. A competing risks model with biomarker expressed in multiple of expected median (MoM) was used. All women and clinicians were unaware of the risk for preterm PE. Effectiveness when screening for preterm PE with and without PAPP-A and PlGF was assessed using the difference in the area under receiver operational curves (AUC). McNemar test was used to compare detection rate at a fixed false positive rate (FPR) of 10%.

RESULTS: 37 women developed preterm PE. The AUC and detection rate at 10% FPR using PlGF in conjunction with history, MAP and UtA-PI were 0.854 and 59.46%, respectively. Corresponding figures when replacing PlGF by PAPP-A or adding PAPP-A to PlGF were 0.813 and 54.05%, and 0.855 and 59.46%. Statistically, non-significant differences were noted in AUC when replacing PlGF with PAPP-A (ΔAUC=0.04; p=0.095) or adding PAPP-A (ΔAUC=0.002; p=0.423). However, on an individual case basis, screening using PlGF in conjunction with MAP and UtA-PI identified three (8.1%) additional pregnancies which developed preterm PE not identified by replacing PlGF with PAPP-A. Adding PAPP-A to history and other biomarkers did not identify any additional pregnancies.

CONCLUSION: On an individual case basis, adopting a screening strategy of using PAPP-A instead of PlGF results in an observed loss of detection consistent with the literature. This article is protected by copyright. All rights reserved.

PMID:35468236 | DOI:10.1002/uog.24918

Ultrasound Obstet Gynecol. 2022 Apr 25. doi: 10.1002/uog.24920. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore and compare fetal cortical brain development and infant neurobehaviour in spontaneously conceived (SC) and assisted reproductive technologies (ART) offspring.

METHODS: A prospective cohort study of 210 singleton pregnancies including 70 SC pregnancies, 70 conceived by in vitro fertilization (IVF) following frozen embryo transfer (ET), and 70 IVF after fresh ET. Fetal neurosonography was performed at 32±2 weeks to assess cortical development. Sulci depths were measured off-line and normalized by biparietal diameter. Additionally, Ages & Stages Questionnaires (ASQ) were obtained postnatally, at 12±1 months of corrected age. Comparisons were adjusted by maternal age, ethnicity, nulliparity, fetal sex, weight centile and gestational age at scan for neurosonography, and by maternal age, ethnicity, nulliparity, educational level, employment status, new-born’s gestational age at birth, breastfeeding, infant’s sex and age at the ASQ evaluation.

RESULTS: In comparison to the SC, the fetuses conceived by ART showed statistically significant differences in cortical development, with reduced parieto-occipital (fresh ET mean[SD] 12.5mm[2.5] vs. frozen ET 13.4[2.6] vs. SC 13.4[2.6], p<0.001), cingulate (fresh ET 5.8[1.8] vs. frozen ET 6.0[2.1] vs. SC 6.4[1.9], p<0.001), and calcarine (fresh ET 13.3[3.9] vs. frozen ET 14.1[2.8] vs. SC 16.1[2.7], p=<0.001) sulci depth, together with lower Sylvian fissure grading score. Changes in cortical development were more pronounced in the fresh ET group as compared to the frozen ET. Additionally, ART infants showed lower ASQ scores, especially in the fresh ET group (global ASQ z-scores: fresh ET mean[SD] -0.3[0.4] vs. frozen ET -0.2[0.4] vs. SC 0[0.4], p<0.001).

CONCLUSIONS: Fetuses conceived by ART show a distinctive pattern of cortical development and suboptimal infant neurodevelopment, with more pronounced changes in fresh ET. These findings support the existence of in utero brain reorganization associated to ART and warrant follow-up studies to assess their long-term persistence. This article is protected by copyright. All rights reserved.

PMID:35468238 | DOI:10.1002/uog.24920

J Anat. 2022 Apr 25. doi: 10.1111/joa.13677. Online ahead of print.

ABSTRACT

Knowledge of the anatomical development of the calcaneal apophysis is essential in clinical assessment and management of both paediatric and sub-adult patients presenting with heel pain. Despite this, the current understanding of calcaneal apophyseal development is constrained by the limitations of the imaging modalities used to examine the apophysis, with no current literature reporting the development of the medial and lateral processes. This study aimed to overcome these limitations by investigating the ossification and fusion of the calcaneal apophysis using three-dimensional computed tomography analysis, and statistically predicting the apophyseal developmental stage in contemporary Australian children. The development and fusion status of the apophysis was scored using a novel 11-stage scoring system on 568 multi-slice computed tomography scans (295 females; 274 males) and 266 lateral radiographic scans (119 females; 147 males) from the Queensland Children’s Hospital. Multinomial logistic regression along with classification tables and predictive probabilities were then utilised to assess developmental stage likelihood from known age and sex. The apophysis commenced ossification at a mean age of 5.2 years for females and 7.2 years for males, and then elongated to form the apophyseal cap around 10 years for females and 12.4 years for males. Fusion of the apophysis commenced at a mean age of 11.18 years for females and 13.3 years for males, with the earliest age of complete fusion observed at 10 years for females and 14 years for males. The results demonstrate significant sexual dimorphism in ossification and fusion with females developing and fusing significantly earlier. Furthermore, the use of computed tomography in this study allowed for the first time evaluation of the ossification and fusion of the medial and lateral processes of the calcaneus. The medial process formed at a mean age of 9.5 years for females and 10.9 years for males while the lateral process formed at around 9.8 years for females and 11.7 years for males. The medial process demonstrated slower rates of fusion compared to the lateral process. The present study provides Queensland specific standards for assessing the calcaneal apophyseal developmental stage as well as novel predictive regression models for apophyseal stage estimation using known age and sex to aid in the diagnosis of heel pain conditions such as apophysitis or screen for developmental delays in children and subadults.

PMID:35468228 | DOI:10.1111/joa.13677

J Anat. 2022 Apr 25. doi: 10.1111/joa.13681. Online ahead of print.

ABSTRACT

Understanding how the brain is provided with glucose and oxygen is of particular interest in human evolutionary studies. In addition to the internal carotid arteries, vertebral arteries contribute significantly to the cerebral and cerebellar blood flow. The size of the transverse foramina has been suggested to represent a reliable proxy for assessing the size of the vertebral arteries in fossil specimens. To test this assumption, here, we statistically explore spatial relationships between the transverse foramina and the vertebral arteries in extant humans. Contrast computed tomography (CT) scans of the cervical regions of 16 living humans were collected. Cross-sectional areas of the right and left transverse foramina and the corresponding vertebral arteries were measured on each cervical vertebra from C1 to C6 within the same individuals. The cross-sectional areas of the foramina and corresponding arteries range between 13.40 and 71.25 mm² and between 4.53 and 29.40 mm² , respectively. The two variables are significantly correlated except in C1. Using regression analyses, we generate equations that can be subsequently used to estimate the size of the vertebral arteries in fossil specimens. By providing additional evidence of intra- and inter-individual size variation of the arteries and corresponding foramina in extant humans, our study introduces an essential database for a better understanding of the evolutionary story of soft tissues in the fossil record.

PMID:35468222 | DOI:10.1111/joa.13681

Inflamm Bowel Dis. 2022 Apr 25:izac079. doi: 10.1093/ibd/izac079. Online ahead of print.

ABSTRACT

BACKGROUND: Owing to the use of immunosuppressive agents, patients with inflammatory bowel disease (IBD) have an increased risk of vaccine preventable diseases, including infection with hepatitis B virus (HBV). Heplisav-B, an FDA-approved vaccine, is more effective (90% to 100%) than Engerix-B (70.5% to 90.2%) at inducing immunity to HBV in clinical studies. Available data on efficacy of Heplisav-B vaccine in patients with IBD are limited.

METHODS: This retrospective observational study included patients age 18 years and older with ulcerative colitis (UC) or Crohn’s disease (CD) who received 1 or 2 doses of Heplisav-B vaccine and had postvaccination serologic testing. Prior to immunization, all participants were seronegative for HBsAb antibodies (HBsAb) measured as <10 IU/mL. Postvaccination HBsAb of ≥10 IU/mL was considered successful vaccination. Patient demographics, disease characteristics, and medications were abstracted.

RESULTS: One hundred six patients were included in the analysis. Median age was 43 years, and 44 (42%) were female. Thirty-nine patients (37%) had UC, whereas 67 (63%) had CD. Eighty-three patients (78.3%) had active immunity after vaccination with Heplisav-B, with median postvaccination HBsAb levels of 114 IU/L. Patients with chronic obstructive pulmonary disease, chronic kidney disease, diabetes mellitus, immunomodulator use, or those on 2 or more of immunosuppressive medications were less likely to respond to Heplisav-B, though these findings were not statistically significant on a multivariate analysis aside from chronic kidney disease.

CONCLUSIONS: Heplisav-B, a 2-dose vaccine, is an effective vaccine for HBV in patients with IBD. In our study, its overall efficacy (78.3%) is greater than that reported for the presently available 3-dose vaccination (Engerix) in patients with IBD.

PMID:35468183 | DOI:10.1093/ibd/izac079

J Cogn Neurosci. 2022 Apr 15:1-5. doi: 10.1162/jocn_a_01857. Online ahead of print.

ABSTRACT

The field of in vivo neurophysiology currently uses statistical standards that are based on tradition rather than formal analysis. Typically, data from two (or few) animals are pooled for one statistical test, or a significant test in a first animal is replicated in one (or few) further animals. The use of more than one animal is widely believed to allow an inference on the population. Here, we explain that a useful inference on the population would require larger numbers and a different statistical approach. The field should consider to perform studies at that standard, potentially through coordinated multicenter efforts, for selected questions of exceptional importance. Yet, for many questions, this is ethically and/or economically not justifiable. We explain why in those studies with two (or few) animals, any useful inference is limited to the sample of investigated animals, irrespective of whether it is based on few animals, two animals, or a single animal.

PMID:35468209 | DOI:10.1162/jocn_a_01857