Tag: statistics

JMIR Public Health Surveill. 2021 Nov 16. doi: 10.2196/33455. Online ahead of print.

ABSTRACT

BACKGROUND: To prepare key stakeholders in countries for the COVID-19 vaccination rollout, WHO and partners have developed online vaccination training packages. The online course launched in December 2020 on the OpenWHO learning platform.

OBJECTIVE: This paper presents findings of an evaluation conducted on these training packages. The evaluation was done to provide insights into user experiences and challenges, measure the impact of the course in terms of knowledge gained, and anticipate potential interest in future online vaccination courses.

METHODS: The primary source of data was the anonymized information on course participants, enrollment, completion, and scores from the OpenWHO platform’s statistical data and metric reporting system. Data from the OpenWHO platform was analyzed from the opening of the courses in mid-December 2020 to mid-April 2021. In addition, a learner feedback survey was sent by email to all course participants to complete within a three-week period (19 March 2021 to 09 April 2021). The survey was designed to determine the perceived strengths and weaknesses of the training packages and to understand barriers to access.

RESULTS: During the study period, 53,593 learners enrolled in the course. Of them, 30,034 (56.0)% completed the course, which is substantially higher than the industry benchmark of 5-10% for a Massive Open Online Course (MOOC). Overall, learners averaged 76.5% on the pre-quiz compared to 85% on the post-quiz, resulting in an increase in average score of 9%. 2,019 learners from the health workers course participated in the survey. Nearly 98% of respondents fully or somewhat agreed that they had more confidence in their ability to support COVID-19 vaccination following completion of this course.

CONCLUSIONS: The online vaccine training was well received by the target audience with a measurable impact on knowledge gained. The key benefits of online training were convenience, self-paced nature, the access to downloadable material, ability to replay material and increased ability to concentrate. Online training was identified as a timely, cost-effective way of delivering essential training to a large number of people to prepare for the COVID-19 vaccination rollout.

PMID:34794116 | DOI:10.2196/33455

Phys Med Biol. 2021 Nov 18. doi: 10.1088/1361-6560/ac3b33. Online ahead of print.

ABSTRACT

Heavy-ion therapy, particularly using scanned (active) beam delivery, provides a precise and highly conformal dose distribution, with maximum dose deposition for each pencil beam at its endpoint (Bragg peak), and low entrance and exit dose. To take full advantage of this precision, robust range verification methods are required; these methods ensure that the Bragg peak is positioned correctly in the patient and the dose is delivered as prescribed. Relative range verification allows intra-fraction monitoring of Bragg peak spacing to ensure full coverage with each fraction, as well as inter-fraction monitoring to ensure all fractions are delivered consistently. To validate the proposed filtered Interaction Vertex Imaging method for relative range verification, a¹⁶O beam was used to deliver 12 Bragg peak positions in a 40 mm poly-(methyl methacrylate) phantom. Secondary particles produced in the phantom were monitored using position-sensitive silicon detectors. Events recorded on these detectors, along with a measurement of the treatment beam axis, were used to reconstruct the sites of origin of these secondary particles in the phantom. The distal edge of the depth distribution of these reconstructed points was determined with logistic fits, and the translation in depth required to minimize the χ²statistic between these fits was used to compute the range shift between any two Bragg peak positions. In all cases, the range shift was determined with sub-millimeter precision, to a standard deviation of the mean of 220(10) μm. This result validates filtered Interaction Vertex Imaging as a reliable relative range verification method, which should be capable of monitoring each energy step in each fraction of a scanned heavy-ion treatment plan.

PMID:34794127 | DOI:10.1088/1361-6560/ac3b33

Public Health. 2021 Nov 15;201:69-74. doi: 10.1016/j.puhe.2021.10.001. Online ahead of print.

ABSTRACT

OBJECTIVES: This study assessed the moderating role of education on the relationship between multimorbidity and mortality among older adults in Brazil.

STUDY DESIGN: This was a cohort study.

METHODS: This study used data from 1768 participants of the Health, Well-Being and Ageing Cohort Study (SABE) who were assessed between 2006 and 2015. The Cox Proportional Risks Model was used to evaluate the association between multimorbidity (two or more chronic diseases) and mortality. An interaction term between education and multimorbidity was included to test the moderating role of education in this association.

RESULTS: The average follow-up time was 4.5 years, with a total of 589 deaths in the period. Multimorbidity increased the risk of mortality (hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.27-1.91), and this association was not moderated by education (HR 1.06, 95% CI 1.00-1.13; P value = 0.07).

CONCLUSIONS: The impact of education and multimorbidity on mortality emphasises the need for an integrated approach directed towards the social determinants of health to prevent multimorbidity and its burden among older adults.

PMID:34794094 | DOI:10.1016/j.puhe.2021.10.001

Bioelectrochemistry. 2021 Oct 26;143:107987. doi: 10.1016/j.bioelechem.2021.107987. Online ahead of print.

ABSTRACT

Electroporation is a well-established technique used to stimulate cells, enhancing membrane permeability by inducing reversible membrane pores. In the absence of experimental observation of the dynamics of pore creation, molecular dynamics studies provide the molecular-level evidence that the electric field promotes pore formation. Although single steps in the pore formation process are well assessed, a kinetic model representing the mathematical description of the electroporation process, is lacking. In the present work we studied the basis of the pore formation process, providing a rationale for the definition of a first-order kinetic scheme. Here, authors propose a three-state kinetic model for the process based on the assessed mechanism of water defects intruding at the water/lipid interface, when applying electric field intensities at the edge of the linear regime. The methodology proposed is based on the use of two robust biophysical quantities analyzed for the water molecules intruding at the water/lipid interface: (i) number of hydrogen bonds; (ii) number of contacts. The final model, sustained by a robust statistical sampling, provides kinetic constants for the transitions from the intact bilayer state to the hydrophobic pore state.

PMID:34794113 | DOI:10.1016/j.bioelechem.2021.107987

Value Health Reg Issues. 2021 Nov 15;28:1-6. doi: 10.1016/j.vhri.2021.02.005. Online ahead of print.

ABSTRACT

BACKGROUND: Gynecological cancers (GCs) are an important cause of morbidity and mortality among women worldwide. The incidence of cancer is increasing in Iran, and according to statistics, it has become the most important cause of mortality. This study aimed to assess the economic burden of GCs, including cervical, ovarian, and endometrial cancers, in Iran in 2014.

METHODS: We used a prevalence-based cost of illness methodology to investigate the annual healthcare cost of GCs and to determine the productivity loss. The productivity loss was estimated, using the human capital approach. We obtained our data from a referral hospital for the year 2014; we also used expert opinion and occupational and statistical data. To estimate direct medical cost, we used bottom-up approach and we estimated the average cost of each procedure, multiplied by the number of patients receiving the procedure.

RESULTS: The total cost of GCs in Iran was estimated at $51 million in 2014. The direct costs were $32 million, and indirect costs were $19 million of the total annual cost. The total cost of ovarian cancer was the highest among 3 cancers.

CONCLUSIONS: Knowing that the cost of GCs has a significant impact on the burden of disease and imposes an economic burden on the country could force policy makers to allocate their resource in the prevention programs and new approach in patient’s management. This could lead to diagnose more GCs in the early stages, reduce mortality, and increase the quality of life.

PMID:34794064 | DOI:10.1016/j.vhri.2021.02.005

Ecotoxicol Environ Saf. 2021 Nov 15;228:112973. doi: 10.1016/j.ecoenv.2021.112973. Online ahead of print.

ABSTRACT

Wastewater contains a wealth of information about the inhabitants of cities. Wastewater-based epidemiology (WBE) has become an effective tool for monitoring public health by analyzing various biomarkers (e.g., chemicals and microorganisms) in wastewater. This way, the estimation of pharmaceuticals’ consumption behavior and/or illicit drugs can be calculated. However, monitoring consumption alone is not the only option. If we consider wastewater as a statistical representation of the population’s health, medical information can be derived. In this work, we used data from 15 different wastewater treatment plants in Slovak Republic to explore correlations between the use of typical pharmaceuticals and illicit drugs. The analysis was based on the wastewater monitoring data from four years (2016-2019), and 68 different compounds were taken into account. One of the strongest correlations found was between Antihyperlipidemics and Antihypertensives, with Pearson’s correlation coefficient of 0.82. This type of analysis within the WBE represents a new potential as an additional source of information for the pharmaceutical, medical and government sectors in assessing health risk factors in the population. Such an evaluation method has even a great potential for artificial intelligence and machine learning for calculating health risk factors together with other sources of data.

PMID:34794023 | DOI:10.1016/j.ecoenv.2021.112973

Clin Neurol Neurosurg. 2021 Oct 30;211:107014. doi: 10.1016/j.clineuro.2021.107014. Online ahead of print.

ABSTRACT

BACKGROUND: Operculoinsular cortectomy is increasingly recognized as a therapeutic avenue for perisylvian refractory epilepsy. However, most neurosurgeons are reluctant to perform this type of procedure because of feared neurological complications, especially in the language-dominant hemisphere, as the insula is involved in speech and language processes. The goal of this retrospective study is to quantify the incidence and types of speech and language deficits associated with operculoinsulectomies in the dominant hemisphere for language, and to identify factors associated with these complications.

METHODS: Clinical, imaging, and surgical data of all patients who had an operculoinsulectomy for refractory epilepsy at our center between 1998 and 2018 were reviewed. Language lateralization was determined by functional magnetic resonance imaging (fMRI) and/or Wada test. Speech and language assessments were carried out by neurosurgeons, neurologists, neuropsychologists and/or speech language pathologists, before surgery, during the first week after surgery, and at least 6 months after surgery.

RESULTS: Amongst 44 operculoinsulectomies, 13 were performed in the language-dominant hemisphere. 46% of these patients presented with transient aphasia post-surgery. However, a few months later, the patients’ performances on language assessments were not statistically different from before surgery, thus suggesting a complete recovery of speech and language functions.

CONCLUSION: Temporary aphasias after operculoinsulectomy for refractory epilepsy in the language-dominant hemisphere are frequent, but eventually subside. Potential mechanisms underlying this recovery are discussed.

PMID:34794058 | DOI:10.1016/j.clineuro.2021.107014

J Acad Nutr Diet. 2021 Nov 15:S2212-2672(21)01486-6. doi: 10.1016/j.jand.2021.11.009. Online ahead of print.

ABSTRACT

BACKGROUND: The health benefits of diets rich in fruits and vegetables (FV) are well established. Recent observational and intervention research suggests that FV consumption may also exert a positive effect on psychological well-being.

OBJECTIVE: This study aimed to assess changes in mean Subjective Happiness Scale (SHS) scores in response to consuming DGA recommended types and amounts of vegetables. It was hypothesized that increased vegetable consumption would increase mean SHS scores.

DESIGN: This study investigated a secondary outcome of a randomized, parallel, non-blinded controlled trial with a 1:1 allocation ratio to a provided vegetable intervention or attention control group.

PARTICIPANTS/SETTING: Men and women (n=75) aged 18-65 years, body mass index ≥25 kg/m², with low habitual vegetable consumption were recruited from Grand Forks, ND, December 2016 to January 2018, for this community-based study.

INTERVENTION: The vegetable intervention consisted of an 8-week feeding phase during which participants were provided with vegetables in DGA recommended types and amounts. The attention control group was not provided vegetables but completed the same testing schedule as the vegetable intervention group.

MAIN OUTCOME MEASURE: Mean SHS scores were assessed before and after the intervention.

STATISTICAL ANALYSES: Mean SHS scores were analyzed using a 2-way factorial mixed linear model analysis of variance.

RESULTS: A significant interaction between treatment and visit (P=0.015) revealed greater mean SHS scores at week 8 than at baseline in the vegetable intervention group (+0.23 ± 0.11 (mean difference ± standard error of the difference) but no change in the attention control group (-0.15 ± 0.11).

CONCLUSIONS: Greater mean SHS scores were observed after increasing vegetable consumption to meet DGA recommendations, suggesting that adhering to DGA vegetable guidance may help promote psychological well-being.

PMID:34793989 | DOI:10.1016/j.jand.2021.11.009

Ecotoxicol Environ Saf. 2021 Nov 15;228:112986. doi: 10.1016/j.ecoenv.2021.112986. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to examine the relationships among N, N-dimethylformamide (DMF) exposure, cytochrome P4502E1 (CYP2E1) single nucleotide polymorphisms (SNPs) (rs2031920, rs3813867, rs6413432), transmembrane 6 superfamily member 2 (TM6SF2) SNP rs58542926 and non-alcoholic fatty liver disease (NAFLD).

METHODS: Baseline data were collected from participants who were then followed for 5 years in a prospective cohort study. The cohort initially consisted of 802 workers and ultimately included 660 people, all of whom underwent annual occupational health examinations from 2010 to 2015.

RESULTS: The above-threshold group (≥7.3 mg/m³ adjusted relative risk (RR)= 3.620, 95%CI 2.072-6.325) was significantly more likely to develop NAFLD than the below-threshold group (<7.3 mg/m³). The TM6SF2 SNP rs58542926 CT (adjusted RR=3.921, 95% CI 2.329-6.600, P = 0.000) and CT+TT (adjusted RR=4.385, 95% CI 2.639-7.287, P = 0.000) genotypes were risk factors for NAFLD, as compared with the TM6SF2 rs58542926 CC genotype. Each dose group (below-threshold group and above-threshold group) interacting with the genotype of TM6SF2 SNP rs58542926 had an adjusted RR from 7.764 (95% CI 3.272-18.420, P = 0.000) to 24.022 (95% CI 8.971-64.328, P = 0.000). The T allele of rs58542926 in the TM6SF2 gene may be a risk factor for susceptibility to DMF-induced NAFLD.

CONCLUSION: Polymorphisms of TM6SF2 SNP rs58542926 may play an important role in susceptibility to NAFLD after exposure to DMF.

PMID:34794021 | DOI:10.1016/j.ecoenv.2021.112986

Contemp Clin Trials. 2021 Nov 15:106625. doi: 10.1016/j.cct.2021.106625. Online ahead of print.

ABSTRACT

MOTIVATION: Platform designs – master protocols that allow for new treatment arms to be added over time – have gained considerable attention in recent years. Between 2001 and 2019, 16 platform trials were initiated globally. The COVID-19 pandemic seems to have provided a new motivation for these designs. We conducted a rapid review to quantify and describe platform trials used in COVID-19.

METHODS: We cross-referenced PubMed, ClinicalTrials.gov, and the Cytel COVID-19 Clinical Trials Tracker to identify platform trials, defined by their stated ability to add future arms.

RESULTS: We identified 58 COVID-19 platform trials globally registered between January 2020 and May 2021. According to trial registries, 16 trials have added new therapies (median 3, IQR 4) and 11 have dropped arms (median 3, IQR 2.5). About 50% of trials publicly share their protocol, and 31 trials (53%) intend to share trial data. Forty-nine trials (84%) explicitly report adaptive features, and 21 trials (36%) state Bayesian methods.

CONCLUSIONS: During the pandemic, there has been a surge in the number of platform trials compared to historical use. While transparency in statistical methods and clarity of data sharing policies needs improvement, platform trials appear particularly well-suited for rapid evidence generation. Trials secured funding quickly and many succeeded in adding new therapies in a short time period, thus demonstrating the potential for these trial designs to be implemented beyond the pandemic. The evidence gathered here may provide ample insight to further inform operational, statistical, and regulatory aspects of future platform trial conduct.

PMID:34793985 | DOI:10.1016/j.cct.2021.106625