Tag: statistics

Epilepsia. 2021 Mar 11. doi: 10.1111/epi.16864. Online ahead of print.

ABSTRACT

OBJECTIVE: Although temporal lobe epilepsy (TLE) is recognized as a system-level disorder, little work has investigated pathoconnectomics from a dynamic perspective. By leveraging computational simulations that quantify patterns of information flow across the connectome, we tested the hypothesis that network communication is abnormal in this condition, studied the interplay between hippocampal- and network-level disease effects, and assessed associations with cognition.

METHODS: We simulated signal spreading via a linear threshold model that temporally evolves on a structural graph derived from diffusion-weighted magnetic resonance imaging (MRI), comparing a homogeneous group of 31 patients with histologically proven hippocampal sclerosis to 31 age- and sex-matched healthy controls. We evaluated the modulatory effects of structural alterations of the neocortex and hippocampus on network dynamics. Furthermore, multivariate statistics addressed the relationship with cognitive parameters.

RESULTS: We observed a slowing of in- and out-spreading times across multiple areas bilaterally, indexing delayed information flow, with the strongest effects in ipsilateral frontotemporal regions, thalamus, and hippocampus. Effects were markedly reduced when controlling for hippocampal volume but not cortical thickness, underscoring the central role of the hippocampus in whole-brain disease expression. Multivariate analysis associated slower spreading time in frontoparietal, limbic, default mode, and subcortical networks with impairment across tasks tapping into sensorimotor, executive, memory, and verbal abilities.

SIGNIFICANCE: Moving beyond descriptions of static topology toward the formulation of brain dynamics, our work provides novel insight into structurally mediated network dysfunction and demonstrates that altered whole-brain communication dynamics contribute to common cognitive difficulties in TLE.

PMID:33705572 | DOI:10.1111/epi.16864

Clin Exp Allergy. 2021 Mar 11. doi: 10.1111/cea.13864. Online ahead of print.

ABSTRACT

BACKGROUND: Several maternal conditions can affect foetal growth, and asthma during pregnancy is known to be associated with lower birth weight and shorter gestational age.

OBJECTIVE: In a new Swedish cohort study on maternal asthma exposure and stress during pregnancy (MAESTRO), we have assessed if there is evidence of early foetal growth restriction in asthmatic women or if a growth restriction might come later during pregnancy.

METHODS: We recruited women from eight antenatal clinics in Stockholm, Sweden. Questionnaires on background factors, asthma status and stress were assessed during pregnancy. The participants were asked to consent to collection of medical records including ultrasound measures during pregnancy, and linkage to national health registers. In women with and without asthma, we studied reduced or increased growth by comparing the second trimester ultrasound with first trimester estimation. We defined reduced growth as estimated days below the 10^th percentile and increased growth as days above the 90^th percentile. At birth, the weight and length of the newborn and the gestational age was compared between women with and without asthma.

RESULTS: We enrolled 1693 participants in early pregnancy and collected data on deliveries and ultrasound scans in 1580 pregnancies, of which 18% of the mothers had asthma. No statistically significant reduced or increased growth between different measurement points were found when women with and without asthma were compared; adjusted odds ratios for reduced growth between first and second trimester 1.11 95 % CI (0.63 – 1.95) and increased growth 1.09 95% CI (0.68 – 1.77).

CONCLUSION AND CLINICAL RELEVANCE: In conclusion, we could not find evidence supporting an influence of maternal asthma on early foetal growth in the present cohort: Although the relatively small sample size, which may enhance the risk of a type II error, it is concluded that a potential difference is likely to be very small.

PMID:33705581 | DOI:10.1111/cea.13864

J Osteopath Med. 2021 Mar 11. doi: 10.1515/jom-2020-0288. Online ahead of print.

ABSTRACT

CONTEXT: Recent studies have suggested a connection between low back pain (LBP) and urinary tract infections (UTI). These disturbances could be triggered via visceral-somatic pathways, and there is evidence that kidney mobility is reduced in patients suffering from nonspecific LBP. Manual treatment of the perinephric fascia could improve both kidney mobility and LBP related symptoms.

OBJECTIVES: To assess whether manual treatment relieves UTI and reduces pain in patients with nonspecific LBP through improvement in kidney mobility.

METHODS: Records from all patients treated at a single physical therapy center in 2019 were retrospectively reviewed. Patients were included if they were 18 years of age or older, had nonspecific LBP, and experienced at least one UTI episode in the 3 months before presentation. Patients were excluded if they had undergone manipulative treatment in the 6 months before presentation, if they had one of several medical conditions, if they had a history of chronic pain medication use, and more. Patient records were divided into two groups for analysis: those who were treated with manipulative techniques of the fascia with thrust movement (Group A) vs those who were treated without thrust movement (Group B). Kidney Mobility Scores (KMS) were analyzed using high resolution ultrasound. Symptoms as reported at patients’ 1 month follow up visits were also used to assess outcomes; these included UTI relapse, lumbar spine mobility assessed with a modified Schober test, and lumbar spine pain.

RESULTS: Of 126 available records, 20 patients were included in this retrospective study (10 in Group A and 10 in Group B), all of whom who completed treatment and attended their 1 month follow up visit. Treatments took place in a single session for all patients and all underwent ultrasound of the right kidney before and after treatment. The mean (± standard deviation) KMS (1.9 ± 1.1), mobility when bending (22.7 ± 1.2), and LBP scores (1.2 ± 2.6) of the patients in Group A improved significantly in comparison with the patients in Group B (mean KMS, 1.1 ± 0.8; mobility when bending, 21.9 ± 1.1; and LBP, 3.9 ± 2.7) KMS, p<0.001; mobility when bending, p=0.003; and LBP, p=0.007). At the 1 month follow up visit, no significant statistical changes were observed in UTI recurrence (secondary outcome) in Group A (-16.5 ± 4.3) compared with Group B (-20.4 ± 7) (p=0.152).

CONCLUSIONS: Manual treatments for nonspecific LBP associated with UTI resulted in improved mobility and symptoms for patients in this retrospective study, including a significant increase in kidney mobility.

PMID:33705610 | DOI:10.1515/jom-2020-0288

PLoS One. 2021 Mar 11;16(3):e0248132. doi: 10.1371/journal.pone.0248132. eCollection 2021.

ABSTRACT

BACKGROUND: COVID-19 is a rapidly spreading disease that has caused extensive burden to individuals, families, countries, and the world. Effective treatments of COVID-19 are urgently needed. This is the second edition of a living systematic review of randomized clinical trials assessing the effects of all treatment interventions for participants in all age groups with COVID-19.

METHODS AND FINDINGS: We planned to conduct aggregate data meta-analyses, trial sequential analyses, network meta-analysis, and individual patient data meta-analyses. Our systematic review was based on PRISMA and Cochrane guidelines, and our eight-step procedure for better validation of clinical significance of meta-analysis results. We performed both fixed-effect and random-effects meta-analyses. Primary outcomes were all-cause mortality and serious adverse events. Secondary outcomes were admission to intensive care, mechanical ventilation, renal replacement therapy, quality of life, and non-serious adverse events. According to the number of outcome comparisons, we adjusted our threshold for significance to p = 0.033. We used GRADE to assess the certainty of evidence. We searched relevant databases and websites for published and unpublished trials until November 2, 2020. Two reviewers independently extracted data and assessed trial methodology. We included 82 randomized clinical trials enrolling a total of 40,249 participants. 81 out of 82 trials were at overall high risk of bias. Meta-analyses showed no evidence of a difference between corticosteroids versus control on all-cause mortality (risk ratio [RR] 0.89; 95% confidence interval [CI] 0.79 to 1.00; p = 0.05; I2 = 23.1%; eight trials; very low certainty), on serious adverse events (RR 0.89; 95% CI 0.80 to 0.99; p = 0.04; I2 = 39.1%; eight trials; very low certainty), and on mechanical ventilation (RR 0.86; 95% CI 0.55 to 1.33; p = 0.49; I2 = 55.3%; two trials; very low certainty). The fixed-effect meta-analyses showed indications of beneficial effects. Trial sequential analyses showed that the required information size for all three analyses was not reached. Meta-analysis (RR 0.93; 95% CI 0.82 to 1.07; p = 0.31; I2 = 0%; four trials; moderate certainty) and trial sequential analysis (boundary for futility crossed) showed that we could reject that remdesivir versus control reduced the risk of death by 20%. Meta-analysis (RR 0.82; 95% CI 0.68 to 1.00; p = 0.05; I2 = 38.9%; four trials; very low certainty) and trial sequential analysis (required information size not reached) showed no evidence of difference between remdesivir versus control on serious adverse events. Fixed-effect meta-analysis showed indications of a beneficial effect of remdesivir on serious adverse events. Meta-analysis (RR 0.40; 95% CI 0.19 to 0.87; p = 0.02; I2 = 0%; two trials; very low certainty) showed evidence of a beneficial effect of intravenous immunoglobulin versus control on all-cause mortality, but trial sequential analysis (required information size not reached) showed that the result was severely underpowered to confirm or reject realistic intervention effects. Meta-analysis (RR 0.63; 95% CI 0.35 to 1.14; p = 0.12; I2 = 77.4%; five trials; very low certainty) and trial sequential analysis (required information size not reached) showed no evidence of a difference between tocilizumab versus control on serious adverse events. Fixed-effect meta-analysis showed indications of a beneficial effect of tocilizumab on serious adverse events. Meta-analysis (RR 0.70; 95% CI 0.51 to 0.96; p = 0.02; I2 = 0%; three trials; very low certainty) showed evidence of a beneficial effect of tocilizumab versus control on mechanical ventilation, but trial sequential analysis (required information size not reached) showed that the result was severely underpowered to confirm of reject realistic intervention effects. Meta-analysis (RR 0.32; 95% CI 0.15 to 0.69; p < 0.00; I2 = 0%; two trials; very low certainty) showed evidence of a beneficial effect of bromhexine versus standard care on non-serious adverse events, but trial sequential analysis (required information size not reached) showed that the result was severely underpowered to confirm or reject realistic intervention effects. Meta-analyses and trial sequential analyses (boundary for futility crossed) showed that we could reject that hydroxychloroquine versus control reduced the risk of death and serious adverse events by 20%. Meta-analyses and trial sequential analyses (boundary for futility crossed) showed that we could reject that lopinavir-ritonavir versus control reduced the risk of death, serious adverse events, and mechanical ventilation by 20%. All remaining outcome comparisons showed that we did not have enough information to confirm or reject realistic intervention effects. Nine single trials showed statistically significant results on our outcomes, but were underpowered to confirm or reject realistic intervention effects. Due to lack of data, it was not relevant to perform network meta-analysis or possible to perform individual patient data meta-analyses.

CONCLUSIONS: No evidence-based treatment for COVID-19 currently exists. Very low certainty evidence indicates that corticosteroids might reduce the risk of death, serious adverse events, and mechanical ventilation; that remdesivir might reduce the risk of serious adverse events; that intravenous immunoglobin might reduce the risk of death and serious adverse events; that tocilizumab might reduce the risk of serious adverse events and mechanical ventilation; and that bromhexine might reduce the risk of non-serious adverse events. More trials with low risks of bias and random errors are urgently needed. This review will continuously inform best practice in treatment and clinical research of COVID-19.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020178787.

PMID:33705495 | DOI:10.1371/journal.pone.0248132

PLoS One. 2021 Mar 11;16(3):e0248421. doi: 10.1371/journal.pone.0248421. eCollection 2021.

ABSTRACT

Postoperative hearing improvement is one of the main expectations for patients receiving tympanoplasty. The capacity to predict postoperative hearing may help to counsel a patient properly and avoid untoward expectations. It is difficult to predict postoperative hearing without knowing the disease process in the middle ear, which can only be assessed intraoperatively. However, the duration and extent of the underlying pathologies may represent in bone-conduction threshold and air-bone gap. Here in patients undergoing tympanoplasty without ossiculoplasty, we sorted and separated the surgery dates into the first group to build the predicting models and the second group to test the predictions. There were 87 and 30 ears, respectively. No specific enrollment or exclusion criteria were based on underlying pathologies such as the perforation size of the tympanic membrane or the middle ear conditions. The results show that bone-conduction threshold and air-bone gap together predicted air-conduction threshold after the surgery, including each frequency of 0.5k, 1k, 2k, and 4k Hz. The discrepancies between the predictions and recordings did not differ among these four frequencies. Of the variance in mean postoperative air-conduction threshold, 56.7% was linearly accounted for by these two preoperative predictors in this sample. The results suggest a trend that, the higher the frequency, the larger the part was accounted for by these two preoperative predictors. These together may help a surgeon to estimate frequency-specific hearing outcome after the surgery, answer patients’ questions with quantitative statistics, and counsel patients with proper expectations.

PMID:33705499 | DOI:10.1371/journal.pone.0248421

J Natl Cancer Inst. 2021 Mar 10:djab035. doi: 10.1093/jnci/djab035. Online ahead of print.

ABSTRACT

BACKGROUND: Accumulated evidence supports the existence of sex-associated differences in immune systems. Understanding the role of sex in immune-related adverse events (irAEs) is important for management of irAE in patients receiving immunotherapy.

METHODS: We performed meta-analysis on published clinical study data and multivariable logistic regression on pharmacovigilance data and applied a propensity algorithm to The Cancer Genome Atlas (TCGA) omics data. We further validated our observations in two independent in-house cohorts of 179 and 767 cancer patients treated with immune checkpoint inhibitors.

RESULTS: A meta-analysis using 13 clinical studies that reported on 1,096 female patients (36.8%, 95% confidence interval [CI] = 35.0%-38.5%) and 1,886 male patients (63.2%, 95% CI = 61.5%-65.0%) demonstrated no statistically significant irAE risk difference between the sexes (odds ratio [OR] = 1.19; 95% CI = 0.91-1.54; 2-sided P = 0.21). Multivariable logistic regression analysis of 12,225 patients from FAERS and 10,979 patients from VigiBase showed no statistically significant difference in irAEs by sex. A propensity score algorithm used on multi-omics data for 6,019 patients from TCGA found no statistically significant difference by sex for irAE-related factors/pathways. The retrospective analysis of two in-house patient cohorts validated these results (OR = 1.55, 95% CI = 0.98-2.47; FDR = 0.13, for cohort 1; OR = 1.16, 95%CI = 0.86-1.57; FDR = 0.39, for cohort 2).

CONCLUSION: We observed minimal sex-associated differences in irAEs among cancer patients who received immune checkpoint inhibitor therapy. It may be unnecessary to consider gender effects for irAE management in clinical practice.

PMID:33705549 | DOI:10.1093/jnci/djab035

PLoS One. 2021 Mar 11;16(3):e0248152. doi: 10.1371/journal.pone.0248152. eCollection 2021.

ABSTRACT

BACKGROUND: The development of mobile computing technology has enabled the delivery of psychological interventions while people go about their everyday lives. The original visions of the potential of these “ecological momentary interventions” were presented over a decade ago, and the widespread adoption of smartphones in the intervening years has led to a variety of research studies exploring the feasibility of these aspirations. However, there is a dearth of research describing the different dimensions, characteristics, and features of these interventions, as constructed.

OBJECTIVE: To provide an overview of the definitions given for “ecological momentary interventions” in the treatment of common mental health disorders, and describe the set of technological and interaction possibilities which have been used in the design of these interventions.

METHODS: A systematic search identified relevant literature published between 2009 and 2020 in the PubMed, PsycInfo, and ACM Guide to the Computing Literature databases. Following screening, data were extracted from eligible articles using a standardized extraction worksheet. Selected articles were then thematically categorized.

RESULTS: The search identified 583 articles of which 64 met the inclusion criteria. The interventions target a range of mental health problems, with diverse aims, intervention designs and evaluation approaches. The studies employed a variety of features for intervention delivery, but recent research is overwhelmingly comprised of studies based on smartphone apps (30 of 42 papers that described an intervention). Twenty two studies employed sensors for the collection of data in order to provide just-in-time support or predict psychological states.

CONCLUSIONS: With the shift towards smartphone apps, the vision for EMIs has begun to be realised. Recent years have seen increased exploration of the use of sensors and machine learning, but the role of humans in the delivery of EMI is also varied. The variety of capabilities exhibited by EMIs motivates development of a more precise vocabulary for capturing both automatic and human tailoring of these interventions.

PMID:33705457 | DOI:10.1371/journal.pone.0248152

PLoS One. 2021 Mar 11;16(3):e0248384. doi: 10.1371/journal.pone.0248384. eCollection 2021.

ABSTRACT

Prior studies indicated that actively using social network sites (SNSs) is positively associated with well-being by enhancing social support and feelings of connectedness. Conversely, passively using SNSs is negatively associated with well-being by fostering upward social comparison and envy. However, the majority of these studies has focused on Facebook. The present research examined the relationships between well-being-satisfaction with life, negative affect, positive affect-and using actively or passively various SNSs-Facebook, Instagram, Twitter, TikTok-during the COVID-19 pandemic. In addition, two mediators were tested: social support and upward social comparison. One thousand four persons completed an online survey during the quarantine measures; the analyses employed structural equation modeling. Results showed that passive usage of Facebook is negatively related to well-being through upward social comparison, whereas active usage of Instagram is positively related to satisfaction with life and negative affect through social support. Furthermore, active usage of Twitter was positively related to satisfaction with life through social support; while passive usage was negatively related to upward social comparison, which, in turn, was associated with more negative affect. Finally, TikTok use was not associated with well-being. Results are discussed in line with SNSs’ architectures and users’ motivations. Future research is required to go beyond methodological and statistical limitations and allow generalization. This study concludes that SNSs must be differentiated to truly understand how they shape human interactions.

PMID:33705462 | DOI:10.1371/journal.pone.0248384

PLoS One. 2021 Mar 11;16(3):e0247932. doi: 10.1371/journal.pone.0247932. eCollection 2021.

ABSTRACT

OBJECTIVE: The objective of this study was to assess the validity of the Strengths and Difficulties Questionnaire in a cohort of New Zealand children followed from birth to the age of eleven. The study also aimed to assess the stability of the child data in relation to behavioural outcomes during this period.

METHODS: Children in the Auckland Birthweight Collaborative Study were assessed at approximately 3½, 7 and 11 years of age. At all time-points parents completed the parent version of the Strengths and Difficulties Questionnaire, and the children themselves completed the self-report version at 11 years of age. The validity and internal consistency were assessed using exploratory factor analysis, Cronbach’s alpha, and McDonald’s Omega. Cross tabulations and Chi-square statistics were used to determine whether Total Difficulty scores, as per accepted cut-offs, remained stable over time (between normal and abnormal/borderline categories).

RESULTS: The factor structure remained relatively consistent across all three time-points, though several questions did not load as per the originally published factor analysis at the earliest age. The internal consistency of the Strengths and Difficulties Questionnaire was good at all time-points and for parent- and child-completed versions. There was low agreement in the total scores between time points.

CONCLUSIONS: The factor analysis shows that the Strengths and Difficulties Questionnaire has a similar factor structure, particularly in older ages, to that previously published and shows good internal consistency. At the pre-school follow up, a larger than expected proportion of children were identified with high scores, particularly in the conduct sub-scale. Children’s behaviour changes over time, with only poor to moderate agreement between those identified as abnormal or borderline over the longitudinal follow up.

PMID:33705464 | DOI:10.1371/journal.pone.0247932

PLoS One. 2021 Mar 11;16(3):e0248319. doi: 10.1371/journal.pone.0248319. eCollection 2021.

ABSTRACT

The outbreak of COVID-19 around the world has caused great damage to the global economy. The tourism industry is among the worst-hit industries. How to focus on visitors who are most helpful to the tourism industry and develop sustainable strategy of operation is a very important question for after the epidemic is over. This study applied two-stage data envelopment analysis (DEA) and principal component analysis (PCA) to investigate past statistics from the Tourism Bureau and explore the shopping patterns of tourists who travel to Taiwan. The focus will be on tourists from major countries such as China, Japan, and Southeast Asian countries. According to the analysis of tourists from different countries, the money spent by tourists from different countries is concentrated on different items, and there are subitems that they particularly like to purchase. For the analysis of the purpose of coming to Taiwan, some tourism areas worth developing (such as medical treatment and leisure) are also presented in the research results. Based on these results, and according to the sustainable development goals, specific recommendations for the sustainability strategy of operation are made as a reference for the government and relevant industries. This research also broadens the scope of application of DEA and points out a different direction for future research.

PMID:33705479 | DOI:10.1371/journal.pone.0248319