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Paediatrics and International Child... Feb 2015Evidence of global progress in treating acute paediatric infections is lacking. (Review)
Review
BACKGROUND
Evidence of global progress in treating acute paediatric infections is lacking.
OBJECTIVES
To assess progress over two decades in prescribing for childhood infections and interventions to improve treatment by reviewing empirical evidence in developing and transitional countries.
METHODS
Data were systematically extracted on the use of medicines for diarrhoea, respiratory infections and malaria from published and unpublished studies (1990-2009) in children under 5 years of age. Medians of each indicator were calculated across studies by study year, geographic region, sector, country income level and prescriber type. To estimate intervention effects from studies meeting methodologically accepted design criteria [randomised controlled trials (RCTs), pre-post with control, and time series studies], the medians of the median effect sizes (median MES) were calculated across outcome measures.
RESULTS
Data were extracted from 344 studies conducted in 78 countries with 394 distinct study groups in public (64%), private (22%) and other facilities to estimate trends over time. Of 226 intervention studies, only the 44 (19%) with an adequate study design were used to estimate intervention effects. Over time, use of anti-diarrhoeals for acute diarrhoea decreased significantly (P<0.01). However, treatment of malaria and acute respiratory infection remained largely sub-optimal. Multi-component interventions resulted in larger improvements than single-component ones. The median MES indicated a 28% improvement with community case-management, an 18% improvement with provider education combined with consumer education, but only 9% improvement with provider education alone.
CONCLUSIONS
While diarrhoea treatment has improved over the last 20 years, treatment of other childhood illnesses remains sub-optimal. Multi-component interventions demonstrated some success in improving management of acute childhood illness.
Topics: Attitude of Health Personnel; Child, Preschool; Developing Countries; Diarrhea; Drug Prescriptions; Drug Therapy; Drug Utilization; Health Policy; Humans; Infant; Infant, Newborn; Malaria; Respiratory Tract Infections
PubMed: 24621245
DOI: 10.1179/2046905514Y.0000000115 -
IEEE Signal Processing Letters Nov 2012In this letter, we note that the denoising performance of Non-Local Means (NLM) can be improved at large noise levels by replacing the mean by the Euclidean median. We...
In this letter, we note that the denoising performance of Non-Local Means (NLM) can be improved at large noise levels by replacing the mean by the Euclidean median. We call this new denoising algorithm the Non-Local Euclidean Medians (NLEM). At the heart of NLEM is the observation that the median is more robust to outliers than the mean. In particular, we provide a simple geometric insight that explains why NLEM performs better than NLM in the vicinity of edges, particularly at large noise levels. NLEM can be efficiently implemented using iteratively reweighted least squares, and its computational complexity is comparable to that of NLM. We provide some preliminary results to study the proposed algorithm and to compare it with NLM.
PubMed: 24817813
DOI: 10.1109/LSP.2012.2217329 -
The British Journal of Mathematical and... May 2021Growth curve models have been widely used to analyse longitudinal data in social and behavioural sciences. Although growth curve models with normality assumptions are...
Growth curve models have been widely used to analyse longitudinal data in social and behavioural sciences. Although growth curve models with normality assumptions are relatively easy to estimate, practical data are rarely normal. Failing to account for non-normal data may lead to unreliable model estimation and misleading statistical inference. In this work, we propose a robust approach for growth curve modelling using conditional medians that are less sensitive to outlying observations. Bayesian methods are applied for model estimation and inference. Based on the existing work on Bayesian quantile regression using asymmetric Laplace distributions, we use asymmetric Laplace distributions to convert the problem of estimating a median growth curve model into a problem of obtaining the maximum likelihood estimator for a transformed model. Monte Carlo simulation studies have been conducted to evaluate the numerical performance of the proposed approach with data containing outliers or leverage observations. The results show that the proposed approach yields more accurate and efficient parameter estimates than traditional growth curve modelling. We illustrate the application of our robust approach using conditional medians based on a real data set from the Virginia Cognitive Aging Project.
Topics: Bayes Theorem; Computer Simulation; Monte Carlo Method
PubMed: 32926414
DOI: 10.1111/bmsp.12216 -
European Journal of Epidemiology Jul 2020Several studies indicate that prognosis for survival in Duchenne muscular dystrophy (DMD) has improved in recent decades. However, published evidence is inconclusive and... (Meta-Analysis)
Meta-Analysis
Several studies indicate that prognosis for survival in Duchenne muscular dystrophy (DMD) has improved in recent decades. However, published evidence is inconclusive and some estimates may be obsolete due to improvements in standards of care, in particular the routine use of mechanical ventilatory support in advanced stages of the disease. In this systematic review and meta-analysis (PROSPERO identifier: CRD42019121800), we searched MEDLINE (through PubMed), CINAHL, Embase, PsycINFO, and Web of Science for studies published from inception up until December 31, 2018, reporting results of life expectancy in DMD. We pooled median survival estimates from individual studies using the median of medians, and weighted median of medians, methods. Risk of bias was established with the Newcastle-Ottawa Scale. Results were stratified by ventilatory support and risk of bias. We identified 15 publications involving 2662 patients from 12 countries from all inhabited continents except Africa. Median life expectancy without ventilatory support ranged between 14.4 and 27.0 years (pooled median: 19.0 years, 95% CI 18.0-20.9; weighted pooled median: 19.4 years, 18.2-20.1). Median life expectancy with ventilatory support, introduced in most settings in the 1990s, ranged between 21.0 and 39.6 years (pooled median: 29.9 years, 26.5-30.8; weighted pooled median: 31.8 years, 29.3-36.2). Risk of bias had little impact on pooled results. In conclusion, median life expectancy at birth in DMD seems to have improved considerably during the last decades. With current standards of care, many patients with DMD can now expect to live into their fourth decade of life.
Topics: Female; Humans; Life Expectancy; Male; Muscular Dystrophy, Duchenne; Parturition; Pregnancy; Prognosis; Quality of Life; Respiration, Artificial; Survival
PubMed: 32107739
DOI: 10.1007/s10654-020-00613-8 -
Journal of Occupational and... Sep 2023This article compares the impact of COVID-19-related restrictions on the level of physical activity, performed by public servants, in April and November 2020.
OBJECTIVES
This article compares the impact of COVID-19-related restrictions on the level of physical activity, performed by public servants, in April and November 2020.
METHODS
The survey examined the amount (in minutes per week) and the energy expenditure (in metabolic equivalent of task in minutes per week [METmin/week]) of physical activity for both before and during contact restrictions in April and November 2020, respectively.
RESULTS
Especially for sports activity difference was determined by the medians before (April/November: median [Mdn] = 180.0 min/wk) and during (April: Mdn = 130 minutes, November: Mdn = 60 min/wk) restrictions ( P < 0.05).Also for energy consumption (METmin/wk), the medians before and during the contact restrictions declined for both periods.
CONCLUSIONS
Measures against the coronavirus have led to a reduction in activity levels among public employees, regardless of their work environment. The decrease in participation in sport activities seemed to be even more noticeable within the second restriction period.
Topics: Humans; COVID-19; Exercise; Sports; Surveys and Questionnaires; Energy Metabolism
PubMed: 37311075
DOI: 10.1097/JOM.0000000000002906 -
Annals of Surgical Oncology Sep 2017Sexual dysfunction is assumed to be common, but understudied, in breast cancer patients. Herein, we use the validated female sexual functioning index (FSFI) to evaluate...
PURPOSE
Sexual dysfunction is assumed to be common, but understudied, in breast cancer patients. Herein, we use the validated female sexual functioning index (FSFI) to evaluate changes in female sexual function after breast cancer surgery.
METHODS
The FSFI assesses sexual function in six domains (desire, arousal, lubrication, orgasm, satisfaction, pain) on a 36-point scale, with scores >26.6 indicating better sexual function. We identified 226 women with unilateral breast cancer undergoing surgery at our institution from June 2010-January 2015. All completed the FSFI preoperatively and at a median of 13 months postoperatively. We quantified declines in FSFI scores and considered p-values <0.05 statistically significant.
RESULTS
Overall, 119 women had breast-conserving surgery (BCS), 40 had unilateral mastectomy (UM), and 67 had UM plus contralateral prophylactic mastectomy (CPM). All women had similar baseline FSFI scores (medians: BCS, 26.3; UM, 25.2; UM+CPM, 23.7; p = 0.23). At follow-up, sexual function had declined significantly in BCS (23.5; p < 0.001) and UM (17.4; p = 0.010), but was unchanged in UM+CPM (22.8; p = 0.74) women. Interestingly, all women maintained their desire for sex (p = 0.17). BCS and UM women demonstrated significant declines in all other subscale domains (all p < 0.045). UM+CPM women demonstrated no decline in any subscale domain, yet did not exhibit superior sexual function to those having UM or BCS (medians: BCS, 23.5; UM, 17.4; UM+CPM, 22.8; p = 0.21).
CONCLUSIONS
Baseline sexual dysfunction exists in women diagnosed with breast cancer. Surgery negatively impacts sexual function. Patients who choose mastectomy do not exhibit superior sexual function over those having BCS at 13 months following surgery.
Topics: Adult; Aged; Breast Neoplasms; Female; Humans; Mastectomy; Mastectomy, Segmental; Middle Aged; Prophylactic Mastectomy; Sexual Dysfunction, Physiological; Sexuality; Surveys and Questionnaires
PubMed: 28560595
DOI: 10.1245/s10434-017-5894-3 -
JNCI Cancer Spectrum Jan 2022When designing a comparative oncology trial for an overall or progression-free survival endpoint, investigators often quantify the treatment effect using a difference in...
When designing a comparative oncology trial for an overall or progression-free survival endpoint, investigators often quantify the treatment effect using a difference in median survival times. However, rather than directly designing the study to estimate this difference, it is almost always converted to a hazard ratio (HR) to determine the study size. At the analysis stage, the hazard ratio is utilized for formal analysis, yet because it may be difficult to interpret clinically, especially when the proportional hazards assumption is not met, the observed medians are also reported descriptively. The hazard ratio and median difference contrast different aspects of the survival curves. Whereas the hazard ratio places greater emphasis on late-occurring separation, the median difference focuses locally on the centers of the distributions and cannot capture either short- or long-term differences. Having 2 sets of summaries (a hazard ratio and the medians) may lead to incoherent conclusions regarding the treatment effect. For instance, the hazard ratio may suggest a treatment difference whereas the medians do not, or vice versa. In this commentary, we illustrate these commonly encountered issues using examples from recent oncology trials. We present a coherent alternative strategy that, unlike relying on the hazard ratio, does not require modeling assumptions and always results in clinically interpretable summaries of the treatment effect.
Topics: Humans; Medical Oncology; Neoplasms; Proportional Hazards Models; Research Design
PubMed: 35699499
DOI: 10.1093/jncics/pkac007 -
International Journal of Sports Medicine May 2004The purpose of this study was to investigate the influence of cycling on sperm characteristics. Twenty subjects volunteered for the study, comprising 10 long distance... (Clinical Trial)
Clinical Trial
The purpose of this study was to investigate the influence of cycling on sperm characteristics. Twenty subjects volunteered for the study, comprising 10 long distance competitive cyclists (median 25.5 y) and 10 sedentary controls (median 24.5 y). A questionnaire was used to obtain a history of training, health, nutrition and life style. Semen analysis consisted of a detailed evaluation of sperm characteristics that included semen volume, sperm count, viability, motility and morphology. Compared to controls, the cyclists had a significantly lower proportion of spermatozoa with normal morphology (medians: 41.5 % versus 19.5 %; p < 0.01) and a significantly higher proportion of morphologically abnormal tapered forms (medians: 4.5 % versus 22.5 %; p < 0.01). No significant difference in semen volume and sperm motility, viability and count was observed between the two groups. We concluded that endurance cycling appears to be associated with a significant alteration in sperm morphology.
Topics: Adult; Bicycling; Cell Survival; Exercise; Humans; Male; Physical Endurance; Reference Values; Semen; Sperm Count; Spermatogenesis; Spermatozoa
PubMed: 15162242
DOI: 10.1055/s-2004-819933 -
Rehabilitation Nursing : the Official... 2011The purpose of this study was to compare the costs of providing specialty wound care to spinal cord injury/disorder (SCI/D) veterans by teleconsultation and traditional...
The purpose of this study was to compare the costs of providing specialty wound care to spinal cord injury/disorder (SCI/D) veterans by teleconsultation and traditional care. A retrospective design was used to conduct this descriptive, correlational study. A convenience sample of 76 SCI/D veterans (2 women, 74 men) met inclusion criteria from a possible 123 subjects. Variables were compared between groups using nonparametric methods (Wilcoxon rank sums and chi-square). There was no significant difference in inpatient admissions or inpatient bed days of care between the two groups. The teleconsultation group had more outpatient encounters (medians 12 vs. 4, p = .007; Wilcoxon statistic = 412.5) and longer inpatient stays (medians 81 vs. 19 days/admission, p = .05; Wilcoxon statistic = 227.0) compared to the traditional care group. There was no significant difference in inpatient cost between the two groups; however, the teleconsultation group had a significantly higher median cost per outpatient encounter ($440 vs. $141, p <.0001; Wilcoxon statistic = 469.0). Although this study only looked at costs directly associated with wound management, continued research exploring the use of teleconsultation in other areas of SCI/D specialty is needed to enhance its application.
Topics: Aged; Ambulatory Care; Female; Health Care Costs; Humans; Male; Middle Aged; Program Evaluation; Rehabilitation Nursing; Retrospective Studies; Spinal Cord Injuries; Telemedicine; Veterans
PubMed: 21721396
DOI: 10.1002/j.2048-7940.2011.tb00083.x -
BioRxiv : the Preprint Server For... Dec 2023The majority of bacteriophage diversity remains uncharacterised, and new intriguing mechanisms of their biology are being continually described. Members of some phage...
The majority of bacteriophage diversity remains uncharacterised, and new intriguing mechanisms of their biology are being continually described. Members of some phage lineages, such as the , repurpose stop codons to encode an amino acid by using alternate genetic codes. Here, we investigated the prevalence of stop codon reassignment in phage genomes and subsequent impacts on functional annotation. We predicted 76 genomes within INPHARED and 712 vOTUs from the Unified Human Gut Virome catalogue (UHGV) that repurpose a stop codon to encode an amino acid. We re-annotated these sequences with modified versions of Pharokka and Prokka, called Pharokka-gv and Prokka-gv, to automatically predict stop codon reassignment prior to annotation. Both tools significantly improved the quality of annotations, with Pharokka-gv performing best. For sequences predicted to repurpose TAG to glutamine (translation table 15), Pharokka-gv increased the median gene length (median of per genome medians) from 287 to 481 bp for UHGV sequences (67.8% increase) and from 318 to 550 bp for INPHARED sequences (72.9% increase). The re-annotation increased mean coding density from 66.8% to 90.0%, and from 69.0% to 89.8% for UHGV and INPHARED sequences. Furthermore, the proportion of genes that could be assigned functional annotation increased, including an increase in the number of major capsid proteins that could be identified. We propose that automatic prediction of stop codon reassignment before annotation is beneficial to downstream viral genomic and metagenomic analyses.
PubMed: 38187747
DOI: 10.1101/2023.12.19.572299