Multiple Category-Lot Quality Assurance Sampling: A New Classification System with Application to Schistosomiasis Control

Background: Originally a binary classifier, Lot Quality Assurance Sampling (LQAS) has proven to be a useful tool for classification of the prevalence of Schistosoma mansoni into multiple categories (≤10%, >10 and <50%, ≥50%), and semi-curtailed sampling has been shown to effectively reduce the number of observations needed to reach a decision. To date the statistical underpinnings for Multiple Category-LQAS (MC-LQAS) have not received full treatment. We explore the analytical properties of MC-LQAS, and validate its use for the classification of S. mansoni prevalence in multiple settings in East Africa. Methodology We outline MC-LQAS design principles and formulae for operating characteristic curves. In addition, we derive the average sample number for MC-LQAS when utilizing semi-curtailed sampling and introduce curtailed sampling in this setting. We also assess the performance of MC-LQAS designs with maximum sample sizes of n = 15 and n = 25 via a weighted kappa-statistic using S. mansoni data collected in 388 schools from four studies in East Africa. Principle Findings Overall performance of MC-LQAS classification was high (kappa-statistic of 0.87). In three of the studies, the kappa-statistic for a design with n = 15 was greater than 0.75. In the fourth study, where these designs performed poorly (kappa-statistic less than 0.50), the majority of observations fell in regions where potential error is known to be high. Employment of semi-curtailed and curtailed sampling further reduced the sample size by as many as 0.5 and 3.5 observations per school, respectively, without increasing classification error. Conclusion/Significance: This work provides the needed analytics to understand the properties of MC-LQAS for assessing the prevalance of S. mansoni and shows that in most settings a sample size of 15 children provides a reliable classification of schools

About de "Concerto for Viola and Orchestra" of Ángel Oliver Pina. An introduction to the analysis of his music

Este artículo propone, como asunto principal, el análisis de ciertos aspectos fundamentales del «Concierto para viola y orquesta» de Ángel Oliver Pina, principalmente los relacionados con la estructura de la obra, el trasfondo oculto de sus correspondencias interválicas, la articulación de la unidad formal y la función ordenadora de la instrumentación. Desde el análisis de la partitura señalamos, paralelamente, algunos de los rasgos propios del estilo compositivo de Oliver Pina y comentamos someramente su adscripción estética. Como compositor, su música destaca por su rigor constructivo y por el afán, no premeditado, de hacerse comprensible al oyente. De aquí que, estéticamente, el total de su obra, salvo excepciones, no pueda clasificarse ni como vanguardista ni como conservadora. De su independencia y originalidad creativas surge una música caracterizada por una expresividad que anida en un sentido interior del discurso y que no hace ostentación innecesaria de recursos y resultados meramente sonoros. La identificación del hombre y su música es, por momentos, absoluta y eso habla de la autenticidad que recorre los rincones de su obra. El «Concierto para viola», la única partitura de gran formato escrita por Ángel Oliver para instrumento solista y orquesta, es una clara muestra de todo cuanto decimos.As a main subject, this article proposes the analysis of certain essential aspects of the "Concert for viola and orchestra" of Ángel Oliver Pina. The analysis is focused, principally, on those realms related with the structure of the work, the secret background of the correspondences among the notes and intervals, the articulation of the formal unity and the structural function of the instrumentation. In parallel, and from an analysis of the score, some features of his own style as a composer is shown; and his esthetic assignement is also shortly commented. As a composer, his music stands out for its constructive rigour and for his not deliberate desire of being understandable to the listener. That is the reason why esthetically, all of his work, only with a few exceptions, cannot be qualified neither characterized by an expressiveness that nests a speech with a sense of interior, arises; a music that does not take advantage of merely sonorous resources and results. The identification of the man and his music is, at times, total. This fact reflects the authenticity of his work. The "Concert for viola", the only score of large format for a soloist instrument and orchestra, written by Ángel Oliver Pina is a clear example of this proposal

Risk Factors for Long-Term Coronary Artery Calcium Progression in the Multi-Ethnic Study of Atherosclerosis.

BackgroundCoronary artery calcium (CAC) detected by noncontrast cardiac computed tomography scanning is a measure of coronary atherosclerosis burden. Increasing CAC levels have been strongly associated with increased coronary events. Prior studies of cardiovascular disease risk factors and CAC progression have been limited by short follow-up or restricted to patients with advanced disease.Methods and resultsWe examined cardiovascular disease risk factors and CAC progression in a prospective multiethnic cohort study. CAC was measured 1 to 4 times (mean 2.5 scans) over 10 years in 6810 adults without preexisting cardiovascular disease. Mean CAC progression was 23.9 Agatston units/year. An innovative application of mixed-effects models investigated associations between cardiovascular disease risk factors and CAC progression. This approach adjusted for time-varying factors, was flexible with respect to follow-up time and number of observations per participant, and allowed simultaneous control of factors associated with both baseline CAC and CAC progression. Models included age, sex, study site, scanner type, and race/ethnicity. Associations were observed between CAC progression and age (14.2 Agatston units/year per 10 years [95% CI 13.0 to 15.5]), male sex (17.8 Agatston units/year [95% CI 15.3 to 20.3]), hypertension (13.8 Agatston units/year [95% CI 11.2 to 16.5]), diabetes (31.3 Agatston units/year [95% CI 27.4 to 35.3]), and other factors.ConclusionsCAC progression analyzed over 10 years of follow-up, with a novel analytical approach, demonstrated strong relationships with risk factors for incident cardiovascular events. Longitudinal CAC progression analyzed in this framework can be used to evaluate novel cardiovascular risk factors

Prevalence, Awareness, Treatment, and Control of Hypertension in United States Counties, 2001–2009

Hypertension is an important and modifiable risk factor for cardiovascular disease and mortality. Over the last decade, national-levels of controlled hypertension have increased, but little information on hypertension prevalence and trends in hypertension treatment and control exists at the county-level. We estimate trends in prevalence, awareness, treatment, and control of hypertension in US counties using data from the National Health and Nutrition Examination Survey (NHANES) in five two-year waves from 1999–2008 including 26,349 adults aged 30 years and older and from the Behavioral Risk Factor Surveillance System (BRFSS) from 1997–2009 including 1,283,722 adults aged 30 years and older. Hypertension was defined as systolic blood pressure (BP) of at least 140 mm Hg, self-reported use of antihypertensive treatment, or both. Hypertension control was defined as systolic BP less than 140 mm Hg. The median prevalence of total hypertension in 2009 was estimated at 37.6% (range: 26.5 to 54.4%) in men and 40.1% (range: 28.5 to 57.9%) in women. Within-state differences in the county prevalence of uncontrolled hypertension were as high as 7.8 percentage points in 2009. Awareness, treatment, and control was highest in the southeastern US, and increased between 2001 and 2009 on average. The median county-level control in men was 57.7% (range: 43.4 to 65.9%) and in women was 57.1% (range: 43.0 to 65.46%) in 2009, with highest rates in white men and black women. While control of hypertension is on the rise, prevalence of total hypertension continues to increase in the US. Concurrent increases in treatment and control of hypertension are promising, but efforts to decrease the prevalence of hypertension are needed

Comparing the performance of cluster random sampling and integrated threshold mapping for targeting trachoma control, using computer simulation.

BACKGROUND: Implementation of trachoma control strategies requires reliable district-level estimates of trachomatous inflammation-follicular (TF), generally collected using the recommended gold-standard cluster randomized surveys (CRS). Integrated Threshold Mapping (ITM) has been proposed as an integrated and cost-effective means of rapidly surveying trachoma in order to classify districts according to treatment thresholds. ITM differs from CRS in a number of important ways, including the use of a school-based sampling platform for children aged 1-9 and a different age distribution of participants. This study uses computerised sampling simulations to compare the performance of these survey designs and evaluate the impact of varying key parameters. METHODOLOGY/PRINCIPAL FINDINGS: Realistic pseudo gold standard data for 100 districts were generated that maintained the relative risk of disease between important sub-groups and incorporated empirical estimates of disease clustering at the household, village and district level. To simulate the different sampling approaches, 20 clusters were selected from each district, with individuals sampled according to the protocol for ITM and CRS. Results showed that ITM generally under-estimated the true prevalence of TF over a range of epidemiological settings and introduced more district misclassification according to treatment thresholds than did CRS. However, the extent of underestimation and resulting misclassification was found to be dependent on three main factors: (i) the district prevalence of TF; (ii) the relative risk of TF between enrolled and non-enrolled children within clusters; and (iii) the enrollment rate in schools. CONCLUSIONS/SIGNIFICANCE: Although in some contexts the two methodologies may be equivalent, ITM can introduce a bias-dependent shift as prevalence of TF increases, resulting in a greater risk of misclassification around treatment thresholds. In addition to strengthening the evidence base around choice of trachoma survey methodologies, this study illustrates the use of a simulated approach in addressing operational research questions for trachoma but also other NTDs

Factors associated with the performance and cost-effectiveness of using lymphatic filariasis transmission assessment surveys for monitoring soil-transmitted helminths: a case study in Kenya.

Transmission assessment surveys (TAS) for lymphatic filariasis have been proposed as a platform to assess the impact of mass drug administration (MDA) on soil-transmitted helminths (STHs). This study used computer simulation and field data from pre- and post-MDA settings across Kenya to evaluate the performance and cost-effectiveness of the TAS design for STH assessment compared with alternative survey designs. Variations in the TAS design and different sample sizes and diagnostic methods were also evaluated. The district-level TAS design correctly classified more districts compared with standard STH designs in pre-MDA settings. Aggregating districts into larger evaluation units in a TAS design decreased performance, whereas age group sampled and sample size had minimal impact. The low diagnostic sensitivity of Kato-Katz and mini-FLOTAC methods was found to increase misclassification. We recommend using a district-level TAS among children 8-10 years of age to assess STH but suggest that key consideration is given to evaluation unit size

Design and validation of the 1-week memory battery for assessing episodic memory and accelerated long-term forgetting in cognitively unimpaired subjects

Subtle decline in memory is thought to arise in the preclinical phase of Alzheimer's disease (AD). However, detecting these initial cognitive difficulties cross-sectionally has been challenging, and the exact nature of the decline is still debated. Accelerated long-term forgetting (ALF) has been recently suggested as one of the earliest and most sensitive indicators of memory dysfunction in subjects at risk of developing AD. The objective of this study was to design and validate the 1-week memory battery (1WMB) for assessing episodic memory and ALF in cognitively unimpaired individuals.The 1WMB is unique in that it assesses multimodal memory and measures recall at both short delay (20 min) and at long term (1 week). Forty-five cognitively unimpaired subjects were assessed with 1WMB and standardized neuropsychological tests. Subjective cognitive decline (SCD), levels of anxiety and depression, and cognitive reserve were also measured.The tests of 1WMB showed a high internal consistency, and concurrent validity was observed with standard tests of episodic memory and executive functions. The analysis revealed a greater loss of information at 1 week compared to short-term forgetting (20 min). Performance in the 1WMB was affected by age and educational level, but was not associated with levels of anxiety and depression. Unlike standard tests, performance in the 1WMB correlated with measures of SCD.Our findings indicate that the 1WMB has good psychometric properties, and future studies are needed to explore its potential usefulness to assess cognitively unimpaired subjects at increased risk of developing AD. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Early-onset Alzheimer's disease shows a distinct neuropsychological profile and more aggressive trajectories of cognitive decline than late-onset

Early- and late-onset Alzheimer's disease (EOAD and LOAD) share the same neuropathological traits but show distinct cognitive features. We aimed to explore baseline and longitudinal outcomes of global and domain-specific cognitive function in a well characterized cohort of patients with a biomarker-based diagnosis.In this retrospective cohort study, 195 participants were included and classified according to their age, clinical status, and CSF AD biomarker profile: 89 EOAD, 37 LOAD, 46 young healthy controls (age???65?years), and 23 old healthy controls (>65?years). All subjects underwent clinical and neuropsychological assessment, neuroimaging, APOE genotyping and lumbar puncture.We found distinct neuropsychological profiles between EOAD and LOAD at the time of diagnosis. Both groups showed similar performances on memory and language domains, but the EOAD patients displayed worsened deficits in visual perception, praxis, and executive tasks (p?<?0.05). Longitudinally, cognitive decline in EOAD was more pronounced than LOAD in the global outcomes at the expense of these non-amnestic domains. We found that years of education significantly influenced the decline in most of the neuropsychological tests. Besides, the APOE ?4 status showed a significant effect on the decline of memory-related tasks within the EOAD cohort (p?<?0.05).Age of onset is a main factor shaping the cognitive trajectories in AD patients, with younger age driving to a steeper decline of the non-memory domains. Years of education are related to a transversal decline in all cognitive domains and APOE ?4 status to a specific decline in memory performance in EOAD.© 2022 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association