Saddlepoint p-values for a class of nonparametric tests for the current status and panel count data under generalized permuted block design

Current status and panel count data appear in many applied fields, including medicine, clinical trials, epidemiology, econometrics, demography, engineering and public health. Therefore, in this article, we use the saddlepoint approximation method to approximate the exact p-value of a number of nonparametric tests for the current status and panel count data under a generalized permuted block design. The saddlepoint approximation is referred to as higher-order approximation and it is more accurate than the methods that lead to approximations that are accurate to the first order, such as the asymptotic normal approximation method. To verify the accuracy and efficiency of the saddlepoint approximation method, a simulation study is conducted. The simulation study results confirm that the saddlepoint approximation method is more powerful than the existing approximation method. Furthermore, number of real current status and panel count data sets are analyzed and displayed as illustrative examples

The Effects of Gamma Irradiation on the Optical and Electrical Properties of Melt Quench Ge18Bi4Se78 Chalcogenide Glass.

The structural, optical, and electrical properties of as-deposited and gamma irradiated (50, 100, 150kGy) Ge18Bi4Se78 thin films have been investigated. The structural characteristics of both the as-deposited and gamma irradiated films are inspected by X-ray diffraction (XRD).The optical constants of all the films are analyzed in the wavelength range 250-2500 nm employing spectrophotometer measurements at normal incidence. The type of transition is estimated using the obtained optical constants. The optical energy gap Eop as well as Urbach Eu energy in addition to plasma frequency ωp are studied. Single oscillator and Drude models are used to discuss the refractive index in the normal dispersion region. The effect of γ irradiation on the DC conductivity of the considered films is inspected

Estimation in Step-Stress Accelerated Life Tests for Weibull Distribution with Progressive First-Failure Censoring

Abstract: Based on progressive first-failure censoring, step-stress partially accelerated life tests are considered when the lifetime of a product follows Weibull distribution. The maximum likelihood estimates (MLEs) are obtained for the distribution parameters and the acceleration factor. In addition, asymptotic variance and covariance matrix of the estimators are given. Furthermore, confidence intervals of the estimators are presented. The optimal stress change time for the step-stress partially accelerated life test is determined by minimizing the asymptotic variance of MLEs of the model parameters and the acceleration factor. Simulation results are carried out to study the precision of the MLEs for the parameters involved

Detection of myocardial infarction based on novel deep transfer learning methods for urban healthcare in smart cities

YesOne of the common cardiac disorders is a cardiac attack called Myocardial infarction (MI), which occurs due to the blockage of one or more coronary arteries. Timely treatment of MI is important and slight delay results in severe consequences. Electrocardiogram (ECG) is the main diagnostic tool to monitor and reveal the MI signals. The complex nature of MI signals along with noise poses challenges to doctors for accurate and quick diagnosis. Manually studying large amounts of ECG data can be tedious and time-consuming. Therefore, there is a need for methods to automatically analyze the ECG data and make diagnosis. Number of studies has been presented to address MI detection, but most of these methods are computationally expensive and faces the problem of overfitting while dealing real data. In this paper, an effective computer-aided diagnosis (CAD) system is presented to detect MI signals using the convolution neural network (CNN) for urban healthcare in smart cities. Two types of transfer learning techniques are employed to retrain the pre-trained VGG-Net (Fine-tuning and VGG-Net as fixed feature extractor) and obtained two new networks VGG-MI1 and VGG-MI2. In the VGG-MI1 model, the last layer of the VGG-Net model is replaced with a specific layer according to our requirements and various functions are optimized to reduce overfitting. In the VGG-MI2 model, one layer of the VGG-Net model is selected as a feature descriptor of the ECG images to describe it with informative features. Considering the limited availability of dataset, ECG data is augmented which has increased the classification performance. A standard well-known database Physikalisch-Technische Bundesanstalt (PTB) Diagnostic ECG is used for the validation of the proposed framework. It is evident from experimental results that the proposed framework achieves a high accuracy surpasses the existing methods. In terms of accuracy, sensitivity, and specificity; VGG-MI1 achieved 99.02%, 98.76%, and 99.17%, respectively, while VGG-MI2 models achieved an accuracy of 99.22%, a sensitivity of 99.15%, and a specificity of 99.49%.This project was funded by University of Jeddah, Jeddah, Saudi Arabia (Project number: UJ-02-018-ICGR)

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. Methods The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model—a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates—with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality—which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. Findings The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2–100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1–290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1–211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4–48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3–37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7–9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. Interpretation Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe