Safety Evaluation of Pedestrian Countdown Signals: Definitive Results from Two Cities in the United States

The pedestrian countdown signals (PCS) treatment involves the display of a numerical countdown that shows how many seconds are left in the flashing DON’T WALK interval. Although many studies have attempted to evaluate the safety of PCS, the results have been inconsistent for many reasons, including inadequate sample size and the inability to control for possible bias from regression to the mean and from exposure. This study performed a before-after empirical Bayes analysis using data from 115 treated intersections in Charlotte, North Carolina and 218 treated intersections in Philadelphia, Pennsylvania to evaluate the safety effects of PCS. The evaluation also included 136 reference intersections in Charlotte, and 597 reference intersections in Philadelphia. Following the implementation of PCS, total crashes decreased by approximately 8% and rear-end crashes decreased by approximately 12%, and these reductions were statistically significant at the 95% confidence level. Pedestrian crashes decreased by about 9% and this reduction was statistically significant at the 90% confidence level. Economic analysis revealed a benefit-cost ratio of 23 with a low of 13 and a high of 32.

Mapping Consistent, Reproducible, and Transcriptionally Relevant Connectome Hubs of the Human Brain

Macroscopic functional connectomic analyses have identified sets of densely connected regions in the human brain, known as connectome hubs, which play a vital role in understanding network communication, cognitive processing, and brain disorders. However, anatomical locations of functional connectome hubs are largely inconsistent and less reproducible among extant reports, partly due to inadequate sample size and differences in image processing and network analysis. Moreover, the genetic signatures underlying the robust connectome hubs remain unknown. Here, we conduct the first worldwide voxelwise meta-connectomic analysis by pooling resting-state functional MRI data of 5,212 healthy young adults across 61 independent international cohorts with harmonized image processing and network analysis protocols. We identify highly consistent and reproducible functional connectome hubs that are spatially distributed in multiple heteromodal and unimodal regions, with the most robust findings mainly located in lateral parietal regions. These connectome hubs show unique, heterogeneous connectivity profiles and are critical for both intra- and inter-network communications. Using transcriptome data from the Allen Human Brain Atlas and BrainSpan Atlas as well as machine learning, we demonstrate that these robust hubs are significantly associated with a transcriptomic pattern dominated by genes involved in the neuropeptide signaling pathway, neurodevelopmental processes, and cellular metabolic processes. This pattern represents microstructural and metabolic substrates underlying the development and functioning of brain hubs. Together, these results highlight robustness of macroscopic connectome hubs of the human brain and their potential cellular and molecular underpinnings and have implications for understanding how brain hubs support the connectome organization in health and disease.

Offline signature recognition system using oriented FAST and rotated BRIEF

Despite recent developments in offline signature recognition systems, there is however limited focus on the recognition problem facet of using an inadequate sample size for training that could deliver reliable and easy to use authentication systems. Signature recognition systems are one of the most popular biometric authentication systems. They are regarded as non-invasive, socially accepted, and adequately precise. Research on offline signature recognition systems still has not shown competent results when a limited number of signatures are used. This paper describes our proposed practical offline signature recognition system using the oriented FAST and rotated BRIEF (ORB) feature extraction algorithm. We focus on the practicality of the proposed system, which requires only the minimum number of signatures per user to achieve a high level of fidelity. We manifest the practicality of our approach with a signature database of 300 signatures from 100 different individuals, implying that only two signatures are needed per person to train the proposed system. Our proposed solution achieves a 91% recognition rate with a median matching time of only 7 ms.

The Impact of Calcitriol on Orthodontic Tooth Movement: A Cumulative Systematic Review and Meta-Analysis

A cumulative review with a systematic approach aimed to provide a comparison of studies’ investigating the possible impact of the active form of vitamin D3, calcitriol (CTL), on the tooth movement caused by orthodontic forces (OTM) by evaluating the quality of evidence, based on collating current data from animal model studies, in vivo cell culture studies, and human clinical trials. Methods: A strict systematic review protocol was applied following the application of the International Prospective Register of Systematic Reviews (PROSPERO). A structured search strategy, including main keywords, was defined during detailed search with the application of electronic database systems: Medline/Pubmed, EMBASE, Scopus, Web of Science, and PsycINFO. In addition, a search was carried out with the use of ClinicalTrials.gov search in order to include ongoing or recently completed trials. The Oxford Level of Evidence and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was utilized to critically evaluate the risk of bias and relative quality of studies included. Meta-analysis with the use of RevMan5 software, random effect, and inverted variable method allowed the quantification of cumulative results. Results: Twenty-seven studies were identified which fulfilled inclusion criteria, including two clinical studies. The assessed level of evidence was variable and inconsistent, predominantly being moderate or low due to a significant difference in study design, sample size, and study protocols. Data synthesis rendered from meta-analysis involving various CTL doses demonstrated slight discrepancies in tooth movement between control and experimental groups (mean difference = 0.27; 95% CI: 0.01–0.53, std mean difference = 0.49; 95% CI: 0.09–0.89), as well as relatively moderate heterogenicity. Conclusions: Although it has been suggested that CTL could accelerate OTM in animal studies and clinical context, these scarce data were supported by a low level of evidence and the studies were carried out using inadequate sample size. Well-powered RCT studies would help to overcome the lack of robustness of the research.

Prevalence and incidence of diabetic peripheral neuropathy in Latin America and the Caribbean: A systematic review and meta-analysis

Aims The objective of this systematic review and meta-analysis is to estimate the prevalence and incidence of diabetic peripheral neuropathy (DPN) in Latin America and the Caribbean (LAC). Materials and methods We searched MEDLINE, SCOPUS, Web of Science, EMBASE and LILACS databases of published observational studies in LAC up to December 2020. Meta-analyses of proportions were performed using random-effects models using Stata Program 15.1. Heterogeneity was evaluated through sensitivity, subgroup, and meta-regression analyses. Evidence certainty was performed with the GRADE approach. Results Twenty-nine studies from eight countries were included. The estimated prevalence of DPN was 46.5% (95%CI: 38.0–55.0) with a significant heterogeneity (I2 = 98.2%; p<0.01). Only two studies reported incidence, and the pooled effect size was 13.7% (95%CI: 10.6–17.2). We found an increasing trend of cumulative DPN prevalence over time. The main sources of heterogeneity associated with higher prevalence were diagnosis criteria, higher A1c (%), and inadequate sample size. We judge the included evidence as very low certainty. Conclusion The overall prevalence of DPN is high in LAC with significant heterogeneity between and within countries that could be explained by population type and methodological aspects. Significant gaps (e.g., under-representation of most countries, lack of incidence studies, and heterogenous case definition) were identified. Standardized and population-based studies of DPN in LAC are needed.

Subnational estimates of factors associated with under-five mortality in Kenya: a spatio-temporal analysis, 1993–2014

BackgroundTo improve child survival, it is necessary to describe and understand the spatial and temporal variation of factors associated with child survival beyond national aggregates, anchored at decentralised health planning units. Therefore, we aimed to provide subnational estimates of factors associated with child survival while elucidating areas of progress, stagnation and decline in Kenya.MethodsTwenty household surveys and three population censuses conducted since 1989 were assembled and spatially aligned to 47 subnational Kenyan county boundaries. Bayesian spatio-temporal Gaussian process regression models accounting for inadequate sample size and spatio-temporal relatedness were fitted for 43 factors at county level between 1993 and 2014.ResultsNationally, the coverage and prevalence were highly variable with 38 factors recording an improvement. The absolute percentage change (1993–2014) was heterogeneous ranging between 1% and 898%. At the county level, the estimates varied across space and over time with a majority showing improvements after 2008 which was preceded by a period of deterioration (late-1990 to early-2000). Counties in Northern Kenya were consistently observed to have lower coverage of interventions and remained disadvantaged in 2014 while areas around Central Kenya had and historically have had higher coverage across all intervention domains. Most factors in Western and South-East Kenya recorded moderate intervention coverage although having a high infection prevalence of both HIV and malaria.ConclusionThe heterogeneous estimates necessitates prioritisation of the marginalised counties to achieve health equity and improve child survival uniformly across the country. Efforts are required to narrow the gap between counties across all the drivers of child survival. The generated estimates will facilitate improved benchmarking and establish a baseline for monitoring child development goals at subnational level.

Administration of Single-Dose Antibiotic Does Not Decrease Oronasal Fistula Rates After Primary Palatoplasty

Objective: Oronasal fistula (ONF) is a known complication after primary palatoplasty (PP). Studies investigating the effect of perioperative antibiotics on fistula rates after PP are limited by inadequate sample size or reliance on self-reporting through national databases. In this study, the authors evaluated the association between single-dose perioperative antibiotics and postoperative fistula rates after PP at a single institution. Design: A retrospective study. Participants: Children younger than 2 years who underwent PP from April 2009 to September 2019 were included. Interventions: Patients were divided into 2 categories: Group 1 received a single intraoperative dose of IV antibiotic, while group 2 did not. Main Outcome Measure(s): Outcome measures included ONF formation, length of stay (LOS), and 30-day readmission rates. Multivariable firth logistic regression, quantile regression, and χ2 tests were performed. Results: Of the 424 patients, 215 and 209 patients were in groups 1 and 2, respectively. The overall ONF rate was 1.9% among all patients. Patients in group 1 experienced an ONF rate of 3.3%, while patients in group 2 had an ONF rate of 0.5%. After correcting for confounding variables, the difference in ONF rates was not statistically different ( P = .68). Median LOS was 35.7 hours and 35.5 hours ( P = .17), while the rate of readmission within 30 days was 4.7% and 2.4% for group 1 and 2, respectively ( P = .96). Conclusions: Administration of a single-dose perioperative antibiotic did not decrease fistula formation after PP, nor did it affect the patient’s LOS or 30-day readmission rate.

Pharmacological and Non-Pharmacological Intervention to Prevent Preeclampsia: A Systematic Literature Review

<p class="TextAbstract"><strong>Background:</strong> Preeclampsia is a disorder of pregnancy that increases risk for long-term health consequences for both mother and child, and if left untreated is one of the main causes of maternal and fetal mortality. However, delivery of the placenta is the only cure, making prevention options for this condition needed but little consensus exist on their effectiveness. Thus, we conducted a systematic review on the effectiveness of pharmacological and non-pharmacological interventions to prevent preeclampsia. <strong>Methods:</strong> We used MEDLINE and ProQuest to conduct a systematic search for peer-review publications on prevention of preeclampsia. We selected studies conducted in human and published in English from 2010 through 2020 on: i) types of interventions; ii) quality of studies and limitations. We selected 22 articles to be reviewed. <strong>Results:</strong> Eleven types of pharmacological and non-pharmacological interventions were identified. Nitric Oxide-donors with Isosorbide Mononitrate (IMN), and aspirin have been shown to be effective, while selenium, calcium, vitamin D, DHA-rich fish oil-concentrate, copper, phytonutrient, Nitric Oxide-donors with Penthaerythrityl Tetranitrate (PETN), folic acid, vitamins C and E and magnesium have not been proved effective to prevent preeclampsia. Although all studies presented good quality of evidence, they had several limitations, the most common limitations are lack of initial therapy, lack of dosage, and inadequate sample size to detect small effect. <strong>Conclusion:</strong> Despite the growing evidence of treatments to prevent preeclampsia, their effect is not large. More research is needed in the field before prevention treatments are prescribed in clinical settings.</p><p class="TextAbstract"><strong>Keywords</strong><strong>: </strong>prevention; pharmacological; non-pharmacological; Systematic Literature Review; preeclampsia.</p>

Abstract 13582: The Effect of Time-restricted Feeding on Weight: A Randomized Feeding Trial

Introduction: Time-restricted feeding (TRF) may improve cardiometabolic outcomes. Prior studies of TRF in humans were limited by lack of randomization and controlled feeding, inadequate sample size and short duration. Hypothesis: Participants following a TRF pattern will lose more weight at 12 weeks than those following a Usual Feeding Pattern (UFP). Methods: We randomized 41 adults with BMI 30-49.9 kg/m 2 and HbA1c 5.7-6.9% to either TRF (80% of total calories before 1 pm) or a UFP (50% of calories after 5 pm) for 12 weeks. Dietary caloric requirement for weight maintenance was determined at baseline for each participant and held constant during the intervention. Participants in both arms consumed the same diet with the same nutrient and food content and only consumed food prepared by the study metabolic kitchen. The primary outcome was weight. Weight and office blood pressure were measured at baseline and 4, 8, and 12 weeks and were analyzed using a linear mixed effects model with an unstructured covariance with indicators for visit and intervention interacted with visit. Results: All participants completed the study (TRF, n=21; UFP, n=20). Demographics were similar across arms; mean age was 59 years, and over 90% of participants were female and were black. Baseline weight and systolic BP were higher in the UFP than TRF arm (Table). Weight and blood pressure decreased in both arms during the study, but these decreases did not differ by arm. Conclusions: In this controlled feeding study, TRF did not reduce weight and blood pressure compared to UFP.

Are Most of the Published Clinical Trial Results in Restorative Dentistry Invalid? An Empirical Investigation

Background: To establish the number of invalid clinical trial reports in restorative dentistry, due to lack of effective randomisation and/or inadequate sample size and whether this number changed, during the 1990-2019 period. Methods: Databases were searched up to 14 July 2019 without limitations regarding publication language. A Journal hand search and reference check were conducted for trial reports. Selection criteria were: reporting on a prospective, controlled clinical trial; relevance to placing direct tooth restorations in human vital teeth; direct comparison between restorative materials concerning tooth restoration longevity; trial report published from 1990. Randomisation reported (Yes/No) and treatment group sample size ≥ 200 were applied as criteria, using the deductive falsification approach for trial report appraisal. Results: 683 trial reports were appraised. 660 lacked effective randomisation. Of the remaining 23 reports, only 2 included a sample size of more than 200 restored teeth (mean number per treatment group 87; Standard deviation = 108.51). 92.5% of all treatment groups had a sample size of < 200. Randomisation reporting increased and sample size remained essentially unchanged between 1990 and 2019. Conclusion: Most of the published clinical trial results in restorative dentistry were judged invalid, due to lack of effective randomisation and adequate sample size. These results are in line with previous findings. Evidence-based recommendations on how to improve trial methodology are available in the dental/medical literature.