Towards optimal model evaluation: enhancing active testing with actively improved estimators.

With rapid advancements in machine learning and statistical models, ensuring the reliability of these models through accurate evaluation has become imperative. Traditional evaluation methods often rely on fully labeled test data, a requirement that is becoming increasingly impractical due to the growing size of datasets. In this work, we address this issue by extending existing work on active testing (AT) methods which are designed to sequentially sample and label data for evaluating pre-trained models. We propose two novel estimators: the Actively Improved Levelled Unbiased Risk (AILUR) and the Actively Improved Inverse Probability Weighting (AIIPW) estimators which are derived from nonparametric smoothing estimation. In addition, a model recalibration process is designed for the AIIPW estimator to optimize the sampling probability within the AT framework. We evaluate the proposed estimators on four real-world datasets and demonstrate that they consistently outperform existing AT methods. Our study also shows that the proposed methods are robust to changes in subsample sizes, and effective at reducing labeling costs.

Trends in medical care utilization in patients with cancer: An analysis of real-world data in a tertiary hospital in Korea, 2014-2019.

BACKGROUND: Rising costs of cancer treatments challenge even areas with universal health coverage. There's a need to assess current medical care utilization trends among patients with cancer to guide public health policy, resource allocation, and set informed healthcare goals. METHODS: We analyzed the latest trends in medical care utilization by cancer patients in four areas-drugs, radiation therapy (RT), surgery, and diagnostic procedures-using clinical databases extracted from electronic medical records of a tertiary hospital in Korea between 2014 and 2019. Compound adjusted growth rates (CAGR) were computed to capture the annual growth over the study period. RESULTS: A total of 74,285 cancer patients were identified, with 40.3% (29,962), 14.2% (10,577), 31.1% (23,066), and 92.6% (68,849) of patients having received at least one anticancer agent, RT, surgery, and diagnostic procedure, respectively, over the period. We observed a 1.7-fold increase in the use of targeted · immune-oncology agents (from 6.8% to 11.6%) and a 21-fold increase (from 3.0% in 2014 to 65.7%) in intensity-modulated RT (IMRT) use over the period. In contrast, we observed a continuous decrease in the proportion of patients who underwent surgical treatment from 12.2% in 2014 to 10.9% in 2019. This decrease was particularly noticeable in patients with colon cancer (from 28.5% to 24.2%) and liver cancer (from 4.1% to 2.9%). CONCLUSION: From 2014 to 2019, there was a significant rise in the use of targeted · immune-oncology agents and IMRT, alongside a decline in surgeries. While targeted · immune-oncology agents and IMRT may offer promising outcomes, their financial impact and potential for overuse necessitate careful oversight and long-term cost-effectiveness studies.

Pathways Through Which Experience in Treatment Decision-Making Affects Health-Related Quality of Life in People with Chronic Conditions.

Patient engagement in treatment decision-making is essential to improve the health-related quality of life (HRQoL) of patients affected by chronic diseases. However, research on how decision-making patterns influence HRQoL is limited. This study investigated the paths linking patient experience in decision-making to HRQoL through healthcare accessibility and physical activity among a representative sample of adults with chronic diseases. Using a cross-sectional design, the data of 4,071 individuals with chronic diseases from the 2015 Korea National Health and Nutrition Examination Survey were analyzed. We used R to account for the complex survey design and weights and conducted structural equation modeling. The EuroQoL 5 Dimensions were used to assess HRQoL. About half of the participants reported that providers always offered sufficient encounter time (48.8%), used lay terms (60.4%), provided opportunities for questions (57.8%), and reflected patient opinions on treatment plans (57.8%). Healthcare accessibility completely mediated the association between patient experience in decision-making and HRQoL, whereas decision-making experiences directly affected HRQoL, not via physical activity. Clinicians should provide solid and tailored advice that entails benefits and detriments to achieve evidence-based decision-making. Programs to enhance access to after-hour healthcare should be considered to improve patients' HRQoL.

The effect of self-management online modules plus nurse-led support on pain and quality of life among young adults with irritable bowel syndrome: A randomized controlled trial.

BACKGROUND: Irritable bowel syndrome is a chronic pain condition that needs life-long self-management. However, the effect of self-management among young adults with irritable bowel syndrome is limited. OBJECTIVES: This study aimed to examine the effect of a nurse-led self-management program on pain, symptoms, and quality of life among young adults with irritable bowel syndrome. DESIGN: A randomized controlled trial. SETTINGS AND PARTICIPANTS: Eighty young adults with irritable bowel syndrome recruited from two campuses of a public university and two gastrointestinal clinics were randomly assigned into a self-management online education and learning modules alone group (Online Modules, n = 41) or a nurse-led one-to-one consultation plus self-management online education and learning modules group (Nurse-Led Online Modules, n = 39). Twenty-one healthy controls were also recruited from these two campuses. METHODS: Both the intervention groups received ten online modules after baseline data collection. Participants in the Nurse-Led Online Modules group received additional three nurse-led one-to-one consultations at baseline, 6- and 12-week follow-ups. Self-reported pain, symptoms, quality of life, self-efficacy for managing chronic disease, and coping were measured at baseline, and 6- and 12-week follow-ups among the participants with irritable bowel syndrome. The healthy controls completed data collection of pain and symptoms at baseline and the 12-week follow-up. The intervention effects across study time points and the comparisons between the two interventional groups were analyzed using linear mixed models. A longitudinal mediation analysis was also conducted to explore the mediation effects of self-management mechanisms of the interventions. RESULTS: Both the intervention groups showed significant interventional effects on decreasing pain intensity and pain interference and increasing quality of life at the 12-week follow-up (all p < 0.05). At the 12-week follow-up, the Nurse-Led Online Modules significantly reduced anxiety (p = 0.016) and had a significant greater improvement in quality of life than the Online Modules (p = 0.040). Increased self-efficacy mediated the intervention effect of the Nurse-Led Online Modules group on reducing pain interference and improving quality of life, while the effect of the Online Modules was mediated through decreasing inefficient coping strategy-catastrophizing. CONCLUSIONS: This study showed that both the pain self-management online education and nurse-led intervention were effective for alleviating pain and improving quality of life among young adults with irritable bowel syndrome by targeting the self-management process. The nurse-led intervention had a better outcome than the online education alone in improving quality of life. REGISTRATION NUMBER: NCT03332537.

The Associations of Single Nucleotide Polymorphisms with Risk and Symptoms of Irritable Bowel Syndrome.

Although several risk single nucleotide polymorphisms (SNPs) have been found to play an important role in etiology of irritable bowel syndrome (IBS), the findings are inconsistent. A descriptive correlational design was used to analyze the baseline data of a randomized controlled trial including participants with IBS and healthy controls (HC). Pain severity and interference, anxiety, sleep, and fatigue were measured using the Brief Pain Inventory (BPI) and patient-reported outcomes measurement information system (PROMIS). Fisher's exact test and multivariate linear regression were used to investigate the associations between IBS risk alleles and IBS symptoms. Participants were predominantly female, white, and had an average age of 21.13 ± 2.42 years. Polymorphisms within TNFSF15 (rs4263839), SLC6A4 5-HTTLPR, HTR3A (rs1062613), and OXTR (rs2254298) were associated with IBS risk, and TNFSF15 (rs4263839), COMT (rs6269), SLC6A4 5-HTTLPR polymorphisms were associated with pain severity. TNFSF15 (rs4263839) and COMT (rs4680; rs4633) genotypes were associated with sleep disturbance, and the ADRA1D SNP rs1556832 was associated with fatigue in both IBS and HC groups. Genotypic differences were associated with IBS risk and symptoms including abdominal pain, sleep disturbance, and fatigue. Further investigation is warranted to reveal the mechanisms by which these genetic variations influence the dynamic nature of IBS symptoms over time.

Associations of neurotransmitters and the gut microbiome with emotional distress in mixed type of irritable bowel syndrome.

Evidence highlights the comorbidity between emotional distress and irritable bowel syndrome (IBS) through the gut-brain axis. However, the underlying mechanism is largely unknown. Thus, the present study aimed to evaluate the associations among neurotransmitter levels and the gut microbiome profiles in persons with IBS and emotional distress. In this nested case-controlled study, emotional symptoms, including anxiety and depressive symptoms, were evaluated in 40 persons with IBS and 20 healthy controls (HC). Plasma neurotransmitters levels (serotonin and norepinephrine) and the gut microbiome profile of the collected fecal samples were examined. Emotional distress and microbiome profile were significantly different between IBS and HC groups. Lower but not significant neurotransmitters' levels (serotonin and norepinephrine) were observed in the IBS group compared to the HC. A negative correlation was found between norepinephrine levels and alpha diversity (Shannon and Simpson indices) in the IBS group. Moreover, serotonin levels were positively associated with the abundance of Proteobacteria, and norepinephrine were positively correlated with Bacteroidetes, but negatively associated with Firmicutes phylum. The present study demonstrated alteration in the gut microbiome between persons with IBS and emotional distress compared to HC. The correlations between plasma neurotransmitters and the gut microbiome suggest that the gut microbiome may impact the regulation of neurotransmitters.

Psychosocial and Sensory Factors Contribute to Self-Reported Pain and Quality of Life in Young Adults with Irritable Bowel Syndrome.

AIMS: Psychosocial and sensory factors, including anxiety, depression, and pressure pain threshold have been used to cluster chronic symptoms in irritable bowel syndrome (IBS). This study examined the contribution of psychosocial sensory factors on pain interference and quality of life (QOL) in this population. DESIGN: We performed a cross-sectional analysis of baseline data from a randomized controlled trial. SETTINGS: Two gastrointestinal clinics, general communities, and two large campuses of a public university in the Northeastern United States. PARTICIPANTS/SUBJECTS: Eighty young adults with IBS aged 21 ± 2.57 years (76.25% female). METHODS: Demographic and psychosocial factors including anxiety, depression, fatigue, cognition or general concerns, sleep disturbance, self-efficacy, coping, and food intake were measured as independent variables. Quantitative sensory testing was conducted to measure mechanical, thermal, and pressure pain thresholds. Self-reported pain measured by the brief pain inventory (BPI) and IBS-QOL were assessed as the outcome variables. Regression analysis and mediation analysis were conducted to determine the associated factors of IBS pain and QOL. RESULTS: Age, sex, and psychosocial factors including coping, self-efficacy, alcohol intake, mechanical pain sensitivity, and cold pain threshold were significantly associated with pain interference (all p < 0.05). Coping, and self-efficacy were significantly associated with IBS-QOL (all p < 0.05). In the mediation analysis, coping catastrophizing and self-efficacy were indirectly associated with IBS-QOL mediated by fatigue. CONCLUSIONS: Psychosocial factors including coping and self-efficacy, and quantitative sensory testing factors significantly correlate with self-reported pain and QOL among young adults with IBS. This preliminary research calls for further interventional studies that target personalized psychosocial and quantitative sensory factors to improve pain management and quality of life in IBS patients.

Altered Gut Microbiota in Irritable Bowel Syndrome and Its Association with Food Components.

The interplay between diet and gut microbiota has gained interest as a potential contributor in pathophysiology of irritable bowel syndrome (IBS). The purpose of this study was to compare food components and gut microbiota patterns between IBS patients and healthy controls (HC) as well as to explore the associations of food components and microbiota profiles. A cross-sectional study was conducted with 80 young adults with IBS and 21 HC recruited. The food frequency questionnaire was used to measure food components. Fecal samples were collected and profiled by 16S rRNA Illumina sequencing. Food components were similar in both IBS and HC groups, except in caffeine consumption. Higher alpha diversity indices and altered gut microbiota were observed in IBS compared to the HC. A negative correlation existed between total observed species and caffeine intake in the HC, and a positive correlation between alpha diversity indices and dietary fiber in the IBS group. Higher alpha diversity and gut microbiota alteration were found in IBS people who consumed caffeine more than 400 mg/d. Moreover, high microbial diversity and alteration of gut microbiota composition in IBS people with high caffeine consumption may be a clue toward the effects of caffeine on the gut microbiome pattern, which warrants further study.

Age at Human Papillomavirus Vaccine Initiation Among Adolescents and Young Adults From 22 Pediatric Practices in the Northeastern United States.

PURPOSE: To examine trends in human papillomavirus (HPV) vaccine initiation and its determinants. DESIGN: This retrospective correlational study involved 12,260 individuals born between 1996 and 2000 receiving care from one of 22 pediatric practices in the northeastern region of the United States between 2016 and 2017. METHODS: We extracted data about HPV vaccination status and date, birth year, race, ethnicity, language, and geographic regions. Mean age at initiation was estimated using descriptive statistics. Multiple linear regression with weighted least squares was used to examine its correlates. FINDINGS: Of 12,260 individuals, about 76% initiated the HPV vaccination series at 9 to 17 years of age. While the initiation age decreased overall for both females and males (e.g., 14.3 vs. 16.2 years and 13.8 vs. 14.4 years in the 1996 vs. 2000 birth cohorts, respectively), a greater reduction was noted for males. Individuals tended to delay initiation if they were non-Hispanic or Asian and resided in urban areas. CONCLUSIONS: Most adolescents in our sample started HPV vaccination later than the recommended age, with variations in different demographic groups. Rapid improvement in on-time HPV vaccination is occurring, especially for males. CLINICAL RELEVANCE: The findings of this analysis emphasize continuous efforts to increase on-time HPV vaccination rates for all groups, including non-Hispanic whites and female adolescents, to eliminate current and possible disparities.