Semaglutide vs Tirzepatide for Weight Loss in Adults With Overweight or Obesity.

Importance: Although tirzepatide and semaglutide were shown to reduce weight in randomized clinical trials, data from head-to-head comparisons in populations with overweight or obesity are not yet available. Objective: To compare on-treatment weight loss and rates of gastrointestinal adverse events (AEs) among adults with overweight or obesity receiving tirzepatide or semaglutide labeled for type 2 diabetes (T2D) in a clinical setting. Design, Setting, and Participants: In this cohort study, adults with overweight or obesity receiving semaglutide or tirzepatide between May 2022 and September 2023 were identified using electronic health record (EHR) data linked to dispensing information from a collective of US health care systems. On-treatment weight outcomes through November 3, 2023, were assessed. Adults with overweight or obesity and regular care in the year before initiation, no prior glucagon-like peptide 1 receptor agonist receptor agonist use, a prescription within 60 days prior to initiation, and an available baseline weight were identified. The analysis was completed on April 3, 2024. Exposures: Tirzepatide or semaglutide in formulations labeled for T2D, on or off label. Main Outcomes and Measures: On-treatment weight change in a propensity score-matched population, assessed as hazard of achieving 5% or greater, 10% or greater, and 15% or greater weight loss, and percentage change in weight at 3, 6, and 12 months. Hazards of gastrointestinal AEs were compared. Results: Among 41 222 adults meeting the study criteria (semaglutide, 32 029; tirzepatide, 9193), 18 386 remained after propensity score matching. The mean (SD) age was 52.0 (12.9) years, 12 970 were female (70.5%), 14 182 were white (77.1%), 2171 Black (11.8%), 354 Asian (1.9%), 1679 were of other or unknown race, and 9563 (52.0%) had T2D. The mean (SD) baseline weight was 110 (25.8) kg. Follow-up was ended by discontinuation for 5140 patients (55.9%) receiving tirzepatide and 4823 (52.5%) receiving semaglutide. Patients receiving tirzepatide were significantly more likely to achieve weight loss (≥5%; hazard ratio [HR], 1.76, 95% CI, 1.68, 1.84; ≥10%; HR, 2.54; 95% CI, 2.37, 2.73; and ≥15%; HR, 3.24; 95% CI, 2.91, 3.61). On-treatment changes in weight were larger for patients receiving tirzepatide at 3 months (difference, -2.4%; 95% CI -2.5% to -2.2%), 6 months (difference, -4.3%; 95% CI, -4.7% to -4.0%), and 12 months (difference, -6.9%; 95% CI, -7.9% to -5.8%). Rates of gastrointestinal AEs were similar between groups. Conclusions and Relevance: In this population of adults with overweight or obesity, use of tirzepatide was associated with significantly greater weight loss than semaglutide. Future study is needed to understand differences in other important outcomes.

Time-Series Analysis of First-Time Pediatric Speech Delays From 2018 to 2022.

This cohort study evaluates changes in pediatric speech delay diagnoses before and after the COVID-19 pandemic.

Risk of COVID-19 breakthrough infection and hospitalization in individuals with comorbidities.

BACKGROUND: The successful development of multiple COVID-19 vaccines has led to a global vaccination effort to reduce severe COVID-19 infection and mortality. However, the effectiveness of the COVID-19 vaccines wane over time leading to breakthrough infections where vaccinated individuals experience a COVID-19 infection. Here we estimate the risks of breakthrough infection and subsequent hospitalization in individuals with common comorbidities who had completed an initial vaccination series. METHODS: Our study population included vaccinated patients between January 1, 2021 to March 31, 2022 who are present in the Truveta patient population. Models were developed to describe 1) time from completing primary vaccination series till breakthrough infection; and 2) if a patient was hospitalized within 14 days of breakthrough infection. We adjusted for age, race, ethnicity, sex, and year-month of vaccination. RESULTS: Of 1,218,630 patients in the Truveta Platform who had completed an initial vaccination sequence between January 1, 2021 and March 31, 2022, 2.85, 3.42, 2.75, and 2.88 percent of patients with CKD, chronic lung disease, diabetes, or are in an immunocompromised state experienced breakthrough infection, respectively, compared to 1.46 percent of the population without any of these four comorbidities. We found an increased risk of breakthrough infection and subsequent hospitalization in individuals with any of the four comorbidities when compared to individuals without these four comorbidities. CONCLUSIONS: Vaccinated individuals with any of the studied comorbidities experienced an increased risk of breakthrough COVID-19 infection and subsequent hospitalizations compared to the people without any of the studied comorbidities. Individuals with immunocompromising conditions and chronic lung disease were most at risk of breakthrough infection, while people with CKD were most at risk of hospitalization following breakthrough infection. Patients with multiple comorbidities have an even greater risk of breakthrough infection or hospitalization compared to patients with none of the studied comorbidities. Individuals with common comorbidities should remain vigilant against infection even if vaccinated.

Racial inequality in COVID-treatment and in-hospital length of stay in the US over time.

Introduction: Demonstrated health inequalities persist in the United States. SARS-CoV-2 (COVID) has been no exception, with access to treatment and hospitalization differing across race or ethnic groups. Here, we aim to assess differences in treatment with remdesivir and hospital length of stay across the four waves of the pandemic. Materials and methods: Using a subset of the Truveta data, we examine the odds ratio (OR) of in-hospital remdesivir treatment and risk ratio (RR) of in-hospital length of stay between Black or African American (Black) to White patients. We adjusted for confounding factors, such as age, sex, and comorbidity status. Results: There were statistically significant lower rates of remdesivir treatment and longer in-hospital length of stay comparing Black patients to White patients early in the pandemic (OR for treatment: 0.88, 95% confidence interval [CI]: 0.80, 0.96; RR for length of stay: 1.17, CI: 1.06, 1.21). Rates became close to parity between groups as the pandemic progressed. Conclusion: While inpatient remdesivir treatment rates increased and length of stay decreased over the beginning course of the pandemic, there are still inequalities in patient care.

An open repository of real-time COVID-19 indicators.

The COVID-19 pandemic presented enormous data challenges in the United States. Policy makers, epidemiological modelers, and health researchers all require up-to-date data on the pandemic and relevant public behavior, ideally at fine spatial and temporal resolution. The COVIDcast API is our attempt to fill this need: Operational since April 2020, it provides open access to both traditional public health surveillance signals (cases, deaths, and hospitalizations) and many auxiliary indicators of COVID-19 activity, such as signals extracted from deidentified medical claims data, massive online surveys, cell phone mobility data, and internet search trends. These are available at a fine geographic resolution (mostly at the county level) and are updated daily. The COVIDcast API also tracks all revisions to historical data, allowing modelers to account for the frequent revisions and backfill that are common for many public health data sources. All of the data are available in a common format through the API and accompanying R and Python software packages. This paper describes the data sources and signals, and provides examples demonstrating that the auxiliary signals in the COVIDcast API present information relevant to tracking COVID activity, augmenting traditional public health reporting and empowering research and decision-making.

Uplift: A Tangible and Immersive Tabletop System for Casual Collaborative Visual Analytics.

Collaborative visual analytics leverages social interaction to support data exploration and sensemaking. These processes are typically imagined as formalised, extended activities, between groups of dedicated experts, requiring expertise with sophisticated data analysis tools. However, there are many professional domains that benefit from support for short 'bursts' of data exploration between a subset of stakeholders with a diverse breadth of knowledge. Such 'casual collaborative' scenarios will require engaging features to draw users' attention, with intuitive, 'walk-up and use' interfaces. This paper presents Uplift, a novel prototype system to support 'casual collaborative visual analytics' for a campus microgrid, co-designed with local stakeholders. An elicitation workshop with key members of the building management team revealed relevant knowledge is distributed among multiple experts in their team, each using bespoke analysis tools. Uplift combines an engaging 3D model on a central tabletop display with intuitive tangible interaction, as well as augmented-reality, mid-air data visualisation, in order to support casual collaborative visual analytics for this complex domain. Evaluations with expert stakeholders from the building management and energy domains were conducted during and following our prototype development and indicate that Uplift is successful as an engaging backdrop for casual collaboration. Experts see high potential in such a system to bring together diverse knowledge holders and reveal complex interactions between structural, operational, and financial aspects of their domain. Such systems have further potential in other domains that require collaborative discussion or demonstration of models, forecasts, or cost-benefit analyses to high-level stakeholders.

Supporting the Problem-Solving Loop: Designing Highly Interactive Optimisation Systems.

Efficient optimisation algorithms have become important tools for finding high-quality solutions to hard, real-world problems such as production scheduling, timetabling, or vehicle routing. These algorithms are typically "black boxes" that work on mathematical models of the problem to solve. However, many problems are difficult to fully specify, and require a "human in the loop" who collaborates with the algorithm by refining the model and guiding the search to produce acceptable solutions. Recently, the Problem-Solving Loop was introduced as a high-level model of such interactive optimisation. Here, we present and evaluate nine recommendations for the design of interactive visualisation tools supporting the Problem-Solving Loop. They range from the choice of visual representation for solutions and constraints to the use of a solution gallery to support exploration of alternate solutions. We first examined the applicability of the recommendations by investigating how well they had been supported in previous interactive optimisation tools. We then evaluated the recommendations in the context of the vehicle routing problem with time windows (VRPTW). To do so we built a sophisticated interactive visual system for solving VRPTW that was informed by the recommendations. Ten participants then used this system to solve a variety of routing problems. We report on participant comments and interaction patterns with the tool. These showed the tool was regarded as highly usable and the results generally supported the usefulness of the underlying recommendations.

Viime: Visualization and Integration of Metabolomics Experiments.

Metabolomics involves the comprehensive measurement of metabolites from a biological system. The resulting metabolite profiles are influenced by genetics, lifestyle, biological stresses, disease, diet and the environment and therefore provides a more holistic biological readout of the pathological condition of the organism (Beger et al., 2016; Wishart, 2016). The challenge for metabolomics is that no single analytical platform can provide a truly comprehensive coverage of the metabolome. The most commonly used platforms are based on mass-spectrometry (MS) and nuclear magnetic resonance (NMR). Investigators are increasingly using both methods to increase the metabolite coverage. The challenge for this type of multi-platform approach is that the data structure may be very different in these two platforms. For example, NMR data may be reported as a list of spectral features, e.g., bins or peaks with arbitrary intensity units or more directly with named metabolites reported in concentration units ranging from micromolar to millimolar. Some MS approaches can also provide data in the form of identified metabolite concentrations, but given the superior sensitivity of MS, the concentrations can be several orders of magnitude lower than for NMR. Other MS approaches yield data in the form of arbitrary response units where the dynamic range can be more than 6 orders of magnitude. Importantly, the variability and reproducibility of the data may differ across platforms. Given the diversity of data structures (i.e., magnitude and dynamic range) integrating the data from multiple platforms can be challenging. This often leads investigators to analyze the datasets separately, which prevents the observation of potentially interesting relationships and correlations between metabolites detected on different platforms. Viime (VIsualization and Integration of Metabolomics Experiments) is an open-source, web-based application designed to integrate metabolomics data from multiple platforms. The workflow of Viime for data integration and visualization is shown in Figure 1.

Ordino: a visual cancer analysis tool for ranking and exploring genes, cell lines and tissue samples.

SUMMARY: Ordino is a web-based analysis tool for cancer genomics that allows users to flexibly rank, filter and explore genes, cell lines and tissue samples based on pre-loaded data, including The Cancer Genome Atlas, the Cancer Cell Line Encyclopedia and manually uploaded information. Interactive tabular data visualization that facilitates the user-driven prioritization process forms a core component of Ordino. Detail views of selected items complement the exploration. Findings can be stored, shared and reproduced via the integrated session management. AVAILABILITY AND IMPLEMENTATION: Ordino is publicly available at https://ordino.caleydoapp.org. The source code is released at https://github.com/Caleydo/ordino under the Mozilla Public License 2.0. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

KnowledgePearls: Provenance-Based Visualization Retrieval.

Storing analytical provenance generates a knowledge base with a large potential for recalling previous results and guiding users in future analyses. However, without extensive manual creation of meta information and annotations by the users, search and retrieval of analysis states can become tedious. We present KnowledgePearls, a solution for efficient retrieval of analysis states that are structured as provenance graphs containing automatically recorded user interactions and visualizations. As a core component, we describe a visual interface for querying and exploring analysis states based on their similarity to a partial definition of a requested analysis state. Depending on the use case, this definition may be provided explicitly by the user by formulating a search query or inferred from given reference states. We explain our approach using the example of efficient retrieval of demographic analyses by Hans Rosling and discuss our implementation for a fast look-up of previous states. Our approach is independent of the underlying visualization framework. We discuss the applicability for visualizations which are based on the declarative grammar Vega and we use a Vega-based implementation of Gapminder as guiding example. We additionally present a biomedical case study to illustrate how KnowledgePearls facilitates the exploration process by recalling states from earlier analyses.

ThermalPlot: Visualizing Multi-Attribute Time-Series Data Using a Thermal Metaphor.

Multi-attribute time-series data plays a vital role in many different domains, such as economics, sensor networks, and biology. An important task when making sense of such data is to provide users with an overview to identify items that show an interesting development over time, including both absolute and relative changes in multiple attributes simultaneously. However, this is not well supported by existing visualization techniques. To address this issue, we present ThermalPlot, a visualization technique that summarizes combinations of multiple attributes over time using an items position, the most salient visual variable. More precisely, the x-position in the ThermalPlot is based on a user-defined degree-of-interest (DoI) function that combines multiple attributes over time. The y-position is determined by the relative change in the DoI value ( ∆DoI) within a user-specified time window. Animating this mapping via a moving time window gives rise to circular movements of items over time-as in thermal systems. To help the user to identify important items that match user-defined temporal patterns and to increase the technique's scalability, we adapt the level of detail of the items' representation based on the DoI value. Furthermore, we present an interactive exploration environment for multi-attribute time-series data that ties together a carefully chosen set of visualizations, designed to support analysts in interacting with the ThermalPlot technique. We demonstrate the effectiveness of our technique by means of two usage scenarios that address the visual analysis of economic development data and of stock market data.

Furby: fuzzy force-directed bicluster visualization.

BACKGROUND: Cluster analysis is widely used to discover patterns in multi-dimensional data. Clustered heatmaps are the standard technique for visualizing one-way and two-way clustering results. In clustered heatmaps, rows and/or columns are reordered, resulting in a representation that shows the clusters as contiguous blocks. However, for biclustering results, where clusters can overlap, it is not possible to reorder the matrix in this way without duplicating rows and/or columns. RESULTS: We present Furby, an interactive visualization technique for analyzing biclustering results. Our contribution is twofold. First, the technique provides an overview of a biclustering result, showing the actual data that forms the individual clusters together with the information which rows and columns they share. Second, for fuzzy clustering results, the proposed technique additionally enables analysts to interactively set the thresholds that transform the fuzzy (soft) clustering into hard clusters that can then be investigated using heatmaps or bar charts. Changes in the membership value thresholds are immediately reflected in the visualization. We demonstrate the value of Furby by loading biclustering results applied to a multi-tissue dataset into the visualization. CONCLUSIONS: The proposed tool allows analysts to assess the overall quality of a biclustering result. Based on this high-level overview, analysts can then interactively explore the individual biclusters in detail. This novel way of handling fuzzy clustering results also supports analysts in finding the optimal thresholds that lead to the best clusters.

Opening the Black Box: Strategies for Increased User Involvement in Existing Algorithm Implementations.

An increasing number of interactive visualization tools stress the integration with computational software like MATLAB and R to access a variety of proven algorithms. In many cases, however, the algorithms are used as black boxes that run to completion in isolation which contradicts the needs of interactive data exploration. This paper structures, formalizes, and discusses possibilities to enable user involvement in ongoing computations. Based on a structured characterization of needs regarding intermediate feedback and control, the main contribution is a formalization and comparison of strategies for achieving user involvement for algorithms with different characteristics. In the context of integration, we describe considerations for implementing these strategies either as part of the visualization tool or as part of the algorithm, and we identify requirements and guidelines for the design of algorithmic APIs. To assess the practical applicability, we provide a survey of frequently used algorithm implementations within R regarding the fulfillment of these guidelines. While echoing previous calls for analysis modules which support data exploration more directly, we conclude that a range of pragmatic options for enabling user involvement in ongoing computations exists on both the visualization and algorithm side and should be used.

Domino: Extracting, Comparing, and Manipulating Subsets Across Multiple Tabular Datasets.

Answering questions about complex issues often requires analysts to take into account information contained in multiple interconnected datasets. A common strategy in analyzing and visualizing large and heterogeneous data is dividing it into meaningful subsets. Interesting subsets can then be selected and the associated data and the relationships between the subsets visualized. However, neither the extraction and manipulation nor the comparison of subsets is well supported by state-of-the-art techniques. In this paper we present Domino, a novel multiform visualization technique for effectively representing subsets and the relationships between them. By providing comprehensive tools to arrange, combine, and extract subsets, Domino allows users to create both common visualization techniques and advanced visualizations tailored to specific use cases. In addition to the novel technique, we present an implementation that enables analysts to manage the wide range of options that our approach offers. Innovative interactive features such as placeholders and live previews support rapid creation of complex analysis setups. We introduce the technique and the implementation using a simple example and demonstrate scalability and effectiveness in a use case from the field of cancer genomics.

LineUp: visual analysis of multi-attribute rankings.

Rankings are a popular and universal approach to structuring otherwise unorganized collections of items by computing a rank for each item based on the value of one or more of its attributes. This allows us, for example, to prioritize tasks or to evaluate the performance of products relative to each other. While the visualization of a ranking itself is straightforward, its interpretation is not, because the rank of an item represents only a summary of a potentially complicated relationship between its attributes and those of the other items. It is also common that alternative rankings exist which need to be compared and analyzed to gain insight into how multiple heterogeneous attributes affect the rankings. Advanced visual exploration tools are needed to make this process efficient. In this paper we present a comprehensive analysis of requirements for the visualization of multi-attribute rankings. Based on these considerations, we propose LineUp--a novel and scalable visualization technique that uses bar charts. This interactive technique supports the ranking of items based on multiple heterogeneous attributes with different scales and semantics. It enables users to interactively combine attributes and flexibly refine parameters to explore the effect of changes in the attribute combination. This process can be employed to derive actionable insights as to which attributes of an item need to be modified in order for its rank to change. Additionally, through integration of slope graphs, LineUp can also be used to compare multiple alternative rankings on the same set of items, for example, over time or across different attribute combinations. We evaluate the effectiveness of the proposed multi-attribute visualization technique in a qualitative study. The study shows that users are able to successfully solve complex ranking tasks in a short period of time.

Entourage: visualizing relationships between biological pathways using contextual subsets.

Biological pathway maps are highly relevant tools for many tasks in molecular biology. They reduce the complexity of the overall biological network by partitioning it into smaller manageable parts. While this reduction of complexity is their biggest strength, it is, at the same time, their biggest weakness. By removing what is deemed not important for the primary function of the pathway, biologists lose the ability to follow and understand cross-talks between pathways. Considering these cross-talks is, however, critical in many analysis scenarios, such as judging effects of drugs. In this paper we introduce Entourage, a novel visualization technique that provides contextual information lost due to the artificial partitioning of the biological network, but at the same time limits the presented information to what is relevant to the analyst's task. We use one pathway map as the focus of an analysis and allow a larger set of contextual pathways. For these context pathways we only show the contextual subsets, i.e., the parts of the graph that are relevant to a selection. Entourage suggests related pathways based on similarities and highlights parts of a pathway that are interesting in terms of mapped experimental data. We visualize interdependencies between pathways using stubs of visual links, which we found effective yet not obtrusive. By combining this approach with visualization of experimental data, we can provide domain experts with a highly valuable tool. We demonstrate the utility of Entourage with case studies conducted with a biochemist who researches the effects of drugs on pathways. We show that the technique is well suited to investigate interdependencies between pathways and to analyze, understand, and predict the effect that drugs have on different cell types.