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Salimi Y, Domingo-Fernández D, Hofmann-Apitius M, Birkenbihl C. Data-Driven Thresholding Statistically Biases ATN Profiling across Cohort Datasets. J Prev Alzheimers Dis 2024; 11:185-195. [PMID: 38230732 PMCID: PMC10995057 DOI: 10.14283/jpad.2023.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/02/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND While the amyloid/tau/neurodegeneration (ATN) framework has found wide application in Alzheimer's disease research, it is unclear if thresholds obtained using distinct thresholding methods are concordant within the same dataset and interchangeable across cohorts. OBJECTIVES To investigate the robustness of data-driven thresholding methods and ATN profiling across cohort datasets. DESIGN AND SETTING We evaluated the impact of thresholding methods on ATN profiles by applying five commonly-used methodologies across cohort datasets. We assessed the generalizability of disease patterns discovered within ATN profiles by clustering individuals from different cohorts who were assigned to the same ATN profile. PARTICIPANTS AND MEASUREMENTS Participants with available CSF amyloid-β 1-42, phosphorylated tau, and total tau measurements were included from eleven AD cohort studies. RESULTS We observed high variability among obtained ATN thresholds, both across methods and datasets that impacted the resulting profile assignments of participants significantly. Clustering participants from different cohorts within the same ATN category indicated that identified disease patterns were comparable across most cohorts and biases introduced through distinct thresholding and data representations remained insignificant in most ATN profiles. CONLUSION Thresholding method selection is a decision of statistical relevance that will inevitably bias the resulting profiling and affect its sensitivity and specificity. Thresholds are likely not directly interchangeable between independent cohorts. To apply the ATN framework as an actionable and robust profiling scheme, a comprehensive understanding of the impact of used thresholding methods, their statistical implications, and a validation of results is crucial.
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Affiliation(s)
- Y. Salimi
- Department of Bioinformatics, Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), Sankt Augustin, 53757 Germany
- Bonn-Aachen International Center for IT, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, 53115 Germany
- Schloß Birlinghoven, Sankt Augustin, 53757 Germany
| | - D. Domingo-Fernández
- Department of Bioinformatics, Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), Sankt Augustin, 53757 Germany
| | - M. Hofmann-Apitius
- Department of Bioinformatics, Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), Sankt Augustin, 53757 Germany
- Bonn-Aachen International Center for IT, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, 53115 Germany
| | - C. Birkenbihl
- Department of Bioinformatics, Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), Sankt Augustin, 53757 Germany
- Bonn-Aachen International Center for IT, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, 53115 Germany
- Schloß Birlinghoven, Sankt Augustin, 53757 Germany
| | - the Alzheimer’s Disease Neuroimaging Initiative
- Department of Bioinformatics, Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), Sankt Augustin, 53757 Germany
- Bonn-Aachen International Center for IT, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, 53115 Germany
- Schloß Birlinghoven, Sankt Augustin, 53757 Germany
| | - the Japanese Alzheimer’s Disease Neuroimaging Initiative
- Department of Bioinformatics, Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), Sankt Augustin, 53757 Germany
- Bonn-Aachen International Center for IT, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, 53115 Germany
- Schloß Birlinghoven, Sankt Augustin, 53757 Germany
| | - the Alzheimer’s Disease Repository Without Borders Investigators
- Department of Bioinformatics, Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), Sankt Augustin, 53757 Germany
- Bonn-Aachen International Center for IT, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, 53115 Germany
- Schloß Birlinghoven, Sankt Augustin, 53757 Germany
| | - the European Prevention of Alzheimer’s Disease (EPAD) Consortium
- Department of Bioinformatics, Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), Sankt Augustin, 53757 Germany
- Bonn-Aachen International Center for IT, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, 53115 Germany
- Schloß Birlinghoven, Sankt Augustin, 53757 Germany
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Risch M, Weber M, Thiel S, Grossmann K, Wohlwend N, Lung T, Hillmann D, Ritzler M, Ferrara F, Bigler S, Egli K, Bodmer T, Imperiali M, Salimi Y, Fleisch F, Cusini A, Renz H, Kohler P, Vernazza P, Kahlert CR, Paprotny M, Risch L. Temporal Course of SARS-CoV-2 Antibody Positivity in Patients with COVID-19 following the First Clinical Presentation. Biomed Res Int 2020; 2020:9878453. [PMID: 33224987 PMCID: PMC7673235 DOI: 10.1155/2020/9878453] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/13/2020] [Accepted: 10/22/2020] [Indexed: 11/18/2022]
Abstract
Knowledge of the sensitivities of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody tests beyond 35 days after the clinical onset of COVID-19 is insufficient. We aimed to describe positivity rate of SARS-CoV-2 assays employing three different measurement principles over a prolonged period. Two hundred sixty-eight samples from 180 symptomatic patients with COVID-19 and a reverse transcription polymerase chain reaction (RT-PCR) test followed by serological investigation of SARS-CoV-2 antibodies were included. We conducted three chemiluminescence (including electrochemiluminescence assay (ECLIA)), four enzyme-linked immunosorbent assay (ELISA), and one lateral flow immunoassay (LFIA) test formats. Positivity rates, as well as positive (PPVs) and negative predictive values (NPVs), were calculated for each week after the first clinical presentation for COVID-19. Furthermore, combinations of tests were assessed within an orthogonal testing approach employing two independent assays and predictive values were calculated. Heat maps were constructed to graphically illustrate operational test characteristics. During a follow-up period of more than 9 weeks, chemiluminescence assays and one ELISA IgG test showed stable positivity rates after the third week. With the exception of ECLIA, the PPVs of the other chemiluminescence assays were ≥95% for COVID-19 only after the second week. ELISA and LFIA had somewhat lower PPVs. IgM exhibited insufficient predictive characteristics. An orthogonal testing approach provided PPVs ≥ 95% for patients with a moderate pretest probability (e.g., symptomatic patients), even for tests with a low single test performance. After the second week, NPVs of all but IgM assays were ≥95% for patients with low to moderate pretest probability. The confirmation of negative results using an orthogonal algorithm with another assay provided lower NPVs than the single assays. When interpreting results from SARS-CoV-2 tests, the pretest probability, time of blood draw, and assay characteristics must be carefully considered. An orthogonal testing approach increases the accuracy of positive, but not negative, predictions.
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Affiliation(s)
- Martin Risch
- Zentrallabor, Kantonsspital Graubünden, Loësstrasse 170, 7000 Chur, Switzerland
| | - Myriam Weber
- Liechtensteinisches Landesspital, Heiligkreuz, 9490 Vaduz, Liechtenstein
| | - Sarah Thiel
- Liechtensteinisches Landesspital, Heiligkreuz, 9490 Vaduz, Liechtenstein
| | - Kirsten Grossmann
- Labormedizinisches Zentrum Dr. Risch, Wuhrstrasse 14, 9490 Vaduz, Liechtenstein
- Private Universität im Fürstentum Liechtenstein, Dorfstrasse, 9495 Triesen, Liechtenstein
| | - Nadia Wohlwend
- Labormedizinisches Zentrum Dr. Risch, Wuhrstrasse 14, 9490 Vaduz, Liechtenstein
| | - Thomas Lung
- Labormedizinisches Zentrum Dr. Risch, Wuhrstrasse 14, 9490 Vaduz, Liechtenstein
| | - Dorothea Hillmann
- Labormedizinisches Zentrum Dr. Risch, Wuhrstrasse 14, 9490 Vaduz, Liechtenstein
| | - Michael Ritzler
- Labormedizinisches Zentrum Dr. Risch, Wuhrstrasse 14, 9490 Vaduz, Liechtenstein
| | - Francesca Ferrara
- Labormedizinisches Zentrum Dr. Risch, Wuhrstrasse 14, 9490 Vaduz, Liechtenstein
| | - Susanna Bigler
- Labormedizinisches Zentrum Dr. Risch, Waldeggstrasse 37, 3097 Liebefeld, Switzerland
| | - Konrad Egli
- Labormedizinisches Zentrum Dr. Risch, Waldeggstrasse 37, 3097 Liebefeld, Switzerland
| | - Thomas Bodmer
- Labormedizinisches Zentrum Dr. Risch, Waldeggstrasse 37, 3097 Liebefeld, Switzerland
| | - Mauro Imperiali
- Centro Medicina di Laboratorio Dr. Risch, Via Arbostra 2, 6963 Pregassona, Switzerland
| | - Yacir Salimi
- Clm Dr. Risch Arc Lémanique SA, Chemin de l'Esparcette 10, 1023 Crissier, Switzerland
| | - Felix Fleisch
- Division of Infectious Diseases, Cantonal Hospital Chur, Loësstrasse 170, 7000 Chur, Switzerland
| | - Alexia Cusini
- Division of Infectious Diseases, Cantonal Hospital Chur, Loësstrasse 170, 7000 Chur, Switzerland
| | - Harald Renz
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps University Marburg, University Hospital Giessen and Marburg, Baldingerstraße, 35043 Marburg, Germany
| | - Philipp Kohler
- Cantonal Hospital St. Gallen, Department of Infectious Diseases and Hospital Epidemiology, Rohrschacherstrasse 95, 9007 St. Gallen, Switzerland
| | - Pietro Vernazza
- Cantonal Hospital St. Gallen, Department of Infectious Diseases and Hospital Epidemiology, Rohrschacherstrasse 95, 9007 St. Gallen, Switzerland
| | - Christian R. Kahlert
- Cantonal Hospital St. Gallen, Department of Infectious Diseases and Hospital Epidemiology, Rohrschacherstrasse 95, 9007 St. Gallen, Switzerland
- Children's Hospital of Eastern Switzerland, Department of Infectious Diseases and Hospital Epidemiology, Claudiusstrasse 6, 9006 St. Gallen, Switzerland
| | - Matthias Paprotny
- Liechtensteinisches Landesspital, Heiligkreuz, 9490 Vaduz, Liechtenstein
| | - Lorenz Risch
- Labormedizinisches Zentrum Dr. Risch, Wuhrstrasse 14, 9490 Vaduz, Liechtenstein
- Private Universität im Fürstentum Liechtenstein, Dorfstrasse, 9495 Triesen, Liechtenstein
- Center of Laboratory Medicine, University Institute of Clinical Chemistry, University of Bern, Inselspital, 3010 Bern, Switzerland
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Asadi-Lari M, Salimi Y, Vaez-Mahdavi MR, Faghihzadeh S, Haeri Mehrizi AA, Jorjoran Shushtari Z, Cheraghian B. Socio-Economic Status and Prevalence of Self-Reported Osteoporosis in Tehran: Results from a Large Population-Based Cross-Sectional Study (Urban HEART-2). J Urban Health 2018; 95:682-690. [PMID: 29637433 PMCID: PMC6181817 DOI: 10.1007/s11524-018-0246-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Osteoporosis is a widespread disease among older peoples. The aim of this study is to estimate the prevalence of self-reported osteoporosis and assessing its association with socio-economic status. A population-based cross-sectional study was conducted in Tehran, Iran in 2011. Participants were 45,990 individuals aged above 20 years from 22 urban districts. Osteoporosis was measured by self-administrative questionnaire. Wealth index was constructed using principal component analysis based on household assets. Chi-square test, chi square test for trend, and crude odds ratio were used to assess associations in univariate analysis. Multiple logistic regression utilized to estimate adjusted associations between self-reported osteoporosis and socio-economic status.The overall estimated prevalence of self-reported osteoporosis was 4% (95% CI 3.88-4.13), 1.19% in men, and 6.84% in women (P < 0.001). The prevalence increased considerably as age increased (P for trend < 0.001). In multivariable analysis, education and wealth status were negative, and smoking was positively associated with the prevalence of self-reported osteoporosis. No association was found between participants' skill levels and Townsend deprivation index with the prevalence of self-reported osteoporosis.The findings of the present study have improved understanding of the association between socioeconomic status and osteoporosis in the Iranian population. It is important to consider socioeconomic status in screening and prevention programs.
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Affiliation(s)
- M Asadi-Lari
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Oncopathology Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Y Salimi
- Department of Epidemiology and Biostatistics, School of Public Health, Kermanshah University of Medical Science, Kermanshah, Iran
| | | | - S Faghihzadeh
- Department of Social Medicine, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - A A Haeri Mehrizi
- Health Education and Promotion Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Z Jorjoran Shushtari
- Determinants of Health, Social Determinants of Health Research Centre, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Bahman Cheraghian
- Department of Epidemiology and Biostatistics, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Sajjadi H, Jorjoran Shushtari Z, Mahboubi S, Rafiey H, Salimi Y. Effect of socio-economic status, family smoking and mental health through social network on the substance use potential in adolescents: a mediation analysis. Public Health 2018; 157:14-19. [PMID: 29475107 DOI: 10.1016/j.puhe.2018.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Understanding pathways that influence substance use potential (SUP) can help with effective substance use prevention interventions among adolescents. The aim of the present study is to contribute to a better understanding of the SUP of adolescents by examining the mediating role of social network quality in the SUP of Iranian adolescents. STUDY DESIGN A cross-sectional study. METHODS Structural equation modeling was conducted to assess the hypothesized model that social network quality would mediate the association of family socio-economic status, a mental health disorder, and family smoking with addiction potential. RESULTS The model shows a good fit to the data. Social network quality mediated the effect of family smoking on the SUP for boys. A mental health disorder had a positive significant direct effect on addiction potential for both girls and boys. CONCLUSIONS Social network quality mediates the effect of family smoking on boys' addiction potential in the context of Iran. Educational programs based on local societal ways and cultural norms are recommended to change tobacco smoking behavior among family members. In addition, to prevent subsequent substance use among adolescents, more effort is needed to improve their mental health.
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Affiliation(s)
- H Sajjadi
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Z Jorjoran Shushtari
- Student research committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - S Mahboubi
- Department of Social Welfare Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - H Rafiey
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Y Salimi
- Department of Epidemiology, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
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