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Let's (not) escalate this! Leadership and communication in a group contest
No full textEconomic and social situations where groups have to compete are ubiquitous. Such group contests create both a coordination problem within and between groups. Introducing leaders may help to mitigate these coordination problems, but little is known about the effect of leadership in group contests. In a group contest experiment, we compare two types of leadership-leading-by-example and transactional leadership-and also investigate the effect of communication between leaders under both leadership styles. We find that the introduction of leaders mostly increases contest investment. Transactional leaders increase followers' investment through the allocation of a relatively larger share of the prize to followers who have invested more. Communication between leaders decreases contest investments when there is leading-by-example but not when there is transactional leadership. Overall, leaders do not mitigate the over-investment problem in group contests
Can ChatGPT provide responses to patients for orthopaedic-related questions? A comparison between ChatGPT and medical support staff
No full textIntroduction: Patient Engagement Platforms, particularly chat functionalities, potentially improve communication but may also heighten workload, contributing to burnout among healthcare professionals. Natural Language Processing advancements, like ChatGPT and Med-PaLM, offer human-like responses to various questions, but concerns about their use in healthcare remain. This study evaluates whether Large Language Models can respond to patient questions as well as support staff in terms of quality and empathy. Methods: In this cross-sectional study, 111 patient questions on lower limb arthroplasty, answered by support staff via an app, were selected. These questions were put into ChatGPT 3.5 to generate responses, and were collected on July 2 and 3, 2024. Two blinded healthcare professionals, an orthopaedic surgeon and an anesthetist, evaluated both the responses generated by ChatGPT and support staff, on quality, empathy, and risk of potential adverse events, selecting their preferred responses and identifying what they thought was ChatGPT's response. A Patient Panel (n = 29) also assessed responses on empathy, preference, and source of the responses. Results: Fifty questions were available for a comparative analysis between ChatGPT and support staff responses. No quality difference was found (p = 0.075) between ChatGPT and support staff, though ChatGPT was rated as more empathetic (p < 0.001). No difference was found between the two responses in the risk of incorrect treatment (p = 0.377). Physicians identified ChatGPT's responses in 84–90 % of cases. The Patient Panel found ChatGPT to be more empathetic (p < 0.001) but showed no preference for ChatGPT (p = 0.086). Patients accurately identified ChatGPT's responses in 34.5 % of cases (p = 0.005). Three ChatGPT responses showed high-risk errors. Conclusion: This study shows ChatGPT generated high quality and empathetic responses to patient questions about lower limb arthroplasty. Further investigation is needed to optimize clinical use, but high appreciation for ChatGPT responses highlights the potential for use in clinical practice in the near future.</p
ESTRO recommendations on preoperative radiation therapy in breast cancer:current and future perspectives-Endorsed by ASTRO
No full textBackground and purpose: Preoperative radiation therapy (RT) for breast cancer is not a novel concept, though available data are insufficient to translate current knowledge into clinical practice. Nonetheless, potential advantages of this approach are emerging in multiple scenarios, incorporating increasing treatment personalization and technological improvements in RT. This paper aims to synthesize and summarize the literature on preoperative RT in distinct breast cancer treatment settings, providing perspectives based on existing evidence and gaps in knowledge. Methods: The ESTRO Breast subgroup proposal for elaborating perspectives on preoperative RT was approved by the ESTRO Guidelines Committee, and a panel of experts in the field was identified. Four working groups were created, focusing on the different clinical settings where preoperative RT has been investigated: patients with early-stage breast cancer at low risk of recurrence, patients with breast cancer at high risk of recurrence, and patients with an indication for mastectomy. The fourth group focused its search on cross cutting themes, such as preclinical and translational aspects, radiobiology, RT techniques and quality assurance. After a literature search including the identification of key points and gaps in the literature, the four working groups presented their findings and perspectives were formulated, discussed and approved by the panel. Results: Overall, 27 phase I and phase II studies enrolling patients from the year 2000 onward were considered, collecting data such as RT dose and fractionation, clinical outcomes, and complications rates. The expert panel stated perspectives for the different clinical scenarios based on available evidence and current gaps in knowledge, to be addressed by future clinical research. Conclusion: Given the current lack of clinical data to support the development of formal guidelines, we present our perspectives, which can be useful for implementing new clinical trials and research projects, overcoming current limitations, and potentially generating high-quality practice-changing data, introducing preoperative RT in specific breast cancer treatment settings in the future
General population preferences for health-related protective behaviors during infectious disease emergencies:a systematic review of conjoint-analysis studies
No full textObjective: To primarily systematically review the evidence from conjoint analysis (CA) studies on general population preferences for health-related protective behavioral measures during infectious disease emergencies, to secondarily assess the role of social networks in shaping decisions and to synthesize quantitative data to inform behaviorally responsive epidemiological models. Methods: PubMed and EMBASE were searched to identify relevant CA studies published up to June 2025. In addition to study characteristics, the scope of protective measures of included studies were examined and categorized according to seven pre-defined groups; the relative importance of attributes in each study was ranked and compared across studies and the heterogeneity of preferences was explored. The ISPOR checklist was used to assess the quality of reporting of included studies. Results: Of 2,523 articles identified, 16 studies were included. The quality of included studies was high with an average score of 24.7 out of 30 (range 18.5-28.5). Lockdown and restriction-related measures were most frequently perceived as important. A moderate level, targeted lockdown in a short period was preferred over severe or no restrictions. Face mask wearing and physical distancing were generally highly valued and preferred; for these measures, there was a clear preference for voluntary compliance over mandatory enforcement. Selective public spaces closures were preferred over broader shutdowns. Long-lasting, mandatory, and broadly applied quarantine was generally less preferred, while targeted quarantine was more acceptable. Substantial heterogeneity in preferences across populations was identified; age-and risk-based discrepancies in preferences were reported. Conclusion: This review demonstrates the complexity of public preferences for protective measures and highlights the importance of aligning public health strategies with individual preferences by taking into account substantial heterogeneity. Incorporating these insights into policy and mathematical modelling frameworks would be helpful to enhance the acceptability and adherence of health-related protective measures in future pandemic preparedness
Risk of new HIV diagnosis by intersecting migration, socioeconomic, and mental health vulnerabilities in the Netherlands:a nationwide analysis of the ATHENA cohort and Statistics Netherlands registry data
No full textBackground: To further reduce new HIV diagnoses in the Netherlands, individual and structural barriers hindering prevention must be addressed. We aimed to estimate the disproportional burden of new HIV diagnoses and explore how intersecting socio-demographic, socio-economic, and health-related factors jointly influence the risk of a new HIV diagnosis. Methods: We combined data from the ATHENA cohort, an ongoing nationwide HIV cohort, with registry data from Statistics Netherlands. We selected individuals with a new HIV diagnosis between 1 January 2012 and 31 December 2023 and matched them to individuals from the general population. We assessed determinants of a new HIV diagnosis using a multivariable generalized linear model. We used Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) to quantify the joint and individual contribution of intersecting variables. Findings: 6055 men and 1020 women were newly diagnosed with HIV. Having a migration background and a low to middle income or income below the poverty line was associated with a higher risk of a new HIV diagnosis for both men (low to middle: adjusted odd ratio (aOR) = 1.24, 95% confidence interval (CI) = 1.17–1.31; below the poverty line: aOR = 1.75, 95% CI = 1.62–1.89) and women (low to middle: aOR = 2.49, 95% CI = 2.05–3.01; below the poverty line: aOR = 4.71, 95% CI = 3.80–5.83). Use of mental health care (aOR = 1.14, 95% CI = 1.01–1.27) or antidepressants (aOR = 1.66, 95% CI = 1.50–1.84) also increased the risk among men; while receiving social welfare (aOR = 1.39, 95% CI = 1.15–1.67) and use of antipsychotic medication (aOR = 1.66, 95% CI = 1.21–2.28) increased the risk among women. Of all intersections identified in MAIHDA, men with a first-generation migration background, income below the poverty line, and who used antidepressants had the highest predicted probability of an HIV diagnosis (0.036%, 95% confidence interval (CI) = 0.025–0.052). Women with a first-generation background, income below the poverty line, who received social welfare, and who used antipsychotic medication had the highest predicted risk (0.019%, 95% CI = 0.011–0.035). Interpretation: A disproportionally higher burden of a new HIV diagnosis was observed for individuals with a migration background and economic and mental health vulnerabilities. HIV prevention and testing need to be reinforced in these groups. Funding: Dutch Ministry of Health, Welfare and Sport; TKI Health Holland
Explainable AI for automatic heart disease diagnosis using 3DFMMecg features:A novel ECG-based approach
No full textThe electrocardiogram (ECG), a gold standard in cardiac diagnostics, is increasingly combined with Artificial Intelligence (AI) methods to enhance its clinical utility. However, many recent studies have prioritised performance over clinical interpretability by focusing on Deep Learning (DL) techniques, which offer limited explainability since they do not directly correlate with clinical features. This lack of transparency causes mistrust among physicians and hinders adoption in daily clinical practice. We developed novel, self-explainable features from the 3DFMMecg model parametrisation, enabling highly accurate and clinically interpretable ML classifiers for cardiovascular pathology diagnosis from 12-lead ECG signals. We evaluated our approach on PTB-XL+, a widely used dataset of annotated ECG recordings. Our framework outperforms existing feature-based methods in four out of six classification tasks, achieving macro-AUC between 0.88 and 0.95 and weighted macro-AUC between 0.90 and 0.95, comparable to and in some tasks surpassing DL approaches. We further show that the model maintains high diagnostic accuracy when using only three of the standard twelve ECG leads, with less than 6% loss in performance, enabling deployment in mobile, wearable, or resource-constrained environments. Feature importance analyses using SHapley Additive exPlanations (SHAP) confirm strong alignment between model predictions and established clinical markers, such as QRS width and T-wave amplitude parameters. These results underscore the potential of 3DFMMecg-based pipelines toward reliable, transparent, and accessible ECG-based diagnostic systems
Association of Sarcopenia With Toxicity and Survival in Patients With Lung Cancer, a Multi-Institutional Study With External Dataset Validation
No full textIntroduction: Sarcopenia is associated with worse survival in non–small cell lung cancer (NSCLC), but less studied in association with toxicity. Here, we investigated the association between imaging-assessed sarcopenia with toxicity in patients with NSCLC. Methods: We analyzed a “chemoradiation” cohort (n = 318) of patients with NSCLC treated with chemoradiation, and an external validation “chemo-surgery” cohort (n = 108) who were treated with chemotherapy and surgery from 2002 to 2013 at a different institution. A deep-learning pipeline utilized pretreatment computed tomography scans to estimate SM area at the third lumbar vertebral level. Sarcopenia was defined by dichotomizing SM index, (SM adjusted for height and sex). Primary endpoint was NCI CTCAE v5.0 grade 3 to 5 (G3-5) toxicity within 21-days of first chemotherapy cycle. Multivariable analyses (MVA) of toxicity endpoints with sarcopenia and baseline characteristics were performed by logistic regression, and overall survival (OS) was analyzed using Cox regression. Results: Sarcopenia was identified in 36% and 36% of patients in the chemoradiation and chemo-surgery cohorts, respectively. On MVA, sarcopenia was associated with worse G3-5 toxicity in chemoradiation (HR 2.00, P < .01) and chemo-surgery cohorts (HR 2.95, P = .02). In the chemoradiation cohort, worse OS was associated with G3-5 toxicity (HR 1.42, P = .02) but not sarcopenia on MVA. In chemo-surgery cohort, worse OS was associated with sarcopenia (HR 2.03, P = .02) but not G3-5 toxicity on MVA. Conclusion: Sarcopenia, assessed by an automated deep-learning system, was associated with worse toxicity and survival outcomes in patients with NSCLC. Sarcopenia can be utilized to tailor treatment decisions to optimize adverse events and survival.</p
Investigating How Age Affects Self-Perception and Voice Awareness in Parkinson's Disease
No full textOBJECTIVE: Parkinson's disease (PD) presents with voice disturbances accompanied by sensory processing and awareness deficits. Sensory feedback from the voice, which is essential in speech production, is often impaired in individuals with PD (IwPD), potentially leading to such difficulties in the self-perception and awareness of voice disorder. However, aging naturally affects sensory and motor brain systems, including those involved in voice production; therefore, it remains unclear whether the combined effects of age and PD exacerbate deficits in voice self-perception and awareness deficit. This study explored how age and sensory feedback in IwPD interact and affect self-perception and awareness of voice changes. Patient-reported outcome measures (PROMs) specific to the voice may not be efficient enough to capture voice changes in IwPD. METHODS: The study included three groups of similar ages: 27 IwPD (61-79 years), 25 individuals with general voice disorders (GVD, aged 57-83 years), and 28 healthy controls (HC, aged 60-80 years). Self-perception of the voice was assessed by three PROMs: the Voice Symptoms Scale, Voice Handicap Index-10, and Voice-Related Quality of Life. Voice loudness was recorded and analyzed using univariate comparisons between the PROM scores. Further, multivariate techniques, such as principal component analysis (PCA) and cluster analysis, were used to identify intergroup differences in voice quality and voice self-awareness. RESULTS: The IwPD group showed lower self-perception and awareness of voice problems than the GVD and HC groups. Within the IwPD group, age did not show a significant impact on self-perception of voice and awareness. This group showed slightly higher PROM scores than the HCs. In contrast, the GVD group showed marked differences in all PROMs and voice parameters compared with the HC and PD groups. PCA revealed significant differences in total scores and voice loudness between the groups. CONCLUSIONS: These findings suggest that age-related changes in sensory feedback are not significant factors affecting reduced self-perception and awareness of voice changes in IwPD. PCA and cluster analysis revealed distinct patterns among the groups, with GVD forming a separate cluster and IwPD displaying variability, partially overlapping with HC and GVD. This variability underscores the limited diagnostic utility of PROMs used to identify voice problems in IwPD compared with older individuals without PD, who generally exhibit greater awareness of voice disorders. Future studies should focus on developing tailored PROMs to better capture these challenges in IwPD
3D bioprinting in tissue engineering:current state-of-the-art and challenges towards system standardization and clinical translation
No full textOver the past decade, three-dimensional (3D) bioprinting has made significant progress, transforming into a key innovation in tissue engineering. Despite the early strides, critical challenges remain in 3D bioprinting that must be addressed to accelerate clinical translation. In particular, there is still a long way to go before functionally-mature, clinically-relevant tissue equivalents are developed. Current limitations range from the sub-optimal bioink properties and degree of biomimicry of bioprintable architectures, to the lack of stem/progenitor cells for massive cell expansion, and fundamental knowledge regarding in vitro culturing conditions. In addition to these problems, the absence of guidelines and well-regulated international standards is creating uncertainty among the biofabrication community stakeholders regarding the reliable and scalable production processes. This review aims at exploring the latest developments in 3D bioprinting approaches, including various additive manufacturing techniques and their applications. A thorough discussion of common bioprinting techniques and recent progresses are compiled along with notable recent studies. Later we discuss the current challenges in clinical application of 3D bioprinting and the major bottlenecks in the commercialization of 3D bioprinted tissue equivalents, including the longevity of bioprinted organs, meeting biomechanical requirements, and the often underrated ethical and legal aspects. Amidst the progress of regulatory efforts for regenerative medicine, we also present an overview of the current regulatory concerns which should be taken into account to translate bioprinted tissues into clinical practice. At last, this review emphasizes future directions in 3D bioprinting that includes the transformative ideas such as bioprinting in microgravity and the integration of artificial intelligence. The study concludes with a discussion on the need for collaborative efforts in resolving the technical and regulatory constraints to improve the quality, reliability, and reproducibility of bioprinted tissue equivalents to ultimately accomplish their successful clinical implementation.</p