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Rasch-Built Overall Disability Scale for IgM-Associated Polyneuropathy With and Without Anti-MAG Antibodies:IgM-RODS
No full textBACKGROUND AND AIM: IgM monoclonal gammopathy-associated polyneuropathy with(out) anti-myelin associated glycoprotein (±anti-MAG) is a rare immune-mediated disease that may cause severe limitations in daily activities and quality of life. The absence of a systematic comparison between patients with/without anti-MAG IgM polyneuropathy, no disease-specific functional metric, and lack of international consensus regarding assessment and treatment of these patients are factors obstructing future clinical trials. Therefore, it was decided to develop an interval Rasch-built activity/participation scale specifically for IgM polyneuropathy ±anti-MAG (IgM-RODS) and examine its clinimetric properties. METHODS: A pre-phase IgM-RODS questionnaire containing 146 activity/participation items, based on the WHO International Classification of Functioning, Disability and Health, was completed by participants (= 18 years) of the IMAGiNe observational registry that fulfilled international criteria for IgM-polyneuropathy ±anti-MAG. Data was subjected to Rasch analyses, and reliability/validity studies were performed as well. RESULTS: The pre-RODS data of 259 subjects (originating from 8 different countries) underwent quality assessment, and 244 remaining records were submitted to the Rasch model, evidencing the model's expectations. Based on requirements like exceeding fit residuals, misfit statistics, item bias, local dependency, and less face validity, we systematically removed items until the final 36-item IgM-RODS fulfilled all Rasch requirements and showed acceptable test-retest reliability, cross-cultural, construct and discriminant validity, and unidimensionality. Compared to the Inflammatory-RODS, the IgM-RODS showed lower standard errors across the metric, indicating greater sensitivity. INTERPRETATION: The 36-item IgM-RODS is a disease-specific interval measure suitable for detecting functional deficits in patients with IgM-polyneuropathy ±anti-MAG. Future studies are needed to determine its responsiveness
Fluoroless bedside implantation of the ProtekDuo cannula:clinical experience at a tertiary care center
No full textThe ProtekDuo dual-lumen cannula allows percutaneous support in right ventricular failure with or without gas exchange impairments. However, positioning of the device is resource demanding. The usual approach requires a fluoroscopy–equipped operating room, possibly limiting its wider and timely adoption. We report our initial experience with bedside, fluoroless ProtekDuo implantation under transesophageal echocardiography (TEE) guidance in a tertiary care national referral center. Eight critically ill patients underwent bedside ProtekDuo placement for right ventricular dysfunction or acute respiratory distress syndrome with right ventricular failure. All procedures were completed successfully without procedural complications. Our findings demonstrate that bedside, TEE-guided, fluoroless ProtekDuo cannulation is feasible and safe, potentially expanding access to advanced mechanical circulatory support.</p
Assessment of psychosocial adjustment and reduced initiative in children with myotonic dystrophy type 1:a pilot study on the reliability and clinical utility of a short parent-report questionnaire
No full textWe describe the reliability and clinical utility of the personal adjustment and role skills scale III (PARS-III) for screening of psychosocial adjustment in children with myotonic dystrophy type 1 (DM1). Data of 36 pediatric DM1 patients were included from the Dutch MYODRAFT patient registry. Reliability was assessed using Cronbach's alpha. Associations between PARS-III scores and estimates of brain-related comorbidity and parent-reported physical disease burden were explored as possible factors affecting psychosocial adjustment. PARS-III data of children with DM1 in this study were compared to PARS-III data from children with Duchenne muscular dystrophy in order to describe specificity to the pediatric DM1 population. The PARS-III showed adequate internal consistency. PARS-III total scores correlated with parent-reported symptoms of autism spectrum disorder and attention deficit/hyperactivity disorder and parent-reported physical disease burden. No statistically significant associations were found with intelligence. Parents reported most problems in reduced social activity and reduced initiative. Reduced initiative was not associated with attention deficit/hyperactivity disorder, autism spectrum disorder or reported physical disease burden. Parents of children with DM1 reported more problems in initiative compared to parents of children with Duchenne muscular dystrophy. We conclude that the PARS-III is a reliable instrument for screening psychosocial adjustment in general and deficits in initiative in particular. More research is needed on this clinically relevant symptom as a possible brain-related comorbidity of children with DM1
Faecal incontinence core outcome set:an international Delphi consensus exercise among patients, health-care professionals, and researchers
No full textFaecal incontinence is a debilitating anorectal disorder that can severely affect a person's quality of life. The variability in reported outcomes in studies on treatments for faecal incontinence complicates the synthesis of evidence, thereby weakening treatment recommendations. Furthermore, the emphasis on clinical outcomes often neglects outcomes that are crucial to patients' daily lives. Incorporating diverse stakeholder perspectives, we aimed to develop a core outcome set (COS)—a minimum set of outcomes that should be measured in future studies evaluating the efficacy of a treatment in adults with faecal incontinence. Following guidelines from the COMET initiative, this study proceeded through three steps: identifying outcomes via patient interviews and a systematic literature review; ranking and refining outcomes through two rounds of Delphi surveys involving patients, health-care professionals, and researchers; and finalising the COS through a consensus meeting with relevant stakeholders. Round 1 of the Delphi survey included 109 participants (73 health-care professionals and researchers and 36 patients) and round 2 involved 74 participants (54 and 20, respectively). In both rounds, participants ranked the importance of potential outcomes on a 9-point Likert scale. Of the 58 outcomes that entered round 1 and the three that were later added, 27 outcomes were voted out and the remaining 34 were discussed during a consensus meeting to finalise the COS. The final COS encompasses 13 outcomes: seven quality of life-related outcomes (quality of life, influence on daily activities, social functioning, treatment satisfaction, enjoyment in life, embarrassment, and peace of mind) and six clinical outcomes (severity of faecal incontinence, number of faecal incontinence episodes, urgency, stool consistency, adverse events, and adherence to therapy). This study establishes what outcomes should be included in a COS for use in faecal incontinence research, but future research is needed to identify the appropriate measurement instruments for each outcome and to establish appropriate timing for their assessment, which will further refine outcome definitions before this COS can be implemented. Once these aspects are clarified, the COS can be adopted into faecal incontinence research, which we hope will ultimately improve clinical care
The impact of sugar-sweetened beverages tax policy on cases of diabetes, depression, heart attacks, hypertension, and stroke in the 35 years and 40 years cohorts of South Africa
No full textIn 2018, South Africa became the first African country to implement a sugar-sweetened beverages (SSB) tax policy. This study evaluates its impact on diabetes, depression, heart attacks, hypertension, and stroke among South Africans aged 35 and 40. Data from 2016 to 2017 (control group) and 2018-2021 (treatment group) were analysed using an Instrumental Variables (IV) estimation model. Results indicate a 16% reduction in diabetes and 23% reduction in depression for the 35-year cohort, while the 40-year cohort saw 6% and 16% decreases, respectively. Heart attacks dropped by 36% and 12%, hypertension by 30% and 10%, and strokes by 16% and 6% in the respective cohorts. The effects were more significant in men and in the younger 35-year cohort, particularly among Black African and Mixed-Race groups, and people from low socio-economic backgrounds. Overall, the policy effectively reduces these health issues, suggesting that higher tax rates could enhance brain health outcomes
Hedonic seat arrangement problems
No full textIn this paper, we study a variant of hedonic games, called Seat Arrangement. The model is defined by a bijection from agents with preferences for each other to vertices in a graph G. The utility of an agent depends on the neighbors assigned in the graph. More precisely, it is the sum over all neighbors of the preferences that the agent has towards the agent assigned to the neighbor. We first consider the price of stability and fairness for different classes of preferences. In particular, we show that there is an instance such that the price of fairness (PoF) is unbounded in general. Moreover, we show an upper bound \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}\end{document} and an almost tight lower bound \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}\end{document} of PoF, where \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}\end{document} is the average degree of an input graph. Then we investigate the computational complexity of problems to find certain "good" seat arrangements, say Utilitarian Arrangement, Egalitarian Arrangement, Stable Arrangement, and Envy-free Arrangement. We give dichotomies of computational complexity of four Seat Arrangement problems from the perspective of the maximum order of connected components in an input graph. For the parameterized complexity, Utilitarian Arrangement can be solved in time \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}n<^>{O(\gamma )}\end{document}, while it cannot be solved in time \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}f(\gamma )n<^>{o(\gamma )}\end{document} under ETH, where n is the number of agents and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}\end{document} is the vertex cover number of an input graph. Moreover, we show that Egalitarian Arrangement and Envy-free Arrangement are weakly NP-hard even on graphs of bounded vertex cover number.Finally, we prove that determining whether a stable arrangement can be obtained from a given arrangement by k swaps is W[1]-hard when parameterized by \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}\end{document}, whereas it can be solved in time \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}n<^>{O(k)}\end{document}
ToF-SIMS spectra of typical substrates in both polarities: Si wafer, Au-coated glass, and ITO-coated glass
No full textToF-SIMS is a surface analysis technique, and as a result, many samples need to be spotted or mounted onto a suitable substrate. Different substrates can be used for ToF-SIMS analysis, and it is essential to properly assign the characteristic chemical signals from the substrate to distinguish them from the sample analyte ions. Here, the authors provide a reference database that provides ToF-SIMS spectra for three widely used substrates in positive and negative polarities. The six spectra were acquired using a 30 keV Bi3+ primary ion beam, with Ar gas cluster ion beam sputter cleaning of the surfaces before analysis.</p
Doubly Robust Control Outcome Calibration Approach Estimation of Conditional Effects with Uncontrolled Confounding
No full textDrawing causal conclusions about nonrandomized exposures rests on assuming no uncontrolled confounding, but it is rarely justifiable to rule out all putative violations of this routinely made yet empirically untestable assumption. Alternatively, this assumption can be avoided by leveraging negative control outcomes using the control outcome calibration approach (COCA). The existing COCA estimator of the average causal effect relies on correctly specifying the mean negative control outcome model, with a closed-form solution for the main exposure effect. In this article, we propose a doubly robust COCA estimator of the average causal effect that relaxes this modeling requirement and permits effect modification through covariate-exposure interaction terms. The doubly robust COCA estimator uses correctly specified exposure and focal outcome models to protect against biases from an incorrectly specified negative control outcome model. The ability to obtain unbiased point estimates and inferences is empirically evaluated using a simulation study. We demonstrate doubly robust COCA using a publicly available dataset to evaluate the effect of volunteering on mental health. This method is practical and easy to implement and permits unbiased estimation of causal effects even amid uncontrolled confounding
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
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