155155 research outputs found
Sort by
Algorithmic fairness in precision psychiatry: analysis of prediction models in individuals at clinical high risk for psychosis.
No full textBACKGROUND
Computational models offer promising potential for personalised treatment of psychiatric diseases. For their clinical deployment, fairness must be evaluated alongside accuracy. Fairness requires predictive models to not unfairly disadvantage specific demographic groups. Failure to assess model fairness prior to use risks perpetuating healthcare inequalities. Despite its importance, empirical investigation of fairness in predictive models for psychiatry remains scarce.
AIMS
To evaluate fairness in prediction models for development of psychosis and functional outcome.
METHOD
Using data from the PRONIA study, we examined fairness in 13 published models for prediction of transition to psychosis (n = 11) and functional outcome (n = 2) in people at clinical high risk for psychosis or with recent-onset depression. Using accuracy equality, predictive parity, false-positive error rate balance and false-negative error rate balance, we evaluated relevant fairness aspects for the demographic attributes 'gender' and 'educational attainment' and compared them with the fairness of clinicians' judgements.
RESULTS
Our findings indicate systematic bias towards assigning less favourable outcomes to individuals with lower educational attainment in both prediction models and clinicians' judgements, resulting in higher false-positive rates in 7 of 11 models for transition to psychosis. Interestingly, the bias patterns observed in algorithmic predictions were not significantly more pronounced than those in clinicians' predictions.
CONCLUSIONS
Educational bias was present in algorithmic and clinicians' predictions, assuming more favourable outcomes for individuals with higher educational level (years of education). This bias might lead to increased stigma and psychosocial burden in patients with lower educational attainment and suboptimal psychosis prevention in those with higher educational attainment
Imaging of alert patients after non-self-inflicted strangulation: MRI is superior to CT.
Get PDFOBJECTIVE
To assess the accuracy of CT and MRI reports of alert patients presenting after non-self-inflicted strangulation (NSIS) and evaluate the appropriateness of these imaging modalities in NSIS.
MATERIAL AND METHODS
The study was a retrospective analysis of patient characteristics and strangulation details, with a comparison of original radiology reports (ORR) to expert read-outs (EXR) of CT and MRI studies of all NSIS cases seen from 2008 to 2020 at a single centre.
RESULTS
The study included 116 patients (71% women, p < .001, χ2), with an average age of 33.8 years, mostly presenting after manual strangulation (97%). Most had experienced intimate partner violence (74% of women, p < .001, χ2) or assault by unknown offender (88% of men, p < 0.002 χ2). Overall, 132 imaging studies (67 CT, 51% and 65 MRI, 49%) were reviewed. Potentially dangerous injuries were present in 7%, minor injuries in 22%, and no injuries in 71% of patients. Sensitivity and specificity of ORR were 78% and 97% for MRI and 30% and 98% for CT. Discrepancies between ORR and EXR occurred in 18% of all patients, or 62% of injured patients, with a substantial number of unreported injuries on CT.
CONCLUSIONS
The results indicate that MRI is more appropriate than CT for alert patients presenting after non-self-inflicted strangulation and underline the need for radiologists with specialist knowledge to report these cases in order to add value to both patient care and potential future medico-legal investigations.
CLINICAL RELEVANCE STATEMENT
MRI should be preferred over CT for the investigation of strangulation related injuries in alert patients because MRI has a higher accuracy than CT and does not expose this usually young patient population to ionizing radiation.
KEY POINTS
• Patients presenting after strangulation are often young women with a history of intimate partner violence while men typically present after assault by an unknown offender. • Expert read-outs of CT and MRI revealed potentially dangerous injuries in one of 14 patients. • MRI has a significantly higher sensitivity than CT and appears to be more appropriate for the diagnostic workup of alert patients after strangulation
The use of mesenchymal stromal cell secretome to enhance guided bone regeneration in comparison with leukocyte and platelet-rich fibrin.
Get PDFOBJECTIVES
Secretomes of mesenchymal stromal cells (MSC) represent a novel strategy for growth-factor delivery for tissue regeneration. The objective of this study was to compare the efficacy of adjunctive use of conditioned media of bone-marrow MSC (MSC-CM) with collagen barrier membranes vs. adjunctive use of conditioned media of leukocyte- and platelet-rich fibrin (PRF-CM), a current growth-factor therapy, for guided bone regeneration (GBR).
METHODS
MSC-CM and PRF-CM prepared from healthy human donors were subjected to proteomic analysis using mass spectrometry and multiplex immunoassay. Collagen membranes functionalized with MSC-CM or PRF-CM were applied on critical-size rat calvaria defects and new bone formation was assessed via three-dimensional (3D) micro-CT analysis of total defect volume (2 and 4 weeks) and 2D histomorphometric analysis of central defect regions (4 weeks).
RESULTS
While both MSC-CM and PRF-CM revealed several bone-related proteins, differentially expressed proteins, especially extracellular matrix components, were increased in MSC-CM. In rat calvaria defects, micro-CT revealed greater total bone coverage in the MSC-CM group after 2 and 4 weeks. Histologically, both groups showed a combination of regular new bone and 'hybrid' new bone, which was formed within the membrane compartment and characterized by incorporation of mineralized collagen fibers. Histomorphometry in central defect sections revealed greater hybrid bone area in the MSC-CM group, while the total new bone area was similar between groups.
CONCLUSION
Based on the in vitro and in vivo investigations herein, functionalization of membranes with MSC-CM represents a promising strategy to enhance GBR
Sex differences in the effectiveness of first-line tumor necrosis factor inhibitors in psoriatic arthritis; results from the EuroSpA Research Collaboration Network.
No full textOBJECTIVE
Women with psoriatic arthritis (PsA) may have reduced tumor necrosis factor inhibitor (TNFi) effectiveness compared to men. We examined sex differences in treatment response and retention rates during 24 months of follow-up among patients with PsA initiating their first TNFi.
METHODS
Data from PsA patients across 13 EuroSpA registries starting their first TNFi were pooled. Logistic regression was used to analyze the association between sex and treatment response, using low disease activity (LDA) according to DAS28-CRP (<3.2) at 6 months as the primary outcome. Analyses were adjusted for age, country, csDMARD use, and TNFi start year. Retention rates were explored using the Kaplan-Meier estimators.
RESULTS
We analyzed the treatment response of 7,679 PsA patients (50% women) with available data on LDA at 6 months. At baseline, women and men had similar characteristics, including mean DAS28-CRP (women vs. men, 4.4 [SD 1.2] vs. 4.2 [1.2]), though patient-reported outcome measures were worse in women. At 6 months, 64% of women and 78% of men had LDA (relative risk, 0.82; 95% confidence interval, 0.80 to 0.84). This difference was similar after adjustment (0.83; 0.81 to 0.85). TNFi retention rates were evaluated in 17,842 PsA patients. Women had significantly lower retention rates than men at all time points (women: 79%/64%/50% at 6/12/24 months versus men: 88%/77%/64%).
CONCLUSION
Despite comparable disease characteristics at baseline, women with PsA have reduced treatment response and retention rates to their first TNFi, highlighting the need to consider sex differences in PsA research and management
Interproximal Soft Tissue Height Changes After Unassisted Socket Healing versus Alveolar Ridge Preservation Therapy.
No full textThe primary aim of this study was to evaluate the efficacy of alveolar ridge preservation (ARP) therapy compared with unassisted socket healing (USH) in attenuating interproximal soft tissue atrophy. Adult subjects that underwent maxillary single-tooth extraction with or without ARP therapy were included in this study. Surface scans and cone beam computed tomography were obtained to digitally assess interproximal soft tissue height changes and measure facial bone thickness (FBT), respectively. Logistic regression models were conducted to investigate the individual effect of demographic and clinical variables. Ninety-six subjects (USH=49; ARP=47) constituted the study population. Linear soft tissue assessments revealed a significant reduction of the interproximal soft tissue over time within and between groups (P1mm), independently of the treatment received (P<.0001). Nevertheless, ARP therapy resulted in better preservation of interproximal soft tissue height especially in thin bone phenotype by a factor of 2 for the mesial site (+1.3mm) and a factor of 1.6 (+0.9mm) for the distal site. This study demonstrated that ARP therapy largely attenuates interproximal soft tissue dimensional reduction after maxillary single-tooth extraction compared with USH
Applying the TRILUMINATE Eligibility Criteria to Real-World Patients Receiving Tricuspid Valve Transcatheter Edge-to-Edge Repair.
No full textBACKGROUND
According to the Clinical TRIal to EvaLUate Cardiovascular OutcoMes IN PAtients Treated with the Tricuspid ValvE Repair System (TRILUMINATE) trial, transcatheter tricuspid edge-to-edge repair (T-TEER) improves quality of life beyond medical treatment, while no effects on heart failure hospitalizations (HFH) and survival were observed at 1 year. However, the generalizability of the TRILUMINATE trial to real-world conditions remains subject of discussion.
OBJECTIVES
To apply the clinical TRILUMINATE in- and exclusion criteria to a real-world T-TEER patient group and evaluate symptomatic and survival outcome in TRILUMINATE eligible and ineligible patients.
METHODS
Clinical TRILUMINATE in- and exclusion criteria were applied to a cohort of patients who underwent T-TEER at five European centers from 2016 until 2022. Study patients were compared regarding baseline characteristics, survival, HFH, and symptomatic outcomes as measured by New York Heart Association (NYHA) functional class, quality of life questionnaire and six-minute walk test distance (6MWD).
RESULTS
Out of 962 patients, 54.8% were classified as TRILUMINATE eligible, presenting with superior left ventricular function and fewer comorbidities compared to the ineligible population. TR reduction, improvement in NYHA class, quality of live and exercise capacity were comparable in both groups. However, the 1-year survival and HFH rates significantly differed (TR≤2+ at discharge: 82% vs. 85%; survival: 85% vs. 75%; HFH: 14% vs. 22% for eligible vs. ineligible patients).
CONCLUSIONS
The observed differences in survival and HFH outcomes suggest a limited generalizability of TRILUMINATE to real-world conditions and they indicate the need for additional studies evaluating the outcomes after T-TEER in less selected patient populations
Patient-reported outcomes 1 and 2 years after transforaminal thoracic interbody fusion (TTIF).
No full textSTUDY DESIGN
Retrospective Cohort Study with prospectively collected data.
PURPOSE
Transforaminal interbody fusion was initially designed for the lumbar spine. A similar approach was later introduced for the thoracic spine (TTIF). Here we report the surgical technique and the Core Outcome Measures Index (COMI) at 1-year and 2-year follow-ups, as well as the sagittal radiographic kyphosis correction of TTIF, achieved at 1 year and the latest follow-up.
METHODS
All TTIF procedures from 2012 to 2020 were included. COMI scores were collected preoperatively and at 1- and 2-year follow-ups. The sagittal angle between the upper and lower endplates at the segment where TTIF was performed was measured on preoperative, 1-year postoperative, and last available radiographs.
RESULTS
Seventy-nine TTIF procedures were performed for 64 patients (36% males; mean age 67.5 (SD 15.3) years). COMI score reduced from a mean value of 8.1 (SD 1.4) preoperatively to 4.7 (SD 2.7) at 1-year follow-up and 4.7 (SD 2.7) at 2-year follow-up. The mean correction of segmental kyphosis was 10.8 (SD 7.3, p < 0.0001) degrees at 1-year follow-up and 9.3 (SD 7.0, p < 0.0001) degrees at the final follow-up 3.4 (SD 1.4) years after the operation. Kaplan-Meier analysis for reoperations showed a 5-year survival of 91% (95% CI 0.795-1) for primary TTIF operations and survival of 77% (95% CI 0.651-0.899) for TTIFs performed after earlier fusion operations.
CONCLUSIONS
TTIF is a feasible procedure in the thoracic spine. Kyphosis correction of approximately 10° was maintained at 1-year and final follow-up. Over 69% at 1-year and 61% at 2-year follow-up achieved MCID for COMI
Abbreviated or Standard Dual Antiplatelet Therapy by Sex in Patients at High Bleeding Risk: A Prespecified Secondary Analysis of a Randomized Clinical Trial.
No full textIMPORTANCE
Abbreviated dual antiplatelet therapy (DAPT) reduces bleeding with no increase in ischemic events in patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI).
OBJECTIVES
To evaluate the association of sex with the comparative effectiveness of abbreviated vs standard DAPT in patients with HBR.
DESIGN, SETTING, AND PATIENTS
This prespecified subgroup comparative effectiveness analysis followed the Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated vs Standard DAPT Regimen (MASTER DAPT) trial, a multicenter, randomized, open-label clinical trial conducted at 140 sites in 30 countries and performed from February 28, 2017, to December 5, 2019. A total of 4579 patients with HBR were randomized at 1 month after PCI to abbreviated or standard DAPT. Data were analyzed from July 1 to October 31, 2022.
INTERVENTIONS
Abbreviated (immediate DAPT discontinuation, followed by single APT for ≥6 months) or standard (DAPT for ≥2 additional months, followed by single APT for 11 months) treatment groups.
MAIN OUTCOMES AND MEASURES
One-year net adverse clinical events (NACEs) (a composite of death due to any cause, myocardial infarction, stroke, or major bleeding), major adverse cardiac or cerebral events (MACCEs) (a composite of death due to any cause, myocardial infarction, or stroke), and major or clinically relevant nonmajor bleeding (MCB).
RESULTS
Of the 4579 patients included in the analysis, 1408 (30.7%) were women and 3171 (69.3%) were men (mean [SD] age, 76.0 [8.7] years). Ischemic and bleeding events were similar between sexes. Abbreviated DAPT was associated with comparable NACE rates in men (hazard ratio [HR], 0.97 [95% CI, 0.75-1.24]) and women (HR, 0.87 [95% CI, 0.60-1.26]; P = .65 for interaction). There was evidence of heterogeneity of treatment effect by sex for MACCEs, with a trend toward benefit in women (HR, 0.68 [95% CI, 0.44-1.05]) but not in men (HR, 1.17 [95% CI, 0.88-1.55]; P = .04 for interaction). There was no significant interaction for MCB across sex, although the benefit with abbreviated DAPT was relatively greater in men (HR, 0.65 [95% CI, 0.50-0.84]) than in women (HR, 0.77 [95% CI, 0.53-1.12]; P = .46 for interaction). Results remained consistent in patients with acute coronary syndrome and/or complex PCI.
CONCLUSIONS AND RELEVANCE
These findings suggest that women with HBR did not experience higher rates of ischemic or bleeding events compared with men and may derive particular benefit from abbreviated compared with standard DAPT owing to these numerically lower rates of events.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03023020
Lower alpha frequency of intraoperative frontal EEG is associated with postoperative delirium: A secondary propensity-matched analysis.
Get PDFBACKGROUND
Postoperative delirium (POD) is a serious complication of surgery, especially in the elderly patient population. It has been proposed that decreasing the amount of anesthetics by titrating to an EEG index will lower POD rate, but clear evidence is missing. A strong age-dependent negative correlation has been reported between the peak oscillatory frequency of alpha waves and end-tidal anesthetic concentration, with older patients generating slower alpha frequencies. We hypothesized, that slower alpha oscillations are associated with a higher rate of POD.
METHOD
Retrospective analysis of patients` data from a prospective observational study in cardiac surgical patients approved by the Bernese Ethics committee. Frontal EEG was recorded during Isoflurane effect-site concentrations of 0.7 to 0.8 and peak alpha frequency was measured at highest power between 6 and 17 Hz. Delirium was assessed by chart review. Demographic and clinical characteristics were compared between POD and non-POD groups. Selection bias was addressed using nearest neighbor propensity score matching (PSM) for best balance. This incorporated 18 variables, whereas patients with missing variable information or without an alpha oscillation were excluded.
RESULT
Of the 1072 patients in the original study, 828 were included, 73 with POD, 755 without. PSM allowed 328 patients into the final analysis, 67 with, 261 without POD. Before PSM, 8 variables were significantly different between POD and non-POD groups, none thereafter. Mean peak alpha frequency was significantly lower in the POD in contrast to non-POD group before and after matching (7.9 vs 8.9 Hz, 7.9 vs 8.8 Hz respectively, SD 1.3, p < 0.001).
CONCLUSION
Intraoperative slower frontal peak alpha frequency is independently associated with POD after cardiac surgery and may be a simple intraoperative neurophysiological marker of a vulnerable brain for POD. Further studies are needed to investigate if there is a causal link between alpha frequency and POD
Evolution of the external crystalline massifs of the European Alps: From massif to lithosphere scale
No full textThis chapter summarizes the Alpine evolution of the so-called “external crystalline massifs” (ECM). The ECM align in an arcuate manner, following the trend of the relatively external part of the Western to the Central Alps. The chapter presents a summary of the current state of knowledge on the exhumation processes, structures, kinematics and geodynamic consequences necessary to form and exhume the ECM. It introduces the geological setting common to all ECM followed by the geological setting and tectonic evolution of each ECM individually. The chapter deals with the lithosphere-scale structural-tectonic framework of the ECM. These multi-scale geometries are then discussed in the context of the evolution of the Western to Central Alpine arc including effects of inheritance of Mesozoic extensional structures and passive margin geometries, deformation structures, as well as kinematics. Finally, the chapter discusses the general ECM evolution in light of Alpine geodynamic processes
Data sources:
BORIS Portal Bern Open Repository and I...BAF-Online: Proceedings of the Berner Al...HASBonline – Hefte zur Archäologie des M...Informationswissenschaft: Theorie, Metho...Jahrbuch Diakonie SchweizJournal of Eye Movement ResearchJournal of Radiation Oncology Informatic...BOP SerialsVersants. Revista suiza de literaturas r...BORIS ThesesAccess Repository Dashboard
Do you manage Bern Open Repository and Information System (BORIS)? Access insider analytics, issue reports and manage access to outputs from your repository in the CORE Repository Dashboard!