Outcomes Of Different Types Research Articles

The role of the AHR in host-pathogen interactions.

Host-microorganism encounters take place in many different ways and with different types of outcomes. Three major types of microorganisms need to be distinguished: (1) pathogens that cause harm to the host and must be controlled; (2) environmental microorganisms that can be ignored but must be controlled at higher abundance; and (3) symbiotic microbiota that require support by the host. Recent evidence indicates that the aryl hydrocarbon receptor (AHR) senses and initiates signalling and gene expression in response to a plethora of microorganisms and infectious conditions. It was originally identified as a receptor that binds xenobiotics. However, it was subsequently found to have a critical role in numerous biological processes, including immunity and inflammation and was recently classified as a pattern recognition receptor. Here we review the role of the AHR in host-pathogen interactions, focusing on AHR sensing of different microbial classes, the ligands involved, responses elicited and disease outcomes. Moreover, we explore the therapeutic potential of targeting the AHR in the context of infection.

Patient and public involvement in healthcare: a systematic mapping review of systematic reviews – identification of current research and possible directions for future research

ObjectivesTo provide an overview of patient and public involvement (PPI) in the mesolevel and macrolevel of healthcare (different from PPI in research) and identify directions for future research by mapping...

New horizons in prediction modelling using machine learning in older people's healthcare research.

Machine learning (ML) and prediction modelling have become increasingly influential in healthcare, providing critical insights and supporting clinical decisions, particularly in the age of big data. This paper serves as an introductory guide for health researchers and readers interested in prediction modelling and explores how these technologies support clinical decisions, particularly with big data, and covers all aspects of the development, assessment and reporting of a model using ML. The paper starts with the importance of prediction modelling for precision medicine. It outlines different types of prediction and machine learning approaches, including supervised, unsupervised and semi-supervised learning, and provides an overview of popular algorithms for various outcomes and settings. It also introduces key theoretical ML concepts. The importance of data quality, preprocessing and unbiased model performance evaluation is highlighted. Concepts of apparent, internal and external validation will be introduced along with metrics for discrimination and calibration for different types of outcomes. Additionally, the paper addresses model interpretation, fairness and implementation in clinical practice. Finally, the paper provides recommendations for reporting and identifies common pitfalls in prediction modelling and machine learning. The aim of the paper is to help readers understand and critically evaluate research papers that present ML models and to serve as a first guide for developing, assessing and implementing their own.

Associations between surgeons' preoperative expectations of lumbar surgery and patient-reported 2-year outcomes.

Surgeons' preoperative expectations of lumbar surgery may be associated with patient-reported postoperative outcomes. Preoperatively spine surgeons completed a validated Expectations Survey for each patient estimating amount of improvement expected (range 0-100). Preoperative variables were clinical characteristics, spine-specific disability (ODI), and general health (RAND-12). Two years postoperatively patients again completed these measures and global assessments of satisfaction. Surgeons' expectations were compared to preoperative variables and to clinically important pre- to postoperative changes (MCID) in ODI, RAND-12, and pain and to satisfaction using hierarchical models. Mean expectations survey score for 402 patients was a 57 (IQR 44-68) reflecting moderate expectations. Lower scores were associated with preoperative older age, abnormal gait, sensation loss, vacuum phenomena, foraminal stenosis, prior surgery, and current surgery to more vertebrae (all p ≤ .05). Lower scores were associated postoperatively with not attaining MCID for the ODI (p = .02), RAND-12 (p = .01), and leg pain (p = .01). There were no associations between surgeons' scores and satisfaction (p = .06-.27). 55 patients (14%) reported unfavorable global outcomes and were more likely to have had fracture/infection/repeat surgery (OR 3.2, CI 1.6-6.7, p = .002). Surgeons' preoperative expectations were associated with patient-reported postoperative improvement in symptoms and function, but not with satisfaction. These findings are consistent with clinical practice in that surgeons expect some but not complete improvement from surgery and do not anticipate that any particular patient will have markedly unfavorable satisfaction ratings. In addition to preoperative discussions about expectations, patients and surgeons should acknowledge different types of outcomes and address them jointly in postoperative discussions.

Claim Types in Canada’s Refugee Determination System

This article overviews outcomes in different types of refugee claims in Canada. It critiques standard legal research methodologies in the refugee law field due to skews in publication practices. To address these skews, the article employs empirical quantitative research methods using administrative tribunal data and computational methods. It provides a snapshot of refugee claim numbers, countries of origin, claim categories, and outcomes. The article then underscores the benefits of supplementing doctrinal legal research with empirical quantitative research methods, outlines barriers to the adoption of such methods, and offers guidance and tools to assist other researchers in overcoming those barriers.

PT32 Assessing the Effect of Risk of Bias Assessments in Randomized Controlled Trials of Pharmacological Interventions with Different Types of Outcomes and Comparators – a Bayesian Meta-Epidemiological Study

PT32 Assessing the Effect of Risk of Bias Assessments in Randomized Controlled Trials of Pharmacological Interventions with Different Types of Outcomes and Comparators – a Bayesian Meta-Epidemiological Study

Incisional Wound Irrigation for the Prevention of Surgical Site Infection

Surgical site infections (SSIs) are common postoperative complications and associated with significant morbidity, mortality, and costs. Prophylactic intraoperative incisional wound irrigation is used to reduce the risk of SSIs, and there is great variation in the type of irrigation solutions and their use. To compare the outcomes of different types of incisional prophylactic intraoperative incisional wound irrigation for the prevention of SSIs in all types of surgery. PubMed, Embase, CENTRAL, and CINAHL databases were searched up to June 12, 2023. Included in this study were randomized clinical trials (RCTs) comparing incisional prophylactic intraoperative incisional wound irrigation with no irrigation or comparing irrigation using different types of solutions, with SSI as a reported outcome. Studies investigating intracavity lavage were excluded. This systematic review and network meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Two reviewers independently extracted the data and assessed the risk of bias within individual RCTs using the Cochrane Risk of Bias 2 tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A frequentist network meta-analysis was conducted, and relative risks (RRs) with corresponding 95% CIs were reported. The primary study outcome was SSI. A total of 1587 articles were identified, of which 41 RCTs were included in the systematic review, with 17 188 patients reporting 1328 SSIs, resulting in an overall incidence of 7.7%. Compared with no irrigation, antiseptic solutions (RR, 0.60; 95% CI, 0.44-0.81; high level of certainty) and antibiotic solutions (RR, 0.46; 95% CI, 0.29-0.73; low level of certainty) were associated with a beneficial reduction in SSIs. Saline irrigation showed no statistically significant difference compared with no irrigation (RR, 0.83; 95% CI, 0.63-1.09; moderate level of certainty). This systematic review and network meta-analysis found high-certainty evidence that prophylactic intraoperative incisional wound irrigation with antiseptic solutions was associated with a reduction in SSIs. It is suggested that the use of antibiotic wound irrigation be avoided due to the inferior certainty of evidence for its outcome and global antimicrobial resistance concerns.

Finding the best subgroup with differential treatment effect with multiple outcomes.

Precision medicine aims to identify specific patient subgroups that may benefit the most from a particular treatment than the whole population. Existing definitions for the best subgroup in subgroup analysis are based on a single outcome and do not consider multiple outcomes; specifically, outcomes of different types. In this article, we introduce a definition for the best subgroup under a multiple-outcome setting with continuous, binary, and censored time-to-event outcomes. Our definition provides a trade-off between the subgroup size and the conditional average treatment effects (CATE) in the subgroup with respect to each of the outcomes while taking the relative contribution of the outcomes into account. We conduct simulations to illustrate the proposed definition. By examining the outcomes of urinary tract infection and renal scarring in the RIVUR clinical trial, we identify a subgroup of children that would benefit the most from long-term antimicrobial prophylaxis.

Breast Cancer Predictor Using Deep Learning

Abstract:- The problem of the Breast Cancer around the world among women becoming worsens each passing day. Curing of Breast Cancer disease is never easy for women. It is also become hard when women are in there 30’s. After several researches or experiments by our doctors and scientists, there is no 100% curable treatment for the cancer. In India, in every 4 minutes one women is diagnosed with breast cancer and in every 13 minutes one women is died due to breast cancer. According to WHO report of year 2022 around 670000 people died due to breast cancer and around 2.3 million women diagnosed with this cancer. Out of 185 countries in the world women from 157 countries suffering from breast cancer. We can also say that due to lack of accurate prediction models results in the difficulty for doctors to prepare for a treatment plan. So, we are trying to develop a model by using two different approaches i.e., train and testing method and by using cross-validation method. We will discuss about which approach gives good accuracy with minimum errors in less time. We will use the algorithms like SVM, AdaBoost, XgBoost, KNN, Naïve Bayes to determine the accuracy. This work is done to predict the outcomes of different types of techniques and which technique has good accuracy, F1 score, precision, recall.

Editorial: Effects of human light exposure on beyond-vision outcomes in different types of built environments

Editorial: Effects of human light exposure on beyond-vision outcomes in different types of built environments

Promoting leisure functions through setting creative linguistic landscapes in recreational zones.

Using creativity to promote recreational services is crucial. Accordingly, creative linguistic landscapes (CLLs) are being used to improve visitors' experiences in some recreational zones. However, relevant research is still in its early stages. Therefore, this study was conducted. It summarized the leisure function categories and function evaluation indicators of CLLs in recreational zones respectively based on image materials and related online reviews. The leisure function outcomes of all CLL types were ranked using the fuzzy PROMETHEE method; based on this ranking, a CLL configuration optimization mode was suggested. The findings reveal the following. (1) Currently, there are mainly nine leisure function types of CLL in practice, although the type structure is severely imbalanced; there are 12 primary corresponding function evaluation indicators, although each of them draws significantly different attention. (2) There are notable variations among the outcomes of different types of functions of CLL: mood adjustment is the most advantageous function of CLL for leisure services, followed by emotional guidance and cognitive building functions; (3) According to the study findings, in the configuration of CLL, which aims at leisure function optimization, the "function focusing and coordinating mode (the superior functions of CLL are focused on and its various functions are coordinated)" should be adopted. The results provide meaningful lessons for the establishment of rational and effective CLL in recreational zones.

Platelet-to-lymphocyte ratio predicts tumor response and survival of patients with hepatocellular carcinoma undergoing immunotherapies

BackgroundLymphocyte-related factors were associated with survival outcome of different types of cancers. Nevertheless, the association between lymphocytes-related factors and tumor response of immunotherapy remains unclear. MethodsThis is a retrospective study. Eligible participants included patients with unresectable or advanced hepatocellular carcinoma (HCC) who underwent immunotherapy as their first-line treatment. Radiological assessment of tumor response adhered to RECIST 1.1 and HCC-specific modified RECIST (mRECIST) criteria. Univariate and multivariate logistic analyses were employed to analyze clinical factors associated with tumor response. Kaplan-Meier survivial analysis were employed to compare progression‐free survival (PFS) and overall survival (OS) across different clinical factors. Furthermore, patients who received treatment with either a combination of bevacizumab and anti-PD-1(L1) antibody (Beva group) or tyrosine-kinase inhibitor (TKI) and anti-PD-1 antibody (TKI group) were examined to explore the relation between clinical factors and tumor response. ResultsA total of 208 patients were enrolled in this study. The median PFS and OS were 9.84 months and 24.44 months,respectively. An independent factor associated with a more favorable tumor response to immunotherapy was identified when PLR<100. Patients with PLR<100 had longer PFS than other patients, while OS showed no significant difference. Further analysis revealed that PLR exhibited superior prognostic value in patients of the Beva group as compared to those in the TKI group. ConclusionsThere exisits an association between PLR and tumor response as well as survival outcomes in patients receiving immunotherapy, particularly those treated with the combination of bevacizumab and anti-PD-1.

Anticorpos biespecíficos em neoplasias hematológicas

Introduction: Immunotherapy is the new frontier in cancer treatment, challenging traditional views regarding the treatment of malignancy. It includes treatment with checkpoint inhibitors, monoclonal antibodies, chimeric antigen receptor T cells (CAR-T), and bispecific monoclonal antibodies (BsAbs). BsAbs are drugs composed of a single monoclonal antibody, which has two binding domains that can bind to two different antigens simultaneously, which is the great advantage of this therapy over others. Therefore, BsAbs have revolutionized clinical outcomes for different types of cancer, especially hematological ones, bringing good results and hope to patients with lymphomas, leukemias and multiple myeloma. Objective: The present research aims to provide an updated overview of BsAbs treatment applied to the main hematological neoplasms, as well as describe its classification and mechanism of action. Material and Methods: This is a literature review based on articles published in the last 9 years (2015-2023) in the PubMed database (Medline), relating hematological malignancies and BsAbs, using the keyword: “Bispecific antibody”. Results: A total of 1,530 articles were found, of which 48 were included in the development of this review article. Conclusions: BsAbs redirect the immune system cells action, generating a new therapeutic response, proving to be an innovative alternative in immunotherapy, being a vanguard option that combines molecular biology engineering and the immune system biological activity.

SURGERY OUTCOMES OF GLAUCOMA DRAINAGE DEVICE IMPLANTATION IN REFRACTORY GLAUCOMA PATIENTS AT SARDJITO GENERAL HOSPITAL

Introduction: Glaucoma drainage device (GDD) implantation was an effective surgical procedure in treating uncontrolled intraocular pressure (IOP) of glaucoma patients in certain complicated conditions. GDD implants were classified into valved and non-valved in which its surgical outcomes in different types of device and various etiologies were not similar. This study aimed to evaluate the surgery outcomes of GDD implantation in patients with refractory glaucoma at Sardjito General Hospital. Methods: All 12 eyes of 11 patient’s medical records who underwent GDD implantation during 2022 at Sardjito General Hospital was reviewed. Baseline data include age, gender, eye laterality, type of glaucoma, IOP and visual acuity. The IOP and visual acuity (LogMAR) were measured at week 1, month 1, 2 and 3. Type of GDD implants, postoperative glaucoma medications, complications and need for further glaucoma surgery were documented. Results: The mean IOP at baseline was 44 ± 14.2 mmHg with 3.4 ± 0.6 glaucoma medications. It decreased after surgery into 19.1 ± 11.2 mmHg (p=0.003) at 3 months follow up with 0.7 ± 1.7 (p=0.002) glaucoma medications. The mean initial visual acuity was 1.9 ± 0.6 and changed insignificantly to 1.7 ± 0.8 (p=0.624) at last follow up. Six eyes (50%) were implanted with valved implant. The most common early postoperative complications were recurrent high IOP (4 eyes, 33.3%) associated to ripcord of non-valved implant (p=0.025). Five eyes (41.7%) needed additional surgery related to non-valved implant type (p=0.003). Conclusion: GDD implantation especially valved type appears to be safe and effective surgical option in treating refractory glaucoma patients Keywords: Glaucoma drainage device, refractory glaucoma, glaucoma surgery, intraocular pressure

Uninformed Teacher-Student for hard-samples distillation in weakly supervised mitosis localization

Background and Objective:Mitotic activity is a crucial biomarker for diagnosing and predicting outcomes for different types of cancers, particularly breast cancer. However, manual mitosis counting is challenging and time-consuming for pathologists, with moderate reproducibility due to biopsy slide size, low mitotic cell density, and pattern heterogeneity. In recent years, deep learning methods based on convolutional neural networks (CNNs) have been proposed to address these limitations. Nonetheless, these methods have been hampered by the available data labels, which usually consist only of the centroids of mitosis, and by the incoming noise from annotated hard negatives. As a result, complex algorithms with multiple stages are often required to refine the labels at the pixel level and reduce the number of false positives. Methods:This article presents a novel weakly supervised approach for mitosis detection that utilizes only image-level labels on histological hematoxylin and eosin (H&E) images, avoiding the need for complex labeling scenarios. Also, an Uninformed Teacher-Student (UTS) pipeline is introduced to detect and distill hard samples by comparing weakly supervised localizations and the annotated centroids, using strong augmentations to enhance uncertainty. Additionally, an automatic proliferation score is proposed that mimicks the pathologist-annotated mitotic activity index (MAI). The proposed approach is evaluated on three publicly available datasets for mitosis detection on breast histology samples, and two datasets for mitotic activity counting in whole-slide images. Results:The proposed framework achieves competitive performance with relevant prior literature in all the datasets used for evaluation without explicitly using the mitosis location information during training. This approach challenges previous methods that rely on strong mitosis location information and multiple stages to refine false positives. Furthermore, the proposed pipeline for hard-sample distillation demonstrates promising dataset-specific improvements. Concretely, when the annotation has not been thoroughly refined by multiple pathologists, the UTS model offers improvements of up to ∼4% in mitosis localization, thanks to the detection and distillation of uncertain cases. Concerning the mitosis counting task, the proposed automatic proliferation score shows a moderate positive correlation with the MAI annotated by pathologists at the biopsy level on two external datasets. Conclusions:The proposed Uninformed Teacher-Student pipeline leverages strong augmentations to distill uncertain samples and measure dissimilarities between predicted and annotated mitosis. Results demonstrate the feasibility of the weakly supervised approach and highlight its potential as an objective evaluation tool for tumor proliferation.

Clinical outcomes of different types of metallic stents in malignant distal duodenum stenosis: A retrospective study

Background/purposeEndoscopic stenting at malignant distal duodenum stenosis (MDDS) is challenging because of the duodenal C-loop configuration, the acute angle of the duodenojejunal junction, and the limited length of the endoscope. Few studies have investigated the clinical outcomes of stenting at the distal duodenum. Therefore, this study aimed to investigate the clinical outcomes of treating MDDS with different types of metallic stents. MethodsFrom January 2012 to December 2020, fifty-six patients with MDDS who underwent duodenal stenting were enrolled for analysis. Thirty-five patients received uncovered self-expandable metallic stents (UC-SEMS), and twenty-one patients received partially covered self-expandable metallic stents (PC-SEMS). All patients were followed up till death or for 18 months. The clinical success rate, stent dysfunction rate, and stent patency were compared between the groups. Multivariate analysis was conducted to identify factors related to stent dysfunction. ResultsThe clinical success rates were 85.7 % in both the UC-SEMS and PC-SEMS groups. Stent dysfunction rates (UC-SEMS: 34.3 %, PC-SEMS: 38.1 %, p = 0.773) and the average stent patency (UC-SEMS: 117.2 days, PC-SEMS: 100.0 days, p = 0.576) were not statistically different between the groups. Multivariate analysis disclosed the age ≥65 years was significantly related to stent dysfunction (odds ratio: 4.78, p = 0.031). ConclusionBoth UC-SEMS and PC-SEMS are safe and effective treatment options for MDDS. However, stent dysfunction remains a significant issue to overcome, particularly in the elderly. Further research is needed to explore novel strategies that can improve the effectiveness of stent placement and reduce the risk of stent dysfunction.

Metabolic surgery in patients with diabesity: A review of the historical backgrounds and scoring systems

Diabesity is a modern term that describes the coexistence of adverse health effects of diabetes mellitus and obesity and indicates a causal pathophysiological relationship between the two phenomena. The progression of diabesity leads to a deterioration of multiple organs and systems. Effective intervention for patients with diabesity must include optimal obesity therapy to prevent secondary complications. Metabolic surgery is the most effective and sustainable therapy for severe obesity and the elimination or prevention of many associated diseases, including type 2 diabetes mellitus, hypertension, sleep apnea, heart disease, and certain cancers. This review provides an up-to-date overview of surgical interventions for obesity, particularly the development of metabolic surgery. It evaluates different scoring systems for evidence-based selection of metabolic surgery based on disease severity. We reviewed different predictive scoring systems for better evidence-based selection of the best metabolic surgery for patients with diabesity. We found that medication type, fasting insulin level, and C-peptide influence the outcomes of different types of metabolic surgery and heterogeneous remission rates. There are different predictive scoring systems for evidence-based selection of the best metabolic surgery, either sleeve or mini-bypass, that will ensure the highest chance of diabetes remission. Using the metabolic score calculator is a useful tool to help medical specialists determine the optimal treatment strategy for a particular patient. More research is needed before we can agree on the ideal bariatric procedure that offers the highest chance of remission with the lowest incidence of hypoglycemia.

Virtual brain network modeling in AD: from pathophysiology towards treatment

AbstractBackgroundWhile much is known about the pathology and clinical symptoms of AD, their mutual relationship to impaired brain function during the AD disease course is incompletely understood. For deriving a coherent, integrated multi‐scale disease mechanism, computational neurophysiology is a promising candidate. Virtual models of neurons, neuronal circuits and large‐scale networks are being used at different scales and for different purposes. Ranging from biologically plausible neural mass models to more abstract models of complex system behaviour or pathology spreading patterns, their diversity and versatility can help to address issues that are hard to tackle experimentally.MethodIn this presentation I will review several recent developments that illustrate how virtual models can help to translate local neuronal activity to brain‐wide network level data, probe the effects of AD pathology on brain network behaviour, and predict neurophysiological outcomes of different types of treatment. More specifically, I will show how amyloid‐induced hyperexcitability is compatible with large‐scale oscillatory slowing in AD, and how we can simulate counteracting activity‐targeting interventions such as non‐invasive brain stimulation using virtual models.ResultAD‐like adaptations in neuronal excitability in neural mass model parameters led to the combination of high absolute power and large‐scale oscillatory slowing in nearly all tested scenarios. In contrast, the hypoexcitable neural mass scenarios did not produce AD‐like oscillatory changes. Furthermore, simulating various counteracting tDCS‐induced excitability changes led to highly variable ‘virtual treatment’ outcomes, supporting the idea that electrode location choice can play a substantial role in tDCS treatment success, and generating specific predictions to be falsified in patient studies.ConclusionVirtual models of altered brain activity can help to understand AD pathophysiology and facilitate treatment development.

A scoping review of wrist-worn wearables in education

Within the past ten years, the public's use of wearables, such as smartwatches and fitness trackers, has greatly increased. Recently, researchers have published systematic reviews to examine how wearables are used in educational settings. However, not all wearables are alike. Head-mounted wearables and exoskeletons may be viewed as invasive, whereas smartwatches and wristbands are commonly worn by the public. In this scoping review, we systematically review the literature around wrist-worn wearables (WWs) in educational settings. Our systematic search revealed 1,932 unique research items, of which 46 met the inclusion criteria and were analyzed. Our findings reveal the trends in the field, we discuss the vast heterogeneity seen in the field, and we make a call for further in-depth systematic reviews in the areas of WWs as educational interventions, of studies where the data from WWs is used to predict or classify different types of outcomes, and about data privacy, data security, ethics, and legal concerns around WWs in educational settings.

OGBN P35 The effect of social deprivation in patient outcomes following cholecystectomy

Abstract Background Socio economic status (SES) has shown to impact patient outcomes in different types of cancer. Socio economically deprived populations experience severe as well as complicated gall stone diseases more frequently in comparison with their affluent counterparts (doi: 10.1089/heq.2022.0063). However, the impact of SES on the presentation and outcomes of gallstone disease(GSD) in deprived population is not well studied. Therefore, a study was set up to assess the impact of deprivation in patients presenting with GSD. Methods A retrospective observational study of cholecystectomies in adults in our trust from August 2022 to December 2022 was performed. Patients were assigned into Affluent(AF) and Non-Affluent(NA) groups based on the Index of Multiple Deprivation (https://data-communities.opendata.arcgis.com/datasets/communities::indices-of-multiple-deprivation-imd-2019-1/explore). Data was collected using MS Excel and analysed using IBM SPSS statistics ver 27. Results 100 patients were included from August to December 2022. Male female ratio was 1:3. The five most deprived deciles (NA) had 46 and the five least deprived deciles (AF) had 54 patients. Median age in years was 48 and 52.5 respectively (p = 0.10). The NA deciles had 37 patients referred via the emergency department (ED) and 9 via GP. AF deciles had 34 referrals via ED and 20 via GP (p=0.05). No statistically significant difference was observed in Charlson’s index (p=0.53), operative time (p=0.58) and length of stay (p=0.74) between the groups. There were no conversions to open. Conclusions A higher ratio of patients came via GP referrals in the affluent deciles whereas more patients were referred via the ED in the non affluent deciles. However, there was no statistically significant difference in time to surgery and outcomes between these two groups.