Probability Of Outcome Research Articles

In-hospital results of therapy with the NGLT-2 inhibitor dapagliflozin in patients with acute decompensation of heart failure: prospective randomized study

BACKGROUND: This study focuses on the development of new approaches to the management of patients with acute decompensation of heart failure (ADHF) using sodium-glucose cotransporter type 2 (iHLT-2) inhibitors, particularly dapagliflozin, and its role in early treatment initiation.
 AIM: Our aim was to determine the predictors of severe ADHF outcomes in patients with low left ventricular ejection fraction (LVEF) and the role of early initiation of iGLT-2 therapy (within the first 24 h).
 MATERIALS AND METHODS: This prospective randomized study included a total of 140 patients hospitalized with ADHF between January 1 to September 1, 2023. The patients were randomized into two groups: in group 1, iGLT-2 therapy was started within 24 h from the moment of admission (n=70), and in group 2, standard therapy was implemented (n=70). Hospital data were analyzed. The endpoint was the persistence of congestion in one or both circulatory circuits with New York Heart Association Functional Classes III–IV, indicating severe ADHF.
 RESULTS: The initial demographic and clinical characteristics of both groups were comparable. In both groups 47% patients did not receive optimal drug therapy (excluding iGLT-2) for chronic heart failure, and no differences were found in this indicator (p=0.081). iGLT-2 therapy did not demonstrate a significant effect on the likelihood of an adverse ADHF outcome (odds ratio [OR]=0.88; 95% confidence interval [CI] 0.43–1.78, p=0.719). Multivariate analysis showed an increase in the probability of this outcome for every 1000 pg/mL increase in N-terminal propeptide of brain natriuretic hormone (NT-proBNP) (OR=1.72, 95% CI 1.37–2.17; p 0.001), blood urea per 1 mmol/L (OR=1.54, 95% CI 1.21–1.97; p=0.001), pulmonary hypertension (OR=7.08, 95% CI 2.15–23.34; p=0.001), and a decrease in the probability of outcome with a 1% increase in LVEF (OR=0.91, 95% CI 0.84–0.99; p=0.031). The sensitivity and specificity of the adverse outcome model were 91.3 and 85.1%, respectively.
 CONCLUSION: The leading predictors of an unfavorable ADHF outcome include increased levels of NT-proBNP and blood urea, pulmonary hypertension, and decreased LVEF.

Age and sex-related differences in outcomes of OHCA patients after adjustment for sex-based in-hospital management disparities

ObjectivesOut-of-hospital cardiac arrest (OHCA) survival differences due to sex remain controversial. Previous studies adjusted for prehospital variables, but not sex-based in-hospital management disparities. We aimed to investigate age and sex-related differences in survival outcomes in OHCA patients after adjustment for sex-based in-hospital management disparities. MethodsThis retrospective observational study used a prospective multicenter OHCA registry to review data of patients from October 2015 to December 2020. The primary outcome was good neurological outcome defined as cerebral performance category score 1 or 2. We performed multivariable logistic regression and restricted cubic spline analysis according to age. ResultsTotally, 8988 patients were analyzed. Women showed poorer prehospital characteristics and received fewer coronary angiography, percutaneous coronary interventions, targeted temperature management, and extracorporeal membrane oxygenation than men. Good neurological outcomes were lower in women than in men (5.8% vs. 12.2%, p < 0.001). After adjustment for age, prehospital variables, and in-hospital management, women were more likely to have good neurological outcomes than men (adjusted odds ratio [aOR] 1.37, 95% confidence interval [CI] 1.07–1.74, p = 0.012). The restricted cubic spline curve showed a reverse sigmoid pattern of adjusted predicted probability of outcomes and dynamic associations of sex and age-based outcomes. ConclusionsWomen with OHCA were more likely to have good neurological outcome after adjusting for age, prehospital variables, and sex-based in-hospital management disparities. There were non-linear associations between sex and survival outcomes according to age and age-related sex-based differences.

Health Care Access and Utilization and the Latino Health Paradox.

The Latino health paradox is the phenomenon whereby recent Latino immigrants have, on average, better health outcomes on some indicators than Latino immigrants who have lived in the United States longer and US-born Latinos and non-Latino Whites. This study examined whether the paradox holds after accounting for health care access and utilization. The 2019-2020 National Health Interview Survey data were used. The main predictors included population groups of foreign-born and US-born Latinos (Mexican or non-Mexican) versus US-born non-Latino Whites. Predicted probabilities of health outcomes (self-reported poor/fair health, overweight/obesity, hypertension, coronary heart disease, diabetes, cancer, and depression) were calculated and stratified by length of residence in the United States (<15 or ≥15 years) among foreign-born Latinos and sex (female or male). Multivariable analyses adjusted for having a usual source of care other than the emergency department, health insurance, a doctor visit in the past 12 months, predisposing and enabling factors, and survey year. After adjusting for health care access, utilization, and predisposing and enabling factors, foreign-born Latinos, including those living in the United States ≥15 years, had lower predicted probabilities for most health outcomes than US-born non-Latino Whites, except overweight/obesity and diabetes. US-born Latinos had higher predicted probabilities of overweight/obesity and diabetes and a lower predicted probability of depression than US-born non-Latino Whites. In this national survey, the Latino health paradox was observed after adjusting for health care access and utilization and predisposing and enabling factors, suggesting that, although these are important factors for good health, they do not necessarily explain the paradox.

Assessing the outcome of drug therapy in adult patients with epilepsy who have experienced seizure recurrence after remission

Background. Remission in general sense means disappearance of signs and symptoms of the disease. The risk of recurrence of seizures is usually evaluated only in terms of the risk of a second unprovoked seizure after the first one or the risk of recurrence of seizures after discontinuation of therapy. There are no studies that assess the probability of achieving a second remission in patients with recurrent seizures.Aim. To develop a tool for assessing the probability of favorable and unfavorable treatment outcomes after recurrent seizures in adult patients with different forms of epilepsy.Materials and methods. We analyzed data from 215 patients with recurrent seizures after achieving remission, followed up for 12 or more months, and analyzed disease outcomes.Results and conclusion. At the end of the study, repeat remission was observed in 67 patients, improvement in 48, and no effect in 100. Patients with remission and improvement were combined into a “favorable outcome” group (n = 115), while patients with no effect from therapy formed an “unfavorable outcome” group (n = 100).Patients with an unfavorable outcome were statistically significantly more likely to have factors such as longer disease duration, coexisting serious somatic diseases, structural etiology of epilepsy, bilateral tonic-clonic seizures with focal onset, focal forms of epilepsy, daily seizures, epileptogenic changes on neuroimaging, and regional epileptiform activity on EEG (p &lt;0.05). In turn, patients with a favorable outcome were statistically significantly more likely to have factors such as genetic etiology of epilepsy, generalized tonic-clonic seizures, absences, myoclonic seizures, generalized forms of epilepsy, no pathology on neuroimaging, diffuse epileptiform activity on electroencephalogram, and no pathology on electroencephalogram (p &lt;0.05).Based on the obtained data using the results of constructing contingency tables, a scale for assessing the probability of achieving repeat remission in patients with recurrent epileptic seizures was developed, consisting of 9 sections. To assess the effectiveness of the model, ROC analysis was performed, confirming statistically significant sensitivity and specificity of the obtained scale.Further research is needed to develop more accurate predictors of epilepsy outcomes to understand the peculiarities of the disease pathogenesis.

Assessing New York City's COVID-19 Vaccine Rollout Strategy: A Case for Risk-Informed Distribution.

This study reviews the impact of eligibility policies in the early rollout of the COVID-19 vaccine on coverage and probable outcomes, with a focus on New York City. We conducted a retrospective ecological study assessing age 65+, area-level income, vaccination coverage, and COVID-19 mortality rates, using linked Census Bureau data and New York City Health administrative data aggregated at the level of modified zip code tabulation areas (MODZCTA). The population for this study was all individuals in 177 MODZCTA in New York City. Population data were obtained from Census Bureau and New York City Health administrative data. The total mortality rate was examined through an ordinary least squares (OLS) regression model, using area-level wealth, the proportion of the population aged 65 and above, and the vaccination rate among this age group as predictors.Low-income areas with high proportions of older people demonstrated lower coverage rates (mean vaccination rate 52.8%; maximum coverage 67.9%) than wealthier areas (mean vaccination rate 74.6%; maximum coverage 99% in the wealthiest quintile) in the first 3months of vaccine rollout and higher mortality over the year. Despite vaccine shortages, many younger people accessed vaccines ahead of schedule, particularly in high-income areas (mean coverage rate 60% among those 45-64years in the wealthiest quintile). A vaccine program that prioritized those at greatest risk of COVID-19-associated morbidity and mortality would have prevented more deaths than the strategy that was implemented. When rolling out a new vaccine, policymakers must account for local contexts and conditions of high-risk population groups. If New York had focused limited vaccine supply on low-income areas with high proportions of residents 65 or older, overall mortality might have been lower.

Deterministic entangling gates with nonlinear quantum photonic interferometers

The single-photon quantum computing paradigm currently relies on the multi-port interference in linear optical devices, which is intrinsically based on probabilistic measurements outcome, and thus non-deterministic. Devising a fully deterministic, universal, and practically achievable quantum computing platform based on single-photon encoding and integrated photonic circuits is still an open challenge. Here we propose to exploit the interplay of distributed self-Kerr nonlinearity and localized hopping in quantum photonic interferometers to implement deterministic entangling quantum gates with dual rail photonic qubits. It is shown that a universal set of single- and two-qubit gates can be designed by a suitable concatenation of few optical interferometric elements, reaching optimal fidelities arbitrarily close to 100% that are theoretically demonstrated through a bound constrained optimization algorithm. The actual realization would require the concatenation of a few tens of elementary operations, as well as on-chip optical nonlinearities that are compatible with some of the existing quantum photonic platforms, as it is finally discussed.

Clinical Predictors and Outcomes of Invasive Anal Cancer for People With HIV in an Inception Cohort.

Due to the heterogeneity of risk for invasive anal cancer (IAC) among people with human immunodeficiency virus (PWH), we investigated predictors of IAC and described outcomes among those with a cancer diagnosis. Using a longitudinal inception cohort of anal cancer screening, we evaluated risk factors and outcome probabilities for incident IAC in Cox models. Screening included anal cytology and digital anorectal examination, and, if results of either were abnormal, high-resolution anoscopy. Between 30 November 2006 and 3 March 2021, a total of 8139 PWH received care at the University of California, San Diego, with 4105 individuals undergoing screening and subsequently followed up over a median of 5.5 years. Anal cancer developed in 33 of them. IAC was more likely to develop in patients with anal high-grade squamous intraepithelial lesions (aHSILs) on initial or subsequent follow-up cytology (hazard ratio, 4.54) and a nadir CD4 cell count ≤200/µL (2.99). The joint effect of aHSILs and nadir CD4 cell count ≤200/µL amplified the hazard of IAC by 9-fold compared with the absence of both. PWH with time-updated cytology aHSIL and CD4 cell counts ≤200/µL had 5- and 10-year probabilities of IAC of 3.40% and 4.27%, respectively. Twelve individuals with cancer died, 7 (21% of the total 33) due to cancer progression, and they had clinical stage IIIA or higher cancer at initial diagnosis. PWH with both aHSIL and a nadir CD4 cell count ≤200/µL have the highest risk of IAC. PWH who died due to IAC progression had clinical stage IIIA cancer or higher at diagnosis, highlighting the importance of early diagnosis through high-resolution anoscopic screening.

Evaluation of augmented reality and social media on patient motivation to undergo fixed orthodontic treatment

Objectives: The objective of the study was to primarily evaluate patient motivation towards doing orthodontic treatment after showing them AR filters. Secondly, the focus was to evaluate patient motivation toward doing orthodontic treatment after showing them their probable post-treatment smile through AR application and to evaluate the efficacy of AR in orthodontics in simulating orthodontic therapy and its final probable outcome. Material and Methods: The data collected from individuals seeking orthodontic treatment was categorized on the level of interest in orthodontic treatment, the level of concern about appearance during treatment, the level of comfort to smiling with braces, the level of excitement about post-treatment smile, the level of willingness to post selfies or photos with braces on social media. Moreover, it was also categorized basis the level of influence of comments or messages from followers, the level of motivation to do the orthodontic treatment after seeing oneself with braces on filters, the level of impact of SmileView filter (By Invisalign India) on interest in orthodontic treatment by showing a probable post-treatment smile. Furthermore, the data was classified according to the level of satisfaction with SmileView probable post-treatment smile among 300 respondents, who rated each aspect on a scale of 1–5, where 1 means extremely reluctant, not bothered, apathetic or unsatisfied and 5 means very enthusiastic, very concerned, greatly influenced, or very satisfied. Results: About 42% of patients were more enthusiastic about orthodontic treatment after showing SmileView results. Patients’ preferences, social media participation, and ‘braces look’ acceptance had a significant association with the decision to initiate orthodontic treatment. Conclusion: This study showed that potential orthodontic patients have varying attitudes and motivations for orthodontic treatment and that visual simulations can positively influence their interest, motivation, and satisfaction with orthodontic treatment.

220 Outcome Evaluation of Repeat Stereotactic Radiosurgery for Cerebral Arteriovenous Malformations

INTRODUCTION: Repeat stereotactic radiosurgery (SRS) for persistent cerebral arteriovenous malformation (AVM) has generally favorable patient outcomes. However, reporting studies are limited by small patient numbers and single-institution biases. METHODS: This multicenter, retrospective cohort study included patients treated with repeat, single-fraction SRS between 1987 and 2022. The primary outcome was a favorable patient outcome, defined as a composite of nidus obliteration in the absence of hemorrhage or radiation-induced neurological deterioration. Secondary outcomes were obliteration, hemorrhage risk, and symptomatic radiation-induced changes. Competing risk analysis was performed to compute yearly rates and identify predictors for each outcome. RESULTS: The cohort comprised 505 patients [254 (50.3%) males; median (IQR) age, 34 (15) years] from 14 centers. The median clinical and MRI follow-up was 52 (61) months and 47 (52) months, respectively. At last follow-up, favorable outcome was achieved by 268 (53.1%) patients (5-year probability = 50%, 95% CI = 45%-55%). Obliteration was achieved by 300 (59.4%) patients (5-year probability = 56%, 95% CI = 51%-61%). Twenty-eight patients (5.6%) experienced post-SRS hemorrhage with an annual incidence rate of 1.38 per 100 patient-years. Symptomatic radiation-induced changes were evident in 28 (5.6%) patients, with most occurring in the first 3 years. Larger nidus volumes (between 2 and 4cm3, subdistribution hazard [SDH] 0.61, 95% CI 0.44-0.86, p = 0.005; &gt;4 cm3, SDH 0.47, 95% CI 0.32-0.7, p &lt; 0.001) and brainstem/basal ganglia involvement (SDH = 0.6, 95% CI = 0.45-0.81, p &lt; 0.001) were associated with reduced probability of favorable outcome. CONCLUSIONS: Repeat stereotactic radiosurgery confers reasonable obliteration rates with a low complication risk. With most complications occurring in the first three years, extending the latency period to 5 years generally increases the rate favorable patient outcomes and reduces the necessity of a third intervention.

Development, Validation and Clinical Utility of a Risk Prediction Model for Maternal and Neonatal Adverse Outcomes in Pregnant Women with Hypothyroidism.

This study aimed to create, verify and assess the clinical utility of a prediction model for maternal and neonatal adverse outcomes in pregnant women with hypothyroidism. A prediction model was developed, and its accuracy was tested using data from a retrospective cohort. The study focused exclusively on female patients diagnosed with hypothyroidism who were admitted to a tertiary hospital. The development and validation cohort comprised individuals who gave birth between 1 October 2020 and 31 December 2022. The primary outcome was a combination of crucial maternal and newborn problems (eg premature births, abortions and neonatal asphyxia). The prediction model was developed using logistic regression. Evaluation of the model's performance was conducted based on its ability to discriminate, calibrate and provide clinical value. In total, nine variables were chosen to develop the predictive model for adverse maternal and neonatal outcomes during pregnancy with hypothyroidism. The area under the curve of the model for predicting maternal adverse outcomes was 0.845, and that for predicting neonatal adverse outcomes was 0.685. The calibration plots showed good agreement between the nomogram predictions and the actual observations in both the training and validation cohorts. Furthermore, decision curve analysis suggested that the nomograms were clinically useful and had good discriminative power to identify high-risk mother-infant cases. Two models to predict the risk probability of maternal and neonatal adverse outcomes in pregnant women with hypothyroidism were developed and verified to assist physicians in evaluating maternal and neonatal adverse outcomes throughout pregnancy with hypothyroidism and to facilitate decision-making regarding therapy.

Pattern and clinical profile of patients with ocular trauma presenting to the emergency department of a teaching hospital in India: A prospective observational study.

One major contributor to avoidable ocular morbidity is ocular trauma (OT). The study aimed to document the epidemiological factors, pattern of injury, and outcome among patients with OT presenting to the emergency department (ED). This was a prospective observational study conducted in the ED of a tertiary care teaching hospital in Eastern India after due approval from the institutional ethics committee. The data were collected during the period from March 2021 to February 2022. Data pertaining to age, sex, type of injury, mechanism of injury, time and place of injury, details of tissue involvement, visual acuity, any prior history of injury, initial diagnosis, and management were noted. To estimate the severity of the injury and the probable visual outcome, we calculated through OT score (OTS), including one raw score and OTS. Statistical analysis was performed using the R, version 4.6.1. A total of 180 patient's data were included for final analysis. The median (interquartile range) age of the patients was 32 (24-45) years. The majority were males (n = 147 [81.6%]) with a male-female ratio of 4.5:1. Road traffic accidents (RTA) were the common cause of injury (n = 122 [67.7%]). Unilateral eye involvement was the most common (n = 147 [81.6%]). In the pattern of injury, most of the patients sustained closed globe injuries (CGIs) (n = 158 [87.7%]). Among the CGIs, injury to the ocular adnexa and conjunctiva (n = 141 and 127, respectively) was the most common. Injury to the retina and choroids occurred in 20 (11%) patients. The vision was not affected in most of the cases (n = 125 [69.4%]) with a visual acuity of > 6/18. The majority (n = 120 [67%]) of the patients had an OTS of grade-4, followed by grade-2 (n = 22 [12%]). Most of the patients required only medical management (n = 100 [56%]), whereas 77 (43%) patients required surgical interventions. OT was a common presentation in the ED. Male patients with monocular injuries involved in RTAs were mostly affected. The vision was preserved in most of the cases.

Patients with Hypochondriasis (Illness Anxiety Disorder): Key Elements of Effective Communication in the Dental Practice

The world data show a large number of people with illness anxiety disorder (hypochondriasis) among the population all over the world. Russia is no exception: hypochondriacal patients often seek dental care. A dentist should be able to identify this category of patients. As a rule, these patients "know everything": their diagnosis and the most modern and effective methods of treatment. They are truly literate people. Their medical literacy is the result of watching popular shows, reading articles in trendy magazines and medical websites. Frequently, these patients are not emotionally stable; they have been stressed for a long time, or are undergoing long-term hormone therapy. Identifying these patients is the key to the successful practice. This article describes an interesting clinical case of the patient, who was treated for 2 months by 5 different specialists and took strong medications. During treatment her condition only worsened: allergic reaction developed to medications, with lesion of mucous membrane of oral cavity. Her reluctance to stop taking medications, insistence on consulting a dentist-oncologist alerted the attending doctor. Analysis of medical history revealed that the patient had experienced severe stress in the recent past and was currently undergoing a course of hormonal corrective therapy. A clinical psychologist confirmed the dentist's suggestion that the patient had hypochondriacal disorder. Patients with hypochondria - who are they? How to recognize them? If you meet such patients at a dental appointment, how you should communicate with them? How to treat them? A good result is achieved by establishing contact with the patients and their family and friends. Sometimes it is impossible to do without the help of a clinical psychologist. Only this specialist can definitively decide: does the patient have hypochondriacal disorder or not? If necessary, the clinical psychologist provides special treatment. The probability of a favorable outcome with this approach is high.

Optimizing the Finishing Treatment of Potato Harvester Transmission Shafts

The potato harvester’s distinctive specifications include the spatially segregated drive of its units from an external engine, operating under stochastic conditions. This setup complicates the loading of its components, including transmission shafts, and creates the prerequisites for decreased durability, leading to an upsurge in fatigue failures. To counteract this process, transmission shafts undergo a special treatment aimed at mitigating concentrated defects. (Research purpose) The purpose of this research is to formulate an objective function for controlling the finishing treatment of transmission shafts in a potato harvester. This function is designed to maximize potato yield while monitoring concentrated defects. (Materials and methods) The implementation of the method requires equipment capable of being controlled through a technical vision channel. The control scheme employs mathematical tools for describing discrete and continuous random variables, Markov processes with discrete time and continuous state space, the maximum likelihood method, and methods of numerical optimization in multifactor space. (Results and discussion) The research has yielded formulas for calculating the probabilities of successful and unsuccessful outcomes of finishing treatment based on the criterion of concentrated defect presence. The paper provides the results of testing the proposed algorithm for predicting the yield of viable products using the proposed method based on interim measurements of defect characteristics during the treatment process. Additionally, a scheme is proposed for integrating the obtained results into the production process of manufacturing transmission shafts for potato harvesters. (Conclusions) An algorithm has been proposed to control the finishing treatment of the transmission shaft based on a predictive assessment of the probability of manufacturing a product that adheres to the specified technical criteria regarding geometry and surface cleanliness. The predictive probability of achieving a surface with the required cleanliness without exceeding permissible defect limits is considered as the objective function. The solution to the problem is achieved through the selection of appropriate technological parameters.

Solving Satisfiability Modulo Counting for Symbolic and Statistical AI Integration with Provable Guarantees

Satisfiability Modulo Counting (SMC) encompasses problems that require both symbolic decision-making and statistical reasoning. Its general formulation captures many real-world problems at the intersection of symbolic and statistical AI. SMC searches for policy interventions to control probabilistic outcomes. Solving SMC is challenging because of its highly intractable nature (NP^PP-complete), incorporating statistical inference and symbolic reasoning. Previous research on SMC solving lacks provable guarantees and/or suffers from suboptimal empirical performance, especially when combinatorial constraints are present. We propose XOR-SMC, a polynomial algorithm with access to NP-oracles, to solve highly intractable SMC problems with constant approximation guarantees. XOR-SMC transforms the highly intractable SMC into satisfiability problems by replacing the model counting in SMC with SAT formulae subject to randomized XOR constraints. Experiments on solving important SMC problems in AI for social good demonstrate that XOR-SMC outperforms several baselines both in solution quality and running time.

Pre-gestational counselling for women living with CKD: starting from the bright side.

Pregnancy in women living with chronic kidney disease (CKD) was often discouraged due to the risk of adverse maternal-fetal outcomes and the progression of kidney disease. This negative attitude has changed in recent years, with greater emphasis on patient empowerment than on the imperative 'non nocere'. Although risks persist, pregnancy outcomes even in advanced CKD have significantly improved, for both the mother and the newborn. Adequate counselling can help to minimize risks and support a more conscious and informed approach to those risks that are unavoidable. Pre-conception counselling enables a woman to plan the most appropriate moment for her to try to become pregnant. Counselling is context sensitive and needs to be discussed also within an ethical framework. Classically, counselling is more focused on risks than on the probability of a successful outcome. 'Positive counselling', highlighting also the chances of a favourable outcome, can help to strengthen the patient-physician relationship, which is a powerful means of optimizing adherence and compliance. Since, due to the heterogeneity of CKD, giving exact figures in single cases is difficult and may even be impossible, a scenario-based approach may help understanding and facing favourable outcomes and adverse events. Pregnancy outcomes modulate the future life of the mother and of her baby; hence the concept of 'post partum' counselling is also introduced, discussing how pregnancy results may modulate the long-term prognosis of the mother and the child and the future pregnancies.

Are Current Survival Prediction Tools Useful When Treating Subsequent Skeletal-related Events From Bone Metastases?

Are Current Survival Prediction Tools Useful When Treating Subsequent Skeletal-related Events From Bone Metastases?

Can Climate Shocks Make Vulnerable Subjects More Willing to Take Risks?

While economists in the past tended to assume that individual preferences, including risk preferences, are stable over time, a recent literature has developed and indicates that risk preferences respond to shocks, with mixed evidence on the direction of the responses. This paper utilizes a natural experiment with covariate (drought) and idiosyncratic shocks in combination with an independent field risk experiment. The risk experiment uses a Certainty Equivalent-Multiple Choice List approach and is played 1–2 years after the subjects were (to a varying degree) exposed to a covariate drought shock or idiosyncratic shocks for a sample of resource-poor young adults living in a risky semi-arid rural environment in Sub-Saharan Africa. The experimental approach facilitates a comprehensive assessment of shock effects on experimental risk premiums for risky prospects with varying probabilities of good and bad outcomes. The experiment also facilitates the estimation of the utility curvature in an Expected Utility (EU) model and, alternatively, separate estimation of probability weighting and utility curvature in three different Rank Dependent Utility models with a two-parameter Prelec probability weighting function. Our study is the first to comprehensively test the theoretical predictions of Gollier and Pratt (Econom J Econom Soc 64:1109–1123, 1996) versus Quiggin (Econ Theor 22(3):607–611, 2003). Gollier and Pratt (1996) build on EU theory and state that an increase in background risk will make subjects more risk averse while Quiggin (2003) states that an increase in background risk can enhance risk-taking in certain types of non-EU models. We find strong evidence that such non-EU preferences dominate in our sample.

Absent leptomeningeal collateralization is associated with greatest benefit from mechanical thrombectomy in the 6-24 hour time window.

The impact of leptomeningeal collateralization on the efficacy of mechanical thrombectomy (MT) in patients with anterior circulation large vessel occlusion (aLVO) presenting in the 6-24 h time window remains poorly elucidated. Retrospective multicenter study of aLVO patients presenting between 6 and 24 h after stroke onset who received MT plus Best Medical Treatment (BMT) or BMT alone. Leptomeningeal collateralization was assessed using single-phase computed tomography angiography (grade 0: no filling; grade 1: filling ⩽50%; grade 2: filling >50% but <100%; grade 3: filling 100% of the occluded territory). Inverse probability of treatment weighted ordinal regression was performed to assess the association between treatment and shift of the modified Rankin Scale (mRS) score toward lower categories at 3 months. We used interaction analysis to explore differential treatment effects on functional outcomes (probabilities for each mRS subcategory at 3 months) at different collateral grades. Among 363 included patients, 62% received MT + BMT. Better collateralization was associated with better functional outcomes at 3 months in the BMT alone group (collateral grade 1 vs 0: acOR 5.06, 95% CI 2.33-10.99). MT + BMT was associated with higher odds of favorable functional outcome at 3 months (acOR 1.70, 95% CI 1.11-2.62) which was consistent after adjustment for collateral status (acOR 1.54, 95% CI 1.01-2.35). Regarding treatment effect modification, patients with absent collateralization had higher probabilities for a mRS of 0-4 and a lower mortality at 3 months for the MT + BMT group. In the 6-to-24-h time window, aLVO patients with absent leptomeningeal collateralization benefit most from MT + BMT, indicating potential advantages for this group despite their poorer baseline prognosis.

YOLK SAC DIAMETER AND EMBRYONIC HEART RATE AS PROGNOSTIC FACTORS OF FIRST TRIMESTER PREGNANCY OUTCOME

Objective: Yolk sac is the primary source of exchange between the embryo and the mother before placental circulation and during organogenesis. Yolk sac has immunologic, metabolic, nutritive, endocrine, secretory, excretory and hematopoietic functions. Embryonic heart rate is seen after the appearance of foetal node at 7 w by TAS and 6 w by TVS. Studies have been conducted to establish the importance of yolk sac and EHR in pregnancy outcome. The prognostic significance of the yolk sac for the pregnancy outcome has been assessed with TVS. To measure yolk sac diameter and embryonic heart rate in early pregnancy (less than 10 weeks), to correlate yolk sac measurement and embryonic heart rate individually as prognostic factors for first trimester outcome and to evaluate the measurements in combination as a prognostic marker of first trimester pregnancy outcome. In view of this, the present study was undertaken.&#x0D; Methods: 108 patients attending OPD of Kempe Gowda institute of Medical Sciences Hospital, between 6 to 9 w of gestation, were evaluated with transvaginal sonography and measurements such as CRL, MSD and YSD were taken.&#x0D; Results: The mean age of the study population was 25 y and 88 % of the study population belonged to 20-30 y. 55.6 % of the study population were primigravida. Incidence of abnormal pregnancy outcome was 18.5%. The probability of abnormal outcome increased with the increase in gravidity of the patient (P= 0.890). There was a significant positive comparison of CRL (P= 0.223), GS (P= 0.251) and YSD (P= 0.016). Yolk sac diameter in the first trimester significantly correlates with the pregnancy outcome. An enlarged yolk sac is associated with an increased risk of preterm delivery. Our study influences the pregnancy outcome by the Embryonic heart rate. Foetal bradycardia is an impending sign of foetal death due to chromosomal abnormalities (Trisomy 18), foetal tachycardia featuring Trisomy 21.&#x0D; Conclusion: Yolk sac diameter and embryonic heart rate in the first trimester significantly correlates with the first trimester pregnancy outcome. Thus, the present study indicates that the yolk sac size and the embryonic heart rate is a reliable, beneficial and cost-effective in predicting first-trimester pregnancy outcome. The measurement of the secondary yolk sac diameter between 5th to 9th week of gestation can be used as a valuable tool to predict early pregnancy outcome.

Impact of Procedure Time on First Pass Effect in Mechanical Thrombectomy for Anterior Circulation Acute Ischemic Stroke.

First pass effect (FPE) is a metric increasingly used to determine the success of mechanical thrombectomy (MT) procedures. However, few studies have investigated whether the duration of the procedure can modify the clinical benefit of FPE. We sought to determine whether FPE after MT for anterior circulation large vessel occlusion acute ischemic stroke is modified by procedural time (PT). A multicenter, international data set was retrospectively analyzed for anterior circulation large vessel occlusion acute ischemic stroke treated by MT who achieved excellent reperfusion (thrombolysis in cerebral infarction 2c/3). The primary outcome was good functional outcome defined by 90-day modified Rankin scale scores of 0-2. The primary study exposure was first pass success (FPS, 1 pass vs ≥2 passes) and the secondary exposure was PT. We fit-adjusted logistic regression models and used marginal effects to assess the interaction between PT (≤30 vs >30 minutes) and FPS, adjusting for potential confounders including time from stroke presentation. A total of 1310 patients had excellent reperfusion. These patients were divided into 2 cohorts based on PT: ≤30 minutes (777 patients, 59.3%) and >30 minutes (533 patients, 40.7%). Good functional outcome was observed in 658 patients (50.2%). The interaction term between FPS and PT was significant ( P = .018). Individuals with FPS in ≤30 minutes had 11.5% higher adjusted predicted probability of good outcome compared with those who required ≥2 passes (58.2% vs 46.7%, P = .001). However, there was no significant difference in the adjusted predicted probability of good outcome in individuals with PT >30 minutes. This relationship appeared identical in models with PT treated as a continuous variable. FPE is modified by PT, with the added clinical benefit lost in longer procedures greater than 30 minutes. A comprehensive metric for MT procedures, namely, FPE 30 , may better represent the ideal of fast, complete reperfusion with a single pass of a thrombectomy device.