Tag: pubmed

J Neurointerv Surg. 2021 Aug 19:neurintsurg-2021-017867. doi: 10.1136/neurintsurg-2021-017867. Online ahead of print.

ABSTRACT

BACKGROUND: Despite constant improvements in recent years, sufficient reperfusion after mechanical thrombectomy (MT) is not reached in up to 15% of patients with large vessel occlusion stroke (LVOS). The outcome of patients with unsuccessful reperfusion after MT especially after intravenous thrombolysis (IVT) use is not known. We investigated the influence of initial IVT in this particular group of patients with failed intracranial recanalization.

METHODS: We conducted a retrospective analysis of the Endovascular Treatment in Ischemic Stroke (ETIS) registry from January 2015 to December 2019. Patients presenting with LVOS of the anterior circulation and final modified Thrombolysis in Cerebral Infarction score (mTICI) of 0, 1 or 2a were included. Posterior circulation, isolated cervical carotid occlusions and successful reperfusions (mTICI 2b, 2c or 3) were excluded. The primary endpoint was favorable outcome (modified Rankin Scale score of 0-2) after 3 months. Secondary endpoints were safety outcomes including mortality, any intracranial hemorrhage (ICH), parenchymal hematoma (PH) and symptomatic intracranial hemorrhage (sICH) rates.

RESULTS: Among 5076 patients with LVOS treated with MT, 524 patients with insufficient recanalization met inclusion criteria, of which 242 received IVT and 282 did not. Functional outcome was improved in the MT+IVT group compared with the MT alone group, although the difference did not reach statistical significance (23.0% vs 12.9%; adjusted OR=1.82; 95% CI 0.98 to 3.38; p=0.058). However, 3 month mRS shift analysis showed a significant benefit of IVT (adjusted OR=1.68; 95% CI 1.56 to 6.54). ICH and sICH rates were similar in both groups, although PH rate was higher in the MT+IVT group (adjusted OR=3.20; 95% CI 1.56 to 6.54).

CONCLUSIONS: Among patients with LVOS in the anterior circulation and unsuccessful MT, IVT was associated with improved functional outcome even after unsuccessful MT. Despite recent trials questioning the place of IVT in the LVOS reperfusion strategy, these findings emphasize a subgroup of patients still benefiting from IVT.

PMID:34413246 | DOI:10.1136/neurintsurg-2021-017867

Proc Natl Acad Sci U S A. 2021 Aug 24;118(34):e2100761118. doi: 10.1073/pnas.2100761118.

ABSTRACT

Binary classification is one of the central problems in machine-learning research and, as such, investigations of its general statistical properties are of interest. We studied the ranking statistics of items in binary classification problems and observed that there is a formal and surprising relationship between the probability of a sample belonging to one of the two classes and the Fermi-Dirac distribution determining the probability that a fermion occupies a given single-particle quantum state in a physical system of noninteracting fermions. Using this equivalence, it is possible to compute a calibrated probabilistic output for binary classifiers. We show that the area under the receiver operating characteristics curve (AUC) in a classification problem is related to the temperature of an equivalent physical system. In a similar manner, the optimal decision threshold between the two classes is associated with the chemical potential of an equivalent physical system. Using our framework, we also derive a closed-form expression to calculate the variance for the AUC of a classifier. Finally, we introduce FiDEL (Fermi-Dirac-based ensemble learning), an ensemble learning algorithm that uses the calibrated nature of the classifier’s output probability to combine possibly very different classifiers.

PMID:34413191 | DOI:10.1073/pnas.2100761118

BMJ Open. 2021 Aug 19;11(8):e047575. doi: 10.1136/bmjopen-2020-047575.

ABSTRACT

BACKGROUND: We can improve healthcare services by better understanding current provision. One way to understand this is by linking data sets from clinical and national audits, national registries and other National Health Service (NHS) encounter data. However, getting to the point of having linked national data sets is challenging.

OBJECTIVE: We describe our experience of the data application and linkage process for our study ‘LAUNCHES QI’, and the time, processes and resource requirements involved. To help others planning similar projects, we highlight challenges encountered and advice for applications in the current system as well as suggestions for system improvements.

FINDINGS: The study set up for LAUNCHES QI began in March 2018, and the process through to data acquisition took 2.5 years. Several challenges were encountered, including the amount of information required (often duplicate information in different formats across applications), lack of clarity on processes, resource constraints that limit an audit’s capacity to fulfil requests and the unexpected amount of time required from the study team. It is incredibly difficult to estimate the resources needed ahead of time, and yet necessary to do so as early on as funding applications. Early decisions can have a significant impact during latter stages and be hard to change, yet it is difficult to get specific information at the beginning of the process.

CONCLUSIONS: The current system is incredibly complex, arduous and slow, stifling innovation and delaying scientific progress. NHS data can inform and improve health services and we believe there is an ethical responsibility to use it to do so. Streamlining the number of applications required for accessing data for health services research and providing clarity to data controllers could facilitate the maintenance of stringent governance, while accelerating scientific studies and progress, leading to swifter application of findings and improvements in healthcare.

PMID:34413101 | DOI:10.1136/bmjopen-2020-047575

Eur Respir J. 2021 Aug 19:2101796. doi: 10.1183/13993003.01796-2021. Online ahead of print.

NO ABSTRACT

PMID:34413149 | DOI:10.1183/13993003.01796-2021

Postgrad Med J. 2021 Aug 19:postgradmedj-2021-140852. doi: 10.1136/postgradmedj-2021-140852. Online ahead of print.

NO ABSTRACT

PMID:34413176 | DOI:10.1136/postgradmedj-2021-140852

eNeuro. 2021 Aug 19:ENEURO.0032-21.2021. doi: 10.1523/ENEURO.0032-21.2021. Online ahead of print.

ABSTRACT

Humans can use their previous experience in form of statistical priors to improve decisions. It is however unclear how such priors are learned and represented. Importantly, it has remained elusive whether prior learning is independent of the sensorimotor system involved in the learning process or not, as both modality-specific and modality-general learning have been reported in the past. Here, we used a saccadic eye movement task to probe the learning and representation of a spatial prior across a few trials. In this task, learning occurs in an unsupervised manner and through encountering trial-by-trial visual hints drawn from a distribution centered on the target location. Using a model-comparison approach, we found that participants’ prior knowledge is largely represented in the form of their previous motor actions, with minimal influence from the previously seen visual hints. By using two different motor contexts for response (looking either at the estimated target location, or exactly opposite to it), we could further compare whether prior experience obtained in one motor context can be transferred to the other. Although learning curves were highly similar, and participants seemed to use the same strategy for both response types, they could not fully transfer their knowledge between contexts, as performance and confidence ratings dropped after a switch of the required response. Together, our results suggest that humans preferably use the internal representations of their previous motor actions, rather than past incoming sensory information, to form statistical sensorimotor priors on the timescale of a few trials.Significance StatementHumans can learn statistical regularities and later use them as priors to inform decisions. It remains unclear what type of representation is used to store and integrate past experience. We designed an experiment where humans had to combine visual information over multiple trials to locate a hidden target location. Using computational modelling, we found that participants represented past experience in the form of their previous decisions, and not directly by memorizing the visual cues. As a consequence of overweighing past decisions relative to the veridical visual information, gained experience did not generalize across two different contexts, albeit they differed minimally with respect to the prior. Hence, the process through which past experience is learned determines its influence on our decisions.

PMID:34413084 | DOI:10.1523/ENEURO.0032-21.2021

BMJ Open. 2021 Aug 19;11(8):e045574. doi: 10.1136/bmjopen-2020-045574.

ABSTRACT

INTRODUCTION: In 2013, the WHO published the first global and regional estimates on physical and sexual intimate partner violence (IPV) and non-partner sexual violence (NPSV) based on a systematic review of population-based prevalence studies. In this protocol, we describe a new systematic review for the production of updated estimates for IPV and NPSV for global monitoring of violence against women, including providing the baseline for measuring Sustainable Development Goal to eliminate all forms of violence against women and girls.

METHODS AND ANALYSIS: The systematic review will update and extend the previous search for population-based surveys (either nationally or subnationally representative) conducted among women aged 15+ years that measured the prevalence of physical, sexual, psychological and physical and/or sexual IPV, NPSV or sexual violence by any perpetrator up to December 2019. Data will be extracted separately for all age groups, setting (urban/rural), partnership status (currently partnered/ever partnered/all women) and recall period (lifetime prevalence/past 12 months). Studies will be identified from electronic searches of online databases of EMBASE, MEDLINE, Global Health and PsycInfo. A search of national statistics office homepages will be conducted for each country to identify reports on population-based, national or subnational studies that include data on IPV or NPSV published outside academic journals. Two reviewers will be involved in quality assessment and data extraction of the review. The review is planned to be updated on a continuous basis. All findings will undergo a country consultation process.

ETHICS AND DISSEMINATION: Formal ethical approval is not required, as primary data will not be collected. This systematic review will provide a basis and a follow-up tool for global monitoring of the Sustainable Development Goal Target 5.2 on the elimination of all forms of violence against women and girls.

PROSPERO REGISTRATION NUMBER: CRD42017054100.

PMID:34413098 | DOI:10.1136/bmjopen-2020-045574

BMJ Open Qual. 2021 Aug;10(3):e001192. doi: 10.1136/bmjoq-2020-001192.

ABSTRACT

BACKGROUND: In a tertiary respiratory centre, large cohorts of patients are managed in an outpatient setting and require blood tests to monitor disease activity and organ toxicity. This requires either visits to tertiary centres for phlebotomy and physician review or utilisation of primary care services.

OBJECTIVES: This study aims to validate remote capillary blood testing in an outpatient setting and analyse impact on clinical pathways.

METHODS: A single-centre prospective cross-sectional validation and parallel observational study was performed. Remote finger prick capillary blood testing was validated compared with local standard venesection using comparative statistical analysis: paired t-test, correlation and Bland-Altman. Capillary was considered interchangeable with venous samples if all three criteria were met: non-significant paired t-test (ie, p>0.05), Pearson’s correlation coefficient (r)>0.8% and 95% of tests within 10% difference through Bland-Altman (limits of agreement). In parallel, current clinical pathways including phlebotomy practice were analysed over 4 weeks to review test predictability. A subsequent pilot cohort study analysed potential impact of remote capillary blood sampling on shared decision making. A final implementation phase ensued to embed the service into clinical pathways within the institution.

RESULTS: 117 paired capillary and venous blood samples were prospectively analysed. Interchangeability with venous blood was seen with glycated haemoglobin (%), total protein and C reactive protein. Further tests, although not interchangeable, are likely useful to enable longitudinal remote monitoring (eg, liver function and total IgE). 65% of outpatient clinic blood tests were predictable with 16% of patients requiring further follow-up. Patient and clinician-reported improvement in shared decision making given contemporaneous blood test results was observed.

CONCLUSIONS: Remote capillary blood sampling can be used accurately for specific tests to monitor chronic disease, and when incorporated into an outpatient clinical pathway can improve shared decision making and patient experience. Further research is required to determine health economic impact and applicability within telemedicine-based outpatient care.

PMID:34413067 | DOI:10.1136/bmjoq-2020-001192

Br J Ophthalmol. 2021 Aug 19:bjophthalmol-2021-319232. doi: 10.1136/bjophthalmol-2021-319232. Online ahead of print.

ABSTRACT

BACKGROUND/AIMS: Glucagon-like peptide-1 receptor (GLP-1R) agonists regulate blood glucose and are commonly used to treat type 2 diabetes mellitus. Recent work showed that treatment with the GLP-1R agonist NLY01 decreased retinal neuroinflammation and glial activation to rescue retinal ganglion cells in a mouse model of glaucoma. In this study, we used an insurance claims database (Clinformatics Data Mart) to examine whether GLP-1R agonist exposure impacts glaucoma risk.

METHODS: A retrospective cohort of patients who initiated a new GLP-1R agonist was 1:3 age, gender, race, classes of active diabetes medications and year of index date matched to patients who initiated a different class of oral diabetic medication. Inverse probability of treatment weighting (IPTW) was used within a multivariable Cox proportional hazard regression model to test the association between GLP-1R agonist exposure and a new diagnosis of primary open-angle glaucoma, glaucoma suspect or low-tension glaucoma.

RESULTS: Cohorts were comprised of 1961 new users of GLP-1R agonists matched to 4371 unexposed controls. After IPTW, all variables were balanced (standard mean deviation <|0.1|) between cohorts. Ten (0.51%) new diagnoses of glaucoma were present in the GLP-1R agonist cohort compared with 58 (1.33%) in the unexposed controls. After adjustment, GLP-1R exposure conferred a reduced hazard of 0.56 (95% CI: 0.36 to 0.89, p=0.01), suggesting that GLP-1R agonists decrease the risk for glaucoma.

CONCLUSIONS: GLP-1R agonist use was associated with a statistically significant hazard reduction for a new diagnosis of glaucoma. Our findings support further investigations into the use of GLP-1R agonists in glaucoma prevention.

PMID:34413054 | DOI:10.1136/bjophthalmol-2021-319232

AJNR Am J Neuroradiol. 2021 Aug 19. doi: 10.3174/ajnr.A7230. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Conventional MR imaging scoring is a valuable tool for risk stratification and prognostication of outcomes, but manual scoring is time-consuming, operator-dependent, and requires high-level expertise. This study aimed to automate the regional measurements of an established brain MR imaging scoring system for preterm neonates scanned between 29 and 47 weeks’ postmenstrual age.

MATERIALS AND METHODS: This study used T2WI from the longitudinal Prediction of PREterm Motor Outcomes cohort study and the developing Human Connectome Project. Measures of biparietal width, interhemispheric distance, callosal thickness, transcerebellar diameter, lateral ventricular diameter, and deep gray matter area were extracted manually (Prediction of PREterm Motor Outcomes study only) and automatically. Scans with poor quality, failure of automated analysis, or severe pathology were excluded. Agreement, reliability, and associations between manual and automated measures were assessed and compared against statistics for manual measures. Associations between measures with postmenstrual age, gestational age at birth, and birth weight were examined (Pearson correlation) in both cohorts.

RESULTS: A total of 652 MRIs (86%) were suitable for analysis. Automated measures showed good-to-excellent agreement and good reliability with manual measures, except for interhemispheric distance at early MR imaging (scanned between 29 and 35 weeks, postmenstrual age; in line with poor manual reliability) and callosal thickness measures. All measures were positively associated with postmenstrual age (r = 0.11-0.94; R² = 0.01-0.89). Negative and positive associations were found with gestational age at birth (r = -0.26-0.71; R² = 0.05-0.52) and birth weight (r = -0.25-0.75; R² = 0.06-0.56). Automated measures were successfully extracted for 80%-99% of suitable scans.

CONCLUSIONS: Measures of brain injury and impaired brain growth can be automatically extracted from neonatal MR imaging, which could assist with clinical reporting.

PMID:34413061 | DOI:10.3174/ajnr.A7230