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Model decision analysis

Rupen Shah, Kristopher Attwood, Shipra Arya, Daniel E Hall, Jason M Johanning, Emmanuel Gabriel, Anthony Visioni, Steven Nurkin, Moshim Kukar, Steven Hochwald, Nader N Massarweh
Importance: Failure to rescue (FTR), or death after a potentially preventable complication, is a nationally endorsed, publicly reported quality measure. However, little is known about the impact of frailty on FTR, in particular after low-risk surgical procedures. Objective: To assess the association of frailty with FTR in patients undergoing inpatient surgery. Design, Setting, and Participants: This study assessed a cohort of 984 550 patients undergoing inpatient general, vascular, thoracic, cardiac, and orthopedic surgery in the National Surgical Quality Improvement Program between January 1, 2005, and December 31, 2012...
March 21, 2018: JAMA Surgery
Tan Li, Qingguo Zhang, Ying Zhang
The assessment of forest ecosystem services can quantify the impact of these services on human life and is the main basis for formulating a standard of compensation for these services. Moreover, the calculation of the indirect value of forest ecosystem services should not be ignored, as has been the case in some previous publications. A low compensation standard and the lack of a dynamic coordination mechanism are the main problems existing in compensation implementation. Using comparison and analysis, this paper employed accounting for both the costs and benefits of various alternatives...
March 21, 2018: International Journal of Environmental Research and Public Health
Bo Hao, Zhen Chen, Baochen Bi, Miaomei Yu, Shuang Yao, Yuehua Feng, Yang Yu, Lili Pan, Dongmei Di, Guanghua Luo, Xiaoying Zhang
Background: Accumulating evidence showed that high expression of toll like receptor 4 (TLR4) was significantly associated with the outcome of patients with solid cancers. However, other studies failed to draw a similar conclusion. Thus, a systematic meta-analysis was performed to assess the prognostic value of TLR4 in solid tumors. Results: Data from 15 studies and 1294 patients were enrolled. Among the 15 studies, 14 studies demonstrated the association between overall survival(OS) and TLR4 expression, and 7 studies described the relationship between disease-free survival(DFS) and TLR4 expression...
February 27, 2018: Oncotarget
Thanh G Phan, Jian Chen, Shaloo Singhal, Henry Ma, Benjamin B Clissold, John Ly, Richard Beare
Background: Prognostication following hypoxic ischemic encephalopathy (brain injury) is important for clinical management. The aim of this exploratory study is to use a decision tree model to find clinical and MRI associates of severe disability and death in this condition. We evaluate clinical model and then the added value of MRI data. Method: The inclusion criteria were as follows: age ≥17 years, cardio-respiratory arrest, and coma on admission (2003-2011)...
2018: Frontiers in Neurology
Lucas Pinto, Sue A Koay, Ben Engelhard, Alice M Yoon, Ben Deverett, Stephan Y Thiberge, Ilana B Witten, David W Tank, Carlos D Brody
The gradual accumulation of sensory evidence is a crucial component of perceptual decision making, but its neural mechanisms are still poorly understood. Given the wide availability of genetic and optical tools for mice, they can be useful model organisms for the study of these phenomena; however, behavioral tools are largely lacking. Here, we describe a new evidence-accumulation task for head-fixed mice navigating in a virtual reality (VR) environment. As they navigate down the stem of a virtual T-maze, they see brief pulses of visual evidence on either side, and retrieve a reward on the arm with the highest number of pulses...
2018: Frontiers in Behavioral Neuroscience
Karin Stenberg, Jeremy A Lauer, Georgios Gkountouras, Christopher Fitzpatrick, Anderson Stanciole
Background: Policy makers require information on costs related to inpatient and outpatient health services to inform resource allocation decisions. Methods: Country data sets were gathered in 2008-2010 through literature reviews, website searches and a public call for cost data. Multivariate regression analysis was used to explore the determinants of variability in unit costs using data from 30 countries. Two models were designed, with the inpatient and outpatient models drawing upon 3407 and 9028 observations respectively...
2018: Cost Effectiveness and Resource Allocation: C/E
Richard J Holden, Preethi Srinivas, Noll L Campbell, Daniel O Clark, Kunal S Bodke, Youngbok Hong, Malaz A Boustani, Denisha Ferguson, Christopher M Callahan
BACKGROUND: Older adults purchase and use over-the-counter (OTC) medications with potentially significant adverse effects. Some OTC medications, such as those with anticholinergic effects, are relatively contraindicated for use by older adults due to evidence of impaired cognition and other adverse effects. OBJECTIVE: To inform the design of future OTC medication safety interventions for older adults, this study investigated consumers' decision making and behavior related to OTC medication purchasing and use, with a focus on OTC anticholinergic medications...
March 6, 2018: Research in Social & Administrative Pharmacy: RSAP
Pierre Onodje Agbani, Konoutan Médard Kafoutchoni, Kolawolé Valère Salako, Rodrigue Castro Gbedomon, Ahuéfa Mauricel Kégbé, Hahn Karen, Brice Sinsin
BACKGROUND: Atakora mountains in Benin are a unique but fragile ecosystem, harboring many endemic plant species. The ecosystem is undergoing degradation, and the woody vegetation is dramatically declining due to high anthropogenic actions and recurrent drought. This study aimed to (i) assess the diversity of threatened woody species and (ii) identify their potential substitutes in the three regions of the Atakora mountains namely East Atakora, Central Atakora, and West Atakora. METHODS: The data were collected during expeditions on surveyed localities through semi-structured individual interviews...
March 20, 2018: Journal of Ethnobiology and Ethnomedicine
Kunal N Karmali, Donald M Lloyd-Jones, Joep van der Leeuw, David C Goff, Salim Yusuf, Alberto Zanchetti, Paul Glasziou, Rodney Jackson, Mark Woodward, Anthony Rodgers, Bruce C Neal, Eivind Berge, Koon Teo, Barry R Davis, John Chalmers, Carl Pepine, Kazem Rahimi, Johan Sundström
BACKGROUND: Clinical practice guidelines have traditionally recommended blood pressure treatment based primarily on blood pressure thresholds. In contrast, using predicted cardiovascular risk has been advocated as a more effective strategy to guide treatment decisions for cardiovascular disease (CVD) prevention. We aimed to compare outcomes from a blood pressure-lowering treatment strategy based on predicted cardiovascular risk with one based on systolic blood pressure (SBP) level. METHODS AND FINDINGS: We used individual participant data from the Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC) from 1995 to 2013...
March 2018: PLoS Medicine
Nicoletta Colombo, Gloria Huang, Giovanni Scambia, Eva Chalas, Sandro Pignata, James Fiorica, Linda Van Le, Sharad Ghamande, Santiago González-Santiago, Isabel Bover, Begoña Graña Suárez, Andrew Green, Philippe Huot-Marchand, Yann Bourhis, Sudeep Karve, Christopher Blakeley
Purpose There is a growing demand for BRCA1/ 2 mutation ( BRCAm) testing in patients with ovarian cancer; however, the limited number of genetic counselors presents a potential barrier. To facilitate more widespread BRCAm testing in ovarian cancer, pretest counseling by the oncology team could shorten testing turnaround times and ease the pressure on genetic counselors. Patients and Methods The prospective, observational Evaluating a Streamlined Onco-genetic BRCA Testing and Counseling Model Among Patients With Ovarian Cancer (ENGAGE) study evaluated a streamlined, oncologist-led BRCAm testing pathway...
March 20, 2018: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Mariana V Meireles, Ana Roberta P Pascom, Elisabeth C Duarte
OBJECTIVE: To identify clinical, sociodemographic and treatment-related factors associated with early virological response in HIV-infected adults starting antiretroviral treatment (ART) in Brazil in 2014-2015. METHODS: Data from four information systems from the Brazilian AIDS Program were combined to create a historical cohort. Unconditional logistic regression models were used to assess the likelihood of not achieving virological suppression (VLS), defined as having either a viral load count (VL) >200 copies/mL or an aids-related death recorded within 180±90 days after treatment initiation...
March 19, 2018: Journal of Acquired Immune Deficiency Syndromes: JAIDS
Maliha Khan, Tariq Muzzafar, Hagop Kantarjian, Ifra Badar, Nicholas Short, Xuemei Wang, Kamal Chamoun, Preetesh Jain, Courtney DiNardo, Naveen Pemmaraju, Prithviraj Bose, Gautam Borthakur, Jorge Cortes, Srdan Verstovsek, Guillermo Garcia-Manero, Zeev Estrov
The impact of bone marrow fibrosis grade on the prognosis of patients with chronic myelomonocytic leukemia (CMML) remains controversial. Therefore, we examined the records of 82 patients diagnosed with CMML at our institution and summarized baseline characteristics and molecular profiles by subgroups of absent or mild (grades 0/1) and moderate (grade 2) fibrosis. Cox proportional hazards models were constructed to assess the prognostic significance of fibrosis grade. Grade 2 fibrosis was identified in 63 patients (76...
March 20, 2018: Annals of Hematology
Hiroki Nishiwaki, Takeshi Hasegawa, Megumi Shinji, Fujio Matsuo, Tsuyoshi Watanabe, Hirofumi Makino, Fumihiko Koiwa, Akira Hishida
BACKGROUND: The practice patterns of exercise restrictions for patients with chronic kidney disease have not been adequately evaluated yet; thus, we examined them using a cross-sectional design and explored the factors related with those restrictions. METHODS: The Chronic Kidney Disease Japan Cohort study was a multicentre cohort study of Japanese patients (age 20-75 years) living in Japan. We used the information in the questionnaire on the restriction of physical activities offered by physicians to the patients during enrolment...
March 19, 2018: Clinical and Experimental Nephrology
Robert Roehle, Viktoria Wieske, Georg M Schuetz, Pascal Gueret, Daniele Andreini, Willem Bob Meijboom, Gianluca Pontone, Mario Garcia, Hatem Alkadhi, Lily Honoris, Jörg Hausleiter, Nuno Bettencourt, Elke Zimmermann, Sebastian Leschka, Bernhard Gerber, Carlos Rochitte, U Joseph Schoepf, Abbas Arjmand Shabestari, Bjarne Nørgaard, Akira Sato, Juhani Knuuti, Matthijs F L Meijs, Harald Brodoefel, Shona M M Jenkins, Kristian Altern Øvrehus, Axel Cosmus Pyndt Diederichsen, Ashraf Hamdan, Bjørn Arild Halvorsen, Vladimir Mendoza Rodriguez, Yung Liang Wan, Johannes Rixe, Mehraj Sheikh, Christoph Langer, Said Ghostine, Eugenio Martuscelli, Hiroyuki Niinuma, Arthur Scholte, Konstantin Nikolaou, Geir Ulimoen, Zhaoqi Zhang, Hans Mickley, Koen Nieman, Philipp Kaufmann, Ronny Ralf Büchel, Bernhard Herzog, Melvin Clouse, David A Halon, Jonathan Leipsic, David Bush, Reda Jakamy, Kai Sun, Lin Yang, Thorsten Johnson, Jean-Pierre Laissy, Roy Marcus, Simone Muraglia, Jean-Claude Tardif, Benjamin Chow, Narinder Paul, David Maintz, John Hoe, Albert de Roos, Robert Haase, Michael Laule, Peter Schlattmann, Marc Dewey
OBJECTIVES: To analyse the implementation, applicability and accuracy of the pretest probability calculation provided by NICE clinical guideline 95 for decision making about imaging in patients with chest pain of recent onset. METHODS: The definitions for pretest probability calculation in the original Duke clinical score and the NICE guideline were compared. We also calculated the agreement and disagreement in pretest probability and the resulting imaging and management groups based on individual patient data from the Collaborative Meta-Analysis of Cardiac CT (CoMe-CCT)...
March 19, 2018: European Radiology
Miguel Ángel Lozada Aguilar, Andrei Khrennikov, Klaudia Oleschko
As was recently shown by the authors, quantum probability theory can be used for the modelling of the process of decision-making (e.g. probabilistic risk analysis) for macroscopic geophysical structures such as hydrocarbon reservoirs. This approach can be considered as a geophysical realization of Hilbert's programme on axiomatization of statistical models in physics (the famous sixth Hilbert problem). In this conceptual paper , we continue development of this approach to decision-making under uncertainty which is generated by complexity, variability, heterogeneity, anisotropy, as well as the restrictions to accessibility of subsurface structures...
April 28, 2018: Philosophical Transactions. Series A, Mathematical, Physical, and Engineering Sciences
Elizabeth A Lakota, Voon Ong, Shawn Flanagan, Christopher M Rubino
Rezafungin (CD101) is a novel echinocandin antifungal agent currently in clinical development for the treatment of candidemia and invasive candidiasis. Rezafungin has potent in vitro activity against Candida albicans and Candida glabrata , including azole- and echinocandin-resistant isolates. The objective of this analysis was to develop a population pharmacokinetic (PK) model to characterize the disposition of rezafungin in plasma following intravenous (IV) administration. Data from two Phase 1 studies, a single-ascending-dose study and a multiple-ascending-dose study, were available...
March 19, 2018: Antimicrobial Agents and Chemotherapy
Douglas Yeung
This viewpoint paper argues that policy interventions can benefit from the continued use of social media analytics, which can serve as an important complement to traditional social science data collection and analysis. Efforts to improve well-being should provide an opportunity to explore these areas more deeply, and encourage the efforts of those conducting national and local data collection on health to incorporate more of these emerging data sources. Social media remains a relatively untapped source of information to catalyze policy action and social change...
March 19, 2018: Journal of Medical Internet Research
Benjamin W Chrisinger, Michael J Kallan, Eliza D Whiteman, Amy Hillier
Food shopping decisions are pathways between food environment, diet and health outcomes, including chronic diseases such as diabetes and obesity. The choices of where to shop and what to buy are interrelated, though a better understanding of this dynamic is needed. The U.S. Department of Agriculture's nationally representative Food Acquisitions and Purchase Survey food-at-home dataset was joined with other databases of retailer characteristics and Healthy Eating Index-2010 (HEI) of purchases. We used linear regression models with general estimating equations to assess relationships between trip, store, and shopper characteristics with trip HEI scores...
March 16, 2018: Preventive Medicine
Stefanie Bachnick, Dietmar Ausserhofer, Marianne Baernholdt, Michael Simon
BACKGROUND: Patient-centered care is a key element of high-quality healthcare and determined by individual, structural and process factors. Patient-centered care is associated with improved patient-reported, clinical and economic outcomes. However, while hospital-level characteristics influence patient-centered care, little evidence is available on the association of patient-centered care with characteristic such as the nurse work environment or implicit rationing of nursing care. OBJECTIVE: The aim of this study was to describe patient-centered care in Swiss acute care hospitals and to explore the associations with nurse work environment factors and implicit rationing of nursing care...
November 24, 2017: International Journal of Nursing Studies
Sarah M Bartsch, Susan S Huang, James A McKinnell, Kim F Wong, Leslie E Mueller, Loren G Miller, Bruce Y Lee
OBJECTIVE While previous work showed that the Centers for Disease Control and Prevention toolkit for carbapenem-resistant Enterobacteriaceae (CRE) can reduce spread regionally, these interventions are costly, and decisions makers want to know whether and when economic benefits occur. DESIGN Economic analysis SETTING Orange County, California METHODS Using our Regional Healthcare Ecosystem Analyst (RHEA)-generated agent-based model of all inpatient healthcare facilities, we simulated the implementation of the CRE toolkit (active screening of interfacility transfers) in different ways and estimated their economic impacts under various circumstances...
March 19, 2018: Infection Control and Hospital Epidemiology
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