Finding a constrained number of predictor phenotypes for multiple outcome prediction

Background:Prognostic models help aid medical decision-making. Various prognostic models are available via websites such as MDCalc, but these models typically predict one outcome, for example, stroke risk. Each model requires individual predictors, for example, age, lab results and comorbidities. There is no clinical tool available to predict multiple outcomes from a list of common medical predictors.Objective: Identify a constrained set of outcome-agnostic predictors. Methods: We proposed a novel technique aggregating the standardised mean difference across hundreds of outcomes to learn a constrained set of predictors that appear to be predictive of many outcomes. Model performance was evaluated using the constrained set of predictors across eight prediction tasks. We compared against existing models, models using only age/sex predictors and models without any predictor constraints. Results: We identified 67 predictors in our constrained set, plus age/sex. Our predictors included illnesses in the following categories: cardiovascular, kidney/liver, mental health, gastrointestinal, infectious and oncologic. Models developed using the constrained set of predictors achieved comparable discrimination compared with models using hundreds or thousands of predictors for five of the eight prediction tasks and slightly lower discrimination for three of the eight tasks. The constrained predictor models performed as good or better than all existing clinical models. Conclusions: It is possible to develop models for hundreds or thousands of outcomes that use the same small set of predictors. This makes it feasible to implement many prediction models via a single website form. Our set of predictors can also be used for future models and prognostic model research.</p

Resilience-based interventions in the public sector workplace:a systematic review

BACKGROUND: Previous studies have advocated the benefits of resilience-based interventions for creating a healthy and sustainable workforce. However, resilience is defined and measured in diverse ways. Therefore, the aim of this systematic review is (1) to identify how resilience is defined within different workplace interventions, translated into intervention content, and measured in these interventions; and (2) to synthesize the effectiveness of these interventions. METHODS: A systematic literature search was conducted and included articles from 2013 - 2023. Twenty-four studies met the inclusion criteria, covering a total of 26 unique interventions. Definitions were categorized as: resilience as a trait, process, or outcome. Cohen's D was calculated to depict the effect sizes within the intervention groups from pre-test to post-test and, when possible, from pre-test to 3-month follow-up. RESULTS: Included studies applied a wide range of definitions; most definitions fitted within the trait-orientation, conceptualizing resilience as an individual characteristic or ability, or the process-orientation, conceptualizing resilience as a dynamic process. No studies solely used the outcome-orientation, but some did combine elements of all three orientations. Various definitions, measures and intervention strategies were applied, however, almost half of the studies (46%) showed inconsistencies within these choices. Furthermore, findings show that most resilience-based interventions in the workplace have a positive impact. While educational workshops with a higher frequency and duration had medium to large effects, solely digital interventions had small effects, changing to small to medium when combined with non-digital elements. CONCLUSIONS: Findings suggest that resilience-based can benefit employees by enhancing their psychological well-being. This, in turn, can lead to improved work-related outcomes such as productivity, thereby offering advantages to employers as well. This underscores the growing recognition that resilience should be viewed as a shared responsibility between the individual and the organization. Further advancement in the field of resilience-based interventions in the workplace calls for future research to focus on maintaining consistency when choosing a definition of resilience, developing intervention content, and choosing an outcome measure. PREREGISTRATION: The search protocol was preregistered in the Open Science Framework, see Hollaar et al. (2023). https://doi.org/10.17605/OSF.IO/UKYF7 .</p

Development and Validation of the EBP-Affinity Questionnaire:A Mixed-Method Study

Background: Implementation of evidence-based practice (EBP) in nursing homes is important to improve quality of care and reduce costs. These facilities primarily employ certified nurse assistants (CNAs) and vocationally-trained registered nurses (VTRNs). Although EBP is scarcely addressed in their education, these caregivers have an important role in EBP. Insight into their affinity with EBP could provide a good starting point for working according to EBP. Aims: To develop a questionnaire that measures affinity with EBP amongst CNAs and VTRNs in nursing homes. To assess the reliability and validity of the questionnaire. Design: Mixed-method design according to the COSMIN-checklist. Methods: Phase 1: the questionnaire was developed in three steps: (1) gathering items from existing questionnaires, occupational profiles and interviews; (2) compression through consensus rounds and (3) a pilot study. Phase 2: psychometric properties were assessed amongst CNAs and VTRNs in nine nursing homes. The factors extracted through principal component analysis were tested for measurement invariance using the one-parameter Rasch model. Results: Phase 1: all experts interviewed (N = 5) indicated CNAs and VTRNs can play specific and significant roles in EBP. A 26-item questionnaire was created through two consensus rounds with experts (N = 7) and a pilot study (N = 7). Phase 2: Principal component analysis revealed a two-factor structure with good internal reliability (N = 428 questionnaires). All items exhibited good fit with the Rasch model and measurement invariance for CNAs and VTRNs. Conclusion: CNAs and VTRNs can fulfil important roles in EBP in nursing homes. The ‘Evidence-Based Practice-Affinity Questionnaire’ is reliable and valid for assessing affinity with EBP amongst CNAs and VTRNs to improve practice and research, and can guide tailored training programs for CNAs and VTRNs, enhancing evidence-based practices in nursing homes. Impact: The research provides insight into the roles CNAs and VTRNs can play in EBP and how to measure their affinity with EBP, which contributes to implementation of EBP in nursing homes. Patient or Public Contribution: No patient or public contribution in the study.</p

Heterogeneous Effects of Generative AI on Knowledge Seeking in Online Communities

Generative AI (GenAI) may fundamentally reshape how users seek knowledge in online knowledge sharing communities. Although prior work found an overall decrease in knowledge seeking in online communities upon the availability of GenAI, the underlying dynamics across user groups have remained unexplored.This study addresses that gap. Drawing on commitment-based theory, we hypothesize that casual users—motivated by cost-benefit considerations—are more likely to reduce their question-posting activity than highly committed members. Using a difference-in-differences analysis, we find that ChatGPT’s arrival leads to a substantial drop in questions on StackExchange, primarily drivenby casual users (about 18.2%). Motivated by information foraging theory, we reveal heterogeneous downstream effects of GenAI on question characteristics. In particular, we find that the questions by casual users become more complex and novel, while those by intensive and top users do not. These results highlight the importance of heterogeneous user motivations in shaping platform dynamics, underscoring that while GenAI may diminish overall participation, it may alsoincrease the value of the remaining content. Our study offers insights for knowledge sharing communities, managers, and stakeholders reliant on usergenerated data, providing a nuanced view of GenAI’s disruptive influence

Upfront surgery for intrahepatic cholangiocarcinoma:Prediction of futility using artificial intelligence

Objective: We sought to identify patients at risk of “futile” surgery for intrahepatic cholangiocarcinoma using an artificial intelligence (AI)–based model based on preoperative variables. Methods: Intrahepatic cholangiocarcinoma patients who underwent resection between 1990 and 2020 were identified from a multi-institutional database. Futility was defined either as mortality or recurrence within 12 months of surgery. Various machine learning and deep learning techniques were used to develop prediction models for futile surgery. Results: Overall, 827 intrahepatic cholangiocarcinoma patients were included. Among 378 patients (45.7%) who had futile surgery, 297 patients (78.6%) developed intrahepatic cholangiocarcinoma recurrence and 81 patients (21.4%) died within 12 months of surgical resection. An ensemble model consisting of multilayer perceptron and gradient boosting classifiers that used 10 preoperative factors demonstrated the highest accuracy, with areas under receiver operating characteristic curves of 0.830 (95% confidence interval 0.798–0.861) and 0.781 (95% confidence interval 0.707–0.853) in the training and testing cohorts, respectively. The model displayed sensitivity and specificity of 64.5% and 80.0%, respectively, with positive and negative predictive values of 73.1% and 72.7%, respectively. Radiologic tumor burden score, serum carbohydrate antigen 19-9, and direct bilirubin levels were the factors most strongly predictive of futile surgery. The artificial intelligence–based model was made available online for ease of use and clinical applicability (https://altaf-pawlik-icc-futilityofsurgery-calculator.streamlit.app/). Conclusion: The artificial intelligence ensemble model demonstrated high accuracy to identify patients preoperatively at high risk of undergoing futile surgery for intrahepatic cholangiocarcinoma. Artificial intelligence–based prediction models can provide clinicians with reliable preoperative guidance and aid in avoiding futile surgical procedures that are unlikely to provide patients long-term benefits.</p

Sexual dimorphism in SMAD3 pathogenic variant-harbouring individuals

Background: Individuals harbouring SMAD3 pathogenic variants are at risk for aneurysms/dissections throughout the arterial tree. Based on prior reports of sex differences in thoracic aortic aneurysm/dissection, we investigated the sexual dimorphism for vascular events in SMAD3-variant-harbouring patients. Methods: We analysed two large pedigrees comprising 84 individuals segregating pathogenic missense variants affecting the same p.Arg287 residue in SMAD3. We excluded individuals&lt;40 years without vascular involvement, as they were too young to be classified. Individuals were subcategorised according to sex, the presence or absence and localisation (aneurysm/dissection with or without involvement of the aortic root/ascending aorta) of vascular lesions. We complemented our familial patient cohort with 178 SMAD3 patients reported in the literature between 2011 and 2023. Results: In our two pedigrees, 11/30 (37%) variant-harbouring females had no vascular involvement, whereas none of the variant-harboring males (n=23) had no vascular involvement (p=0.001). While the two groups did not differ by age, males were at higher risk of vascular complications (p=0.037), there was no age difference between sexes. Of the 19 females with vascular involvement, six (32%) had vascular involvment sparing the aortic root/ascending aorta, whereas of the 23 males with vascular invovlement, only one (4%) had vascular involvement sparing the aortic root/ascending aorta (p=0.034). In the literature, we identified 116 male and 62 female additional patients. In the combined cohort of 220 patients, we demonstrated an over-representation of males (p&lt;0.001) and non-penetrance in females for vascular pathology involving the aortic root/ascending aorta (p=0.028). Conclusions: Non-penetrance is more common in women, and normal echocardiography in at-risk females is not as reassuring for risk of vasculopathy in other locations. The higher non-penetrance in women creates an ascertainment bias and results in an over-representation of male patients in the literature.</p

Development of specialist palliative care in Dutch hospitals between 2014 and 2020:a repeated survey

BACKGROUND: Specialist palliative care teams (SPCTs) have significant benefits for patients with advanced disease or frailty, including improved quality of life, greater satisfaction with care, and less potentially inappropriate care at the end of life. Experienced SPCTs are recognised to have higher referral rates compared to novice teams. The aim of this study was to assess the development of hospital-wide integration of specialist palliative care (PC) and of SPCTs in Dutch hospitals between 2014 and 2020. METHODS: Three cross-sectional surveys of SPCTs in Dutch hospitals were conducted in 2015, 2018 and 2021. Key members of the hospital SPCTs completed questionnaires about the preceding year that included items on hospital and PC program characteristics, hospital-wide integration of specialist PC, and SPCT characteristics (92 hospitals in 2015, 79 in 2018 and 74 in 2021). The analysis included hospitals with an operational SPCT, as determined by providing inpatient PC consultation services. Univariate analyses compared hospitals and SPCTs by year. Significance was determined by p-values &lt; 0.05. RESULTS: In 2014, 65% of participating hospitals provided inpatient PC consultations (n = 48). This increased to 92% in 2017 (n = 58) and 98% in 2020 (n = 48). Over the years, participating hospitals showed an increasing level of hospital-wide integration of specialist PC, such as an increased number of dedicated PC outpatient clinics (56% in 2020, compared with 47% in 2017 and 27% in 2014). The annual number of inpatient referrals to SPCTs has increased significantly over the years. The SPCTs have developed significantly in various aspects, including collaboration between primary and hospital care, the availability of services to patients at home and non-clinical activities. CONCLUSION: Over the years, Dutch hospitals have shown growth in hospital-wide integration of specialist PC. Specialist palliative care teams have made significant progress in increasing inpatient consultations, and in improving collaboration between primary and hospital care.</p

Dystopian efficiency:Reflections on a national quality framework

The Comparison of Strategies of Destination Marketing Organization