Are component endpoints equal?:A preference study into the practice of composite endpoints in clinical trials

Objectives: To examine patients’ perspectives regarding composite endpoints and the utility patients put on possible adverse outcomes of revascularization procedures. Design: In the PRECORE study, a stated preference elicitation method Best-Worst Scaling (BWS) was used to determine patient preference for 8 component endpoints (CEs): need for redo percutaneous coronary intervention (PCI) within 1 year, minor stroke with symptoms <24 hours, minor myocardial infarction (MI) with symptoms <3 months, recurrent angina pectoris, need for redo coronary artery bypass grafting (CABG) within 1 year, major MI causing permanent disability, major stroke causing permanent disability and death within 24 hours. Setting: A tertiary PCI/CABG centre. Participants: One hundred and sixty patients with coronary artery disease who underwent PCI or CABG. Main outcome measures: Importance weights (IWs). Results: Patients considered need for redo PCI within 1 year (IW: 0.008), minor stroke with symptoms <24 hours (IW: 0.017), minor MI with symptoms <3 months (IW: 0.027), need for redo CABG within 1 year (IW: 0.119), recurrent angina pectoris (IW: 0.300) and major MI causing permanent disability (IW: 0.726) less severe than death within 24 hours (IW: 1.000). Major stroke causing permanent disability was considered worse than death within 24 hours (IW: 1.209). Ranking of CEs and the relative values attributed to the CEs differed among subgroups based on gender, age and educational level. Conclusion: Patients attribute different weight to individual CEs. This has significant implications for the interpretation of clinical trial data

Reliability and Agreement of Automated Head Measurements From 3-Dimensional Photogrammetry in Young Children

This study aimed to assess the reliability and agreement of automated head measurements using 3-dimensional (3D) photogrammetry in young children. Specifically, the study evaluated the agreement between manual and automated occipitofrontal circumference (OFC) measurements (n = 264) obtained from 3D images of 188 patients diagnosed with sagittal synostosis using a novel automated method proposed in this study. In addition, the study aimed to determine the interrater and intrarater reliability of the automatically extracted OFC, cephalic index, and volume. The results of the study showed that the automated OFC measurements had an excellent agreement with manual measurements, with a very strong regression score (R2= 0.969) and a small mean difference of -0.1 cm (-0.2%). The limits of agreement ranged from -0.93 to 0.74 cm, falling within the reported limits of agreement for manual OFC measurements. High interrater and intrarater reliability of OFC, cephalic index, and volume measurements were also demonstrated. The proposed method for automated OFC measurements was found to be a reliable alternative to manual measurements, which may be particularly beneficial in young children who undergo 3D imaging in craniofacial centers as part of their treatment protocol and in research settings that require a reproducible and transparent pipeline for anthropometric measurements. The method has been incorporated into CraniumPy, an open-source tool for 3D image visualization, registration, and optimization, which is publicly available on GitHub (https://github.com/T-AbdelAlim/CraniumPy).</p

Reward-Sensitive Basal Ganglia Stabilize the Maintenance of Goal-Relevant Neural Patterns in Adolescents

Maturation of basal ganglia (BG) and frontoparietal circuitry parallels developmental gains in working memory (WM). Neurobiological models posit that adult WM performance is enhanced by communication between reward-sensitive BG and frontoparietal regions, via increased stability in the maintenance of goal-relevant neural patterns. It is not known whether this reward-driven pattern stability mechanism may have a role in WM development. In 34 young adolescents (12.16–14.72 years old) undergoing fMRI, reward-sensitive BG regions were localized using an incentive processing task. WM-sensitive regions were localized using a delayed-response WM task. Functional connectivity analyses were used to examine the stability of goal-relevant functional connectivity patterns during WM delay periods between and within reward-sensitive BG and WM-sensitive frontoparietal regions. Analyses revealed that more stable goal-relevant connectivity patterns between reward-sensitive BG and WM-sensitive frontoparietal regions were associated with both greater adolescent age and WM ability. Computational lesion models also revealed that functional connections to WM-sensitive frontoparietal regions from reward-sensitive BG uniquely increased the stability of goal-relevant functional connectivity patterns within frontoparietal regions. Findings suggested (1) the extent to which goal-relevant communication patterns within reward-frontoparietal circuitry are maintained increases with adolescent development and WM ability and (2) communication from reward-sensitive BG to frontoparietal regions enhances the maintenance of goal-relevant neural patterns in adolescents’ WM. The maturation of reward-driven stability of goal-relevant neural patterns may provide a putative mechanism for understanding the developmental enhancement of WM

Patients’ Priorities for Oral Anticoagulation Therapy in Non-valvular Atrial Fibrillation:a Multi-criteria Decision Analysis

Introduction: Effectiveness of oral anticoagulants (OACs) is critically dependent on patients’ adherence to intake regimens. We studied the relative impact of attributes related to effectiveness, safety, convenience, and costs on the value of OAC therapy from the perspective of patients with non-valvular atrial fibrillation. Methods: Four attributes were identified by literature review and expert interviews: effectiveness (risk of ischemic stroke), safety (risk of major bleeding, minor bleeding, gastrointestinal complaints), convenience (intake frequency, diet restrictions, international normalized ratio [INR] blood monitoring, pill type/intake instructions), and out-of-pocket costs. Focus groups were held in Spain, Germany, France, Italy and the United Kingdom (N = 48) to elicit patients’ preferences through the use of the analytical hierarchy process method. Results: Effectiveness (60%) and side effects (27%) have a higher impact on the perceived value of OACs than drug convenience (7%) and out-of-pocket costs (6%). As for convenience, eliminating monthly INR monitoring was given the highest priority (40%), followed by reducing diet restrictions (27%), reducing intake frequency (17%) and improving the pill type/intake instructions (15%). The most important side effect was major bleeding (75%), followed by minor bleeding (15%) and gastrointestinal complaints (10%). Furthermore, 71% of patients preferred once-daily intake to twice-daily intake. Discussion: Although the relative impact of convenience on therapy value is small, patients have different preferences for options within convenience criteria. Besides considerations on safety and effectiveness, physicians should also discuss attributes of convenience with patients, as it can be assumed that alignment to patient preferences in drug prescription and better patient education could result in higher adherence

Health-related Quality of Life in Children and Adolescents with Sagittal Synostosis

Background: This study evaluated the health-related quality of life (HR-QoL) in patients with sagittal synostosis (SS), and the influence of frequent headaches and surgical techniques on the HR-QoL. Method: Patients with SS aged 8 to 18 years were invited to participate between June 2016 and February 2017. The Child Health Questionnaire was used to assess the HR-QoL. A detailed questionnaire was used to assess the severity of headache symptoms. The control group consisted of 353 school children aged 5 to 14 years. Results: In all, 95 parents of patients with SS were invited to participate, of whom 68 (71.6%) parents completed the CHQ-PF50. The mean age of the participating patients was 12.4 years (10.8 to 14.2). The Psychosocial-and Physical summary of the patients with SS was similar to the general population. In the distinct CHQ scales, "Family cohesion" (P=0.02) was higher, and "Mental health" (P=0.05) was lower compared with the general population. The type and timing of surgery did not affect the HR-QoL. Thirty-two patients (47.1%) reported having headache complaints at least once a month. The CHQ scores of SS patients with frequent headaches had a significantly lower score of mild to large effect than those without headaches. Conclusion: Patients with SS have a slightly lower to similar HR-QoL compared with the general population. In all, 47.1% of SS patients have frequent headaches, resulting in lower average HR-QoL. The type and timing of surgery did not affect the results. Clinicians should be aware of lower HR-QoL in some subgroups of patients with SS.</p

Economic Policy in a More Uncertain World

The Aspen Economic Strategy Group's Annual Policy Volume Economic Policy in a More Uncertain World marks the group's 5th anniversary and is released against a backdrop historic economic and strategic uncertainty. The book's seven chapters, each written by leading experts and edited by AESG Director Melissa S. Kearney and Deputy Director Amy Ganz, provide a deep-dive on long-term economic headwinds confronting the country, including demographic changes—declining fertility and population aging—and what a smaller worker to population ratio means in terms of slower economic growth, reduced revenue, and lower productivity growth. Additional chapters on the US immigration system and US innovation policy highlight potential solutions for countering these trends.  Another chapter explores potential adverse impacts on local labor markets from the green energy transition and highlights policies to avoid repeating painful mistakes of the past, including the response to the decline of the coal industry and rise of globalization and automation. A final chapter highlights lessons learned from the unprecedented federal aid to state and local governments during the COVID-19 pandemic

The Ursinus Weekly, October 3, 1974

Statistics prove rumor unfounded • WRUC FM hits the air • New chaplain brings new ideas to U.C. • Musical forum presented by Mme. Agi Jambor • Dr. Williamson authors new study of Corinthians • Editorial • Pages from Ursinus past • Alumni corner: Assurance to insurance • Summer in the city • Letter from London • S.F.A.R.C. and you • Assistant Deans of Men and Women appointed • Festival help needed • Slow boat to China • Harriers sweep Drew and Eastern • The Spirit of the 76ers • Women\u27s hockey season opens • Why Bears?https://digitalcommons.ursinus.edu/weekly/1020/thumbnail.jp

3D Analysis of the Cranial and Facial Shape in Craniosynostosis Patients:A Systematic Review

With increasing interest in 3D photogrammetry, diverse methods have been developed for craniofacial shape analysis in craniosynostosis patients. This review provides an overview of these methods and offers recommendations for future studies. A systematic literature search was used to identify publications on 3D photogrammetry analyses in craniosynostosis patients until August 2023. Inclusion criteria were original research reporting on 3D photogrammetry analyses in patients with craniosynostosis and written in English. Sixty-three publications that had reproducible methods for measuring cranial, forehead, or facial shape were included in the systematic review. Cranial shape changes were commonly assessed using heat maps and curvature analyses. Publications assessing the forehead utilized volumetric measurements, angles, ratios, and mirroring techniques. Mirroring techniques were frequently used to determine facial asymmetry. Although 3D photogrammetry shows promise, methods vary widely between standardized and less conventional measurements. A standardized protocol for the selection and documentation of landmarks, planes, and measurements across the cranium, forehead, and face is essential for consistent clinical and research applications.</p

Holocene landscape evolution, palaeoclimate and human impact in the Fotsch Valley, Stubai Alps, Austria: Interrogating biomarkers, stable isotopes, macrofossils and palynological indicators from a subalpine mire archive

Peatlands are receiving increasing attention in palaeoenvironmental research and represent very useful terrestrial archives for reconstructing vegetation, climate and human history. Previous palaeoenvironmental studies in the Fotsch Valley, Stubai Alps, Austria, focused on geoarchaeological investigations on the Ullafelsen representing a very important prehistorical encampment site used by Mesolithic hunter-gatherers (10.9–9.5 cal. kyr BP). In order to contribute to a better understanding of the landscape evolution of the Fotsch Valley, we here studied the close-by subalpine ‘Potsdamer Hütte Mire’ by applying radiocarbon dating as well as elemental, biomarker, compound-specific stable isotope, palynological and macrofossil analyses on bulk peat samples. The calculated age-depth model using R Bacon indicates the beginning of peat formation during the Early Holocene and shows a strongly reduced peat accumulation rate (PAR) from 170 to 121 cm depth (8.5–2.1 cal. kyr BP) and/or a striking hiatus. Results of leaf wax-derived n-alkane biomarkers as well as macrofossils and palynological indicators reflect the local presence of coniferous trees and the synchronous expansion of deciduous trees during the Early Holocene. The above-mentioned strongly reduced PAR and/or hiatus coincides with the Neolithic, the Bronze and the Iron Age, and goes hand in hand with strong changes in vegetation and an increase of micro-charcoal and black carbon. Despite age uncertainties, these changes can be explained with strongly increasing human and livestock activities in form of deforestation, domestic fires and the beginning of Alpine pastoralism. The latter is confirmed by the finding of pasture and cultural indicator pollen (Cerealia-type, Rumex, Plantago lanceolata, Poaceae) occurring since the Middle to Late Bronze Age. The oxygen isotope composition of sugar biomarkers (δ18Osugars) likely reflects the dry versus humid climatic variability associated with the Holocene climatic optimum during the Mesolithic, the Roman Age, the Late Antique Little Ice Age, the Middle Ages and the Little Ice Age