261 research outputs found

    Response to letter by Scott Kaplan

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    Online open neuroimaging mass meta-analysis

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    We describe a system for meta-analysis where a wiki stores numerical data in a simple format and a web service performs the numerical computation. We initially apply the system on multiple meta-analyses of structural neuroimaging data results. The described system allows for mass meta-analysis, e.g., meta-analysis across multiple brain regions and multiple mental disorders.Comment: 5 pages, 4 figures SePublica 2012, ESWC 2012 Workshop, 28 May 2012, Heraklion, Greec

    Characterization of Men with Hemophilia B and Factors Associated with Treatment Practices, Participating in the Community Counts Registry from 2014 to 2018.

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    Hemophilia B is an inherited, X-linked, bleeding disorder caused by a mutation of the clotting factor 9 (FIX) gene. The mutation reduces the amount of FIX protein and results in spontaneous and trauma-related bleeding episodes. In 1994, approximately 2,800 men with hemophilia B (MWHB) were treated at hemophilia treatment centers (HTCs) in the United States (US). To date, studies examining health outcomes for MWHB in the US have not been compared across disease severities. Treatment of MWHB has become more complex with changes in prophylaxis practices in the US and the introduction of novel treatment products. Observational studies that describe health outcomes among MWHB and current treatment practices are important to inform future clinical practices. These cross-sectional analyses used data from MWHB enrolled in the Community Counts surveillance Registry (Registry) from 2014 to 2018. The first paper compared the sample of MWHB in the Registry to the population of MWHB who received treatment in HTCs and described the demographic, clinical factors, and health outcomes across disease severities. From 2014-2018, the population of MWHB who received care in HTCs included 4,816 MWHB, of which 2091 participated in the Registry. The second paper examined demographic, clinical factors, and health outcomes associated with treatment regimen, prophylaxis versus episodic; and used a marginal model. The final model included ethnicity, health insurance, history of a joint bleed, and interactions between severity by chronic pain as well as age by history of central venous access device utilization. The third paper examined demographic, clinical factors, and health outcomes associated with treatment product type utilization, standard half-life products versus extended half-life products, among MWHB on continuous prophylaxis; and used a marginal model. The final model included disease severity, enrollment year, HTC region, and percent of missed treatment dose. The second and third paper demonstrated that patient-level treatment outcomes were clustered by the HTCs where they received care. Future studies should examine the treatment dosage and frequency of administration of treatment products for MWHB on prophylaxis and replicate these studies for hemophilia A to determine if the factors associated with treatment are similar for all men with hemophilia

    Costs and Complications of Single Stage Fixation Versus Two-Stage Treatment of Select Bicondylar Tibial Plateau Fractures

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    Objectives: To determine the differences in costs and complications in patients with bicondylar tibial plateau (BTP) fractures treated with one stage definitive fixation compared to two stage fixation following initial spanning external fixation. Design: Retrospective cohort study Setting: Level one trauma center Patients/Participants: Patients with OTA 41-C (Schatzker 6) treated with open reduction internal fixation (ORIF). Intervention: Definitive treatment with ORIF either acutely (one stage) or delayed following initial spanning external fixation (two stage). Main Outcome Measures: Wound healing complications, implant costs, hospital charges, PROMIS outcome measures. Results: 105 patients were identified over a three-year period, of which 52 met inclusion criteria. There were 28 patients in the One-Stage group and 24 patients in the Two-Stage group. Mean follow-up was 21.8 months, and 87% of patients had at least 12 months follow-up. The mean number of days to definitive fixation was 1.2 in the One-Stage group and 7.8 in the Two-Stage group. There were no differences between groups with respect to wound healing or any other surgery-related complications. Functional outcomes (PROMIS) were similar between groups. Mean implant cost in the Two-Stage group was 10,821greaterthantheOneStagegroup,mostlyduetothecostsofexternalfixation.MedianhospitalinpatientchargesintheTwoStagegroupexceededtheOneStagegroupbyover10,821 greater than the One-Stage group, mostly due to the costs of external fixation. Median hospital inpatient charges in the Two-Stage group exceeded the One-Stage group by over 68,000 for all BTP fractures and by $61,000 for isolated BTP fractures. Conclusions: Early single stage treatment of BTP fractures is cost effective, and is not associated with a higher complication rate than two stage treatment in appropriately selected patients. Level of Evidence: Level III- Retrospective cohort stud

    Impact of adverse childhood experiences on educational achievements in young people at clinical high risk of developing psychosis

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    BACKGROUND: Adverse childhood experiences (ACE) can affect educational attainments, but little is known about their impact on educational achievements in people at clinical high risk of psychosis (CHR). METHODS: In total, 344 CHR individuals and 67 healthy controls (HC) were recruited as part of the European Community'sSeventh Framework Programme-funded multicenter study the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI). The brief version of the Child Trauma Questionnaire was used to measure ACE, while educational attainments were assessed using a semi-structured interview. RESULTS: At baseline, compared with HC, the CHR group spent less time in education and had higher rates of ACE, lower rates of employment, and lower estimated intelligence quotient (IQ). Across both groups, the total number of ACE was associated with fewer days in education and lower level of education. Emotional abuse was associated with fewer days in education in HC. Emotional neglect was associated with a lower level of education in CHR, while sexual abuse was associated with a lower level of education in HC. In the CHR group, the total number of ACE, physical abuse, and neglect was significantly associated with unemployment, while emotional neglect was associated with employment. CONCLUSIONS: ACE are strongly associated with developmental outcomes such as educational achievement. Early intervention for psychosis programs should aim at integrating specific interventions to support young CHR people in their educational and vocational recovery. More generally, public health and social interventions focused on the prevention of ACE (or reduce their impact if ACE occur) are recommended.The European Network of National Schizophrenia Networks Studying Gene–Environment Interactions (EU-GEI) Project is funded by grant agreement HEALTH-F2–2010–241909 (Project EU-GEI) from the European Community’s Seventh Framework Programme. Additional support was provided by a Medical Research Council Fellowship to M. Kempton (grant MR/J008915/1). S. Tognin is supported by a Maudsley Charity Grant (1510). B. Nelson was supported by an NHMRC Senior Research Fellowship (1137687)

    Locking Plate Fixation in a Series of Bicondylar Tibial Plateau Fractures Raises Treatment Costs Without Clinical Benefit

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    Objectives: To compare outcomes and costs between locking and nonlocking constructs in the treatment of bicondylar tibial plateau (BTP) fractures. Design: Retrospective cohort study. Setting: Level 1 academic trauma center. Patients: All patients that presented with complete articular, BTP fractures (AO/OTA 41-C and Schatzker 6) between 2013-2015 were screened (n=112). Patients treated with a mode of fixation other than plate-and-screw were excluded. 56 patients with a minimum follow-up of 12 months were included in the analysis. Intervention: Operative fixation of BTP fractures with locking (n=29) or nonlocking (n=27) implants. Main outcome measurements: Implant cost, patient reported outcomes (PROMIS physical function and pain interference), clinical, and radiographic outcomes. Results: There were no differences between the two groups with respect to demographics, injury characteristics, radiographic outcomes (change in alignment) or clinical outcomes (PROMIS, reoperation, nonunion, infection). Implant costs were significantly greater in the locking group compared to the nonlocking group (mean L 4453;meanNL4453; mean NL 2569; p<0.01). Conclusions: This study demonstrated improved value of treatment (less cost with no difference in clinical outcome) with nonlocking implants for bicondylar tibial plateau fractures when dual plate fixation strategies are performed. Level of Evidence: Therapeutic III. See Instructions for Authors for a complete description of levels of evidence
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