Seeking a second medical opinion: composition, reasons and perceived outcomes in Israel.

Background: Seeking a second-opinion (SO) is a common clinical practice that can optimize treatment and reduce unnecessary procedures and risks. We aim to characterize the composition of the population of SO seekers, their reasons for seeking a SO and choosing a specific physician, and their perceived outcomes following the SO. Methods: A cross-sectional national telephone survey, using a representative sample of the general Israeli population (n = 848, response rate = 62%). SO utilization was defined as seeking an additional clinical opinion from a specialist within the same specialty, for the same medical concern. We describe the characteristics of respondents who obtained SOs, their reasons for doing so and their perceived outcomes: (1) Satisfaction with the SO; (2) Experiencing health improvement after receiving a SO; (3) A difference in the diagnosis or treatment suggested in the first opinions and the second opinions; (4) Preference of the SO over the first one. Results: Most of the respondents who sought a SO (n = 344) were above 60 years old, secular, living with a partner, perceived their income to be above average and their health status to be not so good. For the patients who utilized SOs, orthopedic surgeons were sought out more than any other medical professional.Reasons for seeking a SO included doubts about diagnosis or treatment (38%), search for a sub-specialty expert (19%) and dissatisfaction with communication (19%). SO seekers most frequently chose a specific specialist based on a recommendation from a friend or a relative (33%). About half of the SO seekers also searched for information on the internet. Most of the respondents who sought a SO mentioned that they were satisfied with it (84%), felt health improvement (77%), mentioned that there was a difference between the diagnosis or treatment between the first opinion and the SO (56%) and preferred the SO over the first one (91%). Conclusions: Clinical uncertainty or dissatisfaction with patient-physician communication were the main reasons for seeking a SO. Policy makers should be aware that many patients choose a physician for a SO based on recommendations made outside the medical system. We recommend creating mechanisms that help patients in the complicated process of seeking a SO, suggest specialists who are suitable for the specific medical problem of the patient, and provide tools to reconcile discrepant opinions

The Future Impact of AI on Academic Journals and the Editorial Process

This panel explores the emerging impact of Artificial Intelligence (AI) on academic journals and editorial processes. Scholarly publishing is on the cusp of transformation, as generative and other AI technologies challenge established norms and procedures. Advancements could either revolutionize or gradually evolve the intricate ecosystems of academic journals, responsible for validating and disseminating knowledge. How might this happen? Panelists will consider how AI could reshape editorial boards, redefine reviewer roles, and influence the academic value chain. The panel will address concerns about AI-driven review processes, biases, training data, and the integration of Human-in-the-loop AI. The panel will also examine the role of academic journals as drivers of research and innovation, with AI\u27s potential to alter communication, quality assessment, and the building blocks of archival knowledge. Highly experienced editors will share insights, concerns and predictions, engage with audience perspectives, and illuminate the challenges and opportunities that AI brings to scholarly pursuits

The Hidden Inconsistencies Introduced by Predictive Algorithms in Judicial Decision Making

Algorithms, from simple automation to machine learning, have been introduced into judicial contexts to ostensibly increase the consistency and efficiency of legal decision making. In this paper, we describe four types of inconsistencies introduced by risk prediction algorithms. These inconsistencies threaten to violate the principle of treating similar cases similarly and often arise from the need to operationalize legal concepts and human behavior into specific measures that enable the building and evaluation of predictive algorithms. These inconsistencies, however, are likely to be hidden from their end-users: judges, parole officers, lawyers, and other decision-makers. We describe the inconsistencies, their sources, and propose various possible indicators and solutions. We also consider the issue of inconsistencies due to the use of algorithms in light of current trends towards more autonomous algorithms and less human-understandable behavioral big data. We conclude by discussing judges and lawyers' duties of technological ("algorithmic") competence and call for greater alignment between the evaluation of predictive algorithms and corresponding judicial goals

Multi-echo quantitative susceptibility mapping: how to combine echoes for accuracy and precision at 3 Tesla

MRI; Multi-echo QSM; Quantitative susceptibility mappingImágen por resonancia magnética; QSM de ecos múltiples; Mapeo cuantitativo de susceptibilidadImatge per ressonància magnètica; QSM de ressò múltiple; Mapeig quantitatiu de susceptibilitatPurpose To compare different multi-echo combination methods for MRI QSM. Given the current lack of consensus, we aimed to elucidate how to optimally combine multi-echo gradient-recalled echo signal phase information, either before or after applying Laplacian-base methods (LBMs) for phase unwrapping or background field removal. Methods Multi-echo gradient-recalled echo data were simulated in a numerical head phantom, and multi-echo gradient-recalled echo images were acquired at 3 Tesla in 10 healthy volunteers. To enable image-based estimation of gradient-recalled echo signal noise, 5 volunteers were scanned twice in the same session without repositioning. Five QSM processing pipelines were designed: 1 applied nonlinear phase fitting over TEs before LBMs; 2 applied LBMs to the TE-dependent phase and then combined multiple TEs via either TE-weighted or SNR-weighted averaging; and 2 calculated TE-dependent susceptibility maps via either multi-step or single-step QSM and then combined multiple TEs via magnitude-weighted averaging. Results from different pipelines were compared using visual inspection; summary statistics of susceptibility in deep gray matter, white matter, and venous regions; phase noise maps (error propagation theory); and, in the healthy volunteers, regional fixed bias analysis (Bland–Altman) and regional differences between the means (nonparametric tests). Results Nonlinearly fitting the multi-echo phase over TEs before applying LBMs provided the highest regional accuracy of and the lowest phase noise propagation compared to averaging the LBM-processed TE-dependent phase. This result was especially pertinent in high-susceptibility venous regions. Conclusion For multi-echo QSM, we recommend combining the signal phase by nonlinear fitting before applying LBMs.Supported by the UK Engineering and Physical Sciences Research Council (EPSRC), award number: 1489882 (e.b.); by the EPSRC-funded UCL Centre for Doctoral Training in Medical Imaging, grant EP/L016478/1 (a.k.), and the Department of Health's National Institute for Health Research funded Biomedical Research Centre at University College London Hospitals (a.k.); by the UCL Leonard Wolfson Experimental Neurology Centre, grant PR/ylr/18575 (d.l.t) The Queen Square MS Centre, where part of the MRI scans for this work were performed, is supported by grants from the UK MS Society and by the National Institute for Health Research University College London Hospitals Biomedical Research Centre (UCLH/BRC). F. Grussu was supported by PREdICT, a study at the Vall d'Hebron Institute of Oncology in Barcelona funded by AstraZeneca (f.g.), and funding from the postdoctoral fellowships program Beatriu de Pinós (2020 BP 00117), funded by the Secretary of Universities and Research, Government of Catalonia (f.g.

Quantitative Susceptibility Mapping (QSM) is Sensitive to Hippocampal and Subcortical Gray Matter Changes in Temporal Lobe Epilepsy

Although temporal lobe epilepsy (TLE) results in widespread changes in MRI measures of tissue volume, diffusion and functional connectivity, changes in tissue composition in TLE have not been investigated with MRI. Quantitative susceptibility mapping (QSM) is sensitive to changes in tissue composition, in particular to iron and myelin. Here, we show for the first time that QSM is sensitive to gray matter abnormalities in 31patients with temporal lobe epilepsy (TLE) compared to 23 healthy controls, and showed significant susceptibility changes in the hippocampus in left TLE patients, and in the bilateral thalamus in both left and right TLE

Patient-initiated second medical consultations: patient characteristics and motivating factors, impact on care and satisfaction: A systematic review

Objectives: To review the characteristics and motivations of patients seeking second opinions, and the impact of such opinions on patient management, satisfaction, and cost-effectiveness. Data sources: Embase, Medline, PsycINFO and HMIC databases. Study design: A systematic literature search was performed for terms related to second opinion and patient characteristics. Study quality was assessed using the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Data collection / Extraction methods: We included articles focused on patient-initiated second opinions, which provided quantitative data on their impact on diagnosis, treatment, prognosis or patient satisfaction, described the characteristics or motivating factors of patients who initiated a second opinion, or the cost-effectiveness of patient-initiated second opinions. Principal findings: Thirty-one articles were included in the review. 27 studies considered patient characteristics, 18 patient motivating factors, 10 patient satisfaction, and 17 clinical agreement between the first and second opinion. Seeking a second opinion was more common in women, middle age patients, more educated patients; and in people having a chronic condition, with higher income or socioeconomic status or living in central urban areas. Patients seeking a second opinion sought to gain more information or reassurance about their diagnosis or treatment. While many second opinions confirm the original diagnosis or treatment, discrepancies in opinions had a potential major impact on patient outcomes in up to 58% of cases. No studies reporting on the cost-effectiveness of patient initiated second opinions. Conclusions: Seeking a second opinion was more common in women, middle-age patients, and more educated patients, and in people having a chronic condition, with higher income or socioeconomic status or living in central urban areas. Patients seeking a second opinion sought to gain more information or reassurance about their diagnosis or treatment

PET/MRI attenuation estimation in the lung: A review of past, present, and potential techniques

Positron emission tomography/magnetic resonance imaging (PET/MRI) potentially offers several advantages over positron emission tomography/computed tomography (PET/CT), for example, no CT radiation dose and soft tissue images from MR acquired at the same time as the PET. However, obtaining accurate linear attenuation correction (LAC) factors for the lung remains difficult in PET/MRI. LACs depend on electron density and in the lung, these vary significantly both within an individual and from person to person. Current commercial practice is to use a single-valued population-based lung LAC, and better estimation is needed to improve quantification. Given the under-appreciation of lung attenuation estimation as an issue, the inaccuracy of PET quantification due to the use of single-valued lung LACs, the unique challenges of lung estimation, and the emerging status of PET/MRI scanners in lung disease, a review is timely. This paper highlights past and present methods, categorizing them into segmentation, atlas/mapping, and emission-based schemes. Potential strategies for future developments are also presented

The expected payoff to Internet auctions

In an Internet auction, the expected payoff acts as a benchmark of the reasonableness of the price that is paid for the purchased item. Since the number of potential bidders is not observable, the expected payoff is difficult to estimate accurately. We approach this problem by considering the bids as a record and 2-record sequence of the potential bidde

A randomized controlled phase III study of VB-111 combined with bevacizumab vs bevacizumab monotherapy in patients with recurrent glioblastoma (GLOBE)

BACKGROUND: Ofranergene obadenovec (VB-111) is an anticancer viral therapy that demonstrated in a phase II study a survival benefit for patients with recurrent glioblastoma (rGBM) who were primed with VB-111 monotherapy that was continued after progression with concomitant bevacizumab. METHODS: This pivotal phase III randomized, controlled trial compared the efficacy and safety of upfront combination of VB-111 and bevacizumab versus bevacizumab monotherapy. Patients were randomized 1:1 to receive VB-111 1013 viral particles every 8 weeks in combination with bevacizumab 10 mg/kg every 2 weeks (combination arm) or bevacizumab monotherapy (control arm). The primary endpoint was overall survival (OS), and secondary endpoints were objective response rate (ORR) by Response Assessment in Neuro-Oncology (RANO) criteria and progression-free survival (PFS). RESULTS: Enrolled were 256 patients at 57 sites. Median exposure to VB-111 was 4 months. The study did not meet its primary or secondary goals. Median OS was 6.8 versus 7.9 months in the combination versus control arm (hazard ratio, 1.20; 95% CI: 0.91-1.59; P = 0.19) and ORR was 27.3% versus 21.9% (P = 0.26). A higher rate of grades 3-5 adverse events was reported in the combination arm (67% vs 40%), mainly attributed to a higher rate of CNS and flu-like/fever events. Trends for improved survival with combination treatment were seen in the subgroup of patients with smaller tumors and in patients who had a posttreatment febrile reaction. CONCLUSIONS: In this study, upfront concomitant administration of VB-111 and bevacizumab failed to improve outcomes in rGBM. Change of treatment regimen, with the lack of VB-111 monotherapy priming, may explain the differences from the favorable phase II results. CLINICAL TRIALS REGISTRATION: NCT02511405