Abstract Background The Society of Thoracic Surgeons and European System for Cardiac Operative Risk Evaluation (EuroSCORE) II risk scores are the most commonly used risk prediction models for ...in-hospital mortality after adult cardiac surgery. However, they are prone to miscalibration over time and poor generalization across data sets; thus, their use remains controversial. Despite increased interest, a gap in understanding the effect of data set drift on the performance of machine learning (ML) over time remains a barrier to its wider use in clinical practice. Data set drift occurs when an ML system underperforms because of a mismatch between the data it was developed from and the data on which it is deployed. Objective In this study, we analyzed the extent of performance drift using models built on a large UK cardiac surgery database. The objectives were to (1) rank and assess the extent of performance drift in cardiac surgery risk ML models over time and (2) investigate any potential influence of data set drift and variable importance drift on performance drift. Methods We conducted a retrospective analysis of prospectively, routinely gathered data on adult patients undergoing cardiac surgery in the United Kingdom between 2012 and 2019. We temporally split the data 70:30 into a training and validation set and a holdout set. Five novel ML mortality prediction models were developed and assessed, along with EuroSCORE II, for relationships between and within variable importance drift, performance drift, and actual data set drift. Performance was assessed using a consensus metric. Results A total of 227,087 adults underwent cardiac surgery during the study period, with a mortality rate of 2.76% (n=6258). There was strong evidence of a decrease in overall performance across all models ( P <.0001). Extreme gradient boosting (clinical effectiveness metric CEM 0.728, 95% CI 0.728-0.729) and random forest (CEM 0.727, 95% CI 0.727-0.728) were the overall best-performing models, both temporally and nontemporally. EuroSCORE II performed the worst across all comparisons. Sharp changes in variable importance and data set drift from October to December 2017, from June to July 2018, and from December 2018 to February 2019 mirrored the effects of performance decrease across models. Conclusions All models show a decrease in at least 3 of the 5 individual metrics. CEM and variable importance drift detection demonstrate the limitation of logistic regression methods used for cardiac surgery risk prediction and the effects of data set drift. Future work will be required to determine the interplay between ML models and whether ensemble models could improve on their respective performance advantages.
When robots and human users collaborate, trust is essential for user acceptance and engagement. In this paper, we investigated two factors thought to influence user trust towards a robot: preference ...elicitation (a combination of user involvement and explanation) and embodiment. We set our experiment in the application domain of a restaurant recommender system, assessing trust via user decision making and perceived source credibility. Previous research in this area uses simulated environments and recommender systems that present the user with the best choice from a pool of options. This experiment builds on past work in two ways: first, we strengthened the ecological validity of our experimental paradigm by incorporating perceived risk during decision making; and second, we used a system that recommends a nonoptimal choice to the user. While no effect of embodiment is found for trust, the inclusion of preference elicitation features significantly increases user trust towards the robot recommender system. These findings have implications for marketing and health promotion in relation to Human-Robot Interaction and call for further investigation into the development and maintenance of trust between robot and user.
For many patients, the cancer continuum includes a syndrome known as cancer-associated cachexia (CAC), which encompasses the unintended loss of body weight and muscle mass, and is often associated ...with fat loss, decreased appetite, lower tolerance and poorer response to treatment, poor quality of life, and reduced survival. Unfortunately, there are no effective therapeutic interventions to completely reverse cancer cachexia and no FDA-approved pharmacologic agents; hence, new approaches are urgently needed. In May of 2022, researchers and clinicians from Moffitt Cancer Center held an inaugural retreat on CAC that aimed to review the state of the science, identify knowledge gaps and research priorities, and foster transdisciplinary collaborative research projects. This review summarizes research priorities that emerged from the retreat, examples of ongoing collaborations, and opportunities to move science forward. The highest priorities identified include the need to (1) evaluate patient-reported outcome (PRO) measures obtained in clinical practice and assess their use in improving CAC-related outcomes; (2) identify biomarkers (imaging, molecular, and/or behavioral) and novel analytic approaches to accurately predict the early onset of CAC and its progression; and (3) develop and test interventions (pharmacologic, nutritional, exercise-based, and through mathematical modeling) to prevent CAC progression and improve associated symptoms and outcomes.
A Football Bowl Subdivision college head coach position is desired in the American football coaching profession due to associated financial benefits, social network improvements, and prestige. The ...rise of an individual from player, to assistant coach, and eventually head coach, is primarily understood anecdotally. This empirical evaluation of head coaching attainment provided insight into the career progression of these important sport leaders. The purpose of this study was to assess prior experiences (e.g., playing and assistant coaching) of first-time Division I Football Bowl Subdivision college football head coaches hired from 1998–1999 to 2013–2014 (n = 200). Data were collected to determine if the quantity of playing and coaching experiences indicated variance within or predictability for career attainment. The five experiential categories investigated were: Playing Experience, Coaching Experience, Affiliation, Coaching Success, and Descriptive Variables. Several significant predictors among the coaching variables emerged, including coaching experience, affiliation, and past coaching success. Playing experience variables were found to be largely non-significant, suggesting that career attainment of college football coaches does not hinge on playing experience.
Increased prenatal volume in family medicine residencies is associated with a higher proportion of graduates including maternity care in their post-residency practices. However, family medicine ...residencies struggle just to meet the Residency Review Committee's minimum requirements for maternity care volume. Our objective was to evaluate the effectiveness of free pregnancy testing on increasing maternity care volume in our residency.
In this before-after intervention study, free pregnancy testing was offered at the residency's Family Health Center (FHC) from May 2011 through November 2012 to established patients and non-patients. Participants with positive tests were provided information on maternity care and an opportunity to schedule an initial prenatal visit. The primary outcome was the percentage of self-referred patients who established prenatal care at FHC.
Over 19 months, 241 tests were performed on 224 women with a mean age of 26.2±6.3. Over half were minorities (130 58%). Most were under-insured or uninsured (193 86.1%). Ninety-nine women (41.1%) had positive tests; 74 of these 99 women (74.7%) established prenatal care at FHC, and 57 of these 74 women (77%) were new patients. The number of obstetric patients increased 13% from 405 to 456 patients. The percentage of self-referred patients increased from 31.9% to 40.8% (P<.001). The total cost of 241 pregnancy tests was $256.24, and maternity care revenue for just one patient was $1,553.
The program's return on investment is favorable. Offering free pregnancy testing is a simple and inexpensive way to increase maternity care volume in a family medicine residency.
The activation of proopiomelanocortin (POMC) neurons in different regions of the brain, including the arcuate nucleus of the hypothalamus (ARC) and the nucleus of the solitary tract curtails feeding ...and attenuates body weight. In this study, we compared the effects of delivery of a recombinant adeno-associated viral (rAAV) construct encoding POMC to the ARC with delivery to the ventral tegmental area (VTA). F344×Brown Norway rats were high-fat (HF) fed for 14 days after which self-complementary rAAV constructs expressing either green fluorescent protein or the POMC gene were injected using coordinates targeting either the VTA or the ARC. Corresponding increased POMC levels were found at the predicted injection sites and subsequent α-melanocyte-stimulating hormone levels were observed. Food intake and body weight were measured for 4 months. Although caloric intake was unaltered by POMC overexpression, weight gain was tempered with POMC overexpression in either the VTA or the ARC compared with controls. There were parallel decreases in adipose tissue reserves. In addition, levels of oxygen consumption and brown adipose tissue uncoupling protein 1 were significantly elevated with POMC treatment in the VTA. Interestingly, tyrosine hydroxylase levels were increased in both the ARC and VTA with POMC overexpression in either the ARC or the VTA. In conclusion, these data indicate a role for POMC overexpression within the VTA reward center to combat HF-induced obesity.
The interstitial lung disease (ILD) multidisciplinary meetings (MDM), composed of pulmonologists, radiologists, and pathologists, is integral to the rendering of an accurate ILD diagnosis. However, ...there is significant heterogeneity in the conduct of ILD MDMs, and questions regarding their best practices remain unanswered.
To achieve consensus among ILD experts on essential components of an ILD MDM.
Using a Delphi methodology, semi-structured interviews with ILD experts were used to identify key themes and features of ILD MDMs. These items informed two subsequent rounds of online questionnaires that were used to achieve consensus among a broader, international panel of ILD experts. Experts were asked to rate their level of agreement on a five-point Likert scale. An
threshold for consensus was set at a median score 4 or 5 with an interquartile range of 0.
We interviewed 15 ILD experts, and 102 ILD experts participated in the online questionnaires. Five items and two exploratory statements achieved consensus on being essential for an ILD MDM following two questionnaire rounds. There was consensus that the presence of at least one radiologist, a quiet setting with a visual projection system, a high-quality chest high-resolution computed tomography, and a standardized template summarizing collated patient data are essential components of an ILD MDM. Experts also agreed that it would be useful for ILD MDMs to undergo an annual benchmarking process and a validation process by fulfilling a minimum number of cases annually. Twenty-seven additional features were considered to be either highly desirable or desirable features based on the degree of consensus. Although our findings on desirable features are similar to the current literature, several of these remain controversial and warrant further research. The study also showed an agreement among participants on several future concepts to improve the ILD MDM, such as performing regular self-assessments and conducting research into shared practices to develop an international expert guideline statement on ILD MDMs.
This Delphi study showed consensus among international ILD experts on essential and desirable features of an ILD MDM. Our data represent an important step toward potential collaborative research into future standardization of ILD MDMs.
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