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Combining classification systems potentially improves predictive accuracy, but outcomes have proven impossible to predict. Similar to improving binary classification with fusion, fusing ranking systems most commonly increases Pearson or Spearman correlations with a target when the input classifiers are "sufficiently good" (generalized as "accuracy") and "sufficiently different" (generalized as "diversity"), but the individual and joint quantitative influence of these factors on the final outcome remains unknown. We resolve these issues. Building on our previous empirical work establishing the DIRAC (DIversity of Ranks and ACcuracy) framework, which accurately predicts the outcome of fusing binary classifiers, we demonstrate that the DIRAC framework similarly explains the outcome of fusing ranking systems. Specifically, precise geometric representation of diversity and accuracy as angle-based distances within rank-based combinatorial structures (permutahedra) fully captures their synergistic roles in rank approximation, uncouples them from the specific metrics of a given problem, and represents them as generally as possible.
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Bacteriemia , Infección Hospitalaria , Infecciones por Bacterias Gramnegativas , Sepsis , Humanos , Estudios Retrospectivos , Hospitales Generales , Infección Hospitalaria/epidemiología , Infección Hospitalaria/complicaciones , Sepsis/complicaciones , Atención a la Salud , Infecciones por Bacterias Gramnegativas/epidemiología , Infecciones por Bacterias Gramnegativas/complicaciones , Bacteriemia/epidemiología , Bacteriemia/complicaciones , Bacterias GramnegativasRESUMEN
Human leukocyte antigen (HLA) molecular mismatch is a powerful biomarker of rejection. Few studies have explored its use in assessing rejection risk in heart transplant recipients. We tested the hypothesis that a combination of HLA Epitope Mismatch Algorithm (HLA-EMMA) and Predicted Indirectly Recognizable HLA Epitopes (PIRCHE-II) algorithms can improve risk stratification of pediatric heart transplant recipients. Class I and II HLA genotyping were performed by next-generation sequencing on 274 recipient/donor pairs enrolled in the Clinical Trials in Organ Transplantation in Children (CTOTC). Using high-resolution genotypes, we performed HLA molecular mismatch analysis with HLA-EMMA and PIRCHE-II, and correlated these findings with clinical outcomes. Patients without pre-formed donor specific antibody (DSA) (n=100) were used for correlations with post-transplant DSA and antibody mediated rejection (ABMR). Risk cut-offs were determined for DSA and ABMR using both algorithms. HLA-EMMA cut-offs alone predict the risk of DSA and ABMR; however, if used in combination with PIRCHE-II, the population could be further stratified into low-, intermediate-, and high-risk groups. The combination of HLA-EMMA and PIRCHE-II enables more granular immunological risk stratification. Intermediate-risk cases, like low-risk cases, are at a lower risk of DSA and ABMR. This new way of risk evaluation may facilitate individualized immunosuppression and surveillance.
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Antígenos HLA , Trasplante de Corazón , Humanos , Niño , Prueba de Histocompatibilidad , Antígenos HLA/genética , Donantes de Tejidos , Anticuerpos , Epítopos , Antígenos de Histocompatibilidad Clase II , Trasplante de Corazón/efectos adversos , Medición de RiesgoRESUMEN
Combining classifier systems potentially improves predictive accuracy, but outcomes have proven impossible to predict. Classification most commonly improves when the classifiers are "sufficiently good" (generalized as " accuracy ") and "sufficiently different" (generalized as " diversity "), but the individual and joint quantitative influence of these factors on the final outcome remains unknown. We resolve these issues. Beginning with simulated data, we develop the DIRAC framework (DIversity of Ranks and ACcuracy), which accurately predicts outcome of both score-based fusions originating from exponentially modified Gaussian distributions and rank-based fusions, which are inherently distribution independent. DIRAC was validated using biological dual-energy X-ray absorption and magnetic resonance imaging data. The DIRAC framework is domain independent and has expected utility in far-ranging areas such as clinical biomarker development/personalized medicine, clinical trial enrollment, insurance pricing, portfolio management, and sensor optimization.
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Combinatorial fusion algorithm (CFA) is a machine learning and artificial intelligence (ML/AI) framework for combining multiple scoring systems using the rank-score characteristic (RSC) function and cognitive diversity (CD). When measuring the relevance of a publication or document with respect to the 17 Sustainable Development Goals (SDGs) of the United Nations, a classification scheme is used. However, this classification process is a challenging task due to the overlapping goals and contextual differences of those diverse SDGs. In this paper, we use CFA to combine a topic model classifier (Model A) and a semantic link classifier (Model B) to improve the precision of the classification process. We characterize and analyze each of the individual models using the RSC function and CD between Models A and B. We evaluate the classification results from combining the models using a score combination and a rank combination, when compared to the results obtained from human experts. In summary, we demonstrate that the combination of Models A and B can improve classification precision only if these individual models perform well and are diverse.
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Inteligencia Artificial , Desarrollo Sostenible , Salud Global , Humanos , Aprendizaje Automático , Naciones UnidasRESUMEN
BACKGROUND: Freedom from rejection in pediatric heart transplant recipients is highly variable across centers. This study aimed to assess the center variation in methods used to diagnose rejection in the first-year post-transplant and determine the impact of this variation on patient outcomes. METHODS: The PHTS registry was queried for all rejection episodes in the first-year post-transplant (2010-2019). The primary method for rejection diagnosis was determined for each event as surveillance biopsy, echo diagnosis, or clinical. The percentage of first-year rejection events diagnosed by surveillance biopsy was used to approximate the surveillance strategy across centers. Methods of rejection diagnosis were described and patient outcomes were assessed based on surveillance biopsy utilization among centers. RESULTS: A total of 3985 patients from 56 centers were included. Of this group, 873 (22%) developed rejection within the first-year post-transplant. Surveillance biopsy was the most common method of rejection diagnosis (71.7%), but practices were highly variable across centers. The majority (73.6%) of first rejection events occurred within 3-months of transplantation. Diagnosis modality in the first-year was not independently associated with freedom from rejection, freedom from rejection with hemodynamic compromise, or overall graft survival. CONCLUSIONS: Rejection in the first-year after pediatric heart transplant occurs in 22% of patients and most commonly in the first 3 months post-transplant. Significant variation exists across centers in the methods used to diagnose rejection in pediatric heart transplant recipients, however, these variable strategies are not independently associated with freedom from rejection, rejection with hemodynamic compromise, or overall graft survival.
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Rechazo de Injerto/diagnóstico , Trasplante de Corazón/efectos adversos , Pautas de la Práctica en Medicina , Adolescente , Factores de Edad , Niño , Femenino , Rechazo de Injerto/etiología , Humanos , Masculino , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Factores de TiempoRESUMEN
Combinatorial fusion analysis (CFA) is an approach for combining multiple scoring systems using the rank-score characteristic function and cognitive diversity measure. One example is to combine diverse machine learning models to achieve better prediction quality. In this work, we apply CFA to the synthesis of metal halide perovskites containing organic ammonium cations via inverse temperature crystallization. Using a data set generated by high-throughput experimentation, four individual models (support vector machines, random forests, weighted logistic classifier, and gradient boosted trees) were developed. We characterize each of these scoring systems and explore 66 possible combinations of the models. When measured by the precision on predicting crystal formation, the majority of the combination models improves the individual model results. The best combination models outperform the best individual models by 3.9 percentage points in precision. In addition to improving prediction quality, we demonstrate how the fusion models can be used to identify mislabeled input data and address issues of data quality. In particular, we identify example cases where all single models and all fusion models do not give the correct prediction. Experimental replication of these syntheses reveals that these compositions are sensitive to modest temperature variations across the different locations of the heating element that can hinder or enhance the crystallization process. In summary, we demonstrate that model fusion using CFA can not only identify a previously unconsidered influence on reaction outcome but also be used as a form of quality control for high-throughput experimentation.
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Aprendizaje Automático , Máquina de Vectores de Soporte , Compuestos de Calcio , Óxidos , TitanioRESUMEN
BACKGROUND: Multiple clinician-reported outcome measures exist for atopic dermatitis (AD) severity. However, there is no gold standard for use in clinical practice. OBJECTIVES: To determine the measurement properties of the product of validated Investigator's Global Assessment for AD (vIGA) and body surface area (BSA) overall or divided into six categories (cBSA: 0%/0.1, <10%/10, <30%/30, <50%/50, <70%/70 and <90%/90-100%) and compare with other clinician-reported and patient-reported outcomes in adults and children with AD. METHODS: We performed a prospective dermatology practice-based study using questionnaires and evaluation by a dermatologist (n = 653). RESULTS: vIGA*BSA and vIGA*cBSA had good convergent validity with BSA (Spearman's ρ = 0.97 and 0.93), eczema area and severity index (ρ = 0.94 and 0.92), and objective SCORAD (ρ = 0.88 and 0.89); and weak-to-good convergent validity with Numeric Rating Scale average itch (ρ = 0.22 and 0.22) and worst itch (ρ = 0.27 and 0.28), Patient-Oriented Eczema Measure (ρ = 0.44 and 0.43), Dermatology Life Quality Index (ρ = 0.48 and 0.49), ItchyQOL (ρ = 0.45 and 0.46), PROMIS Sleep Disturbance (ρ = 0.46 and 0.37) and sleep-related impairment (ρ = 0.31 and 0.31) in adults and/or children; very good discriminant validity for physician-reported global AD severity; good responsiveness to change of severity of AD and itch; and good reliability (intraclass correlation coefficient [95% confidence interval]: 0.72 [0.60-0.81] and 0.74 [0.62-0.82]) with no floor or ceiling effects. Thresholds for interpretability bands and clinically important difference were established. CONCLUSIONS: vIGA*BSA and vIGA*cBSA scores showed good convergent and discriminant validity, reliability, responsiveness and interpretability in adults and children with AD, and were feasible for use in clinical practice. vIGA*BSA and vIGA*cBSA had slightly lower convergent validity than EASI or objective SCORAD, but might be more efficient to collect and score.
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Dermatitis Atópica , Eccema , Adulto , Superficie Corporal , Niño , Dermatitis Atópica/diagnóstico , Humanos , Estudios Prospectivos , Reproducibilidad de los Resultados , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Multiple strategies have been used to evaluate the minimal important change (MIC) of the Eczema Area and Severity Index (EASI) and Scoring Atopic Dermatitis (SCORAD). The meaningfulness of these MICs is not well established across all severities of atopic dermatitis (AD). OBJECTIVES: To determine the MIC of percentage and absolute improvement of EASI and SCORAD scores in adults and children with AD. METHODS: We performed a prospective dermatology practice-based study using questionnaires and evaluation by a dermatologist (n = 826). An anchor-based approach was used to determine thresholds for the percentage and absolute MICs of EASI, SCORAD and objective SCORAD (O-SCORAD) at follow-up from baseline. RESULTS: One-grade improvements of Physician's Global Assessment (PGA) and validated Investigator Global Assessment scale for AD (vIGA-AD) were associated with 50%, 35% and 35% decreases of EASI, SCORAD and O-SCORAD, respectively. The thresholds for percentage MIC of EASI (Kruskal-Wallis test, P = 0·61), SCORAD (P = 0·07) and O-SCORAD (P = 0·09) were similar across baseline AD severities. One-grade improvements of PGA and vIGA-AD were associated with 14·0- and 14·9-point decreases of EASI, 19·9- and 14·9-point decreases of SCORAD, and 15·5- and 17·4-point decreases of O-SCORAD. The thresholds for the absolute MIC of EASI (P < 0·001), SCORAD (P < 0·001) and O-SCORAD (P < 0·001) significantly differed by baseline AD severity. Percentage and absolute MICs for EASI and SCORAD were associated with improvements of AD symptoms and quality of life. CONCLUSIONS: EASI 50, SCORAD 35 and O-SCORAD 35 were meaningful percentage MICs regardless of baseline AD severity. The absolute MICs for EASI, SCORAD and O-SCORAD varied by baseline AD severity.
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Dermatitis Atópica , Eccema , Adulto , Niño , Dermatitis Atópica/diagnóstico , Dermatitis Atópica/tratamiento farmacológico , Humanos , Estudios Prospectivos , Calidad de Vida , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Little is known about the validity of numeric rating scales (NRS) and verbal rating scales (VRS) for itch and itch frequency for assessing itch severity in atopic dermatitis (AD). We evaluated the Patient-Reported Outcomes Information System (PROMIS® ) Itch Questionnaire (PIQ) - itch severity assessment, including multiple NRS, VRS and frequency of itch assessments, in adults with AD and compared their performance. METHODS: Self-administered questionnaires and skin examinations were performed in 410 patients with AD (aged 18-90 years) in a dermatology practice setting. RESULTS: PIQ NRS, VRS and frequency of itch had good content validity, strong correlations with one another (Spearman correlations P < 0·001) and weak-to-moderate correlations with patient-oriented eczema measure (POEM), Eczema Area and Severity Index (EASI), objective SCORing AD (SCORAD) and Dermatology Life Quality Index (DLQI) (P < 0·001) and very good discriminant validity. Changes from baseline in NRS, VRS and frequency of itch were moderately to strongly correlated with one another, and weakly to moderately correlated with other patient-reported (POEM, SCORAD itch, DLQI) and clinician-reported outcomes (EASI, objective SCORAD). NRS and VRS worst itch and average itch showed moderate-to-good test-retest reliability. There were no floor or ceiling effects for NRS or VRS itch, but there were ceiling effects for itch frequency. Each assessment was completed in < 1 min by all patients. CONCLUSIONS: NRS, VRS and frequency of itch items from PIQ - itch severity showed good content and construct validity, reliability, and/or responsiveness in adults with AD, and were feasible for use in clinical trials and practice. What is already known about this topic? Numeric rating scales (NRS), verbal rating scales (VRS) and frequency of itch have been used to assess the burden of itch. However, there have been limited results demonstrating their validity, responsiveness, interpretability and feasibility, particularly in atopic dermatitis (AD). What does this study add? This study demonstrated that NRS, VRS and frequency of itch items from the Patient-Reported Outcomes Information System (PROMIS® ) Itch Questionnaire (PIQ) - itch severity assessments had good construct validity, responsiveness, reliability and feasibility in the assessment of adult AD. PIQ NRS, VRS and frequency of itch all appear to have sufficient validity, reliability and feasibility for use as assessments of itch in adults with AD in clinical practice and trials. What are the clinical implications of this work? PIQ NRS and VRS are all simple, valid, reliable and feasible for use in clinical practice and trials to assess itch in adults with AD. Linked Comment: Oosterhaven. Br J Dermatol 2020; 183:802-803.
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Dermatitis Atópica , Eccema , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Dermatitis Atópica/complicaciones , Dermatitis Atópica/diagnóstico , Humanos , Sistemas de Información , Persona de Mediana Edad , Medición de Resultados Informados por el Paciente , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Sleep disturbances are common in adults with atopic dermatitis (AD). Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance (SD) and Sleep-Related Impairment (SRI) are validated questionnaires to assess sleep in adults. Little is known about their measurement properties in adults with AD. OBJECTIVES: To assess the measurement properties of the PROMIS SD and SRI eight-item short forms in AD. METHODS: We performed a prospective dermatology-practice-based study using questionnaires and evaluation by a dermatologist (n = 420). RESULTS: PROMIS SD and SRI showed moderate correlations to each other (ρ = 0·67), and weak correlations with Patient-Oriented Eczema Measure (ρ = 0·43 and 0·39, respectively); average (ρ = 0·31/0·30) and worst numerical rating scale for itch (ρ = 0·32/0·30); Eczema Area and Severity Index (ρ = 0·41/0·31); and Scoring Atopic Dermatitis (SCORAD) (ρ = 0·44/0·30) (Spearman correlations, P < 0·001). PROMIS SD and SRI increased significantly and stepwise with more frequent sleep disturbance, severe itch and self-reported global AD severity (ancova, P < 0·001). PROMIS SD and SRI showed good internal consistency (Cronbach alpha 0·84 and 0·91). Changes from baseline in PROMIS SD and SRI were weakly to moderately correlated with each other and with changes of multiple patient-reported and clinician-reported AD outcomes. There were no floor or ceiling effects for PROMIS SD or SRI. The median completion time for PROMIS SD and SRI was 2 min. CONCLUSIONS: PROMIS SD and SRI showed good construct validity, internal consistency, responsiveness and feasibility to assess sleep in adult patients with AD. What is already known about this topic? The Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance (SD) and Sleep-Related Impairment (SRI) scales were found to be valid in adults with chronic disease. However, the validity and feasibility of PROMIS SD and SRI in atopic dermatitis remain unknown. What does this study add? This study demonstrated that PROMIS SD and SRI had good content, concurrent, convergent and discriminant validity; feasibility; and responsiveness, with no floor or ceiling effects observed. What are the clinical implications of this work? The PROMIS SD and SRI eight-item bank short forms appear to have sufficient validity and feasibility to be used as assessments for burden of sleep in adults with atopic dermatitis in clinical practice.
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Dermatitis Atópica , Eccema , Adulto , Dermatitis Atópica/complicaciones , Dermatitis Atópica/epidemiología , Humanos , Sistemas de Información , Medición de Resultados Informados por el Paciente , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Sueño , Encuestas y CuestionariosRESUMEN
Positron emission tomography (PET) systems designed with multiplexed readout do not usually have the capability to resolve individual intercrystal scatter (ICS) interactions, leading to interaction mispositioning that degrades spatial resolution and contrast. A 3D position sensitive scintillation detector capable of individual ICS readout has been designed and incorporated into a 1 mm3 resolution clinical PET system used for locoregional imaging. Incorporating ICS events increases photon sensitivity by 51.5% compared to using only photoelectric events. A Compton scatter angle error minimization algorithm is used to estimate the first ICS interaction location for accurate line-of-response pairing of coincident photons. An optimal scatter angle error threshold of 15 degrees is used to discard ICS events with a high mismatch between energy-derived and position-derived intercrystal scatter angles. Finally, positioning rather than rejecting ICS events boosts peak contrast to noise ratio by 8.1%, and allows for an equivalent dose reduction of 12% while maintaining equivalent image quality.
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Algoritmos , Procesamiento de Imagen Asistido por Computador/métodos , Fantasmas de Imagen , Fotones , Tomografía de Emisión de Positrones/instrumentación , Tomografía de Emisión de Positrones/métodos , Conteo por Cintilación/instrumentación , HumanosRESUMEN
PURPOSE: To examine the impact of diverse syndromes of focal and generalized epilepsy on language function in children with new and recent onset epilepsy. Of special interest was the degree of shared language abnormality across epilepsy syndromes and the unique effects associated with specific epilepsy syndromes. METHODS: Participants were 136 youth with new or recent-onset (diagnosis within past 12â¯months) epilepsy and 107 healthy first-degree cousin controls. The participants with epilepsy included 20 with Temporal Lobe Epilepsy (TLE; M ageâ¯=â¯12.99⯠years, SDâ¯=â¯3.11), 41 with Benign Epilepsy with Centrotemporal Spikes (BECTS; M ageâ¯=â¯10.32, SDâ¯=â¯1.67), 42 with Juvenile Myoclonic Epilepsy (JME; M ageâ¯=â¯14.85, SDâ¯=â¯2.75) and 33 with absence epilepsy (M ageâ¯=â¯10.55, SDâ¯=â¯2.76). All children were administered a comprehensive test battery which included multiple measures of language and language-dependent abilities (i.e., verbal intelligence, vocabulary, verbal reasoning, object naming, reception word recognition, word reading, spelling, lexical and semantic fluency, verbal list learning and delayed verbal memory). Test scores were adjusted for age and gender and analyzed via MANCOVA. RESULTS: Language abnormalities were found in all epilepsy patient groups. The most broadly affected children were those with TLE and absence epilepsy, whose performance differed significantly from controls on 8 of 11 and 9 of 11 tests respectively. Although children with JME and BECTS were less affected, significant differences from controls were found on 4 of 11 tests each. While each group had a unique profile of language deficits, commonalities were apparent across both idiopathic generalized and localization-related diagnostic categories. DISCUSSION: The localization related and generalized idiopathic childhood epilepsies examined here were associated with impact on diverse language abilities early in the course of the disorder.
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Cognición/fisiología , Epilepsia Generalizada/diagnóstico , Epilepsia Generalizada/psicología , Trastornos del Desarrollo del Lenguaje/diagnóstico , Trastornos del Desarrollo del Lenguaje/psicología , Adolescente , Niño , Epilepsia Generalizada/fisiopatología , Femenino , Humanos , Inteligencia/fisiología , Lenguaje , Trastornos del Desarrollo del Lenguaje/fisiopatología , Masculino , Pruebas Neuropsicológicas , Síndrome , Aprendizaje Verbal/fisiologíaRESUMEN
BACKGROUND: Little is known about the impact of ultraviolet exposure, climate factors and pollutants on pemphigus. AIM: To determine whether these factors are associated with pemphigus exacerbation resulting in hospitalization. METHODS: The analysis used data from the 2002-2012 National Inpatient Sample in the USA, including 68 476 920 children and adults, and measurements of relative humidity (%), ultraviolet (UV) index, outdoor air temperature and particulate matter of ≤ 2.5 or ≤ 10 µm (PM2.5 and PM10). RESULTS: Higher rates of admission primarily for pemphigus occurred during the summer and autumn months (June-November), with the highest admission rates in July and October (both 19.7 per million). There was significant statewide variation of the prevalence of hospitalization for pemphigus, with apparent hotspots located in the southwest and northeast states. Hospitalization for a primary diagnosis of pemphigus vs. other diagnosis was associated with significantly lower humidity [mean (95% confidence interval): 64.8% (63.2-66.4%) vs. 66.4% (65.6-67.3%); analysis of variance, P < 0.01) and higher temperature [58.7 (57.1-60.2) vs. 56.3 (55.8-56.7)°F, P = 0.001], UV index [6.0 (5.7-6.2) vs. 5.7 (5.6-5.7), P = 0.02], PM2.5 [12.9 (12.0-13.7) vs. 11.8 (11.5-12.0) mg/m3 , P < 0.001] and PM10 [26.2 (24.5-27.9) vs. 23.1 (22.6-23.6) mg/m3 , P < 0.001]. All associations remained significant in multilevel regression models that controlled for age, sex and race/ethnicity, except for ultraviolet index, which was associated with pemphigus hospitalization only for Hispanic patients [odds ratio (95% CI) for quartile 4: 2.07 (1.02-4.21)]. CONCLUSION: Increasing temperature, UV exposure and small particle air pollution are associated with increased hospitalization for pemphigus. Patients with pemphigus may benefit from avoidance of these potential environmental triggers.
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Clima , Hospitalización/estadística & datos numéricos , Material Particulado/efectos adversos , Pénfigo/etiología , Femenino , Humanos , Humedad , Masculino , Persona de Mediana Edad , Pénfigo/epidemiología , Prevalencia , Factores de Riesgo , Estaciones del Año , Temperatura , Rayos Ultravioleta/efectos adversos , Estados UnidosRESUMEN
BACKGROUND: Standardized quality-of-life (QoL) assessments can provide important and clinically relevant information. There is currently a lack of standardization in QoL assessments used in atopic dermatitis (AD). OBJECTIVES: To determine the content validity, construct validity, internal consistency, differential reporting, responsiveness, floor or ceiling effects and feasibility of the Dermatology Life Quality Index (DLQI), Itchy Quality of Life (ItchyQoL) and 5-dimensions (5-D) itch scales for assessing burden of AD in adults and to compare their performance. METHODS: Self-administered questionnaires and skin examination were performed in 340 adults with AD in a dermatology practice setting. RESULTS: DLQI, ItchyQoL and 5-D all had good content validity. DLQI, mean ItchyQoL and 5-D itch all had strong correlations with frequency of AD symptoms (Patient-Oriented Eczema Measure) and intensity of itch (numerical rating scale for itch), and moderate correlations with AD severity (Eczema Area and Severity Index and Scoring Atopic Dermatitis) (Spearman correlations, P < 0·001 for all). DLQI and 5-D itch showed good internal consistency (Cronbach's alpha = 0·89 and 0·84), although ItchyQoL appeared to have several redundant items (alpha = 0·96). Uniform and nonuniform differential item functioning by age, sex and/or race/ethnicity was found for multiple items in DLQI, ItchyQoL and 5-D itch. DLQI, ItchyQoL and 5-D itch scores all demonstrated responsiveness, although ItchyQoL demonstrated the greatest responsiveness. There were no floor or ceiling effects for total scores. The median times for completion of DLQI, ItchyQoL and 5-D itch were 2 min. CONCLUSIONS: The DLQI, ItchyQoL and 5-D itch scales all showed good content and construct validity, and responsiveness in the assessment of AD in adults, and were feasible for use in clinical trials and practice.
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Costo de Enfermedad , Dermatitis Atópica/diagnóstico , Calidad de Vida , Autoinforme , Índice de Severidad de la Enfermedad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Dermatitis Atópica/complicaciones , Dermatitis Atópica/terapia , Emolientes/uso terapéutico , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fototerapia , Estudios Prospectivos , Nivel de Atención , Adulto JovenRESUMEN
Sensitization is common in pediatric heart transplant candidates and waitlist mortality is high. Transplantation across a positive crossmatch may reduce wait time, but is considered high risk. We prospectively recruited consecutive candidates at eight North American centers. At transplantation, subjects were categorized as nonsensitized or sensitized (presence of ≥1 HLA antibody with MFI ≥1000 using single antigen beads). Sensitized subjects were further classified as complement-dependent cytotoxicity crossmatch (CDC-crossmatch) positive or negative and as donor-specific antibodies (DSA) positive or negative. Immunosuppression was standardized. CDC-crossmatch-positive subjects also received perioperative antibody removal, maintenance corticosteroids, and intravenous immunoglobulin. The primary endpoint was the 1 year incidence rate of a composite of death, retransplantation, or rejection with hemodynamic compromise. 317 subjects were screened, 290 enrolled and 240 transplanted (51 with pretransplant DSA, 11 with positive CDC-crossmatch). The incidence rates of the primary endpoint did not differ statistically between groups; nonsensitized 6.7% (CI: 2.7%, 13.3%), sensitized crossmatch positive 18.2% (CI: 2.3%, 51.8%), sensitized crossmatch negative 10.7% (CI: 5.7%, 18.0%), P = .2354. The primary endpoint also did not differ by DSA status. Freedom from antibody-mediated and cellular rejection was lower in the crossmatch positive group and/or in the presence of DSA. Follow-up will determine if acceptable outcomes can be achieved long-term.
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Tipificación y Pruebas Cruzadas Sanguíneas/mortalidad , Rechazo de Injerto/mortalidad , Antígenos HLA/inmunología , Trasplante de Corazón/efectos adversos , Isoanticuerpos/inmunología , Complicaciones Posoperatorias , Donantes de Tejidos , Adolescente , Niño , Preescolar , Femenino , Estudios de Seguimiento , Rechazo de Injerto/etiología , Supervivencia de Injerto , Prueba de Histocompatibilidad , Humanos , Terapia de Inmunosupresión , Lactante , Isoanticuerpos/sangre , Masculino , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Tasa de SupervivenciaRESUMEN
BACKGROUND: Pemphigus and pemphigoid are blistering disorders associated with barrier disruption, immune dysregulation and use of immunosuppressing systemic therapy, all of which may predispose towards serious infections. OBJECTIVES: To determine whether pemphigus and pemphigoid are associated with increased likelihood of serious infections and the impact of such infections on mortality and cost of care. METHODS: We analysed data from the 2002 to 2012 Nationwide Inpatient Sample, including a representative 20% sample of all hospitalizations in the US (total n = 72 108 077 adults). RESULTS: Overall, 54.6% (95% CI: 53.6-55.6%) and 50.4% (49.0-51.8%) of inpatients with either pemphigoid or pemphigus had a diagnosis of serious infection, respectively, compared with 25.4% (25.2-25.6%) in those without either diagnosis. In multivariable logistic regression models controlling for gender, age, race/ethnicity and insurance status, pemphigoid or pemphigus was associated with 26 or 21 of 48 infections examined, respectively. In particular, both pemphigoid and pemphigus were associated with higher odds of infections of the skin, bones, respiratory, gastrointestinal, genitourinary and central nervous system, septicaemia and antibiotic-resistant infections. Pemphigus was also associated with aspergillus, pharyngitis and Pneumocystis Carinii pneumonia. Associations of any serious infection in both pemphigoid and pemphigus patients were older age, non-White race, lower median household income, government or no insurance, higher number of chronic conditions, and those with a diagnosis of Cushing's syndrome, diabetes, cancer or autoimmune disease. The diagnosis of any serious infection vs. no infection was associated with increased inpatient mortality and costs in both pemphigoid (mortality: 7.85% vs. 2.84%; cost: $16 115 vs. $10 653) and pemphigus (mortality: 6.78% vs. 1.88%; cost: $17 707 vs. $11 545) inpatients (P < 0.0001 for all). CONCLUSIONS: Adults with pemphigus or pemphigoid had increased cutaneous, respiratory, multi-organ and systemic infections, which were associated with considerable inpatient mortality and cost burden. Moreover, there were significant clinical and healthcare disparities with respect to infections in patients with pemphigus or pemphigoid.
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Infecciones/epidemiología , Neoplasias/epidemiología , Penfigoide Ampolloso/epidemiología , Pénfigo/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Enfermedad Crónica , Comorbilidad , Síndrome de Cushing/epidemiología , Diabetes Mellitus/epidemiología , Femenino , Disparidades en Atención de Salud , Mortalidad Hospitalaria , Humanos , Renta , Infecciones/economía , Infecciones/etnología , Infecciones/mortalidad , Tiempo de Internación , Masculino , Medicaid , Pacientes no Asegurados , Medicare , Persona de Mediana Edad , Factores de Riesgo , Estados Unidos/epidemiología , Adulto JovenRESUMEN
BACKGROUND: The aim of this study was to determine the effects of obesity on myocardial mechanics and ventriculo-arterial coupling (V-A) in children. METHODS: Strain parameters, stroke volume, arterial elastance, left ventricular (LV) elastance and V-A were compared after adjusting for age and hypertension and after multivariate sub-group analysis between patients with and without obesity. RESULTS: Among 123 retrospectively enrolled subjects, 6-21 years age, 79.7% males, 52% were obese. Median (range) Body Mass Index Z score was +2.35 (1.67-4.43) for obese and +0.68 (-2.48-1.63) for non-obese. Subjects with obesity had higher LV mass indexed2.7 (LVMI2.7 ) compared with non-obese (P < 0.001). Lower global longitudinal strain (GLS) (P = 0.012), global circumferential strain (GCS) (P = 0.004), average longitudinal strain rate (P = 0.002) and average circumferential strain rate (P < 0.001) were seen in subjects with obesity; no difference was noted in arterial elastance, LV end systolic elastance and V-A. Increased LVMI2.7 , decreased GLS, GCS, average longitudinal strain rate, average circumferential strain rate and maintained V-A were noted in the multivariate analysis between subgroups. CONCLUSIONS: Obesity causes alterations in myocardial mechanics with preserved V-A in children. These findings may aid intervention in preventing the long-term cadiovascular effects of obesity.
Asunto(s)
Arterias/fisiopatología , Ventrículos Cardíacos/fisiopatología , Hipertensión/fisiopatología , Obesidad Infantil/fisiopatología , Remodelación Ventricular/fisiología , Adolescente , Presión Sanguínea , Monitoreo Ambulatorio de la Presión Arterial/métodos , Niño , Ecocardiografía/métodos , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Obesidad Infantil/complicaciones , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: Staphylococcal scalded skin syndrome (SSSS) is a blistering dermatosis caused by exfoliative toxins released from Staphylococcus aureus. OBJECTIVES: To describe the incidence, costs, length of stay (LOS), comorbidities and mortality of SSSS in U.S. children. METHODS: The Nationwide Inpatient Sample 2008-2012 was analysed, including a 20% sample of U.S. hospitalizations and 589 cases of SSSS. RESULTS: The mean annual incidence of SSSS was 7·67 (range 1·83-11·88) per million U.S. children, with 45·1 cases per million U.S. infants age < 2 years. In multivariable logistic regression models, SSSS was significantly associated with the following (shown as adjusted odds ratio and 95% confidence interval): female sex (1·12, 1·00-1·25), age (2-5 years: 13·31, 11·82-14·99; 6-10 years: 2·93, 2·35-3·66; 11-17 years: 0·44, 0·31-0·63); race/ethnicity (black: 0·69, 0·58-0·84) and season (winter: 2·04, 1·66-2·50; summer: 3·47, 2·86-4·22; autumn: 3·04, 2·49-3·70), with increasing odds over time (2010-2011: 2·28, 2·07-2·51; 2012: 2·98, 2·69-3·30). The geometric mean (95% confidence interval) LOS and cost of hospitalization for patients with vs. without SSSS were 3·2 (3·0-3·4) vs. 2·4 (2·4-2·5) days and $4624·0 ($4250-$5030) vs. $1872 ($1782·7-$1965). Crude inpatient mortality rates (with 95% confidence intervals) were similar for children with vs. without SSSS (0·33%, 0·00-0·79% vs. 0·36%, 0·34-0·39%). SSSS was associated with other infections, including in the upper respiratory tract and skin. CONCLUSIONS: The prevalence of SSSS appears to be increasing over time, and was associated with a number of sociodemographic factors and other infections. Further studies are needed to confirm these findings and reduce rising rates of SSSS.
Asunto(s)
Síndrome Estafilocócico de la Piel Escaldada/mortalidad , Adolescente , Niño , Preescolar , Comorbilidad , Costos y Análisis de Costo , Humanos , Incidencia , Lactante , Recién Nacido , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Prevalencia , Características de la Residencia/estadística & datos numéricos , Factores Socioeconómicos , Síndrome Estafilocócico de la Piel Escaldada/economía , Síndrome Estafilocócico de la Piel Escaldada/terapia , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Atopic dermatitis (AD) is associated with a heterogeneous presentation and clinical course. There is a lack of simple and validated severity assessments that are feasible for clinical practice and epidemiological research. OBJECTIVES: We sought to validate patient-reported global AD severity in adults. METHODS: We performed a prospective dermatology practice-based study using questionnaires and evaluation by a dermatologist (n = 265). RESULTS: At baseline and follow-up, patient-reported global AD severity significantly correlated with oSCORAD (Spearman ρ = 0.56 and 0.49), SCORAD (0.64 and 0.56), EASI (0.56 and 0.50), BSA (0.52 and 0.45), NRS-itch (0.60 and 0.53), POEM (0.50 and 0.48), and DLQI (0.50 and 0.49) (P < .0001 for all). Patient-reported moderate and severe AD vs mild AD were associated with significantly higher oSCORAD, SCORAD, EASI, BSA, NRS-itch, POEM, and DLQI (P < .0001 for all). There was moderate concordance between patient-reported AD severity (mild, moderate, and severe) and previously developed severity strata for oSCORAD (κ = 0.39), SCORAD (κ = 0.47), EASI (κ = 0.37), NRS-itch (κ = 0.49), POEM (κ = 0.37), and DLQI (κ = 0.40). Among patients with severe disease at baseline, those who reported mild or moderate disease on follow-up had significantly greater absolute reductions of oSCORAD (-23.4/-9.7/-1.8), SCORAD (-33.0/-13.2/-2.3), EASI (-17.1/-9.8/-3.2), BSA (-46%/-15%/-4%), NRS-itch (-5/-2/0), POEM (-5/-2/0), and DLQI (-8/-6/-1) than those who continued to report severe disease (Kruskal-Wallis, P ≤ .0003 for all). CONCLUSIONS: Patient-reported AD severity appears to be sufficiently valid for assessing AD severity in the clinical and epidemiological setting.