McMaster University
  • Hamilton, Ontario, Canada
Recent publications
Advancements in Microelectromechanical systems (MEMS) have enabled the manufacture of affordable and efficient wearable devices. In sensor-based gait analysis, motion and biofeedback sensor devices are easily attached to different parts of the body. Instrumentation of gait using different sensor technologies enables researchers and clinicians to capture high-resolution quantitative motion data within and beyond the lab. Integration of advanced sensor technologies provides objective and rater-independent multimodal outcomes that complement established clinical examination. Multi-modal data capture in ecologically valid, patient-relevant habitual settings opens new possibilities to monitor fluctuating and rare incidents by informing different aspects of impaired gait. Interconnected device communication and the Internet of Things (IoT) provide the infrastructural platform to enable remote gait assessment. However, an extended period of motion data recorded by different sensor technologies results in a vast amount of unlabelled data. Computational methods and artificial intelligence techniques (e.g., data mining) provide opportunities to manage data collected in unsupervised environments. Although technological advancement and algorithms promote remote gait assessment, more work needs to be done in terms of analytical and clinical validation to achieve robust and reliable gait analysis tools that contribute to better rehabilitation and treatment.
Background Some studies suggest that patients with pulmonary hypertension (PH) may be at higher risk of complications and death after noncardiac surgery. However, the magnitude of these associations is unclear. Objectives To determine the associations between PH and adverse outcomes after noncardiac surgery. Methods We searched PUBMED and EMBASE for studies published from January 1970 to April 2022. We included studies that reported the association between PH and one or more outcomes of interest occurring after noncardiac surgery. Data were pooled using random-effects models and reported as summary odds ratios (ORs) with 95% confidence intervals (CIs). Results Eighteen studies met eligibility criteria (n=18,214,760). PH was independently associated with mortality (adjusted odds ratio [OR] 2.09; 95% CI, 1.51-2.90; I²=98%; 8 studies). PH was associated with a higher unadjusted risk of deep venous thrombosis (OR 4.02; 95% CI, 2.14-7.54; I²=85%; 3 studies), pulmonary embolism (OR 4.16; 95% CI, 3.23-5.36; I²=69%; 7 studies), myocardial infarction (OR 1.49; 95% CI, 1.44-1.54; I²=0%; 5 studies), congestive heart failure or cardiogenic shock (OR 3.37; 95% CI, 1.73–6.60; I²=34%; 5 studies), length of hospital stay (mean difference 1.97 days; 95% CI, 0.81–3.12; I²=99%; 5 studies), and delayed extubation (OR 5.98; 95% CI, 1.70–21.02; I²=3%; 3 studies). PH was associated with lower unadjusted risk of postoperative stroke (OR 0.93; 95% CI, 0.88–0.98; I²=0%; 3 studies). Conclusion PH is a predictor of morbidity and mortality after noncardiac surgery. High quality studies are needed to determine effective strategies for reducing postoperative complications in this population.
The potential of MRI to predict cartilage mechanical properties across an entire cartilage surface in an ex vivo model would enable novel perspectives in modeling cartilage tolerance and predicting disease progression. The purpose of this study was to integrate MR imaging with full-surface indentation mapping to determine the relationship between femoral cartilage thickness and T2 relaxation change following loading, and cartilage mechanical properties in an ex vivo porcine stifle model. Matched-pairs of stifle joints from the same pig were randomized into either 1) an imaging protocol where stifles were imaged at baseline and after 35 min of static axial loading; and 2) full surface mapping of the instantaneous modulus (IM) and an electromechanical property named quantitative parameter (QP). The femur and femoral cartilage were segmented from baseline and post-intervention scans, then meshes were generated. Coordinate locations of the indentation mapping points were rigidly registered to the femur. Multiple linear regressions were performed at each voxel testing the relationship between cartilage outcomes (thickness change, T2 change) and mechanical properties (IM, QP) after accounting for covariates. Statistical Parametric Mapping was used to determine significance of clusters. No significant clusters were identified; however, this integrative method shows promise for future work in ex vivo modeling by identifying spatial relationships among variables.
Background Pancreatic cancer is the third leading cause of cancer death in the United States, which is attributed to limited treatment options. Complementary and alternative medicine (CAM) therapies have been proposed to provide benefits in treating pancreatic cancer. Despite its importance in treatment, clinicians are not generally well equipped to counsel their patients about CAM therapies. This review identified the quantity and assessed the quality of clinical practice guidelines (CPGs) providing CAM recommendations for the treatment and/or management of pancreatic cancer. Methods A systematic review was conducted to identify pancreatic cancer CPGs. MEDLINE, EMBASE and CINAHL were searched from 2011 to 2022. The Guidelines International Network (GIN) and the National Center for Complementary and Integrative Health (NCCIH) websites were also searched. Eligible CPGs published by non-profit agencies on treatment and/or management of pancreatic cancer for adults were assessed using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument. Results From 31 eligible search results, 7 CPGs mentioned CAM and 3 CPGs made CAM recommendations. The mean scaled domain percentages of the CPGs in this study (overall, CAM-specific) were as follows: scope and purpose (81.3%, 77.8%), stakeholder involvement (63.9%, 42.6%), rigor-of-development (51.0%, 40.3%), clarity-of-presentation (83.3%, 54.6%), applicability (42.3%, 30.5%), and editorial independence (58.3%, 58.3%). Conclusions Evaluation of the CPGs demonstrated that quality varied both within and between CPGs. CPGs that scored well could be used by patients and clinicians as the basis for discussion for the use of CAM therapies. Future research should identify other appropriate CAM therapies for further development of CPGs for pancreatic cancer. Registration The protocol was registered on PROSPERO (registration number: CRD42022334025).
Background: SLC13A5 related developmental and epileptic encephalopathy (DEE) is an autosomal recessive condition characterized by neonatal seizures, fever sensitivity, status epilepticus, developmental delay and tooth anomalies. The neuroimaging spectrum of SLC13A5 related DEE is not fully known. We present a case of SLC13A5 related DEE with distinct neuroimaging findings and review the neuroimaging findings of all published cases of SLC13A5 related DEE. Methods: A retrospective case review and focused review of the literature was completed. Results: A 16-month-old male with a clinical phenotype consistent with SLC13A5 related DEE and a previously reported pathogenic variant in SLC13A5, c.655G>A, p.Gly219Arg and a novel likely pathogenic variant in SLC13A5, c.202C>T, p.Pro68Ser was identified. MRI at day 5 of life revealed wide spread punctate white matter lesions (PWMLs) affecting the subcortical white matter, periventricular white matter, splenium of the corpus callosum, posterior limb of the internal capsule, corticospinal tracts, midbrain, pons and medulla, mimicking a metabolic/infectious etiology. MRI at one month showed atrophy and evolution of white matter necrosis. One hundred and five cases of SLC13A5 related DEE were identified. Initial MRI was completed in 62 cases (59%). MRI was normal in 41 cases (66%) and abnormal in 21 (34%). White matter abnormalities were most common (n=15, 71%); PWMLs occurred in 8 cases (38%). Conclusion: Neuroimaging abnormalities may exist in a third of SLC13A5 related DEE cases. White matter abnormalities such as PWMLs appear most common. It remains unknown why some are susceptible to these lesions and how they affect long-term neurodevelopmental outcomes in SLC13A5 related DEE.
Acoustic sensing has attracted significant attention recently, thanks to the pervasive availability of device support. However, adopting consumer-grade devices (e.g., smartphones) to deploy acoustic sensing applications faces the challenge of device/OS heterogeneity. Researchers have to pay tremendous efforts in tackling platform-dependent details even in simply accessing raw audio samples, thus losing focus on innovating sensing algorithms. To this end, this paper presents the first Acoustic Software Defined Platform (ASDP): a versatile sensing and general benchmarking platform. ASDP encompasses several customized acoustic modules running on a ubiquitous computing board, backed by a dedicated software framework. It is superior to commodity devices in controlling and reconfiguring physical layer settings, thus offering much better usability. The tailored software framework abstracts platform details and provides user-friendly interface for fast prototyping, while maintaining adequate programmability. To demonstrate the usefulness of ASDP, we showcase several relevant applications based on it. The promising outcomes make us believe that the release of our ASDP could greatly advance acoustic sensing research.
Individuals differ in the extent to which they believe that their emotions are controllable or not, and these beliefs have significant impacts on emotional functioning. A strong belief that your emotions are uncontrollable (fixed mindset) is a vulnerability for emotional dysfunction, such as internalizing symptoms; however, the proximal mechanisms that might explain how emotional beliefs manifest as symptoms remain unclear. Across two studies, we examined whether mindset was indirectly related to internalizing symptoms through use of avoidance-based strategies and whether perceptions of stress function to amplify this relationship. In Study 1, (N = 163; mean age = 17.9), a fixed mindset was associated with a greater presence of depression and anxiety symptoms in undergraduates indirectly through the use of avoidance for anxiety, but not depression. Perceived stress did not moderate the indirect effect. In Study 2 (N = 183; mean age = 18.74) we replicated this model and extended this finding by examining social-avoidance. There was an indirect effect of mindset on anxiety and on depression via the use of avoidance-based strategies; however, there was no moderating effect of perceived stress. These findings extend the previous literature by demonstrating for role of avoidance in understanding the relationship between fixed mindsets and internalizing symptoms.
The purpose of this study is to improve the quality of the multi-track laser cladding coating. The Taguchi-Grey relation method was selected to realize process parameter optimization. The Taguchi method is used to design an L16 orthogonal experiment. The influence of three important laser cladding parameters (laser power, powder feeding rate, and scanning speed) on the micro-hardness, maximum load value, yield strength, UTS, and elongation had been analyzed based on the analysis of variance (ANOVA) and signal to noise ratio (SNR) methods. The results showed that the yield strength, UTS, and elongation were significantly affected by the laser power; the powder feeding rate denoted a highly significant influence on the microhardness and yield strength; and the scanning speed was a highly significant factor that had an influence on the maximum load value. Then, grey relational analysis (GRA) was used to convert five response targets into a single grey relational grade (GRG) that could be quantified in order to optimize the parameters for maximum micro-hardness, maximum load value, yield strength, UTS, and elongation. Finally, the optimum cladding process parameters were obtained. Through analysis of microstructure, the reduction of the Laves phase might be the main reason for the improvement of coating performance after optimization.
Background Collecting duct carcinoma (CDC) is biologically more aggressive than clear cell renal cell carcinoma (ccRCC). We tested for differences in cancer specific mortality (CSM) rates according to CDC vs. ISUP (International Society of Urological Pathology) 4 ccRCC histological subtype. We hypothesized that the survival disadvantage still applies, even after most detailed adjustments. Methods Within Surveillance, Epidemiology, and End Results database (2004–2018), we identified 380 CDC vs. 6273 ISUP 4 ccRCC patients of all stages. Propensity score matching (age, sex, race/ethnicity, T, N, and M stages, nephrectomy, and systemic therapy status), Kaplan-Meier plots and multivariable Cox regression models were used. Results All 380 CDC were matched (1:2) with 760 ISUP4 ccRCC patients. Prior to matching CDC patients exhibited higher rates of lymph node invasion (37.6 % vs. 14.7 %, p < 0.001), and of distant metastases (40.8 % vs. 30.4 %, p < 0.001). Systemic therapy rates were higher in CDC (29.5 % vs. 20.5 %, p < 0.001). However, nephrectomy rates were higher in ISUP4 ccRCC patients (97.5 % vs. 84.7 %, p < 0.001). After matching, in multivariable Cox regression models addressing CSM, CDC was associated with a HR of 1.5 (p < 0.001) in the overall population vs. 1.9 (p = 0.014) in stage I-II vs. 1.4 (p = 0.022) in stage III vs. 1.6 in stage IV (p < 0.001), relative to ISUP4 ccRCC. Conclusion CDC patients exhibited 40–90 % higher CSM than their ISUP4 ccRCC counterparts in the overall analysis, as well as in stage specific analyses. The CSM disadvantage applies despite higher rates of systemic therapy in CDC patients.
Much research suggests democracies invest more in human capital formation than dictatorships. In particular, scholars have suggested that democracies outspend autocracies on education, due to electoral and interest group pressures. However, some democracies spend no more on education - and some spend much less - than autocracies. What explains this variation within democracies? The answer is the influence of landed agricultural elites. Urban industrial elites support human capital investment because it leads to higher rates of return even if wages increase. Yet greater education spending encourages out-migration from the countryside, reducing the supply and increasing the price of agricultural labor. Given the differential impact of education spending across economic sectors, the effect of democracy on education spending may be conditional on the power of landed elites. We test this argument in two ways. First, we run a series of time series cross-sectional regressions on data from 107 countries for the period 1970 to 2000. Second, we conduct a difference-in-difference analysis, comparing countries that democratize at high versus low levels of land inequality, for 73 countries for the same time period. Results confirm a negative relationship between the power of landed elites and investment in public education under democracy, adding important and novel insight into the sources of differences in public-goods spending and human capital investment both within across political regimes.
Aim Some studies have reported that children with poor motor functioning tend to improve over time. However, much existing research does not account for regression towards the mean (RTM). Here, we examine measurement stability among 589 children aged 4–5 years. Method We administered the Movement Assessment Battery for Children 2nd Edition annually to 269 children initially scoring above and 252 at or below the 16th percentile. We measured agreement between year 1 and year 2 standard scores using Pearson correlation and derived expected regression towards the mean (RTM). We then regressed follow-up on baseline scores, controlling for relative age, sex, and exact interval between assessments. Finally, we performed a small illustrative simulation. Outcomes and results The mean score in the poor-coordination group rose from 5.6 (SD = 1.5) to 7.2 (SD = 2.8). Year 1 and year 2 scores were correlated at r = 0.66, corresponding to predicted RTM in the MI group of 1.56, close to the observed change of 1.57. Degree of change was not associated with time between assessments. Interpretation Observed improvements in motor functioning were consistent with measurement error. The stability of motor functioning may be greater than it appears from past research, and reported functional improvements in some studies may be illusory. What this paper adds? -Impaired motor coordination is common and can meaningfully affect functioning. -Our analysis suggests that coordination is generally stable. -Apparent improvement in research may often be produced by measurement error.
The inclusion of microencapsulated phase change materials (MPCM) in construction materials is a promising solution for increasing the energy efficiency of buildings and reducing their carbon emissions. Although MPCMs provide thermal energy storage capability in concrete, they typically decrease its compressive strength. A unified framework for the mixture design of concrete incorporating MPCM is yet to be developed to facilitate practical applications. This study proposes a mix design procedure using a novel ternary machine learning (ML) paradigm. For this purpose, the tabular generative adversarial network (TGAN) was utilized to generate large synthetic mixture design data based on the limited available experimental observations. The synthetic data is then employed to construct robust predictive ML models. The gradient boosting regressor (GBR) model trained with synthetic data outperformed the model trained with real data, achieving a testing coefficient of determination (R 2) of 0.963 and mean absolute error (MAE) of 2.085 MPa. The TGAN-GBR model was ultimately integrated with the particle swarm optimization (PSO) algorithm to construct a powerful recommendation system for optimizing the mixture design of concrete and mortar incorporating different types of MPCMs. Extensive parametric analyses along with the employed optimization procedure accomplished the mixture design of latent heat thermal energy storage concrete with maximum MPCM inclusion and minimum cement content for various compressive strength classes. The proposed framework enables energy conservation technology in the design of eco-friendly building materials with acceptable mechanical performance.
In patients with non–ST-elevation myocardial infarction (NSTEMI), total occlusion of the culprit coronary artery (OCA) is not uncommon. We sought to determine the frequency and clinical impact of OCA at presentation in a large population of patients presenting with NSTEMI and who underwent systematic early invasive management. We performed a post hoc analysis of the TAO (Treatment of Acute Coronary Syndrome with Otamixaban) randomized trial, which included patients with NSTEMI with systematic coronary angiography within 72 hours. We compared the baseline characteristics and outcomes of patients according to whether the culprit vessel was occluded (thrombolysis in myocardial infarction flow grade [TFG] 0 to 1) or patent (TFG 2 to 3) at presentation. A total of 7,473 patients with NSTEMI with only 1 culprit lesion identified were enrolled, of whom 1,702 patients had OCA (22.8%). In the OCA group, coronary angiography was performed earlier (18 ± 15 vs 20 ± 16 hours, p <0.01), the culprit lesion was less likely to be the left anterior descending artery (26.5% vs 41.4%, p <0.001) but with more frequent angiographic thrombus (49.9% vs 22.7%, p <0.01). Culprit artery percutaneous coronary intervention during the index procedure was also more frequent (88.5% vs 78.1%, p <0.001) but with a lower rate of TFG grade 3 after the procedure and higher subsequent peak troponin I levels (8.3 ± 13.6 µg/L vs 5.6 ± 11.9 µg/L, p <0.001). At day 7, patients with OCA had higher mortality, and this persisted after adjustment on gender, Grace risk score, cardiovascular risk factors, and culprit vessel location (0.9% vs 0.4%, p = 0.02; adjusted odds ratio [OR] = 2.55, 95% confidence interval [CI] 1.23 to 5.29, p = 0.01). The absolute difference of mortality was maintained through 30 days: 1.2% versus 0.8%, p = 0.13; OR: 1.72, 95% CI 0.97 to 3.05, but mortality rates were similar by 180 days: 1.5% versus 1.6%, p = 0.8, adjusted OR = 1.11, 95% CI 0.69 to 1.80, p = 0.66. In conclusion, a significant proportion of patients with NSTEMI have a totally occluded culprit vessel at presentation. These patients are at higher risk of early mortality but not at 6 months.
Context Outcomes in renal cell carcinoma (RCC) are reported inconsistently, with variability in definitions and measurement. Hence, it is difficult to compare intervention effectiveness and synthesise outcomes for systematic reviews and to create clinical practice guidelines. This uncertainty in the evidence makes it difficult to guide patient-clinician decision-making. One solution is a core outcome set (COS): an agreed minimum set of outcomes. Objective To describe outcome reporting, definitions, and measurement heterogeneity as the first stage in co-creating a COS for localised renal cancer. Evidence acquisition We systematically reviewed outcome reporting heterogeneity in effectiveness trials and observational studies in localised RCC. In total, 2822 studies (randomised controlled trials, cohort studies, case-control studies, systematic reviews) up to June 2020 meeting our inclusion criteria were identified. Abstracts and full texts were screened independently by two reviewers; in cases of disagreement, a third reviewer arbitrated. Data extractions were double-checked. Evidence synthesis We included 149 studies and found that there was inconsistency in which outcomes were reported across studies and variability in the definitions used for outcomes that were conceptually the same. We structured our analysis using the outcome classification taxonomy proposed by Dodd et al. Outcomes linked to adverse events (eg, bleeding, outcomes linked to surgery) and renal injury outcomes (reduced renal function) were reported most commonly. Outcomes related to deaths from any cause and from cancer were reported in 44% and 25% of studies, respectively, although the time point for measurement and the analysis methods were inconsistent. Outcomes linked to life impact (eg, global quality of life) were reported least often. Clinician-reported outcomes are more frequently reported than patient-reported outcomes in the renal cancer literature. Conclusions This systematic review underscores the heterogeneity of outcome reporting, definitions, and measurement in research on localised renal cancer. It catalogues the variety of outcomes and serves as a first step towards the development of a COS for localised renal cancer. Patient summary We reviewed studies on localised kidney cancer and found that multiple terms and definitions have been used to describe outcomes. These are not defined consistently, and often not defined at all. Our review is the first phase in developing a core outcome set to allow better comparisons of studies to improve medical care.
Objectives: We set out to determine the accuracy of the interRAI Emergency Department (ED) Screener in predicting the need for detailed geriatric assessment in the ED. Our secondary objective was to determine the discriminative ability of the interRAI ED Screener for predicting the odds of discharge home and extended ED length of stay (>24 hours). Methods: We conducted a multiprovince prospective cohort study in Canada. The need for detailed geriatric assessment was determined using the interRAI ED Screener and the interRAI ED Contact Assessment as the reference standard. A score of ≥5 was used to classify high-risk patients. Assessments were conducted by emergency and research nurses. We calculated the sensitivity, positive predictive value, and false discovery rate of the interRAI ED Screener. We employed logistic regression to predict ED outcomes while adjusting for age, sex, academic status, and the province of care. Results: A total of 5629 older ED patients across 11 ED sites were evaluated using the interRAI ED Screener and 1061 were evaluated with the interRAI ED Contact Assessment. Approximately one-third of patients were discharged home or experienced an extended ED length of stay. The interRAI ED Screener had a sensitivity of 93%, a positive predictive value of 82%, and a false discovery rate of 18%. The interRAI ED Screener predicted discharge home and extended ED length of stay with fair accuracy. Conclusion: The interRAI ED Screener is able to accurately and rapidly identify individuals with medical complexity. The interRAI ED Screener predicts patient-important health outcomes in older ED patients, highlighting its value for vulnerability screening.
Mathematical optimization can be a useful strategy for minimizing energy usage while designing low-energy buildings. To handle building energy optimization challenges, this study provides an effective hybrid technique based on the pelican optimization algorithm (POA) and the single candidate optimizer (SCO). The suggested hybrid algorithm (POSCO) benefits from both the robust local search power of the single candidate method and the efficient global search capabilities of the pelican optimization. To conduct the building optimization task, the optimization method was developed and integrated with the EnergyPlus codes. The effectiveness of the proposed POSCO method was verified using mathematical test functions, and the outcomes were contrasted with those of conventional POA and other effective optimization techniques. Application of POSCO for global function optimization reveals that, among the thirteen considered functions, the proposed method was best at finding the global solution for seven functions, while providing superior results for the other functions when compared with competitive techniques. The suggested POSCO is applied for reducing an office buildings' annual energy use. Comparing POSCO to POA procedures, the building energy usage is reduced. Furthermore, POSCO is compared to simple POA and other algorithms, with the results showing that, at specific temperatures and lighting conditions, the POSCO approach outperforms selected state-of-the-art methods and reduces building energy usage. As a result, all data suggests that POSCO is a very promising, dependable, and feasible optimization strategy for dealing with building energy optimization models. Finally, the building energy optimization findings for various climatic conditions demonstrate that the changes to the weather dataset had limited effect on the efficiency of the optimization procedure.
  • Simona FerraroSimona Ferraro
  • Davide BiganzoliDavide Biganzoli
  • Roberta Simona RossiRoberta Simona Rossi
  • [...]
  • Elia Mario BiganzoliElia Mario Biganzoli
Objectives Clinical practice guidelines endorse the stratification of prostate cancer (PCa) risk according to individual total prostate-specific antigen (tPSA) values and age to enhance the individual risk-benefit ratio. We defined two nomograms to predict the individual risk of high and low grade PCa by combining the assay of tPSA and %free/tPSA (%f/tPSA) in patients with a pre-biopsy tPSA between 2 and 10 μg/L. Methods The study cohort consisted of 662 patients that had fPSA, tPSA, and a biopsy performed (41.3% with a final diagnosis of PCa). Logistic regression including age, tPSA and %f/tPSA was used to model the probability of having high or low grade cancer by defining 3 outcome levels: no PCa, low grade (International Society of Urological Pathology grade, ISUP<3) and high grade PCa (ISUP≥3). Results The nomogram identifying patients with: (a) high vs. those with low grade PCa and without the disease showed a good discriminating capability (∼80%), but the calibration showed a risk of underestimation for predictive probabilities >30% (a considerable critical threshold of risk), (b) ISUP<3 vs. those without the disease showed a discriminating capability of 63% and overestimates predictive probabilities >50%. In ISUP 5 a possible loss of PSA immunoreactivity has been observed. Conclusions The estimated risk of high or low grade PCa by the nomograms may be of aid in the decision-making process, in particular in the case of critical comorbidities and when the digital rectal examinations are inconclusive. The improved characterization of the risk of ISUP≥3 might enhance the use for magnetic resonance imaging in this setting.
Objectives Confounding factors, including sex, age, and renal dysfunction, affect high-sensitivity cardiac troponin T (hs-cTnT) concentrations and the acute myocardial infarction (AMI) diagnosis. This study assessed the effects of these confounders through logistic regression models and evaluated the diagnostic performance of an optimized, integrated prediction model. Methods This retrospective study included a primary derivation cohort of 18,022 emergency department (ED) patients at a US medical center and a validation cohort of 890 ED patients at a Canadian medical center. Hs-cTnT was measured with 0/3 h sampling. The primary outcome was index AMI diagnosis. Logistic regression models were optimized to predict AMI using delta hs-cTnT and its confounders as covariates. The diagnostic performance of model cutoffs was compared to that of the hs-cTnT delta thresholds. Serial logistic regressions were carried out to evaluate the relationship between covariates. Results The area under the curve of the best-fitted model was 0.95. The model achieved a 90.0% diagnostic accuracy in the validation cohort. The optimal model cutoff yielded comparable performance (90.5% accuracy) to the optimal sex-specific delta thresholds (90.3% accuracy), with 95.8% agreement between the two diagnostic methods. Serial logistic regressions revealed that delta hs-cTnT played a more predominant role in AMI prediction than its confounders, among which sex is more predictive of AMI (total effect coefficient 1.04) than age (total effect coefficient 0.05) and eGFR (total effect coefficient −0.008). Conclusions The integrated prediction model incorporating confounding factors does not outperform hs-cTnT delta thresholds. Sex-specific hs-cTnT delta thresholds remain to provide the highest diagnostic accuracy.
Models propose a simplified representation of the reality, which is useful to develop a common ground for describing, analyzing, and understanding complex phenomena. Model building requires three things: Raw materials. Tools. Technical expertise (hopefully!). This is true whether the model is physical (for instance a sculpture), conceptual (a mental map), or statistical/mathematical (the gravity model or a regression model). In the case of a sculpture, the raw materials can be marble, wood, or clay; the tools chisels, mallet, and spatula; and the technique the mastery of the sculptor when working with the tools and the materials. Anyone can try sculpture, and most people can create sculptures.
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18,066 members
Behnam Sadeghirad
  • Departments of Anethesia and Clinical Epidemiology & Biostatistics
Omar M. Bdair
  • Department of Mathematics and Statistics
Matiar Howlader
  • Department of Electrical and Computer Engineering
Carlos Alberto Cuello-Garcia
  • Health Research Methods Evidence and Impact
Loubna Akhabir
  • Department of Medicine
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