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Toward guidelines for the ethical reanalysis and reinterpretation of another's research.

Reanalysis and reinterpretation occur when a person other than the original investigator obtains an epidemiologic data set and conducts analyses to evaluate the quality, reliability or validity of the dataset, methods, results or conclusions reported by the original investigator. We propose ethical guidelines with regard to the duty of original investigators to cooperate with competent impartial reanalysis and for the sponsors of reanalysis and reinterpretation and the epidemiologists who carry it out. The rights and interests of these parties and of the public interest need to be protected.

Cooperative Behavior↗

The association between psoriasis, diabetes mellitus, and atherosclerosis in Israel: a case-control study.

BACKGROUND: Previous reports demonstrated an association between psoriasis and other diseases including heart failure and diabetes mellitus. OBJECTIVES: Our aim was to describe the association between psoriasis, diabetes mellitus, and atherosclerosis in Israel. METHODS: A cross-sectional study was performed utilizing the database of Maccabi Healthcare Services (MHS), a large health provider organization in Israel. Case patients were defined as subjects who were diagnosed with psoriasis. Patients with diabetes and atherosclerosis were identified by using the MHS diabetes and cardiovascular registries, respectively. The control group included MHS enrollees without psoriasis. The proportion of diabetes and atherosclerosis among case and control groups was compared. Chi-square tests were used to compare categorical parameters. Logistic regression models were used for multivariate analyses. RESULTS: The study included 46,095 patients with psoriasis (case patients) and 1,579,037 subjects without psoriasis (control patients). The age-adjusted proportion of diabetes was significantly higher in psoriasis patients as compared with the control group (odds ratio [OR] 1.27, 95% confidence interval [CI] 1.1-1.48). The age-adjusted proportion of atherosclerosis was significantly higher in psoriasis patients as compared with the control group (OR 1.28, 95% CI 1.04-1.59). In patients with psoriasis, a multivariate logistic regression model demonstrated an association between diabetes and the multiple use of very potent topical steroids (P < .05) or use of systemic medication for psoriasis (methotrexate, cyclosporine or acitretin) (P < .001). A similar model demonstrated an association between atherosclerosis and the use of phototherapy (P < .001). LIMITATIONS: Our study was based on a computerized database. The diagnosis of psoriasis was based on digitally transmitted data. Therefore overestimation (false-positive cases) and underestimation (false-negative cases) of psoriasis patients may exist, thereby being a source for information bias. A second limitation is selection bias that may occur due to the possibility that reporting of both psoriasis and associated illnesses is higher in individuals who are seeking medical care. A third limitation concerns the causal effect between occurrence of psoriasis and atherosclerosis or diabetes. The dataset of MHS records diagnoses only from 1997 and does not record the date of disease onset. CONCLUSIONS: Our study supports previous reports for an association between psoriasis and atherosclerosis and psoriasis and diabetes. Further study is needed to support this observation.

Adolescent↗

Thin sectional anatomy, three-dimensional reconstruction and visualization of the heart from the Chinese Visible Human.

The research aimed to provide sectional anatomic and three-dimensional (3D) virtual anatomic bases for imaging diagnosis and surgical operation by the use of data from the heart of the first Chinese digitized Visible Human. Data from the series of thin sections of the heart were analyzed and input into an SGI workstation, and 3D reconstruction and virtualization of the heart were performed. Each image of sectional anatomy was clear and the 3D structures of the heart were reconstructed in their entirety. All reconstructed structures can be displayed by multiple structural and color modes, individually or jointly, and can be rotated continuously in any plane. The model of the virtual heart clearly showed fine structures of the heart in random orientation. The dataset of the sectional anatomy provides a fine and integrated morphologic base for imaging diagnosis. The 3D reconstructed images clearly show the internal and entire structures of the heart.

Anatomy, Cross-Sectional↗

Artificial intelligence for dental caries detection: An umbrella review.

Artificial intelligence (AI) has been proposed as a tool to improve dental caries detection across imaging modalities; however, its clinical value remains uncertain. This umbrella review aimed to synthesize and critically appraise systematic reviews evaluating AI for caries detection and diagnosis. An umbrella review was conducted following PRIOR guidance (PROSPERO CRD420261340728). Searches were performed in MEDLINE, Embase, Scopus, Web of Science, and Google Scholar up to 15 March 2026. Methodological quality was assessed using AMSTAR 2, and overlap of primary studies was quantified using the corrected covered area (CCA). Seventeen systematic reviews were included, of which five reported diagnostic test accuracy meta-analyses using bivariate or HSROC models. Across these meta-analyses, pooled sensitivity ranged from 0.76 to 0.94 and specificity from 0.85 to 0.91. Most systems were based on deep learning models applied to bitewing radiographs and intraoral photographs. However, substantial heterogeneity was observed in imaging modalities, lesion thresholds, analytical tasks, and evaluation metrics. In addition, a high degree of overlap across reviews and recurrent methodological limitations, including reliance on retrospective datasets, limited external validation, and inconsistent reporting, substantially weaken the reliability of the evidence. Although AI models demonstrate high diagnostic performance under experimental conditions, current evidence does not support their use as stand-alone diagnostic tools. Their clinical applicability remains limited, and implementation should be restricted to decision-support contexts until robust prospective validation demonstrates meaningful impact on clinical decision-making and patient outcomes.

Dental Caries↗

Analysis of domain correlations in yeast protein complexes.

MOTIVATION: A growing body of research has concentrated on the identification and definition of conserved sequence motifs. It is widely recognized that these conserved sequence and structural units often mediate protein functions and interactions. The continuing advancements in high-throughput experiments necessitate the development of computational methods to critically assess the results. In this work, we analyzed high-throughput protein complexes using the domain composition of their protein constituents. Domains that mediate similar or related functions may consistently co-occur in protein complexes. RESULTS: We analyzed Saccharomyces cerevisiae protein complexes from curated and high-throughput experimental datasets to identify statistically significant functional associations between domains. The resulting correlations are represented as domain networks that form the basis of comparison between the datasets, as well as to binary protein interactions. The results show that the curated datasets produce domain networks that map to known biological assemblies, such as ribosome, RNA polymerase, proteasome regulators, transcription initiation and histones. Furthermore, many of these domain correlations were also found in binary protein interactions. In contrast, the high-throughput datasets contain one large network of domain associations. High connectivity of RNA processing and binding domains in the high-throughput datasets reflects the abundance of RNA binding proteins in yeast, in agreement with a previous report that identified a nucleolar protein cluster, possibly mediated by rRNA, from these complexes. AVAILABILITY: The software is available upon request from the authors and is dependent on the NCBI C++ toolkit.

Amino Acid Motifs↗

Supervised harvesting of expression trees.

BACKGROUND: We propose a new method for supervised learning from gene expression data. We call it 'tree harvesting'. This technique starts with a hierarchical clustering of genes, then models the outcome variable as a sum of the average expression profiles of chosen clusters and their products. It can be applied to many different kinds of outcome measures such as censored survival times, or a response falling in two or more classes (for example, cancer classes). The method can discover genes that have strong effects on their own, and genes that interact with other genes. RESULTS: We illustrate the method on data from a lymphoma study, and on a dataset containing samples from eight different cancers. It identified some potentially interesting gene clusters. In simulation studies we found that the procedure may require a large number of experimental samples to successfully discover interactions. CONCLUSIONS: Tree harvesting is a potentially useful tool for exploration of gene expression data and identification of interesting clusters of genes worthy of further investigation.

Gene Expression Profiling↗

Relapses and subsequent worsening of disability in relapsing-remitting multiple sclerosis.

OBJECTIVE: To investigate whether relapses contribute to the development of subsequent sustained increase of impairment and disability in patients with multiple sclerosis (MS). METHODS: In a random sampled subset of 256 relapsing-remitting MS (RRMS) patients from the placebo arms of 20 randomized, controlled clinical trials contained in the Sylvia Lawry Centre for MS Research (SLCMSR) open database (mean follow-up time 2.66 years), the authors tested whether time to an increase of the Expanded Disability Status Scale (EDSS) score (confirmed after 6 months) was related to the occurrence of prior relapses. In the primary analysis, EDSS progressions starting within the period used to calculate the on-study relapse rate (sacrifice period) were not counted. The result obtained was then validated in an independent validation part of the SLCMSR database (n = 320). RESULTS: Although in the first subset of 256 RRMS patients, occurrence of relapses in the first 4 months on study appeared to be the best predictor for a shorter time to subsequent sustained increase in the EDSS score (hazard ratio [HR] 2.26 [95% CI: 1.36 to 3.75]), this finding was not confirmed in the validation dataset (HR 1.35, one-sided Wald test, lower limit of the 95% CI: 0.90). CONCLUSION: Although relapses may result into permanent damage and Expanded Disability Status Scale (EDSS) progression, there is no consistent effect of on-study relapses on the subsequent development of sustained EDSS score increase during a typical clinical study observation period.

Adult↗

Usefulness of database studies as applied to managed care.

Benchmarking, an industry comparison tool and a well-known business technology, offers health care a method of establishing standards for health care use with clinical governance. Benchmarking can lead to practice innovations necessary for survival in a managed care environment that has a need for decreasing cost and increasing quality. Information gleaned from the benchmarking dataset can be used to determine where limited resources for disease management programs should be directed. It can also be used to help decision makers manage a drug formulary by providing a basic knowledge about the environment in which a drug will be used and prescribed. This article describes the relationship of database studies and benchmarking and the usefulness as applied to managed care.

Benchmarking↗

Finding function: evaluation methods for functional genomic data.

BACKGROUND: Accurate evaluation of the quality of genomic or proteomic data and computational methods is vital to our ability to use them for formulating novel biological hypotheses and directing further experiments. There is currently no standard approach to evaluation in functional genomics. Our analysis of existing approaches shows that they are inconsistent and contain substantial functional biases that render the resulting evaluations misleading both quantitatively and qualitatively. These problems make it essentially impossible to compare computational methods or large-scale experimental datasets and also result in conclusions that generalize poorly in most biological applications. RESULTS: We reveal issues with current evaluation methods here and suggest new approaches to evaluation that facilitate accurate and representative characterization of genomic methods and data. Specifically, we describe a functional genomics gold standard based on curation by expert biologists and demonstrate its use as an effective means of evaluation of genomic approaches. Our evaluation framework and gold standard are freely available to the community through our website. CONCLUSION: Proper methods for evaluating genomic data and computational approaches will determine how much we, as a community, are able to learn from the wealth of available data. We propose one possible solution to this problem here but emphasize that this topic warrants broader community discussion.

Algorithms↗

Categorization of sentence types in medical abstracts.

This study evaluated the use of machine learning techniques in the classification of sentence type. 7253 structured abstracts and 204 unstructured abstracts of Randomized Controlled Trials from MedLINE were parsed into sentences and each sentence was labeled as one of four types (Introduction, Method, Result, or Conclusion). Support Vector Machine (SVM) and Linear Classifier models were generated and evaluated on cross-validated data. Treating sentences as a simple "bag of words", the SVM model had an average ROC area of 0.92. Adding a feature of relative sentence location improved performance markedly for some models and overall increasing the average ROC to 0.95. Linear classifier performance was significantly worse than the SVM in all datasets. Using the SVM model trained on structured abstracts to predict unstructured abstracts yielded performance similar to that of models trained with unstructured abstracts in 3 of the 4 types. We conclude that classification of sentence type seems feasible within the domain of RCT's. Identification of sentence types may be helpful for providing context to end users or other text summarization techniques.

Abstracting and Indexing↗

The hospital information system as a source for the planning and feed-back of specialized health care.

1. INTRODUCTION. In university hospitals, choices are made to which extend specialized health care will be supported. It is characteristic, for this type of care, that it takes place in a process of the continual advance of medical technology and the growing awareness by consumers and payors. Specialized healthcare contributes to the hospital qualifiers having a political and strategic impact. The hospital board needs information for planning and budgeting these new tasks. Much of the information will be based on data stored in the Hospital Information System (HIS). Due to load limitations, instant retrieval is not preferred. A separate executive information system, uploaded with HIS data, features statistics, on a corporate level, with the power to drill-down to detailed levels. However, the ability to supply information on new types of healthcare is limited since most of these topics require a flexible system for new dedicated cross-sections, like medical treatment from several specialisms and functional levels. 2. DATA RETRIEVAL AND DISTRIBUTION. During the information analysis, details were gathered on the necessary working procedures and the administrative organization, including the data registration in the HIS. In the next phase, all relevant data was organized in a relational datamodel. For each topic of care, dedicated views were developed at both low and high aggregation levels. It revealed that a matching change of the administrative organization was required, with an emphasis on financial registration aspects. For the selection of relevant data, a bottom-up approach was applied, which was based on the registrations starting from the patient administrative subsystem, through several transactional systems, ending at the general ledger in the HIS. Data on all levels was gathered, resulting in medical details presented in quantities, up to financial figures expressed in amounts of money. This procedure distinguishes from the predefined top-down techniques generally used for management and executive information systems. Data was regularly collected from the HIS, then converted and reorganized into relational datasets using XBase protocols. After having performed central quality controls and privacy protection measures, the datasets were distributed electronically to local PCs. Standard low-cost software packages enable analyses by user-friendly selection and presentation facilities. 3. EVALUATION. The method developed for data retrieval is flexible and easy to implement. If all basic data is registered in the HIS, the procedure can be applied for all strategic hospital functions that require planning and controlling during a certain time. Critical success factors and pitfalls will be presented in the poster. Using one consistent dataset, the information required about production and budget is presented at several functional levels and is quantified in units familiar to that level. The motivation for fast and accurate registration in the HIS was improved from the moment the medical and administrative staff recognized their own data in the feed-back on specialized health care.

Decision Making, Organizational↗

Presenting risk information to people with diabetes: evaluating effects and preferences for different formats by a web-based randomised controlled trial.

OBJECTIVE: Web-based patient information is widespread and information on the benefits and risks of treatments is often difficult to understand. We therefore evaluated different risk presentation formats - numerical, graphical and others - addressing the pros and cons of tight control versus usual treatment approaches for diabetes. METHOD DESIGN: Randomised controlled trial. SETTING: Online. Publicity disseminated via Diabetes UK. PARTICIPANTS: People with diabetes or their carers. INTERVENTIONS: Control group information based on British Medical Journal 'Best Treatments'. Four intervention groups received enhanced information resources: (1) detailed numerical information (absolute/relative risk, numbers-needed-to-treat); (2) 'anchoring' to familiar risks or descriptions; (3) graphical (bar charts, thermometer scales, crowd figure formats); (4) combination of 1-3. OUTCOMES: Decision conflict scale (DCS, a measure of uncertainty); satisfaction with information; further free text responses for qualitative content analysis. RESULTS: Seven hundred and ten people visited the website and were randomised. Five hundred and eight completed the questionnaire for quantitative data. Mean DCS scores ranged from 2.12 to 2.24 for the five randomisation groups, indicating neither clear delay or vacillation about decisions (usually DCS>2.5) nor tending to make decisions (usually DCS<2.0). There were no statistically significant effects of the interventions on DCS, or satisfaction with information. Two hundred and fifty-six participants provided responses for qualitative analysis: most found graphical representations helpful, specifically bar chart formats; many found other graphic formats (thermometer style, crowd figures/smiley faces) and 'anchoring' information unhelpful, and indicated information overload. Many negative experiences with healthcare indicate a challenging context for effective information provision and decision support. CONCLUSION: Online evaluation of different risk representation formats was feasible. There was a lack of intervention effects on quantitative outcomes, perhaps reflecting already well-informed participants from the Diabetes UK patient organisation. The large qualitative dataset included many comments about what participants found helpful as formats for communicating risk information. PRACTICE IMPLICATIONS: These findings assist the design of online decision aids and the representation of risk information. The challenge is to provide more information, in appropriate and clear formats, but without risking information overload. Interactive web designs hold much promise to achieve this.

Audiovisual Aids↗

Congenital Heart Surgery Nomenclature and Database Project: update and proposed data harvest.

The first report of The Society of Thoracic Surgeons (STS) National Congenital Heart Surgery Database in 1998 reported the clinical features of 18 congenital heart categories. The report provided a significant amount of important information and also highlighted the strengths and weaknesses of the existing database. Following this report the STS Congenital Heart Surgery Committee in cooperation with the European Association of Cardio-Thoracic Surgery and the European Congenital Heart Surgeons Foundation initiated the International Congenital Heart Surgery Nomenclature and Database Project. The goal was to begin the standardization of nomenclature reporting strategies and establish the foundations for an international congenital heart surgery database. The first report of the International Congenital Heart Surgery Nomenclature Project was published in The Annals of Thoracic Surgery in April 2000. The current report outlines modifications to the minimum dataset as well as the diagnoses and procedure short lists. Plans for the next STS National Congenital Heart Surgery Database harvest are also presented.

Cardiac Surgical Procedures↗

Bayesian models for the analysis of genetic structure when populations are correlated.

MOTIVATION: Population allele frequencies are correlated when populations have a shared history or when they exchange genes. Unfortunately, most models for allele frequency and inference about population structure ignore this correlation. Recent analytical results show that among populations, correlations can be very high, which could affect estimates of population genetic structure. In this study, we propose a mixture beta model to characterize the allele frequency distribution among populations. This formulation incorporates the correlation among populations as well as extending the model to data with different clusters of populations. RESULTS: Using simulated data, we show that in general, the mixture model provides a good approximation of the among-population allele frequency distribution and a good estimate of correlation among populations. Results from fitting the mixture model to a dataset of genotypes at 377 autosomal microsatellite loci from human populations indicate high correlation among populations, which may not be appropriate to neglect. Traditional measures of population structure tend to overestimate the amount of genetic differentiation when correlation is neglected. Inference is performed in a Bayesian framework. CONTACT: fur@ohsu.edu.

Bayes Theorem↗

Mathematical algorithm for discovering states of expression from direct genetic comparison by microarrays.

Highly specific direct genome-scale expression discovery from two biological samples facilitates functional discovery of molecular systems. Here, expression data from cDNA arrays are ranked and curve-fitted. The algorithm uses filters based on the derivatives (slopes) of the curve fits. The rules are set to (i) filter the largest number of artifactual ratios from same-to-same datasets and (ii) maximize discovery from direct comparisons of different samples. The unsupervised discovery is optimized without lowering specificity. The false discovery rates are significantly lower than other methods. The discovered states of genetic expression facilitate functional discovery and are validated by real-time RT-PCR. Better quality improves sensitivity.

Algorithms↗

Accelerated dynamic Fourier velocity encoding by exploiting velocity-spatio-temporal correlations.

OBJECTIVE: To describe how the information content in a Fourier velocity encoding (FVE) scan can be transformed into a very sparse representation and to develop a method that exploits the compactness of the data to significantly accelerate the acquisition. MATERIALS AND METHODS: For validation, fully sampled FVE datasets were acquired in phantom and in vivo experiments. Fivefold and eightfold acceleration was simulated by using only one fifth or one eighth of the data for reconstruction in the proposed method based on the k-t BLAST framework. Reconstructed images were compared quantitatively to those from the fully sampled data. RESULTS: Velocity spectra in the accelerated datasets were comparable to the spectra from fully sampled datasets. The detected peak velocities remained accurate even at eightfold acceleration, and the overall shape of the spectra was well preserved. Slight temporal smoothing was seen in the accelerated datasets. CONCLUSION: A novel technique for accelerating time-resolved FVE scan is presented. It is possible to accelerate FVE to acquisition speeds comparable to a standard time-resolved phase-contrast scan.

Algorithms↗

The association between quality improvement activities performed by managed care organizations and quality of care.

PURPOSE: Little data are available to assess the efforts of managed care organizations to improve quality of care. This analysis assessed differences in performance rates between organizations with and without quality improvement activities. METHODS: We reviewed 399 self-reported quality improvement activities submitted by organizations seeking accreditation by the National Committee for Quality Assurance. Processes or outcomes assessed in quality improvement activities were linked to corresponding measures in the effectiveness-of-care database of the Health Plan Employer Data and Information Set (HEDIS). Performance rates for managed care organizations with and without quality improvement activities were then compared. RESULTS: The cross-sectional analysis included 79 quality improvement activities from 50 organizations, covering 12 effectiveness-of-care categories. Each activity had a matching performance score in the database. Financial incentives for providers were associated with substantially higher performance rates in organizations employing this type of intervention. Eight effectiveness-of-care categories had at least four organizations reporting specific quality improvement activities for the care category of interest; statistically significant improvements were observed for follow-up visits for patients after hospitalization for mental illness, checkups after delivery, and screening for cervical cancer. CONCLUSION: Based on objective and audited information, the estimated effects of self-reported quality improvement activities were often small and inconsistent. In some instances, the observed effect was contrary to the expected direction. Limitations of the available dataset and the caveats of a cross-sectional study design precluded a number of analytical options. Longer-term, prospective studies are needed to explore further the relation between quality improvement activities and objective measures of clinical performance.

Accreditation↗

The Pregnancy Risk Assessment Monitoring System (PRAMS): methods and 1996 response rates from 11 states.

OBJECTIVES: To determine if the Pregnancy Risk Assessment Monitoring System (PRAMS) is a unique and valuable MCH data source and an effective mechanism for states to collect MCH data, and to assess if recent changes in it have improved efficiency and flexibility. METHODS: Each component of the PRAMS methodology is described: sampling and stratification, data collection, questionnaire, and data management and weighting. To assess effectiveness, we calculated response rates, contact rates, cooperation rates, refusal rates, and questionnaire completion rates. Logistic regression was used to examine the relationship between maternal and infant characteristics and the likelihood of response. Four criteria were defined to measure improvement in PRAMS functioning. RESULTS: Overall response rates for the 11 states in 1996 ranged from 66% to 80%. Cooperation rates were high (85-99%), with contact rates somewhat lower (73-87%). Response rates were higher for women who were older, White, married, had more education, were first-time mothers, and had a normal-birthweight infant. In all states, parity and education were the most consistent predictors of response, followed by marital status and race. Between 1988-1990 and 1996-1999, the number of states and areas participating in PRAMS increased from 6 to 23, response rates improved, and the time for a state to start data collection and to obtain a weighted dataset both decreased. CONCLUSIONS: PRAMS is a unique and valuable MCH data source. The mail/telephone methodology used in PRAMS is an effective means of reaching most women who have recently given birth in the 11 states examined; however, some population subgroups are not reached as well as others. The system has become more efficient and flexible over time and more states now participate.

Centers for Disease Control and Prevention, U.S.↗