Possible counter-intuitive impact of local vaccine mandates for vaccine-preventable infectious diseases.

We modeled the impact of local vaccine mandates on the spread of vaccine-preventable infectious diseases, which in the absence of vaccines will mainly affect children. Examples of such diseases are measles, rubella, mumps, and pertussis. To model the spread of the pathogen, we used a stochastic SIR (susceptible, infectious, recovered) model with two levels of mixing in a closed population, often referred to as the household model. In this model, individuals make local contacts within a specific small subgroup of the population (e.g., within a household or a school class), while they also make global contacts with random people in the population at a much lower rate than the rate of local contacts. We considered what would happen if schools were given freedom to impose vaccine mandates on all of their pupils, except for the pupils that were exempt from vaccination because of medical reasons. We investigated first how such a mandate affected the probability of an outbreak of a disease. Furthermore, we focused on the probability that a pupil that was medically exempt from vaccination, would get infected during an outbreak. We showed that if the population vaccine coverage was close to the herd-immunity level, then both probabilities may increase if local vaccine mandates were implemented. This was caused by unvaccinated pupils possibly being moved to schools without mandates.

Mathematical modeling in semelparous biological species through two-sex branching processes.

This research focused its interest on the mathematical modeling of the demographic dynamics of semelparous biological species through branching processes. We continued the research line started in previous papers, providing new methodological contributions of biological and ecological interest. We determined the probability distribution associated with the number of generations elapsed before the possible extinction of the population in its natural habitat. We mathematically modeled the phenomenon of populating or repopulating habitats with semelparous species. We also proposed estimates for the offspring parameters governing the reproductive strategies of the species. To this purpose, we used the maximum likelihood and Bayesian estimation methodologies. The statistical results are illustrated through a simulated example contextualized with Labord chameleon (Furcifer labordi) species.

A Bayesian Analysis of the Probability of the Origin of Life Per Site Conducive to Abiogenesis.

The emergence of life from nonlife, or abiogenesis, remains a fundamental question in scientific inquiry. In this article, we investigate the probability of the origin of life (per conducive site) by leveraging insights from Earth's environments. If life originated endogenously on Earth, its existence is indeed endowed with informative value, although the interpretation of the attendant significance hinges critically upon prior assumptions. By adopting a Bayesian framework, for an agnostic prior, we establish a direct connection between the number of potential locations for abiogenesis on Earth and the probability of life's emergence per site. Our findings suggest that constraints on the availability of suitable environments for the origin(s) of life on Earth may offer valuable insights into the probability of abiogenesis and the frequency of life in the universe.

Variational Supertrees for Bayesian Phylogenetics.

Bayesian phylogenetic inference is powerful but computationally intensive. Researchers may find themselves with two phylogenetic posteriors on overlapping data sets and may wish to approximate a combined result without having to re-run potentially expensive Markov chains on the combined data set. This raises the question: given overlapping subsets of a set of taxa (e.g. species or virus samples), and given posterior distributions on phylogenetic tree topologies for each of these taxon sets, how can we optimize a probability distribution on phylogenetic tree topologies for the entire taxon set? In this paper we develop a variational approach to this problem and demonstrate its effectiveness. Specifically, we develop an algorithm to find a suitable support of the variational tree topology distribution on the entire taxon set, as well as a gradient-descent algorithm to minimize the divergence from the restrictions of the variational distribution to each of the given per-subset probability distributions, in an effort to approximate the posterior distribution on the entire taxon set.

A practically efficient algorithm for identifying critical control proteins in directed probabilistic biological networks.

Network controllability is unifying the traditional control theory with the structural network information rooted in many large-scale biological systems of interest, from intracellular networks in molecular biology to brain neuronal networks. In controllability approaches, the set of minimum driver nodes is not unique, and critical nodes are the most important control elements because they appear in all possible solution sets. On the other hand, a common but largely unexplored feature in network control approaches is the probabilistic failure of edges or the uncertainty in the determination of interactions between molecules. This is particularly true when directed probabilistic interactions are considered. Until now, no efficient algorithm existed to determine critical nodes in probabilistic directed networks. Here we present a probabilistic control model based on a minimum dominating set framework that integrates the probabilistic nature of directed edges between molecules and determines the critical control nodes that drive the entire network functionality. The proposed algorithm, combined with the developed mathematical tools, offers practical efficiency in determining critical control nodes in large probabilistic networks. The method is then applied to the human intracellular signal transduction network revealing that critical control nodes are associated with important biological features and perturbed sets of genes in human diseases, including SARS-CoV-2 target proteins and rare disorders. We believe that the proposed methodology can be useful to investigate multiple biological systems in which directed edges are probabilistic in nature, both in natural systems or when determined with large uncertainties in-silico.

Using joint probability density to create most informative unidimensional indices: a new method using pain and psychiatric severity as examples.

BACKGROUND: Dimension reduction methods do not always reduce their underlying indicators to a single composite score. Furthermore, such methods are usually based on optimality criteria that require discarding some information. We suggest, under some conditions, to use the joint probability density function (joint pdf or JPD) of p-dimensional random variable (the p indicators), as an index or a composite score. It is proved that this index is more informative than any alternative composite score. In two examples, we compare the JPD index with some alternatives constructed from traditional methods. METHODS: We develop a probabilistic unsupervised dimension reduction method based on the probability density of multivariate data. We show that the conditional distribution of the variables given JPD is uniform, implying that the JPD is the most informative scalar summary under the most common notions of information. B. We show under some widely plausible conditions, JPD can be used as an index. To use JPD as an index, in addition to having a plausible interpretation, all the random variables should have approximately the same direction(unidirectionality) as the density values (codirectionality). We applied these ideas to two data sets: first, on the 7 Brief Pain Inventory Interference scale (BPI-I) items obtained from 8,889 US Veterans with chronic pain and, second, on a novel measure based on administrative data for 912 US Veterans. To estimate the JPD in both examples, among the available JPD estimation methods, we used its conditional specifications, identified a well-fitted parametric model for each factored conditional (regression) specification, and, by maximizing the corresponding likelihoods, estimated their parameters. Due to the non-uniqueness of conditional specification, the average of all estimated conditional specifications was used as the final estimate. Since a prevalent common use of indices is ranking, we used measures of monotone dependence [e.g., Spearman's rank correlation (rho)] to assess the strength of unidirectionality and co-directionality. Finally, we cross-validate the JPD score against variance-covariance-based scores (factor scores in unidimensional models), and the "person's parameter" estimates of (Generalized) Partial Credit and Graded Response IRT models. We used Pearson Divergence as a measure of information and Shannon's entropy to compare uncertainties (informativeness) in these alternative scores. RESULTS: An unsupervised dimension reduction was developed based on the joint probability density (JPD) of the multi-dimensional data. The JPD, under regularity conditions, may be used as an index. For the well-established Brief Pain Interference Inventory (BPI-I (the short form with 7 Items) and for a new mental health severity index (MoPSI) with 6 indicators, we estimated the JPD scoring. We compared, assuming unidimensionality, factor scores, Person's scores of the Partial Credit model, the Generalized Partial Credit model, and the Graded Response model with JPD scoring. As expected, all scores' rankings in both examples were monotonically dependent with various strengths. Shannon entropy was the smallest for JPD scores. Pearson Divergence of the estimated densities of different indices against uniform distribution was maximum for JPD scoring. CONCLUSIONS: An unsupervised probabilistic dimension reduction is possible. When appropriate, the joint probability density function can be used as the most informative index. Model specification and estimation and steps to implement the scoring were demonstrated. As expected, when the required assumption in factor analysis and IRT models are satisfied, JPD scoring agrees with these established scores. However, when these assumptions are violated, JPD scores preserve all the information in the indicators with minimal assumption.

Inverse probability weighting for self-selection bias correction in the investigation of social inequality in mortality.

BACKGROUND: Empirical evaluation of inverse probability weighting (IPW) for self-selection bias correction is inaccessible without the full source population. We aimed to: (i) investigate how self-selection biases frequency and association measures and (ii) assess self-selection bias correction using IPW in a cohort with register linkage. METHODS: The source population included 17 936 individuals invited to the Copenhagen Aging and Midlife Biobank during 2009-11 (ages 49-63 years). Participants counted 7185 (40.1%). Register data were obtained for every invited person from 7 years before invitation to the end of 2020. The association between education and mortality was estimated using Cox regression models among participants, IPW participants and the source population. RESULTS: Participants had higher socioeconomic position and fewer hospital contacts before baseline than the source population. Frequency measures of participants approached those of the source population after IPW. Compared with primary/lower secondary education, upper secondary, short tertiary, bachelor and master/doctoral were associated with reduced risk of death among participants (adjusted hazard ratio [95% CI]: 0.60 [0.46; 0.77], 0.68 [0.42; 1.11], 0.37 [0.25; 0.54], 0.28 [0.18; 0.46], respectively). IPW changed the estimates marginally (0.59 [0.45; 0.77], 0.57 [0.34; 0.93], 0.34 [0.23; 0.50], 0.24 [0.15; 0.39]) but not only towards those of the source population (0.57 [0.51; 0.64], 0.43 [0.32; 0.60], 0.38 [0.32; 0.47], 0.22 [0.16; 0.29]). CONCLUSIONS: Frequency measures of study participants may not reflect the source population in the presence of self-selection, but the impact on association measures can be limited. IPW may be useful for (self-)selection bias correction, but the returned results can still reflect residual or other biases and random errors.

SurvdigitizeR: an algorithm for automated survival curve digitization.

BACKGROUND: Decision analytic models and meta-analyses often rely on survival probabilities that are digitized from published Kaplan-Meier (KM) curves. However, manually extracting these probabilities from KM curves is time-consuming, expensive, and error-prone. We developed an efficient and accurate algorithm that automates extraction of survival probabilities from KM curves. METHODS: The automated digitization algorithm processes images from a JPG or PNG format, converts them in their hue, saturation, and lightness scale and uses optical character recognition to detect axis location and labels. It also uses a k-medoids clustering algorithm to separate multiple overlapping curves on the same figure. To validate performance, we generated survival plots form random time-to-event data from a sample size of 25, 50, 150, and 250, 1000 individuals split into 1,2, or 3 treatment arms. We assumed an exponential distribution and applied random censoring. We compared automated digitization and manual digitization performed by well-trained researchers. We calculated the root mean squared error (RMSE) at 100-time points for both methods. The algorithm's performance was also evaluated by Bland-Altman analysis for the agreement between automated and manual digitization on a real-world set of published KM curves. RESULTS: The automated digitizer accurately identified survival probabilities over time in the simulated KM curves. The average RMSE for automated digitization was 0.012, while manual digitization had an average RMSE of 0.014. Its performance was negatively correlated with the number of curves in a figure and the presence of censoring markers. In real-world scenarios, automated digitization and manual digitization showed very close agreement. CONCLUSIONS: The algorithm streamlines the digitization process and requires minimal user input. It effectively digitized KM curves in simulated and real-world scenarios, demonstrating accuracy comparable to conventional manual digitization. The algorithm has been developed as an open-source R package and as a Shiny application and is available on GitHub: https://github.com/Pechli-Lab/SurvdigitizeR and https://pechlilab.shinyapps.io/SurvdigitizeR/ .

Probabilistic prediction and context tree identification in the Goalkeeper game.

In this article we address two related issues on the learning of probabilistic sequences of events. First, which features make the sequence of events generated by a stochastic chain more difficult to predict. Second, how to model the procedures employed by different learners to identify the structure of sequences of events. Playing the role of a goalkeeper in a video game, participants were told to predict step by step the successive directions-left, center or right-to which the penalty kicker would send the ball. The sequence of kicks was driven by a stochastic chain with memory of variable length. Results showed that at least three features play a role in the first issue: (1) the shape of the context tree summarizing the dependencies between present and past directions; (2) the entropy of the stochastic chain used to generate the sequences of events; (3) the existence or not of a deterministic periodic sequence underlying the sequences of events. Moreover, evidence suggests that best learners rely less on their own past choices to identify the structure of the sequences of events.

Seasonal variability and stochastic branching process in malaria outbreak probability.

BACKGROUND: Malaria is the world's most fatal and challenging parasitic disease, caused by the Plasmodium parasite, which is transmitted to humans by the bites of infected female mosquitoes. Bangladesh is the most vulnerable region to spread malaria because of its geographic position. In this paper, we have considered the dynamics of vector-host models and observed the stochastic behavior. This study elaborates on the seasonal variability and calculates the probability of disease outbreaks. METHODS: We present a model for malaria disease transmission and develop its corresponding continuous-time Markov chain (CTMC) representation. The proposed vector-host models illustrate the malaria transmission model along with sensitivity analysis. The deterministic model with CTMC curves is depicted to show the randomness in real scenarios. Sequentially, we expand these studies to a time-varying stochastic vector-host model that incorporates seasonal variability. Phase plane analysis is conducted to explore the characteristics of the disease, examine interactions among various compartments, and evaluate the impact of key parameters. The branching process approximation is developed for the corresponding vector-host model to calculate the probability outbreak. Numerous numerical results are accomplished to observe the analytical investigation. RESULTS: Seasonality and contact patterns affect the dynamics of disease outbreaks. The numerical illustration provides that the probability of a disease outbreak depends on the infected host or vector. Additionally, periodic transmission rates have a great influence on the probability outbreak. The basic reproduction number (R0) is derived, which is the main justification for studying the dynamical behavior of epidemic models. CONCLUSIONS: Seasonal variability significantly impacts malaria transmission, and the probability of disease outbreaks is influenced by time and the initial number of infected individuals. Moreover, the branching process approximation is applicable when the population size is large enough and the basic reproduction number is less than 1. In the future, such analysis can help decision-makers understand the impact of various parameters and their stochastic behavior in the vector-host model to prevent such types of disease outbreaks.

Assessment of tuberculosis transmission probability in three Thai prisons based on five dynamic models.

This study aimed to assess and compare the probability of tuberculosis (TB) transmission based on five dynamic models: the Wells-Riley equation, two Rudnick & Milton-proposed models based on air changes per hour (ACH) and liters per second per person (L/s/p), the model proposed by Issarow et al, and the Applied Susceptible-Exposed-Infected-Recovered (SEIR) TB transmission model. This study also aimed to determine the impact of model parameters on such probabilities in three Thai prisons. A cross-sectional study was conducted using data from 985 prison cells. The TB transmission probability for each cell was calculated using parameters relevant to the specific model formula, and the magnitude of the model agreement was examined by Spearman's rank correlation and Bland-Altman plot. Subsequently, a multiple linear regression analysis was conducted to investigate the influence of each model parameter on the estimated probability. Results revealed that the median (Quartiles 1 and 3) of TB transmission probability among these cells was 0.052 (0.017, 0.180). Compared with the pioneered Wells-Riley's model, the remaining models projected discrepant TB transmission probability from less to more commensurate to the degree of model modification from the pioneered model as follows: Rudnick & Milton (ACH), Issarow et al., and Rudnick & Milton (L/s/p), and the applied SEIR models. The ventilation rate and number of infectious TB patients in each cell or zone had the greatest impact on the estimated TB transmission probability in most models. Additionally, the number of inmates in each cell, the area per person in square meters, and the inmate turnover rate were identified as high-impact parameters in the applied SEIR model. All stakeholders must urgently address these influential parameters to reduce TB transmission in prisons. Moreover, further studies are required to determine their relative validity in accurately predicting TB incidence in prison settings.

RBE-based dose planning, and calculation of TCP and NTCP with gold nanoparticles for intermediate photon energy in pancreatic cancer.

Objective.This study simulated the potential of gold nanoparticles (GNPs) to improve the effectiveness of radiation therapy in pancreatic cancer cases. The purpose of this study was to assess the impact of GNPs on tumor control probability (TCP) and normal tissue complication probability (NTCP) in pancreatic cancer cases undergoing radiation therapy. The work aimed to compare treatment plans generated with a novel 2.5 MV beam using GNPs to conventional 6 MV plans and evaluate the dose-volume histogram (DVH), TCP, and NTCP.Approach.Treatment planning for five pancreatic computed tomography (CT) images was performed using the open-source MATLAB-based treatment planning program matRad. MATLAB codes were developed to calculate the relative biological effectiveness (RBE) of GNPs and apply the corresponding dose and RBE values to each voxel. TCP and NTCP were calculated based on the applied RBE values.Main results.Adding GNPs to the 2.5 MV treatment plan resulted in a significant increase in TCP, from around 59% to 93.5%, indicating that the inclusion of GNPs improved the effectiveness of the radiation treatment. The range in NTCP without GNPs was relatively larger compared to that with GNPs.Significance.The results indicated that the addition of GNPs to a 2.5 MV plan can increase TCP while maintaining a relatively low NTCP value (<1%). The use of GNPs may also reduce NTCP values by decreasing the dose to normal tissues while maintaining the same prescribed dose to the tumor. Hence, the addition of GNPs can improve the balance between TCP and NTCP.

An online tool using clinical factors to estimate the probability of partial clinical remission of adult-onset Type 1 diabetes.

A type 1 diabetes (T1D) diagnosis is often followed by a period of reduced exogenous insulin requirement, with acceptable glucose control, called partial clinical remission (pCR). Various criteria exist to define pCR, which is associated with better clinical outcomes. We aimed to develop formulae and a related online calculator to predict the probability of pCR at 3- and 12-months post-T1D diagnosis. We analysed data from 133 adults at their T1D diagnosis (mean ± SD age: 27 ± 6 yrs., HbA1c 11.1 ± 2.0 %, 98 ± 22 mmol/mol), 3- and 12-months later. All patients were enrolled in the prospective observational InLipoDiab1 study (NCT02306005). We compared four definitions of pCR: 1) stimulated C-peptide >300 pmol/l; 2) insulin dose-adjusted HbA1c ≤9 %; 3) insulin dose <0.3 IU/kg/24 h; and HbA1c ≤6.4 % (46 mmol/mol); and 4) insulin dose <0.5 IU/kg/24 h and HbA1c <7 % (53 mmol/mol). Using readily available demographics and clinical chemistry data exhaustive search methodology was used to model pCR probability. There was low concordance between pCR definitions (kappa 0.10). The combination of age, HbA1c, diastolic blood pressure, triglycerides and smoking at T1D onset predicted pCR at 12-months with an area under the curve (AUC) = 0.87. HbA1c, triglycerides and insulin dose 3-mths post-diagnosis had an AUC = 0.89. A related calculator for pCR in adult-onset T1D is available at http://www.bit.ly/T1D-partial-remission.

A low-dimensional approximation of optimal confidence.

Human decision making is accompanied by a sense of confidence. According to Bayesian decision theory, confidence reflects the learned probability of making a correct response, given available data (e.g., accumulated stimulus evidence and response time). Although optimal, independently learning these probabilities for all possible data combinations is computationally intractable. Here, we describe a novel model of confidence implementing a low-dimensional approximation of this optimal yet intractable solution. This model allows efficient estimation of confidence, while at the same time accounting for idiosyncrasies, different kinds of biases and deviation from the optimal probability correct. Our model dissociates confidence biases resulting from the estimate of the reliability of evidence by individuals (captured by parameter α), from confidence biases resulting from general stimulus independent under and overconfidence (captured by parameter ß). We provide empirical evidence that this model accurately fits both choice data (accuracy, response time) and trial-by-trial confidence ratings simultaneously. Finally, we test and empirically validate two novel predictions of the model, namely that 1) changes in confidence can be independent of performance and 2) selectively manipulating each parameter of our model leads to distinct patterns of confidence judgments. As a tractable and flexible account of the computation of confidence, our model offers a clear framework to interpret and further resolve different forms of confidence biases.

Probability density and information entropy of machine learning derived intracranial pressure predictions.

Even with the powerful statistical parameters derived from the Extreme Gradient Boost (XGB) algorithm, it would be advantageous to define the predicted accuracy to the level of a specific case, particularly when the model output is used to guide clinical decision-making. The probability density function (PDF) of the derived intracranial pressure predictions enables the computation of a definite integral around a point estimate, representing the event's probability within a range of values. Seven hold-out test cases used for the external validation of an XGB model underwent retinal vascular pulse and intracranial pressure measurement using modified photoplethysmography and lumbar puncture, respectively. The definite integral ±1 cm water from the median (DIICP) demonstrated a negative and highly significant correlation (-0.5213±0.17, p< 0.004) with the absolute difference between the measured and predicted median intracranial pressure (DiffICPmd). The concordance between the arterial and venous probability density functions was estimated using the two-sample Kolmogorov-Smirnov statistic, extending the distribution agreement across all data points. This parameter showed a statistically significant and positive correlation (0.4942±0.18, p< 0.001) with DiffICPmd. Two cautionary subset cases (Case 8 and Case 9), where disagreement was observed between measured and predicted intracranial pressure, were compared to the seven hold-out test cases. Arterial predictions from both cautionary subset cases converged on a uniform distribution in contrast to all other cases where distributions converged on either log-normal or closely related skewed distributions (gamma, logistic, beta). The mean±standard error of the arterial DIICP from cases 8 and 9 (3.83±0.56%) was lower compared to that of the hold-out test cases (14.14±1.07%) the between group difference was statistically significant (p<0.03). Although the sample size in this analysis was limited, these results support a dual and complementary analysis approach from independently derived retinal arterial and venous non-invasive intracranial pressure predictions. Results suggest that plotting the PDF and calculating the lower order moments, arterial DIICP, and the two sample Kolmogorov-Smirnov statistic may provide individualized predictive accuracy parameters.

Morphological patterns and spatial probability maps of the inferior frontal sulcus in the human brain.

The inferior frontal sulcus (ifs) is a prominent sulcus on the lateral frontal cortex, separating the middle frontal gyrus from the inferior frontal gyrus. The morphology of the ifs can be difficult to distinguish from adjacent sulci, which are often misidentified as continuations of the ifs. The morphological variability of the ifs and its relationship to surrounding sulci were examined in 40 healthy human subjects (i.e., 80 hemispheres). The sulci were identified and labeled on the native cortical surface meshes of individual subjects, permitting proper intra-sulcal assessment. Two main morphological patterns of the ifs were identified across hemispheres: in Type I, the ifs was a single continuous sulcus, and in Type II, the ifs was discontinuous and appeared in two segments. The morphology of the ifs could be further subdivided into nine subtypes based on the presence of anterior and posterior sulcal extensions. The ifs was often observed to connect, either superficially or completely, with surrounding sulci, and seldom appeared as an independent sulcus. The spatial variability of the ifs and its various morphological configurations were quantified in the form of surface spatial probability maps which are made publicly available in the standard fsaverage space. These maps demonstrated that the ifs generally occupied a consistent position across hemispheres and across individuals. The normalized mean sulcal depths associated with the main morphological types were also computed. The present study provides the first detailed description of the ifs as a sulcal complex composed of segments and extensions that can be clearly differentiated from adjacent sulci. These descriptions, together with the spatial probability maps, are critical for the accurate identification of the ifs in anatomical and functional neuroimaging studies investigating the structural characteristics and functional organization of this region in the human brain.

From Wald to Schnorr: von Mises' definition of randomness in the aftermath of Ville's Theorem.

The first formal definition of randomness, seen as a property of sequences of events or experimental outcomes, dates back to Richard von Mises' work in the foundations of probability and statistics. The randomness notion introduced by von Mises is nowadays widely regarded as being too weak. This is, to a large extent, due to the work of Jean Ville, which is often described as having dealt the death blow to von Mises' approach, and which was integral to the development of algorithmic randomness-the now-standard theory of randomness for elements of a probability space. The main goal of this article is to trace the history and provide an in-depth appraisal of two lesser-known, yet historically and methodologically notable proposals for how to modify von Mises' definition so as to avoid Ville's objection. The first proposal is due to Abraham Wald, while the second one is due to Claus-Peter Schnorr. We show that, once made precise in a natural way using computability theory, Wald's proposal constitutes a much more radical departure from von Mises' framework than intended. Schnorr's proposal, on the other hand, does provide a partial vindication of von Mises' approach: it demonstrates that it is possible to obtain a satisfactory randomness notion-indeed, a canonical algorithmic randomness notion-by characterizing randomness in terms of the invariance of limiting relative frequencies. More generally, we argue that Schnorr's proposal, together with a number of little-known related results, reveals that there is more continuity than typically acknowledged between von Mises' approach and algorithmic randomness. Even though von Mises' exclusive focus on limiting relative frequencies did not survive the passage to the theory of algorithmic randomness, another crucial aspect of his conception of randomness did endure; namely, the idea that randomness amounts to a certain type of stability or invariance under an appropriate class of transformations.

From pre-test and post-test probabilities to medical decision making.

BACKGROUND: A central goal of modern evidence-based medicine is the development of simple and easy to use tools that help clinicians integrate quantitative information into medical decision-making. The Bayesian Pre-test/Post-test Probability (BPP) framework is arguably the most well known of such tools and provides a formal approach to quantify diagnostic uncertainty given the result of a medical test or the presence of a clinical sign. Yet, clinical decision-making goes beyond quantifying diagnostic uncertainty and requires that that uncertainty be balanced against the various costs and benefits associated with each possible decision. Despite increasing attention in recent years, simple and flexible approaches to quantitative clinical decision-making have remained elusive. METHODS: We extend the BPP framework using concepts of Bayesian Decision Theory. By integrating cost, we can expand the BPP framework to allow for clinical decision-making. RESULTS: We develop a simple quantitative framework for binary clinical decisions (e.g., action/inaction, treat/no-treat, test/no-test). Let p be the pre-test or post-test probability that a patient has disease. We show that r ∗ = ( 1 - p ) / p represents a critical value called a decision boundary. In terms of the relative cost of under- to over-acting, r ∗ represents the critical value at which action and inaction are equally optimal. We demonstrate how this decision boundary can be used at the bedside through case studies and as a research tool through a reanalysis of a recent study which found widespread misestimation of pre-test and post-test probabilities among clinicians. CONCLUSIONS: Our approach is so simple that it should be thought of as a core, yet previously overlooked, part of the BPP framework. Unlike prior approaches to quantitative clinical decision-making, our approach requires little more than a hand-held calculator, is applicable in almost any setting where the BPP framework can be used, and excels in situations where the costs and benefits associated with a particular decision are patient-specific and difficult to quantify.

Robustness and exploration between the interplay of the nonlinear co-dynamics HIV/AIDS and pneumonia model via fractional differential operators and a probabilistic approach.

In this article, we considered a nonlinear compartmental mathematical model that assesses the effect of treatment on the dynamics of HIV/AIDS and pneumonia (H/A-P) co-infection in a human population at different infection stages. Understanding the complexities of co-dynamics is now critically necessary as a consequence. The aim of this research is to construct a co-infection model of H/A-P in the context of fractional calculus operators, white noise and probability density functions, employing a rigorous biological investigation. By exhibiting that the system possesses non-negative and bounded global outcomes, it is shown that the approach is both mathematically and biologically practicable. The required conditions are derived, guaranteeing the eradication of the infection. Furthermore, adequate prerequisites are established, and the configuration is tested for the existence of an ergodic stationary distribution. For discovering the system's long-term behavior, a deterministic-probabilistic technique for modeling is designed and operated in MATLAB. By employing an extensive review, we hope that the previously mentioned approach improves and leads to mitigating the two diseases and their co-infections by examining a variety of behavioral trends, such as transitions to unpredictable procedures. In addition, the piecewise differential strategies are being outlined as having promising potential for scholars in a range of contexts because they empower them to include particular characteristics across multiple time frame phases. Such formulas can be strengthened via classical techniques, power law, exponential decay, generalized Mittag-Leffler kernels, probability density functions and random procedures. Furthermore, we get an accurate description of the probability density function encircling a quasi-equilibrium point if the effect of H/A-P minimizes the propagation of the co-dynamics. Consequently, scholars can obtain better outcomes when analyzing facts using random perturbations by implementing these strategies for challenging issues. Random perturbations in H/A-P co-infection are crucial in controlling the spread of an epidemic whenever the suggested circulation is steady and the amount of infection eliminated is closely correlated with the random perturbation level.

Risk management in a clinical pathology laboratory: Application of brainstorming and probability analysis for risk reduction.

INTRODUCTION: Risk management includes identifying various risks, assessing the probability of occurrence, and evaluating the severity of their consequences. As clinical laboratories are integrally involved in patient care, risks in the laboratories could present grave consequences in some instances. This study aimed to utilize simple techniques for risk management in a clinical laboratory. MATERIALS AND METHODS: All potential risks in the pathology laboratory of a tertiary-level hospital were identified and classified into natural calamity, environmental, manpower-related, pre-analytical, analytical, post-analytical, and laboratory hazard-related risks through a brainstorming session. The probability of occurrence of each risk was estimated from departmental and hospital records. The possible impact of risk (score 1-10) was categorized into catastrophic, critical, serious, minor negligible, and insignificant. The unweighted risk score was calculated by multiplying the probability of occurrence and impact score. RESULTS: Inadequate sample-to-anticoagulant ratio had the highest probability of occurrence (22.85%), followed by quantity insufficient for analysis (7.30%) and laboratory information system (LIS) breakdown (6.58%). The highest unweighted risk score in our study was inadequate sample-to-anticoagulant ratio (score 91.40), followed by improperly labeled samples (score 35.61), manpower competency issues (score 32.88), sample insufficient for analysis (score 29.20), and LIS breakdown (score 26.30). CONCLUSION: We found that among all the categories, risks involving the pre-analytical phase had the highest risk scores. The other important risks included manpower competency issues requiring continued on-the-job training of staff as a risk reduction strategy. Brainstorming and probability analysis could be easily used for risk management in a clinical laboratory.