Podcast 3. Lessons learned: managing financial costs and where you can go for more information.

The patient authors with over 48 years of combined real-world experience with chronic myeloid leukemia, and a healthcare professional, use their own personal experiences to describe the factors that may affect the patien-doctor relationship, patient care and outcomes. The authors believe that this podcast series and associated manuscript will aid both patients and healthcare professionals to improve their patient-doctor relationships and communication through diagnosis, treatment decision-making and learning to live with CML (or another disease). In this episode, they discuss managing financial costs and where to find resources and support groups.

Accuracy and prognostic impact of FDG PET/CT and biopsy in bone marrow assessment of follicular lymphoma at diagnosis: A Nation-Wide cohort study.

BACKGOUND: In the workup of follicular lymphoma (FL), bone marrow biopsy (BMB) assessment is a key component of FLIPI and FLIPI2, the most widely used outcome scores. During the previous decade, several studies explored the role of FDG-PET/CT for detecting nodal and extranodal disease, with only one large study comparing both techniques. METHODS: The aim of our study was to evaluate the diagnostic accuracy and the prognostic impact of both procedures in a retrospective cohort of 299 FL patients with both tests performed at diagnosis. In order to avoid a collinearity bias, FLIPI2 was deconstructed in its founding parameters, and the bone marrow involvement (BMI) parameter separately included as: a positive BMB, a positive PET/CT, the combined "PET/CT and BMB positive" or "PET/CT or BMB positive". These variables were also confronted independently with the POD24 in 233 patients treated with intensive regimens. RESULTS: In the total cohort, bone marrow was involved in 124 and 60 patients by BMB and PET/CT, respectively. In terms of overall survival, age > 60 y.o. and the combined "PET/CT or BMB positive" achieved statistical independence as a prognostic factor. In patients treated with an intensive regimen, only the combined "PET/CT or BMB positive" added prognostic value for a shorter overall survival, when confronted with the POD24. CONCLUSION: Our results show that in FL both BMB and PET/CT should be considered at diagnosis, as their combined assessment provides independent prognostic value in the context of the most widely use clinical scores.

Maximizing Interpretability and Cost-Effectiveness of Surgical Site Infection (SSI) Predictive Models Using Feature-Specific Regularized Logistic Regression on Preoperative Temporal Data.

This study describes a novel approach to solve the surgical site infection (SSI) classification problem. Feature engineering has traditionally been one of the most important steps in solving complex classification problems, especially in cases with temporal data. The described novel approach is based on abstraction of temporal data recorded in three temporal windows. Maximum likelihood L1-norm (lasso) regularization was used in penalized logistic regression to predict the onset of surgical site infection occurrence based on available patient blood testing results up to the day of surgery. Prior knowledge of predictors (blood tests) was integrated in the modelling by introduction of penalty factors depending on blood test prices and an early stopping parameter limiting the maximum number of selected features used in predictive modelling. Finally, solutions resulting in higher interpretability and cost-effectiveness were demonstrated. Using repeated holdout cross-validation, the baseline C-reactive protein (CRP) classifier achieved a mean AUC of 0.801, whereas our best full lasso model achieved a mean AUC of 0.956. Best model testing results were achieved for full lasso model with maximum number of features limited at 20 features with an AUC of 0.967. Presented models showed the potential to not only support domain experts in their decision making but could also prove invaluable for improvement in prediction of SSI occurrence, which may even help setting new guidelines in the field of preoperative SSI prevention and surveillance.

Cardiovascular risk assessment in prediabetic patients in a hypertensive population: The role of cystatin C.

BACKGROUND: The aim of our study was to determine whether prediabetes increases cardiovascular (CV) risk compared to the non-prediabetic patients in our hypertensive population. Once this was achieved, the objective was to identify relevant CV prognostic features among prediabetic individuals. METHODS: We included hypertensive 1652 patients. The primary outcome was a composite of incident CV events: cardiovascular death, stroke, heart failure and myocardial infarction. We performed a Cox proportional hazard regression to assess the CV risk of prediabetic patients compared to non-prediabetic and to produce a survival model in the prediabetic cohort. RESULTS: The risk of developing a CV event was higher in the prediabetic cohort than in the non-prediabetic cohort, with a hazard ratio (HR) = 1.61, 95% CI 1.01-2.54, p = 0.04. Our Cox proportional hazard model selected age (HR = 1.04, 95% CI 1.02-1.07, p < 0.001) and cystatin C (HR = 2.4, 95% CI 1.26-4.22, p = 0.01) as the most relevant prognostic features in our prediabetic patients. CONCLUSIONS: Prediabetes was associated with an increased risk of CV events, when compared with the non-prediabetic patients. Age and cystatin C were found as significant risk factors for CV events in the prediabetic cohort.

TrapSeq: An RNA Sequencing-Based Pipeline for the Identification of Gene-Trap Insertions in Mammalian Cells.

The development of haploid mammalian cell lines, coupled to next-generation sequencing, has recently facilitated forward genetic screenings in mammals. For mutagenesis, retrovirus- or transposon-based gene traps are frequently used. Current methods to map gene-trap insertions are based on inverse or splinkerette PCR, which despite their efficacy are prone to artifacts and do not provide information on expression of the targeted gene. Here, we describe a new RNA sequencing-based method (TrapSeq) to map gene-trap insertions. By recognizing chimeric mRNAs containing gene-trap sequences spliced to an exon, our method identifies insertions that lead to productive trapping. When applied to individual mutant clones, our method provides a fast and cost-effective way that not only identifies the insertion site but also reveals its impact on the expression of the trapped gene. As proof of principle, we conducted two independent screenings for resistance against 6-thioguanine and an ATR inhibitor, which identified mutations known to provide resistance to these reagents and revealed ECT2 as a novel determinant for the sensitivity to ATR inhibition.

Probabilistic assessment of the intake of trace elements by consumption of weaning foods in Spain.

A probabilistic model was developed to estimate the intake level for Fe, Zn, Ca, P, Mg, Mn, Cu, Na, and K derived from consumption of weaning foods in Spain. They were pooled into 10 different categories based on the main ingredient used in its formulation (chicken, chicken-veal, hake, ham, varied vegetables, chicken-ham, lamb, veal, sole, and beef-ham). The results reported that trace elements contents were especially low and inadequate according to the Dietary Reference Intake especially to Fe, Zn, and Ca and in less extent for Cu and P. Instead, Na contents were moderately high and near to upper limit of this element.

A Spanish version of the Athens Insomnia Scale.

OBJECTIVES: To develop and validate a Spanish version of the Athens Insomnia Scale (AIS). METHODS: The AIS is designed to assess sleep difficulty and comprises eight items: the first five refer to the sleep disturbance and the last three to the daytime consequences. Either the full eight-item scale (AIS-8) or the brief form (AIS-5) can be administered. The adaptation used a back-translation design. The validation process was based on a sample of 323 participants (undergraduates, community sample and psychiatric outpatients), which completed the AIS and other questionnaires: anxiety (BAI), depression (BDI) and psychological well-being (GHQ-12) scales. RESULTS: The internal consistency coefficients for both versions were above 0.80. The study of dimensionality revealed a single factor with high loadings and a percentage of explained variance above 50% in both versions. Test-retest reliability was above 0.70 (AIS-5) and over 0.80 (AIS-8) at a one-month interval. The correlation between the AIS and the previously mentioned scales was for both the AIS-5 and the AIS-8 above 0.40 and 0.50, respectively. CONCLUSION: The psychometric properties of both versions of the Spanish form of the AIS demonstrate that the scale is a valid and reliable instrument for the assessment of insomnia in Spanish-speaking populations.

ICF-based disability survey in a rural population of adults and older adults living in Cinco Villas, Northeastern Spain: design, methods and population characteristics.

BACKGROUND: This article describes the methods of a door-to-door screening survey exploring the distribution of disability and its major determinants in northeastern Spain. This study will set the basis for the development of disability-related services for the rural elderly in northeastern Spain. METHODS: The probabilistic sample was composed of 1,354 de facto residents from a population of 12,784 Social Security card holders (age: > or = 50 years). Cognitive and disability screenings were conducted (period: June 2008-June 2009). Screening instruments were the MMSE and the World Health Organization Disability Assessment Schedule. Participants screened positive for disability underwent an assessment protocol focusing on primary care diagnoses, disability, lifestyle, and social and health service usage. Participants screened positive for cognitive functioning went through in-depth neurological evaluation. RESULTS: The study sample is described. Usable data were available for 1,216 participants. A total of 625 individuals (51.4%) scored within the positive range in the disability screening, while 135 (11.1%) scored within the positive range of the cognitive screening. The proportion of positively screened individuals was higher for women and increased with age. CONCLUSIONS: Screening surveys represent a feasible design for examining the distribution of disability and its determinants among the elderly. Data quality may benefit from methodological developments tailored to rural populations with a low education level.

[Social valuation and punishment assignment in transgressions of environment protection laws]. / Valoración social y asignación de castigo en transgresiones a las leyes de protección del medio ambiente.

The <> of breaches of environmental law is not always evident. This characteristic contributes to making the study of people's evaluation of anti-ecological behaviour of special interest for the understanding of environmental law compliance. In this study, 573 participants evaluated seven transgressions of environmental law, on seven scales. The results show that participants differentially evaluate the transgressions; that Indignation and the Severity of the consequences are the scales that best predict the punishment that participants think should be assigned to these transgressions; that women are stricter in evaluating; and that there are marginal differences related to area of residence and age.