Racial disparities in stage at bladder cancer diagnosis in the US Veterans Affairs healthcare system.

OBJECTIVE: To describe patient characteristics and pathological stage at bladder cancer (BCa) diagnosis in a diverse population within a national, equal-access healthcare system. METHODS: This retrospective cohort study identified 15 966 men diagnosed with BCa in the Veterans Affairs (VA) healthcare system from 2000 to 2020. The primary outcome was pathological stage at diagnosis, determined by index transurethral resection of bladder tumour. Logistic regression was used to assess the relationship between race and stage. Competing risk models tested the association between race and BCa-specific mortality with cumulative incidence estimates. RESULTS: Of 15 966 BCa patients, 12 868 (81%), 1726 (11%), 493 (3%) and 879 (6%) were White, Black, Hispanic and Other race, respectively. Black patients had significantly higher muscle-invasive bladder cancer (MIBC) rates than White patients (35% vs 32%; P = 0.009). In multivariable analysis, the odds of presenting with MIBC did not differ significantly between Black and White patients (odds ratio [OR] 1.10, 95% confidence interval [CI] 0.98-1.22) or between Hispanic patients (OR 0.82, 95% CI 0.67-1.01) and White patients. Compared to White patients, Black patients had a similar risk of BCa-specific mortality (hazard ratio [HR] 0.89, 95% CI 0.75-1.06), whereas Hispanic patients had a lower risk (HR 0.56, 95% CI 0.38-0.82). CONCLUSIONS: Black patients presented with the highest rates of de novo MIBC. However, in a large, equal-access healthcare system, this did not result in a difference in BCa-specific mortality. In contrast, Hispanic patients had lower risks of MIBC and BCa-specific mortality.

Patients with both cancer and psychosis-to what extent do they receive specialized palliative care.

BACKGROUND: Schizophrenia and advanced cancer are complex conditions that impact life expectancy. This study aimed to examine the receipt of specialized palliative care (SPC) in patients with metastatic cancer and a coexisting diagnosis of psychosis compared to patients with cancer only. Secondary objectives included analyzing differences in emergency visits and place of death in relation to receipt of SPC. PATIENTS AND METHODS: This retrospective, observational registry study utilized health care consumption data from the Stockholm Regional Council. We included 23,056 patients aged >18 years who died between 2015 and 2021 with a diagnosis of metastatic cancer, hematologic malignancy, or malignant brain tumor in the Stockholm Gotland region. Among them, 320 patients had a concomitant diagnosis of psychosis. RESULTS: Patients with cancer and psychosis were less likely to receive SPC compared to patients with cancer only (61% vs. 74%, p < 0.001). Additionally, they were, on average, four and a half years younger at the time of death (68.5 years vs. 73.1 years, p < 0.0001), more likely to reside in nursing homes (25% vs. 11%, p < 0.0001), and had a higher prevalence of low area-based socioeconomic status (46% vs. 32%, p < 0.0001). Receipt of SPC was associated with reduced frequency of emergency visits and a higher probability of place of death to be at home or in a care facility outside the acute hospital. CONCLUSIONS: Patients with a coexisting diagnosis of psychosis and metastatic cancer have a lower probability of receiving SPC. Receipt of specialized palliative care was associated with reduced number of unplanned emergency visits and a lower risk for death at an acute hospital. Efforts are needed to ensure equitable provision of SPC for patients with cancer and psychosis.

Universal health coverage and equal access in Sweden: a century-long perspective on macro-level policy.

BACKGROUND: When today's efforts to achieve universal health coverage are mainly directed towards low-income settings, it is perhaps easy to forget that countries considered to have universal, comprehensive and high-performing health systems have also undergone this journey. In this article, the aim is to provide a century-long perspective to illustrate Sweden's long and ongoing journey towards universal health coverage and equal access to healthcare. METHODS: The focus is on macro-level policy. A document analysis is divided into three broad eras (1919-1955; 1955-1989; 1989-) and synthesises seven points in time when policies relevant to overarching goals and regulation of universal health coverage and equal access were proposed and/or implemented. The development is analysed and concluded in relation to two egalitarian goals in the context of health: equality of access and equal treatment for equal need. RESULTS: Over the past century, macro-level policy evolved from the concept of creating access for the neediest and those reliant on wages for their survival to a mandatory insurance with equal right to healthcare for all. However, universal health coverage was not achieved until 1955, and individuals had to rely on their personal financial resources to cover the cost at the time of care utilization until the 1970s. It was not until 1983 that legislation explicitly stated that access to healthcare should be equal for the entire population (horizontal equity), while a vertical equity-principle was not added until 1997. Subsequently, ideas of free choice and privatization have gained significance. For instance, they aim to increase service access, addressing the Swedish health system's Achilles' heel in this regard. However, the principle of equal access for all is now being challenged by the emergence of private health insurance, which offers quicker access to services. It can be concluded that there is no perpetual Swedish healthcare model and various dimensions of access have been the focus of policy discussion. The discussion on access barriers has shifted from financial to personal and organizational ones. Today, Sweden still ranks high in terms of affordability and equity in international comparisons: although not as well as a decade ago. Whether this marks the beginning of a new trend intertwined with a decline in Sweden's welfare 'exceptionalism', or is a temporary decline remains to be assessed in the future.

A comparative analysis of the doctoral regulations at the medical faculties in Germany.

Objective: In order to be allowed to use the title "Dr. med." in Germany, an independent scientific achievement under the supervision of an established scientist is necessary. The research question, analysis and results are essentially carried out and developed independently by the doctoral student. The doctorate serves as proof that the doctoral candidate is capable of independent academic work. The acquisition of scientific skills and knowledge is of particular importance in medicine, as Germany´s international competitiveness is based on the education of today´s young academics. Fair conditions and uniform quality standards for doctoral studies are therefore indispensable to attract future young scientists at an early stage. Methods: The currently valid doctoral regulations of the medical faculties in Germany were analysed with regards to the following target criteria; update date, dissertation language, possibility of publication-based dissertation and its details (number of first and total authorships, publication organ), knowledge of methods and consideration of "Good Medical Practice" (GMP), plagiarism check, review process and disputation. Results: All faculties with the right to award doctorates, and, thus 40 valid regulations were included in the analysis. This revealed a great divergence in the requirements for doctoral candidates. Although a publication-based doctorate is now possible at 93% (n=37) of the faculties, in addition to the monographic dissertation, the required first and total authorships vary from one required first authorship (n=26, 70%) to two or three first authorships (n=5, 14%), as well as some faculties having no information regarding the number of publications (n=6, 16%). The quality of the publication organ was not described in detail in seven faculties (19%). To ensure quality, requirements have increasingly been anchored in the regulations, so that 22 regulations (56%) now stipulate participation in courses on GMP or qualification programmes. The regulations leave a lot of room for manoeuvre in terms of content and do not allow for comparability of the conditions for preparing doctoral researchers. The specifications range from mere mention, to instruction, to compulsory course participation. Another means of quality assurance is the prevention of plagiarism through the applications of software systems. However, this simple and effective means is not yet mentioned in 65% of the regulations (n=26). While the other regulations make use of this possibility, it is not an obligatory application. A total of 34 regulations provide for the regular drawing up of a supervision agreement to define the rights and obligations of the actors involved. Conclusion: The analysis showed a divergent picture. Although imprecise regulations or gaps in information allow scope for design, they also prevent transparency. Despite revisions of many regulations in the past, these revisions have not led to any significant harmonisation. The implementation of standardised and structured doctoral programmes is desirable and could be tackled within the framework of the planned amendment of medical studies. This opens up the possibility of dealing efficiently with the scarce resource of time in the face of competing curriculum content and of making a doctoral project more attractive to potential young scientists at an early stage.

The robustness of phylogenetic diversity indices to extinctions.

Phylogenetic diversity indices provide a formal way to apportion evolutionary history amongst living species. Understanding the properties of these measures is key to determining their applicability in conservation biology settings. In this work, we investigate some questions posed in a recent paper by Fischer et al. (Syst Biol 72(3):606-615, 2023). In that paper, it is shown that under certain extinction scenarios, the ranking of the surviving species by their Fair Proportion index scores may be the complete reverse of their ranking beforehand. Our main results here show that this behaviour extends to a large class of phylogenetic diversity indices, including the Equal-Splits index. We also provide a necessary condition for reversals of Fair Proportion rankings to occur on phylogenetic trees whose edge lengths obey the ultrametric constraint. Specific examples of rooted phylogenetic trees displaying these behaviours are given and the impact of our results on the use of phylogenetic diversity indices more generally is discussed.

Quantifying the difference between phylogenetic diversity and diversity indices.

Phylogenetic diversity is a popular measure for quantifying the biodiversity of a collection Y of species, while phylogenetic diversity indices provide a way to apportion phylogenetic diversity to individual species. Typically, for some specific diversity index, the phylogenetic diversity of Y is not equal to the sum of the diversity indices of the species in Y. In this paper, we investigate the extent of this difference for two commonly-used indices: Fair Proportion and Equal Splits. In particular, we determine the maximum value of this difference under various instances including when the associated rooted phylogenetic tree is allowed to vary across all rooted phylogenetic trees with the same leaf set and whose edge lengths are constrained by either their total sum or their maximum value.

Application of machine learning for mortality prediction in patients with candidemia: Feasibility verification and comparison with clinical severity scores.

BACKGROUND: Clinical severity scores, such as acute physiology, age, chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), Pitt Bacteremia Score (PBS), and European Confederation of Medical Mycology Quality (EQUAL) score, may not reliably predict candidemia prognosis owing to their prespecified scorings that can limit their adaptability and applicability. OBJECTIVES: Unlike those fixed and prespecified scorings, we aim to develop and validate a machine learning (ML) approach that is able to learn predictive models adaptively from available patient data to increase adaptability and applicability. METHODS: Different ML algorithms follow different design philosophies and consequently, they carry different learning biases. We have designed an ensemble meta-learner based on stacked generalisation to integrate multiple learners as a team to work at its best in a synergy to improve predictive performances. RESULTS: In the multicenter retrospective study, we analysed 512 patients with candidemia from January 2014 to July 2019 and compared a stacked generalisation model (SGM) with APACHE II, SOFA, PBS and EQUAL score to predict the 14-day mortality. The cross-validation results showed that the SGM significantly outperformed APACHE II, SOFA, PBS, and EQUAL score across several metrics, including F1-score (0.68, p < .005), Matthews correlation coefficient (0.54, p < .05 vs. SOFA, p < .005 vs. the others) and the area under the curve (AUC; 0.87, p < .005). In addition, in an independent external test, the model effectively predicted patients' mortality in the external validation cohort, with an AUC of 0.77. CONCLUSIONS: ML models show potential for improving mortality prediction amongst patients with candidemia compared to clinical severity scores.

Design and 3D Electrical Simulations for a Controllable Equal-Gap Large-Area Silicon Drift Detector.

In this study, a controllable equal-gap large-area silicon drift detector (L-SDD) is designed. The surface leakage current is reduced by reducing the SiO2-Si interface through the new controllable equal-gap design. The design of the equal gap also solves the problem whereby the gap widens due to the larger detector size in the previous SDD design, which leads to a large invalid area of the detector. In this paper, a spiral hexagonal equal-gap L-SDD of 1 cm radius is selected for design calculation, and we implement 3D modeling and simulation of the device. The simulation results show that the internal potential gradient distribution of the L-SDD is uniform and forms a drift electric field, with the direction of electron drift pointing towards the collecting anode. The L-SDD has an excellent electron drift channel inside, and this article also analyzes the electrical performance of the drift channel to verify the correctness of the design method of the L-SDD.

Women in Natural Sciences (WiNS) at ETH Zurich Celebrates its 10th Anniversary - A Retrospective and Outlook.

For this CHIMIA special issue on the United Nations Sustainable Development Goals (SDGs) and the coincidental 10th anniversary of the association of Women in Natural Sciences (WiNS) at ETH Zurich, there is no better opportunity to share what we have achieved in the last decade. WiNS was originally founded by female PhD students and PostDocs at the Department of Chemistry and Applied Biosciences (D-CHAB) and has expanded to include three additional departments at ETH Zurich. Join us in celebrating our anniversary, reflecting on what we and other associations with the same mission have done to promote gender equality and reduced inequalities for all. We invite you to reflect on what yet has to be done to enact a systemic change towards achieving equal opportunities for all, rather than simply accommodating the female perspective to Switzerland's predominantly masculine working culture.

A robust and fast two-sample test of equal correlations with an application to differential co-expression.

A robust and fast two-sample test for equal Pearson correlation coefficients (PCCs) is important in solving many biological problems, including, for example, analysis of differential co-expression. However, few existing methods for this test can achieve robustness against deviation from normal distributions, accuracy under small sample sizes, and computational efficiency simultaneously. Here, we propose a new method for testing differential correlation using a saddlepoint approximation of the residual bootstrap (DICOSAR). To achieve robustness, accuracy, and efficiency, DICOSAR combines the ideas underlying the pooled residual bootstrap, the signed root of a likelihood ratio statistic, and a multivariate saddlepoint approximation. Through a comprehensive simulation study and a real data analysis of gene co-expression, we demonstrate that DICOSAR is accurate and robust in controlling the type I error rate for detecting differential correlation and provides a faster alternative to the bootstrap and permutation methods. We further show that DICOSAR can also be used for testing differential correlation matrices. These results suggest that DICOSAR provides an analytical approach to facilitate rapid testing for the equality of PCCs in large-scale analysis.

Spaces of Phylogenetic Diversity Indices: Combinatorial and Geometric Properties.

Biodiversity is a concept most naturally quantified and measured across sets of species. However, for some applications, such as prioritising species for conservation efforts, a species-by-species approach is desirable. Phylogenetic diversity indices are functions that apportion the total biodiversity value of a set of species across its constituent members. As such, they aim to measure each species' individual contribution to, and embodiment of, the diversity present in that set. However, no clear definition exists that encompasses the diversity indices in current use. This paper presents conditions that define diversity indices arising from the phylogenetic diversity measure on rooted phylogenetic trees. In this context, the diversity index 'score' given to a species represents a measure of its unique and shared evolutionary history as displayed in the underlying phylogenetic tree. Our definition generalises the diversity index notion beyond the popular Fair Proportion and Equal-Splits indices. These particular indices may now be seen as two points in a convex space of possible diversity indices, for which the boundary conditions are determined by the underlying shape of each phylogenetic tree. We calculated the dimension of the convex space associated with each tree shape and described the extremal points.

Application of Equal Local Levels to Improve Q-Q Plot Testing Bands with R Package qqconf.

Quantile-Quantile (Q-Q) plots are often difficult to interpret because it is unclear how large the deviation from the theoretical distribution must be to indicate a lack of fit. Most Q-Q plots could benefit from the addition of meaningful global testing bands, but the use of such bands unfortunately remains rare because of the drawbacks of current approaches and packages. These drawbacks include incorrect global Type I error rate, lack of power to detect deviations in the tails of the distribution, relatively slow computation for large data sets, and limited applicability. To solve these problems, we apply the equal local levels global testing method, which we have implemented in the R Package qqconf, a versatile tool to create Q-Q plots and probability-probability (P-P) plots in a wide variety of settings, with simultaneous testing bands rapidly created using recently-developed algorithms. qqconf can easily be used to add global testing bands to Q-Q plots made by other packages. In addition to being quick to compute, these bands have a variety of desirable properties, including accurate global levels, equal sensitivity to deviations in all parts of the null distribution (including the tails), and applicability to a range of null distributions. We illustrate the use of qqconf in several applications: assessing normality of residuals from regression, assessing accuracy of p values, and use of Q-Q plots in genome-wide association studies.

Calibration Model Optimization for Strain Metrology of Equal Strength Beams Using Deflection Measurements.

Strain sensors, especially fiber Bragg grating (FBG) sensors, are of great importance in structural health monitoring, mechanical property analysis, and so on. Their metrological accuracy is typically evaluated by equal strength beams. The traditional strain calibration model using the equal strength beams was built based on an approximation method by small deformation theory. However, its measurement accuracy would be decreased while the beams are under the large deformation condition or under high temperature environments. For this reason, an optimized strain calibration model is developed for equal strength beams based on the deflection method. By combining the structural parameters of a specific equal strength beam and finite element analysis method, a correction coefficient is introduced into the traditional model, and an accurate application-oriented optimization formula is obtained for specific projects. The determination method of optimal deflection measurement position is also presented to further improve the strain calibration accuracy by error analysis of the deflection measurement system. Strain calibration experiments of the equal strength beam were carried out, and the error introduced by the calibration device can be reduced from 10 µÎµ to less than 1 µÎµ. Experimental results show that the optimized strain calibration model and the optimum deflection measurement position can be employed successfully under large deformation conditions, and the deformation measurement accuracy is improved greatly. This study is helpful to effectively establish metrological traceability for strain sensors and furthermore improve the measurement accuracy of strain sensors in practical engineering scenarious.

Optical Fiber Magnetic Field Sensors Based on 3 × 3 Coupler and Iron-Based Amorphous Nanocrystalline Ribbons.

Optical fiber interferometric magnetic field sensors based on magnetostrictive effects have several advantages, e.g., high sensitivity, strong adaptability to harsh environments, long distance transmission, etc. They also have great application prospects in deep wells, oceans, and other extreme environments. In this paper, two optical fiber magnetic field sensors based on iron-based amorphous nanocrystalline ribbons and a passive 3 × 3 coupler demodulation system were proposed and experimentally tested. The sensor structure and the equal-arm Mach-Zehnder fiber interferometer were designed, and the experimental results showed that the magnetic field resolutions of the optical fiber magnetic field sensors with sensing length of 0.25 m and 1 m were 15.4 nT/√Hz @ 10 Hz and 4.2 nT/√Hz @ 10 Hz, respectively. This confirmed the sensitivity multiplication relationship between the two sensors and the feasibility of improving the magnetic field resolution to the pT level by increasing the sensing length.

On the Performance of Decode-and-Forward Equal-Gain-Combining Relay Systems over Weibull Fading Channels.

Relay-assisted wireless communications, where both the relay and the final destiny employ diversity-combining techniques, represent a compelling strategy for improving the signal-to-noise ratio (SNR) for mobile terminals, mainly at millimeter-wave (mmWave) frequency bands. In this sense, this work considers a wireless network that employs a dual-hop decode-and-forward (DF) relaying protocol, in which the receivers at the relay and at the base station (BS) use an antenna array. Moreover, it is considered that the received signals are combined at reception using equal-gain-combining (EGC). Recent works have enthusiastically employed the Weibull distribution so as to emulate the small-scale fading behavior in mmWave frequencies, which also motivates its use in the present work. For this scenario, exact and asymptotic expressions for the system's outage probability (OP) and average bit error probability (ABEP) are derived in closed form. Useful insights are gained from these expressions. More precisely, they illustrate how the system and fading parameters affect the performance of the DF-EGC system. Monte Carlo simulations corroborate the accuracy and validity of the derived expressions. Furthermore, the mean achievable rate of the considered system is also evaluated via simulations. Useful insights regarding the system performance are obtained from these numerical results.

Anomaly Detection Based on a 3D Convolutional Neural Network Combining Convolutional Block Attention Module Using Merged Frames.

With the recent rise in violent crime, the real-time situation analysis capabilities of the prevalent closed-circuit television have been employed for the deterrence and resolution of criminal activities. Anomaly detection can identify abnormal instances such as violence within the patterns of a specified dataset; however, it faces challenges in that the dataset for abnormal situations is smaller than that for normal situations. Herein, using datasets such as UBI-Fights, RWF-2000, and UCSD Ped1 and Ped2, anomaly detection was approached as a binary classification problem. Frames extracted from each video with annotation were reconstructed into a limited number of images of 3×3, 4×3, 4×4, 5×3 sizes using the method proposed in this paper, forming an input data structure similar to a light field and patch of vision transformer. The model was constructed by applying a convolutional block attention module that included channel and spatial attention modules to a residual neural network with depths of 10, 18, 34, and 50 in the form of a three-dimensional convolution. The proposed model performed better than existing models in detecting abnormal behavior such as violent acts in videos. For instance, with the undersampled UBI-Fights dataset, our network achieved an accuracy of 0.9933, a loss value of 0.0010, an area under the curve of 0.9973, and an equal error rate of 0.0027. These results may contribute significantly to solve real-world issues such as the detection of violent behavior in artificial intelligence systems using computer vision and real-time video monitoring.

A fair and interpretable network for clinical risk prediction: a regularized multi-view multi-task learning approach.

In healthcare domain, complication risk profiling which can be seen as multiple clinical risk prediction tasks is challenging due to the complex interaction between heterogeneous clinical entities. With the availability of real-world data, many deep learning methods are proposed for complication risk profiling. However, the existing methods face three open challenges. First, they leverage clinical data from a single view and then lead to suboptimal models. Second, most existing methods lack an effective mechanism to interpret predictions. Third, models learned from clinical data may have inherent pre-existing biases and exhibit discrimination against certain social groups. We then propose a multi-view multi-task network (MuViTaNet) to tackle these issues. MuViTaNet complements patient representation by using a multi-view encoder to exploit more information. Moreover, it uses a multi-task learning to generate more generalized representations using both labeled and unlabeled datasets. Last, a fairness variant (F-MuViTaNet) is proposed to mitigate the unfairness issues and promote healthcare equity. The experiments show that MuViTaNet outperforms existing methods for cardiac complication profiling. Its architecture also provides an effective mechanism for interpreting the predictions, which helps clinicians discover the underlying mechanism triggering the complication onsets. F-MuViTaNet can also effectively mitigate the unfairness with only negligible impact on accuracy.

Co-production as a resolution to authoritarian attitudes in healthcare.

Healthcare services should be provided according to contemporary ethical norms that require patients' active engagement in all the relevant processes. However, authoritarian attitudes and behaviors in healthcare, one of which is paternalism, put patients in a passive role. But, as Avedis Donabedian emphasizes, patients are co-producers of care, reformers of healthcare, informants, and definers and evaluators of quality. Overlooking these significant functions and merely focusing on physicians' benevolence due to their medical knowledge and skills in the production of healthcare services would leave the fate of patients in the hands of clinicians and impose physicians' hegemony on patients and their choices. Nevertheless, the concept of co-production is a practical and effective mechanism to redefine the language used in healthcare by recognizing patients as co-producers and equal partners. The application of co-production in healthcare would improve the therapeutic relationship, decrease ethical violations, and promote the patient's dignity.

Title IX's Unintended Consequences: The Female Athlete Triad and the Need for Special Treatment.

This Note examines the effects of Title IX's equal treatment framework on female collegiate athletes in the context of the female athlete triad. It describes the shortcomings of Title IX's equal treatment approach and its deleterious effects on the health of female student athletes. It argues for the adoption of the special treatment approach as a remedy.

Effect of economic inequality on generosity: A social norm perspective.

Economic inequality has been found to reduce individuals' generosity in western contexts. However, whether this effect is cross-culturally consistent and its internal mechanism remain unclear, as well as how to mitigate this impact. Hence, we explored whether and why economic inequality may erode generosity in a sample of Chinese adults from the social norm perspective and introduced the equal allocation norm to mitigate this effect. Four online studies were conducted: two were correlational (Study 1: n = 300; Study 2: n = 568) and two were experimental (Study 3: n = 289; Study 4: n = 500). Results showed that economic inequality predicted less generosity in the dictator game, and perceived unequal allocation norm accounted for this effect. Moreover, introducing the equal allocation norm could buffer this negative effect. Findings suggest economic inequality impairs generosity, and making the equal allocation norm more salient may guide people to act more generously.