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Stiers M, Vercauteren J, Schepens T, Mergeay M, Janssen L, Hoogmartens O, Neyrinck A, Marinus BG, Sabbe M. Design of a flow modulation device to facilitate individualized ventilation in a shared ventilator setup. J Clin Monit Comput 2024:10.1007/s10877-024-01138-1. [PMID: 38557919 DOI: 10.1007/s10877-024-01138-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/08/2024] [Indexed: 04/04/2024]
Abstract
This study aims to resolve the unmet need for ventilator surge capacity by developing a prototype device that can alter patient-specific flow in a shared ventilator setup. The device is designed to deliver a predictable tidal volume (VT), requiring minimal additional monitoring and workload. The prototyped device was tested in an in vitro bench setup for its performance against the intended use and design criteria. The ventilation parameters: VT and airway pressures, and ventilation profiles: pressure, flow and volume were measured for different ventilator and device settings for a healthy and ARDS simulated lung pathology. We obtained VTs with a linear correlation with valve openings from 10 to 100% across set inspiratory pressures (IPs) of 20 to 30 cmH2O. Airway pressure varied with valve opening and lung elastance but did not exceed set IPs. Performance was consistent in both healthy and ARDS-simulated lung conditions. The ventilation profile diverged from traditional pressure-controlled profiles. We present the design a flow modulator to titrate VTs in a shared ventilator setup. Application of the flow modulator resulted in a characteristic flow profile that differs from pressure- or volume controlled ventilation. The development of the flow modulator enables further validation of the Individualized Shared Ventilation (ISV) technology with individualization of delivered VTs and the development of a clinical protocol facilitating its clinical use during a ventilator surge capacity problem.
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Affiliation(s)
- Michiel Stiers
- Department of Public Health and Primary Care, Research unit Emergency Medicine, KU Leuven, 3000, Leuven, Belgium.
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Jan Vercauteren
- Department of Mechanical Engineering, Royal Military Academy, Renaissancelaan 30, Brussels, Belgium
| | - Tom Schepens
- Department of Intensive Care Medicine, Ghent University Hospital, C Heymanslaan 10, Ghent, Belgium
| | - Matthias Mergeay
- Department of Anesthesiology and Critical Care Medicine, St-Dimpna, J.-B. Stessensstraat 2, 2440, Geel, Belgium
| | - Luc Janssen
- Department of Anesthesiology and Critical Care Medicine, St-Dimpna, J.-B. Stessensstraat 2, 2440, Geel, Belgium
| | - Olivier Hoogmartens
- Department of Public Health and Primary Care, Research unit Emergency Medicine, KU Leuven, 3000, Leuven, Belgium
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Arne Neyrinck
- Department of Cardiovascular Sciences, Research unit Anesthesiology and Algology, KU Leuven, 3000, Leuven, Belgium
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Benoît G Marinus
- Department of Mechanical Engineering, Royal Military Academy, Renaissancelaan 30, Brussels, Belgium
| | - Marc Sabbe
- Department of Public Health and Primary Care, Research unit Emergency Medicine, KU Leuven, 3000, Leuven, Belgium
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
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De Maeseneer T, Van Damme L, Aktan MK, Braem A, Moldenaers P, Van Vlierberghe S, Cardinaels R. Powdered Cross-Linked Gelatin Methacryloyl as an Injectable Hydrogel for Adipose Tissue Engineering. Gels 2024; 10:167. [PMID: 38534585 DOI: 10.3390/gels10030167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 03/28/2024] Open
Abstract
The tissue engineering field is currently advancing towards minimally invasive procedures to reconstruct soft tissue defects. In this regard, injectable hydrogels are viewed as excellent scaffold candidates to support and promote the growth of encapsulated cells. Cross-linked gelatin methacryloyl (GelMA) gels have received substantial attention due to their extracellular matrix-mimicking properties. In particular, GelMA microgels were recently identified as interesting scaffold materials since the pores in between the microgel particles allow good cell movement and nutrient diffusion. The current work reports on a novel microgel preparation procedure in which a bulk GelMA hydrogel is ground into powder particles. These particles can be easily transformed into a microgel by swelling them in a suitable solvent. The rheological properties of the microgel are independent of the particle size and remain stable at body temperature, with only a minor reversible reduction in elastic modulus correlated to the unfolding of physical cross-links at elevated temperatures. Salts reduce the elastic modulus of the microgel network due to a deswelling of the particles, in addition to triple helix denaturation. The microgels are suited for clinical use, as proven by their excellent cytocompatibility. The latter is confirmed by the superior proliferation of encapsulated adipose tissue-derived stem cells in the microgel compared to the bulk hydrogel. Moreover, microgels made from the smallest particles are easily injected through a 20G needle, allowing a minimally invasive delivery. Hence, the current work reveals that powdered cross-linked GelMA is an excellent candidate to serve as an injectable hydrogel for adipose tissue engineering.
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Affiliation(s)
- Tess De Maeseneer
- Soft Matter, Rheology and Technology, Department of Chemical Engineering, KU Leuven, Celestijnenlaan 200J Box 2424, 3001 Leuven, Belgium
| | - Lana Van Damme
- Polymer Chemistry & Biomaterials Group, Centre of Macromolecular Chemistry, Department of Organic and Macromolecular Chemistry, Ghent University (UGent), Krijgslaan 281, S4-Bis, 9000 Ghent, Belgium
| | - Merve Kübra Aktan
- Biomaterials and Tissue Engineering Research Group, Department of Materials Engineering, KU Leuven, Kasteelpark Arenberg 44 Box 2450, 3001 Leuven, Belgium
| | - Annabel Braem
- Biomaterials and Tissue Engineering Research Group, Department of Materials Engineering, KU Leuven, Kasteelpark Arenberg 44 Box 2450, 3001 Leuven, Belgium
| | - Paula Moldenaers
- Soft Matter, Rheology and Technology, Department of Chemical Engineering, KU Leuven, Celestijnenlaan 200J Box 2424, 3001 Leuven, Belgium
| | - Sandra Van Vlierberghe
- Polymer Chemistry & Biomaterials Group, Centre of Macromolecular Chemistry, Department of Organic and Macromolecular Chemistry, Ghent University (UGent), Krijgslaan 281, S4-Bis, 9000 Ghent, Belgium
| | - Ruth Cardinaels
- Soft Matter, Rheology and Technology, Department of Chemical Engineering, KU Leuven, Celestijnenlaan 200J Box 2424, 3001 Leuven, Belgium
- Processing and Performance of Materials, Department of Mechanical Engineering, TU Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
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Kuznetsova T, Daels Y, Ntalianis E, Santana EJ, Sabovčik F, Haddad F, Cauwenberghs N. Clinical and biochemical predictors of longitudinal changes in left atrial structure and function: A general population study. Echocardiography 2024; 41:e15780. [PMID: 38372342 DOI: 10.1111/echo.15780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/11/2024] [Accepted: 01/28/2024] [Indexed: 02/20/2024] Open
Abstract
PURPOSE There is a need for better understanding the factors that modulate left atrial (LA) dysfunction. Therefore, we determined associations of clinical and biochemical biomarkers with serial changes in echocardiographic indexes of LA function in the general population. METHODS We measured LA maximal and minimal volume indexes (LAVImax and LAVImin) by echocardiography and LA reservoir strain (LARS) by two-dimensional speckle-tracking in 627 participants (mean age 50.8 years, 51.2% women) at baseline and after 4.8 years. RESULTS During follow-up, LARS decreased significantly in men (-.90%, P = .033) but not in women (-.23%, P = .60). In stepwise regression analysis, stronger decrease in LARS over time was associated with male sex, a higher age, body mass index (BMI), mean arterial pressure (MAP) and serum insulin at baseline and with a greater increase in BMI and MAP over time (P ≤ .018). Similarly, an increased risk of developing or retaining abnormal LARS was observed in older participants, in subjects with a higher baseline BMI, MAP, heart rate (HR), troponin T and ΔMAP, and in those who used β-blockers at baseline. Both LAVImax and LAVImin increased significantly over time (P ≤ .0007). This increase was associated with a higher baseline age, pulse pressure and a lower HR at baseline and a greater increase in pulse pressure over time (P ≤ .029). Higher serum insulin and D-dimer were independently associated with a stronger increase in LAVImin (P ≤ .0034). CONCLUSION Subclinical worsening in LA dysfunction was associated with older age, hypertension, obesity, insulin resistance and troponin T levels. Cardiovascular risk management strategies may delay LA deterioration.
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Affiliation(s)
- Tatiana Kuznetsova
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Yne Daels
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Evangelos Ntalianis
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Everton J Santana
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - František Sabovčik
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Francois Haddad
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Nicholas Cauwenberghs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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Ceulemans M, Sillis L, Allegaert K, Bogaerts A, De Vos M, Hompes T, Smits A, Van Calsteren K, Verbakel JY, Foulon V. Letter to the Editor re Davis et al., 2023: BELpREG, the first of its kind real-world data source on medication use in pregnancy in Belgium. Pharmacoepidemiol Drug Saf 2024; 33:e5751. [PMID: 38362651 DOI: 10.1002/pds.5751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/21/2023] [Indexed: 02/17/2024]
Affiliation(s)
- Michael Ceulemans
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- L-C&Y, Child and Youth Institute, KU Leuven, Leuven, Belgium
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Laure Sillis
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- L-C&Y, Child and Youth Institute, KU Leuven, Leuven, Belgium
| | - Karel Allegaert
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- L-C&Y, Child and Youth Institute, KU Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Clinical Pharmacy, Erasmus MC Sophia's Children Hospital, Rotterdam, The Netherlands
| | - Annick Bogaerts
- L-C&Y, Child and Youth Institute, KU Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Maarten De Vos
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Electrical Engineering (ESAT), KU Leuven, Leuven, Belgium
| | - Titia Hompes
- Adult Psychiatry UPC, KU Leuven, Leuven, Belgium
- Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Anne Smits
- L-C&Y, Child and Youth Institute, KU Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Kristel Van Calsteren
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Jan Y Verbakel
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- L-C&Y, Child and Youth Institute, KU Leuven, Leuven, Belgium
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Zhao J, Kang M, Wu H, Sun B, Baele G, He WT, Lu M, Suchard MA, Ji X, He N, Su S, Veit M. Risk assessment of SARS-CoV-2 replicating and evolving in animals. Trends Microbiol 2024; 32:79-92. [PMID: 37541811 DOI: 10.1016/j.tim.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 08/06/2023]
Abstract
The retransmissions of SARS-CoV-2 from several mammals - primarily mink and white-tailed deer - to humans have raised concerns for the emergence of a new animal-derived SARS-CoV-2 variant to worsen the pandemic. Here, we discuss animal species that are susceptible to natural or experimental infection with SARS-CoV-2 and can transmit the virus to mates or humans. We describe cutting-edge techniques to assess the impact of a mutation in the viral spike (S) protein on its receptor and on antibody binding. Our review of spike sequences of animal-derived viruses identified nine unique amino acid exchanges in the receptor-binding domain (RBD) that are not present in any variant of concern (VOC). These mutations are present in SARS-CoV-2 found in companion animals such as dogs and cats, and they exhibit a higher frequency in SARS-CoV-2 found in mink and white-tailed deer, suggesting that sustained transmissions may contribute to maintaining novel mutations. Four of these exchanges, such as Leu452Met, could undermine acquired immune protection in humans while maintaining high affinity for the human angiotensin-converting enzyme 2 (ACE2) receptor. Finally, we discuss important avenues of future research into animal-derived viruses with public health risks.
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Affiliation(s)
- Jin Zhao
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China
| | - Mei Kang
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China; Clinical Research Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongyan Wu
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China
| | - Bowen Sun
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China
| | - Guy Baele
- Department of Microbiology, Immunology, and Transplantation, Rega Institute, KU Leuven, Leuven, Belgium
| | - Wan-Ting He
- School of Pharmacy, China Pharmaceutical University, Nanjing, China.
| | - Meng Lu
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China
| | - Marc A Suchard
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA; Department of Biomathematics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Xiang Ji
- Department of Mathematics, School of Science and Engineering, Tulane University, New Orleans, LA, USA
| | - Na He
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China
| | - Shuo Su
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China.
| | - Michael Veit
- Institute for Virology, Center for Infection Medicine, Veterinary Faculty, Free University Berlin, Berlin, Germany.
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Edelmann CM, Boen F, Stouten J, Vande Broek G, Fransen K. The Power of Peer Leaders: Exploring the Link between Peer Leadership Behaviors and Sustainable Work Outcomes. Behav Sci (Basel) 2023; 14:2. [PMID: 38275344 PMCID: PMC10813210 DOI: 10.3390/bs14010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 01/27/2024] Open
Abstract
Most leadership studies primarily focus on formal leaders, often overlooking the influence of leaders within the team. While prior research has shown that peer leaders can have a beneficial impact on various team outcomes, it is yet unclear which peer leadership behaviors precisely foster a supportive and sustainable work environment. Building upon the recent identification of 10 peer leadership roles and 37 underlying functions, the current study aims to investigate the relationships between these peer leadership roles and functions and key outcomes (i.e., job satisfaction, team cohesion, team effectiveness, and OCB). A total of 31 organizational teams, comprising 182 employees from diverse sectors, participated in a quantitative survey. Employing multilevel modeling analysis, the findings demonstrated that each leadership role and nearly every function predicted at least one outcome, highlighting their significance within organizational teams. Additionally, Necessary Condition Analysis revealed that specific roles and functions were necessary for generating one or more outcomes. Finally, we found that most of the significant relationships remained consistent across teams, regardless of their size, tenure, or level of team identification. These findings refine our understanding of shared leadership and how peer leaders can create a sustainable workplace by fostering employee well-being and productivity in organizational teams.
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Affiliation(s)
- Charlotte M. Edelmann
- Department of Movement Sciences, KU Leuven, Tervuursevest 101, P.O. Box 1500, 3001 Leuven, Belgium; (F.B.); (G.V.B.)
| | - Filip Boen
- Department of Movement Sciences, KU Leuven, Tervuursevest 101, P.O. Box 1500, 3001 Leuven, Belgium; (F.B.); (G.V.B.)
| | - Jeroen Stouten
- Faculty of Psychology and Educational Sciences, KU Leuven, Dekenstraat 2, P.O. Box 3725, 3000 Leuven, Belgium;
| | - Gert Vande Broek
- Department of Movement Sciences, KU Leuven, Tervuursevest 101, P.O. Box 1500, 3001 Leuven, Belgium; (F.B.); (G.V.B.)
| | - Katrien Fransen
- Department of Movement Sciences, KU Leuven, Tervuursevest 101, P.O. Box 1500, 3001 Leuven, Belgium; (F.B.); (G.V.B.)
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Li X, Trovão NS, Wertheim JO, Baele G, de Bernardi Schneider A. Optimizing ancestral trait reconstruction of large HIV Subtype C datasets through multiple-trait subsampling. Virus Evol 2023; 9:vead069. [PMID: 38046219 PMCID: PMC10691791 DOI: 10.1093/ve/vead069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/29/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023] Open
Abstract
Large datasets along with sampling bias represent a challenge for phylodynamic reconstructions, particularly when the study data are obtained from various heterogeneous sources and/or through convenience sampling. In this study, we evaluate the presence of unbalanced sampled distribution by collection date, location, and risk group of human immunodeficiency virus Type 1 Subtype C using a comprehensive subsampling strategy and assess their impact on the reconstruction of the viral spatial and risk group dynamics using phylogenetic comparative methods. Our study shows that a most suitable dataset for ancestral trait reconstruction can be obtained through subsampling by all available traits, particularly using multigene datasets. We also demonstrate that sampling bias is inflated when considerable information for a given trait is unavailable or of poor quality, as we observed for the trait risk group. In conclusion, we suggest that, even if traits are not well recorded, including them deliberately optimizes the representativeness of the original dataset rather than completely excluding them. Therefore, we advise the inclusion of as many traits as possible with the aid of subsampling approaches in order to optimize the dataset for phylodynamic analysis while reducing the computational burden. This will benefit research communities investigating the evolutionary and spatio-temporal patterns of infectious diseases.
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Affiliation(s)
| | - Nídia S Trovão
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, 31 Center Dr, Bethesda, MA 20892, USA
| | - Joel O Wertheim
- Department of Medicine, University of California, La Jolla, San Diego, CA 92093, USA
| | - Guy Baele
- Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Leuven BE-3000, Belgium
| | - Adriano de Bernardi Schneider
- Genomics Institute, University of California Santa Cruz, Santa Cruz, CA 95064, USA
- Ningbo No.2 Hospital, Ningbo 315010, China
- Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo 315000, China
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Janssens A, Vaes B, Abels C, Crèvecoeur J, Mamouris P, Merckx B, Libin P, Van Pottelbergh G, Neyens T. Pneumococcal vaccination coverage and adherence to recommended dosing schedules in adults: a repeated cross-sectional study of the INTEGO morbidity registry. BMC Public Health 2023; 23:1104. [PMID: 37286969 DOI: 10.1186/s12889-023-15939-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 05/19/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Since 2014, Belgium's Superior Health Council has recommended pneumococcal vaccination for adults aged 19-85 years at increased risk for pneumococcal diseases with a specific vaccine administration sequence and timing. Currently, Belgium has no publicly funded adult pneumococcal vaccination program. This study investigated the seasonal pneumococcal vaccination trends, evolution of vaccination coverage and adherence to the 2014 recommendations. METHODS INTEGO is a general practice morbidity registry in Flanders (Belgium) that represents 102 general practice centres and comprised over 300.000 patients in 2021. A repeated cross-sectional study was performed for the period between 2017 and 2021. Using adjusted odds ratios computed via multiple logistic regression, the association between an individual's characteristics (gender, age, comorbidities, influenza vaccination status and socioeconomic status) and schedule-adherent pneumococcal vaccination status was assessed. RESULTS Pneumococcal vaccination coincided with seasonal flu vaccination. The vaccination coverage in the population at risk decreased from 21% in 2017 to 18.2% in 2018 and then started to increase to 23.6% in 2021. Coverage in 2021 was highest for high-risk adults (33.8%) followed by 50- to 85-year-olds with comorbidities (25.5%) and healthy 65- to 85-year-olds (18.7%). In 2021, 56.3% of the high-risk adults, 74.6% of the 50+ with comorbidities persons, and 74% of the 65+ healthy persons had an adherent vaccination schedule. Persons with a lower socioeconomic status had an adjusted odds ratio of 0.92 (95% Confidence Interval (CI) 0.87-0.97) for primary vaccination, 0.67 (95% CI 0.60-0.75) for adherence to the recommended second vaccination if the 13-valent pneumococcal conjugate vaccine was administered first and 0.86 (95% CI 0.76-0.97) if the 23-valent pneumococcal polysaccharide vaccine was administered first. CONCLUSION Pneumococcal vaccine coverage is slowly increasing in Flanders, displaying seasonal peaks in sync with influenza vaccination campaigns. However, with less than one-fourth of the target population vaccinated, less than 60% high-risk and approximately 74% of 50 + with comorbidities and 65+ healthy persons with an adherent schedule, there is still much room for improvement. Furthermore, adults with poor socioeconomic status had lower odds of primary vaccination and schedule adherence, demonstrating the need for a publicly funded program in Belgium to ensure equitable access.
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Affiliation(s)
- Arne Janssens
- Department of Public Health and Primary Care, Faculty of Medicine, Academic Centre of General Practice, KU Leuven, Kapucijnenvoer 35, Leuven, B-3000, Belgium.
| | - Bert Vaes
- Department of Public Health and Primary Care, Faculty of Medicine, Academic Centre of General Practice, KU Leuven, Kapucijnenvoer 35, Leuven, B-3000, Belgium
| | | | - Jonas Crèvecoeur
- I-BioStat, Data Science Institute, Hasselt University, Martelarenlaan 42, B-3500, Hasselt, Belgium
| | - Pavlos Mamouris
- Department of Public Health and Primary Care, Faculty of Medicine, Academic Centre of General Practice, KU Leuven, Kapucijnenvoer 35, Leuven, B-3000, Belgium
| | | | - Pieter Libin
- Interuniversity Institute of Biostatistics and Statistical Bioinformatics, Data Science Institute, Hasselt University, Hasselt, Belgium
- Artificial Intelligence Lab, Department of Computer Science, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Microbiology and Immunology, Rega Institute for Medical Research, Clinical and Epidemiological Virology, KU Leuven, Leuven, Belgium
| | - Gijs Van Pottelbergh
- Department of Public Health and Primary Care, Faculty of Medicine, Academic Centre of General Practice, KU Leuven, Kapucijnenvoer 35, Leuven, B-3000, Belgium
| | - Thomas Neyens
- I-BioStat, Data Science Institute, Hasselt University, Martelarenlaan 42, B-3500, Hasselt, Belgium
- Department of Public Health and Primary Care, Faculty of Medicine, L-BioStat, KU Leuven, Kapucijnenvoer 35, Leuven, B-3000, Belgium
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De Wel B, Huysmans L, Depuydt CE, Goosens V, Peeters R, Santos FP, Thal DR, Dupont P, Maes F, Claeys KG. Histopathological correlations and fat replacement imaging patterns in recessive limb-girdle muscular dystrophy type 12. J Cachexia Sarcopenia Muscle 2023. [PMID: 37078404 DOI: 10.1002/jcsm.13234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/13/2023] [Accepted: 03/15/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Despite the widespread use of proton density fat fraction (PDFF) measurements with magnetic resonance imaging (MRI) to track disease progression in muscle disorders, it is still unclear how these findings relate to histopathological changes in muscle biopsies of patients with limb-girdle muscular dystrophy autosomal recessive type 12 (LGMDR12). Furthermore, although it is known that LGMDR12 leads to a selective muscle involvement distinct from other muscular dystrophies, the spatial distribution of fat replacement within these muscles is unknown. METHODS We included 27 adult patients with LGMDR12 and 27 age-matched and sex-matched healthy controls and acquired 6-point Dixon images of the thighs and T1 and short tau inversion recovery (STIR) MR images of the whole body. In 16 patients and 15 controls, we performed three muscle biopsies, one in the semimembranosus, vastus lateralis, and rectus femoris muscles, which are severely, intermediately, and mildly affected in LGMDR12, respectively. We correlated the PDFF to the fat percentage measured on biopsies of the corresponding muscles, as well as to the Rochester histopathology grading scale. RESULTS In patients, we demonstrated a strong correlation of PDFF on MRI and muscle biopsy fat percentage for the semimembranosus (r = 0.85, P < 0.001) and vastus lateralis (r = 0.68, P = 0.005). We found similar results for the correlation between PDFF and the Rochester histopathology grading scale. Out of the five patients with inflammatory changes on muscle biopsy, three showed STIR hyperintensities in the corresponding muscle on MRI. By modelling the PDFF on MRI for 18 thigh muscles from origin to insertion, we observed a significantly inhomogeneous proximo-distal distribution of fat replacement in all thigh muscles of patients with LGMDR12 (P < 0.001), and different patterns of fat replacement within each of the muscles. CONCLUSIONS We showed a strong correlation of fat fraction on MRI and fat percentage on muscle biopsy for diseased muscles and validated the use of Dixon fat fraction imaging as an outcome measure in LGMDR12. The inhomogeneous fat replacement within thigh muscles on imaging underlines the risk of analysing only samples of muscles instead of the entire muscles, which has important implications for clinical trials.
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Affiliation(s)
- Bram De Wel
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Laboratory for Muscle Diseases and Neuropathies, KU Leuven, Leuven Brain Institute (LBI), Leuven, Belgium
| | - Lotte Huysmans
- Medical Imaging Research Centre, University Hospitals Leuven, Leuven, Belgium
- Department ESAT - PSI, KU Leuven, Leuven, Belgium
| | - Christophe E Depuydt
- Department of Neurosciences, Laboratory for Muscle Diseases and Neuropathies, KU Leuven, Leuven Brain Institute (LBI), Leuven, Belgium
| | - Veerle Goosens
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Ronald Peeters
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Filipa P Santos
- Department of Neurosciences, Laboratory for Muscle Diseases and Neuropathies, KU Leuven, Leuven Brain Institute (LBI), Leuven, Belgium
| | - Dietmar R Thal
- Department of Imaging and Pathology, Laboratory for Neuropathology, KU Leuven, Leuven Brain Institute (LBI), Leuven, Belgium
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Patrick Dupont
- Department of Neurosciences, Laboratory for Cognitive Neurology, KU Leuven, Leuven Brain Institute (LBI), Leuven, Belgium
| | - Frederik Maes
- Medical Imaging Research Centre, University Hospitals Leuven, Leuven, Belgium
- Department ESAT - PSI, KU Leuven, Leuven, Belgium
| | - Kristl G Claeys
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Laboratory for Muscle Diseases and Neuropathies, KU Leuven, Leuven Brain Institute (LBI), Leuven, Belgium
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10
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Vogels C, Brackney D, Dupuis A, Robich R, Fauver J, Brito A, Williams S, Anderson J, Lubelczyk C, Lange R, Prusinski M, Kramer L, Gangloff-Kaufmann J, Goodman L, Baele G, Smith R, Armstrong P, Ciota A, Dellicour S, Grubaugh N. Phylogeographic reconstruction of the emergence and spread of Powassan virus in the northeastern United States. Proc Natl Acad Sci U S A 2023; 120:e2218012120. [PMID: 37040418 PMCID: PMC10120011 DOI: 10.1073/pnas.2218012120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/23/2023] [Indexed: 04/12/2023] Open
Abstract
Powassan virus is an emerging tick-borne virus of concern for public health, but very little is known about its transmission patterns and ecology. Here, we expanded the genomic dataset by sequencing 279 Powassan viruses isolated from Ixodes scapularis ticks from the northeastern United States. Our phylogeographic reconstructions revealed that Powassan virus lineage II was likely introduced or emerged from a relict population in the Northeast between 1940 and 1975. Sequences strongly clustered by sampling location, suggesting a highly focal geographical distribution. Our analyses further indicated that Powassan virus lineage II emerged in the northeastern United States mostly following a south-to-north pattern, with a weighted lineage dispersal velocity of ~3 km/y. Since the emergence in the Northeast, we found an overall increase in the effective population size of Powassan virus lineage II, but with growth stagnating during recent years. The cascading effect of population expansion of white-tailed deer and I. scapularis populations likely facilitated the emergence of Powassan virus in the northeastern United States.
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Affiliation(s)
- Chantal B. F. Vogels
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510
| | - Doug E. Brackney
- Center for Vector Biology and Zoonotic Diseases, Department of Entomology, The Connecticut Agricultural Experiment Station, New Haven, CT 06511
| | - Alan P. Dupuis
- The Arbovirus Laboratory, New York State Department of Health, Wadsworth Center, Slingerlands, NY 12159
- Department of Biomedical Sciences, State University of New York at Albany School of Public Health, Albany, NY 12222
| | - Rebecca M. Robich
- Vector-borne Disease Laboratory, MaineHealth Institute for Research, Scarborough, ME 04074
| | - Joseph R. Fauver
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510
- Department of Epidemiology, University of Nebraska Medical Center, Omaha, NE 68198
| | - Anderson F. Brito
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510
- Instituto Todos pela Saúde, São Paulo SP01310-942, Brazil
| | - Scott C. Williams
- Department of Environmental Science and Forestry, The Connecticut Agricultural Experiment Station, New Haven, CT 06511
| | - John F. Anderson
- Center for Vector Biology and Zoonotic Diseases, Department of Entomology, The Connecticut Agricultural Experiment Station, New Haven, CT 06511
| | - Charles B. Lubelczyk
- Vector-borne Disease Laboratory, MaineHealth Institute for Research, Scarborough, ME 04074
| | - Rachel E. Lange
- The Arbovirus Laboratory, New York State Department of Health, Wadsworth Center, Slingerlands, NY 12159
- Department of Biomedical Sciences, State University of New York at Albany School of Public Health, Albany, NY 12222
| | - Melissa A. Prusinski
- New York State Department of Health, Bureau of Communicable Disease Control, Albany, NY 12237
| | - Laura D. Kramer
- The Arbovirus Laboratory, New York State Department of Health, Wadsworth Center, Slingerlands, NY 12159
- Department of Biomedical Sciences, State University of New York at Albany School of Public Health, Albany, NY 12222
| | | | - Laura B. Goodman
- Department of Public and Ecosystem Health, Cornell University, Ithaca, NY 14853
| | - Guy Baele
- Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Leuven3000, Belgium
| | - Robert P. Smith
- Vector-borne Disease Laboratory, MaineHealth Institute for Research, Scarborough, ME 04074
| | - Philip M. Armstrong
- Center for Vector Biology and Zoonotic Diseases, Department of Entomology, The Connecticut Agricultural Experiment Station, New Haven, CT 06511
| | - Alexander T. Ciota
- The Arbovirus Laboratory, New York State Department of Health, Wadsworth Center, Slingerlands, NY 12159
- Department of Biomedical Sciences, State University of New York at Albany School of Public Health, Albany, NY 12222
| | - Simon Dellicour
- Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Leuven3000, Belgium
- Spatial Epidemiology Lab, Université Libre de Bruxelles, Brussels1050, Belgium
| | - Nathan D. Grubaugh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT 06511
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11
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Dellicour S, Hong SL, Hill V, Dimartino D, Marier C, Zappile P, Harkins GW, Lemey P, Baele G, Duerr R, Heguy A. Variant-specific introduction and dispersal dynamics of SARS-CoV-2 in New York City - from Alpha to Omicron. PLoS Pathog 2023; 19:e1011348. [PMID: 37071654 PMCID: PMC10180688 DOI: 10.1371/journal.ppat.1011348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 05/12/2023] [Accepted: 04/09/2023] [Indexed: 04/19/2023] Open
Abstract
Since the latter part of 2020, SARS-CoV-2 evolution has been characterised by the emergence of viral variants associated with distinct biological characteristics. While the main research focus has centred on the ability of new variants to increase in frequency and impact the effective reproductive number of the virus, less attention has been placed on their relative ability to establish transmission chains and to spread through a geographic area. Here, we describe a phylogeographic approach to estimate and compare the introduction and dispersal dynamics of the main SARS-CoV-2 variants - Alpha, Iota, Delta, and Omicron - that circulated in the New York City area between 2020 and 2022. Notably, our results indicate that Delta had a lower ability to establish sustained transmission chains in the NYC area and that Omicron (BA.1) was the variant fastest to disseminate across the study area. The analytical approach presented here complements non-spatially-explicit analytical approaches that seek a better understanding of the epidemiological differences that exist among successive SARS-CoV-2 variants of concern.
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Affiliation(s)
- Simon Dellicour
- Spatial Epidemiology Lab (SpELL), Université Libre de Bruxelles, Bruxelles, Belgium
- Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory for Clinical and Epidemiological Virology, KU Leuven, Leuven, Belgium
| | - Samuel L. Hong
- Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory for Clinical and Epidemiological Virology, KU Leuven, Leuven, Belgium
| | - Verity Hill
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Dacia Dimartino
- Genome Technology Center, Office for Science and Research, NYU Langone Health, New York, New York, United States of America
| | - Christian Marier
- Genome Technology Center, Office for Science and Research, NYU Langone Health, New York, New York, United States of America
| | - Paul Zappile
- Genome Technology Center, Office for Science and Research, NYU Langone Health, New York, New York, United States of America
| | - Gordon W. Harkins
- South African National Bioinformatics Institute, University of the Western Cape, Bellville, South Africa
| | - Philippe Lemey
- Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory for Clinical and Epidemiological Virology, KU Leuven, Leuven, Belgium
| | - Guy Baele
- Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory for Clinical and Epidemiological Virology, KU Leuven, Leuven, Belgium
| | - Ralf Duerr
- Department of Microbiology, NYU Grossman School of Medicine, New York, New York, United States of America
- Department of Medicine, NYU Grossman School of Medicine, New York, New York, United States of America
- Vaccine Center, NYU Grossman School of Medicine, New York, New York, United States of America
| | - Adriana Heguy
- Genome Technology Center, Office for Science and Research, NYU Langone Health, New York, New York, United States of America
- Department of Pathology, NYU Grossman School of Medicine, New York, New York, United States of America
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12
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Landolfo C, Bourne T, Froyman W, Van Calster B, Ceusters J, Testa AC, Wynants L, Sladkevicius P, Van Holsbeke C, Domali E, Fruscio R, Epstein E, Franchi D, Kudla MJ, Chiappa V, Alcazar JL, Leone FPG, Buonomo F, Coccia ME, Guerriero S, Deo N, Jokubkiene L, Savelli L, Fischerova D, Czekierdowski A, Kaijser J, Coosemans A, Scambia G, Vergote I, Timmerman D, Valentin L. Benign descriptors and ADNEX in two-step strategy to estimate risk of malignancy in ovarian tumors: retrospective validation in IOTA5 multicenter cohort. Ultrasound Obstet Gynecol 2023; 61:231-242. [PMID: 36178788 PMCID: PMC10107772 DOI: 10.1002/uog.26080] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 08/26/2022] [Accepted: 09/16/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Previous work has suggested that the ultrasound-based benign simple descriptors (BDs) can reliably exclude malignancy in a large proportion of women presenting with an adnexal mass. This study aimed to validate a modified version of the BDs and to validate a two-step strategy to estimate the risk of malignancy, in which the modified BDs are followed by the Assessment of Different NEoplasias in the adneXa (ADNEX) model if modified BDs do not apply. METHODS This was a retrospective analysis using data from the 2-year interim analysis of the International Ovarian Tumor Analysis (IOTA) Phase-5 study, in which consecutive patients with at least one adnexal mass were recruited irrespective of subsequent management (conservative or surgery). The main outcome was classification of tumors as benign or malignant, based on histology or on clinical and ultrasound information during 1 year of follow-up. Multiple imputation was used when outcome based on follow-up was uncertain according to predefined criteria. RESULTS A total of 8519 patients were recruited at 36 centers between 2012 and 2015. We excluded patients who were already in follow-up at recruitment and all patients from 19 centers that did not fulfil our criteria for good-quality surgical and follow-up data, leaving 4905 patients across 17 centers for statistical analysis. Overall, 3441 (70%) tumors were benign, 978 (20%) malignant and 486 (10%) uncertain. The modified BDs were applicable in 1798/4905 (37%) tumors, of which 1786 (99.3%) were benign. The two-step strategy based on ADNEX without CA125 had an area under the receiver-operating-characteristics curve (AUC) of 0.94 (95% CI, 0.92-0.96). The risk of malignancy was slightly underestimated, but calibration varied between centers. A sensitivity analysis in which we expanded the definition of uncertain outcome resulted in 1419 (29%) tumors with uncertain outcome and an AUC of the two-step strategy without CA125 of 0.93 (95% CI, 0.91-0.95). CONCLUSION A large proportion of adnexal masses can be classified as benign by the modified BDs. For the remaining masses, the ADNEX model can be used to estimate the risk of malignancy. This two-step strategy is convenient for clinical use. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C. Landolfo
- Department of Development and RegenerationKU LeuvenLeuvenBelgium
- Department of Woman, Child and Public HealthFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - T. Bourne
- Department of Development and RegenerationKU LeuvenLeuvenBelgium
- Department of Obstetrics and GynecologyUniversity Hospitals LeuvenLeuvenBelgium
- Queen Charlotte's and Chelsea HospitalImperial College Healthcare NHS TrustLondonUK
| | - W. Froyman
- Department of Development and RegenerationKU LeuvenLeuvenBelgium
- Department of Obstetrics and GynecologyUniversity Hospitals LeuvenLeuvenBelgium
| | - B. Van Calster
- Department of Development and RegenerationKU LeuvenLeuvenBelgium
- Department of Biomedical Data SciencesLeiden University Medical Centre (LUMC)LeidenThe Netherlands
| | - J. Ceusters
- Department of Development and RegenerationKU LeuvenLeuvenBelgium
- Laboratory of Tumor Immunology and Immunotherapy, Department of OncologyLeuven Cancer Institute, KU LeuvenLeuvenBelgium
| | - A. C. Testa
- Department of Woman, Child and Public HealthFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Dipartimento Universitario Scienze della Vita e Sanità PubblicaUniversità Cattolica del Sacro CuoreRomeItaly
| | - L. Wynants
- Department of Development and RegenerationKU LeuvenLeuvenBelgium
- Department of EpidemiologyCAPHRI Care and Public Health Research Institute, Maastricht UniversityMaastrichtThe Netherlands
| | - P. Sladkevicius
- Department of Obstetrics and GynecologySkåne University HospitalMalmöSweden
- Department of Clinical Sciences MalmöLund UniversityLundSweden
| | - C. Van Holsbeke
- Department of Obstetrics and GynecologyZiekenhuis Oost‐LimburgGenkBelgium
| | - E. Domali
- First Department of Obstetrics and GynecologyAlexandra Hospital, National and Kapodistrian University of AthensAthensGreece
| | - R. Fruscio
- Clinic of Obstetrics and GynecologyUniversity of Milano‐Bicocca, San Gerardo HospitalMonzaItaly
| | - E. Epstein
- Department of Clinical Science and EducationKarolinska InstitutetStockholmSweden
- Department of Obstetrics and GynecologySödersjukhusetStockholmSweden
| | - D. Franchi
- Preventive Gynecology Unit, Division of GynecologyEuropean Institute of Oncology IRCCSMilanItaly
| | - M. J. Kudla
- Department of Perinatology and Oncological GynecologyFaculty of Medical Sciences, Medical University of SilesiaKatowicePoland
| | - V. Chiappa
- Department of Gynecologic OncologyNational Cancer Institute of MilanMilanItaly
| | - J. L. Alcazar
- Department of Obstetrics and GynecologyClinica Universidad de Navarra, School of MedicinePamplonaSpain
| | - F. P. G. Leone
- Department of Obstetrics and GynecologyBiomedical and Clinical Sciences Institute L. Sacco, University of MilanMilanItaly
| | - F. Buonomo
- Institute for Maternal and Child HealthIRCCS ‘Burlo Garofolo’TriesteItaly
| | - M. E. Coccia
- Department of Obstetrics and GynecologyUniversity of FlorenceFlorenceItaly
| | - S. Guerriero
- Department of Obstetrics and GynecologyUniversity of Cagliari, Policlinico Universitario Duilio CasulaCagliariItaly
| | - N. Deo
- Department of Obstetrics and GynecologyWhipps Cross HospitalLondonUK
| | - L. Jokubkiene
- Department of Obstetrics and GynecologySkåne University HospitalMalmöSweden
- Department of Clinical Sciences MalmöLund UniversityLundSweden
| | - L. Savelli
- Gynecology and Physiopathology of Human Reproduction UnitSant'Orsola‐Malpighi Hospital of BolognaBolognaItaly
| | - D. Fischerova
- Gynecologic Oncology Centre, Department of Obstetrics and Gynecology, First Faculty of MedicineCharles University and General University Hospital in PraguePragueCzech Republic
| | - A. Czekierdowski
- First Department of Gynecological Oncology and GynecologyMedical University of LublinLublinPoland
| | - J. Kaijser
- Department of Obstetrics and GynecologyIkazia HospitalRotterdamThe Netherlands
| | - A. Coosemans
- Laboratory of Tumor Immunology and Immunotherapy, Department of OncologyLeuven Cancer Institute, KU LeuvenLeuvenBelgium
| | - G. Scambia
- Department of Woman, Child and Public HealthFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Dipartimento Universitario Scienze della Vita e Sanità PubblicaUniversità Cattolica del Sacro CuoreRomeItaly
| | - I. Vergote
- Department of Obstetrics and GynecologyUniversity Hospitals LeuvenLeuvenBelgium
- Laboratory of Tumor Immunology and Immunotherapy, Department of OncologyLeuven Cancer Institute, KU LeuvenLeuvenBelgium
| | - D. Timmerman
- Department of Development and RegenerationKU LeuvenLeuvenBelgium
- Department of Obstetrics and GynecologyUniversity Hospitals LeuvenLeuvenBelgium
| | - L. Valentin
- Department of Obstetrics and GynecologySkåne University HospitalMalmöSweden
- Department of Clinical Sciences MalmöLund UniversityLundSweden
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13
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Christodoulou E, van Smeden M, Edlinger M, Timmerman D, Wanitschek M, Steyerberg EW, Van Calster B. Adaptive sample size determination for the development of clinical prediction models. Diagn Progn Res 2021; 5:6. [PMID: 33745449 PMCID: PMC7983402 DOI: 10.1186/s41512-021-00096-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/15/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND We suggest an adaptive sample size calculation method for developing clinical prediction models, in which model performance is monitored sequentially as new data comes in. METHODS We illustrate the approach using data for the diagnosis of ovarian cancer (n = 5914, 33% event fraction) and obstructive coronary artery disease (CAD; n = 4888, 44% event fraction). We used logistic regression to develop a prediction model consisting only of a priori selected predictors and assumed linear relations for continuous predictors. We mimicked prospective patient recruitment by developing the model on 100 randomly selected patients, and we used bootstrapping to internally validate the model. We sequentially added 50 random new patients until we reached a sample size of 3000 and re-estimated model performance at each step. We examined the required sample size for satisfying the following stopping rule: obtaining a calibration slope ≥ 0.9 and optimism in the c-statistic (or AUC) < = 0.02 at two consecutive sample sizes. This procedure was repeated 500 times. We also investigated the impact of alternative modeling strategies: modeling nonlinear relations for continuous predictors and correcting for bias on the model estimates (Firth's correction). RESULTS Better discrimination was achieved in the ovarian cancer data (c-statistic 0.9 with 7 predictors) than in the CAD data (c-statistic 0.7 with 11 predictors). Adequate calibration and limited optimism in discrimination was achieved after a median of 450 patients (interquartile range 450-500) for the ovarian cancer data (22 events per parameter (EPP), 20-24) and 850 patients (750-900) for the CAD data (33 EPP, 30-35). A stricter criterion, requiring AUC optimism < = 0.01, was met with a median of 500 (23 EPP) and 1500 (59 EPP) patients, respectively. These sample sizes were much higher than the well-known 10 EPP rule of thumb and slightly higher than a recently published fixed sample size calculation method by Riley et al. Higher sample sizes were required when nonlinear relationships were modeled, and lower sample sizes when Firth's correction was used. CONCLUSIONS Adaptive sample size determination can be a useful supplement to fixed a priori sample size calculations, because it allows to tailor the sample size to the specific prediction modeling context in a dynamic fashion.
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Affiliation(s)
| | - Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Michael Edlinger
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium
- Department of Medical Statistics, Informatics, and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Dirk Timmerman
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Maria Wanitschek
- University Clinic of Internal Medicine III - Cardiology and Angiology, Tirol Kliniken, Innsbruck, Austria
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Ben Van Calster
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium.
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands.
- EPI-centre, KU Leuven, Leuven, Belgium.
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14
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Leuridan S, Goossens Q, Pastrav LC, Mulier M, Desmet W, Vander Sloten J, Denis K. Development of an Instrument to Assess the Stability of Cementless Femoral Implants Using Vibration Analysis During Total Hip Arthroplasty. IEEE J Transl Eng Health Med 2021; 9:2500210. [PMID: 35103118 PMCID: PMC8791654 DOI: 10.1109/jtehm.2021.3128276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 10/08/2021] [Accepted: 10/23/2021] [Indexed: 11/06/2022]
Abstract
Objective: The level of primary implant fixation in cementless total hip arthroplasty is a key factor for the longevity of the implant. Vibration-based methods show promise for providing quantitative information to help surgeons monitor implant fixation intraoperatively. A thorough understanding of what is driving these changes in vibrational behavior is important for further development and improvement of these methods. Additionally, an instrument must be designed to enable surgeons to leverage these methods. This study addresses both of these issues. Method: An augmented system approach was used to develop an instrument that improves the sensitivity of the vibrational method and enables the implementation of the necessary excitation and measurement equipment. The augmented system approach took into account the dynamics of the existing bone-implant system and its interaction with the added instrument. Results: Two instrument designs are proposed, accompanied by a convergence-based method to determine the insertion endpoint. The modal strain energy density distribution was shown to affect the vibrational sensitivity to contact changes in certain areas. Conclusion: The augmented system approach led to an instrument design that improved the sensitivity to changes in the proximal region of the combined bone-implant-instrument system. This fact was confirmed both in silico and in vitro. Clinical Impact: The presented method and instruments address practical intraoperative challenges and provide perspective to objectively support the surgeon’s decision-making process, which will ensure optimal patient treatment.
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Affiliation(s)
- Steven Leuridan
- KU LeuvenDepartment of Mechanical EngineeringBiomechanics Section 3000 Leuven Belgium
| | - Quentin Goossens
- KU LeuvenDepartment of Mechanical EngineeringBiomechanics Section 3000 Leuven Belgium
| | - Leonard Cezar Pastrav
- KU LeuvenDepartment of Mechanical EngineeringBiomechanics Section 3000 Leuven Belgium
| | - Michiel Mulier
- University Hospital LeuvenDepartment of Orthopaedics 3000 Leuven Belgium
| | - Wim Desmet
- KU LeuvenDepartment of Mechanical EngineeringLMSD Section 3000 Leuven Belgium
| | - Jos Vander Sloten
- KU LeuvenDepartment of Mechanical EngineeringBiomechanics Section 3000 Leuven Belgium
| | - Kathleen Denis
- KU LeuvenDepartment of Mechanical EngineeringBiomechanics Section 3000 Leuven Belgium
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15
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Van Calster B, Van Hoorde K, Vergouwe Y, Bobdiwala S, Condous G, Kirk E, Bourne T, Steyerberg EW. Validation and updating of risk models based on multinomial logistic regression. Diagn Progn Res 2017; 1:2. [PMID: 31093534 PMCID: PMC6457140 DOI: 10.1186/s41512-016-0002-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 09/09/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Risk models often perform poorly at external validation in terms of discrimination or calibration. Updating methods are needed to improve performance of multinomial logistic regression models for risk prediction. METHODS We consider simple and more refined updating approaches to extend previously proposed methods for dichotomous outcomes. These include model recalibration (adjustment of intercept and/or slope), revision (re-estimation of individual model coefficients), and extension (revision with additional markers). We suggest a closed testing procedure to assist in deciding on the updating complexity. These methods are demonstrated on a case study of women with pregnancies of unknown location (PUL). A previously developed risk model predicts the probability that a PUL is a failed, intra-uterine, or ectopic pregnancy. We validated and updated this model on more recent patients from the development setting (temporal updating; n = 1422) and on patients from a different hospital (geographical updating; n = 873). Internal validation of updated models was performed through bootstrap resampling. RESULTS Contrary to dichotomous models, we noted that recalibration can also affect discrimination for multinomial risk models. If the number of outcome categories is higher than the number of variables, logistic recalibration is obsolete because straightforward model refitting does not require the estimation of more parameters. Although recalibration strongly improved performance in the case study, the closed testing procedure selected model revision. Further, revision of functional form of continuous predictors had a positive effect on discrimination, whereas penalized estimation of changes in model coefficients was beneficial for calibration. CONCLUSIONS Methods for updating of multinomial risk models are now available to improve predictions in new settings. A closed testing procedure is helpful to decide whether revision is preferred over recalibration. Because multicategory outcomes increase the number of parameters to be estimated, we recommend full model revision only when the sample size for each outcome category is large.
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Affiliation(s)
- Ben Van Calster
- grid.5596.f0000000106687884KU Leuven Department of Development and Regeneration, Herestraat 49 box 805, 3000 Leuven, Belgium
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus MC, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | | | - Yvonne Vergouwe
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus MC, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Shabnam Bobdiwala
- grid.7445.20000000121138111Queen Charlotte’s and Chelsea Hospital, Imperial College, Du Cane Road, London, W12 0HS UK
| | - George Condous
- grid.1013.3000000041936834XAcute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Kingswood, NSW Australia
| | - Emma Kirk
- grid.439355.dNorth Middlesex University Hospital, Sterling Way, London, N18 1QX UK
| | - Tom Bourne
- grid.5596.f0000000106687884KU Leuven Department of Development and Regeneration, Herestraat 49 box 805, 3000 Leuven, Belgium
- grid.7445.20000000121138111Queen Charlotte’s and Chelsea Hospital, Imperial College, Du Cane Road, London, W12 0HS UK
- grid.410569.f0000000406263338Department of Obstetrics and Gynecology, University Hospitals Leuven, Herestraat 49 box 7003, Leuven, Belgium
| | - Ewout W. Steyerberg
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus MC, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
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Fransen K, Haslam SA, Mallett CJ, Steffens NK, Peters K, Boen F. Leading from the Centre: A Comprehensive Examination of the Relationship between Central Playing Positions and Leadership in Sport. PLoS One 2016; 11:e0168150. [PMID: 27977734 PMCID: PMC5158024 DOI: 10.1371/journal.pone.0168150] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 11/26/2016] [Indexed: 01/15/2023] Open
Abstract
RESEARCH AIMS The present article provides a comprehensive examination of the relationship between playing position and leadership in sport. More particularly, it explores links between leadership and a player's interactional centrality-defined as the degree to which their playing position provides opportunities for interaction with other team members. This article examines this relationship across different leadership roles, team sex, and performance levels. RESULTS Study 1 (N = 4443) shows that athlete leaders (and the task and motivational leader in particular) are more likely than other team members to occupy interactionally central positions in a team. Players with high interactional centrality were also perceived to be better leaders than those with low interactional centrality. Study 2 (N = 308) established this link for leadership in general, while Study 3 (N = 267) and Study 4 (N = 776) revealed that the same was true for task, motivational, and external leadership. This relationship is attenuated in sports where an interactionally central position confers limited interactional advantages. In other words, the observed patterns were strongest in sports that are played on a large field with relatively fixed positions (e.g., soccer), while being weaker in sports that are played on a smaller field where players switch positions dynamically (e.g., basketball, ice hockey). Beyond this, the pattern is broadly consistent across different sports, different sexes, and different levels of skill. CONCLUSIONS The observed patterns are consistent with the idea that positions that are interactionally central afford players greater opportunities to do leadership-either through communication or through action. Significantly too, they also provide a basis for them to be seen to do leadership by others on their team. Thus while it is often stated that "leadership is an action, not a position," it is nevertheless the case that, when it comes to performing that action, some positions are more advantageous than others.
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Affiliation(s)
| | - S. Alexander Haslam
- School of Psychology, The University of Queensland, St. Lucia, Queensland, Australia
| | - Cliff J. Mallett
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, Queensland, Australia
| | - Niklas K. Steffens
- School of Psychology, The University of Queensland, St. Lucia, Queensland, Australia
| | - Kim Peters
- School of Psychology, The University of Queensland, St. Lucia, Queensland, Australia
| | - Filip Boen
- Department of Kinesiology, KU Leuven, Leuven, Belgium
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