Pennsylvania State University College of Medicine (PSCOM), known simply as Penn State College of Medicine is the medical school of Penn State. While the main Penn State campus is in State College PA, this school is located in Hershey Pennsylvania in order to align with Penn State Milton S. Hershey Medical Center, the medical school’s principal affiliate. The medical school includes 26 basic science and clinical departments and a broad range of clinical programs conducted at its hospital affiliates and numerous ambulatory care sites in the region.
The practice of using validated rating scales to guide treatment—measurement-based care (MBC) remains underutilized in behavioral health. This study examined the association between real-world MBC implementation, ascertained by measure completion, and emergency department (ED) visits. A retrospective cohort design made use of medical insurance claims data (2015–2023) to examine adult psychiatric outpatients exposed to real-world MBC (“MBC” sample; n = 524); 482 were propensity score-matched to patients who received care as usual (“CAU” sample; n = 964). The index visit was the date of registry enrollment for the MBC sample and the first psychiatric encounter while enrolled for the CAU sample. Time-to-event and negative binomial models were used to estimate hazard ratios (HRs) and incidence rate ratios (IRRs) for ED visits. The overall sample included 1,488 patients (63
Neoadjuvant chemotherapy is standard for stage IB-III triple-negative breast cancer (TNBC), with pathological complete response (pCR) strongly associated with survival. Although escalation with platinum and immune checkpoint inhibitors (ICI) improves pCR and long-term outcomes, patients with pCR in control arms of pivotal trials also show favorable outcomes. Whether the regimen leading to pCR impacts long-term survival is largely unknown. We conducted a systematic review and meta-analysis, searching phase II and III trials including early-stage TNBC patients with pCR. A pooled analysis of Kaplan–Meier-derived individual patient data was performed for event-free survival (EFS) and overall survival (OS), with subgroup analyses by treatment regimens. Of 2830 identified publications, 18 trials comprising 3430 patients were included. Neoadjuvant ICI with chemotherapy improved EFS (HR 0.67; 95
This study examines mental health status of patients with complex hypospadias, which include proximal (penoscrotal, scrotal or perineal) hypospadias or hypospadias of any degree with additional urogenital anomalies. Eligible patients of different ages (24
BACKGROUND AND OBJECTIVE:A Likelihood ratio (LR) is a numerical measure of evidential value. Our objective was to use LRs to express the patient-specific evidential values of medical findings that best differentiate abusive versus non-abusive head trauma (AHT). We hypothesized that the evidential values of patients' AHT-related medical findings would be highly variable. METHODS:We analyzed existing, uniform, prospective, de-identified data regarding 973 acutely head-injured children < 3 years hospitalized for intensive care across 18 sites between 2011 and 2021; applied two different proxies for AHT and non-AHT ground truth; trained and validated statistical models that differentiate AHT versus non-AHT; and analyzed patient-specific LRs in a log10 (LLR) format that facilitated assessment of evidential values (where LLR values > 0 and < 0 supported hypotheses of AHT and non-AHT, respectively). RESULTS:The two best performing statistical models revealed evidential (LLR) values for patient-specific, AHT-related medical findings that varied from modest (-1 to + 1) to relatively large (-2.5 to -1 and + 1 to + 3.5), and values that were misleading (AHT patients with LLR values indicative of non-AHT, and vice versa). A few non-AHT patients presented with misleading evidence that was moderately strong, with LLRs approaching + 3. CONCLUSIONS:Reasonable medical certainty of AHT and non-AHT can be enhanced or limited by the highly variable evidential values of patients' most discriminating medical findings. Physicians can use available LRs to inform their AHT-related diagnostic reasoning, opinions, and testimony.
Polygenic scores have potential for predicting health outcomes based on genomic data. However, their portability across diverse populations is hindered by the overrepresentation of European ancestries in discovery genome-wide association (GWAS) studies. The current study evaluated the transferability of substance use polygenic scores across European, African, American, and East Asian populations. European-based scores demonstrated reduced predictive accuracy in non-European populations with mean relative accuracies of 36% in American, 22.5% in East Asian, and 3.8% in African ancestries. Beyond discrete genetic ancestry groups, we found that European-based score prediction declined as a function of genetic distance from the European-stratified GWAS. That is, predictive accuracy declines as genetic distance, derived from continuous measures of ancestry, from the discovery GWAS increases. We evaluated the extent to which differences across populations in linkage disequilibrium (LD), allele frequency, and heritability explained the reduction in accuracy. Across phenotypes we found that approximately 56.0% of accuracy decline in American ancestries was explained by LD and allele frequency differences, with differences in LD appearing to be the primary factor. For East Asian ancestries this was 67.1% and was 84.0% in African ancestries. Differences across populations in heritability accounted for only small portions of reduced polygenic score transferability. This suggests that LD and frequency differences explain significant portions of accuracy loss, but substantial reductions persist, suggesting contributions from other factors like causal effect size differences. The current study provides important information on the causes and extent of the polygenic score transferability problem and has important implications for refinement of polygenic scores. Expanding the diversity of GWAS and target samples remains essential for improving accuracy and equity in prediction.
