Recently developed methods of longitudinal discriminant analysis allow for classification of subjects into prespecified prognostic groups using longitudinal history of both continuous and discrete biomarkers. The classification uses Bayesian estimates of the group membership probabilities for each prognostic group. These estimates are derived from a multivariate generalised linear mixed model of the biomarker's longitudinal evolution in each of the groups and can be updated each time new data is available for a patient, providing a dynamic (over time) allocation scheme. However, the precision of the estimated group probabilities differs for each patient and also over time. This precision can be assessed by looking at credible intervals for the group membership probabilities. In this paper, we propose a new allocation rule that incorporates credible intervals for use in context of a dynamic longitudinal discriminant analysis and show that this can decrease the number of false positives in a prognostic test, improving the positive predictive value. We also establish that by leaving some patients unclassified for a certain period, the classification accuracy of those patients who are classified can be improved, giving increased confidence to clinicians in their decision making. Finally, we show that determining a stopping rule dynamically can be more accurate than specifying a set time point at which to decide on a patient's status. We illustrate our methodology using data from patients with epilepsy and show how patients who fail to achieve adequate seizure control are more accurately identified using credible intervals compared to existing methods.

• Klíčová slova
• allocation scheme, credible intervals, longitudinal discriminant analysis,
• MeSH
• Bayesova věta * MeSH
• diskriminační analýza MeSH
• epilepsie diagnóza   terapie   MeSH
• indukce remise MeSH
• klasifikace metody   MeSH
• lidé MeSH
• lineární modely MeSH
• longitudinální studie MeSH
• multivariační analýza MeSH
• počítačová simulace MeSH
• pravděpodobnost * MeSH
• prognóza MeSH
• rozhodování MeSH
• senzitivita a specificita MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The outcomes of several randomized trials on extracorporeal cardiopulmonary resuscitation (ECPR) in patients with refractory out-of-hospital cardiac arrest were examined using frequentist methods, resulting in a dichotomous interpretation of results based on p-values rather than in the probability of clinically relevant treatment effects. To determine such a probability of a clinically relevant ECPR-based treatment effect on neurological outcomes, the authors of these trials performed a Bayesian meta-analysis of the totality of randomized ECPR evidence. METHODS: A systematic search was applied to three electronic databases. Randomized trials that compared ECPR-based treatment with conventional CPR for refractory out-of-hospital cardiac arrest were included. The study was preregistered in INPLASY (INPLASY2023120060). The primary Bayesian hierarchical meta-analysis estimated the difference in 6-month neurologically favorable survival in patients with all rhythms, and a secondary analysis assessed this difference in patients with shockable rhythms (Bayesian hierarchical random-effects model). Primary Bayesian analyses were performed under vague priors. Outcomes were formulated as estimated median relative risks, mean absolute risk differences, and numbers needed to treat with corresponding 95% credible intervals (CrIs). The posterior probabilities of various clinically relevant absolute risk difference thresholds were estimated. RESULTS: Three randomized trials were included in the analysis (ECPR, n = 209 patients; conventional CPR, n = 211 patients). The estimated median relative risk of ECPR for 6-month neurologically favorable survival was 1.47 (95%CrI 0.73-3.32) with a mean absolute risk difference of 8.7% (- 5.0; 42.7%) in patients with all rhythms, and the median relative risk was 1.54 (95%CrI 0.79-3.71) with a mean absolute risk difference of 10.8% (95%CrI - 4.2; 73.9%) in patients with shockable rhythms. The posterior probabilities of an absolute risk difference > 0% and > 5% were 91.0% and 71.1% in patients with all rhythms and 92.4% and 75.8% in patients with shockable rhythms, respectively. CONCLUSION: The current Bayesian meta-analysis found a 71.1% and 75.8% posterior probability of a clinically relevant ECPR-based treatment effect on 6-month neurologically favorable survival in patients with all rhythms and shockable rhythms. These results must be interpreted within the context of the reported credible intervals and varying designs of the randomized trials. REGISTRATION: INPLASY (INPLASY2023120060, December 14th, 2023, https://doi.org/10.37766/inplasy2023.12.0060 ).

• Klíčová slova
• Bayesian statistical inference, Conventional cardiopulmonary resuscitation, Extracorporeal cardiopulmonary resuscitation, Neurologically favorable survival, Out-of-hospital cardiac arrest, Randomized controlled trials,
• MeSH
• Bayesova věta * MeSH
• kardiopulmonální resuscitace * metody   normy   MeSH
• lidé MeSH
• mimotělní membránová oxygenace metody   MeSH
• randomizované kontrolované studie jako téma metody   MeSH
• výsledek terapie MeSH
• zástava srdce mimo nemocnici * terapie   mortalita   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH

The Arteriovenous Access Stage (AVAS) classification simplifies information about suitability of vessels for vascular access (VA). It's been previously validated in a clinical study. Here, AVAS performance was tested against multiple ultrasound mapping measurements using machine learning. A prospective multicentre international study (NCT04796558) with patient recruitment from March 2021-July 2024. Demographics, risk factors, vessels parameters, types of predicted and created VA (pVA, cVA) were collected. We modelled pVA and cVA using the Random Forest algorithm. Model performance was estimated and compared using Bayesian generalized linear models. ROC AUC with 95% credible intervals was the performance metric. 1151 patients were included. ROC AUC for pVA prediction by AVAS was 0.79 (0.77;0.82) and by mapping was 0.85 (0.83;0.88). ROC AUC for cVA prediction by AVAS was 0.71 (0.69;0.74) and by mapping was 0.8 (0.78;0.83). Using AVAS with other parameters increased the ROC AUC to 0.87 for pVA (0.84;0.89) and 0.82 (0.79;0.84) for cVA. Using mapping with other parameters increased the ROC AUC to 0.88 for pVA (0.86;0.91) and 0.85 (0.83;0.88) for cVA. Multiple mapping measurements showed higher performance at VA prediction than AVAS. However, AVAS is simpler and quicker, so may be preferable for routine clinical practice.

• Klíčová slova
• Arteriovenous access, Classification system, Dialysis, Mapping, Random forest, Renal replacement therapy,
• MeSH
• arteriovenózní zkrat MeSH
• Bayesova věta MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• ROC křivka MeSH
• senioři MeSH
• strojové učení * MeSH
• ultrasonografie * metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

Scaling evolutionary trees to time is essential for understanding the origins of clades. Recently developed methods allow including the entire fossil record known for the group of interest and eliminated the need for specifying prior distributions for node ages. Here we apply the fossilized birth-death (FBD) approach to reconstruct the diversification timeline of the viperines (subfamily Viperinae). Viperinae are an Old World snake subfamily comprising 102 species from 13 genera. The fossil record of vipers is fairly rich and well assignable to clades due to the unique vertebral and fang morphology. We use an unprecedented sampling of 83 modern species and 13 genetic markers in combination with 197 fossils representing 28 extinct taxa to reconstruct a time-calibrated phylogeny of the Viperinae. Our results suggest a late Eocene-early Oligocene origin with several diversification events following soon after the group's establishment. The age estimates inferred with the FBD model correspond to those from previous studies that were based on node dating but FBD provides notably narrower credible intervals around the node ages. Viperines comprise two African and an Eurasian clade, but the ancestral origin of the subfamily is ambiguous. The most parsimonious scenarios require two transoceanic dispersals over the Tethys Sea during the Oligocene.

• MeSH
• biologická evoluce MeSH
• biologické modely MeSH
• fylogeneze MeSH
• genetické markery * MeSH
• sekvenční analýza DNA MeSH
• Viperidae klasifikace   genetika   MeSH
• výpočetní biologie metody   MeSH
• zkameněliny MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• genetické markery * MeSH

BACKGROUND: Although smoking and HPV infection are recognized as important risk factors for oropharyngeal cancer, how their joint exposure impacts on oropharyngeal cancer risk is unclear. Specifically, whether smoking confers any additional risk to HPV-positive oropharyngeal cancer is not understood. METHODS: Using HPV serology as a marker of HPV-related cancer, we examined the interaction between smoking and HPV16 in 459 oropharyngeal (and 1445 oral cavity and laryngeal) cancer patients and 3024 control participants from two large European multi-centre studies. Odds ratios and credible intervals [CrI], adjusted for potential confounders, were estimated using Bayesian logistic regression. RESULTS: Both smoking [odds ratio (OR [CrI]: 6.82 [4.52, 10.29]) and HPV seropositivity (OR [CrI]: 235.69 [99.95, 555.74]) were independently associated with oropharyngeal cancer. The joint association of smoking and HPV seropositivity was consistent with that expected on the additive scale (synergy index [CrI]: 1.32 [0.51, 3.45]), suggesting they act as independent risk factors for oropharyngeal cancer. CONCLUSIONS: Smoking was consistently associated with increase in oropharyngeal cancer risk in models stratified by HPV16 seropositivity. In addition, we report that the prevalence of oropharyngeal cancer increases with smoking for both HPV16-positive and HPV16-negative persons. The impact of smoking on HPV16-positive oropharyngeal cancer highlights the continued need for smoking cessation programmes for primary prevention of head and neck cancer.

• Klíčová slova
• Human papillomavirus, head and neck cancer risk, interaction, oropharynx cancer, tobacco smoking,
• MeSH
• Bayesova věta MeSH
• dospělí MeSH
• ELISA MeSH
• infekce papilomavirem komplikace   MeSH
• kouření tabáku patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lidský papilomavirus 16 * MeSH
• logistické modely MeSH
• nádory orofaryngu patologie   virologie   MeSH
• odds ratio MeSH
• protilátky virové krev   MeSH
• rizikové faktory MeSH
• senioři MeSH
• studie případů a kontrol MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Intramural MeSH
• Geografické názvy
• Evropa MeSH
• Názvy látek
• protilátky virové MeSH

BACKGROUND: Socioeconomic inequalities are increasingly recognised as an important public health issue, although their role in the leading causes of mortality in urban areas in Europe has not been fully evaluated. In this study, we used data from the INEQ-CITIES study to analyse inequalities in cause-specific mortality in 15 European cities at the beginning of the 21st century. METHODS: A cross-sectional ecological study was carried out to analyse 9 of the leading specific causes of death in small areas from 15 European cities. Using a hierarchical Bayesian spatial model, we estimated smoothed Standardized Mortality Ratios, relative risks and 95% credible intervals for cause-specific mortality in relation to a socioeconomic deprivation index, separately for men and women. RESULTS: We detected spatial socioeconomic inequalities for most causes of mortality studied, although these inequalities differed markedly between cities, being more pronounced in Northern and Central-Eastern Europe. In the majority of cities, most of these causes of death were positively associated with deprivation among men, with the exception of prostatic cancer. Among women, diabetes, ischaemic heart disease, chronic liver diseases and respiratory diseases were also positively associated with deprivation in most cities. Lung cancer mortality was positively associated with deprivation in Northern European cities and in Kosice, but this association was non-existent or even negative in Southern European cities. Finally, breast cancer risk was inversely associated with deprivation in three Southern European cities. CONCLUSIONS: The results confirm the existence of socioeconomic inequalities in many of the main causes of mortality, and reveal variations in their magnitude between different European cities.

• Klíčová slova
• MORTALITY, SOCIAL INEQUALITIES, SPATIAL ANALYSIS,
• MeSH
• Bayesova věta MeSH
• chudoba MeSH
• disparity zdravotního stavu * MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• příčina smrti trendy   MeSH
• prostorová analýza MeSH
• průřezové studie MeSH
• sociální determinanty zdraví * MeSH
• socioekonomické faktory MeSH
• stupeň vzdělání MeSH
• velkoměsta ekonomika   statistika a číselné údaje   MeSH
• zdraví ve městech ekonomika   statistika a číselné údaje   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa epidemiologie   MeSH
• velkoměsta ekonomika   statistika a číselné údaje   MeSH

The aim of this prospective study was to assess the duration of culture-viable SARS-CoV-2 and to monitor the emergence of mutations in a cohort of 23 kidney transplant recipients (KTRs) from June 2022 to June 2023. Combined nares/oropharyngeal swabs were collected weekly starting as soon as possible after symptom onset. The time from symptom onset to a negative culture was 11 days (interquartile range, 8-14), while the time to negative reverse transcriptase quantitative polymerase chain reaction was 18 days (interquartile range, 15-30). Beyond the first swab, 21.7% had a positive culture, and 8.7% replicated viable virus for longer than 30 days. T cell depletion (rate ratio, 2.5; 95% confidence interval [95% CI], 1.9-3.3; P < .001) and time from transplantation (rate ratio, 0.93; 95% CI, 0.90-0.97; P = .006) were associated with the time of viable virus shedding. A cycle threshold value of 24.2 demonstrated a 91.3% negative predictive value of viability (95% credible interval [95% CrI], 76-100). The odds of viability decreased by 69% per week of infection (odds ratio, 0.31; 95% CrI, 0.12-0.76). Overall, ribonucleic acid sequencing did not show accelerated molecular evolution though mutation rate could be increased in molnupiravir-treated KTRs. In conclusion, viable SARS-CoV-2 is eliminated rapidly, the risk of virus evolution is low, and prolonged self-isolation is generally unnecessary for most KTRs.

• Klíčová slova
• SARS-CoV-2, immunodeficiency, immunosuppression, infectiousness, kidney transplantation, public health, virus evolution, virus viability,
• Publikační typ
• časopisecké články MeSH

BACKGROUND AND OBJECTIVE: Influenza-like illness (ILI) leads to a substantial disease burden every winter in Europe; however, oseltamivir is not frequently prescribed to ILI patients in the primary-care setting. An open-label, multi-country, multi-season, randomised controlled trial investigated the effectiveness of oseltamivir for treating ILI in 15 European countries. We aimed to evaluate whether patients presenting with ILI in primary care and being managed with the addition of oseltamivir to usual care had lower average direct and indirect costs compared to patients with usual care alone. METHODS: Resource use data were extracted from participants' daily diaries. Itemised country-specific unit costs were collected through official tariffs, pharmacies or literature. Costs were converted to 2018 values. The null hypothesis was tested based on one-sided credible intervals (CrIs) obtained by bootstrapping. Base-case analysis estimated direct cost and productivity losses using itemised costed resource use and the human capital approach. Scenario analyses with self-reported spending rather than itemised costing were also performed. RESULTS: Patients receiving oseltamivir (N = 1306) reported fewer healthcare visits, medication uses, hospital attendances and paid-work hours lost than the other patients (N = 1298). Excluding the oseltamivir cost, the average direct costs were lower in patients treated with oseltamivir from all perspectives, but these differences were not statistically significant (perspective of patient: €17 [0-95% Crl: 16-19] vs. €24 [5-100% Crl: 18-29]; healthcare provider: €37 [28-67] vs. €44 [25-55]; healthcare payers: €54 [45-85] vs. €68 [45-81]; and society: €423 [399-478] vs. €451 [390-478]). Scenario and age-group analyses confirmed these findings, but with some between-country differences. CONCLUSION: The average direct and indirect costs were consistently lower in patients treated with oseltamivir than in patients without from four perspectives (excluding the oseltamivir cost). However, these differences were not statistically significant.

• MeSH
• analýza nákladů a výnosů MeSH
• antivirové látky terapeutické užití   MeSH
• chřipka lidská * farmakoterapie   epidemiologie   MeSH
• lidé MeSH
• oseltamivir * terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• Geografické názvy
• Evropa MeSH
• Názvy látek
• antivirové látky MeSH
• oseltamivir * MeSH

The control of strongylid infections has become challenging globally for equine practitioners due to the development of anthelmintic resistance. Comprehensive information on anthelmintic resistance in the Czech Republic, however, is still lacking. This study monitored the current efficacy of fenbendazole, pyrantel embonate, ivermectin and moxidectin. Forty-eight of 71 operations met the criteria (≥6 horses with ≥200 eggs per gram), with 969 fecal egg count reduction tests performed. Anthelmintic resistance was evaluated on an operation level based on fecal egg count reduction (FECR) and the lower limit of the 95% credible interval (LLCI) using Bayesian hierarchical models. General anthelmintic efficacy across all operations was assessed by posterior FECRs and the occurrence of sub-zero efficacies. Ivermectin and moxidectin demonstrated excellent efficacy (FECR 99.8-100%; 99.4-100 LLCI) in 45 and 23 operations, respectively, pyrantel embonate demonstrated sufficient efficacy in 15 operations and resistance was suspected in seven operations (FECR 88.1-99.1%; 72.5-98.5 LLCI). Fenbendazole, however, was not effective in a single operation (FECR 19.1-77.8%; 8.1-50.1 LLCI) out of 18. Fenbendazole had the highest probability of sub-zero efficacy (29.1%), i.e., post-treatment fecal egg counts exceeded the pre-treatment counts. Our data indicate an increase in the development of anthelmintic resistance, resulting in total failure of fenbendazole and a reduced efficacy of pyrantel embonate. Introducing advanced approaches of parasite control in the Czech Republic to slow the spread of anthelmintic resistance is thus needed.

• Klíčová slova
• Mini-FLOTAC, anthelmintic drug, anthelmintic resistance, equine strongyles, fecal egg count reduction test,
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Few studies have assessed the impact of the financial crisis on inequalities in suicide mortality in European urban areas. The objective of the study was to analyse the trend in area socioeconomic inequalities in suicide mortality in nine European urban areas before and after the beginning of the financial crisis. METHODS: This ecological study of trends was based on three periods, two before the economic crisis (2000-2003, 2004-2008) and one during the crisis (2009-2014). The units of analysis were the small areas of nine European cities or metropolitan areas, with a median population ranging from 271 (Turin) to 193 630 (Berlin). For each small area and sex, we analysed smoothed standardized mortality ratios of suicide mortality and their relationship with a socioeconomic deprivation index using a hierarchical Bayesian model. RESULTS: Among men, the relative risk (RR) comparing suicide mortality of the 95th percentile value of socioeconomic deprivation (severe deprivation) to its 5th percentile value (low deprivation) were higher than 1 in Stockholm and Lisbon in the three periods. In Barcelona, the RR was 2.06 (95% credible interval: 1.24-3.21) in the first period, decreasing in the other periods. No significant changes were observed across the periods. Among women, a positive significant association was identified only in Stockholm (RR around 2 in the three periods). There were no significant changes across the periods except in London with a RR of 0.49 (95% CI: 0.35-0.68) in the third period. CONCLUSIONS: Area socioeconomic inequalities in suicide mortality did not change significantly after the onset of the crisis in the areas studied.

• MeSH
• Bayesova věta MeSH
• ekonomická recese * MeSH
• lidé MeSH
• mortalita MeSH
• sebevražda * MeSH
• socioekonomické faktory MeSH
• velkoměsta MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Španělsko MeSH
• velkoměsta MeSH