Prediction in forensic science: a critical examination of common understandings

In this commentary, we argue that the term 'prediction' is overly used when in fact, referring to foundational writings of de Finetti, the correspondent term should be inference. In particular, we intend (i) to summarize and clarify relevant subject matter on prediction from established statistical theory, and (ii) point out the logic of this understanding with respect practical uses of the term prediction. Written from an interdisciplinary perspective, associating statistics and forensic science as an example, this discussion also connects to related fields such as medical diagnosis and other areas of application where reasoning based on scientific results is practiced in societal relevant contexts. This includes forensic psychology that uses prediction as part of its vocabulary when dealing with matters that arise in the course of legal proceedings.

Exaggerated pulmonary hypertension and right ventricular dysfunction in high-altitude dwellers with patent foramen ovale.

BACKGROUND: There is considerable interindividual variability in pulmonary artery pressure among high-altitude (HA) dwellers, but the underlying mechanism is not known. At low altitude, a patent foramen ovale (PFO) is present in about 25% of the general population. Its prevalence is increased in clinical conditions associated with pulmonary hypertension and arterial hypoxemia, and it is thought to aggravate these problems. METHODS: We searched for a PFO (transesophageal echocardiography) in healthy HA dwellers (n = 22) and patients with chronic mountain sickness (n = 35) at 3,600 m above sea level and studied its effects (transthoracic echocardiography) on right ventricular (RV) function, pulmonary artery pressure, and vascular resistance at rest and during mild exercise (50 W), an intervention designed to further increase pulmonary artery pressure. RESULTS: The prevalence of PFO (32%) was similar to that reported in low-altitude populations and was not different in participants with and without chronic mountain sickness. Its presence was associated with RV enlargement at rest and an exaggerated increase in right-ventricular-to-right-atrial pressure gradient (25 ± 7 mm Hg vs 15 ± 9 mm Hg, P < .001) and a blunted increase in fractional area change of the right ventricle (3% [-1%, 5%] vs 7% [3%, 16%], P = .008) during mild exercise. CONCLUSIONS: These findings show, we believe for the first time, that although the prevalence of PFO is not increased in HA dwellers, its presence appears to facilitate pulmonary vasoconstriction and RV dysfunction during a mild physical effort frequently associated with daily activity. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01182792; URL: www.clinicaltrials.gov.

AltitudeOmics : impaired pulmonary gas exchange efficiency and blunted ventilatory acclimatization in humans with patent foramen ovale after 16 days at 5,260 m.

A patent foramen ovale (PFO), present in ∼40% of the general population, is a potential source of right-to-left shunt that can impair pulmonary gas exchange efficiency [i.e., increase the alveolar-to-arterial Po2 difference (A-aDO2)]. Prior studies investigating human acclimatization to high-altitude with A-aDO2 as a key parameter have not investigated differences between subjects with (PFO+) or without a PFO (PFO-). We hypothesized that in PFO+ subjects A-aDO2 would not improve (i.e., decrease) after acclimatization to high altitude compared with PFO- subjects. Twenty-one (11 PFO+) healthy sea-level residents were studied at rest and during cycle ergometer exercise at the highest iso-workload achieved at sea level (SL), after acute transport to 5,260 m (ALT1), and again at 5,260 m after 16 days of high-altitude acclimatization (ALT16). In contrast to PFO- subjects, PFO+ subjects had 1) no improvement in A-aDO2 at rest and during exercise at ALT16 compared with ALT1, 2) no significant increase in resting alveolar ventilation, or alveolar Po2, at ALT16 compared with ALT1, and consequently had 3) an increased arterial Pco2 and decreased arterial Po2 and arterial O2 saturation at rest at ALT16. Furthermore, PFO+ subjects had an increased incidence of acute mountain sickness (AMS) at ALT1 concomitant with significantly lower peripheral O2 saturation (SpO2). These data suggest that PFO+ subjects have increased susceptibility to AMS when not taking prophylactic treatments, that right-to-left shunt through a PFO impairs pulmonary gas exchange efficiency even after acclimatization to high altitude, and that PFO+ subjects have blunted ventilatory acclimatization after 16 days at altitude compared with PFO- subjects.

Patent claims in certain geographical regions

Työn tavoitteena oli käsitellä mahdollisuutta laatia patenttihakemuksen vaatimuksia siten, että patenttihakemukset toimisivat eri oikeusalueilla, jotka ovat tässä Eurooppa, Suomi ja USA. Aluksi käsiteltiin patentointia ja eri patenttijärjestelmiä yleisesti, jonka jälkeen käsiteltiin lähemmin patenttivaatimuksia, niiden muotoja ja eri vaatimusten edellytyksiä, joita vaaditaan Euroopan patenttisopimuksessa, suomalaisessa ja USA:laisessa patenttijärjestelmässä. Vaikka uutuus, keksinnöllisyys ja teollinen käyttökelpoisuus ovat tärkeimmät edellytykset kun määritetään patenttivaatimuksia, niitä ei käsitelty työn empiirisessä osassa. Työn empiirinen osuus osoittaa selvästi, että erilaiset muodolliset vaatimukset Euroopan patenttisopimuksessa, suomalaisessa ja USA:laisessa patenttijärjestelmässä hankaloittavat patenttivaatimusten laatimista siten että ne toimisivat yhdessä patenttihakemuksessa yllä mainituissa patenttijärjestelmissä. Empiirisen tutkimuksen ja eri oikeusalueilla patenttivaatimusten edellytysten perusteella, ei ole yksinkertaista ratkaisua laatia patenttivaatimuksia (ja myös patenttiselostuksia), jotka toimisivat monilla oikeusalueilla. Eräs ratkaisu ongelmaan on laatia yksi sarja patenttivaatimuksia, jotka täyttävät Euroopan patenttisopimuksen käytännön mukaiset edellytykset (täyttävät myös Suomalaisen patenttijärjestelmän edellytykset) ja toinen sarja patenttivaatimuksia, jotka täyttävät USA:laisen patenttijärjestelmän edellytykset samassa patenttihakemuksessa. Hakemuksen käsittelyvaiheessa hakija voi pudottaa patenttivaatimukset, jotka eivät täytä kansallisen patenttijärjestelmän edellytyksiä patenttihakemuksesta.

Very long-term follow-up after percutaneous closure of patent foramen ovale.

AIMS: To evaluate the very long-term risk of recurrent thromboembolic events in patients treated by percutaneous PFO closure. METHODS AND RESULTS: Between 1998 and 2008, a total of 232 consecutive patients with PFO and a high suspicion of paradoxical embolism were treated by percutaneous closure. The following major events were observed during hospitalisation: implantation failure (one patient) and appearance of an acute left-sided device thrombus requiring surgery (one patient). The primary endpoint of the study was a recurrent embolic event beyond at least five years' follow-up. During a mean follow-up of 7.6±2.4 years, this event occurred in five patients, representing a 0.28% annual/patient risk. Other major complications during follow-up were the following: late thrombus formation on the device (two patients) and transient atrial fibrillation (15 patients). Three patients died during follow-up from cardiovascular causes considered not related to the index procedure. The PFO was judged closed on follow-up echocardiography in 92.3% of patients. CONCLUSIONS: Long-term follow-up following percutaneous PFO closure for presumed paradoxical embolism reveals very low recurrence rates. This observation should be put in perspective with recent published randomised trials comparing percutaneous closure and medical therapy.

Re-examination of Customer Satisfaction Measurement Results

Asiakastyytyväisyys on läheisesti yhteydessä yrityksen taloudelliseen menestykseen ja yrityksen yleisen laadun määrittämiseen. Asiakastyytyväisyyden mittaamista vaaditaan tällä hetkellä myös ISO 9001 laatujärjestelmästandardissa. Tämän vuoksi tarve tutkia ja mitata asiakastyytyväisyyttä on kasvanut yritysten ja yhteisöjen joukossa. Kokonaisvaltainen asiakastyytyväisyyden tutkiminen sisältää sekä asiakastyytyväisyyden mittaamista ja järjestelmällistä asiakaspalautteen tutkimista ja analysointia. Asiakastyytyväisyysmittaamisessa käytetään menettelytapoja ja tekniikoita, jotka ovat yleisesti käytössä markkinointitutkimuksessa. Menetelmiä on kuitenkin mukautettava, jotta ne sopivat asiakastyytyväisyyden mittaamiseksi. Asiakastyytyväisyysmittaustulosten perusanalyysit ovat helppo toteuttaa mutta tulokset voidaan helposti tulkita väärin ilman syvällisempiä tilastomatemaattisia analyysejä. Asiakastyytyväisyyden mittaaminen on helppo toteuttaa mutta tutkimussuunnitelma ja tulostenkeräysmenetelmä pitää suunnitella huolellisesti, jotta mittaustulosten luotettavuus ja validiteetti voidaan taata. Jotta asiakastyytyväisyyden tutkimisesta saataisiin maksimaalinen hyöty, pitäisi tutkimuksen myös tarkastella kuinka asiakastyytyväisyys, yrityksen sisäinen ja ulkoinen laatu sekä asiakaslojaalisuus ovat yhteydessä toisiinsa.

Determinants of antithrombotic choice for patent foramen ovale in cryptogenic stroke.

OBJECTIVE: We examined the influence of clinical, radiologic, and echocardiographic characteristics on antithrombotic choice in patients with cryptogenic stroke (CS) and patent foramen ovale (PFO), hypothesizing that features suggestive of paradoxical embolism might lead to greater use of anticoagulation. METHODS: The Risk of Paradoxical Embolism Study combined 12 databases to create the largest dataset of patients with CS and known PFO status. We used generalized linear mixed models with a random effect of component study to explore whether anticoagulation was preferentially selected based on the following: (1) younger age and absence of vascular risk factors, (2) "high-risk" echocardiographic features, and (3) neuroradiologic findings. RESULTS: A total of 1,132 patients with CS and PFO treated with anticoagulation or antiplatelets were included. Overall, 438 participants (39%) were treated with anticoagulation with a range (by database) of 22% to 54%. Treatment choice was not influenced by age or vascular risk factors. However, neuroradiologic findings (superficial or multiple infarcts) and high-risk echocardiographic features (large shunts, shunt at rest, and septal hypermobility) were predictors of anticoagulation use. CONCLUSION: Both antithrombotic regimens are widely used for secondary stroke prevention in patients with CS and PFO. Radiologic and echocardiographic features were strongly associated with treatment choice, whereas conventional vascular risk factors were not. Prior observational studies are likely to be biased by confounding by indication.

Foreign-Medical-School Graduates object to the VISA Qualifiying Examination

To the editor; The Visa Qualifying Examination is a two-day test composed of approximately 950 multiple-choice questions conerneing the basic and clinical sciences....

Singling out individual inventors from patent data

An increasing number of studies in recent years have sought to identify individual inventors from patent data. A variety of heuristics have been proposed for using the names and other information disclosed in patent documents to establish who is who in patents. This paper contributes to this literature by describing a methodology for identifying inventors using patents applied to the European Patent Office, EPO hereafter. As in much of this literature, we basically follow a threestep procedure : 1- the parsing stage, aimed at reducing the noise in the inventor’s name and other fields of the patent; 2- the matching stage, where name matching algorithms are used to group similar names; and 3- the filtering stage, where additional information and various scoring schemes are used to filter out these similarlynamed inventors. The paper presents the results obtained by using the algorithms with the set of European inventors applying to the EPO over a long period of time.

The new final Clinical Skills examination in human medicine in Switzerland: Essential steps of exam development, implementation and evaluation, and central insights from the perspective of the national Working Group.

OBJECTIVE: Since 2011, the new national final examination in human medicine has been implemented in Switzerland, with a structured clinical-practical part in the OSCE format. From the perspective of the national Working Group, the current article describes the essential steps in the development, implementation and evaluation of the Federal Licensing Examination Clinical Skills (FLE CS) as well as the applied quality assurance measures. Finally, central insights gained from the last years are presented. METHODS: Based on the principles of action research, the FLE CS is in a constant state of further development. On the foundation of systematically documented experiences from previous years, in the Working Group, unresolved questions are discussed and resulting solution approaches are substantiated (planning), implemented in the examination (implementation) and subsequently evaluated (reflection). The presented results are the product of this iterative procedure. RESULTS: The FLE CS is created by experts from all faculties and subject areas in a multistage process. The examination is administered in German and French on a decentralised basis and consists of twelve interdisciplinary stations per candidate. As important quality assurance measures, the national Review Board (content validation) and the meetings of the standardised patient trainers (standardisation) have proven worthwhile. The statistical analyses show good measurement reliability and support the construct validity of the examination. Among the central insights of the past years, it has been established that the consistent implementation of the principles of action research contributes to the successful further development of the examination. CONCLUSION: The centrally coordinated, collaborative-iterative process, incorporating experts from all faculties, makes a fundamental contribution to the quality of the FLE CS. The processes and insights presented here can be useful for others planning a similar undertaking.

Prevalence and sonographic changes compatible with fatty liver disease in patients referred for abdominal ultrasound examination in Aracaju, SE

Abstract Objective: To estimate the prevalence and evaluate sonographic findings compatible with changes consistent with hepatic steatosis in patients referred for abdominal ultrasonography at four reference centers in Aracaju, SE, Brazil. Materials and Methods: Prospective, descriptive survey, with analytical and quantitative approach, comprising abdominal ultrasonography scans performed with a convex, dynamic 3.75 MHz transducer. Liver dimensions and parenchymal echotexture were evaluated, classifying hepatic steatosis into grades (1, 2 or 3). The SPSS® 22.0 software was used for statistical analysis, adopting p < 0.05 as significance level. Results: A total of 800 individuals (561 women and 239 men) were evaluated. The prevalence of steatosis was 29.1%, and the male patients were most affected, presenting with more advanced grades of disease (p = 0.021), as follows: 119 grade 1 (51.0%); 94 grade 2 (40.4%); and 20 grade 3 (8.6%). The median age patients' was 46 years. Conclusion: In the present study sample, the prevalence of hepatic steatosis was high, particularly in the male patients. Ultrasonography is suggested as a first choice for the diagnosis of this condition, considering its wide availability, low cost and absence of side effects or risks to the patient.

Kansallisten immateriaalioikeuksien vaikutus lääkekeksintöihin Suomessa ja Ruotsissa 1980-90-luvulla

Pro gradu- tutkielman tarkoituksena oli tutkia lääkkeiden immateriaalioikeudellisia suojamuotoja Suomen ja Ruotsin osalta. Tutkimuksessa pyrittiin selvittämään lääkkeiden kansallisen patenttisuojan, lisäsuojatodistuksen ja dokumentaatiosuojan vaikutusta lääkekeksintöihin 1980–90-luvun Suomessa ja Ruotsissa. Lääkkeiden lisäsuojatodistuksella tarkoitetaan ainoastaan lääkeaineille tarkoitettua erillistä immateriaalioikeudellista lisäsuojamuotoa, joka pidentää suoja-aikaa enimmillään viidellä vuodella. Dokumentaatiosuojalla tarkoitetaan suojamuotoa, joka suojaa lääkkeiden kehittämisessä aikaan saatuja tutkimus- ja turvallisuustuloksia rinnakkaisvalmistajilta tietyn määritellyn ajan. Suomen ja Ruotsin kansallisessa lainsäädännössä oli tarkasteluajanjaksolla olennaisia eroja. Rinnakkaisongelmana tutkittiin innovaatio- ja patenttipolitiikan merkitystä lääkekeksintöjen määrään ja laatuun. Tutkimuskysymyksiä lähestyttiin virallislähteiden ja kirjallisuuden lisäksi myös teemahaastatteluin. Haastateltavat olivat alan asiantuntijoita. Tutkimus oli haasteellinen. Oli palkitsevaa saada asiaa koskeva ”hiljainen tieto” kansiin. Suomen ja Ruotsin poliittinen ja lainsäädännöllinen ilmapiiri poikkesivat toisistaan. Suomessa vallitsi protektionistinen ilmapiiri ja se näkyi politiikassa ja vaikutti lainsäädäntöön. Menetelmäpatentista ei haluttu luopua. Menetelmäpatentti on patentti, joka käsittää ainoastaan lääkeaineen valmistusmenetelmän, eikä lopputuotetta. Suomessa sallittiin lääkeaineiden tuotepatentti vasta 1995. Toisin oli Ruotsissa; siellä poliittinen ilmapiiri ja valtion sekä lääketeollisuuden näkemykset johtivat kehitystä niin, että tuotepatenttikielto poistettiin huomattavasti aiemmin kuin Suomessa. Ruotsi oli kaukonäköisempi myös muiden suojamuotojen kohdalla. Lopputuloksena tästä seurasi se, että Ruotsin lääketeollisuus on menestynyt huomattavasti paremmin kuin Suomen. Lääkekeksintöjä tehtiin enemmän. Ruotsin lääkekeksinnöistä suuri osa oli uusia molekyylejä; Suomen vastaava osuus oli selvästi pienempi. Myös Ruotsin lääkevienti oli ja on huomattavasti suurempaa kuin Suomen.

Population structure in a highly pelagic seabird, the Cory's shearwater (Calonectris diomedea): an examination of genetics, morphology and ecology

Increasing evidence suggests oceanic traits may play a key role in the genetic structuring of marine organisms. Whereas genetic breaks in the open ocean are well known in fishes and marine invertebrates, the importance of marine habitat characteristics in seabirds remains less certain. We investigated the role of oceanic transitions versus population genetic processes in driving population differentiation in a highly vagile seabird, the Cory"s shearwater, combining molecular, morphological and ecological data from 27 breeding colonies distributed across the Mediterranean (Calonectris diomedea diomedea) and the Atlantic (C. d. borealis). Genetic and biometric analyses showed a clear differentiation between Atlantic and Mediterranean Cory"s shearwaters. Ringing-recovery data indicated high site fidelity of the species, but we found some cases of dispersal among neighbouring breeding sites (<300 km) and a few long distance movements (>1000 km) within and between each basin. In agreement with this, comparison of phenotypic and genetic data revealed both current and historical dispersal events. Within each region, we did not detect any genetic substructure among archipelagos in the Atlantic, but we found a slight genetic differentiation between western and eastern breeding colonies in the Mediterranean. Accordingly, gene flow estimates suggested substantial dispersal among colonies within basins. Overall, genetic structure of the Cory"s shearwater matches main oceanographic breaks (Almería-Oran Oceanic Front and Siculo-Tunisian Strait), but spatial analyses suggest that patterns of genetic differentiation are better explained by geographic rather than oceanographic distances. In line with previous studies, genetic, phenotypic and ecological evidence supported the separation of Atlantic and Mediterranean forms, suggesting the 2 taxa should be regarded as different species.