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PubMed2026

Emerging multidimensional biomarker system for cardiovascular-kidney-metabolic syndrome: from multi-omics integration to clinical artificial intelligence.

Cardiovascular-kidney-metabolic (CKM) syndrome is an emerging clinical entity that highlights the complex, bidirectional interplay among cardiovascular disease, chronic kidney disease, and metabolic disorders, representing a substantial and growing global health burden. This conceptualization marks a paradigm shift from viewing these conditions in isolation to understanding them as an interconnected disease continuum. Traditional biomarkers face significant limitations in the early detection, risk stratification, and precise management of CKM, necessitating a transition towards an integrated framework that captures its multisystem nature. This review systematically outlines an emerging multidimensional biomarker system encompassing key pathological axes such as metabolism, immuno-inflammation, oxidative stress, and biological aging, offering refined risk assessment beyond conventional metrics. The development of this system is propelled by revolutionary platforms, including accessible sampling techniques (e.g., dried blood spots), advanced in vitro models (e.g., multi-organ-on-a-chip), and multi-omics technologies. These platforms not only facilitate a deeper dissection of the heterogeneous origins and inter-organ crosstalk in CKM but also accelerate the discovery and validation of novel biomarkers. Concurrently, artificial intelligence serves as a pivotal tool for clinical translation, effectively integrating high-dimensional data to transform complex molecular profiles into actionable clinical insights. By enabling the construction of dynamic risk prediction and decision-support systems, this review charts a pathway toward proactive, individualized, and precise prevention and management of CKM syndrome.

Humans↗

PubMed2003

Actuarial assessment of risk among sex offenders.

The appraisal of risk among sex offenders has seen recent advances through the advent of actuarial assessments. Statistics derived from Relative Operating Characteristics (ROCs) permit the comparison of predictive accuracies achieved by different instruments even among samples that exhibit different base rates of recidivism. Such statistics cannot, however, solve problems introduced when items from actuarial tools are omitted, when reliability is low, or when there is high between-subject variability in the duration of the follow-up. We present empirical evidence suggesting that when comprehensive actuarial tools (VRAG and SORAG) are scored with high reliability, without missing items, and when samples of offenders have fixed and equal opportunity for recidivism, predictive accuracies are maximized near ROC areas of 0.90. Although the term "dynamic" has not been consistently defined, such accuracies leave little room for further improvement in long-term prediction by dynamic risk factors. We address the mistaken idea that long-term, static risk levels have little relevance for clinical intervention with sex offenders. We conclude that highly accurate prediction of violent criminal recidivism can be achieved by means of highly reliable and thorough scoring of comprehensive multi-item actuarial tools using historical items (at least until potent therapies are identified). The role of current moods, attitudes, insights, and physiological states in causing contemporaneous behavior notwithstanding, accurate prediction about which sex offenders will commit at least one subsequent violent offense can be accomplished using complete information about past conduct.

Actuarial Analysis↗

PubMed2000

Kinetics of early therapeutic response as measured by quantitative PCR predicts survival in a murine xenograft model of human T cell acute lymphoblastic leukemia.

The identification of prognostic parameters and surrogate markers for defining patient risk has been beneficial in effectively guiding therapy and increasing the survival of leukemia patients. It has been hypothesized that the therapeutic response, as measured by a change in tumor burden during therapy, might serve as a new surrogate marker of survival. Here we describe the development of a murine SCID xenograft model of human T cell acute lymphoblastic leukemia (T-ALL), and the use of a sensitive, quantitative PCR assay for the measurement of tumor levels to investigate the relationships between tumor burden quantification, therapeutic response and survival. Animals engrafted with the CCRF-CEM (CEM) human T-ALL cell line develop leukemia that closely resembles the human disease. Quantitative PCR detects the expanding tumor mass in the peripheral blood of the animals several weeks before death. In response to induction therapy with chemotherapeutic agents, both the level of minimal residual disease (MRD) in peripheral blood at the end of therapy and the rate of tumor reduction in peripheral blood during therapy strongly correlated with animal survival. Thus, these surrogate markers, which can be measured during the early stages of therapy, may help improve patient survival through dynamic risk stratification.

Animals↗

PubMed2003

Suicidal behavior in a young offender population.

Young offenders have numerous problems, including increased psychopathology, housing, and psycho-social stresses and increased rates of substance abuse. The current study investigated the contribution that substance use might make to a particularly vulnerable group of young people. Of the 300 young people approached for the study, 23.7% reported a prior suicide attempt. For this group, the most significant predictors of a prior suicide attempt were negative affect, prior exposure to violence, and housing stress. Life-time substance-use variables were most predictive of the number of suicide attempts a young person might make. Self-reported lethality (the expectation that on the last attempt the young person expected to die) was not strongly predicted by any variable. The research identifies the important role that dynamic risk factors (such as mood, substance use, and psychosocial stressors) play in increasing the risk of self-harm for young offenders, and raises the need to provide for more comprehensive discharge planning and support in order to manage these needs.

Adolescent↗

PubMed2005

The characteristics of persistent sexual offenders: a meta-analysis of recidivism studies.

A meta-analysis of 82 recidivism studies (1,620 findings from 29,450 sexual offenders) identified deviant sexual preferences and antisocial orientation as the major predictors of sexual recidivism for both adult and adolescent sexual offenders. Antisocial orientation was the major predictor of violent recidivism and general (any) recidivism. The review also identified some dynamic risk factors that have the potential of being useful treatment targets (e.g., sexual preoccupations, general self-regulation problems). Many of the variables commonly addressed in sex offender treatment programs (e.g., psychological distress, denial of sex crime, victim empathy, stated motivation for treatment) had little or no relationship with sexual or violent recidivism.

Humans↗

PubMed2006

A model of long-term metabolic progression of type 2 diabetes mellitus for evaluating treatment strategies.

AIM: To develop a novel metabolic computer model of the natural lifetime progression of type 2 diabetes that generates dynamic risk factor trajectories consistent with prespecified lifetime therapeutic strategies, in order to enhance the long-term economic and outcome modelling of type 2 diabetes and its complications. METHODS: The main model drivers of progressive disease were changes in insulin sensitivity and islet beta-cell function derived from an analysis of follow-up results from the Belfast Diet Study. These were related to clinical measures through an adaptation of the homeostasis model assessment. Established causal relationships estimating body mass index, lipids and blood pressure from measures of glycaemia and plasma insulin were calibrated using Third National Health and Nutrition Examination Survey (USA) data, standardizing for age, sex, ethnicity and smoking. The effects of individual interventions were calibrated using published trial evidence, in line with the current understanding of the main modes of action of each agent. RESULTS: A comparison of the effects of common therapies using the model showed both similarities and differences. Large improvements in glycaemic control from lifestyle modifications, further enhanced by oral glucose-lowering drugs or insulin, were reproduced. Projections comparing lifetime therapeutic strategies suggest that simple guidelines may not always be valid. CONCLUSION: This novel mathematical model using evidence from the long-term natural history of type 2 diabetes is able to project the expected effects of various antihyperglycaemic therapies. Coupled with an economic model, this metabolic model may provide a mechanism for healthcare professionals and policymakers to evaluate different long-term strategies for the management of type 2 diabetes.

Blood Pressure↗

PubMed2026

Toward a Better Paradigm for Head and Neck Cancer Treatment Applying AI (HNC-TACTIC): Protocol for an International Cohort Study of Electronic Health Records.

BACKGROUND: Head and neck squamous cell carcinomas (HNSCCs) cause considerable morbidity and mortality. Multimodal treatment strategies can cause significant toxicity, and therapy options are limited for recurrent disease. Immunotherapy has emerged as a promising approach. However, patient response variability underscores the need for better predictive markers. OBJECTIVE: This study aims to use artificial intelligence to develop two predictive models in patients with HNSCC to assess (1) progression or recurrence following primary curative treatment and (2) long-term survival after immunotherapy schemes in recurrent and metastatic disease. This study will also describe the characteristics of patients with early, locally advanced, and recurrent or metastatic cancers. METHODS: This is a retrospective, observational study of data captured in electronic health records (EHRs) from participating hospitals between January 1, 2014, and December 31, 2021. This study's population comprises adults diagnosed with HNSCC at any stage. Study variables, including demographics, comorbidities, clinical variables, treatments, and outcomes, will be extracted using EHRead, a technology that applies natural language processing and machine learning to extract and analyze structured and unstructured clinical information in deidentified EHRs. Predictive models based on dynamic risk stratification for treatment response and progression or recurrence will be developed using multivariable logistic regressions, decision tree classifiers, and random forest approaches. Descriptive and outcome analyses will be shown for different anatomic subsites and stratified by stage and treatment. RESULTS: This study began enrolling sites in July 2021 and is currently ongoing. By December 2025, data from 10 centers has been collected, comprising a total of 151,934,990 EHRs from 2,159,719 patients. CONCLUSIONS: Development of predictive models using artificial intelligence will advance clinical understanding of HNSCC to improve patient outcomes.

Humans↗

PubMed2004

Probabilistic model of decompression sickness based on stochastic models of bubbling in tissues.

BACKGROUND: Decompression sickness (DCS) is caused by gas bubbles formed from pre-existing and new microscopic gas nuclei in blood and tissues. Assuming a random pattern of bubbling processes in living tissues, we developed a probabilistic model of DCS. We hypothesized that symptoms of DCS in an individual exposed to decompression appear when the total volume of bubbles in a unit volume of any tissue, w(t), exceeds the critical specific volume of a free gas phase, wcr. Therefore, one may consider the expectation of w(t)/wcr as a measure of the dynamic risk of gas bubble lesion of a given tissue segment. METHODS: Using the standard approach to estimation of various risks and the sum rule of probabilities of joint events, we defined the cumulative probability of DCS onset by the equation Pcum(t) = 1 - exp[Fcum(t)], where Fcum(t) = sigmaVnQnMnc(t), Qn = 1/wncr, where Vn is the volume of a tissue n. The function Mnc(t) coincides with the function Mn(t), defining a time history of the expectation of wn(t) until it achieves its maximum and then becomes a constant. Evaluating Pcum(t) for particular altitude decompressions, we identified the additive cumulative risk function of development of any DCS symptoms, Fcum-tot(t), with the function defining the cumulative risk of any bubble lesion of the "worst" virtual tissue (WVT) of Type A. On the other hand, we identified the additive cumulative risk function of development of intolerable DCS symptoms, Fcum-int(t), with the function defining the cumulative risk of acute bubble lesion of the WVT of Type phi. RESULTS: We found parameters of the curves Pcum-tot(t) and Pcum-int(t) that fit the known empirical curves for the cumulative probability of DCS onset. For men performing mild exercise at 30 kPa after preoxygenation, our estimated parameters for curves Pcum-tot(t) indicate that the WVTs of Type A have nitrogen washout half-times of 260 and 290 min for preoxygenation times of 75 and 135 min, respectively. On the other hand, the parameters of curves Pcum-int(t) show that the WVTs of Type phi in men performing mild exercise at 20-40 kPa after preoxygenation during 0-6 h are virtual tissues with nitrogen washout half-times of 400 to 615 min. CONCLUSION: Our model provides a new approach to predicting DCS risk for various decompression profiles. By demonstrating the dependence of DCS risk on body tissue parameters, the model explains why resistance to DCS in mammals increases with a lower body mass and greater specific blood flow in tissues.

Decompression Sickness↗

PubMedDate not supplied

[Methodological principles of otorhinolaryngological ambulatory examinations and medical rehabilitation of workers exposed to intensive occupational noise and air pollutants].

This paper presents principles of otorhinolaryngological mass-scale examination of industrial workers exposed to noise and dust. They require not only early detection of pathologies of the hearing organ and upper airways but also assessment of the health status of each person and identification of groups at risk. Dynamic observation over healthy and sick subjects as well as proper application of prophylactic and therapeutic measures helps maintain good health and high performance of industrial workers.

Air Pollutants, Occupational↗

PubMed2006

Intra-couple communication dynamics of HIV risk behavior among injecting drug users and their sexual partners in Northern Vietnam.

This paper elucidates the social context of HIV risk behavior and intra-couple risk communication among injecting drug users (IDUs) and their main sex partner. Data on shared injection equipment, unprotected sex with multiple partners, unprotected sex with a main partner and couples' dynamics and risk communication were gathered through separate in-depth interviews with 11 active male IDUs and 11 of their primary female sex partners in Northern Vietnam. The majority of IDUs' sex partners does not inject drugs and is monogamous. In contrast, most IDUs reported a wide range of risky practices including needle sharing and unprotected sex with multiple, often concurrent, sex partners. Men rarely used condoms with primary partners. Many IDUs worried about their HIV-status, but none disclosed their injecting or sexual practices to their sex partners, leaving their partners unaware of their HIV risk. Among women who worried about HIV/AIDS, the vast majority was unable to influence their partner's needle sharing or extramarital affairs and most would not initiate condom use because they feared their partner's reaction. Couple-based interventions to facilitate risk communication combined with programs to promote condom use among male IDUs, may help to reduce HIV transmission from IDUs to their primary partners.

Adult↗

PubMed2002

Effect of diffusion and spatially varying predation risk on the dynamics and equilibrium density of a predator-prey system.

Starting from natural planktonic systems, we present a new mechanism involving spatial heterogeneity, and develop a new spatial structure model of planktonic predation systems. Firstly, the effect of diffusion on the dynamics of the system is investigated. We find that diffusion of only prey or both prey and predator between different patches with different predation risk may stabilize the dynamics, depending on the flow rate. Only a medium flow rate can lead to the stability of the system. Too large a rate can cause the system to approach the non-spatial limit case of a well-mixed system. Too large a rate can cause the system to approach the non-spatial limit case as a well-mixed system, which is characterized by its strongly oscillatory dynamics. When only prey diffuse, the smaller the parameter f (the proportion of the patchy volume with larger predation risk to the total volume), the more stable the system. If both populations can diffuse, however, only medium and very small f values may stabilize the system. Also, the response of the spatially averaged equilibrium densities of the system to the increasing of the flow rate is examined. With increasing flow rate, the spatial-averaged equilibrium density of prey decreases, while that of predator depends on which species can diffuse. For the case of prey diffusion only, it first remains unchanged and then slightly decreases, while it increases for the case of combinations as the flow rate increases. Our results are, qualitatively, determined by the spatially heterogeneous mechanism that we propose, and further regulated by top-down forces. Of practical importance, the results reported here indicate that which species diffuse plays a key role in the ways in which diffusion influences the dynamics and the spatial-average equilibrium densities of the system responses to the flow rate's increasing.

Animals↗

PubMed2001

Dynamics of behavioral risk factors for HIV/AIDS: a 6-year prospective study of injection drug users.

This prospective study of 2960 injection drug users investigated the dynamic nature of HIV behavioral risk factors between 1988 and 1994. Behavioral risks were assessed semi-annually. Robust regression models of time-dependent covariates were used to identify longitudinal predictors of behavior change. Maintenance of risky behaviors varied over time, with risk reduction seen more among HIV infected participants than among HIV seronegatives. Those at highest risk for HIV transmission were least likely to cease engaging in these behaviors. Interventions staged according to risk behaviors, targeting incremental risk reduction rather than only promoting abstinence, may be more successful in reducing HIV transmission among drug injectors.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

[Dynamics of the risk of tuberculosis infection and invalidity in Romania].

Analysis of epidemiological indicators is of particular importance, and relevant for assessing the efficiency of the prevention and fighting programs against tuberculosis. The most relevant epidemiometric indicators are the incidence of the infection and that of the disease itself. The annual risk of infection with tuberculous bacilli is considered as the most valuable indicator of extension or limiting tendencies of endemia, and of the efficiency of anti-tuberculosis programs. The annual incidence of the infection at the age of 14 years established by various methods, and improper conditions determined by mass allergizing of the infantile population by mandatory B.C.G. vaccination has decreased from 3,5% in 1960 to 0.8-1.0% in 1980. The level is still high, as compared with other european countries, but the rate of decrease has accelerated over the last years, a fact which demonstrates the efficiency of fighting measures applied. The incidence of contracting tuberculosis should be dealt with separately with regard to children and adults, since in children it is mainly related to primary infection, while in adults it is related to the presence of minimal lesions with phtysiogenic potential which can be traced to the post-primary stage, as well as to immuno-depressing influence of some environmental factors. In this connection the incidence of tuberculosis in children has been reduced in our country in the last 25 years from 297.2% to 10.3%. The risk of developing the disease has fallen from 1/230 in 1950 to 1/9 700 in 1980. The risk of developing the disease has decreased more rapidly in older children (between 5 and 9 years) than in the younger ones (0 to 4 years). The incidence of tuberculosis in the population aged above 15 years has fallen from 352.6% in 1955 to 70.5% in 1980. The risk of developing the disease in adults was of 1/284 in 1956 and 1/1 418 in 1980. The authors also make an analysis of the dynamics of some demographic risk factors, such as sex, age and environment.

Adolescent↗

PubMed1997

Cross-spectral analysis of cerebral autoregulation dynamics in high risk preterm infants during the perinatal period.

In preterm infants intraventricular hemorrhage occurs predominantly within the perinatal period, which may be due to a "lost autoregulation" of cerebral blood flow (CBF). In this study, perinatal autoregulation dynamics were investigated in high risk preterm infants by cross-spectral analysis (CSA), which is a statistical tool in the analysis of time series. In 15 ventilated preterm infants of 25-32 gestational weeks, a total number of 30 records were made between 24 and 96 h of life. Doppler-derived CBF velocity (CBFv), used as a quantitative measure for CBF, and direct mean arterial blood pressure (MABP) were measured continuously for 10 min. The spectral power of low frequency (LF, 0.02-0.2 Hz) oscillations in CBFv and MABP was quantified by spectral analysis. From the results of CSA, a LF phase-shift between the CBFv and MABP LF oscillations was calculated in each record. Within the study group, the LF spectral power of CBFv and MABP was initially low and increased significantly until 96 h of life. The LF phase-shift was about 0 degrees at 24 h and increased significantly to 55 degrees at 96 h of life. The initially low LF spectral power of CBFv and MABP may indicate a perinatal depression of autonomic nervous centers, which are thought to control LF oscillations of vital parameters. In the light of a high pass filter model for autoregulation, the initially low LF phase-shift may indicate an initially impaired autoregulation, which supports the "lost autoregulation" hypothesis.

Cerebrovascular Circulation↗

PubMed2003

Identifying West Nile virus risk areas: the Dynamic Continuous-Area Space-Time system.

The Dynamic Continuous-Area Space-Time (DYCAST) system was developed to identify and prospectively monitor high-risk areas for West Nile virus in New York, New York (New York City). The system is based on a geographic model that uses a localized Knox test to capture the nonrandom space-time interaction of dead birds, as an indicator of an intense West Nile virus amplification cycle, within a 1.5-mile (2.41-km) buffer area and 21-day moving window. The Knox analysis is implemented as an interpolation function to create a surface of probabilities over a grid of 1,400 cells overlaying New York City. The model's parameters were calibrated using year 2000 data and information on the vector-host transmission cycle. The DYCAST system was implemented in a geographic information system and used operationally in year 2001. It successfully identified areas of high risk for human West Nile virus infection in areas where five of seven human cases resided, at least 13 days prior to the onset of illness, and proved that it can be used as an effective tool for targeting remediation and control efforts.

Animals↗

PubMed1996

Long-term outcome, survival analysis, and risk stratification of dynamic cardiomyoplasty.

METHODS: To analyze the long-term outcome of dynamic cardiomyoplasty, we retrospectively studied 127 consecutive patients who underwent this procedure in Paris, France (n = 76), São Paulo, Brazil (n = 37), and Portland, Oregon (n = 14). Preoperative data were collected for patients operated on between January 1985 and June 1994 and examined with respect to effect on long-term survival. Patients had a mean age of 50 +/- 13 years and were predominantly male (82%). In 46% the cause of disease was ischemic. Concomitant operations were performed in 22 patients. RESULTS: Operative mortality was 12% (15/127). Kaplan-Meier survival +/- standard error at 1 through 5 years was 73% +/- 4%, 57% +/- 5%, 49% +/- 6%, 44% +/- 6%, and 40% +/- 7%, respectively. There was a distinct improvement at 6 months in New York Heart Association functional class (3.2 +/- 0.05 vs 1.7 +/- 0.07, p < 0.0001) and a small but significant increase in left ventricular ejection fraction (20% +/- 0.8% vs 23% +/- 1.5%, p = 0.04). Ninety-day mortality was associated with low right ventricular ejection fraction, a blunted hemodynamic response to exercise testing, and requirement for an intraaortic balloon pump at the time of the operation. Using a stepwise Cox regression method of multivariable survival analysis (n = 101), we determined that atrial fibrillation, New York Heart Association class IV, high pulmonary capillary wedge pressure, and balloon pump use were independent variables simultaneously associated with poor overall survival. When metabolic testing variables were added to this model, peak oxygen consumption eliminated both pulmonary capillary wedge pressure and functional class from the model, albeit with fewer (n = 74) patients. CONCLUSION: Dynamic cardiomyoplasty is an evolving therapy for symptomatic congestive heart failure, the results of which may be enhanced by intelligent, risk-sensitive patient selection.

Cardiomyoplasty↗

PubMed2000

Gendered power dynamics and HIV risk in drug-using sexual relationships.

This study illustrates how a sample (n = 63) of Scottish drug-using women's patterns of injecting and needle sharing were strongly influenced by the nature and type of their sexual relationships. Our data shows that 12 out of the 13 drug-using couples were sharing needles and 33 out of 41 drug-using women who had ever been in a sexual relationship with a male injector had been predominately injected by their partner whilst in that relationship. For the most part, these women placed significant importance on and investment in their heterosexual relationships. These dynamics clearly impacted on the women's HIV risk taking and risk management and the implications of these findings are discussed.

Adolescent↗

PubMed2004

Prediction of fall risk reduction as measured by dynamic gait index in individuals with unilateral vestibular hypofunction.

OBJECTIVE: To determine the effect of vestibular rehabilitation on reduction of fall risk in individuals with unilateral vestibular hypofunction and to identify those factors that predict fall risk reduction. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: Forty-seven patients with unilateral vestibular hypofunction, aged 28 to 86 years, who were at risk for falls on initial assessment. INTERVENTION: All patients underwent vestibular rehabilitation including adaptation exercises, designed to improve gaze stability, and gait and balance exercises. MAIN OUTCOME MEASURES: Fall risk (Dynamic Gait Index), visual acuity during head movements (Dynamic Visual Acuity), and subjective complaints were measured initially, at 2-week intervals, and at completion of physical therapy. RESULTS: As a group, the patients had significantly reduced risk for falls (p <0.001) after rehabilitation. Time from onset of symptoms did not affect the efficacy of vestibular rehabilitation. Both older (> or = 65 yr) and younger (< 65 yr) adults showed significant reductions in fall risk with vestibular rehabilitation (p <0.001). However, a significantly greater proportion (Chi2= 0.016) of older adults remained at risk for falls at discharge compared with young adults (45% versus 11%). Initial Dynamic Gait Index and Dynamic Visual Acuity scores predicted fall risk reduction in patients with unilateral vestibular hypofunction. A model was developed using initial Dynamic Gait Index and Dynamic Visual Acuity scores to predict fall risk reduction. CONCLUSIONS: Vestibular rehabilitation is effective in significantly reducing fall risk in individuals with unilateral vestibular deficit. The model predicts fall risk reduction with good sensitivity (77%) and specificity (90%).

Accidental Falls↗