Gleason scoring is used within a five-tier risk stratification system to guide therapeutic decisions for patients with prostate cancer. This study aimed to compare the predictive performance of routine H&E or biomarker-assisted ISUP (International Society of Urological Pathology) grade grouping for assessing the risk of biochemical recurrence (BCR) and clinical recurrence (CR) in patients with prostate cancer. This retrospective study was an assessment of 114 men with prostate cancer who provided radical prostatectomy samples to the Australian Prostate Cancer Bioresource between 2006 and 2014. The prediction of CR was the primary outcome (median time to CR 79.8 months), and BCR was assessed as a secondary outcome (median time to BCR 41.7 months). The associations of (1) H&E ISUP grade groups and (2) modified ISUP grade groups informed by the Appl1, Sortilin and Syndecan-1 immunohistochemistry (IHC) labelling were modelled with BCR and CR using Cox proportional hazard approaches. IHC-assisted grading was more predictive than H&E for BCR (C-statistic 0.63 vs. 0.59) and CR (C-statistic 0.71 vs. 0.66). On adjusted analysis, IHC-assisted ISUP grading was independently associated with both outcome measures. IHC-assisted ISUP grading using the biomarker panel was an independent predictor of individual BCR and CR. Prospective studies are needed to further validate this biomarker technology and to define BCR and CR associations in real-world cohorts.
Russia’s invasion of Ukraine in February 2022 astounded political commentators across the globe. Seemingly nonsensical from a physical security perspective, the announcement of invasion resulted in economic sanctions against Russia, the rapid decline of President Vladimir Putin’s reputation in the international sphere, and dissent amongst Russian citizens. This article contends that while invasion is difficult to justify from a physical security approach, the pursuit of ontological security is a convincing and meaningful explanation for Russia’s invasion of Ukraine. Unpacking how biographical narratives and behavioural patterns sustain a state’s sense of Self demonstrates that Russian state selfhood was reaffirmed through invasion. This argument is developed in reference to masculinist narratives surrounding the Russian Self, including an imperialist role identity, a masculine Self contrasted with a feminine Ukrainian Other, and a drive to defeat supposed fascist forces within Ukraine. In addition, Russia’s invasion of Ukraine sustains ontological security through fitting into a behavioural pattern of consistent conflict. Ontological security is a highly necessary consideration when analysing global conflict, particularly in the case of the 2022 Ukraine invasion.
UNSTRUCTURED
Innovative tools leveraging machine learning and artificial intelligence (ML/AI) are rapidly being developed for medicine, with new applications emerging in prediction, diagnosis, and treatment across a range of illnesses, patient populations, and clinical procedures. One challenge for successful innovation is the absence, to date, of a robust ethical framework informed by the perspectives of ML/AI researchers and physicians. To help articulate these perspectives, we conducted 21 semi-structured interviews with a purposive sample of ML/AI researchers (n = 10) and physicians (n = 11). We asked interviewees about their views regarding ethical considerations related to the adoption of ML/AI in medicine. Notably, both researchers and physicians described concerns regarding how ML/AI innovations are shaped in early phases even prior to their development and implementation (which from here on will be referred to as the “problem formulation” phase). Considerations encompassed assessment of research priorities and motivations, clarity and centeredness of clinical needs, professional and demographic diversity of research teams, and interdisciplinary knowledge generation and collaboration. These qualitative findings help to elucidate several ethical challenges anticipated or encountered in ML/AI for health care.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.