In this work, we review the history and current role of global fits in the search for physics beyond the Standard Model (BSM), including precision tests of the Standard Model (SM). Although BSM global fits were initially focused on minimal supersymmetric models, we describe how fits have evolved in response to new data from the Large Hadron Collider (LHC) and elsewhere, expanding to encompass a broad spectrum of BSM scenarios including non-minimal supersymmetry, axion-like particles, extended Higgs sectors, dark matter models, and effective field theories such as SMEFT. We discuss how the role of global fits has shifted from forecasting possible signals of new physics at the LHC to understanding the impact of null results from LHC run-I and II and the discovery of the Higgs boson, and how interest has shifted from global fits for parameter estimation to comprehensive model comparison. We close by discussing potential trends and future applications, emphasizing the potential for machine learning and artificial intelligence to enhance the efficiency of sampling algorithms and comparison between theory and experiment, as well as collaboration and software development.
To compare differences in risk factors and 90-day mortality prediction from 2 machine learning (ML) models with a previously published non-ML model and investigate their validity in an external cohort. Prospectively collected data from 2 separate randomized controlled trial (RCT) cohorts from 2020 to 2021, the Therapeutics for Inpatients with COVID-19 (TICO/ACTIV-3) Trial (derivation and internal validation cohort) and the Inpatient Treatment with Anti-Coronavirus Immunoglobulin (ITAC) Trial (external validation cohort) were used. Data were collected from 114 sites in 10 countries (TICO/ACTIV-3) and 63 sites in 11 countries (ITAC). A ML pipeline including 5 classification models, and 1 survival model was used for risk factor identification and clinical outcome prediction. Risk factors were compared between a ML-based classification model, a ML-based survival model and a previously published Cox model. Performance of the ML-based classification model was compared across TICO/ACTIV-3 and ITAC. A total of 2625 (TICO/ACTIV-3) and 579 (ITAC) adults hospitalized for COVID-19 were included. Some overlap of risk factors was identified across models. Five were identified in all models, 3 only in ML models, and 4 only in the non-ML model. The ML model showed good predictive performance in TICO/ACTIV-3. Internal validation showed no overfitting. Lower model performance was observed in ITAC (-15.8%), but performance remained above chance level. Differences in methods for risk factor identification using ML and non-ML complicates the comparison of results derived from each approach, but using multiple approaches may unveil overlooked risk factors. Risk factor identification may benefit from integrating both ML and non-ML methods, but external validation is necessary, even in RCTs.
The visual pathway is an important model system for remyelination and neuroprotection trials in multiple sclerosis, due to its accessibility and the availability of validated methods including visual evoked potential and optical coherence tomography. However, visual evoked potentials are sometimes undetectable and demonstrate limited reliability after acute optic neuritis. This study aims to investigate novel magnetoencephalography markers for assessing myelin content and neuronal dysfunction in the early phase of optic neuritis and describes their inter-run reproducibility ('over a single visit') and association with short-term visual outcomes. Patients with unilateral acute optic neuritis were recruited and underwent ophthalmological assessments, brain MRI and magnetoencephalography. Magnetoencephalography data were acquired during visual stimulation with an alternating checkerboard pattern. We used source localization to reconstruct brain activity in the primary visual cortex (V1) and analysed it in the temporal and frequency domains. In the temporal domain, we focused on M100 latency-the magnetic counterpart of P100 latency. In the frequency domain, we assessed the spectral richness of the steady-state evoked field response by harmonic count, which reflects the diversity of frequency components present in the brain signal. Thirty-two patients were included at a median of 54 days [interquartile range = (37.5-78)] post-symptom onset of optic neuritis. Among patients with optic neuritis, visual evoked field recordings were detectable in 77% of cases, compared with 66% for visual evoked potential recordings. M100 latency demonstrated an excellent inter-run reproducibility for both fellow and affected eyes [intra-class correlation coefficient (ICC) >0.8, mean absolute inter-run difference of 2.99 ± 6.53 and 3.76 ± 7.53 ms, respectively]. By comparison, the reproducibility of P100 latency was good for fellow eye (ICC = 0.7, mean absolute inter-run difference of 3.9 ± 6.2 ms) but moderate for affected eye (ICC = 0.6, mean absolute inter-run difference of 9.1 ± 21.8 ms). In the frequency domain, the harmonic count correlated strongly with ganglion cell layer volume (r = 0.68, P = 0.0001), likely reflecting functional consequences of neuronal loss. Measures reflecting demyelination (P100 and M100 latencies) correlated with measures of neuronal damage (ganglion cell layer volume and harmonic count) from both conventional and magnetoencephalography assessments. Visual impairment was associated with neuronal damage (parameter estimates: β = 0.49, P = 0.017 for ganglion cell layer volume, β = 0.57, P = 0.003 for harmonic count) but not with demyelination measures. Our results highlight magnetoencephalography as a reproducible and comprehensive tool to study both myelin content and neuronal dysfunction shortly after optic neuritis and suggest that, at this early stage, neuronal damage is already the main driver of visual outcome.
Spondyloarthropathies (SpA) are characterized by low back pain and limited mobility. Therefore, physical activity (PA) is an essential part of the treatment, yielding positive effects on clinical symptoms. Digital health applications (DHAs) present new opportunities to promote clinical outcomes, however, their long-term effectiveness is often limited by low adherence and high dropout rates.This study investigates whether integrating personalized or AI-driven coaching enhances the therapeutic benefits of DHA in patients with SpA. SpAs patients were randomized into one of 3 groups. They were instructed to exercise at least 2-3 times per week for 6 months with the DHA according to their group (intervention groups: ViViRA (with personal coaching) or Kaia Health (with AI-based coaching); control group: ViViRA (without coaching)). Personal coaching consisted of a one-time, 30-min online coaching session prior to using DHA, while the AI coaching consisted of video-based AI integrated into DHA to provide movement guidance during each session. At baseline, after 3 and 6 months sociodemographic, questionnaires and mobility were assessed. Data from 78 participants were analyzed (mean age 51 years; 68% female). All three digital interventions showed a significant improvement in mobility (Bath Ankylosing Spondylitis Metrology Index (BASM), range: 0-10, lower scores = better mobility; BL-3 month: mean BASMI change - 0.6 to - 0.7; all p < 0.001). Pain intensity decreased substantially in all arms (PainDETECT, neuropathic pain, range: 0-38, higher scores = more severe pain; BL-6 month: mean reduction - 4.6 to - 6.6 points; all p ≤ 0.006). PAHCO (Physical Activity-related Health Competence) control competence increased over time and reached statistical significance only in the ViViRA + coaching group (PAHCO: higher scores = better physical activity-related health competence; BL-6 month: + 1.02, p = 0.013) but did not exceed the other interventions in a direct comparison. Overall, none of the coaching strategies showed significant superiority over the stand-alone digital therapy. Adherence was the same in all groups after 3 months (2-3 weekly use of DHA). Digital movement therapy with the use of DHA improves mobility and pain independently of coaching in SpAs patients. In contrast, personal coaching has been shown to improve health-related skills which could indicate potential benefits for self-management and long-term treatment adherence.Trial registration The study is registered in the German clinical trial registry (DRKS) under the following ID: DRKS00035191, https://www.drks.de/search/de/trial/DRKS00035191/details, Registration date: 01.10.2024.
Background Gastric oxyntic gland neoplasms (GOGNs)-including oxyntic gland adenoma (OGA), gastric adenocarcinoma of fundic gland type (GA-FG), and gastric adenocarcinoma of fundic gland mucosa type (GA-FGM)-are rare epithelial neoplasms that often lack overt malignant appearance on endoscopy. This study aimed to characterize the endoscopic features of GOGNs that may facilitate their recognition. Methods We retrospectively analyzed consecutive, histologically confirmed GOGNs diagnosed at a tertiary center between January 2019 and July 2025. Endoscopic features on white-light endoscopy (WLE), magnifying narrow-band imaging (NBI), and endoscopic ultrasonography (EUS) were evaluated. Results Among 156,240 upper endoscopic examinations, 35 patients were diagnosed with GOGNs (0.028%). Lesions were mostly small (median 6 mm) and located in the fundus/upper body (52%), predominantly Paris type 0-IIa (57%) or subepithelial-like elevations (60%). Color was similar to the surrounding mucosa (49%) or mildly reddish (37%), occasionally showing branching vessels (31%) or focal pigmentation (14%). On NBI, OGA and GA-FG lesions ( n = 12) frequently showed regularly enlarged crypt openings (92%) and branching vessels (83%) with ill-defined margins (75%), whereas GA-FGM ( n = 4) more often showed a distinct demarcation line (75%) with irregular microvascular/microsurface patterns (50%). EUS demonstrated localization mainly within the middle-to-deep mucosal layer and occasional submucosal extension, with intact muscularis propria. Conclusions GOGNs typically present as small, inconspicuous elevated lesions in the fundus or upper stomach, often with near-normal or slightly reddish mucosal color and characteristic surface vascular and magnifying features. Awareness of these endoscopic patterns may improve recognition of GOGNs during routine endoscopy. Larger studies are needed to validate these findings.
Sustainable groundwater management remains a critical challenge in semi-arid regions, where climatic variability and increasing anthropogenic pressures constrain aquifer resilience. In this context, the present study applies an Analytical Hierarchy Process (AHP)-based GIS framework to delineate groundwater potential zones in the Bouanane Basin, a data-scarce semi-arid environment. The analysis integrates nine hydro-environmental factors, including precipitation, land use, lineament density, drainage density, geology, soil type, slope, elevation, and NDVI, to capture both structural and surface controls on groundwater occurrence. The AHP weighting scheme achieved an acceptable level of consistency (CR = 0.070), ensuring the reliability of the pairwise comparison process. he results identify three groundwater potential classes: very low (1.24%), low (84.88%), and moderate (13.87%). Model performance was evaluated using data from 27 wells and validated through the kappa coefficient (κ = 0.82), indicating strong agreement between predicted and observed conditions. The findings highlight the dominant influence of geological structure, lineament density, and precipitation in controlling groundwater distribution. The predominance of low to moderate potential zones reflects the hydro-climatic and geological constraints typical of semi-arid environments. This study provides a spatially explicit assessment of groundwater potential and contributing factors, offering a practical basis for groundwater management in data-limited semi-arid basins.
Chiral-substituted carbonyl compounds can be sustainably obtained via asymmetric alkene reduction catalyzed by ene-reductases from the Old Yellow Enzyme (OYE) family. Yet OYEs are seldom implemented in scale-up reactions due to low turnover numbers (TONs). Herein, we demonstrate multigram 150 g/L scale reactions with the thermostable OYE from Thermus scotoductus (0.2 wt %) for the asymmetric reduction of monoterpenes. Best results were achieved with (S)-carvone (7.5 g), affording a record TON of 123,000, with 90% isolated yield and >99% enantiomeric excess of (2R,5S)-dihydrocarvone, and an environmental E-factor of 11.6.
Geroscience has advanced rapidly, yet its clinical translation remains limited. A central barrier is the lack of trial outcomes that capture the multidimensional effects of geroprotective interventions while meeting clinical and regulatory standards. Mortality is objective and regulatorily salient but often impractical. By contrast, surrogate measures of healthspan improve feasibility and may better reflect the quality of extended life, but they are generally considered soft endpoints that require further validation. Here, we propose hierarchical composite endpoints using time-to-worst-event analysis as a pragmatic and scientifically sound compromise. Participant pairs are compared using win statistics according to a prespecified clinical hierarchy, in which more severe and objective clinical events are prioritized, while health surrogates and biomarkers contribute information at lower tiers. When outcome selection, ordering and tie rules are clinically and mechanistically justified and agreed with regulators, this approach may improve geromedicine trial efficiency and allow overall treatment effects to be captured without compromising clinical priorities.
Archaeological, osteological and genetic evidence suggests that Neanderthals lived in small groups1,2; however, less is known about whether these groups were part of isolated communities or belonged to larger, well-connected populations3. The dense concentration of broadly contemporaneous Neanderthal sites in the Meuse Basin, Belgium4, provides a rare opportunity to study regional populations at high resolution. Here we generated genetic data from 27 Neanderthals who lived less than approximately 52,500 years ago from ten archaeological sites in Belgium and France, including a high-coverage genome from a 45,000-year-old individual from Goyet, Belgium. We show that most of these individuals are more closely related to one another than to other contemporaneous late Neanderthals in Europe. Further, some of these individuals carry DNA from a Neanderthal lineage predating the split of late Neanderthals. Although these Neanderthals overlapped temporally with early modern humans in northwestern Europe from around 47,000 years ago, we find no evidence of recent gene flow from modern humans. They also do not show the genetic signatures of mating among close relatives found in Altai Neanderthals, suggesting that they lived in larger or better-connected groups. Moreover, genetic load did not accumulate over time, arguing against progressive genetic deterioration as a driver of Neanderthal extinction.
The diagnosis of acute community-acquired bacterial urinary tract infections (UTIs) in adult men presently recognizes four key clinical entities: cystitis, prostatitis, pyelonephritis, and epididymo-orchitis, each with distinct diagnostic criteria. Bacteriuria of clinically undetermined significance, defined as documented bacteriuria with non-specific systemic symptoms (e.g., confusion, functional decline, or isolated fever) but no localized UTI signs, is common in elderly patients and requires evaluation with sepsis risk scores so as to avoid unnecessary antibiotics. Urinary colonization, frequent in older men, does not warrant treatment unless prior to urological procedures. Cystitis is diagnosed by local symptoms (dysuria, urgency, suprapubic pain), absence of fever, and positive urine culture, ruling out prostatitis or pyelonephritis. Acute prostatitis is identified by cystitis symptoms plus fever or sepsis, with imaging reserved for complications. Acute pyelonephritis is diagnosed by fever or sepsis, flank pain (spontaneous or on percussion), and positive urine culture; cystitis symptoms may be absent. Urine culture (thresholds: ≥103 CFU/mL for bacteriuria, leukocyturia >30 × 103/mL) remains the gold standard, while urine dipstick testing is not recommended due to low predictive value. Routine blood tests (inflammatory markers, PSA, or blood cultures) are unnecessary in outpatient management, even for febrile UTIs, unless acute kidney injury or complications are suspected. Pyelonephritis requires imaging (urgent in cases of sepsis or obstruction) to assess for uropathy, and epididymo-orchitis mandates STI screening.
Genome assembly from long-read sequencing data has become a standard approach for resolving complex genomic regions and producing high-contiguity assemblies. However, the diversity of available assemblers, their varying performance across species, and the need for reproducible workflows present ongoing challenges. We developed LORA, an easy-to-use and reproducible application for assembling genomes from long-read data. LORA integrates several well-established assemblers, including Canu, HiFiasm, Flye, and Unicycler, as well as more recent tools such as Necat and Pecat. It is implemented as a Snakemake pipeline to parallelize tasks and support seamless execution on both local machines and computing clusters. LORA includes multiple quality assessment steps, interactive HTML reports for interpretation, BLAST-based taxonomic identification, and completeness evaluation. Together, these features provide users with a comprehensive view of assembly quality and potential problems. We illustrate the capabilities of LORA using datasets from bacterial genomes and unicellular eukaryotes, sequenced with both PacBio and Oxford Nanopore technologies, highlighting typical outcomes and common pitfalls encountered during long-read assemblies. LORA is distributed as part of the Sequana project, an open-source framework designed for reproducibility, maintainability, and straightforward deployment across computing environments.
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Data on the long-term course of neurological immune-related adverse events (n-irAEs) are limited by the size of studies as well as short and heterogeneous follow-up durations. Herein, we assessed the risk and predictors of 1-year neurological sequelae, and the frequency of n-irAE relapses with or without immune checkpoint inhibitor (ICI) rechallenge. Patients with Common Terminology Criteria for Adverse Events (CTCAE) grade ≥2 n-irAEs identified in a national reference center were included (2015-2024). Early neurological recovery was defined as CTCAE grade <3 and an improvement of ≥1 point from baseline at 3 months. Long-term sequelae were defined as CTCAE grade ≥2 at 1 year. Associations between prognostic factors and 1-year neurological sequelae were assessed using multivariable logistic regression. A total of 164 patients were included (median age 69 years, 63% male, median (IQR) follow-up 13 (4-25) months), of whom 59 (36%) had paraneoplastic phenotypes, and 141 (86%) had CTCAE grade 3 or 4 n-irAE at baseline. Most patients (151/163, 93%) received first-line treatments, and 33/163 patients (20%) also received second-line treatments. Early neurological recovery was observed in 82/164 patients (50%). Among 83 patients still alive at 1 year, 33 (40%) had neurological sequelae, and 35 (42%) were receiving treatments. Improvement in CTCAE grade occurred in 13/83 patients (16%) between 3 and 12 months, 1/43 patients (2%) between 12 and 24 months, and it never occurred (0/23) between 24 and 36 months. N-irAE relapses occurred in 25/164 patients (15%), a median (IQR) of 6.8 (3.9-11.8) months after onset. ICI rechallenge led to relapse (CTCAE grade 2) in 1/21 patients (5%). In multivariable analysis, the probability of 1-year neurological sequelae was higher in patients with paraneoplastic phenotypes (OR 11.09, 95% CI (3.24 to 44.51)) and in those who had a relapse within 9 months from baseline (OR 11.12, 95% CI (2.13 to 89.53)). Paraneoplastic phenotypes and relapses increase the risk of neurological sequelae among long-term n-irAE survivors, and ICI rechallenge might be safe in n-irAE patients who have fully recovered. The rarity of recovery and low risk of relapse after 1 year suggest that prolonged immunosuppression may be unnecessary, but prospective studies are needed to refine management strategies.
Background: In routine clinical practice, patient's management may differ from scientific organizations' guidelines and compromise patient's safety. This discrepancy indicates either an educational gap to fill or a need to adapt the guidelines to better reflect the real-world practice. Aims: Describe the management of venous thromboembolism (VTE): deep vein thrombosis (DVT) and pulmonary embolism (PE) among Vascular Medicine Specialists (VMS) practicing in France between 2020 and 2023 and compare it to national and international VTE guidelines. Materials and methods: A random selection of VMS from the national VMS directory were asked to 1) complete a questionnaire on their own management of patients with VTE (VMS survey) and 2) report their personal management of five consecutive patients with acute VTE (VTE case series). The study period partly overlapped with the COVID-19 pandemic, during which outpatient management strategies were increasingly promoted. Results: Among the 163 VMS contacted, 85 agreed to participate. We found that a direct oral anticoagulant (DOAC) was preferentially prescribed as first line anticoagulant in VTE: 65% in the VTE case series and 80% in the VMS survey. Low molecular weight heparins (LMWH) was preferred in case of high-risk PE (60%) or ilio-femoral DVT (35%) and in cancer-associated thrombosis (91%) in the VMS survey. After the first 6 months therapy, 30% of the VMS taper to a reduced-dose DOAC. This management was consistent with the VTE case series. Conclusions: DOAC is the standard of care to treat most VTE conditions in routine clinical practice, in line with VTE guidelines. LMWH is still preferred in case of high risk-PE and cancer-associated thrombosis. ECS use to prevent post-thrombotic syndrome remains frequent after DVT. Outpatient management of PE was common during the study period, reflecting evolving care models that were reinforced during the COVID-19 pandemic.
Magma convection is a mechanism that greatly enhances heat transfer from mobilizable, crystal-poor magma bodies to the surrounding immobile, crystal-rich mush reservoir of Earth's igneous systems. As most of these systems are geophysically shown to be mush-dominated, magma convection is often omitted from thermo-kinetic models, and its role in magma evolution and eruptibility remains underexplored. Here we present 2-D numerical thermal modelling that parameterizes magma convection through a Nusselt-number approach that describes the local enhancement of heat transfers, and examine its effects in the axial mush zone of fast-spreading mid-ocean ridges. We demonstrate that magma convection, while not affecting the overall thermal regime of the mushy reservoir, significantly reduces the lifespan of individual pockets of eruptible melt to <2 years, which is two orders of magnitude shorter than in simulations without convection. Our models also show that magma convection could promote mush reheating and unlocking, potentially participating to the geochemical homogenization of heterogeneous melts extracted from the mantle. Predicted fluctuations in the occurrence and persistence of magma bodies provide insights into their highly transient nature, enhancing our ability to interpret geophysical snapshots of magma-mush systems in oceanic settings, and in other igneous systems.
Chronic dyspnoea is a common and disabling symptom that remains under-investigated as an independent entity at a population level. Most research has focused on dyspnoea as a feature of specific diseases, mainly in high-income countries. We aimed to assess the global prevalence of chronic dyspnoea in population-based studies, and discuss disparities across regions and populations, including low- and middle-income countries. PubMed, the Cumulative Index to Nursing and Allied Health Literature, Google Scholar and Embase were searched using dedicated algorithms. The literature up to 2 September 2025 was reviewed; studies reporting chronic dyspnoea prevalence in general populations were included, and those restricted to older adults or specific subgroups were excluded. 68 studies met the inclusion criteria. Although limited in scope, the modified Medical Research Council scale was the most frequently used tool. Prevalence varied widely, from 5-10% in Europe to >25% in South Asia. Differences were observed between high- and low-income countries, between low-income countries, and within the same country over time. Observed disparities stem from variations in definitions, assessment methods, socioeconomic conditions, possible genetic predispositions, environmental exposures, and lifestyle factors. Chronic dyspnoea has been associated with demographic, behavioural and health-related factors including sex, age, weight, physical activity and comorbidities. There are major global disparities in the prevalence of chronic dyspnoea between and within countries at different income levels. There is a critical need for targeted, country-specific studies, particularly in low- and middle-income countries, to support equitable interventions, and for newly designed studies using more detailed and comprehensive measures of dyspnoea.
Despite significant progress achieved by combining VEGFR tyrosine-kinase inhibitors (TKIs) with immune checkpoint inhibitors (ICIs), complete responses remain rare in metastatic renal cell carcinoma (mRCC), highlighting the need for strategies that optimize therapeutic synergy. Here, we show that the efficacy of VEGFR blockade, vaccination, and PD-1 inhibition critically depends on treatment sequence. Using an orthotopic RENCA model, we show that short-term VEGFR inhibition with axitinib transiently remodels tumor vasculature, alleviates hypoxia, and limits suppressive myeloid subsets, thereby generating an immune-permissive window. Administering a survivin-based long-peptide vaccine (SVX) during this preconditioning phase elicits strong Th1-polarized CD4⁺ and cytotoxic CD8⁺ T-cell infiltration, which exhibit a polyfunctional cytokine and chemokine profile. When PD-1 blockade is introduced concomitantly with vaccination, after, rather than during, axitinib treatment, the triple regimen (axitinib + [SVX + anti-PD-1]) achieves durable tumor control with a high rate of complete responses, outperforming all other treatment schedules. Mechanistically, this sequence aligns vascular reprogramming, antigen-specific priming, and checkpoint release, converting an immune-excluded tumor into a T-cell-dominated, cytotoxic niche. Collectively, these findings identify temporal coordination as a critical determinant of therapeutic success and establish a mechanistically grounded framework for integrating vascular preconditionning, tumor-antigen vaccination, and PD-1 blockade as a curative immunotherapy strategy in renal carcinoma.
Managing branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) remains challenging, as guideline criteria (worrisome features/high-risk stigmata) and nomograms often leave uncertainty. Next-generation sequencing (NGS) may provide actionable molecular information that influences clinical decision-making. We conducted a national, vignette-based decision-impact study involving 132 clinicians (gastroenterologists and surgeons). Four complex BD-IPMN vignettes (each with two to four worrisome features) were evaluated twice: pre-NGS and post-NGS after disclosure of either a high-risk mutation (positive) or its absence (negative). The primary endpoint was the within-physician change in management in the NGS-concordant direction (NGS+ surveillance to surgery; NGS- surgery to surveillance) assessed using McNemar's test and mixed-effects logistic regression. Secondary endpoints included change in decision confidence, inter-physician agreement (Fleiss' κappa), and practitioner factors. NGS significantly changed management in all vignettes (all p < 0.001): with NGS-, surgical plans shifted to surveillance (43% in distal pancreatectomy; 61% in pancreatoduodenectomy scenarios); with NGS+, surveillance shifted to surgery (90% and 72%, respectively; both p < 0.001). In mixed-model, post-NGS reduced surgery in NGS- cases (odd ratio [OR] 0.30, 95%confidence interval [CI] 0.16-0.57) and the post-NGS effect was strongly amplified in NGS+ cases (interaction OR 76.51, 95%CI 26.47-221.13). Population-averaged probabilities of choosing surgery shifted from 20% to 7% (NGS-) and 42% to 94% (NGS+). Decision confidence increased (proportional-odds OR 4.66, 95%CI 3.62-6.02, p < 0.0001). Inter-physician agreement rose from κ = 0.044 (95%CI 0.033-0.055) pre-NGS to κ = 0.590 (95%CI 0.580-0.601) post-NGS (p < 2×10-16). After NGS, practitioner characteristics no longer explained decision patterns. In complex BD-IPMN scenarios, NGS significantly influences clinician decision-making and reduces inter-physician variability. These findings support its role as a decision-support tool.
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