January 19, 2024

Sustaining Credibility in Shifting Research Landscapes

As academic research continuously evolves, maintaining scientific integrity and ethics requires both individual and institutional vigilance. This article advocates embracing opportunities while recalling timeless core principles of honesty, rigor and 'doing no harm.'

Citation: Heston TF. Foundations of scholarly writing. In: An overview on business, management and economics research. BP International; 2024. p. 113-51. 

doi: https://zenodo.org/doi/10.5281/zenodo.10535789 


January 10, 2024

Anginal Symptoms Do Not Predict Myocardial Ischemia in Diabetics

 A 2005 study examined whether the presence of anginal symptoms can predict abnormal myocardial perfusion or function in diabetic patients. Researchers performed a retrospective review of 1074 patients who underwent myocardial perfusion imaging. Among non-diabetics, anginal symptoms significantly correlated with markers of ischemia like summed stress score and myocardial dysfunction like reduced ejection fraction. However, in diabetic patients, the presence of chest pain did not correlate with any of these markers. Regardless of symptoms, diabetics as a group had higher rates of myocardial ischemia. So relying solely on symptoms to determine which diabetics warrant workup for coronary artery disease seems unreliable.

Citation: Heston, Thomas F. (2005). Anginal symptoms are not predictive of myocardial perfusion in diabetics. Journal of Nuclear Cardiology, 12(4), S108. https://doi.org/10.1016/j.nuclcard.2005.06.028

January 3, 2024

Revisiting the Potential of the Heston Model in Medicine

The Heston Model for characterizing unpredictable volatility in finance continues to show promise, if validated, for enhancing analysis in healthcare. By quantifying fluctuating variability, this mathematical approach could strengthen disease modeling and treatment personalization. However, rigorous testing is still needed before clinical adoption. The versatility of techniques across fields merits ongoing open-minded assessment, as proven applications hold meaningful potential.

Citation: Heston TF. Quantifying uncertainty: potential medical applications of the heston model of financial stochastic volatility. Contemporary Perspective on Science, Technology and Research. 2024 Jan 1;3:92-103. doi: https://doi.org/10.9734/bpi/cpstr/v3/2797G  


December 18, 2023

Chatbots persist engaging at dangerous mental health risk levels

Publicly available ChatGPT conversational agents for mental health counseling frequently fail to adequately escalate risk scenarios, a new study found. The chatbots postponed recommending human support until severe depression levels on the PHQ-9 scale. Most provided no crisis resources. Over 80% resumed conversations after insisting users seek help. The findings indicate deficiencies in identifying hazardous psychological states, jeopardizing user safety. Responsible AI development demands prioritizing mental health ethical considerations before real-world deployment.

Citation: Heston TF. Safety of large language models in addressing depression. Cureus. 2023;15(12):e50729. https://doi.org/10.7759/cureus.50729 

December 13, 2023

Standardizing PET/CT Scan Analysis Improves Cancer Care

Clear, thorough PET/CT scan interpretation is crucial for optimal cancer care. A standardized methodology like that outlined here ensures all key elements are addressed - correct protocols, multiplanar review, correlating PET and CT, categorizing anatomy, detailing lesions, assessing therapeutic response, answering the clinical question, recommending further imaging, and reporting metrics like SUVs. This systematization aims to improve clarity for referring physicians to guide treatment. Given the central role PET/CT plays in cancer care, standardizing analysis deserves attention.

Citation: Heston TF, Wahl R, Jacene H. A Systematic Approach to PET/CT Interpretation and Reporting in Oncology. Journal of Nuclear Medicine 2009;50(Supplement 2): 1089. https://jnm.snmjournals.org/content/50/supplement_2/1089 

December 1, 2023

Exploring Interconnections Between Music, Art, Physics and Medicine

 A new article titled "The Beholder - A Symphony of Life in Medicine" traces the author's journey integrating artistic, scientific, and humanistic perspectives. It reveals striking symmetries between music, visual art, quantum physics, and medicine, illuminating an interconnected reality. As a holistic musician drawn to medicine as a creative act of healing, the author has woven together these disparate strands into a remarkable tapestry merging arts, physics, and caregiving.

Citation: Heston, Thomas F. (2023). The Beholder - A Symphony of Life in Medicine. International Journal of Scientific Research. 2023;12(12):1-2. https://doi.org/10.5281/zenodo.10246613

November 30, 2023

Elevated coronary calcium scores in patients with normal myocardial perfusion

 A study evaluated coronary artery calcium scoring in 2351 patients undergoing myocardial perfusion imaging who had normal perfusion results. 55% had a calcium score of 0, 36% had scores from 1-400, and 9% had scores above 400. Higher calcium scores were significantly associated with older age, hypertension, hyperlipidemia, smoking, diabetes, male sex, and family history. After adjustment, age, hypertension, and hyperlipidemia remained associated. Despite having normal myocardial perfusion, nearly 10% of patients had concerningly elevated calcium scores above 400, suggesting the potential utility of assessing coronary calcium even in some patients with normal perfusion.

Citation: Heston T, Merrill J, Bengel F, Wahl R. Coronary calcium scores in patients with normal myocardial perfusion. Journal of Nuclear Medicine. 2009;50(Suppl 2):1160. 

DOI: 10.5281/zenodo.10230802 

URL: https://jnm.snmjournals.org/content/50/supplement_2/1160

November 28, 2023

Safeguarding Medical Research Integrity Through Statistical Ethics

 A new narrative review underscores how the ethical application of statistics is fundamental for rigorous, reproducible medical research. It highlights common statistical pitfalls like p-hacking and over-reliance on p-values that can undermine findings. Historical examples demonstrate how such errors have led to public harm, including with past hormone therapy and vaccine trials. Recommendations to raise standards encompass more statistical oversight during proposal reviews, requiring open access data and mandating an ethical discussion. As the article emphasizes, upholding core ethical principles in clinical trials necessitates meticulous statistical planning and analysis.

Citation: Heston TF. Statistical Ethics in Medical Research: A Narrative Review. Jour Clin Med Res. 2023;4(3):1-10. http://dx.doi.org/10.46889/JCMR.2023.4308

November 27, 2023

One-Third of Normal Patients Misclassified by Typical Statistically Significant Cutoffs

 A study in a nuclear medicine journal investigated how often a statistically significant cutoff between normal and abnormal values would misclassify healthy patients. Analyzing 32 test results, the typical cutoff fell just 0.66 SDs from the mean. At that point, one SD encompasses 34% of normally distributed data on both sides of the mean. Consequently, 34% of healthy patients fall beyond 0.66 SDs and would be erroneously deemed abnormal. The authors conclude statistical significance frequently fails to ensure clinical usefulness on an individual level.

Citation: Heston TF, Wahl RL. How often are statistically significant results clinically relevant? Not often. J Nucl Med. 2009;50(Suppl 2):1370. DOI: 10.5281/zenodo.10198933


November 13, 2023

Comparing Approaches to Smoking Cessation: What Works Best?

In 1993, a meta-analysis examined the efficacy of various smoking cessation strategies. The review found clinical interventions to be more successful than community-based programs. Brief counseling from healthcare providers, nicotine replacement therapy, workplace smoking bans, and increased tobacco taxes were among the most effective clinical approaches. While this meta-analysis illuminated the short-term effectiveness of different cessation tactics, further research is required to understand long-term outcomes. These findings highlight the value of integrating smoking cessation initiatives into comprehensive tobacco control efforts.

Citation: Heston TF. Smoking cessation strategies: a meta-analysis. Southern Medical Journal. 1993;86(Suppl):S36. doi: https://doi.org/10.5281/zenodo.10120006

November 10, 2023

Gender Disparities in Emergency Cardiac Care Persist

 A study from 1997 confirms previous findings that women face gender disparities in emergency care for suspected heart attacks. Compared to men, women experienced delays in obtaining ECGs and being evaluated by physicians. Women were also less likely to be admitted to intensive care units. Despite increased awareness, these gaps in care for women persist nationwide. More training and protocols are needed to eliminate gender bias and improve outcomes for female cardiac patients.

Citation: Heston, T. F., & Lewis, L. M. (1997). Gender bias in acute myocardial infarction. The American Journal of Cardiology, 79(6), 844. https://doi.org/10.5281/zenodo.10095950

November 7, 2023

Efficacy of Behavioral Changes on Weight Loss in Hypertension Risk Groups

This study meticulously examines the correlation between behavioral modifications and weight loss among individuals at risk of hypertension. It scrutinizes the outcomes of a 14-week intervention targeting dietary habits and physical activity. The intervention's efficacy is measured by the change in participants' Body Mass Index (BMI), with a notable reduction from an initial mean BMI of 28.9 kg/m² to 27.5 kg/m². The research identifies the precision of food record-keeping and the initial BMI as significant predictors, explaining a 38% variance in weight loss. These findings advocate for the critical role of self-monitoring dietary intake and starting BMI in weight loss programs, particularly for those at elevated risk for hypertension.

Citation: Heston, T. F. (1992). Predictors of weight loss in a hypertension prevention program. Southern Medical Journal, 85(Supplement), 3S–31. https://doi.org/10.5281/zenodo.10079949

November 3, 2023

Assessing Research Findings: Beyond Statistical Significance

 Traditionally, p-values have been used to determine statistical significance of research findings. However, statistical significance does not guarantee clinical relevance. The fragility index provides additional insight into robustness but still depends on p-values. In contrast, the relative risk index focuses on divergence from therapeutic equivalence, independent of statistical significance. A recent simulation found the relative risk index weakly correlates with p-values, suggesting distinct information. The relative risk index may better capture clinical relevance. Rather than solely relying on p-values and fragility indices, the relative risk index warrants consideration as a complementary metric when evaluating research to guide evidence-based practice.

Citation: Heston TF. Statistical significance versus clinical relevance: a head-to-head comparison of the fragility index and relative risk index. Cureus. 2023;15(10):e47741. DOI:10.7759/cureus.47741.

November 1, 2023

The Cost of Living Index as a Primary Driver of Homelessness

A new study analyzed data across all 50 US states to identify factors driving differences in homelessness rates. It found the cost of living index, mainly housing costs, as the primary contributor to homelessness. Unemployment, poverty, and alcohol misuse also emerged as significant factors. Unexpectedly, reduced access to prescription opioids was linked with increased homelessness, suggesting restrictive opioid policies may have unintended consequences. The insights can inform resource allocation and policies to alleviate homelessness through comprehensive, collaborative approaches.

Citation: Heston TF. The Cost of Living Index as a Primary Driver of Homelessness in the United States: A Cross-State Analysis. Cureus. 2023;15(10):e46975. Published 2023 Oct 13. doi:10.7759/cureus.46975

August 25, 2016

Longitudinal Associations Between Cyberbullying Involvement and Adolescent Mental Health.

Adolescent cyber bully victims are more likely to experience depressive symptoms, social anxiety symptoms, and below average well-being. J Adolesc Health. 2016 Aug 12.

Comment: The most astonishing part of this study was the prevalence of cyber bullying: 8% of subjects reported being cyber bullies, and 20% of subjects reported being a cyber bully victim within the previous year!