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Sample records for survival competing risks

  1. Survival Analysis in the Presence of Competing Risks: The Example of Waitlisted Kidney Transplant Candidates.

    PubMed

    Sapir-Pichhadze, R; Pintilie, M; Tinckam, K J; Laupacis, A; Logan, A G; Beyene, J; Kim, S J

    2016-07-01

    Competing events (or risks) preclude the observation of an event of interest or alter the probability of the event's occurrence and are commonly encountered in transplant outcomes research. Transplantation, for example, is a competing event for death on the waiting list because receiving a transplant may significantly decrease the risk of long-term mortality. In a typical analysis of time-to-event data, competing events may be censored or incorporated into composite end points; however, the presence of competing events violates the assumption of "independent censoring," which is the basis of standard survival analysis techniques. The use of composite end points disregards the possibility that competing events may be related to the exposure in a way that is different from the other components of the composite. Using data from the Scientific Registry of Transplant Recipients, this paper reviews the principles of competing risks analysis; outlines approaches for analyzing data with competing events (cause-specific and subdistribution hazards models); compares the estimates obtained from standard survival analysis, which handle competing events as censoring events; discusses the appropriate settings in which each of the two approaches could be used; and contrasts their interpretation. PMID:26751409

  2. Introduction to the Analysis of Survival Data in the Presence of Competing Risks.

    PubMed

    Austin, Peter C; Lee, Douglas S; Fine, Jason P

    2016-02-01

    Competing risks occur frequently in the analysis of survival data. A competing risk is an event whose occurrence precludes the occurrence of the primary event of interest. In a study examining time to death attributable to cardiovascular causes, death attributable to noncardiovascular causes is a competing risk. When estimating the crude incidence of outcomes, analysts should use the cumulative incidence function, rather than the complement of the Kaplan-Meier survival function. The use of the Kaplan-Meier survival function results in estimates of incidence that are biased upward, regardless of whether the competing events are independent of one another. When fitting regression models in the presence of competing risks, researchers can choose from 2 different families of models: modeling the effect of covariates on the cause-specific hazard of the outcome or modeling the effect of covariates on the cumulative incidence function. The former allows one to estimate the effect of the covariates on the rate of occurrence of the outcome in those subjects who are currently event free. The latter allows one to estimate the effect of covariates on the absolute risk of the outcome over time. The former family of models may be better suited for addressing etiologic questions, whereas the latter model may be better suited for estimating a patient's clinical prognosis. We illustrate the application of these methods by examining cause-specific mortality in patients hospitalized with heart failure. Statistical software code in both R and SAS is provided. PMID:26858290

  3. Survival analyses of radiated animals incorporating competing risks and covariates

    SciTech Connect

    Gupta, R.C.; Albanese, R.A.

    1995-12-01

    The United States Air Force has been interested in studying the effect of different types of radiation encountered by its personnel in space. A study was, therefore, conducted at the USAF School of Aerospace Medicine, Brooks Air Force, Texas with rhesus monkeys as experimental subjects. These subjects were exposed to different types of radiation such as: (1) electromagnetic radiation; (2) electrons; (3) protons; and (4) nuclei of elements of higher numbers with different amount of radiation. These subjects were followed over a period of 338 months. In this paper an interesting problem related to health and radiation has been addressed. The effects of radiation, taking into account the cause of death (cancer or heart disease) along with the covariates such as sex, age, type of exposure, dose, are examined. A general log-linear hazard model approach is studied. The model estimates the cause specific hazard rates, assuming piecewise exponential distribution, and exhibits the survival function for each of the covariate groups and the probability of death due to each cause. A data set called `Delayed Bio-Effects Colony,` of radiated animals, is analysed and some conclusions are drawn. Overall the study has brought out the effect of high and low dose of radiation on both the male and female groups. The procedure presented in the paper distinguishes between time varying hazards. Thus the methodology may be useful for other survival related environmental problems, be this with regard to animal or human survival. Thus, the paper could contribute to its more widespread use.

  4. Bayesian Gamma Frailty Models for Survival Data with Semi-Competing Risks and Treatment Switching

    PubMed Central

    Zhang, Yuanye; Chen, Ming-Hui; Ibrahim, Joseph G.; Zeng, Donglin; Chen, Qingxia; Pan, Zhiying; Xue, Xiaodong

    2013-01-01

    Motivated from a colorectal cancer study, we propose a class of frailty semi-competing risks survival models to account for the dependence between disease progression time, survival time, and treatment switching. Properties of the proposed models are examined and an efficient Gibbs sampling algorithm using the collapsed Gibbs technique is developed. A Bayesian procedure for assessing the treatment effect is also proposed. The Deviance Information Criterion (DIC) with an appropriate deviance function and Logarithm of the Pseudomarginal Likelihood (LPML) are constructed for model comparison. A simulation study is conducted to examine the empirical performance of DIC and LPML and as well as the posterior estimates. The proposed method is further applied to analyze data from a colorectal cancer study. PMID:23543121

  5. Estimation of Ten-Year Survival of Patients with Pulmonary Tuberculosis Based on the Competing Risks Model in Iran

    PubMed Central

    Kazempour-Dizaji, Mehdi; Tabarsi, Payam; Zayeri, Farid

    2016-01-01

    Background: Tuberculosis (TB) is a chronic bacterial disease, which despite the presence of effective drug strategies, still remains a serious health problem worldwide. Estimation of survival rate is an appropriate indicator for prognosis in patients with pulmonary TB. Therefore, this research was designed with the aim of accurate estimation of the survival of patients by taking both the death event and relapse into consideration. Materials and Methods: Based on a retrospective cohort study, information of 2,299 patients with pulmonary TB that had been referred to and treated in Masih Daneshvari Hospital from 2005 to 2015 was reviewed. To estimate the survival of patients with pulmonary TB, the competing risks model, which considered death and relapse as competing events, was used. In addition, the effect of factors affecting the cumulative incidence function (CIF) of death event and relapse was also examined. Results: The effect of risk factors on the CIF of death events and relapse showed that patients’ age, marital status, contact with TB patients, adverse effect of drugs, imprisonment and HIV positivity were factors that affected the CIF of death. Meanwhile, sex, marital status, imprisonment and HIV positivity were factors affecting the CIF of relapse (P <0.05). Considering death and relapse as competing events, survival estimation in pulmonary TB patients showed that survival in this group of patients in the first, third, fifth and tenth year after treatment was 39%, 14%, 7% and 0%, respectively. Conclusion: The use of competing risks model in survival analysis of patients with pulmonary TB with consideration of competing events, enables more accurate estimation of survival. PMID:27403177

  6. Clinical-Pathological Characteristics and Prognosis of a Cohort of Oesophageal Cancer Patients: a Competing Risks Survival Analysis

    PubMed Central

    Rodríguez-Camacho, Elena; Pita-Fernández, Salvador; Pértega-Díaz, Sonia; López-Calviño, Beatriz; Seoane-Pillado, Teresa

    2015-01-01

    Background To determine the clinical course, follow-up strategies, and survival of oesophageal cancer patients using a competing risks survival analysis. Methods We conducted a retrospective and prospective follow-up study. The study included 180 patients with a pathological diagnosis of oesophageal cancer in A Coruña, Spain, between 2003 and 2008. The Kaplan-Meier methodology and competing risks survival analysis were used to calculate the specific survival rate. The study was approved by the Ethics Review Board (code 2011/372, CEIC Galicia). Results The specific survival rate at the first, third, and fifth years was 40.2%, 18.1%, and 12.4%, respectively. Using the Kaplan-Meier methodology, the survival rate was slightly higher after the third year of follow-up. In the multivariate analysis, poor prognosis factors were female sex (hazard ratio [HR] 1.94; 95% confidence interval [CI], 1.24–3.03), Charlson’s comorbidity index (HR 1.17; 95% CI, 1.02–1.33), and stage IV tumours (HR 1.70; 95% CI, 1.11–2.59). The probability of dying decreased with surgical and oncological treatment (chemotherapy and/or radiotherapy) (HR 0.23; 95% CI, 0.12–0.45). The number of hospital consultations per year during the follow-up period, from diagnosis to the appearance of a new event (local recurrences, newly appeared metastasis, and newly appeared neoplasias) did not affect the probability of survival (HR 1.03; 95% CI, 0.92–1.15). Conclusions The Kaplan-Meier methodology overestimates the survival rate in comparison to competing risks analysis. The variables associated with a poor prognosis are female sex, Charlson’s comorbidity score and extensive tumour invasion. Type of follow-up strategy employed after diagnosis does not affect the prognosis of the disease. PMID:25716135

  7. Joint modeling of longitudinal ordinal data and competing risks survival times and analysis of the NINDS rt-PA stroke trial

    PubMed Central

    Li, Ning; Elashoff, Robert M.; Li, Gang; Saver, Jeffrey

    2009-01-01

    SUMMARY Existing joint models for longitudinal and survival data are not applicable for longitudinal ordinal outcomes with possible non-ignorable missing values caused by multiple reasons. We propose a joint model for longitudinal ordinal measurements and competing risks failure time data, in which a partial proportional odds model for the longitudinal ordinal outcome is linked to the event times by latent random variables. At the survival endpoint, our model adopts the competing risks framework to model multiple failure types at the same time. The partial proportional odds model, as an extension of the popular proportional odds model for ordinal outcomes, is more flexible and at the same time provides a tool to test the proportional odds assumption. We use a likelihood approach and derive an EM algorithm to obtain the maximum likelihood estimates of the parameters. We further show that all the parameters at the survival endpoint are identifiable from the data. Our joint model enables one to make inference for both the longitudinal ordinal outcome and the failure times simultaneously. In addition, the inference at the longitudinal endpoint is adjusted for possible non-ignorable missing data caused by the failure times. We apply the method to the NINDS rt-PA stroke trial. Our study considers the modified Rankin Scale only. Other ordinal outcomes in the trial, such as the Barthel and Glasgow scales can be treated in the same way. PMID:19943331

  8. ANALYSIS OF LAMB MORTALITY USING COMPETING RISKS

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A competing risks model was used to describe lamb mortality up to four weeks of age in a composite sheep flock with 8,642 lamb records. Discrete survival methods were applied using sire and animal models. The results indicated that substantial variation exists in the risk of lambs dying from diffe...

  9. Recursive Partitioning Method on Competing Risk Outcomes

    PubMed Central

    Xu, Wei; Che, Jiahua; Kong, Qin

    2016-01-01

    In some cancer clinical studies, researchers have interests to explore the risk factors associated with competing risk outcomes such as recurrence-free survival. We develop a novel recursive partitioning framework on competing risk data for both prognostic and predictive model constructions. We define specific splitting rules, pruning algorithm, and final tree selection algorithm for the competing risk tree models. This methodology is quite flexible that it can corporate both semiparametric method using Cox proportional hazards model and parametric competing risk model. Both prognostic and predictive tree models are developed to adjust for potential confounding factors. Extensive simulations show that our methods have well-controlled type I error and robust power performance. Finally, we apply both Cox proportional hazards model and flexible parametric model for prognostic tree development on a retrospective clinical study on oropharyngeal cancer patients. PMID:27486300

  10. Competing Risk Regression Models for Epidemiologic Data

    PubMed Central

    Cole, Stephen R.; Gange, Stephen J.

    2009-01-01

    Competing events can preclude the event of interest from occurring in epidemiologic data and can be analyzed by using extensions of survival analysis methods. In this paper, the authors outline 3 regression approaches for estimating 2 key quantities in competing risks analysis: the cause-specific relative hazard (csRH) and the subdistribution relative hazard (sdRH). They compare and contrast the structure of the risk sets and the interpretation of parameters obtained with these methods. They also demonstrate the use of these methods with data from the Women's Interagency HIV Study established in 1993, treating time to initiation of highly active antiretroviral therapy or to clinical disease progression as competing events. In our example, women with an injection drug use history were less likely than those without a history of injection drug use to initiate therapy prior to progression to acquired immunodeficiency syndrome or death by both measures of association (csRH = 0.67, 95% confidence interval: 0.57, 0.80 and sdRH = 0.60, 95% confidence interval: 0.50, 0.71). Moreover, the relative hazards for disease progression prior to treatment were elevated (csRH = 1.71, 95% confidence interval: 1.37, 2.13 and sdRH = 2.01, 95% confidence interval: 1.62, 2.51). Methods for competing risks should be used by epidemiologists, with the choice of method guided by the scientific question. PMID:19494242

  11. Competing hazards with shared unmeasured risk factors.

    PubMed

    Hill, D H; Axinn, W G; Thornton, A

    1993-01-01

    "The present paper develops a generalization of the standard discrete-time competing hazards model that allows for the types of stochastic dependencies resulting from shared unmeasured risk factors. An empirical example is provided using the process by which young women form their first conjugal residential union, with married and unmarried cohabitation representing the competing alternatives. The results suggest considerable and significant similarity of the alternatives in terms of the unmeasurables. It is also shown that, as a result, the independence assumption leads to substantially biased estimates of the net marriage and net cohabitation survival functions." The data concern a cohort of white children born in Detroit, Michigan, in 1961 and their mothers, followed up to 1985. PMID:12318164

  12. Familial Risk and Child Competence.

    ERIC Educational Resources Information Center

    Sameroff, Arnold J.; Seifer, Ronald

    1983-01-01

    Examines components of familial risk in the context of a four-year longitudinal study of children with mentally ill mothers. Risk factors examined were parental mental health, social status, parental perspectives, and family stress. Interactions among risk factors were found to be complex and different for cognitive and social-emotional…

  13. Smoking, death, and Alzheimer disease: a case of competing risks.

    PubMed

    Chang, Chung-Chou H; Zhao, Yongyun; Lee, Ching-Wen; Ganguli, Mary

    2012-01-01

    If smoking is a risk factor for Alzheimer disease (AD) but a smoker dies of another cause before developing or manifesting AD, smoking-related mortality may mask the relationship between smoking and AD. This phenomenon, referred to as competing risk, complicates efforts to model the effect of smoking on AD. Typical survival regression models assume that censorship from analysis is unrelated to an individual's probability for developing AD (ie, censoring is noninformative). However, if individuals who die before developing AD are younger than those who survive long enough to develop AD, and if they include a higher percentage of smokers than nonsmokers, the incidence of AD will appear to be higher in older individuals and in nonsmokers. Further, age-specific mortality rates are higher in smokers because they die earlier than nonsmokers. Therefore, if we fail to take into account the competing risk of death when we estimate the effect of smoking on AD, we bias the results and are in fact only comparing the incidence of AD in nonsmokers with that in the healthiest smokers. In this study, we demonstrate that the effect of smoking on AD differs in models that are and are not adjusted for competing risks. PMID:22185783

  14. Risks, risk assessment and risk competence in toxicology

    PubMed Central

    Stahlmann, Ralf; Horvath, Aniko

    2015-01-01

    Understanding the toxic effects of xenobiotics requires sound knowledge of physiology and biochemistry. The often described lack of understanding pharmacology/toxicology is therefore primarily caused by the general absence of the necessary fundamental knowledge. Since toxic effects depend on exposure (or dosage) assessing the risks arising from toxic substances also requires quantitative reasoning. Typically public discussions nearly always neglect quantitative aspects and laypersons tend to disregard dose-effect-relationships. One of the main reasons for such disregard is the fact that exposures often occur at extremely low concentrations that can only be perceived intellectually but not by the human senses. However, thresholds in the low exposure range are often scientifically disputed. At the same time, ignorance towards known dangers is wide-spread. Thus, enhancing the risk competence of laypersons will have to be initially restricted to increasing the awareness of existing problems. PMID:26195922

  15. Nonparametric Analysis of Bivariate Gap Time with Competing Risks

    PubMed Central

    Huang, Chiung-Yu; Wang, Chenguang; Wang, Mei-Cheng

    2016-01-01

    Summary This article considers nonparametric methods for studying recurrent disease and death with competing risks. We first point out that comparisons based on the well-known cumulative incidence function can be confounded by different prevalence rates of the competing events, and that comparisons of the conditional distribution of the survival time given the failure event type are more relevant for investigating the prognosis of different patterns of recurrence disease. We then propose nonparametric estimators for the conditional cumulative incidence function as well as the conditional bivariate cumulative incidence function for the bivariate gap times, that is, the time to disease recurrence and the residual lifetime after recurrence. To quantify the association between the two gap times in the competing risks setting, a modified Kendall’s tau statistic is proposed. The proposed estimators for the conditional bivariate cumulative incidence distribution and the association measure account for the induced dependent censoring for the second gap time. Uniform consistency and weak convergence of the proposed estimators are established. Hypothesis testing procedures for two-sample comparisons are discussed. Numerical simulation studies with practical sample sizes are conducted to evaluate the performance of the proposed nonparametric estimators and tests. An application to data from a pancreatic cancer study is presented to illustrate the methods developed in this article. PMID:26990686

  16. Student Competencies Guide: Survival Skills for a Changing World.

    ERIC Educational Resources Information Center

    Northwest Regional Educational Lab., Portland, OR.

    This guide is designed to help junior and senior high school students acquire basic competencies in daily living. In addition to identifying 13 competencies, the guide explains how students can obtain certification in those skills by members of the community whose jobs require them to be proficient in them. The competencies include transacting…

  17. Modelling competing risks in nephrology research: an example in peritoneal dialysis

    PubMed Central

    2013-01-01

    Background Modelling competing risks is an essential issue in Nephrology Research. In peritoneal dialysis studies, sometimes inappropriate methods (i.e. Kaplan-Meier method) have been used to estimate probabilities for an event of interest in the presence of competing risks. In this situation a competing risk analysis should be preferable. The objectives of this study are to describe the bias resulting from the application of standard survival analysis to estimate peritonitis-free patient survival and to provide alternative statistical approaches taking competing risks into account. Methods The sample comprises patients included in a university hospital peritoneal dialysis program between October 1985 and June 2011 (n = 449). Cumulative incidence function and competing risk regression models based on cause-specific and subdistribution hazards were discussed. Results The probability of occurrence of the first peritonitis is wrongly overestimated using Kaplan-Meier method. The cause-specific hazard model showed that factors associated with shorter time to first peritonitis were age (≥55 years) and previous treatment (haemodialysis). Taking competing risks into account in the subdistribution hazard model, age remained significant while gender (female) but not previous treatment was identified as a factor associated with a higher probability of first peritonitis event. Conclusions In the presence of competing risks outcomes, Kaplan-Meier estimates are biased as they overestimated the probability of the occurrence of an event of interest. Methods which take competing risks into account provide unbiased estimates of cumulative incidence for each specific outcome experienced by patients. Multivariable regression models such as those based on cause-specific hazard and on subdistribution hazard should be used in this competing risk setting. PMID:23705871

  18. Incorporating Classification Uncertainty in Competing- risks Nest- failure Analysis

    EPA Science Inventory

    Nesting birds risk nest failure due to many causes. Though partitioning risk of failure among causes has long been of interest to ornithologists, formal methods for estimating competing risk have been lacking.

  19. Nonparametric estimation with recurrent competing risks data

    PubMed Central

    Peña, Edsel A.

    2014-01-01

    Nonparametric estimators of component and system life distributions are developed and presented for situations where recurrent competing risks data from series systems are available. The use of recurrences of components’ failures leads to improved efficiencies in statistical inference, thereby leading to resource-efficient experimental or study designs or improved inferences about the distributions governing the event times. Finite and asymptotic properties of the estimators are obtained through simulation studies and analytically. The detrimental impact of parametric model misspecification is also vividly demonstrated, lending credence to the virtue of adopting nonparametric or semiparametric models, especially in biomedical settings. The estimators are illustrated by applying them to a data set pertaining to car repairs for vehicles that were under warranty. PMID:24072583

  20. Risk-adjusted monitoring of survival times

    SciTech Connect

    Sego, Landon H.; Reynolds, Marion R.; Woodall, William H.

    2009-02-26

    We consider the monitoring of clinical outcomes, where each patient has a di®erent risk of death prior to undergoing a health care procedure.We propose a risk-adjusted survival time CUSUM chart (RAST CUSUM) for monitoring clinical outcomes where the primary endpoint is a continuous, time-to-event variable that may be right censored. Risk adjustment is accomplished using accelerated failure time regression models. We compare the average run length performance of the RAST CUSUM chart to the risk-adjusted Bernoulli CUSUM chart, using data from cardiac surgeries to motivate the details of the comparison. The comparisons show that the RAST CUSUM chart is more efficient at detecting a sudden decrease in the odds of death than the risk-adjusted Bernoulli CUSUM chart, especially when the fraction of censored observations is not too high. We also discuss the implementation of a prospective monitoring scheme using the RAST CUSUM chart.

  1. Risk factors affecting dental implant survival.

    PubMed

    Vehemente, Valerie A; Chuang, Sung-Kiang; Daher, Shadi; Muftu, Ali; Dodson, Thomas B

    2002-01-01

    Given the predictability of dental implant success, the attention of the scientific community is moving from descriptions of implant success toward a more detailed analysis of factors associated with implant failure. The purposes of this study were (1) to estimate the 1- and 5-year survival of Bicon dental implants and (2) to identify risk factors associated with implant failure in an objective, statistically valid manner. To address the research purposes, we used a retrospective cohort study design and a study sample composed of patients who had one or more implants placed. The predictor variables were grouped into the following categories: demographic, health status, anatomic, implant fixture-specific, prosthetic, perioperative, and ancillary variables. The major outcome variable of interest was implant failure defined as implant removal. Overall implant survival was estimated using the Kaplan-Meier analysis. Risk factors for implant failure were identified using the Cox proportional hazard regression models. The study sample was composed of 677 patients who had 677 implants randomly selected for analysis. The overall 1- and 5-year survival of the Bicon implant system was 95.2% and 90.2%, respectively. After adjusting for other covariates in a multivariate model, both tobacco use (P = .0004) and single-stage implant placement (P = .01) were statistically associated with an increased risk for failure. The results of these analyses suggest that the overall survival of the Bicon dental implant is comparable with other current implant systems. In addition, after controlling for covariates, we identified 2 exposures associated with implant survival, tobacco use and implant staging. Of interest, both of these exposures are under the clinician's control. PMID:12498449

  2. Parametric Estimation in a Recurrent Competing Risks Model

    PubMed Central

    Peña, Edsel A.

    2014-01-01

    A resource-efficient approach to making inferences about the distributional properties of the failure times in a competing risks setting is presented. Efficiency is gained by observing recurrences of the competing risks over a random monitoring period. The resulting model is called the recurrent competing risks model (RCRM) and is coupled with two repair strategies whenever the system fails. Maximum likelihood estimators of the parameters of the marginal distribution functions associated with each of the competing risks and also of the system lifetime distribution function are presented. Estimators are derived under perfect and partial repair strategies. Consistency and asymptotic properties of the estimators are obtained. The estimation methods are applied to a data set of failures for cars under warranty. Simulation studies are used to ascertain the small sample properties and the efficiency gains of the resulting estimators. PMID:25346751

  3. Competing risk: An illustration with aspiration pneumonia in head and neck cancer patients undergoing radical radiotherapy: A biostatistician's perspective.

    PubMed

    Bhattacharyya, T; Bhattacharjee, A

    2014-01-01

    Interest in survival analysis is to look and capture the information about the occurrence of events, i.e., death. In human life different types of events may happen at the same time. Sometimes, few events completely interrupt or make subtle changes on the occurrence of an event of interest. The method to capture information about the specific event of interest along with other events is known as competing risk modeling. This paper is dedicated to explore the application of competing risk model in oncology practice. It is aimed in near future that more and more survival analysis will be performed through application of competing risk modeling instead of traditional survival analysis to generate robust statistical inference. PMID:26842137

  4. Ohio Financial Services and Risk Management. Technical Competency Profile (TCP).

    ERIC Educational Resources Information Center

    Ray, Gayl M.; Wilson, Nick; Mangini, Rick

    This document describes the essential competencies from secondary through post-secondary associate degree programs for a career in financial services and risk management. Ohio College Tech Prep Program standards are described, and a key to profile codes is provided. Sample occupations in this career area, such as financial accountant, loan…

  5. Decision-making competence predicts domain-specific risk attitudes.

    PubMed

    Weller, Joshua A; Ceschi, Andrea; Randolph, Caleb

    2015-01-01

    Decision-making competence (DMC) reflects individual differences in rational responding across several classic behavioral decision-making tasks. Although it has been associated with real-world risk behavior, less is known about the degree to which DMC contributes to specific components of risk attitudes. Utilizing a psychological risk-return framework, we examined the associations between risk attitudes and DMC. Italian community residents (n = 804) completed an online DMC measure, using a subset of the original Adult-DMC battery. Participants also completed a self-reported risk attitude measure for three components of risk attitudes (risk-taking, risk perceptions, and expected benefits) across six risk domains. Overall, greater performance on the DMC component scales were inversely, albeit modestly, associated with risk-taking tendencies. Structural equation modeling results revealed that DMC was associated with lower perceived expected benefits for all domains. In contrast, its association with perceived risks was more domain-specific. These analyses also revealed stronger indirect effects for the DMC → expected benefits → risk-taking path than the DMC → perceived riskrisk-taking path, especially for behaviors that may be considered more maladaptive in nature. These results suggest that DMC performance differentially impacts specific components of risk attitudes, and may be more strongly related to the evaluation of expected value of a specific behavior. PMID:26029128

  6. Decision-making competence predicts domain-specific risk attitudes

    PubMed Central

    Weller, Joshua A.; Ceschi, Andrea; Randolph, Caleb

    2015-01-01

    Decision-making competence (DMC) reflects individual differences in rational responding across several classic behavioral decision-making tasks. Although it has been associated with real-world risk behavior, less is known about the degree to which DMC contributes to specific components of risk attitudes. Utilizing a psychological risk-return framework, we examined the associations between risk attitudes and DMC. Italian community residents (n = 804) completed an online DMC measure, using a subset of the original Adult-DMC battery. Participants also completed a self-reported risk attitude measure for three components of risk attitudes (risk-taking, risk perceptions, and expected benefits) across six risk domains. Overall, greater performance on the DMC component scales were inversely, albeit modestly, associated with risk-taking tendencies. Structural equation modeling results revealed that DMC was associated with lower perceived expected benefits for all domains. In contrast, its association with perceived risks was more domain-specific. These analyses also revealed stronger indirect effects for the DMC → expected benefits → risk-taking path than the DMC → perceived riskrisk-taking path, especially for behaviors that may be considered more maladaptive in nature. These results suggest that DMC performance differentially impacts specific components of risk attitudes, and may be more strongly related to the evaluation of expected value of a specific behavior. PMID:26029128

  7. Societal perspectives on risk awareness and risk competence.

    PubMed

    Koller, Michael; Hoffrage, Ulrich

    2015-01-01

    Medical risks can be assessed by objectifiable therapeutic features; however, these risks are also characterised to a considerable degree by individual and social values. People tend to strive towards both freedom as well as safety; in a medical context, these two aims are taken into account by shared decision-making models and by stricter regulations in the pharmaceutical sector. Media reports on medical risks are caught between providing information and economic interests, and this conflict particularly complicates rational discussions about unexpected risks (for instance, in the field of natural medicine). Thus, it is necessary to create the type of information culture which allows differentiating between real and less pronounced risks. PMID:26195921

  8. Societal perspectives on risk awareness and risk competence

    PubMed Central

    Koller, Michael; Hoffrage, Ulrich

    2015-01-01

    Medical risks can be assessed by objectifiable therapeutic features; however, these risks are also characterised to a considerable degree by individual and social values. People tend to strive towards both freedom as well as safety; in a medical context, these two aims are taken into account by shared decision-making models and by stricter regulations in the pharmaceutical sector. Media reports on medical risks are caught between providing information and economic interests, and this conflict particularly complicates rational discussions about unexpected risks (for instance, in the field of natural medicine). Thus, it is necessary to create the type of information culture which allows differentiating between real and less pronounced risks. PMID:26195921

  9. Competing risk analyses of longevity in Duroc sows with a special emphasis on leg conformation.

    PubMed

    Fernàndez de Sevilla, X; Fàbrega, E; Tibau, J; Casellas, J

    2009-03-01

    A competing risk approach was used to evaluate the influence of several factors on culling risk for 587 Duroc sows. Three different analyses were performed according to whether sow failure was due to death during productive life (DE) or to one of two causes for voluntary culling: low productivity (LP) and low fertility (LF). Sow survival was analyzed by the Cox model. Year at first farrowing (batch effect) significantly affected sow survival in all three analyses (P < 0.05 for DE and P < 0.001 for LP and LF) whereas farm of origin accounted for relevant variation in the LP and LF analyses. LP culling increased with backfat thickness of more than 19 mm at the end of the growth period (P < 0.05), bad teat condition (P < 0.05) and reduced piglets born alive (P < 0.001). For the LF competing risk analysis, culling increased with age at first farrowing (P < 0.1). Special emphasis was placed on the influence of leg and teat conformation on sow survivability, although they did not affect sow failure due to DE (P > 0.1). The overall leg-conformation score significantly influenced sow longevity in LP (P < 0.001) and LF competing risk analyses (P < 0.001), showing a higher hazard ratio (HR) for poorly conformed sows (1.013 and 4.366, respectively) than for well-conformed sows (0.342 and 0.246, respectively). Survival decreased with the presence of abnormal hoof growth in LP and LF analyses (HR = 3.372 and 6.002, respectively; P < 0.001) and bumps or injuries to legs (HR = 4.172 and 5.839, respectively; P < 0.01). Plantigradism reduced sow survival in the LP analysis (P < 0.05), while sickle-hooked leg (P < 0.05) impaired sow survival in the fertility-specific analysis. Estimates of heritability for longevity related to LP culling ranged from 0.008 to 0.024 depending on the estimation procedure, whereas heritability values increased to between 0.017 and 0.083 in LF analysis. These analyses highlighted substantial discrepancies in the sources of variation and genetic

  10. A review of methods to estimate cause-specific mortality in presence of competing risks

    USGS Publications Warehouse

    Heisey, Dennis M.; Patterson, Brent R.

    2006-01-01

    Estimating cause-specific mortality is often of central importance for understanding the dynamics of wildlife populations. Despite such importance, methodology for estimating and analyzing cause-specific mortality has received little attention in wildlife ecology during the past 20 years. The issue of analyzing cause-specific, mutually exclusive events in time is not unique to wildlife. In fact, this general problem has received substantial attention in human biomedical applications within the context of biostatistical survival analysis. Here, we consider cause-specific mortality from a modern biostatistical perspective. This requires carefully defining what we mean by cause-specific mortality and then providing an appropriate hazard-based representation as a competing risks problem. This leads to the general solution of cause-specific mortality as the cumulative incidence function (CIF). We describe the appropriate generalization of the fully nonparametric staggered-entry Kaplan–Meier survival estimator to cause-specific mortality via the nonparametric CIF estimator (NPCIFE), which in many situations offers an attractive alternative to the Heisey–Fuller estimator. An advantage of the NPCIFE is that it lends itself readily to risk factors analysis with standard software for Cox proportional hazards model. The competing risks–based approach also clarifies issues regarding another intuitive but erroneous "cause-specific mortality" estimator based on the Kaplan–Meier survival estimator and commonly seen in the life sciences literature.

  11. Patient risk factors' influence on survival of posterior composites.

    PubMed

    van de Sande, F H; Opdam, N J; Rodolpho, P A Da Rosa; Correa, M B; Demarco, F F; Cenci, M S

    2013-07-01

    This practice-based retrospective study evaluated the survival of resin composite restorations in posterior teeth, focusing on the influence of potential patient risk factors. In total, 306 posterior composite restorations placed in 44 adult patients were investigated after 10 to 18 yrs. The history of each restoration was extracted from the dental records, and a clinical evaluation was performed with those still in situ. The patient risk status was assessed for caries and "occlusal-stress" (bruxism-related). Statistical analysis was performed by the Kaplan-Meier method and Cox-regression multivariate analysis. In total, 30% of the restorations failed, of which 82% were found in patients with 1 or 2 risk factors. Secondary caries was the main reason of failure within caries-risk patients, whereas fracture was the main reason in "occlusal-stress-risk" patients. The patient variables gender and age did not significantly affect survival, but risk did (p < .001). Tooth type (p < .001), arch (p = .013), and pulpal vitality (p = .003) significantly affected restoration survival. Within the limits of this retrospective evaluation, the survival of restorations is affected by patient risk factors, which should be included in survival analyses of restorations. PMID:23690354

  12. Recreational Physical Activity and Ovarian Cancer Risk and Survival

    PubMed Central

    Moorman, Patricia G.; Jones, Lee W.; Akushevich, Lucy; Schildkraut, Joellen M.

    2010-01-01

    Purpose Physical activity may influence ovarian cancer risk and outcomes through effects on ovulation, inflammatory markers and other processes. We examined associations between self-reported physical activity and ovarian cancer risk and survival in a population-based, case-control study in North Carolina. Methods The analyses involved 638 epithelial ovarian cancer cases and 683 controls recruited between 1999-2008. Logistic regression analyses were used to assess ovarian cancer risk in relation to reported average physical activity at various time periods. Kaplan-Meier analyses and proportional hazards modeling were used to assess associations between physical activity and survival among ovarian cancer cases. Results Modestly reduced risks for ovarian cancer were observed in some categories of physical activity, but there were no consistent patterns of greater reductions in risk with higher activity levels. Physical activity prior to diagnosis was not significantly related to ovarian cancer survival overall, but survival was better for women who reported >2 hours of activity/week as compared to those reporting <1 hour/week among women who were non-obese (multivariable hazard ratio=0.69, 95% CI 0.47 – 1.00) Conclusions Our data provide weak evidence in support of beneficial effects of physical activity on ovarian cancer risk and survival, but results should be interpreted cautiously because of the lack of a clear dose response relation with higher levels of exercise and the likely misclassification of self-reported activity. PMID:21296269

  13. The clinical course of cirrhosis: The importance of multistate models and competing risks analysis.

    PubMed

    Jepsen, Peter; Vilstrup, Hendrik; Andersen, Per Kragh

    2015-07-01

    Multistate models are models of disease progression that, for a patient group, define multiple outcome events, each of which may affect the time to develop another outcome event. Multistate models are highly relevant for studies of patients with cirrhosis; both the classical perception of cirrhosis as either compensated or decompensated and the recent, more complex models of cirrhosis progression are multistate models. Therefore, researchers who conduct clinical studies of patients with cirrhosis must realize that most of their research questions assume a multistate disease model. Failure to do so can result in severely biased results and bad clinical decisions. The analyses that can be used to study disease progression in a multistate disease model may be called competing risks analysis, named after the competing risks disease model, which is the simplest multistate disease model. In this review article, we introduce multistate disease models and competing risks analysis and explain why the standard armamentarium of Kaplan-Meier survival estimates and Cox regression sometimes gives bad answers to good questions. We also use real data to answer typical research questions about the course of cirrhosis and illustrate biases resulting from inadequate methods. Finally, we suggest statistical software packages that are helpful and accessible to the clinician-researcher. PMID:25376655

  14. Project Work English Competency-Based Curriculum: Survival-Level One.

    ERIC Educational Resources Information Center

    Northwest Educational Cooperative, Des Plaines, IL.

    This guide outlines a curriculum designed to provide English-as-a-Second-Language (ESL) life-skills instruction for refugees in the Chicago metropolitan area, concentrating on the Level One survival skills. Non-Southeast Asians account for more than half of those served, all of whom receive, or are at risk of receiving, public assistance. Most are…

  15. How Enrollment Ends: Analyzing the Correlates of Student Graduation, Transfer and Dropout with a Competing Risks Model. AIR 1995 Annual Forum Paper.

    ERIC Educational Resources Information Center

    Ronco, Sharron L.

    This study applied the methodology of competing risks survival analysis to determine the probability that a student's first enrollment in the university will end in graduation, transfer, or withdrawal. The risk factors associated with each mode of exit were assessed, with attention to factors such as admission status, full-time or part-time…

  16. Risk Taking: A Required Competency for Merger, Acquisitions, and Partnerships.

    PubMed

    Trepanier, Sylvain; Crenshaw, Jeannette T; Yoder-Wise, Patricia S

    2016-01-01

    Today's nurse executive is likely to find himself or herself in the middle of a merger, acquisition, and/or partnership (MAP). This is the result of health care agencies vying for market share in the midst of stiff competition, as well as decreased reimbursement in a rapidly changing payment system. The phenomenon of MAPs is fueled by the focus on care coordination and population health management. To be prepared for the ongoing and increasing MAP activity, nurse executives need to develop the skill of risk taking as an essential competency for leading change. This article emphasizes the need to maintain and improve health care quality and patient safety. PMID:27584889

  17. Survival Association Rule Mining Towards Type 2 Diabetes Risk Assessment

    PubMed Central

    Simon, Gyorgy J.; Schrom, John; Castro, M. Regina; Li, Peter W.; Caraballo, Pedro J.

    2013-01-01

    Type-2 Diabetes Mellitus is a growing epidemic that often leads to severe complications. Effective preventive measures exist and identifying patients at high risk of diabetes is a major health-care need. The use of association rule mining (ARM) is advantageous, as it was specifically developed to identify associations between risk factors in an interpretable form. Unfortunately, traditional ARM is not directly applicable to survival outcomes and it lacks the ability to compensate for confounders and to incorporate dosage effects. In this work, we propose Survival Association Rule (SAR) Mining, which addresses these shortcomings. We demonstrate on a real diabetes data set that SARs are naturally more interpretable than the traditional association rules, and predictive models built on top of these rules are very competitive relative to state of the art survival models and substantially outperform the most widely used diabetes index, the Framingham score. PMID:24551408

  18. Identifying Important Risk Factors for Survival in Kidney Graft Failure Patients Using Random Survival Forests

    PubMed Central

    HAMIDI, Omid; POOROLAJAL, Jalal; FARHADIAN, Maryam; TAPAK, Leili

    2016-01-01

    Background: Kidney transplantation is the best alternative treatment for end-stage renal disease. Several studies have been devoted to investigate predisposing factors of graft rejection. However, there is inconsistency between the results. The objective of the present study was to utilize an intuitive and robust approach for variable selection, random survival forests (RSF), and to identify important risk factors in kidney transplantation patients. Methods: The data set included 378 patients with kidney transplantation obtained through a historical cohort study in Hamadan, western Iran, from 1994 to 2011. The event of interest was chronic nonreversible graft rejection and the duration between kidney transplantation and rejection was considered as the survival time. RSF method was used to identify important risk factors for survival of the patients among the potential predictors of graft rejection. Results: The mean survival time was 7.35±4.62 yr. Thirty-seven episodes of rejection were occurred. The most important predictors of survival were cold ischemic time, recipient’s age, creatinine level at discharge, donors’ age and duration of hospitalization. RSF method predicted survival better than the conventional Cox-proportional hazards model (out-of-bag C-index of 0.965 for RSF vs. 0.766 for Cox model and integrated Brier score of 0.081 for RSF vs. 0.088 for Cox model). Conclusion: A RSF model in the kidney transplantation patients outperformed traditional Cox-proportional hazard model. RSF is a promising method that may serve as a more intuitive approach to identify important risk factors for graft rejection. PMID:27057518

  19. Loss to Follow-Up as a Competing Risk in an Observational Study of HIV-1 Incidence

    PubMed Central

    Graham, Susan M.; Raboud, Janet; McClelland, R. Scott; Jaoko, Walter; Ndinya-Achola, Jeckoniah; Mandaliya, Kishor; Overbaugh, Julie; Bayoumi, Ahmed M.

    2013-01-01

    Objective Conventional survival estimates may be biased if loss to follow-up (LTF) is associated with the outcome of interest. Our goal was to assess whether the association between sexual risk behavior and HIV-1 acquisition changed after accounting for LTF with competing risks regression. Methods HIV-1-seronegative women who enrolled in a Kenyan sex worker cohort from 1993–2007 were followed prospectively and tested for HIV at monthly clinic visits. Our primary predictor was self-reported sexual risk behavior in the past week, analyzed as a time-dependent covariate. Outcomes included HIV-1 acquisition and LTF. We analyzed the data using Cox proportional hazards regression and competing risks regression, in which LTF was treated as a competing event. Results A total of 1,513 women contributed 4,150 person-years (py), during which 198 (13.1%) acquired HIV-1 infection (incidence, 4.5 per 100 py) and 969 (64.0%) were LTF (incidence, 23.4 per 100 py). After adjusting for potential confounders, women reporting unprotected sex with multiple partners were less likely to be lost to follow-up (adjusted sub-hazard ratio (aSHR) 0.50, 95% confidence interval (CI) 0.32–0.76, relative to no sexual activity). The risk of HIV-1 acquisition after reporting unprotected sex with multiple partners was similar with Cox regression (adjusted hazard ratio (aHR) 2.41, 95% CI 1.36–4.27) and competing risks regression (aSHR 2.47, 95% CI 1.33–4.58). Conclusions Unprotected sex with multiple partners was associated with higher HIV-1 acquisition risk, but lower attrition. This differential attrition did not substantially bias Cox regression estimates when compared to competing risks regression results. PMID:23555041

  20. Developing points-based risk-scoring systems in the presence of competing risks.

    PubMed

    Austin, Peter C; Lee, Douglas S; D'Agostino, Ralph B; Fine, Jason P

    2016-09-30

    Predicting the occurrence of an adverse event over time is an important issue in clinical medicine. Clinical prediction models and associated points-based risk-scoring systems are popular statistical methods for summarizing the relationship between a multivariable set of patient risk factors and the risk of the occurrence of an adverse event. Points-based risk-scoring systems are popular amongst physicians as they permit a rapid assessment of patient risk without the use of computers or other electronic devices. The use of such points-based risk-scoring systems facilitates evidence-based clinical decision making. There is a growing interest in cause-specific mortality and in non-fatal outcomes. However, when considering these types of outcomes, one must account for competing risks whose occurrence precludes the occurrence of the event of interest. We describe how points-based risk-scoring systems can be developed in the presence of competing events. We illustrate the application of these methods by developing risk-scoring systems for predicting cardiovascular mortality in patients hospitalized with acute myocardial infarction. Code in the R statistical programming language is provided for the implementation of the described methods. © 2016 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd. PMID:27197622

  1. A new flexible dependence measure for semi-competing risks.

    PubMed

    Yang, Jing; Peng, Limin

    2016-09-01

    Semi-competing risks data are often encountered in chronic disease follow-up studies that record both nonterminal events (e.g., disease landmark events) and terminal events (e.g., death). Studying the relationship between the nonterminal event and the terminal event can provide insightful information on disease progression. In this article, we propose a new sensible dependence measure tailored to addressing such an interest. We develop a nonparametric estimator, which is general enough to handle both independent right censoring and left truncation. Our strategy of connecting the new dependence measure with quantile regression enables a natural extension to adjust for covariates with minor additional assumptions imposed. We establish the asymptotic properties of the proposed estimators and develop inferences accordingly. Simulation studies suggest good finite-sample performance of the proposed methods. Our proposals are illustrated via an application to Denmark diabetes registry data. PMID:26916804

  2. Competing risk analysis using R: an easy guide for clinicians.

    PubMed

    Scrucca, L; Santucci, A; Aversa, F

    2007-08-01

    In the last decade with widespread use of quantitative analyses in medical research, close co-operation between statisticians and physicians has become essential from the experimental design through all phases of complex statistical analysis. On the other hand, easy-to-use statistical packages allow clinicians to perform basic statistical analyses themselves. Since the software they most commonly use does not perform in depth competing risk analysis, we recommend an add-on package for the R statistical software. We provide all the instructions for downloading it from internet and illustrate how to use it for analysis of a sample dataset of patients who underwent haematopoietic stem cell transplantation for acute leukaemia. PMID:17563735

  3. Competing Risk Analysis for Evaluation of Dalteparin Versus Unfractionated Heparin for Venous Thromboembolism in Medical-Surgical Critically Ill Patients

    PubMed Central

    Li, Guowei; Cook, Deborah J.; Levine, Mitchell A.H.; Guyatt, Gordon; Crowther, Mark; Heels-Ansdell, Diane; Holbrook, Anne; Lamontagne, Francois; Walter, Stephen D.; Ferguson, Niall D.; Finfer, Simon; Arabi, Yaseen M.; Bellomo, Rinaldo; Cooper, D. Jamie; Thabane, Lehana

    2015-01-01

    Abstract Failure to recognize the presence of competing risk or to account for it may result in misleading conclusions. We aimed to perform a competing risk analysis to assess the efficacy of the low molecular weight heparin dalteparin versus unfractionated heparin (UFH) in venous thromboembolism (VTE) in medical-surgical critically ill patients, taking death as a competing risk. This was a secondary analysis of a prospective randomized study of the Prophylaxis for Thromboembolism in Critical Care Trial (PROTECT) database. A total of 3746 medical-surgical critically ill patients from 67 intensive care units (ICUs) in 6 countries receiving either subcutaneous UFH 5000 IU twice daily (n = 1873) or dalteparin 5000 IU once daily plus once-daily placebo (n = 1873) were included for analysis. A total of 205 incident proximal leg deep vein thromboses (PLDVT) were reported during follow-up, among which 96 were in the dalteparin group and 109 were in the UFH group. No significant treatment effect of dalteparin on PLDVT compared with UFH was observed in either the competing risk analysis or standard survival analysis (also known as cause-specific analysis) using multivariable models adjusted for APACHE II score, history of VTE, need for vasopressors, and end-stage renal disease: sub-hazard ratio (SHR) = 0.92, 95% confidence interval (CI): 0.70–1.21, P-value = 0.56 for the competing risk analysis; hazard ratio (HR) = 0.92, 95% CI: 0.68–1.23, P-value = 0.57 for cause-specific analysis. Dalteparin was associated with a significant reduction in risk of pulmonary embolism (PE): SHR = 0.54, 95% CI: 0.31–0.94, P-value = 0.02 for the competing risk analysis; HR = 0.51, 95% CI: 0.30–0.88, P-value = 0.01 for the cause-specific analysis. Two additional sensitivity analyses using the treatment variable as a time-dependent covariate and using as-treated and per-protocol approaches demonstrated similar findings. This competing risk analysis

  4. Competing Risk Analysis for Evaluation of Dalteparin Versus Unfractionated Heparin for Venous Thromboembolism in Medical-Surgical Critically Ill Patients.

    PubMed

    Li, Guowei; Cook, Deborah J; Levine, Mitchell A H; Guyatt, Gordon; Crowther, Mark; Heels-Ansdell, Diane; Holbrook, Anne; Lamontagne, Francois; Walter, Stephen D; Ferguson, Niall D; Finfer, Simon; Arabi, Yaseen M; Bellomo, Rinaldo; Cooper, D Jamie; Thabane, Lehana

    2015-09-01

    Failure to recognize the presence of competing risk or to account for it may result in misleading conclusions. We aimed to perform a competing risk analysis to assess the efficacy of the low molecular weight heparin dalteparin versus unfractionated heparin (UFH) in venous thromboembolism (VTE) in medical-surgical critically ill patients, taking death as a competing risk.This was a secondary analysis of a prospective randomized study of the Prophylaxis for Thromboembolism in Critical Care Trial (PROTECT) database. A total of 3746 medical-surgical critically ill patients from 67 intensive care units (ICUs) in 6 countries receiving either subcutaneous UFH 5000 IU twice daily (n = 1873) or dalteparin 5000 IU once daily plus once-daily placebo (n = 1873) were included for analysis.A total of 205 incident proximal leg deep vein thromboses (PLDVT) were reported during follow-up, among which 96 were in the dalteparin group and 109 were in the UFH group. No significant treatment effect of dalteparin on PLDVT compared with UFH was observed in either the competing risk analysis or standard survival analysis (also known as cause-specific analysis) using multivariable models adjusted for APACHE II score, history of VTE, need for vasopressors, and end-stage renal disease: sub-hazard ratio (SHR) = 0.92, 95% confidence interval (CI): 0.70-1.21, P-value = 0.56 for the competing risk analysis; hazard ratio (HR) = 0.92, 95% CI: 0.68-1.23, P-value = 0.57 for cause-specific analysis. Dalteparin was associated with a significant reduction in risk of pulmonary embolism (PE): SHR = 0.54, 95% CI: 0.31-0.94, P-value = 0.02 for the competing risk analysis; HR = 0.51, 95% CI: 0.30-0.88, P-value = 0.01 for the cause-specific analysis. Two additional sensitivity analyses using the treatment variable as a time-dependent covariate and using as-treated and per-protocol approaches demonstrated similar findings.This competing risk analysis yields no

  5. A Competing Risk Analysis for Hospital Length of Stay in Patients With Burns

    PubMed Central

    Taylor, Sandra L.; Sen, Soman; Greenhalgh, David G.; Lawless, MaryBeth; Curri, Terese; Palmieri, Tina L.

    2016-01-01

    IMPORTANCE Current outcome predictors for illness and injury are measured at a single time point—admission. However, patient prognosis often changes during hospitalization, limiting the usefulness of those predictions. Accurate depiction of the dynamic interaction between competing events during hospitalization may enable real-time outcome assessment. OBJECTIVE To determine how the effects of burn outcome predictors (ie, age, total body surface area burn, and inhalation injury) and the outcomes of interest (ie, mortality and length of stay) vary as a function of time throughout hospitalization. DESIGN, SETTING, AND PARTICIPANTS In this retrospective study, we used the American Burn Association’s National Burn Repository, containing outcomes and patient and injury characteristics, to identify 95 579 patients admitted with an acute burn injury to 80 tertiary American Burn Association burn centers from 2000 through 2009. We applied competing risk statistical methods to analyze patient outcomes. MAIN OUTCOMES AND MEASURES We estimated the cause-specific hazard rates for death and discharge to assess how the instantaneous risk of these events changed across time. We further evaluated the varying effects of patient age, total body surface area burn, and inhalation injury on the probability of discharge and death across time. RESULTS Maximum length of stay among patients who died was 270 days and 731 days among those discharged. Total body surface area, age, and inhalation injury had significant effects on the subdistribution hazard for discharge (P < .001); these effects varied across time (P < .002). Burn size (coefficient –0.046) determined early outcomes, while age (coefficient –0.034) determined outcomes later in the hospitalization. Inhalation injury (coefficient –0.622) played a variable role in survival and hospital length of stay. CONCLUSIONS AND RELEVANCE Real-time measurement of dynamic interrelationships among burn outcome predictors using competing

  6. Marginal and Conditional Distribution Estimation from Double-Sampled Semi-Competing Risks Data

    PubMed Central

    Yu, Menggang; Yiannoutsos, Constantin T

    2015-01-01

    Informative dropout is a vexing problem for any biomedical study. Most existing statistical methods attempt to correct estimation bias related to this phenomenon by specifying unverifiable assumptions about the dropout mechanism. We consider a cohort study in Africa that uses an outreach program to ascertain the vital status for dropout subjects. These data can be used to identify a number of relevant distributions. However, as only a subset of dropout subjects were followed, vital status ascertainment was incomplete. We use semi-competing risk methods as our analysis framework to address this specific case where the terminal event is incompletely ascertained and consider various procedures for estimating the marginal distribution of dropout and the marginal and conditional distributions of survival. We also consider model selection and estimation efficiency in our setting. Performance of the proposed methods is demonstrated via simulations, asymptotic study, and analysis of the study data. PMID:26924877

  7. A Bayesian approach to joint analysis of longitudinal measurements and competing risks failure time data.

    PubMed

    Hu, Wenhua; Li, Gang; Li, Ning

    2009-05-15

    In this paper, we develop a Bayesian method for joint analysis of longitudinal measurements and competing risks failure time data. The model allows one to analyze the longitudinal outcome with nonignorable missing data induced by multiple types of events, to analyze survival data with dependent censoring for the key event, and to draw inferences on multiple endpoints simultaneously. Compared with the likelihood approach, the Bayesian method has several advantages. It is computationally more tractable for high-dimensional random effects. It is also convenient to draw inference. Moreover, it provides a means to incorporate prior information that may help to improve estimation accuracy. An illustration is given using a clinical trial data of scleroderma lung disease. The performance of our method is evaluated by simulation studies. PMID:19308919

  8. Flt3 permits survival during infection by rendering dendritic cells competent to activate NK cells.

    PubMed

    Eidenschenk, Céline; Crozat, Karine; Krebs, Philippe; Arens, Ramon; Popkin, Daniel; Arnold, Carrie N; Blasius, Amanda L; Benedict, Chris A; Moresco, Eva Marie Y; Xia, Yu; Beutler, Bruce

    2010-05-25

    A previously unappreciated signal necessary for dendritic cell (DC)-mediated activation of natural killer (NK) cells during viral infection was revealed by a recessive N-ethyl-N-nitrosourea-induced mutation called warmflash (wmfl). Wmfl homozygotes displayed increased susceptibility to mouse cytomegalovirus (MCMV) infection. In response to MCMV infection in vivo, delayed NK cell activation was observed, but no intrinsic defects in NK cell activation or function were identified. Rather, coculture experiments demonstrated that NK cells are suboptimally activated by wmfl DCs, which showed impaired cytokine production in response to MCMV or synthetic TLR7 and TLR9 ligands. The wmfl mutation was identified in the gene encoding the Fms-like tyrosine kinase 3 (Flt3). Flt3 ligand (Flt3L) is transiently induced in the serum upon infection or TLR activation. However, antibody blockade reveals no acute requirement for Flt3L, suggesting that the Flt3L --> Flt3 axis programs the development of DCs, making them competent to support NK effector function. In the absence of Flt3 signaling, NK cell activation is delayed and survival during MCMV infection is markedly compromised. PMID:20457904

  9. Flt3 permits survival during infection by rendering dendritic cells competent to activate NK cells

    PubMed Central

    Eidenschenk, Céline; Crozat, Karine; Krebs, Philippe; Arens, Ramon; Popkin, Daniel; Arnold, Carrie N.; Blasius, Amanda L.; Benedict, Chris A.; Moresco, Eva Marie Y.; Xia, Yu; Beutler, Bruce

    2010-01-01

    A previously unappreciated signal necessary for dendritic cell (DC)-mediated activation of natural killer (NK) cells during viral infection was revealed by a recessive N-ethyl-N-nitrosourea-induced mutation called warmflash (wmfl). Wmfl homozygotes displayed increased susceptibility to mouse cytomegalovirus (MCMV) infection. In response to MCMV infection in vivo, delayed NK cell activation was observed, but no intrinsic defects in NK cell activation or function were identified. Rather, coculture experiments demonstrated that NK cells are suboptimally activated by wmfl DCs, which showed impaired cytokine production in response to MCMV or synthetic TLR7 and TLR9 ligands. The wmfl mutation was identified in the gene encoding the Fms-like tyrosine kinase 3 (Flt3). Flt3 ligand (Flt3L) is transiently induced in the serum upon infection or TLR activation. However, antibody blockade reveals no acute requirement for Flt3L, suggesting that the Flt3L → Flt3 axis programs the development of DCs, making them competent to support NK effector function. In the absence of Flt3 signaling, NK cell activation is delayed and survival during MCMV infection is markedly compromised. PMID:20457904

  10. Replication competent Semliki Forest virus prolongs survival in experimental lung cancer.

    PubMed

    Määttä, Ann-Marie; Mäkinen, Kimmo; Ketola, Anna; Liimatainen, Timo; Yongabi, Felicitas Newu; Vähä-Koskela, Markus; Pirinen, Risto; Rautsi, Outi; Pellinen, Riikka; Hinkkanen, Ari; Wahlfors, Jarmo

    2008-10-01

    We evaluated the therapeutic potential of the replication competent vector VA7-EGFP, which is based on the avirulent Semliki Forest virus (SFV) strain A7 (74) carrying the EGFP marker gene in an orthotopic lung cancer tumor model in nude mice. We have previously shown that this oncolytic vector destroys tumor cells efficiently in vitro and in vivo (in subcutaneous tumor model). Tumor growth in animals with orthotopically implanted adenocarcinoma cells (A549) were monitored during the study with small animal CT. We show that locally administered virotherapy with VA7-EGFP increased survival rate in experimental lung cancer significantly (p < 0.001) comparable to results obtained with the second generation conditionally replicating adenoviral vector Ad5-Delta24TK-GFP, used for comparison. The limited efficacy in systemically administered oncolytic viruses is the essential problem in oncolytic virotherapy and also in this study we were not able to elicit significant response with systemic administration route. Despite the fact that tumor microenvironment in orthotopic lung cancer is more optimal, viruses failed to home to the tumors and were unable to initiate efficient intratumoral replication. Clearly, the efficacy of virotherapy is influenced by many factors such as the route of virus administration, immunological and physiological barriers and cancer cell-specific features (IFN-responsiveness). PMID:18651570

  11. A Method for Evaluating Competency in Assessment and Management of Suicide Risk

    ERIC Educational Resources Information Center

    Hung, Erick K.; Binder, Renee L.; Fordwood, Samantha R.; Hall, Stephen E.; Cramer, Robert J.; McNiel, Dale E.

    2012-01-01

    Objective: Although health professionals increasingly are expected to be able to assess and manage patients' risk for suicide, few methods are available to evaluate this competency. This report describes development of a competency-assessment instrument for suicide risk-assessment (CAI-S), and evaluates its use in an objective structured clinical…

  12. Taking apart the art: the risk of anatomizing clinical competence.

    PubMed

    Huddle, Thomas S; Heudebert, Gustavo R

    2007-06-01

    The Accreditation Council for Graduate Medical Education (ACGME) is encouraging medical residency programs to objectively assess their trainees for possession of six general clinical competencies by the completion of residency training. This is the thrust of the ACGME Outcome Project, now in its seventh year. As residency programs seek to integrate the general competencies into clinical training, educators have begun to suggest that objective assessment of clinical competence may be able to guide decisions about length of training and timing of subspecialization. The authors contend that higher-level competence is not amenable to assessment by the objective comparison of resident performance with learning objectives, even if such objectives are derived from general competencies. Present-day attempts at such assessment echo the uses to which medical schools hoped to put curricular learning objectives in the 1970s. Objective assessment may capture knowledge and skills that amount to the "building blocks" of competence, but it cannot elucidate or scrutinize higher-level clinical competence. Higher-level competence involves sensitivity to clinical context and can be validly appraised only in such a context by fully competent clinical appraisers. Such assessment is necessarily subjective, but it need not be unreproducible if raters are trained and if sampling of trainee performance is sufficiently extensive. If the ACGME approach to clinical competency is indeed brought to bear on decisions about training length and subspecialization timing, the present apprenticeship model for clinical training in the United States, a model both remarkably successful and directly descendant from Osler's innovations, will be under threat. PMID:17525535

  13. Media influence on risk competence in self-medication and self-treatment

    PubMed Central

    Schweim, Harald; Ullmann, Marcela

    2015-01-01

    Media play an important role in the reception of health risks; thus, media competence is important for enhancing the risk competence of patients and consumers. In addition to life-long health education, risk competence particularly requires careful handling of health information because, at present, the key problem is not the lack of sufficient information on health topics but the quality of such information. Patients and consumers of health procedures and health products also require information which relates to their daily life and matches their life style. PMID:26195923

  14. Media influence on risk competence in self-medication and self-treatment.

    PubMed

    Schweim, Harald; Ullmann, Marcela

    2015-01-01

    Media play an important role in the reception of health risks; thus, media competence is important for enhancing the risk competence of patients and consumers. In addition to life-long health education, risk competence particularly requires careful handling of health information because, at present, the key problem is not the lack of sufficient information on health topics but the quality of such information. Patients and consumers of health procedures and health products also require information which relates to their daily life and matches their life style. PMID:26195923

  15. Predicting Emotional and Social Competence during Early Childhood from Toddler Risk and Maternal Behavior

    PubMed Central

    Blandon, Alysia Y.; Calkins, Susan D.; Keane, Susan P.

    2010-01-01

    The longitudinal associations between maternal parenting behavior and toddler risk with children’s emotional and social competence were examined during the transition to kindergarten, in a sample of 253 children. Toddler risk was characterized by early externalizing behavior and poor emotion regulation skills. Given that we were interested in the multiple pathways that may result in emotional and social competence, we examined the interactions among maternal parenting behavior and toddler risk. There were some significant interactions; although the pattern of results was not consistent across all competence outcomes. Maternal parenting behavior was not directly associated with children’s emotional and social competence. In some instances, maternal control has differential implications for children’s emotional and social competence dependent upon the child’s level of early risk and maternal positive parenting. Specifically, maternal control tended to be more detrimental for children’s emotional competence during the transition to kindergarten, when children exhibit higher levels of risk. Overall, it appears that there are multiple developmental pathways, depending on child and maternal characteristics that lead to early emotional and social competence. PMID:20102651

  16. Association of breast cancer risk loci with breast cancer survival.

    PubMed

    Barrdahl, Myrto; Canzian, Federico; Lindström, Sara; Shui, Irene; Black, Amanda; Hoover, Robert N; Ziegler, Regina G; Buring, Julie E; Chanock, Stephen J; Diver, W Ryan; Gapstur, Susan M; Gaudet, Mia M; Giles, Graham G; Haiman, Christopher; Henderson, Brian E; Hankinson, Susan; Hunter, David J; Joshi, Amit D; Kraft, Peter; Lee, I-Min; Le Marchand, Loic; Milne, Roger L; Southey, Melissa C; Willett, Walter; Gunter, Marc; Panico, Salvatore; Sund, Malin; Weiderpass, Elisabete; Sánchez, María-José; Overvad, Kim; Dossus, Laure; Peeters, Petra H; Khaw, Kay-Tee; Trichopoulos, Dimitrios; Kaaks, Rudolf; Campa, Daniele

    2015-12-15

    The survival of breast cancer patients is largely influenced by tumor characteristics, such as TNM stage, tumor grade and hormone receptor status. However, there is growing evidence that inherited genetic variation might affect the disease prognosis and response to treatment. Several lines of evidence suggest that alleles influencing breast cancer risk might also be associated with breast cancer survival. We examined the associations between 35 breast cancer susceptibility loci and the disease over-all survival (OS) in 10,255 breast cancer patients from the National Cancer Institute Breast and Prostate Cancer Cohort Consortium (BPC3) of which 1,379 died, including 754 of breast cancer. We also conducted a meta-analysis of almost 35,000 patients and 5,000 deaths, combining results from BPC3 and the Breast Cancer Association Consortium (BCAC) and performed in silico analyses of SNPs with significant associations. In BPC3, the C allele of LSP1-rs3817198 was significantly associated with improved OS (HRper-allele =0.70; 95% CI: 0.58-0.85; ptrend  = 2.84 × 10(-4) ; HRheterozygotes  = 0.71; 95% CI: 0.55-0.92; HRhomozygotes  = 0.48; 95% CI: 0.31-0.76; p2DF  = 1.45 × 10(-3) ). In silico, the C allele of LSP1-rs3817198 was predicted to increase expression of the tumor suppressor cyclin-dependent kinase inhibitor 1C (CDKN1C). In the meta-analysis, TNRC9-rs3803662 was significantly associated with increased death hazard (HRMETA =1.09; 95% CI: 1.04-1.15; ptrend  = 6.6 × 10(-4) ; HRheterozygotes  = 0.96 95% CI: 0.90-1.03; HRhomozygotes  = 1.21; 95% CI: 1.09-1.35; p2DF =1.25 × 10(-4) ). In conclusion, we show that there is little overlap between the breast cancer risk single nucleotide polymorphisms (SNPs) identified so far and the SNPs associated with breast cancer prognosis, with the possible exceptions of LSP1-rs3817198 and TNRC9-rs3803662. PMID:25611573

  17. Suicide Risk Assessment Training for Psychology Doctoral Programs: Core Competencies and a Framework for Training

    PubMed Central

    Cramer, Robert J.; Johnson, Shara M.; McLaughlin, Jennifer; Rausch, Emilie M.; Conroy, Mary Alice

    2014-01-01

    Clinical and counseling psychology programs currently lack adequate evidence-based competency goals and training in suicide risk assessment. To begin to address this problem, this article proposes core competencies and an integrated training framework that can form the basis for training and research in this area. First, we evaluate the extent to which current training is effective in preparing trainees for suicide risk assessment. Within this discussion, sample and methodological issues are reviewed. Second, as an extension of these methodological training issues, we integrate empirically- and expert-derived suicide risk assessment competencies from several sources with the goal of streamlining core competencies for training purposes. Finally, a framework for suicide risk assessment training is outlined. The approach employs Objective Structured Clinical Examination (OSCE) methodology, an approach commonly utilized in medical competency training. The training modality also proposes the Suicide Competency Assessment Form (SCAF), a training tool evaluating self- and observer-ratings of trainee core competencies. The training framework and SCAF are ripe for empirical evaluation and potential training implementation. PMID:24672588

  18. Estimating and comparing time-dependent areas under receiver operating characteristic curves for censored event times with competing risks.

    PubMed

    Blanche, Paul; Dartigues, Jean-François; Jacqmin-Gadda, Hélène

    2013-12-30

    The area under the time-dependent ROC curve (AUC) may be used to quantify the ability of a marker to predict the onset of a clinical outcome in the future. For survival analysis with competing risks, two alternative definitions of the specificity may be proposed depending of the way to deal with subjects who undergo the competing events. In this work, we propose nonparametric inverse probability of censoring weighting estimators of the AUC corresponding to these two definitions, and we study their asymptotic properties. We derive confidence intervals and test statistics for the equality of the AUCs obtained with two markers measured on the same subjects. A simulation study is performed to investigate the finite sample behaviour of the test and the confidence intervals. The method is applied to the French cohort PAQUID to compare the abilities of two psychometric tests to predict dementia onset in the elderly accounting for death without dementia competing risk. The 'timeROC' R package is provided to make the methodology easily usable. PMID:24027076

  19. Elderly Peritoneal Dialysis Compared with Elderly Hemodialysis Patients and Younger Peritoneal Dialysis Patients: Competing Risk Analysis of a Korean Prospective Cohort Study

    PubMed Central

    Kim, Hyunsuk; An, Jung Nam; Kim, Dong Ki; Kim, Myoung-Hee; Kim, Ho; Kim, Yong-Lim; Park, Ki Soo; Oh, Yun Kyu; Lim, Chun Soo; Kim, Yon Su; Lee, Jung Pyo

    2015-01-01

    The outcomes of peritoneal dialysis (PD) in elderly patients have not been thoroughly investigated. We aimed to investigate the clinical outcomes and risk factors associated with PD in elderly patients. We conducted a prospective observational nationwide adult end-stage renal disease (ESRD) cohort study in Korea from August 2008 to March 2013. Among incident patients (n = 830), patient and technical survival rate, quality of life, and Beck’s Depression Inventory (BDI) scores of elderly PD patients (≥65 years, n = 95) were compared with those of PD patients aged ≤49 years (n = 205) and 50~64 years (n = 192); and elderly hemodialysis (HD) patients (n = 315). The patient death and technical failure were analyzed by cumulative incidence function. Competing risk regressions were used to assess the risk factors for survival. The patient survival rate of elderly PD patients was inferior to that of younger PD patients (P<0.001). However, the technical survival rate was similar (P = 0.097). Compared with elderly HD patients, the patient survival rate did not differ according to dialysis modality (P = 0.987). Elderly PD patients showed significant improvement in the BDI scores, as compared with the PD patients aged ≤49 years (P = 0.003). Low albumin, diabetes and low residual renal function were significant risk factors for the PD patient survival; and peritonitis was a significant risk factor for technical survival. Furthermore, low albumin and hospitalization were significant risk factors of patient survival among the elderly. The overall outcomes were similar between elderly PD and HD patients. PD showed the benefit in BDI and quality of life in the elderly. Additionally, the technical survival rate of elderly PD patients was similar to that of younger PD patients. Taken together, PD may be a comparable modality for elderly ESRD patients. PMID:26121574

  20. Elderly Peritoneal Dialysis Compared with Elderly Hemodialysis Patients and Younger Peritoneal Dialysis Patients: Competing Risk Analysis of a Korean Prospective Cohort Study.

    PubMed

    Kim, Hyunsuk; An, Jung Nam; Kim, Dong Ki; Kim, Myoung-Hee; Kim, Ho; Kim, Yong-Lim; Park, Ki Soo; Oh, Yun Kyu; Lim, Chun Soo; Kim, Yon Su; Lee, Jung Pyo

    2015-01-01

    The outcomes of peritoneal dialysis (PD) in elderly patients have not been thoroughly investigated. We aimed to investigate the clinical outcomes and risk factors associated with PD in elderly patients. We conducted a prospective observational nationwide adult end-stage renal disease (ESRD) cohort study in Korea from August 2008 to March 2013. Among incident patients (n = 830), patient and technical survival rate, quality of life, and Beck's Depression Inventory (BDI) scores of elderly PD patients (≥65 years, n = 95) were compared with those of PD patients aged ≤49 years (n = 205) and 50~64 years (n = 192); and elderly hemodialysis (HD) patients (n = 315). The patient death and technical failure were analyzed by cumulative incidence function. Competing risk regressions were used to assess the risk factors for survival. The patient survival rate of elderly PD patients was inferior to that of younger PD patients (P<0.001). However, the technical survival rate was similar (P = 0.097). Compared with elderly HD patients, the patient survival rate did not differ according to dialysis modality (P = 0.987). Elderly PD patients showed significant improvement in the BDI scores, as compared with the PD patients aged ≤49 years (P = 0.003). Low albumin, diabetes and low residual renal function were significant risk factors for the PD patient survival; and peritonitis was a significant risk factor for technical survival. Furthermore, low albumin and hospitalization were significant risk factors of patient survival among the elderly. The overall outcomes were similar between elderly PD and HD patients. PD showed the benefit in BDI and quality of life in the elderly. Additionally, the technical survival rate of elderly PD patients was similar to that of younger PD patients. Taken together, PD may be a comparable modality for elderly ESRD patients. PMID:26121574

  1. Mortality and socio-economic differences in Denmark: a competing risks proportional hazard model.

    PubMed

    Munch, Jakob Roland; Svarer, Michael

    2005-03-01

    This paper explores how mortality is related to such socio-economic factors as education, occupation, skill level and income for the years 1992-1997 using an extensive sample of the Danish population. We employ a competing risks proportional hazard model to allow for different causes of death. This method is important as some factors have unequal (and sometimes opposite) influence on the cause-specific mortality rates. We find that the often-found inverse correlation between socio-economic status and mortality is to a large degree absent among Danish women who die of cancer. In addition, for men the negative correlation between socio-economic status and mortality prevails for some diseases, but for women we find that factors such as being married, income, wealth and education are not significantly associated with higher life expectancy. Marriage increases the likelihood of dying from cancer for women, early retirement prolongs survival for men, and homeownership increases life expectancy in general. PMID:15722260

  2. Core Competencies and the Prevention of High-Risk Sexual Behavior

    ERIC Educational Resources Information Center

    Charles, Vignetta Eugenia; Blum, Robert Wm.

    2008-01-01

    Adolescent sexual risk-taking behavior has numerous individual, family, community, and societal consequences. In an effort to contribute to the research and propose new directions, this chapter applies the core competencies framework to the prevention of high-risk sexual behavior. It describes the magnitude of the problem, summarizes explanatory…

  3. Students "At-Risk" Policy: Competing Social and Economic Discourses

    ERIC Educational Resources Information Center

    Mosen-Lowe, Linda Audrey Joy; Vidovich, Lesley; Chapman, Anne

    2009-01-01

    Within a context of global reform agendas that promote economic ideologies in education the discourses surrounding "school failure" have shifted from "individual risk" to "a nation at-risk". Enhancing the quality of schooling through improving educational outcomes and standards for all, and thereby reducing "school failure," is simultaneously…

  4. Self-criticism of physicians, patient participation and risk competence

    PubMed Central

    Wolffsohn, Michael

    2015-01-01

    Self-criticism of physicians and patient participation are the pillars of modern medical ethics and medical programmes. Patients expect risk minimisation from physicians, mostly without realising how much they could actively do themselves in this respect. But what about the willingness of German people to take risks, how high is it really at present? Direct empirical data are not available, but results from general empirical research show that people’s willingness to take risks is probably rather low. Post-heroic societies of welfare states are less likely to take risks than supposedly heroic ones. Therefore, the question whether it is responsible for medical experts to transfer even more responsibility to non-medical laypeople becomes increasingly important in a social context. PMID:26195919

  5. Survival of high-risk pediatric neuroblastoma patients in a developing country.

    PubMed

    Easton, Joseph C; Gomez, Sergio; Asdahl, Peter H; Conner, J Michael; Fynn, Alcira B; Ruiz, Claudia; Ojha, Rohit P

    2016-09-01

    Little information is available about survival of high-risk pediatric neuroblastoma patients in developing countries. We aimed to assess survival among high-risk pediatric neuroblastoma patients in La Plata, Argentina. Individuals eligible for our cohort were aged <20 yr when diagnosed with high-risk neuroblastoma and received cancer-directed therapy including stem cell transplantation at Hospital de Niños Sor Maria Ludovica between February 1999 and February 2015. We estimated overall survival probabilities using an extended Kaplan-Meier approach. Our study population comprised 39 high-risk neuroblastoma patients, of whom 39% were aged >4 yr at diagnosis, 54% were male, and 62% had adrenal neuroblastoma. We observed 18 deaths, and the median survival time of our study population was 1.7 yr. The five-yr overall survival probability was 24% (95% CL: 10%, 41%). In contrast, five-yr survival of high-risk neuroblastoma patients ranges between 23% and 76% in developed countries. Survival among high-risk neuroblastoma patients is generally poor regardless of geographic location, but our results illustrate dramatically worse survival for patients in a developing country. We speculate that the observed survival differences could be attenuated or eliminated with improvements in treatment and supportive care, but addressing these issues will require creative solutions because of resource limitations. PMID:27235336

  6. Are women as likely to take risks and compete? Behavioural findings from central Vietnam.

    PubMed

    Fletschner, Diana; Anderson, C Leigh; Cullen, Alison

    2010-01-01

    Using controlled experiments to compare the risk attitude and willingness to compete of husbands and wives in 500 couples in rural Vietnam, we find that women are more risk averse than men and that, compared to men, women are less likely to choose to compete, irrespective of how likely they are to succeed. Relevant to development programmes concerned with lifting women out of poverty, our findings suggest that women may be more reluctant to adopt new technologies, take out loans, or engage in economic activities that offer higher expected returns, in order to avoid setups that require them to be more competitive or that have less predictable outcomes. PMID:21125722

  7. Reversible Disassembly of the Actin Cytoskeleton Improves the Survival Rate and Developmental Competence of Cryopreserved Mouse Oocytes

    PubMed Central

    Hosu, Basarab G.; Mullen, Steven F.; Critser, John K.; Forgacs, Gabor

    2008-01-01

    Effective cryopreservation of oocytes is critically needed in many areas of human reproductive medicine and basic science, such as stem cell research. Currently, oocyte cryopreservation has a low success rate. The goal of this study was to understand the mechanisms associated with oocyte cryopreservation through biophysical means using a mouse model. Specifically, we experimentally investigated the biomechanical properties of the ooplasm prior and after cryopreservation as well as the consequences of reversible dismantling of the F-actin network in mouse oocytes prior to freezing. The study was complemented with the evaluation of post-thaw developmental competence of oocytes after in vitro fertilization. Our results show that the freezing-thawing process markedly alters the physiological viscoelastic properties of the actin cytoskeleton. The reversible depolymerization of the F-actin network prior to freezing preserves normal ooplasm viscoelastic properties, results in high post-thaw survival and significantly improves developmental competence. These findings provide new information on the biophysical characteristics of mammalian oocytes, identify a pathophysiological mechanism underlying cryodamage and suggest a novel cryopreservation method. PMID:18665248

  8. Contextual risk and parenting as predictors of effortful control and social competence in preschool children

    PubMed Central

    Lengua, Liliana J.; Honorado, Elizabeth; Bush, Nicole R.

    2011-01-01

    Using a short-term longitudinal design (6 months), this study examined cumulative contextual risk as a predictor of effortful control (EC) and social competence in a community sample of children (N = 80, ages 33–40 months at time 1). Maternal parenting was examined as a mediator of contextual risk. EC was assessed using laboratory tasks, and parenting was assessed using observational ratings. Time 1 contextual risk was negatively related to time 2 EC after controlling for time 1 EC. Mothers’ limit setting and scaffolding predicted higher time 2 EC and accounted for the effect of contextual risk. Time 1 EC, contextual risk, and parenting predicted time 2 social competence, and contextual risk had an indirect effect on social competence through parenting. Results suggest that contextual risk predicts smaller relative increases in EC and that parenting accounts for this effect. Knowledge of the factors that divert or promote effortful control can provide targets for intervention to enhance effortful control abilities and better adjustment. PMID:21687825

  9. Contextual risk and parenting as predictors of effortful control and social competence in preschool children.

    PubMed

    Lengua, Liliana J; Honorado, Elizabeth; Bush, Nicole R

    2007-01-01

    Using a short-term longitudinal design (6 months), this study examined cumulative contextual risk as a predictor of effortful control (EC) and social competence in a community sample of children (N = 80, ages 33-40 months at time 1). Maternal parenting was examined as a mediator of contextual risk. EC was assessed using laboratory tasks, and parenting was assessed using observational ratings. Time 1 contextual risk was negatively related to time 2 EC after controlling for time 1 EC. Mothers' limit setting and scaffolding predicted higher time 2 EC and accounted for the effect of contextual risk. Time 1 EC, contextual risk, and parenting predicted time 2 social competence, and contextual risk had an indirect effect on social competence through parenting. Results suggest that contextual risk predicts smaller relative increases in EC and that parenting accounts for this effect. Knowledge of the factors that divert or promote effortful control can provide targets for intervention to enhance effortful control abilities and better adjustment. PMID:21687825

  10. Parametric mixture models to evaluate and summarize hazard ratios in the presence of competing risks with time-dependent hazards and delayed entry

    PubMed Central

    Lau, Bryan; Cole, Stephen R.; Gange, Stephen J.

    2010-01-01

    In the analysis of survival data, there are often competing events that preclude an event of interest from occurring. Regression analysis with competing risks is typically undertaken using a cause-specific proportional hazards model. However, modern alternative methods exist for the analysis of the subdistribution hazard with a corresponding subdistribution proportional hazards model. In this paper, we introduce a flexible parametric mixture model as a unifying method to obtain estimates of the cause-specific and subdistribution hazards and hazard ratio functions. We describe how these estimates can be summarized over time to give a single number that is comparable to the hazard ratio that is obtained from a corresponding cause-specific or subdistribution proportional hazards model. An application to the Women’s Interagency HIV Study is provided to investigate injection drug use and the time to either the initiation of effective antiretroviral therapy, or clinical disease progression as a competing event. PMID:21337360

  11. Rapid Risk-Based Evaluation of Competing Conceptual Designs

    SciTech Connect

    Bott, T.F.; Butner, J.M.

    1999-08-22

    In this paper, the authors have shown how a qualitative analysis can provide good input to a risk reduction design problem. Traditionally qualitative analyses such as the FMEA can be supplemented by qualitative fault trees and event trees to produce logic models of the accident sequences for the different design options. These models can be compared using rule-based manipulations of qualitative branch point probabilities. A qualitative evaluation of other considerations such as collateral safety effects, operational impacts and worker-safety impacts can provide a more complete picture of the trade-off between options. The authors believe that their risk-reduction analysis approach that combines logic models with qualitative and possibility metrics provides an excellent tool for incorporating safety concerns rapidly and effectively into a conceptual design evaluation.

  12. A competing risks approach for time estimation of household WEEE disposal.

    PubMed

    Gutiérrez, E; Adenso-Díaz, B; Lozano, S; González-Torre, P

    2010-01-01

    The recent growth in the number of electrical and electronic devices is viewed as one the priority waste streams in European Union waste management policy. This paper presents the findings of a survey to study domestic habits with respect to Waste Electrical and Electronic Equipment (WEEE) in Spain. A specific problem when performing this estimation arises from the fact that consumers quite often store old appliances at home when they are no longer used. Focusing on four different types of appliance, survival analysis (SA) is used to study both the usage span and the reasons for no longer using each device. The time that the discarded products were kept at home before being disposed of was studied using competing risks (CR) analysis. The results of the analysis provide information on the distribution of the studied variables for the different outcomes as well as the influence exerted by the socio-demographic variables considered. Relations between these characteristics and the storage time of the appliances before disposal emerge based on survey data. For instance, the CR model finds that the storage time of the some appliances (i.e. refrigerator) is related to these social-demographics factors. However, other appliances (i.e. microwave oven) are less influenced by these factors. The attitude and motivation of the respondents to the survey as regards the End-of-Life of appliances were also analysed. A majority of respondents do not store discarded appliances at home. The first reason for storing appliances at home is the possibility of it being useful in the future and the second that the respondents did not know what to do with them. PMID:20231083

  13. A competing risks approach for time estimation of household WEEE disposal

    SciTech Connect

    Gutierrez, E.; Adenso-Diaz, B.; Lozano, S.; Gonzalez-Torre, P.

    2010-08-15

    The recent growth in the number of electrical and electronic devices is viewed as one the priority waste streams in European Union waste management policy. This paper presents the findings of a survey to study domestic habits with respect to Waste Electrical and Electronic Equipment (WEEE) in Spain. A specific problem when performing this estimation arises from the fact that consumers quite often store old appliances at home when they are no longer used. Focusing on four different types of appliance, survival analysis (SA) is used to study both the usage span and the reasons for no longer using each device. The time that the discarded products were kept at home before being disposed of was studied using competing risks (CR) analysis. The results of the analysis provide information on the distribution of the studied variables for the different outcomes as well as the influence exerted by the socio-demographic variables considered. Relations between these characteristics and the storage time of the appliances before disposal emerge based on survey data. For instance, the CR model finds that the storage time of the some appliances (i.e. refrigerator) is related to these social-demographics factors. However, other appliances (i.e. microwave oven) are less influenced by these factors. The attitude and motivation of the respondents to the survey as regards the End-of-Life of appliances were also analysed. A majority of respondents do not store discarded appliances at home. The first reason for storing appliances at home is the possibility of it being useful in the future and the second that the respondents did not know what to do with them.

  14. Social Competence of Students with Learning Disabilities Using a Risk-Resilience Model

    ERIC Educational Resources Information Center

    Benowitz, Alison Joy

    2010-01-01

    Children with learning disabilities (LD) makeup 50.5% of all children identified for special services in the schools. Research has found that children with LD have difficulties in areas of functioning related to social competence. This study is based on a risk and resilience model to explore external protective factors (friendships and social…

  15. Later Competence and Adaptation in Infants Who Survive Severe Heart Defects.

    ERIC Educational Resources Information Center

    O'Dougherty, Margaret; And Others

    1983-01-01

    Describes a model of risk potential for developmental outcome that was based on cardiac, medical, surgical, and family stress factors in 31 children with transposition of the great arteries. All children had undergone reparative open heart surgery utilizing cardiopulmonary bypass during infancy. (Author/RH)

  16. Competing with giants. Survival strategies for local companies in emerging markets.

    PubMed

    Dawar, N; Frost, T

    1999-01-01

    The arrival of a multinational corporation often looks like a death sentence to local companies in an emerging market. After all, how can they compete in the face of the vast financial and technological resources, the seasoned management, and the powerful brands of, say, a Compaq or a Johnson & Johnson? But local companies often have more options than they might think, say the authors. Those options vary, depending on the strength of globalization pressures in an industry and the nature of a company's competitive assets. In the worst case, when globalization pressures are strong and a company has no competitive assets that it can transfer to other countries, it needs to retreat to a locally oriented link within the value chain. But if globalization pressures are weak, the company may be able to defend its market share by leveraging the advantages it enjoys in its home market. Many companies in emerging markets have assets that can work well in other countries. Those that operate in industries where the pressures to globalize are weak may be able to extend their success to a limited number of other markets that are similar to their home base. And those operating in global markets may be able to contend head-on with multinational rivals. By better understanding the relationship between their company's assets and the industry they operate in, executives from emerging markets can gain a clearer picture of the options they really have when multinationals come to stay. PMID:10387768

  17. Evidence-based health information and risk competence

    PubMed Central

    Mühlhauser, Ingrid; Albrecht, Martina; Steckelberg, Anke

    2015-01-01

    Consumers and patients want to be included in decisions regarding their own health and have an ethically justified claim on informed decisions. Therefore, sound information is required, but health information is often misleading and based on different interests. The risks of disease and the benefits of medical interventions tend to be overestimated, whereas harm is often underestimated. Evidence-based health information has to fulfil certain criteria, for instance, it should be evidence-based, independent, complete, true as well as understandable. The aim of a medical intervention has to be explained. The different therapeutic options including the option not to intervene have to be delineated. The probabilities for success, lack of success and unwanted side effects have to be communicated in a numerical and understandable manner. Patients have the right to reject medical interventions without any sanctions. PMID:26195924

  18. A Novel Risk Score to the Prediction of 10-year Risk for Coronary Artery Disease Among the Elderly in Beijing Based on Competing Risk Model

    PubMed Central

    Liu, Long; Tang, Zhe; Li, Xia; Luo, Yanxia; Guo, Jin; Li, Haibin; Liu, Xiangtong; Tao, Lixin; Yan, Aoshuang; Guo, Xiuhua

    2016-01-01

    Abstract The study aimed to construct a risk prediction model for coronary artery disease (CAD) based on competing risk model among the elderly in Beijing and develop a user-friendly CAD risk score tool. We used competing risk model to evaluate the risk of developing a first CAD event. On the basis of the risk factors that were included in the competing risk model, we constructed the CAD risk prediction model with Cox proportional hazard model. Time-dependent receiver operating characteristic (ROC) curve and time-dependent area under the ROC curve (AUC) were used to evaluate the discrimination ability of the both methods. Calibration plots were applied to assess the calibration ability and adjusted for the competing risk of non-CAD death. Net reclassification index (NRI) and integrated discrimination improvement (IDI) were applied to quantify the improvement contributed by the new risk factors. Internal validation of predictive accuracy was performed using 1000 times of bootstrap re-sampling. Of the 1775 participants without CAD at baseline, 473 incident cases of CAD were documented for a 20-year follow-up. Time-dependent AUCs for men and women at t = 10 years were 0.841 [95% confidence interval (95% CI): 0.806–0.877], 0.804 (95% CI: 0.768–0.839) in Fine and Gray model, 0.784 (95% CI: 0.738–0.830), 0.733 (95% CI: 0.692–0.775) in Cox proportional hazard model. The competing risk model was significantly superior to Cox proportional hazard model on discrimination and calibration. The cut-off values of the risk score that marked the difference between low-risk and high-risk patients were 34 points for men and 30 points for women, which have good sensitivity and specificity. A sex-specific multivariable risk factor algorithm-based competing risk model has been developed on the basis of an elderly Chinese cohort, which could be applied to predict an individual's risk and provide a useful guide to identify the groups at a high risk for CAD among the Chinese

  19. Intelligence quotient discrepancy indicates levels of motor competence in preschool children at risk for developmental delays

    PubMed Central

    Yu, Tzu-Ying; Chen, Kuan-Lin; Chou, Willy; Yang, Shu-Han; Kung, Sheng-Chun; Lee, Ya-Chen; Tung, Li-Chen

    2016-01-01

    Purpose This study aimed to establish 1) whether a group difference exists in the motor competence of preschool children at risk for developmental delays with intelligence quotient discrepancy (IQD; refers to difference between verbal intelligence quotient [VIQ] and performance intelligence quotient [PIQ]) and 2) whether an association exists between IQD and motor competence. Methods Children’s motor competence and IQD were determined with the motor subtests of the Comprehensive Developmental Inventory for Infants and Toddlers and Wechsler Preschool and Primary Scale of Intelligence™ – Fourth Edition. A total of 291 children were included in three groups: NON-IQD (n=213; IQD within 1 standard deviation [SD]), VIQ>PIQ (n=39; VIQ>PIQ greater than 1 SD), and PIQ>VIQ (n=39; PIQ>VIQ greater than 1 SD). Results The results of one-way analysis of variance indicated significant differences among the subgroups for the “Gross and fine motor” subdomains of the Comprehensive Developmental Inventory for Infants and Toddlers, especially on the subtests of “body-movement coordination” (F=3.87, P<0.05) and “visual-motor coordination” (F=6.90, P<0.05). Motor competence was significantly worse in the VIQ>PIQ group than in the NON and PIQ>VIQ groups. Significant negative correlations between IQD and most of the motor subtests (r=0.31–0.46, P<0.01) were found only in the VIQ>PIQ group. Conclusion This study demonstrates that 1) IQD indicates the level of motor competence in preschoolers at risk for developmental delays and 2) IQD is negatively associated with motor competence in preschoolers with significant VIQ>PIQ discrepancy. The first finding was that preschoolers with VIQ>PIQ discrepancy greater than 1 SD performed significantly worse on motor competence than did preschoolers without significant IQD and preschoolers with PIQ>VIQ discrepancy greater than 1 SD. However, preschoolers with significant PIQ>VIQ discrepancy performed better on motor competence than

  20. Linking habitat selection and predation risk to spatial variation in survival

    PubMed Central

    DeCesare, Nicholas J; Hebblewhite, Mark; Bradley, Mark; Hervieux, David; Neufeld, Lalenia; Musiani, Marco; Mysterud, Atle

    2014-01-01

    1. A central assumption underlying the study of habitat selection is that selected habitats confer enhanced fitness. Unfortunately, this assumption is rarely tested, and in some systems, gradients of predation risk may more accurately characterize spatial variation in vital rates than gradients described by habitat selection studies. 2. Here, we separately measured spatial patterns of both resource selection and predation risk and tested their relationships with a key demographic trait, adult female survival, for a threatened ungulate, woodland caribou (Rangifer tarandus caribou Gmelin). We also evaluated whether exposure to gradients in both predation risk and resource selection value was manifested temporally through instantaneous or seasonal effects on survival outcomes. 3. We used Cox proportional hazards spatial survival modelling to assess the relative support for 5 selection- and risk-based definitions of habitat quality, as quantified by woodland caribou adult female survival. These hypotheses included scenarios in which selection ideally mirrored survival, risk entirely drove survival, non-ideal selection correlated with survival but with additive risk effects, an ecological trap with maladaptive selection and a non-spatial effect of annual variation in weather. 4. Indeed, we found positive relationships between the predicted values of a resource selection function (RSF) and survival, yet subsequently incorporating an additional negative effect of predation risk greatly improved models further. This revealed a positive, but non-ideal relationship between selection and survival. Gradients in these covariates were also shown to affect individual survival probability at multiple temporal scales. Exposure to increased predation risk had a relatively instantaneous effect on survival outcomes, whereas variation in habitat suitability predicted by an RSF had both instantaneous and longer-term seasonal effects on survival. 5. Predation risk was an additive source

  1. [Assessment of risk of burden in construction: improvement interventions and contribution of the competent physician].

    PubMed

    Martinelli, R; Tarquini, M

    2012-01-01

    Three construction companies in three years have changed the operating modes, making use of innovative carpentry, with little amount of equipment, improved usability of the site, reduced cleaning time, less manual handling and reduced risk of accidents. The Competent Doctor has participated in the review of the risk assessment of manual handling: data has been acquired on musculoskeletal disorders to compare, in terms of this innovation, the average trend and changes, with encouraging results in terms of incidence of musculoskeletal disorders, absenteeism due to illness by these causes, new cases of lumbar diseases. It remains difficult in building to assess manual handling risk, but the collaboration between the Employer, Prevention and Protection Service and Competent Doctor, thanks to the greater attention that the design subject to these issues, suggests improvements and further steps to extend to all phases of operation of building. PMID:23405597

  2. Partial logistic artificial neural network for competing risks regularized with automatic relevance determination.

    PubMed

    Lisboa, Paulo J G; Etchells, Terence A; Jarman, Ian H; Arsene, Corneliu T C; Aung, M S Hane; Eleuteri, Antonio; Taktak, Azzam F G; Ambrogi, Federico; Boracchi, Patrizia; Biganzoli, Elia

    2009-09-01

    Time-to-event analysis is important in a wide range of applications from clinical prognosis to risk modeling for credit scoring and insurance. In risk modeling, it is sometimes required to make a simultaneous assessment of the hazard arising from two or more mutually exclusive factors. This paper applies to an existing neural network model for competing risks (PLANNCR), a Bayesian regularization with the standard approximation of the evidence to implement automatic relevance determination (PLANNCR-ARD). The theoretical framework for the model is described and its application is illustrated with reference to local and distal recurrence of breast cancer, using the data set of Veronesi (1995). PMID:19628458

  3. The Geriatric Nutritional Risk Index Predicts Survival in Elderly Esophageal Squamous Cell Carcinoma Patients with Radiotherapy

    PubMed Central

    Wang, Kunlun; Liu, Yang; You, Jie; Cui, Han; Zhu, Yiwei; Yuan, Ling

    2016-01-01

    The impact of nutritional status on survival among elderly esophageal squamous cell carcinoma (ESCC) patients undergoing radiotherapy is unclear. In this study, we aimed at validating the performance of the geriatric nutritional risk index (GNRI) in predicting overall survival time in elderly ESCC patients with radiotherapy. A retrospective cohort study was conducted on 239 ESCC patients aged 60 and over admitted consecutively from January 2008 to November 2014 in the Department of Radiotherapy, Henan Tumor Hospital (Affiliated Tumor Hospital of Zhengzhou University), Zhengzhou, Henan, China. All patients were subjected to nutritional screening using GNRI, and were followed for the occurrence of lymphatic node metastasis, radiation complication and mortality. The Kaplan–Meier method with Log-rank test was used to estimate survival curves. Univariable Cox regression analysis was used to identify variables associated with overall survival time. Among the 239 patients, 184 patients (76.9%) took no nutritional risk, 32 patients (13.4%) took moderate risk of malnutrition, and 23 patients (9.7%) took a high risk of malnutrition. Univariable Cox regression showed that both high nutritional risk group and moderate nutritional risk group were significantly less likely to survive than no nutritional risk patients (hazard ratio (HR) = 1.688, 95% confidence interval (CI) = 1.019–2.798 for moderate risk group, and HR = 2.699, 95% CI = 1.512–4.819 for high risk group, respectively). The GNRI is an independent prognostic factor for overall survival time in elderly ESCC patients with radiotherapy. A GNRI ≤98 can be suggested as an indicator of surviving less. PMID:27196126

  4. Association between variants in inflammation and cancer-associated genes and risk and survival of cholangiocarcinoma.

    PubMed

    Chaiteerakij, Roongruedee; Juran, Brian D; Aboelsoud, Mohammed M; Harmsen, William S; Moser, Catherine D; Giama, Nasra H; Allotey, Loretta K; Mettler, Teresa A; Baichoo, Esha; Zhang, Xiaodan; Therneau, Terry M; Lazaridis, Konstantinos N; Roberts, Lewis R

    2015-10-01

    Genetic risk factors for cholangiocarcinoma (CCA) remain poorly understood. We assessed the effect of single-nucleotide polymorphisms (SNPs) of genes modulating inflammation or carcinogenesis on CCA risk and survival. We conducted a case-control, candidate gene association study of 370 CCA patients and 740 age-, sex-, and residential area-matched healthy controls. Eighteen functional or putatively functional SNPs in nine genes were genotyped. The log-additive genotype effects of SNPs on CCA risk and survival were determined using logistic regression and the log-rank test, respectively. Initial analysis identified significant associations between SNP rs2143417 and rs689466 in cyclooxygenase 2 (COX-2) and CCA risk, after adjusting for multiple comparisons (cutoff of P = 0.0028). However, these findings were not replicated in another independent cohort of 212 CCA cases and 424 matched controls. No significant association was found between any SNP and survival of CCA patients. Although COX-2 has been shown to contribute to cholangiocarcinogenesis, the COX-2 SNPs tested were not associated with risk of CCA. This study shows a lack of association between variants of genes related to inflammation and carcinogenesis and CCA risk and survival. Other factors than these genetic variants may play more important roles in CCA risk and survival. PMID:26276523

  5. Association between variants in inflammation and cancer-associated genes and risk and survival of cholangiocarcinoma

    PubMed Central

    Chaiteerakij, Roongruedee; Juran, Brian D; Aboelsoud, Mohammed M; Harmsen, William S; Moser, Catherine D; Giama, Nasra H; Allotey, Loretta K; Mettler, Teresa A; Baichoo, Esha; Zhang, Xiaodan; Therneau, Terry M; Lazaridis, Konstantinos N; Roberts, Lewis R

    2015-01-01

    Genetic risk factors for cholangiocarcinoma (CCA) remain poorly understood. We assessed the effect of single-nucleotide polymorphisms (SNPs) of genes modulating inflammation or carcinogenesis on CCA risk and survival. We conducted a case-control, candidate gene association study of 370 CCA patients and 740 age-, sex-, and residential area-matched healthy controls. Eighteen functional or putatively functional SNPs in nine genes were genotyped. The log-additive genotype effects of SNPs on CCA risk and survival were determined using logistic regression and the log-rank test, respectively. Initial analysis identified significant associations between SNP rs2143417 and rs689466 in cyclooxygenase 2 (COX-2) and CCA risk, after adjusting for multiple comparisons (cutoff of P = 0.0028). However, these findings were not replicated in another independent cohort of 212 CCA cases and 424 matched controls. No significant association was found between any SNP and survival of CCA patients. Although COX-2 has been shown to contribute to cholangiocarcinogenesis, the COX-2 SNPs tested were not associated with risk of CCA. This study shows a lack of association between variants of genes related to inflammation and carcinogenesis and CCA risk and survival. Other factors than these genetic variants may play more important roles in CCA risk and survival. PMID:26276523

  6. Survival risk assessment for primary blast exposures to the head.

    PubMed

    Rafaels, Karin; Bass, Cameron R Dale; Salzar, Robert S; Panzer, Matthew B; Woods, William; Feldman, Sanford; Cummings, Thomas; Capehart, Bruce

    2011-11-01

    Many soldiers returning from the current conflicts in Iraq and Afghanistan have had at least one exposure to an explosive event and a significant number have symptoms consistent with traumatic brain injury. Although blast injury risk functions have been determined and validated for pulmonary injury, there is little information on the blast levels necessary to cause blast brain injury. Anesthetized male New Zealand White rabbits were exposed to varying levels of shock tube blast exposure focused on the head, while their thoraces were protected. The specimens were euthanized and evaluated when the blast resulted in respiratory arrest that was non-responsive to resuscitation or at 4?h post-exposure. Injury was evaluated by gross examination and histological evaluation. The fatality data from brain injury were then analyzed using Fisher's exact test to determine a brain fatality risk function. Greater blast intensity was associated with post-blast apnea and the need for mechanical ventilation. Gross examination revealed multifocal subdural hemorrhages, most often near the brainstem, at more intense levels of exposure. Histological evaluation revealed subdural and subarachnoid hemorrhages in the non-responsive respiratory-arrested specimens. A fatality risk function from blast exposure to the head was determined for the rabbit specimens with an LD(50) at a peak overpressure of 750?kPa. Scaling techniques were used to predict injury risk at other blast overpressure/duration combinations. The fatality risk function showed that the blast level needed to cause fatality from an overpressure wave exposure to the head was greater than the peak overpressure needed to cause fatality from pulmonary injury. This risk function can be used to guide future research for blast brain injury by providing a realistic fatality risk to guide the design of protection or to evaluate injury. PMID:21463161

  7. Azithromycin (AZM) treatment increases survival of high risk corneal allotransplants

    PubMed Central

    Medina, Carlos A.; Rowe, Alexander M.; Yun, Hongmin; Knickelbein, Jared E.; Lathrop, Kira L.; Hendricks, Robert L.

    2012-01-01

    Purpose To test the therapeutic efficacy of AZM, a macrolide antibiotic for prolonging murine “high risk” corneal allograft survival. Methods Fully MHC mismatched corneas were transplanted from C57BL/6 donors to BALB/c recipients with suture-induced vascularized “high risk” corneal beds. Recipient mice were either not treated or treated with topical AZM, oral AZM, or both. Evaluation of graft vascularization and clarity was performed in masked fashion. Lymph nodes were excised and analyzed for CD4, FoxP3, and CD44 by flow cytometry; and for T cell priming by proliferation and cytokine production in mixed lymphocyte cultures. Corneal whole mounts were evaluated by confocal microscopy. Results The incidence of graft rejection in the control group (81.8%) was significantly reduced by AZM treatment (18.2% topical, 21.7% oral, 33.3% topical + oral), although corneal vascularization was not affected by treatment. The frequency of corneas that retained complete clarity following transplantation was higher in the AZM treated groups. Reduced graft rejection in the AZM treated groups was not associated with a reduced allospecific T cell response or increased frequency of T regulatory cells. Conclusions AZM is effective in prolonging survival of “high risk” corneal allografts by an as yet undefined mechanism that does not appear to involve modulation of corneal neovascularization or allo-specific T cell priming. PMID:23407315

  8. Covariate adjustment of cumulative incidence functions for competing risks data using inverse probability of treatment weighting.

    PubMed

    Neumann, Anke; Billionnet, Cécile

    2016-06-01

    In observational studies without random assignment of the treatment, the unadjusted comparison between treatment groups may be misleading due to confounding. One method to adjust for measured confounders is inverse probability of treatment weighting. This method can also be used in the analysis of time to event data with competing risks. Competing risks arise if for some individuals the event of interest is precluded by a different type of event occurring before, or if only the earliest of several times to event, corresponding to different event types, is observed or is of interest. In the presence of competing risks, time to event data are often characterized by cumulative incidence functions, one for each event type of interest. We describe the use of inverse probability of treatment weighting to create adjusted cumulative incidence functions. This method is equivalent to direct standardization when the weight model is saturated. No assumptions about the form of the cumulative incidence functions are required. The method allows studying associations between treatment and the different types of event under study, while focusing on the earliest event only. We present a SAS macro implementing this method and we provide a worked example. PMID:27084321

  9. Variable selection in subdistribution hazard frailty models with competing risks data

    PubMed Central

    Do Ha, Il; Lee, Minjung; Oh, Seungyoung; Jeong, Jong-Hyeon; Sylvester, Richard; Lee, Youngjo

    2014-01-01

    The proportional subdistribution hazards model (i.e. Fine-Gray model) has been widely used for analyzing univariate competing risks data. Recently, this model has been extended to clustered competing risks data via frailty. To the best of our knowledge, however, there has been no literature on variable selection method for such competing risks frailty models. In this paper, we propose a simple but unified procedure via a penalized h-likelihood (HL) for variable selection of fixed effects in a general class of subdistribution hazard frailty models, in which random effects may be shared or correlated. We consider three penalty functions (LASSO, SCAD and HL) in our variable selection procedure. We show that the proposed method can be easily implemented using a slight modification to existing h-likelihood estimation approaches. Numerical studies demonstrate that the proposed procedure using the HL penalty performs well, providing a higher probability of choosing the true model than LASSO and SCAD methods without losing prediction accuracy. The usefulness of the new method is illustrated using two actual data sets from multi-center clinical trials. PMID:25042872

  10. A Competence-Based Science Learning Framework Illustrated through the Study of Natural Hazards and Disaster Risk Reduction

    ERIC Educational Resources Information Center

    Oyao, Sheila G.; Holbrook, Jack; Rannikmäe, Miia; Pagunsan, Marmon M.

    2015-01-01

    This article proposes a competence-based learning framework for science teaching, applied to the study of "big ideas", in this case to the study of natural hazards and disaster risk reduction (NH&DRR). The framework focuses on new visions of competence, placing emphasis on nurturing connectedness and behavioral actions toward…

  11. From Reading Readiness to Reading Competence: The Role of Self-Regulation in At-Risk Children

    ERIC Educational Resources Information Center

    Smith, Leann E.; Borkowski, John G.; Whitman, Thomas L.

    2008-01-01

    This study investigated how self-regulation contributes to the development of reading competence in an at-risk sample of 157 children born to adolescent mothers. It was hypothesized that reading readiness at age 5 would shape self-regulation at age 10, which in turn would influence reading competence at age 14. Based on structural equation…

  12. The Learning and Competency Development of Master Teachers in Alternative High Schools for At-Risk Youth: A Case Study

    ERIC Educational Resources Information Center

    Williams, Nida W.

    2012-01-01

    This qualitative case study was designed to explore how master teachers in transfer high schools learn the competencies they perceive are required to engage at-risk students so that they persist and graduate. The study is based on the following assumptions: (1) The requisite teacher competencies can be defined and identified and, in fact,…

  13. Genetic Profiling to Determine Risk of Relapse Free Survival in High-risk Localized Prostate Cancer

    PubMed Central

    Barnett, Christine M.; Heinrich, Michael C.; Lim, Jeong; Nelson, Dylan; Beadling, Carol; Warrick, Andrea; Neff, Tanaya; Higano, Celestia S.; Garzotto, Mark; Qian, David; Corless, Christopher L.; Thomas, George V.; Beer, Tomasz M.

    2014-01-01

    Purpose The characterization of actionable mutations in human tumors is a prerequisite for the development of individualized, targeted therapy. We examined the prevalence of potentially therapeutically actionable mutations in patients with high risk clinically localized prostate cancer. Experimental Design 48 samples of formalin fixed paraffin embedded prostatectomy tissue from a neoadjuvant chemotherapy trial were analyzed. DNA extracted from microdissected tumor was analyzed for 643 common solid tumor mutations in 53 genes using mass spectroscopy based sequencing. In addition, PTEN loss and ERG translocations were examined using immunohistochemistry in associated tissue microarrays. Association with relapse during 5 years of follow-up was examined in exploratory analyses of the potential clinical relevance of the genetic alterations. Results Of the 40 tumors evaluable for mutations, 10% had point mutations in potentially actionable cancer genes. Of the 47 tumors evaluable for IHC, 36% had PTEN loss and 40% had ERG rearrangement. Individual mutations were not frequent enough to determine associations with relapse. Using Kaplan-Meier analysis with a log-rank test, the 16 patients who had PTEN loss had a significantly shorter median relapse free survival, 19 vs. 106 months (p = .01). Conclusions This study confirms that point mutations in the most common cancer regulatory genes in prostate cancer are rare. However, the PIK3CA/AKT pathway was mutated in 10% of our samples. While point mutations alone did not have a statistically significant association with relapse, PTEN loss was associated with an increased relapse in high risk prostate cancer treated with chemotherapy followed by surgery. PMID:24352642

  14. Biochemical Control With Radiotherapy Improves Overall Survival in Intermediate and High-Risk Prostate Cancer Patients Who Have an Estimated 10-Year Overall Survival of >90%

    SciTech Connect

    Herbert, Christopher; Liu, Mitchell; Tyldesley, Scott; Morris, W. James; Joffres, Michel; Khaira, Mandip; Kwan, Winkle; Moiseenko, Vitali; Pickles, Thomas

    2012-05-01

    Purpose: To identify subgroups of patients with carcinoma of the prostate treated with radical radiotherapy that have improved overall survival when disease is biochemically controlled. Methods and Materials: A cohort of 1,060 prostate cancer patients treated with radical radiotherapy was divided into nine subgroups based on National Comprehensive Cancer Network risk category and estimated 10-year overall survival (eOS 10y) derived from the age adjusted Charlson Comorbidity Index. Patients with and without biochemical control were compared with respect to overall survival. Actuarial estimates of overall survival were calculated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards models were used for analysis of overall survival. Results: Median follow-up was 125 months (range, 51-176 months). Only the subgroups with high or intermediate risk disease and an eOS 10y of >90% had a statistically significantly improved overall survival when prostate cancer was biochemically controlled. In all other groups, biochemical control made no significant difference to overall survival. In the subgroup with high-risk disease and eOS 10y >90%, actuarial overall survival was 86.3% (95% confidence interval [CI] 78.5%-94.1%) and 62.1% (95% CI 52.9%-71.3%) for patients with biochemical control and biochemical relapse respectively (p = 0.002). In the intermediate risk group with eOS >90%, actuarial overall survival was 95.3% (95% CI 89.0%-100%) and 79.8% (95% CI 68.0%-91.6%) for biochemically controlled and biochemically relapsed patients (p = 0.033). On multivariate analysis, National Comprehensive Cancer Network risk group (p = 0.005), biochemical control (p = 0.033) and eOS 10y (p < 0.001) were statistically significant. Conclusion: Biochemical control translates into improved overall survival in patients with high or intermediate risk disease and an estimated 10-year overall survival of >90%.

  15. Conduct problems and level of social competence in Head Start children: prevalence, pervasiveness, and associated risk factors.

    PubMed

    Webster-Stratton, C; Hammond, M

    1998-06-01

    The purpose of the current project was to determine the prevalence of conduct problems, low social competence, and associated risk factors in a sample of 4-year-old low-income children (N = 426) from 64 Head Start classrooms in the Seattle area. Conduct problems and social competence were assessed based on a combination of teacher reports, parent reports, and independent observations of children interacting with peers in the classroom and with parents at home. We examined the relative contribution of a variety of risk factors, including maternal history and socioeconomic background, current levels of stress and social support, mothers' emotional state, and parenting competence in relation to "pervasive" (i.e., at home and school) and "nonpervasive" conduct problems and low social competence. Findings indicated similar risk factors for conduct problems and for low social competence, with an ordered increase in the number of risk factors from normal to "nonpervasive" to "pervasive" groups. Harshness of parenting style (i.e., slapping, hitting, yelling) significantly distinguished between the three groups for low social competence and conduct problems. Positive affect, praise, and physical warmth from mothers were positively related to social competence but unrelated to conduct problems. PMID:11324301

  16. Risk Prediction of One-Year Mortality in Patients with Cardiac Arrhythmias Using Random Survival Forest

    PubMed Central

    Miao, Fen; Cai, Yun-Peng; Zhang, Yu-Xiao; Li, Ye; Zhang, Yuan-Ting

    2015-01-01

    Existing models for predicting mortality based on traditional Cox proportional hazard approach (CPH) often have low prediction accuracy. This paper aims to develop a clinical risk model with good accuracy for predicting 1-year mortality in cardiac arrhythmias patients using random survival forest (RSF), a robust approach for survival analysis. 10,488 cardiac arrhythmias patients available in the public MIMIC II clinical database were investigated, with 3,452 deaths occurring within 1-year followups. Forty risk factors including demographics and clinical and laboratory information and antiarrhythmic agents were analyzed as potential predictors of all-cause mortality. RSF was adopted to build a comprehensive survival model and a simplified risk model composed of 14 top risk factors. The built comprehensive model achieved a prediction accuracy of 0.81 measured by c-statistic with 10-fold cross validation. The simplified risk model also achieved a good accuracy of 0.799. Both results outperformed traditional CPH (which achieved a c-statistic of 0.733 for the comprehensive model and 0.718 for the simplified model). Moreover, various factors are observed to have nonlinear impact on cardiac arrhythmias prognosis. As a result, RSF based model which took nonlinearity into account significantly outperformed traditional Cox proportional hazard model and has great potential to be a more effective approach for survival analysis. PMID:26379761

  17. COMPETING RISK BIAS TO EXPLAIN THE INVERSE RELATIONSHIP BETWEEN SMOKING AND MALIGNANT MELANOMA

    PubMed Central

    Thompson, Caroline A.; Zhang, Zuo-Feng; Arah, Onyebuchi A.

    2013-01-01

    The relationship between smoking and melanoma remains unclear. Among the different results is the paradoxical finding that smoking was shown to be inversely associated with the risk of malignant melanoma in some large cohort and case-control studies, even after control for suspected confounding variables. Smoking is a known risk factor for many non-communicable diseases, including coronary heart disease, stroke, as well as other malignancies; it has been shown to be positively associated with other types of skin cancer, and there remains no clear biologic explanation for a possible protective effect on malignant melanoma. In this paper, we propose a plausible mechanism of bias from smoking-related competing risks that may explain or contribute to the inverse association between smoking and melanoma as spurious. Using directed acyclic graphs for formalization and visualization of assumptions, and Monte Carlo simulation techniques, we demonstrate how published inverse associations might be compatible with selection bias resulting from uncontrolled or unmeasured common causes of competing outcomes of smoking-related diseases and malignant melanoma. We present results from various scenarios assuming a true null as well as a true positive association between smoking and malignant melanoma. Under a true null assumption, we find inverse associations due to the biasing mechanism to be compatible with published results in the literature, especially after the addition of unmeasured confounding variables. This study could be seen as offering a cautionary note in the interpretation of published smoking-melanoma findings. PMID:23700026

  18. Sociodemographic risk, developmental competence, and PTSD symptoms in young children exposed to interpersonal trauma in early life.

    PubMed

    Enlow, Michelle Bosquet; Blood, Emily; Egeland, Byron

    2013-12-01

    Young children are disproportionately exposed to interpersonal trauma (maltreatment, witnessing intimate partner violence [IPV]) and appear particularly susceptible to negative sequelae. Little is known about the factors influencing vulnerability to traumatic stress responses and other negative outcomes in early life. This study examined associations among interpersonal trauma exposure, sociodemographic risk, developmental competence, and posttraumatic stress disorder (PTSD) symptoms in 200 children assessed from birth to first grade via standardized observations, record reviews, and maternal and teacher interviews. More severe PTSD symptoms were predicted by greater trauma exposure (r = .43), greater sociodemographic risk (r = .22), and lower developmental competence (rs=−.31 and −.54 for preschool and school-age developmental competence, respectively). Developmental competence partially mediated the association between trauma exposure and symptoms. Trauma exposure fully mediated the association between sociodemographic risk and symptoms. Neither sociodemographic risk nor developmental competence moderated trauma exposure effects on symptoms. The findings suggest that (a)exposure to maltreatment and IPV has additive effects on posttraumatic stress risk in early life, (b) associations between sociodemographic adversity and poor mental health may be attributable to increased trauma exposure in disadvantaged populations, and (c) early exposures have a negative cascade effect on developmental competence and mental health. PMID:24490247

  19. Survival and Risk Comparison of Campylobacter jejuni on Various Processed Meat Products.

    PubMed

    Hong, Soo Hyeon; Kim, Han Sol; Yoon, Ki Sun

    2016-01-01

    The objective of this study was to investigate survival kinetics of Campylobacter jejuni on various processed meat products (dry-cured ham, round ham with/without sodium nitrite, garlic seasoned ham with/without sodium nitrite, and sausage without sodium nitrite). Additionally, a semi-quantitative risk assessment of C. jejuni on various processed meat products was conducted using FDA-iRISK 1.0. Inoculated processed meat products with 6.0 ± 0.5 log CFU/g of C. jejuni were vacuum packed and stored at 4, 10, 17, 24, 30, and 36 °C. Survival curves were fitted to the Weibull model to obtain the delta values of C. jejuni on various processed meat products. The most rapid death of C. jejuni was observed on dry-cured ham, followed by sausage without sodium nitrite. The results of semi-quantitative risk assessment indicate that dry-cured ham represented the lowest risk among all samples. C. jejuni on processed meats presented a greater risk at 4 °C than at 10 °C. The risk of ham was greater than the risk of sausage, regardless of type. Among all samples, the highest risk of C. jejuni was observed in round ham without sodium nitrite. Overall, our data indicates that risk of processed meat products due to C. jejuni is relatively low. PMID:27294947

  20. Survival and Risk Comparison of Campylobacter jejuni on Various Processed Meat Products

    PubMed Central

    Hong, Soo Hyeon; Kim, Han Sol; Yoon, Ki Sun

    2016-01-01

    The objective of this study was to investigate survival kinetics of Campylobacter jejuni on various processed meat products (dry-cured ham, round ham with/without sodium nitrite, garlic seasoned ham with/without sodium nitrite, and sausage without sodium nitrite). Additionally, a semi-quantitative risk assessment of C. jejuni on various processed meat products was conducted using FDA-iRISK 1.0. Inoculated processed meat products with 6.0 ± 0.5 log CFU/g of C. jejuni were vacuum packed and stored at 4, 10, 17, 24, 30, and 36 °C. Survival curves were fitted to the Weibull model to obtain the delta values of C. jejuni on various processed meat products. The most rapid death of C. jejuni was observed on dry-cured ham, followed by sausage without sodium nitrite. The results of semi-quantitative risk assessment indicate that dry-cured ham represented the lowest risk among all samples. C. jejuni on processed meats presented a greater risk at 4 °C than at 10 °C. The risk of ham was greater than the risk of sausage, regardless of type. Among all samples, the highest risk of C. jejuni was observed in round ham without sodium nitrite. Overall, our data indicates that risk of processed meat products due to C. jejuni is relatively low. PMID:27294947

  1. Predictors of student outcomes on perceived knowledge and competence of genetic family history risk assessment.

    PubMed

    Collins, Cathleen A; Stiles, Anne S

    2011-01-01

    The publication of the human genome project has launched a number of discoveries set to change the landscape of healthcare. Unfortunately, nursing faculty across the United States report they are unprepared to teach students who will be practicing in the genomic era. The purpose of this study, utilizing Rogers' (2003) Diffusion of Innovation theory as a framework, was to determine the degree to which nursing school characteristics predict graduating undergraduate nursing students' perceived knowledge and competence of genetic family history risk assessment. School characteristics included school size, proximity to a large city, faculty's perceived barriers to diffusion of genomics into nursing practice, faculty innovativeness, faculty who have attended a genetics program for nursing faculty, and the integration of genomics into the curriculum. Faculty and students from 103 nursing schools across the United States participated in the study by completing online surveys. Hierarchical multiple regression was employed to determine how well the independent variables predicted student perceived knowledge and student perceived competence. No combination of the independent variables in this study predicted student knowledge or competence to the degree expected. This could be attributed to a lack of diffusion of genomics content across nursing curricula, based on Rogers' (2003) theory. Other findings included faculty continue to believe they are not competent to teach genomics, and the curriculum is too dense to include more content. However, contrary to prior research, faculty did believe genomics was valuable. The findings of this study give direction for further research into student outcomes and curriculum evaluation after 2011, when a consensus panel working to diffuse genomics into nursing curriculum and practice will have implemented their strategic plan for this diffusion. PMID:21420042

  2. A competing risk analysis of sequential complication development in Asian type 2 diabetes mellitus patients

    PubMed Central

    Cheng, Li-Jen; Chen, Jeng-Huei; Lin, Ming-Yen; Chen, Li-Chia; Lao, Chun-Huan; Luh, Hsing; Hwang, Shang-Jyh

    2015-01-01

    This retrospective cohort study investigated the progression risk of sequential complication in Asian type 2 diabetes (T2D) patients using the Taiwan Pay-for-Performance Diabetes Registry and claim data from November 2003 to February 2009. 226,310 adult T2D patients without complication were followed from diagnosis to complications, including myocardial infarction (MI), other ischemic heart disease (IHD), congestive heart failure (CHF), stroke, chronic kidney disease (CKD), retinopathy, amputation, death or to the end of study. Cumulative incidences (CIs) of first and second complications were analyzed in 30 and 4 years using the cumulative incidence competing risk method. IHD (29.8%), CKD (24.5%) and stroke (16.0%) are the most common first complications. The further development of T2D complications depends on a patient’s existing complication profiles. Patients who initially developed cardiovascular complications had a higher risk (9.2% to 24.4%) of developing IHD or CKD, respectively. All-cause mortality was the most likely consequence for patients with a prior MI (12.0%), so as stroke in patients with a prior MI (10.8%) or IHD (8.9%). Patients with CKD had higher risk of developing IHD (16.3%), stroke (8.9%) and all-cause mortality (8.7%) than end-stage renal disease (4.0%). Following an amputation, patients had a considerable risk of all-cause mortality (42.1%). PMID:26507664

  3. Varying coefficient subdistribution regression for left-truncated semi-competing risks data

    PubMed Central

    Li, Ruosha

    2014-01-01

    Semi-competing risks data frequently arise in biomedical studies when time to a disease landmark event is subject to dependent censoring by death, the observation of which however is not precluded by the occurrence of the landmark event. In observational studies, the analysis of such data can be further complicated by left truncation. In this work, we study a varying co-efficient subdistribution regression model for left-truncated semi-competing risks data. Our method appropriately accounts for the specifical truncation and censoring features of the data, and moreover has the flexibility to accommodate potentially varying covariate effects. The proposed method can be easily implemented and the resulting estimators are shown to have nice asymptotic properties. We also present inference, such as Kolmogorov-Smirnov type and Cramér Von-Mises type hypothesis testing procedures for the covariate effects. Simulation studies and an application to the Denmark diabetes registry demonstrate good finite-sample performance and practical utility of the proposed method. PMID:25125711

  4. Carfilzomib significantly improves the progression-free survival of high-risk patients in multiple myeloma

    PubMed Central

    Fonseca, Rafael; Siegel, David; Dimopoulos, Meletios A.; Špička, Ivan; Masszi, Tamás; Hájek, Roman; Rosiñol, Laura; Goranova-Marinova, Vesselina; Mihaylov, Georgi; Maisnar, Vladimír; Mateos, Maria-Victoria; Wang, Michael; Niesvizky, Ruben; Oriol, Albert; Jakubowiak, Andrzej; Minarik, Jiri; Palumbo, Antonio; Bensinger, William; Kukreti, Vishal; Ben-Yehuda, Dina; Stewart, A. Keith; Obreja, Mihaela; Moreau, Philippe

    2016-01-01

    The presence of certain high-risk cytogenetic abnormalities, such as translocations (4;14) and (14;16) and deletion (17p), are known to have a negative impact on survival in multiple myeloma (MM). The phase 3 study ASPIRE (N = 792) demonstrated that progression-free survival (PFS) was significantly improved with carfilzomib, lenalidomide, and dexamethasone (KRd), compared with lenalidomide and dexamethasone (Rd) in relapsed MM. This preplanned subgroup analysis of ASPIRE was conducted to evaluate KRd vs Rd by baseline cytogenetics according to fluorescence in situ hybridization. Of 417 patients with known cytogenetic risk status, 100 patients (24%) were categorized with high-risk cytogenetics (KRd, n = 48; Rd, n = 52) and 317 (76%) were categorized with standard-risk cytogenetics (KRd, n = 147; Rd, n = 170). For patients with high-risk cytogenetics, treatment with KRd resulted in a median PFS of 23.1 months, a 9-month improvement relative to treatment with Rd. For patients with standard-risk cytogenetics, treatment with KRd led to a 10-month improvement in median PFS vs Rd. The overall response rates for KRd vs Rd were 79.2% vs 59.6% (high-risk cytogenetics) and 91.2% vs 73.5% (standard-risk cytogenetics); approximately fivefold as many patients with high- or standard-risk cytogenetics achieved a complete response or better with KRd vs Rd (29.2% vs 5.8% and 38.1% vs 6.5%, respectively). KRd improved but did not abrogate the poor prognosis associated with high-risk cytogenetics. This regimen had a favorable benefit-risk profile in patients with relapsed MM, irrespective of cytogenetic risk status, and should be considered a standard of care in these patients. This trial was registered at www.clinicaltrials.gov as #NCT01080391. PMID:27439911

  5. Competing-Risks Mortality After Radiotherapy vs. Observation for Localized Prostate Cancer: A Population-based Study

    SciTech Connect

    Abdollah, Firas; Sun, Maxine; Schmitges, Jan; Thuret, Rodolphe; Tian, Zhe; Shariat, Shahrokh F.; Briganti, Alberto; Jeldres, Claudio; Perrotte, Paul; Montorsi, Francesco; Karakiewicz, Pierre I.

    2012-09-01

    Purpose: Contemporary patients with localized prostate cancer (PCa) are more frequently treated with radiotherapy. However, there are limited data on the effect of this treatment on cancer-specific mortality (CSM). Our objective was to test the relationship between radiotherapy and survival in men with localized PCa and compare it with those treated with observation. Methods: A population-based cohort identified 68,797 men with cT1-T2 PCa treated with radiotherapy or observation between the years 1992 and 2005. Propensity-score matching was used to minimize potential bias related to treatment assignment. Competing-risks analyses tested the effect of treatment type (radiotherapy vs. observation) on CSM, after accounting to other-cause mortality. All analyses were carried out within PCa risk, baseline comorbidity status, and age groups. Results: Radiotherapy was associated with more favorable 10-year CSM rates than observation in patients with high-risk PCa (8.8 vs. 14.4%, hazard ratio [HR]: 0.59, 95% confidence interval [CI]: 0.50-0.68). Conversely, the beneficial effect of radiotherapy on CSM was not evident in patients with low-intermediate risk PCa (3.7 vs. 4.1%, HR: 0.91, 95% CI: 0.80-1.04). Radiotherapy was beneficial in elderly patients (5.6 vs. 7.3%, HR: 0.70, 95% CI: 0.59-0.80). Moreover, it was associated with improved CSM rates among patients with no comorbidities (5.7 vs. 6.5%, HR: 0.81, 95% CI: 0.67-0.98), one comorbidity (4.6 vs. 6.0%, HR: 0.87, 95% CI: 0.75-0.99), and more than two comorbidities (4.2 vs. 5.0%, HR: 0.79, 95% CI: 0.65-0.96). Conclusions: Radiotherapy substantially improves CSM in patients with high-risk PCa, with little or no benefit in patients with low-/intermediate-risk PCa relative to observation. These findings must be interpreted within the context of the limitations of observational data.

  6. Sociodemographic Risk, Developmental Competence, and PTSD Symptoms in Young Children Exposed to Interpersonal Trauma in Early Life

    PubMed Central

    Enlow, Michelle Bosquet; Blood, Emily; Egeland, Byron

    2014-01-01

    Children under age six years are disproportionately exposed to interpersonal trauma, including maltreatment and witnessing intimate partner violence (IPV), and may be particularly susceptible to negative sequelae. However, young children have generally been neglected from trauma research; thus, little is known about the factors influencing vulnerability to traumatic stress responses and other negative outcomes in early life. This study examined associations among interpersonal trauma exposure, sociodemographic risk, developmental competence, and posttraumatic stress disorder (PTSD) symptoms in 200 children assessed prospectively from birth to 1st grade via home and laboratory observations, record reviews, and maternal and teacher interviews. Greater trauma exposure and sociodemographic risk and lower developmental competence predicted more severe PTSD symptoms. Developmental competence partially mediated the association between exposures and symptoms. Trauma exposure fully mediated the association between sociodemographic risk and symptoms. Neither sociodemographic risk nor developmental competence moderated trauma exposure effects on symptoms. The findings suggest that (a) exposure to maltreatment and IPV has additive effects on posttraumatic stress risk in early life, (b) associations between sociodemographic adversity and poor mental health may be attributable to increased trauma exposure in disadvantaged populations, and (c) early exposures have a negative cascade effect on developmental competence and child mental health. PMID:24490247

  7. Genetic polymorphisms in the vitamin D pathway in relation to lung cancer risk and survival

    PubMed Central

    Kong, Jinyu; Xu, Fangxiu; Qu, Jinli; Wang, Yu; Gao, Ming; Yu, Herbert; Qian, Biyun

    2015-01-01

    Studies have suggested that vitamin D may have protective effects against cancer development or tumor progression. To search for additional evidence, we investigated the role of genetic polymorphisms involved in the vitamin D pathway in non-small cell lung cancer (NSCLC). We evaluated common genetic polymorphisms associated with the vitamin D pathway in relation to NSCLC in a case-control study of 603 newly diagnosed NSCLC patients and 661 matched healthy controls. Seven single nucleotide polymorphisms (SNPs) were genotyped, the expression of CYP27B1 and CYP24A1 were measured in 153 tumor samples and their associations with genotypes and patient survival were also analyzed. In the case-control comparison, we found SNP rs3782130 (CYP27B1), rs7041 (GC), rs6068816 and rs4809957 (CYP24A1) associated with NSCLC risk. The risk of NSCLC was increased with the number of risk alleles. CYP27B1 and CYP24A1 expression were significantly different between tumor and normal tissues in NSCLC. High CYP27B1 expression was associated with better overall survival, and the expression was different by the rs3782130 genotype. The study suggests that some genetic polymorphisms involved in the vitamin D pathway may associate with NSCLC risk, and one of the polymorphisms (rs3782130) may affect gene expression and patient survival. PMID:25544771

  8. Long-Term Survival and Risk of Second Cancers After Radiotherapy for Cervical Cancer

    SciTech Connect

    Ohno, Tatsuya; Kato, Shingo; Sato, Shinichiro; Fukuhisa, Kenjiro; Nakano, Takashi; Tsujii, Hirohiko; Arai, Tatsuo

    2007-11-01

    Purpose: To evaluate the risk of second cancers after cervical cancer treated with radiotherapy for Asian populations. Methods and Materials: We reviewed 2,167 patients with cervical cancer undergoing radiotherapy between 1961 and 1986. Intracavitary brachytherapy was performed with high-dose rate source (82%) or low-dose rate source (12%). Relative risk (RR), absolute excess risk (AR), and cumulative risk of second cancer were calculated using the Japanese disease expectancy table. For 1,031 patients, the impact of smoking habit on the increasing risk of second cancer was also evaluated. Results: The total number of person-years of follow-up was 25,771, with 60 patients being lost to follow-up. Among the 2,167 patients, 1,063 (49%) survived more than 10 years. Second cancers were observed in 210 patients, representing a significant 1.2-fold risk (95% confidence interval [CI], 1.1-1.4) of developing second cancer compared with the general population, 1.6% excess risk per person per decade of follow-up, and elevating cumulative risk up to 23.8% (95% CI, 20.3-27.3) at 30 years after radiotherapy. The RR of second cancer was 1.6-fold for patients with the smoking habit and 1.4-fold for those without. Conclusions: Small but significant increased risk of second cancer was observed among Japanese women with cervical cancer mainly treated with high-dose rate brachytherapy. Considering the fact that about half of the patients survived more than 10 years, the benefit of radiotherapy outweighs the risk of developing second cancer.

  9. Incidence and survival of stomach cancer in a high-risk population of Chile

    PubMed Central

    Heise, Katy; Bertran, Enriqueta; Andia, Marcelo E; Ferreccio, Catterina

    2009-01-01

    AIM: To study the incidence and survival rate of stomach cancer (SC) and its associated factors in a high risk population in Chile. METHODS: The population-based cancer registry of Valdivia, included in the International Agency for Research on Cancer system, covers 356 396 residents of Valdivia Province, Southern Chile. We studied all SC cases entered in this Registry during 1998-2002 (529 cases). Population data came from the Chilean census (2002). Standardized incidence rates per 100 000 inhabitants (SIR) using the world population, cumulative risk of developing cancer before age 75, and rate ratios by sex, age, ethnicity and social factors were estimated. Relative survival (Ederer II method) and age-standardized estimates (Brenner method) were calculated. Specific survival rates (Kaplan-Meier) were measured at 3 and 5 years and survival curves were analyzed with the Logrank and Breslow tests. Survival was studied in relation to demographics, clinical presentation, laboratory results and medical management of the cases. Those variables significantly associated with survival were later included in a Cox multivariate model. RESULTS: Between 1998 and 2002, 529 primary gastric cancers occurred in Valdivia (crude incidence rate 29.2 per 100 000 inhabitants). Most cases were male (69.0%), residents of urban areas (57.5%) and Hispanic (83.2%), with a low education level (84.5% < 8 school years). SC SIR was higher in men than women (40.8 and 14.8 respectively, P < 0.001), risk factors were low education RR 4.4 (95% CI: 2.9-6.8) and 1.6, (95% CI: 1.1-2.1) for women and men respectively and Mapuche ethnicity only significant for women (RR 2.2, 95% CI: 1.2-3.7). Of all cases, 76.4% were histologically confirmed, 11.5% had a death certificate only (DCO), 56.1% were TNM stage IV; 445 cases (84.1%) were eligible for survival analysis, all completed five years follow-up; 42 remained alive, 392 died of SC and 11 died from other causes. Specific 5-year survival, excluding cases

  10. Resilience and risk competence in schools: theory/knowledge and international application in project rebound.

    PubMed

    Brown, Joel H; Jean-Marie, Gaetane; Beck, Jerome

    2010-01-01

    Despite a 50-year interdisciplinary and longitudinal research legacy--showing that nearly 80% of young people considered most "at risk" thrive by midlife-only recently have practitioners/researchers engaged in the explicit, prospective facilitation of "resilience" in educational settings. Here, theory/knowledge distinguishing and extending risk and resilience from its risk-based social history to resilience's normative occurrence leads to the first known international and prospective application of resilience in school-based drug education, Project REBOUND [resilience-bound]. It will be implemented as a controlled pilot study, first in Germany, then expand to the United States, as well as other parts of Europe. With evaluation occurring throughout, the goal is to enhance the quality of drug decisions among young people, as well as support their overall competence-based learning and development throughout school. With limitations and underlying psychological mechanisms discussed, it is concluded Project REBOUND offers promising potential for supporting positive drug decisions as well as youth learning and development. PMID:21381462

  11. Connection between competence, usability, environment and risk of falls in elderly adults

    PubMed Central

    Leiva-Caro, José Alex; Salazar-González, Bertha Cecilia; Gallegos-Cabriales, Esther Carlota; Gómez-Meza, Marco Vinicio; Hunter, Kathleen F.

    2015-01-01

    Objective: to determine connections between competence, usability, environment and risk of falls in elderly adults. Method: correlational descriptive study, 123 elderly adults, both male and female, aged 70 years and older were included. Data was collected via the Tinetti Scale, CESD-7 Scale, Montreal Cognitive Assessment, Usability Questionnaire on Housing and Housing Enabler; and sociodemographic and health background certificate data. For data analysis, descriptive and inferential statistics were used, multivariate linear and logistic regression models were adjusted. Results: 42.0% of the elderly adults had presented with falls, with a higher prevalence in women, and in the group of 70-75 years. The physical environment of the house, gait, and usability were set as risk factors for falls. A negative relationship between usability and depressive symptoms, cognitive health, balance, gait, the social and physical environment was found, p <0.05; and a strong positive correlation between walking and balance, p <0.05. Conclusion: this study helps to better understand the phenomenon of falling, to find a connection between usability with the risk of falls, and other variables. PMID:26626006

  12. Risk Factors of Anastomotic Leakage and Long-Term Survival After Colorectal Surgery.

    PubMed

    Park, Jong Seob; Huh, Jung Wook; Park, Yoon Ah; Cho, Yong Beom; Yun, Seong Hyeon; Kim, Hee Cheol; Lee, Woo Yong

    2016-02-01

    Anastomotic leakage (AL) is one of the most serious complications of colorectal surgery. It can affect long-term oncologic outcomes, but the impact on long-term survival remains uncertain. The aim of this study is to evaluate the operative characteristics of leakage and no leakage groups and to analyze long-term oncologic outcomes.We prospectively enrolled 10,477 patients from 2000 to 2011 and retrospectively reviewed the data.Male sex (odds ratio [OR], 3.90; P < 0.001), intraoperative transfusion (OR, 2.31; P = 0.042), and operative time (OR, 1.73; P = 0.032) were independent risk factors of AL in the colon. In the rectum, male sex (OR, 2.37; P < 0.001), neoadjuvant chemoradiotherapy (OR, 2.26; P < 0.001), and regional lymph node metastasis (OR, 1.43; P = 0.012) were independent risk factors of AL, and diverting stoma (OR, 0.24; P < 0.001) was associated with a deceased risk of AL. AL in the rectum without a diverting stoma was associated with disease-free survival (DFS, OR, 1.47; P = 0.037). Colonic leakage was not associated with 5-year DFS (leakage group vs nonleakage group, 72.4% vs 80.9%, P = 0.084); however, in patients undergoing rectal resection, there was a significant difference in 5-year DFS (67.0% vs 76.6%, P = 0.005, respectively).AL in the rectum is associated with worse long-term DFS and overall survival. A diverting stoma was shown to protect against this effect and was associated with long-term survival in rectal surgery. Therefore, creating a diverting stoma should be considered in high-risk patients undergoing rectal surgery. PMID:26937928

  13. Risk Factors of Anastomotic Leakage and Long-Term Survival After Colorectal Surgery

    PubMed Central

    Park, Jong Seob; Huh, Jung Wook; Park, Yoon Ah; Cho, Yong Beom; Yun, Seong Hyeon; Kim, Hee Cheol; Lee, Woo Yong

    2016-01-01

    Abstract Anastomotic leakage (AL) is one of the most serious complications of colorectal surgery. It can affect long-term oncologic outcomes, but the impact on long-term survival remains uncertain. The aim of this study is to evaluate the operative characteristics of leakage and no leakage groups and to analyze long-term oncologic outcomes. We prospectively enrolled 10,477 patients from 2000 to 2011 and retrospectively reviewed the data. Male sex (odds ratio [OR], 3.90; P < 0.001), intraoperative transfusion (OR, 2.31; P = 0.042), and operative time (OR, 1.73; P = 0.032) were independent risk factors of AL in the colon. In the rectum, male sex (OR, 2.37; P < 0.001), neoadjuvant chemoradiotherapy (OR, 2.26; P < 0.001), and regional lymph node metastasis (OR, 1.43; P = 0.012) were independent risk factors of AL, and diverting stoma (OR, 0.24; P < 0.001) was associated with a deceased risk of AL. AL in the rectum without a diverting stoma was associated with disease-free survival (DFS, OR, 1.47; P = 0.037). Colonic leakage was not associated with 5-year DFS (leakage group vs nonleakage group, 72.4% vs 80.9%, P = 0.084); however, in patients undergoing rectal resection, there was a significant difference in 5-year DFS (67.0% vs 76.6%, P = 0.005, respectively). AL in the rectum is associated with worse long-term DFS and overall survival. A diverting stoma was shown to protect against this effect and was associated with long-term survival in rectal surgery. Therefore, creating a diverting stoma should be considered in high-risk patients undergoing rectal surgery. PMID:26937928

  14. BCL2 mutations are associated with increased risk of transformation and shortened survival in follicular lymphoma

    PubMed Central

    Correia, Cristina; Schneider, Paula A.; Dai, Haiming; Dogan, Ahmet; Maurer, Matthew J.; Church, Amy K.; Novak, Anne J.; Feldman, Andrew L.; Wu, Xiaosheng; Ding, Husheng; Meng, X. Wei; Cerhan, James R.; Slager, Susan L.; Macon, William R.; Habermann, Thomas M.; Karp, Judith E.; Gore, Steven D.; Kay, Neil E.; Jelinek, Diane F.; Witzig, Thomas E.; Nowakowski, Grzegorz S.

    2015-01-01

    Follicular lymphoma (FL), an indolent neoplasm caused by a t(14;18) chromosomal translocation that juxtaposes the BCL2 gene and immunoglobulin locus, has a variable clinical course and frequently undergoes transformation to an aggressive lymphoma. Although BCL2 mutations have been previously described, their relationship to FL progression remains unclear. In this study, we evaluated the frequency and nature of BCL2 mutations in 2 independent cohorts of grade 1 and 2 FLs, along with the correlation between BCL2 mutations, transformation risk, and survival. The prevalence of BCL2 coding sequence mutations was 12% in FL at diagnosis and 53% at transformation (P < .0001). The presence of these BCL2 mutations at diagnosis correlated with an increased risk of transformation (hazard ratio 3.6; 95% CI, 2.0-6.2; P < .0001) and increased risk of death due to lymphoma (median survival of 9.5 years with BCL2 mutations vs 20.4 years without; P = .012). In a multivariate analysis, BCL2 mutations and high FL international prognostic index were independent risk factors for transformation and death due to lymphoma. Some mutant Bcl-2 proteins exhibited enhanced antiapoptotic capacity in vitro. Accordingly, BCL2 mutations can affect antiapoptotic Bcl-2 function, are associated with increased activation-induced cytidine deaminase expression, and correlate with increased risk of transformation and death due to lymphoma. PMID:25452615

  15. Multicenter study on caries risk assessment in adults using survival Classification and Regression Trees.

    PubMed

    Arino, Masumi; Ito, Ataru; Fujiki, Shozo; Sugiyama, Seiichi; Hayashi, Mikako

    2016-01-01

    Dental caries is an important public health problem worldwide. This study aims to prove how preventive therapies reduce the onset of caries in adult patients, and to identify patients with high or low risk of caries by using Classification and Regression Trees based survival analysis (survival CART). A clinical data set of 732 patients aged 20 to 64 years in nine Japanese general practices was analyzed with the following parameters: age, DMFT, number of mutans streptococci (SM) and Lactobacilli (LB), secretion rate and buffer capacity of saliva, and compliance with a preventive program. Results showed the incidence of primary carious lesion was affected by SM, LB and compliance with a preventive program; secondary carious lesion was affected by DMFT, SM and LB. Survival CART identified high-risk patients for primary carious lesion according to their poor compliance with a preventive program and SM (≥10(6) CFU/ml) with a hazard ratio of 3.66 (p = 0.0002). In the case of secondary caries, patients with LB (≥10(5) CFU/ml) and DMFT (>15) were identified as high risk with a hazard ratio of 3.50 (p < 0.0001). We conclude that preventive programs can be effective in limiting the incidence of primary carious lesion. PMID:27381750

  16. Thrombotic Thrombocytopenic Purpura in Black People: Impact of Ethnicity on Survival and Genetic Risk Factors.

    PubMed

    Martino, Suella; Jamme, Mathieu; Deligny, Christophe; Busson, Marc; Loiseau, Pascale; Azoulay, Elie; Galicier, Lionel; Pène, Frédéric; Provôt, François; Dossier, Antoine; Saheb, Samir; Veyradier, Agnès; Coppo, Paul

    2016-01-01

    Black people are at increased risk of thrombotic thrombocytopenic purpura (TTP). Whether clinical presentation of TTP in Black patients has specific features is unknown. We assessed here differences in TTP presentation and outcome between Black and White patients. Clinical presentation was comparable between both ethnic groups. However, prognosis differed with a lower death rate in Black patients than in White patients (2.7% versus 11.6%, respectively, P = .04). Ethnicity, increasing age and neurologic involvement were retained as risk factors for death in a multivariable model (P < .05 all). Sixty-day overall survival estimated by the Kaplan-Meier curves and compared with the Log-Rank test confirmed that Black patients had a better survival than White patients (P = .03). Salvage therapies were similarly performed between both groups, suggesting that disease severity was comparable. The comparison of HLA-DRB1*11, -DRB1*04 and -DQB1*03 allele frequencies between Black patients and healthy Black individuals revealed no significant difference. However, the protective allele against TTP, HLA-DRB1*04, was dramatically decreased in Black individuals in comparison with White individuals. Black people with TTP may have a better survival than White patients despite a comparable disease severity. A low natural frequency of HLA-DRB1*04 in Black ethnicity may account for the greater risk of TTP in this population. PMID:27383202

  17. Thrombotic Thrombocytopenic Purpura in Black People: Impact of Ethnicity on Survival and Genetic Risk Factors

    PubMed Central

    Martino, Suella; Jamme, Mathieu; Deligny, Christophe; Busson, Marc; Loiseau, Pascale; Azoulay, Elie; Galicier, Lionel; Pène, Frédéric; Provôt, François; Dossier, Antoine; Saheb, Samir; Veyradier, Agnès; Coppo, Paul

    2016-01-01

    Black people are at increased risk of thrombotic thrombocytopenic purpura (TTP). Whether clinical presentation of TTP in Black patients has specific features is unknown. We assessed here differences in TTP presentation and outcome between Black and White patients. Clinical presentation was comparable between both ethnic groups. However, prognosis differed with a lower death rate in Black patients than in White patients (2.7% versus 11.6%, respectively, P = .04). Ethnicity, increasing age and neurologic involvement were retained as risk factors for death in a multivariable model (P < .05 all). Sixty-day overall survival estimated by the Kaplan-Meier curves and compared with the Log-Rank test confirmed that Black patients had a better survival than White patients (P = .03). Salvage therapies were similarly performed between both groups, suggesting that disease severity was comparable. The comparison of HLA-DRB1*11, -DRB1*04 and -DQB1*03 allele frequencies between Black patients and healthy Black individuals revealed no significant difference. However, the protective allele against TTP, HLA-DRB1*04, was dramatically decreased in Black individuals in comparison with White individuals. Black people with TTP may have a better survival than White patients despite a comparable disease severity. A low natural frequency of HLA-DRB1*04 in Black ethnicity may account for the greater risk of TTP in this population. PMID:27383202

  18. Multicenter study on caries risk assessment in adults using survival Classification and Regression Trees

    PubMed Central

    Arino, Masumi; Ito, Ataru; Fujiki, Shozo; Sugiyama, Seiichi; Hayashi, Mikako

    2016-01-01

    Dental caries is an important public health problem worldwide. This study aims to prove how preventive therapies reduce the onset of caries in adult patients, and to identify patients with high or low risk of caries by using Classification and Regression Trees based survival analysis (survival CART). A clinical data set of 732 patients aged 20 to 64 years in nine Japanese general practices was analyzed with the following parameters: age, DMFT, number of mutans streptococci (SM) and Lactobacilli (LB), secretion rate and buffer capacity of saliva, and compliance with a preventive program. Results showed the incidence of primary carious lesion was affected by SM, LB and compliance with a preventive program; secondary carious lesion was affected by DMFT, SM and LB. Survival CART identified high-risk patients for primary carious lesion according to their poor compliance with a preventive program and SM (≥106 CFU/ml) with a hazard ratio of 3.66 (p = 0.0002). In the case of secondary caries, patients with LB (≥105 CFU/ml) and DMFT (>15) were identified as high risk with a hazard ratio of 3.50 (p < 0.0001). We conclude that preventive programs can be effective in limiting the incidence of primary carious lesion. PMID:27381750

  19. A balanced hazard ratio for risk group evaluation from survival data.

    PubMed

    Branders, Samuel; Dupont, Pierre

    2015-07-30

    Common clinical studies assess the quality of prognostic factors, such as gene expression signatures, clinical variables or environmental factors, and cluster patients into various risk groups. Typical examples include cancer clinical trials where patients are clustered into high or low risk groups. Whenever applied to survival data analysis, such groups are intended to represent patients with similar survival odds and to select the most appropriate therapy accordingly. The relevance of such risk groups, and of the related prognostic factors, is typically assessed through the computation of a hazard ratio. We first stress three limitations of assessing risk groups through the hazard ratio: (1) it may promote the definition of arbitrarily unbalanced risk groups; (2) an apparently optimal group hazard ratio can be largely inconsistent with the p-value commonly associated to it; and (3) some marginal changes between risk group proportions may lead to highly different hazard ratio values. Those issues could lead to inappropriate comparisons between various prognostic factors. Next, we propose the balanced hazard ratio to solve those issues. This new performance metric keeps an intuitive interpretation and is as simple to compute. We also show how the balanced hazard ratio leads to a natural cut-off choice to define risk groups from continuous risk scores. The proposed methodology is validated through controlled experiments for which a prescribed cut-off value is defined by design. Further results are also reported on several cancer prognosis studies, and the proposed methodology could be applied more generally to assess the quality of any prognostic markers. PMID:25894296

  20. Modeling the survival kinetics of Salmonella in tree nuts for use in risk assessment.

    PubMed

    Santillana Farakos, Sofia M; Pouillot, Régis; Anderson, Nathan; Johnson, Rhoma; Son, Insook; Van Doren, Jane

    2016-06-16

    Salmonella has been shown to survive in tree nuts over long periods of time. This survival capacity and its variability are key elements for risk assessment of Salmonella in tree nuts. The aim of this study was to develop a mathematical model to predict survival of Salmonella in tree nuts at ambient storage temperatures that considers variability and uncertainty separately and can easily be incorporated into a risk assessment model. Data on Salmonella survival on raw almonds, pecans, pistachios and walnuts were collected from the peer reviewed literature. The Weibull model was chosen as the baseline model and various fixed effect and mixed effect models were fit to the data. The best model identified through statistical analysis testing was then used to develop a hierarchical Bayesian model. Salmonella in tree nuts showed slow declines at temperatures ranging from 21°C to 24°C. A high degree of variability in survival was observed across tree nut studies reported in the literature. Statistical analysis results indicated that the best applicable model was a mixed effect model that included a fixed and random variation of δ per tree nut (which is the time it takes for the first log10 reduction) and a fixed variation of ρ per tree nut (parameter which defines the shape of the curve). Higher estimated survival rates (δ) were obtained for Salmonella on pistachios, followed in decreasing order by pecans, almonds and walnuts. The posterior distributions obtained from Bayesian inference were used to estimate the variability in the log10 decrease levels in survival for each tree nut, and the uncertainty of these estimates. These modeled uncertainty and variability distributions of the estimates can be used to obtain a complete exposure assessment of Salmonella in tree nuts when including time-temperature parameters for storage and consumption data. The statistical approach presented in this study may be applied to any studies that aim to develop predictive models to be

  1. Risk factors affecting the survival rate in patients with symptomatic pericardial effusion undergoing surgical intervention

    PubMed Central

    Mirhosseini, Seyed Mohsen; Fakhri, Mohammad; Mozaffary, Amirhossein; Lotfaliany, Mojtaba; Behzadnia, Neda; Ansari Aval, Zahra; Ghiasi, Seyed Mohammad Saeed; Boloursaz, Mohammad Reza; Masjedi, Mohammad Reza

    2013-01-01

    OBJECTIVES The optimal management and treatment of pericardial effusion are still controversial. There is limited data related to the risk factors affecting survival in these patients. The aim of this study was to determine the risk factors affecting the survival rate of patients with symptomatic pericardial effusion who underwent surgical interventions. METHODS From 2004 to 2011, we retrospectively analysed 153 patients who underwent subxiphoid pericardial window as their surgical intervention to drain pericardial effusions at the National Research Institute of Tuberculosis and Lung diseases (NRITLD). To determine the effects of risk factors on survival rate, demographic data, clinical records, echocardiographic data, computed tomographic and cytopathological findings and also operative information of patients were recorded. Patients were followed annually until the last clinical follow-up (August 2011). To determine the prognostic factors affecting survival, both univariate analysis and multivariate Cox proportional hazards model were utilized. RESULTS There were 89 men and 64 women with a mean age of 50.3 ± 15.5 years. The most prevalent symptom was dyspnoea. Concurrent malignancies were present in 66 patients. Lungs were the most prevalent primary site for malignancy. The median duration of follow-up was 15 (range 1–85 months). Six-month, 1-year and 18-month survival rates were 85.6, 61.4 and 36.6%, respectively. In a multivariate analysis, positive history of lung cancer (hazard ratio [HR] 2.894, 95% confidence interval [CI] 1.362–6.147, P = 0.006) or other organ cancers (HR 2.315, 95% CI 1.009–50311, P = 0.048), presence of a mass in the computed tomography (HR 1.985, 95% CI 1.100–3.581, P = 0.023), and echocardiographic findings compatible with tamponade (HR 1.745, 95% CI 1.048–2.90 P = 0.032) were the three independent predictors of postoperative death. CONCLUSIONS In the surgical management of pericardial effusion, patients with underlying

  2. MRI breast screening in high-risk women: cancer detection and survival analysis.

    PubMed

    Evans, D Gareth; Gareth, Evans D; Kesavan, Nisha; Nisha, Kesavan; Lim, Yit; Yit, Lim; Gadde, Soujanye; Soujanye, Gadde; Hurley, Emma; Emma, Hurley; Massat, Nathalie J; Maxwell, Anthony J; Ingham, Sarah; Sarah, Ingham; Eeles, Rosalind; Rosalind, Eeles; Leach, Martin O; Howell, Anthony; Anthony, Howell; Duffy, Stephen W; Stephen, Duffy

    2014-06-01

    Women with a genetic predisposition to breast cancer tend to develop the disease at a younger age with denser breasts making mammography screening less effective. The introduction of magnetic resonance imaging (MRI) for familial breast cancer screening programs in recent years was intended to improve outcomes in these women. We aimed to assess whether introduction of MRI surveillance improves 5- and 10-year survival of high-risk women and determine the accuracy of MRI breast cancer detection compared with mammography-only or no enhanced surveillance and compare size and pathology of cancers detected in women screened with MRI + mammography and mammography only. We used data from two prospective studies where asymptomatic women with a very high breast cancer risk were screened by either mammography alone or with MRI also compared with BRCA1/2 carriers with no intensive surveillance. 63 cancers were detected in women receiving MRI + mammography and 76 in women receiving mammography only. Sensitivity of MRI + mammography was 93 % with 63 % specificity. Fewer cancers detected on MRI were lymph node positive compared to mammography/no additional screening. There were no differences in 10-year survival between the MRI + mammography and mammography-only groups, but survival was significantly higher in the MRI-screened group (95.3 %) compared to no intensive screening (73.7 %; p = 0.002). There were no deaths among the 21 BRCA2 carriers receiving MRI. There appears to be benefit from screening with MRI, particularly in BRCA2 carriers. Extended follow-up of larger numbers of high-risk women is required to assess long-term survival. PMID:24687378

  3. Breast cancer in Denmark. Incidence, risk factors, and characteristics of survival.

    PubMed

    Ewertz, M

    1993-01-01

    In Denmark, incidence of female breast cancer remained constant from 1943 to around 1960, whereafter a steady increase has occurred, the level today being about 50% higher than in 1960. No equivalent rise has been observed for breast cancer mortality. Influence of hormonal and dietary factors on breast cancer risk and survival was evaluated in a combined population-based case-control and follow-up study, including 2,445 women, aged less than 70 years, diagnosed with breast cancer in Denmark between 1 March 1983 and 31 August 1984, identified from the files of the nation-wide clinical trial of the Danish Breast Cancer Co-operative Group (DBCG) and the Danish Cancer Registry. The control group was an age-stratified random sample of the general female population, selected from the Central Population Register. Data on risk factors were collected by self-administered questionnaires. Clinical and pathological tumour characteristics derived from DBCG. The case-control analysis confirmed an overall increased risk of breast cancer associated with urban residence, high social status, nulliparity, early age at menarche, late age at natural menopause, hormonal replacement therapy, high dietary fat intake, and high alcohol consumption in a subgroup. It failed to detect an association with age at first childbirth, oral contraceptives, smoking, intake of vegetables, tea, coffee, and sweeteners. Survival was determined by tumour size, skin invasion, number of positive lymph nodes, and grade. There was no relation between survival and reproductive or hormonal factors, dietary variables, alcohol consumption, or smoking. However, a complex relationship may exist between survival and body mass index. PMID:8260176

  4. Examining the role of methamphetamine in permanency: A competing risks analysis of reunification, guardianship, and adoption.

    PubMed

    Akin, Becci A; Brook, Jody; Lloyd, Margaret H

    2015-03-01

    Parental methamphetamine use has drawn significant attention in recent years. Despite prior research that shows that parental substance abuse is a risk factor for lengthy foster care stay, little is known about the effect of specific types of substance use on permanency. This study sought to compare the impact of parental methamphetamine use to alcohol use, other drug use, and polysubstance use on the timing of 3 types of permanency: reunification, guardianship, and adoption. Using an entry cohort of 16,620 children who had entered foster care during a 5-year period, competing risks event history models were conducted for each permanency type. Findings showed that, after controlling for several case characteristics, parent illicit drug use significantly impacted the timing of the 3 types of permanency, but alcohol use did not. Methamphetamine, other drug, and polysubstance with methamphetamine use were associated with lower rates of reunification and higher rates of adoption. Guardianship was also predicted by other drug and polysubstance use without methamphetamine; however, methamphetamine use was not associated with guardianship. Notably, the methamphetamine groups comprised the youngest children and had the shortest median time to adoption. Results suggest that type of parental substance use is predictive of permanency exits and that parental illicit drug use may require tailored strategies for improving permanency outcomes. Further implications of the findings are discussed. PMID:25822603

  5. Competing Risks or Different Pathways? An Event History Analysis of the Relationship between Financial Aid and Educational Outcomes for Latinos

    ERIC Educational Resources Information Center

    Gross, Jacob P. K.; Torres, Vasti

    2010-01-01

    Using a competing risks event history model this study explores the effects of differentiated forms of financial aid on the postsecondary enrollment patterns of Latino college students in Indiana. Much of the prior research on financial aid has employed cross-sectional methods, which assume that the effects of aid do not vary across time. This…

  6. Cumulative Risk, the Mother-Child Relationship, and Social-Emotional Competence in Latino Head Start Children

    ERIC Educational Resources Information Center

    Martí, Maria; Bonillo, Albert; Jané, Maria Claustre; Fisher, Elisa M.; Duch, Helena

    2016-01-01

    Research Findings: Supportive mother-child interactions promote the development of social-emotional competence. Poverty and other associated psychosocial risk factors have a negative impact on mother-child interaction. In spite of Latino children being disproportionately represented among children living in poverty, research on mother-child…

  7. Sensation Seeking: A Potential Factor Influencing Perceived Risk and Perceived Competence in an Introductory Scuba Diving Course

    ERIC Educational Resources Information Center

    Morgan, Cass

    2009-01-01

    This study examined the relationship between the sensation-seeking personality trait to changes in perceived risk and perceived competence during an adventure experience. Participants (n = 57) were enrolled in a 14-week introductory scuba diving course offered at a university in eastern North Carolina in 2006. The data was analyzed using a…

  8. Prediction of long-term cumulative incidences based on short-term parametric model for competing risks: application in early breast cancer.

    PubMed

    Cabarrou, B; Belin, L; Somda, S M; Falcou, M C; Pierga, J Y; Kirova, Y; Delord, J P; Asselain, B; Filleron, T

    2016-04-01

    Use of parametric statistical models can be a solution to reduce the follow-up period time required to estimate long-term survival. Mould and Boag were the first to use the lognormal model. Competing risks methodology seems more suitable when a particular event type is of interest than classical survival analysis. The objective was to evaluate the ability of the Jeong and Fine model to predict long-term cumulative incidence. Survival data recorded by Institut Curie (Paris) from 4761 breast cancer patients treated and followed between 1981 and 2013 were used. Long-term cumulative incidence rates predicted by the model using short-term follow-up data were compared to non-parametric estimation using complete follow-up data. 20- or 25-year cumulative incidence rates for loco-regional recurrence and distant metastasis predicted by the model using a maximum of 10 years of follow-up data had a maximum difference of around 6 % compared to non-parametric estimation. Prediction rates were underestimated for the third and composite event (contralateral or second cancer or death). Predictive ability of Jeong and Fine model on breast cancer data was generally good considering the short follow-up period time used for the estimation especially when a proportion of patient did not experience loco-regional recurrence or distant metastasis. PMID:27075918

  9. Statin use and breast cancer survival and risk: a systematic review and meta-analysis

    PubMed Central

    Li, Yuan-Yuan; Zhu, Jingjing; Qian, Ke-Qing; Li, Wen-Jing; Wu, Lang

    2015-01-01

    The purpose of this study is to determine the associations between statin use and breast cancer survival and risk by performing a systematic review and meta-analysis. We searched PubMed, Embase and Web of Science up to August 2015 for identifying relevant prospective or case-control studies, or randomized clinical trials. Five prospective studies involving 60,911 patients reported the association between statin use and breast cancer mortality. Eleven prospective studies, 12 case-control studies and 9 randomized clinical trials involving 83,919 patients reported the association between statin use and breast cancer risk. After pooling estimates from all available studies, there was a significantly negative association between pre-diagnosis statin use and breast cancer mortality (for overall survival (OS): hazard ratio (HR) = 0.68, 95% confidence interval (CI) 0.54–0.84; for disease specific survival (DSS): HR = 0.72, 95% CI 0.53–0.99). There was also a significant inverse association between post-diagnosis statin use and breast cancer DSS (HR = 0.65, 95% CI 0.43–0.98), although the association with breast cancer OS did not reach statistical significance (HR = 0.71, 95% CI 0.48–1.07). Additionally, there was a non-linear relationship for the duration of post-diagnosis statin use with breast cancer specific mortality. On the other hand, with regards to the relationship between statin use and breast cancer risk, no significant association was detected. Our analyses suggest that although statin use may not influence breast cancer risk, the use of statin may be associated with decrease mortality of breast cancer patients. Further large-scale studies are warranted to validate our findings. PMID:26472026

  10. Obesity as an independent risk factor for decreased survival in node-positive high-risk breast cancer.

    PubMed

    Scholz, Christoph; Andergassen, U; Hepp, P; Schindlbeck, C; Friedl, Thomas W P; Harbeck, N; Kiechle, M; Sommer, H; Hauner, H; Friese, K; Rack, B; Janni, W

    2015-06-01

    Obese breast cancer patients have a higher risk of lymph node metastasis and a poorer prognosis compared to patients with normal weight. For obese women with node-positive breast cancer, an association between body weight and prognosis remains unclear. In this retrospective study, we analyzed patient data from the Phase-III ADEBAR trial, in which high-risk breast cancer patients (pT1-4, pN2-3, pM0) were randomized into a docetaxel-based versus epirubicin-based chemotherapy regimen. Patients were grouped according to their BMI value as underweight/normal weight (BMI < 25 kg/m(2); n = 543), overweight (BMI 25-29.9 kg/m(2); n = 482) or obese (BMI ≥ 30 kg/m(2); n = 285). Overweight and obese patients were older, had larger tumors and were more likely to be postmenopausal at the time of diagnosis compared to underweight/normal-weight patients (all p < 0.001). Multivariate Cox regression analyses adjusting for age and histopathological tumor features showed that obese patients had a significantly shorter disease-free survival (DFS; HR 1.43; 95 % CI 1.11-1.86; p = 0.006) and overall survival (OS; HR 1.56; 95 % CI 1.14-2.14; p = 0.006) than non-obese patients. Subgroup analyses revealed that the differences in DFS and OS were significant for postmenopausal but not for premenopausal patients, and that the survival benefit of non-obese patients was more pronounced in women with hormone-receptor-positive disease. Obesity constitutes an independent, adverse prognostic factor in high-risk node-positive breast cancer patients, in particular for postmenopausal women and women with hormone-receptor-positive disease. PMID:25962694

  11. Association of CD44 Gene Polymorphism with Survival of NSCLC and Risk of Bone Metastasis

    PubMed Central

    Liu, Yaosheng; Qing, Haifeng; Su, Xiuyun; Wang, Cheng; Li, Zhuo; Liu, Shubin

    2015-01-01

    Background Previous studies have reported CD44 expression influenced the development and progression of tumors. The aim of this study was to investigate whether single-nucleotide polymorphisms (SNPs) of the CD44 gene are associated with survival of non-small cell lung cancer (NSCLC) and occurrence rate of bone metastasis. Material/Methods A total of 234 patients with NSCLC between 2003 and 2010 were enrolled in this study and 468 healthy persons were used as controls. Two polymorphisms, rs13347 and rs187115, in the CD44 gene were genotyped using DNA from blood lymphocytes. For statistical analysis we used the chi-square test, Fisher’s exact test, Kaplan-Meier method, and log-rank test. Results CD44 gene rs13347 polymorphism was not associated with NSCLC risk. For rs187115, the association with NSCLC risk was observed (P<0.001). Allele G carriers had significantly higher occurrence rates of bone metastasis (OR=0.4, 95%CI: 0.20–0.64, P<0.001) and more advanced tumor stage (OR=2.6, 95%CI: 1.50–4.45, P=0.001) compared to carriers of allele A. The survival rates for patients with AA genotype were significantly higher than for patients with the AG+GG genotypes (P<0.001). In multivariate analysis of survival in NSCLC patients, significant predictors were CD44 gene (AG+GG) (RR=0.48, 95%CI: 0.34–0.68, P<0.001), tumor stage (RR=0.45, 95%CI: 0. 0.31–0.65, P<0.001), and bone metastasis (RR=1.52, 95%CI: 1.05–2.21, P=0.027). Conclusions CD44 gene rs187115 polymorphism is a potential predictive marker of survival in NSCLC patients, and is significantly correlated with bone metastasis and tumor stage. PMID:26356590

  12. Gallbladder cancer: incidence and survival in a high-risk area of Chile.

    PubMed

    Bertran, Enriqueta; Heise, Katy; Andia, Marcelo E; Ferreccio, Catterina

    2010-11-15

    We assessed population incidence rates 1998-2002 and 5-year survival rates of 317 primary gallbladder cancer (GBC) entered in the population-based cancer registry in Valdivia. We analyzed GBC incidence (Poisson regression) and GBC survival (Cox regression). Cases were identified by histology (69.4%), clinical work-up (21.8%), or death certificate only (8.8%). Main symptoms were abdominal pain (82.8%), jaundice (53.6%) nausea (42.6%), and weight loss (38.2%); at diagnosis, 64% had Stage TNM IV. In the period, 4% of histopathological studies from presumptively benign cholecystectomies presented GBC. GBC cases were mainly females (76.0%), urban residents (70.3%), Hispanic (83.7%) of low schooling <4 years (64.0%). GBC standardized incidence rate per 100,000 (SIR) were all 17.5 (95%CI: 15.5-19.4), women 24.3, and men 8.6 (p < 0.00001); Mapuche 25.0, Hispanic 16.2 (p = 0.09). The highest SIRs were in Mapuche (269.2) and Hispanic women (199.6) with <4 years of schooling. Lowest SIRs were among Hispanic men (19.8) and women (21.9) with >8 years of schooling. Low schooling, female and urban residence were independent risk factors. By December 31, 2007, 6 (1.9%) cases were living, 280 (88.3%) died from GBC, 32 (10.1%) were lost of follow-up. Kaplan Meier Global 5-year survival was: 10.3%, 85% at stage I and 1.9% at stage IV; median survival: 3.4 months. Independent poor prognostic factors were TNM IV, jaundice and nonincidental diagnoses. Our results suggest that women of Mapuche ancestry with low schooling (>50 years) are at the highest risk of presenting and dying from GBC and should be the target for early detection programs. PMID:20473911

  13. Estimation of the standardized risk difference and ratio in a competing risks framework: application to injection drug use and progression to AIDS after initiation of antiretroviral therapy.

    PubMed

    Cole, Stephen R; Lau, Bryan; Eron, Joseph J; Brookhart, M Alan; Kitahata, Mari M; Martin, Jeffrey N; Mathews, William C; Mugavero, Michael J

    2015-02-15

    There are few published examples of absolute risk estimated from epidemiologic data subject to censoring and competing risks with adjustment for multiple confounders. We present an example estimating the effect of injection drug use on 6-year risk of acquired immunodeficiency syndrome (AIDS) after initiation of combination antiretroviral therapy between 1998 and 2012 in an 8-site US cohort study with death before AIDS as a competing risk. We estimate the risk standardized to the total study sample by combining inverse probability weights with the cumulative incidence function; estimates of precision are obtained by bootstrap. In 7,182 patients (83% male, 33% African American, median age of 38 years), we observed 6-year standardized AIDS risks of 16.75% among 1,143 injection drug users and 12.08% among 6,039 nonusers, yielding a standardized risk difference of 4.68 (95% confidence interval: 1.27, 8.08) and a standardized risk ratio of 1.39 (95% confidence interval: 1.12, 1.72). Results may be sensitive to the assumptions of exposure-version irrelevance, no measurement bias, and no unmeasured confounding. These limitations suggest that results be replicated with refined measurements of injection drug use. Nevertheless, estimating the standardized risk difference and ratio is straightforward, and injection drug use appears to increase the risk of AIDS. PMID:24966220

  14. Investigating the association between allergen-specific immunoglobulin E, cancer risk and survival

    PubMed Central

    Wulaningsih, Wahyu; Holmberg, Lars; Garmo, Hans; Karagiannis, Sophia N.; Ahlstedt, Staffan; Malmstrom, Håkan; Lambe, Mats; Hammar, Niklas; Walldius, Göran; Jungner, Ingmar; Ng, Tony; Van Hemelrijck, Mieke

    2016-01-01

    ABSTRACT Prior findings linking allergy and cancer have been inconsistent, which may be driven by diverse assessment methods. We used serum specific immunoglobulin E (IgE) against common inhalant allergens that was assessed prior to cancer diagnosis in studying this association. We selected 8,727 Swedish men and women who had measurements of serum allergen-specific IgE and total IgE between 1992 and 1996. Multivariable Cox regression using age as a timescale was performed to assess the associations of IgE sensitization, defined by any levels of serum specific IgE ≥35 kU/L, with risk of overall and specific cancers. A test for trend was performed by assigning scores derived from allergen-specific IgE levels at baseline as an ordinal scale. Kaplan–Meier curves and log-rank test were used to assess cancer survival by IgE sensitization status. During a mean follow-up of 16 year, 689 persons were diagnosed with cancer. We found an inverse association between IgE sensitization and cancer risk, with a hazard ratio (HR) of 0.83 and 95% confidence intervals (CI) of 0.70–0.99. A similar trend was seen with specific IgE scores overall (Ptrend = 0.007) and in women (Ptrend = 0.01). Although IgE sensitization was not associated with risk of common site-specific cancers, serum specific IgE scores were inversely associated with melanoma risk in men and women combined, and with risk of female breast and gynecological cancers combined. No association with survival was observed. The association between circulating IgE levels and incident cancer may point toward a role of T-helper 2 (TH2)-biased response in development of some cancers. PMID:27471625

  15. Incidence and Risk Factors of Thromboembolism with Multiple Myeloma in the Presence of Death as a Competing Risk: An Empirical Comparison of Statistical Methodologies

    PubMed Central

    Brown, Joshua D.; Adams, Val R.

    2016-01-01

    Multiple myeloma (MM) has an inherent high risk of thromboembolic events associated with patient as well as disease- and treatment-related factors. Previous studies have assessed the association of MM-related thromboembolism using “traditional” Kaplan–Meier (KM) and/or Cox proportional hazard (PH) regression. In the presence of high incidence of death, as would be the case in cancer patients with advanced age, these statistical models will produce bias estimates. Instead, a competing risk framework should be used. This study assessed the baseline patient demographic and clinical characteristics associated with MM-related thromboembolism and compared the cumulative incidence and the measures of association obtained using each statistical approach. The cumulative incidence of thromboembolism was 9.2% using the competing risk framework and nearly 12% using the KM approach. Bias in the measures of covariate risk associations was highest for factors related to risk of death such as increased age (75% bias) and severe liver disease (50%) for the Cox PH model compared to the competing risk model. These results show that correct specification of statistical techniques can have a large impact on the results obtained. PMID:27417604

  16. Sexual assertiveness in low-income African American women: unwanted sex, survival, and HIV risk.

    PubMed

    Whyte Iv, James

    2006-01-01

    The objective of this study was to determine the relationship of social variables related to sexual relationships in African American women. The study used a quantitative descriptive design to gather data from a convenience sample of 524 African American women aged 18 to 49 who dwelled in the southeastern United States. The study utilized the HIV Risk Behavior Questionnaire to determine the participant's level of HIV risk. Results indicated substantial levels of sex in the women due to violence or fear of violence, relationship loss, lost shelter, and high levels of unwanted sex. There was a positive correlation between level of survival sex and high-risk behavior (R = .651, p < .01). Multiple correlations indicated associations between history of forced sex and sex due to fear of violence (R = .604, p < .01). Further correlations indicated a pattern of association between poverty, age, and sex out of fear of relationship loss or shelter loss. The study indicates a need for a broader definition of HIV-related risk in high-risk populations. PMID:17064233

  17. The Prospective, Observational, Multicenter, Major Trauma Transfusion (PROMMTT) Study: Comparative Effectiveness of a Time-varying Treatment with Competing Risks

    PubMed Central

    Holcomb, John B.; del Junco, Deborah J.; Fox, Erin E.; Wade, Charles E.; Cohen, Mitchell J.; Schreiber, Martin A.; Alarcon, Louis H.; Bai, Yu; Brasel, Karen J.; Bulger, Eileen M.; Cotton, Bryan A.; Matijevic, Nena; Muskat, Peter; Myers, John G.; Phelan, Herb A.; White, Christopher E.; Zhang, Jiajie; Rahbar, Mohammad H.

    2013-01-01

    Context Hemorrhagic shock is the leading potentially preventable cause of death after injury. Transfusion of early and increased ratios of plasma and platelets to red blood cells (RBCs) has been associated with decreased mortality; however conflicting reports and the time-varying nature of transfusions and hemorrhagic death raise concern for the validity of the clinical conclusions drawn from the retrospective data. Objective To relate in-hospital mortality to: 1) early transfusion of plasma and/or platelets and 2) time-varying plasma:RBC and platelet:RBC ratios. Design Prospective cohort study documenting the timing of transfusions during active resuscitation and patient outcomes. Data were analyzed using time-dependent proportional hazards models. Setting Ten US Level 1 trauma centers. Patients Adult trauma patients surviving for 30 minutes after admission, transfused at least 1 unit RBC within 6 hours of admission (n=1245, the original study group) and at least 3 total units (of RBC, plasma or platelets) within 24 hours (n=905, the analysis group). Main outcome measure In-hospital mortality Results Plasma:RBC and platelet:RBC ratios were not constant over the first 24 hours (p<.001 for both). In a multivariable time-dependent Cox model, increased ratios of plasma:RBC (adjusted hazard ratio, HR=0.31, 95% CI=0.16–0.58) and platelets:RBC (adjusted HR=0.55, 95% CI=0.31–0.98) were independently associated with decreased 6-hour mortality, when hemorrhagic death predominated. In the first 6 hours, patients with ratios < 1:2 were 3–4 times more likely to die than patients with ratios ≥1:1. After 24 hours, plasma and platelet ratios were unassociated with mortality, when competing risks from non-hemorrhagic causes prevailed. Conclusions Higher plasma and platelet ratios early in resuscitation were associated with decreased mortality in patients transfused at least three units of blood products during the first 24 hours after admission. Among survivors at 24 hours

  18. Quantile Regression Adjusting for Dependent Censoring from Semi-Competing Risks

    PubMed Central

    Li, Ruosha; Peng, Limin

    2014-01-01

    Summary In this work, we study quantile regression when the response is an event time subject to potentially dependent censoring. We consider the semi-competing risks setting, where time to censoring remains observable after the occurrence of the event of interest. While such a scenario frequently arises in biomedical studies, most of current quantile regression methods for censored data are not applicable because they generally require the censoring time and the event time be independent. By imposing rather mild assumptions on the association structure between the time-to-event response and the censoring time variable, we propose quantile regression procedures, which allow us to garner a comprehensive view of the covariate effects on the event time outcome as well as to examine the informativeness of censoring. An efficient and stable algorithm is provided for implementing the new method. We establish the asymptotic properties of the resulting estimators including uniform consistency and weak convergence. The theoretical development may serve as a useful template for addressing estimating settings that involve stochastic integrals. Extensive simulation studies suggest that the proposed method performs well with moderate sample sizes. We illustrate the practical utility of our proposals through an application to a bone marrow transplant trial. PMID:25574152

  19. Commercial kidney transplantation is an important risk factor in long-term kidney allograft survival.

    PubMed

    Prasad, G V Ramesh; Ananth, Sailesh; Palepu, Sneha; Huang, Michael; Nash, Michelle M; Zaltzman, Jeffrey S

    2016-05-01

    Transplant tourism, a form of transplant commercialization, has resulted in serious short-term adverse outcomes that explain reduced short-term kidney allograft survival. However, the nature of longer-term outcomes in commercial kidney transplant recipients is less clear. To study this further, we identified 69 Canadian commercial transplant recipients of 72 kidney allografts transplanted during 1998 to 2013 who reported to our transplant center for follow-up care. Their outcomes to 8 years post-transplant were compared with 702 domestic living donor and 827 deceased donor transplant recipients during this period using Kaplan-Meier survival plots and multivariate Cox regression analysis. Among many complications, notable specific events included hepatitis B or C seroconversion (7 patients), active hepatitis and/or fulminant hepatic failure (4 patients), pulmonary tuberculosis (2 patients), and a type A dissecting aortic aneurysm. Commercial transplantation was independently associated with significantly reduced death-censored kidney allograft survival (hazard ratio 3.69, 95% confidence interval 1.88-7.25) along with significantly delayed graft function and eGFR 30 ml/min/1.73 m(2) or less at 3 months post-transplant. Thus, commercial transplantation represents an important risk factor for long-term kidney allograft loss. Concerted arguments and efforts using adverse recipient outcomes among the main premises are still required in order to eradicate transplant commercialization. PMID:27083285

  20. A tool for the culturally competent assessment of suicide: the Cultural Assessment of Risk for Suicide (CARS) measure.

    PubMed

    Chu, Joyce; Floyd, Rebecca; Diep, Hy; Pardo, Seth; Goldblum, Peter; Bongar, Bruce

    2013-06-01

    Despite important differences in suicide presentation and risk among ethnic and sexual minority groups, cultural variations have typically been left out of systematic risk assessment paradigms. A new self-report instrument for the culturally competent assessment of suicide, the Cultural Assessment of Risk for Suicide (CARS) measure, was administered to a diverse sample of 950 adults from the general population. Exploratory factor analysis yielded a 39-item, 8-factor structure subsumed under and consistent with the Cultural Theory and Model of Suicide (Chu, Goldblum, Floyd, & Bongar, 2010), which characterizes the vast majority of cultural variation in suicide risk among ethnic and sexual minority groups. Psychometric properties showed that the CARS total and subscale scores demonstrated good internal consistency, convergent validity with scores on other suicide-related measures (the Suicide Ideation Scale, the Beck Depression Inventory suicide item, and the Beck Hopelessness Scale), and an ability to discriminate between participants with versus without history of suicide attempts. Regression analyses indicated that the CARS measure can be used with a general population, providing information predictive of suicidal behavior beyond that of minority status alone. Minorities, however, reported experiencing the CARS cultural risk factors to a greater extent than nonminorities, though effect sizes were small. Overall, results show that the CARS items are reliable, and the instrument identifies cultural suicide risk factors not previously attended to in suicide assessment. The CARS is the first to operationalize a systematic model that accounts for cultural competency across multiple cultural identities in suicide risk assessment efforts. PMID:23356681

  1. A Replication Study and Genome-wide Scan of Single Nucleotide Polymorphisms Associated with Pancreatic Cancer Risk and Overall Survival

    PubMed Central

    Willis, Jason A.; Olson, Sara H.; Orlow, Irene; Mukherjee, Semanti; McWilliams, Robert R.; Kurtz, Robert C.; Klein, Robert J.

    2013-01-01

    Purpose To explore the effects of single nucleotide polymorphisms (SNPs) on pancreatic cancer risk and overall survival. Experimental Design The germline DNA of 531 pancreatic cancer cases and 305 healthy controls from a hospital-based study was genotyped at SNPs previously reported to be associated with pancreatic cancer risk or clinical outcome. We analyzed putative risk SNPs for replication of their reported effects on risk and tested for novel effects on overall survival (OS). Similarly, we analyzed putative survival-associated SNPs for replication of their reported effects on OS and tested for novel effects on risk. Lastly, we performed a genome-wide association study of OS using a subset of 252 cases, with two subsequent validation sets of 261 and 572 patients, respectively. Results Among seven risk SNPs analyzed, two (rs505922, rs9543325) were associated with risk (p<0.05). Among 24 survival-associated SNPs analyzed, one (rs9350) was associated with OS (p<0.05). No putative risk SNPs or putative survival-associated SNPs were found to be associated with OS or risk, respectively. Further, our GWAS identified a novel SNP (rs1482426, combined stage 1 and 2 p = 1.7 ×10−6, per-allele HR = 1.74, 95% CI 1.38–2.18) to be putatively associated with OS. Conclusions The effects of SNPs on pancreatic cancer risk and overall survival were replicated in our study, though further work is necessary to understand the functional mechanisms underlying these effects. More importantly, the putative association with OS identified by GWAS suggests that GWAS may be useful in identifying SNPs associated with clinical outcome in pancreatic cancer. PMID:22665904

  2. Adjuvant Transarterial Chemoembolization Following Liver Resection for Intrahepatic Cholangiocarcinoma Based on Survival Risk Stratification

    PubMed Central

    Li, Jun; Wang, Qing; Lei, Zhengqing; Wu, Dong; Si, Anfeng; Wang, Kui; Wan, Xuying; Wang, Yizhou; Yan, Zhenlin; Xia, Yong; Lau, Wan Yee; Wu, Mengchao

    2015-01-01

    Background. The effectiveness of adjuvant transarterial chemoembolization (TACE) for intrahepatic cholangiocarcinoma (ICC) after hepatectomy remains unclear. This study was performed to identify ICC patients who would benefit from adjuvant TACE. Patients and Methods. The study included 553 patients who underwent hepatectomy for ICC between January 2008 and February 2011 at the Eastern Hepatobiliary Surgery Hospital and who were treated with or without TACE (122 with TACE and 431 without TACE). Survival risk stratification was performed using the established prognostic nomogram (ICC nomogram). The predictive performance was evaluated by concordance index and calibration. The tumor recurrence and overall survival (OS) rates were analyzed by the Kaplan-Meier method before and after propensity score matching (PSM). Results. The predictive performance of the ICC nomogram was demonstrated by the well-fitted calibration curves and an optimal c-index of 0.71 for OS prediction. In the whole cohort, the 5-year recurrence and OS rates between the TACE and non-TACE groups were significantly different (5-year recurrence: 72.9% vs. 78.1%; OS: 38.4% vs. 29.7%). After 1:1 PSM, the TACE and non-TACE groups (122 patients each) had similar 5-year recurrence and OS rates (5-year recurrence: 72.9% vs. 74.2%; OS: 38.4% vs. 36.0%). By survival risk stratification based on ICC nomogram, only the patients in the lowest tertile (nomogram scores ≥77) benefited from adjuvant TACE (TACE vs. non-TACE groups: 90.4% vs. 95.9% for 5-year recurrence; 21.3% vs. 6.2% for 5-year OS). Conclusion. Adjuvant TACE following liver resection might be suitable for ICC patients with high ICC nomogram scores (≥77). Implications for Practice: The accurate predictive performance of the established prognostic nomogram for intrahepatic cholangiocarcinoma (ICC) following liver resection was reconfirmed in an independent cohort with 553 patients. Based on the survival risk stratification using the nomogram

  3. Diabetes Mellitus as a Risk Factor in Glaucoma's Physiopathology and Surgical Survival Time: A Literature Review.

    PubMed

    Costa, Lívio; Cunha, João Paulo; Amado, Duarte; Pinto, Luís Abegão; Ferreira, Joana

    2015-01-01

    Glaucoma is a multifactorial condition under serious influence of many risk factors. The role of diabetes mellitus (DM) in glaucoma etiology or progression remains inconclusive. Although, the diabetic patients have different healing mechanism comparing to the general population and it has a possible-negative role on surgical outcomes. This review article attempts to analyze the association of both diseases, glaucoma and DM, before and after the surgery. The epidemiological studies, based mainly in population prevalence analyzes, have shown opposite outcomes in time and even in the most recent articles also the association remains inconclusive. On the contrary, the experimental models based on animal induced chronic hyperglycemia have shown an important association of both diseases, explained by common neurodegenerative mechanisms. Diabetic patients have a different wound healing process in the eye viz-a-viz other organs. The healing process is more and it results in lower surgical survival time, higher intraocular pressure (IOP) levels and, therefore, these patients usually need more medication to lower the IOP. Both randomized and nonrandomized retrospective and experimental molecular studies have shown the association between DM and glaucoma. Further studies are needed to get better explanations about outcomes on more recent surgical procedures and with the exponential use of antifibrotics. How to cite this article: Costa L, Cunha JP, Amado D, Pinto LA, Ferreira J. Diabetes Mellitus as a Risk Factor in Glaucoma's Physiopathology and Surgical Survival Time: A Literature Review. J Curr Glaucoma Pract 2015;9(3):81-85. PMID:26997842

  4. Re-Entry Survivability Risk Assessment of the Extreme Ultraviolet Explorer (EUVE)

    NASA Technical Reports Server (NTRS)

    O'Hara, Robin E.; Johnson, Nicholas L.

    2001-01-01

    A reentry analysis of the Extreme Ultraviolet Explorer (EUVE) spacecraft was performed using the Object Reentry Survival Analysis Tool (ORSAT) - Version 5.0. The analysis was done in response to a request by NASA Headquarters and Goddard Space Flight Center (GSFC) after a preliminary assessment using the NASA Johnson Space Center Debris Assessment Software (DAS) - Version 1.0 had shown that the EUVE reentry may produce a debris area greater than the limit set within the NASA Safety Standard 1740.14 guidelines. DAS predicted that an uncontrolled reentry of the EUVE spacecraft would result in a total casualty area of 12.41 sq m, which exceeds the 8 sq m limit set in the NASA standards and implies a potential human casualty risk of approximately 1 in 5300. The ORSAT model enabled a higher fidelity thermal analysis of the EUVE spacecraft, utilizing sophisticated material and thermal properties such as emissivity, heat of oxidation, thermal conductivity, and material thickness inputs, which provided a foundation for a more in depth analysis of the reentering objects. Due to the conservative nature of the DAS study, it was reasonable to run ORSAT for only the ten objects shown to survive in the original DAS analysis. The result of the ORSAT study was a reduced casualty area of only 5.95 sq m, well within NASA safety limits. With the risk to human life now acceptably low, NASA can avoid having to take mitigation measures and allow EUVE to reenter the Earth's atmosphere uncontrolled.

  5. Prediction of recurrence-free survival using a protein expression-based risk classifier for head and neck cancer

    PubMed Central

    Chauhan, S S; Kaur, J; Kumar, M; Matta, A; Srivastava, G; Alyass, A; Assi, J; Leong, I; MacMillan, C; Witterick, I; Colgan, T J; Shukla, N K; Thakar, A; Sharma, M C; Siu, K W M; Walfish, P G; Ralhan, R

    2015-01-01

    Loco-regional recurrence in 50% of oral squamous cell carcinoma (OSCC) patients poses major challenge for oncologists. Lack of biomarkers that can predict disease aggressiveness and recurrence risk makes the scenario more dismal. On the basis of our earlier global proteomic analyses we identified five differentially expressed proteins in OSCC. This study aimed to develop protein biomarkers-based prognostic risk prediction model for OSCC. Sub-cellular expression of five proteins, S100A7, heterogeneous nuclear ribonucleoproteinK (hnRNPK), prothymosin α (PTMA), 14-3-3ζ and 14-3-3σ was analyzed by immunohistochemistry in test set (282 Indian OSCCs and 209 normal tissues), correlated with clinic–pathological parameters and clinical outcome over 12 years to develop a risk model for prediction of recurrence-free survival. This risk classifier was externally validated in 135 Canadian OSCC and 96 normal tissues. Biomarker signature score based on PTMA, S100A7 and hnRNPK was associated with recurrence free survival of OSCC patients (hazard ratio=1.11; 95% confidence interval 1.08, 1.13, P<0.001, optimism-corrected c-statistic=0.69) independent of clinical parameters. Biomarker signature score stratified OSCC patients into high- and low-risk groups with significant difference for disease recurrence. The high-risk group had median survival 14 months, and 3-year survival rate of 30%, whereas low-risk group survival probability did not reach 50%, and had 3-year survival rate of 71%. As a powerful predictor of 3-year recurrence-free survival in OSCC patients, the newly developed biomarkers panel risk classifier will facilitate patient counseling for personalized treatment. PMID:25893634

  6. Systemic lupus erythematosus complicated by diffuse alveolar haemorrhage: risk factors, therapy and survival

    PubMed Central

    Kazzaz, Nayef M; Coit, Patrick; Lewis, Emily E; McCune, W Joseph; Sawalha, Amr H; Knight, Jason S

    2015-01-01

    Objectives While diffuse alveolar haemorrhage (DAH) is recognised as a life-threatening complication of systemic lupus erythematosus (SLE), little is known about its risk factors and response to treatment. We describe 22 cases of DAH in a US lupus cohort of approximately 1000 patients, and compare them to 66 controls from the same outpatient cohort. Methods We captured variables pertaining to diagnoses of SLE and secondary antiphospholipid syndrome (APS), and analysed them by univariate testing. Those variables with p values <0.05 were then further considered in a multivariate model. Kaplan-Meier curves were constructed for each group, and survival was analysed by Log-rank test. Results Of the 22 patients with DAH, 59% were diagnosed with DAH within 5 years of lupus diagnosis. By univariate testing, several manifestations of SLE and APS were more common in patients with DAH, including history of thrombocytopenia, cardiac valve disease, low C3, leucopenia, neuropsychiatric features, haemolysis, arterial thrombosis, lupus anticoagulant, secondary APS and low C4. On multivariate analysis, history of thrombocytopenia and low C3 were maintained as independent risk factors. Importantly, only two patients had platelet counts <50 000/µL at the time of the DAH episode, arguing that DAH was not simply a haemorrhagic complication of thrombocytopenia. All patients were treated with increased immunosuppression, including various combinations of corticosteroids, plasmapheresis, cyclophosphamide, rituximab and mycophenolate mofetil. Notably, all patients in the cohort survived their initial episode of DAH. While the patients with DAH did well in the short-term, their long-term survival was significantly worse than controls. Several of the deaths were attributable to thrombotic complications after recovering from DAH. Conclusions To the best of our knowledge, this is the largest case–control study of lupus DAH to date. History of thrombocytopenia was strongly predictive of

  7. VEGFA, FLT1, KDR and colorectal cancer: assessment of disease risk, tumor molecular phenotype, and survival.

    PubMed

    Slattery, Martha L; Lundgreen, Abbie; Wolff, Roger K

    2014-02-01

    Angiogenesis is essential for tumor progression. Vascular endothelial growth factor (VEGFA) and its receptors 1 (FLT1) and 2 (KDR), have been identified as major mediators of this process. We hypothesized that genetic variation in FLT1 (38 SNPs), KDR (22 SNPS), and VEGFA (11 SNPs) would be associated with colon and rectal cancer development and survival. Data from a case-control study of 1555 colon cancer cases and 1956 controls and 754 rectal cancer cases and 959 controls were used. An adaptive rank truncation product (ARTP), based on 10,000 permutations, was used to determine the statistical significance of the candidate genes and angiogenesis pathway. Based on ARTP results, FLT1 was significantly associated with risk of colon cancer (P(ARTP) = 0.045) and VEGFA was significantly associated with rectal cancer (P(ARTP) = 0.036). After stratifying by tumor molecular subtype, SNP associations observed for colon cancer were: VEGFA rs2010963 with CIMP+ colon tumors; FLT1 rs4771249 and rs7987649 with TP53; FLT1 rs3751397, rs7337610, rs7987649, and rs9513008 and KDR rs10020464, rs11941492, and rs12498529 with MSI+ and CIMP+/KRAS2-mutated tumors. FLT1 rs2296189 and rs600640 were associated with CIMP+ rectal tumors and FLT1 rs7983774 was associated with TP53-mutated rectal tumors. Four SNPs in FLT1 were associated with colon cancer survival while three SNPs in KDR were associated with survival after diagnosis with rectal cancer. Aspirin/NSAID use, smoking cigarettes, and BMI modified the associations. These findings suggest the importance of inflammation and angiogenesis in the etiology of colorectal cancer and that genetic and lifestyle factors may be targets for modulating disease risk. PMID:23794399

  8. The LD Adolescent at Risk: Developmental Tasks, Social Competence, and Communication Effectiveness.

    ERIC Educational Resources Information Center

    Jackson, Moss A.

    1987-01-01

    Key developmental tasks of adolescence and the unique problems that face the learning-disabled adolescent are outlined, focusing on the role of social competency and communication effectiveness. Components of a comprehensive social competency training program include the nature of the learning disability, the affective-defensive pattern, adaptive…

  9. Transferable Competences of Young People with a High Dropout Risk in Vocational Training in Germany

    ERIC Educational Resources Information Center

    Frey, Andreas; Balzer, Lars; Ruppert, Jean-Jacques

    2014-01-01

    This paper examines whether the subjective beliefs on their competences of 409 trainees in machinery, sales, and logistics constitute a reliable and valid way to measure transferable competences. The analysis of results attributes satisfactory to good reliability values to the assessment procedure. Furthermore, it could be shown that young people…

  10. Percutaneous radiofrequency ablation for early hepatocellular carcinoma: Risk factors for survival

    PubMed Central

    Kikuchi, Luciana; Menezes, Marcos; Chagas, Aline L; Tani, Claudia M; Alencar, Regiane SSM; Diniz, Marcio A; Alves, Venâncio AF; D’Albuquerque, Luiz Augusto Carneiro; Carrilho, Flair José

    2014-01-01

    AIM: To evaluate outcomes of radiofrequency ablation (RFA) therapy for early hepatocellular carcinoma (HCC) and identify survival- and recurrence-related factors. METHODS: Consecutive patients diagnosed with early HCC by computed tomography (CT) or magnetic resonance imaging (MRI) (single nodule of ≤ 5 cm, or multi- (up to 3) nodules of ≤ 3 cm each) and who underwent RFA treatment with curative intent between January 2010 and August 2011 at the Instituto do Câncer do Estado de São Paulo, Brazil were enrolled in the study. RFA of the liver tumors (with 1.0 cm ablative margin) was carried out under CT-fluoro scan and ultrasonic image guidance of the percutaneous ablation probes. Procedure-related complications were recorded. At 1-mo post-RFA and 3-mo intervals thereafter, CT and MRI were performed to assess outcomes of complete response (absence of enhancing tissue at the tumor site) or incomplete response (enhancing tissue remaining at the tumor site). Overall survival and disease-free survival rates were estimated by the Kaplan-Meier method and compared by the log rank test or simple Cox regression. The effect of risk factors on survival was assessed by the Cox proportional hazard model. RESULTS: A total of 38 RFA sessions were performed during the study period on 34 patients (age in years: mean, 63 and range, 49-84). The mean follow-up time was 22 mo (range, 1-33). The study population showed predominance of male sex (76%), less severe liver disease (Child-Pugh A, n = 26; Child-Pugh B, n = 8), and single tumor (65%). The maximum tumor diameters ranged from 10 to 50 mm (median, 26 mm). The initial (immediately post-procedure) rate of RFA-induced complete tumor necrosis was 90%. The probability of achieving complete response was significantly greater in patients with a single nodule (vs patients with multi-nodules, P = 0.04). Two patients experienced major complications, including acute pulmonary edema (resolved with intervention) and intestinal perforation

  11. Finding Risk Groups by Optimizing Artificial Neural Networks on the Area under the Survival Curve Using Genetic Algorithms

    PubMed Central

    Kalderstam, Jonas; Edén, Patrik; Ohlsson, Mattias

    2015-01-01

    We investigate a new method to place patients into risk groups in censored survival data. Properties such as median survival time, and end survival rate, are implicitly improved by optimizing the area under the survival curve. Artificial neural networks (ANN) are trained to either maximize or minimize this area using a genetic algorithm, and combined into an ensemble to predict one of low, intermediate, or high risk groups. Estimated patient risk can influence treatment choices, and is important for study stratification. A common approach is to sort the patients according to a prognostic index and then group them along the quartile limits. The Cox proportional hazards model (Cox) is one example of this approach. Another method of doing risk grouping is recursive partitioning (Rpart), which constructs a decision tree where each branch point maximizes the statistical separation between the groups. ANN, Cox, and Rpart are compared on five publicly available data sets with varying properties. Cross-validation, as well as separate test sets, are used to validate the models. Results on the test sets show comparable performance, except for the smallest data set where Rpart’s predicted risk groups turn out to be inverted, an example of crossing survival curves. Cross-validation shows that all three models exhibit crossing of some survival curves on this small data set but that the ANN model manages the best separation of groups in terms of median survival time before such crossings. The conclusion is that optimizing the area under the survival curve is a viable approach to identify risk groups. Training ANNs to optimize this area combines two key strengths from both prognostic indices and Rpart. First, a desired minimum group size can be specified, as for a prognostic index. Second, the ability to utilize non-linear effects among the covariates, which Rpart is also able to do. PMID:26352405

  12. Adjuvant chemotherapy is not associated with improved survival for all high-risk factors in stage II colon cancer.

    PubMed

    Verhoeff, S R; van Erning, F N; Lemmens, V E P P; de Wilt, J H W; Pruijt, J F M

    2016-07-01

    Adjuvant chemotherapy can be considered in high-risk stage II colon cancer comprising pT4, poor/undifferentiated grade, vascular invasion, emergency surgery and/or <10 evaluated lymph nodes (LNs). Adjuvant chemotherapy administration and its effect on survival was evaluated for each known risk factor. All patients with high-risk stage II colon cancer who underwent resection and were diagnosed in the Netherlands between 2008 and 2012 were included. After stratification by risk factor(s) (vascular invasion could not be included), Cox regression was used to discriminate the independent association of adjuvant chemotherapy with the probability of death. Relative survival was used to estimate disease-specific survival. A total of 4,940 of 10,935 patients with stage II colon cancer were identified as high risk, of whom 790 (16%) patients received adjuvant chemotherapy. Patients with a pT4 received adjuvant chemotherapy more often (37%). Probability of death in pT4 patients receiving chemotherapy was lower compared to non-recipients (3-year overall survival 91% vs. 73%, HR 0.43, 95% CI 0.28-0.66). The relative excess risk (RER) of dying was also lower for pT4 patients receiving chemotherapy compared to non-recipients (3-year relative survival 94% vs. 85%, RER 0.36, 95% CI 0.17-0.74). For patients with only poor/undifferentiated grade, emergency surgery or <10 LNs evaluated, no association between receipt of adjuvant chemotherapy and survival was observed. In high-risk stage II colon cancer, adjuvant chemotherapy was associated with higher survival in pT4 only. To prevent unnecessary chemotherapy-induced toxicity, further refinement of patient subgroups within stage II colon cancer who could benefit from adjuvant chemotherapy seems indicated. PMID:26914273

  13. HDAC1 and HDAC2 independently predict mortality in hepatocellular carcinoma by a competing risk regression model in a Southeast Asian population

    PubMed Central

    LER, SER YENG; LEUNG, CAROL HO WING; KHIN, LAY WAI; LU, GUO-DONG; SALTO-TELLEZ, MANUEL; HARTMAN, MIKAEL; IAU, PHILIP TSAU CHOONG; YAP, CELESTIAL T.; HOOI, SHING CHUAN

    2015-01-01

    Histone deacetylases (HDACs) are enzymes involved in transcriptional repression. We aimed to examine the significance of HDAC1 and HDAC2 gene expression in the prediction of recurrence and survival in 156 patients with hepatocellular carcinoma (HCC) among a South East Asian population who underwent curative surgical resection in Singapore. We found that HDAC1 and HDAC2 were upregulated in the majority of HCC tissues. The presence of HDAC1 in tumor tissues was correlated with poor tumor differentiation. Notably, HDAC1 expression in adjacent non-tumor hepatic tissues was correlated with the presence of satellite nodules and multiple lesions, suggesting that HDAC1 upregulation within the field of HCC may contribute to tumor spread. Using competing risk regression analysis, we found that increased cancer-specific mortality was significantly associated with HDAC2 expression. Mortality was also increased with high HDAC1 expression. In the liver cancer cell lines, HEP3B, HEPG2, PLC5, and a colorectal cancer cell line, HCT116, the combined knockdown of HDAC1 and HDAC2 increased cell death and reduced cell proliferation as well as colony formation. In contrast, knockdown of either HDAC1 or HDAC2 alone had minimal effects on cell death and proliferation. Taken together, our study suggests that both HDAC1 and HDAC2 exert pro-survival effects in HCC cells, and the combination of isoform-specific HDAC inhibitors against both HDACs may be effective in targeting HCC to reduce mortality. PMID:26352599

  14. Competing risk models in reliability systems, a weibull distribution model with bayesian analysis approach

    NASA Astrophysics Data System (ADS)

    Iskandar, Ismed; Satria Gondokaryono, Yudi

    2016-02-01

    In reliability theory, the most important problem is to determine the reliability of a complex system from the reliability of its components. The weakness of most reliability theories is that the systems are described and explained as simply functioning or failed. In many real situations, the failures may be from many causes depending upon the age and the environment of the system and its components. Another problem in reliability theory is one of estimating the parameters of the assumed failure models. The estimation may be based on data collected over censored or uncensored life tests. In many reliability problems, the failure data are simply quantitatively inadequate, especially in engineering design and maintenance system. The Bayesian analyses are more beneficial than the classical one in such cases. The Bayesian estimation analyses allow us to combine past knowledge or experience in the form of an apriori distribution with life test data to make inferences of the parameter of interest. In this paper, we have investigated the application of the Bayesian estimation analyses to competing risk systems. The cases are limited to the models with independent causes of failure by using the Weibull distribution as our model. A simulation is conducted for this distribution with the objectives of verifying the models and the estimators and investigating the performance of the estimators for varying sample size. The simulation data are analyzed by using Bayesian and the maximum likelihood analyses. The simulation results show that the change of the true of parameter relatively to another will change the value of standard deviation in an opposite direction. For a perfect information on the prior distribution, the estimation methods of the Bayesian analyses are better than those of the maximum likelihood. The sensitivity analyses show some amount of sensitivity over the shifts of the prior locations. They also show the robustness of the Bayesian analysis within the range

  15. Medical language proficiency: A discussion of interprofessional language competencies and potential for patient risk.

    PubMed

    Hull, Melodie

    2016-02-01

    In increasingly multilingual healthcare environments worldwide, ensuring accurate, effective communication is requisite. Language proficiency is essential, particularly medical language proficiency. Medical language is a universal construct in healthcare, the shared language of health and allied health professions. It is highly evolved, career-specific, technical and cultural-bound-a language for specific purposes. Its function differs significantly from that of a standard language. Proficiency requires at minimum, a common understanding of discipline-specific jargon, abstracts, euphemisms, abbreviations; acronyms. An optimal medical language situation demands a level of competency beyond the superficial wherein one can convey or interpret deeper meanings, distinguish themes, voice opinion, and follow directions precisely. It necessitates the use of clarity, and the ability to understand both lay and formal language-characteristics not essential to standard language. Proficiency influences professional discourse and can have the potential to positively or negatively affect patient outcomes. While risks have been identified when there is language discordance between care provider and patient, almost nothing has been said about this within care teams themselves. This article will do so in anticipation that care providers, regulators, employers, and researchers will acknowledge potential language-based communication barriers and work towards resolutions. This is predicated on the fact that the growing interest in language and communication in healthcare today appears to be rested in globalization and increasingly linguistically diverse patient populations. Consideration of the linguistically diverse healthcare workforce is absent. An argument will be posited that if potential risks to patient safety exist and there are potentials for disengagement from care by patients when health providers do not speak their languages then logically these language-based issues can

  16. Risk Management. Unit 20. Level 2. Instructor Guide. PACE: Program for Acquiring Competence in Entrepreneurship. Third Edition. Research & Development Series No. 302-20.

    ERIC Educational Resources Information Center

    Ohio State Univ., Columbus. Center on Education and Training for Employment.

    This instructor guide for a unit on risk management in the PACE (Program for Acquiring Competence in Entrepreneurship) curriculum includes the full text of the student module and lesson plans, instructional suggestions, and other teacher resources. The competencies that are incorporated into this module are at Level 2 of learning--planning for a…

  17. Risk.

    PubMed

    Cole, Stephen R; Hudgens, Michael G; Brookhart, M Alan; Westreich, Daniel

    2015-02-15

    The epidemiologist primarily studies transitions between states of health and disease. The purpose of the present article is to define a foundational parameter for such studies, namely risk. We begin simply and build to the setting in which there is more than 1 event type (i.e., competing risks or competing events), as well as more than 1 treatment or exposure level of interest. In the presence of competing events, the risks are a set of counterfactual cumulative incidence functions for each treatment. These risks can be depicted visually and summarized numerically. We use an example from the study of human immunodeficiency virus to illustrate concepts. PMID:25660080

  18. Mortality Risk and Survival in the Aftermath of the Medieval Black Death

    PubMed Central

    DeWitte, Sharon N.

    2014-01-01

    The medieval Black Death (c. 1347-1351) was one of the most devastating epidemics in human history. It killed tens of millions of Europeans, and recent analyses have shown that the disease targeted elderly adults and individuals who had been previously exposed to physiological stressors. Following the epidemic, there were improvements in standards of living, particularly in dietary quality for all socioeconomic strata. This study investigates whether the combination of the selective mortality of the Black Death and post-epidemic improvements in standards of living had detectable effects on survival and mortality in London. Samples are drawn from several pre- and post-Black Death London cemeteries. The pre-Black Death sample comes from the Guildhall Yard (n = 75) and St. Nicholas Shambles (n = 246) cemeteries, which date to the 11th–12th centuries, and from two phases within the St. Mary Spital cemetery, which date to between 1120-1300 (n = 143). The St. Mary Graces cemetery (n = 133) was in use from 1350–1538 and thus represents post-epidemic demographic conditions. By applying Kaplan-Meier analysis and the Gompertz hazard model to transition analysis age estimates, and controlling for changes in birth rates, this study examines differences in survivorship and mortality risk between the pre- and post-Black Death populations of London. The results indicate that there are significant differences in survival and mortality risk, but not birth rates, between the two time periods, which suggest improvements in health following the Black Death, despite repeated outbreaks of plague in the centuries after the Black Death. PMID:24806459

  19. Frequency, Risk Factors and Survival Associated with an Intrasubsegmental Recurrence after Radiofrequency Ablation for Hepatocellular Carcinoma

    PubMed Central

    Tateishi, Ryosuke; Shiina, Shuichiro; Akahane, Masaaki; Sato, Jiro; Kondo, Yuji; Masuzaki, Ryota; Nakagawa, Hayato; Asaoka, Yoshinari; Goto, Tadashi; Otomo, Kuni; Omata, Masao; Yoshida, Haruhiko; Koike, Kazuhiko

    2013-01-01

    Background In the treatment of hepatocellular carcinoma (HCC), hepatic resection has the advantage over radiofrequency ablation (RFA) in terms of systematic removal of a hepatic segment. Methods We enrolled 303 consecutive patients of a single naïve HCC that had been treated by RFA at The University of Tokyo Hospital from 1999 to 2004. Recurrence was categorized as either intra- or extra-subsegmental as according to the Couinaud's segment of the original nodule. To assess the relationship between the subsegments of the original and recurrent nodules, we calculated the kappa coefficient. We assessed the risk factors for intra- and extra-subsegmental recurrence independently using univariate and multivariate Cox proportional hazard regression. We also assessed the impact of the mode of recurrence on the survival outcome. Results During the follow-up period, 201 patients in our cohort showed tumor recurrence distributed in a total of 340 subsegments. Recurrence was categorized as exclusively intra-subsegmental, exclusively extra-subsegmental, and simultaneously intra- and extra-subsegmental in 40 (20%), 110 (55%), and 51 (25%) patients, respectively. The kappa coefficient was measured at 0.135 (95% CI, 0.079–0.190; P<0.001). Multivariate analysis revealed that of the tumor size, AFP value and platelet count were all risk factors for both intra- and extra-subsegmental recurrence. Of the patients in whom recurrent HCC was found to be exclusively intra-subsegmental, extra-subsegmental, and simultaneously intra- and extra-subsegmental, 37 (92.5%), 99 (90.8%) and 42 (82.3%), respectively, were treated using RFA. The survival outcomes after recurrence were similar between patients with an exclusively intra- or extra-subsegmental recurrence. Conclusions The effectiveness of systematic subsegmentectomy may be limited in the patients with both HCC and chronic liver disease who frequently undergo multi-focal tumor recurrence. PMID:23593129

  20. Mortality risk and survival in the aftermath of the medieval Black Death.

    PubMed

    DeWitte, Sharon N

    2014-01-01

    The medieval Black Death (c. 1347-1351) was one of the most devastating epidemics in human history. It killed tens of millions of Europeans, and recent analyses have shown that the disease targeted elderly adults and individuals who had been previously exposed to physiological stressors. Following the epidemic, there were improvements in standards of living, particularly in dietary quality for all socioeconomic strata. This study investigates whether the combination of the selective mortality of the Black Death and post-epidemic improvements in standards of living had detectable effects on survival and mortality in London. Samples are drawn from several pre- and post-Black Death London cemeteries. The pre-Black Death sample comes from the Guildhall Yard (n = 75) and St. Nicholas Shambles (n = 246) cemeteries, which date to the 11th-12th centuries, and from two phases within the St. Mary Spital cemetery, which date to between 1120-1300 (n = 143). The St. Mary Graces cemetery (n = 133) was in use from 1350-1538 and thus represents post-epidemic demographic conditions. By applying Kaplan-Meier analysis and the Gompertz hazard model to transition analysis age estimates, and controlling for changes in birth rates, this study examines differences in survivorship and mortality risk between the pre- and post-Black Death populations of London. The results indicate that there are significant differences in survival and mortality risk, but not birth rates, between the two time periods, which suggest improvements in health following the Black Death, despite repeated outbreaks of plague in the centuries after the Black Death. PMID:24806459

  1. Twitter as a Potential Disaster Risk Reduction Tool. Part IV: Competency-based Education and Training Guidelines to Promote Community Resiliency.

    PubMed

    Yeager, Violet; Cooper, Guy Paul; Burkle, Frederick M; Subbarao, Italo

    2015-01-01

    Twitter can be an effective tool for disaster risk reduction but gaps in education and training exist in current public health and disaster management educational competency standards.  Eleven core public health and disaster management competencies are proposed that incorporate Twitter as a tool for effective disaster risk reduction.  Greater funding is required to promote the education and training of this tool for those in professional schools and in the current public health and disaster management workforce. PMID:26203398

  2. Decreased Kidney Graft Survival in Low Immunological Risk Patients Showing Inflammation in Normal Protocol Biopsies

    PubMed Central

    Helanterä, Ilkka; Melilli, Edoardo; Honkanen, Eero; Bestard, Oriol; Grinyo, Josep M.; Cruzado, Josep M.

    2016-01-01

    Introduction The pros and cons for implementing protocol biopsies (PB) after kidney transplantation are still a matter of debate. We aimed to address the frequency of pathological findings in PB, to analyze their impact on long-term graft survival (GS) and to analyze the risk factors predicting an abnormal histology. Methods We analyzed 946 kidney PB obtained at a median time of 6.5 (±2.9) months after transplantation. Statistics included comparison between groups, Kaplan-Meier and multinomial logistic regression analysis. Results and Discussion PB diagnosis were: 53.4% normal; 46% IFTA; 12.3% borderline and 4.9% had subclinical acute rejection (SCAR). Inflammation had the strongest negative impact on GS. Therefore we split the cases into: “normal without inflammation”, “normal with inflammation”, “IFTA without inflammation”, “IFTA with inflammation” and “rejection” (including SCAR and borderline). 15-year GS in PB diagnosed normal with inflammation was significantly decreased in a similar fashion as in rejection cases. Among normal biopsies, inflammation increased significantly the risk of 15-y graft loss (P = 0.01). Variables that predicted an abnormal biopsy were proteinuria, previous AR and DR-mismatch. Conclusion We conclude that inflammation in normal PB is associated with a significantly lower 15-y GS, comparable to rejection or IFTA with inflammation. PMID:27532630

  3. Validation of a modified clinical risk score to predict cancer-specific survival for stage II colon cancer

    PubMed Central

    Oliphant, Raymond; Horgan, Paul G; Morrison, David S; McMillan, Donald C

    2015-01-01

    Many patients with stage II colon cancer will die of their disease despite curative surgery. Therefore, identification of patients at high risk of poor outcome after surgery for stage II colon cancer is desirable. This study aims to validate a clinical risk score to predict cancer-specific survival in patients undergoing surgery for stage II colon cancer. Patients undergoing surgery for stage II colon cancer in 16 hospitals in the West of Scotland between 2001 and 2004 were identified from a prospectively maintained regional clinical audit database. Overall and cancer-specific survival rates up to 5 years were calculated. A total of 871 patients were included. At 5 years, cancer-specific survival was 81.9% and overall survival was 65.6%. On multivariate analysis, age ≥75 years (hazard ratio (HR) 2.11, 95% confidence intervals (CI) 1.57–2.85; P<0.001) and emergency presentation (HR 1.97, 95% CI 1.43–2.70; P<0.001) were independently associated with cancer-specific survival. Age and mode of presentation HRs were added to form a clinical risk score of 0–2. The cancer-specific survival at 5 years for patients with a cumulative score 0 was 88.7%, 1 was 78.2% and 2 was 65.9%. These results validate a modified simple clinical risk score for patients undergoing surgery for stage II colon cancer. The combination of these two universally documented clinical factors provides a solid foundation for the examination of the impact of additional clinicopathological and treatment factors on overall and cancer-specific survival. PMID:25487740

  4. Covert Hepatic Encephalopathy Is Independently Associated With Poor Survival and Increased Risk of Hospitalization

    PubMed Central

    Patidar, Kavish R.; Thacker, Leroy R.; Wade, James B.; Sterling, Richard K.; Sanyal, Arun J.; Siddiqui, Mohammad S.; Matherly, Scott C.; Stravitz, R. Todd; Puri, Puneet; Luketic, Velimir A.; Fuchs, Michael; White, Melanie B.; Noble, Nicole A.; Unser, Ariel B.; Gilles, HoChong; Heuman, Douglas M.; Bajaj, Jasmohan S.

    2015-01-01

    OBJECTIVES Despite the high prevalence of covert hepatic encephalopathy (CHE) in cirrhotics without previous overt HE (OHE), its independent impact on predicting clinically relevant outcomes is unclear. The aim of this study was to define the impact of CHE on time to OHE, hospitalization, and death/transplant in prospectively followed up patients without previous OHE. METHODS Outpatient cirrhotics without OHE were enrolled and were administered a standard paper–pencil cognitive battery for CHE diagnosis. They were systematically followed up and time to first OHE development, hospitalization (liver-related/unrelated), and transplant/death were compared between CHE and no-CHE patients at baseline using Cox regression. RESULTS A total of 170 cirrhotic patients (55 years, 58% men, 14 years of education, Model for End-Stage Liver Disease (MELD 9), 53% hepatitis C virus (HCV), 20% nonalcoholic etiology) were included, of whom 56% had CHE. The entire population was followed up for 13.0±14.6 months, during which time 30% developed their first OHE episode, 42% were hospitalized, and 19% had a composite death/transplant outcome. Age, gender, etiology, the MELD score, and CHE status were included in Cox regression models for time to first OHE episode, hospitalization, death, and composite death/transplant outcomes. On Cox regression, despite controlling for MELD, those with CHE had a higher risk of developing OHE (hazard ratio: 2.1, 95% confidence interval 1.01–4.5), hospitalization (hazard ratio: 2.5, 95% confidence interval 1.4–4.5), and death/transplant (hazard ratio: 3.4, 95% confidence interval 1.2–9.7) in the follow-up period. CONCLUSIONS Covert HE is associated with worsened survival and increased risk of hospitalization and OHE development, despite controlling for the MELD score. Strategies to detect and treat CHE may improve these risks. PMID:25178701

  5. Risk communication as a core public health competence in infectious disease management: Development of the ECDC training curriculum and programme.

    PubMed

    Dickmann, Petra; Abraham, Thomas; Sarkar, Satyajit; Wysocki, Piotr; Cecconi, Sabrina; Apfel, Franklin; Nurm, Ülla-Karin

    2016-01-01

    Risk communication has been identified as a core competence for guiding public health responses to infectious disease threats. The International Health Regulations (2005) call for all countries to build capacity and a comprehensive understanding of health risks before a public health emergency to allow systematic and coherent communication, response and management. Research studies indicate that while outbreak and crisis communication concepts and tools have long been on the agenda of public health officials, there is still a need to clarify and integrate risk communication concepts into more standardised practices and improve risk communication and health, particularly among disadvantaged populations. To address these challenges, the European Centre for Disease Prevention and Control (ECDC) convened a group of risk communication experts to review and integrate existing approaches and emerging concepts in the development of a training curriculum. This curriculum articulates a new approach in risk communication moving beyond information conveyance to knowledge- and relationship-building. In a pilot training this approach was reflected both in the topics addressed and in the methods applied. This article introduces the new conceptual approach to risk communication capacity building that emerged from this process, presents the pilot training approach developed, and shares the results of the course evaluation. PMID:27103616

  6. Instructional Climates in Preschool Children Who Are At-Risk. Part II: Perceived Physical Competence

    ERIC Educational Resources Information Center

    Robinson, Leah E.; Rudisill, Mary E.; Goodway, Jacqueline D.

    2009-01-01

    In Part II of this study, we examined the effect of two 9-week instructional climates (low-autonomy [LA] and mastery motivational climate [MMC]) on perceived physical competence (PPC) in preschoolers (N = 117). Participants were randomly assigned to an LA, MMC, or comparison group. PPC was assessed by a pretest, posttest, and retention test with…

  7. Enhancing Parental Competencies for High Risk Mothers: An Evaluation of Prevention Effects.

    ERIC Educational Resources Information Center

    Resnick, Gary

    1985-01-01

    A 3-year study examined effects of two prevention programs (life-skills esteem-building and life-skills parent-training) for sole-support mothers with school-aged children. Lack of competency enhancement effects appeared to be a function of reduced exposure to the interventions. There was no support for connections between short-term competency…

  8. Risk and Protective Factors for Children of Adolescents: Maternal Depression and Parental Sense of Competence

    ERIC Educational Resources Information Center

    Knoche, Lisa L.; Givens, Jami E.; Sheridan, Susan M.

    2007-01-01

    We investigated the relationship between depression and parental sense of competence to child cognitive outcomes for a sample of 49 adolescent mothers and their young children ("Mean age" = 9 1/2 months) enrolled in a student parenting program. Cognitive development of the infants and toddlers was assessed using the Bayley Scales of Infant…

  9. Core Competency Modification. A Manual for Working with At-Risk/Special Needs Students.

    ERIC Educational Resources Information Center

    Loess Hills Area Education Agency 13, Council Bluffs, IA.

    This manual assists teachers in providing adaptations for disabled and disadvantaged students to ensure their success in the regular vocational classroom and to meet requirements of the new vocational education standards in Iowa, which call for a competency-based curriculum. Introductory pages include strategies for teaching special needs…

  10. Effects of maternal nutrition, resource use and multi-predator risk on neonatal white-tailed deer survival.

    PubMed

    Duquette, Jared F; Belant, Jerrold L; Svoboda, Nathan J; Beyer, Dean E; Lederle, Patrick E

    2014-01-01

    Growth of ungulate populations is typically most sensitive to survival of neonates, which in turn is influenced by maternal nutritional condition and trade-offs in resource selection and avoidance of predators. We assessed whether resource use, multi-predator risk, maternal nutritional effects, hiding cover, or interactions among these variables best explained variation in daily survival of free-ranging neonatal white-tailed deer (Odocoileus virginianus) during their post-partum period (14 May-31 Aug) in Michigan, USA. We used Cox proportional hazards mixed-effects models to assess survival related to covariates of resource use, composite predation risk of 4 mammalian predators, fawn body mass at birth, winter weather, and vegetation growth phenology. Predation, particularly from coyotes (Canis latrans), was the leading cause of mortality; however, an additive model of non-ideal resource use and maternal nutritional effects explained 71% of the variation in survival. This relationship suggested that dams selected areas where fawns had poor resources, while greater predation in these areas led to additive mortalities beyond those related to resource use alone. Also, maternal nutritional effects suggested that severe winters resulted in dams producing smaller fawns, which decreased their likelihood of survival. Fawn resource use appeared to reflect dam avoidance of lowland forests with poor forage and greater use by wolves (C. lupus), their primary predator. While this strategy led to greater fawn mortality, particularly by coyotes, it likely promoted the life-long reproductive success of dams because many reached late-age (>10 years old) and could have produced multiple generations of fawns. Studies often link resource selection and survival of ungulates, but our results suggested that multiple factors can mediate that relationship, including multi-predator risk. We emphasize the importance of identifying interactions among biological and environmental factors when

  11. A Competence-Based Science Learning Framework Illustrated Through the Study of Natural Hazards and Disaster Risk Reduction

    NASA Astrophysics Data System (ADS)

    Oyao, Sheila G.; Holbrook, Jack; Rannikmäe, Miia; Pagunsan, Marmon M.

    2015-09-01

    This article proposes a competence-based learning framework for science teaching, applied to the study of 'big ideas', in this case to the study of natural hazards and disaster risk reduction (NH&DRR). The framework focuses on new visions of competence, placing emphasis on nurturing connectedness and behavioral actions toward resilience and sustainability. The framework draws together competences familiarly expressed as cognitive knowledge and skills, plus dispositions and adds connectedness and action-related behaviors, and applies this by means of a progression shift associated with NH&DRR from abilities to capabilities. The target is enhanced scientific literacy approached through an education through science focus, amplified through the study of a big idea, promotion of sustained resilience in the face of disaster and the taking of responsibilities for behavioral actions. The framework is applied to a learning progression for each interrelated education dimension, thus serving as a guide for both the development of abilities and as a platform for stimulating student capabilities within instruction and assessment.

  12. Successful survival, growth, and reproductive potential of quagga mussels in low calcium lake water: is there uncertainty of establishment risk?

    PubMed

    Davis, Clinton J; Ruhmann, Emma K; Acharya, Kumud; Chandra, Sudeep; Jerde, Christopher L

    2015-01-01

    The risk of quagga mussel (Dreissena rostriformis bugensis Andrusov 1897) establishment into water-bodies of the western US has expanded the geographic concern regarding the ecological and economic impacts this species will have in aquatic ecosystems. Thresholds based on calcium concentrations, an element critical for mussel growth and physiology, have been used as a primary predictor of quagga mussel establishment success to aid management decisions. We evaluated the invasion potential of quagga mussels in low calcium waters using laboratory experiments to compare the survival, growth and reproductive potential of adult mussels held for 90 days at low (9 and 12 ppm), moderate (15 to 32 ppm) and high (72 ppm) calcium water concentrations. In conjunction with adult experiments, veliger stage survival, growth and settlement were evaluated under similar low, moderate, and high calcium water treatments. Adult mussels survived, grew and showed reproductive potential in low calcium water (12 ppm). Veligers were also able to survive, grow and settle in low calcium water. Higher levels of natural seston biomass appeared to improve adult mussel life history performance in low calcium water. Survival curve analysis predicted that 99% adult mortality could occur in <170 days at 9 ppm and 12 ppm, however water with >15 ppm could have adults surviving more than a year. The results from these bioassays provide further evidence that quagga mussels have higher risk of establishment in low calcium lakes if habitats exist that have slightly elevated calcium. These results should help emphasize the vulnerability of water-body in the 12 to 15 ppm calcium range that could potentially be at risk of establishing sustainable quagga mussel populations. Furthermore, these results provide insights into the uncertainty of using a single parameter in assigning establishment risk given the complexity of variables in specific water-bodies that influence life history performance of introduced

  13. Predicting long-term risk for relationship dissolution using nonparametric conditional survival trees.

    PubMed

    Kliem, Sören; Weusthoff, Sarah; Hahlweg, Kurt; Baucom, Katherine J W; Baucom, Brian R

    2015-12-01

    Identifying risk factors for divorce or separation is an important step in the prevention of negative individual outcomes and societal costs associated with relationship dissolution. Programs that aim to prevent relationship distress and dissolution typically focus on changing processes that occur during couple conflict, although the predictive ability of conflict-specific variables has not been examined in the context of other factors related to relationship dissolution. The authors examine whether emotional responding and communication during couple conflict predict relationship dissolution after controlling for overall relationship quality and individual well-being. Using nonparametric conditional survival trees, the study at hand simultaneously examined the predictive abilities of physiological (systolic and diastolic blood pressure, heart rate, cortisol) and behavioral (fundamental frequency; f0) indices of emotional responding, as well as observationally coded positive and negative communication behavior, on long-term relationship stability after controlling for relationship satisfaction and symptoms of depression. One hundred thirty-six spouses were assessed after participating in a randomized clinical trial of a relationship distress prevention program as well as 11 years thereafter; 32.5% of the couples' relationships had dissolved by follow up. For men, the only significant predictor of relationship dissolution was cortisol change score (p = .012). For women, only f0 range was a significant predictor of relationship dissolution (p = .034). These findings highlight the importance of emotional responding during couple conflict for long-term relationship stability. PMID:26192131

  14. Risks, dangers and competing clinical decisions on venous thromboembolism prophylaxis in hospital care.

    PubMed

    Boiko, Olga; Sheaff, Rod; Child, Susan; Gericke, Christian A

    2014-07-01

    Drawing on wider sociologies of risk, this article examines the complexity of clinical risks and their management, focusing on risk management systems, expert decision-making and safety standards in health care. At the time of this study preventing venous thromboembolism (VTE) among in-patients was one of the top priorities for hospital safety in the English National Health Service (NHS). An analysis of 50 interviews examining hospital professionals' perceptions about VTE risks and prophylaxis illuminates how National Institute for Health and Clinical Excellence (NICE) guidelines influenced clinical decision-making in four hospitals in one NHS region. We examine four themes: the identification of new risks, the institutionalisation and management of risk, the relationship between risk and danger and the tensions between risk management systems and expert decision-making. The implementation of NICE guidelines for VTE prevention extended managerial control over risk management but some irreducible clinical dangers remained that were beyond the scope of the new VTE risk management systems. Linking sociologies of risk with the realities of hospital risk management reveals the capacity of these theories to illuminate both the possibilities and the limits of managerialism in health care. PMID:24635764

  15. Conceptualizing and Re-Evaluating Resilience across Levels of Risk, Time, and Domains of Competence

    ERIC Educational Resources Information Center

    Vanderbilt-Adriance, Ella; Shaw, Daniel S.

    2008-01-01

    This article examines potential theoretical constraints on resilience across levels of risk, time, and domain of outcome. Studies of resilience are reviewed as they relate to the prevalence of resilience across levels of risk (e.g., single life events vs. cumulative risk), time, and domains of adjustment. Based on a thorough review of pertinent…

  16. Assessing treatment benefit with competing risks not affected by the randomized treatment.

    PubMed

    Korn, Edward L; Dignam, James J; Freidlin, Boris

    2015-01-30

    The comparison of overall survival curves between treatment arms will always be of interest in a randomized clinical trial involving a life-shortening disease. In some settings, the experimental treatment is only expected to affect the deaths caused by the disease, and the proportion of deaths caused by the disease is relatively low. In these settings, the ability to assess treatment-effect differences between Kaplan-Meier survival curves can be hampered by the large proportion of deaths in both arms that are unrelated to the disease. To address this problem, frequently displayed are cause-specific survival curves or cumulative incidence curves, which respectively censor and immortalize events (deaths) not caused by the disease. However, the differences between the experimental and control treatment arms for these curves overestimate the difference between the overall survival curves for the treatment arms and thus could result in overestimation of the benefit of the experimental treatment for the patients. To address this issue, we propose new estimators of overall survival for the treatment arms that are appropriate when the treatment does not affect the non-disease-related deaths. These new estimators give a more precise estimate of the treatment benefit, potentially enabling future patients to make a more informed decision concerning treatment choice. We also consider the case where an exponential assumption allows the simple presentation of mortality rates as the outcome measures. Applications are given for estimating overall survival in a prostate-cancer treatment randomized clinical trial, and for estimating the overall mortality rates in a prostate-cancer screening trial. PMID:25363739

  17. Pre-Transplant Cardiovascular Risk Factors Affect Kidney Allograft Survival: A Multi-Center Study in Korea

    PubMed Central

    Lee, Jung Pyo; Bae, Eunjin; Kang, Eunjeong; Kim, Hack-Lyoung; Kim, Yong-Jin; Oh, Yun Kyu; Kim, Yon Su; Kim, Young Hoon; Lim, Chun Soo

    2016-01-01

    Background Pre-transplant cardiovascular (CV) risk factors affect the development of CV events even after successful kidney transplantation (KT). However, the impact of pre-transplant CV risk factors on allograft failure (GF) has not been reported. Methods and Findings We analyzed the graft outcomes of 2,902 KT recipients who were enrolled in a multi-center cohort from 1997 to 2012. We calculated the pre-transplant CV risk scores based on the Framingham risk model using age, gender, total cholesterol level, smoking status, and history of hypertension. Vascular disease (a composite of ischemic heart disease, peripheral vascular disease, and cerebrovascular disease) was noted in 6.5% of the patients. During the median follow-up of 6.4 years, 286 (9.9%) patients had developed GF. In the multivariable-adjusted Cox proportional hazard model, pre-transplant vascular disease was associated with an increased risk of GF (HR 2.51; 95% CI 1.66–3.80). The HR for GF (comparing the highest with the lowest tertile regarding the pre-transplant CV risk scores) was 1.65 (95% CI 1.22–2.23). In the competing risk model, both pre-transplant vascular disease and CV risk score were independent risk factors for GF. Moreover, the addition of the CV risk score, the pre-transplant vascular disease, or both had a better predictability for GF compared to the traditional GF risk factors. Conclusions In conclusion, both vascular disease and pre-transplant CV risk score were independently associated with GF in this multi-center study. Pre-transplant CV risk assessments could be useful in predicting GF in KT recipients. PMID:27501048

  18. Genetic Variants in Matrix Metalloproteinase Genes as Disposition Factors for Ovarian Cancer Risk, Survival, and Clinical Outcome

    PubMed Central

    Wang, Yan; Ye, Yuanqing; Lin, Jie; Meyer, Larissa; Wu, Xifeng; Lu, Karen; Liang, Dong

    2016-01-01

    Ovarian cancer is one of the leading female cancers in the United States. Challenges remain in early diagnosis of this deadly disease. Matrix metalloproteinases (MMPs) family genes are paradoxically involved in cancer promotion and suppression. We hypothesize that genetic variants in MMP genes are associated with ovarian cancer development, so they could be potential markers for ovarian cancer diagnosis and prognosis. In this study of 417 ovarian cancer cases and 417 healthy controls, we genotyped a comprehensive panel of 266 single nucleotide polymorphisms (SNPs) in 23 MMP genes and analysed their associations with ovarian cancer risk, overall survival and treatment response in ovarian cancer cases who received platinum-based chemotherapy with surgery. In the analysis on 339 Caucasian cases and 349 Caucasian controls, 4 SNPs were significantly associated with cancer risk. The most significant association was observed for rs2292730 (OR = 2.03, 95% CI = 1.39–2.96, P = 0.0002). Classification and regression tree analysis identified four terminal nodes with differential risk of ovarian cancer. Thirty-four SNPs were significantly associated with overall survival and four of which showed significant association with response to chemotherapy. Unfavourable genotype analysis of top SNPs on overall risk of death showed significant gene-dosage effect, survival tree analysis differentiated patients into distinct risk groups based on their genetic profiles with median survival times (MSTs) ranging from 17.7 to 151.7 months. In conclusion, our results suggest that genetic variants in MMP pathway genes may modulate the risk and clinical outcomes of ovarian cancer, both individually and jointly. PMID:25867973

  19. Genetic variants in matrix metalloproteinase genes as disposition factors for ovarian cancer risk, survival, and clinical outcome.

    PubMed

    Wang, Yan; Ye, Yuanqing; Lin, Jie; Meyer, Larissa; Wu, Xifeng; Lu, Karen; Liang, Dong

    2015-06-01

    Ovarian cancer is one of the leading female cancers in the United States. Challenges remain in early diagnosis of this deadly disease. Matrix metalloproteinases (MMPs) family genes are paradoxically involved in cancer promotion and suppression. We hypothesize that genetic variants in MMP genes are associated with ovarian cancer development, so they could be potential markers for ovarian cancer diagnosis and prognosis. In this study of 417 ovarian cancer cases and 417 healthy controls, we genotyped a comprehensive panel of 266 single nucleotide polymorphisms (SNPs) in 23 MMP genes and analysed their associations with ovarian cancer risk, overall survival and treatment response in ovarian cancer cases who received platinum-based chemotherapy with surgery. In the analysis on 339 Caucasian cases and 349 Caucasian controls, 4 SNPs were significantly associated with cancer risk. The most significant association was observed for rs2292730 (OR = 2.03, 95% CI = 1.39-2.96, P = 0.0002). Classification and regression tree analysis identified four terminal nodes with differential risk of ovarian cancer. Thirty-four SNPs were significantly associated with overall survival and four of which showed significant association with response to chemotherapy. Unfavourable genotype analysis of top SNPs on overall risk of death showed significant gene-dosage effect, survival tree analysis differentiated patients into distinct risk groups based on their genetic profiles with median survival times (MSTs) ranging from 17.7 to 151.7 months. In conclusion, our results suggest that genetic variants in MMP pathway genes may modulate the risk and clinical outcomes of ovarian cancer, both individually and jointly. PMID:25867973

  20. Conceptualizing and Re-Evaluating Resilience Across Levels of Risk, Time, and Domains of Competence

    PubMed Central

    Shaw, Daniel S.

    2009-01-01

    This article examines potential theoretical constraints on resilience across levels of risk, time, and domain of outcome. Studies of resilience are reviewed as they relate to the prevalence of resilience across levels of risk (e.g., single life events vs. cumulative risk), time, and domains of adjustment. Based on a thorough review of pertinent literature, we conclude that resilience, as a global construct, appears to be rare at the highest levels of risk, and that resilience may benefit from a narrower conceptualization focusing on specific outcomes at specific timepoints in development. The implication of this conclusion for future research and intervention efforts is then discussed. PMID:18379875

  1. Consistency and Timing of Marital Transitions and Survival During Midlife: the Role of Personality and Health Risk Behaviors

    PubMed Central

    Brummett, Beverly H.; Martin, Peter; Helms, Michael J.

    2013-01-01

    Background Marital status is associated with survival. Purpose The aims of this study are to evaluate marital history and timing on mortality during midlife, test the role of pre-marital personality, and quantify the role of health risk behaviors. Methods Cox proportional hazard models were run with varying classifications of marital history and sets of covariates. Results In fully adjusted models compared to the currently married, lifetime marital history predicts premature mortality with never married at 2.33 times risk of death and ever married at 1.64 risk of death. Midlife marital history shows that not having a partner during midlife (hazard ratio (HR)= 3.10 formerly married; HR=2.59 remaining single) has the highest risk of death. Controlling for personality and health risk behaviors reduces but does not eliminate the impact of marital status. Conclusion Consistency of marital status during midlife suggests that lack of a partner is associated with midlife mortality. PMID:23299546

  2. Survival extrapolation using the poly-Weibull model

    PubMed Central

    Lunn, David; Sharples, Linda D

    2015-01-01

    Recent studies of (cost-) effectiveness in cardiothoracic transplantation have required estimation of mean survival over the lifetime of the recipients. In order to calculate mean survival, the complete survivor curve is required but is often not fully observed, so that survival extrapolation is necessary. After transplantation, the hazard function is bathtub-shaped, reflecting latent competing risks which operate additively in overlapping time periods. The poly-Weibull distribution is a flexible parametric model that may be used to extrapolate survival and has a natural competing risks interpretation. In addition, treatment effects and subgroups can be modelled separately for each component of risk. We describe the model and develop inference procedures using freely available software. The methods are applied to two problems from cardiothoracic transplantation. PMID:21937472

  3. Survival extrapolation using the poly-Weibull model.

    PubMed

    Demiris, Nikolaos; Lunn, David; Sharples, Linda D

    2015-04-01

    Recent studies of (cost-) effectiveness in cardiothoracic transplantation have required estimation of mean survival over the lifetime of the recipients. In order to calculate mean survival, the complete survivor curve is required but is often not fully observed, so that survival extrapolation is necessary. After transplantation, the hazard function is bathtub-shaped, reflecting latent competing risks which operate additively in overlapping time periods. The poly-Weibull distribution is a flexible parametric model that may be used to extrapolate survival and has a natural competing risks interpretation. In addition, treatment effects and subgroups can be modelled separately for each component of risk. We describe the model and develop inference procedures using freely available software. The methods are applied to two problems from cardiothoracic transplantation. PMID:21937472

  4. The risk of allograft failure and the survival benefit of kidney transplantation are complicated by delayed graft function.

    PubMed

    Gill, Jagbir; Dong, Jianghu; Rose, Caren; Gill, John S

    2016-06-01

    Concern about the long-term impact of delayed graft function (DGF) may limit the use of high-risk organs for kidney transplantation. To understand this better, we analyzed 29,598 mate kidney transplants from the same deceased donor where only 1 transplant developed DGF. The DGF associated risk of graft failure was greatest in the first posttransplant year, and in patients with concomitant acute rejection (hazard ratio: 8.22, 95% confidence interval: 4.76-14.21). In contrast, the DGF-associated risk of graft failure after the first posttransplant year in patients without acute rejection was far lower (hazard ratio: 1.15, 95% confidence interval: 1.02-1.29). In subsequent analysis, recipients of transplants complicated by DGF still derived a survival benefit when compared with patients who received treatment with dialysis irrespective of donor quality as measured by the Kidney Donor Profile Index (KDPI). The difference in the time required to derive a survival benefit was longer in transplants with DGF than in transplants without DGF, and this difference was greatest in recipients of lower quality kidneys (difference: 250-279 days for KDPI 20%-60% vs. 809 days for the KDPI over 80%). Thus, the association of DGF with graft failure is primarily limited to the first posttransplant year. Transplants complicated by DGF provide a survival benefit compared to treatment with dialysis, but the survival benefit is lower in kidney transplants with lower KDPI. This information may increase acceptance of kidneys at high risk for DGF and inform strategies to minimize the risk of death in the setting of DGF. PMID:27165823

  5. The Relation Between Adolescent Social Competence and Young Adult Delinquency and Educational Attainment Among At-Risk Youth: The Mediating Role of Peer Delinquency

    PubMed Central

    Stepp, Stephanie D; Pardini, Dustin A; Loeber, Rolf; Morris, Nancy A

    2015-01-01

    Objective We examined trajectories of adolescent social competence as a resilience factor among at-risk youth. To examine potential mechanisms of this resilience process, we investigated the putative mediating effect of peer delinquency on the relation between adolescent social competence and young adult delinquency seriousness and educational attainment. Method Participants (n = 257) were screened to be at risk for antisocial behaviour at age 13 years. Data were derived from an ongoing longitudinal study of the development of antisocial and delinquent behaviour among inner-city boys, the Pittsburgh Youth Study. We used data collected from participants when aged 13 years until they were aged 25.5 years for our study. Results Results indicated that boys with high levels of social competence decreased their involvement with deviant peers throughout adolescence, which, in turn, predicted less serious forms of delinquency in early adulthood. Social competence had a direct effect on educational attainment in early adulthood, as boys who developed social competencies in adolescence went further in school irrespective of their involvement with delinquent peers. Conclusions Results suggest that promoting the development of social competencies and reducing involvement with delinquent peers will protect at-risk youth from engaging in serious delinquency in early adulthood while increasing their educational success. PMID:21878156

  6. Chronic Graft Loss and Death in Patients With Post-Transplant Malignancy in Living Kidney Transplantation: A Competing Risk Analysis

    PubMed Central

    Salesi, Mahmoud; Rostami, Zohreh; Rahimi Foroushani, Abbas; Mehrazmay, Ali Reza; Mohammadi, Jamile; Einollahi, Behzad; Asgharian, Saeed; Eshraghian, Mohammad Reza

    2014-01-01

    Background: Malignancy is a common complication after renal transplantation. Death with functioning graft and chronic graft loss are two competing outcomes in patients with post-transplant malignancies. Objectives: The purpose of our study was to evaluate the risk factors associated with cumulative incidence of these two outcomes. Patients and Methods: Fine-Gray model was used for 266 cases with post-transplant malignancy in Iran. These patients were followed-up from the diagnosis until the date of last visit, chronic graft loss, or death, subsequently. Results: At the end of the study, as competing events, chronic graft loss and death with functioning graft were seen in 27 (10.2%) and 53 cases (19.9%), respectively, while 186 cases (69.9%) were accounted as censored. The incidence rate of death was approximately two-time of the incidence rate of chronic graft loss (8.6 vs. 4.4 per 100 person-years). In multivariate analysis, significant risk factors associated with cumulative incidence of death included age (P < 0.007, subhazard ratio (SHR) = 1.03), type of cancer (P < 0.0001), and response to treatment (P < 0.0001, SHR = 0.027). The significant risk factors associated with cumulative incidence of chronic graft loss were gender (P = 0.05, SHR = 0.37), treatment modality (P < 0.0001), and response to treatment (P = 0.048, SHR = 0.47). Conclusions: Using these factors, nephrologists may predict the occurrence of graft loss or death. If the probability of graft loss was higher, physicians can decrease the immunosuppressive medications dosage to decrease the incidence of graft loss. PMID:25032129

  7. Clinical and Biologic Features Predictive of Survival After Relapse of Neuroblastoma: A Report From the International Neuroblastoma Risk Group Project

    PubMed Central

    London, Wendy B.; Castel, Victoria; Monclair, Tom; Ambros, Peter F.; Pearson, Andrew D.J.; Cohn, Susan L.; Berthold, Frank; Nakagawara, Akira; Ladenstein, Ruth L.; Iehara, Tomoko; Matthay, Katherine K.

    2011-01-01

    Purpose Survival after neuroblastoma relapse is poor. Understanding the relationship between clinical and biologic features and outcome after relapse may help in selection of optimal therapy. Our aim was to determine which factors were significantly predictive of postrelapse overall survival (OS) in patients with recurrent neuroblastoma—particularly whether time from diagnosis to first relapse (TTFR) was a significant predictor of OS. Patients and Methods Patients with first relapse/progression were identified in the International Neuroblastoma Risk Group (INRG) database. Time from study enrollment until first event and OS time starting from first event were calculated. Cox regression models were used to calculate the hazard ratio of increased death risk and perform survival tree regression. TTFR was tested in a multivariable Cox model with other factors. Results In the INRG database (N = 8,800), 2,266 patients experienced first progression/relapse. Median time to relapse was 13.2 months (range, 1 day to 11.4 years). Five-year OS from time of first event was 20% (SE, ± 1%). TTFR was statistically significantly associated with OS time in a nonlinear relationship; patients with TTFR of 36 months or longer had the lowest risk of death, followed by patients who relapsed in the period of 0 to less than 6 months or 18 to 36 months. Patients who relapsed between 6 and 18 months after diagnosis had the highest risk of death. TTFR, age, International Neuroblastoma Staging System stage, and MYCN copy number status were independently predictive of postrelapse OS in multivariable analysis. Conclusion Age, stage, MYCN status, and TTFR are significant prognostic factors for postrelapse survival and may help in the design of clinical trials evaluating novel agents. PMID:21768459

  8. Survival and risk of relapse of acute lymphoblastic leukemia in a Mexican population is affected by dihydrofolate reductase gene polymorphisms

    PubMed Central

    GÓMEZ-GÓMEZ, YAZMÍN; ORGANISTA-NAVA, JORGE; SAAVEDRA-HERRERA, MÓNICA VIRGINIA; RIVERA-RAMÍREZ, ANA BERTHA; TERÁN-PORCAYO, MARCO ANTONIO; DEL CARMEN ALARCÓN-ROMERO, LUZ; ILLADES-AGUIAR, BERENICE; LEYVA-VÁZQUEZ, MARCO ANTONIO

    2012-01-01

    Dihydrofolate reductase (DHFR) is the major target of methotrexate, a key component in childhood acute lymphoblastic leukemia (ALL) treatment. Polymorphisms in the gene coding for DHFR have been associated with adverse event treatment. This study evaluated the effect of the -A317G and C829T polymorphisms in the DHFR gene on survival and risk of relapse of ALL. Seventy patients with ALL and 100 healthy individuals were genotyped by the polymerase chain reaction-restriction fragment length polymorphism method. An association between the polymorphisms and the risk of relapse was found (p<0.05); patients with the -317G/G genotype were found to have an 8.55 (95% CI 1.84–39.70) higher chance of relapse and carriers of the 829T/T genotype had a 14.0 (95% CI 1.13–172.63) higher chance of relapse. Other variables, such as age and leukocyte count, were associated (p<0.05) with the risk of relapse of the disease. Individuals with the G/G and T/T genotype of the -A317G and C829T polymorphisms had poorer survival compared to other genotype groups (log-rank test; p<0.05). Although preliminary, these data seem to suggest a role for the DHFR polymorphisms in the risk of relapse of ALL and the mortality risk in these patients. PMID:22969948

  9. Reducing psychosocial risks through supervisors' development: a contribution for a brief version of the "Stress Management Competency Indicator Tool".

    PubMed

    Toderi, Stefano; Gaggia, Andrea; Balducci, Cristian; Sarchielli, Guido

    2015-06-15

    With the recent changes in the world of work psychosocial risks are increasingly prevalent, causing work stress and physical and mental illnesses, which have a tremendous impact on public health and social participation. Supervisors' behaviour development was proposed as an innovative intervention that can reduce psychosocial risks. The "Stress Management Competency Indicator Tool" is one of the most important questionnaires that assess managers' preventive behaviour. However, its psychometric properties have never been evaluated and the length of the questionnaire (66 items) limits its practical applicability. The aim of this study was to contribute to the development of the questionnaire by providing psychometric evidence on a brief version of the tool focusing on the "Managing and Communicating existing and future Work" cluster of behaviours, which has been found to be the crucial one in terms of stress prevention. A questionnaire was administered to 178 employees of two Italian public organizations (a municipality and a hospital), measuring the supervisors' "Managing and Communicating existing and future Work" competency, and the affective well-being and work team effectiveness. The results showed excellent psychometric properties of the supervisors' behaviour scale and confirmed the expected relationships with criterion outcomes (affective well-being and team effectiveness). Overall, the factorial structure and dimensionality, the construct validity and reliability, and the concurrent validity of the tool were strongly supported by this study. We concluded that the brief version of the scale is a valid and reliable measure that can be easily used in practice and that can contribute to the development of research and practice on this topic. PMID:25770947

  10. Comprehensive outcomes of on- and off-antiviral prophylaxis in hepatitis B patients undergoing cancer chemotherapy: A competing risks analysis.

    PubMed

    An, Jihyun; Shim, Ju Hyun; Kim, Seon-Ok; Choi, Jonggi; Kim, Sang-We; Lee, Danbi; Kim, Kang Mo; Lim, Young-Suk; Lee, Han Chu; Chung, Young-Hwa; Lee, Yung Sang; Suh, Dong Jin

    2016-09-01

    Although antiviral prophylaxis is essential in hepatitis B patients in the context of cancer chemotherapy, there is little evidence-based consensus regarding the appropriate prevention strategy depending on the underlying type of cancer and viral status. This retrospective study included a comprehensive cohort of 302 hepatitis B surface antigen-positive patients with various cancers undergoing chemotherapy and antiviral prophylaxis. The rates of hepatitis B virus (HBV) reactivation during antiviral therapy (>1 log10 IU/mL increase or positive conversion of serum HBV DNA) and relapse when off antivirals ([re]appearance of HBV DNA >2,000 IU/ml with related alanine aminotransferase elevation) were evaluated, together with the associated risk factors, in a competing risks analysis where cancer death was considered as the competing event. During antiviral prophylaxis, HBV was reactivated in six patients (1.9%), who had leukemia (n = 4) or lymphoma (n = 2) and were treated with lamivudine (n = 4) or entecavir (n = 2). The incidence rate of HBV relapse in 127 off-prophylaxis patients was 21.3% during a median post-antiviral period of 11.7 months. Lymphoma, pre-prophylactic HBV DNA ≥2,000 IU/ml, and age ≥50 years were independent predictors of off-treatment HBV relapse (adjusted hazard ratios 5.25, 3.07, and 0.34, respectively; Ps < 0.05). Antiviral and anticancer drugs, duration of consolidation on antiviral prophylaxis, and HBeAg positivity were not independent predictors. In conclusion, hepatitis B flare-ups are not rare in patients receiving cancer chemotherapy during and after anti-HBV prophylaxis, even when potent antivirals are used. Patients with hematopoietic or lymphoid neoplasms or high viral burdens should receive prolonged and powerful HBV prophylaxis. J. Med. Virol. 88:1576-1586, 2016. © 2016 Wiley Periodicals, Inc. PMID:26945543

  11. Eating competence of elderly Spanish adults is associated with a healthy diet and a favorable cardiovascular disease risk profile.

    PubMed

    Lohse, Barbara; Psota, Tricia; Estruch, Ramón; Zazpe, Itziar; Sorli, José V; Salas-Salvadó, Jordi; Serra, Mercè; Krall, Jodi Stotts; Márquez, Fabiola; Ros, Emilio

    2010-07-01

    Eating competence (EC), a bio-psychosocial model for intrapersonal approaches to eating and food-related behaviors, is associated with less weight dissatisfaction, lower BMI, and increased HDL-cholesterol in small U.S. studies, but its relationship to nutrient quality and overall cardiovascular risk have not been examined. Prevención con Dieta Mediterránea (PREDIMED) is a 5-y controlled clinical trial evaluating Mediterranean diet efficacy on the primary prevention of cardiovascular diseases (CVD) in Spain. In a cross-sectional study, 638 PREDIMED participants (62% women, mean age 67 y) well phenotyped for cardiovascular risk factors were assessed for food intake and EC using validated questionnaires. Overall, 45.6% were eating-competent. EC was associated with being male and energy intake (P < 0.01). After gender and energy adjustment, participants with EC compared with those without showed higher fruit intake and greater adherence to the Mediterranean diet (P < 0.05) and tended to consume more fish (P = 0.076) and fewer dairy products (P = 0.054). EC participants tended to have a lower BMI (P = 0.057) and had a lower fasting blood glucose concentration and serum LDL-:HDL-cholesterol ratio (P < 0.05) and a higher HDL-cholesterol concentration (P = 0.025) after gender adjustment. EC participants had lower odds ratios (OR) of having a blood glucose concentration >5.6 mmol/L (0.71; 95% CI 0.51-0.98) and HDL-cholesterol <1.0 mmol/L (0.70; 95% CI 0.68-1.00). The OR of actively smoking, being obese, or having a serum LDL-cholesterol concentration > or =3.4 mmol/L were <1.0, but the 95% CI included the 1.0 (P > 0.1). Our findings support further examination of EC as a strategy for enhancing diet quality and CVD prevention. PMID:20505016

  12. Molecular markers to complement sentinel node status in predicting survival in patients with high-risk locally invasive melanoma.

    PubMed

    Rowe, Casey J; Tang, Fiona; Hughes, Maria Celia B; Rodero, Mathieu P; Malt, Maryrose; Lambie, Duncan; Barbour, Andrew; Hayward, Nicholas K; Smithers, B Mark; Green, Adele C; Khosrotehrani, Kiarash

    2016-08-01

    Sentinel lymph node status is a major prognostic marker in locally invasive cutaneous melanoma. However, this procedure is not always feasible, requires advanced logistics and carries rare but significant morbidity. Previous studies have linked markers of tumour biology to patient survival. In this study, we aimed to combine the predictive value of established biomarkers in addition to clinical parameters as indicators of survival in addition to or instead of sentinel node biopsy in a cohort of high-risk melanoma patients. Patients with locally invasive melanomas undergoing sentinel lymph node biopsy were ascertained and prospectively followed. Information on mortality was validated through the National Death Index. Immunohistochemistry was used to analyse proteins previously reported to be associated with melanoma survival, namely Ki67, p16 and CD163. Evaluation and multivariate analyses according to REMARK criteria were used to generate models to predict disease-free and melanoma-specific survival. A total of 189 patients with available archival material of their primary tumour were analysed. Our study sample was representative of the entire cohort (N = 559). Average Breslow thickness was 2.5 mm. Thirty-two (17%) patients in the study sample died from melanoma during the follow-up period. A prognostic score was developed and was strongly predictive of survival, independent of sentinel node status. The score allowed classification of risk of melanoma death in sentinel node-negative patients. Combining clinicopathological factors and established biomarkers allows prediction of outcome in locally invasive melanoma and might be implemented in addition to or in cases when sentinel node biopsy cannot be performed. PMID:26990817

  13. Resilience and Risk Competence in Schools: Theory/Knowledge and International Application in Project REBOUND

    ERIC Educational Resources Information Center

    Brown, Joel H.; Jean-Marie, Gaetane; Beck, Jerome

    2010-01-01

    Despite a 50-year interdisciplinary and longitudinal research legacy--showing that nearly 80% of young people considered most "at risk" thrive by midlife--only recently have practitioners/researchers engaged in the explicit, prospective facilitation of "resilience" in educational settings. Here, theory/knowledge distinguishing and extending risk…

  14. Socioenvironmental Risk and Adjustment in Latino Youth: The Mediating Effects of Family Processes and Social Competence

    ERIC Educational Resources Information Center

    Prelow, Hazel M.; Loukas, Alexandra; Jordan-Green, Lisa

    2007-01-01

    The direct and mediated effects of socioenvironmental risk on internalizing and externalizing problems among Latino youth aged 10-14 were examined using prospective analyses. Participants in this study were 464 Latino mother and child dyads surveyed as part of the "Welfare, Children & Families: A Three City Study." It was hypothesized that…

  15. A Multivariate Investigation of Maternal Risks and Their Relationship to Low-Income, Preschool Children's Competencies

    ERIC Educational Resources Information Center

    Perry, Marlo A.; Fantuzzo, John W.

    2010-01-01

    Utilizing a developmental-ecological framework, the purpose of this study was to understand the unique impact of multiple maternal risks across time on ethnically diverse, low-income, preschool children's cognitive skills, pro-social behaviors, and behavior problems. Additionally, this study sought to understand the variability of maternal risks…

  16. Semiparametric model for semi-competing risks data with application to breast cancer study.

    PubMed

    Zhou, Renke; Zhu, Hong; Bondy, Melissa; Ning, Jing

    2016-07-01

    For many forms of cancer, patients will receive the initial regimen of treatments, then experience cancer progression and eventually die of the disease. Understanding the disease process in patients with cancer is essential in clinical, epidemiological and translational research. One challenge in analyzing such data is that death dependently censors cancer progression (e.g., recurrence), whereas progression does not censor death. We deal with the informative censoring by first selecting a suitable copula model through an exploratory diagnostic approach and then developing an inference procedure to simultaneously estimate the marginal survival function of cancer relapse and an association parameter in the copula model. We show that the proposed estimators possess consistency and weak convergence. We use simulation studies to evaluate the finite sample performance of the proposed method, and illustrate it through an application to data from a study of early stage breast cancer. PMID:26340889

  17. The EARLY ALLIANCE prevention trial: an integrated set of interventions to promote competence and reduce risk for conduct disorder, substance abuse, and school failure.

    PubMed

    Dumas, J E; Prinz, R J; Smith, E P; Laughlin, J

    1999-03-01

    Describes the EARLY ALLIANCE interventions, an integrated set of four programs designed to promote competence and reduce risk for early-onset conduct disorder, substance abuse, and school failure. These interventions are evaluated as part of a prevention trial that begins at school entry and targets child functioning and socializing practices across multiple contexts (school, peer group, family) and multiple domains (affective, social, and achievement coping-competence). The paper presents the conceptual foundation of the four interventions, including a synopsis of the risk and protective factors associated with conduct disorder and related outcomes, and of the coping-competence model driving EARLY ALLIANCE. The developmental rationale, intended impact, and procedures are described for each intervention: a universally administered classroom program and indicated, peer, reading-mentoring, and family programs. Interventions are currently being tested in a prevention trial, which is briefly summarized. PMID:11324096

  18. Improved Survival Endpoints With Adjuvant Radiation Treatment in Patients With High-Risk Early-Stage Endometrial Carcinoma

    SciTech Connect

    Elshaikh, Mohamed A.; Vance, Sean; Suri, Jaipreet S.; Mahan, Meredith; Munkarah, Adnan

    2014-02-01

    Purpose/Objective(s): To determine the impact of adjuvant radiation treatment (RT) on recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS) in patients with high-risk 2009 International Federation of Gynecology and Obstetrics stage I-II endometrial carcinoma. Methods and Materials: We identified 382 patients with high-risk EC who underwent hysterectomy. RFS, DSS, and OS were calculated from the date of hysterectomy by use of the Kaplan-Meier method. Cox regression modeling was used to explore the risks associated with various factors on survival endpoints. Results: The median follow-up time for the study cohort was 5.4 years. The median age was 71 years. All patients underwent hysterectomy and salpingo-oophorectomy, 93% had peritoneal cytology, and 85% underwent lymphadenectomy. Patients with endometrioid histology constituted 72% of the study cohort, serous in 16%, clear cell in 7%, and mixed histology in 4%. Twenty-three percent of patients had stage II disease. Adjuvant management included RT alone in 220 patients (57%), chemotherapy alone in 25 patients (7%), and chemoradiation therapy in 27 patients (7%); 110 patients (29%) were treated with close surveillance. The 5-year RFS, DSS, and OS were 76%, 88%, and 73%, respectively. On multivariate analysis, adjuvant RT was a significant predictor of RFS (P<.001) DSS (P<.001), and OS (P=.017). Lymphovascular space involvement was a significant predictor of RFS and DSS (P<.001). High tumor grade was a significant predictor for RFS (P=.038) and DSS (P=.025). Involvement of the lower uterine segment was also a predictor of RFS (P=.049). Age at diagnosis and lymphovascular space involvement were significant predictors of OS: P<.001 and P=.002, respectively. Conclusion: In the treatment of patients with high-risk features, our study suggests that adjuvant RT significantly improves recurrence-free, disease-specific, and overall survival in patients with early-stage endometrial carcinoma

  19. A Hybrid Approach of Gene Sets and Single Genes for the Prediction of Survival Risks with Gene Expression Data

    PubMed Central

    Seok, Junhee; Davis, Ronald W.; Xiao, Wenzhong

    2015-01-01

    Accumulated biological knowledge is often encoded as gene sets, collections of genes associated with similar biological functions or pathways. The use of gene sets in the analyses of high-throughput gene expression data has been intensively studied and applied in clinical research. However, the main interest remains in finding modules of biological knowledge, or corresponding gene sets, significantly associated with disease conditions. Risk prediction from censored survival times using gene sets hasn’t been well studied. In this work, we propose a hybrid method that uses both single gene and gene set information together to predict patient survival risks from gene expression profiles. In the proposed method, gene sets provide context-level information that is poorly reflected by single genes. Complementarily, single genes help to supplement incomplete information of gene sets due to our imperfect biomedical knowledge. Through the tests over multiple data sets of cancer and trauma injury, the proposed method showed robust and improved performance compared with the conventional approaches with only single genes or gene sets solely. Additionally, we examined the prediction result in the trauma injury data, and showed that the modules of biological knowledge used in the prediction by the proposed method were highly interpretable in biology. A wide range of survival prediction problems in clinical genomics is expected to benefit from the use of biological knowledge. PMID:25933378

  20. Metformin Is Associated With Slightly Reduced Risk of Colorectal Cancer and Moderate Survival Benefits in Diabetes Mellitus

    PubMed Central

    He, Xing-kang; Su, Ting-ting; Si, Jian-min; Sun, Lei-min

    2016-01-01

    Abstract To systematically assess the effect of metformin on colorectal cancer (CRC) risk and mortality in type 2 diabetes mellitus (T2DM) patients. We conducted a systematic search of PubMed, Web of Science, and the Cochrane Library databases for relevant articles before August 2015. Two investigators identified and extracted data independently. We adopted adjusted estimates to calculate summary estimates with 95% confidence interval (CI) using either a fixed-effects or a random-effects model. Subgroup and sensitivity analyses were conducted to evaluate the robustness of the pooled results. The risk of publication bias was assessed by examining funnel plot asymmetry as well as Begg test and Egger test. Fifteen studies on CRC incidence and 6 studies on CRC survival were finally included in our meta-analysis. The pooled odds ratio (OR) of observational studies illustrated that a slight 10% reduction of CRC incidence was associated with metformin use (OR = 0.90, 95% CI: 0.85–0.96). Furthermore, the pooled hazard ratio (HR) revealed an improved survival outcome for metformin users in CRC patients compared to nonusers (HR = 0.68, 95% CI: 0.58–081). There was no publication bias across studies. Our meta-analysis demonstrated that metformin therapy could slightly reduce CRC incidence and moderately improve the survival outcomes in patients with T2DM. More prospective studies are warranted to certify this protective association. PMID:26886616

  1. Examining mortality risk and rate of ageing among Polish Olympic athletes: a survival follow-up from 1924 to 2012

    PubMed Central

    Lin, Yuhui; Gajewski, Antoni; Poznańska, Anna

    2016-01-01

    Objectives Population-based studies have shown that an active lifestyle reduces mortality risk. Therefore, it has been a longstanding belief that individuals who engage in frequent exercise will experience a slower rate of ageing. It is uncertain whether this widely-accepted assumption holds for intense wear-and-tear. Here, using the 88 years survival follow-up data of Polish Olympic athletes, we report for the first time on whether frequent exercise alters the rate of ageing. Design Longitudinal survival data of male elite Polish athletes who participated in the Olympic Games from year 1924 to 2010 were used. Deaths occurring before the end of World War II were excluded for reliable estimates. Setting and participants Recruited male elite athletes N=1273 were preassigned to two categorical birth cohorts—Cohort I 1890–1919; Cohort II 1920–1959—and a parametric frailty survival analysis was conducted. An event-history analysis was also conducted to adjust for medical improvements from year 1920 onwards: Cohort II. Results Our findings suggest (1) in Cohort I, for every threefold reduction in mortality risk, the rate of ageing decelerates by 1%; (2) socioeconomic transitions and interventions contribute to a reduction in mortality risk of 29% for the general population and 50% for Olympic athletes; (3) an optimum benefit gained for reducing the rate of ageing from competitive sports (Cohort I 0.086 (95% CI 0.047 to 0.157) and Cohort II 0.085 (95% CI 0.050 to 0.144)). Conclusions This study further suggests that intensive physical training during youth should be considered as a factor to improve ageing and mortality risk parameters. PMID:27091824

  2. Competence, Self-Esteem, and Coping Efficacy as Mediators of Ecological Risk and Depressive Symptoms in Urban African American and European American Youth

    ERIC Educational Resources Information Center

    Prelow, Hazel M.; Weaver, Scott R.; Swenson, Rebecca R.

    2006-01-01

    Structural equation modeling was used to test [Sandler, "American Journal of Community Psychology" 29: 19-61.] a theoretical model of risk and resilience in an urban sample of African American and European American adolescents. The aims of the present study were to examine whether self-system processes (i.e., competence, self-esteem, and coping…

  3. Background level of risk and the survival of predator-naive prey: can neophobia compensate for predator naivety in juvenile coral reef fishes?

    PubMed Central

    Ferrari, Maud C. O.; McCormick, Mark I.; Meekan, Mark G.; Chivers, Douglas P.

    2015-01-01

    Neophobia—the generalized fear response to novel stimuli—provides the first potential strategy that predator-naive prey may use to survive initial predator encounters. This phenotype appears to be highly plastic and present in individuals experiencing high-risk environments, but rarer in those experiencing low-risk environments. Despite the appeal of this strategy as a ‘solution’ for prey naivety, we lack evidence that this strategy provides any fitness benefit to prey. Here, we compare the relative effect of environmental risk (high versus low) and predator-recognition training (predator-naive versus predator-experienced individuals) on the survival of juvenile fish in the wild. We found that juveniles raised in high-risk conditions survived better than those raised in low-risk conditions, providing the first empirical evidence that environmental risk, in the absence of any predator-specific information, affects the way naive prey survive in a novel environment. Both risk level and experience affected survival; however, the two factors did not interact, indicating that the information provided by both factors did not interfere or enhance each other. From a mechanistic viewpoint, this indicates that the combination of the two factors may increase the intensity, and hence efficacy, of prey evasion strategies, or that both factors provide qualitatively separate benefits that would result in an additive survival success. PMID:25621337

  4. Long‐Term Post‐CABG Survival: Performance of Clinical Risk Models Versus Actuarial Predictions

    PubMed Central

    Carr, Brendan M.; Romeiser, Jamie; Ruan, Joyce; Gupta, Sandeep; Seifert, Frank C.; Zhu, Wei

    2015-01-01

    Abstract Background/aim Clinical risk models are commonly used to predict short‐term coronary artery bypass grafting (CABG) mortality but are less commonly used to predict long‐term mortality. The added value of long‐term mortality clinical risk models over traditional actuarial models has not been evaluated. To address this, the predictive performance of a long‐term clinical risk model was compared with that of an actuarial model to identify the clinical variable(s) most responsible for any differences observed. Methods Long‐term mortality for 1028 CABG patients was estimated using the Hannan New York State clinical risk model and an actuarial model (based on age, gender, and race/ethnicity). Vital status was assessed using the Social Security Death Index. Observed/expected (O/E) ratios were calculated, and the models' predictive performances were compared using a nested c‐index approach. Linear regression analyses identified the subgroup of risk factors driving the differences observed. Results Mortality rates were 3%, 9%, and 17% at one‐, three‐, and five years, respectively (median follow‐up: five years). The clinical risk model provided more accurate predictions. Greater divergence between model estimates occurred with increasing long‐term mortality risk, with baseline renal dysfunction identified as a particularly important driver of these differences. Conclusions Long‐term mortality clinical risk models provide enhanced predictive power compared to actuarial models. Using the Hannan risk model, a patient's long‐term mortality risk can be accurately assessed and subgroups of higher‐risk patients can be identified for enhanced follow‐up care. More research appears warranted to refine long‐term CABG clinical risk models. doi: 10.1111/jocs.12665 (J Card Surg 2016;31:23–30) PMID:26543019

  5. Influence of risk factors and comorbidities on the successful therapy and survival of patients with critical limb ischemia

    PubMed Central

    CONSTANTINESCU, MIHAELA IOANA; CONSTANTINESCU, DAN PETRU; CHIŞ, BOGDAN; ANDERCOU, AUREL; MIRONIUC, ION AUREL

    2013-01-01

    Background Critical limb ischemia (CLI) is associated with an increased risk of limb amputation, low quality of life and cardiovascular death. The aim of this study is to identify the prognostic factors of mortality, revascularization failure and amputation failure, as part of risk factors for athero-sclerosis and comorbidities. Patients and methods We examined 198 patients operated for CLI. Cox analysis was performed to discern the factors that were associated with failure of initial surgical therapy and death. Results For survival analysis, a significant model emerged with hypertension (p=0.00), cardiac comorbidities (p=0.00), renal comorbidities (p=0.04) and respiratory comorbidities (p=0.02) as significant predictors. Regarding the time to amputation failure, there was a significant model with insulin treated diabetes (p=0.00), coronary artery disease (p=0.02) and cerebrovascular disease (p=0.05) as significant predictors. Conclusions Significant predictors for mortality in CLI patients are high risk hypertension, severe coronary artery disease, renal failure requiring dialysis and chronic obstructive pulmonary disease. The association of these prognostic factors results in a proportional decrease of survival. The predictors for amputation failure were, in addition to local factors, insulin treated diabetes, coronary artery disease and cerebrovascular disease. The revascularization for limb salvage depends on the correct indication and accurate surgical technique. PMID:26527918

  6. Cumulative Risk for Early Sexual Initiation among American Indian Youth: A Discrete-Time Survival Analysis

    ERIC Educational Resources Information Center

    Mitchell, Christina M.; Whitesell, Nancy Rumbaugh; Spicer, Paul; Beals, Janette; Kaufman, Carol E.

    2007-01-01

    Approximately 3 million teens are diagnosed with a sexually transmitted disease (STD) annually; STDs rates for American Indian young adults are among the highest of any racial/ethnic group. An important risk factor for STDs is early initiation of sex. In this study, we examined risk for early initiation with 474 American Indian youth ages 14-18,…

  7. Intensity-Modulated Radiotherapy for Craniospinal Irradiation: Target Volume Considerations, Dose Constraints, and Competing Risks

    SciTech Connect

    Parker, William Filion, Edith; Roberge, David; Freeman, Carolyn R.

    2007-09-01

    Purpose: To report the results of an analysis of dose received to tissues and organs outside the target volume, in the setting of spinal axis irradiation for the treatment of medulloblastoma, using three treatment techniques. Methods and Materials: Treatment plans (total dose, 23.4 Gy) for a standard two-dimensional (2D) technique, a three-dimensional (3D) technique using a 3D imaging-based target volume, and an intensity-modulated radiotherapy (IMRT) technique, were compared for 3 patients in terms of dose-volume statistics for target coverage, as well as organ at risk (OAR) and overall tissue sparing. Results: Planning target volume coverage and dose homogeneity was superior for the IMRT plans for V{sub 95%} (IMRT, 100%; 3D, 96%; 2D, 98%) and V{sub 107%} (IMRT, 3%; 3D, 38%; 2D, 37%). In terms of OAR sparing, the IMRT plan was better for all organs and whole-body contour when comparing V{sub 10Gy}, V{sub 15Gy}, and V{sub 20Gy}. The 3D plan was superior for V{sub 5Gy} and below. For the heart and liver in particular, the IMRT plans provided considerable sparing in terms of V{sub 10Gy} and above. In terms of the integral dose, the IMRT plans were superior for liver (IMRT, 21.9 J; 3D, 28.6 J; 2D, 38.6 J) and heart (IMRT, 9 J; 3D, 14.1J; 2D, 19.4 J), the 3D plan for the body contour (IMRT, 349 J; 3D, 337 J; 2D, 555 J). Conclusions: Intensity-modulated radiotherapy is a valid treatment option for spinal axis irradiation. We have shown that IMRT results in sparing of organs at risk without a significant increase in integral dose.

  8. Personalized risk prediction for event-free survival at 24 months in patients with diffuse large B-cell lymphoma.

    PubMed

    Maurer, Matthew J; Jais, Jean-Philippe; Ghesquières, Hervé; Witzig, Thomas E; Hong, Fangxin; Haioun, Corinne; Thompson, Carrie A; Thieblemont, Catherine; Micallef, Ivana N; Porrata, Luis F; Ribrag, Vincent; Nowakowski, Gregorz S; Casasnovas, Olivier; Bologna, Serge; Morschhauser, Franck; Morrison, Vicki A; Peterson, Bruce A; Macon, William R; Copie-Bergman, Christiane; Feldman, Andrew L; Syrbu, Sergei I; Kurtin, Paul J; Gascoyne, Randy D; Li, Hailun; Allmer, Cristine; Kahl, Brad S; Ansell, Stephen M; Slager, Susan L; Link, Brian K; Salles, Gilles; Habermann, Thomas M; Tilly, Hervé; Cerhan, James R

    2016-02-01

    We recently defined event-free survival at 24 months (EFS24) as a clinically relevant outcome for patients with DLBCL. Patients who fail EFS24 have very poor overall survival, while those who achieve EFS24 have a subsequent overall survival equivalent to that of the age- and sex-matched general population. Here, we develop and validate a clinical risk calculator (IPI24) for EFS24. Model building was performed on a discovery dataset of 1,348 patients with DLBCL and treated with anthracycline-based immunochemotherapy. A multivariable model containing age, Ann Arbor stage, normalized serum LDH, ALC, ECOG performance status, bulky disease, and sex was identified. The model was then applied to an independent validation dataset of 1,177 DLBCL patients. The IPI24 score estimates the probability of failing to achieve the EFS24 endpoint for an individual patient. The IPI24 model showed superior discriminatory ability (c-statistic = 0.671) in the validation dataset compared to the IPI (c-statistic = 0.649) or the NCCN-IPI (c-statistic = 0.657). After recalibration of the model on the combined dataset, the median predicted probability of failing to achieve EFS24 was 36% (range, 12-88%), and the IPI24 showed an EFS24 gradient in all IPI groups. The IPI24 also identified a significant percentage of patients with high risk disease, with over 20% of patients having a 50% or higher risk of failing to achieve EFS24. The IPI24 provides an individual patient level probability of achieving the clinically relevant EFS24 endpoint. It can be used via electronic apps. PMID:26492520

  9. Hyperferritinemia at diagnosis predicts relapse and overall survival in younger AML patients with intermediate-risk cytogenetics.

    PubMed

    Lebon, Delphine; Vergez, François; Bertoli, Sarah; Harrivel, Véronique; De Botton, Stéphane; Micol, Jean-Baptiste; Marolleau, Jean-Pierre; Récher, Christian

    2015-08-01

    The prognostic value of ferritin level at diagnosis in AML patients is unknown. We studied 162 younger AML patients with intermediate-risk cytogenetics who received intensive chemotherapy. The median ferritin level at diagnosis was 633 μg/L and 128 (79%) patients had a ferritin level above the upper normal limit. Hyperferritinemia was significantly associated with a higher cumulative incidence of relapse as well as poorer disease-free and overall survival. In multivariate analysis, hyperferritinemia remained an independent poor prognosis factor. The level of ferritin at diagnosis has a major impact on relapse suggesting a link between inflammation, oxidative stress and chemoresistance in AML. PMID:26002512

  10. Risk factors, clinical signs, and survival in cats with a clinical diagnosis of idiopathic hypertrophic cardiomyopathy: 74 cases (1985-1989).

    PubMed

    Atkins, C E; Gallo, A M; Kurzman, I D; Cowen, P

    1992-08-15

    Population characteristics, risk factors, and survival characteristics were evaluated in 74 cats with hypertrophic cardiomyopathy (HC) seen at North Carolina State University veterinary teaching hospital from 1985 to 1989, and compared with 82 clinically normal cats. The mean (+/- SD) age of cats with HC was 6.5 (4.0) years. Neutered males were at significantly greater risk (odds ratio 3.1) than neutered females. Breed, body weight, or coat color were not determined to be risk factors for HC. Tricolor cats were significantly underrepresented, probably reflecting the male predisposition for HC and not a true risk reduction associated with coat color. Forty-one cats were without clinical signs of heart disease (murmur and/or gallop sound only), 24 were in congestive heart failure, and 9 had systemic arterial embolism, 3 of which had concomitant congestive heart failure. The median survival time for 61 cats with HC, for which survival information could be obtained and that were not euthanatized on day 1, was 732 days. Survival was not affected by age at diagnosis, breed, body weight, or sex. However, clinical signs were important in determining prognosis; cats with heart rates greater than 200 beats/min survived significantly longer (median survival greater than 1,830 days) than those with heart rates greater than or equal to 200 beats/min (median survival = 152 days). Cats without clinical signs (median survival greater than 1,830 days) survived longer than those with clinical signs, and cats in heart failure survived a median of 92 days, compared with 61 days for those with systemic arterial embolism. Analysis of survival revealed no significant difference between the 2 groups of cats with clinical signs; however, all cats with embolism and only 60% of cats with heart failure were dead 6 months after diagnosis. PMID:1517140

  11. Evaluating predictors of competing risk outcomes when censoring depends on time-dependent covariates, with application to safety and efficacy of HIV treatment.

    PubMed

    Lok, Judith J; Hughes, Michael D

    2016-06-15

    We propose a prediction model for the cumulative incidence functions of competing risks, based on a logit link. Because of a concern about censoring potentially depending on time-varying covariates in our motivating human immunodeficiency virus (HIV) application, we describe an approach for estimating the parameters in the prediction models using inverse probability of censoring weighting under a missingness at random assumption. We then illustrate the application of this methodology to identify predictors of the competing outcomes of virologic failure, an efficacy outcome, and treatment limiting adverse event, a safety outcome, among human immunodeficiency virus-infected patients first starting antiretroviral treatment. Copyright © 2016 John Wiley & Sons, Ltd. PMID:26763556

  12. A refined risk score for acute GVHD that predicts response to initial therapy, survival and transplant-related mortality

    PubMed Central

    MacMillan, Margaret L.; Robin, Marie; Harris, Andrew C.; DeFor, Todd E.; Martin, Paul J.; Alousi, Amin; Ho, Vincent T.; Bolaños-Meade, Javier; Ferrara, James L.M.; Jones, Richard; Arora, Mukta; Blazar, Bruce R.; Holtan, Shernan G.; Jacobsohn, David; Pasquini, Marcelo; Socie, Gerard; Antin, Joseph H.; Levine, John E.; Weisdorf, Daniel J.

    2015-01-01

    To develop a novel acute graft-versus-host disease (GVHD) Risk Score, we examined the GVHD clinical stage and grade of 1723 patients at the onset of treatment with systemic steroids. Using clinical grouping, descriptive statistics and recursive partitioning, we identified poorly responsive, high-risk (HR) acute GVHD by the number of involved organs and severity of GVHD at onset. The overall response [(complete response/partial response (CR/PR)] rate 28 days after initiation of steroid therapy for acute GVHD was lower in the 269 patients with HR-GVHD than in the 1454 patients with standard risk (SR)-GVHD [44% (95% CI 38–50%) vs. 68% (95% CI 66–70%), p<0.001. Patients with HR-GVHD were less likely to respond at day 28 [odds ratio (OR), 0.3, 95% CI 0.2–0.4, p<0.001], and had higher risks of mortality [relative risk (RR) 2.1, 95% CI 1.7–2.6, P<0.001] and transplant-related mortality (RR 2.5, 95% CI 2.0–3.2%, p<0.001) compared to patients with SR-GVHD. This refined definition of acute GVHD risk is a better predictor of response, survival and transplant-related mortality than other published acute GVHD risk scores. Patients with HR-GVHD are candidates for studies investigating new treatment approaches. Likewise, patients with SR-GVHD are candidates for studies investigating less toxic therapy. PMID:25585275

  13. Negotiating competency, professionalism and risk: the integration of complementary and alternative medicine by nurses and midwives in NHS hospitals.

    PubMed

    Cant, Sarah; Watts, Peter; Ruston, Annmarie

    2011-02-01

    This qualitative interview study examined the use of complementary and alternative medicine (CAM) by nurses and midwives in NHS hospital settings in 2008 in the UK. It showed that the groundswell of interest in CAM in the 1990s had diminished by this time due to changes to policy and funding, and increasingly stringent clinical governance. Nevertheless, CAM provided an opportunity for committed and self-motivated practitioners to extend their therapeutic repertoire and develop affective dimensions of practice. However, the integration of CAM did not afford the autonomy, status and material gains traditionally associated with a collective professional project. In practice, occupational strategies were individualistic, and grounded in the assertion of competency through expressions of professionalism rather than the credentialism which underpins classic professionalisation. Central to these strategies was CAM related risk, which became a means by which to claim occupational space. However, the extent to which the adoption of CAM enhanced the nurses' and midwives' roles was limited by traditional medical authority; the uncertain status of CAM knowledge; and the absence of collective strategies - which together often left practitioners in a position of vulnerability. PMID:21208701

  14. Getting ready for invasions: can background level of risk predict the ability of naïve prey to survive novel predators?

    PubMed Central

    Ferrari, Maud C. O.; Crane, Adam L.; Brown, Grant E.; Chivers, Douglas P.

    2015-01-01

    Factors predicting the outcome of predator invasions on native prey communities are critical to our understanding of invasion ecology. Here, we tested whether background level of risk affected the survival of prey to novel predators, both native and invasive, predicting that high-risk environments would better prepare prey for invasions. We used naïve woodfrog as our prey and exposed them to a high or low risk regime either as embryos (prenatal exposure) or as larvae (recent exposure). Tadpoles were then tested for their survival in the presence of 4 novel predators: two dytiscid beetles, crayfish and trout. Survival was affected by both risk level and predator type. High risk was beneficial to prey exposed to the dytiscids larvae (ambush predators), but detrimental to prey exposed to crayfish or trout (pursuit predators). No effect of ontogeny of risk was found. We further documented that high-risk tadpoles were overall more active than their low-risk counterparts, explaining the patterns found with survival. Our results provide insights into the relationship between risk and resilience to predator invasions. PMID:25655436

  15. Increasing Sibling Relative Risk of Survival to Older and Older Ages and the Importance of Precise Definitions of "Aging," "Life Span," and "Longevity".

    PubMed

    Sebastiani, Paola; Nussbaum, Lisa; Andersen, Stacy L; Black, Mara J; Perls, Thomas T

    2016-03-01

    The lack of a formal definition of human longevity continues to generate confusion about its genetic and nongenetic determinants. In order to characterize how differences in birth year cohorts and percentiles of survival are associated with familial contribution to variation in survival, we estimated sibling relative risk of living to increasingly rare percentiles of survival based on a dataset of 1,917 validated sibships each containing at least one individual living to age 90 years. About 1,042 of the sibships included at least one individual who survived to age 100 and 511 included at least one individual who survived to age 105 and older. We show that sibling relative risk increases with older ages, sex, and earlier birth year cohorts of the proband and siblings of male 90-year-olds (5th percentile of survival) have 1.73 (95% CI: 1.5; 2.0) times the chance of living to age 90, while siblings of both male and female probands who survived to age 105 years (~0.01 percentile of survival) have 35.6 (95%CI: 15.1; 67.7) times the chance of living to age 105 compared with population controls. These results emphasize the importance of consistently defining the longevity phenotype in terms of rarity of survival for appropriate comparisons across studies. PMID:25814633

  16. Diabetes Mellitus as a Risk Factor in Glaucoma’s Physiopathology and Surgical Survival Time: A Literature Review

    PubMed Central

    Cunha, João Paulo; Amado, Duarte; Pinto, Luís Abegão; Ferreira, Joana

    2015-01-01

    ABSTRACT Glaucoma is a multifactorial condition under serious influence of many risk factors. The role of diabetes mellitus (DM) in glaucoma etiology or progression remains inconclusive. Although, the diabetic patients have different healing mechanism comparing to the general population and it has a possible-negative role on surgical outcomes. This review article attempts to analyze the association of both diseases, glaucoma and DM, before and after the surgery. The epidemiological studies, based mainly in population prevalence analyzes, have shown opposite outcomes in time and even in the most recent articles also the association remains inconclusive. On the contrary, the experimental models based on animal induced chronic hyperglycemia have shown an important association of both diseases, explained by common neurodegenerative mechanisms. Diabetic patients have a different wound healing process in the eye viz-a-viz other organs. The healing process is more and it results in lower surgical survival time, higher intraocular pressure (IOP) levels and, therefore, these patients usually need more medication to lower the IOP. Both randomized and nonrandomized retrospective and experimental molecular studies have shown the association between DM and glaucoma. Further studies are needed to get better explanations about outcomes on more recent surgical procedures and with the exponential use of antifibrotics. How to cite this article: Costa L, Cunha JP, Amado D, Pinto LA, Ferreira J. Diabetes Mellitus as a Risk Factor in Glaucoma’s Physiopathology and Surgical Survival Time: A Literature Review. J Curr Glaucoma Pract 2015;9(3):81-85. PMID:26997842

  17. Natural histroy of trisomy 18 and trisomy 13: I. Growth, physical assessment, medical histories, survival, and recurrence risk

    SciTech Connect

    Baty, B.J.; Blackburn, B.L.; Carey, J.C.

    1994-01-15

    The natural history of trisomy 18 and trisomy 13 was investigated using data derived from parent questionnaires and medical records from 98 families with an index case of trisomy 18 and 32 families with an index case of trisomy 13. Data are presented on pregnancy, delivery, survival, medical complications, immunizations, growth, cause of death, cytogenetics, and recurrence risk. Half of the trisomy 18 babies were delivered by C-section. Fetal distress was a factor in half, and the only reason in a third of C-section deliveries. One minute Apgar scores were significantly lower in C-section and breech deliveries. There were more small-for-gestational-age babies than in the general population, but most of the low-birth-weight newborns were small for gestational age, unlike the general population. Survival in this group of children was better than in other studies due to ascertainment bias. There were more girls than boys at all ages for both conditions, and the sex ratio decreased with time. Growth curves for length, weight, head circumference, and weight vs height are provided. Long-term survival did not appear to be due to mosaicism. There were no adverse reactions attributable to immunizations. At age 1 year there was an average of approximately 2 operations per living child. The authors report the second case of successful major cardiac surgery in a trisomy 18 child. Almost 70% of deaths were attributed to cardiopulmonary arrest. The sibling recurrence risk for trisomy 18 or trisomy 13 was 0.55%. 86 refs., 5 figs., 5 tabs.

  18. Acetabular revision with impaction bone grafting and a cemented polyethylene acetabular component: comparison of the Kaplan-Meier analysis to the competing risk analysis in 62 revisions with 25 to 30 years follow-up.

    PubMed

    Te Stroet, M A J; Keurentjes, J C; Rijnen, W H C; Gardeniers, J W M; Verdonschot, N; Slooff, T J J H; Schreurs, B W

    2015-10-01

    We present the results of 62 consecutive acetabular revisions using impaction bone grafting and a cemented polyethylene acetabular component in 58 patients (13 men and 45 women) after a mean follow-up of 27 years (25 to 30). All patients were prospectively followed. The mean age at revision was 59.2 years (23 to 82). We performed Kaplan-Meier (KM) analysis and also a Competing Risk (CR) analysis because with long-term follow-up, the presence of a competing event (i.e. death) prevents the occurrence of the endpoint of re-revision. A total of 48 patients (52 hips) had died or had been re-revised at final review in March 2011. None of the deaths were related to the surgery. The mean Harris hip score of the ten surviving hips in ten patients was 76 points (45 to 99). The KM survivorship at 25 years for the endpoint 're-revision for any reason' was 58.0% (95% confidence interval (CI) 38 to 73) and for 're-revision for aseptic loosening' 72.1% (95% CI 51 to 85). With the CR analysis we calculated the KM analysis overestimates the failure rate with respectively 74% and 93% for these endpoints. The current study shows that acetabular impaction bone grafting revisions provide good clinical results at over 25 years. PMID:26430007

  19. Quantifying intrinsic and extrinsic control of single-cell fates in cancer and stem/progenitor cell pedigrees with competing risks analysis.

    PubMed

    Cornwell, J A; Hallett, R M; der Mauer, S Auf; Motazedian, A; Schroeder, T; Draper, J S; Harvey, R P; Nordon, R E

    2016-01-01

    The molecular control of cell fate and behaviour is a central theme in biology. Inherent heterogeneity within cell populations requires that control of cell fate is studied at the single-cell level. Time-lapse imaging and single-cell tracking are powerful technologies for acquiring cell lifetime data, allowing quantification of how cell-intrinsic and extrinsic factors control single-cell fates over time. However, cell lifetime data contain complex features. Competing cell fates, censoring, and the possible inter-dependence of competing fates, currently present challenges to modelling cell lifetime data. Thus far such features are largely ignored, resulting in loss of data and introducing a source of bias. Here we show that competing risks and concordance statistics, previously applied to clinical data and the study of genetic influences on life events in twins, respectively, can be used to quantify intrinsic and extrinsic control of single-cell fates. Using these statistics we demonstrate that 1) breast cancer cell fate after chemotherapy is dependent on p53 genotype; 2) granulocyte macrophage progenitors and their differentiated progeny have concordant fates; and 3) cytokines promote self-renewal of cardiac mesenchymal stem cells by symmetric divisions. Therefore, competing risks and concordance statistics provide a robust and unbiased approach for evaluating hypotheses at the single-cell level. PMID:27250534

  20. Quantifying intrinsic and extrinsic control of single-cell fates in cancer and stem/progenitor cell pedigrees with competing risks analysis

    PubMed Central

    Cornwell, J. A.; Hallett, R. M.; der Mauer, S. Auf; Motazedian, A.; Schroeder, T.; Draper, J. S.; Harvey, R. P.; Nordon, R. E.

    2016-01-01

    The molecular control of cell fate and behaviour is a central theme in biology. Inherent heterogeneity within cell populations requires that control of cell fate is studied at the single-cell level. Time-lapse imaging and single-cell tracking are powerful technologies for acquiring cell lifetime data, allowing quantification of how cell-intrinsic and extrinsic factors control single-cell fates over time. However, cell lifetime data contain complex features. Competing cell fates, censoring, and the possible inter-dependence of competing fates, currently present challenges to modelling cell lifetime data. Thus far such features are largely ignored, resulting in loss of data and introducing a source of bias. Here we show that competing risks and concordance statistics, previously applied to clinical data and the study of genetic influences on life events in twins, respectively, can be used to quantify intrinsic and extrinsic control of single-cell fates. Using these statistics we demonstrate that 1) breast cancer cell fate after chemotherapy is dependent on p53 genotype; 2) granulocyte macrophage progenitors and their differentiated progeny have concordant fates; and 3) cytokines promote self-renewal of cardiac mesenchymal stem cells by symmetric divisions. Therefore, competing risks and concordance statistics provide a robust and unbiased approach for evaluating hypotheses at the single-cell level. PMID:27250534

  1. Low Academic Competence in First Grade as a Risk Factor for Depressive Cognitions and Symptoms in Middle School

    ERIC Educational Resources Information Center

    Herman, Keith C.; Lambert, Sharon F.; Reinke, Wendy M.; Ialongo, Nicholas S.

    2008-01-01

    The present study investigated the role of low academic competence in the emergence of depressive cognitions and symptoms. Structural equation modeling was conducted on a longitudinal sample of African American boys (n = 253) and girls (n = 221). Results supported the hypothesized path models from academic competence in 1st grade to depressive…

  2. Risks, benefits and survival strategies-views from female sex workers in Savannakhet, Laos

    PubMed Central

    2012-01-01

    Background Female sex workers (FSWs) are vulnerable to sexually transmitted infections (STIs) and encounter socio-economic and health problems, including STIs/HIV, unintended pregnancy and complications from unsafe abortion, stigma, violence, and drug addiction. Reducing risks associated with sex work requires an understanding of the social and cultural context in which sex workers live and work. This study aimed to explore the working environment and perceived risks among FSWs in Savannakhet province in Laos. Methods Five focus group discussions (FGDs) and seven interviews were conducted with FSWs in Kaysone Phomvihan district in Laos. Latent content analysis was used to analyze the transcribed text. Results The results revealed that the FSWs were aware of risks but they also talked about benefits related to their work. The risks were grouped into six categories: STIs/HIV, unintended pregnancy, stigma, violence, being cheated, and social and economic insecurity. The reported benefits were financial security, fulfilling social obligations, and sexual pleasure. The FSWs reported using a number of strategies to reduce risks and increase benefits. Conclusions The desire to be self-sufficient and earn as much money as possible put the FSWs in disadvantaged and vulnerable situations. Fear of financial insecurity, obligations to support one’s family and the need to secure the future influenced FSWs’ decisions to have safe or unsafe sex. The FSWs were, however, not only victims. They also had some control over their lives and working environment, with most viewing their work as an easy and good way of earning money. PMID:23164407

  3. Genetic variants in EBV reactivation-related genes and the risk and survival of breast cancer.

    PubMed

    Zhang, Wei; Zhang, Zheng-Zheng; Tang, Lu-Ying; Lin, Ying; Su, Feng-Xi; Xie, Xiao-Ming; Su, Xue-Fen; Ren, Ze-Fang

    2016-06-01

    Tumor susceptibility gene 101 (TSG101) and activating transcription factor 2 (ATF2) have been suggested to involve in the reactivation of EBV which has implications in the development and progression of breast cancer. Therefore, the polymorphisms of TSG101 and ATF2 may associate with breast cancer risk and prognosis. A case-control study with 1551 breast cancer cases and 1605 age-matched controls were conducted in Guangzhou, China. We have also successfully followed up 1168 cases until December 31, 2014. The variant allele of TSG101 rs2292179 was associated with a non-significant reduced risk of breast cancer, particularly among women with BMI < 24 (kg/m(2)) (P for interaction <0.05). For ATF2 rs3845744, the variant allele was also associated with a significantly reduced breast cancer risk [odds ratio (OR) (95 % confidence interval (CI)) 0.86 (0.74∼1.00)], and the association occurred among only postmenopausal women [OR (95 % CI) 0.69 (0.54∼0.88)] (P for interaction <0.05). Breast cancer risk was further reduced with the increasing numbers of the variant G alleles of the two polymorphisms (P for trend <0.05). We did not find an overall association of the two loci with breast cancer prognosis, while the hazard ratios of the two loci (AG/GG vs. AA) were significantly higher among postmenopausal women than premenopausal women (P = 0.046, 0.016 for TSG101 rs2292179 and ATF2 rs3845744, respectively). In summary, the variant alleles of TSG101 rs2292179 and ATF2 rs3845744 were associated with a reduced risk of breast cancer, particularly for subjects with BMI <24 (kg/m(2)) and postmenopausal women, respectively. The two SNPs and menopausal status may have a significant interaction on breast cancer progression. PMID:26729199

  4. Racial and ethnic disparities in the impact of obesity on breast cancer risk and survival: a global perspective.

    PubMed

    Bandera, Elisa V; Maskarinec, Gertraud; Romieu, Isabelle; John, Esther M

    2015-11-01

    Obesity is a global concern, affecting both developed and developing countries. Although there are large variations in obesity and breast cancer rates worldwide and across racial/ethnic groups, most studies evaluating the impact of obesity on breast cancer risk and survival have been conducted in non-Hispanic white women in the United States or Europe. Given the known racial/ethnic differences in tumor hormone receptor subtype distribution, obesity prevalence, and risk factor profiles, we reviewed published data for women of African, Hispanic, and Asian ancestry in the United States and their countries of origin. Although the data are limited, current evidence suggests a stronger adverse effect of obesity on breast cancer risk and survival in women of Asian ancestry. For African Americans and Hispanics, the strength of the associations appears to be more comparable to that of non-Hispanic whites, particularly when accounting for subtype and menopausal status. Central obesity seems to have a stronger impact in African-American women than general adiposity as measured by body mass index. International data from countries undergoing economic transition offer a unique opportunity to evaluate the impact of rapid weight gain on breast cancer. Such studies should take into account genetic ancestry, which may help elucidate differences in associations between ethnically admixed populations. Overall, additional large studies that use a variety of adiposity measures are needed, because the current evidence is based on few studies, most with limited statistical power. Future investigations of obesity biomarkers will be useful to understand possible racial/ethnic biological differences underlying the complex association between obesity and breast cancer development and progression. PMID:26567202

  5. Extended survival and reduced risk of AML progression in erythroid-responsive lenalidomide-treated patients with lower-risk del(5q) MDS

    PubMed Central

    List, A F; Bennett, J M; Sekeres, M A; Skikne, B; Fu, T; Shammo, J M; Nimer, S D; Knight, R D; Giagounidis, A

    2014-01-01

    Lenalidomide is the approved treatment for patients with red blood cell (RBC) transfusion-dependent lower-risk myelodysplastic syndromes (MDS) and chromosome 5q deletion (del(5q)). We report the long-term outcomes (median follow-up 3.2 years) in patients treated with lenalidomide in the MDS-003 trial. RBC transfusion independence (TI) ⩾8 weeks was achieved in 97 of 148 treated patients (65.5%), with a median response duration of 2.2 years. Partial or complete cytogenetic response was achieved by 63 of 88 evaluable patients (71.6%). Median overall survival (OS) was longer in patients achieving RBC-TI ⩾8 weeks (4.3 vs 2.0 years in non-responders; P<0.0001) or cytogenetic response (4.9 vs 3.1 years in non-responders; P=0.010). Time to acute myeloid leukemia (AML) progression was longer in patients achieving RBC-TI ⩾8 weeks or any cytogenetic response versus non-responders (P=0.001 and P=0.0002, respectively). In a landmark multivariate analysis, RBC-TI ⩾8 weeks was associated with prolonged OS (P<0.001) and a trend toward reduced relative risk of AML progression (P=0.080). Among these lower-risk MDS patients with del(5q), lenalidomide was associated with prolonged RBC-TI and cytogenetic responses, which were linked to improved OS and reduced risk of AML progression. PMID:24150217

  6. HOME for STEPS. Homemaking Opportunity Modules for Education for Use with Surviving Today's Experiences and Problems Successfully. Compiled from Competency Based Modules Based on V-TECS Catalogs.

    ERIC Educational Resources Information Center

    Marshall Univ., Huntington, WV. Dept. of Home Economics.

    Designed to accompany Surviving Today's Experiences and Problems Successfully (STEPS) for 9th and 10th grade home economics courses, this volume consists of individualized learning packages dealing with four areas: management/family economics, human development, housing, and foods/nutrition. The book is divided into four parts. First, the…

  7. Biology of Toxoplasma gondii, its survival in body tissues and liquids, risks for the pregnant woman.

    PubMed

    Zardi, O; Soubotian, B

    1979-01-01

    After briefly outlining the biology of Toxoplasma gondii the authors discuss the resistance of the parasite in body liquids and tissues under certain environmental conditions. Parasite resistance and its consequent risk of human infection, particularly for the pregnant woman, is emphasized. Toxoplasma oocysts, the sexual expression of the parasite, and the cyst facilitate the diffusion of Toxoplasma, as they are much more resistant than the trophozoite. PMID:552276

  8. Risk factors of early onset of MS in women in reproductive age period: survival analysis approach.

    PubMed

    Mohammadbeigi, Abolfazl; Kazemitabaee, Maryamsadat; Etemadifar, Masoud

    2016-08-01

    The incidence of multiple sclerosis (MS) has doubled in over the last decades in women, whereas it has been almost unchanged in men. The purpose of this study was to investigate the risk factors of early onset multiple sclerosis in women during reproductive years. A retrospective longitudinal study conducted on 200 women aged 15 to 50 years with MS, registered by the MS Society in Isfahan. Data gathering was fulfilled by standard questionnaire including variables about reproductive period, demographic characteristics, and history of diseases. Kaplan-Mayer with log-rank test and Cox regression models were used in predicting of the age of effective factors in onset of MS. P values less than 0.05 were considered statistically significant. The mean age of studied women was 31.77 ± 8.13 years and the mean and median age of onset the symptoms of MS was 26.79 ± 7.77 and 26 years, respectively. Based on the cox results occurring menarche at 15 years and higher increase the risk of MS 2.8-fold than those their menarche occurred at 12 years and lower (HR: 2.81, 95 % CI; 1.58-4.98).In addition, having only one pregnancy is related to higher risk of MS than other parities and increase the risk of MS 4.5-fold comparing to without parities. Age of menarche and parity numbers was the most important reproductive factors of MS in women. Nevertheless, history of autoimmune diseases, animal bite, childhood disease, family history of MS, regional area (tropical), and living in rural area were not related to early onset of MS. PMID:26790684

  9. Haptoglobin phenotype is not a predictor of recurrence free survival in high-risk primary breast cancer patients

    PubMed Central

    Gast, Marie-Christine W; van Tinteren, Harm; Bontenbal, Marijke; van Hoesel, René QGCM; Nooij, Marianne A; Rodenhuis, Sjoerd; Span, Paul N; Tjan-Heijnen, Vivianne CG; de Vries, Elisabeth GE; Harris, Nathan; Twisk, Jos WR; Schellens, Jan HM; Beijnen, Jos H

    2008-01-01

    Background Better breast cancer prognostication may improve selection of patients for adjuvant therapy. We conducted a retrospective follow-up study in which we investigated sera of high-risk primary breast cancer patients, to search for proteins predictive of recurrence free survival. Methods Two sample sets of high-risk primary breast cancer patients participating in a randomised national trial investigating the effectiveness of high-dose chemotherapy were analysed. Sera in set I (n = 63) were analysed by surface enhanced laser desorption ionisation time-of-flight mass spectrometry (SELDI-TOF MS) for biomarker finding. Initial results were validated by analysis of sample set II (n = 371), using one-dimensional gel-electrophoresis. Results In sample set I, the expression of a peak at mass-to-charge ratio 9198 (relative intensity ≤ 20 or > 20), identified as haptoglobin (Hp) alpha-1 chain, was strongly associated with recurrence free survival (global Log-rank test; p = 0.0014). Haptoglobin is present in three distinct phenotypes (Hp 1-1, Hp 2-1, and Hp 2-2), of which only individuals with phenotype Hp 1-1 or Hp 2-1 express the haptoglobin alpha-1 chain. As the expression of the haptoglobin alpha-1 chain, determined by SELDI-TOF MS, corresponds to the phenotype, initial results were validated by haptoglobin phenotyping of the independent sample set II by native one-dimensional gel-electrophoresis. With the Hp 1-1 phenotype as the reference category, the univariate hazard ratio for recurrence was 0.87 (95% CI: 0.56 – 1.34, p = 0.5221) and 1.03 (95% CI: 0.65 – 1.64, p = 0.8966) for the Hp 2-1 and Hp 2-2 phenotypes, respectively, in sample set II. Conclusion In contrast to our initial results, the haptoglobin phenotype was not identified as a predictor of recurrence free survival in high-risk primary breast cancer in our validation set. Our initial observation in the discovery set was probably the result of a type I error (i.e. false positive). This study

  10. Reflex and Tonic Autonomic Markers for Risk Stratification in Patients With Type 2 Diabetes Surviving Acute Myocardial Infarction

    PubMed Central

    Barthel, Petra; Bauer, Axel; Müller, Alexander; Junk, Nadine; Huster, Katharina M.; Ulm, Kurt; Malik, Marek; Schmidt, Georg

    2011-01-01

    OBJECTIVE Diabetic postinfarction patients are at increased mortality risk compared with nondiabetic postinfarction patients. In a substantial number of these patients, diabetic cardiac neuropathy already preexists at the time of the infarction. In the current study we investigated if markers of autonomic dysfunction can further discriminate diabetic postinfarction patients into low- and high-risk groups. RESEARCH DESIGN AND METHODS We prospectively enrolled 481 patients with type 2 diabetes who survived acute myocardial infarction (MI), were aged ≤80 years, and presented in sinus rhythm. Primary end point was total mortality at 5 years of follow-up. Severe autonomic failure (SAF) was defined as coincidence of abnormal autonomic reflex function (assessed by means of heart rate turbulence) and of abnormal autonomic tonic activity (assessed by means of deceleration capacity of heart rate). Multivariable risk analyses considered SAF and standard risk predictors including history of previous MI, arrhythmia on Holter monitoring, insulin treatment, and impaired left ventricular ejection fraction (LVEF) ≤30%. RESULTS During follow-up, 83 of the 481 patients (17.3%) died. Of these, 24 deaths were sudden cardiac deaths and 21 nonsudden cardiac deaths. SAF identified a high-risk group of 58 patients with a 5-year mortality rate of 64.0% at a sensitivity level of 38.0%. Multivariately, SAF was the strongest predictor of mortality (hazard ratio 4.9 [95% CI 2.4–9.9]), followed by age ≥65 years (3.4 [1.9–5.8]), and LVEF ≤30% (2.6 [1.5–4.4]). CONCLUSIONS Combined abnormalities of autonomic reflex function and autonomic tonic activity identifies diabetic postinfarction patients with very poor prognoses. PMID:21680727

  11. A functional variant in miR-155 regulation region contributes to lung cancer risk and survival.

    PubMed

    Xie, Kaipeng; Ma, Hongxia; Liang, Cheng; Wang, Cheng; Qin, Na; Shen, Wei; Gu, Yayun; Yan, Caiwang; Zhang, Kai; Dai, Ningbin; Zhu, Meng; Wu, Shuangshuang; Wang, Hui; Dai, Juncheng; Jin, Guangfu; Shen, Hongbing; Hu, Zhibin

    2015-12-15

    Emerging evidence suggested that upregulation of miR-155 could serve as a promising marker for the diagnosis and prognosis of non-small cell lung cancer (NSCLC). In the present study, we genotyped rs767649 (A > T) located in miR-155 regulation region in 1341 cases and 1982 controls, and analyzed the associations of rs767649 with NSCLC risk and survival. Consequently, rs767649 exhibited the significant associations with the risk (adjusted OR = 1.12, 95% CI = 1.01-1.24, P = 0.031) and prognosis of NSCLC (adjusted HR = 1.17, 95% CI = 1.03-1.32, P = 0.014). Meanwhile, rs767649 specifically interacted with radio-chemotherapy (P(int) = 0.013), and patients with both the rs767649-TT genotype and radio-chemotherapy had the highest hazard ratio (adjusted HR = 1.65, 95% CI = 1.26-2.16, P < 0.001). Furthermore, using functional assays and The Cancer Genome Atlas (TCGA) Lung Adenocarcinoma (LUAD) dataset, we found that rs767649 variant allele could increase the transcriptional activity of miR-155, which in turn facilitated tumor growth and metastasis by inhibiting HBP1, TJP1, SMAD5 and PRKAR1A expression. Our findings suggested that rs767649 A > T might contribute to the increased risk and poor prognosis of NSCLC, highlighting the importance of rs767649 in the prevention and therapy of NSCLC. PMID:26543233

  12. A functional variant in miR-155 regulation region contributes to lung cancer risk and survival

    PubMed Central

    Wang, Cheng; Qin, Na; Shen, Wei; Gu, Yayun; Yan, Caiwang; Zhang, Kai; Dai, Ningbin; Zhu, Meng; Wu, Shuangshuang; Wang, Hui; Dai, Juncheng; Jin, Guangfu; Shen, Hongbing; Hu, Zhibin

    2015-01-01

    Emerging evidence suggested that upregulation of miR-155 could serve as a promising marker for the diagnosis and prognosis of non-small cell lung cancer (NSCLC). In the present study, we genotyped rs767649 (A > T) located in miR-155 regulation region in 1341 cases and 1982 controls, and analyzed the associations of rs767649 with NSCLC risk and survival. Consequently, rs767649 exhibited the significant associations with the risk (adjusted OR = 1.12, 95% CI = 1.01–1.24, P = 0.031) and prognosis of NSCLC (adjusted HR = 1.17, 95% CI = 1.03–1.32, P = 0.014). Meanwhile, rs767649 specifically interacted with radio-chemotherapy (Pint = 0.013), and patients with both the rs767649-TT genotype and radio-chemotherapy had the highest hazard ratio (adjusted HR = 1.65, 95% CI = 1.26–2.16, P < 0.001). Furthermore, using functional assays and The Cancer Genome Atlas (TCGA) Lung Adenocarcinoma (LUAD) dataset, we found that rs767649 variant allele could increase the transcriptional activity of miR-155, which in turn facilitated tumor growth and metastasis by inhibiting HBP1, TJP1, SMAD5 and PRKAR1A expression. Our findings suggested that rs767649 A > T might contribute to the increased risk and poor prognosis of NSCLC, highlighting the importance of rs767649 in the prevention and therapy of NSCLC. PMID:26543233

  13. Sarcopenia of thoracic muscle mass is not a risk factor for survival in lung transplant recipients

    PubMed Central

    Lee, Seokkee; Paik, Hyo Chae; Haam, Seok Jin; Lee, Chang Young; Nam, Kyung Sik; Jung, Hee Suk; Do, Young Woo; Shu, Jee Won

    2016-01-01

    Background In lung transplantation (LTx), patients with thoracic muscle sarcopenia may have to require longer to recovery. We measured thoracic muscle volume by using the cross sectional area (CSA) and assessed its effect on early outcomes after LTx. Methods A retrospective analysis was conducted to evaluate the effect of thoracic sarcopenia in patients undergoing LTx between January 2010 and July 2015. The lowest CSA quartile (Q1) was defined as sarcopenia. Results In total, 109 patients were enrolled. The mean CSA was 58.24±15.82 cm2. Patients in the highest CSA quartile were more likely to be male (92.6% vs. 17.9%, P<0.001), older (55.2±10.1 vs. 43.2±14.9 years, P=0.001), to have a higher body mass index (BMI) (22.3±4.0 vs. 19.4±3.7 kg/m2, P=0.007), and to have pulmonary fibrosis (85.2% vs. 35.7%, P=0.003) compared with the lowest CSA quartile. Early outcomes including ventilator support duration [32.9±49.2 vs. 24.5±39.9 days, P= not significant (ns)], intensive care unit (ICU) stay duration (28.4±43.7 vs. 24.4±35.9 days, P= ns) and hospital stay duration (61.4±48.2 vs. 50.8±37.2 days, P= ns) tended to be longer in Q1 than Q4, but the difference was not significant. However, the 1-year survival rate was better in Q1 compared with Q4 (66.6% vs. 46.0%, P=0.04). Conclusions Although patients with thoracic sarcopenia seem to require a longer post-operative recovery time after LTx, this does not compromise their early outcomes. By contrast, patients with larger thoracic muscle volume (Q4) showed poorer survival times.

  14. Drug use, street survival, and risk behaviors among street children in Lahore, Pakistan.

    PubMed

    Sherman, Susan S; Plitt, Sabrina; ul Hassan, Salman; Cheng, Yingkai; Zafar, S Tariq

    2005-09-01

    There are an estimated 3,500-5,000 street children living on the streets of Lahore, Pakistan. A disproportionate number of these children use drugs and engage in survival sex as coping mechanisms. Since August, 2003, Project Smile provides mobile social and health services to street children 6 days a week in selected neighborhoods. This study utilizes data from Project Smile registration data on the program's initial clients (n=347). The study aimed to compare current, former, and nondrug users regarding their reasons for living on the streets, survival and coping mechanisms, and reasons for drug initiation. Of the total sample, 17.0% reported never having used drugs, 15.9% reported being former drug users, and 67.1% reported having used drugs in the month before registration. Participants were 96% boys with a median age of 13 years. The median length of living on the streets was 18 months, and 52.7% had ever been arrested by the police. Odd jobs, begging, and pickpocketing were the primary sources of reported income. Forty-eight percent reported ever having engaging in transactional sex, and 40% reported cutting themselves, primarily to cope with their anger. Variables that were significantly correlated with being a current drug user (vs. never) in the presence of other variables included: being 13 years or older [adjusted odds ratio (AOR)=3.0; 95% confidence interval (95% CI)=1.3-7.0]; reporting a daily income > or =Rs 60 (AOR=2.7; 95% CI=1.1-6.4); having a history of arrest (AOR=3.3; 95% CI=1.3-8.3); wanting to return home (AOR=0.3; 95% CI=0.1-0.8); feeling hatred from the public (AOR=5.1; 95% CI=2.0-12.9); ever exchanging sex for food, shelter, drugs, or money (AOR=3.4; 95% CI=1.3-8.9); and ever having cut themselves (AOR=15.4; 95% CI=3.4-70.7). Drug use is a major coping mechanism among street children in Lahore and is associated with many behaviors. Targeted programs are needed to meet their special needs. PMID:16107434

  15. First incident hospitalisation for Australian women aged 70 and beyond: A 10 year examination using competing risks.

    PubMed

    Harris, Melissa L; Dolja-Gore, Xenia; Kendig, Hal; Byles, Julie E

    2016-01-01

    There are increasing concerns regarding high hospital use among older adults and the capacity to manage the economic impact of the ageing population trend on healthcare systems. First hospitalisation in old age may act as a catalyst for ongoing intensification of health problems and acute care use. This study examined factors associated with first incident hospitalisation in women aged over 70, accounting for the health inequalities associated with geographic location. Survey data from 3780 women from the 1921 to 1926 cohort of the Australian Longitudinal Study on Women's Health were matched with the Admitted Patients Data Collection and National Death Index. Days to first event (hospitalisation or death) were modelled using competing risks methods. A total of 3065 (80.3%) women had at least one hospital admission. More than half of the top 15 reasons for first hospitalisation were related to cardiovascular disease, with atrial fibrillation the most common. Proportional subdistribution hazards models showed that first hospital admission was driven by enabling and need factors including asthma/bronchitis diagnosis (HR=1.16; p=0.047), private health insurance (HR=1.16; p=0.004) more than two prescribed medications in previous month (HR=1.31; p=0.001), more than four general practitioner visits in previous year (HR=1.50; p=0.034), lower physical functioning (HR=0.99; p<0.001) and living in an inner regional area (HR=1.17; p=0.003). First overnight hospitalisation was primarily related with potentially preventable and treatable chronic diseases. Primary and secondary strategies aimed at chronic disease generally, and better chronic disease management particularly for cardiovascular and respiratory diseases, may play a vital role in disease prevention or delay in readmissions among this population. PMID:26952374

  16. Prediagnostic serum inflammatory markers in relation to breast cancer risk, severity at diagnosis and survival in breast cancer patients.

    PubMed

    Wulaningsih, Wahyu; Holmberg, Lars; Garmo, Hans; Malmstrom, Håkan; Lambe, Mats; Hammar, Niklas; Walldius, Göran; Jungner, Ingmar; Van Hemelrijck, Mieke

    2015-10-01

    Inflammation has been linked to cancer but its role in breast cancer is unclear. We investigated common serum markers of inflammation: C-reactive protein (CRP), albumin, haptoglobin and white blood cells (WBC) in relation to breast cancer incidence, severity and survival. A total of 155179 women aged 20 and older without any history of cancer were selected from a large Swedish cohort. Hazard ratios (HRs) for breast cancer were estimated with Cox regression, adjusting for potential confounders. Ordered and binomial logistic regression models were used to assess the associations of serum inflammatory markers with breast cancer severity and oestrogen receptor (ER) positivity at diagnosis, on the other. Cumulative incidence functions by levels of inflammatory markers were assessed for early death from breast cancer and all causes. During a mean follow-up of 18.3 years, 6606 women were diagnosed with breast cancer, of whom 1474 died. A positive association with incident breast cancer was seen for haptoglobin ≥ 1.4g/l [HR 1.09; 95% confidence interval (CI): 1.00-1.18] compared to lower levels. No association was observed between inflammatory markers and breast cancer severity or ER positivity. Higher haptoglobin was linked to risk of early death from breast cancer (HR: 1.27, 95% CI: 1.02-1.59), whereas higher risk of early death from all causes was additionally found with CRP ≥ 10mg/l (HR: 1.19, 95% CI: 1.04-1.36) and WBC ≥ 10×10(9)/l (HR: 1.57, 1.14-2.16). Our findings indicate that prediagnostic serum inflammatory markers were weakly linked to incident breast cancer but corresponded to worse survival after diagnosis. PMID:26130675

  17. A large prospective study of SEP15 genetic variation, interaction with plasma selenium levels, and prostate cancer risk and survival.

    PubMed

    Penney, Kathryn L; Schumacher, Fredrick R; Li, Haojie; Kraft, Peter; Morris, J Steven; Kurth, Tobias; Mucci, Lorelei A; Hunter, David J; Kantoff, Philip W; Stampfer, Meir J; Ma, Jing

    2010-05-01

    The role of selenium in prostate cancer (PCa) risk remains controversial, but many epidemiologic studies suggest an inverse association with more aggressive disease. A recently discovered selenoprotein, SEP15, which is highly expressed in the prostate, may play a role either independently or by modifying the effects of selenium. We genotyped four common single-nucleotide polymorphisms capturing common variation (frequency >5%; R(2) > 0.8) within SEP15, as well as rs5859 in the 3' untranslated region, previously reported to reduce the efficiency of selenium incorporation into SEP15. We examined the association of these single-nucleotide polymorphisms with PCa risk and PCa-specific mortality, as well as their interactions with plasma selenium levels, in the Physicians' Health Study. In this nested case-control study (1,286 cases and 1,267 controls), SEP15 polymorphisms were not significantly associated with PCa risk. However, among the cases, three variants were significantly associated with PCa-specific mortality [rs479341 hazard ratio (HR), 1.94; 95% confidence interval (95% CI), 1.15-3.25; rs1407131 HR, 2.85; 95% CI, 1.45-5.59; rs561104 HR, 1.54; 95% CI, 1.12-2.11] with a recessive model. Additionally, rs561104 significantly modified the association of plasma selenium with PCa survival (P(interaction) = 0.02); an inverse relationship of high levels of selenium with PCa mortality was apparent only among those without the increased risk genotype. This study provides evidence that SEP15 genetic variation may influence PCa mortality. Additionally, the association of selenium with PCa mortality was modified by a variant, suggesting the possibility that some men with PCa may benefit more from selenium than others, depending on their genotype. PMID:20424130

  18. Evaluating competing adverse and beneficial outcomes using a mixture model

    PubMed Central

    Lau, Bryan; Cole, Stephen R.; Moore, Richard D.; Gange, Stephen J.

    2008-01-01

    SUMMARY A competing risk framework occurs when individuals have the potential to experience only one of several mutually exclusive outcomes. Standard survival methods often overestimate the cumulative incidence of events when competing events are censored. Mixture distributions have been previously applied to the competing risk framework to obtain inferences regarding the subdistribution of an event of interest. Often the competing event is treated as a nuisance, but it may be of interest to compare adverse events against the beneficial outcome when dealing with an intervention. In this paper, methods for using a mixture model to estimate an adverse-benefit ratio curve (ratio of the cumulative incidence curves for the two competing events) and the ratio of the subhazards for the two competing events are presented. Both parametric and semi-parametric approaches are described with some remarks for extending the model to include uncertainty in the event type that occurred, left-truncation in order to allow for time-dependent analyses, and uncertainty in the timing of the event resulting in interval censoring. The methods are illustrated with data from a HIV clinical cohort examining whether individuals initiating effective antiretroviral therapy have a greater risk of antiretroviral discontinuation or switching compared to HIV RNA suppression. PMID:18416435

  19. Competency Index. [Health Technology Cluster.

    ERIC Educational Resources Information Center

    Ohio State Univ., Columbus. Center on Education and Training for Employment.

    This competency index lists the competencies included in the 62 units of the Tech Prep Competency Profiles within the Health Technologies Cluster. The unit topics are as follows: employability skills; professionalism; teamwork; computer literacy; documentation; infection control and risk management; medical terminology; anatomy, physiology, and…

  20. Women who sell sex in a Ugandan trading town: life histories, survival strategies and risk.

    PubMed

    Gysels, Marjolein; Pool, Robert; Nnalusiba, Betty

    2002-01-01

    Little is known about the background of commercial sex workers in Africa. This study investigated how women in a trading town on the trans-Africa highway in southwest Uganda become involved in commercial sex work, which factors contribute to their economic success or lack of success, and what effect life trajectories and economic success have on negotiating power and risk behaviour. Over the course of two years detailed life histories of 34 women were collected through recording open, in-depth interviews, the collection of sexual and income and expenditure diaries, visits to the women's native villages, and participant observation. The women share similar disadvantaged backgrounds and this has played a role in their move into commercial sex. They have divergent experiences, however, in their utilisation of opportunities and in the level of success they achieve. They have developed different life styles and a variety of ways of dealing with sexual relationships. Three groups of women were identified: (1) women who work in the back-street bars, have no capital of their own and are almost entirely dependent on selling sex for their livelihood; (2) waitresses in the bars along the main road who engage in a more institutionalised kind of commercial sex, often mediated by middlemen and (3) the more successful entrepreneurs who earn money from their own bars as well as from commercial sex. The three groups had different risk profiles. Due partly to their financial independence from men, women in the latter group have taken control of sexual relationships and can negotiate good sexual deals for themselves, both financially and in terms of safe sex. The poorer women were more vulnerable and less able to negotiate safer sex. A disadvantaged background and restricted access to economic resources are the major reasons for women gravitating to commercial sex work. Various aspects of personality play a role in utilising income from commercial sex to set up an economic basis that

  1. Analyzing Factors Affecting Emergency Department Length of Stay-Using a Competing Risk-accelerated Failure Time Model.

    PubMed

    Chaou, Chung-Hsien; Chiu, Te-Fa; Yen, Amy Ming-Fang; Ng, Chip-Jin; Chen, Hsiu-Hsi

    2016-04-01

    Emergency department (ED) length of stay (LOS) is associated with ED crowding and related complications. Previous studies either analyzed single patient disposition groups or combined different endpoints as a whole. The aim of this study is to evaluate different effects of relevant factors affecting ED LOS among different patient disposition groups.This is a retrospective electronic data analysis. The ED LOS and relevant covariates of all patients between January 2013 and December 2013 were collected. A competing risk accelerated failure time model was used to compute endpoint type-specific time ratios (TRs) for ED LOS.A total of 149,472 patients was included for analysis with an overall medium ED LOS of 2.15 [interquartile range (IQR) = 6.51] hours. The medium LOS for discharged, admission, and mortality patients was 1.46 (IQR = 2.07), 11.3 (IQR = 33.2), and 7.53 (IQR = 28.0) hours, respectively. In multivariate analysis, age (TR = 1.012, P < 0.0001], higher acuity (triage level I vs level V, TR = 2.371, P < 0.0001), pediatric nontrauma (compared with adult nontrauma, TR = 3.084, P < 0.0001), transferred patients (TR = 2.712, P < 0.0001), and day shift arrival (compared with night shift, TR = 1.451, P < 0.0001) were associated with prolonged ED LOS in the discharged patient group. However, opposite results were noted for higher acuity (triage level I vs level V, TR = 0.532, P < 0.0001), pediatric nontrauma (TR = 0.375, P < 0.0001), transferred patients (TR = 0.852, P < 0.0001), and day shift arrival (TR = 0.88, P < 0.0001) in the admission patient group.Common influential factors such as age, patient entity, triage acuity level, or arrival time may have varying effects on different disposition groups of patients. These findings and the suggested model could be used for EDs to develop individually tailored approaches to minimize ED LOS and further improve ED crowding status

  2. Competing risks of death in women treated with adjuvant aromatase inhibitors for early breast cancer on NCIC CTG MA.27.

    PubMed

    Chapman, Judith-Anne W; Shepherd, Lois E; Ingle, James N; Muss, Hyman B; Pritchard, Kathleen I; Gelmon, Karen A; Whelan, Timothy J; Elliott, Catherine; Goss, Paul E

    2016-04-01

    Baseline patient and tumor characteristics differentially affected type of death in the MA.17 placebo-controlled letrozole trial where cardiovascular death was not separately identified. The MA.27 trial allowed competing risks analysis of breast cancer (BC), cardiovascular, and other type (OT) of death. MA.27 was a phase III adjuvant breast cancer trial of exemestane versus anastrozole. Effects of baseline patient and tumor characteristics were tested for whether factors were associated with (1) all cause mortality and (2) cause-specific mortality. We also fit step-wise forward cause-specific-adjusted models. 7576 women (median age 64 years; 5417 (72 %) < 70 years and 2159 (28 %) ≥ 70 years) were enrolled and followed for median 4.1 years. The 432 deaths comprised 187 (43 %) BC, 66 (15 %) cardiovascular, and 179 (41 %) OT. Five baseline factors were differentially associated with type of death. Older patients had greater BC (p = 0.03), cardiovascular (p < 0.001), and other types (p < 0.001) of mortality. Patients with pre-existing cardiovascular history had worse cardiovascular mortality (p < 0.001); those with worse ECOG performance status had worse OT mortality (p < 0.001). Patients with T1 tumors (p < 0.001) and progesterone receptor positive had less BC mortality (p < 0.001). Fewer BC deaths occurred with node-negative disease (p < 0.001), estrogen receptor-positive tumors (p = 0.001), and without adjuvant chemotherapy (p = 0.005); worse cardiovascular mortality (p = 0.01), with trastuzumab; worse OT mortality, for non-whites (p = 0.03) and without adjuvant radiotherapy (p = 0.003). Overall, 57 % of deaths in MA.27 AI-treated patients were non-breast cancer related. Baseline patient and tumor characteristics differentially affected type of death with women 70 or older experiencing more non-breast cancer death. PMID:27006189

  3. Analyzing Factors Affecting Emergency Department Length of Stay—Using a Competing Risk-accelerated Failure Time Model

    PubMed Central

    Chaou, Chung-Hsien; Chiu, Te-Fa; Yen, Amy Ming-Fang; Ng, Chip-Jin; Chen, Hsiu-Hsi

    2016-01-01

    Abstract Emergency department (ED) length of stay (LOS) is associated with ED crowding and related complications. Previous studies either analyzed single patient disposition groups or combined different endpoints as a whole. The aim of this study is to evaluate different effects of relevant factors affecting ED LOS among different patient disposition groups. This is a retrospective electronic data analysis. The ED LOS and relevant covariates of all patients between January 2013 and December 2013 were collected. A competing risk accelerated failure time model was used to compute endpoint type-specific time ratios (TRs) for ED LOS. A total of 149,472 patients was included for analysis with an overall medium ED LOS of 2.15 [interquartile range (IQR) = 6.51] hours. The medium LOS for discharged, admission, and mortality patients was 1.46 (IQR = 2.07), 11.3 (IQR = 33.2), and 7.53 (IQR = 28.0) hours, respectively. In multivariate analysis, age (TR = 1.012, P < 0.0001], higher acuity (triage level I vs level V, TR = 2.371, P < 0.0001), pediatric nontrauma (compared with adult nontrauma, TR = 3.084, P < 0.0001), transferred patients (TR = 2.712, P < 0.0001), and day shift arrival (compared with night shift, TR = 1.451, P < 0.0001) were associated with prolonged ED LOS in the discharged patient group. However, opposite results were noted for higher acuity (triage level I vs level V, TR = 0.532, P < 0.0001), pediatric nontrauma (TR = 0.375, P < 0.0001), transferred patients (TR = 0.852, P < 0.0001), and day shift arrival (TR = 0.88, P < 0.0001) in the admission patient group. Common influential factors such as age, patient entity, triage acuity level, or arrival time may have varying effects on different disposition groups of patients. These findings and the suggested model could be used for EDs to develop individually tailored approaches to minimize ED LOS and further improve ED crowding

  4. Competent psychopharmacology.

    PubMed

    Gardner, David M

    2014-08-01

    There is little doubt that undergraduate and post-graduate training of physicians, pharmacists, and nurses is insufficient to prepare them to use psychotropics safely and effectively, especially in the context of their expanded off-label uses. Therefore, the development of competencies in psychotropic prescribing needs to be approached as a long-term, practice-based learning commitment. Proposed are the abilities and knowledge components necessary for safe and effective use of psychotropics. Typical challenges in prescribing for chronic and recurrent illnesses include highly variable responses and tolerability, drug interactions, and adverse effects that can be serious, irreversible, and even fatal. Prescribing psychotropics is further complicated by negative public and professional reports and growing patient concerns about the quality of care, and questions about the efficacy, safety, and addictive risks of psychotropics. Increased efforts are needed to enhance clinical training and knowledge in psychopharmacology among trainees and practising clinicians, with more comprehensive and sustained attention to the assessment of individual patients, and greater reliance on patient education and collaboration. Improved competence in psychotropic prescribing should lead to more informed, thoughtful, and better-targeted applications as one component of more comprehensive clinical care. PMID:25161064

  5. Competent Psychopharmacology

    PubMed Central

    Gardner, David M

    2014-01-01

    There is little doubt that undergraduate and post-graduate training of physicians, pharmacists, and nurses is insufficient to prepare them to use psychotropics safely and effectively, especially in the context of their expanded off-label uses. Therefore, the development of competencies in psychotropic prescribing needs to be approached as a long-term, practice-based learning commitment. Proposed are the abilities and knowledge components necessary for safe and effective use of psychotropics. Typical challenges in prescribing for chronic and recurrent illnesses include highly variable responses and tolerability, drug interactions, and adverse effects that can be serious, irreversible, and even fatal. Prescribing psychotropics is further complicated by negative public and professional reports and growing patient concerns about the quality of care, and questions about the efficacy, safety, and addictive risks of psychotropics. Increased efforts are needed to enhance clinical training and knowledge in psychopharmacology among trainees and practising clinicians, with more comprehensive and sustained attention to the assessment of individual patients, and greater reliance on patient education and collaboration. Improved competence in psychotropic prescribing should lead to more informed, thoughtful, and better-targeted applications as one component of more comprehensive clinical care. PMID:25161064

  6. Survival analysis of factors affecting incidence risk of Salmonella Dublin in Danish dairy herds during a 7-year surveillance period.

    PubMed

    Nielsen, Liza Rosenbaum; Dohoo, Ian

    2012-12-01

    A national surveillance programme for Salmonella Dublin, based on regular bulk-tank milk antibody screening and movements of cattle, was initiated in Denmark in 2002. From 2002 to end of 2009 the prevalence of test-positive dairy herds was reduced from 26% to 10%. However, new infections and spread of S. Dublin between herds continued to occur. The objective of this study was to investigate factors affecting incidence risk of S. Dublin infection in Danish dairy herds between 2003 and 2009. Herds were considered at risk when they had been test-negative for at least four consecutive year-quarters (YQs), either at the start of the study period or after recovery from infection. Survival analysis was performed on a dataset including 6931 dairy herds with 118,969 YQs at risk, in which 1523 failures (new infection events) occurred. Predictors obtained from register data were tested in a multivariable, proportional hazard model allowing for recurrence within herds. During October to December the hazard of failures was higher (hazard ratio HR=3.4, P=0.0005) than the rest of the year. Accounting for the delay in bulk-tank milk antibody responses to S. Dublin infection, this indicates that introduction of bacteria was most frequent between July and October. Purchase from test-positive cattle herds within the previous 6 months was associated with higher hazard of failures (HR=2.5, P<0.0001) compared to no purchase and purchase from test-negative herds. Increasing local prevalence, herd size and bulk-tank milk somatic cell counts were also associated with increasing hazard of failures. The effect of prior infection was time-dependent; the hazard of failures was reduced following a logarithmic decline with increasing time at risk. The hazard was markedly higher in herds with prior infections the first year after becoming at risk again, and then approached the hazard in herds without known prior infections 2-3 years after becoming test-negative. This showed that herds with prior

  7. Competing risks and the development of adaptive management plans for water resources: Field reconnaissance investigation of risks to fishes and other aquatic biota exposed to endocrine disrupting chemicals (edcs) in lake mead, Nevada USA

    USGS Publications Warehouse

    Linder, G.; Little, E.E.

    2009-01-01

    The analysis and characterization of competing risks for water resources rely on a wide spectrum of tools to evaluate hazards and risks associated with their management. For example, waters of the lower Colorado River stored in reservoirs such as Lake Mead present a wide range of competing risks related to water quantity and water quality. These risks are often interdependent and complicated by competing uses of source waters for sustaining biological resources and for supporting a range of agricultural, municipal, recreational, and industrial uses. USGS is currently conducting a series of interdisciplinary case-studies on water quality of Lake Mead and its source waters. In this case-study we examine selected constituents potentially entering the Lake Mead system, particularly endocrine disrupting chemicals (EDCs). Worldwide, a number of environmental EDCs have been identified that affect reproduction, development, and adaptive behaviors in a wide range of organisms. Many EDCs are minimally affected by current treatment technologies and occur in treated sewage effluents. Several EDCs have been detected in Lake Mead, and several substances have been identified that are of concern because of potential impacts to the aquatic biota, including the sport fishery of Lake Mead and endangered razorback suckers (Xyrauchen texanus) that occur in the Colorado River system. For example, altered biomarkers relevant to reproduction and thyroid function in fishes have been observed and may be predictive of impaired metabolism and development. Few studies, however, have addressed whether such EDC-induced responses observed in the field have an ecologically significant effect on the reproductive success of fishes. To identify potential linkages between EDCs and species of management concern, the risk analysis and characterization in this reconnaissance study focused on effects (and attendant uncertainties) that might be expressed by exposed populations. In addition, risk reduction

  8. Effect of Health Risk Assessment and Counselling on Health Behaviour and Survival in Older People: A Pragmatic Randomised Trial

    PubMed Central

    Stuck, Andreas E.; Moser, André; Morf, Ueli; Wirz, Urban; Wyser, Joseph; Gillmann, Gerhard; Born, Stephan; Zwahlen, Marcel; Iliffe, Steve; Harari, Danielle; Swift, Cameron; Beck, John C.; Egger, Matthias

    2015-01-01

    Background Potentially avoidable risk factors continue to cause unnecessary disability and premature death in older people. Health risk assessment (HRA), a method successfully used in working-age populations, is a promising method for cost-effective health promotion and preventive care in older individuals, but the long-term effects of this approach are unknown. The objective of this study was to evaluate the effects of an innovative approach to HRA and counselling in older individuals for health behaviours, preventive care, and long-term survival. Methods and Findings This study was a pragmatic, single-centre randomised controlled clinical trial in community-dwelling individuals aged 65 y or older registered with one of 19 primary care physician (PCP) practices in a mixed rural and urban area in Switzerland. From November 2000 to January 2002, 874 participants were randomly allocated to the intervention and 1,410 to usual care. The intervention consisted of HRA based on self-administered questionnaires and individualised computer-generated feedback reports, combined with nurse and PCP counselling over a 2-y period. Primary outcomes were health behaviours and preventive care use at 2 y and all-cause mortality at 8 y. At baseline, participants in the intervention group had a mean ± standard deviation of 6.9 ± 3.7 risk factors (including unfavourable health behaviours, health and functional impairments, and social risk factors) and 4.3 ± 1.8 deficits in recommended preventive care. At 2 y, favourable health behaviours and use of preventive care were more frequent in the intervention than in the control group (based on z-statistics from generalised estimating equation models). For example, 70% compared to 62% were physically active (odds ratio 1.43, 95% CI 1.16–1.77, p = 0.001), and 66% compared to 59% had influenza vaccinations in the past year (odds ratio 1.35, 95% CI 1.09–1.66, p = 0.005). At 8 y, based on an intention-to-treat analysis, the estimated

  9. An Arterial Conduit is Not a Risk Factor for Survival Following Orthotopic Liver Transplantation: An Analysis of 20 Years of Liver Transplantation in Innsbruck.

    PubMed

    Denecke, Christian; Weiss, Sascha; Biebl, Matthias; Fritz, Josef; Dziodzio, Tomasz; Aigner, Felix; Sucher, Robert; Brandl, Andreas; Bösmüller, Claudia; Pratschke, Johann; Öllinger, Robert

    2016-01-01

    BACKGROUND In adult liver transplantation, arterial conduits have been associated with increased risk for vascular complications and inferior outcome. MATERIAL AND METHODS Complication rates and outcomes of adult patients undergoing liver transplantation in our center between 1990 and 2012 were analyzed retrospectively. Characteristics, transplantation-related factors, and survival rates of patients with conduit grafts (n=43) were compared to patients with a standard arterial anastomosis (n=904) by univariate and multivariate analysis. RESULTS Patients in the conduit group were younger but had a significantly higher proportion of high-urgency and re-transplantations. While patient survival was comparable between the groups, graft survival was inferior for patients with a conduit (1-year, 5-year, and 10-year survival, control vs. conduit group: 87.3%, 78.8% and 71.5% vs. 72.4%, 63.8%, and 41.8%, respectively, p=0.008). In univariate analysis, an arterial conduit was associated with more arterial and biliary complications. However, an arterial conduit was not an independent risk factor for graft or patient survival in a Cox regression analysis. CONCLUSIONS An arterial conduit is associated with more vascular complications, yet a conduit per se does not influence graft survival. The inferior outcome may reflect the complex situation of the sicker liver transplant patients needing a non-standard arterial anastomosis. PMID:27215293

  10. Treatment of primary liver tumors with Yttrium-90 microspheres (TheraSphere) in high risk patients: analysis of survival and toxicities.

    PubMed

    Reardon, Kelli A; McIntosh, Alyson F; Shilling, A Tanner; Hagspiel, Klaus D; Al-Osaimi, Abdullah; Berg, Carl; Caldwell, Stephen H; Northup, Patrick G; Angle, Fritz; Mulder, Robert; Rich, Tyvin A

    2009-02-01

    This retrospective study was undertaken to obtain information regarding the survival and toxicities after Yttrium-90 microspheres treatment in patients with primary liver malignancies. Baseline, treatment, and follow-up data were collected and analyzed for 21 patients treated with Yttrium-90 microspheres. Survival analysis was then performed. The results of this study showed that median survival for all the patients was 120 days. Twenty of 21 patients were categorized as high-risk with a median survival of 114 days. It was also found that one high-risk patient has survived 858 days with no recurrence of disease. Acute grade 3-5 toxicities were recorded for nine patients and consisted of elevations in AST and bilirubin, thrombocytopenia, abdominal pain, ascites, nausea, fatigue, and death. This study concluded that Yttrium-90 is a low-toxicity, outpatient alternative for individuals with liver cancer and without many options. The maximal value, however, may lie in the treatment of low-risk patients. PMID:19166244