Occupational Exposure to Magnetic Fields and Breast Cancer Among Women Textile Workers in Shanghai, China

PubMed Central

Li, Wenjin; Ray, Roberta M.; Thomas, David B.; Yost, Michael; Davis, Scott; Breslow, Norman; Gao, Dao Li; Fitzgibbons, E. Dawn; Camp, Janice E.; Wong, Eva; Wernli, Karen J.; Checkoway, Harvey

2013-01-01

Exposure to magnetic fields (MFs) is hypothesized to increase the risk of breast cancer by reducing production of melatonin by the pineal gland. A nested case-cohort study was conducted to investigate the association between occupational exposure to MFs and the risk of breast cancer within a cohort of 267,400 female textile workers in Shanghai, China. The study included 1,687 incident breast cancer cases diagnosed from 1989 to 2000 and 4,702 noncases selected from the cohort. Subjects’ complete work histories were linked to a job–exposure matrix developed specifically for the present study to estimate cumulative MF exposure. Hazard ratios and 95% confidence intervals were calculated using Cox proportional hazards modeling that was adapted for the case-cohort design. Hazard ratios were estimated in relation to cumulative exposure during a woman's entire working years. No association was observed between cumulative exposure to MFs and overall risk of breast cancer. The hazard ratio for the highest compared with the lowest quartile of cumulative exposure was 1.03 (95% confidence interval: 0.87, 1.21). Similar null findings were observed when exposures were lagged and stratified by age at breast cancer diagnosis. The findings do not support the hypothesis that MF exposure increases the risk of breast cancer. PMID:24043439

A general framework for parametric survival analysis.

PubMed

Crowther, Michael J; Lambert, Paul C

2014-12-30

Parametric survival models are being increasingly used as an alternative to the Cox model in biomedical research. Through direct modelling of the baseline hazard function, we can gain greater understanding of the risk profile of patients over time, obtaining absolute measures of risk. Commonly used parametric survival models, such as the Weibull, make restrictive assumptions of the baseline hazard function, such as monotonicity, which is often violated in clinical datasets. In this article, we extend the general framework of parametric survival models proposed by Crowther and Lambert (Journal of Statistical Software 53:12, 2013), to incorporate relative survival, and robust and cluster robust standard errors. We describe the general framework through three applications to clinical datasets, in particular, illustrating the use of restricted cubic splines, modelled on the log hazard scale, to provide a highly flexible survival modelling framework. Through the use of restricted cubic splines, we can derive the cumulative hazard function analytically beyond the boundary knots, resulting in a combined analytic/numerical approach, which substantially improves the estimation process compared with only using numerical integration. User-friendly Stata software is provided, which significantly extends parametric survival models available in standard software. Copyright © 2014 John Wiley & Sons, Ltd.

Modelling the changing cumulative vulnerability to climate-related hazards for river basin management using a GIS-based multicriteria decision approach

NASA Astrophysics Data System (ADS)

Hung, Hung-Chih; Wu, Ju-Yu; Hung, Chih-Hsuan

2017-04-01

1. Background Asia-Pacific region is one of the most vulnerable areas of the world to climate-related hazards and extremes due to rapid urbanization and over-development in hazard-prone areas. It is thus increasingly recognized that the management of land use and reduction of hazard risk are inextricably linked. This is especially critical from the perspective of integrated river basin management. A range of studies has targeted existing vulnerability assessments. However, limited attention has been paid to the cumulative effects of multiple vulnerable factors and their dynamics faced by local communities. This study proposes a novel methodology to access the changing cumulative vulnerability to climate-related hazards, and to examine the relationship between the attraction factors relevant to the general process of urbanization and vulnerability variability with a focus on a river basin management unit. 2. Methods and data The methods applied in this study include three steps. First, using Intergovernmental Panel on Climate Change's (IPCC) approach, a Cumulative Vulnerability Assessment Framework (CVAF) is built with a goal to characterize and compare the vulnerability to climate-related hazards within river basin regions based on a composition of multiple indicators. We organize these indicator metrics into three categories: (1) hazard exposure; (2) socioeconomic sensitivity, and (3) adaptive capacity. Second, the CVAF is applied by combining a geographical information system (GIS)-based spatial statistics technique with a multicriteria decision analysis (MCDA) to assess and map the changing cumulative vulnerability, comparing conditions in 1996 and 2006 in Danshui River Basin, Taiwan. Third, to examine the affecting factors of vulnerability changing, we develop a Vulnerability Changing Model (VCM) using four attraction factors to reflect how the process of urban developments leads to vulnerability changing. The factors are transport networks, land uses, production values of industries, and infrastructures. We then conduct a regression analysis to test the VCM. To illustrate the proposed methodology, the data are collected from the National Science and Technology Center for Disaster Reduction, Taiwan as well as the National Land Use Investigation and official census statistics. 3. Results and policy implications Results of CVAF analysis demonstrate heterogeneous patterns of vulnerability in the region, and highlight trends of long-term changes. The vulnerable areas unfold as clustered patterns and spatial analogues across regions, rather than randomly distributed. Highest cumulative vulnerability is concentrated in densely populated and downstream reaches (such as Taipei City) of the Danshui River in both time periods. When examining the VCM, it indicates that upper stream and more remote areas generally show low vulnerability, increases are observed in some areas between 1996 and 2006 due to land use intensification, industrial and infrastructure expansion. These findings suggest that land use planning should consider the socioeconomic progression and infrastructure investment factors that contribute to urban sprawl and address current as well as future urban developments vulnerable to hazard risk transmission. The cumulative vulnerability assessment, mapping methods and modelling presented here can be applied to other climate change and hazard risks to highlight priority areas for further investigation and contribute towards improving river basin management.

Predictive Value of Cumulative Blood Pressure for All-Cause Mortality and Cardiovascular Events

NASA Astrophysics Data System (ADS)

Wang, Yan Xiu; Song, Lu; Xing, Ai Jun; Gao, Ming; Zhao, Hai Yan; Li, Chun Hui; Zhao, Hua Ling; Chen, Shuo Hua; Lu, Cheng Zhi; Wu, Shou Ling

2017-02-01

The predictive value of cumulative blood pressure (BP) on all-cause mortality and cardiovascular and cerebrovascular events (CCE) has hardly been studied. In this prospective cohort study including 52,385 participants from the Kailuan Group who attended three medical examinations and without CCE, the impact of cumulative systolic BP (cumSBP) and cumulative diastolic BP (cumDBP) on all-cause mortality and CCEs was investigated. For the study population, the mean (standard deviation) age was 48.82 (11.77) years of which 40,141 (76.6%) were male. The follow-up for all-cause mortality and CCEs was 3.96 (0.48) and 2.98 (0.41) years, respectively. Multivariate Cox proportional hazards regression analysis showed that for every 10 mm Hg·year increase in cumSBP and 5 mm Hg·year increase in cumDBP, the hazard ratio for all-cause mortality were 1.013 (1.006, 1.021) and 1.012 (1.006, 1.018); for CCEs, 1.018 (1.010, 1.027) and 1.017 (1.010, 1.024); for stroke, 1.021 (1.011, 1.031) and 1.018 (1.010, 1.026); and for MI, 1.013 (0.996, 1.030) and 1.015 (1.000, 1.029). Using natural spline function analysis, cumSBP and cumDBP showed a J-curve relationship with CCEs; and a U-curve relationship with stroke (ischemic stroke and hemorrhagic stroke). Therefore, increases in cumSBP and cumDBP were predictive for all-cause mortality, CCEs, and stroke.

Pre-AIDS mortality in the Edinburgh City Hospital HIV cohort.

PubMed

Seaman, S R; Brettle, R P; Gore, S M

1997-11-15

In this paper, we look at the incidence and predictive factors of pre-AIDS mortality among HIV-infected individuals, and injecting drug users (IDUs) in particular, and compare IDUs with non-IDUs. 627 patients (73 per cent IDUs) of the Edinburgh City Hospital HIV Cohort were enrolled pre-AIDS and followed up until September 1994. Analyses were performed using cumulative hazard and cumulative incidence estimators for a competing risks model, the Cox proportional hazards model and the non-parametric hazard estimator of Fusaro et al. (1993). The effects of age and CD4 T-lymphocyte cell count, progressively depleted during HIV progression, were investigated. 60 deaths occurred in AIDS-free patients during follow-up; 25 were drug-related deaths in IDUs. Pre-AIDS mortality was higher among IDUs than non-IDUs (p = 0.07). The cumulative incidences of pre-AIDS death after five years from enrollment were 11 per cent in IDUs and 6 per cent in non-IDUs; the cumulative AIDS incidences were, respectively, 19 per cent and 32 per cent. After eight years, cumulative pre-AIDS death incidence was 15 per cent among IDUs; cumulative AIDS incidence among IDUs was 35 per cent. Both groups had similar risks of medically-related (non-AIDS)-MRNA-death. Age and CD4 count were both individually predictive of MRNA death (relative risks (RRs); 2.1 per decade of life, p < 0.01; and 1.9 for each 100 cells per 100 microliters lost, p < 0.0001), although when used together age was less significant (RR 1.6, p = 0.07). Neither was statistically significant for drug-related mortality, although hazard may be lower in older individuals and may increase with falling CD4 count. The drug-related mortality was 1.1 per cent: 2.3 per cent in the first two years after enrollment, and 0.4 per cent thereafter. We conclude that older HIV-infected individuals are at greater risk of medically-related death before AIDS. This risk increases as CD4 count declines. Drug-related hazard may be greater in younger individuals and may increase as CD4 counts fall, but neither effect was formally significant.

Overall environmental quality and incidence of childhood cancers

EPA Science Inventory

Childhood cancer is associated with individual ambient environmental exposures such as hazardous air pollutants and pesticides. However, the role of cumulative ambient environmental exposures is not well-understood. To estimate cumulative environmental exposures, an Environmental...

EPA Peer Consultation Workshop on Cumulative Risk Assessment of Phthalates: Potential Options and Methods for Evaluating the Cumulative Hazard Associated with Six Selected Phthalates

EPA Science Inventory

EPA held a 2-day workshop on December 8 and 9, 2010 at the Doubletree Hotel Washington DC-Crystal City in Arlington, Viriginia. The goal of this workshop was to evaulate methods of determining cumulative risk associated with exposure to mulitple phthalates for inclusion in the EP...

76 FR 12745 - Privacy Act of 1974; Department of Homeland Security Office of Operations Coordination and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-08

... Center Tracker Log is the underlying cumulative repository of responses to all-threats and all-hazards... cumulative repository of all NOC responses to threats, incidents, significant activities and Requests for...

Risk of Cause-Specific Death in Individuals With Diabetes: A Competing Risks Analysis.

PubMed

Baena-Díez, Jose Miguel; Peñafiel, Judit; Subirana, Isaac; Ramos, Rafel; Elosua, Roberto; Marín-Ibañez, Alejandro; Guembe, María Jesús; Rigo, Fernando; Tormo-Díaz, María José; Moreno-Iribas, Conchi; Cabré, Joan Josep; Segura, Antonio; García-Lareo, Manel; Gómez de la Cámara, Agustín; Lapetra, José; Quesada, Miquel; Marrugat, Jaume; Medrano, Maria José; Berjón, Jesús; Frontera, Guiem; Gavrila, Diana; Barricarte, Aurelio; Basora, Josep; García, Jose María; Pavone, Natalia C; Lora-Pablos, David; Mayoral, Eduardo; Franch, Josep; Mata, Manel; Castell, Conxa; Frances, Albert; Grau, María

2016-11-01

Diabetes is a common cause of shortened life expectancy. We aimed to assess the association between diabetes and cause-specific death. We used the pooled analysis of individual data from 12 Spanish population cohorts with 10-year follow-up. Participants had no previous history of cardiovascular diseases and were 35-79 years old. Diabetes status was self-reported or defined as glycemia >125 mg/dL at baseline. Vital status and causes of death were ascertained by medical records review and linkage with the official death registry. The hazard ratios and cumulative mortality function were assessed with two approaches, with and without competing risks: proportional subdistribution hazard (PSH) and cause-specific hazard (CSH), respectively. Multivariate analyses were fitted for cardiovascular, cancer, and noncardiovascular noncancer deaths. We included 55,292 individuals (15.6% with diabetes and overall mortality of 9.1%). The adjusted hazard ratios showed that diabetes increased mortality risk: 1) cardiovascular death, CSH = 2.03 (95% CI 1.63-2.52) and PSH = 1.99 (1.60-2.49) in men; and CSH = 2.28 (1.75-2.97) and PSH = 2.23 (1.70-2.91) in women; 2) cancer death, CSH = 1.37 (1.13-1.67) and PSH = 1.35 (1.10-1.65) in men; and CSH = 1.68 (1.29-2.20) and PSH = 1.66 (1.25-2.19) in women; and 3) noncardiovascular noncancer death, CSH = 1.53 (1.23-1.91) and PSH = 1.50 (1.20-1.89) in men; and CSH = 1.89 (1.43-2.48) and PSH = 1.84 (1.39-2.45) in women. In all instances, the cumulative mortality function was significantly higher in individuals with diabetes. Diabetes is associated with premature death from cardiovascular disease, cancer, and noncardiovascular noncancer causes. The use of CSH and PSH provides a comprehensive view of mortality dynamics in a population with diabetes. © 2016 by the American Diabetes Association.

Models and analysis for multivariate failure time data

NASA Astrophysics Data System (ADS)

Shih, Joanna Huang

The goal of this research is to develop and investigate models and analytic methods for multivariate failure time data. We compare models in terms of direct modeling of the margins, flexibility of dependency structure, local vs. global measures of association, and ease of implementation. In particular, we study copula models, and models produced by right neutral cumulative hazard functions and right neutral hazard functions. We examine the changes of association over time for families of bivariate distributions induced from these models by displaying their density contour plots, conditional density plots, correlation curves of Doksum et al, and local cross ratios of Oakes. We know that bivariate distributions with same margins might exhibit quite different dependency structures. In addition to modeling, we study estimation procedures. For copula models, we investigate three estimation procedures. the first procedure is full maximum likelihood. The second procedure is two-stage maximum likelihood. At stage 1, we estimate the parameters in the margins by maximizing the marginal likelihood. At stage 2, we estimate the dependency structure by fixing the margins at the estimated ones. The third procedure is two-stage partially parametric maximum likelihood. It is similar to the second procedure, but we estimate the margins by the Kaplan-Meier estimate. We derive asymptotic properties for these three estimation procedures and compare their efficiency by Monte-Carlo simulations and direct computations. For models produced by right neutral cumulative hazards and right neutral hazards, we derive the likelihood and investigate the properties of the maximum likelihood estimates. Finally, we develop goodness of fit tests for the dependency structure in the copula models. We derive a test statistic and its asymptotic properties based on the test of homogeneity of Zelterman and Chen (1988), and a graphical diagnostic procedure based on the empirical Bayes approach. We study the performance of these two methods using actual and computer generated data.

Study of the respiratory health of employees in seven European plants that manufacture ceramic fibres.

PubMed Central

Trethowan, W N; Burge, P S; Rossiter, C E; Harrington, J M; Calvert, I A

1995-01-01

OBJECTIVES--To study the relation between occupational exposure to ceramic fibres during manufacture and respiratory health. METHODS--The respiratory health of 628 current employees in the manufacture of ceramic fibres in seven European plants in three countries was studied with a respiratory questionnaire, lung function tests, and chest radiography. Simultaneous plant hygiene surveys measured subjects' current exposure to airborne ceramic fibres from personal samples with optical microscopy fibre counts. The measured exposures were combined with occupational histories to derive estimates of each subject's cumulative exposure to respirable fibres. Symptoms were related to current and cumulative exposure to ceramic fibres and lung function and findings from chest radiographs were related to cumulative exposure. RESULTS--The mean duration of employment was 10.2 years and mean (range) cumulative exposure was 3.84 (0-22.94) (f.ml-1.y). Eye and skin symptoms were frequent in all plants and increased significantly, as did breathlessness and wheeze, with increasing current exposure. Dry cough and stuffy nose were less common in the least exposed group but did not increase with increasing exposure. After adjustment for the effects of age, sex, height, smoking, and past occupational exposures to respiratory hazards, there was a significant decrease in both forced expiratory volume in one second (FEV1) and forced midexpiratory flow related to cumulative exposure in current smokers (P < 0.05) and in FEV1 in ex-smokers (P < 0.05). Small opacities were found in 13% of the chest radiographs; their prevalence was not related to cumulative exposure to ceramic fibres. CONCLUSIONS--It is concluded that exposure to ceramic fibres is associated with irritant symptoms similar to those seen in other exposures to man made mineral fibres (MMMFs) and that cumulative exposure to respirable ceramic fibres may cause airways obstruction by promoting the effects of cigarette smoke. PMID:7757174

Study of the respiratory health of employees in seven European plants that manufacture ceramic fibres.

PubMed

Trethowan, W N; Burge, P S; Rossiter, C E; Harrington, J M; Calvert, I A

1995-02-01

To study the relation between occupational exposure to ceramic fibres during manufacture and respiratory health. The respiratory health of 628 current employees in the manufacture of ceramic fibres in seven European plants in three countries was studied with a respiratory questionnaire, lung function tests, and chest radiography. Simultaneous plant hygiene surveys measured subjects' current exposure to airborne ceramic fibres from personal samples with optical microscopy fibre counts. The measured exposures were combined with occupational histories to derive estimates of each subject's cumulative exposure to respirable fibres. Symptoms were related to current and cumulative exposure to ceramic fibres and lung function and findings from chest radiographs were related to cumulative exposure. The mean duration of employment was 10.2 years and mean (range) cumulative exposure was 3.84 (0-22.94) (f.ml-1.y). Eye and skin symptoms were frequent in all plants and increased significantly, as did breathlessness and wheeze, with increasing current exposure. Dry cough and stuffy nose were less common in the least exposed group but did not increase with increasing exposure. After adjustment for the effects of age, sex, height, smoking, and past occupational exposures to respiratory hazards, there was a significant decrease in both forced expiratory volume in one second (FEV1) and forced midexpiratory flow related to cumulative exposure in current smokers (P < 0.05) and in FEV1 in ex-smokers (P < 0.05). Small opacities were found in 13% of the chest radiographs; their prevalence was not related to cumulative exposure to ceramic fibres. It is concluded that exposure to ceramic fibres is associated with irritant symptoms similar to those seen in other exposures to man made mineral fibres (MMMFs) and that cumulative exposure to respirable ceramic fibres may cause airways obstruction by promoting the effects of cigarette smoke.

Higher Fluid Balance Increases the Risk of Death From Sepsis: Results From a Large International Audit.

PubMed

Sakr, Yasser; Rubatto Birri, Paolo Nahuel; Kotfis, Katarzyna; Nanchal, Rahul; Shah, Bhagyesh; Kluge, Stefan; Schroeder, Mary E; Marshall, John C; Vincent, Jean-Louis

2017-03-01

Excessive fluid therapy in patients with sepsis may be associated with risks that outweigh any benefit. We investigated the possible influence of early fluid balance on outcome in a large international database of ICU patients with sepsis. Observational cohort study. Seven hundred and thirty ICUs in 84 countries. All adult patients admitted between May 8 and May 18, 2012, except admissions for routine postoperative surveillance. For this analysis, we included only the 1,808 patients with an admission diagnosis of sepsis. Patients were stratified according to quartiles of cumulative fluid balance 24 hours and 3 days after ICU admission. ICU and hospital mortality rates were 27.6% and 37.3%, respectively. The cumulative fluid balance increased from 1,217 mL (-90 to 2,783 mL) in the first 24 hours after ICU admission to 1,794 mL (-951 to 5,108 mL) on day 3 and decreased thereafter. The cumulative fluid intake was similar in survivors and nonsurvivors, but fluid balance was less positive in survivors because of higher fluid output in these patients. Fluid balances became negative after the third ICU day in survivors but remained positive in nonsurvivors. After adjustment for possible confounders in multivariable analysis, the 24-hour cumulative fluid balance was not associated with an increased hazard of 28-day in-hospital death. However, there was a stepwise increase in the hazard of death with higher quartiles of 3-day cumulative fluid balance in the whole population and after stratification according to the presence of septic shock. In this large cohort of patients with sepsis, higher cumulative fluid balance at day 3 but not in the first 24 hours after ICU admission was independently associated with an increase in the hazard of death.

Cumulative HIV viremia and non-AIDS-defining malignancies among a sample of HIV-infected male veterans.

PubMed

Kowalkowski, Marc A; Day, Rena S; Du, Xianglin L; Chan, Wenyaw; Chiao, Elizabeth Y

2014-10-01

Research suggests that cumulative measurement of HIV exposure is associated with mortality, AIDS, and AIDS-defining malignancies. However, the relationship between cumulative HIV and non-AIDS-defining malignancies (NADMs) remains unclear. The aim of this study was to evaluate the effect of different HIV measures on NADM hazard among HIV-infected male veterans. We performed a retrospective cohort study using Veterans Affairs HIV Clinical Case Registry data from 1985 to 2010. We analyzed the relationship between HIV exposure (recent HIV RNA, % undetectable HIV RNA, and HIV copy-years viremia) and NADM. To evaluate the effect of HIV, we calculated hazard ratios for 3 common virally associated NADM [ie, hepatocarcinoma (HCC), Hodgkin lymphoma (HL), and squamous cell carcinoma of the anus (SCCA)] in multivariable Cox regression models. Among 31,576 HIV-infected male veterans, 383 HCC, 211 HL, and 373 SCCA cases were identified. In multivariable regression models, cross-sectional HIV measurement was not associated with NADM. However, compared with <20% undetectable HIV, individuals with ≥80% had decreased HL [adjusted hazard ratio (aHR) = 0.62; 95% confidence interval (CI): 0.37 to 1.02] and SCCA (aHR = 0.64; 95% CI: 0.44 to 0.93). Conversely, each log10 increase in HIV copy-years was associated with elevated HL (aHR = 1.22; 95% CI: 1.06 to 1.40) and SCCA (aHR = 1.36; 95% CI: 1.21 to 1.52). Model fit was best with HIV copy-years. Cumulative HIV was not associated with HCC. Cumulative HIV was associated with certain virally associated NADM (ie, HL and SCCA), independent of measured covariates. Findings underline the importance of early treatment initiation and durable medication adherence to reduce cumulative HIV burden. Future research should prioritize how to best apply cumulative HIV measures in screening for these cancers.

Results of the Verification of the Statistical Distribution Model of Microseismicity Emission Characteristics

NASA Astrophysics Data System (ADS)

Cianciara, Aleksander

2016-09-01

The paper presents the results of research aimed at verifying the hypothesis that the Weibull distribution is an appropriate statistical distribution model of microseismicity emission characteristics, namely: energy of phenomena and inter-event time. It is understood that the emission under consideration is induced by the natural rock mass fracturing. Because the recorded emission contain noise, therefore, it is subjected to an appropriate filtering. The study has been conducted using the method of statistical verification of null hypothesis that the Weibull distribution fits the empirical cumulative distribution function. As the model describing the cumulative distribution function is given in an analytical form, its verification may be performed using the Kolmogorov-Smirnov goodness-of-fit test. Interpretations by means of probabilistic methods require specifying the correct model describing the statistical distribution of data. Because in these methods measurement data are not used directly, but their statistical distributions, e.g., in the method based on the hazard analysis, or in that that uses maximum value statistics.

Changes in risk of immediate adverse reactions to iodinated contrast media by repeated administrations in patients with hepatocellular carcinoma.

PubMed

Fujiwara, Naoto; Tateishi, Ryosuke; Akahane, Masaaki; Taguri, Masataka; Minami, Tatsuya; Mikami, Shintaro; Sato, Masaya; Uchino, Koji; Uchino, Kouji; Enooku, Kenichiro; Kondo, Yuji; Asaoka, Yoshinari; Yamashiki, Noriyo; Goto, Tadashi; Shiina, Shuichiro; Yoshida, Haruhiko; Ohtomo, Kuni; Koike, Kazuhiko

2013-01-01

To elucidate whether repeated exposures to iodinated contrast media increase the risk of adverse reaction. We retrospectively reviewed 1,861 patients with hepatocellular carcinoma who visited authors' institution, a tertiary referral center, between 2004 and 2008. We analyzed cumulative probability of adverse reactions and risk factors. We categorized all symptoms into hypersensitivity reactions, physiologic reactions, and other reactions, according to the American College of Radiology guidelines, and evaluated each category as an event. We estimated the association between hazard for adverse reactions and the number of cumulative exposures to contrast media. We also evaluated subsequent contrast media injections and adverse reactions. There were 23,684 contrast media injections in 1,729 patients. One hundred and thirty-two patients were excluded because they were given no contrast media during the study period. Adverse reactions occurred in 196 (0.83%) patients. The cumulative incidence at 10(th), 20(th), and 30(th) examination was 7.9%, 15.2%, and 24.1%, respectively. Presence of renal impairment was found to be one of risk factors for adverse reactions. The estimated hazard of overall adverse reaction gradually decreased until around 10(th) exposure and rose with subsequent exposures. The estimated hazard of hypersensitivity showed V-shaped change with cumulative number of exposures. The estimated hazard of physiologic reaction had a tendency toward decreasing and that of other reaction had a tendency toward increasing. Second adverse reaction was more severe than the initial in only one among 130 patients receiving subsequent injections. Repeated exposures to iodinated contrast media increase the risk of adverse reaction.

USING DOSE ADDITION TO ESTIMATE CUMULATIVE RISKS FROM EXPOSURES TO MULTIPLE CHEMICALS

EPA Science Inventory

The Food Quality Protection Act (FQPA) of 1996 requires the EPA to consider the cumulative risk from exposure to multiple chemicals that have a common mechanism of toxicity. Three methods, hazard index (HI), point-of-departure index (PODI), and toxicity equivalence factor (TEF), ...

Health Impact Assessment: Linking Public Health to Community Decisions (Cumulative Impacts Community Vulnerability Symposium)

EPA Science Inventory

The goal of this presentation is to explore how HIA can help inform hazardous waste permitting regulations and incorporate community vulnerability and cumulative impacts to their potential health risks into permitting decision making by the California Department of Toxic Substanc...

Exercise Is Associated with Lower Long-Term Risk of Olfactory Impairment in Older Adults

PubMed Central

Schubert, Carla R.; Cruickshanks, Karen J.; Nondahl, David M.; Klein, Barbara EK; Klein, Ronald; Fischer, Mary E.

2013-01-01

Importance The prevalence of olfactory impairment is high in older adults and this decline in olfactory ability may pose health and safety risks, affect nutrition and decrease quality of life. It is important to identify modifiable risk factors to reduce the burden of olfactory impairment in aging populations. Objectives To determine if exercise is associated with the 10-year cumulative incidence of olfactory impairment. Design, Setting and Participants Observational longitudinal population-based Epidemiology of Hearing Loss Study. Participants without olfactory impairment (n=1611) were ages 53-97 years at baseline and were followed for up to ten years (1998-2010). Interventions None Main Outcome and Measures Olfaction was measured with the San Diego Odor Identification Test at three examinations (1998-2000, 2003-2005, 2009-2010) of the Epidemiology of Hearing Loss Study. The main outcome was the incidence of olfactory impairment five (2003-2005) or ten (2009-2010) years later and the association of baseline exercise with the long-term risk of developing olfactory impairment. Results The 10-year cumulative incidence of olfactory impairment was 27.6% (95% confidence interval =25.3, 29.9) and rates varied by age and sex; those who were older (Hazard Ratio =1.88, 95% Confidence Interval=1.74, 2.03, for every 5 years) or male (Hazard Ratio=1.27, 95% Confidence Interval=1.00, 1.61) had an increased risk of olfactory impairment. Participants who reported exercising at least once a week long enough to work up a sweat had a decreased risk of olfactory impairment (age and sex adjusted Hazard Ratio= 0.76, 95% CI= 0.60, 0.97). Increasing frequency of exercise was associated with decreasing risk of developing olfactory impairment (p for trend = 0.02). Conclusion and Relevance Regular exercise was associated with lower 10-year cumulative incidence of olfactory impairment. Older adults who exercise may be able to retain olfactory function with age. PMID:24135745

Changes in Risk of Immediate Adverse Reactions to Iodinated Contrast Media by Repeated Administrations in Patients with Hepatocellular Carcinoma

PubMed Central

Fujiwara, Naoto; Tateishi, Ryosuke; Akahane, Masaaki; Taguri, Masataka; Minami, Tatsuya; Mikami, Shintaro; Sato, Masaya; Uchino, Kouji; Enooku, Kenichiro; Kondo, Yuji; Asaoka, Yoshinari; Yamashiki, Noriyo; Goto, Tadashi; Shiina, Shuichiro; Yoshida, Haruhiko; Ohtomo, Kuni; Koike, Kazuhiko

2013-01-01

Background To elucidate whether repeated exposures to iodinated contrast media increase the risk of adverse reaction. Materials and Methods We retrospectively reviewed 1,861 patients with hepatocellular carcinoma who visited authors’ institution, a tertiary referral center, between 2004 and 2008. We analyzed cumulative probability of adverse reactions and risk factors. We categorized all symptoms into hypersensitivity reactions, physiologic reactions, and other reactions, according to the American College of Radiology guidelines, and evaluated each category as an event. We estimated the association between hazard for adverse reactions and the number of cumulative exposures to contrast media. We also evaluated subsequent contrast media injections and adverse reactions. Results There were 23,684 contrast media injections in 1,729 patients. One hundred and thirty-two patients were excluded because they were given no contrast media during the study period. Adverse reactions occurred in 196 (0.83%) patients. The cumulative incidence at 10th, 20th, and 30th examination was 7.9%, 15.2%, and 24.1%, respectively. Presence of renal impairment was found to be one of risk factors for adverse reactions. The estimated hazard of overall adverse reaction gradually decreased until around 10th exposure and rose with subsequent exposures. The estimated hazard of hypersensitivity showed V-shaped change with cumulative number of exposures. The estimated hazard of physiologic reaction had a tendency toward decreasing and that of other reaction had a tendency toward increasing. Second adverse reaction was more severe than the initial in only one among 130 patients receiving subsequent injections. Conclusion Repeated exposures to iodinated contrast media increase the risk of adverse reaction. PMID:24098420

Do self-reported concussions have cumulative or enduring effects on drivers' anticipation of traffic hazards?

PubMed

Preece, Megan H W; Horswill, Mark S; Ownsworth, Tamara

2016-01-01

To investigate the cumulative effect of multiple self-reported concussions and the enduring effect of concussion on drivers' hazard perception ability. It was hypothesized: (1) that individuals reporting multiple previous concussions would be slower to anticipate traffic hazards than individuals reporting either one previous concussion or none; and (2) that individuals reporting a concussion within the past 3 months would be slower to anticipate traffic hazards than individuals reporting either an earlier concussion or no prior concussion. Two hundred and eighty-two predominantly young drivers (nconcussed = 68, Mage = 21.57 years, SDage = 6.99 years, 66% female) completed a validated hazard perception test (HPT) and measures of emotional, cognitive, health and driving status. A one-way analysis of variance showed that there was no significant effect of concussion number on HPT response times. Similarly, pairwise comparisons showed no significant differences between the HPT response times of individuals reporting a concussion within the previous 3 months, individuals reporting an earlier concussion and the never concussed group. The findings suggest that previous concussions do not adversely affect young drivers' ability to anticipate traffic hazards; however, due to reliance on self-reports of concussion history, further prospective longitudinal research is needed.

Differential Exposure to Hazardous Air Pollution in the United States: A Multilevel Analysis of Urbanization and Neighborhood Socioeconomic Deprivation

PubMed Central

Young, Gary S.; Fox, Mary A.; Trush, Michael; Kanarek, Norma; Glass, Thomas A.; Curriero, Frank C.

2012-01-01

Population exposure to multiple chemicals in air presents significant challenges for environmental public health. Air quality regulations distinguish criteria air pollutants (CAPs) (e.g., ozone, PM2.5) from hazardous air pollutants (HAPs)—187 chemicals which include carcinogens and others that are associated with respiratory, cardiovascular, neurological and numerous other non-cancer health effects. Evidence of the public’s cumulative exposure and the health effects of HAPs are quite limited. A multilevel model is used to assess differential exposure to HAP respiratory, neurological, and cancer hazards (2005) related to the Townsend Index of Socioeconomic Deprivation (TSI), after adjustment for regional population size and economic activity, and local population density. We found significant positive associations between tract TSI and respiratory and cancer HAP exposure hazards, and smaller effects for neurological HAPs. Tracts in the top quintile of TSI have between 38%–60% higher HAP exposure than the bottom quintile; increasing population size from the bottom quintile to the top quintile modifies HAP exposure hazard related to TSI, increasing cancer HAP exposure hazard by 6% to 20% and increasing respiratory HAP exposure hazard by 12% to 27%. This study demonstrates the value of social epidemiological methods for analyzing differential exposure and advancing cumulative risk assessment. PMID:22829799

Differential exposure to hazardous air pollution in the United States: a multilevel analysis of urbanization and neighborhood socioeconomic deprivation.

PubMed

Young, Gary S; Fox, Mary A; Trush, Michael; Kanarek, Norma; Glass, Thomas A; Curriero, Frank C

2012-06-01

Population exposure to multiple chemicals in air presents significant challenges for environmental public health. Air quality regulations distinguish criteria air pollutants (CAPs) (e.g., ozone, PM2.5) from hazardous air pollutants (HAPs)-187 chemicals which include carcinogens and others that are associated with respiratory, cardiovascular, neurological and numerous other non-cancer health effects. Evidence of the public's cumulative exposure and the health effects of HAPs are quite limited. A multilevel model is used to assess differential exposure to HAP respiratory, neurological, and cancer hazards (2005) related to the Townsend Index of Socioeconomic Deprivation (TSI), after adjustment for regional population size and economic activity, and local population density. We found significant positive associations between tract TSI and respiratory and cancer HAP exposure hazards, and smaller effects for neurological HAPs. Tracts in the top quintile of TSI have between 38%-60% higher HAP exposure than the bottom quintile; increasing population size from the bottom quintile to the top quintile modifies HAP exposure hazard related to TSI, increasing cancer HAP exposure hazard by 6% to 20% and increasing respiratory HAP exposure hazard by 12% to 27%. This study demonstrates the value of social epidemiological methods for analyzing differential exposure and advancing cumulative risk assessment.

Cumulative index to chemicals and to common and scientific names of species listed in Contaminant Hazard Reviews 1 through 34

USGS Publications Warehouse

Eisler, Ronald

1999-01-01

The Contaminant Hazard Review (CHR) series--sponsored by the U.S. Geological Survey, Patuxent Wildlife Research Center--synthesizes ecotoxicological data for selected environmental contaminants, with emphasis on hazards to native species of flora and fauna. From 1985 through 1998, 34 reviews were published in various report series of the U.S. Department of the Interior on agricultural pesticides (acrolein, atrazine, carbofuran, chlordane, chlorpyrifos, diazinon, diflubenzuron, famphur, fenvalerate, mirex, paraquat, toxaphene), metals and metalloids (arsenic, boron, cadmium, chromium, copper, lead, mercury, molybdenum, nickel, selenium, silver, tin, zinc), mammalian biocides (sodium monofluoroacetate), organic industrial and municipal wastes (dioxins, pentachlorophenol, polycyclic aromatic hydrocarbons, polychlorinated biphenyls), minin wastes (cyanide), and ionizing radiations. This current report is a cumulative index to the common and scientific names of all biological species listed in the first 34 reports in the CHR series, with individual species cross-referenced with contaminant hazard review and corresponding page numbers. A similar index for chemicals is included.

Effect of Cumulating Exposure to Abacavir on the Risk of Cardiovascular Disease Events in Patients From the Swiss HIV Cohort Study.

PubMed

Young, Jim; Xiao, Yongling; Moodie, Erica E M; Abrahamowicz, Michal; Klein, Marina B; Bernasconi, Enos; Schmid, Patrick; Calmy, Alexandra; Cavassini, Matthias; Cusini, Alexia; Weber, Rainer; Bucher, Heiner C

2015-08-01

Patients with HIV exposed to the antiretroviral drug abacavir may have an increased risk of cardiovascular disease (CVD). There is concern that this association arises because of a channeling bias. Even if exposure is a risk, it is not clear how that risk changes as exposure cumulates. We assess the effect of exposure to abacavir on the risk of CVD events in the Swiss HIV Cohort Study. We use a new marginal structural Cox model to estimate the effect of abacavir as a flexible function of past exposures while accounting for risk factors that potentially lie on a causal pathway between exposure to abacavir and CVD. A total of 11,856 patients were followed for a median of 6.6 years; 365 patients had a CVD event (4.6 events per 1000 patient-years). In a conventional Cox model, recent--but not cumulative--exposure to abacavir increased the risk of a CVD event. In the new marginal structural Cox model, continued exposure to abacavir during the past 4 years increased the risk of a CVD event (hazard ratio = 2.06; 95% confidence interval: 1.43 to 2.98). The estimated function for the effect of past exposures suggests that exposure during the past 6-36 months caused the greatest increase in risk. Abacavir increases the risk of a CVD event: the effect of exposure is not immediate, rather the risk increases as exposure cumulates over the past few years. This gradual increase in risk is not consistent with a rapidly acting mechanism, such as acute inflammation.

Cumulative HIV viremia during highly active antiretroviral therapy is a strong predictor of AIDS-related lymphoma.

PubMed

Zoufaly, Alexander; Stellbrink, Hans-Jürgen; Heiden, Matthias An der; Kollan, Christian; Hoffmann, Christian; van Lunzen, Jan; Hamouda, Osamah

2009-07-01

AIDS-related lymphoma contributes to significant morbidity and mortality among human immunodeficiency virus (HIV)-infected patients receiving highly active antiretroviral therapy (HAART). We assessed the predictive role of cumulative HIV viremia and other risk factors in the development of AIDS-related non-Hodgkin lymphoma. Data from the Clinical Surveillance of HIV Disease (ClinSurv) study, an ongoing, observational, open cohort study of HIV-infected patients from different urban areas in Germany, were analyzed using a Cox proportional hazards model. In the Cox model, which comprised 6022 patients and 27,812 patient-years of follow-up while patients were receiving HAART from 1999 through 2006, cumulative HIV viremia was found to be independently associated with the risk of lymphoma (hazard ratio, [HR], 1.67 [95% confidence interval {CI}, 1.27-2.20]) (P < .001]). This association differed markedly between lymphoma subtypes. Although the association was more pronounced for Burkitt-type lymphoma (HR, 3.45 [95% CI, 1.52-7.85]) (P = .003), there was no association between cumulative HIV viremia and the incidence of primary central nervous system lymphoma (HR, 1.00 [95% CI, 0.39-2.57]) (P = .997). Other risk factors associated with an increased risk in a multivariable analysis included the latest CD4 T cell count as well as age per 10-year increment. Cumulative HIV viremia is an independent and strong predictor of AIDS-related lymphoma among patients receiving HAART. The influence of cumulative HIV viremia may differ between lymphoma subtypes.

75 FR 12688 - Safety Zone; Gallants Channel, Beaufort, NC

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-17

... immediate action is needed to ensure the safety of human life and property from the hazards of falling... life and property on navigable waters and due to the hazards associated with potential falling debris... which do not individually or cumulatively have a significant effect on the human environment. This rule...

Association Between Cystatin C and 20-Year Cumulative Incidence of Hearing Impairment in the Epidemiology of Hearing Loss Study.

PubMed

Schubert, Carla R; Paulsen, Adam J; Nondahl, David M; Dalton, Dayna S; Fischer, Mary E; Klein, Barbara E K; Klein, Ronald; Tweed, Ted S; Cruickshanks, Karen J

2018-06-01

Hearing impairment (HI) is one of the most common conditions affecting older adults. Identification of factors associated with the development of HI may lead to ways to reduce the incidence of this condition. To investigate the association between cystatin C, both as an independent biomarker and as a marker of kidney function, and the 20-year incidence of HI. Data were obtained from the Epidemiology of Hearing Loss Study (EHLS), a longitudinal, population-based study in Beaver Dam, Wisconsin. Baseline examinations began in 1993 and continued through 1995, and participants were examined approximately every 5 years, with the most recent examination phase completed in 2015. The EHLS participants with serum cystatin C concentration data and without HI at the baseline examination were included in this study. Participants without HI were followed up for incident HI (pure-tone average of hearing thresholds at 0.5, 1, 2, and 4 kHz >25 dB hearing level in either ear) for 20 years. Cystatin C was analyzed as a biomarker (concentration) and used to determine estimated glomerular filtration rate (eGFRCysC). Discrete-time Cox proportional hazards regression models were used to analyze the association between cystatin C concentration and eGFRCysC and the 20-year cumulative incidence of HI. There were 863 participants aged 48 to 86 years with cystatin C data and without HI at baseline. Of these, 599 (69.4%) were women. In models adjusted for age and sex, cystatin C was associated with an increased risk of developing HI (hazard ratio [HR], 1.20; 95% CI, 1.07-1.34 per 0.2-mg/L increase in cystatin C concentration), but the estimate was attenuated after further adjusting for educational level, current smoking, waist circumference, and glycated hemoglobin (HR, 1.11; 95% CI, 0.98-1.27 per 0.2-mg/L increase in cystatin C concentration). Low eGFRCysC was significantly associated with the 20-year cumulative incidence of HI in both the age- and sex-adjusted model (HR, 1.70; 95% CI, 1.16-2.48; <60 vs ≥60 mL/min/1.73 m2) and the multivariable-adjusted model (HR, 1.50; 95% CI, 1.02-2.22; <60 vs ≥60 mL/min/1.73 m2). Reduced kidney function as estimated using cystatin C, but not cystatin C alone, was associated with the 20-year cumulative incidence of HI, suggesting that some age-related HI may occur in conjunction with or as the result of reduced kidney function.

Life-Time Risk for Substance Use Among Offspring of Abusive Family Environment From the Community

PubMed Central

Nomura, Yoko; Hurd, Yasmin L.; Pilowsky, Daniel J.

2018-01-01

The current study examined the cumulative risk, age of initiation, and functional impairments among adults with substance use problems (N = 1748) by child abuse status. Child abuse was associated with earlier initiation of marijuana, cocaine, and heroin use, and had greater risks for all the drugs studied (hazard ratios, 1.7–3.2). Furthermore, child abuse was associated with increased medical and functional impairments, including ER visits, health problems, drug dealing, drug dependence, and drug cravings. Provision of social services and parenting education during the perinatal period may prevent the long-term impact of child abuse on substance use and related impairments. The study’s limitations are noted. PMID:22780838

Adverse health outcomes in women exposed in utero to diethylstilbestrol.

PubMed

Hoover, Robert N; Hyer, Marianne; Pfeiffer, Ruth M; Adam, Ervin; Bond, Brian; Cheville, Andrea L; Colton, Theodore; Hartge, Patricia; Hatch, Elizabeth E; Herbst, Arthur L; Karlan, Beth Y; Kaufman, Raymond; Noller, Kenneth L; Palmer, Julie R; Robboy, Stanley J; Saal, Robert C; Strohsnitter, William; Titus-Ernstoff, Linda; Troisi, Rebecca

2011-10-06

Before 1971, several million women were exposed in utero to diethylstilbestrol (DES) given to their mothers to prevent pregnancy complications. Several adverse outcomes have been linked to such exposure, but their cumulative effects are not well understood. We combined data from three studies initiated in the 1970s with continued long-term follow-up of 4653 women exposed in utero to DES and 1927 unexposed controls. We assessed the risks of 12 adverse outcomes linked to DES exposure, including cumulative risks to 45 years of age for reproductive outcomes and to 55 years of age for other outcomes, and their relationships to the baseline presence or absence of vaginal epithelial changes, which are correlated with a higher dose of, and earlier exposure to, DES in utero. Cumulative risks in women exposed to DES, as compared with those not exposed, were as follows: for infertility, 33.3% vs. 15.5% (hazard ratio, 2.37; 95% confidence interval [CI], 2.05 to 2.75); spontaneous abortion, 50.3% vs. 38.6% (hazard ratio, 1.64; 95% CI, 1.42 to 1.88); preterm delivery, 53.3% vs. 17.8% (hazard ratio, 4.68; 95% CI, 3.74 to 5.86); loss of second-trimester pregnancy, 16.4% vs. 1.7% (hazard ratio, 3.77; 95% CI, 2.56 to 5.54); ectopic pregnancy, 14.6% vs. 2.9% (hazard ratio, 3.72; 95% CI, 2.58 to 5.38); preeclampsia, 26.4% vs. 13.7% (hazard ratio 1.42; 95% CI, 1.07 to 1.89); stillbirth, 8.9% vs. 2.6% (hazard ratio, 2.45; 95% CI, 1.33 to 4.54); early menopause, 5.1% vs. 1.7% (hazard ratio, 2.35; 95% CI, 1.67 to 3.31); grade 2 or higher cervical intraepithelial neoplasia, 6.9% vs. 3.4% (hazard ratio, 2.28; 95% CI, 1.59 to 3.27); and breast cancer at 40 years of age or older, 3.9% vs. 2.2% (hazard ratio, 1.82; 95% CI, 1.04 to 3.18). For most outcomes, the risks among exposed women were higher for those with vaginal epithelial changes than for those without such changes. In utero exposure of women to DES is associated with a high lifetime risk of a broad spectrum of adverse health outcomes. (Funded by the National Cancer Institute.).

Racial/Ethnic Disparities in Cumulative Environmental Health Impacts in California: Evidence From a Statewide Environmental Justice Screening Tool (CalEnviroScreen 1.1)

PubMed Central

Faust, John; August, Laura Meehan; Cendak, Rose; Wieland, Walker; Alexeeff, George

2015-01-01

Objectives. We used an environmental justice screening tool (CalEnviroScreen 1.1) to compare the distribution of environmental hazards and vulnerable populations across California communities. Methods. CalEnviroScreen 1.1 combines 17 indicators created from 2004 to 2013 publicly available data into a relative cumulative impact score. We compared cumulative impact scores across California zip codes on the basis of their location, urban or rural character, and racial/ethnic makeup. We used a concentration index to evaluate which indicators were most unequally distributed with respect to race/ethnicity and poverty. Results. The unadjusted odds of living in one of the 10% most affected zip codes were 6.2, 5.8, 1.9, 1.8, and 1.6 times greater for Hispanics, African Americans, Native Americans, Asian/Pacific Islanders, and other or multiracial individuals, respectively, than for non-Hispanic Whites. Environmental hazards were more regressively distributed with respect to race/ethnicity than poverty, with pesticide use and toxic chemical releases being the most unequal. Conclusions. Environmental health hazards disproportionately burden communities of color in California. Efforts to reduce disparities in pollution burden can use simple screening tools to prioritize areas for action. PMID:26378826

Validation of a heteroscedastic hazards regression model.

PubMed

Wu, Hong-Dar Isaac; Hsieh, Fushing; Chen, Chen-Hsin

2002-03-01

A Cox-type regression model accommodating heteroscedasticity, with a power factor of the baseline cumulative hazard, is investigated for analyzing data with crossing hazards behavior. Since the approach of partial likelihood cannot eliminate the baseline hazard, an overidentified estimating equation (OEE) approach is introduced in the estimation procedure. It by-product, a model checking statistic, is presented to test for the overall adequacy of the heteroscedastic model. Further, under the heteroscedastic model setting, we propose two statistics to test the proportional hazards assumption. Implementation of this model is illustrated in a data analysis of a cancer clinical trial.

Health Impact Assessment: Linking Public Health to ...

EPA Pesticide Factsheets

The goal of this presentation is to explore how HIA can help inform hazardous waste permitting regulations and incorporate community vulnerability and cumulative impacts to their potential health risks into permitting decision making by the California Department of Toxic Substances Control. Presented the Health Impact Assessment (HIA) at the State of California Cumulative Impacts and Community Vulnerability Symposium on July 27 in Diamond Bar, CA.

Women's Health Initiative estrogen plus progestin clinical trial: a study that does not allow establishing relevant clinical risks.

PubMed

Aedo, Sócrates; Cavada, Gabriel; Blümel, Juan E; Chedraui, Peter; Fica, Juan; Barriga, Patricio; Brantes, Sergio; Irribarra, Cristina; Vallejo, María; Campodónico, Ítalo

2015-12-01

This study aims to determine time differences (differences in restricted mean survival times [RMSTs]) in the onset of invasive breast cancer, coronary heart disease, stroke, pulmonary embolism, colorectal cancer, and hip fracture between the placebo group and the conjugated equine estrogens 0.625 mg plus medroxyprogesterone acetate 2.5 mg group of the Women's Health Initiative (WHI) trial based on survival curves of the original report and to provide adequate interpretation of the clinical effects of a given intervention. Distribution of survival function was obtained from cumulative hazard plots of the WHI report; Monte Carlo simulation was performed to obtain censored observations for each outcome, in which assumptions of the Cox model were evaluated once corresponding hazard ratios had been estimated. Using estimation methods such as numerical integration, pseudovalues, and flexible parametric modeling, we determined differences in RMSTs for each outcome. Obtained cumulative hazard plots, hazard ratios, and outcome rates from the simulated model did not show differences in relation to the original WHI report. The differences in RMST between placebo and conjugated equine estrogens 0.625 mg plus medroxyprogesterone acetate 2.5 mg (in flexible parametric modeling) were 1.17 days (95% CI, -2.25 to 4.59) for invasive breast cancer, 7.50 days (95% CI, 2.90 to 12.11) for coronary heart disease, 2.75 days (95% CI, -0.84 to 6.34) for stroke, 4.23 days (95% CI, 1.82 to 6.64) for pulmonary embolism, -2.73 days (95% CI, -5.32 to -0.13) for colorectal cancer, and -2.77 days (95% CI, -5.44 to -0.1) for hip fracture. The differences in RMST for the outcomes of the WHI study are too small to establish clinical risks related to hormone therapy use.

Gout in Older Adults: The Atherosclerosis Risk in Communities Study

PubMed Central

Burke, Bridget Teevan; Köttgen, Anna; Law, Andrew; Grams, Morgan; Baer, Alan N.; Coresh, Josef

2016-01-01

Background: It is unclear whether traditional and genetic risk factors in middle age predict the onset of gout in older age. Methods: We studied the incidence of gout in older adults using the Atherosclerosis Risk in Communities study, a prospective U.S. population–based cohort of middle-aged adults enrolled between 1987 and 1989 with ongoing follow-up. A genetic urate score was formed from common urate-associated single nucleotide polymorphisms for eight genes. The adjusted hazard ratio and 95% confidence interval of incident gout by traditional and genetic risk factors in middle age were estimated using a Cox proportional hazards model. Results: The cumulative incidence from middle age to age 65 was 8.6% in men and 2.5% in women; by age 75 the cumulative incidence was 11.8% and 5.0%. In middle age, increased adiposity, beer intake, protein intake, smoking status, hypertension, diuretic use, and kidney function (but not sex) were associated with an increased gout risk in older age. In addition, a 100 µmol/L increase in genetic urate score was associated with a 3.29-fold (95% confidence interval: 1.63–6.63) increased gout risk in older age. Conclusions: These findings suggest that traditional and genetic risk factors in middle age may be useful for identifying those at risk of gout in older age. PMID:26714568

Fire technology abstracts, volume 4. Cumulative indexes

NASA Astrophysics Data System (ADS)

1982-03-01

Cumulative subject, author, publisher, and report number indexes referencing articles, books, reports, and patents are provided. The dynamics of fire, behavior and properties of materials, fire modeling and test burns, fire protection, fire safety, fire service organization, apparatus and equipment, fire prevention suppression, planning, human behavior, medical problems, codes and standards, hazard identification, safe handling of materials, and insurance economics of loss and prevention are among the subjects covered.

Cumulative Index to Chemicals and to Common and Scientific Names of Species Listed in Contaminant Hazard Reviews 1 through 34

USGS Publications Warehouse

Eisler, R.

1999-01-01

The Patuxent Wildlife Research Center Contaminant Hazard Reviews (CHR) series synthesizes ecotoxicological data of selected environmental contaminants, with emphasis on hazards to native species of flora and fauna. From 1985 through 1998 a total of 34 reviews were published in various Reports series of the U.S. Department of the Interior on agricultural pesticides (carbofuran, chlordane, chlorpyrifos, diazinon, diflubenzuron, fenvalerate, mirex, paraquat, toxaphene), herbicides (acrolein, atrazine), metals and metalloids (arsenic, boron, cadmium, chromium, copper, lead, mercury, molybdenum, nickel, selenium, silver, tin, zinc), predacides (sodium monofluoroacetate), organic industrial wastes (dioxins, pentachlorophenol), veterinary chemicals (famphur), polycyclic aromatic hydrocarbons, polychlorinated biphenyls, mining wastes (cyanide), and ionizing radiations. This report is a cumulative index to the common and scientific names of all biological species listed in the first 34 reports in the CHR series, with individual species cross-referenced by contaminant and corresponding page numbers. A similar index is shown for chemicals.

Implications of applying cumulative risk assessment to the workplace.

PubMed

Fox, Mary A; Spicer, Kristen; Chosewood, L Casey; Susi, Pam; Johns, Douglas O; Dotson, G Scott

2018-06-01

Multiple changes are influencing work, workplaces and workers in the US including shifts in the main types of work and the rise of the 'gig' economy. Work and workplace changes have coincided with a decline in unions and associated advocacy for improved safety and health conditions. Risk assessment has been the primary method to inform occupational and environmental health policy and management for many types of hazards. Although often focused on one hazard at a time, risk assessment frameworks and methods have advanced toward cumulative risk assessment recognizing that exposure to a single chemical or non-chemical stressor rarely occurs in isolation. We explore how applying cumulative risk approaches may change the roles of workers and employers as they pursue improved health and safety and elucidate some of the challenges and opportunities that might arise. Application of cumulative risk assessment should result in better understanding of complex exposures and health risks with the potential to inform more effective controls and improved safety and health risk management overall. Roles and responsibilities of both employers and workers are anticipated to change with potential for a greater burden of responsibility on workers to address risk factors both inside and outside the workplace that affect health at work. A range of policies, guidance and training have helped develop cumulative risk assessment for the environmental health field and similar approaches are available to foster the practice in occupational safety and health. Copyright © 2018 Elsevier Ltd. All rights reserved.

Risk factors for corneal infiltrative events during continuous wear of silicone hydrogel contact lenses.

PubMed

Szczotka-Flynn, Loretta; Lass, Jonathan H; Sethi, Ajay; Debanne, Sara; Benetz, Beth Ann; Albright, Matthew; Gillespie, Beth; Kuo, Jana; Jacobs, Michael R; Rimm, Alfred

2010-11-01

This study determined which microbiologic, clinical, demographic, and behavioral factors are associated with corneal infiltrative events (CIEs) during continuous wear of silicone hydrogel (SH) contact lenses. Subjects (n = 205) were fitted with lotrafilcon A lenses for continuous wear and observed for 1 year. The main exposures of interest were corneal staining and bacterial lens contamination. Kaplan-Meier (KM) plots were used to estimate the cumulative unadjusted probability of remaining CIE free, and Cox proportional hazards regression was used to model the hazard of having a CIE, as a function of key predictor variables. The KM-unadjusted cumulative probability of remaining CIE free was 73.3%. Approximately 53% of subjects had repeated episodes of corneal staining (mild or greater), and 11.3% had repeated episodes of moderate or greater corneal staining. Corneal staining was not associated with the development of a CIE. The frequency of substantial bacterial bioburden on worn lenses at the time of a CIE was 64.7%, compared with only 12.2% during uncomplicated wear. The presence of substantial lens bacterial bioburden was associated with the development of a CIE (adjusted hazards ratio [HR], 8.66; 95% confidence interval [CI], 2.88-26.01). Smoking was also associated with a CIE (adjusted HR, 4.13; 95% CI, 1.27-13.45). Corneal staining is common during continuous wear of SH lenses, but it is not associated with the development of a CIE. Smoking and substantial lens bacterial bioburden pose prominent risks of a CIE. In this study, more than 70% of the total risk of CIE in those with substantial lens bioburden is attributable to this exposure. (ClinicalTrials.gov number, NCT00727402).

Risk Factors for Corneal Infiltrative Events during Continuous Wear of Silicone Hydrogel Contact Lenses

PubMed Central

Lass, Jonathan H.; Sethi, Ajay; Debanne, Sara; Benetz, Beth Ann; Albright, Matthew; Gillespie, Beth; Kuo, Jana; Jacobs, Michael R.; Rimm, Alfred

2010-01-01

Purpose. This study determined which microbiologic, clinical, demographic, and behavioral factors are associated with corneal infiltrative events (CIEs) during continuous wear of silicone hydrogel (SH) contact lenses. Methods. Subjects (n = 205) were fitted with lotrafilcon A lenses for continuous wear and observed for 1 year. The main exposures of interest were corneal staining and bacterial lens contamination. Kaplan-Meier (KM) plots were used to estimate the cumulative unadjusted probability of remaining CIE free, and Cox proportional hazards regression was used to model the hazard of having a CIE, as a function of key predictor variables. Results. The KM-unadjusted cumulative probability of remaining CIE free was 73.3%. Approximately 53% of subjects had repeated episodes of corneal staining (mild or greater), and 11.3% had repeated episodes of moderate or greater corneal staining. Corneal staining was not associated with the development of a CIE. The frequency of substantial bacterial bioburden on worn lenses at the time of a CIE was 64.7%, compared with only 12.2% during uncomplicated wear. The presence of substantial lens bacterial bioburden was associated with the development of a CIE (adjusted hazards ratio [HR], 8.66; 95% confidence interval [CI], 2.88–26.01). Smoking was also associated with a CIE (adjusted HR, 4.13; 95% CI, 1.27–13.45). Conclusions. Corneal staining is common during continuous wear of SH lenses, but it is not associated with the development of a CIE. Smoking and substantial lens bacterial bioburden pose prominent risks of a CIE. In this study, more than 70% of the total risk of CIE in those with substantial lens bioburden is attributable to this exposure. (ClinicalTrials.gov number, NCT00727402). PMID:20538985

Separating spatial search and efficiency rates as components of predation risk

PubMed Central

DeCesare, Nicholas J.

2012-01-01

Predation risk is an important driver of ecosystems, and local spatial variation in risk can have population-level consequences by affecting multiple components of the predation process. I use resource selection and proportional hazard time-to-event modelling to assess the spatial drivers of two key components of risk—the search rate (i.e. aggregative response) and predation efficiency rate (i.e. functional response)—imposed by wolves (Canis lupus) in a multi-prey system. In my study area, both components of risk increased according to topographic variation, but anthropogenic features affected only the search rate. Predicted models of the cumulative hazard, or risk of a kill, underlying wolf search paths validated well with broad-scale variation in kill rates, suggesting that spatial hazard models provide a means of scaling up from local heterogeneity in predation risk to population-level dynamics in predator–prey systems. Additionally, I estimated an integrated model of relative spatial predation risk as the product of the search and efficiency rates, combining the distinct contributions of spatial heterogeneity to each component of risk. PMID:22977145

The Use of Glyburide Compared With Other Sulfonylureas and the Risk of Cancer in Patients With Type 2 Diabetes.

PubMed

Tuccori, Marco; Wu, Jennifer W; Yin, Hui; Majdan, Agnieszka; Azoulay, Laurent

2015-11-01

To determine whether the use of glyburide is associated with an increased risk of cancer compared with the use of other second-generation sulfonylureas among patients with type 2 diabetes. The U.K. Clinical Practice Research Datalink was used to conduct a cohort study among 52,600 patients newly prescribed glyburide or other second-generation sulfonylureas between 1 January 1988 and 31 July 2013. A time-dependent Cox proportional hazards model was used to estimate adjusted hazard ratios (HRs) and 95% CIs of any cancer associated with the use of glyburide compared with the use of second-generation sulfonylureas. Secondary analyses were conducted to determine whether the association varied with cumulative duration of use and cumulative dose (expressed as defined daily dose [DDD]). During 280,288 person-years of follow-up, 4,105 patients were given a new diagnosis of cancer (incidence rate 14.6 per 1,000 person-years). Overall, when compared with the use of other second-generation sulfonylureas, the use of glyburide was associated with a nonsignificant increased risk of any cancer (HR 1.09 [95% CI 0.98-1.22]). In secondary analyses, duration- and dose-response relationships were observed, with longer cumulative durations and cumulative doses associated with an increased risk of any cancer (>36 months: HR 1.21 [95% CI: 1.03-1.42]; >1,096 DDDs: HR 1.27 [95% CI 1.06-1.51]). In this population-based cohort study, longer cumulative durations and higher cumulative doses of glyburide were associated with an increased risk of cancer. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Postoperative Radiation Therapy for Prostate Cancer: Comparison of Conventional Versus Hypofractionated Radiation Regimens.

PubMed

Tandberg, Daniel J; Oyekunle, Taofik; Lee, W Robert; Wu, Yuan; Salama, Joseph K; Koontz, Bridget F

2018-06-01

To compare acute/late toxicity and biochemical control in contemporaneous prostate cancer patient cohorts treated with hypofractionated postprostatectomy radiation therapy (hypoPORT) or conventional PORT (coPORT). Consecutive patients treated with intensity modulated hypoPORT (2.5 Gy per fraction, median cumulative dose 65 Gy [range, 57.5-70 Gy]) or coPORT (1.8-2.0 Gy per fraction, median cumulative dose 66 Gy [range, 60-74 Gy]) between 2005 and 2016 at 2 institutions constituted the study cohort. Acute toxicity and cumulative late grade 2 and ≥3 genitourinary (GU) and gastrointestinal (GI) toxicity incidences were calculated for all patients using the Kaplan-Meier method and compared between cohorts. Biochemical progression-free survival (bPFS) was calculated in patients with ≥12 months' follow-up. Median follow-up for all 461 patients was 38.6 months. Of the 461 patients, 167 (36%) received hypoPORT, and 294 (64%) patients received coPORT. The hypoPORT cohort had significantly worse baseline urinary incontinence. Acute grade ≥2 GU toxicity was more common after hypoPORT (22% vs 8%) (P = .0001). Late grade ≥3 GU toxicity cumulative incidence at 6 years was 11% (hypoPORT) and 4% (coPORT) (P = .0081). However, hypoPORT was not associated with late grade ≥2 GU toxicity on multivariate analysis (hazard ratio 1.39, 95% confidence interval 0.86-2.34) (P = .18). There was no difference in acute or late GI toxicity. In the subset of patients with ≥12 month's follow-up (n = 364, median follow-up 52 months), 4-year bPFS was 78% (95% CI 69.4-85.0) after hypoPORT (P = .0038) and 65% (95% CI 57.6-71.1) after coPORT. HypoPORT was not significant for bPFS on multivariate analysis (hazard ratio 0.64, 95% CI 0.41-1.02, P = .059). HypoPORT shows promising early biochemical control. After controlling for baseline urinary function, hypoPORT was not associated with greater GU toxicity than coPORT. © 2018 Elsevier Inc. Copyright © 2018 Elsevier Inc. All rights reserved.

Survival analysis for the missing censoring indicator model using kernel density estimation techniques

PubMed Central

Subramanian, Sundarraman

2008-01-01

This article concerns asymptotic theory for a new estimator of a survival function in the missing censoring indicator model of random censorship. Specifically, the large sample results for an inverse probability-of-non-missingness weighted estimator of the cumulative hazard function, so far not available, are derived, including an almost sure representation with rate for a remainder term, and uniform strong consistency with rate of convergence. The estimator is based on a kernel estimate for the conditional probability of non-missingness of the censoring indicator. Expressions for its bias and variance, in turn leading to an expression for the mean squared error as a function of the bandwidth, are also obtained. The corresponding estimator of the survival function, whose weak convergence is derived, is asymptotically efficient. A numerical study, comparing the performances of the proposed and two other currently existing efficient estimators, is presented. PMID:18953423

Survival analysis for the missing censoring indicator model using kernel density estimation techniques.

PubMed

Subramanian, Sundarraman

2006-01-01

This article concerns asymptotic theory for a new estimator of a survival function in the missing censoring indicator model of random censorship. Specifically, the large sample results for an inverse probability-of-non-missingness weighted estimator of the cumulative hazard function, so far not available, are derived, including an almost sure representation with rate for a remainder term, and uniform strong consistency with rate of convergence. The estimator is based on a kernel estimate for the conditional probability of non-missingness of the censoring indicator. Expressions for its bias and variance, in turn leading to an expression for the mean squared error as a function of the bandwidth, are also obtained. The corresponding estimator of the survival function, whose weak convergence is derived, is asymptotically efficient. A numerical study, comparing the performances of the proposed and two other currently existing efficient estimators, is presented.

Association of Physical Activity History With Physical Function and Mortality in Old Age

PubMed Central

Koster, Annemarie; Valkeinen, Heli; Patel, Kushang V.; Bandinelli, Stefania; Guralnik, Jack M.; Ferrucci, Luigi

2016-01-01

Background. We examined whether physical activity in early adulthood, late midlife, and old age as well as cumulative physical activity history are associated with changes in physical functioning and mortality in old age. Methods. Data are from participants aged 65 years or older enrolled in the InCHIANTI study who were followed up from 1998–2000 to 2007–2008 (n = 1,149). At baseline, participants recalled their physical activity levels at ages 20–40, 40–60, and in the previous year, and they were categorized as physically inactive, moderately active, and physically active. Physical performance was assessed with the Short Physical Performance Battery and self-reported mobility disability was evaluated at the 3-, 6- and 9-year follow-up. Mortality follow-up was assessed until the end of 2010. Results. Physical inactivity at baseline was associated with greater decline in Short Physical Performance Battery score (mean 9-year change: −2.72, 95% CI: −3.08, −2.35 vs −0.98, 95% −1.57, −0.39) and greater rate of incident mobility disability (hazard ratio 4.66, 95% CI 1.14–19.07) and mortality (hazard ratio 2.18, 95% CI 1.01–4.70) compared to physically active participants at baseline. Being physically active throughout adulthood was associated with smaller decline in physical performance as well as with lower risk of incident mobility disability and premature death compared with those who had been less active during their adult life. Conclusions. Higher cumulative physical activity over the life course was associated with less decline in physical performance and reduced rate of incident mobility disability and mortality in older ages. PMID:26290538

The two-sample problem with induced dependent censorship.

PubMed

Huang, Y

1999-12-01

Induced dependent censorship is a general phenomenon in health service evaluation studies in which a measure such as quality-adjusted survival time or lifetime medical cost is of interest. We investigate the two-sample problem and propose two classes of nonparametric tests. Based on consistent estimation of the survival function for each sample, the two classes of test statistics examine the cumulative weighted difference in hazard functions and in survival functions. We derive a unified asymptotic null distribution theory and inference procedure. The tests are applied to trial V of the International Breast Cancer Study Group and show that long duration chemotherapy significantly improves time without symptoms of disease and toxicity of treatment as compared with the short duration treatment. Simulation studies demonstrate that the proposed tests, with a wide range of weight choices, perform well under moderate sample sizes.

Long-term cardiovascular mortality after procedure-related or spontaneous myocardial infarction in patients with non-ST-segment elevation acute coronary syndrome: a collaborative analysis of individual patient data from the FRISC II, ICTUS, and RITA-3 trials (FIR).

PubMed

Damman, Peter; Wallentin, Lars; Fox, Keith A A; Windhausen, Fons; Hirsch, Alexander; Clayton, Tim; Pocock, Stuart J; Lagerqvist, Bo; Tijssen, Jan G P; de Winter, Robbert J

2012-01-31

The present study was designed to investigate the long-term prognostic impact of procedure-related and spontaneous myocardial infarction (MI) on cardiovascular mortality in patients with non-ST-elevation acute coronary syndrome. Five-year follow-up after procedure-related or spontaneous MI was investigated in the individual patient pooled data set of the FRISC-II (Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Randomized Intervention Trial of Unstable Angina 3) non-ST-elevation acute coronary syndrome trials. The principal outcome was cardiovascular death up to 5 years of follow-up. Cumulative event rates were estimated by the Kaplan-Meier method; hazard ratios were calculated with time-dependent Cox proportional hazards models. Adjustments were made for the variables associated with long-term outcomes. Among the 5467 patients, 212 experienced a procedure-related MI within 6 months after enrollment. A spontaneous MI occurred in 236 patients within 6 months. The cumulative cardiovascular death rate was 5.2% in patients who had a procedure-related MI, comparable to that for patients without a procedure-related MI (hazard ratio 0.66; 95% confidence interval, 0.36-1.20, P=0.17). In patients who had a spontaneous MI within 6 months, the cumulative cardiovascular death rate was 22.2%, higher than for patients without a spontaneous MI (hazard ratio 4.52; 95% confidence interval, 3.37-6.06, P<0.001). These hazard ratios did not change materially after risk adjustments. Five-year follow-up of patients with non-ST-elevation acute coronary syndrome from the 3 trials showed no association between a procedure-related MI and long-term cardiovascular mortality. In contrast, there was a substantial increase in long-term mortality after a spontaneous MI.

Associations Between Geriatric Syndromes and Mortality in Community-Dwelling Elderly: Results of a National Longitudinal Study in Taiwan.

PubMed

Huang, Chi-Chang; Lee, Jenq-Daw; Yang, Deng-Chi; Shih, Hsin-I; Sun, Chien-Yao; Chang, Chia-Ming

2017-03-01

Although geriatric syndromes have been studied extensively, their interactions with one another and their accumulated effects on life expectancy are less frequently discussed. This study examined whether geriatric syndromes and their cumulative effects are associated with risks of mortality in community-dwelling older adults. Data were collected from the Taiwan Longitudinal Study in Aging in 2003, and the participant survival status was followed until December 31, 2007. A total of 2744 participants aged ≥65 years were included in this retrospective cohort study; 634 died during follow-up. Demographic factors, comorbidities, health behaviors, and geriatric syndromes, including underweight, falls, functional impairment, depressive condition, and cognitive impairment, were assessed. Cox proportional hazard regression analysis was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the probability of survival according to the cumulative number of geriatric syndromes. The prevalence of geriatric syndromes increased with age. Mortality was significantly associated with age ≥75 years; male sex; ≤6 years of education; history of stroke, malignancy; smoking; not drinking alcohol; and not exercising regularly. Geriatric syndromes, such as underweight, functional disability, and depressive condition, contributed to the risk of mortality. The accumulative model of geriatric syndromes also predicted higher risks of mortality (N = 1, HR 1.50, 95% CI 1.19-1.89; N = 2, HR 1.69, 95% CI 1.25-2.29; N ≥ 3, HR 2.43, 95% CI 1.62-3.66). Community-dwelling older adults who were male, illiterate, receiving institutional care, underweight, experiencing a depressive condition, functionally impaired, and engaging in poor health behavior were more likely to have a higher risk of mortality. The identification of geriatric syndromes might help to improve comprehensive care for community-dwelling older adults. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Diethylstilbestrol (DES) and Cancer

MedlinePlus

... Genetics Services Directory Cancer Prevention Overview Research Diethylstilbestrol (DES) and Cancer On This Page What is DES? ... outlined in the table below. Fertility Problems in DES Daughters ( 7 ) Fertility Complication Hazard Ratio Percent Cumulative ...

A human health assessment of hazardous air pollutants in Portland, OR.

PubMed

Tam, B N; Neumann, C M

2004-11-01

Ambient air samples collected from five monitoring sites in Portland, OR during July 1999 to August 2000 were analyzed for 43 hazardous air pollutants (HAP). HAP concentrations were compared to carcinogenic and non-carcinogenic benchmark levels. Carcinogenic benchmark concentrations were set at a risk level of one-in-one-million (1x10(-6)). Hazard ratios of 1.0 were used when comparing HAP concentrations to non-carcinogenic benchmarks. Emission sources (point, area, and mobile) were identified and a cumulative cancer risk and total hazard index were calculated for HAPs exceeding these health benchmark levels. Seventeen HAPs exceeded a cancer risk level of 1x10(-6) at all five monitoring sites. Nineteen HAPs exceeded this level at one or more site. Carbon tetrachloride, 1,3-butadiene, formaldehyde, and 1,1,2,2-tetrachloroethane contributed more than 50% to the upper-bound lifetime cumulative cancer risk of 2.47x10(-4). Acrolein was the only non-carcinogenic HAP with hazard ratios that exceeded 1.0 at all five sites. Mobile sources contributed the greatest percentage (68%) of HAP emissions. Additional monitoring and health assessments for HAPs in Portland, OR are warranted, including addressing issues that may have overestimated or underestimated risks in this study. Abatement strategies for HAPs that exceeded health benchmarks should be implemented to reduce potential adverse health risks.

Implication of human telomerase reverse transcriptase in cervical carcinogenesis and cancer recurrence.

PubMed

Wang, P-H; Ko, J-L

2006-01-01

The objective of this study was to evaluate the implication of human telomerase reverse transcriptase (hTERT) in cervical carcinogenesis and cancer recurrence. One hundred three cases of uterine cervix, including 20 normal, 13 low-grade squamous intraepithelial lesion (LSIL), 30 high-grade squamous intraepithelial lesion (HSIL), and 40 squamous cell carcinoma (SCC) tissues, were evaluated for hTERT immunoreactivity. The expressions of hTERT in normal, LSIL, HSIL, and SCC tissues were compared by Fisher exact or Chi-square test. The relationships between hTERT and clinicopathologic variables of SCC were also assessed. Furthermore, SCC patients were subdivided into negative and positive hTERT expression subgroups, and Kaplan-Meier curves were used to plot the cumulative recurrence hazard for 5 years. There was a significant difference for hTERT expression between LSIL and HSIL subgroups (P < 0.001) but no significant difference between normal and LSIL as well as HSIL and SCC subgroups. For SCC patients, hTERT expression was positive in lymph nodes, vagina, and parametrium metastastic cases. However, it did not reach a significant difference. The cumulative recurrence hazard for 5 years was about 29% in positive hTERT expression subgroup compared to 0% in negative hTERT subgroup (P = 0.2866). In conclusion, a point stage of HSIL exists in the progression of cervical carcinogenesis when the hTERT expression increases significantly. Moreover, SCC patients with positive hTERT expression may have higher cumulative recurrence hazard.

Cardiovascular event risk assessment in psoriasis patients treated with tumor necrosis factor-α inhibitors versus methotrexate.

PubMed

Wu, Jashin J; Guérin, Annie; Sundaram, Murali; Dea, Katherine; Cloutier, Martin; Mulani, Parvez

2017-01-01

Psoriasis is associated with increased risk for cardiovascular disease. To compare major cardiovascular event risk in psoriasis patients receiving methotrexate or tumor necrosis factor-α inhibitor (TNFi) and to assess TNFi treatment duration impact on major cardiovascular event risk. Adult psoriasis patients with ≥2 TNFi or methotrexate prescriptions in the Truven MarketScan Databases (Q1 2000-Q3 2011) were classified as TNFi or methotrexate users. The index date for each of these drugs was the TNFi initiation date or a randomly selected methotrexate dispensing date, respectively. Cardiovascular event risks and cumulative TNFi effect were analyzed by using multivariate Cox proportional-hazards models. By 12 months, TNFi users (N = 9148) had fewer cardiovascular events than methotrexate users (N = 8581) (Kaplan-Meier rates: 1.45% vs 4.09%: P < .01). TNFi users had overall lower cardiovascular event hazards than methotrexate users (hazard ratio = 0.55; P < .01). Over 24 months' median follow-up, every 6 months of cumulative exposure to TNFis were associated with an 11% cardiovascular event risk reduction (P = .02). Lack of clinical assessment measures. Psoriasis patients receiving TNFis had a lower major cardiovascular event risk compared to those receiving methotrexate. Cumulative exposure to TNFis was associated with a reduced risk for major cardiovascular events. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Gout in Older Adults: The Atherosclerosis Risk in Communities Study.

PubMed

Burke, Bridget Teevan; Köttgen, Anna; Law, Andrew; Grams, Morgan; Baer, Alan N; Coresh, Josef; McAdams-DeMarco, Mara A

2016-04-01

It is unclear whether traditional and genetic risk factors in middle age predict the onset of gout in older age. We studied the incidence of gout in older adults using the Atherosclerosis Risk in Communities study, a prospective U.S. population-based cohort of middle-aged adults enrolled between 1987 and 1989 with ongoing follow-up. A genetic urate score was formed from common urate-associated single nucleotide polymorphisms for eight genes. The adjusted hazard ratio and 95% confidence interval of incident gout by traditional and genetic risk factors in middle age were estimated using a Cox proportional hazards model. The cumulative incidence from middle age to age 65 was 8.6% in men and 2.5% in women; by age 75 the cumulative incidence was 11.8% and 5.0%. In middle age, increased adiposity, beer intake, protein intake, smoking status, hypertension, diuretic use, and kidney function (but not sex) were associated with an increased gout risk in older age. In addition, a 100 µmol/L increase in genetic urate score was associated with a 3.29-fold (95% confidence interval: 1.63-6.63) increased gout risk in older age. These findings suggest that traditional and genetic risk factors in middle age may be useful for identifying those at risk of gout in older age. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Retrospective Evaluation Reveals That Long-term Androgen Deprivation Therapy Improves Cause-Specific and Overall Survival in the Setting of Dose-Escalated Radiation for High-Risk Prostate Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Feng, Felix Y., E-mail: ffeng@med.umich.edu; Department of Radiation Oncology, Veterans Affairs Medical Center, Ann Arbor, Michigan; Blas, Kevin

2013-05-01

Purpose: To evaluate the role of androgen deprivation therapy (ADT) and duration for high-risk prostate cancer patients treated with dose-escalated radiation therapy (RT). Methods and Materials: A retrospective analysis of high-risk prostate cancer patients treated with dose-escalated RT (minimum 75 Gy) with or without ADT was performed. The relationship between ADT use and duration with biochemical failure (BF), metastatic failure (MF), prostate cancer-specific mortality (PCSM), non-prostate cancer death (NPCD), and overall survival (OS) was assessed as a function of pretreatment characteristics, comorbid medical illness, and treatment using Fine and Gray's cumulative incidence methodology. Results: The median follow-up time was 64more » months. In men with National Comprehensive Cancer Network defined high-risk prostate cancer treated with dose-escalated RT, on univariate analysis, both metastasis (P<.0001; hazard ratio 0.34; 95% confidence interval 0.18-0.67; cumulative incidence at 60 months 13% vs 35%) and PCSM (P=.015; hazard ratio 0.41; 95% confidence interval 0.2-1.0; cumulative incidence at 60 months 6% vs 11%) were improved with the use of ADT. On multivariate analysis for all high-risk patients, Gleason score was the strongest negative prognostic factor, and long-term ADT (LTAD) improved MF (P=.002), PCSM (P=.034), and OS (P=.001). In men with prostate cancer and Gleason scores 8 to 10, on multivariate analysis after adjustment for other risk features, there was a duration-dependent improvement in BF, metastasis, PCSM, and OS, all favoring LTAD in comparison with STAD or RT alone. Conclusion: For men with high-risk prostate cancer treated with dose-escalated EBRT, this retrospective study suggests that the combination of LTAD and RT provided a significant improvement in clinical outcome, which was especially true for those with Gleason scores of 8 to 10.« less

75 FR 34365 - Safety Zone, Alligator River, NC

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-17

... interest, since immediate action is needed to ensure the safety of human life and property from the hazards... do not individually or cumulatively have a significant effect on the human environment. This rule is...

Job Loss, Unemployment and the Incidence of Hazardous Drinking during the Late 2000s Recession in Europe among Adults Aged 50-64 Years.

PubMed

Bosque-Prous, Marina; Espelt, Albert; Sordo, Luis; Guitart, Anna M; Brugal, M Teresa; Bravo, Maria J

2015-01-01

To estimate the incidence of hazardous drinking in middle-aged people during an economic recession and ascertain whether individual job loss and contextual changes in unemployment influence the incidence rate in that period. Longitudinal study based on two waves of the SHARE project (Survey of Health, Ageing and Retirement in Europe). Individuals aged 50-64 years from 11 European countries, who were not hazardous drinkers at baseline (n = 7,615), were selected for this study. We estimated the cumulative incidence of hazardous drinking (≥40g and ≥20g of pure alcohol on average in men and women, respectively) between 2006 and 2012. Furthermore, in the statistical analysis, multilevel Poisson regression models with robust variance were fitted and obtained Risk Ratios (RR) and their 95% Confidence Intervals (95%CI). Over a 6-year period, 505 subjects became hazardous drinkers, with cumulative incidence of 6.6 per 100 persons between 2006 and 2012 (95%CI:6.1-7.2). Age [RR = 1.02 (95%CI:1.00-1.04)] and becoming unemployed [RR = 1.55 (95%CI:1.08-2.23)] were independently associated with higher risk of becoming a hazardous drinker. Conversely, having poorer self-perceived health was associated with lower risk of becoming a hazardous drinker [RR = 0.75 (95%CI:0.60-0.95)]. At country-level, an increase in the unemployment rate during the study period [RR = 1.32 (95%CI:1.17-1.50)] and greater increases in the household disposable income [RR = 0.97 (95%CI:0.95-0.99)] were associated with risk of becoming a hazardous drinker. Job loss among middle-aged individuals during the economic recession was positively associated with becoming a hazardous drinker. Changes in country-level variables were also related to this drinking pattern.

Identification of emergent off-nominal operational requirements during conceptual architecting of the more electric aircraft

NASA Astrophysics Data System (ADS)

Armstrong, Michael James

Increases in power demands and changes in the design practices of overall equipment manufacturers has led to a new paradigm in vehicle systems definition. The development of unique power systems architectures is of increasing importance to overall platform feasibility and must be pursued early in the aircraft design process. Many vehicle systems architecture trades must be conducted concurrent to platform definition. With an increased complexity introduced during conceptual design, accurate predictions of unit level sizing requirements must be made. Architecture specific emergent requirements must be identified which arise due to the complex integrated effect of unit behaviors. Off-nominal operating scenarios present sizing critical requirements to the aircraft vehicle systems. These requirements are architecture specific and emergent. Standard heuristically defined failure mitigation is sufficient for sizing traditional and evolutionary architectures. However, architecture concepts which vary significantly in terms of structure and composition require that unique failure mitigation strategies be defined for accurate estimations of unit level requirements. Identifying of these off-nominal emergent operational requirements require extensions to traditional safety and reliability tools and the systematic identification of optimal performance degradation strategies. Discrete operational constraints posed by traditional Functional Hazard Assessment (FHA) are replaced by continuous relationships between function loss and operational hazard. These relationships pose the objective function for hazard minimization. Load shedding optimization is performed for all statistically significant failures by varying the allocation of functional capability throughout the vehicle systems architecture. Expressing hazards, and thereby, reliability requirements as continuous relationships with the magnitude and duration of functional failure requires augmentations to the traditional means for system safety assessment (SSA). The traditional two state and discrete system reliability assessment proves insufficient. Reliability is, therefore, handled in an analog fashion: as a function of magnitude of failure and failure duration. A series of metrics are introduced which characterize system performance in terms of analog hazard probabilities. These include analog and cumulative system and functional risk, hazard correlation, and extensions to the traditional component importance metrics. Continuous FHA, load shedding optimization, and analog SSA constitute the SONOMA process (Systematic Off-Nominal Requirements Analysis). Analog system safety metrics inform both architecture optimization (changes in unit level capability and reliability) and architecture augmentation (changes in architecture structure and composition). This process was applied for two vehicle systems concepts (conventional and 'more-electric') in terms of loss/hazard relationships with varying degrees of fidelity. Application of this process shows that the traditional assumptions regarding the structure of the function loss vs. hazard relationship apply undue design bias to functions and components during exploratory design. This bias is illustrated in terms of inaccurate estimations of the system and function level risk and unit level importance. It was also shown that off-nominal emergent requirements must be defined specific to each architecture concept. Quantitative comparisons of architecture specific off-nominal performance were obtained which provide evidence to the need for accurate definition of load shedding strategies during architecture exploratory design. Formally expressing performance degradation strategies in terms of the minimization of a continuous hazard space enhances the system architects ability to accurately predict sizing critical emergent requirements concurrent to architecture definition. Furthermore, the methods and frameworks generated here provide a structured and flexible means for eliciting these architecture specific requirements during the performance of architecture trades.

The Cumulative Burden of Mental, Substance Use, and General Medical Disorders and Rehospitalization and Mortality After an Injury.

PubMed

Zatzick, Douglas F; Rowhani-Rahbar, Ali; Wang, Jin; Russo, Joan; Darnell, Doyanne; Ingraham, Leah; Whiteside, Lauren K; Guiney, Roxanne; Hedrick, Margot Kelly; Rivara, Frederick P

2017-06-01

Each year in the United States, 1.5-2.5 million individuals require hospitalization for an injury. Multiple mental, substance use, and chronic general medical disorders are endemic among injury survivors with and without traumatic brain injury (TBI), yet few studies have assessed the association between the cumulative burden of these conditions and health care outcomes. This study of patients hospitalized for an injury assessed associations between comorbid mental, substance use, and general medical disorders, TBI, and violent events or suicide attempts and the postinjury outcomes of recurrent hospitalization and death. Recurrent hospitalization and all-cause mortality were examined in this population-based retrospective cohort study. A total of 76,942 patients hospitalized for an injury in Washington State during 2006-2007 were followed for five years. ICD-9-CM codes identified conditions prior to or at the index injury admission. Index admissions related to injuries from firearms, assaultive violence, suicide attempts, and overdoses were identified through E-codes. Adjusted regression analyses demonstrated a significant, dose-response relationship between an increasing cumulative burden of disorders and an increasing risk of recurrent hospitalization (four or more conditions, relative risk=3.89, 95% confidence interval [CI]=3.66-4.14). Adjusted Cox proportional hazard regression demonstrated a similar relationship between increasing cumulative burden of disorders and all-cause mortality (four or more conditions, hazard ratio=5.33, CI=4.71-6.04). Increasing cumulative burden of disorders was associated with greater postinjury risk of recurrent hospitalization and death. Orchestrated investigative and policy efforts could introduce screening and intervention procedures that target this spectrum of comorbidity.

Cumulative and recent psychiatric symptoms as predictors of substance use onset: does timing matter?

PubMed

Cerdá, Magdalena; Bordelois, Paula M; Keyes, Katherine M; Galea, Sandro; Koenen, Karestan C; Pardini, Dustin

2013-12-01

We examined two questions about the relationship between conduct disorder (CD), depression and anxiety symptoms and substance use onset: (i) what is the relative influence of recent and more chronic psychiatric symptoms on alcohol and marijuana use initiation and (ii) are there sensitive developmental periods when psychiatric symptoms have a stronger influence on substance use initiation? Secondary analysis of longitudinal data from the Pittsburgh Youth Study, a cohort study of boys followed annually from 7 to 19 years of age. Recruitment occurred in public schools in Pittsburgh, Pennsylvania, USA. A total of 503 boys. The primary outcomes were age of alcohol and marijuana use onset. Discrete-time hazard models were used to determine whether (i) recent (prior year); and (ii) cumulative (from age 7 until 2 years prior to substance use onset) psychiatric symptoms were associated with substance use onset. Recent anxiety symptoms [hazard ratio (HR) = 1.10, 95% confidence interval (CI) = 1.03-1.17], recent (HR = 1.59, 95% CI = 1.35-1.87), cumulative (HR = 1.45, 95% CI = 1.03-2.03) CD symptoms, and cumulative depression symptoms (HR = 1.04, 95% CI = 1.01-1.08) were associated with earlier alcohol use onset. Recent (HR = 1.39, 95% CI = 1.22-1.58) and cumulative CD symptoms (HR = 1.38, 95% CI = 1.02-1.85) were associated with marijuana use onset. Recent anxiety symptoms were only associated with alcohol use onset among black participants. Timing matters in the relationship between psychiatric symptoms and substance use onset in childhood and adolescence, and the psychiatric predictors of onset are substance-specific. There is no single sensitive developmental period for the influence of psychiatric symptoms on alcohol and marijuana use initiation. © 2013 Society for the Study of Addiction.

Multiple imputation methods for nonparametric inference on cumulative incidence with missing cause of failure

PubMed Central

Lee, Minjung; Dignam, James J.; Han, Junhee

2014-01-01

We propose a nonparametric approach for cumulative incidence estimation when causes of failure are unknown or missing for some subjects. Under the missing at random assumption, we estimate the cumulative incidence function using multiple imputation methods. We develop asymptotic theory for the cumulative incidence estimators obtained from multiple imputation methods. We also discuss how to construct confidence intervals for the cumulative incidence function and perform a test for comparing the cumulative incidence functions in two samples with missing cause of failure. Through simulation studies, we show that the proposed methods perform well. The methods are illustrated with data from a randomized clinical trial in early stage breast cancer. PMID:25043107

77 FR 60042 - Safety Zone; Research Vessel SIKULIAQ Launch, Marinette, WI

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-02

... of Rule With the aforementioned hazards in mind, the Captain of the Port, Sector Lake Michigan, has... cumulatively have a significant effect on the human environment. This rule involves the establishment of a...

Dropout rates in medical students at one school before and after the installation of admission tests in Austria.

PubMed

Reibnegger, Gilbert; Caluba, Hans-Christian; Ithaler, Daniel; Manhal, Simone; Neges, Heide Maria; Smolle, Josef

2011-08-01

Admission to medical studies in Austria since academic year 2005-2006 has been regulated by admission tests. At the Medical University of Graz, an admission test focusing on secondary-school-level knowledge in natural sciences has been used for this purpose. The impact of this important change on dropout rates of female versus male students and older versus younger students is reported. All 2,860 students admitted to the human medicine diploma program at the Medical University of Graz from academic years 2002-2003 to 2008-2009 were included. Nonparametric and semiparametric survival analysis techniques were employed to compare cumulative probability of dropout between demographic groups. Cumulative probability of dropout was significantly reduced in students selected by active admission procedure versus those admitted openly (P < .0001). Relative hazard ratio of selected versus openly admitted students was only 0.145 (95% CI, 0.106-0.198). Among openly admitted students, but not for selected ones, the cumulative probabilities for dropout were higher for females (P < .0001) and for older students (P < .0001). Generally, dropout hazard is highest during the second year of study. The introduction of admission testing significantly decreased the cumulative probability for dropout. In openly admitted students a significantly higher risk for dropout was found in female students and in older students, whereas no such effects can be detected after admission testing. Future research should focus on the sex dependence, with the aim of improving success rates among female applicants on the admission tests.

PSHREG: A SAS macro for proportional and nonproportional subdistribution hazards regression

PubMed Central

Kohl, Maria; Plischke, Max; Leffondré, Karen; Heinze, Georg

2015-01-01

We present a new SAS macro %pshreg that can be used to fit a proportional subdistribution hazards model for survival data subject to competing risks. Our macro first modifies the input data set appropriately and then applies SAS's standard Cox regression procedure, PROC PHREG, using weights and counting-process style of specifying survival times to the modified data set. The modified data set can also be used to estimate cumulative incidence curves for the event of interest. The application of PROC PHREG has several advantages, e.g., it directly enables the user to apply the Firth correction, which has been proposed as a solution to the problem of undefined (infinite) maximum likelihood estimates in Cox regression, frequently encountered in small sample analyses. Deviation from proportional subdistribution hazards can be detected by both inspecting Schoenfeld-type residuals and testing correlation of these residuals with time, or by including interactions of covariates with functions of time. We illustrate application of these extended methods for competing risk regression using our macro, which is freely available at: http://cemsiis.meduniwien.ac.at/en/kb/science-research/software/statistical-software/pshreg, by means of analysis of a real chronic kidney disease study. We discuss differences in features and capabilities of %pshreg and the recent (January 2014) SAS PROC PHREG implementation of proportional subdistribution hazards modelling. PMID:25572709

Pollution potential leaching index as a tool to assess water leaching risk of arsenic in excavated urban soils.

PubMed

Li, Jining; Kosugi, Tomoya; Riya, Shohei; Hashimoto, Yohey; Hou, Hong; Terada, Akihiko; Hosomi, Masaaki

2018-01-01

Leaching of hazardous trace elements from excavated urban soils during construction of cities has received considerable attention in recent years in Japan. A new concept, the pollution potential leaching index (PPLI), was applied to assess the risk of arsenic (As) leaching from excavated soils. Sequential leaching tests (SLT) with two liquid-to-solid (L/S) ratios (10 and 20Lkg -1 ) were conducted to determine the PPLI values, which represent the critical cumulative L/S ratios at which the average As concentrations in the cumulative leachates are reduced to critical values (10 or 5µgL -1 ). Two models (a logarithmic function model and an empirical two-site first-order leaching model) were compared to estimate the PPLI values. The fractionations of As before and after SLT were extracted according to a five-step sequential extraction procedure. Ten alkaline excavated soils were obtained from different construction projects in Japan. Although their total As contents were low (from 6.75 to 79.4mgkg -1 ), the As leaching was not negligible. Different L/S ratios at each step of the SLT had little influence on the cumulative As release or PPLI values. Experimentally determined PPLI values were in agreement with those from model estimations. A five-step SLT with an L/S of 10Lkg -1 at each step, combined with a logarithmic function fitting was suggested for the easy estimation of PPLI. Results of the sequential extraction procedure showed that large portions of more labile As fractions (non-specifically and specifically sorbed fractions) were removed during long-term leaching and so were small, but non-negligible, portions of strongly bound As fractions. Copyright © 2017 Elsevier Inc. All rights reserved.

Crude incidence in two-phase designs in the presence of competing risks.

PubMed

Rebora, Paola; Antolini, Laura; Glidden, David V; Valsecchi, Maria Grazia

2016-01-11

In many studies, some information might not be available for the whole cohort, some covariates, or even the outcome, might be ascertained in selected subsamples. These studies are part of a broad category termed two-phase studies. Common examples include the nested case-control and the case-cohort designs. For two-phase studies, appropriate weighted survival estimates have been derived; however, no estimator of cumulative incidence accounting for competing events has been proposed. This is relevant in the presence of multiple types of events, where estimation of event type specific quantities are needed for evaluating outcome. We develop a non parametric estimator of the cumulative incidence function of events accounting for possible competing events. It handles a general sampling design by weights derived from the sampling probabilities. The variance is derived from the influence function of the subdistribution hazard. The proposed method shows good performance in simulations. It is applied to estimate the crude incidence of relapse in childhood acute lymphoblastic leukemia in groups defined by a genotype not available for everyone in a cohort of nearly 2000 patients, where death due to toxicity acted as a competing event. In a second example the aim was to estimate engagement in care of a cohort of HIV patients in resource limited setting, where for some patients the outcome itself was missing due to lost to follow-up. A sampling based approach was used to identify outcome in a subsample of lost patients and to obtain a valid estimate of connection to care. A valid estimator for cumulative incidence of events accounting for competing risks under a general sampling design from an infinite target population is derived.

Description of quasiparticle and satellite properties via cumulant expansions of the retarded one-particle Green's function

DOE PAGES

Mayers, Matthew Z.; Hybertsen, Mark S.; Reichman, David R.

2016-08-22

A cumulant-based GW approximation for the retarded one-particle Green's function is proposed, motivated by an exact relation between the improper Dyson self-energy and the cumulant generating function. We explore qualitative aspects of this method within a simple one-electron independent phonon model, where it is seen that the method preserves the energy moment of the spectral weight while also reproducing the exact Green's function in the weak-coupling limit. For the three-dimensional electron gas, this method predicts multiple satellites at the bottom of the band, albeit with inaccurate peak spacing. But, its quasiparticle properties and correlation energies are more accurate than bothmore » previous cumulant methods and standard G0W0. These results point to features that may be exploited within the framework of cumulant-based methods and suggest promising directions for future exploration and improvements of cumulant-based GW approaches.« less

Environmental Assessment for Perimeter Security Lighting at Fort MacArthur, California

DTIC Science & Technology

2007-07-01

transportation, visual resources, cultural resources, socioeconomics, environmental justice, hazardous materials and waste and safety . The environmental...Materials and Wastes 53 3.13 Safety 56 4.0 Environmental Consequences 57 4.1 Air Quality 57 4.2 Noise 58 4.3 Land Use 60 4.4 Geological Resources 61...Socioeconomics 70 4.11 Environmental Justice and Protection of Children 71 4.12 Hazardous Materials and Wastes 73 4.13 Safety 74 5.0 Cumulative

Adverse Childhood Experiences and Alcohol Consumption in Midlife and Early Old-Age

PubMed Central

Leung, Jessica Pui Kei; Britton, Annie; Bell, Steven

2016-01-01

Aims To examine the individual and cumulative effects of adverse childhood experiences (ACEs) on alcohol consumption in midlife and early old-age, and the role of ACEs in 10-year drinking trajectories across midlife. Methods Data were from the Whitehall II study, a longitudinal British civil service-based cohort study (N = 7870, 69.5% male). Multinomial logistic regression was used to examine the individual and cumulative effects of ACEs on weekly alcohol consumption. Mixed-effect multilevel modelling was used to explore the relationship between ACEs and change in alcohol consumption longitudinally. Results Participants who were exposed to parental arguments/fights in childhood were 1.24 (95% CI 1.06, 1.45) times more likely to drink at hazardous levels in midlife (mean age 56 years) after controlling for covariates and other ACEs. For each additional exposure to an ACE, the risk of hazardous drinking versus moderate drinking was increased by 1.12 (95% CI 1.03, 1.21) after adjusting for sex, age, adult socio-economic status, ethnicity and marital status. No associations between ACEs and increased risk of hazardous drinking in early old-age (mean age 66 years) were found. In longitudinal analyses, ACEs did not significantly influence 10-year drinking trajectories across midlife. Conclusion The effect of exposure to parental arguments on hazardous drinking persists into midlife. PMID:26553290

Childhood Cumulative Risk Exposure and Adult Amygdala Volume and Function

PubMed Central

Evans, Gary W.; Swain, James E.; King, Anthony P.; Wang, Xin; Javanbakht, Arash; Ho, S. Shaun; Angstadt, Michael; Phan, K. Luan; Xie, Hong; Liberzon, Israel

2015-01-01

Considerable work indicates that early cumulative risk exposure is aversive to human development, but very little research has examined neurological underpinnings of these robust findings. We investigated amygdala volume and reactivity to facial stimuli among adults (M = 23.7 years, n = 54) as a function of cumulative risk exposure during childhood (ages 9 and 13). In addition, we tested whether expected, cumulative risk elevations in amygdala volume would mediate functional reactivity of the amygdala during socio-emotional processing. Risks included substandard housing quality, noise, crowding, family turmoil, child separation from family, and violence. Total and left hemisphere adult amygdala volumes, respectively were positively related to cumulative risk exposure during childhood. The links between childhood cumulative risk exposure and elevated amygdala responses to emotionally neutral facial stimuli in adulthood were mediated by the respective amygdala volumes. Cumulative risk exposure in later adolescence (17 years), however, was unrelated to subsequent, adult amygdala volume or function. Physical and socioemotional risk exposures early in life appear to alter amygdala development, rendering adults more reactive to ambiguous stimuli such as neutral faces. These stress-related differences in childhood amygdala development might contribute to well-documented psychological distress as a function of early risk exposure. PMID:26469872

Rapidity dependence of proton cumulants and correlation functions

DOE PAGES

Bzdak, Adam; Koch, Volker

2017-11-13

The dependence of multiproton correlation functions and cumulants on the acceptance in rapidity and transverse momentum is studied. Here, we found that the preliminary data of various cumulant ratios are consistent, within errors, with rapidity and transverse momentum-independent correlation functions. But, rapidity correlations which moderately increase with rapidity separation between protons are slightly favored. We propose to further explore the rapidity dependence of multiparticle correlation functions by measuring the dependence of the integrated reduced correlation functions as a function of the size of the rapidity window.

Rapidity dependence of proton cumulants and correlation functions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bzdak, Adam; Koch, Volker

The dependence of multiproton correlation functions and cumulants on the acceptance in rapidity and transverse momentum is studied. Here, we found that the preliminary data of various cumulant ratios are consistent, within errors, with rapidity and transverse momentum-independent correlation functions. But, rapidity correlations which moderately increase with rapidity separation between protons are slightly favored. We propose to further explore the rapidity dependence of multiparticle correlation functions by measuring the dependence of the integrated reduced correlation functions as a function of the size of the rapidity window.

Associations of cumulative Pb exposure and longitudinal changes in Mini-Mental Status Exam scores, global cognition and domains of cognition: The VA Normative Aging Study.

PubMed

Farooqui, Zishaan; Bakulski, Kelly M; Power, Melinda C; Weisskopf, Marc G; Sparrow, David; Spiro, Avron; Vokonas, Pantel S; Nie, Linda H; Hu, Howard; Park, Sung Kyun

2017-01-01

Lead (Pb) exposure has been associated with poorer cognitive function cross-sectionally in aging adults, however the association between cumulative Pb exposure and longitudinal changes in cognition is little characterized. In a 1993-2007 subcohort of the VA Normative Aging Study (Mini-mental status exam (MMSE) n=741; global cognition summary score n=715), we used linear mixed effects models to test associations between cumulative Pb exposure (patella or tibia bone Pb) and repeated measures of cognition (MMSE, individual cognitive tests, and global cognition summary). Cox proportional hazard modeling assessed the risk of an MMSE score falling below 25. Among men 51-98 at baseline, higher patella Pb concentration (IQR: 21μg/g) was associated with -0.13 lower baseline MMSE (95% CI: -0.25, -0.004) and faster longitudinal MMSE decline (-0.016 units/year, 95% CI: -0.032, -0.0004) over 15 years. Each IQR increase in patella Pb was associated with increased risk of a MMSE score below 25 (HR=1.21, 95% CI: 0.99, 1.49; p=0.07). There were no significant associations between Pb and global cognition (both baseline and longitudinal change). Patella Pb was associated with faster longitudinal decline in Word List Total Recall in the language domain (0.014 units/year, 95% CI: -0.026, -0.001) and Word List Delayed Recall in the memory domain (0.014 units/year, 95% CI: -0.027, -0.002). We found weaker associations with tibia Pb. Cumulative Pb exposure is associated with faster declines in MMSE and Word List Total and Delayed Recall tests. These findings support the hypothesis that Pb exposure accelerates cognitive aging. Copyright © 2016 Elsevier Inc. All rights reserved.

Geomorphic and hydrologic assessment of erosion hazards at the Norman municipal landfill, Canadian River floodplain, central Oklahoma

USGS Publications Warehouse

Curtis, Jennifer A.; Whitney, John W.

2003-01-01

The Norman, Oklahoma, municipal landfill closed in 1985 after 63 years of operation, because it was identified as a point source of hazardous leachate composed of organic and inorganic compounds. The landfill is located on the floodplain of the Canadian River, a sand-bed river characterized by erodible channel boundaries and by large variation in mean monthly discharges. In 1986, floodwaters eroded riprap protection at the southern end of the landfill and penetrated the landfill's clay cap, thereby exposing the landfill contents. The impact of this moderate-magnitude flood event (Q12) was the catalyst to investigate erosion hazards at the Norman landfill. This geomorphic investigation analyzed floodplain geomorphology and historical channel changes, flood-frequency distributions, an erosion threshold, the geomorphic effectiveness of discharge events, and other factors that influence erosion hazards at the landfill site. The erosion hazard at the Norman landfill is a function of the location of the landfill with respect to the channel thalweg, erosional resistance of the channel margins, magnitude and duration of discrete discharge events, channel form and hydraulic geometry, and cumulative effects related to a series of discharge events. Based on current climatic conditions and historical channel changes, a minimum erosion threshold is set at bankfull discharge (Q = 572 m3/s). The annual probability of exceeding this threshold is 0.53. In addition, this analysis indicates that peak stream power is less informative than total energy expenditures when estimating the erosion potential or geomorphic effectiveness of discrete discharge events. On the Canadian River, long-duration, moderate-magnitude floods can have larger total energy expenditures than shorter-duration, high-magnitude floods and therefore represent the most serious erosion hazard to floodplain structures.

Estimation of variance in Cox's regression model with shared gamma frailties.

PubMed

Andersen, P K; Klein, J P; Knudsen, K M; Tabanera y Palacios, R

1997-12-01

The Cox regression model with a shared frailty factor allows for unobserved heterogeneity or for statistical dependence between the observed survival times. Estimation in this model when the frailties are assumed to follow a gamma distribution is reviewed, and we address the problem of obtaining variance estimates for regression coefficients, frailty parameter, and cumulative baseline hazards using the observed nonparametric information matrix. A number of examples are given comparing this approach with fully parametric inference in models with piecewise constant baseline hazards.

Workstation Analysis, Ergonomic Style: Don't Despair, Teaching Ergonomic Workstation Analysis Isn't That Tough; but You Need a Plan.

ERIC Educational Resources Information Center

Merrell, Wayne L.; Zeimet, Denis E.

1994-01-01

Lists 15 principles for working safely with equipment. Describes phases of an ergonomic hazards program to identify and prevent problems and causes of cumulative trauma disorders in the workplace. (SK)

Urban-rural status affects associations between domains of environmental quality and childhood cancer

EPA Science Inventory

Childhood cancer is associated with individual ambient environmental exposures such as hazardous air pollutants and pesticides. However, the role of cumulative ambient environmental exposures is not well-understood. An Environmental Quality Index (EQI) for 2000-2005 was construct...

Risk of Intracranial Hemorrhage From Statin Use in Asians: A Nationwide Cohort Study.

PubMed

Chang, Chia-Hsuin; Lin, Chin-Hsien; Caffrey, James L; Lee, Yen-Chieh; Liu, Ying-Chun; Lin, Jou-Wei; Lai, Mei-Shu

2015-06-09

Reports of statin usage and increased risk of intracranial hemorrhage (ICH) have been inconsistent. This study examined potential associations between statin usage and the risk of ICH in subjects without a previous history of stroke. Patients initiating statin therapy between 2005 and 2009 without a previous history of ischemic or hemorrhagic stroke were identified from Taiwan's National Health Insurance database. Participants were stratified by advanced age (≥70 years), sex, and diagnosed hypertension. The outcome of interest was hospital admission for ICH (International Classification of Diseases, Ninth Revision, Clinical Modification codes 430, 431, 432). Cox regression models were applied to estimate the hazard ratio of ICH. The cumulative statin dosage stratified by quartile and adjusted for baseline disease risk score served as the primary variable using the lowest quartile of cumulative dosage as a reference. There were 1 096 547 statin initiators with an average follow-up of 3.3 years. The adjusted hazard ratio for ICH between the highest and the lowest quartile was nonsignificant at 1.06 with a 95% confidence interval spanning 1.00 (0.94-1.19). Similar nonsignificant results were found in sensitivity analyses using different outcome definitions or model adjustments, reinforcing the robustness of the study findings. Subgroup analysis identified an excess of ICH frequency in patients without diagnosed hypertension (adjusted hazard ratio 1.36 [1.11-1.67]). In general, no association was observed between cumulative statin use and the risk of ICH among subjects without a previous history of stroke. An increased risk was identified among the nonhypertensive cohort, but this finding should be interpreted with caution. © 2015 American Heart Association, Inc.

Childhood Cumulative Risk Exposure and Adult Amygdala Volume and Function.

PubMed

Evans, Gary W; Swain, James E; King, Anthony P; Wang, Xin; Javanbakht, Arash; Ho, S Shaun; Angstadt, Michael; Phan, K Luan; Xie, Hong; Liberzon, Israel

2016-06-01

Considerable work indicates that early cumulative risk exposure is aversive to human development, but very little research has examined the neurological underpinnings of these robust findings. This study investigates amygdala volume and reactivity to facial stimuli among adults (mean 23.7 years of age, n = 54) as a function of cumulative risk exposure during childhood (9 and 13 years of age). In addition, we test to determine whether expected cumulative risk elevations in amygdala volume would mediate functional reactivity of the amygdala during socioemotional processing. Risks included substandard housing quality, noise, crowding, family turmoil, child separation from family, and violence. Total and left hemisphere adult amygdala volumes were positively related to cumulative risk exposure during childhood. The links between childhood cumulative risk exposure and elevated amygdala responses to emotionally neutral facial stimuli in adulthood were mediated by the corresponding amygdala volumes. Cumulative risk exposure in later adolescence (17 years of age), however, was unrelated to subsequent adult amygdala volume or function. Physical and socioemotional risk exposures early in life appear to alter amygdala development, rendering adults more reactive to ambiguous stimuli such as neutral faces. These stress-related differences in childhood amygdala development might contribute to the well-documented psychological distress as a function of early risk exposure. © 2015 Wiley Periodicals, Inc.

Loss-of-function mutations in APOC3 and risk of ischemic vascular disease.

PubMed

Jørgensen, Anders Berg; Frikke-Schmidt, Ruth; Nordestgaard, Børge G; Tybjærg-Hansen, Anne

2014-07-03

High plasma levels of nonfasting triglycerides are associated with an increased risk of ischemic cardiovascular disease. Whether lifelong low levels of nonfasting triglycerides owing to mutations in the gene encoding apolipoprotein C3 (APOC3) are associated with a reduced risk of ischemic cardiovascular disease in the general population is unknown. Using data from 75,725 participants in two general-population studies, we first tested whether low levels of nonfasting triglycerides were associated with reduced risks of ischemic vascular disease and ischemic heart disease. Second, we tested whether loss-of-function mutations in APOC3, which were associated with reduced levels of nonfasting triglycerides, were also associated with reduced risks of ischemic vascular disease and ischemic heart disease. During follow-up, ischemic vascular disease developed in 10,797 participants, and ischemic heart disease developed in 7557 of these 10,797 participants. Participants with nonfasting triglyceride levels of less than 1.00 mmol per liter (90 mg per deciliter) had a significantly lower incidence of cardiovascular disease than those with levels of 4.00 mmol per liter (350 mg per deciliter) or more (hazard ratio for ischemic vascular disease, 0.43; 95% confidence interval [CI], 0.35 to 0.54; hazard ratio for ischemic heart disease, 0.40; 95% CI, 0.31 to 0.52). Heterozygosity for loss-of-function mutations in APOC3, as compared with no APOC3 mutations, was associated with a mean reduction in nonfasting triglyceride levels of 44% (P<0.001). The cumulative incidences of ischemic vascular disease and ischemic heart disease were reduced in heterozygotes as compared with noncarriers of APOC3 mutations (P=0.009 and P=0.05, respectively), with corresponding risk reductions of 41% (hazard ratio, 0.59; 95% CI, 0.41 to 0.86; P=0.007) and 36% (hazard ratio, 0.64; 95% CI, 0.41 to 0.99; P=0.04). Loss-of-function mutations in APOC3 were associated with low levels of triglycerides and a reduced risk of ischemic cardiovascular disease. (Funded by the European Union and others.).

Myositis-associated usual interstitial pneumonia has a better survival than idiopathic pulmonary fibrosis.

PubMed

Aggarwal, Rohit; McBurney, Christine; Schneider, Frank; Yousem, Samuel A; Gibson, Kevin F; Lindell, Kathleen; Fuhrman, Carl R; Oddis, Chester V

2017-03-01

To compare the survival outcomes between myositis-associated usual interstitial pneumonia (MA-UIP) and idiopathic pulmonary fibrosis (IPF-UIP). Adult MA-UIP and IPF-UIP patients were identified using CTD and IPF registries. The MA-UIP cohort included myositis or anti-synthetase syndrome patients with interstitial lung disease while manifesting UIP on high-resolution CT chest and/or a lung biopsy revealing UIP histology. IPF subjects met American Thoracic Society criteria and similarly had UIP histopathology. Kaplan-Meier survival curves compared cumulative and pulmonary event-free survival (event = transplant or death) between (i) all MA-UIP and IPF-UIP subjects, (ii) MA-UIP with biopsy proven UIP (n = 25) vs IPF-UIP subjects matched for age, gender and baseline forced vital capacity (±10%). Cox proportional hazards ratios compared the survival controlling for co-variates. Eighty-one IPF-UIP and 43 MA-UIP subjects were identified. The median cumulative and event-free survival time in IPF vs MA-UIP was 5.25/1.8 years vs 16.2/10.8 years, respectively. Cumulative and event-free survival was significantly worse in IPF-UIP vs MA-UIP [hazards ratio of IPF-UIP was 2.9 (95% CI: 1.5, 5.6) and 5.0 (95% CI: 2.8, 8.7) (P < 0.001), respectively]. IPF-UIP event-free survival (but not cumulative) remained significantly worse than MA-UIP with a hazards ratio of 6.4 (95% CI: 3.0, 13.8) after controlling for age at interstitial lung disease diagnosis, gender, ethnicity and baseline forced vital capacity%. Respiratory failure was the most common cause of death in both groups. A sub-analysis of 25 biopsy-proven MA-UIP subjects showed similar results. MA-UIP patients demonstrated a significant survival advantage over a matched IPF cohort, suggesting that despite similar histological and radiographic findings at presentation, the prognosis of MA-UIP is superior to that of IPF-UIP. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Effect of liver cirrhosis on metastasis in colorectal cancer patients: a nationwide population-based cohort study.

PubMed

Chiou, Wen-Yen; Chang, Chun-Ming; Tseng, Kuo-Chih; Hung, Shih-Kai; Lin, Hon-Yi; Chen, Yi-Chun; Su, Yu-Chieh; Tseng, Chih-Wei; Tsai, Shiang-Jiun; Lee, Moon-Sing; Li, Chung-Yi

2015-02-01

The aim of this study is to evaluate the liver metastasis risk among colorectal cancer patients with liver cirrhosis. This was a nationwide population-based cohort study of 2973 newly diagnosed colorectal cancer patients with liver cirrhosis and 11 892 age-sex matched controls enrolled in Taiwan between 2000 and 2010. The cumulative risk by Kaplan-Meier method, hazard ratio by the multivariate Cox proportional model and the incidence density were evaluated. The median time interval from the colorectal cancer diagnosis to the liver metastasis event was 7.42 months for liver cirrhosis group and 7.67 months for non-liver cirrhosis group. The incidence density of liver metastasis was higher in the liver cirrhosis group (61.92/1000 person-years) than in the non-liver cirrhosis group (47.48/1000 person-years), with a significantly adjusted hazard ratio of 1.15 (95% CI = 1.04-1.28, P = 0.007). The 10-year cumulative risk of liver metastasis for the liver cirrhosis and the non-liver cirrhosis group was 27.1 and 23.6%, respectively (P = 0.006). For early cancer stage with locoregional disease patients receiving surgery alone without adjuvant anti-cancer treatments, patients with liver cirrhosis (10-year cumulative risk 23.9 vs. 15.7%, P < 0.001) or cirrhotic symptoms (10-year cumulative risk 25.6 vs. 16.6%, P = 0.009) both still had higher liver metastasis risk compared with their counterparts. For etiologies of liver cirrhosis, the 10-year cumulative risk for hepatitis B virus and hepatitis C virus, hepatitis B virus, hepatitis C virus, other causes and non-liver cirrhosis were 29.5, 28.9, 27.5, 26.7 and 23.4%, respectively, (P = 0.03). Our study found that liver metastasis risk was underestimated and even higher in colorectal cancer patients with liver cirrhosis. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Rockfall hazard and risk assessments along roads at a regional scale: example in Swiss Alps

NASA Astrophysics Data System (ADS)

Michoud, C.; Derron, M.-H.; Horton, P.; Jaboyedoff, M.; Baillifard, F.-J.; Loye, A.; Nicolet, P.; Pedrazzini, A.; Queyrel, A.

2012-03-01

Unlike fragmental rockfall runout assessments, there are only few robust methods to quantify rock-mass-failure susceptibilities at regional scale. A detailed slope angle analysis of recent Digital Elevation Models (DEM) can be used to detect potential rockfall source areas, thanks to the Slope Angle Distribution procedure. However, this method does not provide any information on block-release frequencies inside identified areas. The present paper adds to the Slope Angle Distribution of cliffs unit its normalized cumulative distribution function. This improvement is assimilated to a quantitative weighting of slope angles, introducing rock-mass-failure susceptibilities inside rockfall source areas previously detected. Then rockfall runout assessment is performed using the GIS- and process-based software Flow-R, providing relative frequencies for runout. Thus, taking into consideration both susceptibility results, this approach can be used to establish, after calibration, hazard and risk maps at regional scale. As an example, a risk analysis of vehicle traffic exposed to rockfalls is performed along the main roads of the Swiss alpine valley of Bagnes.

Agricultural Fragility Estimates Subjected to Volcanic Ash Fall Hazards

NASA Astrophysics Data System (ADS)

Ham, H. J.; Lee, S.; Choi, S. H.; Yun, W. S.

2015-12-01

Agricultural Fragility Estimates Subjected to Volcanic Ash Fall Hazards Hee Jung Ham1, Seung-Hun Choi1, Woo-Seok Yun1, Sungsu Lee2 1Department of Architectural Engineering, Kangwon National University, Korea 2Division of Civil Engineering, Chungbuk National University, Korea ABSTRACT In this study, fragility functions are developed to estimate expected volcanic ash damages of the agricultural sector in Korea. The fragility functions are derived from two approaches: 1) empirical approach based on field observations of impacts to agriculture from the 2006 eruption of Merapi volcano in Indonesia and 2) the FOSM (first-order second-moment) analytical approach based on distribution and thickness of volcanic ash observed from the 1980 eruption of Mt. Saint Helens and agricultural facility specifications in Korea. Fragility function to each agricultural commodity class is presented by a cumulative distribution function of the generalized extreme value distribution. Different functions are developed to estimate production losses from outdoor and greenhouse farming. Seasonal climate influences vulnerability of each agricultural crop and is found to be a crucial component in determining fragility of agricultural commodities to an ash fall. In the study, the seasonality coefficient is established as a multiplier of fragility function to consider the seasonal vulnerability. Yields of the different agricultural commodities are obtained from Korean Statistical Information Service to create a baseline for future agricultural volcanic loss estimation. Numerically simulated examples of scenario ash fall events at Mt. Baekdu volcano are utilized to illustrate the application of the developed fragility functions. Acknowledgements This research was supported by a grant 'Development of Advanced Volcanic Disaster Response System considering Potential Volcanic Risk around Korea' [MPSS-NH-2015-81] from the Natural Hazard Mitigation Research Group, Ministry of Public Safety and Security of Korea. References Nimlos, T. J. and Hans, Z., The Distribution and Thickness of Volcanic Ash in Montana, Northwest Science, Vol. 56, No. 3, 1982. Wilson, T., Kaye, G., Stewart, C., and Cole, J., Impacts of the 2006 Eruption of Merapi Volcano, Indonesia, on Agriculture and Infrastructure, GNS Science Report, 2007.

Assessing Stress-Related Treatment Needs among Girls at Risk for Poor Functional Outcomes: The Impact of Cumulative Adversity, Criterion Traumas, and Non-Criterion Events

PubMed Central

Lansing, Amy E.; Plante, Wendy Y.; Beck, Audrey N.

2016-01-01

Despite growing recognition that cumulative adversity (total stressor exposure), including complex trauma, increases the risk for psychopathology and impacts development, assessment strategies lag behind: Trauma-related mental health needs (symptoms, functional impairment, maladaptive coping) are typically assessed in response to only one qualifying Criterion-A event. This is especially problematic for youth at-risk for health and academic disparities who experience cumulative adversity, including non-qualifying events (parental separations) which may produce more impairing symptomatology. Data from 118 delinquent girls demonstrate: 1) an average of 14 adverse Criterion-A and non-Criterion event exposures; 2) serious maladaptive coping strategies (self-injury) directly in response to cumulative adversity; 3) more cumulative adversity-related than worst-event related symptomatology and functional impairment; and 4) comparable symptomatology, but greater functional impairment, in response to non-Criterion events. These data support the evaluation of mental health needs in response to cumulative adversity for optimal identification and tailoring of services in high-risk populations to reduce disparities. PMID:27745922

Assessing stress-related treatment needs among girls at risk for poor functional outcomes: The impact of cumulative adversity, criterion traumas, and non-criterion events.

PubMed

Lansing, Amy E; Plante, Wendy Y; Beck, Audrey N

2017-05-01

Despite growing recognition that cumulative adversity (total stressor exposure, including complex trauma), increases the risk for psychopathology and impacts development, assessment strategies lag behind: Adversity-related mental health needs (symptoms, functional impairment, maladaptive coping) are typically assessed in response to only one qualifying Criterion-A traumatic event. This is especially problematic for youth at-risk for health and academic disparities who experience cumulative adversity, including non-qualifying events (separation from caregivers) which may produce more impairing symptomatology. Data from 118 delinquent girls demonstrate: (1) an average of 14 adverse Criterion-A and non-Criterion event exposures; (2) serious maladaptive coping strategies (self-injury) directly in response to cumulative adversity; (3) more cumulative adversity-related than worst-event related symptomatology and functional impairment; and (4) comparable symptomatology, but greater functional impairment, in response to non-Criterion events. These data support the evaluation of mental health needs in response to cumulative adversity for optimal identification and tailoring of services in high-risk populations to reduce disparities. Copyright © 2016 Elsevier Ltd. All rights reserved.

Role of familial factors in late-onset Alzheimer disease as a function of age.

PubMed

Wu, Z; Kinslow, C; Pettigrew, K D; Rapoport, S I; Schapiro, M B

1998-09-01

Whereas early-onset Alzheimer disease (AD; usually onset at age < 50 years) has been defined with genetic mutation on chromosomes 1, 14, and 21, the degree of familial contribution to late-onset AD is unclear. Further, it is uncertain if subgroups of late-onset AD exist. To examine the influence of familial factors as a function of age in late-onset AD we investigated lifetime risks and age-specific hazard rates of AD-like illness among late-onset AD probands' and controls' first-degree relatives, using questionnaires and medical records. As part of a longitudinal study on aging and AD, we studied 78 AD probands with age of onset > or =50 years (28 "definite" and 50 "probable" AD according to NINCDS/ADRDA criteria) and 101 healthy old controls seen since 1981. Both probands and controls were screened rigorously with medical tests and brain imaging and seen regularly until autopsy. Multiple informants and medical records were used for first-degree relatives. Among first-degree relatives, 49 secondary cases of AD-like illness were found for the AD probands' relatives (391 relatives 40 years old or older) compared with 20 cases among controls' relatives (456 relatives 40 years old or older). Relatives of AD probands had a significantly increased lifetime risk of AD-like illness of 52.8+/-11.4% by age 94 years compared with a lifetime risk in relatives of controls of 22.1+/-5.8% by age 90 years. Age-specific hazard rates in relatives of AD probands increased until the 75-79-year age interval and then decreased; in contrast the age-specific hazard rates increased in relatives of controls after the 80-84-year age interval. To determine if a dividing line exist among late-onset AD, several cutoff ages were used in our study to compare cumulative risk curves of AD-like illness between relatives of late-onset probands and relatives of late-late-onset probands. Differences in the pattern of cumulative incidence of AD in relatives showed that 67-71 years is the range for a dividing line between late- and late-late-onset AD. Age-specific hazard rates of AD in relatives supported a difference between late- and late-late-onset. Whereas these rates increased until the 75-79-year age interval and then decreased in late-onset AD, the rates began increasing after the 65-69-year age interval and through the oldest age interval in both late-late-onset AD and control groups. Our results support the concept that familial factors exist in late-onset AD and that different familial factors may exist in late-onset AD subgroups.

44 CFR 65.15 - List of communities submitting new technical data.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false List of communities... Program IDENTIFICATION AND MAPPING OF SPECIAL HAZARD AREAS § 65.15 List of communities submitting new technical data. This section provides a cumulative list of communities where modifications of the base flood...

Contraceptive confidence and timing of first birth in Moldova: an event history analysis of retrospective data.

PubMed

Lyons-Amos, Mark; Padmadas, Sabu S; Durrant, Gabriele B

2014-08-11

To test the contraceptive confidence hypothesis in a modern context. The hypothesis is that women using effective or modern contraceptive methods have increased contraceptive confidence and hence a shorter interval between marriage and first birth than users of ineffective or traditional methods. We extend the hypothesis to incorporate the role of abortion, arguing that it acts as a substitute for contraception in the study context. Moldova, a country in South-East Europe. Moldova exhibits high use of traditional contraceptive methods and abortion compared with other European countries. Data are from a secondary analysis of the 2005 Moldovan Demographic and Health Survey, a nationally representative sample survey. 5377 unmarried women were selected. The outcome measure was the interval between marriage and first birth. This was modelled using a piecewise-constant hazard regression, with abortion and contraceptive method types as primary variables along with relevant sociodemographic controls. Women with high contraceptive confidence (modern method users) have a higher cumulative hazard of first birth 36 months following marriage (0.88 (0.87 to 0.89)) compared with women with low contraceptive confidence (traditional method users, cumulative hazard: 0.85 (0.84 to 0.85)). This is consistent with the contraceptive confidence hypothesis. There is a higher cumulative hazard of first birth among women with low (0.80 (0.79 to 0.80)) and moderate abortion propensities (0.76 (0.75 to 0.77)) than women with no abortion propensity (0.73 (0.72 to 0.74)) 24 months after marriage. Effective contraceptive use tends to increase contraceptive confidence and is associated with a shorter interval between marriage and first birth. Increased use of abortion also tends to increase contraceptive confidence and shorten birth duration, although this effect is non-linear-women with a very high use of abortion tend to have lengthy intervals between marriage and first birth. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

flexsurv: A Platform for Parametric Survival Modeling in R

PubMed Central

Jackson, Christopher H.

2018-01-01

flexsurv is an R package for fully-parametric modeling of survival data. Any parametric time-to-event distribution may be fitted if the user supplies a probability density or hazard function, and ideally also their cumulative versions. Standard survival distributions are built in, including the three and four-parameter generalized gamma and F distributions. Any parameter of any distribution can be modeled as a linear or log-linear function of covariates. The package also includes the spline model of Royston and Parmar (2002), in which both baseline survival and covariate effects can be arbitrarily flexible parametric functions of time. The main model-fitting function, flexsurvreg, uses the familiar syntax of survreg from the standard survival package (Therneau 2016). Censoring or left-truncation are specified in ‘Surv’ objects. The models are fitted by maximizing the full log-likelihood, and estimates and confidence intervals for any function of the model parameters can be printed or plotted. flexsurv also provides functions for fitting and predicting from fully-parametric multi-state models, and connects with the mstate package (de Wreede, Fiocco, and Putter 2011). This article explains the methods and design principles of the package, giving several worked examples of its use. PMID:29593450

Lean manufacturing comes to China: a case study of its impact on workplace health and safety.

PubMed

Brown, Garrett D; O'Rourke, Dara

2007-01-01

Lean manufacturing, which establishes small production "cells," or teams of workers, who complete an entire product from raw material processing through final assembly and shipment, increases health and safety hazards by mixing previously separated exposures to various chemicals (with possible additive and cumulative effects) and noise. The intensification of work leads to greater ergonomic and stress-related adverse health effects, as well as increased safety hazards. The standard industrial hygiene approach of anticipation, recognition, evaluation, and hazard control is applicable to lean operations. A focus on worker participation in identifying and solving problems is critical for reducing negative impacts. A key to worker safety in lean production operations is the development of informed, empowered, and active workers with the knowledge, skills, and opportunity to act in the workplace to eliminate or reduce hazards.

Cumulants vs correlation functions and the QCD phase diagram at low energies

DOE PAGES

Bzdak, A.; Koch, V.; Skokov, V.; ...

2017-09-25

We discuss the relation between particle number cumulants and genuine correlation functions. Here, it is argued that measuring multi-particle correlation functions could provide cleaner information on possible non-trivial dynamics in heavy-ion collisions.

Cumulants vs correlation functions and the QCD phase diagram at low energies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bzdak, A.; Koch, V.; Skokov, V.

We discuss the relation between particle number cumulants and genuine correlation functions. Here, it is argued that measuring multi-particle correlation functions could provide cleaner information on possible non-trivial dynamics in heavy-ion collisions.

Longitudinal Pathways from Cumulative Contextual Risk at Birth to School Functioning in Adolescence: Analysis of Mediation Effects and Gender Moderation.

PubMed

January, Stacy-Ann A; Mason, W Alex; Savolainen, Jukka; Solomon, Starr; Chmelka, Mary B; Miettunen, Jouko; Veijola, Juha; Moilanen, Irma; Taanila, Anja; Järvelin, Marjo-Riitta

2017-01-01

Children and adolescents exposed to multiple contextual risks are more likely to have academic difficulties and externalizing behavior problems than those who experience fewer risks. This study used data from the Northern Finland Birth Cohort 1986 (a population-based study; N = 6961; 51 % female) to investigate (a) the impact of cumulative contextual risk at birth on adolescents' academic performance and misbehavior in school, (b) learning difficulties and/or externalizing behavior problems in childhood as intervening mechanisms in the association of cumulative contextual risk with functioning in adolescence, and (c) potential gender differences in the predictive associations of cumulative contextual risk at birth with functioning in childhood or adolescence. The results of the structural equation modeling analysis suggested that exposure to cumulative contextual risk at birth had negative associations with functioning 16 years later, and academic difficulties and externalizing behavior problems in childhood mediated some of the predictive relations. Gender, however, did not moderate any of the associations. Therefore, the findings of this study have implications for the prevention of learning and conduct problems in youth and future research on the impact of cumulative risk exposure.

Longitudinal Pathways from Cumulative Contextual Risk at Birth to School Functioning in Adolescence: Analysis of Mediation Effects and Gender Moderation

PubMed Central

January, Stacy-Ann A.; Mason, W. Alex; Savolainen, Jukka; Solomon, Starr; Chmelka, Mary B.; Miettunen, Jouko; Veijola, Juha; Moilanen, Irma; Taanila, Anja; Järvelin, Marjo-Riitta

2016-01-01

Children and adolescents exposed to multiple contextual risks are more likely to have academic difficulties and externalizing behavior problems than those who experience fewer risks. This study used data from the Northern Finland Birth Cohort 1986 (a population-based study; N = 6,961; 51% female) to investigate (a) the impact of cumulative contextual risk at birth on adolescents’ academic performance and misbehavior in school, (b) learning difficulties and/or externalizing behavior problems in childhood as intervening mechanisms in the association of cumulative contextual risk with functioning in adolescence, and (c) potential gender differences in the predictive associations of cumulative contextual risk at birth with functioning in childhood or adolescence. The results of the structural equation modeling analysis suggested that exposure to cumulative contextual risk at birth had negative associations with functioning 16 years later, and academic difficulties and externalizing behavior problems in childhood mediated some of the predictive relations. Gender, however, did not moderate any of the associations. Therefore, the findings of this study have implications for the prevention of learning and conduct problems in youth and future research on the impact of cumulative risk exposure. PMID:27665276

Full counting statistics of conductance for disordered systems

NASA Astrophysics Data System (ADS)

Fu, Bin; Zhang, Lei; Wei, Yadong; Wang, Jian

2017-09-01

Quantum transport is a stochastic process in nature. As a result, the conductance is fully characterized by its average value and fluctuations, i.e., characterized by full counting statistics (FCS). Since disorders are inevitable in nanoelectronic devices, it is important to understand how FCS behaves in disordered systems. The traditional approach dealing with fluctuations or cumulants of conductance uses diagrammatic perturbation expansion of the Green's function within coherent potential approximation (CPA), which is extremely complicated especially for high order cumulants. In this paper, we develop a theoretical formalism based on nonequilibrium Green's function by directly taking the disorder average on the generating function of FCS of conductance within CPA. This is done by mapping the problem into higher dimensions so that the functional dependence of generating a function on the Green's function becomes linear and the diagrammatic perturbation expansion is not needed anymore. Our theory is very simple and allows us to calculate cumulants of conductance at any desired order efficiently. As an application of our theory, we calculate the cumulants of conductance up to fifth order for disordered systems in the presence of Anderson and binary disorders. Our numerical results of cumulants of conductance show remarkable agreement with that obtained by the brute force calculation.

The Pacific Northwest; linkage between earthquake and volcano hazards

USGS Publications Warehouse

Crosson, R.S.

1990-01-01

The Pacific Northwest (Oregon, Washington, and northern California) is experiencing rapid industrial and population growth. The same conditions that make the region attractive- close proximity to both mountains and oceans, volcanoes and spectacular inland waters- also present significant geologic hazards that are easily overlooked in the normal timetable of human activities. The catastrophic eruption of Mount St. Helens 10 years ago serves as a dramatic reminder of the forces of nature that can be unleashed through volcanism. other volcanoes such as  mount Rainier, a majestic symbol of Washington, or Mount hood in Oregon, lie closer to population centers and could present far greater hazards should they become active. Earthquakes may affect even larger regions, prodcuging more cumulative damage. 

Weighted comparison of two cumulative incidence functions with R-CIFsmry package.

PubMed

Li, Jianing; Le-Rademacher, Jennifer; Zhang, Mei-Jie

2014-10-01

In this paper we propose a class of flexible weight functions for use in comparison of two cumulative incidence functions. The proposed weights allow the users to focus their comparison on an early or a late time period post treatment or to treat all time points with equal emphasis. These weight functions can be used to compare two cumulative incidence functions via their risk difference, their relative risk, or their odds ratio. The proposed method has been implemented in the R-CIFsmry package which is readily available for download and is easy to use as illustrated in the example. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Embolic Strokes of Undetermined Source in the Athens Stroke Registry: An Outcome Analysis.

PubMed

Ntaios, George; Papavasileiou, Vasileios; Milionis, Haralampos; Makaritsis, Konstantinos; Vemmou, Anastasia; Koroboki, Eleni; Manios, Efstathios; Spengos, Konstantinos; Michel, Patrik; Vemmos, Konstantinos

2015-08-01

Information about outcomes in Embolic Stroke of Undetermined Source (ESUS) patients is unavailable. This study provides a detailed analysis of outcomes of a large ESUS population. Data set was derived from the Athens Stroke Registry. ESUS was defined according to the Cryptogenic Stroke/ESUS International Working Group criteria. End points were mortality, stroke recurrence, functional outcome, and a composite cardiovascular end point comprising recurrent stroke, myocardial infarction, aortic aneurysm rupture, systemic embolism, or sudden cardiac death. We performed Kaplan-Meier analyses to estimate cumulative probabilities of outcomes by stroke type and Cox-regression to investigate whether stroke type was outcome predictor. 2731 patients were followed-up for a mean of 30.5±24.1months. There were 73 (26.5%) deaths, 60 (21.8%) recurrences, and 78 (28.4%) composite cardiovascular end points in the 275 ESUS patients. The cumulative probability of survival in ESUS was 65.6% (95% confidence intervals [CI], 58.9%-72.2%), significantly higher compared with cardioembolic stroke (38.8%, 95% CI, 34.9%-42.7%). The cumulative probability of stroke recurrence in ESUS was 29.0% (95% CI, 22.3%-35.7%), similar to cardioembolic strokes (26.8%, 95% CI, 22.1%-31.5%), but significantly higher compared with all types of noncardioembolic stroke. One hundred seventy-two (62.5%) ESUS patients had favorable functional outcome compared with 280 (32.2%) in cardioembolic and 303 (60.9%) in large-artery atherosclerotic. ESUS patients had similar risk of composite cardiovascular end point as all other stroke types, with the exception of lacunar strokes, which had significantly lower risk (adjusted hazard ratio, 0.70 [95% CI, 0.52-0.94]). Long-term mortality risk in ESUS is lower compared with cardioembolic strokes, despite similar rates of recurrence and composite cardiovascular end point. Recurrent stroke risk is higher in ESUS than in noncardioembolic strokes. © 2015 American Heart Association, Inc.

Melanoma-specific mortality and competing mortality in patients with non-metastatic malignant melanoma: a population-based analysis.

PubMed

Shen, Weidong; Sakamoto, Naoko; Yang, Limin

2016-07-07

The objectives of this study were to evaluate and model the probability of melanoma-specific death and competing causes of death for patients with melanoma by competing risk analysis, and to build competing risk nomograms to provide individualized and accurate predictive tools. Melanoma data were obtained from the Surveillance Epidemiology and End Results program. All patients diagnosed with primary non-metastatic melanoma during the years 2004-2007 were potentially eligible for inclusion. The cumulative incidence function (CIF) was used to describe the probability of melanoma mortality and competing risk mortality. We used Gray's test to compare differences in CIF between groups. The proportional subdistribution hazard approach by Fine and Gray was used to model CIF. We built competing risk nomograms based on the models that we developed. The 5-year cumulative incidence of melanoma death was 7.1 %, and the cumulative incidence of other causes of death was 7.4 %. We identified that variables associated with an elevated probability of melanoma-specific mortality included older age, male sex, thick melanoma, ulcerated cancer, and positive lymph nodes. The nomograms were well calibrated. C-indexes were 0.85 and 0.83 for nomograms predicting the probability of melanoma mortality and competing risk mortality, which suggests good discriminative ability. This large study cohort enabled us to build a reliable competing risk model and nomogram for predicting melanoma prognosis. Model performance proved to be good. This individualized predictive tool can be used in clinical practice to help treatment-related decision making.

An Integrated Modeling Platform for Human and Ecological Exposure and Risk in Multimedia Environmental Systems (HE2RMES)

EPA Science Inventory

When considering potentially hazardous materials in the context of initial use, reuse, recycling, or ultimate disposal in the landscape, a crux of most decision will be understanding the cumulative contaminant exposure and risk of a given material to human health and well-being. ...

The ten-year incidence of tinnitus among older adults.

PubMed

Nondahl, David M; Cruickshanks, Karen J; Wiley, Terry L; Klein, Barbara E K; Klein, Ron; Chappell, Rick; Tweed, Ted S

2010-08-01

As part of a population-based study in Beaver Dam, Wisconsin, we estimated the 10-year cumulative incidence of tinnitus and its risk factors. Participants (n = 2922, aged 48-92 years) not reporting tinnitus at baseline (1993-1995) were followed for up to ten years. In addition to audiometric testing and anthropometric measures, data on tinnitus, health, and other history were obtained via questionnaire. Potential risk factors were assessed with discrete-time proportional hazards models. The 10-year cumulative incidence of tinnitus was 12.7%. The risk of developing tinnitus was significantly associated with: history of arthritis (hazard ratio (HR = 1.37), history of head injury (HR = 1.76), history of ever smoking (HR = 1.40), and among women, hearing loss (HR = 2.59). Alcohol consumption (HR = 0.63 for > or = 141 grams/week vs. <15 grams/week), age (among women, HR = 0.90 for each five-year increase in age), and among men, obesity (HR = 0.55), were associated with decreased risk. The risk of developing tinnitus was high for older adults, and associated with modifiable health and behavioral factors.

THE PHYSICAL CHARACTERIZATION OF THE POTENTIALLY HAZARDOUS ASTEROID 2004 BL86: A FRAGMENT OF A DIFFERENTIATED ASTEROID

DOE Office of Scientific and Technical Information (OSTI.GOV)

Reddy, Vishnu; Sanchez, Juan A.; Takir, Driss

The physical characterization of potentially hazardous asteroids (PHAs) is important for impact hazard assessment and evaluating mitigation options. Close flybys of PHAs provide an opportunity to study their surface photometric and spectral properties that enable the identification of their source regions in the main asteroid belt. We observed PHA (357439) 2004 BL86 during a close flyby of the Earth at a distance of 1.2 million km (0.0080 AU) on 2015 January 26, with an array of ground-based telescopes to constrain its photometric and spectral properties. Lightcurve observations showed that the asteroid was a binary and subsequent radar observations confirmed themore » binary nature and gave a primary diameter of 300 m and a secondary diameter of 50–100 m. Our photometric observations were used to derive the phase curve of 2004 BL86 in the V-band. Two different photometric functions were fitted to this phase curve, the IAU H–G model and the Shevchenko model. From the fit of the H–G function we obtained an absolute magnitude of H = 19.51 ± 0.02 and a slope parameter of G = 0.34 ± 0.02. The Shevchenko function yielded an absolute magnitude of H = 19.03 ± 0.07 and a phase coefficient b = 0.0225 ± 0.0006. The phase coefficient was used to calculate the geometric albedo (Ag) using the relationship found by Belskaya and Schevchenko, obtaining a value of Ag = 40% ± 8% in the V-band. With the geometric albedo and the absolute magnitudes derived from the H–G and the Shevchenko functions we calculated the diameter (D) of 2004 BL86, obtaining D = 263 ± 26 and D = 328 ± 35 m, respectively. 2004 BL86 spectral band parameters and pyroxene chemistry are consistent with non-cumulate eucrite meteorites. A majority of these meteorites are derived from Vesta and are analogous with surface lava flows on a differentiated parent body. A non-diagnostic spectral curve match using the Modeling for Asteroids tool yielded a best-match with non-cumulate eucrite Bereba. Three other near-Earth asteroids (1993 VW, 1998 KK17, and 2000 XH44) that were observed by Burbine et al. also have spectral properties similar to 2004 BL86. The presence of eucrites with anomalous oxygen isotope ratios compared to the howardites, eucrites, and diogenites meteorites from Vesta suggests the possible presence of multiple differentiated bodies in the inner main belt or the contamination of Vesta’s surface with exogenic material. The spectral properties of both anomalous and Vestan eucrites are degenerate, making it difficult to identify the parent bodies of anomalous eucrites in the main belt and the NEO population using remote sensing. This makes it difficult to link 2004 BL86 directly to Vesta, although the Vesta family is the largest contributor of V-types to near-Earth space.« less

Fertile lifespan characteristics and all-cause and cause-specific mortality among postmenopausal women: the Rotterdam Study.

PubMed

Jaspers, Loes; Kavousi, Maryam; Erler, Nicole S; Hofman, Albert; Laven, Joop S E; Franco, Oscar H

2017-02-01

To characterize the relation between established and previously unexplored characteristics of the fertile life with all-cause and cause-specific mortality. Prospective cohort study. Not applicable. A total of 4,076 postmenopausal women. Women's fertile lifespan (age at menarche to menopause), number of children, maternal age at first and last child, maternal lifespan (interval between maternal age at first and last child), postmaternal fertile lifespan (interval between age at last child and menopause), lifetime cumulative number of menstrual cycles, and unopposed cumulative endogenous estrogen (E) exposure. Registry-based all-cause and cause-specific mortality. A total of 2,754 women died during 14.8 years of follow-up. Compared with women with 2-3 children, a 12% higher hazard of dying was found for women having 1 child (hazard ratio [HR], 1.12; 95% confidence interval [CI] 1.01-1.24), which became nonsignificant in models adjusted for confounders (HR, 1.08; 95% CI 0.96-1.21). Late age at first and last birth were associated with a 1% lower hazard of dying (HR, 0.99; 95% CI 0.98-1.00). Longer maternal and postmaternal fertile lifespan (HR 1.01; 95% CI 1.00-1.02), longer fertile lifespan (HR 1.02; 95% CI 1.00-1.05), and unopposed cumulative E exposure (HR, 1.02; 95% CI 1.00-1.04) were significantly harmful for all-cause mortality. Findings differed with regard to direction, size, and statistical significance when stratifying for cardiovascular disease, cancer, and other mortality. Overall, we found that late first and last reproduction were protective for all-cause mortality, whereas a longer maternal lifespan, postmaternal fertile lifespan, and E exposure were harmful for all-cause mortality. More research is needed in contemporary cohorts with larger sample sizes and more extreme ages of birth. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Associations of cumulative Pb exposure and longitudinal changes in Mini-Mental Status Exam scores, global cognition and domains of cognition: The VA Normative Aging Study

PubMed Central

Farooqui, Zishaan; Bakulski, Kelly M.; Power, Melinda C.; Weisskopf, Marc G.; Sparrow, David; Spiro, Avron; Vokonas, Pantel S.; Nie, Huiling; Hu, Howard; Park, Sung Kyun

2016-01-01

Background Lead (Pb) exposure has been associated with poorer cognitive function cross-sectionally in aging adults, however the association between cumulative Pb exposure and longitudinal changes in cognition is little characterized. Methods In a 1993–2007 subcohort of the VA Normative Aging Study (Mini-mental status exam (MMSE) n=741; global cognition summary score n=715), we used linear mixed effects models to test associations between cumulative Pb exposure (patella or tibia bone Pb) and repeated measures of cognition (MMSE, individual cognitive tests, and global cognition summary). Cox proportional hazard modeling assessed the risk of an MMSE score falling below 25. Results Among men 51–98 at baseline, higher patella Pb concentration (IQR: 21 µg/g) was associated with −0.13 lower baseline MMSE (95% CI: −0.25, −0.004) and faster longitudinal MMSE decline (−0.016 units/year, 95% CI: −0.032, −0.0004) over 15 years. Each IQR increase in patella Pb was associated with increased risk of a MMSE score below 25 (HR=1.21, 95% CI: 0.99, 1.49; p=0.07). There were no significant associations between Pb and global cognition (both baseline and longitudinal change). Patella Pb was associated with faster longitudinal decline in Word List Total Recall in the language domain (0.014 units/year, 95% CI: −0.026, −0.001) and Word List Delayed Recall in the memory domain (0.014 units/year, 95% CI: −0.027, −0.002). We found weaker associations with tibia Pb. Conclusions Cumulative Pb exposure is associated with faster declines in MMSE and Word List Total and Delayed Recall tests. These findings support the hypothesis that Pb exposure accelerates cognitive aging. PMID:27770710

On Interpreting and Extracting Information from the Cumulative Distribution Function Curve: A New Perspective with Applications

ERIC Educational Resources Information Center

Balasooriya, Uditha; Li, Jackie; Low, Chan Kee

2012-01-01

For any density function (or probability function), there always corresponds a "cumulative distribution function" (cdf). It is a well-known mathematical fact that the cdf is more general than the density function, in the sense that for a given distribution the former may exist without the existence of the latter. Nevertheless, while the…

Incidence of brain metastases as a first site of recurrence among women with triple receptor-negative breast cancer.

PubMed

Dawood, Shaheenah; Lei, Xiudong; Litton, Jennifer K; Buchholz, Thomas A; Hortobagyi, Gabriel N; Gonzalez-Angulo, Ana M

2012-10-01

This retrospective study sought to define the incidence of brain metastases as a first site of recurrence among women with triple receptor-negative breast cancer (TNBC). A total of 2448 patients with stage I through III TNBC who were diagnosed between 1990 and 2010 were identified. We computed the cumulative incidence of developing brain metastases as a first site of recurrence at 2 and 5 years. Cox proportional hazards models were fitted to determine factors that could predict for the development of brain metastases as a first site of recurrence. The Kaplan-Meier product limit method was used to compute survival following a diagnosis of brain metastases. At a median follow-up of 39 months, 115 (4.7%) patients had developed brain metastases as a first site of recurrence. The cumulative incidence at 2 and 5 years was 3.7% (95% confidence interval [CI] = 2.9%-4.5%) and 5.4% (95% CI = 4.4%-6.5%), respectively. Among patients with stage I, II, and III disease, the 2-year cumulative incidence of brain metastases was 0.8%, 3.1%, and 8%, respectively (P < .0001). The 5-year cumulative incidence was 2.8%, 4.6%, and 9.6% among patients with stage I, II, and III disease, respectively (P < .0001). In the multivariable model, patients with stage III disease had a significant increase in the risk of developing brain metastases as a first site of recurrence (hazards ratio = 3.51; 95% CI = 1.85-6.67; P = .0001) compared to patients with stage I disease. Those with stage II disease had a nonsignificant increased risk of developing brain metastases as a first site of recurrence (hazards ratio = 1.61; 95% CI = 0.92-2.81; P = .10) compared with patients with stage I disease. Median survival following a diagnosis of brain metastases was 7.2 months (range, 5.7-9.4 months). Patients with nonmetastatic TNBC have a high early incidence of developing brain metastases as a first site of recurrence, which is associated with subsequent poor survival. Patients with stage III TNBC in particular would be an ideal cohort in which to research preventive strategies. Copyright © 2012 American Cancer Society.

The ankle brachial index and change in lower extremity functioning over time: the Women's Health and Aging Study.

PubMed

McDermott, Mary McGrae; Ferrucci, Luigi; Simonsick, Eleanor M; Balfour, Jennifer; Fried, Linda; Ling, Shari; Gibson, Daniel; Guralnik, Jack M

2002-02-01

To define the association between baseline ankle brachial index (ABI) level and subsequent onset of severe disability. Prospective cohort study. Baltimore community. Eight hundred forty-seven disabled women aged 65 and older participating in the Women's Health and Aging Study. At baseline, participants underwent measurement of ABI and lower extremity functioning. Measures of lower extremity functioning included patient's report of their ability to walk one-quarter of a mile, number of city blocks walked last week, number of stair flights climbed last week, and performance-based measures including walking speed over 4 meters, five repeated chair stands, and a summary performance score. Functioning was remeasured every 6 months for 3 years. Definitions of severe disability were developed a priori, and participants who met these definitions at baseline were excluded from subsequent analyses. Participants with an ABI of less than 0.60 at baseline had significantly higher cumulative probabilities of developing severe disability than participants with a baseline ABI of 0.90 to 1.50 for walking-specific outcomes (ability to walk a quarter of a mile, number of city blocks walked last week, and walking velocity) but not for the remaining functional outcomes. In age-adjusted Cox proportional hazards analyses, hazard ratios for participants with a baseline ABI of less than 0.60 were 1.63 for becoming unable to walk a quarter of a mile (P = .044), 2.00 for developing severe disability in the number of blocks walked last week (P = .004), and 1.61 for developing severe disability in walking speed (P = .041), compared with participants with a baseline ABI of 0.90 to 1.50. Adjusting for age, race, baseline performance, and comorbidities, an ABI of less than 0.60 remained associated with becoming severely disabled in the number of blocks walked last week (hazard ratio = 1.97, P = .009) and nearly significantly associated with becoming unable to walk a quarter of a mile (hazard ratio = 1.54, P = .09). In fully adjusted random effects models, a baseline ABI of less than 0.60 was associated with significantly greater decline in walking speed per year (P = .019) and nearly significantly greater decline in number of blocks walked last week per year (P = .053) compared with a baseline ABI of 0.90 to 1.50. In community-dwelling disabled older women, a low ABI is associated with a greater incidence of severe disability in walking-specific but not other lower extremity functional outcomes, compared with persons with a normal ABI over 3 years.

Time-cumulated blood pressure exposure and incident impairment of glucose tolerance and diabetes mellitus.

PubMed

Wu, Yun Tao; Song, Lu; Liu, Xiao Xue; Gao, Jing Sheng; Zheng, Xiao Ming; Ruan, Chun Yu; Zhao, Hai Yan; Chen, Shuo Hua; Gao, Wen Yuan; Jonas, Jost B; Wu, Shou Ling

2017-05-02

With the marked increase in the prevalence of diabetes mellitus, it was the purpose of our study to assess a potential association of time-cumulated exposure to systolic (CumSBP) and of diastolic blood pressure (CumDBP) with onset of impaired glucose tolerance and diabetes mellitus. The prospective investigation included participants of the longitudinal Kailuan Study with three baseline examinations in 2006-2007, 2008-2009 and 2010-2011, re-examination in 2012-2013, and no diabetes mellitus at baseline. Cumulative blood pressure (BP) was calculated as cumBP = [(BP 1  + BP 2 )/2 × time 1-2 ] + [(BP 2  + BP 3 )/2 × time 2-3 ]. Based on cumSBP, the study population was stratified into four groups (cumSBP < 480mmHgxyear;n = 15,339; 480mmHgxyear ≤ cumSBP < 520mmHgxyear;n = 7214; 520mmHgxyears ≤ cumSBP < 560mmHgxyears;n = 5675; and cumSBP ≥ 560mmHgxyears;n = 10,576). After adjusting for demographic, anthropomorphic, biochemical, socioeconomic and lifestyle parameters and as compared with the first group, the second, third and fourth group showed a significantly higher incidence of diabetes (P-trend < 0.001;hazard ratio (HR);95% confidence interval (CI):1.28(1.08,1.51),1.54(1.29,1.84), and 2.33(1.98,2.73), respectively), higher incidence of impairment of glucose tolerance (P-trend < 0.001;HR;95% CI1.17(1.02,1.33), 1.43(1.25,1.64), and 2.09(1.85,2.37), respectively), and higher incidence of diabetes developing out of an impairment of glucose tolerance (P-trend < 0.001;HR;95% CI:1.22(0.97,1.54),1.47(1.16,1.86), and 2.01(1.62,2.50), respectively). An increase in cumSBP by 10 mmHg/year or an increase in cumDBP by 5 mmHg/year was associated with a hazard ratio of incident diabetes of 1.04 (95% CI:1.03,1.04) and 1.02(1.02,1.03), respectively, with a hazard ratio of incident impairment of glucose tolerance of 1.04(95% CI:1.03,1.04) and 1.03(95% CI:1.02,1.03), respectively, and with a hazard ratio of incident diabetes developing from impairment of glucose tolerance of 1.04(95% CI:1.03,1.04) and 1.03(95% CI:1.02,1.03), respectively. Time-cumulated exposure to elevated blood pressure was significantly associated with an elevated incidence of impaired glucose tolerance and diabetes.

Study of cumulative fatigue damage detection for used parts with nonlinear output frequency response functions based on NARMAX modelling

NASA Astrophysics Data System (ADS)

Huang, Honglan; Mao, Hanying; Mao, Hanling; Zheng, Weixue; Huang, Zhenfeng; Li, Xinxin; Wang, Xianghong

2017-12-01

Cumulative fatigue damage detection for used parts plays a key role in the process of remanufacturing engineering and is related to the service safety of the remanufactured parts. In light of the nonlinear properties of used parts caused by cumulative fatigue damage, the based nonlinear output frequency response functions detection approach offers a breakthrough to solve this key problem. First, a modified PSO-adaptive lasso algorithm is introduced to improve the accuracy of the NARMAX model under impulse hammer excitation, and then, an effective new algorithm is derived to estimate the nonlinear output frequency response functions under rectangular pulse excitation, and a based nonlinear output frequency response functions index is introduced to detect the cumulative fatigue damage in used parts. Then, a novel damage detection approach that integrates the NARMAX model and the rectangular pulse is proposed for nonlinear output frequency response functions identification and cumulative fatigue damage detection of used parts. Finally, experimental studies of fatigued plate specimens and used connecting rod parts are conducted to verify the validity of the novel approach. The obtained results reveal that the new approach can detect cumulative fatigue damages of used parts effectively and efficiently and that the various values of the based nonlinear output frequency response functions index can be used to detect the different fatigue damages or working time. Since the proposed new approach can extract nonlinear properties of systems by only a single excitation of the inspected system, it shows great promise for use in remanufacturing engineering applications.

A cumulant functional for static and dynamic correlation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hollett, Joshua W., E-mail: j.hollett@uwinnipeg.ca; Department of Chemistry, University of Manitoba, Winnipeg, Manitoba R3T 2N2; Hosseini, Hessam

A functional for the cumulant energy is introduced. The functional is composed of a pair-correction and static and dynamic correlation energy components. The pair-correction and static correlation energies are functionals of the natural orbitals and the occupancy transferred between near-degenerate orbital pairs, rather than the orbital occupancies themselves. The dynamic correlation energy is a functional of the statically correlated on-top two-electron density. The on-top density functional used in this study is the well-known Colle-Salvetti functional. Using the cc-pVTZ basis set, the functional effectively models the bond dissociation of H{sub 2}, LiH, and N{sub 2} with equilibrium bond lengths and dissociationmore » energies comparable to those provided by multireference second-order perturbation theory. The performance of the cumulant functional is less impressive for HF and F{sub 2}, mainly due to an underestimation of the dynamic correlation energy by the Colle-Salvetti functional.« less

Comparison of the hazards posed to amphibians by the glyphosate spray control program versus the chemical and physical activities of coca production in Colombia.

PubMed

Brain, Richard A; Solomon, Keith R

2009-01-01

This study evaluates the cumulative multifactorial physical and chemical impacts resulting from coca production on amphibian populations in comparison with the potential impacts produced by the herbicide glyphosate (Glyphos), which, mixed with the surfactant Cosmo-Flux, is used in the spray control program for illicit crops in Colombia. Using similar worst-case assumptions for exposure, several other pesticides used for coca production, including mancozeb, lambda cyhalothrin, endosulfan, diazinon, malathion, and chlorpyrifos, were up to 10- to 100-fold more toxic to frogs than the Glyphos-Cosmo-Flux mixture. Comparing hazard quotients based on application rates, several of these compounds demonstrated hazards 3-383 times that of formulated glyphosate. Secondary effects, particularly of insecticides, are also a concern, as these agents selectively target the primary food source of amphibians, which may indirectly impact growth and development. Although the potential chemical impacts by other pesticides are considerable, physical activities associated with coca production, particularly deforestation of primary forests for new coca plots, portend the greatest hazard to amphibian populations. The entire production cycle of cocaine has been linked to ecosystem degradation. The clearing of pristine forests for coca propagation in Colombia is well documented, and some of these regions coincide with those that contain exceptional amphibian biodiversity. This is particularly problematic as coca production encroaches more deeply into more remote areas of tropical rain forest. Transportation of disease, including the chitrid fungus, to these remote regions via human intrusion may also adversely affect amphibian populations. Therefore, the cumulative impacts of coca production, through habitat destruction, application of agrochemicals, and potential transmission of disease, are judged to pose greater risks to amphibian populations in coca-growing regions than the glyphosate spray control program.

Propensity-Matched Mortality Comparison of Incident Hemodialysis and Peritoneal Dialysis Patients

PubMed Central

Weinhandl, Eric D.; Gilbertson, David T.; Arneson, Thomas J.; Snyder, Jon J.; Collins, Allan J.

2010-01-01

Contemporary comparisons of mortality in matched hemodialysis and peritoneal dialysis patients are lacking. We aimed to compare survival of incident hemodialysis and peritoneal dialysis patients by intention-to-treat analysis in a matched-pair cohort and in subsets defined by age, cardiovascular disease, and diabetes. We matched 6337 patient pairs from a retrospective cohort of 98,875 adults who initiated dialysis in 2003 in the United States. In the primary intention-to-treat analysis of survival from day 0, cumulative survival was higher for peritoneal dialysis patients than for hemodialysis patients (hazard ratio 0.92; 95% CI 0.86 to 1.00, P = 0.04). Cumulative survival probabilities for peritoneal dialysis versus hemodialysis were 85.8% versus 80.7% (P < 0.01), 71.1% versus 68.0% (P < 0.01), 58.1% versus 56.7% (P = 0.25), and 48.4% versus 47.3% (P = 0.50) at 12, 24, 36, and 48 months, respectively. Peritoneal dialysis was associated with improved survival compared with hemodialysis among subgroups with age <65 years, no cardiovascular disease, and no diabetes. In a sensitivity analysis of survival from 90 days after initiation, we did not detect a difference in survival between modalities overall (hazard ratio 1.05; 95% CI 0.96 to 1.16), but hemodialysis was associated with improved survival among subgroups with cardiovascular disease and diabetes. In conclusion, despite hazard ratio heterogeneity across patient subgroups and nonconstant hazard ratios during the follow-up period, the overall intention-to-treat mortality risk after dialysis initiation was 8% lower for peritoneal dialysis than for matched hemodialysis patients. These data suggest that increased use of peritoneal dialysis may benefit incident ESRD patients. PMID:20133483

Competing risks regression for clustered data

PubMed Central

Zhou, Bingqing; Fine, Jason; Latouche, Aurelien; Labopin, Myriam

2012-01-01

A population average regression model is proposed to assess the marginal effects of covariates on the cumulative incidence function when there is dependence across individuals within a cluster in the competing risks setting. This method extends the Fine–Gray proportional hazards model for the subdistribution to situations, where individuals within a cluster may be correlated due to unobserved shared factors. Estimators of the regression parameters in the marginal model are developed under an independence working assumption where the correlation across individuals within a cluster is completely unspecified. The estimators are consistent and asymptotically normal, and variance estimation may be achieved without specifying the form of the dependence across individuals. A simulation study evidences that the inferential procedures perform well with realistic sample sizes. The practical utility of the methods is illustrated with data from the European Bone Marrow Transplant Registry. PMID:22045910

Sieve estimation in a Markov illness-death process under dual censoring.

PubMed

Boruvka, Audrey; Cook, Richard J

2016-04-01

Semiparametric methods are well established for the analysis of a progressive Markov illness-death process observed up to a noninformative right censoring time. However, often the intermediate and terminal events are censored in different ways, leading to a dual censoring scheme. In such settings, unbiased estimation of the cumulative transition intensity functions cannot be achieved without some degree of smoothing. To overcome this problem, we develop a sieve maximum likelihood approach for inference on the hazard ratio. A simulation study shows that the sieve estimator offers improved finite-sample performance over common imputation-based alternatives and is robust to some forms of dependent censoring. The proposed method is illustrated using data from cancer trials. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The natural history of adult pulmonary Langerhans cell histiocytosis: a prospective multicentre study.

PubMed

Tazi, Abdellatif; de Margerie, Constance; Naccache, Jean Marc; Fry, Stéphanie; Dominique, Stéphane; Jouneau, Stéphane; Lorillon, Gwenaël; Bugnet, Emmanuelle; Chiron, Raphael; Wallaert, Benoit; Valeyre, Dominique; Chevret, Sylvie

2015-03-14

The natural history of pulmonary Langerhans cell histiocytosis (PLCH) has been unclear due to the absence of prospective studies. The rate of patients who experience an early progression of their disease is unknown. Additionally, conflicting effects of smoking cessation on the outcome of PLCH have been reported. In this prospective, multicentre study, 58 consecutive patients with newly diagnosed PLCH were comprehensively evaluated over a two-year period. Our objectives were to estimate the incidence of early progression of the disease and to evaluate the impact of smoking status on lung function outcomes. Lung function deterioration was defined as a decrease of at least 15% in FEV1 and/or FVC and/or DLCO, compared with baseline values. At each visit, smoking status was recorded based on the patients' self-reports and urinary cotinine measurements that were blinded for the patients. The cumulative incidence of lung function outcomes over time was estimated using the non-parametric Kaplan-Meier method. Multivariate Cox models with time-dependent covariates were used to calculate the hazards ratios of the lung function deterioration associated with smoking status with adjustment for potential confounders. The cumulative incidence of lung function deterioration at 24 months was 38% (22% for FEV1 and DLCO, and 9% for FVC). In the multivariate analysis, smoking status and PaO2 at inclusion were the only factors associated with the risk of lung function deterioration. The patients' smoking statuses markedly changed over time. Only 20% of the patients quit using tobacco for the entire study period. Nevertheless, being a non-smoker was associated with a decreased risk of subsequent lung function deterioration, even after adjustment for baseline predictive factors. By serial lung computed tomography, the extent of cystic lesions increased in only 11% of patients. Serial lung function evaluation on a three- to six-month basis is essential for the follow-up of patients with recently diagnosed PLCH to identify those who experience an early progression of their disease. These patients are highly addicted to tobacco, and robust efforts should be undertaken to include them in smoking cessation programs. ClinicalTrials.gov: No: NCT01225601 .

Cumulants and correlation functions versus the QCD phase diagram

DOE PAGES

Bzdak, Adam; Koch, Volker; Strodthoff, Nils

2017-05-12

Here, we discuss the relation of particle number cumulants and correlation functions. It is argued that measuring couplings of the genuine multiparticle correlation functions could provide cleaner information on possible nontrivial dynamics in heavy-ion collisions. We also extract integrated multiproton correlation functions from the presently available experimental data on proton cumulants. We find that the STAR data contain significant four-proton correlations, at least at the lower energies, with indication of changing dynamics in central collisions. We also find that these correlations are rather long ranged in rapidity. Finally, using the Ising model, we demonstrate how the signs of the multiprotonmore » correlation functions may be used to exclude certain regions of the phase diagram close to the critical point.« less

Cumulants and correlation functions versus the QCD phase diagram

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bzdak, Adam; Koch, Volker; Strodthoff, Nils

Here, we discuss the relation of particle number cumulants and correlation functions. It is argued that measuring couplings of the genuine multiparticle correlation functions could provide cleaner information on possible nontrivial dynamics in heavy-ion collisions. We also extract integrated multiproton correlation functions from the presently available experimental data on proton cumulants. We find that the STAR data contain significant four-proton correlations, at least at the lower energies, with indication of changing dynamics in central collisions. We also find that these correlations are rather long ranged in rapidity. Finally, using the Ising model, we demonstrate how the signs of the multiprotonmore » correlation functions may be used to exclude certain regions of the phase diagram close to the critical point.« less

Probability and Statistics in Sensor Performance Modeling

DTIC Science & Technology

2010-12-01

language software program is called Environmental Awareness for Sensor and Emitter Employment. Some important numerical issues in the implementation...3 Statistical analysis for measuring sensor performance...complementary cumulative distribution function cdf cumulative distribution function DST decision-support tool EASEE Environmental Awareness of

Methodological Considerations in Screening for Cumulative Environmental Health Impacts: Lessons Learned from a Pilot Study in California

PubMed Central

August, Laura Meehan; Faust, John B.; Cushing, Lara; Zeise, Lauren; Alexeeff, George V.

2012-01-01

Polluting facilities and hazardous sites are often concentrated in low-income communities of color already facing additional stressors to their health. The influence of socioeconomic status is not considered in traditional models of risk assessment. We describe a pilot study of a screening method that considers both pollution burden and population characteristics in assessing the potential for cumulative impacts. The goal is to identify communities that warrant further attention and to thereby provide actionable guidance to decision- and policy-makers in achieving environmental justice. The method uses indicators related to five components to develop a relative cumulative impact score for use in comparing communities: exposures, public health effects, environmental effects, sensitive populations and socioeconomic factors. Here, we describe several methodological considerations in combining disparate data sources and report on the results of sensitivity analyses meant to guide future improvements in cumulative impact assessments. We discuss criteria for the selection of appropriate indicators, correlations between them, and consider data quality and the influence of choices regarding model structure. We conclude that the results of this model are largely robust to changes in model structure. PMID:23202671

TESTING FOR DIFFERENCES BETWEEN CUMULATIVE DISTRIBUTION FUNCTIONS FROM COMPLEX ENVIRONMENTAL SAMPLING SURVEYS

EPA Science Inventory

The U.S. Environmental Protection Agency's Environmental Monitoring and Assessment Program (EMAP) employs the cumulative distribution function (cdf) to measure the status of quantitative variables for resources of interest. The ability to compare cdf's for a resource from, say,...

Cumulative Poisson Distribution Program

NASA Technical Reports Server (NTRS)

Bowerman, Paul N.; Scheuer, Ernest M.; Nolty, Robert

1990-01-01

Overflow and underflow in sums prevented. Cumulative Poisson Distribution Program, CUMPOIS, one of two computer programs that make calculations involving cumulative Poisson distributions. Both programs, CUMPOIS (NPO-17714) and NEWTPOIS (NPO-17715), used independently of one another. CUMPOIS determines cumulative Poisson distribution, used to evaluate cumulative distribution function (cdf) for gamma distributions with integer shape parameters and cdf for X (sup2) distributions with even degrees of freedom. Used by statisticians and others concerned with probabilities of independent events occurring over specific units of time, area, or volume. Written in C.

Effect modification of the association of cumulative exposure and cancer risk by intensity of exposure and time since exposure cessation: a flexible method applied to cigarette smoking and lung cancer in the SYNERGY Study.

PubMed

Vlaanderen, Jelle; Portengen, Lützen; Schüz, Joachim; Olsson, Ann; Pesch, Beate; Kendzia, Benjamin; Stücker, Isabelle; Guida, Florence; Brüske, Irene; Wichmann, Heinz-Erich; Consonni, Dario; Landi, Maria Teresa; Caporaso, Neil; Siemiatycki, Jack; Merletti, Franco; Mirabelli, Dario; Richiardi, Lorenzo; Gustavsson, Per; Plato, Nils; Jöckel, Karl-Heinz; Ahrens, Wolfgang; Pohlabeln, Hermann; Tardón, Adonina; Zaridze, David; Field, John K; 't Mannetje, Andrea; Pearce, Neil; McLaughlin, John; Demers, Paul; Szeszenia-Dabrowska, Neonila; Lissowska, Jolanta; Rudnai, Peter; Fabianova, Eleonora; Stanescu Dumitru, Rodica; Bencko, Vladimir; Foretova, Lenka; Janout, Vladimir; Boffetta, Paolo; Forastiere, Francesco; Bueno-de-Mesquita, Bas; Peters, Susan; Brüning, Thomas; Kromhout, Hans; Straif, Kurt; Vermeulen, Roel

2014-02-01

The indiscriminate use of the cumulative exposure metric (the product of intensity and duration of exposure) might bias reported associations between exposure to hazardous agents and cancer risk. To assess the independent effects of duration and intensity of exposure on cancer risk, we explored effect modification of the association of cumulative exposure and cancer risk by intensity of exposure. We applied a flexible excess odds ratio model that is linear in cumulative exposure but potentially nonlinear in intensity of exposure to 15 case-control studies of cigarette smoking and lung cancer (1985-2009). Our model accommodated modification of the excess odds ratio per pack-year of cigarette smoking by time since smoking cessation among former smokers. We observed negative effect modification of the association of pack-years of cigarette smoking and lung cancer by intensity of cigarette smoke for persons who smoked more than 20-30 cigarettes per day. Patterns of effect modification were similar across individual studies and across major lung cancer subtypes. We observed strong negative effect modification by time since smoking cessation. Application of our method in this example of cigarette smoking and lung cancer demonstrated that reducing a complex exposure history to a metric such as cumulative exposure is too restrictive.

Effect Modification of the Association of Cumulative Exposure and Cancer Risk by Intensity of Exposure and Time Since Exposure Cessation: A Flexible Method Applied to Cigarette Smoking and Lung Cancer in the SYNERGY Study

PubMed Central

Vlaanderen, Jelle; Portengen, Lützen; Schüz, Joachim; Olsson, Ann; Pesch, Beate; Kendzia, Benjamin; Stücker, Isabelle; Guida, Florence; Brüske, Irene; Wichmann, Heinz-Erich; Consonni, Dario; Landi, Maria Teresa; Caporaso, Neil; Siemiatycki, Jack; Merletti, Franco; Mirabelli, Dario; Richiardi, Lorenzo; Gustavsson, Per; Plato, Nils; Jöckel, Karl-Heinz; Ahrens, Wolfgang; Pohlabeln, Hermann; Tardón, Adonina; Zaridze, David; Field, John K.; 't Mannetje, Andrea; Pearce, Neil; McLaughlin, John; Demers, Paul; Szeszenia-Dabrowska, Neonila; Lissowska, Jolanta; Rudnai, Peter; Fabianova, Eleonora; Stanescu Dumitru, Rodica; Bencko, Vladimir; Foretova, Lenka; Janout, Vladimir; Boffetta, Paolo; Forastiere, Francesco; Bueno-de-Mesquita, Bas; Peters, Susan; Brüning, Thomas; Kromhout, Hans; Straif, Kurt; Vermeulen, Roel

2014-01-01

The indiscriminate use of the cumulative exposure metric (the product of intensity and duration of exposure) might bias reported associations between exposure to hazardous agents and cancer risk. To assess the independent effects of duration and intensity of exposure on cancer risk, we explored effect modification of the association of cumulative exposure and cancer risk by intensity of exposure. We applied a flexible excess odds ratio model that is linear in cumulative exposure but potentially nonlinear in intensity of exposure to 15 case-control studies of cigarette smoking and lung cancer (1985–2009). Our model accommodated modification of the excess odds ratio per pack-year of cigarette smoking by time since smoking cessation among former smokers. We observed negative effect modification of the association of pack-years of cigarette smoking and lung cancer by intensity of cigarette smoke for persons who smoked more than 20–30 cigarettes per day. Patterns of effect modification were similar across individual studies and across major lung cancer subtypes. We observed strong negative effect modification by time since smoking cessation. Application of our method in this example of cigarette smoking and lung cancer demonstrated that reducing a complex exposure history to a metric such as cumulative exposure is too restrictive. PMID:24355332

Functional polymorphisms of circadian negative feedback regulation genes are associated with clinical outcome in hepatocellular carcinoma patients receiving radical resection.

PubMed

Zhang, Zhaohui; Ma, Fei; Zhou, Feng; Chen, Yibing; Wang, Xiaoyan; Zhang, Hongxin; Zhu, Yong; Bi, Jianwei; Zhang, Yiguan

2014-12-01

Previous studies have demonstrated that circadian negative feedback loop genes play an important role in the development and progression of many cancers. However, the associations between single-nucleotide polymorphisms (SNPs) in these genes and the clinical outcomes of hepatocellular carcinoma (HCC) after surgical resection have not been studied so far. Thirteen functional SNPs in circadian genes were genotyped using the Sequenom iPLEX genotyping system in a cohort of 489 Chinese HCC patients who received radical resection. Multivariate Cox proportional hazards model and Kaplan-Meier curve were used for the prognosis analysis. Cumulative effect analysis and survival tree analysis were used for the multiple SNPs analysis. Four individual SNPs, including rs3027178 in PER1, rs228669 and rs2640908 in PER3 and rs3809236 in CRY1, were significantly associated with overall survival (OS) of HCC patients, and three SNPs, including rs3027178 in PER1, rs228729 in PER3 and rs3809236 in CRY1, were significantly associated with recurrence-free survival (RFS). Moreover, we observed a cumulative effect of significant SNPs on OS and RFS (P for trend < 0.001 for both). Survival tree analysis indicated that wild genotype of rs228729 in PER3 was the primary risk factor contributing to HCC patients' RFS. Our study suggests that the polymorphisms in circadian negative feedback loop genes may serve as independent prognostic biomarkers in predicting clinical outcomes for HCC patients who received radical resection. Further studies with different ethnicities are needed to validate our findings and generalize its clinical utility.

Evaluating cardiovascular mortality in type 2 diabetes patients: an analysis based on competing risks Markov chains and additive regression models.

PubMed

Rosato, Rosalba; Ciccone, G; Bo, S; Pagano, G F; Merletti, F; Gregori, D

2007-06-01

Type 2 diabetes represents a condition significantly associated with increased cardiovascular mortality. The aims of the study are: (i) to estimate the cumulative incidence function for cause-specific mortality using Cox and Aalen model; (ii) to describe how the prediction of cardiovascular or other causes mortality changes for patients with different pattern of covariates; (iii) to show if different statistical methods may give different results. Cox and Aalen additive regression model through the Markov chain approach, are used to estimate the cause-specific hazard for cardiovascular or other causes mortality in a cohort of 2865 type 2 diabetic patients without insulin treatment. The models are compared in the estimation of the risk of death for patients of different severity. For younger patients with a better covariates profile, the Cumulative Incidence Function estimated by Cox and Aalen model was almost the same; for patients with the worst covariates profile, models gave different results: at the end of follow-up cardiovascular mortality rate estimated by Cox and Aalen model was 0.26 [95% confidence interval (CI) = 0.21-0.31] and 0.14 (95% CI = 0.09-0.18). Standard Cox and Aalen model capture the risk process for patients equally well with average profiles of co-morbidities. The Aalen model, in addition, is shown to be better at identifying cause-specific risk of death for patients with more severe clinical profiles. This result is relevant in the development of analytic tools for research and resource management within diabetes care.

Progression rate from new-onset pre-hypertension to hypertension in Korean adults.

PubMed

Kim, Soo Jeong; Lee, Jakyoung; Nam, Chung Mo; Jee, Sun Ha; Park, Il Soo; Lee, Kyung Jong; Lee, Soon Young

2011-01-01

There are limited studies conducted in Asia to investigate the progression rate to hypertension (HTN). This study was done to estimate the progression rate of new-onset pre-HTN (PreHTN) to HTN during an 8-year follow-up period, and to compare the impact of PreHTN on progression to HTN. A total of 49,228 participants, aged 30 to 54 years with new-onset PreHTN at baseline (1994-1996) from a biennial national medical exam were enrolled and followed up every 2 years until 2004. The incidence rate recorded at each interval and the cumulative incidence rate of HTN were analyzed. Hazard ratio of high-normal and high blood pressure (BP) in men and women was calculated. The cumulative incidence rate for high-normal BP was 27.6% and 26.4% at 2-year follow-up, increased to respectively 64.1% and 55.8% in men and women at the 8-year follow-up. Compared to optimal BP, hazard ratios for men with high-normal BP across all age groups were 3- to 4-fold higher at 2-year, and 2- to 3-fold higher at 8-year follow-up. Hazard ratios for women were about 6-fold higher at 2-year and around 4-fold higher at 8-year follow-up. New PreHTN was a significant predisposing factor for future HTN, in young adults and the effect is more prominent in women.

A review on recent progress in observations, and health effects of bioaerosols.

PubMed

Humbal, Charmi; Gautam, Sneha; Trivedi, Ujwalkumar

2018-06-06

Bioaerosol is a particulate mixture of solid and semi-solid matter combined with biotic matter like pollens, microbes and their fragments. The present review stresses on a cumulative understanding of sources, components, quantification and distribution of bioaerosols with respect to size, and its significant impacts on human health. The present review will be instrumental in devising strategies to understand and manage bioaerosols and reducing their human exposure and associated health hazards. The present review aims explore the relationship between particle and associated biological agents responsible for behaviours like dispersal, total potential health hazards and toxicology level during exposure to bioaerosol. Copyright © 2018. Published by Elsevier Ltd.

Association Between Physical Therapy and Risk of Coronary Artery Disease and Dyslipidemia Among Osteoarthritis Patients: A Nationwide Database Study.

PubMed

Yeh, Huan-Jui; Chou, Yiing-Jenq; Yang, Nan-Ping; Cheng, Chi-Chia; Huang, Nicole

2016-01-01

To provide empirical evidence on the effect of early physical therapy (PT) within the first year of osteoarthritis (OA) diagnosis on reduction in OA-related comorbidities in patients with OA. Retrospective cohort study. The study was conducted using a nationally representative sample of 1 million National Health Insurance enrollees. Newly diagnosed patients with OA (N=13,545). One-to-one propensity score matching was used to match patients who received PT within the first year of OA diagnosis (PT group; n=3403) with an equal number of patients with OA who did not receive PT (non-PT group). Not applicable. The 4-year cumulative risk of comorbidities including coronary artery disease (CAD), diabetes mellitus, dyslipidemia, osteoporosis, gastrointestinal tract ulcer, and renal failure was estimated. A Cox proportional hazards regression analysis was performed to identify the dose-response relation between the PT dosage and the risk of OA-related comorbidities. A total of 3403 patients (25.1%) received PT within the first year of OA diagnosis. The PT group had a significantly lower 4-year cumulative risk of dyslipidemia (P=.05) and a potentially lower 4-year cumulative risk of CAD (P=.09). After adjusting for other potential confounders, the Cox proportional hazards regression analysis showed that patients with OA who received a high PT dosage had a low risk of CAD and dyslipidemia. Patients with OA who received PT had a lower risk of OA-related comorbidities such as dyslipidemia or CAD. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

An Analysis of Cumulative Risks Indicated by Biomonitoring ...

EPA Pesticide Factsheets

The Maximum Cumulative Ratio (MCR) quantifies the degree to which a single component of a chemical mixture drives the cumulative risk of a receptor.1 This study used the MCR, the Hazard Index (HI) and Hazard Quotient (HQ) to evaluate co-exposures to six phthalates using biomonitoring data in 2454 individuals aged 6 years and older from the 2011-12 cycle of the National Health and Nutrition Examination Survey. The values of MCR, HI and phthalate-specific HQs were determined by calculating steady-state doses consistent with the concentrations of phthalate metabolites in urine and using Tolerable Daily Intake values.2 There were 22 individuals (0.9%) predicted to have at least one HQ value > 1 and an additional 17 (0.7%) with no HQ value > 1 but with an HI value > 1. The percent of individuals with HI values > 1 differed by age (0.9% for individuals between 6 – 17 y and 1.9% for individuals > 17 y). There is a statistically significant negative relationship between HI and MCR values in both age groups (p-values 1 and all HQs 1 were 1.1 (1.0-1.3) and 2.8 (1.1-13.7), respectively. The combined assessment found that 17/39 (43%) of the individuals with HI values > 1 are missed by chemical-by-chemical assessments of the phthalates. These findings suggest that determining combined exposures for the six phthalates has a modest impact on the predictions of the chemicals’ risks. Additional individuals with HI values >1 are identified, but HI values in these individual

Scaling relationships between bed load volumes, transport distances, and stream power in steep mountain channels

NASA Astrophysics Data System (ADS)

Schneider, Johannes M.; Turowski, Jens M.; Rickenmann, Dieter; Hegglin, Ramon; Arrigo, Sabrina; Mao, Luca; Kirchner, James W.

2014-03-01

Bed load transport during storm events is both an agent of geomorphic change and a significant natural hazard in mountain regions. Thus, predicting bed load transport is a central challenge in fluvial geomorphology and natural hazard risk assessment. Bed load transport during storm events depends on the width and depth of bed scour, as well as the transport distances of individual sediment grains. We traced individual gravels in two steep mountain streams, the Erlenbach (Switzerland) and Rio Cordon (Italy), using magnetic and radio frequency identification tags, and measured their bed load transport rates using calibrated geophone bed load sensors in the Erlenbach and a bed load trap in the Rio Cordon. Tracer transport distances and bed load volumes exhibited approximate power law scaling with both the peak stream power and the cumulative stream energy of individual hydrologic events. Bed load volumes scaled much more steeply with peak stream power and cumulative stream energy than tracer transport distances did, and bed load volumes scaled as roughly the third power of transport distances. These observations imply that large bed load transport events become large primarily by scouring the bed deeper and wider, and only secondarily by transporting the mobilized sediment farther. Using the sediment continuity equation, we can estimate the mean effective thickness of the actively transported layer, averaged over the entire channel width and the duration of individual flow events. This active layer thickness also followed approximate power law scaling with peak stream power and cumulative stream energy and ranged up to 0.57 m in the Erlenbach, broadly consistent with independent measurements.

Lung Cancer and Elemental Carbon Exposure in Trucking Industry Workers

PubMed Central

Laden, Francine; Hart, Jaime E.; Davis, Mary E.; Eisen, Ellen A.; Smith, Thomas J.

2012-01-01

Background: Diesel exhaust has been considered to be a probable lung carcinogen based on studies of occupationally exposed workers. Efforts to define lung cancer risk in these studies have been limited in part by lack of quantitative exposure estimates. Objective: We conducted a retrospective cohort study to assess lung cancer mortality risk among U.S. trucking industry workers. Elemental carbon (EC) was used as a surrogate of exposure to engine exhaust from diesel vehicles, traffic, and loading dock operations. Methods: Work records were available for 31,135 male workers employed in the unionized U.S. trucking industry in 1985. A statistical model based on a national exposure assessment was used to estimate historical work-related exposures to EC. Lung cancer mortality was ascertained through the year 2000, and associations with cumulative and average EC were estimated using proportional hazards models. Results: Duration of employment was inversely associated with lung cancer risk consistent with a healthy worker survivor effect and a cohort composed of prevalent hires. After adjusting for employment duration, we noted a suggestion of a linear exposure–response relationship. For each 1,000-µg/m3 months of cumulative EC, based on a 5-year exposure lag, the hazard ratio (HR) was 1.07 [95% confidence interval (CI): 0.99, 1.15] with a similar association for a 10-year exposure lag [HR = 1.09 (95% CI: 0.99, 1.20)]. Average exposure was not associated with relative risk. Conclusions: Lung cancer mortality in trucking industry workers increased in association with cumulative exposure to EC after adjusting for negative confounding by employment duration. PMID:22739103

Structural variations in prefrontal cortex mediate the relationship between early childhood stress and spatial working memory

PubMed Central

Hanson, Jamie L.; Chung, Moo K.; Avants, Brian B.; Rudolph, Karen D.; Shirtcliff, Elizabeth A.; Gee, James C.; Davidson, Richard J.; Pollak, Seth D.

2012-01-01

A large corpus of research indicates exposure to stress impairs cognitive abilities, specifically executive functioning dependent on the prefrontal cortex (PFC). We collected structural MRI scans (n=61), well-validated assessments of executive functioning, and detailed interviews assessing stress exposure in humans, to examine whether cumulative life stress affected brain morphometry and one type of executive functioning, spatial working memory, during adolescence—a critical time of brain development and reorganization. Analysis of variations in brain structure revealed that cumulative life stress and spatial working memory were related to smaller volumes in the PFC, specifically prefrontal gray and white matter between the anterior cingulate and the frontal poles. Mediation analyses revealed that individual differences in prefrontal volumes accounted for the association between cumulative life stress and spatial working memory. These results suggest that structural changes in the PFC may serve as a mediating mechanism through which greater cumulative life stress engenders decrements in cognitive functioning. PMID:22674267

Standardised survey method for identifying catchment risks to water quality.

PubMed

Baker, D L; Ferguson, C M; Chier, P; Warnecke, M; Watkinson, A

2016-06-01

This paper describes the development and application of a systematic methodology to identify and quantify risks in drinking water and recreational catchments. The methodology assesses microbial and chemical contaminants from both diffuse and point sources within a catchment using Escherichia coli, protozoan pathogens and chemicals (including fuel and pesticides) as index contaminants. Hazard source information is gathered by a defined sanitary survey process involving use of a software tool which groups hazards into six types: sewage infrastructure, on-site sewage systems, industrial, stormwater, agriculture and recreational sites. The survey estimates the likelihood of the site affecting catchment water quality, and the potential consequences, enabling the calculation of risk for individual sites. These risks are integrated to calculate a cumulative risk for each sub-catchment and the whole catchment. The cumulative risks process accounts for the proportion of potential input sources surveyed and for transfer of contaminants from upstream to downstream sub-catchments. The output risk matrices show the relative risk sources for each of the index contaminants, highlighting those with the greatest impact on water quality at a sub-catchment and catchment level. Verification of the sanitary survey assessments and prioritisation is achieved by comparison with water quality data and microbial source tracking.

Leaching behaviour of hazardous demolition waste.

PubMed

Roussat, Nicolas; Méhu, Jacques; Abdelghafour, Mohamed; Brula, Pascal

2008-11-01

Demolition wastes are generally disposed of in unlined landfills for inert waste. However, demolition wastes are not just inert wastes. Indeed, a small fraction of demolition waste contains components that are hazardous to human health and the environment, e.g., lead-based paint, mercury-contained in fluorescent lamps, treated wood, and asbestos. The objective of this study is to evaluate the release potential of pollutants contained in these hazardous components when they are mixed with inert wastes in unlined landfills. After identification of the different building products which can contain hazardous elements and which can be potentially pollutant in landfill scenario, we performed leaching tests using three different lysimeters: one lysimeter containing only inert wastes and two lysimeters containing inert wastes mixed with hazardous demolition wastes. The leachates from these lysimeters were analysed (heavy metals, chlorides, sulphates fluoride, DOC (Dissolved Organic Carbon), phenol index, and PAH). Finally, we compared concentrations and cumulative releases of elements in leachates with the limits values of European regulation for the acceptance of inert wastes at landfill. Results indicate that limit values are exceeded for some elements. We also performed a percolation column test with only demolition hazardous wastes to evaluate the specific contribution of these wastes in the observed releases.

Mountain torrents: Quantifying vulnerability and assessing uncertainties

PubMed Central

Totschnig, Reinhold; Fuchs, Sven

2013-01-01

Vulnerability assessment for elements at risk is an important component in the framework of risk assessment. The vulnerability of buildings affected by torrent processes can be quantified by vulnerability functions that express a mathematical relationship between the degree of loss of individual elements at risk and the intensity of the impacting process. Based on data from the Austrian Alps, we extended a vulnerability curve for residential buildings affected by fluvial sediment transport processes to other torrent processes and other building types. With respect to this goal to merge different data based on different processes and building types, several statistical tests were conducted. The calculation of vulnerability functions was based on a nonlinear regression approach applying cumulative distribution functions. The results suggest that there is no need to distinguish between different sediment-laden torrent processes when assessing vulnerability of residential buildings towards torrent processes. The final vulnerability functions were further validated with data from the Italian Alps and different vulnerability functions presented in the literature. This comparison showed the wider applicability of the derived vulnerability functions. The uncertainty inherent to regression functions was quantified by the calculation of confidence bands. The derived vulnerability functions may be applied within the framework of risk management for mountain hazards within the European Alps. The method is transferable to other mountain regions if the input data needed are available. PMID:27087696

Statistical power to detect violation of the proportional hazards assumption when using the Cox regression model.

PubMed

Austin, Peter C

2018-01-01

The use of the Cox proportional hazards regression model is widespread. A key assumption of the model is that of proportional hazards. Analysts frequently test the validity of this assumption using statistical significance testing. However, the statistical power of such assessments is frequently unknown. We used Monte Carlo simulations to estimate the statistical power of two different methods for detecting violations of this assumption. When the covariate was binary, we found that a model-based method had greater power than a method based on cumulative sums of martingale residuals. Furthermore, the parametric nature of the distribution of event times had an impact on power when the covariate was binary. Statistical power to detect a strong violation of the proportional hazards assumption was low to moderate even when the number of observed events was high. In many data sets, power to detect a violation of this assumption is likely to be low to modest.

Statistical power to detect violation of the proportional hazards assumption when using the Cox regression model

PubMed Central

Austin, Peter C.

2017-01-01

The use of the Cox proportional hazards regression model is widespread. A key assumption of the model is that of proportional hazards. Analysts frequently test the validity of this assumption using statistical significance testing. However, the statistical power of such assessments is frequently unknown. We used Monte Carlo simulations to estimate the statistical power of two different methods for detecting violations of this assumption. When the covariate was binary, we found that a model-based method had greater power than a method based on cumulative sums of martingale residuals. Furthermore, the parametric nature of the distribution of event times had an impact on power when the covariate was binary. Statistical power to detect a strong violation of the proportional hazards assumption was low to moderate even when the number of observed events was high. In many data sets, power to detect a violation of this assumption is likely to be low to modest. PMID:29321694

The distribution of genome shared identical by descent for a pair of full sibs by means of the continuous time Markov chain

NASA Astrophysics Data System (ADS)

Julie, Hongki; Pasaribu, Udjianna S.; Pancoro, Adi

2015-12-01

This paper will allow Markov Chain's application in genome shared identical by descent by two individual at full sibs model. The full sibs model was a continuous time Markov Chain with three state. In the full sibs model, we look for the cumulative distribution function of the number of sub segment which have 2 IBD haplotypes from a segment of the chromosome which the length is t Morgan and the cumulative distribution function of the number of sub segment which have at least 1 IBD haplotypes from a segment of the chromosome which the length is t Morgan. This cumulative distribution function will be developed by the moment generating function.

Blind channel estimation and deconvolution in colored noise using higher-order cumulants

NASA Astrophysics Data System (ADS)

Tugnait, Jitendra K.; Gummadavelli, Uma

1994-10-01

Existing approaches to blind channel estimation and deconvolution (equalization) focus exclusively on channel or inverse-channel impulse response estimation. It is well-known that the quality of the deconvolved output depends crucially upon the noise statistics also. Typically it is assumed that the noise is white and the signal-to-noise ratio is known. In this paper we remove these restrictions. Both the channel impulse response and the noise model are estimated from the higher-order (fourth, e.g.) cumulant function and the (second-order) correlation function of the received data via a least-squares cumulant/correlation matching criterion. It is assumed that the noise higher-order cumulant function vanishes (e.g., Gaussian noise, as is the case for digital communications). Consistency of the proposed approach is established under certain mild sufficient conditions. The approach is illustrated via simulation examples involving blind equalization of digital communications signals.

Functions of cumulative distribution of attenuation due to rain on an interval from 9.5 Km A to 17.8 GHz

NASA Technical Reports Server (NTRS)

Fedi, F.; Migliorini, P.

1981-01-01

Measurement results of attenuation due to rain are reported. Cumulative distribution functions of the attenuation found in three connections are described. Differences between the distribution functions and different polarization frequencies are demonstrated. The possibilty of establishing a bond between the statistics of annual attenuation and worst month attenuation is explored.

Real-world impact of non-breast cancer-specific death on overall survival in resectable breast cancer.

PubMed

Fu, Jianfei; Wu, Lunpo; Jiang, Mengjie; Li, Dan; Jiang, Ting; Fu, Wei; Wang, Liangjing; Du, Jinlin

2017-07-01

The real-world occurrence rate of non-breast cancer-specific death (non-BCSD) and its impact on patients with breast cancer are poorly recognized. Women with resectable breast cancer from 1990 to 2007 in the Surveillance, Epidemiology, and End Results database (n = 199,963) were analyzed. The outcome events of breast cancer were classified as breast cancer-specific death (BCSD), non-BCSD, or survival. Binary logistics was used to estimate the occurrence rates of non-BCSD and BCSD with different clinicopathological factors. The Gray method was used to measure the cumulative incidence of non-BCSD and BCSD. The ratio of non-BCSDs to all causes of death and stacked cumulative incidence function plots were used to present the impact of non-BCSD on overall survival (OS). Models of Cox proportional hazards regression and competing risk regression were compared to highlight the suitable model. There were 12,879 non-BCSDs (6.44%) and 28,784 BCSDs (14.39%). The oldest age group (>62 years), black race, and a single or divorced marital status were associated with more non-BCSDs. With adjustments for age, a hormone receptor-positive (HoR+) status was no longer related to increased non-BCSDs. In patients with grade 1, stage I disease and an HoR+ status as well as the oldest subgroup, a great dilution of non-BCSD on all causes of death could be observed, and this led to incorrect interpretations. The inaccuracy, caused by the commonly used Cox proportional hazards model, could be corrected by a competing risk model. OS was largely impaired by non-BCSD during early breast cancer. For some future clinical trial planning, especially for the oldest patients and those with HoR+ breast cancer, non-BCSD should be considered a competing risk event. Cancer 2017;123:2432-43. © 2017 American Cancer Society. © 2017 American Cancer Society.

The Implications of Strike-Slip Earthquake Source Properties on the Transform Boundary Development Process

NASA Astrophysics Data System (ADS)

Neely, J. S.; Huang, Y.; Furlong, K.

2017-12-01

Subduction-Transform Edge Propagator (STEP) faults, produced by the tearing of a subducting plate, allow us to study the development of a transform plate boundary and improve our understanding of both long-term geologic processes and short-term seismic hazards. The 280 km long San Cristobal Trough (SCT), formed by the tearing of the Australia plate as it subducts under the Pacific plate near the Solomon and Vanuatu subduction zones, shows along-strike variations in earthquake behaviors. The segment of the SCT closest to the tear rarely hosts earthquakes > Mw 6, whereas the SCT sections more than 80 - 100 km from the tear experience Mw7 earthquakes with repeated rupture along the same segments. To understand the effect of cumulative displacement on SCT seismicity, we analyze b-values, centroid-time delays and corner frequencies of the SCT earthquakes. We use the spectral ratio method based on Empirical Green's Functions (eGfs) to isolate source effects from propagation and site effects. We find high b-values along the SCT closest to the tear with values decreasing with distance before finally increasing again towards the far end of the SCT. Centroid time-delays for the Mw 7 strike-slip earthquakes increase with distance from the tear, but corner frequency estimates for a recent sequence of Mw 7 earthquakes are approximately equal, indicating a growing complexity in earthquake behavior with distance from the tear due to a displacement-driven transform boundary development process (see figure). The increasing complexity possibly stems from the earthquakes along the eastern SCT rupturing through multiple asperities resulting in multiple moment pulses. If not for the bounding Vanuatu subduction zone at the far end of the SCT, the eastern SCT section, which has experienced the most displacement, might be capable of hosting larger earthquakes. When assessing the seismic hazard of other STEP faults, cumulative fault displacement should be considered a key input in determining potential earthquake size.

Cumulative Stress and Cortisol Disruption among Black and Hispanic Pregnant Women in an Urban Cohort.

PubMed

Suglia, Shakira Franco; Staudenmayer, John; Cohen, Sheldon; Enlow, Michelle Bosquet; Rich-Edwards, Janet W; Wright, Rosalind J

2010-12-01

While adult hypothalamic-pituitary-adrenocortical (HPA) axis functioning is thought to be altered by traumatic experiences, little data exist on the effects of cumulative stress on HPA functioning among pregnant women or among specific racial and ethnic groups. Individuals may be increasingly vulnerable to physiological alterations when experiencing cumulative effects of multiple stressors. These effects may be particularly relevant in urban poor communities where exposure to multiple stressors is more prevalent. The goal of this study was to explore the effects of multiple social stressors on HPA axis functioning in a sample of urban Black (n = 68) and Hispanic (n = 132) pregnant women enrolled in the Asthma Coalition on Community, Environment, and Social Stress (ACCESS). Pregnant women were administered the Revised Conflict Tactics Scale (R-CTS) survey to assess interpersonal violence, the Experiences of Discrimination (EOD) survey, the Crisis in Family Systems-Revised (CRISYS-R) negative life events survey, and the My Exposure to Violence (ETV) survey, which ascertains exposure to community violence. A cumulative stress measure was derived from these instruments. Salivary cortisol samples were collected five times per day over three days to assess area under the curve (AUC), morning change, and basal awakening response in order to characterize diurnal salivary cortisol patterns. Repeated measures mixed models, stratified by race/ethnicity, were performed adjusting for education level, age, smoking status, body mass index and weeks pregnant at time of cortisol sampling. The majority of Hispanic participants (57%) had low cumulative stress exposure, while the majority of Black participants had intermediate (35%) or high (41%) cumulative stress exposure. Results showed that among Black but not Hispanic women, cumulative stress was associated with lower morning cortisol levels, including a flatter waking to bedtime rhythm. These analyses suggest that the combined effects of cumulative stressful experiences are associated with disrupted HPA functioning among pregnant women. While the etiology of racial/ethnic differences in stress-induced HPA alterations is not clear, this warrants further research.

EVALUATING CUMULATIVE EFFECTS OF DISTURBANCE ON THE HYDROLOGIC FUNCTION OF BOGS, FENS, AND MIRES

EPA Science Inventory

Few quantitative studies have been done on the hydrology of fens, bogs and mires, and consequently any predictions of the cumulative impacts of disturbances on their hydrologic functions is extremely difficult. or example, few data are available on the role of bogs and fens with ...

Gadolinium based contrast agents in current practice: Risks of accumulation and toxicity in patients with normal renal function

PubMed Central

Ranga, Anju; Agarwal, Yatish; Garg, Kanika J

2017-01-01

Despite being decked as the most prized compounds in the nugget box of contrast agents for clinical radiologists, and carrying an indisputable tag of safety of the US Food and Drug Administration for close to three decades, all may not be seemingly well with the family of gadolinium compounds. If the first signs of violations of primum non nocere in relation to gadolinium-based contrast agents (GBCAs) appeared in the millennium year with the first published report of skin fibrosis in patients with compromised renal function, the causal relationship between the development of nephrogenic systemic fibrosis (NSF) and GBCAs, first proposed by two European groups in 2006, further precluded their use in renocompromised patients. The toxicity, pharmacokinetics, and pharmacodynamics of GBCAs, however, has come under hawk-eyed scrutiny with recent reports that gadolinium tends to deposit cumulatively in the brain of patients with normal hepatobiliary function and intact blood–brain barrier. While the jury on the long-term hazard significance of this critical scientific finding is still out, the use of GBCAs must be guided by due clinical diligence, avoidance of repeated doses, and preferring GBCAs with the best safety profiles. PMID:28744073

Thermal Index Evaluation of Local SAR in MRI-Based Head Models of Adult and Children for Portable Telephones

NASA Astrophysics Data System (ADS)

Fujiwara, Osamu; Miyamoto, Kayoko; Wang, Jianqing

Biological hazards due to radio-frequency (RF) waves result mainly from the temperature rise in tissue. It should be, therefore, clarified to what extent the RF waves of portable telephones increase the temperature-rise in human brain that includes the central part governing the body-temperature regulation function. In this paper, we calculated both the specific absorption rate (SAR) and the resultant temperature-rise for 900 MHz and 2 GHz portable telephones using the finite-difference time-domain (FDTD) method for three typical use positions, i.e., the vertical position, cheek position and tilt position. As a result, we found that there was an increase for median and 1% value of the cumulative distribution of temperature-rise in children’s brains for any use positions of the portable telephones compared to that in the adult’s brain, and also that the increasing trend in children’s brains for temperature-rise is identical to the temperature-rise trend in children’s hypothalamus. In addition, we found that the ten-gram averaged peak SAR among the adult and children heads had the same trend as that of the 0.1% value of the relatively cumulative distribution of temperature-rise, which shows that the ten-gram averaged peak SAR reflects only the localized temperature-rise in the brain surface.

Atmospheric Teleconnections From Cumulants

NASA Astrophysics Data System (ADS)

Sabou, F.; Kaspi, Y.; Marston, B.; Schneider, T.

2011-12-01

Multi-point cumulants of fields such as vorticity provide a way to visualize atmospheric teleconnections, complementing other approaches such as the method of empirical orthogonal functions (EOFs). We calculate equal-time two-point cumulants of the vorticity from NCEP reanalysis data during the period 1980 -- 2010 and from direct numerical simulation (DNS) using an idealized dry general circulation model (GCM) (Schneider and Walker, 2006). Extratropical correlations seen in the NCEP data are qualitatively reproduced by the model. Three- and four-point cumulants accumulated from DNS quantify departures of the probability distribution function from a normal distribution, shedding light on the efficacy of direct statistical simulation (DSS) of atmosphere dynamics by cumulant expansions (Marston, Conover, and Schneider, 2008; Marston 2011). Lagged-time two-point cumulants between temperature gradients and eddy kinetic energy (EKE), accumulated by DNS of an idealized moist aquaplanet GCM (O'Gorman and Schneider, 2008), reveal dynamics of storm tracks. Regions of enhanced baroclinicity (as found along the eastern boundary of continents) lead to a local enhancement of EKE and a suppression of EKE further downstream as the storm track self-destructs (Kaspi and Schneider, 2011).

Cumulants of heat transfer across nonlinear quantum systems

NASA Astrophysics Data System (ADS)

Li, Huanan; Agarwalla, Bijay Kumar; Li, Baowen; Wang, Jian-Sheng

2013-12-01

We consider thermal conduction across a general nonlinear phononic junction. Based on two-time observation protocol and the nonequilibrium Green's function method, heat transfer in steady-state regimes is studied, and practical formulas for the calculation of the cumulant generating function are obtained. As an application, the general formalism is used to study anharmonic effects on fluctuation of steady-state heat transfer across a single-site junction with a quartic nonlinear on-site pinning potential. An explicit nonlinear modification to the cumulant generating function exact up to the first order is given, in which the Gallavotti-Cohen fluctuation symmetry is found still valid. Numerically a self-consistent procedure is introduced, which works well for strong nonlinearity.

Association of visual sensory function and higher order visual processing skills with incident driving cessation

PubMed Central

Huisingh, Carrie; McGwin, Gerald; Owsley, Cynthia

2017-01-01

Background Many studies on vision and driving cessation have relied on measures of sensory function, which are insensitive to the higher order cognitive aspects of visual processing. The purpose of this study was to examine the association between traditional measures of visual sensory function and higher order visual processing skills with incident driving cessation in a population-based sample of older drivers. Methods Two thousand licensed drivers aged ≥70 were enrolled and followed-up for three years. Tests for central vision and visual processing were administered at baseline and included visual acuity, contrast sensitivity, sensitivity in the driving visual field, visual processing speed (Useful Field of View (UFOV) Subtest 2 and Trails B), and spatial ability measured by the Visual Closure Subtest of the Motor-free Visual Perception Test. Participants self-reported the month and year of driving cessation and provided a reason for cessation. Cox proportional hazards models were used to generate crude and adjusted hazard ratios with 95% confidence intervals between visual functioning characteristics and risk of driving cessation over a three-year period. Results During the study period, 164 participants stopped driving which corresponds to a cumulative incidence of 8.5%. Impaired contrast sensitivity, visual fields, visual processing speed (UFOVand Trails B), and spatial ability were significant risk factors for subsequent driving cessation after adjusting for age, gender, marital status, number of medical conditions, and miles driven. Visual acuity impairment was not associated with driving cessation. Medical problems (63%), specifically musculoskeletal and neurological problems, as well as vision problems (17%) were cited most frequently as the reason for driving cessation. Conclusion Assessment of cognitive and visual functioning can provide useful information about subsequent risk of driving cessation among older drivers. In addition, a variety of factors, not just vision, influenced the decision to stop driving and may be amenable to intervention. PMID:27353969

UCH-LI acts as a novel prognostic biomarker in gastric cardiac adenocarcinoma.

PubMed

Yang, Honghong; Zhang, Chunhong; Fang, Shan; Ou, Rongying; Li, Wenfeng; Xu, Yunsheng

2015-01-01

Gastric cardiac adenocarcinoma (GCA) accounts for a majority of gastric cancer population and harbors unfavorable outcome. Ubiquitin C-terminal hydrolase L1 (UCH-L1) belongs to the deubiquitinating enzyme family, which could regulate cell growth in human cancers. In the present study, expression of UCH-L1 was evaluated in 196 GCAs by immunohistochemistry using tissue microarray and its function on gastric cancer cells was measured. UCH-L1 expression was increased in GCA specimens, compared with their normal tissues and UCH-L1 overexpression is tightly correlated with tumor size and overall TNM stage. Log-rank analysis showed that UCH-L1 positive is reversely associated with cumulative survival (P<0.001). Multivariate Cox regression model showed that UCH-L1 overexpression is a remarkably negative predictor in GCA prognosis (Hazard Ratio=0.53, P<0.01), along with advanced TNM stage that is a known negative factor in gastric cancers (Hazard Ratio=0.33, P<0.05). Silencing of UCH-L1 reduced the ability of cell proliferation, colony formation, migration and invasion of gastric cancer cells. Our findings suggest that UCH-L1 is a promising prognostic biomarker for GCAs and might play an important role in the carcinogenesis of gastric cancer.

Calculation of the Poisson cumulative distribution function

NASA Technical Reports Server (NTRS)

Bowerman, Paul N.; Nolty, Robert G.; Scheuer, Ernest M.

1990-01-01

A method for calculating the Poisson cdf (cumulative distribution function) is presented. The method avoids computer underflow and overflow during the process. The computer program uses this technique to calculate the Poisson cdf for arbitrary inputs. An algorithm that determines the Poisson parameter required to yield a specified value of the cdf is presented.

The Association Between Barium Examination and Subsequent Appendicitis: A Nationwide Population-Based Study.

PubMed

Li, Hao-Ming; Yeh, Lee-Ren; Huang, Ying-Kai; Lin, Cheng-Li; Kao, Chia-Hung

2017-01-01

The incidence and association between appendicitis and barium examination (BE) remain unclear. Such potential risk may be omitted. We conducted a longitudinal, nationwide, population-based cohort study to investigate the association between BE and appendicitis risk. From the Taiwan National Health Insurance Research Database, a total of 24,885 patients who underwent BE between January 1, 2000 and December 31, 2010 were enrolled in a BE cohort; an additional 98,384 subjects without BE exposure were selected as a non-BE cohort, matched by age, sex, and index date. The cumulative incidences of subsequent appendicitis in the BE and non-BE cohorts were assessed using the Kaplan-Meier curves and log-rank test. Cox proportional hazards regression analyses were employed to calculate the appendicitis risk between the groups. The cumulative incidence of appendicitis was higher in the BE cohort than in the non-BE cohort (P = .001). The overall incidence rates of appendicitis for the BE and non-BE cohorts were 1.19 and 0.80 per 1000 person-years, respectively. After adjustment for sex, age, and comorbidities, the risk of appendicitis was higher in the BE cohort (adjusted hazard ratio = 1.46, 95% confidence interval = 1.23-1.73) compared with the non-BE cohort, especially in the first 2 months (adjusted hazard ratio = 9.72, 95% confidence interval = 4.65-20.3). BE was associated with an increased, time-dependent appendicitis risk. Clinicians should be aware of this potential risk to avoid delayed diagnoses. Copyright © 2016 Elsevier Inc. All rights reserved.

Derivation of Hunt equation for suspension distribution using Shannon entropy theory

NASA Astrophysics Data System (ADS)

Kundu, Snehasis

2017-12-01

In this study, the Hunt equation for computing suspension concentration in sediment-laden flows is derived using Shannon entropy theory. Considering the inverse of the void ratio as a random variable and using principle of maximum entropy, probability density function and cumulative distribution function of suspension concentration is derived. A new and more general cumulative distribution function for the flow domain is proposed which includes several specific other models of CDF reported in literature. This general form of cumulative distribution function also helps to derive the Rouse equation. The entropy based approach helps to estimate model parameters using suspension data of sediment concentration which shows the advantage of using entropy theory. Finally model parameters in the entropy based model are also expressed as functions of the Rouse number to establish a link between the parameters of the deterministic and probabilistic approaches.

Effect of protocol-related variables and women's characteristics on the cumulative false-positive risk in breast cancer screening

PubMed Central

Román, R.; Sala, M.; Salas, D.; Ascunce, N.; Zubizarreta, R.; Castells, X.

2012-01-01

Background: Reducing the false-positive risk in breast cancer screening is important. We examined how the screening-protocol and women's characteristics affect the cumulative false-positive risk. Methods: This is a retrospective cohort study of 1 565 364 women aged 45–69 years who underwent 4 739 498 screening mammograms from 1990 to 2006. Multilevel discrete hazard models were used to estimate the cumulative false-positive risk over 10 sequential mammograms under different risk scenarios. Results: The factors affecting the false-positive risk for any procedure and for invasive procedures were double mammogram reading [odds ratio (OR) = 2.06 and 4.44, respectively], two mammographic views (OR = 0.77 and 1.56, respectively), digital mammography (OR = 0.83 for invasive procedures), premenopausal status (OR = 1.31 and 1.22, respectively), use of hormone replacement therapy (OR = 1.03 and 0.84, respectively), previous invasive procedures (OR = 1.52 and 2.00, respectively), and a familial history of breast cancer (OR = 1.18 and 1.21, respectively). The cumulative false-positive risk for women who started screening at age 50–51 was 20.39% [95% confidence interval (CI) 20.02–20.76], ranging from 51.43% to 7.47% in the highest and lowest risk profiles, respectively. The cumulative risk for invasive procedures was 1.76% (95% CI 1.66–1.87), ranging from 12.02% to 1.58%. Conclusions: The cumulative false-positive risk varied widely depending on the factors studied. These findings are relevant to provide women with accurate information and to improve the effectiveness of screening programs. PMID:21430183

Clinical outcomes after combined Ahmed glaucoma valve implantation and penetrating keratoplasty or pars plana vitrectomy.

PubMed

Lee, Jin Young; Sung, Kyung Rim; Tchah, Hung Won; Yoon, Young Hee; Kim, June Gone; Kim, Myoung Joon; Kim, Jae Yong; Yun, Sung-Cheol; Lee, Joo Yong

2012-12-01

To evaluate whether a combination of penetrating keratoplasty (PKP) or pars plana vitrectomy (PPV) and Ahmed glaucoma valve (AGV) implantation affords a level of success similar to that of AGV implantation alone. Eighteen eyes underwent simultaneous PPV and AGV, 14 eyes with PKP and AGV and 30 eyes with AGV implantation alone were evaluated. Success was defined as attainment of an intraocular pressure (IOP) >5 and <22 mmHg, with or without use of anti-glaucoma medication. Kaplan-Meier survival analysis was performed to compare cumulative survival between the combined surgery groups and the AGV implantation-alone group. Cox proportional hazard regression analysis was conducted to identify factors predictive of success in each of the three groups. Mean (±standard deviation) preoperative IOP was 30.2 ± 10.2 mmHg in the PKP + AGV, 35.2 ± 9.8 mmHg in the PPV + AGV, and 36.2 ± 10.1 mmHg in the AGV implantation-alone group. The cumulative success rate at 18 months was 66.9%, 73.2%, and 70.8% in the three groups, respectively. Neither combined surgery group differed significantly in terms of cumulative success rate compared with the AGV implantation-alone group (p = 0.556, p = 0.487, respectively). The mean number of preoperative anti-glaucoma medications prescribed was significantly associated with success in the PKP + AGV implantation group (hazard ratio, 2.942; p = 0.024). Either PKP or PPV performed in conjunction with AGV implantation afforded similar success rates compared to patients treated with AGV implantation alone. Therefore, in patients with refractory glaucoma who have underlying corneal or retinal pathology requiring treatment with PKP or PPV, AGV implantation can be performed simultaneously.

The incidence of post-colonoscopy colorectal cancer: a retrospective long-term cohort study using a colonoscopy database.

PubMed

Nakada, Ayako; Niikura, Ryota; Yamada, Atsuo; Yoshida, Shuntaro; Hirata, Yoshihiro; Koike, Kazuhiko

2017-06-01

The cumulative incidence of post-colonoscopy colorectal cancer remains unclear. Our aims were to estimate the incidence of and identify risk factors associated with post-colonoscopy colorectal cancer. We conducted a retrospective cohort study using the colonoscopy database of the Department of Gastroenterology, the University of Tokyo Hospital Records from1995-2012. A cohort of 2544 patients, who received multiple colonoscopies without colorectal cancer findings at first colonoscopy, was selected. The primary outcome was post-colonoscopy colorectal cancer; data were censored at the date of final colonoscopy. We assessed patients' background characteristics, colonoscopy findings, and cancer characteristics, including location and size. The cumulative incidence of colorectal cancer was evaluated, and a Cox proportional hazards model was used to estimate hazard ratios (HRs). Colorectal cancer was identified in seven (0.77/1000 person-years) patients during the mean follow-up period of 3.6 years (maximum, 17 years). The cumulative incidence of colorectal cancer was 0, 0.47, 0.62, and 0.62% at 1, 5, 10, and 15 years, respectively. Cancer was identified in the rectum in five of seven patients. Polyp size >10 mm (HR 5.7, p = 0.023) and intubation time >30 min (HR 11.6, p = 0.003) at first colonoscopy were associated significantly with an increased incidence of post-colonoscopy colorectal cancer. Although several factors were associated with an increased risk of post-colonoscopy colorectal cancer, the incidence of this disease might be low in patients who received at least twice colonoscopy. High proportion of rectal cancer in post-colonoscopy colorectal cancer should be noted.

Long-term exposure to crystalline silica and risk of heart disease mortality.

PubMed

Liu, Yuewei; Rong, Yi; Steenland, Kyle; Christiani, David C; Huang, Xiji; Wu, Tangchun; Chen, Weihong

2014-09-01

The association between crystalline silica exposure and risk of heart disease mortality remains less clear. We investigated a cohort of 42,572 Chinese workers who were potentially exposed to crystalline silica and followed from 1960 to 2003. Cumulative silica exposure was estimated by linking a job-exposure matrix to each person's work history. Low-level silica exposure was defined as never having held a job with an exposure higher than 0.1 mg/m. We estimated hazard ratios (HRs) in exposure-response analyses using Cox proportional hazards model. We identified 2846 deaths from heart disease during an average of 35 years follow-up. Positive exposure-response trends were observed for cumulative silica exposure associated with mortality from total heart disease (HRs for increasing quartiles of cumulative silica exposure compared with the unexposed group = 0.89, 1.09, 1.32, 2.10; P for linear trend < 0.001) and pulmonary heart disease (0.92, 1.39, 2.47, 5.46; P for linear trend < 0.001). These positive trends remained among workers with both high- and low-level silica exposure. There was also a positive trend for ischemic heart disease among workers with low-level exposure, with quartile HRs of 1.04, 1.13, 1.52, and 1.60 (P for linear trend < 0.001). Low-level crystalline silica exposure was associated with increased mortality from heart disease, including pulmonary heart disease and ischemic heart disease, whereas high-level exposure mainly increased mortality from pulmonary heart disease. Current permissible exposure limits for crystalline silica in many countries may be insufficient to protect people from deaths due to heart disease.

Passive Smoking and Risk of Breast Cancer in the California Teachers Study*†‡

PubMed Central

Reynolds, Peggy; Goldberg, Debbie; Hurley, Susan; Nelson, David O.; Largent, Joan; Henderson, Katherine D.; Bernstein, Leslie

2010-01-01

Background Although recent reviews have suggested active smoking to be a risk factor for breast cancer, the association with passive smoke exposure remains controversial. This risk association was explored in a large prospective study of women, the California Teachers Study. Methods Detailed lifetime information on passive smoke exposure by setting (home, work, or social) and by age of exposure were collected in 1997 from 57,523 women who were lifetime nonsmokers and had no history of breast cancer. In the ensuing decade, a total of 1,754 women were diagnosed with invasive breast cancer. Cox proportional hazards models were fit to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI) associated with several lifetime passive smoke exposure metrics. Results For all breast cancer, measures of higher lifetime passive smoking intensity and duration were associated with non-statistically significant HRs of 1.11 to 1.14. For postmenopausal women, HRs for lifetime low, medium and high cumulative exposure were 1.17 (95%CI 0.91, 1.49), 1.19 (95%CI 0.93, 1.53), and 1.26 (95% CI 0.99, 1.60). For women exposed in adulthood (age ≥20) risk was elevated at the highest level of cumulative exposure (HR=1.18, 95% CI 1.00, 1.40), primarily among postmenopausal women (HR=1.25, 95% CI 1.01, 1.56). A statistically significant dose response was detected when analysis was restricted to women with moderate to high levels of passive smoke exposure. Conclusion These results suggest that cumulative exposures to high levels of side stream smoke may increase breast cancer risk among postmenopausal women who themselves have never smoked tobacco products. PMID:19959687

Early Probiotic Supplementation for Eczema and Asthma Prevention: A Randomized Controlled Trial.

PubMed

Cabana, Michael D; McKean, Michelle; Caughey, Aaron B; Fong, Lawrence; Lynch, Susan; Wong, Angela; Leong, Russell; Boushey, Homer A; Hilton, Joan F

2017-09-01

To determine if probiotic administration during the first 6 months of life decreases childhood asthma and eczema. We conducted a randomized, double-blind controlled trial of Lactobacillus rhamnosus GG (LGG) supplementation on the cumulative incidence of eczema (primary end point) and asthma and rhinitis (secondary end points) in high-risk infants. For the first 6 months of life, intervention infants ( n = 92) received a daily dose of 10 billion colony-forming units of LGG and 225 mg of inulin (Amerifit Brands, Cromwell, CT), and control infants ( n = 92) received 325 mg of inulin alone. We used survival analysis methods to estimate disease incidences in the presence or absence of LGG and to estimate the efficacy of LGG in delaying or preventing these diseases. Infants were accrued over a 6-year period (median follow-up: 4.6 years; 95% retention rate at 2 years). At 2 years of age, the estimated cumulative incidence of eczema was 30.9% (95% confidence interval [CI], 21.4%-40.4%) in the control arm and 28.7% (95% CI, 19.4%-38.0%) in the LGG arm, for a hazard ratio of 0.95 (95% CI, 0.59-1.53) (log-rank P = .83). At 5 years of age, the cumulative incidence of asthma was 17.4% (95% CI, 7.6%-27.1%) in the control arm and 9.7% (95% CI, 2.7%-16.6%) in the LGG arm, for a hazard ratio of 0.88 (95% CI, 0.41-1.87) (log-rank P = .25). For high-risk infants, early LGG supplementation for the first 6 months of life does not appear to prevent the development of eczema or asthma at 2 years of age. Copyright © 2017 by the American Academy of Pediatrics.

Incompatible Land Uses and the Topology of Cumulative Risk

NASA Astrophysics Data System (ADS)

Lejano, Raul P.; Smith, C. Scott

2006-02-01

The extensive literature on environmental justice has, by now, well defined the essential ingredients of cumulative risk, namely, incompatible land uses and vulnerability. Most problematic is the case when risk is produced by a large aggregation of small sources of air toxics. In this article, we test these notions in an area of Southern California, Southeast Los Angeles (SELA), which has come to be known as Asthmatown. Developing a rapid risk mapping protocol, we scan the neighborhood for small potential sources of air toxics and find, literally, hundreds of small point sources within a 2-mile radius, interspersed with residences. We also map the estimated cancer risks and noncancer hazard indices across the landscape. We find that, indeed, such large aggregations of even small, nondominant sources of air toxics can produce markedly elevated levels of risk. In this study, the risk profiles show additional cancer risks of up to 800 in a million and noncancer hazard indices of up to 200 in SELA due to the agglomeration of small point sources. This is significant (for example, estimates of the average regional point-source-related cancer risk range from 125 to 200 in a million). Most importantly, if we were to talk about the risk contour as if they were geological structures, we would observe not only a handful of distinct peaks, but a general “mountain range” running all throughout the study area, which underscores the ubiquity of risk in SELA. Just as cumulative risk has deeply embedded itself into the fabric of the place, so, too, must intervention seek to embed strategies into the institutions and practices of SELA. This has implications for advocacy, as seen in a recently initiated participatory action research project aimed at building health research capacities into the community in keeping with an ethic of care.

Genetic characterization of multiple hepatitis C virus infections following acute infection in HIV-infected men who have sex with men.

PubMed

Thomas, Xiomara V; Grady, Bart P X; Van Der Meer, Jan T M; Ho, Cynthia K; Vanhommerig, Joost W; Rebers, Sjoerd P; De Jong, Menno D; Van Der Valk, Marc; Prins, Maria; Molenkamp, Richard; Schinkel, Janke

2015-11-01

High rates of hepatitis C virus (HCV) reinfections among HIV-infected men who have sex with men (MSM) following clearance of a primary infection suggest absence of protective immunity. Here, we investigated the incidence of HCV super and reinfections in 85 HIV-infected MSM with incident HCV infection. Serial sequencing of a fragment of NS5B and the HCV envelope was used to longitudinally characterize the virus. If the primary genotype was still present at the most recent viremic time point, as indicated by the NS5B sequence analysis, serial envelope 2/hypervariable region 1 (E2/HRV1) sequence analysis was performed to distinguish a new infection with the same genotype (clade switch) from intrahost evolution. Incidence rate and cumulative incidence of secondary infections were estimated, and the effect of the primary genotype (1a versus non1) on the risk of acquiring a second infection with the same genotype was determined using Cox proportional-hazards analysis. Among 85 patients with a median follow-up of 4.8 years, incidence rate of secondary infections was 5.39 cases/100 person-years (95% confidence interval 3.34-8.26). Cumulative incidence of genotype switches was markedly higher than the cumulative incidence of clade switches (26.7 versus 4.8% at 5 years, respectively). In patients with HCV-1a as primary infection, the risk for acquiring another HCV-1a infection was reduced compared to those with a primary non-HCV-1a subsequently acquiring HCV-1a (hazard ratio 0.25, 95% confidence interval 0.07-0.93). Risk of acquiring a secondary infection with the primary genotype was strikingly reduced compared with the risk of acquiring a secondary infection with a different genotype.

Long-term results (up to 14 years) of the clover technique for the treatment of complex tricuspid valve regurgitation.

PubMed

De Bonis, Michele; Lapenna, Elisabetta; Di Sanzo, Stefania; Del Forno, Benedetto; Pappalardo, Federico; Castiglioni, Alessandro; Vicentini, Luca; Pozzoli, Alberto; Giambuzzi, Ilaria; Latib, Azeem; Schiavi, Davide; La Canna, Giovanni; Alfieri, Ottavio

2017-07-01

To report the long-term results of the clover technique for the treatment of complex forms of tricuspid regurgitation (TR). Ninety-six consecutive patients (mean age 60 ± 16.4, left ventricular ejection fraction 58 ± 8.8%) with severe or moderately-severe TR due to important leaflets prolapse/flail (81 patients), tethering (13 patients) or mixed (2 patients) lesions underwent clover repair combined with annuloplasty. The aetiology of TR was degenerative in 74 cases (77.1%), post-traumatic in 9 (9.4%) and secondary to dilated cardiomyopathy in 13 (13.5%). All patients but 3 (96.8%) underwent ring (59 patients, 61.5%) or suture (34 patients, 35.4%) annuloplasty. Concomitant procedures (mainly mitral surgery) were performed in 82 patients (85.4%). Hospital mortality was 7.2%. At hospital discharge 92 (95.8%) patients had no or mild TR. Follow-up was 98% complete (median 9 years, interquartile range 5.1; 10.9). At 12 years the overall survival was 71.6 ± 7.22% and the cumulative incidence function of cardiac death with non-cardiac death as competing risk 16 ± 4.1% [95% confidence interval (95% CI) 9.5-25.7]. At 12 years the cumulative incidence function of TR ≥ 3+ and TR ≥ 2+ with death as competing risk were 1.2 ± 1.2% (95% CI 0.1-5.8) and 28 ± 7.7% (95% CI 14.3-43.5), respectively. Preoperative left ventricular ejection fraction (hazard ratio 0.9, CI 0.9-1, P  = 0.05) and previous cardiac surgery (hazard ratio 2.7, 95% CI 1-7.1, P  = 0.03) were predictors of recurrent TR ≥ 2+ at univariable but not at multivariable analysis. Complex forms of TR due to severe prolapse or tethering of the leaflets can be effectively treated with the clover technique with very satisfactory long-term results and extremely low recurrence of severe TR. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Hazard characterization and management of tetramethyl tin in the production of photovoltaic cell transparent conductive oxide layers

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kalb, P.D.; Moskowitz, P.D.

1988-01-01

Tetramethyl tin (TMT) has been used by the photovoltaics industry to prepare transparent conductive oxide films on glass. Significant health hazards, however may be associated with the use of TMT. Short-term exposures to TMT vapors in excess of accepted exposure limits can produce a range of physiological symptoms. Although less is known about the hazards from prolonged exposure to low levels of TMT, some studies suggest that effects are both cumulative and persistent. TMT also is highly flammable and emits toxic fumes on decomposition. In an occupational setting, workers may be routinely or accidentally exposed to TMT liquids or vapors.more » Approaches for controlling these occupational hazards are described. Analysis suggests that routine emissions from large scale manufacturing facilities using TMT will need to be reduced by approximately 90% to comply with toxic gas containment guidelines to protect public health. Thermal afterburners combined with particle filtration may be used to meet these guidelines. Accidental release of the total inventory of TMT at a large-scale plant may present hazards to individuals living about 1 km from the facility's boundary. Because of these hazards, strategies to prevent in-plant release coupled with community emergency response programs are needed. 32 refs., 2 figs., 4 tabs.« less

Hazardous characterization and management of tetramethyl tin in the production of photovoltaic cell transparent conductive oxide layers

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kalb, P.D.; Moskowitz, P.D.

1987-08-01

Tetramethyl tin (TMT) has been used by the photovoltaics industry to prepare transparent conductive oxide films on glass. Significant health hazards, however may be associated with the use of TMT. Short-term exposures to TMT vapors in excess of accepted exposure limits can produce a range of physiological symptoms. Although less is known about the hazards from prolonged exposure to low levels of TMT, some studies suggest that effects are both cumulative and persistent. TMT also is highly flammable and emits toxic fumes on decomposition. In an occupational setting, workers may be routinely or accidentally exposed to TMT liquids or vapors.more » Approaches for controlling these occupational hazards are described. Analysis suggests that routine emissions from large scale manufacturing facilities using TMT will need to be reduced by approximately 90% to comply with toxic gas containment guidelines to protect public health. Thermal afterburners combined with particle filtration may be used to meet these guidelines. Accidental release of the total inventory of TMT at a large-scale plant may present hazards to individuals living about 1 km from the facility's boundary. Because of these hazards, strategies to prevent in-plant release coupled with community emergency response programs are needed. 36 refs., 3 figs., 6 tabs.« less

On the Use of a Cumulative Distribution as a Utility Function in Educational or Employment Selection.

DTIC Science & Technology

1981-02-01

monotonic increasing function of true ability or performance score. A cumulative probability function is * then very convenient for describiny; one’s...possible outcomes such as test scores, grade-point averages or other common outcome variables. Utility is usually a monotonic increasing function of true ...r(0) is negative for 8 <i and positive for 0 > M, U(o) is risk-prone for low 0 values and risk-averse for high 0 values. This property is true for

Serial and Parallel Attentive Visual Searches: Evidence from Cumulative Distribution Functions of Response Times

ERIC Educational Resources Information Center

Sung, Kyongje

2008-01-01

Participants searched a visual display for a target among distractors. Each of 3 experiments tested a condition proposed to require attention and for which certain models propose a serial search. Serial versus parallel processing was tested by examining effects on response time means and cumulative distribution functions. In 2 conditions, the…

The Association of Combined GSTM1 and CYP2C9 Genotype Status with the Occurrence of Hemorrhagic Cystitis in Pediatric Patients Receiving Myeloablative Conditioning Regimen Prior to Allogeneic Hematopoietic Stem Cell Transplantation

PubMed Central

Uppugunduri, Chakradhara Rao S.; Storelli, Flavia; Mlakar, Vid; Huezo-Diaz Curtis, Patricia; Rezgui, Aziz; Théorêt, Yves; Marino, Denis; Doffey-Lazeyras, Fabienne; Chalandon, Yves; Bader, Peter; Daali, Youssef; Bittencourt, Henrique; Krajinovic, Maja; Ansari, Marc

2017-01-01

Hemorrhagic cystitis (HC) is one of the complications of busulfan-cyclophosphamide (BU-CY) conditioning regimen during allogeneic hematopoietic stem cell transplantation (HSCT) in children. Identifying children at high risk of developing HC in a HSCT setting could facilitate the evaluation and implementation of effective prophylactic measures. In this retrospective analysis genotyping of selected candidate gene variants was performed in 72 children and plasma Sulfolane (Su, water soluble metabolite of BU) levels were measured in 39 children following treatment with BU-CY regimen. The cytotoxic effects of Su and acrolein (Ac, water soluble metabolite of CY) were tested on human urothelial cells (HUCs). The effect of Su was also tested on cytochrome P 450 (CYP) function in HepaRG hepatic cells. Cumulative incidences of HC before day 30 post HSCT were estimated using Kaplan–Meier curves and log-rank test was used to compare the difference between groups in a univariate analysis. Multivariate Cox regression was used to estimate hazard ratios with 95% confidence intervals (CIs). Multivariate analysis included co-variables that were significantly associated with HC in a univariate analysis. Cumulative incidence of HC was 15.3%. In the univariate analysis, HC incidence was significantly (p < 0.05) higher in children older than 10 years (28.6 vs. 6.8%) or in children with higher Su levels (>40 vs. <11%) or in carriers of both functional GSTM1 and CYP2C9 (33.3 vs. 6.3%) compared to the other group. In a multivariate analysis, combined GSTM1 and CYP2C9 genotype status was associated with HC occurrence with a hazards ratio of 4.8 (95% CI: 1.3–18.4; p = 0.02). Ac was found to be toxic to HUC cells at lower concentrations (33 μM), Su was not toxic to HUC cells at concentrations below 1 mM and did not affect CYP function in HepaRG cells. Our observations suggest that pre-emptive genotyping of CYP2C9 and GSTM1 may aid in selection of more effective prophylaxis to reduce HC development in pediatric patients undergoing allogeneic HSCT. Article summary: (1) Children carrying functional alleles in GSTM1 and CYP2C9 are at high risk for developing hemorrhagic cystitis following treatment with busulfan and cyclophosphamide based conditioning regimen. (2) Identification of children at high risk for developing hemorrhagic cystitis in an allogeneic HSCT setting will enable us to evaluate and implement optimal strategies for its prevention. Trial registration: This study is a part of the trail “clinicaltrials.gov identifier: NCT01257854.” PMID:28744217

The Association of Combined GSTM1 and CYP2C9 Genotype Status with the Occurrence of Hemorrhagic Cystitis in Pediatric Patients Receiving Myeloablative Conditioning Regimen Prior to Allogeneic Hematopoietic Stem Cell Transplantation.

PubMed

Uppugunduri, Chakradhara Rao S; Storelli, Flavia; Mlakar, Vid; Huezo-Diaz Curtis, Patricia; Rezgui, Aziz; Théorêt, Yves; Marino, Denis; Doffey-Lazeyras, Fabienne; Chalandon, Yves; Bader, Peter; Daali, Youssef; Bittencourt, Henrique; Krajinovic, Maja; Ansari, Marc

2017-01-01

Hemorrhagic cystitis (HC) is one of the complications of busulfan-cyclophosphamide (BU-CY) conditioning regimen during allogeneic hematopoietic stem cell transplantation (HSCT) in children. Identifying children at high risk of developing HC in a HSCT setting could facilitate the evaluation and implementation of effective prophylactic measures. In this retrospective analysis genotyping of selected candidate gene variants was performed in 72 children and plasma Sulfolane (Su, water soluble metabolite of BU) levels were measured in 39 children following treatment with BU-CY regimen. The cytotoxic effects of Su and acrolein (Ac, water soluble metabolite of CY) were tested on human urothelial cells (HUCs). The effect of Su was also tested on cytochrome P 450 (CYP) function in HepaRG hepatic cells. Cumulative incidences of HC before day 30 post HSCT were estimated using Kaplan-Meier curves and log-rank test was used to compare the difference between groups in a univariate analysis. Multivariate Cox regression was used to estimate hazard ratios with 95% confidence intervals (CIs). Multivariate analysis included co-variables that were significantly associated with HC in a univariate analysis. Cumulative incidence of HC was 15.3%. In the univariate analysis, HC incidence was significantly ( p < 0.05) higher in children older than 10 years (28.6 vs. 6.8%) or in children with higher Su levels (>40 vs. <11%) or in carriers of both functional GSTM1 and CYP2C9 (33.3 vs. 6.3%) compared to the other group. In a multivariate analysis, combined GSTM1 and CYP2C9 genotype status was associated with HC occurrence with a hazards ratio of 4.8 (95% CI: 1.3-18.4; p = 0.02). Ac was found to be toxic to HUC cells at lower concentrations (33 μM), Su was not toxic to HUC cells at concentrations below 1 mM and did not affect CYP function in HepaRG cells. Our observations suggest that pre-emptive genotyping of CYP2C9 and GSTM1 may aid in selection of more effective prophylaxis to reduce HC development in pediatric patients undergoing allogeneic HSCT. Article summary : (1) Children carrying functional alleles in GSTM1 and CYP2C9 are at high risk for developing hemorrhagic cystitis following treatment with busulfan and cyclophosphamide based conditioning regimen. (2) Identification of children at high risk for developing hemorrhagic cystitis in an allogeneic HSCT setting will enable us to evaluate and implement optimal strategies for its prevention. Trial registration : This study is a part of the trail "clinicaltrials.gov identifier: NCT01257854."

Long-term survival of adult trauma patients.

PubMed

Davidson, Giana H; Hamlat, Christian A; Rivara, Frederick P; Koepsell, Thomas D; Jurkovich, Gregory J; Arbabi, Saman

2011-03-09

Inpatient trauma case fatality rates may provide an incomplete assessment for overall trauma care effectiveness. To date, there have been few large studies evaluating long-term mortality in trauma patients and identifying predictors that increase risk for death following hospital discharge. To determine the long-term mortality of patients following trauma admission and to evaluate survivorship in relationship with discharge disposition. Retrospective cohort study of 124,421 injured adult patients during January 1995 to December 2008 using the Washington State Trauma Registry linked to death certificate data. Kaplan-Meier and Cox proportional hazards models were used to evaluate long-term mortality following hospital admission for trauma. Of the 124,421 trauma patients, 7243 died before hospital discharge and 21,045 died following hospital discharge. Cumulative mortality at 3 years postinjury was 16% (95% confidence interval [CI], 15.8%-16.2%) compared with the expected population cumulative mortality of 5.9% (95% CI, 5.9%-5.9%). In-hospital mortality improved during the 14-year study period from 8% (n = 362) to 4.9% (n = 600), whereas long-term cumulative mortality increased from 4.7% (95% CI, 4.1%-5.4%) to 7.4% (95% CI, 6.8%-8.1%). After adjustments for confounders, patients who were older and those who were discharged to a skilled nursing facility had the highest risk of death. The adjusted hazard ratios (HRs) for death after discharge to a skilled nursing facility compared with that after discharge home were 1.41 (95% CI, 0.72-2.76) for patients aged 18 to 30 years, 1.92 (95% CI, 1.36-2.73) for patients aged 31 to 45 years, 2.02 (95% CI, 1.39-2.93) for patients aged 46 to 55 years, 1.93 (95% CI, 1.40-2.64) for patients aged 56 to 65 years, 1.49 (95% CI, 1.14-1.94) for patients aged 66 to 75 years, 1.54 (95% CI, 1.27-1.87) for patients aged 76 to 80 years, and 1.38 (95% CI, 1.09-1.74) for patients older than 80 years. Other significant predictors of mortality after discharge included maximum head injury score on Abbreviated Injury Score scale (HR, 1.20; 95% CI, 1.13-1.26), Injury Severity Score (HR, 0.98; 95% CI, 0.97-0.98), Functional Independence Measure (HR, 0.89; 95% CI, 0.88-0.91), mechanism of injury being a fall (HR, 1.43; 95% CI, 1.30-1.58), and having Medicare (HR, 1.28; 95% CI, 1.15-1.43) or other government insurance (HR, 1.65; 95% CI, 1.47-1.85). Among adults admitted for trauma in Washington State, 3-year cumulative mortality was 16% despite a decline in in-hospital deaths. Discharge to a skilled nursing facility at any age following trauma admission was associated with a higher risk of subsequent mortality.

What Is the Rerevision Rate After Revising a Hip Resurfacing Arthroplasty? Analysis From the AOANJRR.

PubMed

Wong, James Min-Leong; Liu, Yen-Liang; Graves, Stephen; de Steiger, Richard

2015-11-01

More than 15,000 primary hip resurfacing arthroplasties have been recorded by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) with 884 primary procedures requiring revision for reasons other than infection, a cumulative percent revision rate at 12 years of 11%. However, few studies have reported the survivorship of these revision procedures. (1) What is the cumulative percent rerevision rate for revision procedures for failed hip resurfacings? (2) Is there a difference in rerevision rate among different types of revision or bearing surfaces? The AOANJRR collects data on all primary and revision hip joint arthroplasties performed in Australia and after verification against health department data, checking of unmatched procedures, and subsequent retrieval of unreported procedures is able to obtain an almost complete data set relating to hip arthroplasty in Australia. Revision procedures are linked to the known primary hip arthroplasty. There were 15,360 primary resurfacing hip arthroplasties recorded of which 884 had undergone revision and this was the cohort available to study. The types of revisions were acetabular only, femoral only, or revision of both acetabular and femoral components. With the exception of the acetabular-only revisions, all revisions converted hip resurfacing arthroplasties to conventional (stemmed) total hip arthroplasties (THAs). All initial revisions for infection were excluded. The survivorship of the different types of revisions and that of the different bearing surfaces used were estimated using the Kaplan-Meier method and compared using Cox proportional hazard models. Cumulative percent revision was calculated by determining the complement of the Kaplan-Meier survivorship function at that time multiplied by 100. Of the 884 revisions recorded, 102 underwent further revision, a cumulative percent rerevision at 10 years of 26% (95% confidence interval, 19.6-33.5). There was no difference in the rate of rerevision between acetabular revision and combined femoral and acetabular revision (hazard ratio [HR], 1.06 [0.47-2], p = 0.888), femoral revision and combined femoral and acetabular revision (HR, 1.00 [0.65-2], p = 0.987), and acetabular revision and femoral revision (HR, 1.06 [0.47-2], p = 0.893). There was no difference in the rate of rerevision when comparing different bearing surfaces (metal-on-metal versus ceramic-on-ceramic HR, 0.46 [0.16-1.29], p = 0.141; metal-on-metal versus ceramic-on-crosslinked polyethylene HR, 0.51 [0.15-1.76], p = 0.285; metal-on-metal versus metal-on-crosslinked polyethylene HR, 0.62 [0.20-1.89], p = 0.399; and metal-on-metal versus oxinium-on-crosslinked polyethylene HR, 0.53 [0.14-2.05], p = 0.356). Revision of a primary hip resurfacing arthroplasty is associated with a high risk of rerevision. This study may help surgeons guide their patients about the outcomes in the longer term after the first revision of hip resurfacing arthroplasty. Level III, therapeutic study.

Community Engaged Cumulative Risk Assessment of Exposure to Inorganic Well Water Contaminants, Crow Reservation, Montana

PubMed Central

Doyle, John T.; Lefthand, Myra J.; Young, Sara L.; Kindness, Larry; Other Medicine, Roberta; Ford, Timothy E.; Dietrich, Eric; Parker, Albert E.; Hoover, Joseph H.; Camper, Anne K.

2018-01-01

An estimated 11 million people in the US have home wells with unsafe levels of hazardous metals and nitrate. The national scope of the health risk from consuming this water has not been assessed as home wells are largely unregulated and data on well water treatment and consumption are lacking. Here, we assessed health risks from consumption of contaminated well water on the Crow Reservation by conducting a community-engaged, cumulative risk assessment. Well water testing, surveys and interviews were used to collect data on contaminant concentrations, water treatment methods, well water consumption, and well and septic system protection and maintenance practices. Additive Hazard Index calculations show that the water in more than 39% of wells is unsafe due to uranium, manganese, nitrate, zinc and/or arsenic. Most families’ financial resources are limited, and 95% of participants do not employ water treatment technologies. Despite widespread high total dissolved solids, poor taste and odor, 80% of families consume their well water. Lack of environmental health literacy about well water safety, pre-existing health conditions and limited environmental enforcement also contribute to vulnerability. Ensuring access to safe drinking water and providing accompanying education are urgent public health priorities for Crow and other rural US families with low environmental health literacy and limited financial resources. PMID:29304032

Dietary risk assessment of pesticides from vegetables and drinking water in gardening areas in Burkina Faso.

PubMed

Lehmann, Edouard; Turrero, Nuria; Kolia, Marius; Konaté, Yacouba; de Alencastro, Luiz Felippe

2017-12-01

Vegetables and water samples have been collected around the lake of Loumbila in Burkina Faso. Pesticides residues in food commodities were analyzed using a modified QuEChERS extraction method prior analysis on GC-MS and UPLC-MS/MS of 31 pesticides. Maximum Residue Limits (MRLs) were exceeded in 36% of the samples for seven pesticides: acetamiprid, carbofuran, chlorpyrifos, lambda-cyhalothrin, dieldrin, imidacloprid and profenofos. Exceedance of MRLs suggests a risk for the consumers and limits the opportunities of exportation. In order to define estimated daily intake, dietary surveys were conducted on 126 gardeners using a 24hours recall method. Single pesticide and cumulative exposure risks were assessed for children and adults. Risk was identified for: chlorpyrifos and lambda-cyhalothrin in acute and chronic exposure scenarios. Hazardous chronic exposure to the endocrine disruptor and probable carcinogen dieldrin was also detected. In the studied population, cumulative dietary exposure presented a risk (acute and chronic) for children and adults in respectively >17% and 4% of the cases when considering the worst case scenarios. Processing factor largely influenced the risk of occurrence suggesting that simple washing of vegetables with water considerably reduced the risk of hazardous exposure. Copyright © 2017 Elsevier B.V. All rights reserved.

Estimation of Drug Effectiveness by Modeling Three Time-dependent Covariates: An Application to Data on Cardioprotective Medications in the Chronic Dialysis Population

PubMed Central

Phadnis, Milind A.; Shireman, Theresa I.; Wetmore, James B.; Rigler, Sally K.; Zhou, Xinhua; Spertus, John A.; Ellerbeck, Edward F.; Mahnken, Jonathan D.

2014-01-01

In a population of chronic dialysis patients with an extensive burden of cardiovascular disease, estimation of the effectiveness of cardioprotective medication in literature is based on calculation of a hazard ratio comparing hazard of mortality for two groups (with or without drug exposure) measured at a single point in time or through the cumulative metric of proportion of days covered (PDC) on medication. Though both approaches can be modeled in a time-dependent manner using a Cox regression model, we propose a more complete time-dependent metric for evaluating cardioprotective medication efficacy. We consider that drug effectiveness is potentially the result of interactions between three time-dependent covariate measures, current drug usage status (ON versus OFF), proportion of cumulative exposure to drug at a given point in time, and the patient’s switching behavior between taking and not taking the medication. We show that modeling of all three of these time-dependent measures illustrates more clearly how varying patterns of drug exposure affect drug effectiveness, which could remain obscured when modeled by the more standard single time-dependent covariate approaches. We propose that understanding the nature and directionality of these interactions will help the biopharmaceutical industry in better estimating drug efficacy. PMID:25343005

Estimation of Drug Effectiveness by Modeling Three Time-dependent Covariates: An Application to Data on Cardioprotective Medications in the Chronic Dialysis Population.

PubMed

Phadnis, Milind A; Shireman, Theresa I; Wetmore, James B; Rigler, Sally K; Zhou, Xinhua; Spertus, John A; Ellerbeck, Edward F; Mahnken, Jonathan D

2014-01-01

In a population of chronic dialysis patients with an extensive burden of cardiovascular disease, estimation of the effectiveness of cardioprotective medication in literature is based on calculation of a hazard ratio comparing hazard of mortality for two groups (with or without drug exposure) measured at a single point in time or through the cumulative metric of proportion of days covered (PDC) on medication. Though both approaches can be modeled in a time-dependent manner using a Cox regression model, we propose a more complete time-dependent metric for evaluating cardioprotective medication efficacy. We consider that drug effectiveness is potentially the result of interactions between three time-dependent covariate measures, current drug usage status (ON versus OFF), proportion of cumulative exposure to drug at a given point in time, and the patient's switching behavior between taking and not taking the medication. We show that modeling of all three of these time-dependent measures illustrates more clearly how varying patterns of drug exposure affect drug effectiveness, which could remain obscured when modeled by the more standard single time-dependent covariate approaches. We propose that understanding the nature and directionality of these interactions will help the biopharmaceutical industry in better estimating drug efficacy.

Cumulative Risk Disparities in Children's Neurocognitive Functioning: A Developmental Cascade Model

ERIC Educational Resources Information Center

Wade, Mark; Browne, Dillon T.; Plamondon, Andre; Daniel, Ella; Jenkins, Jennifer M.

2016-01-01

The current longitudinal study examined the role of cumulative social risk on children's theory of mind (ToM) and executive functioning (EF) across early development. Further, we also tested a cascade model of development in which children's social cognition at 18 months was hypothesized to predict ToM and EF at age 4.5 through intermediary…

Cumulant generating function formula of heat transfer in ballistic systems with lead-lead coupling and general nonlinear systems

NASA Astrophysics Data System (ADS)

Li, Huanan

2013-03-01

Based on a two-time observation protocol, we consider heat transfer in a given time interval tM in a lead-junction-lead system taking coupling between the leads into account. In view of the two-time observation, consistency conditions are carefully verified in our specific family of quantum histories. Furthermore, its implication is briefly explored. Then using the nonequilibrium Green's function method, we obtain an exact formula for the cumulant generating function for heat transfer between the two leads, valid in both transient and steady-state regimes. Also, a compact formula for the cumulant generating function in the long-time limit is derived, for which the Gallavotti-Cohen fluctuation symmetry is explicitly verified. In addition, we briefly discuss Di Ventra's repartitioning trick regarding whether the repartitioning procedure of the total Hamiltonian affects the nonequilibrium steady-state current fluctuation. All kinds of properties of nonequilibrium current fluctuations, such as the fluctuation theorem in different time regimes, could be readily given according to these exact formulas. Finally a practical formalism dealing with cumulants of heat transfer across general nonlinear quantum systems is established based on field theoretical/algebraic method.

A long term study of pulmonary function among US refractory ceramic fibre workers

PubMed Central

LeMasters, Grace K; Hilbert, Timothy J; Levin, Linda S; Rice, Carol H; Borton, Eric K; Lockey, James E

2010-01-01

Background Cross-sectional studies have shown declines in lung function among refractory ceramic fibre (RCF) workers with increasing fibre exposure. This study followed current and former workers (n=1396) for up to 17 years and collected 5243 pulmonary function tests. Methods Cumulative fibre exposure and production years were categorised into exposure levels at five manufacturing locations. Conventional longitudinal models did not adequately partition age-related changes from other time-dependent variables. Therefore, a restricted cubic spline model was developed to account for the non-linear decline with age. Results Cumulative fibre >60 fibre-months/cc showed a significant loss in lung function at the first test. When results were examined longitudinally, cumulative exposure was confounded with age as workers with the highest cumulative exposure were generally older. A longitudinal model adjusted by age groups was implemented to control for this confounding. No consistent longitudinal loss in lung function was observed with RCF exposure. Smoking, initial weight and weight increase were significant factors. Conclusion No consistent decline was observed longitudinally with exposure to RCF, although cross-sectional and longitudinal findings were discordant. Confounding and accelerated lung function declines with ageing and the correlation of multiple time-dependent variables should be considered in order to minimise error and maximise precision. An innovative statistical methodology for these types of data is described. PMID:20798015

Pulmonary function of U.S. coal miners related to dust exposure estimates.

PubMed

Attfield, M D; Hodous, T K

1992-03-01

This study of 7,139 U.S. coal miners used linear regression analysis to relate estimates of cumulative dust exposure to several pulmonary function variables measured during medical examinations undertaken between 1969 and 1971. The exposure data included newly derived cumulative dust exposure estimates for the period up to time of examination based on large data bases of underground airborne dust sampling measurements. Negative associations were found between measures of cumulative exposure and FEV1, FVC, and the FEV1/FVC ratio (p less than 0.001). In general, the relationships were similar to those reported for British coal miners. Overall, the results demonstrate an adverse effect of coal mine dust exposure on pulmonary function that occurs even in the absence of radiographically detected pneumoconiosis.

Cumulative psychosocial risk, parental socialization, and child cognitive functioning: A longitudinal cascade model.

PubMed

Wade, Mark; Madigan, Sheri; Plamondon, Andre; Rodrigues, Michelle; Browne, Dillon; Jenkins, Jennifer M

2018-06-01

Previous studies have demonstrated that various psychosocial risks are associated with poor cognitive functioning in children, and these risks frequently cluster together. In the current longitudinal study, we tested a model in which it was hypothesized that cumulative psychosocial adversity of mothers would have deleterious effects on children's cognitive functioning by compromising socialization processes within families (i.e., parental competence). A prospective community birth cohort of 501 families was recruited when children were newborns. At this time, mothers reported on their current psychosocial circumstances (socioeconomic status, teen parenthood, depression, etc.), which were summed into a cumulative risk score. Families were followed up at 18 months and 3 years, at which point maternal reflective capacity and cognitive sensitivity were measured, respectively. Child cognition (executive functioning, theory of mind, and language ability) was assessed at age 4.5 using age-appropriate observational and standardized tasks. Analyses controlled for child age, gender, number of children in the home, number of years married, and mothers' history of adversity. The results revealed significant declines in child cognition as well as maternal reflective capacity and cognitive sensitivity as the number of psychosocial risks increased. Moreover, longitudinal path analysis showed significant indirect effects from cumulative risk to all three cognitive outcomes via reflective capacity and cognitive sensitivity. Findings suggest that cumulative risk of mothers may partially account for child cognitive difficulties in various domains by disrupting key parental socialization competencies. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Assessing the impacts induced by global climate change through a multi-risk approach: lessons learned from the North Adriatic coast (Italy)

NASA Astrophysics Data System (ADS)

Gallina, Valentina; Torressan, Silvia; Zabeo, Alex; Critto, Andrea; Glade, Thomas; Marcomini, Antonio

2015-04-01

Climate change is expected to pose a wide range of impacts on natural and human systems worldwide, increasing risks from long-term climate trends and disasters triggered by weather extremes. Accordingly, in the future, one region could be potentially affected by interactions, synergies and trade-offs of multiple hazards and impacts. A multi-risk risk approach is needed to effectively address multiple threats posed by climate change across regions and targets supporting decision-makers toward a new paradigm of multi-hazard and risk management. Relevant initiatives have been already developed for the assessment of multiple hazards and risks affecting the same area in a defined timeframe by means of quantitative and semi-quantitative approaches. Most of them are addressing the relations of different natural hazards, however, the effect of future climate change is usually not considered. In order to fill this gap, an advanced multi-risk methodology was developed at the Euro-Mediterranean Centre on Climate Change (CMCC) for estimating cumulative impacts related to climate change at the regional (i.e. sub-national) scale. This methodology was implemented into an assessment tool which allows to scan and classify quickly natural systems and human assets at risk resulting from different interacting hazards. A multi-hazard index is proposed to evaluate the relationships of different climate-related hazards (e.g. sea-level rise, coastal erosion, storm surge) occurring in the same spatial and temporal area, by means of an influence matrix and the disjoint probability function. Future hazard scenarios provided by regional climate models are used as input for this step in order to consider possible effects of future climate change scenarios. Then, the multi-vulnerability of different exposed receptors (e.g. natural systems, beaches, agricultural and urban areas) is estimated through a variety of vulnerability indicators (e.g. vegetation cover, sediment budget, % of urbanization), tailored case by case to different sets of natural hazards and elements at risk. Finally, the multi-risk assessment integrates the multi-hazard with the multi-vulnerability index of exposed receptors, providing a relative ranking of areas and targets potentially affected by multiple risks in the considered region. The methodology was applied to the North Adriatic coast (Italy) producing a range of GIS-based multi-hazard, exposure, multi-vulnerability and multi-risk maps that can be used by policy-makers to define risk management and adaptation strategies. Results show that areas affected by higher multi-hazard scores are located close to the coastline where all the investigated hazards are present. Multi-vulnerability assumes relatively high scores in the whole case study, showing that beaches, wetlands, protected areas and river mouths are the more sensible targets. The final estimate of multi-risk for coastal municipalities provides useful information for local public authorities to set future priorities for adaptation and define future plans for shoreline and coastal management in view of climate change.

Association between adjuvant chemotherapy and risk of acute kidney injury in elderly women diagnosed with early-stage breast cancer.

PubMed

Li, Shuling; Liu, Jiannong; Virnig, Beth A; Collins, Allan J

2017-02-01

We studied elderly Medicare enrollees newly diagnosed with early-stage breast cancer to examine the association between adjuvant chemotherapy and acute kidney injury (AKI). Using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we conducted a retrospective cohort study including women diagnosed with stages I-III breast cancer at ages 66-89 years between 1992 and 2007. We performed one-to-one matching on time-dependent propensity score on the day of adjuvant chemotherapy initiation within 6 months after the first cancer-directed surgery based on the estimated probability of chemotherapy initiation at each day for each patient, using a Cox proportional hazards model. We estimated the cumulative incidence of AKI using Kaplan-Meier methods. We used Cox proportional hazards models to evaluate the association between chemotherapy and the risk of AKI, and compared the risk among major chemotherapy types. The study included 28,048 women. The 6-month cumulative incidence of AKI was 0.80% for chemotherapy-treated patients, compared with 0.30% for untreated patients (P < 0.001). Adjuvant chemotherapy was associated with a nearly threefold increased risk of AKI [hazard ratio (HR) 2.73; 95% CI 1.8-4.1]. Compared with anthracycline-based chemotherapy, the HRs (95% CIs) were 1.66 (0.94-2.91), 0.88 (0.53-1.47), and 1.15 (0.57-2.32) for taxane-based, CMF, and other chemotherapy, respectively. Our findings showed that adjuvant chemotherapy was associated with increased risk of AKI in elderly women diagnosed with early-stage breast cancer. The risk seemed to vary by regimen type, but the differences were not statistically significant.

A simulation model for studying the role of pre-slaughter factors on the exposure of beef carcasses to human microbial hazards.

PubMed

Jordan, D; McEwen, S A; Lammerding, A M; McNab, W B; Wilson, J B

1999-06-29

A Monte Carlo simulation model was constructed for assessing the quantity of microbial hazards deposited on cattle carcasses under different pre-slaughter management regimens. The model permits comparison of industry-wide and abattoir-based mitigation strategies and is suitable for studying pathogens such as Escherichia coli O157:H7 and Salmonella spp. Simulations are based on a hierarchical model structure that mimics important aspects of the cattle population prior to slaughter. Stochastic inputs were included so that uncertainty about important input assumptions (such as prevalence of a human pathogen in the live cattle-population) would be reflected in model output. Control options were built into the model to assess the benefit of having prior knowledge of animal or herd-of-origin pathogen status (obtained from the use of a diagnostic test). Similarly, a facility was included for assessing the benefit of re-ordering the slaughter sequence based on the extent of external faecal contamination. Model outputs were designed to evaluate the performance of an abattoir in a 1-day period and included outcomes such as the proportion of carcasses contaminated with a pathogen, the daily mean and selected percentiles of pathogen counts per carcass, and the position of the first infected animal in the slaughter run. A measure of the time rate of introduction of pathogen into the abattoir was provided by assessing the median, 5th percentile, and 95th percentile cumulative pathogen counts at 10 equidistant points within the slaughter run. Outputs can be graphically displayed as frequency distributions, probability densities, cumulative distributions or x-y plots. The model shows promise as an inexpensive method for evaluating pathogen control strategies such as those forming part of a Hazard Analysis and Critical Control Point (HACCP) system.

Active tectonics of the Seattle fault and central Puget sound, Washington - Implications for earthquake hazards

USGS Publications Warehouse

Johnson, S.Y.; Dadisman, S.V.; Childs, J. R.; Stanley, W.D.

1999-01-01

We use an extensive network of marine high-resolution and conventional industry seismic-reflection data to constrain the location, shallow structure, and displacement rates of the Seattle fault zone and crosscutting high-angle faults in the Puget Lowland of western Washington. Analysis of seismic profiles extending 50 km across the Puget Lowland from Lake Washington to Hood Canal indicates that the west-trending Seattle fault comprises a broad (4-6 km) zone of three or more south-dipping reverse faults. Quaternary sediment has been folded and faulted along all faults in the zone but is clearly most pronounced along fault A, the northernmost fault, which forms the boundary between the Seattle uplift and Seattle basin. Analysis of growth strata deposited across fault A indicate minimum Quaternary slip rates of about 0.6 mm/yr. Slip rates across the entire zone are estimated to be 0.7-1.1 mm/yr. The Seattle fault is cut into two main segments by an active, north-trending, high-angle, strike-slip fault zone with cumulative dextral displacement of about 2.4 km. Faults in this zone truncate and warp reflections in Tertiary and Quaternary strata and locally coincide with bathymetric lineaments. Cumulative slip rates on these faults may exceed 0.2 mm/yr. Assuming no other crosscutting faults, this north-trending fault zone divides the Seattle fault into 30-40-km-long western and eastern segments. Although this geometry could limit the area ruptured in some Seattle fault earthquakes, a large event ca. A.D. 900 appears to have involved both segments. Regional seismic-hazard assessments must (1) incorporate new information on fault length, geometry, and displacement rates on the Seattle fault, and (2) consider the hazard presented by the previously unrecognized, north-trending fault zone.

Radiation hazards to vascular surgeon and scrub nurse in mobile fluoroscopy equipped hybrid vascular room

PubMed Central

Kim, Jong Bin; Lee, Jaehoon

2017-01-01

Purpose The aim of the present study was to identify the radiation hazards to vascular surgeons and scrub nurses working in mobile fluoroscopy equipped hybrid vascular operation rooms; additionally, to estimate cumulative cancer risk due to certain exposure dosages. Methods The study was conducted prospectively in 71 patients (53 men and 18 women) who had undergone vascular intervention at our hybrid vascular theater for 6 months. OEC 9900 fluoroscopy was used as mobile C-arm. Exposure dose (ED) was measured by attaching optically stimulated luminescence at in and outside of the radiation protectors. To measure X-ray scatter with the anthropomorphic phantom model, the dose was measured at 3 distances (20, 50, 100 cm) and 3 angles (horizontal, upward 45°, downward 45°) using a personal gamma radiation dosimeter, Ecotest CARD DKG-21, for 1, 3, 5, 10 minutes. Results Lifetime attributable risk of cancer was estimated using the approach of the Biological Effects of Ionizing Radiation report VII. The 6-month ED of vascular surgeons and scrub nurses were 3.85, 1.31 mSv, respectively. The attenuation rate of lead apron, neck protector and goggle were 74.6%, 60.6%, and 70.1%, respectively. All cancer incidences among surgeons and scrub nurses correspond to 2,355 and 795 per 100,000 persons. The 10-minute dose at 100-cm distance was 0.004 mSv at horizontal, 0.009 mSv at downward 45°, 0.003 mSv at upward 45°. Conclusion Although yearly radiation hazards for vascular surgeons and scrub nurses are still within safety guidelines, protection principles can never be too stringent when aiming to minimize the cumulative harmful effects. PMID:28289670

Association of Serious Fall Injuries among United States End Stage Kidney Disease Patients with Access to Kidney Transplantation.

PubMed

Plantinga, Laura C; Lynch, Raymond J; Patzer, Rachel E; Pastan, Stephen O; Bowling, C Barrett

2018-04-06

Serious fall injuries in the setting of ESKD may be associated with poor access to kidney transplant. We explored the burden of serious fall injuries among patients on dialysis and patients on the deceased donor waitlist and the associations of these fall injuries with waitlisting and transplantation. Our analytic cohorts for the outcomes of ( 1 ) waitlisting and ( 2 ) transplantation included United States adults ages 18-80 years old who ( 1 ) initiated dialysis ( n =183,047) and ( 2 ) were waitlisted for the first time ( n =37,752) in 2010-2013. Serious fall injuries were determined by diagnostic codes for falls plus injury (fracture, joint dislocation, or head trauma) in inpatient and emergency department claims; the first serious fall injury after cohort entry was included as a time-varying exposure. Follow-up ended at the specified outcome, death, or the last date of follow-up (September 30, 2014). We used multivariable Cox proportional hazards models to determine the independent associations between serious fall injury and waitlisting or transplantation. Overall, 2-year cumulative incidence of serious fall injury was 6% among patients on incident dialysis; with adjustment, patients who had serious fall injuries were 61% less likely to be waitlisted than patients who did not (hazard ratio, 0.39; 95% confidence interval, 0.35 to 0.44). Among incident waitlisted patients (4% 2-year cumulative incidence), those with serious fall injuries were 29% less likely than their counterparts to be subsequently transplanted (hazard ratio, 0.71; 95% confidence interval, 0.63 to 0.80). Serious fall injuries among United States patients on dialysis are associated with substantially lower likelihood of waitlisting for and receipt of a kidney transplant. Copyright © 2018 by the American Society of Nephrology.

Ventricular conduction and long-term heart failure outcomes and mortality in African Americans: insights from the Jackson Heart Study.

PubMed

Mentz, Robert J; Greiner, Melissa A; DeVore, Adam D; Dunlay, Shannon M; Choudhary, Gaurav; Ahmad, Tariq; Khazanie, Prateeti; Randolph, Tiffany C; Griswold, Michael E; Eapen, Zubin J; O'Brien, Emily C; Thomas, Kevin L; Curtis, Lesley H; Hernandez, Adrian F

2015-03-01

QRS prolongation is associated with adverse outcomes in mostly white populations, but its clinical significance is not well established for other groups. We investigated the association between QRS duration and mortality in African Americans. We analyzed data from 5146 African Americans in the Jackson Heart Study stratified by QRS duration on baseline 12-lead ECG. We defined QRS prolongation as QRS≥100 ms. We assessed the association between QRS duration and all-cause mortality using Cox proportional hazards models and reported the cumulative incidence of heart failure hospitalization. We identified factors associated with the development of QRS prolongation in patients with normal baseline QRS. At baseline, 30% (n=1528) of participants had QRS prolongation. The cumulative incidences of mortality and heart failure hospitalization were greater with versus without baseline QRS prolongation: 12.6% (95% confidence interval [CI], 11.0-14.4) versus 7.1% (95% CI, 6.3-8.0) and 8.2% (95% CI, 6.9-9.7) versus 4.4% (95% CI, 3.7-5.1), respectively. After risk adjustment, QRS prolongation was associated with increased mortality (hazard ratio, 1.27; 95% CI, 1.03-1.56; P=0.02). There was a linear relationship between QRS duration and mortality (hazard ratio per 10 ms increase, 1.06; 95% CI, 1.01-1.12). Older age, male sex, prior myocardial infarction, lower ejection fraction, left ventricular hypertrophy, and left ventricular dilatation were associated with the development of QRS prolongation. QRS prolongation in African Americans was associated with increased mortality and heart failure hospitalization. Factors associated with developing QRS prolongation included age, male sex, prior myocardial infarction, and left ventricular structural abnormalities. © 2015 American Heart Association, Inc.

Comparison of risk scores for the prediction of stroke in African Americans: Findings from the Jackson Heart Study.

PubMed

Foraker, Randi E; Greiner, Melissa; Sims, Mario; Tucker, Katherine L; Towfighi, Amytis; Bidulescu, Aurelian; Shoben, Abigail B; Smith, Sakima; Talegawkar, Sameera; Blackshear, Chad; Wang, Wei; Hardy, Natalie Chantelle; O'Brien, Emily

2016-07-01

Evidence from existing cohort studies supports the prediction of incident coronary heart disease and stroke using 10-year cardiovascular disease (CVD) risk scores and the American Heart Association/American Stroke Association's cardiovascular health (CVH) metric. We included all Jackson Heart Study participants with complete scoring information at the baseline study visit (2000-2004) who had no history of stroke (n = 4,140). We used Kaplan-Meier methods to calculate the cumulative incidence of stroke and used Cox models to estimate hazard ratios and 95% CIs for stroke according to CVD risk and CVH score. We compared the discrimination of the 2 models according to the Harrell c index and plotted predicted vs observed stroke risk calibration plots for each of the 2 models. The median age of the African American participants was 54.5 years, and 65% were female. The cumulative incidence of stroke increased across worsening categories of CVD risk and CVH. A 1-unit increase in CVD risk increased the hazard of stroke (1.07, 1.06-1.08), whereas each 1-unit increase in CVH corresponded to a decreased hazard of stroke (0.76, 0.69-0.83). As evidenced by the c statistics, the CVH model was less discriminating than the CVD risk model (0.59 [0.55-0.64] vs 0.79 [0.76-0.83]). Both scores were associated with incident stroke in a dose-response fashion; however, the CVD risk model was more discriminating than the CVH model. The CVH score may still be preferable for its simplicity in application to broad patient populations and public health efforts. Copyright © 2016 Elsevier Inc. All rights reserved.

Clinical Risk Stratification for Primary Prevention Implantable Cardioverter Defibrillators

PubMed Central

Hardy, Judy; Yee, Raymond; Healey, Jeffrey S.; Birnie, David; Simpson, Christopher S.; Crystal, Eugene; Mangat, Iqwal; Nanthakumar, Kumaraswamy; Wang, Xuesong; Krahn, Andrew D.; Dorian, Paul; Austin, Peter C.; Tu, Jack V.

2015-01-01

Background— A conceptualized model may be useful for understanding risk stratification of primary prevention implantable cardioverter defibrillators considering the competing risks of appropriate implantable cardioverter defibrillator shock versus mortality. Methods and Results— In a prospective, multicenter, population-based cohort with left ventricular ejection fraction ≤35% referred for primary prevention implantable cardioverter defibrillator, we developed dual risk stratification models to determine the competing risks of appropriate defibrillator shock versus mortality using a Fine-Gray subdistribution hazard model. Among 7020 patients referred, 3445 underwent defibrillator implant (79.7% men, median, 66 years [25th, 75th: 58–73]). During 5918 person-years of follow-up, appropriate shock occurred in 204 patients (3.6 shocks/100 person-years) and 292 died (4.9 deaths/100 person-years). Competing risk predictors of appropriate shock included nonsustained ventricular tachycardia, atrial fibrillation, serum creatinine concentration, digoxin or amiodarone use, and QRS duration near 130-ms peak. One-year cumulative incidence of appropriate shock was 0.9% in the lowest risk category, and 1.7%, 2.5%, 4.9%, and 9.3% in low, intermediate, high, and highest risk groups, respectively. Hazard ratios for appropriate shock ranged from 4.04 to 7.79 in the highest 3 deciles (all P≤0.001 versus lowest risk). Cumulative incidence of 1-year death was 0.6%, 1.9%, 3.3%, 6.2%, and 17.7% in lowest, low, intermediate, high, and highest risk groups, respectively. Mortality hazard ratios ranged from 11.48 to 36.22 in the highest 3 deciles (all P<0.001 versus lowest risk). Conclusions— Simultaneous estimation of risks of appropriate shock and mortality can be performed using clinical variables, providing a potential framework for identification of patients who are unlikely to benefit from prophylactic implantable cardioverter defibrillator. PMID:26224792

Untangling the Relationship Between Antiretroviral Therapy Use and Incident Pregnancy: A Marginal Structural Model Analysis Using Data From 47,313 HIV-Positive Women in East Africa.

PubMed

Elul, Batya; Wools-Kaloustian, Kara K; Wu, Yingfeng; Musick, Beverly S; Nuwagaba-Biribonwoha, Harriet; Nash, Denis; Ayaya, Samuel; Bukusi, Elizabeth; Okong, Pius; Otieno, Juliana; Wabwire, Deo; Kambugu, Andrew; Yiannoutsos, Constantin T

2016-07-01

Scale-up of triple-drug antiretroviral therapy (ART) in Africa has transformed the context of childbearing for HIV-positive women and may impact pregnancy incidence in HIV programs. Using observational data from 47,313 HIV-positive women enrolled at 26 HIV clinics in Kenya and Uganda between 2001 and 2009, we calculated the crude cumulative incidence of pregnancy for the pre-ART and on-ART periods. The causal effect of ART use on incident pregnancy was assessed using inverse probability weighted marginal structural models, and the relationship was further explored in multivariable Cox models. Crude cumulative pregnancy incidence at 1 year after enrollment/ART initiation was 4.0% and 3.9% during the pre-ART and on-ART periods, respectively. In marginal structural models, ART use was not significantly associated with incident pregnancy [hazard ratio = 1.06; 95% confidence interval (CI): 0.99 to 1.12]. Similarly, in Cox models, there was no significant relationship between ART use and incident pregnancy (cause-specific hazard ratio: 0.98; 95% CI: 0.91 to 1.05), but effect modification was observed. Specifically, women who were pregnant at enrollment and on ART had an increased risk of incident pregnancy compared to those not pregnant at enrollment and not on ART (cause-specific hazard ratio: 1.11; 95% CI: 1.01 to 1.23). In this large cohort, ART initiation was not associated with incident pregnancy in the general population of women enrolling in HIV care but rather only among those pregnant at enrollment. This finding further highlights the importance of scaling up access to lifelong treatment for pregnant women.

Untangling the Relationship Between Antiretroviral Therapy Use and Incident Pregnancy: A Marginal Structural Model Analysis Using Data From 47,313 HIV-Positive Women in East Africa

PubMed Central

Wools-Kaloustian, Kara K.; Wu, Yingfeng; Musick, Beverly S.; Nuwagaba-Biribonwoha, Harriet; Nash, Denis; Ayaya, Samuel; Bukusi, Elizabeth; Okong, Pius; Otieno, Juliana; Wabwire, Deo; Kambugu, Andrew; Yiannoutsos, Constantin T.

2016-01-01

Background: Scale-up of triple-drug antiretroviral therapy (ART) in Africa has transformed the context of childbearing for HIV-positive women and may impact pregnancy incidence in HIV programs. Methods: Using observational data from 47,313 HIV-positive women enrolled at 26 HIV clinics in Kenya and Uganda between 2001 and 2009, we calculated the crude cumulative incidence of pregnancy for the pre-ART and on-ART periods. The causal effect of ART use on incident pregnancy was assessed using inverse probability weighted marginal structural models, and the relationship was further explored in multivariable Cox models. Results: Crude cumulative pregnancy incidence at 1 year after enrollment/ART initiation was 4.0% and 3.9% during the pre-ART and on-ART periods, respectively. In marginal structural models, ART use was not significantly associated with incident pregnancy [hazard ratio = 1.06; 95% confidence interval (CI): 0.99 to 1.12]. Similarly, in Cox models, there was no significant relationship between ART use and incident pregnancy (cause-specific hazard ratio: 0.98; 95% CI: 0.91 to 1.05), but effect modification was observed. Specifically, women who were pregnant at enrollment and on ART had an increased risk of incident pregnancy compared to those not pregnant at enrollment and not on ART (cause-specific hazard ratio: 1.11; 95% CI: 1.01 to 1.23). Conclusions: In this large cohort, ART initiation was not associated with incident pregnancy in the general population of women enrolling in HIV care but rather only among those pregnant at enrollment. This finding further highlights the importance of scaling up access to lifelong treatment for pregnant women. PMID:26910499

Instrumental variables estimation of exposure effects on a time-to-event endpoint using structural cumulative survival models.

PubMed

Martinussen, Torben; Vansteelandt, Stijn; Tchetgen Tchetgen, Eric J; Zucker, David M

2017-12-01

The use of instrumental variables for estimating the effect of an exposure on an outcome is popular in econometrics, and increasingly so in epidemiology. This increasing popularity may be attributed to the natural occurrence of instrumental variables in observational studies that incorporate elements of randomization, either by design or by nature (e.g., random inheritance of genes). Instrumental variables estimation of exposure effects is well established for continuous outcomes and to some extent for binary outcomes. It is, however, largely lacking for time-to-event outcomes because of complications due to censoring and survivorship bias. In this article, we make a novel proposal under a class of structural cumulative survival models which parameterize time-varying effects of a point exposure directly on the scale of the survival function; these models are essentially equivalent with a semi-parametric variant of the instrumental variables additive hazards model. We propose a class of recursive instrumental variable estimators for these exposure effects, and derive their large sample properties along with inferential tools. We examine the performance of the proposed method in simulation studies and illustrate it in a Mendelian randomization study to evaluate the effect of diabetes on mortality using data from the Health and Retirement Study. We further use the proposed method to investigate potential benefit from breast cancer screening on subsequent breast cancer mortality based on the HIP-study. © 2017, The International Biometric Society.

Incidence of leukemia, lymphoma, and multiple myeloma in Czech uranium miners: a case-cohort study.

PubMed

Rericha, Vladimír; Kulich, Michal; Rericha, Robert; Shore, David L; Sandler, Dale P

2006-06-01

Uranium miners are chronically exposed to low levels of radon and its progeny. We investigated whether radon exposure is associated with increased incidence of leukemia, lymphoma, or multiple myeloma in this population. We conducted a retrospective case-cohort study in 23,043 uranium miners and identified a total of 177 incident cases of leukemia, lymphoma, and myeloma. Detailed information on occupational radon exposure was obtained for the cases and a randomly selected subcohort of 2,393 subjects. We used the proportional hazards model with power relative risk (RR) function to estimate and test the effects of cumulative radon exposures on incidence rates. Incidence of all leukemia combined and chronic lymphocytic leukemia (CLL) alone was positively associated with cumulative radon exposure. The RR comparing high radon exposure [110 working level months (WLM) ; 80th percentile] to low radon exposure (3 WLM ; 20th percentile) was 1.75 [95% confidence interval (CI) , 1.10-2.78 ; p = 0.014] for all leukemia combined and 1.98 (95% CI, 1.10-3.59 ; p = 0.016) for CLL. Myeloid leukemia and Hodgkin lymphoma were also associated with radon, but RRs were not statistically significant. There was no apparent association of radon with either non-Hodgkin lymphoma or multiple myeloma. Exposure to radon and its progeny was associated with an increased risk of developing leukemia in underground uranium miners. CLL, not previously believed to be radiogenic, was linked to radon exposure.

Incidence of Leukemia, Lymphoma, and Multiple Myeloma in Czech Uranium Miners: A Case–Cohort Study

PubMed Central

Řeřicha, Vladimír; Kulich, Michal; Řeřicha, Robert; Shore, David L.; Sandler, Dale P.

2006-01-01

Objective Uranium miners are chronically exposed to low levels of radon and its progeny. We investigated whether radon exposure is associated with increased incidence of leukemia, lymphoma, or multiple myeloma in this population. Design We conducted a retrospective case–cohort study in 23,043 uranium miners and identified a total of 177 incident cases of leukemia, lymphoma, and myeloma. Detailed information on occupational radon exposure was obtained for the cases and a randomly selected subcohort of 2,393 subjects. We used the proportional hazards model with power relative risk (RR) function to estimate and test the effects of cumulative radon exposures on incidence rates. Results Incidence of all leukemia combined and chronic lymphocytic leukemia (CLL) alone was positively associated with cumulative radon exposure. The RR comparing high radon exposure [110 working level months (WLM); 80th percentile] to low radon exposure (3 WLM; 20th percentile) was 1.75 [95% confidence interval (CI), 1.10–2.78; p = 0.014] for all leukemia combined and 1.98 (95% CI, 1.10–3.59; p = 0.016) for CLL. Myeloid leukemia and Hodgkin lymphoma were also associated with radon, but RRs were not statistically significant. There was no apparent association of radon with either non-Hodgkin lymphoma or multiple myeloma. Exposure to radon and its progeny was associated with an increased risk of developing leukemia in underground uranium miners. CLL, not previously believed to be radiogenic, was linked to radon exposure. PMID:16759978

Rock size-frequency distributions on Mars and implications for Mars Exploration Rover landing safety and operations

NASA Astrophysics Data System (ADS)

Golombek, M. P.; Haldemann, A. F. C.; Forsberg-Taylor, N. K.; DiMaggio, E. N.; Schroeder, R. D.; Jakosky, B. M.; Mellon, M. T.; Matijevic, J. R.

2003-10-01

The cumulative fractional area covered by rocks versus diameter measured at the Pathfinder site was predicted by a rock distribution model that follows simple exponential functions that approach the total measured rock abundance (19%), with a steep decrease in rocks with increasing diameter. The distribution of rocks >1.5 m diameter visible in rare boulder fields also follows this steep decrease with increasing diameter. The effective thermal inertia of rock populations calculated from a simple empirical model of the effective inertia of rocks versus diameter shows that most natural rock populations have cumulative effective thermal inertias of 1700-2100 J m-2 s-0.5 K-1 and are consistent with the model rock distributions applied to total rock abundance estimates. The Mars Exploration Rover (MER) airbags have been successfully tested against extreme rock distributions with a higher percentage of potentially hazardous triangular buried rocks than observed at the Pathfinder and Viking landing sites. The probability of the lander impacting a >1 m diameter rock in the first 2 bounces is <3% and <5% for the Meridiani and Gusev landing sites, respectively, and is <0.14% and <0.03% for rocks >1.5 m and >2 m diameter, respectively. Finally, the model rock size-frequency distributions indicate that rocks >0.1 m and >0.3 m in diameter, large enough to place contact sensor instruments against and abrade, respectively, should be plentiful within a single sol's drive at the Meridiani and Gusev landing sites.

Cancer risks in twins and singletons from twin and non-twin families.

PubMed

Chen, Lingjing; Cnattingius, Sven; Nyman Iliadou, Anastasia; Oberg, Anna Sara

2016-03-01

The unique intrauterine environment has been proposed to put twins at increased risk of certain cancers compared to singletons, still large population comparisons have generally indicated lower risks in twins. To improve the understanding of potential twin influence on cancer we compared twins to their singletons siblings, to target a unique twinning influence. Singletons from twin families were contrasted to singletons from non-twin families to further capture potential twin family influence on risk of cancer. Family relations were identified using the Swedish Multi-Generation Register. Among individuals born between 1932 and 1958, 49,156 twins and N = 35,227 singletons were identified from 18,098 unique twin families. All incident cases of specific cancer types were identified in the National Cancer Register up to the end of 2007. Standardized survival functions were estimated using weighted Cox proportional hazard regression and the corresponding cumulative risks plotted against age. Overall, primary cancers were identified in 9% and 18% of all male and female twins, compared to 11% and 19% of their male and female singleton siblings. When specific cancer sites were compared using standardized cumulative risk plots, no consistent statistically significant differences were noted either between twins and singletons of twin families or between singletons of twin and non-twin families. Despite a different intrauterine experience, twinning does not seem to have any greater negative influence on life-time risks of cancer. The findings also indicate that twin family membership has no substantial influence on cancer risks. © 2015 UICC.

About the cumulants of periodic signals

NASA Astrophysics Data System (ADS)

Barrau, Axel; El Badaoui, Mohammed

2018-01-01

This note studies cumulants of time series. These functions originating from the probability theory being commonly used as features of deterministic signals, their classical properties are examined in this modified framework. We show additivity of cumulants, ensured in the case of independent random variables, requires here a different hypothesis. Practical applications are proposed, in particular an analysis of the failure of the JADE algorithm to separate some specific periodic signals.

Declining Risk of Sudden Death in Heart Failure.

PubMed

Shen, Li; Jhund, Pardeep S; Petrie, Mark C; Claggett, Brian L; Barlera, Simona; Cleland, John G F; Dargie, Henry J; Granger, Christopher B; Kjekshus, John; Køber, Lars; Latini, Roberto; Maggioni, Aldo P; Packer, Milton; Pitt, Bertram; Solomon, Scott D; Swedberg, Karl; Tavazzi, Luigi; Wikstrand, John; Zannad, Faiez; Zile, Michael R; McMurray, John J V

2017-07-06

The risk of sudden death has changed over time among patients with symptomatic heart failure and reduced ejection fraction with the sequential introduction of medications including angiotensin-converting-enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, and mineralocorticoid-receptor antagonists. We sought to examine this trend in detail. We analyzed data from 40,195 patients who had heart failure with reduced ejection fraction and were enrolled in any of 12 clinical trials spanning the period from 1995 through 2014. Patients who had an implantable cardioverter-defibrillator at the time of trial enrollment were excluded. Weighted multivariable regression was used to examine trends in rates of sudden death over time. Adjusted hazard ratios for sudden death in each trial group were calculated with the use of Cox regression models. The cumulative incidence rates of sudden death were assessed at different time points after randomization and according to the length of time between the diagnosis of heart failure and randomization. Sudden death was reported in 3583 patients. Such patients were older and were more often male, with an ischemic cause of heart failure and worse cardiac function, than those in whom sudden death did not occur. There was a 44% decline in the rate of sudden death across the trials (P=0.03). The cumulative incidence of sudden death at 90 days after randomization was 2.4% in the earliest trial and 1.0% in the most recent trial. The rate of sudden death was not higher among patients with a recent diagnosis of heart failure than among those with a longer-standing diagnosis. Rates of sudden death declined substantially over time among ambulatory patients with heart failure with reduced ejection fraction who were enrolled in clinical trials, a finding that is consistent with a cumulative benefit of evidence-based medications on this cause of death. (Funded by the China Scholarship Council and the University of Glasgow.).

Circulating endothelial progenitor cells and cardiovascular outcomes.

PubMed

Werner, Nikos; Kosiol, Sonja; Schiegl, Tobias; Ahlers, Patrick; Walenta, Katrin; Link, Andreas; Böhm, Michael; Nickenig, Georg

2005-09-08

Endothelial progenitor cells derived from bone marrow are believed to support the integrity of the vascular endothelium. The number and function of endothelial progenitor cells correlate inversely with cardiovascular risk factors, but the prognostic value associated with circulating endothelial progenitor cells has not been defined. The number of endothelial progenitor cells positive for CD34 and kinase insert domain receptor (KDR) was determined with the use of flow cytometry in 519 patients with coronary artery disease as confirmed on angiography. After 12 months, we evaluated the association between baseline levels of endothelial progenitor cells and death from cardiovascular causes, the occurrence of a first major cardiovascular event (myocardial infarction, hospitalization, revascularization, or death from cardiovascular causes), revascularization, hospitalization, and death from all causes. A total of 43 participants died, 23 from cardiovascular causes. A first major cardiovascular event occurred in 214 patients. The cumulative event-free survival rate increased stepwise across three increasing baseline levels of endothelial progenitor cells in an analysis of death from cardiovascular causes, a first major cardiovascular event, revascularization, and hospitalization. After adjustment for age, sex, vascular risk factors, and other relevant variables, increased levels of endothelial progenitor cells were associated with a reduced risk of death from cardiovascular causes (hazard ratio, 0.31; 95 percent confidence interval, 0.16 to 0.63; P=0.001), a first major cardiovascular event (hazard ratio, 0.74; 95 percent confidence interval, 0.62 to 0.89; P=0.002), revascularization (hazard ratio, 0.77; 95 percent confidence interval, 0.62 to 0.95; P=0.02), and hospitalization (hazard ratio, 0.76; 95 percent confidence interval, 0.63 to 0.94; P=0.01). Endothelial progenitor-cell levels were not predictive of myocardial infarction or of death from all causes. The level of circulating CD34+KDR+ endothelial progenitor cells predicts the occurrence of cardiovascular events and death from cardiovascular causes and may help to identify patients at increased cardiovascular risk. Copyright 2005 Massachusetts Medical Society.

A Geometric View of the Mean of a Set of Numbers

ERIC Educational Resources Information Center

Sarkar, Jyotirmoy; Rashid, Mamunur

2016-01-01

The sample mean is sometimes depicted as a fulcrum placed under the Dot plot. We provide an alternative geometric visualization of the sample mean using the empirical cumulative distribution function or the cumulative histogram data.

Memory Hazard Functions: A Vehicle for Theory Development and Test

ERIC Educational Resources Information Center

Chechile, Richard A.

2006-01-01

A framework is developed to rigorously test an entire class of memory retention functions by examining hazard properties. Evidence is provided that the memory hazard function is not monotonically decreasing. Yet most of the proposals for retention functions, which have emerged from the psychological literature, imply that memory hazard is…

A proportional hazards regression model for the subdistribution with right-censored and left-truncated competing risks data

PubMed Central

Zhang, Xu; Zhang, Mei-Jie; Fine, Jason

2012-01-01

With competing risks failure time data, one often needs to assess the covariate effects on the cumulative incidence probabilities. Fine and Gray proposed a proportional hazards regression model to directly model the subdistribution of a competing risk. They developed the estimating procedure for right-censored competing risks data, based on the inverse probability of censoring weighting. Right-censored and left-truncated competing risks data sometimes occur in biomedical researches. In this paper, we study the proportional hazards regression model for the subdistribution of a competing risk with right-censored and left-truncated data. We adopt a new weighting technique to estimate the parameters in this model. We have derived the large sample properties of the proposed estimators. To illustrate the application of the new method, we analyze the failure time data for children with acute leukemia. In this example, the failure times for children who had bone marrow transplants were left truncated. PMID:21557288

Comparision of the different probability distributions for earthquake hazard assessment in the North Anatolian Fault Zone

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yilmaz, Şeyda, E-mail: seydayilmaz@ktu.edu.tr; Bayrak, Erdem, E-mail: erdmbyrk@gmail.com; Bayrak, Yusuf, E-mail: bayrak@ktu.edu.tr

In this study we examined and compared the three different probabilistic distribution methods for determining the best suitable model in probabilistic assessment of earthquake hazards. We analyzed a reliable homogeneous earthquake catalogue between a time period 1900-2015 for magnitude M ≥ 6.0 and estimated the probabilistic seismic hazard in the North Anatolian Fault zone (39°-41° N 30°-40° E) using three distribution methods namely Weibull distribution, Frechet distribution and three-parameter Weibull distribution. The distribution parameters suitability was evaluated Kolmogorov-Smirnov (K-S) goodness-of-fit test. We also compared the estimated cumulative probability and the conditional probabilities of occurrence of earthquakes for different elapsed timemore » using these three distribution methods. We used Easyfit and Matlab software to calculate these distribution parameters and plotted the conditional probability curves. We concluded that the Weibull distribution method was the most suitable than other distribution methods in this region.« less

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.

Evidence for criticality in financial data

NASA Astrophysics Data System (ADS)

Ruiz, G.; de Marcos, A. F.

2018-01-01

We provide evidence that cumulative distributions of absolute normalized returns for the 100 American companies with the highest market capitalization, uncover a critical behavior for different time scales Δt. Such cumulative distributions, in accordance with a variety of complex - and financial - systems, can be modeled by the cumulative distribution functions of q-Gaussians, the distribution function that, in the context of nonextensive statistical mechanics, maximizes a non-Boltzmannian entropy. These q-Gaussians are characterized by two parameters, namely ( q, β), that are uniquely defined by Δt. From these dependencies, we find a monotonic relationship between q and β, which can be seen as evidence of criticality. We numerically determine the various exponents which characterize this criticality.

Measurement of flow harmonics with multi-particle cumulants in Pb+Pb collisions at √s NN = 2.76  TeV with the ATLAS detector

DOE PAGES

Aad, G.

2014-11-26

ATLAS measurements of the azimuthal anisotropy in lead–lead collisions at √s NN = 2.76 TeV are shown using a dataset of approximately 7 μb –1 collected at the LHC in 2010. The measurements are performed for charged particles with transverse momenta 0.5 < p T < 20 GeV and in the pseudorapidity range |η| < 2.5. The anisotropy is characterized by the Fourier coefficients, v n, of the charged-particle azimuthal angle distribution for n = 2–4. The Fourier coefficients are evaluated using multi-particle cumulants calculated with the generating function method. Results on the transverse momentum, pseudorapidity and centrality dependence ofmore » the v n coefficients are presented. The elliptic flow, v 2, is obtained from the two-, four-, six- and eight-particle cumulants while higher-order coefficients, v 3 and v 4, are determined with two- and four-particle cumulants. Flow harmonics v n measured with four-particle cumulants are significantly reduced compared to the measurement involving two-particle cumulants. A comparison to vn measurements obtained using different analysis methods and previously reported by the LHC experiments is also shown. Results of measurements of flow fluctuations evaluated with multi-particle cumulants are shown as a function of transverse momentum and the collision centrality. As a result, models of the initial spatial geometry and its fluctuations fail to describe the flow fluctuations measurements.« less

The relationship between excess body weight and the risk of death from unnatural causes.

PubMed

Wang, Wei; Obi, Jane C; Engida, Selam; Carter, Elizabeth R; Yan, Fei; Zhang, Jian

2015-07-01

The purpose is to exam whether excess body weight is associated with an increased risk of death from unnatural causes, particularly, injury. We analyzed nationally representative data of 14,453 adults (19 and older) who participated in the third National Health and Nutrition Examination Survey, 1988-1994, and were followed up with vital statuses through December 31, 2006. We used Cox proportional hazard regression to estimate the hazard ratio (HR) of death from all unnatural causes combined and specific ones. Gray's test was performed to assess the equality of cumulative incidence functions between body mass index (BMI) levels. A total of 128 unnatural deaths were recorded during an 18-year follow-up with 193,019 person-years accumulated. Compared with healthy weight participants, a person with excess body weight had a low hazard of death from unnatural causes [HR=1.00 (reference), 0.58 (0.39-0.87), and 0.50 (0.30-0.82) for healthy weight, overweight and obese participants, respectively]. Injuries, including motor vehicle accidents and falls, were the major types of unnatural deaths (n=91, 71% of all unnatural deaths), and the risk of death from injuries was linearly and reversely associated with BMI. The HRs of injury were 1.00 (reference), 0.57 (0.36-0.91), and 0.36 (0.19-0.69) for healthy weight, overweight and obese participants, respectively. All these estimates were obtained after adjustment of socio-demographic variables. Excess body weight appears to be associated with a low risk of death from unnatural causes, particularly, injuries. Additional investigations on the mechanism underlying the relationship between BMI and unnatural deaths are warranted. Copyright © 2015. Published by Elsevier Ltd.

40 CFR 230.11 - Factual determinations.

Code of Federal Regulations, 2013 CFR

2013-07-01

... proposed disposal site, and the availability of contaminants. (e) Aquatic ecosystem and organism... individually and cumulatively, on the structure and function of the aquatic ecosystem and organisms... aquatic ecosystem. (1) Cumulative impacts are the changes in an aquatic ecosystem that are attributable to...

21-Gene Recurrence Score and Locoregional Recurrence in Node-Positive/ER-Positive Breast Cancer Treated With Chemo-Endocrine Therapy

PubMed Central

Mamounas, Eleftherios P.; Liu, Qing; Paik, Soonmyung; Baehner, Frederick L.; Tang, Gong; Jeong, Jong-Hyeon; Kim, S. Rim; Butler, Steven M.; Jamshidian, Farid; Cherbavaz, Diana B.; Sing, Amy P.; Shak, Steven; Julian, Thomas B.; Lembersky, Barry C.; Wickerham, D. Lawrence; Costantino, Joseph P.; Wolmark, Norman

2017-01-01

Background: The 21-gene recurrence score (RS) predicts risk of locoregional recurrence (LRR) in node-negative, estrogen receptor (ER)–positive breast cancer. We evaluated the association between RS and LRR in node-positive, ER-positive patients treated with adjuvant chemotherapy plus tamoxifen in National Surgical Adjuvant Breast and Bowel Project B-28. Methods: B-28 compared doxorubicin/cyclophosphamide (AC X 4) with AC X 4 followed by paclitaxel X 4. Tamoxifen was given to patients age 50 years or older and those younger than age 50 years with ER-positive and/or progesterone receptor–positive tumors. Lumpectomy patients received breast radiotherapy. Mastectomy patients received no radiotherapy. The present study includes 1065 ER-positive, tamoxifen-treated patients with RS assessment. Cumulative incidence functions and subdistribution hazard regression models were used for LRR to account for competing risks including distant recurrence, second primary cancers, and death from other causes. Median follow-up was 11.2 years. All statistical tests were one-sided. Results: There were 80 LRRs (7.5%) as first events (68% local/32% regional). RS was low: 36.2%; intermediate: 34.2%; and high: 29.6%. RS was a statistically significant predictor of LRR in univariate analyses (10-year cumulative incidence of LRR = 3.3%, 7.2%, and 12.2% for low, intermediate, and high RS, respectively, P < .001). In multivariable regression analysis, RS remained an independent predictor of LRR (hazard ratio [HR] = 2.59, 95% confidence interval [CI] = 1.28 to 5.26, for a 50-point difference, P = .008) along with pathologic nodal status (HR = 1.91, 95% CI = 1.20 to 3.03, for four or more vs one to three positive nodes, P = .006) and tumor size (HR = 1.28, 95% CI = 1.05 to 1.55, for a 1 cm difference, P = .02). Conclusions: RS statistically significantly predicts risk of LRR in node-positive, ER-positive breast cancer patients after adjuvant chemotherapy plus tamoxifen. These findings can help in the selection of appropriate candidates for comprehensive radiotherapy. PMID:28122895

21-Gene Recurrence Score and Locoregional Recurrence in Node-Positive/ER-Positive Breast Cancer Treated With Chemo-Endocrine Therapy.

PubMed

Mamounas, Eleftherios P; Liu, Qing; Paik, Soonmyung; Baehner, Frederick L; Tang, Gong; Jeong, Jong-Hyeon; Kim, S Rim; Butler, Steven M; Jamshidian, Farid; Cherbavaz, Diana B; Sing, Amy P; Shak, Steven; Julian, Thomas B; Lembersky, Barry C; Wickerham, D Lawrence; Costantino, Joseph P; Wolmark, Norman

2017-01-01

The 21-gene recurrence score (RS) predicts risk of locoregional recurrence (LRR) in node-negative, estrogen receptor (ER)-positive breast cancer. We evaluated the association between RS and LRR in node-positive, ER-positive patients treated with adjuvant chemotherapy plus tamoxifen in National Surgical Adjuvant Breast and Bowel Project B-28. B-28 compared doxorubicin/cyclophosphamide (AC X 4) with AC X 4 followed by paclitaxel X 4. Tamoxifen was given to patients age 50 years or older and those younger than age 50 years with ER-positive and/or progesterone receptor-positive tumors. Lumpectomy patients received breast radiotherapy. Mastectomy patients received no radiotherapy. The present study includes 1065 ER-positive, tamoxifen-treated patients with RS assessment. Cumulative incidence functions and subdistribution hazard regression models were used for LRR to account for competing risks including distant recurrence, second primary cancers, and death from other causes. Median follow-up was 11.2 years. All statistical tests were one-sided. There were 80 LRRs (7.5%) as first events (68% local/32% regional). RS was low: 36.2%; intermediate: 34.2%; and high: 29.6%. RS was a statistically significant predictor of LRR in univariate analyses (10-year cumulative incidence of LRR = 3.3%, 7.2%, and 12.2% for low, intermediate, and high RS, respectively, P < .001). In multivariable regression analysis, RS remained an independent predictor of LRR (hazard ratio [HR] = 2.59, 95% confidence interval [CI] = 1.28 to 5.26, for a 50-point difference, P = .008) along with pathologic nodal status (HR = 1.91, 95% CI = 1.20 to 3.03, for four or more vs one to three positive nodes, P = .006) and tumor size (HR = 1.28, 95% CI = 1.05 to 1.55, for a 1 cm difference, P = .02). RS statistically significantly predicts risk of LRR in node-positive, ER-positive breast cancer patients after adjuvant chemotherapy plus tamoxifen. These findings can help in the selection of appropriate candidates for comprehensive radiotherapy. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Cancer mortality in patients with psychiatric diagnoses: a higher hazard of cancer death does not lead to a higher cumulative risk of dying from cancer.

PubMed

Guan, Ng Chong; Termorshuizen, Fabian; Laan, Wijnand; Smeets, Hugo M; Zainal, Nor Zuraida; Kahn, René S; De Wit, Niek J; Boks, Marco P M

2013-08-01

Both increased as well as decreased cancer mortality among psychiatric patients has been reported, but competing death causes were not included in the analyses. This study aims to investigate whether observed cancer mortality in patients with psychiatric disorders might be biased by competing death causes. In this retrospective cohort study on data from the Psychiatric Case Register Middle Netherlands linked to the death register of Statistics Netherlands, the risk of cancer death among patients with schizophrenia (N = 4,590), bipolar disorder (N = 2,077), depression (N = 15,130) and their matched controls (N = 87,405) was analyzed using a competing risk model. Compared to controls, higher hazards of cancer death were found in patients with schizophrenia (HR = 1.61, 95 % CI 1.26-2.06), bipolar disorder (HR = 1.20, 95 % CI 0.81-1.79) and depression (HR = 1.26, 95 % CI 1.10-1.44). However, the HRs of death due to suicide and other death causes were more elevated. Consequently, among those who died, the 12-year cumulative risk of cancer death was significantly lower. Our analysis shows that, compared to the general population, psychiatric patients are at higher risk of dying from cancer, provided that they survive the much more elevated risks of suicide and other death causes.

The Composite Strain Index (COSI) and Cumulative Strain Index (CUSI): methodologies for quantifying biomechanical stressors for complex tasks and job rotation using the Revised Strain Index.

PubMed

Garg, Arun; Moore, J Steven; Kapellusch, Jay M

2017-08-01

The Composite Strain Index (COSI) quantifies biomechanical stressors for complex tasks consisting of exertions at different force levels and/or with different exertion times. The Cumulative Strain Index (CUSI) further integrates biomechanical stressors from different tasks to quantify exposure for the entire work shift. The paper provides methodologies to compute COSI and CUSI along with examples. Complex task simulation produced 169,214 distinct tasks. Use of average, time-weighted average (TWA) and peak force and COSI classified 66.9, 28.2, 100 and 38.9% of tasks as hazardous, respectively. For job rotation the simulation produced 10,920 distinct jobs. TWA COSI, peak task COSI and CUSI classified 36.5, 78.1 and 66.6% jobs as hazardous, respectively. The results suggest that the TWA approach systematically underestimates the biomechanical stressors and peak approach overestimates biomechanical stressors, both at the task and job level. It is believed that the COSI and CUSI partially address these underestimations and overestimations of biomechanical stressors. Practitioner Summary: COSI quantifies exposure when applied hand force and/or duration of that force changes during a task cycle. CUSI integrates physical exposures from job rotation. These should be valuable tools for designing and analysing tasks and job rotation to determine risk of musculoskeletal injuries.

Prognostic value of human papillomavirus 16/18 genotyping in low-grade cervical lesions preceded by mildly abnormal cytology.

PubMed

Ye, Jing; Cheng, Bei; Cheng, Yi-Fan; Yao, Ye-Li; Xie, Xing; Lu, Wei-Guo; Cheng, Xiao-Dong

Histological low-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia grade 1 (LSIL/CIN1) preceded by normal or mildly abnormal cytology is recommended for conservative follow-up, with no separated management. In this study, we assessed the triage value of human papillomavirus (HPV) 16/18 genotyping in 273 patients with LSIL/CIN1. HPV16/18 genotyping was performed at baseline and follow-up was at 6-monthly intervals for up to 2 years. At each follow-up, women positive for cytology or high-risk HPV (hrHPV) were referred for colposcopy. Enrollment cytology, HPV16/18 genotyping, and questionnaire-obtained factors were linked to the 2-year cumulative progression rate. Univariate and multivariate analyses were performed taking into account time-to-event with Cox proportional hazard regression. The results showed that 190 cases (69.6%) regressed, 37 (13.6%) persisted, and 46 (16.8%) progressed. HPV16/18 positivity (hazard ratio (HR), 2.708; 95% confidence interval (CI), 1.432-5.121; P=0.002) is significantly associated with higher 2-year cumulative progression rate. Sub-analysis by enrollment cytology and age restricted the positive association among patients preceded by mildly abnormal cytology and aged 30 years or older. Immediate treatment is a rational recommendation for the high-risk subgroup, when good compliance is not assured.

MEDUSA (Martian Environmental DUst Systematic Analyser) for the monitoring of the Martian atmospheric dust and water vapour

NASA Astrophysics Data System (ADS)

Colangeli, L.; Battaglia, R.; della Corte, V.; Esposito, F.; Ferrini, G.; Mazzotta Epifani, E.; Palomba, E.; Palumbo, P.; Panizza, A.; Rotundi, A.

2004-03-01

The knowledge of Martian airborne dust properties and about mechanisms of dust settling/raising to/from the surface are important to determine climate and surface evolution on Mars. Water is an important tracer of climatic changes on long time-scales and is strictly related to the presence of life forms. The study in situ of dust and water vapour properties and evolution in Martian atmosphere is useful to trace back the planet climate, also in function of life form development. This investigation is also appropriate in preparation to future manned exploration of the planet (in relation to hazardous conditions). In this work we discuss the concept of the MEDUSA (Martian Environmental Dust Analyser) experiment that is designed to provide data on grain size and mass distribution, number density, velocity and scattering properties and on water vapour concentration. The instrument is a multisensor system based on optical and impact detection of grains, coupled with cumulative deposition sensors.

Subsequent neoplasms in survivors of childhood central nervous system tumors: risk after modern multimodal therapy.

PubMed

Tsui, Karen; Gajjar, Amar; Li, Chenghong; Srivastava, Deokumar; Broniscer, Alberto; Wetmore, Cynthia; Kun, Larry E; Merchant, Thomas E; Ellison, David W; Orr, Brent A; Boop, Frederick A; Klimo, Paul; Ross, Jordan; Robison, Leslie L; Armstrong, Gregory T

2015-03-01

Multimodal therapy has improved survival for some childhood CNS tumors. However, whether risk for subsequent neoplasms (SNs) also increases is unknown. We report the cumulative incidence of, and risk factors for, SNs after a childhood primary CNS tumor and determine whether treatment that combines radiation therapy (RT) with chemotherapy increases risk for SNs. Analyses included 2779 patients with a primary CNS tumor treated at St Jude Children's Research Hospital between 1985 and 2012. Cumulative incidence and standardized incidence ratios (SIRs) were estimated for SNs confirmed by pathology report. Cumulative incidence among the 237 five-year medulloblastoma survivors treated with multimodal therapy (RT + chemotherapy) was compared with a historical cohort of 139 five-year survivors treated with RT but no chemotherapy in the Childhood Cancer Survivor Study. Eighty-one survivors had 97 SNs. The cumulative incidence of first SN was 3.0% (95% CI: 2.3%-3.9%) at 10 years, and 6.0% (95% CI: 4.6%-7.7%) at 20 years from diagnosis. Risks were highest for subsequent glioma, all grades (SIR = 57.2; 95% CI: 36.2-85.8) and acute myeloid leukemia (SIR = 31.8; 95% CI: 10.2-74.1). Compared with RT alone, RT + chemotherapy did not increase risk for SNs (hazard ratio: 0.64; 95% CI: 0.38-1.06). Among five-year survivors of medulloblastoma treated with multimodal therapy, cumulative incidence of SN was 12.0% (95% CI: 6.4%-19.5%) at 20 years, no different than survivors treated with RT alone (11.3%, P = .44). The cumulative incidence of SNs continues to increase with time from treatment with no obvious plateau, but the risk does not appear to be higher after exposure to multimodal therapy compared with RT alone. Continued follow-up of survivors as they age is essential. © The Author(s) 2014. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Non-Chemical Stressors and Cumulative Risk Assessment: An Overview of Current Initiatives and Potential Air Pollutant Interactions

PubMed Central

Lewis, Ari S.; Sax, Sonja N.; Wason, Susan C.; Campleman, Sharan L.

2011-01-01

Regulatory agencies are under increased pressure to consider broader public health concerns that extend to multiple pollutant exposures, multiple exposure pathways, and vulnerable populations. Specifically, cumulative risk assessment initiatives have stressed the importance of considering both chemical and non-chemical stressors, such as socioeconomic status (SES) and related psychosocial stress, in evaluating health risks. The integration of non-chemical stressors into a cumulative risk assessment framework has been largely driven by evidence of health disparities across different segments of society that may also bear a disproportionate risk from chemical exposures. This review will discuss current efforts to advance the field of cumulative risk assessment, highlighting some of the major challenges, discussed within the construct of the traditional risk assessment paradigm. Additionally, we present a summary of studies of potential interactions between social stressors and air pollutants on health as an example of current research that supports the incorporation of non-chemical stressors into risk assessment. The results from these studies, while suggestive of possible interactions, are mixed and hindered by inconsistent application of social stress indicators. Overall, while there have been significant advances, further developments across all of the risk assessment stages (i.e., hazard identification, exposure assessment, dose-response, and risk characterization) are necessary to provide a scientific basis for regulatory actions and effective community interventions, particularly when considering non-chemical stressors. A better understanding of the biological underpinnings of social stress on disease and implications for chemical-based dose-response relationships is needed. Furthermore, when considering non-chemical stressors, an appropriate metric, or series of metrics, for risk characterization is also needed. Cumulative risk assessment research will benefit from coordination of information from several different scientific disciplines, including, for example, toxicology, epidemiology, nutrition, neurotoxicology, and the social sciences. PMID:21776216

The Association Between the Use of Zolpidem and the Risk of Alzheimer's Disease Among Older People.

PubMed

Cheng, Hui-Ting; Lin, Fang-Ju; Erickson, Steven R; Hong, Jin-Liern; Wu, Chung-Hsuen

2017-11-01

To evaluate the association between zolpidem use and the risk of Alzheimer's disease among older people. A retrospective cohort study using data from 2001 to 2011 from the National Health Insurance Research Database. Taiwan. A total of 6,922 patients aged 65 years or older enrolled from January 2002 to December 2004 (the enrollment period). Zolpidem users were identified as patients who used zolpidem during the enrollment period. The index date was the date of the first zolpidem prescription. Dosage of zolpidem use was defined using cumulative defined daily dose (cDDD) based on the cumulative dosage that patients took within one year after the index date (grouped as: less than 28, 28-90, 91-180, and more than 180 cDDD). The occurrence of Alzheimer's disease was defined as the time period from the end of one year after the index date to the date of the Alzheimer's disease diagnosis. The propensity score was used to adjust the measured confounders of Alzheimer's disease. Cox proportional hazards models were used to evaluate the association between zolpidem use and the incidence of Alzheimer's disease. Zolpidem users with a high cumulative dose (>180 cDDD) in the first year after initiation had a significantly greater risk of Alzheimer's disease than non-zolpidem users (HR = 2.97, 95% CI = 1.61-5.49) and low cumulative dose (<28 cDDD) users (HR = 4.18, 95% CI = 1.77-9.86). We found the use of a high cumulative dose of zolpidem was associated with an increased risk of Alzheimer's disease among older people living in Taiwan. It is advised to use caution when considering long-term use of zolpidem in older patients. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Excess Mortality in Treated and Untreated Hyperthyroidism Is Related to Cumulative Periods of Low Serum TSH.

PubMed

Lillevang-Johansen, Mads; Abrahamsen, Bo; Jørgensen, Henrik Løvendahl; Brix, Thomas Heiberg; Hegedüs, Laszlo

2017-07-01

Cumulative time-dependent excess mortality in hyperthyroid patients has been suggested. However, the effect of antithyroid treatment on mortality, especially in subclinical hyperthyroidism, remains unclarified. We investigated the association between hyperthyroidism and mortality in both treated and untreated hyperthyroid individuals. Register-based cohort study of 235,547 individuals who had at least one serum thyroid-stimulating hormone (TSH) measurement in the period 1995 to 2011 (7.3 years median follow-up). Hyperthyroidism was defined as at least two measurements of low serum TSH. Mortality rates for treated and untreated hyperthyroid subjects compared with euthyroid controls were calculated using multivariate Cox regression analyses, controlling for age, sex, and comorbidities. Cumulative periods of decreased serum TSH were analyzed as a time-dependent covariate. Hazard ratio (HR) for mortality was increased in untreated [1.23; 95% confidence interval (CI), 1.12 to 1.37; P < 0.001], but not in treated, hyperthyroid patients. When including cumulative periods of TSH in the Cox regression analyses, HR for mortality per every 6 months of decreased TSH was 1.11 (95% CI, 1.09 to 1.13; P < 0.0001) in untreated hyperthyroid patients (n = 1137) and 1.13 (95% CI, 1.11 to 1.15; P < 0.0001) in treated patients (n = 1656). This corresponds to a 184% and 239% increase in mortality after 5 years of decreased TSH in untreated and treated hyperthyroidism, respectively. Mortality is increased in hyperthyroidism. Cumulative periods of decreased TSH increased mortality in both treated and untreated hyperthyroidism, implying that excess mortality may not be driven by lack of therapy, but rather inability to keep patients euthyroid. Meticulous follow-up during treatment to maintain biochemical euthyroidism may be warranted. Copyright © 2017 by the Endocrine Society

Cumulant generating function formula of heat transfer in ballistic systems with lead-lead coupling

NASA Astrophysics Data System (ADS)

Li, Huanan; Agarwalla, Bijay Kumar; Wang, Jian-Sheng

2012-10-01

Based on a two-time observation protocol, we consider heat transfer in a given time interval tM in a lead-junction-lead system taking coupling between the leads into account. In view of the two-time observation, consistency conditions are carefully verified in our specific family of quantum histories. Furthermore, its implication is briefly explored. Then using the nonequilibrium Green's function method, we obtain an exact formula for the cumulant generating function for heat transfer between the two leads, valid in both transient and steady-state regimes. Also, a compact formula for the cumulant generating function in the long-time limit is derived, for which the Gallavotti-Cohen fluctuation symmetry is explicitly verified. In addition, we briefly discuss Di Ventra's repartitioning trick regarding whether the repartitioning procedure of the total Hamiltonian affects the nonequilibrium steady-state current fluctuation. All kinds of properties of nonequilibrium current fluctuations, such as the fluctuation theorem in different time regimes, could be readily given according to these exact formulas.

CUMPOIS- CUMULATIVE POISSON DISTRIBUTION PROGRAM

NASA Technical Reports Server (NTRS)

Bowerman, P. N.

1994-01-01

The Cumulative Poisson distribution program, CUMPOIS, is one of two programs which make calculations involving cumulative poisson distributions. Both programs, CUMPOIS (NPO-17714) and NEWTPOIS (NPO-17715), can be used independently of one another. CUMPOIS determines the approximate cumulative binomial distribution, evaluates the cumulative distribution function (cdf) for gamma distributions with integer shape parameters, and evaluates the cdf for chi-square distributions with even degrees of freedom. It can be used by statisticians and others concerned with probabilities of independent events occurring over specific units of time, area, or volume. CUMPOIS calculates the probability that n or less events (ie. cumulative) will occur within any unit when the expected number of events is given as lambda. Normally, this probability is calculated by a direct summation, from i=0 to n, of terms involving the exponential function, lambda, and inverse factorials. This approach, however, eventually fails due to underflow for sufficiently large values of n. Additionally, when the exponential term is moved outside of the summation for simplification purposes, there is a risk that the terms remaining within the summation, and the summation itself, will overflow for certain values of i and lambda. CUMPOIS eliminates these possibilities by multiplying an additional exponential factor into the summation terms and the partial sum whenever overflow/underflow situations threaten. The reciprocal of this term is then multiplied into the completed sum giving the cumulative probability. The CUMPOIS program is written in C. It was developed on an IBM AT with a numeric co-processor using Microsoft C 5.0. Because the source code is written using standard C structures and functions, it should compile correctly on most C compilers. The program format is interactive, accepting lambda and n as inputs. It has been implemented under DOS 3.2 and has a memory requirement of 26K. CUMPOIS was developed in 1988.

Exact probability distribution function for the volatility of cumulative production

NASA Astrophysics Data System (ADS)

Zadourian, Rubina; Klümper, Andreas

2018-04-01

In this paper we study the volatility and its probability distribution function for the cumulative production based on the experience curve hypothesis. This work presents a generalization of the study of volatility in Lafond et al. (2017), which addressed the effects of normally distributed noise in the production process. Due to its wide applicability in industrial and technological activities we present here the mathematical foundation for an arbitrary distribution function of the process, which we expect will pave the future research on forecasting of the production process.

Goal-Oriented Probability Density Function Methods for Uncertainty Quantification

DTIC Science & Technology

2015-12-11

approximations or data-driven approaches. We investigated the accuracy of analytical tech- niques based Kubo -Van Kampen operator cumulant expansions for...analytical techniques based Kubo -Van Kampen operator cumulant expansions for Langevin equations driven by fractional Brownian motion and other noises

Heat wave hazard classification and risk assessment using artificial intelligence fuzzy logic.

PubMed

Keramitsoglou, Iphigenia; Kiranoudis, Chris T; Maiheu, Bino; De Ridder, Koen; Daglis, Ioannis A; Manunta, Paolo; Paganini, Marc

2013-10-01

The average summer temperatures as well as the frequency and intensity of hot days and heat waves are expected to increase due to climate change. Motivated by this consequence, we propose a methodology to evaluate the monthly heat wave hazard and risk and its spatial distribution within large cities. A simple urban climate model with assimilated satellite-derived land surface temperature images was used to generate a historic database of urban air temperature fields. Heat wave hazard was then estimated from the analysis of these hourly air temperatures distributed at a 1-km grid over Athens, Greece, by identifying the areas that are more likely to suffer higher temperatures in the case of a heat wave event. Innovation lies in the artificial intelligence fuzzy logic model that was used to classify the heat waves from mild to extreme by taking into consideration their duration, intensity and time of occurrence. The monthly hazard was subsequently estimated as the cumulative effect from the individual heat waves that occurred at each grid cell during a month. Finally, monthly heat wave risk maps were produced integrating geospatial information on the population vulnerability to heat waves calculated from socio-economic variables.

Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial

PubMed Central

Bonati, Leo H; Dobson, Joanna; Featherstone, Roland L; Ederle, Jörg; van der Worp, H Bart; de Borst, Gert J; Mali, Willem P Th M; Beard, Jonathan D; Cleveland, Trevor; Engelter, Stefan T; Lyrer, Philippe A; Ford, Gary A; Dorman, Paul J; Brown, Martin M

2015-01-01

Summary Background Stenting is an alternative to endarterectomy for treatment of carotid artery stenosis, but long-term efficacy is uncertain. We report long-term data from the randomised International Carotid Stenting Study comparison of these treatments. Methods Patients with symptomatic carotid stenosis were randomly assigned 1:1 to open treatment with stenting or endarterectomy at 50 centres worldwide. Randomisation was computer generated centrally and allocated by telephone call or fax. Major outcomes were assessed by an independent endpoint committee unaware of treatment assignment. The primary endpoint was fatal or disabling stroke in any territory after randomisation to the end of follow-up. Analysis was by intention to treat ([ITT] all patients) and per protocol from 31 days after treatment (all patients in whom assigned treatment was completed). Functional ability was rated with the modified Rankin scale. This study is registered, number ISRCTN25337470. Findings 1713 patients were assigned to stenting (n=855) or endarterectomy (n=858) and followed up for a median of 4·2 years (IQR 3·0–5·2, maximum 10·0). Three patients withdrew immediately and, therefore, the ITT population comprised 1710 patients. The number of fatal or disabling strokes (52 vs 49) and cumulative 5-year risk did not differ significantly between the stenting and endarterectomy groups (6·4% vs 6·5%; hazard ratio [HR] 1·06, 95% CI 0·72–1·57, p=0·77). Any stroke was more frequent in the stenting group than in the endarterectomy group (119 vs 72 events; ITT population, 5-year cumulative risk 15·2% vs 9·4%, HR 1·71, 95% CI 1·28–2·30, p<0·001; per-protocol population, 5-year cumulative risk 8·9% vs 5·8%, 1·53, 1·02–2·31, p=0·04), but were mainly non-disabling strokes. The distribution of modified Rankin scale scores at 1 year, 5 years, or final follow-up did not differ significantly between treatment groups. Interpretation Long-term functional outcome and risk of fatal or disabling stroke are similar for stenting and endarterectomy for symptomatic carotid stenosis. Funding Medical Research Council, Stroke Association, Sanofi-Synthélabo, European Union. PMID:25453443

Relaxation Processes and Time Scale Transformation.

DTIC Science & Technology

1982-03-01

the response function may be immediately recognized as being 14 of the Kubo - Green type in the classical regime. Given this general framework, it is now...discussions of the master equation, 2and has recently been applied in cumulative damage models with discrete time parameter .3 However, it does not seem to...development parameter is taken tG be a positive, cumulative function that increases from an origin monotonically. Consider two continuous time scales e and t

Cumulative incidence and prevalence of childhood autism in children in Japan.

PubMed

Honda, H; Shimizu, Y; Misumi, K; Niimi, M; Ohashi, Y

1996-08-01

An epidemiological survey of childhood autism as defined in ICD-10 Research Criteria was conducted in the northern part of Yokohama, Japan. The routine health checkup for 18-month-old children served as the initial mass-screening, and all facilities which provide child care services function to detect all cases with childhood autism and refer them to the Yokohama Rehabilitation Centre. Cumulative incidence of childhood autism up to 5 years of age among the birth cohort of 1988, and prevalence on 1 January 1994, among residents born in 1988 were estimated Cumulative incidence and prevalence were 16.2 per 10,000 and 21.1 per 10,000, respectively. Children with high-functioning autism who had IQs of 70 and over constituted approximately half of all the children with childhood autism. CONCLUSION. It was confirmed through better detection of high-functioning cases that childhood autism in Japan is more common than formerly estimated.

Do Holocaust survivors show increased vulnerability or resilience to post-Holocaust cumulative adversity?

PubMed

Shrira, Amit; Palgi, Yuval; Ben-Ezra, Menachem; Shmotkin, Dov

2010-06-01

Prior trauma can hinder coping with additional adversity or inoculate against the effect of recurrent adversity. The present study further addressed this issue by examining whether a subsample of Holocaust survivors and comparison groups, drawn from the Israeli component of the Survey of Health, Ageing, and Retirement in Europe, were differentially affected by post-Holocaust cumulative adversity. Post-Holocaust cumulative adversity had a stronger effect on the lifetime depression of Holocaust survivors than on that of comparisons. However, comparisons were more negatively affected by post-Holocaust cumulative adversity when examining markers of physical and cognitive functioning. Our findings suggest that previous trauma can both sensitize and immunize, as Holocaust survivors show general resilience intertwined with specific vulnerability when confronted with additional cumulative adversity.

Defensive functioning of homeless youth in relation to experiences of child maltreatment and cumulative victimization.

PubMed

Mounier, Carrie; Andujo, Estela

2003-10-01

To determine the relationship between use of defense mechanisms and experiences of child maltreatment and cumulative victimization among homeless youth. Twenty-five homeless youth were individually interviewed regarding their victimization experiences and coping strategies. Use of defense mechanisms was assessed using the Defense Mechanism Rating Scale. Relationships were demonstrated between use of defenses and specific as well as cumulative victimization experiences. All levels of defenses became more pervasive in response to victimization, but this was not a predictor of overall immature defensive functioning. Clinical and program interventions to engage homeless youth need to incorporate an understanding of the relationship between defenses and victimization in order to be effective in maximizing upon the strengths of this population.

Incidence and risk factors of thromboembolism in systemic lupus erythematosus: a comparison of three ethnic groups.

PubMed

Mok, Chi Chiu; Tang, Sandy Shuk Kuen; To, Chi Hung; Petri, Michelle

2005-09-01

To compare the incidence and risk factors for thromboembolic events in systemic lupus erythematosus (SLE) patients of different ethnic backgrounds. SLE patients who were newly diagnosed or were referred within 6 months of diagnosis between 1996 and 2002 were prospectively followed up for the occurrence of thromboembolic events. Cumulative hazard and risk factors for thromboembolism were evaluated and compared among patients of different ethnic origins. We studied 625 patients who fulfilled the American College of Rheumatology criteria for SLE (89% women): 258 Chinese, 140 African Americans, and 227 Caucasians. The mean +/- SD age at SLE diagnosis was 35.7 +/- 14 years. After a followup of 3,094 patient-years, 48 arterial events and 40 venous events occurred in 83 patients. The overall incidence of arterial and venous thromboembolism was 16/1,000 patient-years and 13/1,000 patient-years, respectively. The cumulative hazard of arterial events at 60 months after the diagnosis of SLE was 8.5%, 8.1%, and 5.1% for the Chinese, African Americans, and Caucasians, respectively. The corresponding cumulative risk of venous events was 3.7%, 6.6%, and 10.3%, respectively (P = 0.008 for Chinese versus Caucasians, by log rank test). Smoking, obesity, antiphospholipid antibodies, and use of antimalarial agents and exogenous estrogens were less frequent in the Chinese patients. In Cox regression models, low levels of high-density lipoprotein (HDL) cholesterol, Chinese ethnicity, oral ulcers, and serositis predicted arterial events, whereas male sex, low levels of HDL cholesterol, antiphospholipid antibodies, non-Chinese ethnicity, obesity, renal disease, and hemolytic anemia predicted venous events. There are ethnic differences in the incidence of arterial and venous thromboembolism in patients with SLE that cannot be fully explained by the clinical factors studied. Further evaluation of other genetic and immunologic factors is warranted.

Incidence and outcome of surgical procedures after coronary artery bypass grafting compared with those after percutaneous coronary intervention: a report from the Coronary Revascularization Demonstrating Outcome Study in Kyoto PCI/CABG Registry Cohort-2.

PubMed

Tokushige, Akihiro; Shiomi, Hiroki; Morimoto, Takeshi; Ono, Koh; Furukawa, Yutaka; Nakagawa, Yoshihisa; Kadota, Kazushige; Ando, Kenji; Shizuta, Satoshi; Tada, Tomohisa; Tazaki, Junichi; Kato, Yoshihiro; Hayano, Mamoru; Abe, Mitsuru; Hamasaki, Shuichi; Ohishi, Mitsuru; Nakashima, Hitoshi; Mitsudo, Kazuaki; Nobuyoshi, Masakiyo; Kita, Toru; Imoto, Yutaka; Sakata, Ryuzo; Okabayashi, Hitoshi; Hanyu, Michiya; Shimamoto, Mitsuomi; Nishiwaki, Noboru; Komiya, Tatsuhiko; Kimura, Takeshi

2014-08-01

Noncardiac surgery after percutaneous coronary intervention (PCI) has been reported to be carrying high risk for both ischemic and bleeding complications. However, there has been no report comparing the incidence and outcomes of surgical procedures after coronary artery bypass grafting (CABG) with those after PCI. Among 14 383 patients undergoing first coronary revascularization (PCI, n=12 207; CABG, n=2176) enrolled in the Coronary Revascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) PCI/CABG Registry Cohort-2, surgical procedures were performed more frequently after CABG (n=560) than after PCI (n=2398; cumulative 3-year incidence: 27% versus 22%; unadjusted P<0.0001), particularly <6 months of coronary revascularization. The risk for the primary ischemic outcome measure (death/myocardial infarction) at 30-day postsurgical procedures was not significantly different between the CABG and PCI groups (cumulative incidence: 3.1% versus 3.2%; unadjusted P=0.9; adjusted hazard ratio, 0.97; 95% confidence interval, 0.47-1.89; P=0.9). The risk for the primary bleeding outcome measure (moderate or severe bleeding by Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries classification) was lower in the CABG groups than in the PCI group (cumulative incidence: 1.3% versus 2.6%; unadjusted P=0.07; adjusted hazard ratio, 0.36; 95% confidence interval, 0.12-0.87; P=0.02). There were no interactions between the timing of surgery and the types of coronary revascularization (CABG/PCI) for both ischemic and bleeding outcomes. Surgical procedures were performed significantly more frequently after CABG than after PCI, particularly <6 months after coronary revascularization. Surgical procedures after CABG as compared with those after PCI were associated with similar risk for ischemic events and lower risk for bleeding events, regardless of the timing after coronary revascularization. © 2014 American Heart Association, Inc.

Descriptive characteristics of colon and rectal cancer recurrence in a Danish population-based study.

PubMed

Holmes, Ashley C; Riis, Anders H; Erichsen, Rune; Fedirko, Veronika; Ostenfeld, Eva Bjerre; Vyberg, Mogens; Thorlacius-Ussing, Ole; Lash, Timothy L

2017-08-01

Recurrence is a common outcome among patients that have undergone an intended curative resection for colorectal cancer. However, data on factors that influence colorectal cancer recurrence are sparse. We report descriptive characteristics of both colon and rectal cancer recurrence in an unselected population. We identified 21,152 patients with colorectal cancer diagnosed between May 2001 and December 2011 and registered with the Danish Colorectal Cancer Group. Recurrences were identified in 3198 colon and 1838 rectal cancer patients during follow-up. We calculated the frequency, proportion, and incidence rates of colon and rectal cancer recurrence within descriptive categories, and the cumulative five- and ten-year incidences of recurrence, treating death as a competing risk. We used a Cox proportional hazard model to calculate hazard ratios (HR) and 95% confidence intervals (CI). Recurrence risk was highest in the first three years of follow-up. Patients <55 years old at initial diagnosis (incidence rate for colon: 7.2 per 100 person-years; 95% CI: 6.5-7.9; rectum: 8.1 per 100 person-years; 95% CI: 7.2-9.0) and patients diagnosed with stage III cancer (colon HR: 5.70; 95% CI: 4.61-7.06; rectal HR: 7.02; 95% CI: 5.58-8.82) had increased risk of recurrence. Patients diagnosed with stage III cancer from 2009 to 2011 had a lower incidence of recurrence than those diagnosed with stage III cancer in the years before. Cumulative incidences of colon and rectal cancer recurrence were similar for both cancer types among each descriptive category. In this population, increases in colorectal cancer recurrence risk were associated with younger age and increasing stage at diagnosis. Cumulative incidence of recurrence did not differ by cancer type. Descriptive characteristics of colon and rectal cancer recurrence may help to inform patient-physician decision-making, and could be used to determine adjuvant therapies or tailor surveillance strategies so that recurrence may be identified early, particularly within the first 3 years of follow-up.

Breast cancer screening initiation after turning 40 years of age within the PROSPR consortium.

PubMed

Beaber, Elisabeth F; Tosteson, Anna N A; Haas, Jennifer S; Onega, Tracy; Sprague, Brian L; Weaver, Donald L; McCarthy, Anne Marie; Doubeni, Chyke A; Quinn, Virginia P; Skinner, Celette Sugg; Zauber, Ann G; Barlow, William E

2016-11-01

Although United States clinical guidelines differ, the earliest recommended age for average risk breast cancer screening is 40 years. Little is known about factors influencing screening initiation. We conducted a cohort study within the National Cancer Institute-funded Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. We identified 3413 women on their 40th birthday in primary care networks at Geisel School of Medicine at Dartmouth (DH) and Brigham and Women's Hospital (BWH) during 2011-2013 with no prior breast imaging or breast cancer. Cumulative incidence curves and Cox modeling were used to determine time from the 40th birthday to first breast cancer screening, cohort exit, or 42nd birthday. We calculated hazards ratios and 95 % confidence intervals from multivariable Cox proportional hazards models. Breast cancer screening cumulative incidence by the 42nd birthday was 62.9 % (BWH) and 39.8 % (DH). Factors associated with screening initiation were: a primary care visit within a year (HR 4.99, 95 % CI 4.23-5.89), an increasing number of primary care visits within a year (p for trend <0.0001), ZIP code of residence annual median household income ≤$52,000 (HR 0.79, 95 % CI 0.68-0.92), and health insurance type (Medicaid HR 0.72, 95 % CI 0.58-0.88; Medicare HR 0.55, 95 % CI 0.39-0.77; uninsured HR 0.37, 95 % CI 0.25-0.57). Breast cancer screening uptake after the 40th birthday varies by health system, primary care visits, median household income, and health insurance type, suggesting the need for further exploration. Future research should evaluate screening performance metrics after initiation and consider cumulative benefits and risks associated with breast cancer screening over time.

Lead-Related Genetic Loci, Cumulative Lead Exposure and Incident Coronary Heart Disease: The Normative Aging Study

PubMed Central

Weisskopf, Marc G.; Sparrow, David; Schwartz, Joel; Hu, Howard; Park, Sung Kyun

2016-01-01

Background Cumulative exposure to lead is associated with cardiovascular outcomes. Polymorphisms in the δ-aminolevulinic acid dehydratase (ALAD), hemochromatosis (HFE), heme oxygenase-1 (HMOX1), vitamin D receptor (VDR), glutathione S-transferase (GST) supergene family (GSTP1, GSTT1, GSTM1), apolipoprotein E (APOE),angiotensin II receptor-1 (AGTR1) and angiotensinogen (AGT) genes, are believed to alter toxicokinetics and/or toxicodynamics of lead. Objectives We assessed possible effect modification by genetic polymorphisms in ALAD, HFE, HMOX1, VDR, GSTP1, GSTT1, GSTM1, APOE, AGTR1 and AGT individually and as the genetic risk score (GRS) on the association between cumulative lead exposure and incident coronary heart disease (CHD) events. Methods We used K-shell-X-ray fluorescence to measure bone lead levels. GRS was calculated on the basis of 22 lead-related loci. We constructed Cox proportional hazard models to compute adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CHD. We applied inverse probability weighting to account for potential selection bias due to recruitment into the bone lead sub-study. Results Significant effect modification was found by VDR, HMOX1, GSTP1, APOE, and AGT genetic polymorphisms when evaluated individually. Further, the bone lead-CHD associations became larger as GRS increases. After adjusting for potential confounders, a HR of CHD was 2.27 (95%CI: 1.50–3.42) with 2-fold increase in patella lead levels, among participants in the top tertile of GRS. We also detected an increasing trend in HRs across tertiles of GRS (p-trend = 0.0063). Conclusions Our findings suggest that lead-related loci as a whole may play an important role in susceptibility to lead-related CHD risk. These findings need to be validated in a separate cohort containing bone lead, lead-related genetic loci and incident CHD data. PMID:27584680

Clinical and Virologic Outcomes After Changes in First Antiretroviral Regimen at 7 Sites in the Caribbean, Central and South America Network.

PubMed

Wolff, Marcelo; Shepherd, Bryan E; Cortés, Claudia; Rebeiro, Peter; Cesar, Carina; Wagner Cardoso, Sandra; Pape, Jean W; Padgett, Denis; Sierra-Madero, Juan; Echevarria, Juan; McGowan, Catherine C

2016-01-01

HIV-infected persons in resource-limited settings may experience high rates of antiretroviral therapy (ART) change, particularly because of toxicity or other nonfailure reasons. Few reports address patient outcomes after these modifications. HIV-infected adults from the 7 Caribbean, Central and South America network clinical cohorts who modified >1 drug from the first ART regimen (ART-1) for any reason thereby starting a second regimen (ART-2) were included. We assessed cumulative incidence of, and factors associated with, death, virologic failure (VF), and regimen change after starting ART-2. Five thousand five hundred sixty-five ART-naive highly active ART initiators started ART-2 after a median of 9.8 months on ART-1; 39% changed to ART-2 because of toxicity and 11% because of failure. Median follow-up after starting ART-2 was 2.9 years; 45% subsequently modified ART-2. Cumulative incidences of death at 1, 3, and 5 years after starting ART-2 were 5.1%, 8.4%, and 10.5%, respectively. In adjusted analyses, death was associated with older age, clinical AIDS, lower CD4 at ART-2 start, earlier calendar year, and starting ART-2 because of toxicity (adjusted hazard ratio = 1.5 vs. failure, 95% confidence interval: 1.0 to 2.1). Cumulative incidences of VF after 1, 3, and 5 years were 9%, 19%, and 25%. In adjusted analyses, VF was associated with younger age, earlier calendar year, lower CD4 at the start of ART-2, and starting ART-2 because of failure (adjusted hazard ratio = 2.1 vs. toxicity, 95% confidence interval: 1.5 to 2.8). Among patients modifying the first ART regimen, risks of subsequent modifications, mortality, and virologic failure were high. Access to improved antiretrovirals in the region is needed to improve initial treatment success.

CUMULATIVE RISK ASSESSMENT FOR QUANTITATIVE RESPONSE DATA

EPA Science Inventory

The Relative Potency Factor approach (RPF) is used to normalize and combine different toxic potencies among a group of chemicals selected for cumulative risk assessment. The RPF method assumes that the slopes of the dose-response functions are all equal; but this method depends o...

Cognitive neuroscience 2.0: building a cumulative science of human brain function

PubMed Central

Yarkoni, Tal; Poldrack, Russell A.; Van Essen, David C.; Wager, Tor D.

2010-01-01

Cognitive neuroscientists increasingly recognize that continued progress in understanding human brain function will require not only the acquisition of new data, but also the synthesis and integration of data across studies and laboratories. Here we review ongoing efforts to develop a more cumulative science of human brain function. We discuss the rationale for an increased focus on formal synthesis of the cognitive neuroscience literature, provide an overview of recently developed tools and platforms designed to facilitate the sharing and integration of neuroimaging data, and conclude with a discussion of several emerging developments that hold even greater promise in advancing the study of human brain function. PMID:20884276

Longitudinal lung function decline and wood dust exposure in the furniture industry.

PubMed

Jacobsen, G; Schlünssen, V; Schaumburg, I; Taudorf, E; Sigsgaard, T

2008-02-01

The aim of the present study was to investigate the relationship between change in lung function and cumulative exposure to wood dust. In total, 1,112 woodworkers (927 males, 185 females) and 235 reference workers (104 males, 185 females) participated in a 6-yr longitudinal study. Forced expiratory volume in one second (FEV(1)), forced vital capacity (FVC), height and weight were measured, and questionnaire data on respiratory symptoms, wood dust exposure and smoking habits were collected. Cumulative inhalable wood dust exposure was assessed using a study-specific job exposure matrix and exposure time. The median (range) for cumulative wood dust exposure was 3.75 (0-7.55) mg x year x m(-3). A dose-response relationship between cumulative wood dust exposure and percent annual decrease in FEV(1) was suggested for female workers. This was confirmed in a linear regression model adjusted for confounders, including smoking, height and age. An additional difference of -14.50 mL x yr(-1) and -27.97 mL x yr(-1) was revealed for females exposed to 3.75-4.71 mg x yr x m(-3) or to >4.71 mg x yr x m(-3), respectively, compared with non-/low-exposed females. For females, a positive trend between wood dust exposure and the cumulative incidence proportion of FEV(1)/FVC <70% was suggested. In conclusion, in the present low-exposed cohort, female woodworkers had an accelerated decline in lung function, which may be clinically relevant.

Clinical research on liver reserve function by 13C-phenylalanine breath test in aged patients with chronic liver diseases

PubMed Central

2010-01-01

Background The objective of this study was to investigate whether the 13C-phenylalanine breath test could be useful for the evaluation of hepatic function in elderly volunteers and patients with chronic hepatitis B and liver cirrhosis. Methods L-[1-13C] phenylalanine was administered orally at a dose of 100 mg to 55 elderly patients with liver cirrhosis, 30 patients with chronic hepatitis B and 38 elderly healthy subjects. The breath test was performed at 8 different time points (0, 10, 20, 30, 45, 60, 90, 120 min) to obtain the values of Delta over baseline, percentage 13CO2 exhalation rate and cumulative excretion (Cum). The relationships of the cumulative excretion with the 13C-%dose/h and blood biochemical parameters were investigated. Results The 13C-%dose/h at 20 min and 30 min combined with the cumulative excretion at 60 min and 120 min correlated with hepatic function tests, serum albumin, hemoglobin, platelet and Child-Pugh score. Prothrombin time, total and direct bilirubin were significantly increased, while serum albumin, hemoglobin and platelet, the cumulative excretion at 60 min and 120 min values decreased by degrees of intensity of the disease in Child-Pugh A, B, and C patients (P < 0.01). Conclusions The 13C-phenylalanine breath test can be used as a non-invasive assay to evaluate hepatic function in elderly patients with liver cirrhosis. The 13C-%dose/h at 20 min, at 30 min and cumulative excretion at 60 min may be the key value for determination at a single time-point. 13C-phenylalanine breath test is safe and helpful in distinguishing different stages of hepatic dysfunction for elderly cirrhosis patients. PMID:20459849

Health Risk Assessment of Embedded Depleted Uranium: Behavior, Physiology, Histology and Biokenetic Modeling.

DTIC Science & Technology

1996-11-01

increased urinary excretion of beta2-microglobulin and various amino acids. In rats exposed subchronically to low doses (cumulative dose: 0.66 or 1.32 mg/kg...leakage or failure of tubule reabsorption. Urinary enzymes are sensitive, non- invasive markers of toxicity primarily in the kidney tubules46. NAG is a...42 Neuman, W.F., Urinary uranium as a measure of exposure hazard, Industrial. Med. Surgery, 19 (1950) 185-191. 43 Neuman, W.F., Fleming, R.W., Dounce

Cumulative Index to Chemicals and to Common and Scientific Names of Species Listed in Contaminant Hazard Reviews 1 Through 34.

DTIC Science & Technology

1999-03-01

5 21. Anemone Plumose, Metridium senile Sea, Anemonia viridis , Anthopleura xanihogrammica Anemonia viridis : 33 49, 69. Anguilla anguilla: 8 12... Fragaria vesca: 3 4. Gallinule, purple, Porphyrula martinica Fratercula spp.: 2 15; 21 19, 20. Gallus spp.: 1 5, 9, 15,19; 2 iii, 24, 31; 3 11,23, 24...zibethicus Mussel Brown, Perna indica Common, Mytilus edulis Duck, Anodonta anatina, A. nuttalliana Green-lipped, Perna viridis Hooked, Ischadium

Hypothyroidism After Head-and-Neck Radiotherapy in Children and Adolescents: Preliminary Results of the 'Registry for the Evaluation of Side Effects After Radiotherapy in Childhood and Adolescence' (RiSK)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Boelling, Tobias, E-mail: Tobias.Boelling@uni-muenster.de; Department of Radiotherapy, Paracelsus Clinic Osnabrueck, Osnabrueck; Geisenheiser, Alina

Purpose: The 'Registry for the Evaluation of Side Effects After Radiotherapy in Childhood and Adolescence' (RiSK) has been established to prospectively characterize dose-volume effects of radiation in terms of side effects. The aim of this analysis was to characterize the function of the thyroid gland after radiotherapy to the head-and-neck region in children and adolescents. Methods and Materials: Detailed information regarding radiation doses to at-risk organs has been collected across Germany since 2001. Thyroid function was evaluated by blood value examinations of thyroid-stimulating hormone, triiodothyronine, and thyroxine. Information regarding thyroid hormone substitution was requested from the treating physicians. Results: Untilmore » May 2009, 1,086 patients from 62 centers were recruited, including 404 patients (median age, 10.9 years) who had received radiotherapy to the thyroid gland and/or hypophysis. Follow-up information was available for 264 patients (60.9%; median follow-up, 40 months), with 60 patients (22.7%) showing pathologic values. In comparison to patients treated with prophylactic cranial irradiation (median dose, 12 Gy), patients with radiation doses of 15 to 25 Gy to the thyroid gland had a hazard ratio of 3.072 (p = 0.002) for the development of pathologic thyroid blood values. Patients with greater than 25 Gy to the thyroid gland and patients who underwent craniospinal irradiation had hazard ratios of 3.768 (p = 0.009) and 5.674 (p < 0.001), respectively. The cumulative incidence of thyroid hormone substitution therapy did not differ between defined subgroups. Conclusions: Radiation-induced thyroid function impairment, including damage to the thyroid gland and/or hypophysis, can frequently be observed after radiotherapy in children. A structured follow-up examination is advised.« less

Model for Cumulative Solar Heavy Ion Energy and LET Spectra

NASA Technical Reports Server (NTRS)

Xapsos, Mike; Barth, Janet; Stauffer, Craig; Jordan, Tom; Mewaldt, Richard

2007-01-01

A probabilistic model of cumulative solar heavy ion energy and lineary energy transfer (LET) spectra is developed for spacecraft design applications. Spectra are given as a function of confidence level, mission time period during solar maximum and shielding thickness. It is shown that long-term solar heavy ion fluxes exceed galactic cosmic ray fluxes during solar maximum for shielding levels of interest. Cumulative solar heavy ion fluences should therefore be accounted for in single event effects rate calculations and in the planning of space missions.

Ovarian Suppression With Triptorelin During Adjuvant Breast Cancer Chemotherapy and Long-term Ovarian Function, Pregnancies, and Disease-Free Survival: A Randomized Clinical Trial.

PubMed

Lambertini, Matteo; Boni, Luca; Michelotti, Andrea; Gamucci, Teresa; Scotto, Tiziana; Gori, Stefania; Giordano, Monica; Garrone, Ornella; Levaggi, Alessia; Poggio, Francesca; Giraudi, Sara; Bighin, Claudia; Vecchio, Carlo; Sertoli, Mario Roberto; Pronzato, Paolo; Del Mastro, Lucia

Whether the administration of luteinizing hormone-releasing hormone analogues (LHRHa) during chemotherapy is a reliable strategy to preserve ovarian function is controversial owing to both the lack of data on long-term ovarian function and pregnancies and the safety concerns about the potential negative interactions between endocrine therapy and chemotherapy. To evaluate long-term results of LHRHa-induced ovarian suppression during breast cancer chemotherapy. Parallel, randomized, open-label, phase 3 superiority trial conducted at 16 Italian sites. Between October 2003 and January 2008, 281 premenopausal women with stage I to III hormone receptor-positive or hormone receptor-negative breast cancer were enrolled. Last annual follow-up was June 3, 2014. Patients were randomized to receive adjuvant or neoadjuvant chemotherapy alone (control group) or chemotherapy plus triptorelin (LHRHa group). The primary planned end point was incidence of chemotherapy-induced early menopause. Post hoc end points were long-term ovarian function (evaluated by yearly assessment of menstrual activity and defined as resumed by the occurrence of at least 1 menstrual cycle), pregnancies, and disease-free survival (DFS). A total of 281 women (median age, 39 [range, 24-45] years) were randomized. Median follow-up was 7.3 years (interquartile range, 6.3-8.2 years). The 5-year cumulative incidence estimate of menstrual resumption was 72.6% (95% CI, 65.7%-80.3%) among the 148 patients in the LHRHa group and 64.0% (95% CI, 56.2%-72.8%) among the 133 patients in the control group (hazard ratio [HR], 1.28 [95% CI, 0.98-1.68]; P = .07; age-adjusted HR, 1.48 [95% CI, 1.12-1.95]; P = .006). Eight pregnancies (5-year cumulative incidence estimate of pregnancy, 2.1% [95% CI, 0.7%-6.3%]) occurred in the LHRHa group and 3 (5-year cumulative incidence estimate of pregnancy, 1.6% [95% CI, 0.4%-6.2%]) in the control group (HR, 2.56 [95% CI, 0.68-9.60]; P = .14; age-adjusted HR, 2.40 [95% CI, 0.62-9.22]; P = .20). Five-year DFS was 80.5% (95% CI, 73.1%-86.1%) in the LHRHa group and 83.7% (95% CI, 76.1%-89.1%) in the control group (LHRHa vs control: HR, 1.17 [95% CI, 0.72-1.92]; P = .52). Among premenopausal women with either hormone receptor-positive or hormone receptor-negative breast cancer, concurrent administration of triptorelin and chemotherapy, compared with chemotherapy alone, was associated with higher long-term probability of ovarian function recovery, without a statistically significant difference in pregnancy rate. There was no statistically significant difference in DFS for women assigned to triptorelin and those assigned to chemotherapy alone, although study power was limited. clinicaltrials.gov Identifier:NCT00311636.

Vulnerability, safety and response of nuclear power plants to the hydroclimatic hazards

NASA Astrophysics Data System (ADS)

János Katona, Tamás; Vilimi, András

2016-04-01

The Great Tohoku Earthquake and Tsunami, and the severe accident at Fukushima Dai-ichi nuclear power plant 2011 alerted the nuclear industry to danger of extreme rare natural hazards. The subsequent "stress tests" performed by the nuclear industry in Europe and all over the world identifies the nuclear power plant (NPP) vulnerabilities and define the measures for increasing the plant safety. According to the international practice of nuclear safety regulations, the cumulative core damage frequency for NPPs has to be 10-5/a, and the cumulative frequency of early large release has to be 10-6/a. In case of operating plants these annual probabilities can be little higher, but the licensees are obliged to implement all reasonable practicable measures for increasing the plant safety. For achieving the required level of safety, design basis of NPPs for natural hazards has to be defined at the 10-4/a ⎯10-5/a levels of annual exceedance probability. Tornado hazard is some kind of exception, e.g., the design basis annual probability for tornado in the US is equal to 10-7/a. Design of the NPPs shall provide for an adequate margin to protect items ultimately necessary to prevent large or early radioactive releases in the event of levels of natural hazards exceeding those to be considered for design. The plant safety has to be reviewed for accounting the changes of the environmental conditions and natural hazards in case of necessity, but as minimum every ten years in the frame of periodic safety reviews. Long-term forecast of environmental conditions and hazards has to be accounted for in the design basis of the new plants. Changes in hydroclimatic variables, e.g., storms, tornadoes, river floods, flash floods, extreme temperatures, droughts affect the operability and efficiency as well as the safety the NPPs. Low flow rates and high water temperature in the rivers may force to operate at reduced power level or shutdown the plant (Cernavoda NPP, Romania, August 2009). The practice demonstrated that the NPPs could safely withstand the meteorological extremes (Katrina hurricane, 2005). However the floods at some sites cause significant safety issues. Design of NPPs and their response to extreme hydroclimatic events depends on the features of particular hazards, e.g., predictability, possibility and time available for the protective actions, potential for causing cliff-edge effects and the possible combinations of events. The uncertainty of the prediction of extreme values for the design and safety assessment is a fundamental issue. In the paper the consequences of hydroclimatic extremes are analysed for nuclear power plants. The possibility of operational response to extremes is presented. The safety margins are assessed with respect to the effects caused by hydroclimatic extremes. The direct actions (e.g. wind) and the indirect consequences (e.g. changing of ground water level) are also considered. Methods for accounting the uncertainties of the characterisation of low probability hazards are also considered. The preparedness to severe hydroclimatic conditions / events and actions for mitigation and management are presented and discussed. The considerations in the paper are illustrated by the case of the Paks Nuclear Power Plant, Hungary.

Cumulative exposure to dust causes accelerated decline in lung function in tunnel workers

PubMed Central

Ulvestad, B; Bakke, B; Eduard, W; Kongerud, J; Lund, M

2001-01-01

OBJECTIVES—To examine whether underground construction workers exposed to tunnelling pollutants over a follow up period of 8 years have an increased risk of decline in lung function and respiratory symptoms compared with reference subjects working outside the tunnel atmosphere, and relate the findings to job groups and cumulative exposure to dust and gases.
METHODS—96 Tunnel workers and a reference group of 249 other heavy construction workers were examined in 1991 and re-examined in 1999. Exposure measurements were carried out to estimate personal cumulative exposure to total dust, respirable dust, α-quartz, oil mist, and nitrogen dioxide. The subjects answered a questionnaire on respiratory symptoms and smoking habits, performed spirometry, and had chest radiographs taken. Radiological signs of silicosis were evaluated (International Labour Organisation (ILO) classification). Atopy was determined by a multiple radioallergosorbent test (RAST).
RESULTS—The mean exposure to respirable dust and α-quartz in tunnel workers varied from 1.2-3.6 mg/m3 (respirable dust) and 0.019-0.044 mg/m3 (α-quartz) depending on job task performed. Decrease in forced expiratory volume in 1 second (FEV1) was associated with cumulative exposure to respirable dust (p<0.001) and α-quartz (p=0.02). The multiple regression model predicted that in a worker 40 years of age, the annual decrease in FEV1 would be 25 ml in a non-exposed non-smoker, 35 ml in a non-exposed smoker, and 50-63 ml in a non-smoking tunnel worker (depending on job). Compared with the reference group the odds ratio for the occurrence of new respiratory symptoms during the follow up period was increased in the tunnel workers and associated with cumulative exposure to respirable dust.
CONCLUSIONS—Cumulative exposures to respirable dust and α-quartz are the most important risk factors for airflow limitation in underground heavy construction workers, and cumulative exposure to respirable dust is the most important risk factor for respiratory symptoms. The finding of accelerated decline in lung function in tunnel workers suggests that better control of exposures is needed.


Keywords: heavy construction; respirable dust; lung function PMID:11555688

Assessing Quality in Higher Education: New Criteria for Evaluating Students' Satisfaction

ERIC Educational Resources Information Center

Zineldin, Mosad; Akdag, Hatice Camgoz; Vasicheva, Valentina

2011-01-01

The aim of this research is to present a new quality assurance model (5Qs) and to examine the major factors affecting students' perception of cumulative satisfaction. The model includes behavioural dimensions of student satisfaction. The factors included in this cumulative summation are technical, functional, infrastructure, interaction and…

40 CFR Appendix C to Part 191 - Guidance for Implementation of Subpart B

Code of Federal Regulations, 2014 CFR

2014-07-01

... that the remaining probability distribution of cumulative releases would not be significantly changed... with § 191.13 into a “complementary cumulative distribution function” that indicates the probability of... distribution function for each disposal system considered. The Agency assumes that a disposal system can be...

40 CFR Appendix C to Part 191 - Guidance for Implementation of Subpart B

Code of Federal Regulations, 2011 CFR

2011-07-01

... that the remaining probability distribution of cumulative releases would not be significantly changed... with § 191.13 into a “complementary cumulative distribution function” that indicates the probability of... distribution function for each disposal system considered. The Agency assumes that a disposal system can be...

Exploring Robust and Resilient Pathways to Water Security (Invited)

NASA Astrophysics Data System (ADS)

Brown, C. M.

2013-12-01

Lack of water security and the resultant cumulative effects of water-related hazards are understood to hinder economic growth throughout the world. Traditional methods for achieving water security as exemplified in the industrialized world have exerted negative externalities such as degradation of aquatic ecosystems. There is also growing concern that such methods may not be robust to climate variability change. It has been proposed that alternative pathways to water security must be followed in the developing world. However, it is not clear such pathways currently exist and there is an inherent moral hazard in such recommendations. This presentation will present a multidimensional definition of water security, explore the conflict in norms between engineering and ecologically oriented communities, and present a framework synthesizing those norms for assessing and innovating robust and resilient pathways to water security.

Probabilistic Forecasting of Life and Economic Losses due to Natural Disasters

NASA Astrophysics Data System (ADS)

Barton, C. C.; Tebbens, S. F.

2014-12-01

The magnitude of natural hazard events such as hurricanes, tornadoes, earthquakes, and floods are traditionally measured by wind speed, energy release, or discharge. In this study we investigate the scaling of the magnitude of individual events of the 20th and 21stcentury in terms of economic and life losses in the United States and worldwide. Economic losses are subdivided into insured and total losses. Some data sets are inflation or population adjusted. Forecasts associated with these events are of interest to insurance, reinsurance, and emergency management agencies. Plots of cumulative size-frequency distributions of economic and life loss are well-fit by power functions and thus exhibit self-similar scaling. This self-similar scaling property permits use of frequent small events to estimate the rate of occurrence of less frequent larger events. Examining the power scaling behavior of loss data for disasters permits: forecasting the probability of occurrence of a disaster over a wide range of years (1 to 10 to 1,000 years); comparing losses associated with one type of disaster to another; comparing disasters in one region to similar disasters in another region; and, measuring the effectiveness of planning and mitigation strategies. In the United States, life losses due to flood and tornado cumulative-frequency distributions have steeper slopes, indicating that frequent smaller events contribute the majority of losses. In contrast, life losses due to hurricanes and earthquakes have shallower slopes, indicating that the few larger events contribute the majority of losses. Disaster planning and mitigation strategies should incorporate these differences.

Associations between parenting, media use, cumulative risk, and children's executive functioning.

PubMed

Linebarger, Deborah L; Barr, Rachel; Lapierre, Matthew A; Piotrowski, Jessica T

2014-01-01

This study was designed to examine how parenting style, media exposure, and cumulative risk were associated with executive functioning (EF) during early childhood. A nationally representative group of US parents/caregivers (N = 1156) with 1 child between 2 and 8 years participated in a telephone survey. Parents were asked to report on their child's exposure to television, music, and book reading through a 24-hour time diary. Parents also reported a host of demographic and parenting variables as well as questions on their child's EF. Separate multiple regressions for preschool (2-5 years) and school-aged (6-8 years) children grouped by cumulative risk were conducted. Parenting style moderated the risks of exposure to background television on EF for high-risk preschool-age children. Educational TV exposure served as a buffer for high-risk school-aged children. Cumulative risk, age, and parenting quality interacted with a number of the exposure effects. The study showed a complex pattern of associations between cumulative risk, parenting, and media exposure with EF during early childhood. Consistent with the American Academy of Pediatrics, these findings support the recommendation that background television should be turned off when a child is in the room and suggest that exposure to high-quality content across multiple media platforms may be beneficial.

Nonparametric analysis of bivariate gap time with competing risks.

PubMed

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

2016-09-01

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. © 2016, The International Biometric Society.

Statistical tests for whether a given set of independent, identically distributed draws comes from a specified probability density.

PubMed

Tygert, Mark

2010-09-21

We discuss several tests for determining whether a given set of independent and identically distributed (i.i.d.) draws does not come from a specified probability density function. The most commonly used are Kolmogorov-Smirnov tests, particularly Kuiper's variant, which focus on discrepancies between the cumulative distribution function for the specified probability density and the empirical cumulative distribution function for the given set of i.i.d. draws. Unfortunately, variations in the probability density function often get smoothed over in the cumulative distribution function, making it difficult to detect discrepancies in regions where the probability density is small in comparison with its values in surrounding regions. We discuss tests without this deficiency, complementing the classical methods. The tests of the present paper are based on the plain fact that it is unlikely to draw a random number whose probability is small, provided that the draw is taken from the same distribution used in calculating the probability (thus, if we draw a random number whose probability is small, then we can be confident that we did not draw the number from the same distribution used in calculating the probability).

Sinusoidal obstruction syndrome after allogeneic hematopoietic stem cell transplantation: Incidence, risk factors and outcomes.

PubMed

Yakushijin, K; Atsuta, Y; Doki, N; Yokota, A; Kanamori, H; Miyamoto, T; Ohwada, C; Miyamura, K; Nawa, Y; Kurokawa, M; Mizuno, I; Mori, T; Onizuka, M; Taguchi, J; Ichinohe, T; Yabe, H; Morishima, Y; Kato, K; Suzuki, R; Fukuda, T

2016-03-01

This retrospective study was conducted in Japan to determine the incidence, risk factors and outcomes of sinusoidal obstruction syndrome (SOS) after allogeneic hematopoietic stem cell transplantation (HSCT). Among 4290 patients undergoing allogeneic HSCT between 1999 and 2010, 462 were diagnosed with SOS according to the Seattle criteria (cumulative incidence, 10.8%). The cumulative incidence of SOS diagnosed by the modified Seattle criteria was 9.3%. Of 462 patients, 107 met the Baltimore criteria and 168 had severe SOS with renal and/or respiratory failure. The median onset for SOS was 12 days after HSCT (range, -2-30). Overall survival at day 100 was 32% for SOS and 15% for severe SOS. Multivariate analyses showed that significant independent risk factors for SOS were the number of HSCTs, age, performance status, hepatitis C virus-seropositivity, advanced disease status and myeloablative regimen. SOS was highly associated with overall mortality (hazard ratio, 2.09; P<0.001). Our retrospective survey showed that the cumulative incidence of SOS in Japan was 10.8%, similar to that previously reported in Western countries, and that the overall survival of patients who developed SOS was low. Furthermore, several risk factors were identified. Preventive and therapeutic strategies for high-risk SOS patients must be established to improve overall survival.

A novel risk score for mortality in renal transplant recipients beyond the first posttransplant year.

PubMed

Hernández, Domingo; Sánchez-Fructuoso, Ana; González-Posada, José Manuel; Arias, Manuel; Campistol, Josep María; Rufino, Margarita; Morales, José María; Moreso, Francesc; Pérez, Germán; Torres, Armando; Serón, Daniel

2009-09-27

All-cause mortality is high after kidney transplantation (KT), but no prognostic index has focused on predicting mortality in KT using baseline and emergent comorbidity after KT. A total of 4928 KT recipients were used to derive a risk score predicting mortality. Patients were randomly assigned to two groups: a modeling population (n=2452), used to create a new index, and a testing population (n=2476), used to test this index. Multivariate Cox regression model coefficients of baseline (age, weight, time on dialysis, diabetes, hepatitis C, and delayed graft function) and emergent comorbidity within the first posttransplant year (diabetes, proteinuria, renal function, and immunosuppressants) were used to weigh each variable in the calculation of the score and allocated into risk quartiles. The probability of death at 3 years, estimated by baseline cumulative hazard function from the Cox model [P (death)=1-0.993592764 (exp(score/100)], increased from 0.9% in the lowest-risk quartile (score=40) to 4.7% in the highest risk-quartile (score=200). The observed incidence of death increased with increasing risk quartiles in testing population (log-rank analysis, P<0.0001). The overall C-index was 0.75 (95% confidence interval: 0.72-0.78) and 0.74 (95% confidence interval: 0.70-0.77) in both populations, respectively. This new index is an accurate tool to identify high-risk patients for mortality after KT.

Exposure-response analysis and risk assessment for lung cancer in relationship to silica exposure: a 44-year cohort study of 34,018 workers.

PubMed

Liu, Yuewei; Steenland, Kyle; Rong, Yi; Hnizdo, Eva; Huang, Xiji; Zhang, Hai; Shi, Tingming; Sun, Yi; Wu, Tangchun; Chen, Weihong

2013-11-01

Crystalline silica has been classified as a human carcinogen by the International Agency for Research on Cancer (Lyon, France); however, few previous studies have provided quantitative data on silica exposure, silicosis, and/or smoking. We investigated a cohort in China (in 1960-2003) of 34,018 workers without exposure to carcinogenic confounders. Cumulative silica exposure was estimated by linking a job-exposure matrix to work history. Cox proportional hazards model was used to conduct exposure-response analysis and risk assessment. During a mean 34.5-year follow-up, 546 lung cancer deaths were identified. Categorical analyses by quartiles of cumulative silica exposure (using a 25-year lag) yielded hazard ratios of 1.26, 1.54, 1.68, and 1.70, respectively, compared with the unexposed group. Monotonic exposure-response trends were observed among nonsilicotics (P for trend < 0.001). Analyses using splines showed similar trends. The joint effect of silica and smoking was more than additive and close to multiplicative. For workers exposed from ages 20 to 65 years at 0.1 mg/m(3) of silica exposure, the estimated excess lifetime risk (through age 75 years) was 0.51%. These findings confirm silica as a human carcinogen and suggest that current exposure limits in many countries might be insufficient to protect workers from lung cancer. They also indicate that smoking cessation could help reduce lung cancer risk for silica-exposed individuals.

Modern medical treatment with or without carotid endarterectomy for severe asymptomatic carotid atherosclerosis.

PubMed

Kolos, Igor; Troitskiy, Alexandr; Balakhonova, Tatiana; Shariya, Merab; Skrypnik, Denis; Tvorogova, Tatiana; Deev, Alexandr; Boytsov, Sergey

2015-10-01

This study assessed the value of modern medical treatment (MMT) with and without carotid endarterectomy (CEA) in patients with asymptomatic severe carotid artery stenosis. We conducted a randomized trial involving 55 patients with 70% to 79% carotid stenosis at three Russian centers. Between 2009 and 2013, 31 patients were randomized to undergo CEA with MMT (CEA group) and 24 to receive MMT alone. The primary end point was nonfatal ipsilateral stroke or death from any cause during a follow-up period of 5.0 years. The secondary end point was any nonfatal stroke, carotid revascularization, or death from any cause during follow-up. The trial was stopped after a median follow-up of 3.3 years (maximum, 5.0 years). There were two primary events in the CEA group and nine events in the MMT group. The 3.3-year cumulative primary event rates were 6.5% in the CEA group and 37.5% in the MMT group (hazard ratio for the MMT group, 5.06; 95% confidence interval, 1.53-16.79; P = .008). The 3.3-year cumulative secondary end point was 12.9% in the CEA group and 50.0% in the MMT group (hazard ratio for the MMT group, 4.23; 95% confidence interval, 1.55-11.53; P = .0048). CEA as an initial management strategy could reduce the risk of death and major cerebrovascular events when added to MMT. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Prospective Cohort Study to Elucidate the Correlation between Occupational Stress and Hypertension Risk in Oil Workers from Kelamayi City in the Xinjiang Uygur Autonomous Region of China.

PubMed

Li, Rong; Gao, Xiaoyan; Liu, Bo; Ge, Hua; Ning, Li; Zhao, Junling; Liu, Jiwen

2016-12-22

The purpose of this study was to assess the major risk factors for hypertension in oil workers, and investigate the effect of occupational stress on the incidence of hypertension after controlling for other risk factors. A prospective cohort approach was used following enrollment of 1354 oil workers. The occupational stress experienced by oil workers was higher than for the general population in China. By the end of the cohort study, 231 new cases of hypertension among the oil workers had been diagnosed. The cumulative incidence of hypertension was 17.06%. There were 44, 112, and 75 workers who developed hypertension in the low, intermediate, and high occupational stress groups, which represented a 12.0%, 15.6%, and 20.3% cumulative incidence, respectively (chi-square value = 9.812, p < 0.01). Multivariate Cox proportional hazard model analysis showed that type of work, cigarette smoking, excess body weight, and obesity were risk factors for hypertension ( p < 0.05). After risk factors such as type of work, cigarette smoking, alcohol consumption, and body mass index (BMI) were controlled, the hypertension risk (hazard ratio, HR) in the high occupational stress group was 1.549 (1.072-2.236) compared to the low exposure group, and 2.337 (1.191-4.585) in female subjects. Our study indicated that an increase in occupational stress was associated with an increased risk of hypertension after other factors were adjusted.

Prospective Cohort Study to Elucidate the Correlation between Occupational Stress and Hypertension Risk in Oil Workers from Kelamayi City in the Xinjiang Uygur Autonomous Region of China

PubMed Central

Li, Rong; Gao, Xiaoyan; Liu, Bo; Ge, Hua; Ning, Li; Zhao, Junling; Liu, Jiwen

2016-01-01

The purpose of this study was to assess the major risk factors for hypertension in oil workers, and investigate the effect of occupational stress on the incidence of hypertension after controlling for other risk factors. A prospective cohort approach was used following enrollment of 1354 oil workers. The occupational stress experienced by oil workers was higher than for the general population in China. By the end of the cohort study, 231 new cases of hypertension among the oil workers had been diagnosed. The cumulative incidence of hypertension was 17.06%. There were 44, 112, and 75 workers who developed hypertension in the low, intermediate, and high occupational stress groups, which represented a 12.0%, 15.6%, and 20.3% cumulative incidence, respectively (chi-square value = 9.812, p < 0.01). Multivariate Cox proportional hazard model analysis showed that type of work, cigarette smoking, excess body weight, and obesity were risk factors for hypertension (p < 0.05). After risk factors such as type of work, cigarette smoking, alcohol consumption, and body mass index (BMI) were controlled, the hypertension risk (hazard ratio, HR) in the high occupational stress group was 1.549 (1.072–2.236) compared to the low exposure group, and 2.337 (1.191–4.585) in female subjects. Our study indicated that an increase in occupational stress was associated with an increased risk of hypertension after other factors were adjusted. PMID:28025517

Meta-Analysis of Cardiac Mortality in Three Cohorts of Carbon Black Production Workers

PubMed Central

Morfeld, Peter; Mundt, Kenneth A.; Dell, Linda D.; Sorahan, Tom; McCunney, Robert J.

2016-01-01

Epidemiological studies have demonstrated associations between airborne environmental particle exposure and cardiac disease and mortality; however, few have examined such effects from poorly soluble particles of low toxicity such as manufactured carbon black (CB) particles in the work place. We combined standardised mortality ratio (SMR) and Cox proportional hazards results from cohort studies of US, UK and German CB production workers. Under a common protocol, we analysed mortality from all causes, heart disease (HD), ischemic heart disease (IHD) and acute myocardial infarction (AMI). Fixed and random effects (RE) meta-regression models were fit for employment duration, and for overall cumulative and lugged quantitative CB exposure estimates. Full cohort meta-SMRs (RE) were 1.01 (95% confidence interval (CI) 0.79–1.29) for HD; 1.02 (95% CI 0.80–1.30) for IHD, and 1.08 (95% CI 0.74–1.59) for AMI mortality. For all three outcomes, meta-SMRs were heterogeneous, increased with time since first and time since last exposure, and peaked after 25–29 or 10–14 years, respectively. Meta-Cox coefficients showed no association with lugged duration of exposure. A small but imprecise increased AMI mortality risk was suggested for cumulative exposure (RE-hazards ratio (HR) = 1.10 per 100 mg/m3-years; 95% CI 0.92–1.31), but not for lugged exposures. Our results do not demonstrate that airborne CB exposure increases all-cause or cardiac disease mortality. PMID:27005647

Respiratory distress syndrome in preterm infants and risk of epilepsy in a Danish cohort.

PubMed

Thygesen, Sandra Kruchov; Olsen, Morten; Pedersen, Lars; Henderson, Victor W; Østergaard, John Rosendahl; Sørensen, Henrik Toft

2018-03-01

Infant respiratory distress syndrome (IRDS) may be complicated by intracerebral hemorrhage, a known trigger of epilepsy. However, few data exist on long term epilepsy risk following IRDS. We therefore examined the association between IRDS in preterm infants and childhood epilepsy. We conducted a population-based cohort study using individual-level data linkage among nationwide registries. All infants born at 32-36 weeks of gestation in 1978-2009 were identified in the Medical Birth Registry. We identified children with IRDS and those with epilepsy using the Danish National Patient Registry. We computed the cumulative incidence of epilepsy with follow-up from birth until epilepsy, emigration, death, age 15, or December 31, 2014. We used Cox's regression analysis to compute hazard ratios comparing children with and without IRDS, adjusting for sex, birth year, gestational age, multiplicity, major malformations, and maternal age. We identified 95,026 infants, of whom 6426 (6.8%) had IRDS. The cumulative incidence of epilepsy was 3.4% by age 15 in children with IRDS and 2.1% in children without IRDS. The adjusted hazard ratio of epilepsy among children with IRDS compared to those without was 1.4 (95% CI 1.2-1.6). When we restricted the IRDS cohort to children with no simultaneous morbidities that had clinical symptoms overlapping with IRDS, the overall adjusted HR was 1.1 (95% CI 0.9-1.4). In children born preterm at 32-36 weeks' gestation, IRDS was associated with increased risk of childhood epilepsy.

Large-deviation theory for diluted Wishart random matrices

NASA Astrophysics Data System (ADS)

Castillo, Isaac Pérez; Metz, Fernando L.

2018-03-01

Wishart random matrices with a sparse or diluted structure are ubiquitous in the processing of large datasets, with applications in physics, biology, and economy. In this work, we develop a theory for the eigenvalue fluctuations of diluted Wishart random matrices based on the replica approach of disordered systems. We derive an analytical expression for the cumulant generating function of the number of eigenvalues IN(x ) smaller than x ∈R+ , from which all cumulants of IN(x ) and the rate function Ψx(k ) controlling its large-deviation probability Prob[IN(x ) =k N ] ≍e-N Ψx(k ) follow. Explicit results for the mean value and the variance of IN(x ) , its rate function, and its third cumulant are discussed and thoroughly compared to numerical diagonalization, showing very good agreement. The present work establishes the theoretical framework put forward in a recent letter [Phys. Rev. Lett. 117, 104101 (2016), 10.1103/PhysRevLett.117.104101] as an exact and compelling approach to deal with eigenvalue fluctuations of sparse random matrices.

Site-to-Source Finite Fault Distance Probability Distribution in Probabilistic Seismic Hazard and the Relationship Between Minimum Distances

NASA Astrophysics Data System (ADS)

Ortega, R.; Gutierrez, E.; Carciumaru, D. D.; Huesca-Perez, E.

2017-12-01

We present a method to compute the conditional and no-conditional probability density function (PDF) of the finite fault distance distribution (FFDD). Two cases are described: lines and areas. The case of lines has a simple analytical solution while, in the case of areas, the geometrical probability of a fault based on the strike, dip, and fault segment vertices is obtained using the projection of spheres in a piecewise rectangular surface. The cumulative distribution is computed by measuring the projection of a sphere of radius r in an effective area using an algorithm that estimates the area of a circle within a rectangle. In addition, we introduce the finite fault distance metrics. This distance is the distance where the maximum stress release occurs within the fault plane and generates a peak ground motion. Later, we can apply the appropriate ground motion prediction equations (GMPE) for PSHA. The conditional probability of distance given magnitude is also presented using different scaling laws. A simple model of constant distribution of the centroid at the geometrical mean is discussed, in this model hazard is reduced at the edges because the effective size is reduced. Nowadays there is a trend of using extended source distances in PSHA, however it is not possible to separate the fault geometry from the GMPE. With this new approach, it is possible to add fault rupture models separating geometrical and propagation effects.

Severe physical violence between intimate partners during pregnancy: a risk factor for early cessation of exclusive breast-feeding.

PubMed

Moraes, Claudia L; de Oliveira, Alessandra S D; Reichenheim, Michael E; Lobato, Gustavo

2011-12-01

To investigate the role of severe physical violence during pregnancy (SPVP) between intimate partners in early cessation of exclusive breast-feeding (EBF). A health services survey. The revised Conflict Tactics Scale was used to characterize SPVP; premature breast-feeding cessation was identified using a current status data approach, which was based on the information reported from food recall during the preceding 7 d. The cumulative hazard function was estimated by complementary log-log transformation models, which allowed the ensuing estimation of early breast-feeding cessation rates in different age groups and the ratio of rates of weaning between women exposed and not exposed to violence. Five large public primary health-care facilities of Rio de Janeiro, Brazil. The sample comprised 811 randomly selected mothers of children under 5 months of age who were waiting to be consulted. SPVP is an independent risk factor of cessation of EBF since, after controlling for socio-economic, demographic, reproductive and lifestyle variables, women exposed to violence presented an incidence density that was 31% higher than those who were not exposed (hazard ratio = 1·30, 95% CI 1·01, 1·69). The findings corroborate the hypothesis that SPVP is an important risk factor for EBF. This indicates the need for incentives to adequately train health-care personnel in dealing with lactating women in order to gain a broader view of breast-feeding beyond the biological aspects of lactation, including the maternal psychological dimension.

Too old to have children? Lessons from natural fertility populations.

PubMed

Eijkemans, Marinus J C; van Poppel, Frans; Habbema, Dik F; Smith, Ken R; Leridon, Henri; te Velde, Egbert R

2014-06-01

Is it possible to construct an age curve denoting the ages above which women are biologically too old to reproduce? We constructed a curve based on the distribution of female age at last birth in natural fertility populations reflecting the ages above which women have become biologically too old to have children. The median age at last birth (ALB) for females is ∼40-41 years of age across a range of natural fertility populations. This suggests that there is a fairly universal pattern of age-related fertility decline. However, little is known about the distribution of female ALB and in the present era of modern birth control, it is impossible to assess the age-specific distribution of ALB. Reliable information is lacking that could benefit couples who envisage delaying childbearing. This study is a review of high-quality historical data sets of natural fertility populations in which the distributions of female age at last birth were analysed. The studies selected used a retrospective cohort design where women were followed as they age through their reproductive years. Using a common set of eligibility criteria, large data files of natural fertility populations were prepared such that the analysis could be performed in parallel across all populations. Data on the ALB and confounding variables are presented as box and whisker plots denoting the 5th, 25th, 50th, 75th and 95th percentile distribution of the age at last birth for each population. The analysis includes the estimation of Kaplan-Meier curves for age at last birth of each population. The hazard curve for ALB was obtained by plotting the smoothed hazard curve of each population and taking the lowest hazard within a time period of at least 5 years. This lowest hazard curve was then transformed into a cumulative distribution function representing the composite curve of the end of biological fertility. This curve was based on the data from three of the six populations, having the lowest hazards of end of fertility. We selected six natural fertility populations comprising 58 051 eligible women. While these populations represent different historical time periods, the distribution of the ages at last birth is remarkably similar. The curve denoting the end of fertility indicates that <3% of women had their last birth at age 20 years meaning that almost 98% were able to have at least one child thereafter. The cumulative curve for the end of fertility slowly increases from 4.5% at age 25 years, 7% at age 30 years, 12% at age 35 years and 20% at age 38 years. Thereafter, it rises rapidly to about 50% at age 41, almost 90% at age 45 years and approaching 100% at age 50 years. It may be argued that these historical fertility data do not apply to the present time; however, the age-dependent decline in fertility is similar to current populations and is consistent with the pattern seen in women treated by donor insemination. Furthermore, for reproductive ageing, we note that it is unlikely that such a conserved biological process with a high degree of heritability would have changed significantly within a century or two. We argue that the age-specific ALB curve can be used to counsel couples who envisage having children in the future. Our findings challenge the unsubstantiated pessimism regarding the possibility of natural conception after age 35 years. No external funding was either sought or obtained for this study. There are no conflicts of interest to be declared.

Interactive Contributions of Cumulative Peer Stress and Executive Function Deficits to Depression in Early Adolescence

ERIC Educational Resources Information Center

Agoston, Anna M.; Rudolph, Karen D.

2016-01-01

Exposure to peer stress contributes to adolescent depression, yet not all youth experience these effects. Thus, it is important to identify individual differences that shape the consequences of peer stress. This research investigated the interactive contribution of cumulative peer stress during childhood (second-fifth grades) and executive…

Resonances in the cumulative reaction probability for a model electronically nonadiabatic reaction

DOE Office of Scientific and Technical Information (OSTI.GOV)

Qi, J.; Bowman, J.M.

1996-05-01

The cumulative reaction probability, flux{endash}flux correlation function, and rate constant are calculated for a model, two-state, electronically nonadiabatic reaction, given by Shin and Light [S. Shin and J. C. Light, J. Chem. Phys. {bold 101}, 2836 (1994)]. We apply straightforward generalizations of the flux matrix/absorbing boundary condition approach of Miller and co-workers to obtain these quantities. The upper adiabatic electronic potential supports bound states, and these manifest themselves as {open_quote}{open_quote}recrossing{close_quote}{close_quote} resonances in the cumulative reaction probability, at total energies above the barrier to reaction on the lower adiabatic potential. At energies below the barrier, the cumulative reaction probability for themore » coupled system is shifted to higher energies relative to the one obtained for the ground state potential. This is due to the effect of an additional effective barrier caused by the nuclear kinetic operator acting on the ground state, adiabatic electronic wave function, as discussed earlier by Shin and Light. Calculations are reported for five sets of electronically nonadiabatic coupling parameters. {copyright} {ital 1996 American Institute of Physics.}« less

Genetic algorithm-based improved DOA estimation using fourth-order cumulants

NASA Astrophysics Data System (ADS)

Ahmed, Ammar; Tufail, Muhammad

2017-05-01

Genetic algorithm (GA)-based direction of arrival (DOA) estimation is proposed using fourth-order cumulants (FOC) and ESPRIT principle which results in Multiple Invariance Cumulant ESPRIT algorithm. In the existing FOC ESPRIT formulations, only one invariance is utilised to estimate DOAs. The unused multiple invariances (MIs) must be exploited simultaneously in order to improve the estimation accuracy. In this paper, a fitness function based on a carefully designed cumulant matrix is developed which incorporates MIs present in the sensor array. Better DOA estimation can be achieved by minimising this fitness function. Moreover, the effectiveness of Newton's method as well as GA for this optimisation problem has been illustrated. Simulation results show that the proposed algorithm provides improved estimation accuracy compared to existing algorithms, especially in the case of low SNR, less number of snapshots, closely spaced sources and high signal and noise correlation. Moreover, it is observed that the optimisation using Newton's method is more likely to converge to false local optima resulting in erroneous results. However, GA-based optimisation has been found attractive due to its global optimisation capability.

Semi-parametric regression model for survival data: graphical visualization with R

PubMed Central

2016-01-01

Cox proportional hazards model is a semi-parametric model that leaves its baseline hazard function unspecified. The rationale to use Cox proportional hazards model is that (I) the underlying form of hazard function is stringent and unrealistic, and (II) researchers are only interested in estimation of how the hazard changes with covariate (relative hazard). Cox regression model can be easily fit with coxph() function in survival package. Stratified Cox model may be used for covariate that violates the proportional hazards assumption. The relative importance of covariates in population can be examined with the rankhazard package in R. Hazard ratio curves for continuous covariates can be visualized using smoothHR package. This curve helps to better understand the effects that each continuous covariate has on the outcome. Population attributable fraction is a classic quantity in epidemiology to evaluate the impact of risk factor on the occurrence of event in the population. In survival analysis, the adjusted/unadjusted attributable fraction can be plotted against survival time to obtain attributable fraction function. PMID:28090517

Temporal Variability of Cumulative Risk Assessment on Phthalates in Chinese Pregnant Women: Repeated Measurement Analysis.

PubMed

Gao, Hui; Zhu, Bei-Bei; Tao, Xing-Yong; Zhu, Yuan-Duo; Tao, Xu-Guang; Tao, Fang-Biao

2018-06-05

The assessment of the combined effects of multiple phthalate exposures at low levels is a newly developed concept to avoid underestimating their actual cumulative health risk. A previous study included 3455 Chinese pregnant women. Each woman provided up to three urine samples (in total 9529). This previous study characterized the concentrations of phthalate metabolites. In the present study, the data from 9529 samples was reanalyzed to examine the cumulative risk assessment (CRA) with two models: (1) the creatinine-based and (2) the volume-based. Hazard index (HI) values for three phthalates, dibutyl phthalate, butyl benzyl phthalate, and di(2-ethylhexyl) phthalate, in the first, second, and third trimesters of pregnancy, were calculated, respectively. In creatinine-based model, 3.43%, 14.63%, and 17.28% of women showed HI based on the European Food Safety Authority tolerable daily intake exceeding 1 in the first, second, and third trimester of pregnancy, respectively. The intraclass correlation coefficient of HI was 0.49 (95% confidence interval: 0.46-0.53). Spearman correlations between HI of the creatinine model and ∑androgen disruptor (a developed potency weighted approach) ranged from 0.824 to 0.984. In summary, this study suggested a considerable risk of cumulative exposure to phthalates during the whole gestation in Chinese pregnant women. In addition, moderate temporal reproducibility indicated that single HI, estimated by the phthalate concentration in single spot of urine, seemed representative to describe the throughout pregnancy CRA. Finally, strong correlation between HI of the creatinine model and ∑androgen disruptor revealed that the creatinine-based model was more appropriate to evaluate the CRA.

Comparison of treatment outcomes of endoscope-guided pneumatic dilation and laparoscopic Heller myotomy.

PubMed

Wang, Hsin-Ming; Tai, Wei-Chen; Chuah, Seng-Kee; Lu, Hung-I; Lu, Lung-Sheng; Liang, Chih-Ming; Kuo, Chung-Huang; Chiu, Yi-Chun; Wu, Keng-Liang; Changchien, Chi-Sin

2015-12-01

The debate on which is the better choice between laparoscopic Heller myotomy (LHM) and endoscopic pneumatic dilation (PD) for esophageal achalasia has been ongoing for decades. This study aims to compare the results of endoscope-guided PD and LHM in 42 patients with achalasia between May 1996 and August 2011. Twenty-one patients who had received PD and 21 who had received LHM were enrolled. The cumulative remission rate was analyzed using the Kaplan-Meier method with the assessment of symptom scores between grades before and after PD or LHM done at 6 weeks, 6 months, 1 year, and then every year thereafter. Possible confounding factors related to the remissions were analyzed by Cox's proportional hazard model. For PD, the cumulative remission rates were 81.0% (1 year), 76.2% (2), 66.7% (3), 61.9% (4), and 47.6% (5). For LHM, the cumulative remission rates were 90.5% every year from the 1(st) to the 5(th). The LHM patients had significantly better remission rates than the PD patients (p = 0.033, by log-rank test). The LHM group had a longer hospital stay than the PD group [median (interquartile range): 8 (6.5-10) days vs. 3 (2-3) days, p < 0.001) and had more reflux complications (52.4% vs. 19.0%, p = 0.024). No perforation occurred in either group. In conclusion, the 5-year cumulative effectiveness of LHM is better than that of PD despite the association of LHM with more reflux events (52.4%). Copyright © 2015. Published by Elsevier Taiwan.

Causes of morbidity in wild raptor populations admitted at a wildlife rehabilitation centre in Spain from 1995-2007: a long term retrospective study.

PubMed

Molina-López, Rafael A; Casal, Jordi; Darwich, Laila

2011-01-01

Morbidity studies complement the understanding of hazards to raptors by identifying natural or anthropogenic factors. Descriptive epidemiological studies of wildlife have become an important source of information about hazards to wildlife populations. On the other hand, data referenced to the overall wild population could provide a more accurate assessment of the potential impact of the morbidity/mortality causes in populations of wild birds. The present study described the morbidity causes of hospitalized wild raptors and their incidence in the wild populations, through a long term retrospective study conducted at a wildlife rehabilitation centre of Catalonia (1995-2007). Importantly, Seasonal Cumulative Incidences (SCI) were calculated considering estimations of the wild population in the region and trend analyses were applied among the different years. A total of 7021 birds were analysed: 7 species of Strigiformes (n = 3521) and 23 of Falconiformes (n = 3500). The main causes of morbidity were trauma (49.5%), mostly in the Falconiformes, and orphaned/young birds (32.2%) mainly in the Strigiformes. During wintering periods, the largest morbidity incidence was observed in Accipiter gentillis due to gunshot wounds and in Tyto alba due to vehicle trauma. Within the breeding season, Falco tinnunculus (orphaned/young category) and Bubo bubo (electrocution and metabolic disorders) represented the most affected species. Cases due to orphaned/young, infectious/parasitic diseases, electrocution and unknown trauma tended to increase among years. By contrast, cases by undetermined cause, vehicle trauma and captivity decreased throughout the study period. Interestingly, gunshot injuries remained constant during the study period. Frequencies of morbidity causes calculated as the proportion of each cause referred to the total number of admitted cases, allowed a qualitative assessment of hazards for the studied populations. However, cumulative incidences based on estimated wild raptor population provided a more accurate approach to the potential ecological impact of the morbidity causes in the wild populations.

Causes of Morbidity in Wild Raptor Populations Admitted at a Wildlife Rehabilitation Centre in Spain from 1995-2007: A Long Term Retrospective Study

PubMed Central

Molina-López, Rafael A.; Casal, Jordi; Darwich, Laila

2011-01-01

Background Morbidity studies complement the understanding of hazards to raptors by identifying natural or anthropogenic factors. Descriptive epidemiological studies of wildlife have become an important source of information about hazards to wildlife populations. On the other hand, data referenced to the overall wild population could provide a more accurate assessment of the potential impact of the morbidity/mortality causes in populations of wild birds. Methodology/Principal Findings The present study described the morbidity causes of hospitalized wild raptors and their incidence in the wild populations, through a long term retrospective study conducted at a wildlife rehabilitation centre of Catalonia (1995–2007). Importantly, Seasonal Cumulative Incidences (SCI) were calculated considering estimations of the wild population in the region and trend analyses were applied among the different years. A total of 7021 birds were analysed: 7 species of Strigiformes (n = 3521) and 23 of Falconiformes (n = 3500). The main causes of morbidity were trauma (49.5%), mostly in the Falconiformes, and orphaned/young birds (32.2%) mainly in the Strigiformes. During wintering periods, the largest morbidity incidence was observed in Accipiter gentillis due to gunshot wounds and in Tyto alba due to vehicle trauma. Within the breeding season, Falco tinnunculus (orphaned/young category) and Bubo bubo (electrocution and metabolic disorders) represented the most affected species. Cases due to orphaned/young, infectious/parasitic diseases, electrocution and unknown trauma tended to increase among years. By contrast, cases by undetermined cause, vehicle trauma and captivity decreased throughout the study period. Interestingly, gunshot injuries remained constant during the study period. Conclusions/Significance Frequencies of morbidity causes calculated as the proportion of each cause referred to the total number of admitted cases, allowed a qualitative assessment of hazards for the studied populations. However, cumulative incidences based on estimated wild raptor population provided a more accurate approach to the potential ecological impact of the morbidity causes in the wild populations. PMID:21966362

Change in Physical Activity and Sitting Time After Myocardial Infarction and Mortality Among Postmenopausal Women in the Women's Health Initiative-Observational Study.

PubMed

Gorczyca, Anna M; Eaton, Charles B; LaMonte, Michael J; Manson, JoAnn E; Johnston, Jeanne D; Bidulescu, Aurelian; Waring, Molly E; Manini, Todd; Martin, Lisa W; Stefanick, Marcia L; He, Ka; Chomistek, Andrea K

2017-05-15

How physical activity (PA) and sitting time may change after first myocardial infarction (MI) and the association with mortality in postmenopausal women is unknown. Participants included postmenopausal women in the Women's Health Initiative-Observational Study, aged 50 to 79 years who experienced a clinical MI during the study. This analysis included 856 women who had adequate data on PA exposure and 533 women for sitting time exposures. Sitting time was self-reported at baseline, year 3, and year 6. Self-reported PA was reported at baseline through year 8. Change in PA and sitting time were calculated as the difference between the cumulative average immediately following MI and the cumulative average immediately preceding MI. The 4 categories of change were: maintained low, decreased, increased, and maintained high. The cut points were ≥7.5 metabolic equivalent of task hours/week versus <7.5 metabolic equivalent of task hours/week for PA and ≥8 h/day versus <8 h/day for sitting time. Cox proportional hazard models estimated hazard ratios and 95% CIs for all-cause, coronary heart disease, and cardiovascular disease mortality. Compared with women who maintained low PA (referent), the risk of all-cause mortality was: 0.54 (0.34-0.86) for increased PA and 0.52 (0.36-0.73) for maintained high PA. Women who had pre-MI levels of sitting time <8 h/day, every 1 h/day increase in sitting time was associated with a 9% increased risk (hazard ratio=1.09, 95% CI: 1.01, 1.19) of all-cause mortality. Meeting the recommended PA guidelines pre- and post-MI may have a protective role against mortality in postmenopausal women. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Assessing the safety of co-exposure to food packaging migrants in food and water using the maximum cumulative ratio and an established decision tree.

PubMed

Price, Paul; Zaleski, Rosemary; Hollnagel, Heli; Ketelslegers, Hans; Han, Xianglu

2014-01-01

Food contact materials can release low levels of multiple chemicals (migrants) into foods and beverages, to which individuals can be exposed through food consumption. This paper investigates the potential for non-carcinogenic effects from exposure to multiple migrants using the Cefic Mixtures Ad hoc Team (MIAT) decision tree. The purpose of the assessment is to demonstrate how the decision tree can be applied to concurrent exposures to multiple migrants using either hazard or structural data on the specific components, i.e. based on the acceptable daily intake (ADI) or the threshold of toxicological concern. The tree was used to assess risks from co-exposure to migrants reported in a study on non-intentionally added substances (NIAS) eluting from food contact-grade plastic and two studies of water bottles: one on organic compounds and the other on ionic forms of various elements. The MIAT decision tree assigns co-exposures to different risk management groups (I, II, IIIA and IIIB) based on the hazard index, and the maximum cumulative ratio (MCR). The predicted co-exposures for all examples fell into Group II (low toxicological concern) and had MCR values of 1.3 and 2.4 (indicating that one or two components drove the majority of the mixture's toxicity). MCR values from the study of inorganic ions (126 mixtures) ranged from 1.1 to 3.8 for glass and from 1.1 to 5.0 for plastic containers. The MCR values indicated that a single compound drove toxicity in 58% of the mixtures. MCR values also declined with increases in the hazard index for the screening assessments of exposure (suggesting fewer substances contributed as risk potential increased). Overall, it can be concluded that the data on co-exposure to migrants evaluated in these case studies are of low toxicological concern and the safety assessment approach described in this paper was shown to be a helpful screening tool.

Cumulative risk effect of household dysfunction for child maltreatment after intensive intervention of the child protection system in Japan: a longitudinal analysis.

PubMed

Ohashi, Hirotsuna; Wada, Ichiro; Yamaoka, Yui; Nakajima-Yamaguchi, Ryoko; Ogai, Yasukazu; Morita, Nobuaki

2018-04-20

Building an effective casework system for child maltreatment is a global issue. We estimated the effect of household dysfunction (i.e., interparental violence, caregiver mental health problems, and caregiver substance abuse) on child maltreatment to understand how to advance the current framework of child welfare. The sample comprised 759 children (1- to 17-year-old; mean age was 10.6; 404 boys and 355 girls) placed in temporary custody units (one of the strongest intervention of the Japanese child protection system). Caseworkers from 180 units across 43 prefectures completed questionnaires on children and their family and were asked whether a child maltreatment report had been made after cancelation of custody in a 15-month follow-up period. The relations of household dysfunction and maltreatment reports were assessed using the Cox proportional hazard model. About half (48.4%) of the children had been placed in the unit because of maltreatment, and 88.3% had a history of victimization. Seventy-six cases had maltreatment reports after cancelation. We entered household dysfunction variables individually into the model, and each had a significant relationship with maltreatment reports (hazard ratios for interparental violence, caregiver mental health problem, and substance abuse were 1.69, 1.69, and 2.19, respectively) after covariate adjustment. When treating these three variables as cumulative risk score model of household dysfunction, the hazard ratio increased with increasing number of score (1.96 for score two; 2.35 for score three; score 0 as reference). Greater household dysfunction score is a risk of maltreatment after intensive intervention. It is imperative to construct systems facilitating cooperation between child and adult service sectors and to deliver seamless services to children and families. Our findings provide child protect services with risk-stratified interventions for children at victimization risk and promote adult-focused services to be proactive in prevention or intervention for adults with perpetration risk.

A Life Cycle Based Approach to Multi-Hazard Risk Assessment

NASA Astrophysics Data System (ADS)

Keen, A. S.; Lynett, P. J.

2017-12-01

Small craft harbors are important facets to many coastal communities providing a transition from land to ocean. Because of the damage resulting from the 2010 Chile and 2011 Japanese tele-tsunamis, the tsunami risk to the small craft marinas in California has become an important concern. However, tsunamis represent only one of many hazards a harbor is likely to see in California. Other natural hazards including tsunamis, wave attack, storm surge and sea level rise all can damage a harbor but are not typically addressed in traditional risk studies. Existing approaches to assess small craft harbor vulnerably typically look at single events assigning likely damage levels to each event. However, a harbor will likely experience damage from several different types of hazards over its service life with each event contributing proportionally to the total damage state. A new, fully probabilistic risk method will be presented which considers the distribution of return period for various hazards over a harbor's service life. The likelihood of failure is connected to each hazard via vulnerability curves. By simply tabulating the expected damage levels from each event, the method provides a quantitative measure of a harbor's risk to various types of hazards as well as the likelihood of failure (i.e. cumulative risk) during the service life. Crescent City Harbor in Northern California and Kings Harbor in Southern California have been chosen as case studies. Each harbor is dynamically different and were chosen to highlight the strengths and weaknesses of the method. Findings of each study will focus on assisting the stakeholders and decision makers to better understand the relative risk to each harbor with the goal of providing them with a tool to better plan for the future maritime environment.

Estimation of cyclic interstory drift capacity of steel framed structures and future applications for seismic design.

PubMed

Bojórquez, Edén; Reyes-Salazar, Alfredo; Ruiz, Sonia E; Terán-Gilmore, Amador

2014-01-01

Several studies have been devoted to calibrate damage indices for steel and reinforced concrete members with the purpose of overcoming some of the shortcomings of the parameters currently used during seismic design. Nevertheless, there is a challenge to study and calibrate the use of such indices for the practical structural evaluation of complex structures. In this paper, an energy-based damage model for multidegree-of-freedom (MDOF) steel framed structures that accounts explicitly for the effects of cumulative plastic deformation demands is used to estimate the cyclic drift capacity of steel structures. To achieve this, seismic hazard curves are used to discuss the limitations of the maximum interstory drift demand as a performance parameter to achieve adequate damage control. Then the concept of cyclic drift capacity, which incorporates information of the influence of cumulative plastic deformation demands, is introduced as an alternative for future applications of seismic design of structures subjected to long duration ground motions.

Estimation of Cyclic Interstory Drift Capacity of Steel Framed Structures and Future Applications for Seismic Design

PubMed Central

Bojórquez, Edén; Reyes-Salazar, Alfredo; Ruiz, Sonia E.; Terán-Gilmore, Amador

2014-01-01

Several studies have been devoted to calibrate damage indices for steel and reinforced concrete members with the purpose of overcoming some of the shortcomings of the parameters currently used during seismic design. Nevertheless, there is a challenge to study and calibrate the use of such indices for the practical structural evaluation of complex structures. In this paper, an energy-based damage model for multidegree-of-freedom (MDOF) steel framed structures that accounts explicitly for the effects of cumulative plastic deformation demands is used to estimate the cyclic drift capacity of steel structures. To achieve this, seismic hazard curves are used to discuss the limitations of the maximum interstory drift demand as a performance parameter to achieve adequate damage control. Then the concept of cyclic drift capacity, which incorporates information of the influence of cumulative plastic deformation demands, is introduced as an alternative for future applications of seismic design of structures subjected to long duration ground motions. PMID:25089288

Hazardous drinking and military community functioning: identifying mediating risk factors.

PubMed

Foran, Heather M; Heyman, Richard E; Slep, Amy M Smith

2011-08-01

Hazardous drinking is a serious societal concern in military populations. Efforts to reduce hazardous drinking among military personnel have been limited in effectiveness. There is a need for a deeper understanding of how community-based prevention models apply to hazardous drinking in the military. Community-wide prevention efforts may be most effective in targeting community functioning (e.g., support from formal agencies, community cohesion) that impacts hazardous drinking via other proximal risk factors. The goal of the current study is to inform community-wide prevention efforts by testing a model of community functioning and mediating risk factors of hazardous drinking among active duty U.S. Air Force personnel. A large, representative survey sample of U.S. Air Force active duty members (N = 52,780) was collected at 82 bases worldwide. Hazardous drinking was assessed with the widely used Alcohol Use Disorders Identification Test (Saunders, Aasland, Babor, de la Fuente, & Grant, 1993). A variety of individual, family, and community measures were also assessed. Structural equation modeling was used to test a hypothesized model of community functioning, mediating risk factors and hazardous drinking. Depressive symptoms, perceived financial stress, and satisfaction with the U.S. Air Force were identified as significant mediators of the link between community functioning and hazardous drinking for men and women. Relationship satisfaction was also identified as a mediator for men. These results provide a framework for further community prevention research and suggest that prevention efforts geared at increasing aspects of community functioning (e.g., the U.S. Air Force Community Capacity model) may indirectly lead to reductions in hazardous drinking through other proximal risk factors.

Towards a robust framework for Probabilistic Tsunami Hazard Assessment (PTHA) for local and regional tsunami in New Zealand

NASA Astrophysics Data System (ADS)

Mueller, Christof; Power, William; Fraser, Stuart; Wang, Xiaoming

2013-04-01

Probabilistic Tsunami Hazard Assessment (PTHA) is conceptually closely related to Probabilistic Seismic Hazard Assessment (PSHA). The main difference is that PTHA needs to simulate propagation of tsunami waves through the ocean and cannot rely on attenuation relationships, which makes PTHA computationally more expensive. The wave propagation process can be assumed to be linear as long as water depth is much larger than the wave amplitude of the tsunami. Beyond this limit a non-linear scheme has to be employed with significantly higher algorithmic run times. PTHA considering far-field tsunami sources typically uses unit source simulations, and relies on the linearity of the process by later scaling and combining the wave fields of individual simulations to represent the intended earthquake magnitude and rupture area. Probabilistic assessments are typically made for locations offshore but close to the coast. Inundation is calculated only for significantly contributing events (de-aggregation). For local and regional tsunami it has been demonstrated that earthquake rupture complexity has a significant effect on the tsunami amplitude distribution offshore and also on inundation. In this case PTHA has to take variable slip distributions and non-linearity into account. A unit source approach cannot easily be applied. Rupture complexity is seen as an aleatory uncertainty and can be incorporated directly into the rate calculation. We have developed a framework that manages the large number of simulations required for local PTHA. As an initial case study the effect of rupture complexity on tsunami inundation and the statistics of the distribution of wave heights have been investigated for plate-interface earthquakes in the Hawke's Bay region in New Zealand. Assessing the probability that water levels will be in excess of a certain threshold requires the calculation of empirical cumulative distribution functions (ECDF). We compare our results with traditional estimates for tsunami inundation simulations that do not consider rupture complexity. De-aggregation based on moment magnitude alone might not be appropriate, because the hazard posed by any individual event can be underestimated locally if rupture complexity is ignored.

A Critical Review of an Authentic and Transformative Environmental Justice and Health Community — University Partnership

PubMed Central

Wilson, Sacoby; Campbell, Dayna; Dalemarre, Laura; Fraser-Rahim, Herb; Williams, Edith

2014-01-01

Distressed neighborhoods in North Charleston (SC, USA) are impacted by the cumulative effects of multiple environmental hazards and expansion of the Port of Charleston. The Low Country Alliance for Model Communities (LAMC) built an environmental justice partnership to address local concerns. This case study examines the process of building and sustaining a successful transformative and authentic community-university partnership. We apply the framework established by Community-Campus Partnerships for Health (CCPH), focusing on four of the nine principles of Good Practice of Community Campus Partnerships. PMID:25514142

Unplanned releases and injuries associated with aerial application of chemicals, 1995-2002.

PubMed

Rice, Nancy; Messing, Rita; Souther, Larry; Berkowitz, Zahava

2005-11-01

For this article, records of the Hazardous Substances Emergency Events Surveillance (HSEES) system were reviewed to identify and describe acute, unplanned releases of agricultural chemicals and associated injuries related to aerial application during 1995-2002. Records of aerial-application accidents from the National Transportation Safety Board were also reviewed. Of the 54,090 events in the HSEES system for 1995-2002, 91 were identified as aerial-application events. The most commonly released substance was malathion. There were 56 victims; 12 died, and 34 required treatment at a hospital. A higher percentage of HSEES aerial-applicator events involved injury and death than did other HSEES transportation events. The relatively high number of injuries and fatalities underscores the need for precautions such as monitoring and limiting pilot cumulative exposures to pesticides, and using appropriate personal protective equipment and decontamination equipment. Emergency responders should be educated about the hazards associated with chemicals at aerial-application crash sites.

Cumulative watershed effects: a research perspective

Treesearch

Leslie M. Reid; Robert R. Ziemer

1989-01-01

A cumulative watershed effect (CWE) is any response to multiple land-use activities that is caused by, or results in, altered watershed function. The CWE issue is politically defined, as is the significance of particular impacts. But the processes generating CWEs are the traditional focus of geomorphology and ecology, and have thus been studied for decades. The CWE...

Mutation spectrum and risk of colorectal cancer in African American families with Lynch Syndrome

PubMed Central

Guindalini, Rodrigo Santa Cruz; Win, Aung Ko; Gulden, Cassandra; Lindor, Noralane M.; Newcomb, Polly A.; Haile, Robert W.; Raymond, Victoria; Stoffel, Elena; Hall, Michael; Llor, Xavier; Ukaegbu, Chinedu I.; Solomon, Ilana; Weitzel, Jeffrey; Kalady, Matthew; Blanco, Amie; Terdiman, Jonathan; Shuttlesworth, Gladis A.; Lynch, Patrick M.; Hampel, Heather; Lynch, Henry T.; Jenkins, Mark A.; Olopade, Olufunmilayo I.; Kupfer, Sonia S.

2015-01-01

Background & Aims African Americans (AAs) have the highest incidence and mortality of colorectal cancer (CRC) in the United States (US). Few data are available on genetic and non-genetic risk factors for CRC among AAs. Little is known about cancer risks and mutations in mismatch repair (MMR) genes in AAs with the most common inherited CRC syndrome, Lynch syndrome. We aimed to characterize phenotype, mutation spectrum, and risk of CRC in AAs with Lynch Syndrome. Methods We performed a retrospective study of AAs with mutations in MMR genes (MLH1, MSH2, MSH6, and PMS2) using databases from 13 US referral centers. We analyzed data on personal and family histories of cancer. Modified segregation analysis conditioned on ascertainment criteria was used to estimate age- and sex-specific CRC cumulative risk studying members of the mutation-carrying families. Results We identified 51 AA families with deleterious mutations that disrupt function of the MMR gene product: 31 in MLH1 (61%), 11 in MSH2 (21%), 3 in MSH6 (6%), and 6 in PMS2 (12%); 8 mutations were detected in more than 1 individual and 11 have not been previously reported. In the 920 members of the 51 families with deleterious mutations, the cumulative risks of CRC at an age of 80 y were estimated to be 36.2% (95% confidence interval [CI], 10.5%–83.9%) for men and 29.7% (95% CI, 8.31%–76.1%) for women. CRC risk was significantly higher among individuals with mutations in MLH1 or MSH2 (hazard ratio, 13.9; 95% CI, 3.44–56.5). Conclusions We estimate the cumulative risk for CRC in AAs with MMR gene mutations to be similar to that of individuals of European descent with Lynch syndrome. Two-thirds of mutations were found in MLH1—some were found in multiple individuals and some have not been previously reported. Differences in the mutation spectrum are likely to reflect the genetic diversity of this population. PMID:26248088

Mutation spectrum and risk of colorectal cancer in African American families with Lynch syndrome.

PubMed

Guindalini, Rodrigo Santa Cruz; Win, Aung Ko; Gulden, Cassandra; Lindor, Noralane M; Newcomb, Polly A; Haile, Robert W; Raymond, Victoria; Stoffel, Elena; Hall, Michael; Llor, Xavier; Ukaegbu, Chinedu I; Solomon, Ilana; Weitzel, Jeffrey; Kalady, Matthew; Blanco, Amie; Terdiman, Jonathan; Shuttlesworth, Gladis A; Lynch, Patrick M; Hampel, Heather; Lynch, Henry T; Jenkins, Mark A; Olopade, Olufunmilayo I; Kupfer, Sonia S

2015-11-01

African Americans (AAs) have the highest incidence of and mortality resulting from colorectal cancer (CRC) in the United States. Few data are available on genetic and nongenetic risk factors for CRC among AAs. Little is known about cancer risks and mutations in mismatch repair (MMR) genes in AAs with the most common inherited CRC condition, Lynch syndrome. We aimed to characterize phenotype, mutation spectrum, and risk of CRC in AAs with Lynch syndrome. We performed a retrospective study of AAs with mutations in MMR genes (MLH1, MSH2, MSH6, and PMS2) using databases from 13 US referral centers. We analyzed data on personal and family histories of cancer. Modified segregation analysis conditioned on ascertainment criteria was used to estimate age- and sex-specific CRC cumulative risk, studying members of the mutation-carrying families. We identified 51 AA families with deleterious mutations that disrupt function of the MMR gene product: 31 in MLH1 (61%), 11 in MSH2 (21%), 3 in MSH6 (6%), and 6 in PMS2 (12%); 8 mutations were detected in more than 1 individual, and 11 have not been previously reported. In the 920 members of the 51 families with deleterious mutations, the cumulative risks of CRC at 80 years of age were estimated to be 36.2% (95% confidence interval [CI], 10.5%-83.9%) for men and 29.7% (95% CI, 8.31%-76.1%) for women. CRC risk was significantly higher among individuals with mutations in MLH1 or MSH2 (hazard ratio, 13.9; 95% CI, 3.44-56.5). We estimate the cumulative risk for CRC in AAs with MMR gene mutations to be similar to that of individuals of European descent with Lynch syndrome. Two-thirds of mutations were found in MLH1, some of which were found in multiple individuals and some that have not been previously reported. Differences in mutation spectrum are likely to reflect the genetic diversity of this population. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

Association of day 4 cumulative fluid balance with mortality in critically ill patients with influenza: A multicenter retrospective cohort study in Taiwan.

PubMed

Chao, Wen-Cheng; Tseng, Chien-Hua; Chien, Ying-Chun; Sheu, Chau-Chyun; Tsai, Ming-Ju; Fang, Wen-Feng; Chen, Yu-Mu; Kao, Kuo-Chin; Hu, Han-Chung; Perng, Wann-Cherng; Yang, Kuang-Yao; Chen, Wei-Chih; Liang, Shinn-Jye; Wu, Chieh-Liang; Wang, Hao-Chien; Chan, Ming-Cheng

2018-01-01

Fluid balance is a fundamental management of patients with sepsis, and this study aimed to investigate the impact of cumulative fluid balance on critically ill patients with influenza admitted to an intensive care unit (ICU). This multicenter retrospective cohort study was conducted by the Taiwan Severe Influenza Research Consortium (TSIRC) which includes eight medical centers. Patients with virology-proven influenza infection admitted to ICUs between October 2015 and March 2016 were included for analysis. A total of 296 patients were enrolled (mean age: 61.4±15.6 years; 62.8% men), and 92.2% (273/296) of them required mechanical ventilation. In the survivors, the daily fluid balance was positive from day 1 to day 3, and then gradually became negative from day 4 to day 7, whereas daily fluid balance was continuously positive in the non-survivors. Using the cumulative fluid balance from day 1-4 as a cut-off point, we found that a negative cumulative day 1-4 fluid balance was associated with a lower 30-day mortality rate (log-rank test, P = 0.003). To evaluate the impact of shock on this association, we divided the patients into shock and non-shock groups. The positive correlation between negative day 1-4 fluid balance and mortality was significant in the non-shock group (log-rank test, P = 0.008), but not in the shock group (log-rank test, P = 0.396). In a multivariate Cox proportional hazard regression model adjusted for age, sex, cerebrovascular disease, and PaO2/FiO2, day 1-4 fluid balance was independently associated with a higher 30-day mortality rate (aHR 1.088, 95% CI: 1.007-1.174). A negative day 1-4 cumulative fluid balance was associated with a lower mortality rate in critically ill patients with influenza. Our findings indicate the critical role of conservative fluid strategy in the management of patients with complicated influenza.

Cumulative occupational mechanical exposures during working life and risk of sickness absence and disability pension: prospective cohort study.

PubMed

Sundstrup, Emil; Hansen, Åse Marie; Mortensen, Erik Lykke; Poulsen, Otto Melchior; Clausen, Thomas; Rugulies, Reiner; Møller, Anne; Andersen, Lars L

2017-09-01

Objectives The aim of this study was to determine the prospective association of cumulative mechanical exposure during working life with health-related labor market outcomes. Methods This prospective cohort study combines data from 5076 older workers (age 49-63 years) from the Copenhagen Aging and Midlife Biobank with a job exposure matrix and a national register containing information on social transfer payment. By coding individual job histories from the Danish version of ISCO-codes (International Standard Classification of Occupations), we calculated cumulative occupational mechanical exposures from a JEM for ton-years (lifting 1000 kg each day in one year), lifting-years (lifting loads weighing ≥20 kg >10 times each day in one year), kneeling-years (kneeling for one hour each day in one year) and vibration-years (whole-body vibration for one hour each day in one year). Cox-regression analyses estimated the relative risk of register-based long-term sickness absence (LTSA) and disability pension with cumulative occupational mechanical exposures throughout working life. Analyses were censored for competing events and adjusted for multiple confounders. Results During the follow-up period, 970 persons (19.3%) had ≥1 episode of LTSA and 85 persons (1.7%) were granted a disability pension. Number of ton-, lifting- and kneeling-years showed an exposure-response association with increased risk of LTSA (P<0.0001). In addition, both long term [≥20 years; hazard ratio (HR) 1.76 95% CI 1.39-2.22] and short term (<10 years; HR 1.20 95% CI 1.02-1.41) exposure to kneeling work increased the risk of LTSA. Lifting-years, but not the other mechanical exposures, were associated with risk of disability pension (HR 1.75 95% CI 1.01-3.04). Conclusions Cumulative occupational mechanical exposures during working life - such as lifting and kneeling work - increased the risk of LTSA. Importantly, being exposed to lifting increased the risk of disability pension.

Cumulative childhood risk and adult functioning in abused and neglected children grown up

PubMed Central

HORAN, JACQUELINE M.; WIDOM, CATHY SPATZ

2017-01-01

This paper examines the relationship between childhood exposure to cumulative risk and three indicators of psychosocial adjustment in adulthood (educational attainment, mental health, and criminal behavior) and tests three different models (linear, quadratic, and interaction). Data were collected over several time points from individuals who were part of a prospective cohort design study that matched children with documented cases of abuse and/or neglect with children without such histories and followed them into adulthood. Hierarchical multiple regressions compared linear and quadratic models and then examined potential moderating effects of child abuse/neglect and gender. Exposure to a greater number of childhood risk factors was significantly related to fewer years of education, more anxiety and depression symptomatology, and more criminal arrests in adulthood. The relationship between cumulative risk and years of education demonstrated a curvilinear pattern, whereas the relationship between cumulative risk and both mental health and criminal arrests was linear. Child abuse/neglect did not moderate these relationships, although there were direct effects for both child abuse/neglect and gender on criminal arrests, with more arrests for abused/neglected individuals than controls and more for males than females. Gender interacted with cumulative risk to impact educational attainment and criminal behavior, suggesting that interventions may be more effective if tailored differently for males and females. Interventions may need to be multifaceted and designed to address these different domains of functioning. PMID:25196178

Cumulative childhood risk and adult functioning in abused and neglected children grown up.

PubMed

Horan, Jacqueline M; Widom, Cathy Spatz

2015-08-01

This paper examines the relationship between childhood exposure to cumulative risk and three indicators of psychosocial adjustment in adulthood (educational attainment, mental health, and criminal behavior) and tests three different models (linear, quadratic, and interaction). Data were collected over several time points from individuals who were part of a prospective cohort design study that matched children with documented cases of abuse and/or neglect with children without such histories and followed them into adulthood. Hierarchical multiple regressions compared linear and quadratic models and then examined potential moderating effects of child abuse/neglect and gender. Exposure to a greater number of childhood risk factors was significantly related to fewer years of education, more anxiety and depression symptomatology, and more criminal arrests in adulthood. The relationship between cumulative risk and years of education demonstrated a curvilinear pattern, whereas the relationship between cumulative risk and both mental health and criminal arrests was linear. Child abuse/neglect did not moderate these relationships, although there were direct effects for both child abuse/neglect and gender on criminal arrests, with more arrests for abused/neglected individuals than controls and more for males than females. Gender interacted with cumulative risk to impact educational attainment and criminal behavior, suggesting that interventions may be more effective if tailored differently for males and females. Interventions may need to be multifaceted and designed to address these different domains of functioning.

Integrating multi-criteria decision analysis for a GIS-based hazardous waste landfill sitting in Kurdistan Province, western Iran

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sharifi, Mozafar; Hadidi, Mosslem; Vessali, Elahe

2009-10-15

The evaluation of a hazardous waste disposal site is a complicated process because it requires data from diverse social and environmental fields. These data often involve processing of a significant amount of spatial information which can be used by GIS as an important tool for land use suitability analysis. This paper presents a multi-criteria decision analysis alongside with a geospatial analysis for the selection of hazardous waste landfill sites in Kurdistan Province, western Iran. The study employs a two-stage analysis to provide a spatial decision support system for hazardous waste management in a typically under developed region. The purpose ofmore » GIS was to perform an initial screening process to eliminate unsuitable land followed by utilization of a multi-criteria decision analysis (MCDA) to identify the most suitable sites using the information provided by the regional experts with reference to new chosen criteria. Using 21 exclusionary criteria, as input layers, masked maps were prepared. Creating various intermediate or analysis map layers a final overlay map was obtained representing areas for hazardous waste landfill sites. In order to evaluate different landfill sites produced by the overlaying a landfill suitability index system was developed representing cumulative effects of relative importance (weights) and suitability values of 14 non-exclusionary criteria including several criteria resulting from field observation. Using this suitability index 15 different sites were visited and based on the numerical evaluation provided by MCDA most suitable sites were determined.« less

Integrating multi-criteria decision analysis for a GIS-based hazardous waste landfill sitting in Kurdistan Province, western Iran.

PubMed

Sharifi, Mozafar; Hadidi, Mosslem; Vessali, Elahe; Mosstafakhani, Parasto; Taheri, Kamal; Shahoie, Saber; Khodamoradpour, Mehran

2009-10-01

The evaluation of a hazardous waste disposal site is a complicated process because it requires data from diverse social and environmental fields. These data often involve processing of a significant amount of spatial information which can be used by GIS as an important tool for land use suitability analysis. This paper presents a multi-criteria decision analysis alongside with a geospatial analysis for the selection of hazardous waste landfill sites in Kurdistan Province, western Iran. The study employs a two-stage analysis to provide a spatial decision support system for hazardous waste management in a typically under developed region. The purpose of GIS was to perform an initial screening process to eliminate unsuitable land followed by utilization of a multi-criteria decision analysis (MCDA) to identify the most suitable sites using the information provided by the regional experts with reference to new chosen criteria. Using 21 exclusionary criteria, as input layers, masked maps were prepared. Creating various intermediate or analysis map layers a final overlay map was obtained representing areas for hazardous waste landfill sites. In order to evaluate different landfill sites produced by the overlaying a landfill suitability index system was developed representing cumulative effects of relative importance (weights) and suitability values of 14 non-exclusionary criteria including several criteria resulting from field observation. Using this suitability index 15 different sites were visited and based on the numerical evaluation provided by MCDA most suitable sites were determined.

Confidence intervals for the first crossing point of two hazard functions.

PubMed

Cheng, Ming-Yen; Qiu, Peihua; Tan, Xianming; Tu, Dongsheng

2009-12-01

The phenomenon of crossing hazard rates is common in clinical trials with time to event endpoints. Many methods have been proposed for testing equality of hazard functions against a crossing hazards alternative. However, there has been relatively few approaches available in the literature for point or interval estimation of the crossing time point. The problem of constructing confidence intervals for the first crossing time point of two hazard functions is considered in this paper. After reviewing a recent procedure based on Cox proportional hazard modeling with Box-Cox transformation of the time to event, a nonparametric procedure using the kernel smoothing estimate of the hazard ratio is proposed. The proposed procedure and the one based on Cox proportional hazard modeling with Box-Cox transformation of the time to event are both evaluated by Monte-Carlo simulations and applied to two clinical trial datasets.

76 FR 3307 - Hazardous Materials: Harmonization With the United Nations Recommendations, International...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-19

... Compatibility Group S indicates that hazardous effects from accidental functioning are limited to the extent the... package is capable of containing any hazardous effects in the event of an accidental functioning of its... demonstrate that any hazardous effects are confined within a package. In the ANPRM, we invited commenters to...

Cumulative incidence of functional decline after minor injuries in previously independent older Canadian individuals in the emergency department.

PubMed

Sirois, Marie-Josée; Émond, Marcel; Ouellet, Marie-Christine; Perry, Jeffrey; Daoust, Raoul; Morin, Jacques; Dionne, Clermont; Camden, Stéphanie; Moore, Lynne; Allain-Boulé, Nadine

2013-10-01

To estimate the cumulative incidence of functional decline in independent older adults 3 and 6 months after a minor injury treated in the emergency department (ED) and to identify predictors of this functional decline. Prospective cohort study. Three Canadian teaching EDs. Individuals aged 65 and older who were independent in basic activities of daily living before their injury and were evaluated in the ED for minor injuries (N = 335). Functional decline was defined as a loss of 2 or more out of 28 points on the self-reported Older Americans Resources Services scale. Sociodemographic, mobility, and clinical risk factors for functional decline in non-ED studies were measured at the ED visit and 3 and 6 months after the injury. Generalized linear mixed models were used to explore differences in functional decline between groups determined according to the different factors. The cumulative incidence of decline was 14.9% (95% confidence interval (CI) = 7.6-29.1%) at 3 months and 17.3% (95% CI = 9.7-30.9%) at 6 months. Predictors of functional decline were occasional use of a walking aid (relative risk (RR)=2.4, 95% CI = 1.4-4.2), needing help in instrumental activities of daily living (IADLs) before the injury (RR = 3.1, 95% CI=1.7-5.5), taking five or more daily medications (RR = 1.8, 95% CI = 1.0-3.2), and the emergency physicians' assessment of functional decline (RR = 2.8, 95% CI = 1.5-5.3). Minor injuries in independent older adults treated in EDs are associated with a 15% cumulative incidence of functional decline 3 months after the injury that persisted 6 months later. Simple-to-measure factors such as occasional use of a walking aid, daily medication, need for help with IADLs, and physician assessment of decline may help identify independent older adults at risk of functional decline during their consultation. These results confirm the need to improve risk assessment and management of this population in EDs. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Impact of explosive eruption scenarios at Vesuvius

NASA Astrophysics Data System (ADS)

Zuccaro, G.; Cacace, F.; Spence, R. J. S.; Baxter, P. J.

2008-12-01

In the paper the first attempt at the definition of a model to assess the impact of a range of different volcanic hazards on the building structures is presented. This theoretical approach has been achieved within the activities of the EXPLORIS Project supported by the EU. A time history for Sub-Plinian I eruptive scenario of the Vesuvius is assumed by taking advantage of interpretation of historical reports of volcanic crises of the past [Carafa, G. 1632. In opusculum de novissima Vesuvij conflagratione, epistola isagogica, 2 a ed. Napoli, Naples; Mascolo, G.B., 1634. De incendio Vesuvii excitato xvij. Kal. Ianuar. anno trigesimo primo sæculi Decimiseptimi libri X. Cum Chronologia superiorum incendiorum; & Ephemeride ultimi. Napoli; Varrone, S., 1634. Vesuviani incendii historiae libri tres. Napoli], numerical simulations [Neri, A., Esposti Ongaro, T., Macedonio, G., Gidaspow, D., 2003. Multiparticle simulation of collapsing volcanic columns and pyroclastic flows. J. Geophys. Res. Lett. 108, 2202. doi:10.1029/2001 JB000508; Macedonio, G., Costa, A., Longo, A., 2005. HAZMAP: a computer model for volcanic ash fallout and assessment of subsequent hazard. Comput. Geosci. 31,837-845; Costa, A., Macedonio, G., Folch, A., 2006. A three-dimensional Eulerian model for transport and deposition of volcanic ashes. Earth Planet. Sci. Lett. 241,634-647] and experts' elicitations [Aspinall, W.P., 2006. Structured elicitation of expert judgment for probabilistic hazard and risk assessment in volcanic eruptions. In: Mader, H.M. Coles, S.G. Connor, C.B. Connor, L.J. (Eds), Statistics in Volcanology. Geological Society of London on behalf of IAVCEI, pp.15-30; Woo, G., 1999. The Mathematics of Natural Catastrophes. Imperial College Press, London] from which the impact on the building structures is derived. This is achieved by an original definition of vulnerability functions for multi-hazard input and a dynamic cumulative damage model. Factors affecting the variability of the final scenario are highlighted. The results show the high sensitivity of hazard combinations in time and space distribution and address how to mitigate building vulnerability to subsequent eruptive phenomena [Baxter, P., Spence, R., Zuccaro, G., 2008-this issue. Risk mitigation and emergency measures at Vesuvius]. The first part of the work describes the numerical modelling and the methodology adopted to evaluate the resistance of buildings under the combined action of volcanic phenomena. Those considered here for this multi-hazard approach are limited to the following: earthquakes, pyroclastic flows and ash falls. Because of the lack of a systematic and extensive database of building damages observed after eruptions of such intensity of the past, approaches to this work must take a hybrid form of stochastic and deterministic analyses, taking into account written histories of volcanic eruptions and expertise from field geologists to build up a semi-deterministic model of the possible combinations of the above hazards that are situated both in time and space. Once a range of possible scenarios has been determined, a full stochastic method can be applied to find a sub-set of permutations and combinations of possible effects. This preliminary study of identification of the possible combination of the phenomena, subdividing them into those which are discrete and those which are continuous in time and space, enables consideration the vulnerability functions of the combinations to be feasible. In previous works [Spence, R., Brichieri-Colombi, N., Holdsworth, F., Baxter, P., Zuccaro, G., 2004a. Vesuvius: building vulnerability and human casualty estimation for a pyroclastic flow (25 pages). J. Volcanol. Geotherm. Res. 133, 321-343. ISSN 0377-0273; Spence, R., Zuccaro, G., Petrazzuoli, S., Baxter, P.J., 2004b. The resistance of buildings to pyroclastic flows: theoretical and experimental studies in relation to Vesuvius, ASCE Nat. Hazards Rev. 5, 48-50. ISSN 1527-6988; Spence, R., Kelman, I., Petrazzuoli, S., Zuccaro, G., 2005. Residential Buildings and Occupant Vulnerability to Tephra Fall. Nat. Hazards Earth Syst. Sci. vol. 5. European Geosciences Union, pp.1-18; Baxter, P.J., Cole, P.D., Spence, R., Zuccaro, G., Boyd, R., Neri, A., 2005. The impacts of pyroclastic density currents on buildings during the eruption of the Soufrière hills volcano, Montserrat. Bull. Volcanol. vol. 67,292-313] the authors investigated, by means of experimental and analytical methods, the limiting resistance of masonry and reinforced concrete buildings assuming each action separately. In this work the first attempt to estimate the response of the buildings to the volcanic seismic action or to the lateral dynamic pressure due to pyroclastic flow combined with an extra vertical load on the roof due to ash fall is performed. The results show that up to a certain limit of ash fall deposit, the increment of structure weight increases the resistance of a building to pyroclastic flow action while it reduces its seismic resistance. In particular the collapse of the top storey of R.C. buildings having large roofs could occur by accumulation of ash and a strong earthquake. Seismic and pyroclastic flow vulnerability of tall R.C. and masonry buildings with rigid floors is less sensitive to ash fall load combination. The model allows any sequence of events (earthquake, ash fall, pyroclastic flow) to be assumed and evaluates the spatial distribution of the cumulative impact at a given time. Single impact scenarios have been derived and mapped on a suitable grid into which the territory around Vesuvius has been subdivided. The buildings have been classified according to the constructional characteristics that mostly affect their response under the action of the phenomena; hence the vulnerability distribution of the buildings are assigned to each cell of the grid and by taking advantage from the combined vulnerability functions the impact is derived at time t. In the paper the following impact simulations are presented: single cases of selected seismic sequence during the unrest phase (Sub-Plinian I) ash fall damage distribution compatible to a Sub-Plinian I eruption pyroclastic flow cumulative damage scenarios for selected cases (Sub-Plinian I). The model also allows either Monte Carlo simulation to evaluate the most probable final scenario or maximisation of some parameter sensitive to Civil Protection preparedness. The analysis of the results derived for a Sub-Plinian I-like eruption has shown the importance of the seismic intensities released during the unrest phase that could interfere with the evacuation of the area and the huge number of partial collapses (roofs) due to ash fall.

Diffusion of non-Gaussianity in heavy ion collisions

NASA Astrophysics Data System (ADS)

Kitazawa, Masakiyo; Asakawa, Masayuki; Ono, Hirosato

2014-05-01

We investigate the time evolution of higher order cumulants of bulk fluctuations of conserved charges in the hadronic stage in relativistic heavy ion collisions. The dynamical evolution of non-Gaussian fluctuations is modeled by the diffusion master equation. Using this model we predict that the fourth-order cumulant of net-electric charge is suppressed compared with the recently observed second-order one at ALICE for a reasonable parameter range. Significance of the measurements of various cumulants as functions of rapidity window to probe dynamical history of the hot medium created by heavy ion collisions is emphasized.

Volume dependence of baryon number cumulants and their ratios

DOE PAGES

Almási, Gábor A.; Pisarski, Robert D.; Skokov, Vladimir V.

2017-03-17

Here, we explore the influence of finite-volume effects on cumulants of baryon/quark number fluctuations in a nonperturbative chiral model. In order to account for soft modes, we use the functional renormalization group in a finite volume, using a smooth regulator function in momentum space. We compare the results for a smooth regulator with those for a sharp (or Litim) regulator, and show that in a finite volume, the latter produces spurious artifacts. In a finite volume there are only apparent critical points, about which we compute the ratio of the fourth- to the second-order cumulant of quark number fluctuations. Finally,more » when the volume is sufficiently small the system has two apparent critical points; as the system size decreases, the location of the apparent critical point can move to higher temperature and lower chemical potential.« less

Revision of 'Cumulative effect of the filamentation and Weibel instabilities in counterstreaming thermal plasmas' [Phys. Plasmas 13, 102107 (2006)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stockem, A.; Lazar, M.; Department of Physics and Engineering Physics, University of Saskatchewan, Saskatoon

2008-01-15

Dispersion formalism reported in Lazar et al. [Phys. Plasmas 13, 102107 (2006)] is affected by errors due to the misfitting of the distribution function (1) used to interpret the counterstreaming plasmas, with the general dispersion relations (4) and (5), where distribution function (1) has been inserted to find the unstable solutions. The analytical approach is reviewed here, providing a correct analytical and numerical description for the cumulative effect of filamentation and Weibel instabilities arising in initially counterstreaming plasmas with temperature anisotropies. The growth rates are plotted again, and for the cumulative mode, they are orders of magnitude larger than thosemore » obtained in Lazar et al. [Phys. Plasmas 13, 102107 (2006)]. Physically, this can be understood as an increasing of the efficiency of magnetic field generation, and rather enhances the potential role of magnetic instabilities for the fast magnetization scenario in astrophysical applications.« less

Infant Parasympathetic and Sympathetic Activity during Baseline, Stress and Recovery: Interactions with Prenatal Adversity Predict Physical Aggression in Toddlerhood.

PubMed

Suurland, J; van der Heijden, K B; Huijbregts, S C J; van Goozen, S H M; Swaab, H

2018-05-01

Exposure to prenatal adversity is associated with aggression later in life. Individual differences in autonomic nervous system (ANS) functioning, specifically nonreciprocal activation of the parasympathetic (PNS) and sympathetic (SNS) nervous systems, increase susceptibility to aggression, especially in the context of adversity. Previous work examining interactions between early adversity and ANS functioning in infancy is scarce and has not examined interaction between PNS and SNS. This study examined whether the PNS and SNS moderate the relation between cumulative prenatal risk and early physical aggression in 124 children (57% male). Cumulative risk (e.g., maternal psychiatric disorder, substance (ab)use, and social adversity) was assessed during pregnancy. Parasympathetic respiratory sinus arrhythmia (RSA) and sympathetic pre-ejection period (PEP) at baseline, in response to and during recovery from emotional challenge were measured at 6 months. Physical aggression and non-physical aggression/oppositional behavior were measured at 30 months. The results showed that cumulative prenatal risk predicted elevated physical aggression and non-physical aggression/oppositional behavior in toddlerhood; however, the effects on physical aggression were moderated by PNS and SNS functioning. Specifically, the effects of cumulative risk on physical aggression were particularly evident in children characterized by low baseline PNS activity and/or by nonreciprocal activity of the PNS and SNS, characterized by decreased activity (i.e., coinhibition) or increased activity (i.e., coactivation) of both systems at baseline and/or in response to emotional challenge. These findings extend our understanding of the interaction between perinatal risk and infant ANS functioning on developmental outcome.

Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial.

PubMed

Bonati, Leo H; Dobson, Joanna; Featherstone, Roland L; Ederle, Jörg; van der Worp, H Bart; de Borst, Gert J; Mali, Willem P Th M; Beard, Jonathan D; Cleveland, Trevor; Engelter, Stefan T; Lyrer, Philippe A; Ford, Gary A; Dorman, Paul J; Brown, Martin M

2015-02-07

Stenting is an alternative to endarterectomy for treatment of carotid artery stenosis, but long-term efficacy is uncertain. We report long-term data from the randomised International Carotid Stenting Study comparison of these treatments. Patients with symptomatic carotid stenosis were randomly assigned 1:1 to open treatment with stenting or endarterectomy at 50 centres worldwide. Randomisation was computer generated centrally and allocated by telephone call or fax. Major outcomes were assessed by an independent endpoint committee unaware of treatment assignment. The primary endpoint was fatal or disabling stroke in any territory after randomisation to the end of follow-up. Analysis was by intention to treat ([ITT] all patients) and per protocol from 31 days after treatment (all patients in whom assigned treatment was completed). Functional ability was rated with the modified Rankin scale. This study is registered, number ISRCTN25337470. 1713 patients were assigned to stenting (n=855) or endarterectomy (n=858) and followed up for a median of 4·2 years (IQR 3·0-5·2, maximum 10·0). Three patients withdrew immediately and, therefore, the ITT population comprised 1710 patients. The number of fatal or disabling strokes (52 vs 49) and cumulative 5-year risk did not differ significantly between the stenting and endarterectomy groups (6·4% vs 6·5%; hazard ratio [HR] 1·06, 95% CI 0·72-1·57, p=0·77). Any stroke was more frequent in the stenting group than in the endarterectomy group (119 vs 72 events; ITT population, 5-year cumulative risk 15·2% vs 9·4%, HR 1·71, 95% CI 1·28-2·30, p<0·001; per-protocol population, 5-year cumulative risk 8·9% vs 5·8%, 1·53, 1·02-2·31, p=0·04), but were mainly non-disabling strokes. The distribution of modified Rankin scale scores at 1 year, 5 years, or final follow-up did not differ significantly between treatment groups. Long-term functional outcome and risk of fatal or disabling stroke are similar for stenting and endarterectomy for symptomatic carotid stenosis. Medical Research Council, Stroke Association, Sanofi-Synthélabo, European Union. Copyright © 2015 Bonati et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd. All rights reserved.

Respiratory morbidity of pattern and model makers exposed to wood, plastic, and metal products

DOE Office of Scientific and Technical Information (OSTI.GOV)

Robins, T.G.; Haboubi, G.; Demers, R.Y.

Pattern and model makers are skilled tradespersons who may be exposed to hardwoods, softwoods, phenol-formaldehyde resin-impregnated woods, epoxy and polyester/styrene resin systems, and welding and metal-casting fumes. The relationship of respiratory symptoms (wheezing, chronic bronchitis, dyspnea) and pulmonary function (FVC% predicted, FEV1% predicted, FEV1/FVC% predicted) with interview-derived cumulative exposure estimates to specific workplace agents and to all work with wood, plastic, or metal products was investigated in 751 pattern and model makers in southeast Michigan. In stratified analyses and age- and smoking-adjusted linear and logistic regression models, measures of cumulative wood exposures were associated with decrements in pulmonary function andmore » dyspnea, but not with other symptoms. In similar analyses, measures of cumulative plastic exposures were associated with wheezing, chronic bronchitis, and dyspnea, but not with decrements in pulmonary function. Prior studies of exposure levels among pattern and model makers and of respiratory health effects of specific agents among other occupational groups support the plausibility of wood-related effects more strongly than that of plastic-related effects.« less

Predicting Academic Achievement from Cumulative Home Risk: The Mediating Roles of Effortful Control, Academic Relationships, and School Avoidance

ERIC Educational Resources Information Center

Swanson, Jodi; Valiente, Carlos; Lemery-Chalfant, Kathryn

2012-01-01

Components of the home environment are associated with children's academic functioning. The accumulation of risks in the home are expected to prove more detrimental to achievement than any one risk alone, but the processes accounting for this relation are unclear. Using an index of cumulative home risk (CHR) inclusive of protective factors, as…

Measurement of higher cumulants of net-charge multiplicity distributions in Au +Au collisions at √{sN N}=7.7 -200 GeV

NASA Astrophysics Data System (ADS)

Adare, A.; Afanasiev, S.; Aidala, C.; Ajitanand, N. N.; Akiba, Y.; Akimoto, R.; Al-Bataineh, H.; Alexander, J.; Al-Ta'Ani, H.; Angerami, A.; Aoki, K.; Apadula, N.; Aramaki, Y.; Asano, H.; Aschenauer, E. C.; Atomssa, E. T.; Averbeck, R.; Awes, T. C.; Azmoun, B.; Babintsev, V.; Bai, M.; Baksay, G.; Baksay, L.; Bannier, B.; Barish, K. N.; Bassalleck, B.; Basye, A. T.; Bathe, S.; Baublis, V.; Baumann, C.; Baumgart, S.; Bazilevsky, A.; Belikov, S.; Belmont, R.; Bennett, R.; Berdnikov, A.; Berdnikov, Y.; Bickley, A. A.; Black, D.; Blau, D. S.; Bok, J. S.; Boyle, K.; Brooks, M. L.; Bryslawskyj, J.; Buesching, H.; Bumazhnov, V.; Bunce, G.; Butsyk, S.; Camacho, C. M.; Campbell, S.; Castera, P.; Chen, C.-H.; Chi, C. Y.; Chiu, M.; Choi, I. J.; Choi, J. B.; Choi, S.; Choudhury, R. K.; Christiansen, P.; Chujo, T.; Chung, P.; Chvala, O.; Cianciolo, V.; Citron, Z.; Cole, B. A.; Connors, M.; Constantin, P.; Cronin, N.; Crossette, N.; Csanád, M.; Csörgő, T.; Dahms, T.; Dairaku, S.; Danchev, I.; Das, K.; Datta, A.; Daugherity, M. S.; David, G.; Dehmelt, K.; Denisov, A.; Deshpande, A.; Desmond, E. J.; Dharmawardane, K. V.; Dietzsch, O.; Ding, L.; Dion, A.; Do, J. H.; Donadelli, M.; D'Orazio, L.; Drapier, O.; Drees, A.; Drees, K. A.; Durham, J. M.; Durum, A.; Dutta, D.; Edwards, S.; Efremenko, Y. V.; Ellinghaus, F.; Engelmore, T.; Enokizono, A.; En'yo, H.; Esumi, S.; Eyser, K. O.; Fadem, B.; Fields, D. E.; Finger, M.; Finger, M.; Fleuret, F.; Fokin, S. L.; Fraenkel, Z.; Frantz, J. E.; Franz, A.; Frawley, A. D.; Fujiwara, K.; Fukao, Y.; Fusayasu, T.; Gainey, K.; Gal, C.; Garg, P.; Garishvili, A.; Garishvili, I.; Giordano, F.; Glenn, A.; Gong, H.; Gong, X.; Gonin, M.; Goto, Y.; Granier de Cassagnac, R.; Grau, N.; Greene, S. V.; Grosse Perdekamp, M.; Gu, Y.; Gunji, T.; Guo, L.; Gustafsson, H.-Å.; Hachiya, T.; Haggerty, J. S.; Hahn, K. I.; Hamagaki, H.; Hamblen, J.; Han, R.; Hanks, J.; Hartouni, E. P.; Hashimoto, K.; Haslum, E.; Hayano, R.; Hayashi, S.; He, X.; Heffner, M.; Hemmick, T. K.; Hester, T.; Hill, J. C.; Hohlmann, M.; Hollis, R. S.; Holzmann, W.; Homma, K.; Hong, B.; Horaguchi, T.; Hori, Y.; Hornback, D.; Huang, S.; Ichihara, T.; Ichimiya, R.; Ide, J.; Iinuma, H.; Ikeda, Y.; Imai, K.; Imazu, Y.; Imrek, J.; Inaba, M.; Iordanova, A.; Isenhower, D.; Ishihara, M.; Isinhue, A.; Isobe, T.; Issah, M.; Isupov, A.; Ivanishchev, D.; Jacak, B. V.; Javani, M.; Jia, J.; Jiang, X.; Jin, J.; Johnson, B. M.; Joo, K. S.; Jouan, D.; Jumper, D. S.; Kajihara, F.; Kametani, S.; Kamihara, N.; Kamin, J.; Kaneti, S.; Kang, B. H.; Kang, J. H.; Kang, J. S.; Kapustinsky, J.; Karatsu, K.; Kasai, M.; Kawall, D.; Kawashima, M.; Kazantsev, A. V.; Kempel, T.; Key, J. A.; Khandai, P. K.; Khanzadeev, A.; Kijima, K. M.; Kim, B. I.; Kim, C.; Kim, D. H.; Kim, D. J.; Kim, E.; Kim, E.-J.; Kim, H. J.; Kim, K.-B.; Kim, S. H.; Kim, Y.-J.; Kim, Y. K.; Kinney, E.; Kiriluk, K.; Kiss, Á.; Kistenev, E.; Klatsky, J.; Kleinjan, D.; Kline, P.; Kochenda, L.; Komatsu, Y.; Komkov, B.; Konno, M.; Koster, J.; Kotchetkov, D.; Kotov, D.; Kozlov, A.; Král, A.; Kravitz, A.; Krizek, F.; Kunde, G. J.; Kurita, K.; Kurosawa, M.; Kwon, Y.; Kyle, G. S.; Lacey, R.; Lai, Y. S.; Lajoie, J. G.; Lebedev, A.; Lee, B.; Lee, D. M.; Lee, J.; Lee, K.; Lee, K. B.; Lee, K. S.; Lee, S. H.; Lee, S. R.; Leitch, M. J.; Leite, M. A. L.; Leitgab, M.; Leitner, E.; Lenzi, B.; Lewis, B.; Li, X.; Liebing, P.; Lim, S. H.; Linden Levy, L. A.; Liška, T.; Litvinenko, A.; Liu, H.; Liu, M. X.; Love, B.; Luechtenborg, R.; Lynch, D.; Maguire, C. F.; Makdisi, Y. I.; Makek, M.; Malakhov, A.; Malik, M. D.; Manion, A.; Manko, V. I.; Mannel, E.; Mao, Y.; Maruyama, T.; Masui, H.; Masumoto, S.; Matathias, F.; McCumber, M.; McGaughey, P. L.; McGlinchey, D.; McKinney, C.; Means, N.; Meles, A.; Mendoza, M.; Meredith, B.; Miake, Y.; Mibe, T.; Midori, J.; Mignerey, A. C.; Mikeš, P.; Miki, K.; Milov, A.; Mishra, D. K.; Mishra, M.; Mitchell, J. T.; Miyachi, Y.; Miyasaka, S.; Mohanty, A. K.; Mohapatra, S.; Moon, H. J.; Morino, Y.; Morreale, A.; Morrison, D. P.; Moskowitz, M.; Motschwiller, S.; Moukhanova, T. V.; Murakami, T.; Murata, J.; Mwai, A.; Nagae, T.; Nagamiya, S.; Nagle, J. L.; Naglis, M.; Nagy, M. I.; Nakagawa, I.; Nakamiya, Y.; Nakamura, K. R.; Nakamura, T.; Nakano, K.; Nattrass, C.; Nederlof, A.; Netrakanti, P. K.; Newby, J.; Nguyen, M.; Nihashi, M.; Niida, T.; Nouicer, R.; Novitzky, N.; Nukariya, A.; Nyanin, A. S.; Obayashi, H.; O'Brien, E.; Oda, S. X.; Ogilvie, C. A.; Oka, M.; Okada, K.; Onuki, Y.; Oskarsson, A.; Ouchida, M.; Ozawa, K.; Pak, R.; Pantuev, V.; Papavassiliou, V.; Park, B. H.; Park, I. H.; Park, J.; Park, S.; Park, S. K.; Park, W. J.; Pate, S. F.; Patel, L.; Pei, H.; Peng, J.-C.; Pereira, H.; Perepelitsa, D. V.; Peresedov, V.; Peressounko, D. Yu.; Petti, R.; Pinkenburg, C.; Pisani, R. P.; Proissl, M.; Purschke, M. L.; Purwar, A. K.; Qu, H.; Rak, J.; Rakotozafindrabe, A.; Ravinovich, I.; Read, K. F.; Reygers, K.; Reynolds, D.; Riabov, V.; Riabov, Y.; Richardson, E.; Riveli, N.; Roach, D.; Roche, G.; Rolnick, S. D.; Rosati, M.; Rosen, C. A.; Rosendahl, S. S. E.; Rosnet, P.; Rukoyatkin, P.; Ružička, P.; Ryu, M. S.; Sahlmueller, B.; Saito, N.; Sakaguchi, T.; Sakashita, K.; Sako, H.; Samsonov, V.; Sano, M.; Sano, S.; Sarsour, M.; Sato, S.; Sato, T.; Sawada, S.; Sedgwick, K.; Seele, J.; Seidl, R.; Semenov, A. Yu.; Sen, A.; Seto, R.; Sett, P.; Sharma, D.; Shein, I.; Shibata, T.-A.; Shigaki, K.; Shimomura, M.; Shoji, K.; Shukla, P.; Sickles, A.; Silva, C. L.; Silvermyr, D.; Silvestre, C.; Sim, K. S.; Singh, B. K.; Singh, C. P.; Singh, V.; Skolnik, M.; Slunečka, M.; Solano, S.; Soltz, R. A.; Sondheim, W. E.; Sorensen, S. P.; Sourikova, I. V.; Sparks, N. A.; Stankus, P. W.; Steinberg, P.; Stenlund, E.; Stepanov, M.; Ster, A.; Stoll, S. P.; Sugitate, T.; Sukhanov, A.; Sun, J.; Sziklai, J.; Takagui, E. M.; Takahara, A.; Taketani, A.; Tanabe, R.; Tanaka, Y.; Taneja, S.; Tanida, K.; Tannenbaum, M. J.; Tarafdar, S.; Taranenko, A.; Tarján, P.; Tennant, E.; Themann, H.; Thomas, T. L.; Todoroki, T.; Togawa, M.; Toia, A.; Tomášek, L.; Tomášek, M.; Torii, H.; Towell, R. S.; Tserruya, I.; Tsuchimoto, Y.; Tsuji, T.; Vale, C.; Valle, H.; van Hecke, H. W.; Vargyas, M.; Vazquez-Zambrano, E.; Veicht, A.; Velkovska, J.; Vértesi, R.; Vinogradov, A. A.; Virius, M.; Voas, B.; Vossen, A.; Vrba, V.; Vznuzdaev, E.; Wang, X. R.; Watanabe, D.; Watanabe, K.; Watanabe, Y.; Watanabe, Y. S.; Wei, F.; Wei, R.; Wessels, J.; Whitaker, S.; White, S. N.; Winter, D.; Wolin, S.; Wood, J. P.; Woody, C. L.; Wright, R. M.; Wysocki, M.; Xia, B.; Xie, W.; Yamaguchi, Y. L.; Yamaura, K.; Yang, R.; Yanovich, A.; Ying, J.; Yokkaichi, S.; You, Z.; Young, G. R.; Younus, I.; Yushmanov, I. E.; Zajc, W. A.; Zelenski, A.; Zhang, C.; Zhou, S.; Zolin, L.; Phenix Collaboration

2016-01-01

We report the measurement of cumulants (Cn,n =1 ,...,4 ) of the net-charge distributions measured within pseudorapidity (|η |<0.35 ) in Au +Au collisions at √{sNN}=7.7 -200 GeV with the PHENIX experiment at the Relativistic Heavy Ion Collider. The ratios of cumulants (e.g., C1/C2 , C3/C1 ) of the net-charge distributions, which can be related to volume independent susceptibility ratios, are studied as a function of centrality and energy. These quantities are important to understand the quantum-chromodynamics phase diagram and possible existence of a critical end point. The measured values are very well described by expectation from negative binomial distributions. We do not observe any nonmonotonic behavior in the ratios of the cumulants as a function of collision energy. The measured values of C1/C2 and C3/C1 can be directly compared to lattice quantum-chromodynamics calculations and thus allow extraction of both the chemical freeze-out temperature and the baryon chemical potential at each center-of-mass energy. The extracted baryon chemical potentials are in excellent agreement with a thermal-statistical analysis model.

Individual differences in the activity of the hypothalamic pituitary adrenal axis: Relations to age and cumulative risk in early childhood.

PubMed

Holochwost, Steven J; Gariépy, Jean-Louis; Mills-Koonce, W Roger; Propper, Cathi B; Kolacz, Jacek; Granger, Douglas A

2017-07-01

This study examined individual differences in the function of the hypothalamic-pituitary-adrenal (HPA) axis with regard to age and cumulative risk during challenging laboratory tasks administered at 6, 12, 24, and 36 months. Saliva samples were collected from a majority-minority sample of N=185 children (57% African American, 50% female) prior to and following these tasks and later assayed for cortisol. Cumulative distal risk was indexed via a composite of maternal marital status, maternal education, income-to-needs ratio, the number of children in the household, and maternal age at childbirth. Probing of hierarchical models in which cortisol levels and age were nested within child revealed significant differences in cortisol as a function of both age and cumulative risk, such that children exposed to high levels of risk exhibited higher levels of cortisol both within and across age. These results highlight the sensitivity of the HPA axis to environmental context at the level of the individual, even as that sensitivity is manifest against the background of species-typical biological development. Copyright © 2017 Elsevier Ltd. All rights reserved.

Risk of First and Recurrent Stroke in Childhood Cancer Survivors Treated With Cranial and Cervical Radiation Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mueller, Sabine, E-mail: muellers@neuropeds.ucsf.edu; Department of Pediatrics, University of California, San Francisco, California; Department of Neurosurgery, University of California, San Francisco, California

Purpose: To assess, in a retrospective cohort study, rates and predictors of first and recurrent stroke in patients treated with cranial irradiation (CRT) and/or cervical irradiation at ≤18 years of age. Methods and Materials: We performed chart abstraction (n=383) and phone interviews (n=104) to measure first and recurrent stroke in 383 patients who received CRT and/or cervical radiation at a single institution between 1980 and 2009. Stroke was defined as a physician diagnosis and symptoms consistent with stroke. Incidence of first stroke was number of first strokes per person-years of observation after radiation. We used survival analysis techniques to determinemore » cumulative incidence of first and recurrent stroke. Results: Among 325 subjects with sufficient follow-up data, we identified 19 first strokes (13 ischemic, 4 hemorrhagic, 2 unknown subtype) occurring at a median age of 24 years (interquartile range 17-33 years) in patients treated with CRT. Imaging was reviewed when available (n=13), and the stroke was confirmed in 12. Overall rate of first stroke was 625 (95% confidence interval [CI] 378-977) per 100,000 person-years. The cumulative incidence of first stroke was 2% (95% CI 0.01%-5.3%) at 5 years and 4% (95% CI 2.0%-8.4%) at 10 years after irradiation. With each 100-cGy increase in the radiation dose, the stroke hazard increased by 5% (hazard ratio 1.05; 95% CI 1.01-1.09; P=.02). We identified 6 recurrent strokes; 5 had available imaging that confirmed the stroke. Median time to recurrence was 15 months (interquartile range 6 months-3.2 years) after first stroke. The cumulative incidence of recurrent stroke was 38% (95% CI 17%-69%) at 5 years and 59% (95% CI 27%-92%) at 10 years after first stroke. Conclusion: Cranial irradiation puts childhood cancer survivors at high risk of both first and recurrent stroke. Stroke prevention strategies for these survivors are needed.« less

Marijuana Use Is Not Associated With Progression to Advanced Liver Fibrosis in HIV/Hepatitis C Virus–coinfected Women

PubMed Central

Kelly, Erin M.; Dodge, Jennifer L.; Sarkar, Monika; French, Audrey L.; Tien, Phyllis C.; Glesby, Marshall J.; Golub, Elizabeth T.; Augenbraun, Michael; Plankey, Michael; Peters, Marion G.

2016-01-01

Background. Marijuana (hereafter “tetrahydrocannabinol [THC]”) use has been associated with liver fibrosis progression in retrospective analyses of patients with chronic hepatitis C (HCV). We studied long-term effects of THC on fibrosis progression in women coinfected with human immunodeficiency virus (HIV)/HCV enrolled in the Women's Interagency HIV Study (WIHS). Methods. Liver fibrosis was categorized according to FIB-4 scores as none, moderate, or significant. THC and alcohol use were quantified as average exposure per week. Associations between THC use and progression to significant fibrosis were assessed using Cox proportional hazards regression. Results. Among 575 HIV/HCV-coinfected women followed for a median of 11 (interquartile range, 6–17) years, 324 (56%) reported no THC use, 141 (25%) less than weekly use, 70 (12%) weekly use, and 40 (7%) daily use at WIHS entry. In univariable analysis, entry FIB-4 score (hazard ratio [HR], 2.26 [95% confidence interval {CI}, 1.88–2.73], P < .001), log HCV RNA (HR, 1.19 [95% CI, 1.02–1.38], P = .02), tobacco use (HR, 1.37 [95% CI, 1.02–1.85], P = .04), CD4+ count (risk per 100-cell increase: HR, 0.90 [95% CI, .86–.95], P < .001), and log HIV RNA (HR, 1.18 [95% CI, 1.05–1.32], P = .005) were associated with progression to significant fibrosis, as was cumulative alcohol use in follow-up (HR, 1.03 [95% CI, 1.02–1.04], P < .001). In multivariable analysis, entry FIB-4, entry CD4+ count, and cumulative alcohol use remained significant. Cumulative THC use was not associated with fibrosis progression (HR, 1.01 [95% CI, .92–1.10], P = .83). Conclusions. In this large cohort of HIV/HCV-coinfected women, THC was not associated with progression to significant liver fibrosis. Alcohol use was independently associated with liver fibrosis, and may better predict fibrosis progression in HIV/HCV-coinfected women. PMID:27225241

Coronary artery disease severity and long-term cardiovascular risk in patients with myocardial infarction: a Danish nationwide register-based cohort study

PubMed Central

Özcan, Cengiz; Deleskog, Anna; Schjerning Olsen, Anne-Marie; Nordahl Christensen, Helene; Lock Hansen, Morten; Hilmar Gislason, Gunnar

2018-01-01

Abstract Aim Long-term prognostic impact of coronary artery disease (CAD) severity in stable post-myocardial infarction (MI) patients is not well known. We examined the impact of CAD severity and co-morbidity on the long-term (1 year and beyond) risk of cardiovascular events post-MI. Methods and results From nationwide administrative and clinical registers, we identified 55 747 MI patients, during 2004–2010, who had not experienced subsequent MI, stroke, or death within 7 days post-discharge. The risk for primary composite endpoint (MI, stroke, or cardiovascular death) was estimated for the first 365 days after MI (index MI) and from day 366 to study completion (stable post-MI population), corresponding to a mean follow-up of 3.6 (2.2) years. Risk was assessed using cumulative incidence, multivariable adjusted logistic regression and Cox proportional-hazards models. The 1-year cumulative incidence for primary endpoint was 20.0% [95% confidence interval (CI), (19.6–20.3)]. Correspondingly, the 4-year cumulative incidence for primary endpoint was 21.0% (95% CI, 20.6–21.4) in patients without events on the first year. In multivariable models with no significant stenosis as reference, CAD severity was the most important risk factor for cardiovascular events the first 365 days [left main stenosis (LMS): odds ratio and 95% CI, 4.37, 3.69–5.17; 3-vessel disease (VD), 4.18, 3.66–4.77; 2-VD, 3.23, 2.81–3.72; 1-VD, 2.12,–1.85–2.43] and remained from day 366 to study completion [LMS: hazard ratio and 95% CI, 1.91, 1.64–2.22; 3-VD, 1.85,1.65–2.07; 2-VD, 1.55, 1.38–1.74; 1-VD, 1.30, 1.16–1.45]. Conclusion Despite contemporary treatment at baseline, stable post-MI patients’ 4-year outcome was similar to 1-year outcome after MI, and CAD severity remained a critical risk factor the first year and thereafter. PMID:28444162

Early Course of Inflammatory Bowel Disease in a Population-Based Inception Cohort Study From 8 Countries in Asia and Australia.

PubMed

Ng, Siew C; Zeng, Zhirong; Niewiadomski, Ola; Tang, Whitney; Bell, Sally; Kamm, Michael A; Hu, Pinjin; de Silva, H Janaka; Niriella, Madunil A; Udara, W S A A Yasith; Ong, David; Ling, Khoon Lin; Ooi, Choon Jin; Hilmi, Ida; Lee Goh, Khean; Ouyang, Qin; Wang, Yu Fang; Wu, Kaichun; Wang, Xin; Pisespongsa, Pises; Manatsathit, Sathaporn; Aniwan, Satimai; Limsrivilai, Julajak; Gunawan, Jeffri; Simadibrata, Marcellus; Abdullah, Murdani; Tsang, Steve W C; Lo, Fu Hang; Hui, Aric J; Chow, Chung Mo; Yu, Hon Ho; Li, Mo Fong; Ng, Ka Kei; Ching, Jessica Y L; Chan, Victor; Wu, Justin C Y; Chan, Francis K L; Chen, Minhu; Sung, Joseph J Y

2016-01-01

The incidence of inflammatory bowel disease (IBD) is increasing in Asia, but little is known about disease progression in this region. The Asia-Pacific Crohn's and Colitis Epidemiology Study was initiated in 2011, enrolling subjects from 8 countries in Asia (China, Hong Kong, Indonesia, Sri Lanka, Macau, Malaysia, Singapore, and Thailand) and Australia. We present data from this ongoing study. We collected data on 413 patients diagnosed with IBD (222 with ulcerative colitis [UC], 181 with Crohn's disease [CD], 10 with IBD unclassified; median age, 37 y) from 2011 through 2013. We analyzed the disease course and severity and mortality. Risks for medical and surgical therapies were assessed using Kaplan-Meier analysis. The cumulative probability that CD would change from inflammatory to stricturing or penetrating disease was 19.6%. The cumulative probabilities for use of immunosuppressants or anti-tumor necrosis factor agents were 58.9% and 12.0% for patients with CD, and 12.7% and 0.9% for patients with UC, respectively. Perianal CD was associated with an increased risk of anti-tumor necrosis factor therapy within 1 year of its diagnosis (hazard ratio, 2.97; 95% confidence interval, 1.09-8.09). The cumulative probabilities for surgery 1 year after diagnosis were 9.1% for patients with CD and 0.9% for patients with UC. Patients with CD and penetrating disease had a 7-fold increase for risk of surgery, compared with patients with inflammatory disease (hazard ratio, 7.67; 95% confidence interval, 3.93-14.96). The overall mortality for patients with IBD was 0.7%. In a prospective population-based study, we found that the early course of disease in patients with IBD in Asia was comparable with that of the West. Patients with CD frequently progress to complicated disease and have accelerated use of immunosuppressants. Few patients with early stage UC undergo surgery in Asia. Increasing our understanding of IBD progression in different populations can help optimize therapy and improve outcomes. Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

Association between Serum β2-Microglobulin Level and Infectious Mortality in Hemodialysis Patients

PubMed Central

Cheung, Alfred K.; Greene, Tom; Leypoldt, John K.; Yan, Guofen; Allon, Michael; Delmez, James; Levey, Andrew S.; Levin, Nathan W.; Rocco, Michael V.; Schulman, Gerald; Eknoyan, Garabed

2008-01-01

Background and objectives: Secondary analysis of the Hemodialysis Study showed that serum β2-microglobulin levels predicted all-cause mortality and that high-flux dialysis was associated with decreased cardiac deaths in hemodialysis patients. This study examined the association of serum β2-microglobulin levels and dialyzer β2-microglobulin kinetics with the two most common causes of deaths: Cardiac and infectious diseases. Cox regression analyses were performed to relate cardiac or infectious deaths to cumulative mean follow-up predialysis serum β2-microglobulin levels while controlling for baseline demographics, comorbidity, residual kidney function, and dialysis-related variables. Results: The cohort of 1813 patients experienced 180 infectious deaths and 315 cardiac deaths. The adjusted hazard ratio for infectious death was 1.21 (95% confidence interval 1.07 to 1.37) per 10-mg/L increase in β2-microglobulin. This association was independent of the prestudy years on dialysis. In contrast, the association between serum β2-microglobulin level and cardiac death was not statistically significant. In similar regression models, higher cumulative mean Kt/V of β2-microglobulin was not significantly associated with either infectious or cardiac mortality in the full cohort but exhibited trends suggesting an association with lower infectious mortality (relative risk 0.93; 95% confidence interval 0.86 to 1.01, for each 0.1-U increase in β2-microglobulin Kt/V) and lower cardiac mortality (relative risk 0.93; 95% confidence interval 0.87 to 1.00) in the subgroup with >3.7 prestudy years of dialysis. Conclusions: These results generally support the notion that middle molecules are associated with systemic toxicity and that their accumulation predisposes dialysis patients to infectious deaths, independent of the duration of maintenance dialysis. PMID:18057309

Opioids and Breast Cancer Recurrence: A Danish population-based cohort study

PubMed Central

Cronin-Fenton, D.P.; Heide-Jørgensen, U.; Ahern, T.P.; Lash, T.L.; Christiansen, P.M.; Ejlertsen, B.; Sjøgren, P.; Kehlet, H.; Sørensen, H.T.

2015-01-01

Background Opioids may alter immune function and thereby potentially affect cancer recurrence. We investigated the association between post-diagnosis opioid use and breast cancer recurrence. Methods We identified incident early-stage breast cancer patients, diagnosed 1996-2008 in Denmark, registered in the Danish Breast Cancer Cooperative Group Registry. Opioid prescriptions were ascertained from the Danish National Prescription Registry. Follow-up began on the date of breast cancer primary surgery and continued until breast cancer recurrence, death, emigration, ten years, or 31 July 2013, whichever occurred first. We used Cox regression models to compute hazard ratios (HRs) and 95% confidence intervals (95%CI) associating breast cancer recurrence with opioid prescription use overall, and by opioid type and strength, immunosuppressive effect, chronic use (>=6 months continuous exposure), and cumulative morphine-equivalent dose, adjusting for confounders. Results We identified 34,188 patients who together contributed 283,666 person-years of follow-up. There was no association between ever use of opioids and breast cancer recurrence (HRcrude=0.98, 95% CI=0.90 - 1.1, and HRadjusted=1.0, 95% CI=0.92 - 1.1), regardless of opioid type, strength, chronicity of use, and cumulative dose. Breast cancer recurrence rates were lower among users of strong but not weakly immunosuppressive opioids, possibly due to channeling bias among those with high competing risk as mortality was higher among users of this drug type. Conclusions This large prospective cohort study provided no clinically relevant evidence of an association between opioid prescriptions and breast cancer recurrence. Our findings are important to cancer survivorship, as opioids are frequently used to manage pain associated with comorbid conditions. PMID:26207518

Family member deaths across adulthood predict Alzheimer's disease risk: The Cache County Study.

PubMed

Norton, Maria C; Fauth, Elizabeth; Clark, Christine J; Hatch, Dan; Greene, Daylee; Pfister, Roxane; Tschanz, JoAnn T; Smith, Ken R

2016-03-01

Parental death during childhood, and offspring and spouse death during adulthood have individually been associated with faster cognitive decline and higher Alzheimer's disease (AD) risk in late life. However, the cumulative effect of childhood and adulthood family deaths on AD risk among different age cohorts has not been studied. To examine these associations, this prospective cohort study uses a population-based sample of 4545 initially non-demented participants (56.7% female; age M = 75.0/SD = 6.9 years) observed at four triennial waves, linked with objective Utah Population Database data on cumulative mother, father, sibling, spouse, and offspring death experienced during childhood and adulthood. Cox regression modeled survival time from baseline interview to AD onset, as a function of family deaths during childhood or adulthood, among different age groups, along with gender and presence of ε4 allele at apolipoprotein E (APOE) polymorphic genetic locus. Age group significantly moderated the relationship between family death and AD; among persons aged 65-69 years at baseline (children of the Great Depression), those exposed to 3-4 deaths and 5+ deaths during adulthood exhibited a doubling of AD risk (adjusted hazard ratio, aHR = 2.25, p = .038, and aHR = 2.72, p = .029), while among persons aged 80 years and older, those exposed to 3-4 deaths during adulthood exhibited lower AD risk (HR = 0.539, p = 0.014). In a combined model of childhood and adulthood deaths, these findings persisted. Results suggest a cohort effect in the link between family member deaths during adulthood and AD risk later in life. Copyright © 2015 John Wiley & Sons, Ltd.

Beyond the five-year horizon: long-term outcome of high-risk and inoperable patients undergoing TAVR with first-generation devices.

PubMed

Deutsch, Marcus-André; Erlebach, Magdalena; Burri, Melchior; Hapfelmeier, Alexander; Witt, Olivia Ganga; Ziegelmueller, Johannes Amadeus; Wottke, Michael; Ruge, Hendrik; Krane, Markus; Piazza, Nicolo; Bleiziffer, Sabine; Lange, Rüdiger

2018-05-20

We sought to determine the long-term outcome of high-risk patients who underwent transcatheter aortic valve replacement (TAVR) with first-generation devices with a focus on the identification of predictors for mortality and valve durability. Consecutive patients in our prospective single-centre registry undergoing TAVR with first-generation devices (n=214 CoreValve; n=86 SAPIEN) between 06/2007 and 07/2009 were retrospectively analysed (n=300, mean age 81.43±6.55 years, mean STS score 6.5±4.5%). Kaplan-Meier estimates of survival and the Cox proportional hazards model were used to identify independent predictors of all-cause-mortality. At 1, 5, and 7 years, estimated survival rates were 76.0%, 40.2%, and 23.2%, respectively. Age-adjusted baseline predictors of mortality included atrial fibrillation, impaired kidney function, peripheral artery disease, and mitral regurgitation (≥moderate). Baseline risk-adjusted procedure-related predictors for all-cause mortality included acute kidney injury, neurological events, major vascular complications, and major/life-threatening bleeding. At both five and six years, 78.2% of surviving patients were in NYHA Class I or II. PVL was ≤mild in the majority of patients at discharge and throughout follow-up. At seven years, the overall crude cumulative incidence of structural valve deterioration according to the 2017 EAPCI/ESC/EACTS definition was 14.9% (CoreValve 11.8% vs. SAPIEN 22.6%; p=0.01). Seven years after TAVR, 23.2% of high-risk patients were still alive. Independent predictors of all-cause mortality included both patient- and procedure-related factors. With a cumulative incidence of 14.9% at seven years, there is some suggestion that SVD post TAVR may become increasingly relevant during longer-term follow-up.

Comparative study of the failure rates among 3 implantable defibrillator leads.

PubMed

van Malderen, Sophie C H; Szili-Torok, Tamas; Yap, Sing C; Hoeks, Sanne E; Zijlstra, Felix; Theuns, Dominic A M J

2016-12-01

After the introduction of the Biotronik Linox S/SD high-voltage lead, several cases of early failure have been observed. The purpose of this article was to assess the performance of the Linox S/SD lead in comparison to 2 other contemporary leads. We used the prospective Erasmus MC ICD registry to identify all implanted Linox S/SD (n = 408), Durata (St. Jude Medical, model 7122) (n = 340), and Endotak Reliance (Boston Scientific, models 0155, 0138, and 0158) (n = 343) leads. Lead failure was defined by low- or high-voltage impedance, failure to capture, sense or defibrillate, or the presence of nonphysiological signals not due to external interference. During a median follow-up of 5.1 years, 24 Linox (5.9%), 5 Endotak (1.5%), and 5 Durata (1.5%) leads failed. At 5-year follow-up, the cumulative failure rate of Linox leads (6.4%) was higher than that of Endotak (0.4%; P < .0001) and Durata (2.0%; P = .003) leads. The incidence rate was higher in Linox leads (1.3 per 100 patient-years) than in Endotak and Durata leads (0.2 and 0.3 per 100 patient-years, respectively; P < .001). A log-log analysis of the cumulative hazard for Linox leads functioning at 3-year follow-up revealed a stable failure rate of 3% per year. The majority of failures consisted of noise (62.5%) and abnormal impedance (33.3%). This study demonstrates a higher failure rate of Linox S/SD high-voltage leads compared to contemporary leads. Although the mechanism of lead failure is unclear, the majority presents with abnormal electrical parameters. Comprehensive monitoring of Linox S/SD high-voltage leads includes remote monitoring to facilitate early detection of lead failure. Copyright © 2016. Published by Elsevier Inc.

Trivariate characteristics of intensity fluctuations for heavily saturated optical systems.

PubMed

Das, Biman; Drake, Eli; Jack, John

2004-02-01

Trivariate cumulants of intensity fluctuations have been computed starting from a trivariate intensity probability distribution function, which rests on the assumption that the variation of intensity has a maximum entropy distribution with the constraint that the total intensity is constant. The assumption holds for optical systems such as a thin, long, mirrorless gas laser amplifier where under heavy gain saturation the total output approaches a constant intensity, although intensity of any mode fluctuates rapidly over the average intensity. The relations between trivariate cumulants and central moments that were needed for the computation of trivariate cumulants were derived. The results of the computation show that the cumulants have characteristic values that depend on the number of interacting modes in the system. The cumulant values approach zero when the number of modes is infinite, as expected. The results will be useful for comparison with the experimental triavariate statistics of heavily saturated optical systems such as the output from a thin, long, bidirectional gas laser amplifier.

The Very High Premature Mortality Rate among Active Professional Wrestlers Is Primarily Due to Cardiovascular Disease

PubMed Central

Herman, Christopher W.; Conlon, Anna S. C.; Rubenfire, Melvyn; Burghardt, Andrew R.; McGregor, Stephen J.

2014-01-01

Purpose Recently, much media attention has been given to the premature deaths in professional wrestlers. Since no formal studies exist that have statistically examined the probability of premature mortality in professional wrestlers, we determined survival estimates for active wresters over the past quarter century to establish the factors contributing to the premature mortality of these individuals. Methods Data including cause of death was obtained from public records and wrestling publications in wrestlers who were active between January 1, 1985 and December 31, 2011. 557 males were considered consistently active wrestlers during this time period. 2007 published mortality rates from the Center for Disease Control were used to compare the general population to the wrestlers by age, BMI, time period, and cause of death. Survival estimates and Cox hazard regression models were fit to determine incident premature deaths and factors associated with lower survival. Cumulative incidence function (CIF) estimates given years wrestled was obtained using a competing risks model for cause of death. Results The mortality for all wrestlers over the 26-year study period was.007 deaths/total person-years or 708 per 100,000 per year, and 16% of deaths occurred below age 50 years. Among wrestlers, the leading cause of deaths based on CIF was cardiovascular-related (38%). For cardiovascular-related deaths, drug overdose-related deaths and cancer deaths, wrestler mortality rates were respectively 15.1, 122.7 and 6.4 times greater than those of males in the general population. Survival estimates from hazard models indicated that BMI is significantly associated with the hazard of death from total time wrestling (p<0.0001). Conclusion Professional wrestlers are more likely to die prematurely from cardiovascular disease compared to the general population and morbidly obese wrestlers are especially at risk. Results from this study may be useful for professional wrestlers, as well as wellness policy and medical care implementation. PMID:25372569

Aberrant Expression of the Cell Polarity Regulator aPKCλ/ι is Associated With Disease Progression in Cervical Intraepithelial Neoplasia (CIN): A Possible Marker for Predicting CIN Prognosis.

PubMed

Mizushima, Taichi; Asai-Sato, Mikiko; Akimoto, Kazunori; Nagashima, Yoji; Taguri, Masataka; Sasaki, Kazunori; Nakaya, Masa-aki; Asano, Ryoko; Tokinaga, Aya; Kiyono, Tohru; Hirahara, Fumiki; Ohno, Shigeo; Miyagi, Etsuko

2016-03-01

Atypical protein kinase C λ/ι (aPKCλ/ι) is a regulator of epithelial cellular polarity. It is also overexpressed in several cancers and functions in cell proliferation and invasion. Therefore, we hypothesized that aPKCλ/ι may be involved in development and progression of cervical intraepithelial neoplasia (CIN), the precancerous disease of cervical cancer induced by human papillomavirus. To do this, we investigated the relationship between aPKCλ/ι expression and CIN. aPKCλ/ι expression level and subcellular localization were assessed in 192 CIN biopsy samples and 13 normal epithelial samples using immunohistochemistry. aPKCλ/ι overexpression (normal epithelium, 7.7%; CIN1, 41.7%; CIN2/3, 76.4%) and aPKCλ/ι nuclear localization (normal epithelium, 0.0%; CIN1, 36.9%; CIN2/3, 78.7%) were higher in CIN samples than normal samples (P<0.05), suggesting that CIN grade is related to aPKCλ/ι overexpression and nuclear localization. Then, 140 CIN cases were retrospectively analyzed for 4-yr cumulative disease progression and regression rates using the Cox proportional hazards model. CIN1 cases with aPKCλ/ι overexpression or aPKCλ/ι nuclear localization had a higher progression rate than CIN1 cases with normal aPKCλ/ι expression levels or cytoplasmic localization (62.5% vs. 9.7% and 63.1% vs. 9.4%, respectively; P<0.001). Multivariate analysis indicated that human papillomavirus types 16 and 18, aPKCλ/ι overexpression (hazard ratio=4.26; 95% confidence interval, 1.50-12.1; P=0.007), and aPKCλ/ι nuclear localization (hazard ratio=3.59; 95% confidence interval, 1.24-10.4; P=0.019) were independent risk factors for CIN1 progression. In conclusion, aPKCλ/ι could be useful for the therapeutic management of patients with CIN, particularly those with non-human papillomavirus 16/18 types.

Climate variability and increase in intensity and magnitude of dengue incidence in Singapore.

PubMed

Hii, Yien Ling; Rocklöv, Joacim; Ng, Nawi; Tang, Choon Siang; Pang, Fung Yin; Sauerborn, Rainer

2009-11-11

Dengue is currently a major public health burden in Asia Pacific Region. This study aims to establish an association between dengue incidence, mean temperature and precipitation, and further discuss how weather predictors influence the increase in intensity and magnitude of dengue in Singapore during the period 2000-2007. Weekly dengue incidence data, daily mean temperature and precipitation and the midyear population data in Singapore during 2000-2007 were retrieved and analysed. We employed a time series Poisson regression model including time factors such as time trends, lagged terms of weather predictors, considered autocorrelation, and accounted for changes in population size by offsetting. The weekly mean temperature and cumulative precipitation were statistically significant related to the increases of dengue incidence in Singapore. Our findings showed that dengue incidence increased linearly at time lag of 5-16 and 5-20 weeks succeeding elevated temperature and precipitation, respectively. However, negative association occurred at lag week 17-20 with low weekly mean temperature as well as lag week 1-4 and 17-20 with low cumulative precipitation. As Singapore experienced higher weekly mean temperature and cumulative precipitation in the years 2004-2007, our results signified hazardous impacts of climate factors on the increase in intensity and magnitude of dengue cases. The ongoing global climate change might potentially increase the burden of dengue fever infection in near future.

Benzene exposure and risk of lymphohaematopoietic cancers in 25 000 offshore oil industry workers

PubMed Central

Stenehjem, J S; Kjærheim, K; Bråtveit, M; Samuelsen, S O; Barone-Adesi, F; Rothman, N; Lan, Q; Grimsrud, T K

2015-01-01

Background: The aim of this work was to examine the risk of lymphohaematopoietic (LH) cancer according to benzene exposure among offshore workers. Methods: Cancer registry data were used to identify 112 cancer cases diagnosed during 1999–2011 in a cohort of 24 917 Norwegian men reporting offshore work between 1965 and 1999. Analyses were conducted according to a stratified case–cohort design with a reference subcohort of 1661 workers. Cox regression was used to estimate hazard ratios with 95% confidence intervals, adjusted for other benzene exposure and smoking. Results: Most workers were exposed to benzene for <15 years. The upper range values of average intensity and cumulative exposure were estimated to 0.040 p.p.m. and 0.948 p.p.m.-years, respectively. Risks were consistently elevated among exposed workers for all LH cancers combined and for most subgroups, although case numbers were small and yielded imprecise risk estimates. There was evidence of dose-related risk patterns according to cumulative exposure for acute myeloid leukaemia (AML), multiple myeloma (MM) (P trends 0.052 and 0.024, respectively), and suggestively so for chronic lymphocytic leukaemia (CLL) according to average intensity (P trend 0.094). Conclusions: Our results support an association between cumulative and intensity metrics of low-level benzene exposure and risk for AML, MM, and suggestively for CLL. PMID:25867262

Pregnancy after tubal sterilization with silicone rubber band and spring clip application.

PubMed

Peterson, H B; Xia, Z; Wilcox, L S; Tylor, L R; Trussell, J

2001-02-01

To determine risk factors for pregnancy after tubal sterilization with silicone rubber bands or spring clips. A total of 3329 women sterilized using silicone rubber bands and 1595 women sterilized using spring clips were followed for up to 14 years as part of a prospective cohort study conducted in medical centers in nine US cities. We assessed the risk of pregnancy by cumulative life-table probabilities and proportional hazards analysis. The risk of pregnancy for women who had silicone rubber band application differed by location of band application and study site. The 10-year cumulative probabilities of pregnancy varied from a low of 0.0 per 1000 procedures at one study site to a high of 42.5 per 1000 procedures in the four combined sites in which fewer than 100 procedures per site were performed. The risk of pregnancy for women who had spring clip application varied by location of clip application, study site, race or ethnicity, tubal disease, and history of abdominal or pelvic surgery. The probabilities across study sites ranged from 7.1 per 1000 procedures at 10 years to 78.0 per 1000 procedures at 5 years (follow-up was limited to 5 years at that site). The 10-year cumulative probability of pregnancy after silicone rubber band and spring clip application is low but varies substantially by both clinical and demographic characteristics.

Postmenopausal breast cancer risk and cumulative number of menstrual cycles.

PubMed

Chavez-MacGregor, Mariana; Elias, Sjoerd G; Onland-Moret, N Charlotte; van der Schouw, Yvonne T; Van Gils, Carla H; Monninkhof, Evelyn; Grobbee, Diederick E; Peeters, Petra H M

2005-04-01

To explore whether the lifetime cumulative number of menstrual cycles, as an index for total exposure to endogenous estrogens, and the number of menstrual cycles until a first full-term pregnancy (FFTP), are associated with breast cancer risk in postmenopausal women. Population-based study with data from the Prospect-European Prospective Investigation into Cancer and Nutrition study. Naturally menopausal participants were eligible (n = 6,718). The cumulative number of menstrual cycles was computed in 6,031 (90%) women. We calculated the number of cycles until FFTP among parous participants. The number of menstrual cycles was impossible to compute in women who reported to be always irregular; therefore, we added the "always irregular" category in the analysis. During the 46,746 person-years of follow-up, 168 breast cancer cases were identified. Cox regression models were used and adjustments were made to account for potential confounders. Even when our data does not show a clear linear gradient, we observed an increased breast cancer risk in women with a higher number of cumulative menstrual cycles in their lifetime. Using < or = 415 cycles as reference, the hazard ratio for the irregular group, 416-453, 454-490, and > or = 491 cycles was 1.11 (.56, 2.19), 1.88 (1.14, 3.12), 1.74 (1.05, 2.87), and 1.80 (1.09, 2.96), respectively. Although not statistically significant, and of less magnitude, the risk estimates for the number of cycles before FFTP showed the same tendency. Among women who underwent natural menopause, a higher number of menstrual cycles in lifetime, reflecting a longer exposure to endogenous estrogens, is associated with an increased breast cancer risk.

Risk Factors and Outcomes of De Novo Cancers (Excluding Nonmelanoma Skin Cancer) After Liver Transplantation for Primary Sclerosing Cholangitis.

PubMed

Mouchli, Mohamad A; Singh, Siddharth; Loftus, Edward V; Boardman, Lisa; Talwalkar, Jayant; Rosen, Charles B; Heimbach, Julie K; Wiesner, Russell H; Hasan, Bashar; Poterucha, John J; Kymberly, Watt D

2017-08-01

Patients with primary sclerosing cholangitis (PSC) may be at higher risk of malignancy after liver transplantation (LT) compared to other LT recipients. We aimed to determine the cumulative incidence of/risk factors for long-term cancer-related mortality in patients with PSC after LT. All adult patients underwent LT for PSC without cholangiocarcinoma from 1984 to 2012, with follow-up through June 2015. We estimated cumulative incidence, risk factors, and mortality from de novo malignancies after LT. Two hundred ninety-three patients were identified (mean [SD] age, 47 [12] years; 63.3% males; 2.4% smoking at LT). Over a median of 11.5 years (range, 6.4-18.6 years), 64 patients (21.8%) developed 73 nonskin cancers, including 46 solid-organ cancers (renal, 11; colorectal, 11; prostate, 7; breast, 5; pancreas, 5; ovarian/endometrial/vulvar cancers, 3; and de novo cholangiocarcinoma, 4). Twenty-two patients developed hematologic malignancies (posttransplant lymphoproliferative diseases, 18; Hodgkin disease, 2; and myelodysplastic syndrome, 2). Five patients developed melanoma. The 1-, 5-, 10-, and 20-year cumulative incidences of cancer were 2.1%, 8.6%, 18.7%, and 27%, respectively. Mortality of patients with PSC who developed cancer was higher than that of patients with PSC without cancer (hazard ratio, 2.2; P < 0.01). On multivariate analysis, recipient's age and elevated pre-LT international normalized ratio were associated with increased risk of de novo (nonskin) malignancy. The 10-year cumulative risk of cancer after LT for advanced-stage PSC was 18.7%, with posttransplant lymphoproliferative diseases, colorectal cancer, and renal cell cancer being the most common. Post-LT de novo nonskin cancer decreased overall posttransplant survival. Only recipient's age and elevated international normalized ratio at LT were associated with increased nonskin cancer risk.

Cumulative probability of neodymium: YAG laser posterior capsulotomy after phacoemulsification.

PubMed

Ando, Hiroshi; Ando, Nobuyo; Oshika, Tetsuro

2003-11-01

To retrospectively analyze the cumulative probability of neodymium:YAG (Nd:YAG) laser posterior capsulotomy after phacoemulsification and to evaluate the risk factors. Ando Eye Clinic, Kanagawa, Japan. In 3997 eyes that had phacoemulsification with an intact continuous curvilinear capsulorhexis, the cumulative probability of posterior capsulotomy was computed by Kaplan-Meier survival analysis and risk factors were analyzed using the Cox proportional hazards regression model. The variables tested were sex; age; type of cataract; preoperative best corrected visual acuity (BCVA); presence of diabetes mellitus, diabetic retinopathy, or retinitis pigmentosa; type of intraocular lens (IOL); and the year the operation was performed. The IOLs were categorized as 3-piece poly(methyl methacrylate) (PMMA), 1-piece PMMA, 3-piece silicone, and acrylic foldable. The cumulative probability of capsulotomy after cataract surgery was 1.95%, 18.50%, and 32.70% at 1, 3, and 5 years, respectively. Positive risk factors included a better preoperative BCVA (P =.0005; risk ratio [RR], 1.7; 95% confidence interval [CI], 1.3-2.5) and the presence of retinitis pigmentosa (P<.0001; RR, 6.6; 95% CI, 3.7-11.6). Women had a significantly greater probability of Nd:YAG laser posterior capsulotomy (P =.016; RR, 1.4; 95% CI, 1.1-1.8). The type of IOL was significantly related to the probability of Nd:YAG laser capsulotomy, with the foldable acrylic IOL having a significantly lower probability of capsulotomy. The 1-piece PMMA IOL had a significantly higher risk than 3-piece PMMA and 3-piece silicone IOLs. The probability of Nd:YAG laser capsulotomy was higher in women, in eyes with a better preoperative BCVA, and in patients with retinitis pigmentosa. The foldable acrylic IOL had a significantly lower probability of capsulotomy.

Cumulative incidence of suicidal ideation and associated factors among adults living in temporary housing during the three years after the Great East Japan Earthquake.

PubMed

Xu, Qingyi; Fukasawa, Maiko; Kawakami, Norito; Baba, Toshiaki; Sakata, Kiyomi; Suzuki, Ruriko; Tomita, Hiroaki; Nemoto, Harumi; Yasumura, Seiji; Yabe, Hirooki; Horikoshi, Naoko; Umeda, Maki; Suzuki, Yuriko; Shimoda, Haruki; Tachimori, Hisateru; Takeshima, Tadashi; Bromet, Evelyn J

2018-05-01

The effect of disasters on suicidality is not known. We aimed to retrospectively determine the cumulative incidence of suicidal ideation during the 3 years after the Great East Japan Earthquake among residents in temporary housing without prior suicidal ideation, as compared to the general population. Moreover, we aimed to identify the risk factors for the onset of suicidal ideation. A cross-sectional survey involving face-to-face interviews was conducted 3 years after the earthquake with adult community residents in disaster-affected areas and a control area using the World Health Organization Composite International Diagnostic Interview version 3.0. We compared the cumulative incidence of suicidal ideation between the two areas using the Cox proportional hazard model and examined risk factors for the onset of suicidal ideation using a multiple logistic regression analysis. Among 1019 respondents in the disaster-affected areas, the cumulative incidence of suicidal ideation over 1, 2, and 3 years after the earthquake was 1.4%, 2.4%, and 2.8%, respectively, which was significantly higher than that in the control area. Not being married, being injured in the disaster, and poor subjective physical health were associated with the onset of suicidal ideation. We estimated the time of onset of suicidal ideation based on the respondents' current age and self-reported onset age, which limits the accuracy of the onset timing. We revealed a higher incidence of suicidal ideation in temporary housing residents and identified several risk factors, which suggests the importance of developing countermeasures to prevent suicide after a disaster. Copyright © 2018 Elsevier B.V. All rights reserved.

Risk of cardiovascular events from current, recent, and cumulative exposure to abacavir among persons living with HIV who were receiving antiretroviral therapy in the United States: a cohort study.

PubMed

Dorjee, Kunchok; Baxi, Sanjiv M; Reingold, Arthur L; Hubbard, Alan

2017-10-27

There is ongoing controversy regarding abacavir use in the treatment of HIV infection and the risk of subsequent development of cardiovascular disease. It is unclear how the risk varies as exposure accumulates. Using an administrative health-plan dataset, risk of cardiovascular disease events (CVDe), defined as the first episode of an acute myocardial infarction or a coronary intervention procedure, associated with abacavir exposure was assessed among HIV-infected individuals receiving antiretroviral therapy across the U.S. from October 2009 through December 2014. The data were longitudinal, and analyzed using marginal structural models. Over 114,470 person-years (n = 72,733) of ART exposure, 714 CVDe occurred at an incidence rate (IR) (95% CI) of 6·23 (5·80, 6·71)/1000 person-years. Individuals exposed to abacavir had a higher IR of CVDe of 9·74 (8·24, 11·52)/1000 person-years as compared to 5·75 (5·30, 6·24)/1000 person-years for those exposed to other antiretroviral agents. The hazard (HR; 95% CI) of CVDe was increased for current (1·43; 1·18, 1·73), recent (1·41; 1·16, 1·70), and cumulative [(1·18; 1·06, 1·31) per year] exposure to abacavir. The risk for cumulative exposure followed a bell-shaped dose-response curve peaking at 24-months of exposure. Risk was similarly elevated among participants free of pre-existing heart disease or history of illicit substance use at baseline. Current, recent, and cumulative use of abacavir was associated with an increased risk of CVDe. The findings were consistent irrespective of underlying cardiovascular risk factors.

Assessing the effect of a partly unobserved, exogenous, binary time-dependent covariate on survival probabilities using generalised pseudo-values.

PubMed

Pötschger, Ulrike; Heinzl, Harald; Valsecchi, Maria Grazia; Mittlböck, Martina

2018-01-19

Investigating the impact of a time-dependent intervention on the probability of long-term survival is statistically challenging. A typical example is stem-cell transplantation performed after successful donor identification from registered donors. Here, a suggested simple analysis based on the exogenous donor availability status according to registered donors would allow the estimation and comparison of survival probabilities. As donor search is usually ceased after a patient's event, donor availability status is incompletely observed, so that this simple comparison is not possible and the waiting time to donor identification needs to be addressed in the analysis to avoid bias. It is methodologically unclear, how to directly address cumulative long-term treatment effects without relying on proportional hazards while avoiding waiting time bias. The pseudo-value regression technique is able to handle the first two issues; a novel generalisation of this technique also avoids waiting time bias. Inverse-probability-of-censoring weighting is used to account for the partly unobserved exogenous covariate donor availability. Simulation studies demonstrate unbiasedness and satisfying coverage probabilities of the new method. A real data example demonstrates that study results based on generalised pseudo-values have a clear medical interpretation which supports the clinical decision making process. The proposed generalisation of the pseudo-value regression technique enables to compare survival probabilities between two independent groups where group membership becomes known over time and remains partly unknown. Hence, cumulative long-term treatment effects are directly addressed without relying on proportional hazards while avoiding waiting time bias.

Risk Factors for Diabetes Mellitus in Chronic Pancreatitis: A Cohort of 2011 Patients.

PubMed

Pan, Jun; Xin, Lei; Wang, Dan; Liao, Zhuan; Lin, Jin-Huan; Li, Bai-Rong; Du, Ting-Ting; Ye, Bo; Zou, Wen-Bin; Chen, Hui; Ji, Jun-Tao; Zheng, Zhao-Hong; Hu, Liang-Hao; Li, Zhao-Shen

2016-04-01

Diabetes mellitus (DM) is a common complication of chronic pancreatitis (CP) and increases the mortality. The identification of risk factors for DM development may contribute to the early detection and potential risk reduction of DM in patients with CP.Patients with CP admitted to Changhai Hospital (Shanghai, China) from January 2000 to December 2013 were enrolled. Cumulative rates of DM after the onset of CP were calculated by Kaplan-Meier method. Risk factors for DM development after the diagnosis of CP were identified by Cox proportional hazards regression model.A total of 2011 patients with CP were enrolled. During follow-up (median duration, 22.0 years), 564 patients developed DM. Cumulative rates of DM 20 and 50 years after the onset of CP were 45.8% (95% confidence interval [CI], 41.8%-50.0%) and 90.0% (95% CI, 75.4%-97.7%), respectively. Five risk factors for DM development after the diagnosis of CP were identified: male sex (hazard ratio [HR], 1.51; 95% CI, 1.08-2.11), alcohol abuse (HR, 2.00; 95% CI, 1.43-2.79), steatorrhea (HR, 1.46; 95% CI, 1.01-2.11), biliary stricture (HR, 2.25; 95% CI, 1.43-3.52), and distal pancreatectomy (HR, 3.41; 95% CI, 1.80-6.44).In conclusion, the risk of developing DM in patients with CP is not only influenced by the development of biliary stricture and steatorrhea indicating disease progression, and inherent nature of study subjects such as male sex, but also by modifiable factors including alcohol abuse and distal pancreatectomy .

Risk Factors for Diabetes Mellitus in Chronic Pancreatitis: A Cohort of 2,011 Patients.

PubMed

Pan, Jun; Xin, Lei; Wang, Dan; Liao, Zhuan; Lin, Jin-Huan; Li, Bai-Rong; Du, Ting-Ting; Ye, Bo; Zou, Wen-Bin; Chen, Hui; Ji, Jun-Tao; Zheng, Zhao-Hong; Hu, Liang-Hao; Li, Zhao-Shen

2016-04-01

Diabetes mellitus (DM) is a common complication of chronic pancreatitis (CP) and increases the mortality. The identification of risk factors for DM development may contribute to the early detection and potential risk reduction of DM in patients with CP.Patients with CP admitted to Changhai Hospital (Shanghai, China) from January 2000 to December 2013 were enrolled. Cumulative rates of DM after the onset of CP were calculated by Kaplan-Meier method. Risk factors for DM development after the diagnosis of CP were identified by Cox proportional hazards regression model.A total of 2011 patients with CP were enrolled. During follow-up (median duration, 22.0 years), 564 patients developed DM. Cumulative rates of DM 20 and 50 years after the onset of CP were 45.8% (95% confidence interval [CI], 41.8%-50.0%) and 90.0% (95% CI, 75.4%-97.7%), respectively. Five risk factors for DM development after the diagnosis of CP were identified: male sex (hazard ratio [HR], 1.51; 95% CI, 1.08-2.11), alcohol abuse (HR, 2.00; 95% CI, 1.43-2.79), steatorrhea (HR, 1.46; 95% CI, 1.01-2.11), biliary stricture (HR, 2.25; 95% CI, 1.43-3.52), and distal pancreatectomy (HR, 3.41; 95% CI, 1.80-6.44).In conclusion, the risk of developing DM in patients with CP is not only influenced by the development of biliary stricture and steatorrhea indicating disease progression, and inherent nature of study subjects such as male sex, but also by modifiable factors including alcohol abuse and distal pancreatectomy.

Osteonecrosis of the femoral head in sickle cell disease: prevalence, comorbidities, and surgical outcomes in California.

PubMed

Adesina, Oyebimpe; Brunson, Ann; Keegan, Theresa H M; Wun, Ted

2017-07-11

Osteonecrosis of the femoral head (ONFH) is a prevalent complication of sickle cell disease (SCD) that has not been well described in population-based cohort studies. Using California's Office of Statewide Planning and Development discharge databases (1991-2013), we estimated the cumulative incidence of ONFH after accounting for the competing risk of death and used a multivariable Cox proportional hazards regression to identify factors associated with ONFH diagnosis. We also calculated rates of readmissions to the hospital or emergency department within 30 to 90 days of hip replacement surgery. Of the 6237 patients in our SCD cohort, 22% (n = 1356) developed ONFH at a median age of 27 years, and 23% (n = 308) of the patients with ONFH underwent hip replacement surgery at a median age of 36 years. The cumulative incidence of ONFH to age 30 years was higher among SCD patients with more severe disease (24%; vs 8% in less severe) and those with antecedent acute chest syndrome (ACS) (18%; vs 8% without prior history of ACS). From 2003 to 2013, SCD patients with more severe disease (hazard ratio [HR], 2.77; 95% confidence interval [CI], 2.38-3.23) or with antecedent ACS (HR, 1.61; CI, 1.35-1.91) were more likely to develop ONFH. Twenty-seven percent of post-hip surgery patients were readmitted within 30 days, mostly for painful vaso-occlusive crises. ONFH is a common SCD complication that increases with age; ongoing studies into prevention and effective nonsurgical interventions for SCD-induced osteonecrosis must remain a high research priority.

Incidence of Venous Thromboembolism after Elective Knee Arthroscopic Surgery: A Historical Cohort Study

PubMed Central

Mauck, Karen F.; Froehling, David A.; Daniels, Paul R.; Dahm, Diane L.; Ashrani, Aneel A.; Crusan, Daniel J.; Petterson, Tanya M.; Bailey, Kent R.; Heit, John A.

2013-01-01

Summary Background The incidence of symptomatic venous thromboembolism (VTE) after knee arthroscopy is uncertain. In this study, we estimate the incidence of symptomatic VTE after knee arthroscopy. Objectives To estimate the incidence of symptomatic VTE after arthroscopic knee surgery. Methods In a population-based historical cohort study, all Olmsted County, MN residents undergoing a first arthroscopic knee surgery over the 18-year period, 1988-2005, were followed forward in time for incident deep vein thrombosis (DVT) or pulmonary embolism (PE). The cumulative incidence of VTE after knee arthroscopy was determined using the Kaplan-Meier product limit estimator. Patient age at surgery, sex, calendar year of surgery, body mass index, anesthesia characteristics and hospitalization were tested as potential predictors of VTE using Cox proportional hazards modeling, both univariately and adjusted for age and sex. Results Among 4833 Olmsted County residents with knee arthroscopy, 18 developed postoperative VTE, all within the first 6 weeks after surgery. The cumulative incidence rates of symptomatic VTE at 7, 14 and 35 days were 0.2%, 0.3% and 0.4%, respectively. The hazard for postoperative VTE was significantly increased for older patient age (HR=1.34 for each ten-year increase in patient age; p=0.03) and hospitalization either prior to or after knee arthroscopy (HR=14.1; p<0.001). Conclusions The incidence of symptomatic VTE after arthroscopic knee surgery is very low. Older age and hospitalization are associated with increased risk. Routine prophylaxis to prevent symptomatic venous thromboembolism is likely not needed in this patient population. PMID:23648016

Risk of developing psoriasis in patients with schizophrenia: a nationwide retrospective cohort study.

PubMed

Yu, S; Yu, C-L; Huang, Y-C; Tu, H-P; Lan, C-C E

2017-09-01

Schizophrenia is a complex disease which proceeds from an interaction between genetic background and environmental factors. Recent studies showed T helper 17 (Th17) signalling, which is the main downstream immune response of psoriasis, is activated in schizophrenia. To investigate whether patients with schizophrenia have higher risk of psoriasis. In this nationwide retrospective cohort study, we analysed the 1 million enrollees' cohort from Taiwan's National Health Insurance Research Database. Psoriasis and schizophrenia were ascertained by International Classification of Diseases, 9th revision, Clinical Modification coding. The study cohort was comprised of enrollees diagnosed with schizophrenia during the period from 1 January 1996 through 31 December 2010, while the comparison population consisted of enrollees who had not been diagnosed with schizophrenia during the study period. Hazard ratio (HR) and 95% confidence interval (CI) were calculated for the risk of psoriasis associated with schizophrenia using Cox proportional hazard regression. The adjusted HR of psoriasis associated with schizophrenia was 2.32 (95% CI = 1.81-2.98). After 15 years, the cumulative incidence of psoriasis in patients with schizophrenia and comparison population was 2.82% and 1.17%, respectively. The Kaplan-Meier curves for the cumulative incidence of psoriasis in individuals with and without schizophrenia differed significantly (P < 0.0001, log-rank test). Patients with schizophrenia have higher risk of psoriasis, which may be due to common genetic susceptibilities and/or immunologic mechanisms in both diseases. Th17 signalling and pro-inflammatory cytokines may act as a link between these two diseases and are potential therapeutic targets for schizophrenia. © 2017 European Academy of Dermatology and Venereology.

Risk of Suicide Attempt in Poststroke Patients: A Population-Based Cohort Study.

PubMed

Harnod, Tomor; Lin, Cheng-Li; Kao, Chia-Hung

2018-01-10

This nationwide population-based cohort study evaluated the risk of and risk factors for suicide attempt in poststroke patients in Taiwan. The poststroke and nonstroke cohorts consisted of 713 690 patients and 1 426 009 controls, respectively. Adults (aged >18 years) who received new stroke diagnoses according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM ; codes 430-438) between 2000 and 2011 were included in the poststroke cohort. We calculated the adjusted hazard ratio for suicide attempt ( ICD-9-CM codes E950-E959) after adjustment for age, sex, monthly income, urbanization level, occupation category, and various comorbidities. Kaplan-Meier analysis was used to measure the cumulative incidence of suicide attempt, and the Fine and Gray method was used as a competing event when estimating death subhazard ratios and 95% confidence intervals between groups. The cumulative incidence of suicide attempt was higher in the poststroke cohort, and the adjusted hazard ratio of suicide attempt was 2.20 (95% confidence interval, 2.04-2.37) compared with that of the controls. The leading risk factors for poststroke suicide attempt were earning low monthly income (<660 US dollars), living in less urbanized regions, doing manual labor, and having a stroke before age 50 years. The attempted suicide risk did not differ significantly between male and female patients in this study. These results convey crucial information to clinicians and governments for preventing suicide attempt in poststroke patients in Taiwan and other Asian countries. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Occupational Exposure to Benzene and Non-Hodgkin Lymphoma in a Population-Based Cohort: The Shanghai Women's Health Study.

PubMed

Bassig, Bryan A; Friesen, Melissa C; Vermeulen, Roel; Shu, Xiao-Ou; Purdue, Mark P; Stewart, Patricia A; Xiang, Yong-Bing; Chow, Wong-Ho; Zheng, Tongzhang; Ji, Bu-Tian; Yang, Gong; Linet, Martha S; Hu, Wei; Zhang, Heping; Zheng, Wei; Gao, Yu-Tang; Rothman, Nathaniel; Lan, Qing

2015-10-01

The association between benzene exposure and non-Hodgkin lymphoma (NHL) has been the subject of debate as a result of inconsistent epidemiologic evidence. An International Agency for Research on Cancer (IARC) working group evaluated benzene in 2009 and noted evidence for a positive association between benzene exposure and NHL risk. We evaluated the association between occupational benzene exposure and NHL among 73,087 women enrolled in the prospective population-based Shanghai Women's Health Study. Benzene exposure estimates were derived using a previously developed exposure assessment framework that combined ordinal job-exposure matrix intensity ratings with quantitative benzene exposure measurements from an inspection database of Shanghai factories collected between 1954 and 2000. Associations between benzene exposure metrics and NHL (n = 102 cases) were assessed using Cox proportional hazard models, with study follow-up occurring from December 1996 through December 2009. Women ever exposed to benzene had a significantly higher risk of NHL [hazard ratio (HR) = 1.87, 95% CI: 1.19, 2.96]. Compared with unexposed women, significant trends in NHL risk were observed for increasing years of benzene exposure (p(trend) = 0.006) and increasing cumulative exposure levels (p(trend) = 0.005), with the highest duration and cumulative exposure tertiles having a significantly higher association with NHL (HR = 2.07, 95% CI: 1.07, 4.01 and HR = 2.16, 95% CI: 1.17, 3.98, respectively). Our findings, using a population-based prospective cohort of women with diverse occupational histories, provide additional evidence that occupational exposure to benzene is associated with NHL risk.

Risk of renal cell carcinoma following exposure to metalworking fluids among autoworkers.

PubMed

Shrestha, Deepika; Liu, Sa; Hammond, S Katharine; LaValley, Michael P; Weiner, Daniel E; Eisen, Ellen A; Applebaum, Katie M

2016-10-01

Metalworking fluids (MWF), used to cool and lubricate metal in occupational settings, are linked to several cancers but data on kidney cancer are limited. We examine how MWF influence the rate of renal cell carcinoma (RCC) in a large prospective study. A cohort of Michigan autoworkers consisting of 33 421 individuals was followed from 1985 to 2009. The cohort was linked to the Michigan Cancer Registry to identify new cases of RCC. We analysed RCC in relation to cumulative exposure to each specific type of MWF (straight, soluble and synthetic) and all 3 types pooled into a single MWF variable, with a 15-year lag. Cox proportional hazards regression with splines were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), controlling for age, gender, race, calendar year, year hired, time since hire, plant and other MWF types. There were 135 incident cases. A linear increase in the log-HR was observed for RCC with increasing cumulative exposure to each MWF type and total MWF exposure. At the mean of total MWF exposure (18.80 mg/m(3)-year), the estimated HR was 1.11 (95% CI 1.04 to 1.19). Our results provide evidence for a dose-dependent association between MWF exposure and RCC. The influence of components of oil-based and water-based MWF needs further examination. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Osteonecrosis of the femoral head in sickle cell disease: prevalence, comorbidities, and surgical outcomes in California

PubMed Central

Brunson, Ann; Keegan, Theresa H. M.

2017-01-01

Osteonecrosis of the femoral head (ONFH) is a prevalent complication of sickle cell disease (SCD) that has not been well described in population-based cohort studies. Using California’s Office of Statewide Planning and Development discharge databases (1991-2013), we estimated the cumulative incidence of ONFH after accounting for the competing risk of death and used a multivariable Cox proportional hazards regression to identify factors associated with ONFH diagnosis. We also calculated rates of readmissions to the hospital or emergency department within 30 to 90 days of hip replacement surgery. Of the 6237 patients in our SCD cohort, 22% (n = 1356) developed ONFH at a median age of 27 years, and 23% (n = 308) of the patients with ONFH underwent hip replacement surgery at a median age of 36 years. The cumulative incidence of ONFH to age 30 years was higher among SCD patients with more severe disease (24%; vs 8% in less severe) and those with antecedent acute chest syndrome (ACS) (18%; vs 8% without prior history of ACS). From 2003 to 2013, SCD patients with more severe disease (hazard ratio [HR], 2.77; 95% confidence interval [CI], 2.38-3.23) or with antecedent ACS (HR, 1.61; CI, 1.35-1.91) were more likely to develop ONFH. Twenty-seven percent of post–hip surgery patients were readmitted within 30 days, mostly for painful vaso-occlusive crises. ONFH is a common SCD complication that increases with age; ongoing studies into prevention and effective nonsurgical interventions for SCD-induced osteonecrosis must remain a high research priority. PMID:29296770

[Survival following the first admission in an integrated dual disorders treatment ward (IDDTW): preliminary results from a cohort study].

PubMed

Gimelfarb, Yuri; Becatel, Ety; Wolf, Aviva; Baruch, Yehuda

2014-01-01

Dual disorders (co-occurring severe mental illness [SMI] and substance abuse disorders in the same person) are extremely common among patients receiving mental health services. Dual disorders are associated with increased all-cause mortality, as compared with patients with SMI. Scientific evidence is lacking on the survival of dual disorders subjects, who had psychiatric inpatient care. To determine the long term survival rates of patients after the first admission in an IDDTW and to identify their baseline predictors. The charts of 258 subjects admitted to IDDTW during the period 2002-2004 were assessed at least 8 years after the first admission. Psychiatric diagnoses were established and grouped according to the International Statistical Classification of Diseases and Related Health Problems 10th edition (ICD-10). The Kaplan-Meier survival analysis was used to estimate the cumulative survival rates, and the predictive values of different variables were assessed by Cox proportional-hazards regression model. The cumulative 1-, 2-, 4-, 6- and 8-year survival rates of all subjects were 98.06%, 96.51%, 91.47, 86.43% and 81.78%, respectively, without statistically significant differences between subgroups of psychiatric diagnoses. Multivariate Cox regression analysis revealed that the age at death was the only independent predictor of all-cause mortality (hazard ratio = .96; 95% confidence interval .93 to .99; p < .009). Those of young age are at a particularly low risk of long term survival. More targeted health care is required to address the specific needs of this vulnerable subgroup. Further research of survival into specific risk groups is required.

Cumulative stress and autonomic dysregulation in a community sample.

PubMed

Lampert, Rachel; Tuit, Keri; Hong, Kwang-Ik; Donovan, Theresa; Lee, Forrester; Sinha, Rajita

2016-05-01

Whether cumulative stress, including both chronic stress and adverse life events, is associated with decreased heart rate variability (HRV), a non-invasive measure of autonomic status which predicts poor cardiovascular outcomes, is unknown. Healthy community dwelling volunteers (N = 157, mean age 29 years) participated in the Cumulative Stress/Adversity Interview (CAI), a 140-item event interview measuring cumulative adversity including major life events, life trauma, recent life events and chronic stressors, and underwent 24-h ambulatory ECG monitoring. HRV was analyzed in the frequency domain and standard deviation of NN intervals (SDNN) calculated. Initial simple regression analyses revealed that total cumulative stress score, chronic stressors and cumulative adverse life events (CALE) were all inversely associated with ultra low-frequency (ULF), very low-frequency (VLF) and low-frequency (LF) power and SDNN (all p < 0.05). In hierarchical regression analyses, total cumulative stress and chronic stress each was significantly associated with SDNN and ULF even after the highly significant contributions of age and sex, with no other covariates accounting for additional appreciable variance. For VLF and LF, both total cumulative stress and chronic stress significantly contributed to the variance alone but were not longer significant after adjusting for race and health behaviors. In summary, total cumulative stress, and its components of adverse life events and chronic stress were associated with decreased cardiac autonomic function as measured by HRV. Findings suggest one potential mechanism by which stress may exert adverse effects on mortality in healthy individuals. Primary preventive strategies including stress management may prove beneficial.

Cumulative stress and autonomic dysregulation in a community sample

PubMed Central

Lampert, Rachel; Tuit, Keri; Hong, Kwang-ik; Donovan, Theresa; Lee, Forrester; Sinha, Rajita

2016-01-01

Whether cumulative stress, including both chronic stress and adverse life events, is associated with decreased heart rate variability (HRV), a non-invasive measure of autonomic status which predicts poor cardiovascular outcomes, is unknown. Healthy community dwelling volunteers, (N= 157, mean age 29 years) participated in the Cumulative Stress/Adversity Interview, (CAI) a 140-item event interview measuring cumulative adversity including major life events, life trauma, recent life events and chronic stressors, and underwent 24 hour ambulatory ECG monitoring. HRV was analyzed in the frequency domain and standard deviation of NN intervals (SDNN) calculated. Initial simple regression analyses revealed that total cumulative stress score, chronic stressors, and cumulative adverse life events (CALE) were all inversely associated with ultra low frequency (ULF), very low frequency (VLF), and low frequency (LF) power and SDNN (all p<0.05). In hierarchical regression analyses, total cumulative stress and chronic stress each was significantly associated with SDNN and ULF even after the high significant contribution of age and sex, with no other covariates accounting for additional appreciable variance. For VLF and LF, both total cumulative stress and chronic stress significantly contributed to the variance were no longer significant after adjusting for race and health behaviors. (p’s<.05). In summary, total cumulative stress, and its components of adverse life events and chronic stress were associated with decreased cardiac autonomic function as measured by HRV. Findings suggest one potential mechanism by which stress may exert adverse effects on mortality in healthy individuals. Primary preventive strategies including stress management may prove beneficial. PMID:27112063

Late-career unemployment and all-cause mortality, functional disability and depression among the older adults in Taiwan: A 12-year population-based cohort study.

PubMed

Chu, Wei-Min; Liao, Wen-Chun; Li, Chi-Rong; Lee, Shu-Hsin; Tang, Yih-Jing; Ho, Hsin-En; Lee, Meng-Chih

2016-01-01

To evaluate whether late-career unemployment is associated with increased all-cause mortality, functional disability, and depression among older adults in Taiwan. In this long-term prospective cohort study, data were retrieved from the Taiwan Longitudinal Study on Aging. This study was conducted from 1996 to 2007. The complete data from 716 men and 327 women aged 50-64 years were retrieved. Participants were categorized as normally employed or unemployed depending on their employment status in 1996. The cumulative number of unemployment after age 50 was also calculated. Logistic regression analysis was used to examine the effect of the association between late-career unemployment and cumulative number of late-career unemployment on all-cause mortality, functional disability, and depression in 2007. The average age of the participants in 1996 was 56.3 years [interquartile range (IQR)=7.0]. A total of 871 participants were in the normally employed group, and 172 participants were in the unemployed group. After adjustment of gender, age, level of education, income, self-rated health and major comorbidities, late-career unemployment was associated with increased all-cause mortality [Odds ratio (OR)=2.79; 95% confidence interval (CI)=1.74-4.47] and functional disability [OR=2.33; 95% CI=1.54-3.55]. The cumulative number of late-career unemployment was also associated with increased all-cause mortality [OR=1.91; 95% CI=1.35-2.70] and functional disability [OR=2.35; 95% CI=1.55-3.55]. Late-career unemployment and cumulative number of late-career unemployment are associated with increased all-cause mortality and functional disability. Older adults should be encouraged to maintain normal employment during the later stage of their career before retirement. Employers should routinely examine the fitness for work of older employees to prevent future unemployment. Copyright © 2016. Published by Elsevier Ireland Ltd.

Tracking Temporal Hazard in the Human Electroencephalogram Using a Forward Encoding Model

PubMed Central

2018-01-01

Abstract Human observers automatically extract temporal contingencies from the environment and predict the onset of future events. Temporal predictions are modeled by the hazard function, which describes the instantaneous probability for an event to occur given it has not occurred yet. Here, we tackle the question of whether and how the human brain tracks continuous temporal hazard on a moment-to-moment basis, and how flexibly it adjusts to strictly implicit variations in the hazard function. We applied an encoding-model approach to human electroencephalographic data recorded during a pitch-discrimination task, in which we implicitly manipulated temporal predictability of the target tones by varying the interval between cue and target tone (i.e. the foreperiod). Critically, temporal predictability either was driven solely by the passage of time (resulting in a monotonic hazard function) or was modulated to increase at intermediate foreperiods (resulting in a modulated hazard function with a peak at the intermediate foreperiod). Forward-encoding models trained to predict the recorded EEG signal from different temporal hazard functions were able to distinguish between experimental conditions, showing that implicit variations of temporal hazard bear tractable signatures in the human electroencephalogram. Notably, this tracking signal was reconstructed best from the supplementary motor area, underlining this area’s link to cognitive processing of time. Our results underline the relevance of temporal hazard to cognitive processing and show that the predictive accuracy of the encoding-model approach can be utilized to track abstract time-resolved stimuli. PMID:29740594

[Current status of occupational health and related countermeasures in Guangzhou, China].

PubMed

Zeng, W F; Wu, S H; Wang, Z; Liu, Y M

2016-02-20

To investigate the current status of occupational health and related countermeasures in Guangzhou, China. Related data were collected from occupational poisoning accident investigation, diagnosis and identification of occupational diseases, and the occupational disease hazard reporting system, and the statistical data of occupational health in Guangzhou were analyzed retrospectively. The number of enterprises reporting for occupational disease hazards in Guangzhou was 20 890, and the total number of workers was 1 457 583. The number of workers exposed to occupational hazards was 284 233, and the cumulative number of workers with occupational diseases was 1 502. There were many risk factors for occupational diseases in enterprises, and there were a large number of workers with occupational diseases, as well as newly diagnosed cases. From 2001 to 2014, the total number of cases of occupational diseases was 958. The situation for the prevention and control of occupational diseases is grim in Guangzhou. Occupational health supervision and law enforcement should be enhanced, the three-level supervision system should be established and perfected, and the occupational health supervision system with a combination of "prevention, treatment, and protection" should be established and promoted, so as to gradually establish a technical service support system for occupational health.

[Hazard function and life table: an introduction to the failure time analysis].

PubMed

Matsushita, K; Inaba, H

1987-04-01

Failure time analysis has become popular in demographic studies. It can be viewed as a part of regression analysis with limited dependent variables as well as a special case of event history analysis and multistate demography. The idea of hazard function and failure time analysis, however, has not been properly introduced to nor commonly discussed by demographers in Japan. The concept of hazard function in comparison with life tables is briefly described, where the force of mortality is interchangeable with the hazard rate. The basic idea of failure time analysis is summarized for the cases of exponential distribution, normal distribution, and proportional hazard models. The multiple decrement life table is also introduced as an example of lifetime data analysis with cause-specific hazard rates.

Projecting cumulative benefits of multiple river restoration projects: an example from the Sacramento-San Joaquin River system in California

USGS Publications Warehouse

Kondolf, G. Mathias; Angermeier, Paul L.; Cummins, Kenneth; Dunne, Thomas; Healey, Michael; Kimmerer, Wim; Moyle, Peter B.; Murphy, Dennis; Patten, Duncan; Railsback, Steve F.; Reed, Denise J.; Spies, Robert B.; Twiss, Robert

2008-01-01

Despite increasingly large investments, the potential ecological effects of river restoration programs are still small compared to the degree of human alterations to physical and ecological function. Thus, it is rarely possible to “restore” pre-disturbance conditions; rather restoration programs (even large, well-funded ones) will nearly always involve multiple small projects, each of which can make some modest change to selected ecosystem processes and habitats. At present, such projects are typically selected based on their attributes as individual projects (e.g., consistency with programmatic goals of the funders, scientific soundness, and acceptance by local communities), and ease of implementation. Projects are rarely prioritized (at least explicitly) based on how they will cumulatively affect ecosystem function over coming decades. Such projections require an understanding of the form of the restoration response curve, or at least that we assume some plausible relations and estimate cumulative effects based thereon. Drawing on our experience with the CALFED Bay-Delta Ecosystem Restoration Program in California, we consider potential cumulative system-wide benefits of a restoration activity extensively implemented in the region: isolating/filling abandoned floodplain gravel pits captured by rivers to reduce predation of outmigrating juvenile salmon by exotic warmwater species inhabiting the pits. We present a simple spreadsheet model to show how different assumptions about gravel pit bathymetry and predator behavior would affect the cumulative benefits of multiple pit-filling and isolation projects, and how these insights could help managers prioritize which pits to fill.

ATM Polymorphisms Predict Severe Radiation Pneumonitis in Patients With Non-Small Cell Lung Cancer Treated With Definitive Radiation Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Xiong, Huihua; Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Liao, Zhongxing, E-mail: zliao@mdanderson.org

2013-03-15

Purpose: The ataxia telangiectasia mutated (ATM) gene mediates detection and repair of DNA damage. We investigated associations between ATM polymorphisms and severe radiation-induced pneumonitis (RP). Methods and Materials: We genotyped 3 potentially functional single nucleotide polymorphisms (SNPs) of ATM (rs1801516 [D1853N/5557G>A], rs189037 [-111G>A] and rs228590) in 362 patients with non-small cell lung cancer (NSCLC), who received definitive (chemo)radiation therapy. The cumulative severe RP probabilities by genotypes were evaluated using the Kaplan-Meier analysis. The associations between severe RP risk and genotypes were assessed by both logistic regression analysis and Cox proportional hazard model with time to event considered. Results: Of 362more » patients (72.4% of non-Hispanic whites), 56 (15.5%) experienced grade ≥3 RP. Patients carrying ATM rs189037 AG/GG or rs228590 TT/CT genotypes or rs189037G/rs228590T/rs1801516G (G-T-G) haplotype had a lower risk of severe RP (rs189037: GG/AG vs AA, adjusted hazard ratio [HR] = 0.49, 95% confidence interval [CI], 0.29-0.83, P=.009; rs228590: TT/CT vs CC, HR=0.57, 95% CI, 0.33-0.97, P=.036; haplotype: G-T-G vs A-C-G, HR=0.52, 95% CI, 0.35-0.79, P=.002). Such positive findings remained in non-Hispanic whites. Conclusions: ATM polymorphisms may serve as biomarkers for susceptibility to severe RP in non-Hispanic whites. Large prospective studies are required to confirm our findings.« less

Incidence and Risk Factors for Leukopenia in Kidney Transplant Recipients Receiving Valganciclovir for Cytomegalovirus Prophylaxis.

PubMed

Liang, Xinyun; Famure, Olusegun; Li, Yanhong; Kim, S Joseph

2018-06-01

Valganciclovir is used not only for cytomegalovirus prophylaxis after kidney transplantation but can also induce leukopenia, thereby making patients more susceptible to other infections. The epidemiology of leukopenia in patients on valganciclovir remains poorly understood. To determine the incidence and risk factors for leukopenia in patients receiving valganciclovir for cytomegalovirus prophylaxis after kidney transplantation. In this single-center, retrospective, cohort study, we included kidney recipients transplanted from January 1, 2003, to December 31, 2010, to determine the incidence and risk factors for leukopenia in patients who received valganciclovir for cytomegalovirus prophylaxis. The Kaplan-Meier product limit method was used to graphically assess time to leukopenia, and risk factors were assessed using Cox proportional hazards models. A total of 542 kidney transplant recipients were included in the study cohort. The cumulative incidence of leukopenia at 6 months posttransplant was 39.3% (11.0% for neutropenia). Low baseline white blood cell count (hazard ratio [HR] 2.34 [95% confidence interval [CI], 1.37-4.00]) and high baseline body mass index (HR 1.05 [95% CI, 1.02-1.09]) were independently associated with an increased risk of leukopenia, while higher Cockcroft-Gault creatinine clearance (HR 0.87 [95% CI, 0.78-0.97]) was significantly associated with a decreased risk of leukopenia. These data suggest that recipient baseline white blood cell count, baseline body mass index, and kidney function are clinical predictors of new-onset leukopenia after kidney transplantation. Our results may inform the approach to cytomegalovirus prophylaxis to reduce the risk of valganciclovir-induced leukopenia in kidney transplant recipients.

Anemia risk in relation to lead exposure in lead-related manufacturing.

PubMed

Hsieh, Nan-Hung; Chung, Shun-Hui; Chen, Szu-Chieh; Chen, Wei-Yu; Cheng, Yi-Hsien; Lin, Yi-Jun; You, Su-Han; Liao, Chung-Min

2017-05-05

Lead-exposed workers may suffer adverse health effects under the currently regulated blood lead (BPb) levels. However, a probabilistic assessment about lead exposure-associated anemia risk is lacking. The goal of this study was to examine the association between lead exposure and anemia risk among factory workers in Taiwan. We first collated BPb and indicators of hematopoietic function data via health examination records that included 533 male and 218 female lead-exposed workers between 2012 and 2014. We used benchmark dose (BMD) modeling to estimate the critical effect doses for detection of abnormal indicators. A risk-based probabilistic model was used to characterize the potential hazard of lead poisoning for job-specific workers by hazard index (HI). We applied Bayesian decision analysis to determine whether BMD could be implicated as a suitable BPb standard. Our results indicated that HI for total lead-exposed workers was 0.78 (95% confidence interval: 0.50-1.26) with risk occurrence probability of 11.1%. The abnormal risk of anemia indicators for male and female workers could be reduced, respectively, by 67-77% and 86-95% by adopting the suggested BPb standards of 25 and 15 μg/dL. We conclude that cumulative exposure to lead in the workplace was significantly associated with anemia risk. This study suggests that current BPb standard needs to be better understood for the application of lead-exposed population protection in different scenarios to provide a novel standard for health management. Low-level lead exposure risk is an occupational and public health problem that should be paid more attention.

Brain Vulnerability to Repeated Blast Overpressure and Polytrauma

DTIC Science & Technology

2015-10-01

characterization of the mouse model of repeated blast also found no cumula- tive effect of repeated blast on cortical levels of reactive oxygen species [39]. C...overpressure in rats to investigate the cumulative effects of multiple blast exposures on neurologic status, neurobehavioral function, and brain...preclinical model of blast overpressure in rats to investigate the cumulative effects of multiple blast exposures using neurological, neurochemical

Cumulative exposure to dust and gases as determinants of lung function decline in tunnel construction workers

PubMed Central

Bakke, B; Ulvestad, B; Stewart, P; Eduard, W

2004-01-01

Aims: To study the relation between lung function decrease and cumulative exposure to dust and gases in tunnel construction workers. Methods: A total of 651 male construction workers (drill and blast workers, tunnel concrete workers, shotcreting operators, and tunnel boring machine workers) were followed up by spirometric measurements in 1989–2002 for an average of six years. Outdoor concrete workers, foremen, and engineers served as a low exposed referent population. Results: The between worker component of variability was considerably reduced within the job groups compared to the whole population, suggesting that the workers within job groups had similar exposure levels. The annual decrease in FEV1 in low-exposed non-smoking workers was 21 ml and 24 ml in low-exposed ever smokers. The annual decrease in FEV1 in tunnel construction workers was 20–31 ml higher than the low exposed workers depending on job group for both non-smokers and ever smokers. After adjustment for age and observation time, cumulative exposure to nitrogen dioxide showed the strongest association with a decrease in FEV1 in both non-smokers, and ever smokers. Conclusion: Cumulative exposure to nitrogen dioxide appeared to be a major risk factor for lung function decreases in these tunnel construction workers, although other agents may have contributed to the observed effect. Contact with blasting fumes should be avoided, diesel exhaust emissions should be reduced, and respiratory devices should be used to protect workers against dust and nitrogen dioxide exposure. PMID:14985522

Universal Off-Equilibrium Scaling of Critical Cumulants in the QCD Phase Diagram

DOE PAGES

Mukherjee, Swagato; Venugopalan, Raju; Yin, Yi

2016-11-23

Exploiting the universality between the QCD critical point and the three-dimensional Ising model, closed form expressions derived for nonequilibrium critical cumulants on the crossover side of the critical point reveal that they can differ in both magnitude and sign from equilibrium expectations. Here, we demonstrate here that key elements of the Kibble-Zurek framework of nonequilibrium phase transitions can be employed to describe the dynamics of these critical cumulants. Lastly, our results suggest that observables sensitive to critical dynamics in heavy-ion collisions should be expressible as universal scaling functions, thereby providing powerful model-independent guidance in searches for the QCD critical point.

Sustained Partial Sleep Deprivation: Effects on Immune Modulation and Growth Factors

NASA Technical Reports Server (NTRS)

Mullington, Janet M.

1999-01-01

The vulnerability to medical emergencies is greatest in space where there are real limits to the availability or effectiveness of ground based assistance. Moreover, astronaut safety and health maintenance will be of increasing importance as we venture out into space for extended periods of time. It is therefore critical to understand the mechanisms of the regulatory physiology of homeostatic systems (sleep, circadian, neuroendocrine, fluid and nutritional balance) and the key roles played in adaptation. This synergy project has combined aims of the "Human Performance Factors, Sleep and Chronobiology Team"; the "Immunology, Infection and Hematology Team"; and the "Muscle Alterations and Atrophy Team", to broadly address the effects of long term sleep reduction, as is frequently encountered in space exploration, on neuroendocrine, neuroimmune and circulating growth factors. Astronaut sleep is frequently curtailed to averages of between 4- 6.5 hours per night. There is evidence that this amount of sleep is inadequate for maintaining optimal daytime functioning. However, there is a lack of information concerning the effects of chronic sleep restriction, or reduction, on regulatory physiology in general, and there have been no controlled studies of the cumulative effects of chronic sleep reduction on neuroendocrine and neuroimmune parameters. This synergy project represents a pilot study designed to characterize the effects of chronic partial sleep deprivation (PSD) on neuroendocrine, neuroimmune and growth factors. This project draws its subjects from two (of 18) conditions of the larger NSBRI project, "Countermeasures to Neurobehavioral Deficits from Cumulative Partial Sleep Deprivation During Space Flight", one of the projects on the "Human Performance Factors, Sleep and Chronobiology Team ". For the purposes of this study, to investigate the effects of chronic sleep loss on neuroendocrine and neuroimmune function, we have focused on the two extreme sleep conditions from this larger study: a 4.2 hour per night condition, and a 8.2 hour per night condition. During space flight, muscle mass and bone density are reduced, apparently due to loss of GH and IGF-I, associated with microgravity. Since >70% of growth hormone (GH) is secreted at night in normal adults, we hypothesized that the chronic sleep restriction to 4 hours per night would reduce GH levels as measured in the periphery. In this synergy project, in collaboration with the "Muscle Alterations and Atrophy Team ", we are measuring insulin-like growth factor-I (IGF-I) in peripheral circulation to test the prediction that it will be reduced by chronic sleep restriction. In addition to stress modulation of immune function, recent research suggests that sleep is also involved. While we all have the common experience of being sleepy when suffering from infection, and being susceptible to infection when not getting enough sleep, the mechanisms involved in this process are not understood and until recently have gone largely overlooked. We believe that the immune function changes seen in spaceflight may also be related to the cumulative effects of sleep loss. Moreover, in space flight, the possibility of compromised immune function or of the reactivation of latent viruses are serious potential hazards for the success of long term missions. Confined living conditions, reduced sleep, altered diet and stress are all factors that may compromise immune function, thereby increasing the risks of developing and transmitting disease. Medical complications, which would not pose serious problems on earth, may be disastrous if they emerged in space.

fixedTimeEvents: An R package for the distribution of distances between discrete events in fixed time

NASA Astrophysics Data System (ADS)

Liland, Kristian Hovde; Snipen, Lars

When a series of Bernoulli trials occur within a fixed time frame or limited space, it is often interesting to assess if the successful outcomes have occurred completely at random, or if they tend to group together. One example, in genetics, is detecting grouping of genes within a genome. Approximations of the distribution of successes are possible, but they become inaccurate for small sample sizes. In this article, we describe the exact distribution of time between random, non-overlapping successes in discrete time of fixed length. A complete description of the probability mass function, the cumulative distribution function, mean, variance and recurrence relation is included. We propose an associated test for the over-representation of short distances and illustrate the methodology through relevant examples. The theory is implemented in an R package including probability mass, cumulative distribution, quantile function, random number generator, simulation functions, and functions for testing.

Trajectory phase transitions and dynamical Lee-Yang zeros of the Glauber-Ising chain.

PubMed

Hickey, James M; Flindt, Christian; Garrahan, Juan P

2013-07-01

We examine the generating function of the time-integrated energy for the one-dimensional Glauber-Ising model. At long times, the generating function takes on a large-deviation form and the associated cumulant generating function has singularities corresponding to continuous trajectory (or "space-time") phase transitions between paramagnetic trajectories and ferromagnetically or antiferromagnetically ordered trajectories. In the thermodynamic limit, the singularities make up a whole curve of critical points in the complex plane of the counting field. We evaluate analytically the generating function by mapping the generator of the biased dynamics to a non-Hermitian Hamiltonian of an associated quantum spin chain. We relate the trajectory phase transitions to the high-order cumulants of the time-integrated energy which we use to extract the dynamical Lee-Yang zeros of the generating function. This approach offers the possibility to detect continuous trajectory phase transitions from the finite-time behavior of measurable quantities.

Hazard Function Estimation with Cause-of-Death Data Missing at Random.

PubMed

Wang, Qihua; Dinse, Gregg E; Liu, Chunling

2012-04-01

Hazard function estimation is an important part of survival analysis. Interest often centers on estimating the hazard function associated with a particular cause of death. We propose three nonparametric kernel estimators for the hazard function, all of which are appropriate when death times are subject to random censorship and censoring indicators can be missing at random. Specifically, we present a regression surrogate estimator, an imputation estimator, and an inverse probability weighted estimator. All three estimators are uniformly strongly consistent and asymptotically normal. We derive asymptotic representations of the mean squared error and the mean integrated squared error for these estimators and we discuss a data-driven bandwidth selection method. A simulation study, conducted to assess finite sample behavior, demonstrates that the proposed hazard estimators perform relatively well. We illustrate our methods with an analysis of some vascular disease data.

Productive Activities and Development of Frailty in Older Adults

PubMed Central

Jung, Yunkyung; Gruenewald, Tara L.; Seeman, Teresa E.

2010-01-01

Objective. Our aim was to examine whether engagement in productive activities, including volunteering, paid work, and childcare, protects older adults against the development of geriatric frailty. Methods. Data from the first (1988) and second (1991) waves of the MacArthur Study of Successful Aging, a prospective cohort study of high-functioning older adults aged 70–79 years (n = 1,072), was used to examine the hypothesis that engagement in productive activities is associated with lower levels of frailty 3 years later. Results. Engagement in productive activities at baseline was associated with a lower cumulative odds of frailty 3 years later in unadjusted models (odds ratio [OR] = 0.74, 95% confidence interval [CI] = 0.58–0.96) but not after adjusting for age, disability, and cognitive function (adjusted OR = 0.78, 95% CI = 0.60–1.01). Examination of productive activity domains showed that volunteering (but neither paid work nor childcare) was associated with a lower cumulative odds of frailty after adjusting for age, disability, and cognitive function. This relationship diminished and was no longer statistically significant after adjusting for personal mastery and religious service attendance. Discussion. Though high-functioning older adults who participate in productive activities are less likely to become frail, after adjusting for age, disability, and cognitive function, only volunteering is associated with a lower cumulative odds of frailty. PMID:20018794

On the analysis of Canadian Holstein dairy cow lactation curves using standard growth functions.

PubMed

López, S; France, J; Odongo, N E; McBride, R A; Kebreab, E; AlZahal, O; McBride, B W; Dijkstra, J

2015-04-01

Six classical growth functions (monomolecular, Schumacher, Gompertz, logistic, Richards, and Morgan) were fitted to individual and average (by parity) cumulative milk production curves of Canadian Holstein dairy cows. The data analyzed consisted of approximately 91,000 daily milk yield records corresponding to 122 first, 99 second, and 92 third parity individual lactation curves. The functions were fitted using nonlinear regression procedures, and their performance was assessed using goodness-of-fit statistics (coefficient of determination, residual mean squares, Akaike information criterion, and the correlation and concordance coefficients between observed and adjusted milk yields at several days in milk). Overall, all the growth functions evaluated showed an acceptable fit to the cumulative milk production curves, with the Richards equation ranking first (smallest Akaike information criterion) followed by the Morgan equation. Differences among the functions in their goodness-of-fit were enlarged when fitted to average curves by parity, where the sigmoidal functions with a variable point of inflection (Richards and Morgan) outperformed the other 4 equations. All the functions provided satisfactory predictions of milk yield (calculated from the first derivative of the functions) at different lactation stages, from early to late lactation. The Richards and Morgan equations provided the most accurate estimates of peak yield and total milk production per 305-d lactation, whereas the least accurate estimates were obtained with the logistic equation. In conclusion, classical growth functions (especially sigmoidal functions with a variable point of inflection) proved to be feasible alternatives to fit cumulative milk production curves of dairy cows, resulting in suitable statistical performance and accurate estimates of lactation traits. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Effects of a multifactorial fall prevention program on fall incidence and physical function in community-dwelling older adults with risk of falls.

PubMed

Lee, Hsuei-Chen; Chang, Ku-Chou; Tsauo, Jau-Yih; Hung, Jen-Wen; Huang, Yu-Ching; Lin, Sang-I

2013-04-01

To evaluate effects of a multifactorial fall prevention program on fall incidence and physical function in community-dwelling older adults. Multicenter randomized controlled trial. Three medical centers and adjacent community health centers. Community-dwelling older adults (N=616) who have fallen in the previous year or are at risk of falling. After baseline assessment, eligible subjects were randomly allocated into the intervention group (IG) or the control group (CG), stratified by the Physiological Profile Assessment (PPA) fall risk level. The IG received a 3-month multifactorial intervention program including 8 weeks of exercise training, health education, home hazards evaluation/modification, along with medication review and ophthalmology/other specialty consults. The CG received health education brochures, referrals, and recommendations without direct exercise intervention. Primary outcome was fall incidence within 1 year. Secondary outcomes were PPA battery (overall fall risk index, vision, muscular strength, reaction time, balance, and proprioception), Timed Up & Go (TUG) test, Taiwan version of the International Physical Activity Questionnaire, EuroQol-5D, Geriatric Depression Scale (GDS), and the Falls Efficacy Scale-International at 3 months after randomization. Participants were 76±7 years old and included low risk 25.6%, moderate risk 25.6%, and marked risk 48.7%. The cumulative 1-year fall incidence was 25.2% in the IG and 27.6% in the CG (hazard ratio=.90; 95% confidence interval, .66-1.23). The IG improved more favorably than the CG on overall PPA fall risk index, reaction time, postural sway with eyes open, TUG test, and GDS, especially for those with marked fall risk. The multifactorial fall prevention program with exercise intervention improved functional performance at 3 months for community-dwelling older adults with risk of falls, but did not reduce falls at 1-year follow-up. Fall incidence might have been decreased simultaneously in both groups by heightened awareness engendered during assessments, education, referrals, and recommendations. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Quantification and Radiological Risk Estimation Due to the Presence of Natural Radionuclides in Maiganga Coal, Nigeria.

PubMed

Kolo, Matthew Tikpangi; Khandaker, Mayeen Uddin; Amin, Yusoff Mohd; Abdullah, Wan Hasiah Binti

2016-01-01

Following the increasing demand of coal for power generation, activity concentrations of primordial radionuclides were determined in Nigerian coal using the gamma spectrometric technique with the aim of evaluating the radiological implications of coal utilization and exploitation in the country. Mean activity concentrations of 226Ra, 232Th, and 40K were 8.18±0.3, 6.97±0.3, and 27.38±0.8 Bq kg-1, respectively. These values were compared with those of similar studies reported in literature. The mean estimated radium equivalent activity was 20.26 Bq kg-1 with corresponding average external hazard index of 0.05. Internal hazard index and representative gamma index recorded mean values of 0.08 and 0.14, respectively. These values were lower than their respective precautionary limits set by UNSCEAR. Average excess lifetime cancer risk was calculated to be 0.04×10-3, which was insignificant compared with 0.05 prescribed by ICRP for low level radiation. Pearson correlation matrix showed significant positive relationship between 226Ra and 232Th, and with other estimated hazard parameters. Cumulative mean occupational dose received by coal workers via the three exposure routes was 7.69 ×10-3 mSv y-1, with inhalation pathway accounting for about 98%. All radiological hazard indices evaluated showed values within limits of safety. There is, therefore, no likelihood of any immediate radiological health hazards to coal workers, final users, and the environment from the exploitation and utilization of Maiganga coal.

Quantification and Radiological Risk Estimation Due to the Presence of Natural Radionuclides in Maiganga Coal, Nigeria

PubMed Central

Kolo, Matthew Tikpangi; Khandaker, Mayeen Uddin; Amin, Yusoff Mohd; Abdullah, Wan Hasiah Binti

2016-01-01

Following the increasing demand of coal for power generation, activity concentrations of primordial radionuclides were determined in Nigerian coal using the gamma spectrometric technique with the aim of evaluating the radiological implications of coal utilization and exploitation in the country. Mean activity concentrations of 226Ra, 232Th, and 40K were 8.18±0.3, 6.97±0.3, and 27.38±0.8 Bq kg-1, respectively. These values were compared with those of similar studies reported in literature. The mean estimated radium equivalent activity was 20.26 Bq kg-1 with corresponding average external hazard index of 0.05. Internal hazard index and representative gamma index recorded mean values of 0.08 and 0.14, respectively. These values were lower than their respective precautionary limits set by UNSCEAR. Average excess lifetime cancer risk was calculated to be 0.04×10−3, which was insignificant compared with 0.05 prescribed by ICRP for low level radiation. Pearson correlation matrix showed significant positive relationship between 226Ra and 232Th, and with other estimated hazard parameters. Cumulative mean occupational dose received by coal workers via the three exposure routes was 7.69 ×10−3 mSv y-1, with inhalation pathway accounting for about 98%. All radiological hazard indices evaluated showed values within limits of safety. There is, therefore, no likelihood of any immediate radiological health hazards to coal workers, final users, and the environment from the exploitation and utilization of Maiganga coal. PMID:27348624

Cumulative Exposure to Systolic Blood Pressure During Young Adulthood Through Midlife and the Urine Albumin-to-Creatinine Ratio at Midlife.

PubMed

Kramer, Holly; Colangelo, Laura; Lewis, Cora E; Jacobs, David R; Pletcher, Mark; Bibbins-Domingo, Kirstin; Chang, Alex; Siscovick, David; Shlipak, Michael; Peralta, Carmen A; Bansal, Nisha; Muntner, Paul; Liu, Kiang

2017-05-01

Higher blood pressure during young adulthood may increase cardiovascular and kidney disease risk later in life. This study examined the association of cumulative systolic blood pressure (SBP) exposure during young adulthood through midlife with urine albumin-to-creatinine ratios (ACR) measured during midlife. We used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a biracial cohort recruited in 4 urban areas during years 1985-1986. Cumulative SBP was calculated as the average SBP between 2 exams multiplied by years between exams over 20 year years. ACR was measured 20 years after baseline when participants were age 43-50 years (midlife). A generalized additive model was used to examine the association of log ACR as a function of cumulative SBP with adjustment for covariates including SBP measured concurrently with ACR. Cumulative SBP ranged from a low of 1,671 to a high of 3,260 mm Hg. Participants in the highest cumulative SBP quartile were more likely to be male (61.4% vs. 20.7%; P < 0.001), Black (61.5% vs. 25.6%; P < 0.001) and have elevated ACR (18.7% vs. 4.8%; P < 0.001) vs. lowest quartile. Spline regression curves of ACR vs. cumulative SBP demonstrated an inflection point in ACR with cumulative SBP levels >2,350 mm Hg with linear increases in ACR above this threshold. Adjusted geometric mean ACR values were significantly higher with cumulative SBP ≥2,500 vs. <2500 (9.18 [1.06] vs. 6.92 [1.02]; P < 0.0001). Higher SBP during young adulthood through midlife is associated with higher ACR during midlife. © American Journal of Hypertension, Ltd 2017. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Pouch functional outcomes after restorative proctocolectomy with ileal-pouch reconstruction in patients with ulcerative colitis: Japanese multi-center nationwide cohort study.

PubMed

Uchino, Motoi; Ikeuchi, Hiroki; Sugita, Akira; Futami, Kitaro; Watanabe, Toshiaki; Fukushima, Kouhei; Tatsumi, Kenji; Koganei, Kazutaka; Kimura, Hideaki; Hata, Keisuke; Takahashi, Kenichi; Watanabe, Kazuhiro; Mizushima, Tsunekazu; Funayama, Yuji; Higashi, Daijiro; Araki, Toshimitsu; Kusunoki, Masato; Ueda, Takeshi; Koyama, Fumikazu; Itabashi, Michio; Nezu, Riichiro; Suzuki, Yasuo

2018-05-01

Although several complications capable of causing pouch failure may develop after restorative proctocolectomy (RPC) for ulcerative colitis (UC), the incidences and causes are conflicting and vary according to country, race and institution. To avoid pouch failure, this study aimed to evaluate the rate of pouch failure and its risk factors in UC patients over the past decade via a nationwide cohort study. We conducted a retrospective, observational, multicenter study that included 13 institutions in Japan. Patients who underwent RPC between January 2005 and December 2014 were included. The characteristics and backgrounds of the patients before and during surgery and their postoperative courses and complications were reviewed. A total of 2376 patients were evaluated over 6.7 ± 3.5 years of follow-up. Twenty-seven non-functional pouches were observed, and the functional pouch rate was 98.9% after RPC. Anastomotic leakage (odds ratio, 9.1) was selected as a risk factor for a non-functional pouch. The cumulative pouch failure rate was 4.2%/10 years. A change in diagnosis to Crohn's disease/indeterminate colitis (hazard ratio, 13.2) was identified as an independent risk factor for pouch failure. The significant risk factor for a non-functional pouch was anastomotic leakage. The optimal staged surgical procedure should be selected according to a patient's condition to avoid anastomotic failure during RPC. Changes in diagnosis after RPC confer a substantial risk of pouch failure. Additional cohort studies are needed to obtain an understanding of the long-standing clinical course of and proper treatment for pouch failure.

Benchmarking PARTISN with Analog Monte Carlo: Moments of the Neutron Number and the Cumulative Fission Number Probability Distributions

DOE Office of Scientific and Technical Information (OSTI.GOV)

O'Rourke, Patrick Francis

The purpose of this report is to provide the reader with an understanding of how a Monte Carlo neutron transport code was written, developed, and evolved to calculate the probability distribution functions (PDFs) and their moments for the neutron number at a final time as well as the cumulative fission number, along with introducing several basic Monte Carlo concepts.

Understanding the Relation of Low Income to HPA-Axis Functioning in Preschool Children: Cumulative Family Risk and Parenting as Pathways to Disruptions in Cortisol

ERIC Educational Resources Information Center

Zalewski, Maureen; Lengua, Liliana J.; Kiff, Cara J.; Fisher, Philip A.

2012-01-01

This study examined the relation of low income and poverty to cortisol levels, and tested potential pathways from low income to disruptions in cortisol through cumulative family risk and parenting. The sample of 306 mothers and their preschool children included 29 % families at or near poverty, 27 % families below the median income, and the…

The Effects of Small Sample Size on Identifying Polytomous DIF Using the Liu-Agresti Estimator of the Cumulative Common Odds Ratio

ERIC Educational Resources Information Center

Carvajal, Jorge; Skorupski, William P.

2010-01-01

This study is an evaluation of the behavior of the Liu-Agresti estimator of the cumulative common odds ratio when identifying differential item functioning (DIF) with polytomously scored test items using small samples. The Liu-Agresti estimator has been proposed by Penfield and Algina as a promising approach for the study of polytomous DIF but no…

Measurement of higher cumulants of net-charge multiplicity distributions in Au + Au collisions at s N N = 7.7 – 200 GeV

DOE PAGES

Adare, A.; Afanasiev, S.; Aidala, C.; ...

2016-01-19

Our report presents the measurement of cumulants (C n,n=1,...,4) of the net-charge distributions measured within pseudorapidity (|η|<0.35) in Au+Au collisions at √s NN=7.7–200GeV with the PHENIX experiment at the Relativistic Heavy Ion Collider. The ratios of cumulants (e.g., C 1/C 2, C 3/C 1) of the net-charge distributions, which can be related to volume independent susceptibility ratios, are studied as a function of centrality and energy. These quantities are important to understand the quantum-chromodynamics phase diagram and possible existence of a critical end point. The measured values are very well described by expectation from negative binomial distributions. We do notmore » observe any nonmonotonic behavior in the ratios of the cumulants as a function of collision energy. These measured values of C 1/C 2 and C 3/C 1 can be directly compared to lattice quantum-chromodynamics calculations and thus allow extraction of both the chemical freeze-out temperature and the baryon chemical potential at each center-of-mass energy. Moreover, the extracted baryon chemical potentials are in excellent agreement with a thermal-statistical analysis model.« less

Step 1: Human System Integration Pilot-Technology Interface Requirements for Weather Management

NASA Technical Reports Server (NTRS)

2005-01-01

This document involves definition of technology interface requirements for Hazardous Weather Avoidance. Technology concepts in use by the Access 5 Weather Management Work Package were considered. Beginning with the Human System Integration (HIS) high-level functional requirement for Hazardous Weather Avoidance, and Hazardous Weather Avoidance technology elements, HSI requirements for the interface to the pilot were identified. Results of the analysis describe (1) the information required by the pilot to have knowledge of hazardous weather, and (2) the control capability needed by the pilot to obtain hazardous weather information. Fundamentally, these requirements provide the candidate Hazardous Weather Avoidance technology concepts with the necessary human-related elements to make them compatible with human capabilities and limitations. The results of the analysis describe how Hazardous Weather Avoidance operations and functions should interface with the pilot to provide the necessary Weather Management functionality to the UA-pilot system. Requirements and guidelines for Hazardous Weather Avoidance are partitioned into four categories: (1) Planning En Route (2) Encountering Hazardous Weather En Route, (3) Planning to Destination, and (4) Diversion Planning Alternate Airport. Each requirement is stated and is supported with a rationale and associated reference(s).

Hazard Function Estimation with Cause-of-Death Data Missing at Random

PubMed Central

Wang, Qihua; Dinse, Gregg E.; Liu, Chunling

2010-01-01

Hazard function estimation is an important part of survival analysis. Interest often centers on estimating the hazard function associated with a particular cause of death. We propose three nonparametric kernel estimators for the hazard function, all of which are appropriate when death times are subject to random censorship and censoring indicators can be missing at random. Specifically, we present a regression surrogate estimator, an imputation estimator, and an inverse probability weighted estimator. All three estimators are uniformly strongly consistent and asymptotically normal. We derive asymptotic representations of the mean squared error and the mean integrated squared error for these estimators and we discuss a data-driven bandwidth selection method. A simulation study, conducted to assess finite sample behavior, demonstrates that the proposed hazard estimators perform relatively well. We illustrate our methods with an analysis of some vascular disease data. PMID:22267874

Modeling cumulative dose and exposure duration provided insights regarding the associations between benzodiazepines and injuries.

PubMed

Abrahamowicz, Michal; Bartlett, Gillian; Tamblyn, Robyn; du Berger, Roxane

2006-04-01

Accurate assessment of medication impact requires modeling cumulative effects of exposure duration and dose; however, postmarketing studies usually represent medication exposure by baseline or current use only. We propose new methods for modeling various aspects of medication use history and employment of them to assess the adverse effects of selected benzodiazepines. Time-dependent measures of cumulative dose or duration of use, with weighting of past exposures by recency, were proposed. These measures were then included in alternative versions of the multivariable Cox model to analyze the risk of fall related injuries among the elderly new users of three benzodiazepines (nitrazepam, temazepam, and flurazepam) in Quebec. Akaike's information criterion (AIC) was used to select the most predictive model for a given benzodiazepine. The best-fitting model included a combination of cumulative duration and current dose for temazepam, and cumulative dose for flurazepam and nitrazepam, with different weighting functions. The window of clinically relevant exposure was shorter for flurazepam than for the two other products. Careful modeling of the medication exposure history may enhance our understanding of the mechanisms underlying their adverse effects.

The Role of Cumulative Trauma, Betrayal, and Appraisals in Understanding Trauma Symptomatology.

PubMed

Martin, Christina Gamache; Cromer, Lisa Demarni; Deprince, Anne P; Freyd, Jennifer J

2013-03-01

Poor psychological outcomes are common among trauma survivors, yet not all survivors experience adverse sequelae. The current study examined links between cumulative trauma exposure as a function of the level of betrayal (measured by the relational closeness of the survivor and the perpetrator), trauma appraisals, gender, and trauma symptoms. Participants were 273 college students who reported experiencing at least one traumatic event on a trauma checklist. Three cumulative indices were constructed to assess the number of different types of traumas experienced that were low (LBTs), moderate (MBTs), or high in betrayal (HBTs). Greater trauma exposure was related to more symptoms of depression, dissociation, and PTSD, with exposure to HBTs contributing the most. Women were more likely to experience HBTs than men, but there were no gender differences in trauma-related symptoms. Appraisals of trauma were predictive of trauma-related symptoms over and above the effects explained by cumulative trauma at each level of betrayal. The survivor's relationship with the perpetrator, the effect of cumulative trauma, and their combined impact on trauma symptomatology are discussed.

The Role of Cumulative Trauma, Betrayal, and Appraisals in Understanding Trauma Symptomatology

PubMed Central

Martin, Christina Gamache; Cromer, Lisa DeMarni; DePrince, Anne P.; Freyd, Jennifer J.

2012-01-01

Poor psychological outcomes are common among trauma survivors, yet not all survivors experience adverse sequelae. The current study examined links between cumulative trauma exposure as a function of the level of betrayal (measured by the relational closeness of the survivor and the perpetrator), trauma appraisals, gender, and trauma symptoms. Participants were 273 college students who reported experiencing at least one traumatic event on a trauma checklist. Three cumulative indices were constructed to assess the number of different types of traumas experienced that were low (LBTs), moderate (MBTs), or high in betrayal (HBTs). Greater trauma exposure was related to more symptoms of depression, dissociation, and PTSD, with exposure to HBTs contributing the most. Women were more likely to experience HBTs than men, but there were no gender differences in trauma-related symptoms. Appraisals of trauma were predictive of trauma-related symptoms over and above the effects explained by cumulative trauma at each level of betrayal. The survivor’s relationship with the perpetrator, the effect of cumulative trauma, and their combined impact on trauma symptomatology are discussed. PMID:23542882

An adiabatic linearized path integral approach for quantum time-correlation functions II: a cumulant expansion method for improving convergence.

PubMed

Causo, Maria Serena; Ciccotti, Giovanni; Bonella, Sara; Vuilleumier, Rodolphe

2006-08-17

Linearized mixed quantum-classical simulations are a promising approach for calculating time-correlation functions. At the moment, however, they suffer from some numerical problems that may compromise their efficiency and reliability in applications to realistic condensed-phase systems. In this paper, we present a method that improves upon the convergence properties of the standard algorithm for linearized calculations by implementing a cumulant expansion of the relevant averages. The effectiveness of the new approach is tested by applying it to the challenging computation of the diffusion of an excess electron in a metal-molten salt solution.

A Poisson process approximation for generalized K-5 confidence regions

NASA Technical Reports Server (NTRS)

Arsham, H.; Miller, D. R.

1982-01-01

One-sided confidence regions for continuous cumulative distribution functions are constructed using empirical cumulative distribution functions and the generalized Kolmogorov-Smirnov distance. The band width of such regions becomes narrower in the right or left tail of the distribution. To avoid tedious computation of confidence levels and critical values, an approximation based on the Poisson process is introduced. This aproximation provides a conservative confidence region; moreover, the approximation error decreases monotonically to 0 as sample size increases. Critical values necessary for implementation are given. Applications are made to the areas of risk analysis, investment modeling, reliability assessment, and analysis of fault tolerant systems.

The role of health behaviours across the life course in the socioeconomic patterning of all-cause mortality: the west of Scotland twenty-07 prospective cohort study.

PubMed

Whitley, Elise; Batty, G David; Hunt, Kate; Popham, Frank; Benzeval, Michaela

2014-04-01

Socioeconomic differentials in mortality are increasing in many industrialised countries. This study aims to examine the role of behaviours (smoking, alcohol, exercise, and diet) in explaining socioeconomic differentials in mortality and whether this varies over the life course, between cohorts and by gender. Analysis of two representative population cohorts of men and women, born in the 1950s and 1930s, were performed. Health behaviours were assessed on five occasions over 20 years. Health behaviours explained a substantial part of the socioeconomic differentials in mortality. Cumulative behaviours and those that were more strongly associated with socioeconomic status had the greatest impact. For example, in the 1950s cohort, the age-sex adjusted hazard ratio comparing respondents with manual versus non-manual occupational status was 1.80 (1.25, 2.58); adjustment for cumulative smoking over 20 years attenuated the association by 49 %, diet by 43 %, drinking by 13 % and inactivity by only 1%. Health behaviours have an important role in explaining socioeconomic differentials in mortality.

What We Have Learned From the Ocular Hypertension Treatment Study.

PubMed

Gordon, Mae O; Kass, Michael A

2018-05-01

To identify results from the Ocular Hypertension Study that can aid patients and clinicians to make evidence-based decisions about the management of ocular hypertension. Perspective. At 60 months, the cumulative frequency of developing primary open-angle glaucoma (POAG) was 4.4% in the medication group and 9.5% in the observation group (hazard ratio for medication, 0.40; 95% confidence interval [CI], 0.27-0.59; P < .0001). At 13 years the cumulative proportion of participants who developed POAG was 0.22 (95% CI 0.19-0.25) in the original observation group and 0.16 (95% CI 0.13-0.19) in the original medication group (complementary log-log x 2 P = .009). A 5-factor model (older age, higher IOP, thinner central corneal thickness, larger cup-to-disc ratio, and higher visual field pattern standard deviation) separated participants at high and low risk of developing POAG. Clinicians and patients can make evidence-based decisions about the management of ocular hypertension using the risk model and considering patient age, medical status, life expectancy, and personal preference. Copyright © 2018 Elsevier Inc. All rights reserved.

Cumulative effects of antiandrogenic chemical mixtures and their relevance to human health risk assessment.

PubMed

Howdeshell, Kembra L; Hotchkiss, Andrew K; Gray, L Earl

2017-03-01

Toxicological studies of defined chemical mixtures assist human health risk assessment by establishing how chemicals interact with one another to induce an effect. This paper reviews how antiandrogenic chemical mixtures can alter reproductive tract development in rats with a focus on the reproductive toxicant phthalates. The reviewed studies compare observed mixture data to mathematical mixture model predictions based on dose addition or response addition to determine how the individual chemicals in a mixture interact (e.g., additive, greater, or less than additive). Phthalate mixtures were observed to act in a dose additive manner based on the relative potency of the individual phthalates to suppress fetal testosterone production. Similar dose additive effects have been reported for mixtures of phthalates with antiandrogenic pesticides of differing mechanisms of action. Overall, data from these phthalate experiments in rats can be used in conjunction with human biomonitoring data to determine individual hazard indices, and recent cumulative risk assessments in humans indicate an excess risk to antiandrogenic chemical mixtures that include phthalates only or phthalates in combination with other antiandrogenic chemicals. Published by Elsevier GmbH.

The 3-Year Incidence of Gout in Elderly Patients with CKD.

PubMed

Tan, Vivian S; Garg, Amit X; McArthur, Eric; Lam, Ngan N; Sood, Manish M; Naylor, Kyla L

2017-04-03

The risk of gout across CKD stages is not well described. We performed a retrospective cohort study using linked health care databases from Ontario, Canada from 2002 to 2010. The primary outcome was the 3-year cumulative incidence of gout, on the basis of diagnostic codes. We presented our results by level of kidney function (eGFR≥90 ml/min per 1.73 m 2 , 60-89, 45-59, 30-44, 15-29, and chronic dialysis) and by sex. Additional analyses examined the risk of gout adjusting for clinical characteristics, incidence of gout defined by the receipt of allopurinol or colchicine, and gout risk in a subpopulation stratified by the level of eGFR and albuminuria. Of the 282,925 adults aged ≥66 years, the mean age was 75 years and 57.9% were women. The 3-year cumulative incidence of gout was higher in older adults with a lower level of eGFR. In women, the 3-year cumulative incidence of gout was 0.6%, 0.7%, 1.3%, 2.2%, and 3.4%, and in men the values were 0.8%, 1.2%, 2.5%, 3.7%, and 4.6%, respectively. However, patients on chronic dialysis had a lower 3-year cumulative incidence of gout (women 2.0%, men 2.9%) than those with more moderate reductions in kidney function ( i.e. , eGFR 15-44 ml/min per 1.73 m 2 ). The association between a greater loss of kidney function and a higher risk of diagnosed gout was also evident after adjustment for clinical characteristics and in all additional analyses. Patients with a lower level of eGFR had a higher 3-year cumulative incidence of gout, with the exception of patients receiving dialysis. Results can be used for risk stratification. Copyright © 2017 by the American Society of Nephrology.

The 3-Year Incidence of Gout in Elderly Patients with CKD

PubMed Central

Tan, Vivian S.; Garg, Amit X.; McArthur, Eric; Lam, Ngan N.; Sood, Manish M.

2017-01-01

Background and objectives The risk of gout across CKD stages is not well described. Design, setting, participants, & measurements We performed a retrospective cohort study using linked health care databases from Ontario, Canada from 2002 to 2010. The primary outcome was the 3-year cumulative incidence of gout, on the basis of diagnostic codes. We presented our results by level of kidney function (eGFR≥90 ml/min per 1.73 m2, 60–89, 45–59, 30–44, 15–29, and chronic dialysis) and by sex. Additional analyses examined the risk of gout adjusting for clinical characteristics, incidence of gout defined by the receipt of allopurinol or colchicine, and gout risk in a subpopulation stratified by the level of eGFR and albuminuria. Results Of the 282,925 adults aged ≥66 years, the mean age was 75 years and 57.9% were women. The 3-year cumulative incidence of gout was higher in older adults with a lower level of eGFR. In women, the 3-year cumulative incidence of gout was 0.6%, 0.7%, 1.3%, 2.2%, and 3.4%, and in men the values were 0.8%, 1.2%, 2.5%, 3.7%, and 4.6%, respectively. However, patients on chronic dialysis had a lower 3-year cumulative incidence of gout (women 2.0%, men 2.9%) than those with more moderate reductions in kidney function (i.e., eGFR 15–44 ml/min per 1.73 m2). The association between a greater loss of kidney function and a higher risk of diagnosed gout was also evident after adjustment for clinical characteristics and in all additional analyses. Conclusions Patients with a lower level of eGFR had a higher 3-year cumulative incidence of gout, with the exception of patients receiving dialysis. Results can be used for risk stratification. PMID:28153936

Risk factors for keratinocyte skin cancer in patients diagnosed with melanoma, a large retrospective study.

PubMed

Espinosa, Pablo; Pfeiffer, Ruth M; García-Casado, Zaida; Requena, Celia; Landi, Maria Teresa; Kumar, Rajiv; Nagore, Eduardo

2016-01-01

Melanoma survivors are at an increased risk of developing other malignancies, including keratinocyte skin cancer (KSC). While it is known that many risk factors for melanoma also impact risk of KSC in the general population, no previous study has investigated risk factors for KSC development in melanoma patients. We assessed associations of personal and clinical characteristics, including skin phenotype and variations in the melanocortin 1 receptor (MC1R) gene, with KSC risk in melanoma patients. We used prospective follow-up information on 1200 patients treated for melanoma at the Instituto Valenciano de Oncología, Spain, between 2000 and 2011. We computed hazard ratios and 95% confidence intervals (CIs) for the association of clinical, personal and genetic characteristics with risk of KSC, squamous cell carcinoma (SCC), or basal cell carcinoma (BCC) from Cox proportional hazard models. Five-year cumulative incidence based on competing risk models of SCC, BCC or KSC overall was computed using multivariate subdistribution hazard models. To assess predictive performance of the models, we computed areas under the receiver-operating characteristic curves (AUCs, discriminatory power) using cross-validation. Median follow-up was 57.2 months; a KSC was detected in 163 patients (13.6%). In multivariable Cox models, age, sex, sunburns, chronic sun exposure, past personal history of non-melanoma skin cancer or other non-cutaneous neoplasia, and the MC1R variants p.D294H and p.R163Q were significantly associated with KSC risk. A cumulative incidence model including age, sex, personal history of KSC, and of other non-cutaneous neoplasia had an AUC of 0.76 (95% CI: 0.71-0.80). When p.D294H and p.R163Q variants were added to the model, the AUC increased to 0.81 (95% CI: 0.77-0.84) (p-value for difference <0.0001). In addition to age, sex, skin characteristics, and sun exposure, p.R163Q and p.D294H MC1R variants significantly increased KSC risk among melanoma patients. Our findings may help identify patients who could benefit most from preventive measures. Copyright © 2015 Elsevier Ltd. All rights reserved.

Very Long-Term (10 to 14 Year) Outcomes After Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Multivessel Coronary Artery Disease in the Bare-Metal Stent Era.

PubMed

Shiomi, Hiroki; Yamaji, Kyohei; Morimoto, Takeshi; Shizuta, Satoshi; Nakatsuma, Kenji; Higami, Hirooki; Furukawa, Yutaka; Nakagawa, Yoshihisa; Kadota, Kazushige; Ando, Kenji; Sakata, Ryuzo; Okabayashi, Hitoshi; Hanyu, Michiya; Shimamoto, Mitsuomi; Nishiwaki, Noboru; Komiya, Tatsuhiko; Kimura, Takeshi

2016-08-01

Many of the previous randomized trials comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in patients with multivessel coronary artery disease reported equivalent or better survival with CABG as compared with PCI at 5-year follow-up. However, 5-year follow-up might be too short to evaluate the true differences in long-term clinical outcomes between PCI and CABG. Among 8934 patients enrolled in the extended 10- to 14-year follow-up study of the CREDO-Kyoto registry cohort-1 (Coronary Revascularization Demonstrating Outcome study in Kyoto) conducted in the bare-metal stent era, 5152 (PCI: n=3490 and CABG: n=1662) patients had multivessel coronary artery disease without left main disease. Median follow-up duration was 11.2 (interquartile range: 10.2-12.2) years. The cumulative 10-year incidence of all-cause death was not significantly different between PCI and CABG (32.2% versus 31.7%; log-rank P=0.93). After adjusting for confounders, however, the mortality risk of PCI was significantly higher than that of CABG (hazard ratio, 1.19 [95% confidence interval, 1.02-1.39]; P=0.03). Within 5 years after the index procedure, the risk for all-cause death was significantly higher after PCI than after CABG (hazard ratio, 1.41; 95% CI, 1.12-1.79; P=0.004). By a landmark analysis at 5 years, however, the cumulative 10-year incidence of and adjusted risk for all-cause death beyond 5 years were not significantly different between PCI and CABG (19.3% versus 20.0%; log-rank P=0.22 and hazard ratio, 1.02, 95% confidence interval, 0.83-1.26; P=0.82). CABG as compared with PCI was associated with better 10-year survival in patients with multivessel coronary artery disease. However, the benefit of CABG compared with PCI on late mortality beyond 5 years was not observed in this study. © 2016 American Heart Association, Inc.

Long-term effect of statins on the risk of new-onset osteoporosis: A nationwide population-based cohort study.

PubMed

Lin, Tsung-Kun; Chou, Pesus; Lin, Ching-Heng; Hung, Yi-Jen; Jong, Gwo-Ping

2018-01-01

Several observational cohort and meta-analytical studies in humans have shown that statin users have a lower risk of fractures or greater bone mineral densities (BMD) than nonusers. However, some studies including randomized clinical trials have the opposite results, particularly in Asian populations. This study investigates the impacts of statins on new-onset osteoporosis in Taiwan. In a nationwide retrospective population-based cohort study, 45,342 subjects aged between 50-90 years having received statin therapy (statin-users) since January 1 2001, and observed through December 31 2013 were selected from the National Health Insurance Research Database of Taiwan. Likewise, 115,594 patients had no statin therapy (statin-non-users) were included as controls in this study. Multivariable Cox proportional hazards analysis for drug exposures was employed to evaluate the association between statin treatment and new-onset of osteoporosis risk. We also used the long-rank test to evaluate the difference of probability of osteoporosis-free survival. During the 13-year follow-up period, 16,146 of all enrolled subjects (10.03%) developed osteoporosis, including 3097 statin-users (6.83%) and 13,049 statin-non-users (11.29%). Overall, statin therapy reduced the risk of new-onset osteoporosis by 48% (adjusted hazard ratio [HR] 0.52; 95% CI 0.50 to 0.54). A dose-response relationship between statin treatment and the risk of new-onset osteoporosis was observed. The adjusted hazard ratios for new-onset osteoporosis were 0.84 (95% CI, 0.78 to 0.90), 0.56 (95% CI, 0.52 to 0.60) and 0.23 (95% CI, 0.21 to 0.25) when cumulative defined daily doses (cDDDs) ranged from 28 to 90, 91 to 365, and more than 365, respectively, relative to nonusers. Otherwise, high-potency statins (rosuvastatin and atorvastatin) and moderate-potency statin (simvastatin) seemed to have a potential protective effect for osteoporosis. In this population-based cohort study, we found that statin use is associated with a decreased risk of osteoporosis in both genders. The osteoprotective effect of statins seemed to be more prominent with a dependency on the cumulative dosage and statin intensity.

Somatoform disorder as a predictor of interstitial cystitis/bladder pain syndrome: Evidence from a nested case-control study and a retrospective cohort study.

PubMed

Chen, I-Chun; Lee, Ming-Huei; Lin, Hsuan-Hung; Wu, Shang-Liang; Chang, Kun-Min; Lin, Hsiu-Ying

2017-05-01

Interstitial cystitis/bladder pain syndrome (IC/BPS) has several well-known comorbid psychiatric manifestations, including insomnia, anxiety, and depression. We hypothesized that somatoform disorder, which is a psychosomatic disease, can be used as a sensitive psychiatric phenotype of IC/BPS. We investigated whether somatoform disorder increases the risk of IC/BPS.A nested case-control study and a retrospective cohort study were followed up over a 12-year period (2002-2013) in the Taiwan Health Insurance Reimbursement Database. In the nested case-control study, 1612 patients with IC/BPS were matched in a 1:2 ratio to 3224 controls based on propensity scores. The odds ratio for somatoform disorder was calculated using conditional logistic regression analysis. In the retrospective cohort study, 1436 patients with somatoform disorder were matched in a 1:2 ratio to 2872 patients with nonsomatoform disorder based on propensity scores. Cox regression analysis was used to estimate the hazard ratio associated with the development of IC/BPS in patients with somatoform disorder, and the cumulative survival probability was tested using the Kaplan-Meier analysis.We found that the odds ratio for somatoform disorder was 2.46 (95% confidence interval [CI], 1.05-5.76). Although the average time until IC/BPS development in the control subjects was 11.5 ± 1.3 years, this interval was shorter in patients with somatoform disorder (6.3 ± 3.6 years). The hazard ratio for developing IC/BPS was 2.50 (95% CI 1.23-5.58); the adjusted hazard ratio was 2.26 (95% CI 1.002-5.007). The patients and controls also differed significantly in their cumulative survival probability for IC/BPS (log rank P < .05).Evidence from the nested case-control study and retrospective cohort study consistently indicated that somatoform disorder increases the risk for IC/BPS. Our study suggests that somatoform disorder can be used as a sensitive psychiatric phenotype to predict IC/BPS. Any past history of somatoform disorder should be documented while examining patients with IC/BPS.

Lung function not affected by asbestos exposure in workers with normal Computed Tomography scan.

PubMed

Schikowsky, Christian; Felten, Michael K; Eisenhawer, Christian; Das, Marco; Kraus, Thomas

2017-05-01

It has been suggested that asbestos exposure affects lung function, even in the absence of asbestos-related pulmonary interstitial or pleural changes or emphysema. We analyzed associations between well-known asbestos-related risk factors, such as individual cumulative asbestos exposure, and key lung function parameters in formerly asbestos-exposed power industry workers (N = 207) with normal CT scans. For this, we excluded participants with emphysema, fibrosis, pleural changes, or any combination of these. The lung function parameters of FVC, FEV1, DLCO/VA, and airway resistance were significantly associated with the burden of smoking, BMI and years since end of exposure (only DLCO/VA). However, they were not affected by factors directly related to amount (eg, cumulative exposure) or duration of asbestos exposure. Our results confirm the well-known correlation between lung function, smoking habits, and BMI. However, we found no significant association between lung function and asbestos exposure. © 2017 Wiley Periodicals, Inc.

The limits to cumulative causation: international migration from Mexican urban areas.

PubMed

Fussell, Elizabeth; Massey, Douglas S

2004-02-01

We present theoretical arguments and empirical research to suggest that the principal mechanisms of cumulative causation do not function in large urban settings. Using data from the Mexican Migration Project, we found evidence of cumulative causation in small cities, rural towns and villages, but not in large urban areas. With event-history models, we found little positive effect of community-level social capital and a strong deterrent effect of urban labor markets on the likelihood of first and later U.S. trips for residents of urban areas in Mexico, suggesting that the social process of migration from urban areas is distinct from that in the more widely studied rural migrant-sending communities of Mexico.

Toward a cumulative ecological risk model for the etiology of child maltreatment

PubMed Central

MacKenzie, Michael J.; Kotch, Jonathan B.; Lee, Li-Ching

2011-01-01

The purpose of the current study was to further the integration of cumulative risk models with empirical research on the etiology of child maltreatment. Despite the well-established literature supporting the importance of the accumulation of ecological risk, this perspective has had difficulty infiltrating empirical maltreatment research and its tendency to focus on more limited risk factors. Utilizing a sample of 842 mother-infant dyads, we compared the capacity of individual risk factors and a cumulative index to predict maltreatment reports in a prospective longitudinal investigation over the first sixteen years of life. The total load of risk in early infancy was found to be related to maternal cognitions surrounding her new role, measures of social support and well-being, and indicators of child cognitive functioning. After controlling for total level of cumulative risk, most single factors failed to predict later maltreatment reports and no single variable provided odd-ratios as powerful as the predictive power of a cumulative index. Continuing the shift away from simplistic causal models toward an appreciation for the cumulative nature of risk would be an important step forward in the way we conceptualize intervention and support programs, concentrating them squarely on alleviating the substantial risk facing so many of society’s families. PMID:24817777

Incidence of silicosis among ceramic workers in central Italy.

PubMed

Cavariani, F; Di Pietro, A; Miceli, M; Forastiere, F; Biggeri, A; Scavalli, P; Petti, A; Borgia, P

1995-01-01

The incidence of radiological silicosis was studied among 2480 male workers employed in the ceramics industry. The subjects entered the surveillance program during 1974-1987 and were followed through 1991 with annual chest radiographs. The cumulative risk of silicosis (1/1 or greater; p,q,r) reached 48% (95% confidence interval 41.5-54.9) after 30 years of employment. In a multivariate Cox's proportional hazards model, the effect of duration of exposure increased linearly up to the category of 25-29 years; an extremely high hazard risk of 14.6 was found among those with 30 years or more of exposure in comparison with those employed 10 years or less. Smoking habit also significantly contributed to the model, although its role in the biological process is unclear. In conclusion, exposure to silica dust has been associated with a high incidence of silicosis among ceramics workers. The risk estimates are consistent with the recent findings of silicosis incidence among South African gold miners.

Risk assessment of airborne pesticides in a Mediterranean region of Spain.

PubMed

López, Antonio; Yusà, Vicent; Muñoz, Amalia; Vera, Teresa; Borràs, Esther; Ródenas, Milagros; Coscollà, Clara

2017-01-01

A risk assessment strategy based on the quantitative target analysis and semi-quantitative retrospective screening determination of pesticides in PM10 has been developed. The proposed methodology was applied to 345 real samples from nine stations of a Mediterranean area in Spain, and the risk was assessed for adult, children and infants. Forty pesticides were detected with average concentrations ranging from 8 to 30,000pgm -3 . Each station showed its specific pesticide profile, which is linked to the different types of crops around each station. For adults, children and infants the estimated chronic inhalation risk, expressed as Hazard Quotient (HQ), was <1 for all pesticides. The cumulative exposure for organophosphates, neonicotinoids, benzimidazoles, carbamates, micro-organism and triazoles pesticides (HI, Hazard Index) were <1 for the three groups of populations assessed. For infants, the cancer risk estimated for the detected pesticides classified as possible and potential carcinogens were lower than 1.0 E-06, except for carbendazim and hexythiazox. Copyright © 2016 Elsevier B.V. All rights reserved.

Weather-Related Hazards and Population Change: A Study of Hurricanes and Tropical Storms in the United States, 1980–2012

PubMed Central

FUSSELL, ELIZABETH; CURRAN, SARA R.; DUNBAR, MATTHEW D.; BABB, MICHAEL A.; THOMPSON, LUANNE; MEIJER-IRONS, JACQUELINE

2017-01-01

Environmental determinists predict that people move away from places experiencing frequent weather hazards, yet some of these areas have rapidly growing populations. This analysis examines the relationship between weather events and population change in all U.S. counties that experienced hurricanes and tropical storms between 1980 and 2012. Our database allows for more generalizable conclusions by accounting for heterogeneity in current and past hurricane events and losses and past population trends. We find that hurricanes and tropical storms affect future population growth only in counties with growing, high-density populations, which are only 2 percent of all counties. In those counties, current year hurricane events and related losses suppress future population growth, although cumulative hurricane-related losses actually elevate population growth. Low-density counties and counties with stable or declining populations experience no effect of these weather events. Our analysis provides a methodologically informed explanation for contradictory findings in prior studies. PMID:29326480

Weather-Related Hazards and Population Change: A Study of Hurricanes and Tropical Storms in the United States, 1980-2012.

PubMed

Fussell, Elizabeth; Curran, Sara R; Dunbar, Matthew D; Babb, Michael A; Thompson, Luanne; Meijer-Irons, Jacqueline

2017-01-01

Environmental determinists predict that people move away from places experiencing frequent weather hazards, yet some of these areas have rapidly growing populations. This analysis examines the relationship between weather events and population change in all U.S. counties that experienced hurricanes and tropical storms between 1980 and 2012. Our database allows for more generalizable conclusions by accounting for heterogeneity in current and past hurricane events and losses and past population trends. We find that hurricanes and tropical storms affect future population growth only in counties with growing, high-density populations, which are only 2 percent of all counties. In those counties, current year hurricane events and related losses suppress future population growth, although cumulative hurricane-related losses actually elevate population growth. Low-density counties and counties with stable or declining populations experience no effect of these weather events. Our analysis provides a methodologically informed explanation for contradictory findings in prior studies.

Dispersion and line shape of plasmon satellites in one, two, and three dimensions

DOE PAGES

Vigil-Fowler, Derek; Louie, Steven G.; Lischner, Johannes

2016-06-27

Using state-of-the-art many-body Green's function calculations based on the GW plus cumulant approach, we analyze the properties of plasmon satellites in the electron spectral function resulting from electron-plasmon interactions in one-, two-, and three-dimensional systems. Specifically, we show how their dispersion relation, line shape, and linewidth are related to the properties of the constituent electrons and plasmons. In addition, to gain insight into the many-body processes giving rise to the formation of plasmon satellites, we connect the GW plus cumulant approach to a many-body wave-function picture of electron-plasmon interactions and introduce the coupling-strength-weighted electron-plasmon joint density states as a powerfulmore » concept for understanding plasmon satellites.« less

[Relationship between baseline heart rate and all-cause death in general population].

PubMed

Chen, Ji; Chen, Shuo-hua; Liu, Xing; Zhang, Cai-feng; Yao, Tao; Yang, Hui; Wang, Jian-li; Wu, Shou-ling

2013-06-01

To investigate the relationship between baseline heart rate(HR) and all-cause death(ACD)in general population. 93 716 workers with heart rate between 40 bpm/min-120 bpm/min and without histories of stroke were selected from the '2006-2007 health examination records' in Kailuan and completed the electrocardiogram exam. Related information were also gathered. These subjects were followed up from July 2006 to December 2010, with the mean time of follow-up as 47.5±4.3 months. During the follow-up period, the occurrence of all-cause death was observed every half a year. (1)The lowest cumulative mortality rate was 1.61% in the group with 60-69 bpm/min. The lowest cumulative mortality rate was 1.78% in the group of 60-69 bpm/min in men. There was no death events observed in women with less than 50 bpm/min and the lowest cumulative mortality rate was 0.60% in the group of 80-89 bpm/min in women. (2)Data from Cox proportional hazard regression analysis showed that the RR(95%CI)of cumulative mortality rates in general population were 1.187 (1.039-1.336), 1.392(1.185-1.636), 1.733(1.404-2.139)and 2.716 (2.171-3.398)in the groups of 70-79, 80-89, 90-99 and ≥100 bpm/min, respectively. The RRs (95% CI) of cumulative mortality in men were 1.227(1.067-1.410), 1.481(1.254-1.750), 1.754 (1.406-2.188)and 2.831 (2.245-3.571) respectively. In women, when comparing with the group of 80-89 bpm/min, the RRs (95%CI)of all-cause death were 0.671(0.568-0.793), 0.825(0.703-0.970) and 1.925 (1.512-2.453)respectively in the groups of 60-69, 70-79 and ≥100 bpm/min. When HR exceeding ≥70 bpm/min, the increase of HR would also increase the rate of ACD. Results of our study also showed a J-shaped curve relation between HR and mortality.

Association of day 4 cumulative fluid balance with mortality in critically ill patients with influenza: A multicenter retrospective cohort study in Taiwan

PubMed Central

Chien, Ying-Chun; Sheu, Chau-Chyun; Tsai, Ming-Ju; Fang, Wen-Feng; Chen, Yu-Mu; Kao, Kuo-Chin; Hu, Han-Chung; Perng, Wann-Cherng; Yang, Kuang-Yao; Chen, Wei-Chih; Liang, Shinn-Jye; Wu, Chieh-Liang; Wang, Hao-Chien; Chan, Ming-Cheng

2018-01-01

Background Fluid balance is a fundamental management of patients with sepsis, and this study aimed to investigate the impact of cumulative fluid balance on critically ill patients with influenza admitted to an intensive care unit (ICU). Methods This multicenter retrospective cohort study was conducted by the Taiwan Severe Influenza Research Consortium (TSIRC) which includes eight medical centers. Patients with virology-proven influenza infection admitted to ICUs between October 2015 and March 2016 were included for analysis. Results A total of 296 patients were enrolled (mean age: 61.4±15.6 years; 62.8% men), and 92.2% (273/296) of them required mechanical ventilation. In the survivors, the daily fluid balance was positive from day 1 to day 3, and then gradually became negative from day 4 to day 7, whereas daily fluid balance was continuously positive in the non-survivors. Using the cumulative fluid balance from day 1–4 as a cut-off point, we found that a negative cumulative day 1–4 fluid balance was associated with a lower 30-day mortality rate (log-rank test, P = 0.003). To evaluate the impact of shock on this association, we divided the patients into shock and non-shock groups. The positive correlation between negative day 1–4 fluid balance and mortality was significant in the non-shock group (log-rank test, P = 0.008), but not in the shock group (log-rank test, P = 0.396). In a multivariate Cox proportional hazard regression model adjusted for age, sex, cerebrovascular disease, and PaO2/FiO2, day 1–4 fluid balance was independently associated with a higher 30-day mortality rate (aHR 1.088, 95% CI: 1.007–1.174). Conclusions A negative day 1–4 cumulative fluid balance was associated with a lower mortality rate in critically ill patients with influenza. Our findings indicate the critical role of conservative fluid strategy in the management of patients with complicated influenza. PMID:29315320

Risk of epilepsy and autism in full and half siblings-A population-based cohort study.

PubMed

Christensen, Jakob; Overgaard, Morten; Parner, Erik T; Vestergaard, Mogens; Schendel, Diana

2016-12-01

Epilepsy and autism spectrum disorder (ASD) often occur together in the same individual. However, it remains unknown whether siblings of children with ASD have an increased risk of epilepsy and vice versa. This study determines the risk of ASD and epilepsy among younger siblings of children with ASD and epilepsy. The study included all children born in Denmark between January 1, 1980 and 31 December 2006 who participated in follow-up until December 31, 2012 (1,663,302 children). We used Cox regression to calculate the adjusted hazard ratio (aHR) and the Kaplan-Meier method to calculate the cumulative incidence. The overall aHR of epilepsy in younger siblings increased by 70% (aHR 1.70, 95% confidence interval [CI] 1.34-2.16%) if the older sibling had ASD compared with siblings where the older sibling did not have ASD. The cumulative incidence of epilepsy at 20 years of age was 2.54% (95% CI 1.97-3.26%) if the older sibling had ASD, whereas the cumulative incidence of epilepsy at 20 years of age was 1.63% (95% CI 1.60-1.66%) if the older sibling did not have ASD. The overall aHR of ASD in younger siblings increased by 54% if the older sibling had epilepsy (aHR 1.54, 95% CI 1.32-1.80) compared with siblings where the older sibling did not have epilepsy. The cumulative incidence of ASD at 20 years of age was 2.06% (95% CI 1.84-2.32%) if the older sibling had epilepsy, whereas the cumulative incidence of ASD at 20 years of age was 1.27% (95% CI 1.25-1.29%) if the older sibling did not have epilepsy. The cross-disorder sibling risk of epilepsy and ASD was increased for the two disorders, which suggests that genes or environmental factors shared by family members may play a causal role in the co-occurrence of ASD and epilepsy. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

Incident Detection of High-Risk Human Papillomavirus Infections in a Cohort of High-Risk Women Aged 25–65 Years

PubMed Central

Winer, Rachel L.; Hughes, James P.; Feng, Qinghua; Stern, Joshua E.; Xi, Long Fu; Koutsky, Laura A.

2016-01-01

Background. The risk of incident high-risk human papillomavirus (HR-HPV) infection associated with recent sexual behaviors is undefined in mid-adult women (defined as women aged 25–65 years). Methods. Triannually, 420 female online daters aged 25–65 years submitted vaginal specimens for HPV testing and completed health and sexual behavior questionnaires. The cumulative incidence of and risk factors for incident HR-HPV detection were estimated by Kaplan–Meier and Cox proportional hazards methods. Results. The 12-month cumulative incidence of HR-HPV detection was 25.4% (95% confidence interval [CI], 21.3%–30.1%). Current hormonal contraceptive use was positively associated with incident HR-HPV detection. Lifetime number of male sex partners was also positively associated but only among women not recently sexually active with male partners. In analysis that adjusted for hormonal contraceptive use and marital status, women reporting multiple male partners or male partners who were new, casual, or had ≥1 concurrent partnership had a hazard of incident HR-HPV detection that was 2.81 times (95% CI, 1.38–5.69 times) that for women who reported no male sex partners in the past 6 months. Thus, among women with multiple male partners or male partners who were new, casual, or had ≥1 concurrent partnership, approximately 64% of incident HR-HPV infections were attributable to one of those partners. Conclusions. Among high-risk mid-adult women with recent new male partners, multiple male partners, or male partners who were casual or had ≥1 concurrent partnership, about two thirds of incident HR-HPV detections are likely new acquisitions, whereas about one third of cases are likely redetections of prior infections. PMID:27009602

Effect of dipyridamole plus aspirin on hemodialysis graft patency.

PubMed

Dixon, Bradley S; Beck, Gerald J; Vazquez, Miguel A; Greenberg, Arthur; Delmez, James A; Allon, Michael; Dember, Laura M; Himmelfarb, Jonathan; Gassman, Jennifer J; Greene, Tom; Radeva, Milena K; Davidson, Ingemar J; Ikizler, T Alp; Braden, Gregory L; Fenves, Andrew Z; Kaufman, James S; Cotton, James R; Martin, Kevin J; McNeil, James W; Rahman, Asif; Lawson, Jeffery H; Whiting, James F; Hu, Bo; Meyers, Catherine M; Kusek, John W; Feldman, Harold I

2009-05-21

Arteriovenous graft stenosis leading to thrombosis is a major cause of complications in patients undergoing hemodialysis. Procedural interventions may restore patency but are costly. Although there is no proven pharmacologic therapy, dipyridamole may be promising because of its known vascular antiproliferative activity. We conducted a randomized, double-blind, placebo-controlled trial of extended-release dipyridamole, at a dose of 200 mg, and aspirin, at a dose of 25 mg, given twice daily after the placement of a new arteriovenous graft until the primary outcome, loss of primary unassisted patency (i.e., patency without thrombosis or requirement for intervention), was reached. Secondary outcomes were cumulative graft failure and death. Primary and secondary outcomes were analyzed with the use of a Cox proportional-hazards regression with adjustment for prespecified covariates. At 13 centers in the United States, 649 patients were randomly assigned to receive dipyridamole plus aspirin (321 patients) or placebo (328 patients) over a period of 4.5 years, with 6 additional months of follow-up. The incidence of primary unassisted patency at 1 year was 23% (95% confidence interval [CI], 18 to 28) in the placebo group and 28% (95% CI, 23 to 34) in the dipyridamole-aspirin group, an absolute difference of 5 percentage points. Treatment with dipyridamole plus aspirin significantly prolonged the duration of primary unassisted patency (hazard ratio, 0.82; 95% CI, 0.68 to 0.98; P=0.03) and inhibited stenosis. The incidences of cumulative graft failure, death, the composite of graft failure or death, and serious adverse events (including bleeding) did not differ significantly between study groups. Treatment with dipyridamole plus aspirin had a significant but modest effect in reducing the risk of stenosis and improving the duration of primary unassisted patency of newly created grafts. (ClinicalTrials.gov number, NCT00067119.) 2009 Massachusetts Medical Society

Lifetime trauma exposure and prospective cardiovascular events and all-cause mortality: findings from the Heart and Soul Study.

PubMed

Hendrickson, Carolyn M; Neylan, Thomas C; Na, Beeya; Regan, Mathilda; Zhang, Qian; Cohen, Beth E

2013-01-01

Little is known about the effect of cumulative psychological trauma on health outcomes in patients with cardiovascular disease. The objective of this study was to prospectively examine the association between lifetime trauma exposure and recurrent cardiovascular events or all-cause mortality in patients with existing cardiovascular disease. A total of 1021 men and women with cardiovascular disease were recruited in 2000 to 2002 and followed annually. Trauma history and psychiatric comorbidities were assessed at baseline using the Computerized Diagnostic Interview Schedule for DSM-IV. Health behaviors were assessed using standardized questionnaires. Outcome data were collected annually, and all medical records were reviewed by two independent, blinded physician adjudicators. We used Cox proportional hazards models to evaluate the association between lifetime trauma exposure and the composite outcome of cardiovascular events and all-cause mortality. During an average of 7.5 years of follow-up, there were 503 cardiovascular events and deaths. Compared with the 251 participants in the lowest trauma exposure quartile, the 256 participants in the highest exposure quartile had a 38% greater risk of adverse outcomes (hazard ratio = 1.38, 95% confidence interval = 1.06-1.81), adjusted for age, sex, race, income, education, depression, posttraumatic stress disorder, generalized anxiety disorder, smoking, physical inactivity, and illicit drug abuse. Cumulative exposure to psychological trauma was associated with an increased risk of recurrent cardiovascular events and mortality, independent of psychiatric comorbidities and health behaviors. These data add to a growing literature showing enduring effects of repeated trauma exposure on health that are independent of trauma-related psychiatric disorders such as depression and posttraumatic stress disorder.

The pulse-mass index as a predictor of cardiovascular events in women with systemic lupus erythematosus.

PubMed

García-Villegas, Elsy Aidé; Márquez-González, Horacio; Flores-Suárez, Luis Felipe; Villa-Romero, Antonio Rafael

2017-01-20

Patients with systemic lupus erythematosus (SLE) have 3times the risk of death compared to the rest of the population, with cardiovascular events (CVD) being one of the main causes. Índices such as waist-height (W-Ht I), waist-hip (W-Hp I) and pulse-mass (PMI) predict CVD, though the behaviour is unknown in patients with SLE. The aim of this study was to determine the prognostic value of PMI in the development of CVD in premenopausal women with SLE. Cohort study. Included were premenopausal women with SLE without prior CVD; excluded were those patients with antiphospholipid syndrome (APS), pregnancy, thyroid disease, recent liposuction, and chronic kidney disease. Exposure variables were: PMI, W-Ht I, W-Hp I and metabolic syndrome at onset of the cohort. Considered confounding variables were time of evolution, disease activity, cumulative damage and treatment. Through semi-annual appointments, accident and emergency admittance and hospitalisation records the CVD were screened. Analysis was performed with Cox for proportional hazards and survival with Kaplan Meier. We included 238 women with a median age of 31 (18-52) years, with a follow-up of 8years. We identified 22 (9.6%) cases of CVD. In the Cox proportional hazards analysis, the prognostic variables were: PMI with HR=8.1 (95% CI: 1.1-65), metabolic syndrome with 2.4 (95% CI: 1-5.8), cumulative damage with HR=1.5 (95% CI: 1.1-2.2) and body fat percentage HR=2.8 (95% CI: 1.1-6.9) CONCLUSIONS: The PMI is a better predictor factor of CVD in women with SLE. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Corneal inflammatory events with daily silicone hydrogel lens wear.

PubMed

Szczotka-Flynn, Loretta; Jiang, Ying; Raghupathy, Sangeetha; Bielefeld, Roger A; Garvey, Matthew T; Jacobs, Michael R; Kern, Jami; Debanne, Sara M

2014-01-01

This study aimed to determine the probability and risk factors for developing a corneal inflammatory event (CIE) during daily wear of lotrafilcon A silicone hydrogel contact lenses. Eligible participants (n = 218) were fit with lotrafilcon A lenses for daily wear and followed up for 12 months. Participants were randomized to either a polyhexamethylene biguanide-preserved multipurpose solution or a one-step peroxide disinfection system. The main exposures of interest were bacterial contamination of lenses, cases, lid margins, and ocular surface. Kaplan-Meier (KM) plots were used to estimate the cumulative unadjusted probability of remaining free from a CIE, and multivariate Cox proportional hazards regression was used to model the hazard of experiencing a CIE. The KM unadjusted cumulative probability of remaining free from a CIE for both lens care groups combined was 92.3% (95% confidence interval [CI], 88.1 to 96.5%). There was one participant with microbial keratitis, five participants with asymptomatic infiltrates, and seven participants with contact lens peripheral ulcers, providing KM survival estimates of 92.8% (95% CI, 88.6 to 96.9%) and 98.1% (95% CI, 95.8 to 100.0%) for remaining free from noninfectious and symptomatic CIEs, respectively. The presence of substantial (>100 colony-forming units) coagulase-negative staphylococci bioburden on lid margins was associated with about a five-fold increased risk for the development of a CIE (p = 0.04). The probability of experiencing a CIE during daily wear of lotrafilcon A contact lenses is low, and symptomatic CIEs are rare. Patient factors, such as high levels of bacterial bioburden on lid margins, contribute to the development of noninfectious CIEs during daily wear of silicone hydrogel lenses.

Cardiac surgery in patients with congenital heart disease is associated with acute kidney injury and the risk of chronic kidney disease.

PubMed

Madsen, Nicolas L; Goldstein, Stuart L; Frøslev, Trine; Christiansen, Christian F; Olsen, Morten

2017-09-01

Cardiac surgery associated-acute kidney injury (CS-AKI) occurs in 30-50% of patients undergoing surgery for congenital heart disease. Here we determine if CS-AKI is associated with chronic kidney disease (CKD) in patients with congenital heart disease. Using Danish regional population-based registries, our cohort study included patients with congenital heart disease born between 1990-2010 with first cardiac surgery between 2005 and 2010 (under 15 years of age). Utilizing in- and out-patient laboratory serum creatinine data, we identified individuals fulfilling KDIGO stages of AKI within 5 days of cardiac surgery. A unique personal identifier enabled unambiguous data linkage and virtually complete follow-up. The cumulative incidences of CKD stages 2-5 according to presence of CS-AKI were computed utilizing serum creatinine values and Pottel's formula. Using Cox regression, the corresponding hazard ratios were computed, adjusting for sex, age at first cardiac surgery, calendar period of surgery, and congenital heart disease severity. Of 382 patients with congenital heart disease undergoing cardiac surgery, 127 experienced CS-AKI within 5 days of surgery. Median follow-up was 4.9 years. The five-year cumulative incidence of CKD for patients with CS-AKI was 12% (95% confidence interval 7%-20%), significantly higher than the 3% (1%-5%) for those without CS-AKI with a significant adjusted hazard ratio of 3.8 (1.4-10.4). Thus, CS-AKI in patients with congenital heart disease is common and is associated with an increased risk for CKD. Copyright © 2017 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

Bounding Analysis of Drinking Water Health Risks from a Spill of Hydraulic Fracturing Flowback Water.

PubMed

Rish, William R; Pfau, Edward J

2018-04-01

A bounding risk assessment is presented that evaluates possible human health risk from a hypothetical scenario involving a 10,000-gallon release of flowback water from horizontal fracturing of Marcellus Shale. The water is assumed to be spilled on the ground, infiltrates into groundwater that is a source of drinking water, and an adult and child located downgradient drink the groundwater. Key uncertainties in estimating risk are given explicit quantitative treatment using Monte Carlo analysis. Chemicals that contribute significantly to estimated health risks are identified, as are key uncertainties and variables to which risk estimates are sensitive. The results show that hypothetical exposure via drinking water impacted by chemicals in Marcellus Shale flowback water, assumed to be spilled onto the ground surface, results in predicted bounds between 10 -10 and 10 -6 (for both adult and child receptors) for excess lifetime cancer risk. Cumulative hazard indices (HI CUMULATIVE ) resulting from these hypothetical exposures have predicted bounds (5th to 95th percentile) between 0.02 and 35 for assumed adult receptors and 0.1 and 146 for assumed child receptors. Predicted health risks are dominated by noncancer endpoints related to ingestion of barium and lithium in impacted groundwater. Hazard indices above unity are largely related to exposure to lithium. Salinity taste thresholds are likely to be exceeded before drinking water exposures result in adverse health effects. The findings provide focus for policy discussions concerning flowback water risk management. They also indicate ways to improve the ability to estimate health risks from drinking water impacted by a flowback water spill (i.e., reducing uncertainty). © 2017 Society for Risk Analysis.

Increased incidence of cancer observed in HIV/hepatitis C virus-coinfected patients versus HIV-monoinfected.

PubMed

Meijide, Héctor; Pértega, Sonia; Rodríguez-Osorio, Iria; Castro-Iglesias, Ángeles; Baliñas, Josefa; Rodríguez-Martínez, Guillermo; Mena, Álvaro; Poveda, Eva

2017-05-15

Cancer is a growing problem in persons living with HIV infection (PLWH) and hepatitis C virus (HCV) coinfection could play an additional role in carcinogenesis. Herein, all cancers in an HIV-mono and HIV/HCV-coinfected cohort were evaluated and compared to identify any differences between these two populations. A retrospective cohort study was conducted including all cancers in PLWH between 1993 and 2014. Cancers were classified in two groups: AIDS-defining cancer (ADC) and non-AIDS-defining cancer (NADC). Cancer incidence rates were calculated and compared with that observed in the Spanish general population (GLOBOCAN, 2012), computing the standardized incidence ratios (SIRs). A competing risk approach was used to estimate the probability of cancer after HIV diagnosis. Cumulative incidence in HIV-monoinfected and HIV/HCV-coinfected patients was also compared using multivariable analysis. A total of 185 patients (117 HIV-monoinfected and 68 HIV/HCV) developed cancer in the 26 580 patient-years cohort, with an incidence rate of 696 cancers per 100 000 person-years, higher than in the general population (SIR = 3.8). The incidence rate of NADC in HIV/HCV-coinfected patients was 415.0 (SIR = 3.4), significantly higher than in monoinfected (377.3; SIR = 1.8). After adjustments, HIV/HCV-coinfected patients had a higher cumulative incidence of NADC than HIV-monoinfected (adjusted hazard ratio = 1.80), even when excluding hepatocellular carcinomas (adjusted hazard ratio = 1.26). PLWH have a higher incidence of NADC than the general population and HCV-coinfection is associated with a higher incidence of NADC. These data justify the need for prevention strategies in these two populations and the importance of eradicating HCV.

Fertility of Male Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

PubMed Central

Green, Daniel M.; Kawashima, Toana; Stovall, Marilyn; Leisenring, Wendy; Sklar, Charles A.; Mertens, Ann C.; Donaldson, Sarah S.; Byrne, Julianne; Robison, Leslie L.

2010-01-01

Purpose This study was undertaken to determine the effect of treatment for childhood cancer on male fertility. Patients and Methods We reviewed the fertility of male Childhood Cancer Survivor Study survivor and sibling cohorts who completed a questionnaire. We abstracted the chemotherapeutic agents administered, the cumulative dose of drug administered for selected drugs, and the doses and volumes of all radiation therapy from medical records. Risk factors for siring a pregnancy were evaluated using Cox proportional hazards models. Results The 6,224 survivors age 15 to 44 years who were not surgically sterile were less likely to sire a pregnancy than siblings (hazard ratio [HR], 0.56; 95% CI, −0.49 to 0.63). Among survivors, the HR of siring a pregnancy was decreased by radiation therapy of more than 7.5 Gy to the testes (HR, 0.12; 95% CI, −0.02 to 0.64), higher cumulative alkylating agent dose (AAD) score or treatment with cyclophosphamide (third tertile HR, 0.42; 95% CI, −0.31 to 0.57) or procarbazine (second tertile HR, 0.48; 95% CI, −0.26 to 0.87; third tertile HR, 0.17; 95% CI, −0.07 to 0.41). Compared with siblings, the HR for ever siring a pregnancy for survivors who had an AAD score = 0, a hypothalamic/pituitary radiation dose = 0 Gy, and a testes radiation dose = 0 Gy was 0.91 (95% CI, 0.73 to 1.14; P = .41). Conclusion This large study identified risk factors for decreased fertility that may be used for counseling male cancer patients. PMID:19949008

Pesticide exposure and end-stage renal disease risk among wives of pesticide applicators in the Agricultural Health Study.

PubMed

Lebov, Jill F; Engel, Lawrence S; Richardson, David; Hogan, Susan L; Sandler, Dale P; Hoppin, Jane A

2015-11-01

Pesticide exposure has been found to cause renal damage and dysfunction in experimental studies, but epidemiological research on the renal effects of chronic low-level pesticide exposure is limited. We investigated the relationships between end-stage renal disease (ESRD) among wives of licensed pesticide applicators (N=31,142) in the Agricultural Health Study (AHS) and (1) personal pesticide use, (2) exposure to the husband's pesticide use, and (3) other pesticide-associated farming and household activities. AHS participants reported pesticide exposure via self-administered questionnaires at enrollment (1993-1997). ESRD cases were identified via linkage to the United States Renal Data System. Associations between ESRD and pesticide exposures were estimated with Cox proportional hazard regression models controlling for age at enrollment. Models of associations with farming and household factors were additionally adjusted for personal use of pesticides. We identified 98 ESRD cases diagnosed between enrollment and 31 December 2011. Although women who ever applied pesticides (56% of cohort) were less likely than those who did not apply to develop ESRD (Hazard Ratio (HR): 0.42; 95% CI: 0.28, 0.64), among women who did apply pesticides, the rate of ESRD was significantly elevated among those who reported the highest (vs. lowest) cumulative general pesticide use (HR: 4.22; 95% CI: 1.26, 14.20). Among wives who never applied pesticides, ESRD was associated with husbands' ever use of paraquat (HR=1.99; 95% CI: 1.14, 3.47) and butylate (HR=1.71; 95% CI: 1.00, 2.95), with a positive exposure-response pattern for husband's cumulative use of these pesticides. ESRD may be associated with direct and/or indirect exposure to pesticides among farm women. Future studies should evaluate indirect exposure risk among other rural populations. Published by Elsevier Inc.

Impact of Tacrolimus Compared With Cyclosporin on the Incidence of Acute Allograft Rejection in Human Immunodeficiency Virus-Positive Kidney Transplant Recipients.

PubMed

Gathogo, Esther; Harber, Mark; Bhagani, Sanjay; Levy, Jeremy; Jones, Rachael; Hilton, Rachel; Davies, Graham; Post, Frank A

2016-04-01

Kidney transplantation (KT) of human immunodeficiency virus (HIV)-positive patients has transformed the management of end-stage kidney disease in this population. Although favourable outcomes have been reported, patients experience high rates of acute allograft rejection (AR). We examined factors associated with AR in the first year after KT, with particular emphasis on the choice of calcineurin inhibitor (CNI) immunosuppressive therapy. We conducted a national observational cohort study of HIV/KT in the United Kingdom. Patients were included if HIV positive at KT, transplanted in the United Kingdom between January 2005 and December 2013, and did not experience primary graft failure. Kaplan-Meier methods were used to estimate host/graft survival and cumulative incidence of biopsy proven AR. Logrank tests were used to compare survival, and Cox proportional hazard models to examine factors associated with AR. Our study analyzed the incidence of AR in the first year after KT in 78 HIV-positive patients of whom 31 initiated cyclosporin (CsA) and 47 tacrolimus (Tac) based immunosuppression. AR was observed in 28 patients (36%) after a median of 2.6 (interquartile range, 0.5-5.9) months. The cumulative incidence of AR at 1 year was 58% and 21% among patients on CsA and Tac, respectively (P =0.003). Choice of CNI was the only factor significantly associated with AR (hazard ratio for Tac vs CsA 0.25 [95% confidence interval, 0.11-0.57], P = 0.001). Subtherapeutic CNI concentrations were common in the first 12 weeks after KT. Our data suggest that Tac may be the preferred CNI for use in KT in people living with HIV.

Outcomes of T1b esophageal adenocarcinoma patients.

PubMed

Tian, Jianmin; Prasad, Ganapathy A; Lutzke, Lori S; Lewis, Jason T; Wang, Kenneth K

2011-12-01

Esophagectomy is usually recommended for patients with submucosal esophageal adenocarcinoma (T1b EAC) because of the potential for lymph node metastasis (LNM). Endoscopic management often differs based on the risk of metastasis. There is limited information on the difference in outcomes for T1b-EAC with and without esophagectomy. To investigate (1) the outcomes of T1b EAC treatments with and without esophagectomy and (2) the percentage of LNM at esophagectomy for T1b-EAC. Retrospective cohort. A tertiary Barrett's esophagus unit. Sixty-eight T1b EAC patients based on EMR histology. Esophagectomy and endoscopic therapies. Survival duration and mortality rate. A total of 68 patients had T1b EAC; cumulative mortality rate was 30.9% and median survival duration was 39.5 months. Thirty-nine underwent esophagectomy and 29 did not. Among patients who underwent esophagectomy, 13 (33.3%) had LNM, and the mortality rate was 50.0% and 11.1% for those with and without LNM, respectively (P < .01). For those with and without esophagectomy, the cumulative mortality rates were 25.6% and 37.9%, and median survival duration was 48.9 and 34.8 months, respectively. There was no statistical difference in Charlson comorbidity index, number of EMRs, mortality rate, or survival duration. In Cox proportional hazard model analysis, the hazard ratio for esophagectomy was 0.5 (P = .21). Retrospective, nonrandomized small sample size cohort. Among the patients with T1b EAC found in EMR specimens who underwent esophagectomy, one third had regional LNM. In our small series, patients who underwent esophagectomy did not have a significantly different survival duration from that of those who did not, indicating that these patients may have similar outcomes [corrected]. Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Growth of Untreated Unruptured Small-sized Aneurysms (≺7mm): Incidence and Related Factors.

PubMed

Choi, Hyun Ho; Cho, Young Dae; Jeon, Jin Pyeong; Yoo, Dong Hyun; Moon, Jusun; Lee, Jeongjun; Kang, Hyun-Seung; Cho, Won-Sang; Kim, Jeong Eun; Zhang, Li; Han, Moon Hee

2018-06-01

The need to treat small (<7 mm) unruptured aneurysms is still controversial, despite data collected through several large cohort studies. Such lesions typically are incidental findings, usually followed for potential growth through serial imaging. For this study, growth estimates for untreated unruptured small-sized aneurysms were generated, examining incidence and related risk factors. A cohort of 135 consecutive patients harboring 173 untreated unruptured small-sized aneurysms (<7 mm) was subjected to extended monitoring (mean, 73.1 ± 30.0 months). Growth was defined as a 1-mm increase at minimum in one or more aneurysmal dimensions or as a significant change in shape. Medical records and radiological data were reviewed. Cumulative growth rate and related risk factors were analyzed via Cox proportional hazards regression and Kaplan-Meier product-limit estimator. A total of 28 aneurysms (16.2%) displayed growth during continued surveillance (1054.1 aneurysm-years). The annual growth rate was 2.65% per aneurysm-year, with 15 surfacing within 60 months and 13 after 60 months. Multivariate analysis indicated that bifurcation type was the sole significant risk factor (hazard ratio HR = 7.64; p < 0.001) in terms of growth. Cumulative survival rates without growth were significantly lower in subjects with bifurcation aneurysms than with side-wall aneurysms (p < 0.001). During the follow-up period, one patient suffered a subarachnoid hemorrhage and then aneurysm growth was detected. Most (83.8%) untreated unruptured small-sized aneurysms (<7 mm) remained stable and devoid of growth in long-term follow-up. Because bifurcation aneurysms were prone to eventual growth, careful long-term monitoring at regular intervals is advised if left untreated.

Green banana-supplemented diet in the home management of acute and prolonged diarrhoea in children: a community-based trial in rural Bangladesh.

PubMed

Rabbani, G H; Larson, C P; Islam, R; Saha, U R; Kabir, A

2010-10-01

To determine the effectiveness of green banana in the home management of acute (<7 days) or prolonged (≥ 7 days) diarrhoea at the community level. A cluster randomized field trial was conducted among 2968 Bangladeshi rural children 6-36 months old. Wards (villages) were randomly assigned to either a standard care group or a standard care plus green banana group where mothers were instructed to add cooked green banana to the diets of diarrhoeal children. Through a village-based surveillance system, diarrhoeal morbidity data (severity, duration, compliance) were collected for 14 days. Treatment effects were determined by analysing cumulative probability of cure by testing Cox proportional hazards models and relative risk (RR). The cumulative probability of cure was significantly (P < 0.001) different in children receiving GB for both acute [hazard ratio (HR) = 0.63 (95% CI: 0.56-0.67)] and prolonged diarrhoea [HR = 0.38 (95% CI: 0.26-0.59)]. The recovery rates of children with acute diarrhoea receiving GB (vs. control) were significantly more by day 3: 79.9%vs. 53.3% [(RR) = 0.47, 95% CI: 0.41-0.55], (P < 0.001) and day 7: 96.6%vs. 89.1% (RR = 0.32; 0.22-0.46), (P < 0.001). Children with prolonged diarrhoea receiving green banana had significantly higher recovery rates by day 10: 79.8%vs. 51.9% (RR = 0.42; 0.23-0.73), (P < 0.001) and day 14: 93.6%vs. 67.2% (RR = 0.22; 0.08-0.54), (P < 0.001). A green banana-supplemented diet hastened recovery of acute and prolonged childhood diarrhoea managed at home in rural Bangladesh. © 2010 Blackwell Publishing Ltd.

Risk of Colorectal Cancer Among Caucasian and African American Veterans with Ulcerative Colitis

PubMed Central

Hou, Jason K.; Kramer, Jennifer R.; Richardson, Peter; Mei, Minghua; El-Serag, Hashem B.

2014-01-01

Background African Americans are at an increased risk of developing sporadic colorectal cancer (CRC) compared to Caucasians. Ulcerative colitis (UC) is a risk factor for developing CRC; however, risk differences for CRC between African Americans and Caucasians with UC are unknown. Methods We performed a cohort study of patients with a diagnosis of UC during fiscal years 1998 to 2009 using the national Veterans Affairs administrative datasets. Cumulative CRC incidence rates and incidence rate ratios were calculated and Cox proportional hazards models were used to examine the association between race and the CRC risk. Results The cohort comprised of 20,949 patients with UC. A total of 168 incident cases of CRC were identified during 112,243 patient-years (PY) of follow-up; overall CRC incidence rate was 163/100,000 PY (95% confidence interval [CI] 139–187/100,000 PY). The CRC incidence rates were 158/100,000 PY (95% CI 134–181/100,000 PY) and 180/100,000 PY (95% CI 155–205/100,000 PY) in Caucasians and African Americans, respectively, with an incidence rate ratio of 1.17 (95% CI 0.69–1.97). The 3, 5, and 10-year cumulative incidence rates for CRC were 0.36%, 0.76%, 1.79% for African Americans and 0.41%, 0.76%, 1.43% for Caucasians. African Americans were not at an increased risk for CRC (adjusted hazard ratio: 1.10, 95% CI 0.65–1.87) compared to Caucasians. Conclusions In a national cohort of UC patients the risk of developing CRC in African Americans was no higher than in Caucasians. The reasons for lack of racial differences compared to sporadic CRC are not clear; access to care, genetic factors, and molecular pathways require further study. PMID:22334479

Freedom Solo Versus Trifecta Bioprotheses: Clinical and Hemodynamic Evaluation after Propensity Score Matching.

PubMed

J Cerqueira, Rui; Melo, Renata; Moreira, Soraia; A Saraiva, Francisca; Andrade, Marta; Salgueiro, Elson; Almeida, Jorge; J Amorim, Mário; Pinho, Paulo; Lourenço, André; F Leite-Moreira, Adelino

2017-01-01

To compare stentless Freedom Solo and stented Trifecta aortic bioprostheses regarding hemodynamic profile, left ventricular mass regression, early and late postoperative outcomes and survival. Longitudinal cohort study of consecutive patients undergoing aortic valve replacement (from 2009 to 2016) with either Freedom Solo or Trifecta at one centre. Local databases and national records were queried. Postoperative echocardiography (3-6 months) was obtained for hemodynamic profile (mean transprosthetic gradient and effective orifice area) and left ventricle mass determination. After propensity score matching (21 covariates), Kaplan-Meier analysis and cumulative incidence analysis were performed for survival and combined outcome of structural valve deterioration and endocarditis, respectively. Hemodynamics and left ventricle mass regression were assessed by a mixed- -effects model including propensity score as a covariate. From a total sample of 397 Freedom Solo and 525 Trifecta patients with a median follow-up time of 4.0 (2.2- 6.0) and 2.4 (1.4-3.7) years, respectively, a matched sample of 329 pairs was obtained. Well-balanced matched groups showed no difference in survival (hazard ratio=1.04, 95% confidence interval=0.69-1.56) or cumulative hazards of combined outcome (subhazard ratio=0.54, 95% confidence interval=0.21-1.39). Although Trifecta showed improved hemodynamic profile compared to Freedom Solo, no differences were found in left ventricle mass regression. Trifecta has a slightly improved hemodynamic profile compared to Freedom Solo but this does not translate into differences in the extent of mass regression, postoperative outcomes or survival, which were good and comparable for both bioprostheses. Long-term follow-up is needed for comparisons with older models of bioprostheses.

Children's Executive Function in a CPS-Involved Sample: Effects of Cumulative Adversity and Specific Types of Adversity.

PubMed

Roos, Leslie E; Kim, Hyoun K; Schnabler, Simone; Fisher, Philip A

2016-12-01

Prior research has identified the presence of executive function (EF) deficits in child protective service (CPS) involved (versus non-involved) children but minimal work has examined predictors that might explain individual differences within these CPS-involved children. Here, we sought to characterize EF in a large sample (N=694) of CPS-involved children and examine how specific adversities (physical abuse, neglect, caregiver domestic violence, and caregiver substance dependence) and cumulative adversity (at ages 0-3 and 3-6 years) predict EF (at approximately 5-6 years). It was expected that the sample would exhibit low EF overall based on previous research in maltreated children. Specific adversity and cumulative adversity analyses were largely exploratory given the limited previous work in this area. Results indicated poor EF overall, with 43.5% of children performing worse than chance. Amongst children who performed greater than chance, higher cumulative adversity, physical abuse, and caregiver substance use (at ages 3-6 years) predicted better EF. These findings join literature documenting that, within CPS-involved children, the presence of certain adversities predicts variable cognitive function. Findings highlight the potential relevance of evolutionary psychology to understanding how alterations in behavior linked to harsh and unpredictable early environments may cue accelerated brain development underlying relative cognitive advantages, within at-risk, low performing samples. Longitudinal studies are critical to determine if the relative EF advantages linked to higher adversity persist over time or result in lower EF later on, reflecting a more rapid, but overall limited, trajectory of cognitive development.

Climate variability and increase in intensity and magnitude of dengue incidence in Singapore

PubMed Central

Hii, Yien Ling; Rocklöv, Joacim; Ng, Nawi; Tang, Choon Siang; Pang, Fung Yin; Sauerborn, Rainer

2009-01-01

Introduction Dengue is currently a major public health burden in Asia Pacific Region. This study aims to establish an association between dengue incidence, mean temperature and precipitation, and further discuss how weather predictors influence the increase in intensity and magnitude of dengue in Singapore during the period 2000–2007. Materials and methods Weekly dengue incidence data, daily mean temperature and precipitation and the midyear population data in Singapore during 2000–2007 were retrieved and analysed. We employed a time series Poisson regression model including time factors such as time trends, lagged terms of weather predictors, considered autocorrelation, and accounted for changes in population size by offsetting. Results The weekly mean temperature and cumulative precipitation were statistically significant related to the increases of dengue incidence in Singapore. Our findings showed that dengue incidence increased linearly at time lag of 5–16 and 5–20 weeks succeeding elevated temperature and precipitation, respectively. However, negative association occurred at lag week 17–20 with low weekly mean temperature as well as lag week 1–4 and 17–20 with low cumulative precipitation. Discussion As Singapore experienced higher weekly mean temperature and cumulative precipitation in the years 2004–2007, our results signified hazardous impacts of climate factors on the increase in intensity and magnitude of dengue cases. The ongoing global climate change might potentially increase the burden of dengue fever infection in near future. PMID:20052380

Dementia incidence and predictors in cerebral amyloid angiopathy patients without intracerebral hemorrhage.

PubMed

Xiong, Li; Boulouis, Gregoire; Charidimou, Andreas; Roongpiboonsopit, Duangnapa; Jessel, Michael J; Pasi, Marco; Reijmer, Yael D; Fotiadis, Panagiotis; Ayres, Alison; Merrill, Emily; Schwab, Kristin; Blacker, Deborah; Gurol, M Edip; Greenberg, Steven M; Viswanathan, Anand

2018-02-01

Cerebral amyloid angiopathy (CAA) is a common cause of cognitive impairment in older individuals. This study aimed to investigate predictors of dementia in CAA patients without intracerebral hemorrhage (ICH). A total of 158 non-demented patients from the Stroke Service or the Memory Clinic who met the modified Boston Criteria for probable CAA were included. At baseline, neuroimaging markers, including lobar microbleeds (cerebral microbleeds (CMBs)), white matter hyperintensities (WMH), cortical superficial siderosis (cSS), magnetic resonance imaging (MRI)-visible centrum semiovale perivascular spaces (CSO-PVS), lacunes, and medial temporal atrophy (MTA) were assessed. The overall burden of small vessel disease (SVD) for CAA was calculated by a cumulative score based on CMB number, WMH severity, cSS presence and extent and CSO-PVS severity. The estimated cumulative dementia incidence at 1 year was 14% (95% confidence interval (CI): 5%-23%), and 5 years 73% (95% CI: 55%, 84%). Age (hazard ratio (HR) 1.05 per year, 95% CI: 1.01-1.08, p = 0.007), presence of MCI status (HR 3.40, 95% CI: 1.97-6.92, p < 0.001), MTA (HR 1.71 per point, 95% CI: 1.26-2.32, p = 0.001), and SVD score (HR 1.23 per point, 95% CI: 1.20-1.48, p = 0.030) at baseline were independent predictors for dementia conversion in these patients. Cognitive deterioration of CAA patients appears attributable to cumulative changes, from both vasculopathic and neurodegenerative lesions.

Estimated Daily Intake and Cumulative Risk Assessment of Phthalates in the General Taiwanese after the 2011 DEHP Food Scandal

NASA Astrophysics Data System (ADS)

Chang, Jung-Wei; Lee, Ching-Chang; Pan, Wen-Harn; Chou, Wei-Chun; Huang, Han-Bin; Chiang, Hung-Che; Huang, Po-Chin

2017-03-01

A food scandal occurred in Taiwan in 2011 because the DEHP (di-2-ethylhexyl phthalate) had been intentionally used in food products. We assessed the daily intakes (DIs) and cumulative risk of phthalates in Taiwan’s general population after the scandal. The DIs of 6 phthalates, including di-n-butyl phthalate (DnBP), di-iso-butyl phthalate (DiBP), and DEHP, were evaluated using urinary phthalate metabolites. Hazard quotients of phthalates classified as affecting the reproductive (HQrep) and hepatic (HQhep) systems were assessed using cumulative approach. The creatinine-based model showed that the highest DI values in children 7-to 12- years-old were for DEHP (males: median: 4.79 μg/kg bw/d; females: median: 2.62 μg/kg bw/d). The 95th percentile (P95) of HQrep values were all >1 in the 7- to 12-year-old and 18- to 40-year-old male groups. The P95 of HQhep values were all >1 in the 7- to 18- year-old male groups. Most of the HQrep was attributable to the HQs of DnBP and DiBP (53.9-84.7%), and DEHP contributed most to HQhep (83.1-98.6%), which reveals that DnBP, DiBP and DEHP were the main risk of phthalate exposure for Taiwanese. Taiwan’s general population is widely exposed to DnBP, DiBP and DEHP, especially for young children.

Association of cumulative social risk with mortality and adverse cardiovascular disease outcomes.

PubMed

Erqou, Sebhat; Echouffo-Tcheugui, Justin B; Kip, Kevin E; Aiyer, Aryan; Reis, Steven E

2017-05-08

Quantifying the cumulative effect of social risk factors on cardiovascular disease (CVD) risk can help to better understand the sources of disparities in health outcomes. Data from the Heart Strategies Concentrating on Risk Evaluation (HeartSCORE) study were used to create an index of cumulative social risk (CSR) and quantify its association with incident CVD and all-cause mortality. CSR was defined by assigning a score of 1 for the presence of each of 4 social factors: i) racial minority status (Black race), ii) single living status, iii) low income, and iv) low educational level. Hazard ratios (HRs) were computed using Cox-regression models, adjusted for CVD risk factors. Over a median follow-up period of 8.3 years, 127 incident events were observed. The incidence of the primary outcome for subgroups of participants with 0, 1, and ≥2 CSR scores was 5.31 (95% CI, 3.40-7.22), 10.32 (7.16-13.49) and 17.80 (12.94-22.67) per 1000 person-years, respectively. Individuals with CSR score of 1 had an adjusted HR of 1.85 (1.15-2.97) for incident primary outcomes, compared to those with score of 0. The corresponding HR for individuals with CSR score of 2 or more was 2.58 (1.60-4.17). An accumulation of social risk factors independently increased the likelihood of CVD events and deaths in a cohort of White and Black individuals.

Using the abbreviated injury severity and Glasgow Coma Scale scores to predict 2-week mortality after traumatic brain injury.

PubMed

Timmons, Shelly D; Bee, Tiffany; Webb, Sharon; Diaz-Arrastia, Ramon R; Hesdorffer, Dale

2011-11-01

Prediction of outcome after traumatic brain injury (TBI) remains elusive. We tested the use of a single hospital Glasgow Coma Scale (GCS) Score, GCS Motor Score, and the Head component of the Abbreviated Injury Scale (AIS) Score to predict 2-week cumulative mortality in a large cohort of TBI patients admitted to the eight U.S. Level I trauma centers in the TBI Clinical Trials Network. Data on 2,808 TBI patients were entered into a centralized database. These TBI patients were categorized as severe (GCS score, 3-8), moderate (9-12), or complicated mild (13-15 with positive computed tomography findings). Intubation and chemical paralysis were recorded. The cumulative incidence of mortality in the first 2 weeks after head injury was calculated using Kaplan-Meier survival analysis. Cox proportional hazards regression was used to estimate the magnitude of the risk for 2-week mortality. Two-week cumulative mortality was independently predicted by GCS, GCS Motor Score, and Head AIS. GCS Severity Category and GCS Motor Score were stronger predictors of 2-week mortality than Head AIS. There was also an independent effect of age (<60 vs. ≥60) on mortality after controlling for both GCS and Head AIS Scores. Anatomic and physiologic scales are useful in the prediction of mortality after TBI. We did not demonstrate any added benefit to combining the total GCS or GCS Motor Scores with the Head AIS Score in the short-term prediction of death after TBI.

Parameter estimation techniques based on optimizing goodness-of-fit statistics for structural reliability

NASA Technical Reports Server (NTRS)

Starlinger, Alois; Duffy, Stephen F.; Palko, Joseph L.

1993-01-01

New methods are presented that utilize the optimization of goodness-of-fit statistics in order to estimate Weibull parameters from failure data. It is assumed that the underlying population is characterized by a three-parameter Weibull distribution. Goodness-of-fit tests are based on the empirical distribution function (EDF). The EDF is a step function, calculated using failure data, and represents an approximation of the cumulative distribution function for the underlying population. Statistics (such as the Kolmogorov-Smirnov statistic and the Anderson-Darling statistic) measure the discrepancy between the EDF and the cumulative distribution function (CDF). These statistics are minimized with respect to the three Weibull parameters. Due to nonlinearities encountered in the minimization process, Powell's numerical optimization procedure is applied to obtain the optimum value of the EDF. Numerical examples show the applicability of these new estimation methods. The results are compared to the estimates obtained with Cooper's nonlinear regression algorithm.

Structural Improvements of Flexible Pavements Using Geosynthetics for Base Course Reinforcement

DTIC Science & Technology

2009-10-01

as a function of cumulative ESALs measured in an unloaded condition....................................................................... 71 Figure...74 Figure 71 . Comparison of microstrains predicted by the FE model and measured by the...TR-09-11 71 0 1 2 3 4 5 6 7 x 10 6 110 120 130 140 150 160 170 180 190 200 Cumulative ESALs S tr es s (k P a) 100 mm AC 300 mm Base 150 mm AC 300

Cumulative childhood maltreatment and its dose-response relation with adult symptomatology: Findings in a sample of adult survivors of sexual abuse.

PubMed

Steine, Iris M; Winje, Dagfinn; Krystal, John H; Bjorvatn, Bjørn; Milde, Anne Marita; Grønli, Janne; Nordhus, Inger Hilde; Pallesen, Ståle

2017-03-01

In the present study, we examined the role of cumulative childhood maltreatment experiences for several health related outcomes in adulthood, including symptoms of psychological distress as well as perceived social support and hardiness. The sample comprised adult survivors of sexual abuse (N=278, 95.3% women, mean age at first abusive incident=6.4 years). One-way ANOVAs revealed a statistically significant dose-response relation between cumulative childhood maltreatment scores and self-reported symptoms of posttraumatic stress (PTSS), anxiety, depression, eating disorders, dissociation, insomnia, nightmare related distress, physical pain, emotional pain, relational problems, self-harm behaviors as well as on a measure of symptom complexity. Cumulative childhood maltreatment was also associated with lower levels of work functioning. An inverse dose-response relation was found for perceived social support and hardiness. Using a Bonferroni corrected alpha level, cumulative childhood maltreatment remained significantly associated with all outcome measures with the exception of eating disorder symptoms after controlling for abuse-related independent variables in hierarchical regression analyses. Results add to previous literature by showing that dose-response relation between cumulative childhood adversities and adult symptom outcomes could also be identified in a sample characterized by high exposure to adversities, and lends support to the notion put forth by previous authors that cumulative childhood adversities seem to be related to the severity of adult health outcomes in a rule-governed way. Copyright © 2017 Elsevier Ltd. All rights reserved.

Cumulative radiation exposure and associated cancer risk estimates for scoliosis patients: Impact of repetitive full spine radiography.

PubMed

Law, Martin; Ma, Wang-Kei; Lau, Damian; Chan, Eva; Yip, Lawrance; Lam, Wendy

2016-03-01

To quantitatively evaluate the cumulative effective dose and associated cancer risk for scoliotic patients undergoing repetitive full spine radiography during their diagnosis and follow up periods. Organ absorbed doses of full spine exposed scoliotic patients at different age were computer simulated with the use of PCXMC software. Gender specific effective dose was then calculated with the ICRP-103 approach. Values of lifetime attributable cancer risk for patients exposed at different age were calculated for both patient genders and for Asian and Western population. Mathematical fitting for effective dose and for lifetime attributable cancer risk, as function of exposed age, was analytically obtained to quantitatively estimate patient cumulated effective dose and cancer risk. The cumulative effective dose of full spine radiography with posteroanterior and lateral projection for patients exposed annually at age between 5 and 30 years using digital radiography system was calculated as 15mSv. The corresponding cumulative lifetime attributable cancer risk for Asian and Western population was calculated as 0.08-0.17%. Female scoliotic patients would be at a statistically significant higher cumulated cancer risk than male patients under the same full spine radiography protocol. We demonstrate the use of computer simulation and analytic formula to quantitatively obtain the cumulated effective dose and cancer risk at any age of exposure, both of which are valuable information to medical personnel and patients' parents concern about radiation safety in repetitive full spine radiography. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Quantification of soil water retention parameters using multi-section TDR-waveform analysis

NASA Astrophysics Data System (ADS)

Baviskar, S. M.; Heimovaara, T. J.

2017-06-01

Soil water retention parameters are important for describing flow in variably saturated soils. TDR is one of the standard methods used for determining water content in soil samples. In this study, we present an approach to estimate water retention parameters of a sample which is initially saturated and subjected to an incremental decrease in boundary head causing it to drain in a multi-step fashion. TDR waveforms are measured along the height of the sample at assumed different hydrostatic conditions at daily interval. The cumulative discharge outflow drained from the sample is also recorded. The saturated water content is obtained using volumetric analysis after the final step involved in multi-step drainage. The equation obtained by coupling the unsaturated parametric function and the apparent dielectric permittivity is fitted to a TDR wave propagation forward model. The unsaturated parametric function is used to spatially interpolate the water contents along TDR probe. The cumulative discharge outflow data is fitted with cumulative discharge estimated using the unsaturated parametric function. The weight of water inside the sample estimated at the first and final boundary head in multi-step drainage is fitted with the corresponding weights calculated using unsaturated parametric function. A Bayesian optimization scheme is used to obtain optimized water retention parameters for these different objective functions. This approach can be used for samples with long heights and is especially suitable for characterizing sands with a uniform particle size distribution at low capillary heads.

Effects of Antiretroviral Therapy and Depressive Symptoms on All-Cause Mortality Among HIV-Infected Women

PubMed Central

Todd, Jonathan V.; Cole, Stephen R.; Pence, Brian W.; Lesko, Catherine R.; Bacchetti, Peter; Cohen, Mardge H.; Feaster, Daniel J.; Gange, Stephen; Griswold, Michael E.; Mack, Wendy; Rubtsova, Anna; Wang, Cuiwei; Weedon, Jeremy; Anastos, Kathryn; Adimora, Adaora A.

2017-01-01

Abstract Depression affects up to 30% of human immunodeficiency virus (HIV)-infected individuals. We estimated joint effects of antiretroviral therapy (ART) initiation and depressive symptoms on time to death using a joint marginal structural model and data from a cohort of HIV-infected women from the Women's Interagency HIV Study (conducted in the United States) from 1998–2011. Among 848 women contributing 6,721 years of follow-up, 194 participants died during follow-up, resulting in a crude mortality rate of 2.9 per 100 women-years. Cumulative mortality curves indicated greatest mortality for women who reported depressive symptoms and had not initiated ART. The hazard ratio for depressive symptoms was 3.38 (95% confidence interval (CI): 2.15, 5.33) and for ART was 0.47 (95% CI: 0.31, 0.70). Using a reference category of women without depressive symptoms who had initiated ART, the hazard ratio for women with depressive symptoms who had initiated ART was 3.60 (95% CI: 2.02, 6.43). For women without depressive symptoms who had not started ART, the hazard ratio was 2.36 (95% CI: 1.16, 4.81). Among women reporting depressive symptoms who had not started ART, the hazard ratio was 7.47 (95% CI: 3.91, 14.3). We found a protective effect of ART initiation on mortality, as well as a harmful effect of depressive symptoms, in a cohort of HIV-infected women. PMID:28430844

Impact of community disadvantage and air pollution burden on geographic disparities of ovarian cancer survival in California.

PubMed

Vieira, Verónica M; Villanueva, Carolina; Chang, Jenny; Ziogas, Argyrios; Bristow, Robert E

2017-07-01

Ovarian cancer survival varies geographically throughout California. The objective of this study is to determine the impact of living in disadvantaged communities on spatial patterns of survival disparities. Including a bivariate spatial smooth of geographic location within the Cox proportional hazard models is an effective approach for spatial analyses of cancer survival. Women diagnosed with advanced Stage IIIC/IV epithelial ovarian cancer (1996-2006) were identified from the California Cancer Registry. The impact of living in disadvantaged communities, as measured by the California Office of Environmental Health Hazard Assessment cumulative CalEnviroScreen 2.0 score, on geographic disparities in survival was assessed while controlling for age, tumor characteristics, quality of care, and race. Community-level air quality indicators and socioeconomic status (SES) were also independently examined in secondary analyses. The Cox proportional hazard spatial methods are available in the MapGAM package implemented in R. An increase in the community disadvantage from the 5th (less disadvantage) to the 95th percentile (more disadvantage) was significantly associated with poorer ovarian cancer survival (hazard ratio [HR], 1.16; 95% confidence interval [CI], 1.07-1.26). Ozone levels and SES were the most influential indicators on geographic disparities that warrant further investigation. The use of a bivariate smoother of location within the survival model allows for more advanced spatial analyses for exploring potential air quality-related predictors of geographic disparities. Copyright © 2017. Published by Elsevier Inc.

Neuropsychological Correlates of Hazard Perception in Older Adults.

PubMed

McInerney, Katalina; Suhr, Julie

2016-03-01

Hazard perception, the ability to identify and react to hazards while driving, is of growing importance in driving research, given its strong relationship to real word driving variables. Furthermore, although poor hazard perception is associated with novice drivers, recent research suggests that it declines with advanced age. In the present study, we examined the neuropsychological correlates of hazard perception in a healthy older adult sample. A total of 68 adults age 60 and older who showed no signs of dementia and were active drivers completed a battery of neuropsychological tests as well as a hazard perception task. Tests included the Repeatable Battery for the Assessment of Neuropsychological Status, Wechsler Test of Adult Reading, Trail Making Test, Block Design, Useful Field of View, and the Delis-Kaplan Executive Function System Color Word Interference Test. Hazard perception errors were related to visuospatial/constructional skills, processing speed, memory, and executive functioning skills, with a battery of tests across these domains accounting for 36.7% of the variance in hazard perception errors. Executive functioning, particularly Trail Making Test part B, emerged as a strong predictor of hazard perception ability. Consistent with prior work showing the relationship of neuropsychological performance to other measures of driving ability, neuropsychological performance was associated with hazard perception skill. Future studies should examine the relationship of neuropsychological changes in adults who are showing driving impairment and/or cognitive changes associated with Mild Cognitive Impairment or dementia.

Landslide hazard in Bukavu (DR Congo): a geomorphological assessment in a data-poor context

NASA Astrophysics Data System (ADS)

Dewitte, Olivier; Mugaruka Bibentyo, Toussaint; Kulimushi Matabaro, Sylvain; Balegamire, Clarisse; Basimike, Joseph; Delvaux, Damien; Dille, Antoine; Ganza Bamulezi, Gloire; Jacobs, Liesbet; Michellier, Caroline; Monsieurs, Elise; Mugisho Birhenjira, Espoir; Nshokano, Jean-Robert; Nzolang, Charles; Kervyn, François

2017-04-01

Many cities in the Global South are known for facing an important increase in their population size. Many of them are then struggling with the sprawl of new settlements and very often urban planning and sustainable management policies are limited, if not non-existent. When those cities are set in landslide-prone environments, this situation is even more problematic. Despite these environmental constrains, landslide hazard assessments relevant for landscape planning remain rare. The objective of this research is to assess the landslide hazard in Bukavu, a city in DR Congo that is facing such a situation. We used a geomorphological approach (adapted from Cardinali et al., 2002) taking into account the data-poor context and the impact of anthropogenic activities. First, we built a multi-temporal historical inventory for a period of 60 years. A total of 151 landslides were mapped (largest landslide 1.5 km2). Their cumulative areas cover 29% of the urban territory and several types of processes are identified. Changes in the distribution and pattern of landslides allowed then to infer the possible evolution of the slopes, the most probable type of failures, and their expected frequency of occurrence and intensity. Despite this comprehensive inventory, hazard linked to the occurrence of new large deep-seated slides cannot be assessed due a scarcity of reliable data on the environmental factors controlling their occurrence. In addition, age estimation of the occurrence of some of the largest landslides refers to periods at the beginning of the Holocene where climatic and seismic conditions were probably different. Therefore, based on the inventory, we propose four hazard scenarios that coincide with today's environment. Hazard assessment was done for (1) reactivation of deep-seated slides, (2) occurrence of new small shallow slides, (3) rock falls, and (4) movements within existing landslides. Based on these assessments, we produced four hazard maps that indicate the zones where landslides may occur as well as the runout zones. Rock fall hazard concerns a very small portion of the urban territory. The other three hazards are much more widely spread. For these three scenarios, the hazard is the highest in areas that cover about 5 to 10% of the urban territory. The maps are presented in four classes. They present an information that can be easily used for further risk analysis and/or urban planning purposes.

Reducing Production Basis Risk through Rainfall Intensity Frequency (RIF) Indexes: Global Sensitivity Analysis' Implication on Policy Design

NASA Astrophysics Data System (ADS)

Muneepeerakul, Chitsomanus; Huffaker, Ray; Munoz-Carpena, Rafael

2016-04-01

The weather index insurance promises financial resilience to farmers struck by harsh weather conditions with swift compensation at affordable premium thanks to its minimal adverse selection and moral hazard. Despite these advantages, the very nature of indexing causes the presence of "production basis risk" that the selected weather indexes and their thresholds do not correspond to actual damages. To reduce basis risk without additional data collection cost, we propose the use of rain intensity and frequency as indexes as it could offer better protection at the lower premium by avoiding basis risk-strike trade-off inherent in the total rainfall index. We present empirical evidences and modeling results that even under the similar cumulative rainfall and temperature environment, yield can significantly differ especially for drought sensitive crops. We further show that deriving the trigger level and payoff function from regression between historical yield and total rainfall data may pose significant basis risk owing to their non-unique relationship in the insured range of rainfall. Lastly, we discuss the design of index insurance in terms of contract specifications based on the results from global sensitivity analysis.

Modelling road accident blackspots data with the discrete generalized Pareto distribution.

PubMed

Prieto, Faustino; Gómez-Déniz, Emilio; Sarabia, José María

2014-10-01

This study shows how road traffic networks events, in particular road accidents on blackspots, can be modelled with simple probabilistic distributions. We considered the number of crashes and the number of fatalities on Spanish blackspots in the period 2003-2007, from Spanish General Directorate of Traffic (DGT). We modelled those datasets, respectively, with the discrete generalized Pareto distribution (a discrete parametric model with three parameters) and with the discrete Lomax distribution (a discrete parametric model with two parameters, and particular case of the previous model). For that, we analyzed the basic properties of both parametric models: cumulative distribution, survival, probability mass, quantile and hazard functions, genesis and rth-order moments; applied two estimation methods of their parameters: the μ and (μ+1) frequency method and the maximum likelihood method; used two goodness-of-fit tests: Chi-square test and discrete Kolmogorov-Smirnov test based on bootstrap resampling; and compared them with the classical negative binomial distribution in terms of absolute probabilities and in models including covariates. We found that those probabilistic models can be useful to describe the road accident blackspots datasets analyzed. Copyright © 2014 Elsevier Ltd. All rights reserved.

Semiparametric regression analysis of interval-censored competing risks data.

PubMed

Mao, Lu; Lin, Dan-Yu; Zeng, Donglin

2017-09-01

Interval-censored competing risks data arise when each study subject may experience an event or failure from one of several causes and the failure time is not observed directly but rather is known to lie in an interval between two examinations. We formulate the effects of possibly time-varying (external) covariates on the cumulative incidence or sub-distribution function of competing risks (i.e., the marginal probability of failure from a specific cause) through a broad class of semiparametric regression models that captures both proportional and non-proportional hazards structures for the sub-distribution. We allow each subject to have an arbitrary number of examinations and accommodate missing information on the cause of failure. We consider nonparametric maximum likelihood estimation and devise a fast and stable EM-type algorithm for its computation. We then establish the consistency, asymptotic normality, and semiparametric efficiency of the resulting estimators for the regression parameters by appealing to modern empirical process theory. In addition, we show through extensive simulation studies that the proposed methods perform well in realistic situations. Finally, we provide an application to a study on HIV-1 infection with different viral subtypes. © 2017, The International Biometric Society.

Pioglitazone use and risk of bladder cancer in patients with type 2 diabetes: retrospective cohort study using datasets from four European countries.

PubMed

Korhonen, Pasi; Heintjes, Edith M; Williams, Rachael; Hoti, Fabian; Christopher, Solomon; Majak, Maila; Kool-Houweling, Leanne; Strongman, Helen; Linder, Marie; Dolin, Paul; Bahmanyar, Shahram

2016-08-16

 To evaluate the association between pioglitazone use and bladder cancer risk in patients with type 2 diabetes.  Retrospective cohort study using propensity score matched cohorts.  Healthcare databases from Finland, the Netherlands, Sweden, and the United Kingdom. Data comprised country specific datasets of linked records on prescriptions, hospitals, general practitioners, cancer, and deaths.  Patients with type 2 diabetes who initiated pioglitazone (n=56 337) matched with patients with type 2 diabetes in the same country exposed to diabetes drug treatments other than pioglitazone (n=317 109). Two matched cohorts were created, using a 1:1 fixed ratio (nearest match cohort) and a 1:10 variable ratio (multiple match cohort). Patients were matched on treatment history and propensity scores accounting for several variables associated with pioglitazone initiation.  Hazard ratios and 95% confidence intervals were estimated by Cox's proportional hazards model with adjustments for relevant confounders. To assess the robustness of the findings, several sensitivity and stratified analyses were performed.  In the cohort exposed to pioglitazone treatment, 130 bladder cancers occurred over a mean follow-up time of 2.9 years. In the nearest match and multiple match cohorts not exposed to pioglitazone treatment, 153 and 970 bladder cancers were recorded, with a mean follow‑up time of 2.8 and 2.9 years, respectively. With regards to bladder cancer risk, the adjusted hazard ratio for patients ever exposed versus never exposed to pioglitazone was 0.99 (95% confidence interval 0.75 to 1.30) and 1.00 (0.83 to 1.21) in the nearest and multiple match cohorts, respectively. Increasing duration of pioglitazone use and increasing cumulative dose were not associated with risk of bladder cancer (>48 months of pioglitazone use, adjusted hazard ratio 0.86 (0.44 to 1.66); >40 000 mg cumulative dose, 0.65 (0.33 to 1.26) in the nearest match cohort).  This study shows no evidence of an association between ever use of pioglitzone and risk of bladder cancer compared with never use, which is consistent with results from other recent studies that also included a long follow-up period.  Registered to the European Union electronic register of post-authorisation studies (EU PAS register no EUPAS3626). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Integration of MODIS data and Short Baseline Subset (SBAS) technique for land subsidence monitoring in Datong, China

NASA Astrophysics Data System (ADS)

Zhao, Chao-ying; Zhang, Qin; Yang, Chengsheng; Zou, Weibao

2011-07-01

Datong is located in the north of Shanxi Province, which is famous for its old-fashioned coal-mining preservation in China. Some serious issues such as land subsidence, ground fissures, mining collapse, and earthquake hazards have occurred over this area for a long time resulting in significant damages to buildings and roads. In order to monitor and mitigate these natural man-made hazards, Short Baseline Subsets (SBAS) InSAR technique with ten Envisat ASAR data is applied to detect the surface deformation over an area of thousands of square kilometers. Then, five MODIS data are used to check the atmospheric effects on InSAR interferograms. Finally, nine nonlinear land subsidence cumulative results during September 2004 and February 2008 are obtained. Based on the deformation data, three kinds of land subsidence are clearly detected, caused by mine extraction, underground water withdrawal and construction of new economic zones, respectively. The annual mean velocity of subsidence can reach 1 to 4 cm/year in different subsidence areas. A newly designed high-speed railway (HSR) with speeds of 350 km/h will cross through the Datong hi-tech zone. Special measures should be taken for the long run of this project. In addition, another two subsidence regions need further investigation to mitigate such hazards.

Effectiveness of cervical screening after age 60 years according to screening history: Nationwide cohort study in Sweden.

PubMed

Wang, Jiangrong; Andrae, Bengt; Sundström, Karin; Ploner, Alexander; Ström, Peter; Elfström, K Miriam; Dillner, Joakim; Sparén, Pär

2017-10-01

The relatively high incidence of cervical cancer in women at older ages is a continuing concern in countries with long-established cervical screening. Controversy remains on when and how to cease screening. Existing population-based studies on the effectiveness of cervical screening at older ages have not considered women's screening history. We performed a nationwide cohort study to investigate the incidence of cervical cancer after age 60 years and its association with cervical screening at age 61-65, stratified by screening history at age 51-60. Using the Total Population Register, we identified 569,132 women born between 1 January 1919 and 31 December 1945, resident in Sweden since age 51. Women's cytological screening records, cervical cancer occurrence, and FIGO stage (for those diagnosed with cancer) were retrieved from national registers and medical charts. We calculated the cumulative incidence of cervical cancer from age 61 to age 80 using a survival function considering competing risk, and estimated the hazard ratio (HR) of cervical cancer in relation to screening status at age 61-65 from Cox models, adjusted for birth cohort and level of education, conditioning on women's screening history in their 50s. In women unscreened in their 50s, the cumulative incidence up to age 80 was 5.0 per 1,000 women, and screening at age 61-65 was associated with a lower risk for cervical cancer (HR = 0.42, 95% CI 0.24-0.72), corresponding to a decrease of 3.3 cancer cases per 1,000 women. A higher cumulative incidence and similarly statistically significant risk decrease was seen for women with abnormal smears in their 50s. In women adequately or inadequately screened with only normal results between age 51 and age 60, the cumulative incidence of cervical cancer from age 61 to 80 was 1.6 and 2.5 per 1,000 women, respectively, and further screening at age 61-65 was not associated with statistically significant decreases of cervical cancer risk up to age 80, but with fewer cancer cases of advanced stages at age 61-65. Adjustment for potential lifestyle confounders was limited. In this study, cervical screening with cytology at age 61-65 was associated with a statistically significant reduction of subsequent cervical cancer risk for women who were unscreened, or screened with abnormalities, in their 50s. In women screened with normal results in their 50s, the risk for future cancer was not sizeable, and the risk reduction associated with continued screening appeared limited. These findings should inform the current debate regarding age and criteria to discontinue cervical screening.

CREATION OF A MODEL TO PREDICT SURVIVAL IN PATIENTS WITH REFRACTORY COELIAC DISEASE USING A MULTINATIONAL REGISTRY

PubMed Central

Rubio-Tapia, Alberto; Malamut, Georgia; Verbeek, Wieke H.M.; van Wanrooij, Roy L.J.; Leffler, Daniel A.; Niveloni, Sonia I.; Arguelles-Grande, Carolina; Lahr, Brian D.; Zinsmeister, Alan R.; Murray, Joseph A.; Kelly, Ciaran P.; Bai, Julio C.; Green, Peter H.; Daum, Severin; Mulder, Chris J.J.; Cellier, Christophe

2016-01-01

Background Refractory coeliac disease is a severe complication of coeliac disease with heterogeneous outcome. Aim To create a prognostic model to estimate survival of patients with refractory coeliac disease. Methods We evaluated predictors of 5-year mortality using Cox proportional hazards regression on subjects from a multinational registry. Bootstrap re-sampling was used to internally validate the individual factors and overall model performance. The mean of the estimated regression coefficients from 400 bootstrap models was used to derive a risk score for 5-year mortality. Results The multinational cohort was composed of 232 patients diagnosed with refractory coeliac disease across 7 centers (range of 11–63 cases per center). The median age was 53 years and 150 (64%) were women. A total of 51 subjects died during 5-year follow-up (cumulative 5-year all-cause mortality = 30%). From a multiple variable Cox proportional hazards model, the following variables were significantly associated with 5-year mortality: age at refractory coeliac disease diagnosis (per 20 year increase, hazard ratio = 2.21; 95% confidence interval: 1.38, 3.55), abnormal intraepithelial lymphocytes (hazard ratio = 2.85; 95% confidence interval: 1.22, 6.62), and albumin (per 0.5 unit increase, hazard ratio = 0.72; 95% confidence interval: 0.61, 0.85). A simple weighted 3-factor risk score was created to estimate 5-year survival. Conclusions Using data from a multinational registry and previously-reported risk factors, we create a prognostic model to predict 5-year mortality among patients with refractory coeliac disease. This new model may help clinicians to guide treatment and follow-up. PMID:27485029

Creation of a model to predict survival in patients with refractory coeliac disease using a multinational registry.

PubMed

Rubio-Tapia, A; Malamut, G; Verbeek, W H M; van Wanrooij, R L J; Leffler, D A; Niveloni, S I; Arguelles-Grande, C; Lahr, B D; Zinsmeister, A R; Murray, J A; Kelly, C P; Bai, J C; Green, P H; Daum, S; Mulder, C J J; Cellier, C

2016-10-01

Refractory coeliac disease is a severe complication of coeliac disease with heterogeneous outcome. To create a prognostic model to estimate survival of patients with refractory coeliac disease. We evaluated predictors of 5-year mortality using Cox proportional hazards regression on subjects from a multinational registry. Bootstrap resampling was used to internally validate the individual factors and overall model performance. The mean of the estimated regression coefficients from 400 bootstrap models was used to derive a risk score for 5-year mortality. The multinational cohort was composed of 232 patients diagnosed with refractory coeliac disease across seven centres (range of 11-63 cases per centre). The median age was 53 years and 150 (64%) were women. A total of 51 subjects died during a 5-year follow-up (cumulative 5-year all-cause mortality = 30%). From a multiple variable Cox proportional hazards model, the following variables were significantly associated with 5-year mortality: age at refractory coeliac disease diagnosis (per 20 year increase, hazard ratio = 2.21; 95% confidence interval, CI: 1.38-3.55), abnormal intraepithelial lymphocytes (hazard ratio = 2.85; 95% CI: 1.22-6.62), and albumin (per 0.5 unit increase, hazard ratio = 0.72; 95% CI: 0.61-0.85). A simple weighted three-factor risk score was created to estimate 5-year survival. Using data from a multinational registry and previously reported risk factors, we create a prognostic model to predict 5-year mortality among patients with refractory coeliac disease. This new model may help clinicians to guide treatment and follow-up. © 2016 John Wiley & Sons Ltd.

Association between divorce and risks for acute myocardial infarction.

PubMed

Dupre, Matthew E; George, Linda K; Liu, Guangya; Peterson, Eric D

2015-05-01

Divorce is a major life stressor that can have economic, emotional, and physical health consequences. However, the cumulative association between divorce and risks for acute myocardial infarction (AMI) is unknown. This study investigated the association between lifetime exposure to divorce and the incidence of AMI in US adults. We used nationally representative data from a prospective cohort of ever-married adults aged 45 to 80 years (n=15,827) who were followed biennially from 1992 to 2010. Approximately 14% of men and 19% of women were divorced at baseline and more than one third of the cohort had ≥1 divorce in their lifetime. In 200,524 person-years of follow-up, 8% (n=1211) of the cohort had an AMI and age-specific rates of AMI were consistently higher in those who were divorced compared with those who were continuously married (P<0.05). Results from competing-risk hazard models showed that AMI risks were significantly higher in women who had 1 divorce (hazard ratio, 1.24; 95% confidence interval, 1.01-1.55), ≥2 divorces (hazard ratio, 1.77; 95% confidence interval, 1.30-2.41), and among the remarried (hazard ratio, 1.35; 95% confidence interval, 1.07-1.70) compared with continuously married women after adjusting for multiple risk factors. Multivariable-adjusted risks were elevated only in men with a history of ≥2 divorces (hazard ratio, 1.30; 95% confidence interval, 1.02-1.66) compared with continuously married men. Men who remarried had no significant risk for AMI. Interaction terms for sex were not statistically significant. Divorce is a significant risk factor for AMI. The risks associated with multiple divorces are especially high in women and are not reduced with remarriage. © 2015 American Heart Association, Inc.

Occupational health hazards in the interventional laboratory: Time for a safer environment.

PubMed

Klein, Lloyd W; Miller, Donald L; Balter, Stephen; Laskey, Warren; Naito, Neil; Haines, David; Ross, Allan; Mauro, Matthew A; Goldstein, James A

2018-01-04

Over the past 30 years, the advent of fluoroscopically guided interventional procedures has resulted in dramatic increments in both X-ray exposure and physical demands that predispose interventionists to distinct occupational health hazards. The hazards of accumulated radiation exposure have been known for years, but until recently the other potential risks have been ill-defined and under-appreciated. The physical stresses inherent in this career choice appear to be associated with a predilection to orthopedic injuries, attributable in great part to the cumulative adverse effects of bearing the weight and design of personal protective apparel worn to reduce radiation risk and to the poor ergonomic design of interventional suites. These occupational health concerns pertain to cardiologists, radiologists and surgeons working with fluoroscopy, pain management specialists performing nonvascular fluoroscopic procedures, and the many support personnel working in these environments. This position paper is the work of representatives of the major societies of physicians who work in the interventional laboratory environment, and has been formally endorsed by all. In this paper, the available data delineating the prevalence of these occupational health risks is reviewed and ongoing epidemiological studies designed to further elucidate these risks are summarized. The main purpose is to publicly state speaking with a single voice that the interventional laboratory poses workplace hazards that must be acknowledged, better understood and mitigated to the greatest extent possible, and to advocate vigorously on behalf of efforts to reduce these hazards. Interventional physicians and their professional societies, working together with industry, should strive toward the ultimate zero radiation exposure work environment that would eliminate the need for personal protective apparel and prevent its orthopedic and ergonomic consequences. © 2008 Wiley-Liss, Inc. Copyright © 2008 Wiley‐Liss, Inc.

Geospatial Approach on Landslide Hazard Zonation Mapping Using Multicriteria Decision Analysis: A Study on Coonoor and Ooty, Part of Kallar Watershed, The Nilgiris, Tamil Nadu

NASA Astrophysics Data System (ADS)

Rahamana, S. Abdul; Aruchamy, S.; Jegankumar, R.

2014-12-01

Landslides are one of the critical natural phenomena that frequently lead to serious problems in hilly area, resulting to loss of human life and property, as well as causing severe damage to natural resources. The local geology with high degree of slope coupled with high intensity of rainfall along with unplanned human activities of the study area causes many landslides in this region. The present study area is more attracted by tourist throughout the year, so this area must be considered for preventive measures. Geospatial based Multicriteria decision analysis (MCDA) technique is increasingly used for landslide vulnerability and hazard zonation mapping. It enables the integration of different data layers with different levels of uncertainty. In this present study, it is used analytic hierarchy process (AHP) method to prepare landslide hazard zones of the Coonoor and Ooty, part of Kallar watershed, The Nilgiris, Tamil Nadu. The study was carried out using remote sensing data, field surveys and geographic information system (GIS) tools. The ten factors that influence landslide occurrence, such as elevation, slope aspect, slope angle, drainage density, lineament density, soil, precipitation, land use/land cover (LULC), distance from road and NDVI were considered. These factors layers were extracted from the various related spatial data's. These factors were evaluated, and then, the individual factor weight and class weight were assigned to each of the related factors. The Landslide Hazard Zone Index (LHZI) was calculated using Multicriteria decision analysis (MCDA) the technique based on the assigned weight and the rating is given by the Analytical Hierarchy Process (AHP) method. The final cumulative map of the study area was categorized into four hazard zones and classified as zone I to IV. There are 3.56% of the area comes under the hazard zone IV fallowed by 48.19% of the area comes under zone III, 43.63 % of the area in zone II and 4.61% of the area comes hazard zone I. Further resulted hazard zone map and landuse/landcover map are overlaid to check the hazard status, and existing inventory of known landslides within the present study area was compared with the resulting vulnerable and hazard zone maps. The landslide hazard zonation map is useful for landslide hazard prevention, mitigation, and improvement to society, and proper planning for land use and construction in the future.

Constrained multiple indicator kriging using sequential quadratic programming

NASA Astrophysics Data System (ADS)

Soltani-Mohammadi, Saeed; Erhan Tercan, A.

2012-11-01

Multiple indicator kriging (MIK) is a nonparametric method used to estimate conditional cumulative distribution functions (CCDF). Indicator estimates produced by MIK may not satisfy the order relations of a valid CCDF which is ordered and bounded between 0 and 1. In this paper a new method has been presented that guarantees the order relations of the cumulative distribution functions estimated by multiple indicator kriging. The method is based on minimizing the sum of kriging variances for each cutoff under unbiasedness and order relations constraints and solving constrained indicator kriging system by sequential quadratic programming. A computer code is written in the Matlab environment to implement the developed algorithm and the method is applied to the thickness data.

Serial and parallel attentive visual searches: evidence from cumulative distribution functions of response times.

PubMed

Sung, Kyongje

2008-12-01

Participants searched a visual display for a target among distractors. Each of 3 experiments tested a condition proposed to require attention and for which certain models propose a serial search. Serial versus parallel processing was tested by examining effects on response time means and cumulative distribution functions. In 2 conditions, the results suggested parallel rather than serial processing, even though the tasks produced significant set-size effects. Serial processing was produced only in a condition with a difficult discrimination and a very large set-size effect. The results support C. Bundesen's (1990) claim that an extreme set-size effect leads to serial processing. Implications for parallel models of visual selection are discussed.

Summability of Connected Correlation Functions of Coupled Lattice Fields

NASA Astrophysics Data System (ADS)

Lukkarinen, Jani; Marcozzi, Matteo; Nota, Alessia

2018-04-01

We consider two nonindependent random fields ψ and φ defined on a countable set Z. For instance, Z=Z^d or Z=Z^d× I, where I denotes a finite set of possible "internal degrees of freedom" such as spin. We prove that, if the cumulants of ψ and φ enjoy a certain decay property, then all joint cumulants between ψ and φ are ℓ _2-summable in the precise sense described in the text. The decay assumption for the cumulants of ψ and φ is a restricted ℓ _1 summability condition called ℓ _1-clustering property. One immediate application of the results is given by a stochastic process ψ _t(x) whose state is ℓ _1-clustering at any time t: then the above estimates can be applied with ψ =ψ _t and φ =ψ _0 and we obtain uniform in t estimates for the summability of time-correlations of the field. The above clustering assumption is obviously satisfied by any ℓ _1-clustering stationary state of the process, and our original motivation for the control of the summability of time-correlations comes from a quest for a rigorous control of the Green-Kubo correlation function in such a system. A key role in the proof is played by the properties of non-Gaussian Wick polynomials and their connection to cumulants

Lunar mission safety and rescue: Hazards analysis and safety requirements

NASA Technical Reports Server (NTRS)

1971-01-01

The results are presented of the hazards analysis which was concerned only with hazards to personnel and not with loss of equipment or property. Hazards characterization includes the definition of a hazard, the hazard levels, and the hazard groups. The analysis methodology is described in detail. The methodology was used to prepare the top level functional flow diagrams, to perform the first level hazards assessment, and to develop a list of conditions and situations requiring individual hazard studies. The 39 individual hazard study results are presented in total.

Assessment of burning characteristics of aircraft interior materials

NASA Technical Reports Server (NTRS)

Grand, A. F.; Valys, A. J.

1981-01-01

The performance of a series of seat cushion design constructions was compared based on their heat and smoke release characteristics. Tests were conducted in a room size calorimeter instrumented for measuring weight loss, rate of heat release, smoke and volatile decomposition products and the cumulative energy release. Baseline data were obtained from burn tests conducted on commercial airline salvage sets as a comparison with more advanced seat designs. A toxicological assessment of smoke and fire gases involved the exposure of test animals and their biological responses ascertained. Relative toxicological hazards of the combustion gases are discussed based on the animal response studies and the analysis of the combustion gases.

Human health effects of ozone reduction

NASA Technical Reports Server (NTRS)

1975-01-01

Modification of the stratosphere, such as a reduction in its equilibrium ozone content, could produce direct and indirect effects on human health. The direct hazard to humans would be caused by an increase in the cumulative amount of UV radiation reaching the earth's surface in the range of 285 to 340 nm, encompassing the UV-B or erythemal wavelength region of 280 to 320 nm. Exposing the susceptible human population to an increased total UV dosage of shorter wavelengths could increase skin cancer incidence. Although effects would be delayed by decades, for each 1% decrease in ozone the expected increase in skin cancer incidence would be on the order of 2%.

Engagement in paid work as a protective predictor of basic activities of daily living disability in Japanese urban and rural community-dwelling elderly residents: An 8-year prospective study.

PubMed

Fujiwara, Yoshinori; Shinkai, Shoji; Kobayashi, Erika; Minami, Ushio; Suzuki, Hiroyuki; Yoshida, Hideyo; Ishizaki, Tatsuro; Kumagai, Shu; Watanabe, Shuichiro; Furuna, Taketo; Suzuki, Takao

2016-01-01

To examine whether engaging in paid work is a predictor of maintaining good functional health among Japanese older adults in both urban and rural communities. We used the 8-year longitudinal Tokyo Metropolitan Institute of Gerontology Longitudinal Interdisciplinary Study on Aging with 306 and 675 persons aged 65-84 years from Koganei City (urban) and Nangai Village (rural), respectively, who are independent in basic activities of daily living (BADL). In order to examine the declining patterns in BADL and evaluate the predictive value of working status for future BADL disability, we applied the log-rank test of cumulative proportion curves and the Cox proportional hazard model by sex, controlling for age, research fields, years of education, marital state, chronic medical conditions, pain, instrumental activities of daily living (IADL), smoking status, exercise habits, life satisfaction, usual walking speed and serum albumin for evaluating the predictive value of working status at baseline for future BADL disability. In both areas, participants who were not working were more likely to decline in BADL than those working (P < 0.05), except for women in urban Koganei. Male participants who did not engage in paid work had a higher adjusted hazard ratio of onset of BADL disability, compared with those working, but this was not seen for female participants. Working might be protective from a decline in BADL only for men, but not for women. Regarding the difference of sex roles in conventional Japanese society, working would be an effective solution especially for men to participate in social activities. © 2015 Japan Geriatrics Society.

PROMAB-GIS: A GIS based Tool for Estimating Runoff and Sediment Yield in running Waters

NASA Astrophysics Data System (ADS)

Jenewein, S.; Rinderer, M.; Ploner, A.; Sönser, T.

2003-04-01

In recent times settlements have expanded, traffic and tourist activities have increased in most alpine regions. As a consequence, on the one hand humans and goods are affected by natural hazard processes more often, while on the other hand the demand for protection by both technical constructions and planning measures carried out by public authorities is growing. This situation results in an ever stronger need of reproducibility, comparability, transparency of all methods applied in modern natural hazard management. As a contribution to a new way of coping this situation Promab-GIS Version 1.0 has been developed. Promab-Gis has been designed as a model for time- and space-dependent determination of both runoff and bedload transport in rivers of small alpine catchment areas. The estimation of the unit hydrograph relies upon the "rational formula" and the time-area curves of the watershed. The time area diagram is a graph of cumulative drainage area contributing to discharge at the watershed outlet within a specified time of travel. The sediment yield is estimated for each cell of the channel network by determining the actual process type (erosion, transport or accumulation). Two types of transport processes are considered, sediment transport and debris flows. All functions of Promab-GIS are integrated in the graphical user interface of ArcView as pull-up menus and tool buttons. Hence the application of Promab-GIS does not rely on a sophisticated knowledge of GIS in general, respectively the ArcView software. However, despite the use of computer assistance, Promab-GIS still is an expert support system. In order to obtain plausible results, the users must be familiar with all the relevant processes controlling runoff and sediment yield in torrent catchments.

Reduction of hypoglycaemic events with a behavioural intervention: a randomized clinical trial for paediatric patients with Type 1 diabetes mellitus.

PubMed

Gee, B T; Nansel, T R; Liu, A

2017-03-01

To determine if a low-intensity, clinic-integrated behavioural intervention reduced the incidence of hypoglycaemic events in children with Type 1 diabetes. A total of 390 families with children with Type 1 diabetes were enrolled in a 2-year, randomized clinical trial of a behavioural intervention. The intervention was designed to improve diabetes management practices by targeting the family's diabetes problem-solving skills. Hypoglycaemic events were categorized in two groups: those treated by oral ingestion and those treated by parenteral therapy. Events were self-reported by participants at each clinic visit, which occurred approximately every 3-4 months. Analyses included two-sample t-tests, the mean cumulative function test, and the Cox proportional hazards model for recurrent events to compare the incidence between groups. Across the entire 2-year study period, the incidence of hypoglycaemic events treated by oral ingestion of glucose-rich foods and events requiring parenteral therapy did not significantly differ between study conditions; however, during the second year of participant enrolment, the incidence of events treated by oral ingestion in the intervention group was 13.6 per 100 person-years compared with 27.3 per 100 patient-years in the control group (P = 0.02). The hazard ratio of these events during the second year was 0.49 (95% CI 0.27-0.90; P = 0.02). Our findings suggest the need for a long-term (> 1 year) focus on the implementation of interventions targeting diabetes management in young people. Behavioural interventions targeting problem-solving skills could be considered as practical, non-pharmacological strategies to reduce hypoglycaemia in adolescents with Type 1 diabetes. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

Contribution of Maternal Antiretroviral Therapy and Breastfeeding to 24-Month Survival in Human Immunodeficiency Virus-Exposed Uninfected Children: An Individual Pooled Analysis of African and Asian Studies.

PubMed

Arikawa, Shino; Rollins, Nigel; Jourdain, Gonzague; Humphrey, Jean; Kourtis, Athena P; Hoffman, Irving; Essex, Max; Farley, Tim; Coovadia, Hoosen M; Gray, Glenda; Kuhn, Louise; Shapiro, Roger; Leroy, Valériane; Bollinger, Robert C; Onyango-Makumbi, Carolyne; Lockman, Shahin; Marquez, Carina; Doherty, Tanya; Dabis, François; Mandelbrot, Laurent; Le Coeur, Sophie; Rolland, Matthieu; Joly, Pierre; Newell, Marie-Louise; Becquet, Renaud

2018-05-17

Human immunodeficiency virus (HIV)-infected pregnant women increasingly receive antiretroviral therapy (ART) to prevent mother-to-child transmission (PMTCT). Studies suggest HIV-exposed uninfected (HEU) children face higher mortality than HIV-unexposed children, but most evidence relates to the pre-ART era, breastfeeding of limited duration, and considerable maternal mortality. Maternal ART and prolonged breastfeeding while on ART may improve survival, although this has not been reliably quantified. Individual data on 19 219 HEU children from 21 PMTCT trials/cohorts undertaken from 1995 to 2015 in Africa and Asia were pooled to estimate the association between 24-month mortality and maternal/infant factors, using random-effects Cox proportional hazards models. Adjusted attributable fractions of risks computed using the predict function in the R package "frailtypack" were used to estimate the relative contribution of risk factors to overall mortality. Cumulative incidence of death was 5.5% (95% confidence interval, 5.1-5.9) by age 24 months. Low birth weight (LBW <2500 g, adjusted hazard ratio (aHR, 2.9), no breastfeeding (aHR, 2.5), and maternal death (aHR, 11.1) were significantly associated with increased mortality. Maternal ART (aHR, 0.5) was significantly associated with lower mortality. At the population level, LBW accounted for 16.2% of 24-month mortality, never breastfeeding for 10.8%, mother not receiving ART for 45.6%, and maternal death for 4.3%; combined, these factors explained 63.6% of deaths by age 24 months. Survival of HEU children could be substantially improved if public health practices provided all HIV-infected mothers with ART and supported optimal infant feeding and care for LBW neonates.

Change in plasma Aß peptides and onset of dementia in adults with Down syndrome.

PubMed

Schupf, N; Zigman, W B; Tang, M-X; Pang, D; Mayeux, R; Mehta, P; Silverman, W

2010-11-02

To examine changes in levels of plasma amyloid-β (Aβ) peptides, Aβ42 and Aβ40, in relation to onset of Alzheimer disease (AD) in adults with Down syndrome (DS). Plasma Aβ42 and Aβ40 were measured at initial examination and at follow-up in a community-based cohort of 225 adults with DS who did not have dementia at baseline and were assessed for cognitive/functional abilities and health status and followed at 14- to 20-month intervals. We used Cox proportional hazards modeling to estimate the cumulative incidence of AD by Aβ peptide change group (increasing, no change, or decreasing), adjusting for covariates. Sixty-one (27.1%) of the participants developed AD. At follow-up, a decrease in Aβ42 levels, a decrease in the Aβ42/Aβ40 ratio, and an increase in Aβ40 levels were related to conversion to AD. Compared with the group with increasing levels of Aβ42, the likelihood of developing AD was 5 times higher for those whose plasma Aβ42 levels decreased over follow-up (hazard ratio [HR] = 4.9, 95% confidence interval [CI] 2.1-11.4). Decreasing Aβ42/Aβ40 was also strongly related to AD risk (HR = 4.9, 95% CI 1.8-13.2), while decreasing Aβ40 was associated with lower risk (HR = 0.4, 95% CI 0.2-0.9). Among adults with DS, decreasing levels of plasma Aβ42, a decline in the Aβ42/Aβ40 ratio, or increasing levels of Aβ40 may be sensitive indicators of conversion to AD, possibly reflecting compartmentalization of Aβ peptides in the brain.

Survival function and protein malnutrition in burns patients at a rural hospital in Africa.

PubMed

Kingu, H J; Longo-Mbenza, Benjamin; Dhaffala, A; Mazwai, E L

2011-07-01

The aim of this study was to estimate the incidence of acute malnutrition and to identify predictors of case fatality among burn patients in the poorest South African province, Eastern Cape. This longitudinal follow-up study was conducted among consecutive burn patients admitted to Nelson Mandela Academic Hospital, Mthatha, South Africa, between 2006 and 2008. Patients were monitored and treated daily from admission to discharge. Outcomes were acute protein malnutrition and mortality. Patients' demography, total body surface area (TBSA) of the burn, cause of the burn, weight, height, location of the burn, hemoglobin, serum albumin, wound infection, and antibiotics after culture and sensitivity results were the potential predictors of in-hospital mortality. A Cox's proportional hazards model for the time to death was then used to identify independent predictors of mortality after adjusting for confounding factors. Kaplan-Meier survival curves were generated for each arm of exposure status. In all, 67 patients (35 males, 59 children) were studied. The mean (range) age was 8±12 years (1 month to 59 years). The cumulative incidence of acute malnutrition was 62.0% (n=42): 46.3% (n=31) at admission and 15.7% (n=11) after 7 days of hospitalization. Incidence of mortality was 16.4% (n=11 with in-hospital acute malnutrition). The only significant and independent predictors of mortality were total body surface area (TBSA) burn>40% [hazard ratio (HR) 10.5, 95% confidence interval (CI) 1.7-63; P<0.01] and affected anterior trunk (HR 4.4, 95% CI 1.3-14.7; P=0.018). Urgent prevention strategies of burns and evidence-based practice with early nutritional supplementation are needed to reduce high rates of malnutrition and mortality.

Effect of Postnatal HIV Treatment on Clinical Mastitis and Breast Inflammation in HIV-Infected Breast-feeding Women.

PubMed

Zadrozny, Sabrina; Westreich, Daniel; Hudgens, Michael G; Chasela, Charles; Jamieson, Denise J; Martinson, Francis; Zimba, Chifundo; Tegha, Gerald; Hoffman, Irving; Miller, William C; Pence, Brian W; King, Caroline C; Kourtis, Athena P; Msungama, Wezi; van der Horst, Charles

2017-03-01

The relationship between mastitis and antiretroviral therapy among HIV-positive, breast-feeding women is unclear. In the Breastfeeding, Antiretrovirals, and Nutrition (BAN) study, conducted in Lilongwe, Malawi, 2369 mother-infant pairs were randomized to a nutritional supplement group and to one of three treatment groups: maternal antiretroviral therapy (ART), infant nevirapine (NVP) or standard of care for 24 weeks of exclusive breast-feeding and 4 weeks of weaning. Among 1472 HIV-infected women who delivered live infants between 2004 and 2007, we estimated cumulative incidence functions and sub-distribution hazard ratios (HR) of mastitis or breast inflammation comparing women in maternal ART (n = 487) or infant nevirapine (n = 492) groups to the standard of care (n = 493). Nutritional supplement groups (743 took, 729 did not) were also compared. Through 28-weeks post-partum, 102 of 1472 women experienced at least one occurrence of mastitis or breast inflammation. The 28-week risk was higher for maternal ART (risk difference (RD) 4.5, 95% confidence interval (CI) 0.9, 8.1) and infant NVP (RD 3.6, 95% CI 0.3, 6.9) compared to standard of care. The hazard of late-appearing mastitis or breast inflammation (from week 5-28) was also higher for maternal ART (HR 6.7, 95% CI 2.0, 22.6) and infant NVP (HR 5.1, 95% CI 1.5, 17. 5) compared to the standard of care. Mastitis or breast inflammation while breast-feeding is a possible side effect for women taking prophylactic ART and women whose infants take NVP, warranting additional research in the context of postnatal HIV transmission. © 2017 John Wiley & Sons Ltd.

Duration of Androgen Suppression Before Radiotherapy for Localized Prostate Cancer: Radiation Therapy Oncology Group Randomized Clinical Trial 9910

PubMed Central

Pisansky, Thomas M.; Hunt, Daniel; Gomella, Leonard G.; Amin, Mahul B.; Balogh, Alexander G.; Chinn, Daniel M.; Seider, Michael J.; Duclos, Marie; Rosenthal, Seth A.; Bauman, Glenn S.; Gore, Elizabeth M.; Rotman, Marvin Z.; Lukka, Himanshu R.; Shipley, William U.; Dignam, James J.; Sandler, Howard M.

2015-01-01

Purpose To determine whether prolonged androgen suppression (AS) duration before radiotherapy improves survival and disease control in prostate cancer. Patients and Methods One thousand five hundred seventy-nine men with intermediate-risk prostate cancer were randomly assigned to 8 weeks of AS followed by radiotherapy with an additional 8 weeks of concurrent AS (16 weeks total) or to 28 weeks of AS followed by radiotherapy with an additional 8 weeks of AS (36 weeks total). The trial sought primarily to detect a 33% reduction in the hazard of prostate cancer death in the 28-week assignment. Time-to-event end points are reported for up to 10 years of follow-up. Results There were no between-group differences in baseline characteristics of 1,489 eligible patients with follow-up. For the 8- and 28-week assignments, 10-year disease-specific survival rates were 95% (95% CI, 93.3% to 97.0%) and 96% (95% CI, 94.6% to 98.0%; hazard ratio [HR], 0.81; P = .45), respectively, and 10-year overall survival rates were 66% (95% CI, 62.0% to 69.9%) and 67% (95% CI, 63.0% to 70.8%; HR, 0.95; P = .62), respectively. For the 8- and 28-week assignments, 10-year cumulative incidences of locoregional progression were 6% (95% CI, 4.3% to 8.0%) and 4% (95% CI, 2.5% to 5.7%; HR, 0.65; P = .07), respectively; 10-year distant metastasis cumulative incidences were 6% (95% CI, 4.0% to 7.7%) and 6% (95% CI, 4.0% to 7.6%; HR, 1.07; P = .80), respectively; and 10-year prostate-specific antigen–based recurrence cumulative incidences were 27% (95% CI, 23.1% to 29.8%) and 27% (95% CI, 23.4% to 30.3%; HR, 0.97; P = .77), respectively. Conclusion Extending AS duration from 8 weeks to 28 weeks before radiotherapy did not improve outcomes. A lower than expected prostate cancer death rate reduced ability to detect a between-group difference in disease-specific survival. The schedule of 8 weeks of AS before radiotherapy plus 8 weeks of AS during radiotherapy remains a standard of care in intermediate-risk prostate cancer. PMID:25534388

Intermediate and longer-term outcomes from a prospective active-surveillance program for favorable-risk prostate cancer. Tosoian JJ, Mamawala M, Epstein JI, Landis P, Wolf S, Trock BJ, Carter HB.J Clin Oncol. 2015 Oct 20;33(30):3379-85. [Epub 2015 Aug 31]. doi: 10.1200/JCO.2015.62.5764.

PubMed

Scott, Eggener; Mamawala, M; Epstein, J I; Landis, P; Wolf, S; Trock; Carter, H B

2017-03-01

To assess long-term outcomes of men with favorable-risk prostate cancer in a prospective, active surveillance program. Curative intervention was recommended for disease reclassification to higher cancer grade or volume on prostate biopsy. Primary outcomes were overall, cancer-specific, and metastasis-free survival. Secondary outcomes were the cumulative incidence of reclassification and curative intervention. Factors associated with grade reclassification and curative intervention were evaluated in a Cox proportional hazards model. A total of 1,298 men (median age = 66y) with a median follow-up of 5 years (range: 0.01-18.00y) contributed 6,766 person-years of follow-up since 1995. Overall, cancer-specific, and metastasis-free survival rates were 93%, 99.9%, and 99.4%, respectively, at 10 years and 69%, 99.9%, and 99.4%, respectively, at 15 years. The cumulative incidence of grade reclassification was 26% at 10 years and was 31% at 15 years; cumulative incidence of curative intervention was 50% at 10 years and was 57% at 15 years. The median treatment-free survival was 8.5 years (range: 0.01-18y). Factors associated with grade reclassification were older age (hazard ratio [HR] = 1.03 for each additional year; 95% CI: 1.01-1.06), prostate-specific antigen density (HR = 1.21 per 0.1 unit increase; 95% CI: 1.12-1.46), and greater number of positive biopsy cores (HR = 1.47 for each additional positive core; 95% CI: 1.26-1.69). Factors associated with intervention were prostate-specific antigen density (HR = 1.38 per 0.1 unit increase; 95% CI: 1.22-1.56) and a greater number of positive biopsy cores (HR = 1.35 for one additional positive core; 95% CI: 1.19-1.53). Men with favorable-risk prostate cancer should be informed of the low likelihood of harm from their diagnosis and should be encouraged to consider surveillance rather than curative intervention. Copyright © 2017. Published by Elsevier Inc.

Cumulative environmental impacts and integrated coastal management: the case of Xiamen, China.

PubMed

Xue, Xiongzhi; Hong, Huasheng; Charles, Anthony T

2004-07-01

This paper examines the assessment of cumulative environmental impacts and the implementation of integrated coastal management within the harbour of Xiamen, China, an urban region in which the coastal zone is under increasing pressure as a result of very rapid economic growth. The first stage of analysis incorporates components of a cumulative effects assessment, including (a) identification of sources of environmental impacts, notably industrial expansion, port development, shipping, waste disposal, aquaculture and coastal construction, (b) selection of a set of valued ecosystem components, focusing on circulation and siltation, water quality, sediment, the benthic community, and mangrove forests, and (c) use of a set of key indicators to examine cumulative impacts arising from the aggregate of human activities. In the second stage of analysis, the paper describes and assesses the development of an institutional framework for integrated coastal management in Xiamen, one that combines policy and planning (including legislative and enforcement mechanisms) with scientific and monitoring mechanisms (including an innovative 'marine functional zoning' system). The paper concludes that the integrated coastal management framework in Xiamen has met all relevant requirements for 'integration' as laid out in the literature, and has explicitly incorporated consideration of cumulative impacts within its management and monitoring processes.

Intermittency and dynamical Lee-Yang zeros of open quantum systems.

PubMed

Hickey, James M; Flindt, Christian; Garrahan, Juan P

2014-12-01

We use high-order cumulants to investigate the Lee-Yang zeros of generating functions of dynamical observables in open quantum systems. At long times the generating functions take on a large-deviation form with singularities of the associated cumulant generating functions-or dynamical free energies-signifying phase transitions in the ensemble of dynamical trajectories. We consider a driven three-level system as well as the dissipative Ising model. Both systems exhibit dynamical intermittency in the statistics of quantum jumps. From the short-time behavior of the dynamical Lee-Yang zeros, we identify critical values of the counting field which we attribute to the observed intermittency and dynamical phase coexistence. Furthermore, for the dissipative Ising model we construct a trajectory phase diagram and estimate the value of the transverse field where the stationary state changes from being ferromagnetic (inactive) to paramagnetic (active).

Cumulative Brain Injury from Motor Vehicle-Induced Whole-Body Vibration and Prevention by Human Apolipoprotein A-I Molecule Mimetic (4F) Peptide (an Apo A-I Mimetic)

PubMed Central

Yan, Ji-Geng; Zhang, Lin-ling; Agresti, Michael; Yan, Yuhui; LoGiudice, John; Sanger, James R.; Matloub, Hani S.; Pritchard, Kirkwood A.; Jaradeh, Safwan S.; Havlik, Robert

2017-01-01

Background Insidious cumulative brain injury from motor vehicle-induced whole-body vibration (MV-WBV) has not yet been studied. The objective of the present study is to validate whether whole-body vibration for long periods causes cumulative brain injury and impairment of the cerebral function. We also explored a preventive method for MV-WBV injury. Methods A study simulating whole-body vibration was conducted in 72 male Sprague-Dawley rats divided into 9 groups (N = 8): (1) 2-week normal control; (2) 2-week sham control (in the tube without vibration); (3) 2-week vibration (exposed to whole-body vibration at 30 Hz and .5 G acceleration for 4 hours/day, 5 days/week for 2 weeks; vibration parameters in the present study are similar to the most common driving conditions); (4) 4-week sham control; (5) 4-week vibration; (6) 4-week vibration with human apolipoprotein A-I molecule mimetic (4F)-preconditioning; (7) 8-week sham control; (8) 8-week vibration; and (9) 8-week 4F-preconditioning group. All the rats were evaluated by behavioral, physiological, and histological studies of the brain. Results Brain injury from vibration is a cumulative process starting with cerebral vasoconstriction, squeezing of the endothelial cells, increased free radicals, decreased nitric oxide, insufficient blood supply to the brain, and repeated reperfusion injury to brain neurons. In the 8-week vibration group, which indicated chronic brain edema, shrunken neuron numbers increased and whole neurons atrophied, which strongly correlated with neural functional impairment. There was no prominent brain neuronal injury in the 4F groups. Conclusions The present study demonstrated cumulative brain injury from MV-WBV and validated the preventive effects of 4F preconditioning. PMID:26433438

Further Evidence for Robust Familiality of Pediatric Bipolar-I Disorder: Results from a Very Large Controlled Family Study of Pediatric Bipolar-I Disorder and a Meta-Analysis

PubMed Central

Wozniak, Janet; Faraone, Stephen V.; Martelon, MaryKate; McKillop, Hannah N.; Biederman, Joseph

2013-01-01

Objective To determine the risk for BP-I disorder in first-degree relatives of children with DSM-IV bipolar-I disorder (BP-I) via meta-analysis and expanded controlled study. Data Sources and Extraction Meta-Analysis We searched the Pubmed database for scientific articles published in the world literature in the English language through 2011. The key words searched were: bipolar disorder, first-degree relatives, family study, control. All online abstracts were reviewed and relevant full manuscripts were collected and reviewed. Citations were also examined for other potential relevant articles. We included only controlled family studies that examined rates of bipolar-I disorder in all first-degree relatives (parents and siblings) of pediatric bipolar-I probands and included only studies that had age and sex matched controls. Family history studies were excluded. Also excluded were studies that were not in English, did not report the rates of all first-degree relatives, and reported only bipolar spectrum rates. We also excluded family studies that included only adult probands. We conducted a meta-analysis of the five controlled family studies of pediatric BP-I probands that met our search criteria using the random effects model of DerSimonian and Laird. Method Family Study We greatly expanded our previous sample of DSM-IV BP-I probands using structured diagnostic interviews. Our new study included 239 children satisfying full with DSM-IV diagnostic criteria for BP-I (n=726 first-degree relatives), 162 ADHD (without BP-I) probands (n=511 first-degree relatives), and 136 healthy control (without ADHD or BP-I) probands (n=411 first-degree relatives). We used the Kaplan-Meier cumulative failure function to calculate survival curves and cumulative, lifetime risk in relatives. Cox proportional hazard models were used to calculate the risk of BP-I in relatives. Results The pooled odds ratio for BP-I disorder in relatives was estimated to be 6.96 (95% Confidence Interval (CI): 4.8 to 10.1). We also found first-degree relatives of BP-I probands to be significantly more likely than first-degree relatives of both ADHD (Hazards Ratio: 3.02; 95% CI: 1.85 to 4.93; p<0.001) and control probands (HR: 2.83; 1.65 to 4.84; p<0.001) to have bipolar-I disorder. Conclusion Our results document an increased familial risk for BP-I disorder in relatives of pediatric probands with DSM-IV BP-I. PMID:23140652

Respiratory symptoms and lung function in bauxite miners.

PubMed

Beach, J R; de Klerk, N H; Fritschi, L; Sim, M R; Musk, A W; Benke, G; Abramson, M J; McNeil, J J

2001-09-01

To determine whether cumulative bauxite exposure is associated with respiratory symptoms or changes in lung function in a group of bauxite miners. Current employees at three bauxite mines in Australia were invited to participate in a survey comprising: questionnaire on demographic details, respiratory symptoms, and work history; skin prick tests for four common aeroallergens; and spirometry. A task exposure matrix was constructed for bauxite exposure in all tasks in all jobs based on monitoring data. Data were examined for associations between cumulative bauxite exposure, and respiratory symptoms and lung function, by regression analyses. The participation rate was 86%. Self-reported work-related respiratory symptoms were reported by relatively few subjects (1.5%-11.8%). After adjustment for age and smoking no significant differences in the prevalence of respiratory symptoms were identified between subjects, in the quartiles of cumulative bauxite exposure distribution. The forced expiratory volume in I s (FEV1) of the exposed group was found to be significantly lower than that for the unexposed group. After adjustment for age, height, and smoking there were no statistically significant differences between quartiles in FEVI, forced vital capacity (FVC) and FEVl/FVC ratio. These data provide little evidence of a serious adverse effect on respiratory health associated with exposure to bauxite in an open-cut bauxite mine in present day conditions.

Association Between Lifetime Marijuana Use and Cognitive Function in Middle Age: The Coronary Artery Risk Development in Young Adults (CARDIA) Study.

PubMed

Auer, Reto; Vittinghoff, Eric; Yaffe, Kristine; Künzi, Arnaud; Kertesz, Stefan G; Levine, Deborah A; Albanese, Emiliano; Whitmer, Rachel A; Jacobs, David R; Sidney, Stephen; Glymour, M Maria; Pletcher, Mark J

2016-03-01

Marijuana use is increasingly common in the United States. It is unclear whether it has long-term effects on memory and other domains of cognitive function. To study the association between cumulative lifetime exposure to marijuana use and cognitive performance in middle age. We used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a cohort of 5115 black and white men and women aged 18 to 30 years at baseline from March 25, 1985, to June 7, 1986 (year 0), and followed up over 25 years from June 7, 1986, to August 31, 2011, to estimate cumulative years of exposure to marijuana (1 year = 365 days of marijuana use) using repeated measures and to assess associations with cognitive function at year 25. Linear regression was used to adjust for demographic factors, cardiovascular risk factors, tobacco smoking, use of alcohol and illicit drugs, physical activity, depression, and results of the mirror star tracing test (a measure of cognitive function) at year 2. Data analysis was conducted from June 7, 1986, to August 31, 2011. Three domains of cognitive function were assessed at year 25 using the Rey Auditory Verbal Learning Test (verbal memory), the Digit Symbol Substitution Test (processing speed), and the Stroop Interference Test (executive function). Among 3385 participants with cognitive function measurements at the year 25 visit, 2852 (84.3%) reported past marijuana use, but only 392 (11.6%) continued to use marijuana into middle age. Current use of marijuana was associated with worse verbal memory and processing speed; cumulative lifetime exposure was associated with worse performance in all 3 domains of cognitive function. After excluding current users and adjusting for potential confounders, cumulative lifetime exposure to marijuana remained significantly associated with worse verbal memory. For each 5 years of past exposure, verbal memory was 0.13 standardized units lower (95% CI, -0.24 to -0.02; P = .02), corresponding to a mean of 1 of 2 participants remembering 1 word fewer from a list of 15 words for every 5 years of use. After adjustment, we found no associations with lower executive function (-0.03 [95% CI, -0.12 to 0.07]; P = .56) or processing speed (-0.04 [95% CI, -0.16 to 0.08]; P = .51). Past exposure to marijuana is associated with worse verbal memory but does not appear to affect other domains of cognitive function.

Incidence and risk factors of postoperative pneumonia following cancer surgery in adult patients with selected solid cancer: results of "Cancer POP" study.

PubMed

Jung, Jiwon; Moon, Song Mi; Jang, Hee-Chang; Kang, Cheol-In; Jun, Jae-Bum; Cho, Yong Kyun; Kang, Seung-Ji; Seo, Bo-Jeong; Kim, Young-Joo; Park, Seong-Beom; Lee, Juneyoung; Yu, Chang Sik; Kim, Sung-Han

2018-01-01

The aim of this study was to investigate the incidence and risk factors of postoperative pneumonia (POP) within 1 year after cancer surgery in patients with the five most common cancers (gastric, colorectal, lung, breast cancer, and hepatocellular carcinoma [HCC]) in South Korea. This was a multicenter and retrospective cohort study performed at five nationwide cancer centers. The number of cancer patients in each center was allocated by the proportion of cancer surgery. Adult patients were randomly selected according to the allocated number, among those who underwent cancer surgery from January to December 2014 within 6 months after diagnosis of cancer. One-year cumulative incidence of POP was estimated using Kaplan-Meier analysis. An univariable Cox's proportional hazard regression analysis was performed to identify risk factors for POP development. As a multivariable analysis, confounders were adjusted using multiple Cox's PH regression model. Among the total 2000 patients, the numbers of patients with gastric cancer, colorectal cancer, lung cancer, breast cancer, and HCC were 497 (25%), 525 (26%), 277 (14%), 552 (28%), and 149 (7%), respectively. Overall, the 1-year cumulative incidence of POP was 2.0% (95% CI, 1.4-2.6). The 1-year cumulative incidences in each cancer were as follows: lung 8.0%, gastric 1.8%, colorectal 1.0%, HCC 0.7%, and breast 0.4%. In multivariable analysis, older age, higher Charlson comorbidity index (CCI) score, ulcer disease, history of pneumonia, and smoking were related with POP development. In conclusions, the 1-year cumulative incidence of POP in the five most common cancers was 2%. Older age, higher CCI scores, smoker, ulcer disease, and previous pneumonia history increased the risk of POP development in cancer patients. © 2017 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Adenosine triphosphate stress myocardial perfusion imaging for risk stratification of patients aged 70 years and older with suspected coronary artery disease.

PubMed

Yao, Zhiming; Zhu, Hui; Li, Wenchan; Chen, Congxia; Wang, Hua; Shi, Lei; Zhang, Wenjie

2017-04-01

We investigated the cardiac risk stratification value of adenosine triphosphate stress myocardial perfusion imaging (ATP-MPI) in patients aged 70 years and older with suspected coronary artery disease (CAD). We identified a series of 415 consecutive patients aged 70 years and older with suspected CAD, who had undergone ATP-MPI with 99m Tc-MIBI. The presence of a fixed and/or reversible perfusion defect was considered as an abnormal MPI. Follow-up was available in 399 patients (96.1%) over 3.45 ± 1.71 years after excluding 16 patients who underwent early coronary revascularization <60 days after MPI. The major adverse cardiac events (MACE), including cardiac death, nonfatal infarction, and late coronary revascularization, were recorded. One hundred twenty-five (31.3%) patients had abnormal MPI and the remaining had normal MPI. A multivariable analysis using Cox regression demonstrated that abnormal MPI was independently associated with MACE (hazard ratio 19.50 and 95% confidence interval 5.91-64.31, P value .000). The patients with SSS > 8 had significantly higher cumulative MACE rate than patients with SSS ≤ 8 had (37.8% vs 5.2%, respectively, P < .001). The Kaplan-Meier cumulative MACE-free survival in patients with abnormal MPI (57.0%) was significantly lower than that in patients with normal MPI (89.6%), P < .0001. Among patients with SSS > 8, the Kaplan-Meier cumulative MACE-free survival were 36.9% in patients ≥80 years old and 49.5% in patients 70-79 years old, respectively, P < .05. However, among patients with SSS ≤ 8, there was no difference between the Kaplan-Meier cumulative MACE-free survivals of these two age groups. ATP-MPI data are useful for the prediction of major adverse cardiac events in patients aged 70 years and older with suspected CAD.

Incidence and risk factors for secondary malignancy in patients with neuroblastoma after treatment with (131)I-metaiodobenzylguanidine.

PubMed

Huibregtse, Kelly E; Vo, Kieuhoa T; DuBois, Steven G; Fetzko, Stephanie; Neuhaus, John; Batra, Vandana; Maris, John M; Weiss, Brian; Marachelian, Araz; Yanik, Greg A; Matthay, Katherine K

2016-10-01

Several reports of second malignant neoplasm (SMN) in patients with relapsed neuroblastoma after treatment with (131)I-MIBG suggest the possibility of increased risk. Incidence of and risk factors for SMN after (131)I-MIBG have not been defined. This is a multi-institutional retrospective review of patients with neuroblastoma treated with (131)I-MIBG therapy. A competing risk approach was used to calculate the cumulative incidence of SMN from time of first exposure to (131)I-MIBG. A competing risk regression was used to identify potential risk factors for SMN. The analytical cohort included 644 patients treated with (131)I-MIBG. The cumulative incidence of SMN was 7.6% (95% confidence interval [CI], 4.4-13.0%) and 14.3% (95% CI, 8.3-23.9%) at 5 and 10 years from first (131)I-MIBG, respectively. No increase in SMN risk was found with increased number of (131)I-MIBG treatments or higher cumulative activity per kilogram of (131)I-MIBG received (p = 0.72 and p = 0.84, respectively). Thirteen of the 19 reported SMN were haematologic. In a multivariate analysis controlling for variables with p < 0.1 (stage, age at first (131)I-MIBG, bone disease, disease status at time of first (131)I-MIBG), patients with relapsed/progressive disease had significantly lower risk of SMN (subdistribution hazard ratio 0.3, 95% CI, 0.1-0.8, p = 0.023) compared to patients with persistent/refractory neuroblastoma. The cumulative risk of SMN after (131)I-MIBG therapy for patients with relapsed or refractory neuroblastoma is similar to the greatest published incidence for high-risk neuroblastoma after myeloablative therapy, with no dose-dependent increase. As the number of patients treated and length of follow-up time increase, it will be important to reassess this risk. Copyright © 2016 Elsevier Ltd. All rights reserved.

Glucocorticoid exposure and fracture risk in a cohort of US patients with selected conditions.

PubMed

Balasubramanian, A; Wade, S W; Adler, R A; Saag, K; Pannacciulli, N; Curtis, J R

2018-06-20

We evaluated systemic glucocorticoid exposure and fracture among patients with newly-diagnosed inflammatory and immune-modulated conditions. Using administrative data, inception cohorts of RA, asthma/COPD, IBD, MS, lupus, and sarcoidosis patients age 18-64 years with benefits coverage ≥12 months before diagnosis (1/1/2005-12/31/2012) were followed to clinical fracture, cancer diagnosis, or 12/31/2012. Glucocorticoid users were new to therapy. Fracture incidence rates (IR) per 1,000 person-years were stratified by prednisone equivalent doses. Cox's proportional hazards models assessed risk by daily and cumulative dose, and by time since discontinuation, adjusted for baseline characteristics. Most patients (72% of 403,337) had glucocorticoid exposure; 52% were under age 50. IR (95% confidence intervals [CI]) of any osteoporotic fracture was elevated at doses < 5 mg/day, IR: 9.33 [7.29, 11.77] versus 0 mg/day, IR: 4.87 [4.72, 5.02]). Fracture rates were elevated at doses < 5 mg/day in patients < 50 years and those ≥ 50 years. In both age groups, fracture risk increased with increasing cumulative exposure, being approximately 2.5-fold higher at cumulative dose ≥ 5400 mg compared to < 675 mg. At ≥ 5400 mg, IR were 5.69 [4.32, 7.35] in patients < 50 years and 17.10 [14.97, 19.46] in older patients. Fracture risk decreased significantly within months following glucocorticoid discontinuation. In patients with a variety of inflammatory conditions, fracture risk increased at doses as low as < 5 mg/day. Risk increased with increasing cumulative exposure and decreased soon following glucocorticoid discontinuation. Trends were similar between patients older and younger than 50 years. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Synergistic effects of family history of hepatocellular carcinoma and hepatitis B virus infection on risk for incident hepatocellular carcinoma.

PubMed

Loomba, Rohit; Liu, Jessica; Yang, Hwai-I; Lee, Mei-Hsuan; Lu, Sheng-Nan; Wang, Li-Yu; Iloeje, Uchenna H; You, San-Lin; Brenner, David; Chen, Chien-Jen

2013-12-01

Little is known about the effects of family history of hepatocellular carcinoma (HCC) on hepatitis B progression or risk of HCC. We examined how family HCC history and presence or stage of hepatitis B virus (HBV) infection affect risk for HCC. We performed a population-based cohort study of 22,472 participants from 7 townships in Taiwan who underwent evaluation for liver disease from 1991 through 1992. Those who received a first diagnosis of HCC from January 1, 1991, to December 31, 2008, were identified from the Taiwanese cancer registry. There were 374 cases of incident HCC over 362,268 person-years of follow-up evaluation. The cumulative risk of HCC in hepatitis B surface antigen (HBsAg)-seronegative patients without a family history of HCC was 0.62%, in those with a family history of HCC the cumulative risk was 0.65%, in HBsAg-seropositive patients without a family history of HCC the cumulative risk was 7.5%, and in HBsAg-seropositive patients with a family history of HCC the cumulative risk was 15.8% (P < .001). The multivariate-adjusted hazard ratio for HBsAg-seropositive individuals with family history, compared with HBsAg-seronegative individuals without a family history of HCC, was 32.33 (95% confidence interval, 20.8-50.3; P < .001). The relative excess risk owing to interaction was 19, the attributable proportion was 0.59, and the synergy index value was 2.54. These findings indicate synergy between family HCC history and HBsAg serostatus. The synergy between these factors remained significant in stratification analyses by HBeAg serostatus and serum level of HBV DNA. Family history of HCC multiplies the risk of HCC at each stage of HBV infection. Patients with a family history of HCC require more intensive management of HBV infection and surveillance for liver cancer. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.

Estimation of age- and stage-specific Catalan breast cancer survival functions using US and Catalan survival data

PubMed Central

2009-01-01

Background During the last part of the 1990s the chance of surviving breast cancer increased. Changes in survival functions reflect a mixture of effects. Both, the introduction of adjuvant treatments and early screening with mammography played a role in the decline in mortality. Evaluating the contribution of these interventions using mathematical models requires survival functions before and after their introduction. Furthermore, required survival functions may be different by age groups and are related to disease stage at diagnosis. Sometimes detailed information is not available, as was the case for the region of Catalonia (Spain). Then one may derive the functions using information from other geographical areas. This work presents the methodology used to estimate age- and stage-specific Catalan breast cancer survival functions from scarce Catalan survival data by adapting the age- and stage-specific US functions. Methods Cubic splines were used to smooth data and obtain continuous hazard rate functions. After, we fitted a Poisson model to derive hazard ratios. The model included time as a covariate. Then the hazard ratios were applied to US survival functions detailed by age and stage to obtain Catalan estimations. Results We started estimating the hazard ratios for Catalonia versus the USA before and after the introduction of screening. The hazard ratios were then multiplied by the age- and stage-specific breast cancer hazard rates from the USA to obtain the Catalan hazard rates. We also compared breast cancer survival in Catalonia and the USA in two time periods, before cancer control interventions (USA 1975–79, Catalonia 1980–89) and after (USA and Catalonia 1990–2001). Survival in Catalonia in the 1980–89 period was worse than in the USA during 1975–79, but the differences disappeared in 1990–2001. Conclusion Our results suggest that access to better treatments and quality of care contributed to large improvements in survival in Catalonia. On the other hand, we obtained detailed breast cancer survival functions that will be used for modeling the effect of screening and adjuvant treatments in Catalonia. PMID:19331670

Additive scales in degenerative disease--calculation of effect sizes and clinical judgment.

PubMed

Riepe, Matthias W; Wilkinson, David; Förstl, Hans; Brieden, Andreas

2011-12-16

The therapeutic efficacy of an intervention is often assessed in clinical trials by scales measuring multiple diverse activities that are added to produce a cumulative global score. Medical communities and health care systems subsequently use these data to calculate pooled effect sizes to compare treatments. This is done because major doubt has been cast over the clinical relevance of statistically significant findings relying on p values with the potential to report chance findings. Hence in an aim to overcome this pooling the results of clinical studies into a meta-analyses with a statistical calculus has been assumed to be a more definitive way of deciding of efficacy. We simulate the therapeutic effects as measured with additive scales in patient cohorts with different disease severity and assess the limitations of an effect size calculation of additive scales which are proven mathematically. We demonstrate that the major problem, which cannot be overcome by current numerical methods, is the complex nature and neurobiological foundation of clinical psychiatric endpoints in particular and additive scales in general. This is particularly relevant for endpoints used in dementia research. 'Cognition' is composed of functions such as memory, attention, orientation and many more. These individual functions decline in varied and non-linear ways. Here we demonstrate that with progressive diseases cumulative values from multidimensional scales are subject to distortion by the limitations of the additive scale. The non-linearity of the decline of function impedes the calculation of effect sizes based on cumulative values from these multidimensional scales. Statistical analysis needs to be guided by boundaries of the biological condition. Alternatively, we suggest a different approach avoiding the error imposed by over-analysis of cumulative global scores from additive scales.

Cumulant-based expressions for the multibody terms for the correlation between local and electrostatic interactions in the united-residue force field

NASA Astrophysics Data System (ADS)

Liwo, Adam; Czaplewski, Cezary; Pillardy, Jarosław; Scheraga, Harold A.

2001-08-01

A general method to derive site-site or united-residue potentials is presented. The basic principle of the method is the separation of the degrees of freedom of a system into the primary and secondary ones. The primary degrees of freedom describe the basic features of the system, while the secondary ones are averaged over when calculating the potential of mean force, which is hereafter referred to as the restricted free energy (RFE) function. The RFE can be factored into one-, two-, and multibody terms, using the cluster-cumulant expansion of Kubo. These factors can be assigned the functional forms of the corresponding lowest-order nonzero generalized cumulants, which can, in most cases, be evaluated analytically, after making some simplifying assumptions. This procedure to derive coarse-grain force fields is very valuable when applied to multibody terms, whose functional forms are hard to deduce in another way (e.g., from structural databases). After the functional forms have been derived, they can be parametrized based on the RFE surfaces of model systems obtained from all-atom models or on the statistics derived from structural databases. The approach has been applied to our united-residue force field for proteins. Analytical expressions were derived for the multibody terms pertaining to the correlation between local and electrostatic interactions within the polypeptide backbone; these expressions correspond to up to sixth-order terms in the cumulant expansion of the RFE. These expressions were subsequently parametrized by fitting to the RFEs of selected peptide fragments, calculated with the empirical conformational energy program for peptides force field. The new multibody terms enable not only the heretofore predictable α-helical segments, but also regular β-sheets, to form as the lowest-energy structures, as assessed by test calculations on a model helical protein A, as well as a model 20-residue polypeptide (betanova); the latter was not possible without introducing these new terms.

Basophil-lineage commitment in acute promyelocytic leukemia predicts for severe bleeding after starting therapy.

PubMed

Matarraz, Sergio; Leoz, Pilar; Fernández, Carlos; Colado, Enrique; Chillón, María Carmen; Vidriales, María Belén; González, Marcos; Rivera, Daniel; Osuna, Carlos Salvador; Caballero-Velázquez, Teresa; Van Der Velden, Vincent; Jongen-Lavrencic, Mojca; Gutiérrez, Oliver; Bermejo, Ana Yeguas; Alonso, Luis García; García, Monique Bourgeois; De Ramón Sánchez, Cristina; García-Donas, Gloria; Mateo, Aránzazu García; Recio, Isabel; Sánchez-Real, Javier; Mayado, Andrea; Gutiérrez, María Laura; Bárcena, Paloma; Barrena, Susana; López, Antonio; Van Dongen, Jacques; Orfao, Alberto

2018-03-23

Severe hemorrhagic events occur in a significant fraction of acute promyelocytic leukemia patients, either at presentation and/or early after starting therapy, leading to treatment failure and early deaths. However, identification of independent predictors for high-risk of severe bleeding at diagnosis, remains a challenge. Here, we investigated the immunophenotype of bone marrow leukemic cells from 109 newly diagnosed acute promyelocytic leukemia patients, particularly focusing on the identification of basophil-related features, and their potential association with severe bleeding episodes and patient overall survival.From all phenotypes investigated on leukemic cells, expression of the CD203c and/or CD22 basophil-associated markers showed the strongest association with the occurrence and severity of bleeding (p ≤ 0.007); moreover, aberrant expression of CD7, coexpression of CD34 + /CD7 + and lack of CD71 was also more frequently found among patients with (mild and severe) bleeding at baseline and/or after starting treatment (p ≤ 0.009). Multivariate analysis showed that CD203c expression (hazard ratio: 26.4; p = 0.003) and older age (hazard ratio: 5.4; p = 0.03) were the best independent predictors for cumulative incidence of severe bleeding after starting therapy. In addition, CD203c expression on leukemic cells (hazard ratio: 4.4; p = 0.01), low fibrinogen levels (hazard ratio: 8.8; p = 0.001), older age (hazard ratio: 9.0; p = 0.002), and high leukocyte count (hazard ratio: 5.6; p = 0.02) were the most informative independent predictors for overall survival.In summary, our results show that the presence of basophil-associated phenotypic characteristics on leukemic cells from acute promyelocytic leukemia patients at diagnosis is a powerful independent predictor for severe bleeding and overall survival, which might contribute in the future to (early) risk-adapted therapy decisions.

Hazard function theory for nonstationary natural hazards

NASA Astrophysics Data System (ADS)

Read, L. K.; Vogel, R. M.

2015-11-01

Impact from natural hazards is a shared global problem that causes tremendous loss of life and property, economic cost, and damage to the environment. Increasingly, many natural processes show evidence of nonstationary behavior including wind speeds, landslides, wildfires, precipitation, streamflow, sea levels, and earthquakes. Traditional probabilistic analysis of natural hazards based on peaks over threshold (POT) generally assumes stationarity in the magnitudes and arrivals of events, i.e. that the probability of exceedance of some critical event is constant through time. Given increasing evidence of trends in natural hazards, new methods are needed to characterize their probabilistic behavior. The well-developed field of hazard function analysis (HFA) is ideally suited to this problem because its primary goal is to describe changes in the exceedance probability of an event over time. HFA is widely used in medicine, manufacturing, actuarial statistics, reliability engineering, economics, and elsewhere. HFA provides a rich theory to relate the natural hazard event series (X) with its failure time series (T), enabling computation of corresponding average return periods, risk and reliabilities associated with nonstationary event series. This work investigates the suitability of HFA to characterize nonstationary natural hazards whose POT magnitudes are assumed to follow the widely applied Generalized Pareto (GP) model. We derive the hazard function for this case and demonstrate how metrics such as reliability and average return period are impacted by nonstationarity and discuss the implications for planning and design. Our theoretical analysis linking hazard event series X, with corresponding failure time series T, should have application to a wide class of natural hazards with rich opportunities for future extensions.

Hazard function theory for nonstationary natural hazards

NASA Astrophysics Data System (ADS)

Read, Laura K.; Vogel, Richard M.

2016-04-01

Impact from natural hazards is a shared global problem that causes tremendous loss of life and property, economic cost, and damage to the environment. Increasingly, many natural processes show evidence of nonstationary behavior including wind speeds, landslides, wildfires, precipitation, streamflow, sea levels, and earthquakes. Traditional probabilistic analysis of natural hazards based on peaks over threshold (POT) generally assumes stationarity in the magnitudes and arrivals of events, i.e., that the probability of exceedance of some critical event is constant through time. Given increasing evidence of trends in natural hazards, new methods are needed to characterize their probabilistic behavior. The well-developed field of hazard function analysis (HFA) is ideally suited to this problem because its primary goal is to describe changes in the exceedance probability of an event over time. HFA is widely used in medicine, manufacturing, actuarial statistics, reliability engineering, economics, and elsewhere. HFA provides a rich theory to relate the natural hazard event series (X) with its failure time series (T), enabling computation of corresponding average return periods, risk, and reliabilities associated with nonstationary event series. This work investigates the suitability of HFA to characterize nonstationary natural hazards whose POT magnitudes are assumed to follow the widely applied generalized Pareto model. We derive the hazard function for this case and demonstrate how metrics such as reliability and average return period are impacted by nonstationarity and discuss the implications for planning and design. Our theoretical analysis linking hazard random variable X with corresponding failure time series T should have application to a wide class of natural hazards with opportunities for future extensions.

Characteristics and predictors of home injury hazards among toddlers in Wenzhou, China: a community-based cross-sectional study

PubMed Central

2014-01-01

Background Home hazards are associated with toddlers receiving unintentional home injuries (UHI). These result in not only physical and psychological difficulties for children, but also economic losses and additional stress for their families. Few researchers pay attention to predictors of home hazards among toddlers in a systematic way. The purpose of this study is firstly to describe the characteristics of homes with hazards and secondly to explore the predicted relationship of children, parents and family factors to home hazards among toddlers aged 24–47 months in Wenzhou, China. Methods A random cluster sampling was employed to select 366 parents having children aged 24 – 47 months from 13 kindergartens between March and April of 2012. Four instruments assessed home hazards, demographics, parent’s awareness of UHI, as well as family functioning. Results Descriptive statistics showed that the mean of home hazards was 12.29 (SD = 6.39). The nine kinds of home hazards that were identified in over 50% of households were: plastic bags (74.3%), coin buttons (69.1%), and toys with small components (66.7%) etc. Multivariate linear regression revealed that the predictors of home hazards were the child’s age, the child’s residential status and family functioning (b = .19, 2.02, - .07, p < .01, < .05 and < .01, respectively). Conclusions The results showed that a higher number of home hazards were significantly attributed to older toddlers, migrant toddlers and poorer family functioning. This result suggested that heath care providers should focus on the vulnerable family and help the parents assess home hazards. Further study is needed to find interventions on how to manage home hazards for toddlers in China. PMID:24953678

Systematic review and cumulative analysis of oncologic and functional outcomes after robot-assisted radical cystectomy.

PubMed

Yuh, Bertram; Wilson, Timothy; Bochner, Bernie; Chan, Kevin; Palou, Joan; Stenzl, Arnulf; Montorsi, Francesco; Thalmann, George; Guru, Khurshid; Catto, James W F; Wiklund, Peter N; Novara, Giacomo

2015-03-01

Although open radical cystectomy (ORC) is still the standard approach, laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) are increasingly performed. To report on a systematic literature review and cumulative analysis of pathologic, oncologic, and functional outcomes of RARC in comparison with ORC and LRC. Medline, Scopus, and Web of Science databases were searched using a free-text protocol including the terms robot-assisted radical cystectomy or da Vinci radical cystectomy or robot* radical cystectomy. RARC case series and studies comparing RARC with either ORC or LRC were collected. A cumulative analysis was conducted. The searches retrieved 105 papers, 87 of which reported on pathologic, oncologic, or functional outcomes. Most series were retrospective and had small case numbers, short follow-up, and potential patient selection bias. The lymph node yield during lymph node dissection was 19 (range: 3-55), with half of the series following an extended template (yield range: 11-55). The lymph node-positive rate was 22%. The performance of lymphadenectomy was correlated with surgeon and institutional volume. Cumulative analyses showed no significant difference in lymph node yield between RARC and ORC. Positive surgical margin (PSM) rates were 5.6% (1-1.5% in pT2 disease and 0-25% in pT3 and higher disease). PSM rates did not appear to decrease with sequential case numbers. Cumulative analyses showed no significant difference in rates of surgical margins between RARC and ORC or RARC and LRC. Neoadjuvant chemotherapy use ranged from 0% to 31%, with adjuvant chemotherapy used in 4-29% of patients. Only six series reported a mean follow-up of >36 mo. Three-year disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) rates were 67-76%, 68-83%, and 61-80%, respectively. The 5-yr DFS, CSS, and OS rates were 53-74%, 66-80%, and 39-66%, respectively. Similar to ORC, disease of higher pathologic stage or evidence of lymph node involvement was associated with worse survival. Very limited data were available with respect to functional outcomes. The 12-mo continence rates with continent diversion were 83-100% in men for daytime continence and 66-76% for nighttime continence. In one series, potency was recovered in 63% of patients who were evaluable at 12 mo. Oncologic and functional data from RARC remain immature, and longer-term prospective studies are needed. Cumulative analyses demonstrated that lymph node yields and PSM rates were similar between RARC and ORC. Conclusive long-term survival outcomes for RARC were limited, although oncologic outcomes up to 5 yr were similar to those reported for ORC. Although open radical cystectomy (RC) is still regarded as the standard treatment for muscle-invasive bladder cancer, laparoscopic and robot-assisted RCs are becoming more popular. Templates of lymph node dissection, lymph node yields, and positive surgical margin rates are acceptable with robot-assisted RC. Although definitive comparisons with open RC with respect to oncologic or functional outcomes are lacking, early results appear comparable. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

[SYMPTOMS OF NEGATIVE EFFECTS CUMULATION IN HUMANS AND ANIMALS UNDER THE ACTION OF G-LOADS OF VARYING DIRECTION IN CONTEXT OF AVIATION AND SPACE FLIGHTS].

PubMed

Kotovskaya, A R

2015-01-01

Author's and literary data are analyzed to evince symptoms of cumulation in humans and animals of the negative effects caused by g-forces of different directions experienced in aviation and space flights. The author cites evidence for the decisive importance of g-duration for the development of negative effects. Functional indices of g-tolerance do not rule out possible latent changes in visceral organs and body tissues.

Quasi-linear theory via the cumulant expansion approach

NASA Technical Reports Server (NTRS)

Jones, F. C.; Birmingham, T. J.

1974-01-01

The cumulant expansion technique of Kubo was used to derive an intergro-differential equation for f , the average one particle distribution function for particles being accelerated by electric and magnetic fluctuations of a general nature. For a very restricted class of fluctuations, the f equation degenerates exactly to a differential equation of Fokker-Planck type. Quasi-linear theory, including the adiabatic assumption, is an exact theory for this limited class of fluctuations. For more physically realistic fluctuations, however, quasi-linear theory is at best approximate.

Evaluation of mortality among marines and navy personnel exposed to contaminated drinking water at USMC base Camp Lejeune: a retrospective cohort study.

PubMed

Bove, Frank J; Ruckart, Perri Zeitz; Maslia, Morris; Larson, Theodore C

2014-02-19

Two drinking water systems at U.S. Marine Corps Base Camp Lejeune, North Carolina were contaminated with solvents during 1950s-1985. We conducted a retrospective cohort mortality study of Marine and Naval personnel who began service during 1975-1985 and were stationed at Camp Lejeune or Camp Pendleton, California during this period. Camp Pendleton's drinking water was uncontaminated. Mortality follow-up was 1979-2008. Standardized Mortality Ratios were calculated using U.S. mortality rates as reference. We used survival analysis to compare mortality rates between Camp Lejeune (N = 154,932) and Camp Pendleton (N = 154,969) cohorts and assess effects of cumulative exposures to contaminants within the Camp Lejeune cohort. Models estimated monthly contaminant levels at residences. Confidence intervals (CIs) indicated precision of effect estimates. There were 8,964 and 9,365 deaths respectively, in the Camp Lejeune and Camp Pendleton cohorts. Compared to Camp Pendleton, Camp Lejeune had elevated mortality hazard ratios (HRs) for all cancers (HR = 1.10, 95% CI: 1.00, 1.20), kidney cancer (HR = 1.35, 95% CI: 0.84, 2.16), liver cancer (HR = 1.42, 95% CI: 0.92, 2.20), esophageal cancer (HR = 1.43 95% CI: 0.85, 2.38), cervical cancer (HR = 1.33, 95% CI: 0.24, 7.32), Hodgkin lymphoma (HR = 1.47, 95% CI: 0.71, 3.06), and multiple myeloma (HR = 1.68, 95% CI: 0.76, 3.72). Within the Camp Lejeune cohort, monotonic categorical cumulative exposure trends were observed for kidney cancer and total contaminants (HR, high cumulative exposure = 1.54, 95% CI: 0.63, 3.75; log10 β = 0.06, 95% CI: -0.05, 0.17), Hodgkin lymphoma and trichloroethylene (HR, high cumulative exposure = 1.97, 95% CI: 0.55, 7.03; β = 0.00005, 95% CI: -0.00003, 0.00013) and benzene (HR, high cumulative exposure = 1.94, 95% CI: 0.54, 6.95; β = 0.00203, 95% CI: -0.00339, 0.00745). Amyotrophic Lateral Sclerosis (ALS) had HR = 2.21 (95% CI: 0.71, 6.86) at high cumulative vinyl chloride exposure but a non-monotonic exposure-response relationship (β = 0.0011, 95% CI: 0.0002, 0.0020). The study found elevated HRs at Camp Lejeune for several causes of death including cancers of the kidney, liver, esophagus, cervix, multiple myeloma, Hodgkin lymphoma and ALS. CIs were wide for most HRs. Because <6% of the cohort had died, long-term follow-up would be necessary to comprehensively assess effects of drinking water exposures at the base.

Polymer tensiometer with ceramic cones: a case study for a Brazilian soil.

NASA Astrophysics Data System (ADS)

Durigon, A.; de Jong van Lier, Q.; van der Ploeg, M. J.; Gooren, H. P. A.; Metselaar, K.; de Rooij, G. H.

2009-04-01

Laboratory outflow experiments, in combination with inverse modeling techniques, allow to simultaneously determine retention and hydraulic conductivity functions. A numerical model solves the pressure-head-based form of the Richards' equation for unsaturated flow in a rigid porous medium. Applying adequate boundary conditions, the cumulative outflow is calculated at prescribed times, and as a function of the set of optimized parameters. These parameters are evaluated by nonlinear least-squares fitting of predicted to observed cumulative outflow with time. An objective function quantifies this difference between calculated and observed cumulative outflow and between predicted and measured soil water retention data. Using outflow data only in the objective function, the multistep outflow method results in unique estimates of the retention and hydraulic conductivity functions. To obtain more reliable estimates of the hydraulic conductivity as a function of the water content using the inverse method, the outflow data must be supplemented with soil retention data. To do so tensiometers filled with a polymer solution instead of water were used. The measurement range of these tensiometers is larger than that of the conventional tensiometers, being able to measure the entire pressure head range over which crops take up water, down to values in the order of -1.6 MPa. The objective of this study was to physically characterize a Brazilian red-yellow oxisol using measurements in outflow experiments by polymer tensiometers and processing these data with the inverse modeling technique for use in the analysis of a field experiment and in modeling. The soil was collected at an experimental site located in Piracicaba, Brazil, 22° 42 S, 47° 38 W, 550 m above sea level.

Ruptured Tendons in Anabolic-Androgenic Steroid Users: A Cross-Sectional Cohort Study.

PubMed

Kanayama, Gen; DeLuca, James; Meehan, William P; Hudson, James I; Isaacs, Stephanie; Baggish, Aaron; Weiner, Rory; Micheli, Lyle; Pope, Harrison G

2015-11-01

Accumulating case reports have described tendon rupture in men who use anabolic-androgenic steroids (AAS). However, no controlled study has assessed the history of tendon rupture in a large cohort of AAS users and comparison nonusers. Men reporting long-term AAS abuse would report an elevated lifetime incidence of tendon rupture compared with non-AAS-using bodybuilders. Cohort study; Level of evidence, 3. Medical histories were obtained from 142 experienced male bodybuilders aged 35 to 55 years recruited in the course of 2 studies. Of these men, 88 reported at least 2 years of cumulative lifetime AAS use, and 54 reported no history of AAS use. In men reporting a history of tendon rupture, the circumstances of the injury, prodromal symptoms, concomitant drug or alcohol use, and details of current and lifetime AAS use (if applicable) were recorded. Surgical records were obtained for most participants. Nineteen (22%) of the AAS users, but only 3 (6%) of the nonusers, reported at least 1 lifetime tendon rupture. The hazard ratio for a first ruptured tendon in AAS users versus nonusers was 9.0 (95% CI, 2.5-32.3; P < .001). Several men reported 2 or more independent lifetime tendon ruptures. Interestingly, upper-body tendon ruptures occurred exclusively in the AAS group (15 [17%] AAS users vs 0 nonusers; risk difference, 0.17 [95% CI, 0.09-0.25]; P < .001 [hazard ratio not estimable]), whereas there was no significant difference between users and nonusers in risk for lower-body ruptures (6 [7%] AAS users, 3 [6%] nonusers; hazard ratio, 3.1 [95% CI, 0.7-13.8]; P = .13). Of 31 individual tendon ruptures assessed, only 6 (19%) occurred while weightlifting, with the majority occurring during other sports activities. Eight (26%) ruptures followed prodromal symptoms of nonspecific pain in the region. Virtually all ruptures were treated surgically, with complete or near-complete ultimate restoration of function. AAS abusers, compared with otherwise similar bodybuilders, showed a markedly increased risk of tendon ruptures, particularly upper-body tendon rupture. © 2015 The Author(s).

Incidence and Long-term Outcomes of the HIV-Neuroretinal Disorder in Patients with the Acquired Immunodeficiency Syndrome

PubMed Central

Jabs, Douglas A.; Drye, Lea; Van Natta, Mark L.; Thorne, Jennifer E.; Holland, Gary N.

2014-01-01

Objectives Patients with the acquired immunodeficiency syndrome (AIDS) have an abnormality of retina/optic nerve function, manifested as decreased contrast sensitivity (in the absence of ocular opportunistic infections or media opacity), abnormalities on automated perimetry, and loss of retinal nerve fiber layer, even among those with good visual acuity, termed the HIV-neuroretinal disorder. The objectives of this study were to determine the prevalence, incidence, risk factors for, and outcomes of HIV-neuroretinal disorder. Design Prospective cohort study Participants 1822 patients with AIDS without ocular infections or media opacities. Methods Patients with HIV-neuroretinal disorder were identified by a contrast sensitivity < 1.50 log units in either eye in the absence of ocular opportunistic infections or media opacity. Main outcome measures Incidence of HIV-neuroretinal disorder, mortality, visual impairment (visual acuity 20/50 or worse), and blindness (20/200 or worse) on logarithmic visual acuity charts. Results Sixteen percent of participants had HIV-neuroretinal disorder at enrollment. The estimated cumulative incidence by 20 years after AIDS diagnosis was 51% (95% confidence interval [CI] 46%–55%). HIV-neuroretinal disorder was more common in women and African American persons. Risk factors for it included hepatitis C infection, low CD4+ T cells, and detectable HIV RNA in the blood. Patients with HIV neuroretinal disorder had a 70% excess mortality vs. those without it, even after adjusting for CD4+ T cells and HIV load (hazard ratio=1.7, 95% CI= 1.3–2.1, P<0.0001). Patients with HIV-neuroretinal disorder had increased risks of bilateral visual impairment (hazard ratio=6.5, 95% CI=2.6–10.6, P<0.0001) and blindness (hazard ratio=5.9, 95% CI=2.8–13.7, P=0.01) vs. those without HIV neuroretinal disorder. Conclusions HIV-neuroretinal disorder is a common finding among patients with AIDS, and it is associated with an increased mortality and an increased risk of visual impairment. Successful antiretroviral therapy decreases but does not eliminate the risk of HIV-neuroretinal disorder. PMID:25600199

Efficient estimation of Pareto model: Some modified percentile estimators.

PubMed

Bhatti, Sajjad Haider; Hussain, Shahzad; Ahmad, Tanvir; Aslam, Muhammad; Aftab, Muhammad; Raza, Muhammad Ali

2018-01-01

The article proposes three modified percentile estimators for parameter estimation of the Pareto distribution. These modifications are based on median, geometric mean and expectation of empirical cumulative distribution function of first-order statistic. The proposed modified estimators are compared with traditional percentile estimators through a Monte Carlo simulation for different parameter combinations with varying sample sizes. Performance of different estimators is assessed in terms of total mean square error and total relative deviation. It is determined that modified percentile estimator based on expectation of empirical cumulative distribution function of first-order statistic provides efficient and precise parameter estimates compared to other estimators considered. The simulation results were further confirmed using two real life examples where maximum likelihood and moment estimators were also considered.

Impact of Prolonged Mechanical Ventilation in Very Low Birth Weight Infants: Results From a National Cohort Study.

PubMed

Choi, Young-Bin; Lee, Juyoung; Park, Jisun; Jun, Yong Hoon

2018-03-01

To evaluate the in-hospital consequences of prolonged respiratory support with invasive mechanical ventilation in very low birth weight infants. A cohort study was performed using prospectively collected data from 69 neonatal intensive care units participating in the Korean national registry. In total, 3508 very low birth weight infants born between January 1, 2013 and December 31, 2014 were reviewed. The adjusted hazard ratio for death increased significantly for infants who received mechanical ventilation for more than 2 weeks compared with those were mechanically ventilated for 7 days or less. The individual mortality rate increased after 8 weeks, reaching 50% and 60% at 14 and 16 weeks of cumulative mechanical ventilation, respectively. After adjusting for potential confounders, the cumulative duration of mechanical ventilation was associated with a clinically significant increase in the odds of bronchopulmonary dysplasia and pulmonary hypertension. Mechanical ventilation exposure for longer than 2 weeks, compared with 7 days or less, was associated with retinopathy of prematurity requiring laser coagulation and periventricular leukomalacia. The odds of abnormal auditory screening test results were significantly increased in infants who needed mechanical ventilation for more than 4 weeks. A longer cumulative duration of mechanical ventilation was associated with increased lengths of hospitalization and parenteral nutrition and a higher probability of discharge with poor achievement of physical growth. Although mechanical ventilation is a life-saving intervention for premature infants, these results indicate that it is associated with negative consequences when applied for prolonged periods. Copyright © 2017 Elsevier Inc. All rights reserved.

Marital history from age 15 to 40 years and subsequent 10-year mortality: a longitudinal study of Danish males born in 1953.

PubMed

Lund, Rikke; Holstein, Bjørn Evald; Osler, Merete

2004-04-01

The aims of the present study are to analyse the association between marital status at age 24, 29, 34, and 39 years and subsequent mortality in a cohort of men born in 1953 (sensitive period); to study the impact of number of years married, number of years divorced/widowed, and number of marital break-ups on mortality (cumulative effect), and to examine whether these effects were independent of marital status at age 39 (proximity effect). Prospective birth cohort study with follow-up of mortality from 1992 to 2002. Participants were 10891 men born within the metropolitan area of Copenhagen, Denmark. Marital status in 1992 as well as start and termination of all previous marital status events from 1968 to 1992 were retrieved from the Danish Civil Registration System. Were hazard ratios (HR) for all-cause mortality from age 40 to 49 years. We found a strong protective effect of being married compared with never being married or divorced/widowed at every age. The association increased in strength with increasing age. Number of years divorced was associated with increased mortality risk in a dose-dependent manner at age 34 and 39 years. One or more marital break-ups was associated with higher mortality, whereas increasing number of years married was associated with lower mortality. Inclusion of current marital status attenuated the strength of the associations but most of them remained statistically significant. Marital status and cumulated marital periods, especially cumulated periods divorced/widowed are strong independent predictors of mortality among younger males.

UBIQUITOUS POLLUTANTS FROM CUMULATIVE ...

EPA Pesticide Factsheets

The occurrence of pharmaceuticals and personal care products (PPCPS) as environmental pollutants is a multifaceted issue whose scope continues to become better delineated since the escalation of concerted attention beginning in the 1980s. PPCPs typically occur as trace environmental pollutants (primarily in surface but also in ground waters) as a result of their widespread, continuous, combined usage in a broad range of human and veterinary therapeutic activities and practices. With respect to the risk-assessment paradigm, the growing body of published work has focused primarily on the origin and occurrence of these substances. Comparatively less is known about human and ecological exposure, and even less about the known or even potential hazards associated with exposure to these anthropogenic substances, many of which are highly bioactive. The continually growing, worldwide importance of freshwater resources underscores the need for ensuring that any aggregate or cumulative impacts on water supplies and resultant potential for human or ecological exposure be minimized. This has prompted the more recent investigations on waste treatment processes for one of the major sources of environmental disposition, namely sewage. Despite the paucity of health effects data for long-term, simultaneous exposure to multiple xenobiotics (particularly PPCPS) at low doses (a major toxicological issue that can be described by the

Cumulative risk assessment lessons learned: a review of case studies and issue papers.

PubMed

Gallagher, Sarah S; Rice, Glenn E; Scarano, Louis J; Teuschler, Linda K; Bollweg, George; Martin, Lawrence

2015-02-01

Cumulative risk assessments (CRAs) examine potential risks posed by exposure to multiple and sometimes disparate environmental stressors. CRAs are more resource intensive than single chemical assessments, and pose additional challenges and sources of uncertainty. CRAs may examine the impact of several factors on risk, including exposure magnitude and timing, chemical mixture composition, as well as physical, biological, or psychosocial stressors. CRAs are meant to increase the relevance of risk assessments, providing decision makers with information based on real world exposure scenarios that improve the characterization of actual risks and hazards. The U.S. Environmental Protection Agency has evaluated a number of CRAs, performed by or commissioned for the Agency, to seek insight into CRA concepts, methods, and lessons learned. In this article, ten case studies and five issue papers on key CRA topics are examined and a set of lessons learned are identified for CRA implementation. The lessons address the iterative nature of CRAs, importance of considering vulnerability, need for stakeholder engagement, value of a tiered approach, new methods to assess multiroute exposures to chemical mixtures, and the impact of geographical scale on approach and purpose. Copyright © 2014 Elsevier Ltd. All rights reserved.

An evaluation of longitudinal changes in serum uric acid levels and associated risk of cardio-metabolic events and renal function decline in gout.

PubMed

Desai, Rishi J; Franklin, Jessica M; Spoendlin-Allen, Julia; Solomon, Daniel H; Danaei, Goodarz; Kim, Seoyoung C

2018-01-01

Gout patients have a high burden of co-morbid conditions including diabetes mellitus (DM), chronic kidney disease (CKD), and cardiovascular disease (CVD). We sought to evaluate the association between changes in serum uric acid (SUA) levels over time and the risk of incident DM, CVD, and renal function decline in gout patients. An observational cohort study was conducted among enrollees of private health insurance programs in the US between 2004 and 2015. Gout patients were included on the index date of a SUA measurement ≥6.8 mg/dl. The exposure of interest was cumulative change in SUA levels from baseline. Hazard ratios (HR) and 95% confidence intervals (CI) for incident DM, incident CVD, and renal function decline (≥30% reduction in glomerular filtration rate) were derived using marginal structural models with stabilized inverse probability weights accounting for baseline confounders (age, gender, co-morbidities, co-medications) and time-varying confounders (serum creatinine, blood urea nitrogen, glycated hemoglobin). Among 26,341 patients with gout, the average age was 62, 75% were men, and the median baseline SUA was 8.6 mg/dl (interquartile range 7.7 to 9.5). The incidence rates/100 person-years (95% CI) were 1.63 (1.51-1.75) for DM, 0.77 (0.70-0.84) for CVD, and 4.32 (4.14-4.49) for renal function decline. The adjusted HR (95% CI) per 3 mg/dl reduction in SUA, corresponding on average to achieving the target level of <6 mg/dl in this population, was 1.04 (0.92-1.17) for DM, 1.07 (0.89-1.29) for CVD, and 0.85 (0.78-0.92) for renal function decline. Reduction in SUA in patients with gout may be associated with a reduced risk of renal function decline, but not with DM or CVD.

Effect of Age and Renal Function on Survival After Left Ventricular Assist Device Implantation.

PubMed

Muslem, Rahatullah; Caliskan, Kadir; Akin, Sakir; Yasar, Yunus E; Sharma, Kavita; Gilotra, Nisha A; Kardys, Isabella; Houston, Brian; Whitman, Glenn; Tedford, Ryan J; Hesselink, Dennis A; Bogers, Ad J J C; Manintveld, Olivier C; Russell, Stuart D

2017-12-15

Left ventricular assist devices (LVAD) are increasingly used, especially as destination therapy in in older patients. The aim of this study was to evaluate the effect of age on renal function and mortality in the first year after implantation. A retrospective multicenter cohort study was conducted, evaluating all LVAD patients implanted in the 2 participating centers (age ≥18 years). Patients were stratified according to the age groups <45, 45-54, 55-64, and ≥65 years old. Overall, 241 patients were included (mean age 52.4 ± 12.9 years, 76% males, 33% destination therapy). The mean estimated Glomerular Filtration Rate (eGFR) at 1 year was 85, 72, 69, and 49 mL/min per 1.73 m 2 in the age groups <45(n = 65, 27%), 45-54(n = 52, 22%), 55-64(n = 87, 36%), and ≥65 years (n = 37, 15%) p <0.001)), respectively. Older age and lower eGFR at baseline (p <0.01) were independent predictors of worse renal function at 1 year. The 1-year survival post-implantation was 79%,84%, 68%, and 54% for those in the age group <45, 45-54, 55-64 and ≥65 years (Log-rank p = 0.003). Older age, lower eGFR and, INTERMACS class I were independent predictors of 1-year mortality. Furthermore, older patients (age > 60 years) with an impaired renal function (eGFR <55 mL/min per 1.73 m 2 ) had a 5-fold increased hazard ratio for mortality during the first year after implantation (p <0.001). In conclusion, age >60 years is an independent predictor for an impaired renal function and mortality. Older age combined with reduced renal function pre-implantation had a cumulative adverse effect on survival in patients receiving a LVAD. Copyright © 2017 Elsevier Inc. All rights reserved.