Relative survival: a useful tool to assess generalisability in longitudinal studies of health in older persons

PubMed Central

2011-01-01

Background Generalisability of longitudinal studies is threatened by issues such as choice of sampling frame, representativeness of the initial sample, and attrition. To determine representativeness, cohorts are often compared with the population of interest at baseline on demographic and health characteristics. This study illustrates the use of relative survival as a tool for assessing generalisability of results from a cohort of older people among whom death is a potential threat to generalisability. Methods The authors used data from the 1921-26 cohort (n = 12,416, aged 70-75 in 1996) of the Australian Longitudinal Study on Women's Health (ALSWH). Vital status was determined by linkage to the National Death Index, and expected deaths were derived using Australian life tables. Relative survival was estimated using observed survival in the cohort divided by expected survival among women of the same age and State or Territory. Results Overall, the ALSWH women showed relative survival 9.5% above the general population. Within States and Territories, the relative survival advantage varied from 6% to 23%. The interval-specific relative survival remained relatively constant over the 12 years (1996-2008) under review, indicating that the survival advantage of the cohort has not diminished over time. Conclusion This study demonstrates that relative survival can be a useful measure of generalisability in a longitudinal study of the health of the general population, particularly when participants are older. PMID:21294918

Eliciting Survival Expectations of the Elderly in Low-Income Countries: Evidence From India.

PubMed

Delavande, Adeline; Lee, Jinkook; Menon, Seetha

2017-04-01

We examine several methodological considerations when eliciting probabilistic expectations in a developing country context using the Longitudinal Ageing Study in India (LASI). We conclude that although, on average, individuals are able to understand the concept of probability, responses are sensitive to framing effects and to own versus hypothetical-person effects. We find that overall, people are pessimistic about their survival probabilities compared with state-specific life tables and that socioeconomic status does influence beliefs about own survival expectations as found in previous literature in other countries. Higher levels of education and income have a positive association with survival expectations, and these associations persist even when conditioning on self-reported health. The results remain robust to several alternative specifications. We then compare the survival measures with objective measures of health. We find that activities of daily life, height, and low hemoglobin levels covary with subjective expectations in expected directions.

Using Survival Analysis to Improve Estimates of Life Year Gains in Policy Evaluations.

PubMed

Meacock, Rachel; Sutton, Matt; Kristensen, Søren Rud; Harrison, Mark

2017-05-01

Policy evaluations taking a lifetime horizon have converted estimated changes in short-term mortality to expected life year gains using general population life expectancy. However, the life expectancy of the affected patients may differ from the general population. In trials, survival models are commonly used to extrapolate life year gains. The objective was to demonstrate the feasibility and materiality of using parametric survival models to extrapolate future survival in health care policy evaluations. We used our previous cost-effectiveness analysis of a pay-for-performance program as a motivating example. We first used the cohort of patients admitted prior to the program to compare 3 methods for estimating remaining life expectancy. We then used a difference-in-differences framework to estimate the life year gains associated with the program using general population life expectancy and survival models. Patient-level data from Hospital Episode Statistics was utilized for patients admitted to hospitals in England for pneumonia between 1 April 2007 and 31 March 2008 and between 1 April 2009 and 31 March 2010, and linked to death records for the period from 1 April 2007 to 31 March 2011. In our cohort of patients, using parametric survival models rather than general population life expectancy figures reduced the estimated mean life years remaining by 30% (9.19 v. 13.15 years, respectively). However, the estimated mean life year gains associated with the program are larger using survival models (0.380 years) compared to using general population life expectancy (0.154 years). Using general population life expectancy to estimate the impact of health care policies can overestimate life expectancy but underestimate the impact of policies on life year gains. Using a longer follow-up period improved the accuracy of estimated survival and program impact considerably.

Stereotactic Body Radiotherapy Versus Surgery for Medically Operable Stage I Non-Small-Cell Lung Cancer: A Markov Model-Based Decision Analysis

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

Louie, Alexander V.; Rodrigues, George, E-mail: george.rodrigues@lhsc.on.ca; Department of Epidemiology/Biostatistics, University of Western Ontario, London, ON

Purpose: To compare the quality-adjusted life expectancy and overall survival in patients with Stage I non-small-cell lung cancer (NSCLC) treated with either stereotactic body radiation therapy (SBRT) or surgery. Methods and Materials: We constructed a Markov model to describe health states after either SBRT or lobectomy for Stage I NSCLC for a 5-year time frame. We report various treatment strategy survival outcomes stratified by age, sex, and pack-year history of smoking, and compared these with an external outcome prediction tool (Adjuvant{exclamation_point} Online). Results: Overall survival, cancer-specific survival, and other causes of death as predicted by our model correlated closely withmore » those predicted by the external prediction tool. Overall survival at 5 years as predicted by baseline analysis of our model is in favor of surgery, with a benefit ranging from 2.2% to 3.0% for all cohorts. Mean quality-adjusted life expectancy ranged from 3.28 to 3.78 years after surgery and from 3.35 to 3.87 years for SBRT. The utility threshold for preferring SBRT over surgery was 0.90. Outcomes were sensitive to quality of life, the proportion of local and regional recurrences treated with standard vs. palliative treatments, and the surgery- and SBRT-related mortalities. Conclusions: The role of SBRT in the medically operable patient is yet to be defined. Our model indicates that SBRT may offer comparable overall survival and quality-adjusted life expectancy as compared with surgical resection. Well-powered prospective studies comparing surgery vs. SBRT in early-stage lung cancer are warranted to further investigate the relative survival, quality of life, and cost characteristics of both treatment paradigms.« less

Urgent chemotherapy in hematological patients in the ICU.

PubMed

Moors, Ine; Pène, Frédéric; Lengline, Étienne; Benoit, Dominique

2015-12-01

Over the past decades, survival of critically ill hematological patients has dramatically improved, and these patients are more frequently referred to the ICU for intensive treatment, including a rising need for administering anticancer-therapy in this setting. The scarce literature on this subject provides evidence for feasibility of administering chemotherapy in the ICU, with expected ICU survival of 60-70%, and one in three patients surviving at least 1 year after discharge. We summarize the recent evidence concerning outcome, dosing and indications of chemotherapy in the ICU, and provide practical guidelines for some special oncological situations. Anticancer-therapy in the ICU is feasible and no longer futile as long as it is initiated in a selected, well-informed patient population with reasonable prognostic expectations. Accurate recognition of organ failure and early referral to the ICU for both supportive care and timely administration of chemotherapy is recommended before the development of multisystem organ failure.

Diminished Disease-Free Survival After Lobectomy: Screening Implications.

PubMed

Reich, Jerome M; Kim, Jong S; Asaph, James W

2015-09-01

The aim of this study was to estimate the effect of lobectomy on life expectancy in healthy smokers and consider the implications for lung cancer screening. In a retrospective cohort study that provided a minimum of 15 years of follow-up, we analyzed lung cancer survival, all-cause survival, and fatality (1-survival) of 261 persons with stage I non-small-cell lung cancer who underwent lobectomy at Portland Providence Medical Center between 1978 and 1994. We: (1) compared 5-year disease-free fatality (non-lung-cancer fatality) with lung cancer fatality; and (2) based on actuarial data that demonstrated life expectancy equivalence of the healthiest smokers (whom we assumed would be comparable with subjects judged eligible for lobectomy) in the US population, we compared their long-term, disease-free survival (our primary end point) with actuarial expectations by computing the Kaplan-Meier survival function of the differences between lifetimes since surgery in disease-free persons versus matched, expected remaining lifetimes in the US population. (1) Five-year disease-free fatality (16.1%) was 58% as high as 5-year lung cancer fatality (27.6%); (2) disease-free survival was reduced by 6.9-years (95% confidence interval, 5.5-8.3), 41% of actuarial life expectancy (17 years). The divergence from expected survival took place largely after 6 years of follow-up. Lobectomy materially diminishes long-term disease-free survival in the healthiest smokers--persons judged healthy enough to tolerate major surgery and to have sufficient pulmonary reserve to sustain loss of one-fifth of their lung tissue. In screened populations, diminished survival in overdiagnosed persons will offset, to an undetermined extent, the mortality benefit imparted by preemption of advanced lung cancer. Copyright © 2015 Elsevier Inc. All rights reserved.

Challenges faced in long term ventricular assist device support.

PubMed

Ikegami, Hirohisa; Kurlansky, Paul; Takeda, Koji; Naka, Yoshifumi

2016-08-01

The development of ventricular assist device (VAD) has been one of the revolutionary advancements in end-stage heart failure management. Although the device has developed and improved significantly over the last few decades, we still face multiple challenges. This review will discuss quality of life, survival, and clinically encountered complications in patients with VAD support. The literature was extensively reviewed for studies describing the above topic area. We describe the impact of major challenges faced in VAD support and discuss their future and expectations. Expert commentary: The technological advancement of VADs has contributed to major improvement of overall survival, enhancement of quality of life and decrease of incidence of complications. It is expected that technologies will continue to evolve. At the same time, the indications for and timing of device implantation, and selection of device type are continuously important in clinical practice setting.

Improving but Inferior Survival in Patients with Chronic Lymphocytic Leukemia in Taiwan: A Population-Based Study, 1990–2004

PubMed Central

Wu, Shang-Ju; Chiang, Chun-Ju; Lin, Chien-Ting; Tien, Hwei-Fang; Lai, Mei-Shu

2013-01-01

Background Chronic lymphocytic leukemia (CLL) is much less prevalent in Asian countries. Whether there are differences in survival outcomes between the East and West, however, remain unclear. Methods The survival data for CLL patients identified in the Taiwan Cancer Registry database between 1990 and 2004, together with corresponding data in the US Surveillance, Epidemiology, and End Results database, were retrieved. The relative survivals (RS, adjusted for the expected survival in the general population) were estimated in patients diagnosed in three 5-year periods of time. Results CLL drastically shortened patients’ life expectancy; more importantly, this negative impact in Taiwan was much larger than that in the US: the 5-year RS in Taiwan and US were 59% and 76%, and the 10-year RS, 45% and 56%, respectively. Nevertheless, survival in Taiwan was better in the periods after 1995 (5-year RS, from 53.0% to 60.6%), a time period corresponding to the introduction of the Taiwan National Health Insurance scheme. Such improvement was largely due to decreased mortality in patients younger than 65 (5-year RS, from 53.5% to 69.1%). Despite the improvement, patients’ RS in Taiwan in recent periods remain steadily 15∼20% inferior to that in the US in both younger and older patient groups. Conclusions The improved RS in Taiwan implies that therapeutic advances are changing the prognosis of CLL. The stable RS gap between Taiwanese and the US patients suggests the existence of an ethnic difference in CLL patients’ outcomes. PMID:23638168

["That flesh, pink and perishable": analysis of disease-free survival analysis in breast cancer in Gipuzkoa (Spain) in the presence of competing risks].

PubMed

Martínez-Camblor, Pablo; Larrañaga, Nerea; Sarasqueta, Cristina; Mitxelena, María José; Basterretxea, Mikel

2009-01-01

To analyze time of disease-free survival and relative survival in women diagnosed with breast cancer in the province of Gipuzkoa within the context of competing risks by assessing differences between the direct use of the Kaplan-Meier estimator and the multiple decrement method on the one hand, and relative survival on the other. All registered breast cancer cases in Gipuzkoa in 1995 and 1996 with stages other than stage IV were included. An 8-year follow-up for recurrence and a 10-year follow-up for survival were performed. Time of disease-free survival was studied by the multiple decrement model. Observed survival and survival corrected by the expected mortality in the population (relative survival) were also studied. Estimation of the probability of recurrence at 8 years with the multiple decrement method was 8.8% lower than that obtained with the Kaplan-Meier method. The difference between the observed and relative survival rates at 10 years was 10.8%. Both results show how, in this case, the Kaplan-Meier estimator overestimates both the probability of recurrence and that of mortality from the disease. Two issues are often overlooked when performing survival analyses: firstly, because of the lack of independence between survival time and censoring time, the results obtained by the Kaplan-Meier estimator are uninterpretable; secondly, it is an incontrovertible fact that one way or another, everyone causes failures. In this approach, survival analyses must take into account the probability of failure in the general population of reference. The results obtained in this study show that superficial use of the Kaplan Meier estimator overestimates both the probability of recurrence and that of mortality caused by the disease.

Stochastic variation in avian survival rates: Life-history predictions, population consequences, and the potential responses to human perturbations and climate change

USGS Publications Warehouse

Schmutz, Joel A.; Thomson, David L.; Cooch, Evan G.; Conroy, Michael J.

2009-01-01

Stochastic variation in survival rates is expected to decrease long-term population growth rates. This expectation influences both life-history theory and the conservation of species. From this expectation, Pfister (1998) developed the important life-history prediction that natural selection will have minimized variability in those elements of the annual life cycle (such as adult survival rate) with high sensitivity. This prediction has not been rigorously evaluated for bird populations, in part due to statistical difficulties related to variance estimation. I here overcome these difficulties, and in an analysis of 62 populations, I confirm her prediction by showing a negative relationship between the proportional sensitivity (elasticity) of adult survival and the proportional variance (CV) of adult survival. However, several species deviated significantly from this expectation, with more process variance in survival than predicted. For instance, projecting the magnitude of process variance in annual survival for American redstarts (Setophaga ruticilla) for 25 years resulted in a 44% decline in abundance without assuming any change in mean survival rate. For most of these species with high process variance, recent changes in harvest, habitats, or changes in climate patterns are the likely sources of environmental variability causing this variability in survival. Because of climate change, environmental variability is increasing on regional and global scales, which is expected to increase stochasticity in vital rates of species. Increased stochasticity in survival will depress population growth rates, and this result will magnify the conservation challenges we face.

Geographic disparities in colorectal cancer survival

PubMed Central

Henry, Kevin A; Niu, Xiaoling; Boscoe, Francis P

2009-01-01

Background Examining geographic variation in cancer patient survival can help identify important prognostic factors that are linked by geography and generate hypotheses about the underlying causes of survival disparities. In this study, we apply a recently developed spatial scan statistic method, designed for time-to-event data, to determine whether colorectal cancer (CRC) patient survival varies by place of residence after adjusting survival times for several prognostic factors. Methods Using data from a population-based, statewide cancer registry, we examined a cohort of 25,040 men and women from New Jersey who were newly diagnosed with local or regional stage colorectal cancer from 1996 through 2003 and followed to the end of 2006. Survival times were adjusted for significant prognostic factors (sex, age, stage at diagnosis, race/ethnicity and census tract socioeconomic deprivation) and evaluated using a spatial scan statistic to identify places where CRC survival was significantly longer or shorter than the statewide experience. Results Age, sex and stage adjusted survival times revealed several areas in the northern part of the state where CRC survival was significantly different than expected. The shortest and longest survival areas had an adjusted 5-year survival rate of 73.1% (95% CI 71.5, 74.9) and 88.3% (95% CI 85.4, 91.3) respectively, compared with the state average of 80.0% (95% CI 79.4, 80.5). Analysis of survival times adjusted for age, sex and stage as well as race/ethnicity and area socioeconomic deprivation attenuated the risk of death from CRC in several areas, but survival disparities persisted. Conclusion The results suggest that in areas where additional adjustments for race/ethnicity and area socioeconomic deprivation changed the geographic survival patterns and reduced the risk of death from CRC, the adjustment factors may be contributing causes of the disparities. Further studies should focus on specific and modifiable individual and neighborhood factors in the high risk areas that may affect a person's chance of surviving cancer. PMID:19627576

Cyclicality, Mortality, and the Value of Time: The Case of Coffee Price Fluctuations and Child Survival in Colombia

PubMed Central

Miller, Grant; Urdinola, B. Piedad

2011-01-01

Recent studies demonstrate procyclical mortality in wealthy countries, but there are reasons to expect a countercyclical relationship in developing nations. We investigate how child survival in Colombia responds to fluctuations in world Arabica coffee prices – and document starkly procyclical child deaths. In studying this result’s behavioral underpinnings, we highlight that: (1) The leading determinants of child health are inexpensive but require considerable time, and (2) As the value of time declines with falling coffee prices, so does the relative price of health. We find a variety of direct evidence consistent with the primacy of time in child health production. PMID:22090662

The Clinical Significance of Digital Examination-Indicated Cerclage in Women with a Dilated Cervix at 14 0/7 - 29 6/7 Weeks

PubMed Central

Ko, Hyun Sun; Jo, Yun Seong; Kil, Ki Cheol; Chang, Ha Kyun; Park, Yong-Gyu; Park, In Yang; Lee, Guisera; Kim, Sajin; Shin, Jong Chul

2011-01-01

Objective. This study was to compare pregnancy outcomes between cerclage and expectant management in wemen with a dilated cervix. Design. Retrospective multicenter cohort study. Setting. Five hospitals of Catholic University Medical Center Network in Korea. Population. A total of 173 women between 14 0/7 and 29 6/7 weeks' gestation with cervical dilation of 1 cm or greater by digital examination. Methods. Pregnancy outcomes were compared according to cerclage or expectant management, with the use of propensity-score matching. Main Outcome Measures. Primary outcome was time from presentation until delivery (weeks). Secondary outcomes were gestational age at delivery, neonatal survival, morbidity, preterm birth, and so on. Results. Of 173 women, 116 received a cerclage (cerclage group), and 57 were managed expectantly without cerclage (expectant group). Cervical dilation at presentation, and the use of amniocentesis performed to exclude subclinical chorioamnionitis differed between two groups. In the overall matched cohort, there was significant difference in the time from presentation until delivery (cerclage vs. expectant group, 10.6±6.2 vs. 2.9±3.2 weeks, p <0.0001). While there was no significant difference in the neonatal survival between two groups, there werelower neonatal morbidity as well as higher pregnancy maintenance rate at 28, 32, 34 and 37 weeks' gestation in the cerclage group, compared with the expectant group. Conclusion. This study suggests that digital examination-indicated cerclage appears to prolong gestation and decrease neonatal morbidity, compared with expectant management in women with cervical dilation between 14 0/7 and 29 6/7 weeks. PMID:21960743

Cure frailty models for survival data: application to recurrences for breast cancer and to hospital readmissions for colorectal cancer.

PubMed

Rondeau, Virginie; Schaffner, Emmanuel; Corbière, Fabien; Gonzalez, Juan R; Mathoulin-Pélissier, Simone

2013-06-01

Owing to the natural evolution of a disease, several events often arise after a first treatment for the same subject. For example, patients with a primary invasive breast cancer and treated with breast conserving surgery may experience breast cancer recurrences, metastases or death. A certain proportion of subjects in the population who are not expected to experience the events of interest are considered to be 'cured' or non-susceptible. To model correlated failure time data incorporating a surviving fraction, we compare several forms of cure rate frailty models. In the first model already proposed non-susceptible patients are those who are not expected to experience the event of interest over a sufficiently long period of time. The other proposed models account for the possibility of cure after each event. We illustrate the cure frailty models with two data sets. First to analyse time-dependent prognostic factors associated with breast cancer recurrences, metastases, new primary malignancy and death. Second to analyse successive rehospitalizations of patients diagnosed with colorectal cancer. Estimates were obtained by maximization of likelihood using SAS proc NLMIXED for a piecewise constant hazards model. As opposed to the simple frailty model, the proposed methods demonstrate great potential in modelling multivariate survival data with long-term survivors ('cured' individuals).

Are Global and Regional Improvements in Life Expectancy and in Child, Adult and Senior Survival Slowing?

PubMed Central

Hum, Ryan J.; Verguet, Stéphane; Cheng, Yu-Ling; McGahan, Anita M.; Jha, Prabhat

2015-01-01

Improvements in life expectancy have been considerable over the past hundred years. Forecasters have taken to applying historical trends under an assumption of continuing improvements in life expectancy in the future. A linear mixed effects model was used to estimate the trends in global and regional rates of improvements in life expectancy, child, adult, and senior survival, in 166 countries between 1950 and 2010. Global improvements in life expectancy, including both child and adult survival rates, decelerated significantly over the study period. Overall life expectancy gains were estimated to have declined from 5.9 to 4.0 months per year for a mean deceleration of -0.07 months/year2; annual child survival gains declined from 4.4 to 1.6 deaths averted per 1000 for a mean deceleration of -0.06 deaths/1000/year2; adult survival gains were estimated to decline from 4.8 to 3.7 deaths averted per 1000 per year for a mean deceleration of -0.08 deaths/1000/year2. Senior survival gains however increased from 2.4 to 4.2 deaths averted per 1000 per year for an acceleration of 0.03 deaths/1000/year2. Regional variation in the four measures was substantial. The rates of global improvements in life expectancy, child survival, and adult survival have declined since 1950 despite an increase in the rate of improvements among seniors. We postulate that low-cost innovation, related to the last half-century progress in health–primarily devoted to children and middle age, is reaping diminishing returns on its investments. Trends are uneven across regions and measures, which may be due in part to the state of epidemiological transition between countries and regions and disparities in the diffusion of innovation, accessible only in high-income countries where life expectancy is already highest. PMID:25992949

Assessment of imatinib as first-line treatment of chronic myeloid leukemia: 10-year survival results of the randomized CML study IV and impact of non-CML determinants.

PubMed

Hehlmann, R; Lauseker, M; Saußele, S; Pfirrmann, M; Krause, S; Kolb, H J; Neubauer, A; Hossfeld, D K; Nerl, C; Gratwohl, A; Baerlocher, G M; Heim, D; Brümmendorf, T H; Fabarius, A; Haferlach, C; Schlegelberger, B; Müller, M C; Jeromin, S; Proetel, U; Kohlbrenner, K; Voskanyan, A; Rinaldetti, S; Seifarth, W; Spieß, B; Balleisen, L; Goebeler, M C; Hänel, M; Ho, A; Dengler, J; Falge, C; Kanz, L; Kremers, S; Burchert, A; Kneba, M; Stegelmann, F; Köhne, C A; Lindemann, H W; Waller, C F; Pfreundschuh, M; Spiekermann, K; Berdel, W E; Müller, L; Edinger, M; Mayer, J; Beelen, D W; Bentz, M; Link, H; Hertenstein, B; Fuchs, R; Wernli, M; Schlegel, F; Schlag, R; de Wit, M; Trümper, L; Hebart, H; Hahn, M; Thomalla, J; Scheid, C; Schafhausen, P; Verbeek, W; Eckart, M J; Gassmann, W; Pezzutto, A; Schenk, M; Brossart, P; Geer, T; Bildat, S; Schäfer, E; Hochhaus, A; Hasford, J

2017-11-01

Chronic myeloid leukemia (CML)-study IV was designed to explore whether treatment with imatinib (IM) at 400 mg/day (n=400) could be optimized by doubling the dose (n=420), adding interferon (IFN) (n=430) or cytarabine (n=158) or using IM after IFN-failure (n=128). From July 2002 to March 2012, 1551 newly diagnosed patients in chronic phase were randomized into a 5-arm study. The study was powered to detect a survival difference of 5% at 5 years. After a median observation time of 9.5 years, 10-year overall survival was 82%, 10-year progression-free survival was 80% and 10-year relative survival was 92%. Survival between IM400 mg and any experimental arm was not different. In a multivariate analysis, risk group, major-route chromosomal aberrations, comorbidities, smoking and treatment center (academic vs other) influenced survival significantly, but not any form of treatment optimization. Patients reaching the molecular response milestones at 3, 6 and 12 months had a significant survival advantage. For responders, monotherapy with IM400 mg provides a close to normal life expectancy independent of the time to response. Survival is more determined by patients' and disease factors than by initial treatment selection. Although improvements are also needed for refractory disease, more life-time can currently be gained by carefully addressing non-CML determinants of survival.

Dynamic patient counseling: a novel concept in idiopathic pulmonary fibrosis.

PubMed

Brown, A Whitney; Shlobin, Oksana A; Weir, Nargues; Albano, Maria C; Ahmad, Shahzad; Smith, Mary; Leslie, Kevin; Nathan, Steven D

2012-10-01

The characteristics of long-term survivors with idiopathic pulmonary fibrosis (IPF) have never been fully elucidated. We sought to illustrate the attenuated mortality and describe the characteristics of patients with IPF who survived at least 5 years beyond their initial presentation. Patients with IPF evaluated between 1997 and 2006 were identified through the clinic database. Patients who survived beyond 5 years from the time of their evaluation were compared with those who died or underwent lung transplantation within 5 years. Survival analyses were performed from the time of initial evaluation and contingent on annualized survival thereafter. Eighty-seven patients who survived at least 5 years formed the comparator group to whom other patients were contrasted. These patients had a higher BMI, FVC % predicted, FEV1 % predicted, total lung capacity % predicted, and diffusing capacity of lung for carbon monoxide % predicted, but a lower FEV1/FVC ratio and lower mean pulmonary artery pressures. More than one-half of these patients had moderate or severe disease at the time of presentation. Our annualized contingent survival analyses revealed a progressively increasing median survival dependent on the duration of the disease. Although we were able to demonstrate differences in our 5-year survivors, rather than being a distinct group, these patients appear to exist within a continuum of improving survival dependent on prior disease duration. This progressively improving time-dependent prognosis mandates the serial reevaluation of an individual patient’s projected outcomes. The implementation of dynamic counseling is an important concept in more accurately predicting life expectancy for patients with IPF who are frequently haunted by the prospects of a dismal survival.

Relationships among the cervical mucus urea and acetone, accuracy of insemination timing, and sperm survival in Holstein cows.

PubMed

Beran, J; Stádník, L; Ducháček, J; Okrouhlá, M; Doležalová, M; Kadlecová, V; Ptáček, M

2013-11-01

The objectives of this study were to evaluate the relationships among urea and acetone content in cows' cervical mucus (CM), its crystallization type (CT) and sperm survival (SS) after timed AI. Samples of CM were collected from 192 Holstein cows treated by Ovsynch(®) protocol. Analysis of the urea and acetone content for identification of the metabolic status, the arborization test for evaluation of insemination timing and the short-term heat test of SS for assessment of its suitability as a biological matrix were performed. The data set was analyzed by the GLM procedure using SAS(®). The results documented the existence of substantial differences in individual response to the Ovsynch(®) protocol causing insemination of 55.2% cows at an inappropriate time. The urea content was found as a possible indicator of a cow's metabolism and/or of insemination timing, concentrations of less than 500 mg/L corresponded (P<0.05-0.01) to the cows' expected response to timed AI. The greater the urea content, the greater the proportion of cows inseminated at an inappropriate time. Effects (P<0.05-0.01) of CT, urea and acetone content on SS were determined. The greatest values of SS were detected in cows with an expected response to precisely timed oestrus documented by the corresponding CT. Greater values of urea (>260 mg/L) and acetone (>5mg/L) negatively affected SS as well (P<0.05-0.01). The results confirmed that the accuracy of insemination timing can be affected by the metabolism intensity, just as CM quality directly influences sperm survival. Copyright © 2013 Elsevier B.V. All rights reserved.

Trends in life expectancy by education in Norway 1961-2009.

PubMed

Steingrímsdóttir, Olöf Anna; Næss, Øyvind; Moe, Joakim Oliu; Grøholt, Else-Karin; Thelle, Dag Steinar; Strand, Bjørn Heine; Bævre, Kåre

2012-03-01

Educational attainment and longevity are strongly related. Large population studies covering long periods to provide evidence of trends in educational inequalities regarding life expectancy are scarce though, especially prior to the 1980s. Our objective was to document changes in life expectancy by education in Norway in the period 1961-2009, and to determine whether the patterns differ between sexes. This is a register-based population study of all Norwegian residents over 34 years, with data from the National Central Population Registry and the National Education Database. For each calendar year during 1961-2009, death rates by 1 year age groups were calculated separately for each sex and three educational categories (primary, secondary and tertiary). Annual life tables were used to calculate life expectancy at age 35 (e ( 35 )) and survival probability for the three age-intervals 35-44, 45-64, and 65-90. All education groups increased their e ( 35 ) over time, but inequalities in e ( 35 ) between tertiary and primary educational categories widened 5.3 years for men and 3.2 years for women during the study period. The probability for women with primary education to survive to age 64 did not improve from 1961 to 2009. The gain in life expectancy lagged about 10 years in lower compared to higher education groups which might suggest that improvements in life sustaining factors reach different segments of the population at different times. The widening of the gap seems to have partly tapered off over the last two decades, and the changes in life expectancy should be followed carefully in the future to document the development.

Uncertainty, robustness, and the value of information in managing an expanding Arctic goose population

USGS Publications Warehouse

Johnson, Fred A.; Jensen, Gitte H.; Madsen, Jesper; Williams, Byron K.

2014-01-01

We explored the application of dynamic-optimization methods to the problem of pink-footed goose (Anser brachyrhynchus) management in western Europe. We were especially concerned with the extent to which uncertainty in population dynamics influenced an optimal management strategy, the gain in management performance that could be expected if uncertainty could be eliminated or reduced, and whether an adaptive or robust management strategy might be most appropriate in the face of uncertainty. We combined three alternative survival models with three alternative reproductive models to form a set of nine annual-cycle models for pink-footed geese. These models represent a wide range of possibilities concerning the extent to which demographic rates are density dependent or independent, and the extent to which they are influenced by spring temperatures. We calculated state-dependent harvest strategies for these models using stochastic dynamic programming and an objective function that maximized sustainable harvest, subject to a constraint on desired population size. As expected, attaining the largest mean objective value (i.e., the relative measure of management performance) depended on the ability to match a model-dependent optimal strategy with its generating model of population dynamics. The nine models suggested widely varying objective values regardless of the harvest strategy, with the density-independent models generally producing higher objective values than models with density-dependent survival. In the face of uncertainty as to which of the nine models is most appropriate, the optimal strategy assuming that both survival and reproduction were a function of goose abundance and spring temperatures maximized the expected minimum objective value (i.e., maxi–min). In contrast, the optimal strategy assuming equal model weights minimized the expected maximum loss in objective value. The expected value of eliminating model uncertainty was an increase in objective value of only 3.0%. This value represents the difference between the best that could be expected if the most appropriate model were known and the best that could be expected in the face of model uncertainty. The value of eliminating uncertainty about the survival process was substantially higher than that associated with the reproductive process, which is consistent with evidence that variation in survival is more important than variation in reproduction in relatively long-lived avian species. Comparing the expected objective value if the most appropriate model were known with that of the maxi–min robust strategy, we found the value of eliminating uncertainty to be an expected increase of 6.2% in objective value. This result underscores the conservatism of the maxi–min rule and suggests that risk-neutral managers would prefer the optimal strategy that maximizes expected value, which is also the strategy that is expected to minimize the maximum loss (i.e., a strategy based on equal model weights). The low value of information calculated for pink-footed geese suggests that a robust strategy (i.e., one in which no learning is anticipated) could be as nearly effective as an adaptive one (i.e., a strategy in which the relative credibility of models is assessed through time). Of course, an alternative explanation for the low value of information is that the set of population models we considered was too narrow to represent key uncertainties in population dynamics. Yet we know that questions about the presence of density dependence must be central to the development of a sustainable harvest strategy. And while there are potentially many environmental covariates that could help explain variation in survival or reproduction, our admission of models in which vital rates are drawn randomly from reasonable distributions represents a worst-case scenario for management. We suspect that much of the value of the various harvest strategies we calculated is derived from the fact that they are state dependent, such that appropriate harvest rates depend on population abundance and weather conditions, as well as our focus on an infinite time horizon for sustainability.

Simple Clinical Score to Predict 24-Week Survival Times in Patients with Inoperable Malignant Distal Biliary Obstruction as a Tool for Selecting Palliative Metallic or Plastic Stents.

PubMed

Sripongpun, Pimsiri; Attasaranya, Siriboon; Chamroonkul, Naichaya; Sookpaisal, Theerapong; Khow-Ean, Uthai; Siripun, Aroon; Kongkamol, Chanon; Piratvisuth, Teerha; Ovartlarnporn, Bancha

2018-06-01

Endoscopic biliary drainage (EBD) is the mainstay treatment for inoperable malignant distal biliary obstruction (MDBO). Some authorities suggest that metallic stents are more cost-effective than plastic stents in patients with expected survival of at least 6 months. However, studies attempting to define the predictive factors for such survival times are limited. This study aims to develop a scoring system for predicting a survival time of <24 weeks in these patients. Patients with MDBO from inoperable periampullary cancers who underwent EBD at Songklanagarind Hospital during 2004-2009 were retrospectively analyzed. Baseline clinical, laboratory, and imaging data were retrieved. The survival time data were retrieved from the medical records and Thailand's civil registration database. Multivariate Cox regression model coefficients were used in the development of a survival time prediction scoring system. Ninety-eight patients were included. The overall median survival was 17.6 weeks. Fifty-seven (58.1%) survived <24 weeks. By multivariate analysis, cancer type and liver metastasis were significant predictive factors. The Simple Clinical Score (SCS) was calculated from (2× liver metastasis) + (1× pancreatic cancer) - (2× ampullary cancer) - (1× cholangiocarcinoma), when 1 and 0 were used for the presence and absence of each factor, respectively. The cutoff value of the score ≥0 had a sensitivity and specificity of 0.77 and 0.63, respectively, for predicting a survival time of <24 weeks, with AUC of 0.76. The median survival of patients with SCS <0 and ≥0 was 36.6 and 13.1 weeks, respectively. The scoring system from this study may be beneficial for clinicians to select the appropriate stents in endoscopic biliary drainage in inoperable MDBO patients.

Dynamic frailty models based on compound birth-death processes.

PubMed

Putter, Hein; van Houwelingen, Hans C

2015-07-01

Frailty models are used in survival analysis to model unobserved heterogeneity. They accommodate such heterogeneity by the inclusion of a random term, the frailty, which is assumed to multiply the hazard of a subject (individual frailty) or the hazards of all subjects in a cluster (shared frailty). Typically, the frailty term is assumed to be constant over time. This is a restrictive assumption and extensions to allow for time-varying or dynamic frailties are of interest. In this paper, we extend the auto-correlated frailty models of Henderson and Shimakura and of Fiocco, Putter and van Houwelingen, developed for longitudinal count data and discrete survival data, to continuous survival data. We present a rigorous construction of the frailty processes in continuous time based on compound birth-death processes. When the frailty processes are used as mixtures in models for survival data, we derive the marginal hazards and survival functions and the marginal bivariate survival functions and cross-ratio function. We derive distributional properties of the processes, conditional on observed data, and show how to obtain the maximum likelihood estimators of the parameters of the model using a (stochastic) expectation-maximization algorithm. The methods are applied to a publicly available data set. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Economic evaluation of nivolumab for the treatment of second-line advanced squamous NSCLC in Canada: a comparison of modeling approaches to estimate and extrapolate survival outcomes.

PubMed

Goeree, Ron; Villeneuve, Julie; Goeree, Jeff; Penrod, John R; Orsini, Lucinda; Tahami Monfared, Amir Abbas

2016-06-01

Background Lung cancer is the most common type of cancer in the world and is associated with significant mortality. Nivolumab demonstrated statistically significant improvements in progression-free survival (PFS) and overall survival (OS) for patients with advanced squamous non-small cell lung cancer (NSCLC) who were previously treated. The cost-effectiveness of nivolumab has not been assessed in Canada. A contentious component of projecting long-term cost and outcomes in cancer relates to the modeling approach adopted, with the two most common approaches being partitioned survival (PS) and Markov models. The objectives of this analysis were to estimate the cost-utility of nivolumab and to compare the results using these alternative modeling approaches. Methods Both PS and Markov models were developed using docetaxel and erlotinib as comparators. A three-health state model was used consisting of progression-free, progressed disease, and death. Disease progression and time to progression were estimated by identifying best-fitting survival curves from the clinical trial data for PFS and OS. Expected costs and health outcomes were calculated by combining health-state occupancy with medical resource use and quality-of-life assigned to each of the three health states. The health outcomes included in the model were survival and quality-adjusted-life-years (QALYs). Results Nivolumab was found to have the highest expected per-patient cost, but also improved per-patient life years (LYs) and QALYs. Nivolumab cost an additional $151,560 and $140,601 per QALY gained compared to docetaxel and erlotinib, respectively, using a PS model approach. The cost-utility estimates using a Markov model were very similar ($152,229 and $141,838, respectively, per QALY gained). Conclusions Nivolumab was found to involve a trade-off between improved patient survival and QALYs, and increased cost. It was found that the use of a PS or Markov model produced very similar estimates of expected cost, outcomes, and incremental cost-utility.

Survival time of the susceptible-infected-susceptible infection process on a graph.

PubMed

van de Bovenkamp, Ruud; Van Mieghem, Piet

2015-09-01

The survival time T is the longest time that a virus, a meme, or a failure can propagate in a network. Using the hitting time of the absorbing state in an uniformized embedded Markov chain of the continuous-time susceptible-infected-susceptible (SIS) Markov process, we derive an exact expression for the average survival time E[T] of a virus in the complete graph K_{N} and the star graph K_{1,N-1}. By using the survival time, instead of the average fraction of infected nodes, we propose a new method to approximate the SIS epidemic threshold τ_{c} that, at least for K_{N} and K_{1,N-1}, correctly scales with the number of nodes N and that is superior to the epidemic threshold τ_{c}^{(1)}=1/λ_{1} of the N-intertwined mean-field approximation, where λ_{1} is the spectral radius of the adjacency matrix of the graph G. Although this new approximation of the epidemic threshold offers a more intuitive understanding of the SIS process, it remains difficult to compare outbreaks in different graph types. For example, the survival in an arbitrary graph seems upper bounded by the complete graph and lower bounded by the star graph as a function of the normalized effective infection rate τ/τ_{c}^{(1)}. However, when the average fraction of infected nodes is used as a basis for comparison, the virus will survive in the star graph longer than in any other graph, making the star graph the worst-case graph instead of the complete graph. Finally, in non-Markovian SIS, the distribution of the spreading attempts over the infectious period of a node influences the survival time, even if the expected number of spreading attempts during an infectious period (the non-Markovian equivalent of the effective infection rate) is kept constant. Both early and late infection attempts lead to shorter survival times. Interestingly, just as in Markovian SIS, the survival times appear to be exponentially distributed, regardless of the infection and curing time distributions.

Excess mortality attributable to hip-fracture: a relative survival analysis.

PubMed

Frost, Steven A; Nguyen, Nguyen D; Center, Jacqueline R; Eisman, John A; Nguyen, Tuan V

2013-09-01

Individuals with hip fracture are at substantially increased risk of mortality. The aim of this study was to estimate the excess mortality attributable to hip fracture in elderly men and women. The Dubbo Osteoporosis Epidemiology Study was designed as a prospective epidemiologic investigation, in which more than 2000 men and women aged 60+ as of 1989 had been followed for 21 years. During the follow-up period, the incidence of atraumatic hip fractures was ascertained by X-ray reports, and mortality was ascertained by the New South Wales Birth, Death and Marriage Registry. Relative survival ratios were estimated by taking into account the age-and-sex specific expected survival in the general Australian population from 1989 to 2010. During the follow-up period 151 women and 55 men sustained a hip fracture. Death occurred in 86 (57%) women and 36 (66%) men. In women, the cumulative relative survival post hip-fracture at 1, 5 and 10 years was 0.83 (95% confidence interval (CI) 0.76-0.89), 0.59 (95% CI 0.48-0.68), and 0.31 (95% CI 0.20-0.43), respectively; in men, the corresponding estimates of relative survival were: 0.63 (95% CI 0.48-0.75), 0.48 (95% CI 0.32-0.63), and 0.36 (95% CI 0.18-0.56). On average post hip-fracture women died 4 years earlier (median: 4.1, inter-quartile range (IQR) 1.7-7.8) and men died 5 years earlier (median = 4.8, IQR 2.4-7.0) than expected. For every six women and for every three men with hip fracture one extra death occurred above that expected in the background population. Hip fracture is associated with reduced life expectancy, with men having a greater reduction than women, even after accounting for time-related changes in background mortality in the population. These data underscore that hip fracture is an independent clinical risk factor for mortality. Copyright © 2013 Elsevier Inc. All rights reserved.

Net Effects of Ecotourism on Threatened Species Survival

PubMed Central

Buckley, Ralf C.; Morrison, Clare; Castley, J. Guy

2016-01-01

Many threatened species rely on ecotourism for conservation funding, but simultaneously suffer direct ecological impacts from ecotourism. For a range of IUCN-Redlisted terrestrial and marine bird and mammal species worldwide, we use population viability analyses to calculate the net effects of ecotourism on expected time to extinction, in the presence of other anthropogenic threats such as poaching, primary industries and habitat loss. Species for which these calculations are currently possible, for one or more subpopulations, include: orangutan, hoolock gibbon, golden lion tamarin, cheetah, African wild dog, New Zealand sealion, great green macaw, Egyptian vulture, and African penguin. For some but not all of these species, tourism can extend expected survival time, i.e., benefits outweigh impacts. Precise outcomes depend strongly on population parameters and starting sizes, predation, and ecotourism scale and mechanisms. Tourism does not currently overcome other major conservation threats associated with natural resource extractive industries. Similar calculations for other threatened species are currently limited by lack of basic population data. PMID:26886876

Net Effects of Ecotourism on Threatened Species Survival.

PubMed

Buckley, Ralf C; Morrison, Clare; Castley, J Guy

2016-01-01

Many threatened species rely on ecotourism for conservation funding, but simultaneously suffer direct ecological impacts from ecotourism. For a range of IUCN-Redlisted terrestrial and marine bird and mammal species worldwide, we use population viability analyses to calculate the net effects of ecotourism on expected time to extinction, in the presence of other anthropogenic threats such as poaching, primary industries and habitat loss. Species for which these calculations are currently possible, for one or more subpopulations, include: orangutan, hoolock gibbon, golden lion tamarin, cheetah, African wild dog, New Zealand sealion, great green macaw, Egyptian vulture, and African penguin. For some but not all of these species, tourism can extend expected survival time, i.e., benefits outweigh impacts. Precise outcomes depend strongly on population parameters and starting sizes, predation, and ecotourism scale and mechanisms. Tourism does not currently overcome other major conservation threats associated with natural resource extractive industries. Similar calculations for other threatened species are currently limited by lack of basic population data.

The contribution of cancer incidence, stage at diagnosis and survival to racial differences in years of life expectancy.

PubMed

Wong, Mitchell D; Ettner, Susan L; Boscardin, W John; Shapiro, Martin F

2009-04-01

African Americans have higher cancer mortality rates than whites. Understanding the relative contribution of cancer incidence, stage at diagnosis and survival after diagnosis to the racial gap in life expectancy has important implications for directing future health disparity interventions toward cancer prevention, screening and treatment. We estimated the degree to which higher cancer mortality among African Americans is due to higher incidence rates, later stage at diagnosis or worse survival after diagnosis. Stochastic model of cancer incidence and survival after diagnosis. Surveillance and Epidemiology End Result cancer registry and National Health Interview Survey data. Life expectancy if African Americans had the same cancer incidence, stage and survival after diagnosis as white adults. African-American men and women live 1.47 and 0.91 fewer years, respectively, than whites as the result of all cancers combined. Among men, racial differences in cancer incidence, stage at diagnosis and survival after diagnosis account for 1.12 (95% CI: 0.52 to 1.36), 0.17 (95% CI: -0.03 to 0.33) and 0.21 (95% CI: 0.05 to 0.34) years of the racial gap in life expectancy, respectively. Among women, incidence, stage and survival after diagnosis account for 0.41 (95% CI: -0.29 to 0.60), 0.26 (95% CI: -0.06 to 0.40) and 0.31 (95% CI: 0.05 to 0.40) years, respectively. Differences in stage had a smaller impact on the life expectancy gap compared with the impact of incidence. Differences in cancer survival after diagnosis had a significant impact for only two cancers-breast (0.14 years; 95% CI: 0.05 to 0.16) and prostate (0.05 years; 95% CI 0.01 to 0.09). In addition to breast and colorectal cancer screening, national efforts to reduce disparities in life expectancy should also target cancer prevention, perhaps through smoking cessation, and differences in survival after diagnosis among persons with breast and prostate cancer.

Improved survival time: what can survival cure models tell us about population-based survival improvements in late-stage colorectal, ovarian, and testicular cancer?

PubMed

Huang, Lan; Cronin, Kathleen A; Johnson, Karen A; Mariotto, Angela B; Feuer, Eric J

2008-05-15

The objective of the current study was to investigate the long-term impact of treatment advances on the survival of patients with late-stage ovarian, colorectal (American Joint Committee on Cancer stage III, men), and testicular cancers by estimating the increase in the percentage cured from their disease and the change in survival time of uncured patients. Cause-specific survival data from 1973 to 2000 were obtained from the Surveillance, Epidemiology, and End Results Program. Survival cure models were fit and were used to estimate the gain in life expectancy (GLE) attributed to an increase in the fraction of cured patients and to prolonged survival among noncured patients. Treatment improvement for ovarian cancer resulted in a total GLE of 2 years, and 80% of that GLE was because of an extension of survival time in uncured patients (from 0.9 years to 2.1 years) rather than an increased cure fraction (from 12% to 14%). In contrast, the cure rate rose from 29% to 47% for colorectal cancer, representing 82% of a 2.8-year GLE, and from 23% to 81% for testicular cancer, representing 100% of a 24-year GLE. The current results suggested that treatment benefits for testicular and colorectal cancer in men with late-stage disease primarily are the result of increases in cure fraction, whereas survival gains for ovarian cancer occur despite persisting disease. Cure models, in combination with population-level data, provide insight into how treatment advances are changing survival and ultimately impacting mortality. Survival patterns reflect the underlying biology of response to cancer treatment and suggest promising directions for future research.

Expectation maximization-based likelihood inference for flexible cure rate models with Weibull lifetimes.

PubMed

Balakrishnan, Narayanaswamy; Pal, Suvra

2016-08-01

Recently, a flexible cure rate survival model has been developed by assuming the number of competing causes of the event of interest to follow the Conway-Maxwell-Poisson distribution. This model includes some of the well-known cure rate models discussed in the literature as special cases. Data obtained from cancer clinical trials are often right censored and expectation maximization algorithm can be used in this case to efficiently estimate the model parameters based on right censored data. In this paper, we consider the competing cause scenario and assuming the time-to-event to follow the Weibull distribution, we derive the necessary steps of the expectation maximization algorithm for estimating the parameters of different cure rate survival models. The standard errors of the maximum likelihood estimates are obtained by inverting the observed information matrix. The method of inference developed here is examined by means of an extensive Monte Carlo simulation study. Finally, we illustrate the proposed methodology with a real data on cancer recurrence. © The Author(s) 2013.

Understanding the impact of socioeconomic differences in breast cancer survival in England and Wales: avoidable deaths and potential gain in expectation of life.

PubMed

Rutherford, M J; Andersson, T M-L; Møller, H; Lambert, P C

2015-02-01

Socioeconomic differences in cancer patient survival are known to exist for women diagnosed with breast cancer. Standard metrics tend not to place great emphasis on evaluating the actual impact of these differences. We used two alternative, but related, methods of reporting the impact of socioeconomic differences for breast cancer patients in England and Wales. We calculated the average gain in life years for each patient should socioeconomic differences in relative survival be removed and show how this is related to the number of all-cause deaths that could be postponed by removing socioeconomic differences in cancer patient survival. Our results indicate that deprivation differences for women with breast cancer exist and result in women from more deprived areas losing a larger proportion of their life due to a diagnosis of cancer. We also estimate that on average 1.1 years could be gained for a 60 year old breast cancer patient in the most deprived group by improving their relative survival to match the least deprived group. However, our results also show that deprivation differences in general survival have a large impact on life expectancy; showing that over two-thirds of the gap in differential life expectancy is explained by differences in other-cause survival. Socioeconomic differences in relative survival have an impact on life expectancy for patients and result in higher early mortality for more deprived patients. However, differences in general survival across socioeconomic groups explain a larger proportion of the deprivation gap in life expectancy for breast cancer patients. Copyright © 2014 Elsevier Ltd. All rights reserved.

Additive homeopathy in cancer patients: Retrospective survival data from a homeopathic outpatient unit at the Medical University of Vienna.

PubMed

Gaertner, Katharina; Müllner, Michael; Friehs, Helmut; Schuster, Ernst; Marosi, Christine; Muchitsch, Ilse; Frass, Michael; Kaye, Alan David

2014-04-01

Current literature suggests a positive influence of additive classical homeopathy on global health and well-being in cancer patients. Besides encouraging case reports, there is little if any research on long-term survival of patients who obtain homeopathic care during cancer treatment. Data from cancer patients who had undergone homeopathic treatment complementary to conventional anti-cancer treatment at the Outpatient Unit for Homeopathy in Malignant Diseases, Medical University Vienna, Department of Medicine I, Vienna, Austria, were collected, described and a retrospective subgroup-analysis with regard to survival time was performed. Patient inclusion criteria were at least three homeopathic consultations, fatal prognosis of disease, quantitative and qualitative description of patient characteristics, and survival time. In four years, a total of 538 patients were recorded to have visited the Outpatient Unit Homeopathy in Malignant Diseases, Medical University Vienna, Department of Medicine I, Vienna, Austria. 62.8% of them were women, and nearly 20% had breast cancer. From the 53.7% (n=287) who had undergone at least three homeopathic consultations within four years, 18.7% (n=54) fulfilled inclusion criteria for survival analysis. The surveyed neoplasms were glioblastoma, lung, cholangiocellular and pancreatic carcinomas, metastasized sarcoma, and renal cell carcinoma. Median overall survival was compared to expert expectations of survival outcomes by specific cancer type and was prolonged across observed cancer entities (p<0.001). Extended survival time in this sample of cancer patients with fatal prognosis but additive homeopathic treatment is interesting. However, findings are based on a small sample, and with only limited data available about patient and treatment characteristics. The relationship between homeopathic treatment and survival time requires prospective investigation in larger samples possibly using matched-pair control analysis or randomized trials. Copyright © 2014 Elsevier Ltd. All rights reserved.

Month of birth and survival to age 105+: evidence from the age validation study of German semi-supercentenarians.

PubMed

Doblhammer, Gabriele; Scholz, Rembrandt; Maier, Heiner

2005-10-01

Using data from Germany, we examine if month of birth influences survival up to age 105. Since age reporting at the highest ages is notoriously unreliable we draw on age-validated information from a huge age validation project of 1487 alleged German semi-supercentenarians aged 105+. We use month of birth as an exogenous indicator for seasonal changes in the environment around the time of birth. We find that the seasonal distribution of birth dates changes with age. For 925 age-validated semi-supercentenarians the seasonality is more pronounced than at the time of their birth (1880-1900). Among the December-born the relative risk of survival from birth to age 105+is 16% higher than the average, among the June-born, 23% lower. The month-of-birth pattern in the survival risk of the German semi-supercentenarians resembles closely the month-of-birth pattern in remaining life expectancy at age 50 in Denmark.

Optimizing repeat liver transplant graft utility through strategic matching of donor and recipient characteristics.

PubMed

Hung, Kenneth; Gralla, Jane; Dodge, Jennifer L; Bambha, Kiran M; Dirchwolf, Melisa; Rosen, Hugo R; Biggins, Scott W

2015-11-01

Repeat liver transplantation (LT) is controversial because of inferior outcomes versus primary LT. A minimum 1-year expected post-re-LT survival of 50% has been proposed. We aimed to identify combinations of Model for End-Stage Liver Disease (MELD), donor risk index (DRI), and recipient characteristics achieving this graft survival threshold. We identified re-LT recipients listed in the United States from March 2002 to January 2010 with > 90 days between primary LT and listing for re-LT. Using Cox regression, we estimated the expected probability of 1-year graft survival and identified combinations of MELD, DRI, and recipient characteristics attaining >50% expected 1-year graft survival. Re-LT recipients (n = 1418) had a median MELD of 26 and median age of 52 years. Expected 1-year graft survival exceeded 50% regardless of MELD or DRI in Caucasian recipients who were not infected with hepatitis C virus (HCV) of all ages and Caucasian HCV-infected recipients <50 years old. As age increased in HCV-infected Caucasian and non-HCV-infected African American recipients, lower MELD scores or lower DRI grafts were needed to attain the graft survival threshold. As MELD scores increased in HCV-infected African American recipients, lower-DRI livers were required to achieve the graft survival threshold. Use of high-DRI livers (>1.44) in HCV-infected recipients with a MELD score > 26 at re-LT failed to achieve the graft survival threshold with recipient age ≥ 60 years (any race), as well as at age ≥ 50 years for Caucasians and at age < 50 years for African Americans. Strategic donor selection can achieve >50% expected 1-year graft survival even in high-risk re-LT recipients (HCV infected, older age, African American race, high MELD scores). Low-risk transplant recipients (age < 50 years, non-HCV-infected) can achieve the survival threshold with varying DRI and MELD scores. © 2015 American Association for the Study of Liver Diseases.

Expectancy influences on attention to threat are only weak and transient: Behavioral and physiological evidence.

PubMed

Aue, Tatjana; Chauvigné, Léa A S; Bristle, Mirko; Okon-Singer, Hadas; Guex, Raphaël

2016-12-01

Can prior expectancies shape attention to threat? To answer this question, we manipulated the expectancies of spider phobics and nonfearful controls regarding the appearance of spider and bird targets in a visual search task. We observed robust evidence for expectancy influences on attention to birds, reflected in error rates, reaction times, pupil diameter, and heart rate (HR). We found no solid effect, however, of the same expectancies on attention to spiders; only HR revealed a weak and transient impact of prior expectancies on the orientation of attention to threat. Moreover, these asymmetric effects for spiders versus birds were observed in both phobics and controls. Our results are thus consistent with the notion of a threat detection mechanism that is only partially permeable to current expectancies, thereby increasing chances of survival in situations that are mistakenly perceived as safe. Copyright © 2016 Elsevier B.V. All rights reserved.

Survival probabilities of patients with childhood spinal muscle atrophy.

PubMed

Mannaa, Mohannad M; Kalra, Maninder; Wong, Brenda; Cohen, Aliza P; Amin, Raouf S

2009-03-01

Medical and technological advances over the past 2 decades have resulted in improved patient care for children with spinal muscular atrophy (SMA). The objective of the present study was to describe changes in the life expectancy of pediatric patients with SMA over time and to compare these findings with previously reported survival patterns. Medical records of all patients diagnosed with SMA over a 16-year period (1989-2005) at Cincinnati Children's Hospital Medical Center were reviewed. Data pertaining to date of birth, type of SMA, medical and surgical interventions, pulmonary complications, and date of death were obtained. Kaplan-Meier survival analyses showed a significant improvement in survival probabilities in the severest form of SMA. We found a positive trend in the survival of patients with severe SMA. Although we cannot attribute this trend to any single factor, it is likely that advances in pulmonary care and aggressive nutritional support have played a significant role.

Adjusting Expected Mortality Rates Using Information From a Control Population: An Example Using Socioeconomic Status.

PubMed

Bower, Hannah; Andersson, Therese M-L; Crowther, Michael J; Dickman, Paul W; Lambe, Mats; Lambert, Paul C

2018-04-01

Expected or reference mortality rates are commonly used in the calculation of measures such as relative survival in population-based cancer survival studies and standardized mortality ratios. These expected rates are usually presented according to age, sex, and calendar year. In certain situations, stratification of expected rates by other factors is required to avoid potential bias if interest lies in quantifying measures according to such factors as, for example, socioeconomic status. If data are not available on a population level, information from a control population could be used to adjust expected rates. We have presented two approaches for adjusting expected mortality rates using information from a control population: a Poisson generalized linear model and a flexible parametric survival model. We used a control group from BCBaSe-a register-based, matched breast cancer cohort in Sweden with diagnoses between 1992 and 2012-to illustrate the two methods using socioeconomic status as a risk factor of interest. Results showed that Poisson and flexible parametric survival approaches estimate similar adjusted mortality rates according to socioeconomic status. Additional uncertainty involved in the methods to estimate stratified, expected mortality rates described in this study can be accounted for using a parametric bootstrap, but this might make little difference if using a large control population.

Receipt of Cancer Screening Is a Predictor of Life Expectancy.

PubMed

Goodwin, James S; Sheffield, Kristin; Li, Shuang; Tan, Alai

2016-11-01

Obtaining cancer screening on patients with limited life expectancy has been proposed as a measure for low quality care for primary care physicians (PCPs). However, administrative data may underestimate life expectancy in patients who undergo screening. To determine the association between receipt of screening mammography or PSA and overall survival. Retrospective cohort study from 1/1/1999 to 12/31/2012. Receipt of screening was assessed for 2001-2002 and survival from 1/1/2003 to 12/31/2012. Life expectancy was estimated as of 1/1/03 using a validated algorithm, and was compared to actual survival for men and women, stratified by receipt of cancer screening. A 5 % sample of Medicare beneficiaries aged 69-90 years as of 1/1/2003 (n = 906,723). Receipt of screening mammography in 2001-2002 for women, or a screening PSA test in 2002 for men. Survival from 1/1/2003 through 12/31/2012. Subjects were stratified by life expectancy based on age and comorbidity. Within each stratum, the subjects with prior cancer screening had actual median survivals higher than those who were not screened, with differences ranging from 1.7 to 2.1 years for women and 0.9 to 1.1 years for men. In a Cox model, non-receipt of screening in women had an impact on survival (HR = 1.52; 95 % CI = 1.51, 1.54) similar in magnitude to a diagnosis of complicated diabetes or heart failure, and was comparable to uncomplicated diabetes or liver disease in men (HR = 1.23; 1.22, 1.25). Receipt of cancer screening is a powerful marker of health status that is not captured by comorbidity measures in administrative data. Because life expectancy algorithms using administrative data underestimate the life expectancy of patients who undergo screening, they can overestimate the problem of cancer screening in patients with limited life expectancy.

Nonparametric estimation of median survival times with applications to multi-site or multi-center studies.

PubMed

Rahbar, Mohammad H; Choi, Sangbum; Hong, Chuan; Zhu, Liang; Jeon, Sangchoon; Gardiner, Joseph C

2018-01-01

We propose a nonparametric shrinkage estimator for the median survival times from several independent samples of right-censored data, which combines the samples and hypothesis information to improve the efficiency. We compare efficiency of the proposed shrinkage estimation procedure to unrestricted estimator and combined estimator through extensive simulation studies. Our results indicate that performance of these estimators depends on the strength of homogeneity of the medians. When homogeneity holds, the combined estimator is the most efficient estimator. However, it becomes inconsistent when homogeneity fails. On the other hand, the proposed shrinkage estimator remains efficient. Its efficiency decreases as the equality of the survival medians is deviated, but is expected to be as good as or equal to the unrestricted estimator. Our simulation studies also indicate that the proposed shrinkage estimator is robust to moderate levels of censoring. We demonstrate application of these methods to estimating median time for trauma patients to receive red blood cells in the Prospective Observational Multi-center Major Trauma Transfusion (PROMMTT) study.

Nonparametric estimation of median survival times with applications to multi-site or multi-center studies

PubMed Central

Choi, Sangbum; Hong, Chuan; Zhu, Liang; Jeon, Sangchoon; Gardiner, Joseph C.

2018-01-01

We propose a nonparametric shrinkage estimator for the median survival times from several independent samples of right-censored data, which combines the samples and hypothesis information to improve the efficiency. We compare efficiency of the proposed shrinkage estimation procedure to unrestricted estimator and combined estimator through extensive simulation studies. Our results indicate that performance of these estimators depends on the strength of homogeneity of the medians. When homogeneity holds, the combined estimator is the most efficient estimator. However, it becomes inconsistent when homogeneity fails. On the other hand, the proposed shrinkage estimator remains efficient. Its efficiency decreases as the equality of the survival medians is deviated, but is expected to be as good as or equal to the unrestricted estimator. Our simulation studies also indicate that the proposed shrinkage estimator is robust to moderate levels of censoring. We demonstrate application of these methods to estimating median time for trauma patients to receive red blood cells in the Prospective Observational Multi-center Major Trauma Transfusion (PROMMTT) study. PMID:29772007

Expectant management compared with physical examination-indicated cerclage (EM-PEC) in selected women with a dilated cervix at 14(0/7)-25(6/7) weeks: results from the EM-PEC international cohort study.

PubMed

Pereira, Leonardo; Cotter, Amanda; Gómez, Ricardo; Berghella, Vincenzo; Prasertcharoensuk, Witoon; Rasanen, Juha; Chaithongwongwatthana, Surasith; Mittal, Suneeta; Daly, Sean; Airoldi, Jim; Tolosa, Jorge E

2007-11-01

The objective of the study was to compare pregnancy outcomes in selected women with a dilated cervix who underwent expectant management or physical examination-indicated cerclage. This was a historical cohort study conducted by the Global Network for Perinatal and Reproductive Health. Women between 14(0/7) and 25(6/7) weeks' gestation with a dilated cervix were identified at 10 centers by ultrasound or digital examination. Primary outcome was time from presentation until delivery (weeks). Secondary outcomes were neonatal survival, birthweight greater than 1500 g and preterm birth less than 28 weeks. Multivariate regression was used to assess the likelihood of neonatal outcomes and control for confounders. Of 225 women, 152 received a physical examination-indicated cerclage, and 73 were managed expectantly without cerclage. Cervical dilation, gestational age at presentation, and antenatal steroid use differed between groups. In the adjusted analyses, cerclage was associated with longer interval from presentation until delivery, improved neonatal survival, birthweight greater than 1500 g and preterm birth less than 28 weeks, compared with expectant management. Similar results were obtained in the analyses limited to women dilated between 2 and 4 cm (n = 122). In this study, the largest cohort reported to date, physical examination-indicated cerclage appears to prolong gestation and improve neonatal survival, compared with expectant management in selected women with cervical dilation between 14(0/7) and 25(6/7) weeks. A randomized, controlled trial should be conducted to determine whether these potential benefits outweigh the risks of cerclage placement in this population.

Survival of Norway spruce remains higher in mixed stands under a dryer and warmer climate.

PubMed

Neuner, Susanne; Albrecht, Axel; Cullmann, Dominik; Engels, Friedrich; Griess, Verena C; Hahn, W Andreas; Hanewinkel, Marc; Härtl, Fabian; Kölling, Christian; Staupendahl, Kai; Knoke, Thomas

2015-02-01

Shifts in tree species distributions caused by climatic change are expected to cause severe losses in the economic value of European forestland. However, this projection disregards potential adaptation options such as tree species conversion, shorter production periods, or establishment of mixed species forests. The effect of tree species mixture has, as yet, not been quantitatively investigated for its potential to mitigate future increases in production risks. For the first time, we use survival time analysis to assess the effects of climate, species mixture and soil condition on survival probabilities for Norway spruce and European beech. Accelerated Failure Time (AFT) models based on an extensive dataset of almost 65,000 trees from the European Forest Damage Survey (FDS)--part of the European-wide Level I monitoring network--predicted a 24% decrease in survival probability for Norway spruce in pure stands at age 120 when unfavorable changes in climate conditions were assumed. Increasing species admixture greatly reduced the negative effects of unfavorable climate conditions, resulting in a decline in survival probabilities of only 7%. We conclude that future studies of forest management under climate change as well as forest policy measures need to take this, as yet unconsidered, strongly advantageous effect of tree species mixture into account. © 2014 John Wiley & Sons Ltd.

How long do patients with chronic disease expect to live? A systematic review of the literature

PubMed Central

Salem, Joseph

2016-01-01

Objective To systematically identify and summarise the literature on perceived life expectancy among individuals with non-cancer chronic disease. Setting Published and grey literature up to and including September 2016 where adults with non-cancer chronic disease were asked to estimate their own life expectancy. Participants From 6837 screened titles, 9 articles were identified that met prespecified criteria for inclusion. Studies came from the UK, Netherlands and USA. A total of 729 participants were included (heart failure (HF) 573; chronic obstructive pulmonary disease (COPD) 89; end-stage renal failure 62; chronic kidney disease (CKD) 5). No papers reporting on other lung diseases, neurodegenerative disease or cirrhosis were found. Primary and secondary outcome measures All measures of self-estimated life expectancy were accepted. Self-estimated life expectancy was compared, where available, with observed survival, physician-estimated life expectancy and model-estimated life expectancy. Meta-analysis was not conducted due to the heterogeneity of the patient groups and study methodologies. Results Among patients with HF, median self-estimated life expectancy was 40% longer than predicted by a validated model. Outpatients receiving haemodialysis were more optimistic about prognosis than their nephrologists and overestimated their chances of surviving 5 years. Patients with HF and COPD were approximately three times more likely to die in the next year than they predicted. Data available for patients with CKD were of insufficient quality to draw conclusions. Conclusions Individuals with chronic disease may have unrealistically optimistic expectations of their prognosis. More research is needed to understand how perceived life expectancy affects behaviour. Meanwhile, clinicians should attempt to identify each patient's prognostic preferences and provide information in a way that they can understand and use to inform their decisions. Trial registration number CRD42015020732. PMID:28039288

Stomach position in prediction of survival in left-sided congenital diaphragmatic hernia with or without fetoscopic endoluminal tracheal occlusion.

PubMed

Cordier, A-G; Jani, J C; Cannie, M M; Rodó, C; Fabietti, I; Persico, N; Saada, J; Carreras, E; Senat, M-V; Benachi, A

2015-08-01

To investigate the value of fetal stomach position in predicting postnatal outcome in left-sided congenital diaphragmatic hernia (CDH) with and without fetoscopic endoluminal tracheal occlusion (FETO). This was a retrospective review of CDH cases that were expectantly managed or treated with FETO, assessed from May 2008 to October 2013, in which we graded, on a scale of 1-4, stomach position on the four-chamber view of the heart with respect to thoracic structures. Logistic regression analysis was used to investigate the effect of management center (Paris, Brussels, Barcelona, Milan), stomach grading, observed-to-expected lung area-to-head circumference ratio (O/E-LHR), gestational age at delivery, birth weight in expectantly managed CDH, gestational ages at FETO and at removal and period of tracheal occlusion, on postnatal survival in CDH cases treated with FETO. We identified 67 expectantly managed CDH cases and 47 CDH cases that were treated with FETO. In expectantly managed CDH, stomach position and O/E-LHR predicted postnatal survival independently. In CDH treated with FETO, stomach position and gestational age at delivery predicted postnatal survival independently. In left-sided CDH with or without FETO, stomach position is predictive of postnatal survival. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

Integrating health profile with survival for quality of life assessment.

PubMed

Hwang, Jing-Shiang; Wang, Jung-Der

2004-02-01

In cohort studies or clinical trials, measurements of quality of life (QoL) were averaged across available individuals for each group at given points in time to produce single measures for comparisons. However, estimates of these single measures may be severely biased if substantial mortality occurs over time. The objective of this study is to develop a method that integrates QoL measurement and survival for long-term evaluation of health services. We defined a mean QoL score function over time for an index population as the average QoL score of all individuals both alive and dead at each time point in the population. While a living subject's QoL can be assessed by asking one's subjective preference, the score of a decedent can be assigned a fixed value depending on the specific facet on health profile. The mean QoL score function over time is reduced to a single measure of expected cumulative QoL score, which is the area under the curve of mean QoL score function over a given time interval and can be estimated by taking a random sample from a cross-sectional survey. For the QoL score function to be extrapolated to life-long, it requires the assumption that the disease causes premature death or a long-term moderate impairment of QoL. We provided methods and computer programs for estimating mean QoL score functions and the reduced single measures for use in comparisons. A cohort of 779 breast cancer patients from Chiangmai, Thailand were followed for 12 years to demonstrate the proposed methods. The data included the 12-year complete survival records and QoL scores on 233 patients collected from a cross-sectional survey using WHOQOL questionnaire and standard gamble method. The expected cumulative QoL scores using utility and psychometric scales were compared among patients in four groups of clinical stages in this cohort for time from onset up to 12 years and life-long. We conclude that such an integration of QoL measurement with survival can be useful for the evaluation of health service and clinical decision.

Evaluating the cost-effectiveness of afatinib after platinum-based therapy for the treatment of squamous non-small-cell lung cancer in France

PubMed Central

Pignata, Maud; Chouaid, Christos; Le Lay, Katell; Luciani, Laura; McConnachie, Ceilidh; Gordon, James; Roze, Stéphane

2017-01-01

Background and aims Lung cancer has the highest mortality rate of all cancers worldwide. Non-small-cell lung cancer (NSCLC) accounts for 85% of all lung cancers and has an extremely poor prognosis. Afatinib is an irreversible ErbB family blocker designed to suppress cellular signaling and inhibit cellular growth and is approved in Europe after platinum-based therapy for squamous NSCLC. The objective of the present analysis was to evaluate the cost-effectiveness of afatinib after platinum-based therapy for squamous NSCLC in France. Methods The study population was based on the LUX-Lung 8 trial that compared afatinib with erlotinib in patients with squamous NSCLC. The analysis was performed from the perspective of all health care funders and affected patients. A partitioned survival model was developed to evaluate cost-effectiveness based on progression-free survival and overall survival in the trial. Life expectancy, quality-adjusted life expectancy and direct costs were evaluated over a 10-year time horizon. Future costs and clinical benefits were discounted at 4% annually. Deterministic and probabilistic sensitivity analyses were performed. Results Model projections indicated that afatinib was associated with greater life expectancy (0.16 years) and quality-adjusted life expectancy (0.094 quality-adjusted life years [QALYs]) than that projected for erlotinib. The total cost of treatment over a 10-year time horizon was higher for afatinib than erlotinib, EUR12,364 versus EUR9,510, leading to an incremental cost-effectiveness ratio of EUR30,277 per QALY gained for afatinib versus erlotinib. Sensitivity analyses showed that the base case findings were stable under variation of a range of model inputs. Conclusion Based on data from the LUX-Lung 8 trial, afatinib was projected to improve clinical outcomes versus erlotinib, with a 97% probability of being cost-effective assuming a willingness to pay of EUR70,000 per QALY gained, after platinum-based therapy in patients with squamous NSCLC in France. PMID:29123418

Reaction-diffusion on the fully-connected lattice: A+A\\rightarrow A

NASA Astrophysics Data System (ADS)

Turban, Loïc; Fortin, Jean-Yves

2018-04-01

Diffusion-coagulation can be simply described by a dynamic where particles perform a random walk on a lattice and coalesce with probability unity when meeting on the same site. Such processes display non-equilibrium properties with strong fluctuations in low dimensions. In this work we study this problem on the fully-connected lattice, an infinite-dimensional system in the thermodynamic limit, for which mean-field behaviour is expected. Exact expressions for the particle density distribution at a given time and survival time distribution for a given number of particles are obtained. In particular, we show that the time needed to reach a finite number of surviving particles (vanishing density in the scaling limit) displays strong fluctuations and extreme value statistics, characterized by a universal class of non-Gaussian distributions with singular behaviour.

Cost-effectiveness of enzyme replacement therapy with alglucosidase alfa in classic-infantile patients with Pompe disease

PubMed Central

2014-01-01

Background Infantile Pompe disease is a rare metabolic disease. Patients generally do not survive the first year of life. Enzyme replacement therapy (ERT) has proven to have substantial effects on survival in infantile Pompe disease. However, the costs of therapy are very high. In this paper, we assess the cost-effectiveness of enzyme replacement therapy in infantile Pompe disease. Methods A patient simulation model was used to compare costs and effects of ERT with costs of effects of supportive therapy (ST). The model was filled with data on survival, quality of life and costs. For both arms of the model, data on survival were obtained from international literature. In addition, survival as observed among 20 classic-infantile Dutch patients, who all received ERT, was used. Quality of life was measured using the EQ-5D and assumed to be the same in both treatment groups. Costs included the costs of ERT (which depend on a child’s weight), infusions, costs of other health care utilization, and informal care. A lifetime time horizon was used, with 6-month time cycles. Results Life expectancy was significantly longer in the ERT group than in the ST group. On average, ST receiving patients were modelled not to survive the first half year of life; whereas the life expectancy in the ERT patients was modelled to be almost 14 years. Lifetime incremental QALYs were 6.8. Incremental costs were estimated to be € 7.0 million, which primarily consisted of treatment costs (95%). The incremental costs per QALY were estimated to be € 1.0 million (range sensitivity analyses: € 0.3 million - € 1.3 million). The incremental cost per life year gained was estimated to be € 0.5 million. Conclusions The incremental costs per QALY ratio is far above the conventional threshold values. Results from univariate and probabilistic sensitivity analyses showed the robustness of the results. PMID:24884717

Noninvasive embryo assessment technique based on buoyancy and its association with embryo survival after cryopreservation.

PubMed

Wessels, Cara; Penrose, Lindsay; Ahmad, Khaliq; Prien, Samuel

2017-11-01

Embryo cryopreservation offers many benefits by allowing genetic preservation, genetic screening, cost reduction, global embryo transport and single embryo transfer. However, freezing of embryos decreases embryo viability, as intracellular ice crystal formation often damages embryos. Success rates of frozen embryo transfer are expected to be 15-20% less than fresh embryo transfer. We have developed a noninvasive embryo assessment technique (NEAT) which enables us to predict embryo viability based on buoyancy. The purpose of this research was twofold. First was to determine if a NEAT, through a specific gravity device can detect embryo survival of cryopreservation. Second, it was to relate embryo buoyancy to embryo viability for establishing pregnancies in sheep. Blastocysts descent times were measured on one-hundred sixty-nine mice blastocysts before cryopreservation, according to standard protocol and post-thawing blastocysts descent times were measured again. There was a significant difference in blastocyst post-thaw descent times with NEAT in those blastocysts which demonstrated viability from those that did not (P < 0.05). This suggests NEAT is successful in determining blastocysts viability in cryopreserved mice blastocysts. At a commercial ovine facility, NEAT was performed on fourteen frozen and thawed ovine blastocysts. Blastocysts of similar descent times were paired and transferred into recipient ewes as twins. Pregnancy was later confirmed by blood test and multiple gestation outcomes were determined at lambing. Six of seven recipient ewes were pregnant and all pregnant ewes delivered lambs without complication. Four ewes delivered twin lambs and two ewes delivered singletons, which totals ten of the fourteen (71%) blastocysts surviving to term. This pregnancy rate is comparable to expected to pregnancy rates in a commercial setting. The blastocysts which did not establish pregnancy demonstrated less buoyancy versus those blastocysts which established pregnancies which survived to term (P < 0.05). These results suggest NEAT can identify which blastocysts survive cryopreservation, thus significantly reduce the transfer of non-viable embryos. Further studies on a larger scale commercial setting will evaluate the efficacy of NEAT. Copyright © 2017 Elsevier Inc. All rights reserved.

Racial disparity in survival from early breast cancer in the department of defense healthcare system.

PubMed

Rizzo, Julie A; Sherman, William E; Arciero, Cletus A

2015-06-01

Racial disparity is often identified as a factor in survival from breast cancer in the United States. Current data regarding survival in patients treated in the Department of Defense Military Healthcare System is lacking. The Department of Defense Automated Central Tumor Registry (ACTUR) was queried for all women diagnosed with Stage I or II breast cancer from January 1, 1996 through December 31, 2008. Statistical analyses evaluated demographics, surgical treatment, tumor stage, and survival rates. There were 8,890 patients meeting inclusion criteria. Patients who were younger, Asian American (versus white or black), lower T and/or N stage had significantly improved survival rates. Interestingly, white and black patients demonstrated similar survival in this study. Patients with a longer period of time between diagnosis and treatment had no decrement in survival. As would be expected, patients with a longer recurrence free period enjoyed longer survival. Survival from early stage breast cancer is equivalent between white and black patients in the Department of Defense Healthcare System. This finding is contrary to reports from our civilian counterparts and may be indicative of improved access to care and overall improved cancer surveillance. © 2015 Wiley Periodicals, Inc.

Survival in patients with metachronous second primary lung cancer.

PubMed

Ha, Duc; Choi, Humberto; Chevalier, Cory; Zell, Katrina; Wang, Xiao-Feng; Mazzone, Peter J

2015-01-01

Four to 10% of patients with non-small cell lung cancer subsequently develop a metachronous second primary lung cancer. The decision to perform surveillance or screening imaging for patients with potentially cured lung cancer must take into account the outcomes expected when detecting metachronous second primaries. To assess potential survival differences between patients with metachronous second primary lung cancer compared to matched patients with first primary lung cancer. We retrospectively reviewed patients diagnosed with lung cancer at the Cleveland Clinic (2006-2010). Metachronous second primary lung cancer was defined as lung cancer diagnosed after a 4-year, disease-free interval from the first lung cancer, or if there were two different histologic subtypes diagnosed at different times. Patients with first primary lung cancer diagnosed in the same time period served as control subjects. Propensity score matching was performed using age, sex, smoking history, histologic subtype, and collaborative stage, with a 1:3 case-control ratio. Survival analyses were performed by Cox proportional hazards modeling and Kaplan-Meier estimates. Forty-four patients met criteria for having a metachronous second primary lung cancer. There were no statistically significant differences between case subjects and control subjects in prognostic variables. The median survival time and 2-year overall survival rate for the metachronous second primary group, compared with control subjects, were as follows: 11.8 versus 18.4 months (P = 0.18) and 31.0 versus 40.9% (P = 0.28). The survival difference was largest in those with stage I metachronous second primaries (median survival time, 26.8 vs. 60.4 mo, P = 0.09; 2-year overall survival, 56.3 vs. 71.2%, P = 0.28). Patients with stage I metachronous second primary lung cancer may have worse survival than those who present with a first primary lung cancer. This could influence the benefit-risk balance of screening the high-risk cohort with a previously treated lung cancer.

Imagining the Future, or How the Standard Model May Survive the Attacks

NASA Astrophysics Data System (ADS)

Hooft, Gerard'T.

After the last missing piece, the Higgs particle, has probably been identified, the Standard Model of the subatomic particles appears to be a quite robust structure, that can survive on its own for a long time to come. Most researchers expect considerable modifications and improvements to come in the near future, but it could also be that the Model will stay essentially as it is. This, however, would also require a change in our thinking, and the question remains whether and how it can be reconciled with our desire for our theories to be "natural".

Imagining the future, or how the Standard Model may survive the attacks

NASA Astrophysics Data System (ADS)

'T Hooft, Gerard

2016-06-01

After the last missing piece, the Higgs particle, has probably been identified, the Standard Model of the subatomic particles appears to be a quite robust structure, that can survive on its own for a long time to come. Most researchers expect considerable modifications and improvements to come in the near future, but it could also be that the Model will stay essentially as it is. This, however, would also require a change in our thinking, and the question remains whether and how it can be reconciled with our desire for our theories to be “natural”.

Progression-free survival: gaining on overall survival as a gold standard and accelerating drug development.

PubMed

Lebwohl, David; Kay, Andrea; Berg, William; Baladi, Jean Francois; Zheng, Ji

2009-01-01

In clinical trials of oncology drugs, overall survival (OS) is a direct measure of clinical efficacy and is considered the gold standard primary efficacy end point. The purpose of this study was to discuss the difficulties in using OS as a primary efficacy end point in the setting of evolving cancer therapies. We suggest that progression-free survival is an appropriate efficacy end point in many types of cancer, specifically those for which OS is expected to be prolonged and for which subsequent treatments are expected to affect OS.

Immortal time bias: a frequently unrecognized threat to validity in the evaluation of postoperative radiotherapy.

PubMed

Park, Henry S; Gross, Cary P; Makarov, Danil V; Yu, James B

2012-08-01

To evaluate the influence of immortal time bias on observational cohort studies of postoperative radiotherapy (PORT) and the effectiveness of sequential landmark analysis to account for this bias. First, we reviewed previous studies of the Surveillance, Epidemiology, and End Results (SEER) database to determine how frequently this bias was considered. Second, we used SEER to select three tumor types (glioblastoma multiforme, Stage IA-IVM0 gastric adenocarcinoma, and Stage II-III rectal carcinoma) for which prospective trials demonstrated an improvement in survival associated with PORT. For each tumor type, we calculated conditional survivals and adjusted hazard ratios of PORT vs. postoperative observation cohorts while restricting the sample at sequential monthly landmarks. Sixty-two percent of previous SEER publications evaluating PORT failed to use a landmark analysis. As expected, delivery of PORT for all three tumor types was associated with improved survival, with the largest associated benefit favoring PORT when all patients were included regardless of survival. Preselecting a cohort with a longer minimum survival sequentially diminished the apparent benefit of PORT. Although the majority of previous SEER articles do not correct for it, immortal time bias leads to altered estimates of PORT effectiveness, which are very sensitive to landmark selection. We suggest the routine use of sequential landmark analysis to account for this bias. Copyright © 2012 Elsevier Inc. All rights reserved.

Immortal Time Bias: A Frequently Unrecognized Threat to Validity in the Evaluation of Postoperative Radiotherapy

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

Park, Henry S.; Gross, Cary P.; Makarov, Danil V.

2012-08-01

Purpose: To evaluate the influence of immortal time bias on observational cohort studies of postoperative radiotherapy (PORT) and the effectiveness of sequential landmark analysis to account for this bias. Methods and Materials: First, we reviewed previous studies of the Surveillance, Epidemiology, and End Results (SEER) database to determine how frequently this bias was considered. Second, we used SEER to select three tumor types (glioblastoma multiforme, Stage IA-IVM0 gastric adenocarcinoma, and Stage II-III rectal carcinoma) for which prospective trials demonstrated an improvement in survival associated with PORT. For each tumor type, we calculated conditional survivals and adjusted hazard ratios of PORTmore » vs. postoperative observation cohorts while restricting the sample at sequential monthly landmarks. Results: Sixty-two percent of previous SEER publications evaluating PORT failed to use a landmark analysis. As expected, delivery of PORT for all three tumor types was associated with improved survival, with the largest associated benefit favoring PORT when all patients were included regardless of survival. Preselecting a cohort with a longer minimum survival sequentially diminished the apparent benefit of PORT. Conclusions: Although the majority of previous SEER articles do not correct for it, immortal time bias leads to altered estimates of PORT effectiveness, which are very sensitive to landmark selection. We suggest the routine use of sequential landmark analysis to account for this bias.« less

Getting back the missing men of Aotearoa: declining gender inequality in NZ life expectancy.

PubMed

Sandiford, Peter

2009-12-01

Men's health is of increasing concern to policy makers worldwide. Although women generally live significantly longer than men, the difference in life expectancy in many countries is now narrowing. To document the trend in sex differences in New Zealand (NZ) life expectancy at birth (LEB) over the last decades and to determine disease patterns which account for it. Decomposition of sex differences in LEB by age and cause for the periods 1980-82, 1985-87, 1990-92,1995-97, 2000-02, and 2005-06, using registered deaths and model life tables. Sex differences in LEB increased from 1951 to peak in 1976 before narrowing again. In 2006 they reached almost exactly the level they were at 55 years earlier. Changes in relative mortality from ischaemic heart disease (IHD) and to a lesser extent accidents, respiratory disease and other circulatory causes, brought about the recent decline in gender survival disparities. IHD continues to be a significant cause of gender inequality, but cancers have now become a major component of the sex difference in LEB. NZ's experience mirrors closely that of other developed countries in pattern, timingand the age-cause composition of the trend in gender survival disparities. Thus differences in the timing of taking up smoking, found to explain a substantial portion of the trend elsewhere, were probably also important in NZ, but improvements in medical outcomes for smokers also must have played a significant role. Primary care practitioners will continue to reduce gender survival disparities by workingto ensure a high uptake of services such as screening for colorectal cancer, one of many diseases responsible for lower male life expectancy.

How to Deal with Interval-Censored Data Practically while Assessing the Progression-Free Survival: A Step-by-Step Guide Using SAS and R Software.

PubMed

Dugué, Audrey Emmanuelle; Pulido, Marina; Chabaud, Sylvie; Belin, Lisa; Gal, Jocelyn

2016-12-01

We describe how to estimate progression-free survival while dealing with interval-censored data in the setting of clinical trials in oncology. Three procedures with SAS and R statistical software are described: one allowing for a nonparametric maximum likelihood estimation of the survival curve using the EM-ICM (Expectation and Maximization-Iterative Convex Minorant) algorithm as described by Wellner and Zhan in 1997; a sensitivity analysis procedure in which the progression time is assigned (i) at the midpoint, (ii) at the upper limit (reflecting the standard analysis when the progression time is assigned at the first radiologic exam showing progressive disease), or (iii) at the lower limit of the censoring interval; and finally, two multiple imputations are described considering a uniform or the nonparametric maximum likelihood estimation (NPMLE) distribution. Clin Cancer Res; 22(23); 5629-35. ©2016 AACR. ©2016 American Association for Cancer Research.

Spatiotemporal neurodynamics of automatic temporal expectancy in 9-month old infants.

PubMed

Mento, Giovanni; Valenza, Eloisa

2016-11-04

Anticipating events occurrence (Temporal Expectancy) is a crucial capacity for survival. Yet, there is little evidence about the presence of cortical anticipatory activity from infancy. In this study we recorded the High-density electrophysiological activity in 9 month-old infants and adults undergoing an audio-visual S1-S2 paradigm simulating a lifelike "Peekaboo" game inducing automatic temporal expectancy of smiling faces. The results indicate in the S2-preceding Contingent Negative Variation (CNV) an early electrophysiological signature of expectancy-based anticipatory cortical activity. Moreover, the progressive CNV amplitude increasing across the task suggested that implicit temporal rule learning is at the basis of expectancy building-up over time. Cortical source reconstruction suggested a common CNV generator between adults and infants in the right prefrontal cortex. The decrease in the activity of this area across the task (time-on-task effect) further implied an early, core role of this region in implicit temporal rule learning. By contrast, a time-on-task activity boost was found in the supplementary motor area (SMA) in adults and in the temporoparietal regions in infants. Altogether, our findings suggest that the capacity of the human brain to translate temporal predictions into anticipatory neural activity emerges ontogenetically early, although the underlying spatiotemporal cortical dynamics change across development.

Expectation-maximization algorithms for learning a finite mixture of univariate survival time distributions from partially specified class values

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

Lee, Youngrok

2013-05-15

Heterogeneity exists on a data set when samples from di erent classes are merged into the data set. Finite mixture models can be used to represent a survival time distribution on heterogeneous patient group by the proportions of each class and by the survival time distribution within each class as well. The heterogeneous data set cannot be explicitly decomposed to homogeneous subgroups unless all the samples are precisely labeled by their origin classes; such impossibility of decomposition is a barrier to overcome for estimating nite mixture models. The expectation-maximization (EM) algorithm has been used to obtain maximum likelihood estimates ofmore » nite mixture models by soft-decomposition of heterogeneous samples without labels for a subset or the entire set of data. In medical surveillance databases we can find partially labeled data, that is, while not completely unlabeled there is only imprecise information about class values. In this study we propose new EM algorithms that take advantages of using such partial labels, and thus incorporate more information than traditional EM algorithms. We particularly propose four variants of the EM algorithm named EM-OCML, EM-PCML, EM-HCML and EM-CPCML, each of which assumes a specific mechanism of missing class values. We conducted a simulation study on exponential survival trees with five classes and showed that the advantages of incorporating substantial amount of partially labeled data can be highly signi cant. We also showed model selection based on AIC values fairly works to select the best proposed algorithm on each specific data set. A case study on a real-world data set of gastric cancer provided by Surveillance, Epidemiology and End Results (SEER) program showed a superiority of EM-CPCML to not only the other proposed EM algorithms but also conventional supervised, unsupervised and semi-supervised learning algorithms.« less

Nonparametric Bayesian inference for mean residual life functions in survival analysis.

PubMed

Poynor, Valerie; Kottas, Athanasios

2018-01-19

Modeling and inference for survival analysis problems typically revolves around different functions related to the survival distribution. Here, we focus on the mean residual life (MRL) function, which provides the expected remaining lifetime given that a subject has survived (i.e. is event-free) up to a particular time. This function is of direct interest in reliability, medical, and actuarial fields. In addition to its practical interpretation, the MRL function characterizes the survival distribution. We develop general Bayesian nonparametric inference for MRL functions built from a Dirichlet process mixture model for the associated survival distribution. The resulting model for the MRL function admits a representation as a mixture of the kernel MRL functions with time-dependent mixture weights. This model structure allows for a wide range of shapes for the MRL function. Particular emphasis is placed on the selection of the mixture kernel, taken to be a gamma distribution, to obtain desirable properties for the MRL function arising from the mixture model. The inference method is illustrated with a data set of two experimental groups and a data set involving right censoring. The supplementary material available at Biostatistics online provides further results on empirical performance of the model, using simulated data examples. © The Author 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The impact of simultaneous pancreas-kidney transplantation on long-term patient survival.

PubMed

Ojo, A O; Meier-Kriesche, H U; Hanson, J A; Leichtman, A; Magee, J C; Cibrik, D; Wolfe, R A; Port, F K; Agodoa, L; Kaufman, D B; Kaplan, B

2001-01-15

Simultaneous pancreas-kidney transplantation (SPK) ameliorates the progression of microvascular diabetic complications but the procedure is associated with excess initial morbidity and an uncertain effect on patient survival when compared with solitary cadaveric or living donor renal transplantation. We evaluated mortality risks associated with SPK, solitary renal transplantation, and dialysis treatment in a national cohort of type 1 diabetics with end-stage nephropathy. A total of 13,467 adult-type 1 diabetics enrolled on the renal and renal-pancreas transplant waiting list between 10/01/88 and 06/30/97 were followed until 06/30/98. Time-dependent mortality risks and life expectancy were calculated according to the treatment received subsequent to wait-list registration: SPK; cadaveric kidney only (CAD); living donor kidney only (LKD) transplantation; and dialysis [wait-listed, maintenance dialysis treatment (WLD)]. Adjusted 10-year patient survival was 67% for SPK vs. 65% for LKD recipients (P=0.19) and 46% for CAD recipients (P<0.001). The excess initial mortality normally associated with renal transplantation and the risk of early infectious death was 2-fold higher in SPK recipients. The time to achieve equal proportion of survivors as the WLD patients was 170, 95, and 72 days for SPK, CAD, and LKD recipients, respectively (P<0.001). However, the adjusted 5-year morality risk (RR) using WLD as the reference and the expected remaining life years were 0.40, 0.45, and 0.75 and 23.4, 20.9, and 12.6 years for SPK, LKD, and CAD, respectively. There was no survival benefit in SPK recipients > or =50 years old (RR=1.38, P=0.81). Among patients with type 1 DM with end-stage nephropathy, SPK transplantation before the age of 50 years was associated with long-term improvement in survival compared to solitary cadaveric renal transplantation or dialysis.

Long-Term Effects of Tetanus Toxoid Inoculation on the Demography and Life Expectancy of the Cayo Santiago Rhesus Macaques

PubMed Central

KESSLER, MATTHEW J.; PACHECO, RAISA HERNÁNDEZ; RAWLINS, RICHARD G.; RUIZ-LAMBRIDES, ANGELINA; DELGADO, DIANA L.; SABAT, ALBERTO M.

2014-01-01

Tetanus was a major cause of mortality in the free-ranging population of rhesus monkeys on Cayo Santiago prior to 1985 when the entire colony was given its first dose of tetanus toxoid. The immediate reduction in mortality that followed tetanus toxoid inoculation (TTI) has been documented, but the long-term demographic effects of eliminating tetanus infections have not. This study uses the Cayo Santiago demographic database to construct comparative life tables 12 years before, and 12 years after, TTI. Life tables and matrix projection models are used to test for differences in: (i) survival among all individuals as well as among social groups, (ii) long-term fitness of the population, (iii) age distribution, (iv) reproductive value, and (v) life expectancy. A retrospective life table response experiment (LTRE) was performed to determine which life cycle transition contributed most to observed changes in long-term fitness of the population post-TTI. Elimination of clinical tetanus infections through mass inoculation improved the health and well-being of the monkeys. It also profoundly affected the population by increasing survivorship and long-term fitness, decreasing the differences in survival rates among social groups, shifting the population’s age distribution towards older individuals, and increasing reproductive value and life expectancy. These findings are significant because they demonstrate the long-term effects of eradicating a major cause of mortality at a single point in time on survival, reproduction, and overall demography of a naturalistic population of primates. PMID:25230585

The role of poverty rate and racial distribution in the geographic clustering of breast cancer survival among older women: a geographic and multilevel analysis.

PubMed

Schootman, Mario; Jeffe, Donna B; Lian, Min; Gillanders, William E; Aft, Rebecca

2009-03-01

The authors examined disparities in survival among women aged 66 years or older in association with census-tract-level poverty rate, racial distribution, and individual-level factors, including patient-, treatment-, and tumor-related factors, utilization of medical care, and mammography use. They used linked data from the 1992-1999 Surveillance, Epidemiology, and End Results (SEER) programs, 1991-1999 Medicare claims, and the 1990 US Census. A geographic information system and advanced statistics identified areas of increased or reduced breast cancer survival and possible reasons for geographic variation in survival in 2 of the 5 SEER areas studied. In the Detroit, Michigan, area, one geographic cluster of shorter-than-expected breast cancer survival was identified (hazard ratio (HR) = 1.60). An additional area where survival was longer than expected approached statistical significance (HR = 0.4; P = 0.056). In the Atlanta, Georgia, area, one cluster of shorter- (HR = 1.81) and one cluster of longer-than-expected (HR = 0.72) breast cancer survival were identified. Stage at diagnosis and census-tract poverty (and patient's race in Atlanta) explained the geographic variation in breast cancer survival. No geographic clusters were identified in the 3 other SEER programs. Interventions to reduce late-stage breast cancer, focusing on areas of high poverty and targeting African Americans, may reduce disparities in breast cancer survival in the Detroit and Atlanta areas.

[Estimation of infant mortality and life expectancy in the time of the Roman Empire: a methodological examination].

PubMed

Langner, G

1998-01-01

"The first available written source in human history relating to the description of the life expectancy of a living population is a legal text which originates from the Roman jurist Ulpianus (murdered in AD 228). In contrast to the prevailing opinion in demography, I not only do consider the text to be of ¿historical interest'...but to be a document of inestimable worth for evaluating the population survival probability in the Roman empire. The criteria specified by Ulpianus are in line with the ¿pan-human' survival function as described by modern model life tables, when based on adulthood. Values calculated from tomb inscriptions follow the lowest level of the model life tables as well and support Ulpianus' statements. The specifications by Ulpianus for the population of the Roman world empire as a whole in the ¿best fit' with modern life tables lead to an average level of 20 years of life expectancy. As a consequence a high infant mortality rate of almost 400 [per thousand] can be concluded resulting in no more than three children at the age of five in an average family in spite of a high fertility rate." (EXCERPT)

Sporulation and Germination patterns - hedging a bet on long term microbial survivability in dry soil

NASA Astrophysics Data System (ADS)

Claes, N.; Or, D.

2012-04-01

Soil hosts unparalleled diversity of microbial life that is constantly challenged by the vagaries of fluctuating ambient conditions. Desiccation stresses play a key role not only by directly affecting individual bacterial cells, but also by shaping diffusion pathways and cell dispersion. The gradual thinning and fragmentation of the aqueous environment during drying have led to different survival mechanisms including dormancy and sporulation, resulting in a highly resistive state capable of surviving extreme and prolonged environmental stresses until conditions improve in the future. Our aim is to investigate how temporal changes in hydration status shape microbial communities over time, based on simple survival strategy rules for each individual bacterium. The two survival strategies considered are dormancy and sporulation. Dormancy is the state in which bacterial cells significantly reduce their metabolism with minor morphological adaptations. The required energy and time for attaining this state are low relative to sporulation costs. Sporulation involves several morphological and biochemical changes that result in a resistive capsule that endures extreme stresses over long periods of time. The working hypothesis is that different micro-ecological conditions and community compositions would result from temporal patterns and magnitude of desiccation stresses. An Individual Based Model (IBM) considering habitats on rough soil surfaces and local effects of micro-hydrological conditions on dispersion and nutrient diffusion would enable systematic study of emerging communities over extended periods. Different population compositions are expected to emerge based on low and high frequency, duration and amplitudes of wetting-drying cycles reflecting relative success or failure of survival strategy.

A review of statistical issues with progression-free survival as an interval-censored time-to-event endpoint.

PubMed

Sun, Xing; Li, Xiaoyun; Chen, Cong; Song, Yang

2013-01-01

Frequent rise of interval-censored time-to-event data in randomized clinical trials (e.g., progression-free survival [PFS] in oncology) challenges statistical researchers in the pharmaceutical industry in various ways. These challenges exist in both trial design and data analysis. Conventional statistical methods treating intervals as fixed points, which are generally practiced by pharmaceutical industry, sometimes yield inferior or even flawed analysis results in extreme cases for interval-censored data. In this article, we examine the limitation of these standard methods under typical clinical trial settings and further review and compare several existing nonparametric likelihood-based methods for interval-censored data, methods that are more sophisticated but robust. Trial design issues involved with interval-censored data comprise another topic to be explored in this article. Unlike right-censored survival data, expected sample size or power for a trial with interval-censored data relies heavily on the parametric distribution of the baseline survival function as well as the frequency of assessments. There can be substantial power loss in trials with interval-censored data if the assessments are very infrequent. Such an additional dependency controverts many fundamental assumptions and principles in conventional survival trial designs, especially the group sequential design (e.g., the concept of information fraction). In this article, we discuss these fundamental changes and available tools to work around their impacts. Although progression-free survival is often used as a discussion point in the article, the general conclusions are equally applicable to other interval-censored time-to-event endpoints.

Expected time-invariant effects of biological traits on mammal species duration.

PubMed

Smits, Peter D

2015-10-20

Determining which biological traits influence differences in extinction risk is vital for understanding the differential diversification of life and for making predictions about species' vulnerability to anthropogenic impacts. Here I present a hierarchical Bayesian survival model of North American Cenozoic mammal species durations in relation to species-level ecological factors, time of origination, and phylogenetic relationships. I find support for the survival of the unspecialized as a time-invariant generalization of trait-based extinction risk. Furthermore, I find that phylogenetic and temporal effects are both substantial factors associated with differences in species durations. Finally, I find that the estimated effects of these factors are partially incongruous with how these factors are correlated with extinction risk of the extant species. These findings parallel previous observations that background extinction is a poor predictor of mass extinction events and suggest that attention should be focused on mass extinctions to gain insight into modern species loss.

Challenges in small animal parturition--timing elective and emergency cesarian sections.

PubMed

Smith, F O

2007-08-01

Given the societal emphasis placed on the deliberate breeding of purebred animals, the practitioner today is faced with issues relative to successful parturition in these animals. Today, the serious hobby breeder expects to use planned breeding management to result in a high conception and pregnancy rate and survival rates of offspring that may exceed published parameters. These clients may elect to schedule cesarean section to maximize puppy survival and assure that they have access to quality veterinary care. Using a combination of hormone assays, temperature changes in the dam and carefully timed and documented breeding management, a cesarean section can be planned. Emergency cesarean sections will still be required for the bitch that experiences dystocia or a medical condition that warrants intervention. Timed cesarean section results in a favorable medical outcome for the dam and litter and a better financial outcome for the owner.

Cost-Effectiveness of Pembrolizumab Versus Ipilimumab in Ipilimumab-Naïve Patients with Advanced Melanoma in the United States.

PubMed

Wang, Jingshu; Chmielowski, Bartosz; Pellissier, James; Xu, Ruifeng; Stevinson, Kendall; Liu, Frank Xiaoqing

2017-02-01

Recent clinical trials have shown that pembrolizumab significantly prolonged progression-free survival and overall survival compared with ipilimumab in ipilimumab-naïve patients with unresectable or metastatic melanoma. However, there has been no published evidence on the cost-effectiveness of pembrolizumab for this indication. To assess the long-term cost-effectiveness of pembrolizumab versus ipilimumab in ipilimumab-naïve patients with unresectable or meta-static melanoma from a U.S. integrated health system perspective. A partitioned-survival model was developed, which divided overall survival time into progression-free survival and postprogression survival. The model used Kaplan-Meier estimates of progression-free survival and overall survival from a recent randomized phase 3 study (KEYNOTE-006) that compared pembrolizumab and ipilimumab. Extrapolation of progression-free survival and overall survival beyond the clinical trial was based on parametric functions and literature data. The base-case time horizon was 20 years, and costs and health outcomes were discounted at a rate of 3% per year. Clinical data-including progression-free survival and overall survival data spanning a median follow-up time of 15 months, as well as quality of life and adverse event data from the ongoing KEYNOTE-006 trial-and cost data from public sources were used to populate the model. Costs included those of drug acquisition, treatment administration, adverse event management, and disease management of advanced melanoma. The incremental cost-effectiveness ratio (ICER) expressed as cost difference per quality-adjusted life-year (QALY) gained was the main outcome, and a series of sensitivity analyses were performed to test the robustness of the results. In the base case, pembrolizumab was projected to increase the life expectancy of U.S. patients with advanced melanoma by 1.14 years, corresponding to a gain of 0.79 discounted QALYs over ipilimumab. The model also projected an average increase of $63,680 in discounted perpatient costs of treatment with pembrolizumab versus ipilimumab. The corresponding ICER was $81,091 per QALY ($68,712 per life-year) over a 20-year time horizon. With $100,000 per QALY as the threshold, when input parameters were varied in deterministic one-way sensitivity analyses, the use of pembrolizumab was cost-effective relative to ipilimumab in most ranges. Further, in a comprehensive probabilistic sensitivity analysis, the ICER was cost-effective in 83% of the simulations. Compared with ipilimumab, pembrolizumab had higher expected QALYs and was cost-effective for the treatment of patients with unresectable or metastatic melanoma from a U.S. integrated health system perspective. This study was supported by funding from Merck & Co., which reviewed and approved the manuscript before journal submission. Wang, Pellissier, Xu, Stevinson, and Liu are employees of, and own stock in, Merck & Co. Chmielowski has served as a paid consultant for Merck & Co. and received a consultant fee for clinical input in connection with this study. Chmielowski also reports receiving advisory board and speaker bureau fees from multiple major pharmaceutical companies. Wang led the modeling and writing of the manuscript. Chmielowski, Xu, Stevinson, and Pellissier contributed substantially to the modeling design and methodology. Liu led the data collection work and contributed substantially to writing the manuscript. In conducting the analysis and writing the manuscript, the authors followed Merck publication polices and the "cost-effectiveness analysis alongside clinical trials-good research practices and the CHEERS reporting format as recommended by the International Society for Pharmacoeconomics and Outcomes Research.

Utilization of advanced-age donors in renal transplantation.

PubMed

Olaverri, J G; Mora Christian, J; Elorrieta, P; Esnaola, K; Rodríguez, P; Marrón, I; Uriarte, I; Landa, M J; Zarraga, S; Gainza, F J; Aranzabal, J; Zabala, J A; Pertusa, C

2011-11-01

The shortage of organ availability in recent years has made it necessary to use grafts from advanced-aged donors to maintain the rate of renal transplantation in our country. The objective of this study was to evaluate the graft function and patient survival using kidneys from deceased donors of over 65 year of age. From 2005 until 2010, we compared the outcomes of patients who received grafts from donors over 65 years old vs less than 65 years. We observed no significant difference in sex, time on dialysis, or cold ischemia time between the groups. As expected the recipient age was significantly different. For the analysis of survival, we used the Tablecloth-Haenzel test and the Kaplan-Meier survival estimator. Actuarial survivals at 3 years after transplantation showed 84.8% among patients transplanted with kidneys from donors over 65 years old versus 97.5% in the control group. The graft survival was 78.8% among expanded criteria versus 86.85% in the control group. When we analyzed graft survival using an "exitus-censured" analysis, we obtained graft survivals of 89.1% in the expanded criteria kidney group versus 88.6% among the controls. We concluded that the use of kidney from donors over 65 years of age allows us to increase the rate of renal transplantation to about 15 to 20 per million population, with good graft and patient survivals provided that the protocol for expanded criteria organs ensured proper macroscopic and microscopic evaluation of the organ for transplantation. Copyright © 2011. Published by Elsevier Inc.

Dysfunctional oligodendrocyte progenitor cell (OPC) populations may inhibit repopulation of OPC depleted tissue.

PubMed

Chari, D M; Huang, W L; Blakemore, W F

2003-09-15

We have attempted to extend a previously described rat model of focal oligodendrocyte progenitor cell (OPC) depletion, using 40 Gy X-irradiation (Chari and Blakemore [2002] Glia 37:307-313), to the adult mouse spinal cord, to examine the ability of OPCs present in adjacent normal areas to colonise areas of progenitor depletion. In contrast to rat, OPCs in the mouse spinal cord appeared to be a comparatively radiation-resistant population, as 30-35% of OPCs survived in X-irradiated tissue (whereas <1% of OPCs survive in X-irradiated rat spinal cord). The numbers of surviving OPCs remained constant with time indicating that this population was incapable of regenerating itself in response to OPC loss. Additionally, these OPCs did not contribute to remyelination of axons when demyelinating lesions were placed in X-irradiated tissue, suggesting that the surviving cells are functionally impaired. Importantly, the length of the OPC-depleted area did not diminish with time, as would be expected if progressive repopulation of OPC-depleted areas by OPCs from normal areas was occurring. Our findings therefore raise the possibility that the presence of a residual dysfunctional OPC population may inhibit colonisation of such areas by normal OPCs. Copyright 2003 Wiley-Liss, Inc.

A randomized controlled trial of the effect of prednisone omission from a multidrug chemotherapy protocol on treatment outcome in dogs with peripheral nodal lymphomas.

PubMed

Childress, Michael O; Ramos-Vara, José A; Ruple, Audrey

2016-11-01

OBJECTIVE To determine the effect of prednisone omission from a multidrug chemotherapy protocol on outcome in dogs with peripheral nodal lymphomas. DESIGN Single-center, nonblinded, parallel-group, randomized, controlled trial. ANIMALS 40 client-owned dogs with a histopathologically confirmed diagnosis of peripheral nodal lymphoma and an expected survival time of > 4 weeks with treatment. PROCEDURES Treatment consisted of a combination of L-asparaginase, cyclophosphamide, doxorubicin, vincristine, and prednisone (L-CHOP) or an identical protocol except for the omission of prednisone (L-CHO). The primary outcome of interest was progression-free survival time. Veterinary caregivers and assessors of outcome were not blinded to treatment assignment. Treatment assignment was concealed from the owners of study dogs prior to enrollment, but was revealed after written informed consent was provided. RESULTS The trial was terminated early because of slow enrollment. The 40 dogs successfully enrolled in the study were randomly assigned to the L-CHOP (n = 18) or L-CHO (22) group; results for all 40 dogs were analyzed with respect to the primary outcome. Median progression-free survival time was 142.5 days for dogs receiving L-CHO and 292 days for dogs receiving L-CHOP (hazard ratio, 1.79; 95% confidence interval, 0.85 to 3.75). Serious adverse events were more common among dogs receiving L-CHO. However, this difference was not significant. CONCLUSIONS AND CLINICAL RELEVANCE The exclusion of prednisone from the L-CHOP protocol did not appear to result in improved progression-free survival time for dogs with peripheral nodal lymphomas. However, the present trial was likely underpowered to detect a clinically meaningful difference in progression-free survival time between groups.

Impact of a portal/superior mesenteric vein resection during pancreatico-duodenectomy for pancreatic head adenocarcinoma.

PubMed

Dumitrascu, T; Dima, S; Brasoveanu, V; Stroescu, C; Herlea, V; Moldovan, S; Ionescu, M; Popescu, I

2014-12-01

The impact of venous resection (VR) in pancreatico-dudenectomy (PD) for pancreatic adenocarcinoma (PDAC) is controversial. The aim of the study is to comparatively assess the postoperative outcomes after PD with and without VR for PDAC and to identify predictors of morbidity and survival in the subgroup of PD with VR. The data of 51 PD with VR were compared with those of 183 PD without VR. Binary logistic regression and Cox survival analyses were performed. Both the operative time and estimated blood loss was significantly higher in the VR group (P<0.001). A trend towards an increased 90-day mortality (9.8% vs. 5.5%) and severe morbidity (20% vs. 13%) was observed when a VR was performed (P ≥0.264). The median overall survival time after the PD with and without VR was 13 months and 17 months, respectively (P=0.845). The absence of histological tumor invasion of the VR was found as the only independent predictor for a better survival (HR=0.359; 95% CI 0.161-0.803; P=0.013). A PD with VR can be safely incorporated in a pancreatic surgeon armamentarium. However, the trend towards increased mortality and severe morbidity rates should be expected, along with higher operative time and blood loss, compared with PD without VR. Associated VR does not appear to significantly impair the prognosis after PD for PDAC; however, histological tumor invasion of the VR has a negative impact on the survival.

Defensive platform size and survivability. [Platform survivability

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

Canavan, Gregory H.

1988-06-01

This report discusses the survivability of space platforms, concentrating on space based kinetic energy interceptors. It evaluates the efficacy of hardening, maneuver, self-defense, and deception in extending the survivability of platforms of varying sizes to expected threats, concluding that they should be adequate in the near and mid terms.

Heterogeneity in the Strehler-Mildvan general theory of mortality and aging.

PubMed

Zheng, Hui; Yang, Yang; Land, Kenneth C

2011-02-01

This study examines and further develops the classic Strehler-Mildvan (SM) general theory of mortality and aging. Three predictions from the SM theory are tested by examining the age dependence of mortality patterns for 42 countries (including developed and developing countries) over the period 1955-2003. By applying finite mixture regression models, principal component analysis, and random-effects panel regression models, we find that (1) the negative correlation between the initial adulthood mortality rate and the rate of increase in mortality with age derived in the SM theory exists but is not constant; (2) within the SM framework, the implied age of expected zero vitality (expected maximum survival age) also is variable over time; (3) longevity trajectories are not homogeneous among the countries; (4) Central American and Southeast Asian countries have higher expected age of zero vitality than other countries in spite of relatively disadvantageous national ecological systems; (5) within the group of Central American and Southeast Asian countries, a more disadvantageous national ecological system is associated with a higher expected age of zero vitality; and (6) larger agricultural and food productivities, higher labor participation rates, higher percentages of population living in urban areas, and larger GDP per capita and GDP per unit of energy use are important beneficial national ecological system factors that can promote survival. These findings indicate that the SM theory needs to be generalized to incorporate heterogeneity among human populations.

Curative-intent Surgery for Perihilar Cholangiocarcinoma with and without Portal Vein Resection - A Comparative Analysis of Early and Late Outcomes.

PubMed

Dumitraşcu, Traian; Stroescu, Cezar; Braşoveanu, Vladislav; Herlea, Vlad; Ionescu, Mihnea; Popescu, Irinel

2017-01-01

Introduction: The safety of portal vein resection (PVR) during surgery for perihilar cholangiocarcinoma (PHC) has been demonstrated in Asia, America, and Western Europe. However, no data about this topic are reported from Eastern Europe. The aim of the present study is to comparatively assess the early and long-term outcomes after resection for PHC with and without PVR. The data of 21 patients with PVR were compared with those of 102 patients with a curative-intent surgery for PHC without PVR. The appropriate statistical tests were used to compare different variables between the groups. Results: A PVR was performed in 17% of the patients. In the PVR group, significantly more right trisectionectomies (p=0.031) and caudate lobectomies (0.049) were performed and, as expected, both the operative time (p=0.015) and blood loss (p=0.002) were significantly higher. No differences between the groups were observed regarding the severe postoperative morbidity and mortality rates, and completion of adjuvant therapy. However, in the PVR group the postoperative clinicallyrelevant liver failure rate was significantly higher (p=0.001). No differences between the groups were observed for the median overall survival times (34 vs. 26 months, p = 0.566). A histological proof of the venous tumor invasion was observed in 52% of the patients with a PVR and was associated with significantly worse survival (p=0.027). A PVR can be safely performed during resection for PHC, without significant added severe morbidity or mortality rates. However, clinically-relevant liver failure rates are significantly higher when a PVR is performed. Furthermore, increased operative times and blood loss should be expected when a PVR is performed. Histological tumor invasion of the portal vein is associated with significantly worse survival. Celsius.

Epidemiology of Polymyalgia Rheumatica 2000-2014 and Examination of Incidence and Survival Trends Over 45 Years: A Population-Based Study.

PubMed

Raheel, Shafay; Shbeeb, Izzat; Crowson, Cynthia S; Matteson, Eric L

2017-08-01

To determine time trends in the incidence and survival of polymyalgia rheumatica (PMR) over a 15-year period in Olmsted County, Minnesota, and to examine trends in incidence of PMR in the population by comparing this time period to a previous incidence cohort from the same population base. All cases of incident PMR among Olmsted County, Minnesota residents in 2000-2014 were identified to extend the previous 1970-1999 cohort. Detailed review of all individual medical records was performed. Incidence rates were age- and sex-adjusted to the US white 2010 population. Survival rates were compared with the expected rates in the population of Minnesota. There were 377 incident cases of PMR during the 15-year study period. Of these, 64% were female and the mean age at incidence was 74.1 years. The overall age- and sex-adjusted annual incidence of PMR was 63.9 (95% confidence interval [95% CI] 57.4-70.4) per 100,000 population ages ≥50 years. Incidence rates increased with age in both sexes, but incidence fell after age 80 years. There was a slight increase in incidence of PMR in the recent time period compared to 1970-1999 (P = 0.063). Mortality among individuals with PMR was not significantly worse than that expected in the general population (standardized mortality ratio 0.70 [95% CI 0.57-0.85]). The incidence of PMR has increased slightly in the past 15 years compared to previous decades. Survivorship in patients with PMR is not worse than in the general population. © 2016, American College of Rheumatology.

Improved long-term survival with subdural drains following evacuation of chronic subdural haematoma.

PubMed

Guilfoyle, Mathew R; Hutchinson, Peter J A; Santarius, Thomas

2017-05-01

Chronic subdural haematoma (CSDH) is a common condition that is effectively managed by burrhole drainage but requires repeat surgery in a significant minority of patients. The Cambridge Chronic Subdural Haematoma Trial (CCSHT) was a randomised controlled study that showed placement of subdural drains for 48 h following burrhole evacuation significantly reduces the incidence of reoperation and improves survival at 6 months. The present study examined the long-term survival of the patients in the trial. In the original trial patients at a single neurosurgical centre from 2004-2007 were randomly assigned to receive a drain (n = 108) or no drain (n = 107) following burrhole drainage of CSDH. We ascertained whether the trial patients were alive in February 2016-a minimum of 8 years following enrollment-via the UK NHS tracing service. Survival was compared between the trial groups and against expected survival for the UK general population matched for age and sex. At 5 years following surgery the drain group continued to have significantly better survival than the no drain patients (p = 0.027), but this was no longer apparent at 10 years. Survival of patients in the drain group did not differ significantly from that of the general population whereas patients who did not receive a drain had significantly lower survival than expected (p = 0.0006). Subdural drains following CSDH evacuation are associated with improved long-term survival, which appears similar to that expected for the general population of the same age and sex. All patients having burrhole CSDH evacuation should receive a drain as standard practice unless specifically contraindicated.

Long-term survival after ablation of the atrioventricular node and implantation of a permanent pacemaker in patients with atrial fibrillation.

PubMed

Ozcan, C; Jahangir, A; Friedman, P A; Patel, P J; Munger, T M; Rea, R F; Lloyd, M A; Packer, D L; Hodge, D O; Gersh, B J; Hammill, S C; Shen, W K

2001-04-05

In patients with atrial fibrillation that is refractory to drug therapy, radio-frequency ablation of the atrioventricular node and implantation of a permanent pacemaker are an alternative therapeutic approach. The effect of this procedure on long-term survival is unknown. We studied all patients who underwent ablation of the atrioventricular node and implantation of a permanent pacemaker at the Mayo Clinic between 1990 and 1998. Observed survival was compared with the survival rates in two control populations: age- and sex-matched members of the Minnesota population between 1970 and 1990 and consecutive patients with atrial fibrillation who received drug therapy in 1993. A total of 350 patients (mean [+/-SD] age, 68+/-11 years) were studied. During a mean of 36+/-26 months of follow-up, 78 patients died. The observed survival rate was significantly lower than the expected survival rate based on the general Minnesota population (P<0.001). Previous myocardial infarction (P<0.001), a history of congestive heart failure (P=0.02), and treatment with cardiac drugs after ablation (P=0.03) were independent predictors of death. Observed survival among patients without these three risk factors was similar to expected survival (P=0.43). None of the 26 patients with lone atrial fibrillation died during follow-up (37+/-27 months). The observed survival rate among patients who underwent ablation was similar to that among 229 controls with atrial fibrillation (mean age, 67+/-12 years) who received drug therapy (P=0.44). In the absence of underlying heart disease, survival among patients with atrial fibrillation after ablation of the atrioventricular node is similar to expected survival in the general population. Long-term survival is similar for patients with atrial fibrillation, whether they receive ablation or drug therapy. Control of the ventricular rate by ablation of the atrioventricular node and permanent pacing does not adversely affect long-term survival.

[Evolution of the curves of total survivorship, without chronic illness and without incapacity in France from 1981 to 1991: the application of an OMS model].

PubMed

Robine, J M; Mormiche, P; Cambois, E

1996-01-01

In 1984, World Health Organisation (WHO) has proposed a demo-epidemiological model which allows the assessment of the possible consequences of the lengthening of life on the level of health. This model is represented in a graphic form by three curves: the observed survival curve, the hypothetical survival curve without chronic diseases and the hypothetical survival curve without disability; thus, as life expectancy at any age is calculated from the survival curve, this model allows the computation of life expectancy without chronic diseases and life expectancy without disability. The relationships between the three curves, can be used to illustrate the numerous theories dealing with the evolution of the populations' health which enliven debates in public health since several decades. Application of the model to French data on mortality, morbidity and disability also allows to enlighten the evolution of the health status of the French population over the last decade.

Treatment preferences of patients and physicians: influences of summary data when framing effects are controlled.

PubMed

Mazur, D J; Hickam, D H

1990-01-01

The presentation of efficacy data influences preferences for treatment options. To determine how the amount of data provided to patients influenced patient decision making after framing and labeling effects were controlled, patients and physicians were presented results of two alternative treatments for an unidentified serious medical condition, derived from summary data of lung cancer treatment after surgery (better long-term survival) or radiation therapy (better short-term survival). These data are the same as used in previous studies of framing. When summary data at one month, one year, and five years were presented in terms of both survival and mortality, patients preferred the option that would be expected if only mortality data had been presented. When more detailed data were presented (data at six discrete time points), both patients and physicians preferred the option associated with a survival frame influence in previous studies. Thus, once framing influences are controlled, preference changes can be influenced by another attribute of summary data: the amount of data presented.

[Effect of maternal death on family dynamics and infant survival].

PubMed

Reyes Frausto, S; Bobadilla Fernández, J L; Karchmer Krivitzky, S; Martínez González, L

1998-10-01

Family adjustments, which are generated by a maternal death, have been analysed previously in Mexico by using a reduced number of cases in rural areas. This study was design in order to establish changes in family dynamic generated b y a maternal death and to analyse child surviving after one year of birth. Family members of maternal deaths cases, which occurred during 1988-89 in the Federal District, were interviewed by first time in order to know information related to family dynamic and women's characteristics. A second interview was made after one year of birth for cases in which the newborn survived hospital discharge. Simple frequencies were calculated and using X2 test compared groups. Main consequences were family disintegration, child acquiring new roles and economic problems when woman was the main or the only one support of the family. Child surviving was higher than we expected considering other national or international reports. Children were mainly integrated to their grandparent's family.

Managing hospitals in turbulent times: do organizational changes improve hospital survival?

PubMed Central

Lee, S Y; Alexander, J A

1999-01-01

OBJECTIVE: To examine (1) the degree to which organizational changes affected hospital survival; (2) whether core and peripheral organizational changes affected hospital survival differently; and (3) how simultaneous organizational changes affected hospital survival. DATA SOURCES: AHA Hospital Surveys, the Area Resource File, and the AHA Hospital Guides, Part B: Multihospital Systems. STUDY DESIGN: The study employed a longitudinal panel design. We followed changes in all community hospitals in the continental United States from 1981 through 1994. The dependent variable, hospital closure, was examined as a function of multiple changes in a hospital's core and peripheral structures as well as the hospital's organizational and environmental characteristics. Cox regression models were used to test the expectations that core changes increased closure risk while peripheral changes decreased such risk, and that simultaneous core and peripheral changes would lead to higher risk of closure. PRINCIPAL FINDINGS: Results indicated more peripheral than core changes in community hospitals. Overall, findings contradicted our expectations. Change in specialty, a core change, was beneficial for hospitals, because it reduced closure risk. The two most frequent peripheral changes, downsizing and leadership change, were positively associated with closure. Simultaneous organizational changes displayed a similar pattern: multiple core changes reduced closure risk, while multiple peripheral changes increased the risk. These patterns held regardless of the level of uncertainty in hospital environments. CONCLUSIONS: Organizational changes are not all beneficial for hospitals, suggesting that hospital leaders should be both cautious and selective in their efforts to turn their hospitals around. PMID:10536977

Predictors of long-term survival among first-ever ischemic and hemorrhagic stroke in a Brazilian stroke cohort.

PubMed

Goulart, Alessandra C; Fernandes, Tiotrefis G; Santos, Itamar S; Alencar, Airlane P; Bensenor, Isabela M; Lotufo, Paulo A

2013-05-24

Few studies have examined both ischemic and hemorrhagic stroke to identify prognostic factors associated to long-term stroke survival. We investigated long-term survival and predictors that could adversely influence ischemic and hemorrhagic first-ever stroke prognosis. We prospectively ascertained 665 consecutive first-ever ischemic and hemorrhagic stroke cases from "The Study of Stroke Mortality and Morbidity" (The EMMA Study) in a community hospital in São Paulo, Brazil. We evaluated cardiovascular risk factors and sociodemographic characteristics (age, gender, race and educational level). We found a lower survival rate among hemorrhagic cases compared to ischemic stroke cases at the end of 4 years of follow-up (52% vs. 44%, p = 0.04). The risk of death was two times higher among people with ischemic stroke without formal education. Also, we found consistently higher risk of death for diabetics with ischemic stroke (HR = 1.45; 95% CI = 1.07-1.97) compared to no diabetics. As expected, age equally influenced on the high risk of poor survival, regardless of stroke subtype. For ischemic stroke, the lack of formal education and diabetes were significant independent predictors of poor long-term survival.

Meta-analysis for aggregated survival data with competing risks: a parametric approach using cumulative incidence functions.

PubMed

Bonofiglio, Federico; Beyersmann, Jan; Schumacher, Martin; Koller, Michael; Schwarzer, Guido

2016-09-01

Meta-analysis of a survival endpoint is typically based on the pooling of hazard ratios (HRs). If competing risks occur, the HRs may lose translation into changes of survival probability. The cumulative incidence functions (CIFs), the expected proportion of cause-specific events over time, re-connect the cause-specific hazards (CSHs) to the probability of each event type. We use CIF ratios to measure treatment effect on each event type. To retrieve information on aggregated, typically poorly reported, competing risks data, we assume constant CSHs. Next, we develop methods to pool CIF ratios across studies. The procedure computes pooled HRs alongside and checks the influence of follow-up time on the analysis. We apply the method to a medical example, showing that follow-up duration is relevant both for pooled cause-specific HRs and CIF ratios. Moreover, if all-cause hazard and follow-up time are large enough, CIF ratios may reveal additional information about the effect of treatment on the cumulative probability of each event type. Finally, to improve the usefulness of such analysis, better reporting of competing risks data is needed. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Prognostic and survival analysis of presbyopia: The healthy twin study

NASA Astrophysics Data System (ADS)

Lira, Adiyani; Sung, Joohon

2015-12-01

Presbyopia, a vision condition in which the eye loses its flexibility to focus on near objects, is part of ageing process which mostly perceptible in the early or mid 40s. It is well known that age is its major risk factor, while sex, alcohol, poor nutrition, ocular and systemic diseases are known as common risk factors. However, many other variables might influence the prognosis. Therefore in this paper we developed a prognostic model to estimate survival from presbyopia. 1645 participants which part of the Healthy Twin Study, a prospective cohort study that has recruited Korean adult twins and their family members based on a nation-wide registry at public health agencies since 2005, were collected and analyzed by univariate analysis as well as Cox proportional hazard model to reveal the prognostic factors for presbyopia while survival curves were calculated by Kaplan-Meier method. Besides age, sex, diabetes, and myopia; the proposed model shows that education level (especially engineering program) also contribute to the occurrence of presbyopia as well. Generally, at 47 years old, the chance of getting presbyopia becomes higher with the survival probability is less than 50%. Furthermore, our study shows that by stratifying the survival curve, MZ has shorter survival with average onset time about 45.8 compare to DZ and siblings with 47.5 years old. By providing factors that have more effects and mainly associate with presbyopia, we expect that we could help to design an intervention to control or delay its onset time.

Evaluation of long-term survival: use of diagnostics and robust estimators with Cox's proportional hazards model.

PubMed

Valsecchi, M G; Silvestri, D; Sasieni, P

1996-12-30

We consider methodological problems in evaluating long-term survival in clinical trials. In particular we examine the use of several methods that extend the basic Cox regression analysis. In the presence of a long term observation, the proportional hazard (PH) assumption may easily be violated and a few long term survivors may have a large effect on parameter estimates. We consider both model selection and robust estimation in a data set of 474 ovarian cancer patients enrolled in a clinical trial and followed for between 7 and 12 years after randomization. Two diagnostic plots for assessing goodness-of-fit are introduced. One shows the variation in time of parameter estimates and is an alternative to PH checking based on time-dependent covariates. The other takes advantage of the martingale residual process in time to represent the lack of fit with a metric of the type 'observed minus expected' number of events. Robust estimation is carried out by maximizing a weighted partial likelihood which downweights the contribution to estimation of influential observations. This type of complementary analysis of long-term results of clinical studies is useful in assessing the soundness of the conclusions on treatment effect. In the example analysed here, the difference in survival between treatments was mostly confined to those individuals who survived at least two years beyond randomization.

Long-term effects of tetanus toxoid inoculation on the demography and life expectancy of the Cayo Santiago rhesus macaques.

PubMed

Kessler, Matthew J; Hernández Pacheco, Raisa; Rawlins, Richard G; Ruiz-Lambrides, Angelina; Delgado, Diana L; Sabat, Alberto M

2015-02-01

Tetanus was a major cause of mortality in the free-ranging population of rhesus monkeys on Cayo Santiago prior to 1985 when the entire colony was given its first dose of tetanus toxoid. The immediate reduction in mortality that followed tetanus toxoid inoculation (TTI) has been documented, but the long-term demographic effects of eliminating tetanus infections have not. This study uses the Cayo Santiago demographic database to construct comparative life tables 12 years before, and 12 years after, TTI. Life tables and matrix projection models are used to test for differences in: (i) survival among all individuals as well as among social groups, (ii) long-term fitness of the population, (iii) age distribution, (iv) reproductive value, and (v) life expectancy. A retrospective life table response experiment (LTRE) was performed to determine which life cycle transition contributed most to observed changes in long-term fitness of the population post-TTI. Elimination of clinical tetanus infections through mass inoculation improved the health and well-being of the monkeys. It also profoundly affected the population by increasing survivorship and long-term fitness, decreasing the differences in survival rates among social groups, shifting the population's age distribution towards older individuals, and increasing reproductive value and life expectancy. These findings are significant because they demonstrate the long-term effects of eradicating a major cause of mortality at a single point in time on survival, reproduction, and overall demography of a naturalistic population of primates. © 2014 Wiley Periodicals, Inc.

Analysis of underlying and multiple-cause mortality data: the life table methods.

PubMed

Moussa, M A

1987-02-01

The stochastic compartment model concepts are employed to analyse and construct complete and abbreviated total mortality life tables, multiple-decrement life tables for a disease, under the underlying and pattern-of-failure definitions of mortality risk, cause-elimination life tables, cause-elimination effects on saved population through the gain in life expectancy as a consequence of eliminating the mortality risk, cause-delay life tables designed to translate the clinically observed increase in survival time as the population gain in life expectancy that would occur if a treatment protocol was made available to the general population and life tables for disease dependency in multiple-cause data.

Management of metastatic renal cell carcinoma in the era of targeted therapies.

PubMed

Webber, K; Cooper, A; Kleiven, H; Yip, D; Goldstein, D

2011-08-01

Metastatic renal cell cancer is associated with poor prognosis and survival and is resistant to conventional chemotherapy. Therapeutic targeting of molecular pathways for tumour angiogenesis and other specific activation mechanisms offers improved tumour response and prolonged survival. To conduct a retrospective audit of metastatic renal cell carcinoma patients treated with targeted therapies. Data were extracted from clinical records of patients undergoing targeted treatment between 2005 and 2009 at two hospital sites. Data collected included pathology, systemic therapy class, toxicity and survival. Univariate and multivariate survival analyses were performed. Sixty-one patients were treated with 102 lines of therapy with a median overall survival (OS) of 23 months, median time to failure of first-line treatment (TTF1) of 10 months and median time to failure of second-line treatment (TTF2) of 5.2 months. Time from first diagnosis to treatment >12 months was significantly associated with improved OS, longer TTF1, TTF2 and response to first-line anti-vascular endothelial growth factor receptor tyrosine kinase inhibitors (anti-VEGF TKI) therapy. Variables associated with tumour biology, natural history and the systemic inflammatory response were associated with improved OS and TTF1. Development of hypertension was predictive of anti-VEGF TKI outcome. Toxicities were as expected for each drug class.   Survival and toxicity outcomes from two Australian sites are comparable to published data. The adverse event profile differs to conventional chemotherapy. Clinicians caring for patients with metastatic renal cancer will need to become familiar with these toxicities and their management as these agents enter widespread use. © 2011 The Authors. Internal Medicine Journal © 2011 Royal Australasian College of Physicians.

Temporal trends in patient characteristics and survival of intensive care admissions with sepsis: a multicenter analysis*.

PubMed

Dreiher, Jacob; Almog, Yaniv; Sprung, Charles L; Codish, Shlomi; Klein, Moti; Einav, Sharon; Bar-Lavie, Yaron; Singer, Pierre P; Nimrod, Adi; Sachs, Jeffrey; Talmor, Daniel; Friger, Michael; Greenberg, Dan; Olsfanger, David; Hersch, Moshe; Novack, Victor

2012-03-01

To estimate in-hospital, 1-yr, and long-term mortality and to assess time trends in incidence and outcomes of sepsis admissions in the intensive care unit. A population-based, multicenter, retrospective cohort study. Patients hospitalized with sepsis in the intensive care unit in seven general hospitals in Israel during 2002-2008. None. Survival data were collected and analyzed according to demographic and background clinical characteristics, as well as features of the sepsis episode, using Kaplan-Meier approach for long-term survival. A total of 5,155 patients were included in the cohort (median age: 70, 56.3% males; median Charlson comorbidity index: 4). The mean number of intensive care unit admissions per month increased over time, while no change in in-hospital mortality was observed. The proportion of patients surviving to hospital discharge was 43.9%. The 1-, 2-, 5-, and 8-yr survival rates were 33.0%, 29.8%, 23.3%, and 19.8%, respectively. Mortality was higher in older patients, patients with a higher Charlson comorbidity index, and those with multiorgan failure, and similar in males and females. One-year age-standardized mortality ratio was 21-fold higher than expected, based on the general population rates. Mortality following intensive care unit sepsis admission remains high and is correlated with underlying patients' characteristics, including age, comorbidities, and the number of failing organ systems.

The lived experience of surviving breast cancer.

PubMed

Pelusi, J

1997-09-01

To explore women's perspectives of the experience of surviving breast cancer. Descriptive, phenomenologic. A community in the Southwestern United States. Eight women, ages 34-70 (mean = 54.6 years), who had completed breast cancer therapy. Average time since completion of therapy was 7.6 years (range = 2-15 years). Open-ended, audiotaped interviews were transcribed and analyzed using Colaizzi's method. Woman's description of the experience of surviving breast cancer. Nine theme categories were identified from the data: a future of uncertainty, abandonment, sanctuaries along the way, self-transcendence, finding resolution to the financial cost of cancer, mediating expectations of others, survivors' lifelines, circle of influences, and the journey. The themes were developed into an essential structure. The essential structure of the experience of surviving breast cancer is one of facing the unknown and experiencing many losses. At the same time, this journey evolves into one of growth and enlightenment, providing the woman with many unexpected and new opportunities. In searching for the meaning of the journey (which changes over time), one grows and finds comfort and challenge in the midst of uncertainty. The journey affects not only the women themselves but also those around them. Surviving breast cancer evokes many feelings and concerns for the women and those around them. By identifying, acknowledging, and addressing these feelings and concerns, women can find meaning in their journey, which provides comfort and self-growth while facing the unknown future. This journey continues and changes over time, as does the meaning of the journey. An awareness and description of current issues and feelings surrounding survivors of breast cancer can assist the multidisciplinary healthcare team in caring for and supporting women and their families and friends during this experience.

Italian regional health system structure and expected cancer survival.

PubMed

Vercelli, Marina; Lillini, Roberto; Quaglia, Alberto; Capocaccia, Riccardo

2014-01-01

Few studies deal with the association of socioeconomic and health system resource variables with cancer survival at the Italian regional level, where the greatest number of decisions about social and health policies and resource allocations are taken. The present study aimed to describe the causal relationships between socioeconomic and health system resource factors and regional cancer survival and to compute the expected cancer survival at provincial, regional and area levels. Age-standardized relative survival at 5 years from diagnosis of cases incident in 1995-1998 and followed up to 2004 were derived by gender for 11 sites from the Italian Association of Cancer Registries data bank. The socioeconomic and health system resource variables, describing at a regional level the macro-economy, demography, labor market, and health resources for 1995-2005, came from the Health for All database. A principal components factor analysis was applied to the socioeconomic and health system resource variables. For every site, linear regression models were computed considering the relative survival at 5 years as a dependent variable and the principal components factor analysis factors as independent variables. The factors described the socioeconomic and health-related features of the regional systems and were causally related to the characteristics of the patient taken in charge. The models built by the factors allowed computation of the expected relative survival at 5 years with very good concordance with those observed at regional, macro-regional and national levels. In the regions without any cancer registry, survival was coherent with that of neighboring regions with similar socioeconomic and health system resources characteristics. The models highlighted the causal correlations between socioeconomic and health system resources and cancer survival, suggesting that they could be good evaluation tools for the efficiency of the resources allocation and use.

Development and validation of a prognostic nomogram for terminally ill cancer patients.

PubMed

Feliu, Jaime; Jiménez-Gordo, Ana María; Madero, Rosario; Rodríguez-Aizcorbe, José Ramón; Espinosa, Enrique; Castro, Javier; Acedo, Jesús Domingo; Martínez, Beatriz; Alonso-Babarro, Alberto; Molina, Raquel; Cámara, Juan Carlos; García-Paredes, María Luisa; González-Barón, Manuel

2011-11-02

Determining life expectancy in terminally ill cancer patients is a difficult task. We aimed to develop and validate a nomogram to predict the length of survival in patients with terminal disease. From February 1, 2003, to December 31, 2005, 406 consecutive terminally ill patients were entered into the study. We analyzed 38 features prognostic of life expectancy among terminally ill patients by multivariable Cox regression and identified the most accurate and parsimonious model by backward variable elimination according to the Akaike information criterion. Five clinical and laboratory variables were built into a nomogram to estimate the probability of patient survival at 15, 30, and 60 days. We validated and calibrated the nomogram with an external validation cohort of 474 patients who were treated from June 1, 2006, through December 31, 2007. The median overall survival was 29.1 days for the training set and 18.3 days for the validation set. Eastern Cooperative Oncology Group performance status, lactate dehydrogenase levels, lymphocyte levels, albumin levels, and time from initial diagnosis to diagnosis of terminal disease were retained in the multivariable Cox proportional hazards model as independent prognostic factors of survival and formed the basis of the nomogram. The nomogram had high predictive performance, with a bootstrapped corrected concordance index of 0.70, and it showed good calibration. External independent validation revealed 68% predictive accuracy. We developed a highly accurate tool that uses basic clinical and analytical information to predict the probability of survival at 15, 30, and 60 days in terminally ill cancer patients. This tool can help physicians making decisions on clinical care at the end of life.

Linking Costs and Survival in the Treatment of Older Adults With Chronic Myeloid Leukemia: An Analysis of SEER-Medicare Data From 1995 to 2007.

PubMed

Lin, Pei-Jung; Winn, Aaron N; Parsons, Susan K; Neumann, Peter J; Weiss, Elisa S; Cohen, Joshua T

2016-04-01

The high prices of chronic myeloid leukemia (CML) therapy are well recognized, but less discussion has focused on the value of health care spending on the disease. This study examined whether the added costs have been "worth" the benefits among older adults with CML. We analyzed trends in health care costs and survival over time of 2164 CML patients over age 65 using the Surveillance, Epidemiology and End Results-Medicare-linked database. We estimated life expectancy over a 15-year duration after diagnosis using a Weibull survival model and projected the corresponding costs using a 2-part model, adjusting for patient characteristics. We estimated population-level survival, total health care costs, and incremental cost-effectiveness ratios (expressed as cost per life year gained) over the period of 1995-2007. We found that therapeutic improvements in the treatment of CML have been associated with survival gains among older adults. Mean life expectancy was 2.2 years in 1995 and increased to 4.2 years in 2007. During the same timeframe, CML care costs have increased, from $127,000 in 1995 to $278,000 in 2007 (2010 dollars), mostly due to increasing tyrosine kinase inhibitor costs. The aggregated incremental cost-effectiveness ratio was $74,000/life year gained. Our findings showed that, despite high costs, CML care may provide reasonable value for money among older patients between 1995-2007. Our study sheds light on the value of health care spending on CML by considering both the costs and the benefits. Future research should investigate strategies to improve treatment adherence to maximize the value of CML care.

Surviving annual performance reviews.

PubMed

Lazarus, Arthur

2008-01-01

Physicians who work in organizational settings can expect to be evaluated at least twice a year. Yet physicians are accustomed to functioning autonomously, and they may resist having their performance measured or become anxious at the thought of it. Several recommendations are made to help physicians survive the ordeal: (1) establish measurable goals and objectives for the year; (2) perform at your very best at all times; (3) obtain feedback about your performance from your colleagues; (4) ask for a mentor if you lack experience; (5) learn to manage upward; (6) let your boss know when other people have praised your work; (7) insist on face-to-face evaluations; and (8) sign your annual performance review and indicate agreement or disagreement.

Survival in Extreme Conditions.

ERIC Educational Resources Information Center

Bloom, Martin; Halsema, James

1983-01-01

Explores the psychosocial and environmental configurations involved in the survival of 500 civilians in a Japanese internment camp in the Philippines during World War II. Although conditions were very harsh, the survival rate of this group was better than expected. Discusses available demographic, social organizational, and cultural information.…

Hospital consolidation outlook: surviving in a tough economy.

PubMed

Myers, Chris; Lineen, Jason

2009-11-01

The rapid hospital consolidation activity of the late 1990s has tapered off, but it's expected to pick up again. The reasons for hospital consolidation have shifted from gaining leverage with payers to achieving cost savings and operating efficiencies to survive in the market. The hospital industry can expect to undergo more profound structural and organizational changes in the decade ahead than it did in the past decade.

A model for predicting life expectancy of children with cystic fibrosis.

PubMed

Aurora, P; Wade, A; Whitmore, P; Whitehead, B

2000-12-01

In this study the authors aimed to produce a model for predicting the life expectancy of children with severe cystic fibrosis (CF) lung disease. The survival of 181 children with severe CF lung disease referred for transplantation assessment 1988-1998 (mean age 11.5 yrs, median survival without transplant 1.9 yrs from date of assessment) were studied. Proportional hazards modelling was used to identify assessment measurements that are of value in predicting longevity. The resultant model included low height predicted forced expiratory volume in one second (FEV1), low minimum oxygen saturation (Sa,O2min) during a 12-min walk, high age adjusted resting heart rate, young age, female sex, low plasma albumin, and low blood haemoglobin as predictors for poor prognosis. Extrapolation from the model suggests that a 12-yr old male child with an FEV1 of 30% pred and a Sa,O2min of 85% has a 44% risk of death within 2 yrs (95% confidence interval (CI) 35-54%), whilst a female child with the same measurements has a 63% risk of death (95% CI 52-73%) within the same period. The model produced may be of value in predicting the life expectancy of children with severe cystic fibrosis lung disease and in optimizing the timing of lung transplantation.

DIFFERENCES IN IMMUNE RESPONSE MAY EXPLAIN LOWER SURVIVAL AMONG OLDER MEN WITH PNEUMONIA

PubMed Central

Reade, Michael C.; Yende, Sachin; D’Angelo, Gina; Kong, Lan; Kellum, John A; Barnato, Amber E.; Milbrandt, Eric B.; Dooley, Christopher; Mayr, Florian B.; Weissfeld, Lisa; Angus, Derek C.

2009-01-01

Objective Lower life expectancy in men is generally attributed to higher likelihood of risky behavior and because men develop chronic conditions earlier. If sex-related differences in survival are independent of pre-infection chronic health and health behavior, it would suggest that survival differences may occur due to sex differences in quality of care and biologic response to infection and these differences may contribute to sex differences in life expectancy. We assessed if sex-related survival difference following community-acquired pneumonia (CAP) is due to differences in clinical characteristics, quality of care, or immune response. Design, setting, and subjects Prospective observational cohort of 2183 subjects with CAP. Measurements and main results Mean age was 64.9 years. Compared to women, men were more likely to smoke and had more comorbidity. At emergency department presentation, men had different biomarker patterns, as evidenced by higher inflammation (tumor necrosis factor (TNF), interleukin (IL)-6, and IL-10) and fibrinolysis (D-dimer), and lower coagulation biomarkers (antithrombin-III and Factor IX) (P<0.05). Small differences in favor of men were seen in care quality, including antibiotic timing and compliance with American Thoracic Society guidelines. Men had lower survival at 30, 90, 365 days. The higher one-year mortality was not attenuated when adjusted for differences in demographics, smoking, resuscitation, insurance, and vaccination status, comorbidity, hospital characteristics, and illness severity (unadjusted hazard ratio (HR)=1.35, p=0.003 and adjusted HR=1.29, p=0.004). HR were no longer statistically significant when additionally adjusted for differences in ED concentrations of TNF, IL-6, IL-10, D-dimer, antithrombin-III, and Factor IX (adjusted HR=1.27, p=0.17). Patterns of biomarkers observed in men were associated with worse survival over one year. Conclusions Lower survival among men following CAP was not explained by differences in chronic diseases, health behaviors, and quality of care. Patterns of inflammatory, coagulation, and fibrinolysis biomarkers among men may explain reduced short and long-term survival. PMID:19325487

Factors Which Influence Owners When Deciding to Use Chemotherapy in Terminally Ill Pets.

PubMed

Williams, Jane; Phillips, Catherine; Byrd, Hollie Marie

2017-03-07

Chemotherapy is a commonly integrated treatment option within human and animal oncology regimes. Limited research has investigated pet owners' treatment decision-making in animals diagnosed with malignant neoplasia. Dog and cat owners were asked to complete an online questionnaire to elucidate factors which are key to the decision making process. Seventy-eight respondents completed the questionnaire in full. Fifty-eight percent of pet owners would not elect to treat pets with chemotherapy due to the negative impact of the associated side effects. Seventytwo percent of respondents over estimated pet survival time post chemotherapy, indicating a general perception that it would lead to remission or a cure. Vomiting was considered an acceptable side effect but inappetence, weight loss and depression were considered unacceptable. Owners did expect animals' to be less active, sleep more and play less, but common side effects were not rated as acceptable despite the potential benefits of chemotherapy. Based on the results, veterinary teams involved with oncology consultations should establish if clients have prior experience of cancer treatments and their expectations of survival time. Quality of life assessments should also be implemented during initial oncology consultations and conducted regularly during chemotherapy courses to inform client decision making and to safe guard animal welfare.

Estimating restricted mean treatment effects with stacked survival models

PubMed Central

Wey, Andrew; Vock, David M.; Connett, John; Rudser, Kyle

2016-01-01

The difference in restricted mean survival times between two groups is a clinically relevant summary measure. With observational data, there may be imbalances in confounding variables between the two groups. One approach to account for such imbalances is estimating a covariate-adjusted restricted mean difference by modeling the covariate-adjusted survival distribution, and then marginalizing over the covariate distribution. Since the estimator for the restricted mean difference is defined by the estimator for the covariate-adjusted survival distribution, it is natural to expect that a better estimator of the covariate-adjusted survival distribution is associated with a better estimator of the restricted mean difference. We therefore propose estimating restricted mean differences with stacked survival models. Stacked survival models estimate a weighted average of several survival models by minimizing predicted error. By including a range of parametric, semi-parametric, and non-parametric models, stacked survival models can robustly estimate a covariate-adjusted survival distribution and, therefore, the restricted mean treatment effect in a wide range of scenarios. We demonstrate through a simulation study that better performance of the covariate-adjusted survival distribution often leads to better mean-squared error of the restricted mean difference although there are notable exceptions. In addition, we demonstrate that the proposed estimator can perform nearly as well as Cox regression when the proportional hazards assumption is satisfied and significantly better when proportional hazards is violated. Finally, the proposed estimator is illustrated with data from the United Network for Organ Sharing to evaluate post-lung transplant survival between large and small-volume centers. PMID:26934835

Discrete mixture modeling to address genetic heterogeneity in time-to-event regression

PubMed Central

Eng, Kevin H.; Hanlon, Bret M.

2014-01-01

Motivation: Time-to-event regression models are a critical tool for associating survival time outcomes with molecular data. Despite mounting evidence that genetic subgroups of the same clinical disease exist, little attention has been given to exploring how this heterogeneity affects time-to-event model building and how to accommodate it. Methods able to diagnose and model heterogeneity should be valuable additions to the biomarker discovery toolset. Results: We propose a mixture of survival functions that classifies subjects with similar relationships to a time-to-event response. This model incorporates multivariate regression and model selection and can be fit with an expectation maximization algorithm, we call Cox-assisted clustering. We illustrate a likely manifestation of genetic heterogeneity and demonstrate how it may affect survival models with little warning. An application to gene expression in ovarian cancer DNA repair pathways illustrates how the model may be used to learn new genetic subsets for risk stratification. We explore the implications of this model for censored observations and the effect on genomic predictors and diagnostic analysis. Availability and implementation: R implementation of CAC using standard packages is available at https://gist.github.com/programeng/8620b85146b14b6edf8f Data used in the analysis are publicly available. Contact: kevin.eng@roswellpark.org Supplementary information: Supplementary data are available at Bioinformatics online. PMID:24532723

Survival after initial diagnosis of Alzheimer disease.

PubMed

Larson, Eric B; Shadlen, Marie-Florence; Wang, Li; McCormick, Wayne C; Bowen, James D; Teri, Linda; Kukull, Walter A

2004-04-06

Alzheimer disease is an increasingly common condition in older people. Knowledge of life expectancy after the diagnosis of Alzheimer disease and of associations of patient characteristics with survival may help planning for future care. To investigate the course of Alzheimer disease after initial diagnosis and examine associations hypothesized to correlate with survival among community-dwelling patients with Alzheimer disease. Prospective observational study. An Alzheimer disease patient registry from a base population of 23 000 persons age 60 years and older in the Group Health Cooperative, Seattle, Washington. 521 newly recognized persons with Alzheimer disease enrolled from 1987 to 1996 in an Alzheimer disease patient registry. Baseline measurements included patient demographic features, Mini-Mental State Examination score, Blessed Dementia Rating Scale score, duration since reported onset of symptoms, associated symptoms, comorbid conditions, and selected signs. Survival was the outcome of interest. The median survival from initial diagnosis was 4.2 years for men and 5.7 years for women with Alzheimer disease. Men had poorer survival across all age groups compared with females. Survival was decreased in all age groups compared with the life expectancy of the U.S. population. Predictors of mortality based on proportional hazards models included a baseline Mini-Mental State Examination score of 17 or less, baseline Blessed Dementia Rating Scale score of 5.0 or greater, presence of frontal lobe release signs, presence of extrapyramidal signs, gait disturbance, history of falls, congestive heart failure, ischemic heart disease, and diabetes at baseline. The base population, although typical of the surrounding Seattle community, may not be representative of other, more diverse populations. In this sample of community-dwelling elderly persons who received a diagnosis of Alzheimer disease, survival duration was shorter than predicted on the basis of U.S. population data, especially for persons with onset at relatively younger ages. Features significantly associated with reduced survival at diagnosis were increased severity of cognitive impairment, decreased functional level, history of falls, physical examination findings of frontal release signs, and abnormal gait. The variables most strongly associated with survival were measures of disease severity at the time of diagnosis. These results should be useful to patients and families experiencing Alzheimer disease, other caregivers, clinicians, and policymakers when planning for future care needs.

Variable life-adjusted display (VLAD) for hip fracture patients: a prospective trial.

PubMed

Williams, H; Gwyn, R; Smith, A; Dramis, A; Lewis, J

2015-08-01

With restructuring within the NHS, there is increased public and media interest in surgical outcomes. The Nottingham Hip Fracture Score (NHFS) is a well-validated tool in predicting 30-day mortality in hip fractures. VLAD provides a visual plot in real time of the difference between the cumulative expected mortality and the actual death occurring. Survivors are incorporated as a positive value equal to 1 minus the probability of survival and deaths as a negative value equal to the probability of survival. Downward deflections indicate mortality and potentially suboptimal care. We prospectively included every hip fracture admitted to UHW that underwent surgery from January-August 2014. NHFS was then calculated and predicted survival identified. A VLAD plot was then produced comparing the predicted with the actual 30-day mortality. Two hundred and seventy-seven patients have completed the 30-day follow-up, and initial results showed that the actual 30-day mortality (7.2 %) was much lower than that predicted by the NHFS (8.0 %). This was reflected by a positive trend on the VLAD plot. Variable life-adjusted display provides an easy-to-use graphical representation of risk-adjusted survival over time and can act as an "early warning" system to identify trends in mortality for hip fractures.

Pilot study to access the role of Ceratomyxa shasta infection in mortality of fall-run Chinook smolts migrating through the lower Klamath River in 2008

USGS Publications Warehouse

Foott, Scott; Stutzer, Greg; Fogerty, R.; Hansel, Hal; Juhnke, Steven; Beeman, John W.

2009-01-01

Apparent survival and migration rate of radio-tagged hatchery subyearling Chinook salmon released at Iron Gate Hatchery was monitored in the Klamath River to see if the timing of mortality coincided with observations of ceratomyxosis in re-captured coded wire tag cohorts. Despite rapid emigration, these relatively large (mean fork length 92 mm) smolts had a cumulative apparent survival to the estuary of 0.074 (SE 0.024) and standardized rates of survival per 100 km tended to decrease linearly with distance from the hatchery. The last fish detection occurred 26 days after release but median travel time between Iron Gate Hatchery (rkm 309) and the last receiver near the Klamath estuary (Blake’s Riffle rkm 13) was about 10 days. The majority of apparent mortality (8-10 d post-release) occurred before disease from Ceratomyxa shasta infection is expected after exposure to infectious waters. Despite numerous observations of ceratomyxosis in the Klamath R. during June, an obvious link between disease and apparent survival was not present in this study. Future studies should examine the acute (e.g., predator types and densities) and chronic (e.g., swimming performance impairment due to disease) mortality factors for juvenile Chinook salmon smolts in the Klamath River.

Factors Which Influence Owners When Deciding to Use Chemotherapy in Terminally Ill Pets

PubMed Central

Williams, Jane; Phillips, Catherine; Byrd, Hollie Marie

2017-01-01

Simple Summary Cancer is as common amongst pets as it in humans. Chemotherapy can be integrated into treatment regimes for terminally ill pets to attempt to shrink tumours to extend life expectancy, but it does not cure cancer and it can have negative side effects including vomiting, depression and behavioral changes. To date, little research has been undertaken to explore owners’ decisions whether or not to treat their animals with chemotherapy. Seventy-eight dog and cat owners completed an online questionnaire to determine if they would opt for chemotherapy if their pet was diagnosed with cancer, and asked how they thought their pet’s quality of life would be affected. Fifty-eight percent of respondents would not use chemotherapy largely due to their previous experience of it. Seventy-two percent over estimated pet survival time post chemotherapy, with most people believing it would lead to remission or a cure. Owners expected their pets to be less active, sleep more and play less, reducing their quality of life. Common side effects associated with chemotherapy were not rated as acceptable. The results suggest pet owners would benefit from an increased understanding of the positive and negative impacts of chemotherapy when initially discussing treatment options with the veterinary team. Abstract Chemotherapy is a commonly integrated treatment option within human and animal oncology regimes. Limited research has investigated pet owners’ treatment decision-making in animals diagnosed with malignant neoplasia. Dog and cat owners were asked to complete an online questionnaire to elucidate factors which are key to the decision making process. Seventy-eight respondents completed the questionnaire in full. Fifty-eight percent of pet owners would not elect to treat pets with chemotherapy due to the negative impact of the associated side effects. Seventy-two percent of respondents over estimated pet survival time post chemotherapy, indicating a general perception that it would lead to remission or a cure. Vomiting was considered an acceptable side effect but inappetence, weight loss and depression were considered unacceptable. Owners did expect animals’ to be less active, sleep more and play less, but common side effects were not rated as acceptable despite the potential benefits of chemotherapy. Based on the results, veterinary teams involved with oncology consultations should establish if clients have prior experience of cancer treatments and their expectations of survival time. Quality of life assessments should also be implemented during initial oncology consultations and conducted regularly during chemotherapy courses to inform client decision making and to safe guard animal welfare. PMID:28272340

Prognostically favorable abdominal breast cancer metastases with stomach involvement.

PubMed

Akcali, Zafer; Sakalli, Hakan; Ozyilkan, Ozgur; Demirhan, Beyhan; Haberal, Mehmet

2005-05-01

Abdominal metastases with stomach involvement are rare in breast cancer. The median disease free interval from the time of breast cancer diagnosis to gastric metastasis is usually very long. Treatment is generally palliative, and expected survival time is less than 1 year. A 59-year-old woman with breast cancer developed diffuse abdominal metastases involving stomach, abdominal lymph nodes, and omentum 9 years after she underwent mastectomy and adjuvant chemotherapy. The histopathologic diagnosis found by stomach specimen examination was invasive lobular carcinoma, and the cells expressed high levels of estrogen and progesterone receptors. The abdominal metastases were treated with surgery, postoperative chemotherapy, and further hormonal therapy. This was successful, and the patient has been in remission for more than 3 years. Once the definitive diagnosis of breast cancer metastases to the abdomen including the stomach is established, treatment that targets systemic breast cancer must be initiated. Our patient's extended survival time suggests that surgical treatment could be considered for selected patients.

Immediate loading with fixed full-arch prostheses in the maxilla: Review of the literature

PubMed Central

Peñarrocha-Oltra, David; Covani, Ugo; Peñarrocha-Diago, Miguel

2014-01-01

Objectives: To critically review the evidence-based literature on immediate loading of implants with fixed full-arch prostheses in the maxilla to determine 1) currently recommended performance criteria and 2) the outcomes that can be expected with this procedure. Study Desing: Studies from 2001 to 2011 on immediate loading with fixed full-arch maxillary prostheses were reviewed. Clinical series with at least 5 patients and 12 months of follow-up were included. Case reports, studies with missing data and repeatedly published studies were excluded. In each study the following was assessed: type of study, implant type, number of patients, number of implants, number of implants per patient, use of post-extraction implants, minimum implant length and diameter, type of prosthesis, time until loading, implant survival rate, prosthesis survival rate, marginal bone loss, complications andmean follow-up time. Criteria for patient selection, implant primary stability and bone regeneration were also studied. Results: Thirteen studies were included, reporting a total of 2484 immediately loaded implants in 365 patients. Currently accepted performance criteria regarding patient and implant selection, and surgical and prosthetic procedures were deduced from the reviewed articles. Implant survival rates went from 87.5% to 100%, prosthesis survival rates from 93.8% to 100% and radiographic marginal bone loss from 0.8 mm to 1.6 mm.No intraoperative complications and only minor prosthetic complications were reported. Conclusions: The literature on immediate loading with fixed full-arch prostheses in the maxilla shows that a successful outcome can be expected if adequate criteria are used to evaluate the patient, choose the implant and perform the surgical and prosthetic treatment. Lack of homogeneity within studies limits the relevance of the conclusions that can be drawn, and more controlled randomized studies are necessary to enable comparison between the immediate and the conventional loading procedures. Key words:Immediate loading, full-arch, dental implants, loading protocols. PMID:24880445

Using cure models for analyzing the influence of pathogens on salmon survival

USGS Publications Warehouse

Ray, Adam R; Perry, Russell W.; Som, Nicholas A.; Bartholomew, Jerri L

2014-01-01

Parasites and pathogens influence the size and stability of wildlife populations, yet many population models ignore the population-level effects of pathogens. Standard survival analysis methods (e.g., accelerated failure time models) are used to assess how survival rates are influenced by disease. However, they assume that each individual is equally susceptible and will eventually experience the event of interest; this assumption is not typically satisfied with regard to pathogens of wildlife populations. In contrast, mixture cure models, which comprise logistic regression and survival analysis components, allow for different covariates to be entered into each part of the model and provide better predictions of survival when a fraction of the population is expected to survive a disease outbreak. We fitted mixture cure models to the host–pathogen dynamics of Chinook Salmon Oncorhynchus tshawytscha and Coho Salmon O. kisutch and the myxozoan parasite Ceratomyxa shasta. Total parasite concentration, water temperature, and discharge were used as covariates to predict the observed parasite-induced mortality in juvenile salmonids collected as part of a long-term monitoring program in the Klamath River, California. The mixture cure models predicted the observed total mortality well, but some of the variability in observed mortality rates was not captured by the models. Parasite concentration and water temperature were positively associated with total mortality and the mortality rate of both Chinook Salmon and Coho Salmon. Discharge was positively associated with total mortality for both species but only affected the mortality rate for Coho Salmon. The mixture cure models provide insights into how daily survival rates change over time in Chinook Salmon and Coho Salmon after they become infected with C. shasta.

Recovery of polyclonal immunoglobulins one year after autologous stem cell transplantation as a long-term predictor marker of progression and survival in multiple myeloma.

PubMed

González-Calle, Verónica; Cerdá, Seila; Labrador, Jorge; Sobejano, Eduardo; González-Mena, Beatriz; Aguilera, Carmen; Ocio, Enrique María; Vidriales, María Belén; Puig, Noemí; Gutiérrez, Norma Carmen; García-Sanz, Ramón; Alonso, José María; López, Rosa; Aguilar, Carlos; de Coca, Alfonso García; Hernández, Roberto; Hernández, José Mariano; Escalante, Fernando; Mateos, María-Victoria

2017-05-01

Immunoparesis or suppression of polyclonal immunoglobulins is a very common condition in newly diagnosed myeloma patients. However, the recovery of polyclonal immunoglobulins in the setting of immune reconstitution after autologous stem cell transplantation and its effect on outcome has not yet been explored. We conducted this study in a cohort of 295 patients who had undergone autologous transplantation. In order to explore the potential role of immunoglubulin recovery as a dynamic predictor of progression or survival after transplantation, conditional probabilities of progression-free survival and overall survival were estimated according to immunoglobulin recovery at different time points using a landmark approach. One year after transplant, when B-cell reconstitution is expected to be completed, among 169 patients alive and progression free, 88 patients (52%) showed immunoglobulin recovery and 81 (48%) did not. Interestingly, the group with immunoglobulin recovery had a significantly longer median progression-free survival than the group with persistent immunoparesis (median 60.4 vs. 27.9 months, respectively; Hazard Ratio: 0.45, 95%Confidence Interval: 0.31-0.66; P <0.001), and improved overall survival (11.3 vs. 7.3 years; Hazard Ratio: 0.45, 95%Confidence Interval: 0.27-0.74; P =0.002). Furthermore, the percentage of normal plasma cells detected by flow cytometry in the bone marrow assessed at day 100 after transplantation was associated with the immunoglobulin recovery at that time and may predict immunoglobulin recovery in the subsequent months: nine months and one year. In conclusion, the recovery of polyclonal immunoglobulins one year after autologous transplantation in myeloma patients is an independent long-term predictor marker for progression and survival. Copyright© Ferrata Storti Foundation.

Fall and winter survival of brook trout and brown trout in a north-central Pennsylvania watershed

USGS Publications Warehouse

Sweka, John A.; Davis, Lori A.; Wagner, Tyler

2017-01-01

Stream-dwelling salmonids that spawn in the fall generally experience their lowest survival during the fall and winter due to behavioral changes associated with spawning and energetic deficiencies during this time of year. We used data from Brook Trout Salvelinus fontinalis and Brown Trout Salmo trutta implanted with radio transmitters in tributaries of the Hunts Run watershed of north-central Pennsylvania to estimate survival from the fall into the winter seasons (September 2012–February 2013). We examined the effects that individual-level covariates (trout species, size, and movement rates) and stream-level covariates (individual stream and cumulative drainage area of a stream) have on survival. Brook Trout experienced significantly lower survival than Brown Trout, especially in the early fall during their peak spawning period. Besides a significant species effect, none of the other covariates examined influenced survival for either species. A difference in life history between these species, with Brook Trout having a shorter life expectancy than Brown Trout, is likely the primary reason for the lower survival of Brook Trout. However, Brook Trout also spawn earlier in the fall than Brown Trout and low flows during Brook Trout spawning may have resulted in a greater risk of predation for Brook Trout compared with Brown Trout, thereby also contributing to the observed differences in survival between these species. Our estimates of survival can aid parameterization of future population models for Brook Trout and Brown Trout through the spawning season and into winter.

Breeding Young as a Survival Strategy during Earth’s Greatest Mass Extinction

NASA Astrophysics Data System (ADS)

Botha-Brink, Jennifer; Codron, Daryl; Huttenlocker, Adam K.; Angielczyk, Kenneth D.; Ruta, Marcello

2016-04-01

Studies of the effects of mass extinctions on ancient ecosystems have focused on changes in taxic diversity, morphological disparity, abundance, behaviour and resource availability as key determinants of group survival. Crucially, the contribution of life history traits to survival during terrestrial mass extinctions has not been investigated, despite the critical role of such traits for population viability. We use bone microstructure and body size data to investigate the palaeoecological implications of changes in life history strategies in the therapsid forerunners of mammals before and after the Permo-Triassic Mass Extinction (PTME), the most catastrophic crisis in Phanerozoic history. Our results are consistent with truncated development, shortened life expectancies, elevated mortality rates and higher extinction risks amongst post-extinction species. Various simulations of ecological dynamics indicate that an earlier onset of reproduction leading to shortened generation times could explain the persistence of therapsids in the unpredictable, resource-limited Early Triassic environments, and help explain observed body size distributions of some disaster taxa (e.g., Lystrosaurus). Our study accounts for differential survival in mammal ancestors after the PTME and provides a methodological framework for quantifying survival strategies in other vertebrates during major biotic crises.

Breeding Young as a Survival Strategy during Earth's Greatest Mass Extinction.

PubMed

Botha-Brink, Jennifer; Codron, Daryl; Huttenlocker, Adam K; Angielczyk, Kenneth D; Ruta, Marcello

2016-04-05

Studies of the effects of mass extinctions on ancient ecosystems have focused on changes in taxic diversity, morphological disparity, abundance, behaviour and resource availability as key determinants of group survival. Crucially, the contribution of life history traits to survival during terrestrial mass extinctions has not been investigated, despite the critical role of such traits for population viability. We use bone microstructure and body size data to investigate the palaeoecological implications of changes in life history strategies in the therapsid forerunners of mammals before and after the Permo-Triassic Mass Extinction (PTME), the most catastrophic crisis in Phanerozoic history. Our results are consistent with truncated development, shortened life expectancies, elevated mortality rates and higher extinction risks amongst post-extinction species. Various simulations of ecological dynamics indicate that an earlier onset of reproduction leading to shortened generation times could explain the persistence of therapsids in the unpredictable, resource-limited Early Triassic environments, and help explain observed body size distributions of some disaster taxa (e.g., Lystrosaurus). Our study accounts for differential survival in mammal ancestors after the PTME and provides a methodological framework for quantifying survival strategies in other vertebrates during major biotic crises.

The remote prognosis of eclamptic women. Sixth periodic report.

PubMed

Chesley, L C; Annitto, J E; Cosgrove, R A

1976-03-01

All but three of the 270 women surviving eclampsia at the Margaret Hague Maternity Hospital in the period 1931 through 1951 were traced to 1973-74. Seventy-six have died and 13 were not re-examined. In white women having eclampsia in the first pregnancy carried to viability the remote mortality rate is not increased over that in unselected women; in white women having eclampsia as mulitparas and in all black women the remote mortality rate is from 2 to 5 times the expected numbers. Primiparous eclamptic women are not different from women matched for age, in several epidemiologic studies, in the prevalence of hypertension or in the frequency distributions of systolic and diastolic blood pressures. There is, however, a considerable increase in the prevalence of hypertension among women having had eclampsia as multiparas and that has accounted for their increased remote death rates. The prevalence of diabetes, developing many years after eclampsia is 2.5 times the expected rate in primiparous and about 4 times the expected rate among multiparous eclamptic women. Eclampsia neither is a sign of latent essential hypertension nor causes hypertension. Hypertensive pregnancies following eclampsia indicate the probabilty of later chronic hypertension, but do not cause it.

Standard Period Life Table Used to Compute the Life Expectancy of Diseased Subpopulations: More Confusing Than Helpful.

PubMed

Perron, Linda; Simard, Marc; Brisson, Jacques; Hamel, Denis; Lo, Ernest

2017-10-01

Life expectancy (LE) based on a period life table (PLT) traditionally serves as a general population summary metric. It is, however, becoming more frequently reported for chronically afflicted subpopulations. In general populations, there is always an obvious real cohort sharing the hypothetical PLT cohort characteristics, and the LE estimate is intuitively understood as that real cohort mean survival time, assuming constancy of death risks. In diseased subpopulations, the correspondence between the hypothetical cohort and a real cohort is not straightforward. Furthermore, the excess mortality of chronic diseases usually changes according to age at onset and time since onset. The standard PLT method does not allow for proper control of these issues, so the LE estimate can only be deemed valid under specific assumptions. Without clear statements about the real cohort to whom the estimate is intended and the assumptions allowing disregard of the effect of age at onset and time since onset, LEs of afflicted subpopulations computed with the PLT are only abstract numbers summarizing mortality rates. If called "life expectancy," they can be seriously misleading. The same applies to health-adjusted LE.

Cost-effectiveness of pembrolizumab versus docetaxel for the treatment of previously treated PD-L1 positive advanced NSCLC patients in the United States.

PubMed

Huang, Min; Lou, Yanyan; Pellissier, James; Burke, Thomas; Liu, Frank Xiaoqing; Xu, Ruifeng; Velcheti, Vamsidhar

2017-02-01

This analysis aimed to evaluate the cost-effectiveness of pembrolizumab compared with docetaxel in patients with previously treated advanced non-squamous cell lung cancer (NSCLC) with PD-L1 positive tumors (total proportion score [TPS] ≥ 50%). The analysis was conducted from a US third-party payer perspective. A partitioned-survival model was developed using data from patients from the KEYNOTE 010 clinical trial. The model used Kaplan-Meier (KM) estimates of progression-free survival (PFS) and overall survival (OS) from the trial for patients treated with either pembrolizumab 2 mg/kg or docetaxel 75 mg/m 2 with extrapolation based on fitted parametric functions and long-term registry data. Quality-adjusted life years (QALYs) were derived based on EQ-5D data from KEYNOTE 010 using a time to death approach. Costs of drug acquisition/administration, adverse event management, and clinical management of advanced NSCLC were included in the model. The base-case analysis used a time horizon of 20 years. Costs and health outcomes were discounted at a rate of 3% per year. A series of one-way and probabilistic sensitivity analyses were performed to test the robustness of the results. Base case results project for PD-L1 positive (TPS ≥50%) patients treated with pembrolizumab a mean survival of 2.25 years. For docetaxel, a mean survival time of 1.07 years was estimated. Expected QALYs were 1.71 and 0.76 for pembrolizumab and docetaxel, respectively. The incremental cost per QALY gained with pembrolizumab vs docetaxel is $168,619/QALY, which is cost-effective in the US using a threshold of 3-times GDP per capita. Sensitivity analyses showed the results to be robust over plausible values of the majority of inputs. Results were most sensitive to extrapolation of overall survival. Pembrolizumab improves survival, increases QALYs, and can be considered as a cost-effective option compared to docetaxel in PD-L1 positive (TPS ≥50%) pre-treated advanced NSCLC patients in the US.

The impact of waiting for intervention on costs and effectiveness: the case of transcatheter aortic valve replacement.

PubMed

Ribera, Aida; Slof, John; Ferreira-González, Ignacio; Serra, Vicente; García-Del Blanco, Bruno; Cascant, Purificació; Andrea, Rut; Falces, Carlos; Gutiérrez, Enrique; Del Valle-Fernández, Raquel; Morís-de laTassa, César; Mota, Pedro; Oteo, Juan Francisco; Tornos, Pilar; García-Dorado, David

2017-11-23

The economic crisis in Europe might have limited access to some innovative technologies implying an increase of waiting time. The purpose of the study is to evaluate the impact of waiting time on the costs and benefits of transcatheter aortic valve replacement (TAVR) for the treatment of severe aortic stenosis. This is a cost-utility analysis from the perspective of the Spanish National Health Service. Results of two prospective hospital registries (158 and 273 consecutive patients) were incorporated into a probabilistic Markov model to compare quality adjusted life years (QALYs) and costs for TAVR after waiting for 3-12 months, relative to immediate TAVR. We simulated a cohort of 1000 patients, male, and 80 years old; other patient profiles were assessed in sensitivity analyses. As waiting time increased, costs decreased at the expense of lower survival and loss of QALYs, leading to incremental cost-effectiveness ratios for eliminating waiting lists of about 12,500 € per QALY. In subgroup analyses prioritization of patients for whom higher benefit was expected led to a smaller loss of QALYs. Concerning budget impact, long waiting lists reduced spending considerably and permanently. A shorter waiting time is likely to be cost-effective (considering commonly accepted willingness-to-pay thresholds in Europe) relative to 3 months or longer waiting periods. If waiting lists are nevertheless seen as unavoidable due to severe but temporary budgetary restrictions, prioritizing patients for whom higher benefit is expected appears to be a way of postponing spending without utterly sacrificing patients' survival and quality of life.

Innate resistance to sporicides and potential failure to decontaminate.

PubMed

Maillard, J-Y

2011-03-01

Bacterial spores are frequently intrinsically resistant to biocides and only a number of alkylating and oxidising biocides are sporicidal under certain conditions. Activity against spores is affected by several key factors such as concentration, exposure time, soiling, and the types of surface to be treated. Sporicidal efficacy is usually achieved after an exposure time of several minutes with a high concentration of a biocide. Failure to understand these factors will result in decreased sporicide activity and spore survival. Sporicides in healthcare settings are used for surface disinfection and for the high level disinfection of certain medical devices (e.g. endoscopes). With efficacy data in mind, sporicidal activity should be achieved for the disinfection of medical devices where both high concentration and long exposure time occur. However, for the disinfection of environmental surfaces, high concentration is not recommended, nor is long exposure time achievable. In this case, sporicidal activity is severely reduced and spore survival following treatment is to be expected and contributes to the explanation of spore persistence on surfaces. Copyright © 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

The era of comparable life expectancy between thalassaemia major and intermedia: Is it time to revisit the major-intermedia dichotomy?

PubMed

Vitrano, Angela; Calvaruso, Giuseppina; Lai, Eliana; Colletta, Grazia; Quota, Alessandra; Gerardi, Calogera; Concetta Rigoli, Luciana; Pitrolo, Lorella; Cuccia, Liana; Gagliardotto, Francesco; Filosa, Aldo; Caruso, Vincenzo; Argento, Crocetta; Campisi, Saveria; Rizzo, Michele; Prossomariti, Luciano; Fidone, Carmelo; Fustaneo, Maria; Di Maggio, Rosario; Maggio, Aurelio

2017-01-01

In the last few decades, the life expectancy of regularly transfused β-thalassaemia major (TM) patients has dramatically improved following the introduction of safe transfusion practices, iron chelation therapy, aggressive treatment of infections and improved management of cardiac complications. How such changes, especially those attributed to the introduction of iron chelation therapy, improved the survival of TM patients to approach those with β-thalassaemia intermedia (TI) remains unknown. Three hundred and seventy-nine patients with TM (n = 284, dead 40) and TI (n = 95, dead 13) were followed retrospectively since birth until 30 June 2015 or death. Kaplan-Meir curves showed statistically significant differences in TM and TI survival (P < 0·0001) before the introduction of iron chelation in 1965, which were no longer apparent after that date (P = 0·086), reducing the Hazard Ratio of death in TM compared to TI from 6·8 [95% confidence interval (CI) 2·6-17·5] before 1965 to 2·8 (95% CI 0·8-9·2). These findings suggest that, in the era of iron chelation therapy and improved survival for TM, the major-intermedia dichotomy needs to be revisited alongside future directions in general management and prevention for both conditions. © 2016 John Wiley & Sons Ltd.

In vitro bond strength and fatigue stress test evaluation of different adhesive cements used for fixed space maintainer cementation

PubMed Central

Cantekin, Kenan; Delikan, Ebru; Cetin, Secil

2014-01-01

Objective: The purposes of this research were to (1) compare the shear-peel bond strength (SPBS) of a band of a fixed space maintainer (SM) cemented with five different adhesive cements; and (2) compare the survival time of bands of SM with each cement type after simulating mechanical fatigue stress. Materials and Methods: Seventy-five teeth were used to assess retentive strength and another 50 teeth were used to assess the fatigue survival time. SPBS was determined with a universal testing machine. Fatigue testing was conducted in a ball mill device. Results: The mean survival time of bands cemented with R & D series Nova Glass-LC (6.2 h), Transbond Plus (6.7 h), and R & D series Nova Resin (6.8 h) was significantly longer than for bands cemented with Ketac-Cem (5.4 h) and GC Equia (5.2 h) (P < 0.05). Conclusion: Although traditional glass ionomer cement (GIC) cement presented higher retentive strength than resin-based cements (resin, resin modified GIC, and compomer cement), resin based cements, especially dual cure resin cement (nova resin cement) and compomer (Transbond Plus), can be expected to have lower failure rates for band cementation than GIC (Ketac-Cem) in the light of the results of the ball mill test. PMID:25202209

Impact of hot events at different developmental stages of a moth: the closer to adult stage, the less reproductive output

PubMed Central

Zhang, Wei; Chang, Xiang-Qian; Hoffmann, AryA.; Zhang, Shu; Ma, Chun-Sen

2015-01-01

Hot days in summer (involving a few hours at particularly high temperatures) are expected to become more common under climate change. How such events at different life stages affect survival and reproduction remains unclear in most organisms. Here, we investigated how an exposure to 40 °C at different life stages in the global insect pest, Plutella xylostella, affects immediate survival, subsequent survival and reproductive output. First-instar larvae showed the lowest survival under heat stress, whereas 3rd-instar larvae were relatively heat resistant. Heat exposure at the 1st-instar or egg stage did not influence subsequent maturation success, while exposure at the 3rd-instar larval stage did have an effect. We found that heat stress at developmental stages closer to adult stage caused greater detrimental effects on reproduction than heat stress experienced at earlier life stages. The effects of hot events on insect populations can therefore depend critically on the timing of the event relative to an organism’s life-cycle. PMID:26000790

Primary nodal hemangiosarcoma in four dogs.

PubMed

Chan, Catherine M; Zwahlen, Courtney H; de Lorimier, Louis-Philippe; Yeomans, Stephen M; Hoffmann, Karon L; Moore, Antony S

2016-11-01

CASE DESCRIPTION 4 dogs with a slow-growing mass in the cervical region were evaluated. CLINICAL FINDINGS All dogs had no clinical signs at the time of the evaluation. There was no apparent evidence of visceral metastases or other primary tumor based on available CT or MRI data for any dog. TREATMENT AND OUTCOME For each dog, surgery to remove the mass was performed. Histologic examination of the excised tissue revealed a completely excised grade 1 or 2 lymph node hemangiosarcoma. All dogs received adjuvant chemotherapy; 2 dogs underwent curative intent chemotherapy, 1 dog underwent metronomic treatment with cyclophosphamide, and 1 dog underwent metronomic treatment with chlorambucil. The survival time was 259 days in 1 dog; 3 dogs were still alive 615, 399, and 365 days after surgery. CLINICAL RELEVANCE Primary nodal hemangiosarcoma in dogs is a rare and, to the authors' knowledge, previously undescribed disease that appears to develop in the cervical lymph nodes as a slow-growing mass or masses. Surgical excision and adjunct treatment resulted in long survival times for 3 of the 4 dogs of the present report. Given the aggressive biologic behavior of hemangiosarcomas in other body locations, adjunct chemotherapy should be considered for affected dogs, although its role in the cases described in this report was unclear. Additional clinical information is required to further characterize the biologic behavior of this tumor type and determine the expected survival times and associated risk factors in dogs.

Why do some diabetic patients on the kidney transplant waiting list not receive a transplant?

PubMed

Kyllönen, Lauri; Salmela, Kaija

2004-10-01

The waiting list (WL) history of 405 diabetic patients placed on the kidney transplantation WL for the years 1993-2000 was examined. By 31 December 2000, 295 (73 %) patients had received a transplant. Of the remaining 110 patients 53 (13 %) were still on the WL; 27 of these were temporarily withdrawn, i.e. non-active, 46 others (11 %) had died and 11 (3 %) had been permanently removed. Patient follow-up continued until the end of 2002. Although the mean total time on the WL of the non-transplanted was twice that of the transplanted patients there were no significant differences in the mean active times on the WL. The mean cumulative withdrawal time of the transplanted and those on the active WL was less than 10 % of their total time on the list, but for the patients who had died or were withdrawn on 31 December 2000 it exceeded 50 %, usually because of diabetic complications. The 5-year survival of the transplanted patients was greatly superior to that of the non-transplanted, as expected. However, the better survival of the transplanted patients is not necessarily proof of a better treatment modality but rather a consequence of the exclusion from transplantation of patients suffering from diabetic complications. It is not justified to compare the survival of transplantable and non-transplantable WL patients.

A risk-adjusted O-E CUSUM with monitoring bands for monitoring medical outcomes.

PubMed

Sun, Rena Jie; Kalbfleisch, John D

2013-03-01

In order to monitor a medical center's survival outcomes using simple plots, we introduce a risk-adjusted Observed-Expected (O-E) Cumulative SUM (CUSUM) along with monitoring bands as decision criterion.The proposed monitoring bands can be used in place of a more traditional but complicated V-shaped mask or the simultaneous use of two one-sided CUSUMs. The resulting plot is designed to simultaneously monitor for failure time outcomes that are "worse than expected" or "better than expected." The slopes of the O-E CUSUM provide direct estimates of the relative risk (as compared to a standard or expected failure rate) for the data being monitored. Appropriate rejection regions are obtained by controlling the false alarm rate (type I error) over a period of given length. Simulation studies are conducted to illustrate the performance of the proposed method. A case study is carried out for 58 liver transplant centers. The use of CUSUM methods for quality improvement is stressed. Copyright © 2013, The International Biometric Society.

Cost Effectiveness of Ofatumumab Plus Chlorambucil in First-Line Chronic Lymphocytic Leukaemia in Canada.

PubMed

Herring, William; Pearson, Isobel; Purser, Molly; Nakhaipour, Hamid Reza; Haiderali, Amin; Wolowacz, Sorrel; Jayasundara, Kavisha

2016-01-01

Our objective was to estimate the cost effectiveness of ofatumumab plus chlorambucil (OChl) versus chlorambucil in patients with chronic lymphocytic leukaemia for whom fludarabine-based therapies are considered inappropriate from the perspective of the publicly funded healthcare system in Canada. A semi-Markov model (3-month cycle length) used survival curves to govern progression-free survival (PFS) and overall survival (OS). Efficacy and safety data and health-state utility values were estimated from the COMPLEMENT-1 trial. Post-progression treatment patterns were based on clinical guidelines, Canadian treatment practices and published literature. Total and incremental expected lifetime costs (in Canadian dollars [$Can], year 2013 values), life-years and quality-adjusted life-years (QALYs) were computed. Uncertainty was assessed via deterministic and probabilistic sensitivity analyses. The discounted lifetime health and economic outcomes estimated by the model showed that, compared with chlorambucil, first-line treatment with OChl led to an increase in QALYs (0.41) and total costs ($Can27,866) and to an incremental cost-effectiveness ratio (ICER) of $Can68,647 per QALY gained. In deterministic sensitivity analyses, the ICER was most sensitive to the modelling time horizon and to the extrapolation of OS treatment effects beyond the trial duration. In probabilistic sensitivity analysis, the probability of cost effectiveness at a willingness-to-pay threshold of $Can100,000 per QALY gained was 59 %. Base-case results indicated that improved overall response and PFS for OChl compared with chlorambucil translated to improved quality-adjusted life expectancy. Sensitivity analysis suggested that OChl is likely to be cost effective subject to uncertainty associated with the presence of any long-term OS benefit and the model time horizon.

Differential survival among sSOD-1* genotypes in Chinook Salmon

USGS Publications Warehouse

Hayes, Michael C.; Reisenbichler, Reginald R.; Rubin, Stephen P.; Wetzel, Lisa A.; Marshall , Anne R.

2011-01-01

Differential survival and growth were tested in Chinook salmon Oncorhynchus tshawytscha expressing two common alleles, *–100 and *–260, at the superoxide dismutase locus (sSOD-1*). These tests were necessary to support separate studies in which the two alleles were used as genetic marks under the assumption of mark neutrality. Heterozygous adults were used to produce progeny with –100/–100, –100/–260, and –260/–260 genotypes that were reared in two natural streams and two hatcheries in the states of Washington and Oregon. The latter also were evaluated as returning adults. In general, the genotype ratios of juveniles reared at hatcheries were consistent with high survival and little or no differential survival in the hatchery. Adult returns at one hatchery were significantly different from the expected proportions, and the survival of the –260/–260 genotype was 0.56–0.89 times that of the –100/–100 genotype over four year-classes. Adult returns at a second hatchery (one year-class) were similar but not statistically significant: survival of the –260/–260genotype relative to the –100/–100 genotype was 0.76. The performance of the heterozygote group was intermediate at both hatcheries. Significant differences in growth were rarely observed among hatchery fish (one year-class of juveniles and one age-class of adult males) but were consistent with greater performance for the –100/–100 genotype. Results from two groups of juveniles reared in streams (one year-class from each stream) suggested few differences in growth, but the observed genotype ratios were significantly different from the expected ratios in one stream. Those differences were consistent with the adult data; survival for the –260/–260 genotype was 76% of that of the –100/–100 genotype. These results, which indicate nonneutrality among sSOD-1* genotypes, caused us to modify our related studies and suggest caution in the interpretation of results and analyses in which allozyme marks are assumed to be neutral.

The message of the survival curves: I. Composite analysis of long-term treatment studies in bipolar disorder.

PubMed

Frecska, Ede; Kovacs, Attila Istvan; Balla, Petra; Falussy, Linda; Ferencz, Akos; Varga, Zsofia

2012-09-01

There is a shortage of studies analyzing the time course of recurrent episodes and comparing effectiveness of long-term treatments in bipolar disorder. 'Number needed to treat' (NNT) analyses have been proven to be useful for clinically meaningful comparisons, but results vary considerably among studies. The survival curves of different trials also show a great variability preventing reliable conclusions on the time course of maintenance therapies. The variance of survival analyses on long-term medication management can be reduced with increasing the statistical power by combining the life-tables of individual studies. In this study the survival tables of 28 studies on maintenance treatment of bipolar disorder were reconstructed from the published diagrams, and the numbers of relapsed patients in the original studies were estimated for plotting composite survival curves of an inactive, mono- and combination therapy arm. The review was finally based on 5231 subjects. The resulting composite diagrams indicate that within the first year 48% of patients on monotherapy, and 35% on combination therapy experienced recurrence of any affective episode ('early relapsers'). The rest of the patient population was affected by recurrences in a smaller rate over a more extended period of time ('late relapsers'). For a favorable outcome at 40 months of episode prevention in bipolar disorder the NNT was 6 for mono- and 3 for combination therapy. Log-rank analyses of the composite data supported the effectiveness of both medication protocols over placebo, and the superiority of drug combination over monotherapy; though there were some indications of decreased efficacy in the two treatment arms after extended maintenance. Composite analysis offers increased statistical power for studying the time course of survival data. Mood episodes in bipolar disorder are likely to recur early on and relapses in "real-life" can be more frequent than the rates published here. Our results favor combination therapy for the long-term management of bipolar disorder. Concerns are expressed that NNT analyses have significant limitations when applied to recurring events with cumulative deterioration instead of cases where cumulative improvement is expected over time.

Liver recurrence in endometrial cancer: a multi-institutional analysis of factors predictive of postrecurrence survival.

PubMed

Toptas, Tayfun; Karalok, Alper; Ureyen, Isin; Tasci, Tolga; Erol, Onur; Bozkurt, Selen; Tulunay, Gokhan; Simsek, Tayup; Turan, Taner

2016-10-01

Predictive factors for survival following liver metastasis in endometrial cancer (EC) have not been studied to date. It is expected that patients who initially presented with liver metastasis or developed liver metastasis as the subsequent metastatic site of progressive disease are likely to have poor outcomes. However, patients developing liver metastasis as the first site of recurrence may have a chance of benefiting from the salvage therapies. Therefore, we aimed to determine factors influencing postrecurrence survival in EC patients who developed liver metastasis as the first site of recurrence. Patients with EC who underwent primary surgery at three centers between 1993 and 2013 were reviewed. Liver recurrence was defined as documentation of parenchymal liver metastasis either by radiologically or biopsy, after a disease-free interval of ≥3 months. Patients with liver metastasis at presentation, or liver metastasis as the subsequent metastatic site of progressive disease were excluded. Forty-six patients were identified. Median time to liver recurrence was 12 months, with 91.3 % of recurrences detected within 3 years. Most patients (73.9 %) had liver recurrence concomitant with extra-hepatic disease. Median survival after the diagnosis of liver recurrence was 9 months. While in univariate analysis, time to liver recurrence (p < 0.001) and presence of concomitant extra-hepatic metastasis (p = 0.048) were potential predictors of survival, multivariate analysis revealed that time to liver recurrence (p < 0.001) was the only independent predictor. This criterion may be used as a marker for stratifying patients into different prognostic risk groups and for selection of patients for salvage therapies.

Death certificate only proportions should be age adjusted in studies comparing cancer survival across populations and over time.

PubMed

Brenner, Hermann; Castro, Felipe A; Eberle, Andrea; Emrich, Katharina; Holleczek, Bernd; Katalinic, Alexander; Jansen, Lina

2016-01-01

The proportion of cases notified by death certificate only (DCO) is a commonly used data quality indicator in studies comparing cancer survival across regions and over time. We aimed to assess dependence of DCO proportions on the age structure of cancer patients. Using data from a national cancer survival study in Germany, we determined age specific and overall (crude) DCO proportions for 24 common forms of cancer. We then derived overall (crude) DCO proportions expected in case of shifts of the age distribution of the cancer populations by 5 and 10 years, respectively, assuming age specific DCO proportions to remain constant. Median DCO proportions across the 24 cancers were 2.4, 3.7, 5.5, 8.5 and 23.9% in age groups 15-44, 45-54, 55-64, 65-74, and 75+, respectively. A decrease of ages by 5 and 10 years resulted in decreases of cancer specific crude DCO proportions ranging from 0.4 to 4.8 and from 0.7 to 8.6 percent units, respectively. Conversely, an increase of ages by 5 and 10 years led to increases of cancer specific crude DCO proportions ranging from 0.8 to 4.8 and from 1.8 to 9.6 percent units, respectively. These changes were of similar magnitude (but in opposite direction) as changes in crude 5-year relative survival resulting from the same shifts in age distribution. The age structure of cancer patient populations has a substantial impact on DCO proportions. DCO proportions should therefore be age adjusted in comparative studies on cancer survival across regions and over time. Copyright © 2015 Elsevier Ltd. All rights reserved.

Heart Rate, Life Expectancy and the Cardiovascular System: Therapeutic Considerations.

PubMed

Boudoulas, Konstantinos Dean; Borer, Jeffrey S; Boudoulas, Harisios

2015-01-01

It has long been known that life span is inversely related to resting heart rate in most organisms. This association between heart rate and survival has been attributed to the metabolic rate, which is greater in smaller animals and is directly associated with heart rate. Studies have shown that heart rate is related to survival in apparently healthy individuals and in patients with different underlying cardiovascular diseases. A decrease in heart rate due to therapeutic interventions may result in an increase in survival. However, there are many factors regulating heart rate, and it is quite plausible that these may independently affect life expectancy. Nonetheless, a fast heart rate itself affects the cardiovascular system in multiple ways (it increases ventricular work, myocardial oxygen consumption, endothelial stress, aortic/arterial stiffness, decreases myocardial oxygen supply, other) which, in turn, may affect survival. In this brief review, the effects of heart rate on the heart, arterial system and survival will be discussed. © 2015 S. Karger AG, Basel.

Life expectancy living with HIV: recent estimates and future implications.

PubMed

Nakagawa, Fumiyo; May, Margaret; Phillips, Andrew

2013-02-01

The life expectancy of people living with HIV has dramatically increased since effective antiretroviral therapy has been available, and still continues to improve. Here, we review the latest literature on estimates of life expectancy and consider the implications for future research. With timely diagnosis, access to a variety of current drugs and good lifelong adherence, people with recently acquired infections can expect to have a life expectancy which is nearly the same as that of HIV-negative individuals. Modelling studies suggest that life expectancy could improve further if there were increased uptake of HIV testing, better antiretroviral regimens and treatment strategies, and the adoption of healthier lifestyles by those living with HIV. In particular, earlier diagnosis is one of the most important factors associated with better life expectancy. A consequence of improved survival is the increasing number of people with HIV who are aged over 50 years old, and further research into the impact of ageing on HIV-positive people will therefore become crucial. The development of age-specific HIV treatment and management guidelines is now called for. Analyses on cohort studies and mathematical modelling studies have been used to estimate life expectancy of those with HIV, providing useful insights of importance to individuals and healthcare planning.

Factors Associated with Life Expectancy in Patients with Metastatic Spine Disease from Adenocarcinoma of the Lung

PubMed Central

Goodwin, C. Rory; Khattab, Mohamed H.; Sankey, Eric W.; Elder, Benjamin D.; Kosztowski, Thomas A.; Sarabia-Estrada, Rachel; Bydon, Ali; Witham, Timothy F.; Wolinsky, Jean-Paul; Gokaslan, Ziya L.; Sciubba, Daniel M.

2015-01-01

Study Design Retrospective study. Objective Our objective was to identify preoperative prognostic factors associated with survival in patients with spinal metastasis from lung carcinoma. Methods A retrospective analysis of 26 patients diagnosed with lung carcinoma metastatic to the spinal column was performed to determine factors associated with survival. We used 3 months survival as the clinical cutoff for whether surgical intervention should be performed. We analyzed patients who survived less than 3 months compared with those who survived more than 3 months. Demographic, preoperative, operative, and postoperative factors including functional scores were collected for analysis. Results The median survival for all patients in our study was 3.5 months. We found a statistically significant difference between the group that survived less than 3 months and the group that survived greater than 3 months in terms of extrathoracic metastasis, visceral metastasis, and average postoperative modified Rankin score. Conclusion Determining which patients with lung cancer spinal metastases will benefit from surgical intervention is often dictated by the patient's predicted life expectancy. Factors associated with poorer prognosis include age, functional status, visceral metastases, and extrathoracic metastases. Although the prognosis for patients with lung cancer spinal metastases is poor, some patients may experience long-term benefit from surgical intervention. PMID:26430597

Long-term adverse outcomes in survivors of childhood bone sarcoma: the British Childhood Cancer Survivor Study

PubMed Central

Fidler, M M; Frobisher, C; Guha, J; Wong, K; Kelly, J; Winter, D L; Sugden, E; Duncan, R; Whelan, J; Reulen, R C; Hawkins, M M

2015-01-01

Background: With improved survival, more bone sarcoma survivors are approaching middle age making it crucial to investigate the late effects of their cancer and its treatment. We investigated the long-term risks of adverse outcomes among 5-year bone sarcoma survivors within the British Childhood Cancer Survivor Study. Methods: Cause-specific mortality and risk of subsequent primary neoplasms (SPNs) were investigated for 664 bone sarcoma survivors. Use of health services, health and marital status, alcohol and smoking habits, and educational qualifications were investigated for survivors who completed a questionnaire. Results: Survivors were seven times more likely to experience all-cause mortality than expected, and there were substantial differences in risk depending on tumour type. Beyond 25 years follow-up the risk of dying from all-causes was comparable to the general population. This is in contrast to dying before 25 years where the risk was 12.7-fold that expected. Survivors were also four times more likely to develop a SPN than expected, where the excess was restricted to 5–24 years post diagnosis. Increased health-care usage and poor health status were also found. Nonetheless, for some psychosocial outcomes survivors were better off than expected. Conclusions: Up to 25 years after 5-year survival, bone sarcoma survivors are at substantial risk of death and SPNs, but this is greatly reduced thereafter. As 95% of all excess deaths before 25 years follow-up were due to recurrences and SPNs, increased monitoring of survivors could prevent mortality. Furthermore, bone and breast SPNs should be a particular concern. Since there are variations in the magnitude of excess risk depending on the specific adverse outcome under investigation and whether the survivors were initially diagnosed with osteosarcoma or Ewing sarcoma, risks need to be assessed in relation to these factors. These findings should provide useful evidence for risk stratification and updating clinical follow-up guidelines. PMID:25989269

Mortality in incident dementia - results from the German Study on Aging, Cognition, and Dementia in Primary Care Patients.

PubMed

Roehr, S; Luck, T; Bickel, H; Brettschneider, C; Ernst, A; Fuchs, A; Heser, K; König, H-H; Jessen, F; Lange, C; Mösch, E; Pentzek, M; Steinmann, S; Weyerer, S; Werle, J; Wiese, B; Scherer, M; Maier, W; Riedel-Heller, S G

2015-10-01

Dementia is known to increase mortality, but the relative loss of life years and contributing factors are not well established. Thus, we aimed to investigate mortality in incident dementia from disease onset. Data were derived from the prospective longitudinal German AgeCoDe study. We used proportional hazards models to assess the impact of sociodemographic and health characteristics on mortality after dementia onset, Kaplan-Meier method for median survival times. Of 3214 subjects at risk, 523 (16.3%) developed incident dementia during a 9-year follow-up period. Median survival time after onset was 3.2 years (95% CI = 2.8-3.7) at a mean age of 85.0 (SD = 4.0) years (≥2.6 life years lost compared with the general German population). Survival was shorter in older age, males other dementias than Alzheimer's, and in the absence of subjective memory complaints (SMC). Our findings emphasize that dementia substantially shortens life expectancy. Future studies should further investigate the potential impact of SMC on mortality in dementia. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Physician Expectations of Treatment Outcomes for Patients With Brain Metastases Referred for Whole Brain Radiotherapy

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

Barnes, Elizabeth A., E-mail: toni.barnes@sunnybrook.c; Chow, Edward; Tsao, May N.

2010-01-15

Purpose: Patients with advanced cancer are referred to our Rapid Response Radiotherapy Program for quick access to palliative radiotherapy. The primary objective of this prospective study was to determine the physician expectations of the treatment outcomes for patients with brain metastases referred for whole brain radiotherapy (WBRT). The secondary objectives were to determine the factors influencing the expectations and to examine the accuracy of the physician-estimated patient survival. Methods and Materials: Patients were identified during a 17-month period. The referring physicians were sent a survey by facsimile to be completed and returned before the patient consultation. Information was sought onmore » the patient's disease status, the physician's expectations of WBRT, the estimated patient survival and performance status, and physician demographic data. Results: A total of 137 surveys were sent out, and the overall response rate was 57.7%. The median patient age was 66 years (range, 35-87), 78.5% had multiple brain metastases, 42.3% had a controlled primary tumor, and 62.3% had extracranial disease. WBRT was thought to stabilize neurologic symptoms, improve quality of life, and allow for a Decadron (dexamethasone) taper by >=94.9% of the referring physicians; 87.0% thought WBRT would improve performance status; 77.9% thought it would improve neurologic symptoms; and 40.8% thought it would improve survival. The referring physicians estimated patient survival as a median of 6.0 months; however, the actual survival was a median of 2.5 months, for a median individual difference of 1.9 months (p < .0001). Conclusion: Physicians referring patients with brain metastases for consideration of WBRT are often overly optimistic when estimating the clinical benefit of the treatment and overestimate patient survival. These findings highlight the need for education and additional research in this field.« less

Validation of the Social Security Administration Life Tables (2004-2014) in Localized Prostate Cancer Patients within the Surveillance, Epidemiology, and End Results database.

PubMed

Preisser, Felix; Bandini, Marco; Mazzone, Elio; Nazzani, Sebastiano; Marchioni, Michele; Tian, Zhe; Saad, Fred; Pompe, Raisa S; Shariat, Shahrokh F; Heinzer, Hans; Montorsi, Francesco; Huland, Hartwig; Graefen, Markus; Tilki, Derya; Karakiewicz, Pierre I

2018-05-22

Accurate life expectancy estimation is crucial in clinical decision-making including management and treatment of clinically localized prostate cancer (PCa). We hypothesized that Social Security Administration (SSA) life tables' derived survival estimates closely follow observed survival of PCa patients. To test this relationship, we examined 10-yr overall survival rates in patients with clinically localized PCa and compared it with survival estimates derived from the SSA life tables. Within the Surveillance, Epidemiology, and End Results database (2004), we identified patients aged >50-<90yr. Follow-up was at least 10 yr for patients who did not die of disease or other causes. Monte Carlo method was used to define individual survival in years, according to the SSA life tables (2004-2014). Subsequently, SSA life tables' predicted survival was compared with observed survival rates in Kaplan-Meier analyses. Subgroup analyses were stratified according to treatment type and D'Amico risk classification. Overall, 39191 patients with localized PCa were identified. At 10-yr follow-up, the SSA life tables' predicted survival was 69.5% versus 73.1% according to the observed rate (p<0.0001). The largest differences between estimated versus observed survival rates were recorded for D'Amico low-risk PCa (8.0%), brachytherapy (9.1%), and radical prostatectomy (8.6%) patients. Conversely, the smallest differences were recorded for external beam radiotherapy (1.7%) and unknown treatment type (1.6%) patients. Overall, SSA life tables' predicted life expectancy closely approximate observed overall survival rates. However, SSA life tables' predicted rates underestimate by as much as 9.1% the survival in brachytherapy patients, as well as in D'Amico low-risk and radical prostatectomy patients. In these patient categories, an adjustment for the degree of underestimation might be required when counseling is provided in clinical practice. Social Security Administration (SSA) life tables' predicted life expectancy closely approximate observed overall survival rates. However, SSA life tables' predicted rates underestimate by as much as 9.1% the survival in brachytherapy patients, as well as in D'Amico low-risk and radical prostatectomy patients. Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Modelling postfledging survival and age- specific breeding probabilities in species with delayed maturity: A case study of Roseate Terns at Falkner Island, Connecticut

USGS Publications Warehouse

Spendelow, J.A.; Nichols, J.D.; Hines, J.E.; Lebreton, J.D.; Pradel, R.

2002-01-01

We modelled postfledging survival and age-specific breeding probabilities in endangered Roseate Terns (Sterna dougallii) at Falkner Island, Connecticut, USA using capture-recapture data from 1988-1998 of birds ringed as chicks and as adults. While no individuals bred as 2-year-olds during this period, about three-quarters of the young that survived and returned as 3-year-olds nested, and virtually all surviving birds had begun breeding by the time they reached 5 years of age. We found no evidence of temporal variation age of first breeding of birds from different cohorts. There was significant temporal variation in the annual survival of adults and the survival over the typical 3-year maturation period of prebreeding birds, with extremely low values for both groups from the 1991 breeding season. The estimated overwinter survival rate (0.62) for adults from 1991-1992 was about three-quarters the usual rate of about 0.83, but the low survival of fledglings from 1991 resulted in less than 25% of the otherwise expected number of young from that cohort returning as breeding birds; this suggests that fledglings suffered a greater proportional decrease in survival than did adults. The survival estimates of young from 1989 and 1990 show that these cohorts were not negatively influenced by the events that decimated the young from 1991, and the young from 1992 and 1993 had above-average survival estimates. The apparent decrease since 1996 in development of fidelity of new recruits to this site is suspected to be due mainly to nocturnal disturbance and predation of chicks causing low productivity.

Modelling postfledging survival and age-specific breeding probabilities in species with delayed maturity: a case study of Roseate Terns at Falkner Island, Connecticut

USGS Publications Warehouse

Spendelow, J.A.; Nichols, J.D.; Hines, J.E.; Lebreton, J.D.; Pradel, R.

2002-01-01

We modeled postfledging survival and age-specific breeding probabilities in endangered Roseate Terns (Sterna dougallii) at Falkner Island, Connecticut, USA using capture-recapture data from 1988-1998 of birds ringed as chicks and as adults. While no individuals bred as 2-yr-olds during this period, about three-quarters of the young that survived and returned as 3-yr-olds nested, and virtually all surviving birds had begun breeding by the time they reached 5 years of age. We found no evidence of temporal variation in age of first breeding of birds from different cohorts. There was significant temporal variation in the annual survival of adults and the survival over the typical 3-yr maturation period of prebreeding birds, with extremely low values for both groups from the 1991 breeding season. The estimated overwinter survival rate (0.62) for adults from 1991-1992 was about three-quarters the usual rate of about 0.83, but the low survival of fledglings from 1991 resulted in less than 25% of the otherwise expected number of young from that cohort returning as breeding birds; this suggests that fledglings suffered a greater proportional decrease in survival than did adults. The survival estimates of young from 1989 and 1990 show that these cohorts were not negatively influenced by the events that decimated the young from 1991, and the young from 1992 and 1993 had above-average survival estimates. The apparent decrease since 1996 in development of fidelity of new recruits to this site is suspected due mainly to nocturnal disturbance and predation of chicks causing low productivity.

Mechanisms of plant survival and mortality during drought: Why do some plants survive while others succumb to drought?

Treesearch

Nate McDowell; William T. Pockman; Craig D. Allen; David D. Breshears; Neil Cobb; Thomas Kolb; Jennifer Plaut; John Sperry; Adam West; David G. Williams; Enrico A. Yepez

2008-01-01

Severe droughts have been associated with regional-scale forest mortality worldwide. Climate change is expected to exacerbate regional mortality events; however, prediction remains difficult because the physiological mechanisms underlying drought survival and mortality are poorly understood. We developed a hydraulically based theory considering carbon balance and...

Educational attainment and differences in relative survival after acute myocardial infarction in Norway: a registry-based population study.

PubMed

Klitkou, Søren Toksvig; Wangen, Knut R

2017-08-28

Although there is a broad societal interest in socioeconomic differences in survival after an acute myocardial infarction, only a few studies have investigated how such differences relate to the survival in general population groups. We aimed to investigate education-specific survival after acute myocardial infarction and to compare this with the survival of corresponding groups in the general population. Our study included the entire population of Norwegian patients admitted to hospitals for acute myocardial infarction during 2008-2010, with a 6- year follow-up period. Patient survival was measured relative to the expected survival in the general population for three educational groups: primary, secondary and tertiary. Education, sex, age and calendar year-specific expected survival were obtained from population life tables and adjusted for the presence of infarction-related mortality. Six-year patient survivals were 56.3% (55.3-57.2) and 65.5% (65.6-69.3) for the primary and tertiary educational groups (95% CIs), respectively. Also 6-year relative survival was markedly lower for the primary educational group: 70.2% (68.6-71.8) versus 81.2% (77.4-84.4). Throughout the follow-up period, patient survival tended to remain lower than the survival in the general population with the same educational background. Both patient survival and relative survival after acute myocardial infarction are positively associated with educational level. Our findings may suggest that secondary prevention has been more effective for the highly educated. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Defining the Role of Alpha-Synuclein in Enteric Dysfunction in Parkinsons Disease

DTIC Science & Technology

2017-10-01

direction. o What were the major goals of the project?  Animal use approvals – accomplished pre-funding  Vector production - 1st round of vector...August 2017. 100% Complete  Vector injections. We injected all animals for the long-term survival group as well as additional subjects for shorter...time points. However, as noted below, the transgene expression seen in these animals was below that which was expected/intended. Thus, we are currently

Qualification of Fiber Optic Cables for Martian Extreme Temperature Environments

NASA Technical Reports Server (NTRS)

Ramesham, Rajeshuni; Lindensmith, Christian A.; Roberts, William T.; Rainen, Richard A.

2011-01-01

Means have been developed for enabling fiber optic cables of the Laser Induced Breakdown Spectrometer instrument to survive ground operations plus the nominal 670 Martian conditions that include Martian summer and winter seasons. The purpose of this development was to validate the use of the rover external fiber optic cabling of ChemCam for space applications under the extreme thermal environments to be encountered during the Mars Science Laboratory (MSL) mission. Flight-representative fiber optic cables were subjected to extreme temperature thermal cycling of the same diurnal depth (or delta T) as expected in flight, but for three times the expected number of in-flight thermal cycles. The survivability of fiber optic cables was tested for 600 cumulative thermal cycles from -130 to +15 C to cover the winter season, and another 1,410 cumulative cycles from -105 to +40 C to cover the summer season. This test satisfies the required 3 times the design margin that is a total of 2,010 thermal cycles (670 x 3). This development test included functional optical transmission tests during the course of the test. Transmission of the fiber optic cables was performed prior to and after 1,288 thermal cycles and 2,010 thermal cycles. No significant changes in transmission were observed on either of the two representative fiber cables subject through the 3X MSL mission life that is 2,010 thermal cycles.

Network survivability performance (computer diskette)

NASA Astrophysics Data System (ADS)

1993-11-01

File characteristics: Data file; 1 file. Physical description: 1 computer diskette; 3 1/2 in.; high density; 2.0MB. System requirements: Mac; Word. This technical report has been developed to address the survivability of telecommunications networks including services. It responds to the need for a common understanding of, and assessment techniques for network survivability, availability, integrity, and reliability. It provides a basis for designing and operating telecommunication networks to user expectations for network survivability.

Improved Survival After the Ross Procedure Compared With Mechanical Aortic Valve Replacement.

PubMed

Buratto, Edward; Shi, William Y; Wynne, Rochelle; Poh, Chin L; Larobina, Marco; O'Keefe, Michael; Goldblatt, John; Tatoulis, James; Skillington, Peter D

2018-03-27

It is unclear whether the Ross procedure offers superior survival compared with mechanical aortic valve replacement (AVR). This study evaluated experience and compared long-term survival between the Ross procedure and mechanical AVR. Between 1992 and 2016, a total of 392 Ross procedures were performed. These were compared with 1,928 isolated mechanical AVRs performed during the same time period as identified using the University of Melbourne and Australia and New Zealand Society of Cardiac and Thoracic Surgeons' Cardiac Surgery Databases. Only patients between 18 and 65 years of age were included. Propensity-score matching was performed for risk adjustment. Ross procedure patients were younger, and had fewer cardiovascular risk factors. The Ross procedure was associated with longer cardiopulmonary bypass and aortic cross-clamp times. Thirty-day mortality was similar (Ross, 0.3%; mechanical, 0.8%; p = 0.5). Ross procedure patients experienced superior unadjusted long-term survival at 20 years (Ross, 95%; mechanical, 68%; p < 0.001). Multivariable analysis showed the Ross procedure to be associated with a reduced risk of late mortality (hazard ratio: 0.34; 95% confidence internal: 0.17 to 0.67; p < 0.001). Among 275 propensity-score matched pairs, Ross procedure patients had superior survival at 20 years (Ross, 94%; mechanical, 84%; p = 0.018). In this Australian, propensity-score matched study, the Ross procedure was associated with better long-term survival compared with mechanical AVR. In younger patients, with a long life expectancy, the Ross procedure should be considered in centers with sufficient expertise. Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.

White-Black Differences in Cancer Incidence, Stage at Diagnosis, and Survival among Adults Aged 85 Years and Older in the United States.

PubMed

Krok-Schoen, Jessica L; Fisher, James L; Baltic, Ryan D; Paskett, Electra D

2016-11-01

Increased life expectancy, growth of minority populations, and advances in cancer screening and treatment have resulted in an increasing number of older, racially diverse cancer survivors. Potential black/white disparities in cancer incidence, stage, and survival among the oldest old (≥85 years) were examined using data from the SEER Program of the National Cancer Institute. Differences in cancer incidence and stage at diagnosis were examined for cases diagnosed within the most recent 5-year period, and changes in these differences over time were examined for white and black cases aged ≥85 years. Five-year relative cancer survival rate was also examined by race. Among those aged ≥85 years, black men had higher colorectal, lung and bronchus, and prostate cancer incidence rates than white men, respectively. From 1973 to 2012, lung and bronchus and female breast cancer incidence increased, while colorectal and prostate cancer incidence decreased among this population. Blacks had higher rates of unstaged cancer compared with whites. The 5-year relative survival rate for all invasive cancers combined was higher for whites than blacks. Notably, whites had more than three times the relative survival rate of lung and bronchus cancer when diagnosed at localized (35.1% vs. 11.6%) and regional (12.2% vs. 3.2%) stages than blacks, respectively. White and black differences in cancer incidence, stage, and survival exist in the ≥85 population. Continued efforts are needed to reduce white and black differences in cancer prevention and treatment among the ≥85 population. Cancer Epidemiol Biomarkers Prev; 25(11); 1517-23. ©2016 AACR. ©2016 American Association for Cancer Research.

Survival Differences among Native-Born and Foreign-Born Older Adults in the United States

PubMed Central

Dupre, Matthew E.; Gu, Danan; Vaupel, James W.

2012-01-01

Background Studies show that the U.S. foreign-born population has lower mortality than the native-born population before age 65. Until recently, the lack of data prohibited reliable comparisons of U.S. mortality by nativity at older ages. This study provides reliable estimates of U.S. foreign-born and native-born mortality at ages 65 and older at the end of the 20th century. Life expectancies of the U.S. foreign born are compared to other developed nations and the foreign-born contribution to total life expectancy (TLE) in the United States is assessed. Methods Newly available data from Medicare Part B records linked with Social Security Administration files are used to estimate period life tables for nearly all U.S. adults aged 65 and older in 1995. Age-specific survival differences and life expectancies are examined in 1995 by sex, race, and place of birth. Results Foreign-born men and women had lower mortality at almost every age from 65 to 100 compared to native-born men and women. Survival differences by nativity were substantially greater for blacks than whites. Foreign-born blacks had the longest life expectancy of all population groups (18.73 [95% confidence interval {CI}, 18.15–19.30] years at age 65 for men and 22.76 [95% CI, 22.28–23.23] years at age 65 for women). The foreign-born population increased TLE in the United States at older ages, and by international comparison, the U.S. foreign born were among the longest-lived persons in the world. Conclusion Survival estimates based on reliable Medicare data confirm that foreign-born adults have longer life expectancy at older ages than native-born adults in the United States. PMID:22615929

Time-specific patterns of nest survival for ducks and passerines breeding in North Dakota

USGS Publications Warehouse

Shaffer, Terry L.; Grant, Todd A.

2012-01-01

In many bird species, survival can vary with the age of the nest, with the date a nest was initiated, or among years within the same nesting area. A literature review showed that patterns of survival vary in relation to nest age and date and are often contradictory. Inconsistencies could be a result of temporal variation in the environment or life-history differences among species. We examined patterns of nest survival in relation to nest age, date, and year for several duck and passerine species nesting at a single location in North Dakota during 1998–2003. We predicted that if environment shaped nest survival patterns, then temporal patterns in survival might be similar among three species of upland nesting ducks, and also among three species of grassland passerines nesting at the same site. We expected that survival patterns would differ between ducks and passerines because of relatively disparate life histories and differences in predators that prey on their nests. Nest survival was rarely constant among years, seasonally, or with age of the nest for species that we studied. As predicted, the pattern of survival was similar among duck species, driven mainly by differences in nest survival associated with nest initiation date. The pattern of survival also was similar among passerine species, but nest survival was more influenced by nest age than by date. Our findings suggest that some but not all variation in temporal patterns of nest survival in grassland birds reported in the literature can be explained on the basis of temporal environmental variation. Because patterns of survival were dissimilar among ducks and passerines, it is likely that mechanisms such as predation or brood parasitism have variable influences on productivity of ducks and passerines nesting in the same area. Our results indicate that biologists and managers should not assume that temporal environmental variations, especially factors that affect nest survival, act similarly on all grassland birds.

Effects of human recreation on the incubation behavior of American Oystercatchers

USGS Publications Warehouse

McGowan, C.P.; Simons, T.R.

2006-01-01

Human recreational disturbance and its effects on wildlife demographics and behavior is an increasingly important area of research. We monitored the nesting success of American Oystercatchers (Haematopus palliatus) in coastal North Carolina in 2002 and 2003. We also used video monitoring at nests to measure the response of incubating birds to human recreation. We counted the number of trips per hour made by adult birds to and from the nest, and we calculated the percent time that adults spent incubating. We asked whether human recreational activities (truck, all-terrain vehicle [ATV], and pedestrian traffic) were correlated with parental behavioral patterns. Eleven a priori models of nest survival and behavioral covariates were evaluated using Akaike's Information Criterion (AIC) to see whether incubation behavior influenced nest survival. Factors associated with birds leaving their nests (n = 548) included ATV traffic (25%), truck traffic (17%), pedestrian traffic (4%), aggression with neighboring oystercatchers or paired birds exchanging incubation duties (26%), airplane traffic (1%) and unknown factors (29%). ATV traffic was positively associated with the rate of trips to and away from the nest (??1 = 0.749, P < 0.001) and negatively correlated with percent time spent incubating (??1 = -0.037, P = 0.025). Other forms of human recreation apparently had little effect on incubation behaviors. Nest survival models incorporating the frequency of trips by adults to and from the nest, and the percentage of time adults spent incubating, were somewhat supported in the AIC analyses. A low frequency of trips to and from the nest and, counter to expectations, low percent time spent incubating were associated with higher daily nest survival rates. These data suggest that changes in incubation behavior might be one mechanism by which human recreation affects the reproductive success of American Oystercatchers.

Network survivability performance

NASA Astrophysics Data System (ADS)

1993-11-01

This technical report has been developed to address the survivability of telecommunications networks including services. It responds to the need for a common understanding of, and assessment techniques for network survivability, availability, integrity, and reliability. It provides a basis for designing and operating telecommunications networks to user expectations for network survivability and a foundation for continuing industry activities in the subject area. This report focuses on the survivability of both public and private networks and covers a wide range of users. Two frameworks are established for quantifying and categorizing service outages, and for classifying network survivability techniques and measures. The performance of the network survivability techniques is considered; however, recommended objectives are not established for network survivability performance.

[Clinical analysis of prenatal diagnosis and intervention for primary pleural effusion of 13 cases].

PubMed

Wang, X Q; Li, W J; Yan, R L; Xiang, J W; Liu, M Y

2018-02-25

Objective: To optimize the clinical managements of primary fetal hydrothorax (PFHT) fetus by comparing the perinatal survival rate of different prenatal treatments. Methods: Totally 13 fetuses diagnosed with PFHT from July 2009 to December 2015 in the First Affiliated Hospital of Jinan University were collected and received prenatal expectant treatment, thoracocentesis (TC), and thoraco-amniotic shunting (TAS), respectively. The perinatal survival rate was compared among the three treatments. Results: Among 13 fetuses of PFHT, pleural effusion was absorbed or remained stable in 2(2/13) cases, and progressed in 11(11/13) cases. Six cases received expectant treatment (2 cases had termination of pregnancy due to progressing effusion, 2 cases had term delivery, and 2 cases had intrauterine death); the perinatal survival rate was 2/6. Six cases received TC (2 cases had term delivery, 2 cases had preterm delivery, and 2 cases had termination of pregnancy due to progressing effusion), the perinatal survival rate was 4/6. One case received TC+TAS (term delivery), the perinatal survival rate was 1/1. The overall perinatal survival rate of prenatal intrauterine intervention was 5/7. Conclusions: The clinical process of PFHT is changeable, and the pleural effusion will progress with gestational age. Intrauterine interventions could improve the perinatal survival rate.

Survival After Accidental Extrahepatic Distribution of Y90 Microspheres to the Mesentery During a Radioembolization Procedure

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

Sabet, Amir; Ahmadzadehfar, Hojjat; Schaefer, Nico

2012-08-15

We present the acute management and outcome of a patient after an accidental mesenteric distribution of Y90 microspheres during radioembolization (RE). This report describes and highlights: (1) the incidence of a significant reflux during a RE session while injecting into a replaced right hepatic artery from the superior mesenteric artery, (2) the appearance of diffuse mesenteric Y90 distribution in bremsstrahlung-imaging, (3) the management protocol with the radiation protection agent amifostine, (4) the development of typical adverse effects in the expected time window, and (5) survival of the patient without long-term sequelae. This report should sensitize physicians to this particular problemmore » and may help to avoid as well as manage similar radioembolization incidences.« less

Solution of the Generalized Noah's Ark Problem.

PubMed

Billionnet, Alain

2013-01-01

The phylogenetic diversity (PD) of a set of species is a measure of the evolutionary distance among the species in the collection, based on a phylogenetic tree. Such a tree is composed of a root, internal nodes, and leaves that correspond to the set of taxa under study. With each edge of the tree is associated a non-negative branch length (evolutionary distance). If a particular survival probability is associated with each taxon, the PD measure becomes the expected PD measure. In the Noah's Ark Problem (NAP) introduced by Weitzman (1998), these survival probabilities can be increased at some cost. The problem is to determine how best to allocate a limited amount of resources to maximize the expected PD of the considered species. It is easy to formulate the NAP as a (difficult) nonlinear 0-1 programming problem. The aim of this article is to show that a general version of the NAP (GNAP) can be solved simply and efficiently with any set of edge weights and any set of survival probabilities by using standard mixed-integer linear programming software. The crucial point to move from a nonlinear program in binary variables to a mixed-integer linear program, is to approximate the logarithmic function by the lower envelope of a set of tangents to the curve. Solving the obtained mixed-integer linear program provides not only a near-optimal solution but also an upper bound on the value of the optimal solution. We also applied this approach to a generalization of the nature reserve problem (GNRP) that consists of selecting a set of regions to be conserved so that the expected PD of the set of species present in these regions is maximized. In this case, the survival probabilities of different taxa are not independent of each other. Computational results are presented to illustrate potentialities of the approach. Near-optimal solutions with hypothetical phylogenetic trees comprising about 4000 taxa are obtained in a few seconds or minutes of computing time for the GNAP, and in about 30 min for the GNRP. In all the cases the average guarantee varies from 0% to 1.20%.

Genetic analysis of longevity in Dutch dairy cattle using random regression.

PubMed

van Pelt, M L; Meuwissen, T H E; de Jong, G; Veerkamp, R F

2015-06-01

Longevity, productive life, or lifespan of dairy cattle is an important trait for dairy farmers, and it is defined as the time from first calving to the last test date for milk production. Methods for genetic evaluations need to account for censored data; that is, records from cows that are still alive. The aim of this study was to investigate whether these methods also need to take account of survival being genetically a different trait across the entire lifespan of a cow. The data set comprised 112,000 cows with a total of 3,964,449 observations for survival per month from first calving until 72 mo in productive life. A random regression model with second-order Legendre polynomials was fitted for the additive genetic effect. Alternative parameterizations were (1) different trait definitions for the length of time interval for survival after first calving (1, 3, 6, and 12 mo); (2) linear or threshold model; and (3) differing the order of the Legendre polynomial. The partial derivatives of a profit function were used to transform variance components on the survival scale to those for lifespan. Survival rates were higher in early life than later in life (99 vs. 95%). When survival was defined over 12-mo intervals survival curves were smooth compared with curves when 1-, 3-, or 6-mo intervals were used. Heritabilities in each interval were very low and ranged from 0.002 to 0.031, but the heritability for lifespan over the entire period of 72 mo after first calving ranged from 0.115 to 0.149. Genetic correlations between time intervals ranged from 0.25 to 1.00. Genetic parameters and breeding values for the genetic effect were more sensitive to the trait definition than to whether a linear or threshold model was used or to the order of Legendre polynomial used. Cumulative survival up to the first 6 mo predicted lifespan with an accuracy of only 0.79 to 0.85; that is, reliability of breeding value with many daughters in the first 6 mo can be, at most, 0.62 to 0.72, and changes of breeding values are still expected when daughters are getting older. Therefore, an improved model for genetic evaluation should treat survival as different traits during the lifespan by splitting lifespan in time intervals of 6 mo or less to avoid overestimated reliabilities and changes in breeding values when daughters are getting older. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Effects of the amphibian chytrid fungus and four insecticides on Pacific treefrogs (Pseudacris regilla)

USGS Publications Warehouse

Kleinhez, Peter; Boone, Michelle D.; Fellers, Gary

2012-01-01

Chemical contamination may influence host-pathogen interactions, which has implications for amphibian population declines. We examined the effects of four insecticides alone or as a mixture on development and metamorphosis of Pacific Treefrogs (Pseudacris regilla) in the presence or absence of the amphibian chytrid fungus (Batrachochytrium dendrobatidis [Bd]). Bd exposure had a negative impact on tadpole activity, survival to metamorphosis, time to metamorphosis, and time of tail absorption (with a marginally negative effect on mass at metamorphosis); however, no individuals tested positive for Bd at metamorphosis. The presence of sublethal concentrations of insecticides alone or in a mixture did not impact Pacific Treefrog activity as tadpoles, survival to metamorphosis, or time and size to metamorphosis. Insecticide exposure did not influence the effect of Bd exposure. Our study did not support our prediction that effects of Bd would be greater in the presence of expected environmental concentrations of insecticide(s), but it did show that Bd had negative effects on responses at metamorphosis that could reduce the quality of juveniles recruited into the population.

A flexible cure rate model with dependent censoring and a known cure threshold.

PubMed

Bernhardt, Paul W

2016-11-10

We propose a flexible cure rate model that accommodates different censoring distributions for the cured and uncured groups and also allows for some individuals to be observed as cured when their survival time exceeds a known threshold. We model the survival times for the uncured group using an accelerated failure time model with errors distributed according to the seminonparametric distribution, potentially truncated at a known threshold. We suggest a straightforward extension of the usual expectation-maximization algorithm approach for obtaining estimates in cure rate models to accommodate the cure threshold and dependent censoring. We additionally suggest a likelihood ratio test for testing for the presence of dependent censoring in the proposed cure rate model. We show through numerical studies that our model has desirable properties and leads to approximately unbiased parameter estimates in a variety of scenarios. To demonstrate how our method performs in practice, we analyze data from a bone marrow transplantation study and a liver transplant study. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Treatment and survival among 1594 patients with ATL.

PubMed

Katsuya, Hiroo; Ishitsuka, Kenji; Utsunomiya, Atae; Hanada, Shuichi; Eto, Tetsuya; Moriuchi, Yukiyoshi; Saburi, Yoshio; Miyahara, Masaharu; Sueoka, Eisaburo; Uike, Naokuni; Yoshida, Shinichiro; Yamashita, Kiyoshi; Tsukasaki, Kunihiro; Suzushima, Hitoshi; Ohno, Yuju; Matsuoka, Hitoshi; Jo, Tatsuro; Amano, Masahiro; Hino, Ryosuke; Shimokawa, Mototsugu; Kawai, Kazuhiro; Suzumiya, Junji; Tamura, Kazuo

2015-12-10

Adult T-cell leukemia/lymphoma (ATL) is a malignancy of mature T lymphocytes caused by human T-lymphotropic virus type I. Intensive combination chemotherapy and allogeneic hematopoietic stem cell transplantation have been introduced since the previous Japanese nationwide survey was performed in the late 1980s. In this study, we delineated the current features and management of ATL in Japan. The clinical data were collected retrospectively from the medical records of patients diagnosed with ATL between 2000 and 2009, and a total of 1665 patients' records were submitted to the central office from 84 institutions in Japan. Seventy-one patients were excluded; 895, 355, 187, and 157 patients with acute, lymphoma, chronic, and smoldering types, respectively, remained. The median survival times were 8.3, 10.6, 31.5, and 55.0 months, and 4-year overall survival (OS) rates were 11%, 16%, 36%, and 52%, respectively, for acute, lymphoma, chronic, and smoldering types. The number of patients with allogeneic hematopoietic stem cell transplantation was 227, and their median survival time and OS at 4 years after allogeneic hematopoietic stem cell transplantation was 5.9 months and 26%, respectively. This study revealed that the prognoses of the patients with acute and lymphoma types were still unsatisfactory, despite the recent progress in treatment modalities, but an improvement of 4-year OS was observed in comparison with the previous survey. Of note, one-quarter of patients who could undergo transplantation experienced long survival. It is also noted that the prognosis of the smoldering type was worse than expected. © 2015 by The American Society of Hematology.

Classification of TP53 Mutations and HPV Predict Survival in Advanced Larynx Cancer

PubMed Central

Scheel, Adam; Bellile, Emily; McHugh, Jonathan B.; Walline, Heather M.; Prince, Mark E.; Urba, Susan; Wolf, Gregory T.; Eisbruch, Avraham; Worden, Francis; Carey, Thomas E.; Bradford, Carol

2016-01-01

OBJECTIVE Assess TP53 functional mutations in the context of other biomarkers in advanced larynx cancer. STUDY DESIGN Prospective analysis of pretreatment tumor TP53, HPV, Bcl-xL and cyclin D1 status in stage III and IV larynx cancer patients in a clinical trial. METHODS TP53 exons 4-9 from 58 tumors were sequenced. Mutations were grouped using three classifications based on their expected function. Each functional group was analyzed for response to induction chemotherapy, time to surgery, survival, HPV status, p16INK4a, Bcl-xl and cyclin D1 expression. RESULTS TP53 Mutations were found in 22/58 (37.9%) patients with advanced larynx cancer, including missense mutations in 13/58 (22.4%) patients, nonsense mutations in 4/58 (6.9%), and deletions in 5/58 (8.6%). High risk HPV was found in 20/52 (38.5%) tumors. A classification based on crystal Evolutionary Action score of p53 (EAp53) distinguished missense mutations with high risk for decreased survival from low risk mutations (p=0.0315). A model including this TP53 classification, HPV status, cyclin D1 and Bcl-xL staining significantly predicts survival (p=0.0017). CONCLUSION EAp53 functional classification of TP53 mutants and biomarkers predict survival in advanced larynx cancer. PMID:27345657

Mate loss affects survival but not breeding in black brant geese

USGS Publications Warehouse

Nicolai, Christopher A.; Sedinger, James S.; Ward, David H.; Boyd, W. Sean

2012-01-01

For birds maintaining long-term monogamous relationships, mate loss might be expected to reduce fitness, either through reduced survival or reduced future reproductive investment. We used harvest of male brant during regular sport hunting seasons as an experimental removal to examine effects of mate loss on fitness of female black brant (Branta bernicla nigricans; hereafter brant). We used the Barker model in program MARK to examine effects of mate loss on annual survival, reporting rate, and permanent emigration. Survival rates decreased from 0.847 ± 0.004 for females who did not lose their mates to 0.690 ± 0.072 for birds who lost mates. Seber ring reporting rate for females that lost their mates were 2 times higher than those that did not lose mates, 0.12 ± 0.086 and 0.06 ± 0.006, respectively, indicating that mate loss increased vulnerability to harvest and possibly other forms of predation. We found little support for effects of mate loss on fidelity to breeding site and consequently on breeding. Our results indicate substantial fitness costs to females associated with mate loss, but that females who survived and were able to form new pair bonds may have been higher quality than the average female in the population.

First in line: Prioritizing receipt of Social Security disability benefits based on likelihood of death during adjudication

PubMed Central

Rasch, Elizabeth K.; Huynh, Minh; Ho, Pei-Shu; Heuser, Aaron; Houtenville, Andrew; Chan, Leighton

2014-01-01

Background: Given the complexity of the adjudication process and volume of applications to Social Security Administration’s (SSA) disability programs, many individuals with serious medical conditions die while awaiting an application decision. Limitations of traditional survival methods called for a new empirical approach to identify conditions resulting in rapid mortality. Objective: To identify health conditions associated with significantly higher mortality than a key reference group among applicants for SSA disability programs. Research design: We identified mortality patterns and generated a survival surface for a reference group using conditions already designated for expedited processing. We identified conditions associated with significantly higher mortality than the reference group and prioritized them by the expected likelihood of death during the adjudication process. Subjects: Administrative records of 29 million Social Security disability applicants, who applied for benefits from 1996 – 2007, were analyzed. Measures: We computed survival spells from time of onset of disability to death, and from date of application to death. Survival data were organized by entry cohort. Results: In our sample, we observed that approximately 42,000 applicants died before a decision was made on their disability claims. We identified 24 conditions with survival profiles comparable to the reference group. Applicants with these conditions were not likely to survive adjudication. Conclusions: Our approach facilitates ongoing revision of the conditions SSA designates for expedited awards and has applicability to other programs where survival profiles are a consideration. PMID:25310524

WAERS: an application for Web-assisted estimation of relative survival.

PubMed

Clèries, Ramon; Valls, Joan; Esteban, Laura; Gálvez, Jordi; Pareja, Laura; Sanz, Xavier; Alliste, Luisa; Martínez, José Miguel; Moreno, Víctor; Bosch, Xavier; Borràs, Josep Maria; Ribes, Josepa Maria

2007-09-01

Net cancer survival estimation is usually performed by computing relative survival (RS), which is defined as the ratio between observed and expected survival rates. The mortality of a reference population is required in order to compute the expected survival rate, which can be performed using a variety of statistical packages. A new Web interface to compute RS, called WAERS, has been developed by the Catalan Institute of Oncology. The reference population is first selected, and then the RS of a cohort is computed. A remote server is used for this purpose. A mock example serves to illustrate the use of the tool with a hypothetical cohort, for which RS is estimated based on three different reference populations (a province of Spain, an autonomous community (Region), and the entire Spanish population). At present, only mortality tables for different areas of Spain are available. Future improvements of this application will include mortality tables of Latin American and European Union countries, and stratified (control variable) analysis. This application can be also useful for cohort mortality studies and for registries of several diseases.

Recovery Expectations and Long-term Prognosis of Patients With Coronary Heart Disease

PubMed Central

Barefoot, John C.; Brummett, Beverly H.; Williams, Redford B.; Siegler, Ilene C.; Helms, Michael J.; Boyle, Stephen H.; Clapp-Channing, Nancy E.; Mark, Daniel B.

2013-01-01

Background Expectations of patients regarding their prospects for recovery have been shown to predict subsequent physical and social functioning. Evidence regarding the impact of expectations on clinical outcomes is limited. Methods At the inpatient service of a tertiary care hospital, we evaluated beliefs of patients undergoing coronary angiography about their prognosis as predictors of long-term survival and 1-year functional status. Baseline assessments, including a measure of expectations for recovery, were obtained during hospitalization with mortality follow-up for approximately 15 years. Patients with significant obstructive coronary artery disease were interviewed while in the hospital and enrolled in follow-up. Functional status was assessed at baseline and 1 year later with questionnaires reflecting physical capabilities. Analyses controlled for age, sex, disease severity, comorbidities, treatments, demographics, depressive symptoms, social support, and functional status. There were 1637 total deaths, 885 from cardiovascular causes, in the 2818 patients in these analyses. The outcomes were total mortality, cardiovascular mortality, and 1-year functional status. Results Expectations were positively associated with survival after controlling for background and clinical disease indicators. For a difference equivalent to an inter-quartile range of expectations, the hazard ratio (HR) for total mortality was 0.76 (95% confidence interval [CI], 0.71–0.82) and 0.76 (95% CI, 0.69–0.83) for cardiovascular mortality. The HRs were 0.83 (95% CI, 0.76–0.91) and 0.79 (95% CI, 0.70–0.89) with further adjustments for demographic and psychosocial covariates. Similar associations (P<.001) were observed for functional status. Conclusion Recovery expectations at baseline were positively associated with long-term survival and functioning in patients with coronary artery disease. PMID:21357800

Recovery expectations and long-term prognosis of patients with coronary heart disease.

PubMed

Barefoot, John C; Brummett, Beverly H; Williams, Redford B; Siegler, Ilene C; Helms, Michael J; Boyle, Stephen H; Clapp-Channing, Nancy E; Mark, Daniel B

2011-05-23

Expectations of patients regarding their prospects for recovery have been shown to predict subsequent physical and social functioning. Evidence regarding the impact of expectations on clinical outcomes is limited. At the inpatient service of a tertiary care hospital, we evaluated beliefs of patients undergoing coronary angiography about their prognosis as predictors of long-term survival and 1-year functional status. Baseline assessments, including a measure of expectations for recovery, were obtained during hospitalization with mortality follow-up for approximately 15 years. Patients with significant obstructive coronary artery disease were interviewed while in the hospital and enrolled in follow-up. Functional status was assessed at baseline and 1 year later with questionnaires reflecting physical capabilities. Analyses controlled for age, sex, disease severity, comorbidities, treatments, demographics, depressive symptoms, social support, and functional status. There were 1637 total deaths, 885 from cardiovascular causes, in the 2818 patients in these analyses. The outcomes were total mortality, cardiovascular mortality, and 1-year functional status. Expectations were positively associated with survival after controlling for background and clinical disease indicators. For a difference equivalent to an interquartile range of expectations, the hazard ratio (HR) for total mortality was 0.76 (95% confidence interval [CI], 0.71-0.82) and 0.76 (95% CI, 0.69-0.83) for cardiovascular mortality. The HRs were 0.83 (95% CI, 0.76-0.91) and 0.79 (95% CI, 0.70-0.89) with further adjustments for demographic and psychosocial covariates. Similar associations (P < .001) were observed for functional status. Recovery expectations at baseline were positively associated with long-term survival and functioning in patients with coronary artery disease.

SU-F-T-497: Spatiotemporally Optimal, Personalized Prescription Scheme for Glioblastoma Patients Using the Proliferation and Invasion Glioma Model

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

Kim, M; Rockhill, J; Phillips, M

Purpose: To investigate a spatiotemporally optimal radiotherapy prescription scheme and its potential benefit for glioblastoma (GBM) patients using the proliferation and invasion (PI) glioma model. Methods: Standard prescription for GBM was assumed to deliver 46Gy in 23 fractions to GTV1+2cm margin and additional 14Gy in 7 fractions to GTV2+2cm margin. We simulated the tumor proliferation and invasion in 2D according to the PI glioma model with a moving velocity of 0.029(slow-move), 0.079(average-move), and 0.13(fast-move) mm/day for GTV2 with a radius of 1 and 2cm. For each tumor, the margin around GTV1 and GTV2 was varied to 0–6 cm and 1–3more » cm respectively. Total dose to GTV1 was constrained such that the equivalent uniform dose (EUD) to normal brain equals EUD with the standard prescription. A non-stationary dose policy, where the fractional dose varies, was investigated to estimate the temporal effect of the radiation dose. The efficacy of an optimal prescription scheme was evaluated by tumor cell-surviving fraction (SF), EUD, and the expected survival time. Results: Optimal prescription for the slow-move tumors was to use 3.0(small)-3.5(large) cm margins to GTV1, and 1.5cm margin to GTV2. For the average- and fast-move tumors, it was optimal to use 6.0cm margin for GTV1 suggesting that whole brain therapy is optimal, and then 1.5cm (average-move) and 1.5–3.0cm (fast-move, small-large) margins for GTV2. It was optimal to deliver the boost sequentially using a linearly decreasing fractional dose for all tumors. Optimal prescription led to 0.001–0.465% of the tumor SF resulted from using the standard prescription, and increased tumor EUD by 25.3–49.3% and the estimated survival time by 7.6–22.2 months. Conclusion: It is feasible to optimize a prescription scheme depending on the individual tumor characteristics. A personalized prescription scheme could potentially increase tumor EUD and the expected survival time significantly without increasing EUD to normal brain.« less

Sex differences in the consequences of early-life exposure to epidemiological stress--a life-history approach.

PubMed

Störmer, Charlotte

2011-01-01

Exposure to infectious disease in early life has been suggested to have a negative effect on later-life survival,possibly through the induction of inflammatory responses. Although a life-course perspective emphasizes the importance of both survival and reproduction for individual fitness, to date, no studies have investigated whether early-life exposure to infectious disease has an impact on reproduction as it has been suggested for later survival. To address this question, I have used family reconstitution data from a historical (18th and 19th century) human population in the Krummhörn (Germany) comparing survival and reproduction between an exposed and a non-exposed group. The exposed group comprised those exposed to a high-infectious disease load during prenatal and early postnatal development. The results show a marked sex difference in the impact of early-life exposure to infectious disease. Exposed females show no effect on their life expectancy but significantly reduced fertility (number of children). For exposed males, however, the effect on survival is opponent over time: mortality is increased during childhood but decreased in late adulthood. Above that, exposed males reproduce earlier and have a smaller proportion of surviving children. This study does not support former studies indicating a negative association between early-life disease load and later survival. I argue that due to differences in male and female life strategies, males in general are more vulnerable especially early in life. Hence, adverse environmental conditions may have a stronger effect on male survivability and reproductive performance.

Are we selecting the right patients for treatment of localized prostate cancer? Results of an actuarial analysis.

PubMed

Koch, M O; Miller, D A; Butler, R; Lebos, L; Collings, D; Smith, J A

1998-02-01

To determine our accuracy in selecting patients with at least a 10-year life expectancy for aggressive treatment of localized prostate cancer. The medical records of 261 consecutive patients who underwent radical retropubic prostatectomy were submitted to the actuarial division of American General Life and Accident Insurance Company (AGLA) for estimation of life expectancy, excluding the diagnosis of prostate cancer. Survival curves were generated from predicted individual survivals. In patients with less than a 10-year life expectancy, AGLA provided us with the basis for assigning suboptimal survival rates. The mean life expectancy for the group was 15.2 years. Two hundred ten men (80%) were projected to have a life expectancy of more than 10 years, including 27 of 55 (49%) and 4 of 8 (50%) men who were older than or equal to 70 and 75 years of age, respectively. Coronary artery disease and diabetes mellitus were the most common coexisting medical conditions that adversely affected risk as single disease entities. Although clinicians do not estimate life expectancy with the scientific exactitude of an actuary, the ability to assess the patient in person and assimilate pertinent medical information in a less rigid format yields similar results. Selection of men for definitive treatment of localized prostate cancer should be based on the inherent aggressiveness of the disease and the health of the individual and should not be limited by specific age cutoffs. Populations of men undergoing radical prostatectomy are younger and healthier than those in reported series of watchful waiting for prostate cancer.

To Invest or Not to Invest, That Is the Question: Analysis of Firm Behavior under Anticipated Shocks

PubMed Central

Kovac, Dejan; Vukovic, Vuk; Kleut, Nikola; Podobnik, Boris

2016-01-01

When companies are faced with an upcoming and expected economic shock some of them tend to react better than others. They adapt by initiating investments thus successfully weathering the storm, while others, even though they possess the same information set, fail to adopt the same business strategy and eventually succumb to the crisis. We use a unique setting of the recent financial crisis in Croatia as an exogenous shock that hit the country with a time lag, allowing the domestic firms to adapt. We perform a survival analysis on the entire population of 144,000 firms in Croatia during the period from 2003 to 2015, and test whether investment prior to the anticipated shock makes firms more likely to survive the recession. We find that small and micro firms, which decided to invest, had between 60 and 70% higher survival rates than similar firms that chose not to invest. This claim is supported by both non-parametric and parametric tests in the survival analysis. From a normative perspective this finding could be important in mitigating the negative effects on aggregate demand during strong recessionary periods. PMID:27508896

To Invest or Not to Invest, That Is the Question: Analysis of Firm Behavior under Anticipated Shocks.

PubMed

Kovac, Dejan; Vukovic, Vuk; Kleut, Nikola; Podobnik, Boris

2016-01-01

When companies are faced with an upcoming and expected economic shock some of them tend to react better than others. They adapt by initiating investments thus successfully weathering the storm, while others, even though they possess the same information set, fail to adopt the same business strategy and eventually succumb to the crisis. We use a unique setting of the recent financial crisis in Croatia as an exogenous shock that hit the country with a time lag, allowing the domestic firms to adapt. We perform a survival analysis on the entire population of 144,000 firms in Croatia during the period from 2003 to 2015, and test whether investment prior to the anticipated shock makes firms more likely to survive the recession. We find that small and micro firms, which decided to invest, had between 60 and 70% higher survival rates than similar firms that chose not to invest. This claim is supported by both non-parametric and parametric tests in the survival analysis. From a normative perspective this finding could be important in mitigating the negative effects on aggregate demand during strong recessionary periods.

Cost-effectiveness of histamine receptor-2 antagonist versus proton pump inhibitor for stress ulcer prophylaxis in critically ill patients*.

PubMed

MacLaren, Robert; Campbell, Jon

2014-04-01

To examine the cost-effectiveness of using histamine receptor-2 antagonist or proton pump inhibitor for stress ulcer prophylaxis. Decision analysis model examining costs and effectiveness of using histamine receptor-2 antagonist or proton pump inhibitor for stress ulcer prophylaxis. Costs were expressed in 2012 U.S. dollars from the perspective of the institution and included drug regimens and the following outcomes: clinically significant stress-related mucosal bleed, ventilator-associated pneumonia, and Clostridium difficile infection. Effectiveness was the mortality risk associated with these outcomes and represented by survival. Costs, occurrence rates, and mortality probabilities were extracted from published data. A simulation model. A mixed adult ICU population. Histamine receptor-2 antagonist or proton pump inhibitor for 9 days of stress ulcer prophylaxis therapy. Output variables were expected costs, expected survival rates, incremental cost, and incremental survival rate. Univariate sensitivity analyses were conducted to determine the drivers of incremental cost and incremental survival. Probabilistic sensitivity analysis was conducted using second-order Monte Carlo simulation. For the base case analysis, the expected cost of providing stress ulcer prophylaxis was $6,707 with histamine receptor-2 antagonist and $7,802 with proton pump inhibitor, resulting in a cost saving of $1,095 with histamine receptor-2 antagonist. The associated mortality probabilities were 3.819% and 3.825%, respectively, resulting in an absolute survival benefit of 0.006% with histamine receptor-2 antagonist. The primary drivers of incremental cost and survival were the assumptions surrounding ventilator-associated pneumonia and bleed. The probabilities that histamine receptor-2 antagonist was less costly and provided favorable survival were 89.4% and 55.7%, respectively. A secondary analysis assuming equal rates of C. difficile infection showed a cost saving of $908 with histamine receptor-2 antagonists, but the survival benefit of 0.0167% favored proton pump inhibitors. Histamine receptor-2 antagonist therapy appears to reduce costs with survival benefit comparable to proton pump inhibitor therapy for stress ulcer prophylaxis. Ventilator-associated pneumonia and bleed are the variables most affecting these outcomes. The uncertainty in the findings justifies a prospective trial.

The growth rate of bone sarcomas and survival after radiotherapy with tourniquet-induced hypoxia: a clinical study. [/sup 60/Co

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

Balmukhanov, S.B.; Turdugulov, I.; Karibjanova, Z.

1982-04-15

The volume doubling time of primary bone sarcomas and lung metastases was determined by measurements made on serial radiographs. For the primary tumors, the volume doubling times were lognormal distributed and varied in the range of 20-200 days with a mean around 50 days. The volume doubling times of the metastases also showed a log-normal distribution in the range of 10-100 days, but with a mean twice as short as that of the primaries. Radiation therapy was given with three-four doses of 20-25 Gy to the tumors that, together with the surrounding normal tissues, had been made hypoxic by themore » application of a tourniquet. Amputations were not performed unless required eventually by some serious late radiation damage, such as grave functional deficiency, and/or painful fibrosis and ankyloses. In no case did microscopic examination of the amputated tissues reveal the persistance of any viable, neoplastic cell. The five-year survival of a total of 69 patients was 26%. Survival expectancy was found to be closely related to the volume doubling time of the tumors, as was the incidence of the metastases. The data stress the importance of volume doubling time as a predictive factor and indicate, furthermore, that treatment with a few massive radiation doses in combination with tourniquet-induced hypoxia is effective in the local control of bone sarcomas. The severe late reaction of the normal tissues to the treatment will, however, require amputations in most of the five-year survivors.« less

Multiple Weather Factors Affect Apparent Survival of European Passerine Birds

PubMed Central

Salewski, Volker; Hochachka, Wesley M.; Fiedler, Wolfgang

2013-01-01

Weather affects the demography of animals and thus climate change will cause local changes in demographic rates. In birds numerous studies have correlated demographic factors with weather but few of those examined variation in the impacts of weather in different seasons and, in the case of migrants, in different regions. Using capture-recapture models we correlated weather with apparent survival of seven passerine bird species with different migration strategies to assess the importance of selected facets of weather throughout the year on apparent survival. Contrary to our expectations weather experienced during the breeding season did not affect apparent survival of the target species. However, measures for winter severity were associated with apparent survival of a resident species, two short-distance/partial migrants and a long-distance migrant. Apparent survival of two short distance migrants as well as two long-distance migrants was further correlated with conditions experienced during the non-breeding season in Spain. Conditions in Africa had statistically significant but relatively minor effects on the apparent survival of the two long-distance migrants but also of a presumably short-distance migrant and a short-distance/partial migrant. In general several weather effects independently explained similar amounts of variation in apparent survival for the majority of species and single factors explained only relatively low amounts of temporal variation of apparent survival. Although the directions of the effects on apparent survival mostly met our expectations and there are clear predictions for effects of future climate we caution against simple extrapolations of present conditions to predict future population dynamics. Not only did weather explains limited amounts of variation in apparent survival, but future demographics will likely be affected by changing interspecific interactions, opposing effects of weather in different seasons, and the potential for phenotypic and microevolutionary adaptations. PMID:23593131

Prediction of postnatal outcomes in fetuses with isolated congenital diaphragmatic hernias using different lung-to-head ratio measurements.

PubMed

Kehl, Sven; Siemer, Jörn; Brunnemer, Suna; Weiss, Christel; Eckert, Sven; Schaible, Thomas; Sütterlin, Marc

2014-05-01

The purpose of this study was to compare different methods for measuring the fetal lung area-to-head circumference ratio and to investigate their prediction of postpartum survival and the need for neonatal extracorporeal membrane oxygenation (ECMO) therapy in fetuses with isolated congenital diaphragmatic hernias. This prospective study included 118 fetuses of at least 20 weeks' gestation with isolated left-sided congenital diaphragmatic hernias. The lung-to-head ratio was measured with 3 different methods (longest diameter, anteroposterior diameter, and tracing). To eliminate the influence of gestational age, the observed-to-expected lung-to-head ratio was calculated. Receiver operating characteristic (ROC) curves were calculated for the statistical prediction of survival and need for ECMO therapy by the observed-to-expected lung-to-head ratio measured with the different methods. For survival and ECMO necessity 118 and 102 cases (16 neonates were not eligible for ECMO) were assessed, respectively. For prediction of postpartum survival and ECMO necessity, the areas under the ROC curves and 95% confidence intervals showed very similar results for the 3 methods for prediction of survival (tracing, 0.8445 [0.7553-0.9336]; longest diameter, 0.8248 [0.7360-0.9136]; and anteroposterior diameter, 0.8002 [0.7075-0.8928]) and for ECMO necessity (tracing, 0.7344 [0.6297-0.8391]; longest diameter, 0.7128 [0.6027-0.8228]; and anteroposterior diameter, 0.7212 [0.6142-0.8281]). Comparisons between the areas under the ROC curves showed that the tracing method was superior to the anteroposterior diameter method in predicting postpartum survival (P = .0300). Lung-to-head ratio and observed-to-expected lung-to-head ratio measurements were shown to accurately predict postnatal survival and the need for ECMO therapy in fetuses with left-sided congenital diaphragmatic hernias. Tracing the limits of the lungs seems to be the favorable method for calculating the fetal lung area.

Utility and impact of early t(15;17) identification by Fluorescence In Situ Hybridization (FISH) in clinical decision making for patients in Acute Promyelocytic Leukemia (APL).

PubMed

Kolhe, R; Mangaonkar, A; Mansour, J; Clemmons, A; Shaw, J; Dupont, B; Walczak, L; Mondal, A; Rojiani, A; Jillella, A; Kota, V

2015-08-01

Acute Promyelocytic Leukemia (APL) is a curable malignancy with studies showing above 90% survival. However, population-based studies looking at survival suggest that approximately 30% of patients with APL die during induction. Early demonstration of t(15;17) will lead to accurate decision making regarding treatment. The aim of this project was to validate earlier time frames for the Abbott Molecular Vysis LSI promyelocytic leukemia (PML)/ retinoic acid receptor alpha (RARA) fluorescence in situ hybridization (FISH) probe (ASR 6-16 h). Twenty patients (15 APL cases and five non-APL cases) were selected for validating various hybridization times for the FISH probe. Expected normal signal pattern was two red and two green signals (2R2G), and the most common expected abnormal signal pattern was two fusion (yellow) signals, one red and one green (2F1R1G) and/or one fusion, one red and one green (1F1R1G). The specificity of the probe ranged from 84% at 2 h, 86% at 4 h, 84% at 6 h, and 87% for overnight hybridization. The sensitivity increased from 79% at 2 h, 80% at 4 h, 81% at 6 h to 87% for overnight hybridization. Based on the validation studies, we recommend reading of FISH results at the 4-h incubation mark for a preliminary diagnosis and confirmation with overnight hybridization. © 2015 John Wiley & Sons Ltd.

Assessing impacts of oil-shale development on the Piceance Basin mule deer herd

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

White, G.C.; Garrott, R.A.

Development of energy resources on big game ranges generally negatively impacts these important wildlife resources. Although habitat disturbance is generally important, this impact is overshadowed by the negative impacts due to an increasing human population in the area. Increased human activities particularly stress animals during winter periods when inadequate nutrition levels may have already severely impacted the population. Increased road traffic and poaching causes additional deaths, which a decline in survival rates expected, or at least changes in the cause of mortality. This paper describes the experimental design to monitor and mitigate the impact of oil shale development in northwesternmore » Colorado on the Piceance Basin mule deer herd. Biotelemetry techniques are used to measure changes through time in movements, habitat utilization, and survival rates between control and treatment areas. 2 figures.« less

Hybrid Viability and Fertility in Co-occuring Plant Species

NASA Astrophysics Data System (ADS)

Hernandez, E.; Garcia, C.; Yost, J.

2012-12-01

Similar species of plants can co-exist due to reproductive barriers that keep them from hybridizing. In the case of Lasthenia gracilis and L. californica, certain reproductive barriers allow them to co-exist at Jasper Ridge without hybridization. The two species are locally adapted to different regions of the same hillside, and have slight differences in flowering time but hybrids can be created at low rate in the green house. We tested the viability and fertility of green house produced hybrids to quantify post-zygotic reproductive isolation at Jasper Ridge. We planted 10 hybrid seeds and 10 control seeds from 11 different families. We measured the percent germination, survival to flowering and pollen fertility of the seeds. We expect lower germination, lower survival to flowering, and lower pollen viability of hybrid seeds as compared to control seeds.

Postdoctoral Clinical-Research Training in Psychiatry

PubMed Central

Reynolds, Charles F.; Martin, Christopher; Brent, David; Ryan, Neal; Dahl, Ronald E.; Pilkonis, Paul; Marcus, Marsha D.; Kupfer, David J.

2009-01-01

The authors describe a model for teaching grant writing and other research survival skills to postdoctoral clinical-research fellows in psychiatry and for improving research mentoring. Over the past 4 years, the authors have developed a course on writing grant applications for postdoctoral clinical-research fellows, using peer-review processes modeled after a National Institutes of Health study section. At the same time, the authors have clarified expectations of mentors in ways designed to help fellows prepare “K” (Research Career Development) applications and to receive mentored practice in skills being taught in the course. Sixteen of 30 fellows have succeeded in receiving their first extramural support by the end of their two-year fellowship tenure or during the succeeding year. The authors conclude that by teaching grant-writing skills in a supportive peer environment, providing peer review of proposals, and sharpening expectations of mentors, it may be possible to reduce the time between the end of fellowship and the receipt of the first extramural grant. PMID:19617924

Higher limb asymmetry in deceased human fetuses and infants with aneuploidy

PubMed Central

Bots, Jessica; ten Broek, Clara M. A.; Belien, Jeroen A. M.; Bugiani, Marianna; Galis, Frietson; Van Dongen, Stefan

2014-01-01

Aneuploidies cause gene-dosage imbalances that presumably result in a generalized decreased developmental homeostasis, which is expected to be detectable through an increase in fluctuating asymmetry (FA) of bilateral symmetric traits. However, support for the link between aneuploidy and FA is currently limited and no comparisons among different aneuploidies have been made. Here, we study FA in deceased human fetuses and infants from a 20-year hospital collection. Mean FA of limb bones was compared among groups of aneuploidies with different prenatal and postnatal survival chances and two reference groups (normal karyogram or no congenital anomalies). Limb asymmetry was 1.5 times higher for aneuploid cases with generally very short life expectancies (trisomy 13, trisomy 18, monosomy X, triploidy) than for trisomy 21 patients and both reference groups with higher life expectancies. Thus, FA levels are highest in groups for which developmental disturbances have been highest. Our results show a significant relationship between fluctuating asymmetry, human genetic disorders and severity of the associated abnormalities. PMID:24424506

Simulation of Comet Impact and Survivability of Organic Compounds

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

Liu, B T; Lomov, I N; Blank, J G

Comets have long been proposed as a potential means for the transport of complex organic compounds to early Earth. For this to be a viable mechanism, a significant fraction of organic compounds must survive the high temperatures due to impact. We have undertaken three-dimensional numerical simulations to track the thermodynamic state of a comet during oblique impacts. The comet was modeled as a 1-km water-ice sphere impacting a basalt plane at 11.2 km/s; impact angles of 15{sup o} (from horizontal), 30{sup o}, 45{sup o}, 65{sup o}, and 90{sup o} (normal impact) were examined. The survival of organic cometary material, modeledmore » as water ice for simplicity, was calculated using three criteria: (1) peak temperatures, (2) the thermodynamic phase of H{sub 2}O, and (3) final temperature upon isentropic unloading. For impact angles greater than or equal to 30{sup o}, no organic material is expected to survive the impact. For the 15{sup o} impact, most of the material survives the initial impact and significant fractions (55%, 25%, and 44%, respectively) satisfy each survival criterion at 1 second. Heating due to deceleration, in addition to shock heating, plays a role in the heating of the cometary material for nonnormal impacts. This effect is more noticeable for more oblique impacts, resulting in significant deviations from estimates using scaling of normal impacts. The deceleration heating of the material at late times requires further modeling of breakup and mixing.« less

Composite Partial Likelihood Estimation Under Length-Biased Sampling, With Application to a Prevalent Cohort Study of Dementia

PubMed Central

Huang, Chiung-Yu; Qin, Jing

2013-01-01

The Canadian Study of Health and Aging (CSHA) employed a prevalent cohort design to study survival after onset of dementia, where patients with dementia were sampled and the onset time of dementia was determined retrospectively. The prevalent cohort sampling scheme favors individuals who survive longer. Thus, the observed survival times are subject to length bias. In recent years, there has been a rising interest in developing estimation procedures for prevalent cohort survival data that not only account for length bias but also actually exploit the incidence distribution of the disease to improve efficiency. This article considers semiparametric estimation of the Cox model for the time from dementia onset to death under a stationarity assumption with respect to the disease incidence. Under the stationarity condition, the semiparametric maximum likelihood estimation is expected to be fully efficient yet difficult to perform for statistical practitioners, as the likelihood depends on the baseline hazard function in a complicated way. Moreover, the asymptotic properties of the semiparametric maximum likelihood estimator are not well-studied. Motivated by the composite likelihood method (Besag 1974), we develop a composite partial likelihood method that retains the simplicity of the popular partial likelihood estimator and can be easily performed using standard statistical software. When applied to the CSHA data, the proposed method estimates a significant difference in survival between the vascular dementia group and the possible Alzheimer’s disease group, while the partial likelihood method for left-truncated and right-censored data yields a greater standard error and a 95% confidence interval covering 0, thus highlighting the practical value of employing a more efficient methodology. To check the assumption of stable disease for the CSHA data, we also present new graphical and numerical tests in the article. The R code used to obtain the maximum composite partial likelihood estimator for the CSHA data is available in the online Supplementary Material, posted on the journal web site. PMID:24000265

Rectangularization of the survival curve in The Netherlands, 1950-1992.

PubMed

Nusselder, W J; Mackenbach, J P

1996-12-01

In this article we determine whether rectangularization of the survival curve occurred in the Netherlands in the period 1950-1992. Rectangularization is defined as a trend toward a more rectangular shape of the survival curve due to increased survival and concentration of deaths around the mean age at death. We distinguish between absolute and relative rectangularization, depending on whether an increase in life expectancy is accompanied by concentration of deaths into a smaller age interval or into a smaller proportion of total life expectancy. We used measures of variability based on Keyfitz' H and the standard deviation, both life table-based. Our results show that absolute and relative rectangularization of the entire survival curve occurred in both sexes and over the complete period (except for the years 1955-1959 and 1965-1969 in men). At older ages, results differ between sexes, periods, and an absolute versus a relative definition of rectangularization. Above age 60 1/2, relative rectangularization occurred in women over the complete period and in men since 1975-1979 only, whereas absolute rectangularization occurred in both sexes since the period of 1980-1984. The implications of the recent rectangularization at older ages for achieving compression of morbidity are discussed.

Comonotonic bounds on the survival probabilities in the Lee-Carter model for mortality projection

NASA Astrophysics Data System (ADS)

Denuit, Michel; Dhaene, Jan

2007-06-01

In the Lee-Carter framework, future survival probabilities are random variables with an intricate distribution function. In large homogeneous portfolios of life annuities, value-at-risk or conditional tail expectation of the total yearly payout of the company are approximately equal to the corresponding quantities involving random survival probabilities. This paper aims to derive some bounds in the increasing convex (or stop-loss) sense on these random survival probabilities. These bounds are obtained with the help of comonotonic upper and lower bounds on sums of correlated random variables.

Longevity of outstanding sporting achievers: Mind versus muscle

PubMed Central

Smerdon, David C.; Clarke, Philip M.

2018-01-01

Background While there is strong evidence showing the survival advantage of elite athletes, much less is known about those engaged in mind sports such as chess. This study aimed to examine the overall as well as regional survival of International Chess Grandmasters (GMs) with a reference to the general population, and compare relative survival (RS) of GMs with that of Olympic medallists (OMs). Methods Information on 1,208 GMs and 15,157 OMs, respectively, from 28 countries were extracted from the publicly available data sources. The Kaplan-Meier method was used to estimate the survival rates of the GMs. A Cox proportional hazards model was used to adjust the survival for region, year at risk, age at risk and sex, and to estimate the life expectancy of the GMs. The RS rate was computed by matching each GM or OM by year at risk, age at risk and sex to the life table of the country the individual represented. Results The survival rates of GMs at 30 and 60 years since GM title achievement were 87% and 15%, respectively. The life expectancy of GMs at the age of 30 years (which is near the average age when they attained a GM title) was 53.6 ([95% CI]: 47.7–58.5) years, which is significantly greater than the overall weighted mean life expectancy of 45.9 years for the general population. Compared to Eastern Europe, GMs in North America (HR [95% CI]: 0.51 [0.29–0.88]) and Western Europe (HR [95% CI]: 0.53 [0.34–0.83]) had a longer lifespan. The RS analysis showed that both GMs and OMs had a significant survival advantage over the general population, and there was no statistically significant difference in the RS of GMs (RS [95% CI]: 1.14 [1.08–1.20]) compared to OMs: (RS [95% CI]: 1.09 [1.07–1.11]) at 30 years. Conclusion Elite chess players live longer than the general population and have a similar survival advantage to elite competitors in physical sports. PMID:29723296

Unbiased survival estimates and evidence for skipped breeding opportunities in females

USGS Publications Warehouse

Muths, Erin L.; Scherer, Rick D.; Lambert, Brad A.

2010-01-01

5. Establishing the occurrence of temporary emigration not only reduces bias in estimates of survival probabilities but also provides information about expected breeding attempts by females, a critical element in understanding the ecology of an organism and the impacts of outside stressors and conservation actions.

Personalized predictive modeling for patients with Alzheimer's disease using an extension of Sullivan's life table model.

PubMed

Stallard, Eric; Kinosian, Bruce; Stern, Yaakov

2017-09-20

Alzheimer's disease (AD) progression varies substantially among patients, hindering calculation of residual total life expectancy (TLE) and its decomposition into disability-free life expectancy (DFLE) and disabled life expectancy (DLE) for individual patients with AD. The objective of the present study was to assess the accuracy of a new synthesis of Sullivan's life table (SLT) and longitudinal Grade of Membership (L-GoM) models that estimates individualized TLEs, DFLEs, and DLEs for patients with AD. If sufficiently accurate, such information could enhance the quality of important decisions in AD treatment and patient care. We estimated a new SLT/L-GoM model of the natural history of AD over 10 years in the Predictors 2 Study cohort: N = 229 with 6 fixed and 73 time-varying covariates over 21 examinations covering 11 measurement domains including cognitive, functional, behavioral, psychiatric, and other symptoms/signs. Total remaining life expectancy was censored at 10 years. Disability was defined as need for full-time care (FTC), the outcome most strongly associated with AD progression. All parameters were estimated via weighted maximum likelihood using data-dependent weights designed to ensure that the estimates of the prognostic subtypes were of high quality. Goodness of fit was tested/confirmed for survival and FTC disability for five relatively homogeneous subgroups defined to cover the range of patient outcomes over the 21 examinations. The substantial heterogeneity in initial patient presentation and AD progression was captured using three clinically meaningful prognostic subtypes and one terminal subtype exhibiting highly differentiated symptom severity on 7 of the 11 measurement domains. Comparisons of the observed and estimated survival and FTC disability probabilities demonstrated that the estimates were accurate for all five subgroups, supporting their use in AD life expectancy calculations. Mean 10-year TLE differed widely across subgroups: range 3.6-8.0 years, average 6.1 years. Mean 10-year DFLE differed relatively even more widely across subgroups: range 1.2-6.5 years, average 4.0 years. Mean 10-year DLE was relatively much closer: range 1.5-2.3 years, average 2.1 years. The SLT/L-GoM model yields accurate maximum likelihood estimates of TLE, DFLE, and DLE for patients with AD; it provides a realistic, comprehensive modeling framework for endpoint and resource use/cost calculations.

Unique protein expression signatures of survival time in kidney renal clear cell carcinoma through a pan-cancer screening.

PubMed

Han, Guangchun; Zhao, Wei; Song, Xiaofeng; Kwok-Shing Ng, Patrick; Karam, Jose A; Jonasch, Eric; Mills, Gordon B; Zhao, Zhongming; Ding, Zhiyong; Jia, Peilin

2017-10-03

In 2016, it is estimated that there will be 62,700 new cases of kidney cancer in the United States, and 14,240 patients will die from the disease. Because the incidence of kidney renal clear cell carcinoma (KIRC), the most common type of kidney cancer, is expected to continue to increase in the US, there is an urgent need to find effective diagnostic biomarkers for KIRC that could help earlier detection of and customized treatment strategies for the disease. Accordingly, in this study we systematically investigated KIRC's prognostic biomarkers for survival using the reverse phase protein array (RPPA) data and the high throughput sequencing data from The Cancer Genome Atlas (TCGA). With comprehensive data available in TCGA, we systematically screened protein expression based survival biomarkers in 10 major cancer types, among which KIRC presented many protein prognostic biomarkers of survival time. This is in agreement with a previous report that expression level changes (mRNAs, microRNA and protein) may have a better performance for prognosis of KIRC. In this study, we also identified 52 prognostic genes for KIRC, many of which are involved in cell-cycle and cancer signaling, as well as 15 tumor-stage-specific prognostic biomarkers. Notably, we found fewer prognostic biomarkers for early-stage than for late-stage KIRC. Four biomarkers (the RPPA protein IDs: FASN, ACC1, Cyclin_B1 and Rad51) were found to be prognostic for survival based on both protein and mRNA expression data. Through pan-cancer screening, we found that many protein biomarkers were prognostic for patients' survival in KIRC. Stage-specific survival biomarkers in KIRC were also identified. Our study indicated that these protein biomarkers might have potential clinical value in terms of predicting survival in KIRC patients and developing individualized treatment strategies. Importantly, we found many biomarkers in KIRC at both the mRNA expression level and the protein expression level. These biomarkers shared a significant overlap, indicating that they were technically replicable.

Estimation and Projection of Prevalence of Colorectal Cancer in Iran, 2015-2020.

PubMed

Vardanjani, Hossein Molavi; Haghdoost, AliAkbar; Bagheri-Lankarani, Kamran; Hadipour, Maryam

2018-01-01

Population aging and more prevalent westernized lifestyle would be expected to result in a markedly rising burden of colorectal cancer (CRC) in the future years. The aim of this study is to estimate the limited-time prevalence of CRC in Iran between 2015 and 2020. Aggregated CRC incidence data were extracted from the Iranian national cancer registry (IR.NCR) reports for 2003-2009 and from GLOBOCAN-2012 database for 2012. Incidence trends were analyzed by age groups, genders, histopathologic, and topographic subtypes to estimate annual percentage changes. Incidence was projected for 2020. The prevalence was estimated applying an adopted version of a previously introduced equation to estimate limited-time prevalence based on the incidence and survival data. Monte Carlo sensitivity analyses were applied to estimate 95% uncertainty levels (ULs). In each scenario, incidence, survival, annual percentage changes, and completeness of case ascertainment at IR.NCR were replaced under pre-assumed distributions. Number of estimated within 1, 2-3 and 4-5-year CRC patients in 2015 were 13676 (95% UL: 10051-18807), 20964 (15835-28268), and 14485 (11188-19293), respectively. Estimated 5-year prevalence for 2020 (99463; 75150-134744) was 2.03 times of that for 2015. Highest 5-year prevalence was estimated in ages 55-59 for females and 75 + for males. Adenocarcinoma (41376; 31227 55898) was the most prevalent histologic subtype. The most prevalent tumor location was colon (30822, 23262-41638). A substantial growth in the prevalence of CRC survivors is highly expected for future years in Iran. Establishment of specialized institutes is highly recommended to provide medical and especially social supports for Iranian CRC survivors.

Ten-year survival and complication rates of lithium-disilicate (Empress 2) tooth-supported crowns, implant-supported crowns, and fixed dental prostheses.

PubMed

Teichmann, Maren; Göckler, Fabian; Weber, Volker; Yildirim, Murat; Wolfart, Stefan; Edelhoff, Daniel

2017-01-01

To prospectively evaluate the clinical long-term outcome of tooth-supported crowns (SCs), implant-supported crowns (ISCs), and fixed dental prostheses (FDPs) made of a lithium-disilicate glass-ceramic framework material (IPS Empress 2). Between 1997 and 1999, a total of 184 restorations (106 SCs, 32 ISCs, 33 FDPs, and 13 diverse restorations) were placed in 73 patients. Kaplan-Meier estimation was applied for survival and chipping-free rates. Inter-group comparison of both rates was realized by a log rank test and a 2×2 contingency table. Also, SCs and FDPs were compared regarding adhesive vs. conventional cementation, and anterior vs. posterior positioning, for impact on survival. Due to 14 dropouts (34 restorations) and reasonable exclusion of 19 other restorations, the final dataset included: i) 87 SCs [37 patients, mean observation time 11.4 (±3.8)years]; ii) 17 ISCs [12 patients, mean observation time 13.3 (±2.3)years; and iii) 27 FDPs [19 patients, mean observation time 8.9 (±5.4)years]. The 10-year survival rate/chipping-free rate for SCs were 86.1%/83.4%, for ISCs 93.8%/94.1%, and for FDPs were 51.9%/90.8%. Both ISCs and SCs had a significantly higher survival than FDPs (ISCs vs. FDPs: both tests p=0.001; SCs vs. FDPs: p=0.001 and p=0.005). Differences in the chipping-free rates did not reach significance. Also, neither the cementation mode nor positioning of the restoration had an impact on survival. SCs had a slightly lower outcome than can generally be expected from single crowns. In contrast, ICSs had a favorable outcome and the FDPs predominantly failed. The practitioner's choice of dental materials is based (at best) on long-term experience. The present 10-year results are based on comprehensive data analyses and show the high potential of lithium-disilicate as a reliable material, especially for single-unit restoration. Copyright © 2016 Elsevier Ltd. All rights reserved.

Epidemiological Follow-up 15 Years after the Breast Cancer Scandal in Essen

PubMed Central

Hauth, E. A. M.; Berkemeyer, S.; Jaeger, H.; Forsting, M.; Hoffmann, B.; Jöckel, K.-H.

2012-01-01

Purpose: In the years 1993–1996 a number of presumably false-positive breast cancer diagnoses were made by a pathologist in Essen. A follow-up, undertaken 15 years later, investigated how many women had tumour recurrence and/or metastasis or had died from breast cancer. Material and Methods: A total of 151 (68 %) out of 222 women could be traced. One hundred and forty-seven (66.2 %) of the 222 women were alive. The observed survival rate, number of recurrences and/or metastases, and number of deaths from breast cancer were compared with data from the Munich Tumour Registry. The number of breast cancer cases among daughters of the affected women was ascertained. Results: The total observed survival rate at follow-up after 15 years was 93 %, a much higher figure than the survival rate of 45 % given by the Munich Tumour Registry. Recurrence and/or metastasis or death from breast cancer occurred in 9/222 cases (4.1 %). The incidence for these events calculated according to data from the Munich Tumour Registry is 13 %. Two daughters (2.2 %) out of a total of 90 were diagnosed with breast cancer whereas, according to the German Cancer Research Centre, the expected rate would have been between 5 and 10 %. Conclusions: The results of our follow-up after 15 years show that more women survived than expected and that the number of recurrences and/or metastases and deaths due to breast cancer was lower than expected. Fewer daughters of affected women were diagnosed with breast cancer than expected. These results support our suspicion that not all women diagnosed with breast cancer by a pathologist in Essen actually had breast cancer. PMID:25284840

Outcomes of expectantly managed pregnancies with multiple gestations and preterm premature rupture of membranes prior to 26 weeks.

PubMed

Wong, Luchin F; Holmgren, Calla M; Silver, Robert M; Varner, Michael W; Manuck, Tracy A

2015-02-01

The objective of the study was to determine the obstetric and neonatal outcomes of expectantly managed multifetal pregnancies complicated by early preterm premature rupture of membranes (PPROM) prior to 26 weeks. This was a retrospective cohort of all multifetal pregnancies complicated by documented PPROM occurring before 26 0/7 weeks and managed expectantly by a single maternal-fetal medicine practice between July 4, 2002, and Sept. 1, 2013. Neonatal and maternal outcomes were assessed and comparisons made between the fetus with ruptured membranes and the first fetus to deliver with intact membranes. Twenty-three pregnancies (46 fetuses) were analyzed with a median gestational age at PPROM of 22.9 weeks; 74% experienced PPROM at less than 24 weeks' gestation. A median latency of 11 days was achieved with expectant management. Of the 46 neonates, 20 (43%) survived to hospital discharge. Of these, 12 (60%) experienced severe neonatal morbidity defined as defined as grade III or IV intraventricular hemorrhage, bronchopulmonary dysplasia, pulmonary hypoplasia, necrotizing enterocolitis requiring surgical intervention, and/or grade 3 or 4 retinopathy of prematurity. Eight neonates survived to hospital discharge without severe neonatal morbidity. The multiple with ruptured membranes was more likely to experience intrauterine demise but otherwise had similar outcomes as the multiple with intact membranes. Maternal morbidity was considerable, with 7 of 23 pregnancies (30%) complicated by clinical chorioamnionitis, 12 of 23 (52%) delivering by cesarean, of which 3 of 12 (25%) were classical cesarean deliveries. Overall, neonatal survival to hospital discharge was 43%, but only 17% survived without significant neonatal morbidity. These data provide a basis for counseling and management of women with multifetal gestation complicated by very early PPROM. Copyright © 2015 Elsevier Inc. All rights reserved.

Racial and ethnic disparities in end-stage kidney failure-survival paradoxes in African-Americans.

PubMed

Agodoa, Lawrence; Eggers, Paul

2007-01-01

The risk of death is nearly 45% lower in African-Americans than Caucasians undergoing chronic hemodialysis. In light of the higher mortality rate in African-Americans in the general US population, this paradox requires explanation and further investigation. Factors that may contribute to this survival advantage include a younger age at which African-Americans arrive at end-stage renal disease (ESRD) and the slightly higher body mass index. On the other hand, factors, such as lower residual renal function, lower mean hemoglobin and hematocrit, increased prevalence of hypertension, a higher prevalence of catheter use for initial dialysis, and generally lower dose of dialysis should put African-Americans on dialysis at a higher risk of death. This survival advantage seems to be completely annulled with a successful renal transplant. Finally, it should be noted that ESRD carries with it a very high mortality rate in all racial and ethnic groups. A successful renal transplant improves but does not restore the expected remaining life times. Therefore, aggressive approach is required in investigating the factors that confer such high mortality risk on ESRD patients.

Addressing the expected survival benefit for clinical trial design in metastatic castration-resistant prostate cancer: Sensitivity analysis of randomized trials.

PubMed

Massari, Francesco; Modena, Alessandra; Ciccarese, Chiara; Pilotto, Sara; Maines, Francesca; Bracarda, Sergio; Sperduti, Isabella; Giannarelli, Diana; Carlini, Paolo; Santini, Daniele; Tortora, Giampaolo; Porta, Camillo; Bria, Emilio

2016-02-01

We performed a sensitivity analysis, cumulating all randomized clinical trials (RCTs) in which patients with metastatic castration-resistant prostate cancer (mCRPC) received systemic therapy, to evaluate if the comparison of RCTs may drive to biased survival estimations. An overall survival (OS) significant difference according to therapeutic strategy was more likely be determined in RCTs evaluating hormonal drugs versus those studies testing immunotherapy, chemotherapy or other strategies. With regard to control arm, an OS significant effect was found for placebo-controlled trials versus studies comparing experimental treatment with active therapies. Finally, regarding to docetaxel (DOC) timing, the OS benefit was more likely to be proved in Post-DOC setting in comparison with DOC and Pre-DOC. These data suggest that clinical trial design should take into account new benchmarks such as the type of treatment strategy, the choice of the comparator and the phase of the disease in relation to the administration of standard chemotherapy. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Bevacizumab in Combination with Chemotherapy for Colorectal Brain Metastasis.

PubMed

Finkelmeier, Fabian; You, Se-Jong; Waidmann, Oliver; Wolff, Robert; Zeuzem, Stefan; Bähr, Oliver; Trojan, Jörg

2016-03-01

Brain metastases are rare in patients with colorectal cancer, but the incidence is expected to rise due to prolonged survival resulting from more effective regimens including anti-EGF-receptor and anti-angiogenic antibodies. Because of the potential fear of intracranial hemorrhage, patients with colorectal brain metastases have been excluded from clinical trials involving bevacizumab or aflibercept. Five patients with colorectal brain metastases treated with bevacizumab-containing chemotherapy regimen following either neurosurgery, radiosurgery, or whole-brain radiotherapy were identified between 2009 and 2014. The clinicopathological data and outcomes for these patients were reviewed. Mean time to disease progression concerning brain metastases was 14.8 months (range 5-25). Overall survival was 26.2 months (range 7-42 months) and overall survival since diagnosis of brain metastases was 20.6 month (7-42). Best response was a partial response in two and a stable disease in three patients. Treatment-related adverse events were mild hypertension (grade 1), diarrhea (grade 1), and fatigue (grade 1). No intracranial hemorrhage was observed. Bevacizumab in combination with chemotherapy is a feasible option for palliative treatment of patients with colorectal brain metastasis with a good safety profile.

Internal dispersal of seeds by waterfowl: effect of seed size on gut passage time and germination patterns

NASA Astrophysics Data System (ADS)

Figuerola, Jordi; Charalambidou, Iris; Santamaria, Luis; Green, Andy J.

2010-06-01

Long distance dispersal may have important consequences for gene flow and community structure. The dispersal of many plants depends on transport by vertebrate seed dispersers. The shapes of seed shadows produced by vertebrates depend both on movement patterns of the dispersers and on the dynamics and effects of passage through the disperser’s gut (i.e. the retention time, survival and germination of ingested seeds). A combination of experiments with captive waterbirds and aquatic plant seeds was used to analyse the following: (a) the effects of inter- and intra-specific variation in seed size and duck species on seed retention time in the gut and (b) the relationship between retention time and the percent germination and germination rates of seeds. Among the three Scirpus species used, those with smaller seeds showed higher survival after ingestion by birds and longer retention times inside their guts than those with larger seeds. For Potamogeton pectinatus, only seeds from the smaller size class (<8 mg) survived ingestion. Retention time affected the percent germination and germination rate of Scirpus seeds but in a manner that varied for the different plant and bird species studied. We recorded both linear and non-linear effects of retention time on percent germination. In addition, germination rate was positively correlated with retention time in Scirpus litoralis but negatively correlated in Scirpus lacustris. Small seed size can favour dispersal over larger distances. However, the effects of retention time on percent germination can modify the seed shadows produced by birds due to higher percent germination of seeds retained for short or intermediate periods. The changes in dispersal quality associated with dispersal distance (which is expected to be positively related to retention time) will affect the probability of seedling establishment over longer distances and, thus, the spatial characteristics of the effective seed shadow.

The ability of intensive care unit physicians to estimate long-term prognosis in survivors of critical illness.

PubMed

Soliman, Ivo W; Cremer, Olaf L; de Lange, Dylan W; Slooter, Arjen J C; van Delden, Johannes Hans J M; van Dijk, Diederik; Peelen, Linda M

2018-02-01

To assess the reliability of physicians' prognoses for intensive care unit (ICU) survivors with respect to long-term survival and health related quality of life (HRQoL). We performed an observational cohort-study in a single mixed tertiary ICU in The Netherlands. ICU survivors with a length of stay >48h were included. At ICU discharge, one-year prognosis was estimated by physicians using the four-option Sabadell score to record their expectations. The outcome of interest was poor outcome, which was defined as dying within one-year follow-up, or surviving with an EuroQoL5D-3L index <0.4. Among 1399 ICU survivors, 1068 (76%) subjects were expected to have a good outcome; 243 (18%) a poor long-term prognosis; 43 (3%) a poor short-term prognosis, and 45 (3%) to die in hospital (i.e. Sabadell score levels). Poor outcome was observed in 38%, 55%, 86%, and 100% of these groups respectively (concomitant c-index: 0.61). The expected prognosis did not match observed outcome in 365 (36%) patients. This was almost exclusively (99%) due to overoptimism. Physician experience did not affect results. Prognoses estimated by physicians incorrectly predicted long-term survival and HRQoL in one-third of ICU survivors. Moreover, inaccurate prognoses were generally the result of overoptimistic expectations of outcome. Copyright © 2017 Elsevier Inc. All rights reserved.

[Survival analysis of patients with pneumoconiosis from 1956 to 2010 in Changsha].

PubMed

Xue, Jing; Chen, Lizhang

2012-01-01

To investigate the survival rate and life expectancy of patients with pneumoconiosis and influence factors in Changsha from 1956 to 2010. A total of 3685 patients with pneumoconiosis were diagnosed and reported from 1956 to 2010 in Changsha. The fatality rate and life expectancy were analyzed by life table and the cause of death was analyzed by Kaplan-Meier method and Cox regression model. The death rate increased obviously with age. Age and accumulation death probability showed linearity (Ŷ=1.271+0.041X, r=0.989). The life expectancy was 60.12 years. The first cause of death was pulmonary tuberculosis in patients with pneumoconiosis. Ruling out the influence of pulmonary tuberculosis, pneumoconiosis, and lung source heart disease, the life expectancy of patients with pneumoconiosis averagely extended 0.83, 0.99, and 0.02 years. The death rate of pneumoconiosis-tuberculosis had significant difference with that of the pneumoconiosisnontuberculosis (P<0.01). Cox regression analysis revealed that the main risk factors for the survival of patients with pneumoconiosis included type of work (smashing worker), complication with tuberculosis, type of pneumoconiosis (silicosis). The death hazard ratio or relative risk caused by them was 1.927, 1.749, and 1.609, respectively. Prevention of pneumoconiosis should focus on smashing workers in Changsha, while its the treatment primarily attaches importance to complication of tuberculosis and lung infection.

Recent tree die-off has little effect on streamflow in contrast to expected increases from historical studies

NASA Astrophysics Data System (ADS)

Biederman, Joel A.; Somor, Andrew J.; Harpold, Adrian A.; Gutmann, Ethan D.; Breshears, David D.; Troch, Peter A.; Gochis, David J.; Scott, Russell L.; Meddens, Arjan J. H.; Brooks, Paul D.

2015-12-01

Recent bark beetle epidemics have caused regional-scale tree mortality in many snowmelt-dominated headwater catchments of western North America. Initial expectations of increased streamflow have not been supported by observations, and the basin-scale response of annual streamflow is largely unknown. Here we quantified annual streamflow responses during the decade following tree die-off in eight infested catchments in the Colorado River headwaters and one nearby control catchment. We employed three alternative empirical methods: (i) double-mass comparison between impacted and control catchments, (ii) runoff ratio comparison before and after die-off, and (iii) time-trend analysis using climate-driven linear models. In contrast to streamflow increases predicted by historical paired catchment studies and recent modeling, we did not detect streamflow changes in most basins following die-off, while one basin consistently showed decreased streamflow. The three analysis methods produced generally consistent results, with time-trend analysis showing precipitation was the strongest predictor of streamflow variability (R2 = 74-96%). Time-trend analysis revealed post-die-off streamflow decreased in three catchments by 11-29%, with no change in the other five catchments. Although counter to initial expectations, these results are consistent with increased transpiration by surviving vegetation and the growing body of literature documenting increased snow sublimation and evaporation from the subcanopy following die-off in water-limited, snow-dominated forests. The observations presented here challenge the widespread expectation that streamflow will increase following beetle-induced forest die-off and highlight the need to better understand the processes driving hydrologic response to forest disturbance.

Long-term survival following open repair of ruptured abdominal aortic aneurysm.

PubMed

Englund, Raymond; Katib, Nedal

2017-05-01

Long-term results for patients being managed for ruptured compared to elective abdominal aortic aneurysms (AAA) are unclear. We hypothesize that patients who survive 30 days or more following repair of ruptured AAA (RAAA) performed by open technique have a life expectancy no different to those patients surviving 30 days or more following elective AAA repair, or compared to a general age-matched population. Between 1987 and December 2014, 620 consecutive patients were treated by the principal author for aortic aneurysmal disease. Two subgroups were selected from this population, elective open abdominal repair (215) and RAAA open repair (105). Comparable age-matched life curves with the general population were used from the Australian Bureau of Statistics for each patient according to gender, age and date of presentation. Statistical comparison was by Kaplan-Meier survival analysis. Both the open and RAAA groups were well matched for age and sex. There was no statistical difference between RAAA survival and an age-matched population P = 0.23, or was there any difference between open repair and an age-matched population, P = 0.1. Survival curves for RAAA and open repair were similar, P = 0.98. For elective open repair 1-, 5-, 10-, 15- and 20-year survival was 93.6, 71.2, 40, 17 and 2% respectively. Corresponding results for RAAA were 92.5, 74, 36.7, 13.5 and 5% respectively. Open AAA repair for RAAA or elective aneurysm treatment restores predicted life expectancy for those patients surviving 30 days or more and is therefore a durable method of treatment for this condition. © 2016 Royal Australasian College of Surgeons.

Epidemiology and survival of systemic lupus erythematosus in Hong Kong Chinese.

PubMed

Mok, C C

2011-06-01

Systemic lupus erythematosus (SLE) is a fairly common rheumatic disease in Hong Kong, China. The prevalence and annual incidence of SLE are estimated to be 0.1% and 6.7/100,000 population, respectively. The 10-year cumulative survival of SLE patients in Hong Kong is 83% and the age and gender-adjusted standardized mortality ratio was 5.25 (1.64-10.4) from 1999 to 2008. The commonest cause of death is infections (60%), followed by cardiovascular complications (16%). Life expectancy analysis reveals a loss of 20 years in women and 27 years in men when SLE develops at birth. The loss in life years is greatest in the younger age groups. Renal damage is the most frequent disease-related damage, whereas musculoskeletal damage is the commonest treatment-related complication. The quality of life of our SLE patients is impaired and declines over time, which is contributed by new organ damage. One-third of our patients lose their ability to work within 5 years of disease onset, which is mainly attributed to musculoskeletal pain, fatigue, anxiety and depression symptoms, and memory deterioration. With the availability of novel therapeutics and an increased awareness of complication prevention in SLE, it is expected that our patients will live longer with a better quality of life in the next decade.

Chaotic dynamics of Comet 1P/Halley: Lyapunov exponent and survival time expectancy

NASA Astrophysics Data System (ADS)

Muñoz-Gutiérrez, M. A.; Reyes-Ruiz, M.; Pichardo, B.

2015-03-01

The orbital elements of Comet Halley are known to a very high precision, suggesting that the calculation of its future dynamical evolution is straightforward. In this paper we seek to characterize the chaotic nature of the present day orbit of Comet Halley and to quantify the time-scale over which its motion can be predicted confidently. In addition, we attempt to determine the time-scale over which its present day orbit will remain stable. Numerical simulations of the dynamics of test particles in orbits similar to that of Comet Halley are carried out with the MERCURY 6.2 code. On the basis of these we construct survival time maps to assess the absolute stability of Halley's orbit, frequency analysis maps to study the variability of the orbit, and we calculate the Lyapunov exponent for the orbit for variations in initial conditions at the level of the present day uncertainties in our knowledge of its orbital parameters. On the basis of our calculations of the Lyapunov exponent for Comet Halley, the chaotic nature of its motion is demonstrated. The e-folding time-scale for the divergence of initially very similar orbits is approximately 70 yr. The sensitivity of the dynamics on initial conditions is also evident in the self-similarity character of the survival time and frequency analysis maps in the vicinity of Halley's orbit, which indicates that, on average, it is unstable on a time-scale of hundreds of thousands of years. The chaotic nature of Halley's present day orbit implies that a precise determination of its motion, at the level of the present-day observational uncertainty, is difficult to predict on a time-scale of approximately 100 yr. Furthermore, we also find that the ejection of Halley from the Solar system or its collision with another body could occur on a time-scale as short as 10 000 yr.

Modeling the expected lifetime and evolution of a deme's principal genetic sequence.

NASA Astrophysics Data System (ADS)

Clark, Brian

2014-03-01

The principal genetic sequence (PGS) is the most common genetic sequence in a deme. The PGS changes over time because new genetic sequences are created by inversions, compete with the current PGS, and a small fraction become PGSs. A set of coupled difference equations provides a description of the evolution of the PGS distribution function in an ensemble of demes. Solving the set of equations produces the survival probability of a new genetic sequence and the expected lifetime of an existing PGS as a function of inversion size and rate, recombination rate, and deme size. Additionally, the PGS distribution function is used to explain the transition pathway from old to new PGSs. We compare these results to a cellular automaton based representation of a deme and the drosophila species, D. melanogaster and D. yakuba.

Estimates of genetic and environmental (co)variances for first lactation on milk yield, survival, and calving interval.

PubMed

Dong, M C; van Vleck, L D

1989-03-01

Variance and covariance components for milk yield, survival to second freshening, calving interval in first lactation were estimated by REML with the expectation and maximization algorithm for an animal model which included herd-year-season effects. Cows without calving interval but with milk yield were included. Each of the four data sets of 15 herds included about 3000 Holstein cows. Relationships across herds were ignored to enable inversion of the coefficient matrix of mixed model equations. Quadratics and their expectations were accumulated herd by herd. Heritability of milk yield (.32) agrees with reports by same methods. Heritabilities of survival (.11) and calving interval(.15) are slightly larger and genetic correlations smaller than results from different methods of estimation. Genetic correlation between milk yield and calving interval (.09) indicates genetic ability to produce more milk is lightly associated with decreased fertility.

Social deprivation and prognosis in Scottish patients with pulmonary arterial hypertension.

PubMed

Pellino, Katherine; Kerridge, Simon; Church, Colin; Peacock, Andrew J; Crowe, Timothy; Jayasekera, Geeshath; Johnson, Martin K; MacKenzie, Alison M

2018-02-01

Several demographic and clinical factors have prognostic significance in idiopathic pulmonary arterial hypertension (IPAH). Studies in China and the USA have suggested an association between low socioeconomic status and reduced survival. The impact of social deprivation on IPAH survival in the UK is not known.280 patients with IPAH and hereditary PAH (HPAH) attending the Scottish Pulmonary Vascular Unit (Glasgow, UK) were assigned to social deprivation quintiles using the Scottish Index of Multiple Deprivation database. The association between survival and social deprivation quintile was assessed using Cox proportional hazards regression analysis.The distribution of IPAH/HPAH patients was more socially deprived than would be expected based on Scottish citizenry as a whole (Chi-squared 16.16, p=0.003), suggesting referral and access to care is not impeded by socioeconomic status. Univariate analysis demonstrated no significant association between social deprivation and survival (p=0.81), and this association failed to reach significance with inclusion of time, sex and age as covariates in the model (p=0.23). There were no statistically significant correlations between social deprivation and baseline clinical variables of prognostic importance except for age, sex and quality of life.Social deprivation is not a significant referral barrier or prognostic factor for IPAH and HPAH in Scotland. Copyright ©ERS 2018.

Predictors of lung transplant survival in eurotransplant.

PubMed

Smits, J M A; Mertens, B J A; Van Houwelingen, H C; Haverich, A; Persijn, G G; Laufer, G

2003-11-01

This study was undertaken to assess the influence of patient/donor and center factors on lung transplantation outcome. Outcomes of all consecutive first cadaveric lung transplants performed at 21 Eurotransplant centers in 1997-99 were analyzed. The risk-adjusted center effect on mortality was estimated. A Cox model was built including donor and recipient age and gender, primary disease, HLA mismatches, patient's residence, cold ischemic time, donor's cause of death, serum creatinine, type of lung transplant, respiratory support status, clinical condition and percentage predicted FEV1. The center effect was calculated (expressed as the standardized difference between the observed and expected survival rates), and empirical and full Bayes methods were applied to evaluate between-center differences. A total of 590 adults underwent lung transplantation. The primary disease (p=0.01), HLA-mismatches (p = 0.02), clinical condition(p < 0.0001) and the patient's respiratory support status (p = 0.05) were significantly associated with survival. After adjusting for case-mix, no between-center differences could be found. An in-depth empirical Bayes analysis showed the between-center variation to be zero. Similar results were obtained from the full Bayes analysis. Based on these data, there is no scientific basis to support a hypothesis of possible association between center volume and lung survival rates.

Investigating the benefits of molecular profiling of advanced non-small cell lung cancer tumors to guide treatments.

PubMed

Alifrangis, Costi; Carter, Philip; Cereser, Biancastella; Chandrasinghe, Pramodh; Belluz, Lisa Del Bel; Lim, Eric; Moderau, Nina; Poyia, Fotini; Tabassum, Neha; Zhang, Hua; Krell, Jonathan; Stebbing, Justin

2018-02-27

In this study we utilized data on patient responses to guided treatments, and we evaluated their benefit for a non-small cell lung cancer cohort. The recommended therapies used were predicted using tumor molecular profiles that involved a range of biomarkers but primarily used immunohistochemistry markers. A dataset describing 91 lung non-small cell lung cancer patients was retrospectively split into two. The first group's drugs were consistent with a treatment plan whereby all drugs received agreed with their tumor's molecular profile. The second group each received one or more drug that was expected to lack benefit. We found that there was no significant difference in overall survival or mortality between the two groups. Patients whose treatments were predicted to be of benefit survived for an average of 402 days, compared to 382 days for those that did not ( P = 0.7934). In the matched treatment group, 48% of patients were deceased by the time monitoring had finished compared to 53% in the unmatched group ( P = 0.6094). The immunohistochemistry biomarker for the ERCC1 receptor was found to be a marker that could be used to predict future survival; ERCC1 loss was found to be predictive of poor survival.

The effect of health programs on breastfeeding and child mortality in Peninsular Malaysia.

PubMed

Anderson, K H

1984-01-01

Examining household behavior in Peninsular Malaysia, this study attempts to determine if the availability of certain government health programs significantly alters breastfeeding and if these changes in input prices significantly affect mortality rates and fertility decisions. To explain the interrelationships, an economic model of the demand for infant survival and fertility and the derived demand for breastfeeding is developed. Using household and community level data, the demand equations are then estimated and the results discussed in relation to the predictions of the model and the prospect of additional government inputs. The theoretical model predicts that, if income effects are small: a decline in the price of children (hospital distance) will increase fertility, decrease survival and reduce breastfeeding; a decline in the price of health goods inputs (hospital distance and sanitation) will reduce fertility and increase survival; and a decline in the price of contraceptives (family planning distance) will reduce fertility but increase survival and breastfeeding. The empirical results support some of the model's predictions. In communities with modern sanitation, breastfeeding was shorter on average, as predicted, but differences in mortality were not detected and fertility was actually higher. The latter effect can result from an income effect in the price decline that exceeds the cross substitution effect. Distance to a hospital was positively associated with breastfeeding length. This is expected if the effect of distance on the price of children exceeds the effect of distance on the price of survival. Hospital distance had no impact on either survival or fertility. Distance to a family planning clinic had no effect on breastfeeding or fertility but had a slight positive association with mortality. This positive relationship is expected if fertility and survival are substitutes. Parental schooling and race also are important in determining demand. As economic development proceeds and educational attainment increases, breastfeeding and fertility declined and survival increased. The Chinese, the wealthiest racial group, had lower fertility and mortality and breastfed less than Malays or Indians. The empirical results failed to support the prediction of differences in male and female survival. The results suggest some interesting implications. If breastfeeding has been declining in low income countries such as Malaysia as they develop, the culprit may be the economic development process itself, which increases the value of a woman's time and raises family income. The decline in breastfeeding does not necessarily imply a significant increase in infant mortality if good substitutes for breastfeeding exist. In addition, breastfeeding is highly substitutable with many government programs designed to reduce mortality. In designing policies which will bring about a decline in infant mortality rates, both cross substitution and joint production must be considered. Programs that can be most successful in reducing mortality will be the programs that are the least substitutable with breastfeeding.

Variability in Migration Routes Influences Early Marine Survival of Juvenile Salmon Smolts

PubMed Central

Furey, Nathan B.; Vincent, Stephen P.; Hinch, Scott G.; Welch, David W.

2015-01-01

Variability in animal migratory behavior is expected to influence fitness, but few empirical examples demonstrating this relationship exist. The initial marine phase in the migration of juvenile salmon smolts has been identified as a potentially critical life history stage to overall population productivity, yet how fine-scale migration routes may influence survival are unknown. Large-scale acoustic telemetry studies have estimated survival rates of outmigrant Pacific salmon smolts through the Strait of Georgia (SOG) along the British Columbian coastline to the Pacific Ocean, but these data have not been used to identify and characterize fine-scale movements. Data collected on over 850 sockeye salmon (Oncorhynchus nerka) and steelhead (Oncorhynchus mykiss) smolts detected at an array in the Strait of Georgia in 2004–2008 and 2010–2013 were analyzed to characterize migration routes and link movements to subsequent survival at an array 250 km further along the marine migration pathway. Both species exhibited disproportionate use of the most eastern route in the Strait of Georgia (Malaspina Strait). While many smolts moved across the northern Strait of Georgia acoustic array with no indication of long-term milling or large-scale east-to-west movements, large proportions (20–40% of sockeye and 30–50% of steelhead) exhibited a different behavior, apparently moving in a westward or counterclockwise pattern. Variability in migratory behavior for both species was linked to subsequent survival through the Strait of Georgia. Survival for both species was influenced by initial east-to-west location, and sockeye were further influenced by migration timing and duration of time spent near the northern Strait of Georgia array. Westward movements result in a net transport of smolts from Malaspina Strait to the Strait of Georgia, particularly for steelhead. Counterclockwise movements may be due to the currents in this area during the time of outmigration, and the higher proportion of steelhead smolts exhibiting this counterclockwise behavior may reflect a greater exposure to wind-altered currents for the more surface-oriented steelhead. Our results provide an empirical example of how movements can affect migration survival, for which examples remain rare in movement ecology, confirming that variability in movements themselves are an important part of the migratory process. PMID:26451837

Survival Skills: A Basic Skills Program.

ERIC Educational Resources Information Center

Mahoney, Don

The guide describes an approach designed to promote the basic skills of hearing impaired students Basic or survival skills are identified which cover the student's daily functioning at home, school, and in the community. The guide is aimed at the 10-15 year old hearing impaired student, but techniques are expected to be applicable to both…

Quantifying the changes in survival inequality for Indigenous people diagnosed with cancer in Queensland, Australia.

PubMed

Baade, Peter D; Dasgupta, Paramita; Dickman, Paul W; Cramb, Susanna; Williamson, John D; Condon, John R; Garvey, Gail

2016-08-01

The survival inequality faced by Indigenous Australians after a cancer diagnosis is well documented; what is less understood is whether this inequality has changed over time and what this means in terms of the impact a cancer diagnosis has on Indigenous people. Survival information for all patients identified as either Indigenous (n=3168) or non-Indigenous (n=211,615) and diagnosed in Queensland between 1997 and 2012 were obtained from the Queensland Cancer Registry, with mortality followed up to 31st December, 2013. Flexible parametric survival models were used to quantify changes in the cause-specific survival inequalities and the number of lives that might be saved if these inequalities were removed. Among Indigenous cancer patients, the 5-year cause-specific survival (adjusted by age, sex and broad cancer type) increased from 52.9% in 1997-2006 to 58.6% in 2007-2012, while it improved from 61.0% to 64.9% among non-Indigenous patients. This meant that the adjusted 5-year comparative survival ratio (Indigenous: non-Indigenous) increased from 0.87 [0.83-0.88] to 0.89 [0.87-0.93], with similar improvements in the 1-year comparative survival. Using a simulated cohort corresponding to the number and age-distribution of Indigenous people diagnosed with cancer in Queensland each year (n=300), based on the 1997-2006 cohort mortality rates, 35 of the 170 deaths due to cancer (21%) expected within five years of diagnosis were due to the Indigenous: non-Indigenous survival inequality. This percentage was similar when applying 2007-2012 cohort mortality rates (19%; 27 out of 140 deaths). Indigenous people diagnosed with cancer still face a poorer survival outlook than their non-Indigenous counterparts, particularly in the first year after diagnosis. The improving survival outcomes among both Indigenous and non-Indigenous cancer patients, and the decreasing absolute impact of the Indigenous survival disadvantage, should provide increased motivation to continue and enhance current strategies to further reduce the impact of the survival inequalities faced by Indigenous people diagnosed with cancer. Copyright © 2016 Elsevier Ltd. All rights reserved.

Population size, survival, growth, and movements of Rana sierrae

USGS Publications Warehouse

Fellers, Gary M.; Kleeman, Patrick M.; Miller, David A. W.; Halstead, Brian J.; Link, William

2013-01-01

Based on 2431 captures of 757 individual frogs over a 9-yr period, we found that the population of R. sierrae in one meadow–stream complex in Yosemite National Park ranged from an estimated 45 to 115 adult frogs. Rana sierrae at our relatively low elevation site (2200 m) grew at a fast rate (K = 0.73–0.78), had high overwintering survival rates (44.6–95%), lived a long time (up to 16 yr), and tended to be fairly sedentary during the summer (100% minimum convex polygon annual home ranges of 139 m2) but had low year-to-year site fidelity. Even though the amphibian chytrid fungus (Batrachochytrium dendrobatidis, Bd) has been present in the population for at least 13 yr, there was no clear downward trend as might be expected from reports of R. sierrae population declines associated with Bd or from reports of widespread population decline of R. sierrae throughout its range.

Changes in cohort wealth over a generation.

PubMed

David, M H; Menchik, P L

1988-08-01

Empirical computation of expected wealth is hampered by two problems: mortality risks vary in the population and over time; and observation of net estates for most cohorts is truncated, as some individuals in a cohort survive the calendar date on which observation is terminated. These two problems are solved in estimating cohort wealth for a sample of Wisconsin taxpayers. Hazard rate models of differential occupational mortality risks were estimated from the occupational information on the tax records. Values of net estate are simulated for individuals in each birth cohort who survived. Survivors have characteristics that imply greater wealth holdings than the deceased in every birth year covered by the study (1890-1924). Because of this, estimates of wealth-age relationships produced by the estate multiplier method for any given year will have a serious downward bias. Longitudinal data imply that dissaving does not occur after age 65.

Risk factors for sexual victimization among male and female homeless and runaway youth.

PubMed

Tyler, Kimberly A; Whitbeck, Les B; Hoyt, Dan R; Cauce, Ana M

2004-05-01

Risk factors associated with the likelihood of being sexually victimized by a stranger or friend/acquaintance since being on the street was examined among 372 homeless and runaway youth. Young people were interviewed on the streets and in shelters by outreach workers using a systematic sampling strategy. Youth who engaged in more high-risk behaviors were expected to be at greater risk for sexual victimization by both known and unknown assailants. Results indicated that for females, running from home for the first time at an earlier age was associated with sexual victimization by both a stranger and friend/acquaintance. However, engaging in deviant subsistence strategies, survival sex, and grooming predicted being sexually victimized by a friend/acquaintance. For males, survival sex and grooming predicted stranger sexual victimization, whereas sexual orientation was associated with sexual victimization by a friend/acquaintance. Overall, 35% of the sample had been sexually victimized.

Culture's influence in Japanese and American maternal role perception and confidence.

PubMed

Shand, N

1985-02-01

Japanese recognition of the importance of the mother in ensuring survival of the culture group is very old. This antiquity is spelled out dramatically in the ancient Chinese-Japanese ideographs (in Japan called kanji), which remain in use today. The kanji reflect the cultural isolation of Japan during 300 years of insularity preceding the Meiji period, and reveal the deep historical link to even greater antiquity in continental Asia. The historical development of kanji explicitly associates the concept of woman with passiveness, the home, and domesticity (see "woman," "peaceful," "to marry," and the concept "wife" in Figure 1) and attributes to the mother survival of the infant (see "mother" and "milk" in Figure 1). The dependence of this new member of the culture group on its mother also is conveyed in the kanji depiction of the "child" with its arms open and unable to walk. In contrast, diverse European progenitors of the comparatively recent "American" perception of the maternal role contributed an array of maternal role expectations; though often conflicting, each set of expectations was well-suited to the exigencies of the particular immigrant group's circumstances. Given the contrasting historical circumstances, substantial difference between present Japanese and American perceptions of the maternal role, and in the degree of a woman's confidence in taking the maternal role for the first time, could be expected. These hypotheses were tested using questionnaire responses and drawings made by 102 Japanese women and 104 American Caucasian women in the last trimester of their first pregnancy. The findings are examined in relation to achievement dynamics in the context of culture.

Perinatal Decision Making for Preterm Infants with Congenital Heart Disease: Determinable Risk Factors for Mortality.

PubMed

Lynema, Stephanie; Fifer, Carlen G; Laventhal, Naomi T

2016-06-01

For premature infants with congenital heart disease (CHD), it may be unclear when the burdens of treatment outweigh potential benefits. Parents may thus have to choose between comfort care at birth and medical stabilization until surgical repair is feasible. Better defined outcome data, including risk factors for mortality, are needed to counsel expectant parents who are considering intensive care for premature infants with CHD. We sought to evaluate outcomes in this population to inform expectant parents considering intensive versus palliative care at birth. We performed a retrospective cohort study of infants born <34 weeks who received intensive care with critical or moderately severe CHD predicted to require surgery in the neonatal period or the first 6 months of life. 46 % of 54 infants survived. Among non-survivors, 74 % died prior to surgery (median age 24 days). Of the infants that underwent surgery, 75 % survived. Survival was lower among infants <32 weeks gestational age (GA) (p = 0.013), with birth weight (BW) <1500 g (p = 0.011), or with extra-cardiac anomalies (ECA) (p = 0.015). GA and ECA remained significant risk factors for mortality in multiple logistic regression analysis. In summary, GA < 32 weeks, BW < 1500 g, and ECA are determinable prenatally and were significant risk factors for mortality. The majority of infants who survived to cardiac intervention survived neonatal hospitalization, whereas most of the infants who died did so prior to surgery. For some expectant parents, this early declaration of mortality may support a trial of intensive care while avoiding burdensome interventions.

Additive impacts of experimental climate change increase risk to an ectotherm at the Arctic's edge

USGS Publications Warehouse

Davenport, Jon M.; Hossack, Blake R.; Fishback, LeeAnn

2017-01-01

Globally, Arctic and Subarctic regions have experienced the greatest temperature increases during the last 30 years. These extreme changes have amplified threats to the freshwater ecosystems that dominate the landscape in many areas by altering water budgets. Several studies in temperate environments have examined the adaptive capacity of organisms to enhance our understanding of the potential repercussions of warming and associated accelerated drying for freshwater ecosystems. However, few experiments have examined these impacts in Arctic or Subarctic freshwater ecosystems, where the climate is changing most rapidly. To evaluate the capacity of a widespread ectotherm to anticipated environmental changes, we conducted a mesocosm experiment with wood frogs (Rana sylvatica) in the Canadian Subarctic. Three warming treatments were fully crossed with three drying treatments to simulate a range of predicted changes in wetland environments. We predicted wetland warming and drying would act synergistically, with water temperature partially compensating for some of the negative effects of accelerated drying. Across all drying regimes, a 1 °C increase in water temperature increased the odds of survival by 1.79, and tadpoles in 52-day and 64-day hydroperiod mesocosms were 4.1–4.3 times more likely to survive to metamorphosis than tadpoles in 45-day mesocosms. For individuals who survived to metamorphosis, there was only a weak negative effect of temperature on size. As expected, increased temperatures accelerated tadpole growth through day 30 of the experiment. Our results reveal that one of the dominant herbivores in Subarctic wetlands, wood frog tadpoles, are capable of increasing their developmental rates in response to increased temperature and accelerated drying, but only in an additive manner. The strong negative effects of drying on survival, combined with lack of compensation between these two environmental drivers, suggest changes in the aquatic environment that are expected in this ecosystem will reduce mean fitness of populations across the landscape.

Additive impacts of experimental climate change increase risk to an ectotherm at the Arctic's edge.

PubMed

Davenport, Jon M; Hossack, Blake R; Fishback, LeeAnn

2017-06-01

Globally, Arctic and Subarctic regions have experienced the greatest temperature increases during the last 30 years. These extreme changes have amplified threats to the freshwater ecosystems that dominate the landscape in many areas by altering water budgets. Several studies in temperate environments have examined the adaptive capacity of organisms to enhance our understanding of the potential repercussions of warming and associated accelerated drying for freshwater ecosystems. However, few experiments have examined these impacts in Arctic or Subarctic freshwater ecosystems, where the climate is changing most rapidly. To evaluate the capacity of a widespread ectotherm to anticipated environmental changes, we conducted a mesocosm experiment with wood frogs (Rana sylvatica) in the Canadian Subarctic. Three warming treatments were fully crossed with three drying treatments to simulate a range of predicted changes in wetland environments. We predicted wetland warming and drying would act synergistically, with water temperature partially compensating for some of the negative effects of accelerated drying. Across all drying regimes, a 1 °C increase in water temperature increased the odds of survival by 1.79, and tadpoles in 52-day and 64-day hydroperiod mesocosms were 4.1-4.3 times more likely to survive to metamorphosis than tadpoles in 45-day mesocosms. For individuals who survived to metamorphosis, there was only a weak negative effect of temperature on size. As expected, increased temperatures accelerated tadpole growth through day 30 of the experiment. Our results reveal that one of the dominant herbivores in Subarctic wetlands, wood frog tadpoles, are capable of increasing their developmental rates in response to increased temperature and accelerated drying, but only in an additive manner. The strong negative effects of drying on survival, combined with lack of compensation between these two environmental drivers, suggest changes in the aquatic environment that are expected in this ecosystem will reduce mean fitness of populations across the landscape. © 2016 John Wiley & Sons Ltd.

Experimental evidence for adaptive personalities in a wild passerine bird

PubMed Central

Nicolaus, Marion; Tinbergen, Joost M.; Bouwman, Karen M.; Michler, Stephanie P. M.; Ubels, Richard; Both, Christiaan; Kempenaers, Bart; Dingemanse, Niels J.

2012-01-01

Individuals of the same species differ consistently in risky actions. Such ‘animal personality’ variation is intriguing because behavioural flexibility is often assumed to be the norm. Recent theory predicts that between-individual differences in propensity to take risks should evolve if individuals differ in future fitness expectations: individuals with high long-term fitness expectations (i.e. that have much to lose) should behave consistently more cautious than individuals with lower expectations. Consequently, any manipulation of future fitness expectations should result in within-individual changes in risky behaviour in the direction predicted by this adaptive theory. We tested this prediction and confirmed experimentally that individuals indeed adjust their ‘exploration behaviour’, a proxy for risk-taking behaviour, to their future fitness expectations. We show for wild great tits (Parus major) that individuals with experimentally decreased survival probability become faster explorers (i.e. increase risk-taking behaviour) compared to individuals with increased survival probability. We also show, using quantitative genetics approaches, that non-genetic effects (i.e. permanent environment effects) underpin adaptive personality variation in this species. This study thereby confirms a key prediction of adaptive personality theory based on life-history trade-offs, and implies that selection may indeed favour the evolution of personalities in situations where individuals differ in future fitness expectations. PMID:23097506

Determinants of Patient-Oncologist Prognostic Discordance in Advanced Cancer

PubMed Central

Gramling, Robert; Fiscella, Kevin; Xing, Guibo; Hoerger, Michael; Duberstein, Paul; Plumb, Sandy; Mohile, Supriya; Fenton, Joshua J.; Tancredi, Daniel J.; Kravitz, Richard L.; Epstein, Ronald M.

2018-01-01

IMPORTANCE Patients with advanced cancer often report expectations for survival that differ from their oncologists’ expectations. Whether patients know that their survival expectations differ from those of their oncologists remains unknown. This distinction is important because knowingly expressing differences of opinion is important for shared decision making, whereas patients not knowing that their understanding differs from that of their treating physician is a potential marker of inadequate communication. OBJECTIVE To describe the prevalence, distribution, and proportion of prognostic discordance that is due to patients’ knowingly vs unknowingly expressing an opinion that differs from that of their oncologist. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study conducted at academic and community oncology practices in Rochester, New York, and Sacramento, California. The sample comprises 236 patients with advanced cancer and their 38 oncologists who participated in a randomized trial of an intervention to improve clinical communication. Participants were enrolled from August 2012 to June 2014 and followed up until October 2015. MAIN OUTCOMES AND MEASURES We ascertained discordance by comparing patient and oncologist ratings of 2-year survival probability. For discordant pairs, we determined whether patients knew that their opinions differed from those of their oncologists by asking the patients to report how they believed their oncologists rated their 2-year survival. RESULTS Among the 236 patients (mean [SD] age, 64.5 [11.4] years; 54%female), 161 patient-oncologist survival prognosis ratings (68%; 95%CI, 62%–75%) were discordant. Discordance was substantially more common among nonwhite patients compared with white patients (95%[95%CI, 86%–100%] vs 65%[95%CI, 58%–73%], respectively; P = .03). Among 161 discordant patients, 144 (89%) did not know that their opinions differed from that of their oncologists and nearly all of them (155 of 161 [96%]) were more optimistic than their oncologists. CONCLUSIONS AND RELEVANCE In this study, patient-oncologist discordance about survival prognosis was common and patients rarely knew that their opinions differed from those of their oncologists. PMID:27415765

[Total knee arthroplasty in 2014 : Results, expectations, and complications].

PubMed

Matziolis, G; Röhner, E

2015-04-01

Aseptic loosening seems to have become a minor problem in total knee arthroplasty. In contrast to that, new challenges are defined by changing patients' expectations. Beside reduction of pain and improving mobility, modern implants should not be noticed as such and should not limit sports activities. In this paper, a summary of the development and the current situation of total knee arthroplasty (e.g., implantation numbers, hospitality, operation time, and infection rates) are provided. The data are compared in an international context. In addition, current trends and developments from recent years are shown and rated according to the literature. The paper is based on a literature search (PubMed) and analyses of published official statistical data and expert recommendations. Implantation numbers have been declining gradually in Germany since 2009. In 2013, 127,077 total knee arthroplasties were implanted. In contrast, the number of revision operations has increased gradually during the last decade. In addition, hospital stay and operation time have declined. The development of implants, instruments, and operation techniques results from changing patients' expectations. All innovations must be compared against the results of well-proven techniques. The arthroplasty register may be an instrument to evaluate the results of new techniques and implants in a broad clinical application in terms of survival.

Serum thymidine kinase 1 levels predict cancer-free survival following neoadjuvant, surgical and adjuvant treatment of patients with locally advanced breast cancer

PubMed Central

CHEN, FEIYU; TANG, LILI; XIA, TING; HE, ELLEN; HU, GUOZHU; LI, YUAN; ZHANG, MING; ZHOU, JI; ERIKSSON, STAFFAN; SKOG, SVEN

2013-01-01

In this study, the use of serum thymidine kinase 1 protein (STK1p) concentration for the prognosis of the overall survival of patients with locally advanced breast cancer (n=51) following routine treatment (neoadjuvant treatment, surgery and chemotherapy) was investigated. The patients were followed up for 44 months and the STK1p values were determined by a high-sensitivity enhanced chemiluminescence (ECL) dot blot assay. The variables investigated in relation to metastasis and survival were STK1p, clinical stage, tumor size and age, by the Kaplan-Meier method, the log-rank test and Cox uni- and multivariate analyses. Patients with high STK1p values (≥2.0 pM) 3–6 months after surgery exhibited a positive correlation to clinical stage, tumor size, occurrence of metastasis and survival. The hazard risk for the development of metastatic disease and mortality among breast cancer patients was 11–12 times higher in patients with high compared to those with low STK1p values (<2.0 pM). Notably, patients with stage III/IV disease and low STK1p values exhibited statistically significantly improved survival compared to patients with high STK1p values. A multivariate Cox analysis demonstrated that the STK1p levels 6 months after surgery was the only independent prognostic factor for metastasis and survival. In conclusion, STK1p is a prognostic marker in patients with locally advanced breast cancer and it may help identify a subgroup of stage III/IV patients with improved cancer-free survival expectancy, enabling personalized treatment. PMID:24649267

Inferior survival in liver transplant recipients with hepatocellular carcinoma receiving donation after cardiac death liver allografts.

PubMed

Croome, Kris P; Wall, William; Chandok, Natasha; Beck, Gavin; Marotta, Paul; Hernandez-Alejandro, Roberto

2013-11-01

The impact of ischemia/reperfusion injury in the setting of transplantation for hepatocellular carcinoma (HCC) has not been thoroughly investigated. The present study examined data from the Scientific Registry of Transplant Recipients for all recipients of deceased donor liver transplants performed between January 1, 1995 and October 31, 2011. In a multivariate Cox analysis, significant predictors of patient survival included the following: HCC diagnosis (P < 0.01), donation after cardiac death (DCD) allograft (P < 0.001), hepatitis C virus-positive status (P < 0.01), recipient age (P < 0.01), donor age (P < 0.001), Model for End-Stage Liver Disease score (P < 0.001), recipient race, and an alpha-fetoprotein level > 400 ng/mL at the time of transplantation. In order to test whether the decreased survival seen for HCC recipients of DCD grafts was more than would be expected because of the inferior nature of DCD grafts and the diagnosis of HCC, a DCD allograft/HCC diagnosis interaction term was created to look for potentiation of effect. In a multivariate analysis adjusted for all other covariates, this interaction term was statistically significant (P = 0.049) and confirmed that there was potentiation of inferior survival with the use of DCD allografts in recipients with HCC. In conclusion, patient survival and graft survival were inferior for HCC recipients of DCD allografts versus recipients of donation after brain death allografts. This potentiation of effect of inferior survival remained even after adjustments for the inherent inferiority observed in DCD allografts as well as other known risk factors. It is hypothesized that this difference could reflect an increased rate of recurrence of HCC. © 2013 American Association for the Study of Liver Diseases.

Risk of Progression and Survival in Multiple Myeloma Relapsing After Therapy with IMiDs and Bortezomib: A Multicenter International Myeloma Working Group Study

PubMed Central

Kumar, Shaji; Lee, Jae Hoon; Lahuerta, Juan J.; Morgan, Gareth; Richardson, Paul G.; Crowley, John; Haessler, Jeff; Feather, John; Hoering, Antje; Moreau, Philippe; LeLeu, Xavier; Hullin, Cyrille; Klein, Saskia K.; Sonneveld, Pieter; Siegel, David; Bladé, Joan; Goldschmidt, Hartmut; Jagannath, Sundar; San Miguel, Jesus; Orlowski, Robert; Palumbo, Antonio; Sezer, Orhan; Durie, Brian G.M.

2014-01-01

Promising new drugs are being evaluated for treatment of multiple myeloma (MM), but their impact should be measured against the expected outcome in patients failing current therapies. However, the natural history of relapsed disease in the current era remains unclear. We studied 286 patients with relapsed MM, who were refractory to bortezomib and were relapsed, refractory, or ineligible, to an IMiD (Immunomodulatory Drug), with measurable disease and ECOG PS of 0, 1 or 2. The date patients satisfied the entry criteria was defined as time zero (T0). The median age at diagnosis was 58 years and time from diagnosis to T0 was 3.3 years. Following T0, 213 (74%) patients had a treatment recorded with one or more regimens (median=1; range 0-8). The first regimen contained bortezomib in 55 (26%) patients and an IMiD in 70 (33%). A minor response or better was seen to at least one therapy after T0 in 94 patients (51%) including >=partial response in 69 (38%). The median overall survival and event free survival from T0 were 9 and 5 months respectively. This study confirms the poor outcome once patients become refractory to current treatments. The results provide context for interpreting ongoing trials of new drugs. PMID:21799510

Capture-recapture survival models taking account of transients

USGS Publications Warehouse

Pradel, R.; Hines, J.E.; Lebreton, J.D.; Nichols, J.D.

1997-01-01

The presence of transient animals, common enough in natural populations, invalidates the estimation of survival by traditional capture- recapture (CR) models designed for the study of residents only. Also, the study of transit is interesting in itself. We thus develop here a class of CR models to describe the presence of transients. In order to assess the merits of this approach we examme the bias of the traditional survival estimators in the presence of transients in relation to the power of different tests for detecting transients. We also compare the relative efficiency of an ad hoc approach to dealing with transients that leaves out the first observation of each animal. We then study a real example using lazuli bunting (Passerina amoena) and, in conclusion, discuss the design of an experiment aiming at the estimation of transience. In practice, the presence of transients is easily detected whenever the risk of bias is high. The ad hoc approach, which yields unbiased estimates for residents only, is satisfactory in a time-dependent context but poorly efficient when parameters are constant. The example shows that intermediate situations between strict 'residence' and strict 'transience' may exist in certain studies. Yet, most of the time, if the study design takes into account the expected length of stay of a transient, it should be possible to efficiently separate the two categories of animals.

Nonthyroid Metastasis to the Thyroid Gland: Case Series and Review with Observations by Primary Pathology.

PubMed

Russell, Jonathon O; Yan, Kenneth; Burkey, Brian; Scharpf, Joseph

2016-12-01

Nonthyroid metastases to the thyroid gland can cause morbidity, including dysphagia, dysphonia, and airway compromise. Because metastatic malignancies portend a poor prognosis, obtaining equipoise between treatment morbidity and local disease progression is paramount. We reviewed cases of nonthyroid metastases to determine treatment and prognostic recommendations. Case series with chart review. Tertiary care hospital. We searched PubMed for reported cases between 1994 and September 2013 using search terms as follows: any combination of primary tumor locations and thyroid, as well as the terms thyroid and metastasis. Only unique cases of nonthyroid metastases were included. Combined with 17 additional tumors at our own institution, we found 818 unique nonthyroid metastases, of which 384 had management and survival data available. Renal cell carcinoma was most common, presenting in 293 (35.8%) patients, followed by lung and gastrointestinal malignancies. Patients were treated with total thyroidectomy (34.0%), subtotal thyroidectomy including lobectomy (32.6%), and no surgery (33.5%). Surgical management was associated with improved survival duration (P < .01). Locoregional recurrence was less likely in patients treated with total versus partial thyroidectomy (4.8% vs 13%). Extent of surgical management did not have a significant effect on patient survival. Delayed presentation was associated with improved survival duration (P = .01). Nonthyroid metastases to the thyroid gland are unusual tumors. Surgical intervention is associated with improved survival, but expected morbidity of untreated tumors is difficult to assess. Site of origin, time to diagnosis, and surgical approach are related to survival and recurrence rates. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Restriction to period of interest improves informative value of death certificate only proportions in period analysis of cancer survival.

PubMed

Brenner, Hermann; Jansen, Lina

2015-12-01

The proportion of cases registered by death certificates only (DCO) is a widely used indicator for potential bias in cancer survival studies. Period analysis is increasingly used to derive up-to-date cancer survival estimates. We aimed to assess whether reported DCO proportions should be restricted to the specific recent calendar period ("restricted period") or refer to all diagnosis years of included patients ("full period"). We assessed correlations of bias in period survival estimates resulting from DCO cases with DCO proportions in the restricted and full period, respectively. We used cancer registry data to simulate bias and DCO proportions resulting from various patterns of underreporting of deceased cases. We show results for six common cancers with very different prognosis and five different age groups. In all scenarios, the expected bias was highly correlated with expected DCO proportions in both periods, but correlations were consistently higher with DCO proportions in the restricted period. In period analyses of cancer survival, DCO proportions for the restricted period of specific interest are a better indicator of potential bias due to underreporting of deceased cases than DCO proportions for all years of diagnosis of included patients. Copyright © 2015 Elsevier Inc. All rights reserved.

Long-Term Survival, Quality of Life, and Quality-Adjusted Survival in Critically Ill Patients With Cancer.

PubMed

Normilio-Silva, Karina; de Figueiredo, Adelaide Cristina; Pedroso-de-Lima, Antonio Carlos; Tunes-da-Silva, Gisela; Nunes da Silva, Adriana; Delgado Dias Levites, Andresa; de-Simone, Ana Tereza; Lopes Safra, Patrícia; Zancani, Roberta; Tonini, Paula Camilla; Vasconcelos de Andrade E Silva, Ulysses; Buosi Silva, Thiago; Martins Giorgi, Juliana; Eluf-Neto, José; Costa, Anderson; Abrahão Hajjar, Ludhmila; Biasi Cavalcanti, Alexandre

2016-07-01

To assess the long-term survival, health-related quality of life, and quality-adjusted life years of cancer patients admitted to ICUs. Prospective cohort. Two cancer specialized ICUs in Brazil. A total of 792 participants. None. The health-related quality of life before ICU admission; at 15 days; and at 3, 6, 12, and 18 months was assessed with the EQ-5D-3L. In addition, the vital status was assessed at 24 months. The mean age of the subjects was 61.6 ± 14.3 years, 42.5% were female subjects and half were admitted after elective surgery. The mean Simplified Acute Physiology Score 3 was 47.4 ± 15.6. Survival at 12 and 18 months was 42.4% and 38.1%, respectively. The mean EQ-5D-3L utility measure before admission to the ICU was 0.47 ± 0.43, at 15 days it was 0.41 ± 0.44, at 90 days 0.56 ± 0.42, at 6 months 0.60 ± 0.41, at 12 months 0.67 ± 0.35, and at 18 months 0.67 ± 0.35. The probabilities for attaining 12 and 18 months of quality-adjusted survival were 30.1% and 19.1%, respectively. There were statistically significant differences in survival time and quality-adjusted life years according to all assessed baseline characteristics (ICU admission after elective surgery, emergency surgery, or medical admission; Simplified Acute Physiology Score 3; cancer extension; cancer status; previous surgery; previous chemotherapy; previous radiotherapy; performance status; and previous health-related quality of life). Only the previous health-related quality of life and performance status were associated with the health-related quality of life during the 18-month follow-up. Long-term survival, health-related quality of life, and quality-adjusted life year expectancy of cancer patients admitted to the ICU are limited. Nevertheless, these clinical outcomes exhibit wide variability among patients and are associated with simple characteristics present at the time of ICU admission, which may help healthcare professionals estimate patients' prognoses.

Survival time with pacemaker implantation for dogs diagnosed with persistent atrial standstill.

PubMed

Cervenec, R M; Stauthammer, C D; Fine, D M; Kellihan, H B; Scansen, B A

2017-06-01

To evaluate survival time in dogs with persistent atrial standstill after pacemaker implantation and to compare the survival times for cardiac-related vs. non-cardiac deaths. Secondary objectives were to evaluate the effects of breed and the presence of congestive heart failure (CHF) at the time of diagnosis on survival time. Twenty dogs with persistent atrial standstill and pacemaker implantation. Medical records were searched to identify dogs diagnosed with persistent atrial standstill based on electrocardiogram that underwent pacemaker implantation. Survival after pacemaker implantation was analyzed using the Kaplan-Meier method. The median survival time after pacemaker implantation for all-cause mortality was 866 days. There was no significant difference (p=0.573) in median survival time for cardiac (506 days) vs. non-cardiac deaths (400 days). The presence of CHF at the time of diagnosis did not affect the survival time (P=0.854). No difference in median survival time was noted between breeds (P=0.126). Dogs with persistent atrial standstill have a median survival time of 866 days with pacemaker implantation, though a wide range of survival times was observed. There was no difference in the median survival time for dogs with cardiac-related deaths and those without. Patient breed and the presence of CHF before pacemaker implantation did not affect median survival time. Copyright © 2017 Elsevier B.V. All rights reserved.

42 CFR 482.82 - Condition of participation: Data submission, clinical experience, and outcome requirements for re...

Code of Federal Regulations, 2011 CFR

2011-10-01

... observed number of patient deaths and graft failures 1-year post-transplant to the center's expected number of patient deaths and graft failures 1-year post-transplant using data contained in the most recent...'s patient and graft survival rates to be acceptable if: (i) A center's observed patient survival...

42 CFR 482.82 - Condition of participation: Data submission, clinical experience, and outcome requirements for re...

Code of Federal Regulations, 2012 CFR

2012-10-01

... observed number of patient deaths and graft failures 1-year post-transplant to the center's expected number of patient deaths and graft failures 1-year post-transplant using data contained in the most recent...'s patient and graft survival rates to be acceptable if: (i) A center's observed patient survival...

42 CFR 482.80 - Condition of participation: Data submission, clinical experience, and outcome requirements for...

Code of Federal Regulations, 2011 CFR

2011-10-01

... will compare each transplant center's observed number of patient deaths and graft failures 1-year post-transplant to the center's expected number of patient deaths and graft failures 1-year post-transplant using... graft survival rates to be acceptable if: (i) A center's observed patient survival rate or observed...

42 CFR 482.82 - Condition of participation: Data submission, clinical experience, and outcome requirements for re...

Code of Federal Regulations, 2014 CFR

2014-10-01

... transplant center's observed number of patient deaths and graft failures 1-year post-transplant to the center's expected number of patient deaths and graft failures 1-year post-transplant using data contained... graft survival rates to be acceptable if: (i) A center's observed patient survival rate or observed...

42 CFR 482.82 - Condition of participation: Data submission, clinical experience, and outcome requirements for re...

Code of Federal Regulations, 2013 CFR

2013-10-01

... observed number of patient deaths and graft failures 1-year post-transplant to the center's expected number of patient deaths and graft failures 1-year post-transplant using data contained in the most recent...'s patient and graft survival rates to be acceptable if: (i) A center's observed patient survival...

Feminist Group Counseling with South Asian Women Who Have Survived Intimate Partner Violence

ERIC Educational Resources Information Center

Singh, Anneliese A.; Hays, Danica G.

2008-01-01

This article examines how to use a feminist approach in group counseling with South Asian women who have survived intimate partner violence (IPV). South Asian culture, including gender-role expectations and attitudes about family violence, is discussed. A case study detailing a feminist counseling group conducted with this population is presented.…

"Doing Gender," Ensuring Survival: Mexican Migration and Economic Crisis in the Rural Mountain West

ERIC Educational Resources Information Center

Schmalzbauer, Leah

2011-01-01

This article draws on ethnographic research to explore the impacts of the current economic crisis on Mexican migrant families in rural Montana. It looks specifically at the ways rural families negotiate gender roles and expectations as they devise survival strategies in response to major economic shifts. My analysis suggests that traditional…

How long do centenarians survive? Life expectancy and maximum lifespan.

PubMed

Modig, K; Andersson, T; Vaupel, J; Rau, R; Ahlbom, A

2017-08-01

The purpose of this study was to explore the pattern of mortality above the age of 100 years. In particular, we aimed to examine whether Scandinavian data support the theory that mortality reaches a plateau at particularly old ages. Whether the maximum length of life increases with time was also investigated. The analyses were based on individual level data on all Swedish and Danish centenarians born from 1870 to 1901; in total 3006 men and 10 963 women were included. Birth cohort-specific probabilities of dying were calculated. Exact ages were used for calculations of maximum length of life. Whether maximum age changed over time was analysed taking into account increases in cohort size. The results confirm that there has not been any improvement in mortality amongst centenarians in the past 30 years and that the current rise in life expectancy is driven by reductions in mortality below the age of 100 years. The death risks seem to reach a plateau of around 50% at the age 103 years for men and 107 years for women. Despite the rising life expectancy, the maximum age does not appear to increase, in particular after accounting for the increasing number of individuals of advanced age. Mortality amongst centenarians is not changing despite improvements at younger ages. An extension of the maximum lifespan and a sizeable extension of life expectancy both require reductions in mortality above the age of 100 years. © 2017 The Association for the Publication of the Journal of Internal Medicine.

Difference between observed and expected number of involved lymph nodes reflects the metastatic potential of breast cancer independent to intrinsic subtype.

PubMed

Yu, Ke-Da; Jiang, Yi-Zhou; Shao, Zhi-Ming

2015-06-30

Poor prognosis associated with metastasis in breast cancer patients highlights the critical need to develop an effective evaluation model for metastatic potential (MP). We hypothesized that MP could be also indicated by primary tumor size and involved lymph nodes (LNs). The expected number of involved LNs is defined as tumor size (cm) divided by 1.5. The effect of the surrogate for MP (defined as difference between the number of observed and expected involved LNs) on breast cancer-specific survival (BCSS) was investigated in the first cohort from SEER (n = 108,814). Validation was performed in another SEER cohort (n = 50,414) and a third cohort (n = 3,755). MP is an independent predictor for BCSS in the overall population [hazard ratio (HR) for high MP: 2.92; 95% confidence interval (CI): 2.80-3.03] and in subgroups. The effect of surrogate for MP on survival was independent to intrinsic subtype, with adjusted HRs of 3.46 (95%CI, 2.02-5.93), 2.30 (95%CI, 1.64-3.24), 4.05 (95%CI, 2.85-5.76), and 1.45 (95%CI, 1.04-2.03) in luminal-A, luminal-B, triple-negative, and HER2-positive subtypes, respectively. Difference between the observed and expected number of involved LNs serves as an indicator for MP, which is independent to intrinsic subtype and could predict survival. Our findings need further validation.

Classification of TP53 mutations and HPV predict survival in advanced larynx cancer.

PubMed

Scheel, Adam; Bellile, Emily; McHugh, Jonathan B; Walline, Heather M; Prince, Mark E; Urba, Susan; Wolf, Gregory T; Eisbruch, Avraham; Worden, Francis; Carey, Thomas E; Bradford, Carol

2016-09-01

Assess tumor suppressor p53 (TP53) functional mutations in the context of other biomarkers in advanced larynx cancer. Prospective analysis of pretreatment tumor TP53, human papillomavirus (HPV), Bcl-xL, and cyclin D1 status in stage III and IV larynx cancer patients in a clinical trial. TP53 exons 4 through 9 from 58 tumors were sequenced. Mutations were grouped using three classifications based on their expected function. Each functional group was analyzed for response to induction chemotherapy, time to surgery, survival, HPV status, p16INK4a, Bcl-xl, and cyclin D1 expression. TP53 mutations were found in 22 of 58 (37.9%) patients with advanced larynx cancer, including missense mutations in 13 of 58 (22.4%) patients, nonsense mutations in four of 58 (6.9%), and deletions in five of 58 (8.6%). High-risk HPV was found in 20 of 52 (38.5%) tumors. A classification based on Evolutionary Action score of p53 (EAp53) distinguished missense mutations with high risk for decreased survival from low-risk mutations (P = 0.0315). A model including this TP53 classification, HPV status, cyclin D1, and Bcl-xL staining significantly predicts survival (P = 0.0017). EAp53 functional classification of TP53 mutants and biomarkers predict survival in advanced larynx cancer. NA. Laryngoscope, 126:E292-E299, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Three Decades of Follow-up of Adults After Recovery From Invasive Pneumococcal Pneumonia.

PubMed

Ajayi, Oluwadamilare O; Norton, Nancy B; Gress, Todd W; Stanek, Ronald J; Mufson, Maurice A

2017-05-01

Streptococcus pneumoniae infection is the most common cause of community-acquired pneumonia in adults. Invasive pneumococcal disease (IPD) carries a high case fatality rate. We investigated the lifespan of adults who recovered from IPD during a 32-year follow-up. We determined whether adults discharged after an episode of IPD from hospitals affiliated with the Marshall University Joan C. Edwards School of Medicine in Huntington, West Virginia from 1983-2003 were alive on June 30, 2014. Lifespan was assessed by Kaplan-Meier methodology, Cox proportional hazards multivariate analysis, life expectancy using life tables for West Virginia, years of potential life lost and serotype occurrence. The study group comprised 155 adults who survived IPD. They had a mean age at discharge of 64.6 years, mean lifespan after IPD of 7.1 years, mean expected lifespan after IPD of 17.0 years, mean age at death of 71.6 years and a mean life expectancy of 81.6 years. Only 14 (9.0%) patients lived longer than their life expectancy. Of the 13 comorbid diseases analyzed, cancer and neurologic diseases and the number of comorbid diseases suffered by each patient were the significant variables associated with survival. The mean years of potential life lost was 9.936 years. Only serotype 12 of 31 serotypes recovered occurred more often in patients who survived for 11 or more years after discharge (relative risk = 3.44, 95% CI: 1.19-9.95). The fact that most adult patients who recovered from IPD died before their documented life expectancy argues for the pernicious severity of IPD and the importance of immunization of adults with pneumococcal vaccines. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

Integrated survival analysis using an event-time approach in a Bayesian framework

USGS Publications Warehouse

Walsh, Daniel P.; Dreitz, VJ; Heisey, Dennis M.

2015-01-01

Event-time or continuous-time statistical approaches have been applied throughout the biostatistical literature and have led to numerous scientific advances. However, these techniques have traditionally relied on knowing failure times. This has limited application of these analyses, particularly, within the ecological field where fates of marked animals may be unknown. To address these limitations, we developed an integrated approach within a Bayesian framework to estimate hazard rates in the face of unknown fates. We combine failure/survival times from individuals whose fates are known and times of which are interval-censored with information from those whose fates are unknown, and model the process of detecting animals with unknown fates. This provides the foundation for our integrated model and permits necessary parameter estimation. We provide the Bayesian model, its derivation, and use simulation techniques to investigate the properties and performance of our approach under several scenarios. Lastly, we apply our estimation technique using a piece-wise constant hazard function to investigate the effects of year, age, chick size and sex, sex of the tending adult, and nesting habitat on mortality hazard rates of the endangered mountain plover (Charadrius montanus) chicks. Traditional models were inappropriate for this analysis because fates of some individual chicks were unknown due to failed radio transmitters. Simulations revealed biases of posterior mean estimates were minimal (≤ 4.95%), and posterior distributions behaved as expected with RMSE of the estimates decreasing as sample sizes, detection probability, and survival increased. We determined mortality hazard rates for plover chicks were highest at <5 days old and were lower for chicks with larger birth weights and/or whose nest was within agricultural habitats. Based on its performance, our approach greatly expands the range of problems for which event-time analyses can be used by eliminating the need for having completely known fate data.

Integrated survival analysis using an event-time approach in a Bayesian framework.

PubMed

Walsh, Daniel P; Dreitz, Victoria J; Heisey, Dennis M

2015-02-01

Event-time or continuous-time statistical approaches have been applied throughout the biostatistical literature and have led to numerous scientific advances. However, these techniques have traditionally relied on knowing failure times. This has limited application of these analyses, particularly, within the ecological field where fates of marked animals may be unknown. To address these limitations, we developed an integrated approach within a Bayesian framework to estimate hazard rates in the face of unknown fates. We combine failure/survival times from individuals whose fates are known and times of which are interval-censored with information from those whose fates are unknown, and model the process of detecting animals with unknown fates. This provides the foundation for our integrated model and permits necessary parameter estimation. We provide the Bayesian model, its derivation, and use simulation techniques to investigate the properties and performance of our approach under several scenarios. Lastly, we apply our estimation technique using a piece-wise constant hazard function to investigate the effects of year, age, chick size and sex, sex of the tending adult, and nesting habitat on mortality hazard rates of the endangered mountain plover (Charadrius montanus) chicks. Traditional models were inappropriate for this analysis because fates of some individual chicks were unknown due to failed radio transmitters. Simulations revealed biases of posterior mean estimates were minimal (≤ 4.95%), and posterior distributions behaved as expected with RMSE of the estimates decreasing as sample sizes, detection probability, and survival increased. We determined mortality hazard rates for plover chicks were highest at <5 days old and were lower for chicks with larger birth weights and/or whose nest was within agricultural habitats. Based on its performance, our approach greatly expands the range of problems for which event-time analyses can be used by eliminating the need for having completely known fate data.

Leisure Time Physical Activity of Moderate to Vigorous Intensity and Mortality: A Large Pooled Cohort Analysis

PubMed Central

Moore, Steven C.; Patel, Alpa V.; Matthews, Charles E.; Berrington de Gonzalez, Amy; Park, Yikyung; Katki, Hormuzd A.; Linet, Martha S.; Weiderpass, Elisabete; Visvanathan, Kala; Helzlsouer, Kathy J.; Thun, Michael; Gapstur, Susan M.; Hartge, Patricia; Lee, I-Min

2012-01-01

Background Leisure time physical activity reduces the risk of premature mortality, but the years of life expectancy gained at different levels remains unclear. Our objective was to determine the years of life gained after age 40 associated with various levels of physical activity, both overall and according to body mass index (BMI) groups, in a large pooled analysis. Methods and Findings We examined the association of leisure time physical activity with mortality during follow-up in pooled data from six prospective cohort studies in the National Cancer Institute Cohort Consortium, comprising 654,827 individuals, 21–90 y of age. Physical activity was categorized by metabolic equivalent hours per week (MET-h/wk). Life expectancies and years of life gained/lost were calculated using direct adjusted survival curves (for participants 40+ years of age), with 95% confidence intervals (CIs) derived by bootstrap. The study includes a median 10 y of follow-up and 82,465 deaths. A physical activity level of 0.1–3.74 MET-h/wk, equivalent to brisk walking for up to 75 min/wk, was associated with a gain of 1.8 (95% CI: 1.6–2.0) y in life expectancy relative to no leisure time activity (0 MET-h/wk). Higher levels of physical activity were associated with greater gains in life expectancy, with a gain of 4.5 (95% CI: 4.3–4.7) y at the highest level (22.5+ MET-h/wk, equivalent to brisk walking for 450+ min/wk). Substantial gains were also observed in each BMI group. In joint analyses, being active (7.5+ MET-h/wk) and normal weight (BMI 18.5–24.9) was associated with a gain of 7.2 (95% CI: 6.5–7.9) y of life compared to being inactive (0 MET-h/wk) and obese (BMI 35.0+). A limitation was that physical activity and BMI were ascertained by self report. Conclusions More leisure time physical activity was associated with longer life expectancy across a range of activity levels and BMI groups. Please see later in the article for the Editors' Summary PMID:23139642

Future Expectations of Brasilian Street Youth

ERIC Educational Resources Information Center

Raffaelli, M.; Koller, S.H.

2005-01-01

Future expectations of youth surviving on the streets of Porto Alegre, Brasil, were examined. The sample consisted of 35 boys and 34 girls aged 10-18 (M age 14.4) who participated in a sentence completion task and semi-structured interviews. Responses to two incomplete sentences regarding the future revealed a mismatch between hoped-for and…

Predicting Life Expectancy for Pirfenidone in Idiopathic Pulmonary Fibrosis.

PubMed

Fisher, Mark; Nathan, Steven D; Hill, Christian; Marshall, Jade; Dejonckheere, Fred; Thuresson, Per-Olof; Maher, Toby M

2017-03-01

Conducting an adequately powered survival study in idiopathic pulmonary fibrosis (IPF) is challenging due to the rare nature of the disease and the need for extended follow-up. Consequently, registration trials of IPF treatments have not been designed to estimate long-term survival. To predict life expectancy for patients with IPF receiving pirfenidone versus best supportive care (BSC) in a population that met the inclusion criteria of patients enrolled in the ASCEND and CAPACITY trials. Kaplan-Meier survival data for pirfenidone and BSC were obtained from randomized controlled clinical studies (CAPACITY, ASCEND), an open-label extension study (RECAP), and the Inova Fairfax Hospital database. Data from the Inova registry were matched to the inclusion criteria of the CAPACITY and ASCEND trials. Life expectancy was estimated by the area under the curve of parametric survival distributions fit to the Kaplan-Meier data. Mean (95% confidence interval) life expectancy was calculated as 8.72 (7.65-10.15) years with pirfenidone and 6.24 (5.38-7.18) years with BSC. Therefore, pirfenidone improved life expectancy by 2.47 (1.26-4.17) years compared with BSC. In addition, treatment with pirfenidone recuperated 25% of the expected years of life lost due to IPF. Sensitivity analyses found that results were sensitive to the choice of parametric survival distribution, and alternative piecewise and parametric approaches. This analysis suggests that this population of patients with IPF has an improved life expectancy if treated with pirfenidone compared with BSC. This study was funded by InterMune International AG, a wholly owned Roche subsidiary since 2014. Fisher was previously employed by InterMune UK, a wholly owned Roche subsidiary, until July 2015. He is currently employed by FIECON, which has received funding from F. Hoffmann-La Roche for consulting services. Nathan has received consulting fees from Roche-Genentech and Boehringer Ingelheim. He is also on the speakers' bureau for Roche-Genentech and Boehringer Ingelheim and has received research funding from both companies. Hill was previously employed by InterMune UK until October 2014. Hill and Marshall are employees of MAP BioPharma, which has received funding from F. Hoffmann-La Roche for consulting services. Dejonckheere and Thuresson are employees of F. Hoffmann-La Roche. Maher has received grants, consulting fees, and speaker fees from GlaxoSmithKline and UCB, and grants from Novartis. He has also received consulting fees and speaker fees from AstraZeneca, Bayer, Biogen Idec, Boehringer Ingelheim, Cipla, Lanthio, InterMune International AG, F. Hoffmann-La Roche, Sanofi-Aventis, and Takeda. Maher is supported by a National Institute for Health Research Clinician Scientist Fellowship (NIHR Ref: CS: -2013-13-017). Study concept and design were contributed by Fisher, Hill, Marshall, and Dejonckheere. Fisher, Nathan, and Thuresson collected the data, along with Hill and Marshall. Data interpretation was performed by Fisher, Maher, Nathan, and Dejonckheere. The manuscript was written primarily by Fisher, along with Maher and Dejonckheere, and revised by Fisher and Maher, along with the other authors.

Lung cancer survival in the United States by race and stage (2001-2009): Findings from the CONCORD-2 study.

PubMed

Richards, Thomas B; Henley, S Jane; Puckett, Mary C; Weir, Hannah K; Huang, Bin; Tucker, Thomas C; Allemani, Claudia

2017-12-15

Results from the second CONCORD study (CONCORD-2) indicated that 5-year net survival for lung cancer was low (range, 10%-20%) between 1995 and 2009 in most countries, including the United States, which was at the higher end of this range. Data from CONCORD-2 were used to analyze net survival among patients with lung cancer (aged 15-99 years) who were diagnosed in 37 states covering 80% of the US population. Survival was corrected for background mortality using state-specific and race-specific life tables and age-standardized using International Cancer Survival Standard weights. Net survival was estimated for patients diagnosed between 2001 and 2003 and between 2004 and 2009 at 1, 3, and 5 years after diagnosis by race (all races, black, and white); Surveillance, Epidemiology, and End Results Summary Stage 2000; and US state. Five-year net survival increased from 16.4% (95% confidence interval, 16.3%-16.5%) for patients diagnosed 2001-2003 to 19.0% (18.8%-19.1%) for those diagnosed 2004-2009, with increases in most states and among both blacks and whites. Between 2004 and 2009, 5-year survival was lower among blacks (14.9%) than among whites (19.4%) and ranged by state from 14.5% to 25.2%. Lung cancer survival improved slightly between the periods 2001-2003 and 2004-2009 but was still low, with variation between states, and persistently lower survival among blacks than whites. Efforts to control well established risk factors would be expected to have the greatest impact on reducing the burden of lung cancer, and efforts to ensure that all patients receive timely and appropriate treatment should reduce the differences in survival by race and state. Cancer 2017;123:5079-99. Published 2017. This article is a U.S. Government work and is in the public domain in the USA. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Breast cancer survival in New Zealand women.

PubMed

Campbell, Ian D; Scott, Nina; Seneviratne, Sanjeewa; Kollias, James; Walters, David; Taylor, Corey; Webster, Fleur; Zorbas, Helen; Roder, David M

2015-01-01

The Quality Audit (BQA) of Breast Surgeons of Australia and New Zealand includes a broad range of data and is the largest New Zealand (NZ) breast cancer (BC) database outside the NZ Cancer Registry. We used BQA data to compare BC survival by ethnicity, deprivation, remoteness, clinical characteristic and case load. BQA and death data were linked using the National Health Index. Disease-specific survival for invasive cases was benchmarked against Australian BQA data and NZ population-based survivals. Validity was explored by comparison with expected survival by risk factor. Compared with 93% for Australian audit cases, 5-year survival was 90% for NZ audit cases overall, 87% for Maori, 84% for Pacific and 91% for other. BC survival in NZ appears lower than in Australia, with inequities by ethnicity. Differences may be due to access, timeliness and quality of health services, patient risk profiles, BQA coverage and death-record methodology. © 2014 Royal Australasian College of Surgeons.

Clay mineral type effect on bacterial enteropathogen survival in soil.

PubMed

Brennan, Fiona P; Moynihan, Emma; Griffiths, Bryan S; Hillier, Stephen; Owen, Jason; Pendlowski, Helen; Avery, Lisa M

2014-01-15

Enteropathogens released into the environment can represent a serious risk to public health. Soil clay content has long been known to have an important effect on enteropathogen survival in soil, generally enhancing survival. However, clay mineral composition in soils varies, and different clay minerals have specific physiochemical properties that would be expected to impact differentially on survival. This work investigated the effect of clay materials, with a predominance of a particular mineral type (montmorillonite, kaolinite, or illite), on the survival in soil microcosms over 96 days of Listeria monocytogenes, Salmonella Dublin, and Escherichia coli O157. Clay mineral addition was found to alter a number of physicochemical parameters in soil, including cation exchange capacity and surface area, and this was specific to the mineral type. Clay mineral addition enhanced enteropathogen survival in soil. The type of clay mineral was found to differentially affect enteropathogen survival and the effect was enteropathogen-specific. © 2013.

Analysis of dam-passage survival of yearling and subyearling Chinook salmon and juvenile steelhead at The Dalles Dam, Oregon, 2010

USGS Publications Warehouse

Beeman, John W.; Kock, Tobias J.; Perry, Russell W.; Smith, Steven G.

2011-01-01

We performed a series of analyses of mark-recapture data from a study at The Dalles Dam during 2010 to determine if model assumptions for estimation of juvenile salmonid dam-passage survival were met and if results were similar to those using the University of Washington's newly developed ATLAS software. The study was conducted by the Pacific Northwest National Laboratory and used acoustic telemetry of yearling Chinook salmon, juvenile steelhead, and subyearling Chinook salmon released at three sites according to the new virtual/paired-release statistical model. This was the first field application of the new model, and the results were used to measure compliance with minimum survival standards set forth in a recent Biological Opinion. Our analyses indicated that most model assumptions were met. The fish groups mixed in time and space, and no euthanized tagged fish were detected. Estimates of reach-specific survival were similar in fish tagged by each of the six taggers during the spring, but not in the summer. Tagger effort was unevenly allocated temporally during tagging of subyearling Chinook salmon in the summer; the difference in survival estimates among taggers was more likely a result of a temporal trend in actual survival than of tagger effects. The reach-specific survival of fish released at the three sites was not equal in the reaches they had in common for juvenile steelhead or subyearling Chinook salmon, violating one model assumption. This violation did not affect the estimate of dam-passage survival, because data from the common reaches were not used in its calculation. Contrary to expectation, precision of survival estimates was not improved by using the most parsimonious model of recapture probabilities instead of the fully parameterized model. Adjusting survival estimates for differences in fish travel times and tag lives increased the dam-passage survival estimate for yearling Chinook salmon by 0.0001 and for juvenile steelhead by 0.0004. The estimate was unchanged for subyearling Chinook salmon. The tag-life-adjusted dam-passage survival estimates from our analyses were 0.9641 (standard error [SE] 0.0096) for yearling Chinook salmon, 0.9534 (SE 0.0097) for juvenile steelhead, and 0.9404 (SE 0.0091) for subyearling Chinook salmon. These were within 0.0001 of estimates made by the University of Washington using the ATLAS software. Contrary to the intent of the virtual/paired-release model to adjust estimates of the paired-release model downward in order to account for differential handling mortality rates between release groups, random variation in survival estimates may result in an upward adjustment of survival relative to estimates from the paired-release model. Further investigation of this property of the virtual/paired-release model likely would prove beneficial. In addition, we suggest that differential selective pressures near release sites of the two control groups could bias estimates of dam-passage survival from the virtual/paired-release model.

Longevity and Patau syndrome: what determines survival?

PubMed

Peroos, Sherina; Forsythe, Elizabeth; Pugh, Jennifer Harriet; Arthur-Farraj, Peter; Hodes, Deborah

2012-12-06

The authors report of an 8-year-old girl with non-mosaic Patau syndrome. The median life expectancy of Patau syndrome is 7-10 days, and 90% die in the first year of life. Survival is often attributed to mosaicism and the severity of associated malformations. We delineate the developing phenotype and review the literature discussing potential contributory factors to longevity.

Racial disparities in stage-specific colorectal cancer mortality: 1960-2005.

PubMed

Soneji, Samir; Iyer, Shally Shalini; Armstrong, Katrina; Asch, David A

2010-10-01

We examined whether racial disparities in stage-specific colorectal cancer survival changed between 1960 and 2005. We used US Mortality Multiple-Cause-of-Death Data Files and intercensal estimates to calculate standardized mortality rates by gender and race from 1960 to 2005. We used Surveillance, Epidemiology, and End Results (SEER) data to estimate stage-specific colorectal cancer survival. To account for SEER sampling uncertainty, we used a bootstrap resampling procedure and fit a Cox proportional hazards model. Between 1960-2005, patterns of decline in mortality rate as a result of colorectal cancer differed greatly by gender and race: 54% reduction for White women, 14% reduction for Black women, 39% reduction for White men, and 28% increase for Black men. Blacks consistently experienced worse rates of stage-specific survival and life expectancy than did Whites for both genders, across all age groups, and for localized, regional, and distant stages of the disease. The rates of stage-specific colorectal cancer survival differed among Blacks when compared with Whites during the 4-decade study period. Differences in stage-specific life expectancy were the result of differences in access to care or quality of care. More attention should be given to racial disparities in colorectal cancer management.

A probabilistic approach to the assessment of some life history pattern parameters in a Middle Pleistocene human population.

PubMed

Durand, A I; Ipina, S L; Bermúdez de Castro, J M

2000-06-01

Parameters of a Middle Pleistocene human population such as the expected length of the female reproductive period (E(Y)), the expected interbirth interval (E(X)), the survival rate (tau) for females after the expected reproductive period, the rate (phi(2)) of women who, given that they reach first birth, do not survive to the end of the expected reproductive period, and the female infant plus juvenile mortality rate (phi(1)) have been assessed from a probabilistic standpoint provided that such a population were stationary. The hominid sample studied, the Sima de los Huesos (SH) cave site, Sierra de Atapuerca (Spain), is the most exhaustive human fossil sample currently available. Results suggest that the Atapuerca (SH) sample can derive from a stationary population. Further, in the case that the expected reproductive period ends between 37 and 40 yr of age, then 24 less, similarE(Y) less, similar27 yr, E(X)=3 yr, 0.224

Seasonal life history trade-offs in two leafwing butterflies: Delaying reproductive development increases life expectancy.

PubMed

McElderry, Robert M

2016-04-01

Surviving inhospitable periods or seasons may greatly affect fitness. Evidence of this exists in the prevalence of dormant stages in the life cycles of most insects. Here I focused on butterflies with distinct seasonal morphological types (not a genetic polymorphism) in which one morphological type, or form, delays reproduction until favorable conditions return, while the other form develops in an environment that favors direct reproduction. For two butterflies, Anaea aidea and A. andria, I tested the hypothesis that the development of each seasonal form involves a differential allocation of resources to survival at eclosion. I assayed differences in adult longevity among summer and winter forms in either a warm, active environment or a cool, calm environment. Winter form adults lived 40 times longer than summer form but only in calm, cool conditions. The magnitude of this difference provided compelling evidence that the winter form body plan and metabolic strategy (i.e. resource conservatism) favor long term survival. This research suggests that winter form adults maintain lowered metabolic rate, a common feature of diapause, to conserve resources and delay senescence while overwintering. Copyright © 2016 Elsevier Ltd. All rights reserved.

Optimizing Quality of Life in Patients with Hormone Receptor-Positive Metastatic Breast Cancer: Treatment Options and Considerations.

PubMed

Chalasani, Pavani

2017-01-01

The treatment landscape for hormone receptor-positive metastatic breast cancer continues to evolve as the molecular mechanisms of this heterogeneous disease are better understood and targeted treatment strategies are developed. Patients are now living for extended periods of time with this disease as they progress through sequential lines of treatment. With a rapidly expanding therapeutic armamentarium, the prevalence of metastatic breast cancer patients with prolonged survival is expected to increase, as is the duration of survival. Practice guidelines recommend endocrine therapy alone as first-line therapy for the majority of patients with metastatic hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer. The approval of new agents and expanded combination options has extended their use beyond first line, but endocrine therapy is not used as widely in clinical practice as recommended. As all treatments are palliative, even as survival is prolonged, optimizing and maintaining patient quality of life is crucial. This article surveys data relevant to the use of endocrine therapy in the setting of hormone receptor-positive metastatic breast cancer, including key clinical evidence regarding approved therapies and the impact of these therapies on patient quality of life. © 2017 S. Karger AG, Basel.

Cell-delivered magnetic nanoparticles caused hyperthermia-mediated increased survival in a murine pancreatic cancer model.

PubMed

Basel, Matthew T; Balivada, Sivasai; Wang, Hongwang; Shrestha, Tej B; Seo, Gwi Moon; Pyle, Marla; Abayaweera, Gayani; Dani, Raj; Koper, Olga B; Tamura, Masaaki; Chikan, Viktor; Bossmann, Stefan H; Troyer, Deryl L

2012-01-01

Using magnetic nanoparticles to absorb alternating magnetic field energy as a method of generating localized hyperthermia has been shown to be a potential cancer treatment. This report demonstrates a system that uses tumor homing cells to actively carry iron/iron oxide nanoparticles into tumor tissue for alternating magnetic field treatment. Paramagnetic iron/ iron oxide nanoparticles were synthesized and loaded into RAW264.7 cells (mouse monocyte/ macrophage-like cells), which have been shown to be tumor homing cells. A murine model of disseminated peritoneal pancreatic cancer was then generated by intraperitoneal injection of Pan02 cells. After tumor development, monocyte/macrophage-like cells loaded with iron/ iron oxide nanoparticles were injected intraperitoneally and allowed to migrate into the tumor. Three days after injection, mice were exposed to an alternating magnetic field for 20 minutes to cause the cell-delivered nanoparticles to generate heat. This treatment regimen was repeated three times. A survival study demonstrated that this system can significantly increase survival in a murine pancreatic cancer model, with an average post-tumor insertion life expectancy increase of 31%. This system has the potential to become a useful method for specifically and actively delivering nanoparticles for local hyperthermia treatment of cancer.

Insect outbreak shifts the direction of selection from fast to slow growth rates in the long-lived conifer Pinus ponderosa.

PubMed

de la Mata, Raul; Hood, Sharon; Sala, Anna

2017-07-11

Long generation times limit species' rapid evolution to changing environments. Trees provide critical global ecosystem services, but are under increasing risk of mortality because of climate change-mediated disturbances, such as insect outbreaks. The extent to which disturbance changes the dynamics and strength of selection is unknown, but has important implications on the evolutionary potential of tree populations. Using a 40-y-old Pinus ponderosa genetic experiment, we provide rare evidence of context-dependent fluctuating selection on growth rates over time in a long-lived species. Fast growth was selected at juvenile stages, whereas slow growth was selected at mature stages under strong herbivory caused by a mountain pine beetle ( Dendroctonus ponderosae ) outbreak. Such opposing forces led to no net evolutionary response over time, thus providing a mechanism for the maintenance of genetic diversity on growth rates. Greater survival to mountain pine beetle attack in slow-growing families reflected, in part, a host-based life-history trade-off. Contrary to expectations, genetic effects on tree survival were greatest at the peak of the outbreak and pointed to complex defense responses. Our results suggest that selection forces in tree populations may be more relevant than previously thought, and have implications for tree population responses to future environments and for tree breeding programs.

Survival rates of birds of tropical and temperate forests: will the dogma survive?

USGS Publications Warehouse

Karr, J.R.; Nichols, J.D.; Klimkiewicz, M.K.; Brawn, J.D.

1990-01-01

Survival rates of tropical forest birds are widely assumed to be high relative to the survival rates of temperate forest birds. Much life-history theory is based on this assumption despite the lack of empirical data to support it. We provide the first detailed comparison of survival rates of tropical and temperate forest birds based on extensive data bases and modern capture-recapture models. We find no support for the conventional wisdom. Because clutch size is only one component of reproductive rate, the frequently assumed, simple association between clutch size and adult survival rates should not necessarily be expected. Our results emphasize the need to consider components of fecundity in addition to clutch size when comparing the life histories of tropical and temperate birds and suggest similar considerations in the development of vertebrate life-history theory.

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

Frangakis, Constantine; Geschwind, Jean-Francois; Kim, Daniel

Introduction: The drop-off risk for patients awaiting liver transplantation for hepatocellular carcinoma (HCC) is 22%. Transplant liver availability is expected to worsen, resulting in longer waiting times and increased drop-off rates. Our aim was to determine whether chemoembolization can decrease this risk. Patients and Methods: Eighty-seven consecutive HCC patients listed for liver transplant (Milan criteria) underwent statistical comparability adjustments using the propensity score (Wilcoxon, Fisher's, and chi-square tests). Forty-three nonchemoembolization patients and 22 chemoembolization patients were comparable for Child-Pugh and Model for End-Stage Liver Disease scores, tumor size and number, alpha fetoprotein (AFP) levels, and cause of cirrhosis. We calculatedmore » the risk of dropping off the transplant list by assigning a transplant time to those who dropped off (equal probability with patients who were on the list longer than the patient in question). The significance level was obtained by calculating the simulation distribution of the difference compared with the permutations of chemoembolization versus nonchemoembolization assignment of the patients. Kaplan-Meier estimators (log-rank test) were used to determine survival rates. Results: Median follow-up was 187 {+-} 110 weeks (range 38 to 435, date of diagnosis). The chemoembolization group had an 80% drop-off risk decrease (15% nonchemoembolization versus 3% chemoembolization, p = 0.04). Although survival was better for the chemoembolization group, it did not reach statistical significance. Two-year survival for the nonchemoembolization and chemoembolization group was 57.3% {+-} 7.1% and 76.0% {+-} 7.9%, respectively (p = 0.078). Conclusions: Chemoembolization appears to result in a significant decrease in the risk of dropping off liver transplant list for patients with HCC and results in a tendency toward longer survival.« less

Research on Captive Broodstock Programs for Pacific Salmon, 2001-2002 Annual Report.

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

Berejikian, Barry; Tezak, E.; Endicott, Rick

The efficacy of captive broodstock programs depends on high in-culture survival and the fitness of cultured salmon after release, either as adults or juveniles. Continuing captive broodstock research designed to improve technology is being conducted to cover all major life history stages of Pacific salmon. The following summarizes some of the work performed and results from the FY 2001 performance period: (1) The incidence of male maturation of age-1 chinook salmon was significantly reduced by reducing growth in the first year of rearing. (2) Experimentally manipulated growth rates of captively-reared coho salmon had significant effects on female maturation rate, eggmore » size, and fecundity, and the effects were stage-specific (i.e., pre-smolt vs. post-smolt). (3) A combination of Renogen and MT239 vaccination of yearling chinook salmon given an acute R. salmoninarum challenge had a significantly longer survival time than the mock-vaccinated group. The survival time was marginally higher than was seen in acutely challenged fish vaccinated with either Renogen or MT239 alone and suggests that a combination vaccine of Renogen and MT239 may be useful as both a prophylactic and therapeutic agent against BKD. (4) Full-sib (inbred) groups of chinook salmon have thus far exhibited lower ocean survival than half-sib and non-related groups. Effects of inbreeding on fluctuating asymmetry did not follow expected patterns. (5) Sockeye salmon were exposed to specific odorants at either the alevin/emergent fry stage or the smolt stage to determine the relative importance of odorant exposure during key developmental periods and the importance of exposure duration. (6) Experimental studies to determine the effects of exercise conditioning on steelhead reproductive behavior and the effects of male body size on chinook salmon fertilization success during natural spawning were completed.« less

Survival and settling of larval Macoma balthica in a large-scale mesocosm experiment at different fCO2 levels

NASA Astrophysics Data System (ADS)

Jansson, Anna; Lischka, Silke; Boxhammer, Tim; Schulz, Kai G.; Norkko, Joanna

2016-06-01

Anthropogenic carbon dioxide (CO2) emissions are causing severe changes in the global inorganic carbon balance of the oceans. Associated ocean acidification is expected to pose a major threat to marine ecosystems worldwide, and it is also expected to be amplified in the Baltic Sea where the system is already exposed to relatively large natural seasonal and diel pH fluctuations. We studied the responses of larvae of the benthic key species Macoma balthica to a range of future CO2 scenarios using six ˜ 55 m3 mesocosms encompassing the entire pelagic community. The mesocosms were deployed in the northern Baltic Sea in June 2012. We focused on the survival, growth and subsequent settlement process of Macoma balthica when exposed to different levels of future CO2. The size and time to settlement of M. balthica increased along the CO2 gradient, suggesting a developmental delay. With ongoing climate change, both the frequency and extent of regularly occurring high CO2 conditions are likely to increase, and a permanent pH decrease will likely occur. The strong impact of increasing CO2 levels on early-stage bivalves is alarming as these stages are crucial for sustaining viable populations, and a failure in their recruitment would ultimately lead to negative effects on the population.

Dark recovery of uv-irradiated phage TI. I. A minor recovery effect whose exclusion permits the study of survival kinetics under presumably repairless conditions

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

Harm, W.

1973-12-01

The survival of uv-irradiated phage Tl is much lower in excision repair- deficient than in excision repair-proficient E.coli cells, due to lack of host ceH reactivation (HCR). sn additional decrease in phage survival occurs when repair-deficient (HCR-) host cells have been exposed to uv doses from 3000 to 10,000 erg mm/-sup 2/ of 254 nm uv radiation prior to infection. The observed effect is attributed to loss of a minor phage recovery process, which requires neither the bacterial excision repair nor the bacterial REC repair system. This type of recovery is little affected by caffeine or acriflavine at concentrations thatmore » preclude HCR completely. Its full inhibition by uv-irradiation of the cells requires on approximately 8 times larger dose than complete inhibition of HCR. In heavily preirradiated cells, the TI burst size is extremely small and multiplicity reactivation is considerably less extensive than in unirradiated cells. Presumably the survival of singly infecting Tl in these cells reflects absence of any type of repair. The observed phage sensitivity and shape of the curve are compatible with the expectation for completely repairless conditions. The mechanism underlying the minor recovery is not known; theoretical considerations make a phage REC repair mechanism seem likely. (auth)« less

A hybrid approach of gene sets and single genes for the prediction of survival risks with gene expression data.

PubMed

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

2015-01-01

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

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

PubMed Central

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

2015-01-01

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

Management of advanced pancreatic cancer in daily clinical practice.

PubMed

Giuliani, Jacopo; Piacentini, Paolo; Bonetti, Andrea

2016-01-01

The aim of this outcome study was to evaluate the management of advanced pancreatic cancer in a real-world clinical practice; few such experiences have been reported in the literature. A retrospective analysis was performed of all consecutive patients with advanced pancreatic ductal adenocarcinoma followed at our medical oncology unit between January 2003 and December 2013. We evaluated 78 patients, mostly with metastatic disease (64.1%). Median follow-up was 10.77 months, by which time 74 patients (94.9%) had died. Median overall survival was 8.29 months. Median age was 67 years. In univariate analysis, pain at onset (p = 0.020), ECOG performance status (p<0.001), stage (p = 0.047), first-line chemotherapy (p<0.001), second-line chemotherapy (p<0.001) and weight loss at diagnosis (p = 0.029) were factors that had an impact on overall survival. In multivariate analysis, the presence of pain at onset (p = 0.043), stage (p = 0.003) and second-line chemotherapy (p = 0.004) were confirmed as independent prognostic factors. Our data, derived from daily clinical practice, confirmed advanced pancreatic cancer as an aggressive malignant disease with a very short expected survival. Second-line treatment seems to provide an advantage in terms of overall survival in patients who showed a partial response as their best response to first-line treatment.

Management of occluded self-expanding biliary metal stents in malignant biliary disease.

PubMed

Nennstiel, Simon; Tschurtschenthaler, Isolde; Neu, Bruno; Algül, Hana; Bajbouj, Monther; Schmid, Roland M; von Delius, Stefan; Weber, Andreas

2018-02-01

Occlusion of self-expanding metal stents (SEMS) in malignant biliary obstruction occurs in up to 40% of patients. This study aimed to compare the different techniques to resolve stent occlusion in our collective of patients. Patients with malignant biliary obstruction and occlusion of biliary metal stent at a tertiary referral endoscopic center were retrospectively identified between April 1, 1994 and May 31, 2014. The clinical records were further analyzed regarding the characteristics of patients, malignant strictures, SEMS, management strategies, stent patency, subsequent interventions, survival time and case charges. A total of 108 patients with biliary metal stent occlusion were identified. Seventy-nine of these patients were eligible for further analysis. Favored management was plastic stent insertion in 73.4% patients. Second SEMS were inserted in 12.7% patients. Percutaneous transhepatic biliary drainage and mechanical cleansing were conducted in a minority of patients. Further analysis showed no statistically significant difference in median overall secondary stent patency (88 vs. 143 days, P = 0.069), median survival time (95 vs. 192 days, P = 0.116), median subsequent intervention rate (53.4% vs. 40.0%, P = 0.501) and median case charge (€5145 vs. €3473, P = 0.803) for the treatment with a second metal stent insertion compared to plastic stent insertion. In patients with survival time of more than three months, significantly more patients treated with plastic stents needed re-interventions than patients treated with second SEMS (93.3% vs. 57.1%, P = 0.037). In malignant biliary strictures, both plastic and metal stent insertions are feasible strategies for the treatment of occluded SEMS. Our data suggest that in palliative biliary stenting, patients especially those with longer expected survival might benefit from second SEMS insertion. Careful patient selection is important to ensure a proper decision for either management strategy. Copyright © 2018 First Affiliated Hospital, Zhejiang University School of Medicine in China. Published by Elsevier B.V. All rights reserved.

Rise and fall of HCV-related hepatocellular carcinoma in Italy: a long-term survey from the ITA.LI.CA centres.

PubMed

Cazzagon, Nora; Trevisani, Franco; Maddalo, Gemma; Giacomin, Anna; Vanin, Veronica; Pozzan, Caterina; Poggio, Paolo Del; Rapaccini, Gianludovico; Nolfo, Anna M Di; Benvegnù, Luisa; Zoli, Marco; Borzio, Franco; Giannini, Edoardo G; Caturelli, Eugenio; Chiaramonte, Maria; Foschi, Francesco G; Cabibbo, Giuseppe; Felder, Martina; Ciccarese, Francesca; Missale, Gabriele; Baroni, Gianluca Svegliati; Morisco, Filomena; Pecorelli, Anna; Farinati, Fabio

2013-10-01

Hepatitis C virus (HCV) is the leading aetiological factor of HCC in the western world where, overall, its incidence is increasing, despite data suggesting an initial drop in some areas. The aim of this study was to evaluate epidemiology, clinical features and survival of HCV-related HCC (HCV-HCC) in a wide time range in Italy. Multicentre retrospective study including 3695 patients prospectively recruited by the ITA.LI.CA group. Patients were classified into three subgroups according to aetiology (Group A[GA], pure HCV; Group B[GB], HCV + cofactors; and Group C[GC], non-HCV) and in 5 time cohorts (5 years each), according to the year of diagnosis. Age, gender, Child-Pugh score, modality of diagnosis, stage, presence of thrombosis/metastases, type of treatment and survival were analysed. A total of 1801 GA patients, 445 GB and 1333 GC were recruited. The number of GA patients peaked in the 1996-2000, gradually dropping thereafter (P < 0.0001), as observed for GB (P < 0.0001). Age at diagnosis increased (P < 0.0001), while percentage of patients diagnosed during surveillance and stage improved only in GA (P = 0.02 and P = 0.003 respectively). The survival significantly increased over time particularly in GA (median 37 months) and was longer in GA than in GB and GC (P < 0.0001). The prevalence of HCC-HCV is decreasing in Italy since 2001. HCV-HCC patients are older, more frequently diagnosed under surveillance and in an earlier stage. HCC survival improved in the last 15 years and is significantly higher in patients with HCV-HCC. We therefore expect a further drop in both incidence and mortality for HCV-HCC in the years to come. © 2013 John Wiley & Sons A/S.

Tumour cell dormancy as a contributor to the reduced survival of GBM patients who received standard therapy.

PubMed

Tong, Luqing; Yi, Li; Liu, Peidong; Abeysekera, Iruni Roshanie; Hai, Long; Li, Tao; Tao, Zhennan; Ma, Haiwen; Xie, Yang; Huang, Yubao; Yu, Shengping; Li, Jiabo; Yuan, Feng; Yang, Xuejun

2018-07-01

Glioblastoma multiforme (GBM) is a fatal cancer with varying life expectancy, even for patients undergoing the same standard therapy. Identification of differentially expressed genes in GBM patients with different survival rates may benefit the development of effective therapeutic strategies. In the present study, key pathways and genes correlated with survival in GBM patients were screened with bioinformatic analysis. Included in the study were 136 eligible patients who had undertaken surgical resection of GBM followed by temozolomide (TMZ) chemoradiation and long-term therapy with TMZ. A total of 383 differentially expressed genes (DEGs) related to GBM survival were identified. Gene Ontology and pathway enrichment analysis as well as hub gene screening and module analysis were performed. As expected, angiogenesis and migration of GBM cells were closely correlated with a poor prognosis. Importantly, the results also indicated that cell dormancy was an essential contributor to the reduced survival of GBM patients. Given the lack of specific targeted genes and pathways known to be involved in tumour cell dormancy, we proposed enriched candidate genes related to the negative regulation of cell proliferation, signalling pathways regulating pluripotency of stem cells and neuroactive ligand-receptor interaction, and 3 hub genes (FTH1, GRM1 and DDIT3). Maintaining persistent cell dormancy or preventing tumour cells from entering dormancy during chemoradiation should be a promising therapeutic strategy.

Adipose-Derived Mesenchymal Stem Cell Administration Does Not Improve Corneal Graft Survival Outcome

PubMed Central

Fuentes-Julián, Sherezade; Arnalich-Montiel, Francisco; Jaumandreu, Laia; Leal, Marina; Casado, Alfonso; García-Tuñon, Ignacio; Hernández-Jiménez, Enrique; López-Collazo, Eduardo; De Miguel, Maria P.

2015-01-01

The effect of local and systemic injections of mesenchymal stem cells derived from adipose tissue (AD-MSC) into rabbit models of corneal allograft rejection with either normal-risk or high-risk vascularized corneal beds was investigated. The models we present in this study are more similar to human corneal transplants than previously reported murine models. Our aim was to prevent transplant rejection and increase the length of graft survival. In the normal-risk transplant model, in contrast to our expectations, the injection of AD-MSC into the graft junction during surgery resulted in the induction of increased signs of inflammation such as corneal edema with increased thickness, and a higher level of infiltration of leukocytes. This process led to a lower survival of the graft compared with the sham-treated corneal transplants. In the high-risk transplant model, in which immune ocular privilege was undermined by the induction of neovascularization prior to graft surgery, we found the use of systemic rabbit AD-MSCs prior to surgery, during surgery, and at various time points after surgery resulted in a shorter survival of the graft compared with the non-treated corneal grafts. Based on our results, local or systemic treatment with AD-MSCs to prevent corneal rejection in rabbit corneal models at normal or high risk of rejection does not increase survival but rather can increase inflammation and neovascularization and break the innate ocular immune privilege. This result can be partially explained by the immunomarkers, lack of immunosuppressive ability and immunophenotypical secretion molecules characterization of AD-MSC used in this study. Parameters including the risk of rejection, the inflammatory/vascularization environment, the cell source, the time of injection, the immunosuppression, the number of cells, and the mode of delivery must be established before translating the possible benefits of the use of MSCs in corneal transplants to clinical practice. PMID:25730319

Working memory load eliminates the survival processing effect.

PubMed

Kroneisen, Meike; Rummel, Jan; Erdfelder, Edgar

2014-01-01

In a series of experiments, Nairne, Thompson, and Pandeirada (2007) demonstrated that words judged for their relevance to a survival scenario are remembered better than words judged for a scenario not relevant on a survival dimension. They explained this survival-processing effect by arguing that nature "tuned" our memory systems to process and remember fitness-relevant information. Kroneisen and Erdfelder (2011) proposed that it may not be survival processing per se that facilitates recall but the richness and distinctiveness with which information is encoded. To further test this account, we investigated how the survival processing effect is affected by cognitive load. If the survival processing effect is due to automatic processes or, alternatively, if survival processing is routinely prioritized in dual-task contexts, we would expect this effect to persist under cognitive load conditions. If the effect relies on cognitively demanding processes like richness and distinctiveness of encoding, however, the survival processing benefit should be hampered by increased cognitive load during encoding. Results were in line with the latter prediction, that is, the survival processing effect vanished under dual-task conditions.

Antagonistic effect of helpers on breeding male and female survival in a cooperatively breeding bird

PubMed Central

Paquet, Matthieu; Doutrelant, Claire; Hatchwell, Ben J; Spottiswoode, Claire N; Covas, Rita

2015-01-01

1. Cooperatively breeding species are typically long lived and hence, according to theory, are expected to maximize their lifetime reproductive success through maximizing survival. Under these circumstances, the presence of helpers could be used to lighten the effort of current reproduction for parents to achieve higher survival. 2. In addition, individuals of different sexes and ages may follow different strategies, but whether male and female breeders and individuals of different ages benefit differently from the presence of helpers has often been overlooked. Moreover, only one study that investigated the relationship between parental survival and the presence of helpers used capture–mark–recapture analyses (CMR). These methods are important since they allow us to account for the non-detection of individuals that are alive in the population but not detected, and thus, the effects on survival and recapture probability to be disentangled. 3. Here, we used multi-event CMR methods to investigate whether the number of helpers was associated with an increase in survival probability for male and female breeders of different ages in the sociable weaver Philetairus socius. In this species, both sexes reduce their feeding rate in the presence of helpers. We therefore predicted that the presence of helpers should increase the breeders' survival in both sexes, especially early in life when individuals potentially have more future breeding opportunities. In addition, sociable weaver females reduce their investment in eggs in the presence of helpers, so we predicted a stronger effect of helpers on female than male survival. 4. As expected we found that females had a higher survival probability when breeding with more helpers. Unexpectedly, however, male survival probability decreased with increasing number of helpers. This antagonistic effect diminished as the breeders grew older. 5. These results illustrate the complexity of fitness costs and benefits underlying cooperative behaviours and how these may vary with the individuals' sex and age. They also highlight the need for further studies on the sex-specific effects of helpers on survival. PMID:25850564

A time reference distribution concept for a time division communication network

NASA Technical Reports Server (NTRS)

Stover, H. A.

1973-01-01

Starting with an assumed ideal network having perfect clocks at every node and known fixed transmission delays between nodes, the effects of adding tolerances to both transmission delays and nodal clocks is described. The advantages of controlling tolerances on time rather than frequency are discussed. Then a concept is presented for maintaining these tolerances on time throughout the network. This concept, called time reference distribution, is a systematic technique for distributing time reference to all nodes of the network. It is reliable, survivable and possesses many other desirable characteristics. Some of its features such as an excellent self monitoring capability will be pointed out. Some preliminary estimates of the accuracy that might be expected are developed and there is a brief discussion of the impact upon communication system costs. Time reference distribution is a concept that appears very attractive. It has not had experimental evaluation and has not yet been endorsed for use in any communication network.

Initial therapy of mantle cell lymphoma

PubMed Central

Witzig, Thomas E.

2011-01-01

Mantle cell lymphoma is a well-recognized distinct clinicopathologic subtype of B-cell non-Hodgkin lymphoma. The current World Health Organization (WHO) classification subdivides this entity into aggressive and other variants. The disease has a predilection for older males, and patients typically present at an advanced stage with frequent splenomegaly and extranodal involvement including bone marrow, peripheral blood, gastrointestinal, and occasional central nervous system involvement. Early studies of therapy outcomes in this disease revealed that while response rates where high, relapse was expected after a limited period of time. Prolonged survival was uncommon, with initial median survival rates typically in the 3–4-year range. Those with a high proliferative rate, blastoid morphology, and selected clinical features were recognized as having a worse prognosis. Therapeutic approaches have diverged into aggressive therapies with high response rates and promising progression free survival rates, which may be applied to younger healthy patients, and less aggressive approaches. Aggressive therapies include intensive chemotherapy alone or chemotherapy followed by autologous stem cell transplant, which has been shown to be most effective when applied in first remission. Whether these more intense therapies result in improved survival as compared with less aggressive therapies is not well established. Allogeneic transplant has also been investigated, although high treatment-related mortality and the risk of chronic graft versus host disease and the relatively advanced age of this patient population have tempered enthusiasm for this approach. A number of less aggressive therapies have been shown to produce promising results. Consolidation and maintenance strategies are an active area of investigation. A number of newer agents have shown promising activity in relapsed disease, and are being investigated in the front-line setting. Overall survival rates are improving in this disease, with current studies suggesting a median survival of 5 or more years. PMID:23556104

Conditional survival of all primary brain tumor patients by age, behavior, and histology.

PubMed

Porter, Kimberly R; McCarthy, Bridget J; Berbaum, Michael L; Davis, Faith G

2011-01-01

Survival statistics commonly reflect survival from the time of diagnosis but do not take into account survival already achieved after a diagnosis. The objective of this study was to provide conditional survival estimates for brain tumor patients as a more accurate measure of survival for those who have already survived for a specified amount of time after diagnosis. Data on primary malignant and nonmalignant brain tumor cases diagnosed from 1985-2005 from selected SEER state cancer registries were obtained. Relative survival up to 15 years postdiagnosis and varying relative conditional survival rates were computed using the life-table method. The overall 1-year relative survival estimate derived from time of diagnosis was 67.8% compared to the 6-month relative conditional survival rate of 85.7% for 6-month survivors (the probability of surviving to 1 year given survival to 6 months). The 10-year overall relative survival rate was 49.5% from time of diagnosis compared to the 8-year relative conditional survival rate of 79.2% for 2-year survivors. Conditional survival estimates and standard survival estimates varied by histology, behavior, and age at diagnosis. The 5-year relative survival estimate derived from time of diagnosis for glioblastoma was 3.6% compared to the 3-year relative conditional survival rate of 36.4% for 2-year survivors. For most nonmalignant tumors, the difference between relative survival and the corresponding conditional survival estimates were minimal. Older age groups had greater numeric gains in survival but lower conditional survival estimates than other age groups. Similar findings were seen for other conditional survival intervals. Conditional survival is a useful disease surveillance measure for clinicians and brain tumor survivors to provide them with better 'real-time' estimates and hope. Copyright © 2011 S. Karger AG, Basel.

Incidence, prevalence, and survival of chronic pancreatitis: a population-based study.

PubMed

Yadav, Dhiraj; Timmons, Lawrence; Benson, Joanne T; Dierkhising, Ross A; Chari, Suresh T

2011-12-01

Population-based data on chronic pancreatitis (CP) in the United States are scarce. We determined incidence, prevalence, and survival of CP in Olmsted County, MN. Using Mayo Clinic Rochester's Medical Diagnostic Index followed by a detailed chart review, we identified 106 incident CP cases from 1977 to 2006 (89 clinical cases, 17 diagnosed only at autopsy); CP was defined by previously published Mayo Clinic criteria. We calculated age- and sex-adjusted incidence (for each decade) and prevalence rate (1 January 2006) per 100,000 population (adjusted to 2000 US White population). We compared the observed survival rate for patients with expected survival for age- and sex-matched Minnesota White population. Median age at diagnosis of CP was 58 years, 56% were male, and 51% had alcoholic CP. The overall (clinical cases or diagnosed only at autopsy) age- and sex-adjusted incidence was 4.05/100,000 person-years (95% confidence interval (CI) 3.27-4.83). The incidence rate for clinical cases increased significantly from 2.94/100,000 during 1977-1986 to 4.35/100,000 person-years during 1997-2006 (P<0.05) because of an increase in the incidence of alcoholic CP. There were 51 prevalent CP cases on 1 January 2006 (57% male, 53% alcoholic). The age- and sex-adjusted prevalence rate per 100,000 population was 41.76 (95% CI 30.21-53.32). At last follow-up, 50 patients were alive. Survival among CP patients was significantly lower than age- and sex-specific expected survival in Minnesota White population (P<0.001). Incidence and prevalence of CP are low, and ∼50% are alcohol related. The incidence of CP cases diagnosed during life is increasing. Survival of CP patients is lower than in the Minnesota White population.

A nationwide study of serous "borderline" ovarian tumors in Denmark 1978-2002: centralized pathology review and overall survival compared with the general population.

PubMed

Hannibal, Charlotte Gerd; Vang, Russell; Junge, Jette; Frederiksen, Kirsten; Kjaerbye-Thygesen, Anette; Andersen, Klaus Kaae; Tabor, Ann; Kurman, Robert J; Kjaer, Susanne K

2014-08-01

To describe the study population and estimate overall survival of women with a serous "borderline" ovarian tumor (SBT) in Denmark over 25 years relative to the general population. The Danish Pathology Data Bank and the Danish Cancer Registry were used to identify 1487 women diagnosed with SBTs from 1978 to 2002. The histologic slides were collected from Danish pathology departments and reviewed by expert pathologists and classified as SBT/atypical proliferative serous tumor (APST) or noninvasive low-grade serous carcinoma (LGSC). Associated implants were classified as noninvasive or invasive. Medical records were collected from hospital departments and reviewed. Data were analyzed using Kaplan-Meier and relative survival was estimated with follow-up through September 2, 2013. A cohort of 1042 women with a confirmed SBT diagnosis was identified. Women with stage I had an overall survival similar to the overall survival expected from the general population (p=0.3), whereas women with advanced stage disease had a poorer one (p<0.0001). This was evident both in women with noninvasive (p<0.0001) and invasive implants (p<0.0001). Only among women with advanced stage, overall survival of women with SBT/APST (p<0.0001) and noninvasive LGSC (p<0.0001) was poorer than expected from the general population. To date this is the largest nationwide cohort of SBTs where all tumors have been verified by expert pathologists. Only in women with advanced stage SBT, overall survival is poorer than in the general population which applies both to women with noninvasive and invasive implants as well as to women with SBT/APST and noninvasive LGSC. Copyright © 2014. Published by Elsevier Inc.

Casualties Produced by Impact and Related Topics of People Survivability in a Direct Effects Environment

DTIC Science & Technology

1974-08-01

COPY Reinforced concrete members ( beams and columns ): sizes, spans, support conditions, reinforcement ratios Steel members (open web joists, beams ...order of 30 to 50 percent of gross wall area are expected in upper portions butnt i n areas ’housing EOC’s. Open web joists and precast concrete units...are expected to dominate roof systems. Floors over the EOC’s are expected to be of rein- forced concrete . Cast-in-place flat plates and precast

Sedimentation and belowground carbon accumulation rates in mangrove forests that differ in diversity and land use: a tale of two mangroves

Treesearch

Richard A. MacKenzie; Patra B. Foulk; J. Val Klump; Kimberly Weckerly; Joko Purbospito; Daniel Murdiyarso; Daniel C. Donato; Vien Ngoc Nam

2016-01-01

Increased sea level is the climate change effect expected to have the greatest impact on mangrove forest survival. Mangroves have survived extreme fluctuations in sea level in the past through sedimentation and belowground carbon (C) accumulation, yet it is unclear what factors may influence these two parameters. We measured sedimentation, vertical accretion, and...

Longevity and Patau syndrome: what determines survival?

PubMed Central

Peroos, Sherina; Forsythe, Elizabeth; Pugh, Jennifer Harriet; Arthur-Farraj, Peter; Hodes, Deborah

2012-01-01

The authors report of an 8-year-old girl with non-mosaic Patau syndrome. The median life expectancy of Patau syndrome is 7–10 days, and 90% die in the first year of life. Survival is often attributed to mosaicism and the severity of associated malformations. We delineate the developing phenotype and review the literature discussing potential contributory factors to longevity. PMID:23220825

Survival in individuals with severe alpha 1-antitrypsin deficiency (PiZZ) in comparison to a general population with known smoking habits.

PubMed

Tanash, Hanan A; Ekström, Magnus; Rönmark, Eva; Lindberg, Anne; Piitulainen, Eeva

2017-09-01

Knowledge about the natural history of severe alpha 1-antitrypsin (AAT) deficiency (PiZZ) is limited. Our aim was to compare the survival of PiZZ individuals with randomly selected controls from the Swedish general population.The PiZZ subjects (n=1585) were selected from the Swedish National AATD Register. The controls (n=5999) were randomly selected from the Swedish population register. Smoking habits were known for all subjects.Median follow-up times for the PiZZ subjects (731 never-smokers) and controls (3179 never-smokers) were 12 and 17 years, respectively (p<0.001). During follow-up, 473 PiZZ subjects (30%), and 747 controls (12%) died. The PiZZ subjects had a significantly shorter survival time than the controls, p<0.001. After adjustment for gender, age, smoking habits and presence of respiratory symptoms, the risk of death was still significantly higher for the PiZZ individuals than for the controls, hazard ratio (HR) 3.2 (95% CI 2.8-3.6; p<0.001). By contrast, the risk of death was not increased in never-smoking PiZZ individuals identified by screening, compared to never-smoking controls, HR 1.2 (95% CI 0.6-2.2).The never-smoking PiZZ individuals identified by screening had a similar life expectancy to the never-smokers in the Swedish general population. Early diagnosis of AAT deficiency is of utmost importance. Copyright ©ERS 2017.

Diagnosis and treatment of malignant pleural effusion: a systematic literature review and new approaches.

PubMed

Lombardi, Giuseppe; Zustovich, Fable; Nicoletto, Maria Ornella; Donach, Martin; Artioli, Grazia; Pastorelli, Davide

2010-08-01

Malignant pleural effusion is a frequent complication in many types of tumors, and its presence indicates short expected survival. This review updates the current knowledge about diagnosis and management of malignant pleural effusion. In recent years, progress has been made in diagnosis through the use of new pathologic and radiologic approaches, such as the introduction of positron emission tomography-computed tomography, immunohistochemical marker combinations, and genetic studies to identify malignant cells. Treatment is always palliative. New promising drugs have been tested, but, awaiting randomized studies, talc pleurodesis is still the treatment of choice, although doubts remain about its safety. A long-term indwelling pleural catheter could be a valid alternative to talc pleurodesis in selected patients with trapped lung syndrome (a lung that fails to reexpand after drainage of pleural effusion) and short life expectancy. However, the correct treatment depends on several factors such as performance status, expected survival, presence of lung reexpansion following pleural drainage and comorbidities.

Brand strengthening decision making delved from brand-contacts in health services organizations.

PubMed

Takayanagi, Kazue; Hagihara, Yukiko

2007-01-01

Under the Japanese Government's strong enforcement of Japanese national medical cost reduction, only hospitals which emphasize patient values, and creation of brands according to them can survive. This study extracted patients' expectations as brand from Campbell's Brand-Contact lists. The authors also proposed to add Brand-strengthening strategies both for short-term strategies (large improvement is not required) and for long-term strategies (restructuring hardware and systems). This method would enable hospitals to collect customers' underlying expectations, and would create high-value brands. Trustful medical service would provide mutual and synergetic medical care effects. It is already considered out of date to conduct qualitative patient satisfaction interviews on current medical services to current customers. It is the only way to survive that hospitals themselves produce their original brands to increase patient loyalty and customer satisfaction. In the process, customer value should be reconsidered from both aspects of the quality of clinical care and of other medically related services. Then hospitals would be able to satisfy both customers' output and process expectations.

Endovascular Thrombectomy for Ischemic Stroke Increases Disability-Free Survival, Quality of Life, and Life Expectancy and Reduces Cost.

PubMed

Campbell, Bruce C V; Mitchell, Peter J; Churilov, Leonid; Keshtkaran, Mahsa; Hong, Keun-Sik; Kleinig, Timothy J; Dewey, Helen M; Yassi, Nawaf; Yan, Bernard; Dowling, Richard J; Parsons, Mark W; Wu, Teddy Y; Brooks, Mark; Simpson, Marion A; Miteff, Ferdinand; Levi, Christopher R; Krause, Martin; Harrington, Timothy J; Faulder, Kenneth C; Steinfort, Brendan S; Ang, Timothy; Scroop, Rebecca; Barber, P Alan; McGuinness, Ben; Wijeratne, Tissa; Phan, Thanh G; Chong, Winston; Chandra, Ronil V; Bladin, Christopher F; Rice, Henry; de Villiers, Laetitia; Ma, Henry; Desmond, Patricia M; Meretoja, Atte; Cadilhac, Dominique A; Donnan, Geoffrey A; Davis, Stephen M

2017-01-01

Endovascular thrombectomy improves functional outcome in large vessel occlusion ischemic stroke. We examined disability, quality of life, survival and acute care costs in the EXTEND-IA trial, which used CT-perfusion imaging selection. Large vessel ischemic stroke patients with favorable CT-perfusion were randomized to endovascular thrombectomy after alteplase versus alteplase-only. Clinical outcome was prospectively measured using 90-day modified Rankin scale (mRS). Individual patient expected survival and net difference in Disability/Quality-adjusted life years (DALY/QALY) up to 15 years from stroke were modeled using age, sex, 90-day mRS, and utility scores. Level of care within the first 90 days was prospectively measured and used to estimate procedure and inpatient care costs (US$ reference year 2014). There were 70 patients, 35 in each arm, mean age 69, median NIHSS 15 (IQR 12-19). The median (IQR) disability-weighted utility score at 90 days was 0.65 (0.00-0.91) in the alteplase-only versus 0.91 (0.65-1.00) in the endovascular group ( p  = 0.005). Modeled life expectancy was greater in the endovascular versus alteplase-only group (median 15.6 versus 11.2 years, p  = 0.02). The endovascular thrombectomy group had fewer simulated DALYs lost over 15 years [median (IQR) 5.5 (3.2-8.7) versus 8.9 (4.7-13.8), p  = 0.02] and more QALY gained [median (IQR) 9.3 (4.2-13.1) versus 4.9 (0.3-8.5), p  = 0.03]. Endovascular patients spent less time in hospital [median (IQR) 5 (3-11) days versus 8 (5-14) days, p  = 0.04] and rehabilitation [median (IQR) 0 (0-28) versus 27 (0-65) days, p  = 0.03]. The estimated inpatient costs in the first 90 days were less in the thrombectomy group (average US$15,689 versus US$30,569, p  = 0.008) offsetting the costs of interhospital transport and the thrombectomy procedure (average US$10,515). The average saving per patient treated with thrombectomy was US$4,365. Thrombectomy patients with large vessel occlusion and salvageable tissue on CT-perfusion had reduced length of stay and overall costs to 90 days. There was evidence of clinically relevant improvement in long-term survival and quality of life. http://www.ClinicalTrials.gov NCT01492725 (registered 20/11/2011).

Deep sea minerals prolong life span of streptozotocin-induced diabetic rats by compensatory augmentation of the IGF-I-survival signaling and inhibition of apoptosis.

PubMed

Liao, Hung-En; Shibu, Marthandam Asokan; Kuo, Wei-Wen; Pai, Pei-Ying; Ho, Tsung-Jung; Kuo, Chia-Hua; Lin, Jing-Ying; Wen, Su-Ying; Viswanadha, Vijaya Padma; Huang, Chih-Yang

2016-07-01

Consumption of deep sea minerals (DSM), such as magnesium, calcium, and potassium, is known to reduce hypercholesterolemia-induced myocardial hypertrophy and cardiac-apoptosis and provide protection against cardiovascular diseases. Heart diseases develop as a lethal complication among diabetic patients usually due to hyperglycemia-induced cardiac-apoptosis that causes severe cardiac-damages, heart failure, and reduced life expectancy. In this study, we investigated the potential of DSM and its related cardio-protection to increase the life expectancy in diabetic rats. In this study, a heart failure rat model was developed by using streptozotocin (65 mg kg(-1) ) IP injection. Different doses of DSM-1× (37 mg kg(-1) day(-1) ), 2× (74 mg kg(-1) day(-1) ) and 3× (111 mg kg(-1) day(-1) ), were administered to the rats through gavages for 4 weeks. The positive effects of DSM on the survival rate of diabetes rats were determined with respect to the corresponding effects of MgSO4 . Further, to understand the mechanism by which DSM enhances the survival of diabetic rats, their potential to regulate cardiac-apoptosis and control cardiac-dysfunction were examined. Echocardiogram, tissue staining, TUNEL assay, and Western blotting assay were used to investigate modulations in the myocardial contractile function and related signaling protein expression. The results showed that DSM regulate apoptosis and complement the cardiomyocyte proliferation by enhancing survival mechanisms. Moreover DSM significantly reduced the mortality rate and enhanced the survival rate of diabetic rats. Experimental results show that DSM administration can be an effective strategy to improve the life expectancy of diabetic subjects by improving cardiac-cell proliferation and by controlling cardiac-apoptosis and associated cardiac-dysfunction. © 2015 Wiley Periodicals, Inc. Environ Toxicol 31: 769-781, 2016. © 2015 Wiley Periodicals, Inc.

The Natural History of Nonobstructive Hypertrophic Cardiomyopathy.

PubMed

Hebl, Virginia B; Miranda, William R; Ong, Kevin C; Hodge, David O; Bos, J Martijn; Gentile, Federico; Klarich, Kyle W; Nishimura, Rick A; Ackerman, Michael J; Gersh, Bernard J; Ommen, Steve R; Geske, Jeffrey B

2016-03-01

To describe the survival of a large nonobstructive hypertrophic cardiomyopathy (NO-HCM) cohort and to identify risk factors for increased mortality in this population. Patients were identified from the Mayo Clinic HCM database from January 1, 1975, through November 30, 2006, for this retrospective observational study. Patients with resting or provocable left ventricular outflow tract gradients were excluded. Echocardiographic, clinical, and genetic data were compared between subgroups, and survival data were compared with expected population rates. A total of 706 patients with NO-HCM were identified. During median follow-up of 5 years (mean, 7 years), there were 208 deaths. Overall survival was no different than expected compared with age- and sex-matched white US population mortality rates (P=.77). Independent predictors of death were age at diagnosis, "burned out" HCM, and history of transient ischemic attack or stroke; use of an implantable cardioverter defibrillator (ICD) was inversely related to death. After exclusion of patients with an ICD, there was no difference in survival compared with age- and sex- matched individuals (P=.39); age, previous transient ischemic attack/stroke, and burned out HCM were predictors of death. In this cohort, patients with NO-HCM had similar survival rates as age- and sex-matched white US population mortality rates. Although use of an ICD was inversely related to death, no differences in overall survival were seen after those patients were excluded. Burned out HCM was independently associated with an increased risk of death, identifying a subset of patients who may benefit from more aggressive therapies. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Estimating outcomes of astronauts with myocardial infarction in exploration class space missions.

PubMed

Gillis, David B; Hamilton, Douglas R

2012-02-01

We estimate likelihood of presenting rhythms and survival to hospital discharge outcome after acute cardiac ischemia with arrhythmia and/or myocardial infarction (AMI) during long-duration space missions (LDSM) using selected terrestrial cohorts in medical literature. Medical scenarios were risk-stratified by coronary artery calcium score (CAC) and Framingham risk factors (FRF). AMI with and without sudden cardiac arrest (SCA) likelihoods and clinically significant rhythm scenarios and associated outcomes in "astronaut-like" cohorts were derived from two prospective trials identified by an evidence-based literature review. Results are presented using an event sequence diagram and event time line. The association of increasing CAC scores and FRF with AMI and SCA outcomes was calculated. Low AMI likelihoods are estimated in individuals with CAC scores of zero or < 100 and a low number of FRF. Survival rate to hospital discharge after out of hospital SCA in a large urban environment study was 5.2%. EMS-witnessed ventricular tachycardia and/or ventricular fibrillation survival rate of 37.5% represents < 1% of all urban out of hospital AMI, and these patients have a high proportion of known ischemic cardiovascular and pulmonary disease "disqualifying for spaceflight." Multiple factors may be expected to delay or defeat rapid access to "chain of survival" resources during LDSM, lowering survival rates below urban levels of 5.2%. Low CAC and FRF reflect lower risk for AMI events. Zero CAC was associated with the lowest risk of AMI after 3.5 yr of follow-up. Quantifiable incidence and outcome characterization suggests AMI in LDSM outcomes will be relatively independent of in-flight medical resources.

Nest survival is influenced by parental behaviour and heterospecifics in a mixed-species colony

USGS Publications Warehouse

Brussee, Brianne E.; Coates, Peter S.; Hothem, Roger L.; Howe, Kristy; Casazza, Michael L.; Eadie, John M.

2016-01-01

Studies of avian nest success often focus on examining influences of variation in environmental and seasonal factors. However, in-depth evaluations can also incorporate variation in individual incubation behaviour to further advance our understanding of avian reproductive ecology. We examined these relationships in colonially nesting Black-crowned Night-Herons Nycticorax nycticorax using intensive video-monitoring methods to quantify incubation behaviours. We modelled nest survival as a function of both extrinsic factors and incubation behaviours over a 3-year period (2010–12) on Alcatraz Island, USA. Model-averaged parameter estimates indicated that nest survival increased as a function of greater incubation constancy (% of time spent incubating eggs within a 24-h period), and average daily precipitation throughout the nesting stage. Common Ravens Corvus corax are the only known nest predator of Night-Herons on Alcatraz Island, as on many other coastal Pacific islands. We also investigated the effects of heterospecific nesting of California Gulls Larus californicus and Western Gulls Larus occidentalis in a mixed-species colony with Night-Herons, based on nesting proximity data collected over a 2-year period (2011–12). This second analysis indicated that, in addition to incubation behaviours, nesting heterospecifics are an important factor for explaining variation in Night-Heron nest survival. However, contrary to our original expectation, we found that Night-Herons experienced increased nest survival with increasing distance from gull colony boundaries. These results may apply to other areas with multiple colonial nesting species and similar predator communities and climatic patterns.

[Treatment with nutrition and fluids in patients with non-curable cancer].

PubMed

Nordøy, Tone; Thoresen, Lene; Kvikstad, Anne; Svensen, Rune

2006-02-23

Patients with non-curable cancer represent a large and heterogeneous group in which malnutrition and weight loss is a frequent finding. This article is based on relevant literature and our own clinical experience. For every patient a thorough examination of possible underlying causes should be explored and corrected as soon as possible (secondary cachexia). However, in many patients primary cachexia is the cause, a catabolic condition where muscle protein and lipids are degraded and even aggressive nutrition will not reverse the process. This condition is very different from starvation. Metoclopramide, corticosteroids and gestagens can relieve symptoms as anorexia, chronic nausea and asthenia which frequently occur in patients with cachexia. Treatments that may maintain or increase muscle function and modulate inflammatory processes are new approaches, such as eicosapentaneoic acid, adenosine triphosphate, specific amino acids and nonsteroidal antiinflammatory drugs. Nutrition is an integrated part of supportive therapy to all cancer patients, unless expected survival is short. At this time in life, nutrition will not influence survival and focus should be on symptom control.

Long-term medical costs and life expectancy of acute myeloid leukemia: a probabilistic decision model.

PubMed

Wang, Han-I; Aas, Eline; Howell, Debra; Roman, Eve; Patmore, Russell; Jack, Andrew; Smith, Alexandra

2014-03-01

Acute myeloid leukemia (AML) can be diagnosed at any age and treatment, which can be given with supportive and/or curative intent, is considered expensive compared with that for other cancers. Despite this, no long-term predictive models have been developed for AML, mainly because of the complexities associated with this disease. The objective of the current study was to develop a model (based on a UK cohort) to predict cost and life expectancy at a population level. The model developed in this study combined a decision tree with several Markov models to reflect the complexity of the prognostic factors and treatments of AML. The model was simulated with a cycle length of 1 month for a time period of 5 years and further simulated until age 100 years or death. Results were compared for two age groups and five different initial treatment intents and responses. Transition probabilities, life expectancies, and costs were derived from a UK population-based specialist registry-the Haematological Malignancy Research Network (www.hmrn.org). Overall, expected 5-year medical costs and life expectancy ranged from £8,170 to £81,636 and 3.03 to 34.74 months, respectively. The economic and health outcomes varied with initial treatment intent, age at diagnosis, trial participation, and study time horizon. The model was validated by using face, internal, and external validation methods. The results show that the model captured more than 90% of the empirical costs, and it demonstrated good fit with the empirical overall survival. Costs and life expectancy of AML varied with patient characteristics and initial treatment intent. The robust AML model developed in this study could be used to evaluate new diagnostic tools/treatments, as well as enable policy makers to make informed decisions. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

The use of radio-collars for monitoring wildlife diseases: a case study from Iberian ibex affected by Sarcoptes scabiei in Sierra Nevada, Spain

PubMed Central

2013-01-01

Background Wildlife radio tracking has gained popularity during the recent past. Ecologists and conservationists use radio-collars for different purposes: animal movement monitoring, home range, productivity, population estimation, behaviour, habitat use, survival, and predator-prey interaction, among others. The aim of our present study is to highlight the application of radio-collars for wildlife diseases monitoring. The spread of wildlife diseases and the efficacy of management actions for controlling them propose serious challenges for ecologists and conservationists, since it is difficult to re-capture (or simply observe) the same animal in pre-determined temporal interval, but such difficulty is overcome by the use of gps-gsm radio collars. Methods In the present study we report, for the first time to our knowledge, the use of radio-collars in the monitoring of Iberian ibex affected by Sarcoptes scabiei in Sierra Nevada mountain range, Spain. Twenty-five moderate or slightly mangy animals were radio-collared between 2006 and 2013. Results The radio-collars allowed us to confirm the presence of resistance to S. scabiei within Iberian ibex population. Twenty (80%) of the collared animals recovered totally from mange, while the disease progressed in the other five Iberian ibex (20% of the collared animals) and the animals died. The average estimated recovery time of the resistant animals was 245 ± 277 days, and the estimated average survival time of the non-resistant Iberian ibex was 121 ± 71 days. Non-resistant animals survived at least 100 days, while all of them died with less than 200 days. Sixty per cent of the resistant animals were recovered with less than 200 days. Conclusions We report, for the first time, the successful use of radio collars for wildlife diseases monitoring using Iberian ibex/S. scabiei as a model. By using radio collars we documented that most of the Sarcoptes-infected Iberian ibex are resistant to this disease, and we estimated the average time for Iberian ibex recovering from mange infection and the average survival time of the non-resistant ones. We expect wider use of radio-collars for wild animals diseases monitoring, affected/not-affected animals interaction, and treatment efficacy, among others. PMID:23965311

Trifluridine/Tipiracil (TAS-102) in Refractory Metastatic Colorectal Cancer: A Multicenter Register in the Frame of the Italian Compassionate Use Program.

PubMed

Cremolini, Chiara; Rossini, Daniele; Martinelli, Erika; Pietrantonio, Filippo; Lonardi, Sara; Noventa, Silvia; Tamburini, Emiliano; Frassineti, Giovanni Luca; Mosconi, Stefania; Nichetti, Federico; Murgioni, Sabina; Troiani, Teresa; Borelli, Beatrice; Zucchelli, Gemma; Dal Maso, Alessandro; Sforza, Vincenzo; Masi, Gianluca; Antoniotti, Carlotta; Di Bartolomeo, Maria; Miceli, Rosalba; Ciardiello, Fortunato; Falcone, Alfredo

2018-05-08

TAS-102 is indicated for patients with metastatic colorectal cancer (mCRC) previously treated with, or not considered candidates for, available therapies. Given the complete inefficacy in half of patients, the lack of predictive factors, the palliative setting, and the financial and clinical toxicity, optimizing the cost-benefit ratio is crucial. The "ColonLife" nomogram allows an estimate of the 12-week life expectancy of patients with refractory mCRC. We collected data from patients treated at eight Italian centers in the compassionate use program. Baseline characteristics of patients who were or were not progression free at 6 months were compared. The discriminative ability of the ColonLife nomogram was assessed. Among patients who received both TAS-102 and regorafenib, clinical outcomes of the two sequences were compared. This study included 341 patients. Six (2%) and 93 (27%) patients achieved response and disease stabilization, respectively. The median progression-free survival (PFS) was 2.4 months with an estimated 6-month PFS rate of 19%; the median overall survival (OS) was 6.2 months. An Eastern Cooperative Oncology Group performance status (ECOG PS) of 0, normal lactate dehydrogenase (LDH), and a time from the diagnosis of metastatic disease of >18 months were independently associated with higher chances of a patient being progression free at 6 months. The discriminative ability of ColonLife was confirmed. Among 121 patients who received both regorafenib and TAS-102, no differences in first or second PFS or OS were reported between the two sequences. One out of five patients achieves clinical benefit with TAS-102. ECOG PS, LDH, and time from diagnosis of metastatic disease may help to identify these patients. Excluding patients with very short life expectancy appears a reasonable approach. Improving the cost-efficacy ratio of TAS-102 in metastatic colorectal cancer is needed to spare useless toxicities in a definitely palliative setting. Eastern Cooperative Oncology Group performance status, lactate dehydrogenase levels, and time from the diagnosis of metastatic disease may help to identify patients more likely to achieve benefit. Properly designed prognostic tools (i.e., the "ColonLife" nomogram) may enable excluding from further treatments patients with very limited life expectancy. © AlphaMed Press 2018.

Expected and perceived efficacy of complementary and alternative medicine: A comparison views of patients with cancer and oncologists.

PubMed

Kim, Sang Hyuck; Shin, Dong Wook; Nam, You-Seon; Kim, So Young; Yang, Hyung-Kook; Cho, Be Long; Park, Keeho; Jo, Heui-Sug; Yim, Chang-Yeol; Kam, Sin; Park, Jong-Hyock

2016-10-01

This study sought to identify discrepancies between the expectations of patients with cancer and oncologists regarding the efficacy of complementary and alternative medicines (CAMs), and to determine how patients evaluate CAM efficacy after its use. Data from the Cancer Patient Experience Study, a nationwide survey, were used. Seven subdivided efficacy domains were included in the survey. An oncologist-patient matching analysis was done to assess the concordance of CAM efficacies between oncologists and patients with cancer. In addition, the patients' expectations of CAM efficacies were compared before and after use. Out of 719 participants, 201 patients with cancer (28.0%) reported using CAMs. The patients with cancer generally tended to be more positive about CAM efficacies than the oncologists. The largest discrepancy in efficacy perception was found in the efficacy domain of survival benefit, which included complete disease remission and prolonged survival. Many patients reported that they did not experience the positive efficacy they had anticipated before use. However, a substantial proportion of patients indicated that CAMs were as effective as they had expected, even though there is little evidence supporting the CAM efficacies. There was a marked discrepancy and a lack of concordance in expectations of CAM efficacy between patients with cancer and oncologists. Better communication between the patients and oncologists regarding CAM efficacy would be needed to make the patients to have shared expectations, and to reduce unnecessary CAM use. Copyright © 2016. Published by Elsevier Ltd.

A comparison between surgical resection in combination with WBRT or hypofractionated stereotactic irradiation in the treatment of solitary brain metastases.

PubMed

Lindvall, Peter; Bergström, Per; Löfroth, Per-Olov; Tommy Bergenheim, A

2009-09-01

The standard treatment of solitary brain metastases previously has been tumour resection in combination with whole-brain radiation therapy (WBRT). Stereotactic radiotherapy has emerged as a non-invasive treatment option especially for small brain metastases. We now report our results on resection + WBRT or hypofractionated stereotactic irradiation (HCSRT) in the treatment of solitary brain metastases. Between 1993 and 2004 patients with metastatic cancer and solitary brain metastases were selected for surgical resection + WBRT or HCSRT alone at the Umeå University Hospital. Fifty-nine patients were treated with surgical resection + WBRT (34 male, 25 female, mean age 63.3 years). Forty-seven patients were treated with HCSRT alone (15 male, 32 female, mean age 64.9 years). In patients followed radiologically, 28% treated with resection + WBRT showed a local recurrence after a median time of 8.0 months, whereas there was a lack of local control in 16% in the HCSRT group after a median time of 3.0 months. There was a significantly longer survival time for patients treated with resection + WBRT (median 7.9, mean 12.9 months) compared to HCSRT (median 5.0, mean 7.6 months). Even in patients with a tumour volume <10 cc, there was a significantly longer survival in favour of resection + WBRT (median 8.4, mean 17.4 months) compared to HCSRT (median 5.0, mean 7.9 months). This retrospective and non-randomised study indicates that surgical resection in combination with WBRT may be an option even for small brain metastases suitable for treatment with HCSRT. Since survival and local control following resection + WBRT was at least as favourable as compared to HCSRT alone, tumour location and expected neurological outcome may be the strongest aspect when selecting treatment modality.

An ecologic study of prostate-specific antigen screening and prostate cancer mortality in nine geographic areas of the United States.

PubMed

Shaw, Pamela A; Etzioni, Ruth; Zeliadt, Steven B; Mariotto, Angela; Karnofski, Kent; Penson, David F; Weiss, Noel S; Feuer, Eric J

2004-12-01

Ecologic studies of cancer screening examine cancer mortality rates in relation to use of population screening. These studies can be confounded by treatment patterns or influenced by choice of outcome and time horizon. Interpretation can be complicated by uncertainty about when mortality differences might be expected. The authors examined these issues in an ecologic analysis of prostate-specific antigen (PSA) screening and prostate cancer mortality across nine cancer registries in the United States. Results suggested a weak trend for areas with greater PSA screening rates to have greater declines in prostate cancer mortality; however, the magnitude of this trend varied considerably with the time horizon and outcome measure. A computer model was used to determine whether divergence of mortality declines would be expected under an assumption of a clinically significant survival benefit due to screening. Given a mean lead time of 5 years, the model projected that differences in mortality between high- and low-use areas should be apparent by 1999 in the absence of other factors affecting mortality. The authors concluded that modest differences in PSA screening rates across areas, together with additional sources of variation, could have produced a negative ecologic result. Ecologic analyses of the effectiveness of PSA testing should be interpreted with caution.

Do heads of government age more quickly? Observational study comparing mortality between elected leaders and runners-up in national elections of 17 countries

PubMed Central

Olenski, Andrew R; Abola, Matthew V

2015-01-01

Objectives To determine whether being elected to head of government is associated with accelerated mortality by studying survival differences between people elected to office and unelected runner-up candidates who never served. Design Observational study. Setting Historical survival data on elected and runner-up candidates in parliamentary or presidential elections in Australia, Austria, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, New Zealand, Norway, Poland, Spain, Sweden, United Kingdom, and United States, from 1722 to 2015. Participants Elected and runner-up political candidates. Main outcome measure Observed number of years alive after each candidate’s last election, relative to what would be expected for an average person of the same age and sex as the candidate during the year of the election, based on historical French and British life tables. Observed post-election life years were compared between elected candidates and runners-up, adjusting for life expectancy at time of election. A Cox proportional hazards model (adjusted for candidate’s life expectancy at the time of election) considered years until death (or years until end of study period for those not yet deceased by 9 September 2015) for elected candidates versus runners-up. Results The sample included 540 candidates: 279 winners and 261 runners-up who never served. A total of 380 candidates were deceased by 9 September 2015. Candidates who served as a head of government lived 4.4 (95% confidence interval 2.1 to 6.6) fewer years after their last election than did candidates who never served (17.8 v 13.4 years after last election; adjusted difference 2.7 (0.6 to 4.8) years). In Cox proportional hazards analysis, which considered all candidates (alive or deceased), the mortality hazard for elected candidates relative to runners-up was 1.23 (1.00 to 1.52). Conclusions Election to head of government is associated with a substantial increase in mortality risk compared with candidates in national elections who never served. PMID:26666894

Global change and relative sea level rise at Venice: what impact in term of flooding

NASA Astrophysics Data System (ADS)

Carbognin, Laura; Teatini, Pietro; Tomasin, Alberto; Tosi, Luigi

2010-11-01

Relative sea level rise (RSLR) due to climate change and geodynamics represents the main threat for the survival of Venice, emerging today only 90 cm above the Northern Adriatic mean sea level (msl). The 25 cm RSLR occurred over the 20th century, consisting of about 12 cm of land subsidence and 13 cm of sea level rise, has increased the flood frequency by more than seven times with severe damages to the urban heritage. Reasonable forecasts of the RSLR expected to the century end must be investigated to assess the suitability of the Mo.S.E. project planned for the city safeguarding, i.e., the closure of the lagoon inlets by mobile barriers. Here we consider three RSLR scenarios as resulting from the past sea level rise recorded in the Northern Adriatic Sea, the IPCC mid-range A1B scenario, and the expected land subsidence. Available sea level measurements show that more than 5 decades are required to compute a meaningful eustatic trend, due to pseudo-cyclic 7-8 year long fluctuations. The period from 1890 to 2007 is characterized by an average rate of 0.12 ± 0.01 cm/year. We demonstrate that linear regression is the most suitable model to represent the eustatic process over these 117 year. Concerning subsidence, at present Venice is sinking due to natural causes at 0.05 cm/year. The RSLR is expected to range between 17 and 53 cm by 2100, and its repercussions in terms of flooding frequency are associated here to each scenario. In particular, the frequency of tides higher than 110 cm, i.e., the value above which the gates would close the lagoon to the sea, will increase from the nowadays 4 times per year to a range between 20 and 250. These projections provide a large spread of possible conditions concerning the survival of Venice, from a moderate nuisance to an intolerable aggression. Hence, complementary solutions to Mo.S.E. may well be investigated.

Do heads of government age more quickly? Observational study comparing mortality between elected leaders and runners-up in national elections of 17 countries.

PubMed

Olenski, Andrew R; Abola, Matthew V; Jena, Anupam B

2015-12-14

To determine whether being elected to head of government is associated with accelerated mortality by studying survival differences between people elected to office and unelected runner-up candidates who never served. Observational study. Historical survival data on elected and runner-up candidates in parliamentary or presidential elections in Australia, Austria, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, New Zealand, Norway, Poland, Spain, Sweden, United Kingdom, and United States, from 1722 to 2015. Elected and runner-up political candidates. Observed number of years alive after each candidate's last election, relative to what would be expected for an average person of the same age and sex as the candidate during the year of the election, based on historical French and British life tables. Observed post-election life years were compared between elected candidates and runners-up, adjusting for life expectancy at time of election. A Cox proportional hazards model (adjusted for candidate's life expectancy at the time of election) considered years until death (or years until end of study period for those not yet deceased by 9 September 2015) for elected candidates versus runners-up. The sample included 540 candidates: 279 winners and 261 runners-up who never served. A total of 380 candidates were deceased by 9 September 2015. Candidates who served as a head of government lived 4.4 (95% confidence interval 2.1 to 6.6) fewer years after their last election than did candidates who never served (17.8 v 13.4 years after last election; adjusted difference 2.7 (0.6 to 4.8) years). In Cox proportional hazards analysis, which considered all candidates (alive or deceased), the mortality hazard for elected candidates relative to runners-up was 1.23 (1.00 to 1.52). Election to head of government is associated with a substantial increase in mortality risk compared with candidates in national elections who never served. 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.

From vision to reality: strategic agility in complex times.

PubMed

Soule, Barbara M

2002-04-01

Health care is experiencing turbulent times. Change has become the constant. Complexity and sometimes chaos are common characteristics. Within this context, infection control professionals strive to maintain their practices, achieve excellence, and plan for the future. As demands shift and expectations increase, professionals in infection surveillance, prevention, and control (ISPC) programs must develop strategic agility. This article describes the rationale for strategic thinking and action set within a framework of 6 thought-provoking questions. It also describes a number of techniques to use for thinking strategically, such as designing visions, becoming entrepreneurial, and engaging in creative and futuristic exercises to evaluate possibilities for program direction. These techniques can guide individual professionals or ISPC programs in strategic decision-making that will increase the ability to survive and succeed in the future.

"Freedom. Money. Fun. Love.": the warlore of Vietnamese bargirls.

PubMed

Gustafsson, Mai Lan

2011-01-01

Memories of the Vietnam War abound in the minds of those who survived it, be they veterans or civilians, Vietnamese or American. Vietnamese refugees, forced to flee their homeland after the war ended in 1975, tell particularly poignant stories of loss -- of country, of family, of tradition, and of identity. Not so the women featured in this article. During the war, they served as bargirls in Saigon, entertaining American soldiers. The stories they tell of the war paint an entirely different picture: one of good times, and camaraderie, and the exhilaration of being young and free in the city. They were able to break free from tradition and the expectations imposed on their gender because of the war, and because of that, remember the war as the best time of their lives.

A Bayesian Hybrid Adaptive Randomisation Design for Clinical Trials with Survival Outcomes.

PubMed

Moatti, M; Chevret, S; Zohar, S; Rosenberger, W F

2016-01-01

Response-adaptive randomisation designs have been proposed to improve the efficiency of phase III randomised clinical trials and improve the outcomes of the clinical trial population. In the setting of failure time outcomes, Zhang and Rosenberger (2007) developed a response-adaptive randomisation approach that targets an optimal allocation, based on a fixed sample size. The aim of this research is to propose a response-adaptive randomisation procedure for survival trials with an interim monitoring plan, based on the following optimal criterion: for fixed variance of the estimated log hazard ratio, what allocation minimizes the expected hazard of failure? We demonstrate the utility of the design by redesigning a clinical trial on multiple myeloma. To handle continuous monitoring of data, we propose a Bayesian response-adaptive randomisation procedure, where the log hazard ratio is the effect measure of interest. Combining the prior with the normal likelihood, the mean posterior estimate of the log hazard ratio allows derivation of the optimal target allocation. We perform a simulation study to assess and compare the performance of this proposed Bayesian hybrid adaptive design to those of fixed, sequential or adaptive - either frequentist or fully Bayesian - designs. Non informative normal priors of the log hazard ratio were used, as well as mixture of enthusiastic and skeptical priors. Stopping rules based on the posterior distribution of the log hazard ratio were computed. The method is then illustrated by redesigning a phase III randomised clinical trial of chemotherapy in patients with multiple myeloma, with mixture of normal priors elicited from experts. As expected, there was a reduction in the proportion of observed deaths in the adaptive vs. non-adaptive designs; this reduction was maximized using a Bayes mixture prior, with no clear-cut improvement by using a fully Bayesian procedure. The use of stopping rules allows a slight decrease in the observed proportion of deaths under the alternate hypothesis compared with the adaptive designs with no stopping rules. Such Bayesian hybrid adaptive survival trials may be promising alternatives to traditional designs, reducing the duration of survival trials, as well as optimizing the ethical concerns for patients enrolled in the trial.

The entropy of the life table: A reappraisal.

PubMed

Fernandez, Oscar E; Beltrán-Sánchez, Hiram

2015-09-01

The life table entropy provides useful information for understanding improvements in mortality and survival in a population. In this paper we take a closer look at the life table entropy and use advanced mathematical methods to provide additional insights for understanding how it relates to changes in mortality and survival. By studying the entropy (H) as a functional, we show that changes in the entropy depend on both the relative change in life expectancy lost due to death (e(†)) and in life expectancy at birth (e0). We also show that changes in the entropy can be further linked to improvements in premature and older deaths. We illustrate our methods with empirical data from Latin American countries, which suggests that at high mortality levels declines in H (which are associated with survival increases) linked with larger improvements in e0, whereas at low mortality levels e(†) made larger contributions to H. We additionally show that among countries with low mortality level, contributions of e(†) to changes in the life table entropy resulted from averting early deaths. These findings indicate that future increases in overall survival in low mortality countries will likely result from improvements in e(†). Copyright © 2015 Elsevier Inc. All rights reserved.

Association of Bystander Cardiopulmonary Resuscitation and Survival According to Ambulance Response Times After Out-of-Hospital Cardiac Arrest.

PubMed

Rajan, Shahzleen; Wissenberg, Mads; Folke, Fredrik; Hansen, Steen Møller; Gerds, Thomas A; Kragholm, Kristian; Hansen, Carolina Malta; Karlsson, Lena; Lippert, Freddy K; Køber, Lars; Gislason, Gunnar H; Torp-Pedersen, Christian

2016-12-20

Bystander-initiated cardiopulmonary resuscitation (CPR) increases patient survival after out-of-hospital cardiac arrest, but it is unknown to what degree bystander CPR remains positively associated with survival with increasing time to potential defibrillation. The main objective was to examine the association of bystander CPR with survival as time to advanced treatment increases. We studied 7623 out-of-hospital cardiac arrest patients between 2005 and 2011, identified through the nationwide Danish Cardiac Arrest Registry. Multiple logistic regression analysis was used to examine the association between time from 911 call to emergency medical service arrival (response time) and survival according to whether bystander CPR was provided (yes or no). Reported are 30-day survival chances with 95% bootstrap confidence intervals. With increasing response times, adjusted 30-day survival chances decreased for both patients with bystander CPR and those without. However, the contrast between the survival chances of patients with versus without bystander CPR increased over time: within 5 minutes, 30-day survival was 14.5% (95% confidence interval [CI]: 12.8-16.4) versus 6.3% (95% CI: 5.1-7.6), corresponding to 2.3 times higher chances of survival associated with bystander CPR; within 10 minutes, 30-day survival chances were 6.7% (95% CI: 5.4-8.1) versus 2.2% (95% CI: 1.5-3.1), corresponding to 3.0 times higher chances of 30-day survival associated with bystander CPR. The contrast in 30-day survival became statistically insignificant when response time was >13 minutes (bystander CPR vs no bystander CPR: 3.7% [95% CI: 2.2-5.4] vs 1.5% [95% CI: 0.6-2.7]), but 30-day survival was still 2.5 times higher associated with bystander CPR. Based on the model and Danish out-of-hospital cardiac arrest statistics, an additional 233 patients could potentially be saved annually if response time was reduced from 10 to 5 minutes and 119 patients if response time was reduced from 7 (the median response time in this study) to 5 minutes. The absolute survival associated with bystander CPR declined rapidly with time. Yet bystander CPR while waiting for an ambulance was associated with a more than doubling of 30-day survival even in case of long ambulance response time. Decreasing ambulance response time by even a few minutes could potentially lead to many additional lives saved every year. © 2016 American Heart Association, Inc.

Thermal stress response of General Purpose Heat Source (GPHS) aeroshell material

NASA Technical Reports Server (NTRS)

Grinberg, I. M.; Hulbert, L. E.; Luce, R. G.

1980-01-01

A thermal stress test was conducted to determine the ability of the GPHS aeroshell 3 D FWPF material to maintain physical integrity when exposed to a severe heat flux such as would occur from prompt reentry of GPHS modules. The test was performed in the Giant Planetary Facility at NASA's Ames Research Center. Good agreement was obtained between the theoretical and experimental results for both temperature and strain time histories. No physical damage was observed in the test specimen. These results provide initial corroboration both of the analysis techniques and that the GPHS reentry member will survive the reentry thermal stress levels expected.

Trends in the survival of patients diagnosed with cancer in the Nordic countries 1964-2003 followed up to the end of 2006. Material and methods.

PubMed

Engholm, Gerda; Gislum, Mette; Bray, Freddie; Hakulinen, Timo

2010-06-01

Comparable data on cancer incidence and mortality in Denmark, Finland, Iceland, Norway, and Sweden are available for analysis through a collaboration of the national Cancer Registries via the NORDCAN website (http://ancr.nu). In the continued spirit of Nordic collaborative research, a number of studies examining trends in cancer survival are published in this journal. The data were divided into eight 5-year periods by sex in five Nordic countries. Age-standardised 5-year relative survival ratios and excess mortality rates in the short-term (first month and 1-3 months following diagnosis), and the long-term (2-5 years after diagnosis) were calculated, as were age-specific 5-year relative survival using cohort-survival methods. A hybrid method combining the cohort and period methods was used for the period 1999-2003 as not all patients were followed for five years. Age-standardisation used the International Cancer Survival Standard, and calculation of expected deaths used country-specific population mortality rates. The data series constitutes 3 360 397 tumours among 3 160 802 patients followed up for death through 2006 for 39 different cancer sites diagnosed in the years 1964-2003. The paper describes the data, exclusions and imputations, design and analysis, age structure and standardisation procedures, follow-up, and case-mix adjustment methods. The strengths of this study include the overall comparability and quality of the data, the national coverage, and the length of the time series. Collecting and analysing data from the five Nordic countries for 39 different cancer sites over 40 years in a systematised and comparable way is a major undertaking. A thorough description of the analyses, definitions and exclusions in the survival study, supplemented with corresponding information on cancer incidence and mortality is needed for appropriate interpretation and comparison between countries, and between and within cancer sites. This information must be made available to provide appropriate interpretation of the site-specific results.

Winter Survival of Individual Honey Bees and Honey Bee Colonies Depends on Level of Varroa destructor Infestation

PubMed Central

van Dooremalen, Coby; Gerritsen, Lonne; Cornelissen, Bram; van der Steen, Jozef J. M.; van Langevelde, Frank; Blacquière, Tjeerd

2012-01-01

Background Recent elevated winter loss of honey bee colonies is a major concern. The presence of the mite Varroa destructor in colonies places an important pressure on bee health. V. destructor shortens the lifespan of individual bees, while long lifespan during winter is a primary requirement to survive until the next spring. We investigated in two subsequent years the effects of different levels of V. destructor infestation during the transition from short-lived summer bees to long-lived winter bees on the lifespan of individual bees and the survival of bee colonies during winter. Colonies treated earlier in the season to reduce V. destructor infestation during the development of winter bees were expected to have longer bee lifespan and higher colony survival after winter. Methodology/Principal Findings Mite infestation was reduced using acaricide treatments during different months (July, August, September, or not treated). We found that the number of capped brood cells decreased drastically between August and November, while at the same time, the lifespan of the bees (marked cohorts) increased indicating the transition to winter bees. Low V. destructor infestation levels before and during the transition to winter bees resulted in an increase in lifespan of bees and higher colony survival compared to colonies that were not treated and that had higher infestation levels. A variety of stress-related factors could have contributed to the variation in longevity and winter survival that we found between years. Conclusions/Significance This study contributes to theory about the multiple causes for the recent elevated colony losses in honey bees. Our study shows the correlation between long lifespan of winter bees and colony loss in spring. Moreover, we show that colonies treated earlier in the season had reduced V. destructor infestation during the development of winter bees resulting in longer bee lifespan and higher colony survival after winter. PMID:22558421

Survival rates among Seventh Day Adventists compared with the general population in Poland.

PubMed

Jedrychowski, W; Tobiasz-Adamczyk, B; Olma, A; Gradzikiewicz, P

1985-01-01

The purpose of the work was to test the hypothesis that the survival rate is higher among the Seventh Day Adventists (SDA) than in the general population of Poland, because of the strictly respected customs adhered to by members of this church community, such as abstinence from smoking and from alcohol. The data on life expectancy in the SDA community covered a total of 236 members of this denomination in Kraków (86 males and 150 females). The survival probability rates were estimated by the life table method, for both men and women separately, and were subsequently compared with the corresponding parameters of the Polish Life Tables. Over a period of 10 years, in which these data were studied, there were 11 deaths in males and 24 deaths in females. Mean age at death was 71.9 years among men and 75.1 among women. The survival curves traced over the age groups of both sexes of SDA members were fairly similar, but they were markedly higher than in the general population of Poland. In the general population the survival rates for people over 40 years old were higher in females than in males, whereas no corresponding sex differences in rates concerning SDA members were observed. The greater benefit in life expectancy is gained in the SDA group in comparison with men in the general population. This is attributable to their abstinence from very harmful habits, otherwise more widespread in this sex group.

Increases in adult life expectancy in rural South Africa: valuing the scale-up of HIV treatment

PubMed Central

Bor, Jacob; Herbst, Abraham J; Newell, Marie-Louise; Bärnighausen, Till

2013-01-01

The scale-up of antiretroviral therapy (ART) is expected to raise adult life expectancy in populations with high HIV prevalence. Using data from a population cohort of over 101,000 individuals in rural KwaZulu-Natal, South Africa, we measured changes in adult life expectancy for 2000–2011. In 2003, the year before ART became available in the public sector health system, adult life expectancy was 49.2 years; by 2011, adult life expectancy had increased to 60.5 years – an 11.3-year gain. Based on standard monetary valuation of life, the survival benefits of ART far outweigh the costs of providing treatment in this community. These gains in adult life expectancy signify the social value of ART and have implications for investment decisions of individuals, governments, and donors. PMID:23430655

Arabidopsis plants perform arithmetic division to prevent starvation at night

PubMed Central

Scialdone, Antonio; Mugford, Sam T; Feike, Doreen; Skeffington, Alastair; Borrill, Philippa; Graf, Alexander; Smith, Alison M; Howard, Martin

2013-01-01

Photosynthetic starch reserves that accumulate in Arabidopsis leaves during the day decrease approximately linearly with time at night to support metabolism and growth. We find that the rate of decrease is adjusted to accommodate variation in the time of onset of darkness and starch content, such that reserves last almost precisely until dawn. Generation of these dynamics therefore requires an arithmetic division computation between the starch content and expected time to dawn. We introduce two novel chemical kinetic models capable of implementing analog arithmetic division. Predictions from the models are successfully tested in plants perturbed by a night-time light period or by mutations in starch degradation pathways. Our experiments indicate which components of the starch degradation apparatus may be important for appropriate arithmetic division. Our results are potentially relevant for any biological system dependent on a food reserve for survival over a predictable time period. DOI: http://dx.doi.org/10.7554/eLife.00669.001 PMID:23805380

A varied pattern of change of the sex differential in survival in the G7 countries.

PubMed

Trovato, Frank; Heyen, Nils B

2006-05-01

Over the course of the 20th century the sex differential in life expectancy at birth in the industrialized countries has widened considerably in favour of women. Starting in the early 1970s, the beginning of a reversal in the long-term pattern of this differential has been noted in some high-income countries. This study documents a sustained pattern of narrowing of this measure into the later part of the 1990s for six of the populations that comprise the G7 countries: Canada, France, Germany, Italy, England and Wales (as representative of the United Kingdom) and USA. For Japan, a persistence of widening sex differences in survival is noted. The sex differences in life expectancy are decomposed over roughly three decades (early 1970s to late 1990s) from the point of view of four major cause-of-death categories: circulatory diseases, cancers, accidents/violence/suicide, and 'other' (residual) causes. In the six countries where the sex gap has narrowed, this has resulted primarily from reduced sex differences in circulatory disease mortality, and secondarily from reduced differences in male and female death rates due to accidents, violence and suicide combined. In some of the countries sex differentials in cancer mortality have been converging lately, and this has also contributed to a narrowing of the difference in life expectancy. In Japan, males have been less successful in reducing their survival disadvantage in relation to Japanese women with regard to circulatory disease and cancer; and in the case of accidents/violence/suicide, male death rates increased during the 1990s. These trends explain the divergent pattern of the sex difference in life expectation in Japan as compared with the other G7 nations.

[Educational inequalities in mortality and survival of women and men in the Americas, 1990-2010].

PubMed

Haeberer, Mariana; Noguer, Isabel; Mújica, Oscar J

2015-08-01

Analyze magnitude and trends in educational inequality in mortality and survival of women and men in countries of the Americas. Gap and gradient metrics were used to calculate inequality between countries in adult mortality, average age of death, life expectancy, and healthy life expectancy, according to educational level in men and women for 1990 and 2010. Between 1990 and 2010, the average number of years of education increased from 8 to 10 with no difference between sexes. Adult mortality (15-59 years) did not change: 1.9 per 1 000 women and 3.7 per 1 000 men. The slope index of inequality (SII) increased from -1.0 to -2.0 per 1 000 women and from -1.2 to -4.4 per 1 000 men. Life expectancy increased from 75.6 to 78.7 years in women and from 68.9 to 72.4 in men; absolute inequality decreased from 7.8 to 7.2 years in women and increased from 7.2 to 9.2 years in men. Healthy life expectancy increased from 63.7 to 65.9 years in women and from 59.5 to 62.5 years in men; the SII declined from 6.9 to 5.8 years in women and increased from 6.9 to 7.8 years in men. In the countries of the Americas, men are at greater risk of dying, die earlier, and live fewer disease- and disability-free years than women; educational level is a determinant of mortality and survival in both sexes, and educational inequalities are more pronounced and increasing among men, and are disproportionately concentrated in the most socially disadvantaged populations.

Cold Tolerance of Mountain Pine Beetle (Coleoptera: Curculionidae) Eggs From the Historic and Expanded Ranges.

PubMed

Bleiker, K P; Smith, G D; Humble, L M

2017-10-01

Winter mortality is expected to be a key factor determining the ability of mountain pine beetle, Dendroctonus ponderosae Hopkins (Coleoptera: Curculionidae), to expand its range in Canada. We determined the mortality rate and supercooling points of eggs from the beetle's historic range in southern British Columbia as well as the recently expanded range in north-central Alberta and tested if eggs require an extended period of chilling to reach their maximum cold tolerance. We found no effect of population source or acclimation time on egg cold tolerance. Although 50% of eggs can survive brief exposure to -20.5 °C (LT50), storage at 0.3 °C and -7.5 °C for 59 d resulted in 50% and 100% mortality, respectively. Our results indicate that eggs suffer significant prefreeze mortality and are not well-adapted to overwintering: eggs are unlikely to survive winter throughout much of the beetle's range. Our results provide information that can be used to help model the climatic suitability of mountain pine beetle, including how changes in seasonality associated with new or changing climates may affect winter survival. In addition to lower lethal temperatures, it is critical that the duration of exposure to sublethal cold temperatures are considered in a comprehensive index of cold tolerance and incorporated into survival and population models. © The Authors 2017. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The Response of Halophiles from the Atacama Desert to Humidity Changes

NASA Astrophysics Data System (ADS)

Allen, C.; Lera, M.; Chandra, J.; Webb, S.; Marcu, O.

2011-12-01

Survival of extremophiles in dry desert conditions implies adaptations to fluctuations in temperature, desiccation and radiation levels. The Atacama Desert, located in Chile, is the driest desert in the world. Despite the extreme desiccation conditions, cyanobacteria and heterotrophic bacteria are still able to survive in the evaporitic halite rocks that scatter the surface of the desert. The purpose of this study was to determine whether the extremely dry conditions cause cellular oxidative stress and to examine the adaptations that allow these extremophiles to survive. One potential adaptation is the import/export of redox metals which can scavenge reactive oxygen species, preventing oxidative stress. Another potential adaptation is based on changes in gene expression. Genes involved in the stress pathway, which help microorganisms combat intracellular oxidation and survive the harsh environment, are expected to have different expression levels based on the humidity and level of stress. The aims of this project were: 1. to characterize the elemental signature of cyanobacteria; 2. to identify possible intracellular elemental changes that may occur in response to changes in humidity; 3. to identify and quantify the expression of stress genes involved in the response to humidity changes. Here we will show the elemental composition of cells in the halite sample as determined by X-ray fluorescence imaging (microprobe beamline 2-3 at the Stanford Synchrotron Radiation Laboratory), real-time elemental fluctuations measured in live cells exposed to changing relative humidity values, and partial amplification of genes of interest using degenerate primers based on homologous cyanobacterial sequences.

Coupling suitable prey field to in situ fish larval condition and abundance in a subtropical estuary

NASA Astrophysics Data System (ADS)

Machado, Irene; Calliari, Danilo; Denicola, Ana; Rodríguez-Graña, Laura

2017-03-01

Survival of fish larvae is influenced by the suitability of the prey field and its variability in time and space. Relationships among food quality, quantity and recruitment have been explored in temperate ecosystems where spawning and secondary production are strongly seasonal, but for subtropical estuaries the mechanisms responsible for larval survival remain poorly identified. This study evaluated the nutritional condition (feeding incidence and AARS activity) and abundance of a multi-specific assemblage of fish larvae from a subtropical estuary in South America (Solís Grande, Uruguay) during the fish reproductive season; and related both variables to prey abundance, composition, size and fatty acids content. The larval assemblage was composed of 13 species belonging to different functional groups and composition varied seasonally. Contrary to expectations larval condition did not match an increase in prey quality. Food availability was high throughout the study period, although significant changes existed in the size and taxonomic structure of the prey assemblage. The temporal succession of complementary factors - temperature, prey composition, abundance and quality - promoted a wide window of opportunity for larvae, where quality seemed to have compensated quantity. Such combination of factors could allow an extended larval survival along the spawning season. These findings underline the importance of a better understanding of subtropical estuaries as nursery areas.

Cell-delivered magnetic nanoparticles caused hyperthermia-mediated increased survival in a murine pancreatic cancer model

PubMed Central

Basel, Matthew T; Balivada, Sivasai; Wang, Hongwang; Shrestha, Tej B; Seo, Gwi Moon; Pyle, Marla; Abayaweera, Gayani; Dani, Raj; Koper, Olga B; Tamura, Masaaki; Chikan, Viktor; Bossmann, Stefan H; Troyer, Deryl L

2012-01-01

Using magnetic nanoparticles to absorb alternating magnetic field energy as a method of generating localized hyperthermia has been shown to be a potential cancer treatment. This report demonstrates a system that uses tumor homing cells to actively carry iron/iron oxide nanoparticles into tumor tissue for alternating magnetic field treatment. Paramagnetic iron/ iron oxide nanoparticles were synthesized and loaded into RAW264.7 cells (mouse monocyte/ macrophage-like cells), which have been shown to be tumor homing cells. A murine model of disseminated peritoneal pancreatic cancer was then generated by intraperitoneal injection of Pan02 cells. After tumor development, monocyte/macrophage-like cells loaded with iron/ iron oxide nanoparticles were injected intraperitoneally and allowed to migrate into the tumor. Three days after injection, mice were exposed to an alternating magnetic field for 20 minutes to cause the cell-delivered nanoparticles to generate heat. This treatment regimen was repeated three times. A survival study demonstrated that this system can significantly increase survival in a murine pancreatic cancer model, with an average post-tumor insertion life expectancy increase of 31%. This system has the potential to become a useful method for specifically and actively delivering nanoparticles for local hyperthermia treatment of cancer. PMID:22287840

Erythrocyte survival time in Greyhounds as assessed by use of in vivo biotinylation.

PubMed

Garon, Catherine L; Cohn, Leah A; Scott, Michael A

2010-09-01

To determine erythrocyte survival time in Greyhounds. 6 Greyhounds used as blood donors and 3 privately owned non-Greyhound dogs. In vivo biotinylation of erythrocytes was performed by infusion of biotin-N-hydroxysuccinimide into each dog via a jugular vein catheter. Blood samples were collected 12 hours later and then at weekly intervals and were used to determine the percentage of biotin-labeled erythrocytes at each time point. Erythrocytes were washed, incubated with avidin-fluorescein isothiocyanate, and washed again before the percentage of biotinylated erythrocytes was measured by use of flow cytometry. Survival curves for the percentage of biotinylated erythrocytes were generated, and erythrocyte survival time was defined as the x-intercept of a least squares best-fit line for the linear portion of each curve. The R2 for survival curves ranged from 0.93 to 0.99 during the first 10 weeks after infusion of erythrocytes. Erythrocyte survival time for the 3 non-Greyhound dogs was 94, 98, and 116 days, respectively, which was consistent with previously reported values. Erythrocyte survival time for the 6 Greyhounds ranged from 83 to 110 days (mean, 93 days; median, 88 days). As determined by use of in vivo biotinylation, erythrocyte survival times in Greyhounds were similar to those determined for non-Greyhound dogs and did not differ significantly from erythrocyte survival times reported previously for non-Greyhound dogs. Erythrocyte survival time was similar in Greyhounds and non-Greyhound dogs. Greyhounds can be used as erythrocyte donors without concerns about inherently shorter erythrocyte survival time.

Artificial enzyme-powered microfish for water-quality testing.

PubMed

Orozco, Jahir; García-Gradilla, Victor; D'Agostino, Mattia; Gao, Wei; Cortés, Allan; Wang, Joseph

2013-01-22

We present a novel micromotor-based strategy for water-quality testing based on changes in the propulsion behavior of artificial biocatalytic microswimmers in the presence of aquatic pollutants. The new micromotor toxicity testing concept mimics live-fish water testing and relies on the toxin-induced inhibition of the enzyme catalase, responsible for the biocatalytic bubble propulsion of tubular microengines. The locomotion and survival of the artificial microfish are thus impaired by exposure to a broad range of contaminants, that lead to distinct time-dependent irreversible losses in the catalase activity, and hence of the propulsion behavior. Such use of enzyme-powered biocompatible polymeric (PEDOT)/Au-catalase tubular microengine offers highly sensitive direct optical visualization of changes in the swimming behavior in the presence of common contaminants and hence to a direct real-time assessment of the water quality. Quantitative data on the adverse effects of the various toxins upon the swimming behavior of the enzyme-powered artificial swimmer are obtained by estimating common ecotoxicological parameters, including the EC(50) (exposure concentration causing 50% attenuation of the microfish locomotion) and the swimmer survival time (lifetime expectancy). Such novel use of artificial microfish addresses major standardization and reproducibility problems as well as ethical concerns associated with live-fish toxicity assays and hence offers an attractive alternative to the common use of aquatic organisms for water-quality testing.

Insect outbreak shifts the direction of selection from fast to slow growth rates in the long-lived conifer Pinus ponderosa

PubMed Central

Sala, Anna

2017-01-01

Long generation times limit species’ rapid evolution to changing environments. Trees provide critical global ecosystem services, but are under increasing risk of mortality because of climate change-mediated disturbances, such as insect outbreaks. The extent to which disturbance changes the dynamics and strength of selection is unknown, but has important implications on the evolutionary potential of tree populations. Using a 40-y-old Pinus ponderosa genetic experiment, we provide rare evidence of context-dependent fluctuating selection on growth rates over time in a long-lived species. Fast growth was selected at juvenile stages, whereas slow growth was selected at mature stages under strong herbivory caused by a mountain pine beetle (Dendroctonus ponderosae) outbreak. Such opposing forces led to no net evolutionary response over time, thus providing a mechanism for the maintenance of genetic diversity on growth rates. Greater survival to mountain pine beetle attack in slow-growing families reflected, in part, a host-based life-history trade-off. Contrary to expectations, genetic effects on tree survival were greatest at the peak of the outbreak and pointed to complex defense responses. Our results suggest that selection forces in tree populations may be more relevant than previously thought, and have implications for tree population responses to future environments and for tree breeding programs. PMID:28652352

Justification for a Nuclear Global Health Workforce: multidisciplinary analysis of risk, survivability & preparedness, with emphasis on the triage management of thermal burns.

PubMed

Burkle, Frederick M; Potokar, Tom; Gosney, James E; Dallas, Cham

2017-01-01

Major challenges and crises in global health will not be solved by health alone; requiring rather a multidisciplinary, evidence-based analytical approach to prevention, preparedness and response. One such potential crisis is the continued spread of nuclear weapons to more nations concurrent with the increased volatility of international relations that has significantly escalated the risk of a major nuclear weapon exchange. This study argues for the development of a multidisciplinary global health response agenda based on the reality of the current political analysis of nuclear risk, research evidence suggesting higher-than-expected survivability risk, and the potential for improved health outcomes based on medical advances. To date, the medical consequences of such an exchange are not credibly addressed by any nation at this time, despite recent advances. While no one country could mount such a response, an international body of responders organized in the same fashion as the current World Health Organization's global health workforce initiative for large-scale natural and public health emergencies could enlist and train for just such an emergency. A Nuclear Global Health Workforce is described for addressing the unprecedented medical and public health needs to be expected in the event of a nuclear conflict or catastrophic accident. The example of addressing mass casualty nuclear thermal burns outlines the potential triage and clinical response management of survivors enabled by this global approach.

Surviving the Current Hard Insurance Market.

ERIC Educational Resources Information Center

Shoaf, Lawrence G.

1986-01-01

School districts can expect to see significant increases in insurance renewal premiums. Advice is offered on safety and loss control procedures, dealing with an insurance broker, and bidding for insurance coverage. (MLF)

Current status of adjuvant chemotherapy after radical cystectomy for deeply invasive bladder cancer.

PubMed

Skinner, D G; Daniels, J R; Lieskovsky, G

1984-07-01

Between March, 1976, and December, 1982, 70 of 157 patients (45%) undergoing single-stage radical cystectomy with pelvic lymphadenectomy and urinary diversion with the intent to cure invasive bladder cancer were found to have pathologic Stage P3B, P4 and/or N + disease. Thirty-four of the 70 patients received adjuvant prophylactic chemotherapy after cystectomy and 36 patients were followed expectantly. From 1976 through 1977 adjuvant chemotherapy consisted of cyclophosphamide 1 Gm/M2 each month for six months; from 1978 through June, 1980, adjuvant chemotherapy consisted of cis-platinum 100 mg/M2 each month for four months with the exception of 1 patient treated more aggressively with combination chemotherapy (CISCA). Since July, 1980, a prospective study has been utilized in which patients were randomized into two groups, Group A receiving combination chemotherapy and Group B followed up expectantly; adjuvant chemotherapy appears to result in a slight delay in time to relapse but no influence in overall survival was observed.

Temperature mediated moose survival in Northeastern Minnesota

USGS Publications Warehouse

Lenarz, M.S.; Nelson, M.E.; Schrage, M.W.; Edwards, A.J.

2009-01-01

The earth is in the midst of a pronounced warming trend and temperatures in Minnesota, USA, as elsewhere, are projected to increase. Northern Minnesota represents the southern edge to the circumpolar distribution of moose (Alces alces), a species intolerant of heat. Moose increase their metabolic rate to regulate their core body temperature as temperatures rise. We hypothesized that moose survival rates would be a function of the frequency and magnitude that ambient temperatures exceeded the upper critical temperature of moose. We compared annual and seasonal moose survival in northeastern Minnesota between 2002 and 2008 with a temperature metric. We found that models based on January temperatures above the critical threshold were inversely correlated with subsequent survival and explained >78 of variability in spring, fall, and annual survival. Models based on late-spring temperatures also explained a high proportion of survival during the subsequent fall. A model based on warm-season temperatures was important in explaining survival during the subsequent winter. Our analyses suggest that temperatures may have a cumulative influence on survival. We expect that continuation or acceleration of current climate trends will result in decreased survival, a decrease in moose density, and ultimately, a retreat of moose northward from their current distribution.

Life Expectancy and Years of Potential Life Lost After Acute Myocardial Infarction by Sex and Race: A Cohort-Based Study of Medicare Beneficiaries.

PubMed

Bucholz, Emily M; Normand, Sharon-Lise T; Wang, Yun; Ma, Shuangge; Lin, Haiqun; Krumholz, Harlan M

2015-08-11

Most studies of sex and race differences after acute myocardial infarction (AMI) have not taken into account differences in life expectancy in the general population. Years of potential life lost (YPLL) is a metric that takes into account the burden of disease and can be compared by sex and race. This study sought to determine sex and race differences in long-term survival after AMI using life expectancy and YPLL to account for differences in population-based life expectancy. Using data from the Cooperative Cardiovascular Project, a prospective cohort study of Medicare beneficiaries hospitalized for AMI between 1994 and 1995 (N = 146,743), we calculated life expectancy and YPLL using Cox proportional hazards regression with extrapolation using exponential models. Of the 146,743 patients with AMI, 48.1% were women and 6.4% were black; the average age was 75.9 years. Post-AMI life expectancy estimates were similar for men and women of the same race but lower for black patients than white patients. On average, women lost 10.5% (SE 0.3%) more of their expected life than men, and black patients lost 6.2% (SE 0.6%) more of their expected life than white patients. After adjustment, women still lost an average of 7.8% (0.3%) more of their expected life than men, but black race became associated with a survival advantage, suggesting that racial differences in YPLL were largely explained by differences in clinical presentation and treatment between black and white patients. Women and black patients lost more years of life after AMI, on average, than men and white patients, an effect that was not explained in women by clinical or treatment differences. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

SEER Data & Software

Cancer.gov

Options for accessing datasets for incidence, mortality, county populations, standard populations, expected survival, and SEER-linked and specialized data. Plus variable definitions, documentation for reporting and using datasets, statistical software (SEER*Stat), and observational research resources.

What functional strategies drive drought survival and recovery of perennial species from upland grassland?

PubMed Central

Zwicke, Marine; Picon-Cochard, Catherine; Morvan-Bertrand, Annette; Prud’homme, Marie-Pascale; Volaire, Florence

2015-01-01

Background and Aims Extreme climatic events such as severe droughts are expected to increase with climate change and to limit grassland perennity. The present study aimed to characterize the adaptive responses by which temperate herbaceous grassland species resist, survive and recover from a severe drought and to explore the relationships between plant resource use and drought resistance strategies. Methods Monocultures of six native perennial species from upland grasslands and one Mediterranean drought-resistant cultivar were compared under semi-controlled and non-limiting rooting depth conditions. Above- and below-ground traits were measured under irrigation in spring and during drought in summer (50 d of withholding water) in order to characterize resource use and drought resistance strategies. Plants were then rehydrated and assessed for survival (after 15 d) and recovery (after 1 year). Key Results Dehydration avoidance through water uptake was associated with species that had deep roots (>1·2 m) and high root mass (>4 kg m−3). Cell membrane stability ensuring dehydration tolerance of roots and meristems was positively correlated with fructan content and negatively correlated with sucrose content. Species that survived and recovered best combined high resource acquisition in spring (leaf elongation rate >9 mm d−1 and rooting depth >1·2 m) with both high dehydration avoidance and tolerance strategies. Conclusions Most of the native forage species, dominant in upland grassland, were able to survive and recover from extreme drought, but with various time lags. Overall the results suggest that the wide range of interspecific functional strategies for coping with drought may enhance the resilience of upland grassland plant communities under extreme drought events. PMID:25851134

What functional strategies drive drought survival and recovery of perennial species from upland grassland?

PubMed

Zwicke, Marine; Picon-Cochard, Catherine; Morvan-Bertrand, Annette; Prud'homme, Marie-Pascale; Volaire, Florence

2015-11-01

Extreme climatic events such as severe droughts are expected to increase with climate change and to limit grassland perennity. The present study aimed to characterize the adaptive responses by which temperate herbaceous grassland species resist, survive and recover from a severe drought and to explore the relationships between plant resource use and drought resistance strategies. Monocultures of six native perennial species from upland grasslands and one Mediterranean drought-resistant cultivar were compared under semi-controlled and non-limiting rooting depth conditions. Above- and below-ground traits were measured under irrigation in spring and during drought in summer (50 d of withholding water) in order to characterize resource use and drought resistance strategies. Plants were then rehydrated and assessed for survival (after 15 d) and recovery (after 1 year). Dehydration avoidance through water uptake was associated with species that had deep roots (>1·2 m) and high root mass (>4 kg m(-3)). Cell membrane stability ensuring dehydration tolerance of roots and meristems was positively correlated with fructan content and negatively correlated with sucrose content. Species that survived and recovered best combined high resource acquisition in spring (leaf elongation rate >9 mm d(-1) and rooting depth >1·2 m) with both high dehydration avoidance and tolerance strategies. Most of the native forage species, dominant in upland grassland, were able to survive and recover from extreme drought, but with various time lags. Overall the results suggest that the wide range of interspecific functional strategies for coping with drought may enhance the resilience of upland grassland plant communities under extreme drought events. © The Author 2015. Published by Oxford University Press on behalf of the Annals of Botany Company. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Complex demographic heterogeneity from anthropogenic impacts in a coastal marine predator.

PubMed

Oro, Daniel; Álvarez, David; Velando, Alberto

2018-04-01

Environmental drivers, including anthropogenic impacts, affect vital rates of organisms. Nevertheless, the influence of these drivers may depend on the physical features of the habitat and how they affect life history strategies depending on individual covariates such as age and sex. Here, the long-term monitoring (1994-2014) of marked European Shags in eight colonies in two regions with different ecological features, such as foraging habitat, allowed us to test several biological hypotheses about how survival changes by age and sex in each region by means of multi-event capture-recapture modeling. Impacts included fishing practices and bycatch, invasive introduced carnivores and the severe Prestige oil spill. Adult survival was constant but, unexpectedly, it was different between sexes. This difference was opposite in each region. The impact of the oil spill on survival was important only for adults (especially for females) in one region and lasted a single year. Juvenile survival was time dependent but this variability was not synchronized between regions, suggesting a strong signal of regional environmental variability. Mortality due to bycatch was also different between sex, age and region. Interestingly the results showed that the size of the fishing fleet is not necessarily a good proxy for assessing the impact of bycatch mortality, which may be more dependent on the fishing grounds and the fishing gears employed in each season of the year. Anthropogenic impacts affected survival differently by age and sex, which was expected for a long-lived organism with sexual size dimorphism. Strikingly, these differences varied depending on the region, indicating that habitat heterogeneity is demographically important to how environmental variability (including anthropogenic impacts) and resilience influence population dynamics. © 2018 by the Ecological Society of America.

Radiotherapy of metastatic spinal cord compression in very elderly patients

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

Rades, Dirk; Hoskin, Peter J.; Karstens, Johann H.

2007-01-01

Purpose: Owing to the aging of the population, the proportion of elderly patients receiving cancer treatment has increased. This study investigated the results of radiotherapy (RT) for metastatic spinal cord compression (MSCC) in the very elderly, because few data are available for these patients. Methods and Materials: The data from 308 patients aged {>=}75 years who received short-course (treatment time 1-5 days) or long-course RT (2-4 weeks) for MSCC were retrospectively analyzed for functional outcome, local control, and survival. Furthermore, nine potential prognostic factors were investigated: gender, performance status, interval from tumor diagnosis to MSCC, tumor type, number of involvedmore » vertebrae, other bone or visceral metastases, ambulatory status, and speed at which motor deficits developed. Results: Improvement of motor deficits occurred in 25% of patients, with no further progression of MSCC in an additional 59%. The 1-year local control and survival rate was 92% and 43%, respectively. Improved functional outcomes were associated with ambulatory status and slower developing motor deficits. Improved local control resulted from long-course RT. Improved survival was associated with a longer interval from tumor diagnosis to MSCC, tumor type (breast/prostate cancer, myeloma/lymphoma), lack of visceral or other bone metastases, ambulatory status, and a slower development of motor deficits. Conclusion: Short- and long-course RT are similarly effective in patients aged {>=}75 years regarding functional outcome and survival. Long-course RT provided better local control. Patients with better expected survival should receive long-course RT and others short-course RT. The criteria for selection of an appropriate regimen for MSCC in very elderly patients should be the same as for younger individuals.« less

Interaction Analysis of Longevity Interventions Using Survival Curves.

PubMed

Nowak, Stefan; Neidhart, Johannes; Szendro, Ivan G; Rzezonka, Jonas; Marathe, Rahul; Krug, Joachim

2018-01-06

A long-standing problem in ageing research is to understand how different factors contributing to longevity should be expected to act in combination under the assumption that they are independent. Standard interaction analysis compares the extension of mean lifespan achieved by a combination of interventions to the prediction under an additive or multiplicative null model, but neither model is fundamentally justified. Moreover, the target of longevity interventions is not mean life span but the entire survival curve. Here we formulate a mathematical approach for predicting the survival curve resulting from a combination of two independent interventions based on the survival curves of the individual treatments, and quantify interaction between interventions as the deviation from this prediction. We test the method on a published data set comprising survival curves for all combinations of four different longevity interventions in Caenorhabditis elegans . We find that interactions are generally weak even when the standard analysis indicates otherwise.

Interaction Analysis of Longevity Interventions Using Survival Curves

PubMed Central

Nowak, Stefan; Neidhart, Johannes; Szendro, Ivan G.; Rzezonka, Jonas; Marathe, Rahul; Krug, Joachim

2018-01-01

A long-standing problem in ageing research is to understand how different factors contributing to longevity should be expected to act in combination under the assumption that they are independent. Standard interaction analysis compares the extension of mean lifespan achieved by a combination of interventions to the prediction under an additive or multiplicative null model, but neither model is fundamentally justified. Moreover, the target of longevity interventions is not mean life span but the entire survival curve. Here we formulate a mathematical approach for predicting the survival curve resulting from a combination of two independent interventions based on the survival curves of the individual treatments, and quantify interaction between interventions as the deviation from this prediction. We test the method on a published data set comprising survival curves for all combinations of four different longevity interventions in Caenorhabditis elegans. We find that interactions are generally weak even when the standard analysis indicates otherwise. PMID:29316622

Natural history of rhizomelic chondrodysplasia punctata.

PubMed

White, Amy L; Modaff, Peggy; Holland-Morris, Francesca; Pauli, Richard M

2003-05-01

Rhizomelic chondrodysplasia punctata (RCP) is a rare autosomal recessive disorder with many associated medical complications. Prior to this study, natural history information about RCP was limited and based on experiences with small populations of affected individuals. We delineate the natural history of RCP through systematic analysis of 35 previously unreported individuals (as well as review of 62 literature cases with respect to survival and cause of death). Survival, growth, and developmental expectations and medical needs are summarized based upon experience with this population. Survival is greater among this population than previously reported, with 90% surviving up to 1 year and 50% surviving up to 6 years. Cause of death is most often respiratory problem. All infants with RCP have joint contractures, bilateral cataracts, and severe growth and psychomotor delays. Recommendations for health supervision of children with RCP and for parental counseling are presented. Copyright 2003 Wiley-Liss, Inc.

Survival of genetically modified and self-cloned strains of commercial baker's yeast in simulated natural environments: environmental risk assessment.

PubMed

Ando, Akira; Suzuki, Chise; Shima, Jun

2005-11-01

Although genetic engineering techniques for baker's yeast might improve the yeast's fermentation characteristics, the lack of scientific data on the survival of such strains in natural environments as well as the effects on human health prevent their commercial use. Disruption of acid trehalase gene (ATH1) improves freeze tolerance, which is a crucial characteristic in frozen-dough baking. In this study, ATH1 disruptants constructed by genetic modification (GM) and self-cloning (SC) techniques were used as models to study such effects because these strains have higher freeze tolerance and are expected to be used commercially. Behavior of the strains in simulated natural environments, namely, in soil and water, was studied by measuring the change in the number of viable cells and in the concentration of DNA that contains ATH1 loci. Measurements were made using a real-time PCR method during 40 days of cultivation. Results showed that the number of viable cells of GM and SC strains decreased in a time-dependent manner and that the decrease rate was nearly equal to or higher than that for wild-type (WT) yeast. For all three strains (SC, GM, and WT) in the two simulated natural environments (water and soil), the DNA remained longer than did viable cells but the decrease patterns of either the DNA or the viable cells of SC and GM strains had tendencies similar to those of the WT strain. In conclusion, disruption of ATH1 by genetic engineering apparently does not promote the survival of viable cells and DNA in natural environments.

Kidney transplantation after previous liver transplantation: analysis of the organ procurement transplant network database.

PubMed

Gonwa, Thomas A; McBride, Maureen A; Mai, Martin L; Wadei, Hani M

2011-07-15

Patients after liver transplant have a high incidence of chronic kidney disease and end-stage renal disease (ESRD). We investigated kidney transplantation after liver transplantation using the Organ Procurement Transplant Network database. The Organ Procurement Transplant Network database was queried for patients who received kidney transplantation after previous liver transplantation. These patients were compared with patients who received primary kidney transplantation alone during the same time period. Between 1997 and 2008, 157,086 primary kidney transplants were performed. Of these, 680 deceased donor kidney transplants and 410 living donor kidney transplants were performed in previous recipients of liver transplants. The number of kidney after liver transplants performed each year has increased from 37 per year to 124 per year in 2008. The time from liver transplant to kidney transplant increased from 8.2 to 9.0 years for living donor transplants and from 5.4 to 9.6 years for deceased donor. The 1, 3, and 5 year actuarial graft survival in both living donor kidney after liver transplant and deceased donor kidney after liver transplant are less than the kidney transplant alone patients. However, the death-censored graft survivals are equal. The patient survival is also less but is similar to what would be expected in liver transplant recipients who did not have ESRD. In 2008, kidney after liver transplantation represented 0.9% of the total kidney alone transplants performed in the United States. Kidney transplantation is an appropriate therapy for selected patients who develop ESRD after liver transplantation.

Hazard-Rate Analysis and Patterns of Recurrence in Early Stage Melanoma: Moving towards a Rationally Designed Surveillance Strategy

PubMed Central

Scheri, Randall P.; Pruitt, Scott K.; Herndon, James E.; Marcello, Jennifer; Tyler, Douglas S.; Abernethy, Amy P.

2013-01-01

Background While curable at early stages, few treatment options exist for advanced melanoma. Currently, no consensus exists regarding the optimal surveillance strategy for patients after resection. The objectives of this study were to identify patterns of metastatic recurrence, to determine the influence of metastatic site on survival, and to identify high-risk periods for recurrence. Methods A retrospective review of the Duke Melanoma Database from 1970 to 2004 was conducted that focused on patients who were initially diagnosed without metastatic disease. The time to first recurrence was computed from the date of diagnosis, and the associated hazard function was examined to determine the peak risk period of recurrence. Metastatic sites were coded by the American Joint Committee on Cancer (AJCC) system including local skin, distant skin and nodes (M1a), lung (M1b), and other distant (M1c). Results Of 11,615 patients initially diagnosed without metastatic disease, 4616 (40%) had at least one recurrence. Overall the risk of initial recurrence peaked at 12 months. The risk of initial recurrence at the local skin, distant skin, and nodes peaked at 8 months, and the risk at lung and other distant sites peaked at 24 months. Patients with a cutaneous or nodal recurrence had improved survival compared to other recurrence types. Conclusions The risk of developing recurrent melanoma peaked at one year, and the site of first recurrence had a significant impact on survival. Defining the timing and expected patterns of recurrence will be important in creating an optimized surveillance strategy for this patient population. PMID:23516415

Outcomes of Modified Harrington Reconstructions for Nonprimary Periacetabular Tumors: An Effective and Inexpensive Technique.

PubMed

Bernthal, Nicholas M; Price, Shawn L; Monument, Michael J; Wilkinson, Brandon; Jones, Kevin B; Randall, R Lor

2015-11-01

Metastatic disease to the acetabulum presents a difficult technical and philosophical challenge: complicated surgeries in patients with often short life expectancies force us to examine both the outcome and cost of these operations. Therefore, we studied the durability of a cement-screw rebar reconstruction technique and risk factors for failure, and we compare the results to other reconstruction options. This is a retrospective review of 52 acetabular reconstructions in 50 patients for nonprimary disease using a retrograde screw-rebar-cement all-polyethylene technique. Mean age was 57 years (range 25-81 years). Twenty-four lesions were classified as Harrington class II; 28 were Harrington class III. Mean follow-up was 17.7 months (range 1-92 months). Outcomes included patient survival, prosthesis survival, and complications. Forty-eight of 50 (96 %) patients ambulated after surgery. Five of 52 (9.6 %) of prostheses failed, three from loosening due to tumor progression, one from aseptic loosening, and one from soft tissue instability (dislocation). The three cases of tumor progression failure occurred in patients with massive preoperative ischial tumor burden. Mean surgical time was 198 min, and hospital stay was 5.2 days. The screw-cement-rebar all-polyethylene cup reconstruction technique is a comparatively successful and inexpensive reconstruction option for treating nonprimary oncologic disease in the acetabulum. All cases of loosening occurred beyond the median patient survival. Surgeons should be wary of massive ischial tumor burden in patients with projected longevity, as it may be associated with implant failure. Surgical time and hospital stay are consistent with historical data for alternative implants, and implant cost is lower.

The association between health-related quality-of-life scores and clinical outcomes in metastatic castration-resistant prostate cancer patients: Exploratory analyses of AFFIRM and PREVAIL studies.

PubMed

Beer, Tomasz M; Miller, Kurt; Tombal, Bertrand; Cella, David; Phung, De; Holmstrom, Stefan; Ivanescu, Cristina; Skaltsa, Konstantina; Naidoo, Shevani

2017-12-01

Our exploratory analysis examined the association between health-related quality of life (HRQoL) (baseline and change over time) and clinical outcomes (overall survival [OS]/radiographic progression-free survival [rPFS]) in metastatic castration-resistant prostate cancer (mCRPC). HRQoL, OS and rPFS were assessed in phase III trials comparing enzalutamide with placebo in chemotherapy-naïve (PREVAIL; NCT01212991) or post-chemotherapy (AFFIRM; NCT00974311) mCRPC. HRQoL was assessed using the Functional Assessment of Cancer Therapy-Prostate (FACT-P). Multivariate analyses evaluated the prognostic significance of baseline and time-dependent scores after adjusting for treatment and clinical/demographic variables. Hazard ratios (HRs) and 95% confidence intervals (CIs) represented the hazard of rPFS or OS per minimally important difference (MID) score change in HRQoL variables. In baseline and time-dependent multivariate analyses, OS was independently associated with multiple HRQoL measures across both studies. In time-dependent analyses, a 10-point (upper bound of MID range) increase (improvement) in FACT-P total score was associated with reductions in mortality risk of 19% in AFFIRM (HR 0.81 [95% CI 0.78-0.84]) and 21% in PREVAIL (HR 0.79 [0.76-0.83]). For baseline analyses, a 10-point increase in FACT-P total score was associated with reductions in mortality risk of 12% (HR 0.88 [0.84-0.93]) and 10% (HR 0.90 [0.86-0.95]) in AFFIRM and PREVAIL, respectively. rPFS was associated with a subset of HRQoL domains in both studies. Several baseline HRQoL domains were prognostic for rPFS and OS in patients with mCRPC, and this association was maintained during treatment, indicating that changes in HRQoL are informative for patients' expected survival. Copyright © 2017 Elsevier Ltd. All rights reserved.

Fledgling survival increases with development time and adult survival across north and south temperate zones

USGS Publications Warehouse

Lloyd, Penn; Martin, Thomas E.

2016-01-01

Slow life histories are characterized by high adult survival and few offspring, which are thought to allow increased investment per offspring to increase juvenile survival. Consistent with this pattern, south temperate zone birds are commonly longer-lived and have fewer young than north temperate zone species. However, comparative analyses of juvenile survival, including during the first few weeks of the post-fledging period when most juvenile mortality occurs, are largely lacking. We combined our measurements of fledgling survival for eight passerines in South Africa with estimates from published studies of 57 north and south temperate zone songbird species to test three predictions: (1) fledgling survival increases with length of development time in the nest; (2) fledgling survival increases with adult survival and reduced brood size controlled for development time; and (3) south temperate zone species, with their higher adult survival and smaller brood sizes, exhibit higher fledgling survival than north temperate zone species controlled for development time. We found that fledgling survival was higher among south temperate zone species and generally increased with development time and adult survival within and between latitudinal regions. Clutch size did not explain additional variation, but was confounded with adult survival. Given the importance of age-specific mortality to life history evolution, understanding the causes of these geographical patterns of mortality is important.

A selfish genetic element influencing longevity correlates with reactive behavioural traits in female house mice (Mus domesticus).

PubMed

Auclair, Yannick; König, Barbara; Lindholm, Anna K

2013-01-01

According to theory in life-history and animal personality, individuals with high fitness expectations should be risk-averse, while individuals with low fitness expectations should be more bold. In female house mice, a selfish genetic element, the t haplotype, is associated with increased longevity under natural conditions, representing an appropriate case study to investigate this recent theory empirically. Following theory, females heterozygous for the t haplotype (+/t) are hypothesised to express more reactive personality traits and be more shy, less explorative and less active compared to the shorter-lived homozygous wildtype females (+/+). As males of different haplotype do not differ in survival, no similar pattern is expected. We tested these predictions by quantifying boldness, exploration, activity, and energetic intake in both +/t and +/+ mice. +/t females, unlike +/+ ones, expressed some reactive-like personality traits: +/t females were less active, less prone to form an exploratory routine and tended to ingest less food. Taken together these results suggest that differences in animal personality may contribute to the survival advantage observed in +/t females but fail to provide full empirical support for recent theory.

Alternative Measures of Self-Rated Health for Predicting Mortality Among Older People: Is Past or Future Orientation More Important?

PubMed

Ferraro, Kenneth F; Wilkinson, Lindsay R

2015-10-01

The purpose of this study was to compare the prognostic validity of alternative measures of health ratings, including those that tap temporal reflections, on adult mortality. The study uses a national sample of 1,266 Americans 50-74 years old in 1995, with vital status tracked through 2005, to compare the effect of 3 types of health ratings on mortality: conventional indicator of self-rated health (SRH), age comparison form of SRH, and health ratings that incorporate temporal dimensions. Logistic regression was used to estimate the odds of mortality associated with alternative health ratings while adjusting for health conditions, lifestyle factors, and status characteristics and resources. Self-rated health was a consistent predictor of mortality, but the respondent's expected health rating-10 years in the future-was an independent predictor. Future health expectations were more important than past (recalled change) in predicting mortality risk: People with more negative expectations of future health were less likely to survive. The findings reveal the importance of future time perspective for older people and suggest that it is more useful to query older people about their future health expectations than about how their health has changed. © The Author 2013. 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.

Process monitoring in intensive care with the use of cumulative expected minus observed mortality and risk-adjusted P charts.

PubMed

Cockings, Jerome G L; Cook, David A; Iqbal, Rehana K

2006-02-01

A health care system is a complex adaptive system. The effect of a single intervention, incorporated into a complex clinical environment, may be different from that expected. A national database such as the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme in the UK represents a centralised monitoring, surveillance and reporting system for retrospective quality and comparative audit. This can be supplemented with real-time process monitoring at a local level for continuous process improvement, allowing early detection of the impact of both unplanned and deliberately imposed changes in the clinical environment. Demographic and UK Acute Physiology and Chronic Health Evaluation II (APACHE II) data were prospectively collected on all patients admitted to a UK regional hospital between 1 January 2003 and 30 June 2004 in accordance with the ICNARC Case Mix Programme. We present a cumulative expected minus observed (E-O) plot and the risk-adjusted p chart as methods of continuous process monitoring. We describe the construction and interpretation of these charts and show how they can be used to detect planned or unplanned organisational process changes affecting mortality outcomes. Five hundred and eighty-nine adult patients were included. The overall death rate was 0.78 of predicted. Calibration showed excess survival in ranges above 30% risk of death. The E-O plot confirmed a survival above that predicted. Small transient variations were seen in the slope that could represent random effects, or real but transient changes in the quality of care. The risk-adjusted p chart showed several observations below the 2 SD control limits of the expected mortality rate. These plots provide rapid analysis of risk-adjusted performance suitable for local application and interpretation. The E-O chart provided rapid easily visible feedback of changes in risk-adjusted mortality, while the risk-adjusted p chart allowed statistical evaluation. Local analysis of risk-adjusted mortality data with an E-O plot and a risk-adjusted p chart is feasible and allows the rapid detection of changes in risk-adjusted outcome of intensive care patients. This complements the centralised national database, which is more archival and comparative in nature.

Using the 21-gene assay to guide adjuvant chemotherapy decision-making in early-stage breast cancer: a cost-effectiveness evaluation in the German setting.

PubMed

Blohmer, J U; Rezai, M; Kümmel, S; Kühn, T; Warm, M; Friedrichs, K; Benkow, A; Valentine, W J; Eiermann, W

2013-01-01

The 21-gene assay (Oncotype DX Breast Cancer Test (Genomic Health Inc., Redwood City, CA)) is a well validated test that predicts the likelihood of adjuvant chemotherapy benefit and the 10-year risk of distant recurrence in patients with ER+, HER2- early-stage breast cancer. The aim of this analysis was to evaluate the cost-effectiveness of using the assay to inform adjuvant chemotherapy decisions in Germany. A Markov model was developed to make long-term projections of distant recurrence, survival, quality-adjusted life expectancy, and direct costs for patients with ER+, HER2-, node-negative, or up to 3 node-positive early-stage breast cancer. Scenarios using conventional diagnostic procedures or the 21-gene assay to inform treatment recommendations for adjuvant chemotherapy were modeled based on a prospective, multi-center trial in 366 patients. Transition probabilities and risk adjustment were based on published landmark trials. Costs (2011 Euros (€)) were estimated from a sick fund perspective based on resource use in patients receiving chemotherapy. Future costs and clinical benefits were discounted at 3% annually. The 21-gene assay was projected to increase mean life expectancy by 0.06 years and quality-adjusted life expectancy by 0.06 quality-adjusted life years (QALYs) compared with current clinical practice over a 30-year time horizon. Clinical benefits were driven by optimized allocation of adjuvant chemotherapy. Costs from a healthcare payer perspective were lower with the 21-gene assay by ∼€561 vs standard of care. Probabilistic sensitivity analysis indicated that there was an 87% probability that the 21-gene assay would be dominant (cost and life saving) to standard of care. Country-specific data on the risk of distant recurrence and quality-of-life were not available. Guiding decision-making on adjuvant chemotherapy using the 21-gene assay was projected to improve survival, quality-adjusted life expectancy, and be cost saving vs the current standard of care women with ER+, HER2- early-stage breast cancer.

Influence of Treatment With Tumor-Treating Fields on Health-Related Quality of Life of Patients With Newly Diagnosed Glioblastoma: A Secondary Analysis of a Randomized Clinical Trial.

PubMed

Taphoorn, Martin J B; Dirven, Linda; Kanner, Andrew A; Lavy-Shahaf, Gitit; Weinberg, Uri; Taillibert, Sophie; Toms, Steven A; Honnorat, Jerome; Chen, Thomas C; Sroubek, Jan; David, Carlos; Idbaih, Ahmed; Easaw, Jacob C; Kim, Chae-Yong; Bruna, Jordi; Hottinger, Andreas F; Kew, Yvonne; Roth, Patrick; Desai, Rajiv; Villano, John L; Kirson, Eilon D; Ram, Zvi; Stupp, Roger

2018-04-01

Tumor-treating fields (TTFields) therapy improves both progression-free and overall survival in patients with glioblastoma. There is a need to assess the influence of TTFields on patients' health-related quality of life (HRQoL). To examine the association of TTFields therapy with progression-free survival and HRQoL among patients with glioblastoma. This secondary analysis of EF-14, a phase 3 randomized clinical trial, compares TTFields and temozolomide or temozolomide alone in 695 patients with glioblastoma after completion of radiochemotherapy. Patients with glioblastoma were randomized 2:1 to combined treatment with TTFields and temozolomide or temozolomide alone. The study was conducted from July 2009 until November 2014, and patients were followed up through December 2016. Temozolomide, 150 to 200 mg/m2/d, was given for 5 days during each 28-day cycle. TTFields were delivered continuously via 4 transducer arrays placed on the shaved scalp of patients and were connected to a portable medical device. Primary study end point was progression-free survival; HRQoL was a predefined secondary end point, measured with questionnaires at baseline and every 3 months thereafter. Mean changes from baseline scores were evaluated, as well as scores over time. Deterioration-free survival and time to deterioration were assessed for each of 9 preselected scales and items. Of the 695 patients in the study, 639 (91.9%) completed the baseline HRQoL questionnaire. Of these patients, 437 (68.4%) were men; mean (SD) age, 54.8 (11.5) years. Health-related quality of life did not differ significantly between treatment arms except for itchy skin. Deterioration-free survival was significantly longer with TTFields for global health (4.8 vs 3.3 months; P < .01); physical (5.1 vs 3.7 months; P < .01) and emotional functioning (5.3 vs 3.9 months; P < .01); pain (5.6 vs 3.6 months; P < .01); and leg weakness (5.6 vs 3.9 months; P < .01), likely related to improved progression-free survival. Time to deterioration, reflecting the influence of treatment, did not differ significantly except for itchy skin (TTFields worse; 8.2 vs 14.4 months; P < .001) and pain (TTFields improved; 13.4 vs 12.1 months; P < .01). Role, social, and physical functioning were not affected by TTFields. The addition of TTFields to standard treatment with temozolomide for patients with glioblastoma results in improved survival without a negative influence on HRQoL except for more itchy skin, an expected consequence from the transducer arrays. clinicaltrials.gov Identifier: NCT00916409.

Annual survival and population estimates of Mountain Plovers in Southern Phillips County, Montana

USGS Publications Warehouse

Dinsmore, S.J.; White, Gary C.; Knopf, F.L.

2003-01-01

Information about the demography of declining species is especially relevant to their conservation and future recovery. Knowledge of survival rates and population size can be used to assess long-term viability and population trends, both of which are of interest to conservation biologists. We used capture–recapture techniques to study the demography of Mountain Plovers (Charadrius montanus Townsend) in southern Phillips County, Montana, USA, in 1995–2000. We used the robust design to estimate annual survival (φ), conditional capture (p and r) and recapture (c) probabilities, and the annual population size (N) in the presence of temporary emigration. The results support age-specific differences in annual survival that are a function of juvenile body mass and are correlated with the area occupied by prairie dogs. Body mass had a positive effect on juvenile survival; the slope coefficient for the additive effect of body mass on juvenile survival was 0.77 (95% ci = 0.25, 1.28) on a logit scale. A measure of plover habitat (the area occupied by prairie dogs) appeared to have no effect on survival; the slope coefficient for the additive effect of area occupied by prairie dogs on survival was –0.00004 (95% ci = –0.00003, –0.0001) on a logit scale. Estimated annual apparent survival rates were 0.46–0.49 for juveniles and 0.68 for adult plovers. Using these estimates, the life span of a Mountain Plover was 1.92 ± 0.17 years (mean ± 1 se) from time of capture as a chick. Resighting rates positively influenced capture probabilities; the slope coefficient for the additive resighting effect was –0.49 (95% ci = –0.86, –0.11) on a logit scale. The size of this adult Mountain Plover population was estimated at 95–180 adults annually. Population size closely tracked annual changes in the area occupied by black-tailed prairie dogs, with both plovers and prairie dogs rapidly recovering from an outbreak of sylvatic plague in the mid-1990s. Given the low annual survival rates and low mean life expectancy of Mountain Plovers, we conclude that sustainable local populations are currently maintained by annual rates of productivity greater than those for other ground-nesting birds.

Up-to-date and projected estimates of survival for people with cystic fibrosis using baseline characteristics: A longitudinal study using UK patient registry data.

PubMed

Keogh, Ruth H; Szczesniak, Rhonda; Taylor-Robinson, David; Bilton, Diana

2018-03-01

Cystic fibrosis (CF) is the most common inherited disease in Caucasians, affecting around 10,000 individuals in the UK today. Prognosis has improved considerably over recent decades with ongoing improvements in treatment and care. Providing up-to-date survival predictions is important for patients, clinicians and health services planning. Flexible parametric survival modelling of UK CF Registry data from 2011 to 2015, capturing 602 deaths in 10,428 individuals. Survival curves were estimated from birth; conditional on reaching older ages; and projected under different assumptions concerning future mortality trends, using baseline characteristics of sex, CFTR genotype (zero, one, two copies of F508del) and age at diagnosis. Male sex was associated with better survival, as was older age at diagnosis, but only in F508del non-homozygotes. Survival did not differ by genotype among individuals diagnosed at birth. Median survival ages at birth in F508del homozygotes were 46years (males) and 41years (females), and similar in non-homozygotes diagnosed at birth. F508del heterozygotes diagnosed aged 5 had median survival ages of 57 (males) and 51 (females). Conditional on survival to 30, median survival age rises to 52 (males) and 49 (females) in homozygotes. Mortality rates decreased annually by 2% during 2006-2015. Future improvements at this rate suggest median survival ages for F508del homozygous babies of 65 (males) and 56 (females). Over half of babies born today, and of individuals aged 30 and above today, can expect to survive into at least their fifth decade. Evidence before this study We searched PubMed with terms "(cystic fibrosis survival) and (projection OR model OR registry OR United Kingdom OR UK)" to identify relevant studies on survival estimates for individuals with cystic fibrosis (CF). We also considered the most recent annual report from the UK Cystic Fibrosis Registry (Cystic Fibrosis Trust, 2016), a review by Buzzetti and colleagues (2009), the chapter on Epidemiology of Cystic Fibrosis by MacNeill (2016), the study of MacKenzie and colleagues (2014), and references therein. There have been many studies of factors associated with survival in CF; most have focused on identifying risk factors, and only a few have presented estimated survival curves, which are the focus of this work. The most recent study of survival in the UK is by Dodge and colleagues (2007), who used data obtained from CF clinics and the national death register, and gave an estimate of survival for babies born in 2003. We found no previous studies that have obtained detailed information on survival using UK Cystic Fibrosis Registry data. Jackson and colleagues obtained survival estimates for the US and Ireland using registry data (Jackson et al., 2011). MacKenzie and colleagues used US Cystic Fibrosis Foundation Patient Registry data from 2000 to 2010 to project survival for children born and diagnosed with CF in 2010, accounting for sex, genotype and age at diagnosis (MacKenzie et al., 2014). Previous studies on estimated survival in CF have become out of date or have not accounted for the full range of patient characteristics available at birth. Few have presented conditional survival estimates (Dodge et al., 2007). Added value of this study This is the first study to yield detailed survival statistics using the UK Cystic Fibrosis Registry, which is one of the largest national CF registries outside of the US and has almost complete coverage of the UK CF population. The primary goal was to leverage the long-term follow-up of the nearly complete UK CF population available in the Registry for the purposes of producing accurate, precise predictions in the modern era of CF care. Estimates are presented from birth and conditional on survival to older ages. These are the first conditional estimates in CF to also account for genotype, sex and age at diagnosis, which were each included in the modelling using a flexible approach. Projections are also provided under different scenarios based on downward trends in mortality rates. Our use of flexible parametric survival models is novel in this field, and our approach could be used to provide modern survival statistics for other chronic diseases and disorders. Implications of all the available evidence Our estimates of future survival in CF under a range of different scenarios are based on data on nearly all individuals living with the disease in the UK in recent times, reflective of a modern era of care, and are most appropriate for the families of babies being born in the present day with CF. Conditional estimates inform patients who have already reached an older age, and their clinicians. Over half of babies born today, and of individuals aged 30years and above alive today, can expect to survive into their fifth decade. Insights based on our survival projections can be used to inform future needs in CF health care provision. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

U.S. Datasets

Cancer.gov

Datasets for U.S. mortality, U.S. populations, standard populations, county attributes, and expected survival. Plus SEER-linked databases (SEER-Medicare, SEER-Medicare Health Outcomes Survey [SEER-MHOS], SEER-Consumer Assessment of Healthcare Providers and Systems [SEER-CAHPS]).

A quantitative life history of endangered humpback chub that spawn in the Little Colorado River: variation in movement, growth, and survival

USGS Publications Warehouse

Yackulic, Charles B.; Yard, Michael D.; Korman, Josh; Van Haverbeke, David R.

2014-01-01

While the ecology and evolution of partial migratory systems (defined broadly to include skip spawning) have been well studied, we are only beginning to understand how partial migratory populations are responding to ongoing environmental change. Environmental change can lead to differences in the fitness of residents and migrants, which could eventually lead to changes in the frequency of the strategies in the overall population. Here, we address questions concerning the life history of the endangered Gila cypha (humpback chub) in the regulated Colorado River and the unregulated tributary and primary spawning area, the Little Colorado River. We develop eight multistate models for the population based on three movement hypotheses, in which states are defined in terms of fish size classes and river locations. We fit these models to mark–recapture data collected in 2009–2012. We compare survival and growth estimates between the Colorado River and Little Colorado River and calculate abundances for all size classes. The best model supports the hypotheses that larger adults spawn more frequently than smaller adults, that there are residents in the spawning grounds, and that juveniles move out of the Little Colorado River in large numbers during the monsoon season (July–September). Monthly survival rates for G. cypha in the Colorado River are higher than in the Little Colorado River in all size classes; however, growth is slower. While the hypothetical life histories of life-long residents in the Little Colorado River and partial migrants spending most of its time in the Colorado River are very different, they lead to roughly similar fitness expectations when we used expected number of spawns as a proxy. However, more research is needed because our study period covers a period of years when conditions in the Colorado River for G. cypha are likely to have been better than has been typical over the last few decades.

Primary Localization and Tumor Thickness as Prognostic Factors of Survival in Patients with Mucosal Melanoma

PubMed Central

Mehra, Tarun; Grözinger, Gerd; Mann, Steven; Guenova, Emmanuella; Moos, Rudolf; Röcken, Martin; Claussen, Claus Detlef; Dummer, Reinhard; Clasen, Stephan

2014-01-01

Background Data on survival with mucosal melanoma and on prognostic factors of are scarce. It is still unclear if the disease course allows for mucosal melanoma to be treated as primary cutaneous melanoma or if differences in overall survival patterns require adapted therapeutic approaches. Furthermore, this investigation is the first to present 10-year survival rates for mucosal melanomas of different anatomical localizations. Methodology 116 cases from Sep 10 1984 until Feb 15 2011 retrieved from the Comprehensive Cancer Center and of the Central Register of the German Dermatologic Society databases in Tübingen were included in our analysis. We recorded anatomical location and tumor thickness, and estimated overall survival at 2, 5 and 10 years and the mean overall survival time. Survival times were analyzed with the Kaplan-Meier method. The log-rank test was used to compare survival times by localizations and by T-stages. Principal Findings We found a median overall survival time of 80.9 months, with an overall 2-year survival of 71.7%, 5-year survival of 55.8% and 10-year survival of 38.3%. The 10-year survival rates for patients with T1, T2, T3 or T4 stage tumors were 100.0%, 77.9%, 66.3% and 10.6% respectively. 10-year survival of patients with melanomas of the vulva was 64.5% in comparison to 22.3% of patients with non-vulva mucosal melanomas. Conclusion Survival times differed significantly between patients with melanomas of the vulva compared to the rest (p = 0.0006). It also depends on T-stage at the time of diagnosis (p<0.0001). PMID:25383553

Primary localization and tumor thickness as prognostic factors of survival in patients with mucosal melanoma.

PubMed

Mehra, Tarun; Grözinger, Gerd; Mann, Steven; Guenova, Emmanuella; Moos, Rudolf; Röcken, Martin; Claussen, Claus Detlef; Dummer, Reinhard; Clasen, Stephan; Naumann, Aline; Garbe, Claus

2014-01-01

Data on survival with mucosal melanoma and on prognostic factors of are scarce. It is still unclear if the disease course allows for mucosal melanoma to be treated as primary cutaneous melanoma or if differences in overall survival patterns require adapted therapeutic approaches. Furthermore, this investigation is the first to present 10-year survival rates for mucosal melanomas of different anatomical localizations. 116 cases from Sep 10 1984 until Feb 15 2011 retrieved from the Comprehensive Cancer Center and of the Central Register of the German Dermatologic Society databases in Tübingen were included in our analysis. We recorded anatomical location and tumor thickness, and estimated overall survival at 2, 5 and 10 years and the mean overall survival time. Survival times were analyzed with the Kaplan-Meier method. The log-rank test was used to compare survival times by localizations and by T-stages. We found a median overall survival time of 80.9 months, with an overall 2-year survival of 71.7%, 5-year survival of 55.8% and 10-year survival of 38.3%. The 10-year survival rates for patients with T1, T2, T3 or T4 stage tumors were 100.0%, 77.9%, 66.3% and 10.6% respectively. 10-year survival of patients with melanomas of the vulva was 64.5% in comparison to 22.3% of patients with non-vulva mucosal melanomas. Survival times differed significantly between patients with melanomas of the vulva compared to the rest (p = 0.0006). It also depends on T-stage at the time of diagnosis (p < 0.0001).

Global divergence in critical income for adult and childhood survival: analyses of mortality using Michaelis–Menten

PubMed Central

Hum, Ryan J; Jha, Prabhat; McGahan, Anita M; Cheng, Yu-Ling

2012-01-01

Life expectancy has risen sharply in the last 50 years. We applied the classic Michaelis–Menten enzyme kinetics to demonstrate a novel mathematical relationship of income to childhood (aged 0–5 years) and adult (aged 15–60 years) survival. We treat income as a substrate that is catalyzed to increase survival (from technologies that income buys) for 180 countries from 1970 and 2007. Michaelis–Menten kinetics permit estimates of maximal survival and, uniquely, the critical income needed to achieve half of the period-specific maximum. Maximum child and adult survival rose by about 1% per year. Critical incomes fell by half for children, but doubled for men. HIV infection and smoking account for some, but not all, of the rising critical incomes for adult survival. Altering the future cost curve for adult survival will require more widespread use of current interventions, most notably tobacco control, but also research to identify practicable low-cost drugs, diagnostics, and strategies. DOI: http://dx.doi.org/10.7554/eLife.00051.001 PMID:23240081

Logarithmic speed-up of relaxation in A -B annihilation with exclusion

NASA Astrophysics Data System (ADS)

Dandekar, Rahul

2018-04-01

We show that the decay of the density of active particles in the reaction A +B →0 in one dimension, with exclusion interaction, results in logarithmic corrections to the expected power law decay, when the starting initial condition (i.c.) is periodic. It is well known that the late-time density of surviving particles goes as t-1 /4 with random initial conditions, and as t-1 /2 with alternating initial conditions (A B A B A B ⋯ ). We show that the decay for periodic i.c.'s made of longer blocks (AnBnAnBn⋯ ) do not show a pure power-law decay when n is even. By means of first-passage Monte Carlo simulations, and a mapping to a q -state coarsening model which can be solved in the independent interval approximation (IIA), we show that the late-time decay of the density of surviving particles goes as t-1 /2[ln(t ) ] -1 for n even, but as t-1 /2 when n is odd. We relate this kinetic symmetry breaking in the Glauber Ising model. We also see a very slow crossover from a t-1 /2[ln(t ) ] -1 regime to eventual t-1 /2 behavior for i.c.'s made of mixtures of odd- and even-length blocks.

Malignant ascites: A review of prognostic factors, pathophysiology and therapeutic measures

PubMed Central

Sangisetty, Suma L; Miner, Thomas J

2012-01-01

Malignant ascites indicates the presence of malignant cells in the peritoneal cavity and is a grave prognostic sign. While survival in this patient population is poor, averaging about 20 wk from time of diagnosis, quality of life can be improved through palliative procedures. Selecting the appropriate treatment modality remains a careful process, which should take into account potential risks and benefits and the life expectancy of the patient. Traditional therapies, including paracentesis, peritoneovenous shunt placement and diuretics, are successful and effective in varying degrees. After careful review of the patient’s primary tumor origin, tumor biology, tumor stage, patient performance status and comorbidities, surgical debulking and intraperitoneal chemotherapy should be considered if the benefit of therapy outweighs the risk of operation because survival curves can be extended and palliation of symptomatic malignant ascites can be achieved in select patients. In patients with peritoneal carcinomatosis who do not qualify for surgical cytoreduction but suffer from the effects of malignant ascites, intraperitoneal chemotherapy can be safely and effectively administered via laparoscopic techniques. Short operative times, short hospital stays, low complication rates and ultimately symptomatic relief are the advantages of laparoscopically administering heated intraperitoneal chemotherapy, making it not only a valuable treatment modality but also the most successful treatment modality for achieving palliative cure of malignant ascites. PMID:22590662

The evolution of tumor metastases during clonal expansion.

PubMed

Haeno, Hiroshi; Michor, Franziska

2010-03-07

Cancer is a leading cause of morbidity and mortality in many countries. Solid tumors generally initiate at one particular site called the primary tumor, but eventually disseminate and form new colonies in other organs. The development of such metastases greatly diminishes the potential for a cure of patients and is thought to represent the final stage of the multi-stage progression of human cancer. The concept of early metastatic dissemination, however, postulates that cancer cell spread might arise early during the development of a tumor. It is important to know whether metastases are present at diagnosis since this determines treatment strategies and outcome. In this paper, we design a stochastic mathematical model of the evolution of tumor metastases in an expanding cancer cell population. We calculate the probability of metastasis at a given time during tumor evolution, the expected number of metastatic sites, and the total number of cancer cells as well as metastasized cells. Furthermore, we investigate the effect of drug administration and tumor resection on these quantities and predict the survival time of cancer patients. The model presented in this paper allows us to determine the probability and number of metastases at diagnosis and to identify the optimum treatment strategy to maximally prolong survival of cancer patients. 2009 Elsevier Ltd. All rights reserved.

Mortality in the Children of Atomic Bomb Survivors and Controls

PubMed Central

Neel, James V.; Kato, Hiroo; Schull, William J.

1974-01-01

A continuing study of mortality rates among children born to survivors of the atomic bombings and a suitable group of controls has been updated; the average interval between birth and verification of death or survival is 17 years. The mortality experience is now based on 18,946 children liveborn to parents one or both of whom were proximally exposed, receiving jointly an estimated dose of 117 rem; 16,516 children born to distally exposed parents receiving essentially no radiation; and 17,263 children born to parents not in Hiroshima or Nagasaki at the time of the bombings. No clearly significant effect of parental exposure on child's survival can be demonstrated either by a contingency χ2 type of analysis or regression analysis. On the basis of the regression data, the minimal gametic doubling dose of radiation of this type for mutations resulting in death during (on the average) the first 17 years of life among liveborn infants conceived 0–13 years after parental exposure is estimated at 46 rem for fathers and 125 rem for mothers. On the basis of experimental data, the gametic doubling dose for chronic, low-level radiation would be expected to be three to four times this value for males and as much as 1000 rem for females. PMID:4822470

[Effect of Fuzheng Huayu capsules on survival rate of patients with liver cirrhosis].

PubMed

Ge, X J; Zhao, C Q; Xu, L M

2017-11-20

Objective: To investigate the effect of Fuzheng Huayu capsules on the survival rate of patients with liver cirrhosis. Methods: A retrospective analysis was performed for the clinical data of the patients with various types of liver cirrhosis who were hospitalized in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 1, 2006 to December 31, 2008. The data collected for these patients included their basic information, diagnosis and treatment, and results of laboratory examination. The Kaplan-Meier method was used to analyze the effect of Fuzheng Huayu capsules on the survival rate of patients with liver cancer. The starting point of observation was the first day of the patient's admission and the ending point of follow-up observation was the date of death or the end of follow-up April 1, 2014. The cut-off value was obtained if the patient did not experience any outcome event (death) at the end of follow-up. With reference to the outcome, the time when the outcome occurred, and the cut-off value, the life-table method was used to calculate survival rates and survival curves were plotted. The Kaplan-Meier product-limit method was used to calculate the arithmetic mean of survival time and median survival time, and the log-rank test was used to compare the survival data. Results: A total of 430 patients with liver cirrhosis were enrolled, among whom 191 died and 239 survived or were censored. The average constituent ratio of death was 55.6% and the average constituent ratio of survival was 44.4%. The life-table method showed that the half-, 1-, 2-, and 5-year survival rates were 70%, 64%, 58%, and 48%, respectively. The median survival time was 112.1 weeks for the patients who did not take Fuzheng Huayu capsules and 351.6 weeks for those who did, and there was a significant difference in survival rate between the two groups ( P = 0.000). Among 313 patients who had an etiology of hepatitis B, 164 did not take Fuzheng Huayu capsules and had a median survival time of 195.9 weeks and a 5-year survival rate of 44%, and 149 took Fuzheng Huayu capsules and had a median survival time of 336.9 weeks and a 5-year survival rate of 59%; there was a significant difference in survival rate between the two groups ( P = 0.038). Among 117 patients who did not have hepatitis B, 68 did not take Fuzheng Huayu capsules and had a median survival time of 78.1 weeks and a 5-year survival rate of 32%, and 49 took Fuzheng Huayu capsules and had a median survival time of 277.4 weeks and a 5-year survival rate of 53%; there was a significant difference in survival rate between the two groups ( P = 0.013). Among 92 patients with compensated liver cirrhosis, 47 did not take Fuzheng Huayu capsules and had a 5-year survival rate of 65%, and 45 took Fuzheng Huayu capsules and had a 5-year survival rate of 82%; both groups of patients had a median survival of 440 weeks; there was a significant difference in survival rate between the two groups ( P = 0.027). Among 338 patients with decompensated liver cirrhosis, 185 did not take Fuzheng Huayu capsules and had a median survival time of 60.3 weeks and a 5-year survival rate of 33%, and 153 took Fuzheng Huayu capsules and had a median survival time of 267.7 weeks and a 5-year survival rate of 51%; there was a significant difference in survival rate between the two groups ( P = 0.001). Conclusion: Fuzheng Huayu capsules can improve the prognosis of patients with liver cirrhosis and increase their survival rates and have good long-term efficacy.

Clinical Diagnoses before Age 75 and Men's Survival to Their 85th Birthday: The Manitoba Follow-Up Study

ERIC Educational Resources Information Center

Tate, Robert B.; Michaels, Leon; Cuddy, T. Edward; Bayomi, Dennis J.

2013-01-01

Purpose: Of all Canadian and American men who live to age 75 years, about half can expect to live to age 85. Our objective is to examine how clinical diagnoses made before age 75 relate to a man's survival to age 85 years. Design and Methods: Since 1948, a cohort of 3,983 young men (mean age of 31 years at entry) has been followed with routine…

Development of a model with which to predict the life expectancy of patients with spinal epidural metastasis.

PubMed

Bartels, Ronald H M A; Feuth, Ton; van der Maazen, Richard; Verbeek, André L M; Kappelle, Arnoud C; André Grotenhuis, J; Leer, Jan Willem

2007-11-01

The surgical treatment of spinal epidural metastasis is evolving. To be a surgical candidate, a patient should have a life expectancy of at least 3 months. Estimation of survival by experienced specialists has proven to be unreliable. The Cox proportional hazards model was used to make a prediction model. To validate the model, Efron optimism correction by bootstrapping was performed. Retrospective data of patients treated for a spinal metastasis were used. Possible predictive factors were defined based on clinical experience and the literature. Statistical methods and clinical knowledge were also used to reveal an optimal set of predictors of survival. Data from patients treated at the Department of Radiation Oncology for spinal metastasis between 1998 and 2005 were evaluated. The case notes of 219 patients form the base of this study. In the final model, only 5 variables were required to predict the survival of a patient with spinal metastasis: sex, location of the primary lesion, intentional curative treatment of the primary tumor, cervical location of the spinal metastasis, and Karnofsky performance score. Examples with different predictors are given. The R(2) (N) index of Nagelkerke was 0.36 (95% confidence interval [95% CI], 0.28-0.48) and the c-index 0.72 (95% CI, 0.68-0.77). A reliable and simple model with which to predict the survival of a patient with spinal epidural metastasis is presented. Without the need for extensive investigations, survival can be predicted and only 5 easily obtainable parameters are required.

Antenatal assessment of liver position, rather than lung-to-head ratio (LHR) or observed/expected LHR, is predictive of outcome in fetuses with isolated left-sided congenital diaphragmatic hernia.

PubMed

Straňák, Zbyněk; Krofta, Ladislav; Haak, Lucia Anna; Vojtěch, Jiří; Hašlík, Luboš; Rygl, Michal; Pýcha, Karel; Feyereisl, Jaroslav

2017-01-01

Respiratory morbidity in congenital diaphragmatic hernia (CDH) is associated with high mortality and adverse outcome. Accurate prenatal diagnosis is essential for prognosis and potential treatment in utero. The aim was to evaluate the prenatal ultrasound findings in assessing the respiratory prognosis in fetuses with isolated left-sided CDH. We retrospectively analyzed the medical records of 59 prenatally diagnosed left-sided CDH cases managed at a tertiary perinatal center. Survival rate in the study group was 73% (43/59). We found no statistically significant relationship between survival and the presence of polyhydramnios, gestational age at diagnosis, lung-to-head ratio (LHR) and observed/expected LHR (O/E LHR) values, gestational age at birth and birth weight. Intrathoracic liver herniation was a statistically significant parameter adversely affecting survival (37.2% in survivors, 68.8% in non-survivors, p = 0.031) and logistic regression confirmed this relationship. The presence of pneumothorax and severe pulmonary hypertension were significantly associated with mortality (82% non-survivors versus 15% in survivors, p = 0.0001). Intrathoracic liver herniation seems to be a reliable parameter in the prediction of survival and neonatal respiratory morbidity in fetuses with isolated left-sided CDH. In contrast, we found no significant correlation between perinatal outcome and LHR, O/E LHR values, birth weight and gestational age.

Floc Formation Reduces the pH Stress Experienced by Microorganisms Living in Alkaline Environments

PubMed Central

Charles, C. J.; Rout, S. P.; Patel, K. A.; Akbar, S.; Laws, A. P.; Jackson, B. R.; Boxall, S. A.

2017-01-01

ABSTRACT The survival of microorganisms within a cementitious geological disposal facility for radioactive wastes heavily depends on their ability to survive the calcium-dominated, hyperalkaline conditions resulting from the dissolution of the cementitious materials. The results from this study show that the formation of flocs, composed of a complex mixture of extracellular polymeric substances (EPS), provides protection against alkaline pH values up to 13.0. The flocs were dominated by Alishewanella and Dietzia spp., producing a mannose-rich carbohydrate fraction incorporating extracellular DNA, resulting in Ca2+ sequestration. EPS provided a ∼10-μm thick layer around the cells within the center of the flocs, which were capable of growth at pH values of 11.0 and 11.5, maintaining internal pH values of 10.4 and 10.7, respectively. Microorganisms survived at a pH of 12.0, where an internal floc pH of 11.6 was observed, as was a reduced associated biomass. We observed limited floc survival (<2 weeks) at a pH of 13.0. This study demonstrates that flocs maintain lower internal pHs in response to the hyperalkaline conditions expected to occur within a cementitious geological disposal facility for radioactive wastes and indicates that floc communities within such a facility can survive at pHs up to 12.0. IMPORTANCE The role of extracellular polymeric substances (EPS) in the survival of microorganisms in hyperalkaline conditions is poorly understood. Here, we present the taxonomy, morphology, and chemical characteristics of an EPS-based microbial floc, formed by a consortium isolated from an anthropogenic hyperalkaline site. Short-term (<2 weeks) survival of the flocs at a pH of 13 was observed, with indefinite survival observed at a pH of 12.0. Measurements from micro-pH electrodes (10-μm-diameter tip) demonstrated that flocs maintain lower internal pHs in response to hyperalkaline conditions (pH 11.0, 11.5, and 12.0), demonstrating that floc formation and EPS production are survival strategies under hyperalkaline conditions. The results indicate how microbial communities may survive and propagate within the hyperalkaline environment that is expected to prevail in a cementitious geological disposal facility for radioactive wastes; the results are also relevant to the wider extremophile community. PMID:28087527

Floc Formation Reduces the pH Stress Experienced by Microorganisms Living in Alkaline Environments.

PubMed

Charles, C J; Rout, S P; Patel, K A; Akbar, S; Laws, A P; Jackson, B R; Boxall, S A; Humphreys, P N

2017-03-15

The survival of microorganisms within a cementitious geological disposal facility for radioactive wastes heavily depends on their ability to survive the calcium-dominated, hyperalkaline conditions resulting from the dissolution of the cementitious materials. The results from this study show that the formation of flocs, composed of a complex mixture of extracellular polymeric substances (EPS), provides protection against alkaline pH values up to 13.0. The flocs were dominated by Alishewanella and Dietzia spp., producing a mannose-rich carbohydrate fraction incorporating extracellular DNA, resulting in Ca 2+ sequestration. EPS provided a ∼10-μm thick layer around the cells within the center of the flocs, which were capable of growth at pH values of 11.0 and 11.5, maintaining internal pH values of 10.4 and 10.7, respectively. Microorganisms survived at a pH of 12.0, where an internal floc pH of 11.6 was observed, as was a reduced associated biomass. We observed limited floc survival (<2 weeks) at a pH of 13.0. This study demonstrates that flocs maintain lower internal pHs in response to the hyperalkaline conditions expected to occur within a cementitious geological disposal facility for radioactive wastes and indicates that floc communities within such a facility can survive at pHs up to 12.0. IMPORTANCE The role of extracellular polymeric substances (EPS) in the survival of microorganisms in hyperalkaline conditions is poorly understood. Here, we present the taxonomy, morphology, and chemical characteristics of an EPS-based microbial floc, formed by a consortium isolated from an anthropogenic hyperalkaline site. Short-term (<2 weeks) survival of the flocs at a pH of 13 was observed, with indefinite survival observed at a pH of 12.0. Measurements from micro-pH electrodes (10-μm-diameter tip) demonstrated that flocs maintain lower internal pHs in response to hyperalkaline conditions (pH 11.0, 11.5, and 12.0), demonstrating that floc formation and EPS production are survival strategies under hyperalkaline conditions. The results indicate how microbial communities may survive and propagate within the hyperalkaline environment that is expected to prevail in a cementitious geological disposal facility for radioactive wastes; the results are also relevant to the wider extremophile community. Copyright © 2017 American Society for Microbiology.

Using relative survival measures for cross-sectional and longitudinal benchmarks of countries, states, and districts: the BenchRelSurv- and BenchRelSurvPlot-macros

PubMed Central

2013-01-01

Background The objective of screening programs is to discover life threatening diseases in as many patients as early as possible and to increase the chance of survival. To be able to compare aspects of health care quality, methods are needed for benchmarking that allow comparisons on various health care levels (regional, national, and international). Objectives Applications and extensions of algorithms can be used to link the information on disease phases with relative survival rates and to consolidate them in composite measures. The application of the developed SAS-macros will give results for benchmarking of health care quality. Data examples for breast cancer care are given. Methods A reference scale (expected, E) must be defined at a time point at which all benchmark objects (observed, O) are measured. All indices are defined as O/E, whereby the extended standardized screening-index (eSSI), the standardized case-mix-index (SCI), the work-up-index (SWI), and the treatment-index (STI) address different health care aspects. The composite measures called overall-performance evaluation (OPE) and relative overall performance indices (ROPI) link the individual indices differently for cross-sectional or longitudinal analyses. Results Algorithms allow a time point and a time interval associated comparison of the benchmark objects in the indices eSSI, SCI, SWI, STI, OPE, and ROPI. Comparisons between countries, states and districts are possible. Exemplarily comparisons between two countries are made. The success of early detection and screening programs as well as clinical health care quality for breast cancer can be demonstrated while the population’s background mortality is concerned. Conclusions If external quality assurance programs and benchmark objects are based on population-based and corresponding demographic data, information of disease phase and relative survival rates can be combined to indices which offer approaches for comparative analyses between benchmark objects. Conclusions on screening programs and health care quality are possible. The macros can be transferred to other diseases if a disease-specific phase scale of prognostic value (e.g. stage) exists. PMID:23316692

Abdominally implanted satellite transmitters affect reproduction and survival rather than migration of large shorebirds

USGS Publications Warehouse

Hooijmeijer, Jos C. E. W.; Gill, Robert E.; Mulcahy, Daniel M.; Tibbitts, T. Lee; Kentie, Rosemarie; Gerritsen, Gerrit J.; Bruinzeel, Leo W.; Tijssen, David C.; Harwood, Christopher M.; Piersma, Theunis

2014-01-01

Satellite telemetry has become a common technique to investigate avian life-histories, but whether such tagging will affect fitness is a critical unknown. In this study, we evaluate multi-year effects of implanted transmitters on migratory timing and reproductive performance in shorebirds. Shorebirds increasingly are recognized as good models in ecology and evolution. That many of them are of conservation concern adds to the research responsibilities. In May 2009, we captured 56 female Black-tailed Godwits Limosa limosa limosa during late incubation in The Netherlands. Of these, 15 birds were equipped with 26-g satellite transmitters with a percutaneous antenna (7.8 % ± 0.2 SD of body mass), surgically implanted in the coelom. We compared immediate nest survival, timing of migration, subsequent nest site fidelity and reproductive behaviour including egg laying with those of the remaining birds, a comparison group of 41 females. We found no effects on immediate nest survival. Fledging success and subsequent southward and northward migration patterns of the implanted birds conformed to the expectations, and arrival time on the breeding grounds in 2010–2012 did not differ from the comparison group. Compared with the comparison group, in the year after implantation, implanted birds were equally faithful to the nest site and showed equal territorial behaviour, but a paucity of behaviours indicating nests or clutches. In the 3 years after implantation, the yearly apparent survival of implanted birds was 16 % points lower. Despite intense searching, we found only three eggs of two implanted birds; all were deformed. A similarly deformed egg was reported in a similarly implanted Whimbrel Numenius phaeopus returning to breed in central Alaska. The presence in the body cavity of an object slightly smaller than a normal egg may thus lead to egg malformation and, likely, reduced egg viability. That the use of implanted satellite transmitters in these large shorebirds reduced nesting propensity and might also lead to fertility losses argues against the use of implanted transmitters for studies on breeding biology, and for a careful evaluation of the methodology in studies of migration.

Fecal indicator bacteria persistence under natural conditions in an ice-covered river.

PubMed Central

Davenport, C V; Sparrow, E B; Gordon, R C

1976-01-01

Total coliform (TC), fecal coliform (FC), and fecal streptococcus (FS) survival characteristics, under natural conditions at 0 degrees C in an ice-covered river, were examined during February and March 1975. The membrane filter (MF) technique was used throughout the study, and the multiple-tube (MPN) method was used in parallel on three preselected days for comparative recovery of these bacteria. Survival was studied at seven sample stations downstream from all domestic pollution sources in a 317-km reach of the river having 7.1 days mean flow time (range of 6.0 to 9.1 days). The mean indicator bacteria densities decreased continuously at successive stations in this reach and, after adjustment for dilution, the most rapid die-off was found to occur during the first 1.9 days, followed by a slower decrease. After 7.1 days, the relative survival was TC less than FC less than FS, with 8.4%, 15.7%, and 32.8% of the initial populations remaining viable, respectively. These rates are higher than previously reported and suggest that the highest survival rates for these bacteria in receiving streams can be expected at 0 degree C under ice cover. Additionally, the FC-FS ratio was greater than 5 at all stations, indicating that this ratio may be useable for determining the source of fecal pollution in receiving streams for greater than 7 days flow time at low water temperatures. The MPN and MF methods gave comparable results for the TC and FS at all seven sample stations, with both the direct and verified MF counts within the 95% confidence limits of the respective MPNs in most samples, but generally lower than the MPN index. Although FC recovery on membrane filters was comparable results at stations near the pollution source. However, the results became more comparable with increasing flow time. The results of this study indicate that heat shock is a major factor in suppression of the FC counts on the membrane filters at 44.5 degree C. Heat shock may be minimized by extended incubation at 35 degrees C before exposure to the higher temperature. PMID:825042

Semiparametric methods to contrast gap time survival functions: Application to repeat kidney transplantation.

PubMed

Shu, Xu; Schaubel, Douglas E

2016-06-01

Times between successive events (i.e., gap times) are of great importance in survival analysis. Although many methods exist for estimating covariate effects on gap times, very few existing methods allow for comparisons between gap times themselves. Motivated by the comparison of primary and repeat transplantation, our interest is specifically in contrasting the gap time survival functions and their integration (restricted mean gap time). Two major challenges in gap time analysis are non-identifiability of the marginal distributions and the existence of dependent censoring (for all but the first gap time). We use Cox regression to estimate the (conditional) survival distributions of each gap time (given the previous gap times). Combining fitted survival functions based on those models, along with multiple imputation applied to censored gap times, we then contrast the first and second gap times with respect to average survival and restricted mean lifetime. Large-sample properties are derived, with simulation studies carried out to evaluate finite-sample performance. We apply the proposed methods to kidney transplant data obtained from a national organ transplant registry. Mean 10-year graft survival of the primary transplant is significantly greater than that of the repeat transplant, by 3.9 months (p=0.023), a result that may lack clinical importance. © 2015, The International Biometric Society.

How to choose the right financial planner.

PubMed

Maurer, Timothy J

2010-01-01

An "economic Pearl Harbor." That is how the world's most famous investor, Warren Buffett, described what we have gone through and what we're still going through.' Even the most optimistic appraisals of our economic conditions suggest that we are likely to feel the effects of the Great Recession through the decade we recently entered. Healthcare reform, in whatever form, may also create change in your medical practice ranging from immaterial to revolutionary. To whom should you turn to ensure that your personal economy survives and thrives, especially in these times? A financial planner, possibly, but what is a financial planner, how do you choose one, and what sort of service should you expect?

Safety and survival in an earthquake

USGS Publications Warehouse

,

1969-01-01

Many earth scientists in this country and abroad are focusing their studies on the search for means of predicting impending earthquakes, but, as yet, an accurate prediction of the time and place of such an event cannot be made. From past experience, however, one can assume that earthquakes will continue to harass mankind and that they will occur most frequently in the areas where they have been relatively common in the past. In the United States, earthquakes can be expected to occur most frequently in the western states, particularly in Alaska, California, Washington, Oregon, Nevada, Utah, and Montana. The danger, however, is not confined to any one part of the country; major earthquakes have occurred at widely scattered locations.

The role of cystectomy in elderly patients - a multicentre analysis.

PubMed

Izquierdo, Laura; Peri, Lluis; Leon, Priscila; Ramírez-Backhaus, Miguel; Manning, Thomas; Alcaraz, Antonio; Roupret, Morgan; Solsona, Eduardo; Rubio, Jose; Sengupta, Shomik; Chan, Yee; Liodakis, Peter; Gyomber, Dennis; Bolton, Damien; Lawrentschuk, Nathan

2015-10-01

Life expectancy in developed countries is continuously increasing. Hence elderly patients are becoming more common in our clinical practice. Currently, one of the greatest challenges of medicine is balancing the life expectancy of elderly patients against aggressive treatments that carry significant risks. To outline the complications and survival in surgical patients 80 years and over undergoing radical cystectomy for bladder cancer. A review of a radical cystectomy in elderly recorded in four different institutional prospective databases during the period between 1991 and 2014. Clinical and pathologic features, complications and survival were evaluated. A total of 111 patients were available. Median (range) age 82.2 (80-89) years. Seventeen women and 94 men. Regarding the ASA score, 6 patients were ASA I, 47 patients were ASA II, 49 patients ASA III and 9 ASA IV. Prior to surgery, 48 patients had hydronephrosis. The median (range) creatinine series was 1.1 (0.71-11.1) ng/dL. In 88 cases an ileal conduit was performed, 17 a cutaneous ureterostomy diversion, 5 neobladders and 1 ureterosigmoidostomy case. The median (range) operative time was 230 (120-420) min and a total of 97 patients required blood transfusion. The median (range) hospital stay was 14 (7-126) days. The early and late complication rates were 50.4% and 32%, respectively. A total of 14 patients (12.6%) required surgical reintervention. Eight patients (7.2%) died in the immediate postoperative period. The readmission rate of the series was 27.2%. The mean follow-up of the series was 18 (0.27-134.73) months. During this period 66 patients died, 52 of them due to the tumor. Twelve month tumour progression free survival was 83.9% for ≤pT1, 70.2% for pT2 and 36% for ≥pT3, respectively. Twelve month cancer specific survival was 85.6% for ≤pT1, 75.1% for pT2 and 42.5% for ≥pT3, respectively. Radical cystectomy in elderly population is an aggressive surgical treatment with a significant complication rate, hospital readmission and perioperative mortality rate. Careful selection of patients is essential in order to minimize the complications of this surgery and balance benefits against risks in the elderly population. Tumour progression and cancer specific survival are poor for patients with ≥pT3 disease. Alternatives such as tri-modality therapy need to be considered within a multi-disciplinary approach. More data is required to determine which sub-groups of elderly patients would benefit from a complication, survival and quality of life perspective. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

Mortality experience of the 1986-2000 National Health Interview Survey Linked Mortality Files participants.

PubMed

Ingram, Deborah D; Lochner, Kimberly A; Cox, Christine S

2008-10-01

The National Center for Health Statistics (NCHS) has produced the 1986-2000 National Health Interview Survey (NHIS) Linked Mortality Files by linking eligible adults in the 1986-2000 NHIS cohorts through probabilistic record linkage to the National Death Index to obtain mortality follow-up through December 31, 2002. The resulting files contain more than 120,000 deaths and an average of 9 years of survival time. To assess how well mortality was ascertained in the linked mortality files, NCHS has conducted a comparison of the mortality experience of the 1986-2000 NHIS cohorts with that of the U.S. population. This report presents the results of this comparative mortality assessment. Methods The survival of each annual NHIS cohort was compared with that of the U.S. population during the same period. Cumulative survival probabilities for each annual NHIS cohort were derived using the Kaplan-Meier product limit method, and corresponding cumulative survival probabilities were computed for the U.S. population using information from annual U.S. life tables. The survival probabilities were calculated at various lengths of follow-up for each age-race-sex group of each NHIS cohort and for the U.S. population. Results As expected, mortality tended to be underestimated in the NHIS cohorts because the sample includes only civilian, noninstitutionalized persons, but this underestimation generally was not statistically significant. Statistically significant differences increased with length of follow-up, occurred more often for white females than for the other race-sex groups, and occurred more often in the oldest age groups. In general, the survival experience of the age-race-sex groups of each NHIS cohort corresponds quite closely to that of the U.S. population, providing support that the ascertainment of mortality through the probabilistic record linkage accurately reflects the mortality experience of the NHIS cohorts.

Teacher Survival Rates--A Current Look

ERIC Educational Resources Information Center

Mark, Jonathan H.; Anderson, Barry D.

1978-01-01

To examine how survival rates change with time, each cohort of new entrants to the public school teaching profession between 1968 and 1976 was examined. Results replicated Charters' downward sloping survival curve, although the curve has shifted up steadily through time. The survival rate differential between men and women is decreasing over time.…

Neurophysiologic Methods to Measure Stress During Survival, Evasion, Resistance, and Escape Training

DTIC Science & Technology

2007-05-01

amygdala function as well as perceived stress, trait anxiety , and trait anger. Overview of current research strategy: HRV analysis represents another...expected to relate to perceived stress, trait anxiety , and trait anger. In prospective analyses, HRV is expected to pre- dict cortisol reactivity...studying brain activity linked with fear, anxiety , and other emotional states in humans, is described in this section. The ASER is elicited by an abrupt

Demisability and survivability sensitivity to design-for-demise techniques

NASA Astrophysics Data System (ADS)

Trisolini, Mirko; Lewis, Hugh G.; Colombo, Camilla

2018-04-01

The paper is concerned with examining the effects that design-for-demise solutions can have not only on the demisability of components, but also on their survivability that is their capability to withstand impacts from space debris. First two models are introduced. A demisability model to predict the behaviour of spacecraft components during the atmospheric re-entry and a survivability model to assess the vulnerability of spacecraft structures against space debris impacts. Two indices that evaluate the level of demisability and survivability are also proposed. The two models are then used to study the sensitivity of the demisability and of the survivability indices as a function of typical design-for-demise options. The demisability and the survivability can in fact be influenced by the same design parameters in a competing fashion that is while the demisability is improved, the survivability is worsened and vice versa. The analysis shows how the design-for-demise solutions influence the demisability and the survivability independently. In addition, the effect that a solution has simultaneously on the two criteria is assessed. Results shows which, among the design-for-demise parameters mostly influence the demisability and the survivability. For such design parameters maps are presented, describing their influence on the demisability and survivability indices. These maps represent a useful tool to quickly assess the level of demisability and survivability that can be expected from a component, when specific design parameters are changed.

Fetal lung volume in congenital diaphragmatic hernia: association of prenatal MR imaging findings with postnatal chronic lung disease.

PubMed

Debus, Angelika; Hagelstein, Claudia; Kilian, A Kristina; Weiss, Christel; Schönberg, Stefan O; Schaible, Thomas; Neff, K Wolfgang; Büsing, Karen A

2013-03-01

To assess whether chronic lung disease (CLD) in surviving infants with congenital diaphragmatic hernia (CDH) is associated with lung hypoplasia on the basis of the results of antenatal observed-to-expected fetal lung volume (FLV) ratio measurement at magnetic resonance (MR) imaging. The study received approval from the institutional review board, with waiver of informed consent for this retrospective review from patients who had previously given informed consent for prospective studies. The ratio of observed to expected FLV at MR imaging was calculated in 172 fetuses with CDH. At postpartum day 28, the need for supplemental oxygen implicated the diagnosis of CLD. At day 56, patients with CLD were assigned to one of three groups-those with mild, moderate, or severe CLD-according to their demand for oxygen. Logistic regression analysis was used to assess the prognostic value of the individual observed-to-expected FLV ratio for association with postnatal development of CLD. Children with CLD were found to have significantly smaller observed-to-expected FLV ratios at MR imaging than infants without CLD (P < .001). Grading of CLD revealed significant differences in observed-to-expected FLV ratio between patients with mild CLD and those with moderate (P = .012) or severe (P = .007) CLD. For an observed-to-expected FLV ratio of 5%, 99% of patients with CDH developed CLD, compared with less than 5% of fetuses with an observed-to-expected FLV ratio of 50%. Perinatally, development and grade of CLD were further influenced by the need for extracorporeal membrane oxygenation (ECMO) (P < .001) and gestational age at delivery (P = .009). Manifestation of CLD in surviving infants with CDH is associated with the prenatally determined observed-to-expected FLV ratio. Early neonatal therapeutic decisions can additionally be based on this ratio. Perinatally, ECMO requirement and gestational age at delivery are useful in further improving the estimated probability of CLD.

Impact of triple-negative phenotype on prognosis of patients with breast cancer brain metastases.

PubMed

Xu, Zhiyuan; Schlesinger, David; Toulmin, Sushila; Rich, Tyvin; Sheehan, Jason

2012-11-01

To elucidate survival times and identify potential prognostic factors in patients with triple-negative (TN) phenotype who harbored brain metastases arising from breast cancer and who underwent stereotactic radiosurgery (SRS). A total of 103 breast cancer patients with brain metastases were treated with SRS and then studied retrospectively. Twenty-four patients (23.3%) were TN. Survival times were estimated using the Kaplan-Meier method, with a log-rank test computing the survival time difference between groups. Univariate and multivariate analyses to predict potential prognostic factors were performed using a Cox proportional hazard regression model. The presence of TN phenotype was associated with worse survival times, including overall survival after the diagnosis of primary breast cancer (43 months vs. 82 months), neurologic survival after the diagnosis of intracranial metastases, and radiosurgical survival after SRS, with median survival times being 13 months vs. 25 months and 6 months vs. 16 months, respectively (p < 0.002 in all three comparisons). On multivariate analysis, radiosurgical survival benefit was associated with non-TN status and lower recursive partitioning analysis class at the initial SRS. The TN phenotype represents a significant adverse prognostic factor with respect to overall survival, neurologic survival, and radiosurgical survival in breast cancer patients with intracranial metastasis. Recursive partitioning analysis class also served as an important and independent prognostic factor. Copyright © 2012 Elsevier Inc. All rights reserved.

Health care expenditures and longevity: is there a Eubie Blake effect?

PubMed

Breyer, Friedrich; Lorenz, Normann; Niebel, Thomas

2015-01-01

It is still an open question whether increasing life expectancy as such causes higher health care expenditures (HCE) in a population. According to the "red herring" hypothesis, the positive correlation between age and HCE is exclusively due to the fact that mortality rises with age and a large share of HCE is caused by proximity to death. As a consequence, rising longevity-through falling mortality rates-may even reduce HCE. However, a weakness of many previous empirical studies is that they use cross-sectional evidence to make inferences on a development over time. In this paper, we analyse the impact of rising longevity on the trend of HCE over time by using data from a pseudo-panel of German sickness fund members over the period 1997-2009. Using (dynamic) panel data models, we find that age, mortality and 5-year survival rates each have a positive impact on per-capita HCE. Our explanation for the last finding is that physicians treat patients more aggressively if the results of these treatments pay off over a longer time span, which we call "Eubie Blake effect". A simulation on the basis of an official population forecast for Germany is used to isolate the effect of demographic ageing on real per-capita HCE over the coming decades. We find that, while falling mortality rates as such lower HCE, this effect is more than compensated by an increase in remaining life expectancy so that the net effect of ageing on HCE over time is clearly positive.

Linking age, survival, and transit time distributions

NASA Astrophysics Data System (ADS)

Calabrese, Salvatore; Porporato, Amilcare

2015-10-01

Although the concepts of age, survival, and transit time have been widely used in many fields, including population dynamics, chemical engineering, and hydrology, a comprehensive mathematical framework is still missing. Here we discuss several relationships among these quantities by starting from the evolution equation for the joint distribution of age and survival, from which the equations for age and survival time readily follow. It also becomes apparent how the statistical dependence between age and survival is directly related to either the age dependence of the loss function or the survival-time dependence of the input function. The solution of the joint distribution equation also allows us to obtain the relationships between the age at exit (or death) and the survival time at input (or birth), as well as to stress the symmetries of the various distributions under time reversal. The transit time is then obtained as a sum of the age and survival time, and its properties are discussed along with the general relationships between their mean values. The special case of steady state case is analyzed in detail. Some examples, inspired by hydrologic applications, are presented to illustrate the theory with the specific results. This article was corrected on 11 Nov 2015. See the end of the full text for details.

PRFM enhance wound healing process in skin graft.

PubMed

Reksodiputro, Mirta; Widodo, Dini; Bashiruddin, Jenny; Siregar, Nurjati; Malik, Safarina

2014-12-01

Facial plastic and reconstructive surgery often used skin graft on defects that cannot be covered primarily by a local flap. However, wound healing using skin graft is slow, most of the time the graft is contractured and the take of graft is not optimal. Platelet rich fibrin matrix (PRFM) is a new generation of concentrated platelets that produce natural fibrin and reported to speed up the healing process. Application of PRFM in the skin graft implants is expected to increase the survival of the graft. We used porcine as animal models to elucidate the effect of autologous PRFM on wound healing in full-thickness (FTSG) and split-thickness (STSG) skin grafts. Survival level of the skin graft was determined by using ImageJ software based on the formation of collagen type 1 and graft take. We observed that the use of PRFM in FTSG and STSG increased type 1 collagen formation. We also found that PRFM addition in STSG gave the best skin graft take. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Death losses due to stillbirth, neonatal death and diseases in cloned cattle derived from somatic cell nuclear transfer and their progeny: a result of nationwide survey in Japan.

PubMed

Watanabe, Shinya; Nagai, Takashi

2009-06-01

To obtain the data concerning death losses due to stillbirth, neonatal death and diseases in cloned cattle derived from somatic cell nuclear transfer (SCNT) and their progeny produced by Japanese institutions, a nationwide survey was carried out in July-August, 2006. As a result, lifetime data concerning 482 SCNT cattle (97.5% of cattle produced in the country at that time) and 202 progeny of SCNT cattle were accumulated and the death loss of these cattle was analyzed. Although 1/3 of delivered SCNT calves died during the perinatal period due to stillbirth and neonatal death, incidence of death loss due to diseases in SCNT cattle surviving more than 200 days after birth seems to be the same as these in conventionally bred cattle. In contrast, progeny of SCNT cattle showed the same level in death loss as observed in conventionally bred cattle throughout their lifetime. These results suggest that robust health would be expected in SCNT cattle surviving to adulthood and their progeny.

Bifurcation into functional niches in adaptation.

PubMed

White, Justin S; Adami, Christoph

2004-01-01

One of the central questions in evolutionary biology concerns the dynamics of adaptation and diversification. This issue can be addressed experimentally if replicate populations adapting to identical environments can be investigated in detail. We have studied 501 such replicas using digital organisms adapting to at least two fundamentally different functional niches (survival strategies) present in the same environment: one in which fast replication is the way to live, and another where exploitation of the environment's complexity leads to complex organisms with longer life spans and smaller replication rates. While these two modes of survival are closely analogous to those expected to emerge in so-called r and K selection scenarios respectively, the bifurcation of evolutionary histories according to these functional niches occurs in identical environments, under identical selective pressures. We find that the branching occurs early, and leads to drastic phenotypic differences (in fitness, sequence length, and gestation time) that are permanent and irreversible. This study confirms an earlier experimental effort using microorganisms, in that diversification can be understood at least in part in terms of bifurcations on saddle points leading to peak shifts, as in the picture drawn by Sewall Wright.

Gentamicin pharmacokinetics in the chicken inner ear.

PubMed

Bunting, Eric C; Park, Debra L; Durham, Dianne; Girod, Douglas A

2004-06-01

Avians have the unique ability to regenerate cochlear hair cells that are lost due to ototoxins or excessive noise. Many methodological techniques are available to damage the hair cells for subsequent scientific study. A recent method utilizes topical application of an ototoxic drug to the round window membrane. The current study examines the pharmacokinetics of gentamicin in the inner ear of chickens following topical application to the round window membrane or a single systemic high dose given intraperitoneally. Chickens were given gentamicin topically or systemically and survived for 1, 4, 12, 24, or 120 h (controls at 4 and 120 h). Serum and perilymph samples were obtained prior to sacrifice and measured for gentamicin levels. Results revealed higher levels of gentamicin in the perilymph of topically treated chickens than systemically treated chickens, with significant amounts of gentamicin still present in both at the latest survival time of 5 days. As expected, systemically treated chickens had much higher levels of gentamicin in the serum than topically treated chickens. Advantages and disadvantages to each method of drug administration are discussed.

Second cancers in patients with Chronic Lymphocytic Leukemia who received frontline FCR therapy – Distribution and clinical outcomes

PubMed Central

Benjamini, Ohad; Jain, Preetesh; Trinh, Long; Qiao, Wei; Strom, Sara S.; Lerner, Susan; Wang, Xuemei; Burger, Jan; Ferrajoli, Alessandra; Kantarjian, Hagop; O’Brien, Susan; Wierda, William; Estrov, Zeev; Keating, Michael

2015-01-01

Patients with Chronic Lymphocytic Leukemia (CLL) are known to have an increased incidence of second cancers, but the contribution of commonly used frontline therapies to the incidence of second cancers is unclear. We report on the characteristics, incidence, outcomes and factors associated with second cancers in 234 patients receiving Fludarabine, Cyclophosphamide, and Rituximab (FCR) based regimens in the frontline setting. The risk of second cancers was 2.38 times higher than the expected risk in the general population. Ninety three patients (40%) had other cancers before and 66 patients (28%) after FCR. The rates of t-AML/MDS (5.1%) and Richter’s transformation (RT) (9%) were high while solid tumors were not increased. Overall survival of patients with second cancers after frontline FCR was shorter (median of 4.5 years) compared to patients with and without prior cancers. Second cancer risk after frontline FCR is mainly due to high rates of t-AML/MDS and RT and as speculated the survival of affected patients is shorter. PMID:25308294

Survivability Versus Time

NASA Technical Reports Server (NTRS)

Joyner, James J., Sr.

2014-01-01

Develop Survivability vs Time Model as a decision-evaluation tool to assess various emergency egress methods used at Launch Complex 39B (LC 39B) and in the Vehicle Assembly Building (VAB) on NASAs Kennedy Space Center. For each hazard scenario, develop probability distributions to address statistical uncertainty resulting in survivability plots over time and composite survivability plots encompassing multiple hazard scenarios.

Exploration of Exercise Outcome Expectations among Breast Cancer Survivors

PubMed Central

Hirschey, Rachel; Docherty, Sharron L.; Pan, Wei; Lipkus, Isaac

2016-01-01

Background Exercise is associated with decreased recurrence risk, improved survival and quality of life for breast cancer survivors. However only an estimated 17% - 37% of survivors adhere to the American Cancer Society exercise guidelines. A critical first step to increase exercise among survivors is to understand how they believe exercise will effect them. Objective To explore common exercise outcome expectations among 20 female survivors of stage IA – IIB breast cancer who completed adjuvant treatment and an exercise intervention. Interventions/Methods A mixed-method descriptive study consisting of semi-structured telephone interviews assessed exercise outcome expectations and how the experience of cancer and its treatment influenced expected outcomes of exercise. The qualitative data were analyzed using a summative content analysis procedure; means were calculated for each item of the exercise outcome questionnaire. The qualitative and quantitative data were compared and contrasted. Results The sample was 70% Caucasian and 30% African American with a mean age was 62 years (± 8.5) and average time since treatment completion of 4.2 years (± 1.3). Three themes emerged from the interviews: 1) prevalence of common expectations, 2) pervasive impact of fatigue, and 3) a brighter future. Overall, findings revealed that breast cancer survivors have low levels of agreement that exercise may mitigate late and long-term cancer and treatment effects. Conclusions In general, breast cancer survivors (even those who are motivated to exercise) do not hold strong beliefs that exercise will decrease late and long-term treatment effects. Implications for Practice Clinicians can educate survivors about exercise benefits. PMID:26925999

Differential Impact of Whole-Brain Radiotherapy Added to Radiosurgery for Brain Metastases

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

Kong, Doo-Sik; Lee, Jung-Il, E-mail: jilee@skku.ed; Im, Yong-Seok

2010-10-01

Purpose: The authors investigated whether the addition of whole-brain radiotherapy (WBRT) to stereotactic radiosurgery (SRS) provided any therapeutic benefit according to recursive partitioning analysis (RPA) class. Methods and Materials: Two hundred forty-five patients with 1 to 10 metastases who underwent SRS between January 2002 and December 2007 were included in the study. Of those, 168 patients were treated with SRS alone and 77 patients received SRS followed by WBRT. Actuarial curves were estimated using the Kaplan-Meier method regarding overall survival (OS), distant brain control (DC), and local brain control (LC) stratified by RPA class. Analyses for known prognostic variables weremore » performed using the Cox proportional hazards model. Results: Univariate and multivariate analysis revealed that control of the primary tumor, small number of brain metastases, Karnofsky performance scale (KPS) > 70, and initial treatment modalities were significant predictors for survival. For RPA class 1, SRS plus WBRT was associated with a longer survival time compared with SRS alone (854 days vs. 426 days, p = 0.042). The SRS plus WBRT group also showed better LC rate than did the SRS-alone group (p = 0.021), although they did not show a better DC rate (p = 0.079). By contrast, for RPA class 2 or 3, no significant difference in OS, LC, or DC was found between the two groups. Conclusions: These results suggest that RPA classification should determine whether or not WBRT is added to SRS. WBRT may be recommended to be added to SRS for patients in whom long-term survival is expected on the basis of RPA classification.« less

Establishing a murine model of the hematopoietic syndrome of the acute radiation syndrome.

PubMed

Plett, P Artur; Sampson, Carol H; Chua, Hui Lin; Joshi, Mandar; Booth, Catherine; Gough, Alec; Johnson, Cynthia S; Katz, Barry P; Farese, Ann M; Parker, Jeffrey; MacVittie, Thomas J; Orschell, Christie M

2012-10-01

The authors have developed a murine model of the Hematopoietic Syndrome of the Acute Radiation Syndrome (H-ARS) for efficacy testing of medical countermeasures (MCM) against radiation according to the FDA Animal Rule. Ten- to 12-wk-old male and female C57BL/6 mice were exposed to the LD50/30-LD70/30 dose of total body irradiation (TBI, (137)Cs, 0.62-0.67 Gy min(-1)) in the morning hours when mice were determined to be most radiosensitive, and they were assessed for 30-d survival and mean survival time (MST). Antibiotics were delivered in drinking water on days 4-30 post-TBI at a concentration based on the amount of water that lethally-irradiated mice were found to consume. The fluoroquinolones, ciprofloxacin and levofloxacin, as well as the tetracycline doxycycline, and aminoglycoside neomycin, all significantly increased MST of decedent mice, while ciprofloxacin (p = 0.061) and doxycycline + neomycin (p = 0.005) showed at least some efficacy to increase 30-d survival. Blood sampling (30 μL/mouse every fifth day) was found to negatively impact 30-d survival. Histopathology of tissues harvested from nonmoribund mice showed expected effects of lethal irradiation, while moribund mice were largely septicemic with a preponderance of enteric organisms. Kinetics of loss and recovery of peripheral blood cells in untreated mice and those treated with two MCM, granulocyte-colony stimulating factor and Amifostine further characterized and validated this model for use in screening studies and pivotal efficacy studies of candidate MCM for licensure to treat irradiated individuals suffering from H-ARS.

What are the benefits of parental care? The importance of parental effects on developmental rate

PubMed Central

Klug, Hope; Bonsall, Michael B

2014-01-01

The evolution of parental care is beneficial if it facilitates offspring performance traits that are ultimately tied to offspring fitness. While this may seem self-evident, the benefits of parental care have received relatively little theoretical exploration. Here, we develop a theoretical model that elucidates how parental care can affect offspring performance and which aspects of offspring performance (e.g., survival, development) are likely to be influenced by care. We begin by summarizing four general types of parental care benefits. Care can be beneficial if parents (1) increase offspring survival during the stage in which parents and offspring are associated, (2) improve offspring quality in a way that leads to increased offspring survival and/or reproduction in the future when parents are no longer associated with offspring, and/or (3) directly increase offspring reproductive success when parents and offspring remain associated into adulthood. We additionally suggest that parental control over offspring developmental rate might represent a substantial, yet underappreciated, benefit of care. We hypothesize that parents adjust the amount of time offspring spend in life-history stages in response to expected offspring mortality, which in turn might increase overall offspring survival, and ultimately, fitness of parents and offspring. Using a theoretical evolutionary framework, we show that parental control over offspring developmental rate can represent a significant, or even the sole, benefit of care. Considering this benefit influences our general understanding of the evolution of care, as parental control over offspring developmental rate can increase the range of life-history conditions (e.g., egg and juvenile mortalities) under which care can evolve. PMID:25360271

Prognostic value of efficiently correcting nocturnal desaturations after one month of non-invasive ventilation in amyotrophic lateral sclerosis: a retrospective monocentre observational cohort study.

PubMed

Gonzalez-Bermejo, Jésus; Morelot-Panzini, Capucine; Arnol, Nathalie; Meininger, Vincent; Kraoua, Salah; Salachas, François; Similowski, Thomas

2013-09-01

Abstract NIV adherence ('quantity' of ventilation) has a prognostic impact in amyotrophic lateral sclerosis (ALS). We hypothesized that NIV effectiveness ('quality') could also have a similar impact. NIV effectiveness was evaluated in 82 patients within the first month (M1) and every three months (symptoms, arterial blood bases, and nocturnal pulsed oxygen saturation - SpO2). Kaplan-Meier survival and risk factors for mortality one year after NIV initiation were evaluated. Forty patients were considered 'correctly ventilated' at M1 (Group 1, less than 5% of nocturnal oximetry time with an SpO2<90% - TS90) while 42 were not (Group 2). Both groups were comparable in terms of respiratory and neurological baseline characteristics. Survival was better in Group 1 (75% survival at 12 months) than in Group 2 (43% survival at 12 months, p = 0.002). In 12 Group 2 patients corrective measures were efficient in correcting TS90 at six months. In this subgroup, one-year mortality was not different from that in Group 1. Multivariate analysis identified independent mortality risk factors expectedly including bulbar involvement (HR = 4.31 (1.73 - 10.76), p = 0.002), 'rapid respiratory decline' (HR = 3.55 (1.29 - 9.75), p = 0.014) and vital capacity (HR = 0.97 (0.95 - 0.99), p = 0.010), but also inadequate ventilation in the first month (HR = 2.32 (1.09 - 4.94), p = 0.029). In conclusion, in ALS patients NIV effectiveness to correct nocturnal desaturations is an independent prognostic factor.

Malignancy associated hypercalcaemia-responsiveness to IV bisphosphonates and prognosis in a palliative population.

PubMed

Mallik, Shreyashee; Mallik, Girijasankar; Macabulos, Shireen Teves; Dorigo, Andrew

2016-04-01

Hypercalcaemia is a potentially fatal paraneoplastic complication of malignancy. It primarily manifests during the advanced phase of cancer, with the life expectancy of patients ranging from weeks to months. The mainstay of treatment is with bisphosphonates, but these are not frequently used in a palliative population due to potential conflict with goals of care. The goals of this study was to determine the reversibility of hypercalcaemia amongst patients whose underlying malignancy is not being treated and assess whether correction results in improvement in symptoms attributable to hypercalcaemia, while identifying risk factors that can predict responsiveness. We conducted a retrospective cohort study of 63 patients aged >18 years who were admitted to the St Joseph's Palliative Care Unit, Australia between 2007 and 2013, having evidence of malignancy-associated hypercalcaemia which was treated with bisphosphonates. We assessed the response to bisphosphonates based on improvement of symptoms attributable to hypercalcaemia, as well as a reduction in serum calcium. We used the Kaplan-Meier survival method and parametric survival analysis to estimate the effect of the independent variables on time till death. Thirty-six of sixty three patients achieved normocalcaemia following treatment with an intravenous bisphosphonate. Complete response was influenced by the number of instances of hypercalcaemia in the past and patient factors, such as age and albumin levels. We found that a reduction in calcium level was associated with a significantly prolonged survival, as well as symptomatic improvement, irrespective of whether normocalcaemia was achieved. Our study suggests that bisphosphonates can be recommended as a palliative measure for selected patients to improve symptoms and prolong survival.

What to Expect During a Mastectomy Surgery

MedlinePlus

... Managing Side Effects and Supportive Care Managing Pain Quality of Life Survival and Risk of Recurrence Breast Cancer Recurrence ... Pain Managing Side Effects and Supportive Care Support Quality of Life Survivorship Topics Survivorship Topics Medical Care After Treatment ...

Rectal cancer. Treatment advances that reduce recurrence rates and lengthen survival.

PubMed

Sexe, R; Miedema, B W

1993-07-01

The risk of malignant disease arising in rectal mucosa is high. Surgery is the most effective form of treatment but results in cure in only 50% of patients. Adjuvant preoperative radiation therapy reduces the likelihood of local recurrence but does not improve survival rates. Fluorouracil is the most effective agent for adjuvant chemotherapy and slightly improves survival when given after surgery. Combining radiation therapy with chemotherapy appears to have a synergistic effect, and recent studies show that providing this combination after surgery improves survival. Future trends in the treatment of rectal cancer are expected to include expanded use of local excision to preserve anal sphincter function, preoperative use of a combination of radiation therapy and chemotherapy, perioperative use of chemotherapy combined with immunostimulating therapy, and use of tumor antibodies for diagnostic and therapeutic purposes.

[Expectation about maintenance therapy among the GINECO French ovarian cancer cohort from the European NOGGO/ENGOT-ov22 Expression IV survey].

PubMed

Lorcet, Marianne; Lortholary, Alain; Kurtz, Jean Emmanuel; Berton-Rigaud, Dominique; Fabbro, Michel; De La Motte Rouge, Thibault; Kaminsky-Forrett, Marie Christine; Floquet, Anne; Freyer, Gilles; Combe, Pierre; Dohollou, Nadine; Kalbacher, Elsa; Despax, Raymond; Largillier, Remy; Hardy Bessard, Anne Claire; Gane, Nicolas; Sehouli, Jalid; Oskay-Oezcelik, Guelten; Licaj, Idlir; Ray-Coquard, Isabelle; Joly Lobbedez, Florence

2018-05-01

Expression IV survey evaluated the patients' expectations to a maintenance therapy. From January 2015 to March 2016, 401 French patients, in first line or recurrent disease, answered a 24-items anonymous questionnaire. The results were specifically analyzed according to the demographic characteristics and treatment lines. Among the patients, 62% had already been informed about maintenance therapy. Thirty-seven percent of patients received a maintenance treatment: 111 patients during first line and 39 patients in relapse. Expectations of patients were: 1) the chance of cure (73%), 2) the tumor shrinkage (36%), 3) quality of life improvement (35%) and 4) tumor growth reduction (27%). Among the responders, 42% were willing to take the treatment for 6-24 months, 20% for 24-60 months and 38% until tumor progression. 64% of patients expected more than a 6 months progression-free survival. Patients older than 70 years were less informed than their younger counterparts (48% vs 66%) and had lesser hope for cure with maintenance treatment (60% vs 77%). Patients in relapse had more expectation than patients in remission (tumor shrinkage: 47% vs 22%, slowing of tumor growth: 37% vs 15%, improving the progression-free survival of more than 6 months: 71% vs 53%, respectively). Among patients, 48% in relapse consented to take a treatment until progression vs 24% of patients in remission. This sub-analysis in French patients demonstrate a gap between the efficacy of maintenance therapy and the patients' expectations in ovarian cancer, particularly in relapsing disease justifying better information and explanations. Copyright © 2018 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

A novel mechanism for a survival advantage of vigilant individuals in groups.

PubMed

van der Post, Daniel J; de Weerd, Harmen; Verbrugge, Rineke; Hemelrijk, Charlotte K

2013-11-01

In many animal species, vigilance is crucial for avoiding predation. In groups, however, nonvigilant individuals could benefit from the vigilance of others without any of the associated costs. In an evolutionary sense, such exploitation may be compensated if vigilant individuals have a survival advantage. The novelty in our model is that the probability to detect a predator is "distance dependent." We show that even if nonvigilant individuals benefit fully from information produced by vigilant individuals, vigilant individuals nevertheless enjoy a survival advantage. This happens because detection of predators is more likely when vigilant individuals happen to be targets of predation. We expect this distance-dependent mechanism to be compatible with previously reported mechanisms.

Optimization of 15 parameters influencing the long-term survival of bacteria in aquatic systems

NASA Technical Reports Server (NTRS)

Obenhuber, D. C.

1993-01-01

NASA is presently engaged in the design and development of a water reclamation system for the future space station. A major concern in processing water is the control of microbial contamination. As a means of developing an optimal microbial control strategy, studies were undertaken to determine the type and amount of contamination which could be expected in these systems under a variety of changing environmental conditions. A laboratory-based Taguchi optimization experiment was conducted to determine the ideal settings for 15 parameters which influence the survival of six bacterial species in aquatic systems. The experiment demonstrated that the bacterial survival period could be decreased significantly by optimizing environmental conditions.

Effective Science Communication; A practical guide to surviving as a scientist

NASA Astrophysics Data System (ADS)

Illingworth, Sam

2016-09-01

Effective Science Communication: A practical guide to surviving as a scientist is devoted to the variety of ways that scientists are expected to communicate in their day-to-day professional lives. It includes practical advice on how to publish your work in scientific journals, apply for grants, and effectively communicate your research to both scientific and non-scientific audiences. There are chapters devoted to constructing a digital footprint, dealing with the media, and influencing science policy. Guiding you throughout are a number of useful exercises that will help you to become a more effective communicator, providing a helping hand in your scientific journey to not only survive, but to prosper in the process.

Successful replantation of 2 digits in a patient with thrombocytosis after splenectomy: A case report.

PubMed

Hwang, Jae Ha; Kim, Dong Wan; Kim, Kwang Seog; Lee, Sam Yong

2018-06-01

Thrombosis is the most common complication of thrombocytosis, which can be particularly damaging to reattached digits. We present a guideline about digital replantation when thrombocytosis is expected. We report a case of an 18-year-old man who sustained a traumatic amputation of two fingers and splenic rupture in a traffic accident. He underwent digital replantation the day after splenectomy when life-threatening conditions had been managed. The platelet count increased to over 1,300,000/mm and post-splenectomy reactive thrombocytosis was diagnosed. Hydroxyurea and anagrelide were administered to control the platelet count after consultation with a hematologist. The reattached fingers survived without any complication. In patients with digital amputation, replantation can be attempted, even when thrombocytosis is expected, when requested by the patient. Furthermore, the platelet count should be actively controlled with medication to improve the survival rate of the reattached finger.

Chronic high-fat diet-induced obesity decreased survival and increased hypertrophy of rats with experimental eccentric hypertrophy from chronic aortic regurgitation.

PubMed

Dhahri, Wahiba; Drolet, Marie-Claude; Roussel, Elise; Couet, Jacques; Arsenault, Marie

2014-09-24

The composition of a diet can influence myocardial metabolism and development of left ventricular hypertrophy (LVH). The impact of a high-fat diet in chronic left ventricular volume overload (VO) causing eccentric LVH is unknown. This study examined the effects of chronic ingestion of a high-fat diet in rats with chronic VO caused by severe aortic valve regurgitation (AR) on LVH, function and on myocardial energetics and survival. Male Wistar rats were divided in four groups: Shams on control or high-fat (HF) diet (15 rats/group) and AR rats fed with the same diets (ARC (n = 56) and ARHF (n = 32)). HF diet was started one week before AR induction and the protocol was stopped 30 weeks later. As expected, AR caused significant LV dilation and hypertrophy and this was exacerbated in the ARHF group. Moreover, survival in the ARHF group was significantly decreased compared the ARC group. Although the sham animals on HF also developed significant obesity compared to those on control diet, this was not associated with heart hypertrophy. The HF diet in AR rats partially countered the expected shift in myocardial energy substrate preference usually observed in heart hypertrophy (from fatty acids towards glucose). Systolic function was decreased in AR rats but HF diet had no impact on this parameter. The response to HF diet of different fatty acid oxidation markers as well as the increase in glucose transporter-4 translocation to the plasma membrane compared to ARC was blunted in AR animals compared to those on control diet. HF diet for 30 weeks decreased survival of AR rats and worsened eccentric hypertrophy without affecting systolic function. The expected adaptation of myocardial energetics to volume-overload left ventricle hypertrophy in AR animals seemed to be impaired by the high-fat diet suggesting less metabolic flexibility.

Anaesthetic techniques for risk of malignant tumour recurrence.

PubMed

Cakmakkaya, Ozlem S; Kolodzie, Kerstin; Apfel, Christian C; Pace, Nathan Leon

2014-11-07

Surgery remains a mainstay of treatment for malignant tumours; however, surgical manipulation leads to a significant systemic release of tumour cells. Whether these cells lead to metastases is largely dependent on the balance between aggressiveness of the tumour cells and resilience of the body. Surgical stress per se, anaesthetic agents and administration of opioid analgesics perioperatively can compromise immune function and might shift the balance towards progression of minimal residual disease. Regional anaesthesia techniques provide perioperative pain relief; they therefore reduce the quantity of systemic opioids and of anaesthetic agents used. Additionally, regional anaesthesia techniques are known to prevent or attenuate the surgical stress response. In recent years, the potential benefit of regional anaesthesia techniques for tumour recurrence has received major attention and has been discussed many times in the literature. In preparing this review, we aimed to summarize the current evidence systematically and comprehensively. To establish whether anaesthetic technique (general anaesthesia versus regional anaesthesia or a combination of the two techniques) influences the long-term prognosis for individuals with malignant tumours. We searched The Cochrane Library (2013, Issue 12), PubMed (1950 to 15 December 2013), EMBASE (1974 to 15 December 2013), BIOSIS (1926 to 15 December 2013) and Web of Science (1965 to 15 December 2013). We handsearched relevant websites and conference proceedings and reference lists of cited articles. We applied no language restrictions. We included all randomized controlled trials or controlled clinical trials that investigated the effects of general versus regional anaesthesia on the risk of malignant tumour recurrence in patients undergoing resection of primary malignant tumours. Comparisons of interventions consisted of (1) general anaesthesia alone versus general anaesthesia combined with one or more regional anaesthetic techniques; (2) general anaesthesia combined with one or more regional anaesthetic techniques versus one or more regional anaesthetic techniques; and (3) general anaesthesia alone versus one or more regional anaesthetic techniques. Primary outcomes included (1) overall survival, (2) progression-free survival and (3) time to tumour progression. Two review authors independently scanned the titles and abstracts of identified reports and extracted study data.All primary outcome variables are time-to-event data. If the individual trial report provided summary statistics with odds ratios, relative risks or Kaplan-Meier curves, extracted data enabled us to calculate the hazard ratio using the hazard ratio calculating spreadsheet. To assess risk of bias, we used the standard methodological procedures expected by The Cochrane Collaboration. We included four studies with a total of 746 participants. All studies included adult patients undergoing surgery for primary tumour resection. Two studies enrolled male and female participants undergoing major abdominal surgery for cancer. One study enrolled male participants undergoing surgery for prostate cancer, and one study male participants undergoing surgery for colon cancer. Follow-up time ranged from nine to 17 years. All four studies compared general anaesthesia alone versus general anaesthesia combined with epidural anaesthesia and analgesia. All four studies are secondary data analyses of previously conducted prospective randomized controlled trials.Of the four included studies, only three contributed to the outcome of overall survival, and two each to the outcomes of progression-free survival and time to tumour progression. In our meta-analysis, we could not find an advantage for either study group for the outcomes of overall survival (hazard ratio (HR) 1.03, 95% confidence interval (CI) 0.86 to 1.24) and progression-free survival (HR 0.88, 95% CI 0.56 to 1.38). For progression-free survival, the level of inconsistency was high. Pooled data for time to tumour progression showed a slightly favourable outcome for the control group (general anaesthesia alone) compared with the intervention group (epidural and general anaesthesia) (HR 1.50, 95% CI 1.00 to 2.25).Quality of evidence was graded low for overall survival and very low for progression-free survival and time to tumour progression. The outcome of overall survival was downgraded for serious imprecision and serious indirectness. The outcomes of progression-free survival and time to tumour progression were also downgraded for serious inconsistency and serious risk of bias, respectively.Reporting of adverse events was sparse, and data could not be analysed. Currently, evidence for the benefit of regional anaesthesia techniques on tumour recurrence is inadequate. An encouraging number of prospective randomized controlled trials are ongoing, and it is hoped that their results, when reported, will add evidence for this topic in the near future.

Survival time of dogs with splenic hemangiosarcoma treated by splenectomy with or without adjuvant chemotherapy: 208 cases (2001-2012).

PubMed

Wendelburg, Kristin M; Price, Lori Lyn; Burgess, Kristine E; Lyons, Jeremiah A; Lew, Felicia H; Berg, John

2015-08-15

To determine survival time for dogs with splenic hemangiosarcoma treated with splenectomy alone, identify potential prognostic factors, and evaluate the efficacy of adjuvant chemotherapy. Retrospective case series. 208 dogs. Medical records were reviewed, long-term follow-up information was obtained, and survival data were analyzed statistically. 154 dogs were treated with surgery alone, and 54 were treated with surgery and chemotherapy. Twenty-eight dogs received conventional chemotherapy, 13 received cyclophosphamide-based metronomic chemotherapy, and 13 received both conventional and metronomic chemotherapy. Median survival time of dogs treated with splenectomy alone was 1.6 months. Clinical stage was the only prognostic factor significantly associated with survival time. When the entire follow-up period was considered, there was no significant difference in survival time between dogs treated with surgery alone and dogs treated with surgery and chemotherapy. However, during the first 4 months of follow-up, after adjusting for the effects of clinical stage, survival time was significantly prolonged among dogs receiving any type of chemotherapy (hazard ratio, 0.6) and among dogs receiving both conventional and metronomic chemotherapy (hazard ratio, 0.4). Clinical stage was strongly associated with prognosis for dogs with splenic hemangiosarcoma. Chemotherapy was effective in prolonging survival time during the early portion of the follow-up period. Combinations of doxorubicin-based conventional protocols and cyclophosphamide-based metronomic protocols appeared to be more effective than either type of chemotherapy alone, but prolongations in survival time resulting from current protocols were modest.

The New Demographic Transition: Most Gains in Life Expectancy Now Realized Late in Life

PubMed Central

Eggleston, Karen N.; Fuchs, Victor R.

2013-01-01

The share of increases in life expectancy realized after age 65 was only about 20 percent at the beginning of the 20th century for the US and 16 other countries at comparable stages of development; but that share was close to 80 percent by the dawn of the 21st century, and is almost certainly approaching 100 percent asymptotically. This new demographic transition portends a diminished survival effect on working life. For high-income countries at the forefront of the longevity transition, expected lifetime labor force participation as a percent of life expectancy is declining. Innovative policies are needed if societies wish to preserve a positive relationship running from increasing longevity to greater prosperity. PMID:25076810

Timely disclosure of progress in long-term cancer survival: the boomerang method substantially improved estimates in a comparative study.

PubMed

Brenner, Hermann; Jansen, Lina

2016-02-01

Monitoring cancer survival is a key task of cancer registries, but timely disclosure of progress in long-term survival remains a challenge. We introduce and evaluate a novel method, denoted "boomerang method," for deriving more up-to-date estimates of long-term survival. We applied three established methods (cohort, complete, and period analysis) and the boomerang method to derive up-to-date 10-year relative survival of patients diagnosed with common solid cancers and hematological malignancies in the United States. Using the Surveillance, Epidemiology and End Results 9 database, we compared the most up-to-date age-specific estimates that might have been obtained with the database including patients diagnosed up to 2001 with 10-year survival later observed for patients diagnosed in 1997-2001. For cancers with little or no increase in survival over time, the various estimates of 10-year relative survival potentially available by the end of 2001 were generally rather similar. For malignancies with strongly increasing survival over time, including breast and prostate cancer and all hematological malignancies, the boomerang method provided estimates that were closest to later observed 10-year relative survival in 23 of the 34 groups assessed. The boomerang method can substantially improve up-to-dateness of long-term cancer survival estimates in times of ongoing improvement in prognosis. Copyright © 2016 Elsevier Inc. All rights reserved.

Coaxial Cables for Martian Extreme Temperature Environments

NASA Technical Reports Server (NTRS)

Ramesham, Rajeshuni; Harvey, Wayne L.; Valas, Sam; Tsai, Michael C.

2011-01-01

Work was conducted to validate the use of the rover external flexible coaxial cabling for space under the extreme environments to be encountered during the Mars Science Laboratory (MSL) mission. The antennas must survive all ground operations plus the nominal 670-Martian-day mission that includes summer and winter seasons of the Mars environment. Successful development of processes established coaxial cable hardware fatigue limits, which were well beyond the expected in-flight exposures. In keeping with traditional qualification philosophy, this was accomplished by subjecting flight-representative coaxial cables to temperature cycling of the same depth as expected in-flight, but for three times the expected number of in-flight thermal cycles. Insertion loss and return loss tests were performed on the coaxial cables during the thermal chamber breaks. A vector network analyzer was calibrated and operated over the operational frequency range 7.145 to 8.450 GHz. Even though some of the exposed cables function only at UHF frequencies (approximately 400 MHz), the testing was more sensitive, and extending the test range down to 400 MHz would have cost frequency resolution. The Gore flexible coaxial cables, which were the subject of these tests, proved to be robust and displayed no sign of degradation due to the 3X exposure to the punishing Mars surface operations cycles.

Survival times for canine intranasal sarcomas treated with radiation therapy: 86 cases (1996-2011).

PubMed

Sones, Evan; Smith, Annette; Schleis, Stephanie; Brawner, William; Almond, Gregory; Taylor, Kathryn; Haney, Siobhan; Wypij, Jackie; Keyerleber, Michele; Arthur, Jennifer; Hamilton, Terrance; Lawrence, Jessica; Gieger, Tracy; Sellon, Rance; Wright, Zack

2013-01-01

Sarcomas comprise approximately one-third of canine intranasal tumors, however few veterinary studies have described survival times of dogs with histologic subtypes of sarcomas separately from other intranasal tumors. One objective of this study was to describe median survival times for dogs treated with radiation therapy for intranasal sarcomas. A second objective was to compare survival times for dogs treated with three radiation therapy protocols: daily-fractionated radiation therapy; Monday, Wednesday, and Friday fractionated radiation therapy; and palliative radiation therapy. Medical records were retrospectively reviewed for dogs that had been treated with radiation therapy for confirmed intranasal sarcoma. A total of 86 dogs met inclusion criteria. Overall median survival time for included dogs was 444 days. Median survival time for dogs with chondrosarcoma (n = 42) was 463 days, fibrosarcoma (n = 12) 379 days, osteosarcoma (n = 6) 624 days, and undifferentiated sarcoma (n = 22) 344 days. Dogs treated with daily-fractionated radiation therapy protocols; Monday, Wednesday and Friday fractionated radiation therapy protocols; and palliative radiation therapy protocols had median survival times of 641, 347, and 305 days, respectively. A significant difference in survival time was found for dogs receiving curative intent radiation therapy vs. palliative radiation therapy (P = 0.032). A significant difference in survival time was also found for dogs receiving daily-fractionated radiation therapy vs. Monday, Wednesday and Friday fractionated radiation therapy (P = 0.0134). Findings from this study support the use of curative intent radiation therapy for dogs with intranasal sarcoma. Future prospective, randomized trials are needed for confirmation of treatment benefits. © 2012 Veterinary Radiology & Ultrasound.

Value-added service in health care institutions.

PubMed

Umiker, W

1996-12-01

In today's highly competitive atmosphere, the survival of health care institutions depends largely on the ability to provide value-added services (VAS) at the lowest possible cost. Managers must identify their customers and delineate the needs and expectation of those customers. A strategy for satisfying these needs and expectations is essential. While technical advances and reasonable charges are important, a successful "high-tech," "high touch" approach demands the combination of process reengineering and employee training in customer relations.

Efficiency of porcine somatic cell nuclear transfer – a retrospective study of factors related to embryo recipient and embryos transferred

PubMed Central

Huang, Yongye; Ouyang, Hongsheng; Yu, Hao; Lai, Liangxue; Pang, Daxin; Li, Zhanjun

2013-01-01

Summary The successful generation of pigs via somatic cell nuclear transfer depends on reducing risk factors in several aspects. To provide an overview of some influencing factors related to embryo transfer, the follow-up data related to cloned pig production collected in our laboratory was examined. (i) Spring showed a higher full-term pregnancy rate compared with winter (33.6% vs 18.6%, P = 0.006). Furthermore, a regression equation can be drawn between full-term pregnancy numbers and pregnancy numbers in different months (y = 0.692x−3.326). (ii) There were no significant differences detected in the number of transferred embryos between surrogate sows exhibiting full-term development compared to those that did not. (iii) Non-ovulating surrogate sows presented a higher percentage of full-term pregnancies compared with ovulating sows (32.0% vs 17.5%, P = 0.004; respectively). (iv) Abortion was most likely to take place between Day 27 to Day 34. (v) Based on Life Table Survival Analysis, delivery in normally fertilized and surrogate sows is expected to be completed before Day 117 or Day 125, respectively. Additionally, the length of pregnancy in surrogate sows was negatively correlated with the average litter size, which was not found for normally fertilized sows. In conclusion, performing embryo transfer in appropriate seasons, improving the quality of embryos transferred, optimizing the timing of embryo transfer, limiting the occurrence of abortion, combined with ameliorating the management of delivery, is expected to result in the harvest of a great number of surviving cloned piglets. PMID:24244859

Midtrimester preterm prelabour rupture of membranes (PPROM): expectant management or amnioinfusion for improving perinatal outcomes (PPROMEXIL - III trial).

PubMed

van Teeffelen, Augustinus S P; van der Ham, David P; Willekes, Christine; Al Nasiry, Salwan; Nijhuis, Jan G; van Kuijk, Sander; Schuyt, Ewoud; Mulder, Twan L M; Franssen, Maureen T M; Oepkes, Dick; Jansen, Fenna A R; Woiski, Mallory D; Bekker, Mireille N; Bax, Caroline J; Porath, Martina M; de Laat, Monique W M; Mol, Ben W; Pajkrt, Eva

2014-04-04

Babies born after midtrimester preterm prelabour rupture of membranes (PPROM) are at risk to develop neonatal pulmonary hypoplasia. Perinatal mortality and morbidity after this complication is high. Oligohydramnios in the midtrimester following PPROM is considered to cause a delay in lung development. Repeated transabdominal amnioinfusion with the objective to alleviate oligohydramnios might prevent this complication and might improve neonatal outcome. Women with PPROM and persisting oligohydramnios between 16 and 24 weeks gestational age will be asked to participate in a multi-centre randomised controlled trial. random allocation to (repeated) abdominal amnioinfusion (intervention) or expectant management (control). The primary outcome is perinatal mortality. Secondary outcomes are lethal pulmonary hypoplasia, non-lethal pulmonary hypoplasia, survival till discharge from NICU, neonatal mortality, chronic lung disease (CLD), number of days ventilatory support, necrotizing enterocolitis (NEC), periventricular leucomalacia (PVL) more than grade I, severe intraventricular hemorrhage (IVH) more than grade II, proven neonatal sepsis, gestational age at delivery, time to delivery, indication for delivery, successful amnioinfusion, placental abruption, cord prolapse, chorioamnionitis, fetal trauma due to puncture. The study will be evaluated according to intention to treat. To show a decrease in perinatal mortality from 70% to 35%, we need to randomise two groups of 28 women (two sided test, β-error 0.2 and α-error 0.05). This study will answer the question if (repeated) abdominal amnioinfusion after midtrimester PPROM with associated oligohydramnios improves perinatal survival and prevents pulmonary hypoplasia and other neonatal morbidities. Moreover, it will assess the risks associated with this procedure. NTR3492 Dutch Trial Register (http://www.trialregister.nl).

How Radiation Oncologists Evaluate and Incorporate Life Expectancy Estimates Into the Treatment of Palliative Cancer Patients: A Survey-Based Study

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

Tseng, Yolanda D., E-mail: ydtseng@partners.org; Krishnan, Monica S.; Sullivan, Adam J.

2013-11-01

Purpose: We surveyed how radiation oncologists think about and incorporate a palliative cancer patient’s life expectancy (LE) into their treatment recommendations. Methods and Materials: A 41-item survey was e-mailed to 113 radiation oncology attending physicians and residents at radiation oncology centers within the Boston area. Physicians estimated how frequently they assessed the LE of their palliative cancer patients and rated the importance of 18 factors in formulating LE estimates. For 3 common palliative case scenarios, physicians estimated LE and reported whether they had an LE threshold below which they would modify their treatment recommendation. LE estimates were considered accurate whenmore » within the 95% confidence interval of median survival estimates from an established prognostic model. Results: Among 92 respondents (81%), the majority were male (62%), from an academic practice (75%), and an attending physician (70%). Physicians reported assessing LE in 91% of their evaluations and most frequently rated performance status (92%), overall metastatic burden (90%), presence of central nervous system metastases (75%), and primary cancer site (73%) as “very important” in assessing LE. Across the 3 cases, most (88%-97%) had LE thresholds that would alter treatment recommendations. Overall, physicians’ LE estimates were 22% accurate with 67% over the range predicted by the prognostic model. Conclusions: Physicians often incorporate LE estimates into palliative cancer care and identify important prognostic factors. Most have LE thresholds that guide their treatment recommendations. However, physicians overestimated patient survival times in most cases. Future studies focused on improving LE assessment are needed.« less

Intrauterine stress and male cohort quality: the case of September 11, 2001.

PubMed

Bruckner, Tim A; Nobles, Jenna

2013-01-01

Empirical research and the theory of natural selection assert that male mortality more than female mortality responds to ambient stressors in utero. Although population stressors may adversely damage males that survive to birth, the rival culled cohort hypothesis contends that males born during stressful times may exhibit better health than males in other cohorts because fetal loss has "culled" the frailest males. We tested these hypotheses by examining child developmental outcomes in a U.S. birth cohort reportedly affected in utero by the September 11, 2001 attacks. We used as outcomes the Bayley cognitive score and child height-for-age from the Early Childhood Longitudinal Study-Birth Cohort. Previous research demonstrates a male-specific effect of 9/11 on California infants born in December 2001. We, therefore, compared cognition and height of this cohort with males born prior to the 9/11 attacks. We controlled for unobserved confounding across gender, season, and region by using triple-difference regression models (N = 6950). At 24 months, California males born in December scored greater than expected in cognitive ability (coef = 9.55, standard error = 3.37; p = 0.004). We observed no relation with height. Results remained robust to alternative specifications. Findings offer partial support for the culled cohort hypothesis in that we observed greater than expected cognitive scores at two years of age among a cohort of males affected by 9/11 in utero. Contemporary population stressors may induce male-specific culling, thereby resulting in relatively improved development among males that survive to birth. Copyright © 2012 Elsevier Ltd. All rights reserved.

Persistence of pathogenic prion protein during simulated wastewater treatment processes

USGS Publications Warehouse

Hinckley, G.T.; Johnson, C.J.; Jacobson, K.H.; Bartholomay, C.; Mcmahon, K.D.; McKenzie, D.; Aiken, Judd M.; Pedersen, J.A.

2008-01-01

Transmissible spongiform encephalopathies (TSEs, prion diseases) are a class of fatal neurodegenerative diseases affecting a variety of mammalian species including humans. A misfolded form of the prion protein (PrP TSE) is the major, if not sole, component of the infectious agent. Prions are highly resistant to degradation and to many disinfection procedures suggesting that, if prions enter wastewater treatment systems through sewers and/or septic systems (e.g., from slaughterhouses, necropsy laboratories, rural meat processors, private game dressing) or through leachate from landfills that have received TSE-contaminated material, prions could survive conventional wastewater treatment Here, we report the results of experiments examining the partitioning and persistence of PrPTSE during simulated wastewater treatment processes including activated and mesophilic anaerobic sludge digestion. Incubation with activated sludge did not result in significant PrPTSE degradation. PrPTSE and prion infectivity partitioned strongly to activated sludge solids and are expected to enter biosolids treatment processes. A large fraction of PrPTSE survived simulated mesophilic anaerobic sludge digestion. The small reduction in recoverable PrPTSE after 20-d anaerobic sludge digestion appeared attributable to a combination of declining extractability with time and microbial degradation. Our results suggest that if prions were to enter municipal wastewater treatment systems, most would partition to activated sludge solids, survive mesophilic anaerobic digestion, and be present in treated biosolids. ?? 2008 American Chemical Society.

Patient volume per surgeon does not predict survival in adult level I trauma centers.

PubMed

Margulies, D R; Cryer, H G; McArthur, D L; Lee, S S; Bongard, F S; Fleming, A W

2001-04-01

The 1999 American College of Surgeons resources for optimal care document added the requirement that Level I trauma centers admit over 240 patients with Injury Severity Score (ISS) > 15 per year or that trauma surgeons care for at least 35 patients per year. The purpose of this study was to test the hypothesis that high volume of patients with ISS > 15 per individual trauma surgeon is associated with improved outcome. Data were obtained from the trauma registry of the five American College of Surgeons-verified adult Level I trauma centers in our mature trauma system between January 1, 1998, and March 31, 1999. Data abstracted included age, sex, Glasgow Coma Scale (GCS) score, intensive care unit length of stay, hospital length of stay, probability of survival (Ps), mechanism of injury, number of patients per each trauma surgeon and institution, and mortality. Multiple logistic regression was performed to select independent variables for modeling of survival. From the five Level I centers there were 11,932 trauma patients in this time interval; of these, 1,754 patients (14.7%) with ISS > 15 were identified and used for analysis. Patients with ISS > 15 varied from 173 to 625 per institution; trauma surgeons varied from 8 to 25 per institution; per-surgeon patient volume varied from 0.8 to 96 per year. Logistic regression analysis revealed that the best independent predictors of survival were Ps, GCS score, age, mechanism of injury, and institutional volume (p < 0.01). Age and institutional volume correlated negatively with survival. Analysis of per-surgeon patient caseload added no additional predictive value (p = 0.44). The significant independent predictors of survival in severely injured trauma patients are Ps, GCS score, age, mechanism of injury, and institutional volume. We found no statistically meaningful contribution to the prediction of survival on the basis of per-surgeon patient volume. Since this volume criterion for surgeon enpanelment and trauma center designation would not be expected to improve outcome, such a requirement should be justified by other measures or abandoned.

Effects of multiple levels of social organization on survival and abundance.

PubMed

Ward, Eric J; Semmens, Brice X; Holmes, Elizabeth E; Balcomb Iii, Ken C

2011-04-01

Identifying how social organization shapes individual behavior, survival, and fecundity of animals that live in groups can inform conservation efforts and improve forecasts of population abundance, even when the mechanism responsible for group-level differences is unknown. We constructed a hierarchical Bayesian model to quantify the relative variability in survival rates among different levels of social organization (matrilines and pods) of an endangered population of killer whales (Orcinus orca). Individual killer whales often participate in group activities such as prey sharing and cooperative hunting. The estimated age-specific survival probabilities and survivorship curves differed considerably among pods and to a lesser extent among matrilines (within pods). Across all pods, males had lower life expectancy than females. Differences in survival between pods may be caused by a combination of factors that vary across the population's range, including reduced prey availability, contaminants in prey, and human activity. Our modeling approach could be applied to demographic rates for other species and for parameters other than survival, including reproduction, prey selection, movement, and detection probabilities. Conservation Biology ©2010 Society for Conservation Biology. No claim to original US government works.

Gardening in the zone of death: an experimental assessment of the absolute elevation limit of vascular plants

NASA Astrophysics Data System (ADS)

Dvorský, Miroslav; Chlumská, Zuzana; Altman, Jan; Čapková, Kateřina; Řeháková, Klára; Macek, Martin; Kopecký, Martin; Liancourt, Pierre; Doležal, Jiří

2016-04-01

Vascular plants in the western Tibetan Plateau reach 6000 m-the highest elevation on Earth. Due to the significant warming of the region, plant ranges are expected to shift upwards. However, factors governing maximum elevational limits of plant are unclear. To experimentally assess these factors, we transplanted 12 species from 5750 m to 5900 m (upper edge of vegetation) and 6100 m (beyond range) and monitored their survival for six years. In the first three years (2009-2012), there were plants surviving beyond the regional upper limit of vegetation. This supports the hypothesis of dispersal and/or recruitment limitation. Substantial warming, recorded in-situ during this period, very likely facilitated the survival. The survival was ecologically a non-random process, species better adapted to repeated soil freezing and thawing survived significantly better. No species have survived at 6100 m since 2013, probably due to the extreme snowfall in 2013. In conclusion, apart from the minimum heat requirements, our results show that episodic climatic events are decisive determinants of upper elevational limits of vascular plants.

Individual survival curves comparing subjective and observed mortality risks.

PubMed

Bissonnette, Luc; Hurd, Michael D; Michaud, Pierre-Carl

2017-12-01

We compare individual survival curves constructed from objective (actual mortality) and elicited subjective information (probability of survival to a given target age). We develop a methodology to estimate jointly subjective and objective individual survival curves accounting for rounding on subjective reports of perceived survival. We make use of the long follow-up period in the Health and Retirement Study and the high quality of mortality data to estimate individual survival curves that feature both observed and unobserved heterogeneity. This allows us to compare objective and subjective estimates of remaining life expectancy for various groups and compare welfare effects of objective and subjective mortality risk using the life cycle model of consumption. We find that subjective and objective hazards are not the same. The median welfare loss from misperceptions of mortality risk when annuities are not available is 7% of current wealth at age 65 whereas more than 25% of respondents have losses larger than 60% of wealth. When annuities are available and exogenously given, the welfare loss is substantially lower. Copyright © 2017 John Wiley & Sons, Ltd.

Gardening in the zone of death: an experimental assessment of the absolute elevation limit of vascular plants.

PubMed

Dvorský, Miroslav; Chlumská, Zuzana; Altman, Jan; Čapková, Kateřina; Řeháková, Klára; Macek, Martin; Kopecký, Martin; Liancourt, Pierre; Doležal, Jiří

2016-04-13

Vascular plants in the western Tibetan Plateau reach 6000 m--the highest elevation on Earth. Due to the significant warming of the region, plant ranges are expected to shift upwards. However, factors governing maximum elevational limits of plant are unclear. To experimentally assess these factors, we transplanted 12 species from 5750 m to 5900 m (upper edge of vegetation) and 6100 m (beyond range) and monitored their survival for six years. In the first three years (2009-2012), there were plants surviving beyond the regional upper limit of vegetation. This supports the hypothesis of dispersal and/or recruitment limitation. Substantial warming, recorded in-situ during this period, very likely facilitated the survival. The survival was ecologically a non-random process, species better adapted to repeated soil freezing and thawing survived significantly better. No species have survived at 6100 m since 2013, probably due to the extreme snowfall in 2013. In conclusion, apart from the minimum heat requirements, our results show that episodic climatic events are decisive determinants of upper elevational limits of vascular plants.

Development of a clinical prediction model to calculate patient life expectancy: the measure of actuarial life expectancy (MALE).

PubMed

Clarke, M G; Kennedy, K P; MacDonagh, R P

2009-01-01

To develop a clinical prediction model enabling the calculation of an individual patient's life expectancy (LE) and survival probability based on age, sex, and comorbidity for use in the joint decision-making process regarding medical treatment. A computer software program was developed with a team of 3 clinicians, 2 professional actuaries, and 2 professional computer programmers. This incorporated statistical spreadsheet and database access design methods. Data sources included life insurance industry actuarial rating factor tables (public and private domain), Government Actuary Department UK life tables, professional actuarial sources, and evidence-based medical literature. The main outcome measures were numerical and graphical display of comorbidity-adjusted LE; 5-, 10-, and 15-year survival probability; in addition to generic UK population LE. Nineteen medical conditions, which impacted significantly on LE in actuarial terms and were commonly encountered in clinical practice, were incorporated in the final model. Numerical and graphical representations of statistical predictions of LE and survival probability were successfully generated for patients with either no comorbidity or a combination of the 19 medical conditions included. Validation and testing, including actuarial peer review, confirmed consistency with the data sources utilized. The evidence-based actuarial data utilized in this computer program design represent a valuable resource for use in the clinical decision-making process, where an accurate objective assessment of patient LE can so often make the difference between patients being offered or denied medical and surgical treatment. Ongoing development to incorporate additional comorbidities and enable Web-based access will enhance its use further.

Benefits of marriage on relative and conditional relative cancer survival differ between males and females in the USA.

PubMed

Merrill, Ray M; Johnson, Erin

2017-10-01

The purpose of the paper is to assess the influence of marital status on conditional relative survival of cancer according to sex. Analyses involved 779,978 males and 1,032,868 females diagnosed with 1 of 13 cancer types between 2000 and 2008, and followed through 2013. Data are from the Surveillance, Epidemiology, and End Results (SEER) Program. Regression models were adjusted for age, sex, race, and tumor stage. Five-year relative survival conditional on years already survived is higher among married patients with less lethal cancers (oral cavity and pharynx, colon and rectum, breast, urinary bladder, kidney and renal pelvis, melanoma of the skin, thyroid, lymphoma). For more lethal cancers, married patients have similar (liver, lung and bronchus, pancreas, leukemia) or poorer (brain and other nervous system) cancer survival. Separated/divorced or widowed patients have the lowest conditional relative survival rates. For most cancers, 5-year cancer relative survival rates conditional on time already survived through 5 years approach 70 to 90% of that for the general population. The beneficial effect of marriage on survival decreases with years already survived. Superior conditional relative survival rates in females decrease with time already survived and are less pronounced in married patients. Five-year relative survival rates improve with time already survived. The benefits of marriage on conditional relative survival are greater for less lethal cancers. Greater 5-year conditional relative survival rates in females narrow with time already survived and are less pronounced in married patients. Conditional relative survival rates of cancer can lead to more informed decisions and understanding regarding treatment and prognosis.

Mother-caregiver expectations for function among survivors of childhood brain tumors

PubMed Central

Barakat, Lamia P.; Ulrich, Connie M.; Jones, Nora L.; Deatrick, Janet A.

2015-01-01

Purpose Children diagnosed with brain tumors increasingly survive to adulthood, although they do so with needs often requiring continued parental caregiving. We sought to describe the nature of caregivers’ expectations about survivors’ function and how expectations connect to ongoing management and decision-making. Methods Forty-five qualitative interviews with mother-caregivers were conducted and coded for themes related to expectations for their adolescent/young adult children living post-childhood brain tumors. Results Five main themes emerged as integral to mother-caregiver expectations: realizing a difference in the survivor, noticing limitations to independence in the survivor, memories of learning about clinical prognoses as understood from consent meetings and education, managing these realizations, and acknowledging unresolved challenges. Conclusions Caregiver expectations are influenced by both initial clinical interactions and contemporary family dynamics and require individual- and family-specific survivorship planning. As caregiver expectations can influence management behaviors that impact outcomes and possibly independence, implications for clinician-caregiver shared decision-making are substantial. PMID:26556212

Cost-effectiveness of adding rituximab to fludarabine and cyclophosphamide for treatment of chronic lymphocytic leukemia in Ukraine.

PubMed

Mandrik, Olena; Corro Ramos, Isaac; Knies, Saskia; Al, Maiwenn; Severens, Johan L

2015-01-01

The aim of this study was to assess the cost-effectiveness, from a health care perspective, of adding rituximab to fludarabine and cyclophosphamide scheme (FCR versus FC) for treatment-naïve and refractory/relapsed Ukrainian patients with chronic lymphocytic leukemia. A decision-analytic Markov cohort model with three health states and 1-month cycle time was developed and run within a life time horizon. Data from two multinational, prospective, open-label Phase 3 studies were used to assess patients' survival. While utilities were generalized from UK data, local resource utilization and disease-associated treatment, hospitalization, and side effect costs were applied. The alternative scenario was performed to assess the impact of lower life expectancy of the general population in Ukraine on the incremental cost-effectiveness ratio (ICER) for treatment-naïve patients. One-way, two-way, and probabilistic sensitivity analyses were conducted to assess the robustness of the results. The ICER (in US dollars) of treating chronic lymphocytic leukemia patients with FCR versus FC is US$8,704 per quality-adjusted life year gained for treatment-naïve patients and US$11,056 for refractory/relapsed patients. When survival data were modified to the lower life expectancy of the general population in Ukraine, the ICER for treatment-naïve patients was higher than US$13,000. This value is higher than three times the current gross domestic product per capita in Ukraine. Sensitivity analyses have shown a high impact of rituximab costs and a moderate impact of differences in utilities on the ICER. Furthermore, probabilistic sensitivity analyses have shown that for refractory/relapsed patients the probability of FCR being cost-effective is higher than for treatment-naïve patients and is close to one if the threshold is higher than US$15,000. State coverage of rituximab treatment may be considered a cost-effective treatment for the Ukrainian population under conditions of economic stability, cost-effectiveness threshold growth, or rituximab price negotiations.

Survival of Spacecraft-Associated Microorganisms under Simulated Martian UV Irradiation

PubMed Central

Newcombe, David A.; Schuerger, Andrew C.; Benardini, James N.; Dickinson, Danielle; Tanner, Roger; Venkateswaran, Kasthuri

2005-01-01

Spore-forming microbes recovered from spacecraft surfaces and assembly facilities were exposed to simulated Martian UV irradiation. The effects of UVA (315 to 400 nm), UVA+B (280 to 400 nm), and the full UV spectrum (200 to 400 nm) on the survival of microorganisms were studied at UV intensities expected to strike the surfaces of Mars. Microbial species isolated from the surfaces of several spacecraft, including Mars Odyssey, X-2000 (avionics), and the International Space Station, and their assembly facilities were identified using 16S rRNA gene sequencing. Forty-three Bacillus spore lines were screened, and 19 isolates showed resistance to UVC irradiation (200 to 280 nm) after exposure to 1,000 J m−2 of UVC irradiation at 254 nm using a low-pressure mercury lamp. Spores of Bacillus species isolated from spacecraft-associated surfaces were more resistant than a standard dosimetric strain, Bacillus subtilis 168. In addition, the exposure time required for UVA+B irradiation to reduce the viable spore numbers by 90% was 35-fold longer than the exposure time required for the full UV spectrum to do this, confirming that UVC is the primary biocidal bandwidth. Among the Bacillus species tested, spores of a Bacillus pumilus strain showed the greatest resistance to all three UV bandwidths, as well as the total spectrum. The resistance to simulated Mars UV irradiation was strain specific; B. pumilus SAFR-032 exhibited greater resistance than all other strains tested. The isolation of organisms like B. pumilus SAFR-032 and the greater survival of this organism (sixfold) than of the standard dosimetric strains should be considered when the sanitation capabilities of UV irradiation are determined. PMID:16332797

Survival of spacecraft-associated microorganisms under simulated martian UV irradiation.

PubMed

Newcombe, David A; Schuerger, Andrew C; Benardini, James N; Dickinson, Danielle; Tanner, Roger; Venkateswaran, Kasthuri

2005-12-01

Spore-forming microbes recovered from spacecraft surfaces and assembly facilities were exposed to simulated Martian UV irradiation. The effects of UVA (315 to 400 nm), UVA+B (280 to 400 nm), and the full UV spectrum (200 to 400 nm) on the survival of microorganisms were studied at UV intensities expected to strike the surfaces of Mars. Microbial species isolated from the surfaces of several spacecraft, including Mars Odyssey, X-2000 (avionics), and the International Space Station, and their assembly facilities were identified using 16S rRNA gene sequencing. Forty-three Bacillus spore lines were screened, and 19 isolates showed resistance to UVC irradiation (200 to 280 nm) after exposure to 1,000 J m(-2) of UVC irradiation at 254 nm using a low-pressure mercury lamp. Spores of Bacillus species isolated from spacecraft-associated surfaces were more resistant than a standard dosimetric strain, Bacillus subtilis 168. In addition, the exposure time required for UVA+B irradiation to reduce the viable spore numbers by 90% was 35-fold longer than the exposure time required for the full UV spectrum to do this, confirming that UVC is the primary biocidal bandwidth. Among the Bacillus species tested, spores of a Bacillus pumilus strain showed the greatest resistance to all three UV bandwidths, as well as the total spectrum. The resistance to simulated Mars UV irradiation was strain specific; B. pumilus SAFR-032 exhibited greater resistance than all other strains tested. The isolation of organisms like B. pumilus SAFR-032 and the greater survival of this organism (sixfold) than of the standard dosimetric strains should be considered when the sanitation capabilities of UV irradiation are determined.

A model for spatial variations in life expectancy; mortality in Chinese regions in 2000.

PubMed

Congdon, Peter

2007-05-02

Life expectancy in China has been improving markedly but health gains have been uneven and there is inequality in survival chances between regions and in rural as against urban areas. This paper applies a statistical modelling approach to mortality data collected in conjunction with the 2000 Census to formally assess spatial mortality contrasts in China. The modelling approach provides interpretable summary parameters (e.g. the relative mortality risk in rural as against urban areas) and is more parsimonious in terms of parameters than the conventional life table model. Predictive fit is assessed both globally and at the level of individual five year age groups. A proportional model (age and area effects independent) has a worse fit than one allowing age-area interactions following a bilinear form. The best fit is obtained by allowing for child and oldest age mortality rates to vary spatially. There is evidence that age (21 age groups) and area (31 Chinese administrative divisions) are not proportional (i.e. independent) mortality risk factors. In fact, spatial contrasts are greatest at young ages. There is a pronounced rural survival disadvantage, and large differences in life expectancy between provinces.

Late effects of radiation therapy for cancer of the uterine cervix

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

Zippin, C.; Lum, D.; Kohn, H.I.

1981-01-01

This report presents follow-up information on 497 women diagnosed with cancer of the uterine cervix in Connecticut and California between 1932 and 1951 who received only radiation as their initial course of therapy. Patients entered into the study were all treated before age 55 and all were five-year-survivors following treatment in order to eliminate early deaths due to the cervical cancer. Three radiologic dosage groups (high, medium, and low) were formed with 93, 244, and 160 patients, respectively. For all dosage groups combined 108 subsequent cancers were observed more than 5 yr after cancer treatment compared with 64 expected (Pmore » less than 0.01). Sites for which subsequent cancers were significantly (P less than 0.05) in excess of expectation were rectum, ovary, lung, vulva and vagina, small intestine, oropharynx, and central nervous system excluding brain. The ratio of observed to expected cases of subsequent cancers rose only slightly with increasing radiologic dose. No significant differences in overall survival patterns for the three dosage groups were found. For all dosage groups survival was poorer than in the corresponding segment of the general population.« less

Does framing of cancer survival affect perceived value of care? A willingness-to-pay survey of US residents.

PubMed

Lin, Pei-Jung; Concannon, Thomas W; Greenberg, Dan; Cohen, Joshua T; Rossi, Gregory; Hille, Jeffrey; Auerbach, Hannah R; Fang, Chi-Hui; Nadler, Eric S; Neumann, Peter J

2013-08-01

To investigate the relationship between the framing of survival gains and the perceived value of cancer care. Through a population-based survey of 2040 US adults, respondents were randomized to one of the two sets of hypothetical scenarios, each of which described the survival benefit for a new treatment as either an increase in median survival time (median survival), or an increase in the probability of survival for a given length of time (landmark survival). Each respondent was presented with two randomly selected scenarios with different prognosis and survival improvements, and asked about their willingness to pay (WTP) for the new treatments. Predicted WTP increased with survival benefits and respondents' income, regardless of how survival benefits were described. Framing therapeutic benefits as improvements in landmark rather than median time survival increased the proportion of the population willing to pay for that gain by 11-35%, and the mean WTP amount by 42-72% in the scenarios we compared. How survival benefits are described may influence the value people place on cancer care.

[Management of outpatients with cardiac disease: follow-up timing and modalities].

PubMed

Rossini, Roberta; Lina, Daniela; Ferlini, Marco; Belotti, Giuseppina; Caico, Salvatore Ivan; Caravati, Fabrizio; Faggiano, Pompilio; Iorio, Annamaria; Lauri, Davide; Lettieri, Corrado; Locati, Emanuela Teresa; Maggi, Antonio; Massari, Ferdinando; Mortara, Andrea; Moschini, Luigi; Musumeci, Giuseppe; Nassiacos, Daniele; Negri, Fabrizio; Pecora, Domenico; Pierini, Simona; Pedretti, Roberto; Ravizza, Pierfranco; Romano, Michele; Oliva, Fabrizio

2017-06-01

The increasing rate of cardiovascular diseases, the improved survival after the acute phase, the aging of the population and the implementation of primary prevention caused an exponential increase in outpatient cardiac performance, thereby making it difficult to maintain a balance between the citizen-patient request and the economic sustainability of the healthcare system. On the other side, the prescription of many diagnostic tests with a view to defensive medicine and the related growth of patients' expectations, has led several scientific societies to educational campaigns highlighting the concept that "less is more".The present document is aimed at providing the general practitioner with practical information about a prompt diagnosis of signs/symptoms (angina, dyspnea, palpitations, syncope) of the major cardiovascular diseases. It will also provide an overview about appropriate use of diagnostic exams (echocardiogram, stress test), about the appropriate timing of their execution, in order to ensure effectiveness, efficiency, and equity of the health system.

Fractional Brownian motion and the critical dynamics of zipping polymers.

PubMed

Walter, J-C; Ferrantini, A; Carlon, E; Vanderzande, C

2012-03-01

We consider two complementary polymer strands of length L attached by a common-end monomer. The two strands bind through complementary monomers and at low temperatures form a double-stranded conformation (zipping), while at high temperature they dissociate (unzipping). This is a simple model of DNA (or RNA) hairpin formation. Here we investigate the dynamics of the strands at the equilibrium critical temperature T=T(c) using Monte Carlo Rouse dynamics. We find that the dynamics is anomalous, with a characteristic time scaling as τ∼L(2.26(2)), exceeding the Rouse time ∼L(2.18). We investigate the probability distribution function, velocity autocorrelation function, survival probability, and boundary behavior of the underlying stochastic process. These quantities scale as expected from a fractional Brownian motion with a Hurst exponent H=0.44(1). We discuss similarities to and differences from unbiased polymer translocation.

Investigating dark matter substructure with pulsar timing - II. Improved limits on small-scale cosmology

NASA Astrophysics Data System (ADS)

Clark, Hamish A.; Lewis, Geraint F.; Scott, Pat

2016-02-01

Ultracompact minihaloes (UCMHs) have been proposed as a type of dark matter substructure seeded by large-amplitude primordial perturbations and topological defects. UCMHs are expected to survive to the present era, allowing constraints to be placed on their cosmic abundance using observations within our own Galaxy. Constraints on their number density can be linked to conditions in the early Universe that impact structure formation, such as increased primordial power on small scales, generic weak non-Gaussianity, and the presence of cosmic strings. We use new constraints on the abundance of UCMHs from pulsar timing to place generalized limits on the parameters of each of these cosmological scenarios. At some scales, the limits are the strongest to date, exceeding those from dark matter annihilation. Our new limits have the added advantage of being independent of the particle nature of dark matter, as they are based only on gravitational effects.

Using physiology to predict the responses of ants to climatic warming.

PubMed

Diamond, Sarah E; Penick, Clint A; Pelini, Shannon L; Ellison, Aaron M; Gotelli, Nicholas J; Sanders, Nathan J; Dunn, Robert R

2013-12-01

Physiological intolerance of high temperatures places limits on organismal responses to the temperature increases associated with global climatic change. Because ants are geographically widespread, ecologically diverse, and thermophilic, they are an ideal system for exploring the extent to which physiological tolerance can predict responses to environmental change. Here, we expand on simple models that use thermal tolerance to predict the responses of ants to climatic warming. We investigated the degree to which changes in the abundance of ants under warming reflect reductions in the thermal niche space for their foraging. In an eastern deciduous forest system in the United States with approximately 40 ant species, we found that for some species, the loss of thermal niche space for foraging was related to decreases in abundance with increasing experimental climatic warming. However, many ant species exhibited no loss of thermal niche space. For one well-studied species, Temnothorax curvispinosus, we examined both survival of workers and growth of colonies (a correlate of reproductive output) as functions of temperature in the laboratory, and found that the range of thermal tolerances for colony growth was much narrower than for survival of workers. We evaluated these functions in the context of experimental climatic warming and found that the difference in the responses of these two attributes to temperature generates differences in the means and especially the variances of expected fitness under warming. The expected mean growth of colonies was optimized at intermediate levels of warming (2-4°C above ambient); yet, the expected variance monotonically increased with warming. In contrast, the expected mean and variance of the survival of workers decreased when warming exceeded 4°C above ambient. Together, these results for T. curvispinosus emphasize the importance of measuring reproduction (colony growth) in the context of climatic change: indeed, our examination of the loss of thermal niche space with the larger species pool could be missing much of the warming impact due to these analyses being based on survival rather than reproduction. We suggest that while physiological tolerance of temperature can be a useful predictive tool for modeling responses to climatic change, future efforts should be devoted to understanding the causes and consequences of variability in models of tolerance calibrated with different metrics of performance and fitness.

How long will I have my ACE? The natural history of the antegrade continence enema stoma in idiopathic constipation.

PubMed

Khoo, A Kate; Askouni, Evita; Basson, Sonia; Ng, Jessica; Cleeve, Stewart

2017-11-01

We aim to determine the natural history of the ACE in idiopathic constipation and factors predictive of closure. A retrospective case-note review of all patients undergo ACE formation for idiopathic constipation Jan 2003-Mar 2016. Kaplan-Meier analysis was used to determine ACE survival and Cox's proportional hazard models to examine potential predictors of closure. 29/84 (35%) ACEs were closed: 21/84 due to success and 8/84 due to failure. Median age of closure was 15.5 years (3.5-23.6). Median ACE survival was 77.0 months (95% CI 58.0-96.0). An ACE survival curve was derived from which we estimate that 5-year post-ACE, one-third of patients can expect to have had their ACE closed. Younger age at ACE was predictive of earlier closure (p = 0.023) and closure for success (p < 0.001). Neither patient sex (p = 0.546) nor presence of psychological comorbidities (p = 0.769) predicted likelihood of closure. Incontinence 6-week post-ACE was also associated with increased likelihood of closure (p = 0.042). The ACE survival curve estimates the proportion of patients with idiopathic constipation who can expect closure (either due to success or failure) at certain timepoints. This may be useful for patient counseling. Younger age at ACE was associated with earlier closure (for success).

Foraging proficiency during the nonbreeding season of a specialized forager: are juvenile American Oystercatchers "bumble-beaks" compared to adults?

USGS Publications Warehouse

Hand, Christine E.; Sanders, Felicia J.; Jodice, Patrick G.R.

2010-01-01

In many species, immature individuals are less proficient at foraging than are adults, and this difference may be especially critical during winter when survival can be at its minimum. We investigated the foraging proficiency of adult and immature American Oystercatchers (Haematopus palliatus) during the nonbreeding season. Oystercatchers forage on prey that must be handled with specialized skills, so age-related differences in foraging behavior may be expected. We found that adults spent more time searching than did immatures, a trend toward immatures taking longer to handle prey than did adults, and immatures more often handling prey unsuccessfully than did adults. Feeding rates and diet composition did not differ by age class. We posit that the immature birds traded off longer handling times with shorter searching times and that ultimately the abundant prey in the region may contribute to the ability of immature birds to feed at rates similar to those of adults.

Adult survival and population growth rate in Colorado big brown bats (Eptesicus fuscus)

USGS Publications Warehouse

O'Shea, T.J.; Ellison, L.E.; Stanley, T.R.

2011-01-01

We studied adult survival and population growth at multiple maternity colonies of big brown bats (Eptesicus fuscus) in Fort Collins, Colorado. We investigated hypotheses about survival using information-theoretic methods and mark-recapture analyses based on passive detection of adult females tagged with passive integrated transponders. We constructed a 3-stage life-history matrix model to estimate population growth rate (??) and assessed the relative importance of adult survival and other life-history parameters to population growth through elasticity and sensitivity analysis. Annual adult survival at 5 maternity colonies monitored from 2001 to 2005 was estimated at 0.79 (95% confidence interval [95% CI] = 0.77-0.82). Adult survival varied by year and roost, with low survival during an extreme drought year, a finding with negative implications for bat populations because of the likelihood of increasing drought in western North America due to global climate change. Adult survival during winter was higher than in summer, and mean life expectancies calculated from survival estimates were lower than maximum longevity records. We modeled adult survival with recruitment parameter estimates from the same population. The study population was growing (?? = 1.096; 95% CI = 1.057-1.135). Adult survival was the most important demographic parameter for population growth. Growth clearly had the highest elasticity to adult survival, followed by juvenile survival and adult fecundity (approximately equivalent in rank). Elasticity was lowest for fecundity of yearlings. The relative importances of the various life-history parameters for population growth rate are similar to those of large mammals. ?? 2011 American Society of Mammalogists.

Green survivability in Fiber-Wireless (FiWi) broadband access network

NASA Astrophysics Data System (ADS)

Liu, Yejun; Guo, Lei; Gong, Bo; Ma, Rui; Gong, Xiaoxue; Zhang, Lincong; Yang, Jiangzi

2012-03-01

Fiber-Wireless (FiWi) broadband access network is a promising "last mile" access technology, because it integrates wireless and optical access technologies in terms of their respective merits, such as high capacity and stable transmission from optical access technology, and easy deployment and flexibility from wireless access technology. Since FiWi is expected to carry a large amount of traffic, numerous traffic flows may be interrupted by the failure of network components. Thus, survivability in FiWi is a key issue aiming at reliable and robust service. However, the redundant deployment of backup resource required for survivability usually causes huge energy consumption, which aggravates the global warming and accelerates the incoming of energy crisis. Thus, the energy-saving issue should be considered when it comes to survivability design. In this paper, we focus on the green survivability in FiWi, which is an innovative concept and remains untouched in the previous works to our best knowledge. We first review and discuss some challenging issues about survivability and energy-saving in FiWi, and then we propose some instructive solutions for its green survivability design. Therefore, our work in this paper will provide the technical references and research motivations for the energy-efficient and survivable FiWi development in the future.

Measuring survival time: a probability-based approach useful in healthcare decision-making.

PubMed

2011-01-01

In some clinical situations, the choice between treatment options takes into account their impact on patient survival time. Due to practical constraints (such as loss to follow-up), survival time is usually estimated using a probability calculation based on data obtained in clinical studies or trials. The two techniques most commonly used to estimate survival times are the Kaplan-Meier method and the actuarial method. Despite their limitations, they provide useful information when choosing between treatment options.

Radiotherapeutic and surgical management for newly diagnosed brain metastasis(es): An American Society for Radiation Oncology evidence-based guideline

PubMed Central

Tsao, May N.; Rades, Dirk; Wirth, Andrew; Lo, Simon S.; Danielson, Brita L.; Gaspar, Laurie E.; Sperduto, Paul W.; Vogelbaum, Michael A.; Radawski, Jeffrey D.; Wang, Jian Z.; Gillin, Michael T.; Mohideen, Najeeb; Hahn, Carol A.; Chang, Eric L.

2012-01-01

Purpose To systematically review the evidence for the radiotherapeutic and surgical management of patients newly diagnosed with intraparenchymal brain metastases. Methods and Materials Key clinical questions to be addressed in this evidence-based Guideline were identified. Fully published randomized controlled trials dealing with the management of newly diagnosed intraparenchymal brain metastases were searched systematically and reviewed. The U.S. Preventative Services Task Force levels of evidence were used to classify various options of management. Results The choice of management in patients with newly diagnosed single or multiple brain metastases depends on estimated prognosis and the aims of treatment (survival, local treated lesion control, distant brain control, neurocognitive preservation). Single brain metastasis and good prognosis (expected survival 3 months or more): For a single brain metastasis larger than 3 to 4 cm and amenable to safe complete resection, whole brain radiotherapy (WBRT) and surgery (level 1) should be considered. Another alternative is surgery and radiosurgery/radiation boost to the resection cavity (level 3). For single metastasis less than 3 to 4 cm, radiosurgery alone or WBRT and radiosurgery or WBRT and surgery (all based on level 1 evidence) should be considered. Another alternative is surgery and radiosurgery or radiation boost to the resection cavity (level 3). For single brain metastasis (less than 3 to 4 cm) that is not resectable or incompletely resected, WBRT and radiosurgery, or radiosurgery alone should be considered (level 1). For nonresectable single brain metastasis (larger than 3 to 4 cm), WBRT should be considered (level 3). Multiple brain metastases and good prognosis (expected survival 3 months or more): For selected patients with multiple brain metastases (all less than 3 to 4 cm), radiosurgery alone, WBRT and radiosurgery, or WBRT alone should be considered, based on level 1 evidence. Safe resection of a brain metastasis or metastases causing significant mass effect and postoperative WBRT may also be considered (level 3). Patients with poor prognosis (expected survival less than 3 months): Patients with either single or multiple brain metastases with poor prognosis should be considered for palliative care with or without WBRT (level 3). It should be recognized, however, that there are limitations in the ability of physicians to accurately predict patient survival. Prognostic systems such as recursive partitioning analysis, and diagnosis-specific graded prognostic assessment may be helpful. Conclusions Radiotherapeutic intervention (WBRT or radiosurgery) is associated with improved brain control. In selected patients with single brain metastasis, radiosurgery or surgery has been found to improve survival and locally treated metastasis control (compared with WBRT alone). PMID:25925626

Survival time estimation using Injury Severity Score (ISS) in homicide cases.

PubMed

Cros, Jérôme; Alvarez, Jean-Claude; Sbidian, Emilie; Charlier, Philippe; de la Grandmaison, Geoffroy Lorin

2013-12-10

The aim of our study was to assess the value of ISS to estimate survival time in a retrospective study of all homicidal deaths in the Western suburbs of Paris between 1994 and 2008. Stab wounds were the most common cause of death. Survival time between assault and death, determined in 107 cases out of 511 homicide cases, ranged from 0 min to 25 days (mean 39 h). There was an overall significant association between the survival time and the ISS score. ISS and survival time were strongly associated with male victims and a clear trend was seen with women. Regarding the type of wounds, a trend was seen with gunshot wounds and blunt injuries, but not with stab wounds. There was no influence of blood toxicological results and resuscitation attempts. Overall, ISS was a good predictor of a survival under 30 min. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Large-amplitude internal waves sustain coral health during thermal stress

NASA Astrophysics Data System (ADS)

Schmidt, Gertraud M.; Wall, Marlene; Taylor, Marc; Jantzen, Carin; Richter, Claudio

2016-09-01

Ocean warming is a major threat for coral reefs causing widespread coral bleaching and mortality. Potential refugia are thus crucial for coral survival. Exposure to large-amplitude internal waves (LAIW) mitigated heat stress and ensured coral survival and recovery during and after an extreme heat anomaly. The physiological status of two common corals, Porites lutea and Pocillopora meandrina, was monitored in host and symbiont traits, in response to LAIW-exposure throughout the unprecedented 2010 heat anomaly in the Andaman Sea. LAIW-exposed corals of both species survived and recovered, while LAIW-sheltered corals suffered partial and total mortality in P. lutea and P. meandrina, respectively. LAIW are ubiquitous in the tropics and potentially generate coral refuge areas. As thermal stress to corals is expected to increase in a warming ocean, the mechanisms linking coral bleaching to ocean dynamics will be crucial to predict coral survival on a warming planet.

Cardiopulmonary resuscitation of out-of-hospital traumatic cardiac arrest in Qatar: A nationwide population-based study.

PubMed

Irfan, Furqan B; Consunji, Rafael; El-Menyar, Ayman; George, Pooja; Peralta, Ruben; Al-Thani, Hassan; Thomas, Stephen Hodges; Alinier, Guillaume; Shuaib, Ashfaq; Al-Suwaidi, Jassim; Singh, Rajvir; Castren, Maaret; Cameron, Peter A; Djarv, Therese

2017-08-01

Traumatic cardiac arrest studies have reported improved survival rates recently, ranging from 1.7-7.5%. This population-based nationwide study aims to describe the epidemiology, interventions and outcomes, and determine predictors of survival from out-of-hospital traumatic cardiac arrest (OHTCA) in Qatar. An observational retrospective population-based study was conducted on OHTCA patients in Qatar, from January 2010 to December 2015. Traumatic cardiac arrest was redefined to include out-of-hospital traumatic cardiac arrest (OHTCA) and in-hospital traumatic cardiac arrest (IHTCA). A total of 410 OHTCA patients were included in the 6-year study period. The mean annual crude incidence rate of OHTCA was 4.0 per 100,000 population, in Qatar. OHTCA mostly occurred in males with a median age of 33. There was a preponderance of blunt injuries (94.3%) and head injuries (66.3%). Overall, the survival rate was 2.4%. Shockable rhythm, prehospital external hemorrhage control, in-hospital blood transfusion, and surgery were associated with higher odds of survival. Adrenaline (Epinephrine) lowered the odds of survival. The incidence of OHTCA was less than expected, with a low rate of survival. Thoracotomy was not associated with improved survival while Adrenaline administration lowered survival in OHTCA patients with majority blunt injuries. Interventions to enable early prehospital control of hemorrhage, blood transfusion, thoracostomy and surgery improved survival. Copyright © 2017 Elsevier B.V. All rights reserved.

Viking '75 spacecraft design and test summary. Volume 3: Engineering test summary

NASA Technical Reports Server (NTRS)

Holmberg, N. A.; Faust, R. P.; Holt, H. M.

1980-01-01

The engineering test program for the lander and the orbiter are presented. The engineering program was developed to achieve confidence that the design was adequate to survive the expected mission environments and to accomplish the mission objective.

[Alternative hemodialysis regimens].

PubMed

Matos, Jorge Paulo Strogoff de; Lugon, Jocemir Ronaldo

2010-03-01

The mortality rate among patients on hemodialysis (HD) is extremely high. Remaining life expectancy for a patient initiating HD is only approximately one quarter of that of the general population at the same age bracket. The conventional HD regimen based on four-hour sessions three times a week was empirically established nearly four decades ago and needs to be revisited. Since the failure of the HEMO Study to demonstrate the clinical benefits of higher urea Kt/V for patients on conventional HD, an increasing interest for alternative HD regimens has emerged aiming at providing a treatment for improving survival rates. Short daily HD and long nocturnal HD stand out as the most promising alternative regimens. Economical obstacles which could hinder the clinical application of emerging knowledge in the field should be overcome.

Global Shifts in Cardiovascular Disease, the Epidemiologic Transition, and Other Contributing Factors: Toward a New Practice of Global Health Cardiology.

PubMed

Mendoza, Walter; Miranda, J Jaime

2017-02-01

One of the major drivers of change in the practice of cardiology is population change. This article discusses the current debate about epidemiologic transition paired with other ongoing transitions with direct relevance to cardiovascular conditions. Challenges specific to patterns of risk factors over time; readiness for disease surveillance and meeting global targets; health system, prevention, and treatment efforts; and physiologic traits and human-environment interactions are identified. This article concludes that a focus on the most populated regions of the world will contribute substantially to protecting the large gains in global survival and life expectancy accrued over the last decades. Copyright © 2016 Elsevier Inc. All rights reserved.

Response rates and survival times for cats with lymphoma treated with the University of Wisconsin-Madison chemotherapy protocol: 38 cases (1996-2003).

PubMed

Milner, Rowan J; Peyton, Jamie; Cooke, Kirsten; Fox, Leslie E; Gallagher, Alexander; Gordon, Patti; Hester, Juli

2005-10-01

To determine response rates and survival times for cats with lymphoma treated with the University of Wisconsin-Madison chemotherapy protocol. Retrospective study. 38 cats with lymphoma. Medical records were reviewed, and information on age, sex, breed, FeLV and FIV infection status, anatomic form, clinical stage, and survival time was obtained. Immunophenotyping was not performed. Mean +/- SD age of the cats was 10.9 +/- 4.4 years. Overall median survival time was 210 days (interquartile range, 90 to 657 days), and overall duration of first remission was 156 days (interquartile range, 87 to 316 days). Age, sex, anatomic form, and clinical stage were not significantly associated with duration of first remission or survival time. Eighteen of the 38 (47%) cats had complete remission, 14 (37%) had partial remission, and 6 (16%) had no response. Duration of first remission was significantly longer for cats with complete remission (654 days) than for cats with partial remission (114 days). Median survival time for cats with complete remission (654 days) was significantly longer than median survival time for cats with partial remission (122 days) and for cats with no response (11 days). Results suggested that a high percentage of cats with lymphoma will respond to treatment with the University of Wisconsin-Madison chemotherapy protocol. Age, sex, anatomic form, and clinical stage were not significantly associated with duration of first response or survival time, but initial response to treatment was.

Longevity and survival curves of Rhinella icterica (Anura, Bufonidae) under laboratory conditions.

PubMed

Lima, M S C S; Pederassi, J; Souza, C A S

2014-05-01

Life tables and survival curves of tadpoles from Rhinella icterica species were studied in the laboratory, under abiotic conditions controlled by a purification filter, a timer and a chiller. The survival curve for larval stage confirms a great mortality trend in the initial stages, which decreases when reaching the mature morphological condition (r = -0.94). Stages 37, 38, 39, 40 and 41 showed gradual values for their age structures, while stages 42, 43 and 44 presented high variations. Based on the results under laboratory conditions, it can be concluded that the maturity of R. icterica tadpoles development between 37 and 44 stages has a negative correlation and their predicted life expectancy is a logarithmic growth curve (y=-761.96Ln(x)+5298.5).

Estimating latent time of maturation and survival costs of reproduction in continuous time from capture-recapture data

USGS Publications Warehouse

Ergon, T.; Yoccoz, N.G.; Nichols, J.D.; Thomson, David L.; Cooch, Evan G.; Conroy, Michael J.

2009-01-01

In many species, age or time of maturation and survival costs of reproduction may vary substantially within and among populations. We present a capture-mark-recapture model to estimate the latent individual trait distribution of time of maturation (or other irreversible transitions) as well as survival differences associated with the two states (representing costs of reproduction). Maturation can take place at any point in continuous time, and mortality hazard rates for each reproductive state may vary according to continuous functions over time. Although we explicitly model individual heterogeneity in age/time of maturation, we make the simplifying assumption that death hazard rates do not vary among individuals within groups of animals. However, the estimates of the maturation distribution are fairly robust against individual heterogeneity in survival as long as there is no individual level correlation between mortality hazards and latent time of maturation. We apply the model to biweekly capture?recapture data of overwintering field voles (Microtus agrestis) in cyclically fluctuating populations to estimate time of maturation and survival costs of reproduction. Results show that onset of seasonal reproduction is particularly late and survival costs of reproduction are particularly large in declining populations.

Epidermal growth factor receptor and anaplastic lymphoma kinase testing and mutation prevalence in patients with advanced non-small cell lung cancer in Switzerland: A comprehensive evaluation of real world practices.

PubMed

Ess, S M; Herrmann, C; Frick, H; Krapf, M; Cerny, T; Jochum, W; Früh, M

2017-11-01

In order to improve outcomes, identification of the epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) genes has become crucial in advanced non-small-cell lung cancer (NSCLC). The aim of the present study is to analyse time trends and frequency of testing, factors affecting testing as well as prevalence of mutations in the Swiss population. We analysed EGFR and ALK testing in a cohort of patients with newly diagnosed metastasised non-squamous NSCLC in the catchment area of the cancer registry Eastern Switzerland in the years 2008-2014. We analysed prevalence of mutations and studied clinicopathological characteristics and survival of tested and non-tested patients and of patients with and without mutations. Among 718 patients identified, 11% (51/447) harboured an EGFR mutation in the exons 18, 19 or 21 and further 12% (31/265) showed a positive test result for ALK rearrangements. In non-smokers the proportions of mutations were 31% and 23% respectively. Testing rates increased over time and reached 79% in 2014. We observed significantly lower testing rates and poorer survival in elderly, patients with limited life expectancy and patients treated at hospitals not involved in clinical research. Outcomes can be further improved in a considerable proportion of patients with advanced non-squamous NSCLC. © 2017 John Wiley & Sons Ltd.

Periodic matrix models for seasonal dynamics of structured populations with application to a seabird population.

PubMed

Cushing, J M; Henson, Shandelle M

2018-02-03

For structured populations with an annual breeding season, life-stage interactions and behavioral tactics may occur on a faster time scale than that of population dynamics. Motivated by recent field studies of the effect of rising sea surface temperature (SST) on within-breeding-season behaviors in colonial seabirds, we formulate and analyze a general class of discrete-time matrix models designed to account for changes in behavioral tactics within the breeding season and their dynamic consequences at the population level across breeding seasons. As a specific example, we focus on egg cannibalism and the daily reproductive synchrony observed in seabirds. Using the model, we investigate circumstances under which these life history tactics can be beneficial or non-beneficial at the population level in light of the expected continued rise in SST. Using bifurcation theoretic techniques, we study the nature of non-extinction, seasonal cycles as a function of environmental resource availability as they are created upon destabilization of the extinction state. Of particular interest are backward bifurcations in that they typically create strong Allee effects in population models which, in turn, lead to the benefit of possible (initial condition dependent) survival in adverse environments. We find that positive density effects (component Allee effects) due to increased adult survival from cannibalism and the propensity of females to synchronize daily egg laying can produce a strong Allee effect due to a backward bifurcation.

Mercury monitoring in fish using a non-lethal tissue biopsy method

USGS Publications Warehouse

Ackerson, J; Schmitt, Christopher J.; McKee, J; Brumbaugh, W. G.

2010-01-01

A non-lethal method is particularly desirable for sampling rare or endangered fish or highly valued fisheries. The Missouri Department of Conservation manages several fisheries where the public is sensitive to excessive fish removal, yet there is a desire for mercury information. One such example is the trophy smallmouth bass (Micropterus dolomieu) fishery in the Ozark’s Eleven Point River. Plug removal is not expected to affect fish survival in the shortterm. However, limited information is available on survival of fish for weeks or months after plug removal.

Immunotherapy for advanced melanoma: future directions.

PubMed

Valpione, Sara; Campana, Luca G

2016-02-01

As calculated by the meta-analysis of Korn et al., the prognosis of metastatic melanoma in the pretarget and immunological therapy era was poor, with a median survival of 6.2 and a 1-year life expectancy of 25.5%. Nowadays, significant advances in melanoma treatment have been gained, and immunotherapy is one of the promising approaches to get to durable responses and survival improvement. The aim of the present review is to highlight the recent innovations in melanoma immunotherapy and to propose a critical perspective of the future directions of this enthralling oncology subspecialty.

Surgical therapy of canine nasal tumors: A retrospective study (1982-1986)

PubMed Central

Laing, Elizabeth J.; Binnington, Allen G.

1988-01-01

The results of surgical therapy in 15 dogs with histologically confirmed nasal tumors were analyzed retrospectively and compared to previous reports. Median survival time for all dogs was seven months. When adjusted for nontumor-related deaths, median survival increased to nine months. These values are two to three times longer than previous reports. To determine possible prognostic indicators, tumor stage, location, and histological type were compared to survival time. Dogs with unilateral nasal tumors had a median survival of 11 months, as compared to three months for dogs with bilateral tumors (p = 0.005). Tumor stage and histological type were not significant factors in comparing survival times. PMID:17423139

Second Primary Head and Neck Cancers After Non-Head and Neck Primary Cancers.

PubMed

Schlieve, Thomas; Heidel, R Eric; Carlson, Eric R

2016-12-01

The purpose of the present study was to determine the rate of second primary head and neck cancer development among patients with a primary cancer diagnosed outside the head and neck region, to present the clinical characteristics of this population, and to determine whether any variables are associated with survival. We designed a case series based on a sample of patients diagnosed with head and neck cancer who had previously been diagnosed with cancer located outside the head and neck region. The primary predictor variable was a diagnosis of cancer outside the head and neck region. The primary outcome variable was the diagnosis of a second cancer in the head and neck region. χ 2  Goodness-of-fit tests were used to test for differences between the observed and expected rates. A total of 19,406 cancers were diagnosed at the University of Tennessee Cancer Institute during the study period from July 1, 2004 to June 30, 2014. The rate of second primary head and neck cancer among patients with a non-head and neck primary cancer was 0.2%. These 40 cancers occurred among a total of 849 head and neck squamous cell carcinoma (HNSCC) cases (5%) diagnosed during the study period. The most common location for a second primary HNSCC was the gingiva (27.5%), followed by the oral tongue (17.5%). Significantly more gingival cancers were diagnosed than expected (P < .001) and significantly fewer tongue cancers than expected (P = .01). The most common primary cancer was prostate (27.5%), followed by breast (25%). The median survival was 28.5 months after the second primary diagnosis. A nonsignificant effect was found for age (P = .30), tobacco use (P = .12), gender (P = .60), TNM stage (P = .29), and treatment protocol (P = .96) on survival. The development of a second primary HNSCC in a population of patients with non-head and neck primary cancers is associated with decreased overall survival. The most common presentation of a second primary HNSCC in our study was in the gingiva and the most common primary cancer was in the prostate. Clinicians should consider the increased proportion of gingival cancers in this population when examining patients and be aware of the decrease in overall survival. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Role of survivor bias in pancreatic cancer case-control studies.

PubMed

Hu, Zhen-Huan; Connett, John E; Yuan, Jian-Min; Anderson, Kristin E

2016-01-01

The purpose of this study was to evaluate the impact of survivor bias on pancreatic cancer case-control studies. The authors constructed five case-loss scenarios based on the Iowa Women's Health Study cohort to reflect how case recruitment in population-based studies varies by case survival time. Risk factors for disease incidence included smoking, body mass index (BMI), waist circumference, diabetes, and alcohol consumption. Odds ratios (ORs) were estimated by conditional logistic regression and quantitatively compared by the interactions between risk factors and 3-month survival time. Additionally, Kaplan-Meier estimates for overall survival were compared within the subset cohort of pancreatic cancer cases. BMI and waist circumference showed a significant inverse relationship with survival time. Decreasing trends in ORs for BMI and waist circumference were observed with increasing case survival time. The interaction between BMI and survival time based on a cutpoint of 3 months was significant (P < .01) as was the interaction between waist circumference and survival time (P < .01). The findings suggested that case losses could result in survivor bias causing underestimated odds ratios for both BMI and waist circumference, whereas other risk factors were not significantly affected by case losses. Copyright © 2016 Elsevier Inc. All rights reserved.

Individual traits as determinants of time to death under extreme drought in Pinus sylvestris L.

PubMed

Garcia-Forner, Núria; Sala, Anna; Biel, Carme; Savé, Robert; Martínez-Vilalta, Jordi

2016-10-01

Plants exhibit a variety of drought responses involving multiple interacting traits and processes, which makes predictions of drought survival challenging. Careful evaluation of responses within species, where individuals share broadly similar drought resistance strategies, can provide insight into the relative importance of different traits and processes. We subjected Pinus sylvestris L. saplings to extreme drought (no watering) leading to death in a greenhouse to (i) determine the relative effect of predisposing factors and responses to drought on survival time, (ii) identify and rank the importance of key predictors of time to death and (iii) compare individual characteristics of dead and surviving trees sampled concurrently. Time until death varied over 3 months among individual trees (from 29 to 147 days). Survival time was best predicted (higher explained variance and impact on the median survival time) by variables related to carbon uptake and carbon/water economy before and during drought. Trees with higher concentrations of monosaccharides before the beginning of the drought treatment and with higher assimilation rates prior to and during the treatment survived longer (median survival time increased 25-70 days), even at the expense of higher water loss. Dead trees exhibited less than half the amount of nonstructural carbohydrates (NSCs) in branches, stem and relative to surviving trees sampled concurrently. Overall, our results indicate that the maintenance of carbon assimilation to prevent acute depletion of NSC content above some critical level appears to be the main factor explaining survival time of P. sylvestris trees under extreme drought. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Prognosis for dogs with stage III osteosarcoma following treatment with amputation and chemotherapy with and without metastasectomy.

PubMed

Turner, Hailey; Séguin, Bernard; Worley, Deanna R; Ehrhart, Nicole P; Lafferty, Mary H; Withrow, Stephen J; Selmic, Laura E

2017-12-01

OBJECTIVE To determine survival times of selected dogs with metastatic (stage III) osteosarcoma, whether disease-free interval (DFI) was associated with survival time after diagnosis of stage III disease (ie, stage III survival time), and whether a survival benefit of metastasectomy existed. DESIGN Retrospective case series with nested cohort study. ANIMALS 194 client-owned dogs treated for histologically confirmed appendicular osteosarcoma from 1997 through 2009. PROCEDURES Dogs were included if they had stage I or II osteosarcoma at the time of initial evaluation, had amputation of the affected appendage and ≥ 1 dose of chemotherapy afterward, and developed metastasis within the follow-up period or prior to death. Data collected from the medical records included signalment, primary tumor location, clinical and laboratory findings, whether metastasectomy was performed, and outcome. Various factors were examined for associations with outcome. RESULTS Dogs that received no treatment for the metastasis had a median survival time between 49 and 57 days after diagnosis of stage III osteosarcoma. Duration of the preceding DFI had no association with this period. Metastasectomy alone was associated with a longer median stage III survival time (232 days) than no metastasectomy (49 days). Among all dogs identified as qualifying for pulmonary metastasectomy on the basis of < 3 pulmonary nodules visible on thoracic radiographs and a DFI > 275 days (n = 21), a survival advantage was also identified for those that actually received pulmonary metastasectomy (6). CONCLUSIONS AND CLINICAL RELEVANCE Preceding DFI had no influence on survival time of dogs with stage III osteosarcoma. Metastasectomy was associated with an increase in survival time for selected dogs.

The ability to survive intracellular freezing in nematodes is related to the pattern and distribution of ice formed.

PubMed

Raymond, Méliane R; Wharton, David A

2016-07-01

A few species of nematodes can survive extensive intracellular freezing throughout all their tissues, an event that is usually thought to be fatal to cells. How are they able to survive in this remarkable way? The pattern and distribution of ice formed, after freezing at -10°C, can be observed using freeze substitution and transmission electron microscopy, which preserves the former position of ice as white spaces. We compared the pattern and distribution of ice formed in a nematode that survives intracellular freezing well (Panagrolaimus sp. DAW1), one that survives poorly (Panagrellus redivivus) and one with intermediate levels of survival (Plectus murrayi). We also examined Panagrolaimus sp. in which the survival of freezing had been compromised by starvation. Levels of survival were as expected and the use of vital dyes indicated cellular damage in those that survived poorly (starved Panagrolaimus sp. and P. murrayi). In fed Panagrolaimus sp. the intracellular ice spaces were small and uniform, whereas in P. redivivus and starved Panagrolaimus sp. there were some large spaces that may be causing cellular damage. The pattern and distribution of ice formed was different in P. murrayi, with a greater number of individuals having no ice or only small intracellular ice spaces. Control of the size of the ice formed is thus important for the survival of intracellular freezing in nematodes. © 2016. Published by The Company of Biologists Ltd.

Evaluation of clinical and histologic factors associated with survival time in dogs with stage II splenic hemangiosarcoma treated by splenectomy and adjuvant chemotherapy: 30 cases (2011-2014).

PubMed

Moore, Antony S; Rassnick, Kenneth M; Frimberger, Angela E

2017-09-01

OBJECTIVE To determine histologic and clinical factors associated with survival time in dogs with stage II splenic hemangiosarcoma treated by splenectomy and a chemotherapy protocol in which an anthracycline was alternated with lomustine. DESIGN Retrospective case series. ANIMALS 30 dogs with stage II splenic hemangiosarcoma. PROCEDURES Medical records of 3 facilities were reviewed to identify dogs treated for stage II splenic hemangiosarcoma between June 2011 and October 2014. Information collected included signalment, disease staging data, whether anemia was present, date of splenectomy, chemotherapy protocol, adverse effects, and date of death or last follow-up. Histologic slides were reviewed and scored by pathologists. Associations between variables of interest and survival data were evaluated statistically. RESULTS Median survival time for all dogs was 158 days (range, 55 to 560 days), and the 1-year survival rate was 16%. On multivariate analysis, only the histologically determined mitotic score was significantly associated with survival time. The median survival time of 292 days for dogs with a mitotic score of 0 (< 11 mitoses/10 hpf; n = 9) was significantly longer than that for dogs with higher scores (indicating higher mitotic rates); the 1-year survival rate for these dogs was 42%. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that future studies should take histologic factors, particularly mitotic rate, as well as tumor stage into account when assessing treatment effects on survival time of dogs with splenic hemangiosarcoma.

Mining gene link information for survival pathway hunting.

PubMed

Jing, Gao-Jian; Zhang, Zirui; Wang, Hong-Qiang; Zheng, Hong-Mei

2015-08-01

This study proposes a gene link-based method for survival time-related pathway hunting. In this method, the authors incorporate gene link information to estimate how a pathway is associated with cancer patient's survival time. Specifically, a gene link-based Cox proportional hazard model (Link-Cox) is established, in which two linked genes are considered together to represent a link variable and the association of the link with survival time is assessed using Cox proportional hazard model. On the basis of the Link-Cox model, the authors formulate a new statistic for measuring the association of a pathway with survival time of cancer patients, referred to as pathway survival score (PSS), by summarising survival significance over all the gene links in the pathway, and devise a permutation test to test the significance of an observed PSS. To evaluate the proposed method, the authors applied it to simulation data and two publicly available real-world gene expression data sets. Extensive comparisons with previous methods show the effectiveness and efficiency of the proposed method for survival pathway hunting.

SOME PROBLEMS OF COSMICAL PHYSICS, SOLVED AND UNSOLVED.

PubMed

Rayleigh, L

1929-07-26

The Great success of theoretical investigations in recent times naturally leads enterprising spirits to use them not only in interpreting what we know or can verify by observation, but to lead us into regions where experiment is not available as a check. I believe that this does nothing but good in times like ours, when there is no danger of the doctrines even of a master being unduly pressed, if the evidence of observed fact turns against them. At the same time, we must not expect too much of pure intellect unchecked by observation. Theories that do not stand the test of time pass for the most part into complete oblivion, and we are apt to forget how appallingly large a mass of wreekage the total of them represents. The next generation remembers chiefly those that survive, and does not take full advantage of the lesson of how easy it is for an apparently inevitable conslusion to be wrong. Unless the argument carried its own verification by some accurate and previously unforeseen numerical coincidence, it is hard indeed to tell if we are on the right track.

Breast implants and breast cancer: a review of incidence, detection, mortality, and survival.

PubMed

Deapen, Dennis

2007-12-01

Soon after breast implants were commercially introduced over 30 years ago, questions about potential carcinogenicity were raised. Animal experiments dating back to the mid-twentieth century demonstrated that foreign body implantation of many materials, including silicone, can induce sarcomas. Indeed, female breast cancer incidence rates in the United States have increased substantially over that period. Of the several published studies from various countries that have formally investigated the risk of breast cancer among augmentation mammaplasty patients, none show any evidence of increased risk. In fact, most find lower than expected risk, some with statistically significant reductions. Similarly, breast cancer mortality among these patients is generally found to be below that expected of other similar women. Delayed detection of breast cancer is a concern for these patients because implants can interfere with mammography. However, using indicators such as stage at diagnosis and tumor size, current research shows that augmentation patients do not experience delayed detection. Furthermore, several comparisons of post-breast cancer survival of augmented versus nonaugmented patients have found no significant differences. In summary, breast implants are not associated with an increased risk of breast cancer incidence or death, and these patients do not experience delayed detection or poorer post-breast cancer survival.

Impact of educational differences as measure of socioeconomic status on survival for breast cancer patients.

PubMed

Nowara, Elżbieta; Suwiński, Rafał

2012-01-01

Breast cancer is the most frequent malignancy affecting women. Some reports suggest the influence of socioeconomic status, including education, on survival rates for cancer patients. This report analyzes the effect of patients' education level on their survival. A retrospective analysis of the group of 810 breast cancer patients treated in single center in Poland was performed. The analyzed group included women with elementary education (24%), vocational training (19%), secondary (38%) or higher education (16%). Overall, recurrence-free and metastasis free survival times were analyzed. The actuarial 5-year overall survival was 72% (median 4.7 years), 5-year local recurrence-free survival was 84%, whereas metastasis-free survival 76%. Multivariate Cox model has shown that lower education had independent significantly negative influence on local recurrence-free survival time (p = 0.024). The highest risk of recurrence was found for patients with elementary education (p = 0.009). The same was confirmed for distant metastasis-free survival (p = 0.001), with the highest risk of metastases in patients with vocational education and stage IIIB breast cancer (p < 0.001). Education level had significant impact on overall survival. The patients with higher-level education lived longer (p = 0.042). Shorter recurrence-free survival time among women attaining lowest education level and longer overall survival time for women with higher education level suggest the necessity for intensified cancer awareness educational effort and screening among less-educated healthy Polish women.

Story Behind the Story: Some Latter-Day Alchemists.

ERIC Educational Resources Information Center

Wotiz, John H., Ed.; Trimble, R. F.

1980-01-01

This article is a brief survey of alchemy since the chemical revolution. It shows that the reasonable expectation that alchemy could not survive the new chemistry is wrong, through a description of the work and beliefs of several prominent alchemists. (Author/DS)

Then & Now: Research Pays Off for All Americans

MedlinePlus

... summer of 1909. Daisy, left rear, and Ray, right, were the only two of the Harrisons' nine children to have survived into adulthood. U.S. Population : 90,500,000 Life Expectancy: Male – 50.5 years; Female – 53.8 years Top ...

Vibrations that live long and prosper

NASA Astrophysics Data System (ADS)

Utz, Arthur L.

2018-06-01

Molecular vibrations can be highly effective promoters of gas-phase chemistry. Now, measurements show that excited vibrational states can survive on metal surfaces far longer than expected — reshaping our understanding of how vibrational excitation might also promote or modify heterogeneously catalysed chemistry on metals.

Evaluating Intermittent Androgen-Deprivation Therapy Phase III Clinical Trials: The Devil Is in the Details.

PubMed

Hussain, Maha; Tangen, Catherine; Higano, Celestia; Vogelzang, Nicholas; Thompson, Ian

2016-01-20

Intermittent androgen deprivation (IAD) has been widely tested in prostate cancer. However, phase III trials testing continuous androgen deprivation (CAD) versus IAD have reached inconclusive and seemingly contradictory results. Different design and conduct issues must be critically evaluated to better interpret the results. Seven published phase III trials were examined for prespecified design and outcomes. Treatment specifications; primary end point; superiority versus noninferiority design assumptions, including magnitude of assumed versus observed noninferiority margin (NIM); duration of follow-up; and quality-of-life (QOL) outcomes were considered in terms of the results and conclusions reported. Five trials had a superiority and three had a noninferiority primary hypothesis. Only three trials had a uniform population and overall survival (OS) end point. All trials observed better outcomes in terms of OS and progression-free survival (PFS) than assumed at time of study design, translating into prespecified NIMs or hazard ratios that reflected larger absolute differences in OS or PFS between arms. Lower-than-expected event rates also reduced statistical power for the trials. Other factors, including length of follow-up, cause of death, QOL, and primary end point, and their impact on trial interpretation are discussed. No trial to date has demonstrated survival superiority of IAD compared with CAD. Trials concluding IAD is noninferior to CAD were based on wide NIMs that included clinically important survival differences, not likely to be considered comparable by physicians or patients. Interim analyses relying on short follow-up and including a majority of non-prostate cancer deaths will favor a noninferiority conclusion and should be interpreted cautiously. Adequate follow-up is required to ensure capture of prostate cancer deaths in both superiority and noninferiority trials. © 2015 by American Society of Clinical Oncology.

The genetics of overwintering performance in two-year old common carp and its relation to performance until market size

PubMed Central

Kause, Antti; Vandeputte, Marc; Gela, David; Allamellou, Jean-Michel; Kumar, Girish; Bestin, Anastasia; Bugeon, Jérôme; Zhao, Jinfeng; Kocour, Martin

2018-01-01

Using farmed common carp, we investigated the genetic background of the second year overwintering performance and its relation to the performance during the third growing season and at market size. The experimental stock was established by partial factorial design with a series of 4 factorial matings of 5 dams and 10 sires each. The families were reared communally and pedigree was re-constructed with 93.6% success using 12 microsatellites on 2008 offspring. Three successive recordings (second autumn, third spring, and third autumn—market size) covering two periods (second overwintering, third growing season) were included. Body weight, Fulton’s condition factor and percent muscle fat content were recorded at all times and headless carcass yield and fillet yield were recorded at market size. Specific growth rate, absolute and relative fat change and overall survival were calculated for each period. Heritability estimates were significantly different from zero and almost all traits were moderately to highly heritable (h2 = 0.36–1.00), except survival in both periods and fat change (both patterns) during overwintering (h2 = 0.12–0.15). Genetic and phenotypic correlations imply that selection against weight loss and fat loss during overwintering is expected to lead to a better winter survival, together with a positive effect on growth in the third growing season. Interestingly, higher muscle fat content was genetically correlated to lower survival in the following period (rg = -0.59; -0.53, respectively for winter and the third summer). On the other hand, higher muscle fat was also genetically linked to better slaughter yields. Moreover, selection for higher condition factor would lead to better performance during winter, growing season and at market size. PMID:29370279

Trehalose does not improve neuronal survival on exposure to alpha-synuclein pre-formed fibrils.

PubMed

Redmann, Matthew; Wani, Willayat Y; Volpicelli-Daley, Laura; Darley-Usmar, Victor; Zhang, Jianhua

2017-04-01

Parkinson's disease is a debilitating neurodegenerative disorder that is pathologically characterized by intracellular inclusions comprised primarily of alpha-synuclein (αSyn) that can also be transmitted from neuron to neuron. Several lines of evidence suggest that these inclusions cause neurodegeneration. Thus exploring strategies to improve neuronal survival in neurons with αSyn aggregates is critical. Previously, exposure to αSyn pre-formed fibrils (PFFs) has been shown to induce aggregation of endogenous αSyn resulting in cell death that is exacerbated by either starvation or inhibition of mTOR by rapamycin, both of which are able to induce autophagy, an intracellular protein degradation pathway. Since mTOR inhibition may also inhibit protein synthesis and starvation itself can be detrimental to neuronal survival, we investigated the effects of autophagy induction on neurons with αSyn inclusions by a starvation and mTOR-independent autophagy induction mechanism. We exposed mouse primary cortical neurons to PFFs to induce inclusion formation in the presence and absence of the disaccharide trehalose, which has been proposed to induce autophagy and stimulate lysosomal biogenesis. As expected, we observed that on exposure to PFFs, there was increased abundance of pS129-αSyn aggregates and cell death. Trehalose alone increased LC3-II levels, consistent with increased autophagosome levels that remained elevated with PFF exposure. Interestingly, trehalose alone increased cell viability over a 14-d time course. Trehalose was also able to restore cell viability to control levels, but PFFs still exhibited toxic effects on the cells. These data provide essential information regarding effects of trehalose on αSyn accumulation and neuronal survival on exposure to PFF. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Prognosis of bedridden patients with end-stage renal failure after starting hemodialysis.

PubMed

Sugaya, Kimio; Hokama, Asanori; Hayashi, Eiri; Naka, Hidekatsu; Oda, Masami; Nishijima, Saori; Miyazato, Minoru; Hokama, Sanehiro; Ogawa, Yoshihide

2007-06-01

The mean age of starting hemodialysis (HD) in patients with end-stage renal failure is gradually increasing in Japan. It is not uncommon for HD to be commenced in bedridden elderly patients who cannot give informed consent, because of brain damage. However, we have not been able to provide useful advice to their families because there was no relevant information available about the prognosis of bedridden patients on HD. Therefore, we examined the prognosis of bedridden HD patients. Two hundred and nineteen patients who received HD were enrolled. These subjects were divided into five groups; (aged <50, 50-59, 60-69, 70-79, and >or=80 years at the commencement of HD), and we compared the overall prognosis between bedridden and nonbedridden patients, as well as that for each age group. There were 76 bedridden patients among the 219 HD patients, and the main cause of their bedridden state before starting HD was cerebrovascular disease. The 50% survival time after the start of HD was 120 months for the nonbedridden patients versus 56 months for bedridden patients. However, the mean (+/-SD) age of the bedridden patients was higher than that of nonbedridden patients (70 +/- 13 versus 64 +/- 14 years). In patients under age 50 years at the start of dialysis, the survival rate was lower in the bedridden than in the nonbedridden patients, but there were no differences between survival rates for bedridden and nonbedridden patients in the other four age groups. The prognosis of HD patients is poor compared with the general life expectancy of the Japanese population, but whether these patients are bedridden or not has little influence on their survival.

Female reproductive success in a species with an age-inversed hierarchy.

PubMed

DE Vries, Dorien; Koenig, Andreas; Borries, Carola

2016-11-01

In most group-living mammals, reproductive success declines with increasing age and increases with increasing rank. Such effects have mainly been studied in matrilineal and in "age positive" hierarchies, which are stable and in which high ranking females often outperform low ranking ones. These relationships are less well-understood in age-inversed dominance hierarchies, in which a female's rank changes over time. We analyzed demographic data of 2 wild, unprovisioned groups of gray langurs (Semnopithecus schistaceus) near Ramnagar, Nepal covering periods of 5 years each. Female rank was unstable and age-inversed. We measured reproductive success via birth rates (57 births), infant survival (proportion of infants surviving to 2 years) and number of offspring surviving to 2 years of age (successful births) for 3 age and 3 rank classes. We found that old females performed significantly worse than expected (birth rate P = 0.04; successful births P = 0.03). The same was true for low ranking females (P = 0.04, and P < 0.01, respectively). Infant survival was highest for young and middle-aged as well as for high and middle ranking females. Overall, the results for these unstable hierarchies were rather similar to those for stable hierarchies of other mammals, particularly several nonhuman primates. Compared to a provisioned population of a closely related species, the wild and unprovisioned population examined (i) showed stronger age effects, while (ii) female reproductive success was equally affected by rank. Future comparative studies are needed to examine whether captive or provisioned populations deviate predictably from wild populations. © 2016 International Society of Zoological Sciences, Institute of Zoology/Chinese Academy of Sciences and John Wiley & Sons Australia, Ltd.

Anemia as a risk factor for chronic kidney disease.

PubMed

Iseki, K; Kohagura, K

2007-11-01

Chronic kidney disease (CKD) is an important and leading cause of end-stage renal disease (ESRD) and moreover, plays a role in the morbidity and mortality due to cardiovascular disease, infection, and cancer. Anemia develops during the early stages of CKD and is common in patients with ESRD. Anemia is an important cause of left ventricular hypertrophy and congestive heart failure. Correction of anemia by erthyropoiesis-stimulating agent (ESA) has been shown to improve survival in patients with congestive heart failure. Anemia is counted as one of the non-conventional risk factors associated with CKD. Hypoxia is one of the common mechanisms of CKD progression. Treatment by ESA is expected to improve quality of life, survival, and prevent the CKD progression. Several clinical studies have shown the beneficial effects of anemia correction on renal outcomes. However, recent prospective trials both in ESRD and in CKD stages 3 and 4 failed to confirm the beneficial effects of correcting anemia on survival. Similarly, treatment of other risk factors such as hyperlipidemia by statin showed no improvement in the survival of dialysis patients. Given the high prevalence of anemia in ESRD and untoward effects of anemia in CKD stages 3 and 4, appropriate and timely intervention on renal anemia using ESA is required for practicing nephrologists and others involved in the care of high-risk population. Lessons from the recent studies are to correct renal anemia (hemoglobin <10 g/dl not hemoglobin > or =13 g/dl). Early intervention for renal anemia is a part of the treatment option in the prevention clinic. In this study, clinical significance of anemia management in patients with CKD is discussed.

The genetics of overwintering performance in two-year old common carp and its relation to performance until market size.

PubMed

Prchal, Martin; Kause, Antti; Vandeputte, Marc; Gela, David; Allamellou, Jean-Michel; Kumar, Girish; Bestin, Anastasia; Bugeon, Jérôme; Zhao, Jinfeng; Kocour, Martin

2018-01-01

Using farmed common carp, we investigated the genetic background of the second year overwintering performance and its relation to the performance during the third growing season and at market size. The experimental stock was established by partial factorial design with a series of 4 factorial matings of 5 dams and 10 sires each. The families were reared communally and pedigree was re-constructed with 93.6% success using 12 microsatellites on 2008 offspring. Three successive recordings (second autumn, third spring, and third autumn-market size) covering two periods (second overwintering, third growing season) were included. Body weight, Fulton's condition factor and percent muscle fat content were recorded at all times and headless carcass yield and fillet yield were recorded at market size. Specific growth rate, absolute and relative fat change and overall survival were calculated for each period. Heritability estimates were significantly different from zero and almost all traits were moderately to highly heritable (h2 = 0.36-1.00), except survival in both periods and fat change (both patterns) during overwintering (h2 = 0.12-0.15). Genetic and phenotypic correlations imply that selection against weight loss and fat loss during overwintering is expected to lead to a better winter survival, together with a positive effect on growth in the third growing season. Interestingly, higher muscle fat content was genetically correlated to lower survival in the following period (rg = -0.59; -0.53, respectively for winter and the third summer). On the other hand, higher muscle fat was also genetically linked to better slaughter yields. Moreover, selection for higher condition factor would lead to better performance during winter, growing season and at market size.

Cytokines and 90Y-Radioembolization: Relation to Liver Function and Overall Survival.

PubMed

Seidensticker, Max; Powerski, Maciej; Seidensticker, Ricarda; Damm, Robert; Mohnike, Konrad; Garlipp, Benjamin; Klopffleisch, Maurice; Amthauer, Holger; Ricke, Jens; Pech, Maciej

2017-08-01

To evaluate the course of pro- and anti-inflammatory cytokines after 90 Y-radioembolization (RE) of liver malignancies and to identify prognosticators for liver-related adverse events and survival. In 34 consecutive patients with secondary or primary liver tumors scheduled for RE, the following cytokines were measured prior to and 2 h, 3 days, and 6 weeks after RE: interleukin (IL) -1, IL-2, IL-4, IL-6, IL-8, tumor necrosis factor alpha (TNF-α), and interferon-γ. Liver function impairment was defined as an elevation of liver-related laboratory values as graded by CTCAE ≥ 2 and/or serum bilirubin ≥30 µmol/l and/or development of ascites at 6-week follow-up. Significant changes over time were seen in IL-1 (increase from 0.4 pg/ml (±0.7) at baseline to 1.1 pg/ml (±1.4) 3 days after RE (p = 0.02)), and in IL-6 (increase from 16.8 pg/ml (±21.8) at baseline to 54.6 pg/ml (±78.2) 3 days after RE (p = 0.003)). Baseline values of IL-6 and IL-8 were independently associated with liver function impairment at follow-up as well as decreased survival with an optimal cutoff at 6.53 and 60.8 pg/ml, respectively. Expected changes in pro- and anti-inflammatory cytokines after RE were shown. Furthermore, baseline values of IL-6 and IL-8 were associated with later liver dysfunction and survival. We hypothesize that these biomarkers are potential prognosticators and might help in patient selection for RE.

Transurethral resection and degeneration of bladder tumour

PubMed Central

Li, Aihua; Fang, Wei; Zhang, Feng; Li, Weiwu; Lu, Honghai; Liu, Sikuan; Wang, Hui; Zhang, Binghui

2013-01-01

Introduction: We evaluate the efficacy and safety of transurethral resection and degeneration of bladder tumour (TURD-Bt). Methods: In total, 56 patients with bladder tumour were treated by TURD-Bt. The results in these patients were compared with 32 patients treated by current transurethral resection of bladder tumour (TUR-Bt). Patients with or without disease progressive factors were respectively compared between the 2 groups. The factors included recurrent tumour, multiple tumours, tumour ≥3 cm in diameter, clinical stage T2, histological grade 3, adenocarcinoma, and ureteral obstruction or hydronephrosis. Results: Follow-up time was 48.55 ± 23.74 months in TURD-Bt group and 56.28 ± 17.61 months in the TUR-Bt group (p > 0.05). In patients without progressive factors, no tumour recurrence was found and overall survival was 14 (100%) in the TURD-Bt group; 3 (37.50%) patients had recurrence and overall survival was 5 (62.5%) in the TUR-Bt group. In patients with progressive factors, 8 (19.05%) patients had tumour recurrence, overall survival was 32 (76.19%) and cancer death was 3 (7.14%) in TURD-Bt group; 18 (75.00%) patients had tumour recurrence (p < 0.05), overall survival was 12 (50.00%) (p < 0.01) and cancer death was 8 (33.33%) (p < 0.05) in TUR-Bt group. No significant complication was found in TURD-Bt group. Conclusion: This study suggests that complete resection and degeneration of bladder tumour can be expected by TURD-Bt. The surgical procedure is safe and efficacious, and could be predictable and controllable before and during surgery. We would conclude that for bladder cancers without lymph node metastasis and distal metastasis, TURD-Bt could be performed to replace radical TUR-Bt and preserve the bladder. PMID:24475002

Ulnar osteosarcoma in dogs: 30 cases (1992-2008).

PubMed

Sivacolundhu, Ramesh K; Runge, Jeffrey J; Donovan, Taryn A; Barber, Lisa G; Saba, Corey F; Clifford, Craig A; de Lorimier, Louis-Philippe; Atwater, Stephen W; DiBernardi, Lisa; Freeman, Kim P; Bergman, Philip J

2013-07-01

To examine the biological behavior of ulnar osteosarcoma and evaluate predictors of survival time in dogs. Retrospective case series. 30 dogs with primary ulnar osteosarcoma. Medical records were reviewed. Variables recorded and examined to identify predictors of survival time were signalment, tumor location in the ulna, tumor length, serum alkaline phosphatase activity, surgery type, completeness of excision, tumor stage, tumor grade, histologic subtype, development of metastases, and use of chemotherapy. 30 cases were identified from 9 institutions. Eleven dogs were treated with partial ulnar ostectomy and 14 with amputation; in 5 dogs, a resection was not performed. Twenty-two dogs received chemotherapy. Median disease-free interval and survival time were 437 and 463 days, respectively. Negative prognostic factors for survival time determined via univariate analyses were histologic subtype and development of lung metastases. Telangiectatic or telangiectatic-mixed subtype (n = 5) was the only negative prognostic factor identified via multivariate analysis (median survival time, 208 days). Dogs with telangiectatic subtype were 6.99 times as likely to die of the disease. The prognosis for ulnar osteosarcoma in this population was no worse and may have been better than the prognosis for dogs with osteosarcoma involving other appendicular sites. Partial ulnar ostectomy was associated with a low complication rate and good to excellent function and did not compromise survival time. Telangiectatic or telangiectatic-mixed histologic subtype was a negative prognostic factor for survival time. The efficacy of chemotherapy requires further evaluation.

Association of Time between Surgery and Adjuvant Therapy with Survival in Oral Cavity Cancer.

PubMed

Chen, Michelle M; Harris, Jeremy P; Orosco, Ryan K; Sirjani, Davud; Hara, Wendy; Divi, Vasu

2018-06-01

Objective The National Cancer Center Network recommends starting radiation therapy within 6 weeks after surgery for oral cavity squamous cell carcinoma (OCSCC), but there is limited evidence of the importance of the total time from surgery to completion of radiation therapy (package time). We set out to determine if there was an association between package time and survival in OCSCC and to evaluate the impact of treatment location on outcomes. Study Design Retrospective cohort study. Setting Tertiary academic medical center. Subjects and Methods We reviewed the records of patients with OCSCC who completed postoperative radiation therapy at an academic medical center from 2008 to 2016. The primary endpoints were overall survival and recurrence-free survival. Statistical analysis included χ 2 tests and Cox proportional hazards regressions. Results We identified 132 patients with an average package time of 12.6 weeks. On multivariate analysis, package time >11 weeks was independently associated with decreased overall survival (hazard ratio, 6.68; 95% CI, 1.42-31.44) and recurrence-free survival (hazard ratio, 2.94; 95% CI, 1.20-7.18). Patients who received radiation therapy at outside facilities were more likely to have treatment delays (90.2% vs 62.9%, P = .001). Conclusions Prolonged package times are associated with decreased overall and recurrence-free survival among patients with OCSCC. Patients who received radiation therapy at outside facilities are more likely to have prolonged package times.

Survival time and effect of selected predictor variables on survival in owned pet cats seropositive for feline immunodeficiency and leukemia virus attending a referral clinic in northern Italy.

PubMed

Spada, Eva; Perego, Roberta; Sgamma, Elena Assunta; Proverbio, Daniela

2018-02-01

Feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV) are among the most important feline infectious diseases worldwide. This retrospective study investigated survival times and effects of selected predictor factors on survival time in a population of owned pet cats in Northern Italy testing positive for the presence of FIV antibodies and FeLV antigen. One hundred and three retrovirus-seropositive cats, 53 FIV-seropositive cats, 40 FeLV-seropositive cats, and 10 FIV+FeLV-seropositive cats were included in the study. A population of 103 retrovirus-seronegative age and sex-matched cats was selected. Survival time was calculated and compared between retrovirus-seronegative, FIV, FeLV and FIV+FeLV-seropositive cats using Kaplan-Meier survival analysis. Cox proportional-hazards regression analysis was used to study the effect of selected predictor factors (male gender, peripheral blood cytopenia as reduced red blood cells - RBC- count, leukopenia, neutropenia and lymphopenia, hypercreatininemia and reduced albumin to globulin ratio) on survival time in retrovirus-seropositive populations. Median survival times for seronegative cats, FIV, FeLV and FIV+FeLV-seropositive cats were 3960, 2040, 714 and 77days, respectively. Compared to retrovirus-seronegative cats median survival time was significantly lower (P<0.000) in FeLV and FIV+FeLV-seropositive cats. Median survival time in FeLV and FIV+FeLV-seropositive cats was also significant lower (P<0.000) when compared to FIV-seropositive cats. Hazard ratio of death in FeLV and FIV+FeLV-seropositive cats being respectively 3.4 and 7.4 times higher, in comparison to seronegative cats and 2.3 and 4.8 times higher in FeLV and FIV+FeLV-seropositive cats as compared to FIV-seropositive cats. A Cox proportional-hazards regression analysis showed that FIV and FeLV-seropositive cats with reduced RBC counts at time of diagnosis of seropositivity had significantly shorter survival times when compared to FIV and FeLV-seropositive cats with normal RBC counts at diagnosis. In summary, FIV-seropositive status did not significantly affect longevity of cats in this study, unlike FeLV and FIV+FeLV-seropositivity. Reduced RBC counts at time of FIV and FeLV diagnosis could impact negatively on the longevity of seropositive cats and therefore blood counts should always be evaluated at diagnosis and follow-up of retrovirus-seropositive cats. Copyright © 2017 Elsevier B.V. All rights reserved.

Albumin treatment regimen for type 1 hepatorenal syndrome: a dose-response meta-analysis.

PubMed

Salerno, Francesco; Navickis, Roberta J; Wilkes, Mahlon M

2015-11-25

Recommended treatment for type 1 hepatorenal syndrome consists of albumin and vasoconstrictor. The optimal albumin dose remains poorly characterized. This meta-analysis aimed to determine the impact of albumin dose on treatment outcomes. Clinical studies of type 1 hepatorenal syndrome treatment with albumin and vasoconstrictor were sought. Search terms included: hepatorenal syndrome; albumin; vasoconstrictor; terlipressin; midodrine; octreotide; noradrenaline; and norepinephrine. A meta-analysis was performed of hepatorenal syndrome reversal and survival in relation to albumin dose. Nineteen clinical studies with 574 total patients were included, comprising 8 randomized controlled trials, 8 prospective studies and 3 retrospective studies. The pooled percentage of patients achieving hepatorenal syndrome reversal was 49.5% (95% confidence interval, 40.0-59.1%). Increments of 100 g in cumulative albumin dose were accompanied by significantly increased survival (hazard ratio, 1.15; 95% confidence interval, 1.02-1.31; p = 0.023). A non-significant increase of similar magnitude in hepatorenal syndrome reversal was also observed (odds ratio, 1.15; 95% confidence interval, 0.97-1.37; p = 0.10). Expected survival rates at 30 days among patients receiving cumulative albumin doses of 200, 400 and 600 g were 43.2% (95% confidence interval, 36.4-51.3%), 51.4% (95% confidence interval, 46.3-57.1%) and 59.0% (95% confidence interval, 51.9-67.2), respectively. Neither survival nor hepatorenal syndrome reversal was significantly affected by vasoconstrictor dose or type, treatment duration, age, baseline serum creatinine, bilirubin or albumin, baseline mean arterial pressure, or study design, size or time period. This meta-analysis suggests a dose-response relationship between infused albumin and survival in patients with type 1 hepatorenal syndrome. The meta-analysis provides the best current evidence on the potential role of albumin dose selection in improving outcomes of treatment for type 1 HRS and furnishes guidance for the design of future dose-ranging studies.

Molecular adsorbent recirculating system dialysis in patients with acute liver failure who are assessed for liver transplantation.

PubMed

Camus, Christophe; Lavoué, Sylvain; Gacouin, Arnaud; Le Tulzo, Yves; Lorho, Richard; Boudjéma, Karim; Jacquelinet, Christian; Thomas, Rémi

2006-11-01

To assess the usefulness of dialysis with the molecular adsorbent recirculating system (MARS) in patients with acute liver failure who fulfil criteria for liver transplantation. Observational cohort study. ICU at a liver transplantation centre. Twenty-two patients (23 episodes) received MARS dialysis. They were either listed for LT (n=14), delayed (n=1), or not listed (contra-indication, n=7). A total of 56 MARS treatments (median per patient 2; mean duration 7.6+/-2.6h) were performed on haemodialysis. Clinical and biological variables were assessed before and 24[Symbol: see text]h after MARS therapy. The rate of recovery of liver function without transplantation was compared with an expected rate and survival was analysed. Following MARS dialysis, we observed an improvement in the grade of hepatic encephalopathy (P=0.02) and the Glasgow coma score (P=0.02), a decrease in conjugated bilirubin (P=0.05) and INR (P=0.006), and an increase in prothrombin index (P=0.005). Overall, liver function improved in seven patients (32%): four listed patients in whom transplantation could be avoided and three patients among those not listed due to contra-indications. The transplant-free recovery rate in listed patients was 29% (vs. expected 9%, P=0.036). Listed patients (n=14) had a higher 30-day survival rate [86% (12/14) vs 38% (3/8), P=0.05] and a higher long-term survival rate (P=0.02). A statistically significant improvement of liver function was observed after MARS therapy. Transplant-free recovery was more frequent than expected. The apparent benefit of MARS dialysis to treat acute liver failure needs to be confirmed by a controlled study.

Using age-specific mortality of HIV infected persons to predict anti-retroviral treatment need: a comparative analysis of data from five African population-based cohort studies.

PubMed

Zaba, Basia; Kasamba, Ivan; Floyd, Sian; Isingo, Raphael; Herbst, Kobus; Bärnighausen, Till; Gregson, Simon; Nyamukapa, Constance; Kayuni, Ndoliwe; Todd, Jim; Marston, Milly; Wringe, Alison

2012-08-01

To present a simple method for estimating population-level anti-retroviral therapy (ART) need that does not rely on knowledge of past HIV incidence. A new approach to estimating ART need is developed based on calculating age-specific proportions of HIV-infected adults expected to die within a fixed number of years in the absence of treatment. Mortality data for HIV-infected adults in the pre-treatment era from five African HIV cohort studies were combined to construct a life table, starting at age 15, smoothed with a Weibull model. Assuming that ART should be made available to anyone expected to die within 3 years, conditional 3-year survival probabilities were computed to represent proportions needing ART. The build-up of ART need in a successful programme continuously recruiting infected adults into treatment as they age to within 3 years of expected death was represented by annually extending the conditional survival range. The Weibull model: survival probability in the infected state from age 15 = exp(-0.0073 × (age - 15)(1.69)) fitted the pooled age-specific mortality data very closely. Initial treatment need for infected persons increased rapidly with age, from 15% at age 20-24 to 32% at age 40-44 and 42% at age 60-64. Overall need in the treatment of naïve population was 24%, doubling within 5 years in a programme continually recruiting patients entering the high-risk period for dying. A reasonable projection of treatment need in an ART naive population can be made based on the age and gender profile of HIV-infected people. © 2012 Blackwell Publishing Ltd.

Causes of death and expected years of life lost among treated opioid-dependent individuals in the United States and Taiwan

PubMed Central

Chang, Kun-Chia; Wang, Jung-Der; Saxon, Andrew; Matthews, Abigail G.; Woody, George; Hser, Yih-Ing

2017-01-01

Aims This study compared the cause-specific standardized mortality ratios (SMRs) and expected years of life lost (EYLL) among opioid-dependent individuals in the United States and Taiwan. Methods Survival data came from two cohorts followed until 2014: The U.S. data were based on a randomized trial of 1,267 opioid-dependent participants enrolled between 2006 and 2009; the Taiwan data were from a study of 983 individuals that began in 2006, when opioid agonist treatment (OAT) was implemented in Taiwan. SMRs were calculated for each national cohort and compared. Kaplan-Meier estimation was performed on the survival data, then lifespans were extrapolated to 70 years (840 months) to estimate life expectancy using a semi-parametric method. EYLLs for both cohorts were estimated by subtracting their life expectancies from the age- and gender-matched referents within the general population of their respective country. Results Compared with age- and gender- matched referents, the SMRs were 3.2 for the U.S. sample and 7.8 for the Taiwan sample; the EYLLs were 7.7 and 16.4 years, respectively. Half of decedents died of unnatural causes in both cohorts; overdose deaths predominated in the U.S. and suicide in Taiwan. Conclusions Our study identified differences by country in EYLL and causes of deaths. These findings suggest that intervention strategies to reduce mortality risk by overdose (particularly in the U.S.) and suicide (particularly in Taiwan) are urgently needed in these countries. PMID:28160734

Growth Patterns of Fetal Lung Volumes in Healthy Fetuses and Fetuses With Isolated Left-Sided Congenital Diaphragmatic Hernia.

PubMed

Ruano, Rodrigo; Britto, Ingrid Schwach Werneck; Sananes, Nicolas; Lee, Wesley; Sangi-Haghpeykar, Haleh; Deter, Russell L

2016-06-01

To evaluate fetal lung growth using 3-dimensional sonography in healthy fetuses and those with congenital diaphragmatic hernia (CDH). Right and total lung volumes were serially evaluated by 3-dimensional sonography in 66 healthy fetuses and 52 fetuses with left-sided CDH between 20 and 37 weeks' menstrual age. Functions fitted to these parameters were compared for 2 groups: (1) healthy versus those with CDH; and (2) fetuses with CHD who survived versus those who died. Fetal right and total lung volumes as well as fetal observed-to-expected right and total lung volume ratios were significantly lower in fetuses with CDH than healthy fetuses (P< .001) and in those fetuses with CDH who died (P< .001). The observed-to-expected right and total lung volume ratios did not vary with menstrual age in healthy fetuses or in those with CDH (independent of outcome). Lung volume rates were lower in fetuses with left-sided CDH compared to healthy fetuses, as well as in fetuses with CDH who died compared to those who survived. The observed-to-expected right and total lung volume ratios were relatively constant throughout menstrual age in fetuses with left-sided CDH, suggesting that the origin of their lung growth abnormalities occurred before 20 weeks and did not progress. The observed-to-expected ratios may be useful in predicting the outcome in fetuses with CDH independent of menstrual age. © 2016 by the American Institute of Ultrasound in Medicine.

DELETERIOUS EFFECTS OF HIGH FAT DIETS ON SURVIVAL TIME OF X-IRRADIATED MICE

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

Ershoff, B.H.

1961-02-01

The effects of multiple sublethal doses of total body x-irradiation were determined on survival time of male mice fed either a purified fat-free ration or a similar diet supplemented with 2, 10, 20, or 30% cottonseed oil, marganine fat, or butter fat. The effects obtnined were dependent on the amount and source of dietary fat. At levels of 2 or 10% of the diet, cottonseed oil and margarine fat increased survival time over that on the fat-free ration. When these fats were fed at higher levels (i.e., 20 or 30% of the diet), however, survival time was decreased below thatmore » obtained at the lower levels of supplementation. In contrast to the results obtained with the cottonseed oil or margarine fat supplements, butter fat at levels of 2 or 10% of the diet did not prolong survival over that on the fat-free ration; nor did it decrease survival time when fed at higher levels in the diet. (auth)« less

Spatial Epidemiology and Risk Factor Analysis of White Spot Disease in the Shrimp Farming Industry of Sinaloa, Mexico, from 2005 to 2011.

PubMed

Muniesa, A; Mardones, F O; Chávez, M C; Montoya, L; Cabanillas, J A; de Blas, I; Martínez-López, B

2017-10-01

White spot disease (WSD), caused by the white spot syndrome virus, is currently one of the primary causes of mortality and economic losses in the shrimp farming industry worldwide. In Mexico, shrimp production is one of the most important primary activities generating an annual income of USD 711 million. However, WSD introduction in 1999 had a devastating impact for the Mexican shrimp industry. The aim of this study was to characterize the WSD spatio-temporal patterns and to identify the primary risk factors contributing to WSD occurrence from 2005 to 2011 in Sinaloa, Mexico. We used data collected by the 'Comité Estatal de Sanidad Acuícola de Sinaloa' from 2005 to 2011 regarding WSD outbreaks as well as environmental, production and husbandry factors at farm level. The spatio-temporal patterns of WSD were described using space-time scan statistics. The effect of 52 variables on the time to WSD outbreak occurrence was assessed using a multivariable Cox proportional hazards model. Results reveal that WSD risk and survival time were not homogeneously distributed as suggested by the significant clusters obtained using the space-time permutation model and the space-time exponential model, respectively. The Cox model revealed that the first production cycle [hazard ratio (HR) = 11.31], changes from 1 to 1.4°C of temperature oscillation caused by 'El Niño'/'La Niña' events (HR = 1.44) and high average daily growths (HR = 1.26) were significantly associated with lower survival (i.e. shorter time to WSD outbreak) on farm. Conversely, shrimp weight at the moment of the outbreak (HR = 0.159), changes from -0.9 to -0.5°C of temperature oscillation caused by 'El Niño'/'La Niña' events (HR = 0.540), high superficial water temperature during the pound stocking (HR = 0.823) and high (>100) number of days of culture (HR = 0.830) were factors associated with higher survival. Results are expected to inform the design of risk-based, intervention strategies to minimize the impact of WSD in Mexico. © 2016 Blackwell Verlag GmbH.

The HLA-matching effect in different cohorts of kidney transplant recipients: 10 years later.

PubMed

Sasaki, Nori; Idica, Adam

2010-01-01

Almost all the HLA-matching effects found by the 2000 analysis were confirmed by this study. The only HLA-matching effect found in the 2000 analysis that disappeared were those of "small matching effect" found in sub-populations of type I diabetes (PRA < 10%, donor age 20-35). The 2000 analysis found a lack of HLA matching effect in non-African American kidney transplant patients with type I diabetes between 1987 and 2000. The 2000 analysis found that a patients' ethnic group was a factor in graft survival; African American patients were found to have a significantly lower 10-year graft survival in the 5 or 6 mismatched group (27%) compared to Caucasian patients (40%). In addition, Asian patients (42%) had higher graft survival compared to that of Caucasian patients. In this study, we observe a similar pattern with death-censored graft analysis for all ethnic groups with 10-year graft survivals at 72.9% for Asians, 69.5% for Caucasians, and 49.3% for African Americans. There was an overall lack of HLA-matching effect on patient survival in the 2000 analysis. In our current analysis, the patient survivals remained virtually the same despite moderate increase in graft survival over the same period of time. The HLA-C locus mismatch was found to have additive effect to the 10-year graft survival trends observed in A and B mismatch cases. HLA-DQ mismatch on the other hand, showed limited HLA-matching effect and did not show the same additive effect as C. There are various possible issues in the DQ mismatch analysis, from the consistency of DQ typing results, lack of diversity in the DQ antigen, to the possibility of DQ mismatch having little effect on the graft survival. Utilizing kidney transplant cases performed from 1995 through 2000, the 2000 analysis projected 10-year survivals of 64% and 47% for the 0 ABDR mismatch and 5 or 6 ABDR mismatched cases respectively; the 2000 projection only missed actual death-censored survivals by 9% lower for the 0 mismatch and 17% lower for the 5 or 6 mismatch cases. Utilizing the transplant cases of 2005 through 2009, we projected their 10-year graft survivals for year 2020. The 10-year graft survival for 0 ABDR mismatched patients is expected to be over 85% and nearly 70% for 5 or 6 ABDR mismatched patients. The general upward trend of graft survival we have observed in the last 10 years has been dependent upon the development of novel transplant protocols and use of novel immunomodulatory reagents. This trend is likely to continue given the promise of new drugs and personalized healthcare. The decreasing range of the differences in the 10-year graft survival between best matched and worst matched HLA groups is also likely to continue. One interesting trend that is clearly evident is the increasing difference between the best and worst HLA-matching in terms of the associated graft half-life. The positive HLA-matching effect on long-term graft survival is clearly evident and should be taken into consideration for all kidney transplants.

Effects of ambient air temperature, humidity and rainfall on annual survival of adult little penguins Eudyptula minor in southeastern Australia

NASA Astrophysics Data System (ADS)

Ganendran, L. B.; Sidhu, L. A.; Catchpole, E. A.; Chambers, L. E.; Dann, P.

2016-08-01

Seabirds are subject to the influences of local climate variables during periods of land-based activities such as breeding and, for some species, moult; particularly if they undergo a catastrophic moult (complete simultaneous moult) as do penguins. We investigated potential relationships between adult penguin survival and land-based climate variables (ambient air temperature, humidity and rainfall) using 46 years of mark-recapture data of little penguins Eudyptula minor gathered at a breeding colony on Phillip Island in southeastern Australia. Our results showed that adult penguin survival had a stronger association with land-based climate variables during the moult period, when birds were unable to go to sea for up to 3 weeks, than during the breeding period, when birds could sacrifice breeding success in favour of survival. Annual adult survival probability was positively associated with humidity during moult and negatively associated with rainfall during moult. Prolonged heat during breeding and moult had a negative association with annual adult survival. Local climate projections suggest increasing days of high temperatures, fewer days of rainfall which will result in more droughts (and by implication, lower humidity) and more extreme rainfall events. All of these predicted climate changes are expected to have a negative impact on adult penguin survival.

Effects of ambient air temperature, humidity and rainfall on annual survival of adult little penguins Eudyptula minor in southeastern Australia.

PubMed

Ganendran, L B; Sidhu, L A; Catchpole, E A; Chambers, L E; Dann, P

2016-08-01

Seabirds are subject to the influences of local climate variables during periods of land-based activities such as breeding and, for some species, moult; particularly if they undergo a catastrophic moult (complete simultaneous moult) as do penguins. We investigated potential relationships between adult penguin survival and land-based climate variables (ambient air temperature, humidity and rainfall) using 46 years of mark-recapture data of little penguins Eudyptula minor gathered at a breeding colony on Phillip Island in southeastern Australia. Our results showed that adult penguin survival had a stronger association with land-based climate variables during the moult period, when birds were unable to go to sea for up to 3 weeks, than during the breeding period, when birds could sacrifice breeding success in favour of survival. Annual adult survival probability was positively associated with humidity during moult and negatively associated with rainfall during moult. Prolonged heat during breeding and moult had a negative association with annual adult survival. Local climate projections suggest increasing days of high temperatures, fewer days of rainfall which will result in more droughts (and by implication, lower humidity) and more extreme rainfall events. All of these predicted climate changes are expected to have a negative impact on adult penguin survival.

Women live longer than men even during severe famines and epidemics

PubMed Central

Zarulli, Virginia; Barthold Jones, Julia A.; Oksuzyan, Anna; Lindahl-Jacobsen, Rune; Christensen, Kaare; Vaupel, James W.

2018-01-01

Women in almost all modern populations live longer than men. Research to date provides evidence for both biological and social factors influencing this gender gap. Conditions when both men and women experience extremely high levels of mortality risk are unexplored sources of information. We investigate the survival of both sexes in seven populations under extreme conditions from famines, epidemics, and slavery. Women survived better than men: In all populations, they had lower mortality across almost all ages, and, with the exception of one slave population, they lived longer on average than men. Gender differences in infant mortality contributed the most to the gender gap in life expectancy, indicating that newborn girls were able to survive extreme mortality hazards better than newborn boys. Our results confirm the ubiquity of a female survival advantage even when mortality is extraordinarily high. The hypothesis that the survival advantage of women has fundamental biological underpinnings is supported by the fact that under very harsh conditions females survive better than males even at infant ages when behavioral and social differences may be minimal or favor males. Our findings also indicate that the female advantage differs across environments and is modulated by social factors. PMID:29311321

Prevalence of hypertension and type 2 diabetes mellitus in patients with colorectal cancer and their median survival time: A cohort study.

PubMed

Ahmadi, Ali; Mobasheri, Mahmoud; Hashemi-Nazari, Seyed Saeed; Baradaran, Azar; Choobini, Zahra Molavi

2014-09-01

Type 2 diabetes mellitus (DM) and hypertension are worldwide epidemic. Association between DM and colon cancer was obtained in previous studies. Prevalence of DM and hypertension in the patients with colorectal cancer (CRC) has not been reported in Iran. The present study was aimed to investigate the prevalence of hypertension and type 2 DM and their effect on median survival time in patients with CRC. Overall, 2570 individual-year follow-ups were conducted for 1127 patients with CRC. For the diagnosis of type 2 DM, fasting blood sugar test and glycosylated hemoglobin test were used and for hypertension, blood pressure was measured in two turns. The descriptive indices were calculated, and the mean and median survival from CRC diagnosis time was calculated using survival analysis and a comparison among survival times was done through log-rank test. Stata software 12 (Stata Corp. 2011. Stata Statistical Software: Release 12. College Station, TX: Stata Corp LP) was used for data analysis. The prevalence of hypertension and type 2 DM in the patients with CRC was respectively 13.38% (95% confidence interval [CI]: 11.1-15.8) and 8.69% (95% CI: 7-10.7). Median survival time in patients with hypertension and DM were 8.52 and 4.9 years. According to log-rank test, no significant difference was observed between the survival time of CRC patients suffering from hypertension and diabetes type 2. The obtained findings in this study indicate that survival time in patients with type 2 DM less than hypertension but two metabolic diseases have the same effect on survival rate of the patients with CRC. Understanding the risk factors for CRC may guide the development of strategies targeted toward its prevention.

Supply and Demand for Radiation Oncology in the United States: Updated Projections for 2015 to 2025

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

Pan, Hubert Y.; Haffty, Bruce G.; Falit, Benjamin P.

Purpose: Prior studies have forecasted demand for radiation therapy to grow 10 times faster than the supply between 2010 and 2020. We updated these projections for 2015 to 2025 to determine whether this imbalance persists and to assess the accuracy of prior projections. Methods and Materials: The demand for radiation therapy between 2015 and 2025 was estimated by combining current radiation utilization rates determined by the Surveillance, Epidemiology, and End Results data with population projections provided by the US Census Bureau. The supply of radiation oncologists was forecast by using workforce demographics and full-time equivalent (FTE) status provided by themore » American Society for Radiation Oncology (ASTRO), current resident class sizes, and expected survival per life tables from the US Centers for Disease Control. Results: Between 2015 and 2025, the annual total number of patients receiving radiation therapy during their initial treatment course is expected to increase by 19%, from 490,000 to 580,000. Assuming a graduating resident class size of 200, the number of FTE physicians is expected to increase by 27%, from 3903 to 4965. In comparison with prior projections, the new projected demand for radiation therapy in 2020 dropped by 24,000 cases (a 4% relative decline). This decrease is attributable to an overall reduction in the use of radiation to treat cancer, from 28% of all newly diagnosed cancers in the prior projections down to 26% for the new projections. By contrast, the new projected supply of radiation oncologists in 2020 increased by 275 FTEs in comparison with the prior projection for 2020 (a 7% relative increase), attributable to rising residency class sizes. Conclusion: The supply of radiation oncologists is expected to grow more quickly than the demand for radiation therapy from 2015 to 2025. Further research is needed to determine whether this is an appropriate correction or will result in excess capacity.« less

Survival analysis: Part I — analysis of time-to-event

PubMed Central

2018-01-01

Length of time is a variable often encountered during data analysis. Survival analysis provides simple, intuitive results concerning time-to-event for events of interest, which are not confined to death. This review introduces methods of analyzing time-to-event. The Kaplan-Meier survival analysis, log-rank test, and Cox proportional hazards regression modeling method are described with examples of hypothetical data. PMID:29768911

Cost and health consequences of treatment of primary biliary cirrhosis with ursodeoxycholic acid.

PubMed

Boberg, K M; Wisløff, T; Kjøllesdal, K S; Støvring, H; Kristiansen, I S

2013-10-01

Long-term use of ursodeoxycholic acid (UDCA) is the recommended therapy in primary biliary cirrhosis (PBC). The lifetime effectiveness and cost-effectiveness of UDCA in PBC have, however, not been assessed. To estimate the health outcomes and lifetime costs of a Norwegian cohort of PBC patients on UDCA. Norwegian PBC patients (n = 182) (90% females; mean age 56.3 ± 8.9 years; Mayo risk score 4.38) who were included in a 5-year open-label study of UDCA therapy were subsequently followed up for up to 11.5 years. The lifetime survival was estimated using a Weibull survival model. The survival benefit from UDCA was based on a randomised clinical trial from Canada, comparing the effect of non-UDCA and UDCA. Survival and costs of standard care vs. standard care plus UDCA were simulated in a Markov model with death and liver transplantation as major events, invoking transition of a patient's state in the model. The gain in life expectancy for a PBC patient on UDCA compared with standard care was 2.24 years (1.19 years discounted). The lifetime treatment costs were EUR 151,403 and EUR 157,741 (EUR 102,912 and EUR 115,031 discounted) for patients with and without UDCA respectively. A probabilistic sensitivity analysis indicated an 82% probability that UDCA entails both greater life expectancy and lower costs than standard care. The results of this study indicate that UDCA therapy is a dominant strategy as it confers reduced morbidity and mortality, as well as cost savings, compared with standard therapy. © 2013 John Wiley & Sons Ltd.