CpG island methylator phenotype identifies high risk patients among microsatellite stable BRAF mutated colorectal cancers.

PubMed

Vedeld, Hege Marie; Merok, Marianne; Jeanmougin, Marine; Danielsen, Stine A; Honne, Hilde; Presthus, Gro Kummeneje; Svindland, Aud; Sjo, Ole H; Hektoen, Merete; Eknaes, Mette; Nesbakken, Arild; Lothe, Ragnhild A; Lind, Guro E

2017-09-01

The prognostic value of CpG island methylator phenotype (CIMP) in colorectal cancer remains unsettled. We aimed to assess the prognostic value of this phenotype analyzing a total of 1126 tumor samples obtained from two Norwegian consecutive colorectal cancer series. CIMP status was determined by analyzing the 5-markers CAGNA1G, IGF2, NEUROG1, RUNX3 and SOCS1 by quantitative methylation specific PCR (qMSP). The effect of CIMP on time to recurrence (TTR) and overall survival (OS) were determined by uni- and multivariate analyses. Subgroup analyses were conducted according to MSI and BRAF mutation status, disease stage, and also age at time of diagnosis (<60, 60-74, ≥75 years). Patients with CIMP positive tumors demonstrated significantly shorter TTR and worse OS compared to those with CIMP negative tumors (multivariate hazard ratio [95% CI] 1.86 [1.31-2.63] and 1.89 [1.34-2.65], respectively). In stratified analyses, CIMP tumors showed significantly worse outcome among patients with microsatellite stable (MSS, P < 0.001), and MSS BRAF mutated tumors (P < 0.001), a finding that persisted in patients with stage II, III or IV disease, and that remained significant in multivariate analysis (P < 0.01). Consistent results were found for all three age groups. To conclude, CIMP is significantly associated with inferior outcome for colorectal cancer patients, and can stratify the poor prognostic patients with MSS BRAF mutated tumors. © 2017 The Authors International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.

Relationship between central and peripheral atherosclerosis and left ventricular dysfunction in a community population.

PubMed

Tsao, Connie W; Gona, Philimon; Salton, Carol; Murabito, Joanne M; Oyama, Noriko; Danias, Peter G; O'Donnell, Christopher J; Manning, Warren J; Yeon, Susan B

2011-08-01

We aimed to determine the relationships between resting left ventricular (LV) wall motion abnormalities (WMAs), aortic plaque, and peripheral artery disease (PAD) in a community cohort. A total of 1726 Framingham Heart Study Offspring Cohort participants (806 males, 65 ± 9 years) underwent cardiovascular magnetic resonance with quantification of aortic plaque volume and assessment of regional left ventricular systolic function. Claudication, lower extremity revascularization, and ankle-brachial index (ABI) were recorded at the most contemporaneous examination visit. WMAs were associated with greater aortic plaque burden, decreased ABI, and claudication in age- and sex-adjusted analyses (all p < 0.001), which were not significant after adjustment for cardiovascular risk factors. In age- and sex-adjusted analyses, both the presence (p < 0.001) and volume of aortic plaque were associated with decreased ABI (p < 0.001). After multivariable adjustment, an ABI ≤ 0.9 or prior revascularization was associated with a threefold odds of aortic plaque (p = 0.0083). Plaque volume significantly increased with decreasing ABI in multivariable-adjusted analyses (p < 0.0001). In this free-living population, associations of WMAs with aortic plaque burden and clinical measures of PAD were attenuated after adjustment for coronary heart disease risk factors. Aortic plaque volume and ABI remained strongly negatively correlated after multivariable adjustment. Our findings suggest that the association between coronary heart disease and non-coronary atherosclerosis is explained by cardiovascular risk factors. Aortic atherosclerosis and PAD remain strongly associated after multivariable adjustment, suggesting shared mechanisms beyond those captured by traditional risk factors.

Empirical study of the dependence of the results of multivariable flexible survival analyses on model selection strategy.

PubMed

Binquet, C; Abrahamowicz, M; Mahboubi, A; Jooste, V; Faivre, J; Bonithon-Kopp, C; Quantin, C

2008-12-30

Flexible survival models, which avoid assumptions about hazards proportionality (PH) or linearity of continuous covariates effects, bring the issues of model selection to a new level of complexity. Each 'candidate covariate' requires inter-dependent decisions regarding (i) its inclusion in the model, and representation of its effects on the log hazard as (ii) either constant over time or time-dependent (TD) and, for continuous covariates, (iii) either loglinear or non-loglinear (NL). Moreover, 'optimal' decisions for one covariate depend on the decisions regarding others. Thus, some efficient model-building strategy is necessary.We carried out an empirical study of the impact of the model selection strategy on the estimates obtained in flexible multivariable survival analyses of prognostic factors for mortality in 273 gastric cancer patients. We used 10 different strategies to select alternative multivariable parametric as well as spline-based models, allowing flexible modeling of non-parametric (TD and/or NL) effects. We employed 5-fold cross-validation to compare the predictive ability of alternative models.All flexible models indicated significant non-linearity and changes over time in the effect of age at diagnosis. Conventional 'parametric' models suggested the lack of period effect, whereas more flexible strategies indicated a significant NL effect. Cross-validation confirmed that flexible models predicted better mortality. The resulting differences in the 'final model' selected by various strategies had also impact on the risk prediction for individual subjects.Overall, our analyses underline (a) the importance of accounting for significant non-parametric effects of covariates and (b) the need for developing accurate model selection strategies for flexible survival analyses. Copyright 2008 John Wiley & Sons, Ltd.

A Multivariate Analysis of the Early Dropout Process

ERIC Educational Resources Information Center

Fiester, Alan R.; Rudestam, Kjell E.

1975-01-01

Principal-component factor analyses were performed on patient input (demographic and pretherapy expectations), therapist input (demographic), and patient perspective therapy process variables that significantly differentiated early dropout from nondropout outpatients at two community mental health centers. (Author)

Comparison of Xenon-Enhanced Area-Detector CT and Krypton Ventilation SPECT/CT for Assessment of Pulmonary Functional Loss and Disease Severity in Smokers.

PubMed

Ohno, Yoshiharu; Fujisawa, Yasuko; Takenaka, Daisuke; Kaminaga, Shigeo; Seki, Shinichiro; Sugihara, Naoki; Yoshikawa, Takeshi

2018-02-01

The objective of this study was to compare the capability of xenon-enhanced area-detector CT (ADCT) performed with a subtraction technique and coregistered 81m Kr-ventilation SPECT/CT for the assessment of pulmonary functional loss and disease severity in smokers. Forty-six consecutive smokers (32 men and 14 women; mean age, 67.0 years) underwent prospective unenhanced and xenon-enhanced ADCT, 81m Kr-ventilation SPECT/CT, and pulmonary function tests. Disease severity was evaluated according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification. CT-based functional lung volume (FLV), the percentage of wall area to total airway area (WA%), and ventilated FLV on xenon-enhanced ADCT and SPECT/CT were calculated for each smoker. All indexes were correlated with percentage of forced expiratory volume in 1 second (%FEV 1 ) using step-wise regression analyses, and univariate and multivariate logistic regression analyses were performed. In addition, the diagnostic accuracy of the proposed model was compared with that of each radiologic index by means of McNemar analysis. Multivariate logistic regression showed that %FEV 1 was significantly affected (r = 0.77, r 2 = 0.59) by two factors: the first factor, ventilated FLV on xenon-enhanced ADCT (p < 0.0001); and the second factor, WA% (p = 0.004). Univariate logistic regression analyses indicated that all indexes significantly affected GOLD classification (p < 0.05). Multivariate logistic regression analyses revealed that ventilated FLV on xenon-enhanced ADCT and CT-based FLV significantly influenced GOLD classification (p < 0.0001). The diagnostic accuracy of the proposed model was significantly higher than that of ventilated FLV on SPECT/CT (p = 0.03) and WA% (p = 0.008). Xenon-enhanced ADCT is more effective than 81m Kr-ventilation SPECT/CT for the assessment of pulmonary functional loss and disease severity.

Prognostic Factors Affecting Locally Recurrent Rectal Cancer and Clinical Significance of Hemoglobin

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

Rades, Dirk; Kuhn, Hildegard; Schultze, Juergen

2008-03-15

Purpose: To investigate potential prognostic factors, including hemoglobin levels before and during radiotherapy, for associations with survival and local control in patients with unirradiated locally recurrent rectal cancer. Patients and Methods: Ten potential prognostic factors were investigated in 94 patients receiving radiotherapy for recurrent rectal cancer: age ({<=}68 vs. {>=}69 years), gender, Eastern Cooperative Oncology Group performance status (0-1 vs. 2-3), American Joint Committee on Cancer (AJCC) stage ({<=}II vs. III vs. IV), grading (G1-2 vs. G3), surgery, administration of chemotherapy, radiation dose (equivalent dose in 2-Gy fractions: {<=}50 vs. >50 Gy), and hemoglobin levels before (<12 vs. {>=}12 g/dL)more » and during (majority of levels: <12 vs. {>=}12 g/dL) radiotherapy. Multivariate analyses were performed, including hemoglobin levels, either before or during radiotherapy (not both) because these are confounding variables. Results: Improved survival was associated with better performance status (p < 0.001), lower AJCC stage (p = 0.023), surgery (p = 0.011), chemotherapy (p = 0.003), and hemoglobin levels {>=}12 g/dL both before (p = 0.031) and during (p < 0.001) radiotherapy. On multivariate analyses, performance status, AJCC stage, and hemoglobin levels during radiotherapy maintained significance. Improved local control was associated with better performance status (p = 0.040), lower AJCC stage (p = 0.010), lower grading (p = 0.012), surgery (p < 0.001), chemotherapy (p < 0.001), and hemoglobin levels {>=}12 g/dL before (p < 0.001) and during (p < 0.001) radiotherapy. On multivariate analyses, chemotherapy, grading, and hemoglobin levels before and during radiotherapy remained significant. Subgroup analyses of the patients having surgery demonstrated the extent of resection to be significantly associated with local control (p = 0.011) but not with survival (p = 0.45). Conclusion: Predictors for outcome in patients who received radiotherapy for locally recurrent rectal cancer were performance status, AJCC stage, chemotherapy, surgery, extent of resection, histologic grading, and hemoglobin levels both before and during radiotherapy.« less

An Exploratory Study of Fatigue and Physical Activity in Canadian Thyroid Cancer Patients.

PubMed

Alhashemi, Ahmad; Jones, Jennifer M; Goldstein, David P; Mina, Daniel Santa; Thabane, Lehana; Sabiston, Catherine M; Chang, Eugene K; Brierley, James D; Sawka, Anna M

2017-09-01

Fatigue is common among cancer survivors, but fatigue in thyroid cancer (TC) survivors may be under-appreciated. This study investigated the severity and prevalence of moderate and severe fatigue in TC survivors. Potential predictive factors, including physical activity, were explored. A cross-sectional, written, self-administered TC patient survey and retrospective chart review were performed in an outpatient academic Endocrinology clinic in Toronto, Canada. The primary outcome measure was the global fatigue score measured by the Brief Fatigue Inventory (BFI). Physical activity was evaluated using the International Physical Activity Questionnaire-7 day (IPAQ-7). Predictors of BFI global fatigue score were explored in univariate analyses and a multivariable linear regression model. The response rate was 63.1% (205/325). Three-quarters of the respondents were women (152/205). The mean age was 52.5 years, and the mean time since first TC surgery was 6.8 years. The mean global BFI score was 3.5 (standard deviation 2.4) out of 10 (10 is worst). The prevalence of moderate-severe fatigue (global BFI score 4.1-10 out of 10) was 41.4% (84/203). Individuals who were unemployed or unable to work due to disability reported significantly higher levels of fatigue compared to the rest of the study population, in uni-and multivariable analyses. Furthermore, increased physical activity was associated with reduced fatigue in uni- and multivariable analyses. Other socio-demographic, disease, or biochemical variables were not significantly associated with fatigue in the multivariable model. Moderate or severe fatigue was reported in about 4/10 TC survivors. Independent predictors of worse fatigue included unemployment and reduced physical activity.

Multivariate analyses of peripheral blood leukocyte transcripts distinguish Alzheimer's, Parkinson's, control, and those at risk for developing Alzheimer's.

PubMed

Delvaux, Elaine; Mastroeni, Diego; Nolz, Jennifer; Chow, Nienwen; Sabbagh, Marwan; Caselli, Richard J; Reiman, Eric M; Marshall, Frederick J; Coleman, Paul D

2017-10-01

The need for a reliable, simple, and inexpensive blood test for Alzheimer's disease (AD) suitable for use in a primary care setting is widely recognized. This has led to a large number of publications describing blood tests for AD, which have, for the most part, not been replicable. We have chosen to examine transcripts expressed by the cellular, leukocyte compartment of blood. We have used hypothesis-based cDNA arrays and quantitative PCR to quantify the expression of selected sets of genes followed by multivariate analyses in multiple independent samples. Rather than a single study with no replicates, we chose an experimental design in which there were multiple replicates using different platforms and different sample populations. We have divided 177 blood samples and 27 brain samples into multiple replicates to demonstrate the ability to distinguish early clinical AD (Clinical Dementia Rating scale 0.5), Parkinson's disease (PD), and cognitively unimpaired APOE4 homozygotes, as well as to determine persons at risk for future cognitive impairment with significant accuracy. We assess our methods in a training/test set and also show that the variables we use distinguish AD, PD, and control brain. Importantly, we describe the variability of the weights assigned to individual transcripts in multivariate analyses in repeated studies and suggest that the variability we describe may be the cause of inability to repeat many earlier studies. Our data constitute a proof of principle that multivariate analysis of the transcriptome related to cell stress and inflammation of peripheral blood leukocytes has significant potential as a minimally invasive and inexpensive diagnostic tool for diagnosis and early detection of risk for AD. Copyright © 2017 Elsevier Inc. All rights reserved.

Factors associated with seasonal influenza vaccination in pregnant women.

PubMed

Henninger, Michelle L; Irving, Stephanie A; Thompson, Mark; Avalos, Lyndsay Ammon; Ball, Sarah W; Shifflett, Pat; Naleway, Allison L

2015-05-01

This observational study followed a cohort of pregnant women during the 2010-2011 influenza season to determine factors associated with vaccination. Participants were 1105 pregnant women who completed a survey assessing health beliefs related to vaccination upon enrollment and were then followed to determine vaccination status by the end of the 2010-2011 influenza season. We conducted univariate and multivariate analyses to explore factors associated with vaccination status and a factor analysis of survey items to identify health beliefs associated with vaccination. Sixty-three percent (n=701) of the participants were vaccinated. In the univariate analyses, multiple factors were associated with vaccination status, including maternal age, race, marital status, educational level, and gravidity. Factor analysis identified two health belief factors associated with vaccination: participant's positive views (factor 1) and negative views (factor 2) of influenza vaccination. In a multivariate logistic regression model, factor 1 was associated with increased likelihood of vaccination (adjusted odds ratio [aOR]=2.18; 95% confidence interval [CI]=1.72-2.78), whereas factor 2 was associated with decreased likelihood of vaccination (aOR=0.36; 95% CI=0.28-0.46). After controlling for the two health belief factors in multivariate analyses, demographic factors significant in univariate analyses were no longer significant. Women who received a provider recommendation were about three times more likely to be vaccinated (aOR=3.14; 95% CI=1.99-4.96). Pregnant women's health beliefs about vaccination appear to be more important than demographic and maternal factors previously associated with vaccination status. Provider recommendation remains one of the most critical factors influencing vaccination during pregnancy.

On measuring bird habitat: influence of observer variability and sample size

Treesearch

William M. Block; Kimberly A. With; Michael L. Morrison

1987-01-01

We studied the effects of observer variability when estimating vegetation characteristics at 75 0.04-ha bird plots. Observer estimates were significantly different for 31 of 49 variables. Multivariate analyses showed significant interobserver differences for five of the seven classes of variables studied. Variable classes included the height, number, and diameter of...

Measuring Professional Identity Development among Counselor Trainees

ERIC Educational Resources Information Center

Prosek, Elizabeth A.; Hurt, Kara M.

2014-01-01

This study examined the differences in professional identity development between novice and advanced counselor trainees (N = 161). Multivariate analyses of variance indicated significant differences between groups. Specifically, advanced counselor trainees demonstrated greater professional development compared with novice counselor trainees. No…

Gender differences in health-related quality of life of adolescents with cystic fibrosis

PubMed Central

Arrington-Sanders, Renata; Yi, Michael S; Tsevat, Joel; Wilmott, Robert W; Mrus, Joseph M; Britto, Maria T

2006-01-01

Background Female patients with cystic fibrosis (CF) have consistently poorer survival rates than males across all ages. To determine if gender differences exist in health-related quality of life (HRQOL) of adolescent patients with CF, we performed a cross-section analysis of CF patients recruited from 2 medical centers in 2 cities during 1997–2001. Methods We used the 87-item child self-report form of the Child Health Questionnaire to measure 12 health domains. Data was also collected on age and forced expiratory volume in 1 second (FEV1). We analyzed data from 98 subjects and performed univariate analyses and linear regression or ordinal logistic regression for multivariable analyses. Results The mean (SD) age was 14.6 (2.5) years; 50 (51.0%) were female; and mean FEV1 was 71.6% (25.6%) of predicted. There were no statistically significant gender differences in age or FEV1. In univariate analyses, females reported significantly poorer HRQOL in 5 of the 12 domains. In multivariable analyses controlling for FEV1 and age, we found that female gender was associated with significantly lower global health (p < 0.05), mental health (p < 0.01), and general health perceptions (p < 0.05) scores. Conclusion Further research will need to focus on the causes of these differences in HRQOL and on potential interventions to improve HRQOL of adolescent patients with CF. PMID:16433917

Biological significance of long non-coding RNA FTX expression in human colorectal cancer.

PubMed

Guo, Xiao-Bo; Hua, Zhu; Li, Chen; Peng, Li-Pan; Wang, Jing-Shen; Wang, Bo; Zhi, Qiao-Ming

2015-01-01

The purpose of this study was to determine the expression of long non-coding RNA (lncRNA) FTX and analyze its prognostic and biological significance in colorectal cancer (CRC). A quantitative reverse transcription PCR was performed to detect the expression of long non-coding RNA FTX in 35 pairs of colorectal cancer and corresponding noncancerous tissues. The expression of long non-coding RNA FTX was detected in 187 colorectal cancer tissues and its correlations with clinicopathological factors of patients were examined. Univariate and multivariate analyses were performed to analyze the prognostic significance of Long Non-coding RNA FTX expression. The effects of long non-coding RNA FTX expression on malignant phenotypes of colorectal cancer cells and its possible biological significances were further determined. Long non-coding RNA FTX was significantly upregulated in colorectal cancer tissues, and low long non-coding RNA FTX expression was significantly correlated with differentiation grade, lymph vascular invasion, and clinical stage. Patients with high long non-coding RNA FTX showed poorer overall survival than those with low long non-coding RNA FTX. Multivariate analyses indicated that status of long non-coding RNA FTX was an independent prognostic factor for patients. Functional analyses showed that upregulation of long non-coding RNA FTX significantly promoted growth, migration, invasion, and increased colony formation in colorectal cancer cells. Therefore, long non-coding RNA FTX may be a potential biomarker for predicting the survival of colorectal cancer patients and might be a molecular target for treatment of human colorectal cancer.

Multivariate two-part statistics for analysis of correlated mass spectrometry data from multiple biological specimens.

PubMed

Taylor, Sandra L; Ruhaak, L Renee; Weiss, Robert H; Kelly, Karen; Kim, Kyoungmi

2017-01-01

High through-put mass spectrometry (MS) is now being used to profile small molecular compounds across multiple biological sample types from the same subjects with the goal of leveraging information across biospecimens. Multivariate statistical methods that combine information from all biospecimens could be more powerful than the usual univariate analyses. However, missing values are common in MS data and imputation can impact between-biospecimen correlation and multivariate analysis results. We propose two multivariate two-part statistics that accommodate missing values and combine data from all biospecimens to identify differentially regulated compounds. Statistical significance is determined using a multivariate permutation null distribution. Relative to univariate tests, the multivariate procedures detected more significant compounds in three biological datasets. In a simulation study, we showed that multi-biospecimen testing procedures were more powerful than single-biospecimen methods when compounds are differentially regulated in multiple biospecimens but univariate methods can be more powerful if compounds are differentially regulated in only one biospecimen. We provide R functions to implement and illustrate our method as supplementary information CONTACT: sltaylor@ucdavis.eduSupplementary information: Supplementary data are available at Bioinformatics online. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Incorporating Single-nucleotide Polymorphisms Into the Lyman Model to Improve Prediction of Radiation Pneumonitis

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

Tucker, Susan L., E-mail: sltucker@mdanderson.org; Li Minghuan; Xu Ting

2013-01-01

Purpose: To determine whether single-nucleotide polymorphisms (SNPs) in genes associated with DNA repair, cell cycle, transforming growth factor-{beta}, tumor necrosis factor and receptor, folic acid metabolism, and angiogenesis can significantly improve the fit of the Lyman-Kutcher-Burman (LKB) normal-tissue complication probability (NTCP) model of radiation pneumonitis (RP) risk among patients with non-small cell lung cancer (NSCLC). Methods and Materials: Sixteen SNPs from 10 different genes (XRCC1, XRCC3, APEX1, MDM2, TGF{beta}, TNF{alpha}, TNFR, MTHFR, MTRR, and VEGF) were genotyped in 141 NSCLC patients treated with definitive radiation therapy, with or without chemotherapy. The LKB model was used to estimate the risk ofmore » severe (grade {>=}3) RP as a function of mean lung dose (MLD), with SNPs and patient smoking status incorporated into the model as dose-modifying factors. Multivariate analyses were performed by adding significant factors to the MLD model in a forward stepwise procedure, with significance assessed using the likelihood-ratio test. Bootstrap analyses were used to assess the reproducibility of results under variations in the data. Results: Five SNPs were selected for inclusion in the multivariate NTCP model based on MLD alone. SNPs associated with an increased risk of severe RP were in genes for TGF{beta}, VEGF, TNF{alpha}, XRCC1 and APEX1. With smoking status included in the multivariate model, the SNPs significantly associated with increased risk of RP were in genes for TGF{beta}, VEGF, and XRCC3. Bootstrap analyses selected a median of 4 SNPs per model fit, with the 6 genes listed above selected most often. Conclusions: This study provides evidence that SNPs can significantly improve the predictive ability of the Lyman MLD model. With a small number of SNPs, it was possible to distinguish cohorts with >50% risk vs <10% risk of RP when they were exposed to high MLDs.« less

Publication of statistically significant research findings in prosthodontics & implant dentistry in the context of other dental specialties.

PubMed

Papageorgiou, Spyridon N; Kloukos, Dimitrios; Petridis, Haralampos; Pandis, Nikolaos

2015-10-01

To assess the hypothesis that there is excessive reporting of statistically significant studies published in prosthodontic and implantology journals, which could indicate selective publication. The last 30 issues of 9 journals in prosthodontics and implant dentistry were hand-searched for articles with statistical analyses. The percentages of significant and non-significant results were tabulated by parameter of interest. Univariable/multivariable logistic regression analyses were applied to identify possible predictors of reporting statistically significance findings. The results of this study were compared with similar studies in dentistry with random-effects meta-analyses. From the 2323 included studies 71% of them reported statistically significant results, with the significant results ranging from 47% to 86%. Multivariable modeling identified that geographical area and involvement of statistician were predictors of statistically significant results. Compared to interventional studies, the odds that in vitro and observational studies would report statistically significant results was increased by 1.20 times (OR: 2.20, 95% CI: 1.66-2.92) and 0.35 times (OR: 1.35, 95% CI: 1.05-1.73), respectively. The probability of statistically significant results from randomized controlled trials was significantly lower compared to various study designs (difference: 30%, 95% CI: 11-49%). Likewise the probability of statistically significant results in prosthodontics and implant dentistry was lower compared to other dental specialties, but this result did not reach statistical significant (P>0.05). The majority of studies identified in the fields of prosthodontics and implant dentistry presented statistically significant results. The same trend existed in publications of other specialties in dentistry. Copyright © 2015 Elsevier Ltd. All rights reserved.

Expression of Vascular Notch Ligand Delta-Like 4 and Inflammatory Markers in Breast Cancer

PubMed Central

Jubb, Adrian M.; Soilleux, Elizabeth J.; Turley, Helen; Steers, Graham; Parker, Andrew; Low, Irene; Blades, Jennifer; Li, Ji-Liang; Allen, Paul; Leek, Russell; Noguera-Troise, Irene; Gatter, Kevin C.; Thurston, Gavin; Harris, Adrian L.

2010-01-01

Delta-like ligand 4 (Dll4) is a Notch ligand that is predominantly expressed in the endothelium. Evidence from xenografts suggests that inhibiting Dll4 may overcome resistance to antivascular endothelial growth factor therapy. The aims of this study were to characterize the expression of Dll4 in breast cancer and assess whether it is associated with inflammatory markers and prognosis. We examined 296 breast adenocarcinomas and 38 ductal carcinoma in situ tissues that were represented in tissue microarrays. Additional whole sections representing 10 breast adenocarcinomas, 10 normal breast tissues, and 16 angiosarcomas were included. Immunohistochemistry was then performed by using validated antibodies against Dll4, CD68, CD14, Dendritic Cell-Specific Intercellular adhesion molecule-3-Grabbing Non-integrin (DC-SIGN), CD123, neutrophil elastase, CD31, and carbonic anhydrase 9. Dll4 was selectively expressed by intratumoral endothelial cells in 73% to 100% of breast adenocarcinomas, 18% of in situ ductal carcinomas, and all lactating breast cases, but not normal nonlactating breast. High intensity of endothelial Dll4 expression was a statistically significant adverse prognostic factor in univariate (P = 0.002 and P = 0.01) and multivariate analyses (P = 0.03 and P = 0.04) of overall survival and relapse-free survival, respectively. Among the inflammatory markers, only CD68 and DC-SIGN were significant prognostic factors in univariate (but not multivariate) analyses of overall survival (P = 0.01 and 0.002, respectively). In summary, Dll4 was expressed by endothelium associated with breast cancer cells. In these retrospective subset analyses, endothelial Dll4 expression was a statistically significant multivariate prognostic factor. PMID:20167860

Depressive symptoms in HIV-infected and seronegative control subjects in Cameroon: Effect of age, education and gender

PubMed Central

Kanmogne, Georgette D.; Qiu, Fang; Ntone, Félicien E.; Fonsah, Julius Y.; Njamnshi, Dora M.; Kuate, Callixte T.; Doh, Roland F.; Kengne, Anne M.; Tagny, Claude T.; Nchindap, Emilienne; Kenmogne, Léopoldine; Mbanya, Dora; Cherner, Mariana; Heaton, Robert K.; Njamnshi, Alfred K.

2017-01-01

Depression is a leading cause of HIV/AIDS disease burden; it worsens health outcomes and quality of life. Addressing this problem requires accurate quantification of the extra burden of depression to HIV/AIDS in a given population, and knowledge of the baseline depression prevalence in the general population. There has been no previous study of depression in the general Cameroonian population. The current study attempts to address that important need. We used the Beck Depression Inventory-II to assess the prevalence and severity of depressive symptoms in 270 HIV-infected and seronegative Cameroonians. Univariate analyses showed a trend toward higher depressive symptoms among cases, compared to controls (p = 0.055), and among older subjects (>40 years), compared to younger subjects (≤40 years) (p = 0.059). Analysis of depression severity showed that 33.73% of cases had moderate-to-severe depressive symptoms, compared to 19.8% of controls (p<0.01). However, multivariable negative binomial regression analyses showed no effect of age, HIV status, CD4 levels, viral loads, ART, or opportunistic infections on the risk of depressive symptoms. Both univariate and multivariable regression analyses showed significantly higher risk of depressive symptoms among females compared to males; this was significant for both female controls and female cases. Female cases had significantly higher CD4 cell counts and lower viral loads, compared to males. Both univariate and multivariable regression analyses showed that lower education (≤10 years) was associated with increased risk of depressive symptoms. This study shows a high prevalence of depressive symptoms among seronegative controls and HIV-infected Cameroonians. Integrating care for mental disorders such as depression into primary health care and existing HIV/AIDS treatment programs in Cameroon may improve the wellbeing of the general population and could lower the HIV/AIDS burden. PMID:28231258

Depressive symptoms in HIV-infected and seronegative control subjects in Cameroon: Effect of age, education and gender.

PubMed

Kanmogne, Georgette D; Qiu, Fang; Ntone, Félicien E; Fonsah, Julius Y; Njamnshi, Dora M; Kuate, Callixte T; Doh, Roland F; Kengne, Anne M; Tagny, Claude T; Nchindap, Emilienne; Kenmogne, Léopoldine; Mbanya, Dora; Cherner, Mariana; Heaton, Robert K; Njamnshi, Alfred K

2017-01-01

Depression is a leading cause of HIV/AIDS disease burden; it worsens health outcomes and quality of life. Addressing this problem requires accurate quantification of the extra burden of depression to HIV/AIDS in a given population, and knowledge of the baseline depression prevalence in the general population. There has been no previous study of depression in the general Cameroonian population. The current study attempts to address that important need. We used the Beck Depression Inventory-II to assess the prevalence and severity of depressive symptoms in 270 HIV-infected and seronegative Cameroonians. Univariate analyses showed a trend toward higher depressive symptoms among cases, compared to controls (p = 0.055), and among older subjects (>40 years), compared to younger subjects (≤40 years) (p = 0.059). Analysis of depression severity showed that 33.73% of cases had moderate-to-severe depressive symptoms, compared to 19.8% of controls (p<0.01). However, multivariable negative binomial regression analyses showed no effect of age, HIV status, CD4 levels, viral loads, ART, or opportunistic infections on the risk of depressive symptoms. Both univariate and multivariable regression analyses showed significantly higher risk of depressive symptoms among females compared to males; this was significant for both female controls and female cases. Female cases had significantly higher CD4 cell counts and lower viral loads, compared to males. Both univariate and multivariable regression analyses showed that lower education (≤10 years) was associated with increased risk of depressive symptoms. This study shows a high prevalence of depressive symptoms among seronegative controls and HIV-infected Cameroonians. Integrating care for mental disorders such as depression into primary health care and existing HIV/AIDS treatment programs in Cameroon may improve the wellbeing of the general population and could lower the HIV/AIDS burden.

Does speed matter? The impact of operative time on outcome in laparoscopic surgery

PubMed Central

Jackson, Timothy D.; Wannares, Jeffrey J.; Lancaster, R. Todd; Rattner, David W.

2012-01-01

Introduction Controversy exists concerning the importance of operative time on patient outcomes. It is unclear whether faster is better or haste makes waste or similarly whether slower procedures represent a safe, meticulous approach or inexperienced dawdling. The objective of the present study was to determine the effect of operative time on 30-day outcomes in laparoscopic surgery. Methods Patients who underwent laparoscopic general surgery procedures (colectomy, cholecystectomy, Nissen fundoplication, inguinal hernia, and gastric bypass) from the ACS-NSQIP 2005–2008 participant use file were identified. Exclusion criteria were defined a priori to identify same-day admission, elective procedures. Operative time was divided into deciles and summary statistics were analyzed. Univariate analyses using a Cochran-Armitage test for trend were completed. The effect of operative time on 30-day morbidity was further analyzed for each procedure type using multivariate regression controlling for case complexity and additional patient factors. Patients within the highest deciles were excluded to reduce outlier effect. Results A total of 76,748 elective general surgical patients who underwent laparoscopic procedures were analyzed. Univariate analyses of deciles of operative time demonstrated a statistically significant trend (p \\ 0.0001) toward increasing odds of complications with increasing operative time for laparoscopic colectomy (n = 10,135), cholecystectomy (n = 37,407), Nissen fundoplication (n = 4,934), and gastric bypass (n = 17,842). The trend was not found to be significant for laparoscopic inguinal hernia repair (n = 6,430; p = 0.14). Multivariate modeling revealed the effect of operative time to remain significant after controlling for additional patient factors. Conclusion Increasing operative time was associated with increased odds of complications and, therefore, it appears that speed may matter in laparoscopic surgery. These analyses are limited in their inability to adjust for all patient factors, potential confounders, and case complexities. Additional hierarchical multivariate analyses at the surgeon level would be important to examine this relationship further. PMID:21298533

Does speed matter? The impact of operative time on outcome in laparoscopic surgery.

PubMed

Jackson, Timothy D; Wannares, Jeffrey J; Lancaster, R Todd; Rattner, David W; Hutter, Matthew M

2011-07-01

Controversy exists concerning the importance of operative time on patient outcomes. It is unclear whether faster is better or haste makes waste or similarly whether slower procedures represent a safe, meticulous approach or inexperienced dawdling. The objective of the present study was to determine the effect of operative time on 30-day outcomes in laparoscopic surgery. Patients who underwent laparoscopic general surgery procedures (colectomy, cholecystectomy, Nissen fundoplication, inguinal hernia, and gastric bypass) from the ACS-NSQIP 2005-2008 participant use file were identified. Exclusion criteria were defined a priori to identify same-day admission, elective procedures. Operative time was divided into deciles and summary statistics were analyzed. Univariate analyses using a Cochran-Armitage test for trend were completed. The effect of operative time on 30-day morbidity was further analyzed for each procedure type using multivariate regression controlling for case complexity and additional patient factors. Patients within the highest deciles were excluded to reduce outlier effect. A total of 76,748 elective general surgical patients who underwent laparoscopic procedures were analyzed. Univariate analyses of deciles of operative time demonstrated a statistically significant trend (p<0.0001) toward increasing odds of complications with increasing operative time for laparoscopic colectomy (n=10,135), cholecystectomy (n=37,407), Nissen fundoplication (n=4,934), and gastric bypass (n=17,842). The trend was not found to be significant for laparoscopic inguinal hernia repair (n=6,430; p=0.14). Multivariate modeling revealed the effect of operative time to remain significant after controlling for additional patient factors. Increasing operative time was associated with increased odds of complications and, therefore, it appears that speed may matter in laparoscopic surgery. These analyses are limited in their inability to adjust for all patient factors, potential confounders, and case complexities. Additional hierarchical multivariate analyses at the surgeon level would be important to examine this relationship further.

Comparative multivariate analyses of transient otoacoustic emissions and distorsion products in normal and impaired hearing.

PubMed

Stamate, Mirela Cristina; Todor, Nicolae; Cosgarea, Marcel

2015-01-01

The clinical utility of otoacoustic emissions as a noninvasive objective test of cochlear function has been long studied. Both transient otoacoustic emissions and distorsion products can be used to identify hearing loss, but to what extent they can be used as predictors for hearing loss is still debated. Most studies agree that multivariate analyses have better test performances than univariate analyses. The aim of the study was to determine transient otoacoustic emissions and distorsion products performance in identifying normal and impaired hearing loss, using the pure tone audiogram as a gold standard procedure and different multivariate statistical approaches. The study included 105 adult subjects with normal hearing and hearing loss who underwent the same test battery: pure-tone audiometry, tympanometry, otoacoustic emission tests. We chose to use the logistic regression as a multivariate statistical technique. Three logistic regression models were developed to characterize the relations between different risk factors (age, sex, tinnitus, demographic features, cochlear status defined by otoacoustic emissions) and hearing status defined by pure-tone audiometry. The multivariate analyses allow the calculation of the logistic score, which is a combination of the inputs, weighted by coefficients, calculated within the analyses. The accuracy of each model was assessed using receiver operating characteristics curve analysis. We used the logistic score to generate receivers operating curves and to estimate the areas under the curves in order to compare different multivariate analyses. We compared the performance of each otoacoustic emission (transient, distorsion product) using three different multivariate analyses for each ear, when multi-frequency gold standards were used. We demonstrated that all multivariate analyses provided high values of the area under the curve proving the performance of the otoacoustic emissions. Each otoacoustic emission test presented high values of area under the curve, suggesting that implementing a multivariate approach to evaluate the performances of each otoacoustic emission test would serve to increase the accuracy in identifying the normal and impaired ears. We encountered the highest area under the curve value for the combined multivariate analysis suggesting that both otoacoustic emission tests should be used in assessing hearing status. Our multivariate analyses revealed that age is a constant predictor factor of the auditory status for both ears, but the presence of tinnitus was the most important predictor for the hearing level, only for the left ear. Age presented similar coefficients, but tinnitus coefficients, by their high value, produced the highest variations of the logistic scores, only for the left ear group, thus increasing the risk of hearing loss. We did not find gender differences between ears for any otoacoustic emission tests, but studies still debate this question as the results are contradictory. Neither gender, nor environment origin had any predictive value for the hearing status, according to the results of our study. Like any other audiological test, using otoacoustic emissions to identify hearing loss is not without error. Even when applying multivariate analysis, perfect test performance is never achieved. Although most studies demonstrated the benefit of using the multivariate analysis, it has not been incorporated into clinical decisions maybe because of the idiosyncratic nature of multivariate solutions or because of the lack of the validation studies.

Comparative multivariate analyses of transient otoacoustic emissions and distorsion products in normal and impaired hearing

PubMed Central

STAMATE, MIRELA CRISTINA; TODOR, NICOLAE; COSGAREA, MARCEL

2015-01-01

Background and aim The clinical utility of otoacoustic emissions as a noninvasive objective test of cochlear function has been long studied. Both transient otoacoustic emissions and distorsion products can be used to identify hearing loss, but to what extent they can be used as predictors for hearing loss is still debated. Most studies agree that multivariate analyses have better test performances than univariate analyses. The aim of the study was to determine transient otoacoustic emissions and distorsion products performance in identifying normal and impaired hearing loss, using the pure tone audiogram as a gold standard procedure and different multivariate statistical approaches. Methods The study included 105 adult subjects with normal hearing and hearing loss who underwent the same test battery: pure-tone audiometry, tympanometry, otoacoustic emission tests. We chose to use the logistic regression as a multivariate statistical technique. Three logistic regression models were developed to characterize the relations between different risk factors (age, sex, tinnitus, demographic features, cochlear status defined by otoacoustic emissions) and hearing status defined by pure-tone audiometry. The multivariate analyses allow the calculation of the logistic score, which is a combination of the inputs, weighted by coefficients, calculated within the analyses. The accuracy of each model was assessed using receiver operating characteristics curve analysis. We used the logistic score to generate receivers operating curves and to estimate the areas under the curves in order to compare different multivariate analyses. Results We compared the performance of each otoacoustic emission (transient, distorsion product) using three different multivariate analyses for each ear, when multi-frequency gold standards were used. We demonstrated that all multivariate analyses provided high values of the area under the curve proving the performance of the otoacoustic emissions. Each otoacoustic emission test presented high values of area under the curve, suggesting that implementing a multivariate approach to evaluate the performances of each otoacoustic emission test would serve to increase the accuracy in identifying the normal and impaired ears. We encountered the highest area under the curve value for the combined multivariate analysis suggesting that both otoacoustic emission tests should be used in assessing hearing status. Our multivariate analyses revealed that age is a constant predictor factor of the auditory status for both ears, but the presence of tinnitus was the most important predictor for the hearing level, only for the left ear. Age presented similar coefficients, but tinnitus coefficients, by their high value, produced the highest variations of the logistic scores, only for the left ear group, thus increasing the risk of hearing loss. We did not find gender differences between ears for any otoacoustic emission tests, but studies still debate this question as the results are contradictory. Neither gender, nor environment origin had any predictive value for the hearing status, according to the results of our study. Conclusion Like any other audiological test, using otoacoustic emissions to identify hearing loss is not without error. Even when applying multivariate analysis, perfect test performance is never achieved. Although most studies demonstrated the benefit of using the multivariate analysis, it has not been incorporated into clinical decisions maybe because of the idiosyncratic nature of multivariate solutions or because of the lack of the validation studies. PMID:26733749

EVENT-LEVEL ANALYSIS OF ANAL SEX ROLES AND SEX DRUG USE AMONG GAY AND BISEXUAL MEN IN VANCOUVER, BRITISH COLUMBIA, CANADA

PubMed Central

Rich, Ashleigh J; Lachowsky, Nathan J; Cui, Zishan; Sereda, Paul; Lal, Allan; Moore, David M; Hogg, Robert S; Roth, Eric A

2015-01-01

This study analyzed event-level partnership data from a computer-assisted survey of 719 gay and bisexual men (GBM) enrolled in the Momentum Health Study to delineate potential linkages between anal sex roles and so-called “sex drugs”, i.e. erectile dysfunction drugs (EDD), poppers and crystal methamphetamine. Univariable and multivariable analyses using generalized linear mixed models with logit link function with sexual encounters (n=2,514) as the unit of analysis tested four hypotheses: 1) EDD are significantly associated with insertive anal sex roles, 2) poppers are significantly associated with receptive anal sex, 3) both poppers and EDD are significantly associated with anal sexual versatility and, 4) crystal methamphetamine is significantly associated with all anal sex roles. Data for survey respondents and their sexual partners allowed testing these hypotheses for both anal sex partners in the same encounter. Multivariable results supported the first three hypotheses. Crystal methamphetamine was significantly associated with all anal sex roles in the univariable models, but not significant in any multivariable ones. Other multivariable significant variables included attending group sex events, venue where first met, and self-described sexual orientation. Results indicate that GBM sex-drug use behavior features rational decision-making strategies linked to anal sex roles. They also suggest that more research on anal sex roles, particularly versatility, is needed, and that sexual behavior research can benefit from partnership analysis. PMID:26525571

Event-Level Analysis of Anal Sex Roles and Sex Drug Use Among Gay and Bisexual Men in Vancouver, British Columbia, Canada.

PubMed

Rich, Ashleigh J; Lachowsky, Nathan J; Cui, Zishan; Sereda, Paul; Lal, Allan; Moore, David M; Hogg, Robert S; Roth, Eric A

2016-08-01

This study analyzed event-level partnership data from a computer-assisted survey of 719 gay and bisexual men (GBM) enrolled in the Momentum Health Study to delineate potential linkages between anal sex roles and the so-called "sex drugs," i.e., erectile dysfunction drugs (EDD), poppers, and crystal methamphetamine. Univariable and multivariable analyses using generalized linear mixed models with logit link function with sexual encounters (n = 2514) as the unit of analysis tested four hypotheses: (1) EDD are significantly associated with insertive anal sex roles, (2) poppers are significantly associated with receptive anal sex, (3) both poppers and EDD are significantly associated with anal sexual versatility, and (4) crystal methamphetamine is significantly associated with all anal sex roles. Data for survey respondents and their sexual partners allowed testing these hypotheses for both anal sex partners in the same encounter. Multivariable results supported the first three hypotheses. Crystal methamphetamine was significantly associated with all anal sex roles in the univariable models, but not significant in any multivariable ones. Other multivariable significant variables included attending group sex events, venue where first met, and self-described sexual orientation. Results indicate that GBM sex-drug use behavior features rational decision-making strategies linked to anal sex roles. They also suggest that more research on anal sex roles, particularly versatility, is needed, and that sexual behavior research can benefit from partnership analysis.

Collagen Triple Helix Repeat Containing-1 (CTHRC1) Expression in Oral Squamous Cell Carcinoma (OSCC): Prognostic Value and Clinico-Pathological Implications

PubMed Central

Lee, Chia Ee; Vincent-Chong, Vui King; Ramanathan, Anand; Kallarakkal, Thomas George; Karen-Ng, Lee Peng; Ghani, Wan Maria Nabillah; Rahman, Zainal Ariff Abdul; Ismail, Siti Mazlipah; Abraham, Mannil Thomas; Tay, Keng Kiong; Mustafa, Wan Mahadzir Wan; Cheong, Sok Ching; Zain, Rosnah Binti

2015-01-01

BACKGROUND: Collagen Triple Helix Repeat Containing 1 (CTHRC1) is a protein often found to be over-expressed in various types of human cancers. However, correlation between CTHRC1 expression level with clinico-pathological characteristics and prognosis in oral cancer remains unclear. Therefore, this study aimed to determine mRNA and protein expression of CTHRC1 in oral squamous cell carcinoma (OSCC) and to evaluate the clinical and prognostic impact of CTHRC1 in OSCC. METHODS: In this study, mRNA and protein expression of CTHRC1 in OSCCs were determined by quantitative PCR and immunohistochemistry, respectively. The association between CTHRC1 and clinico-pathological parameters were evaluated by univariate and multivariate binary logistic regression analyses. Correlation between CTHRC1 protein expressions with survival were analysed using Kaplan-Meier and Cox regression models. RESULTS: Current study demonstrated CTHRC1 was significantly overexpressed at the mRNA level in OSCC. Univariate analyses indicated a high-expression of CTHRC1 that was significantly associated with advanced stage pTNM staging, tumour size ≥ 4 cm and positive lymph node metastasis (LNM). However, only positive LNM remained significant after adjusting with other confounder factors in multivariate logistic regression analyses. Kaplan-Meier survival analyses and Cox model demonstrated that patients with high-expression of CTHRC1 protein were associated with poor prognosis and is an independent prognostic factor in OSCC. CONCLUSION: This study indicated that over-expression of CTHRC1 potentially as an independent predictor for positive LNM and poor prognosis in OSCC. PMID:26664254

Development and validation of prognostic models in metastatic breast cancer: a GOCS study.

PubMed

Rabinovich, M; Vallejo, C; Bianco, A; Perez, J; Machiavelli, M; Leone, B; Romero, A; Rodriguez, R; Cuevas, M; Dansky, C

1992-01-01

The significance of several prognostic factors and the magnitude of their influence on response rate and survival were assessed by means of uni- and multivariate analyses in 362 patients with stage IV (UICC) breast carcinoma receiving combination chemotherapy as first systemic treatment over an 8-year period. Univariate analyses identified performance status and prior adjuvant radiotherapy as predictors of objective regression (OR), whereas the performance status, prior chemotherapy and radiotherapy (adjuvants), white blood cells count, SGOT and SGPT levels, and metastatic pattern were significantly correlated to survival. In multivariate analyses favorable characteristics associated to OR were prior adjuvant radiotherapy, no prior chemotherapy and postmenopausal status. Regarding survival, the performance status and visceral involvement were selected by the Cox model. The predictive accuracy of the logistic and the proportional hazards models was retrospectively tested in the training sample, and prospectively in a new population of 126 patients also receiving combined chemotherapy as first treatment for metastatic breast cancer. A certain overfitting to data in the training sample was observed with the regression model for response. However, the discriminative ability of the Cox model for survival was clearly confirmed.

Exploring the facilitators and barriers to engagement in physical activity for people with multiple sclerosis.

PubMed

Kayes, Nicola M; McPherson, Kathryn M; Schluter, Philip; Taylor, Denise; Leete, Marta; Kolt, Gregory S

2011-01-01

To explore the relationship that cognitive behavioural and other previously identified variables have with physical activity engagement in people with multiple sclerosis (MS). This study adopted a cross-sectional questionnaire design. Participants were 282 individuals with MS. Outcome measures included the Physical Activity Disability Survey--Revised, Cognitive and Behavioural Responses to Symptoms Questionnaire, Barriers to Health Promoting Activities for Disabled Persons Scale, Multiple Sclerosis Self-efficacy Scale, Self-Efficacy for Chronic Diseases Scales and Chalder Fatigue Questionnaire. Multivariable stepwise regression analyses found that greater self-efficacy, greater reported mental fatigue and lower number of perceived barriers to physical activity accounted for a significant proportion of variance in physical activity behaviour, over that accounted for by illness-related variables. Although fear-avoidance beliefs accounted for a significant proportion of variance in the initial analyses, its effect was explained by other factors in the final multivariable analyses. Self-efficacy, mental fatigue and perceived barriers to physical activity are potentially modifiable variables which could be incorporated into interventions designed to improve physical activity engagement. Future research should explore whether a measurement tool tailored to capture beliefs about physical activity identified by people with MS would better predict participation in physical activity.

Is somatic comorbidity associated with more somatic symptoms, mental distress, or unhealthy lifestyle in elderly cancer survivors?

PubMed

Grov, Ellen Karine; Fosså, Sophie D; Dahl, Alv A

2009-06-01

The associations of lifestyle factors, somatic symptoms, mental distress, and somatic comorbidity in elderly cancer survivors have not been well studied. This study examines these associations among elderly cancer survivors (age >or=65 years) in a population-based sample. A cross-sectional comparative study of Norwegian elderly cancer survivors. Combining information from The Norwegian Cancer Registry, and by self-reporting, 972 elderly cancer survivors were identified, of whom 632 (65%) had somatic comorbidity and 340 did not. Elderly cancer survivors with somatic comorbidity had significantly higher BMI, more performed minimal physical activity, had more somatic symptoms, used more medication, and had more frequently seen a medical doctor than survivors without somatic comorbidity. In multivariable analyses, unhealthy lifestyle and higher somatic symptoms scores were significantly associated with cancer cases with somatic comorbidity. In univariate analyses those with somatic comorbidity were significantly older, had lower levels of education, higher proportions of BMI >or= 30, less physical activity, poorer self-rated health, higher somatic symptoms score, more mental distress, had more frequently seen a medical doctor last year, and more frequently used daily medication. Our outcome measures of lifestyle, somatic symptoms and mental distress were all significantly associated with somatic comorbidity in elderly cancer survivors, however only lifestyle and somatic symptoms were significant in multivariable analyses. In elderly cancer survivors not only cancer, but also somatic comorbidity, deserve attention. Such comorbidity is associated with unhealthy lifestyles, more somatic symptoms and mental distress which should be evaluated and eventually treated.

Biological significance of long non-coding RNA FTX expression in human colorectal cancer

PubMed Central

Guo, Xiao-Bo; Hua, Zhu; Li, Chen; Peng, Li-Pan; Wang, Jing-Shen; Wang, Bo; Zhi, Qiao-Ming

2015-01-01

The purpose of this study was to determine the expression of long non-coding RNA (lncRNA) FTX and analyze its prognostic and biological significance in colorectal cancer (CRC). A quantitative reverse transcription PCR was performed to detect the expression of long non-coding RNA FTX in 35 pairs of colorectal cancer and corresponding noncancerous tissues. The expression of long non-coding RNA FTX was detected in 187 colorectal cancer tissues and its correlations with clinicopathological factors of patients were examined. Univariate and multivariate analyses were performed to analyze the prognostic significance of Long Non-coding RNA FTX expression. The effects of long non-coding RNA FTX expression on malignant phenotypes of colorectal cancer cells and its possible biological significances were further determined. Long non-coding RNA FTX was significantly upregulated in colorectal cancer tissues, and low long non-coding RNA FTX expression was significantly correlated with differentiation grade, lymph vascular invasion, and clinical stage. Patients with high long non-coding RNA FTX showed poorer overall survival than those with low long non-coding RNA FTX. Multivariate analyses indicated that status of long non-coding RNA FTX was an independent prognostic factor for patients. Functional analyses showed that upregulation of long non-coding RNA FTX significantly promoted growth, migration, invasion, and increased colony formation in colorectal cancer cells. Therefore, long non-coding RNA FTX may be a potential biomarker for predicting the survival of colorectal cancer patients and might be a molecular target for treatment of human colorectal cancer. PMID:26629053

Reprint of: Relationship between cataract severity and socioeconomic status.

PubMed

Wesolosky, Jason D; Rudnisky, Christopher J

2015-06-01

To determine the relationship between cataract severity and socioeconomic status (SES). Retrospective, observational case series. A total of 1350 eyes underwent phacoemulsification cataract extraction by a single surgeon using an Alcon Infiniti system. Cataract severity was measured using phaco time in seconds. SES was measured using area-level aggregate census data: median income, education, proportion of common-law couples, and employment rate. Preoperative best corrected visual acuity was obtained and converted to logarithm of the minimum angle of resolution values. For patients undergoing bilateral surgery, the generalized estimating equation was used to account for the correlation between eyes. Univariate analyses were performed using simple regression, and multivariate analyses were performed to account for variables with significant relationships (p < 0.05) on univariate testing. Sensitivity analyses were performed to assess the effect of including patient age in the controlled analyses. Multivariate analyses demonstrated that cataracts were more severe when the median income was lower (p = 0.001) and the proportion of common-law couples living in a patient's community (p = 0.012) and the unemployment rate (p = 0.002) were higher. These associations persisted even when controlling for patient age. Patients of lower SES have more severe cataracts. Copyright © 2015. Published by Elsevier Inc.

Comparison of 20% sulfur hexafluoride with air for intraocular tamponade in Descemet membrane endothelial keratoplasty (DMEK).

PubMed

Botsford, Benjamin; Vedana, Gustavo; Cope, Leslie; Yiu, Samuel C; Jun, Albert S

2016-01-01

To compare the effect of 20% sulfur hexafluoride (SF6) with that of air on graft detachment rates for intraocular tamponade in Descemet membrane endothelial keratoplasty (DMEK). Forty-two eyes of patients who underwent DMEK by a single surgeon (A.S.J.) at Wilmer Eye Institute between January 2012 and 2014 were identified; 21 received air for intraocular tamponade and the next consecutive 21 received SF6. The main outcome measure was the graft detachment rate; univariate and multivariate analyses were performed. The graft detachment rate was 67% in the air group and 19% in the SF6 group (p<0.05). No complete graft detachments occurred, and all partial detachments underwent intervention with injection of intraocular air. The percentages of eyes with 20/25 or better vision were not different between the groups (67% vs. 71%). Univariate analysis showed significantly higher detachment rates with air tamponade (OR, 8.50; p<0.005) and larger donor graft size (OR, 14.96; p<0.05). Multivariate analysis with gas but not graft size included showed that gas was an independent statistically significant predictor of outcome (OR, 6.65; p<0.05). When graft size was included as a covariate, gas was no longer a statistically significant predictor of detachment but maintained OR of 7.81 (p=0.063) similar to the results of univariate and multivariate analyses without graft size. In comparison with air, graft detachment rates for intraocular tamponade in DMEK were significantly reduced by 20% SF6.

Prognostic importance of DNA ploidy in non-endometrioid, high-risk endometrial carcinomas.

PubMed

Sorbe, Bengt

2016-03-01

The present study investigated the predictive and prognostic impact of DNA ploidy together with other well-known prognostic factors in a series of non-endometrioid, high-risk endometrial carcinomas. From a complete consecutive series of 4,543 endometrial carcinomas of International Federation of Gynecology and Obstetrics (FIGO) stages I-IV, 94 serous carcinomas, 48 clear cell carcinomas and 231 carcinosarcomas were selected as a non-endometrioid, high-risk group for further studies regarding prognosis. The impact of DNA ploidy, as assessed by flow cytometry, was of particular focus. The age of the patients, FIGO stage, depth of myometrial infiltration and tumor expression of p53 were also included in the analyses (univariate and multivariate). In the complete series of cases, the recurrence rate was 37%, and the 5-year overall survival rate was 39% with no difference between the three histological subtypes. The primary cure rate (78%) was also similar for all tumor types studied. DNA ploidy was a significant predictive factor (on univariate analysis) for primary tumor cure rate, and a prognostic factor for survival rate (on univariate and multivariate analyses). The predictive and prognostic impact of DNA ploidy was higher in carcinosarcomas than in serous and clear cell carcinomas. In the majority of multivariate analyses, FIGO stage and depth of myometrial infiltration were the most important predictive (tumor recurrence) and prognostic (survival rate) factors. DNA ploidy status is a less important predictive and prognostic factor in non-endometrioid, high-risk endometrial carcinomas than in the common endometrioid carcinomas, in which FIGO and nuclear grade also are highly significant and important factors.

Analysis of risk factors for central venous port failure in cancer patients

PubMed Central

Hsieh, Ching-Chuan; Weng, Hsu-Huei; Huang, Wen-Shih; Wang, Wen-Ke; Kao, Chiung-Lun; Lu, Ming-Shian; Wang, Chia-Siu

2009-01-01

AIM: To analyze the risk factors for central port failure in cancer patients administered chemotherapy, using univariate and multivariate analyses. METHODS: A total of 1348 totally implantable venous access devices (TIVADs) were implanted into 1280 cancer patients in this cohort study. A Cox proportional hazard model was applied to analyze risk factors for failure of TIVADs. Log-rank test was used to compare actuarial survival rates. Infection, thrombosis, and surgical complication rates (χ2 test or Fisher’s exact test) were compared in relation to the risk factors. RESULTS: Increasing age, male gender and open-ended catheter use were significant risk factors reducing survival of TIVADs as determined by univariate and multivariate analyses. Hematogenous malignancy decreased the survival time of TIVADs; this reduction was not statistically significant by univariate analysis [hazard ratio (HR) = 1.336, 95% CI: 0.966-1.849, P = 0.080)]. However, it became a significant risk factor by multivariate analysis (HR = 1.499, 95% CI: 1.079-2.083, P = 0.016) when correlated with variables of age, sex and catheter type. Close-ended (Groshong) catheters had a lower thrombosis rate than open-ended catheters (2.5% vs 5%, P = 0.015). Hematogenous malignancy had higher infection rates than solid malignancy (10.5% vs 2.5%, P < 0.001). CONCLUSION: Increasing age, male gender, open-ended catheters and hematogenous malignancy were risk factors for TIVAD failure. Close-ended catheters had lower thrombosis rates and hematogenous malignancy had higher infection rates. PMID:19787834

Facilitating the Transition from Bright to Dim Environments

DTIC Science & Technology

2016-03-04

For the parametric data, a multivariate ANOVA was used in determining the systematic presence of any statistically significant performance differences...performed. All significance levels were p < 0.05, and statistical analyses were performed with the Statistical Package for Social Sciences ( SPSS ...1950. Age changes in rate and level of visual dark adaptation. Journal of Applied Physiology, 2, 407–411. Field, A. 2009. Discovering statistics

Inhalant Use, Inhalant-Use Disorders, and Antisocial Behavior: Findings From the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)*

PubMed Central

Howard, Matthew O.; Perron, Brian E.; Vaughn, Michael G.; Bender, Kimberly A.; Garland, Eric

2010-01-01

Objective: Few studies have explored the topography of antisocial behavior in a nationally representative sample of inhalant users. We examined (a) the lifetime prevalence of 20 childhood and adult antisocial behaviors in inhalant users with inhalant-use disorders (IUD+) and without IUDs (IUD−); (b) the nature and strength of associations between inhalant use, IUDs, and specific antisocial behaviors in multi-variate analyses; and (c) the relationships between inhalant use, IUDs, and antisocial behaviors in a national sample of adults with antisocial personality disorder. Method: The National Epidemiologic Survey on Alcohol and Related Conditions was a multistage national survey of 43,093 U.S. residents. Respondents completed a structured psychiatric interview. Results: IUD+ and IUD− respondents were significantly younger and more likely to be unemployed, to be male, to have never married, and to report family and personal histories of alcohol and drug problems than inhalant nonusers. Family histories of alcohol problems and personal histories of drug problems were significantly more prevalent among IUD+ respondents, compared with IUD− respondents. In bivariate analyses, IUD+ and IUD− respondents evidenced significantly higher lifetime levels of all childhood and adult antisocial behaviors than inhalant nonusers. IUD+ respondents were significantly more likely than their IUD− counterparts to report bullying behavior, starting physical fights, using dangerous weapons, physical cruelty to people, staying out all night without permission, running away, and frequent truancy in childhood, as well as greater deceitfulness, impulsivity, irritability/aggressiveness, recklessness, and irresponsibility in adulthood. Multivari-ate analyses indicated that IUD+ respondents had a significantly elevated risk for childhood and adult antisocial behaviors, compared with inhalant nonusers, with the strongest effects for using dangerous weapons, physical cruelty to animals, and physical cruelty to people. Similarly, IUD+ respondents differed significantly from their IUD− counterparts primarily across measures of interpersonal violence. Among persons with antisocial personality disorder, inhalant use and IUDs were associated with greater antisocial behavior, albeit with fewer and weaker effects. Conclusions: Respondents with IUDs had pervasively elevated levels of antisocial conduct, including diverse forms of early-onset and inter-personally violent behavior. PMID:20230717

Speed of response in ultrabrief and brief pulse width right unilateral ECT.

PubMed

Loo, Colleen K; Garfield, Joshua B B; Katalinic, Natalie; Schweitzer, Isaac; Hadzi-Pavlovic, Dusan

2013-05-01

Ultrabrief pulse width stimulation electroconvulsive therapy (ECT) results in less cognitive side-effects than brief pulse ECT, but recent work suggests that more treatment sessions may be required to achieve similar efficacy. In this retrospective analysis of subjects pooled from three research studies, time to improvement was analysed in 150 depressed subjects who received right unilateral ECT with a brief pulse width (at five times seizure threshold) or ultrabrief pulse width (at six times seizure threshold). Multivariate Cox regression analyses compared the number of treatments required for 50% reduction in depression scores (i.e. speed of response) in these two samples. The analyses controlled for clinical, demographic and treatment variables that differed between the samples or that were found to be significant predictors of speed of response in univariate analyses. In the multivariate analysis, older age predicted faster speed of response. There was a non-significant trend for faster time to 50% improvement with brief pulse ECT (p = 0.067). Remission rates were higher after brief pulse ECT than ultrabrief pulse ECT (p = 0.007) but response rates were similar. This study, the largest of its kind reported to date, suggests that fewer treatments may be needed to attain response with brief than ultrabrief pulse ECT and that remission rates are higher with brief pulse ECT. Further research with a larger randomized and blinded study is recommended.

Associations between ABO blood groups and biochemical recurrence after radical prostatectomy.

PubMed

Ohno, Yoshio; Ohori, Makoto; Nakashima, Jun; Okubo, Hidenori; Satake, Naoya; Takizawa, Issei; Hashimoto, Takeshi; Hamada, Riu; Nakagami, Yoshihiro; Yoshioka, Kunihiko; Tachibana, Masaaki

2015-01-01

Recent studies have demonstrated associations between ABO blood groups and prognosis in various types of cancers. The aim of this study was to investigate the association between ABO blood groups and biochemical recurrence (BCR) after radical prostatectomy (RP). A total of 555 patients with prostate cancer who underwent RP were included in the study. No patients received neoadjuvant and/or adjuvant therapy. The effect of ABO blood groups on BCR was examined using univariate and multivariate analyses. During the follow-up period (mean, 52.0 months), 166 patients (29.9%) experienced BCR, with a 5-year BCR-free rate of 67.3%. Although the ABO blood group was not a significantly associated with BCR in the univariate analysis, it was an independent predictor of BCR in the multivariate analysis: blood type O patients had a significantly lower risk of BCR compared to type A patients (Hazard ratio, 0.608; 95% confidence interval, 0.410-0.902; P = 0.014). Further analyses revealed that surgical margin status confounded the assessment of the association between the ABO blood group and BCR. In the analyses of patients with a negative surgical margin, the 5-year BCR-free rate in blood type O patients was a significantly higher than that in type A patients (91.2% vs. 71.0%; P = 0.026). Blood type O is significantly associated with a decreased risk of biochemical recurrence after radical prostatectomy. Further studies are needed to clarify the nature of this association.

The Decoding Toolbox (TDT): a versatile software package for multivariate analyses of functional imaging data

PubMed Central

Hebart, Martin N.; Görgen, Kai; Haynes, John-Dylan

2015-01-01

The multivariate analysis of brain signals has recently sparked a great amount of interest, yet accessible and versatile tools to carry out decoding analyses are scarce. Here we introduce The Decoding Toolbox (TDT) which represents a user-friendly, powerful and flexible package for multivariate analysis of functional brain imaging data. TDT is written in Matlab and equipped with an interface to the widely used brain data analysis package SPM. The toolbox allows running fast whole-brain analyses, region-of-interest analyses and searchlight analyses, using machine learning classifiers, pattern correlation analysis, or representational similarity analysis. It offers automatic creation and visualization of diverse cross-validation schemes, feature scaling, nested parameter selection, a variety of feature selection methods, multiclass capabilities, and pattern reconstruction from classifier weights. While basic users can implement a generic analysis in one line of code, advanced users can extend the toolbox to their needs or exploit the structure to combine it with external high-performance classification toolboxes. The toolbox comes with an example data set which can be used to try out the various analysis methods. Taken together, TDT offers a promising option for researchers who want to employ multivariate analyses of brain activity patterns. PMID:25610393

Assessing signal-to-noise in quantitative proteomics: multivariate statistical analysis in DIGE experiments.

PubMed

Friedman, David B

2012-01-01

All quantitative proteomics experiments measure variation between samples. When performing large-scale experiments that involve multiple conditions or treatments, the experimental design should include the appropriate number of individual biological replicates from each condition to enable the distinction between a relevant biological signal from technical noise. Multivariate statistical analyses, such as principal component analysis (PCA), provide a global perspective on experimental variation, thereby enabling the assessment of whether the variation describes the expected biological signal or the unanticipated technical/biological noise inherent in the system. Examples will be shown from high-resolution multivariable DIGE experiments where PCA was instrumental in demonstrating biologically significant variation as well as sample outliers, fouled samples, and overriding technical variation that would not be readily observed using standard univariate tests.

Prognostic significance of pleural lavage cytology after thoracotomy and before closure of the chest in lung cancer.

PubMed

Taniguchi, Yuji; Nakamura, Hiroshige; Miwa, Ken; Adachi, Yoshin; Fujioka, Shinji; Haruki, Tomohiro; Horie, Yasushi

2009-07-01

Some reports have described pleural lavage cytology (PLC) to be a prognostic factor for non-small cell lung cancer (NSCLC) patients. However, there have only been a few reports describing the findings both immediately after thoracotomy (PLC after thoracotomy) and before the closure of the chest (PLC before closure). From April 2002 to April 2008, both PLC after thoracotomy and PLC before closure were performed in 296 consecutive patients who underwent resections for NSCLC. PLC after thoracotomy was positive in 14 patients. The survival rate in the PLC after thoracotomy positive cases was significantly poorer than in PLC after thoracotomy negative cases (P=0.047). In contrast, there were 26 PLC before closure positive cases. The survival rate in the PLC before closure positive cases was significantly poorer than in the PLC before closure negative cases (P<0.0001). Multivariate analyses revealed that PLC after thoracotomy is not an independent prognostic factor in our study. However, PLC before closure was an independent prognostic factor based on multivariate analyses. We conclude that PLC before closure was found to be a better prognostic factor than PLC after thoracotomy for NSCLC patients.

Splenectomy Causes 10-Fold Increased Risk of Portal Venous System Thrombosis in Liver Cirrhosis Patients.

PubMed

Qi, Xingshun; Han, Guohong; Ye, Chun; Zhang, Yongguo; Dai, Junna; Peng, Ying; Deng, Han; Li, Jing; Hou, Feifei; Ning, Zheng; Zhao, Jiancheng; Zhang, Xintong; Wang, Ran; Guo, Xiaozhong

2016-07-19

BACKGROUND Portal venous system thrombosis (PVST) is a life-threatening complication of liver cirrhosis. We conducted a retrospective study to comprehensively analyze the prevalence and risk factors of PVST in liver cirrhosis. MATERIAL AND METHODS All cirrhotic patients without malignancy admitted between June 2012 and December 2013 were eligible if they underwent contrast-enhanced CT or MRI scans. Independent predictors of PVST in liver cirrhosis were calculated in multivariate analyses. Subgroup analyses were performed according to the severity of PVST (any PVST, main portal vein [MPV] thrombosis >50%, and clinically significant PVST) and splenectomy. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. RESULTS Overall, 113 cirrhotic patients were enrolled. The prevalence of PVST was 16.8% (19/113). Splenectomy (any PVST: OR=11.494, 95%CI=2.152-61.395; MPV thrombosis >50%: OR=29.987, 95%CI=3.247-276.949; clinically significant PVST: OR=40.415, 95%CI=3.895-419.295) and higher hemoglobin (any PVST: OR=0.974, 95%CI=0.953-0.996; MPV thrombosis >50%: OR=0.936, 95%CI=0.895-0.980; clinically significant PVST: OR=0.935, 95%CI=0.891-0.982) were the independent predictors of PVST. The prevalence of PVST was 13.3% (14/105) after excluding splenectomy. Higher hemoglobin was the only independent predictor of MPV thrombosis >50% (OR=0.952, 95%CI=0.909-0.997). No independent predictors of any PVST or clinically significant PVST were identified in multivariate analyses. Additionally, PVST patients who underwent splenectomy had a significantly higher proportion of clinically significant PVST but lower MELD score than those who did not undergo splenectomy. In all analyses, the in-hospital mortality was not significantly different between cirrhotic patient with and without PVST. CONCLUSIONS Splenectomy may increase by at least 10-fold the risk of PVST in liver cirrhosis independent of severity of liver dysfunction.

Splenectomy Causes 10-Fold Increased Risk of Portal Venous System Thrombosis in Liver Cirrhosis Patients

PubMed Central

Qi, Xingshun; Han, Guohong; Ye, Chun; Zhang, Yongguo; Dai, Junna; Peng, Ying; Deng, Han; Li, Jing; Hou, Feifei; Ning, Zheng; Zhao, Jiancheng; Zhang, Xintong; Wang, Ran; Guo, Xiaozhong

2016-01-01

Background Portal venous system thrombosis (PVST) is a life-threatening complication of liver cirrhosis. We conducted a retrospective study to comprehensively analyze the prevalence and risk factors of PVST in liver cirrhosis. Material/Methods All cirrhotic patients without malignancy admitted between June 2012 and December 2013 were eligible if they underwent contrast-enhanced CT or MRI scans. Independent predictors of PVST in liver cirrhosis were calculated in multivariate analyses. Subgroup analyses were performed according to the severity of PVST (any PVST, main portal vein [MPV] thrombosis >50%, and clinically significant PVST) and splenectomy. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. Results Overall, 113 cirrhotic patients were enrolled. The prevalence of PVST was 16.8% (19/113). Splenectomy (any PVST: OR=11.494, 95%CI=2.152–61.395; MPV thrombosis >50%: OR=29.987, 95%CI=3.247–276.949; clinically significant PVST: OR=40.415, 95%CI=3.895–419.295) and higher hemoglobin (any PVST: OR=0.974, 95%CI=0.953–0.996; MPV thrombosis >50%: OR=0.936, 95%CI=0.895–0.980; clinically significant PVST: OR=0.935, 95%CI=0.891–0.982) were the independent predictors of PVST. The prevalence of PVST was 13.3% (14/105) after excluding splenectomy. Higher hemoglobin was the only independent predictor of MPV thrombosis >50% (OR=0.952, 95%CI=0.909–0.997). No independent predictors of any PVST or clinically significant PVST were identified in multivariate analyses. Additionally, PVST patients who underwent splenectomy had a significantly higher proportion of clinically significant PVST but lower MELD score than those who did not undergo splenectomy. In all analyses, the in-hospital mortality was not significantly different between cirrhotic patient with and without PVST. Conclusions Splenectomy may increase by at least 10-fold the risk of PVST in liver cirrhosis independent of severity of liver dysfunction. PMID:27432511

Transmission of sporadic Creutzfeldt-Jakob disease by blood transfusion: risk factor or possible biases.

PubMed

Puopolo, Maria; Ladogana, Anna; Vetrugno, Vito; Pocchiari, Maurizio

2011-07-01

The occurrence of transfusion transmissions of variant Creutzfeldt-Jakob disease (CJD) cases has reawakened attention to the possible similar risk posed by other forms of CJD. CJD with a definite or probable diagnosis (sporadic CJD, n = 741; genetic CJD, n = 175) and no-CJD patients with definite alternative diagnosis (n = 482) with available blood transfusion history were included in the study. The risk of exposure to blood transfusion occurring more than 10 years before disease onset and for some possible confounding factors was evaluated by calculating crude odds ratios (ORs). Variables with significant ORs in univariate analyses were included in multivariate logistic regression analyses. In the univariate model, blood transfusion occurring more than 10 years before clinical onset is 4.1-fold more frequent in sporadic CJD than in other neurologic disorders. This significance is lost when the 10-year lag time was not considered. Multivariate analyses show that the risk of developing sporadic CJD after transfusion increases (OR, 5.05) after adjusting for possible confounding factors. Analysis conducted on patients with genetic CJD did not reveal any significant risk factor associated with transfusion. This is the first case-control study showing a significant risk of transfusion occurring more than 10 years before clinical onset in sporadic CJD patients. It remains questionable whether the significance of these data is biologically plausible or the consequence of biases in the design of the study, but they counterbalance previous epidemiologic negative reports that might have overestimated the assessment of blood safety in sporadic CJD. © 2010 American Association of Blood Banks.

Neurodevelopmental functioning in children with FAS, pFAS, and ARND.

PubMed

Chasnoff, Ira J; Wells, Anne M; Telford, Erin; Schmidt, Christine; Messer, Gwendolyn

2010-04-01

The purpose of this article is to compare the neurodevelopmental profiles of 78 foster and adopted children with fetal alcohol syndrome (FAS), partial FAS (pFAS), or alcohol-related neurodevelopmental disorder (ARND). Seventy-eight foster and adopted children underwent a comprehensive diagnostic evaluation. By using criteria more stringent than those required by current guidelines, the children were placed in 1 of 3 diagnostic categories: FAS, pFAS, or ARND. Each child was evaluated across the domains of neuropsychological functioning most frequently affected by prenatal exposure to alcohol. Multivariate analyses of variance were conducted to examine differences in neuropsychological functioning between the 3 diagnostic groups. Descriptive discriminant analyses were performed in follow-up to the multivariate analyses of variance. The children in the 3 diagnostic categories were similar for descriptive and child welfare variables. Children with FAS had significantly decreased mean weight, height, and head circumference. Children with FAS exhibited the most impaired level of general intelligence, significantly worse language-based memory compared with children with ARND, and significantly poorer functional communication skills than children with pFAS. On executive functioning, the FAS group of children performed significantly worse on sequencing and shift than either the pFAS or ARND groups. Children with pFAS and ARND were similar in all neurodevelopmental domains that were tested. The children who met tightly defined physical criteria for a diagnosis of FAS demonstrated significantly poorer neurodevelopmental functioning than children with pFAS and ARND. Children in these latter 2 groups were similar in all neurodevelopmental domains that were tested.

Risk factors for tube exposure as a late complication of glaucoma drainage implant surgery.

PubMed

Chaku, Meenakshi; Netland, Peter A; Ishida, Kyoko; Rhee, Douglas J

2016-01-01

The purpose of this study was to evaluate the risk factors for tube exposure after glaucoma drainage implant surgery. This was a retrospective case-controlled observational study of 64 eyes from 64 patients. Thirty-two eyes of 32 patients with tube erosion requiring surgical revision were compared with 32 matched control eyes of 32 patients. Univariate and multivariate risk factor analyses were performed. Mean age was significantly younger in the tube exposure group compared with the control group (48.2±28.1 years versus 67.3±18.0 years, respectively; P=0.003). The proportion of diabetic patients (12.5%) in the tube exposure group was significantly less (P=0.041) compared with the control group (37.5%). Comparisons of the type and position of the drainage implant were not significantly different between the two groups. The average time to tube exposure was 17.2±18.0 months after implantation of the drainage device. In both univariate and multivariate analyses, younger age (P=0.005 and P=0.027) and inflammation prior to tube exposure (P≤0.001 and P=0.004) were significant risk factors. Diabetes was a significant risk factor only in the univariate analysis (P=0.027). Younger age and inflammation were significant risk factors for tube exposure after drainage implant surgery.

The rate of country-level improvements of the infant mortality rate is mainly determined by previous history.

PubMed

Bremberg, Sven G

2016-08-01

Studies of country-level determinants of health have produced conflicting results even when the analyses have been restricted to high-income counties. Yet, most of these studies have not taken historical, country-specific developments into account. Thus, it is appropriate to separate the influence of current exposures from historical aspects. Determinants of the infant mortality rate (IMR) were studied in 28 OECD countries over the period 1990-2012. Twelve determinants were selected. They refer to the level of general resources, resources that specifically address child health and characteristics that affect knowledge dissemination, including level of trust, and a health related behaviour: the rate of female smoking. Bivariate analyses with the IMR in year 2000 as outcome and the 12 determinants produced six statistically significant models. In multivariate analyses, the rate of decrease in the IMR was investigated as outcome and a history variable (IMR in 1990) was included in the models. The history variable alone explained 95% of the variation. None of the multivariate models, with the 12 determinants included, explained significantly more variation. Taking into account the historical development of the IMR will critically affect correlations between country-level determinants and the IMR. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Employment, Work Conditions, and the Home Environment in Single-Mother Families

ERIC Educational Resources Information Center

Lleras, Christy

2008-01-01

This study investigates the impact of employment status and work conditions on the quality of the home environment provided by single mothers of preschool-age children. Multivariate analyses were conducted using data from the National Longitudinal Survey of Youth. The results indicate that employment status is not a significant predictor of the…

Sexual Revictimization in Adult Women: Examining Factors Associated with Their Childhood and Adulthood Experiences

ERIC Educational Resources Information Center

Simmel, Cassandra; Postmus, Judy L.; Lee, Inseon

2012-01-01

Using data collected from a sample of adult women (n = 234), this study examined the relationship between the experience and disclosure of childhood sexual abuse and subsequent adult sexual violence. Multivariate analyses revealed that physical force during the childhood sexual abuse experience was significant in both children's decisions to…

Housing Status and HIV Risk Behaviors among Transgender Women in Los Angeles

PubMed Central

Fletcher, Jesse B.; Kisler, Kimberly A.; Reback, Cathy J.

2014-01-01

Due to social stigma, lack of social support, and minimal legal employment opportunities, transgender women (transwomen) face elevated rates of unstable housing. This study examined the association between housing status and HIV risk behaviors among 517 transwomen encountered through street outreach. Seven variables (including sociodemographics, HIV status, housing status, and sexual partner type) were used to estimate partial associations during multivariable analyses; housing status was coded trichotomously (housed, marginally housed, and homeless) for these analyses. Results demonstrated that homeless and marginally housed transwomen engaged in significantly higher rates of illicit drug use than housed transwomen; however, marginally housed and housed transwomen engaged in significantly higher rates of illegal hormone injections than homeless transwomen. Rates of sex work were high in the sample as a whole, though sex with an exchange partner was most common among the marginally housed transwomen. Multivariate logistic regression revealed that unstable housing moderated the association between HIV status and engagement in unprotected serodiscordant anal intercourse. The marginally housed transwomen exhibited the greatest risk profile for HIV acquisition or transmission. PMID:25190499

Spectroscopy and multivariate analyses applications related to solid rocket nozzle bondline

NASA Technical Reports Server (NTRS)

Arendale, W. F.; Hatcher, Richard; Benson, Brian; Workman, Gary L.

1991-01-01

Chemical composition and molecular orientation define the properties of materials. Information related to chemical composition and molecular configuration is obtained by various forms of spectroscopy. Software algorithms developed for multivariate analyses, expert systems, and Artificial Intelligence (AI) are used to conduct repetitive operations. The techniques are believed to be of particular significance toward achieving TQM objectives. The objective was to obtain information related to the quality of the bondline in the solid rocket motor, SRM, nozzle. Hysol 934 NA, a room temperature curing epoxide resin, is used as the bonding agent. A good bond requires that the adhesive be placed on a properly prepared metal surface, the adhesives Part A and B be mixed in appropriate ratio from material within shelf life specifications. Spectroscopic data was obtained for surfaces prepared according to specifications, contaminated metal surfaces, samples of the epoxide adhesive at times that represent shelf aging from 3 months to 2 years, several mix ratio of A to B, and curing material. Temperature was found to be a significant factor. The study concentrated on pot life and mix ratio.

Multivariate Models for Normal and Binary Responses in Intervention Studies

ERIC Educational Resources Information Center

Pituch, Keenan A.; Whittaker, Tiffany A.; Chang, Wanchen

2016-01-01

Use of multivariate analysis (e.g., multivariate analysis of variance) is common when normally distributed outcomes are collected in intervention research. However, when mixed responses--a set of normal and binary outcomes--are collected, standard multivariate analyses are no longer suitable. While mixed responses are often obtained in…

Quality of life in Chronic Pancreatitis is determined by constant pain, disability/unemployment, current smoking and associated co-morbidities

PubMed Central

Machicado, Jorge D.; Amann, Stephen T; Anderson, Michelle A.; Abberbock, Judah; Sherman, Stuart; Conwell, Darwin; Cote, Gregory A.; Singh, Vikesh K.; Lewis, Michele; Alkaade, Samer; Sandhu, Bimaljit S.; Guda, Nalini M.; Muniraj, Thiruvengadam; Tang, Gong; Baillie, John; Brand, Randall; Gardner, Timothy B.; Gelrud, Andres; Forsmark, Christopher E.; Banks, Peter A.; Slivka, Adam; Wilcox, C. Mel; Whitcomb, David C.; Yadav, Dhiraj

2018-01-01

Background Chronic pancreatitis (CP) has a profound independent effect on quality of life (QOL). Our aim was to identify factors that impact the QOL in CP patients. Methods We used data on 1,024 CP patients enrolled in the three NAPS2 studies. Information on demographics, risk factors, co-morbidities, disease phenotype and treatments was obtained from responses to structured questionnaires. Physical (PCS) and mental (MCS) component summary scores generated using responses to the Short Form-12 (SF-12) survey were used to assess QOL at enrollment. Multivariable linear regression models determined independent predictors of QOL. Results Mean PCS and MCS scores were 36.7±11.7 and 42.4±12.2, respectively. Significant (p<0.05) negative impact on PCS scores in multivariable analyses was noted due to constant mild-moderate pain with episodes of severe pain or constant severe pain (10 points), constant mild-moderate pain (5.2), pain-related disability/unemployment (5.1), current smoking (2.9 points) and medical co-morbidities. Significant (p<0.05) negative impact on MCS scores was related to constant pain irrespective of severity (6.8-6.9 points), current smoking (3.9 points) and pain-related disability/unemployment (2.4 points). In women, disability/unemployment resulted in an additional reduction 3.7 point reduction in MCS score. Final multivariable models explained 27% and 18% of the variance in PCS and MCS scores, respectively. Etiology, disease duration, pancreatic morphology, diabetes, exocrine insufficiency and prior endotherapy/pancreatic surgery had no significant independent effect on QOL. Conclusion Constant pain, pain-related disability/unemployment, current smoking, and concurrent co-morbidities significantly affect the QOL in CP. Further research is needed to identify factors impacting QOL not explained by our analyses. PMID:28244497

Quality of Life in Chronic Pancreatitis is Determined by Constant Pain, Disability/Unemployment, Current Smoking, and Associated Co-Morbidities.

PubMed

Machicado, Jorge D; Amann, Stephen T; Anderson, Michelle A; Abberbock, Judah; Sherman, Stuart; Conwell, Darwin L; Cote, Gregory A; Singh, Vikesh K; Lewis, Michele D; Alkaade, Samer; Sandhu, Bimaljit S; Guda, Nalini M; Muniraj, Thiruvengadam; Tang, Gong; Baillie, John; Brand, Randall E; Gardner, Timothy B; Gelrud, Andres; Forsmark, Christopher E; Banks, Peter A; Slivka, Adam; Wilcox, C Mel; Whitcomb, David C; Yadav, Dhiraj

2017-04-01

Chronic pancreatitis (CP) has a profound independent effect on quality of life (QOL). Our aim was to identify factors that impact the QOL in CP patients. We used data on 1,024 CP patients enrolled in the three NAPS2 studies. Information on demographics, risk factors, co-morbidities, disease phenotype, and treatments was obtained from responses to structured questionnaires. Physical and mental component summary (PCS and MCS, respectively) scores generated using responses to the Short Form-12 (SF-12) survey were used to assess QOL at enrollment. Multivariable linear regression models determined independent predictors of QOL. Mean PCS and MCS scores were 36.7±11.7 and 42.4±12.2, respectively. Significant (P<0.05) negative impact on PCS scores in multivariable analyses was noted owing to constant mild-moderate pain with episodes of severe pain or constant severe pain (10 points), constant mild-moderate pain (5.2), pain-related disability/unemployment (5.1), current smoking (2.9 points), and medical co-morbidities. Significant (P<0.05) negative impact on MCS scores was related to constant pain irrespective of severity (6.8-6.9 points), current smoking (3.9 points), and pain-related disability/unemployment (2.4 points). In women, disability/unemployment resulted in an additional 3.7 point reduction in MCS score. Final multivariable models explained 27% and 18% of the variance in PCS and MCS scores, respectively. Etiology, disease duration, pancreatic morphology, diabetes, exocrine insufficiency, and prior endotherapy/pancreatic surgery had no significant independent effect on QOL. Constant pain, pain-related disability/unemployment, current smoking, and concurrent co-morbidities significantly affect the QOL in CP. Further research is needed to identify factors impacting QOL not explained by our analyses.

The classification of secondary colorectal liver cancer in human biopsy samples using angular dispersive x-ray diffraction and multivariate analysis

NASA Astrophysics Data System (ADS)

Theodorakou, Chrysoula; Farquharson, Michael J.

2009-08-01

The motivation behind this study is to assess whether angular dispersive x-ray diffraction (ADXRD) data, processed using multivariate analysis techniques, can be used for classifying secondary colorectal liver cancer tissue and normal surrounding liver tissue in human liver biopsy samples. The ADXRD profiles from a total of 60 samples of normal liver tissue and colorectal liver metastases were measured using a synchrotron radiation source. The data were analysed for 56 samples using nonlinear peak-fitting software. Four peaks were fitted to all of the ADXRD profiles, and the amplitude, area, amplitude and area ratios for three of the four peaks were calculated and used for the statistical and multivariate analysis. The statistical analysis showed that there are significant differences between all the peak-fitting parameters and ratios between the normal and the diseased tissue groups. The technique of soft independent modelling of class analogy (SIMCA) was used to classify normal liver tissue and colorectal liver metastases resulting in 67% of the normal tissue samples and 60% of the secondary colorectal liver tissue samples being classified correctly. This study has shown that the ADXRD data of normal and secondary colorectal liver cancer are statistically different and x-ray diffraction data analysed using multivariate analysis have the potential to be used as a method of tissue classification.

Relationship between hunger, adherence to antiretroviral therapy and plasma HIV RNA suppression among HIV-positive illicit drug users in a Canadian setting.

PubMed

Anema, Aranka; Kerr, Thomas; Milloy, M-J; Feng, Cindy; Montaner, Julio S G; Wood, Evan

2014-04-01

Food insecurity may be a barrier to achieving optimal HIV treatment-related outcomes among illicit drug users. This study therefore, aimed to assess the impact of severe food insecurity, or hunger, on plasma HIV RNA suppression among illicit drug users receiving antiretroviral therapy (ART). A cross-sectional Multivariate logistic regression model was used to assess the potential relationship between hunger and plasma HIV RNA suppression. A sample of n = 406 adults was derived from a community-recruited open prospective cohort of HIV-positive illicit drug users, in Vancouver, British Columbia (BC), Canada. A total of 235 (63.7%) reported "being hungry and unable to afford enough food," and 241 (59.4%) had plasma HIV RNA < 50 copies/ml. In unadjusted analyses, self-reported hunger was associated with lower odds of plasma HIV RNA suppression (Odds Ratio = 0.59, 95% confidence interval [CI]: 0.39-0.90, p = 0.015). In multivariate analyses, this association was no longer significant after controlling for socio-demographic, behavioral, and clinical characteristics, including 95% adherence (Adjusted Odds Ratio [AOR] = 0.65, 95% CI: 0.37-1.10, p = 0.105). Multivariate models stratified by 95% adherence found that the direction and magnitude of this association was not significantly altered by the adherence level. Hunger was common among illicit drug users in this setting. Although, there was an association between hunger and lower likelihood of plasma HIV RNA suppression, this did not persist in adjusted analyses. Further research is warranted to understand the social-structural, policy, and physical factors shaping the HIV outcomes of illicit drug users.

Behavioral and Psychosocial Correlates of HIV Testing Among Male Clients of Female Sex Workers in Tijuana, Mexico.

PubMed

Fleming, Paul J; Patterson, Thomas L; Chavarin, Claudia V; Semple, Shirley J; Magis-Rodriguez, Carlos; Pitpitan, Eileen V

2017-08-01

We use data collected from a sample of 400 male clients of female sex workers (FSW) to examine their HIV testing behavior. We present frequencies of HIV testing and used bivariate and multivariable analyses to assess its socio-demographic, behavioral, and psychosocial correlates. We found that the majority (55 %) of male clients of FSW in Tijuana, Mexico had never had an HIV test and the prevalence of HIV testing within the past year was low (9 %). In multivariable analyses, significant correlates of having ever tested for HIV were higher age, higher HIV knowledge score, lower sexual compulsiveness score, lower misogynistic attitudes score, having a condom break during sex with a FSW, and higher frequency of sex with a FSW while she was high. Our findings represent an important starting point for developing effective interventions to address the need to promote HIV testing among this population.

Condomless Sex Among Homeless Youth: The Role of Multidimensional Social Norms and Gender.

PubMed

Barman-Adhikari, Anamika; Hsu, Hsun-Ta; Begun, Stephanie; Portillo, Andrea Perez; Rice, Eric

2017-03-01

Most studies of condomless sex among homeless youth have focused on peer norms, while excluding other potentially pertinent influences. This study explored how different types of relationships contributed to norms about condomless sex and whether such norms were associated with engagement in condomless sex among homeless youth. Additionally, because recent work has noted gender differences in social networks of male and female homeless youth, gender differences in social network norms of condomless sex were also assessed. Egocentric network data were collected from homeless youth accessing services at two drop-in centers in Los Angeles, CA (N = 976). Multivariate analyses (non-stratified and stratified by gender) assessed associations between descriptive, injunctive, and communicative norms and participants' engagement in condomless sex. Multivariate analyses indicated that perception of peer condom use and communication with sexual partners were significantly associated with not engaging in condomless sex. These relationships, however, varied by gender. Implications for interventions are discussed.

A multivariate model of parent-adolescent relationship variables in early adolescence.

PubMed

McKinney, Cliff; Renk, Kimberly

2011-08-01

Given the importance of predicting outcomes for early adolescents, this study examines a multivariate model of parent-adolescent relationship variables, including parenting, family environment, and conflict. Participants, who completed measures assessing these variables, included 710 culturally diverse 11-14-year-olds who were attending a middle school in a Southeastern state. The parents of a subset of these adolescents (i.e., 487 mother-father pairs) participated in this study as well. Correlational analyses indicate that authoritative and authoritarian parenting, family cohesion and adaptability, and conflict are significant predictors of early adolescents' internalizing and externalizing problems. Structural equation modeling analyses indicate that fathers' parenting may not predict directly externalizing problems in male and female adolescents but instead may act through conflict. More direct relationships exist when examining mothers' parenting. The impact of parenting, family environment, and conflict on early adolescents' internalizing and externalizing problems and the importance of both gender and cross-informant ratings are emphasized.

Frequency and risk factors associated with emergency medical readmissions in Galway University Hospitals.

PubMed

Gorman, J; Vellinga, A; Gilmartin, J J; O'Keeffe, S T

2010-06-01

Unplanned readmissions of medical hospital patients have been increasing in recent years. We examined the frequency and associates of emergency medical readmissions to Galway University Hospitals (GUH). Readmissions during the calendar year 2006 were examined using hospital in-patient enquiry data. Associations with clinical and demographic factors were determined using univariate and multivariate analyses. The medical emergency readmission rate to GUH, after correction for death during the index admission, was 19.5%. Age 65 years or more, male gender, length of stay more than 7 days and primary diagnoses of chronic obstructive pulmonary disease, myocardial infarction, alcohol-related disease and heart failure during the index admission were significantly associated with readmission in univariate and multivariate analyses. The medical emergency readmission rate in GUH is comparable to other acute hospitals in Ireland and Britain. Further evaluation is needed to estimate the proportion of readmissions that are potentially avoidable.

Subtle but ubiquitous selection on body size in a natural population of collared flycatchers over 33 years.

PubMed

Björklund, M; Gustafsson, L

2017-07-01

Understanding the magnitude and long-term patterns of selection in natural populations is of importance, for example, when analysing the evolutionary impact of climate change. We estimated univariate and multivariate directional, quadratic and correlational selection on four morphological traits (adult wing, tarsus and tail length, body mass) over a time period of 33 years (≈ 19 000 observations) in a nest-box breeding population of collared flycatchers (Ficedula albicollis). In general, selection was weak in both males and females over the years regardless of fitness measure (fledged young, recruits and survival) with only few cases with statistically significant selection. When data were analysed in a multivariate context and as time series, a number of patterns emerged; there was a consistent, but weak, selection for longer wings in both sexes, selection was stronger on females when the number of fledged young was used as a fitness measure, there were no indications of sexually antagonistic selection, and we found a negative correlation between selection on tarsus and wing length in both sexes but using different fitness measures. Uni- and multivariate selection gradients were correlated only for wing length and mass. Multivariate selection gradient vectors were longer than corresponding vector of univariate gradients and had more constrained direction. Correlational selection had little importance. Overall, the fitness surface was more or less flat with few cases of significant curvature, indicating that the adaptive peak with regard to body size in this species is broader than the phenotypic distribution, which has resulted in weak estimates of selection. © 2017 European Society For Evolutionary Biology. Journal of Evolutionary Biology © 2017 European Society For Evolutionary Biology.

Utility of Intermediate-Delay Washout CT Images for Differentiation of Malignant and Benign Adrenal Lesions: A Multivariate Analysis.

PubMed

Ng, Chaan S; Altinmakas, Emre; Wei, Wei; Ghosh, Payel; Li, Xiao; Grubbs, Elizabeth G; Perrier, Nancy D; Lee, Jeffrey E; Prieto, Victor G; Hobbs, Brian P

2018-06-27

The objective of this study was to identify features that impact the diagnostic performance of intermediate-delay washout CT for distinguishing malignant from benign adrenal lesions. This retrospective study evaluated 127 pathologically proven adrenal lesions (82 malignant, 45 benign) in 126 patients who had undergone portal venous phase and intermediate-delay washout CT (1-3 minutes after portal venous phase) with or without unenhanced images. Unenhanced images were available for 103 lesions. Quantitatively, lesion CT attenuation on unenhanced (UA) and delayed (DL) images, absolute and relative percentage of enhancement washout (APEW and RPEW, respectively), descriptive CT features (lesion size, margin characteristics, heterogeneity or homogeneity, fat, calcification), patient demographics, and medical history were evaluated for association with lesion status using multiple logistic regression with stepwise model selection. Area under the ROC curve (A z ) was calculated from both univariate and multivariate analyses. The predictive diagnostic performance of multivariate evaluations was ascertained through cross-validation. A z for DL, APEW, RPEW, and UA was 0.751, 0.795, 0.829, and 0.839, respectively. Multivariate analyses yielded the following significant CT quantitative features and associated A z when combined: RPEW and DL (A z = 0.861) when unenhanced images were not available and APEW and UA (A z = 0.889) when unenhanced images were available. Patient demographics and presence of a prior malignancy were additional significant factors, increasing A z to 0.903 and 0.927, respectively. The combined predictive classifier, without and with UA available, yielded 85.7% and 87.3% accuracies with cross-validation, respectively. When appropriately combined with other CT features, washout derived from intermediate-delay CT with or without additional clinical data has potential utility in differentiating malignant from benign adrenal lesions.

The degree of circumferential tumour involvement as a prognostic factor in oesophageal cancer.

PubMed

Sillah, Karim; Pritchard, Susan A; Watkins, Gillian R; McShane, James; West, Catharine M; Page, Richard; Welch, Ian M

2009-08-01

Tumour length is an adverse prognostic factor in oesophageal cancer. However, the prognostic role of the degree of oesophageal circumference (DOC) involved by tumour with or without resection margin invasion is not clear. This work assessed the relationship between DOC involved by tumour, clinico-pathological variables and prognosis. The clinico-pathological details of 320 patients who underwent potentially curative oesophagogastrectomy for cancer between 1994 and 2007 were analysed. The DOC involved with tumour measured macroscopically on the resected specimen was classified as small (<2.5 cm, n = 115), large (> or = 2.5 cm, n = 144) or circumferential (i.e. involving the whole circumference, n = 61). Univariate and multivariate survival analyses were carried out. The DOC with tumour was higher in ulcerating tumours than stenosing or polypoidal types (p = 0.017). Tumour length, T-stage, neoadjuvant chemotherapy and vascular invasion were independently associated with DOC with tumour on multivariate analysis (p < 0.05 for all). DOC > or = 2.5 cm was an adverse prognostic factor in univariate analysis (p = 0.002) with a hazard ratio of 1.52 [95% CI 1.13-2.04] compared with those <2.5 cm. Circumferential tumours had a similar prognosis to tumours > or = 2.5 cm (p = 0.60). The prognostic significance of DOC with tumour was lost in multivariate analysis where the factors retaining independence were patient age, T-stage, lymph node metastasis, vascular invasion and positive resection margins. However, when patients were stratified by use of neoadjuvant chemotherapy (n = 121), the DOC with tumour retained prognostic significance on multivariate analysis in the 199 patients who did not undergo neoadjuvant chemotherapy (p = 0.04). The DOC with tumour appears to provide prognostic information in oesophageal cancer surgery, especially in patients who do not undergo preoperative chemotherapy.

Racial Differences in Circulating Natriuretic Peptide Levels: The Atherosclerosis Risk in Communities Study

PubMed Central

Gupta, Deepak K; Claggett, Brian; Wells, Quinn; Cheng, Susan; Li, Man; Maruthur, Nisa; Selvin, Elizabeth; Coresh, Josef; Konety, Suma; Butler, Kenneth R; Mosley, Thomas; Boerwinkle, Eric; Hoogeveen, Ron; Ballantyne, Christie M; Solomon, Scott D

2015-01-01

Background Natriuretic peptides promote natriuresis, diuresis, and vasodilation. Experimental deficiency of natriuretic peptides leads to hypertension (HTN) and cardiac hypertrophy, conditions more common among African Americans. Hospital-based studies suggest that African Americans may have reduced circulating natriuretic peptides, as compared to Caucasians, but definitive data from community-based cohorts are lacking. Methods and Results We examined plasma N-terminal pro B-type natriuretic peptide (NTproBNP) levels according to race in 9137 Atherosclerosis Risk in Communities (ARIC) Study participants (22% African American) without prevalent cardiovascular disease at visit 4 (1996–1998). Multivariable linear and logistic regression analyses were performed adjusting for clinical covariates. Among African Americans, percent European ancestry was determined from genetic ancestry informative markers and then examined in relation to NTproBNP levels in multivariable linear regression analysis. NTproBNP levels were significantly lower in African Americans (median, 43 pg/mL; interquartile range [IQR], 18, 88) than Caucasians (median, 68 pg/mL; IQR, 36, 124; P<0.0001). In multivariable models, adjusted log NTproBNP levels were 40% lower (95% confidence interval [CI], −43, −36) in African Americans, compared to Caucasians, which was consistent across subgroups of age, gender, HTN, diabetes, insulin resistance, and obesity. African-American race was also significantly associated with having nondetectable NTproBNP (adjusted OR, 5.74; 95% CI, 4.22, 7.80). In multivariable analyses in African Americans, a 10% increase in genetic European ancestry was associated with a 7% (95% CI, 1, 13) increase in adjusted log NTproBNP. Conclusions African Americans have lower levels of plasma NTproBNP than Caucasians, which may be partially owing to genetic variation. Low natriuretic peptide levels in African Americans may contribute to the greater risk for HTN and its sequalae in this population. PMID:25999400

Retention of community college students in online courses

NASA Astrophysics Data System (ADS)

Krajewski, Sarah

The issue of attrition in online courses at higher learning institutions remains a high priority in the United States. A recent rapid growth of online courses at community colleges has been instigated by student demand, as they meet the time constraints many nontraditional community college students have as a result of the need to work and care for dependents. Failure in an online course can cause students to become frustrated with the college experience, financially burdened, or to even give up and leave college. Attrition could be avoided by proper guidance of who is best suited for online courses. This study examined factors related to retention (i.e., course completion) and success (i.e., receiving a C or better) in an online biology course at a community college in the Midwest by operationalizing student characteristics (age, race, gender), student skills (whether or not the student met the criteria to be placed in an AFP course), and external factors (Pell recipient, full/part time status, first term) from the persistence model developed by Rovai. Internal factors from this model were not included in this study. Both univariate analyses and multivariate logistic regression were used to analyze the variables. Results suggest that race and Pell recipient were both predictive of course completion on univariate analyses. However, multivariate analyses showed that age, race, academic load and first term were predictive of completion and Pell recipient was no longer predictive. The univariate results for the C or better showed that age, race, Pell recipient, academic load, and meeting AFP criteria were predictive of success. Multivariate analyses showed that only age, race, and Pell recipient were significant predictors of success. Both regression models explained very little (<15%) of the variability within the outcome variables of retention and success. Therefore, although significant predictors were identified for course completion and retention, there are still many factors that remain unaccounted for in both regression models. Further research into the operationalization of Rovai's model, including internal factors, to predict completion and success is necessary.

Predictive factors in patients with hepatocellular carcinoma receiving sorafenib therapy using time-dependent receiver operating characteristic analysis.

PubMed

Nishikawa, Hiroki; Nishijima, Norihiro; Enomoto, Hirayuki; Sakamoto, Azusa; Nasu, Akihiro; Komekado, Hideyuki; Nishimura, Takashi; Kita, Ryuichi; Kimura, Toru; Iijima, Hiroko; Nishiguchi, Shuhei; Osaki, Yukio

2017-01-01

To investigate variables before sorafenib therapy on the clinical outcomes in hepatocellular carcinoma (HCC) patients receiving sorafenib and to further assess and compare the predictive performance of continuous parameters using time-dependent receiver operating characteristics (ROC) analysis. A total of 225 HCC patients were analyzed. We retrospectively examined factors related to overall survival (OS) and progression free survival (PFS) using univariate and multivariate analyses. Subsequently, we performed time-dependent ROC analysis of continuous parameters which were significant in the multivariate analysis in terms of OS and PFS. Total sum of area under the ROC in all time points (defined as TAAT score) in each case was calculated. Our cohort included 175 male and 50 female patients (median age, 72 years) and included 158 Child-Pugh A and 67 Child-Pugh B patients. The median OS time was 0.68 years, while the median PFS time was 0.24 years. On multivariate analysis, gender, body mass index (BMI), Child-Pugh classification, extrahepatic metastases, tumor burden, aspartate aminotransferase (AST) and alpha-fetoprotein (AFP) were identified as significant predictors of OS and ECOG-performance status, Child-Pugh classification and extrahepatic metastases were identified as significant predictors of PFS. Among three continuous variables (i.e., BMI, AST and AFP), AFP had the highest TAAT score for the entire cohort. In subgroup analyses, AFP had the highest TAAT score except for Child-Pugh B and female among three continuous variables. In continuous variables, AFP could have higher predictive accuracy for survival in HCC patients undergoing sorafenib therapy.

Effect of pretreatment with statins on ischemic stroke outcomes.

PubMed

Reeves, Mathew J; Gargano, Julia Warner; Luo, Zhehui; Mullard, Andrew J; Jacobs, Bradley S; Majid, Arshad

2008-06-01

Statins reduce the risk of stroke in at-risk populations and may improve outcomes in patients taking statins before an ischemic stroke (IS). Our objectives were to examine the effects of pretreatment with statins on poor outcome in IS patients. Over a 6-month period all acute IS admissions were prospectively identified in 15 hospitals participating in a statewide acute stroke registry. Poor stroke outcome was defined as modified Rankin score >/=4 at discharge (ie, moderate-severe disability or death). Multivariable logistic regression models and matched propensity score analyses were used to quantify the effect of statin pretreatment on poor outcome. Of 1360 IS patients, 23% were using statins before their stroke event and 42% had a poor stroke outcome. After multivariable adjustment, pretreatment with statins was associated with lower odds of poor outcome (OR=0.74, 95% CI 0.52, 1.02). A significant interaction (P<0.01) was found between statin use and race. In whites, statins were associated with statistically significantly lower odds of poor outcome (OR=0.61, 95% CI 0.42, 0.86), but in blacks statins were associated with a nonstatistically significant increase in poor outcome (OR=1.82, 95% CI 0.98, 3.39). Matched propensity score analyses were consistent with the multivariable model results. Pretreatment with statins was associated with better stroke outcomes in whites, but we found no evidence of a beneficial effect of statins in blacks. These findings indicate the need for further studies, including randomized trials, to examine differential effects of statins on ischemic stroke outcomes among whites and blacks.

Relationship between cataract severity and socioeconomic status.

PubMed

Wesolosky, Jason D; Rudnisky, Christopher J

2013-12-01

To determine the relationship between cataract severity and socioeconomic status (SES). Retrospective, observational case series. A total of 1350 eyes underwent phacoemulsification cataract extraction by a single surgeon using an Alcon Infiniti system. Cataract severity was measured using phaco time in seconds. SES was measured using area-level aggregate census data: median income, education, proportion of common-law couples, and employment rate. Preoperative best corrected visual acuity was obtained and converted to logarithm of the minimum angle of resolution values. For patients undergoing bilateral surgery, the generalized estimating equation was used to account for the correlation between eyes. Univariate analyses were performed using simple regression, and multivariate analyses were performed to account for variables with significant relationships (p < 0.05) on univariate testing. Sensitivity analyses were performed to assess the effect of including patient age in the controlled analyses. Multivariate analyses demonstrated that cataracts were more severe when the median income was lower (p = 0.001) and the proportion of common-law couples living in a patient's community (p = 0.012) and the unemployment rate (p = 0.002) were higher. These associations persisted even when controlling for patient age. Patients of lower SES have more severe cataracts. Copyright © 2013 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Fibroblast Growth Factor 2-A Predictor of Outcome for Patients Irradiated for Stage II-III Non-Small-Cell Lung Cancer

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

Rades, Dirk, E-mail: Rades.Dirk@gmx.net; Setter, Cornelia; Dahl, Olav

2012-01-01

Purpose: The prognostic value of the tumor cell expression of the fibroblast growth factor 2 (FGF-2) in patients with non-small-cell lung cancer (NSCLC) is unclear. The present study investigated the effect of tumor cell expression of FGF-2 on the outcome of 60 patients irradiated for Stage II-III NSCLC. Methods and Materials: The effect of FGF-2 expression and 13 additional factors on locoregional control (LRC), metastasis-free survival (MFS), and overall survival (OS) were retrospectively evaluated. These additional factors included age, gender, Karnofsky performance status, histologic type, histologic grade, T and N category, American Joint Committee on Cancer stage, surgery, chemotherapy, pack-years,more » smoking during radiotherapy, and hemoglobin during radiotherapy. Locoregional failure was identified by endoscopy or computed tomography. Univariate analyses were performed with the Kaplan-Meier method and the Wilcoxon test and multivariate analyses with the Cox proportional hazard model. Results: On univariate analysis, improved LRC was associated with surgery (p = .017), greater hemoglobin levels (p = .036), and FGF-2 negativity (p <.001). On multivariate analysis of LRC, surgery (relative risk [RR], 2.44; p = .037), and FGF-2 expression (RR, 5.06; p <.001) maintained significance. On univariate analysis, improved MFS was associated with squamous cell carcinoma (p = .020), greater hemoglobin levels (p = .007), and FGF-2 negativity (p = .001). On multivariate analysis of MFS, the hemoglobin levels (RR, 2.65; p = .019) and FGF-2 expression (RR, 3.05; p = .004) were significant. On univariate analysis, improved OS was associated with a lower N category (p = .048), greater hemoglobin levels (p <.001), and FGF-2 negativity (p <.001). On multivariate analysis of OS, greater hemoglobin levels (RR, 4.62; p = .002) and FGF-2 expression (RR, 3.25; p = .002) maintained significance. Conclusions: Tumor cell expression of FGF-2 appeared to be an independent negative predictor of LRC, MFS, and OS.« less

Development and Validation of a Novel Evidence-Based Lupus Multivariable Outcome Score for Clinical Trials.

PubMed

Abrahamowicz, Michal; Esdaile, John M; Ramsey-Goldman, Rosalind; Simon, Lee S; Strand, Vibeke; Lipsky, Peter E

2018-04-12

Trials of new SLE treatments are hampered by the lack of effective outcome measures. To address this, we developed a new Lupus Multivariable Lupus Outcome Score (LuMOS). The LuMOS formula was developed by analyzing raw data of two pivotal trials: BLISS-52 and BLISS-76, the basis for approval of belimumab (Bel). Using data from BLISS-76 as the learning dataset, we optimized discrimination between outcomes for patients treated with 10mg/kg Bel versus placebo over the first 52 weeks of follow-up using multivariable logistic regression analyses. Performance of LuMOS was assessed using an independent validation dataset from the BLISS-52 trial. The LuMOS model incorporated reduction in SELENA-SLEDAI ≥4 points, increase in C4, decrease in anti-dsDNA titer, and changes in BILAG organ system manifestations: no worsening in renal and improvements in mucocutaneous components. Decreases in prednisone doses and increases in C3 had very minor impacts on total LuMOS. In all analyses of BLISS-76 and BLISS-52 RCTs, mean LuMOS were significantly higher (p < 0.0001) for Bel 10mg and Bel 1mg treatment groups than placebo. LuMOS also found significant differences between active treatment and placebo when SRI did not, as for Bel 1mg in BLISS-76. The Effect Sizes were significantly much higher with LuMOS compared with SLE Response Index(SRI-4). The evidenced-based LuMOS developed with data from BLISS-76 and validated with data from BLISS-52 exhibits superior capacity to discriminate responders from nonresponders compared to the SRI-4. Use of LuMOS may improve the efficiency and power of analyses in future lupus trials. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Relationship between the prognostic value of ventilatory efficiency and age in patients with heart failure.

PubMed

Kato, Yuko; Suzuki, Shinya; Uejima, Tokuhisa; Semba, Hiroaki; Nagayama, Osamu; Hayama, Etsuko; Arita, Takuto; Yagi, Naoharu; Kano, Hiroto; Matsuno, Shunsuke; Otsuka, Takayuki; Oikawa, Yuji; Kunihara, Takashi; Yajima, Junji; Yamashita, Takeshi

2018-05-01

Background Ventilatory efficiency decreases with age. This study aimed to investigate the prognostic significance and cut-off value of the minute ventilation/carbon dioxide production (VE/VCO 2 ) slope according to age in patients with heart failure. Methods and results We analysed 1501 patients with heart failure from our observational cohort who performed maximal symptom-limited cardiopulmonary exercise testing and separated them into three age groups (≤55 years, 56-70 years and ≥71 years) in total and according to the three ejection fraction categories defined by European Society of Cardiology guidelines. The endpoint was set as heart failure events, hospitalisation for heart failure or death from heart failure. The VE/VCO 2 slope increased with age. During the median follow-up period of 4 years, 141 heart failure (9%) events occurred. In total, univariate Cox analyses showed that the VE/VCO 2 slope (cont.) was significantly related to heart failure events, while on multivariate analysis, the prognostic significance of the VE/VCO 2 slope (cont.) was poor, accompanied by a significant interaction with age ( P < 0.0001). The cut-off value of the VE/VCO 2 slope increased with the increase in age in not only the total but also the sub-ejection fraction categories. Multivariate analyses with a stepwise method adjusted for estimated glomerular filtration rate, peak oxygen consumption, atrial fibrillation and brain natriuretic peptide, showed that the predictive value of the binary VE/VCO 2 slope separated by the cut-off value varied according to age. There was a tendency for the prognostic significance to increase with age irrespective of ejection fraction. Conclusion The prognostic significance and cut-off value of the VE/VCO 2 slope may increase with advancing age.

Advanced multivariate analysis to assess remediation of hydrocarbons in soils.

PubMed

Lin, Deborah S; Taylor, Peter; Tibbett, Mark

2014-10-01

Accurate monitoring of degradation levels in soils is essential in order to understand and achieve complete degradation of petroleum hydrocarbons in contaminated soils. We aimed to develop the use of multivariate methods for the monitoring of biodegradation of diesel in soils and to determine if diesel contaminated soils could be remediated to a chemical composition similar to that of an uncontaminated soil. An incubation experiment was set up with three contrasting soil types. Each soil was exposed to diesel at varying stages of degradation and then analysed for key hydrocarbons throughout 161 days of incubation. Hydrocarbon distributions were analysed by Principal Coordinate Analysis and similar samples grouped by cluster analysis. Variation and differences between samples were determined using permutational multivariate analysis of variance. It was found that all soils followed trajectories approaching the chemical composition of the unpolluted soil. Some contaminated soils were no longer significantly different to that of uncontaminated soil after 161 days of incubation. The use of cluster analysis allows the assignment of a percentage chemical similarity of a diesel contaminated soil to an uncontaminated soil sample. This will aid in the monitoring of hydrocarbon contaminated sites and the establishment of potential endpoints for successful remediation.

Predictors of obesity in Michigan Operating Engineers.

PubMed

Duffy, Sonia A; Cohen, Kathleen A; Choi, Seung Hee; McCullagh, Marjorie C; Noonan, Devon

2012-06-01

Blue collar workers are at risk for obesity. Little is known about obesity in Operating Engineers, a group of blue collar workers, who operate heavy earth-moving equipment in road building and construction. Therefore, 498 Operating Engineers in Michigan were recruited to participate in a cross-sectional survey to determine variables related to obesity in this group. Bivariate and multivariate analyses were conducted to determine personal, psychological, and behavioral factors predicting obesity. Approximately 45% of the Operating Engineers screened positive for obesity, and another 40% were overweight. Multivariate analysis revealed that younger age, male sex, higher numbers of self-reported co-morbidities, not smoking, and low physical activity levels were significantly associated with obesity among Operating Engineers. Operating Engineers are significantly at risk for obesity, and workplace interventions are needed to address this problem.

Treatment of patent ductus arteriosus and neonatal mortality/morbidities: adjustment for treatment selection bias.

PubMed

Mirea, Lucia; Sankaran, Koravangattu; Seshia, Mary; Ohlsson, Arne; Allen, Alexander C; Aziz, Khalid; Lee, Shoo K; Shah, Prakesh S

2012-10-01

To examine the association between treatment for patent ductus arteriosus (PDA) and neonatal outcomes in preterm infants, after adjustment for treatment selection bias. Secondary analyses were conducted using data collected by the Canadian Neonatal Network for neonates born at a gestational age ≤ 32 weeks and admitted to neonatal intensive care units in Canada between 2004 and 2008. Infants who had PDA and survived beyond 72 hours were included in multivariable logistic regression analyses that compared mortality or any severe neonatal morbidity (intraventricular hemorrhage grades ≥ 3, retinopathy of prematurity stages ≥ 3, bronchopulmonary dysplasia, or necrotizing enterocolitis stages ≥ 2) between treatment groups (conservative management, indomethacin only, surgical ligation only, or both indomethacin and ligation). Propensity scores (PS) were estimated for each pair of treatment comparisons, and used in PS-adjusted and PS-matched analyses. Among 3556 eligible infants with a diagnosis of PDA, 577 (16%) were conservatively managed, 2026 (57%) received indomethacin only, 327 (9%) underwent ligation only, and 626 (18%) were treated with both indomethacin and ligation. All multivariable and PS-based analyses detected significantly higher mortality/morbidities for surgically ligated infants, irrespective of prior indomethacin treatment (OR ranged from 1.25-2.35) compared with infants managed conservatively or those who received only indomethacin. No significant differences were detected between infants treated with only indomethacin and those managed conservatively. Surgical ligation of PDA in preterm neonates was associated with increased neonatal mortality/morbidity in all analyses adjusted for measured confounders that attempt to account for treatment selection bias. Copyright © 2012 Mosby, Inc. All rights reserved.

Tafamidis delays disease progression in patients with early stage transthyretin familial amyloid polyneuropathy: additional supportive analyses from the pivotal trial.

PubMed

Keohane, Denis; Schwartz, Jeffrey; Gundapaneni, Balarama; Stewart, Michelle; Amass, Leslie

2017-03-01

Tafamidis, a non-NSAID highly specific transthyretin stabilizer, delayed neurologic disease progression as measured by Neuropathy Impairment Score-Lower Limbs (NIS-LL) in an 18-month, double-blind, placebo-controlled randomized trial in 128 patients with early-stage transthyretin V30M familial amyloid polyneuropathy (ATTRV30M-FAP). The current post hoc analyses aimed to further evaluate the effects of tafamidis in delaying ATTRV30M-FAP progression in this trial. Pre-specified, repeated-measures analysis of change from baseline in NIS-LL in this trial (ClinicalTrials.gov NCT00409175) was repeated with addition of baseline as covariate and multiple imputation analysis for missing data by treatment group. Change in NIS-LL plus three small-fiber nerve tests (NIS-LL + Σ3) and NIS-LL plus seven nerve tests (NIS-LL + Σ7) were assessed without baseline as covariate. Treatment outcomes over the NIS-LL, Σ3, Σ7, modified body mass index and Norfolk Quality of Life-Diabetic Neuropathy Total Quality of Life Score were also examined using multivariate analysis techniques. Neuropathy progression based on NIS-LL change from baseline to Month 18 remained significantly reduced for tafamidis versus placebo in the baseline-adjusted and multiple imputation analyses. NIS-LL + Σ3 and NIS-LL + Σ7 captured significant treatment group differences. Multivariate analyses provided strong statistical evidence for a superior tafamidis treatment effect. These supportive analyses confirm that tafamidis delays neurologic progression in early-stage ATTRV30M-FAP. NCT00409175.

Is treatment under general anaesthesia associated with dental neglect and dental disability among caries active preschool children?

PubMed

Kvist, T; Zedrén-Sunemo, J; Graca, E; Dahllöf, G

2014-10-01

To study if treatment under general anaesthesia (GA) is associated with dental neglect or dental disability. This was a retrospective study. Dental records of all children in the age 0-6 years who underwent GA at a specialist paediatric dentistry clinic during 2006-2011 were studied with regard to decayed-missed-filled teeth, traumatic injuries, emergency visits, behaviour management problems and the history of attendance. The final sample consisted of 134 children. Matched controls were selected among recall patients who had not received treatment under GA. Fishers exact test or Pearson Chi-square test analysed response distribution and comparisons between groups, and for multivariate analyses, logistic regression was used. The results show that children treated under GA had significantly higher caries prevalence, apical periodontitis and infections due to pulpal necrosis. Dental neglect as well as dental disability was significantly more prevalent in the GA group compared to the control group. In a multivariate analysis with dental neglect as independent factor, dental disability was the only significant factor (p = 0.006). Children treated under general anaesthesia were significantly more often diagnosed with both dental neglect and dental disability. Dental disability was the only factor significantly related to dental neglect. There is a need for improved documentation in the dental records to better identify dental neglect and dental disability, and also a continued training of dentists regarding child protection.

Permutation Tests of Hierarchical Cluster Analyses of Carrion Communities and Their Potential Use in Forensic Entomology.

PubMed

van der Ham, Joris L

2016-05-19

Forensic entomologists can use carrion communities' ecological succession data to estimate the postmortem interval (PMI). Permutation tests of hierarchical cluster analyses of these data provide a conceptual method to estimate part of the PMI, the post-colonization interval (post-CI). This multivariate approach produces a baseline of statistically distinct clusters that reflect changes in the carrion community composition during the decomposition process. Carrion community samples of unknown post-CIs are compared with these baseline clusters to estimate the post-CI. In this short communication, I use data from previously published studies to demonstrate the conceptual feasibility of this multivariate approach. Analyses of these data produce series of significantly distinct clusters, which represent carrion communities during 1- to 20-day periods of the decomposition process. For 33 carrion community samples, collected over an 11-day period, this approach correctly estimated the post-CI within an average range of 3.1 days. © The Authors 2016. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Predictors of workplace sexual health policy at sex work establishments in the Philippines.

PubMed

Withers, M; Dornig, K; Morisky, D E

2007-09-01

Based on the literature, we identified manager and establishment characteristics that we hypothesized are related to workplace policies that support HIV protective behavior. We developed a sexual health policy index consisting of 11 items as our outcome variable. We utilized both bivariate and multivariate analysis of variance. The significant variables in our bivariate analyses (establishment type, number of employees, manager age, and membership in manager association) were entered into a multivariate regression model. The model was significant (p<.01), and predicted 42) of the variability in the development and management of a workplace sexual health policy supportive of condom use. The significant predictors were number of employees and establishment type. In addition to individually-focused CSW interventions, HIV prevention programs should target managers and establishment policies. Future HIV prevention programs may need to focus on helping smaller establishments, in particular those with less employees, to build capacity and develop sexual health policy guidelines.

Infection with Schistosoma mansoni has an Effect on Quality of Life, but not on Physical Fitness in Schoolchildren in Mwanza Region, North-Western Tanzania: A Cross-Sectional Study

PubMed Central

Kinung’hi, Safari; Magnussen, Pascal; Kaatano, Godfrey

2016-01-01

Background Infection with Schistosoma mansoni negatively impact children’s physical health and may influence their general well-being. The aim of this study was to investigate the effect of S. mansoni infections on a panel of morbidity indicators with emphasis on quality of life (PedsQL; measured in four different dimensions) and physical fitness (measured as VO2 max) among 572 schoolchildren aged 7–8 years. Methodology/Principal findings Prevalence of S. mansoni infections was 58.7%, with an arithmetic mean (95% CI) among positives of 207.3 (169.2–245.4) eggs per gram (epg). Most infections were light (56.5%), while 16.4% had heavy infections. Girls had significantly higher arithmetic mean intensities (95% CI) than boys (247.4 (189.2–305.6) vs. 153.2 (110.6–195.8); P = 0.004). A total of 30.1% were anaemic with no sex difference. Stunting and wasting was found in less than 10% of the population. There was no association between S. mansoni prevalence or intensities and the following parameters: anthropometry, anaemia, liver or spleen pathology in neither univariable nor multivariable linear regression analyses. However, in univariable analyses children with S. mansoni infection had a significantly lower score in emotional PedsQL (95% CI) than uninfected (77.3 (74.5–80.1) vs. 82.7 (79.9–85.5); P = 0.033) and infected children had a higher VO2 max (95% CI) compared to uninfected (51.4 (51.0–51.8) vs. 50.8 (50.3–51.3); P = 0.042). In multivariable linear regression analyses, age, S. mansoni infection, haemoglobin and VO2 max were significant predictors for emotional PedsQL while significant predictors for VO2 max were physical PedsQL, height, age and haemoglobin. S. mansoni infection was thus not retained in the multivariable regression analyses on VO2 max. Conclusions/Significance Of the measured morbidity parameters, S. mansoni infection had a significant effect on the emotional dimension of quality of life, but not on physical fitness. If PedsQL should be a useful tool to measure schistosome related morbidity, more in depth studies are needed in order to refine the tool so it focuses more on aspects of quality of life that may be affected by schistosome infections. PMID:28027317

Pretreatment health behaviors predict survival among patients with head and neck squamous cell carcinoma.

PubMed

Duffy, Sonia A; Ronis, David L; McLean, Scott; Fowler, Karen E; Gruber, Stephen B; Wolf, Gregory T; Terrell, Jeffrey E

2009-04-20

Our prior work has shown that the health behaviors of head and neck cancer patients are interrelated and are associated with quality of life; however, other than smoking, the relationship between health behaviors and survival is unclear. A prospective cohort study was conducted to determine the relationship between five pretreatment health behaviors (smoking, alcohol, diet, physical activity, and sleep) and all-cause survival among 504 head and neck cancer patients. Smoking status was the strongest predictor of survival, with both current smokers (hazard ratio [HR] = 2.4; 95% CI, 1.3 to 4.4) and former smokers (HR = 2.0; 95% CI, 1.2 to 3.5) showing significant associations with poor survival. Problem drinking was associated with survival in the univariate analysis (HR = 1.4; 95% CI, 1.0 to 2.0) but lost significance when controlling for other factors. Low fruit intake was negatively associated with survival in the univariate analysis only (HR = 1.6; 95% CI, 1.1 to 2.1), whereas vegetable intake was not significant in either univariate or multivariate analyses. Although physical activity was associated with survival in the univariate analysis (HR = 0.95; 95% CI, 0.93 to 0.97), it was not significant in the multivariate model. Sleep was not significantly associated with survival in either univariate or multivariate analysis. Control variables that were also independently associated with survival in the multivariate analysis were age, education, tumor site, cancer stage, and surgical treatment. Variation in selected pretreatment health behaviors (eg, smoking, fruit intake, and physical activity) in this population is associated with variation in survival.

Factors associated with school-aged children's body mass index in Korean American families.

PubMed

Jang, Myoungock; Grey, Margaret; Sadler, Lois; Jeon, Sangchoon; Nam, Soohyun; Song, Hee-Jung; Whittemore, Robin

2017-08-01

To examine factors associated with children's body mass index and obesity-risk behaviours in Korean American families. Limited data are available about family factors related to overweight and obesity in Korean American children. A cross-sectional study. Convenient sampling was employed to recruit Korean American families in the Northeast of the United States between August 2014 and January 2015. Child, family and societal/demographic/community factors were measured with self-report questionnaires completed by mothers and children. Height and weight were measured to calculate body mass index. Data were analyzed using mixed effects models incorporating within-group correlation in siblings. The sample included 170 Korean American children and 137 mothers. In bivariate analyses, more child screen time, number of children in the household, greater parental underestimation of child's weight and children's participation in the school lunch program were significantly associated with higher child body mass index. In multivariate analyses that included variables showing significant bivariate relationship, no variable was associated with child body mass index. There were no child, family and societal/demographic/community factors related to child body mass index in Korean American families in the multivariate analysis, which is contrary to research in other racial/ethnic groups. In bivariate analyses, there is evidence that some factors were significantly related to child body mass index. Further research is needed to understand the unique behavioural, social and cultural features that contribute to childhood obesity in Korean American families. © 2017 John Wiley & Sons Ltd.

Differentiation of benign and malignant ampullary obstruction by multi-row detector CT.

PubMed

Angthong, Wirana; Jiarakoop, Kran; Tangtiang, Kaan

2018-05-21

To determine useful CT parameters to differentiate ampullary carcinomas from benign ampullary obstruction. This study included 93 patients who underwent abdominal CT, 31 patients with ampullary carcinomas, and 62 patients with benign ampullary obstruction. Two radiologists independently evaluated CT parameters then reached consensus decisions. Statistically significant CT parameters were identified through univariate and multivariate analyses. In univariate analysis, the presence of ampullary mass, asymmetric, abrupt narrowing of distal common bile duct (CBD), dilated intrahepatic bile duct (IHD), dilated pancreatic duct (PD), peripancreatic lymphadenopathy, duodenal wall thickening, and delayed enhancement were more frequently in ampullary carcinomas observed (P < 0.05). Multivariate logistic regression analysis using significant CT parameters and clinical data from univariate analysis, and clinical symptom with jaundice (P = 0.005) was an independent predictor of ampullary carcinomas. For multivariate analysis using only significant CT parameters, abrupt narrowing of distal CBD was an independent predictor of ampullary carcinomas (P = 0.019). Among various CT criteria, abrupt narrowing of distal CBD and dilated IHD had highest sensitivity (77.4%) and highest accuracy (90.3%). The abrupt narrowing of distal CBD and dilated IHD is useful for differentiation of ampullary carcinomas from benign entity in patients without the presence of mass.

The Influence of Urinary Incontinence on Publicly Financed Home Care Services to Low-Income Elderly People.

ERIC Educational Resources Information Center

Baker, Dorothy I.; Bice, Thomas W.

1995-01-01

A retrospective cohort design is used to estimate the effect of urinary incontinence (UI) on the public costs of home care services to elderly individuals. Multivariate analyses controlling for other individual, household, and supply characteristics demonstrate that those with UI generate significantly greater public costs for home care services.…

A Case Control Study of Suicide and Attempted Suicide in Older Adults.

ERIC Educational Resources Information Center

Beautrais, Annette L.

2002-01-01

Risk factors for serious suicidal behavior among older adults were examined in a case control study of adults aged 55 and older who died by suicide or made suicide attempts and who were compared with randomly selected comparison subjects. Multivariate analyses suggested that mood disorders were the most significant risk factor for suicidal…

Use of Multivariate Linkage Analysis for Dissection of a Complex Cognitive Trait

PubMed Central

Marlow, Angela J.; Fisher, Simon E.; Francks, Clyde; MacPhie, I. Laurence; Cherny, Stacey S.; Richardson, Alex J.; Talcott, Joel B.; Stein, John F.; Monaco, Anthony P.; Cardon, Lon R.

2003-01-01

Replication of linkage results for complex traits has been exceedingly difficult, owing in part to the inability to measure the precise underlying phenotype, small sample sizes, genetic heterogeneity, and statistical methods employed in analysis. Often, in any particular study, multiple correlated traits have been collected, yet these have been analyzed independently or, at most, in bivariate analyses. Theoretical arguments suggest that full multivariate analysis of all available traits should offer more power to detect linkage; however, this has not yet been evaluated on a genomewide scale. Here, we conduct multivariate genomewide analyses of quantitative-trait loci that influence reading- and language-related measures in families affected with developmental dyslexia. The results of these analyses are substantially clearer than those of previous univariate analyses of the same data set, helping to resolve a number of key issues. These outcomes highlight the relevance of multivariate analysis for complex disorders for dissection of linkage results in correlated traits. The approach employed here may aid positional cloning of susceptibility genes in a wide spectrum of complex traits. PMID:12587094

Integration of vessel traits, wood density, and height in angiosperm shrubs and trees.

PubMed

Martínez-Cabrera, Hugo I; Schenk, H Jochen; Cevallos-Ferriz, Sergio R S; Jones, Cynthia S

2011-05-01

Trees and shrubs tend to occupy different niches within and across ecosystems; therefore, traits related to their resource use and life history are expected to differ. Here we analyzed how growth form is related to variation in integration among vessel traits, wood density, and height. We also considered the ecological and evolutionary consequences of such differences. In a sample of 200 woody plant species (65 shrubs and 135 trees) from Argentina, Mexico, and the United States, standardized major axis (SMA) regression, correlation analyses, and ANOVA were used to determine whether relationships among traits differed between growth forms. The influence of phylogenetic relationships was examined with a phylogenetic ANOVA and phylogenetically independent contrasts (PICs). A principal component analysis was conducted to determine whether trees and shrubs occupy different portions of multivariate trait space. Wood density did not differ between shrubs and trees, but there were significant differences in vessel diameter, vessel density, theoretical conductivity, and as expected, height. In addition, relationships between vessel traits and wood density differed between growth forms. Trees showed coordination among vessel traits, wood density, and height, but in shrubs, wood density and vessel traits were independent. These results hold when phylogenetic relationships were considered. In the multivariate analyses, these differences translated as significantly different positions in multivariate trait space occupied by shrubs and trees. Differences in trait integration between growth forms suggest that evolution of growth form in some lineages might be associated with the degree of trait interrelation.

Prognostic factors for return to work in patients with sciatica.

PubMed

Grøvle, Lars; Haugen, Anne J; Keller, Anne; Ntvig, Bård; Brox, Jens I; Grotle, Margreth

2013-12-01

Little is known about the prognostic factors for work-related outcomes of sciatica caused by disc herniation. To identify the prognostic factors for return to work (RTW) during a 2-year follow-up among sciatica patients referred to secondary care. Multicenter prospective cohort study including 466 patients. Administrative data from the National Sickness Benefit Register were accessed for 227 patients. Two samples were used. Sample A comprised patients who at the time of inclusion in the cohort reported being on partial sick leave or complete sick leave or were undergoing rehabilitation because of back pain/sciatica. Sample B comprised patients who, according to the sickness benefit register, at the time of inclusion received sickness benefits or rehabilitation allowances because of back pain/sciatica. In Sample A, the outcome was self-reported return to full-time work at the 2-year follow-up. In Sample B, the outcome was time to first sustained RTW, defined as the first period of more than 60 days without receiving benefits from the register. Significant baseline predictors of self-reported RTW at 2 years (Analysis A) were identified by multivariate logistic regression. Significant predictors of time to sustained RTW (Analysis B) were identified by multivariate Cox proportional hazard modeling. Both analyses included adjustment for age and sex. To assess the effect of surgery on the probability of RTW, analyses similar to A and B were performed, including the variable surgery (yes/no). One-fourth of the patients were still out of work at the 2-year follow-up. In Sample A (n=237), younger age, better general health, lower baseline sciatica bothersomeness, less fear-avoidance work, and a negative straight-leg-raising test result were significantly associated with a higher probability of RTW at the 2-year follow-up. Surgery was not significantly associated with the outcome. In Sample B (n=125), history of sciatica, duration of the current sciatica episode more than 3 months, greater sciatica bothersomeness, fear-avoidance work, and back pain were significantly associated with a longer time to sustained RTW. Surgery was significantly negatively associated with time to sustained RTW both in univariate (hazard ratio [HR] 0.60; 95% confidence interval [CI] 0.39, 0.93; p=.02) and in multivariate (HR 0.49; 95% CI 0.31, 0.79; p=.003) analyses. The baseline factors associated with RTW identified in multivariate analysis were age, general health, history of sciatica, duration of the current episode, baseline sciatica bothersomeness, fear-avoidance work, back pain, and the straight-leg-raising test result. Surgical treatment was associated with slower RTW, but surgical patients were more severely affected than patients treated without surgery; so, this finding should be interpreted with caution. Copyright © 2013 Elsevier Inc. All rights reserved.

Gene-set and multivariate genome-wide association analysis of oppositional defiant behavior subtypes in attention-deficit/hyperactivity disorder.

PubMed

Aebi, Marcel; van Donkelaar, Marjolein M J; Poelmans, Geert; Buitelaar, Jan K; Sonuga-Barke, Edmund J S; Stringaris, Argyris; Consortium, Image; Faraone, Stephen V; Franke, Barbara; Steinhausen, Hans-Christoph; van Hulzen, Kimm J E

2016-07-01

Oppositional defiant disorder (ODD) is a frequent psychiatric disorder seen in children and adolescents with attention-deficit-hyperactivity disorder (ADHD). ODD is also a common antecedent to both affective disorders and aggressive behaviors. Although the heritability of ODD has been estimated to be around 0.60, there has been little research into the molecular genetics of ODD. The present study examined the association of irritable and defiant/vindictive dimensions and categorical subtypes of ODD (based on latent class analyses) with previously described specific polymorphisms (DRD4 exon3 VNTR, 5-HTTLPR, and seven OXTR SNPs) as well as with dopamine, serotonin, and oxytocin genes and pathways in a clinical sample of children and adolescents with ADHD. In addition, we performed a multivariate genome-wide association study (GWAS) of the aforementioned ODD dimensions and subtypes. Apart from adjusting the analyses for age and sex, we controlled for "parental ability to cope with disruptive behavior." None of the hypothesis-driven analyses revealed a significant association with ODD dimensions and subtypes. Inadequate parenting behavior was significantly associated with all ODD dimensions and subtypes, most strongly with defiant/vindictive behaviors. In addition, the GWAS did not result in genome-wide significant findings but bioinformatics and literature analyses revealed that the proteins encoded by 28 of the 53 top-ranked genes functionally interact in a molecular landscape centered around Beta-catenin signaling and involved in the regulation of neurite outgrowth. Our findings provide new insights into the molecular basis of ODD and inform future genetic studies of oppositional behavior. © 2015 The Authors. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics Published by Wiley Periodicals, Inc. © 2015 The Authors. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics Published by Wiley Periodicals, Inc.

Epidemiology of antibiotic-resistant wound infections from six countries in Africa

PubMed Central

Bebell, Lisa M; Meney, Carron; Valeri, Linda

2017-01-01

Introduction Little is known about the antimicrobial susceptibility of common bacteria responsible for wound infections from many countries in sub-Saharan Africa. Methods We performed a retrospective review of microbial isolates collected based on clinical suspicion of wound infection between 2004 and 2016 from Mercy Ships, a non-governmental organisation operating a single mobile surgical unit in Benin, Congo, Liberia, Madagascar, Sierra Leone and Togo. Antimicrobial resistant organisms of interest were defined as methicillin-resistant Staphylococcus aureus (MRSA) or Enterobacteriaceae resistant to third-generation cephalosporins. Generalised mixed-effects models accounting for repeated isolates in a patient, potential clustering by case mix for each field service, age, gender and country were used to test the hypothesis that rates of antimicrobial resistance differed between countries. Results 3145 isolates from repeated field services in six countries were reviewed. In univariate analyses, the highest proportion of MRSA was found in Benin (34.6%) and Congo (31.9%), while the lowest proportion was found in Togo (14.3%) and Madagascar (14.5%); country remained a significant predictor in multivariate analyses (P=0.002). In univariate analyses, the highest proportion of third-generation cephalosporin-resistant Enterobacteriaceae was found in Benin (35.8%) and lowest in Togo (14.3%) and Madagascar (16.3%). Country remained a significant predictor for antimicrobial-resistant isolates in multivariate analyses (P=0.009). Conclusion A significant proportion of isolates from wound cultures were resistant to first-line antimicrobials in each country. Though antimicrobial resistance isolates were not verified in a reference laboratory and these data may not be representative of all regions of the countries studied, differences in the proportion of antimicrobial-resistant isolates and resistance profiles between countries suggest site-specific surveillance should be a priority and local antimicrobial resistance profiles should be used to guide empiric antibiotic selection. PMID:29588863

Gene‐set and multivariate genome‐wide association analysis of oppositional defiant behavior subtypes in attention‐deficit/hyperactivity disorder

PubMed Central

van Donkelaar, Marjolein M. J.; Poelmans, Geert; Buitelaar, Jan K.; Sonuga‐Barke, Edmund J. S.; Stringaris, Argyris; consortium, IMAGE; Faraone, Stephen V.; Franke, Barbara; Steinhausen, Hans‐Christoph; van Hulzen, Kimm J. E.

2015-01-01

Oppositional defiant disorder (ODD) is a frequent psychiatric disorder seen in children and adolescents with attention‐deficit‐hyperactivity disorder (ADHD). ODD is also a common antecedent to both affective disorders and aggressive behaviors. Although the heritability of ODD has been estimated to be around 0.60, there has been little research into the molecular genetics of ODD. The present study examined the association of irritable and defiant/vindictive dimensions and categorical subtypes of ODD (based on latent class analyses) with previously described specific polymorphisms (DRD4 exon3 VNTR, 5‐HTTLPR, and seven OXTR SNPs) as well as with dopamine, serotonin, and oxytocin genes and pathways in a clinical sample of children and adolescents with ADHD. In addition, we performed a multivariate genome‐wide association study (GWAS) of the aforementioned ODD dimensions and subtypes. Apart from adjusting the analyses for age and sex, we controlled for “parental ability to cope with disruptive behavior.” None of the hypothesis‐driven analyses revealed a significant association with ODD dimensions and subtypes. Inadequate parenting behavior was significantly associated with all ODD dimensions and subtypes, most strongly with defiant/vindictive behaviors. In addition, the GWAS did not result in genome‐wide significant findings but bioinformatics and literature analyses revealed that the proteins encoded by 28 of the 53 top‐ranked genes functionally interact in a molecular landscape centered around Beta‐catenin signaling and involved in the regulation of neurite outgrowth. Our findings provide new insights into the molecular basis of ODD and inform future genetic studies of oppositional behavior. © 2015 The Authors. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics Published by Wiley Periodicals, Inc. PMID:26184070

Comparison of connectivity analyses for resting state EEG data

NASA Astrophysics Data System (ADS)

Olejarczyk, Elzbieta; Marzetti, Laura; Pizzella, Vittorio; Zappasodi, Filippo

2017-06-01

Objective. In the present work, a nonlinear measure (transfer entropy, TE) was used in a multivariate approach for the analysis of effective connectivity in high density resting state EEG data in eyes open and eyes closed. Advantages of the multivariate approach in comparison to the bivariate one were tested. Moreover, the multivariate TE was compared to an effective linear measure, i.e. directed transfer function (DTF). Finally, the existence of a relationship between the information transfer and the level of brain synchronization as measured by phase synchronization value (PLV) was investigated. Approach. The comparison between the connectivity measures, i.e. bivariate versus multivariate TE, TE versus DTF, TE versus PLV, was performed by means of statistical analysis of indexes based on graph theory. Main results. The multivariate approach is less sensitive to false indirect connections with respect to the bivariate estimates. The multivariate TE differentiated better between eyes closed and eyes open conditions compared to DTF. Moreover, the multivariate TE evidenced non-linear phenomena in information transfer, which are not evidenced by the use of DTF. We also showed that the target of information flow, in particular the frontal region, is an area of greater brain synchronization. Significance. Comparison of different connectivity analysis methods pointed to the advantages of nonlinear methods, and indicated a relationship existing between the flow of information and the level of synchronization of the brain.

Visual classification of very fine-grained sediments: Evaluation through univariate and multivariate statistics

USGS Publications Warehouse

Hohn, M. Ed; Nuhfer, E.B.; Vinopal, R.J.; Klanderman, D.S.

1980-01-01

Classifying very fine-grained rocks through fabric elements provides information about depositional environments, but is subject to the biases of visual taxonomy. To evaluate the statistical significance of an empirical classification of very fine-grained rocks, samples from Devonian shales in four cored wells in West Virginia and Virginia were measured for 15 variables: quartz, illite, pyrite and expandable clays determined by X-ray diffraction; total sulfur, organic content, inorganic carbon, matrix density, bulk density, porosity, silt, as well as density, sonic travel time, resistivity, and ??-ray response measured from well logs. The four lithologic types comprised: (1) sharply banded shale, (2) thinly laminated shale, (3) lenticularly laminated shale, and (4) nonbanded shale. Univariate and multivariate analyses of variance showed that the lithologic classification reflects significant differences for the variables measured, difference that can be detected independently of stratigraphic effects. Little-known statistical methods found useful in this work included: the multivariate analysis of variance with more than one effect, simultaneous plotting of samples and variables on canonical variates, and the use of parametric ANOVA and MANOVA on ranked data. ?? 1980 Plenum Publishing Corporation.

Pontin Acts as a Potential Biomarker for Poor Clinical Outcome and Promotes Tumor Invasion in Hilar Cholangiocarcinoma.

PubMed

Sun, Qi; Li, Fanni; Yu, Songyang; Zhang, Xiang; Shi, Feiyu; She, Junjun

2018-01-01

Hilar cholangiocarcinoma (HC) is a devastating malignancy that carries a poor overall prognosis. As a member of the AAA+ superfamily, Pontin becomes highly expressed in several malignant tumors, which contributes to tumor progression and influences tumor prognosis. In our research, Pontin expression in tumor specimens resected from 86 HC patients was detected by immunohistochemistry. Interestingly, high expression of Pontin was significantly associated with lymph node metastasis ( p = 0.011) and tumor node metastasis (TNM) stage ( p = 0.005). The Kaplan-Meier overall survival rate and multivariate analyses were performed to evaluate the prognosis of patients with HC. Patients with high Pontin expression had significantly poorer overall survival outcomes. Multivariate analyses found that Pontin was an independent prognostic factor ( p = 0.001). Moreover, bioinformatics analysis confirmed the increase in Pontin mRNA expression levels in cholangiocarcinoma tissues. In addition, in vitro experiments showed that Pontin expression was inhibited at the mRNA as well as protein levels after transfection with Pontin siRNA in human cholangiocarcinoma cell lines. Moreover, significant suppression of cell invasion was observed after the downregulation of Pontin. Taken together, the present study suggested that Pontin could act as a potential prognostic predictor, which might be a new valuable molecular candidate for the prevention and treatment of HC.

Analysis of threats to research validity introduced by audio recording clinic visits: Selection bias, Hawthorne effect, both, or neither?

PubMed Central

Henry, Stephen G.; Jerant, Anthony; Iosif, Ana-Maria; Feldman, Mitchell D.; Cipri, Camille; Kravitz, Richard L.

2015-01-01

Objective To identify factors associated with participant consent to record visits; to estimate effects of recording on patient-clinician interactions Methods Secondary analysis of data from a randomized trial studying communication about depression; participants were asked for optional consent to audio record study visits. Multiple logistic regression was used to model likelihood of patient and clinician consent. Multivariable regression and propensity score analyses were used to estimate effects of audio recording on 6 dependent variables: discussion of depressive symptoms, preventive health, and depression diagnosis; depression treatment recommendations; visit length; visit difficulty. Results Of 867 visits involving 135 primary care clinicians, 39% were recorded. For clinicians, only working in academic settings (P=0.003) and having worked longer at their current practice (P=0.02) were associated with increased likelihood of consent. For patients, white race (P=0.002) and diabetes (P=0.03) were associated with increased likelihood of consent. Neither multivariable regression nor propensity score analyses revealed any significant effects of recording on the variables examined. Conclusion Few clinician or patient characteristics were significantly associated with consent. Audio recording had no significant effect on any dependent variables. Practice Implications Benefits of recording clinic visits likely outweigh the risks of bias in this setting. PMID:25837372

Biomarker evidence of tobacco smoke exposure in children participating in lead screening.

PubMed

Joseph, Anne; Spector, Logan; Wickham, Katherine; Janis, Gregory; Winickoff, Jonathan; Lindgren, Bruce; Murphy, Sharon

2013-12-01

We assessed tobacco smoke exposure (TSE), defined according to detection of cotinine, in dried blood spots collected from children for lead screening. Dried blood spots collected from a national sample of 1541 Black and White children and submitted to a commercial laboratory for lead analysis were analyzed for cotinine. We used an anonymous administrative data set including information on children's characteristics to conduct univariate and multivariate analyses. Cotinine was detected in 61% of dried blood spots; 17% of samples had cotinine levels above 3 nanograms per gram. Median cotinine levels were significantly higher among Black than White children (0.66 ng/g vs 0.30 ng/g) and among Medicaid recipients (0.94 ng/g vs < 0.3 ng/g). In multivariate analyses, significant increases in cotinine levels were associated with Black (vs White) race, older age, Medicaid coverage, higher state smoking rate, and higher average winter temperature. Detectable cotinine levels were significantly associated with higher lead levels. TSE is highly prevalent among children undergoing lead screening, and exposure levels are greater among Black children and children on Medicaid. TSE may contribute to lead exposure. Concurrent lead screening and biological screening for TSE may be a feasible approach to increasing childhood TSE detection.

Assessment of Computer Literacy of Nurses in Lesotho.

PubMed

Mugomeri, Eltony; Chatanga, Peter; Maibvise, Charles; Masitha, Matseliso

2016-11-01

Health systems worldwide are moving toward use of information technology to improve healthcare delivery. However, this requires basic computer skills. This study assessed the computer literacy of nurses in Lesotho using a cross-sectional quantitative approach. A structured questionnaire with 32 standardized computer skills was distributed to 290 randomly selected nurses in Maseru District. Univariate and multivariate logistic regression analyses in Stata 13 were performed to identify factors associated with having inadequate computer skills. Overall, 177 (61%) nurses scored below 16 of the 32 skills assessed. Finding hyperlinks on Web pages (63%), use of advanced search parameters (60.2%), and downloading new software (60.1%) proved to be challenging to the highest proportions of nurses. Age, sex, year of obtaining latest qualification, computer experience, and work experience were significantly (P < .05) associated with inadequate computer skills in univariate analysis. However, in multivariate analyses, sex (P = .001), year of obtaining latest qualification (P = .011), and computer experience (P < .001) emerged as significant factors. The majority of nurses in Lesotho have inadequate computer skills, and this is significantly associated with having many years since obtaining their latest qualification, being female, and lack of exposure to computers. These factors should be considered during planning of training curriculum for nurses in Lesotho.

Low creatinine clearance is a risk factor for D2 gastrectomy after neoadjuvant chemotherapy.

PubMed

Hayashi, Tsutomu; Aoyama, Toru; Tanabe, Kazuaki; Nishikawa, Kazuhiro; Ito, Yuichi; Ogata, Takashi; Cho, Haruhiko; Morita, Satoshi; Miyashita, Yumi; Tsuburaya, Akira; Sakamoto, Junichi; Yoshikawa, Takaki

2014-09-01

The feasibility and safety of D2 surgery following neoadjuvant chemotherapy (NAC) has not been fully evaluated in patients with gastric cancer. Moreover, risk factor for surgical complications after D2 gastrectomy following NAC is also unknown. The purpose of the present study was to identify risk factors of postoperative complications after D2 surgery following NAC. This study was conducted as an exploratory analysis of a prospective, randomized Phase II trial of NAC. The surgical complications were assessed and classified according to the Clavien-Dindo classification. A uni- and multivariate logistic regression analyses were performed to identify risk factors for morbidity. Among 83 patients who were registered to the Phase II trial, 69 patients received the NAC and D2 gastrectomy. Postoperative complications were identified in 18 patients and the overall morbidity rate was 26.1 %. The results of univariate and multivariate analyses of various factors for overall operative morbidity, creatinine clearance (CCr) ≤ 60 ml/min (P = 0.016) was identified as sole significant independent risk factor for overall morbidity. Occurrence of pancreatic fistula was significantly higher in the patients with a low CCr than in those with a high CCr. Low CCr was a significant risk factor for surgical complications in D2 gastrectomy after NAC. Careful attention is required for these patients.

High serum uric acid concentration predicts poor survival in patients with breast cancer.

PubMed

Yue, Cai-Feng; Feng, Pin-Ning; Yao, Zhen-Rong; Yu, Xue-Gao; Lin, Wen-Bin; Qian, Yuan-Min; Guo, Yun-Miao; Li, Lai-Sheng; Liu, Min

2017-10-01

Uric acid is a product of purine metabolism. Recently, uric acid has gained much attraction in cancer. In this study, we aim to investigate the clinicopathological and prognostic significance of serum uric acid concentration in breast cancer patients. A total of 443 female patients with histopathologically diagnosed breast cancer were included. After a mean follow-up time of 56months, survival was analysed using the Kaplan-Meier method. To further evaluate the prognostic significance of uric acid concentrations, univariate and multivariate Cox regression analyses were applied. Of the clinicopathological parameters, uric acid concentration was associated with age, body mass index, ER status and PR status. Univariate analysis identified that patients with increased uric acid concentration had a significantly inferior overall survival (HR 2.13, 95% CI 1.15-3.94, p=0.016). In multivariate analysis, we found that high uric acid concentration is an independent prognostic factor predicting death, but insufficient to predict local relapse or distant metastasis. Kaplan-Meier analysis indicated that high uric acid concentration is related to the poor overall survival (p=0.013). High uric acid concentration predicts poor survival in patients with breast cancer, and might serve as a potential marker for appropriate management of breast cancer patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Predictive factors for 1-year outcome of a cohort of patients with severe traumatic brain injury (TBI): results from the PariS-TBI study.

PubMed

Jourdan, C; Bosserelle, V; Azerad, S; Ghout, I; Bayen, E; Aegerter, P; Weiss, J J; Mateo, J; Lescot, T; Vigué, B; Tazarourte, K; Pradat-Diehl, P; Azouvi, P

2013-01-01

To assess outcome and predicting factors 1 year after a severe traumatic brain injury (TBI). Multi-centre prospective inception cohort study of patients aged 15 or older with a severe TBI in the Parisian area, France. Data were collected prospectively starting the day of injury. One-year evaluation included the relatives-rating of the Dysexecutive Questionnaire (DEX-R), the Glasgow Outcome Scale-Extended (GOSE) and employment. Univariate and multivariate tests were computed. Among 257 survivors, 134 were included (mean age 36 years, 84% men). Good recovery concerned 19%, moderate disability 43% and severe disability 38%. Among patients employed pre-injury, 42% were working, 28% with no job change. DEX-R score was significantly associated with length of education only. Among initial severity measures, only the IMPACT prognostic score was significantly related to GOSE in univariate analyses, while measures relating to early evolution were more significant predictors. In multivariate analyses, independent predictors of GOSE were length of stay in intensive care (LOS), age and education. Independent predictors of employment were LOS and age. Age, education and injury severity are independent predictors of global disability and return to work 1 year after a severe TBI.

Prevalence and Determinants of Physical Activity and Fluid Intake in Kidney Transplant Recipients

PubMed Central

Gordon, Elisa J.; Prohaska, Thomas R.; Gallant, Mary P.; Sehgal, Ashwini R.; Strogatz, David; Conti, David; Siminoff, Laura A.

2009-01-01

Background and Significance Self-care for kidney transplantation is recommended to maintain kidney function. Little is known about levels of self-care practices, and demographic, psychosocial, and health-related correlates. Aim We investigated patients’ self-reported exercise and fluid intake, demographic and psychosocial factors associated with these self-care practices, and health-related quality of life. Methods Eighty-eight of 158 kidney recipients from two academic medical centers completed a semi-structured interview and surveys 2 months post-transplant. Results Most patients were sedentary (76%) with a quarter exercising either regularly (11%) or not at current recommendations (13%). One third (35%) reported drinking the recommended three liters of fluid daily. Multivariate analyses indicated that private insurance, high self-efficacy, and better physical functioning were significantly associated with engaging in physical activity (p<0.05); while male gender, private insurance, high self-efficacy, and not attributing oneself responsible for transplant success were significant predictors of adherence to fluid intake (p<0.05). Despite the significance of these predictors, models for physical activity and fluid intake explained 10–15% of the overall variance in these behaviors. Multivariate analyses indicated that younger age, high value of exercise, and higher social functioning significantly (p<0.05) predicted high self-efficacy for physical activity, while being married significantly (p<0.05) predicted high self-efficacy for fluid intake. Conclusion Identifying patients at risk of inadequate self-care practice is essential for educating patients about the importance of self-care. PMID:19925468

[The impact of stress and personality on resilience of patients with ulcerative colitis].

PubMed

Liu, W; Wang, J; Wang, H; Chen, X Y; Li, J S

2018-02-01

Objective: To study relevant factors that influence psychological resilience in patients with ulcerative colitis(UC), especially the role of perceived stress and personality. Methods: Patients with UC were recruited from January 2015 to December 2016 in the First Hospital of Zhengzhou University. Education levels, income, duration of disease, Mayo score and disease phenotype according to Montreal classification were collected. Resilience was measured using Connor-Davidson resilience scale (CD-RISC). Perceived stress was measured by perceived stress scale (PSS). Personality was evaluated using Eysenck personality questionnaire (EPQ). Univariate analyses were conducted to determine the correlation of variables with resilience and thereafter those statistically significant were reanalyzed via a multivariate regression model. Results: A total of 188 patients with UC were finally recruited. Univariate analyses demonstrated resilience was inversely associated with perceived stress, Mayo score and neuroticism. Extraversion, income, college education were positively related to resilience. However, multivariate analyses revealed that perceived stress( OR= 0.901, 95% CI 0.833-0.975), extraversion ( OR= 1.257, 95% CI 1.087-1.454), neuroticism ( OR= 0.818, 95% CI 0.679-0.985), Mayo score ( OR= 0.856, 95% CI 0.742-0.988) and income ( OR= 6.411, 95% CI 2.136-9.244) were significantly related to resilience. Conclusions: Resilience of UC patients is not only associated with disease activity, but also with personality, perceived stress and income.

The intervals method: a new approach to analyse finite element outputs using multivariate statistics

PubMed Central

De Esteban-Trivigno, Soledad; Püschel, Thomas A.; Fortuny, Josep

2017-01-01

Background In this paper, we propose a new method, named the intervals’ method, to analyse data from finite element models in a comparative multivariate framework. As a case study, several armadillo mandibles are analysed, showing that the proposed method is useful to distinguish and characterise biomechanical differences related to diet/ecomorphology. Methods The intervals’ method consists of generating a set of variables, each one defined by an interval of stress values. Each variable is expressed as a percentage of the area of the mandible occupied by those stress values. Afterwards these newly generated variables can be analysed using multivariate methods. Results Applying this novel method to the biological case study of whether armadillo mandibles differ according to dietary groups, we show that the intervals’ method is a powerful tool to characterize biomechanical performance and how this relates to different diets. This allows us to positively discriminate between specialist and generalist species. Discussion We show that the proposed approach is a useful methodology not affected by the characteristics of the finite element mesh. Additionally, the positive discriminating results obtained when analysing a difficult case study suggest that the proposed method could be a very useful tool for comparative studies in finite element analysis using multivariate statistical approaches. PMID:29043107

Preference-based Health status in a German outpatient cohort with multiple sclerosis

PubMed Central

2013-01-01

Background To prospectively determine health status and health utility and its predictors in patients with multiple sclerosis (MS). Methods A total of 144 MS patients (mean age: 41.0 ±11.3y) with different subtypes (patterns of progression) and severities of MS were recruited in an outpatient university clinic in Germany. Patients completed a questionnaire at baseline (n = 144), 6 months (n = 65) and 12 months (n = 55). Health utilities were assessed using the EuroQol instrument (EQ-5D, EQ VAS). Health status was assessed by several scales (Expanded Disability Severity Scale (EDSS), Modified Fatigue Impact Scale (M-FIS), Functional Assessment of MS (FAMS), Beck Depression Inventory (BDI-II) and Multiple Sclerosis Functional Composite (MSFC)). Additionally, demographic and socioeconomic parameters were assessed. Multivariate linear and logistic regressions were applied to reveal independent predictors of health status. Results Health status is substantially diminished in MS patients and the EQ VAS was considerably lower than that of the general German population. No significant change in health-status parameters was observed over a 12-months period. Multivariate analyses revealed M-FIS, BDI-II, MSFC, and EDSS to be significant predictors of reduced health status. Socioeconomic and socio-demographic parameters such as working status, family status, number of household inhabitants, age, and gender did not prove significant in multivariate analyses. Conclusion MS considerably impairs patients’ health status. Guidelines aiming to improve self-reported health status should include treatment options for depression and fatigue. Physicians should be aware of depression and fatigue as co-morbidities. Future studies should consider the minimal clinical difference when health status is a primary outcome. PMID:24089999

Efficacy of Sleeve Gastrectomy with Duodenal-Jejunal Bypass for the Treatment of Obese Severe Diabetes Patients in Japan: a Retrospective Multicenter Study.

PubMed

Naitoh, Takeshi; Kasama, Kazunori; Seki, Yosuke; Ohta, Masayuki; Oshiro, Takashi; Sasaki, Akira; Miyazaki, Yasuhiro; Yamaguchi, Tsuyoshi; Hayashi, Hideki; Imoto, Hirofumi; Tanaka, Naoki; Unno, Michiaki

2018-02-01

The incidence of obesity with type 2 diabetes (T2DM) is increasing in Japan. The main bariatric surgery procedures in Japan are laparoscopic sleeve gastrectomy (LSG) and LSG with duodenal-jejunal bypass (LSG/DJB) because of the high incidence of gastric cancer and difficulty exploring a remnant stomach after gastric bypass. However, few studies have compared the antidiabetic effect of LSG/DJB with LSG alone. The purpose of this study is to compare the antidiabetic effect of LSG/DJB with that of LSG alone in Japanese obese diabetic patients. This was a retrospective multicenter study including 298 cases: 177 and 121 LSG and LSG/DJB cases, respectively. We investigated the antidiabetic effect of these two procedures at 12 months after surgery. Univariate and multivariate analyses were done to evaluate the predictive factors of T2DM remission. The diabetes remission rate at 12 months after surgery was 80.8% for LSG and 86.0% for LSG/DJB. Insulin use and HbA1c ≤ 6.7% were significant predictive factors in multivariate analysis for all patients. In patients with ABCD score ≥ 6, the diabetes remission rate was 94.8% and there was no difference between procedures. Only duration of diabetes and insulin use were significant predictive factors both in univariate and multivariate analyses. However, in cases with ABCD score ≤ 5, the remission rate was 70.3% and procedure type was the most significant predictive factor for diabetes remission (odds ratio [OR] 5.140). Although both LSG and LSG/DJB have good antidiabetic effects in Japanese obese patients, LSG/DJB is more effective for patients with lower ABCD scores.

PHI and PCA3 improve the prognostic performance of PRIAS and Epstein criteria in predicting insignificant prostate cancer in men eligible for active surveillance.

PubMed

Cantiello, Francesco; Russo, Giorgio Ivan; Cicione, Antonio; Ferro, Matteo; Cimino, Sebastiano; Favilla, Vincenzo; Perdonà, Sisto; De Cobelli, Ottavio; Magno, Carlo; Morgia, Giuseppe; Damiano, Rocco

2016-04-01

To assess the performance of prostate health index (PHI) and prostate cancer antigen 3 (PCA3) when added to the PRIAS or Epstein criteria in predicting the presence of pathologically insignificant prostate cancer (IPCa) in patients who underwent radical prostatectomy (RP) but eligible for active surveillance (AS). An observational retrospective study was performed in 188 PCa patients treated with laparoscopic or robot-assisted RP but eligible for AS according to Epstein or PRIAS criteria. Blood and urinary specimens were collected before initial prostate biopsy for PHI and PCA3 measurements. Multivariate logistic regression analyses and decision curve analysis were carried out to identify predictors of IPCa using the updated ERSPC definition. At the multivariate analyses, the inclusion of both PCA3 and PHI significantly increased the accuracy of the Epstein multivariate model in predicting IPCa with an increase of 17 % (AUC = 0.77) and of 32 % (AUC = 0.92), respectively. The inclusion of both PCA3 and PHI also increased the predictive accuracy of the PRIAS multivariate model with an increase of 29 % (AUC = 0.87) and of 39 % (AUC = 0.97), respectively. DCA revealed that the multivariable models with the addition of PHI or PCA3 showed a greater net benefit and performed better than the reference models. In a direct comparison, PHI outperformed PCA3 performance resulting in higher net benefit. In a same cohort of patients eligible for AS, the addition of PHI and PCA3 to Epstein or PRIAS models improved their prognostic performance. PHI resulted in greater net benefit in predicting IPCa compared to PCA3.

Kidney transplantation from deceased donors with elevated serum creatinine.

PubMed

Gallinat, Anja; Leerhoff, Sabine; Paul, Andreas; Molmenti, Ernesto P; Schulze, Maren; Witzke, Oliver; Sotiropoulos, Georgios C

2016-12-01

Elevated donor serum creatinine has been associated with inferior graft survival in kidney transplantation (KT). The aim of this study was to evaluate the impact of elevated donor serum creatinine on short and long-term outcomes and to determine possible ways to optimize the use of these organs. All kidney transplants from 01-2000 to 12-2012 with donor creatinine ≥ 2 mg/dl were considered. Risk factors for delayed graft function (DGF) were explored with uni- and multivariate regression analyses. Donor and recipient data were analyzed with uni- and multivariate cox proportional hazard analyses. Graft and patient survival were calculated using the Kaplan-Meier method. Seventy-eight patients were considered. Median recipient age and waiting time on dialysis were 53 years and 5.1 years, respectively. After a median follow-up of 6.2 years, 63 patients are alive. 1, 3, and 5-year graft and patient survival rates were 92, 89, and 89 % and 96, 93, and 89 %, respectively. Serum creatinine level at procurement and recipient's dialysis time prior to KT were predictors of DGF in multivariate analysis (p = 0.0164 and p = 0.0101, respectively). Charlson comorbidity score retained statistical significance by multivariate regression analysis for graft survival (p = 0.0321). Recipient age (p = 0.0035) was predictive of patient survival by multivariate analysis. Satisfactory long-term kidney transplant outcomes in the setting of elevated donor serum creatinine ≥2 mg/dl can be achieved when donor creatinine is <3.5 mg/dl, and the recipient has low comorbidities, is under 56 years of age, and remains in dialysis prior to KT for <6.8 years.

Computational neuroanatomy using brain deformations: From brain parcellation to multivariate pattern analysis and machine learning.

PubMed

Davatzikos, Christos

2016-10-01

The past 20 years have seen a mushrooming growth of the field of computational neuroanatomy. Much of this work has been enabled by the development and refinement of powerful, high-dimensional image warping methods, which have enabled detailed brain parcellation, voxel-based morphometric analyses, and multivariate pattern analyses using machine learning approaches. The evolution of these 3 types of analyses over the years has overcome many challenges. We present the evolution of our work in these 3 directions, which largely follows the evolution of this field. We discuss the progression from single-atlas, single-registration brain parcellation work to current ensemble-based parcellation; from relatively basic mass-univariate t-tests to optimized regional pattern analyses combining deformations and residuals; and from basic application of support vector machines to generative-discriminative formulations of multivariate pattern analyses, and to methods dealing with heterogeneity of neuroanatomical patterns. We conclude with discussion of some of the future directions and challenges. Copyright © 2016. Published by Elsevier B.V.

Computational neuroanatomy using brain deformations: From brain parcellation to multivariate pattern analysis and machine learning

PubMed Central

Davatzikos, Christos

2017-01-01

The past 20 years have seen a mushrooming growth of the field of computational neuroanatomy. Much of this work has been enabled by the development and refinement of powerful, high-dimensional image warping methods, which have enabled detailed brain parcellation, voxel-based morphometric analyses, and multivariate pattern analyses using machine learning approaches. The evolution of these 3 types of analyses over the years has overcome many challenges. We present the evolution of our work in these 3 directions, which largely follows the evolution of this field. We discuss the progression from single-atlas, single-registration brain parcellation work to current ensemble-based parcellation; from relatively basic mass-univariate t-tests to optimized regional pattern analyses combining deformations and residuals; and from basic application of support vector machines to generative-discriminative formulations of multivariate pattern analyses, and to methods dealing with heterogeneity of neuroanatomical patterns. We conclude with discussion of some of the future directions and challenges. PMID:27514582

Racial disparities in diabetes mortality in the 50 most populous US cities.

PubMed

Rosenstock, Summer; Whitman, Steve; West, Joseph F; Balkin, Michael

2014-10-01

While studies have consistently shown that in the USA, non-Hispanic Blacks (Blacks) have higher diabetes prevalence, complication and death rates than non-Hispanic Whites (Whites), there are no studies that compare disparities in diabetes mortality across the largest US cities. This study presents and compares Black/White age-adjusted diabetes mortality rate ratios (RRs), calculated using national death files and census data, for the 50 most populous US cities. Relationships between city-level diabetes mortality RRs and 12 ecological variables were explored using bivariate correlation analyses. Multivariate analyses were conducted using negative binomial regression to examine how much of the disparity could be explained by these variables. Blacks had statistically significantly higher mortality rates compared to Whites in 39 of the 41 cities included in analyses, with statistically significant rate ratios ranging from 1.57 (95 % CI: 1.33-1.86) in Baltimore to 3.78 (95 % CI: 2.84-5.02) in Washington, DC. Analyses showed that economic inequality was strongly correlated with the diabetes mortality disparity, driven by differences in White poverty levels. This was followed by segregation. Multivariate analyses showed that adjusting for Black/White poverty alone explained 58.5 % of the disparity. Adjusting for Black/White poverty and segregation explained 72.6 % of the disparity. This study emphasizes the role that inequalities in social and economic determinants, rather than for example poverty on its own, play in Black/White diabetes mortality disparities. It also highlights how the magnitude of the disparity and the factors that influence it can vary greatly across cities, underscoring the importance of using local data to identify context specific barriers and develop effective interventions to eliminate health disparities.

Morphological and Hemodynamic Discriminators for Rupture Status in Posterior Communicating Artery Aneurysms

PubMed Central

Karmonik, Christof; Fang, Yibin; Xu, Jinyu; Yu, Ying; Cao, Wei; Liu, Jianmin; Huang, Qinghai

2016-01-01

Background and Purpose The conflicting findings of previous morphological and hemodynamic studies on intracranial aneurysm rupture may be caused by the relatively small sample sizes and the variation in location of the patient-specific aneurysm models. We aimed to determine the discriminators for aneurysm rupture status by focusing on only posterior communicating artery (PCoA) aneurysms. Materials and Methods In 129 PCoA aneurysms (85 ruptured, 44 unruptured), clinical, morphological and hemodynamic characteristics were compared between the ruptured and unruptured cases. Multivariate logistic regression analysis was performed to determine the discriminators for rupture status of PCoA aneurysms. Results While univariate analyses showed that the size of aneurysm dome, aspect ratio (AR), size ratio (SR), dome-to-neck ratio (DN), inflow angle (IA), normalized wall shear stress (NWSS) and percentage of low wall shear stress area (LSA) were significantly associated with PCoA aneurysm rupture status. With multivariate analyses, significance was only retained for higher IA (OR = 1.539, p < 0.001) and LSA (OR = 1.393, p = 0.041). Conclusions Hemodynamics and morphology were related to rupture status of intracranial aneurysms. Higher IA and LSA were identified as discriminators for rupture status of PCoA aneurysms. PMID:26910518

Morphological and Hemodynamic Discriminators for Rupture Status in Posterior Communicating Artery Aneurysms.

PubMed

Lv, Nan; Wang, Chi; Karmonik, Christof; Fang, Yibin; Xu, Jinyu; Yu, Ying; Cao, Wei; Liu, Jianmin; Huang, Qinghai

2016-01-01

The conflicting findings of previous morphological and hemodynamic studies on intracranial aneurysm rupture may be caused by the relatively small sample sizes and the variation in location of the patient-specific aneurysm models. We aimed to determine the discriminators for aneurysm rupture status by focusing on only posterior communicating artery (PCoA) aneurysms. In 129 PCoA aneurysms (85 ruptured, 44 unruptured), clinical, morphological and hemodynamic characteristics were compared between the ruptured and unruptured cases. Multivariate logistic regression analysis was performed to determine the discriminators for rupture status of PCoA aneurysms. While univariate analyses showed that the size of aneurysm dome, aspect ratio (AR), size ratio (SR), dome-to-neck ratio (DN), inflow angle (IA), normalized wall shear stress (NWSS) and percentage of low wall shear stress area (LSA) were significantly associated with PCoA aneurysm rupture status. With multivariate analyses, significance was only retained for higher IA (OR = 1.539, p < 0.001) and LSA (OR = 1.393, p = 0.041). Hemodynamics and morphology were related to rupture status of intracranial aneurysms. Higher IA and LSA were identified as discriminators for rupture status of PCoA aneurysms.

The High Prevalence of Incarceration History Among Black Men Who Have Sex With Men in the United States: Associations and Implications

PubMed Central

Magnus, Manya; Kuo, Irene; Wang, Lei; Liu, Ting-Yuan; Mayer, Kenneth H.

2014-01-01

Objectives. We examined lifetime incarceration history and its association with key characteristics among 1553 Black men who have sex with men (BMSM) recruited in 6 US cities. Methods. We conducted bivariate analyses of data collected from the HIV Prevention Trials Network 061 study from July 2009 through December 2011 to examine the relationship between incarceration history and demographic and psychosocial variables predating incarceration and multivariate logistic regression analyses to explore the associations between incarceration history and demographic and psychosocial variables found to be significant. We then used multivariate logistic regression models to explore the independent association between incarceration history and 6 outcome variables. Results. After adjusting for confounders, we found that increasing age, transgender identity, heterosexual or straight identity, history of childhood violence, and childhood sexual experience were significantly associated with incarceration history. A history of incarceration was also independently associated with any alcohol and drug use in the past 6 months. Conclusions. The findings highlight an elevated lifetime incarceration history among a geographically diverse sample of BMSM and the need to adequately assess the impact of incarceration among BMSM in the United States. PMID:24432948

Borrowing of strength and study weights in multivariate and network meta-analysis.

PubMed

Jackson, Dan; White, Ian R; Price, Malcolm; Copas, John; Riley, Richard D

2017-12-01

Multivariate and network meta-analysis have the potential for the estimated mean of one effect to borrow strength from the data on other effects of interest. The extent of this borrowing of strength is usually assessed informally. We present new mathematical definitions of 'borrowing of strength'. Our main proposal is based on a decomposition of the score statistic, which we show can be interpreted as comparing the precision of estimates from the multivariate and univariate models. Our definition of borrowing of strength therefore emulates the usual informal assessment. We also derive a method for calculating study weights, which we embed into the same framework as our borrowing of strength statistics, so that percentage study weights can accompany the results from multivariate and network meta-analyses as they do in conventional univariate meta-analyses. Our proposals are illustrated using three meta-analyses involving correlated effects for multiple outcomes, multiple risk factor associations and multiple treatments (network meta-analysis).

Borrowing of strength and study weights in multivariate and network meta-analysis

PubMed Central

Jackson, Dan; White, Ian R; Price, Malcolm; Copas, John; Riley, Richard D

2016-01-01

Multivariate and network meta-analysis have the potential for the estimated mean of one effect to borrow strength from the data on other effects of interest. The extent of this borrowing of strength is usually assessed informally. We present new mathematical definitions of ‘borrowing of strength’. Our main proposal is based on a decomposition of the score statistic, which we show can be interpreted as comparing the precision of estimates from the multivariate and univariate models. Our definition of borrowing of strength therefore emulates the usual informal assessment. We also derive a method for calculating study weights, which we embed into the same framework as our borrowing of strength statistics, so that percentage study weights can accompany the results from multivariate and network meta-analyses as they do in conventional univariate meta-analyses. Our proposals are illustrated using three meta-analyses involving correlated effects for multiple outcomes, multiple risk factor associations and multiple treatments (network meta-analysis). PMID:26546254

Religion and body weight: a review of quantitative studies.

PubMed

Yeary, Karen Hye-Cheon Kim; Sobal, Jeffery; Wethington, Elaine

2017-10-01

Increasing interest in relationships between religion and health has encouraged research about religion and body weight, which has produced mixed findings. We systematically searched 11 bibliographic databases for quantitative studies of religion and weight, locating and coding 85 studies. We conducted a systematic review, analysing descriptive characteristics of the studies as well as relevant religion-body weight associations related to study characteristics. We summarized findings for two categories of religion variables: religious affiliation and religiosity. For religious affiliation, we found evidence for significant associations with body weight in both cross-sectional and longitudinal studies. In particular, Seventh-Day Adventists had lower body weight than other denominations in cross-sectional analyses. For religiosity, significant associations occurred between greater religiosity and higher body weight in both cross-sectional and longitudinal studies. In particular, greater religiosity was significantly associated with higher body weight in bivariate analyses but less so in multivariate analyses. A greater proportion of studies that used a representative sample, longitudinal analyses, and samples with only men reported significant associations between religiosity and weight. Evidence in seven studies suggested that health behaviours and psychosocial factors mediate religion-weight relationships. More longitudinal studies and analyses of mediators are needed to provide stronger evidence and further elucidate religion-weight relationships. © 2017 World Obesity Federation.

BrainAGE score indicates accelerated brain aging in schizophrenia, but not bipolar disorder.

PubMed

Nenadić, Igor; Dietzek, Maren; Langbein, Kerstin; Sauer, Heinrich; Gaser, Christian

2017-08-30

BrainAGE (brain age gap estimation) is a novel morphometric parameter providing a univariate score derived from multivariate voxel-wise analyses. It uses a machine learning approach and can be used to analyse deviation from physiological developmental or aging-related trajectories. Using structural MRI data and BrainAGE quantification of acceleration or deceleration of in individual aging, we analysed data from 45 schizophrenia patients, 22 bipolar I disorder patients (mostly with previous psychotic symptoms / episodes), and 70 healthy controls. We found significantly higher BrainAGE scores in schizophrenia, but not bipolar disorder patients. Our findings indicate significantly accelerated brain structural aging in schizophrenia. This suggests, that despite the conceptualisation of schizophrenia as a neurodevelopmental disorder, there might be an additional progressive pathogenic component. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Pretreatment Health Behaviors Predict Survival Among Patients With Head and Neck Squamous Cell Carcinoma

PubMed Central

Duffy, Sonia A.; Ronis, David L.; McLean, Scott; Fowler, Karen E.; Gruber, Stephen B.; Wolf, Gregory T.; Terrell, Jeffrey E.

2009-01-01

Purpose Our prior work has shown that the health behaviors of head and neck cancer patients are interrelated and are associated with quality of life; however, other than smoking, the relationship between health behaviors and survival is unclear. Patients and Methods A prospective cohort study was conducted to determine the relationship between five pretreatment health behaviors (smoking, alcohol, diet, physical activity, and sleep) and all-cause survival among 504 head and neck cancer patients. Results Smoking status was the strongest predictor of survival, with both current smokers (hazard ratio [HR] = 2.4; 95% CI, 1.3 to 4.4) and former smokers (HR = 2.0; 95% CI, 1.2 to 3.5) showing significant associations with poor survival. Problem drinking was associated with survival in the univariate analysis (HR = 1.4; 95% CI, 1.0 to 2.0) but lost significance when controlling for other factors. Low fruit intake was negatively associated with survival in the univariate analysis only (HR = 1.6; 95% CI, 1.1 to 2.1), whereas vegetable intake was not significant in either univariate or multivariate analyses. Although physical activity was associated with survival in the univariate analysis (HR = 0.95; 95% CI, 0.93 to 0.97), it was not significant in the multivariate model. Sleep was not significantly associated with survival in either univariate or multivariate analysis. Control variables that were also independently associated with survival in the multivariate analysis were age, education, tumor site, cancer stage, and surgical treatment. Conclusion Variation in selected pretreatment health behaviors (eg, smoking, fruit intake, and physical activity) in this population is associated with variation in survival. PMID:19289626

Impacts of rising health care costs on families with employment-based private insurance: a national analysis with state fixed effects.

PubMed

Yu, Hao; Dick, Andrew W

2012-10-01

Given the rapid growth of health care costs, some experts were concerned with erosion of employment-based private insurance (EBPI). This empirical analysis aims to quantify the concern. Using the National Health Account, we generated a cost index to represent state-level annual cost growth. We merged it with the 1996-2003 Medical Expenditure Panel Survey. The unit of analysis is the family. We conducted both bivariate and multivariate logistic analyses. The bivariate analysis found a significant inverse association between the cost index and the proportion of families receiving an offer of EBPI. The multivariate analysis showed that the cost index was significantly negatively associated with the likelihood of receiving an EBPI offer for the entire sample and for families in the first, second, and third quartiles of income distribution. The cost index was also significantly negatively associated with the proportion of families with EBPI for the entire year for each family member (EBPI-EYEM). The multivariate analysis confirmed significance of the relationship for the entire sample, and for families in the second and third quartiles of income distribution. Among the families with EBPI-EYEM, there was a positive relationship between the cost index and this group's likelihood of having out-of-pocket expenditures exceeding 10 percent of family income. The multivariate analysis confirmed significance of the relationship for the entire group and for families in the second and third quartiles of income distribution. Rising health costs reduce EBPI availability and enrollment, and the financial protection provided by it, especially for middle-class families. © Health Research and Educational Trust.

Impacts of Rising Health Care Costs on Families with Employment-Based Private Insurance: A National Analysis with State Fixed Effects

PubMed Central

Yu, Hao; Dick, Andrew W

2012-01-01

Background Given the rapid growth of health care costs, some experts were concerned with erosion of employment-based private insurance (EBPI). This empirical analysis aims to quantify the concern. Methods Using the National Health Account, we generated a cost index to represent state-level annual cost growth. We merged it with the 1996–2003 Medical Expenditure Panel Survey. The unit of analysis is the family. We conducted both bivariate and multivariate logistic analyses. Results The bivariate analysis found a significant inverse association between the cost index and the proportion of families receiving an offer of EBPI. The multivariate analysis showed that the cost index was significantly negatively associated with the likelihood of receiving an EBPI offer for the entire sample and for families in the first, second, and third quartiles of income distribution. The cost index was also significantly negatively associated with the proportion of families with EBPI for the entire year for each family member (EBPI-EYEM). The multivariate analysis confirmed significance of the relationship for the entire sample, and for families in the second and third quartiles of income distribution. Among the families with EBPI-EYEM, there was a positive relationship between the cost index and this group's likelihood of having out-of-pocket expenditures exceeding 10 percent of family income. The multivariate analysis confirmed significance of the relationship for the entire group and for families in the second and third quartiles of income distribution. Conclusions Rising health costs reduce EBPI availability and enrollment, and the financial protection provided by it, especially for middle-class families. PMID:22417314

Does placental inflammation relate to brain lesions and volume in preterm infants?

PubMed

Reiman, Milla; Kujari, Harry; Maunu, Jonna; Parkkola, Riitta; Rikalainen, Hellevi; Lapinleimu, Helena; Lehtonen, Liisa; Haataja, Leena

2008-05-01

To evaluate the association between histologic inflammation of placenta and brain findings in ultrasound examinations and regional brain volumes in magnetic resonance imaging in very-low-birth-weight (VLBW) or in very preterm infants. VLBW or very preterm infants (n = 121) were categorized into 3 groups according to the most pathologic brain finding on ultrasound examinations until term. The brain magnetic resonance imaging performed at term was analyzed for regional brain volumes. The placentas were analyzed for histologic inflammatory findings. Histologic chorioamnionitis on the fetal side correlated to brain lesions in univariate but not in multivariate analyses. Low gestational age was the only significant risk factor for brain lesions in multivariate analysis (P < .0001). Histologic chorioamnionitis was not associated with brain volumes in multivariate analyses. Female sex, low gestational age, and low birth weight z score correlated to smaller volumes in total brain tissue (P = .001, P = .0002, P < .0001, respectively) and cerebellum (P = .047, P = .003, P = .001, respectively). In addition, low gestational age and low-birth-weight z score correlated to a smaller combined volume of basal ganglia and thalami (P = .0002). Placental inflammation does not appear to correlate to brain lesions or smaller regional brain volumes in VLBW or in very preterm infants at term age.

Prevalence and determinants of physical activity and fluid intake in kidney transplant recipients.

PubMed

Gordon, Elisa J; Prohaska, Thomas R; Gallant, Mary P; Sehgal, Ashwini R; Strogatz, David; Conti, David; Siminoff, Laura A

2010-01-01

Self-care for kidney transplantation is recommended to maintain kidney function. Little is known about levels of self-care practices and demographic, psychosocial, and health-related correlates. To investigate patients' self-reported exercise and fluid intake, demographic and psychosocial factors associated with these self-care practices, and health-related quality of life. Eighty-eight of 158 kidney recipients from two academic medical centers completed a semi-structured interview and surveys 2 months post-transplant. Most patients were sedentary (76%) with a quarter exercising either regularly (11%) or not at current recommendations (13%). One-third (35%) reported drinking the recommended 3 L of fluid daily. Multivariate analyses indicated that private insurance, high self-efficacy, and better physical functioning were significantly associated with engaging in physical activity (p < 0.05); while male gender, private insurance, high self-efficacy, and not attributing oneself responsible for transplant success were significant predictors of adherence to fluid intake (p < 0.05). Despite the significance of these predictors, models for physical activity and fluid intake explained 10-15% of the overall variance in these behaviors. Multivariate analyses indicated that younger age, high value of exercise, and higher social functioning significantly (p < 0.05) predicted high self-efficacy for physical activity, while being married significantly (p < 0.05) predicted high self-efficacy for fluid intake. Identifying patients at risk of inadequate self-care practice is essential for educating patients about the importance of self-care.

The Impact of Asking Intention or Self-Prediction Questions on Subsequent Behavior

PubMed Central

Wood, Chantelle; Conner, Mark; Miles, Eleanor; Sandberg, Tracy; Taylor, Natalie; Godin, Gaston; Sheeran, Paschal

2015-01-01

The current meta-analysis estimated the magnitude of the impact of asking intention and self-prediction questions on rates of subsequent behavior, and examined mediators and moderators of this question–behavior effect (QBE). Random-effects meta-analysis on 116 published tests of the effect indicated that intention/prediction questions have a small positive effect on behavior (d+ = 0.24). Little support was observed for attitude accessibility, cognitive dissonance, behavioral simulation, or processing fluency explanations of the QBE. Multivariate analyses indicated significant effects of social desirability of behavior/behavior domain (larger effects for more desirable and less risky behaviors), difficulty of behavior (larger effects for easy-to-perform behaviors), and sample type (larger effects among student samples). Although this review controls for co-occurrence of moderators in multivariate analyses, future primary research should systematically vary moderators in fully factorial designs. Further primary research is also needed to unravel the mechanisms underlying different variants of the QBE. PMID:26162771

The impact on social relationships of moving from congregated settings to personalized accommodation.

PubMed

McConkey, Roy; Bunting, Brendan; Keogh, Fiona; Garcia Iriarte, Edurne

2017-01-01

A natural experiment contrasted the social relationships of people with intellectual disabilities ( n = 110) before and after they moved from congregated settings to either personalized accommodation or group homes. Contrasts could also be drawn with individuals who had enduring mental health problems ( n = 46) and who experienced similar moves. Face-to-face interviews were conducted in each person's residence on two occasions approximately 24 months apart. Multivariate statistical analyses were used to determine significant effects. Greater proportions of people living in personalized settings scored higher on the five chosen indicators of social relationships than did persons living in grouped accommodation. However, multivariate statistical analyses identified that only one in five persons increased their social relationships as a result of changes in their accommodation, particularly persons with an intellectual disability and high support needs. These findings reinforce the extent of social isolation experienced by people with disabilities and mental health problems that changes in their accommodation only partially counter.

From Hippocampus to Whole-Brain: The Role of Integrative Processing in Episodic Memory Retrieval

PubMed Central

Geib, Benjamin R.; Stanley, Matthew L.; Dennis, Nancy A.; Woldorff, Marty G.; Cabeza, Roberto

2017-01-01

Multivariate functional connectivity analyses of neuroimaging data have revealed the importance of complex, distributed interactions between disparate yet interdependent brain regions. Recent work has shown that topological properties of functional brain networks are associated with individual and group differences in cognitive performance, including in episodic memory. After constructing functional whole-brain networks derived from an event-related fMRI study of memory retrieval, we examined differences in functional brain network architecture between forgotten and remembered words. This study yielded three main findings. First, graph theory analyses showed that successfully remembering compared to forgetting was associated with significant changes in the connectivity profile of the left hippocampus and a corresponding increase in efficient communication with the rest of the brain. Second, bivariate functional connectivity analyses indicated stronger interactions between the left hippocampus and a retrieval assembly for remembered versus forgotten items. This assembly included the left precuneus, left caudate, bilateral supramarginal gyrus, and the bilateral dorsolateral superior frontal gyrus. Integrative properties of the retrieval assembly were greater for remembered than forgotten items. Third, whole-brain modularity analyses revealed that successful memory retrieval was marginally significantly associated with a less segregated modular architecture in the network. The magnitude of the decreases in modularity between remembered and forgotten conditions was related to memory performance. These findings indicate that increases in integrative properties at the nodal, retrieval assembly, and whole-brain topological levels facilitate memory retrieval, while also underscoring the potential of multivariate brain connectivity approaches for providing valuable new insights into the neural bases of memory processes. PMID:28112460

Self-efficacy and health locus of control: relationship to occupational disability among workers with back pain.

PubMed

Richard, Sylvie; Dionne, Clermont E; Nouwen, Arie

2011-09-01

Although self-efficacy and health locus of control (HLC) have been extensively studied in health research, little is known about their contribution to occupational disability among workers with back pain. This 2 year prospective study examined the association between these control belief constructs and "return to work in good health" (RWGH), a four-category, composite index of back pain outcome. The participants (n = 1,007, participation = 68.4%, follow-up = 86%) were workers with occupational disruptions who sought a medical consultation for non specific back pain in primary care and emergency settings in the Quebec City area, Canada. Information about self-efficacy for return to work (SERW) and HLC, as well as potential confounders, was collected during a telephone interview about 3 weeks after the baseline medical consultation. Polytomous logistic regression was used to assess the relationship between the baseline control variables and RWGH at 2 year. Odds ratios (OR) and their 95% confidence intervals were used to quantify the strength of associations. For all analyses, the "success" category was considered the reference group. Although bivariate analyses showed a significant association between external HLC and RWGH at 2 year, this relationship was not significant in multivariate analyses. Higher scores on the self-efficacy questionnaire were however protective of "failure to return to work after attempt(s)" (OR: 0.28; 95% CI: 0.14-0.57) and of "failure to return to work" (OR: 0.19; 95% CI: 0.07-0.48) in multivariate analyses. Self-efficacy is an important determinant of the occupational outcome of back pain.

Social networks and inflammatory markers in the Framingham Heart Study.

PubMed

Loucks, Eric B; Sullivan, Lisa M; D'Agostino, Ralph B; Larson, Martin G; Berkman, Lisa F; Benjamin, Emelia J

2006-11-01

Lack of social integration predicts coronary heart disease mortality in prospective studies; however, the biological pathways that may be responsible are poorly understood. The specific aims of this study were to examine whether social networks are associated with serum concentrations of the inflammatory markers interleukin-6 (IL-6), C-reactive protein (CRP), soluble intercellular adhesion molecule-1 (sICAM-1) and monocyte chemoattractant protein-1 (MCP-1). Participants in the Framingham Study attending examinations from 1998 to 2001 (n=3267) were eligible for inclusion in the study. Social networks were assessed using the Berkman-Syme Social Network Index (SNI). Concentrations of IL-6, CRP, sICAM-1 and MCP-1 were measured in fasting serum samples. Multivariable linear regression analyses were used to assess the association of social networks with inflammatory markers adjusting for potential confounders including age, smoking, blood pressure, total:HDL cholesterol ratio, body mass index, lipid-lowering and antihypertensive medication, diabetes, cardiovascular disease, depression and socioeconomic status. Results found that the SNI was significantly inversely associated with IL-6 in men (p=0.03) after adjusting for potential confounders. In age-adjusted analyses, social networks also were significantly inversely associated with IL-6 for women (p=0.03) and were marginally to modestly associated with CRP and sICAM-1 for men (p=0.08 and 0.02, respectively), but these associations were not significant in the multivariate analyses. In conclusion, social networks were found to be inversely associated with interleukin-6 levels in men. The possibility that inflammatory markers may be potential mediators between social integration and coronary heart disease merits further investigation.

The Religiosity/Spirituality of Latina Breast Cancer Survivors and Influence on Health-Related Quality of Life

PubMed Central

Wildes, Kimberly A.; Miller, Alexander R.; de Majors, Sandra San Miguel; Ramirez, Amelie G.

2010-01-01

Objective The study evaluated the association of religiosity/spirituality (R/S) and health-related quality of life (HRQOL) among Latina breast cancer survivors (BCS) in order to determine whether R/S would be positively correlated with HRQOL and whether R/S would significantly influence HRQOL. Methods The cross-sectional study utilized self-report data from 117 Latina BCS survivors. R/S was measured with the Systems of Belief Inventory - 15 Revised (SBI-15R) and HRQOL was measured with the Functional Assessment of Cancer Therapy – General (FACT-G). Analyses included calculation of descriptive statistics, t-tests, bivariate correlations, and multivariate analyses. Results Latina BCS had very high levels of R/S and generally good HRQOL. The SBI-15R total score was positively correlated with FACT-G social well-being (r=0.266, p=0.005), relationship with doctor (r=0.219, p=0.020), and functional well-being (r=0.216, p=0.022). Multivariate analyses revealed that SBI-15R was a significant predictor of FACT-G functional well-being (p=0.041) and satisfaction with the relationship with the doctor (p=0.050), where higher levels of R/S predicted higher levels of well-being. Conclusions Latina BCS had very high levels of R/S, which were significantly, positively correlated with dimensions of HRQOL (social well-being, functional well-being, relationship with doctor). Further, these high levels of R/S predicted better functional well-being and satisfaction with the patient-doctor relationship while controlling for potentially confounding variables. Implications are discussed. PMID:19034922

No improvement in the reporting of clinical trial subgroup effects in high-impact general medical journals.

PubMed

Gabler, Nicole B; Duan, Naihua; Raneses, Eli; Suttner, Leah; Ciarametaro, Michael; Cooney, Elizabeth; Dubois, Robert W; Halpern, Scott D; Kravitz, Richard L

2016-07-16

When subgroup analyses are not correctly analyzed and reported, incorrect conclusions may be drawn, and inappropriate treatments provided. Despite the increased recognition of the importance of subgroup analysis, little information exists regarding the prevalence, appropriateness, and study characteristics that influence subgroup analysis. The objective of this study is to determine (1) if the use of subgroup analyses and multivariable risk indices has increased, (2) whether statistical methodology has improved over time, and (3) which study characteristics predict subgroup analysis. We randomly selected randomized controlled trials (RCTs) from five high-impact general medical journals during three time periods. Data from these articles were abstracted in duplicate using standard forms and a standard protocol. Subgroup analysis was defined as reporting any subgroup effect. Appropriate methods for subgroup analysis included a formal test for heterogeneity or interaction across treatment-by-covariate groups. We used logistic regression to determine the variables significantly associated with any subgroup analysis or, among RCTs reporting subgroup analyses, using appropriate methodology. The final sample of 416 articles reported 437 RCTs, of which 270 (62 %) reported subgroup analysis. Among these, 185 (69 %) used appropriate methods to conduct such analyses. Subgroup analysis was reported in 62, 55, and 67 % of the articles from 2007, 2010, and 2013, respectively. The percentage using appropriate methods decreased over the three time points from 77 % in 2007 to 63 % in 2013 (p < 0.05). Significant predictors of reporting subgroup analysis included industry funding (OR 1.94 (95 % CI 1.17, 3.21)), sample size (OR 1.98 per quintile (1.64, 2.40), and a significant primary outcome (OR 0.55 (0.33, 0.92)). The use of appropriate methods to conduct subgroup analysis decreased by year (OR 0.88 (0.76, 1.00)) and was less common with industry funding (OR 0.35 (0.18, 0.70)). Only 33 (18 %) of the RCTs examined subgroup effects using a multivariable risk index. While we found no significant increase in the reporting of subgroup analysis over time, our results show a significant decrease in the reporting of subgroup analyses using appropriate methods during recent years. Industry-sponsored trials may more commonly report subgroup analyses, but without utilizing appropriate methods. Suboptimal reporting of subgroup effects may impact optimal physician-patient decision-making.

Multivariate analyses of Erzgebirge granite and rhyolite composition: Implications for classification of granites and their genetic relations

USGS Publications Warehouse

Forster, H.-J.; Davis, J.C.; Tischendorf, G.; Seltmann, R.

1999-01-01

High-precision major, minor and trace element analyses for 44 elements have been made of 329 Late Variscan granitic and rhyolitic rocks from the Erzgebirge metallogenic province of Germany. The intrusive histories of some of these granites are not completely understood and exposures of rock are not adequate to resolve relationships between what apparently are different plutons. Therefore, it is necessary to turn to chemical analyses to decipher the evolution of the plutons and their relationships. A new classification of Erzgebirge plutons into five major groups of granites, based on petrologic interpretations of geochemical and mineralogical relationships (low-F biotite granites; low-F two-mica granites; high-F, high-P2O5 Li-mica granites; high-F, low-P2O5 Li-mica granites; high-F, low-P2O5 biotite granites) was tested by multivariate techniques. Canonical analyses of major elements, minor elements, trace elements and ratio variables all distinguish the groups with differing amounts of success. Univariate ANOVA's, in combination with forward-stepwise and backward-elimination canonical analyses, were used to select ten variables which were most effective in distinguishing groups. In a biplot, groups form distinct clusters roughly arranged along a quadratic path. Within groups, individual plutons tend to be arranged in patterns possibly reflecting granitic evolution. Canonical functions were used to classify samples of rhyolites of unknown association into the five groups. Another canonical analysis was based on ten elements traditionally used in petrology and which were important in the new classification of granites. Their biplot pattern is similar to that from statistically chosen variables but less effective at distinguishing the five groups of granites. This study shows that multivariate statistical techniques can provide significant insight into problems of granitic petrogenesis and may be superior to conventional procedures for petrological interpretation.

External validity of a hierarchical dimensional model of child and adolescent psychopathology: Tests using confirmatory factor analyses and multivariate behavior genetic analyses.

PubMed

Waldman, Irwin D; Poore, Holly E; van Hulle, Carol; Rathouz, Paul J; Lahey, Benjamin B

2016-11-01

Several recent studies of the hierarchical phenotypic structure of psychopathology have identified a General psychopathology factor in addition to the more expected specific Externalizing and Internalizing dimensions in both youth and adult samples and some have found relevant unique external correlates of this General factor. We used data from 1,568 twin pairs (599 MZ & 969 DZ) age 9 to 17 to test hypotheses for the underlying structure of youth psychopathology and the external validity of the higher-order factors. Psychopathology symptoms were assessed via structured interviews of caretakers and youth. We conducted phenotypic analyses of competing structural models using Confirmatory Factor Analysis and used Structural Equation Modeling and multivariate behavior genetic analyses to understand the etiology of the higher-order factors and their external validity. We found that both a General factor and specific Externalizing and Internalizing dimensions are necessary for characterizing youth psychopathology at both the phenotypic and etiologic levels, and that the 3 higher-order factors differed substantially in the magnitudes of their underlying genetic and environmental influences. Phenotypically, the specific Externalizing and Internalizing dimensions were slightly negatively correlated when a General factor was included, which reflected a significant inverse correlation between the nonshared environmental (but not genetic) influences on Internalizing and Externalizing. We estimated heritability of the general factor of psychopathology for the first time. Its moderate heritability suggests that it is not merely an artifact of measurement error but a valid construct. The General, Externalizing, and Internalizing factors differed in their relations with 3 external validity criteria: mother's smoking during pregnancy, parent's harsh discipline, and the youth's association with delinquent peers. Multivariate behavior genetic analyses supported the external validity of the 3 higher-order factors by suggesting that the General, Externalizing, and Internalizing factors were correlated with peer delinquency and parent's harsh discipline for different etiologic reasons. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Acoustic neuroma: potential risk factors and audiometric surveillance in the aluminium industry

PubMed Central

Taiwo, Oyebode; Galusha, Deron; Tessier-Sherman, Baylah; Kirsche, Sharon; Cantley, Linda; Slade, Martin D; Cullen, Mark R; Donoghue, A Michael

2014-01-01

Objectives To look for an association between acoustic neuroma (AN) and participation in a hearing conservation programme (HCP) and also for an association between AN and possible occupational risk factors in the aluminium industry. Methods We conducted a case–control analysis of a population of US aluminium production workers in 8 smelters and 43 other plants. Using insurance claims data, 97 cases of AN were identified between 1996 and 2009. Each was matched with four controls. Covariates included participation in a HCP, working in an aluminium smelter, working in an electrical job and hearing loss. Results In the bivariate analyses, covariates associated with AN were participation in the HCP (OR=1.72; 95% CI 1.09 to 2.69) and smelter work (OR=1.88; 95% CI 1.06 to 3.36). Electrical work was not significant (OR=1.60; 95% CI 0.65 to 3.94). Owing to high participation in the HCP in smelters, multivariate subanalyses were required. In the multivariate analyses, participation in the HCP was the only statistically significant risk factor for AN. In the multivariate analysis restricted to employees not working in a smelter, the OR was 1.81 (95% CI 1.04 to 3.17). Hearing loss, an indirect measure of in-ear noise dose, was not predictive of AN. Conclusions Our results suggest the incidental detection of previously undiagnosed tumours in workers who participated in the company-sponsored HCP. The increased medical surveillance among this population of workers most likely introduced detection bias, leading to the identification of AN cases that would have otherwise remained undetected. PMID:25015928

Inherited behavioral susceptibility to adiposity in infancy: a multivariate genetic analysis of appetite and weight in the Gemini birth cohort.

PubMed

Llewellyn, Clare H; van Jaarsveld, Cornelia H M; Plomin, Robert; Fisher, Abigail; Wardle, Jane

2012-03-01

The behavioral susceptibility model proposes that inherited differences in traits such as appetite confer differential risk of weight gain and contribute to the heritability of weight. Evidence that the FTO gene may influence weight partly through its effects on appetite supports this model, but testing the behavioral pathways for multiple genes with very small effects is not feasible. Twin analyses make it possible to get a broad-based estimate of the extent of shared genetic influence between appetite and weight. The objective was to use multivariate twin analyses to test the hypothesis that associations between appetite and weight are underpinned by shared genetic effects. Data were from Gemini, a population-based birth cohort of twins (n = 4804) born in 2007. Infant weights at 3 mo were taken from the records of health professionals. Appetite was assessed at 3 mo for the milk-feeding period by using the Baby Eating Behaviour Questionnaire (BEBQ), a parent-reported measure of appetite [enjoyment of food, food responsiveness, slowness in eating (SE), satiety responsiveness (SR), and appetite size (AS)]. Multivariate quantitative genetic modeling was used to test for shared genetic influences. Significant correlations were found between all BEBQ traits and weight. Significant shared genetic influence was identified for weight with SE, SR, and AS; genetic correlations were between 0.22 and 0.37. Shared genetic effects explained 41-45% of these phenotypic associations. Differences in weight in infancy may be due partly to genetically determined differences in appetitive traits that confer differential susceptibility to obesogenic environments.

[Relationship between highly sensitive cardiac troponin T and sepsis and outcome in critically ill patients].

PubMed

Wang, T T; Jiang, L

2017-10-01

Objective: To investigate the prognostic value of highly sensitive cardiac Troponin T (hs-cTn T) for sepsis in critically ill patients. Methods: Patients estimated to stay in the ICU of Fuxing Hospital for more than 24h were enrolled at from March 2014 to December 2014. Serum hs-cTn T was tested within two hours. Univariate and multivariate linear regression analyses were used to determine the association of variables with the hs-cTn T. Multivariable logistic regression analysis was used to evaluate the risk factors of 28-day mortality. Results: A total of 125 patients were finally enrolled including 68 patients with sepsis and 57 without. The levels of hs-cTn T in sepsis and non-sepsis groups were significantly different[52.0(32.5, 87.5) ng/L vs 14.0(6.5, 29.0) ng/L respectively, P <0.001]. In sepsis group, hs-cTn T among common sepsis, severe sepsis and septic shock were similar. Hs-cTn T was significantly higher in non-survivors than survivors [27(13, 52)ng/L vs 44.5(28.8, 83.5)ng/L, P <0.001]. Age, sepsis, serum creatinine were independent risk factors affecting hs-cTn T by multivariate linear regression analyses. But hs-cTn T was not a risk factor for death. Conclusion: Patients with sepsis had higher serum hs-cTn T than those without sepsis. but it was not found to be associated with the severity of sepsis.

Sample size calculations for case-control studies

Cancer.gov

This R package can be used to calculate the required samples size for unconditional multivariate analyses of unmatched case-control studies. The sample sizes are for a scalar exposure effect, such as binary, ordinal or continuous exposures. The sample sizes can also be computed for scalar interaction effects. The analyses account for the effects of potential confounder variables that are also included in the multivariate logistic model.

Probabilistic, meso-scale flood loss modelling

NASA Astrophysics Data System (ADS)

Kreibich, Heidi; Botto, Anna; Schröter, Kai; Merz, Bruno

2016-04-01

Flood risk analyses are an important basis for decisions on flood risk management and adaptation. However, such analyses are associated with significant uncertainty, even more if changes in risk due to global change are expected. Although uncertainty analysis and probabilistic approaches have received increased attention during the last years, they are still not standard practice for flood risk assessments and even more for flood loss modelling. State of the art in flood loss modelling is still the use of simple, deterministic approaches like stage-damage functions. Novel probabilistic, multi-variate flood loss models have been developed and validated on the micro-scale using a data-mining approach, namely bagging decision trees (Merz et al. 2013). In this presentation we demonstrate and evaluate the upscaling of the approach to the meso-scale, namely on the basis of land-use units. The model is applied in 19 municipalities which were affected during the 2002 flood by the River Mulde in Saxony, Germany (Botto et al. submitted). The application of bagging decision tree based loss models provide a probability distribution of estimated loss per municipality. Validation is undertaken on the one hand via a comparison with eight deterministic loss models including stage-damage functions as well as multi-variate models. On the other hand the results are compared with official loss data provided by the Saxon Relief Bank (SAB). The results show, that uncertainties of loss estimation remain high. Thus, the significant advantage of this probabilistic flood loss estimation approach is that it inherently provides quantitative information about the uncertainty of the prediction. References: Merz, B.; Kreibich, H.; Lall, U. (2013): Multi-variate flood damage assessment: a tree-based data-mining approach. NHESS, 13(1), 53-64. Botto A, Kreibich H, Merz B, Schröter K (submitted) Probabilistic, multi-variable flood loss modelling on the meso-scale with BT-FLEMO. Risk Analysis.

Calculating the individual probability of successful ocriplasmin treatment in eyes with VMT syndrome: a multivariable prediction model from the EXPORT study.

PubMed

Paul, Christoph; Heun, Christine; Müller, Hans-Helge; Hoerauf, Hans; Feltgen, Nicolas; Wachtlin, Joachim; Kaymak, Hakan; Mennel, Stefan; Koss, Michael Janusz; Fauser, Sascha; Maier, Mathias M; Schumann, Ricarda G; Mueller, Simone; Chang, Petrus; Schmitz-Valckenberg, Steffen; Kazerounian, Sara; Szurman, Peter; Lommatzsch, Albrecht; Bertelmann, Thomas

2017-10-31

To evaluate predictive factors for the treatment success of ocriplasmin and to use these factors to generate a multivariate model to calculate the individual probability of successful treatment. Data were collected in a retrospective, multicentre cohort study. Patients with vitreomacular traction (VMT) syndrome without a full-thickness macular hole were included if they received an intravitreal injection (IVI) of ocriplasmin. Five factors (age, gender, lens status, presence of epiretinal membrane (ERM) formation and horizontal diameter of VMT) were assessed on their association with VMT resolution. A multivariable logistic regression model was employed to further analyse these factors and calculate the individual probability of successful treatment. 167 eyes of 167 patients were included. Univariate analysis revealed a significant correlation to VMT resolution for all analysed factors: age (years) (OR 0.9208; 95% CI 0.8845 to 0.9586; p<0.0001), gender (male) (OR 0.480; 95% CI 0.241 to 0.957; p=0.0371), lens status (phakic) (OR 2.042; 95% CI 1.054 to 3.958; p=0.0344), ERM formation (present) (OR 0.384; 95% CI 0.179 to 0.821; p=0.0136) and horizontal VMT diameter (µm) (OR 0.99812; 95% CI 0.99684 to 0.99941, p=0.0042). A significant multivariable logistic regression model was established with age and VMT diameter. Known predictive factors for VMT resolution after ocriplasmin IVI were confirmed in our study. We were able to combine them into a formula, ultimately allowing the calculation of an individual probability of treatment success with ocriplasmin in patients with VMT syndrome without FTHM. © 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.

Racial differences in circulating natriuretic peptide levels: the atherosclerosis risk in communities study.

PubMed

Gupta, Deepak K; Claggett, Brian; Wells, Quinn; Cheng, Susan; Li, Man; Maruthur, Nisa; Selvin, Elizabeth; Coresh, Josef; Konety, Suma; Butler, Kenneth R; Mosley, Thomas; Boerwinkle, Eric; Hoogeveen, Ron; Ballantyne, Christie M; Solomon, Scott D

2015-05-21

Natriuretic peptides promote natriuresis, diuresis, and vasodilation. Experimental deficiency of natriuretic peptides leads to hypertension (HTN) and cardiac hypertrophy, conditions more common among African Americans. Hospital-based studies suggest that African Americans may have reduced circulating natriuretic peptides, as compared to Caucasians, but definitive data from community-based cohorts are lacking. We examined plasma N-terminal pro B-type natriuretic peptide (NTproBNP) levels according to race in 9137 Atherosclerosis Risk in Communities (ARIC) Study participants (22% African American) without prevalent cardiovascular disease at visit 4 (1996-1998). Multivariable linear and logistic regression analyses were performed adjusting for clinical covariates. Among African Americans, percent European ancestry was determined from genetic ancestry informative markers and then examined in relation to NTproBNP levels in multivariable linear regression analysis. NTproBNP levels were significantly lower in African Americans (median, 43 pg/mL; interquartile range [IQR], 18, 88) than Caucasians (median, 68 pg/mL; IQR, 36, 124; P<0.0001). In multivariable models, adjusted log NTproBNP levels were 40% lower (95% confidence interval [CI], -43, -36) in African Americans, compared to Caucasians, which was consistent across subgroups of age, gender, HTN, diabetes, insulin resistance, and obesity. African-American race was also significantly associated with having nondetectable NTproBNP (adjusted OR, 5.74; 95% CI, 4.22, 7.80). In multivariable analyses in African Americans, a 10% increase in genetic European ancestry was associated with a 7% (95% CI, 1, 13) increase in adjusted log NTproBNP. African Americans have lower levels of plasma NTproBNP than Caucasians, which may be partially owing to genetic variation. Low natriuretic peptide levels in African Americans may contribute to the greater risk for HTN and its sequalae in this population. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

NMR Spectroscopy Identifies Metabolites Translocated from Powdery Mildew Resistant Rootstocks to Susceptible Watermelon Scions.

PubMed

Mahmud, Iqbal; Kousik, Chandrasekar; Hassell, Richard; Chowdhury, Kamal; Boroujerdi, Arezue F

2015-09-16

Powdery mildew (PM) disease causes significant loss in watermelon. Due to the unavailability of a commercial watermelon variety that is resistant to PM, grafting susceptible cultivars on wild resistant rootstocks is being explored as a short-term management strategy to combat this disease. Nuclear magnetic resonance-based metabolic profiles of susceptible and resistant rootstocks of watermelon and their corresponding susceptible scions (Mickey Lee) were compared to screen for potential metabolites related to PM resistance using multivariate principal component analysis. Significant score plot differences between the susceptible and resistant groups were revealed through Mahalanobis distance analysis. Significantly different spectral buckets and their corresponding metabolites (including choline, fumarate, 5-hydroxyindole-3-acetate, and melatonin) have been identified quantitatively using multivariate loading plots and verified by volcano plot analyses. The data suggest that these metabolites were translocated from the powdery mildew resistant rootstocks to their corresponding powdery mildew susceptible scions and can be related to PM disease resistance.

Prefrontal gray matter volume mediates genetic risks for obesity.

PubMed

Opel, N; Redlich, R; Kaehler, C; Grotegerd, D; Dohm, K; Heindel, W; Kugel, H; Thalamuthu, A; Koutsouleris, N; Arolt, V; Teuber, A; Wersching, H; Baune, B T; Berger, K; Dannlowski, U

2017-05-01

Genetic and neuroimaging research has identified neurobiological correlates of obesity. However, evidence for an integrated model of genetic risk and brain structural alterations in the pathophysiology of obesity is still absent. Here we investigated the relationship between polygenic risk for obesity, gray matter structure and body mass index (BMI) by the use of univariate and multivariate analyses in two large, independent cohorts (n=330 and n=347). Higher BMI and higher polygenic risk for obesity were significantly associated with medial prefrontal gray matter decrease, and prefrontal gray matter was further shown to significantly mediate the effect of polygenic risk for obesity on BMI in both samples. Building on this, the successful individualized prediction of BMI by means of multivariate pattern classification algorithms trained on whole-brain imaging data and external validations in the second cohort points to potential clinical applications of this imaging trait marker.

A queer day in Canada: examining Canadian high school students' experiences with school-based homophobia in two large-scale studies.

PubMed

Peter, Tracey; Taylor, Catherine; Chamberland, Line

2015-01-01

The goal of the study is to examine how location (nationally, compared to Canadian regions) is related to indicators of a hostile school environment for sexual minority youth, particularly when physical abuse is used as the outcome variable. Data representing 5,766 Canadian students were analyzed using bivariate and multivariate techniques. Results from the multivariate analyses showed that non-physical abuse was the most significant predictor of homophobically based physical abuse, for both LGBQ and non-LGBQ students. Findings reiterate the importance of considering the progression of harmful events as an escalation of violence as well as the need to view homophobic bullying as having a significant impact on all students. Finally, while the presence of homophobia is prevalent across all Canadian regions, there are, nevertheless, many regional differences, which could be used to inform region-specific action plans.

Increasing Awareness about HIV Prevention among Young People Who Initiated Injection Drug Use in a Canadian Setting, 1988–2014

PubMed Central

Bahji, Anees; Wood, Evan; Ahamad, Keith; Dong, Huiru; DeBeck, Kora; Milloy, M-J; Kerr, Thomas; Hayashi, Kanna

2015-01-01

Background Globally, harm reduction interventions, including needle and syringe programs (NSPs), have been shown to reduce HIV risks among people who inject drugs (PWID). However, little is known about the impact of these efforts on the circumstances of first injection. Therefore, we sought to identify changes in the awareness about HIV prevention and syringe borrowing at the time of first injection drug use in Vancouver, Canada, during a period of NSP expansion. Methods Data were drawn from prospective cohorts of PWID in Vancouver, who initiated injecting between 1988 and 2014. Multivariable regression was used to assess changes in the awareness about HIV and NSPs and syringe borrowing behaviour at first injection against calendar year of first injection. Results Among 1,044 participants (36.9% female), at the time of first injection 73.9% reported having known syringe sharing was an HIV risk, 54.1% reported having heard of NSPs, and 7.8% reported having borrowed a syringe used by others. In multivariable analyses, calendar year of first injection was independently and positively associated with awareness about HIV (adjusted prevalence ratio [APR]: 1.09; 95% confidence interval [CI]: 1.06, 1.11) and awareness about NSPs (APR: 1.18; 95% CI: 1.13, 1.24). While calendar year of first injection was significantly and negatively associated with syringe borrowing at first injection in bivariable analyses, the association did not remain significant in multivariable analyses (adjusted odds ratio: 0.90; 95% CI: 0.72, 1.14). Conclusions We found that awareness about HIV and NSPs at first injection have increased over time amongst PWID in this setting. However, declining trends in syringe borrowing at first injection were not determined after adjustment for socio-demographic characteristics. This suggests that HIV prevention efforts may have contributed to increased awareness about HIV prevention, but further research is needed to identify sub-populations at heightened risk of HIV at first injection. PMID:26514080

The effects of socioeconomic status, clinical factors, and genetic ancestry on pulmonary tuberculosis disease in northeastern Mexico.

PubMed

Young, Bonnie N; Rendón, Adrian; Rosas-Taraco, Adrian; Baker, Jack; Healy, Meghan; Gross, Jessica M; Long, Jeffrey; Burgos, Marcos; Hunley, Keith L

2014-01-01

Diverse socioeconomic and clinical factors influence susceptibility to tuberculosis (TB) disease in Mexico. The role of genetic factors, particularly those that differ between the parental groups that admixed in Mexico, is unclear. The objectives of this study are to identify the socioeconomic and clinical predictors of the transition from latent TB infection (LTBI) to pulmonary TB disease in an urban population in northeastern Mexico, and to examine whether genetic ancestry plays an independent role in this transition. We recruited 97 pulmonary TB disease patients and 97 LTBI individuals from a public hospital in Monterrey, Nuevo León. Socioeconomic and clinical variables were collected from interviews and medical records, and genetic ancestry was estimated for a subset of 142 study participants from 291,917 single nucleotide polymorphisms (SNPs). We examined crude associations between the variables and TB disease status. Significant predictors from crude association tests were analyzed using multivariable logistic regression. We also compared genetic ancestry between LTBI individuals and TB disease patients at 1,314 SNPs in 273 genes from the TB biosystem in the NCBI BioSystems database. In crude association tests, 12 socioeconomic and clinical variables were associated with TB disease. Multivariable logistic regression analyses indicated that marital status, diabetes, and smoking were independently associated with TB status. Genetic ancestry was not associated with TB disease in either crude or multivariable analyses. Separate analyses showed that LTBI individuals recruited from hospital staff had significantly higher European genetic ancestry than LTBI individuals recruited from the clinics and waiting rooms. Genetic ancestry differed between individuals with LTBI and TB disease at SNPs located in two genes in the TB biosystem. These results indicate that Monterrey may be structured with respect to genetic ancestry, and that genetic differences in TB susceptibility in parental populations may contribute to variation in disease susceptibility in the region.

The Effects of Socioeconomic Status, Clinical Factors, and Genetic Ancestry on Pulmonary Tuberculosis Disease in Northeastern Mexico

PubMed Central

Young, Bonnie N.; Rendón, Adrian; Rosas-Taraco, Adrian; Baker, Jack; Healy, Meghan; Gross, Jessica M.; Long, Jeffrey; Burgos, Marcos; Hunley, Keith L.

2014-01-01

Diverse socioeconomic and clinical factors influence susceptibility to tuberculosis (TB) disease in Mexico. The role of genetic factors, particularly those that differ between the parental groups that admixed in Mexico, is unclear. The objectives of this study are to identify the socioeconomic and clinical predictors of the transition from latent TB infection (LTBI) to pulmonary TB disease in an urban population in northeastern Mexico, and to examine whether genetic ancestry plays an independent role in this transition. We recruited 97 pulmonary TB disease patients and 97 LTBI individuals from a public hospital in Monterrey, Nuevo León. Socioeconomic and clinical variables were collected from interviews and medical records, and genetic ancestry was estimated for a subset of 142 study participants from 291,917 single nucleotide polymorphisms (SNPs). We examined crude associations between the variables and TB disease status. Significant predictors from crude association tests were analyzed using multivariable logistic regression. We also compared genetic ancestry between LTBI individuals and TB disease patients at 1,314 SNPs in 273 genes from the TB biosystem in the NCBI BioSystems database. In crude association tests, 12 socioeconomic and clinical variables were associated with TB disease. Multivariable logistic regression analyses indicated that marital status, diabetes, and smoking were independently associated with TB status. Genetic ancestry was not associated with TB disease in either crude or multivariable analyses. Separate analyses showed that LTBI individuals recruited from hospital staff had significantly higher European genetic ancestry than LTBI individuals recruited from the clinics and waiting rooms. Genetic ancestry differed between individuals with LTBI and TB disease at SNPs located in two genes in the TB biosystem. These results indicate that Monterrey may be structured with respect to genetic ancestry, and that genetic differences in TB susceptibility in parental populations may contribute to variation in disease susceptibility in the region. PMID:24728409

Prediabetes Is Associated with an Increased Risk of Testosterone Deficiency, Independent of Obesity and Metabolic Syndrome

PubMed Central

Ho, Chen-Hsun; Yu, Hong-Jeng; Wang, Chih-Yuan; Jaw, Fu-Shan; Hsieh, Ju-Ton; Liao, Wan-Chung; Pu, Yeong-Shiau; Liu, Shih-Ping

2013-01-01

Objective The association between type 2 diabetes and low testosterone has been well recognized. However, testosterone levels in men with prediabetes have been rarely reported. We aimed to investigate whether prediabetes was associated with an increased risk of testosterone deficiency. Methods This study included 1,306 men whose sex hormones was measured during a medical examination. Serum total testosterone and sex hormone-binding globulin were measured; free and bioavailable testosterone concentrations were calculated by Vermeulen’s formula. Prediabetes was defined by impaired fasting glucose (IFG), impaired postprandial glucose (IPG), or glycated hemoglobin (HbA1c) 5.7%-6.4%. Logistic regression was performed to obtain the odds ratios (OR) for subnormal total testosterone (<300 ng/dL) or free testosterone (<6 ng/dL) in prediabetic and diabetic men compared with normoglycemic individuals, while adjusting for age, BMI, waist circumference, and metabolic syndrome (MetS). Results Normoglycemia, prediabetes, and diabetes were diagnosed in 577 (44.2%), 543 (41.6%), and 186 (14.2%) men, respectively. Prediabetes was associated with an increased risk of subnormal total testosterone compared to normoglycemic individuals (age-adjusted OR=1.87; 95%CI=1.38-2.54). The risk remained significant in all multivariate analyses. After adjusting for MetS, the OR in prediabetic men equals that of diabetic patients (1.49 versus 1.50). IFG, IPG, and HbA1c 5.7%-6.4% were all associated with an increased risk of testosterone deficiency, with different levels of significance in multivariate analyses. However, neither prediabetes nor diabetes was associated with subnormal free testosterone in multivariate analyses. Conclusions Prediabetes is associated with an increased risk of testosterone deficiency, independent of obesity and MetS. After adjusting for MetS, the risk equals that of diabetes. Our data suggest that testosterone should be measured routinely in men with prediabetes. PMID:24069277

Correlates of suicide ideation and attempt among youth living in the slums of Kampala.

PubMed

Swahn, Monica H; Palmier, Jane B; Kasirye, Rogers; Yao, Huang

2012-02-01

While suicidal behavior is recognized as a growing public health problem world-wide, little is known about the prevalence and risk factors for suicidal behaviors among street and slum youth in Africa, and in Uganda, specifically. The number of youth who live on the streets and in the slums of Kampala appears to be growing rapidly, but their mental health needs have not been documented, which has hampered resource allocation and service implementation. This study of youth, ages 14-24, was conducted in May and June of 2011, to assess the prevalence and correlates of suicidal behavior. Participants (N = 457) were recruited for a 30-minute interviewer-administered survey through eight drop-in centers operated by the Uganda Youth Development Link for youth in need of services. Bivariate and multivariate logistic regression analyses were computed to determine associations between psychosocial correlates and suicide ideation and suicide attempt. Reporting both parents deceased Adj.OR = 2.36; 95% CI: 1.23-4.52), parental neglect due to alcohol use (Adj.OR = 2.09; 95% CI: 1.16-3.77), trading sex for food, shelter or money (Adj.OR = 1.95; 95% CI: 1.09-3.51), sadnesss (Adj.OR = 2.42; 95% CI: 1.20-4.89), loneliness (Adj.OR = 2.67; 95% CI: 1.12-6.40) and expectations of dying prior to age 30 (Adj.OR = 2.54; 95% CI: 1.53-4.23) were significantly associated with suicide ideation in multivariate analyses. Parental neglect due to alcohol use (Adj.OR = 2.04; 95% CI: 1.11-3.76), sadness (Adj.OR = 2.42; 95% CI: 1.30-7.87), and expectations of dying prior to age 30 (Adj.OR = 2.18; 95% CI: 1.25-3.79) were significantly associated with suicide attempt in multivariate analyses. Given the dire circumstances of this vulnerable population, increased services and primary prevention efforts to address the risk factors for suicidal behavior are urgently needed.

Prevalence of Online Reading among High School Students in Qatar: Evidence from the Programme for International Student Assessment 2009

ERIC Educational Resources Information Center

Cheema, Jehanzeb R.

2014-01-01

Recent research has suggested presence of a significant relationship between prevalence of online reading and reading literacy. In this study we examined the prevalence of online reading among 15-year old students in Qatar using a nationally representative sample of 8,089 students. Bivariate and multivariate analyses were conducted at the item and…

Lymphopenia Association With Gross Tumor Volume and Lung V5 and Its Effects on Non-Small Cell Lung Cancer Patient Outcomes

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

Tang, Chad; Liao, Zhongxing, E-mail: zliao@mdanderson.org; Gomez, Daniel

2014-08-01

Purpose: Radiation therapy (RT) can both suppress and stimulate the immune system. We sought to investigate the mechanisms underlying radiation-induced lymphopenia and its associations with patient outcomes in non-small cell lung cancer (NSCLC). Methods and Materials: Subjects consisted of 711 patients who had received definitive RT for NSCLC. A lymphocyte nadir was calculated as the minimum lymphocyte value measured during definitive RT. Associations between gross tumor volumes (GTVs) and lung dose-volume histogram (DVH) parameters with lymphocyte nadirs were assessed with Spearman correlation coefficients. Relationships between lymphocyte nadirs with overall survival (OS) and event free survival (EFS) were evaluated with Kaplan-Meiermore » analysis and compared with log-rank test results. Multivariate regressions were conducted with linear and Cox regression analyses. All variables were analyzed as continuous if possible. Results: Larger GTVs were correlated with lower lymphocyte nadirs regardless of concurrent chemotherapy receipt (with concurrent: r = −0.26, P<.0001; without: r = −0.48, P<.0001). Analyses of lung DVH parameters revealed significant correlations at lower doses (lung V5-V10: P<.0001) that incrementally decreased and became nonsignificant at higher doses (lung V60-V70: P>.05). Of note, no significant associations were detected between GTV and lung DVH parameters with total leukocyte, neutrophil, or monocyte nadirs during RT or with lymphocyte count prior to RT. Multivariate analysis revealed larger GTV (P<.0001), receipt of concurrent chemotherapy (P<.0001), twice-daily radiation fractionation (P=.02), and stage III disease (P=.05) to be associated with lower lymphocyte nadirs. On univariate analysis, patients with higher lymphocyte nadirs exhibited significantly improved OS (hazard ratio [HR] = 0.51 per 10{sup 3} lymphocytes/μL, P=.01) and EFS (HR = 0.46 per 10{sup 3} lymphocytes/μL, P<.0001). These differences held on multivariate analyses, controlling for common disease and treatment characteristics including GTV. Conclusions: Lower lymphocyte nadirs during definitive RT were associated with larger GTVs and worse patient outcomes.« less

Two time-series analyses of the impact of antibiotic consumption and alcohol-based hand disinfection on the incidences of nosocomial methicillin-resistant Staphylococcus aureus infection and Clostridium difficile infection.

PubMed

Kaier, Klaus; Hagist, Christian; Frank, Uwe; Conrad, Andreas; Meyer, Elisabeth

2009-04-01

To determine the impact of antibiotic consumption and alcohol-based hand disinfection on the incidences of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection and Clostridium difficile infection (CDI). Two multivariate time-series analyses were performed that used as dependent variables the monthly incidences of nosocomial MRSA infection and CDI at the Freiburg University Medical Center during the period January 2003 through October 2007. The volume of alcohol-based hand rub solution used per month was quantified in liters per 1,000 patient-days. Antibiotic consumption was calculated in terms of the number of defined daily doses per 1,000 patient-days per month. The use of alcohol-based hand rub was found to have a significant impact on the incidence of nosocomial MRSA infection (P< .001). The multivariate analysis (R2=0.66) showed that a higher volume of use of alcohol-based hand rub was associated with a lower incidence of nosocomial MRSA infection. Conversely, a higher level of consumption of selected antimicrobial agents was associated with a higher incidence of nosocomial MRSA infection. This analysis showed this relationship was the same for the use of second-generation cephalosporins (P= .023), third-generation cephalosporins (P= .05), fluoroquinolones (P= .01), and lincosamides (P= .05). The multivariate analysis (R2=0.55) showed that a higher level of consumption of third-generation cephalosporins (P= .008), fluoroquinolones (P= .084), and/or macrolides (P= .007) was associated with a higher incidence of CDI. A correlation with use of alcohol-based hand rub was not detected. In 2 multivariate time-series analyses, we were able to show the impact of hand hygiene and antibiotic use on the incidence of nosocomial MRSA infection, but we found no association between hand hygiene and incidence of CDI.

Relationship between alcohol intake, body fat, and physical activity – a population-based study

PubMed Central

Liangpunsakul, Suthat; Crabb, David W.; Qi, Rong

2010-01-01

Objectives Aside from fat, ethanol is the macronutrient with the highest energy density. Whether the energy derived from ethanol affects the body composition and fat mass is debatable. We investigated the relationship between alcohol intake, body composition, and physical activity in the US population using the third National Health and Nutrition Examination Survey (NHANES III). Methods Ten thousand five hundred and fifty subjects met eligible criteria and constituted our study cohort. Estimated percent body fat and resting metabolic rate were calculated based on the sum of the skinfolds. Multivariate regression analyses were performed accounting for the study sampling weight. Results In both genders, moderate and hazardous alcohol drinkers were younger (p<0.05), had significantly lower BMI (P<0.01) and body weight (p<0.01) than controls, non drinkers. Those with hazardous alcohol consumption had significantly less physical activity compared to those with no alcohol use and moderate drinkers in both genders. Female had significantly higher percent body fat than males. In the multivariate linear regression analyses, the levels of alcohol consumption were found to be an independent predictor associated with lower percent body fat only in male subjects. Conclusions Our results showed that alcoholics are habitually less active and that alcohol drinking is an independent predictor of lower percent body fat especially in male alcoholics. PMID:20696406

Risk factors for indications of intraoperative blood transfusion among patients undergoing surgical treatment for colorectal adenocarcinoma.

PubMed

Gonçalves, Iara; Linhares, Marcelo; Bordin, Jose; Matos, Delcio

2009-01-01

Identification of risk factors for requiring transfusions during surgery for colorectal cancer may lead to preventive actions or alternative measures, towards decreasing the use of blood components in these procedures, and also rationalization of resources use in hemotherapy services. This was a retrospective case-control study using data from 383 patients who were treated surgically for colorectal adenocarcinoma at 'Fundação Pio XII', in Barretos-SP, Brazil, between 1999 and 2003. To recognize significant risk factors for requiring intraoperative blood transfusion in colorectal cancer surgical procedures. Univariate analyses were performed using Fisher's exact test or the chi-squared test for dichotomous variables and Student's t test for continuous variables, followed by multivariate analysis using multiple logistic regression. In the univariate analyses, height (P = 0.06), glycemia (P = 0.05), previous abdominal or pelvic surgery (P = 0.031), abdominoperineal surgery (P<0.001), extended surgery (P<0.001) and intervention with radical intent (P<0.001) were considered significant. In the multivariate analysis using logistic regression, intervention with radical intent (OR = 10.249, P<0.001, 95% CI = 3.071-34.212) and abdominoperineal amputation (OR = 3.096, P = 0.04, 95% CI = 1.445-6.623) were considered to be independently significant. This investigation allows the conclusion that radical intervention and the abdominoperineal procedure in the surgical treatment of colorectal adenocarcinoma are risk factors for requiring intraoperative blood transfusion.

Differential Expression and Clinical Significance of Transforming Growth Factor-Beta Isoforms in GBM Tumors.

PubMed

Roy, Laurent-Olivier; Poirier, Marie-Belle; Fortin, David

2018-04-08

Glioblastoma (GBM) represents the most common and aggressive malignant primary brain tumors in adults. Response to standard treatment is transitory and the survival of clinical trial cohorts are little more than 14 months. GBM are characterized by excessive proliferation, invasiveness, and radio-/chemoresistance features; which are strongly upregulated by transforming growth factor-beta (TGF-β). We hypothesized that TGF-β gene expression could correlate with overall survival (OS) and serve as a prognostic biomarker. TGF-β₁ and -β₂ expression were analyzed by qPCR in 159 GBM tumor specimens. Kaplan-Meier and multivariate analyses were used to correlate expression with OS and progression-free survival (PFS). In GBM, TGF-β₁ and -β₂ levels were 33- and 11-fold higher respectively than in non-tumoral samples. Kaplan-Meier and multivariate analyses revealed that high to moderate expressions of TGF-β₁ significantly conferred a strikingly poorer OS and PFS in newly diagnosed patients. Interestingly, at relapse, neither isoforms had meaningful impact on clinical evolution. We demonstrate that TGF-β₁ is the dominant isoform in newly diagnosed GBM rather than the previously acknowledged TGF-β₂. We believe our study is the first to unveil a significant relationship between TGF-β₁ expression and OS or PFS in newly diagnosed GBM. TGF-β₁ could serve as a prognostic biomarker or target affecting treatment planning and patient follow-up.

Participation in organized sports is positively associated with employment in adults with spinal cord injury.

PubMed

Blauwet, Cheri; Sudhakar, Supreetha; Doherty, Ashley L; Garshick, Eric; Zafonte, Ross; Morse, Leslie R

2013-05-01

The aim of this study was to determine the association between participation in organized sports programs and employment in adults with chronic spinal cord injury. This is a cross-sectional study of 149 adults with chronic spinal cord injury. Motor level and completeness of injury were confirmed by physical examination. Information related to demographics, employment, level of education, body mass index, duration of injury, participation in individually planned exercise, and participation in organized sports was obtained using a standardized questionnaire. Multivariable logistic regression analyses were used to assess factors associated with employment. In univariate analyses, employment was associated with younger age (P = 0.001) and a higher level of education (P = 0.01), whereas obesity decreased the likelihood of employment (P = 0.04). Participation in organized sports approached significance (P = 0.06). In the multivariable analysis and after adjusting for age, education, and body mass index, participation in organized sports was significantly associated with employment (odds ratio, 2.4; P = 0.04). Sex, duration of injury, wheelchair use, and participation in individually planned exercise were not significantly associated with employment (P = 0.16-0.94). In the adults with chronic spinal cord injury, participation in organized sports was positively associated with employment. Further studies are necessary to determine the causative nature of this association and how various factors related to sports participation may contribute.

Mouse double minute-2 homolog (MDM2)-rs2279744 polymorphism associated with lung cancer risk in a Northeastern Chinese population.

PubMed

Wang, Xu; Jin, Lina; Cui, Jiuwei; Ma, Kewei; Chen, Xiao; Li, Wei

2015-01-01

Altered expression or function of mouse double minute-2 (MDM2) protein could contribute to lung carcinogenesis; thus, this study investigated MDM2-rs2279744 polymorphism together with other epidemiologic factors for their association with lung cancer risk. A total of 500 lung cancer patients and 500 age and gender-matched healthy controls living in Northeastern China were recruited for genotyping of MDM2-rs2279744. Clinicopathological data was collected and subjected to univariate and multivariate analyses. In univariate analysis, the MDM2-rs2279744 G/G genotype versus T/T + T/G genotypes showed a tendency toward a higher incidence of lung cancer in the recessive model (P = 0.043). However, there were no significant differences when it was analyzed by the dominant, additive, or multiplicative models. A significantly increased lung cancer risk was observed associated with lower education level, lower body mass index, cancer family history, prior diagnosis of chronic obstructive pulmonary disease and pneumonia, exposure to pesticide or gasoline/diesel, tobacco smoking, and heavy cooking emissions when assessed by multivariate analyses. Moreover, MDM2-rs2279744 was still a significant risk factor even after incorporating environmental and lifestyle factors. However, there was no association between MDM2-rs2279744 and other factors. The MDM2-rs2279744 G/G genotype was associated with a higher lung cancer risk, even after incorporating other epidemiologic factors.

Multivariate temporal pattern analysis applied to the study of rat behavior in the elevated plus maze: methodological and conceptual highlights.

PubMed

Casarrubea, M; Magnusson, M S; Roy, V; Arabo, A; Sorbera, F; Santangelo, A; Faulisi, F; Crescimanno, G

2014-08-30

Aim of this article is to illustrate the application of a multivariate approach known as t-pattern analysis in the study of rat behavior in elevated plus maze. By means of this multivariate approach, significant relationships among behavioral events in the course of time can be described. Both quantitative and t-pattern analyses were utilized to analyze data obtained from fifteen male Wistar rats following a trial 1-trial 2 protocol. In trial 2, in comparison with the initial exposure, mean occurrences of behavioral elements performed in protected zones of the maze showed a significant increase counterbalanced by a significant decrease of mean occurrences of behavioral elements in unprotected zones. Multivariate t-pattern analysis, in trial 1, revealed the presence of 134 t-patterns of different composition. In trial 2, the temporal structure of behavior become more simple, being present only 32 different t-patterns. Behavioral strings and stripes (i.e. graphical representation of each t-pattern onset) of all t-patterns were presented both for trial 1 and trial 2 as well. Finally, percent distributions in the three zones of the maze show a clear-cut increase of t-patterns in closed arm and a significant reduction in the remaining zones. Results show that previous experience deeply modifies the temporal structure of rat behavior in the elevated plus maze. In addition, this article, by highlighting several conceptual, methodological and illustrative aspects on the utilization of t-pattern analysis, could represent a useful background to employ such a refined approach in the study of rat behavior in elevated plus maze. Copyright © 2014 Elsevier B.V. All rights reserved.

Hearing loss among older construction workers: Updated analyses.

PubMed

Dement, John; Welch, Laura S; Ringen, Knut; Cranford, Kim; Quinn, Patricia

2018-04-01

A prior study of this construction worker population found significant noise-associated hearing loss. This follow-up study included a much larger study population and consideration of additional risk factors. Data included audiometry, clinical chemistry, personal history, and work history. Qualitative exposure metrics for noise and solvents were developed. Analyses compared construction workers to an internal reference group with lower exposures and an external worker population with low noise exposure. Among participants (n = 19 127) an overall prevalence of hearing loss of 58% was observed, with significantly increased prevalence across all construction trades. Construction workers had significantly increased risk of hearing loss compared to reference populations, with increasing risk by work duration. Noise exposure, solvent exposure, hypertension, and smoking were significant risk factors in multivariate models. Results support a causal relationship between construction trades work and hearing loss. Prevention should focus on reducing exposure to noise, solvents, and cigarette smoke. © 2018 Wiley Periodicals, Inc.

Inflammation-based prognostic score is a novel predictor of postoperative outcome in patients with colorectal cancer.

PubMed

Ishizuka, Mitsuru; Nagata, Hitoshi; Takagi, Kazutoshi; Horie, Toru; Kubota, Keiichi

2007-12-01

To investigate the significance of preoperative Glasgow prognostic score (GPS) for postoperative prognostication of patients with colorectal cancer. Recent studies have revealed that the GPS, an inflammation-based prognostic score that includes only C-reactive protein (CRP) and albumin, is a useful tool for predicting postoperative outcome in cancer patients. However, few studies have investigated the GPS in the field of colorectal surgery. The GPS was calculated on the basis of admission data as follows: patients with an elevated level of both CRP (>10 mg/L) and hypoalbuminemia (Alb <35 g/L) were allocated a score of 2, and patients showing 1 or none of these blood chemistry abnormalities were allocated a score of 1 or 0, respectively. Prognostic significance was analyzed by univariate and multivariate analyses. A total of 315 patients were evaluated. Kaplan-Meier analysis and log-rank test revealed that a higher GPS predicted a higher risk of postoperative mortality (P < 0.01). Univariate analyses revealed that postoperative TNM was the most sensitive predictor of postoperative mortality (odds ratio, 0.148; 95% confidence interval, 0.072-0.304; P < 0.0001). Multivariate analyses using factors such as age, sex, tumor site, serum carcinoembryonic antigen, CA19-9, CA72-4, CRP, albumin, and GPS revealed that GPS (odds ratio, 0.165; 95% confidence interval, 0.037-0.732; P = 0.0177) was associated with postoperative mortality. Preoperative GPS is considered to be a useful predictor of postoperative mortality in patients with colorectal cancer.

Cost and utilisation of hospital based delivery care in Empowered Action Group (EAG) states of India.

PubMed

Mohanty, Sanjay K; Srivastava, Akanksha

2013-10-01

Large scale investment in the National Rural Health Mission is expected to increase the utilization and reduce the cost of maternal care in public health centres in India. The objective of this paper is to examine recent trends in the utilization and cost of hospital based delivery care in the Empowered Action Group (EAG) states of India. The unit data from the District Level Household Survey 3, 2007-2008 is used in the analyses. The coverage and the cost of hospital based delivery at constant price is analyzed for five consecutive years preceding the survey. Descriptive and multivariate analyses are used to understand the socio-economic differentials in cost and utilization of delivery care. During 2004-2008, the utilization of delivery care from public health centres has increased in all the eight EAG states. Adjusting for inflation, the household cost of delivery care has declined for the poor, less educated and in public health centres in the EAG states. The cost of delivery care in private health centres has not shown any significant changes across the states. Results of the multivariate analyses suggest that time, state, place of residence, economic status; educational attainment and delivery characteristics of mother are significant predictors of hospital based delivery care in India. The study demonstrates the utility of public spending on health care and provides a thrust to the ongoing debate on universal health coverage in India.

[The significance of lymph node status in papillary and follicular thyroid gland carcinoma for the nuclear medicine physician].

PubMed

Farahati, J; Mörtl, M; Reiners, C

2000-01-01

The impact of lymph node metastases on prognosis of differentiated thyroid cancer is discussed controversially. Therefore the data of 596 patients with papillary or follicular thyroid cancer are analysed retrospectively, which have been treated between 1980 and 1995 at the Clinic and Policlinic for Nuclear Medicine of the University of Würzburg. The influence of lymph node metastases on prognosis with respect to survival is analysed with the univariate Kaplan-Meier-method and with the multivariate discriminant analysis. In addition, the influence of the prognostic factor "lymph node involvement" on distant metastases is analysed by a stratified comparison and an univariate test. In papillary thyroid cancer, the 15 year-survival-rate for stage pN1 is significantly lower (p < 0.001) with 88.7% as compared to stage pN0 (99.4%). In patients with follicular thyroid cancer this difference is even more pronounced (64.7% versus 97.2%, p < 0.001). However, the multivariate discriminant analysis shows that the only prognostic factors are tumour stage and distant metastases, and--in papillary thyroid cancer--patient's age. So lymph node metastases are not an independent prognostic factor concerning survival. However, lymph node metastases have a prognostic unfavourable influence with respect to distant metastases especially in papillary thyroid cancer stage pT4 (distant metastases in patients with negative lymph nodes 0% and in patients with positive lymph nodes 35.3% [p < 0.001]).

A cross-sectional study to estimate associations between education level and osteoporosis in a Chinese postmenopausal women sample.

PubMed

Piao, Hui-Hong; He, Jiajia; Zhang, Keqin; Tang, Zihui

2015-01-01

Our research aims to investigate the associations between education level and osteoporosis (OP) in Chinese postmenopausal women. A large-scale, community-based, cross-sectional study was conducted to examine the associations between education level and OP. A self-reported questionnaire was used to access the demographical information and medical history of the participants. A total of 1905 postmenopausal women were available for data analysis in this study. Multiple regression models controlling for confounding factors to include education level were performed to investigate the relationship with OP. The prevalence of OP was 28.29% in our study sample. Multivariate linear regression analyses adjusted for relevant potential confounding factors detected significant associations between education level and T-score (β = 0.025, P-value = 0.095, 95% CI: -0.004-0.055 for model 1; and β = 0.092, P-value = 0.032, 95% CI: 0.008-0.175 for model 2). Multivariate logistic regression analyses detected significant associations between education level and OP in model 1 (P-value = 0.070 for model 1, Table 5), while no significant associations was reported in model 2 (P value = 0.131). In participants with high education levels, the OR for OP was 0.914 (95% CI: 0.830-1.007). The findings indicated that education level was independently and significantly associated with OP. The prevalence of OP was more frequent in Chinese postmenopausal women with low educational status.

The relationship of disability and employment for veterans from the 2010 Medical Expenditure Panel Survey (MEPS).

PubMed

Smith, Diane L

2015-06-05

Veterans with disabilities, especially those with posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) have difficulty obtaining and maintaining competitive employment. To determine if there are significant differences in employment between veterans with and without disability, between veterans with a disability and nonveterans with a disability, and to investigate the association of veteran status and disability with employment. Chi square analyses were conducted on data obtained from the 2010 Medical Expenditure Panel Survey to determine if significant differences in employment occurred between veterans with disabilities, veterans without disabilities and nonveterans with disabilities. Multivariate regression analyses were used to determine how veteran status and disability are associated with employment. Significant differences in employment were found between veterans with and without a disability; however, no significant differences existed in employment between veterans and nonveterans with a disability. Multivariate analysis showed that veteran status (aOR=1.80), having any disability (aOR=7.29), social disability (aOR=3.47) or a cognitive disability (aOR=3.16) were associated with not being employed. Veterans with disabilities are more likely not to be employed than veteran populations without disabilities. Veterans; however have unique disabilities, different than nonveterans with disabilities, that need to be addressed, such as social and cognitive disabilities resulting from TBI and PTSD. Future research should focus on evaluating the effectiveness of employment programs and policies designed to address the unique issues faced by veterans with disabilities.

Serum dehydroepiandrosterone sulphate, psychosocial factors and musculoskeletal pain in workers.

PubMed

Marinelli, A; Prodi, A; Pesel, G; Ronchese, F; Bovenzi, M; Negro, C; Larese Filon, F

2017-12-30

The serum level of dehydroepiandrosterone sulphate (DHEA-S) has been suggested as a biological marker of stress. To assess the association between serum DHEA-S, psychosocial factors and musculoskeletal (MS) pain in university workers. The study population included voluntary workers at the scientific departments of the University of Trieste (Italy) who underwent periodical health surveillance from January 2011 to June 2012. DHEA-S level was analysed in serum. The assessment tools included the General Health Questionnaire (GHQ) and a modified Nordic musculoskeletal symptoms questionnaire. The relation between DHEA-S, individual characteristics, pain perception and psychological factors was assessed by means of multivariable linear regression analysis. There were 189 study participants. The study population was characterized by high reward and low effort. Pain perception in the neck, shoulder, upper limbs, upper back and lower back was reported by 42, 32, 19, 29 and 43% of people, respectively. In multivariable regression analysis, gender, age and pain perception in the shoulder and upper limbs were significantly related to serum DHEA-S. Effort and overcommitment were related to shoulder and neck pain but not to DHEA-S. The GHQ score was associated with pain perception in different body sites and inversely to DHEA-S but significance was lost in multivariable regression analysis. DHEA-S was associated with age, gender and perception of MS pain, while effort-reward imbalance dimensions and GHQ score failed to reach the statistical significance in multivariable regression analysis. © The Author(s) 2017. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Multimodal Feature Integration in the Angular Gyrus during Episodic and Semantic Retrieval

PubMed Central

Bonnici, Heidi M.; Richter, Franziska R.; Yazar, Yasemin

2016-01-01

Much evidence from distinct lines of investigation indicates the involvement of angular gyrus (AnG) in the retrieval of both episodic and semantic information, but the region's precise function and whether that function differs across episodic and semantic retrieval have yet to be determined. We used univariate and multivariate fMRI analysis methods to examine the role of AnG in multimodal feature integration during episodic and semantic retrieval. Human participants completed episodic and semantic memory tasks involving unimodal (auditory or visual) and multimodal (audio-visual) stimuli. Univariate analyses revealed the recruitment of functionally distinct AnG subregions during the retrieval of episodic and semantic information. Consistent with a role in multimodal feature integration during episodic retrieval, significantly greater AnG activity was observed during retrieval of integrated multimodal episodic memories compared with unimodal episodic memories. Multivariate classification analyses revealed that individual multimodal episodic memories could be differentiated in AnG, with classification accuracy tracking the vividness of participants' reported recollections, whereas distinct unimodal memories were represented in sensory association areas only. In contrast to episodic retrieval, AnG was engaged to a statistically equivalent degree during retrieval of unimodal and multimodal semantic memories, suggesting a distinct role for AnG during semantic retrieval. Modality-specific sensory association areas exhibited corresponding activity during both episodic and semantic retrieval, which mirrored the functional specialization of these regions during perception. The results offer new insights into the integrative processes subserved by AnG and its contribution to our subjective experience of remembering. SIGNIFICANCE STATEMENT Using univariate and multivariate fMRI analyses, we provide evidence that functionally distinct subregions of angular gyrus (AnG) contribute to the retrieval of episodic and semantic memories. Our multivariate pattern classifier could distinguish episodic memory representations in AnG according to whether they were multimodal (audio-visual) or unimodal (auditory or visual) in nature, whereas statistically equivalent AnG activity was observed during retrieval of unimodal and multimodal semantic memories. Classification accuracy during episodic retrieval scaled with the trial-by-trial vividness with which participants experienced their recollections. Therefore, the findings offer new insights into the integrative processes subserved by AnG and how its function may contribute to our subjective experience of remembering. PMID:27194327

Epidemiology of multiple sclerosis in US veterans: VII. Risk factors for MS.

PubMed

Kurtzke, J F; Page, W F

1997-01-01

In previous papers of this series, we explored the epidemiology of MS, examining the effects of race, sex, geography, latitude and climate, migration, age at onset, population ancestry, and individual ethnicity on the risk of MS, using an unusually large cohort of MS cases and pre-illness matched controls comprising US veterans of World War II (WWII) and the Korean Conflict (KC). In this paper, we examine primarily the effect of other factors on the risk of MS in this cohort and their relation to those previously studied. We found here that latitude tier of residence at entry into active duty (EAD), years of education, and socioeconomic class (coded from occupation) were similarly associated with MS risk among white men, black men, and white women. Higher levels of each factor showed increased MS risk. Multivariate analyses indicated that for white male WWII subjects an urban address, 9 or more years of education, uncorrected visual acuity less than 20/20 at EAD, a more northern latitude, and a higher proportion of the subject's EAD state population reporting Swedish ancestry each significantly increased the risk of MS. White male KC subjects showed roughly the same patterns, except that uncorrected visual acuity less than 20/20 was associated with lower MS risk (ancestry/ethnicity was not studied). For black male WWII and KC subjects combined, a similar analysis (omitting ancestry/ethnicity) showed that only latitude at EAD and 9 or more years of education were independently associated with a significantly higher MS risk, and for WWII plus KC white women (also without ancestry/ethnicity), only latitude was a significant risk factor in these multivariate analyses. The smaller number of subjects, especially in these last two groups, limited the power to detect statistically significant risks in these last analyses. Similarities to white men of WWII in univariate analyses for all other groups suggest that findings for the former would otherwise apply to the latter. Although the interpretations of these associations may be obscure, in addition to geography, age, sex, and race, per se, higher socioeconomic status is significantly associated with higher MS risk in black and white men and in white women in the United States.

ENSO related variability in the Southern Hemisphere, 1948-2000

NASA Astrophysics Data System (ADS)

Ribera, Pedro; Mann, Michael E.

2003-01-01

The spatiotemporal evolution of Southern Hemisphere climate variability is diagnosed based on the use of the NCEP reanalysis (1948-2000) dataset. Using the MTM-SVD analysis method, significant narrowband variability is isolated from the multi-variate dataset. It is found that the ENSO signal exhibits statistically significant behavior at quasiquadrennial (3-6 yr) timescales for the full time-period. A significant quasibiennial (2-3 yr) timescales emerges only for the latter half of period. Analyses of the spatial evolution of the two reconstructed signals shed additional light on linkages between low and high-latitude Southern Hemisphere climate anomalies.

Attrition analysed in five waves of a longitudinal yearly survey of smokers: findings from the ITC Netherlands survey.

PubMed

Zethof, Dennis; Nagelhout, Gera E; de Rooij, Mark; Driezen, Pete; Fong, Geoffrey T; van den Putte, Bas; Hummel, Karin; de Vries, Hein; Thompson, Mary E; Willemsen, Marc C

2016-08-01

Attrition bias can affect the external validity of findings. This article analyses attrition bias and assesses the effectiveness of replenishment samples on demographic and smoking-related characteristics for the International Tobacco Control Netherlands Survey, a longitudinal survey among smokers. Attrition analyses were conducted for the first five survey waves (2008-12). We assessed, including and excluding replenishment samples, whether the demographic composition of the samples changed between the first and fifth waves. Replenishment samples were tailored to ensure the sample remained representative of the smoking population. We also constructed a multivariable survival model of attrition that included all five waves with replenishment samples. Of the original 1820 respondents recruited in 2008, 46% participated again in 2012. Demographic differences between waves due to attrition were generally small and replenishment samples tended to minimize them further. The multivariable survival analysis revealed that only two of the 10 variables analysed were significant predictors of attrition: a weak effect for gender (men dropped out more often) and weak to moderate effects for age (respondents aged 15-24 years dropped out more than aged 25-39 years, who dropped out more than those aged 40+ years). Weak to moderate attrition effects were found for men and younger age groups. This information could be used to minimize respondent attrition. Our findings suggest that sampling weights and tailored replenishment samples can effectively compensate for attrition effects. This is already being done for the International Tobacco Control Netherlands Survey, including the categories that significantly predicted attrition in this study. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

The association of serum prolactin concentration with inflammatory biomarkers - cross-sectional findings from the population-based Study of Health in Pomerania.

PubMed

Friedrich, Nele; Schneider, Harald J; Spielhagen, Christin; Markus, Marcello Ricardo Paulista; Haring, Robin; Grabe, Hans J; Buchfelder, Michael; Wallaschofski, Henri; Nauck, Matthias

2011-10-01

Prolactin (PRL) is involved in immune regulation and may contribute to an atherogenic phenotype. Previous results on the association of PRL with inflammatory biomarkers have been conflicting and limited by small patient studies. Therefore, we used data from a large population-based sample to assess the cross-sectional associations between serum PRL concentration and high-sensitivity C-reactive protein (hsCRP), fibrinogen, interleukin-6 (IL-6), and white blood cell (WBC) count. From the population-based Study of Health in Pomerania (SHIP), a total of 3744 subjects were available for the present analyses. PRL and inflammatory biomarkers were measured. Linear and logistic regression models adjusted for age, sex, body-mass-index, total cholesterol and glucose were analysed. Multivariable linear regression models revealed a positive association of PRL with WBC. Multivariable logistic regression analyses showed a significant association of PRL with increased IL-6 in non-smokers [highest vs lowest quintile: odds ratio 1·69 (95% confidence interval 1·10-2·58), P = 0·02] and smokers [OR 2·06 (95%-CI 1·10-3·89), P = 0·02]. Similar results were found for WBC in non-smokers [highest vs lowest quintile: OR 2·09 (95%-CI 1·21-3·61), P = 0·01)] but not in smokers. Linear and logistic regression analyses revealed no significant associations of PRL with hsCRP or fibrinogen. Serum PRL concentrations are associated with inflammatory biomarkers including IL-6 and WBC, but not hsCRP or fibrinogen. The suggested role of PRL in inflammation needs further investigation in future prospective studies. © 2011 Blackwell Publishing Ltd.

From hippocampus to whole-brain: The role of integrative processing in episodic memory retrieval.

PubMed

Geib, Benjamin R; Stanley, Matthew L; Dennis, Nancy A; Woldorff, Marty G; Cabeza, Roberto

2017-04-01

Multivariate functional connectivity analyses of neuroimaging data have revealed the importance of complex, distributed interactions between disparate yet interdependent brain regions. Recent work has shown that topological properties of functional brain networks are associated with individual and group differences in cognitive performance, including in episodic memory. After constructing functional whole-brain networks derived from an event-related fMRI study of memory retrieval, we examined differences in functional brain network architecture between forgotten and remembered words. This study yielded three main findings. First, graph theory analyses showed that successfully remembering compared to forgetting was associated with significant changes in the connectivity profile of the left hippocampus and a corresponding increase in efficient communication with the rest of the brain. Second, bivariate functional connectivity analyses indicated stronger interactions between the left hippocampus and a retrieval assembly for remembered versus forgotten items. This assembly included the left precuneus, left caudate, bilateral supramarginal gyrus, and the bilateral dorsolateral superior frontal gyrus. Integrative properties of the retrieval assembly were greater for remembered than forgotten items. Third, whole-brain modularity analyses revealed that successful memory retrieval was marginally significantly associated with a less segregated modular architecture in the network. The magnitude of the decreases in modularity between remembered and forgotten conditions was related to memory performance. These findings indicate that increases in integrative properties at the nodal, retrieval assembly, and whole-brain topological levels facilitate memory retrieval, while also underscoring the potential of multivariate brain connectivity approaches for providing valuable new insights into the neural bases of memory processes. Hum Brain Mapp 38:2242-2259, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Susceptible genes of restless legs syndrome in migraine.

PubMed

Fuh, Jong-Ling; Chung, Ming-Yi; Yao, Shu-Chih; Chen, Ping-Kun; Liao, Yi-Chu; Hsu, Chia-Lin; Wang, Po-Jen; Wang, Yen-Feng; Chen, Shih-Pin; Fann, Cathy S-J; Kao, Lung-Sen; Wang, Shuu-Jiun

2016-10-01

Objective Several genetic variants have been found to increase the risk of restless legs syndrome (RLS). The aim of the present study was to determine if these genetic variants were also associated with the comorbidity of RLS and migraine in patients. Methods Thirteen single-nucleotide polymorphisms (SNPs) at six RLS risk loci ( MEIS1, BTBD9, MAP2K5, PTPRD, TOX3, and an intergenic region on chromosome 2p14) were genotyped in 211 migraine patients with RLS and 781 migraine patients without RLS. Association analyses were performed for the overall cohort, as well as for the subgroups of patients who experienced migraines with and without aura and episodic migraines (EMs) vs. chronic migraines (CMs). In order to verify which genetic markers were potentially related to the incidence of RLS in migraine patients, multivariate regression analyses were also performed. Results Among the six tested loci, only MEIS1 was significantly associated with RLS. The most significant SNP of MEIS1, rs2300478, increased the risk of RLS by 1.42-fold in the overall cohort ( p = 0.0047). In the subgroup analyses, MEIS1 augmented the risk of RLS only in the patients who experienced EMs (odds ratio (OR) = 1.99, p = 0.0004) and not those experiencing CMs. Multivariate regression analyses further showed that rs2300478 in MEIS1 (OR = 1.39, p = 0.018), a CM diagnosis (OR = 1.52, p = 0.022), and depression (OR = 1.86, p = 0.005) were independent predictors of RLS in migraine. Conclusions MEIS1 variants were associated with an increased risk of RLS in migraine patients. It is possible that an imbalance in iron homeostasis and the dopaminergic system may represent a link between RLS incidence and migraines.

The Association Between Body Mass Index and Open-angle Glaucoma in a South Korean Population-based Sample.

PubMed

Lin, Shuai-Chun; Pasquale, Louis R; Singh, Kuldev; Lin, Shan C

2018-03-01

The purpose of this article is to investigate the association between body mass index (BMI) and open-angle glaucoma (OAG) in a sample of the South Korean population. The sample consisted of a cross-sectional, population-based sample of 10,978 participants, 40 years of age and older, enrolled in the 2008 to 2011 Korean National Health and Nutrition Examination Survey. All participants had measured intraocular pressure <22 mm Hg and open anterior chamber angles. OAG was defined using disc and visual field criteria established by the International Society for Geographical and Epidemiological Ophthalmology. Multivariable analyses were performed to determine the association between BMI and OAG. These analyses were also performed in a sex-stratified and age-stratified manner. After adjusting for potential confounding variables, lower BMI (<19 kg/m) was associated with greater risk of OAG compared with normal BMI (19 to 24.9 kg/m) [odds ratio (OR), 2.28; 95% confidence interval (CI), 1.22-4.26]. In sex-stratified analyses, low BMI remained adversely related to glaucoma in women (OR, 3.45; 95% CI, 1.42-8.38) but not in men (OR, 1.72; 95% CI, 0.71-4.20). In age-stratified analyses, lower BMI was adversely related to glaucoma among subjects 40- to 49-year old (OR, 5.16; 95% CI, 1.86-14.36) but differences in glaucoma prevalence were not statistically significant between those with low versus normal BMI in other age strata. Lower BMI was associated with increased odds of OAG in a sample of the South Korean population. Multivariate analysis revealed the association to be statistically significant in women and those in the youngest age stratum.

Effects of unplanned treatment interruptions on HIV treatment failure - results from TAHOD.

PubMed

Jiamsakul, Awachana; Kerr, Stephen J; Ng, Oon Tek; Lee, Man Po; Chaiwarith, Romanee; Yunihastuti, Evy; Van Nguyen, Kinh; Pham, Thuy Thanh; Kiertiburanakul, Sasisopin; Ditangco, Rossana; Saphonn, Vonthanak; Sim, Benedict L H; Merati, Tuti Parwati; Wong, Wingwai; Kantipong, Pacharee; Zhang, Fujie; Choi, Jun Yong; Pujari, Sanjay; Kamarulzaman, Adeeba; Oka, Shinichi; Mustafa, Mahiran; Ratanasuwan, Winai; Petersen, Boondarika; Law, Matthew; Kumarasamy, Nagalingeswaran

2016-05-01

Treatment interruptions (TIs) of combination antiretroviral therapy (cART) are known to lead to unfavourable treatment outcomes but do still occur in resource-limited settings. We investigated the effects of TI associated with adverse events (AEs) and non-AE-related reasons, including their durations, on treatment failure after cART resumption in HIV-infected individuals in Asia. Patients initiating cART between 2006 and 2013 were included. TI was defined as stopping cART for >1 day. Treatment failure was defined as confirmed virological, immunological or clinical failure. Time to treatment failure during cART was analysed using Cox regression, not including periods off treatment. Covariables with P < 0.10 in univariable analyses were included in multivariable analyses, where P < 0.05 was considered statistically significant. Of 4549 patients from 13 countries in Asia, 3176 (69.8%) were male and the median age was 34 years. A total of 111 (2.4%) had TIs due to AEs and 135 (3.0%) had TIs for other reasons. Median interruption times were 22 days for AE and 148 days for non-AE TIs. In multivariable analyses, interruptions >30 days were associated with failure (31-180 days HR = 2.66, 95%CI (1.70-4.16); 181-365 days HR = 6.22, 95%CI (3.26-11.86); and >365 days HR = 9.10, 95% CI (4.27-19.38), all P < 0.001, compared to 0-14 days). Reasons for previous TI were not statistically significant (P = 0.158). Duration of interruptions of more than 30 days was the key factor associated with large increases in subsequent risk of treatment failure. If TI is unavoidable, its duration should be minimised to reduce the risk of failure after treatment resumption. © 2016 John Wiley & Sons Ltd.

Effects of unplanned treatment interruptions on HIV treatment failure– results from TAHOD

PubMed Central

Jiamsakul, Awachana; Kerr, Stephen J.; Ng, Oon Tek; Lee, Man Po; Chaiwarith, Romanee; Yunihastuti, Evy; Van Nguyen, Kinh; Pham, Thuy Thanh; Kiertiburanakul, Sasisopin; Ditangco, Rossana; Saphonn, Vonthanak; Sim, Benedict L. H.; Merati, Tuti Parwati; Wong, Wingwai; Kantipong, Pacharee; Zhang, Fujie; Choi, Jun Yong; Pujari, Sanjay; Kamarulzaman, Adeeba; Oka, Shinichi; Mustafa, Mahiran; Ratanasuwan, Winai; Petersen, Boondarika; Law, Matthew; Kumarasamy, Nagalingeswaran

2016-01-01

Objectives Treatment interruptions (TI) of combination antiretroviral therapy (cART) are known to lead to unfavourable treatment outcomes but do still occur in resource-limited settings. We investigated the effects of TI associated with adverse events (AEs) and non-AE-related reasons, including their durations, on treatment failure after cART resumption in HIV-infected individuals in Asia. Methods Patients initiating cART between 2006-2013 were included. TI was defined as stopping cART for >1 day. Treatment failure was defined as confirmed virological, immunological or clinical failure. Time to treatment failure during cART was analysed using Cox regression, not including periods off treatment. Co-variables with p<0.10 in univariable analyses were included in multivariable analyses, where p<0.05 was considered statistically significant. Results Of 4549 patients from 13 countries in Asia, 3176 (69.8%) were male and the median age was 34 years. A total of 111 (2.4%) had TIs due to AEs and 135 (3.0%) had TIs for other reasons. Median interruption times were 22 days for AE and 148 days for non-AE TIs. In multivariable analyses, interruptions >30 days were associated with failure (31-180 days HR=2.66, 95%CI (1.70-4.16); 181-365 days HR=6.22, 95%CI (3.26-11.86); and >365 days HR=9.10, 95% CI (4.27-19.38), all p<0.001, compared to 0-14 days). Reasons for previous TI were not statistically significant (p=0.158). Conclusions Duration of interruptions of more than 30 days was the key factor associated with large increases in subsequent risk of treatment failure. If TI is unavoidable, its duration should be minimised to reduce the risk of failure after treatment resumption. PMID:26950901

DPYD*2A and MTHFR C677T predict toxicity and efficacy, respectively, in patients on chemotherapy with 5-fluorouracil for colorectal cancer.

PubMed

Nahid, Noor Ahmed; Apu, Mohd Nazmul Hasan; Islam, Md Reazul; Shabnaz, Samia; Chowdhury, Surid Mohammad; Ahmed, Maizbha Uddin; Nahar, Zabun; Islam, Md Siddiqul; Islam, Mohammad Safiqul; Hasnat, Abul

2018-01-01

Significant inter-individual variation in the sensitivity to 5-fluorouracil (5-FU) represents a major therapeutic hindrance either by impairing drug response or inducing adverse drug reactions (ADRs). This study aimed at exploring the cause behind this inter-individual alterations in consequences of 5-fluorouracil-based chemotherapy by investigating the effects of DPYD*2A and MTHFR C677T polymorphisms on toxicity and response of 5-FU in Bangladeshi colorectal cancer patients. Colorectal cancer patients (n = 161) receiving 5-FU-based chemotherapy were prospectively enrolled. DPYD and MTHFR polymorphisms were assessed in peripheral leukocytes. Multivariate analyses were applied to evaluate which variables could predict chemotherapy-induced toxicity and efficacy. Multivariate analyses showed that DPYD*2A polymorphism was a predictive factor (P = 0.023) for grade 3 and grade 4 5-fluorouracil-related toxicities. Although MTHFR C677T polymorphism might act as forecasters for grade 3 or grade 4 neutropenia, diarrhea, and mucositis, this polymorphism was found to increase significantly (P = 0.006) the response of 5-FU. DPYD*2A and MTHFR C677T polymorphisms could explain 5-FU toxicity or clinical outcome in Bangladeshi colorectal patients.

Are social relationships a healthy influence on obesogenic behaviors among racially/ethnically diverse and socio-economically disadvantaged residents?

PubMed Central

Tamers, Sara L.; Okechukwu, Cassandra; Allen, Jennifer; Yang, May; Stoddard, Anne; Tucker-Seeley, Reginald; Sorensen, Glorian

2012-01-01

Objective To examine associations between social support and ties (family, friend, neighbors) individually and jointly with diet and physical activity among an ethnically-diverse, low-income population. Methods The Health in Common study (2005–2009) was designed to examine risk factors among individuals residing in low-income housing in the Boston, MA area. Cross-sectional surveys (n = 828) were administered in residents’ homes. Linear/logistic multivariable analyses were employed with clustering of individuals within housing sites controlled as a random effect. Results In multivariable analyses, total social support was significantly associated with higher red meat consumption per day (p = 0.029). Having more friends was significantly associated with more daily fruit and vegetable intake (p = 0.007) and higher levels of daily vigorous physical activity (p = 0.011). Those who reported having a greater number of family ties also reported higher daily consumption of sugary drinks (p = 0.013) and fast food (p = 0.011). More neighbor social ties was associated with more fast food per day (p = 0.024). Conclusions Social relationships can have both positive and negative associations with health behaviors. Understanding these relationships could help to inform the design of interventions that promote healthy behavior change among vulnerable populations. PMID:23200880

Risk factors for urinary tract infection in children with urinary urgency.

PubMed

Gondim, Rhaiana; Azevedo, Roberta; Braga, Ana Aparecida Nascimento Martinelli; Veiga, Maria Luiza; Barroso, Ubirajara

2018-01-01

To identify which independent variable would be strong predictor of febrile urinary tract infection (UTI) in children and adolescents with overactive bladder. A search was made of the institute's database for all patients diagnosed with overactive bladder over the preceding four years. Children and adolescents under 18 years of age with overactive bladder and no neurological or anatomical alterations of the lower urinary tract were included in the study. The independent variables were: sex, age, ethnicity (Brazilians of African descendence/others), the presence of urinary urgency, daytime incontinence, enuresis, frequent urination, infrequent voiding (≤3 voids/day), nocturia, holding maneuvers, straining to void, intermittent urinary flow, constipation and encopresis. An analysis was conducted to identify patients with febrile UTI and subsequently determine predictors of this condition. Univariate and multivariate analyses were performed. Overall, 326 patients (214 girls/112 boys) were evaluated. The mean age of the patients was 7.7±3.19 years (± standard deviation). The incidence of febrile UTI was 39.2%. Being female and infrequent voiding were factors significantly associated with febrile UTI, both in the univariate and multivariate analyses. These results show that being female and infrequent voiding constituted significant risk factors for a diagnosis of febrile UTI in these children. Copyright® by the International Brazilian Journal of Urology.

Genetic Structure of Bluefin Tuna in the Mediterranean Sea Correlates with Environmental Variables

PubMed Central

Riccioni, Giulia; Stagioni, Marco; Landi, Monica; Ferrara, Giorgia; Barbujani, Guido; Tinti, Fausto

2013-01-01

Background Atlantic Bluefin Tuna (ABFT) shows complex demography and ecological variation in the Mediterranean Sea. Genetic surveys have detected significant, although weak, signals of population structuring; catch series analyses and tagging programs identified complex ABFT spatial dynamics and migration patterns. Here, we tested the hypothesis that the genetic structure of the ABFT in the Mediterranean is correlated with mean surface temperature and salinity. Methodology We used six samples collected from Western and Central Mediterranean integrated with a new sample collected from the recently identified easternmost reproductive area of Levantine Sea. To assess population structure in the Mediterranean we used a multidisciplinary framework combining classical population genetics, spatial and Bayesian clustering methods and a multivariate approach based on factor analysis. Conclusions FST analysis and Bayesian clustering methods detected several subpopulations in the Mediterranean, a result also supported by multivariate analyses. In addition, we identified significant correlations of genetic diversity with mean salinity and surface temperature values revealing that ABFT is genetically structured along two environmental gradients. These results suggest that a preference for some spawning habitat conditions could contribute to shape ABFT genetic structuring in the Mediterranean. However, further studies should be performed to assess to what extent ABFT spawning behaviour in the Mediterranean Sea can be affected by environmental variation. PMID:24260341

Does tip-of-the-tongue for proper names discriminate amnestic mild cognitive impairment?

PubMed

Juncos-Rabadán, Onésimo; Facal, David; Lojo-Seoane, Cristina; Pereiro, Arturo X

2013-04-01

Difficulty in retrieving people's names is very common in the early stages of Alzheimer's disease and mild cognitive impairment. Such difficulty is often observed as the tip-of-the-tongue (TOT) phenomenon. The main aim of this study was to explore whether a famous people's naming task that elicited the TOT state can be used to discriminate between amnestic mild cognitive impairment (aMCI) patients and normal controls. Eighty-four patients with aMCI and 106 normal controls aged over 50 years performed a task involving naming 50 famous people shown in pictures. Univariate and multivariate regression analyses were used to study the relationships between aMCI and semantic and phonological measures in the TOT paradigm. Univariate regression analyses revealed that all TOT measures significantly predicted aMCI. Multivariate analysis of all these measures correctly classified 70% of controls (specificity) and 71.6% of aMCI patients (sensitivity), with an AUC (area under curve ROC) value of 0.74, but only the phonological measure remained significant. This classification value was similar to that obtained with the Semantic verbal fluency test. TOTs for proper names may effectively discriminate aMCI patients from normal controls through measures that represent one of the naming processes affected, that is, phonological access.

Using multivariate analyses and GIS to identify pollutants and their spatial patterns in urban soils in Galway, Ireland.

PubMed

Zhang, Chaosheng

2006-08-01

Galway is a small but rapidly growing tourism city in western Ireland. To evaluate its environmental quality, a total of 166 surface soil samples (0-10 cm depth) were collected from parks and grasslands at the density of 1 sample per 0.25 km2 at the end of 2004. All samples were analysed using ICP-AES for the near-total concentrations of 26 chemical elements. Multivariate statistics and GIS techniques were applied to classify the elements and to identify elements influenced by human activities. Cluster analysis (CA) and principal component analysis (PCA) classified the elements into two groups: the first group predominantly derived from natural sources, the second being influenced by human activities. GIS mapping is a powerful tool in identifying the possible sources of pollutants. Relatively high concentrations of Cu, Pb and Zn were found in the city centre, old residential areas, and along major traffic routes, showing significant effects of traffic pollution. The element As is enriched in soils of the old built-up areas, which can be attributed to coal and peat combustion for home heating. Such significant spatial patterns of pollutants displayed by urban soils may imply potential health threat to residents of the contaminated areas of the city.

Effects of proton pump inhibitors and histamine-2 receptor antagonists on response to fidaxomicin or vancomycin in patients with Clostridium difficile-associated diarrhoea

PubMed Central

Weiss, Karl; Louie, Thomas; Miller, Mark A; Mullane, Kathleen; Crook, Derrick W; Gorbach, Sherwood L

2015-01-01

Objective It has been established that use of proton pump inhibitors (PPIs) is associated with an increased risk of acquiring Clostridium difficile-associated diarrhoea (CDAD). However, it is not known whether the use of PPIs or histamine-2 receptor antagonists (H2RAs) concurrently with CDAD-targeted antibiotic treatment affects clinical response or recurrence rates. Design In two phase 3 trials, patients with toxin-positive CDAD were randomised to receive fidaxomicin 200 mg twice daily or vancomycin 125 mg four times daily for 10 days. Only inpatients with CDAD (due to complete medication record availability) were included in this post hoc analysis: 701 patients, of whom 446 (64%) used PPIs or H2RAs during study drug treatment or follow-up. Baseline factors that were statistically significant in univariate analyses were analysed in multivariate analyses of effects on clinical response and recurrence. Results Multivariate analysis showed that leukocytosis, elevated creatinine and hypoalbuminemia, but not PPI or H2RA use, were significant factors associated with poor clinical responses. Treatment group was the single significant predictor of recurrence; the probability of recurrence after fidaxomicin therapy was half that following vancomycin therapy. Conclusions Acid-suppressing drugs, used by nearly two-thirds of inpatients with CDAD, did not worsen clinical response or recurrence when used concurrently with fidaxomicin or vancomycin. Therefore, development of CDAD does not require discontinuation of anti-acid treatment in patients who have an indication for continuing PPI or H2RA therapy, such as gastro-oesophageal reflux disease and risk of gastrointestinal bleed. PMID:26462279

The prevalence and characteristics of low back pain among sitting workers in a Japanese manufacturing company.

PubMed

Inoue, Gen; Miyagi, Masayuki; Uchida, Kentaro; Ishikawa, Tetsuhiro; Kamoda, Hiroto; Eguchi, Yawara; Orita, Sumihisa; Yamauchi, Kazuyo; Takaso, Masashi; Tsuchiya, Kei-Ichi; Takahashi, Kazuhisa; Ohtori, Seiji

2015-01-01

Low back pain (LBP) is a major public health problem and the most common cause of workers' disability, resulting in substantial economic burden in terms of workers' compensation and medical costs. Sitting is a recognized potential risk factor for developing LBP. Therefore, eliminating risk factors associated with working conditions and individual work capacity may be beneficial in preventing LBP in sitting workers. The purpose of this prospective cross-sectional study is to investigate the prevalence of LBP and examine risk factors that contribute to the development of LBP in sitting workers at an electronics manufacturing company. A cross-sectional survey was administered to all subjects to assess the prevalence of LBP persisting for at least 48 h during the recent week. Data on demographic characteristics and potential risk factors for LBP were collected at routine annual check-ups. Patients with LBP completed the Roland-Morris Disability Questionnaire (RDQ), which provided information on the attributes of LBP. Univariate and multivariate regression analyses examined the association between LBP and potential risk factors. Of the 1,329 sitting workers, 201 (15.1 %) acknowledged experiencing LBP during the recent week. In female workers, weight and body mass index were significantly correlated with the RDQ score. Univariate analyses identified male sex, prior history of LBP, height ≥170 cm, and weight ≥70 kg as significant risk factors of LBP. Multivariate logistic regression analyses identified prior history of LBP and past history of lumbar spine surgery as significant risk factors of LBP. This study characterized the prevalence and attributes of LBP in Japanese sitting workers and provided information about potential risk factors contributing to occurrence of LBP in the workplace.

Adverse obstetric outcomes in pregnant women with uterine fibroids in China: A multicenter survey involving 112,403 deliveries

PubMed Central

Zhao, Rong; Wang, Xin; Zou, Liying; Li, Guanghui; Chen, Yi; Li, Changdong; Zhang, Weiyuan

2017-01-01

Objective To estimate the association between uterine fibroids and adverse obstetric outcomes. Methods This was a retrospective cross-sectional study of 112,403 deliveries from 14 provinces and 39 different hospitals in 2011 in mainland China. We compared pregnancy outcomes in women with and without uterine fibroids who underwent detailed second trimester obstetric ultrasonography during 18 to 22 weeks. Obstetric outcomes include cesarean delivery, breech presentation, preterm delivery, placenta previa, placental abruption, premature rupture of membranes and neonatal birthweight. Univariate analyses and multivariate logistic regression analyses were performed. Results Of 112,403 women who underwent routine obstetric survey, 3,012 (2.68%) women were identified with at least 1 fibroid. By univariate and multivariate analyses, the presence of uterine fibroids was significantly associated with cesarean delivery (Adjusted odds radio [AOR] 1.8, 95% confidence interval [CI] 1.7–2.0), breech presentation (AOR 1.3, 95% CI 1.2–1.5) and postpartum hemorrhage (AOR 1.2, 95% CI 1.1–1.4). The size of uterine fibroids and location in uterus had important effect on the mode of delivery. The rates of PPH were significantly higher with increasing size of the uterine fibroid (P<0.001). And the location of fibroid (intramural, submucosal or subserosal) also have a statistically significant impact on the risk of PPH (5.6% [subserosal] vs 4.7% [submucosal] vs 8.6% [intramural]). Conclusion Pregnant women with uterine fibroids are at increased risk for cesarean delivery, breech presentation and postpartum hemorrhage. And different characteristics of uterine fibroids affect obstetric outcomes through different ways. Such detailed information may be useful in risk-stratifying pregnant women with fibroids. PMID:29136018

Impact of malocclusion on oral health related quality of life in young people

PubMed Central

2013-01-01

Background The objectives for this study were to assess Oral Health Related Quality of Life (OHRQoL) in young people aged 15–25 who sought orthodontic treatment, and to measure the association between orthodontic treatment need (using the IOTN), sex, age and education level, and oral health related quality of life (OHRQoL). Methods Survey of a consecutive series of 323 young adults aged 15 to 25 years, attending orthodontic clinics at the Faculty of Dentistry, Universiti Teknologi MARA. Participants completed the Oral Health Impact Profile-14 (OHIP-14) and had a clinical examination including the Index of Orthodontic Treatment Need- Dental Health Component (IOTN-DHC). Data analyses included descriptive statistics, One-way ANOVA and bivariate and multivariate regression models. Results The mean overall score (± SD) for OHIP-14 in young people aged 15–25 was 22.6 ± 12.5. The psychological discomfort domain was the domain where highest impact was recorded with a mean (± SD) of 4.0 ± 1.9. The regression analyses showed a significant association of IOTN-DHC with overall OHIP-14 score (p < 0.05). Although females reported a slightly higher impact than males, this was not significant in both bivariate and multivariate analyses. Age group had a significant negative association with overall OHIP-14 score (p < 0.05). The 15–18 year old group showed the highest impact on their quality of life due to malocclusion. Participants with a university education report a significantly higher impact on OHRQoL as compared to participants with only secondary education. Conclusion Malocclusion has a significant negative impact on OHRQoL and its domains. This is greatest for the psychological discomfort domain. Younger people and those with a university education report higher levels of impact. There was no reported difference in impact between male and females. PMID:23443041

Aspects of posttraumatic stress disorder in long-term testicular cancer survivors: cross-sectional and longitudinal findings.

PubMed

Dahl, Alv A; Østby-Deglum, Marie; Oldenburg, Jan; Bremnes, Roy; Dahl, Olav; Klepp, Olbjørn; Wist, Erik; Fosså, Sophie D

2016-10-01

The purpose of this research is to study the prevalence of posttraumatic stress disorder (PTSD) and variables associated with PTSD in Norwegian long-term testicular cancer survivors (TCSs) both cross-sectionally and longitudinally. At a mean of 11 years after diagnosis, 1418 TCSs responded to a mailed questionnaire, and at a mean of 19 years after diagnosis, 1046 of them responded again to a modified questionnaire. Posttraumatic symptoms related to testicular cancer were self-rated with the Impact of Event Scale (IES) at the 11-year study only. An IES total score ≥35 defined Full PTSD, and a score 26-34 identified Partial PTSD, and the combination of Full and Partial PTSD defined Probable PTSD. At the 11-year study, 4.5 % had Full PTSD, 6.4 % had Partial PTSD, and 10.9 % Probable had PTSD. At both studies, socio-demographic variables, somatic health, anxiety/depression, chronic fatigue, and neurotoxic adverse effects were significantly associated with Probable PTSD in bivariate analyses. Probable anxiety disorder, poor self-rated health, and neurotoxicity remained significant with Probable PTSD in multivariate analyses at the 11-year study. In bivariate analyses, probable PTSD at that time significantly predicted socio-demographic variables, somatic health, anxiety/depression, chronic fatigue, and neurotoxicity among participants of the 19-year study, but only probable anxiety disorder remained significant in multivariable analysis. In spite of excellent prognosis, 10.9 % of long-term testicular cancer survivors had Probable PTSD at a mean of 11 years after diagnosis. Probable PTSD was significantly associated with a broad range of problems both at that time and was predictive of considerable problems at a mean of 19 year postdiagnosis. Among long-term testicular cancer survivors, 10.9 % have Probable PTSD with many associated problems, and therefore health personnel should explore stress symptoms at follow-up since efficient treatments are available.

Systemic lupus erythematosus in a multiethnic cohort (LUMINA): XXVIII. Factors predictive of thrombotic events.

PubMed

Ho, K T; Ahn, C W; Alarcón, G S; Baethge, B A; Tan, F K; Roseman, J; Bastian, H M; Fessler, B J; McGwin, G; Vilá, L M; Calvo-Alén, J; Reveille, J D

2005-10-01

To determine the relationship between the presence of antiphospholipid (aPL) antibodies, hydroxychloroquine use and the occurrence of thrombotic events in patients with systemic lupus erythematosus (SLE). Four hundred and forty-two SLE patients from the LUMINA (Lupus in Minorities: Nature vs Nurture) cohort, a multiethnic (Hispanics from Texas, n = 99 and Puerto Rico, n = 36; African Americans, n = 172; and Caucasians, n = 135) cohort, were studied by generalized estimating equation (GEE) to determine the relationship between antiphospholipid (aPL) antibodies (measured as IgG and IgM aPL antibodies and/or the lupus anticoagulant) at enrolment or historically prior to enrolment, hydroxychloroquine use (ever) and the occurrence of thrombotic (central and/or peripheral, arterial and/or venous) events after adjusting for known and possible confounders [socioeconomic-demographic features, smoking, disease activity and damage, serum cholesterol levels, anti-oxidized low-density lipoprotein IgG and IgM antibodies, and high-sensitivity (hs) C-reactive protein]. Postanalysis correlation between aPL and anticardiolipin (aCL) assays was attempted by performing aCL assays on random samples of patients whose aPL status was known. A number of clinical variables were significant in the univariable analyses; however, in the multivariable GEE analyses, only smoking [odds ratio (OR) 2.777, 95% confidence interval (CI) 1.317-5.852] and disease activity as measured by the SLAM (Systemic Lupus Activity Measure) (OR 1.099; 95% CI 1.053-1.147) were significant. In particular, hydroxychloroquine use, which appeared to be protective against thrombotic events in the univariable analyses, was not retained in the multivariable analyses. aPL antibodies were not significant in either analysis. Few additional aPL-positive patients emerged from the validation study. Smoking and disease activity emerged as important determinants in the occurrence of thrombotic events in our patients. Comprehensive treatment strategies should be directed to both smoking cessation and control of disease activity in patients with SLE.

MULTIVARIATE ANALYSES (CONONICAL CORRELATION AND PARTIAL LEAST SQUARE, PLS) TO MODEL AND ASSESS THE ASSOCIATION OF LANDSCAPE METRICS TO SURFACE WATER CHEMICAL AND BIOLOGICAL PROPERTIES USING SAVANNAH RIVER BASIN DATA.

EPA Science Inventory

Many multivariate methods are used in describing and predicting relation; each has its unique usage of categorical and non-categorical data. In multivariate analysis of variance (MANOVA), many response variables (y's) are related to many independent variables that are categorical...

Parental IQ and cognitive development of malnourished Indonesian children.

PubMed

Webb, K E; Horton, N J; Katz, D L

2005-04-01

A cross-sectional study of children in West Kalimantan, Indonesia, was conducted to examine the relationship between malnutrition history, child IQ, school attendance, socioeconomic status, parental education and parental IQ. In unadjusted analyses, severely stunted children had significantly lower IQ scores than mild-moderately stunted children. This effect was significant when stunting, school attendance and parental education were included in multivariable models but was attenuated when parental IQ was included. Our research underscores the importance of accounting for parental IQ as a critical covariate when modeling the association between childhood stunting and IQ.

Probabilistic flood damage modelling at the meso-scale

NASA Astrophysics Data System (ADS)

Kreibich, Heidi; Botto, Anna; Schröter, Kai; Merz, Bruno

2014-05-01

Decisions on flood risk management and adaptation are usually based on risk analyses. Such analyses are associated with significant uncertainty, even more if changes in risk due to global change are expected. Although uncertainty analysis and probabilistic approaches have received increased attention during the last years, they are still not standard practice for flood risk assessments. Most damage models have in common that complex damaging processes are described by simple, deterministic approaches like stage-damage functions. Novel probabilistic, multi-variate flood damage models have been developed and validated on the micro-scale using a data-mining approach, namely bagging decision trees (Merz et al. 2013). In this presentation we show how the model BT-FLEMO (Bagging decision Tree based Flood Loss Estimation MOdel) can be applied on the meso-scale, namely on the basis of ATKIS land-use units. The model is applied in 19 municipalities which were affected during the 2002 flood by the River Mulde in Saxony, Germany. The application of BT-FLEMO provides a probability distribution of estimated damage to residential buildings per municipality. Validation is undertaken on the one hand via a comparison with eight other damage models including stage-damage functions as well as multi-variate models. On the other hand the results are compared with official damage data provided by the Saxon Relief Bank (SAB). The results show, that uncertainties of damage estimation remain high. Thus, the significant advantage of this probabilistic flood loss estimation model BT-FLEMO is that it inherently provides quantitative information about the uncertainty of the prediction. Reference: Merz, B.; Kreibich, H.; Lall, U. (2013): Multi-variate flood damage assessment: a tree-based data-mining approach. NHESS, 13(1), 53-64.

Stature and jumping height are required in female volleyball, but motor coordination is a key factor for future elite success.

PubMed

Pion, Johan A; Fransen, Job; Deprez, Dieter N; Segers, Veerle I; Vaeyens, Roel; Philippaerts, Renaat M; Lenoir, Matthieu

2015-06-01

It was hypothesized that differences in anthropometry, physical performance, and motor coordination would be found between Belgian elite and sub-elite level female volleyball players using a retrospective analysis of test results gathered over a 5-year period. The test sample in this study consisted of 21 young female volleyball players (15.3 ± 1.5 years) who were selected to train at the Flemish Top Sports Academy for Volleyball in 2008. All players (elite, n = 13; sub-elite, n = 8) were included in the same talent development program, and the elite-level athletes were of a high to very high performance levels according to European competition level in 2013. Five multivariate analyses of variance were used. There was no significant effect of playing level on measures of anthropometry (F = 0.455, p = 0.718, (Equation is included in full-text article.)= 0.07), flexibility (F = 1.861, p = 0.188, (Equation is included in full-text article.)= 0.19), strength (F = 1.218, p = 0.355, (Equation is included in full-text article.)= 0.32); and speed and agility (F = 1.176, p = 0.350, (Equation is included in full-text article.)= 0.18). Multivariate analyses of variance revealed significant multivariate effects between playing levels for motor coordination (F = 3.470, p = 0.036, (Equation is included in full-text article.)= 0.59). A Mann-Whitney U test and a sequential discriminant analysis confirmed these results. Previous research revealed that stature and jump height are prerequisites for talent identification in female volleyball. In addition, the results show that motor coordination is an important factor in determining inclusion into the elite level in female volleyball.

Acoustic neuroma: potential risk factors and audiometric surveillance in the aluminium industry.

PubMed

Taiwo, Oyebode; Galusha, Deron; Tessier-Sherman, Baylah; Kirsche, Sharon; Cantley, Linda; Slade, Martin D; Cullen, Mark R; Donoghue, A Michael

2014-09-01

To look for an association between acoustic neuroma (AN) and participation in a hearing conservation programme (HCP) and also for an association between AN and possible occupational risk factors in the aluminium industry. We conducted a case-control analysis of a population of US aluminium production workers in 8 smelters and 43 other plants. Using insurance claims data, 97 cases of AN were identified between 1996 and 2009. Each was matched with four controls. Covariates included participation in a HCP, working in an aluminium smelter, working in an electrical job and hearing loss. In the bivariate analyses, covariates associated with AN were participation in the HCP (OR=1.72; 95% CI 1.09 to 2.69) and smelter work (OR=1.88; 95% CI 1.06 to 3.36). Electrical work was not significant (OR=1.60; 95% CI 0.65 to 3.94). Owing to high participation in the HCP in smelters, multivariate subanalyses were required. In the multivariate analyses, participation in the HCP was the only statistically significant risk factor for AN. In the multivariate analysis restricted to employees not working in a smelter, the OR was 1.81 (95% CI 1.04 to 3.17). Hearing loss, an indirect measure of in-ear noise dose, was not predictive of AN. Our results suggest the incidental detection of previously undiagnosed tumours in workers who participated in the company-sponsored HCP. The increased medical surveillance among this population of workers most likely introduced detection bias, leading to the identification of AN cases that would have otherwise remained undetected. 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.

Socio-economic Correlates of Malnutrition among Married Women in Bangladesh.

PubMed

Mostafa Kamal, S M; Md Aynul, Islam

2010-12-01

This paper examines the prevalence and socio-economic correlates of malnutrition among ever married non-pregnant women of reproductive age of Bangladesh using a nationally representative weighted sample of 10,145. Body mass index was used to measure nutritional status. Both bivariate and multivariate statistical analyses were employed to assess the relationship between socio-economic characteristics and women's nutritional status. Overall, 28.5% of the women were found to be underweight. The fixed effect multivariate binary logistic regression analysis yielded significantly increased risk of underweight for the young, currently working, non-Muslim, rural residents, widowed, divorced or separated women. Significant wide variations of malnourishment prevailed in the administrative regions of the country. Wealth index and women's education were the most important determinants of underweight. The multivariate logistic regression analysis revealed that the risk of being underweight was almost seven times higher (OR=6.76, 95% CI=5.20-8.80) among women with no formal education as compared to those with higher education and the likelihood of underweight was significantly (p<0.001) 5.2 times (OR=5.23, 95% CI=4.51-6.07) in the poorest as compared to their richest counterparts. Poverty alleviation programmes should be strengthened targeting the poor. Effective policies, information and health education programmes for women are required to ensure adequate access to health services and for them to understand the components of a healthy diet.

Aging, not menopause, is associated with higher prevalence of hyperuricemia among older women.

PubMed

Krishnan, Eswar; Bennett, Mihoko; Chen, Linjun

2014-11-01

This work aims to study the associations, if any, of hyperuricemia, gout, and menopause status in the US population. Using multiyear data from the National Health and Nutrition Examination Survey, we performed unmatched comparisons and one to three age-matched comparisons of women aged 20 to 70 years with and without hyperuricemia (serum urate ≥6 mg/dL). Analyses were performed using survey-weighted multiple logistic regression and conditional logistic regression, respectively. Overall, there were 1,477 women with hyperuricemia. Age and serum urate were significantly correlated. In unmatched analyses (n = 9,573 controls), postmenopausal women were older, were heavier, and had higher prevalence of renal impairment, hypertension, diabetes, and hyperlipidemia. In multivariable regression, after accounting for age, body mass index, glomerular filtration rate, and diuretic use, menopause was associated with hyperuricemia (odds ratio, 1.36; 95% CI, 1.05-1.76; P = 0.002). In corresponding multivariable regression using age-matched data (n = 4,431 controls), the odds ratio for menopause was 0.94 (95% CI, 0.83-1.06). Current use of hormone therapy was not associated with prevalent hyperuricemia in both unmatched and matched analyses. Age is a better statistical explanation for the higher prevalence of hyperuricemia among older women than menopause status.

Low Social Status Markers: Do They Predict Depressive Symptoms in Adolescence?

PubMed

Jackson, Benita; Goodman, Elizabeth

2011-07-01

Some markers of social disadvantage are associated robustly with depressive symptoms among adolescents: female gender and lower socioeconomic status (SES), respectively. Others are associated equivocally, notably Black v. White race/ethnicity. Few studies examine whether markers of social disadvantage by gender, SES, and race/ethnicity jointly predict self-reported depressive symptoms during adolescence; this was our goal. Secondary analyses were conducted on data from a socioeconomically diverse community-based cohort study of non-Hispanic Black and White adolescents (N = 1,263, 50.4% female). Multivariable general linear models tested if female gender, Black race/ethnicity, and lower SES (assessed by parent education and household income), and their interactions predicted greater depressive symptoms reported on the Center for Epidemiological Studies-Depression scale. Models adjusted for age and pubertal status. Univariate analyses revealed more depressive symptoms in females, Blacks, and participants with lower SES. Multivariable models showed females across both racial/ethnic groups reported greater depressive symptoms; Blacks demonstrated more depressive symptoms than did Whites but when SES was included this association disappeared. Exploratory analyses suggested Blacks gained less mental health benefit from increased SES. However there were no statistically significant interactions among gender, race/ethnicity, or SES. Taken together, we conclude that complex patterning among low social status domains within gender, race/ethnicity, and SES predicts depressive symptoms among adolescents.

The association between a body shape index and cardiovascular risk in overweight and obese children and adolescents.

PubMed

Mameli, Chiara; Krakauer, Nir Y; Krakauer, Jesse C; Bosetti, Alessandra; Ferrari, Chiara Matilde; Moiana, Norma; Schneider, Laura; Borsani, Barbara; Genoni, Teresa; Zuccotti, Gianvincenzo

2018-01-01

A Body Shape Index (ABSI) and normalized hip circumference (Hip Index, HI) have been recently shown to be strong risk factors for mortality and for cardiovascular disease in adults. We conducted an observational cross-sectional study to evaluate the relationship between ABSI, HI and cardiometabolic risk factors and obesity-related comorbidities in overweight and obese children and adolescents aged 2-18 years. We performed multivariate linear and logistic regression analyses with BMI, ABSI, and HI age and sex normalized z scores as predictors to examine the association with cardiometabolic risk markers (systolic and diastolic blood pressure, fasting glucose and insulin, total cholesterol and its components, transaminases, fat mass % detected by bioelectrical impedance analysis) and obesity-related conditions (including hepatic steatosis and metabolic syndrome). We recruited 217 patients (114 males), mean age 11.3 years. Multivariate linear regression showed a significant association of ABSI z score with 10 out of 15 risk markers expressed as continuous variables, while BMI z score showed a significant correlation with 9 and HI only with 1. In multivariate logistic regression to predict occurrence of obesity-related conditions and above-threshold values of risk factors, BMI z score was significantly correlated to 7 out of 12, ABSI to 5, and HI to 1. Overall, ABSI is an independent anthropometric index that was significantly associated with cardiometabolic risk markers in a pediatric population affected by overweight and obesity.

Use of the Analysis of the Volatile Faecal Metabolome in Screening for Colorectal Cancer

PubMed Central

2015-01-01

Diagnosis of colorectal cancer is an invasive and expensive colonoscopy, which is usually carried out after a positive screening test. Unfortunately, existing screening tests lack specificity and sensitivity, hence many unnecessary colonoscopies are performed. Here we report on a potential new screening test for colorectal cancer based on the analysis of volatile organic compounds (VOCs) in the headspace of faecal samples. Faecal samples were obtained from subjects who had a positive faecal occult blood sample (FOBT). Subjects subsequently had colonoscopies performed to classify them into low risk (non-cancer) and high risk (colorectal cancer) groups. Volatile organic compounds were analysed by selected ion flow tube mass spectrometry (SIFT-MS) and then data were analysed using both univariate and multivariate statistical methods. Ions most likely from hydrogen sulphide, dimethyl sulphide and dimethyl disulphide are statistically significantly higher in samples from high risk rather than low risk subjects. Results using multivariate methods show that the test gives a correct classification of 75% with 78% specificity and 72% sensitivity on FOBT positive samples, offering a potentially effective alternative to FOBT. PMID:26086914

Histological changes associated with neoadjuvant chemotherapy are predictive of nodal metastases in high-risk prostate cancer patients

PubMed Central

O’Brien, Catherine; True, Lawrence D.; Higano, Celestia S.; Rademacher, Brooks L. S.; Garzotto, Mark; Beer, Tomasz M.

2011-01-01

Clinical trials are evaluating the effect of neoadjuvant chemotherapy on men with high risk prostate cancer. Little is known about the clinical significance of post-chemotherapy tumor histopathology. We assessed the prognostic and predictive value of histological features (intraductal carcinoma, vacuolated cell morphology, inconspicuous glands, cribriform architecture, and inconspicuous cancer cells) observed in 50 high-risk prostate cancers treated with pre-prostatectomy docetaxel and mitoxantrone. At a median follow-up of 65 months, the overall relapse-free survival (RFS) at 2 and 5 years was 65% and 49%, respectively. In univariate analyses (using Kaplan-Meier method and log-rank tests) intraductal (p=0.001) and cribriform (p=0.014) histologies were associated with shorter RFS. In multivariate analyses, using Cox’s proportional hazards regression, baseline PSA (p=0.004), lymph node metastases (p<0.001), and cribriform histology (p=0.007) were associated with shorter RFS. In multivariable logistic regression analysis, only intraductal pattern (p=0.007) predicted lymph node metastases. Intraductal and cribriform histologies apparently predict post-chemotherapy outcome. PMID:20231619

Predictors of Low Back Pain Onset in a Prospective British Study

PubMed Central

Power, Chris; Frank, John; Hertzman, Clyde; Schierhout, Gill; Li, Leah

2001-01-01

Objectives. This study examined predictors of low back pain onset in a British birth cohort. Methods. Univariate and multivariate analyses focused on individuals who experienced onset of low back pain at 32 to 33 years of age (n= 571) and individuals who were pain free (n = 5210). Participants were members of the 1958 British birth cohort. Results. Incident pain was elevated among those with psychological distress at 23 years of age (adjusted odds ratio [OR] = 2.52, 95% confidence interval [CI] = 1.65, 3.86) and among persistent moderate or heavy smokers (adjusted OR = 1.63, 95% CI = 1.23, 2.17). Significant univariate associations involving other factors (e.g., social class, childhood emotional status, body mass index, job satisfaction) did not persist in multivariate analyses. Conclusions. This prospectively studied cohort provides evidence that psychological distress more than doubles later risk of low back pain, with smoking having a modest independent effect. Other prospective studies are needed to confirm these findings before implications for low back pain prevention can be assessed. PMID:11574334

The use of time-series data in the assessment of macrobenthic community change after the cessation of sewage-sludge disposal in Liverpool Bay (UK).

PubMed

Whomersley, P; Schratzberger, M; Huxham, M; Bates, H; Rees, H

2007-01-01

Sewage sludge was disposed of in Liverpool Bay for over 100 years. Annual amounts increased from 0.5 million tonnes per annum in 1900 to approximately 2 million tonnes per annum by 1995. Macrofauna and a suite of environmental variables were collected at a station adjacent to, and a reference station distant from, the disposal site over 13 years, spanning a pre- (1990-1998) and post- (1999-2003) cessation period. Univariate and multivariate analyses of the time-series data showed significant community differences between reference and disposal site stations and multivariate analyses revealed station-specific community development post-disposal. Temporal variability of communities collected at the disposal station post-cessation was higher than during years of disposal, when temporally stable dominance patterns of disturbance-tolerant species had established. Alterations of community structure post-disturbance reflected successional changes possibly driven by facilitation. Subtle faunistic changes at the Liverpool Bay disposal site indicate that the near-field effects of the disposal of sewage sludge were small and therefore could be considered environmentally acceptable.

Cognitive function after the initiation of adjuvant endocrine therapy in early-stage breast cancer: an observational cohort study.

PubMed

Ganz, Patricia A; Petersen, Laura; Castellon, Steven A; Bower, Julienne E; Silverman, Daniel H S; Cole, Steven W; Irwin, Michael R; Belin, Thomas R

2014-11-01

This report examines cognitive complaints and neuropsychological (NP) testing outcomes in patients with early-stage breast cancer after the initiation of endocrine therapy (ET) to determine whether this therapy plays any role in post-treatment cognitive complaints. One hundred seventy-three participants from the Mind Body Study (MBS) observational cohort provided data from self-report questionnaires and NP testing obtained at enrollment (T1, before initiation of ET), and 6 months later (T2). Bivariate analyses compared demographic and treatment variables, cognitive complaints, depressive symptoms, quality of life, and NP functioning between those who received ET versus not. Multivariable linear regression models examined predictors of cognitive complaints at T2, including selected demographic variables, depressive symptoms, ET use, and other medical variables, along with NP domains that were identified in bivariate analyses. Seventy percent of the 173 MBS participants initiated ET, evenly distributed between tamoxifen or aromatase inhibitors. ET-treated participants reported significantly increased language and communication (LC) cognitive complaints at T2 (P = .003), but no significant differences in NP test performance. Multivariable regression on LC at T2 found higher LC complaints significantly associated with T1 LC score (P < .001), ET at T2 (P = .004), interaction between ET and past hormone therapy (HT) (P < .001), and diminished improvement in NP psychomotor function (P = .05). Depressive symptoms were not significant (P = .10). Higher LC complaints are significantly associated with ET 6 months after starting treatment and reflect diminished improvements in some NP tests. Past HT is a significant predictor of higher LC complaints after initiation of ET. © 2014 by American Society of Clinical Oncology.

Cognitive Function After the Initiation of Adjuvant Endocrine Therapy in Early-Stage Breast Cancer: An Observational Cohort Study

PubMed Central

Ganz, Patricia A.; Petersen, Laura; Castellon, Steven A.; Bower, Julienne E.; Silverman, Daniel H.S.; Cole, Steven W.; Irwin, Michael R.; Belin, Thomas R.

2014-01-01

Purpose This report examines cognitive complaints and neuropsychological (NP) testing outcomes in patients with early-stage breast cancer after the initiation of endocrine therapy (ET) to determine whether this therapy plays any role in post-treatment cognitive complaints. Patients and Methods One hundred seventy-three participants from the Mind Body Study (MBS) observational cohort provided data from self-report questionnaires and NP testing obtained at enrollment (T1, before initiation of ET), and 6 months later (T2). Bivariate analyses compared demographic and treatment variables, cognitive complaints, depressive symptoms, quality of life, and NP functioning between those who received ET versus not. Multivariable linear regression models examined predictors of cognitive complaints at T2, including selected demographic variables, depressive symptoms, ET use, and other medical variables, along with NP domains that were identified in bivariate analyses. Results Seventy percent of the 173 MBS participants initiated ET, evenly distributed between tamoxifen or aromatase inhibitors. ET-treated participants reported significantly increased language and communication (LC) cognitive complaints at T2 (P = .003), but no significant differences in NP test performance. Multivariable regression on LC at T2 found higher LC complaints significantly associated with T1 LC score (P < .001), ET at T2 (P = .004), interaction between ET and past hormone therapy (HT) (P < .001), and diminished improvement in NP psychomotor function (P = .05). Depressive symptoms were not significant (P = .10). Conclusion Higher LC complaints are significantly associated with ET 6 months after starting treatment and reflect diminished improvements in some NP tests. Past HT is a significant predictor of higher LC complaints after initiation of ET. PMID:25267747

Alcohol use, sexual relationship power, and unprotected sex among patrons in bars and taverns in rural areas of North West province, South Africa.

PubMed

Nkosi, Sebenzile; Rich, Eileen P; Morojele, Neo K

2014-11-01

We examined the relative importance of alcohol consumption and sexual relationship power (SRP) in predicting unprotected sex among 406 bar patrons in North West province, South Africa. We assessed participants' demographic characteristics, alcohol consumption, SRP, and number of unprotected sexual episodes in the past 6 months. In correlational analyses, alcohol consumption was significantly associated with frequency of unprotected sex for both males and females. SRP was significantly associated with frequency of unprotected sex for males and marginally associated for females. In multivariate regression analyses, alcohol consumption was significantly associated with frequency of unprotected sex for both males and females. SRP's association was marginally significant for females and not significant for males. Alcohol consumption is more strongly associated with unprotected sex than is SRP among bar patrons. Combination HIV prevention approaches to curb problem drinking and increase condom accessibility, and regular and effective use are needed in tavern settings. SRP needs further examination among tavern populations.

Changes of visual-field global indices after cataract surgery in primary open-angle glaucoma patients.

PubMed

Seol, Bo Ram; Jeoung, Jin Wook; Park, Ki Ho

2016-11-01

To determine changes of visual-field (VF) global indices after cataract surgery and the factors associated with the effect of cataracts on those indices in primary open-angle glaucoma (POAG) patients. A retrospective chart review of 60 POAG patients who had undergone phacoemulsification and intraocular lens insertion was conducted. All of the patients were evaluated with standard automated perimetry (SAP; 30-2 Swedish interactive threshold algorithm; Carl Zeiss Meditec Inc.) before and after surgery. VF global indices before surgery were compared with those after surgery. The best-corrected visual acuity, intraocular pressure (IOP), number of glaucoma medications before surgery, mean total deviation (TD) values, mean pattern deviation (PD) value, and mean TD-PD value were also compared with the corresponding postoperative values. Additionally, postoperative peak IOP and mean IOP were evaluated. Univariate and multivariate logistic regression analyses were performed to identify the factors associated with the effect of cataract on global indices. Mean deviation (MD) after cataract surgery was significantly improved compared with the preoperative MD. Pattern standard deviation (PSD) and visual-field index (VFI) after surgery were similar to those before surgery. Also, mean TD and mean TD-PD were significantly improved after surgery. The posterior subcapsular cataract (PSC) type showed greater MD changes than did the non-PSC type in both the univariate and multivariate logistic regression analyses. In the univariate logistic regression analysis, the preoperative TD-PD value and type of cataract were associated with MD change. However, in the multivariate logistic regression analysis, type of cataract was the only associated factor. None of the other factors was associated with MD change. MD was significantly affected by cataracts, whereas PSD and VFI were not. Most notably, the PSC type showed better MD improvement compared with the non-PSC type after cataract surgery. Clinicians therefore should carefully analyze VF examination results for POAG patients with the PSC type.

Patient experience and process measures of quality of care at home health agencies: Factors associated with high performance.

PubMed

Smith, Laura M; Anderson, Wayne L; Lines, Lisa M; Pronier, Cristalle; Thornburg, Vanessa; Butler, Janelle P; Teichman, Lori; Dean-Whittaker, Debra; Goldstein, Elizabeth

2017-01-01

We examined the effects of provider characteristics on home health agency performance on patient experience of care (Home Health CAHPS) and process (OASIS) measures. Descriptive, multivariate, and factor analyses were used. While agencies score high on both domains, factor analyses showed that the underlying items represent separate constructs. Freestanding and Visiting Nurse Association agencies, higher number of home health aides per 100 episodes, and urban location were statistically significant predictors of lower performance. Lack of variation in composite measures potentially led to counterintuitive results for effects of organizational characteristics. This exploratory study showed the value of having separate quality domains.

Risk factors for microbial bioburden during daily wear of silicone hydrogel contact lenses.

PubMed

Jiang, Ying; Jacobs, Michael; Bajaksouzian, Saralee; Foster, Altreisha N; Debanne, Sara M; Bielefeld, Roger; Garvey, Matt; Raghupathy, Sangeetha; Kern, Jami; Szczotka-Flynn, Loretta B

2014-05-01

To assess risk factors associated with substantial microbial bioburden of lids, conjunctivae, contact lenses, and storage cases during daily wear of silicone hydrogel contact lenses. Two hundred eighteen patients were fit to lotrafilcon A lenses, randomized to use either a multipurpose solution or a hydrogen peroxide care system, and followed up for 1 year. Lenses, lens transport saline, lids, conjunctivae, and storage cases were cultured and considered to have substantial microbial bioburden when they harbored high levels of commensal or pathogenic organisms. Univariate and multivariate logistic regression analyses were conducted to examine which demographic covariates were associated with significant bioburden at each location while controlling for solution use. In multivariate analyses, smoking trended toward an association with lens bioburden (odds ratio [OR]=2.15, 95% confidence interval [CI]: 0.95-4.88). Clerical occupations were found to be associated with more frequent overall storage case contamination (OR=3.51, 95% CI: 1.15-10.70) and, specifically, higher gram-positive storage case contamination (OR=5.57, 95% CI: 1.82-17.06). The peroxide system was associated with more frequent storage case contamination (OR=7.6, 95% CI: 3.79-15.19). Coagulase-negative staphylococci (CNS) were the most frequently cultured organisms within storage cases, and in multivariate analyses, CNS were more frequently found in storage cases of peroxide users (OR=6.12, 95% CI: 2.91-13.09). Clerical occupations were associated with increased microbial bioburden of storage cases during daily wear of silicone hydrogel lenses. Smoking may increase the risk of lens contamination. Storage cases are most frequently contaminated with normal skin flora, and peroxide cases were associated with more frequent contamination. However, the solution type was not associated with lid or lens contamination nor with corneal infiltrative events in this study.

BRAF and RAS mutations as prognostic factors in metastatic colorectal cancer patients undergoing liver resection

PubMed Central

Schirripa, M; Bergamo, F; Cremolini, C; Casagrande, M; Lonardi, S; Aprile, G; Yang, D; Marmorino, F; Pasquini, G; Sensi, E; Lupi, C; De Maglio, G; Borrelli, N; Pizzolitto, S; Fasola, G; Bertorelle, R; Rugge, M; Fontanini, G; Zagonel, V; Loupakis, F; Falcone, A

2015-01-01

Background: Despite major advances in the management of metastatic colorectal cancer (mCRC) with liver-only involvement, relapse rates are high and reliable prognostic markers are needed. Methods: To assess the prognostic impact of BRAF and RAS mutations in a large series of liver-resected patients, medical records of 3024 mCRC patients were reviewed. Eligible cases undergoing potentially curative liver resection were selected. BRAF and RAS mutational status was tested on primary and/or metastases by means of pyrosequencing and mass spectrometry genotyping assay. Primary endpoint was relapse-free survival (RFS). Results: In the final study population (N=309) BRAF mutant, RAS mutant and all wild-type (wt) patients were 12(4%), 160(52%) and 137(44%), respectively. Median RFS was 5.7, 11.0 and 14.4 months respectively and differed significantly (Log-rank, P=0.043). At multivariate analyses, BRAF mutant had a higher risk of relapse in comparison to all wt (multivariate hazard ratio (HR)=2.31; 95% CI, 1.09–4.87; P=0.029) and to RAS mutant (multivariate HR=2.06; 95% CI, 1.02–4.14; P=0.044). Similar results were obtained in terms of overall survival. Compared with all wt patients, RAS mutant showed a higher risk of death (HR=1.47; 95% CI, 1.05–2.07; P=0.025), but such effect was lost at multivariate analyses. Conclusions: BRAF mutation is associated with an extremely poor median RFS after liver resection and with higher probability of relapse and death. Knowledge of BRAF mutational status may optimise clinical decision making in mCRC patients potentially candidate to hepatic surgery. RAS status as useful marker in this setting might require further studies. PMID:25942399

Neoadjuvant Radiotherapy: A Risk Factor for Short-Term Wound Complications after Radical Resection for Rectal Cancer?

PubMed

Holubar, Stefan D; Brickman, Rachel K; Greaves, Spencer W; Ivatury, S Joga

2016-08-01

Neoadjuvant radiotherapy (RT) for rectal cancer may increase wound complications after oncologic proctectomy. We aimed to assess the relationship between neoadjuvant RT and 30-day wound complications after radical surgery for rectal cancer. We identified rectal cancer patients (International Classification of Diseases, revision-9 [ICD-9] code 154.1) who underwent radical resection, using NSQIP from 2005 to 2010. Patients were stratified into preoperative radiation vs no radiation groups. Our primary outcome was any wound complication. The association between preoperative RT and postoperative wound complication rate was assessed by univariate, multivariable, and propensity score analyses. Of 242,670 colorectal cases, 6,297 patients were included. Of these, 2,476 (39%) received RT within 90 days preoperatively. The RT group, compared with the no RT group, received more chemotherapy within 30 days preoperatively (15.0% vs 2.5%, p < 0.0001), and had less laparoscopic (18.9% vs 25.1%, p < 0.0001) or sphincter-preserving surgery (61.8% vs 67.1%, p < 0.0001). In the univariate analyses, there was no difference in wound complications (19.6% vs 18.7%, p = 0.42) between groups. Similarly, there was no difference in overall complications (29.6% vs 29.8%, p = 0.89), return to operating room (6.7% vs 6.7%, p = 0.96), or length of stay (8.4 vs 8.4 days, p = 0.72) between the RT and no RT groups, respectively. The mortality rate in the RT group was lower on univariate analysis (0.7% vs 1.4%, p = 0.008), but was not significantly different in the multivariable analyses. Multivariable and propensity score analyses were consistent with the lack of association between preoperative RT and postoperative wound complications. Neoadjuvant radiotherapy does not appear to be an independent risk factor for wound complications after radical surgery for rectal cancer. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Recurrent Dreams and Psychosocial Adjustment in Preteenaged Children

PubMed Central

Gauchat, Aline; Zadra, Antonio; Tremblay, Richard E.; Zelazo, Philip David; Séguin, Jean R.

2014-01-01

Research indicates that recurrent dreams in adults are associated with impoverished psychological well-being. Whether similar associations exist in children remains unknown. The authors hypothesized that children reporting recurrent dreams would show poorer psychosocial adjustment than children without recurrent dreams. One hundred sixty-eight 11-year-old children self-reported on their recurrent dreams and on measures of psychosocial adjustment. Although 35% of children reported having experienced a recurrent dream during the past year, our hypothesis was only partially supported. Multivariate analyses revealed a marginally significant interaction between gender and recurrent dream presence and a significant main effect of gender. Univariate analyses revealed that boys reporting recurrent dreams reported significantly higher scores on reactive aggression than those who did not (d = 0.58). This suggests that by age 11 years, the presence of recurrent dreams may already reflect underlying emotional difficulties in boys but not necessarily in girls. Challenges in addressing this developmental question are discussed. PMID:24976740

Causal diagrams and multivariate analysis II: precision work.

PubMed

Jupiter, Daniel C

2014-01-01

In this Investigators' Corner, I continue my discussion of when and why we researchers should include variables in multivariate regression. My examination focuses on studies comparing treatment groups and situations for which we can either exclude variables from multivariate analyses or include them for reasons of precision. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

A comparison of two follow-up analyses after multiple analysis of variance, analysis of variance, and descriptive discriminant analysis: A case study of the program effects on education-abroad programs

Treesearch

Alvin H. Yu; Garry Chick

2010-01-01

This study compared the utility of two different post-hoc tests after detecting significant differences within factors on multiple dependent variables using multivariate analysis of variance (MANOVA). We compared the univariate F test (the Scheffé method) to descriptive discriminant analysis (DDA) using an educational-tour survey of university study-...

Global cardiovascular mortality risk in the adult Polish population: prospective assessment of the cohorts studied in multicentre national WOBASZ and WOBASZ Senior studies.

PubMed

Piotrowski, Walerian; Waśkiewicz, Anna; Cicha-Mikołajczyk, Alicja

2016-01-01

To develop a global cardiovascular disease (CVD) mortality risk model for the Polish population and to verify these data in the context of the SCORE risk algorithm. We analysed data obtained in two multicentre national population studies, the WOBASZ study which was conducted in 2003-2005 and included 14,769 subjects aged 20-74 years, and the WOBASZ Senior study which was conducted in 2007 and included 1096 subjects above 74 years of age. All these subjects were followed for survival status until 2012 and the cause of death was determined. The mean duration of follow-up was 8.2 years for WOBASZ study participants and about 5 years for WOBASZ Senior study participants. Overall, 1436 subjects died, including 568 due to CVD. For the purpose of our analysis of overall and CVD mortality, 15 established risk factors were selected. Survival was analysed separately in WOBASZ and WOBASZ Senior study participants. Statistical methods included descriptive statistics, Kaplan-Meier curves, Cox proportional hazard models, and the SCORE risk algorithm. Measure of incompatibility of the SCORE risk model to the Polish population was determined as the difference between mortality rates by the SCORE risk quartiles and the Cox approach. During the 8-year follow-up of the WOBASZ study population, mortality due to CVD was 38% among men and 31% among women. The most common causes of CVD mortality were ischaemic heart disease (IHD, 33%) followed by cerebro-vascular disease (17%) in men, and cerebrovascular disease (31%) followed by IHD (23%) in women. We found significant differences between men and women in regard to survival curves for both overall mortality and CVD mortality (p < 0.0001). For overall mortality among men and women, nearly all selected risk factors were shown to be significant in univariate analyses, except for high density lipoprotein cholesterol (HDL-C) level and the total cholesterol/HDL-C ratio in men, and smoking status in women. In multivariate analysis, independent predictors in men included age, glucose level, systolic blood pressure, and smoking status. In women, independent predictors were age, smoking status, and diabetes. During the 5-year follow-up of the WOBASZ Senior study population, mortality due to CVD was 48% among men and 58% among women. The most common cause of CVD mortality in both men and women was IHD (29% and 24%, respectively), followed by cerebrovascular disease (16% and 21%, respectively). We found significant differences between men and women in regard to survival curves for overall mortality (p < 0.0001) but not for CVD mortality (p = 0.0755). Due to the fact that survival curves for CVD mortality did not differ between men and women, we estimated the cut-off age for no survival difference in the WOBASZ study. By selecting the oldest patients and adding them to the WOBASZ Senior cohort, we obtained the cut-off age of 70 years above which the survival curves were not significantly different between men and women. In univariate analyses, independent predictors in men were age and creatinine level. These factors remained significant in multivariate analysis. In women above 74 years of age, independent predictors in univariate analyses included age, HDL-C level, creatinine level, total cholesterol/HDL-C ratio, and smoking status. Age, HDL-C level, creatinine level, and smoking status remained independent predictors of overall mortality in multivariate analysis. For CVD mortality, significant predictors were the same as for overall mortality. In women, significant predictors in uni- and multivariate analyses were age and smoking status. Overall disagreement between CVD mortality rates by the SCORE risk model and the Cox model was 5.7% in men and 2% in women. 1. Long-term follow-up of WOBASZ and WOBASZ Senior study participants allowed assessment of the inde-pendent association of the evaluated cardiovascular risk factors with CVD mortality in the Polish population. 2. Validation of the SCORE risk algorithm to estimate individual global CVD risk in the Polish population showed a high predictive value of this algorithm.

Career and lifestyle satisfaction among surgeons: what really matters? The National Lifestyles in Surgery Today Survey.

PubMed

Troppmann, Kathrin M; Palis, Bryan E; Goodnight, James E; Ho, Hung S; Troppmann, Christoph

2009-08-01

Optimizing recruitment of the next surgical generation is paramount. Unfortunately, many nonsurgeons perceive surgeons' lifestyle as undesirable. It is unknown, however, whether the surgeons-important opinion makers about their profession-are indeed dissatisfied. We analyzed responses to a survey mailed to all surgeons who were certified by the American Board of Surgery in 1988, 1992, 1996, 2000, and 2004. We performed multivariate analyses to study career dissatisfaction and inability to achieve work-life balance, while adjusting for practice characteristics, demographics, and satisfaction with reimbursement. A total of 895 (25.5%) surgeons responded: mean age was 46 years; 80% were men; 88% were married; 86% had children; 45% were general surgeons; 72% were in urban practice; and 83% were in nonuniversity practice. Surgeons worked 64 hours per week; ideally, they would prefer to work 50 hours per week (median). Fifteen percent were dissatisfied with their careers. On multivariate analysis, significant (p < 0.05) risk factors were nonuniversity practice (odds ratio [OR] 3.3) and dissatisfaction with reimbursement (OR 5.9). Forty percent would not recommend a surgical career to their own children. On multivariate analysis, significant risk factors were nonuniversity practice (OR 2.5) and dissatisfaction with reimbursement (OR 3.4). In all, 33.5% did not achieve work-life balance. On multivariate analysis, dissatisfaction with reimbursement (OR 3.0) was a significant risk factor. Respondents' lives could be improved by "limiting emergency call" (77%), "diminishing litigation" (92%), and "improving reimbursement" (94%). Most surgeons are satisfied with their careers. Areas in need of improvement, particularly for nonuniversity surgeons, include reimbursement, work hours, and litigation. Strong local and national advocacy may not only improve career satisfaction, but could also render the profession more attractive for those contemplating a surgical career.

Retrospective Analysis of Radiological Recurrence Patterns in Glioblastoma, Their Prognostic Value And Association to Postoperative Infarct Volume.

PubMed

Bette, Stefanie; Barz, Melanie; Huber, Thomas; Straube, Christoph; Schmidt-Graf, Friederike; Combs, Stephanie E; Delbridge, Claire; Gerhardt, Julia; Zimmer, Claus; Meyer, Bernhard; Kirschke, Jan S; Boeckh-Behrens, Tobias; Wiestler, Benedikt; Gempt, Jens

2018-03-14

Recent studies suggested that postoperative hypoxia might trigger invasive tumor growth, resulting in diffuse/multifocal recurrence patterns. Aim of this study was to analyze distinct recurrence patterns and their association to postoperative infarct volume and outcome. 526 consecutive glioblastoma patients were analyzed, of which 129 met our inclusion criteria: initial tumor diagnosis, surgery, postoperative diffusion-weighted imaging and tumor recurrence during follow-up. Distinct patterns of contrast-enhancement at initial diagnosis and at first tumor recurrence (multifocal growth/progression, contact to dura/ventricle, ependymal spread, local/distant recurrence) were recorded by two blinded neuroradiologists. The association of radiological patterns to survival and postoperative infarct volume was analyzed by uni-/multivariate survival analyses and binary logistic regression analysis. With increasing postoperative infarct volume, patients were significantly more likely to develop multifocal recurrence, recurrence with contact to ventricle and contact to dura. Patients with multifocal recurrence (Hazard Ratio (HR) 1.99, P = 0.010) had significantly shorter OS, patients with recurrent tumor with contact to ventricle (HR 1.85, P = 0.036), ependymal spread (HR 2.97, P = 0.004) and distant recurrence (HR 1.75, P = 0.019) significantly shorter post-progression survival in multivariate analyses including well-established prognostic factors like age, Karnofsky Performance Score (KPS), therapy, extent of resection and patterns of primary tumors. Postoperative infarct volume might initiate hypoxia-mediated aggressive tumor growth resulting in multifocal and diffuse recurrence patterns and impaired survival.

Nocturnal periodic limb movements decrease antioxidant capacity in post-stroke women.

PubMed

Chen, C-Y; Yu, C-C; Chen, C-L

2016-04-01

Considerable evidence suggests that periodic limb movements during sleep (PLMS) are associated with cardiovascular risk and poor stroke outcome. However, the pathogenesis for this association in stroke patients remains largely unknown. This cross-sectional study enrolled 112 consecutive patients who were admitted to rehabilitation ward due to ischemic stroke. Polysomnography and laboratory tests for oxidative stress and inflammatory biomarkers including C-reactive protein, interleukin 6, total antioxidant capacity (TAC), and urinary 8-hydroxy-2-deoxyguanosine were conducted. Patients were stratified into three categories according to their PLMS index. Patients in the PLMS index ≥15 group were significantly older (P = 0.011), presented a significantly higher National Institute of Health Stroke Scale at stroke onset (P = 0.032), and lower Barthel index (P = 0.035) than patients in the PLMS index <5 group. The level of TAC differed significantly (P = 0.018) among the three groups. Multivariate linear regression analyses show that the PLMS index was negatively and independently correlated with TAC (P = 0.024) in women. Besides, multivariate logistic regression analyses also reveal that patients with a PLMS index ≥15 compared with the referent PLMS index <5 had a 7.58-fold increased relative hazard for stroke recurrence (odds ratio 7.58, [1.31-43.88], P = 0.024). This study suggests that PLMS was independently associated with decreased antioxidant capacity in women with ischemic stroke. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Predictors of regular cigarette smoking among adolescent females: Does body image matter?

PubMed Central

Kaufman, Annette R.; Augustson, Erik M.

2013-01-01

This study examined how factors associated with body image predict regular smoking in adolescent females. Data were from the National Longitudinal Study of Adolescent Health (Add Health), a study of health-related behaviors in a nationally representative sample of adolescents in grades 7 through 12. Females in Waves I and II (n=6,956) were used for this study. Using SUDAAN to adjust for the sampling frame, univariate and multivariate analyses were performed to investigate if baseline body image factors, including perceived weight, perceived physical development, trying to lose weight, and self-esteem, were predictive of regular smoking status 1 year later. In univariate analyses, perceived weight (p<.01), perceived physical development (p<.0001), trying to lose weight (p<.05), and self-esteem (p<.0001) significantly predicted regular smoking 1 year later. In the logistic regression model, perceived physical development (p<.05), and self-esteem (p<.001) significantly predicted regular smoking. The more developed a female reported being in comparison to other females her age, the more likely she was to be a regular smoker. Lower self-esteem was predictive of regular smoking. Perceived weight and trying to lose weight failed to reach statistical significance in the multivariate model. This current study highlights the importance of perceived physical development and self-esteem when predicting regular smoking in adolescent females. Efforts to promote positive self-esteem in young females may be an important strategy when creating interventions to reduce regular cigarette smoking. PMID:18686177

Study of Cognitive Impairments Following Clipping of Ruptured Anterior Circulation Aneurysms.

PubMed

Mohanty, Manju; Dhandapani, Sivashanmugam; Gupta, Sunil Kumar; Shahid, Adnan Hussain; Patra, Debi Prasad; Sharma, Anchal; Mathuriya, Suresh Narayan

2018-06-16

The cognitive impairments following treatment of ruptured aneurysms have often been underestimated. This study was to assess their prevalence and analyze various associated factors. Patients who were operated for ruptured anterior circulation aneurysms and discharged in Glasgow outcome scale 4-5 were studied at 3 months for various cognitive impairments. Continuous scales of memory (recent, remote, verbal, visual and overall memory), verbal fluency (phonemic and category fluency) and others were studied in relation to various factors. Univariate and multivariate analyses were performed using SPSS21. There were a total of 87 patients included in our study. Phonemic fluency was the most affected noted in 66% of patients. While 56% had some memory related impairments, 13 (15%) and 6 (7%) had moderate and severe deficits in recent memory, and 19 (22%) and 12 (14%) had moderate and severe deficits in remote memory respectively. Patients operated for anterior cerebral artery (ACA) aneurysms have significantly greater impairments in recent (34% vs 8%) and remote memory (43% vs 28%) compared to the rest, both in univariate (P values 0.01 & 0.002 respectively) and multivariate analyses (P values 0.01 & 0.03 respectively). ACA related aneurysms also had significantly greater independent impairments in phonemic fluency (P-value 0.04), compared to others. The clinical grade had a significant independent impact only on remote memory (P-value 0.01). Cognitive impairments are frequent following treatment of ruptured anterior circulation aneurysms. Impairments in recent memory, remote memory, and phonemic fluency are significantly greater following treatment of ACA related aneurysms, compared to others, independent of other factors. Copyright © 2018. Published by Elsevier Inc.

Current pregnancy among women with spinal cord injury: findings from the US national spinal cord injury database.

PubMed

Iezzoni, L I; Chen, Y; McLain, A B J

2015-11-01

Cross-sectional study. To examine the prevalence of pregnancy and associations with sociodemographic and clinical factors among women with spinal cord injury (SCI). US National Spinal Cord Injury Database, an SCI registry that interviews participants 1, 5 and then every 5 years post injury. Data include SCI clinical details, functional impairments, participation measures, depressive symptoms and life satisfaction. Women aged 18-49 are asked about hospitalizations in the last year relating to pregnancy or its complications. Data represent 1907 women, who completed 3054 interviews. We used generalized estimating equations to examine bivariable associations between pregnancy and clinical and psychosocial variables and to perform multivariable regressions predicting pregnancy. Across all women, 2.0% reported pregnancy during the prior 12 months. This annual prevalence differed significantly by the years elapsed since injury; the highest rate occurred 15 years post injury (3.7%). Bivariable analyses found that younger age at injury was significantly associated with current pregnancy (P<0.0001). Compared with nonpregnant women, those reporting current pregnancy were significantly more likely to be married or partnered, have sport-related SCI, have higher motor scores and have more positive psychosocial status scores. Multivariable analyses found significant associations between current pregnancy and age, marital status, motor score and mobility and occupation scale scores. Current pregnancy rates among reproductive-aged women with SCI are similar to rates of other US women with chronic mobility impairments. More information is needed about pregnancy experiences and outcomes to inform both women with SCI seeking childbearing and clinicians providing their care.

Chronic pruritus: evaluation of patient needs and treatment goals with a special regard to differences according to pruritus classification and sex.

PubMed

Steinke, S; Bruland, P; Blome, C; Osada, N; Dugas, M; Fritz, F; Augustin, M; Ständer, S

2017-02-01

Chronic pruritus (CP) is present in approximately one-third of all dermatological patients. Diagnostics and treatment are challenging and impair patients' quality of life. To analyse therapeutic needs in terms of the importance of treatment goals in a large sample of patients with CP. Routine data of 2747 patients with CP were analysed with descriptive methods and significance tests (univariate and multivariate variance analyses). The importance of 27 need items was measured using the Patient Needs Questionnaire of the Patient Benefit Index. The most important needs were to find a clear diagnosis and treatment, to no longer experience itching and to have confidence in the therapy, which were quite or very important to > 90% of the patients. The least important goals concerned a normal working or sex life. Nine needs related mostly to disease and psychological symptoms, and some social needs differed in importance between sexes (P ≤ 0·05). Patients with pruritus on inflamed skin or with chronic scratch lesions judged more than half of all needs as more important than did patients with pruritus on noninflamed skin (P ≤ 0·05). In the multivariate model, age, pruritus intensity and quality of life had a significant effect on the importance of therapeutic needs besides sex and pruritus classification. Patients with CP present high levels of various therapeutic needs with differences by sex and clinical phenotype. The most important needs can be addressed through medical activities such as appropriate itch medication and a trustful doctor-patient relationship. © 2016 British Association of Dermatologists.

Medicaid Managed Care Structures and Care Coordination.

PubMed

Gilchrist-Scott, Douglas H; Feinstein, James A; Agrawal, Rishi

2017-09-01

Child enrollment in Medicaid managed care (MMC) has expanded dramatically, primarily through state mandates. Care coordination is a key metric in MMC evaluation because it drives much of the proposed cost savings and may be associated with improved health outcomes and utilization. We evaluated the relationships between enrollment in 2 MMC structures, primary care case management (PCCM) and health maintenance organization (HMO) and access to and receipt of care coordination by children. Using data from the 2011/2012 National Survey of Children's Health and the Medicaid Statistical Information System state data mart, we conducted a retrospective, cross-sectional analysis of the relationships between fee-for-service, PCCM or HMO enrollment, and access to and receipt of care coordination. State-level univariate analyses and individual and state multilevel multivariable analyses evaluated correlations between MMC enrollment and care coordination, controlling for demographic characteristics and state financing levels. In univariate and multilevel multivariable analyses, the PCCM penetration rate was significantly associated with increased access to care coordination (adjusted odds ratio: 1.23, P = .034) and receipt of care coordination (adjusted odds ratio: 1.37, P = .02). The HMO penetration rate was significantly associated with lower access to care coordination (adjusted odds ratio: 0.85, P = .05) and receipt of care coordination (adjusted odds ratio: 0.71, P < .001). Fee-for-service served as the referent. State utilization of MMC varied widely. These data suggest that care coordination may be more effective in PCCM than HMO structures. States should consider care coordination outcomes when structuring their Medicaid programs. Copyright © 2017 by the American Academy of Pediatrics.

Fruit and vegetable intake and risk of breast cancer by hormone receptor status.

PubMed

Jung, Seungyoun; Spiegelman, Donna; Baglietto, Laura; Bernstein, Leslie; Boggs, Deborah A; van den Brandt, Piet A; Buring, Julie E; Cerhan, James R; Gaudet, Mia M; Giles, Graham G; Goodman, Gary; Hakansson, Niclas; Hankinson, Susan E; Helzlsouer, Kathy; Horn-Ross, Pamela L; Inoue, Manami; Krogh, Vittorio; Lof, Marie; McCullough, Marjorie L; Miller, Anthony B; Neuhouser, Marian L; Palmer, Julie R; Park, Yikyung; Robien, Kim; Rohan, Thomas E; Scarmo, Stephanie; Schairer, Catherine; Schouten, Leo J; Shikany, James M; Sieri, Sabina; Tsugane, Schoichiro; Visvanathan, Kala; Weiderpass, Elisabete; Willett, Walter C; Wolk, Alicja; Zeleniuch-Jacquotte, Anne; Zhang, Shumin M; Zhang, Xuehong; Ziegler, Regina G; Smith-Warner, Stephanie A

2013-02-06

Estrogen receptor-negative (ER(-)) breast cancer has few known or modifiable risk factors. Because ER(-) tumors account for only 15% to 20% of breast cancers, large pooled analyses are necessary to evaluate precisely the suspected inverse association between fruit and vegetable intake and risk of ER(-) breast cancer. Among 993 466 women followed for 11 to 20 years in 20 cohort studies, we documented 19 869 estrogen receptor positive (ER(+)) and 4821 ER(-) breast cancers. We calculated study-specific multivariable relative risks (RRs) and 95% confidence intervals (CIs) using Cox proportional hazards regression analyses and then combined them using a random-effects model. All statistical tests were two-sided. Total fruit and vegetable intake was statistically significantly inversely associated with risk of ER(-) breast cancer but not with risk of breast cancer overall or of ER(+) tumors. The inverse association for ER(-) tumors was observed primarily for vegetable consumption. The pooled relative risks comparing the highest vs lowest quintile of total vegetable consumption were 0.82 (95% CI = 0.74 to 0.90) for ER(-) breast cancer and 1.04 (95% CI = 0.97 to 1.11) for ER(+) breast cancer (P (common-effects) by ER status < .001). Total fruit consumption was non-statistically significantly associated with risk of ER(-) breast cancer (pooled multivariable RR comparing the highest vs lowest quintile = 0.94, 95% CI = 0.85 to 1.04). We observed no association between total fruit and vegetable intake and risk of overall breast cancer. However, vegetable consumption was inversely associated with risk of ER(-) breast cancer in our large pooled analyses.

Bad nights or bad bars? Multi-level analysis of environmental predictors of aggression in late-night large-capacity bars and clubs.

PubMed

Graham, Kathryn; Bernards, Sharon; Osgood, D Wayne; Wells, Samantha

2006-11-01

To clarify environmental predictors of bar-room aggression by differentiating relationships due to nightly variations versus across bar variations, frequency versus severity of aggression and patron versus staff aggression. Male-female pairs of researcher-observers conducted 1334 observations in 118 large capacity (> 300) bars and clubs in Toronto, Canada. Observers independently rated aspects of the environment (e.g. crowding) at every visit and wrote detailed narratives of each incident of aggression that occurred. Measures of severity of aggression for the visit were calculated by aggregating ratings for each person in aggressive incidents. Although bivariate analyses confirmed the significance of most environmental predictors of aggression identified in previous research, multivariate analyses identified the following key visit-level predictors (controlling for bar-level relationships): rowdiness/permissive environment and people hanging around after closing predicted both frequency and severity of aggression; sexual activity, contact and competition and people with two or more drinks at closing predicted frequency but not severity of aggression; lack of staff monitoring predicted more severe patron aggression, while having more and better coordinated staff predicted more severe staff aggression. Intoxication of patrons was significantly associated with more frequent and severe patron aggression at the bar level (but not at the visit level) in the multivariate analyses and negatively associated with severity of staff aggression at the visit level. The results demonstrate clearly the importance of the immediate environment (not just the type of bar or characteristics of usual patrons) and the importance of specific environmental factors, including staff behaviour, in predicting both frequency and severity of aggression.

Dispatch from the non-HITECH-incented Health IT world: electronic medication history adoption and utilization.

PubMed

Gabriel, Meghan Hufstader; Smith, Jaime Y; Sow, Max; Charles, Dustin; Joseph, Seth; Wilkins, Tricia Lee

2016-05-01

To document national trends of electronic medication history use in the ambulatory setting and describe the characteristics and predicting factors of providers who regularly use medication history transaction capabilities through their e-prescribing systems. The study used provider-initiated medication history data requests, electronically sent over an e-prescribing network from all 50 states and the District of Columbia. Data from 138,000 prescribers were evaluated using multivariate analyses from 2007 to 2013. Medication history use showed significant growth, increasing from 8 to 850 million history requests during the study period. Prescribers on the network for <5 years had a lower likelihood of requests than those on the network for 5 or more years. Although descriptive analyses showed that prescribers in rural areas were alongside e-prescribing, and requesting medication histories more often than those in large and small cities, these findings were not significant in multivariate analyses. Providers in orthopedic surgery and internal medicine had a higher likelihood of more requests than family practice prescribers, with 12% and 7% higher likelihood, respectively. Early adopters of e-prescribing have remained medication history users and have continually increased their volume of requests for medication histories. Despite the fact that the use of medication histories through e-prescribing networks in the ambulatory care setting has not been encouraged through federal incentive programs, there has been substantial growth in the use of medication histories offered through e-prescribing networks. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Risk factors for acute surgical site infections after lumbar surgery: a retrospective study.

PubMed

Lai, Qi; Song, Quanwei; Guo, Runsheng; Bi, Haidi; Liu, Xuqiang; Yu, Xiaolong; Zhu, Jianghao; Dai, Min; Zhang, Bin

2017-07-19

Currently, many scholars are concerned about the treatment of postoperative infection; however, few have completed multivariate analyses to determine factors that contribute to the risk of infection. Therefore, we conducted a multivariate analysis of a retrospectively collected database to analyze the risk factors for acute surgical site infection following lumbar surgery, including fracture fixation, lumbar fusion, and minimally invasive lumbar surgery. We retrospectively reviewed data from patients who underwent lumbar surgery between 2014 and 2016, including lumbar fusion, internal fracture fixation, and minimally invasive surgery in our hospital's spinal surgery unit. Patient demographics, procedures, and wound infection rates were analyzed using descriptive statistics, and risk factors were analyzed using logistic regression analyses. Twenty-six patients (2.81%) experienced acute surgical site infection following lumbar surgery in our study. The patients' mean body mass index, smoking history, operative time, blood loss, draining time, and drainage volume in the acute surgical site infection group were significantly different from those in the non-acute surgical site infection group (p < 0.05). Additionally, diabetes mellitus, chronic obstructive pulmonary disease, osteoporosis, preoperative antibiotics, type of disease, and operative type in the acute surgical site infection group were significantly different than those in the non-acute surgical site infection group (p < 0.05). Using binary logistic regression analyses, body mass index, smoking, diabetes mellitus, osteoporosis, preoperative antibiotics, fracture, operative type, operative time, blood loss, and drainage time were independent predictors of acute surgical site infection following lumbar surgery. In order to reduce the risk of infection following lumbar surgery, patients should be evaluated for the risk factors noted above.

Oral care experiences and challenges in children with autism spectrum disorders.

PubMed

Stein, Leah I; Polido, José C; Najera, Sandy Oliver Lopez; Cermak, Sharon A

2012-01-01

The purpose of this study was to investigate the differences between children with autism spectrum disorders (ASD) and their typically developing peers in relation to aspects of oral care. Participants included 396 parents of ASD children or typically developing 2- to 18-year-olds. Parents completed a 37-item questionnaire designed by authors to elicit information about oral care in the home and dental office. Descriptive, bivariate, and multivariate regression analyses were conducted to examine the association between diagnostic group and oral care variables. Significantly more parents of ASD children than parents of typically developing children reported difficulty across almost all oral care variables explored, including oral care in the home, oral care at the dentist, and access to oral care. Following multivariate regression to control for possible confounders-including age, gender, Hispanic status, and paternal education level-all previously significant variables remained significant. This study indicates that children with autism spectrum disorders experience greater difficulties and barriers to care in both the home and dental office settings than their typically developing peers.

Use of hearing protection and perceptions of noise exposure and hearing loss among construction workers.

PubMed

Lusk, S L; Kerr, M J; Kauffman, S A

1998-07-01

The purpose of this study was to describe construction workers' use of hearing protection devices (HPDs) and determine their perceptions of noise exposure and hearing loss. Operating engineers, carpenters, and plumbers/pipe fitters in the Midwest (n = 400) completed a written questionnaire regarding their use of HPDs and their perceptions of noise exposure and hearing loss. Subjects were recruited through their trade union groups. Mean reported use of HPDs and mean perceived noise exposure were compared across trade groups. Bivariate and multivariate analysis techniques were used to assess relationships between use of HPDs and trade category, education, age, years of employment, noise exposure, and hearing loss. Bivariate analyses identified significant differences in mean use of HPDs by age, years of employment, and trade group. Multivariate logistic regression assessing the independent effects of these variables found significant differences only by trade group. Results indicate a need for significant improvement in all three trade groups' use of HPDs, and suggest a need to consider use and exposure levels, demographics, and trade group membership in designing hearing conservation programs.

Anthropometrics and prognosis in diffuse large B-cell lymphoma: a multicentre study of 653 patients.

PubMed

Bendtsen, Mette Dahl; Munksgaard, Peter Svenssen; Severinsen, Marianne Tang; Bekric, Eric; Brieghel, Christian; Nielsen, Kristina Buchardi; Brown, Peter de Nully; Dybkaer, Karen; Johnsen, Hans Erik; Bøgsted, Martin; El-Galaly, Tarec Christoffer

2017-04-01

The impact of body mass index (BMI) and body surface area (BSA) on survival in diffuse large B-cell lymphoma (DLBCL) is controversial. Recent studies show superior outcomes for overweight and obese patients. A total of 653 R-CHOP(-like)-treated DLBCL patients were included in this retrospective cohort study. Patients, baseline clinicopathologic characteristics and treatment information were retrieved from the Danish Lymphoma Registry. Anthropometric measures were obtained from chemotherapy prescription charts. Underweight (BMI <18.5 kg/m 2 ) was associated with significantly worse progression-free survival (PFS) for male patients only in sex-stratified analyses (HR 3.92, 95% CI: 1.57-9.75, P = 0.003, for males; HR 1.65, 95% CI: 0.90-3.02, P = 0.107, for females). In multivariate analyses, underweight was associated with worse PFS for both sexes (HR 5.34, 95% CI: 2.07-13.79, P = 0.001, for males; HR 2.14, 95% CI: 1.12-4.08, P = 0.021, for females). Similar results were obtained in analyses of overall survival. In crude analyses, BSA <1.8 m 2 was associated with worse PFS for men and women (HR 1.65, 95% CI: 1.03-2.65, P = 0.039, for men; HR 1.62, 95% CI: 1.03-2.56, P = 0.037, for women). In multivariate analyses, however, these associations diminished. Our study demonstrates that underweight DLBCL patients have worse outcomes following R-CHOP as compared to normal as well as overweight patients. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Environmental quality assessment of Grand Harbour (Valletta, Maltese Islands): a case study of a busy harbour in the Central Mediterranean Sea.

PubMed

Romeo, Teresa; D'Alessandro, Michela; Esposito, Valentina; Scotti, Gianfranco; Berto, Daniela; Formalewicz, Malgorzata; Noventa, Seta; Giuliani, Silvia; Macchia, Simona; Sartori, Davide; Mazzola, Angelo; Andaloro, Franco; Giacobbe, Salvatore; Deidun, Alan; Renzi, Monia

2015-12-01

Contamination levels by plastic debris, trace elements and persistent organic pollutants were assessed and related to macrobenthic diversity within soft bottoms of Grand Harbour (Malta, Central Mediterranean). Sediment toxicity was evaluated by ecotoxicological method, deploying Bacteria (Vibrio fischeri), Echinodermata (Paracentrotus lividus) and Crustacea (Corophium orientale). Univariate analysis (Pearson's test) was used to test relationships between biodiversity indices, pollutants and grain size. A multivariate approach (PERMANOVA) was applied to investigate for any significant differences among sampling stations concerning plastic abundances and to test the relationship between infaunal abundances and pollutant concentrations (the BIOENV test). Significant differences in the plastic abundances were found between sampling stations. The lowest value for Shannon-Wiener biodiversity index was associated to the highest sediment pollution level. Multivariate analyses suggest that MBT and TBT were factors that most influenced macrozoobenthic abundance and biodiversity. The bivalve Corbula gibba and the introduced polychaete Monticellina dorsobranchialis were the most abundant found species.

Intrapersonal self-transcendence, meaning-in-life and nurse-patient interaction: powerful assets for quality of life in cognitively intact nursing-home patients.

PubMed

Haugan, Gørill; Moksnes, Unni Karin; Løhre, Audhild

2016-12-01

Spirituality has demonstrated a significant impact on quality of life in nursing-home patients. Likewise, as essential aspects of spirituality, hope, self-transcendence, and meaning are found to be vital resources to nursing-home patients' global well-being. Further, nurse-patient interaction has demonstrated a powerful influence on patient's hope, self-transcendence, and meaning-in-life, as well as on anxiety and depression. The present study investigated the associations of hope, self-transcendence, meaning, and perceived nurse-patient interaction with quality of life. In a cross-sectional design, a sample of 202 cognitively intact nursing-home patients in Mid-Norway responded to the Herth Hope Index, the Self-Transcendence scale, the Purpose-in-Life test, the Nurse-Patient Interaction scale, and a one-item overall measure on quality of life. Using SPSS ordinal regression, bivariate and multivariate analyses were conducted with quality of life as dependent variable. Controlling for gender, age, and residential time, all the scales were significantly related to quality of life in the bivariate analyses. Intrapersonal self-transcendence showed an exceptional position presenting a very high odds ratio in the bivariate analysis, and also the strongest association with quality of life in multivariate analyses. Meaning and nurse-patient interaction also showed independent and significant associations with quality of life. The associations found encourage the idea that intrapersonal self-transcendence, meaning-in-life, and nurse-patient interaction are powerful health-promoting factors that significantly influence on nursing-home patients' quality of life. Therefore, pedagogical approaches for advancing caregivers' presence and confidence in health-promoting interaction should be upgraded and matured. Proper educational programs for developing interacting skills including assessing and supporting patients' intrapersonal self-transcendence and meaning-in-life should be utilised and their effectiveness evaluated. © 2016 Nordic College of Caring Science.

The impact of HIV status and antiretroviral treatment on TB treatment outcomes of new tuberculosis patients attending co-located TB and ART services in South Africa: a retrospective cohort study.

PubMed

Nglazi, Mweete D; Bekker, Linda-Gail; Wood, Robin; Kaplan, Richard

2015-11-19

The implementation of collaborative TB-HIV services is challenging. We, therefore, assessed TB treatment outcomes in relation to HIV infection and antiretroviral therapy (ART) among TB patients attending a primary care service with co-located ART and TB clinics in Cape Town, South Africa. In this retrospective cohort study, all new TB patients aged ≥ 15 years who registered and initiated TB treatment between 1 October 2009 and 30 June 2011 were identified from an electronic database. The effects of HIV-infection and ART on TB treatment outcomes were analysed using a multinomial logistic regression model, in which treatment success was the reference outcome. The 797 new TB patients included in the analysis were categorized as follows: HIV- negative, in 325 patients (40.8 %); HIV-positive on ART, in 339 patients (42.5 %) and HIV-positive not on ART, in 133 patients (16.7 %). Overall, bivariate analyses showed no significant difference in death and default rates between HIV-positive TB patients on ART and HIV-negative patients. Statistically significant higher mortality rates were found among HIV-positive patients not on ART compared to HIV-negative patients (unadjusted odds ratio (OR) 3.25; 95 % confidence interval (CI) 1.53-6.91). When multivariate analyses were conducted, the only significant difference between the patient categories on TB treatment outcomes was that HIV-positive TB patients not on ART had significantly higher mortality rates than HIV-negative patients (adjusted OR 4.12; 95 % CI 1.76-9.66). Among HIV-positive TB patients (n = 472), 28.2 % deemed eligible did not initiate ART in spite of the co-location of TB and ART services. When multivariate analyses were restricted to HIV-positive patients in the cohort, we found that being HIV-positive not on ART was associated with higher mortality (adjusted OR 7.12; 95 % CI 2.95-18.47) and higher default rates (adjusted OR 2.27; 95 % CI 1.15-4.47). There was no significant difference in death and default rates between HIV-positive TB patients on ART and HIV negative TB patients. Despite the co-location of services 28.2 % of 472 HIV-positive TB patients deemed eligible did not initiate ART. These patients had a significantly higher death and default rates.

The association between GGCX, miR-133 genetic polymorphisms and warfarin stable dosage in Han Chinese patients with mechanical heart valve replacement.

PubMed

Tang, X-Y; Zhang, J; Peng, J; Tan, S-L; Zhang, W; Song, G-B; Liu, L-M; Li, C-L; Ren, H; Zeng, L; Liu, Z-Q; Chen, X-P; Zhou, X-M; Zhou, H-H; Hu, J-X; Li, Z

2017-08-01

Warfarin is a widely used anticoagulant with a narrow therapeutic index. Polymorphisms in the VKORC1, CYP2C9 and CYP4F2 genes have been verified to correlate with warfarin stable dosage (WSD). Whether any other genes or variants affect the dosage is unknown. The aim of our study was to investigate the relationship between GGCX, miR-133 variants and the WSD in Han Chinese patients with mechanical heart valve replacement (MHVR). A total of 231 patients were enrolled in the study. Blood samples were collected for genotyping. The average WSD among subjects with different GGCX or miR-133 genotypes was compared. Regression analyses were performed to test for any association of genetic polymorphisms with WSD. The warfarin dosage in patients with the GGCX rs699664 TT and rs12714145 TT genotypes was 3.77±0.93 (95% CI: 3.35-4.19) mg/d and 3.70±1.00 (95% CI: 3.32-4.09) mg/d, respectively. The GGCX rs699664 and rs12714145 genotypes were significantly associated with WSD (P<.05). But they were ruled out in the multivariate regression analysis. There were no significant differences in the average warfarin stable dosage between subjects with MIR133B rs142410335 wild-type and variant genotypes (P>.05). The genotypes of GGCX rs699644 and rs12714145 were significantly associated with WSD (P<.05), but their contributions were not significant after accounting for other factors. MIR133B rs142410335 makes no significant contributions to warfarin stable dosage in Han Chinese patients with MHVR neither in univariate regression nor in multivariate regression analyses. © 2017 John Wiley & Sons Ltd.

Comparison of the characteristics of fire and non-fire households in the 2004-2005 survey of fire department-attended and unattended fires.

PubMed

Greene, Michael A

2012-06-01

Comparison of characteristics of fire with non-fire households to determine factors differentially associated with fire households (fire risk factors). National household telephone survey in 2004-2005 by the US Consumer Product Safety Commission with 916 fire households and a comparison sample of 2161 non-fire households. There were an estimated 7.4 million fires (96.6% not reported to fire departments) with 130,000 injuries. Bivariate analysis and multivariate logistic regression analyses to assess differences in household characteristics. Significant factors associated with fire households were renting vs. owning (OR 1.988 p<0.0001); household members under 18 year of age (OR 1.277 p<0.0001); lack of residents over 64 years old (OR 0.552 p=0.0007); and college or higher education (some college OR 1.444 p=0.0360, college graduate OR 1.873, p<0.0001, postgraduate OR 2.156 p<0.0001). Not significant were age of house; race; ethnicity; and income. Number of smokers was borderline significant (OR 1.132 p=0.1019) but was significant in the subset of fire households with non-cooking fires (OR 1.383 p=0.0011). Single family houses were associated with non-fire households in the bivariate analysis but not in the multivariate analyses. Renting, household members under 18 years old and smokers are risk factors for unattended fires, similar to the literature for fatal and injury fires. Differences included household members over 65 years old (associated with non-fire households), college/postgraduate education (associated with fire households) and lack of significance of income. Preventing cooking fires (64% of survey incidents), smoking prevention efforts and fire prevention education for families with young children have the potential for reducing unattended fires and injuries.

Sex Hormones and Sleep in Men and Women From the General Population: A Cross-Sectional Observational Study.

PubMed

Kische, Hanna; Ewert, Ralf; Fietze, Ingo; Gross, Stefan; Wallaschofski, Henri; Völzke, Henry; Dörr, Marcus; Nauck, Matthias; Obst, Anne; Stubbe, Beate; Penzel, Thomas; Haring, Robin

2016-11-01

Associations between sex hormones and sleep habits originate mainly from small and selected patient-based samples. We examined data from a population-based sample with various sleep characteristics and the major part of sex hormones measured by mass spectrometry. We used data from 204 men and 213 women of the cross-sectional Study of Health in Pomerania-TREND. Associations of total T (TT) and free T, androstenedione (ASD), estrone, estradiol (E2), dehydroepiandrosterone-sulphate, SHBG, and E2 to TT ratio with sleep measures (including total sleep time, sleep efficiency, wake after sleep onset, apnea-hypopnea index [AHI], Insomnia Severity Index, Epworth Sleepiness Scale, and Pittsburgh Sleep Quality Index) were assessed by sex-specific multivariable regression models. In men, age-adjusted associations of TT (odds ratio 0.62; 95% confidence interval (CI) 0.46-0.83), free T, and SHBG with AHI were rendered nonsignificant after multivariable adjustment. In multivariable analyses, ASD was associated with Epworth Sleepiness Scale (β-coefficient per SD increase in ASD: -0.71; 95% CI: -1.18 to -0.25). In women, multivariable analyses showed positive associations of dehydroepiandrosterone-sulphate with wake after sleep onset (β-coefficient: .16; 95% CI 0.03-0.28) and of E2 and E2 to TT ratio with Epworth Sleepiness Scale. Additionally, free T and SHBG were associated with AHI in multivariable models among premenopausal women. The present cross-sectional, population-based study observed sex-specific associations of androgens, E2, and SHBG with sleep apnea and daytime sleepiness. However, multivariable-adjusted analyses confirmed the impact of body composition and health-related lifestyle on the association between sex hormones and sleep.

Cross-cultural differences in comorbid symptoms of children with autism spectrum disorders: an international examination between Israel, South Korea, the United Kingdom and the United States of America.

PubMed

Zachor, Ditza; Yang, Jae-Won; Itzchak, Esther Ben; Furniss, Frederick; Pegg, Elinor; Matson, Johnny L; Horovitz, Max; Sipes, Megan; Chung, Kyong-Mee; Jung, Woohyun

2011-01-01

To examine the relationship between culture and symptoms of comorbid psychopathology in those with autism spectrum disorders (ASD). Multivariate analyses of variance (MANOVAs) for each country and each sub-scale of the Autism Spectrum Disorders-Comorbid for Children (ASD-CC). Follow-up independent univariate analyses and post-hoc tests as needed. Separate samples from South Korea, the UK and Israel were compared to a sample from the US in order to examine cultural contributions, using the ASD-CC. Overall, few differences were found. Significantly, the US had significantly higher scores than South Korea on the avoidant sub-scale. Additionally, the US had significantly higher scores than Israel on the over-eating and tantrum sub-scales. No significant differences were found between the US and the UK. Cultural factors, such as views of typical behaviour, should be taken into account when examining symptoms of comorbidity in children with ASD.

Tree Density and Species Decline in the African Sahel Attributable to Climate

NASA Technical Reports Server (NTRS)

Gonzalez, Patrick; Tucker, Compton J.; Sy, H.

2012-01-01

Increased aridity and human population have reduced tree cover in parts of the African Sahel and degraded resources for local people. Yet, tree cover trends and the relative importance of climate and population remain unresolved. From field measurements, aerial photos, and Ikonos satellite images, we detected significant 1954-2002 tree density declines in the western Sahel of 18 +/- 14% (P = 0.014, n = 204) and 17 +/- 13% (P = 0.0009, n = 187). From field observations, we detected a significant 1960-2000 species richness decline of 21 +/- 11% (P = 0.0028, n = 14) across the Sahel and a southward shift of the Sahel, Sudan, and Guinea zones. Multivariate analyses of climate, soil, and population showed that temperature most significantly (P < 0.001) explained tree cover changes. Multivariate and bivariate tests and field observations indicated the dominance of temperature and precipitation, supporting attribution of tree cover changes to climate variability. Climate change forcing of Sahel climate variability, particularly the significant (P < 0.05) 1901-2002 temperature increases and precipitation decreases in the research areas, connects Sahel tree cover changes to global climate change. This suggests roles for global action and local adaptation to address ecological change in the Sahel.

Risk factors for age-related macular degeneration: findings from the Andhra Pradesh eye disease study in South India.

PubMed

Krishnaiah, Sannapaneni; Das, Taraprasad; Nirmalan, Praveen K; Nutheti, Rishita; Shamanna, Bindiganavale R; Rao, Gullapalli N; Thomas, Ravi

2005-12-01

To assess prevalence, potential risk factors, and population attributable risk percentage (PAR%) for age-related macular degeneration (AMD) in the Indian state of Andhra Pradesh. A population-based study, using a stratified, random, cluster, systematic sampling strategy, was conducted in the state of Andhra Pradesh in India from 1996 to 2000. Participants from 94 clusters in one urban and three rural areas representative of the population of Andhra Pradesh underwent a detailed interview and a detailed dilated ocular evaluation by trained professionals. In this report, the authors present the prevalence estimates of AMD and examine the association of AMD with potential risk factors in persons aged 40 to 102 years (n = 3723). AMD was defined according to the international classification and grading system. Standard bivariate and multivariate analyses were performed to identify the potential risk factors for AMD. PAR% was calculated by Levin's formula. AMD was present in 71 subjects--an age-gender-area-adjusted prevalence of 1.82% (95% confidence interval [CI], 1.39%-2.25%). Risk factors that were significant in bivariate analyses were considered for multivariate logistic regression analysis. Multivariate analysis showed that the adjusted prevalence of AMD was significantly higher in those 60 years of age or older (odds ratio [OR], 3.55; 95% CI, 1.61-7.82) and history of prior cigar smoking (OR, 3.29; 95%CI, 1.42-7.57). Presence of cortical cataract and prior cataract surgery were significantly associated with increased prevalence of AMD (adjusted OR, 2.87; 95% CI, 1.57-5.26 and 3.79; 95% CI, 2.1-6.78), respectively. The prevalence of AMD was significantly lower in light alcohol drinkers (adjusted OR, 0.38; 95% CI, 0.19-0.76) compared with nondrinkers. The PAR% for hypertension and heavy cigar smoking was 10% and 14%, respectively, in this population. The prevalence of AMD in this south Indian population is similar to those reported in other developed countries. Abstinence from smoking may reduce the risk of AMD in this population.

East-West gradient in cardio-vascular mortality in Austria: how much can we explain by following the pattern of risk factors?

PubMed Central

2011-01-01

Background Various studies show major regional differences in the prevalence of cardio-vascular disease morbidity and mortality, both in Europe and within European countries. In Austria, these differences are documented by an East-West gradient with declining morbidity and mortality rates when moving from the East to the West of the country. It was the aim of this study to analyse if, and to what extent, socio-demographic and socio-economic determinants, social resources and health behaviour can contribute to the clarification of this East-West gradient by conducting secondary analyses of an existing Austrian health dataset. Results The data were analysed using bivariate analyses, as well as univariate and multivariate logistic regression models. These analyses revealed significant East-West gradients for various risk factors, as well as socio-demographic and socio-economic health determinants. There was a gradual decrease of hypertension, diabetes mellitus, obesity, and psycho-social discomfort in both sexes, with the highest prevalences in those Austrian regions with the highest cardio-vascular mortality and a stepwise decrease to the regions with the lowest cardio-vascular mortality. Controlling for educational level significantly raised the odds for diabetes, hypertension and obesity. In the results of the multivariate analyses, factors that significantly and independently predicted diabetes mellitus were geographic location, psycho-social discomfort, lack of physical exercise, and age in both sexes. For women these factors additionally included a low educational level, lack of social support, and being born abroad. Conclusions Our study shows a clear gradual decline of cardio-vascular mortality and some of its risk factors from East to West in Austria. Concerning these risk factors, the geographic region and psycho-social discomfort showed the greatest association with diabetes mellitus, hypertension, and obesity. Hence, they contribute to the explanation of the variance in spatial cardio-vascular disease mortality. Yet, a large proportion of this variance remains unexplained. It would be of great importance to public health and preventive measures to take a closer look at spatial differences in cardio-vascular disease morbidity and mortality to better tailor programmes to the regional environments and settings. Our results also call for a greater importance of preventative measures for psycho-social discomfort and increase of social support. PMID:22082341

Correlates of Suicide Ideation and Attempt among Youth Living in the Slums of Kampala

PubMed Central

Swahn, Monica H.; Palmier, Jane B.; Kasirye, Rogers; Yao, Huang

2012-01-01

While suicidal behavior is recognized as a growing public health problem world-wide, little is known about the prevalence and risk factors for suicidal behaviors among street and slum youth in Africa, and in Uganda, specifically. The number of youth who live on the streets and in the slums of Kampala appears to be growing rapidly, but their mental health needs have not been documented, which has hampered resource allocation and service implementation. This study of youth, ages 14–24, was conducted in May and June of 2011, to assess the prevalence and correlates of suicidal behavior. Participants (N = 457) were recruited for a 30-minute interviewer-administered survey through eight drop-in centers operated by the Uganda Youth Development Link for youth in need of services. Bivariate and multivariate logistic regression analyses were computed to determine associations between psychosocial correlates and suicide ideation and suicide attempt. Reporting both parents deceased Adj.OR = 2.36; 95% CI: 1.23–4.52), parental neglect due to alcohol use (Adj.OR = 2.09; 95% CI: 1.16–3.77), trading sex for food, shelter or money (Adj.OR = 1.95; 95% CI: 1.09–3.51), sadnesss (Adj.OR = 2.42; 95% CI: 1.20–4.89), loneliness (Adj.OR = 2.67; 95% CI: 1.12–6.40) and expectations of dying prior to age 30 (Adj.OR = 2.54; 95% CI: 1.53–4.23) were significantly associated with suicide ideation in multivariate analyses. Parental neglect due to alcohol use (Adj.OR = 2.04; 95% CI: 1.11–3.76), sadness (Adj.OR = 2.42; 95% CI: 1.30–7.87), and expectations of dying prior to age 30 (Adj.OR = 2.18; 95% CI: 1.25–3.79) were significantly associated with suicide attempt in multivariate analyses. Given the dire circumstances of this vulnerable population, increased services and primary prevention efforts to address the risk factors for suicidal behavior are urgently needed. PMID:22470312

Prognostic significance of preoperative metabolic tumour volume and total lesion glycolysis measured by (18)F-FDG PET/CT in squamous cell carcinoma of the oral cavity.

PubMed

Ryu, In Sun; Kim, Jae Seung; Roh, Jong-Lyel; Cho, Kyung-Ja; Choi, Seung-Ho; Nam, Soon Yuhl; Kim, Sang Yoon

2014-03-01

Metabolic tumour volume (MTV) and total lesion glycolysis (TLG) from (18)F-FDG PET/CT are emerging prognostic biomarkers in human solid cancers; yet few studies have investigated their clinical and prognostic significance in oral cavity squamous cell carcinoma (OSCC). The present retrospective study evaluated the utility of pretreatment MTV and TLG measured by (18)F-FDG PET/CT to predict survival and occult metastasis (OM) in OSCC. Of 162 patients with OSCC evaluated preoperatively by (18)F-FDG PET/CT, 105 who underwent definitive surgery with or without adjuvant therapy were eligible. Maximum standardized uptake value (SUVmax), MTV and TLG were measured. For calculation of MTV, 3-D regions of interest were drawn and a SUV threshold of 2.5 was used for defining regions. Univariate and multivariate analyses identified clinicopathological and imaging variables associated with OM, disease-free survival (DFS) and overall survival (OS). The median (range) SUVmax, MTV and TLG were 7.3 (0.7-41.9), 4.5 ml (0.7-115.1 ml) and 18.3 g (2.4-224.1 g), respectively. Of 53 patients with clinically negative lymph nodes, OM was detected in 19 (36%). By univariate and multivariate analyses, MTV (P = 0.018) and TLG (P = 0.011) were both independent predictive factors for OM, although they were not independent of each other. The 4-year DFS and OS rates were 53.0% and 62.0%, respectively. Univariate and multivariate analyses revealed that MTV (P = 0.001) and TLG (P = 0.006), with different cut-off levels, were both independent predictive factors for DFS, although they were not independent of each other, and MTV (P = 0.001), TLG (P = 0.002) and the involved resection margin (P = 0.007) were independent predictive factors for OS. Pretreatment MTV and TLG may be useful in stratifying the likelihood of survival and predicting OM in OSCC.

Association of comorbid mental health symptoms and physical health conditions with employee productivity.

PubMed

Parker, Kristin M; Wilson, Mark G; Vandenberg, Robert J; DeJoy, David M; Orpinas, Pamela

2009-10-01

This study tests the hypothesis that employees with comorbid physical health conditions and mental health symptoms are less productive than other employees. Self-reported health status and productivity measures were collected from 1723 employees of a national retail organization. chi2, analysis of variance, and linear contrast analyses were conducted to evaluate whether health status groups differed on productivity measures. Multivariate linear regression and multinomial logistic regression analyses were conducted to analyze how predictive health status was of productivity. Those with comorbidities were significantly less productive on all productivity measures compared with all other health status groups and those with only physical health conditions or mental health symptoms. Health status also significantly predicted levels of employee productivity. These findings provide evidence for the relationship between health statuses and productivity, which has potential programmatic implications.

Inhalant use, inhalant-use disorders, and antisocial behavior: findings from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

PubMed

Howard, Matthew O; Perron, Brian E; Vaughn, Michael G; Bender, Kimberly A; Garland, Eric

2010-03-01

Few studies have explored the topography of antisocial behavior in a nationally representative sample of inhalant users. We examined (a) the lifetime prevalence of 20 childhood and adult antisocial behaviors in inhalant users with inhalant-use disorders (IUD+) and without IUDs (IUD-); (b) the nature and strength of associations between inhalant use, IUDs, and specific antisocial behaviors in multivariate analyses; and (c) the relationships between inhalant use, IUDs, and antisocial behaviors in a national sample of adults with antisocial personality disorder. The National Epidemiologic Survey on Alcohol and Related Conditions was a multistage national survey of 43,093 U.S. residents. Respondents completed a structured psychiatric interview. IUD+ and IUD- respondents were significantly younger and more likely to be unemployed, to be male, to have never married, and to report family and personal histories of alcohol and drug problems than inhalant nonusers. Family histories of alcohol problems and personal histories of drug problems were significantly more prevalent among IUD+ respondents, compared with IUD- respondents. In bivariate analyses, IUD+ and IUD- respondents evidenced significantly higher lifetime levels of all childhood and adult antisocial behaviors than inhalant nonusers. IUD+ respondents were significantly more likely than their IUD- counterparts to report bullying behavior, starting physical fights, using dangerous weapons, physical cruelty to people, staying out all night without permission, running away, and frequent truancy in childhood, as well as greater deceitfulness, impulsivity, irritability/aggressiveness, recklessness, and irresponsibility in adulthood. Multivariate analyses indicated that IUD+ respondents had a significantly elevated risk for childhood and adult antisocial behaviors, compared with inhalant nonusers, with the strongest effects for using dangerous weapons, physical cruelty to animals, and physical cruelty to people. Similarly, IUD+ respondents differed significantly from their IUD- counterparts primarily across measures of interpersonal violence. Among persons with antisocial personality disorder, inhalant use and IUDs were associated with greater antisocial behavior, albeit with fewer and weaker effects. Respondents with IUDs had pervasively elevated levels of antisocial conduct, including diverse forms of early-onset and interpersonally violent behavior.

mvMapper: statistical and geographical data exploration and visualization of multivariate analysis of population structure

USDA-ARS?s Scientific Manuscript database

Characterizing population genetic structure across geographic space is a fundamental challenge in population genetics. Multivariate statistical analyses are powerful tools for summarizing genetic variability, but geographic information and accompanying metadata is not always easily integrated into t...

Nurses' attitudes and knowledge regarding organ and tissue donation and transplantation in a provincial hospital: A descriptive and multivariate analysis.

PubMed

Lomero, Maria Del Mar; Jiménez-Herrera, María F; Rasero, Maria José; Sandiumenge, Alberto

2017-09-01

The attitudes and knowledge of nursing personnel regarding organ and tissue donation can influence the decision to donate. This study aimed to determine these two factors among nurses at a district hospital in Barcelona, Spain. A survey was carried out using a 35 item questionnaire. Results were subjected to descriptive and comparative statistical analyses using bivariate and multivariate analyses to examine the relation between demographic data and attitudes toward donation. The completion rate was 68.2%, with 98.6% of those responding stating that they were in favor of organ donation. The respondents were unsure as to whether the criteria for inclusion in transplant waiting lists were appropriate (57.5%), whereas 72.2% agreed that brain death is equivalent to death. The bivariate analysis revealed a significant association between a positive attitude toward donation and working on permanent night shift no religious beliefs. Attitudes toward donation among nurses were generally positive; a negative attitude, although attitudes towards donation among the nurses participating in the study were generally positive, it should be pointed out that when a negative attitude does exist this affects significant aspects such as belief in the diagnosis of brain death or the criteria for inclusion on the waiting list, amongst others, which reflects that specific training in donation focused on nurses continues to be needed. © 2017 John Wiley & Sons Australia, Ltd.

Patient satisfaction with intravenous acetaminophen: a pooled analysis of five randomized, placebo-controlled studies in the acute postoperative setting.

PubMed

Apfel, Christian C; Souza, Kimberly; Portillo, Juan; Dalal, Poorvi; Bergese, Sergio D

2015-01-01

Intravenous (IV) acetaminophen has been shown to reduce postoperative pain and opioid consumption, which may lead to increased patient satisfaction. To determine the effect IV acetaminophen has on patient satisfaction, a pooled analysis from methodologically homogenous studies was conducted. We obtained patient-level data from five randomized, placebo-controlled studies in adults undergoing elective surgery in which patient satisfaction was measured using a 4-point categorical rating scale. The primary endpoint was "excellent" satisfaction and the secondary endpoint was "good" or "excellent" satisfaction at 24 hr after first study drug administration. Bivariate analyses were conducted using the chi-square test and Student's t-test and multivariable analyses were conducted using logistic regression analysis. Patients receiving IV acetaminophen were more than twice as likely as those who received placebo to report "excellent" patient satisfaction ratings (32.3% vs. 15.9%, respectively). Of all variables that remained statistically significant in the multivariable analysis (i.e., type of surgery, duration of anesthesia, last pain rating, and opioid consumption), IV acetaminophen had the strongest positive effect on "excellent" patient satisfaction with an odds ratio of 2.76 (95% CI 1.81-4.23). Results for "excellent" or "good" satisfaction were similar. When given as part of a perioperative analgesic regimen, IV acetaminophen was associated with significantly improved patient satisfaction.

Univariate and multivariate molecular spectral analyses of lipid related molecular structural components in relation to nutrient profile in feed and food mixtures

NASA Astrophysics Data System (ADS)

Abeysekara, Saman; Damiran, Daalkhaijav; Yu, Peiqiang

2013-02-01

The objectives of this study were (i) to determine lipid related molecular structures components (functional groups) in feed combination of cereal grain (barley, Hordeum vulgare) and wheat (Triticum aestivum) based dried distillers grain solubles (wheat DDGSs) from bioethanol processing at five different combination ratios using univariate and multivariate molecular spectral analyses with infrared Fourier transform molecular spectroscopy, and (ii) to correlate lipid-related molecular-functional structure spectral profile to nutrient profiles. The spectral intensity of (i) CH3 asymmetric, CH2 asymmetric, CH3 symmetric and CH2 symmetric groups, (ii) unsaturation (Cdbnd C) group, and (iii) carbonyl ester (Cdbnd O) group were determined. Spectral differences of functional groups were detected by hierarchical cluster analysis (HCA) and principal components analysis (PCA). The results showed that the combination treatments significantly inflicted modifications (P < 0.05) in nutrient profile and lipid related molecular spectral intensity (CH2 asymmetric stretching peak height, CH2 symmetric stretching peak height, ratio of CH2 to CH3 symmetric stretching peak intensity, and carbonyl peak area). Ratio of CH2 to CH3 symmetric stretching peak intensity, and carbonyl peak significantly correlated with nutrient profiles. Both PCA and HCA differentiated lipid-related spectrum. In conclusion, the changes of lipid molecular structure spectral profiles through feed combination could be detected using molecular spectroscopy. These changes were associated with nutrient profiles and functionality.

Childhood adversity in association with personality disorder dimensions: new findings in an old debate.

PubMed

Hengartner, M P; Ajdacic-Gross, V; Rodgers, S; Müller, M; Rössler, W

2013-10-01

Various studies have reported a positive relationship between child maltreatment and personality disorders (PDs). However, few studies included all DSM-IV PDs and even fewer adjusted for other forms of childhood adversity, e.g. bullying or family problems. We analyzed questionnaires completed by 512 participants of the ZInEP epidemiology survey, a comprehensive psychiatric survey of the general population in Zurich, Switzerland. Associations between childhood adversity and PDs were analyzed bivariately via simple regression analyses and multivariately via multiple path analysis. The bivariate analyses revealed that all PD dimensions were significantly related to various forms of family and school problems as well as child abuse. In contrast, according to the multivariate analysis only school problems and emotional abuse were associated with various PDs. Poverty was uniquely associated with schizotypal PD, conflicts with parents with obsessive-compulsive PD, physical abuse with antisocial PD, and physical neglect with narcissistic PD. Sexual abuse was statistically significantly associated with schizotypal and borderline PD, but corresponding effect sizes were small. Childhood adversity has a serious impact on PDs. Bullying and violence in schools and emotional abuse appear to be more salient markers of general personality pathology than other forms of childhood adversity. Associations with sexual abuse were negligible when adjusted for other forms of adversity. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Assessment of vocal fold mobility before and after cardiothoracic surgery in children.

PubMed

Carpes, Luthiana F; Kozak, Frederick K; Leblanc, Jacques G; Campbell, Andrew I; Human, Derek G; Fandino, Marcela; Ludemann, Jeffrey P; Moxham, J Paul; Fiori, Humberto

2011-06-01

To assess the incidence of vocal fold immobility (VFI) after cardiothoracic surgery in children and to determine the factors potentially associated with this outcome. Flexible laryngoscopy to assess vocal fold mobility was performed before surgery and within 72 hours after extubation in 100 pediatric patients who underwent cardiothoracic procedures. The 2 operating surgeons recorded the surgical technique and their impression of possible injury to the recurrent laryngeal nerve. The presence of laryngeal symptoms, such as stridor, hoarseness, and strength of cry, after extubation was documented. Of 100 children included in this study, 8 had VFI after surgery. Univariate analyses showed that these 8 patients were younger and weighed less than the patients with normal vocal fold movement. Monopolar cautery was used in all patients with VFI. On univariate analysis, factors statistically significantly associated with VFI were circulatory arrest and dissection or ligation of the patent ductus arteriosus, left pulmonary artery, right pulmonary artery, or descending aorta. However, multivariate analyses failed to show these associations. The incidence of VFI after cardiothoracic surgery in our population of children was 8.0% (8 of 100). Of several factors found to be potentially associated with VFI on univariate analysis, none were significant on multivariate analysis. This may be a result of the few patients with VFI. A larger multicenter prospective study would be needed to definitively identify factors associated with the outcome of VFI.

Multivariate analysis of prognostic factors for idiopathic sudden sensorineural hearing loss treated with adjuvant hyperbaric oxygen therapy.

PubMed

Xie, Shaobing; Qiang, Qingfen; Mei, Lingyun; He, Chufeng; Feng, Yong; Sun, Hong; Wu, Xuewen

2018-01-01

The objective of this study is to evaluate possible prognostic factors of idiopathic sudden sensorineural hearing loss (ISSNHL) treated with adjuvant hyperbaric oxygen therapy (HBOT) using univariate and multivariate analyses. From January 2008 to October 2016, records of 178 ISSNHL patients treated with auxiliary hyperbaric oxygen therapy were reviewed to assess hearing recovery and evaluate associated prognostic factors (gender, age, localization, initial hearing threshold, presence of tinnitus, vertigo, ear fullness, hypertension, diabetes, onset of HBOT, number of HBOT, and audiogram), by using univariate and multivariate analyses. The overall recovery rate was 37.1%, including complete recovery (19.7%) and partial recovery (17.4%). According to multivariate analysis, later onset of HBOT and higher initial hearing threshold were associated with a poor prognosis in ISSNHL patients treated with HBOT. HBOT is a safe and beneficial adjuvant therapy for ISSNHL patients. 20 sessions of HBOT is possibly enough to show its therapeutic effect. Earlier HBOT onset and lower initial hearing threshold is associated with favorable hearing recovery.

Multivariate Analysis and Prediction of Dioxin-Furan ...

EPA Pesticide Factsheets

Peer Review Draft of Regional Methods Initiative Final Report Dioxins, which are bioaccumulative and environmentally persistent, pose an ongoing risk to human and ecosystem health. Fish constitute a significant source of dioxin exposure for humans and fish-eating wildlife. Current dioxin analytical methods are costly, time-consuming, and produce hazardous by-products. A Danish team developed a novel, multivariate statistical methodology based on the covariance of dioxin-furan congener Toxic Equivalences (TEQs) and fatty acid methyl esters (FAMEs) and applied it to North Atlantic Ocean fishmeal samples. The goal of the current study was to attempt to extend this Danish methodology to 77 whole and composite fish samples from three trophic groups: predator (whole largemouth bass), benthic (whole flathead and channel catfish) and forage fish (composite bluegill, pumpkinseed and green sunfish) from two dioxin contaminated rivers (Pocatalico R. and Kanawha R.) in West Virginia, USA. Multivariate statistical analyses, including, Principal Components Analysis (PCA), Hierarchical Clustering, and Partial Least Squares Regression (PLS), were used to assess the relationship between the FAMEs and TEQs in these dioxin contaminated freshwater fish from the Kanawha and Pocatalico Rivers. These three multivariate statistical methods all confirm that the pattern of Fatty Acid Methyl Esters (FAMEs) in these freshwater fish covaries with and is predictive of the WHO TE

Multivariate generalized multifactor dimensionality reduction to detect gene-gene interactions

PubMed Central

2013-01-01

Background Recently, one of the greatest challenges in genome-wide association studies is to detect gene-gene and/or gene-environment interactions for common complex human diseases. Ritchie et al. (2001) proposed multifactor dimensionality reduction (MDR) method for interaction analysis. MDR is a combinatorial approach to reduce multi-locus genotypes into high-risk and low-risk groups. Although MDR has been widely used for case-control studies with binary phenotypes, several extensions have been proposed. One of these methods, a generalized MDR (GMDR) proposed by Lou et al. (2007), allows adjusting for covariates and applying to both dichotomous and continuous phenotypes. GMDR uses the residual score of a generalized linear model of phenotypes to assign either high-risk or low-risk group, while MDR uses the ratio of cases to controls. Methods In this study, we propose multivariate GMDR, an extension of GMDR for multivariate phenotypes. Jointly analysing correlated multivariate phenotypes may have more power to detect susceptible genes and gene-gene interactions. We construct generalized estimating equations (GEE) with multivariate phenotypes to extend generalized linear models. Using the score vectors from GEE we discriminate high-risk from low-risk groups. We applied the multivariate GMDR method to the blood pressure data of the 7,546 subjects from the Korean Association Resource study: systolic blood pressure (SBP) and diastolic blood pressure (DBP). We compare the results of multivariate GMDR for SBP and DBP to the results from separate univariate GMDR for SBP and DBP, respectively. We also applied the multivariate GMDR method to the repeatedly measured hypertension status from 5,466 subjects and compared its result with those of univariate GMDR at each time point. Results Results from the univariate GMDR and multivariate GMDR in two-locus model with both blood pressures and hypertension phenotypes indicate best combinations of SNPs whose interaction has significant association with risk for high blood pressures or hypertension. Although the test balanced accuracy (BA) of multivariate analysis was not always greater than that of univariate analysis, the multivariate BAs were more stable with smaller standard deviations. Conclusions In this study, we have developed multivariate GMDR method using GEE approach. It is useful to use multivariate GMDR with correlated multiple phenotypes of interests. PMID:24565370

Family-Based Rare Variant Association Analysis: A Fast and Efficient Method of Multivariate Phenotype Association Analysis.

PubMed

Wang, Longfei; Lee, Sungyoung; Gim, Jungsoo; Qiao, Dandi; Cho, Michael; Elston, Robert C; Silverman, Edwin K; Won, Sungho

2016-09-01

Family-based designs have been repeatedly shown to be powerful in detecting the significant rare variants associated with human diseases. Furthermore, human diseases are often defined by the outcomes of multiple phenotypes, and thus we expect multivariate family-based analyses may be very efficient in detecting associations with rare variants. However, few statistical methods implementing this strategy have been developed for family-based designs. In this report, we describe one such implementation: the multivariate family-based rare variant association tool (mFARVAT). mFARVAT is a quasi-likelihood-based score test for rare variant association analysis with multiple phenotypes, and tests both homogeneous and heterogeneous effects of each variant on multiple phenotypes. Simulation results show that the proposed method is generally robust and efficient for various disease models, and we identify some promising candidate genes associated with chronic obstructive pulmonary disease. The software of mFARVAT is freely available at http://healthstat.snu.ac.kr/software/mfarvat/, implemented in C++ and supported on Linux and MS Windows. © 2016 WILEY PERIODICALS, INC.

Determinants of Paramedic Response Readiness for CBRNE Threats

PubMed Central

Jones, Alison; Smith, George; Nelson, Jenny; Agho, Kingsley; Taylor, Melanie; Raphael, Beverley

2010-01-01

Paramedics play a pivotal role in the response to major emergencies. Recent evidence indicates that their confidence and willingness to respond to chemical, biological, radiological, nuclear, and explosives-related (CBRNE) incidents differs from that relating to their “routine” emergency work. To further investigate the factors underpinning their readiness to respond to CBRNE incidents, paramedics in New South Wales (NSW), Australia, were asked to complete a validated online survey instrument. Univariate and multivariate analyses were performed to examine associated factors determining readiness. The sample of 663 respondents was weighted to reflect the NSW paramedic population as a whole. The univariate analysis indicated that gender, length of service, deployment concern, perceived personal resilience, CBRNE training, and incident experience were significantly associated with perceived CBRNE response readiness. In the initial multivariate analysis, significantly higher response readiness was associated with male gender, university education, and greater length of service (10-15 years). In the final multivariate model, the combined effect of training/incident experience negated the significant effects observed in the initial model and, importantly, showed that those with recent training reported higher readiness, irrespective of incident experience. Those with lower concern regarding CBRNE deployment and those with higher personal resilience were significantly more likely to report higher readiness (Adjusted Relative Risk [ARR] = 0.91, 95% CI: 0.84-0.99; ARR = 1.40, 95% CI: 1.11-1.72, respectively). These findings will assist emergency medical planners in recognizing occupational and dispositional factors associated with enhanced CBRNE readiness and highlight the important role of training in redressing potential readiness differences associated with these factors. PMID:20569060

Peripheral vascular damage in systemic lupus erythematosus: data from LUMINA, a large multi-ethnic U.S. cohort (LXIX).

PubMed

Burgos, P I; Vilá, L M; Reveille, J D; Alarcón, G S

2009-12-01

To determine the factors associated with peripheral vascular damage in systemic lupus erythematosus patients and its impact on survival from Lupus in Minorities, Nature versus Nurture, a longitudinal US multi-ethnic cohort. Peripheral vascular damage was defined by the Systemic Lupus International Collaborating Clinics Damage Index (SDI). Factors associated with peripheral vascular damage were examined by univariable and multi-variable logistic regression models and its impact on survival by a Cox multi-variable regression. Thirty-four (5.3%) of 637 patients (90% women, mean [SD] age 36.5 [12.6] [16-87] years) developed peripheral vascular damage. Age and the SDI (without peripheral vascular damage) were statistically significant (odds ratio [OR] = 1.05, 95% confidence interval [CI] 1.01-1.08; P = 0.0107 and OR = 1.30, 95% CI 0.09-1.56; P = 0.0043, respectively) in multi-variable analyses. Azathioprine, warfarin and statins were also statistically significant, and glucocorticoid use was borderline statistically significant (OR = 1.03, 95% CI 0.10-1.06; P = 0.0975). In the survival analysis, peripheral vascular damage was independently associated with a diminished survival (hazard ratio = 2.36; 95% CI 1.07-5.19; P = 0.0334). In short, age was independently associated with peripheral vascular damage, but so was the presence of damage in other organs (ocular, neuropsychiatric, renal, cardiovascular, pulmonary, musculoskeletal and integument) and some medications (probably reflecting more severe disease). Peripheral vascular damage also negatively affected survival.

Expression of Tissue Factor in Epithelial Ovarian Carcinoma Is Involved in the Development of Venous Thromboembolism.

PubMed

Sakurai, Manabu; Matsumoto, Koji; Gosho, Masahiko; Sakata, Akiko; Hosokawa, Yoshihiko; Tenjimbayashi, Yuri; Katoh, Takashi; Shikama, Ayumi; Komiya, Haruna; Michikami, Hiroo; Tasaka, Nobutaka; Akiyama-Abe, Azusa; Nakao, Sari; Ochi, Hiroyuki; Onuki, Mamiko; Minaguchi, Takeo; Yoshikawa, Hiroyuki; Satoh, Toyomi

2017-01-01

Our 2007 study of 32 patients with ovarian cancer reported the possible involvement of tissue factor (TF) in the development of venous thromboembolism (VTE) before treatment, especially in clear cell carcinoma (CCC). This follow-up study further investigated this possibility in a larger cohort. We investigated the intensity of TF expression (ITFE) and other variables for associations with VTE using univariate and multivariate analyses in 128 patients with epithelial ovarian cancer initially treated between November 2004 and December 2010, none of whom had received neoadjuvant chemotherapy. Before starting treatment, all patients were ultrasonographically screened for VTE. The ITFE was graded based on immunostaining of surgical specimens. Histological types were serous carcinoma (n = 42), CCC (n = 12), endometrioid carcinoma (n = 15), mucinous carcinoma (n = 53), and undifferentiated carcinoma (n = 6). The prevalence of VTE was significantly higher in CCC (34%) than in non-CCC (17%, P = 0.03). As ITFE increased, the frequencies of CCC and VTE increased significantly (P < 0.001 and P = 0.014, respectively). Multivariate analysis identified TF expression and pretreatment dimerized plasmin fragment D level as significant independent risk factors for VTE development. These factors showed particularly strong impacts on advanced-stage disease (P = 0.021). The 2007 cohort was small, preventing multivariate analysis. This study of a larger cohort yielded stronger evidence that the development of VTE in epithelial ovarian cancer may involve TF expression in cancer tissues.

FBST for Cointegration Problems

NASA Astrophysics Data System (ADS)

Diniz, M.; Pereira, C. A. B.; Stern, J. M.

2008-11-01

In order to estimate causal relations, the time series econometrics has to be aware of spurious correlation, a problem first mentioned by Yule [21]. To solve the problem, one can work with differenced series or use multivariate models like VAR or VEC models. In this case, the analysed series are going to present a long run relation i.e. a cointegration relation. Even though the Bayesian literature about inference on VAR/VEC models is quite advanced, Bauwens et al. [2] highlight that "the topic of selecting the cointegrating rank has not yet given very useful and convincing results." This paper presents the Full Bayesian Significance Test applied to cointegration rank selection tests in multivariate (VAR/VEC) time series models and shows how to implement it using available in the literature and simulated data sets. A standard non-informative prior is assumed.

Mortality Prediction Model of Septic Shock Patients Based on Routinely Recorded Data

PubMed Central

Carrara, Marta; Baselli, Giuseppe; Ferrario, Manuela

2015-01-01

We studied the problem of mortality prediction in two datasets, the first composed of 23 septic shock patients and the second composed of 73 septic subjects selected from the public database MIMIC-II. For each patient we derived hemodynamic variables, laboratory results, and clinical information of the first 48 hours after shock onset and we performed univariate and multivariate analyses to predict mortality in the following 7 days. The results show interesting features that individually identify significant differences between survivors and nonsurvivors and features which gain importance only when considered together with the others in a multivariate regression model. This preliminary study on two small septic shock populations represents a novel contribution towards new personalized models for an integration of multiparameter patient information to improve critical care management of shock patients. PMID:26557154

Financial hardship and drug use among men who have sex with men.

PubMed

Park, Su Hyun; Al-Ajlouni, Yazan; Palamar, Joseph J; Goedel, William C; Estreet, Anthony; Elbel, Brian; Sherman, Scott E; Duncan, Dustin T

2018-05-24

Little is known about the role of financial hardship as it relates to drug use, especially among men who have sex with men (MSM). As such, this study aimed to investigate potential associations between financial hardship status and drug use among MSM. We conducted a cross-sectional survey of 580 MSM in Paris recruited using a popular geosocial-networking smartphone application (GSN apps). Descriptive analyses and multivariate analyses were performed. A modified Poisson model was used to assess associations between financial hardship status and use of drugs (any drugs, tobacco, alcohol, marijuana, inhalant nitrites, and club drugs). In our sample, 45.5% reported that it was somewhat, very, or extremely difficult to meet monthly payments of bills (high financial hardship). In multivariate analyses, a high level of financial hardship was significantly associated with an increased likelihood of reporting use of any substance use (adjusted risk ratio [aRR] = 1.15; 95% CI = 1.05-1.27), as well as use of tobacco (aRR = 1.45; 95% CI = 1.19-1.78), marijuana (aRR = 1.48; 95% CI =1.03-2.13), and inhalant nitrites (aRR = 1.24; 95% CI = 1.03-1.50). Financial hardship was associated with drug use among MSM, suggesting the need for interventions to reduce the burden of financial hardship in this population.

Serum total hCGβ level is an independent prognostic factor in transitional cell carcinoma of the urothelial tract.

PubMed

Douglas, J; Sharp, A; Chau, C; Head, J; Drake, T; Wheater, M; Geldart, T; Mead, G; Crabb, S J

2014-04-02

Serum total human chorionic gonadotrophin β subunit (hCGβ) level might have prognostic value in urothelial transitional cell carcinoma (TCC) but has not been investigated for independence from other prognostic variables. We utilised a clinical database of patients receiving chemotherapy between 2005 and 2011 for urothelial TCC and an independent cohort of radical cystectomy patients for validation purposes. Prognostic variables were tested by univariate Kaplan-Meier analyses and log-rank tests. Statistically significant variables were then assessed by multivariate Cox regression. Total hCGβ level was dichotomised at < vs ≥2 IU l(-1). A total of 235 chemotherapy patients were eligible. For neoadjuvant chemotherapy, established prognostic factors including low ECOG performance status, normal haemoglobin, lower T stage and suitability for cisplatin-based chemotherapy were associated with favourable survival in univariate analyses. In addition, low hCGβ level was favourable when assessed either before (median survival not reached vs 1.86 years, P=0.001) or on completion of chemotherapy (4.27 vs 0.42 years, P=0.000002). This was confirmed in multivariate analyses and in patients receiving first- and second-line palliative chemotherapy, and in a radical cystectomy validation set. Serum total hCGβ level is an independent prognostic factor in patients receiving chemotherapy for urothelial TCC in both curative and palliative settings.

Intratumoral heterogeneity analysis reveals hidden associations between protein expression losses and patient survival in clear cell renal cell carcinoma

PubMed Central

Devarajan, Karthik; Parsons, Theodore; Wang, Qiong; O'Neill, Raymond; Solomides, Charalambos; Peiper, Stephen C.; Testa, Joseph R.; Uzzo, Robert; Yang, Haifeng

2017-01-01

Intratumoral heterogeneity (ITH) is a prominent feature of kidney cancer. It is not known whether it has utility in finding associations between protein expression and clinical parameters. We used ITH that is detected by immunohistochemistry (IHC) to aid the association analysis between the loss of SWI/SNF components and clinical parameters.160 ccRCC tumors (40 per tumor stage) were used to generate tissue microarray (TMA). Four foci from different regions of each tumor were selected. IHC was performed against PBRM1, ARID1A, SETD2, SMARCA4, and SMARCA2. Statistical analyses were performed to correlate biomarker losses with patho-clinical parameters. Categorical variables were compared between groups using Fisher's exact tests. Univariate and multivariable analyses were used to correlate biomarker changes and patient survivals. Multivariable analyses were performed by constructing decision trees using the classification and regression trees (CART) methodology. IHC detected widespread ITH in ccRCC tumors. The statistical analysis of the “Truncal loss” (root loss) found additional correlations between biomarker losses and tumor stages than the traditional “Loss in tumor (total)”. Losses of SMARCA4 or SMARCA2 significantly improved prognosis for overall survival (OS). Losses of PBRM1, ARID1A or SETD2 had the opposite effect. Thus “Truncal Loss” analysis revealed hidden links between protein losses and patient survival in ccRCC. PMID:28445125

Prediction of adherent placenta in pregnancy with placenta previa using ultrasonography and magnetic resonance imaging.

PubMed

Tanimura, Kenji; Yamasaki, Yui; Ebina, Yasuhiko; Deguchi, Masashi; Ueno, Yoshiko; Kitajima, Kazuhiro; Yamada, Hideto

2015-04-01

Adherent placenta is a life-threatening condition in pregnancy, and is often complicated by placenta previa. The aim of this prospective study was to determine prenatal imaging findings that predict the presence of adherent placenta in pregnancies with placenta previa. The study included 58 consecutive pregnant women with placenta previa who underwent both ultrasonography and magnetic resonance imaging prenatally. Ultrasonographic findings of anterior placental location, grade 2 or higher placental lacunae (PL≥G2), loss of retroplacental hypoechoic clear zone (LCZ) and the presence of turbulent blood flow in the arteries were evaluated, in addition to MRI findings. Forty-three women underwent cesarean section alone; 15 women with adherent placenta underwent cesarean section followed by hysterectomy with pathological examination. To determine imaging findings that predict adherent placenta, univariate and multivariate logistic regression analyses were performed. Univariate logistic regression analyses demonstrated that anterior placental location, PL≥G2, LCZ, and MRI were associated with the presence of adherent placenta. Multivariate analyses revealed that LCZ (p<0.01, odds ratio 15.6, 95%CI 2.1-114.6) was a single significant predictor of adherent placenta in women with placenta previa. This prospective study demonstrated for the first time that US findings, especially LCZ, might be useful for identifying patients at high risk for adherent placenta among pregnant women with placenta previa. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Do state characteristics matter? State level factors related to tobacco cessation quitlines

PubMed Central

Keller, Paula A; Koss, Kalsea J; Baker, Timothy B; Bailey, Linda A; Fiore, Michael C

2007-01-01

Background Quitline services are an effective population‐wide tobacco cessation strategy adopted widely in the United States as part of state comprehensive tobacco control efforts. Despite widespread evidence supporting quitlines' effectiveness, many states lack sufficient financial resources to adequately fund and promote this service. Efforts to augment state tobacco control efforts might be fostered by greater knowledge of state level factors associated with the funding and implementation of those efforts. Methods We analysed data from the 2004 North American Quitline Consortium survey and from publicly available sources to identify state level factors related to quitline implementation and funding. Factors included in the analyses were state demographic characteristics, tobacco use variables, state tobacco control spending, and economic and political climate variables. Univariate and multivariate regression analyses were conducted. Results The best fitting multivariate model that significantly predicted the presence or absence of a state quitline included only cigarette excise tax rate (p = 0.020). In terms of funding levels, states with high rates of cigarette consumption (p = 0.047) and with higher per capita expenditures for tobacco control programmes (p = 0 .0.004) were most likely to spend more on per capita operations budget for quitlines. Conclusion State level factors appear to play a part in whether states had established quitlines by mid‐2004 and the amount of per capita quitline funding. PMID:18048637

Relations of insulin resistance and glycemic abnormalities to cardiovascular magnetic resonance measures of cardiac structure and function: the Framingham Heart Study.

PubMed

Velagaleti, Raghava S; Gona, Philimon; Chuang, Michael L; Salton, Carol J; Fox, Caroline S; Blease, Susan J; Yeon, Susan B; Manning, Warren J; O'Donnell, Christopher J

2010-05-01

Data regarding the relationships of diabetes, insulin resistance, and subclinical hyperinsulinemia/hyperglycemia with cardiac structure and function are conflicting. We sought to apply volumetric cardiovascular magnetic resonance (CMR) in a free-living cohort to potentially clarify these associations. A total of 1603 Framingham Heart Study Offspring participants (age, 64+/-9 years; 55% women) underwent CMR to determine left ventricular mass (LVM), LVM to end-diastolic volume ratio (LVM/LVEDV), relative wall thickness (RWT), ejection fraction, cardiac output, and left atrial size. Data regarding insulin resistance (homeostasis model, HOMA-IR) and glycemia categories (normal, impaired insulinemia or glycemia, prediabetes, and diabetes) were determined. In a subgroup (253 men, 290 women) that underwent oral glucose tolerance testing, we related 2-hour insulin and glucose with CMR measures. In both men and women, all age-adjusted CMR measures increased across HOMA-IR quartiles, but multivariable-adjusted trends were significant only for LVM/ht(2.7) and LVM/LVEDV. LVM/LVEDV and RWT were higher in participants with prediabetes and diabetes (in both sexes) in age-adjusted models, but these associations remained significant after multivariable adjustment only in men. LVM/LVEDV was significantly associated with 2-hour insulin in men only, and RWT was significantly associated with 2-hour glucose in women only. In multivariable stepwise selection analyses, the inclusion of body mass index led to a loss in statistical significance. Although insulin and glucose indices are associated with abnormalities in cardiac structure, insulin resistance and worsening glycemia are consistently and independently associated with LVM/LVEDV. These data implicate hyperglycemia and insulin resistance in concentric LV remodeling.

Relations of Insulin Resistance and Glycemic Abnormalities to Cardiovascular Magnetic Resonance Measures of Cardiac Structure and Function: the Framingham Heart Study

PubMed Central

Velagaleti, Raghava S.; Gona, Philimon; Chuang, Michael L.; Salton, Carol J.; Fox, Caroline S.; Blease, Susan J.; Yeon, Susan B.; Manning, Warren J.; O’Donnell, Christopher J.

2011-01-01

Background Data regarding the relationships of diabetes, insulin resistance and sub-clinical hyperinsulinemia/hyperglycemia with cardiac structure and function are conflicting. We sought to apply volumetric cardiovascular magnetic resonance (CMR) in a free-living cohort to potentially clarify these associations. Methods and Results A total of 1603 Framingham Heart Study Offspring participants (age 64±9 years; 55% women) underwent CMR to determine left ventricular mass (LVM), LVM to end-diastolic volume ratio (LVM/LVEDV), relative wall thickness (RWT), ejection fraction (EF), cardiac output (CO) and left atrial size (LAD). Data regarding insulin resistance (homeostasis model, HOMA-IR) and glycemia categories (normal, impaired insulinemia or glycemia, pre-diabetes and diabetes) were determined. In a subgroup (253 men, 290 women) that underwent oral glucose tolerance testing, we related 2-hr insulin and glucose with CMR measures. In both men and women, all age-adjusted CMR measures increased across HOMA-IR quartiles, but multivariable-adjusted trends were significant only for LVM/ht2.7 and LVM/LVEDV. LVM/LVEDV and RWT were higher in participants with pre-diabetes and diabetes (in both sexes) in age-adjusted models, but these associations remained significant after multivariable-adjustment only in men. LVM/LVEDV was significantly associated with 2-hr insulin in men only, and RWT was significantly associated with 2-hr glucose in women only. In multivariable stepwise selection analyses, the inclusion of BMI led to a loss in statistical significance. Conclusions While insulin and glucose indices are associated with abnormalities in cardiac structure, insulin resistance and worsening glycemia are consistently and independently associated with LVM/LVEDV. These data implicate hyperglycemia and insulin resistance in concentric LV remodeling. PMID:20208015

Prognostic significance of MRI findings in patients with myxoid-round cell liposarcoma.

PubMed

Tateishi, Ukihide; Hasegawa, Tadashi; Beppu, Yasuo; Kawai, Akira; Satake, Mitsuo; Moriyama, Noriyuki

2004-03-01

The aims of this study were to determine the prognostic significance of MRI findings in patients with myxoid-round cell liposarcomas and to clarify which MRI features best indicate tumors with adverse clinical behavior. The initial MRI studies of 36 pathologically confirmed myxoid-round cell liposarcomas were retrospectively reviewed, and observations from this review were correlated with the histopathologic features. MR images were evaluated by two radiologists with agreement by consensus, and both univariate and multivariate analyses were conducted to evaluate survival with a median clinical follow-up of 33 months (range, 9-276 months). Statistically significant MRI findings that favored a diagnosis of intermediate- or high-grade tumor were large tumor size (> 10 cm), deeply situated tumor, tumor possessing irregular contours, absence of lobulation, absence of thin septa, presence of thick septa, absence of tumor capsule, high-intensity signal pattern, pronounced enhancement, and globular or nodular enhancement. Of these MRI findings, thin septa (p < 0.05), a tumor capsule (p < 0.01), and pronounced enhancement (p < 0.01) were associated significantly, according to univariate analysis, with overall survival. Multivariate analysis indicated that pronounced enhancement was associated significantly with overall survival (p < 0.05). Contrast-enhanced MRI findings can indicate a good or adverse prognosis in patients with myxoid-round cell liposarcomas.

A Multivariate Genome-Wide Association Analysis of 10 LDL Subfractions, and Their Response to Statin Treatment, in 1868 Caucasians

PubMed Central

Shim, Heejung; Chasman, Daniel I.; Smith, Joshua D.; Mora, Samia; Ridker, Paul M.; Nickerson, Deborah A.; Krauss, Ronald M.; Stephens, Matthew

2015-01-01

We conducted a genome-wide association analysis of 7 subfractions of low density lipoproteins (LDLs) and 3 subfractions of intermediate density lipoproteins (IDLs) measured by gradient gel electrophoresis, and their response to statin treatment, in 1868 individuals of European ancestry from the Pharmacogenomics and Risk of Cardiovascular Disease study. Our analyses identified four previously-implicated loci (SORT1, APOE, LPA, and CETP) as containing variants that are very strongly associated with lipoprotein subfractions (log10Bayes Factor > 15). Subsequent conditional analyses suggest that three of these (APOE, LPA and CETP) likely harbor multiple independently associated SNPs. Further, while different variants typically showed different characteristic patterns of association with combinations of subfractions, the two SNPs in CETP show strikingly similar patterns - both in our original data and in a replication cohort - consistent with a common underlying molecular mechanism. Notably, the CETP variants are very strongly associated with LDL subfractions, despite showing no association with total LDLs in our study, illustrating the potential value of the more detailed phenotypic measurements. In contrast with these strong subfraction associations, genetic association analysis of subfraction response to statins showed much weaker signals (none exceeding log10Bayes Factor of 6). However, two SNPs (in APOE and LPA) previously-reported to be associated with LDL statin response do show some modest evidence for association in our data, and the subfraction response proles at the LPA SNP are consistent with the LPA association, with response likely being due primarily to resistance of Lp(a) particles to statin therapy. An additional important feature of our analysis is that, unlike most previous analyses of multiple related phenotypes, we analyzed the subfractions jointly, rather than one at a time. Comparisons of our multivariate analyses with standard univariate analyses demonstrate that multivariate analyses can substantially increase power to detect associations. Software implementing our multivariate analysis methods is available at http://stephenslab.uchicago.edu/software.html. PMID:25898129

Consumer Decision-Making Abilities and Long-Term Care Insurance Purchase.

PubMed

McGarry, Brian E; Tempkin-Greener, Helena; Grabowski, David C; Chapman, Benjamin P; Li, Yue

2018-04-16

To determine the impact of consumer decision-making abilities on making a long-term care insurance (LTCi) purchasing decision that is consistent with normative economic predictions regarding policy ownership. Using data from the Health and Retirement Study, multivariate analyses are implemented to estimate the effect of decision-making ability factors on owning LTCi. Stratified multivariate analyses are used to examine the effect of decision-making abilities on the likelihood of adhering to economic predictions of LTCi ownership. In the full sample, better cognitive capacity was found to significantly increase the odds of ownership. When the sample was stratified based on expected LTCi ownership status, cognitive capacity was positively associated with ownership among those predicted to own and negatively associated with ownership among those predicted not to own who could likely afford a policy. Consumer decision-making abilities, specifically cognitive capacity, are an important determinant of LTCi decision outcomes. Deficits in this ability may prevent individuals from successfully preparing for future long-term care expenses. Policy makers should consider changes that reduce the cognitive burden of this choice, including the standardization of the LTCi market, the provision of consumer decision aids, and alternatives to voluntary and private insuring mechanisms.

[Modulating variables of work disability in depressive disorders].

PubMed

Catalina Romero, C; Cabrera Sierra, M; Sainz Gutiérrez, J C; Barrenechea Albarrán, J L; Madrid Conesa, A; Calvo Bonacho, E

2011-01-01

To describe the duration of sickness absence in unipolar depression and to determine the relationship of demographic, job-related and clinical variables with length of temporary work disability in depressive disorders. Prospective observational study. A total of 1,292 subjects with depressive disorder diagnosis (ICD-9-CM) were selected claiming sick leave in an Occupational Diseases and Accident sat Work Insurance Scheme (sampling on successive occasions). Descriptive analyses of sickness absence duration, and bivariate (median test) and multivariate analysis (logistic regression) were performed to find relationships between demographic, job-related and clinical variables. Mean duration of sickness absence episodes due to a depressive disorder was 120 days. After multivariate analyses, female sex (p < 0.01), higher age (p < 0.01), lower educational level (p < 0.01), method of payment according to whether self-employed or unemployed workers (p < 0.01) and being referred to both psychiatrist and psychologist (p < 0.01) remained significantly associated with sick leave length. These findings confirm a strong association of depression with long periods of work disability and high absenteeism, and also suggest the need for improvements in functional ability assessment and promotion, treatment and referral of depressed patients. Copyright © 2010 SECA. Published by Elsevier Espana. All rights reserved.

Optimization of large animal MI models; a systematic analysis of control groups from preclinical studies.

PubMed

Zwetsloot, P P; Kouwenberg, L H J A; Sena, E S; Eding, J E; den Ruijter, H M; Sluijter, J P G; Pasterkamp, G; Doevendans, P A; Hoefer, I E; Chamuleau, S A J; van Hout, G P J; Jansen Of Lorkeers, S J

2017-10-27

Large animal models are essential for the development of novel therapeutics for myocardial infarction. To optimize translation, we need to assess the effect of experimental design on disease outcome and model experimental design to resemble the clinical course of MI. The aim of this study is therefore to systematically investigate how experimental decisions affect outcome measurements in large animal MI models. We used control animal-data from two independent meta-analyses of large animal MI models. All variables of interest were pre-defined. We performed univariable and multivariable meta-regression to analyze whether these variables influenced infarct size and ejection fraction. Our analyses incorporated 246 relevant studies. Multivariable meta-regression revealed that infarct size and cardiac function were influenced independently by choice of species, sex, co-medication, occlusion type, occluded vessel, quantification method, ischemia duration and follow-up duration. We provide strong systematic evidence that commonly used endpoints significantly depend on study design and biological variation. This makes direct comparison of different study-results difficult and calls for standardized models. Researchers should take this into account when designing large animal studies to most closely mimic the clinical course of MI and enable translational success.

Impact of “Sick” and “Recovery” Roles on Brain Injury Rehabilitation Outcomes

PubMed Central

Barclay, David A.

2012-01-01

This study utilizes a multivariate, correlational, expost facto research design to examine Parsons' “sick role” as a dynamic, time-sensitive process of “sick role” and “recovery role” and the impact of this process on goal attainment (H1) and psychosocial distress (H2) of adult survivors of acquired brain injury. Measures used include the Brief Symptom Inventory-18, a Goal Attainment Scale, and an original instrument to measure sick role process. 60 survivors of ABI enrolled in community reentry rehabilitation participated. Stepwise regression analyses did not fully support the multivariate hypotheses. Two models emerged from the stepwise analyses. Goal attainment, gender, and postrehab responsibilities accounted for 40% of the shared variance of psychosocial distress. Anxiety and depression accounted for 22% of the shared variance of goal attainment with anxiety contributing to the majority of the explained variance. Bivariate analysis found sick role variables, anxiety, somatization, depression, gender, and goal attainment as significant. The study has implications for ABI rehabilitation in placing greater emphasis on sick role processes, anxiety, gender, and goal attainment in guiding program planning and future research with survivors of ABI. PMID:23119164

Intrinsic factors, adrenal gland morphology, and disease burden in captive cheetahs (Acinonyx jubatus) in South Africa.

PubMed

Gillis-Germitsch, Nina; Vybiral, Pamela-Rose; Codron, Daryl; Clauss, Marcus; Kotze, Antoinette; Mitchell, Emily P

2017-01-01

Adrenal gland weight (AW) and corticomedullary ratio (ACMR) are used as indicators of stress in animals. Captive cheetahs (Acinonyx jubatus) have higher ACMRs than free-ranging ones and stress has been linked to gastritis, amyloidosis, glomerulosclerosis, and myocardial fibrosis. We reviewed age, sex, body weight (BW), kidney weight (KW), and left AW and ACMR with necropsy findings in 51 South African captive cheetahs. Eleven common histopathologic lesions were counted for each animal as measure of its disease burden. Adrenal corticomedullary hyperplasia was significantly correlated with left AW and ACMR. Males had significantly higher AWs than females; other parameters showed no difference between the sexes. Disease burden, gastritis, and myocardial fibrosis were moderately correlated with adrenal morphology supporting prior evidence that gastritis and myocardial fibrosis are linked to stress. Glomerulosclerosis was not correlated with adrenal morphology and neither kidney nor liver amyloidosis contributed significantly to variation in AW or ACMR on multivariate analyses. Interstitial nephritis showed much stronger correlations with kidney and liver amyloidosis than gastritis. All three adrenal parameters were correlated with age; age was the only significant variable affecting ACMR on the multivariate analyses; and disease burden as well as systemic amyloidosis and kidney disease (except for fibrosis) showed moderate correlations with age. Age may, therefore, be important in the pathogenesis of disease in captive cheetahs, particularly of amyloidosis and kidney disease. None of the intrinsic measurements or adrenal parameters were sufficiently closely linked to disease to be used as ante-mortem proxies for disease burden or specific diseases. Zoo Biol. 36:40-49, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Detecting changes resulting from human pressure in a naturally quick-changing and heterogeneous environment: Spatial and temporal scales of variability in coastal lagoons

NASA Astrophysics Data System (ADS)

Pérez-Ruzafa, A.; Marcos, C.; Pérez-Ruzafa, I. M.; Barcala, E.; Hegazi, M. I.; Quispe, J.

2007-10-01

To detect changes in ecosystems due to human impact, experimental designs must include replicates at the appropriate scale to avoid pseudoreplication. Although coastal lagoons, with their highly variable environmental factors and biological assemblages, are relatively well-studied systems, very little is known about their natural scales of variation. In this study, we investigate the spatio-temporal scales of variability in the Mar Menor coastal lagoon (SE Spain) using structured hierarchical sampling designs, mixed and permutational multi-variate analyses of variance, and ordination multi-variate analyses applied to hydrographical parameters, nutrients, chlorophyll a and ichthyoplankton in the water column, and to macrophyte and fish benthic assemblages. Lagoon processes in the Mar Menor show heterogeneous patterns at different temporal and spatial scales. The water column characteristics (including nutrient concentration) showed small-scale spatio-temporal variability, from 10 0 to 10 1 km and from fortnightly to seasonally. Biological features (chlorophyll a concentration and ichthyoplankton assemblage descriptors) showed monthly changes and spatial patterns at the scale of 10 0 (chlorophyll a) - 10 1 km (ichthyoplankton). Benthic assemblages (macrophytes and fishes) showed significant differences between types of substrates in the same locality and between localities, according to horizontal gradients related with confinement in the lagoon, at the scale of 10 0-10 1 km. The vertical zonation of macrophyte assemblages (at scales of 10 1-10 2 cm) overlaps changes in substrata and horizontal gradients. Seasonal patterns in vegetation biomass were not significant, but the significant interaction between Locality and Season indicated that the seasons of maximum and minimum biomass depend on local environmental conditions. Benthic fish assemblages showed no significant patterns at the monthly scale but did show seasonal patterns.

Effect of Rotation on Perineal Lacerations in Forceps-Assisted Vaginal Deliveries

PubMed Central

Bradley, Megan S.; Kaminski, Robert J.; Streitman, David C.; Dunn, Shannon L.; Krans, Elizabeth E.

2013-01-01

Objective To determine the difference in the rates of severe perineal lacerations between forceps-assisted vaginal deliveries in the occiput-posterior (OP) position compared with forceps-assisted vaginal deliveries in which the fetal head was rotated to occiput anterior (OA) prior to delivery. Methods We studied a retrospective cohort of 148 women who had a forceps-assisted vaginal delivery from 2008–2011 at the University of Pittsburgh. Mild perineal lacerations were defined as first or second degree, and severe lacerations were defined as third or fourth degree. Chi-square and t tests were used for bivariate and logistic regression was used for multivariable analyses. P<.05 was considered statistically significant. Results Of 148 forceps-assisted deliveries, 81 delivered OA after either manual or forceps rotation, 10 delivered in the OP or occiput-transverse position after an unsuccessful rotation, and 57 delivered OP without attempted rotation. No significant differences were found between demographic, obstetric and neonatal characteristics of the groups. Overall, 86 (67.7%) women had mild lacerations and 41 (32.3%) had severe lacerations. A significantly greater rate of severe perineal lacerations were found in the OP nonrotated compared with the rotated group (43.4% compared with 24.3%; P=.02). In multivariable analyses, adjusted for age, race, insurance, body mass index, gestational age, parity, episiotomy and neonatal weight, forceps-assisted vaginal delivery in the OP position without rotation remained significantly more likely to be associated with severe lacerations (OR 3.67; 95% CI 1.42–9.47). Conclusion Forceps-assisted vaginal delivery after rotation of an OP position to an OA position is associated with less severe maternal perineal trauma than forceps-assisted delivery in the OP position. PMID:23743462

Effect of rotation on perineal lacerations in forceps-assisted vaginal deliveries.

PubMed

Bradley, Megan S; Kaminski, Robert J; Streitman, David C; Dunn, Shannon L; Krans, Elizabeth E

2013-07-01

To determine the difference in the rates of severe perineal lacerations between forceps-assisted vaginal deliveries in the occiput-posterior position compared with forceps-assisted vaginal deliveries in which the fetal head was rotated to occiput-anterior before delivery. We studied a retrospective cohort of 148 women who had a forceps-assisted vaginal delivery from 2008 to 2011 at the University of Pittsburgh. Mild perineal lacerations were defined as first or second degree, and severe lacerations were defined as third or fourth degree. χ and t tests were used for bivariate and logistic regression was used for multivariable analyses. P<.05 was considered statistically significant. Of 148 forceps-assisted deliveries, 81 delivered occiput-anterior after either manual or forceps rotation, 10 delivered in the occiput-posterior or occiput-transverse position after an unsuccessful rotation, and 57 delivered occiput-posterior without attempted rotation. No significant differences were found among demographic, obstetric, and neonatal characteristics of the groups. Overall, 86 (67.7%) women had mild lacerations and 41 (32.3%) had severe lacerations. A significantly greater rate of severe perineal lacerations was found in the occiput-posterior nonrotated compared with the rotated group (43.4% compared with 24.3%; P=.02). In multivariable analyses, adjusted for age, race, insurance, body mass index, gestational age, parity, episiotomy, and birth weight, forceps-assisted vaginal delivery in the occiput-posterior position without rotation remained significantly more likely to be associated with severe lacerations (odds ratio 3.67, 95% confidence interval 1.42-9.47). Forceps-assisted vaginal delivery after rotation of an occiput-posterior position to an occiput-anterior position is associated with less severe maternal perineal trauma than forceps-assisted delivery in the occiput-posterior position. II.

A 10-Year Retrospective Review of a Nonrandomized Cohort of 458 Patients Undergoing Radical Radiotherapy or Cystectomy in Yorkshire, UK

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

Munro, Nicholas P., E-mail: nic@munron.plus.co; Sundaram, Subramnian K.; Weston, Philip

2010-05-01

Purpose: We have previously reported on the mortality, morbidity, and 5-year survival of 458 patients who underwent radical radiotherapy or surgery for invasive bladder cancer in Yorkshire from 1993 to 1996. We aim to present the 10-year outcomes of these patients and to reassess factors predicting survival. Methods and Materials: The Northern and Yorkshire Cancer Registry identified 458 patients whose cases were subjected to Kaplan-Meier all-cause survival analyses, and a retrospective casenote analysis was undertaken on 398 (87%) for univariate and multivariate Cox proportional hazards modeling. Additional proportional hazards regression modeling was used to assess the statistical significance of variablesmore » on overall survival. Results: The ratio of radiotherapy to cystectomy was 3:1. There was no significant difference in overall 10-year survival between those who underwent radiotherapy (22%) and radical cystectomy (24%). Univariate analyses suggested that female sex, performance status, hydronephrosis and clinical T stage, were associated with an inferior outcome at 10 years. Patient age, tumor grade, treatment delay, and caseload factors were not significant. Multivariate analysis models were created for 0-2 and 2-10 years after treatment. There were no significant differences in treatment for 0-2 years; however, after 2 years follow-up there was some evidence of increased survival for patients receiving surgery compared with radiotherapy (hazard ratio 0.66, 95% confidence interval: 0.44-1.01, p = 0.06). Conclusions: a 10-year minimum follow-up has rarely been reported after radical treatment for invasive bladder cancer. At 10 years, there was no statistical difference in all-cause survival between surgery and radiotherapy treatment modalities.« less

Lithium and neuroleptics in combination: is there enhancement of neurotoxicity leading to permanent sequelae?

PubMed

Goldman, S A

1996-10-01

Neurotoxicity in relation to concomitant administration of lithium and neuroleptic drugs, particularly haloperidol, has been an ongoing issue. This study examined whether use of lithium with neuroleptic drugs enhances neurotoxicity leading to permanent sequelae. The Spontaneous Reporting System database of the United States Food and Drug Administration and extant literature were reviewed for spectrum cases of lithium/neuroleptic neurotoxicity. Groups taking lithium alone (Li), lithium/haloperidol (LiHal) and lithium/ nonhaloperidol neuroleptics (LiNeuro), each paired for recovery and sequelae, were established for 237 cases. Statistical analyses included pairwise comparisons of lithium levels using the Wilcoxon Rank Sum procedure and logistic regression to analyze the relationship between independent variables and development of sequelae. The Li and Li-Neuro groups showed significant statistical differences in median lithium levels between recovery and sequelae pairs, whereas the LiHal pair did not differ significantly. Lithium level was associated with sequelae development overall and within the Li and LiNeuro groups; no such association was evident in the LiHal group. On multivariable logistic regression analysis, lithium level and taking lithium/haloperidol were significant factors in the development of sequelae, with multiple possibly confounding factors (e.g., age, sex) not statistically significant. Multivariable logistic regression analyses with neuroleptic dose as five discrete dose ranges or actual dose did not show an association between development of sequelae and dose. Database limitations notwithstanding, the lack of apparent impact of serum lithium level on the development of sequelae in patients treated with haloperidol contrasts notably with results in the Li and LiNeuro groups. These findings may suggest a possible effect of pharmacodynamic factors in lithium/neuroleptic combination therapy.

Chronic hepatitis C infection is associated with insulin resistance and lipid profiles.

PubMed

Dai, Chia-Yen; Yeh, Ming-Lun; Huang, Chung-Feng; Hou, Chen-Hsiu; Hsieh, Ming-Yen; Huang, Jee-Fu; Lin, I-Ling; Lin, Zu-Yau; Chen, Shinn-Chern; Wang, Liang-Yen; Chuang, Wan-Long; Yu, Ming-Lung; Tung, Hung-Da

2015-05-01

Chronic hepatitis C virus (HCV) infection has been suggested to be associated with non-insulin-dependent diabetes mellitus and lipid profiles. This study aimed to investigate the possible relationships of insulin resistance (IR) and lipid profiles with chronic hepatitis C (CHC) patients in Taiwan. We enrolled 160 hospital-based CHC patients with liver biopsy and the 480 controlled individuals without CHC and chronic hepatitis B from communities without known history of non-insulin-dependent diabetes mellitus. Fasting plasma glucose, total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), alanine aminotransferase, and serum insulin levels, and homeostasis model assessment (HOMA-IR) were tested. When comparing factors between CHC patients, and sex- and age-matched controls who had no HCV infection, patients with HCV infection had a significantly higher alanine aminotransferase level, fasting plasma glucose level, insulin level, and HOMA-IR (P < 0.001, P = 0.023, P = 0.017, and P = 0.011, respectively), and significantly lower TG level (P = 0.023), total cholesterol, and HDL-C and LDL-C levels (all P < 0.001) than 480 controls. In multivariate logistic regression analyses, a low total cholesterol, a low TGs, and a high HOMA-IR are independent factors significantly associated with chronic HCV infection. In the 160 CHC patients (41 patients with high HOMA-IR [> 2.5]), a high body mass index, TGs, and HCV RNA level are independent factors significantly associated with high HOMA-IR in multivariate logistic analyses. Chronic HCV infection was associated with metabolic characteristics including IR and lipid profile. IR was also associated with virological characteristics. © 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

Factors associated with generic health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD): a cross-sectional study.

PubMed

Brandl, Magdalena; Böhmer, Merle M; Brandstetter, Susanne; Finger, Tamara; Fischer, Wiebke; Pfeifer, Michael; Apfelbacher, Christian

2018-02-01

Health-related quality of life (HRQOL) is impaired in chronic obstructive pulmonary disease (COPD) patients, but determining factors for HRQOL are still not unequivocal. This study measures HRQOL among patients with COPD and aims to determine factors associated with HRQOL. Data for cross-sectional analyses were obtained from the baseline of a cohort study. The study population includes adult COPD patients (disease duration ≥3 months), recruited from primary and secondary care settings in Germany, without acute psychiatric/neurologic disease (exception: affective/ anxiety disorders). HRQOL was assessed using the Short-Form 12 (SF-12) Health Survey Questionnaire, comprising a physical and mental component. Independent variables encompass socio-demographic, disease-specific, treatment-related and psychological factors. Multivariable linear regression analyses were conducted. In total, 206 COPD patients (60.7% male; mean age: 65.3 years) took part in the study. In multivariable analysis, the physical component score showed a significant negative association with the COPD Assessment Test (CAT) (P<0.001) and a higher total number of prescribed medications (P=0.001). A higher forced expiratory volume in 1 second (FEV1) value in percent predicted was significantly related to the physical component score in a positive manner (P=0.006). The mental component score was significantly associated with elevated patient-reported symptoms of anxiety (P=0.002) or depression (P<0.001), measured by the hospital anxiety and depression scale (HADS) in a negative way. Like for the physical component score (P<0.001), a worse CAT score was significantly associated with a lower mental component score (P=0.033). Focusing on patient reported outcomes and screening for depression and anxiety with potential successive treatment might be promising approaches to improve HRQOL in patients with COPD.

Current Pregnancy Among Women with Spinal Cord Injury: Findings from the U.S. National Spinal Cord Injury Database

PubMed Central

Iezzoni, Lisa I.; Chen, Yuying; McLain, Aime B. Jackson

2015-01-01

Study design Cross-sectional study Objective To examine prevalence of pregnancy and associations with sociodemographic and clinical factors among women with spinal cord injury (SCI) Setting U.S. National Spinal Cord Injury Database, an SCI registry that interviews participants 1, 5, and then every 5 years post-injury. Data include SCI clinical details, functional impairments, participation measures, depressive symptoms, and life satisfaction. Women ages 18-49 are asked about hospitalizations in the last year relating to pregnancy or its complications. Data represent 1,907 women, who completed 3,054 interviews. Methods We used generalized estimating equations to examine bivariable associations between pregnancy and clinical and psychosocial variables and to perform multivariable regressions predicting pregnancy. Results Across all women, 2.0% reported pregnancy during the prior 12 months. This annual prevalence differed significantly by years elapsed since injury; the highest rate occurred 15 years post-injury (3.7%). Bivariable analyses found that younger age at injury was significantly associated with current pregnancy (P < 0.0001). Compared with nonpregnant women, those reporting current pregancy were significantly more likely to be married or partnered, have sport-related SCI, have higher motor scores, and have more positive psychosocial status scores. Multivariable analyses found significant associations between current pregnancy and age, marital status, motor score, and mobility and occupation scale scores. Conclusions Current pregnancy rates among reproductive-aged women with SCI are similar to rates of other U.S. women with chronic mobility impairments. More information is needed about pregnancy experiences and outcomes to inform both women with SCI seeking childbearing and clinicians providing their care. PMID:25987000

Endoscopic repair of primary versus recurrent male unilateral inguinal hernias: Are there differences in the outcome?

PubMed

Köckerling, F; Jacob, D; Wiegank, W; Hukauf, M; Schug-Pass, C; Kuthe, A; Bittner, R

2016-03-01

To date, there are no prospective randomized studies that compare the outcome of endoscopic repair of primary versus recurrent inguinal hernias. It is therefore now attempted to answer that key question on the basis of registry data. In total, 20,624 patients were enrolled between September 1, 2009, and April 31, 2013. Of these patients, 18,142 (88.0%) had a primary and 2482 (12.0%) had a recurrent endoscopic repair. Only patients with male unilateral inguinal hernia and with a 1-year follow-up were included. The dependent variables were intra- and postoperative complications, reoperations, recurrence, and chronic pain rates. The results of unadjusted analyses were verified via multivariable analyses. Unadjusted analysis did not reveal any significant differences in the intraoperative complications (1.28 vs 1.33%; p = 0.849); however, there were significant differences in the postoperative complications (3.20 vs 4.03%; p = 0.036), the reoperation rate due to complications (0.84 vs 1.33%; p = 0.023), pain at rest (4.08 vs 6.16%; p < 0.001), pain on exertion (8.03 vs 11.44%; p < 0.001), chronic pain requiring treatment (2.31 vs 3.83%; p < 0.001), and the recurrence rates (0.94 vs 1.45%; p = 0.0023). Multivariable analysis confirmed the significant impact of endoscopic repair of recurrent hernia on the outcome. Comparison of perioperative and 1-year outcome for endoscopic repair of primary versus recurrent male unilateral inguinal hernia showed significant differences to the disadvantage of the recurrent operation. Therefore, endoscopic repair of recurrent inguinal hernias calls for particular competence on the part of the hernia surgeon.

Epidemiology of Skin Cancer in the German Population: Impact of Socioeconomic and Geographic Factors.

PubMed

Augustin, J; Kis, A; Sorbe, C; Schäfer, I; Augustin, M

2018-04-06

Skin cancer being the most common cancer in Germany has shown increasing incidence in the past decade. Since mostly caused by excessive UV exposure, skin cancer is largely related to behaviour. So far, the impact of regional and sociodemographic factors on the development of skin cancer in Germany is unclear. The current study aimed to investigate the association of potential predictive factors with the prevalence of skin cancers in Germany. Nationwide ambulatory care claims data from persons insured in statutory health insurances (SHI) with malignant melanoma (MM, ICD-10 C43) and non-melanoma skin cancer (NMSC, ICD-10 C44) in the years 2009-2015 were analysed. In addition, sociodemographic population data and satellite based UV and solar radiation data were associated. Descriptive as well as multivariate (spatial) statistical analyses (for example Bayes' Smoothing) were conducted on county level. Data from 70.1 million insured persons were analysed. Age standardized prevalences per 100,000 SHI insured persons for MM and NMSC were 284.7 and 1126.9 in 2009 and 378.5 and 1708.2 in 2015. Marked regional variations were observed with prevalences between 32.9% and 51.6%. Multivariate analysis show statistically significant positive correlations between higher income and education, and MM/NMSC prevalence. Prevalence of MM and NMSC in Germany shows spatio-temporal dynamics. Our results show that regional UV radiation, sunshine hours and sociodemographic factors have significant impact on skin cancer prevalence in Germany. Individual behaviour obviously is a major determinant which should be subject to preventive interventions. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Multivariate evaluation of the effectiveness of treatment efficacy of cypermethrin against sea lice (Lepeophtheirus salmonis) in Atlantic salmon (Salmo salar)

PubMed Central

2013-01-01

Background The sea louse Lepeophtheirus salmonis is the most important ectoparasite of farmed Atlantic salmon (Salmo salar) in Norwegian aquaculture. Control of sea lice is primarily dependent on the use of delousing chemotherapeutants, which are both expensive and toxic to other wildlife. The method most commonly used for monitoring treatment effectiveness relies on measuring the percentage reduction in the mobile stages of Lepeophtheirus salmonis only. However, this does not account for changes in the other sea lice stages and may result in misleading or incomplete interpretation regarding the effectiveness of treatment. With the aim of improving the evaluation of delousing treatments, we explored multivariate analyses of bath treatments using the topical pyrethroid, cypermethrin, in salmon pens at five Norwegian production sites. Results Conventional univariate analysis indicated reductions of over 90% in mobile stages at all sites. In contrast, multivariate analyses indicated differing treatment effectiveness between sites (p-value < 0.01) based on changes in the proportion and abundance of the chalimus and PAAM (pre-adult and adult males) stages. Low water temperatures and shortened intervals between sampling after treatment may account for the differences in the composition of chalimus and PAAM stage groups following treatment. Using multivariate analysis, such factors could be separated from those which were attributable to inadequate treatment or chemotherapeutant failure. Conclusions Multivariate analyses for evaluation of treatment effectiveness against multiple life cycle stages of L. salmonis yield additional information beyond that derivable from univariate methods. This can aid in the identification of causes of apparent treatment failure in salmon aquaculture. PMID:24354936

Satisfaction and adherence in patients with iron overload receiving iron chelation therapy as assessed by a newly developed patient instrument.

PubMed

Rofail, Diana; Abetz, Linda; Viala, Muriel; Gait, Claire; Baladi, Jean-Francois; Payne, Krista

2009-01-01

This study assesses satisfaction with iron chelation therapy (ICT) based on a reliable and valid instrument, and explores the relationship between satisfaction and adherence to ICT. Patients in the USA and UK completed a new "Satisfaction with ICT" (SICT) instrument consisting of 28 items, three pertaining to adherence. Simple and multivariate regression analyses assessed the relationship between satisfaction with different aspects of ICT and adherence. First assessments of the SICT instrument indicate its validity and reliability. Recommended thresholds for internal consistency, convergent validity, discriminant validity, and floor and ceiling effects were met. A number of variables were identified in the simple linear regression analyses as significant predictors of "never thinking about stopping ICT," a proxy for adherence. These significant variables were entered into the multivariate model to assess the combined factor effects, explaining 42% of the total variance of "never thinking about stopping ICT." A significant and positive relationship was demonstrated between "never thinking about stopping ICT" and age (P = 0.04), Perceived Effectiveness of ICT (P = 0.003), low Burden of ICT (P = 0.002), and low Side Effects of ICT (P = 0.01). The SICT is a reliable and valid instrument which will be useful in ICT clinical trials. Furthermore, the administration of ICT by slow subcutaneous infusion negatively impacts on satisfaction with ICT which was shown to be a determinant of adherence. This points to the need for new more convenient and less burdensome oral iron chelators to increase adherence, and ultimately to improve patient outcomes.

Do we provide affordable, accessible and administrable health care? An assessment of SES differential in out of pocket expenditure on delivery care in India.

PubMed

Pradhan, Jalandhar; Dwivedi, Rinshu

2017-03-01

Reproductive and Child Health (RCH) financing is a key area of focus which can lead towards an overall empowerment of women through financial inclusion. The major objectives of this paper are: first; to examine the socio-economic differentials in Out of Pocket Expenditure (OOPE) on delivery care, second; to look into the role of insurance coverage, third; to analyse various sources of financing, and fourth; to measure the adjusted effect of various covariates on the level of OOPE. Data were extracted from the National Sample Survey Organisations (NSSO), 71st round "Key indicators of social consumption in India, Health" conducted by the GoI during January to June 2014. Multivariate Generalised Linear Regression Model (GLRM) has been used to analyse the various covariates of OOPE on maternity care. Multivariate analysis has demonstrated a significant association between socioeconomic status of women and the level of OOPE on delivery care. Level of education, urban residence, higher caste and social group affiliation, strong economic conditions, and use of private facilities for the child birth among the mothers were a significant predictor of the expenditure on maternity care. Despite various efforts by the central and state governments to reduce financial burden, still a large number of households are paying a significant amount from their own pockets. There is an immediate need to re-look in the aspects of insurance coverage and high level of OOPE in delivery care. Copyright © 2016 Elsevier B.V. All rights reserved.

Open access to journal articles in dentistry: Prevalence and citation impact.

PubMed

Hua, Fang; Sun, Heyuan; Walsh, Tanya; Worthington, Helen; Glenny, Anne-Marie

2016-04-01

To investigate the current prevalence of open access (OA) in the field of dentistry, the means used to provide OA, as well as the association between OA and citation counts. PubMed was searched for dental articles published in 2013. The OA status of each article was determined by manually checking Google, Google Scholar, PubMed and ResearchGate. Citation data were extracted from Google Scholar, Scopus and Web of Science. Chi-square tests were used to compare the OA prevalence by different subjects, study types, and continents of origin. The association between OA and citation count was studied with multivariable logistic regression analyses. A random sample of 908 articles was deemed eligible and therefore included. Among these, 416 were found freely available online, indicating an overall OA rate of 45.8%. Significant difference in OA rate was detected among articles in different subjects (P<0.001) and among those from different continents (P<0.001). Of articles that were OA, 74.2% were available via self-archiving ('Green road' OA), 53.3% were available from publishers ('Gold road' OA). According to multivariable logistic regression analyses, OA status was not significantly associated with either the existence of citation (P=0.37) or the level of citation (P=0.52). In the field of dentistry, 54% of recent journal articles are behind the paywall (non-OA) one year after their publication dates. The 'Green road' of providing OA was more common than the 'Gold road'. No evidence suggested that OA articles received significantly more citations than non-OA articles. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Association Between Prepregnancy Parental Support and Control and Adolescent Girls’ Pregnancy Resolution Decisions

PubMed Central

Madkour, Aubrey Spriggs; Xie, Yiqiong; Harville, Emily W.

2013-01-01

Purpose To examine the influence of prepregnancy parental support and control on adolescent girls’ pregnancy resolution decisions. Methods Data from the National Longitudinal Study of Adolescent Health were analyzed. Girls whose first pregnancy reported in wave IV occurred after wave I and before age 20 were included (n = 1,107). Participants self-reported pregnancy disposition (abortion, ectopic or tubal pregnancy, miscarriage, stillbirth, live birth) for each pregnancy; responses were dichotomized as abortion versus other. Girls’ perceptions of parental support and control were measured at wave I. Controls were included for wave I age, age at pregnancy, year at the end of pregnancy, race/ethnicity, and parent characteristics (i.e., education, religious affiliation, age at first marriage, and educational expectations). Weighted multivariable logistic regression models were performed. Results Approximately 18% of girls reporting a teen pregnancy reported having an abortion. In crude analyses, parental support was marginally negatively related to abortion (odds ratio [OR] =.83, p =.06) and parental control was significantly negatively related to abortion (OR = .78, p = .02). In multivariable analyses, higher parental control was significantly negatively related to abortion versus other pregnancy outcomes (adjusted OR .80, 95% confidence interval .66–.98). Perceived parental support was unassociated with pregnancy resolution decisions. The only other factor associated with abortion decisions was parent education: odds of choosing abortion versus other pregnancy outcomes were significantly higher for adolescent girls whose parents had a bachelor’s degree or greater versus those with lower educational attainment. Conclusions Pregnant adolescents with less educated parents or parents exercising greater control were less likely to have an abortion. PMID:23763966

Main effect and interactions of brain regions and gender in the calculation of volumetric asymmetry indices in healthy human brains: ANCOVA analyses of in vivo 3T MRI data.

PubMed

Roldan-Valadez, Ernesto; Rios, Camilo; Suarez-May, Marcela A; Favila, Rafel; Aguilar-Castañeda, Erika

2013-12-01

Macroanatomical right-left hemispheric differences in the brain are termed asymmetries, although there is no clear information on the global influence of gender and brain-regions. The aim of this study was to evaluate the main effects and interactions of these variables on the measurement of volumetric asymmetry indices (VAIs). Forty-seven healthy young-adult volunteers (23 males, 24 females) agreed to undergo brain magnetic resonance imaging in a 3T scanner. Image post processing using voxel-based volumetry allowed the calculation of 54 VAIs from the frontal, temporal, parietal and occipital lobes, limbic system, basal ganglia, and cerebellum for each cerebral hemisphere. Multivariate ANCOVA analysis calculated the main effects and interactions on VAIs of gender and brain regions controlling the effect of age. The only significant finding was the main effect of brain regions (F (6, 9373.605) 44.369, P < .001; partial η2 = .101, and power of 1.0), with no significant interaction between gender and brain regions (F (6, 50.517) .239, P = .964). Volumetric asymmetries are present across all brain regions, with larger values found in the limbic system and parietal lobe. The absence of a significant influence of gender and age in the evaluation of the numerous measurements generated by multivariate analyses in this study should not discourage researchers to report and interpret similar results, as this topic still deserves further assessment. Copyright © 2013 Wiley Periodicals, Inc.

Clinicopathological factors increased the risk of malignancy in thyroid nodules with atypical or follicular lesions of undetermined significance (AUS/FLUS) risk factor of malignancy in thyroid nodule with AUS/FLUS

PubMed Central

Hong, In Ki; Kim, Jun Ho; Cho, Young Up; Park, Shin-Young

2016-01-01

Purpose Ultrasound-guided fine needle aspiration (US-FNA) in thyroid nodules is presently most commonly used to identify whether these nodules are benign or malignant. However, atypical or follicular lesions of undetermined significance (AUS/FLUS), as categorized in the Bethesda System for reporting the results of FNA, cannot be classified as benign or malignant. Therefore, several clinical factors should be considered to assess the risk of malignancy in patients with AUS/FLUS. The purpose of the present study was to determine which clinical factor increased the risk of malignancy in patients with AUS/FLUS. Methods A retrospective study was done on 129 patients with fine needle aspiration categorized as AUS/FLUS from January 2011 through April 2015. Univariate and multivariate analyses were performed to assess the independent effect of risk factors such as age, sex, size of nodule, atypical descriptors, and ultrasonography criteria for malignancy. Results We identified that the presence of spiculated margin (odds ratio [OR], 5.655; 95% confidence interval [CI], 2.114-15.131; P = 0.001), nuclear grooving (OR, 3.697; 95% CI, 1.409-9.701; P = 0.008), irregular nuclei (OR, 3.903; 95% CI, 1.442-10.560; P = 0.001) were shown to be significantly related to malignancy on univariate and multivariate analyses. Conclusion We recommend that surgical resection of thyroid nodules be considered in patients with AUS/FLUS showing the histologic findings such as nuclear grooving, irregular nuclei along with spiculated margin of ultrasonographic finding. PMID:27073790

Implementation of a guideline for local health policy making by regional health services: exploring determinants of use by a web survey.

PubMed

Kuunders, Theo J M; Jacobs, Monique A M; Goor, Ien A M van de; Bon-Martens, Marja J H van; Oers, Hans A M van; Paulussen, Theo G W M

2017-08-15

Previous evaluation showed insufficient use of a national guideline for integrated local health policy by Regional Health Services (RHS) in the Netherlands. The guideline focuses on five health topics and includes five checklists to support integrated municipal health policies. This study explores the determinants of guideline use by regional Dutch health professionals. A web survey was send to 304 RHS health professionals. The questionnaire was based on a theory- and research-based framework of determinants of public health innovations. Main outcomes were guideline use and completeness of use, defined as the number of health topics and checklists used. Associations between determinants and (completeness of) guideline use were explored by multivariate regression models. The survey was started by 120 professionals (39%). Finally, results from 73 respondents (24%) were eligible for analyses. All 28 Dutch RHS organizations were represented in the final dataset. About half of the respondents (48%) used the guideline. The average score for completeness of use (potential range 1-10) was 2.37 (sd = 1.78; range 1-7). Knowledge, perceived task responsibility and usability were significantly related to guideline use in univariate analyses. Only usability remained significant in the multivariate model on guideline use. Only self-efficacy accounted for significant proportions of variance in completeness of use. The results imply that strategies to improve guideline use by RHSs should primarily target perceived usability. Self-efficacy appeared the primary target for improving completeness of guideline use. Methods for targeting these determinants in RHSs are discussed.

Low birthweight and preterm birth rates 1 year before and after the Irish workplace smoking ban.

PubMed

Kabir, Z; Clarke, V; Conroy, R; McNamee, E; Daly, S; Clancy, L

2009-12-01

It is well-established that maternal smoking has adverse birth outcomes (low birthweight, LBW, and preterm births). The comprehensive Irish workplace smoking ban was successfully introduced in March 2004. We examined LBW and preterm birth rates 1 year before and after the workplace smoking ban in Dublin. A cross-sectional observational study analysing routinely collected data using the Euroking K2 maternity system. Coombe University Maternal Hospital. Only singleton live births were included for analyses (7593 and 7648, in 2003 and 2005, respectively). Detailed gestational and clinical characteristics were collected and analysed using multivariable logistic regression analyses and subgroup analyses. Maternal smoking rates, mean birthweights, and adjusted odds ratios (ORs) of LBW and preterm births in 2005 versus 2003. There was a 25% decreased risk of preterm births (OR, 0.75; 95% CI, 0.59-0.96), a 43% increased risk of LBW (OR, 1.43; 95% CI, 1.10-1.85), and a 12% fall in maternal smoking rates (from 23.4 to 20.6%) in 2005 relative to 2003. Such patterns were significantly maintained when specific subgroups were also analysed. Mean birthweights decreased in 2005, but were not significant (P=0.99). There was a marginal increase in smoking cessation before pregnancy in 2005 (P=0.047). Significant declines in preterm births and in maternal smoking rates after the smoking ban are welcome signs. However, the increased LBW birth risks might reflect a secular trend, as observed in many industrialised nations, and merits further investigations.

Influence of the National Trauma Data Bank on the study of trauma outcomes: is it time to set research best practices to further enhance its impact?

PubMed

Haider, Adil H; Saleem, Taimur; Leow, Jeffrey J; Villegas, Cassandra V; Kisat, Mehreen; Schneider, Eric B; Haut, Elliott R; Stevens, Kent A; Cornwell, Edward E; MacKenzie, Ellen J; Efron, David T

2012-05-01

Risk-adjusted analyses are critical in evaluating trauma outcomes. The National Trauma Data Bank (NTDB) is a statistically robust registry that allows such analyses; however, analytical techniques are not yet standardized. In this study, we examined peer-reviewed manuscripts published using NTDB data, with particular attention to characteristics strongly associated with trauma outcomes. Our objective was to determine if there are substantial variations in the methodology and quality of risk-adjusted analyses and therefore, whether development of best practices for risk-adjusted analyses is warranted. A database of all studies using NTDB data published through December 2010 was created by searching PubMed and Embase. Studies with multivariate risk-adjusted analyses were examined for their central question, main outcomes measures, analytical techniques, covariates in adjusted analyses, and handling of missing data. Of 286 NTDB publications, 122 performed a multivariable adjusted analysis. These studies focused on clinical outcomes (51 studies), public health policy or injury prevention (30), quality (16), disparities (15), trauma center designation (6), or scoring systems (4). Mortality was the main outcome in 98 of these studies. There were considerable differences in the covariates used for case adjustment. The 3 covariates most frequently controlled for were age (95%), Injury Severity Score (85%), and sex (78%). Up to 43% of studies did not control for the 5 basic covariates necessary to conduct a risk-adjusted analysis of trauma mortality. Less than 10% of studies used clustering to adjust for facility differences or imputation to handle missing data. There is significant variability in how risk-adjusted analyses using data from the NTDB are performed. Best practices are needed to further improve the quality of research from the NTDB. Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Lack of independent relationships between left ventricular mass and cardiovascular reactivity to physical and psychological stress in the Coronary Artery Risk Development in Young Adults (CARDIA) Study.

PubMed

Markovitz, J H; Raczynski, J M; Lewis, C E; Flack, J; Chesney, M; Chettur, V; Hardin, J M; Johnson, E

1996-09-01

The objective of this study was to determine whether exaggerated blood pressure (BP) reactivity to stress and psychosocial characteristics are related to left ventricular mass (LVM) in a large cohort of young adults. Analyses were conducted with 3,742 participants of the CARDIA study (945 white men, 1,024 white women, 781 black men, and 992 black women), evaluated in 1990 to 1091 with echocardiographic measurement of LVM. Analyses were stratified by gender and race. The relationships of LVM/height2.7 and cardiovascular reactivity to physical and psychological stressors (treadmill exercise, cold pressor, video game, and star-tracing tasks), were examined in both univariate and multivariate analyses adjusting for baseline BP, weight, and other relevant biobehavioral variables. The relationships between LVM and several psychosocial characteristics (hostility, anger suppression, anxiety, depressive symptoms, and education) were also assessed. Systolic blood pressure (SBP) reactivity to exercise was significantly related to LVM in black and white men; LVM was 10% greater among white men with exaggerated (upper quintile) peak exercise SBP than among other white men. SBP reactivity to the cold pressor test was related to LVM in all race/gender groups, although the relationship remained significant only among white men and women in the multivariate analysis. Diastolic blood pressure (DBP) reactivity to the video game was related to LVM only among black men in adjusted analyses. After adjusting for resting BP, weight, and other covariates in linear multiple regression models, SBP reactivity to exercise explained only 3% of the variance in LVM among white men. Otherwise, reactivity to other stressors or psychosocial variables accounted for no more than 1% of the variance in LVM. It was concluded that among a cohort of young adults, blood pressure reactivity to physical and mental stressors did not add substantially to the prediction of LVM when resting BP, weight, and other covariates were taken into account.

National Income Inequality and Declining GDP Growth Rates Are Associated with Increases in HIV Diagnoses among People Who Inject Drugs in Europe: A Panel Data Analysis

PubMed Central

Nikolopoulos, Georgios K.; Fotiou, Anastasios; Kanavou, Eleftheria; Richardson, Clive; Detsis, Marios; Pharris, Anastasia; Suk, Jonathan E.; Semenza, Jan C.; Costa-Storti, Claudia; Paraskevis, Dimitrios; Sypsa, Vana; Malliori, Melpomeni-Minerva; Friedman, Samuel R.; Hatzakis, Angelos

2015-01-01

Background There is sparse evidence that demonstrates the association between macro-environmental processes and drug-related HIV epidemics. The present study explores the relationship between economic, socio-economic, policy and structural indicators, and increases in reported HIV infections among people who inject drugs (PWID) in the European Economic Area (EEA). Methods We used panel data (2003–2012) for 30 EEA countries. Statistical analyses included logistic regression models. The dependent variable was taking value 1 if there was an outbreak (significant increase in the national rate of HIV diagnoses in PWID) and 0 otherwise. Explanatory variables included the growth rate of Gross Domestic Product (GDP), the share of the population that is at risk for poverty, the unemployment rate, the Eurostat S80/S20 ratio, the Gini coefficient, the per capita government expenditure on health and social protection, and variables on drug control policy and drug-using population sizes. Lags of one to three years were investigated. Findings In multivariable analyses, using two-year lagged values, we found that a 1% increase of GDP was associated with approximately 30% reduction in the odds of an HIV outbreak. In GDP-adjusted analyses with three-year lagged values, the effect of the national income inequality on the likelihood of an HIV outbreak was significant [S80/S20 Odds Ratio (OR) = 3.89; 95% Confidence Interval (CI): 1.15 to 13.13]. Generally, the multivariable analyses produced similar results across three time lags tested. Interpretation Given the limitations of ecological research, we found that declining economic growth and increasing national income inequality were associated with an elevated probability of a large increase in the number of HIV diagnoses among PWID in EEA countries during the last decade. HIV prevention may be more effective if developed within national and European-level policy contexts that promote income equality, especially among vulnerable groups. PMID:25875598

National income inequality and declining GDP growth rates are associated with increases in HIV diagnoses among people who inject drugs in Europe: a panel data analysis.

PubMed

Nikolopoulos, Georgios K; Fotiou, Anastasios; Kanavou, Eleftheria; Richardson, Clive; Detsis, Marios; Pharris, Anastasia; Suk, Jonathan E; Semenza, Jan C; Costa-Storti, Claudia; Paraskevis, Dimitrios; Sypsa, Vana; Malliori, Melpomeni-Minerva; Friedman, Samuel R; Hatzakis, Angelos

2015-01-01

There is sparse evidence that demonstrates the association between macro-environmental processes and drug-related HIV epidemics. The present study explores the relationship between economic, socio-economic, policy and structural indicators, and increases in reported HIV infections among people who inject drugs (PWID) in the European Economic Area (EEA). We used panel data (2003-2012) for 30 EEA countries. Statistical analyses included logistic regression models. The dependent variable was taking value 1 if there was an outbreak (significant increase in the national rate of HIV diagnoses in PWID) and 0 otherwise. Explanatory variables included the growth rate of Gross Domestic Product (GDP), the share of the population that is at risk for poverty, the unemployment rate, the Eurostat S80/S20 ratio, the Gini coefficient, the per capita government expenditure on health and social protection, and variables on drug control policy and drug-using population sizes. Lags of one to three years were investigated. In multivariable analyses, using two-year lagged values, we found that a 1% increase of GDP was associated with approximately 30% reduction in the odds of an HIV outbreak. In GDP-adjusted analyses with three-year lagged values, the effect of the national income inequality on the likelihood of an HIV outbreak was significant [S80/S20 Odds Ratio (OR) = 3.89; 95% Confidence Interval (CI): 1.15 to 13.13]. Generally, the multivariable analyses produced similar results across three time lags tested. Given the limitations of ecological research, we found that declining economic growth and increasing national income inequality were associated with an elevated probability of a large increase in the number of HIV diagnoses among PWID in EEA countries during the last decade. HIV prevention may be more effective if developed within national and European-level policy contexts that promote income equality, especially among vulnerable groups.

Childhood Victimization, Attachment, Coping, and Substance Use Among Victimized Women on Probation and Parole.

PubMed

Dishon-Brown, Amanda; Golder, Seana; Renn, Tanya; Winham, Katherine; Higgins, George E; Logan, T K

2017-06-01

Justice-involved women report high rates of victimization across their life span, and these experiences contribute to their involvement in the criminal justice (CJ) system. Within this population, research has identified an overlap among victimization and substance use, a high-risk coping mechanism. Furthermore, research indicates attachment style is related to coping and high-risk behaviors. Research is needed to understand the relationship among these mechanisms as they relate to intimate partner violence (IPV). To address this gap, this study investigated the relationship between attachment, coping, childhood victimization, substance use, and IPV among 406 victimized women on probation/parole. Results of 6 multivariate regression analyses were statistically significant, accounting for 8%-13% of the variance in IPV. Particularly, childhood sexual victimization and negative coping were significant in all analyses. Findings provide practitioners, administrators, and policymakers information about the specific needs of justice-involved women.

Association of tRNA methyltransferase NSUN2/IGF-II molecular signature with ovarian cancer survival.

PubMed

Yang, Jia-Cheng; Risch, Eric; Zhang, Meiqin; Huang, Chan; Huang, Huatian; Lu, Lingeng

2017-09-01

To investigate the association between NSUN2/IGF-II signature and ovarian cancer survival. Using a publicly accessible dataset of RNA sequencing and clinical follow-up data, we performed Classification and Regression Tree and survival analyses. Patients with NSUN2 high IGF-II low had significantly superior overall and disease progression-free survival, followed by NSUN2 low IGF-II low , NSUN2 high IGF-II high and NSUN2 low IGF-II high (p < 0.0001 for overall, p = 0.0024 for progression-free survival, respectively). The associations of NSUN2/IGF-II signature with the risks of death and relapse remained significant in multivariate Cox regression models. Random-effects meta-analyses show the upregulated NSUN2 and IGF-II expression in ovarian cancer versus normal tissues. The NSUN2/IGF-II signature associates with heterogeneous outcome and may have clinical implications in managing ovarian cancer.

Validation of decisional balance and self-efficacy measures for HPV vaccination in college women.

PubMed

Lipschitz, Jessica M; Fernandez, Anne C; Larson, H Elsa; Blaney, Cerissa L; Meier, Kathy S; Redding, Colleen A; Prochaska, James O; Paiva, Andrea L

2013-01-01

Women younger than 25 years are at greatest risk for human papillomavirus (HPV) infection, including high-risk strains associated with 70% of cervical cancers. Effective model-based measures that can lead to intervention development to increase HPV vaccination rates are necessary. This study validated Transtheoretical Model measures of Decisional Balance and Self-Efficacy for seeking the HPV vaccine in a sample of female college students. Cross-sectional measurement development. Setting. Online survey of undergraduate college students. A total of 340 female students ages 18 to 26 years. Stage of Change, Decisional Balance, and Self-Efficacy. The sample was randomly split into halves for exploratory principal components analyses (PCAs), followed by confirmatory factor analyses (CFAs) to test measurement models. Multivariate analyses examined relationships between constructs. For Decisional Balance, PCA indicated two 4-item factors (Pros -α = .90; and Cons -α = .66). CFA supported a two-factor correlated model, χ(2)(19) = 39.33; p < .01; comparative fit index (CFI) = .97; and average absolute standardized residual statistic (AASR) = .03; with Pros α = .90 and Cons α = .67. For Self-Efficacy, PCA indicated one 6-item factor (α = .84). CFA supported this structure, χ(2)(9) = 50.87; p < .05; CFI = .94; AASR = .03; and α = .90. Multivariate analyses indicated significant cross-stage differences on Pros, Cons, and Self-Efficacy in expected directions. Findings support the internal and external validity of these measures and their use in Transtheoretical Model-tailored interventions. Stage-construct relationships suggest that reducing the Cons of vaccination may be more important for HPV than for behaviors with a true Maintenance stage.

Clinical trials attitudes and practices of Latino physicians.

PubMed

Ramirez, Amelie G; Wildes, Kimberly; Talavera, Greg; Nápoles-Springer, Anna; Gallion, Kipling; Pérez-Stable, Eliseo J

2008-07-01

Ethnic differences in physicians' attitudes and behaviors related to clinical trials might partially account for disparities in clinical trial participation among Latino patients. Literature regarding Latino physicians' clinical trials attitudes and practices, in comparison to White physicians, was lacking. Cross-sectional data from randomly selected physicians (N=695), stratified by ethnicity, were analyzed to test associations of ethnicity with physicians' participation in and attitudes toward referral of patients to clinical trials. Chi-square analyses showed significant (p<0.05) associations of physician race/ethnicity and clinical trials involvement, type of trial for which the physician is likely to recommend a patient, belief in scientific value, and factors that would influence recommendation for a patient to participate. Multivariate analyses resulted in several significant (p<0.05) predictors of clinical trials outcomes, including physician race/ethnicity. Latino physicians were significantly less involved in clinical trials than White physicians and found less scientific value in them, highlighting areas for future education and intervention.

Integrated Multivariate Analysis with Nondetects for the Development of Human Sewage Source-Tracking Tools Using Bacteriophages of Enterococcus faecalis.

PubMed

Wangkahad, Bencharong; Mongkolsuk, Skorn; Sirikanchana, Kwanrawee

2017-02-21

We developed sewage-specific microbial source tracking (MST) tools using enterococci bacteriophages and evaluated their performance with univariate and multivariate analyses involving data below detection limits. Newly isolated Enterococci faecalis bacterial strains AIM06 (DSM100702) and SR14 (DSM100701) demonstrated 100% specificity and 90% sensitivity to human sewage without detecting 68 animal manure pooled samples of cats, chickens, cows, dogs, ducks, pigs, and pigeons. AIM06 and SR14 bacteriophages were present in human sewage at 2-4 orders of magnitude. A principal component analysis confirmed the importance of both phages as main water quality parameters. The phages presented only in the polluted water, as classified by a cluster analysis, and at median concentrations of 1.71 × 10 2 and 4.27 × 10 2 PFU/100 mL, respectively, higher than nonhost specific RYC2056 phages and sewage-specific KS148 phages (p < 0.05). Interestingly, AIM06 and SR14 phages exhibited significant correlations with each other and with total coliforms, E. coli, enterococci, and biochemical oxygen demand (Kendall's tau = 0.348 to 0.605, p < 0.05), a result supporting their roles as water quality indicators. This research demonstrates the multiregional applicability of enterococci hosts in MST application and highlights the significance of multivariate analysis with nondetects in evaluating the performance of new MST host strains.

Effects of Flavor and Texture on the Sensory Perception of Gouda-Type Cheese Varieties during Ripening Using Multivariate Analysis.

PubMed

Shiota, Makoto; Iwasawa, Ai; Suzuki-Iwashima, Ai; Iida, Fumiko

2015-12-01

The impact of flavor composition, texture, and other factors on desirability of different commercial sources of Gouda-type cheese using multivariate analyses on the basis of sensory and instrumental analyses were investigated. Volatile aroma compounds were measured using headspace solid-phase microextraction gas chromatography/mass spectrometry (GC/MS) and steam distillation extraction (SDE)-GC/MS, and fatty acid composition, low-molecular-weight compounds, including amino acids, and organic acids, as well pH, texture, and color were measured to determine their relationship with sensory perception. Orthogonal partial least squares-discriminant analysis (OPLS-DA) was performed to discriminate between 2 different ripening periods in 7 sample sets, revealing that ethanol, ethyl acetate, hexanoic acid, and octanoic acid increased with increasing sensory attribute scores for sweetness, fruity, and sulfurous. A partial least squares (PLS) regression model was constructed to predict the desirability of cheese using these parameters. We showed that texture and buttery flavors are important factors affecting the desirability of Gouda-type cheeses for Japanese consumers using these multivariate analyses. © 2015 Institute of Food Technologists®

Up-scaling of multi-variable flood loss models from objects to land use units at the meso-scale

NASA Astrophysics Data System (ADS)

Kreibich, Heidi; Schröter, Kai; Merz, Bruno

2016-05-01

Flood risk management increasingly relies on risk analyses, including loss modelling. Most of the flood loss models usually applied in standard practice have in common that complex damaging processes are described by simple approaches like stage-damage functions. Novel multi-variable models significantly improve loss estimation on the micro-scale and may also be advantageous for large-scale applications. However, more input parameters also reveal additional uncertainty, even more in upscaling procedures for meso-scale applications, where the parameters need to be estimated on a regional area-wide basis. To gain more knowledge about challenges associated with the up-scaling of multi-variable flood loss models the following approach is applied: Single- and multi-variable micro-scale flood loss models are up-scaled and applied on the meso-scale, namely on basis of ATKIS land-use units. Application and validation is undertaken in 19 municipalities, which were affected during the 2002 flood by the River Mulde in Saxony, Germany by comparison to official loss data provided by the Saxon Relief Bank (SAB).In the meso-scale case study based model validation, most multi-variable models show smaller errors than the uni-variable stage-damage functions. The results show the suitability of the up-scaling approach, and, in accordance with micro-scale validation studies, that multi-variable models are an improvement in flood loss modelling also on the meso-scale. However, uncertainties remain high, stressing the importance of uncertainty quantification. Thus, the development of probabilistic loss models, like BT-FLEMO used in this study, which inherently provide uncertainty information are the way forward.

Prognostic factors in patients with advanced cholangiocarcinoma: Role of surgery, chemotherapy and body mass index

PubMed Central

Farhat, Mirna H; Shamseddine, Ali I; Tawil, Ayman N; Berjawi, Ghina; Sidani, Charif; Shamseddeen, Wael; Barada, Kassem A

2008-01-01

AIM: To study the factors that may affect survival of cholangiocarcinoma in Lebanon. METHODS: A retrospective review of the medical records of 55 patients diagnosed with cholangio-carcinoma at the American University of Beirut between 1990 and 2005 was conducted. Univariate and multivariate analyses were performed to determine the impact of surgery, chemotherapy, body mass index, bilirubin level and other factors on survival. RESULTS: The median survival of all patients was 8.57 mo (0.03-105.2). Univariate analysis showed that low bilirubin level (< 10 mg/dL), radical surgery and chemotherapy administration were significantly associated with better survival (P = 0.012, 0.038 and 0.038, respectively). In subgroup analysis on patients who had no surgery, chemotherapy administration prolonged median survival significantly (17.0 mo vs 3.5 mo, P = 0.001). Multivariate analysis identified only low bilirubin level < 10 mg/dL and chemotherapy administration as independent predictors associated with better survival (P < 0.05). CONCLUSION: Our data show that palliative and postoperative chemotherapy as well as a bilirubin level < 10 mg/dL are independent predictors of a significant increase in survival in patients with cholangiocarcinoma. PMID:18506930

Clinical implications of the BRAF mutation in papillary thyroid carcinoma and chronic lymphocytic thyroiditis.

PubMed

Kim, Woon Won; Ha, Tae Kwun; Bae, Sung Kwon

2018-01-09

The purpose of this study was to examine the possible prognostics and clinicopathologic characteristics underlying the BRAFV600E mutation and papillary thyroid carcinoma (PTC) coexisting or in absence of chronic lymphocytic thyroiditis (CLT). This study was conducted on 172 patients who had undergone total thyroidectomy or unilateral total thyroidectomy for PTC; the patients were then examined for the BRAFV600E mutation using specimens obtained after their surgery from January 2013 to August 2015. BRAF mutations were found in 130 of 172 patients (75.6%). CLT was present in 27.9% of patients (48/172). The incidence of the BRAFV600E mutation was significantly increased in the group with no CLT (P = 0.001). The findings of the multivariate analysis pertaining to the coexistence of CLT and PTC showed no significant correlation other than the BRAFV600E mutation. No significant difference was noted in the clinicopathologic factors between the two groups based on the coexistence of CLT in univariate and multivariate analyses. The BRAFV600E mutation is less frequent in PTC coexisting with CLT presumably because CLT and the BRAFV600E mutation operate independently in the formation and progression of thyroid cancer.

Elemental content of Vietnamese rice. Part 2. Multivariate data analysis.

PubMed

Kokot, S; Phuong, T D

1999-04-01

Rice samples were obtained from the Red River region and some other parts of Vietnam as well as from Yanco, Australia. These samples were analysed for 14 elements (P, K, Mg, Ca, Mn, Zn, Fe, Cu, Al, Na, Ni, As, Mo and Cd) by ICP-AES, ICP-MS and FAAS as described in Part 1. This data matrix was then submitted to multivariate data analysis by principal component analysis to investigate the influences of environmental and crop cultivation variables on the elemental content of rice. Results revealed that geographical location, grain variety, seasons and soil conditions are the most likely significant factors causing changes in the elemental content between the rice samples. To assess rice quality according to its elemental content and physio-biological properties, a multicriteria decision making method (PROMETHEE) was applied. With the Vietnamese rice, the sticky rice appeared to contain somewhat higher levels of nutritionally significant elements such as P, K and Mg than the non-sticky rice. Also, rice samples grown during the wet season have better levels of nutritionally significant mineral elements than those of the dry season, but in general, the wet season seemed to provide better overall elemental and physio-biological rice quality.

Extending Inferential Group Analysis in Type 2 Diabetic Patients with Multivariate GLM Implemented in SPM8.

PubMed

Ferreira, Fábio S; Pereira, João M S; Duarte, João V; Castelo-Branco, Miguel

2017-01-01

Although voxel based morphometry studies are still the standard for analyzing brain structure, their dependence on massive univariate inferential methods is a limiting factor. A better understanding of brain pathologies can be achieved by applying inferential multivariate methods, which allow the study of multiple dependent variables, e.g. different imaging modalities of the same subject. Given the widespread use of SPM software in the brain imaging community, the main aim of this work is the implementation of massive multivariate inferential analysis as a toolbox in this software package. applied to the use of T1 and T2 structural data from diabetic patients and controls. This implementation was compared with the traditional ANCOVA in SPM and a similar multivariate GLM toolbox (MRM). We implemented the new toolbox and tested it by investigating brain alterations on a cohort of twenty-eight type 2 diabetes patients and twenty-six matched healthy controls, using information from both T1 and T2 weighted structural MRI scans, both separately - using standard univariate VBM - and simultaneously, with multivariate analyses. Univariate VBM replicated predominantly bilateral changes in basal ganglia and insular regions in type 2 diabetes patients. On the other hand, multivariate analyses replicated key findings of univariate results, while also revealing the thalami as additional foci of pathology. While the presented algorithm must be further optimized, the proposed toolbox is the first implementation of multivariate statistics in SPM8 as a user-friendly toolbox, which shows great potential and is ready to be validated in other clinical cohorts and modalities.

Extending Inferential Group Analysis in Type 2 Diabetic Patients with Multivariate GLM Implemented in SPM8

PubMed Central

Ferreira, Fábio S.; Pereira, João M.S.; Duarte, João V.; Castelo-Branco, Miguel

2017-01-01

Background: Although voxel based morphometry studies are still the standard for analyzing brain structure, their dependence on massive univariate inferential methods is a limiting factor. A better understanding of brain pathologies can be achieved by applying inferential multivariate methods, which allow the study of multiple dependent variables, e.g. different imaging modalities of the same subject. Objective: Given the widespread use of SPM software in the brain imaging community, the main aim of this work is the implementation of massive multivariate inferential analysis as a toolbox in this software package. applied to the use of T1 and T2 structural data from diabetic patients and controls. This implementation was compared with the traditional ANCOVA in SPM and a similar multivariate GLM toolbox (MRM). Method: We implemented the new toolbox and tested it by investigating brain alterations on a cohort of twenty-eight type 2 diabetes patients and twenty-six matched healthy controls, using information from both T1 and T2 weighted structural MRI scans, both separately – using standard univariate VBM - and simultaneously, with multivariate analyses. Results: Univariate VBM replicated predominantly bilateral changes in basal ganglia and insular regions in type 2 diabetes patients. On the other hand, multivariate analyses replicated key findings of univariate results, while also revealing the thalami as additional foci of pathology. Conclusion: While the presented algorithm must be further optimized, the proposed toolbox is the first implementation of multivariate statistics in SPM8 as a user-friendly toolbox, which shows great potential and is ready to be validated in other clinical cohorts and modalities. PMID:28761571

Multivariate geomorphic analysis of forest streams: Implications for assessment of land use impacts on channel condition

Treesearch

Richard. D. Wood-Smith; John M. Buffington

1996-01-01

Multivariate statistical analyses of geomorphic variables from 23 forest stream reaches in southeast Alaska result in successful discrimination between pristine streams and those disturbed by land management, specifically timber harvesting and associated road building. Results of discriminant function analysis indicate that a three-variable model discriminates 10...

Application of multivariate statistical techniques in microbial ecology.

PubMed

Paliy, O; Shankar, V

2016-03-01

Recent advances in high-throughput methods of molecular analyses have led to an explosion of studies generating large-scale ecological data sets. In particular, noticeable effect has been attained in the field of microbial ecology, where new experimental approaches provided in-depth assessments of the composition, functions and dynamic changes of complex microbial communities. Because even a single high-throughput experiment produces large amount of data, powerful statistical techniques of multivariate analysis are well suited to analyse and interpret these data sets. Many different multivariate techniques are available, and often it is not clear which method should be applied to a particular data set. In this review, we describe and compare the most widely used multivariate statistical techniques including exploratory, interpretive and discriminatory procedures. We consider several important limitations and assumptions of these methods, and we present examples of how these approaches have been utilized in recent studies to provide insight into the ecology of the microbial world. Finally, we offer suggestions for the selection of appropriate methods based on the research question and data set structure. © 2016 John Wiley & Sons Ltd.

Decoding the Traumatic Memory among Women with PTSD: Implications for Neurocircuitry Models of PTSD and Real-Time fMRI Neurofeedback

PubMed Central

Cisler, Josh M.; Bush, Keith; James, G. Andrew; Smitherman, Sonet; Kilts, Clinton D.

2015-01-01

Posttraumatic Stress Disorder (PTSD) is characterized by intrusive recall of the traumatic memory. While numerous studies have investigated the neural processing mechanisms engaged during trauma memory recall in PTSD, these analyses have only focused on group-level contrasts that reveal little about the predictive validity of the identified brain regions. By contrast, a multivariate pattern analysis (MVPA) approach towards identifying the neural mechanisms engaged during trauma memory recall would entail testing whether a multivariate set of brain regions is reliably predictive of (i.e., discriminates) whether an individual is engaging in trauma or non-trauma memory recall. Here, we use a MVPA approach to test 1) whether trauma memory vs neutral memory recall can be predicted reliably using a multivariate set of brain regions among women with PTSD related to assaultive violence exposure (N=16), 2) the methodological parameters (e.g., spatial smoothing, number of memory recall repetitions, etc.) that optimize classification accuracy and reproducibility of the feature weight spatial maps, and 3) the correspondence between brain regions that discriminate trauma memory recall and the brain regions predicted by neurocircuitry models of PTSD. Cross-validation classification accuracy was significantly above chance for all methodological permutations tested; mean accuracy across participants was 76% for the methodological parameters selected as optimal for both efficiency and accuracy. Classification accuracy was significantly better for a voxel-wise approach relative to voxels within restricted regions-of-interest (ROIs); classification accuracy did not differ when using PTSD-related ROIs compared to randomly generated ROIs. ROI-based analyses suggested the reliable involvement of the left hippocampus in discriminating memory recall across participants and that the contribution of the left amygdala to the decision function was dependent upon PTSD symptom severity. These results have methodological implications for real-time fMRI neurofeedback of the trauma memory in PTSD and conceptual implications for neurocircuitry models of PTSD that attempt to explain core neural processing mechanisms mediating PTSD. PMID:26241958

Decoding the Traumatic Memory among Women with PTSD: Implications for Neurocircuitry Models of PTSD and Real-Time fMRI Neurofeedback.

PubMed

Cisler, Josh M; Bush, Keith; James, G Andrew; Smitherman, Sonet; Kilts, Clinton D

2015-01-01

Posttraumatic Stress Disorder (PTSD) is characterized by intrusive recall of the traumatic memory. While numerous studies have investigated the neural processing mechanisms engaged during trauma memory recall in PTSD, these analyses have only focused on group-level contrasts that reveal little about the predictive validity of the identified brain regions. By contrast, a multivariate pattern analysis (MVPA) approach towards identifying the neural mechanisms engaged during trauma memory recall would entail testing whether a multivariate set of brain regions is reliably predictive of (i.e., discriminates) whether an individual is engaging in trauma or non-trauma memory recall. Here, we use a MVPA approach to test 1) whether trauma memory vs neutral memory recall can be predicted reliably using a multivariate set of brain regions among women with PTSD related to assaultive violence exposure (N=16), 2) the methodological parameters (e.g., spatial smoothing, number of memory recall repetitions, etc.) that optimize classification accuracy and reproducibility of the feature weight spatial maps, and 3) the correspondence between brain regions that discriminate trauma memory recall and the brain regions predicted by neurocircuitry models of PTSD. Cross-validation classification accuracy was significantly above chance for all methodological permutations tested; mean accuracy across participants was 76% for the methodological parameters selected as optimal for both efficiency and accuracy. Classification accuracy was significantly better for a voxel-wise approach relative to voxels within restricted regions-of-interest (ROIs); classification accuracy did not differ when using PTSD-related ROIs compared to randomly generated ROIs. ROI-based analyses suggested the reliable involvement of the left hippocampus in discriminating memory recall across participants and that the contribution of the left amygdala to the decision function was dependent upon PTSD symptom severity. These results have methodological implications for real-time fMRI neurofeedback of the trauma memory in PTSD and conceptual implications for neurocircuitry models of PTSD that attempt to explain core neural processing mechanisms mediating PTSD.

Combined high-field intraoperative magnetic resonance imaging and endoscopy increase extent of resection and progression-free survival for pituitary adenomas

PubMed Central

Sylvester, Peter T.; Evans, John A.; Zipfel, Gregory J.; Chole, Richard A.; Uppaluri, Ravindra; Haughey, Bruce H.; Getz, Anne E.; Silverstein, Julie; Rich, Keith M.; Kim, Albert H.; Dacey, Ralph G.

2014-01-01

Purpose The clinical benefit of combined intraoperative magnetic resonance imaging (iMRI) and endoscopy for transsphenoidal pituitary adenoma resection has not been completely characterized. This study assessed the impact of microscopy, endoscopy, and/or iMRI on progression-free survival, extent of resection status (gross-, near-, and subtotal resection), and operative complications. Methods Retrospective analyses were performed on 446 transsphenoidal pituitary adenoma surgeries at a single institution between 1998 and 2012. Multivariate analyses were used to control for baseline characteristics, differences during extent of resection status, and progression-free survival analysis. Results Additional surgery was performed after iMRI in 56/156 cases (35.9 %), which led to increased extent of resection status in 15/156 cases (9.6 %). Multivariate ordinal logistic regression revealed no increase in extent of resection status following iMRI or endoscopy alone; however, combining these modalities increased extent of resection status (odds ratio 2.05, 95 % CI 1.21–3.46) compared to conventional transsphenoidal microsurgery. Multivariate Cox regression revealed that reduced extent of resection status shortened progression-free survival for near- versus gross-total resection [hazard ratio (HR) 2.87, 95 % CI 1.24–6.65] and sub- versus near-total resection (HR 2.10; 95 % CI 1.00–4.40). Complication comparisons between microscopy, endoscopy, and iMRI revealed increased perioperative deaths for endoscopy versus microscopy (4/209 and 0/237, respectively), but this difference was non-significant considering multiple post hoc comparisons (Fisher exact, p = 0.24). Conclusions Combined use of endoscopy and iMRI increased pituitary adenoma extent of resection status compared to conventional transsphenoidal microsurgery, and increased extent of resection status was associated with longer progression-free survival. Treatment modality combination did not significantly impact complication rate. PMID:24599833

NONPARAMETRIC MANOVA APPROACHES FOR NON-NORMAL MULTIVARIATE OUTCOMES WITH MISSING VALUES

PubMed Central

He, Fanyin; Mazumdar, Sati; Tang, Gong; Bhatia, Triptish; Anderson, Stewart J.; Dew, Mary Amanda; Krafty, Robert; Nimgaonkar, Vishwajit; Deshpande, Smita; Hall, Martica; Reynolds, Charles F.

2017-01-01

Between-group comparisons often entail many correlated response variables. The multivariate linear model, with its assumption of multivariate normality, is the accepted standard tool for these tests. When this assumption is violated, the nonparametric multivariate Kruskal-Wallis (MKW) test is frequently used. However, this test requires complete cases with no missing values in response variables. Deletion of cases with missing values likely leads to inefficient statistical inference. Here we extend the MKW test to retain information from partially-observed cases. Results of simulated studies and analysis of real data show that the proposed method provides adequate coverage and superior power to complete-case analyses. PMID:29416225

Graphite Web: web tool for gene set analysis exploiting pathway topology

PubMed Central

Sales, Gabriele; Calura, Enrica; Martini, Paolo; Romualdi, Chiara

2013-01-01

Graphite web is a novel web tool for pathway analyses and network visualization for gene expression data of both microarray and RNA-seq experiments. Several pathway analyses have been proposed either in the univariate or in the global and multivariate context to tackle the complexity and the interpretation of expression results. These methods can be further divided into ‘topological’ and ‘non-topological’ methods according to their ability to gain power from pathway topology. Biological pathways are, in fact, not only gene lists but can be represented through a network where genes and connections are, respectively, nodes and edges. To this day, the most used approaches are non-topological and univariate although they miss the relationship among genes. On the contrary, topological and multivariate approaches are more powerful, but difficult to be used by researchers without bioinformatic skills. Here we present Graphite web, the first public web server for pathway analysis on gene expression data that combines topological and multivariate pathway analyses with an efficient system of interactive network visualizations for easy results interpretation. Specifically, Graphite web implements five different gene set analyses on three model organisms and two pathway databases. Graphite Web is freely available at http://graphiteweb.bio.unipd.it/. PMID:23666626

Acute Kidney Injury Predicts Major Adverse Outcomes in Diabetes: Synergic Impact With Low Glomerular Filtration Rate and Albuminuria.

PubMed

Monseu, Mathilde; Gand, Elise; Saulnier, Pierre-Jean; Ragot, Stéphanie; Piguel, Xavier; Zaoui, Philippe; Rigalleau, Vincent; Marechaud, Richard; Roussel, Ronan; Hadjadj, Samy; Halimi, Jean-Michel

2015-12-01

Subjects with diabetes are prone to the development of cardiovascular and noncardiovascular complications. In separate studies, acute kidney injury (AKI), albuminuria, and low estimated glomerular filtration rate (eGFR) were shown to predict adverse outcomes, but, when considered together, their respective prognostic value is unknown. Patients with type 2 diabetes consecutively recruited in the SURDIAGENE cohort were prospectively followed up for major diabetes-related events, as adjudicated by an independent committee: death (with cause), major cardiovascular events (myocardial infarction, stroke, congestive heart failure, amputation, and arterial revascularization), and renal failure (i.e., sustained doubling of serum creatinine level or end-stage renal disease). Intrahospital AKI occurred in 411 of 1,371 patients during the median follow-up period of 69 months. In multivariate analyses, AKI was significantly associated with cardiovascular and noncardiovascular death, including cancer-related death. In multivariate analyses, AKI was a powerful predictor of major adverse cardiovascular events, heart failure requiring hospitalization, myocardial infarction, stroke, lower-limb amputation or revascularization, and carotid artery revascularization. AKI, eGFR, and albuminuria, even when simultaneously considered in multivariate models, predicted all-cause and cardiovascular deaths. All three renal biomarkers were also prognostic of most adverse outcomes and of the risk of renal failure. AKI, low eGFR, and elevated albuminuria, separately or together, are compelling biomarkers of major adverse outcomes and death in diabetes. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Examining the association between late-life leisure activity participation and global cognitive decline in community-dwelling elderly Chinese in Hong Kong.

PubMed

Leung, Grace Tak Yu; Fung, Ada Wai Tung; Tam, Cindy Woon Chi; Lui, Victor Wing Cheong; Chiu, Helen Fung Kum; Chan, Wai Man; Lam, Linda Chiu Wa

2011-01-01

This study examines the association between late-life leisure activity participation and global cognitive decline in community-dwelling elderly Chinese in Hong Kong. Five hundred and five participants, not clinically demented at the baseline, were analysed in the follow-up study of a population-based community survey among Hong Kong Chinese aged 60 and over. Information regarding leisure activity participation, global cognitive function and important sociodemographic variables was collected. Late life leisure activity profiles were classified into intellectual, social, physical and recreational categories, and were measured by total hours per week, total frequency and total number of subtypes. Multivariate logistic regression analyses were used to evaluate the association between leisure activity participation at the baseline and the incidence of global cognitive decline at the 22-month follow-up. The incidence of global cognitive decline was defined as a one-point drop in z-score of the Cantonese version of the mini-mental state examination (CMMSE). At the follow-up, a higher level of participation in intellectual activities was significantly associated with a lower incidence of global cognitive decline as measured by both the total hours per week (multivariate-adjusted OR 0.97 (95% CI 0.94-0.99, p=0.003)), and the total number of subtypes (multivariate-adjusted OR 0.74 (95% CI 0.58-0.95, p=0.018)). A higher level of late-life intellectual activity participation was associated with less global cognitive decline among community-dwelling elderly Chinese in Hong Kong. Copyright © 2010 John Wiley & Sons, Ltd.

Association of sleep disturbances with cognitive impairment and depression in maintenance hemodialysis patients.

PubMed

Rodriguez, Luke; Tighiouart, Hocine; Scott, Tammy; Lou, Kristina; Giang, Lena; Sorensen, Eric; Weiner, Daniel E; Sarnak, Mark J

2013-01-01

There are few data on the relationship of sleep with measures of cognitive function and symptoms of depression in dialysis patients. We evaluated the relationship of sleep with cognitive function and symptoms of depression in 168 hemodialysis patients, using multivariable linear and logistic regression. Sleep disturbances were assessed using the sleep subscale battery of the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Health Experience Questionnaire. The cognitive battery assessed a broad range of functioning including global ability, verbal intelligence, supraspan learning, auditory retention, visual retention, attention/mental processing speed, visual construction/fluid reasoning and motor speed. Depressive symptoms were assessed using the Center for Epidemiological Studies of Depression (CESD) Scale, with depression indicated by a CESD score >16. Mean (SD) age of participants was 62 (17) years, 49% were women, 30% were African American and 33% had diabetes. There was no significant relationship between sleep score and performance on any neurocognitive test (p>0.13, for all multivariable analyses). The prevalence of depression increased from 16% in the highest quartile (best) of sleep score, to 31% in the lowest quartile (worst) of sleep score. In multivariable analyses, each 1 SD increase in sleep score was associated with a 2.18 (95% confidence interval, 1.07-3.29, p<0.001) lower CESD score. Results were consistent when considering individual components of both the CESD and sleep score. Disturbances in sleep are associated with symptoms of depression but not measures of cognitive function. Dialysis patients with disturbances in sleep should be screened for depression.

The role of objective cognitive dysfunction in subjective cognitive complaints after stroke.

PubMed

van Rijsbergen, M W A; Mark, R E; Kop, W J; de Kort, P L M; Sitskoorn, M M

2017-03-01

Objective cognitive performance (OCP) is often impaired in patients post-stroke but the consequences of OCP for patient-reported subjective cognitive complaints (SCC) are poorly understood. We performed a detailed analysis on the association between post-stroke OCP and SCC. Assessments of OCP and SCC were obtained in 208 patients 3 months after stroke. OCP was evaluated using conventional and ecologically valid neuropsychological tests. Levels of SCC were measured using the CheckList for Cognitive and Emotional (CLCE) consequences following stroke inventory. Multivariate hierarchical regression analyses were used to evaluate the association of OCP with CLCE scores adjusting for age, sex and intelligence quotient. Analyses were performed to examine the global extent of OCP dysfunction (based on the total number of impaired neuropsychological tests, i.e. objective cognitive impairment index) and for each OCP test separately using the raw neuropsychological (sub)test scores. The objective cognitive impairment index for global OCP was positively correlated with the CLCE score (Spearman's rho = 0.22, P = 0.003), which remained significant in multivariate adjusted models (β = 0.25, P = 0.01). Results for the separate neuropsychological tests indicated that only one task (the ecologically valid Rivermead Behavioural Memory Test) was independently associated with the CLCE in multivariate adjusted models (β = -0.34, P < 0.001). Objective neuropsychological test performance, as measured by the global dysfunction index or an ecologically valid memory task, was associated with SCC. These data suggest that cumulative deficits in multiple cognitive domains contribute to subjectively experienced poor cognitive abilities in daily life in patients post-stroke. © 2016 EAN.

Rare Variant Association Test with Multiple Phenotypes

PubMed Central

Lee, Selyeong; Won, Sungho; Kim, Young Jin; Kim, Yongkang; Kim, Bong-Jo; Park, Taesung

2016-01-01

Although genome-wide association studies (GWAS) have now discovered thousands of genetic variants associated with common traits, such variants cannot explain the large degree of “missing heritability,” likely due to rare variants. The advent of next generation sequencing technology has allowed rare variant detection and association with common traits, often by investigating specific genomic regions for rare variant effects on a trait. Although multiply correlated phenotypes are often concurrently observed in GWAS, most studies analyze only single phenotypes, which may lessen statistical power. To increase power, multivariate analyses, which consider correlations between multiple phenotypes, can be used. However, few existing multi-variant analyses can identify rare variants for assessing multiple phenotypes. Here, we propose Multivariate Association Analysis using Score Statistics (MAAUSS), to identify rare variants associated with multiple phenotypes, based on the widely used Sequence Kernel Association Test (SKAT) for a single phenotype. We applied MAAUSS to Whole Exome Sequencing (WES) data from a Korean population of 1,058 subjects, to discover genes associated with multiple traits of liver function. We then assessed validation of those genes by a replication study, using an independent dataset of 3,445 individuals. Notably, we detected the gene ZNF620 among five significant genes. We then performed a simulation study to compare MAAUSS's performance with existing methods. Overall, MAAUSS successfully conserved type 1 error rates and in many cases, had a higher power than the existing methods. This study illustrates a feasible and straightforward approach for identifying rare variants correlated with multiple phenotypes, with likely relevance to missing heritability. PMID:28039885

Predictors of workplace violence among female sex workers in Tijuana, Mexico.

PubMed

Katsulis, Yasmina; Durfee, Alesha; Lopez, Vera; Robillard, Alyssa

2015-05-01

For sex workers, differences in rates of exposure to workplace violence are likely influenced by a variety of risk factors, including where one works and under what circumstances. Economic stressors, such as housing insecurity, may also increase the likelihood of exposure. Bivariate analyses demonstrate statistically significant associations between workplace violence and selected predictor variables, including age, drug use, exchanging sex for goods, soliciting clients outdoors, and experiencing housing insecurity. Multivariate regression analysis shows that after controlling for each of these variables in one model, only soliciting clients outdoors and housing insecurity emerge as statistically significant predictors for workplace violence. © The Author(s) 2014.

Variation in handshape and orientation in British Sign Language: The case of the ‘1’ hand configuration

PubMed Central

Fenlon, Jordan; Schembri, Adam; Rentelis, Ramas; Cormier, Kearsy

2013-01-01

This paper investigates phonological variation in British Sign Language (BSL) signs produced with a ‘1’ hand configuration in citation form. Multivariate analyses of 2084 tokens reveals that handshape variation in these signs is constrained by linguistic factors (e.g., the preceding and following phonological environment, grammatical category, indexicality, lexical frequency). The only significant social factor was region. For the subset of signs where orientation was also investigated, only grammatical function was important (the surrounding phonological environment and social factors were not significant). The implications for an understanding of pointing signs in signed languages are discussed. PMID:23805018

Source Evaluation and Trace Metal Contamination in Benthic Sediments from Equatorial Ecosystems Using Multivariate Statistical Techniques

PubMed Central

Benson, Nsikak U.; Asuquo, Francis E.; Williams, Akan B.; Essien, Joseph P.; Ekong, Cyril I.; Akpabio, Otobong; Olajire, Abaas A.

2016-01-01

Trace metals (Cd, Cr, Cu, Ni and Pb) concentrations in benthic sediments were analyzed through multi-step fractionation scheme to assess the levels and sources of contamination in estuarine, riverine and freshwater ecosystems in Niger Delta (Nigeria). The degree of contamination was assessed using the individual contamination factors (ICF) and global contamination factor (GCF). Multivariate statistical approaches including principal component analysis (PCA), cluster analysis and correlation test were employed to evaluate the interrelationships and associated sources of contamination. The spatial distribution of metal concentrations followed the pattern Pb>Cu>Cr>Cd>Ni. Ecological risk index by ICF showed significant potential mobility and bioavailability for Cu, Cu and Ni. The ICF contamination trend in the benthic sediments at all studied sites was Cu>Cr>Ni>Cd>Pb. The principal component and agglomerative clustering analyses indicate that trace metals contamination in the ecosystems was influenced by multiple pollution sources. PMID:27257934

ADHD and mental health status in Brazilian school-age children.

PubMed

Arruda, Marco A; Querido, Cícero Nardini; Bigal, Marcelo E; Polanczyk, Guilherme V

2015-01-01

To assess the prevalence of ADHD, mental health status, and risk factors in a sample of Brazilian children. Target sample consisted of all children from 5 to 13 years registered in the public elementary school. Children with ADHD were compared with those without ADHD for sociodemographic, risk factors, and Child Behavior Checklist (CBCL) symptom dimensions. Multivariate models estimated determinants of ADHD diagnosis. Of the target sample, consents and complete information were obtained from 1,830 children (91.8%). The prevalence rate of ADHD was 5.1% (95% confidence interval [CI] = [4.2, 6.2]). In contrast to controls, children with ADHD presented higher levels of symptoms in the CBCL dimensions. In multivariate analyses, the diagnosis of ADHD was significantly influenced by maternal educational status (p = .019), income class (p = .012), and prenatal exposure to tobacco (p = .032). Prevalence and demographic features of ADHD in Brazil are similar to what has been reported worldwide. © 2012 SAGE Publications.

Psychosocial distress in patients with thyroid cancer.

PubMed

Buchmann, Luke; Ashby, Shaelene; Cannon, Richard B; Hunt, Jason P

2015-04-01

The purpose of this study is to evaluate levels of psychosocial distress in thyroid cancer patients. An analysis of factors contributing to levels of distress is included. Individual retrospective cohort study. Head and neck cancer clinic at the Huntsman Cancer Institute. A total of 118 newly diagnosed thyroid cancer patients were included in the study. Univariate and multivariate analyses evaluated levels of and factors contributing to distress. Almost half (43.3%) of patients had significant distress. Those with self-reported psychiatric history, use of antidepressant medication, and history of radiation treatment had higher levels of distress. On multivariate analysis, patient endorsement of emotional issues predicted a higher distress level. Thyroid cancer patients have high distress levels. Identification of thyroid cancer patients with high distress levels is important to offer additional support during cancer therapy. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

Analysis of fatty acid composition of sea cucumber Apostichopus japonicus using multivariate statistics

NASA Astrophysics Data System (ADS)

Xu, Qinzeng; Gao, Fei; Xu, Qiang; Yang, Hongsheng

2014-11-01

Fatty acids (FAs) provide energy and also can be used to trace trophic relationships among organisms. Sea cucumber Apostichopus japonicus goes into a state of aestivation during warm summer months. We examined fatty acid profiles in aestivated and non-aestivated A. japonicus using multivariate analyses (PERMANOVA, MDS, ANOSIM, and SIMPER). The results indicate that the fatty acid profiles of aestivated and non-aestivated sea cucumbers differed significantly. The FAs that were produced by bacteria and brown kelp contributed the most to the differences in the fatty acid composition of aestivated and nonaestivated sea cucumbers. Aestivated sea cucumbers may synthesize FAs from heterotrophic bacteria during early aestivation, and long chain FAs such as eicosapentaenoic (EPA) and docosahexaenoic acid (DHA) that produced from intestinal degradation, are digested during deep aestivation. Specific changes in the fatty acid composition of A. japonicus during aestivation needs more detailed study in the future.

Compulsive buying: Earlier illicit drug use, impulse buying, depression, and adult ADHD symptoms.

PubMed

Brook, Judith S; Zhang, Chenshu; Brook, David W; Leukefeld, Carl G

2015-08-30

This longitudinal study examined the association between psychosocial antecedents, including illicit drug use, and adult compulsive buying (CB) across a 29-year time period from mean age 14 to mean age 43. Participants originally came from a community-based random sample of residents in two upstate New York counties. Multivariate linear regression analysis was used to study the relationship between the participant's earlier psychosocial antecedents and adult CB in the fifth decade of life. The results of the multivariate linear regression analyses showed that gender (female), earlier adult impulse buying (IB), depressive mood, illicit drug use, and concurrent ADHD symptoms were all significantly associated with adult CB at mean age 43. It is important that clinicians treating CB in adults should consider the role of drug use, symptoms of ADHD, IB, depression, and family factors in CB. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Compulsive Buying: Earlier Illicit Drug Use, Impulse Buying, Depression, and Adult ADHD Symptoms

PubMed Central

Brook, Judith S.; Zhang, Chenshu; Brook, David W.; Leukefeld, Carl G.

2015-01-01

This longitudinal study examined the association between psychosocial antecedents, including illicit drug use, and adult compulsive buying (CB) across a 29-year time period from mean age 14 to mean age 43. Participants originally came from a community-based random sample of residents in two upstate New York counties. Multivariate linear regression analysis was used to study the relationship between the participant’s earlier psychosocial antecedents and adult CB in the fifth decade of life. The results of the multivariate linear regression analyses showed that gender (female), earlier adult impulse buying (IB), depressive mood, illicit drug use, and concurrent ADHD symptoms were all significantly associated with adult CB at mean age 43. It is important that clinicians treating CB in adults should consider the role of drug use, symptoms of ADHD, IB, depression, and family factors in CB. PMID:26165963

Parenting Style and Behavior as Longitudinal Predictors of Adolescent Alcohol Use.

PubMed

Minaie, Matin Ghayour; Hui, Ka Kit; Leung, Rachel K; Toumbourou, John W; King, Ross M

2015-09-01

Adolescent alcohol use is a serious problem in Australia and other nations. Longitudinal data on family predictors are valuable to guide parental education efforts. The present study tested Baumrind's proposal that parenting styles are direct predictors of adolescent alcohol use. Latent class modeling was used to investigate adolescent perceptions of parenting styles and multivariate regression to examine their predictive effect on the development of adolescent alcohol use. The data set comprised 2,081 secondary school students (55.9% female) from metropolitan Melbourne, Australia, who completed three waves of annual longitudinal data starting in 2004. Baumrind's parenting styles were significant predictors in unadjusted analyses, but these effects were not maintained in multivariate models that also included parenting behavior dimensions. Family influences on the development of adolescent alcohol use appear to operate more directly through specific family management behaviors rather than through more global parenting styles.

The Impact of Work Ability on Work Motivation and Health: A Longitudinal Study Based on Older Employees.

PubMed

Feißel, Annemarie; Swart, Enno; March, Stefanie

2018-05-01

Work participation is determined by work motivation and work ability with health as a significant component. Within the lidA-study, we explore the impact of work ability on work motivation and health with consideration of further influencing factors. Four thousand one hundred nine older employees were interviewed two times (t0 = 2011, t1 = 2014). Two multivariate analyses were performed regarding the influence of work ability on work motivation (Model 1) and health (Model 2). Within the multivariate analysis, of all the influencing factors, work ability has the strongest effect on work motivation (F = 37.761) and health (F = 76.402). It appears as a decisive determinant for both dimensions. Regarding the results, it is useful to focus on the work ability of older employees in order to maintain and boost their work motivation and health.

Predictors of effects of lifestyle intervention on diabetes mellitus type 2 patients.

PubMed

Jacobsen, Ramune; Vadstrup, Eva; Røder, Michael; Frølich, Anne

2012-01-01

The main aim of the study was to identify predictors of the effects of lifestyle intervention on diabetes mellitus type 2 patients by means of multivariate analysis. Data from a previously published randomised clinical trial, which compared the effects of a rehabilitation programme including standardised education and physical training sessions in the municipality's health care centre with the same duration of individual counseling in the diabetes outpatient clinic, were used. Data from 143 diabetes patients were analysed. The merged lifestyle intervention resulted in statistically significant improvements in patients' systolic blood pressure, waist circumference, exercise capacity, glycaemic control, and some aspects of general health-related quality of life. The linear multivariate regression models explained 45% to 80% of the variance in these improvements. The baseline outcomes in accordance to the logic of the regression to the mean phenomenon were the only statistically significant and robust predictors in all regression models. These results are important from a clinical point of view as they highlight the more urgent need for and better outcomes following lifestyle intervention for those patients who have worse general and disease-specific health.

Prediction of HIV Sexual Risk Behaviors among Disadvantaged African American Adults using a Syndemic Conceptual Framework

PubMed Central

Nehl, Eric J.; Klein, Hugh; Sterk, Claire E.; Elifson, Kirk W.

2015-01-01

The focus of this paper is on HIV sexual risk taking among a community-based sample of disadvantaged African American adults. The objective is to examine multiple factors associated with sexual HIV risk behaviors within a syndemic conceptual framework. Face-to-face, computer-assisted, structured interviews were conducted with 1,535 individuals in Atlanta, Georgia. Bivariate analyses indicated a high level of relationships among the HIV sexual risks and other factors. Results from multivariate models indicated that gender, sexual orientation, relationship status, self-esteem, condom use self-efficacy, sex while the respondent was high, and sex while the partner was high were significant predictors of condomless sex. Additionally, a multivariate additive model of risk behaviors indicated that the number of health risks significantly increased the risk of condomless sex. This intersection of HIV sexual risk behaviors and their associations with various other behavioral, socio-demographics, and psychological functioning factors helps explain HIV risk-taking among this sample of African American adults and highlights the need for research and practice that accounts for multiple health behaviors and problems. PMID:26188618

Association of pretreatment body mass index and survival in human papillomavirus positive oropharyngeal squamous cell carcinoma.

PubMed

Albergotti, William G; Davis, Kara S; Abberbock, Shira; Bauman, Julie E; Ohr, James; Clump, David A; Heron, Dwight E; Duvvuri, Umamaheswar; Kim, Seungwon; Johnson, Jonas T; Ferris, Robert L

2016-09-01

Pretreatment body mass index (BMI) >25kg/m(2) is a positive prognostic factor in patients with head and neck cancer. Previous studies have not been adequately stratified by human papilloma virus (HPV) status or subsite. Our objective is to determine prognostic significance of pretreatment BMI on overall survival in HPV+ oropharyngeal squamous cell carcinoma (OPSCC). This is a retrospective review of patients with HPV+ OPSCC treated between 8/1/2006 and 8/31/2014. Patients were stratified by BMI status (>/<25kg/m(2)). Univariate and multivariate analyses of survival were performed. 300 patients met our inclusion/exclusion criteria. Patients with a BMI >25kg/m(2) had a longer overall survival (HR=0.49, P=0.01) as well as a longer disease-specific survival (HR=0.43, P=0.02). Overall survival remained significantly associated with high BMI on multivariate analysis (HR=0.54, P=0.04). Pre-treatment normal or underweight BMI status is associated with worse overall survival in HPV+ OPSCC. Copyright © 2016 Elsevier Ltd. All rights reserved.

Consistent assignment of nurse aides: association with turnover and absenteeism.

PubMed

Castle, Nicholas G

2013-01-01

Consistent assignment refers to the same caregivers consistently caring for the same residents almost every time caregivers are on duty. This article examines the association of consistent assignment of nurse aides with turnover and absenteeism. Data came from a survey of nursing home administrators, the Online Survey Certification and Reporting data, and the Area Resource File. The measures were from 2007 and came from 3,941 nursing homes. Multivariate logistic regression models were used to examine turnover and absenteeism. An average of 68% of nursing homes reported using consistent assignment, with 28% of nursing homes using nurse aides consistent assignment at the often recommended level of 85% (or more). Nursing homes using recommended levels of consistent assignment had significantly lower rates of turnover and of absenteeism. In the multivariate analyses, consistent assignment was significantly associated with both lower turnover and lower absenteeism (p < .01). Consistent assignment is a practice recommended by many policy makers, government agencies, and industry advocates. The findings presented here provide some evidence that the use of this staffing practice can be beneficial.

The effect of hospital mergers on long-term sickness absence among hospital employees: a fixed effects multivariate regression analysis using panel data.

PubMed

Kjekshus, Lars Erik; Bernstrøm, Vilde Hoff; Dahl, Espen; Lorentzen, Thomas

2014-02-03

Hospitals are merging to become more cost-effective. Mergers are often complex and difficult processes with variable outcomes. The aim of this study was to analyze the effect of mergers on long-term sickness absence among hospital employees. Long-term sickness absence was analyzed among hospital employees (N = 107 209) in 57 hospitals involved in 23 mergers in Norway between 2000 and 2009. Variation in long-term sickness absence was explained through a fixed effects multivariate regression analysis using panel data with years-since-merger as the independent variable. We found a significant but modest effect of mergers on long-term sickness absence in the year of the merger, and in years 2, 3 and 4; analyzed by gender there was a significant effect for women, also for these years, but only in year 4 for men. However, men are less represented among the hospital workforce; this could explain the lack of significance. Mergers has a significant effect on employee health that should be taken into consideration when deciding to merge hospitals. This study illustrates the importance of analyzing the effects of mergers over several years and the need for more detailed analyses of merger processes and of the changes that may occur as a result of such mergers.

Alcohol Consumption and Aneurysmal Subarachnoid Hemorrhage.

PubMed

Can, Anil; Castro, Victor M; Ozdemir, Yildirim H; Dagen, Sarajune; Dligach, Dmitriy; Finan, Sean; Yu, Sheng; Gainer, Vivian; Shadick, Nancy A; Savova, Guergana; Murphy, Shawn; Cai, Tianxi; Weiss, Scott T; Du, Rose

2018-02-01

Alcohol consumption may be a modifiable risk factor for rupture of intracranial aneurysms. Our aim is to evaluate the association between ruptured aneurysms and alcohol consumption, intensity, and cessation. The medical records of 4701 patients with 6411 radiographically confirmed intracranial aneurysms diagnosed at the Brigham and Women's Hospital and Massachusetts General Hospital between 1990 and 2016 were reviewed. Individuals were divided into cases with ruptured aneurysms and controls with unruptured aneurysms. Univariable and multivariable logistic regression analyses were performed to determine the association between alcohol consumption and rupture of intracranial aneurysms. In multivariable analysis, current alcohol use (OR 1.36, 95% CI 1.17-1.58) was associated with rupture status compared with never drinkers, whereas former alcohol use was not significant (OR 1.23, 95% CI 0.92-1.63). In addition, the number of alcoholic beverages per day among current alcohol users (OR 1.13, 95% CI 1.04-1.23) was significantly associated with rupture status, whereas alcohol use intensity was not significant among former users (OR 1.02, 95% CI 0.94-1.11). Current alcohol use and intensity are significantly associated with intracranial aneurysm rupture. However, this increased risk does not persist in former alcohol users, emphasizing the potential importance of alcohol cessation in patients harboring unruptured aneurysms.

Association between Dietary Patterns during Pregnancy and Birth Size Measures in a Diverse Population in Southern US

PubMed Central

Colón-Ramos, Uriyoán; Racette, Susan B.; Ganiban, Jody; Nguyen, Thuy G.; Kocak, Mehmet; Carroll, Kecia N.; Völgyi, Eszter; Tylavsky, Frances A.

2015-01-01

Despite increased interest in promoting nutrition during pregnancy, the association between maternal dietary patterns and birth outcomes has been equivocal. We examined maternal dietary patterns during pregnancy as a determinant of offspring’s birth weight-for-length (WLZ), weight-for-age (WAZ), length-for-age (LAZ), and head circumference (HCZ) Z-scores in Southern United States (n = 1151). Maternal diet during pregnancy was assessed by seven dietary patterns. Multivariable linear regression models described the association of WLZ, WAZ, LAZ, and HCZ with diet patterns controlling for other maternal and child characteristics. In bivariate analyses, WAZ and HCZ were significantly lower for processed and processed-Southern compared to healthy dietary patterns, whereas LAZ was significantly higher for these patterns. In the multivariate models, mothers who consumed a healthy-processed dietary pattern had children with significantly higher HCZ compared to the ones who consumed a healthy dietary pattern (HCZ β: 0.36; p = 0.019). No other dietary pattern was significantly associated with any of the birth outcomes. Instead, the major outcome determinants were: African American race, pre-pregnancy BMI, and gestational weight gain. These findings justify further investigation about socio-environmental and genetic factors related to race and birth outcomes in this population. PMID:25690420

Psychiatric and neurological disorders in late adolescence and risk of convictions for violent crime in men.

PubMed

Moberg, Tomas; Stenbacka, Marlene; Tengström, Anders; Jönsson, Erik G; Nordström, Peter; Jokinen, Jussi

2015-11-23

The relationship between mental illness and violent crime is complex because of the involvement of many other confounding risk factors. In the present study, we analysed psychiatric and neurological disorders in relation to the risk of convictions for violent crime, taking into account early behavioural and socio-economic risk factors. The study population consisted of 49,398 Swedish men, who were thoroughly assessed at conscription for compulsory military service during the years 1969-1970 and followed in national crime registers up to 2006. Five diagnostic groups were analysed: anxiety-depression/neuroses, personality disorders, substance-related disorders, mental retardation and neurological conditions. In addition, eight confounders measured at conscription and based on the literature on violence risk assessment, were added to the analyses. The relative risks of convictions for violent crime during 35 years after conscription were examined in relation to psychiatric diagnoses and other risk factors at conscription, as measured by odds ratios (ORs) and confidence intervals (CIs) from bivariate and multivariate logistic regression analyses. In the bivariate analyses there was a significant association between receiving a psychiatric diagnosis at conscription and a future conviction for violent crime (OR = 3.83, 95 % CI = 3.47-4.22), whereas no significant association between neurological conditions and future violent crime (OR = 1.03, 95 % CI = 0.48-2.21) was found. In the fully adjusted multivariate logistic regression model, mental retardation had the strongest association with future violent crime (OR = 3.60, 95 % CI = 2.73-4.75), followed by substance-related disorders (OR = 2.81, 95 % CI = 2.18-3.62), personality disorders (OR = 2.66, 95 % CI = 2.21-3.19) and anxiety-depression (OR = 1.29, 95 % CI = 1.07-1.55). Among the other risk factors, early behavioural problem had the strongest association with convictions for violent crime. Mental retardation, substance-related disorders, personality disorders and early behavioural problems are important predictors of convictions for violent crime in men.

Radiotherapy is associated with significant improvement in local and regional control in Merkel cell carcinoma

PubMed Central

2012-01-01

Introduction Merkel cell carcinoma (MCC) is a rare tumour of skin. This study is a retrospective audit of patients with MCC from St Vincent’s and Mater Hospital, Sydney, Australia. The aim of this study was to investigate the influence of radiotherapy (RT) on the local and regional control of MCC lesions and survival of patients with MCC. Method The data bases in anatomical pathology, RT and surgery. We searched for patients having a diagnosis of MCC between 1996 and 2007. Patient, tumour and treatment characteristics were collected and analysed. Univariate survival analysis of categorical variables was conducted with the Kaplan-Meier method together with the Log-Rank test for statistical significance. Continuous variables were assessed using the Cox regression method. Multivariate analysis was performed for significant univariate results. Results Sixty seven patients were found. Sixty two who were stage I-III and were treated with radical intent were analysed. 68% were male. The median age was 74 years. Forty-two cases (68%) were stage I or II, and 20 cases (32%) were stage III. For the subset of 42 stage I and II patients, those that had RT to their primary site had a 2-year local recurrence free survival of 89% compared with 36% for patients not receiving RT (p<0.001). The cumulative 2-year regional recurrence free survival for patients having adjuvant regional RT was 84% compared with 43% for patients not receiving this treatment (p<0.001). Immune status at initial surgery was a significant predictor for OS and MCCSS. In a multivariate analysis combining macroscopic size (mm) and immune status at initial surgery, only immune status remained a significant predictor of overall survival (HR=2.096, 95% CI: 1.002-4.385, p=0.049). Conclusions RT is associated with significant improvement in local and regional control in Merkel cell carcinoma. Immunosuppression is an important factor in overall survival. PMID:23075308

Fat metaplasia and backfill are key intermediaries in the development of sacroiliac joint ankylosis in patients with ankylosing spondylitis.

PubMed

Maksymowych, Walter P; Wichuk, Stephanie; Chiowchanwisawakit, Praveena; Lambert, Robert G; Pedersen, Susanne J

2014-11-01

Fat metaplasia in bone marrow on T1-weighted magnetic resonance imaging (MRI) scans may develop after resolution of inflammation in patients with ankylosing spondylitis (AS) and may predict new bone formation in the spine. Similar tissue, termed backfill, may also fill areas of excavated bone in the sacroiliac (SI) joints and may reflect resolution of inflammation and tissue repair at sites of erosions. The purpose of this study was to test our hypothesis that SI joint ankylosis develops following repair of erosions and that tissue characterized by fat metaplasia is a key intermediary step in this pathway. We used the Spondyloarthritis Research Consortium of Canada (SPARCC) SI structural lesion score (SSS) method to assess fat metaplasia, erosions, backfill, and ankylosis on MRIs of the SI joints in 147 patients with AS monitored for 2 years. Univariate and multivariate regression analyses focused first on identifying significant MRI predictors of new backfill and fat metaplasia. We then assessed the role of backfill and fat metaplasia in the development of new ankylosis. All analyses were adjusted for demographic features, treatment, and baseline and 2-year change in SSS values for parameters of inflammation and MRI structural lesions. Resolution of inflammation and reduction of erosions were each independently associated with the development of new backfill and fat metaplasia at 2 years on multivariate analyses. Multivariate regression analysis that included demographic features, baseline and 2-year change in parameters of inflammation and MRI structural lesion showed that reduction in erosions (P = 0.0005) and increase in fat metaplasia (P = 0.002) at 2 years was each independently associated with the development of new ankylosis. Our data support a disease model whereby ankylosis develops following repair of erosions, and fat metaplasia and backfill are key intermediary steps in this pathway. Copyright © 2014 by the American College of Rheumatology.

Mannitol and Outcome in Intracerebral Hemorrhage: Propensity Score and Multivariable Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial 2 Results.

PubMed

Wang, Xia; Arima, Hisatomi; Yang, Jie; Zhang, Shihong; Wu, Guojun; Woodward, Mark; Muñoz-Venturelli, Paula; Lavados, Pablo M; Stapf, Christian; Robinson, Thompson; Heeley, Emma; Delcourt, Candice; Lindley, Richard I; Parsons, Mark; Chalmers, John; Anderson, Craig S

2015-10-01

Mannitol is often used to reduce cerebral edema in acute intracerebral hemorrhage but without strong supporting evidence of benefit. We aimed to determine the impact of mannitol on outcome among participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). INTERACT2 was an international, open, blinded end point, randomized controlled trial of 2839 patients with spontaneous intracerebral hemorrhage (<6 hours) and elevated systolic blood pressure allocated to intensive (target systolic blood pressure, <140 mm Hg within 1 hour) or guideline-recommended (target systolic blood pressure, <180 mm Hg) blood pressure-lowering treatment. Propensity score and multivariable analyses were performed to investigate the relationship between mannitol treatment (within 7 days) and poor outcome, defined by death or major disability on the modified Rankin Scale score (3-6) at 90 days. There was no significant difference in poor outcome between mannitol (n=1533) and nonmannitol (n=993) groups: propensity score-matched odds ratio of 0.90 (95% confidence interval, 0.75-1.09; P=0.30) and multivariable odds ratio of 0.87 (95% confidence interval, 0.71-1.07; P=0.18). Although a better outcome was suggested in patients with larger (≥15 mL) than those with smaller (<15 mL) baseline hematomas who received mannitol (odds ratio, 0.52 [95% confidence interval, 0.35-0.78] versus odds ratio, 0.91 [95% confidence interval, 0.72-1.15]; P homogeneity<0.03 in propensity score analyses), the association was not consistent in analyses across other cutoff points (≥10 and ≥20 mL) and for differing grades of neurological severity. Mannitol was not associated with excess serious adverse events. Mannitol seems safe but might not improve outcome in patients with acute intracerebral hemorrhage. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00716079. © 2015 American Heart Association, Inc.

Predictors of interest in taking pre-exposure prophylaxis among men who have sex with men who used a rapid HIV-testing site in Montreal (Actuel sur Rue).

PubMed

Lebouché, B; Engler, K; Machouf, N; Lessard, D; Thomas, R

2016-02-01

The effective use of pre-exposure prophylaxis (PrEP) as an HIV prevention strategy depends on its uptake by individuals at high risk of infection. Few Canadian data are available on interest in PrEP among men who have sex with men (MSM). This study aimed to identify predictors of interest in PrEP among MSM clients of a rapid HIV-testing site in Montreal's gay village (Actuel sur Rue). Data were collected using a self-administered and a community agent-administered questionnaire. Among men reporting at least one male sexual partner and visiting the site between July 2012 and November 2013, we aimed to identify sociodemographic, sexual and temporal predictors of interest in taking effective PrEP with logistic regression analyses (univariate and multivariable). Over half (55%; n = 653) of the sample of 1179 MSM were interested in PrEP. Among the 14 variables considered in the univariate analyses, only (younger) age, (greater) number of sexual partners (in the past 3 months), being part of a serodiscordant couple (in the past 12 months), ever combining sex with drugs and temporal events were associated with interest in PrEP at P < 0.20 and were included in the multivariable analyses. In the multivariable model, only being part of a serodiscordant couple [adjusted odds ratio (aOR) 2.56; 95% confidence interval (CI) 1.44-4.58], having > 10 partners (aOR 1.73; 95% CI 1.17-2.55) and responding after the publication of Quebec's interim PrEP guidelines (aOR 1.82; 95% CI 1.22-2.71) proved significant. In this assessment of predictors of PrEP interest among Canadian MSM, partnering issues and the arrival of PrEP guidelines in Quebec (10 July 2013) were most closely linked to PrEP interest. © 2015 British HIV Association.

Association between statin therapy and tendon rupture: a case-control study.

PubMed

Beri, Abhimanyu; Dwamena, Francesca C; Dwamena, Ben A

2009-05-01

Although case reports of a possible association between statin therapy and tendon rupture have been published, no analytical studies exploring this relationship have been reported. We conducted a case-control study using the electronic medical records at Michigan State University from 2002 to 2007 to assess whether statin use is a risk factor for tendon rupture. We compared exposure to statins in 93 cases of tendon rupture with similar exposure in 279 sex- and age-matched controls. Exposure to statins was defined as documentation in the electronic medical record of statin use in the 12 months preceding tendon rupture. For controls, the exposure period was defined as 1 year preceding the last office visit. We used a multivariate logistic regression model, controlling for diabetes, renal disease, rheumatologic disease, and steroid use, to calculate the adjusted odds ratios (ORs). There was no significant difference between cases and controls in the rates of statin use, with either univariate [OR = 1.0, 95% confidence interval (CI) 0.54-1.84] or multivariate analyses (OR = 1.10, 95% CI 0.57-2.13). Based on predetermined subgroup analyses, statin exposure was found to be a significant risk factor for tendon rupture in women (adjusted OR = 3.76, 95% CI 1.11-12.75) but not in men (adjusted OR = 0.66, 95% CI 0.29-1.51). In conclusion, we found no overall association between statin use and tendon rupture, but subgroup analysis suggested that women with tendon rupture were more likely to be on statins.

Computed tomography predictors of hepatocellular carcinoma tumour necrosis after chemoembolization

PubMed Central

Bryant, Mary K; Dorn, David P; Zarzour, Jessica; Smith, J Kevin; Redden, David T; Saddekni, Souheil; Aal, Ahmed Kamel Abdel; Gray, Stephen H; Eckhoff, Devin E; DuBay, Derek A

2014-01-01

Background Radiographical features associated with a favourable response to trans-arterial chemoembolization (TACE) are poorly defined for patients with hepatocellular carcinoma (HCC). Methods From 2008 to 2012, all first TACE interventions for HCC performed at the University of Alabama at Birmingham (UAB) were retrospectively reviewed. Only patients with a pre-TACE and a post-TACE computed tomography (CT) scan were included in the analyses (n = 115). HCC tumour response to TACE was quantified via the the modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria. Univariate and multivariable analyses were constructed. Results The index HCC tumours experienced a > 90% or complete tumour necrosis in 59/115 (51%) of patients after the first TACE intervention. On univariate analysis, smaller tumour size, peripheral tumour location and arterial enhancement were associated with a > 90% or complete tumour necrosis, whereas, only smaller tumour size [odds ratio (OR) 0.62; 95% confidence interval (CI) 0.48, 0.81] and peripheral location (OR 6.91; 95% CI 1.75, 27.29) were significant on multivariable analysis. There was a trend towards improved survival in the patients that experienced a > 90% or complete tumour necrosis (P = 0.08). Conclusions Peripherally located smaller HCC tumours are most likely to experience a > 90% or complete tumour necrosis after TACE. Surprisingly, arterial-phase enhancement and portal venous-phase washout were not significantly predictive of TACE-induced tumour necrosis. The TACE response was not statistically associated with improved survival. PMID:23980917

Visceral fat area predicts survival in patients with advanced hepatocellular carcinoma treated with tyrosine kinase inhibitors.

PubMed

Nault, Jean-Charles; Pigneur, Frédéric; Nelson, Anaïs Charles; Costentin, Charlotte; Tselikas, Lambros; Katsahian, Sandrine; Diao, Guoqing; Laurent, Alexis; Mallat, Ariane; Duvoux, Christophe; Luciani, Alain; Decaens, Thomas

2015-10-01

Anthropometric measurements have been linked to resistance to anti-angiogenic treatment and survival. Patients with advanced hepatocellular carcinoma treated with sorafenib or brivanib in 2008-2011 were included in this retrospective study. Anthropometric measurements were assessed using computed tomography and were correlated with drug toxicity, radiological response, and overall survival. 52 patients were included, Barcelona Clinic Liver Classification B (38%) and C (62%), with a mean value of α-fetoprotein of 29,554±85,654 ng/mL, with a median overall survival of 10.5 months. Sarcopenia was associated with a greater rate of hand-foot syndrome (P=0.049). Modified Response Evaluation Criteria In Solid Tumours (mRECIST) and Choi criteria were significantly associated with survival, but RECIST criteria were not. An absence of hand-foot syndrome and high-visceral fat area were associated with progressive disease as assessed by RECIST and mRECIST criteria. In multivariate analyses, high visceral fat area (HR=3.6; P=0.002), low lean body mass (HR=2.4; P=0.015), and presence of hand-foot syndrome (HR=1.8; P=0.004) were significantly associated with overall survival. In time-dependent multivariate analyses; only high visceral fat area was associated with survival. Visceral fat area is associated with survival and seems to be a predictive marker for primary resistance to tyrosine kinase inhibitors in patients with advanced hepatocellular carcinoma. Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

An Examination of the Sociodemographic and Health Determinants of Major Depressive Disorder Among Black Women.

PubMed

Amutah-Onukagha, Ndidiamaka N; Doamekpor, Lauren A; Gardner, Michelle

2017-12-01

Black women disproportionately share the distribution of risk factors for physical and mental illnesses. The goal of this study was to examine the sociodemographic and health correlates of major depressive disorder (MDD) symptoms among black women. Pooled data from the 2005-2010 National Health and Nutrition Examination Survey (NHANES) were used to assess the sociodemographic and health correlates of MDD symptoms among black women (n = 227). Multivariate logistic regression techniques assessed the association between MDD symptoms and age, socioeconomic status, health status, and health behaviors. Poverty income ratio and smoking status were significantly associated with the likelihood of having MDD symptoms. Black women who were smokers were also more likely to have MDD symptoms compared to non-smokers [OR = 8.05, 95% CI = (4.56, 14.23)]. After controlling for all other socioeconomic and health variables, this association remained statistically significant. In addition, after controlling for all other variables, the multivariate analyses showed that black women below 299% federal poverty level (FPL) were nearly three times more likely to have MDD symptoms compared to women above 300% FPL [OR = 2.82, 95% CI = (1.02, 7.96)]. These analyses suggest that poverty and smoking status are associated with MDD symptoms among black women. A deeper understanding of the underlying mechanisms and key factors which influence MDD symptoms are needed in order to develop and create mental health programs targeting women of color.

Factors affecting choice between ureterostomy, ileal conduit and continent reservoir after radical cystectomy: Japanese series.

PubMed

Sugihara, Toru; Yasunaga, Hideo; Horiguchi, Hiromasa; Fujimura, Tetsuya; Fushimi, Kiyohide; Yu, Changhong; Kattan, Michael W; Homma, Yukio

2014-12-01

Little is known about the disparity of choices between three urinary diversions after radical cystectomy, focusing on patient and institutional factors. We identified urothelial carcinoma patients who received radical cystectomy with cutaneous ureterostomy, ileal conduit or continent reservoir using the Japanese Diagnosis Procedure Combination database from 2007 to 2012. Data comprised age, sex, comorbidities (converted into the Charlson index), TNM classification (converted into oncological stage), hospitals' academic status, hospital volume, bed volume and geographical region. Multivariate ordinal logistic regression analyses fitted with the proportional odds model were performed to analyze factors affecting urinary diversion choices. For dependent variables, the three diversions were converted into an ordinal variable in order of complexity: cutaneous ureterostomy (reference), ileal conduit and continent reservoir. Geographical variations were also examined by multivariate logistic regression models. A total of 4790 patients (1131 cutaneous ureterostomies [23.6 %], 2970 ileal conduits [62.0 %] and 689 continent reservoirs [14.4 %]) were included. Ordinal logistic regression analyses showed that male sex, lower age, lower Charlson index, early tumor stage, higher hospital volume (≥3.4 cases/year) and larger bed volume (≥450 beds) were significantly associated with the preference of more complex urinary diversion. Significant geographical disparity was also found. Good patient condition and early oncological status, as well as institutional factors, including high hospital volume, large bed volume and specific geographical regions, are independently related to the likelihood of choosing complex diversions. Recognizing this disparity would help reinforce the need for clinical practice uniformity.

Environmental heterogeneity explains the genetic structure of Continental and Mediterranean populations of Fraxinus angustifolia Vahl.

PubMed

Temunović, Martina; Franjić, Jozo; Satovic, Zlatko; Grgurev, Marin; Frascaria-Lacoste, Nathalie; Fernández-Manjarrés, Juan F

2012-01-01

Tree species with wide distributions often exhibit different levels of genetic structuring correlated to their environment. However, understanding how environmental heterogeneity influences genetic variation is difficult because the effects of gene flow, drift and selection are confounded. We investigated the genetic variation and its ecological correlates in a wind-pollinated Mediterranean tree species, Fraxinus angustifolia Vahl, within a recognised glacial refugium in Croatia. We sampled 11 populations from environmentally divergent habitats within the Continental and Mediterranean biogeographical regions. We combined genetic data analyses based on nuclear microsatellite loci, multivariate statistics on environmental data and ecological niche modelling (ENM). We identified a geographic structure with a high genetic diversity and low differentiation in the Continental region, which contrasted with the significantly lower genetic diversity and higher population divergence in the Mediterranean region. The positive and significant correlation between environmental and genetic distances after controlling for geographic distance suggests an important influence of ecological divergence of the sites in shaping genetic variation. The ENM provided support for niche differentiation between the populations from the Continental and Mediterranean regions, suggesting that contemporary populations may represent two divergent ecotypes. Ecotype differentiation was also supported by multivariate environmental and genetic distance analyses. Our results suggest that despite extensive gene flow in continental areas, long-term stability of heterogeneous environments have likely promoted genetic divergence of ashes in this region and can explain the present-day genetic variation patterns of these ancient populations.

Environmental Heterogeneity Explains the Genetic Structure of Continental and Mediterranean Populations of Fraxinus angustifolia Vahl

PubMed Central

Temunović, Martina; Franjić, Jozo; Satovic, Zlatko; Grgurev, Marin; Frascaria-Lacoste, Nathalie; Fernández-Manjarrés, Juan F.

2012-01-01

Tree species with wide distributions often exhibit different levels of genetic structuring correlated to their environment. However, understanding how environmental heterogeneity influences genetic variation is difficult because the effects of gene flow, drift and selection are confounded. We investigated the genetic variation and its ecological correlates in a wind-pollinated Mediterranean tree species, Fraxinus angustifolia Vahl, within a recognised glacial refugium in Croatia. We sampled 11 populations from environmentally divergent habitats within the Continental and Mediterranean biogeographical regions. We combined genetic data analyses based on nuclear microsatellite loci, multivariate statistics on environmental data and ecological niche modelling (ENM). We identified a geographic structure with a high genetic diversity and low differentiation in the Continental region, which contrasted with the significantly lower genetic diversity and higher population divergence in the Mediterranean region. The positive and significant correlation between environmental and genetic distances after controlling for geographic distance suggests an important influence of ecological divergence of the sites in shaping genetic variation. The ENM provided support for niche differentiation between the populations from the Continental and Mediterranean regions, suggesting that contemporary populations may represent two divergent ecotypes. Ecotype differentiation was also supported by multivariate environmental and genetic distance analyses. Our results suggest that despite extensive gene flow in continental areas, long-term stability of heterogeneous environments have likely promoted genetic divergence of ashes in this region and can explain the present-day genetic variation patterns of these ancient populations. PMID:22905171

Psychosocial work conditions, unemployment and self-reported psychological health: a population-based study.

PubMed

Lindström, Martin

2005-10-01

To investigate the association between psychosocial conditions at work, unemployment and self-reported psychological health. A cross-sectional postal questionnaire for the 2000 public health survey in Scania was administered to both working and unemployed people aged 18-64 years. Logistic regression models were used to investigate the association between psychosocial factors at work/unemployment and self-reported psychological health (General Health Questionnaire 12). Psychosocial conditions at work were classified according to the Karasek-Theorell demand-control/decision latitudes into relaxed, active, passive and job strain. The multivariate analyses included age, country of origin, education, economic stress and social participation. A total of 5180 people returned their questionnaire, giving a participation rate of 59%. Fifteen per cent of men and 20% of women reported poor psychological health. Those with high demands and high control (active category), those with high demands and low control (job strain category) and the unemployed had significantly higher odds ratios of poor psychological health compared to those with low demands and high control (relaxed category). Those with low demands and low control (passive category) did not differ significantly from the relaxed category. The associations remained in the multivariate analyses. The study found that certain psychosocial work factors are associated with higher levels of self-reported psychological ill-health and illustrates the great importance of psychosocial conditions in determining psychological health at the population level. As found elsewhere, being unemployed was an even stronger predictor of psychological ill-health.

Self-efficacy toward physical activity and the physical activity behavior of children with and without Developmental Coordination Disorder.

PubMed

Batey, C A; Missiuna, C A; Timmons, B W; Hay, J A; Faught, B E; Cairney, J

2014-08-01

Affecting 5-6% of children, Developmental Coordination Disorder (DCD) is a prevalent chronic condition. The nature of the disorder - impaired motor coordination - makes avoidance of physical activity (PA) common. The purpose of this study was to examine the effect of barrier and task self-efficacy on PA behavior in children with DCD and a group of typically developing (TD) children. Children were compared on their perceived ability to complete different intensities and duration of PA (task efficacy) and their confidence in completing PA when faced with everyday barriers (barrier efficacy). An accelerometer was used to record their activity over the subsequent week. Children with DCD were found to have significantly lower task efficacy and barrier efficacy. They also spent significantly less time in moderate to vigorous physical activity (MVPA). Multivariate analyses revealed that gender modified the relationship for both groups. Separate multivariate regressions, were therefore conducted by gender. A direct effect of DCD on PA was observed for boys, but not for girls. Further analyses showed that neither task efficacy nor barrier efficacy influenced the relationship between DCD and PA. Results from this study confirm that children with DCD have lower task and barrier self-efficacy than TD children and that males have lower PA levels than their TD peers; however neither task or barrier self-efficacy mediated the relationship between DCD and PA. Copyright © 2013. Published by Elsevier B.V.

Univariate and multivariate molecular spectral analyses of lipid related molecular structural components in relation to nutrient profile in feed and food mixtures.

PubMed

Abeysekara, Saman; Damiran, Daalkhaijav; Yu, Peiqiang

2013-02-01

The objectives of this study were (i) to determine lipid related molecular structures components (functional groups) in feed combination of cereal grain (barley, Hordeum vulgare) and wheat (Triticum aestivum) based dried distillers grain solubles (wheat DDGSs) from bioethanol processing at five different combination ratios using univariate and multivariate molecular spectral analyses with infrared Fourier transform molecular spectroscopy, and (ii) to correlate lipid-related molecular-functional structure spectral profile to nutrient profiles. The spectral intensity of (i) CH(3) asymmetric, CH(2) asymmetric, CH(3) symmetric and CH(2) symmetric groups, (ii) unsaturation (CC) group, and (iii) carbonyl ester (CO) group were determined. Spectral differences of functional groups were detected by hierarchical cluster analysis (HCA) and principal components analysis (PCA). The results showed that the combination treatments significantly inflicted modifications (P<0.05) in nutrient profile and lipid related molecular spectral intensity (CH(2) asymmetric stretching peak height, CH(2) symmetric stretching peak height, ratio of CH(2) to CH(3) symmetric stretching peak intensity, and carbonyl peak area). Ratio of CH(2) to CH(3) symmetric stretching peak intensity, and carbonyl peak significantly correlated with nutrient profiles. Both PCA and HCA differentiated lipid-related spectrum. In conclusion, the changes of lipid molecular structure spectral profiles through feed combination could be detected using molecular spectroscopy. These changes were associated with nutrient profiles and functionality. Copyright © 2012 Elsevier B.V. All rights reserved.

Complications Following Primary and Revision Transsphenoidal Surgeries for Pituitary Tumors

PubMed Central

Krings, James G.; Kallogjeri, Dorina; Wineland, Andre; Nepple, Kenneth G.; Piccirillo, Jay F.; Getz, Anne E.

2014-01-01

Objective This study aimed to determine the incidence of major complications following both primary and revision transsphenoidal pituitary surgery. Major complications included endocrinopathic, skull base, orbital, hemorrhagic and thromboembolic complications, respiratory failure, and death. Secondarily, this study aimed to examine factors associated with the occurrence of complications. Study Design Retrospective cohort analysis of California and Florida all-payer databases from 2005-2008. Methods The major complication rate following both primary and revision transsphenoidal pituitary surgery was calculated. Bivariate analyses were performed to investigate the relationship of patient characteristics with complication occurrence, and a multivariate model was constructed to determine risk factors associated with these complications. Results 5,277 primary cases and 192 revision cases met inclusion criteria. There was a non-significant absolute difference of 3.09% (95% CI −11.00 to 16.14) between the rate of complications following primary (n=443; 8.39%) and revision (n=22; 11.46%) surgeries. Multivariate analyses showed that patients with Medicare (OR=1.74; 95% CI 1.17 to 2.61), Medicaid (OR=2.13; 95% CI 1.59 to 2.86), or a malignant neoplasm (OR=3.10; 95% CI 1.62 to 5.93) were more likely to have complications. Conclusions The rate of major complications following transsphenoidal pituitary surgery is lower than earlier retrospective reports. The overall complication rate following revision surgery was not significantly different from primary surgery. Insurance status and a diagnosis of a malignant neoplasm were associated with a higher rate of complications. PMID:25263939

Network Analysis of Associations between Serum Interferon Alpha Activity, Autoantibodies, and Clinical Features in Systemic Lupus Erythematosus

PubMed Central

Weckerle, Corinna E.; Franek, Beverly S.; Kelly, Jennifer A.; Kumabe, Marissa; Mikolaitis, Rachel A.; Green, Stephanie L.; Utset, Tammy O.; Jolly, Meenakshi; James, Judith A.; Harley, John B.; Niewold, Timothy B.

2010-01-01

Background Interferon-alpha (IFN-α) is a primary pathogenic factor in systemic lupus erythematosus (SLE), and high IFN-α levels may be associated with particular clinical manifestations. The prevalence of individual clinical and serologic features differs significantly by ancestry. We used multivariate and network analyses to detect associations between clinical and serologic disease manifestations and serum IFN-α activity in a large diverse SLE cohort. Methods 1089 SLE patients were studied (387 African-American, 186 Hispanic-American, and 516 European-American). Presence or absence of ACR clinical criteria for SLE, autoantibodies, and serum IFN-α activity data were analyzed in univariate and multivariate models. Iterative multivariate logistic regression was performed in each background separately to establish the network of associations between variables that were independently significant following Bonferroni correction. Results In all ancestral backgrounds, high IFN-α activity was associated with anti-Ro and anti-dsDNA antibodies (p-values 4.6×10−18 and 2.9 × 10−16 respectively). Younger age, non-European ancestry, and anti-RNP were also independently associated with increased serum IFN-α activity (p≤6.7×10−4). We found 14 unique associations between variables in network analysis, and only 7 of these associations were shared by more than one ancestral background. Associations between clinical criteria were different in different ancestral backgrounds, while autoantibody-IFN-α relationships were similar across backgrounds. IFN-α activity and autoantibodies were not associated with ACR clinical features in multivariate models. Conclusions Serum IFN-α activity was strongly and consistently associated with autoantibodies, and not independently associated with clinical features in SLE. IFN-α may be more relevant to humoral tolerance and initial pathogenesis than later clinical disease manifestations. PMID:21162028

DSM-based problem gambling: increasing the odds of heavy drinking in a national sample of U.S. college athletes?

PubMed

Huang, Jiun-Hau; Jacobs, Durand F; Derevensky, Jeffrey L

2011-03-01

Despite previously found co-occurrence of youth gambling and alcohol use, their relationship has not been systematically explored in a national sample using DSM-based gambling measures and multivariate modeling, adjusted for potential confounders. This study aimed to empirically examine the prevalence patterns and odds of at-least-weekly alcohol use and heavy episodic drinking (HED) in relation to various levels of gambling severity in college athletes. Multivariate logistic regression analyses were performed on data from a national sample of 20,739 U.S. college athletes from the first National Collegiate Athletic Association national survey of gambling and health-risk behaviors. Prevalence of at-least-weekly alcohol use significantly increased as DSM-IV-based gambling severity increased, from non-gambling (24.5%) to non-problem gambling (43.7%) to sub-clinical gambling (58.5%) to problem gambling (67.6%). Multivariate results indicated that all levels of gambling were associated with significantly elevated risk of at-least-weekly HED, from non-problem (OR = 1.25) to sub-clinical (OR = 1.75) to problem gambling (OR = 3.22); the steep increase in the relative risk also suggested a possible quadratic relationship between gambling level and HED risk. Notably, adjusted odds ratios showed problem gambling had the strongest association with at-least-weekly HED, followed by marijuana (OR = 3.08) and cigarette use (OR = 2.64). Gender interactions and differences were also identified and assessed. In conclusion, attention should be paid to college athletes exhibiting gambling problems, especially considering their empirical multivariate associations with high-risk drinking; accordingly, screening for problem gambling is recommended. More research is warranted to elucidate the etiologic mechanisms of these associations. Copyright © 2010 Elsevier Ltd. All rights reserved.

Association between sleep difficulties as well as duration and hypertension: is BMI a mediator?

PubMed

Carrillo-Larco, R M; Bernabe-Ortiz, A; Sacksteder, K A; Diez-Canseco, F; Cárdenas, M K; Gilman, R H; Miranda, J J

2017-01-01

Sleep difficulties and short sleep duration have been associated with hypertension. Though body mass index (BMI) may be a mediator variable, the mediation effect has not been defined. We aimed to assess the association between sleep duration and sleep difficulties with hypertension, to determine if BMI is a mediator variable, and to quantify the mediation effect. We conducted a mediation analysis and calculated prevalence ratios with 95% confidence intervals. The exposure variables were sleep duration and sleep difficulties, and the outcome was hypertension. Sleep difficulties were statistically significantly associated with a 43% higher prevalence of hypertension in multivariable analyses; results were not statistically significant for sleep duration. In these analyses, and in sex-specific subgroup analyses, we found no strong evidence that BMI mediated the association between sleep indices and risk of hypertension. Our findings suggest that BMI does not appear to mediate the association between sleep patterns and hypertension. These results highlight the need to further study the mechanisms underlying the relationship between sleep patterns and cardiovascular risk factors.

Direct-to-consumer and physician promotion of tegaserod correlated with physician visits, diagnoses, and prescriptions.

PubMed

Dorn, Spencer D; Farley, Joel F; Hansen, Richard A; Shah, Nilay D; Sandler, Robert S

2009-08-01

Direct-to-consumer advertisement (DTCA) and physician promotion of drugs can influence patient and physician behaviors. We sought to determine the relationship between promotion of tegaserod and the number of office visits for abdominal pain, constipation, and bloating; diagnoses of irritable bowel syndrome (IBS); and tegaserod prescriptions. We used an Integrated Promotional Services database to estimate tegaserod DTCA and promotion expenditures; the National Ambulatory/Hospital Medical Care Surveys (1997-2005) to estimate the number of ambulatory care visits for abdominal pain, constipation, and bloating and diagnoses of IBS; and IMS Health's National Prescription Audit Plus (Fairfield, CT) to estimate the number of prescriptions. We constructed segmented and multivariate regression models to analyze the data. In the 3 months immediately following the start of tegaserod DTCA, there was a significant increase in physician visits (by 1 million; 95% confidence interval [CI], 0.5-1.6 million) and IBS diagnoses (by 397,025; 95% CI, 3909-790,141). Subsequently, the trend of visits and IBS diagnoses was reduced. In multivariate analyses that examined the overall relationship of promotion with visits, diagnoses, and prescriptions, only the relationship between physician promotion and tegaserod prescribing was significant; every $1 million spent on physician promotion resulted in an additional 4108 prescriptions (95% CI, 2526-5691). The initial DTCA of tegaserod was associated with a significant, immediate increase in physician visits and IBS diagnoses. This trend reversed and, in multivariate models, neither DTCA nor physician promotion correlated with visits or diagnoses. Physician promotion (although not DTCA) correlated with tegaserod prescription volume.

Direct to consumer and physician promotion of tegaserod correlated with physician visits, diagnoses, and prescriptions

PubMed Central

Dorn, Spencer D.; Farley, Joel F.; Hansen, Richard A.; D. Shah, Nilay; Sandler, Robert S.

2009-01-01

Background & Aims Direct to consumer advertisement (DTCA) and physician promotion of drugs can influence patient and physician behaviors. We sought to determine the relationship between promotion of tegaserod and the number of office visits for abdominal pain, constipation, and bloating; diagnoses of irritable bowel syndrome (IBS); and tegaserod prescriptions. Methods We used an Integrated Promotional Services database to estimate tegaserod DTCA and promotion expenditures, The National Ambulatory/Hospital Medical Care Surveys (1997–2005) to estimate the number of ambulatory care visits for abdominal pain, constipation, and bloating and diagnoses of IBS, and IMS Health's National Prescription Audit Plus to estimate the number of prescriptions. We constructed segmented and multivariate regression models to analyze the data. Results In the 3 months immediately following the start of tegaserod DTCA, there was a significant increase in physician visits (by 1 million; 95% CI 0.5–1.6 million) and IBS diagnoses (by 397,025; 95% CI 3,909–790,141). Subsequently, the trend of visits and IBS diagnoses reduced. In multivariate analyses that examined the overall relationship of promotion with visits, diagnoses, and prescriptions, only the relationship between physician promotion and tegaserod prescribing was significant; every $1 million spent on physician promotion resulted in an additional 4,108 prescriptions (95% CI: 2,526–5,691). Conclusions The initial DTCA of tegaserod was associated with a significant, immediate increase in physician visits and IBS diagnoses. This trend reversed and in multivariate models, neither DTCA nor physician promotion correlated with visits or diagnoses. Physician promotion (though not DTCA) correlated with tegaserod prescription volume. PMID:19445943

Breakthrough seizures—Further analysis of the Standard versus New Antiepileptic Drugs (SANAD) study

PubMed Central

Powell, Graham A.; Tudur Smith, Catrin; Marson, Anthony G.

2017-01-01

Objectives To develop prognostic models for risk of a breakthrough seizure, risk of seizure recurrence after a breakthrough seizure, and likelihood of achieving 12-month remission following a breakthrough seizure. A breakthrough seizure is one that occurs following at least 12 months remission whilst on treatment. Methods We analysed data from the SANAD study. This long-term randomised trial compared treatments for participants with newly diagnosed epilepsy. Multivariable Cox models investigated how clinical factors affect the probability of each outcome. Best fitting multivariable models were produced with variable reduction by Akaike’s Information Criterion. Risks associated with combinations of risk factors were calculated from each multivariable model. Results Significant factors in the multivariable model for risk of a breakthrough seizure following 12-month remission were number of tonic-clonic seizures by achievement of 12-month remission, time taken to achieve 12-month remission, and neurological insult. Significant factors in the model for risk of seizure recurrence following a breakthrough seizure were total number of drugs attempted to achieve 12-month remission, time to achieve 12-month remission prior to breakthrough seizure, and breakthrough seizure treatment decision. Significant factors in the model for likelihood of achieving 12-month remission after a breakthrough seizure were gender, age at breakthrough seizure, time to achieve 12-month remission prior to breakthrough, and breakthrough seizure treatment decision. Conclusions This is the first analysis to consider risk of a breakthrough seizure and subsequent outcomes. The described models can be used to identify people most likely to have a breakthrough seizure, a seizure recurrence following a breakthrough seizure, and to achieve 12-month remission following a breakthrough seizure. The results suggest that focussing on achieving 12-month remission swiftly represents the best therapeutic aim to reduce the risk of a breakthrough seizure and subsequent negative outcomes. This will aid individual patient risk stratification and the design of future epilepsy trials. PMID:29267375

A Multivariate Genetic Analysis of Specific Phobia, Separation Anxiety and Social Phobia in Early Childhood

ERIC Educational Resources Information Center

Eley, Thalia C.; Rijsdijk, Fruhling V.; Perrin, Sean; O'Connor, Thomas G.; Bolton, Derek

2008-01-01

Background: Comorbidity amongst anxiety disorders is very common in children as in adults and leads to considerable distress and impairment, yet is poorly understood. Multivariate genetic analyses can shed light on the origins of this comorbidity by revealing whether genetic or environmental risks for one disorder also influence another. We…

Decomposing biodiversity data using the Latent Dirichlet Allocation model, a probabilistic multivariate statistical method

Treesearch

Denis Valle; Benjamin Baiser; Christopher W. Woodall; Robin Chazdon; Jerome Chave

2014-01-01

We propose a novel multivariate method to analyse biodiversity data based on the Latent Dirichlet Allocation (LDA) model. LDA, a probabilistic model, reduces assemblages to sets of distinct component communities. It produces easily interpretable results, can represent abrupt and gradual changes in composition, accommodates missing data and allows for coherent estimates...

A Unified Framework for Association Analysis with Multiple Related Phenotypes

PubMed Central

Stephens, Matthew

2013-01-01

We consider the problem of assessing associations between multiple related outcome variables, and a single explanatory variable of interest. This problem arises in many settings, including genetic association studies, where the explanatory variable is genotype at a genetic variant. We outline a framework for conducting this type of analysis, based on Bayesian model comparison and model averaging for multivariate regressions. This framework unifies several common approaches to this problem, and includes both standard univariate and standard multivariate association tests as special cases. The framework also unifies the problems of testing for associations and explaining associations – that is, identifying which outcome variables are associated with genotype. This provides an alternative to the usual, but conceptually unsatisfying, approach of resorting to univariate tests when explaining and interpreting significant multivariate findings. The method is computationally tractable genome-wide for modest numbers of phenotypes (e.g. 5–10), and can be applied to summary data, without access to raw genotype and phenotype data. We illustrate the methods on both simulated examples, and to a genome-wide association study of blood lipid traits where we identify 18 potential novel genetic associations that were not identified by univariate analyses of the same data. PMID:23861737

Religion and HPV vaccine-related awareness, knowledge, and receipt among insured women aged 18-26 in Utah

PubMed Central

2017-01-01

Introduction We investigate the associations between religious practice and human papillomavirus (HPV) vaccine-related awareness, knowledge, and receipt among young women in Utah. Methods We surveyed 326 insured women aged 18–26 by mail. Fisher's Exact Tests and multivariable logistic regression models were used to evaluate the relations between religious practice and HPV vaccine-related outcomes. Data collection occurred January-December 2013; analyses were conducted June-September 2015. Results Multivariable analyses reveal that when controlling for age, educational attainment, and marital status, participants who practiced an organized religion were significantly less likely to have heard of HPV (aOR = 0.25, p = 0.0123), to have heard of the HPV vaccine (aOR = 0.41, p = 0.0368), to know how HPV is spread (aOR = 0.45, p = 0.0074), to have received a provider recommendation for the HPV vaccine (aOR = 0.36, p = 0.0332), and to have received at least one (aOR = 0.50, p = 0.0073) or all three (aOR = 0.47, p = 0.0026) doses of the HPV vaccine. Bivariate analyses produce parallel results. Conclusions Results indicate that religious young women in Utah are not only under-vaccinated, but are also under-informed about HPV and the HPV vaccine. These results suggest that suboptimal vaccine coverage among religious young women may present a serious health risk for the community. Strategies for educational interventions targeted to this population are discussed. PMID:28841681

Combination of c-reactive protein and squamous cell carcinoma antigen in predicting postoperative prognosis for patients with squamous cell carcinoma of the esophagus.

PubMed

Feng, Ji-Feng; Chen, Sheng; Yang, Xun

2017-09-08

We initially proposed a useful and novel prognostic model, named CCS [Combination of c-reactive protein (CRP) and squamous cell carcinoma antigen (SCC)], for predicting the postoperative survival in patients with esophageal squamous cell carcinoma (ESCC). Two hundred and fifty-two patients with resectable ESCC were included in this retrospective study. A logistic regression was performed and yielded a logistic equation. The CCS was calculated by the combined CRP and SCC. The optimal cut-off value for CCS was evaluated by X-tile program. Univariate and multivariate analyses were used to evaluate the predictive factors. In addition, a novel nomogram model was also performed to predict the prognosis for patients with ESCC. In the current study, CCS was calculated as CRP+6.33 SCC according to the logistic equation. The optimal cut-off value was 15.8 for CCS according to the X-tile program. Kaplan-Meier analyses demonstrated that high CCS group had a significantly poor 5-year cancer-specific survival (CSS) than low CCS group (10.3% vs. 47.3%, P <0.001). According to multivariate analyses, CCS ( P =0.004), but not CRP ( P =0.466) or SCC ( P =0.926), was an independent prognostic factor. A nomogram could be more accuracy for CSS (Harrell's c-index: 0.70). The CCS is a usefull and independent predictive factor in patients with ESCC.

Impacts of graft-versus-host disease on outcomes after allogeneic hematopoietic stem cell transplantation for chronic myelomonocytic leukemia: A nationwide retrospective study.

PubMed

Itonaga, Hidehiro; Iwanaga, Masako; Aoki, Kazunari; Aoki, Jun; Ishiyama, Ken; Ishikawa, Takayuki; Sakura, Toru; Fukuda, Takahiro; Najima, Yuho; Yujiri, Toshiaki; Mori, Takehiko; Kurokawa, Mineo; Nawa, Yuichiro; Uchida, Naoyuki; Morishita, Yoshihisa; Hashimoto, Hisako; Eto, Tetsuya; Hirokawa, Makoto; Morishima, Yasuo; Nagamura-Inoue, Tokiko; Atsuta, Yoshiko; Miyazaki, Yasushi

2016-02-01

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a therapeutic option that may lead to improved outcomes in patients with chronic myelomonocytic leukemia (CMML). However, few studies have examined the impact of the grade of graft-versus-host disease (GVHD) on post-transplant outcomes for CMML. We retrospectively analyzed the outcomes of 141 patients with CMML who underwent allo-HSCT between 1987 and 2010, and achieved neutrophil engraftment. The effects of acute GVHD (aGVHD) or chronic GVHD (cGVHD) on overall survival (OS), leukemia-associated mortality (LAM), and transplant-related mortality were evaluated by hazards regression models, in which the onset date of aGVHD or cGVHD was treated as a time-dependent covariate. Grade I aGVHD was associated with better OS and lower LAM (P=0.042, P=0.033, respectively) than no GVHD in univariate analyses, but not in the multivariate analyses. The multivariate analyses demonstrated that extensive cGVHD significantly associated with better OS (Hazard Ratio [HR] 0.35 [95% confidence intervals (CI), 0.16-0.74]; P=0.007) and lower LAM (HR 0.36 [95% CI, 0.14-0.92]; P=0.033) in patients who were not in complete remission at transplantation. In conclusion, the occurrence of cGVHD may be an important factor affecting the outcomes of CMML patients who received transplantation. Copyright © 2015 Elsevier Ltd. All rights reserved.

Religion and HPV vaccine-related awareness, knowledge, and receipt among insured women aged 18-26 in Utah.

PubMed

Bodson, Julia; Wilson, Andrew; Warner, Echo L; Kepka, Deanna

2017-01-01

We investigate the associations between religious practice and human papillomavirus (HPV) vaccine-related awareness, knowledge, and receipt among young women in Utah. We surveyed 326 insured women aged 18-26 by mail. Fisher's Exact Tests and multivariable logistic regression models were used to evaluate the relations between religious practice and HPV vaccine-related outcomes. Data collection occurred January-December 2013; analyses were conducted June-September 2015. Multivariable analyses reveal that when controlling for age, educational attainment, and marital status, participants who practiced an organized religion were significantly less likely to have heard of HPV (aOR = 0.25, p = 0.0123), to have heard of the HPV vaccine (aOR = 0.41, p = 0.0368), to know how HPV is spread (aOR = 0.45, p = 0.0074), to have received a provider recommendation for the HPV vaccine (aOR = 0.36, p = 0.0332), and to have received at least one (aOR = 0.50, p = 0.0073) or all three (aOR = 0.47, p = 0.0026) doses of the HPV vaccine. Bivariate analyses produce parallel results. Results indicate that religious young women in Utah are not only under-vaccinated, but are also under-informed about HPV and the HPV vaccine. These results suggest that suboptimal vaccine coverage among religious young women may present a serious health risk for the community. Strategies for educational interventions targeted to this population are discussed.

The Impact of SMAD4 Loss on Outcome in Patients with Advanced Pancreatic Cancer Treated with Systemic Chemotherapy

PubMed Central

Ormanns, Steffen; Haas, Michael; Remold, Anna; Kruger, Stephan; Holdenrieder, Stefan; Kirchner, Thomas; Heinemann, Volker; Boeck, Stefan

2017-01-01

The role of the tumor suppressor mothers against decapentaplegic homolog 4 (SMAD4) has not yet been defined in patients (pts) with advanced pancreatic cancer (aPC). This translational research study was designed to evaluate the impact of tumoral SMAD4 loss on clinicopathological parameters and outcome in PC patients receiving palliative chemotherapy. Using immunohistochemistry, we examined SMAD4 expression in tumor tissue of 143 aPC pts treated within completed prospective clinical and biomarker trials. In uni- and multivariate analyses, SMAD4 expression status was correlated to clinicopathological patient characteristics and outcome. At chemotherapy initiation, 128 pts had metastatic PC; most pts (n = 99) received a gemcitabine-based regimen. SMAD4 loss was detected in 92 pts (64%); patient characteristics such as gender, age, tumor grading, disease stage or number of metastatic sites had no significant impact on tumoral SMAD4 status. In univariate analyses, SMAD4 loss had no impact on overall survival (hazard ratio (HR) 1.008, p = 0.656); however, we observed a prolonged progression-free survival (HR 1.565, p = 0.038) in pts with tumoral SMAD4 loss. This finding was confirmed in multivariate analyses (HR 1.790, p = 0.040), but only for gemcitabine-treated pts. In contrast to previous studies in resectable PC, loss of SMAD4 expression was not associated with a negative outcome in patients with advanced PC receiving systemic chemotherapy. PMID:28534865

Depression in patients with chronic kidney disease on dialysis in Saudi Arabia.

PubMed

Al Zaben, Faten; Khalifa, Doaa Ahmed; Sehlo, Mohammad Gamal; Al Shohaib, Saad; Shaheen, Faisul; Alhozali, Hanadi; Hariri, Alferdose Osama; Ahmad, Riyadh Ghazi; Kabli, Moayad Reda; Koenig, Harold G

2014-12-01

Patients with chronic kidney disease on hemodialysis experience considerable psychological stress due to physical and social changes brought on by illness, increasing the risk of depressive disorder (DD). We examined the prevalence of DD and depressive symptoms, identified treatments for depression, and determined baseline demographic, social/behavioral, physical, and psychological correlates. A convenience sample of 310 dialysis patients in Jeddah, Saudi Arabia, was screened for DD using the Structured Clinical Interview for Depression and for depressive symptoms using the Hamilton Depression Rating Scale (HDRS). Established measures of psychosocial and physical health characteristics were administered, along with questions about current and past treatments. Bivariate and multivariate analyses identified independent correlates of DD and symptoms. The prevalence of DD was 6.8 % (major depression 3.2 %, minor depression 3.6 %), and significant depressive symptoms were present in 24.2 % (HDRS 8 or higher). No patients with DD were being treated with antidepressant medication, whereas 28.6 % (6 of 21) were receiving counseling. Being a Saudi national, married, in counseling, or having a history of antidepressant were associated with DD in bivariate analyses. Correlates of depressive symptoms HDRS in multivariate analyses were Saudi nationality, marital status, stressful life events, poor physical functioning, cognitive impairment, overall severity of medical illness, and history of family psychiatric problems. The prevalence of DD and depressive symptoms is lower in Saudi dialysis patients than in the rest of the world, largely untreated, and is associated with a distinct set of demographic, psychosocial, and physical health characteristics.

The Impact of SMAD4 Loss on Outcome in Patients with Advanced Pancreatic Cancer Treated with Systemic Chemotherapy.

PubMed

Ormanns, Steffen; Haas, Michael; Remold, Anna; Kruger, Stephan; Holdenrieder, Stefan; Kirchner, Thomas; Heinemann, Volker; Boeck, Stefan

2017-05-19

The role of the tumor suppressor mothers against decapentaplegic homolog 4 (SMAD4) has not yet been defined in patients (pts) with advanced pancreatic cancer (aPC). This translational research study was designed to evaluate the impact of tumoral SMAD4 loss on clinicopathological parameters and outcome in PC patients receiving palliative chemotherapy. Using immunohistochemistry, we examined SMAD4 expression in tumor tissue of 143 aPC pts treated within completed prospective clinical and biomarker trials. In uni- and multivariate analyses, SMAD4 expression status was correlated to clinicopathological patient characteristics and outcome. At chemotherapy initiation, 128 pts had metastatic PC; most pts ( n = 99) received a gemcitabine-based regimen. SMAD4 loss was detected in 92 pts (64%); patient characteristics such as gender, age, tumor grading, disease stage or number of metastatic sites had no significant impact on tumoral SMAD4 status. In univariate analyses, SMAD4 loss had no impact on overall survival (hazard ratio (HR) 1.008, p = 0.656); however, we observed a prolonged progression-free survival (HR 1.565, p = 0.038) in pts with tumoral SMAD4 loss. This finding was confirmed in multivariate analyses (HR 1.790, p = 0.040), but only for gemcitabine-treated pts. In contrast to previous studies in resectable PC, loss of SMAD4 expression was not associated with a negative outcome in patients with advanced PC receiving systemic chemotherapy.

Long-term outcome of pronation-external rotation ankle fractures treated with syndesmotic screws only.

PubMed

Lambers, Kaj T A; van den Bekerom, Michel P J; Doornberg, Job N; Stufkens, Sjoerd A S; van Dijk, C Niek; Kloen, Peter

2013-09-04

There is sparse information in the literature on the outcome of Maisonneuve-type pronation-external rotation ankle fractures treated with syndesmotic screws. The primary aim of this study was to determine the long-term results of such treatment of these fractures as indicated by standardized patient-based and physician-based outcome measures. The secondary aim was to identify predictors of the outcome with use of bivariate and multivariate statistical analysis. Fifty patients with pronation-external rotation (predominantly Maisonneuve) fractures were treated with open reduction and internal fixation of the syndesmosis utilizing only one or two screws. The results were evaluated at a mean of twenty-one years after the fracture utilizing three standardized outcomes instruments: (1) the Foot and Ankle Ability Measure (FAAM), (2) the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale, and (3) the Center for Epidemiologic Studies-Depression (CES-D) Scale. Osteoarthritis was graded according to the van Dijk and revised Takakura radiographic scoring systems. Bivariate and multivariate analyses were performed to identify predictors of long-term outcome. Forty-four (92%) of forty-eighty patients had good or excellent AOFAS scores, and forty-four (90%) of forty-nine had good or excellent FAAM scores. Arthrodesis for severe osteoarthritis was performed in two patients. Radiographic evidence of osteoarthritis was observed in twenty-four (49%) of forty-nine patients. Multivariate analysis identified pain as the most important independent predictor of long-term ankle function as indicated by the AOFAS and FAAM scores, explaining 91% and 53% of the variation in scores, respectively. Analysis of pain as the dependent variable in bivariate analyses revealed that depression, ankle range of motion, and a subsequent surgery were significantly correlated with higher pain scores. No firm conclusions could be drawn after multivariate analysis of predictors of pain. Long-term functional outcomes at a mean of twenty-one years after pronation-external rotation ankle fractures treated with one or two syndesmotic screws were good to excellent in the great majority of patients despite substantial radiographic evidence of osteoarthritis in one-half of the patients. The most important predictor of long-term functional outcome was patient-reported pain rather than physician-reported function or posttraumatic osteoarthritis. There was no significant association between radiographic signs of posttraumatic osteoarthritis and perceived pain in the present series.

Multimodal Feature Integration in the Angular Gyrus during Episodic and Semantic Retrieval.

PubMed

Bonnici, Heidi M; Richter, Franziska R; Yazar, Yasemin; Simons, Jon S

2016-05-18

Much evidence from distinct lines of investigation indicates the involvement of angular gyrus (AnG) in the retrieval of both episodic and semantic information, but the region's precise function and whether that function differs across episodic and semantic retrieval have yet to be determined. We used univariate and multivariate fMRI analysis methods to examine the role of AnG in multimodal feature integration during episodic and semantic retrieval. Human participants completed episodic and semantic memory tasks involving unimodal (auditory or visual) and multimodal (audio-visual) stimuli. Univariate analyses revealed the recruitment of functionally distinct AnG subregions during the retrieval of episodic and semantic information. Consistent with a role in multimodal feature integration during episodic retrieval, significantly greater AnG activity was observed during retrieval of integrated multimodal episodic memories compared with unimodal episodic memories. Multivariate classification analyses revealed that individual multimodal episodic memories could be differentiated in AnG, with classification accuracy tracking the vividness of participants' reported recollections, whereas distinct unimodal memories were represented in sensory association areas only. In contrast to episodic retrieval, AnG was engaged to a statistically equivalent degree during retrieval of unimodal and multimodal semantic memories, suggesting a distinct role for AnG during semantic retrieval. Modality-specific sensory association areas exhibited corresponding activity during both episodic and semantic retrieval, which mirrored the functional specialization of these regions during perception. The results offer new insights into the integrative processes subserved by AnG and its contribution to our subjective experience of remembering. Using univariate and multivariate fMRI analyses, we provide evidence that functionally distinct subregions of angular gyrus (AnG) contribute to the retrieval of episodic and semantic memories. Our multivariate pattern classifier could distinguish episodic memory representations in AnG according to whether they were multimodal (audio-visual) or unimodal (auditory or visual) in nature, whereas statistically equivalent AnG activity was observed during retrieval of unimodal and multimodal semantic memories. Classification accuracy during episodic retrieval scaled with the trial-by-trial vividness with which participants experienced their recollections. Therefore, the findings offer new insights into the integrative processes subserved by AnG and how its function may contribute to our subjective experience of remembering. Copyright © 2016 Bonnici, Richter, et al.

Why are hyperactivity and academic achievement related?

PubMed

Saudino, Kimberly J; Plomin, Robert

2007-01-01

Although a negative association between hyperactivity and academic achievement is well documented, little is known about the genetic and/or environmental mechanisms responsible for the association. The present study explored links between parent and teacher ratings of hyperactive behavior problems and teacher-assessed achievement in a sample of 1,876 twin pairs (mean age 7.04 years). The results did not differ across rater, nor were there significant differences between males or females or for twins in the same or different classrooms. Hyperactivity was significantly correlated with achievement. Multivariate model-fitting analyses revealed significant genetic and nonshared environmental covariance between the two phenotypes. In addition, bivariate heritabilities were substantial, indicating that the phenotypic correlations between hyperactivity and achievement were largely mediated by genetic influences.

Detecting significant change in stream benthic macroinvertebrate communities in wilderness areas

USGS Publications Warehouse

Milner, Alexander M.; Woodward, Andrea; Freilich, Jerome E.; Black, Robert W.; Resh, Vincent H.

2016-01-01

Within a region, both MDS analyses typically identified similar years as exceeding reference condition variation, illustrating the utility of the approach for identifying wider spatial scale effects that influence more than one stream. MDS responded to both simulated water temperature stress and a pollutant event, and generally outlying years on MDS plots could be explained by environmental variables, particularly higher precipitation. Multivariate control charts successfully identified whether shifts in community structure identified by MDS were significant and whether the shift represented a press disturbance (long-term change) or a pulse disturbance. We consider a combination of TD and MDS with control charts to be a potentially powerful tool for determining years significantly outside of a reference condition variation.

Prognostic significance of anaplasia and angiogenesis in childhood medulloblastoma: a pediatric oncology group study.

PubMed

Ozer, Erdener; Sarialioglu, Faik; Cetingoz, Riza; Yüceer, Nurullah; Cakmakci, Handan; Ozkal, Sermin; Olgun, Nur; Uysal, Kamer; Corapcioglu, Funda; Canda, Serefettin

2004-01-01

The purpose of this study was to investigate whether quantitative assessment of cytologic anaplasia and angiogenesis may predict the clinical prognosis in medulloblastoma and stratify the patients to avoid both undertreatment and overtreatment. Medulloblastomas from 23 patients belonging to the Pediatric Oncology Group were evaluated with respect to some prognostic variables, including histologic assessment of nodularity and desmoplasia, grading of anaplasia, measurement of nuclear size, mitotic cell count, quantification of angiogenesis, including vascular surface density (VSD) and microvessel number (NVES), and immunohistochemical scoring of vascular endothelial growth factor (VEGF) expression. Univariate and multivariate analyses for prognostic indicators for survival were performed. Univariate analysis revealed that extensive nodularity was a significant favorable prognostic factor, whereas the presence of anaplasia, increased nuclear size, mitotic rate, VSD, and NVES were significant unfavorable prognostic factors. Using multivariate analysis, increased nuclear size was found to be an independent unfavorable prognostic factor for survival. Neither the presence of desmoplasia nor VEGF expression was significantly related to patient survival. Although care must be taken not to overstate the importance of the results of this single-institution preliminary report, pathologic grading of medulloblastomas with respect to grading of anaplasia and quantification of nodularity, nuclear size, and microvessel profiles may be clinically useful for the treatment of medulloblastomas. Further validation of the independent prognostic significance of nuclear size in stratifying patients is required.

Assessment of fatigue in routine care on a Multidimensional Health Assessment Questionnaire (MDHAQ): a cross-sectional study of associations with RAPID3 and other variables in different rheumatic diseases.

PubMed

Castrejon, Isabel; Nikiphorou, Elena; Jain, Ruchi; Huang, Annie; Block, Joel A; Pincus, Theodore

2016-01-01

To characterise associations of fatigue with other variables within a multidimensional health assessment questionnaire (MDHAQ) in routine care of patients with different rheumatic diagnoses. All patients complete MDHAQ, which includes fatigue on a 0-10 visual analogue scale (VAS), and routine assessment of patient index data (RAPID3), a composite of function, pain, and patient global. Physicians complete a RheuMetric checklist which includes 4 VAS for overall global status (DOCGL), inflammation, damage, and distress. Median score for fatigue and other MDHAQ and RheuMetric scores were compared in 4 diagnosis groups: rheumatoid arthritis (RA), osteoarthritis (OA), systemic lupus erythematosus (SLE), and fibromyalgia (FM), using a Kruskall-Wallis test. Associations of fatigue with other variables were analysed using Spearman correlations and multivariate regressions. 612 patients were included: 173 RA, 199 with OA, 146 with SLE, and 94 with FM. Median fatigue was significantly higher in FM (7) than in RA (4), OA (5), and SLE (5). Fatigue was correlated significantly with all other MDHAQ scores, at higher levels in RA and SLE versus OA and FM. Fatigue was correlated significantly with DOCGL in RA, OA, SLE, but not FM. In multivariate analyses, fatigue scores were explained independently by higher pain and symptom number in RA; lower age and higher symptom number in OA; only higher pain in SLE; and none of the variables in FM. Fatigue is common in rheumatic diseases and strongly associated with higher pain and number of symptoms. The MDHAQ provides a useful tool to assess fatigue in clinical settings.

Reformed smokers have survival benefits after head and neck cancer.

PubMed

Cao, Wei; Liu, Zheqi; Gokavarapu, Sandhya; Chen, YiMing; Yang, Rong; Ji, Tong

2016-09-01

Smoking tobacco is the main risk factor for head and neck cancer, is proportional to the number of pack years (number of packs smoked/day x number of years of smoking), and is reduced when the patient stops smoking. Current molecular evidence has suggested that tobacco-related cancers could be clinically more aggressive than cancers in non-smokers, particularly in the head and neck. However, clinical studies have not uniformly reproduced the relation between survival and tobacco, possibly because they ignore the health benefit that reformed smokers obtain during the period between giving up smoking and the diagnosis of cancer, which is not shared by those who continue to smoke and develop cancer. We have investigated the survival of reformed smokers, non-smokers, and continuing smokers after a diagnosis of head and neck cancer. The data of patients with head and neck cancer from 1992 -2013 from the Cancer Genome Atlas database were analysed using a multivariate Cox's regression model for survival, and Kaplan-Meier curves were produced for smoking history. A total of 521 patients were treated for head and neck cancer, and there was a significant difference in survival between reformed and non-smokers on the one hand, and current smokers on the other (p=0.02). The significance increased when reformed smokers were grouped according to their duration of abstinence and time of diagnosis of cancer (>15 and ≤15 years, p<0.01). Smoking history was a significant prognostic factor in the multivariate Cox's regression model when analysed with age, stage, grade, and site. We conclude that reformed smokers have a survival benefit in head and neck cancer. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Weight and lean body mass change with antiretroviral initiation and impact on bone mineral density.

PubMed

Erlandson, Kristine M; Kitch, Douglas; Tierney, Camlin; Sax, Paul E; Daar, Eric S; Tebas, Pablo; Melbourne, Kathleen; Ha, Belinda; Jahed, Nasreen C; McComsey, Grace A

2013-08-24

To compare the effect that initiating different antiretroviral therapy (ART) regimens has on weight, BMI, and lean body mass (LBM) and explore how changes in body composition are associated with bone mineral density (BMD). A5224s was a sub-study of A5202, a prospective trial of 1857 ART-naive participants randomized to blinded abacavir-lamivudine (ABC/3TC) or tenofovir DF-emtricitabine (TDF/FTC) with open-label efavirenz (EFV) or atazanavir-ritonavir (ATV/r). All participants underwent dual-energy absorptiometry (DXA) and abdominal computed tomography for body composition. Analyses used two-sample t-tests and linear regression. A5224s included 269 participants: 85% men, 47% white non-Hispanic, median age 38 years, HIV-1 RNA 4.6 log10 copies/ml, and CD4 cell count 233 cells/μl. Overall, significant gains occurred in weight, BMI, and LBM at 96 weeks post-randomization (all P<0.001). Assignment to ATV/r (vs. EFV) resulted in significantly greater weight (mean difference 3.35 kg) and BMI gain (0.88 kg/m; both P=0.02), but not LBM (0.67 kg; P=0.15), whereas ABC/3TC and TDF/FTC were not significantly different (P≥0.10). In multivariable analysis, only lower baseline CD4 cell count and higher HIV-1 RNA were associated with greater increase in weight, BMI, or LBM. In multivariable analyses, increased LBM was associated with an increased hip BMD. ABC/3TC vs. TDF/FTC did not differ in change in weight, BMI, or LBM; ATV/r vs. EFV resulted in greater weight and BMI gain but not LBM. A positive association between increased LBM and increased hip BMD should be further investigated through prospective interventional studies to verify the impact of increased LBM on hip BMD.

Food and mental health: relationship between food and perceived stress and depressive symptoms among university students in the United Kingdom.

PubMed

El Ansari, Walid; Adetunji, Hamed; Oskrochi, Reza

2014-06-01

The current study assessed, by university and sex, the association between nutritional behaviour (twelve independent variables), and stress and depressive symptoms (dependent variables) in a sample from three UK countries. A cross-sectional survey was undertaken among undergraduates enrolled across seven universities in England, Wales and Northern Ireland (N = 3,706). Self-administered questionnaires included a 12-item food frequency questionnaire, Cohen's Perceived Stress Scale and modified Beck Depression Inventory. Sex and university comparisons were undertaken. Univariable and multivariable regression analyses were computed for each of the two outcomes--perceived stress and depressive symptoms. The frequencies of consuming of the various food groups differed by university and sex, as did depressive symptoms and perceived stress. Multivariable regression analyses indicated that consuming 'unhealthy' foods (e.g. sweets, cookies, snacks, fast food) was significantly positively associated with perceived stress (females only) and depressive symptoms (both males and females). Conversely, consuming 'healthy' foods (e.g. fresh fruits, salads, cooked vegetables) was significantly negatively associated with perceived stress and depressive symptoms scores for both sexes. There was significant negative association between consuming fish/sea food and depressive symptoms among males only. For males and for females, consuming lemonade/soft drinks, meat/sausage products, dairy/dairy products, and cereal/cereal products were not associated with either perceived stress or depressive symptoms. The associations between consuming 'unhealthy' foods and higher depressive symptoms and perceived stress among male and female students as well as the associations between consuming 'healthy' foods and lower depressive symptoms and perceived stress among male and female students in three UK countries suggest that interventions to reduce depressive symptoms and stress among students could also result in the consumption of healthier foods and/or vice versa.

Plant traits demonstrate that temperate and tropical giant eucalypt forests are ecologically convergent with rainforest not savanna.

PubMed

Tng, David Y P; Jordan, Greg J; Bowman, David M J S

2013-01-01

Ecological theory differentiates rainforest and open vegetation in many regions as functionally divergent alternative stable states with transitional (ecotonal) vegetation between the two forming transient unstable states. This transitional vegetation is of considerable significance, not only as a test case for theories of vegetation dynamics, but also because this type of vegetation is of major economic importance, and is home to a suite of species of conservation significance, including the world's tallest flowering plants. We therefore created predictions of patterns in plant functional traits that would test the alternative stable states model of these systems. We measured functional traits of 128 trees and shrubs across tropical and temperate rainforest - open vegetation transitions in Australia, with giant eucalypt forests situated between these vegetation types. We analysed a set of functional traits: leaf carbon isotopes, leaf area, leaf mass per area, leaf slenderness, wood density, maximum height and bark thickness, using univariate and multivariate methods. For most traits, giant eucalypt forest was similar to rainforest, while rainforest, particularly tropical rainforest, was significantly different from the open vegetation. In multivariate analyses, tropical and temperate rainforest diverged functionally, and both segregated from open vegetation. Furthermore, the giant eucalypt forests overlapped in function with their respective rainforests. The two types of giant eucalypt forests also exhibited greater overall functional similarity to each other than to any of the open vegetation types. We conclude that tropical and temperate giant eucalypt forests are ecologically and functionally convergent. The lack of clear functional differentiation from rainforest suggests that giant eucalypt forests are unstable states within the basin of attraction of rainforest. Our results have important implications for giant eucalypt forest management.

Determinants and Prognostic Significance of Hematoma Sedimentation Levels in Acute Intracerebral Hemorrhage.

PubMed

Sato, Shoichiro; Delcourt, Candice; Zhang, Shihong; Arima, Hisatomi; Heeley, Emma; Zheng, Danni; Al-Shahi Salman, Rustam; Stapf, Christian; Tzourio, Christophe; Robinson, Thompson; Lindley, Richard I; Chalmers, John; Anderson, Craig S

2016-01-01

This study aimed at identifying the determinants and prognostic significance of a sedimentation level (fluid-blood level) in the hematoma among patients with acute intracerebral hemorrhage (ICH) who participated in the main Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). Post-hoc analysis of the INTERACT2 dataset, a randomized controlled trial of patients with acute ICH with elevated systolic blood pressure (SBP), randomly assigned to intensive (target SBP <140 mm Hg) or guideline-based (<180 mm Hg) BP management. Patients with a sedimentation level at baseline assessment on CT, and modified Rankin Scale score at 90-day, were included in these analyses. Factors associated with a sedimentation level and its significance in relation to 90-day clinical outcomes were assessed in univariable and multivariable logistic regression models. Of 2,065 participants, 19 (1%) had sedimentation level on baseline CT, which was independently associated with warfarin use (p = 0.006) and lobar ICH (p = 0.025). Sedimentation level was also associated with death or major disability at 90-day in both crude (84 vs. 53%; p = 0.014) and multivariable analyses adjusted for age, gender, Chinese region, warfarin use, baseline National Institutes of Health Stroke Scale score, onset to CT time, volume and location of ICH, intraventricular extension, and randomized intensive BP lowering (OR 3.94, 95% CI 1.01-15.37; p = 0.049). The presence of hematoma sedimentation level on baseline CT is associated with warfarin use and lobar location of ICH, and predicts a worse outcome. Although uncommon, sedimentation level is an easily detectable prognostic factor in acute ICH. © 2015 S. Karger AG, Basel.

Plant Traits Demonstrate That Temperate and Tropical Giant Eucalypt Forests Are Ecologically Convergent with Rainforest Not Savanna

PubMed Central

Tng, David Y. P.; Jordan, Greg J.; Bowman, David M. J. S.

2013-01-01

Ecological theory differentiates rainforest and open vegetation in many regions as functionally divergent alternative stable states with transitional (ecotonal) vegetation between the two forming transient unstable states. This transitional vegetation is of considerable significance, not only as a test case for theories of vegetation dynamics, but also because this type of vegetation is of major economic importance, and is home to a suite of species of conservation significance, including the world’s tallest flowering plants. We therefore created predictions of patterns in plant functional traits that would test the alternative stable states model of these systems. We measured functional traits of 128 trees and shrubs across tropical and temperate rainforest – open vegetation transitions in Australia, with giant eucalypt forests situated between these vegetation types. We analysed a set of functional traits: leaf carbon isotopes, leaf area, leaf mass per area, leaf slenderness, wood density, maximum height and bark thickness, using univariate and multivariate methods. For most traits, giant eucalypt forest was similar to rainforest, while rainforest, particularly tropical rainforest, was significantly different from the open vegetation. In multivariate analyses, tropical and temperate rainforest diverged functionally, and both segregated from open vegetation. Furthermore, the giant eucalypt forests overlapped in function with their respective rainforests. The two types of giant eucalypt forests also exhibited greater overall functional similarity to each other than to any of the open vegetation types. We conclude that tropical and temperate giant eucalypt forests are ecologically and functionally convergent. The lack of clear functional differentiation from rainforest suggests that giant eucalypt forests are unstable states within the basin of attraction of rainforest. Our results have important implications for giant eucalypt forest management. PMID:24358359

[Relationship between employees' management factor of visual display terminal (VDT) work time and 28-item General Health Questionnaire (GHQ-28) at one Japanese IT company's computer worksite].

PubMed

Sugimura, Hisamichi; Horiguchi, Itsuko; Shimizu, Takashi; Marui, Eiji

2007-09-01

We studied 1365 male workers at a Japanese computer worksite in 2004 to determine the relationship between employees' time management factor of visual display terminal (VDT) work and General Health Questionnaire (GHQ) score. We developed questionnaires concerning age, management factor of VDT work time (total daily VDT work time, duration of continuous work), other work-related conditions (commuting time, job rank, type of job, hours of monthly overtime), lifestyle (smoking, alcohol consumption, exercise, having breakfast, sleeping hours), and the Japanese version of 28-item General Health Questionnaire (GHQ). Multivariate logistic regression analyses were performed to estimate the odds ratios (ORs) of the high-GHQ groups (>6.0) associated with age and the time management factor of VDT work. Multivariate logistic regression analyses indicated lower ORs for certain groups: workers older than 50 years old had significantly a lower OR than those younger than 30 years old; workers sleeping less than 6 h showed a lower OR than those sleeping more than 6 h. In contrast, significantly higher ORs were shown for workers with continuous work durations of more than 3 h compared with those with less than 1 h, those with more than 25 h/mo overtime compared with those with less, those doing VDT work of more than 7.5 h/day compared with those doing less than 4.5 h/day, and those with more than 25 h/mo of overtime compared with those with less. Male Japanese computer workers' GHQ scores are significantly associated with time management factors of VDT work.

Linear Accelerator-Based Radiosurgery Alone for Arteriovenous Malformation: More Than 12 Years of Observation

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

Matsuo, Takayuki, E-mail: takayuki@nagasaki-u.ac.jp; Kamada, Kensaku; Izumo, Tsuyoshi

Purpose: Although radiosurgery is an accepted treatment method for intracranial arteriovenous malformations (AVMs), its long-term therapeutic effects have not been sufficiently evaluated, and many reports of long-term observations are from gamma-knife facilities. Furthermore, there are few reported results of treatment using only linear accelerator (LINAC)-based radiosurgery (LBRS). Methods and Materials: Over a period of more than 12 years, we followed the long-term results of LBRS treatment performed in 51 AVM patients. Results: The actuarial obliteration rates, after a single radiosurgery session, at 3, 5, 10, and 15 years were 46.9%, 54.0%, 64.4%, and 68.0%, respectively; when subsequent radiosurgeries were included, themore » rates were 46.9%, 61.3%, 74.2%, and 90.3%, respectively. Obliteration rates were significantly related to target volumes ≥4 cm{sup 3}, marginal doses ≥12 Gy, Spetzler-Martin grades (1 vs other), and AVM scores ≥1.5; multivariate analyses revealed a significant difference for target volumes ≥4 cm{sup 3}. The postprocedural actuarial symptomatic radiation injury rates, after a single radiation surgery session, at 5, 10, and 15 years were 12.3%, 16.8%, and 19.1%, respectively. Volumes ≥4 cm{sup 3}, location (lobular or other), AVM scores ≥1.5, and the number of radiosurgery were related to radiation injury incidence; multivariate analyses revealed significant differences associated with volumes ≥4 cm{sup 3} and location (lobular or other). Conclusions: Positive results can be obtained with LBRS when performed with a target volume ≤4 cm{sup 3}, an AVM score ≤1.5, and ≥12 Gy radiation. Bleeding and radiation injuries may appear even 10 years after treatment, necessitating long-term observation.« less

Impact of Long-Term Serum Platinum Concentrations on Neuro- and Ototoxicity in Cisplatin-Treated Survivors of Testicular Cancer

PubMed Central

Sprauten, Mette; Darrah, Thomas H.; Peterson, Derick R.; Campbell, M. Ellen; Hannigan, Robyn E.; Cvancarova, Milada; Beard, Clair; Haugnes, Hege S.; Fosså, Sophie D.; Oldenburg, Jan; Travis, Lois B.

2012-01-01

Purpose Cisplatin-induced neurotoxicity and ototoxicity (NTX) are important adverse effects after chemotherapy for testicular cancer (TC). Although serum platinum is measurable years after therapy, its impact on NTX has not been evaluated. Patients and Methods In all, 169 cisplatin-treated survivors of TC provided blood samples at Survey I and reported NTX during Survey I (1998-2002) and Survey II (2007-2008). Serum platinum was quantified by inductively coupled plasma mass spectrometry. Patient-reported outcomes were evaluated with the Scale for Chemotherapy-Induced Neurotoxicity (SCIN), regarding the extent of symptom bother as 0, “not at all”; 1, “a little”; 2, “quite a bit”; or 3, “very much.” Summing the six symptom scores yielded a total SCIN score of 0 to 18. Categorizing total SCIN scores into quartiles yielded similar-sized groups with increasing symptoms. Multivariate ordinal logistic regression analyses evaluated associations between NTX and long-term serum platinum levels, adjusting for cisplatin dose, dosing schedule, and age. Results At Survey I, a significant four- to five-fold association with total SCIN score emerged for the highest serum platinum quartile (odds ratio [OR], 4.69; 95% CI, 1.82 to 12.08). Paresthesias and Raynaud's syndrome (hands and feet) showed significant two- to four-fold increased risks with the highest platinum quartile. At Survey II, total SCIN score remained significantly associated with the highest platinum quartile (OR, 4.28; 95% CI, 1.36 to 13.48). Paresthesias (hands and feet) and tinnitus showed significant three- to four-fold increased risks for the highest platinum quartile. Cumulative cisplatin dose was not associated with total SCIN score or individual SCIN symptoms in multivariate analyses. Conclusion Here we document a significant relationship between increasing levels of residual serum platinum and NTX severity after adjusting for initial cisplatin dose. PMID:22184390

The role of breast-feeding beyond postpartum amenorrhoea on the return of fertility in India: a life table and hazards model analysis.

PubMed

Nath, D C; Land, K C; Singh, K K

1994-04-01

This paper investigates the effects of continued breast-feeding after resumption of menses on fertility, using data from two retrospective surveys in India and single decrement life table and multivariate time-dependent hazards analyses. Breast-feeding even after the return of menses is found to be associated with longer birth intervals. The interaction of breast-feeding duration after resumption of menses and postpartum amenorrhoea has a significant effect on the risk of conception after return of menses.

White-black and white-Hispanic differences on fluid and crystallized abilities by age across the 11- to 94-year range.

PubMed

Kaufman, J C; McLean, J E; Kaufman, A S; Kaufman, N L

1994-12-01

Standardization data for the Kaufman Adolescent and Adult Intelligence Test (KAIT) were used to examine white-black and white-Hispanic differences on the Horn-Cattell crystallized and fluid constructs at several age groups across the broad 11- to 94-year span. Samples included 1,547 white, 241 black, and 140 Hispanic persons. Multivariate analyses with educational attainment covaried yielded only one significant finding: the white-black difference on the Crystallized Famous Faces subtest became smaller with increasing age.

A framework for multivariate data-based at-site flood frequency analysis: Essentiality of the conjugal application of parametric and nonparametric approaches

NASA Astrophysics Data System (ADS)

Vittal, H.; Singh, Jitendra; Kumar, Pankaj; Karmakar, Subhankar

2015-06-01

In watershed management, flood frequency analysis (FFA) is performed to quantify the risk of flooding at different spatial locations and also to provide guidelines for determining the design periods of flood control structures. The traditional FFA was extensively performed by considering univariate scenario for both at-site and regional estimation of return periods. However, due to inherent mutual dependence of the flood variables or characteristics [i.e., peak flow (P), flood volume (V) and flood duration (D), which are random in nature], analysis has been further extended to multivariate scenario, with some restrictive assumptions. To overcome the assumption of same family of marginal density function for all flood variables, the concept of copula has been introduced. Although, the advancement from univariate to multivariate analyses drew formidable attention to the FFA research community, the basic limitation was that the analyses were performed with the implementation of only parametric family of distributions. The aim of the current study is to emphasize the importance of nonparametric approaches in the field of multivariate FFA; however, the nonparametric distribution may not always be a good-fit and capable of replacing well-implemented multivariate parametric and multivariate copula-based applications. Nevertheless, the potential of obtaining best-fit using nonparametric distributions might be improved because such distributions reproduce the sample's characteristics, resulting in more accurate estimations of the multivariate return period. Hence, the current study shows the importance of conjugating multivariate nonparametric approach with multivariate parametric and copula-based approaches, thereby results in a comprehensive framework for complete at-site FFA. Although the proposed framework is designed for at-site FFA, this approach can also be applied to regional FFA because regional estimations ideally include at-site estimations. The framework is based on the following steps: (i) comprehensive trend analysis to assess nonstationarity in the observed data; (ii) selection of the best-fit univariate marginal distribution with a comprehensive set of parametric and nonparametric distributions for the flood variables; (iii) multivariate frequency analyses with parametric, copula-based and nonparametric approaches; and (iv) estimation of joint and various conditional return periods. The proposed framework for frequency analysis is demonstrated using 110 years of observed data from Allegheny River at Salamanca, New York, USA. The results show that for both univariate and multivariate cases, the nonparametric Gaussian kernel provides the best estimate. Further, we perform FFA for twenty major rivers over continental USA, which shows for seven rivers, all the flood variables followed nonparametric Gaussian kernel; whereas for other rivers, parametric distributions provide the best-fit either for one or two flood variables. Thus the summary of results shows that the nonparametric method cannot substitute the parametric and copula-based approaches, but should be considered during any at-site FFA to provide the broadest choices for best estimation of the flood return periods.

Can Preoperative Psychological Assessment Predict Outcomes After Temporomandibular Joint Arthroscopy?

PubMed

Bouloux, Gary F; Zerweck, Ashley G; Celano, Marianne; Dai, Tian; Easley, Kirk A

2015-11-01

Psychological assessment has been used successfully to predict patient outcomes after cardiothoracic and bariatric surgery. The purpose of this study was to determine whether preoperative psychological assessment could be used to predict patient outcomes after temporomandibular joint arthroscopy. Consecutive patients with temporomandibular dysfunction (TMD) who could benefit from arthroscopy were enrolled in a prospective cohort study. All patients completed the Millon Behavior Medicine Diagnostic survey before surgery. The primary predictor variable was the preoperative psychological scores. The primary outcome variable was the difference in pain between the pre- and postoperative periods. The Spearman rank correlation coefficient and the Pearson product-moment correlation were used to determine the association between psychological factors and change in pain. Univariable and multivariable analyses were performed using a mixed-effects linear model and multiple linear regression. A P value of .05 was considered significant. Eighty-six patients were enrolled in the study. Seventy-five patients completed the study and were included in the final analyses. The mean change in visual analog scale (VAS) pain score 1 month after arthroscopy was -15.4 points (95% confidence interval, -6.0 to -24.7; P < .001). Jaw function also improved after surgery (P < .001). No association between change in VAS pain score and each of the 5 preoperative psychological factors was identified with univariable correlation analyses. Multivariable analyses identified that a greater pain decrease was associated with a longer duration of preoperative symptoms (P = .054) and lower chronic anxiety (P = .064). This study has identified a weak association between chronic anxiety and the magnitude of pain decrease after arthroscopy for TMD. Further studies are needed to clarify the role of chronic anxiety in the outcome after surgical procedures for the treatment of TMD. Copyright © 2015. Published by Elsevier Inc.

Which factors enhance positive drug reimbursement recommendation in Scotland? A retrospective analysis 2006-2013.

PubMed

Charokopou, Mata; Majer, Istvan M; Raad, Johan de; Broekhuizen, Stefan; Postma, Maarten; Heeg, Bart

2015-03-01

To identify the factors that influence the Scottish Medicines Consortium (SMC) in deciding whether to accept pharmaceutical technologies for use within the Scottish health care system. A database of SMC submissions between 2006 and 2013 was created, containing a range of clinical, economic, and other factors extracted from published health technology assessment reports. A binomial outcome variable was used, defined as the decision to "accept for use" or "not recommend" a technology. Univariate and multivariate analyses were conducted to assess the impact by means of odds ratios (ORs) of the submitted evidence on the recommendation decision. Out of 463 applications, 265 were accepted for use (57%) and 198 (43%) were not recommended for use within National Health Service Scotland. Univariate analyses showed that 13 variables significantly affected the SMC decision. Of these 13 variables, 7 variables were shown to have a meaningful impact in the multivariate analysis. Four of these concerned the outcome of cost-effectiveness analyses; the fact that a submission was supported by a cost-minimization analysis was the strongest positive variable (OR = 10.30) and a submission showing a product not being cost-effective (i.e., incremental cost-effectiveness ratio above £30,000/quality-adjusted life-year gained) was the strongest negative predictor (OR = 0.47). The other variables concerned whether the submission was related to a product indicated for a nervous system disease (OR = 0.41), whether it was indicated for nonchronic use (OR = 1.66), and whether the submission was performed by a big company (OR = 2.83). This study demonstrated that the outcome of cost-effectiveness analyses is an important factor affecting the SMC's reimbursement recommendation decision. Copyright © 2015. Published by Elsevier Inc.

Trends in the use of mechanical circulatory support as a bridge to heart transplantation across different age groups.

PubMed

Ciarka, Agnieszka; Edwards, Leah; Nilsson, Johan; Stehlik, Josef; Lund, Lars H

2017-03-15

Numerous cohort analyses suggest rapidly increasing use of mechanical circulatory support (MCS) as a bridge to heart transplantation (HTx), but the role of age in selection for MCS remains unknown. We assessed adult HTx in the International Society for Heart And Lung Transplantation Registry between 2005 and 2013 and we determined MCS use by recipient age group and transplant year. Multivariable logistic regression models were constructed to identify variables associated with continuous flow (CF) left ventricular assist device (LVAD) use within each age group. Among 16,480 HTx recipients the percentage of overall MCS use increased from 23% to 38%, 21% to 41%, and 17% to 42% in age groups 18-39 years, 40-59 years and over 60 years, respectively. This effect was mainly due to an increase in CF LVAD use and primarily in HTx recipients aged over 60. In multivariable analyses, male gender and blood group O were significantly associated with CF LVAD use in all age groups. Bridge to transplant MCS use increased dramatically between 2005 and 2013 primarily due to increased use of CF LVAD and primarily in higher ages. Pre-HTx CF LVAD use was more frequent in men and blood group O. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Morphology of the snake spectacle reflects its evolutionary adaptation and development.

PubMed

Da Silva, Mari-Ann Otkjaer; Heegaard, Steffen; Wang, Tobias; Gade, Jacob Thorup; Damsgaard, Christian; Bertelsen, Mads Frost

2017-08-18

Covering the eye of all snakes is a transparent integumental structure known as the spectacle. In order to determine variations in spectacle thickness among species, the spectacles of 217 alcohol-preserved museum specimens of 44 species belonging to 14 different families underwent optical coherence tomography (OCT) to measure spectacular thickness. Multivariable analyses were made to determine whether family, activity period (diurnal/nocturnal) and habitat (arboreal/terrestrial/fossorial/aquatic) influenced spectacle thickness. The thinnest spectacles in absolute terms were found in the Usambara bush viper (Viperidae) with a thickness of 74 ± 9 μm and the absolute thickest spectacle was found in the red-tailed pipe snake (Cylindrophiidae) which had a spectacle thickness of 244 ± 57 μm. Fossorial and aquatic snakes had significantly thicker spectacles than arboreal and terrestrial snakes. When spectacle thickness was correlated to eye size (horizontal spectacle diameter), Gray's earth snake (Uropeltidae) had the lowest ratio (1:7) and the cottonmouth (Viperidae) had the highest ratio (1:65). Multivariable and phylogenetic analyses showed that spectacular thickness could be predicted by taxonomic family and habitat, but not activity period. This phylogenetically broad systematic study of the thickness of the snake spectacle showed that spectacular thickness varies greatly across snake species and may reflect evolutionary adaptation and development.

Using venlafaxine to treat behavioral disorders in patients with autism spectrum disorder.

PubMed

Carminati, Giuliana Galli; Gerber, Fabienne; Darbellay, Barbara; Kosel, Markus Mathaus; Deriaz, Nicolas; Chabert, Jocelyne; Fathi, Marc; Bertschy, Gilles; Ferrero, François; Carminati, Federico

2016-02-04

To test the efficacy of venlafaxine at a dose of 18.75 mg/day on the reduction of behavioral problems such as irritability and hyperactivity/noncompliance in patients with intellectual disabilities and autism spectrum disorder (ASD). Our secondary hypothesis was that the usual doses of zuclopenthixol and/or clonazepam would decrease in the venlafaxine-treated group. In a randomized double-blind study, we compared six patients who received venlafaxine along with their usual treatment (zuclopenthixol and/or clonazepam) with seven patients who received placebo plus usual care. Irritability, hyperactivity/noncompliance, and overall clinical improvement were measured after 2 and 8 weeks, using validated clinical scales. Univariate analyses showed that the symptom of irritability improved in the entire sample (p = 0.023 after 2 weeks, p = 0.061 at study endpoint), although no difference was observed between the venlafaxine and placebo groups. No significant decrease in hyperactivity/noncompliance was observed during the study. At the end of the study, global improvement was observed in 33% of participants treated with venlafaxine and in 71% of participants in the placebo group (p = 0.29). The study found that decreased cumulative doses of clonazepam and zuclopenthixol were required for the venlafaxine group. Multivariate analyses (principal component analyses) with at least three combinations of variables showed that the two populations could be clearly separated (p b 0.05). Moreover, in all cases, the venlafaxine population had lower values for the Aberrant Behavior Checklist (ABC), Behavior Problems Inventory (BPI), and levels of urea with respect to the placebo group. In one case, a reduction in the dosage of clonazepam was also suggested. For an additional set of variables (ABC factor 2, BPI frequency of aggressive behaviors, hematic ammonia at Day 28, and zuclopenthixol and clonazepam intake), the separation between the two samples was statistically significant as was the Bartlett's test, but the Kaiser–Meyer–Olkin Measure of Sampling Adequacy was below the accepted threshold. This set of variables showed a reduction in the cumulative intake of both zuclopenthixol and clonazepam. Despite the small sample sizes, this study documented a statistically significant effect of venlafaxine. Moreover, we showed that lower doses of zuclopenthixol and clonazepam were needed in the venlafaxine group, although this difference was not statistically significant. This was confirmed by multivariate analyses, where this difference reached statistical significance when using a combination of variables involving zuclopenthixol. Larger-scale studies are recommended to better investigate the effectiveness of venlafaxine treatment in patients with intellectual disabilities and ASD.

Multivariate pattern analysis of MEG and EEG: A comparison of representational structure in time and space.

PubMed

Cichy, Radoslaw Martin; Pantazis, Dimitrios

2017-09-01

Multivariate pattern analysis of magnetoencephalography (MEG) and electroencephalography (EEG) data can reveal the rapid neural dynamics underlying cognition. However, MEG and EEG have systematic differences in sampling neural activity. This poses the question to which degree such measurement differences consistently bias the results of multivariate analysis applied to MEG and EEG activation patterns. To investigate, we conducted a concurrent MEG/EEG study while participants viewed images of everyday objects. We applied multivariate classification analyses to MEG and EEG data, and compared the resulting time courses to each other, and to fMRI data for an independent evaluation in space. We found that both MEG and EEG revealed the millisecond spatio-temporal dynamics of visual processing with largely equivalent results. Beyond yielding convergent results, we found that MEG and EEG also captured partly unique aspects of visual representations. Those unique components emerged earlier in time for MEG than for EEG. Identifying the sources of those unique components with fMRI, we found the locus for both MEG and EEG in high-level visual cortex, and in addition for MEG in low-level visual cortex. Together, our results show that multivariate analyses of MEG and EEG data offer a convergent and complimentary view on neural processing, and motivate the wider adoption of these methods in both MEG and EEG research. Copyright © 2017 Elsevier Inc. All rights reserved.

A system to build distributed multivariate models and manage disparate data sharing policies: implementation in the scalable national network for effectiveness research.

PubMed

Meeker, Daniella; Jiang, Xiaoqian; Matheny, Michael E; Farcas, Claudiu; D'Arcy, Michel; Pearlman, Laura; Nookala, Lavanya; Day, Michele E; Kim, Katherine K; Kim, Hyeoneui; Boxwala, Aziz; El-Kareh, Robert; Kuo, Grace M; Resnic, Frederic S; Kesselman, Carl; Ohno-Machado, Lucila

2015-11-01

Centralized and federated models for sharing data in research networks currently exist. To build multivariate data analysis for centralized networks, transfer of patient-level data to a central computation resource is necessary. The authors implemented distributed multivariate models for federated networks in which patient-level data is kept at each site and data exchange policies are managed in a study-centric manner. The objective was to implement infrastructure that supports the functionality of some existing research networks (e.g., cohort discovery, workflow management, and estimation of multivariate analytic models on centralized data) while adding additional important new features, such as algorithms for distributed iterative multivariate models, a graphical interface for multivariate model specification, synchronous and asynchronous response to network queries, investigator-initiated studies, and study-based control of staff, protocols, and data sharing policies. Based on the requirements gathered from statisticians, administrators, and investigators from multiple institutions, the authors developed infrastructure and tools to support multisite comparative effectiveness studies using web services for multivariate statistical estimation in the SCANNER federated network. The authors implemented massively parallel (map-reduce) computation methods and a new policy management system to enable each study initiated by network participants to define the ways in which data may be processed, managed, queried, and shared. The authors illustrated the use of these systems among institutions with highly different policies and operating under different state laws. Federated research networks need not limit distributed query functionality to count queries, cohort discovery, or independently estimated analytic models. Multivariate analyses can be efficiently and securely conducted without patient-level data transport, allowing institutions with strict local data storage requirements to participate in sophisticated analyses based on federated research networks. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Panic disorder and agoraphobia: A direct comparison of their multivariate comorbidity patterns.

PubMed

Greene, Ashley L; Eaton, Nicholas R

2016-01-15

Scientific debate has long surrounded whether agoraphobia is a severe consequence of panic disorder or a frequently comorbid diagnosis. Multivariate comorbidity investigations typically treat these diagnoses as fungible in structural models, assuming both are manifestations of the fear-subfactor in the internalizing-externalizing model. No studies have directly compared these disorders' multivariate associations, which could clarify their conceptualization in classification and comorbidity research. In a nationally representative sample (N=43,093), we examined the multivariate comorbidity of panic disorder (1) without agoraphobia, (2) with agoraphobia, and (3) regardless of agoraphobia; and (4) agoraphobia without panic. We conducted exploratory and confirmatory factor analyses of these and 10 other lifetime DSM-IV diagnoses in a nationally representative sample (N=43,093). Differing bivariate and multivariate relations were found. Panic disorder without agoraphobia was largely a distress disorder, related to emotional disorders. Agoraphobia without panic was largely a fear disorder, related to phobias. When considered jointly, concomitant agoraphobia and panic was a fear disorder, and when panic was assessed without regard to agoraphobia (some individuals had agoraphobia while others did not) it was a mixed distress and fear disorder. Diagnoses were obtained from comprehensively trained lay interviewers, not clinicians and analyses used DSM-IV diagnoses (rather than DSM-5). These findings support the conceptualization of agoraphobia as a distinct diagnostic entity and the independent classification of both disorders in DSM-5, suggesting future multivariate comorbidity studies should not assume various panic/agoraphobia diagnoses are invariably fear disorders. Copyright © 2015 Elsevier B.V. All rights reserved.

Stem cell-associated genes are extremely poor prognostic factors for soft-tissue sarcoma patients.

PubMed

Taubert, H; Würl, P; Greither, T; Kappler, M; Bache, M; Bartel, F; Kehlen, A; Lautenschläger, C; Harris, L C; Kaushal, D; Füssel, S; Meye, A; Böhnke, A; Schmidt, H; Holzhausen, H-J; Hauptmann, S

2007-11-01

Cancer stem cells can play an important role in tumorigenesis and tumor progression. However, it is still difficult to detect and isolate cancer stem cells. An alternative approach is to analyse stem cell-associated gene expression. We investigated the coexpression of three stem cell-associated genes, Hiwi, hTERT and survivin, by quantitative real-time-PCR in 104 primary soft-tissue sarcomas (STS). Multivariate Cox's proportional hazards regression analyses allowed correlating gene expression with overall survival for STS patients. Coexpression of all three stem cell-associated genes resulted in a significantly increased risk of tumor-related death. Importantly, tumors of patients with the poorest prognosis were of all four tumor stages, suggesting that their risk is based upon coexpression of stem cell-associated genes rather than on tumor stage.

Neuropsychological tests for predicting cognitive decline in older adults

PubMed Central

Baerresen, Kimberly M; Miller, Karen J; Hanson, Eric R; Miller, Justin S; Dye, Richelin V; Hartman, Richard E; Vermeersch, David; Small, Gary W

2015-01-01

Summary Aim To determine neuropsychological tests likely to predict cognitive decline. Methods A sample of nonconverters (n = 106) was compared with those who declined in cognitive status (n = 24). Significant univariate logistic regression prediction models were used to create multivariate logistic regression models to predict decline based on initial neuropsychological testing. Results Rey–Osterrieth Complex Figure Test (RCFT) Retention predicted conversion to mild cognitive impairment (MCI) while baseline Buschke Delay predicted conversion to Alzheimer’s disease (AD). Due to group sample size differences, additional analyses were conducted using a subsample of demographically matched nonconverters. Analyses indicated RCFT Retention predicted conversion to MCI and AD, and Buschke Delay predicted conversion to AD. Conclusion Results suggest RCFT Retention and Buschke Delay may be useful in predicting cognitive decline. PMID:26107318

Applying generalizability theory to examine the antecedents of perceived coach support.

PubMed

Coussens, Adam Howard; Rees, Tim; Freeman, Paul

2015-02-01

Although social support is integral to the coaching process, there is only a limited understanding of the antecedents of perceived coach support. We applied generalizability theory to examine perceived coach support and its antecedents at perceiver, provider, and relational levels of analysis. Two studies were conducted in which athletes rated the degree to which they identified with a selection of coaches, and the personality, competency, and supportiveness of those coaches. Univariate analyses demonstrated that the relational component accounted for a significant amount of variance in perceived coach support in both studies. Multivariate analyses demonstrated that when athletes perceive specific coaches to be highly agreeable, competent, and individuals with whom they share a common identity, they also perceive these same coaches to be particularly supportive in comparison with other coaches.

Heritability of somatotype components from early adolescence into young adulthood: a multivariate analysis on a longitudinal twin study.

PubMed

Peeters, M W; Thomis, M A; Claessens, A L; Loos, R J F; Maes, H H M; Lysens, R; Vanden Eynde, B; Vlietinck, R; Beunen, G

2003-01-01

Several studies with different designs have attempted to estimate the heritability of somatotype components. However they often ignore the covariation between the three components as well as possible sex and age effects. Shared environmental factors are not always controlled for. This study explores the pattern of genetic and environmental determination of the variation in Heath-Carter somatotype components from early adolescence into young adulthood. Data from the Leuven Longitudinal Twin Study, a longitudinal sample of Belgian same-aged twins followed from 10 to 18 years (n = 105 pairs, equally divided over five zygosity groups), is entered into a multivariate path analysis. Thus the covariation between the somatotype components is taken into account, gender heterogeneity can be tested, common environmental influences can be distinguished from genetic effects and age effects are controlled for. Heritability estimates from 10 to 18 years range from 0.21 to 0.88, 0.46 to 0.76 and 0.16 to 0.73 for endomorphy, mesomorphy and ectomorphy in boys. In girls, heritability estimates range from 0.76 to 0.89, 0.36 to 0.57 and 0.57 to 0.76 for the respective somatotype components. Sex differences are significant from 14 years onwards. More than half of the variance in all somatotype components for both sexes at all time points is explained by factors the three components have in common. The finding of substantial genetic influence on the variability of somatotype components is further supported. The need to consider somatotype as a whole is stressed as well as the need for sex- and perhaps age-specific analyses. Further multivariate analyses are needed to confirm the present findings.

Insulin Sensitivity Measured With Euglycemic Clamp Is Independently Associated With Glomerular Filtration Rate in a Community-Based Cohort

PubMed Central

Nerpin, Elisabet; Risérus, Ulf; Ingelsson, Erik; Sundström, Johan; Jobs, Magnus; Larsson, Anders; Basu, Samar; Ärnlöv, Johan

2008-01-01

OBJECTIVE—To investigate the association between insulin sensitivity and glomerular filtration rate (GFR) in the community, with prespecified subgroup analyses in normoglycemic individuals with normal GFR. RESEARCH DESIGN AND METHODS—We investigated the cross-sectional association between insulin sensitivity (M/I, assessed using euglycemic clamp) and cystatin C–based GFR in a community-based cohort of elderly men (Uppsala Longitudinal Study of Adult Men [ULSAM], n = 1,070). We also investigated whether insulin sensitivity predicted the incidence of renal dysfunction at a follow-up examination after 7 years. RESULTS—Insulin sensitivity was directly related to GFR (multivariable-adjusted regression coefficient for 1-unit higher M/I 1.19 [95% CI 0.69–1.68]; P < 0.001) after adjusting for age, glucometabolic variables (fasting plasma glucose, fasting plasma insulin, and 2-h glucose after an oral glucose tolerance test), cardiovascular risk factors (hypertension, dyslipidemia, and smoking), and lifestyle factors (BMI, physical activity, and consumption of tea, coffee, and alcohol). The positive multivariable-adjusted association between insulin sensitivity and GFR also remained statistically significant in participants with normal fasting plasma glucose, normal glucose tolerance, and normal GFR (n = 443; P < 0.02). In longitudinal analyses, higher insulin sensitivity at baseline was associated with lower risk of impaired renal function (GFR <50 ml/min per 1.73 m2) during follow-up independently of glucometabolic variables (multivariable-adjusted odds ratio for 1-unit higher of M/I 0.58 [95% CI 0.40–0.84]; P < 0.004). CONCLUSIONS—Our data suggest that impaired insulin sensitivity may be involved in the development of renal dysfunction at an early stage, before the onset of diabetes or prediabetic glucose elevations. Further studies are needed in order to establish causality. PMID:18509205

Sexual Assault Disclosure: The Effect of Victim Race and Perpetrator Type on Empathy, Culpability, and Service Referral for Survivors in a Hypothetical Scenario.

PubMed

Franklin, Cortney A; Garza, Alondra D

2018-03-01

The aftermath of sexual assault warrants further attention surrounding the responses provided by those to whom survivors disclose, especially when perpetrator type or victim race may affect whether the bystander response is supportive or attributes culpability to the victim. Disclosure responses have significant consequences for survivors' posttrauma mental health and formal help-seeking behavior. The current study used a sample of 348 self-report, paper-and-pencil surveys administered during the fall 2015 semester to a purposive sample of undergraduate students with a mean age of 20.94 years old at a midsized, Southern public university. Survey design included a randomly assigned 2 × 2 hypothetical sexual assault disclosure vignette. The objective of the study was to assess the effect of perpetrator type (stranger vs. acquaintance) and victim race (White vs. Black) on empathic concern, culpability attributions, and resource referral. Between-subjects factorial ANOVA and multivariate ordinary least squares (OLS) regression models were estimated to identify the role of vignette manipulations, participant-sexual victimization history, and rape myth acceptance on empathy, culpability, and resource referral for the sexual assault survivor portrayed in the vignette. Multivariate analyses included main effects and moderation models. Findings revealed increased culpability and decreased resource referral for victims of acquaintance rape as compared with stranger rape, independent of victim race. Although no direct victim race effects emerged in the multivariate analyses, race moderated the effect of culpability on resource referral indicating culpability attributions decreased resource referral, but only when the victim was Black . Implications from the results presented here include a continued focus on bystander intervention strategies, empathy-building techniques, and educational programming targeting potential sexual assault disclosees and race stereotypes that disadvantage victims of color.

Selected Gray Matter Volumes and Gender but Not Basal Ganglia nor Cerebellum Gyri Discriminate Left Versus Right Cerebral Hemispheres: Multivariate Analyses in human Brains at 3T.

PubMed

Roldan-Valadez, Ernesto; Suarez-May, Marcela A; Favila, Rafael; Aguilar-Castañeda, Erika; Rios, Camilo

2015-07-01

Interest in the lateralization of the human brain is evident through a multidisciplinary number of scientific studies. Understanding volumetric brain asymmetries allows the distinction between normal development stages and behavior, as well as brain diseases. We aimed to evaluate volumetric asymmetries in order to select the best gyri able to classify right- versus left cerebral hemispheres. A cross-sectional study performed in 47 right-handed young-adults healthy volunteers. SPM-based software performed brain segmentation, automatic labeling and volumetric analyses for 54 regions involving the cerebral lobes, basal ganglia and cerebellum from each cerebral hemisphere. Multivariate discriminant analysis (DA) allowed the assembling of a predictive model. DA revealed one discriminant function that significantly differentiated left vs. right cerebral hemispheres: Wilks' λ = 0.008, χ(2) (9) = 238.837, P < 0.001. The model explained 99.20% of the variation in the grouping variable and depicted an overall predictive accuracy of 98.8%. With the influence of gender; the selected gyri able to discriminate between hemispheres were middle orbital frontal gyrus (g.), angular g., supramarginal g., middle cingulum g., inferior orbital frontal g., calcarine g., inferior parietal lobule and the pars triangularis inferior frontal g. Specific brain gyri are able to accurately classify left vs. right cerebral hemispheres by using a multivariate approach; the selected regions correspond to key brain areas involved in attention, internal thought, vision and language; our findings favored the concept that lateralization has been evolutionary favored by mental processes increasing cognitive efficiency and brain capacity. © 2015 Wiley Periodicals, Inc.

A multivariate model exploring the predictive value of demographic, adolescent, and family factors on glycemic control in adolescents with type 1 diabetes.

PubMed

Agarwal, Shivani; Jawad, Abbas F; Miller, Victoria A

2016-11-01

The current study examined how a comprehensive set of variables from multiple domains, including at the adolescent and family level, were predictive of glycemic control in adolescents with type 1 diabetes (T1D). Participants included 100 adolescents with T1D ages 10-16 yrs and their parents. Participants were enrolled in a longitudinal study about youth decision-making involvement in chronic illness management of which the baseline data were available for analysis. Bivariate associations with glycemic control (HbA1C) were tested. Hierarchical linear regression was implemented to inform the predictive model. In bivariate analyses, race, family structure, household income, insulin regimen, adolescent-reported adherence to diabetes self-management, cognitive development, adolescent responsibility for T1D management, and parent behavior during the illness management discussion were associated with HbA1c. In the multivariate model, the only significant predictors of HbA1c were race and insulin regimen, accounting for 17% of the variance. Caucasians had better glycemic control than other racial groups. Participants using pre-mixed insulin therapy and basal-bolus insulin had worse glycemic control than those on insulin pumps. This study shows that despite associations of adolescent and family-level variables with glycemic control at the bivariate level, only race and insulin regimen are predictive of glycemic control in hierarchical multivariate analyses. This model offers an alternative way to examine the relationship of demographic and psychosocial factors on glycemic control in adolescents with T1D. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Functional Gain After Inpatient Stroke Rehabilitation: Correlates and Impact on Long-Term Survival.

PubMed

Scrutinio, Domenico; Monitillo, Vincenzo; Guida, Pietro; Nardulli, Roberto; Multari, Vincenzo; Monitillo, Francesco; Calabrese, Gianluigi; Fiore, Pietro

2015-10-01

Prediction of functional outcome after stroke rehabilitation (SR) is a growing field of interest. The association between SR and survival still remains elusive. We sought to investigate the factors associated with functional outcome after SR and whether the magnitude of functional improvement achieved with rehabilitation is associated with long-term mortality risk. The study population consisted of 722 patients admitted for SR within 90 days of stroke onset, with an admission functional independence measure (FIM) score of <80 points. We used univariable and multivariable linear regression analyses to assess the association between baseline variables and FIM gain and univariable and multivariable Cox analyses to assess the association of FIM gain with long-term mortality. Age (P<0.001), marital status (P=0.003), time from stroke onset to rehabilitation admission (P<0.001), National Institutes of Health Stroke Scale score at rehabilitation admission (P<0.001), and aphasia (P=0.021) were independently associated with FIM gain. The R2 of the model was 0.275. During a median follow-up of 6.17 years, 36.9% of the patients died. At multivariable Cox analysis, age (P<0.0001), coronary heart disease (P=0.018), atrial fibrillation (P=0.042), total cholesterol (P=0.015), and total FIM gain (P<0.0001) were independently associated with mortality. The adjusted hazard ratio for death significantly decreased across tertiles of increasing FIM gain. Several factors are independently associated with functional gain after SR. Our findings strongly suggest that the magnitude of functional improvement is a powerful predictor of long-term mortality in patients admitted for SR. © 2015 American Heart Association, Inc.

Risk factors for parastomal hernia in Japanese patients with permanent colostomy.

PubMed

Funahashi, Kimihiko; Suzuki, Takayuki; Nagashima, Yasuo; Matsuda, Satoshi; Koike, Junichi; Shiokawa, Hiroyuki; Ushigome, Mitsunori; Arai, Kenichiro; Kaneko, Tomoaki; Kurihara, Akiharu; Kaneko, Hironori

2014-08-01

Although the definitive risk factors for parastomal hernia development remain unclear, potential contributing factors have been reported from Western countries. The aim of this study was to identify the risk factors for parastomal hernia in Japanese patients with permanent colostomies. All patients who received abdominoperineal resection or total pelvic exenteration at our institution between December 2004 and December 2011 were reviewed. Patient-related, operation-related and postoperative variables were evaluated, in both univariate and multivariate analyses, to identify the risk factors for parastomal hernia formation. Of the 80 patients who underwent colostomy, 22 (27.5 %) developed a parastomal hernia during a median follow-up period of 953 days (range 15-2792 days). Hernia development was significantly associated with increasing patient age and body mass index, a laparoscopic surgical approach and the transperitoneal route of colostomy formation. In the multivariate analysis, the body mass index (p = 0.022), the laparoscopic approach (p = 0.043) and transperitoneal stoma creation (p = 0.021) retained statistical significance. Our findings in Japanese ostomates match those from Western countries: a higher body mass index, the use of a laparoscopic approach and a transperitoneal colostomy are significant independent risk factors for parastomal hernia formation. The precise role of the stoma creation route remains unclear.

Heroin Use Is Associated with Ruptured Saccular Aneurysms.

PubMed

Can, Anil; Castro, Victor M; Ozdemir, Yildirim H; Dagen, Sarajune; Dligach, Dmitriy; Finan, Sean; Yu, Sheng; Gainer, Vivian; Shadick, Nancy A; Savova, Guergana; Murphy, Shawn; Cai, Tianxi; Weiss, Scott T; Du, Rose

2017-11-04

While cocaine use is thought to be associated with aneurysmal rupture, it is not known whether heroin use increases the risk of rupture in patients with non-mycotic saccular aneurysms. Our goal was to investigate the association between heroin and cocaine use and the rupture of saccular non-mycotic aneurysms. The medical records of 4701 patients with 6411 intracranial aneurysms, including 1201 prospective patients, diagnosed at the Brigham and Women's Hospital and Massachusetts General Hospital between 1990 and 2016 were reviewed and analyzed. Patients were separated into ruptured and non-ruptured groups. Univariable and multivariable logistic regression analyses were performed to determine the association between heroin, cocaine, and methadone use and the presence of ruptured intracranial aneurysms. In multivariable analysis, current heroin use was significantly associated with rupture status (OR 3.23, 95% CI 1.33-7.83) whereas former heroin use (with and without methadone replacement therapy), and current and former cocaine use were not significantly associated with intracranial aneurysm rupture. In the present study, heroin rather than cocaine use is significantly associated with intracranial aneurysm rupture in patients with non-mycotic saccular cerebral aneurysms, emphasizing the possible role of heroin in the pathophysiology of aneurysm rupture and the importance of heroin cessation in patients harboring unruptured intracranial aneurysms.

Safety and effectiveness of olanzapine in monotherapy: a multivariate analysis of a naturalistic study.

PubMed

Ciudad, Antonio; Gutiérrez, Miguel; Cañas, Fernando; Gibert, Juan; Gascón, Josep; Carrasco, José-Luis; Bobes, Julio; Gómez, Juan-Carlos; Alvarez, Enrique

2005-07-01

This study investigated safety and effectiveness of olanzapine in monotherapy compared with conventional antipsychotics in treatment of acute inpatients with schizophrenia. This was a prospective, comparative, nonrandomized, open-label, multisite, observational study of Spanish inpatients with an acute episode of schizophrenia. Data included safety assessments with an extrapyramidal symptoms (EPS) questionnaire and the report of spontaneous adverse events, plus clinical assessments with the Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Impressions-Severity of Illness (CGI-S). A multivariate methodology was used to more adequately determine which factors can influence safety and effectiveness of olanzapine in monotherapy. 339 patients treated with olanzapine in monotherapy (OGm) and 385 patients treated with conventional antipsychotics (CG) were included in the analysis. Treatment-emergent EPS were significantly higher in the CG (p<0.0001). Response rate was significantly higher in the OGm (p=0.005). Logistic regression analyses revealed that the only variable significantly correlated with treatment-emergent EPS and clinical response was treatment strategy, with patients in OGm having 1.5 times the probability of obtaining a clinical response and patients in CG having 5 times the risk of developing EPS. In this naturalistic study olanzapine in monotherapy was better-tolerated and at least as effective as conventional antipsychotics.

Association between Breast Cancer Recurrence and Cellular Dissociation Assessed Using Fine-Needle Aspiration.

PubMed

Koike, Etsuko; Iwaya, Keiichi; Watanabe, Akinori; Miyake, Shinji; Sato, Eiichi; Ishikawa, Takashi

2016-01-01

To determine the associations between breast cancer recurrence and cytological findings of fine-needle aspiration cytology (FNAC). The study included 117 women who had undergone a modified radical mastectomy for invasive ductal carcinoma of the breast. FNAC samples of these patients were reexamined, and cytological findings, such as cellular dissociation, nuclear pleomorphism, nuclear atypia, chromatin pattern, and nuclear size, were scored. Uni- and multivariate analyses were performed to determine the prognostic significance of the cytological findings. Corresponding cancer tissues were immunostained for estrogen receptor, progesterone receptor, human epidermal growth factor 2 (HER2), p53, and E-cadherin to determine their associations with cytological findings. Coexpression of Arp2 and WAVE2 was also examined immunohistochemically as a cell locomotion signal. Cellular dissociation (p = 0.0259) and nuclear size (p = 0.0417) were significantly associated with cancer recurrence. Multivariate analysis showed that cellular dissociation and histological grade were significant independent predictors of cancer recurrence. Cellular dissociation was found to be associated with coexpression of Arp2 and WAVE2 (p = 0.0356) and HER2 (p = 0.0469). The cytological finding of cell dissociation was associated with the activation of Arp2 and WAVE2 signals and was an independent predictor of recurrence. © 2016 S. Karger AG, Basel.

Determinants of pre-lacteal feeding practices in urban and rural Nigeria; a population-based cross-sectional study using the 2013 Nigeria demographic and health survey data.

PubMed

Berde, Anselm Shekwagu; Yalcin, Siddika Songul; Ozcebe, Hilal; Uner, Sarp; Caman, Ozge Karadag

2017-09-01

Prelacteal feeding (PLF) is a barrier to exclusive breast feeding. To determine factors associated with PLF in rural and urban Nigeria. We utilized data from the 2013 Nigerian Demographic and Health Survey. Bivariate and multivariate analyses were used to test for association between PLF and related factors. Prevalence of PLF in urban Nigeria was 49.8%, while in rural Nigeria it was 66.4%. Sugar or glucose water was given more in urban Nigeria (9.7% vs 2.9%), plain water was given more in rural Nigeria (59.9% vs 40.8%). The multivariate analysis revealed that urban and rural Nigeria shared similarities with respect to factors like mother's education, place of delivery, and size of child at birth being significant predictors of PLF. Mode of delivery and type of birth were significant predictors of PLF only in urban Nigeria, whereas, mother's age at birth was a significant predictor of PLF only in rural Nigeria. Zones also showed variations in the odds of PLF according to place of residence. Interventions aimed at decreasing PLF rate should be through a tailored approach, and should target at risk sub-groups based on place of residence.

Effects of an artificial oyster shell reef on macrobenthic communities in Rongcheng Bay, East China

NASA Astrophysics Data System (ADS)

Xu, Qinzeng; Zhang, Libin; Zhang, Tao; Zhou, Yi; Xia, Sudong; Liu, Hui; Yang, Hongsheng

2014-01-01

An artificial oyster shell reef was deployed in Rongcheng Bay, East China. However, the effects of this reef on the surrounding macrobenthic communities were unknown. We compared sedimentary factors, macrobenthic biomass, abundance, and community composition and ecological indicators between the reef and non-reef areas over a one year period. The mean values for chlorophyll a (Chl a), total organic matter (TOM), total organic carbon (TOC), and total nitrogen (TN) content in surface sediments in the reef area were slightly higher than those in the non-reef area. The Chl a levels differed significantly between the two areas, but the TOM, TOC, and TN were not significantly different. The abundance of crustaceans was significantly different between the two areas, but the abundance and biomass of polychaetes, echinoderms, mollusk did not differ significantly. The permutational multivariate analysis of variance (PERMANOVA) revealed that the macrobenthic community differed significantly through time and analysis of similarity multivariate analyses (ANOSIM) revealed that the macrobenthic community differed significantly in some months. The ecological indicators revealed that the environmental quality of the reef area was slightly better than that of the non-reef area. Overall, our results suggest that the artificial oyster shell reef may change the macrobenthic community and the quality of the environment. Despite the lack of an effect in the short term, long-term monitoring is still needed to evaluate the effects of artificial oyster shell reefs on macrobenthic communities.

Menopausal status and physical performance in middle aged women: a cross-sectional community-based study in Northeast Brazil.

PubMed

da Câmara, Saionara M A; Zunzunegui, Maria Victoria; Pirkle, Catherine; Moreira, Mayle A; Maciel, Álvaro C C

2015-01-01

To examine associations between menopausal status and physical performance in middle-aged women from the Northeast region of Brazil. Cross-sectional study of women between 40 to 65 years old living in Parnamirim. Women were recruited by advertisements in primary care neighborhood centers across the city. Physical performance was assessed by grip strength, gait speed and chair stands. Menopausal status was determined using the Stages of Reproductive Aging Workshop classification and women were classified in: premenopausal, perimenopausal or postmenopausal. Multiple linear regression analyses were performed to model the effect of menopausal status on each physical performance measure, adjusting for covariates (age, family income, education, body mass index, parity and age at first birth). The premenopausal women were significantly stronger and performed better in chair stands than perimenopausal and postmenopausal women. Gait speed did not vary significantly by menopausal status. In multivariate analyses, menopausal status remained statistically significant only for grip strength. In fully adjusted analyses, premenopausal women had grip strength mean of 2.226 Kgf (95% CI: 0.361 - 4.091) higher than the postmenopausal group. This study provides further evidence for the associations between menopause and physical performance in middle-aged women, since grip strength is weaker in peri and postmenopausal women compared to premenopausal, even adjusted for age and other covariates.

Modeling the Drift Towards Sex Role Deviance.

ERIC Educational Resources Information Center

James, Jennifer; Vitaliano, Peter Paul

The interrelationships of deviant life experiences and current status, i.e., prostitution versus non-prostitution, were investigated by the application of multivariate analyses. Variables were studied involving early home life, pregnancy history, sexual history, and criminal involvement. Based on the analyses, three models were developed that…

A multivariate time series approach to modeling and forecasting demand in the emergency department.

PubMed

Jones, Spencer S; Evans, R Scott; Allen, Todd L; Thomas, Alun; Haug, Peter J; Welch, Shari J; Snow, Gregory L

2009-02-01

The goals of this investigation were to study the temporal relationships between the demands for key resources in the emergency department (ED) and the inpatient hospital, and to develop multivariate forecasting models. Hourly data were collected from three diverse hospitals for the year 2006. Descriptive analysis and model fitting were carried out using graphical and multivariate time series methods. Multivariate models were compared to a univariate benchmark model in terms of their ability to provide out-of-sample forecasts of ED census and the demands for diagnostic resources. Descriptive analyses revealed little temporal interaction between the demand for inpatient resources and the demand for ED resources at the facilities considered. Multivariate models provided more accurate forecasts of ED census and of the demands for diagnostic resources. Our results suggest that multivariate time series models can be used to reliably forecast ED patient census; however, forecasts of the demands for diagnostic resources were not sufficiently reliable to be useful in the clinical setting.

Synergism in work site adoption of employee assistance programs and health promotion activities.

PubMed

Blum, T C; Roman, P M; Patrick, L

1990-05-01

As workplaces increasingly adopt proactive programs directed toward employee health issues, the interrelation between different programs becomes an important issue. Of interest here is the "synergy" in patterns of program adoption between employee assistance programs (EAPs) and health promotion activities (HPAs). We utilize the 1985 National Survey of Worksite Health Promotion Activities (N = 1358) for analyses of the dual presence of EAPs and HPAs, and in multivariate analyses we consider factors affecting such dual presence. The data suggest that synergy occurs, with EAP adoption appearing to influence HPA adoption to a greater extent than the reverse. In multivariate analyses, synergy is confirmed by the finding that, among a variety of relevant organizational characteristics, EAP presence and HPA presence are the best predictors of each other's presence. The analyses also indicate that there is minimal commonality in program ingredients across organizations reporting the presence of HPAs. Implications of the data for the future development of these two programming strategies are discussed.

Influence of individual and social contextual factors on changes in leisure-time physical activity in working-class populations: results of the Healthy Directions–Small Businesses Study

PubMed Central

Stoddard, Anne; Bennett, Gary G.; Wolin, Kathleen Y.; Sorensen, Glorian G.

2012-01-01

Background As part of the Harvard Cancer Prevention Program Project, we sought to address disparities reflected in social class and race/ethnicity by developing and testing a behavioral intervention model that targeted fruit and vegetable consumption, red meat consumption, multivitamin intake, and physical activity in working-class, multiethnic populations. Methods This paper examined the associations between change in leisure-time physical activity and individual and social contextual factors in participants employed in small businesses (n = 850) at both baseline and at 18-month final. Results In bivariate analyses, age, language acculturation, social ties, and workplace social capital were significantly associated with physical activity at final. In multivariable analyses, being younger and having high language acculturation were significantly associated with greater leisuretime physical activity at final; high workplace social capital was significantly associated with a decline in physical activity at final. Conclusion These findings have implications for understanding factors that are integral to promoting change in physical activity among working-class, multiethnic populations. PMID:22806257

Selective serotonin reuptake inhibitors and risk of major congenital anomalies for pregnancies in Japan: A nationwide birth cohort study of the Japan Environment and Children's Study.

PubMed

Nishigori, Hidekazu; Obara, Taku; Nishigori, Toshie; Mizuno, Satoshi; Metoki, Hirohito; Hoshiai, Tetsuro; Watanabe, Zen; Sakurai, Kasumi; Ishikuro, Mami; Tatsuta, Nozomi; Nishijima, Ichiko; Fujiwara, Ikuma; Kuriyama, Shinichi; Arima, Takahiro; Nakai, Kunihiko; Yaegashi, Nobuo

2017-05-01

We analyzed data from the Japan Environment and Children's Study (JECS), on the association between selective serotonin reuptake inhibitors (SSRI) use during pregnancy and the risk of developing of major congenital anomalies in Japan. JECS is an ongoing nationwide birth cohort study. The study includes 95 994 single pregnant women and their offspring. Among them, 172 used any SSRI up to the 12 th gestational week. Crude analyses show a significantly increased incidence of upper limb, abdominal, and urogenital abnormalities. In particular, the incidence of microcephaly, hydrencephalus, esophageal atresia, small intestinal atresia, and achondroplasia was significantly higher with than without exposure to these substances. On multivariate analyses, urogenital abnormality was significant (odds ratio 3.227; 95% confidence interval: 1.460-7.134). This Japanese nationwide birth cohort survey clarified that the use of any SSRI until the 12 th gestational week was associated with urogenital abnormality in children. The survey for association with minor classification abnormality needs further examination in Japan. © 2016 Japanese Teratology Society.

TIA, stroke and orthostatic hypotension: a disease spectrum related to ageing vasculature?

PubMed

Kwok, C S; Ong, A C L; Potter, J F; Metcalf, A K; Myint, P K

2014-06-01

We sought to identify the determinants of orthostatic hypotension (OH) among patients referred to the transient ischaemic attack (TIA) clinic. We conducted a retrospective analysis of prospectively collected data on patients who attended the TIA clinic in a UK hospital between January 2006 and September 2009. Each patient had their supine and standing or sitting blood pressure measured. Logistic regression was used to estimate the univariate and multivariate odds of OH for the subgroups of patients based on their diagnosis. A 10% significance level for the univariate analysis was used to identify variables in the multivariate model. A total of 3222 patients were studied of whom 1131 had a TIA, 665 a stroke and 1426 had other diagnoses. The prevalence of either systolic or diastolic OH in the TIA, stroke and patients with other diagnoses was similar being 22% (n = 251), 24% (n = 162) and 20% (n = 292), respectively. Multivariate analyses showed age, prior history of TIA, and diabetes were independently significantly associated with systolic OH alone or diastolic OH alone or either systolic or diastolic OH [ORs 1.03 (1.02-1.05); 1.56 (1.05-2.31); 1.65 (1.10-2.47), respectively]. Among the patients with the diagnosis of stroke, peripheral vascular disease (PVD) was significantly associated with increased odds of OH (3.56, 1.53-8.31), whereas male gender had a significantly lower odds of OH (0.61, 0.42-0.88). In patients with other diagnoses, age (1.04, 1.02-1.05) and diabetes (1.47, 1.04-2.09) were associated with OH, whereas male gender was (0.76, 0.58-1.00) not associated with OH. Orthostatic hypotension is prevalent among patients presenting to TIA clinic. Previous history of vascular disease (prior TIA/stroke/PVD) appears to be a significant associate of OH in this patient population. © 2014 John Wiley & Sons Ltd.

Levels and determinants of complementary feeding based on meal frequency among children of 6 to 23 months in Bangladesh.

PubMed

Chowdhury, Mohammad Rocky Khan; Rahman, Md Shafiur; Khan, Md Mobarak Hossain

2016-09-07

Information concerning complementary feeding (CF) practice during infancy and early childhood is still scarce in Bangladesh. Therefore, this study aimed to estimate the level of CF among children of 6-23 months and identify individual, household and community level determinants in Bangladesh. Secondary data from the Bangladesh Demographic Health Survey (BDHS) 2011 was used. A total of 2,373 children aged 6-23 months were selected. A simplified index called "dimension index" was used to estimate the level of CF. The score of this index was used either as continuous or categorical dependent variables. The highest score based on dimension index is associated to an adequate CF. Statistical analyses and tests were guided by types of variables. Finally, multivariable logistic regression (binary and multinomial) analyses were performed to identify the significant determinants of CF. The overall level of CF among children of 6-23 months was low. More than 90 % of children experienced either no (2.9 %) or inadequate CF (92.7 %). According to bivariable analyses, mean levels of CF as well as percentages of no/inadequate CF were significantly lower among children of the youngest age group, uneducated parents, unemployed/laborer fathers, socio-economically poor families, food insecure families and rural areas. No weekly exposure to mass media (namely watching TV and reading newspapers/magazines) also revealed significant associations with CF. However, only few variables remained significant for adequate CF in the multivariable logistic regression analysis. For example, the likelihood of experiencing adequate CF was significantly lower among children of 6-11 months (OR: 0.22, 95 % CI: 0.10-0.47), children of illiterate fathers (OR: 0.32, 95 % CI: 0.11-0.95) and socio-economically middle-class families (OR: 0.28, 95 % CI: 0.09-0.86) as compared to their reference categories. A high level of inadequate CF leading to malnutrition may cause serious health problems among children of 6-23 months in Bangladesh. Vulnerable groups of children (e.g., the children aged 6 to 11 months and children of illiterate fathers), who received low levels of adequate CF, should be targeted by government and other stakeholders while developing strategies and interventions in order to improve overall situation of CF in Bangladesh.

Gender Differences in Knowledge, Attitudes and Practices towards Cardiovascular Disease and its Treatment among Asian Patients.

PubMed

Shen, Tong; Teo, Tse Yean; Yap, Jonathan Jl; Yeo, Khung Keong

2017-01-01

Introduction : Knowledge, attitudes and practices (KAP) impact on cardiac disease outcomes, with noted cultural and gender differences. In this Asian cohort, we aimed to analyse the KAP of patients towards cardiac diseases and pertinent factors that influence such behaviour, focusing on gender differences. Materials and Methods : A cross-sectional survey was performed among consecutive outpatients from a cardiac clinic over 2 months in 2014. Results : Of 1406 patients approached, 1000 (71.1%) responded (mean age 57.0 ± 12.7 years, 713 [71.3%] males). There was significant correlation between knowledge and attitude scores (r = 0.224, P <0.001), and knowledge and practice scores (r = 0.114, P <0.001). There was no correlation between attitude and practice scores. Multivariate predictors of higher knowledge scores included female sex, higher education, higher attitude and practice scores and prior coronary artery disease. Multivariate predictors of higher attitude scores included higher education, higher knowledge scores and non-Indian ethnicity. Multivariate predictors of higher practice scores included male sex, Indian ethnicity, older age, higher knowledge score and hypertension. Males had lower knowledge scores (85.8 ± 8.0% vs 88.0 ± 8.2%, P <0.001), lower attitude scores (91.4 ± 9.4% vs 93.2 ± 8.3%, P = 0.005) and higher practice scores (58.4 ± 18.7% vs 55.1 ± 19.3%, P = 0.013) than females. Conclusion : In our Asian cohort, knowledge of cardiovascular health plays a significant role in influencing attitudes and practices. There exists significant gender differences in KAP. Adopting gender-specific strategies for future public health campaigns could address the above gender differences.

Association between gait characteristics and endothelial oxidative stress and inflammation in patients with symptomatic peripheral artery disease.

PubMed

Gardner, Andrew W; Montgomery, Polly S; Casanegra, Ana I; Silva-Palacios, Federico; Ungvari, Zoltan; Csiszar, Anna

2016-06-01

The aim of the study was to determine whether gait characteristics were associated with endothelial cell inflammation, oxidative stress, and apoptosis and with circulating biomarkers of inflammation and antioxidant capacity in older patients with symptomatic peripheral artery disease (PAD). Gait measurements of 231 symptomatic men and women with PAD were assessed during a 4-m walk test. Patients were further characterized on endothelial effects of circulating factors present in the sera using a cell culture-based bioassay on primary human arterial endothelial cells and on circulating inflammatory and vascular biomarkers. In a multivariate regression model for gait speed, the significant independent variables were age (p < 0.001), intercellular cell adhesion molecule-1 (ICAM-1) (p < 0.001), diabetes (p = 0.003), sex (p = 0.003), and history of cerebrovascular accidents (p = 0.021). In multivariate analyses for gait cadence, the significant independent predictors included high-sensitivity C-reactive protein (HsCRP) (p < 0.001), diabetes (p = 0.001), and hypertension (p = 0.001). In a multivariate regression model for gait stride length, the significant independent variables were HsCRP (p < 0.001), age (p < 0.001), ICAM-1 (p < 0.001), hypertension (p = 0.002), cellular reactive oxygen species production (p = 0.007), and sex (p = 0.008). Higher levels of circulating biomarkers of inflammation and endothelial cell oxidative stress were associated with slower gait speed, slower cadence, and shorter stride length in older symptomatic patients with PAD. Additionally, this profile of impaired gait was more evident in older patients, in women, and in those with diabetes, hypertension, and history of cerebrovascular accidents.

Transforming growth factor-β and toll-like receptor-4 polymorphisms are not associated with fibrosis in haemochromatosis

PubMed Central

Wood, Marnie J; Powell, Lawrie W; Dixon, Jeannette L; Subramaniam, V Nathan; Ramm, Grant A

2013-01-01

AIM: To investigate the role of genetic polymorphisms in the progression of hepatic fibrosis in hereditary haemochromatosis. METHODS: A cohort of 245 well-characterised C282Y homozygous patients with haemochromatosis was studied, with all subjects having liver biopsy data and DNA available for testing. This study assessed the association of eight single nucleotide polymorphisms (SNPs) in a total of six genes including toll-like receptor 4 (TLR4), transforming growth factor-beta (TGF-β), oxoguanine DNA glycosylase, monocyte chemoattractant protein 1, chemokine C-C motif receptor 2 and interleukin-10 with liver disease severity. Genotyping was performed using high resolution melt analysis and sequencing. The results were analysed in relation to the stage of hepatic fibrosis in multivariate analysis incorporating other cofactors including alcohol consumption and hepatic iron concentration. RESULTS: There were significant associations between the cofactors of male gender (P = 0.0001), increasing age (P = 0.006), alcohol consumption (P = 0.0001), steatosis (P = 0.03), hepatic iron concentration (P < 0.0001) and the presence of hepatic fibrosis. Of the candidate gene polymorphisms studied, none showed a significant association with hepatic fibrosis in univariate or multivariate analysis incorporating cofactors. We also specifically studied patients with hepatic iron loading above threshold levels for cirrhosis and compared the genetic polymorphisms between those with no fibrosis vs cirrhosis however there was no significant effect from any of the candidate genes studied. Importantly, in this large, well characterised cohort of patients there was no association between SNPs for TGF-β or TLR4 and the presence of fibrosis, cirrhosis or increasing fibrosis stage in multivariate analysis. CONCLUSION: In our large, well characterised group of haemochromatosis subjects we did not demonstrate any relationship between candidate gene polymorphisms and hepatic fibrosis or cirrhosis. PMID:24409064

Transforming growth factor-β and toll-like receptor-4 polymorphisms are not associated with fibrosis in haemochromatosis.

PubMed

Wood, Marnie J; Powell, Lawrie W; Dixon, Jeannette L; Subramaniam, V Nathan; Ramm, Grant A

2013-12-28

To investigate the role of genetic polymorphisms in the progression of hepatic fibrosis in hereditary haemochromatosis. A cohort of 245 well-characterised C282Y homozygous patients with haemochromatosis was studied, with all subjects having liver biopsy data and DNA available for testing. This study assessed the association of eight single nucleotide polymorphisms (SNPs) in a total of six genes including toll-like receptor 4 (TLR4), transforming growth factor-beta (TGF-β), oxoguanine DNA glycosylase, monocyte chemoattractant protein 1, chemokine C-C motif receptor 2 and interleukin-10 with liver disease severity. Genotyping was performed using high resolution melt analysis and sequencing. The results were analysed in relation to the stage of hepatic fibrosis in multivariate analysis incorporating other cofactors including alcohol consumption and hepatic iron concentration. There were significant associations between the cofactors of male gender (P = 0.0001), increasing age (P = 0.006), alcohol consumption (P = 0.0001), steatosis (P = 0.03), hepatic iron concentration (P < 0.0001) and the presence of hepatic fibrosis. Of the candidate gene polymorphisms studied, none showed a significant association with hepatic fibrosis in univariate or multivariate analysis incorporating cofactors. We also specifically studied patients with hepatic iron loading above threshold levels for cirrhosis and compared the genetic polymorphisms between those with no fibrosis vs cirrhosis however there was no significant effect from any of the candidate genes studied. Importantly, in this large, well characterised cohort of patients there was no association between SNPs for TGF-β or TLR4 and the presence of fibrosis, cirrhosis or increasing fibrosis stage in multivariate analysis. In our large, well characterised group of haemochromatosis subjects we did not demonstrate any relationship between candidate gene polymorphisms and hepatic fibrosis or cirrhosis.

Alkalosis in Critically Ill Patients with Severe Sepsis and Septic Shock

PubMed Central

Jazrawi, Allan; Miller, Jan; Baigi, Amir; Chew, Michelle

2017-01-01

Introduction Although metabolic alkalosis is a common occurrence in intensive care units (ICUs), no study has evaluated its prevalence or outcomes in patients with severe sepsis or septic shock. Methods This is a retrospective cohort study of critically ill patients suffering from severe sepsis and septic shock admitted to the ICUs of Halmstad and Varberg County hospitals. From 910 patient records, 627 patients met the inclusion criteria. We investigated the relationship between metabolic alkalosis and mortality. Further, we studied the relationship between metabolic alkalosis and ICU length of stay (LOS). Results Metabolic alkalosis was associated with decreased 30-day and 12-month mortalities. This effect was however lost when a multivariate analysis was conducted, correcting for age, gender, pH on admission, base excess (BE) on admission, Simplified Acute Physiology Score III (SAPS III) and acute kidney injury (AKI). We then analyzed for any dose-response effect between the severity of metabolic alkalosis and mortality and found no relationship. Bivariate analysis showed that metabolic alkalosis had a significant effect on the length of ICU stay. When adjusting for age, sex, pH at admission, BE at admission, SAPS III and AKI in a multivariate analysis, metabolic alkalosis significantly contributed to prolonged ICU length of stay. In two separate sensitivity analyses pure metabolic alkalosis and late metabolic alkalosis (time of onset >48 hours) were the only significant predictor of increased ICU length of stay. Conclusion Metabolic alkalosis did not have any effect on 30-day and 12-month mortalities after adjusting for age, sex, SAPS III-score, pH and BE on admission and AKI in a multivariate analysis. The presence of metabolic alkalosis was independently associated with an increased ICU length of stay. PMID:28045915

The effect of hospital mergers on long-term sickness absence among hospital employees: a fixed effects multivariate regression analysis using panel data

PubMed Central

2014-01-01

Background Hospitals are merging to become more cost-effective. Mergers are often complex and difficult processes with variable outcomes. The aim of this study was to analyze the effect of mergers on long-term sickness absence among hospital employees. Methods Long-term sickness absence was analyzed among hospital employees (N = 107 209) in 57 hospitals involved in 23 mergers in Norway between 2000 and 2009. Variation in long-term sickness absence was explained through a fixed effects multivariate regression analysis using panel data with years-since-merger as the independent variable. Results We found a significant but modest effect of mergers on long-term sickness absence in the year of the merger, and in years 2, 3 and 4; analyzed by gender there was a significant effect for women, also for these years, but only in year 4 for men. However, men are less represented among the hospital workforce; this could explain the lack of significance. Conclusions Mergers has a significant effect on employee health that should be taken into consideration when deciding to merge hospitals. This study illustrates the importance of analyzing the effects of mergers over several years and the need for more detailed analyses of merger processes and of the changes that may occur as a result of such mergers. PMID:24490750

Complications and outcomes of JJ stenting of the ureter in urological practice: A single-centre experience☆

PubMed Central

Al-Marhoon, Mohammed S.; Shareef, Omar; Venkiteswaran, Krishna P.

2012-01-01

Objective To determine the factors affecting the development of complications and the outcomes of JJ stenting. Patients and methods The study included 220 patients (133 males and 87 females, mean age 39.5 years, SD 15.4) who had self-retaining JJ ureteric stents placed while in the authors’ institution. Univariate and multivariate analyses were used to identify the significant variables affecting the development of complications and outcome of stenting (condition ‘improved’ or ‘not improved’). Results Using a modified Clavien classification, there were grade I, II, IIIa, IIIb complications in 67 (30.4%), 39 (17.7%), two (0.9%) and 23 (10.5%) patients, respectively, and none of grades IVa, IVb and V. Loin pain (10.9%) and urinary tract infection (10.9%) were the most common complications, followed by dysuria (7.7%). There were significant complications requiring treatment in 29% of patients, and 71.4% of patients improved after stenting. On multivariate analysis the significant independent factor affecting the complication rate was the stent length (P = 0.016), and the significant independent factor affecting the ‘improved’ outcome was age (P = 0.014). Conclusion Longer stents are associated with increased complication rates, and the older the patient the more likely they are to have a poor outcome after stenting. Future prospective multicentre studies with more patients are needed to confirm the present conclusions. PMID:26558052

Complications and outcomes of JJ stenting of the ureter in urological practice: A single-centre experience.

PubMed

Al-Marhoon, Mohammed S; Shareef, Omar; Venkiteswaran, Krishna P

2012-12-01

To determine the factors affecting the development of complications and the outcomes of JJ stenting. The study included 220 patients (133 males and 87 females, mean age 39.5 years, SD 15.4) who had self-retaining JJ ureteric stents placed while in the authors' institution. Univariate and multivariate analyses were used to identify the significant variables affecting the development of complications and outcome of stenting (condition 'improved' or 'not improved'). Using a modified Clavien classification, there were grade I, II, IIIa, IIIb complications in 67 (30.4%), 39 (17.7%), two (0.9%) and 23 (10.5%) patients, respectively, and none of grades IVa, IVb and V. Loin pain (10.9%) and urinary tract infection (10.9%) were the most common complications, followed by dysuria (7.7%). There were significant complications requiring treatment in 29% of patients, and 71.4% of patients improved after stenting. On multivariate analysis the significant independent factor affecting the complication rate was the stent length (P = 0.016), and the significant independent factor affecting the 'improved' outcome was age (P = 0.014). Longer stents are associated with increased complication rates, and the older the patient the more likely they are to have a poor outcome after stenting. Future prospective multicentre studies with more patients are needed to confirm the present conclusions.

Geographic inequities in liver allograft supply and demand: does it affect patient outcomes?

PubMed

Rana, Abbas; Kaplan, Bruce; Riaz, Irbaz B; Porubsky, Marian; Habib, Shahid; Rilo, Horacio; Gruessner, Angelika C; Gruessner, Rainer W G

2015-03-01

Significant geographic inequities mar the distribution of liver allografts for transplantation. We analyzed the effect of geographic inequities on patient outcomes. During our study period (January 1 through December 31, 2010), 11,244 adult candidates were listed for liver transplantation: 5,285 adult liver allografts became available, and 5,471 adult recipients underwent transplantation. We obtained population data from the 2010 United States Census. To determine the effect of regional supply and demand disparities on patient outcomes, we performed linear regression and multivariate Cox regression analyses. Our proposed disparity metric, the ratio of listed candidates to liver allografts available varied from 1.3 (region 11) to 3.4 (region 1). When that ratio was used as the explanatory variable, the R(2) values for outcome measures were as follows: 1-year waitlist mortality, 0.23 and 1-year posttransplant survival, 0.27. According to our multivariate analysis, the ratio of listed candidates to liver allografts available had a significant effect on waitlist survival (hazards ratio, 1.21; 95% confidence interval, 1.04-1.40) but was not a significant risk factor for posttransplant survival. We found significant differences in liver allograft supply and demand--but these differences had only a modest effect on patient outcomes. Redistricting and allocation-sharing schemes should seek to equalize regional supply and demand rather than attempting to equalize patient outcomes.

Recent Findings on the Prevalence of E-Cigarette Use Among Adults in the U.S.

PubMed

Wilson, Fernando A; Wang, Yang

2017-03-01

This study uses a recent source of nationally representative data from in-person surveys to examine national estimates of e-cigarette use among adults and their relationship with demographic, socioeconomic, and health behavior measures. Data were provided by the National Health Interview Survey, conducted by the Centers for Disease Control and Prevention. A total of 34,356 respondents aged ≥18 years were examined for 2014, the most recent and only year in which the National Health Interview Survey included questions on e-cigarette use. E-cigarette information included ever and current use. Univariate and multivariable logistic regression analyses were performed, adjusting for age, sex, race/ethnicity, education level, marital status, poverty, and smoking status. Analyses were conducted in 2016. Compared with those who had never tried e-cigarettes, e-cigarette users were more likely to be younger, male, non-Hispanic white, non-married, poorer, and current smokers. Multivariable logistic regression suggested that respondents with high school or some college education had significantly higher adjusted odds of ever using e-cigarettes relative to those with less than high school education. However, the adjusted odds were not significantly different for college or graduate school education. The results suggest that, unlike tobacco use, ever using e-cigarettes is positively related to income. Interestingly, e-cigarette use exhibits a non-linear relationship with education. Reasons for the relationship of e-cigarettes with education are unclear and warrant further research. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Predicting Dural Tear in Compound Depressed Skull Fractures: A Prospective Multicenter Correlational Study.

PubMed

Salia, Shemsedin Musefa; Mersha, Hagos Biluts; Aklilu, Abenezer Tirsit; Baleh, Abat Sahlu; Lund-Johansen, Morten

2018-06-01

Compound depressed skull fracture (DSF) is a neurosurgical emergency. Preoperative knowledge of dural status is indispensable for treatment decision making. This study aimed to determine predictors of dural tear from clinical and imaging characteristics in patients with compound DSF. This prospective, multicenter correlational study in neurosurgical hospitals in Addis Ababa, Ethiopia, included 128 patients operated on from January 1, 2016, to October 31, 2016. Clinical, imaging, and intraoperative findings were evaluated. Univariate and multivariate analyses were used to establish predictors of dural tear. A logistic regression model was developed to predict probability of dural tear. Model validation was done using the receiver operating characteristic curve. Dural tear was seen in 55.5% of 128 patients. Demographics, injury mechanism, clinical presentation, and site of DSF had no significant correlation with dural tear. In univariate and multivariate analyses, depth of fracture depression (odds ratio 1.3, P < 0.001), pneumocephalus (odds ratio 2.8, P = 0.005), and brain contusions/intracerebral hematoma (odds ratio 5.5, P < 0.001) were significantly correlated with dural tear. We developed a logistic regression model (diagnostic test) to calculate probability of dural tear. Using the receiver operating characteristic curve, we determined the cutoff value for a positive test giving the highest accuracy to be 30% with a corresponding sensitivity of 93.0% and specificity of 43.9%. Dural tear in compound DSF can be predicted with 93.0% sensitivity using preoperative findings and may guide treatment decision making in resource-limited settings where risk of extensive cranial surgery outweighs the benefit. Copyright © 2018 Elsevier Inc. All rights reserved.

Determination of sex from radiographic measurements of the humerus by discriminant function analysis in Saudi population, Qassim region, KSA.

PubMed

Shehri, Fahad Al; Soliman, Khaled E A

2015-08-01

Diagnosis of sex from skeleton or individual bone plays an important role in identifying unknown bodies, parts of bodies or skeletal remains for forensic purposes. This study aims to examine the applicability of the measurements taken from the humerus to assess sex, and to contribute to establishing discriminant function equations for Saudi populations for medico legal applications. Archived X-ray radiographs of humerus for 387 patients (216 males & 171 females) who attended the orthopedic clinics at Suleiman Al-Habib Hospital, Qassim region, KSA in the period from January 2011 to December 2013 were reviewed and analyzed. Five dimensions, including maximum length, vertical head diameter, diameter of head+greater tubercle, right-left diameter at midshaft, and epicondylar breadth were taken and subjected to Univariate and multivariate discriminant function analysis. The studied radiographic dimensions of the humerus indicate that there are significant differences (p<0.05) between the males and females measurements while the difference between right and left measurements was not significant. The findings revealed that the proximal part of the humerus has greater diagnostic accuracy than distal and middle parts. Accuracy of correct classification varies between 68.0% (epicondylar breadth) and 90.4% (vertical head diameter) for univariate analyses. When the multivariate analyses were conducted, three functions were produced, with the accuracy of ranging between 88.4% and 94.3%. These findings suggested that the dimensions of the humerus, especially the measurements taken from the proximal parts, could be used successfully for sex diagnosis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

The clinical value of circulating tumour cells (CTCs) in patients undergoing pulmonary metastasectomy for metastatic colorectal cancer.

PubMed

Hashimoto, Masaki; Tanaka, Fumihiro; Yoneda, Kazue; Takuwa, Teruhisa; Kuroda, Ayumi; Matsumoto, Seiji; Okumura, Yoshitomo; Kondo, Nobuyuki; Tsujimura, Tohru; Nakano, Takashi; Hasegawa, Seiki

2018-03-01

Circulating tumour cells (CTCs) are a potential surrogate for distant metastasis and are considered a useful clinical prognostic marker for metastatic colorectal cancer (mCRC). This prospective study evaluated the preoperative CTC count as a prognostic factor for pulmonary metastasectomy in mCRC patients. Seventy-nine mCRC patients who underwent curative-intent pulmonary metastasectomy were included. Preoperatively, 7.5 mL of peripheral blood from each patient was quantitatively evaluated for CTCs with the CellSearch ® system. The clinical significance of CTC count was evaluated according to Kaplan-Meier analyses and log-rank test. Multivariate analyses of the perioperative variables were performed. The distribution of CTC counts were as follows; 0 in 66 patients (83.5%), 1 in eight patients (10.1%), 2 in three patients (3.8%), and 3 and 6 in one patient (1.3%). The patients with multiple CTCs (CTC count ≥2) had significant shorter disease-free survival (DFS) (P=0.005, median DFS; 19.8 vs . 8.6 months) and overall survival (OS) (P=0.035, median DFS; not reached vs. 37.8 months), respectively. Multivariate analysis showed the patients with multiple CTCs had elevated risk of recurrence [hazard ratio (HR), 3.28; 95% confidence interval (CI), 1.24-8.67; P=0.017]. The detected rate of CTCs was quite low in mCRC patients who underwent pulmonary metastasectomy. The patient with multiple CTCs had shorter DFS in this study. The larger prospective clinical study is needed to establish the meaning of CTC in mCRC candidate for pulmonary metastasectomy.

Gene Methylation and Cytological Atypia in Random Fine Needle Aspirates for Assessment of Breast Cancer Risk

PubMed Central

Hafeez, Sidra; Bujanda, Zoila Lopez; Chatterton, Robert T.; Jacobs, Lisa K.; Khouri, Nagi F.; Ivancic, David; Kenney, Kara; Shehata, Christina; Jeter, Stacie C.; Wolfman, Judith A.; Zalles, Carola M.; Huang, Peng

2016-01-01

Methods to determine individualized breast cancer risk lack sufficient sensitivity to select women most likely to benefit from preventive strategies. Alterations in DNA methylation occur early in breast cancer. We hypothesized that cancer-specific methylation markers could enhance breast cancer risk assessment. We evaluated 380 women without a history of breast cancer. We determined their menopausal status or menstrual cycle phase, risk of developing breast cancer (Gail model), and breast density, and obtained random fine needle aspiration (rFNA) samples for assessment of cytopathology and cumulative methylation index (CMI). Eight methylated gene markers were identified through whole genome methylation analysis and included novel and previously established breast cancer detection genes. We performed correlative and multivariate linear regression analyses to evaluate DNA methylation of a gene panel as a function of clinical factors associated with breast cancer risk. CMI and individual gene methylation were independent of age, menopausal status or menstrual phase, lifetime Gail risk score, and breast density. CMI and individual gene methylation for the eight genes increased significantly (p<0.001) with increasing cytological atypia. The findings were verified with multivariate analyses correcting for age, log (Gail), log (percent density), rFNA cell number and BMI. Our results demonstrate a significant association between cytological atypia and high CMI, which does not vary with menstrual phase or menopause and is independent of Gail risk and mammographic density. Thus CMI is an excellent candidate breast cancer risk biomarker, warranting larger prospective studies to establish its utility for cancer risk assessment. PMID:27261491

Variations in management of common inpatient pediatric illnesses: hospitalists and community pediatricians.

PubMed

Conway, Patrick H; Edwards, Sarah; Stucky, Erin R; Chiang, Vincent W; Ottolini, Mary C; Landrigan, Christopher P

2006-08-01

The goal was to test the hypothesis that pediatric hospitalists use evidence-based therapies and tests more consistently in the care of inpatients and use therapies and tests of unproven benefit less often, compared with community pediatricians. A national survey was administered to hospitalists and a random sample of community pediatricians. Hospitalists and community pediatricians reported their frequency of use of diagnostic tests and therapies, on 5-point Likert scales (ranging from never to almost always), for common inpatient pediatric illnesses. Responses were compared in univariate and multivariable logistic regression analyses controlling for gender, race, years out of residency, days spent attending per year, hospital practice type, and completion of fellowship/postgraduate training. Two hundred thirteen pediatric hospitalists and 352 community pediatricians responded. In multivariable regression analyses, hospitalists were significantly more likely to report often or almost always using the following evidence-based therapies for asthma: albuterol and ipratropium in the first 24 hours of hospitalization. After the first urinary tract infection, hospitalists were more likely to report obtaining the recommended renal ultrasound and voiding cystourethrogram. Hospitalists were significantly more likely than community pediatricians to report rarely or never using the following therapies of unproven benefit: levalbuterol, inhaled steroid therapy, and oral steroid therapy for bronchiolitis; stool culture and rotavirus testing for gastroenteritis; and ipratropium after 24 hours of hospitalization for asthma. Overall, in comparison with community pediatricians, hospitalists reported greater adherence to evidence-based therapies and tests in the care of hospitalized patients and less use of therapies and tests of unproven benefit.

Urban food environments and residents' shopping behaviors.

PubMed

Cannuscio, Carolyn C; Tappe, Karyn; Hillier, Amy; Buttenheim, Alison; Karpyn, Allison; Glanz, Karen

2013-11-01

Food environments may promote or undermine healthy behaviors, but questions remain regarding how individuals interact with their local food environments. This study incorporated an urban food environment audit as well as an examination of residents' food shopping behaviors within that context. In 2010, the research team audited the variety and healthfulness of foods available in 373 Philadelphia stores, using the validated Nutrition Environment Measures Survey in Stores (NEMS-S); higher scores indicate more diverse and healthful food inventories. The team also surveyed urban residents (n=514) regarding their food shopping. Descriptive and multivariate analyses (conducted in 2012) assessed variation in retail food environments and in shoppers' store choices. Corner and convenience stores were common (78.6% of food retail outlets) and had the lowest mean NEMS-S scores of any store type. Most participants (94.5%) did their primary food shopping at higher-scoring chain supermarkets, and the majority of participants did not shop at the supermarket closest to home. Supermarket offerings varied, with significantly fewer healthful foods at supermarkets closest to the homes of disadvantaged residents. In multivariate analyses, participants were significantly more likely to shop at supermarkets closest to home if those supermarkets had higher NEMS-S scores. These data suggest that, when possible, shoppers chose supermarkets that offered more variety and more healthful foods. Findings from this study also reinforce concern regarding unhealthy immediate food environments for disadvantaged residents, who disproportionately relied on nearby stores with more limited food items. Interventions to improve nutrition and health should address not only food store proximity but also diversity of healthful foods available. © 2013 American Journal of Preventive Medicine.

SOX9 expression predicts relapse of stage II colon cancer patients.

PubMed

Marcker Espersen, Maiken Lise; Linnemann, Dorte; Christensen, Ib Jarle; Alamili, Mahdi; Troelsen, Jesper T; Høgdall, Estrid

2016-06-01

The aim of this study was to investigate if the protein expression of sex-determining region y-box 9 (SOX9) in primary tumors could predict relapse of stage II colon cancer patients. One hundred forty-four patients with stage II primary colon cancer were retrospectively enrolled in the study. SOX9 expression was evaluated by immunohistochemistry, and mismatch repair status was assessed by both immunohistochemistry and promoter hypermethylation assay. High SOX9 expression at the invasive front was significantly associated with lower risk of relapse when including the SOX9 expression as a continuous variable (from low to high expression) in univariate (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.56-0.94; P = .01) and multivariate Cox proportional hazards analyses (HR, 0.75; 95% CI, 0.58-0.96; P = .02), adjusting for mismatch repair deficiency and histopathologic risk factors. Conversely, low SOX9 expression at the invasive front was significantly associated with high risk of relapse, when including SOX9 expression as a dichotomous variable, in univariate (HR, 2.32; 95% CI, 1.14-4.69; P = .02) and multivariate analyses (HR, 2.32; 95% CI, 1.14-4.69; P = .02), adjusting for histopathologic risk factors and mismatch repair deficiency. In conclusion, high levels of SOX9 of primary stage II colon tumors predict low risk of relapse, whereas low levels of SOX9 predict high risk of relapse. SOX9 may have an important value as a biomarker when evaluating risk of relapse for personalized treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

Associations Between Internet-Based Professional Social Networking and Emotional Distress.

PubMed

Jones, Jacquelynn R; Colditz, Jason B; Shensa, Ariel; Sidani, Jaime E; Lin, Liu Yi; Terry, Martha Ann; Primack, Brian A

2016-10-01

Professional social networking websites are commonly used among young professionals. In light of emerging concerns regarding social networking use and emotional distress, the purpose of this study was to investigate the association between frequency of use of LinkedIn, the most commonly used professional social networking website, and depression and anxiety among young adults. In October 2014, we assessed a nationally representative sample of 1,780 U.S. young adults between the ages of 19-32 regarding frequency of LinkedIn use, depression and anxiety, and sociodemographic covariates. We measured depression and anxiety using validated Patient-Reported Outcomes Measurement Information System measures. We used bivariable and multivariable logistic regression to assess the association between LinkedIn use and depression and anxiety, while controlling for age, sex, race, relationship status, living situation, household income, education level, and overall social media use. In weighted analyses, 72% of participants did not report use of LinkedIn, 16% reported at least some use, but less than once each week, and 12% reported use at least once per week. In multivariable analyses controlling for all covariates, compared with those who did not use LinkedIn, participants using LinkedIn at least once per week had significantly greater odds of increased depression (adjusted odds ratio [AOR] = 2.10, 95% confidence interval [CI] = 1.31-3.38) and increased anxiety (AOR = 2.79, 95% CI = 1.72-4.53). LinkedIn use was significantly related to both outcomes in a dose-response manner. Future research should investigate directionality of this association and possible reasons for it.

 Alkaline phosphatase normalization is a biomarker of improved survival in primary sclerosing cholangitis.

PubMed

Hilscher, Moira; Enders, Felicity B; Carey, Elizabeth J; Lindor, Keith D; Tabibian, James H

2016-01-01

 Introduction. Recent studies suggest that serum alkaline phosphatase may represent a prognostic biomarker in patients with primary sclerosing cholangitis. However, this association remains poorly understood. Therefore, the aim of this study was to investigate the prognostic significance and clinical correlates of alkaline phosphatase normalization in primary sclerosing cholangitis. This was a retrospective cohort study of patients with a new diagnosis of primary sclerosing cholangitis made at an academic medical center. The primary endpoint was time to hepatobiliaryneoplasia, liver transplantation, or liver-related death. Secondary endpoints included occurrence of and time to alkaline phosphatase normalization. Patients who did and did not achieve normalization were compared with respect to clinical characteristics and endpoint-free survival, and the association between normalization and the primary endpoint was assessed with univariate and multivariate Cox proportional-hazards analyses. Eighty six patients were included in the study, with a total of 755 patient-years of follow-up. Thirty-eight patients (44%) experienced alkaline phosphatase normalization within 12 months of diagnosis. Alkaline phosphatase normalization was associated with longer primary endpoint-free survival (p = 0.0032) and decreased risk of requiring liver transplantation (p = 0.033). Persistent normalization was associated with even fewer adverse endpoints as well as longer survival. In multivariate analyses, alkaline phosphatase normalization (adjusted hazard ratio 0.21, p = 0.012) and baseline bilirubin (adjusted hazard ratio 4.87, p = 0.029) were the only significant predictors of primary endpoint-free survival. Alkaline phosphatase normalization, particularly if persistent, represents a robust biomarker of improved long-term survival and decreased risk of requiring liver transplantation in patients with primary sclerosing cholangitis.

Variable uptake of recommended interventions to reduce mother-to-child transmission of HIV in Australia, 1982-2005.

PubMed

Giles, Michelle L; McDonald, Ann M; Elliott, Elizabeth J; Ziegler, John B; Hellard, Margaret E; Lewin, Sharon R; Kaldor, John M

2008-08-04

To analyse the uptake of interventions known to reduce the risk of perinatal HIV transmission among Australian women with HIV infection (who knew their HIV status before delivery), and identify predictors of uptake. Retrospective analysis of perinatal HIV surveillance data in Australia. Women reported as having HIV infection and having given birth to a child (1982-2005) were identified through three mechanisms: an informal network of clinicians (1982-1993); an active surveillance program through paediatricians (since 1993); and state health department reports of children born to women newly diagnosed with HIV (since 1995). Uptake of interventions - avoidance of breastfeeding (after 1985), use of zidovudine during pregnancy (after 1994), and elective caesarean section (after 1999). Factors associated with uptake of these interventions were identified by univariate and multivariate analyses. 367 live births were reported in 291 women with HIV infection. Among the subgroup diagnosed with HIV infection before delivery, 4/255 (1.6%) elected to breastfeed (post 1985), 44/185 (24%) did not receive zidovudine (after 1994), and 41/118 (35%) did not have an elective caesarean section (after 1999). In multivariate analysis, there were significant differences in uptake of zidovudine and elective caesarean section according to year of birth and state in which the birth took place. In Australia between 1982 and 2005, uptake of interventions to reduce mother-to-child transmission of HIV was high. There were significant differences associated with use of zidovudine and mode of delivery according to location of delivery and year of birth.

Clinical predictors of interpersonal functioning in patients with bipolar disorder.

PubMed

Rosa, Adriane R; Bonnin, Caterina Mar; Mazzarini, Luis; Amann, Benedikt; Kapczinski, Flavio P; Vieta, Eduard

2009-04-01

Functional impairment has been repeatedly reported in patients with bipolar disorder even during clinical remission. Less is known about specific domains, such as interpersonal relationships. The aim of this study was to identify clinical predictors of poor interpersonal relationships. Using a specific subscale of the Functioning Assessment Short Test (FAST), we assessed the interpersonal relationships of a sample of 71 euthymic bipolar (Hamilton Depression Rating Scale [HAM-D] < 8; Young Mania Rating Scale [YMRS] < 5) patients. The sample was divided into two categories: low vs. high level functioning in interpersonal relationships according to the median of the sample. Multivariate analyses were applied to identify significant predictors of interpersonal functioning. Age (p=0.026), the number of previous depressive and mixed episodes and HAM-D scores differed significantly between the two groups (p<0.05). For manic episodes, only a tendency was detected (p=0.064). After running multivariate analyses, age (p=0.026), depressive symptoms (p=0.055) and the number of previous manic episodes (p=0.033) could be considered predictors of poor interpersonal functioning. The model predicted 83.3% of the variance (R=0.59; gl=1; p<0.001). Our results indicate a link between greater impairment in interpersonal relationships and being older and having more residual symptoms and a higher number of previous manic episodes. Patients with these features should be carefully monitored and specific psychosocial interventions should be implemented to improve their outcome. Copyright © 2009 Sociedad Española de Psiquiatría and Sociedad Española de Psiquiatría Biológica. Published by Elsevier Espana. All rights reserved.

Analysis of Exhaled Breath Volatile Organic Compounds in Inflammatory Bowel Disease: A Pilot Study.

PubMed

Hicks, Lucy C; Huang, Juzheng; Kumar, Sacheen; Powles, Sam T; Orchard, Timothy R; Hanna, George B; Williams, Horace R T

2015-09-01

Distinguishing between the inflammatory bowel diseases [IBD], Crohn's disease [CD] and ulcerative colitis [UC], is important for determining management and prognosis. Selected ion flow tube mass spectrometry [SIFT-MS] may be used to analyse volatile organic compounds [VOCs] in exhaled breath: these may be altered in disease states, and distinguishing breath VOC profiles can be identified. The aim of this pilot study was to identify, quantify, and analyse VOCs present in the breath of IBD patients and controls, potentially providing insights into disease pathogenesis and complementing current diagnostic algorithms. SIFT-MS breath profiling of 56 individuals [20 UC, 18 CD, and 18 healthy controls] was undertaken. Multivariate analysis included principal components analysis and partial least squares discriminant analysis with orthogonal signal correction [OSC-PLS-DA]. Receiver operating characteristic [ROC] analysis was performed for each comparative analysis using statistically significant VOCs. OSC-PLS-DA modelling was able to distinguish both CD and UC from healthy controls and from one other with good sensitivity and specificity. ROC analysis using combinations of statistically significant VOCs [dimethyl sulphide, hydrogen sulphide, hydrogen cyanide, ammonia, butanal, and nonanal] gave integrated areas under the curve of 0.86 [CD vs healthy controls], 0.74 [UC vs healthy controls], and 0.83 [CD vs UC]. Exhaled breath VOC profiling was able to distinguish IBD patients from controls, as well as to separate UC from CD, using both multivariate and univariate statistical techniques. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Effect of Cobicistat on Tenofovir Disoproxil Fumarate (TDF): What Is True for TAF May Also Be True for TDF.

PubMed

Cattaneo, Dario; Minisci, Davide; Baldelli, Sara; Mazzali, Cristina; Giacomelli, Andrea; Milazzo, Laura; Meraviglia, Paola; Resnati, Chiara; Rizzardini, Giuliano; Clementi, Emilio; Galli, Massimo; Gervasoni, Cristina

2018-01-01

The dose of tenofovir alafenamide is reduced from 25 to 10 mg daily when given with boosting agents. However, such dose reduction has never been adopted for tenofovir disoproxil fumarate (TDF). In this study, we aim to quantify the effect of cobicistat (COBI) both on tenofovir concentrations and TDF durability in real life setting. HIV-positive patients receiving TDF-containing antiretroviral therapies with at least 1 assessment of tenofovir plasma trough concentrations were included in the study. Univariate and multivariate regression analyses were performed considering tenofovir concentration as the dependent variable and clinical characteristics as independent covariates. Subsequently, survival and Cox analyses were performed considering as the primary outcome TDF discontinuation for any reasons. Patients were given TDF with protease inhibitors/ritonavir (n = 212), non-nucleoside reverse transcriptase inhibitors (n = 176), integrase inhibitors (dolutegravir or raltegravir, n = 46), or with elvitegravir/COBI (ELV/COBI) (n = 76). By multivariate analysis, concomitant antiretroviral therapies resulted significantly associated with tenofovir levels, with the highest drug concentrations measured in patients given ELV/COBI. By survival analysis, we found that patients given TDF with ELV/COBI had the lowest rate of drug durability. Overall, these patients had a 2.3-fold increased risk to experience TDF discontinuation. Coadministration with COBI resulted in significantly higher tenofovir concentrations and higher TDF discontinuation compared with other antiretroviral regimens. Accordingly, the possibility that the lack of proper dose adjustment for TDF when given with COBI might have biased the safety comparisons with tenofovir alafenamide during registrative trials cannot be ruled out.

Multivariate geometry as an approach to algal community analysis

USGS Publications Warehouse

Allen, T.F.H.; Skagen, S.

1973-01-01

Multivariate analyses are put in the context of more usual approaches to phycological investigations. The intuitive common-sense involved in methods of ordination, classification and discrimination are emphasised by simple geometric accounts which avoid jargon and matrix algebra. Warnings are given that artifacts result from technique abuses by the naive or over-enthusiastic. An analysis of a simple periphyton data set is presented as an example of the approach. Suggestions are made as to situations in phycological investigations, where the techniques could be appropriate. The discipline is reprimanded for its neglect of the multivariate approach.

Connectedness, social support and internalising emotional and behavioural problems in adolescents displaced by the Chechen conflict

PubMed Central

Betancourt, Theresa S.; Salhi, Carmel; Buka, Stephen; Leaning, Jennifer; Dunn, Gillian; Earls, Felton

2013-01-01

The study investigated factors associated with internalising emotional and behavioural problems among adolescents displaced during the most recent Chechen conflict. A cross-sectional survey (N=183) examined relationships between social support and connectedness with family, peers and community in relation to internalising problems. Levels of internalising were higher in displaced Chechen youth compared to published norms among non-referred youth in the United States and among Russian children not affected by conflict. Girls demonstrated higher problem scores compared to boys. Significant inverse correlations were observed between family, peer and community connectedness and internalising problems. In multivariate analyses, family connectedness was indicated as a significant predictor of internalising problems, independent of age, gender, housing status and other forms of support evaluated. Sub-analyses by gender indicated stronger protective relationships between family connectedness and internalising problems in boys. Results indicate that family connectedness is an important protective factor requiring further exploration by gender in war-affected adolescents. PMID:22443099

Using a health message with a testimonial to motivate colon cancer screening: associations with perceived identification and vividness.

PubMed

Dillard, Amanda J; Main, Jackie L

2013-12-01

Research suggests that testimonials, or first-person narratives, influence health behavior and health-related decision making, but few studies have examined conceptual factors that may be responsible for these effects. In the current study, older adults who were due for colorectal cancer screening read a message about screening that included a testimonial from a similar other who had previously made the screening decision. We assessed participants' identification with the testimonial character and the degree to which they found the message to be vivid. We explored associations between these factors and participants' knowledge following the message, mood, certainty about screening, and their behavioral intentions to look for more information about screening and to have a test in the next year. In bivariate analyses, identification and vividness were both significantly, positively associated with knowledge and behavioral intentions to have screening in the next year. However, multivariate analyses revealed that only vividness remained significantly associated with knowledge and intentions to be screened.

Multivariate Quantitative Chemical Analysis

NASA Technical Reports Server (NTRS)

Kinchen, David G.; Capezza, Mary

1995-01-01

Technique of multivariate quantitative chemical analysis devised for use in determining relative proportions of two components mixed and sprayed together onto object to form thermally insulating foam. Potentially adaptable to other materials, especially in process-monitoring applications in which necessary to know and control critical properties of products via quantitative chemical analyses of products. In addition to chemical composition, also used to determine such physical properties as densities and strengths.

Causal diagrams and multivariate analysis III: confound it!

PubMed

Jupiter, Daniel C

2015-01-01

This commentary concludes my series concerning inclusion of variables in multivariate analyses. We take up the issues of confounding and effect modification and summarize the work we have thus far done. Finally, we provide a rough algorithm to help guide us through the maze of possibilities that we have outlined. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

The relationship between physical appearance concerns, disgust, and anti-fat prejudice.

PubMed

O'Brien, Kerry S; Daníelsdóttir, Sigrún; Ólafsson, Ragnar P; Hansdóttir, Ingunn; Fridjónsdóttir, Thorarna G; Jónsdóttir, Halla

2013-09-01

This study examined relationships between physical appearance concerns (fear of fat, body image disturbance; BIDQ), disgust, and anti-fat prejudice (dislike, blame), and tested whether disgust mediates relationships between physical appearance concerns and anti-fat prejudice. Participants (N=1649; age=28 years) provided demographic data and completed measures of anti-fat prejudice, tendency to feel disgust, and physical appearance concerns. Univariate, multivariate, and mediation analyses were conducted. Univariate and multivariate associations were found between fear of fat, BIDQ, disgust, and anti-fat prejudice for women. For women only, mediation analyses showed that disgust partially mediated relationships between physical appearance concerns and dislike of fat people. For men, univariate and multivariate relationships were found between fear of fat, and dislike and blame of fat people, but disgust was not related to anti-fat prejudice. Newer constructs centering on physical appearance concerns and disgust appear promising candidates for understanding anti-fat prejudice. Copyright © 2013 Elsevier Ltd. All rights reserved.

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.

An exploration of socio-economic and food characteristics of high trans fatty acid consumers in the Dutch and UK national surveys after voluntary product reformulation.

PubMed

Rippin, H L; Hutchinson, J; Ocke, M; Jewell, J; Breda, J J; Cade, J E

2017-01-01

Trans fatty acids (TFA) increase the risk of mortality and chronic diseases. TFA intakes have fallen since reformulation, but may still be high in certain, vulnerable, groups. This paper investigates socio-economic and food consumption characteristics of high TFA consumers after voluntary reformulation in the Netherlands and UK. Post-reformulation data of adults aged 19-64 was analysed in two national surveys: the Dutch National Food Consumption Survey (DNFCS) collected 2007-2010 using 2*24hr recalls (N = 1933) and the UK National Diet and Nutrition Survey (NDNS) years 3&4 collected 2010/11 and 2011/12 using 4-day food diaries (N = 848). The socio-economic and food consumption characteristics of the top 10% and remaining 90% TFA consumers were compared. Means of continuous data were compared using t-tests and categorical data means using chi-squared tests. Multivariate logistic regression models indicated which socio-demographic variables were associated with high TFA consumption. In the Dutch analyses, women and those born outside the Netherlands were more likely to be top 10% TFA consumers than men and Dutch-born. In the UK unadjusted analyses there was no significant trend in socio-economic characteristics between high and lower TFA consumers, but there were regional differences in the multivariate logistic regression analyses. In the Netherlands, high TFA consumers were more likely to be consumers of cakes, buns & pastries; cream; and fried potato than the remaining 90%. Whereas in the UK, high TFA consumers were more likely to be consumers of lamb; cheese; and dairy desserts and lower crisps and savoury snack consumers. Some socio-demographic differences between high and lower TFA consumers were evident post-reformulation. High TFA consumers in the Dutch 2007-10 survey appeared more likely to obtain TFA from artificial sources than those in the UK survey. Further analyses using more up-to-date food composition databases may be needed.

Spatial patterns of brain atrophy in MCI patients, identified via high-dimensional pattern classification, predict subsequent cognitive decline

PubMed Central

Fan, Yong; Batmanghelich, Nematollah; Clark, Chris M.; Davatzikos, Christos

2010-01-01

Spatial patterns of brain atrophy in mild cognitive impairment (MCI) and Alzheimer’s disease (AD) were measured via methods of computational neuroanatomy. These patterns were spatially complex and involved many brain regions. In addition to the hippocampus and the medial temporal lobe gray matter, a number of other regions displayed significant atrophy, including orbitofrontal and medial-prefrontal grey matter, cingulate (mainly posterior), insula, uncus, and temporal lobe white matter. Approximately 2/3 of the MCI group presented patterns of atrophy that overlapped with AD, whereas the remaining 1/3 overlapped with cognitively normal individuals, thereby indicating that some, but not all, MCI patients have significant and extensive brain atrophy in this cohort of MCI patients. Importantly, the group with AD-like patterns presented much higher rate of MMSE decline in follow-up visits; conversely, pattern classification provided relatively high classification accuracy (87%) of the individuals that presented relatively higher MMSE decline within a year from baseline. High-dimensional pattern classification, a nonlinear multivariate analysis, provided measures of structural abnormality that can potentially be useful for individual patient classification, as well as for predicting progression and examining multivariate relationships in group analyses. PMID:18053747

A Two Year Longitudinal Outcome Study of Addicted Health Care Professionals: An Investigation of the Role of Personality Variables

PubMed Central

Angres, Daniel; Bologeorges, Stephanie; Chou, Jessica

2013-01-01

The co-morbidity of personality disorders (PDs) and other dysregulatory personality patterns with addiction have been well-established, although few studies have examined this interplay on long-term sobriety outcome. In addition, health care professionals suffering from addiction have both a significant public health impact and a unique set of treatment and recovery challenges. The aim of this study was to investigate if personality variables differentiated sobriety outcome in this population over a two year interval. A clinical sample of health care professionals participated in a substance abuse hospital treatment program individually tailored with respect to personality. Participants took the Temperament and Character Inventory and the Millon Clinical Multiaxial Inventory at intake, and were tracked two years post-discharge to determine sobriety status. Univariate analyses showed antisocial personality, female gender, and alcohol dependence were independent predictors of relapse, however a significant relationship between personality and substance use did not exist in multivariate analysis when controlling for demographic variables The lack of multivariate relationships demonstrates the heterogeneity in self-report measures of personality, which suggests the interplay of personality and addiction is complex and individualized. PMID:23531922

Asian American Women in California: A Pooled Analysis of Predictors for Breast and Cervical Cancer Screening

PubMed Central

Breen, Nancy; Liu, Benmei; Lee, Richard; Kagawa-Singer, Marjorie

2015-01-01

Objectives. We examined patterns of cervical and breast cancer screening among Asian American women in California and assessed their screening trends over time. Methods. We pooled weighted data from 5 cycles of the California Health Interview Survey (2001, 2003, 2005, 2007, 2009) to examine breast and cervical cancer screening trends and predictors among 6 Asian nationalities. We calculated descriptive statistics, bivariate associations, multivariate logistic regressions, predictive margins, and 95% confidence intervals. Results. Multivariate analyses indicated that Papanicolaou test rates did not significantly change over time (77.9% in 2001 vs 81.2% in 2007), but mammography receipt increased among Asian American women overall (75.6% in 2001 vs 81.8% in 2009). Length of time in the United States was associated with increased breast and cervical cancer screening among all nationalities. Sociodemographic and health care access factors had varied effects, with education and insurance coverage significantly predicting screening for certain groups. Overall, we observed striking variation by nationality. Conclusions. Our results underscore the need for intervention and policy efforts that are targeted to specific Asian nationalities, recent immigrants, and individuals without health care access to increase screening rates among Asian women in California. PMID:25521898

Short leukocyte telomere length is associated with obesity in American Indians: the Strong Heart Family study.

PubMed

Chen, Shufeng; Yeh, Fawn; Lin, Jue; Matsuguchi, Tet; Blackburn, Elizabeth; Lee, Elisa T; Howard, Barbara V; Zhao, Jinying

2014-05-01

Shorter leukocyte telomere length (LTL) has been associated with a wide range of age-related disorders including cardiovascular disease (CVD) and diabetes. Obesity is an important risk factor for CVD and diabetes. The association of LTL with obesity is not well understood. This study for the first time examines the association of LTL with obesity indices including body mass index, waist circumference, percent body fat, waist-to-hip ratio, and waist-to-height ratio in 3,256 American Indians (14-93 years old, 60% women) participating in the Strong Heart Family Study. Association of LTL with each adiposity index was examined using multivariate generalized linear mixed model, adjusting for chronological age, sex, study center, education, lifestyle (smoking, alcohol consumption, and total energy intake), high-sensitivity C-reactive protein, hypertension and diabetes. Results show that obese participants had significantly shorter LTL than non-obese individuals (age-adjusted P=0.0002). Multivariate analyses demonstrate that LTL was significantly and inversely associated with all of the studied obesity parameters. Our results may shed light on the potential role of biological aging in pathogenesis of obesity and its comorbidities.

Relationship Characteristics Associated with Teen Dating Violence Perpetration.

PubMed

Vivolo-Kantor, Alana M; Massetti, Greta; Niolon, Phyllis; Foshee, Vangie; McNaughton-Reyes, Luz

2016-01-01

Teen dating violence (TDV) is unstable across dating relationships, suggesting that characteristics of the relationship could be related to TDV. Few empirical studies have examined these links. This study examined associations between relationship characteristics and TDV perpetration among teens and sex differences in those associations. Relationship characteristics examined include tactics used to manipulate partners; ways of responding to relationship problems; relationship duration; exclusivity of the relationship; age difference between partners; and history of sexual intercourse with partner. Data were drawn from 667 teens in a current relationship (62.5% female and 81.4% white) enrolled in the 11 th or 12 th grade in 14 public schools in a rural US state. Bivariate and multivariable regression analyses examined proposed associations. 30.1% and 8.2% of teens reported controlling and physical TDV perpetration, respectively. In multivariable models, frequent use manipulation tactics increased risk for controlling or physical TDV perpetration. Teens dating a partner two or more years younger were at significantly increased risk for both controlling and physical perpetration. A significant interaction emerged between sex and exit/neglect accommodation for physical TDV. Characteristics of a current dating relationship play an important role in determining risk for controlling and physical TDV perpetration.

Attitudes and exercise adherence: test of the Theories of Reasoned Action and Planned Behaviour.

PubMed

Smith, R A; Biddle, S J

1999-04-01

Three studies of exercise adherence and attitudes are reported that tested the Theory of Reasoned Action and the Theory of Planned Behaviour. In a prospective study of adherence to a private fitness club, structural equation modelling path analysis showed that attitudinal and social normative components of the Theory of Reasoned Action accounted for 13.1% of the variance in adherence 4 months later, although only social norm significantly predicted intention. In a second study, the Theory of Planned Behaviour was used to predict both physical activity and sedentary behaviour. Path analyses showed that attitude and perceived control, but not social norm, predicted total physical activity. Physical activity was predicted from intentions and control over sedentary behaviour. Finally, an intervention study with previously sedentary adults showed that intentions to be active measured at the start and end of a 10-week intervention were associated with the planned behaviour variables. A multivariate analysis of variance revealed no significant multivariate effects for time on the planned behaviour variables measured before and after intervention. Qualitative data provided evidence that participants had a positive experience on the intervention programme and supported the role of social normative factors in the adherence process.

A Multivariate Twin Study of Hippocampal Volume, Self-Esteem and Well-Being in Middle Aged Men

PubMed Central

Kubarych, Thomas S.; Prom-Wormley, Elizabeth C.; Franz, Carol E.; Panizzon, Matthew S.; Dale, Anders M.; Fischl, Bruce; Eyler, Lisa T.; Fennema-Notestine, Christine; Grant, Michael D.; Hauger, Richard L.; Hellhammer, Dirk H.; Jak, Amy J.; Jernigan, Terry L.; Lupien, Sonia J.; Lyons, Michael J.; Mendoza, Sally P.; Neale, Michael C.; Seidman, Larry J.; Tsuang, Ming T.; Kremen, William S.

2012-01-01

Self-esteem and well-being are important for successful aging, and some evidence suggests that self-esteem and well-being are associated with hippocampal volume, cognition, and stress responsivity. Whereas most of this evidence is based on studies of older adults, we investigated self-esteem, well-being and hippocampal volume in 474 male middle-age twins. Self-esteem was significantly positively correlated with hippocampal volume (.09, p=.03 for left hippocampus, .10, p=.04 for right). Correlations for well-being were not significant (ps ≫.05). There were strong phenotypic correlations between self-esteem and well-being (.72, p<.001) and between left and right hippocampal volume (.72, p<.001). In multivariate genetic analyses, a 2-factor AE model with well-being and self-esteem on one factor and left and right hippocampal volumes on the other factor fit the data better than Cholesky, independent pathway or common pathway models. The correlation between the two genetic factors was .12 (p=.03); the correlation between the environmental factors was .09 (p>05). Our results indicate that largely different genetic and environmental factors underlie self-esteem and well-being on the one hand and hippocampal volume on the other. PMID:22471516

Assessment of changes of vector borne diseases with wetland characteristics using multivariate analysis.

PubMed

Sheela, A M; Sarun, S; Justus, J; Vineetha, P; Sheeja, R V

2015-04-01

Vector borne diseases are a threat to human health. Little attention has been paid to the prevention of these diseases. We attempted to identify the significant wetland characteristics associated with the spread of chikungunya, dengue fever and malaria in Kerala, a tropical region of South West India using multivariate analyses (hierarchical cluster analysis, factor analysis and multiple regression). High/medium turbid coastal lagoons and inland water-logged wetlands with aquatic vegetation have significant effect on the incidence of chikungunya while dengue influenced by high turbid coastal beaches and malaria by medium turbid coastal beaches. The high turbidity in water is due to the urban waste discharge namely sewage, sullage and garbage from the densely populated cities and towns. The large extent of wetland is low land area favours the occurrence of vector borne diseases. Hence the provision of pollution control measures at source including soil erosion control measures is vital. The identification of vulnerable zones favouring the vector borne diseases will help the authorities to control pollution especially from urban areas and prevent these vector borne diseases. Future research should cover land use cover changes, climatic factors, seasonal variations in weather and pollution factors favouring the occurrence of vector borne diseases.

Decoding of visual activity patterns from fMRI responses using multivariate pattern analyses and convolutional neural network.

PubMed

Zafar, Raheel; Kamel, Nidal; Naufal, Mohamad; Malik, Aamir Saeed; Dass, Sarat C; Ahmad, Rana Fayyaz; Abdullah, Jafri M; Reza, Faruque

2017-01-01

Decoding of human brain activity has always been a primary goal in neuroscience especially with functional magnetic resonance imaging (fMRI) data. In recent years, Convolutional neural network (CNN) has become a popular method for the extraction of features due to its higher accuracy, however it needs a lot of computation and training data. In this study, an algorithm is developed using Multivariate pattern analysis (MVPA) and modified CNN to decode the behavior of brain for different images with limited data set. Selection of significant features is an important part of fMRI data analysis, since it reduces the computational burden and improves the prediction performance; significant features are selected using t-test. MVPA uses machine learning algorithms to classify different brain states and helps in prediction during the task. General linear model (GLM) is used to find the unknown parameters of every individual voxel and the classification is done using multi-class support vector machine (SVM). MVPA-CNN based proposed algorithm is compared with region of interest (ROI) based method and MVPA based estimated values. The proposed method showed better overall accuracy (68.6%) compared to ROI (61.88%) and estimation values (64.17%).

Beyond Reading Alone: The Relationship Between Aural Literacy And Asthma Management

PubMed Central

Rosenfeld, Lindsay; Rudd, Rima; Emmons, Karen M.; Acevedo-García, Dolores; Martin, Laurie; Buka, Stephen

2010-01-01

Objectives To examine the relationship between literacy and asthma management with a focus on the oral exchange. Methods Study participants, all of whom reported asthma, were drawn from the New England Family Study (NEFS), an examination of links between education and health. NEFS data included reading, oral (speaking), and aural (listening) literacy measures. An additional survey was conducted with this group of study participants related to asthma issues, particularly asthma management. Data analysis focused on bivariate and multivariable logistic regression. Results In bivariate logistic regression models exploring aural literacy, there was a statistically significant association between those participants with lower aural literacy skills and less successful asthma management (OR:4.37, 95%CI:1.11, 17.32). In multivariable logistic regression analyses, controlling for gender, income, and race in separate models (one-at-a-time), there remained a statistically significant association between those participants with lower aural literacy skills and less successful asthma management. Conclusion Lower aural literacy skills seem to complicate asthma management capabilities. Practice Implications Greater attention to the oral exchange, in particular the listening skills highlighted by aural literacy, as well as other related literacy skills may help us develop strategies for clear communication related to asthma management. PMID:20399060

Serum Iron Level Is Associated with Time to Antibiotics in Cystic Fibrosis.

PubMed

Gifford, Alex H; Dorman, Dana B; Moulton, Lisa A; Helm, Jennifer E; Griffin, Mary M; MacKenzie, Todd A

2015-12-01

Serum levels of hepcidin-25, a peptide hormone that reduces blood iron content, are elevated when patients with cystic fibrosis (CF) develop pulmonary exacerbation (PEx). Because hepcidin-25 is unavailable as a clinical laboratory test, we questioned whether a one-time serum iron level was associated with the subsequent number of days until PEx, as defined by the need to receive systemic antibiotics (ABX) for health deterioration. Clinical, biochemical, and microbiological parameters were simultaneously checked in 54 adults with CF. Charts were reviewed to determine when they first experienced a PEx after these parameters were assessed. Time to ABX was compared in subgroups with and without specific attributes. Multivariate linear regression was used to identify parameters that significantly explained variation in time to ABX. In univariate analyses, time to ABX was significantly shorter in subjects with Aspergillus-positive sputum cultures and CF-related diabetes. Multivariate linear regression models demonstrated that shorter time to ABX was associated with younger age, lower serum iron level, and Aspergillus sputum culture positivity. Serum iron, age, and Aspergillus sputum culture positivity are factors associated with shorter time to subsequent PEx in CF adults. © 2015 Wiley Periodicals, Inc.

Depression and poverty among African American women at risk for type 2 diabetes.

PubMed

de Groot, Mary; Auslander, Wendy; Williams, James Herbert; Sherraden, Michael; Haire-Joshu, Debra

2003-01-01

Poverty is associated with negative health outcomes, including depression. Little is known about the specific elements of poverty that contribute to depression, particularly among African American women at risk for type 2 diabetes. This study examined the relationships of economic and social resources to depression among African American women at high risk for the development of type 2 diabetes (N = 181) using the Conservation of Resources theory as a conceptual framework. Women were assessed at 3 time points in conjunction with a dietary change intervention. At baseline, 40% of women reported clinically significant depression, and 43.3% were below the poverty line. Depressed women reported fewer economic assets and greater economic distress than nondepressed peers. Multivariate logistic regression analyses indicated that nonwork status, lack of home ownership, low appraisal of one's economic situation, low self-esteem, and increased life events were significantly associated with depression at baseline. Longitudinal multivariate logistic regression models indicated that income, home ownership, future economic appraisal, life events, and self-esteem predicted depression trajectories at Time 3. These results speak to the multifaceted sources of stress in the lives of poor African American women. Interventions that address the economic and social factors associated with depression are needed.

An evaluation of substance misuse treatment providers used by an employee assistance program.

PubMed

Miller, N A

1992-05-01

Structural measures of access, continuity, and quality of substance misuse treatment services were compared in 30 fee-for-service (FFS) facilities and nine health maintenance organizations (HMOs). Probit models related effects of the provider system (FFS or HMO) and the system's structural characteristics to 243 employees' access to and outcomes from treatment. Access was decreased in Independent Practice Association (IPA)/network HMOs and in all facilities which did not employ an addictionologist or provide coordinated treatment services. When bivariate correlations were examined, both use of copayments and imposing limits to the levels of treatment covered were negatively related to access, while a facility's provision of ongoing professional development was positively associated with access. These correlations did not remain significant in the multivariate probits. Receiving treatment in a staff model HMO and facing limits to the levels of treatment covered were negatively associated with attaining sufficient progress, while receiving treatment in a facility which provided ongoing professional development was positively related to progress: these effects did not remain significant in multivariate analyses. Implications for employee assistance program (EAP) staff in their role as case managers and for EAP staff and employers in their shared role as purchasers of treatment are discussed.

Impact of Secreted Protein Acidic and Rich in Cysteine (SPARC) Expression on Prognosis After Surgical Resection for Biliary Carcinoma.

PubMed

Toyota, Kazuhiro; Murakami, Yoshiaki; Kondo, Naru; Uemura, Kenichiro; Nakagawa, Naoya; Takahashi, Shinya; Sueda, Taijiro

2017-06-01

Secreted protein acidic and rich in cysteine (SPARC) is a matricellular protein that influences chemotherapy effectiveness and prognosis. The aim of this study was to investigate whether SPARC expression correlates with the postoperative survival of patients treated with surgical resection for biliary carcinoma. SPARC expression in resected biliary carcinoma specimens was investigated immunohistochemically in 175 patients. The relationship between SPARC expression and prognosis after surgery was evaluated using univariate and multivariate analyses. High SPARC expression in peritumoral stroma was found in 61 (35%) patients. In all patients, stromal SPARC expression was significantly associated with overall survival (OS) (P = 0.006). Multivariate analysis revealed that high stromal SPARC expression was an independent risk factor for poor OS (HR 1.81, P = 0.006). Moreover, high stromal SPARC expression was independently associated with poor prognosis in a subset of 118 patients treated with gemcitabine-based adjuvant chemotherapy (HR 2.04, P = 0.010) but not in the 57 patients who did not receive adjuvant chemotherapy (P = 0.21). Stromal SPARC expression correlated with the prognosis of patients with resectable biliary carcinoma, and its significance was enhanced in patients treated with adjuvant gemcitabine-based chemotherapy.

The Contribution of Missed Clinic Visits to Disparities in HIV Viral Load Outcomes

PubMed Central

Westfall, Andrew O.; Gardner, Lytt I.; Giordano, Thomas P.; Wilson, Tracey E.; Drainoni, Mari-Lynn; Keruly, Jeanne C.; Rodriguez, Allan E.; Malitz, Faye; Batey, D. Scott; Mugavero, Michael J.

2015-01-01

Objectives. We explored the contribution of missed primary HIV care visits (“no-show”) to observed disparities in virological failure (VF) among Black persons and persons with injection drug use (IDU) history. Methods. We used patient-level data from 6 academic clinics, before the Centers for Disease Control and Prevention and Health Resources and Services Administration Retention in Care intervention. We employed staged multivariable logistic regression and multivariable models stratified by no-show visit frequency to evaluate the association of sociodemographic factors with VF. We used multiple imputations to assign missing viral load values. Results. Among 10 053 patients (mean age = 46 years; 35% female; 64% Black; 15% with IDU history), 31% experienced VF. Although Black patients and patients with IDU history were significantly more likely to experience VF in initial analyses, race and IDU parameter estimates were attenuated after sequential addition of no-show frequency. In stratified models, race and IDU were not statistically significantly associated with VF at any no-show level. Conclusions. Because missed clinic visits contributed to observed differences in viral load outcomes among Black and IDU patients, achieving an improved understanding of differential visit attendance is imperative to reducing disparities in HIV. PMID:26270301

Partial Least Square Analyses of Landscape and Surface Water Biota Associations in the Savannah River Basin

EPA Science Inventory

Ecologists are often faced with problem of small sample size, correlated and large number of predictors, and high noise-to-signal relationships. This necessitates excluding important variables from the model when applying standard multiple or multivariate regression analyses. In ...

Matrix metalloproteinase-2 gene variants and abdominal aortic aneurysm.

PubMed

Smallwood, L; Warrington, N; Allcock, R; van Bockxmeer, F; Palmer, L J; Iacopetta, B; Golledge, J; Norman, P E

2009-08-01

To investigate associations between two polymorphisms of the matrix metalloproteinase-2 gene (MMP2) and the incidence and progression of abdominal aortic aneurysm (AAA). Cases and controls were recruited from a trial of screening for AAAs. The association between two variants of MMP2 (-1360C>T, and +649C>T) in men with AAA (n=678) and in controls (n=659) was examined using multivariate analyses. The association with AAA expansion (n=638) was also assessed. In multivariate analyses with adjustments for multiple testing, no association between either SNP and AAA presence or expansion was detected. MMP2 -1360C>T and +649C>T variants are not risk factors for AAA.

Evaluation of risk factors for perforated peptic ulcer.

PubMed

Yamamoto, Kazuki; Takahashi, Osamu; Arioka, Hiroko; Kobayashi, Daiki

2018-02-15

The aim of this study was to evaluate the prediction factors for perforated peptic ulcer (PPU). At St. Luke's International Hospital in Tokyo, Japan, a case control study was performed between August 2004 and March 2016. All patients diagnosed with PPU were included. As control subjects, patients with age, sex and date of CT scan corresponding to those of the PPU subjects were included in the study at a proportion of 2 controls for every PPU subject. All data such as past medical histories, physical findings, and laboratory data were collected through chart reviews. Univariate analyses and multivariate analyses with logistic regression were conducted, and receiver operating characteristic curves (ROCs) were calculated to show validity. Sensitivity analyses were performed to confirm results using a stepwise method and conditional logistic regression. A total of 408 patients were included in this study; 136 were a group of patients with PPU, and 272 were a control group. Univariate analysis showed statistical significance in many categories. Four different models of multivariate analyses were conducted, and significant differences were found for muscular defense and a history of peptic ulcer disease (PUD) in all models. The conditional forced-entry analysis of muscular defense showed an odds ratio (OR) of 23.8 (95% confidence interval [CI]: 5.70-100.0), and the analysis of PUD history showed an OR of 6.40 (95% CI: 1.13-36.2). The sensitivity analysis showed consistent results, with an OR of 23.8-366.2 for muscular defense and an OR of 3.67-7.81 for PUD history. The area under the curve (AUC) of all models was high enough to confirm the results. However, anticoagulants, known risk factors for PUD, did not increase the risk for PPU in our study. The conditional forced-entry analysis of anticoagulant use showed an OR of 0.85 (95% CI: 0.03-22.3). The evaluation of prediction factors and development of a prediction rule for PPU may help our decision making in performing a CT scan for patients with acute abdominal pain.

The macrophage activation marker CD163 is associated with IL28B genotype and hepatic inflammation in chronic hepatitis C virus infected patients.

PubMed

Dultz, G; Gerber, L; Zeuzem, S; Sarrazin, C; Waidmann, O

2016-04-01

Recent data highlighted the association of the macrophage activation marker CD163 with histological inflammation and fibrosis in chronic hepatitis C virus (HCV) infection. The aim of this study was to investigate the influence of successful antiviral treatment and IL28B genotypes on macrophage activation reflected by CD163 levels in HCV infected patients. In a retrospective cohort study, serum sCD163 levels were correlated with results of liver histopathology, IL28B genotyping and clinical parameters in 329 patients with HCV infection, 15 healthy controls and in 161 patients who achieved a sustained virologic response after antiviral treatment. sCD163 levels were significantly higher in patients with chronic HCV infection in comparison to healthy controls (5202 vs 896 ng/mL, P < 0.001). In the multivariate logistic regression analyses, sCD163 was independently associated with histologically determined inflammation (P = 0.043) but not with fibrosis (P = 0.091). sCD163 dropped significantly after successful antiviral treatment in comparison to baseline values (5202 vs 3093 ng/mL, P < 0.001). In the univariate analyses, sCD163 was significantly associated with IL28B genotype (C/C vs C/T+T/T) with higher values in the C/C group (6098 vs 4812 ng/mL, P = 0.003). In the multivariate logistic regression model, sCD163 levels were significantly associated with IL28B genotype (P = 0.003) and sustained virologic response (SVR) (P < 0.001). Our data support the association of activated liver macrophages with hepatic necroinflammation in chronic HCV infection as sCD163 levels drop rapidly after SVR. The irresponsiveness of IL28B minor genotypes to interferon might be related to a lower level of macrophage activation in these patients. © 2015 John Wiley & Sons Ltd.

The effects of question-generation training on metacognitive knowledge, self regulation and learning approaches in science.

PubMed

Cano García, Francisco; García, Ángela; Berbén, A B G; Pichardo, M C; Justicia, Fernando

2014-01-01

Although much research has examined the impact of question generation on students' reading comprehension and learning from lectures, far less research has analysed its influence on how students learn and study science. The present study aims to bridge this knowledge gap. Using a quasi-experimental design, three complete ninth-grade science classes, with a total of 72 students, were randomly assigned to three conditions (groups): (G1) questioning-training by providing prompts; (G2) question-generation without any explicit instruction; and (G3) no question control. Participants' pre-test and post-test self-reported measures of metacognitive knowledge, self-regulation and learning approaches were collected and data analysed with multivariate and univariate analyses of covariance. (a) MANCOVA revealed a significant effect for group; (b) ANCOVAs showed the highest average gains for G1 and statistically significant between-group differences in the two components of metacognition: metacognitive knowledge and self-regulation; and (c) the direction of these differences seemed to vary in each of these components. Question-generation training influenced how students learned and studied, specifically their metacognition, and it had a medium to large effect size, which was somewhat related to the prompts used.

Prognostic Significance of Blood Transfusion in Elderly Patients with Primary Diffuse Large B-Cell Lymphoma

PubMed Central

Fan, Liping; Fu, Danhui; Hong, Jinquan; He, Wenqian; Zeng, Feng; Lin, Qiuyan; Xie, Qianling

2018-01-01

The current study sought to evaluate whether blood transfusions affect survival of elderly patients with primary diffuse large B-cell lymphoma (DLBCL). A total of 104 patients aged 60 years and over were enrolled and divided into two groups: 24 patients who received transfusions and 80 patients who did not. Statistical analyses showed significant differences in LDH levels, platelet (Plt) counts, and hemoglobin (Hb) and albumin (Alb) levels between the two groups. Univariate analyses showed that LDH level ≥ 245 IU/L, cell of origin (germinal center/nongerminal center), and blood transfusion were associated with both overall survival (OS) and progression-free survival (PFS). Higher IPI (3–5), Alb level < 35 g/L, and rituximab usage were associated with OS. Appearance of B symptoms was associated with PFS. Multivariate analyses showed that cell of origin and rituximab usage were independent factors for OS and LDH level was an independent factor for PFS. Blood transfusion was an independent factor for PFS, but not for OS. Our preliminary results suggested that elderly patients with primary DLBCL may benefit from a restrictive blood transfusion strategy. PMID:29750167

Perceived treatment effectiveness, medication compliance, and complementary and alternative medicine use among veterans with bipolar disorder.

PubMed

Jarman, Christopher N; Perron, Brian E; Kilbourne, Amy M; Teh, Carrie Farmer

2010-03-01

Recent research shows a high rate of complementary and alternative medicine (CAM) use among persons with mental disorders, although correlates and patterns of CAM use are relatively unknown. This study tested whether CAM use is associated with perceived effectiveness of conventional treatment (i.e., psychotropic medication and psychotherapy) and medication compliance among persons with bipolar disorder. Patients with bipolar disorder (n = 435) were included as part of a naturalistic cohort study. Measures of CAM utilization, medication compliance, and perceptions of the effectiveness of psychotropic medications and psychotherapy were based on previously established questionnaires. Associations were tested using bivariate and multivariate analyses. Bivariate analyses showed that patients who did not perceive psychotherapy as effective at improving social, family, or job functioning reported greater CAM use. However, medication compliance was not significantly associated with use of CAM. Patients who used oral (e.g., herbal therapies) or cognitive (e.g., meditation) CAM were more likely to report that their medications were not effective at relieving manic or depressive symptoms. Users of cognitive CAM were more likely to report that their medications did not help with social, job, or family functioning, and that they did not prevent recurrences of manic or depressive episodes. None of the bivariate associations remained significant in multivariate analyses. Prior research has suggested that persons who are dissatisfied with treatment for medical conditions are more likely to use CAM therapies. However, the results of this study do not show CAM therapies to be associated with perceived effectiveness of treatments for mental health problems among this sample of persons with serious mental illnesses. This suggests that motivations for CAM use may vary by population and condition. Because few correlates of CAM use among persons with serious mental illnesses are known, providers should conduct routine assessments of CAM use.

Time from prior chemotherapy enhances prognostic risk grouping in the second-line setting of advanced urothelial carcinoma: a retrospective analysis of pooled, prospective phase 2 trials.

PubMed

Sonpavde, Guru; Pond, Gregory R; Fougeray, Ronan; Choueiri, Toni K; Qu, Angela Q; Vaughn, David J; Niegisch, Guenter; Albers, Peter; James, Nicholas D; Wong, Yu-Ning; Ko, Yoo-Joung; Sridhar, Srikala S; Galsky, Matthew D; Petrylak, Daniel P; Vaishampayan, Ulka N; Khan, Awais; Vogelzang, Nicholas J; Beer, Tomasz M; Stadler, Walter M; O'Donnell, Peter H; Sternberg, Cora N; Rosenberg, Jonathan E; Bellmunt, Joaquim

2013-04-01

Outcomes for patients in the second-line setting of advanced urothelial carcinoma (UC) are dismal. The recognized prognostic factors in this context are Eastern Cooperative Oncology Group (ECOG) performance status (PS) >0, hemoglobin level (Hb) <10 g/dl, and liver metastasis (LM). The purpose of this retrospective study of prospective trials was to investigate the prognostic value of time from prior chemotherapy (TFPC) independent of known prognostic factors. Data from patients from seven prospective trials with available baseline TFPC, Hb, PS, and LM values were used for retrospective analysis (n=570). External validation was conducted in a second-line phase 3 trial comparing best supportive care (BSC) versus vinflunine plus BSC (n=352). Cox proportional hazards regression was used to evaluate the association of factors, with overall survival (OS) and progression-free survival (PFS) being the respective primary and secondary outcome measures. ECOG-PS >0, LM, Hb <10 g/dl, and shorter TFPC were significant prognostic factors for OS and PFS on multivariable analysis. Patients with zero, one, two, and three to four factors demonstrated median OS of 12.2, 6.7, 5.1, and 3.0 mo, respectively (concordance statistic=0.638). Setting of prior chemotherapy (metastatic disease vs perioperative) and prior platinum agent (cisplatin or carboplatin) were not prognostic factors. External validation demonstrated a significant association of TFPC with PFS on univariable and most multivariable analyses, and with OS on univariable analyses. Limitations of retrospective analyses are applicable. Shorter TFPC enhances prognostic classification independent of ECOG-PS >0, Hb <10 g/dl, and LM in the setting of second-line therapy for advanced UC. These data may facilitate drug development and interpretation of trials. Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Time from Prior Chemotherapy Enhances Prognostic Risk Grouping in the Second-line Setting of Advanced Urothelial Carcinoma: A Retrospective Analysis of Pooled, Prospective Phase 2 Trials

PubMed Central

Sonpavde, Guru; Pond, Gregory R.; Fougeray, Ronan; Choueiri, Toni K.; Qu, Angela Q.; Vaughn, David J.; Niegisch, Guenter; Albers, Peter; James, Nicholas D.; Wong, Yu-Ning; Ko, Yoo-Joung; Sridhar, Srikala S.; Galsky, Matthew D.; Petrylak, Daniel P.; Vaishampayan, Ulka N.; Khan, Awais; Vogelzang, Nicholas J.; Beer, Tomasz M.; Stadler, Walter M.; O’Donnell, Peter H.; Sternberg, Cora N.; Rosenberg, Jonathan E.; Bellmunt, Joaquim

2014-01-01

Background Outcomes for patients in the second-line setting of advanced urothelial carcinoma (UC) are dismal. The recognized prognostic factors in this context are Eastern Cooperative Oncology Group (ECOG) performance status (PS) >0, hemoglobin level (Hb) <10 g/dl, and liver metastasis (LM). Objectives The purpose of this retrospective study of prospective trials was to investigate the prognostic value of time from prior chemotherapy (TFPC) independent of known prognostic factors. Design, setting, and participants: Data from patients from seven prospective trials with available baseline TFPC, Hb, PS, and LM values were used for retrospective analysis (n = 570). External validation was conducted in a second-line phase 3 trial comparing best supportive care (BSC) versus vinflunine plus BSC (n = 352). Outcome measurements and statistical analysis Cox proportional hazards regression was used to evaluate the association of factors, with overall survival (OS) and progression-free survival (PFS) being the respective primary and secondary outcome measures. Results and limitations ECOG-PS >0, LM, Hb <10 g/dl, and shorter TFPC were significant prognostic factors for OS and PFS on multivariable analysis. Patients with zero, one, two, and three to four factors demonstrated median OS of 12.2, 6.7, 5.1, and 3.0 mo, respectively (concordance statistic = 0.638). Setting of prior chemotherapy (metastatic disease vs perioperative) and prior platinum agent (cisplatin or carboplatin) were not prognostic factors. External validation demonstrated a significant association of TFPC with PFS on univariable and most multivariable analyses, and with OS on univariable analyses. Limitations of retrospective analyses are applicable. Conclusions Shorter TFPC enhances prognostic classification independent of ECOG-PS>0, Hb<10 g/ dl, and LM in the setting of second-line therapy for advanced UC. These data may facilitate drug development and interpretation of trials. PMID:23206856

Associations of urinary phthalate metabolites with residential characteristics, lifestyles, and dietary habits among young children in Shanghai, China.

PubMed

Liao, Chenxi; Liu, Wei; Zhang, Jialing; Shi, Wenming; Wang, Xueying; Cai, Jiao; Zou, Zhijun; Lu, Rongchun; Sun, Chanjuan; Wang, Heng; Huang, Chen; Zhao, Zhuohui

2018-03-01

Exposure to household phthalates has been reported to have adverse effects on children's health. In this paper, we used phthalate metabolites in the first morning urine as indicators of household phthalate exposures and examined their associations with residential characteristics, lifestyles and dietary habits among young children. During 2013-2014, we collected morning urines from children aged 5-10years in Shanghai, China and obtained the related information about analyzed factors in this study by questionnaires. Urinary phthalate metabolites were analyzed by isotope dilution-high performance liquid chromatography (HPLC)-heated electrospray ionization source (HESI) coupled with a triple quadrupole mass spectrometry. ANOVA, the Mann-Whitney or Kruskai-Wallis rank tests, and multivariate linear regression analyses were used to examine the target associations. Ten metabolites of seven phthalates in 434 urine samples were analyzed. The detection rates of eight metabolites (MiBP, MnBP, MEHP, MECPP, MEHHP, MEOHP, MEP, and MMP) were >90%, except for MBzP (51.2%), and MCHP with <10.0% of detection rate was not included in analyses. By multivariate linear regression analyses, factors significantly associated with higher concentrations of metabolites included non-usage household air cleaners (MEP and MEHP), changing the child's pillowcase less than one time a week (DEHP metabolites), dusting furniture in the child's bedroom less than three times a week (MMP and MnBP), using more plastic toys (DEHP metabolites and MEP), often having soft drinks (DEHP metabolites) and candies (MiBP). Our results indicated that phthalate exposures were common among Shanghai children and residential characteristics had less significant associations with urinary phthalate metabolites compared with lifestyles and dietary habits. Using less plastic toys, having less candies and soft drinks, using household air cleaner, as well as frequently changing the child's pillowcase and dusting furniture in the child's bedroom could reduce phthalate exposures among children. Copyright © 2017 Elsevier B.V. All rights reserved.

Geometric morphometric analysis of mandibular shape diversity in Pan.

PubMed

Robinson, Chris

2012-07-01

The aim of this research is to determine whether geometric morphometric (GM) techniques can provide insights into how the shape of the mandibular corpus differs between bonobos and chimpanzees and to explore the potential implications of those results for our understanding of hominin evolution. We focused on this region of the mandible because of the relative frequency with which it has been recovered in the hominin fossil record. In addition, no previous study had explored in-depth three-dimensional (3D) mandibular corpus shape differences between adults of the two Pan species using geometric morphometrics. GM methods enable researchers to quantitatively analyze and visualize 3D shape changes in skeletal elements and provide an important compliment to traditional two-dimensional analyses. Eighteen mandibular landmarks were collected using a Microscribe 3DX portable digitizer. Specimen configurations were superimposed using Generalized Procrustes analysis and the projections of the fitted coordinates to tangent space were analyzed using multivariate statistics. The size-adjusted corpus shapes of Pan paniscus and Pan troglodytes could be assigned to species with approximately 93% accuracy and the Procrustes distance between the two species was significant. Analyses of the residuals from a multivariate linear regression of the data on centroid size suggested that much of the shape difference between the species is size-related. Chimpanzee subspecies and a small sample of Australopithecus specimens could be correctly identified to taxon, at best, only 75% of the time, although the Procrustes distances between these taxa were significant. The shape of the mandibular symphysis was identified as especially useful in differentiating Pan species from one another. This suggests that this region of the mandible has the potential to be informative for taxonomic analyses of fossil hominoids, including hominins. The results also have implications for phylogenetic hypotheses of hominoid evolution. Copyright © 2012 Elsevier Ltd. All rights reserved.

Does human resource management improve family planning service quality? Analysis from the Kenya Service Provision Assessment 2010.

PubMed

Thatte, Nandita; Choi, Yoonjoung

2015-04-01

Human resource (HR) management is a priority for health systems strengthening in developing countries, yet few studies have empirically examined associations with service quality. The purpose of this study was to assess the relationship between HR management and family planning (FP) service quality. Data came from the 2010 Kenya Service Provision Assessment, a nationally representative health facility assessment. In total, 912 FP consultations from 301 facilities were analysed. Four indices were created to measure quality on reproductive history taking, physical examination, sexually transmitted infections prevention and pill/injectable specific counselling. HR management variables included training in the past year, any and supportive (i.e. with feedback, technical updates and discussion) in-person supervision in the past 6 months and having a written job description. Multivariate linear regression analyses were conducted to estimate coefficients of HR management variables on each of the four quality indices, adjusting for background characteristics of clients, provider and facilities. The level of service quality ranged from 16 to 53 out of a maximum score of 100 across the indices. Fifty-two per cent of consultations were done by providers who received supportive in-person supervision in the previous 6 months. In 23% and 38% of consultations, the provider was trained in the past year and had a written job description, respectively. Multivariate analyses indicated that having a written job description was associated with higher service quality in history taking, physical examination and the pill/injectable specific counselling. Other HR management variables were not significantly associated with service quality. Having a written job description was significantly associated with higher service quality and may be a useful tool for strengthening management practices. The details of such job descriptions and the quality of other management indicators should be explored to better understand the relationship between HR management and FP service quality. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

High protein and cholesterol intakes associated with emergence of glucose intolerance in a low-risk Canadian Inuit population.

PubMed

Sefidbakht, Saghar; Johnson-Down, Louise; Young, T Kue; Egeland, Grace M

2016-07-01

The rate of type 2 diabetes mellitus among Inuit is 12·2 % in individuals over 50 years of age, similar to the Canadian prevalence. Given marked dietary transitions in the Arctic, we evaluated the dietary and other correlates of not previously diagnosed glucose intolerance, defined as type 2 diabetes mellitus, impaired fasting glucose or impaired glucose tolerance. Cross-sectional analyses were limited to adults with a completed 2 h oral glucose tolerance test and without pre-existing diabetes. Anthropometric assessments, health and medication usage questionnaires and a 24 h dietary recall were administered. Canadian International Polar Year Inuit Health Survey (2007-2008). Inuit adults (n 777). Glucose intolerance was associated with older age and adiposity. Percentage of energy from protein above the Acceptable Macronutrient Distribution Range of 35 %, compared with intake within the range, was associated with increased odds of glucose intolerance (OR=1·98; 95 % CI 1·09, 3·61) in multivariable analyses. Further, cholesterol intake in the highest three quartiles combined (median exposures of 207, 416 and 778 mg/d, respectively) compared with the lowest quartile (median intake of 81 mg/d) was associated with glucose intolerance (OR=2·15; 95 % CI 1·23, 3·78) in multivariable analyses. Past-day traditional food consumption was borderline protective of glucose intolerance (P=0·054) and high fibre intake was not significantly protective (P=0·08). The results contribute to the existing literature on high protein and cholesterol intakes as they may relate to diabetes risk.

Low bone mineral density and risk of incident fracture in HIV-infected adults.

PubMed

Battalora, Linda; Buchacz, Kate; Armon, Carl; Overton, Edgar T; Hammer, John; Patel, Pragna; Chmiel, Joan S; Wood, Kathy; Bush, Timothy J; Spear, John R; Brooks, John T; Young, Benjamin

2016-01-01

Prevalence rates of low bone mineral density (BMD) and bone fractures are higher among HIV-infected adults compared with the general United States (US) population, but the relationship between BMD and incident fractures in HIV-infected persons has not been well described. Dual energy X-ray absorptiometry (DXA) results of the femoral neck of the hip and clinical data were obtained prospectively during 2004-2012 from participants in two HIV cohort studies. Low BMD was defined by a T-score in the interval >-2.5 to <-1.0 (osteopenia) or ≤-2.5 (osteoporosis). We analysed the association of low BMD with risk of subsequent incident fractures, adjusted for sociodemographics, other risk factors and covariables, using multivariable proportional hazards regression. Among 1,006 participants analysed (median age 43 years [IQR 36-49], 83% male, 67% non-Hispanic white, median CD4(+) T-cell count 461 cells/mm(3) [IQR 311-658]), 36% (n=358) had osteopenia and 4% (n=37) osteoporosis; 67 had a prior fracture documented. During 4,068 person-years of observation after DXA scanning, 85 incident fractures occurred, predominantly rib/sternum (n=18), hand (n=14), foot (n=13) and wrist (n=11). In multivariable analyses, osteoporosis (adjusted hazard ratio [aHR] 4.02, 95% CI 2.02, 8.01) and current/prior tobacco use (aHR 1.59, 95% CI 1.02, 2.50) were associated with incident fracture. In this large sample of HIV-infected adults in the US, low baseline BMD was significantly associated with elevated risk of incident fracture. There is potential value of DXA screening in this population.

The Environment and Children's Health Care in Northwest China.

PubMed

Trasande, Leonardo; Niu, Jingping; Li, Juansheng; Liu, Xingrong; Zhang, Benzhong; Li, Zhilan; Ding, Guowu; Sun, Yingbiao; Chen, Meichi; Hu, Xiaobin; Chen, Lung-Chi; Mendelsohn, Alan; Chen, Yu; Qu, Qingshan

2014-03-27

Industrialization in the northwest provinces of the People's Republic of China is accelerating rapid increases in early life environmental exposures, yet no publications have assessed health care provider capacity to manage common hazards. To assess provider attitudes and beliefs regarding the environment in children's health, determine self-efficacy in managing concerns, and identify common approaches to managing patients with significant exposures or environmentally-mediated conditions, a two-page survey was administered to pediatricians, child care specialists, and nurses in five provinces (Gansu, Shaanxi, Xinjiang, Qinghai, and Ningxia). Descriptive and multivariable analyses assessed predictors of strong self-efficacy, beliefs or attitudes. 960 surveys were completed with <5% refusal; 695 (72.3%) were valid for statistical analyses. The role of environment in health was rated highly (mean 4.35 on a 1-5 scale). Self-efficacy reported with managing lead, pesticide, air pollution, mercury, mold and polychlorinated biphenyl exposures were generally modest (2.22-2.52 mean). 95.4% reported patients affected with 11.9% reporting seeing >20 affected patients. Only 12.0% reported specific training in environmental history taking, and 12.0% reported owning a text on children's environmental health. Geographic disparities were most prominent in multivariable analyses, with stronger beliefs in environmental causation yet lower self-efficacy in managing exposures in the northwestern-most province. Health care providers in Northwest China have strong beliefs regarding the role of environment in children's health, and frequently identify affected children. Few are trained in environmental history taking or rate self-efficacy highly in managing common hazards. Enhancing provider capacity has promise for improving children's health in the region.

Predictors of pain and disability outcomes in one thousand, one hundred and eight patients who underwent lumbar discectomy surgery.

PubMed

Cook, Chad E; Arnold, Paul M; Passias, Peter G; Frempong-Boadu, Anthony K; Radcliff, Kristen; Isaacs, Robert

2015-11-01

A key component toward improving surgical outcomes is proper patient selection. Improved selection can occur through exploration of prognostic studies that identify variables which are associated with good or poorer outcomes with a specific intervention, such as lumbar discectomy. To date there are no guidelines identifying key prognostic variables that assist surgeons in proper patient selection for lumbar discectomy. The purpose of this study was to identify baseline characteristics that were related to poor or favourable outcomes for patients who undergo lumbar discectomy. In particular, we were interested in prognostic factors that were unique to those commonly reported in the musculoskeletal literature, regardless of intervention type. This retrospective study analysed data from 1,108 patients who underwent lumbar discectomy and had one year outcomes for pain and disability. All patient data was part of a multicentre, multi-national spine repository. Ten relatively commonly captured data variables were used as predictors for the study: (1) age, (2) body mass index, (3) gender, (4) previous back surgery history, (5) baseline disability, unique baseline scores for pain for both (6) low back and (7) leg pain, (8) baseline SF-12 Physical Component Summary (PCS) scores, (9) baseline SF-12 Mental Component Summary (MCS) scores, and (10) leg pain greater than back pain. Univariate and multivariate logistic regression analyses were run against one year outcome variables of pain and disability. For the multivariate analyses associated with the outcome of pain, older patients, those with higher baseline back pain, those with lesser reported disability and higher SF-12 MCS quality of life scores were associated with improved outcomes. For the multivariate analyses associated with the outcome of disability, presence of leg pain greater than back pain and no previous surgery suggested a better outcome. For this study, several predictive variables were either unique or conflicted with those advocated in general prognostic literature, suggesting they may have value for clinical decision making for lumbar discectomy surgery. In particular, leg pain greater than back pain and older age may yield promising value. Other significant findings such as quality of life scores and prior surgery may yield less value since these findings are similar to those that are considered to be prognostic regardless of intervention type.

Multimarker Strategy for Heart Failure Prognostication. Value of Neurohormonal Biomarkers: Neprilysin vs NT-proBNP.

PubMed

Bayes-Genis, Antoni; Barallat, Jaume; Galán, Amparo; de Antonio, Marta; Domingo, Mar; Zamora, Elisabet; Gastelurrutia, Paloma; Vila, Joan; Peñafiel, Judith; Gálvez-Montón, Carolina; Lupón, Josep

2015-12-01

Neprilysin breaks down numerous vasoactive peptides. The soluble form of neprilysin, which was recently identified in heart failure, is associated with cardiovascular outcomes. Within a multibiomarker strategy, we directly compared soluble neprilysin and N-terminal pro-B-type natriuretic peptide as risk stratifiers in a real-life cohort of heart failure patients. Soluble neprilysin, N-terminal pro-B-type natriuretic peptide, ST2, and high-sensitivity troponin T levels were measured in 797 consecutive ambulatory heart failure patients followed up for 4.7 years. Comprehensive multivariable analyses and soluble neprilysin vs N-terminal pro-B-type natriuretic peptide head-to-head assessments of performance were performed. A primary composite endpoint included cardiovascular death or heart failure hospitalization. A secondary endpoint explored cardiovascular death alone. Median soluble neprilysin and N-terminal pro-B-type natriuretic peptide concentrations were 0.64ng/mL and 1187 ng/L, respectively. Both biomarkers significantly correlated with age (P<.001) and ST2 (P<.001), but only N-terminal pro-B-type natriuretic peptide significantly correlated with estimated glomerular filtration rate (P<.001), body mass index (P<.001), left ventricular ejection fraction (P=.02) and high-sensitivity troponin T (P<.001). In multivariable Cox regression analyses, soluble neprilysin remained independently associated with the composite endpoint (hazard ratio=1.14; 95% confidence interval, 1.02-1.27; P=.03) and cardiovascular death (hazard ratio=1.15; 95% confidence interval, 1.01-1.31; P=.04), but N-terminal pro-B-type natriuretic peptide did not. The head-to-head soluble neprilysin vs N-terminal pro-B-type natriuretic peptide comparison showed good calibration and similar discrimination and reclassification for both neurohormonal biomarkers, but only soluble neprilysin improved overall goodness-of-fit. When added to a multimarker strategy, soluble neprilysin remained an independent prognosticator, while N-terminal pro-B-type natriuretic peptide lost significance as a risk stratifier in ambulatory patients with heart failure. Both biomarkers performed similarly in head-to-head analyses. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Swiss residents' speciality choices – impact of gender, personality traits, career motivation and life goals

PubMed Central

Buddeberg-Fischer, Barbara; Klaghofer, Richard; Abel, Thomas; Buddeberg, Claus

2006-01-01

Background The medical specialities chosen by doctors for their careers play an important part in the development of health-care services. This study aimed to investigate the influence of gender, personality traits, career motivation and life goal aspirations on the choice of medical speciality. Methods As part of a prospective cohort study of Swiss medical school graduates on career development, 522 fourth-year residents were asked in what speciality they wanted to qualify. They also assessed their career motivation and life goal aspirations. Data concerning personality traits such as sense of coherence, self-esteem, and gender role orientation were collected at the first assessment, four years earlier, in their final year of medical school. Data analyses were conducted by univariate and multivariate analyses of variance and covariance. Results In their fourth year of residency 439 (84.1%) participants had made their speciality choice. Of these, 45 (8.6%) subjects aspired to primary care, 126 (24.1%) to internal medicine, 68 (13.0%) to surgical specialities, 31 (5.9%) to gynaecology & obstetrics (G&O), 40 (7.7%) to anaesthesiology/intensive care, 44 (8.4%) to paediatrics, 25 (4.8%) to psychiatry and 60 (11.5%) to other specialities. Female residents tended to choose G&O, paediatrics, and anaesthesiology, males more often surgical specialities; the other specialities did not show gender-relevant differences of frequency distribution. Gender had the strongest significant influence on speciality choice, followed by career motivation, personality traits, and life goals. Multivariate analyses of covariance indicated that career motivation and life goals mediated the influence of personality on career choice. Personality traits were no longer significant after controlling for career motivation and life goals as covariates. The effect of gender remained significant after controlling for personality traits, career motivation and life goals. Conclusion Gender had the greatest impact on speciality and career choice, but there were also two other relevant influencing factors, namely career motivation and life goals. Senior physicians mentoring junior physicians should pay special attention to these aspects. Motivational guidance throughout medical training should not only focus on the professional career but also consider the personal life goals of those being mentored. PMID:17054803

Genetic and Environmental Influences on Female Sexual Orientation, Childhood Gender Typicality and Adult Gender Identity

PubMed Central

Burri, Andrea; Cherkas, Lynn; Spector, Timothy; Rahman, Qazi

2011-01-01

Background Human sexual orientation is influenced by genetic and non-shared environmental factors as are two important psychological correlates – childhood gender typicality (CGT) and adult gender identity (AGI). However, researchers have been unable to resolve the genetic and non-genetic components that contribute to the covariation between these traits, particularly in women. Methodology/Principal Findings Here we performed a multivariate genetic analysis in a large sample of British female twins (N = 4,426) who completed a questionnaire assessing sexual attraction, CGT and AGI. Univariate genetic models indicated modest genetic influences on sexual attraction (25%), AGI (11%) and CGT (31%). For the multivariate analyses, a common pathway model best fitted the data. Conclusions/Significance This indicated that a single latent variable influenced by a genetic component and common non-shared environmental component explained the association between the three traits but there was substantial measurement error. These findings highlight common developmental factors affecting differences in sexual orientation. PMID:21760939

Use of electronic nicotine delivery systems and recent initiation of smoking among US youth.

PubMed

Cardenas, Victor M; Evans, Victoria L; Balamurugan, Appathurai; Faramawi, Mohammed F; Delongchamp, Robert R; Wheeler, J Gary

2016-03-01

We assessed whether the prevalence of recent (within a year) initiation of cigarette smoking was associated with reports of ever using electronic delivery systems (ENDS) in the National Youth Tobacco Survey (NYTS) and whether the association varied by age. Weighted cross-sectional analysis of use of ENDS, cigarette smoking, age at interview and age at initiation of smoking collected systematically through the 2011-2013 NYTS cycles. In multivariate analyses those who ever used ENDS were twice as likely as nonusers of ENDS to have tried cigarette smoking in the last year (multivariate PR: 2.3; 95 % CI 1.9, 2.7). This average hid significant variations by age: a 4.1-fold increase (95 %; 2.6, 6.4) among those 11-13 years of age, compared to a smaller increase among those 16-18 years: 1.4-fold (95 % CI 1.1, 1.8). Use of ENDS by adolescents was associated with initiation of cigarette smoking in the last year. This association was stronger in younger adolescents.

Handwriting Examination: Moving from Art to Science

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

Jarman, K.H.; Hanlen, R.C.; Manzolillo, P.A.

In this document, we present a method for validating the premises and methodology of forensic handwriting examination. This method is intuitively appealing because it relies on quantitative measurements currently used qualitatively by FDE's in making comparisons, and it is scientifically rigorous because it exploits the power of multivariate statistical analysis. This approach uses measures of both central tendency and variation to construct a profile for a given individual. (Central tendency and variation are important for characterizing an individual's writing and both are currently used by FDE's in comparative analyses). Once constructed, different profiles are then compared for individuality using clustermore » analysis; they are grouped so that profiles within a group cannot be differentiated from one another based on the measured characteristics, whereas profiles between groups can. The cluster analysis procedure used here exploits the power of multivariate hypothesis testing. The result is not only a profile grouping but also an indication of statistical significance of the groups generated.« less

Sexual and Nonsexual Homicide in Scotland: Is There a Difference?

PubMed

Skott, Sara; Beauregard, Eric; Darjee, Rajan

2018-05-01

While a number of previous studies have compared sexual homicides to nonlethal sexual offenses, there have been few studies comparing sexual and nonsexual homicides. This study examines whether sexual homicide offenders differ from nonsexual homicide offenders in Scotland regarding characteristics of the offender, the victim, and the homicide incident. Unlike previous studies, only homicides committed by males against females were examined. Data from a national police database were used to compare 89 male sexual homicide offenders who killed adult females with 306 male nonsexual homicide offenders who had also killed adult females using bivariate and multivariate (logistic regression) analyses. The findings revealed not only some similarities between the two groups, particularly regarding some victim variables, but also significant bivariate and multivariate differences. Sexual homicides appeared to be associated with indicators of instrumentality and sexual deviance. We conclude that sexual homicide offenders might be considered a distinct group of homicide offenders, more similar to sexual offenders than to other homicide offenders.

Health-state utilities in a prisoner population: a cross-sectional survey

PubMed Central

Chong, Christopher AKY; Li, Sicong; Nguyen, Geoffrey C; Sutton, Andrew; Levy, Michael H; Butler, Tony; Krahn, Murray D; Thein, Hla-Hla

2009-01-01

Background Health-state utilities for prisoners have not been described. Methods We used data from a 1996 cross-sectional survey of Australian prisoners (n = 734). Respondent-level SF-36 data was transformed into utility scores by both the SF-6D and Nichol's method. Socio-demographic and clinical predictors of SF-6D utility were assessed in univariate analyses and a multivariate general linear model. Results The overall mean SF-6D utility was 0.725 (SD 0.119). When subdivided by various medical conditions, prisoner SF-6D utilities ranged from 0.620 for angina to 0.764 for those with none/mild depressive symptoms. Utilities derived by the Nichol's method were higher than SF-6D scores, often by more than 0.1. In multivariate analysis, significant independent predictors of worse utility included female gender, increasing age, increasing number of comorbidities and more severe depressive symptoms. Conclusion The utilities presented may prove useful for future economic and decision models evaluating prison-based health programs. PMID:19715571