Science.gov

Sample records for significant outcome predictor

  1. Tumor Markers for Hepatocellular Carcinoma: Simple and Significant Predictors of Outcome in Patients with HCC

    PubMed Central

    Toyoda, Hidenori; Kumada, Takashi; Tada, Toshifumi; Sone, Yasuhiro; Kaneoka, Yuji; Maeda, Atsuyuki

    2015-01-01

    Background The effectiveness of tumor markers in evaluating outcomes of patients with hepatocellular carcinoma (HCC) remains to be clarified. Summary The usefulness of the HCC tumor markers, alpha-fetoprotein (AFP), Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein (AFP-L3), and des-gamma-carboxy prothrombin (DCP) was reviewed. Elevations in these tumor markers at the time of HCC diagnosis correlate with disease progression as assessed by both imaging studies and pathologic examinations. The combination of these three tumor markers results in good predictive ability for patient survival after diagnosis. In addition, combination at the time of HCC diagnosis of these three tumor markers (as a measure of tumor progression) and serum albumin and bilirubin levels (as indicators of remnant liver function) can be used for HCC staging and further predicts prognosis in patients with HCC. Key Message The prognosis of patients with HCC can be well discriminated based solely on serum markers. Staging of HCC with serum markers is objective; if stored serum samples are available, HCC stages can be standardized across different countries and time periods. PMID:26020034

  2. Predictors of outcome in myxoedema coma

    PubMed Central

    Beynon, Jennifer; Akhtar, Simeen; Kearney, Tara

    2008-01-01

    Myxoedema coma is a rare and life-threatening illness the outcome of which has not been robustly studied in large numbers, partly due to its low incidence. Dutta and colleagues have explored outcome predictors in a developing country where access to thyroid function tests is more limited than in the Western world. Cardiovascular instability, reduced consciousness, persistent hypothermia, and sepsis all contributed to a poorer outcome, as has been demonstrated before, but a generic outcome predictor model was shown to be useful in this group of patients. Unfortunately, this observational study was unable to show differences in outcome based on replacement treatment methods and the mortality remains at 40%. PMID:18254932

  3. Psychosocial predictors of treatment outcome for trauma-affected refugees

    PubMed Central

    Sonne, Charlotte; Carlsson, Jessica; Bech, Per; Vindbjerg, Erik; Mortensen, Erik Lykke; Elklit, Ask

    2016-01-01

    Background The effects of treatment in trials with trauma-affected refugees vary considerably not only between studies but also between patients within a single study. However, we know little about why some patients benefit more from treatment, as few studies have analysed predictors of treatment outcome. Objective The objective of the study was to examine possible psychosocial predictors of treatment outcome for trauma-affected refugees. Method The participants were 195 adult refugees with posttraumatic stress disorder (PTSD) who were enrolled in a 6- to 7-month treatment programme at the Competence Centre for Transcultural Psychiatry (CTP), Denmark. The CTP Predictor Index used in the study included 15 different possible outcome predictors concerning the patients’ past, chronicity of mental health problems, pain, treatment motivation, prerequisites for engaging in psychotherapy, and social situation. The primary outcome measure was PTSD symptoms measured on the Harvard Trauma Questionnaire (HTQ). Other outcome measures included the Hopkins Symptom Check List-25, the WHO-5 Well-being Index, Sheehan Disability Scale, Hamilton Depression and Anxiety Scales, the somatisation scale of the Symptoms Checklist-90, Global Assessment of Functioning scales, and pain rated on visual analogue scales. The relations between treatment outcomes and the total score as well as subscores of the CTP Predictor Index were analysed. Results Overall, the total score of the CTP Predictor Index was significantly correlated to pre- to post treatment score changes on the majority of the ratings mentioned above. While employment status was the only single item significantly correlated to HTQ-score changes, a number of single items from the CTP Predictor Index correlated significantly with changes in depression and anxiety symptoms, but the size of the correlation coefficients were modest. Conclusions The total score of the CTP Predictor Index correlated significantly with outcomes on most

  4. Predictors of Functional Outcome Following Stroke.

    PubMed

    Harvey, Richard L

    2015-11-01

    Predicting functional outcome in stroke is challenging to most clinicians, partly because of the complexity of the condition and also because of the lack of validated prognostic models. The strongest predictors of functional outcome are age and motor function at stroke onset. There is a growing literature on predicting recovery of upper limb after stroke; however, literature on prediction of language recovery remains sparse. This review covers the current status of predicting functional outcome after stroke focusing on recovery of activities of daily living, ambulation, upper limb use, and aphasia. Use of clinical factors, imaging, and neurophysiological measures are discussed.

  5. Therapeutic hypothermia after cardiac arrest: outcome predictors

    PubMed Central

    Leão, Rodrigo Nazário; Ávila, Paulo; Cavaco, Raquel; Germano, Nuno; Bento, Luís

    2015-01-01

    Objective The determination of coma patient prognosis after cardiac arrest has clinical, ethical and social implications. Neurological examination, imaging and biochemical markers are helpful tools accepted as reliable in predicting recovery. With the advent of therapeutic hypothermia, these data need to be reconfirmed. In this study, we attempted to determine the validity of different markers, which can be used in the detection of patients with poor prognosis under hypothermia. Methods Data from adult patients admitted to our intensive care unit for a hypothermia protocol after cardiac arrest were recorded prospectively to generate a descriptive and analytical study analyzing the relationship between clinical, neurophysiological, imaging and biochemical parameters with 6-month outcomes defined according to the Cerebral Performance Categories scale (good 1-2, poor 3-5). Neuron-specific enolase was collected at 72 hours. Imaging and neurophysiologic exams were carried out in the 24 hours after the rewarming period. Results Sixty-seven patients were included in the study, of which 12 had good neurological outcomes. Ventricular fibrillation and electroencephalographic theta activity were associated with increased likelihood of survival and improved neurological outcomes. Patients who had more rapid cooling (mean time of 163 versus 312 minutes), hypoxic-ischemic brain injury on magnetic resonance imaging or neuron-specific enolase > 58ng/mL had poor neurological outcomes (p < 0.05). Conclusion Hypoxic-ischemic brain injury on magnetic resonance imaging and neuron-specific enolase were strong predictors of poor neurological outcomes. Although there is the belief that early achievement of target temperature improves neurological prognoses, in our study, there were increased mortality and worse neurological outcomes with earlier target-temperature achievement. PMID:26761469

  6. Gyrification brain abnormalities as predictors of outcome in anorexia nervosa.

    PubMed

    Favaro, Angela; Tenconi, Elena; Degortes, Daniela; Manara, Renzo; Santonastaso, Paolo

    2015-12-01

    Gyrification brain abnormalities are considered a marker of early deviations from normal developmental trajectories and a putative predictor of poor outcome in psychiatric disorders. The aim of this study was to explore cortical folding morphology in patients with anorexia nervosa (AN). A MRI brain study was conducted on 38 patients with AN, 20 fully recovered patients, and 38 healthy women. Local gyrification was measured with procedures implemented in FreeSurfer. Vertex-wise comparisons were carried out to compare: (1) AN patients and healthy women; (2) patients with a full remission at a 3-year longitudinal follow-up assessment and patients who did not recover. AN patients exhibited significantly lower gyrification when compared with healthy controls. Patients with a poor 3-year outcome had significantly lower baseline gyrification when compared to both healthy women and patients with full recovery at follow-up, even after controlling for the effects of duration of illness and gray matter volume. No significant correlation has been found between gyrification, body mass index, amount of weight loss, onset age, and duration of illness. Brain gyrification significantly predicted outcome at follow-up even after controlling for the effects of duration of illness and other clinical prognostic factors. Although the role of starvation in determining our findings cannot be excluded, our study showed that brain gyrification might be a predictor of outcome in AN. Further studies are needed to understand if brain gyrification abnormalities are indices of early neurodevelopmental alterations, the consequence of starvation, or the interaction between both factors.

  7. Predictors of outcome of myasthenic crisis.

    PubMed

    Kalita, J; Kohat, A K; Misra, U K

    2014-07-01

    There is paucity of study on predictors of myasthenic crisis (MC), prolonged ventilation and their outcome, a reason why this study was undertaken. Sixty-four patients with myasthenia gravis (MG) were included whose median age was 45 (6-84) years. Their clinical treatment, presence of thymoma, anti-acetylcholine receptor antibody (AchRAb), thymectomy, comorbidities, offending drugs and occurrence of MC were noted. Patients needing prolonged ventilation (>15 days) were noted. Hospital mortality, MG quality of life (QOL) at discharge and thereafter annual hospital visit, admission, expenditure and work day loss were enquired. Fourteen (21.9 %) patients had MC within 1-120 (median 8.5) months of disease onset within a median follow-up of 48 (3-264) months. The precipitating factors were infection in six, surgery in five, tapering of drugs in two and reaction to iodinated contrast in one patient. Male gender, bulbar weakness, AchRAb, thymoma, surgery and comorbid illnesses were related to MC. Eight of them (57.1 %) needed prolonged ventilation. Half the patients with MC had recurrent crisis (2-4 attacks). Death was not related to MC although MC patients had worse QOL, higher annual treatment expenditure with frequent hospital visit and hospitalization. In conclusion, association of comorbid illness with MC and prolonged ventilation highlights the need of close follow-up and appropriate management.

  8. Predictors of outcome for cognitive behaviour therapy in binge eating disorder.

    PubMed

    Lammers, Mirjam W; Vroling, Maartje S; Ouwens, Machteld A; Engels, Rutger C M E; van Strien, Tatjana

    2015-05-01

    The aim of this naturalistic study was to identify pretreatment predictors of response to cognitive behaviour therapy in treatment-seeking patients with binge eating disorder (BED; N = 304). Furthermore, we examined end-of-treatment factors that predict treatment outcome 6 months later (N = 190). We assessed eating disorder psychopathology, general psychopathology, personality characteristics and demographic variables using self-report questionnaires. Treatment outcome was measured using the bulimia subscale of the Eating Disorder Inventory 1. Predictors were determined using hierarchical linear regression analyses. Several variables significantly predicted outcome, four of which were found to be both baseline predictors of treatment outcome and end-of-treatment predictors of follow-up: Higher levels of drive for thinness, higher levels of interoceptive awareness, lower levels of binge eating pathology and, in women, lower levels of body dissatisfaction predicted better outcome in the short and longer term. Based on these results, several suggestions are made to improve treatment outcome for BED patients.

  9. Lumbar disk herniation surgery: outcome and predictors.

    PubMed

    Sedighi, Mahsa; Haghnegahdar, Ali

    2014-12-01

    Study Design A retrospective cohort study. Objectives To determine the outcome and any differences in the clinical results of three different surgical methods for lumbar disk herniation and to assess the effect of factors that could predict the outcome of surgery. Methods We evaluated 148 patients who had operations for lumbar disk herniation from March 2006 to March 2011 using three different surgical techniques (laminectomy, microscopically assisted percutaneous nucleotomy, and spinous process osteotomy) by using Japanese Orthopaedic Association (JOA) Back Pain Evaluation Questionnaire, Resumption of Activities of Daily Living scale and changes of visual analog scale (VAS) for low back pain and radicular pain. Our study questionnaire addressed patient subjective satisfaction with the operation, residual complaints, and job resumption. Data were analyzed with SPSS version 16.0 (SPSS, Inc., Chicago, Illinois, United States). Statistical significance was set at 0.05. For statistical analysis, chi-square test, Mann-Whitney U test, Kruskal-Wallis test, and repeated measure analysis were performed. For determining the confounding factors, univariate analysis by chi-square test was used and followed by logistic regression analysis. Results Ninety-four percent of our patients were satisfied with the results of their surgeries. VAS documented an overall 93.3% success rate for reduction of radicular pain. Laminectomy resulted in better outcome in terms of JOA Back Pain Evaluation Questionnaire. The outcome of surgery did not significantly differ by age, sex, level of education, preoperative VAS for back, preoperative VAS for radicular pain, return to previous job, or level of herniation. Conclusion Surgery for lumbar disk herniation is effective in reducing radicular pain (93.4%). All three surgical approaches resulted in significant decrease in preoperative radicular pain and low back pain, but intergroup variation in the outcome was not achieved. As indicated

  10. Lumbar disk herniation surgery: outcome and predictors.

    PubMed

    Sedighi, Mahsa; Haghnegahdar, Ali

    2014-12-01

    Study Design A retrospective cohort study. Objectives To determine the outcome and any differences in the clinical results of three different surgical methods for lumbar disk herniation and to assess the effect of factors that could predict the outcome of surgery. Methods We evaluated 148 patients who had operations for lumbar disk herniation from March 2006 to March 2011 using three different surgical techniques (laminectomy, microscopically assisted percutaneous nucleotomy, and spinous process osteotomy) by using Japanese Orthopaedic Association (JOA) Back Pain Evaluation Questionnaire, Resumption of Activities of Daily Living scale and changes of visual analog scale (VAS) for low back pain and radicular pain. Our study questionnaire addressed patient subjective satisfaction with the operation, residual complaints, and job resumption. Data were analyzed with SPSS version 16.0 (SPSS, Inc., Chicago, Illinois, United States). Statistical significance was set at 0.05. For statistical analysis, chi-square test, Mann-Whitney U test, Kruskal-Wallis test, and repeated measure analysis were performed. For determining the confounding factors, univariate analysis by chi-square test was used and followed by logistic regression analysis. Results Ninety-four percent of our patients were satisfied with the results of their surgeries. VAS documented an overall 93.3% success rate for reduction of radicular pain. Laminectomy resulted in better outcome in terms of JOA Back Pain Evaluation Questionnaire. The outcome of surgery did not significantly differ by age, sex, level of education, preoperative VAS for back, preoperative VAS for radicular pain, return to previous job, or level of herniation. Conclusion Surgery for lumbar disk herniation is effective in reducing radicular pain (93.4%). All three surgical approaches resulted in significant decrease in preoperative radicular pain and low back pain, but intergroup variation in the outcome was not achieved. As indicated

  11. Lumbar Disk Herniation Surgery: Outcome and Predictors

    PubMed Central

    Sedighi, Mahsa; Haghnegahdar, Ali

    2014-01-01

    Study Design A retrospective cohort study. Objectives To determine the outcome and any differences in the clinical results of three different surgical methods for lumbar disk herniation and to assess the effect of factors that could predict the outcome of surgery. Methods We evaluated 148 patients who had operations for lumbar disk herniation from March 2006 to March 2011 using three different surgical techniques (laminectomy, microscopically assisted percutaneous nucleotomy, and spinous process osteotomy) by using Japanese Orthopaedic Association (JOA) Back Pain Evaluation Questionnaire, Resumption of Activities of Daily Living scale and changes of visual analog scale (VAS) for low back pain and radicular pain. Our study questionnaire addressed patient subjective satisfaction with the operation, residual complaints, and job resumption. Data were analyzed with SPSS version 16.0 (SPSS, Inc., Chicago, Illinois, United States). Statistical significance was set at 0.05. For statistical analysis, chi-square test, Mann-Whitney U test, Kruskal-Wallis test, and repeated measure analysis were performed. For determining the confounding factors, univariate analysis by chi-square test was used and followed by logistic regression analysis. Results Ninety-four percent of our patients were satisfied with the results of their surgeries. VAS documented an overall 93.3% success rate for reduction of radicular pain. Laminectomy resulted in better outcome in terms of JOA Back Pain Evaluation Questionnaire. The outcome of surgery did not significantly differ by age, sex, level of education, preoperative VAS for back, preoperative VAS for radicular pain, return to previous job, or level of herniation. Conclusion Surgery for lumbar disk herniation is effective in reducing radicular pain (93.4%). All three surgical approaches resulted in significant decrease in preoperative radicular pain and low back pain, but intergroup variation in the outcome was not achieved. As indicated

  12. Frailty as a predictor of short-term adverse outcomes

    PubMed Central

    Coelho, Tiago; Paúl, Constança; Gobbens, Robbert J.J.

    2015-01-01

    The objectives of this study were to compare how different frailty measures (Frailty Phenotype/FP, Groningen Frailty Indicator/GFI and Tilburg Frailty Indicator/TFI) predict short-term adverse outcomes. Secondarily, adopting a multidimensional approach to frailty (integral conceptual model–TFI), this study aims to compare how physical, psychological and social frailty predict the outcomes. A longitudinal study was carried out with 95 community-dwelling elderly. Participants were assessed at baseline for frailty, determinants of frailty, and adverse outcomes (healthcare utilization, quality of life, disability in basic and instrumental activities of daily living/ADL and IADL). Ten months later the outcomes were assessed again. Frailty was associated with specific healthcare utilization indicators: the FP with a greater utilization of informal care; GFI with an increased contact with healthcare professionals; and TFI with a higher amount of contacts with a general practitioner. After controlling for the effect of life-course determinants, comorbidity and adverse outcome at baseline, GFI predicted IADL disability and TFI predicted quality of life. The effect of the FP on the outcomes was not significant, when compared with the other measures. However, when comparing TFI’s domains, the physical domain was the most significant predictor of the outcomes, even explaining part of the variance of ADL disability. Frailty at baseline was associated with adverse outcomes at follow-up. However, the relationship of each frailty measure (FP, GFI and TFI) with the outcomes was different. In spite of the role of psychological frailty, TFI’s physical domain was the determinant factor for predicting disability and most of the quality of life. PMID:26246968

  13. Neurocognitive Predictors of Reading Outcomes for Children with Reading Disabilities

    ERIC Educational Resources Information Center

    Frijters, Jan C.; Lovett, Maureen W.; Steinbach, Karen A.; Wolf, Maryanne; Sevcik, Rose A.; Morris, Robin D.

    2011-01-01

    This study reports on several specific neurocognitive process predictors of reading outcomes for a sample of 278 children with reading disabilities. Three categories of response (i.e., poor, average, and good) were formed via growth curve models of six reading outcomes. Two nested discriminant function analyses were conducted to evaluate the…

  14. Predictors of CBT outcome in older adults with GAD.

    PubMed

    Hundt, Natalie E; Amspoker, Amber B; Kraus-Schuman, Cynthia; Cully, Jeffrey A; Rhoades, Howard; Kunik, Mark E; Stanley, Melinda A

    2014-12-01

    The current study is a secondary analysis of data from a randomized controlled trial of CBT for late-life GAD (Stanley et al., 2014) which provided an opportunity to examine predictors of outcome among those who received CBT. Participants were 150 older adults who were randomized to receive 10 sessions of CBT. Completer analyses found that homework completion, number of sessions attended, lower worry severity, lower depression severity, and recruitment site predicted 6-month worry outcome on the PSWQ-A, whereas homework completion, credibility of the therapy, lower anxiety severity, and site predicted 6-month anxiety outcome on the STAI-T. In intent-to-treat multivariate analyses, however, only initial worry and anxiety severity, site, and number of sessions completed predicted treatment outcome. These results are largely consistent with predictors of outcome in younger adults and suggest that lower initial symptom severity and variables consistent with greater engagement in treatment predict outcome. PMID:25445074

  15. Time-course pattern of blood 25-hydroxycholecalciferol is a significant predictor of survival outcome in metastatic colorectal cancer: a clinical practice-based study.

    PubMed

    Obermannova, R; Dusek, L; Greplova, K; Jarkovsky, J; Sterba, J; Vyzula, R; Demlova, R; Zdrazilova-Dubska, L; Valik, D

    2015-01-01

    Vitamin D deficiency has been implicated in the epidemiology of common malignancies including colorectal cancer. We studied consecutive blood levels of 25-hydroxycholecalciferol (25-OHD) in relation to other clinical and laboratory variables in metastatic colorectal cancer patients to ascertain whether their variations may be prognostic or predictive parameters of survival outcomes. Eighty four patients treated with first-line oxaliplatin-based chemotherapy with or without bevacizumab were included. The patients were enrolled on the intent-to-treat basis considering their performance status, comorbidities and laboratory parameters to be medically apt for intensive chemotherapy. Overall survival and progression-free survival were selected as the primary outcomes. Progression free survival and overall survival medians were 15.4 months and 41.2 months, respectively. The cut-off levels of 40 nmol/l for 25-OHD and 11 µg/l for first CEA were identified to be clinical decision levels stratifying patients to the respective prognostic groups. We found that the most consistent outcome predictors were i) any patient surgery, ii) CEA and, independently, iii) time-related blood levels of 25-OHD. We confirmed fundamental and consistent vitamin D deficiency in metastatic colorectal cancer. We demonstrated that all patients with at least one blood level above 40 nmol/l versus all below this cut-off showed profound differences in their disease outcomes. The primary disease stage or time to metastatic stage did not influence the predictive power of blood 25-OHD levels, implying that the time-course pattern of 25-OHD but not the first single measurement may be an independent prognostic factor. PMID:26458311

  16. Separable Attentional Predictors of Language Outcome

    ERIC Educational Resources Information Center

    Salley, Brenda; Panneton, Robin K.; Colombo, John

    2013-01-01

    The aim of this study was to examine the combined influences of infants' attention and use of social cues in the prediction of their language outcomes. This longitudinal study measured infants' visual attention on a distractibility task (11 months), joint attention (14 months), and language outcomes (word-object association, 14 months;…

  17. Anterior cruciate ligament reconstruction and rehabilitation: predictors of functional outcome

    PubMed Central

    DELLA VILLA, FRANCESCO; RICCI, MARGHERITA; PERDISA, FRANCESCO; FILARDO, GIUSEPPE; GAMBERINI, JACOPO; CAMINATI, DANIELE; DELLA VILLA, STEFANO

    2015-01-01

    Surgical reconstruction of an injured anterior cruciate ligament (ACL) leads to full recovery of function and sports activity in a high percentage of cases. The aim of the present study was to analyze variables related to the patient, the surgical technique and the post-surgical rehabilitation methods, seeking to identify predictors of outcome and recovery time after ACL reconstruction. One hundred and four patients (81 M, 23 F) undergoing a step-based rehabilitation protocol after ACL reconstruction were evaluated. 43.2% of them had an isolated ACL lesion, whereas 56.8% had one or more concurrent injuries. Data relating to personal characteristics, surgery and post-operative management were collected and analyzed for correlation. Clinical outcome was evaluated with IKDC subjective score and the Tegner score, and the time to reach full recovery was noted as well. Young patients with a higher pre-injury Tegner activity level or who practice sport at professional level, no concurrent capsular lesions and no postoperative knee bracing had better clinical results and took shorter time to recover. Also, a higher percentage of on-the-field rehabilitation sessions, and absence of significant muscle strength deficits at the first knee isokinetic test emerged as rehabilitation-related factors leading to a better post-surgical outcome. Personal, surgical and rehabilitation factors should be considered in order to optimize patient management and maximize the expected results. Further studies are needed to find the strongest factors in different patients. Level of evidence Level IV, retrospective study. PMID:26904523

  18. Predictors of outcomes of psychological treatments for disordered gambling: A systematic review.

    PubMed

    Merkouris, S S; Thomas, S A; Browning, C J; Dowling, N A

    2016-08-01

    This systematic review aimed to synthesise the evidence relating to pre-treatment predictors of gambling outcomes following psychological treatment for disordered gambling across multiple time-points (i.e., post-treatment, short-term, medium-term, and long-term). A systematic search from 1990 to 2016 identified 50 articles, from which 11 socio-demographic, 16 gambling-related, 21 psychological/psychosocial, 12 treatment, and no therapist-related variables, were identified. Male gender and low depression levels were the most consistent predictors of successful treatment outcomes across multiple time-points. Likely predictors of successful treatment outcomes also included older age, lower gambling symptom severity, lower levels of gambling behaviours and alcohol use, and higher treatment session attendance. Significant associations, at a minimum of one time-point, were identified between successful treatment outcomes and being employed, ethnicity, no gambling debt, personality traits and being in the action stage of change. Mixed results were identified for treatment goal, while education, income, preferred gambling activity, problem gambling duration, anxiety, any psychiatric comorbidity, psychological distress, substance use, prior gambling treatment and medication use were not significantly associated with treatment outcomes at any time-point. Further research involving consistent treatment outcome frameworks, examination of treatment and therapist predictor variables, and evaluation of predictors across long-term follow-ups is warranted to advance this developing field of research. PMID:27372437

  19. Preschool Predictors of Kindergarten Language Outcomes

    ERIC Educational Resources Information Center

    Walk, Anne; Matsuo, Hisako; Giovanoni, Alex

    2015-01-01

    The aim of the present study is to explore a variety of cognitive and social variables which are most relevant to children's linguistic success in an educational setting. The study examines kindergarten English language outcomes in classrooms containing monolingual English speaking children and bilingual children who speak English and one other…

  20. Change in Autism Classification with Early Intervention: Predictors and Outcomes

    ERIC Educational Resources Information Center

    Ben Itzchak, Esther; Zachor, Ditza A.

    2009-01-01

    The current study characterized stability and changes of autism diagnostic classification with intervention in very young children and examined pre-treatment predictors and post-intervention outcome. Sixty-eight children diagnosed with autism, aged 18-35 months (M = 25.4, SD = 4.0) participated in the study. Children underwent comprehensive…

  1. Anxiety, Stress and Social Support: Prenatal Predictors of Obstetrical Outcomes.

    ERIC Educational Resources Information Center

    Nethercut, Gail; Adler, Nancy

    The role of anxiety, stress, and social support in predicting negative obstetrical outcomes was examined in a high-risk group of pregnant women. The predictor variables were assessed with separate self-report scales, including The Sarason Life Experience Survey, the Spielberger State/Trait Inventory, and a modified version of the Lazarus and Cohen…

  2. Relational Aggression in Middle Childhood: Predictors and Adolescent Outcomes

    ERIC Educational Resources Information Center

    Spieker, Susan J.; Campbell, Susan B.; Vandergrift, Nathan; Pierce, Kim M.; Cauffman, Elizabeth; Susman, Elizabeth J.; Roisman, Glenn I.

    2012-01-01

    This study examined gender differences in the level and developmental course of relational aggression in middle childhood, as well as early predictors and outcomes of relational aggression, after controlling for concurrent physical aggression. Relational (RAgg) and Physical aggression (PAgg) scores for 558 boys and 545 girls at the ages of eight…

  3. Evaluating Predictors of Outcome for Children in Psychotherapy.

    ERIC Educational Resources Information Center

    Bush, Rita Masden; And Others

    Most research in psychotherapy has focused on adult clients, while child psychotherapy has been comparatively neglected. To identify predictors of outcome in psychotherapy for children, the relationship between several client, therapist, and economic variables was examined. Subjects were 268 children and their families who had completed treatment…

  4. Predictors of Developmental Outcomes for Infants Who Are Medically Fragile.

    ERIC Educational Resources Information Center

    Smith, Timothy B.; Boyce, Glenna C.

    This paper presents results of a preliminary study which evaluated medical birth data as potential predictors of developmental outcome, and developed and tested an instrument designed for this purpose. Forty low birthweight children, all of whom had experienced neonatal intraventricular hemorrhage, were evaluated at school age (66 months) on the…

  5. Predictors of outcomes in outpatients with anorexia nervosa - Results from the ANTOP study.

    PubMed

    Wild, Beate; Friederich, Hans-Christoph; Zipfel, Stephan; Resmark, Gaby; Giel, Katrin; Teufel, Martin; Schellberg, Dieter; Löwe, Bernd; de Zwaan, Martina; Zeeck, Almut; Herpertz, Stephan; Burgmer, Markus; von Wietersheim, Jörn; Tagay, Sefik; Dinkel, Andreas; Herzog, Wolfgang

    2016-10-30

    This study aimed to determine predictors of BMI and recovery for outpatients with anorexia nervosa (AN). Patients were participants of the ANTOP (Anorexia Nervosa Treatment of Out-Patients) trial and randomized to focal psychodynamic therapy (FPT), enhanced cognitive behavior therapy (CBT-E), or optimized treatment as usual (TAU-O). N=169 patients participated in the one-year follow-up (T4). Outcomes were the BMI and global outcome (recovery/partial syndrome/full syndrome) at T4. We examined the following baseline variables as possible predictors: age, BMI, duration of illness, subtype of AN, various axis I diagnoses, quality of life, self-esteem, and psychological characteristics relevant to AN. Linear and logistic regression analyses were conducted to identify the predictors of the BMI and global outcome. The strongest positive predictor for BMI and recovery at T4 was a higher baseline BMI of the patients. Negative predictors for BMI and recovery were a duration of illness >6 years and a lifetime depression diagnosis at baseline. Additionally, higher bodily pain was significantly associated with a lower BMI and self-esteem was a positive predictor for recovery at T4. A higher baseline BMI and shorter illness duration led to a better outcome. Further research is necessary to investigate whether or not AN patients with lifetime depression, higher bodily pain, and lower self-esteem may benefit from specific treatment approaches. PMID:27467700

  6. Significant predictors of patients' uncertainty in primary brain tumors.

    PubMed

    Lin, Lin; Chien, Lung-Chang; Acquaye, Alvina A; Vera-Bolanos, Elizabeth; Gilbert, Mark R; Armstrong, Terri S

    2015-05-01

    Patients with primary brain tumors (PBT) face uncertainty related to prognosis, symptoms and treatment response and toxicity. Uncertainty is correlated to negative mood states and symptom severity and interference. This study identified predictors of uncertainty during different treatment stages (newly-diagnosed, on treatment, followed-up without active treatment). One hundred eighty six patients with PBT were accrued at various points in the illness trajectory. Data collection tools included: a clinical checklist/a demographic data sheet/the Mishel Uncertainty in Illness Scale-Brain Tumor Form. The structured additive regression model was used to identify significant demographic and clinical predictors of illness-related uncertainty. Participants were primarily white (80 %) males (53 %). They ranged in age from 19-80 (mean = 44.2 ± 12.6). Thirty-two of the 186 patients were newly-diagnosed, 64 were on treatment at the time of clinical visit with MRI evaluation, 21 were without MRI, and 69 were not on active treatment. Three subscales (ambiguity/inconsistency; unpredictability-disease prognoses; unpredictability-symptoms and other triggers) were different amongst the treatment groups (P < .01). However, patients' uncertainty during active treatment was as high as in newly-diagnosed period. Other than treatment stages, change of employment status due to the illness was the most significant predictor of illness-related uncertainty. The illness trajectory of PBT remains ambiguous, complex, and unpredictable, leading to a high incidence of uncertainty. There was variation in the subscales of uncertainty depending on treatment status. Although patients who are newly diagnosed reported the highest scores on most of the subscales, patients on treatment felt more uncertain about unpredictability of symptoms than other groups. Due to the complexity and impact of the disease, associated symptoms, and interference with functional status, comprehensive assessment of patients

  7. Predictors of outcome for cognitive behaviour therapy in binge eating disorder.

    PubMed

    Lammers, Mirjam W; Vroling, Maartje S; Ouwens, Machteld A; Engels, Rutger C M E; van Strien, Tatjana

    2015-05-01

    The aim of this naturalistic study was to identify pretreatment predictors of response to cognitive behaviour therapy in treatment-seeking patients with binge eating disorder (BED; N = 304). Furthermore, we examined end-of-treatment factors that predict treatment outcome 6 months later (N = 190). We assessed eating disorder psychopathology, general psychopathology, personality characteristics and demographic variables using self-report questionnaires. Treatment outcome was measured using the bulimia subscale of the Eating Disorder Inventory 1. Predictors were determined using hierarchical linear regression analyses. Several variables significantly predicted outcome, four of which were found to be both baseline predictors of treatment outcome and end-of-treatment predictors of follow-up: Higher levels of drive for thinness, higher levels of interoceptive awareness, lower levels of binge eating pathology and, in women, lower levels of body dissatisfaction predicted better outcome in the short and longer term. Based on these results, several suggestions are made to improve treatment outcome for BED patients. PMID:25802175

  8. Relational Aggression in Middle Childhood: Predictors and Adolescent Outcomes

    PubMed Central

    Spieker, Susan J.; Campbell, Susan B.; Vandergrift, Nathan; Pierce, Kim M.; Cauffman, Elizabeth; Susman, Elizabeth J.; Roisman, Glenn I.

    2012-01-01

    This study examined gender differences in the level and developmental course of relational aggression in middle childhood, as well as early predictors and outcomes of relational aggression, after controlling for concurrent physical aggression. Relational (RAgg) and Physical aggression (PAgg) scores for 558 boys and 545 girls at ages 8–11 in the NICHD Study of Early Child Care and Youth Development (SECCYD) were created by combining the highest rating for each item across mother and teacher reports. Longitudinal analyses were conducted using Latent Curve Models of RAgg with PAgg as a time-varying covariate, with all parameters allowed to vary by gender. Boys and girls had different growth parameters of RAgg. Girls’ RAgg intercept was higher and the slope was not different from zero; boys’ RAgg intercept was lower and the slope declined. Mother-child conflict in early childhood predicted RAgg intercept for both boys and girls, but maternal harsh control and sensitivity were also uniquely predictive for girls, whereas center care was uniquely predictive for boys. RAgg intercept predicted adolescent self-reports of depression for girls and delinquency and risk-taking for both boys and girls; the magnitude of the association with risk-taking was significantly greater for boys. PMID:22665946

  9. Predictors of Outcome of Convulsive Status Epilepticus Among an Egyptian Pediatric Tertiary Hospital.

    PubMed

    Halawa, Eman F; Draz, Iman; Ahmed, Dalia; Shaheen, Hala A

    2015-11-01

    Convulsive status epilepticus is a common neurologic emergency in pediatrics. We aimed to study the etiology, clinical features, and prognostic factors among pediatric patients with convulsive status epilepticus. Seventy patients were included in this cohort study from pediatric emergency department of the specialized Children Hospital of Cairo University. The outcome was evaluated using the Glasgow Outcome Score. Acute symptomatic etiology was the most common cause of convulsive status epilepticus. Refractory convulsive status epilepticus was observed more significantly in cases caused by acute symptomatic etiologies. The outcome was mortality in 26 (37.1%) patients, severe disability in 15 (21.4%), moderate disability in 17 (24.3%), and good recovery in 12 (17.1%) patients. The significant predictor of mortality was lower modified Glasgow Coma Scale score on admission, whereas lower modified Glasgow Coma Scale score on admission and refractory convulsive status epilepticus were the significant predictors for disability and mortality.

  10. Predictors and outcomes of elder-care-based interrole conflict.

    PubMed

    Barling, J; MacEwen, K E; Kelloway, E K; Higginbottom, S F

    1994-09-01

    The authors propose and test a model of the predictors and outcomes of the role conflicts experienced by individuals simultaneously holding full-time employment and providing care for elderly parents. It is proposed that interrole conflict is predicted by physical and psychological involvement in elder care and predicts both partial absenteeism from work and psychological strain. In turn, psychological strain predicts marital interactions. Data from 141 full-time employees from 2 universities provided strong support for the proposed mediational model using LISREL VII. In contrast, 2 alternative models were not supported by the data.

  11. School-based counseling using systematic feedback: a cohort study evaluating outcomes and predictors of change.

    PubMed

    Cooper, Mick; Stewart, Dave; Sparks, Jacqueline; Bunting, Lisa

    2013-01-01

    The outcomes of school-based counseling incorporating the Partners for Change Outcome Monitoring System (PCOMS) were evaluated using a cohort design, with multilevel modeling to identify predictors of change. Participants were 288 7-11 year olds experiencing social, emotional or behavioral difficulties. The intervention was associated with significant reductions in psychological distress, with a pre-post effect size (d) of 1.49 on the primary outcome measure and 88.7% clinical improvement. Greater improvements were found for disabled children, older children, and where CBT methods were used. The findings provide support for the use of systematic feedback in therapy with children.

  12. Breast reconstruction following conservative mastectomies: predictors of complications and outcomes

    PubMed Central

    Voineskos, Sophocles H.; Frank, Simon G.

    2015-01-01

    Breast reconstruction can be performed using a variety of techniques, most commonly categorized into an alloplastic approach or an autologous tissue method. Both strategies have certain risk factors that influence reconstructive outcomes and complication rates. In alloplastic breast reconstruction, surgical outcomes and complication rates are negatively impacted by radiation, smoking, increased body mass index (BMI), hypertension, and prior breast conserving therapy. Surgical factors such as the type of implant material, undergoing immediate breast reconstruction, and the use of fat grafting can improve patient satisfaction and aesthetic outcomes. In autologous breast reconstruction, radiation, increased BMI, certain previous abdominal surgery, smoking, and delayed reconstruction are associated with higher complication rates. Though a pedicled transverse rectus abdominis myocutaneous (TRAM) flap is the most common type of flap used for autologous breast reconstruction, pedicled TRAMs are more likely to be associated with fat necrosis than a free TRAM or deep inferior epigastric perforator (DIEP) flap. Fat grafting can also be used to improve aesthetic outcomes in autologous reconstruction. This article focuses on factors, both patient and surgical, that are predictors of complications and outcomes in breast reconstruction. PMID:26645003

  13. Why significant variables aren’t automatically good predictors

    PubMed Central

    Lo, Adeline; Chernoff, Herman; Zheng, Tian; Lo, Shaw-Hwa

    2015-01-01

    Thus far, genome-wide association studies (GWAS) have been disappointing in the inability of investigators to use the results of identified, statistically significant variants in complex diseases to make predictions useful for personalized medicine. Why are significant variables not leading to good prediction of outcomes? We point out that this problem is prevalent in simple as well as complex data, in the sciences as well as the social sciences. We offer a brief explanation and some statistical insights on why higher significance cannot automatically imply stronger predictivity and illustrate through simulations and a real breast cancer example. We also demonstrate that highly predictive variables do not necessarily appear as highly significant, thus evading the researcher using significance-based methods. We point out that what makes variables good for prediction versus significance depends on different properties of the underlying distributions. If prediction is the goal, we must lay aside significance as the only selection standard. We suggest that progress in prediction requires efforts toward a new research agenda of searching for a novel criterion to retrieve highly predictive variables rather than highly significant variables. We offer an alternative approach that was not designed for significance, the partition retention method, which was very effective predicting on a long-studied breast cancer data set, by reducing the classification error rate from 30% to 8%. PMID:26504198

  14. Brainstem encephalitis: etiologies, treatment, and predictors of outcome

    PubMed Central

    Tan, Ik Lin; Mowry, Ellen M.; Steele, Sonya U.; Pardo, Carlos A.; McArthur, Justin C.; Nath, Avindra

    2016-01-01

    Brainstem encephalitis (BE) is an uncommon condition. We sought to characterize clinical presentations, etiologies, response to treatment, and predictors of outcome. We performed a retrospective review of non–HIV infected patients diagnosed with BE at Johns Hopkins Hospital (January 1997–April 2010). We characterized clinical and paraclinical features, and used regression models to assess associations with poor outcome. BE was diagnosed in 81 patients. An etiology was identified in 58 of 81 (71.6 %) of cases, most of which were confirmed or probable inflammatory/autoimmune conditions. Of the remaining 23 cases in which a specific diagnosis remained undefined, clinical presentation, CSF, neuroimaging studies, and outcomes were similar to the inflammatory/autoimmune group. Brain biopsy identified a specific diagnosis in 7 of 14 patients (50 %). Fifteen patients (18.5 %) either died or had a poor outcome. In multivariate logistic regression models, a higher CSF protein (per 5 mg/dl, OR = 1.11, 95 % CI: 1.03–1.20), a higher CSF glucose (per 5 mg/dl, OR = 1.36, 95 % CI: 1.09–1.70), and higher serum glucose (per 5 mg/dl, OR = 1.27, 95 % CI: 1.06–1.52) were independently associated with increased odds of poor outcome. Inflammatory and non-infectious conditions accounted for most cases of BE. Higher CSF protein and glucose were independently associated with poor outcome. In immunocompetent patients with BE of undefined etiology despite extensive investigation, a trial of immunosuppressive treatment may be warranted, though deterioration clinically or on magnetic resonance imaging should prompt a brain biopsy. PMID:23749332

  15. System and individual outcomes and their predictors in services and support for people with IDD.

    PubMed

    Tichá, Renáta; Hewitt, Amy; Nord, Derek; Larson, Sherri

    2013-10-01

    The growth and advancement of community-based services for people with intellectual and developmental disabilities (IDD) have resulted in vast changes in the long-term services and support landscape as well as in expected outcomes of service systems for service recipients. Investments in IDD research have been made to provide a deeper understanding of these outcomes and to explain them. This article summarizes outcomes and their predictors through systems and individual lenses by examining the research and findings of the Administration on Intellectual and Developmental Disabilities' Data Projects of National Significance that address residential services, employment services, costs of services, and individual outcomes. The article also discusses challenges and debates associated with outcome-related research and poses future research questions. PMID:24303819

  16. Predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion.

    PubMed

    Cobo Soriano, Javier; Sendino Revuelta, Marcos; Fabregate Fuente, Martín; Cimarra Díaz, Ignacio; Martínez Ureña, Paloma; Deglané Meneses, Roberto

    2010-11-01

    There has been no agreement among different authors on guidelines to specify the situations in which arthrodesis is justified in terms of results, risks and complications. The aim of this study was to identify preoperative predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion. A prospective observational study design was performed on 203 consecutive patients. Potential preoperative predictors of outcome included sociodemographic factors as well as variables pertaining to the preoperative clinical situation, diagnosis, expectations and surgery. Separate multiple linear regression models were used to assess the association between selected predictors and outcome variables, defined as the improvement after 1 year on the visual analog scale (VAS) for back pain, VAS for leg pain, physical component scores (PCS) of SF-36 and Oswestry disability index (ODI). Follow-up was available for 184 patients (90.6%). Patients with higher educational level and optimistic preoperative expectations had a more favourable postoperative leg pain (VAS) and ODI. Smokers had less leg pain relief. Patients with better mental component score (emotional health) had greater ODI improvement. Less preoperative walking capacity predicted more leg pain relief. Patients with disc herniation had greater relief from back pain and more PCS and ODI improvement. More severe lumbar pain was predictive of less improvement on ODI and PCS. Age, sex, body mass index, analgesic use, surgeon, self-rated health, the number of decompressed levels and the length of fusion had no association with outcome. This study concludes that a higher educational level, optimistic expectations for improvement, the diagnosis of "disc herniation", less walking capacity and good emotional health may significantly improve clinical outcome. Smoking and more severe lumbar pain are predictors of worse results. PMID:20135333

  17. Predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion

    PubMed Central

    Sendino Revuelta, Marcos; Cimarra Díaz, Ignacio; Martínez Ureña, Paloma; Deglané Meneses, Roberto

    2010-01-01

    There has been no agreement among different authors on guidelines to specify the situations in which arthrodesis is justified in terms of results, risks and complications. The aim of this study was to identify preoperative predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion. A prospective observational study design was performed on 203 consecutive patients. Potential preoperative predictors of outcome included sociodemographic factors as well as variables pertaining to the preoperative clinical situation, diagnosis, expectations and surgery. Separate multiple linear regression models were used to assess the association between selected predictors and outcome variables, defined as the improvement after 1 year on the visual analog scale (VAS) for back pain, VAS for leg pain, physical component scores (PCS) of SF-36 and Oswestry disability index (ODI). Follow-up was available for 184 patients (90.6%). Patients with higher educational level and optimistic preoperative expectations had a more favourable postoperative leg pain (VAS) and ODI. Smokers had less leg pain relief. Patients with better mental component score (emotional health) had greater ODI improvement. Less preoperative walking capacity predicted more leg pain relief. Patients with disc herniation had greater relief from back pain and more PCS and ODI improvement. More severe lumbar pain was predictive of less improvement on ODI and PCS. Age, sex, body mass index, analgesic use, surgeon, self-rated health, the number of decompressed levels and the length of fusion had no association with outcome. This study concludes that a higher educational level, optimistic expectations for improvement, the diagnosis of “disc herniation”, less walking capacity and good emotional health may significantly improve clinical outcome. Smoking and more severe lumbar pain are predictors of worse results. PMID:20135333

  18. Predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion.

    PubMed

    Cobo Soriano, Javier; Sendino Revuelta, Marcos; Fabregate Fuente, Martín; Cimarra Díaz, Ignacio; Martínez Ureña, Paloma; Deglané Meneses, Roberto

    2010-11-01

    There has been no agreement among different authors on guidelines to specify the situations in which arthrodesis is justified in terms of results, risks and complications. The aim of this study was to identify preoperative predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion. A prospective observational study design was performed on 203 consecutive patients. Potential preoperative predictors of outcome included sociodemographic factors as well as variables pertaining to the preoperative clinical situation, diagnosis, expectations and surgery. Separate multiple linear regression models were used to assess the association between selected predictors and outcome variables, defined as the improvement after 1 year on the visual analog scale (VAS) for back pain, VAS for leg pain, physical component scores (PCS) of SF-36 and Oswestry disability index (ODI). Follow-up was available for 184 patients (90.6%). Patients with higher educational level and optimistic preoperative expectations had a more favourable postoperative leg pain (VAS) and ODI. Smokers had less leg pain relief. Patients with better mental component score (emotional health) had greater ODI improvement. Less preoperative walking capacity predicted more leg pain relief. Patients with disc herniation had greater relief from back pain and more PCS and ODI improvement. More severe lumbar pain was predictive of less improvement on ODI and PCS. Age, sex, body mass index, analgesic use, surgeon, self-rated health, the number of decompressed levels and the length of fusion had no association with outcome. This study concludes that a higher educational level, optimistic expectations for improvement, the diagnosis of "disc herniation", less walking capacity and good emotional health may significantly improve clinical outcome. Smoking and more severe lumbar pain are predictors of worse results.

  19. Predictors of good outcome in medium to large spontaneous supratentorial intracerebral haemorrhages

    PubMed Central

    Castellanos, M; Leira, R; Tejada, J; Gil-Peralta, A; Davalos, A; Castillo, J; t for

    2005-01-01

    Objective: To determine potential predictors of good outcome in primary medium to large intracerebral haemorrhages (ICH) which could be useful for selecting patients for surgical procedures. Methods: Subjects were 138 patients with spontaneous hemispheric ICH >20 ml. They were non-surgically treated and were admitted consecutively to 15 hospitals within the first 12 hours of symptom onset (mean (SD), 5.8 (3.1) hours). Haematoma volume was measured on computed tomography (CT) at admission. Stroke severity was assessed by the Canadian stroke scale (CSS). Good outcome was defined as modified Rankin score ⩽2 at three months. Results: At the end of the follow up period, 45 patients (32.6%) had good outcome. Baseline stroke severity, systolic and diastolic blood pressure, body temperature, and acute phase reaction biochemical markers (ESR, C-reactive protein, fibrinogen, neutrophil count) were significantly associated with good outcome in bivariate analyses. Of the initial CT scan variables, intraventricular contamination, deep location, mass effect, and greater ICH volume were related to poor outcome. On multiple logistic regression analysis, cortical location of bleeding (odds ratio 3.79 (95% confidence interval 1.2 to 12.01); p = 0.023), high CSS score (OR 2.3 (1.6 to 3.1); p<0.0001), and low fibrinogen concentrations (OR 0.92 (0.87 to 0.97); p = 0.001) were independent predictors of good outcome. These three factors correctly classified 85% of patients. Conclusions: Good outcome in medium to large ICH can be predicted on admission by three readily assessable factors (CSS score, ICH location, and fibrinogen levels). These predictors may be helpful in selecting patients for surgical treatment. PMID:15834028

  20. Temperament and Impulsivity Predictors of Smoking Cessation Outcomes

    PubMed Central

    López-Torrecillas, Francisca; Perales, José C.; Nieto-Ruiz, Ana; Verdejo-García, Antonio

    2014-01-01

    Aims Temperament and impulsivity are powerful predictors of addiction treatment outcomes. However, a comprehensive assessment of these features has not been examined in relation to smoking cessation outcomes. Methods Naturalistic prospective study. Treatment-seeking smokers (n = 140) were recruited as they engaged in an occupational health clinic providing smoking cessation treatment between 2009 and 2013. Participants were assessed at baseline with measures of temperament (Temperament and Character Inventory), trait impulsivity (Barratt Impulsivity Scale), and cognitive impulsivity (Go/No Go, Delay Discounting and Iowa Gambling Task). The outcome measure was treatment status, coded as “dropout” versus “relapse” versus “abstinence” at 3, 6, and 12 months endpoints. Participants were telephonically contacted and reminded of follow-up face to face assessments at each endpoint. The participants that failed to answer the phone calls or self-reported discontinuation of treatment and failed to attend the upcoming follow-up session were coded as dropouts. The participants that self-reported continuing treatment, and successfully attended the upcoming follow-up session were coded as either “relapse” or “abstinence”, based on the results of smoking behavior self-reports cross-validated with co-oximetry hemoglobin levels. Multinomial regression models were conducted to test whether temperament and impulsivity measures predicted dropout and relapse relative to abstinence outcomes. Results Higher scores on temperament dimensions of novelty seeking and reward dependence predicted poorer retention across endpoints, whereas only higher scores on persistence predicted greater relapse. Higher scores on the trait dimension of non-planning impulsivity but not performance on cognitive impulsivity predicted poorer retention. Higher non-planning impulsivity and poorer performance in the Iowa Gambling Task predicted greater relapse at 3 and 6 months and 6 months

  1. Changes in Body Composition in Anorexia Nervosa: Predictors of Recovery and Treatment Outcome

    PubMed Central

    Arcelus, Jon; Sánchez, Isabel; Riesco, Nadine; Jiménez-Murcia, Susana; González-Gómez, Jana; Granero, Roser; Custal, Nuria; Montserrat-Gil de Bernabé, Monica; Tárrega, Salomé; Baños, Rosa M.; Botella, Cristina; de la Torre, Rafael; Fernández-García, José C.; Fernández-Real, José M.; Frühbeck, Gema; Gómez-Ambrosi, Javier; Tinahones, Francisco J.; Crujeiras, Ana B.; Casanueva, Felipe F.; Menchón, José M.; Fernández-Aranda, Fernando

    2015-01-01

    The restoration of body composition (BC) parameters is considered to be one of the most important goals in the treatment of patients with anorexia nervosa (AN). However, little is known about differences between AN diagnostic subtypes [restricting (AN-R) and binge/purging (AN-BP)] and weekly changes in BC during refeeding treatment. Therefore, the main objectives of our study were twofold: 1) to assess the changes in BC throughout nutritional treatment in an AN sample and 2) to analyze predictors of BC changes during treatment, as well as predictors of treatment outcome. The whole sample comprised 261 participants [118 adult females with AN (70 AN-R vs. 48 AN-BP), and 143 healthy controls]. BC was measured weekly during 15 weeks of day-hospital treatment using bioelectrical impedance analysis (BIA). Assessment measures also included the Eating Disorders Inventory-2, as well as a number of other clinical indices. Overall, the results showed that AN-R and AN-BP patients statistically differed in all BC measures at admission. However, no significant time×group interaction was found for almost all BC parameters. Significant time×group interactions were only found for basal metabolic rate (p = .041) and body mass index (BMI) (p = .035). Multiple regression models showed that the best predictors of pre-post changes in BC parameters (namely fat-free mass, muscular mass, total body water and BMI) were the baseline values of BC parameters. Stepwise predictive logistic regressions showed that only BMI and age were significantly associated with outcome, but not with the percentage of body fat. In conclusion, these data suggest that although AN patients tended to restore all BC parameters during nutritional treatment, only AN-BP patients obtained the same fat mass values as healthy controls. Put succinctly, the best predictors of changes in BC were baseline BC values, which did not, however, seem to influence treatment outcome. PMID:26600309

  2. Predictors of poor hospital discharge outcome in acute stroke due to atrial fibrillation.

    PubMed

    Tian, Melissa J; Tayal, Ashis H; Schlenk, Elizabeth A

    2015-02-01

    Atrial fibrillation (AF) is a frequent cause of acute ischemic stroke that results in severe neurological disability and death despite treatment with intravenous thrombolysis (intravenous recombinant tissue plasminogen activator [rtPA]). We performed a retrospective review of a single-center registry of patients treated with intravenous rtPA for stroke. The purposes of this study were to compare intravenous rtPA treated patients with stroke with and without AF to examine independent predictors of poor hospital discharge outcome (in-hospital death or hospital discharge to a skilled nursing facility, long-term acute care facility, or hospice care). A univariate analysis was performed on 144 patients receiving intravenous rtPA for stroke secondary to AF and 190 patients without AF. Characteristics that were significantly different between the two groups were age, initial National Institutes of Health Stroke Scale score, length of hospital stay, gender, hypertension, hyperlipidemia, smoking status, presence of large cerebral infarct, and hospital discharge outcome. Bivariate logistic regression analysis indicated that patients with stroke secondary to AF with a poor hospital discharge outcome had a greater likelihood of older age, higher initial National Institutes of Health Stroke Scale scores, longer length of hospital stay, intubation, and presence of large cerebral infarct compared with those with good hospital discharge outcome (discharged to home or inpatient rehabilitation or signed oneself out against medical advice). A multivariate logistic regression analysis showed that older age, longer length of hospital stay, and presence of large cerebral infarct were independent predictors of poor hospital discharge outcome. These predictors can guide nursing interventions, aid the multidisciplinary treating team with treatment decisions, and suggest future directions for research. PMID:25503541

  3. Rehabilitation Predictors of Clinical Outcome following Revision ACL Reconstruction

    PubMed Central

    Wright, Rick W.; Group, Mars

    2016-01-01

    Objectives: Revision ACL reconstruction has been documented to have worse outcomes compared with primary ACL reconstructions. The reasons why remain unknown. The purpose of this study was to determine whether rehabilitation-related factors prescribed at the time of ACL revision reconstruction significantly influence two year outcomes, as well as the incidence of incurring a subsequent re-operation. Our hypothesis was that immediate versus passive, active range of motion (ROM) and weightbearing will result in improved outcomes without incidence of subsequent surgery. Use of postoperative and functional return to sport braces will not improve return to sports function. Methods: Revision ACL reconstruction patients were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline demographics, surgical technique and pathology, prescribed post-op and rehabilitation instructions (ie. timing of weightbearing, timing of passive and active ROM, use of postoperative and return to sport braces) and a series of validated patient reported outcome instruments (IKDC, KOOS, and Marx activity rating score). Patients were followed up for 2 years, and asked to complete the identical set of outcome instruments. Because meniscal repair, meniscal transplants, HTOs, concurrent ligamentous reconstructions, and certain chondral treatments (ie. microfracture, abrasion arthroplasty, mosiacplasty, etc) are known to affect prescribed rehab treatments, patients with these pathologies were excluded from the analyses. Regression analysis was used to control for age, gender, activity level, baseline outcome scores, and the above-mentioned rehabilitation-related variables, in order to assess the risk factors for clinical outcomes 2 years after revision ACL reconstruction. Results: A total of 843 patients met the inclusion criteria and were successfully enrolled. 482 (57%) were males, with a median cohort age of 27 years. Baseline characteristics of the cohort are

  4. Predictors of Outcome and Severity in Adult Filipino Patients with Febrile Neutropenia.

    PubMed

    Yu, Marc Gregory Y; Villalobos, Ralph Elvi M; Juan-Bartolome, Ma Jasmin Marinela C; Berba, Regina P

    2015-01-01

    Aim. The study aimed to describe the profile of Filipino febrile neutropenia patients and to determine parameters associated with severe outcomes. Methods. This is a retrospective study of Filipino febrile neutropenia patients admitted to the Philippine General Hospital. Patients were described in terms of clinical presentation and stratified according to the presence or absence of severe outcomes. Prognostic factors were then identified using regression analysis. Results. 115 febrile episodes in 102 patients were identified. Regression analysis yielded prolonged fever >7 days prior to admission (OR 2.43; 95% CI, 0.77-7.74), isolation of a pathogen on cultures (OR 2.69; 95% CI, 1.04-6.98), and nadir absolute neutrophil count (ANC) < 100 during admission (OR 1.96; 95% CI, 0.75-5.12) as significant predictors of poor outcome. Factors that significantly correlated with better outcome were granulocyte colony-stimulating factor (G-CSF) use (OR 0.31; 95% CI, 0.11-0.85) and completeness of antibiotic therapy (OR 0.26; 95% CI, 0.10-0.67). Conclusion. Prolonged fever >7 days prior to admission, positive pathogen on cultures, and nadir ANC < 100 during admission predicted severe outcomes, whereas G-CSF use and complete antibiotic therapy were associated with better outcomes. These prognostic variables might be useful in identifying patients that need more intensive treatment and monitoring.

  5. Overall Well-Being as a Predictor of Health Care, Productivity, and Retention Outcomes in a Large Employer

    PubMed Central

    Shi, Yuyan; Coberley, Carter R.; Pope, James E.

    2013-01-01

    Abstract Employers struggle with the high cost of health care, lost productivity, and turnover in their workforce. The present study aims to understand the association between overall well-being and these employer outcomes. In a sample of 11,700 employees who took the Well-being Assessment, the authors used multivariate linear and logistic regression to investigate overall well-being as a predictor of health care outcomes (total health care expenditure, emergency room visits, hospitalizations), productivity outcomes (unscheduled absence, short-term disability leave, presenteeism, job performance ratings), and retention outcomes (intention to stay, voluntary turnover, involuntary turnover). Testing this hypothesis both cross-sectionally and longitudinally, the authors investigated the association between baseline well-being and these outcomes in the following year, and the relationship between change in overall well-being and change in these outcomes over 1 year. The results demonstrated that baseline overall well-being was a significant predictor of all outcomes in the following year when holding baseline employee characteristics constant. Change in overall well-being over 1 year also was significantly associated with the change in employer outcomes, with the exception that the relationship to change in manager-rated job performance was marginally significant. The relationships between overall well-being and outcomes suggest that implementing a well-being improvement solution could have a significant bottom and top line impact on business performance. (Population Health Management 2013;16:397–405) PMID:23480368

  6. Overall well-being as a predictor of health care, productivity, and retention outcomes in a large employer.

    PubMed

    Sears, Lindsay E; Shi, Yuyan; Coberley, Carter R; Pope, James E

    2013-12-01

    Employers struggle with the high cost of health care, lost productivity, and turnover in their workforce. The present study aims to understand the association between overall well-being and these employer outcomes. In a sample of 11,700 employees who took the Well-being Assessment, the authors used multivariate linear and logistic regression to investigate overall well-being as a predictor of health care outcomes (total health care expenditure, emergency room visits, hospitalizations), productivity outcomes (unscheduled absence, short-term disability leave, presenteeism, job performance ratings), and retention outcomes (intention to stay, voluntary turnover, involuntary turnover). Testing this hypothesis both cross-sectionally and longitudinally, the authors investigated the association between baseline well-being and these outcomes in the following year, and the relationship between change in overall well-being and change in these outcomes over 1 year. The results demonstrated that baseline overall well-being was a significant predictor of all outcomes in the following year when holding baseline employee characteristics constant. Change in overall well-being over 1 year also was significantly associated with the change in employer outcomes, with the exception that the relationship to change in manager-rated job performance was marginally significant. The relationships between overall well-being and outcomes suggest that implementing a well-being improvement solution could have a significant bottom and top line impact on business performance. PMID:23480368

  7. Predictors of Outcome for Children Receiving Intensive Behavioral Intervention in a Large, Community-Based Program

    ERIC Educational Resources Information Center

    Perry, Adrienne; Cummings, Anne; Geier, Jennifer Dunn; Freeman, Nancy L.; Hughes, Susan; Managhan, Tom; Reitzel, Jo-Ann; Williams, Janis

    2011-01-01

    This study reports on predictors of outcome in 332 children, aged 2-7 years, enrolled in the community-based Intensive Behavioral Intervention (IBI) program in Ontario, Canada. Data documenting children's progress were reported in an earlier publication (Perry et al., 2008). The present paper explores the degree to which four predictors (measured…

  8. Predictors and Moderators of Treatment Outcome in the Pediatric Obsessive Compulsive Treatment Study (POTS I)

    ERIC Educational Resources Information Center

    Garcia, Abbe Marrs; Sapyta, Jeffrey J.; Moore, Phoebe S.; Freeman, Jennifer B.; Franklin, Martin E.; March, John S.; Foa, Edna B.

    2010-01-01

    Objective: To identify predictors and moderators of outcome in the first Pediatric OCD Treatment Study (POTS I) among youth (N = 112) randomly assigned to sertraline, cognitive behavioral therapy (CBT), both sertraline and CBT (COMB), or a pill placebo. Method: Potential baseline predictors and moderators were identified by literature review. The…

  9. Predictors of professional placement outcome: cultural background, English speaking and international student status.

    PubMed

    Attrill, Stacie; McAllister, Sue; Lincoln, Michelle

    2016-08-01

    Placements provide opportunities for students to develop practice skills in professional settings. Learning in placements may be challenging for culturally and linguistically diverse (CALD) students, international students, or those without sufficient English proficiency for professional practice. This study investigated whether these factors, which are hypothesized to influence acculturation, predict poor placement outcome. Placement outcome data were collected for 854 students who completed 2747 placements. Placement outcome was categorized into 'Pass' or 'At risk' categories. Multilevel binomial regression analysis was used to determine whether being CALD, an international student, speaking 'English as an additional language', or a 'Language other than English at home' predicted placement outcome. In multiple multilevel analysis speaking English as an additional language and being an international student were significant predictors of 'at risk' placements, but other variables tested were not. Effect sizes were small indicating untested factors also influenced placement outcome. These results suggest that students' English as an additional language or international student status influences success in placements. The extent of acculturation may explain the differences in placement outcome for the groups tested. This suggests that learning needs for placement may differ for students undertaking more acculturative adjustments. Further research is needed to understand this and to identify placement support strategies. PMID:27492321

  10. Predictors of professional placement outcome: cultural background, English speaking and international student status.

    PubMed

    Attrill, Stacie; McAllister, Sue; Lincoln, Michelle

    2016-08-01

    Placements provide opportunities for students to develop practice skills in professional settings. Learning in placements may be challenging for culturally and linguistically diverse (CALD) students, international students, or those without sufficient English proficiency for professional practice. This study investigated whether these factors, which are hypothesized to influence acculturation, predict poor placement outcome. Placement outcome data were collected for 854 students who completed 2747 placements. Placement outcome was categorized into 'Pass' or 'At risk' categories. Multilevel binomial regression analysis was used to determine whether being CALD, an international student, speaking 'English as an additional language', or a 'Language other than English at home' predicted placement outcome. In multiple multilevel analysis speaking English as an additional language and being an international student were significant predictors of 'at risk' placements, but other variables tested were not. Effect sizes were small indicating untested factors also influenced placement outcome. These results suggest that students' English as an additional language or international student status influences success in placements. The extent of acculturation may explain the differences in placement outcome for the groups tested. This suggests that learning needs for placement may differ for students undertaking more acculturative adjustments. Further research is needed to understand this and to identify placement support strategies.

  11. Medical and social factors as predictors of outcome in infant tracheostomy.

    PubMed

    Singer, L T; Hill, B P; Orlowski, J P; Doershuk, C F

    1991-01-01

    We examined the relative impact of infant tracheostomy in comparison to associated medical and social factors, on developmental outcome as part of a cross-sectional follow-up of 32 children. These children had no mental retardation, physical handicap, or severe neurological problems, but had a history of long-term tracheostomy in infancy, ranging from 3 to 146 months duration. Medical factors evaluated included prematurity, neurological status, severity of illness, and number of weeks hospitalized. Social factors included parental education and occupation. Outcome measures included IQ, language quotient, growth parameters, and behavioral competence. Correlation analyses, stepwise multiple regression analyses, and t-tests were used. Early medical illnesses were significant predictors of cognitive, language, and growth outcome. Severity of medical complications at birth and the presence of any neurological problem predicted 49% of the variance in IQ at follow-up. Social class was the only variable to predict behavioral outcome, accounting for 28% of the variance. For children without confounding medical conditions, tracheostomy had a negative impact on overall language and auditory comprehension. Once children with confounding medical risk factors were removed from the sample, children with history of infant tracheostomy exhibited significantly lower overall mean language scores (106 versus 120), and lower mean language comprehension scores (104 versus 119) than a matched comparison group.

  12. 24-Hour ICH Score Is a Better Predictor of Outcome than Admission ICH Score

    PubMed Central

    Aysenne, Aimee M.; Albright, Karen C.; Mathias, Tiffany; Chang, Tiffany R.; Boehme, Amelia K.; Beasley, T. Mark; Martin-Schild, Sheryl

    2016-01-01

    Background The ICH score is a validated tool for predicting 30-day morbidity and mortality in patients with intracerebral hemorrhage. Aims and/or Hypothesis The aim of this study is to determine if the ICH score calculated 24 hours after admission is a better predictor of mortality than the ICH score calculated on admission. Methods Patients presenting to our center with ICH from 7/08-12/10 were retrospectively identified from our prospective stroke registry. ICH scores were calculated based on initial Glasgow coma scale (GCS) and emergent head computed tomography (CT) on initial presentation and were recalculated after 24 hours. Results A total of 91 patients out of 121 had complete data for admission and 24-hour ICH score. The ICH score changed in 38% from baseline to 24 hours. After adjusting for age, NIHSS on admission, and glucose, ICH score at 24 hours was a significant, independent predictor of mortality (OR = 2.71, 95% CI 1–19–6.20, and P = 0.018), but ICH score on admission was not (OR = 2.14, 95% CI 0.88-5.24, and P = 0.095). Conclusion Early determination of the ICH score may incorrectly estimate the severity and expected outcome after ICH. Calculations of the ICH score 24 hours after admission will better predict early outcomes.

  13. Predictors of Treatment Outcomes for Substance-Abusing Women: A Retrospective Study.

    PubMed

    Comfort, Marilee; Kaltenbach, Karol A.

    2000-03-01

    This study examined whether client characteristics at admission predict Retention, Abstinence, and utilization of Required Services and Specialized Services for pregnant women in outpatient and residential substance abuse treatment. Retrospective data were collected with the Psychosocial History (PSH), a structured clinical interview that is an expansion of the Addiction Severity Index, designed specifically to assess substance abusing women. The PSH was administered at intake for 183 pregnant women admitted to outpatient (n = 133) or residential (n = 50) treatment. Factor analysis reduced predictors to five factors with composite scores, and multiple regression procedures determined client characteristics that predict treatment outcomes. The findings suggest the complexity of predicting treatment outcomes for pregnant women. Significant predictors were composites of variables that encompassed all aspects of women's personal and family lives including medical and psychiatric needs, family and parenting issues, housing, victimization, and clients' perceived needs for treatment and assistance in all of these areas. The results suggest the need for a holistic approach to substance abuse treatment and continued exploration of a broad range of psychosocial assessments at intake in order to develop substance abuse treatment programs that effectively address multiple aspects of women's lives. PMID:12466646

  14. Left Ventricular End-Diastolic Pressure as an Independent Predictor of Outcome During Balloon Aortic Valvuloplasty

    PubMed Central

    Cubeddu, Roberto J.; Don, Creighton W.; Horvath, Sofia A.; Gupta, Pritha P.; Cruz-Gonzalez, Ignacio; Witzke, Christian; Inglessis, Ignacio; Palacios, Igor F.

    2014-01-01

    Objectives In this study, we examined the predictive value of the left ventricular enddiastolic pressure (LVEDP) in patients undergoing balloon aortic valvuloplasty (BAV). Background The LVEDP is a useful indicator of hemodynamic status in patients with severe aortic stenosis. In BAV, decompensated heart failure is associated with worse outcomes. Methods We identified all consecutive patients with severe symptomatic aortic stenosis who underwent retrograde BAV at the Massachusetts General Hospital from 2004 to 2008. Patients were stratified and compared according to their baseline LVEDP into ≤15 mm Hg, 16–20 mm Hg, 21–25 mm Hg, and ≥26 mm Hg. Procedural and in-hospital outcomes and adverse events were compared. Multivariate logistic regression was used for the adjusted analysis. Results A total of 111 patients with a mean age of 83±11 years underwent BAV. Of these, the LVEDP was ≤15 mm Hg in 29 (26%), 16–20 mm Hg in 41 (37%), 21–25 mm Hg in 16 (14%), and ≥26 mm Hg in 25 (23%) patients. Baseline characteristics were similar among the four groups. Noticeably, patients with high LVEDP levels had significantly higher rates of the combined endpoint of in-hospital death, myocardial infarction (MI), cardiopulmonary arrest, and tamponade was P = 0.02. Periprocedural MI was more common among those with higher LVEDP (16% vs. 2.3%; P = 0.04). Multivariate analysis revealed LVEDP (OR 1.08, for each mm Hg increase in pressure, 95 % CI 1.02–1.14), small LV chamber size, and New York Heart Association class as independent predictors of adverse outcomes. Conclusions The LVEDP is an important independent predictor of poor in-hospital outcome during BAV. In these patients, the immediate hemodynamic status may be more important than the baseline left ventricular systolic function. Hemodynamic optimization before or during BAV should be considered and may be beneficial. PMID:22511584

  15. Predictors of Employment Outcomes for State-Federal Vocational Rehabilitation Consumers with HIV/AIDS

    ERIC Educational Resources Information Center

    Jung, Youngoh; Schaller, James; Bellini, James

    2010-01-01

    In this study, the authors investigated the effects of demographic, medical, and vocational rehabilitation service variables on employment outcomes of persons living with HIV/AIDS. Binary logistic regression analyses were conducted to determine predictors of employment outcomes using two groups drawn from Rehabilitation Services Administration…

  16. The Antidepressant Treatment Response Index as a Predictor of Reboxetine Treatment Outcome in Major Depressive Disorder.

    PubMed

    Caudill, Marissa M; Hunter, Aimee M; Cook, Ian A; Leuchter, Andrew F

    2015-10-01

    Biomarkers to predict clinical outcomes early during the treatment of major depressive disorder (MDD) could reduce suffering and improve outcomes. A quantitative electroencephalogram (qEEG) biomarker, the Antidepressant Treatment Response (ATR) index, has been associated with outcomes of treatment with selective serotonin reuptake inhibitor antidepressants in patients with MDD. Here, we report the results of a post hoc analysis initiated to evaluate whether the ATR index may also be associated with reboxetine treatment outcome, given that its putative mechanism of action is via norepinephrine reuptake inhibition (NRI). Twenty-five adults with MDD underwent qEEG studies during open-label treatment with reboxetine at doses of 8 to 10 mg daily for 8 weeks. The ATR index calculated after 1 week of reboxetine treatment was significantly associated with overall Hamilton Depression Rating Scale (HAM-D) improvement at week 8 (r=0.605, P=.001), even after controlling for baseline depression severity (P=.002). The ATR index predicted response (≥50% reduction in HAM-D) with 70.6% sensitivity and 87.5% specificity, and remission (final HAM-D≤7) with 87.5% sensitivity and 64.7% specificity. These results suggest that the ATR index may be a useful biomarker of clinical response during NRI treatment of adults with MDD. Future studies are warranted to investigate further the potential utility of the ATR index as a predictor of noradrenergic antidepressant treatment response.

  17. Process Predictors of the Outcome of Group Drug Counseling

    PubMed Central

    Crits-Christoph, Paul; Johnson, Jennifer E.; Gibbons, Mary Beth Connolly; Gallop, Robert

    2012-01-01

    Objective This study examined the relation of process variables to the outcome of group drug counseling, a commonly used community treatment, for cocaine dependence. Method Videotaped group drug counseling sessions from 440 adult patients (23% female, 41% minority) were rated for member alliance, group cohesion, participation, self-disclosure, positive and non-positive feedback and advice, during the 6-month treatment of cocaine dependence. Average, session-level, and slopes of process scores were evaluated. Primary outcomes were monthly cocaine use (days using out of 30), next session cocaine use, and duration of sustained abstinence from cocaine. Secondary outcomes were endorsement of 12-step philosophy and beliefs about substance abuse. Results More positive alliances (with counselor) were associated with reductions in days using cocaine per month and next-session cocaine use, and increases in endorsement of 12-step philosophy. Patient self-disclosure about the past and degree of participation in the group were generally not predictive of group drug counseling outcomes. More advice from counselor and other group members were consistently associated with poorer outcomes in all categories. Individual differences in changes in process variables over time (linear slopes) were generally not predictive of treatment outcomes. Conclusions Some group behaviors widely believed to be associated with outcome, such as self-disclosure and participation, were not generally predictive of outcomes of group drug counseling, but alliance with the group counselor was positively associated, and advice giving negatively associated, with the outcome of treatments for cocaine dependence. PMID:23106760

  18. Predictors of emotional distress, general health, and caregiving outcomes in family caregivers of stroke survivors.

    PubMed

    Bakas, Tamilyn; Burgener, Sandy C

    2002-01-01

    Predictors of emotional distress, general health, and stroke-related caregiving outcomes were determined in 104 family caregivers of stroke survivors based on a conceptual model derived from Lazarus' theory of stress and coping. Predictors of emotional distress (R(2) =.48, p <.001) were low caregiver self-esteem, high task difficulty, and high threat appraisal. Predictors of poorer health (R(2) =.25, p <.001) were not living with the patient, low household income, and high threat appraisal. Predictors of poor stroke-related care-giving outcomes (R(2) =.45, p <.001) were emotional distress, low benefit appraisal, high task difficulty, and high threat appraisal. Findings suggest potential areas for multidimensional caregiver interventions.

  19. Predictors of outcome in childhood intracerebral hemorrhage: a prospective consecutive cohort study

    PubMed Central

    Beslow, Lauren A; Licht, Daniel J; Smith, Sabrina E; Storm, Phillip B; Heuer, Gregory G; Zimmerman, Robert A; Feiler, Alana M; Kasner, Scott E; Ichord, Rebecca N; Jordan, Lori C

    2010-01-01

    Background and Purpose To describe features of children with intracerebral hemorrhage (ICH) and to determine predictors of short-term outcome in a single-center prospective cohort study. Methods Single-center prospective consecutive cohort study of spontaneous ICH in children age 1-18 years from January 2006 to June 2008. Exclusion criteria were inciting trauma; intracranial tumor; isolated epidural, subdural, intraventricular, or subarachnoid hemorrhage; hemorrhagic transformation of ischemic stroke; and cerebral sinovenous thrombosis. Hospitalization records were abstracted. Follow-up assessments included outcome scores using the Pediatric Stroke Outcome Measure (PSOM) and King's Outcome Scale for Childhood Head Injury (KOSCHI). ICH volumes and total brain volumes (TBV) were measured by manual tracing. Results Twenty-two patients, median age of 10.3 years (range 4.2-16.6 years), had presenting symptoms of headache in 77%, focal deficits 50%, altered mental status 50%, and seizures 41%. Vascular malformations caused hemorrhage in 91%. Surgical treatment (hematoma evacuation, lesion embolization or excision) was performed during acute hospitalization in 50%. One patient died acutely. At median follow-up of 3.5 months (range 0.3-7.5 months), 71% of survivors had neurological deficits; 55% had clinically significant disability. Outcome based on PSOM and KOSCHI scores was worse in patients with ICH volume >2% of TBV (p=0.023) and altered mental status at presentation (p = 0.005). Conclusions Spontaneous childhood ICH was due mostly to vascular malformations. Acute surgical intervention was commonly performed. Although death was rare, 71% of survivors had persisting neurological deficits. Larger ICH volume and altered mental status predicted clinically significant disability. PMID:20019325

  20. Personality predictors of academic outcomes: big five correlates of GPA and SAT scores.

    PubMed

    Noftle, Erik E; Robins, Richard W

    2007-07-01

    The authors examined relations between the Big Five personality traits and academic outcomes, specifically SAT scores and grade-point average (GPA). Openness was the strongest predictor of SAT verbal scores, and Conscientiousness was the strongest predictor of both high school and college GPA. These relations replicated across 4 independent samples and across 4 different personality inventories. Further analyses showed that Conscientiousness predicted college GPA, even after controlling for high school GPA and SAT scores, and that the relation between Conscientiousness and college GPA was mediated, both concurrently and longitudinally, by increased academic effort and higher levels of perceived academic ability. The relation between Openness and SAT verbal scores was independent of academic achievement and was mediated, both concurrently and longitudinally, by perceived verbal intelligence. Together, these findings show that personality traits have independent and incremental effects on academic outcomes, even after controlling for traditional predictors of those outcomes. ((c) 2007 APA, all rights reserved). PMID:17605593

  1. Educational skills: long-term outcome and predictors following paediatric traumatic brain injury.

    PubMed

    Catroppa, Cathy; Anderson, Vicki A; Muscara, Frank; Morse, Sue A; Haritou, Flora; Rosenfeld, Jeffrey V; Heinrich, Liesl M

    2009-10-01

    Given that reading, spelling and arithmetic skills are acquired through childhood, their development may be compromised following a childhood traumatic brain injury (TBI). The present study examined educational skills (reading accuracy, spelling and arithmetic) at a mean follow-up interval of 6.8 years post-injury in children who had sustained a mild, moderate, or severe TBI at two ages: 'Young' (age at injury: 3-7 years, n = 48) and 'Old': (age at injury: 8-12 years, n = 36). Comparisons between the young and old TBI groups resulted in inconsistent findings. While a dose-response relationship for severity was evident for the young group, this was not always the case for the old group. Significant predictors of outcome included both severity and acute intellectual function. PMID:19306233

  2. Outcome-adaptive randomization for a delayed outcome with a short-term predictor: imputation-based designs.

    PubMed

    Kim, Mi-Ok; Liu, Chunyan; Hu, Feifang; Lee, J Jack

    2014-10-15

    Delay in the outcome variable is challenging for outcome-adaptive randomization, as it creates a lag between the number of subjects accrued and the information known at the time of the analysis. Motivated by a real-life pediatric ulcerative colitis trial, we consider a case where a short-term predictor is available for the delayed outcome. When a short-term predictor is not considered, studies have shown that the asymptotic properties of many outcome-adaptive randomization designs are little affected unless the lag is unreasonably large relative to the accrual process. These theoretical results assumed independent identical delays, however, whereas delays in the presence of a short-term predictor may only be conditionally homogeneous. We consider delayed outcomes as missing and propose mitigating the delay effect by imputing them. We apply this approach to the doubly adaptive biased coin design (DBCD) for motivating pediatric ulcerative colitis trial. We provide theoretical results that if the delays, although non-homogeneous, are reasonably short relative to the accrual process similarly as in the iid delay case, the lag is also asymptotically ignorable in the sense that a standard DBCD that utilizes only observed outcomes attains target allocation ratios in the limit. Empirical studies, however, indicate that imputation-based DBCDs performed more reliably in finite samples with smaller root mean square errors. The empirical studies assumed a common clinical setting where a delayed outcome is positively correlated with a short-term predictor similarly between treatment arm groups. We varied the strength of the correlation and considered fast and slow accrual settings. PMID:24889540

  3. Optimum predictors of therapeutic outcome in HCV patients in Pakistan.

    PubMed

    Aziz, Hafsa; Raza, Abida; Irfan, Javaid

    2016-01-01

    Hepatitis C virus (HCV) constitutes a major public health issue in Pakistan. Interferon α and ribavirin is used widely in routine practice in HCV infected patients in Pakistan.Treatment prediction is an important tool in therapy management. The present study aims to evaluate trends of predictive variables of treatment outcome in patients with different genotypes. The analysis comprised of 921 patients infected with different HCV genotypes. All the patients received IFN α-2b combined with ribavirin for 24 weeks. Overall, 60.2% patients achieved Sustained virologic response (SVR). In females sustained virologic response (SVR) was higher in age group <40 years (77.2%) than ≥40-50 years (60%) but in male SVR was almost equal in both age groups. We also found higher SVR with low pretreatment viral load (72.4%, P < 0.0001). Sustained Virologic Response in genotype 3a was 63.1%, 3b was 55%, 1a was 36.3% and 1b was 35% 3a +3b was 55.0% and 1a+3a was 42.9%. According to multivariable logistic regression analysis age < 40 years (2.0; 95%CI, 1.49-2.84; P = 0.0001), low pretreatment RNA level<800,000 IU/ml (4.0; 95%CI, 2.64-6.17; P = 0.0001), early virologic response at week 12 (12.3; 95%CI, 8.18-18.58; P < 0.0001) and non-fatty liver (2.5; 95%CI, 3.6-6.2; P = 0.005) showed significance for SVR. Nucleotide substitution in 5'UTR before treatment failed to show any characteristic pattern that has correlation with sustained response. Subtype 3a showed 95% presence among patients with age <40 years while older patients showed 79.9%.

  4. Predictors of Functional Outcome Among Stroke Patients in Lima, Peru

    PubMed Central

    Abanto, Carlos; Ton, Thanh G.N.; Tirschwell, David L.; Montano, Silvia; Quispe, Yrma; Gonzales, Isidro; Valencia, Ana; Calle, Pilar; Garate, Arturo; Zunt, Joseph

    2013-01-01

    Background Due to the aging population in low- and middle-income countries, cerebrovascular disease is expected to remain a leading cause of death. Little has been published about stroke in Peru. Aims We conducted a retrospective cohort study of hospitalized stroke patients at a referral center hospital in Lima, Peru to explore factors associated with functional outcome among stroke patients. Methods We identified 579 patients hospitalized for ischemic stroke or intracerebral hemorrhage stroke at the National Institute of Neurologic Sciences in Lima, Peru in 2008 and 2009. A favorable outcome was defined as a modified Rankin score of ≤2 at discharge. Results The mean age was 63.3 years; 75.6% had ischemic stroke; the average length of stay was 17.3 days. At hospital discharge, 231 (39.9%) had a favorable outcome. The overall mortality rate was 5.2%. In multivariate models, the likelihood of having a favorable outcome decreased linearly with increasing age (p=0.02) and increasing NIHSS (p=0.02). Favorable outcome was also associated with male gender (relative risk [RR]=1.2; 95% confidence interval [CI]: 1.0, 1.5) and divorced status (RR=1.3, 95% CI: 1.1, 1.7). Patients on Salud Integral de Salud (public assistance-type insurance, SIS) (RR=0.7, 95% CI: 0.5,1.0) were also less likely to have a favorable outcome. Conclusions Favorable outcome after stroke was independently associated with younger age, lower NIHSS score, male gender, being divorced, and not being on SIS insurance. These findings suggest further study of worse functional outcomes in patients with SIS insurance and confirm the importance of risk adjustment for age, stroke severity (NIHSS) and other socioeconomic factors in outcomes studies. Future studies should preferentially assess outcome at 30-days and 6-months to provide more reliable comparisons and allow additional study of Peruvian end-of-life decision-making and care. PMID:23352681

  5. Physiological and Computed Tomographic Predictors of Outcome from Lung Volume Reduction Surgery

    PubMed Central

    Washko, George R.; Martinez, Fernando J.; Hoffman, Eric A.; Loring, Stephen H.; Estépar, Raúl San José; Diaz, Alejandro A.; Sciurba, Frank C.; Silverman, Edwin K.; Han, MeiLan K.; DeCamp, Malcolm; Reilly, John J.

    2010-01-01

    of emphysema and its distribution are weak but statistically significant predictors of outcome after LVRS. PMID:19965810

  6. Predictors and outcomes of resistant hypertension among patients with coronary artery disease and hypertension

    PubMed Central

    Smith, Steven M.; Gong, Yan; Handberg, Eileen; Messerli, Franz H.; Bakris, George L.; Ahmed, Ali; Bavry, Anthony A.; Pepine, Carl J.; Cooper-DeHoff, Rhonda M.

    2014-01-01

    Objective Resistant hypertension (res-HTN) is a challenging problem, but little is known of res-HTN in patients with coronary artery disease (CAD). In this post-hoc INternational VErapamil SR-Trandolapril STudy (INVEST) analysis, we assessed prevalence, predictors, and impact on outcomes of res-HTN in CAD patients with hypertension. Methods Participants (n=17 190) were divided into three groups according to achieved blood pressure (BP): controlled (BP <140/90 mmHg on three or fewer drugs); uncontrolled (BP ≥140/90mmHg on two or fewer drugs); or resistant (BP ≥140/90 mmHg on three drugs or any patient on at least four drugs). Results The prevalence of res-HTN was 38%: significant predictors of res-HTN included heart failure [odds ratio (OR) 1.73], diabetes (OR 1.63), Black race (OR 1.50), and US residence (OR 1.50). Compared with controlled HTN, res-HTN had multivariate-adjusted association with higher risk of adverse outcomes {first occurrence of all-cause death, nonfatal myocardial infarction, or nonfatal stroke [hazard ratio 1.27, 95% confidence interval (CI) 1.13–1.43], and individual outcomes of all-cause death (hazard ratio 1.29, 95% CI 1.13–1.48), cardiovascular mortality (hazard ratio 1.47, 95% CI 1.21–1.78), and nonfatal stroke (hazard ratio 1.61, 95% CI 1.17–2.22), but not nonfatal myocardial infarction (hazard ratio 0.98, 95% CI 0.72–1.34)}. Adverse outcomes, except nonfatal stroke, did not differ in patients with res-HTN compared to uncontrolled HTN. Conclusions Res-HTN is common in patients with CAD and hypertension, associated with poor prognosis, and linked with a number of conditions. Emphasis should be placed on recognizing those at risk for res-HTN and future studies should examine whether more aggressive treatment of res-HTN improves outcomes. PMID:24299915

  7. Predictors of Outcome in Traumatic Brain Injury: New Insight Using Receiver Operating Curve Indices and Bayesian Network Analysis

    PubMed Central

    Zador, Zsolt; Sperrin, Matthew; King, Andrew T.

    2016-01-01

    Background Traumatic brain injury remains a global health problem. Understanding the relative importance of outcome predictors helps optimize our treatment strategies by informing assessment protocols, clinical decisions and trial designs. In this study we establish importance ranking for outcome predictors based on receiver operating indices to identify key predictors of outcome and create simple predictive models. We then explore the associations between key outcome predictors using Bayesian networks to gain further insight into predictor importance. Methods We analyzed the corticosteroid randomization after significant head injury (CRASH) trial database of 10008 patients and included patients for whom demographics, injury characteristics, computer tomography (CT) findings and Glasgow Outcome Scale (GCS) were recorded (total of 13 predictors, which would be available to clinicians within a few hours following the injury in 6945 patients). Predictions of clinical outcome (death or severe disability at 6 months) were performed using logistic regression models with 5-fold cross validation. Predictive performance was measured using standardized partial area (pAUC) under the receiver operating curve (ROC) and we used Delong test for comparisons. Variable importance ranking was based on pAUC targeted at specificity (pAUCSP) and sensitivity (pAUCSE) intervals of 90–100%. Probabilistic associations were depicted using Bayesian networks. Results Complete AUC analysis showed very good predictive power (AUC = 0.8237, 95% CI: 0.8138–0.8336) for the complete model. Specificity focused importance ranking highlighted age, pupillary, motor responses, obliteration of basal cisterns/3rd ventricle and midline shift. Interestingly when targeting model sensitivity, the highest-ranking variables were age, severe extracranial injury, verbal response, hematoma on CT and motor response. Simplified models, which included only these key predictors, had similar performance (pAUCSP = 0

  8. Eye Color as a Predictor of Outcomes in Behavior Therapy.

    ERIC Educational Resources Information Center

    Markle, Allan; And Others

    1984-01-01

    Examined the relationship between outcomes of behaviorally oriented treatment for children (N=366) and eye color. Findings were consistent with theoretical expectations: Dark-eyed children and teenagers responded better to reactive treatment programs than their light-eyed counterparts, while the reverse was true for self-paced treatment programs.…

  9. Planning in Middle Childhood: Early Predictors and Later Outcomes

    ERIC Educational Resources Information Center

    Friedman, Sarah L.; Scholnick, Ellin K.; Bender, Randall H.; Vandergrift, Nathan; Spieker, Susan; Pasek, Kathy Hirsh; Keating, Daniel P.; Park, Yoonjung

    2014-01-01

    Data from 1,364 children and families who participated in the National Institute of Child Health and Human Development's Study of Early Child Care and Youth Development were analyzed to track the early correlates and later academic outcomes of planning during middle childhood. Maternal education, through its effect on parenting quality when…

  10. Predictors of Parenting and Infant Outcomes for Impoverished Adolescent Parents

    ERIC Educational Resources Information Center

    Whitson, Melissa L.; Martinez, Andrew; Ayala, Carmen; Kaufman, Joy S.

    2011-01-01

    Adolescent mothers and their children are at risk for a myriad of negative outcomes. This study examined risk and protective factors and their impact on a sample (N = 172) of impoverished adolescent mothers. Multiple regression analyses revealed that depressed adolescent mothers report higher levels of parenting stress and that their children are…

  11. Process Predictors of the Outcome of Group Drug Counseling

    ERIC Educational Resources Information Center

    Crits-Christoph, Paul; Johnson, Jennifer E.; Connolly Gibbons, Mary Beth; Gallop, Robert

    2013-01-01

    Objective: This study examined the relation of process variables to the outcome of group drug counseling, a commonly used community treatment, for cocaine dependence. Method: Videotaped group drug counseling sessions from 440 adult patients (23% female, 41% minority) were rated for member alliance, group cohesion, participation, self-disclosure,…

  12. Students with Intellectual Disabilities: Predictors of Transition Outcomes

    ERIC Educational Resources Information Center

    Baer, Robert M.; Daviso, Alfred W., III; Flexer, Robert W.; Queen, Rachel McMahan; Meindl, Richard S.

    2011-01-01

    This study examined the outcomes of 409 students with mental retardation or multiple disabilities from 177 school districts in a Great Lakes state. These students with intellectual disabilities were interviewed at exit and 1 year following graduation. The authors developed and tested three regression models--two to predict full-time employment and…

  13. Predictors of Outcome following Acquired Brain Injury in Children

    ERIC Educational Resources Information Center

    Johnson, Abigail R.; DeMatt, Ellen; Salorio, Cynthia F.

    2009-01-01

    Acquired brain injury (ABI) in children and adolescents can result from multiple causes, including trauma, central nervous system infections, noninfectious disorders (epilepsy, hypoxia/ischemia, genetic/metabolic disorders), tumors, and vascular abnormalities. Prediction of outcomes is important, to target interventions, allocate resources,…

  14. Predictors of Study Abroad Intent, Participation, and College Outcomes

    ERIC Educational Resources Information Center

    Luo, Jiali; Jamieson-Drake, David

    2015-01-01

    This study examined US undergraduate students' intent to study abroad upon college entry and their actual participation in study abroad during their undergraduate years, correlating the college outcomes of three cohorts to identify trends. The findings show that study abroad intent and participation are interrelated and shaped by an array of…

  15. Patient Outcomes and Predictors of Success After Revision Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Johnson, William R.; Makani, Amun; Wall, Andrew J.; Hosseini, Ali; Hampilos, Perry; Li, Guoan; Gill, Thomas J.

    2015-01-01

    Background: Patient outcomes and predictors of success after revision anterior cruciate ligament (ACL) reconstruction are currently limited in the literature. Existing studies either have a small study size or are difficult to interpret because of the multiple surgeons involved in the care of the study sample. Purpose: To determine patient outcomes and predictors of success or failure after a single-stage revision ACL reconstruction by a single fellowship-trained senior surgeon at a single institution. Study Design: Case series; Level of evidence, 4. Methods: A total of 78 patients who underwent revision ACL reconstruction by a single surgeon from 2010 to 2014 were contacted and available for follow-up. The mean time from revision procedure to follow-up was 52 months. Those patients who were able to participate in the study sent in a completed Tegner activity level scale, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and IKDC Current Health Assessment Form. The patients’ medical records were also thoroughly reviewed. Results: Five patients had subsequent failure after revision surgery. The median Tegner score was 6 at follow-up, and the mean subjective IKDC score was 72.5. There was no statistically significant difference in outcome scores when comparing revision graft type, body mass index, sex, need for bone grafting, and time from failure to revision. Patients with failures after primary ACL reconstruction secondary to a traumatic event were found to have statistically significantly higher IKDC scores (mean, 76.6) after revision when compared with nontraumatic failures (mean, 67.1), even when controlling for confounders (P < .017). Conclusion: Revision ACL reconstruction is effective in improving patient activity levels and satisfaction. However, the subjective IKDC results are quite variable and likely based on multiple factors. Patients with traumatic injuries contributing to graft failure after primary ACL reconstruction

  16. [F-18] FDG-PET/CT parameters as predictors of outcome in inoperable NSCLC patients

    PubMed Central

    Nappi, Antonio; Gallicchio, Rosj; Simeon, Vittorio; Nardelli, Anna; Pelagalli, Alessandra; Zupa, Angela; Vita, Giulia; Venetucci, Angela; Di Cosola, Michele; Barbato, Francesco; Storto, Giovanni

    2015-01-01

    Background We evaluated the prognostic significance of standardized uptake value (SUVmax), metabolic tumour volume (MTV), and total lesion glycolysis (TLG) in [F-18] FDG PET/CT findings in patients with inoperable non-small-cell lung cancer (NSCLC). Patients and methods. One hundred and three patients (mean age, 65.6 ± 16 years) underwent [F-18] FDG PET/CT before the chemotherapy. The SUVmax value, the MTV (cm3; 42% threshold) and the TLG (g) were registered. The patients were followed up to 18 months thereafter (range 12–55 months). Failure to respond without progression, progression and/or disease-related death constituted surrogate end-points. The optimal SUVmax, MTV and TLG cut-off to predict the patients’ outcome were estimated. PET/CT results were then related to disease outcome (progression free survival; PFS). Results The Kaplan-Meier survival analysis for SUVmax showed a significant shorter PFS in patients presenting with lower values as compared to those with higher (p < 0.05, log-rank test). MTV and TLG were not suitable for predicting PFS apart from the subset of patients with mediastinal nodal involvement. Conclusions Despite the availability of new tools for the quantitative assessment of disease activity on PET/CT, the SUVmax rather than MTV and TLG remains the only predictor for PFS in NSCLC patients. MTV holds a value only when concomitant nodal involvement occurs. PMID:26834517

  17. Predictors of Outcomes after Arthroscopic Double-row Rotator Cuff Repair in 155 Cases

    PubMed Central

    Katthagen, Jan Christoph; Millett, Peter J.; Espinoza-Ervin, Christopher; Horan, Marilee P.; Ho, Charles P.; Warth, Ryan J.; Dornan, Grant

    2016-01-01

    Objectives: The purpose of this study was to analyze predictors of clinical outcomes of knotted versus knotless double-row self-reinforcing rotator cuff repairs of full-thickness rotator cuff tears with propensity score matching. Methods: Patients with arthroscopic repair of full-thickness rotator cuff tears involving the supraspinatus tendon using either a knotted or knotless linked, self-reinforcing double-row technique were included in the study. Preoperative subjective evaluation was performed using the ASES and SF-12 PCS scores. After a minimum two-year follow-up period, ASES and SF-12 PCS scores were collected again along with the SANE score, the QuickDASH score, and patient satisfaction. All data were collected prospectively and retrospectively reviewed. Postoperative ASES and SF-12 PCS scores were then modeled using inverse propensity score weighting in a multiple linear regression model (MLR) with multiple imputations. Age, sex, baseline ASES score, length of follow-up, number of anchors, worker’s compensation, previous cuff repair, and double-row repair technique (knotted or knotless) were the covariates used in this model. Results: 155 shoulders in 151 patients (109 men, 42 women; mean age at time of surgery 59±10 years) were eligible for inclusion. Outcomes data were available for 130 of 148 shoulders (87.8%) after exclusion of seven shoulders (4.5%) that underwent revision rotator cuff repair before final follow up (n=33/39 in the knotted group [84.6%]; n=97/109 [88.9%] in the knotless group).The mean follow-up was 2.9 years (range, 2.0-5.4 years). Overall, postoperative outcomes scores were significantly improved when compared to preoperative baselines (p<0.05), with a median postoperative ASES score of 97 for the entire cohort. Our model showed that previous rotator cuff repair had a significant negative effect on postoperative ASES (β = -12.7, p<0.001) and SF-12 PCS scores (β = -5.0, p = 0.036). A workers’ compensation claim (β = -10.6, p

  18. Medial prefrontal cortex as an action-outcome predictor.

    PubMed

    Alexander, William H; Brown, Joshua W

    2011-10-01

    The medial prefrontal cortex (mPFC) and especially anterior cingulate cortex is central to higher cognitive function and many clinical disorders, yet its basic function remains in dispute. Various competing theories of mPFC have treated effects of errors, conflict, error likelihood, volatility and reward, using findings from neuroimaging and neurophysiology in humans and monkeys. No single theory has been able to reconcile and account for the variety of findings. Here we show that a simple model based on standard learning rules can simulate and unify an unprecedented range of known effects in mPFC. The model reinterprets many known effects and suggests a new view of mPFC, as a region concerned with learning and predicting the likely outcomes of actions, whether good or bad. Cognitive control at the neural level is then seen as a result of evaluating the probable and actual outcomes of one's actions.

  19. Genetic predictors of outcome following traumatic brain injury.

    PubMed

    Lipsky, Robert H; Lin, Mingkuan

    2015-01-01

    The nature of traumatic brain injury (TBI) has acute and chronic outcomes for those who survive. Over time, the chronic process of injury impacts multiple organ systems that may lead to disease. We discuss possible mechanisms and methodological issues in the context of candidate gene association studies using TBI patient populations. Because study population sizes have been generally limited, we discussed results on genes that have been the focus of independent studies. We also present a justification for testing more speculative candidate genes in recovery from TBI, such as those involved in circadian rhythm, to outline the importance of prioritizing functional variants in genes that may modulate recovery or provide neuroprotection from TBI. Finally, we provide a perspective on how future research will integrate population level genetic findings with the biological basis of disease in order to create a resource of predictive outcome measures for individual patients.

  20. Predictors of Substance Use and Family Therapy Outcome among Physically and Sexually Abused Runaway Adolescents

    ERIC Educational Resources Information Center

    Slesnick, Natasha; Bartle-Haring, Suzanne; Gangamma, Rashmi

    2006-01-01

    There is a dearth of research that examines the impact of family systems therapy on problems among sexually and/or physically abused youth. Given this void, differential outcome and predictors of substance use change were evaluated for abused, as compared with nonabused, runaway adolescents who were randomly assigned to family therapy or treatment…

  1. Predictors and Health-Related Outcomes of Positive Body Image in Adolescent Girls: A Prospective Study

    ERIC Educational Resources Information Center

    Andrew, Rachel; Tiggemann, Marika; Clark, Levina

    2016-01-01

    This study aimed to investigate prospective predictors and health-related outcomes of positive body image in adolescent girls. In so doing, the modified acceptance model of intuitive eating was also examined longitudinally. A sample of 298 girls aged 12 to 16 years completed a questionnaire containing measures of body appreciation, potential…

  2. Predictors and Outcomes of Parental Involvement with High School Students in Science

    ERIC Educational Resources Information Center

    Shumow, Lee; Lyutykh, Elena; Schmidt, Jennifer A.

    2011-01-01

    Demographic and psychological predictors of parent involvement with their children's science education both at home and at school were examined during high school. Associations between both types of parent involvement and numerous academic outcomes were tested. Data were collected from 244 high school students in 12 different science classrooms…

  3. Predictors and Moderators of Outcome in Family-Based Treatment for Adolescent Bulimia Nervosa

    ERIC Educational Resources Information Center

    Le Grange, Daniel; Crosby, Ross D.; Lock, James

    2008-01-01

    The predictors and moderators of treatment outcome for adolescents with bulimia nervosa (BN) are explored among those who participated in family based treatment or individual supportive psychotherapy. It is concluded that family-based treatment of BN may be most effective in those cases with low levels of eating disorder psychopathology.

  4. Surgery versus Nerve Blocks for Lumbar Disc Herniation : Quantitative Analysis of Radiological Factors as a Predictor for Successful Outcomes

    PubMed Central

    Kim, Joohyun; Hur, Junseok W.; Lee, Jang-Bo

    2016-01-01

    Objective To assess the clinical and radiological factors as predictors for successful outcomes in lumbar disc herniation (LDH) treatment. Methods Two groups of patients with single level LDH (L4–5) requiring treatment were retrospectively studied. The surgery group (SG) included 34 patients, and 30 patients who initially refused the surgery were included in the nerve blocks group (NG). A visual analogue scale (VAS) for leg and back pain and motor deficit were initially evaluated before procedures, and repeated at 1, 6, and 12 months. Radiological factors including the disc herniation length, disc herniation area, canal length-occupying ratio, and canal area-occupying ratio were measured and compared. Predicting factors of successful outcomes were determined with multivariate logistic regression analysis after the optimal cut off values were established with a receiver operating characteristic curve. Results There was no significant demographic difference between two groups. A multivariate logistic regression analysis with radiological and clinical (12 months follow-up) data revealed that the high disc herniation length with cutoff value 6.31 mm [odds ratio (OR) 2.35; confidence interval (CI) 1.21–3.98] was a predictor of successful outcomes of leg pain relief in the SG. The low disc herniation length with cutoff value 6.23 mm (OR 0.05; CI 0.003–0.89) and high baseline VAS leg (OR 12.63; CI 1.64–97.45) were identified as predictors of successful outcomes of leg pain relief in the NG. Conclusion The patients with the disc herniation length larger than 6.31 mm showed successful outcomes with surgery whereas the patients with the disc herniation length less than 6.23 mm showed successful outcomes with nerve block. These results could be considered as a radiological criteria in choosing optimal treatment options for LDH. PMID:27651866

  5. Surgery versus Nerve Blocks for Lumbar Disc Herniation : Quantitative Analysis of Radiological Factors as a Predictor for Successful Outcomes

    PubMed Central

    Kim, Joohyun; Hur, Junseok W.; Lee, Jang-Bo

    2016-01-01

    Objective To assess the clinical and radiological factors as predictors for successful outcomes in lumbar disc herniation (LDH) treatment. Methods Two groups of patients with single level LDH (L4–5) requiring treatment were retrospectively studied. The surgery group (SG) included 34 patients, and 30 patients who initially refused the surgery were included in the nerve blocks group (NG). A visual analogue scale (VAS) for leg and back pain and motor deficit were initially evaluated before procedures, and repeated at 1, 6, and 12 months. Radiological factors including the disc herniation length, disc herniation area, canal length-occupying ratio, and canal area-occupying ratio were measured and compared. Predicting factors of successful outcomes were determined with multivariate logistic regression analysis after the optimal cut off values were established with a receiver operating characteristic curve. Results There was no significant demographic difference between two groups. A multivariate logistic regression analysis with radiological and clinical (12 months follow-up) data revealed that the high disc herniation length with cutoff value 6.31 mm [odds ratio (OR) 2.35; confidence interval (CI) 1.21–3.98] was a predictor of successful outcomes of leg pain relief in the SG. The low disc herniation length with cutoff value 6.23 mm (OR 0.05; CI 0.003–0.89) and high baseline VAS leg (OR 12.63; CI 1.64–97.45) were identified as predictors of successful outcomes of leg pain relief in the NG. Conclusion The patients with the disc herniation length larger than 6.31 mm showed successful outcomes with surgery whereas the patients with the disc herniation length less than 6.23 mm showed successful outcomes with nerve block. These results could be considered as a radiological criteria in choosing optimal treatment options for LDH.

  6. Predictors, treatment, and outcomes of STEMI occurring in hospitalized patients.

    PubMed

    Dai, Xuming; Kaul, Prashant; Smith, Sidney C; Stouffer, George A

    2016-03-01

    ST-segment elevation myocardial infarction (STEMI) is most commonly caused by an acute thrombotic occlusion of a coronary artery. For patients in whom the onset of STEMI occurs outside of hospital (outpatient STEMI), early reperfusion therapy with either fibrinolysis or primary percutaneous coronary intervention reduces complications and improves survival, compared with delayed reperfusion. STEMI systems of care are defined as integrated groups of separate entities focused on reperfusion therapy for STEMI, generally including emergency medical services, emergency medicine, cardiology, nursing, and hospital administration. These systems of care have been successful at reducing total ischaemia time and outpatient STEMI mortality. By contrast, much less is known about STEMI that occurs in hospitalized patients (inpatient STEMI), which has unique clinical features and much worse outcomes than outpatient STEMI. Inpatient STEMI is associated with older age, a higher female:male ratio, and more comorbidities than outpatient STEMI. Delays in diagnosis and infrequent use of reperfusion therapy probably also contribute to unfavourable outcomes for inpatient STEMI.

  7. Natriuretic peptides: diagnostic tools and predictors of heart failure outcome.

    PubMed

    Isakson, Susan R; Gardetto, Nancy J; Maisel, Alan S

    2006-11-01

    Congestive heart failure (CHF) is a progressive disease whose outcome largely depends on early, accurate and prompt diagnosis, accompanied by evidence-based treatment. The explosion of uptake of natriuretic peptides (NPs) in clinical practice belies an understanding of how peptides are used. The signal for NP release is the same signal that causes symptoms of CHF, such as increased wall stress. Thus, NPs can reliably add to the information a physician brings to the table as they attempt to diagnose the acutely dyspneic patient with CHF. Additionally, NPs have strong prognostic utility in the emergency room and the hospital. Monitoring of NPs during treatment for acute CHF may help manage the patient. In the future, it is possible that NPs will play a more prominent role in early detection of left ventricular dysfunction as well as guiding chronic CHF treatment. PMID:19804259

  8. Planning in middle childhood: early predictors and later outcomes.

    PubMed

    Friedman, Sarah L; Scholnick, Ellin K; Bender, Randall H; Vandergrift, Nathan; Spieker, Susan; Hirsh Pasek, Kathy; Keating, Daniel P; Park, Yoonjung

    2014-01-01

    Data from 1,364 children and families who participated in the National Institute of Child Health and Human Development's Study of Early Child Care and Youth Development were analyzed to track the early correlates and later academic outcomes of planning during middle childhood. Maternal education, through its effect on parenting quality when children were 54 months old, predicts their concurrent performance on sustained attention, inhibition, and short-term verbal memory tests. This performance predicts planning in first grade, which predicts third-grade reading and mathematics attainment, but not the rate of growth in academic skills from first to fifth grades. This path was also found when the same parenting, cognitive, and academic constructs were measured at later time points. PMID:24476334

  9. The vortex--an early predictor of cardiovascular outcome?

    PubMed

    Pedrizzetti, Gianni; La Canna, Giovanni; Alfieri, Ottavio; Tonti, Giovanni

    2014-09-01

    Blood motion in the heart features vortices that accompany the redirection of jet flows towards the outlet tracks. Vortices have a crucial role in fluid dynamics. The stability of cardiac vorticity is vital to the dynamic balance between rotating blood and myocardial tissue and to the development of cardiac dysfunction. Moreover, vortex dynamics immediately reflect physiological changes to the surrounding system, and can provide early indications of long-term outcome. However, the pathophysiological relevance of cardiac fluid dynamics is still unknown. We postulate that maladaptive intracardiac vortex dynamics might modulate the progressive remodelling of the left ventricle towards heart failure. The evaluation of blood flow presents a new paradigm in cardiac function analysis, with the potential for sensitive risk identification of cardiac abnormalities. Description of cardiac flow patterns after surgery or device therapy provides an intrinsic qualitative evaluation of therapeutic procedures, and could enable early risk stratification of patients vulnerable to adverse cardiac remodelling.

  10. Eye color as a predictor of outcomes in behavior therapy.

    PubMed

    Markle, A; Rinn, R C; Bell, C

    1984-03-01

    Eye color research has centered primarily on the dimension of self-paced vs. reactive performance. Self-paced activities are those in which the individual may initiate the activity when he/she chooses while the stimulus situation remains relatively constant. Reactive activities must be initiated at the precise time dictated by a rapidly changing stimulus situation. The present study examined the relationship between outcomes of behaviorally oriented treatment for children (N = 366) and eye color. The findings were consistent with theoretical expectations: Dark-eyed children and teenagers responded better to reactive treatment programs than their light-eyed counterparts, while the reverse was true for self-paced treatment programs. Implications for research and practice were discussed.

  11. Chinese school teachers' organizational citizenship behavior (OCB): Predictors and outcomes.

    PubMed

    Li, Xia

    2013-08-01

    Teacher's organizational citizenship behavior (OCB) is a multifaceted construct that is critical to school effectiveness and to the education enterprise. Four hundred ninety-three teachers in eight different cities on the Chinese mainland were surveyed using the OCB scale developed by Bo Shiuan Cheng, a Taiwanese scholar. The antecedent and outcome variables of OCB were examined in this study. The results showed that the teachers' attitudinal characteristics of career satisfaction and career commitment, and the dispositional characteristic of locus of control, influenced teachers' OCB. In addition, teachers' OCB influenced their work performance as well as their career and organizational turnover intention. The implications of this study suggest a base of knowledge from which school administrators could enhance their school's organizational function and retain teachers. PMID:26271183

  12. Body composition changes in pregnancy: measurement, predictors and outcomes

    PubMed Central

    Widen, EM; Gallagher, D

    2014-01-01

    Prevalence of overweight and obesity has risen in the United States over the past few decades. Concurrent with this rise in obesity has been an increase in pregravid body mass index and gestational weight gain affecting maternal body composition changes in pregnancy. During pregnancy, many of the assumptions inherent in body composition estimation are violated, particularly the hydration of fat-free mass, and available methods are unable to disentangle maternal composition from fetus and supporting tissues; therefore, estimates of maternal body composition during pregnancy are prone to error. Here we review commonly used and available methods for assessing body composition changes in pregnancy, including: (1) anthropometry, (2) total body water, (3) densitometry, (4) imaging, (5) dual-energy X-ray absorptiometry, (6) bioelectrical impedance and (7) ultrasound. Several of these methods can measure regional changes in adipose tissue; however, most of these methods provide only whole-body estimates of fat and fat-free mass. Consideration is given to factors that may influence changes in maternal body composition, as well as long-term maternal and offspring outcomes. Finally, we provide recommendations for future research in this area. PMID:24667754

  13. First-ever ischemic stroke in elderly patients: predictors of functional outcome following carotid artery stenting

    PubMed Central

    Lin, Chih-Ming; Chang, Yu-Jun; Liu, Chi-Kuang; Yu, Cheng-Sheng; Lu, Henry Horng-Shing

    2016-01-01

    Age is an important risk factor for stroke, and carotid artery stenosis is the primary cause of first-ever ischemic stroke. Timely intervention with stenting procedures can effectively prevent secondary stroke; however, the impact of stenting on various periprocedural physical functionalities has never been thoroughly investigated. The primary aim of this study was to investigate whether prestenting characteristics were associated with long-term functional outcomes in patients presenting with first-ever ischemic stroke. The secondary aim was to investigate whether patient age was an important factor in outcomes following stenting, measured by the modified Rankin scale (mRS). In total, 144 consecutive patients with first-ever ischemic stroke who underwent carotid artery stenting from January 2010 to November 2014 were included. Clinical data were obtained by review of medical records. The Barthel index (BI) and mRS were used to assess disability before stenting and at 12-month follow-up. In total, 72/144 patients showed improvement (mRS[+]), 71 showed stationary and one showed deterioration in condition (mRS[−]). The prestenting parameters, ratio of cerebral blood volume (1.41 vs 1.2 for mRS[−] vs mRS[+]), BI (75 vs 85), and high-sensitivity C-reactive protein (hsCRP 5.0 vs 3.99), differed significantly between the two outcome groups (P<0.05). The internal carotid artery/common carotid artery ratio (P=0.011), BI (P=0.019), ipsilateral internal carotid artery resistance index (P=0.003), and HbA1c (P=0.039) were all factors significantly associated with patient age group. There was no significant association between age and poststenting outcome measured by mRS with 57% of patients in the ≥75 years age group showing mRS(−) and 43% showing mRS(+) (P=0.371). Our findings indicate that in our elderly patient series, carotid artery stenting may benefit a significant proportion of carotid stenotic patients regardless of age. Ratio of cerebral blood volume, BI, and

  14. First-ever ischemic stroke in elderly patients: predictors of functional outcome following carotid artery stenting.

    PubMed

    Lin, Chih-Ming; Chang, Yu-Jun; Liu, Chi-Kuang; Yu, Cheng-Sheng; Lu, Henry Horng-Shing

    2016-01-01

    Age is an important risk factor for stroke, and carotid artery stenosis is the primary cause of first-ever ischemic stroke. Timely intervention with stenting procedures can effectively prevent secondary stroke; however, the impact of stenting on various periprocedural physical functionalities has never been thoroughly investigated. The primary aim of this study was to investigate whether prestenting characteristics were associated with long-term functional outcomes in patients presenting with first-ever ischemic stroke. The secondary aim was to investigate whether patient age was an important factor in outcomes following stenting, measured by the modified Rankin scale (mRS). In total, 144 consecutive patients with first-ever ischemic stroke who underwent carotid artery stenting from January 2010 to November 2014 were included. Clinical data were obtained by review of medical records. The Barthel index (BI) and mRS were used to assess disability before stenting and at 12-month follow-up. In total, 72/144 patients showed improvement (mRS[+]), 71 showed stationary and one showed deterioration in condition (mRS[-]). The prestenting parameters, ratio of cerebral blood volume (1.41 vs 1.2 for mRS[-] vs mRS[+]), BI (75 vs 85), and high-sensitivity C-reactive protein (hsCRP 5.0 vs 3.99), differed significantly between the two outcome groups (P<0.05). The internal carotid artery/common carotid artery ratio (P=0.011), BI (P=0.019), ipsilateral internal carotid artery resistance index (P=0.003), and HbA1c (P=0.039) were all factors significantly associated with patient age group. There was no significant association between age and poststenting outcome measured by mRS with 57% of patients in the ≥75 years age group showing mRS(-) and 43% showing mRS(+) (P=0.371). Our findings indicate that in our elderly patient series, carotid artery stenting may benefit a significant proportion of carotid stenotic patients regardless of age. Ratio of cerebral blood volume, BI, and

  15. Religiosity as a Predictor of Adolescents' Substance Use Disorder Treatment Outcomes

    PubMed Central

    Yeterian, Julie D.; Bursik, Krisanne; Kelly, John F.

    2014-01-01

    Background A growing body of research on adults with substance use disorders (SUD) suggests that higher levels of religiosity and/or spirituality are associated with better treatment outcomes. However, investigation into the role of religiosity and spirituality in adolescent SUD treatment response remains scarce. The present study examines religiosity as a predictor of treatment outcomes in an adolescent sample, with alcohol/other drug problem recognition as a hypothesized moderator of this relationship. Problem recognition was selected as a moderator in an attempt to identify a subset of adolescents who would be more likely to use religious resources when attempting to change their substance use. Methods 127 outpatient adolescents age 14 to 19 (M age = 16.7, SD = 1.2, 24% female) were followed for 1 year after treatment intake. Growth curve analyses were used to assess the impact of baseline religiosity and problem recognition on subsequent abstinence rates, drug-related consequences, and psychological distress. Results On average, abstinence did not change significantly during the follow-up period, whereas drug-related consequences and psychological distress decreased significantly. Religiosity did not predict changes in abstinence or psychological distress over time. Religiosity did predict reductions in drug-related consequences over time (b = -0.20, t = -2.18, p = .03). However, when problem recognition was added to the model, the impact of religiosity on consequences became non-significant and there was no interaction between religiosity and problem recognition on consequences. Conclusions The main hypothesis was largely unsupported. Possible explanations include that the sample was low in religiosity and few participants were actively seeking sobriety at treatment intake. Findings suggest adolescent outpatients with SUD may differ from their adult counterparts in the role that religiosity plays in recovery. PMID:25222569

  16. Cardiopulmonary exercise testing variables as predictors of long-term outcome in thoracic sarcoidosis

    PubMed Central

    Lopes, A.J.; Menezes, S.L.S.; Dias, C.M.; Oliveira, J.F.; Mainenti, M.R.M.; Guimarães, F.S.

    2012-01-01

    Cardiopulmonary exercise testing (CPET) plays an important role in the assessment of functional capacity in patients with interstitial lung disease. The aim of this study was to identify CPET measures that might be helpful in predicting the vital capacity and diffusion capacity outcomes of patients with thoracic sarcoidosis. A longitudinal study was conducted on 42 nonsmoking patients with thoracic sarcoidosis (median age = 46.5 years, 22 females). At the first evaluation, spirometry, the measurement of single-breath carbon monoxide diffusing capacity (DLCOsb) and CPET were performed. Five years later, the patients underwent a second evaluation consisting of spirometry and DLCOsb measurement. After 5 years, forced vital capacity (FVC)% and DLCOsb% had decreased significantly [95.5 (82-105) vs 87.5 (58-103) and 93.5 (79-103) vs 84.5 (44-102), respectively; P < 0.0001 for both]. In CPET, the peak oxygen uptake, maximum respiratory rate, breathing reserve, alveolar-arterial oxygen pressure gradient at peak exercise (P(A-a)O2), and Δ SpO2 values showed a strong correlation with the relative differences for FVC% and DLCOsb% (P < 0.0001 for all). P(A-a)O2 ≥22 mmHg and breathing reserve ≤40% were identified as significant independent variables for the decline in pulmonary function. Patients with thoracic sarcoidosis showed a significant reduction in FVC% and DLCOsb% after 5 years of follow-up. These data show that the outcome measures of CPET are predictors of the decline of pulmonary function. PMID:22331135

  17. An investigation of predictors of NCLEX-RN outcomes among nursing content standardized tests.

    PubMed

    Yeom, Yei-Jin

    2013-12-01

    In order to meet increased demands for qualified registered nurses and prevent negative effects from graduates' failure on the National Council Licensure Examination-Registered Nurse, it is important to promote students' success in the exam. The purpose of this study was to investigate effective predictors of NCLEX-RN outcomes on the first attempt among nursing content standardized tests (adult medical-surgical, fundamentals for nursing, pharmacology, maternal-newborn, nursing care of children, mental health, community health, and leadership and management) conducted throughout the nursing program. NCLEX-RN outcomes and individual adjusted scores on the standardized tests of 151 graduates from the traditional baccalaureate nursing program of a public university located in the Midwest from May 2010 to December 2011 were analyzed by a t-test and logistic regression. The participants included 118 graduates who passed and 33 graduates who failed the NCLEX-RN on the first attempt. Significant statistical differences were found between the two groups with NCLEX-RN success and failure in the individual adjusted scores on all of the standardized tests except the fundamental for nursing (p=.62) and nursing care of children (p=.759) standardized tests. In addition, logistic regression indicated that the overall regression models were significant in predicting both NCLEX-RN success and failure. Adult medical-surgical, pharmacology, and community health standardized tests were central to the prediction of both NCLEX-RN success and failure; however, a much lower percentage of NCLEX-RN failure than success was classified. It can be concluded that the adult medical-surgical, pharmacology, and community health standardized tests were effective in predicting NCLEX-RN success and not effective in predicting NCLEX-RN failure on the first attempt. The NCLEX-RN success predictors can be utilized to identify students at risk and provide early remediation. After early remediation is

  18. Cognitive behavioural treatment for chronic fatigue syndrome in a rehabilitation setting: effectiveness and predictors of outcome.

    PubMed

    Schreurs, K M G; Veehof, M M; Passade, L; Vollenbroek-Hutten, M M R

    2011-12-01

    Cognitive behavioural therapy (CBT) was combined with graded exercise therapy (GET) for patients with chronic fatigue syndrome (CFS) in an uncontrolled implementation study of an inpatient multidisciplinary group therapy. During the intake procedure, 160 CFS patients completed a questionnaire on fatigue related measurements, physical impairment, depression, somatic and psychological attributions, somatic focus, and sense of control over symptoms. Pre-treatment physical activity level was measured with an actometer. At baseline, post-treatment and 6-month follow-up individual strength, subjective fatigue and physical impairment, were reassessed. Large effect sizes were found on subjective fatigue (1.2 post-treatment; 1.2 follow-up) and physical impairment (-.9 post-treatment; -.9 follow-up), Clinically significant improvement was found in 33.8% of the participants at post-treatment and 30.6% at follow-up. Individual strength at post-treatment was predicted by level of physical activity before treatment, and by sense of control over symptoms and physical activity at follow-up. Clinically significant improvement in subjective fatigue was predicted by not receiving a disablement insurance benefit, shorter duration of fatigue, higher sense of control over symptoms and, at follow-up by more pre-treatment physical activity. In conclusion, the intervention was effective for CFS patients. Cognitive behavioural factors that perpetuate fatigue symptoms are also predictors of treatment outcome.

  19. Outcome after burns: an observational study on burn scar maturation and predictors for severe scarring.

    PubMed

    van der Wal, Martijn B A; Vloemans, Jos F P M; Tuinebreijer, Wim E; van de Ven, Peter; van Unen, Ella; van Zuijlen, Paul P M; Middelkoop, Esther

    2012-01-01

    Long-term outcome of burn scars as well as the relation with clinically relevant parameters has not been studied quantitatively. Therefore, we conducted a detailed analysis on the clinical changes of burn scars in a longitudinal setup. In addition, we focused on the differences in scar quality in relation to the depth, etiology of the burn wound and age of the patient. Burn scars of 474 patients were subjected to a scar assessment protocol 3, 6, and 12 months postburn. Three different age groups were defined (≤5, 5-18, and ≥18 years). The observer part of the patient and observer scar assessment scale revealed a significant (p < 0.001) improvement in scar quality at 12 months compared with the 3- and 6-month data. Predictors for severe scarring are depth of the wound (p < 0.001) and total body surface area burned (p < 0.001). Etiology (p = 0.753) and age (p > 0.230) have no significant influence on scar quality when corrected for sex, total body surface area burned, time, and age or etiology, respectively.

  20. Naturalistic study of course, effectiveness, and predictors of outcome among female adolescents in residential treatment for eating disorders.

    PubMed

    Delinsky, S S; St Germain, S A; Thomas, J J; Craigen, K Ellison; Fagley, W H; Weigel, T J; Levendusky, P; Becker, A E

    2010-09-01

    Few empirical data address naturalistic outcomes of residential eating disorder (ED) treatment. Study aims were to evaluate course, effectiveness, and predictors of outcome in a residential treatment program. We evaluated 80 consecutively admitted female adolescents with the SCID-IV. Primary outcomes were treatment completion, subsequent readmission, clinical global impressions, and changes in body weight. Mean length of stay was 51 days, and 80% of patients were discharged according to treatment plans. Mean expected body weight (EBW) for AN patients increased from 80% to 91%. Patients reported significant improvements in ED symptoms, depression, and quality of life. Low admission %EBW and previous psychiatric hospitalizations were associated with premature termination. Overall, findings support that residential treatment is largely acceptable to patients, and that residential care may provide an opportunity for substantive therapeutic gains.

  1. Behavioral Economic Predictors of Brief Alcohol Intervention Outcomes

    PubMed Central

    Murphy, James G.; Dennhardt, Ashley A.; Martens, Matthew P.; Yurasek, Ali M.; Skidmore, Jessica R.; MacKillop, James; McDevitt-Murphy, Meghan E.

    2015-01-01

    Objective The present study attempted to determine if behavioral economic indices of elevated alcohol reward value, measured before and immediately after a brief alcohol intervention, predict treatment response. Method Participants were 133 heavy drinking college students (49.6% female, 51.4% male; 64.3% Caucasian, 29.5% African American) who were randomized to one of three conditions: motivational interviewing plus personalized feedback (BMI), computerized personalized feedback intervention (e-CHUG), and assessment only. Results Baseline levels of alcohol demand significantly predicted drinks per week and alcohol problems at 1-month (demand intensity= maximum expenditure) and 6-month (relative discretionary expenditures on alcohol) follow-up. BMI and e-CHUG were associated with an immediate post-session reduction in alcohol demand (p < .001, ηρ2 = .29) that persisted at the 1-month follow-up, with greater post-session reductions in the BMI condition (p = .02, ηρ2 = .06). Reductions in demand intensity and Omax (maximum expenditure) immediately post-intervention significantly predicted drinking reductions at one-month follow up (p = .04, ΔR2 = .02 & p = .01, ΔR2 = .03, respectively). Reductions in relative discretionary expenditures on alcohol at 1-month significantly predicted drinking (p = .002, ΔR2 = .06,) and alcohol problem (p < .001, ΔR2 = .13) reductions at the 6-month follow-up. Conclusions These results suggest that behavioral economic reward value indices may function as risk factors for poor intervention response and as clinically-relevant markers of change in heavy drinkers. PMID:26167945

  2. Predictors of early school age outcomes in very low birth weight children.

    PubMed

    Taylor, H G; Klein, N; Schatschneider, C; Hack, M

    1998-08-01

    The purpose of this study was to examine predictors of outcome in very low birth weight (< 1500 g) children. The very low birth weight sample consisted of 68 children weighing less than 750 g at birth and 65 children weighing 750 to 1499 g at birth who had been matched to the less than 750 g birth weight children in terms of hospital of birth, age, sex, and race. Mean ages for these two groups were 6.7 and 6.9 years, respectively. Outcomes were measured in terms of tests of cognitive function, neuropsychological abilities, and academic achievement and parent and teacher ratings of child behavior and school performance. A weighted sum of the number of major neonatal medical complications (Neonatal Risk Index) provided a composite measure of biological risk. Social risks were also assessed. Results indicated that the Neonatal Risk Index was the most consistent predictor of outcomes. Even after taking social risks into account, neonatal risk predicted overall cognitive ability and other achievement, neuropsychological, and behavior outcomes. Individual neonatal complications that predicted outcomes included severe cerebral ultrasonographic abnormality, chronic lung disease, necrotizing enterocolitis, and apnea of prematurity. Research and therapy to prevent or reduce neonatal complications and amelioration of social risks are of critical importance in improving outcomes of very low birth weight.

  3. Frontal White Matter Integrity Predictors of Adult Alcohol Treatment Outcome

    PubMed Central

    Sorg, Scott F.; Taylor, Michael J.; Alhassoon, Omar M.; Gongvatana, Assawin; Theilmann, Rebecca J.; Frank, Lawrence R.; Grant, Igor

    2013-01-01

    Background Previous research has associated abnormalities in frontal lobe functioning with alcohol relapse. In this study, we used diffusion tensor imaging to investigate whether frontal white matter integrity measured at the start of treatment differs between persons with alcohol use disorders (AUD) who sustain treatment gains and those who return to heavy use after treatment. Methods Forty-five treatment-seeking AUD inpatients and 30 healthy control subjects were included in the study. Six months after completing treatment, 16 of the AUD participants had resumed heavy use (RHU) and 29 others remained abstinent or drank minimally (treatment sustainers [TS]). Voxel-wise group comparisons (TS vs. RHU) were performed on fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity maps generated from each subject’s diffusion tensor imaging scan at the start of treatment. Results We found significantly lower FA and significantly higher RD in the frontal lobes of the RHU group, relative to the TS group. The RHU group data are consistent with previous reports of abnormal frontal white matter tract abnormalities in persons with AUD. Conclusions It is possible that the lower FA and higher RD in the RHU group reflect microstructural injury to frontal circuitries, and these may underlie the reduced cognitive control amid heightened reward sensitivity associated with resumption of heavy drinking. PMID:22047719

  4. Neuroimaging characteristics of ruptured aneurysm as predictors of outcome after aneurysmal subarachnoid hemorrhage: pooled analyses of the SAHIT cohort.

    PubMed

    Jaja, Blessing N R; Lingsma, Hester; Steyerberg, Ewout W; Schweizer, Tom A; Thorpe, Kevin E; Macdonald, R Loch

    2016-06-01

    OBJECT Neuroimaging characteristics of ruptured aneurysms are important to guide treatment selection, and they have been studied for their value as outcome predictors following aneurysmal subarachnoid hemorrhage (SAH). Despite multiple studies, the prognostic value of aneurysm diameter, location, and extravasated SAH clot on computed tomography scan remains debatable. The authors aimed to more precisely ascertain the relation of these factors to outcome. METHODS The data sets of studies included in the Subarachnoid Hemorrhage International Trialists (SAHIT) repository were analyzed including data on ruptured aneurysm location and diameter (7 studies, n = 9125) and on subarachnoid clot graded on the Fisher scale (8 studies; n = 9452) for the relation to outcome on the Glasgow Outcome Scale (GOS) at 3 months. Prognostic strength was quantified by fitting proportional odds logistic regression models. Univariable odds ratios (ORs) were pooled across studies using random effects models. Multivariable analyses were adjusted for fixed effect of study, age, neurological status on admission, other neuroimaging factors, and treatment modality. The neuroimaging predictors were assessed for their added incremental predictive value measured as partial R(2). RESULTS Spline plots indicated outcomes were worse at extremes of aneurysm size, i.e., less than 4 or greater than 9 mm. In between, aneurysm size had no effect on outcome (OR 1.03, 95% CI 0.98-1.09 for 9 mm vs 4 mm, i.e., 75th vs 25th percentile), except in those who were treated conservatively (OR 1.17, 95% CI 1.02-1.35). Compared with anterior cerebral artery aneurysms, posterior circulation aneurysms tended to result in slightly poorer outcome in patients who underwent endovascular coil embolization (OR 1.13, 95% CI 0.82-1.57) or surgical clipping (OR 1.32, 95% CI 1.10-1.57); the relation was statistically significant only in the latter. Fisher CT subarachnoid clot burden was related to outcome in a gradient manner. Each

  5. Our experience of melanoma thickness as a predictor of outcome of sentinel node biopsy.

    PubMed

    Homolak, Damir; Vucetić, Borki; Puljiz, Zvonimir; Blajć, Iva; Vurnek Zivković, Maja; Situm, Mirna

    2008-10-01

    All follow up protocols for patients with malignant melanoma (MM) are oriented to early detection of metastases. As most of the relapses happened in regional lymph nodes, special attention is given to this region, using different diagnostic tools. Sentinel lymph node biopsy (SLNB) is generally accepted method in determining status of lymph nodes in MM patients, in their staging. This method provides valuable prognostic information, facilitates early therapeutical lymphadenectomy and so provides good base for identification of those patients who are candidates for different adjuvant modalities of treatment. (In 2001 American Joint Committee on Cancer introduced new staging system for melanoma patients which presents good frame for prognosis and therapeutical approach. Inclusion of new criteria will allow better and more individualized prognosis and treatment.) The most important predictor of SLNB outcome is thickness of tumor according to Breslow, while there is no sufficient data to show correlation with other factors. We retrospectively studded 431 patients, out of which SLNB was performed on 188. Forty patients or 21.3% had positive lymph nodes. Our results showed strong correlation of tumor thickness and Clark level of invasion with SLNB outcome. Metastatic lymph nodes were founded in all acral-lentiginous melanoma patients, followed by nodular melanoma--55.6% and superficial spreading melanoma--14.1%. Results showed statistically significant predilection of positive SLNB in male patients and no correlation of positive SLNB with histological type of tumor. On the contrary, it showed significant correlation with development of metastases. Thus our results are similar to other comparable studies. PMID:19138008

  6. Decompressive hemicraniectomy: predictors of functional outcome in patients with ischemic stroke.

    PubMed

    Daou, Badih; Kent, Anthony P; Montano, Maria; Chalouhi, Nohra; Starke, Robert M; Tjoumakaris, Stavropoula; Rosenwasser, Robert H; Jabbour, Pascal

    2016-06-01

    OBJECT Patients presenting with large-territory ischemic strokes may develop intractable cerebral edema that puts them at risk of death unless intervention is performed. The purpose of this study was to identify predictors of outcome for decompressive hemicraniectomy (DH) in ischemic stroke. METHODS The authors conducted a retrospective electronic medical record review of 1624 patients from 2006 to 2014. Subjects were screened for DH secondary to ischemic stroke involving the middle cerebral artery, internal carotid artery, or both. Ninety-five individuals were identified. Univariate and multivariate analyses were performed for an array of clinical variables in relationship to functional outcome according to the modified Rankin Scale (mRS). Clinical outcome was assessed at 90 days and at the latest follow-up (mean duration 16.5 months). RESULTS The mean mRS score at 90 days and at the latest follow-up post-DH was 4. Good functional outcome was observed in 40% of patients at 90 days and in 48% of patient at the latest follow-up. The mortality rate at 90 days was 18% and at the last follow-up 20%. Univariate analysis identified a greater likelihood of poor functional outcome (mRS scores of 4-6) in patients with a history of stroke (OR 6.54 [95% CI1.39-30.66]; p = 0.017), peak midline shift (MLS) > 10 mm (OR 3.35 [95% CI 1.33-8.47]; p = 0.011), or a history of myocardial infarction (OR 8.95 [95% CI1.10-72.76]; p = 0.04). Multivariate analysis demonstrated elevated odds of poor functional outcome associated with a history of stroke (OR 9.14 [95% CI 1.78-47.05]; p = 0.008), MLS > 10 mm (OR 5.15 [95% CI 1.58-16.79; p = 0.007), a history of diabetes (OR 5.63 [95% CI 1.52-20.88]; p = 0.01), delayed time from onset of stroke to DH (OR 1.32 [95% CI 1.02-1.72]; p = 0.037), and evidence of pupillary dilation prior to DH (OR 4.19 [95% CI 1.06-16.51]; p = 0.04). Patients with infarction involving the dominant hemisphere had higher odds of unfavorable functional outcome at 90

  7. Sleep problems: predictor or outcome of media use among emerging adults at university?

    PubMed

    Tavernier, Royette; Willoughby, Teena

    2014-08-01

    The pervasiveness of media use in our society has raised concerns about its potential impact on important lifestyle behaviours, including sleep. Although a number of studies have modelled poor sleep as a negative outcome of media use, a critical assessment of the literature indicates two important gaps: (i) studies have almost exclusively relied on concurrent data, and thus have not been able to assess the direction of effects; and (ii) studies have largely been conducted with children and adolescents. The purpose of the present 3-year longitudinal study, therefore, was to examine whether both sleep duration and sleep problems would be predictors or outcomes of two forms of media use (i.e. television and online social networking) among a sample of emerging adults. Participants were 942 (71.5% female) university students (M = 19.01 years, SD = 0.90) at Time 1. Survey measures, which were assessed for three consecutive years starting in the first year of university, included demographics, sleep duration, sleep problems, television and online social networking use. Results of a cross-lagged model indicated that the association between sleep problems and media use was statistically significant: sleep problems predicted longer time spent watching television and on social networking websites, but not vice versa. Contrary to our hypotheses, sleep duration was not associated with media use. Our findings indicate no negative effects of media use on sleep among emerging adults, but instead suggest that emerging adults appear to seek out media as a means of coping with their sleep problems. PMID:24552437

  8. SOARing Into Strategic Planning: Engaging Nurses to Achieve Significant Outcomes.

    PubMed

    Wadsworth, Barbara; Felton, Fiona; Linus, Rita

    2016-01-01

    In 2013, a new system chief nursing officer engaged the nursing leaders and staff in an Appreciative Inquiry process utilizing strengths, opportunities, aspirations, and results (SOAR), and a Journey of Excellence to assess and understand the current environment. The ultimate goal was to engage all nurses in strategic planning and goal setting to connect their patient care to the system strategic initiatives. This work led to the creation of a nursing vision, a revised professional practice model and greater council alignment, resulting in significant positive change and ongoing advancement throughout the system. The shared decision-making structure was key to the process with a direct connection of each council's goals, leading to the successful achievement of 34 of the 36 goals in 2 years. This article outlines the process, tools, and staff engagement strategies used to achieve system-wide success. This methodology has improved the outcomes across the organization in both small and system-wide work groups. This work can easily be replicated and adapted to help disparate staffs brought together through mergers or acquisitions to become aligned as a new team. This process, model, and framework, provides structure and results in significant outcomes that recognizes and celebrates the work of individual entities while aligning future strategies and goals.

  9. SOARing Into Strategic Planning: Engaging Nurses to Achieve Significant Outcomes.

    PubMed

    Wadsworth, Barbara; Felton, Fiona; Linus, Rita

    2016-01-01

    In 2013, a new system chief nursing officer engaged the nursing leaders and staff in an Appreciative Inquiry process utilizing strengths, opportunities, aspirations, and results (SOAR), and a Journey of Excellence to assess and understand the current environment. The ultimate goal was to engage all nurses in strategic planning and goal setting to connect their patient care to the system strategic initiatives. This work led to the creation of a nursing vision, a revised professional practice model and greater council alignment, resulting in significant positive change and ongoing advancement throughout the system. The shared decision-making structure was key to the process with a direct connection of each council's goals, leading to the successful achievement of 34 of the 36 goals in 2 years. This article outlines the process, tools, and staff engagement strategies used to achieve system-wide success. This methodology has improved the outcomes across the organization in both small and system-wide work groups. This work can easily be replicated and adapted to help disparate staffs brought together through mergers or acquisitions to become aligned as a new team. This process, model, and framework, provides structure and results in significant outcomes that recognizes and celebrates the work of individual entities while aligning future strategies and goals. PMID:27584888

  10. Predictor Variables Associated With Positive Fast Track Outcomes at the End of Third Grade

    PubMed Central

    2009-01-01

    Progress has been made in understanding the outcome effects of preventive interventions and treatments designed to reduce children's conduct problems. However, limited research has explored the factors that may affect the degree to which an intervention is likely to benefit particular individuals. This study examines selected child, family, and community baseline characteristics that may predict proximal outcomes from the Fast Track intervention. The primary goal of this study was to examine predictors of outcomes after 3 years of intervention participation, at the end of 3rd grade. Three types of proximal outcomes were examined: parent-rated aggression, teacher-rated oppositional-aggressive behavior, and special education involvement. The relation between 11 risk factors and these 3 outcomes was examined, with separate regression analyses for the intervention and control groups. Moderate evidence of prediction of outcome effects was found, although none of the baseline variables were found to predict all 3 outcomes, and different patterns of prediction emerged for home versus school outcomes. PMID:11930970

  11. Teres Minor Hypertrophy is a Common and Negative Predictor of Outcomes after Rotator Cuff Repair

    PubMed Central

    Tokish, John M.; Thigpen, Charles A.; Kissenberth, Michael J.; Hunt, Quinn; Tolan, Stefan John; Swinehart, S. Dane; Shelley, Christina; Hawkins, Richard J.

    2016-01-01

    patients without an infraspinatus tear, teres minor hypertrophy was still present in 19/40 (48%) of patients. Teres minor hypertrophy had a significant, negative effect ASES scores after rotator cuff repair in patients with and without infraspinatus tearing, infraspinatus atrophy, and fatty infiltrative changes(P<0.05). In general, the presence of teres minor hypertrophy demonstrated a 15% lower score (Figure 1) than when no hypertrophy was present, and this was consistent across all tear sizes, independent of Goutallier changes. Conclusion: Teres minor hypertrophy is a common finding in the setting of rotator cuff tearing, including in the absence of infraspinatus tearing. Contrary to previous publications, the presence of teres minor hypertrophy in patients with rotator cuff repair does not appear to be protective as a compensatory mechanism. While further study is necessary to determine the mechanism or implication of teres minor hypertrophy in setting of rotator cuff repair, our results show it is not a positive predictor of outcomes following rotator cuff repair. Summary Sentence: The mechanism of teres minor hypertrophy was found to be a negative predictor in rotator cuff repair after pre and post-op measures were collected on patients undergoing cuff repair.

  12. Comparison of Substance Use Typologies as Predictors of Sexual Risk Outcomes in African American Adolescent Females.

    PubMed

    Swartzendruber, Andrea; Sales, Jessica M; Brown, Jennifer L; DiClemente, Ralph J; Rose, Eve S

    2016-01-01

    African American female adolescents have a disproportionate risk of sexually transmitted infections (STIs) and other adverse sexual health outcomes. Both alcohol and marijuana use have been shown to predict sexual risk among young African American women. However, no studies have attempted to differentiate alcohol and marijuana typologies use as predictors of sexual risk outcomes exclusively among adolescents who use these substances. This study compared recent alcohol and/or marijuana use as predictors of sexual risk outcomes over 18 months among 182 African American female adolescents. African American females (14-20 years) completed interviews at baseline, 6-, 12-, and 18-months. At each assessment, pregnancy testing was conducted and self-collected vaginal swab specimens were assayed for Trichomonas vaginalis, Chlamydia trachomatis, and Neisseria gonorrhoeae using DNA amplification. Logistic subject-specific random-intercept models compared sexual risk outcomes during follow-up among adolescents who reported recent use of alcohol only (AO), marijuana only (MO) or both substances (A + M) at the baseline assessment. Relative to baseline AO use, baseline MO use predicted condom non-use at last sex. Relative to AO use, A + M use predicted pregnancy. Relative to MO use, A + M use predicted pregnancy and acquisition of T. vaginalis and any STI. The results suggest that African American female adolescents who use A + M may represent a priority population for STI, HIV, and pregnancy prevention efforts. PMID:25929200

  13. Comparison of Substance Use Typologies as Predictors of Sexual Risk Outcomes in African American Adolescent Females.

    PubMed

    Swartzendruber, Andrea; Sales, Jessica M; Brown, Jennifer L; DiClemente, Ralph J; Rose, Eve S

    2016-01-01

    African American female adolescents have a disproportionate risk of sexually transmitted infections (STIs) and other adverse sexual health outcomes. Both alcohol and marijuana use have been shown to predict sexual risk among young African American women. However, no studies have attempted to differentiate alcohol and marijuana typologies use as predictors of sexual risk outcomes exclusively among adolescents who use these substances. This study compared recent alcohol and/or marijuana use as predictors of sexual risk outcomes over 18 months among 182 African American female adolescents. African American females (14-20 years) completed interviews at baseline, 6-, 12-, and 18-months. At each assessment, pregnancy testing was conducted and self-collected vaginal swab specimens were assayed for Trichomonas vaginalis, Chlamydia trachomatis, and Neisseria gonorrhoeae using DNA amplification. Logistic subject-specific random-intercept models compared sexual risk outcomes during follow-up among adolescents who reported recent use of alcohol only (AO), marijuana only (MO) or both substances (A + M) at the baseline assessment. Relative to baseline AO use, baseline MO use predicted condom non-use at last sex. Relative to AO use, A + M use predicted pregnancy. Relative to MO use, A + M use predicted pregnancy and acquisition of T. vaginalis and any STI. The results suggest that African American female adolescents who use A + M may represent a priority population for STI, HIV, and pregnancy prevention efforts.

  14. Predictors and Moderators of Treatment Outcome in the Pediatric Obsessive Compulsive Treatment Study (POTS I)

    PubMed Central

    Garcia, Abbe Marrs; Sapyta, Jeffrey J.; Moore, Phoebe S.; Freeman, Jennifer B.; Franklin, Martin E.; March, John S.; Foa, Edna B.

    2010-01-01

    Objective To identify predictors and moderators of outcome in the first Pediatric OCD Treatment Study (POTS I) among youth (N=112) randomly assigned to sertraline, cognitive behavioral therapy (CBT), both sertraline and CBT (COMB), or a pill placebo. Method Potential baseline predictors and moderators were identified by literature review. The outcome measure was an adjusted week 12 predicted score for the Children’s Yale Brown Obsessive Compulsive Scale (CY-BOCS). Main and interactive effects of treatment condition and each candidate predictor or moderator variable were examined using GLM on the adjusted predicted week 12 CY-BOCS scores. Results Youth with lower OCD severity, less OCD-related functional impairment, greater insight, fewer comorbid externalizing symptoms, and lower levels of family accommodation showed greater improvement across treatment conditions than their counterparts after acute POTS treatment. Those with a family history of OCD had a six-fold decrease in effect size in CBT monotherapy relative to their counterparts in CBT without a family history of OCD. Conclusions Greater attention is needed to build optimized intervention strategies for more complex youth with OCD. Youth with a family history of OCD are not likely to benefit from CBT unless offered in combination with an SSRI. PMID:20855047

  15. Predictors of poor response during asthma therapy differ with definition of outcome

    PubMed Central

    Rogers, Angela J; Tantisira, Kelan G; Fuhlbrigge, Anne L; Litonjua, Augusto A; Lasky-Su, Jessica A; Szefler, Stanley J; Strunk, Robert C; Zeiger, Robert S; Weiss, Scott T

    2009-01-01

    Aims To evaluate phenotypic and genetic variables associated with a poor long-term response to inhaled corticosteroid therapy for asthma, based independently on lung function changes or asthma exacerbations. Materials & methods We tested 17 phenotypic variables and polymorphisms in FCER2 and CRHR1 in 311 children (aged 5–12 years) randomized to a 4-year course of inhaled corticosteroid during the Childhood Asthma Management Program (CAMP). Results Predictors of recurrent asthma exacerbations are distinct from predictors of poor lung function response. A history of prior asthma exacerbations, younger age and a higher IgE level (p < 0.05) are associated with recurrent exacerbations. By contrast, lower bronchodilator response to albuterol and the minor alleles of RS242941 in CRHR1 and T2206C in FCER2 (p < 0.05) are associated with poor lung function response. Poor lung function response does not increase the risk of exacerbations and vice versa (p = 0.72). Conclusion Genetic and phenotypic predictors of a poor long-term response to inhaled corticosteroids differ markedly depending on definition of outcome (based on exacerbations vs lung function). These findings are important in comparing outcomes of clinical trials and in designing future pharmacogenetic studies. PMID:19663668

  16. Predictors and health-related outcomes of positive body image in adolescent girls: A prospective study.

    PubMed

    Andrew, Rachel; Tiggemann, Marika; Clark, Levina

    2016-03-01

    This study aimed to investigate prospective predictors and health-related outcomes of positive body image in adolescent girls. In so doing, the modified acceptance model of intuitive eating was also examined longitudinally. A sample of 298 girls aged 12 to 16 years completed a questionnaire containing measures of body appreciation, potential predictors, and a range of health outcomes, at 2 time points separated by 1 year. Longitudinal change regression models showed that perceived body acceptance by others (positively), self-objectification and social comparison (negatively), and body appreciation (positively) prospectively predicted intuitive eating 1 year later, consistent with the acceptance model of intuitive eating. Perceived body acceptance by others was the only proposed predictor to prospectively predict an increase in body appreciation over time. Time 1 body appreciation prospectively predicted a decrease in dieting, alcohol, and cigarette use, and an increase in physical activity 1 year later. In particular, girls with low body appreciation were more likely than girls with high body appreciation to take up alcohol and cigarette use between time points. The results highlight body appreciation as an important target for interventions designed to prevent or delay the uptake of alcohol and cigarette consumption among girls. More broadly, they suggest that a positive body image can confer considerable benefit for adolescent girls. PMID:26727595

  17. Predictors and health-related outcomes of positive body image in adolescent girls: A prospective study.

    PubMed

    Andrew, Rachel; Tiggemann, Marika; Clark, Levina

    2016-03-01

    This study aimed to investigate prospective predictors and health-related outcomes of positive body image in adolescent girls. In so doing, the modified acceptance model of intuitive eating was also examined longitudinally. A sample of 298 girls aged 12 to 16 years completed a questionnaire containing measures of body appreciation, potential predictors, and a range of health outcomes, at 2 time points separated by 1 year. Longitudinal change regression models showed that perceived body acceptance by others (positively), self-objectification and social comparison (negatively), and body appreciation (positively) prospectively predicted intuitive eating 1 year later, consistent with the acceptance model of intuitive eating. Perceived body acceptance by others was the only proposed predictor to prospectively predict an increase in body appreciation over time. Time 1 body appreciation prospectively predicted a decrease in dieting, alcohol, and cigarette use, and an increase in physical activity 1 year later. In particular, girls with low body appreciation were more likely than girls with high body appreciation to take up alcohol and cigarette use between time points. The results highlight body appreciation as an important target for interventions designed to prevent or delay the uptake of alcohol and cigarette consumption among girls. More broadly, they suggest that a positive body image can confer considerable benefit for adolescent girls.

  18. BMI, HOMA-IR, and Fasting Blood Glucose Are Significant Predictors of Peripheral Nerve Dysfunction in Adult Overweight and Obese Nondiabetic Nepalese Individuals: A Study from Central Nepal.

    PubMed

    Thapa, Lekhjung; Rana, P V S

    2016-01-01

    Objective. Nondiabetic obese individuals have subclinical involvement of peripheral nerves. We report the factors predicting peripheral nerve function in overweight and obese nondiabetic Nepalese individuals. Methodology. In this cross-sectional study, we included 50 adult overweight and obese nondiabetic volunteers without features of peripheral neuropathy and 50 healthy volunteers to determine the normative nerve conduction data. In cases of abnormal function, the study population was classified on the basis of the number of nerves involved, namely, "<2" or "≥2." Multivariable logistic regression analysis was carried out to predict outcomes. Results. Fasting blood glucose (FBG) was the significant predictor of motor nerve dysfunction (P = 0.039, 95% confidence interval (CI) = 1.003-1.127). Homeostatic model assessment of insulin resistance (HOMA-IR) was the significant predictor (P = 0.019, 96% CI = 1.420-49.322) of sensory nerve dysfunction. Body mass index (BMI) was the significant predictor (P = 0.034, 95% CI = 1.018-1.577) in case of ≥2 mixed nerves' involvement. Conclusion. FBG, HOMA-IR, and BMI were significant predictors of peripheral nerve dysfunction in overweight and obese Nepalese individuals. PMID:27200189

  19. Premotor Symptoms as Predictors of Outcome in Parkinsons Disease: A Case-Control Study

    PubMed Central

    Wu, Yu-Hsuan; Lee, Wei-Ju; Chen, Yi-Huei

    2016-01-01

    Background To evaluate the association between the premotor symptoms and the prognosis of PD. Methods A total of 1213 patients who were diagnosed of PD from January 2001 to December 2008 were selected from the Taiwan’s National Health Insurance Research Database. Patients were traced back to determine the presence of premotor symptoms, including rapid eye movement sleep behavior disorder (RBD), depression, and constipation. Cox’s regression analysis was used to detect the risks between the occurrence of premotor symptoms and the outcome (including death, psychosis, accidental injury, dementia and aspiration pneumonia). In addition, the association between premotor symptoms and levodopa equivalent dosage (LED) was examined. Results Higher occurrence of death, dementia and aspiration pneumonia were identified in PD patients with premotor symptoms than without premotor symptoms (HR 1·69, 95% CI 1·34–2·14, p <0·001 for death; HR 1·63, 95% CI 1·20–2·22, p = 0·002 for dementia; HR 2·45, 95% CI 1·42–4·21, p = 0·001 for aspiration pneumonia). In a comorbidities-stratified analysis, PD patients with premotor symptoms showed significantly high risks of mortality and morbidity (dementia and aspiration pneumonia), especially in the absence of comorbidities. Independent predictors of mortality in PD were found to be higher age, male sex, constipation, RBD, RBD with constipation and depression, and diabetes. Furthermore, no significant differences of LED and subsequent accidental injury were noted between PD patient with or without premotor symptoms. Conclusion Premotor symptoms seem to be not merely risk factors, but also prognostic factors of PD. PMID:27533053

  20. IQ as a predictor of functional outcome in schizophrenia: a longitudinal, four-year study of first-episode psychosis.

    PubMed

    Leeson, Verity C; Barnes, Thomas R E; Hutton, Sam B; Ron, Maria A; Joyce, Eileen M

    2009-01-01

    Studies of established schizophrenia have consistently found that cognitive function predicts social and clinical outcomes. The findings from first-episode studies have been more variable, with only some studies reporting predictive relationships. We tested the possibility that an index of general cognitive ability, IQ, may be a more sensitive and reliable predictor of outcome in first-episode schizophrenia than specific measures of memory and executive function. Fifty-four patients with first-episode schizophrenia or schizoaffective disorder were assessed for cognitive and social function as well as symptoms at three time points over the four years following first presentation of their psychotic illness. Regression analyses were performed to determine whether IQ and specific neuropsychological measures at first episode and one-year follow-up predicted four-year social function and residual symptoms. The effects of premorbid and concurrent IQ on outcome were also assessed. Premorbid IQ and IQ at each assessment significantly predicted social function at four-year follow-up. This relationship remained significant after the social function or symptom scores at first presentation were accounted for in the regression. Specific measures predicted certain domains of social function, but these were weaker and less consistent than IQ. The predictive values of cognition on residual symptoms were less strong; the most consistent finding was a relationship between IQ and the negative syndrome. This study suggests that early in the course of schizophrenia, general cognitive ability, as measured by IQ, is a more sensitive and reliable predictor of functional outcome than measures of specific ability. PMID:18793828

  1. IQ as a predictor of functional outcome in schizophrenia: A longitudinal, four-year study of first-episode psychosis

    PubMed Central

    Leeson, Verity C.; Barnes, Thomas R.E.; Hutton, Sam B.; Ron, Maria A.; Joyce, Eileen M.

    2009-01-01

    Studies of established schizophrenia have consistently found that cognitive function predicts social and clinical outcomes. The findings from first-episode studies have been more variable, with only some studies reporting predictive relationships. We tested the possibility that an index of general cognitive ability, IQ, may be a more sensitive and reliable predictor of outcome in first-episode schizophrenia than specific measures of memory and executive function. Fifty-four patients with first-episode schizophrenia or schizoaffective disorder were assessed for cognitive and social function as well as symptoms at three time points over the four years following first presentation of their psychotic illness. Regression analyses were performed to determine whether IQ and specific neuropsychological measures at first episode and one-year follow-up predicted four-year social function and residual symptoms. The effects of premorbid and concurrent IQ on outcome were also assessed. Premorbid IQ and IQ at each assessment significantly predicted social function at four-year follow-up. This relationship remained significant after the social function or symptom scores at first presentation were accounted for in the regression. Specific measures predicted certain domains of social function, but these were weaker and less consistent than IQ. The predictive values of cognition on residual symptoms were less strong; the most consistent finding was a relationship between IQ and the negative syndrome. This study suggests that early in the course of schizophrenia, general cognitive ability, as measured by IQ, is a more sensitive and reliable predictor of functional outcome than measures of specific ability. PMID:18793828

  2. Outcome expectancy as a predictor of treatment response in cognitive behavioral therapy for public speaking fears within social anxiety disorder.

    PubMed

    Price, Matthew; Anderson, Page L

    2012-06-01

    Outcome expectancy, the extent that clients anticipate benefiting from therapy, is theorized to be an important predictor of treatment response for cognitive-behavioral therapy. However, there is a relatively small body of empirical research on outcome expectancy and the treatment of social anxiety disorder. This literature, which has examined the association mostly in group-based interventions, has yielded mixed findings. The current study sought to further evaluate the effect of outcome expectancy as a predictor of treatment response for public-speaking fears across both individual virtual reality and group-based cognitive-behavioral therapies. The findings supported outcome expectancy as a predictor of the rate of change in public-speaking anxiety during both individual virtual reality exposure therapy and group cognitive-behavioral therapy. Furthermore, there was no evidence to suggest that the impact of outcome expectancy differed across virtual reality or group treatments. PMID:21967073

  3. Clinical predictors and outcomes of patients with left ventricular thrombus following ST-segment elevation myocardial infarction.

    PubMed

    Garber, Adam M; Mentz, Robert J; Al-Khalidi, Hussein R; Shaw, Linda K; Fiuzat, Mona; O'Connor, Christopher M; Velazquez, Eric J

    2016-04-01

    We aimed to characterize the independent predictors of LVT following STEMI and the association with outcomes. The clinical predictors of left ventricular thrombus (LVT) formation after ST-segment elevation myocardial infarction (STEMI) are not well-defined in the contemporary era. We performed a retrospective analysis of STEMI patients at Duke from 2000 to 2011 who had a transthoracic echocardiogram within 90 days post-STEMI and compared patients with and without LVT (LVT+ vs. LVT-). Univariate Cox proportional hazards regression models of baseline characteristics were examined and significant variables were used in a multivariable model to assess adjusted relationships with LVT. A multivariable Cox PH survival model with covariate adjustments was used for assessment of LVT and long-term mortality. Of all eligible patients, 1734 patients met inclusion criteria and 4.3 % (N = 74) had a LVT. LVT+ patients tended to have a history of heart failure (HF) and higher initial troponin compared to LVT- patients. After adjustment, higher heart rate, non-white race, HF severity, and presence of left anterior descending artery (LAD) disease were independent predictors of LVT. There was a trend toward an association between LVT and increased all-cause mortality (HR 1.36; 95 % CI 0.84-2.21, P = 0.22), however this was not statistically significant. LVT was seen in over 4 % of this contemporary post-STEMI population. Several baseline characteristics were independently associated with LVT: Heart rate, HF severity, LAD disease, and non-white race. Prospective studies are warranted to determine whether anticoagulation in patients at increased risk for LVT improves outcomes.

  4. Echo-Doppler determinants of outcomes in patients with unoperated significant mitral regurgitation in current era

    PubMed Central

    Rafique, Asim M; Zarrini, Parham; Singh, Nirmal; Beigel, Roy; Tadwalkar, Rigved; Chonde, Meshe; Slipczuk, Leandro; Cercek, Bojan; Kar, Saibal; Siegel, Robert J

    2016-01-01

    Objective One-half of patients with severe symptomatic mitral regurgitation (MR) do not undergo surgery due to comorbidities. We evaluated prognosticators of outcomes in patients with unoperated significant MR. Methods In this observational study, we retrospectively evaluated medical records of 75 consecutive patients with unoperated significant MR. Results All-cause mortality was 39% at 5 years. Non-survivors (n=29) versus survivors (n=46) were: older (77±9.8 vs 68±14, p=0.006), had higher New York Heart Association (NYHA) class (2.7±0.8 vs 2.3±0.8, p=0.037), higher brain natriuretic peptide (1157±717 vs 427±502 pg/mL, p=0.024, n=18), more coronary artery disease (61% vs 35%, p=0.031), more frequent left ventricular ejection fraction <50% (20.7% vs 4.3%, p=0.026), more functional MR (41% vs 22%, p=0.069), higher mitral E/E′ (12.7±4.6 vs 9.8±4, p=0.008), higher pulmonary artery systolic pressure (PASP; 52.6±18.7 vs 36.7±14, p <0.001), more ≥3+ tricuspid regurgitation (28% vs 4%, p=0.005) and more right ventricular dysfunction (26% vs 6%, p=0.035). Significant predictors of 5-year mortality were PASP (p=0.001) and E/E′ (p=0.011) using multivariate regression analysis. Conclusions Patients with unoperated significant MR have high mortality. Elevated PASP and mitral E/E′ were the most significant predictors of 5-year survival in patients with unoperated significant MR. Current American College of Cardiology (ACC)/American Heart Association (AHA) guidelines provide a limited incorporation of echo-Doppler parameters in the preoperative risk stratification of patients with severe MR. PMID:27547425

  5. Distress Screening in a Multidisciplinary Lung Cancer Clinic: Prevalence and Predictors of Clinically-Significant Distress

    PubMed Central

    Graves, Kristi D.; Arnold, Susanne M.; Love, Celia L.; Kirsh, Kenneth L.; Moore, Pamela G.; Passik, Steven D.

    2007-01-01

    Summary Screening for distress in cancer patients is recommended by the National Comprehensive Cancer Network, and a Distress Thermometer has previously been developed and empirically-validated for this purpose. The present study sought to determine the rates and predictors of distress in a sample of patients being seen in a multidisciplinary lung cancer clinic. Consecutive patients (N = 333) were recruited from an outpatient multidisciplinary lung cancer clinic to complete the Distress Thermometer, an associated Problem Symptom List, and two questions about interest in receiving help for symptoms. Over half (61.6%) of patients reported distress at a clinically significant level, and 22.5% of patients indicated interest in receiving help with their distress and/or symptoms. Problems in the areas of family relationships, emotional functioning, lack of information about diagnosis/treatment, physical functioning, and cognitive functioning were associated with higher reports of distress. Specific symptoms of depression, anxiety, pain and fatigue were most predictive of distress. Younger age was also associated with higher levels of distress. Distress was not associated with other clinical variables, including stage of illness or medical treatment approach. Similar results were obtained when individuals who had not yet received a definitive diagnosis of lung cancer (n = 134) were excluded from analyses; however, family problems and anxiety were no longer predictive of distress. Screening for distress in a multidisciplinary lung cancer clinic is feasible and a significant number of patients can be expected to meet clinical criteria for distress. Results also highlight younger age and specific physical and psychosocial symptoms as predictive of clinically-significant distress. Identification of the presence and predictors of distress are the first steps toward appropriate referral and treatment of symptoms and problems that contribute to cancer patients’ distress. PMID

  6. Immune thrombocytopenia in adults: a prospective cohort study of clinical features and predictors of outcome

    PubMed Central

    Grimaldi-Bensouda, Lamiae; Nordon, Clémentine; Michel, Marc; Viallard, Jean-François; Adoue, Daniel; Magy-Bertrand, Nadine; Durand, Jean-Marc; Quittet, Philippe; Fain, Olivier; Bonnotte, Bernard; Morin, Anne-Sophie; Morel, Nathalie; Costedoat-Chalumeau, Nathalie; Pan-Petesch, Brigitte; Khellaf, Mehdi; Perlat, Antoinette; Sacre, Karim; Lefrere, François; Abenhaim, Lucien; Godeau, Bertrand

    2016-01-01

    This prospective observational cohort study aimed to explore the clinical features of incident immune thrombocytopenia in adults and predictors of outcome, while determining if a family history of autoimmune disorder is a risk factor for immune thrombocytopenia. All adults, 18 years of age or older, recently diagnosed with immune thrombocytopenia were consecutively recruited across 21 hospital centers in France. Data were collected at diagnosis and after 12 months. Predictors of chronicity at 12 months were explored using logistic regression models. The association between family history of autoimmune disorder and the risk of developing immune thrombocytopenia was explored using a conditional logistic regression model after matching each case to 10 controls. One hundred and forty-three patients were included: 63% female, mean age 48 years old (Standard Deviation=19), and 84% presented with bleeding symptoms. Median platelet count was 10×109/L. Initial treatment was required in 82% of patients. After 12 months, only 37% of patients not subject to disease-modifying interventions achieved cure. The sole possible predictor of chronicity at 12 months was a higher platelet count at baseline [Odds Ratio 1.03; 95%CI: 1.00, 1.06]. No association was found between outcome and any of the following features: age, sex, presence of either bleeding symptoms or antinuclear antibodies at diagnosis. Likewise, family history of autoimmune disorder was not associated with incident immune thrombocytopenia. Immune thrombocytopenia in adults has been shown to progress to a chronic form in the majority of patients. A lower platelet count could be indicative of a more favorable outcome. PMID:27229715

  7. Predictors of outcome in myxoedema coma: a study from a tertiary care centre

    PubMed Central

    Dutta, Pinaki; Bhansali, Anil; Masoodi, Shriq Rashid; Bhadada, Sanjay; Sharma, Navneet; Rajput, Rajesh

    2008-01-01

    Background With the easy availability of thyroid hormone assays, thyroid disorders are now recognised even in a subclinical state. However, patients are still seen with advanced manifestations of the disease, particularly in developing countries. This observational study analysed the predictors of outcome in patients with myxoedema coma and tested the validity of different modules to define morbidity and mortality in these patients. Methods Twenty-three consecutive patients with myxoedema coma who presented from January 1999 to August 2006 were studied. The thyroid function test and random serum cortisol were measured in all patients at the time of admission. Patients were given oral or intravenous (IV) thyroxine with intention to treat with the latter according to availability. Various modules that predict outcome, including Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and Sequential Organ Failure Assessment (SOFA) score, were analysed. SOFA score was repeated every 2 days until the time of discharge or demise. Results Twenty-three patients (20 women; 87%) of 59.5 ± 14.4 years of age (range, 30 to 89 years) were seen during the study period. Nine (39%) patients were diagnosed with hypothyroidism for the first time at the time of presentation of myxoedema coma, whereas 14 (70%) were diagnosed with hypothyroidism previously. However, the treatment defaulters presented early to the hospital and had more severe manifestations than de novo subjects. Nineteen (82%) had thyroprivic (primary) and 4 (17%) had trophoprivic (secondary) hypothyroidism. Fifteen (65%) patients presented in the winter and in 17 (74%) sepsis was the major accompanying comorbidity. Twelve (52%) had a history of diuretic use, thereby delaying the initial diagnosis. Patients who received oral L-thyroxine had no difference in outcome from those receiving IV thyroxine. Twelve (52%) subjects died and sepsis was the predominant cause of death. Various

  8. Perioperative Blood Transfusion as a Significant Predictor of Biochemical Recurrence and Survival after Radical Prostatectomy in Patients with Prostate Cancer

    PubMed Central

    Kim, Jung Kwon; Kim, Hyung Suk; Park, Juhyun; Jeong, Chang Wook; Ku, Ja Hyeon; Kim, Hyun Hoe; Kwak, Cheol

    2016-01-01

    Purpose There have been conflicting reports regarding the association of perioperative blood transfusion (PBT) with oncologic outcomes including recurrence rates and survival outcomes in prostate cancer. We aimed to evaluate whether perioperative blood transfusion (PBT) affects biochemical recurrence-free survival (BRFS), cancer-specific survival (CSS), and overall survival (OS) following radical prostatectomy (RP) for patients with prostate cancer. Materials and Methods A total of 2,713 patients who underwent RP for clinically localized prostate cancer between 1993 and 2014 were retrospectively analyzed. We performed a comparative analysis based on receipt of transfusion (PBT group vs. no-PBT group) and transfusion type (autologous PBT vs. allogeneic PBT). Univariate and multivariate Cox-proportional hazard regression analysis were performed to evaluate variables associated with BRFS, CSS, and OS. The Kaplan-Meier method was used to calculate survival estimates for BRFS, CSS, and OS, and log-rank test was used to conduct comparisons between the groups. Results The number of patients who received PBT was 440 (16.5%). Among these patients, 350 (79.5%) received allogeneic transfusion and the other 90 (20.5%) received autologous transfusion. In a multivariate analysis, allogeneic PBT was found to be statistically significant predictors of BRFS, CSS, and OS; conversely, autologous PBT was not. The Kaplan-Meier survival analysis showed significantly decreased 5-year BRFS (79.2% vs. 70.1%, log-rank, p = 0.001), CSS (98.5% vs. 96.7%, log-rank, p = 0.012), and OS (95.5% vs. 90.6%, log-rank, p < 0.001) in the allogeneic PBT group compared to the no-allogeneic PBT group. In the autologous PBT group, however, none of these were statistically significant compared to the no-autologous PBT group. Conclusions We found that allogeneic PBT was significantly associated with decreased BRFS, CSS, and OS. This provides further support for the immunomodulation hypothesis for allogeneic

  9. Pedagogical Significance of Wikis: Towards Gaining Effective Learning Outcomes

    ERIC Educational Resources Information Center

    Hewege, Chandana Rathnasiri; Perera, Liyanage Chamila Roshani

    2013-01-01

    Purpose: The purpose of this paper is to explore the effectiveness and pedagogical implications of integrating wikis into the curriculum and the subsequent learning outcomes of a group of Net-Gens who enrolled in an International Marketing course. The research problem of the study is: "What are the learning outcomes and pedagogical implications…

  10. Outcomes for Spine Stereotactic Body Radiation Therapy and an Analysis of Predictors of Local Recurrence

    SciTech Connect

    Bishop, Andrew J.; Tao, Randa; Rebueno, Neal C.; Christensen, Eva N.; Allen, Pamela K.; Wang, Xin A.; Amini, Behrang; Tannir, Nizar M.; Tatsui, Claudio E.; Rhines, Laurence D.; Li, Jing; Chang, Eric L.; Brown, Paul D.; Ghia, Amol J.

    2015-08-01

    Purpose: To investigate local control, survival outcomes, and predictors of local relapse for patients treated with spine stereotactic body radiation therapy. Methods and Materials: We reviewed the records of 332 spinal metastases consecutively treated with stereotactic body radiation therapy between 2002 and 2012. The median follow-up for all living patients was 33 months (range, 0-111 months). Endpoints were overall survival and local control (LC); recurrences were classified as either in-field or marginal. Results: The 1-year actuarial LC and overall survival rates were 88% and 64%, respectively. Patients with local relapses had poorer dosimetric coverage of the gross tumor volume (GTV) compared with patients without recurrence (minimum dose [Dmin] biologically equivalent dose [BED] 23.9 vs 35.1 Gy, P<.001; D98 BED 41.8 vs 48.1 Gy, P=.001; D95 BED 47.2 vs 50.5 Gy, P=.004). Furthermore, patients with marginal recurrences had poorer prescription coverage of the GTV (86% vs 93%, P=.01) compared with those with in-field recurrences, potentially because of more upfront spinal canal disease (78% vs 24%, P=.001). Using a Cox regression univariate analysis, patients with a GTV BED Dmin ≥33.4 Gy (median dose) (equivalent to 14 Gy in 1 fraction) had a significantly higher 1-year LC rate (94% vs 80%, P=.001) compared with patients with a lower GTV BED Dmin; this factor was the only significant variable on multivariate Cox analysis associated with LC (P=.001, hazard ratio 0.29, 95% confidence interval 0.14-0.60) and also was the only variable significant in a separate competing risk multivariate model (P=.001, hazard ratio 0.30, 95% confidence interval 0.15-0.62). Conclusions: Stereotactic body radiation therapy offers durable control for spinal metastases, but there is a subset of patients that recur locally. Patients with local relapse had significantly poorer tumor coverage, which was likely attributable to treatment planning directives that prioritized the

  11. Predictors of the Severity and Serious Outcomes of Anaphylaxis in Korean Adults: A Multicenter Retrospective Case Study

    PubMed Central

    Ye, Young-Min; Kim, Mi Kyeong; Kang, Hye-Ryun; Kim, Tae-Bum; Sohn, Seong-Wook; Koh, Young-Il; Park, Hye-Kyung; Jang, Gwang Cheon; Kim, Cheol-Woo; Hur, Gyu-Young; Kim, Joo-Hee; Kim, Sang-Heon; Choi, Gil-Soon; Lee, Soo-Keol

    2015-01-01

    Purpose Differences in definitions of the condition, relevant triggers, and the geographical locations of study centers, cause estimates of the prevalence of anaphylaxis to vary. Recent epidemiological data indicate that the incidence of anaphylaxis is rising. Methods To investigate the causes and clinical features of anaphylaxis in Korean adults, factors associated with the severity of the condition, and serious outcomes, a retrospective medical record review was performed on adult patients diagnosed with anaphylaxis between 2007 and 2011 in 15 University Hospitals of South Korea. Results A total of 1,806 cases (52% male, age 16-86 years) were reported. Cutaneous symptoms (84.0%), combined with respiratory (53.9%) and/or cardiovascular (55.4%) symptoms, were the most frequent presentations. Using a recognized grading system, 1,776 cases could be classified as either mild, 340; moderate, 690; or severe, 746. Although eliciting factors varied significantly by age, gender, and regional and seasonal factors, drugs (46.5%; including nonsteroidal anti-inflammatory drugs, antibiotics, and radiocontrast media) were the most common cause of anaphylaxis, followed by foods (24.2%), insect stings (16.4%), exercise (5.9%), and unknown etiology (7.0%). All of age, multi-organ involvement, a history of allergic disease, and drug-induced anaphylaxis, were significant predictors of serious outcomes requiring hospital admission or prolongation of hospital stay. Epinephrine auto-injectors were prescribed for 7.4% of reported cases. Conclusions The principal causes of anaphylaxis in Korean adults were drugs, food, and insect stings. Drug-associated anaphylaxis, a history of allergic disease, multi-organ involvement, and older age, were identified as predictors of serious outcomes. PMID:25553259

  12. Prevalence, predictors and clinical significance of Blastocystis sp. in Sebha, Libya

    PubMed Central

    2013-01-01

    Background Blastocystis sp. has a worldwide distribution and is often the most common human intestinal protozoan reported in children and adults in developing countries. The clinical relevance of Blastocystis sp. remains controversial. This study was undertaken to determine the prevalence of Blastocystis infection and its association with gastrointestinal symptoms among outpatients in Sebha city, Libya. Methods A total of 380 stool samples were collected from outpatients attending the Central Laboratory in Sebha, Libya for routine stool examination. The presence of Blastocystis sp. was screened comparing light microscopy of direct smears against in vitro cultivation. Demographic and socioeconomic information were collected with a standardized questionnaire. Results The overall prevalence of Blastocystis infection was 22.1%. The prevalence was significantly higher among patients aged ≥18 years compared to those aged < 18 years (29.4% vs 9.9%; x2 = 19.746; P < 0.001), and in males compared to females (26.4% vs 17.5%; x2 = 4.374; P = 0.036). Univariate analysis showed significant associations between Blastocystis infection and the occupational status (P = 0.017), family size (P = 0.023) and educational level (P = 0.042) of the participants. Multiple logistic regression analysis confirmed that the age of ≥ 18 years (OR = 5.7; 95% CI = 2.21; 9.86) and occupational status (OR = 2.2; 95% CI = 1.02, 4.70) as significant predictors of Blastocystis infection among this population. In those who had only Blastocystis infection but no other gastrointestinal parasitic infections, the prevalence of gastrointestinal symptoms was higher compared to those without Blastocystis infection (35.3% vs 13.2%; x2 = 25.8; P < 0.001). The most common symptoms among these patients were abdominal pain (76.4%), flatulence (41.1%) and diarrhoea (21.5%). Conclusions Blastocystis sp. is prevalent and associated with

  13. Significance of Image Guidance to Clinical Outcomes for Localized Prostate Cancer

    PubMed Central

    Zhong, Qiuzi; Gao, Hong; Li, Gaofeng; Xiu, Xia; Wu, Qinhong; Li, Ming; Xu, Yonggang

    2014-01-01

    Purpose. To compare toxicity profiles and biochemical tumor control outcomes between patients treated with image-guided intensity-modulated radiotherapy (IG-IMRT) and non-IGRT intensity-modulated radiotherapy (IMRT) for clinically localized prostate cancer. Materials and Methods. Between 2009 and 2012, 65 patients with localized prostate cancer were treated with IG-IMRT. This group of patients was retrospectively compared with a similar cohort of 62 patients who were treated between 2004 and 2009 with IMRT to the same dose without image guidance. Results. The median follow-up time was 4.8 years. The rectal volume receiving ≥40 and ≥70 Gy was significantly lower in the IG-IMRT group. Grade 2 and higher acute and late GI and GU toxicity rates were lower in IG-IMRT group, but there was no statistical difference. No significant improvement in biochemical control at 5 years was observed in two groups. In a Cox regression analysis identifying predictors for PSA relapse-free survival, only preradiotherapy PSA was significantly associated with biochemical control; IG-IMRT was not a statistically significant indicator. Conclusions. The use of image guidance in the radiation of prostate cancer at our institute did not show significant reduction in the rates of GI and GU toxicity and did not improve the biochemical control compared with IMRT. PMID:25110701

  14. Nutritional predictors for postoperative short-term and long-term outcomes of patients with gastric cancer

    PubMed Central

    Kanda, Mitsuro; Mizuno, Akira; Tanaka, Chie; Kobayashi, Daisuke; Fujiwara, Michitaka; Iwata, Naoki; Hayashi, Masamichi; Yamada, Suguru; Nakayama, Goro; Fujii, Tsutomu; Sugimoto, Hiroyuki; Koike, Masahiko; Takami, Hideki; Niwa, Yukiko; Murotani, Kenta; Kodera, Yasuhiro

    2016-01-01

    Abstract Evidence indicates that impaired immunocompetence and nutritional status adversely affect short-term and long-term outcomes of patients with cancer. We aimed to evaluate the clinical significance of preoperative immunocompetence and nutritional status according to Onodera's prognostic nutrition index (PNI) among patients who underwent curative gastrectomy for gastric cancer (GC). This study included 260 patients with stage II/III GC who underwent R0 resection. The predictive values of preoperative nutritional status for postoperative outcome (morbidity and prognosis) were evaluated. Onodera's PNI was calculated as follows: 10 × serum albumin (g/dL) + 0.005 × lymphocyte count (per mm3). The mean preoperative PNI was 47.8. The area under the curve for predicting complications was greater for PNI compared with the serum albumin concentration or lymphocyte count. Multivariate analysis identified preoperative PNI < 47 as an independent predictor of postoperative morbidity. Moreover, patients in the PNI < 47 group experienced significantly shorter overall and disease-free survival compared with those in the PNI ≥ 47 group, notably because of a higher prevalence of hematogenous metastasis as the initial recurrence. Subgroup analysis according to disease stage and postoperative adjuvant treatment revealed that the prognostic significance of PNI was more apparent in patients with stage II GC and in those who received adjuvant chemotherapy. Preoperative PNI is easy and inexpensive to determine, and our findings indicate that PNI served as a significant predictor of postoperative morbidity, prognosis, and recurrence patterns of patients with stage II/III GC. PMID:27310954

  15. Drinking water is a significant predictor of Blastocystis infection among rural Malaysian primary schoolchildren.

    PubMed

    Abdulsalam, Awatif M; Ithoi, Init; Al-Mekhlafi, Hesham M; Ahmed, Abdulhamid; Surin, Johari; Mak, Joon-Wah

    2012-07-01

    Blastocystis infection has a worldwide distribution especially among the disadvantaged population and immunocompromised subjects. This study was carried out to determine the prevalence and the association of Blastocystis infection with the socio-economic characteristics among 300 primary schoolchildren, living in rural communities in Lipis and Raub districts of Pahang state, Malaysia. Stool samples were collected and examined for the presence of Blastocystis using direct smear microscopy after in vitro cultivation in Jones' medium. The overall prevalence of Blastocystis infection was found to be as high as 25.7%. The prevalence was significantly higher among children with gastrointestinal symptoms as compared to asymptomatic children (x2 =4.246; P=0.039). Univariate and multivariate analyses showed that absence of a piped water supply (OR=3.13; 95% CI=1.78, 5.46; P<0.001) and low levels of mothers' education (OR=3.41; 95% CI=1.62, 7.18; P<0.01) were the significant predictors of Blastocystis infection. In conclusion, Blastocystis is prevalent among rural children and the important factors that determine the infection were the sources of drinking water and mothers' educational level. Interventions with provision of clean water supply and health education especially to mothers are required. PMID:22444778

  16. Drinking water is a significant predictor of Blastocystis infection among rural Malaysian primary schoolchildren.

    PubMed

    Abdulsalam, Awatif M; Ithoi, Init; Al-Mekhlafi, Hesham M; Ahmed, Abdulhamid; Surin, Johari; Mak, Joon-Wah

    2012-07-01

    Blastocystis infection has a worldwide distribution especially among the disadvantaged population and immunocompromised subjects. This study was carried out to determine the prevalence and the association of Blastocystis infection with the socio-economic characteristics among 300 primary schoolchildren, living in rural communities in Lipis and Raub districts of Pahang state, Malaysia. Stool samples were collected and examined for the presence of Blastocystis using direct smear microscopy after in vitro cultivation in Jones' medium. The overall prevalence of Blastocystis infection was found to be as high as 25.7%. The prevalence was significantly higher among children with gastrointestinal symptoms as compared to asymptomatic children (x2 =4.246; P=0.039). Univariate and multivariate analyses showed that absence of a piped water supply (OR=3.13; 95% CI=1.78, 5.46; P<0.001) and low levels of mothers' education (OR=3.41; 95% CI=1.62, 7.18; P<0.01) were the significant predictors of Blastocystis infection. In conclusion, Blastocystis is prevalent among rural children and the important factors that determine the infection were the sources of drinking water and mothers' educational level. Interventions with provision of clean water supply and health education especially to mothers are required.

  17. Predictors and in-hospital outcomes of preoperative acute kidney injury in patients with type A acute aortic dissection

    PubMed Central

    Wang, Xiao; Ren, Hong-Mei; Hu, Chun-Yan; Que, Bin; Ai, Hui; Wang, Chun-Mei; Sun, Li-Zhong; Nie, Shao-Ping

    2016-01-01

    Background Acute kidney injury (AKI) is common after surgery for acute aortic dissection (AAD) and increases in-hospital and long-term mortality. However, few data exist on the clinical and prognostic relevance of early preoperative AKI in patients with type A AAD. We aimed to determine the incidence and predictors of preoperative AKI and the impact of AKI on in-hospital outcomes in patients with type A AAD. Methods From May 2009 to June 2014, we retrospectively enrolled 178 patients admitted to our hospital within 48 h from symptom onset and receiving open surgery for type A AAD. The patients were divided into no AKI and AKI groups and staged with AKI severity according to the KDIGO criteria before surgery. Results AKI occurred in 41 patients (23.0%). The incidence of in-hospital complications was significantly higher in patients with preoperative AKI compared to no AKI (41.5% vs. 9.5%, P < 0.001), including renal infarction (7.3% vs. 0, P = 0.012), and it increased with AKI severity (Ptrend < 0.001). Patients with AKI had higher in-hospital mortality compared with patients without AKI, although no significant difference was found (14.6% vs. 5.1%, P = 0.079). Multivariate analysis indicated that male gender, diastolic blood pressure on admission and bilateral renal artery involvement were independent predictors of preoperative AKI in patients with type A AAD. Conclusions Early AKI before surgery was common in patients with type A AAD, and was associated with increased in-hospital complications. Male gender, diastolic blood pressure on admission and bilateral renal artery involvement were major predictors for preoperative AKI. PMID:27781058

  18. Sex differences in sleep apnea predictors and outcomes from home sleep apnea testing

    PubMed Central

    Cairns, Alyssa; Poulos, Greg; Bogan, Richard

    2016-01-01

    Study objectives To evaluate sex differences in predictors of obstructive sleep apnea (OSA) as per outcomes from home sleep apnea testing. Design This was a retrospective analysis of a large repository of anonymous test results and pretest risk factors for OSA. Setting and patients A total of 272,705 patients were referred for home sleep apnea testing from a variety of clinical practices for suspected sleep disordered breathing across North America from 2009 to 2013. Interventions Not applicable. Measurements and results Predictors of OSA (apnea hypopnea index4%≥5) were evaluated by multiple logistic regression; sex differences were evaluated by interaction effects. Middle age was the single most robust predictor of OSA for both sexes and was particularly foretelling for females (P<0.001) even after controlling for measures of adiposity and medical conditions. Females over the age of 45 years were much more likely to have OSA compared to their younger counterparts (78.7% vs 42.5%, respectively; odds ratio: 5.0) versus males (88.1% vs 68.8%, respectively; odds ratio: 3.4). Snoring, although more frequently reported by males, was similarly predictive of OSA for both sexes. Witnessed apneas and measures of adiposity were better predictors of OSA for males than females. Insomnia, depression, and use of sleep medication, although more commonly reported in females, did not predict OSA. Hypertension, although equally reported by both sexes, performed better as a predictor in females (P<0.001), even after controlling for age, measures of adiposity, and other medical conditions. Diabetes, heart disease, stroke, and sleepiness did not contribute unique variance in OSA in adjusted models. Conclusion This study found that males and females report different symptoms upon clinical evaluation for suspected sleep apnea, with some of the “classic” OSA features to be more common in and robustly predictive for males. The finding that advancing age uniquely and robustly

  19. Trauma exposure and refugee status as predictors of mental health outcomes in treatment-seeking refugees.

    PubMed

    Knipscheer, Jeroen W; Sleijpen, Marieke; Mooren, Trudy; Ter Heide, F Jackie June; van der Aa, Niels

    2015-08-01

    Aims and method This study aimed to identify predictors of symptom severity for post-traumatic stress disorder (PTSD) and depression in asylum seekers and refugees referred to a specialised mental health centre. Trauma exposure (number and domain of event), refugee status and severity of PTSD and depression were assessed in 688 refugees. Results Symptom severity of PTSD and depression was significantly associated with lack of refugee status and accumulation of traumatic events. Four domains of traumatic events (human rights abuse, lack of necessities, traumatic loss, and separation from others) were not uniquely associated with symptom severity. All factors taken together explained 11% of variance in PTSD and depression. Clinical implications To account for multiple predictors of symptom severity including multiple traumatic events, treatment for traumatised refugees may need to be multimodal and enable the processing of multiple traumatic memories within a reasonable time-frame.

  20. Trauma exposure and refugee status as predictors of mental health outcomes in treatment-seeking refugees

    PubMed Central

    Knipscheer, Jeroen W.; Sleijpen, Marieke; Mooren, Trudy; ter Heide, F. Jackie June; van der Aa, Niels

    2015-01-01

    Aims and method This study aimed to identify predictors of symptom severity for post-traumatic stress disorder (PTSD) and depression in asylum seekers and refugees referred to a specialised mental health centre. Trauma exposure (number and domain of event), refugee status and severity of PTSD and depression were assessed in 688 refugees. Results Symptom severity of PTSD and depression was significantly associated with lack of refugee status and accumulation of traumatic events. Four domains of traumatic events (human rights abuse, lack of necessities, traumatic loss, and separation from others) were not uniquely associated with symptom severity. All factors taken together explained 11% of variance in PTSD and depression. Clinical implications To account for multiple predictors of symptom severity including multiple traumatic events, treatment for traumatised refugees may need to be multimodal and enable the processing of multiple traumatic memories within a reasonable time-frame. PMID:26755950

  1. Anxiety Disorder-Specific Predictors of Treatment Outcome in the Coordinated Anxiety Learning and Management (CALM) Trial.

    PubMed

    Jakubovski, Ewgeni; Bloch, Michael H

    2016-09-01

    Identifying baseline characteristics associated with treatment outcome in generalized anxiety disorder, panic disorder, social anxiety disorder (SAD) or post-traumatic stress disorder. We performed two secondary analyses of the Coordinated Anxiety Learning and Management trial. Baseline characteristics and their interactions with treatment assignment were analyzed via stepwise logistic regression models and receiver-operating criterion analyses by disorder predicting remission and response for each disorder. Predictors for poor outcome across diagnoses were comorbid depression and low socioeconomic status. Good outcome was associated with positive treatment expectancy and high self-efficacy expectancy. SAD had the lowest rate of remission and response compared to the other anxiety disorders, and differed in respect to its predictors of treatment outcome. Perceived social support predicted treatment outcome in SAD. The special role of SAD among the other anxiety disorders requires further study both because of its worse prognosis and its more specific treatment needs.

  2. Service characteristics as predictors of parents' perceptions of child rehabilitation outcomes.

    PubMed

    Järvikoski, Aila; Härkäpää, Kristiina; Martin, Marjatta; Vasari, Pekka; Autti-Rämö, Ilona

    2015-03-01

    Medical rehabilitation arranged by the Social Insurance Institution of Finland is provided for children with severe disabilities. The study aimed to find out which service characteristics were associated with perceived outcomes of rehabilitation. Parents whose children had participated in rehabilitation (n = 496) responded to a mail questionnaire that included questions on service characteristics and possible outcomes. Based on factor analysis, four outcome variables were formed. Logistic regression analysis was used to identify the particular service characteristics that were associated with the perceived outcomes. The family's participation in rehabilitation planning and the child's willingness to participate in rehabilitation activities were associated with good outcomes. Having a contact person for the rehabilitation process predicted child and family empowerment outcomes. The results emphasize the significance of establishing a good partnership between the professionals and the family; of developing the contents of the rehabilitation program, so that they motivate the child, and of organizing service coordinators for each family.

  3. Predictors and Outcomes of Routine Versus Optimal Medical Therapy in Stable Coronary Heart Disease.

    PubMed

    Chun, Soohun; Qiu, Feng; Austin, Peter C; Ko, Dennis T; Mamdani, Muhammad; Wijeysundera, Duminda N; Czarnecki, Andrew; Bennell, Maria C; Wijeysundera, Harindra C

    2015-09-01

    Although randomized studies have shown optimal medical therapy (OMT) to be as efficacious as revascularization in stable coronary heart disease (CHD), the application of OMT in routine practice is suboptimal. We sought to understand the predictors of receiving OMT in stable CHD and its impact on clinical outcomes. All patients with stable CHD based on coronary angiography from October 2008 to September 2011 were identified in Ontario, Canada. OMT was defined as concurrent use of β blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and statin. Aspirin use was not part of the OMT definition because of database limitations. Multivariable hierarchical logistic models identified predictors of OMT in the 12 months after angiography. Cox proportional hazard models with time-varying covariates for OMT and revascularization status examined differences in death and nonfatal myocardial infarction (MI). In these models, patients transitioned among 4 mutually exclusive treatment groups: no OMT and no revascularization, no OMT and revascularization, OMT and no revascularization, OMT and revascularization. Our cohort had 20,663 patients. Over a mean period of 2.5 years, 8.7% had died. Only 61% received OMT within 12 months. The strongest predictor of receiving OMT at 12 months was OMT before the angiogram (odds ratio 14.40, 95% confidence interval [CI] 13.17 to 15.75, p <0.001). Relative to no OMT and nonrevascularized patients, patients on OMT and revascularized had the greatest reduction in mortality (hazard ratio 0.52, 95% CI 0.45 to 0.60, p <0.001) and nonfatal MI (hazard ratio 0.74, 95% CI 0.64 to 0.84, p <0.001). In conclusion, our study highlights the low rate of OMT in stable CHD. Patients who received both OMT and revascularization achieved the greatest reduction in mortality and nonfatal MI. PMID:26119653

  4. Contextual and intrapersonal predictors of adolescent risky sexual behavior and outcomes.

    PubMed

    Shneyderman, Yuliya; Schwartz, Seth J

    2013-08-01

    The present study was designed to test a model of contextual and intrapersonal predictors of adolescent risky sexual behaviors and of sexually transmitted infection diagnoses. Using Waves I and II from the National Longitudinal Study of Adolescent Health, the authors estimated a structural model in which intrapersonal factors such as adolescents' attitudes about sex, perceived parental norms, knowledge about sexual health, and birth-control self-efficacy partially mediated the effects of contextual factors such as parent-adolescent relationship quality, school connectedness, and exposure to AIDS and pregnancy education on a number of risky sexual behaviors and outcomes: early sex initiation, sex under the influence of substances, condom use at last intercourse, and having been diagnosed with a sexually transmitted infection. Different patterns of direct and mediated effects emerged for each sexual outcome. Results are discussed in terms of the complex interplay between environment and individual and in terms of how, when, and with whom to intervene in order to improve adolescent sexual health outcomes.

  5. Attachment as a predictor of therapeutic outcome: a case study of a young patient with psychosis.

    PubMed

    Mihoci, Janja; Pesek, Marjeta Blinc

    2010-11-01

    Therapeutic alliance is one of the predictors of a successful therapy. In the current case study of the 26 year old male student diagnosed with paranoid schizophrenia we discuss the possible consequences of a short break in the therapeutic process on the treatment outcome. The client was appointed to an assistant psychologist for study support sessions and to work on his social skills and anxieties. The therapy continued regularly for a month and a half with some visible results in motivation, engagement and mood. After a break in the sessions due to the psychologist's absence, the client did not attend the sessions regularly. He became more withdrawn, his compliance with medical treatment was diminished and he did not meet his study goals.

  6. Infratentorial medulloepithelioma with divergent differentiation: Possibly a predictor of poor outcome.

    PubMed

    Chakrabarti, Indranil; Majumdar, Kaushik; Giri, Amita

    2012-05-01

    Medulloepitheliomas (WHO grade IV) are rare, malignant embryonal tumors of pediatric population, classified under the central nervous system (CNS) primitive neuroectodermal tumors (PNET). Histologically, these tumors are characterized by neoplastic neuroepithelium recapitulating the embryonic neural tube. We describe a rare case of infratentorial medulloepithelioma with divergent differentiation in a 1-year-old male child who presented with headache, vomiting, and seizures. Histopathologic examination of the excised tumor revealed the characteristic neuroepithelium, along with other areas showing primitive neuroectodermal (blastemal) cells in sheets, ependymoblastic rosettes, and nodular areas of neuronal differentiation. Possibly, this proliferating immature neuroepithelium is the cause of poor outcome in medulloepitheliomas. Due to the rarity of these tumors, it remains to be established whether infratentorial location or tumors with divergent differentiation are also predictors of adverse prognosis.

  7. Evaluation of positive and negative predictors of seizure outcomes among patients with immune-mediated epilepsy: a meta-analysis

    PubMed Central

    Dubey, Divyanshu; Farzal, Zehra; Hays, Ryan; Brown, L Steven; Vernino, Steven

    2016-01-01

    Background: The objective of this study was to analyze published literature on autoimmune epilepsy and assess predictors of seizure outcome. Methods: From PubMed and EMBASE databases, two reviewers independently identified publications reporting clinical presentations, management and outcomes of patients with autoimmune epilepsy. A meta-analysis of 46 selected studies was performed. Demographic/clinical variables (sex, age, clinical presentation, epilepsy focus, magnetic resonance imaging [MRI] characteristics, time to diagnosis and initiation of immunomodulatory therapy, and type of immunomodulatory therapy) were compared between two outcome groups (responders and nonresponders). Clinical response was defined as >50% reduction in seizure frequency. Unstandardized effect sizes were collected for the studies for responder and nonresponder groups. Sample size was used as the weight in the meta-analysis. The random effects model was used to account for heterogeneity in the studies. Results: The 46 reports included 186 and 96 patients in responder and nonresponder groups respectively. Mean age of the responders and nonresponders was 43 and 31 years (p < 0.01). Responders were more likely to have cell-surface antibodies (68% versus 39%, p < 0.05), particularly voltage-gated potassium channel complex antibodies (p < 0.01). Mean duration from symptom onset to diagnosis, and symptom onset to initiation of immunomodulation was significantly lower among the responders (75 versus 431 days, p < 0.05, and 80 versus 554, p < 0.01, respectively). There was no outcome difference based on gender, MRI characteristics, seizure type, type of acute immunomodulatory therapy, or use of chronic immunomodulation. Conclusions: Among published cases to date, older age, presence of cell-surface antibodies, early diagnosis and immunomodulatory treatment are associated with better seizure outcomes among patients with autoimmune epilepsy. PMID:27582892

  8. Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Meta-Analysis of Treatment Outcome and Predictors of Response

    PubMed Central

    Alonso, Pino; Cuadras, Daniel; Gabriëls, Loes; Denys, Damiaan; Goodman, Wayne; Greenberg, Ben D.; Jimenez-Ponce, Fiacro; Kuhn, Jens; Lenartz, Doris; Mallet, Luc; Nuttin, Bart; Real, Eva; Segalas, Cinto; Schuurman, Rick; Tezenas du Montcel, Sophie; Menchon, Jose M.

    2015-01-01

    Background Deep brain stimulation (DBS) has been proposed as an alternative to ablative neurosurgery for severe treatment-resistant Obsessive-Compulsive Disorder (OCD), although with partially discrepant results probably related to differences in anatomical targetting and stimulation conditions. We sought to determine the efficacy and tolerability of DBS in OCD and the existence of clinical predictors of response using meta-analysis. Methods We searched the literature on DBS for OCD from 1999 through January 2014 using PubMed/MEDLINE and PsycINFO. We performed fixed and random-effect meta-analysis with score changes (pre-post DBS) on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) as the primary-outcome measure, and the number of responders to treatment, quality of life and acceptability as secondary measures. Findings Thirty-one studies involving 116 subjects were identified. Eighty-three subjects were implanted in striatal areas—anterior limb of the internal capsule, ventral capsule and ventral striatum, nucleus accumbens and ventral caudate—27 in the subthalamic nucleus and six in the inferior thalamic peduncle. Global percentage of Y-BOCS reduction was estimated at 45.1% and global percentage of responders at 60.0%. Better response was associated with older age at OCD onset and presence of sexual/religious obsessions and compulsions. No significant differences were detected in efficacy between targets. Five patients dropped out, but adverse effects were generally reported as mild, transient and reversible. Conclusions Our analysis confirms that DBS constitutes a valid alternative to lesional surgery for severe, therapy-refractory OCD patients. Well-controlled, randomized studies with larger samples are needed to establish the optimal targeting and stimulation conditions and to extend the analysis of clinical predictors of outcome. PMID:26208305

  9. Patterns, predictors and outcomes of asthma control and exacerbations during pregnancy: a prospective cohort study

    PubMed Central

    Grzeskowiak, Luke E.; Smith, Brian; Roy, Anil; Dekker, Gustaaf A.

    2016-01-01

    There exists a paucity of data for socially disadvantaged populations describing patterns and predictors of asthma control status and exacerbations during pregnancy, and their relationship to adverse perinatal outcomes. Asthmatic women (n=189) were followed prospectively during pregnancy, with visits at 12, 20, 28 and 36 weeks gestation. Data on loss of control, recurrent uncontrolled asthma and moderate/severe exacerbations were collected at each visit and their relationship to perinatal outcomes examined following stratification for fetal sex. 50% of asthmatic women experienced a loss of control or moderate/severe exacerbation during pregnancy, with 22% of women experiencing a moderate/severe exacerbation. Factors associated with an increased risk of women experiencing recurrent uncontrolled asthma during pregnancy included smoking (relative risk 2.92, 95% CI 1.53–5.58), inhaled corticosteroid use at the beginning of pregnancy (relative risk 2.40, 95% CI 1.25–4.60) and increasing maternal age (relative risk 1.06, 95% CI 1.01–1.11). No factors were associated with moderate/severe exacerbations. Asthma control rather than exacerbations during pregnancy appeared to be most strongly correlated with perinatal outcomes. Following stratification by fetal sex, the presence of recurrent uncontrolled asthma was associated with an increased risk of being small for gestational age in women pregnant with females (33.3% versus 9.5%; p=0.018). In contrast, there was a nonsignificant increased risk of preterm birth in women with recurrent uncontrolled asthma that were pregnant with males (25.0% versus 11.8%; p=0.201) These results suggest that the key to improving perinatal outcomes lies in improving asthma control as early as possible in pregnancy and monitoring throughout pregnancy, rather than focusing on preventing exacerbations alone. PMID:27730170

  10. Predicting the In-Hospital Responsiveness to Treatment of Alcoholics. Social Factors as Predictors of Outcome. Brain Damage as a Factor in Treatment Outcome of Chronic Alcoholic Patients.

    ERIC Educational Resources Information Center

    Mascia, George V.; And Others

    The authors attempt to locate predictor variables associated with the outcome of alcoholic treatment programs. Muscia's study focuses on the predictive potential of: (1) response to a GSR conditioning procedure; (2) several personality variables; and (3) age and IQ measures. Nine variables, reflecting diverse perspectives, were selected as a basis…

  11. 'Mum's the word': Predictors and outcomes of weight concerns in pre-adolescent and early adolescent girls.

    PubMed

    Thøgersen-Ntoumani, Cecilie; Ng, Johan Yau Yin; Ntoumanis, Nikos; Chatzisarantis, Nikos; Vlachopoulos, Symeon; Katartzi, Ermioni S; Nikitaras, Nikitas

    2016-03-01

    Predictors and outcomes of weight concerns in pre-adolescent and adolescent girls are well known, but few models have incorporated concerns reported directly by mothers as a predictor, and both eating and exercise outcomes. Using questionnaires, a comprehensive model of 232 pre-adolescent and early adolescent girls' weight concerns, eating restraint, and exercise behavior was tested. Structural equation modeling showed that daughters' weight concerns were predicted primarily by their perceptions of their mothers' concerns about the daughters' weight, as well as by daughters' BMI, appearance conversations with friends, and perceived media pressure. Mothers' concerns with their daughters' weight were indirectly associated with daughters' own concerns, via the daughters' perceptions of their mothers' concerns. Daughters' concerns with their weight were a strong predictor of eating restraint, but not exercise behavior. PMID:26803392

  12. Latino and Caucasian Students' Academic and Non-Academic Characteristics as Predictors of Educational Outcomes, High School and Beyond

    ERIC Educational Resources Information Center

    Sanchez, Jafeth Evelyn

    2010-01-01

    The pathway to a postsecondary education is challenging for many students, including students from the growing Latino population in the United States. This research project focused on Latino and Caucasian students' academic and non-academic characteristics as predictors of educational outcomes, high school and beyond. The introduction to the…

  13. Predictors of Outcomes for African Americans in a Rehabilitation State Agency: Implications for National Policy and Practice

    ERIC Educational Resources Information Center

    Balcazar, Fabricio E.; Oberoi, Ashmeet K.; Suarez-Balcazar, Yolanda; Alvarado, Francisco

    2012-01-01

    A review of vocational rehabilitation (VR) data from a Midwestern state was conducted to identify predictors of rehabilitation outcomes for African American consumers. The database included 37,404 African Americans who were referred or self-referred over a period of five years. Logistic regression analysis indicated that except for age and…

  14. Thought Disorder and Communication Deviance as Predictors of Outcome in Youth at Clinical High Risk for Psychosis

    ERIC Educational Resources Information Center

    Bearden, Carrie E.; Wu, Keng Nei; Caplan, Rochelle; Cannon, Tyrone D.

    2011-01-01

    Objective: Given the fundamental role of thought disorder in schizophrenia, subtle communication disturbance may be a valuable predictor of subsequent development of psychosis. Here we examined the contribution of thought and communication disturbance to the prediction of outcome in adolescents identified as putatively prodromal for psychosis.…

  15. Is the Authoritarian Trait in Mental Health Workers a Significant Predictor Variable of Patient Assault?

    ERIC Educational Resources Information Center

    Safian-Rush, Donna

    Mental health workers may be assaulted by their violent patients. A study was conducted to examine one predictor variable of aggressive behavior in patients. It was hypothesized that authoritarian traits in the mental health worker could result in more assaults against the mental health worker by patients. Participants (N=32) were mental health…

  16. Childhood predictors and age 48 outcomes of self-reports and official records of offending

    PubMed Central

    DUBOW, ERIC F.; HUESMANN, L. ROWELL; BOXER, PAUL; SMITH, CATHY

    2014-01-01

    Background The key question is: are self-reports and official records equally valid indicators of criminal offending? Aims We examine the correspondence between self-reports and official records of offending, the similarity of childhood and adolescent individual and contextual predictors of both measures of offending, and the similarity of age 48 correlates of both measures of offending. Methods Men (N = 436) from the Columbia County Longitudinal Study, a sample of all 3rd graders in Columbia County, New York, in 1959–60, participated. The youth, their peers and their parents were interviewed when the youth were age 8; the youth were later interviewed at ages 19, 30 and 48. Results We found moderate to high correspondence between self-reports of having been in trouble with the law and official arrest records. Lifetime self-reports and official records of offending were generally predicted by the same childhood and adolescent variables, and were correlated with many of the same adult outcome measures. By age 48, life-course non-offenders defined by either self-reports or official records had better outcomes than offenders. Conclusions The results validate the use of adolescent and adult self-reports of offending, and the early identification of individuals at risk for adult criminal behaviour through childhood parent and peer reports and adolescent self and peer reports. PMID:25294162

  17. Callous unemotional traits in children with disruptive behavior disorder: Predictors of developmental trajectories and adolescent outcomes.

    PubMed

    Muratori, Pietro; Lochman, John E; Manfredi, Azzurra; Milone, Annarita; Nocentini, Annalaura; Pisano, Simone; Masi, Gabriele

    2016-02-28

    The present study investigated trajectories of Callous Unemotional (CU) traits in youth with Disruptive Behavior Disorder diagnosis followed-up from childhood to adolescence, to explore possible predictors of these trajectories, and to individuate adolescent clinical outcomes. A sample of 59 Italian referred children with Disruptive Behavior Disorder (53 boys and 6 girls, 21 with Conduct Disorder) was followed up from childhood to adolescence. CU traits were assessed with CU-scale of the Antisocial Process Screening Device-parent report. Latent growth curve models showed that CU traits are likely to decrease linearly from 9 to 15 years old, with a deceleration in adolescence (from 12 to 15). There was substantial individual variability in the rate of change of CU traits over time: patients with a minor decrease of CU symptoms during childhood were at increased risk for severe behavioral problems and substance use into adolescence. Although lower level of socio-economic status and lower level of parenting involvement were associated to elevated levels of CU traits at baseline evaluation, none of the considered clinical and environmental factors predicted the levels of CU traits. The current longitudinal research suggests that adolescent outcomes of Disruptive Behavior Disorder be influenced by CU traits trajectories during childhood. PMID:26791396

  18. Recovery from Anemia in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation – Prevalence, Predictors and Clinical Outcome

    PubMed Central

    De Backer, Ole; Arnous, Samer; Lønborg, Jacob; Brooks, Matthew; Biasco, Luigi; Jönsson, Anders; Franzen, Olaf W.; Søndergaard, Lars

    2014-01-01

    Introduction Preoperative anemia is common in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) and has been linked to a poorer outcome – including a higher 1-year mortality. The aim of this study was to investigate the impact of successful TAVI on baseline anemia. Methods A total of 253 patients who survived at least 1 year following TAVI were included in this study. The prevalence, predictors and clinical outcome of hemoglobin (Hb)-recovery were assessed. Results The prevalence of baseline anemia was 49% (n = 124) – recovery from anemia occurred in 40% of the anemic patients (n = 49) at 1 year after TAVI with an increase in mean Hb-level of 1.35 g/dL from baseline. This increase was not related to an improvement in renal function. At multivariate analysis, a high peak gradient (OR 4.82, P = 0.003) was shown to be an independent predictor for Hb-recovery, while blood transfusion (OR 0.31, P = 0.038) and chronic kidney disease (CKD, OR 0.33, P = 0.043) were identified as negative predictors at, respectively, one and two years after TAVI. When compared to patients without baseline anemia, those anemic patients with Hb-recovery had a similar functional improvement (OR 0.98, P = 0.975), whereas those without Hb-recovery had a significantly lower likelihood of functional improvement with ≧2 NYHA classes (OR 0.49, P = 0.034) and a higher likelihood of re-hospitalization within the first year after TAVI (OR 1.91, P = 0.024). Conclusion Recovery from anemia occurs in 40% of anemic patients at 1 year after TAVI – mainly in those with a high gradient and without CKD. Blood transfusion was found to have a transient adverse effect on this Hb-recovery. Finally, anemic patients without Hb-recovery experience less functional improvement and have a higher re-hospitalization rate within the first year after TAVI. PMID:25437191

  19. Subclinical Depressive Symptoms and Continued Cannabis Use: Predictors of Negative Outcomes in First Episode Psychosis

    PubMed Central

    González-Ortega, Itxaso; Alberich, Susana; Echeburúa, Enrique; Aizpuru, Felipe; Millán, Eduardo; Vieta, Eduard; Matute, Carlos; González-Pinto, Ana

    2015-01-01

    Background Although depressive symptoms in first episode psychosis have been associated with cannabis abuse, their influence on the long-term functional course of FEP patients who abuse cannabis is unknown. The aims of the study were to examine the influence of subclinical depressive symptoms on the long-term outcome in first episode-psychosis patients who were cannabis users and to assess the influence of these subclinical depressive symptoms on the ability to quit cannabis use. Methods 64 FEP patients who were cannabis users at baseline were followed-up for 5 years. Two groups were defined: (a) patients with subclinical depressive symptoms at least once during follow-up (DPG), and (b) patients without subclinical depressive symptoms during follow-up (NDPG). Psychotic symptoms were measured using the Positive and Negative Syndrome Scale (PANSS), depressive symptoms using the Hamilton Depression Rating Scale (HDRS)-17, and psychosocial functioning was assessed using the Global Assessment of Functioning (GAF). A linear mixed-effects model was used to analyze the combined influence of cannabis use and subclinical depressive symptomatology on the clinical outcome. Results Subclinical depressive symptoms were associated with continued abuse of cannabis during follow-up (β= 4.45; 95% confidence interval [CI]: 1.78 to 11.17; P = .001) and with worse functioning (β = -5.50; 95% CI: -9.02 to -0.33; P = .009). Conclusions Subclinical depressive symptoms and continued cannabis abuse during follow-up could be predictors of negative outcomes in FEP patients. PMID:25875862

  20. Predictors and Outcomes of Contralateral Prophylactic Mastectomy Among Breast Cancer Survivors

    PubMed Central

    Graves, Kristi D.; Peshkin, Beth N.; Halbert, Chanita H.; DeMarco, Tiffani A.; Isaacs, Claudine; Schwartz, Marc D.

    2011-01-01

    Background Women affected with breast cancer who carry a BRCA1 or BRCA2 (BRCA1/2) mutation are at risk of developing contralateral breast cancer. To reduce the risk of contralateral breast cancer, some patients opt for prophylactic surgery of the unaffected breast (contralateral prophylactic mastectomy; CPM) in addition to mastectomy of the affected breast. Methods We conducted the present study to determine the predictors and outcomes of CPM in the year following BRCA1/2 genetic counseling and testing. 435 women affected with unilateral breast cancer who received positive or uninformative BRCA1/2 genetic test results completed assessments prior to genetic counseling and testing and 1, 6, and 12 months after receipt of results. Results Prior to testing, 16% had undergone CPM (in conjunction with mastectomy of the affected breast). In the year following testing, 18% with positive test results and 3% with uninformative test results opted for CPM. CPM following testing was associated with a positive genetic test result, younger age at cancer diagnosis (OR = .94), and higher cancer-specific distress at baseline (OR = 3.28). CPM was not associated with distress outcomes at 12-months. Conclusions Following a positive test result, 18% of women previously affected with unilateral breast cancer had a CPM. Women affected with breast cancer at a younger age, particularly those with positive genetic test results and higher cancer-specific distress, are more likely to choose CPM than women who receive uninformative test results and who are less distressed and older at diagnosis. CPM does not appear to impact distress outcomes. PMID:17066320

  1. Circulating Tumor Cells Following First Chemotherapy Cycle: An Early and Strong Predictor of Outcome in Patients With Metastatic Breast Cancer

    PubMed Central

    Custodio, Sara; de las Casas, Maria-Luisa Maestro; García-Sáenz, José-Ángel; de la Torre, Julio-César; Bellón-Cano, Jose-María; López-Tarruella, Sara; Vidaurreta-Lazaro, Marta; de la Orden, Virginia; Jerez, Yolanda; Márquez-Rodas, Iván; Casado, Antonio; Sastre, Javier; Díaz-Rubio, Eduardo

    2013-01-01

    We investigated the prognostic significance of circulating tumor cells (CTCs) determined immediately before the second cycle of chemotherapy in patients with metastatic breast cancer (MBC). The CTC counts were taken at baseline, before the first cycle of chemotherapy (CTC-0), and on day 21 before commencing the second cycle of chemotherapy (CTC-21) in consecutive MBC patients. The study's primary objectives were to analyze relationships between CTC-21 count and overall survival (OS). Based on the current literature, the CTC measurements were dichotomized as 0–4 versus ≥5 CTCs. Of 117 patients recruited, 99 were evaluable. Patients with 0–4 CTCs on day 21 had a significantly better OS than those with ≥5 CTCs (median OS: 38.5 months vs. 8.7 months). They also had a significantly better progression-free survival (PFS; median: 9.4 months vs. 3.0 months) and clinical benefit rate (77% vs. 44%). The OS of patients whose baseline CTCs were ≥5 but dropped to <5 on day 21 was apparently similar to those who had <5 CTCs at baseline. In a Cox regression analysis, CTC-21 was the only independent variable significantly predicting OS and PFS. Our data indicate that CTCs determined immediately before the second cycle of chemotherapy is an early and strong predictor of treatment outcome in MBC patients. PMID:23873719

  2. Activities of daily living as an additional predictor of complications and outcomes in elderly patients with acute myocardial infarction

    PubMed Central

    Nakajima, Hiroyuki; Yoshioka, Jiro; Totsuka, Nobuyuki; Miyazawa, Izumi; Usui, Tatsuya; Urasawa, Nobuyuki; Kobayashi, Takahiro; Mochidome, Tomoaki

    2016-01-01

    Background Age is an important determinant of outcome in acute myocardial infarction (AMI). However, in clinical settings, there is an occasional mismatch between chronological age and physical age. We evaluated whether activities of daily living (ADL), which reflect physical age, also predict complications and prognosis in elderly patients with AMI. Design Single-center, observational, and retrospective cohort study. Methods Preserved ADL and low ADL were defined according to the scale for independence degree of daily living for the disabled elderly by the Japanese Ministry of Health, Labour, and Welfare. We examined 82 consecutive patients aged ≥75 years with AMI who underwent primary percutaneous coronary intervention. Patients were divided into preserved ADL (n=52; mean age, 81.8±4.8 years; male, 59.6%) and low ADL (n=30; mean age, 85.8±4.7 years; male, 40.0%) groups according to prehospital ADL. Results The prevalence of Killip class II–IV and in-hospital mortality rate were significantly higher with low ADL compared to that with preserved ADL (23.1% vs 60.0%, P=0.0019; 5.8% vs 30.0%, P=0.0068, respectively). Multivariate analysis showed that ADL was an independent predictor of Killip class II–IV and 1-year mortality after adjusting for age, sex, and other possible confounders (odds ratio 5.11, 95% confidence interval [CI] 1.52–17.2, P=0.0083; hazard ratio 4.32, 95% CI 1.31–14.3, P=0.017, respectively). Conclusion Prehospital ADL is a significant predictor of heart failure complications and prognosis in elderly patients with AMI undergoing primary percutaneous coronary intervention, irrespective of age and sex. PMID:27601890

  3. Activities of daily living as an additional predictor of complications and outcomes in elderly patients with acute myocardial infarction

    PubMed Central

    Nakajima, Hiroyuki; Yoshioka, Jiro; Totsuka, Nobuyuki; Miyazawa, Izumi; Usui, Tatsuya; Urasawa, Nobuyuki; Kobayashi, Takahiro; Mochidome, Tomoaki

    2016-01-01

    Background Age is an important determinant of outcome in acute myocardial infarction (AMI). However, in clinical settings, there is an occasional mismatch between chronological age and physical age. We evaluated whether activities of daily living (ADL), which reflect physical age, also predict complications and prognosis in elderly patients with AMI. Design Single-center, observational, and retrospective cohort study. Methods Preserved ADL and low ADL were defined according to the scale for independence degree of daily living for the disabled elderly by the Japanese Ministry of Health, Labour, and Welfare. We examined 82 consecutive patients aged ≥75 years with AMI who underwent primary percutaneous coronary intervention. Patients were divided into preserved ADL (n=52; mean age, 81.8±4.8 years; male, 59.6%) and low ADL (n=30; mean age, 85.8±4.7 years; male, 40.0%) groups according to prehospital ADL. Results The prevalence of Killip class II–IV and in-hospital mortality rate were significantly higher with low ADL compared to that with preserved ADL (23.1% vs 60.0%, P=0.0019; 5.8% vs 30.0%, P=0.0068, respectively). Multivariate analysis showed that ADL was an independent predictor of Killip class II–IV and 1-year mortality after adjusting for age, sex, and other possible confounders (odds ratio 5.11, 95% confidence interval [CI] 1.52–17.2, P=0.0083; hazard ratio 4.32, 95% CI 1.31–14.3, P=0.017, respectively). Conclusion Prehospital ADL is a significant predictor of heart failure complications and prognosis in elderly patients with AMI undergoing primary percutaneous coronary intervention, irrespective of age and sex.

  4. Prognostic significance of electrical alternans versus signal averaged electrocardiography in predicting the outcome of electrophysiological testing and arrhythmia-free survival

    NASA Technical Reports Server (NTRS)

    Armoundas, A. A.; Rosenbaum, D. S.; Ruskin, J. N.; Garan, H.; Cohen, R. J.

    1998-01-01

    OBJECTIVE: To investigate the accuracy of signal averaged electrocardiography (SAECG) and measurement of microvolt level T wave alternans as predictors of susceptibility to ventricular arrhythmias. DESIGN: Analysis of new data from a previously published prospective investigation. SETTING: Electrophysiology laboratory of a major referral hospital. PATIENTS AND INTERVENTIONS: 43 patients, not on class I or class III antiarrhythmic drug treatment, undergoing invasive electrophysiological testing had SAECG and T wave alternans measurements. The SAECG was considered positive in the presence of one (SAECG-I) or two (SAECG-II) of three standard criteria. T wave alternans was considered positive if the alternans ratio exceeded 3.0. MAIN OUTCOME MEASURES: Inducibility of sustained ventricular tachycardia or fibrillation during electrophysiological testing, and 20 month arrhythmia-free survival. RESULTS: The accuracy of T wave alternans in predicting the outcome of electrophysiological testing was 84% (p < 0.0001). Neither SAECG-I (accuracy 60%; p < 0.29) nor SAECG-II (accuracy 71%; p < 0.10) was a statistically significant predictor of electrophysiological testing. SAECG, T wave alternans, electrophysiological testing, and follow up data were available in 36 patients while not on class I or III antiarrhythmic agents. The accuracy of T wave alternans in predicting the outcome of arrhythmia-free survival was 86% (p < 0.030). Neither SAECG-I (accuracy 65%; p < 0.21) nor SAECG-II (accuracy 71%; p < 0.48) was a statistically significant predictor of arrhythmia-free survival. CONCLUSIONS: T wave alternans was a highly significant predictor of the outcome of electrophysiological testing and arrhythmia-free survival, while SAECG was not a statistically significant predictor. Although these results need to be confirmed in prospective clinical studies, they suggest that T wave alternans may serve as a non-invasive probe for screening high risk populations for malignant ventricular

  5. Assessing English literacy as a predictor of postschool outcomes in the lives of deaf individuals.

    PubMed

    Garberoglio, Carrie Lou; Cawthon, Stephanie W; Bond, Mark

    2014-01-01

    Lower English literacy achievement of deaf students is often hypothesized to be an impediment for successful adult life experiences. Yet, literacy practices that individuals engage in throughout their daily lives are much more complex than what school-based measures of English can capture and particularly so for deaf individuals. A national large-scale data set with a sample of over 1,000 deaf youths was used to assess what, precisely, standardized measures of literacy may predict in terms of postschool outcomes in three domains: life, employment, and education. Regression analyses indicate that these measures predicted some postschool outcomes, but not all, and if significant, only a small amount of variation in the outcomes was explained. Findings suggest that English literacy, particularly the narrow conceptualization of English literacy skills that are measured through school-based assessments, may not play a significant role in the lives of deaf individuals, contrary to expectations. PMID:24077877

  6. 12-Month Outcome and Predictors of Recurrence in Psychiatric Treatment of Depression: A Retrospective Study.

    PubMed

    Johansson, Olof; Lundh, Lars-Gunnar; Bjärehed, Jonas

    2015-09-01

    Many individuals treated for depression suffer relapse or recurrence after treatment. Known risk factors include number of previous depressive episodes and residual symptoms after treatment. Both relapse/recurrence rates and predictors of relapse/recurrence, however, may differ between various settings. To perform a naturalistic evaluation of the sustained effectiveness of treatment for adult clinical depression in a psychiatric out-patient setting and to examine psychosocial and clinical predictors of relapse/recurrence. 51 individuals, who were successfully treated/discharged from psychiatric care 12 months prior, were assessed regarding current depressive status and regarding relapse and recurrence. Logistic regression was used to assess the predictive impact of the variables measured. At the 12-month follow-up, 26% of the participants were in complete remission, 45% were in partial remission, and 29% were clinically depressed. In 1 year, 61% suffered a new depressive episode. Having a greater number of previous episodes and having no partner significantly increased the risk of relapse or recurrence. A high prevalence of depression and partially remitted depression is reported at 12-month follow up, and a large proportion of the sample would likely benefit from active treatment. Relapse/recurrence rates are higher in this study than in many other studies, and it may be hypothesized that they are generally higher in psychiatric settings than in primary care. If so, this would indicate the need for a different treatment strategy in the psychiatric care of depression, with emphasis on long-term management of depression.

  7. Lactate in Amniotic Fluid: Predictor of Labor Outcome in Oxytocin-Augmented Primiparas’ Deliveries

    PubMed Central

    Pembe, Andrea B.; Järnbert-Pettersson, Hans; Norman, Margareta; Wihlbäck, Anna-Carin; Hoesli, Irene; Todesco Bernasconi, Monya; Azria, Elie; Åkerud, Helena; Darj, Elisabet

    2016-01-01

    Background One of the major complications related to delivery is labor dystocia, or an arrested labor progress. Many dystocic deliveries end vaginally after administration of oxytocin, but a large numbers of women with labor dystocia will undergo a long and unsafe parturition. As a result of the exertion required in labor, the uterus produces lactate. The uterine production of lactate is mirrored by the level of lactate in amniotic fluid (AFL). Objectives To evaluate whether the level of AFL, analysed in a sample of amniotic fluid collected vaginally at arrested labor when oxytocin was needed, could predict labor outcome in nulliparous deliveries. Methods A prospective multicentre study including 3000 healthy primiparous women all with a singleton pregnancy, gestational age 37 to 42 weeks and no maternal /fetal chronic and/or pregnancy-related conditions. A spontaneous onset of labor, regular contractions and cervical dilation ≥ 3 cm were required before the women were invited to take part in the study. Results AFL, analysed within 30 minutes before augmentation, provides information about delivery outcome. Sensitivity for an acute cesarean section according to high (≥10.1mmol/l) or low (< 10.1mmol/l) AFL values was 39.0% (95% CI; 27–50), specificity 90.3% (95% CI; 87–93) PPV 37.3% (95% CI; 27–48) and NPV was 91.0% (95% CI; 88–93). The overall percentage of correct predictions of delivery outcome when the AFL level was used was 83.7%. Deliveries with a high AFL-level correlated with delivery time >12h (p = 0.04), post-partum fever (>38°C, p = 0.01) and post-partum haemorrhage >1.5L (p = 0.04). Conclusion The AFL is a good predictor of delivery outcome in arrested nulliparous deliveries. Low levels of AFL may support the decision to continue a prolonged vaginal labor by augmentation with oxytocin. A high level of AFL correlates with operative interventions and post-partum complications. PMID:27783611

  8. Primary failure of bortezomib in newly diagnosed multiple myeloma--understanding the magnitude, predictors, and significance.

    PubMed

    Cohen, Yael C; Joffe, Erel; Benyamini, Noam; Dimopoulos, Meletios A; Terpos, Evangelos; Trestman, Svetlana; Held-Kuznetsov, Viki; Avivi, Irit; Kastritis, Efstathios

    2016-01-01

    Botezomib-based induction is highly effective for the treatment of newly diagnosed multiple myeloma (NDMM). We investigated the outcomes of NDMM patients who failed to respond to bortezomib-based induction in a 'real-life' clinical setting. In a cohort of 295 consecutive NDMM patients in 3 medical centers, 74 (25%) failed to achieve at least partial response after 4 induction cycles, and were classified as non-responsive. Compared to induction responders, they were older, more frequently anemic, had a higher incidence of del17p and ISS-3, and a worse performance status. In multivariable analysis, bortezomib-based induction failure occurred in 25% of patients and was the strongest independent factor predicting mortality with a 5-fold hazard ratio (95% CI 1.44-8.68). Three-year overall survival in responsive vs. non-responsive patients were 76% vs. 53%, respectively (p < 0.0001). Survival from time of salvage second-line treatment was significantly shorter among induction non-responders vs. responders (25 months vs. not-reached, p = 0.024). PMID:26727104

  9. Anxiety as a Predictor of Behavioral Therapy Outcome for Cancer Chemotherapy Patients.

    ERIC Educational Resources Information Center

    Carey, Michael P.; Burish, Thomas G.

    1985-01-01

    Determined if baseline anxiety levels are predictive of outcome on treatments associated with cancer chemotherapy. Results indicated low-anxiety patients reported less anxiety and depression before behavioral training but nonetheless exhibited significantly greater reductions in anxiety, depression, and diastolic blood pressure after training.…

  10. Waist-to-Hip Ratio versus Body Mass Index as Predictor of Obesity-Related Pregnancy Outcomes.

    PubMed

    McDonnold, Mollie; Mele, Lisa M; Myatt, Leslie; Hauth, John C; Leveno, Kenneth J; Reddy, Uma M; Mercer, Brian M

    2016-05-01

    Objective In nonpregnant populations the waist-to-hip ratio (WHR) is a better predictor of obesity-related outcomes than body mass index (BMI). Our objective was to determine, in pregnancy, the relationship between these measures of obesity, and large-for-gestational age (LGA) and cesarean delivery (CD). Methods This is a secondary analysis of data from the Combined Antioxidant and Preeclampsia Prediction Study. Women with a WHR of ≥ 0.85 and 0.80 to 0.84 at 9 to 16 weeks gestation were compared with those with a WHR < 0.80. Women with early pregnancy BMI ≥ 30.0 kg/m(2) (obese) and 25.0 to 29.9 kg/m(2) (overweight) were compared with those < 25.0 kg/m(2). LGA was defined as > 90% by Alexander nomogram. Univariable analysis, logistic regression, and receiver operating characteristic curves were used. Results Data from 2,276 women were analyzed. After correcting for potential confounders, only BMI ≥ 30 was significantly associated with LGA (adjusted odds ratio [aOR]: 2.07, 1.35-3.16) while BMI 25.0-29.9 (aOR: 1.5, 0.98-2.28), WHR 0.8-0.84 (aOR: 1.33, 0.83-2.13), and WHR ≥ 0.85 (aOR: 1.05, 0.67-1.65) were not. Risk for CD was increased for women with elevated WHR and with higher BMI compared with normal. Conclusion WHR is not associated with LGA. While BMI performed better than WHR, neither was a strong predictor of LGA or need for CD in low-risk nulliparous women.

  11. Within-Treatment Factors as Predictors of Outcomes Following Conversational Recasting

    PubMed Central

    Hassink, Johanna M.; Leonard, Laurence B.

    2013-01-01

    Purpose Although conversational recasting has been a generally successful treatment approach, the precise factors that influence children’s learning through recasts are not yet understood. In this study, we examined details of the child utterance – clinician utterance relationship that seemed likely to influence learning. Method Three measures were calculated from transcripts of recasting sessions with 17 preschoolers with specific language impairment. In all sessions, third person singular – s served as the target. The measures of interest were the frequency of recasts following child utterances that were prompted by clinicians, the frequency of clinicians’ recasts of subjectless sentences, and the frequency of clinicians’ noncorrective recasts. We assessed the short-term and long-term predictive value of these measures through regression analyses. Results Noncorrective recasts proved to be a positive predictor of short- and long-term gains in the use of the target form. Recasts of subjectless sentences were associated with poorer outcomes, though their contribution was relatively small. Conclusions The nature of learning that takes place varies according to the relationship between child and clinician utterances during the recasting process. These variations have implications for clinical practice and for how learning through recasting is characterized. PMID:20308290

  12. Self-efficacy of knee function as a pre-operative predictor of outcome 1 year after anterior cruciate ligament reconstruction.

    PubMed

    Thomeé, Pia; Währborg, Peter; Börjesson, Mats; Thomeé, Roland; Eriksson, B I; Karlsson, Jon

    2008-02-01

    The knee self-efficacy scale (K-SES) has been shown to have good reliability, validity and responsiveness during rehabilitation for patients' perceived self-efficacy of knee function. Determinants of self-efficacy of knee function 1 year after ACL reconstruction have been found to be the patients' internal locus of control and knee symptoms in sports and recreation. The predictive ability of perceived self-efficacy of knee function measured by the K-SES has not been studied in terms of patient outcome after an ACL reconstruction. The purpose of this study was to explore the potential for pre-operative self-efficacy of knee function measured by the K-SES to predict patient outcome in terms of physical activity, knee symptoms and muscle function 1 year after an ACL reconstruction. Thirty-eight patients were evaluated for outcome in terms of physical activity with the Tegner activity scale and the physical activity scale (PAS), knee symptoms with the Lysholm knee scoring scale and the knee injury and osteoarthritis outcome score (KOOS) and knee function with ability tests for muscle function 1 year after ACL reconstruction. Multiple regression and logistic multiple regression analysis were used to evaluate the K-SES as a possible predictor of outcome. The patients' present perceived self-efficacy of knee function (K-SES(Present)) pre-operatively was a significant predictor (P = 0.016) of the patients returning to their intensity and frequency of physical activity (PAS) 1 year after ACL reconstruction, when adjusted for age, gender and pre-injury physical activity level (Tegner(Pre-injury)) (odds ratio = 2.1). The patients' perceived future self-efficacy of knee function (K-SES(Future)) pre-operatively was a significant predictor (P = 0.045) of their self-rated knee function in sports/recreational activities (KOOS(Sports/recreation)) at the 1-year follow-up, when adjusted for age, gender and Tegner(Pre-injury )(R (2 )=0.25). The pre-operative K-SES(Future) was also a

  13. Brain function predictors and outcome of weight loss and weight loss maintenance.

    PubMed

    Szabo-Reed, Amanda N; Breslin, Florence J; Lynch, Anthony M; Patrician, Trisha M; Martin, Laura E; Lepping, Rebecca J; Powell, Joshua N; Yeh, Hung-Wen Henry; Befort, Christie A; Sullivan, Debra; Gibson, Cheryl; Washburn, Richard; Donnelly, Joseph E; Savage, Cary R

    2015-01-01

    Obesity rates are associated with public health consequences and rising health care costs. Weight loss interventions, while effective, do not work for everyone, and weight regain is a significant problem. Eating behavior is influenced by a convergence of processes in the brain, including homeostatic factors and motivational processing that are important contributors to overeating. Initial neuroimaging studies have identified brain regions that respond differently to visual food cues in obese and healthy weight individuals that are positively correlated with reports of hunger in obese participants. While these findings provide mechanisms of overeating, many important questions remain. It is not known whether brain activation patterns change after weight loss, or if they change differentially based on amount of weight lost. Also, little is understood regarding biological processes that contribute to long-term weight maintenance. This study will use neuroimaging in participants while viewing food and non-food images. Functional Magnetic Resonance Imaging will take place before and after completion of a twelve-week weight loss intervention. Obese participants will be followed though a 6-month maintenance period. The study will address three aims: 1. Characterize brain activation underlying food motivation and impulsive behaviors in obese individuals. 2. Identify brain activation changes and predictors of weight loss. 3. Identify brain activation predictors of weight loss maintenance. Findings from this study will have implications for understanding mechanisms of obesity, weight loss, and weight maintenance. Results will be significant to public health and could lead to a better understanding of how differences in brain activation relate to obesity. PMID:25533729

  14. Brain function predictors and outcome of weight loss and weight loss maintenance

    PubMed Central

    Szabo-Reed, Amanda N.; Breslin, Florence J.; Lynch, Anthony M.; Patrician, Trisha M.; Martin, Laura E.; Lepping, Rebecca J.; Powell, Joshua N.; Yeh, Hung-Wen (Henry); Befort, Christie A.; Sullivan, Debra; Gibson, Cheryl; Washburn, Richard; Donnelly, Joseph E.; Savage, Cary R.

    2015-01-01

    Obesity rates are associated with public health consequences and rising health care costs. Weight loss interventions, while effective, do not work for everyone, and weight regain is a significant problem. Eating behavior is influenced by a convergence of processes in the brain, including homeostatic factors and motivational processing that are important contributors to overeating. Initial neuroimaging studies have identified brain regions that respond differently to visual food cues in obese and healthy weight individuals that are positively correlated with reports of hunger in obese participants. While these findings provide mechanisms of overeating, many important questions remain. It is not known whether brain activation patterns change after weight loss, or if they change differentially based on amount of weight lost. Also, little is understood regarding biological processes that contribute to long-term weight maintenance. This study will use neuroimaging in participants while viewing food and non-food images. Functional Magnetic Resonance Imaging will take place before and after completion of a twelve-week weight loss intervention. Obese participants will be followed though a 6-month maintenance period. The study will address three aims: 1. Characterize brain activation underlying food motivation and impulsive behaviors in obese individuals. 2. Identify brain activation changes and predictors of weight loss. 3. Identify brain activation predictors of weight loss maintenance. Findings from this study will have implications for understanding mechanisms of obesity, weight loss, and weight maintenance. Results will be significant to public health and could lead to a better understanding of how differences in brain activation relate to obesity. PMID:25533729

  15. Brain function predictors and outcome of weight loss and weight loss maintenance.

    PubMed

    Szabo-Reed, Amanda N; Breslin, Florence J; Lynch, Anthony M; Patrician, Trisha M; Martin, Laura E; Lepping, Rebecca J; Powell, Joshua N; Yeh, Hung-Wen Henry; Befort, Christie A; Sullivan, Debra; Gibson, Cheryl; Washburn, Richard; Donnelly, Joseph E; Savage, Cary R

    2015-01-01

    Obesity rates are associated with public health consequences and rising health care costs. Weight loss interventions, while effective, do not work for everyone, and weight regain is a significant problem. Eating behavior is influenced by a convergence of processes in the brain, including homeostatic factors and motivational processing that are important contributors to overeating. Initial neuroimaging studies have identified brain regions that respond differently to visual food cues in obese and healthy weight individuals that are positively correlated with reports of hunger in obese participants. While these findings provide mechanisms of overeating, many important questions remain. It is not known whether brain activation patterns change after weight loss, or if they change differentially based on amount of weight lost. Also, little is understood regarding biological processes that contribute to long-term weight maintenance. This study will use neuroimaging in participants while viewing food and non-food images. Functional Magnetic Resonance Imaging will take place before and after completion of a twelve-week weight loss intervention. Obese participants will be followed though a 6-month maintenance period. The study will address three aims: 1. Characterize brain activation underlying food motivation and impulsive behaviors in obese individuals. 2. Identify brain activation changes and predictors of weight loss. 3. Identify brain activation predictors of weight loss maintenance. Findings from this study will have implications for understanding mechanisms of obesity, weight loss, and weight maintenance. Results will be significant to public health and could lead to a better understanding of how differences in brain activation relate to obesity.

  16. The adductor pollicis muscle: a poor predictor of clinical outcome in ICU patients.

    PubMed

    Leong Shu-Fen, Claudia; Ong, Venetia; Kowitlawakul, Yanika; Ling, Teh Ai; Mukhopadhyay, Amartya; Henry, Jeya

    2015-01-01

    No nutrition assessment tools specifically tailored for intensive care unit (ICU) patients have been developed and validated in Singapore. Studies conducted in Brazilian populations suggest that the thickness of the adductor pollicis muscle (TAPM) may be used to assess nutritional status and predict mortality of critically ill patients. The aim of this study was to determine if TAPM can be used as a predictive indicator of mortality in Singapore ICU patients. TAPM values were obtained using skinfold calipers in 229 patients admitted to the medical ICU. TAPM measured in both hands showed no significant correlation with either the primary outcome (28-day mortality) or secondary outcomes (hospital outcome and hospital length of stay). This study demonstrated that TAPM does not predict 28-day mortality and hospital outcome, and is not correlated to length of stay in Singapore ICU patients. More studies are necessary to validate the use of TAPM as an anthropometric indicator of ICU outcome in other regions of the world. PMID:26693744

  17. Intra-arterial nimodipine for cerebral vasospasm after subarachnoid haemorrhage: Influence on clinical course and predictors of clinical outcome.

    PubMed

    Bashir, Asma; Andresen, Morten; Bartek, Jiri; Cortsen, Marie; Eskesen, Vagn; Wagner, Aase

    2016-02-01

    Intra-arterial nimodipine (IAN) has shown a promising effect on cerebral vasospasm (CV) after aneurysmal subarachnoid haemorrhage. At our institution, Rigshospitalet, IAN treatment has been used since 2009, but the short- and long-term clinical efficacy of IAN has not yet been assessed. The purpose was to evaluate the efficacy and clinical outcome of IAN treatment of symptomatic CV, and to assess the predictors of clinical outcome. Medical records of 25 patients undergoing a total of 41 IAN treatment sessions were retrospectively reviewed. Data on angiographic results, blood-flow velocities and the clinical condition before and after the IAN treatment were recorded. Predictors of the clinical outcome were assessed with a linear regression model. Positive angiographic response was achieved in 95.1% of 41 IAN treatment sessions. Flow-velocity measurements showed no relationship with angiographic responses of IAN. The immediate clinical improvement was observed in three patients (12%). Five patients (20%) had a favourable outcome at discharge and at three-month follow-up; 10 patients (40%) had a moderate to poor outcome; and the rest (40%) died. Increased number of affected vessels and number of procedures carried out per patient, and a trend toward an increased delay time from symptomatic CV to confirming angiographic CV and thus instituting IAN treatment predicted the poor clinical outcome. IAN treatment appears to be effective in reversing angiographic CV. However, it is not always effective in reversing clinical deterioration, as several other factors including treatment delay affect the clinical course.

  18. Cerebral Infarction following Acute Subdural Hematoma in Infants and Young Children: Predictors and Significance of FLAIR Vessel Hyperintensity

    PubMed Central

    MOMOSE, Hiroaki; SORIMACHI, Takatoshi; AOKI, Rie; ATSUMI, Hideki; MATSUMAE, Mitsunori

    A phenomenon of cerebral infarction following acute subdural hematoma (ASDH) in infants and young children, termed cerebral infarction following ASDH (CIASDH), has been well recognized, though both its mechanisms and risk factors have been poorly understood. The purpose of the present study was to investigate the predictors for CIASDH in a population of ASDH, and to evaluate the imaging studies to presume the mechanisms of CIASDH. We retrospectively examined consecutive children 6 years of age or younger, who were diagnosed with ASDH and were admitted to our hospital between 2000 and 2014. In 57 consecutive children with ASDH, 12 (21.1%) developed CIASDH. The multivariate analysis revealed five predictors for CIASDH: presence of seizure, consciousness disturbance at admission, absence of skull fracture, hematoma thickness ≥ 5 mm on computed tomography (CT), and midline shift ≥ 3 mm on CT (p < 0.05). In three of six patients (50%) undergoing magnetic resonance (MR) imaging/fluid-attenuated inversion recovery (FLAIR) within 5 days of admission, serpentine hyperintensities in the subarachnoid space (FLAIR vessel hyperintensities) were demonstrated. MR angiography showed neither occlusion nor stenosis of the cerebral arteries. Single photon emission CT performed at admission in one patient showed a cerebral blood flow reduction in the ASDH side. All the children with CIASDH showed unfavorable outcomes at discharge. Children showing multiple predictors at admission should be carefully observed for development of CIASDH. Evaluation of the imaging studies suggested that a blood flow disturbance in the level of peripheral arteries to microcirculation was one candidate for possible mechanisms to induce the CIASDH. PMID:26041626

  19. Neonatal White Matter Abnormalities an Important Predictor of Neurocognitive Outcome for Very Preterm Children

    PubMed Central

    Woodward, Lianne J.; Clark, Caron A. C.; Bora, Samudragupta; Inder, Terrie E.

    2012-01-01

    Background Cerebral white matter abnormalities on term MRI are a strong predictor of motor disability in children born very preterm. However, their contribution to cognitive impairment is less certain. Objective Examine relationships between the presence and severity of cerebral white matter abnormalities on neonatal MRI and a range of neurocognitive outcomes assessed at ages 4 and 6 years. Design/Methods The study sample consisted of a regionally representative cohort of 104 very preterm (≤32 weeks gestation) infants born from 1998–2000 and a comparison group of 107 full-term infants. At term equivalent, all preterm infants underwent a structural MRI scan that was analyzed qualitatively for the presence and severity of cerebral white matter abnormalities, including cysts, signal abnormalities, loss of white matter volume, ventriculomegaly, and corpus callosal thinning/myelination. At corrected ages 4 and 6 years, all children underwent a comprehensive neurodevelopmental assessment that included measures of general intellectual ability, language development, and executive functioning. Results At 4 and 6 years, very preterm children without cerebral white matter abnormalities showed no apparent neurocognitive impairments relative to their full-term peers on any of the domain specific measures of intelligence, language, and executive functioning. In contrast, children born very preterm with mild and moderate-to-severe white matter abnormalities were characterized by performance impairments across all measures and time points, with more severe cerebral abnormalities being associated with increased risks of cognitive impairment. These associations persisted after adjustment for gender, neonatal medical risk factors, and family social risk. Conclusions Findings highlight the importance of cerebral white matter connectivity for later intact cognitive functioning amongst children born very preterm. Preterm born children without cerebral white matter abnormalities on

  20. Adenoid cystic carcinoma of head and neck: clinical predictors of outcome from a Canadian centre

    PubMed Central

    Ko, J.J.; Siever, J.E.; Hao, D.; Simpson, R.; Lau, H.Y.

    2016-01-01

    Objectives Adenoid cystic carcinoma (acc) is often treated with surgery, with or without adjuvant radiation therapy (rt). We evaluated disease characteristics, treatments, and potentially prognostic variables in patients with acc. Methods Our retrospective analysis considered consecutive cases of acc presenting at a tertiary care hospital between 2000 and 2014. Factors predictive of overall survival (os) and disease-free survival (dfs) were identified by univariate analysis. Results The 60 patients analyzed had a mean age of 58 years (range: 22–88 years), with a 2:1 female:male ratio. Tumour locations included the major salivary glands (40% parotid, 17% submandibular and sublingual), the oro-nasopharyngeal cavity (27%), and other locations (16%). Of the 60 patients, 35 (58%) received surgery with adjuvant rt; 12 (20%), rt only; 13 (22%), surgery only. Of 18 patients (30%) who experienced a recurrence within 5 years, 3 (5%) developed local recurrence only, and the remaining 15 (25%), distant metastasis. The 5-year os and dfs were 64.5% [95% confidence interval (ci): 45.9% to 78.1%] and 46.2% (95% ci: 29.7% to 61.2%) respectively. In patients without recurrence, 5-year os was 77% (95% ci: 52.8% to 89.9%), and in patients with recurrence, it was 42.7% (95% ci: 15.8% to 67.6%). Patients treated with rt only had a 5-year os of 9.2%. Predictors of 5-year dfs were TNM stage, T stage, nodal status, treatment received, and margin status; age, nodal status, treatment received, and margin status predicted 5-year os. Conclusions Despite surgery and rt, one third of patients with acc experience distant recurrence. Patients whose tumours are not amenable to surgery have a poor prognosis, indicating a need for alternative approaches to improve outcomes. PMID:26966401

  1. Oncogenetics and minimal residual disease are independent outcome predictors in adult patients with acute lymphoblastic leukemia.

    PubMed

    Beldjord, Kheira; Chevret, Sylvie; Asnafi, Vahid; Huguet, Françoise; Boulland, Marie-Laure; Leguay, Thibaut; Thomas, Xavier; Cayuela, Jean-Michel; Grardel, Nathalie; Chalandon, Yves; Boissel, Nicolas; Schaefer, Beat; Delabesse, Eric; Cavé, Hélène; Chevallier, Patrice; Buzyn, Agnès; Fest, Thierry; Reman, Oumedaly; Vernant, Jean-Paul; Lhéritier, Véronique; Béné, Marie C; Lafage, Marina; Macintyre, Elizabeth; Ifrah, Norbert; Dombret, Hervé

    2014-06-12

    With intensified pediatric-like therapy and genetic disease dissection, the field of adult acute lymphoblastic leukemia (ALL) has evolved recently. In this new context, we aimed to reassess the value of conventional risk factors with regard to new genetic alterations and early response to therapy, as assessed by immunoglobulin/T-cell receptor minimal residual disease (MRD) levels. The study was performed in 423 younger adults with Philadelphia chromosome-negative ALL in first remission (265 B-cell precursor [BCP] and 158 T-cell ALL), with cumulative incidence of relapse (CIR) as the primary end point. In addition to conventional risk factors, the most frequent currently available genetic alterations were included in the analysis. A higher specific hazard of relapse was independently associated with postinduction MRD level ≥10(-4) and unfavorable genetic characteristics (ie, MLL gene rearrangement or focal IKZF1 gene deletion in BCP-ALL and no NOTCH1/FBXW7 mutation and/or N/K-RAS mutation and/or PTEN gene alteration in T-cell ALL). These 2 factors allowed definition of a new risk classification that is strongly associated with higher CIR and shorter relapse-free and overall survival. These results indicate that genetic abnormalities are important predictors of outcome in adult ALL not fully recapitulated by early response to therapy. Patients included in this study were treated in the multicenter GRAALL-2003 and GRAALL-2005 trials. Both trials were registered at http://www.clinicaltrials.gov as #NCT00222027 and #NCT00327678, respectively. PMID:24740809

  2. Oncogenetics and minimal residual disease are independent outcome predictors in adult patients with acute lymphoblastic leukemia.

    PubMed

    Beldjord, Kheira; Chevret, Sylvie; Asnafi, Vahid; Huguet, Françoise; Boulland, Marie-Laure; Leguay, Thibaut; Thomas, Xavier; Cayuela, Jean-Michel; Grardel, Nathalie; Chalandon, Yves; Boissel, Nicolas; Schaefer, Beat; Delabesse, Eric; Cavé, Hélène; Chevallier, Patrice; Buzyn, Agnès; Fest, Thierry; Reman, Oumedaly; Vernant, Jean-Paul; Lhéritier, Véronique; Béné, Marie C; Lafage, Marina; Macintyre, Elizabeth; Ifrah, Norbert; Dombret, Hervé

    2014-06-12

    With intensified pediatric-like therapy and genetic disease dissection, the field of adult acute lymphoblastic leukemia (ALL) has evolved recently. In this new context, we aimed to reassess the value of conventional risk factors with regard to new genetic alterations and early response to therapy, as assessed by immunoglobulin/T-cell receptor minimal residual disease (MRD) levels. The study was performed in 423 younger adults with Philadelphia chromosome-negative ALL in first remission (265 B-cell precursor [BCP] and 158 T-cell ALL), with cumulative incidence of relapse (CIR) as the primary end point. In addition to conventional risk factors, the most frequent currently available genetic alterations were included in the analysis. A higher specific hazard of relapse was independently associated with postinduction MRD level ≥10(-4) and unfavorable genetic characteristics (ie, MLL gene rearrangement or focal IKZF1 gene deletion in BCP-ALL and no NOTCH1/FBXW7 mutation and/or N/K-RAS mutation and/or PTEN gene alteration in T-cell ALL). These 2 factors allowed definition of a new risk classification that is strongly associated with higher CIR and shorter relapse-free and overall survival. These results indicate that genetic abnormalities are important predictors of outcome in adult ALL not fully recapitulated by early response to therapy. Patients included in this study were treated in the multicenter GRAALL-2003 and GRAALL-2005 trials. Both trials were registered at http://www.clinicaltrials.gov as #NCT00222027 and #NCT00327678, respectively.

  3. Procedural Predictors of Outcome in Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke

    SciTech Connect

    Rai, Ansaar T. Jhadhav, Yahodeep; Domico, Jennifer; Hobbs, Gerald R.

    2012-12-15

    Purpose: To identify factors impacting outcome in patients undergoing interventions for acute ischemic stroke (AIS). Materials and Methods: This was a retrospective analysis of patients undergoing endovascular therapy for AIS secondary during a 30 month period. Outcome was based on modified Rankin score at 3- to 6-month follow-up. Recanalization was defined as Thrombolysis in myocardial infarction score 2 to 3. Collaterals were graded based on pial circulation from the anterior cerebral artery either from an ipsilateral injection in cases of middle cerebral artery (MCA) occlusion or contralateral injection for internal carotid artery terminus (ICA) occlusion as follows: no collaterals (grade 0), some collaterals with retrograde opacification of the distal MCA territory (grade 1), and good collaterals with filling of the proximal MCA (M2) branches or retrograde opacification up to the occlusion site (grade 2). Occlusion site was divided into group 1 (ICA), group 2 (MCA with or without contiguous M2 involvement), and group 3 (isolated M2 or M3 branch occlusion). Results: A total of 89 patients were studied. Median age and National Institutes of health stroke scale (NIHSS) score was 71 and 15 years, respectively. Favorable outcome was seen in 49.4% of patients and mortality in 25.8% of patients. Younger age (P = 0.006), lower baseline NIHSS score (P = 0.001), successful recanalization (P < 0.0001), collateral support (P = 0.0008), distal occlusion (P = 0.001), and shorter procedure duration (P = 0.01) were associated with a favorable outcome. Factors affecting successful recanalization included younger age (P = 0.01), lower baseline NIHSS score (P = 0.05), collateral support (P = 0.01), and shorter procedure duration (P = 0.03). An ICA terminus occlusion (P < 0.0001), lack of collaterals (P = 0.0003), and unsuccessful recanalization (P = 0.005) were significantly associated with mortality. Conclusion: Angiographic findings and preprocedure variables can help

  4. An Evaluation of Cerebral and Systemic Predictors of 18-Month Outcomes for Neonates With Hypoxic Ischemic Encephalopathy.

    PubMed

    Shellhaas, Renée A; Kushwaha, Juhi S; Plegue, Melissa A; Selewski, David T; Barks, John D E

    2015-10-01

    Amplitude-integrated EEG (aEEG) is a commonly used predictor of outcome after hypoxic ischemic encephalopathy. Cerebral and systemic near-infrared spectroscopy and acute kidney injury might also have prognostic value. The authors monitored neonates with aEEG, cerebral and systemic near-infrared spectroscopy during therapeutic hypothermia, assigned an acute kidney injury stage, and measured neurodevelopmental outcome. For 18 infants, cerebral near-infrared spectroscopy variables did not differentiate between those with favorable (n = 13) versus adverse (death or moderate-severe disability; n = 5) 18-month outcomes. However, systemic rSO2 variability was higher during hours 48-72 of cooling among those with favorable outcomes (.02 < P < .03). Mean aEEG amplitude during hours 24 to 48 of cooling was higher among those with good outcomes (.027 < P < .032). The aEEG lower margin was also higher during hours 12 to 48 for those with good outcomes (.014 < P < .035). Acute kidney injury did not predict outcome (P > .05). aEEG is a useful prognostic tool for outcomes after neonatal hypoxic ischemic encephalopathy, but the role of near-infrared spectroscopy in the hypothermia-treated population remains uncertain.

  5. An Evaluation of Cerebral and Systemic Predictors of 18-Month Outcomes for Neonates With Hypoxic Ischemic Encephalopathy.

    PubMed

    Shellhaas, Renée A; Kushwaha, Juhi S; Plegue, Melissa A; Selewski, David T; Barks, John D E

    2015-10-01

    Amplitude-integrated EEG (aEEG) is a commonly used predictor of outcome after hypoxic ischemic encephalopathy. Cerebral and systemic near-infrared spectroscopy and acute kidney injury might also have prognostic value. The authors monitored neonates with aEEG, cerebral and systemic near-infrared spectroscopy during therapeutic hypothermia, assigned an acute kidney injury stage, and measured neurodevelopmental outcome. For 18 infants, cerebral near-infrared spectroscopy variables did not differentiate between those with favorable (n = 13) versus adverse (death or moderate-severe disability; n = 5) 18-month outcomes. However, systemic rSO2 variability was higher during hours 48-72 of cooling among those with favorable outcomes (.02 < P < .03). Mean aEEG amplitude during hours 24 to 48 of cooling was higher among those with good outcomes (.027 < P < .032). The aEEG lower margin was also higher during hours 12 to 48 for those with good outcomes (.014 < P < .035). Acute kidney injury did not predict outcome (P > .05). aEEG is a useful prognostic tool for outcomes after neonatal hypoxic ischemic encephalopathy, but the role of near-infrared spectroscopy in the hypothermia-treated population remains uncertain. PMID:25724376

  6. Motivation for change as a predictor of eating disorder treatment outcomes using a brief self-report YBC-EDS in a residential eating disorder population.

    PubMed

    Fitzpatrick, Mary E; Weltzin, Theodore

    2014-08-01

    The aim of this study was to investigate the factor structure and psychometric properties of a new brief self-report form of the Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS-BSR) in a transdiagnostic eating disorder population, and to determine the predictive ability of motivation for change and ego syntonic subscales on treatment outcome. Self-report measures of the YBC-EDS-BSR, eating pathology, depression, anxiety and obsessive compulsive symptoms were collected from 164 individuals entering residential treatment. Of these, 107 individuals completed identical measures at discharge. The admission items on the YBC-EDS-BSR were examined for factor structure, and subscales were examined for internal, convergent and discriminant validity. Multiple regression analysis was used to investigate predictive value of the motivation and ego syntonic subscales on two measures of treatment outcome. Results indicate that the YBC-EDS-BSR demonstrated a robust factor structure and good psychometric properties in this population. The predicted ego-syntonic subscale did not emerge as an independent factor. The motivation for change subscale significantly predicted treatment outcome on the EDE-Q and the EDI-3 Global Maladjustment Scale. The ego-syntonic items and other psychopathology measures had no predictive value on treatment outcome. Results suggest that motivation for change is a significant predictor of treatment outcome over and above baseline psychopathology.

  7. Intimate partner violence and Hurricane Katrina: predictors and associated mental health outcomes.

    PubMed

    Schumacher, Julie A; Coffey, Scott F; Norris, Fran H; Tracy, Melissa; Clements, Kahni; Galea, Sandro

    2010-01-01

    This study sought to establish the prevalence and correlates of intimate partner violence (IPV) victimization in the 6 months before and after Hurricane Katrina. Participants were 445 married or cohabiting persons who were living in the 23 southernmost counties of Mississippi at the time of Hurricane Katrina. Data for this study were collected as part of a larger, population-based, representative study. The percentage of women reporting psychological victimization increased from 33.6% prior to Hurricane Katrina to 45.2% following Hurricane Katrina (p < .001). The percentage of men reporting psychological victimization increased from 36.7% to 43.1% (p = .01). Reports of physical victimization increased from 4.2% to 8.3% for women (p = .01) but were unchanged for men. Significant predictors of post-Katrina victimization included pre-Katrina victimization, age, educational attainment, marital status, and hurricane-related stressors. Reports of IPV were associated with greater risk of post-Katrina depression and posttraumatic stress disorder. Data from the first population-based study to document IPV following a large-scale natural disaster suggest that IPV may be an important but often overlooked public health concern following disasters.

  8. Overexpression of transglutaminase 4 and prostate cancer progression: a potential predictor of less favourable outcomes

    PubMed Central

    Cao, Zhi; Wang, Yang; Liu, Zhi-Yong; Zhang, Zhen-Sheng; Ren, Shan-Cheng; Yu, Yong-Wei; Qiao, Meng; Zhai, Bei-Bei; Sun, Ying-Hao

    2013-01-01

    Transglutaminase 4 has been shown to enhance various biological properties of prostate cancer cells, e.g., cell–matrix adhesion, invasiveness and the epithelial–mesenchymal transition. The objectives of this study were to investigate the associations between transglutaminase 4 expression and the established features and biochemical recurrence of prostate cancer. Transglutaminase 4 immunostaining was performed on a tissue microarray. The expression of transglutaminase 4 was evaluated by a scoring method based on the intensity and extent of staining. The clinical and pathological information was obtained through a review of medical records. Follow-up data were obtained by consulting the hospital medical records and the prostate cancer database of our department and by contacting patients or family members. We then compared the transglutaminase 4 expression levels between the prostate cancer tissues and the paracarcinoma tissues and evaluated the correlation of transglutaminase 4 expression with the clinical parameters and biochemical recurrence of prostate cancer. Our results indicated that the transglutaminase 4 staining was significantly higher in tumour tissue than in paracarcinoma tissue (P<0.001) and was positively associated with higher Gleason score (P<0.001) and higher prostate-specific antigen level (P=0.005). Patients with transglutaminase 4 overexpression experienced shorter biochemical recurrence-free survival after surgery (P=0.042) in the univariate analysis but not in the multivariate analysis (P=0.139), which indicated that transglutaminase 4 may serve as a potential predictor of biochemical recurrence of prostate cancer. PMID:23974364

  9. Potential predictors of functional outcomes after home-based constraint-induced therapy for children with cerebral palsy.

    PubMed

    Chen, Chia-ling; Lin, Keh-chung; Kang, Lin-ju; Wu, Ching-yi; Chen, Hsieh-ching; Hsieh, Yu-wei

    2014-01-01

    OBJECTIVE. Our objective was to identify predictors for treatment outcomes after home-based constraint-induced therapy (CIT) in children with cerebral palsy (CP). METHOD. Forty-three children (aged 4-12 yr) with CP were treated with individualized CIT at home for 4 wk. Potential predictors were age, sex, affected hand, and upper-extremity motor capacity measured by the Peabody Developmental Motor Scale, 2nd edition (PDMS-2). Outcomes were the Pediatric Motor Activity Log (PMAL) Amount of Hand Use and Quality of Hand Use subscales and the Functional Independence Measure for Children (WeeFIM). RESULTS. A higher PDMS-2 Visual-Motor Integration subscale score predicted a better WeeFIM score after home-based CIT (adjusted R² = .35). Younger age predicted better performance on the PMAL Amount of Hand Use and Quality of Hand Use subscales (adjusted R² = .06-.08) after home-based CIT. CONCLUSION. The potential predictors may allow occupational therapy practitioners to target those children who will benefit most after home-based constraint-induced therapy.

  10. Patient Expectations as Predictors of Outcome In Patients with Acute Low Back Pain

    PubMed Central

    Phillips, Russell S.; Davis, Roger B.; Cherkin, Daniel C.; Legedza, Anna; Kaptchuk, Ted J.; Hrbek, Andrea; Buring, Julie E.; Post, Diana; Connelly, Maureen T.; Eisenberg, David M.

    2007-01-01

    BACKGROUND Few studies have evaluated the association between patient expectations for recovery and clinical outcomes, and no study has evaluated whether asking patients to choose their therapy modifies such an association. OBJECTIVE To evaluate the association between patients’ expectations and functional recovery in patients with acute low back pain (LBP), and to determine whether that association is affected by giving patients choice of therapy. DESIGN AND PARTICIPANTS A secondary analysis of a randomized controlled trial comparing usual care alone to usual care plus choice of chiropractic, acupuncture, or massage in 444 adults with acute LBP, lasting less than 21 days. MEASUREMENTS AND MAIN RESULTS Primary outcome was functional disability (Roland score) at 5 and 12 weeks. Patients’ general expectations for improvement were associated with improvement in functional status (β = 0.96, 95% CI = 0.56, 1.36). A 1-point increase in general expectations was associated with a 0.96-point improvement in Roland score. The association of expectation with outcome was 2–3 times greater in the usual care group than the choice group. However, these differences did not reach statistical significance. CONCLUSIONS In patients with acute LBP, higher expectations for recovery are associated with greater functional improvement. Eliciting patient expectations for improvement may be a simple way to identify patients with the highest (or lowest) likelihood of experiencing functional improvement. Incorporating questions about patient expectations in future trials may clarify the role of this important correlate of clinical outcomes. PMID:18066631

  11. An audit of the predictors of outcome in status epilepticus from a resource-poor country: a comparison with developed countries.

    PubMed

    Hassan, Haseeb; Rajiv, Keni Ravish; Menon, Ramshekhar; Menon, Deepak; Nair, Muralidharan; Radhakrishnan, Ashalatha

    2016-06-01

    Status epilepticus is a neurological emergency with significant morbidity and mortality. This study describes the clinical profile, treatment, and predictors of outcome of status epilepticus in a tertiary referral centre in a developing country and aims to highlight the similarities and differences from data available from the western world. A retrospective analysis of data of patients treated for status epilepticus was conducted from prospectively maintained records, between January 2000 and September 2010. The demographic data, clinical profile and investigations (including neuroimaging and EEG), aetiology, treatment, and outcomes were studied and compared with data available from the western world. The analysis included 108 events in 84 patients. A single episode of status epilepticus was treated in 72 patients (86%) and multiple status epilepticus events, ranging from two to six per patient, were managed in 12 patients (14%). Mean age was 24.1±20.3 years and 63% were males. The types of status epilepticus included convulsive status in 98 (90.7%), non-convulsive status in seven (6.5%), and myoclonic status in three (2.8%). The majority of events (60%) were remote symptomatic, 16% were acute symptomatic, 16% were of unexplained aetiology, and 8% were progressive symptomatic. In 85 events (79%), status epilepticus could be aborted with first and second-line drugs. The remaining 23 events (21%) progressed to refractory status epilepticus, among which, 13 (56%) were controlled with continuous intravenous midazolam infusion. Case fatality rate was 11%, neurological sequelae were reported in 22%, and 67% returned to baseline. Acute symptomatic status, older age, altered sensorium at the time of admission, and delayed hospitalisation were predictors of poor outcome. Aetiology was the most important determinant of outcome of status epilepticus, as in reports from the western world, with remote symptomatic aetiology secondary to gliosis being the most common

  12. Granule cell dispersion is not a predictor of surgical outcome in temporal lobe epilepsy with mesial temporal sclerosis.

    PubMed

    da Costa Neves, Rafael Scarpa; Jardim, Anaclara Prada; Caboclo, Luís Otávio; Lancellotti, Carmen; Marinho, Taissa Ferrari; Hamad, Ana Paula; Marinho, Murilo; Centeno, Ricardo; Cavalheiro, Esper Abrão; Scorza, Carla Alessandra; Targas Yacubian, Elza Márcia

    2013-01-01

    The aim of this retrospective study of a series of patients with mesial temporal lobe epilepsy (MTLE) and mesial temporal sclerosis (MTS) was to analyze the association of granule cell dispersion (GCD) with surgical prognosis, patterns of MTS and clinical data. Hippocampal specimens from 66 patients with MTLE and unilateral MTS and from 13 controls were studied. Quantitative neuropathological evaluation was performed on NeuN-stained hippocampal sections. Patients' clinical data, types of MTS and surgical outcome were reviewed. GCD occurred in 45.5% of cases and was not correlated with clinical variable. More severe neuronal loss was observed in patients with GCD. Except for MTS Type 2 - observed only in four no- GCD patients - groups did not differ with respect to the types of MTS. Surgical outcome was similar in both groups. In conclusion, GCD was associated with the degree of hippocampal cell loss, but was not a predictor of surgical outcome.

  13. Enhancing the Number of African Americans Who Pursue STEM PhDs: Meyerhoff Scholarship Program Outcomes, Processes, and Individual Predictors

    PubMed Central

    Maton, Kenneth I.; Sto Domingo, Mariano R.; Stolle-McAllister, Kathleen E.; Zimmerman, J. Lynn; Hrabowski, Freeman A.

    2011-01-01

    The current study examines the outcomes, processes, and individual predictors of pursuit of a STEM PhD among African-American students in the Meyerhoff Scholarship Program. Meyerhoff students were nearly five times more likely than comparison students to pursue a STEM PhD. Program components consistently rated as important were financial scholarship, being part of the Meyerhoff Program community, the Summer Bridge program, study groups, staff academic advising, and summer research opportunities. Furthermore, focus group findings revealed student internalization of key Meyerhoff Program values, including a commitment to excellence, accountability, group success, and giving back. In terms of individual predictors, multinomial logit regression analyses revealed that Meyerhoff students with higher levels of research excitement at college entry were more likely to pursue a STEM PhD. PMID:21841904

  14. Predictors of Ominous Outcome in Infants who Undergo Cardiac Surgery and Cardiopulmonary By-Pass: S100B Protein.

    PubMed

    Varrica, Alessandro; Satriano, Angela; Tettamanti, Guido; Pelissero, Gabriele; Gavilanes, Antonio D W; Zimmermann, Luc J; Vles, Hans J S; Florio, Pasquale; Pluchinotta, Francesca R; Gazzolo, Diego

    2015-01-01

    S100B protein has been recently proposed as a consolidated marker of brain damage and death in adult, children and newborn patients. The present study evaluates whether the longitudinal measurement of S100B at different perioperative time-points may be a useful tool to identify the occurrence of perioperative early death in congenital heart disease (CHD) newborns. We conducted a case-control study in 88 CHD infants, without pre-existing neurological disorders or other co-morbidities, of whom 22 were complicated by perioperative death in the first week from surgery. Control group was composed by 66 uncomplicated CHD infants matched for age at surgical procedure. Blood samples were drawn at five predetermined timepoints before during and after surgery. In all CHD children, S100B levels showed a pattern characterized by a significant increase in protein's concentration from hospital admission up to 24-h after procedure reaching their maximum peak (P<0.01) during cardiopulmonary by-pass and at the end of the surgical procedure. Moreover, S100B concentrations in CHD death group were significantly higher (P<0.01) than controls at all monitoring time-points. The ROC curve analysis showed that S100B measured before surgical procedure was the best predictor of perioperative death, among a series of clinical and laboratory parameters, reaching at a cut-off of 0.1 µg/L a sensitivity of 100% and a specificity of 63.7%. The present data suggest that in CHD infants biochemical monitoring in the perioperative period is becoming possible and S100B can be included among a series of parameters for adverse outcome prediction.

  15. Documenting Impact of Educational Contexts on Long-Term Outcomes for Students with Significant Disabilities

    ERIC Educational Resources Information Center

    Ryndak, Diane Lea; Alper, Sandra; Hughes, Carolyn; McDonnell, John

    2012-01-01

    Follow-up studies of students with significant disabilities consistently indicate poor post-school outcomes. Although existing research indicates that services in inclusive general education contexts can result in positive short-term outcomes for these individuals during their school years, there are few investigations of the lives of adults with…

  16. Hospital Acquired Pneumonia is an Independent Predictor of Poor Global Outcome in Severe Traumatic Brain Injury up to 5 Years after Discharge

    PubMed Central

    Kesinger, Matthew R.; Kumar, Raj G.; Wagner, Amy K.; Puyana, Juan C.; Peitzman, Andrew P.; Billiar, Timothy R.; Sperry, Jason L.

    2016-01-01

    Objectives Long-term outcomes following traumatic brain injury (TBI) correlate with initial head injury severity and other acute factors. Hospital-acquired pneumonia (HAP) is a common complication in TBI. Little information exists regarding the significance of infectious complications on long-term outcomes post-TBI. We sought to characterize risks associated with HAP on outcomes 5 years post-TBI. Methods Ddata from the merger of an institutional trauma registry and the TBI Model Systems outcome data. Individuals with severe head injuries (Abbreviated Injury Scale≥4), who survived to rehabilitation were analyzed. Primary outcome was Glasgow Outcome Scaled-Extended (GOSE) at 1, 2, and 5 years. GOSE was dichotomized into LOW (GOSE<6) and HIGH (GOSE≥6). Logistic regression was utilized to determine adjusted odds of LOW-GOSE associated with HAP after controlling for age, sex, head and overall injury severity, cranial surgery, Glasgow Coma Scale (GCS), ventilation days, and other important confounders. A general estimating equation (GEE) model was used to analyze all outcome observations simultaneously while controlling for within-patient correlation. Results A total of 141 individuals met inclusion criteria, with a 30% incidence of HAP. Individuals with and without HAP had similar demographic profiles, presenting vitals, head injury severity, and prevalence of cranial surgery. Individuals with HAP had lower presenting GCS. Logistic regression demonstrated that HAP was independently associated with LOW-GOSE scores at follow-up (1year: OR=6.39, 95%CI: 1.76-23.14, p=0.005; 2-years: OR=7.30, 95%CI 1.87-27.89, p=0.004; 5-years: OR=6.89, 95%CI: 1.42-33.39, p=0.017). Stratifying by GCS≤8 and early intubation, HAP remained a significant independent predictor of LOW-GOSE in all strata. In the GEE model, HAP continued to be an independent predictor of LOW-GOSE (OR: 4.59; 95%CI: 1.82-11.60′ p=0.001). Conclusion HAP is independently associated with poor outcomes in severe

  17. Pneumonia in rural Malawians under five years old: Treatment outcomes and clinical predictors of death on admission

    PubMed Central

    Mzumara, Suzgo; Mlenga, Maurice; Talipu, Raphael; Kasagila, Eric

    2009-01-01

    ABSTRACT Background High mortality and disability due to pneumonia occur worldwide. The introduction of the Integrated Management of Childhood Illness strategy in Malawi brought with it hope of an improvement in the outcome of pneumonia. However, the risk of death and treatment outcomes remain unknown in many districts. Method The medical records of 466 consecutive patients admitted to the Mchinji District Hospital from January 2004 to January 2006 whose disease met the World Health Organization criteria for pneumonia were reviewed. Data were collected from forms that had been filled out and different treatment outcomes and determinants of death were analysed using logistic regression. Results Of the 466 patients, 62.7% completed treatment, 15.9% had unknown outcomes, 12.9% died, 8.4% were lost to follow-up, 0.8% failed to improve with treatment, and 0.4% were transferred to other facilities. Independent predictors of death were: age less than 2 years, female sex, history of pneumonia, chest retractions, type of pneumonia, and central cyanosis. Conclusion A high proportion of deaths and unknown outcomes occurred among participants. Young age, female sex, history of pneumonia, chest retractions and central cyanosis were associated with death. Mortality from pneumonia may be reduced by close monitoring of these risk factors and by improving health education programmes and communicating these findings to parents and health workers. Further investigations of local reasons for high rates of unknown/unreported outcomes are welcomed.

  18. Yoga & cancer interventions: a review of the clinical significance of patient reported outcomes for cancer survivors.

    PubMed

    Culos-Reed, S Nicole; Mackenzie, Michael J; Sohl, Stephanie J; Jesse, Michelle T; Zahavich, Ashley N Ross; Danhauer, Suzanne C

    2012-01-01

    Limited research suggests yoga may be a viable gentle physical activity option with a variety of health-related quality of life, psychosocial and symptom management benefits. The purpose of this review was to determine the clinical significance of patient-reported outcomes from yoga interventions conducted with cancer survivors. A total of 25 published yoga intervention studies for cancer survivors from 2004-2011 had patient-reported outcomes, including quality of life, psychosocial or symptom measures. Thirteen of these studies met the necessary criteria to assess clinical significance. Clinical significance for each of the outcomes of interest was examined based on 1 standard error of the measurement, 0.5 standard deviation, and relative comparative effect sizes and their respective confidence intervals. This review describes in detail these patient-reported outcomes, how they were obtained, their relative clinical significance and implications for both clinical and research settings. Overall, clinically significant changes in patient-reported outcomes suggest that yoga interventions hold promise for improving cancer survivors' well-being. This research overview provides new directions for examining how clinical significance can provide a unique context for describing changes in patient-reported outcomes from yoga interventions. Researchers are encouraged to employ indices of clinical significance in the interpretation and discussion of results from yoga studies. PMID:23125870

  19. Yoga & Cancer Interventions: A Review of the Clinical Significance of Patient Reported Outcomes for Cancer Survivors

    PubMed Central

    Culos-Reed, S. Nicole; Mackenzie, Michael J.; Sohl, Stephanie J.; Jesse, Michelle T.; Zahavich, Ashley N. Ross; Danhauer, Suzanne C.

    2012-01-01

    Limited research suggests yoga may be a viable gentle physical activity option with a variety of health-related quality of life, psychosocial and symptom management benefits. The purpose of this review was to determine the clinical significance of patient-reported outcomes from yoga interventions conducted with cancer survivors. A total of 25 published yoga intervention studies for cancer survivors from 2004–2011 had patient-reported outcomes, including quality of life, psychosocial or symptom measures. Thirteen of these studies met the necessary criteria to assess clinical significance. Clinical significance for each of the outcomes of interest was examined based on 1 standard error of the measurement, 0.5 standard deviation, and relative comparative effect sizes and their respective confidence intervals. This review describes in detail these patient-reported outcomes, how they were obtained, their relative clinical significance and implications for both clinical and research settings. Overall, clinically significant changes in patient-reported outcomes suggest that yoga interventions hold promise for improving cancer survivors' well-being. This research overview provides new directions for examining how clinical significance can provide a unique context for describing changes in patient-reported outcomes from yoga interventions. Researchers are encouraged to employ indices of clinical significance in the interpretation and discussion of results from yoga studies. PMID:23125870

  20. Primary Tumor Site as a Predictor of Treatment Outcome for Definitive Radiotherapy of Advanced-Stage Oral Cavity Cancers

    SciTech Connect

    Lin, Chien-Yu; Wang, Hung-Ming; Kang, Chung-Jan; Lee, Li-Yu; Huang, Shiang-Fu; Fan, Kang-Hsing; Chen, Eric Yen-Chao

    2010-11-15

    Purpose: To evaluate the outcome of definitive radiotherapy (RT) for oral cavity cancers and to assess prognostic factors. Methods and Materials: Definitive RT was performed on 115 patients with oral cavity cancers at Stages III, IVA, and IVB, with a distribution of 6%, 47%, and 47%, respectively. The median dose of RT was 72Gy (range, 62-76Gy). Cisplatin-based chemotherapy was administered to 95% of the patients. Eleven patients underwent salvage surgery after RT failure. Results: Eight-eight (76.5%) patients responded partially and 23 (20%) completely; of the patients who responded, 18% and 57%, respectively, experienced a durable effect of treatment. The 3-year overall survival, disease-specific survival, and progression-free survival were 22%, 27%, and 25%, respectively. The 3-year PFS rates based on the primary tumor sites were as follows: Group I (buccal, mouth floor, and gum) 51%, Group II (retromolar and hard palate) 18%, and Group III (tongue and lip) 6% (p < 0.0001). The 3-year progression-free survival was 41% for N0 patients and 19% for patients with N+ disease (p = 0.012). The T stage and RT technique did not affect survival. The patients who underwent salvage surgery demonstrated better 3-year overall survival and disease-specific survival (53% vs. 19%, p = 0.015 and 53% vs. 24%, p = 0.029, respectively). Subsite group, N+, and salvage surgery were the only significant prognostic factors for survival after multivariate analysis. Conclusion: The primary tumor site and neck stage are prognostic predictors in advanced-stage oral cancer patients who received radical RT. The primary tumor extension and RT technique did not influence survival.

  1. Bundle-Branch Block Morphology and Other Predictors of Outcome After Cardiac Resynchronization Therapy in Medicare Patients

    PubMed Central

    Bilchick, Kenneth C.; Kamath, Sandeep; DiMarco, John P.; Stukenborg, George J.

    2013-01-01

    Background Clinical trials of cardiac resynchronization therapy (CRT) have enrolled a select group of patients, with few patients in subgroups such as right bundle-branch block (RBBB). Analysis of population-based outcomes provides a method to identify real-world predictors of CRT outcomes. Methods and Results Medicare Implantable Cardioverter-Defibrillator Registry (2005 to 2006) data were merged with patient outcomes data. Cox proportional-hazards models assessed death and death/heart failure hospitalization outcomes in patients with CRT and an implantable cardioverter-defibrillator (CRT-D). The 14 946 registry patients with CRT-D (median follow-up, 40 months) had 1-year, 3-year, and overall mortality rates of 12%, 32%, and 37%, respectively. New York Heart Association class IV heart failure status (1-year hazard ratio [HR], 2.23; 3-year HR, 1.98; P<0.001) and age ≥80 years (1-year HR, 1.74; 3-year HR, 1.75; P<0.001) were associated with increased mortality both early and late after CRT-D. RBBB (1-year HR, 1.44; 3-year HR, 1.37; P<0.001) and ischemic cardiomyopathy (1-year HR, 1.39; 3-year HR, 1.44; P<0.001) were the next strongest adjusted predictors of both early and late mortality. RBBB and ischemic cardiomyopathy together had twice the adjusted hazard for death (HR, 1.99; P<0.001) as left BBB and nonischemic cardiomyopathy. QRS duration of at least 150 ms predicted more favorable outcomes in left BBB but had no impact in RBBB. A secondary analysis showed lower hazards for CRT-D compared with standard implantable cardioverter-defibrillators in left BBB compared with RBBB. Conclusions In Medicare patients, RBBB, ischemic cardiomyopathy, New York Heart Association class IV status, and advanced age were powerful adjusted predictors of poor outcome after CRT-D. Real-world mortality rates 3 to 4 years after CRT-D appear higher than previously recognized. PMID:21041691

  2. Predictors of Outcome of a Parenting Group Curriculum: A Pilot Study

    ERIC Educational Resources Information Center

    Parent, Justin; Forehand, Rex L.; Merchant, Mary Jane; Long, Nicholas; Jones, Deborah J.

    2011-01-01

    One pressing issue facing parenting interventions for disruptive behaviors of young children is forecasting who will benefit from participation. The purpose of this study was to examine four personal and interpersonal predictors (i.e., parent depressive symptoms, parent education, coparent conflict, and marital status) of engagement (i.e., number…

  3. Pretreatment and Process Predictors of Outcome in Interpersonal and Cognitive Behavioral Psychotherapy for Binge Eating Disorder

    ERIC Educational Resources Information Center

    Hilbert, Anja; Saelens, Brian E.; Stein, Richard I.; Mockus, Danyte S.; Welch, R. Robinson; Matt, Georg E.; Wilfley, Denise E.

    2007-01-01

    The present study examined pretreatment and process predictors of individual nonresponse to psychological group treatment of binge eating disorder (BED). In a randomized trial, 162 overweight patients with BED were treated with either group cognitive-behavioral therapy or group interpersonal psychotherapy. Treatment nonresponse, which was defined…

  4. Contextual and Intrapersonal Predictors of Adolescent Risky Sexual Behavior and Outcomes

    ERIC Educational Resources Information Center

    Shneyderman, Yuliya; Schwartz, Seth J.

    2013-01-01

    The present study was designed to test a model of contextual and intrapersonal predictors of adolescent risky sexual behaviors and of sexually transmitted infection diagnoses. Using Waves I and II from the National Longitudinal Study of Adolescent Health, the authors estimated a structural model in which intrapersonal factors such as…

  5. Predictors and Correlates of Homework Completion and Treatment Outcomes in Parent-Child Interaction Therapy

    ERIC Educational Resources Information Center

    Danko, Christina M.; Brown, Tasha; Van Schoick, Lauren; Budd, Karen S.

    2016-01-01

    Background: Behavioral parent training has been demonstrated to be an effective treatment for child behavior problems; however, lack of parent engagement can limit the effectiveness of treatment. Understanding more about predictors and correlates of a specific measure of parent engagement--homework completion--in parent training can help to…

  6. Are Social Norms the Best Predictor of Outcomes Among Heavy-Drinking College Students?*

    PubMed Central

    NEIGHBORS, CLAYTON; LEE, CHRISTINE M.; LEWIS, MELISSA A.; FOSSOS, NICOLE; LARIMER, MARY E.

    2008-01-01

    Objective This research was designed to evaluate the relative contribution of social norms, demographics, drinking motives, and alcohol expectancies in predicting alcohol consumption and related problems among heavy-drinking college students. Method Participants included 818 (57.6% women) first-year undergraduates who reported at least one heavy-drinking episode in the previous month. In addition to providing demographic information (gender and fraternity/sorority membership) participants completed Web-based assessments of social norms (perceived descriptive norms regarding typical student drinking, injunctive norms regarding friends’ and parents’ approval), motives (social, enhancement, coping, and conformity), and expectancies and evaluations of positive and negative alcohol effects. Results Regression results indicated that descriptive and injunctive norms were among the best predictors of college student drinking. With respect to alcohol problems, results indicated that coping motives accounted for the largest proportion of unique variance. Finally, results revealed that alcohol consumption mediated the relationships between predictors and problems for social norms, whereas coping motives, negative expectancies, and evaluation of negative effects were directly associated with alcohol problems despite having relatively weak or null unique associations with consumption. Conclusions The results of this study substantiate social norms as being among the best predictors of alcohol consumption in this population and suggest that drinking to cope is a better predictor of problems. The findings are discussed in terms of practical prevention and treatment implications. PMID:17568961

  7. Predictors and Moderators of Acute Outcome in the Treatment for Adolescents with Depression Study (TADS)

    ERIC Educational Resources Information Center

    Curry, John; Rohde, Paul; Simons, Anne; Silva, Susan; Vitiello, Benedetto; Kratochvil, Christopher; Reinecke, Mark; Feeny, Norah; Wells, Karen; Pathak, Sanjeev; Weller, Elizabeth; Rosenberg, David; Kennard, Betsy; Robins, Michele; Ginsburg, Golda; March, John

    2006-01-01

    Objective: To identify predictors and moderators of response to acute treatments among depressed adolescents (N = 439) randomly assigned to fluoxetine, cognitive-behavioral therapy (CBT), both fluoxetine and CBT, or clinical management with pill placebo in the Treatment for Adolescents With Depression Study (TADS). Method: Potential baseline…

  8. An Examination of Behavioral Rehearsal During Consultation as a Predictor of Training Outcomes

    PubMed Central

    Kendall, Philip C.; Ringle, Vanesa A.; Read, Kendra L.; Brodman, Douglas A.; Pimentel, Sandra S.; Beidas, Rinad S.

    2013-01-01

    The training literature suggests that ongoing support following initial therapist training enhances training outcomes, yet little is known about what occurs during ongoing support and what accounts for its effectiveness. The present study examined consultation sessions provided to 99 clinicians following training in cognitive-behavioral therapy for youth anxiety. The 104 recorded consultation sessions were coded for content and consultative methods. It was hypothesized that behavioral rehearsal (an active learning technique) would predict therapist adherence, skill, self-efficacy, and satisfaction at post-consultation. Regression analyses found no significant relation, however, clinician involvement during consultation sessions positively moderated the relationship between behavioral rehearsals and skill. Implications, limitations, and future directions are discussed. PMID:23616234

  9. Trefoil factor 2 expression and its significance as a predictor of severity of sepsis in children.

    PubMed

    Zurek, Jiří; Kýr, Michal; Vavřina, Martin; Fedora, Michal

    2013-08-01

    Intestinal injury significantly contributes to critical illness, sepsis and multiorgan failure. TFF2 (Trefoil Factor 2) is expressed and secreted preferentially by gastric mucous neck cells. TFF2 gene expression is promptly increased after gut injury, and its expression profile broadens to include the regenerative epithelia of virtually the entire gastrointestinal tract. The first objective of our study was an analysis of TFF2 levels dynamics in patients with Systemic Inflammatory Response Syndrome (SIRS) or septic condition during a 5-day period after admission. The second objective was to determine optimal cut-off value and quantify diagnostic characteristics of TFF2 between controls and patients with various septic states. The study included 57 children aged 0-19 years, with expected or proven SIRS and septic condition. The degree of severity was evaluated according to PELOD Score (Pediatric Logistic Organ Dysfunction). Blood samples to determine levels of TFF2 factor were taken during the time patient met the criteria of SIRS or sepsis. Control group samples to determine the serum levels of TFF2 were taken from patients undergoing elective surgery. Analysis of TFF2 levels dynamics revealed that TFF2 levels kept steady state during the 5-day period. Significantly higher levels of TFF2 were in patients with Multiple Organ Dysfunction Syndrome (MODS). The difference was noticed also in ROC analysis.

  10. Prognostic significance of electrical alternans versus signal averaged electrocardiography in predicting the outcome of electrophysiological testing and arrhythmia-free survival

    PubMed Central

    Armoundas, A; Rosenbaum, D; Ruskin, J; Garan, H; Cohen, R

    1998-01-01

    Objective—To investigate the accuracy of signal averaged electrocardiography (SAECG) and measurement of microvolt level T wave alternans as predictors of susceptibility to ventricular arrhythmias.
Design—Analysis of new data from a previously published prospective investigation.
Setting—Electrophysiology laboratory of a major referral hospital.
Patients and interventions—43 patients, not on class I or class III antiarrhythmic drug treatment, undergoing invasive electrophysiological testing had SAECG and T wave alternans measurements. The SAECG was considered positive in the presence of one (SAECG-I) or two (SAECG-II) of three standard criteria. T wave alternans was considered positive if the alternans ratio exceeded 3.0.
Main outcome measures—Inducibility of sustained ventricular tachycardia or fibrillation during electrophysiological testing, and 20 month arrhythmia-free survival.
Results—The accuracy of T wave alternans in predicting the outcome of electrophysiological testing was 84% (p < 0.0001). Neither SAECG-I (accuracy 60%; p < 0.29) nor SAECG-II (accuracy 71%; p < 0.10) was a statistically significant predictor of electrophysiological testing. SAECG, T wave alternans, electrophysiological testing, and follow up data were available in 36 patients while not on class I or III antiarrhythmic agents. The accuracy of T wave alternans in predicting the outcome of arrhythmia-free survival was 86% (p < 0.030). Neither SAECG-I (accuracy 65%; p < 0.21) nor SAECG-II (accuracy 71%; p < 0.48) was a statistically significant predictor of arrhythmia-free survival. 
Conclusions—T wave alternans was a highly significant predictor of the outcome of electrophysiological testing and arrhythmia-free survival, while SAECG was not a statistically significant predictor. Although these results need to be confirmed in prospective clinical studies, they suggest that T wave alternans may serve as a non-invasive probe for screening high risk

  11. Conduct Problems in Childhood and Adolescence: Developmental Trajectories, Predictors and Outcomes in a Six-Year Follow Up.

    PubMed

    López-Romero, Laura; Romero, Estrella; Andershed, Henrik

    2015-10-01

    Understanding youth conduct problems requires examination from a developmental perspective, analyzing distinctive pathways across childhood and adolescence, and identifying early predictors which will lead to specific adolescent outcomes. Bearing this in mind, developmental trajectories of conduct problems were identified from a person-oriented perspective, and using data collected from three waves over a six-year period, in a sample of Spanish children aged 6-11 at the onset of the study. Conduct problems showed five distinctive trajectories which were grouped into three major pathways in further analyses: Stable low, Stable high, and Decreasing. Associations with early personality and psychopathic traits, as well as with a wide range of adolescent behavioral and psychosocial outcomes were examined, revealing the Stable high group as exhibiting the highest risk profile. These results contribute to improving our knowledge about one of the most relevant problems in youth populations, and will help in refining interventions strategies by recognizing the developmental heterogeneity of the construct. PMID:25354563

  12. Preoperative Chemoradiotherapy (CRT) Followed by Laparoscopic Surgery for Rectal Cancer: Predictors of the Tumor Response and the Long-Term Oncologic Outcomes

    SciTech Connect

    Lee, Jong Hoon; Kim, Sung Hwan; Kim, Jun-Gi; Cho, Hyun Min; Shim, Byoung Yong

    2011-10-01

    Purpose: We have evaluated the predictors of a tumor response to chemoradiotherapy (CRT) and the long-term oncologic outcomes of preoperative CRT and laparoscopic surgery for patients who suffer from rectal cancer. Methods and Materials: The study involved 274 patients with locally advanced rectal cancer and who had been treated with preoperative CRT and curative laparoscopic total mesorectal excision between January 2003 and January 2009. We assessed the long-term oncologic outcomes, in terms of recurrence and survival, of the treated patients. Results: Forty-two (15.3%) of the 274 patients had complete pathologic responses (pCR). The pre-CRT carcinoembryonic antigen level was the only significant predictor of a pCR on the multivariate analysis (p = 0.01). The overall survival at 5 years was 73.1%, with a mean survival period of 59.7 months (95% CI, 57.1-62.3). The disease-free survival at 5 years was 67.3% with a mean survival period of 54.7 months (95% CI, 51.7-57.8). The pCR group had a higher rate of overall survival at 5 years than did the non-pCR group, and the difference was significant (86.0% vs. 71.2%; hazard ratio = 0.87; 95% CI, 0.78-0.96; p = 0.03). The cumulative incidences of local and distant recurrences at 5 years were 5.8% and 28.3%, respectively. A total of 84.5% (234 of 274) of the patients had their anal sphincters preserved. Grade 3 or 4 acute and long-term toxic effects occurred in 22.2% and 8.4% of the patients, respectively. Conclusion: Preoperative CRT and laparoscopic surgery seems safe and feasible with favorable long-term outcomes and a high rate of sphincter preservation for the patients with low-lying tumors of the rectum.

  13. Plasma neutrophil gelatinase-associated lipocalin as a potential predictor of adverse renal outcomes in immunoglobulin A nephropathy

    PubMed Central

    Park, Ga-Young; Yu, Chung-Hoon; Kim, Jun-Seop; Kang, Yun-Jeong; Kwon, Owen; Choi, Ji-Young; Cho, Jang-Hee; Kim, Chan-Duck; Kim, Yong-Lim

    2015-01-01

    Background/Aims Neutrophil gelatinase-associated lipocalin (NGAL) is a well-known biomarker of acute kidney injury. We evaluated the value of plasma NGAL (pNGAL) as an independent predictor of prognosis in immunoglobulin A nephropathy (IgAN). Methods In total, 91 patients with biopsy-proven IgAN at a single center were evaluated. pNGAL was measured using a commercial enzyme-linked immunosorbent assay kit (R&D Systems). Adverse renal outcome was defined as chronic kidney disease (CKD) stage 3 or above at the last follow-up. Pearson correlation coefficient and Cox regression were used for analyses. Results The mean age of all patients (male:female, 48:43) was 35 years (range, 18 to 77). pNGAL ranged between 21.68 and 446.40 ng/mL (median, 123.97) and showed a correlation with age (r = 0.332, p = 0.001), creatinine (r = 0.336, p = 0.001), estimated glomerular filtration rate (r = -0.397, p < 0.001), uric acid (r = 0.289, p = 0.006), and the protein-to-creatinine ratio (r = 0.288, p = 0.006). During a mean follow-up period of 37.6 months, 11 patients (12.1%) had CKD stage 3 or above. In a multivariate Cox regression model, hypertension (hazard ratio [HR], 8.779; 95% confidence interval [CI], 1.526 to 50.496; p = 0.015), proteinuria > 1 g/day (HR, 5.184; 95% CI, 1.124 to 23.921; p = 0.035), and pNGAL (HR, 1.012; 95% CI, 1.003 to 1.022; p = 0.013) were independent predictors associated with adverse renal outcome. Conclusions pNGAL showed strong correlations with other clinical prognostic factors and was also an independent predictor of adverse renal outcome. We suggest pNGAL as a potential predictor for prognosis in IgAN, while further studies are needed to confirm the clinical value. PMID:25995665

  14. Mandibular advancement devices: indications and predictors of treatment outcome. A review.

    PubMed

    Cuccia, A M; Caradonna, C

    2007-09-01

    Obstructive sleep apnea syndrome (OSAS) is a chronic sleep and respiratory disorder, which causes a partial or total obstruction of the air passage at the upper airway level. Mandibular advancement devices (MADs) have been used in the treatment of snoring, but may be a valid alternative to the continuous nasal positive airway pressure (CPAP) for certain OSAS cases. Therapy by means of MADs arises the interest of the scientific community and now there are many sleep-centres where dentists work as experts in sleep disorders. MADs are instruments of value because they are simple to use, reversible, portable and they generally have a low complication rate. They mechanically increase the oropharyngeal space by advancing the mandible and/or the tongue and reduce pharyngeal collapsibility. More than 60 different MADs are in use, with considerable variations in design. Several studies show that their systematic use produces an evident improvement in the global quality of life as well as in the symptoms of patients with OSAS, especially sleepiness. Even though significant progress has been made in proving the efficacy of MADs for OSAS, the ability to predict the treatment outcome and hence pre-select suitable candidates for this treatment still remains in its early stage. The first aim of this review is to supply to the clinician informations on the cephalometric and polysomnographic parameters that can be used to predict the efficacy of the outcome of MAD therapy in OSAS. Moreover, we examine the cases for which the use of a MAD is indicated. PMID:17938623

  15. Estrogen receptors α and β and aromatase as independent predictors for prostate cancer outcome.

    PubMed

    Grindstad, Thea; Skjefstad, Kaja; Andersen, Sigve; Ness, Nora; Nordby, Yngve; Al-Saad, Samer; Fismen, Silje; Donnem, Tom; Khanehkenari, Mehrdad Rakaee; Busund, Lill-Tove; Bremnes, Roy M; Richardsen, Elin

    2016-01-01

    Androgens are considered important in normal prostate physiology and prostate cancer (PCa) pathogenesis. However, androgen-targeted treatment preventing PCa recurrence is still lacking. This indicates additional mediators contributing to cancer development. We sought to determine the prognostic significance of estrogen receptors, ERα and -β, and the aromatase enzyme in PCa. Tissue microarrays were created from 535 PCa patients treated with radical prostatectomy. Expression of ERα, ERβ and aromatase were evaluated using immunohistochemistry. Representative tumor epithelial (TE) and tumor stromal (TS) areas were investigated separately. Survival analyses were used to evaluate the markers correlation to PCa outcome. In univariate analyses, ERα in TS was associated with delayed time to clinical failure (CF) (p = 0.042) and PCa death (p = 0.019), while ERβ was associated with reduced time to biochemical failure (BF) (p = 0.002). Aromatase in TS and TE was associated with increased time to BF and CF respectively (p = 0.016, p = 0.046). Multivariate analyses supported these observations, indicating an independent prognostic impact of all markers. When stratifying the analysis according to different surgical centers the results were unchanged. In conclusion, significant prognostic roles of ERα, ERβ and aromatase were discovered in the in PCa specimens of our large multicenter cohort. PMID:27610593

  16. Bronchoalveolar lavage cell counts as a predictor of short term outcome in pulmonary sarcoidosis.

    PubMed

    Foley, N M; Coral, A P; Tung, K; Hudspith, B N; James, D G; Johnson, N M

    1989-09-01

    Sixty seven patients with biopsy proven pulmonary sarcoidosis were prospectively studied to determine whether single point bronchoalveolar lavage cell counts were a useful indicator of functional outcome and whether repeated lavage helped in management. The mean follow up period was 25 (range 13-37) months. No patient was having corticosteroid treatment at the time of initial bronchoalveolar lavage. "High intensity alveolitis" (lymphocyte count greater than or equal to 28%) was present at the initial lavage in 42 patients. These patients showed a significant improvement in their pulmonary function and chest radiographs over the follow up period whereas patients with "low intensity alveolitis" did not. Of the 42 patients with high intensity alveolitis, 31 had chronic sarcoidosis (duration over two years, mean 80 months). These patients showed a significant improvement in FVC but not in TLCO. Corticosteroids resulted in greater functional and radiological improvement in the patients with high intensity alveolitis than in those with low intensity alveolitis. Repeat bronchoalveolar lavage in 34 patients, mean 8.4 months after the original lavage, showed a weak inverse relation between a reduced lymphocyte count and change in forced vital capacity and isotope uptake on a gallium scan. These correlations were too weak to make repeated cell counts useful in management. Our results suggest that high intensity alveolitis may be a favourable prognostic factor for lung function in pulmonary sarcoidosis, even in patients with chronic disease, but that repeat lavage adds little to the management of the individual patient. PMID:2588210

  17. Estrogen receptors α and β and aromatase as independent predictors for prostate cancer outcome

    PubMed Central

    Grindstad, Thea; Skjefstad, Kaja; Andersen, Sigve; Ness, Nora; Nordby, Yngve; Al-Saad, Samer; Fismen, Silje; Donnem, Tom; Khanehkenari, Mehrdad Rakaee; Busund, Lill-Tove; Bremnes, Roy M.; Richardsen, Elin

    2016-01-01

    Androgens are considered important in normal prostate physiology and prostate cancer (PCa) pathogenesis. However, androgen-targeted treatment preventing PCa recurrence is still lacking. This indicates additional mediators contributing to cancer development. We sought to determine the prognostic significance of estrogen receptors, ERα and -β, and the aromatase enzyme in PCa. Tissue microarrays were created from 535 PCa patients treated with radical prostatectomy. Expression of ERα, ERβ and aromatase were evaluated using immunohistochemistry. Representative tumor epithelial (TE) and tumor stromal (TS) areas were investigated separately. Survival analyses were used to evaluate the markers correlation to PCa outcome. In univariate analyses, ERα in TS was associated with delayed time to clinical failure (CF) (p = 0.042) and PCa death (p = 0.019), while ERβ was associated with reduced time to biochemical failure (BF) (p = 0.002). Aromatase in TS and TE was associated with increased time to BF and CF respectively (p = 0.016, p = 0.046). Multivariate analyses supported these observations, indicating an independent prognostic impact of all markers. When stratifying the analysis according to different surgical centers the results were unchanged. In conclusion, significant prognostic roles of ERα, ERβ and aromatase were discovered in the in PCa specimens of our large multicenter cohort. PMID:27610593

  18. Reflected appraisals and perceived importance of significant others' appraisals as predictors of college athletes' self-perceptions of competence.

    PubMed

    Amorose, Anthony J

    2003-03-01

    This study examined the reflected appraisal process with college athletes (N = 325). Specifically, the study tested (a) the relative influence of the reflected appraisals of mothers, fathers, coaches, and teammates (i.e., how athletes perceive these others view their ability) on athletes' self-perceptions of competence, and (b) whether the importance placed on these significant others as sources of competence information moderated the relationship. Based on a factor analysis, composite variables were formed representing the reflected appraisals of the athletes' parents (i.e., father, mother) and the reflected appraisals of sport-others (i.e., coach, teammates). Regression analyses revealed that the reflected appraisals of parents (beta = .21) and sport-others (beta = .55) predicted self-perceptions of competence (p < .05, R2 = .45). Follow-up analyses determined that the reflected appraisal of sport-others was a significantly stronger predictor. Hierarchical regression analyses revealed that the interaction of reflected appraisals and the importance of significant others did not significantly add to the prediction of self-perceptions of competence (p > .05, deltaR2 = .01) beyond the independent effects of these constructs. Results are discussed in terms of the reflected appraisal process and the influence of significant others on athletes' self-perceptions. PMID:12659477

  19. Reconstructive Treatment of Ruptured Intracranial Spontaneous Vertebral Artery Dissection Aneurysms: Long-Term Results and Predictors of Unfavorable Outcomes

    PubMed Central

    Huang, Qing-Hai; Xu, Yi; Hong, Bo; Li, Qiang; Liu, Jian-Min; Zhao, Wen-Yuan; Deng, Ben-Qiang

    2013-01-01

    Introduction Few studies focused on predictors of unfavorable outcomes (modified Rankin Scale, 2–6) after reconstructive treatment of the ruptured intracranial spontaneous vertebral artery dissection aneurysms (ris-VADAs), which was evaluated based on 57 reconstructed lesions in this study. Methods Results of 57 consecutive patients (M:F = 29∶28; median age, 48 years; range, 27 to 69 years) harboring 57 ris-VADAs, which were treated with coils combined with single stent(n = 32), double overlapping stents (n = 16), and triple overlapping stents (n = 9) between October 2000 to March 2011, were retrospectively reviewed and analyzed. Results The available (n = 54) mean durations of angiographic and clinical follow-ups were 27 months (range, 12 to 78) and 62 months (range, 12 to 132), respectively. The involvement of PICA (p = 0.004), size of lesions (p = 0.000), quantity of stent (p = 0.001), and coil type (p = 0.002) affected the immediate obliteration grade, which was only risk factor for angiographic recurrences (p = 0.031). Although the post-treatment outcomes did not differ between single stent and multiple stents (p = 0.434), 5 angiographic recurrences, 1 rebleeding and 1 suspected rebleeding, all occurred in partial obliteration after single-stent-assisted coiling. Progressive thrombosis and in-stent obliteration were not detected on follow-up angiograms. Older age (odds ratio [OR] = 1.090; 95% confidence interval [CI], 1.004–1.184; p = 0.040) and unfavorable Hunt-Hess scale (OR = 4.289; 95%CI, 1.232–14.933; p = 0.022) were independent predictors of unfavorable outcomes in the reconstructed ris-VADAs. Conclusions Immediate obliteration grade was only risk factor for angiographic recurrence after reconstructive treatment. Unfavorable Hunt-Hess grade and older age were independent predictors of unfavorable outcomes in ris-VADAs. PMID:23840616

  20. Predictors and Diagnostic Significance of the Adenosine Related Side Effects on Myocardial Perfusion SPECT/CT Imaging

    PubMed Central

    Yıldırım Poyraz, Nilüfer; Özdemir, Elif; Poyraz, Barış Mustafa; Kandemir, Zuhal; Keskin, Mutlay; Türkölmez, Şeyda

    2014-01-01

    Objective: The aim of this study was to investigate the relationship between patient characteristics and adenosine-related side-effects during stress myocard perfusion imaging (MPI). The effect of presence of adenosine-related side-effects on the diagnostic value of MPI with integrated SPECT/CT system for coronary artery disease (CAD), was also assessed in this study. Methods: Total of 281 patients (109 M, 172 F; mean age:62.6±10) who underwent standard adenosine stress protocol for MPI, were included in this study. All symptoms during adenosine infusion were scored according to the severity and duration. For the estimation of diagnostic value of adenosine MPI with integrated SPECT/CT system, coronary angiography (CAG) or clinical follow-up were used as gold standard. Results: Total of 173 patients (61.6%) experienced adenosine-related side-effects (group 1); flushing, dyspnea, and chest pain were the most common. Other 108 patients completed pharmacologic stress (PS) test without any side-effects (group 2). Test tolerability were similar in the patients with cardiovascular or airway disease to others, however dyspnea were observed significantly more common in patients with mild airway disease. Body mass index (BMI) ≥30 kg/m2 and age ≤45 years were independent predictors of side-effects. The diagnostic value of MPI was similar in both groups. Sensitivity of adenosine MPI SPECT/CT was calculated to be 86%, specificity was 94% and diagnostic accuracy was 92% for diagnosis of CAD. Conclusion: Adenosine MPI is a feasible and well tolerated method in patients who are not suitable for exercise stress test as well as patients with cardiopulmonary disease. However age ≤45 years and BMI ≥30 kg/m2 are the positive predictors of adenosine-related side-effects, the diagnostic value of adenosine MPI SPECT/CT is not affected by the presence of adenosine related side-effects. PMID:25541932

  1. Perceived Social Support and Locus of Control as the Predictors of Vocational Outcome Expectations

    ERIC Educational Resources Information Center

    Isik, Erkan

    2013-01-01

    The purpose of this study was to examine the relationships of vocational outcome expectation to social support which is an environmental factor and locus of control which is a personal factor. With this purpose, using Social Cognitive Career Theory as the theoretical framework, 263 undergraduate students completed Vocational Outcome Expectations…

  2. Parenting, Community, and Religious Predictors of Positive and Negative Developmental Outcomes among Muslim Adolescents

    ERIC Educational Resources Information Center

    Krauss, Steven Eric; Hamzah, Azimi; Ismail, Ismi Arif; Suandi, Turiman; Hamzah, Siti Raba'ah; Dahalan, Dzuhailmi; Idris, Fazilah

    2014-01-01

    Despite existing research on the contribution of social context and religiosity to adolescent behavioral outcomes, few studies have attempted to explore this topic among Muslim adolescents in non-Western settings, looking at both positive and negative outcomes. In response to this gap, the current study explored the effects of three dimensions of…

  3. Client Pretreatment Characteristics as Predictors of Outcome in Brief Therapy for Bulimia.

    ERIC Educational Resources Information Center

    Guiffrida, Douglas A.; Barnes, Kristin L.; Hoskins, Christine M.; Roman, Lisa L.

    2001-01-01

    Presents an overview for college counselors of the literature on bulimia treatment outcomes for purposes of screening, treatment, and referral. Outlines pretreatment characteristics that seem amenable to success in brief therapy, as well as those that do not lead to a positive outcome. (Contains 37 references and 2 tables.) (Author/GCP)

  4. Outcomes and Predictors in Preschoolers with Speech-Language and/or Developmental Mobility Impairments

    ERIC Educational Resources Information Center

    Washington, Karla N.; Thomas-Stonell, Nancy; McLeod, Sharynne; Warr-Leeper, Genese

    2015-01-01

    The purpose of this article is to describe communicative-participation outcomes measured by the Focus on the Outcomes of Communication Under Six (FOCUS©; Thomas-Stonell et al., 2013) for interventions provided by speech-language pathologists (SLPs) in different community settings for preschoolers with speech-language impairments (Sp/LI) with and…

  5. Genetic variants in combination with early partial improvement as a clinical utility predictor of treatment outcome in major depressive disorder: the result of two pooled RCTs.

    PubMed

    Kato, M; Serretti, A; Nonen, S; Takekita, Y; Wakeno, M; Azuma, J; Kinoshita, T

    2015-01-01

    Pharmacogenetics may allow for a personalized treatment, but a combination with clinical variables may further enhance prediction. In particular, in the present paper, we investigated early partial improvement (EPI) defined as 20% or more improvement by rating scales 2  weeks after treatment, in combination with selected gene variants as a predictor of treatment outcome in patients with major depressive disorder. Two randomized controlled trials with 168 Japanese depressed patients were used. A stepwise multiple linear regression model with HAM-D score change at week 6 as the dependent variable and genotypes, EPI, baseline HAM-D score, age and sex as independent variables was performed in paroxetine, fluvoxamine and milnacipran, respectively, to estimate the prediction of HAM-D change at week 6. In the paroxetine sample, only EPI (P<0.001) was significantly associated with HAM-D change (n=81, R(2)=0.25, P<0.001). In the fluvoxamine sample, 5-HTTLPR La/Lg, S (P=0.029), FGF2 rs1449683C/T (P=0.013) and EPI (P=0.003) were associated with HAM-D change (n=42, R(2)=0.43, P<0.001). In the milnacipran sample, HTR-1A-1019C/G (P=0.001), ADRA2A-1297C/G (P=0.028) and EPI (P<0.001) were associated with outcome (n=45, R(2)=0.71, P<0.001). EPI in combination with genetic variants could be a useful predictor of treatment outcome and could strengthen the practical use of pharmacogenetic data in clinical practice. PMID:25710119

  6. Genetic variants in combination with early partial improvement as a clinical utility predictor of treatment outcome in major depressive disorder: the result of two pooled RCTs

    PubMed Central

    Kato, M; Serretti, A; Nonen, S; Takekita, Y; Wakeno, M; Azuma, J; Kinoshita, T

    2015-01-01

    Pharmacogenetics may allow for a personalized treatment, but a combination with clinical variables may further enhance prediction. In particular, in the present paper, we investigated early partial improvement (EPI) defined as 20% or more improvement by rating scales 2  weeks after treatment, in combination with selected gene variants as a predictor of treatment outcome in patients with major depressive disorder. Two randomized controlled trials with 168 Japanese depressed patients were used. A stepwise multiple linear regression model with HAM-D score change at week 6 as the dependent variable and genotypes, EPI, baseline HAM-D score, age and sex as independent variables was performed in paroxetine, fluvoxamine and milnacipran, respectively, to estimate the prediction of HAM-D change at week 6. In the paroxetine sample, only EPI (P<0.001) was significantly associated with HAM-D change (n=81, R2=0.25, P<0.001). In the fluvoxamine sample, 5-HTTLPR La/Lg, S (P=0.029), FGF2 rs1449683C/T (P=0.013) and EPI (P=0.003) were associated with HAM-D change (n=42, R2=0.43, P<0.001). In the milnacipran sample, HTR-1A-1019C/G (P=0.001), ADRA2A-1297C/G (P=0.028) and EPI (P<0.001) were associated with outcome (n=45, R2=0.71, P<0.001). EPI in combination with genetic variants could be a useful predictor of treatment outcome and could strengthen the practical use of pharmacogenetic data in clinical practice. PMID:25710119

  7. Electrophysiological Predictors of Clinical Outcome in Traumatic Neuropathies: A Multicenter Prospective Study.

    PubMed

    Ciaramitaro, Palma; Mondelli, Mauro; Rota, Eugenia; Battiston, Bruno; Sard, Arman; Pontini, Italo; Faccani, Giuliano; Migliaretti, Giuseppe; Merola, Aristide; Cocito, Dario; Neuropathies, Italian Network For Traumatic

    2016-01-01

    Objectives. This prospective, observational, multicentre study aims to identify electrodiagnostic (EDX) markers of clinical recovery in patients with traumatic neuropathy (TN) receiving surgical (S) and nonsurgical (NS) treatments. Methods. Subjects referred to the Italian Traumatic Neuropathy Network between 2010 and 2011 (307 patients, for a total of 444 TN) were evaluated with serial clinical/EDX evaluations at 6, 12, 24, and 36 months of follow-up. Results. Primary surgery was performed in 21 subjects with open lesions and evidence of neurotmesis, while closed lesions were treated with either conservative medical approach (216 patients) or secondary surgery (70 patients), according to the clinical spontaneous recovery at 4-6 months. Clinical improvement correlated with the increase of the compound muscle action potential amplitude (OR 3.76; CI 1.61-8.76), particularly in the S group (OR 7.25; CI 1.2-43.87), and with sensory nerve action potential amplitude in the NS group (OR 4.35; CI 1.14-16.69). No correlations were found with needle electromyography qualitative evaluations, changes in maximal voluntary recruitment, age, and gender. Conclusions. Nerve conduction studies (NCS) represent the more accurate neurophysiological markers of clinical outcome in patients with TN. Significance. Serial NCS assessments predict the functional recovery in TN, increasing the accuracy of peripheral nerves surgical decision-making process.

  8. First trimester predictors of diet and birth outcomes in low-income pregnant women.

    PubMed

    Fowles, Eileen R; Gabrielson, Marcena

    2005-01-01

    The purpose1 of this study is to test a model describing the relations of various biopsychosocial, behavioral, and cognitive factors on the health outcomes of nutritional adequacy and infant birth weight in low-income pregnant women. Descriptive, cohort design assessed low-income women (N=55) in their 1st trimester of pregnancy. Eighty percent of the women did not meet the recommended number of food servings outlined in the Food Guide Pyramid. Prepregnant body mass index (BMI) and pregnancy-related dietary changes explained 19% of the variance in nutritional adequacy. Maternal age, prepregnant BMI, nutritional knowledge, and infant gestation at birth explained 52% of the variance in infant birth weight. Nutritional adequacy in the 1st trimester and infant birth weight were not significantly related. Most low-income women are not meeting the nutritional requirements of pregnancy. Careful monitoring of dietary quality may help target women in need of additional nutritional education. Providing nutritional education throughout pregnancy may lead to improved dietary patterns that may reduce low birth weight. PMID:15877540

  9. Electrophysiological Predictors of Clinical Outcome in Traumatic Neuropathies: A Multicenter Prospective Study.

    PubMed

    Ciaramitaro, Palma; Mondelli, Mauro; Rota, Eugenia; Battiston, Bruno; Sard, Arman; Pontini, Italo; Faccani, Giuliano; Migliaretti, Giuseppe; Merola, Aristide; Cocito, Dario; Neuropathies, Italian Network For Traumatic

    2016-01-01

    Objectives. This prospective, observational, multicentre study aims to identify electrodiagnostic (EDX) markers of clinical recovery in patients with traumatic neuropathy (TN) receiving surgical (S) and nonsurgical (NS) treatments. Methods. Subjects referred to the Italian Traumatic Neuropathy Network between 2010 and 2011 (307 patients, for a total of 444 TN) were evaluated with serial clinical/EDX evaluations at 6, 12, 24, and 36 months of follow-up. Results. Primary surgery was performed in 21 subjects with open lesions and evidence of neurotmesis, while closed lesions were treated with either conservative medical approach (216 patients) or secondary surgery (70 patients), according to the clinical spontaneous recovery at 4-6 months. Clinical improvement correlated with the increase of the compound muscle action potential amplitude (OR 3.76; CI 1.61-8.76), particularly in the S group (OR 7.25; CI 1.2-43.87), and with sensory nerve action potential amplitude in the NS group (OR 4.35; CI 1.14-16.69). No correlations were found with needle electromyography qualitative evaluations, changes in maximal voluntary recruitment, age, and gender. Conclusions. Nerve conduction studies (NCS) represent the more accurate neurophysiological markers of clinical outcome in patients with TN. Significance. Serial NCS assessments predict the functional recovery in TN, increasing the accuracy of peripheral nerves surgical decision-making process. PMID:27547450

  10. Homocysteine in embryo culture media as a predictor of pregnancy outcome in assisted reproductive technology.

    PubMed

    Boyama, Burcu Aydin; Cepni, Ismail; Imamoglu, Metehan; Oncul, Mahmut; Tuten, Abdullah; Yuksel, Mehmet Aytac; Kervancioglu, Mehmet Ertan; Kaleli, Semih; Ocal, Pelin

    2016-01-01

    The aim of this study was to determine whether homocysteine (hcy) concentrations in embryo culture media correlate with pregnancy outcome in assisted reproductive technology (ART) cycles. Forty patients who underwent single embryo transfer at the infertility clinic of a tertiary care center were recruited for this case-control study. Spent embryo culture media from all patients were collected after single embryo transfer on day 3 (n = 40). Hcy concentrations in embryo culture media were analyzed by enzyme cycling method. Patients were grouped according to the diagnosis of a clinical pregnancy. Sixteen patients were pregnant while 24 patients failed to achieve conception. Mean Hcy levels in the culture media were significantly different between the groups (p < 0.003), as 4.58 ± 1.31 μmol/l in the non-pregnant group and 3.37 ± 0.92 μmol/l in the pregnant group. Receiver operator curve analysis for determining the diagnostic potential of Hcy for pregnancy revealed an area under the curve of 0.792 (confidence interval: 0.65-0.94; p < 0.05). A cut-off value of 3.53 μmol/l was determined with a sensitivity of 83.3%, and a specificity of 68.8%. Lower hcy levels were associated with a better chance of pregnancy and better embryo grades. Hcy may be introduced as an individual metabolomic profiling marker for embryos.

  11. Electrophysiological Predictors of Clinical Outcome in Traumatic Neuropathies: A Multicenter Prospective Study

    PubMed Central

    Mondelli, Mauro; Battiston, Bruno; Sard, Arman; Pontini, Italo; Faccani, Giuliano; Migliaretti, Giuseppe; Cocito, Dario; Neuropathies, Italian Network for Traumatic

    2016-01-01

    Objectives. This prospective, observational, multicentre study aims to identify electrodiagnostic (EDX) markers of clinical recovery in patients with traumatic neuropathy (TN) receiving surgical (S) and nonsurgical (NS) treatments. Methods. Subjects referred to the Italian Traumatic Neuropathy Network between 2010 and 2011 (307 patients, for a total of 444 TN) were evaluated with serial clinical/EDX evaluations at 6, 12, 24, and 36 months of follow-up. Results. Primary surgery was performed in 21 subjects with open lesions and evidence of neurotmesis, while closed lesions were treated with either conservative medical approach (216 patients) or secondary surgery (70 patients), according to the clinical spontaneous recovery at 4–6 months. Clinical improvement correlated with the increase of the compound muscle action potential amplitude (OR 3.76; CI 1.61–8.76), particularly in the S group (OR 7.25; CI 1.2–43.87), and with sensory nerve action potential amplitude in the NS group (OR 4.35; CI 1.14–16.69). No correlations were found with needle electromyography qualitative evaluations, changes in maximal voluntary recruitment, age, and gender. Conclusions. Nerve conduction studies (NCS) represent the more accurate neurophysiological markers of clinical outcome in patients with TN. Significance. Serial NCS assessments predict the functional recovery in TN, increasing the accuracy of peripheral nerves surgical decision-making process. PMID:27547450

  12. Prevalence and clinical significance of nonorgan specific antibodies in patients with autoimmune thyroiditis as predictor markers for rheumatic diseases.

    PubMed

    Elnady, Basant M; Kamal, Naglaa M; Shaker, Raneyah H M; Soliman, Amal F; Hasan, Waleed A; Alghamdi, Hamed A; Algethami, Mohammed M; Jajah, Mohamed Bilal

    2016-09-01

    Autoimmune diseases are considered the 3rd leading cause of morbidity and mortality in the industrialized countries. Autoimmune thyroid diseases (ATDs) are associated with high prevalence of nonorgan-specific autoantibodies, such as antinuclear antibodies (ANA), antidouble-stranded deoxyribonucleic acid (anti-dsDNA), antiextractable-nuclear antigens (anti-ENAs), rheumatoid factor (RF), and anticyclic-citrullinated peptides (anti-CCP) whose clinical significance is unknown.We aimed to assess the prevalence of various nonorgan-specific autoantibodies in patients with ATD, and to investigate the possible association between these autoantibodies and occurrence of rheumatic diseases and, if these autoantibodies could be considered as predictor markers for autoimmune rheumatic diseases in the future.This study had 2 phases: phase 1; in which 61 ATD patients free from rheumatic manifestations were assessed for the presence of these nonorgan-specific autoantibodies against healthy 61 control group, followed by 2nd phase longitudinal clinical follow-up in which cases are monitored systematically to establish occurrence and progression of any rheumatic disease in association to these autoantibodies with its influences and prognosis.Regarding ATD patients, ANA, anti-dsDNA, Anti-ENA, and RF were present in a percentage of (50.8%), (18%), (21.3%), and (34.4%), respectively, with statistically significance difference (P < 0.5) rather than controls. Nearly one third of the studied group (32.8%) developed the rheumatic diseases, over 2 years follow-up. It was obvious that those with positive anti-dsDNA had higher risk (2.45 times) to develop rheumatic diseases than those without. There was a statistically significant positive linear relationship between occurrence of disease in months and (age, anti-dsDNA, anti-CCP, RF, and duration of thyroiditis). Anti-dsDNA and RF are the most significant predictors (P < 0.0001).ATD is more associated with rheumatic diseases than

  13. Prevalence and clinical significance of nonorgan specific antibodies in patients with autoimmune thyroiditis as predictor markers for rheumatic diseases

    PubMed Central

    Elnady, Basant M.; Kamal, Naglaa M.; Shaker, Raneyah H.M.; Soliman, Amal F.; Hasan, Waleed A.; Alghamdi, Hamed A.; Algethami, Mohammed M.; Jajah, Mohamed Bilal

    2016-01-01

    Abstract Autoimmune diseases are considered the 3rd leading cause of morbidity and mortality in the industrialized countries. Autoimmune thyroid diseases (ATDs) are associated with high prevalence of nonorgan-specific autoantibodies, such as antinuclear antibodies (ANA), antidouble-stranded deoxyribonucleic acid (anti-dsDNA), antiextractable-nuclear antigens (anti-ENAs), rheumatoid factor (RF), and anticyclic-citrullinated peptides (anti-CCP) whose clinical significance is unknown. We aimed to assess the prevalence of various nonorgan-specific autoantibodies in patients with ATD, and to investigate the possible association between these autoantibodies and occurrence of rheumatic diseases and, if these autoantibodies could be considered as predictor markers for autoimmune rheumatic diseases in the future. This study had 2 phases: phase 1; in which 61 ATD patients free from rheumatic manifestations were assessed for the presence of these nonorgan-specific autoantibodies against healthy 61 control group, followed by 2nd phase longitudinal clinical follow-up in which cases are monitored systematically to establish occurrence and progression of any rheumatic disease in association to these autoantibodies with its influences and prognosis. Regarding ATD patients, ANA, anti-dsDNA, Anti-ENA, and RF were present in a percentage of (50.8%), (18%), (21.3%), and (34.4%), respectively, with statistically significance difference (P < 0.5) rather than controls. Nearly one third of the studied group (32.8%) developed the rheumatic diseases, over 2 years follow-up. It was obvious that those with positive anti-dsDNA had higher risk (2.45 times) to develop rheumatic diseases than those without. There was a statistically significant positive linear relationship between occurrence of disease in months and (age, anti-dsDNA, anti-CCP, RF, and duration of thyroiditis). Anti-dsDNA and RF are the most significant predictors (P < 0.0001). ATD is more associated with rheumatic

  14. Complex Karyotype is a Stronger Predictor than Del(17p) for Inferior Outcome in Relapsed or Refractory CLL Patients Treated with Ibrutinib-Based Regimens

    PubMed Central

    Thompson, Philip A.; O’Brien, Susan M.; Wierda, William G.; Ferrajoli, Alessandra; Stingo, Francesco; Smith, Susan C.; Burger, Jan A.; Estrov, Zeev; Jain, Nitin; Kantarjian, Hagop M.; Keating, Michael J.

    2016-01-01

    Background Ibrutinib is active in patients with relapsed/refractory (R/R) CLL. In patients treated with ibrutinib for R/R CLL, del(17p) identified by interphase fluorescence in situ hybridization (FISH) is associated with inferior progression-free survival, despite equivalent initial response rates. Del(17p) is frequently associated with complex metaphase karyotype (CKT); the prognostic significance of CKT in ibrutinib-treated patients has not been reported. Methods We reviewed 88 patients treated for R/R CLL at MD Anderson Cancer Center with investigational ibrutinib-based regimens from 2010–2013. Pre-treatment FISH and Lipopolysaccharide-stimulated metaphase cytogenetic analysis were performed on bone marrow. Results Adequate pre-treatment metaphase karyotype was available for 56/88 patients. Karyotype was complex in 21 of 56 cases; 17 of the 21 had del(17p) by FISH. Overall response rate, including partial remission with persistent lymphocytosis, was 94% with 17% complete responses. In multivariable analysis (MVA), only CKT was significantly associated with event-free survival (EFS) [HR 6.6 (1.7–25.6), p=0.006]. Fludarabine-refractory CLL [HR 6.9 (1.8–27.1), p=0.005] and CKT [HR 5.9 (1.6–22.2), p=0.008] were independently associated with inferior overall survival (OS) in MVA. Del(17p) by FISH was not significantly associated with EFS or OS in MVA. Conclusions CKT is a powerful predictor of outcome in ibrutinib-treated patients with R/R CLL and may be a stronger predictor of biological behavior than del(17p) by FISH. Given their relatively poor outcomes, patients with CKT are ideal candidates for studies of consolidative treatment strategies or novel treatment combinations. PMID:26193999

  15. Temporal lobe surgery in childhood and neuroanatomical predictors of long-term declarative memory outcome

    PubMed Central

    Skirrow, Caroline; Cross, J. Helen; Harrison, Sue; Cormack, Francesca; Harkness, William; Coleman, Rosie; Meierotto, Ellen; Gaiottino, Johanna; Vargha-Khadem, Faraneh

    2015-01-01

    The temporal lobes play a prominent role in declarative memory function, including episodic memory (memory for events) and semantic memory (memory for facts and concepts). Surgical resection for medication-resistant and well-localized temporal lobe epilepsy has good prognosis for seizure freedom, but is linked to memory difficulties in adults, especially when the removal is on the left side. Children may benefit most from surgery, because brain plasticity may facilitate post-surgical reorganization, and seizure cessation may promote cognitive development. However, the long-term impact of this intervention in children is not known. We examined memory function in 53 children (25 males, 28 females) who were evaluated for epilepsy surgery: 42 underwent unilateral temporal lobe resections (25 left, 17 right, mean age at surgery 13.8 years), 11 were treated only pharmacologically. Average follow-up was 9 years (range 5–15). Post-surgical change in visual and verbal episodic memory, and semantic memory at follow-up were examined. Pre- and post-surgical T1-weighted MRI brain scans were analysed to extract hippocampal and resection volumes, and evaluate post-surgical temporal lobe integrity. Language lateralization indices were derived from functional magnetic resonance imaging. There were no significant pre- to postoperative decrements in memory associated with surgery. In contrast, gains in verbal episodic memory were seen after right temporal lobe surgery, and visual episodic memory improved after left temporal lobe surgery, indicating a functional release in the unoperated temporal lobe after seizure reduction or cessation. Pre- to post-surgical change in memory function was not associated with any indices of brain structure derived from MRI. However, better verbal memory at follow-up was linked to greater post-surgical residual hippocampal volumes, most robustly in left surgical participants. Better semantic memory at follow-up was associated with smaller resection

  16. Temporal lobe surgery in childhood and neuroanatomical predictors of long-term declarative memory outcome.

    PubMed

    Skirrow, Caroline; Cross, J Helen; Harrison, Sue; Cormack, Francesca; Harkness, William; Coleman, Rosie; Meierotto, Ellen; Gaiottino, Johanna; Vargha-Khadem, Faraneh; Baldeweg, Torsten

    2015-01-01

    The temporal lobes play a prominent role in declarative memory function, including episodic memory (memory for events) and semantic memory (memory for facts and concepts). Surgical resection for medication-resistant and well-localized temporal lobe epilepsy has good prognosis for seizure freedom, but is linked to memory difficulties in adults, especially when the removal is on the left side. Children may benefit most from surgery, because brain plasticity may facilitate post-surgical reorganization, and seizure cessation may promote cognitive development. However, the long-term impact of this intervention in children is not known. We examined memory function in 53 children (25 males, 28 females) who were evaluated for epilepsy surgery: 42 underwent unilateral temporal lobe resections (25 left, 17 right, mean age at surgery 13.8 years), 11 were treated only pharmacologically. Average follow-up was 9 years (range 5-15). Post-surgical change in visual and verbal episodic memory, and semantic memory at follow-up were examined. Pre- and post-surgical T1-weighted MRI brain scans were analysed to extract hippocampal and resection volumes, and evaluate post-surgical temporal lobe integrity. Language lateralization indices were derived from functional magnetic resonance imaging. There were no significant pre- to postoperative decrements in memory associated with surgery. In contrast, gains in verbal episodic memory were seen after right temporal lobe surgery, and visual episodic memory improved after left temporal lobe surgery, indicating a functional release in the unoperated temporal lobe after seizure reduction or cessation. Pre- to post-surgical change in memory function was not associated with any indices of brain structure derived from MRI. However, better verbal memory at follow-up was linked to greater post-surgical residual hippocampal volumes, most robustly in left surgical participants. Better semantic memory at follow-up was associated with smaller resection

  17. Portal pressure and blood nitric oxide levels as predictors of outcome in biliary atresia

    PubMed Central

    Khanna, Vikram; Bhatnagar, Veereshwar; Agarwala, Sandeep; Srinivas, Maddur; Das, Nibhriti; Singh, Manoj Kumar

    2016-01-01

    Aim: To evaluate the incidence of portal hypertension (PHT) in biliary atresia (BA) patients and to monitor its progress after Kasai portoenterostomy (KP) by measuring nitric oxide (NO) levels in peripheral blood. Materials and Methods: A prospective cross-sectional study conducted over a period of 2 years. Intraoperative portal pressure (PP) and blood NO levels at presentation, 1-month, 3-month, and 6-month follow-up, were correlated with clinical and biochemical parameters in BA patients. The mean NO level in age-matched control group was 4.64 ± 2.32 μmol/L. Results: Thirty-four BA patients underwent KP over a period of 2 years. The mean age of presentation was 2.7 months (range 1-4 months). The mean intraoperative PP was 21.3 ± 5.4 mmHg. The mean PP in patients aged <60 days, 61–90 days, and >90 days was 18.53 ± 4.45 mmHg, 20.33 ± 3.07 mmHg, and 26.5 ± 5.01 mmHg, respectively. The mean PP in the patients who underwent successful KP was 16.75 ± 3.54 mmHg while for those who continued to have jaundice it was 23.94 ± 4.63 mmHg (P < 0.001). NO levels closely followed the PP as shown by the regression equation NO = 4.79 + 0.64 PP mmHg, R2 = 0.69. The mean NO level at presentation was 18.48 ± 4.17 μmol/L and at 1-month, 3-month, and 6-month follow-up was 11.94 ± 5.62 μmol/L, 10.79 ± 6.02 μmol/L, and 9.93 ± 6.53 μmol/L, respectively (P < 0.001). The difference in NO levels was also statistically significant between the patients who cleared jaundice and those with persisting jaundice. Conclusion: All BA patients had PHT at presentation. PHT worsens with age and has an adverse effect on outcome of KP. NO levels in blood closely follow PP and higher levels are associated with poor outcome. PMID:27046973

  18. Predictors of radiotherapy outcome in patients with T2 supraglottic carcinoma.

    PubMed

    Rutkowski, Tomasz; Wygoda, A; Składowski, K; Hejduk, B; Rutkowski, R; Lukaszczyk-Widel, B; Hutnik, M; Maciejewski, B

    2012-03-01

    The decision regarding treatment of early supraglottic carcinoma remains controversial. Single institution clinical data of patients with T2 supraglottic carcinoma treated exclusively with radiotherapy in terms of prognostic factors and treatment results were analyzed. Patient-related factors that would potentially by useful for optimal therapeutic decision to be undertaken were especially investigated. Between 1994 and 2004, 78 patients with T2 supraglottic carcinoma underwent radiotherapy (RT) in Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Poland. There were 54 (69%) males and 24 (31%) females in the median age of 61 years. There were 17 (22%) patients with N+. Median body mass of patients before (BM0) and after RT (BM1) was 74 kg (range 45.2-130 kg) and 72.9 kg (range 49.9-122.5 kg), respectively. Median hemoglobin concentrations before (Hb0) and after (Hb1) RT were 14.3 and 13.4 g/dl, respectively. Median change of Hb concentration during RT (dHb) was -0.8 g/dl. All were treated up to total doses (TD) ranged from 62.5 to 72 Gy. The overall treatment time (OTT) ranged from 30 to 70 days. Estimates of local control (LC), ultimate local control (uLC), and overall survival (OS) were calculated using the Kaplan-Meier method. Log rank statistics, Cox proportional hazard model and step-wise Cox regression hazard model were employed to identify prognostic factors for LC, uLC, and OS in univariate and multivariate analyses. The 5-year LC, RC, uLC and OS rates were 85, 92, 88, and 56%, respectively. In multivariate analysis N+ (p = 0.01) and prolonged OTT (p = 0.03) significantly decreased LC. Females (p = 0.02), higher BM0 (p = 0.03), and HB0 (p = 0.006) significantly prolonged OS. Patient-related factors like gender, hemoglobin concentration, and body mass may predict treatment outcome. Radiotherapy is effective for T2 supraglottic carcinoma of the larynx unless higher dose intensity is provided. Involved regional lymph

  19. Clinical outcome and predictors of mortality in children with sepsis, severe sepsis, and septic shock from Rohtak, Haryana: A prospective observational study

    PubMed Central

    Kaur, Gurpreet; Vinayak, Nikhil; Mittal, Kundan; Kaushik, Jaya Shankar; Aamir, Mohammad

    2014-01-01

    Background: Information regarding early predictive factors for mortality and morbidity in sepsis is limited from developing countries. Methods: A prospective observational study was conducted to determine the clinical outcome and predictors of mortality in children with sepsis, severe sepsis, and septic shock. Children aged 1 month to 14 years admitted to a tertiary care pediatric intensive care unit (PICU) with a diagnosis of sepsis, severe sepsis, or septic shock were enrolled in the study. Hemodynamic and laboratory parameters which discriminate survivors from nonsurvivors were evaluated. Results: A total of 50 patients (30 [60%] males) were enrolled in the study, of whom 21 (42%) were discharged (survivors) and rest 29 (58%) expired (nonsurvivor). Median (interquartile range) age of enrolled patients were 18 (6, 60) months. Mortality was not significantly predicted individually by any factor including age (odds ratio [OR] [95% confidence interval [CI

  20. Endometrial thickness as a predictor of pregnancy outcomes in 10787 fresh IVF-ICSI cycles.

    PubMed

    Yuan, Xi; Saravelos, Sotirios H; Wang, Qiong; Xu, Yanwen; Li, Tin-Chiu; Zhou, Canquan

    2016-08-01

    This retrospective study assessed the predictive value of endometrial thickness (EMT) on HCG administration day for the clinical outcome of fresh IVF and intracytoplasmic sperm injection (ICSI) cycles. A total of 8690 consecutive women undergoing 10,787 cycles over a 5-year period were included. The 5th, 50th and 95th centiles for EMT were determined as 8, 11 and 15 mm, respectively. Group analysis according to these centiles (Group 1: < 8 mm; Group 2: ≥ 8 and ≤11 mm; Group 3: > 11 and ≤15 mm; Group 4: > 15 mm) demonstrated significant differences (P < 0.001) in clinical pregnancy rates (23.0%, 37.2%, 46.2% and 53.3%, respectively), live birth rates per clinical pregnancy (63.3%, 72.0%, 78.1% and 80.3%, respectively), spontaneous abortion rates (26.7%, 23.8%, 19.9% and 17.5%, respectively), and ectopic pregnancy rates (10.0%, 4.3%, 2.1% and 2.2%, respectively). Logistic regression analyses showed EMT as one of the independent variables predictive of clinical pregnancy (OR = 1.097; P < 0.001), live birth (OR = 1.078; P < 0.001), spontaneous abortion (OR = 0.948; P < 0.001), and ectopic pregnancy (OR = 0.851; P < 0.001). Future research should aim to understand the underlying mechanisms relating EMT to conception, ectopic implantation and spontaneous abortion.

  1. Polymorphism at the 3'-UTR of the thymidylate synthase gene: A potential predictor for outcomes in Caucasian patients with esophageal adenocarcinoma treated with preoperative chemoradiation

    SciTech Connect

    Liao Zhongxing . E-mail: zliao@mdanderson.org; Liu Hongji; Swisher, Stephen G.; Wang Luo; Wu, Tsung-Teh; Correa, Arlene M.; Roth, Jack A.; Cox, James D.; Komaki, Ritsuko; Ajani, Jaffer A.; Wei Qingyi

    2006-03-01

    Purpose: To test the hypothesis that TS3'UTR polymorphisms predict outcomes in 146 Caucasian patients with esophageal adenocarcinoma treated with preoperative 5-fluorouracil-based chemoradiation. Methods and Materials: DNA was extracted from hematoxylin-and-eosin stained histologic slides of normal esophageal or gastric mucosa sections from paraffin blocks of esophagectomy specimens. Genotypes of the TS3'UTR polymorphism were determined by polymerase chain reaction for a 6-bp insertion. The genotype groups (0bp/0bp, 6bp/0bp, and 6bp/6bp) were compared for clinical features and overall survival, recurrence-free-survival, locoregional control (LRC), and distant metastasis control. Multivariable Cox regression analyses were performed to find independent predictors for the stated outcomes. Results: There was a trend of association between 6bp/6bp genotype and a decreased risk of local regional recurrence (hazards ratio = 0.211, 95% confidence interval = 0.041-1.095, p = 0.06) compared with other genotypes. There was a trend that patients with 6bp/6bp genotype had a higher 3-year probability of LRC compared with patients with the other two genotypes combined (p = 0.07); however, the difference was not statistically significant. Conclusions: The null hypotheses were not rejected in this study, probably owing to small sample size or the single gene examined. Prospective studies with adequate statistical power analyzing a family of genes involved in the 5-fluorouracil metabolism are needed to assess genetic determinants of treatment-related outcomes in esophageal adenocarcinoma.

  2. Vestibulo-ocular monitoring as a predictor of outcome after severe traumatic brain injury

    PubMed Central

    2009-01-01

    Introduction Based on the knowledge that traumatic brainstem damage often leads to alteration in brainstem functions, including the vestibulo-ocular reflex, the present study is designed to determine whether prediction of outcome in the early phase after severe traumatic brain injury is possible by means of vestibulo-ocular monitoring. Methods Vestibulo-ocular monitoring is based on video-oculographic recording of eye movements during galvanic labyrinth polarization. The integrity of vestibulo-ocular reflex is determined from the eye movement response during vestibular galvanic labyrinth polarization stimulation. Vestibulo-ocular monitoring is performed within three days after traumatic brain injury and the oculomotor response compared to outcome after six months (Glasgow Outcome Score). Results Twenty-seven patients underwent vestibulo-ocular monitoring within three days after severe traumatic brain injury. One patient was excluded from the study. In 16 patients oculomotor response was induced, in the remaining 11 patients no oculomotor response was observed. The patients' outcome was classified as Glasgow Outcome Score 1-2 or as Glasgow Outcome Score 3 to 5. Statistical testing supported the hypothesis that those patients with oculomotor response tended to recover (exact two-sided Fisher-Test (P < 10-3)). Conclusions The results indicate that vestibulo-ocular monitoring with galvanic labyrinth polarization performed during the first days after traumatic brain injury helps to predict favourable or unfavourable outcome. As an indicator of brainstem function, vestibulo-ocular monitoring provides a useful, complementary approach to the identification of brainstem lesions by imaging techniques. PMID:19948056

  3. Adjusted Left Atrial Emptying Fraction as a Predictor of Procedural Outcome after Catheter Ablation for Atrial Fibrillation

    PubMed Central

    Im, Sung Il; Kim, Sun Won; Choi, Cheol Ung; Kim, Jin Won; Yong, Hwan Seok; Kim, Eung Ju; Rha, Seung-Woon; Park, Chang Gyu; Seo, Hong Seog; Oh, Dong Joo; Lim, Hong Euy

    2015-01-01

    Structural remodeling of the left atrium is a risk factor for recurrent arrhythmia after catheter ablation for atrial fibrillation; however, data are sparse regarding the role of functional left atrial remodeling in predicting procedural outcomes. We evaluated whether left atrial transport function could be used to predict recurrent atrial fibrillation. From July 2008 through August 2010, we enrolled 202 consecutive patients who underwent catheter ablation for atrial fibrillation (paroxysmal=120, persistent=82). Left atrial volumes (LAVs) were measured by means of multislice computed tomography at every 10% of the R-R interval, and measurements were adjusted for body surface area to yield the LAV index (LAVI) at baseline. The left atrial emptying fraction (LAEF) was calculated according to LAV differences. During the mean follow-up period of 10 ± 4 months after a single ablation procedure, atrial fibrillation recurred in 59 patients (paroxysmal=19, persistent=40). Multivariate analysis revealed that persistent atrial fibrillation, early mitral inflow velocity, LAVImax, LAVImin, LAEF, LAVImax/LAEF, and LAVImin/LAEF were all independent predictors of atrial fibrillation, but the best predictor was LAVImin/LAEF (β=1.329, P=0.001). The cutoff value was 1.61 (mL/m2)/%, and the sensitivity and specificity were 74.6% and 62.2%, respectively (area under the curve=0.761). Our study shows that adjusted left atrial emptying fraction with use of multislice computed tomography might be a useful, noninvasive method to select patients for ablation. PMID:26175632

  4. Working memory as a predictor of negative symptoms and functional outcome in first episode psychosis.

    PubMed

    González-Ortega, Itxaso; de Los Mozos, Vanesa; Echeburúa, Enrique; Mezo, Maria; Besga, Ariadna; Ruiz de Azúa, Sonia; González-Pinto, Asunción; Gutierrez, Miguel; Zorrilla, Iñaki; González-Pinto, Ana

    2013-03-30

    The relationship of neurocognitive course with clinical and functional outcomes in psychosis is not well known, especially in the long term. The aim of the study was to examine the clinical and neuropsychological course of first-episode psychosis patients at 5-year follow-up and analyze the relationship of cognitive performance with clinical and functional outcome. The 5-year follow-up was conducted with 26 first-episode psychosis patients. Psychotic symptoms were measured by the Positive and Negative Syndrome Scale, manic and depressive symptoms by the Young Mania Rating Scale and Hamilton Depression Rating Scale respectively, and psychosocial functioning by the Functioning Assessment Short Test. The cognitive domains were assessed by the Wechsler Adult Intelligence Scale, the Wisconsin Card Sorting Test, the Trail Making Test, the Verbal Fluency Test, the Stroop Colour-Word Test and the Wechsler Memory Scale. Patients showed symptomatic improvement in the follow-up except in negative psychotic symptoms. There was also improvement in most cognitive domains except in working memory and processing speed in the follow-up. Working memory impairment was associated to negative psychotic symptoms and poor functional outcomes. Negative symptoms mediated the relationship between working memory and outcome. Therefore, negative symptoms should be a primary target of treatment to improve functional outcomes.

  5. Behavioral and Cognitive Predictors of Educational Outcomes in Pediatric Traumatic Brain Injury

    PubMed Central

    Arnett, Anne B.; Peterson, Robin L.; Kirkwood, Michael W.; Taylor, H. Gerry; Stancin, Terry; Brown, Tanya M.; Wade, Shari L.

    2014-01-01

    Research reveals mixed results regarding the utility of standardized cognitive and academic tests to predict educational outcomes in youth following a traumatic brain injury (TBI). Yet, deficits in everyday school-based outcomes are prevalent after pediatric TBI. The current study used path modeling to test the hypothesis that parent ratings of adolescents’ daily behaviors associated with executive functioning (EF) would predict long-term functional educational outcomes following pediatric TBI, even when injury severity and patient demographics were included in the model. Furthermore, we contrasted the predictive strength of the EF behavioral ratings with that of a common measure of verbal memory. A total of 132 adolescents who were hospitalized for moderate to severe TBI were recruited to participate in a randomized clinical intervention trial. EF ratings and verbal memory were measured within 6 months of the injury; functional educational outcomes were measured 12 months later. EF ratings and verbal memory added to injury severity in predicting educational competence post injury but did not predict post-injury initiation of special education. The results demonstrated that measurement of EF behaviors is an important research and clinical tool for prediction of functional outcomes in pediatric TBI. PMID:23790158

  6. Nonlinear logistic regression model for outcomes after endourologic procedures: a novel predictor.

    PubMed

    Kadlec, Adam O; Ohlander, Samuel; Hotaling, James; Hannick, Jessica; Niederberger, Craig; Turk, Thomas M

    2014-08-01

    The purpose of this study was to design a thorough and practical nonlinear logistic regression model that can be used for outcome prediction after various forms of endourologic intervention. Input variables and outcome data from 382 renal units endourologically treated at a single institution were used to build and cross-validate an independently designed nonlinear logistic regression model. Model outcomes were stone-free status and need for a secondary procedure. The model predicted stone-free status with sensitivity 75.3% and specificity 60.4%, yielding a positive predictive value (PPV) of 75.3% and negative predictive value (NPV) of 60.4%, with classification accuracy of 69.6%. Receiver operating characteristic area under the curve (ROC AUC) was 0.749. The model predicted the need for a secondary procedure with sensitivity 30% and specificity 98.3%, yielding a PPV of 60% and NPV of 94.2%. ROC AUC was 0.863. The model had equivalent predictive value to a traditional logistic regression model for the secondary procedure outcome. This study is proof-of-concept that a nonlinear regression model adequately predicts key clinical outcomes after shockwave lithotripsy, ureteroscopic lithotripsy, and percutaneous nephrolithotomy. This model holds promise for further optimization via dataset expansion, preferably with multi-institutional data, and could be developed into a predictive nomogram in the future.

  7. Therapist-reported alliance: is it really a predictor of outcome?

    PubMed Central

    Zilcha-Mano, Sigal; Solomonov, Nili; Chui, Harold; McCarthy, Kevin S.; Barrett, Marna S.; Barber, Jacques P.

    2015-01-01

    Most of the literature on the alliance-outcome association is based exclusively on differences between patient reports on alliance. Much less is known about the unique contribution of the therapist’s report to this association across treatment, that is, the association between therapist-reported alliance and outcome over the course of treatment, after controlling for the patient’s contribution. The present study is the first to examine the unique contribution of the therapist-reported alliance to outcome, accounting for reverse causation (symptomatic levels predicting alliance), at several time points in the course of treatment. Of 156 patients randomized to dynamic supportive-expressive psychotherapy, antidepressant medication with clinical management, and placebo with clinical management, 149 were included in the present study. Alliance was assessed from the perspective of both the patient and the therapist. Outcome measures included the patients’ self-reported and diagnostician-rated depressive symptoms. Overall, the findings demonstrate that the therapists’ contribution to the alliance-outcome association was explained mainly by prior symptomatic levels. However, when a time lag of several sessions was introduced between alliance and symptoms, a positive association emerged between alliance at one time point and symptomatic distress assessed several sessions later in the treatment, controlling for previous symptomatic level. The findings were similar whether or not we controlled for the patient’s perspective on the alliance. Taken together, the findings attest to the importance of improving therapists’ ability to detect deterioration in the alliance. PMID:26323043

  8. Cognitive and Affective Predictors of Treatment Outcome in Cognitive Processing Therapy and Prolonged Exposure for Posttraumatic Stress Disorder

    PubMed Central

    Rizvi, Shireen L.; Vogt, Dawne S.; Resick, Patricia A.

    2009-01-01

    This study examined cognitive and affective predictors of treatment dropout and treatment efficacy in Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) for PTSD. Study participants were women with PTSD from a sexual assault who received at least one session of either treatment (n=145) as part of a randomized clinical trial. Results revealed that younger age, lower intelligence, and less education were associated with higher treatment dropout, whereas higher depression and guilt at pretreatment were associated with greater improvement in PTSD symptomatology. Results by treatment condition indicated that women with higher anger at pretreatment were more likely to drop out of PE and that older women in PE and younger women in CPT had the best overall outcomes. These findings have implications for efforts to enhance treatment efficacy and retention in CBT treatment protocols. PMID:19595295

  9. Cognitive and affective predictors of treatment outcome in Cognitive Processing Therapy and Prolonged Exposure for posttraumatic stress disorder.

    PubMed

    Rizvi, Shireen L; Vogt, Dawne S; Resick, Patricia A

    2009-09-01

    This study examined cognitive and affective predictors of treatment dropout and treatment efficacy in Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) for PTSD. Study participants were women with PTSD from a sexual assault who received at least one session of either treatment (n = 145) as part of a randomized clinical trial. Results revealed that younger age, lower intelligence, and less education were associated with higher treatment dropout, whereas higher depression and guilt at pretreatment were associated with greater improvement in PTSD symptomatology. Results by treatment condition indicated that women with higher anger at pretreatment were more likely to dropout of PE and that older women in PE and younger women in CPT had the best overall outcomes. These findings have implications for efforts to enhance treatment efficacy and retention in CBT treatment protocols. PMID:19595295

  10. The role of self-image as a predictor of psychotherapy outcome.

    PubMed

    Ryum, Truls; Vogel, Patrick A; Walderhaug, Eirik P; Stiles, Tore C

    2015-02-01

    The present study examined the relationship between self-image and outcome in psychotherapy. Patients (n = 170) received treatment-as-usual at a university clinic, and met diagnostic criteria for mostly anxiety and depression related disorders. Self-image was measured with the Structural Analysis of Social Behavior (SASB-I) introject pre and post-treatment. Using multiple regression analyses, higher levels of Self-ignore and Self-blame pre-treatment predicted a poorer treatment outcome in terms of symptoms (SCL-90-R) and interpersonal problems (IIP-64), respectively. Increase in Self-love and decrease in Self-blame (pre to post) predicted reduced symptoms at post-treatment, whereas decrease in Self-attack and Self-control, as well as increase in Self-affirm, predicted reduced interpersonal problems. The results suggest that self-image improvement may be important in order to achieve a good outcome in psychotherapy.

  11. Early Adolescent Relationship Predictors of Emerging Adult Outcomes: Youth with and without Type 1 Diabetes

    PubMed Central

    Helgeson, Vicki S.; Palladino, Dianne K.; Reynolds, Kerry A.; Becker, Dorothy; Escobar, Oscar; Siminerio, Linda

    2013-01-01

    Background Emerging adulthood is a high-risk period for mental health problems and risk behaviors for youth generally and for physical health problems among those with type 1 diabetes. Purpose To examine whether adolescents’ relationships with parents and friends predict health and risk behaviors during emerging adulthood. Method Youth with and without diabetes were enrolled at average age 12 and followed for 7 years. Parent and friend relationship variables, measured during adolescence, were used to predict emerging adulthood outcomes: depression, risk behavior, and, for those with diabetes, diabetes outcomes. Results Parent relationship quality predicted decreased depressive symptoms and, for those with diabetes, decreased alcohol use. Parent control predicted increased smoking, reduced college attendance, and, for control participants, increased depressive symptoms. For those with diabetes, parent control predicted decreased depressive symptoms and better self-care. Friend relationship variables predicted few outcomes. Conclusions Adolescent parent relationships remain an important influence on emerging adults’ lives. PMID:24178509

  12. Neonatal respiratory distress in a reference neonatal unit in Cameroon: an analysis of prevalence, predictors, etiologies and outcomes

    PubMed Central

    Tochie, Joel Noutakdie; Choukem, Simeon-Pierre; Langmia, Regina Ndasi; Barla, Esther; Koki-Ndombo, Paul

    2016-01-01

    Introduction Neonatal respiratory distress (NRD) is a main cause of neonatal morbidity and mortality in developing countries. Early detection of its risk factors and early treatment of its etiologies are major challenges. However, few studies in developing countries have provided data needed to tackle it. We aimed to determine the prevalence, predictors, etiologies and outcome of NRD in a tertiary health care centre of Cameroon. Methods We analyzed the hospital files of all newborns admitted to the Neonatal unit of Douala General Hospital from 1st January 2011 to 28th February 2013. NRD was diagnosed based on the presence of one or more of the following signs: an abnormal respiratory rate, expiratory grunting, nasal flaring, chest wall recessions and thoraco-abdominal asynchrony with or without cyanosis, in their files. Socio-demographic and clinical variables of newborns and their mothers were analyzed using logistic regression analysis. Results The prevalence of NRD was 47.5% out of the 703 newborns studied. Acute fetal distress, elective caesarean delivery, APGAR score < 7 at the 1st minute, prematurity, male gender and macrosomia were independent predictors of NRD. The main etiologies were neonatal infections (31%) and transient tachypnea of the newborn (25%). Its neonatal mortality rate was 24.5%, mainly associated with neonatal sepsis and hyaline membrane disease. Conclusion NRD is a frequent emergency and causes high morbidity and mortality. Most of its risk factors and etiologies are preventable. Adequate follow-up of pregnancy and labor for timely intervention may improve the neonatal outcomes. PMID:27642489

  13. Outcomes and predictors of prolonged ventilation in patients undergoing elective coronary surgery†

    PubMed Central

    Saleh, Hesham Z.; Shaw, Matthew; Al-Rawi, Omar; Yates, Jonathan; Pullan, D. Mark; Chalmers, John A.C.; Fabri, Brian M.

    2012-01-01

    OBJECTIVES Despite the seriousness of prolonged mechanical ventilation (PMV) as a postoperative complication, previously proposed risk prediction models were met with limited success. The purpose of this study was to identify perioperative variables associated with PMV in elective primary coronary bypass surgery. PMV was defined as the need for intubation and mechanical ventilation for >72 h, after completion of the operation. METHODS Between April 1997 and September 2010, 10 977 consecutive patients were retrospectively reviewed. A series of two multivariate logistic regression analyses were carried out to identify preoperative predictors of prolonged ventilation and the impact of operative variables. RESULTS PMV occurred in 215 (1.96%) patients; 119 (55.3%) of these underwent tracheostomy. At multivariate analysis, predictors included NYHA higher than class II (odds ratio [OR], 1.77; 95% confidence intervals [CI], 1.34–2.34), renal dialysis (OR, 5.5; 95% CI, 2.08–14.65), age at operation (OR, 1.04; 95% CI, 1.02–1.06), reduced FEV1 (OR, 0.99; 95% CI, 0.98–0.99), body mass index >35 kg/m2 (OR, 1.73; 95% CI, 1.14–2.63). On serial logistic regression analyses, operative variables added little to the discriminatory power of the model. Kaplan–Meier survival curves showed reduced survival among PMV patients (P < 0.001) with an improved survival in the tracheostomy subgroup. CONCLUSIONS PMV after coronary bypass is associated with a reduction in early and mid-term survival. Risk modelling for PMV remains problematic even when examining a more homogenous lower risk group. PMID:22495507

  14. Predictors of Employment Outcomes for Vocational Rehabilitation Consumers With HIV/AIDS: 2002-2007

    ERIC Educational Resources Information Center

    Jung, Youngoh; Bellini, James L.

    2011-01-01

    This study examined the predictability of two employment outcomes--employment status and weekly earnings at closure--from consumer demographic, medical, and service variables for multiple groups of vocational rehabilitation (VR) consumers with HIV/AIDS retrieved from the RSA-911 data for fiscal years 2002 through 2007. A logistic regression…

  15. Stimulus, Task, and Learning Effects on Measures of Temporal Resolution: Implications for Predictors of Language Outcome

    ERIC Educational Resources Information Center

    Smith, Nicholas A.; Trainor, Laurel J.; Gray, Kellie; Plantinga, Judy A.; Shore, David I.

    2008-01-01

    Purpose: Some studies find that temporal processing ability predicts language outcome whereas other studies do not. Resolution of this debate is hindered by the variety of temporal measures used, nonsensory loading of the tasks, and differential amounts of practice across studies. The goal of this study was to examine the effects of stimulus…

  16. Teacher (Mis)Perceptions of Preschoolers' Academic Skills: Predictors and Associations with Longitudinal Outcomes

    ERIC Educational Resources Information Center

    Baker, Courtney N.; Tichovolsky, Marianne H.; Kupersmidt, Janis B.; Voegler-Lee, Mary Ellen; Arnold, David H.

    2015-01-01

    Preschool teachers have important impacts on children's academic outcomes, and teachers' misperceptions of children's academic skills could have negative consequences, particularly for low-income preschoolers. This study utilized data gathered from 123 preschool teachers and their 760 preschoolers from 70 low-income, racially diverse centers.…

  17. Heterogeneity in Youth Symptom Trajectories Following Psychiatric Crisis: Predictors and Placement Outcome

    ERIC Educational Resources Information Center

    Halliday-Boykins, Colleen A.; Henggeler, Scott W.; Rowland, Melisa D.; DeLucia, Christian

    2004-01-01

    The authors examined heterogeneity in symptom trajectories among youths following psychiatric crises as well as the psychosocial correlates and placement outcomes associated with identified trajectories. Using semiparametric mixture modeling with 156 youths approved for psychiatric hospitalization, the authors identified 5 trajectories based on…

  18. Fathering and Attachment in the USA and Taiwan: Contextual Predictors and Child Outcomes

    ERIC Educational Resources Information Center

    Newland, Lisa A.; Coyl, Diana D.; Chen, Hui-Hua

    2010-01-01

    This study examined connections between fathering context (stress, social support, and fathers' internal working models), fathering dimensions, children's attachment to fathers, and children's social-emotional and academic outcomes within two culturally diverse samples in the USA and Taiwan. Participants included 274 fathers and their eight- to…

  19. Similarity of Outcome Predictors across Opiate, Cocaine, and Alcohol Treatments: Role of Treatment Services.

    ERIC Educational Resources Information Center

    McLellan, A. Thomas; And Others

    1994-01-01

    Outcomes were predicted by similar factors, regardless of drug problem or type of treatment. Greater substance use at follow-up was predicted by greater severity of use at admission, not number of services during treatment. Social adjustment was negatively predicted by more severe psychiatric problems at admission and positively predicted by more…

  20. Depression and Geographic Status as Predictors for Coronary Artery Bypass Surgery Outcomes

    ERIC Educational Resources Information Center

    Dao, Tam K.; Chu, Danny; Springer, Justin; Hiatt, Emily; Nguyen, Quang

    2010-01-01

    Purpose: To examine the relationships between depression, geographic status, and clinical outcomes following a coronary artery bypass grafting (CABG) surgery. Methods: Using the 2004 Nationwide Inpatient Sample database, we identified 63,061 discharge records of patients who underwent a primary CABG surgery (urban 57,247 and rural 5,814). We…

  1. Quality of relationships as predictors of outcomes in people with dementia: a systematic review protocol

    PubMed Central

    Savović, Jelena; Whiting, Penny; Leach, Verity; Richards, Alison; Cullum, Sarah; Cheston, Richard

    2016-01-01

    Introduction Serious adverse outcomes for people with dementia include institutionalisation, hospitalisation, death, development of behavioural and psychiatric symptoms, and reduced quality of life. The quality of the relationship between the person with dementia and their informal/family carer is thought to affect the risk of these outcomes. However, little is known about which aspects of relationship quality are important, or how they affect outcomes for people with dementia. Methods and analysis This will be a systematic review of the literature. Electronic databases MEDLINE, EMBASE, Web of Science, PsycInfo, the Cochrane Database, ALOIS and OpenGrey will be searched from inception. 2 independent reviewers will screen results for eligibility with standardised criteria. Data will be extracted for relevant studies, and information on the associations between relationship quality and dementia outcomes will be synthesised. Meta-analysis will be performed if possible to calculate pooled effect sizes. Narrative synthesis will be performed if study heterogeneity rules out meta-analysis. Ethics and dissemination Ethical review is not necessary as this review summarises data from previous studies. Results will be disseminated via peer-reviewed publication. Results will also be disseminated to a patient and public involvement group and an expert panel for their views on the findings and implications for future work. Trial registration number CRD42015020518. PMID:27044583

  2. Child and Family Predictors of Therapy Outcome for Children with Behavioral and Emotional Problems

    ERIC Educational Resources Information Center

    Hemphill, Sheryl A.; Littlefield, Lyn

    2006-01-01

    This study investigated the characteristics of 106 children primarily referred for externalizing behavior problems and their families, and assessed the prediction of treatment outcome following a standardized short-term, cognitive behavioral group program. "Exploring Together" comprised a children's group (anger management, problem-solving and…

  3. Contextual and Personal Predictors of Adaptive Outcomes under Terror Attack: The Case of Israeli Adolescents

    ERIC Educational Resources Information Center

    Zeidner, Moshe

    2005-01-01

    This paper explores individual differences in perceptions of political violence, strategies for coping with violence, and adaptive outcomes. Data on political violence stress, personal variables, coping strategies, and stress reactions were gathered on a sample of 227 Israeli adolescents in Haifa and Northern Israel confronted with a prolonged…

  4. Predictors of Short-Term Treatment Outcomes among California's Proposition 36 Participants

    ERIC Educational Resources Information Center

    Hser, Yih-Ing; Evans, Elizabeth; Teruya, Cheryl; Huang, David; Anglin, M. Douglas

    2007-01-01

    California's voter-initiated Proposition 36 offers non-violent drug offenders community-based treatment as an alternative to incarceration or probation without treatment. This article reports short-term treatment outcomes subsequent to this major shift in drug policy. Data are from 1104 individuals randomly selected from all Proposition 36…

  5. System and Individual Outcomes and Their Predictors in Services and Support for People with IDD

    ERIC Educational Resources Information Center

    Ticha, Renata; Hewitt, Amy; Nord, Derek; Larson, Sherri

    2013-01-01

    The growth and advancement of community-based services for people with intellectual and developmental disabilities (IDD) have resulted in vast changes in the long-term services and support landscape as well as in expected outcomes of service systems for service recipients. Investments in IDD research have been made to provide a deeper…

  6. Predictors of Course Outcomes: Early Indicators of Delay in Online Classrooms

    ERIC Educational Resources Information Center

    McElroy, Barbara Woods; Lubich, Bruce H.

    2013-01-01

    Studies have long shown that students who begin or submit their work later tend to have negative academic outcomes. The measures of procrastination used in those studies may not have provided information timely enough for instructor intervention. This article focuses on delay in the online environment among graduate students. We propose two new…

  7. The Tinnitus Research Initiative (TRI) database: A new approach for delineation of tinnitus subtypes and generation of predictors for treatment outcome

    PubMed Central

    2010-01-01

    Tinnitus, the phantom perception of sound, is a frequent disorder that causes significant morbidity and treatment is elusive. A large variety of different treatment options have been proposed and from most of them some patients benefit. However, a particular treatment that helps one patient may fail for others. This suggests that there are different forms of tinnitus which differ in their pathophysiology and their response to specific treatments. Therefore, it is a major challenge for tinnitus treatment to identify the most promising therapy for a specific patient. However, most published clinical treatment studies have enrolled only relatively small patient samples, making it difficult to identify predictors of treatment response for specific approaches. Furthermore, inter-study comparability is limited because of varying methods of tinnitus assessment and different outcome parameters. Performing clinical trials according to standardized methodology and pooling the data in a database should facilitate both clinical subtypisation of different forms of tinnitus, and identification of promising treatments for different types of tinnitus. This would be an important step towards the goal of individualized treatment of tinnitus. For these reasons, an international database of tinnitus patients, who undergo specific treatments, and are assessed during the course of this treatment with standardized instruments (e.g., psychoacoustic measures, questionnaires) has been established. The primary objectives of this database are (1) collecting a standardized set of data on patient characteristics, treatments, and outcomes from tinnitus patients consulting specialized tinnitus clinics all over the world (at present 13 centers in 8 countries), (2) delineating different subtypes of tinnitus based on data that has been systematically collected and (3) identifying predictors for individual treatment response based on the clinical profile. Starting in 2008, the database currently

  8. Effectiveness and predictors of outcome in routine out-patient mental health care for older adults.

    PubMed

    Veerbeek, Marjolein A; Oude Voshaar, Richard C; Pot, Anne Margriet

    2014-04-23

    ABSTRACT Background: Meta-analyses show efficacy of several psychological and pharmacological interventions for late-life psychiatric disorders, but generalization of effects to routine mental health care for older people remains unknown. Aim of this study is to investigate the improvement of functioning within one year of referral to an outpatient mental health clinic for older adults. Methods: Pre-post measurement of the Health of Nations Outcome Scale 65+ (HoNOS 65+) in 704 older people referred for psychiatric problems (no dementia) to any of the seven participating mental health care organizations. Results: The pre-post-test Cohen's d effect size was 1.08 in the total group and 1.23 in depressed patients, the largest subgroup. Linear regression identified better functioning at baseline, comorbid personality disorder, somatic comorbidity and life events during treatment as determinants of a worse outcome. Conclusions: Functioning of older persons with psychiatric problems largely improves after treatment in routine mental health care.

  9. Why Can't We Bet on ISD Outcomes: ISD ``Form'' as a Predictor of Success

    NASA Astrophysics Data System (ADS)

    Newman, Mike; Pan, Shan L.; Pan, Gary

    The record of failure to deliver large-scale information systems (IS) in a timely fashion that offer value to major commercial and public organizations is legendary. Just looking to critical success factors such as top management support and user involvement in order to understand how to deliver better systems can at best be a partial solution. We seem to overlook an obvious area in our organizations: what can we learn from our information system development (ISD) historical patterns? In order to develop this idea we draw on parallels in sport where current performance and behaviour are believed to be closely linked to historical precedents, or “form”. In that domain, historical patterns are a fallible but valuable predictor of success. Our thesis is that past negative patterns in ISD will tend to repeat themselves without radical intervention. Put another way, failure begets failure. After examining the game of football as an allegory for ISD, we look briefly at two organizations that have experienced a pattern of failure in the IS area in the past but have transformed the way they build IS, moving from negative patterns to successful ones. This chapter ends with suggestions for managers charged with developing new IS as to how they might use their understanding of ISD “form” to improve their chances of success.

  10. Openness to experience as a predictor and outcome of upward job changes into managerial and professional positions.

    PubMed

    Nieß, Christiane; Zacher, Hannes

    2015-01-01

    In industrial and organizational psychology, there is a long tradition of studying personality as an antecedent of work outcomes. Recently, however, scholars have suggested that personality characteristics may not only predict, but also change due to certain work experiences, a notion that is depicted in the dynamic developmental model (DDM) of personality and work. Upward job changes are an important part of employees' careers and career success in particular, and we argue that these career transitions can shape personality over time. In this study, we investigate the Big Five personality characteristics as both predictors and outcomes of upward job changes into managerial and professional positions. We tested our hypotheses by applying event history analyses and propensity score matching to a longitudinal dataset collected over five years from employees in Australia. Results indicated that participants' openness to experience not only predicted, but that changes in openness to experience also followed from upward job changes into managerial and professional positions. Our findings thus provide support for a dynamic perspective on personality characteristics in the context of work and careers. PMID:26110527

  11. Is hyperglycaemia an independent predictor of poor outcome after acute stroke? Results of a long-term follow up study.

    PubMed Central

    Weir, C. J.; Murray, G. D.; Dyker, A. G.; Lees, K. R.

    1997-01-01

    OBJECTIVE: To determine whether raised plasma glucose concentration independently influences outcome after acute stroke or is a stress response reflecting increased stroke severity. DESIGN: Long-term follow up study of patients admitted to an acute stroke unit. SETTING: Western Infirmary, Glasgow. SUBJECTS: 811 patients with acute stroke confirmed by computed tomography. Analysis was restricted to the 750 non-diabetic patients. MAIN OUTCOME MEASURES: Survival time and placement three months after stroke. RESULTS: 645 patients (86%) had ischaemic stroke and 105 patients (14%) haemorrhagic stroke. Cox's proportional hazards modelling with stratification according to Oxfordshire Community Stroke Project categories identified increased age (relative hazard 1.36 per decade; 95% confidence interval 1.21 to 1.53), haemorrhagic stroke (relative hazard 1.67; 1.22 to 2.28), time to resolution of symptoms > 72 hours (relative hazard 2.15; 1.15 to 4.05), and hyperglycaemia (relative hazard 1.87; 1.43 to 2.45) as predictors of mortality. The effect of glucose concentration on survival was greatest in the first month. CONCLUSIONS: Plasma glucose concentration above 8 mmol/l after acute stroke predicts a poor prognosis after correcting for age, stroke severity, and stroke subtype. Raised plasma glucose concentration is therefore unlikely to be solely a stress response and should arguably be treated actively. A randomised trial is warranted. PMID:9158464

  12. Openness to Experience as a Predictor and Outcome of Upward Job Changes into Managerial and Professional Positions

    PubMed Central

    Nieß, Christiane; Zacher, Hannes

    2015-01-01

    In industrial and organizational psychology, there is a long tradition of studying personality as an antecedent of work outcomes. Recently, however, scholars have suggested that personality characteristics may not only predict, but also change due to certain work experiences, a notion that is depicted in the dynamic developmental model (DDM) of personality and work. Upward job changes are an important part of employees’ careers and career success in particular, and we argue that these career transitions can shape personality over time. In this study, we investigate the Big Five personality characteristics as both predictors and outcomes of upward job changes into managerial and professional positions. We tested our hypotheses by applying event history analyses and propensity score matching to a longitudinal dataset collected over five years from employees in Australia. Results indicated that participants’ openness to experience not only predicted, but that changes in openness to experience also followed from upward job changes into managerial and professional positions. Our findings thus provide support for a dynamic perspective on personality characteristics in the context of work and careers. PMID:26110527

  13. Clinical heterogeneity and predictors of outcome in primary autoimmune hemolytic anemia: a GIMEMA study of 308 patients.

    PubMed

    Barcellini, Wilma; Fattizzo, Bruno; Zaninoni, Anna; Radice, Tommaso; Nichele, Ilaria; Di Bona, Eros; Lunghi, Monia; Tassinari, Cristina; Alfinito, Fiorella; Ferrari, Antonella; Leporace, Anna Paola; Niscola, Pasquale; Carpenedo, Monica; Boschetti, Carla; Revelli, Nicoletta; Villa, Maria Antonietta; Consonni, Dario; Scaramucci, Laura; De Fabritiis, Paolo; Tagariello, Giuseppe; Gaidano, Gianluca; Rodeghiero, Francesco; Cortelezzi, Agostino; Zanella, Alberto

    2014-11-01

    The clinical outcome, response to treatment, and occurrence of acute complications were retrospectively investigated in 308 primary autoimmune hemolytic anemia (AIHA) cases and correlated with serological characteristics and severity of anemia at onset. Patients had been followed up for a median of 33 months (range 12-372); 60% were warm AIHA, 27% cold hemagglutinin disease, 8% mixed, and 5% atypical (mostly direct antiglobulin test negative). The latter 2 categories more frequently showed a severe onset (hemoglobin [Hb] levels ≤6 g/dL) along with reticulocytopenia. The majority of warm AIHA patients received first-line steroid therapy only, whereas patients with mixed and atypical forms were more frequently treated with 2 or more therapy lines, including splenectomy, immunosuppressants, and rituximab. The cumulative incidence of relapse was increased in more severe cases (hazard ratio 3.08; 95% confidence interval, 1.44-6.57 for Hb ≤6 g/dL; P < .001). Thrombotic events were associated with Hb levels ≤6 g/dL at onset, intravascular hemolysis, and previous splenectomy. Predictors of a fatal outcome were severe infections, particularly in splenectomized cases, acute renal failure, Evans syndrome, and multitreatment (4 or more lines). The identification of severe and potentially fatal AIHA in a largely heterogeneous disease requires particular experienced attention by clinicians.

  14. Magnetic Resonance Imaging Predictors of Surgical Outcome in Patients with Lumbar Intervertebral Disc Herniation

    PubMed Central

    Lurie, Jon D.; Moses, Rachel A.; Tosteson, Anna N. A.; Tosteson, Tor D.; Carragee, Eugene J.; Carrino, John A.; Kaiser, Jay A.; Herzog, Richard J.

    2013-01-01

    Study Design A retrospective cohort design Objective To determine if baseline MRI findings including central/foraminal stenosis, Modic change, disc morphology, facet arthropathy, disc degeneration, nerve root impingement, and thecal sac compression are associated with differential surgical treatment effect. Summary of Background Data Intervertebral Disc Herniation (IDH)remains the most common source of lumbar radiculopathy treated either with discectomy or non-operative intervention. Although MRI remains the reliable gold standard for diagnosis, uncertainty surrounds the relationship between MRI findings and treatment outcomes. Methods Three-hundred-and-seven “complete” images from patients enrolled in a previous trial were de-identified and evaluated by one of 4 independent readers. Findings were compared to outcome measures including the Oswestry Disability Index. Differences in surgery and non-operative treatment outcomes were evaluated between image characteristic subgroups and TE determined by the difference in ODI scores. Results The cohort was comprised of 40% females with an average age of 41.5 (±11.6), 61% of which underwent discectomy for IDH. Patients undergoing surgery with Modic type I endplate changes had worse outcomes (−26.4 versus −39.7 for none and −39.2 for type 2, p=0.002) and smaller treatment effect (−3.5 versus −19.3 for none and −15.7 for type 2, p=0.003). Those with compression >=1/3 showed the greatest improvement within the surgical group (−41.9 for >=1/3 versus −31.6 for none and −38.1 for <1/3,p=0.007), and the highest TE (−23 compared to −11.7 for none and −15.2 for <1/3, p=0.015). Furthermore, patients with minimal nerve root impingement demonstrated worse surgical outcomes(−26.5 versus −41.1 for “displaced” and −38.9 for “compressed”, p=0.016). Conclusion Among patients with IDH, those with thecal sac compression >=1/3 had greater surgical treatment effect than those with small disc

  15. Surgical Outcome Predictor in Degenerative Lumbar Spinal Disease Based on Health Related Quality of Life Using Euro-Quality 5 Dimensions Analysis

    PubMed Central

    Lee, Byung Ho; Yang, Jae-Ho; Lee, Hwan-Mo; Park, Jun-Young; Park, Sang-Eun

    2016-01-01

    Purpose We aim to introduce the predictive value of a quantitatively described formula model in a multicenter prospective analysis using the EuroQol-5 dimensions (EQ-5D) health scale to anticipate postoperative improvement in patients with degenerative lumbar spine disease (DLSD). Materials and Methods Quality of life was evaluated in 376 patients from 17 tertiary hospitals before and after spinal decompression and fusion surgery. The five items of the EQ-5D, mobility (M), self-care (S), usual activities (A), pain/discomfort (P), and anxiety/depression (D), were checked as level 1, 2, or 3, with 3 being the worst. A minimal significant change in the calculated EQ-5D (cEQ-5D) was set as 0.05. Logistic regression analysis was performed to predict the highest successful outcome (cEQ-5D improvement after operation >0.05) with the given sets of 5 items of the EQ-5D. Results In the cEQ-5D analysis, among patients with a formula score of S+A+2×P+D≤8, 18/68 (27%) showed significant improvement in the cEQ-5D at 1 year postoperatively (p<0.05). However, in patients with a formula score of ≥9, 265/308 (86%) demonstrated significant improvements in the cEQ-5D at 1 year postoperatively (p<0.05). Conclusion We suggest that S+A+2×P+D≥9 in the EQ-5D can quantitatively describe the better surgical outcome predictors for DLSD. With a definite DLSD lesion confirmed by an imaging study, patients who meet the formula scores of 9 or over and have refractory symptoms to non-operative treatment could be better surgical candidates resulting in satisfactory surgical outcomes of over 86%, than those who scored 8 or lower. PMID:27401654

  16. Body mass index is not a clinically meaningful predictor of patient reported outcomes of primary hip replacement surgery: prospective cohort study

    PubMed Central

    Judge, Andy; Batra, Rajbir N; Thomas, Geraint; Beard, David; Javaid, M Kassim; Murray, David; Dieppe, Paul A; Dreinhoefer, Karsten; Peter-Guenther, Klaus; Field, Richard; Cooper, Cyrus; Arden, Nigel K

    2014-01-01

    Objectives To describe whether body mass index (BMI) is a clinically meaningful predictor of patient reported outcomes following primary total hip replacement (THR) surgery Design Combined data from prospective cohort studies. We obtained information from four cohorts of patients receiving primary THR for osteoarthritis: Exeter Primary Outcomes Study (n=1431); EUROHIP (n=1327); Elective Orthopaedic Centre (n=2832); and St. Helier (n=787). The exposure of interest was pre-operative BMI. Confounding variables included: age, sex, SF-36 mental health, comorbidities, fixed flexion, analgesic use, college education, OA in other joints, expectation of less pain, radiographic K&L grade, ASA grade, years of hip pain. The primary outcome was the Oxford Hip Score (OHS). Regression models describe the association of BMI on outcome adjusting for all confounders. Results For a 5-unit increase in BMI, the attained 12-month OHS decreases by 0.78 points 95%CI (0.27 to 1.28), p-value 0.001. Compared to people of normal BMI (20 to 25), those in the obese class II (BMI 35 to 40) would have a 12-month OHS that is 2.34 points lower. Although statistically significant this effect is small and not clinically meaningful in contrast to the substantial change in OHS seen across all BMI groupings. In obese class II patients achieved a 22.2 point change in OHS following surgery. Conclusions Patients achieved substantial change in OHS after THR across all BMI categories, which greatly outweighs the small difference in attained post-operative score. The findings suggest BMI should not present a barrier to access THR in terms of PROMs. PMID:24418679

  17. Folic acid supplement use is the most significant predictor of folate concentrations in Canadian women of childbearing age.

    PubMed

    Colapinto, Cynthia K; O'Connor, Deborah L; Dubois, Lise; Tremblay, Mark S

    2012-04-01

    One-fifth of Canadian women of childbearing age (WCBA) have red blood cell (RBC) folate concentrations below those considered optimal for neural tube defect risk reduction (≥906 nmol·L(-1)). Determinants of optimal concentrations have not been examined in a nationally representative sample of Canadian WCBA since food fortification with folic acid was implemented. This study explored correlates of optimal RBC folate concentrations and characteristics of folic acid supplement users in a sample of Canadian WCBA. RBC folate concentrations from the 2007-2009 Canadian Health Measures Survey were assessed in women aged 15 to 45 years (n = 1162). Sociodemographic, behavioural, and clinical determinants of RBC folate ≥906 nmol·L(-1) were examined using univariate and separate multiple logistic regression models that controlled for age and household income. t tests were used to study differences between folic acid supplement users and nonusers. WCBA not taking folic acid supplements were less likely to achieve a RBC folate concentration ≥906 nmol·L(-1) compared with folic acid supplement users (odds ratio, 0.47; 95% confidence interval, 0.24, 0.92). Twenty-five percent of WCBA reported folic acid supplement use, and there was a higher percentage of folic acid supplement users in the highest income group. Folic acid supplement users were also more frequent consumers of supplemental vitamin B(12) and of fruit and vegetables (>3 times per day). Folic acid supplement use was the most significant predictor of WCBA achieving optimal RBC folate concentrations. These results indicate a need for targeted strategies to improve compliance with folic acid supplement recommendations among WCBA.

  18. Body Size Is a Significant Predictor of Congruency in Species Richness Patterns: A Meta-Analysis of Aquatic Studies

    PubMed Central

    Velghe, Katherine; Gregory-Eaves, Irene

    2013-01-01

    Biodiversity losses over the next century are predicted to result in alterations of ecosystem functions that are on par with other major drivers of global change. Given the seriousness of this issue, there is a need to effectively monitor global biodiversity. Because performing biodiversity censuses of all taxonomic groups is prohibitively costly, indicator groups have been studied to estimate the biodiversity of different taxonomic groups. Quantifying cross-taxon congruence is a method of evaluating the assumption that the diversity of one taxonomic group can be used to predict the diversity of another. To improve the predictive ability of cross-taxon congruence in aquatic ecosystems, we evaluated whether body size, measured as the ratio of average body length between organismal groups, is a significant predictor of their cross-taxon biodiversity congruence. To test this hypothesis, we searched the published literature and screened for studies that used species richness correlations as their metric of cross-taxon congruence. We extracted 96 correlation coefficients from 16 studies, which encompassed 784 inland water bodies. With these correlation coefficients, we conducted a categorical meta-analysis, grouping data based on the body size ratio of organisms. Our results showed that cross-taxon congruence is variable among sites and between different groups (r values ranging between −0.53 to 0.88). In addition, our quantitative meta-analysis demonstrated that organisms most similar in body size showed stronger species richness correlations than organisms which differed increasingly in size (radj2 = 0.94, p = 0.02). We propose that future studies applying biodiversity indicators in aquatic ecosystems consider functional traits such as body size, so as to increase their success at predicting the biodiversity of taxonomic groups where cost-effective conservation tools are needed. PMID:23468903

  19. Prostate volume and biopsy tumor length are significant predictors for classical and redefined insignificant cancer on prostatectomy specimens in Japanese men with favorable pathologic features on biopsy

    PubMed Central

    2014-01-01

    Background Gleason pattern 3 less often has molecular abnormalities and often behaves indolent. It is controversial whether low grade small foci of prostate cancer (PCa) on biopsy could avoid immediate treatment or not, because substantial cases harbor unfavorable pathologic results on prostatectomy specimens. This study was designed to identify clinical predictors for classical and redefined insignificant cancer on prostatectomy specimens in Japanese men with favorable pathologic features on biopsy. Methods Retrospective review of 1040 PCa Japanese patients underwent radical prostatectomy between 2006 and 2013. Of those, 170 patients (16.3%) met the inclusion criteria of clinical stage ≤ cT2a, Gleason score (GS) ≤ 6, up to two positive biopsies, and no more than 50% of cancer involvement in any core. The associations between preoperative data and unfavorable pathologic results of prostatectomy specimens, and oncological outcome were analyzed. The definition of insignificant cancer consisted of pathologic stage ≤ pT2, GS ≤ 6, and an index tumor volume < 0.5 mL (classical) or 1.3 mL (redefined). Results Pathologic stage ≥ pT3, upgraded GS, index tumor volume ≥ 0.5 mL, and ≥ 1.3 mL were detected in 25 (14.7%), 77 (45.3%), 83 (48.8%), and 53 patients (31.2%), respectively. Less than half of cases had classical (41.2%) and redefined (47.6%) insignificant cancer. The 5-year recurrence-free survival was 86.8%, and the insignificant cancers essentially did not relapse regardless of the surgical margin status. MRI-estimated prostate volume, tumor length on biopsy, prostate-specific antigen density (PSAD), and findings of magnetic resonance imaging were associated with the presence of classical and redefined insignificant cancer. Large prostate volume and short tumor length on biopsy remained as independent predictors in multivariate analysis. Conclusions Favorable features of biopsy often are followed by adverse pathologic

  20. Cerebral Malaria Retinopathy Predictors of Persisting Neurocognitive Outcomes in Malawian Children

    PubMed Central

    Boivin, Michael J.; Vokhiwa, Maclean; Sikorskii, Alla; Magen, Jed G.; Beare, Nicholas A.V.

    2014-01-01

    Background Neuropsychological sequelae from pediatric cerebral malaria (CM) have been well documented. Although malaria-specific retinopathy during acute illness has become a defining criterion for CM, its relationship to neurocognitive sequelae has not been documented. This relationship is important if malaria-specific retinopathy reflects the possible brain neuropathogenesis leading to long-term neurocognitive deficits. Methods From 2008 to 2012, 49 Malawian children 4.5 to 12 yrs of age surviving retinopathy-positive cerebral malaria (CM-R) were tested 1 to 3 yrs following illness with the Kaufman Assessment Battery for Children, 2nd edition (KABC-II), the Tests of Variables of Attention (TOVA), and the Achenbach Child Behavior Checklist (CBCL). In an observational study of a cohort of cerebral malaria survivors, these neurocognitive and behavioral outcomes were statistically related to types and severity of retinopathy measures, while controlling for age, sex, body mass index, socio-economic status, and time interval between illness and testing. Results Worse scores for hemorrhages, papilledema, optic disk hyperemia, retinal whitening of macula and foveal annulus were associated with poorer KABC-II mental processing index and global scale scores. Disk hyperemia was also predictive of TOVA D prime overall attention performance (inattention) and commission errors (impulsivity). Few associations were found between retinopathy scores and CBCL (emotional and behavioral) outcomes. Conclusions We are the first to report the relationship between severity of malaria-specific retinopathy during acute illness in CM survivors, and persisting neurocognitive problems. These findings support earlier studies documenting that severity of retinopathy during acute illness is medically prognostic in CM survivors. We extend these findings to include long-term neurocognitive outcomes. PMID:24763139

  1. Soluble Adhesion Molecules in Patients Coinfected with HIV and HCV: A Predictor of Outcome

    PubMed Central

    Aldámiz-Echevarría, Teresa; Berenguer, Juan; Miralles, Pilar; Jiménez-Sousa, María A.; Carrero, Ana; Pineda-Tenor, Daniel; Díez, Cristina; Tejerina, Francisco; Pérez-Latorre, Leire; Bellón, José M.; Resino, Salvador

    2016-01-01

    Background Higher serum levels of adhesion molecules (sICAM-1 and sVCAM-1) are associated with advanced liver fibrosis in patients coinfected with human immunodeficiency virus and hepatitis C virus. We assessed the relationship between serum levels of adhesion molecules and liver-related events (LRE) or death, in coinfected patients. Methods We studied clinical characteristics and outcomes of 182 coinfected patients with a baseline liver biopsy (58 with advanced fibrosis) and simultaneous plasma samples who were followed for median of 9 years. We used receiver-operating characteristic (ROC) curves to calculate optimized cutoff values (OCV) of sICAM-1 and sVCAM-1, defined as the values with the highest combination of sensitivity and specificity for LRE. We used multivariate regression analysis to test the association between OCVs of sICAM-1 and sVCAM-1 and outcomes. The variables for adjustment were age, HIV transmission category, liver fibrosis, baseline CD4+ T-cell counts, antiretroviral therapy, and sustained virologic response (SVR). Results During the study period 51 patients had SVR, 19 had LRE, and 16 died. The OCVs for LRE were 5.68 Log pg/mL for sICAM-1 and 6.25 Log pg/mL for sVCAM-1, respectively. The adjusted subhazard ratio (aSHR) (95% confidence interval [CI]) of death or LRE, whichever occurred first, for sICAM-1 and sVCAM-1 > OCV were 3.98 ([1.14; 13.89], P = 0.030) and 2.81 ([1.10; 7.19], respectively (P = 0.030). Conclusions Serum levels of sICAM-1 and sVCAM-1 can serve as markers of outcome in HIV/HCV-coinfected patients. Therapies targeting necroinflammatory damage and fibrogenesis may have a role in the management chronic hepatitis C. PMID:26849641

  2. Predictors of poor outcomes among patients treated for multidrug-resistant tuberculosis at DOTS-plus projects.

    PubMed

    Kurbatova, Ekaterina V; Taylor, Allison; Gammino, Victoria M; Bayona, Jaime; Becerra, Mercedes; Danilovitz, Manfred; Falzon, Dennis; Gelmanova, Irina; Keshavjee, Salmaan; Leimane, Vaira; Mitnick, Carole D; Quelapio, Ma Imelda; Riekstina, Vija; Viiklepp, Piret; Zignol, Matteo; Cegielski, J Peter

    2012-09-01

    The Objective of this analysis was to identify predictors of death, failure, and default among MDR-TB patients treated with second-line drugs in DOTS-plus projects in Estonia, Latvia, Philippines, Russia, and Peru, 2000-2004. Risk ratios (RR) with 95% confidence intervals (CI) were calculated using multivariable regression. Of 1768 patients, treatment outcomes were: cure/completed - 1156 (65%), died - 200 (11%), default - 241 (14%), failure - 118 (7%). Independent predictors of death included: age>45 years (RR = 1.90 (95%CI 1.29-2.80), HIV infection (RR = 4.22 (2.65-6.72)), extrapulmonary disease (RR = 1.54 (1.04-2.26)), BMI<18.5 (RR = 2.71 (1.91-3.85)), previous use of fluoroquinolones (RR = 1.91 (1.31-2.78)), resistance to any thioamide (RR = 1.59 (1.14-2.22)), baseline positive smear (RR = 2.22 (1.60-3.10)), no culture conversion by 3rd month of treatment (RR = 1.69 (1.19-2.41)); failure: cavitary disease (RR = 1.73 (1.07-2.80)), resistance to any fluoroquinolone (RR = 2.73 (1.71-4.37)) and any thioamide (RR = 1.62 (1.12-2.34)), and no culture conversion by 3rd month (RR = 5.84 (3.02-11.27)); default: unemployment (RR = 1.50 (1.12-2.01)), homelessness (RR = 1.52 (1.00-2.31)), imprisonment (RR = 1.86 (1.42-2.45)), alcohol abuse (RR = 1.60 (1.18-2.16)), and baseline positive smear (RR = 1.35 (1.07-1.71)). Patients with biomedical risk factors for treatment failure or death should receive heightened medical attention. To prevent treatment default, management of patients who are unemployed, homeless, alcoholic, or have a prison history requires extra measures to insure treatment completion. PMID:22789497

  3. The visual aura rating scale as an outcome predictor for persistent visual aura without infarction.

    PubMed

    Wang, Y-F; Fuh, J-L; Chen, W-T; Wang, S-J

    2008-12-01

    Persistent visual aura without infarction is rare. Its pathogenic mechanism is unknown, and the response to migraine prophylactic agents varies. A systematic analysis of 29 patients (23 from the literature and six in the present report; 6M/23F, mean age 37.6 years) was carried out in terms of demographics, headache and visual symptom profiles, treatment regimens and outcomes. Patterns of visual disturbances (VDs) were re-assessed with the Visual Aura Rating Scale (VARS, score 0-10). Even though the majority of patients had headache improvement, only eight (27.6%) had complete resolution of persistent VD, without definite relevance to any specific agent. Patients with complete resolution of VD tended to have scotoma (50.0% vs. 0%; P = 0.003), unilateral/homonymous involvement (62.5% vs. 9.5%; P = 0.008), higher VARS scores (1.88 +/- 1.73 vs. 0.10 +/- 0.30; P < 0.001) and shorter duration of illness (10.0 +/- 12.9 vs. 60.2 +/- 90.9 months, P = 0.008) compared with those without. These findings remained even when the six current patients were not included for analyses. In conclusion, the prognosis of persistent VD was poor, and higher VARS scores, i.e. more typical of migraine visual aura, predicted a better outcome. For those with a potential for complete resolution, improvement would occur early in the course.

  4. Outcome predictors of treatment effectiveness for fungal malignant external otitis: a systematic review.

    PubMed

    Mion, M; Bovo, R; Marchese-Ragona, R; Martini, A

    2015-10-01

    The aim of this review is to summarise literature data on clinical aspects and traditional management of fungal malignant external otitis (FMEO), and to identify potential predictive factors of positive treatment outcome. Articles were initially selected based on their titles or abstracts. Full articles were then retrieved and further scrutinised according to predetermined criteria. Reference lists of selected articles were searched for any missed publications. The selected articles were methodologically evaluated. Of an initial 143 references, 14 were selected that focalised on the management of FMEO. The majority of studies demonstrated a correlation between treatment effectiveness, assessed as symptom resolution, and clinical and management variables: abstention from surgical debridement, absence of facial palsy, Aspergillus spp. as causative pathogen and absence of imaging findings at diagnosis and follow-up. The effectiveness of FMEO treatment depends on the assessment of cranial nerve state, the causative pathogen and imaging findings. Above all, absence of facial nerve palsy, Aspergillus spp. and absence of radiological signs at diagnosis and during follow-up correlate with symptom resolution. The fact that conservative treatment may be associated with a better outcome than surgical debridement could purely reflect that patients with more aggressive and advanced illness required debridement, whereas milder disease was treated conservatively. Thus, caution should be advised in the interpretation of data due to the need for further trials on the topic.

  5. Early predictors of outcome in infants treated with hypothermia for hypoxic-ischaemic encephalopathy.

    PubMed

    Merchant, Nazakat; Azzopardi, Denis

    2015-04-01

    Hypoxic-ischaemic encephalopathy (HIE) is a leading cause of acquired neonatal brain injury. Assessment of the severity of cerebral injury and likely neurological outcome in infants with HIE is important for determining management and prognosis, for counselling parents, and for selection for neuroprotective trials. The condition of the infant at birth, the severity of HIE, neurophysiological tests, including amplitude-integrated electroencephalography (aEEG), biochemical markers, and neuroimaging have been used to assess prognosis and predict long-term outcome. The predictive accuracy of these indicators in the early postnatal period is modest. Neurophysiological assessment seems to be most helpful during the first 24 to 48 hours after birth whilst magnetic resonance imaging (MRI) seems most informative later. Several biochemical markers, including serum S100β and neuron-specific enolase (NSE), are also associated with HIE but their levels depend on the timing of sampling and their prognostic value is uncertain. Comprehensive neurophysiological assessment and neuroimaging may be limited to specialist centres. Therapeutic hypothermia is now standard care in infants with moderate to severe HIE so it is important to examine the influence of hypothermia on the assessment of prognosis in these infants.

  6. Early predictors of outcome in infants treated with hypothermia for hypoxic-ischaemic encephalopathy.

    PubMed

    Merchant, Nazakat; Azzopardi, Denis

    2015-04-01

    Hypoxic-ischaemic encephalopathy (HIE) is a leading cause of acquired neonatal brain injury. Assessment of the severity of cerebral injury and likely neurological outcome in infants with HIE is important for determining management and prognosis, for counselling parents, and for selection for neuroprotective trials. The condition of the infant at birth, the severity of HIE, neurophysiological tests, including amplitude-integrated electroencephalography (aEEG), biochemical markers, and neuroimaging have been used to assess prognosis and predict long-term outcome. The predictive accuracy of these indicators in the early postnatal period is modest. Neurophysiological assessment seems to be most helpful during the first 24 to 48 hours after birth whilst magnetic resonance imaging (MRI) seems most informative later. Several biochemical markers, including serum S100β and neuron-specific enolase (NSE), are also associated with HIE but their levels depend on the timing of sampling and their prognostic value is uncertain. Comprehensive neurophysiological assessment and neuroimaging may be limited to specialist centres. Therapeutic hypothermia is now standard care in infants with moderate to severe HIE so it is important to examine the influence of hypothermia on the assessment of prognosis in these infants. PMID:25800487

  7. HYPERGLYCOSYLATED HUMAN CHORIONIC GONADOTROPIN AS AN EARLY PREDICTOR OF PREGNANCY OUTCOMES AFTER IN VITRO FERTILIZATION

    PubMed Central

    Chuan, Sandy; Homer, Michael; Pandian, Raj; Conway, Deirdre; Garzo, Gabriel; Yeo, Lisa; Su, H. Irene

    2014-01-01

    Objective To determine if hyperglycosylated hCG (hhCG), produced by invasive trophoblasts, measured as early as 9 days after egg retrieval can predict ongoing pregnancies (OP) after in vitro fertilization and fresh embryo transfer (IVF-ET). Design Cohort Setting Academic ART center Patients Consecutive patients undergoing IVF-ET Interventions Serum hhCG and hCG levels measured 9 (D9) and 16 (D16) days after egg retrieval Outcome Ongoing pregnancy (OP) beyond 9 weeks of gestation Results OP (62 of 112 participants) was associated with higher D9 levels of hhCG and hCG However, hhCG was detectable in all D9 OP samples, while hCG was detectable in only 22%. D9 hhCG levels >110 pg/mL was 96% specific for OP, yielding a positive predictive value of 95%. Compared to D9 hCG levels, hhCG was more sensitive and had a larger area under the curve (0.87 vs. 0.67). Diagnostic test characteristics were similar between D16 hhCG and hCG levels. Conclusions In patients undergoing assisted reproduction, a test to detect pregnancy early and predict outcomes is highly desirable. HhCG is detectable in serum 9 days after egg retrieval IVF-ET cycles. At this early assessment, hhCG is superior to traditional hCG and highly predictive of ongoing pregnancies. PMID:24355054

  8. Molecular remission is an independent predictor of clinical outcome in patients with mantle cell lymphoma after combined immunochemotherapy: a European MCL intergroup study

    PubMed Central

    Pott, Christiane; Hoster, Eva; Delfau-Larue, Marie-Hélène; Beldjord, Kheira; Böttcher, Sebastian; Asnafi, Vahid; Plonquet, Anne; Siebert, Reiner; Callet-Bauchu, Evelyne; Andersen, Niels; Van Dongen, Jacques J. M.; Klapper, Wolfram; Berger, Françoise; Ribrag, Vincent; Van Hoof, Achiel L.; Trneny, Marek; Walewski, Jan; Dreger, Peter; Unterhalt, Michael; Hiddemann, Wolfgang; Kneba, Michael; Kluin-Nelemans, Hanneke C.; Hermine, Olivier; Macintyre, Elizabeth; Dreyling, Martin

    2010-01-01

    The prognostic impact of minimal residual disease (MRD) was analyzed in 259 patients with mantle cell lymphoma (MCL) treated within two randomized trials of the European MCL Network (MCL Younger and MCL Elderly trial). After rituximab-based induction treatment 106/190 evaluable patients (56%) achieved a molecular remission (MR) based upon blood and/or bone marrow (BM) analysis. MR resulted in a significantly improved response duration (RD) (87% vs. 61% patients in remission at 2 years, p=0.0043) and emerged to be an independent prognostic factor for RD (HR 0.4, 95% CI 0.1–0.9, p=0.027). MR was highly predictive for prolonged RD independent of clinical response (CR, CRu, PR) (RD at 2 years: 100% in BM MRD-negative CR and 88% in BM MRD-negative CRu/PR, compared to 78% in BM MRD-positive CR and 53% in BM MRD-positive CRu/PR, p=0.0015). Sustained MR during the post-induction period was predictive for outcome in MCL Younger after ASCT (RD at 2 years 100% vs. 65%, p=0.0007) and during maintenance in MCL Elderly (RD at 2 years: 76% vs. 36%, p=0.015). ASCT in MCL Younger patients increased the proportion of patients in MR from 55% prior to high dose therapy to 72% thereafter. Sequential MRD monitoring is a powerful predictor for treatment outcome in MCL. PMID:20032498

  9. Alabama's Education Report Card, 2000: Significant Predictors of Student Achievement at the District and School Level. Research Brief.

    ERIC Educational Resources Information Center

    Miller-Whitehead, Marie

    This paper examines Alabama's State Education Report Card for the year 2000. It identifies predictors for student academic achievement at both the district and school levels for 128 public school systems and 1,272 public schools. Separate analyses were conducted for 61 city and 67 county school systems. The variables included number of students,…

  10. Predictors of Adverse Cosmetic Outcome in the RAPID Trial: An Exploratory Analysis

    SciTech Connect

    Peterson, David; Truong, Pauline T.; Parpia, Sameer; Olivotto, Ivo A.; Berrang, Tanya; Kim, Do-Hoon; Kong, Iwa; Germain, Isabelle; Nichol, Alan; Akra, Mohamed; Roy, Isabelle; Reed, Melanie; Fyles, Anthony; Trotter, Theresa; Perera, Francisco; Balkwill, Susan; Lavertu, Sophie; Elliott, Elizabeth; and others

    2015-04-01

    Purpose: To evaluate factors associated with adverse cosmesis outcome in breast cancer patients randomized to accelerated partial breast irradiation (APBI) using 3-dimensional conformal radiation therapy or whole-breast irradiation in the RAPID (Randomized Trial of Accelerated Partial Breast Irradiation) trial. Methods and Materials: Subjects were trial participants with nurse-assessed global cosmetic scores at baseline and at 3 years. Adverse cosmesis was defined as a score of fair or poor. Cosmetic deterioration was defined as any adverse change in score from baseline to 3 years. The analysis is based on data from the previously reported interim analysis. Logistic regression models were used to assess the association of risk factors for these outcomes among all patients and those treated with APBI only. Results: Clinicopathologic characteristics were similar between subjects randomized to APBI (n=569) or whole-breast irradiation (n=539). For all subjects, factors associated with adverse cosmesis at 3 years were older age, central/inner tumor location, breast infection, smoking, seroma volume, breast volume, and use of APBI; factors associated with cosmetic deterioration were smoking, seroma volume, and use of APBI (P<.05). For APBI subjects, tumor location, smoking, age, and seroma volume were associated with adverse cosmesis (P<.05), and smoking was associated with cosmetic deterioration (P=.02). An independent association between the V95/whole-breast volume ratio and adverse cosmesis (P=.28) or cosmetic deterioration (P=.07) was not detected. On further exploration a V95/whole-breast volume ratio <0.15 was associated with a lower risk of cosmetic deterioration (p=.04), but this accounted for only 11% of patients. Conclusion: In the RAPID trial, a number of patient tumor and treatment-related factors, including the use of APBI, were associated with adverse cosmesis and cosmetic deterioration. For patients treated with APBI alone, the high-dose treatment

  11. Childhood disintegrative disorder: distinction from autistic disorder and predictors of outcome.

    PubMed

    Rosman, N Paul; Bergia, Berta M

    2013-12-01

    Childhood disintegrative disorder, a rare, relentlessly progressive neurologic disorder, first described by Heller in 1908, remains a condition of great interest. It has long been debated whether it is a discrete disorder or simply a late-onset variant of childhood autism. We have studied 6 cases of childhood disintegrative disorder, collected over 8 years, and followed for 2.5 to 22 years (mean 8.6 years). Childhood disintegrative disorder begins later in life than autism, and following a period of entirely normal development; the regression is more global and more severe than in autism; seizures are more frequent than in autism, yet demonstrable organicity in childhood disintegrative disorder is decidedly rare. Lastly, the prognosis is usually much worse than in autism, but in those cases with neither seizures nor epileptiform activity on electroencephalography (EEG), the outcome may be more favorable. Childhood disintegrative disorder should be viewed as a condition distinct from childhood autism.

  12. Primary Tumor Volume Is an Important Predictor of Clinical Outcomes Among Patients With Locally Advanced Squamous Cell Cancer of the Head and Neck Treated With Definitive Chemoradiotherapy

    SciTech Connect

    Strongin, Anna; Yovino, Susannah; Taylor, Rodney; Wolf, Jeffrey; Cullen, Kevin; Zimrin, Ann; Strome, Scott; Regine, William; Suntharalingam, Mohan

    2012-04-01

    Purpose: The tumor volume has been established as a significant predictor of outcomes among patients with head-and-neck cancer undergoing radiotherapy alone. The present study attempted to add to the existing data on tumor volume as a prognostic factor among patients undergoing chemoradiotherapy. Methods and Materials: A total of 78 patients who had undergone definitive chemoradiotherapy for Stage III-IV squamous cell cancer of the hypopharynx, oropharynx, and larynx were identified. The primary tumor volumes were calculated from the treatment planning computed tomography scans, and these were correlated to the survival and tumor control data obtained from the retrospective analysis. Results: The interval to progression correlated with the primary tumor volume (p = .007). The critical cutoff point for the tumor volume was identified as 35 cm{sup 3}, and patients with a tumor volume <35 cm{sup 3} had a significantly better prognosis than those with a tumor volume >35 cm{sup 3} at 5 years (43% vs. 71%, p = .010). Longer survival was also correlated with smaller primary tumor volumes (p = .022). Similarly, patients with a primary tumor volume <35 cm{sup 3} had a better prognosis in terms of both progression-free survival (61% vs. 33%, p = .004) and overall survival (84% vs. 41%, p = < .001). On multivariate analysis, the primary tumor volume was the best predictor of recurrence (hazard ratio 4.7, 95% confidence interval 1.9-11.6; p = .001) and survival (hazard ratio 10.0, 95% confidence interval 2.9-35.1; p = < .001). In contrast, the T stage and N stage were not significant factors. Analysis of variance revealed that tumors with locoregional failure were on average 21.6 cm{sup 3} larger than tumors without locoregional failure (p = .028) and 27.1-cm{sup 3} larger than tumors that recurred as distant metastases (p = .020). Conclusion: The results of our study have shown that the primary tumor volume is a significant prognostic factor in patients with advanced cancer

  13. Brain Serotonin 1A Receptor Binding as a Predictor of Treatment Outcome in Major Depressive Disorder

    PubMed Central

    Miller, Jeffrey M.; Hesselgrave, Natalie; Ogden, R. Todd; Zanderigo, Francesca; Oquendo, Maria A.; Mann, J. John; Parsey, Ramin V.

    2013-01-01

    Background We previously reported higher serotonin 1A receptor (5-HT1A) binding in subjects with major depressive disorder (MDD) during a major depressive episode using positron emission tomography imaging with [11C]WAY-100635. 5-HT1A receptor binding is also associated with treatment outcome after nonstandardized antidepressant treatment. We examined whether pretreatment 5-HT1A binding is associated with treatment outcome following standardized escitalopram treatment in MDD. We also compared 5-HT1A binding between all MDD subjects in this cohort and a sample of healthy control subjects. Methods Twenty-four MDD subjects in a current major depressive episode and 51 previously studied healthy control subjects underwent positron emission tomography scanning with [11C]WAY-100635, acquiring a metabolite-corrected arterial input function and free-fraction measurement to estimate 5-HT1A binding potential (BPF = Bmax/KD, where Bmax = available receptors and KD = dissociation constant). Major depressive disorder subjects then received 8 weeks of treatment with escitalopram; remission was defined as a posttreatment 24-item Hamilton Depression Rating Scale <10 and ≥50% reduction in Hamilton Depression Rating Scale. Results Remitters to escitalopram had 33% higher baseline 5-HT1A binding in the raphe nuclei than nonremitters (p = .047). Across 12 cortical and subcortical regions, 5-HT1A binding did not differ between remitters and nonremitters (p = .86). Serotonin 1A receptor binding was higher in MDD than control subjects across all regions (p = .0003). Remitters did not differ from nonremitters in several relevant clinical measures. Conclusions Elevated 5-HT1A binding in raphe nuclei is associated with subsequent remission with the selective serotonin reuptake inhibitor escitalopram; this is consistent with data from a separate cohort receiving naturalistic antidepressant treatment. We confirmed our previous findings of higher 5-HT1A binding in current MDD compared with

  14. Predictors for Clinical Outcomes After Accelerated Partial Breast Intensity-Modulated Radiotherapy

    SciTech Connect

    Reeder, Reed; Carter, Dennis L. Howell, Kathryn; Henkenberns, Phyllis; Tallhamer, Michael; Johnson, Tim; Kercher, Jane; Widner, Jodi; Kaske, Terese; Paul, Devchand; Sedlacek, Scot; Leonard, Charles E.

    2009-05-01

    Purpose: To correlate the treatment planning parameters with the clinical outcomes in patients treated with accelerated partial breast intensity-modulated radiotherapy. Methods and Materials: A total of 105 patients with Stage I breast cancer were treated between February 2004 and March 2007 in a Phase II prospective trial and had detailed information available on the planning target volume (PTV), ipsilateral breast volume (IBV), PTV/IBV ratio, lung volume, chest wall volume, surgery to radiotherapy interval, follow-up interval, breast pain, and cosmesis. The first 7 of these patients were treated to 34 Gy, and the remaining 98 were treated to 38.5 Gy. All patients were treated twice daily for 5 consecutive days. Univariate and multivariate analyses were performed. Results: The median follow-up was 13 months. No recurrences or deaths were observed. Of the 105 patients, 30 reported mild or moderate breast pain in their most recently recorded follow-up visit. The irradiated lung volume (p < 0.05) and chest wall volume receiving >35 Gy (p < 0.01) were associated with pain. The PTV, but not the PTV/IBV ratio, also correlated with pain (p < 0.01 and p = 0.42, respectively). A total of 72 patients reported excellent, 32 reported good, and 1 reported poor cosmesis. Physician-rated cosmesis reported 90 excellent and 15 good. None of the tested variables correlated with the cosmetic outcomes. Conclusion: Radiotherapy to the chest wall (chest wall volume receiving >35 Gy) and to lung correlated with reports of mild pain after accelerated partial breast intensity-modulated radiotherapy. Also, the PTV, but not the PTV/IBV ratio, was predictive of post-treatment reports of pain.

  15. Predictors and Outcomes of Early vs. Later English Language Proficiency Among English Language Learners

    PubMed Central

    Halle, Tamara; Hair, Elizabeth; Wandner, Laura; McNamara, Michelle; Chien, Nina

    2011-01-01

    The development of English language learners (ELLs) was explored from kindergarten through eighth grade within a nationally representative sample of first-time kindergartners (N = 19,890). Growth curve analyses indicated that, compared to native English speakers, ELLs were rated by teachers more favorably on approaches to learning, self control, and externalizing behaviors in kindergarten and generally continued to grow in a positive direction on these social/behavioral outcomes at a steeper rate compared to their native English-speaking peers, holding other factors constant. Differences in reading and math achievement between ELLs and native English speakers varied based on the grade at which English proficiency is attained. Specifically, ELLs who were proficient in English by kindergarten entry kept pace with native English speakers in both reading and math initially and over time; ELLs who were proficient by first grade had modest gaps in reading and math achievement compared to native English speakers that closed narrowly or persisted over time; and ELLs who were not proficient by first grade had the largest initial gaps in reading and math achievement compared to native speakers but the gap narrowed over time in reading and grew over time in math. Among those whose home language is not English, acquiring English proficiency by kindergarten entry was associated with better cognitive and behavioral outcomes through eighth grade compared to taking longer to achieve proficiency. Multinomial regression analyses indicated that child, family, and school characteristics predict achieving English proficiency by kindergarten entry compared to achieving proficiency later. Results are discussed in terms of policies and practices that can support ELL children’s growth and development. PMID:22389551

  16. Perioperative Predictors of Extubation Failure and the Effect on Clinical Outcome After Infratentorial Craniotomy

    PubMed Central

    Cai, Ye-Hua; Wang, Hai-Tang; Zhou, Jian-Xin

    2016-01-01

    Background The purpose of the study was to analyze the risk factors for failed extubation in subjects submitted to infratentorial craniotomy. Material/Methods Patients aged over 18 years who received infratentorial craniotomy for brain tumor resection were consecutively included in this study. Perioperative variables were collected and analyzed. Univariate analyses and multiple logistic regression were used to derive factors related to failed extubation. Patients had follow-up care until either out of hospital or death. Results Throughout the course of the study, 2118 patients were eligible and 94 (4.4%) suffered from extubation failure at some point during their hospital stay. Five factors were recognized as independent risk factors for postoperative failed extubation: craniotomy history, preoperative lower cranial nerve dysfunction, tumor size, tumor position, and maximum change in blood pressure (BP) during the operation. Failed extubation was related to a higher incidence rate of pneumonia, mortality, unfavorable Glasgow Outcome Scale score, longer stay in the neuro-intensive care unit (ICU) and hospitalization, and higher hospitalization costs compared with successful extubation. Conclusions History of craniotomy, preoperative lower cranial nerve dysfunction, tumor size, tumor position, and maximum change in BP during the operation were independent risk factors related to postoperative failed extubation in patients submitted to infratentorial craniotomy. Extubation failure raises the incidences of postoperative pneumonia, mortality, and higher hospitalization costs, and prolongs neuro-ICU and postoperative length of stay. PMID:27404044

  17. Perioperative Predictors of Extubation Failure and the Effect on Clinical Outcome After Infratentorial Craniotomy.

    PubMed

    Cai, Ye-Hua; Wang, Hai-Tang; Zhou, Jian-Xin

    2016-07-12

    BACKGROUND The purpose of the study was to analyze the risk factors for failed extubation in subjects submitted to infratentorial craniotomy. MATERIAL AND METHODS Patients aged over 18 years who received infratentorial craniotomy for brain tumor resection were consecutively included in this study. Perioperative variables were collected and analyzed. Univariate analyses and multiple logistic regression were used to derive factors related to failed extubation. Patients had follow-up care until either out of hospital or death. RESULTS Throughout the course of the study, 2118 patients were eligible and 94 (4.4%) suffered from extubation failure at some point during their hospital stay. Five factors were recognized as independent risk factors for postoperative failed extubation: craniotomy history, preoperative lower cranial nerve dysfunction, tumor size, tumor position, and maximum change in blood pressure (BP) during the operation. Failed extubation was related to a higher incidence rate of pneumonia, mortality, unfavorable Glasgow Outcome Scale score, longer stay in the neuro-intensive care unit (ICU) and hospitalization, and higher hospitalization costs compared with successful extubation. CONCLUSIONS History of craniotomy, preoperative lower cranial nerve dysfunction, tumor size, tumor position, and maximum change in BP during the operation were independent risk factors related to postoperative failed extubation in patients submitted to infratentorial craniotomy. Extubation failure raises the incidences of postoperative pneumonia, mortality, and higher hospitalization costs, and prolongs neuro-ICU and postoperative length of stay.

  18. Validation of ZAP-70 methylation and its relative significance in predicting outcome in chronic lymphocytic leukemia

    PubMed Central

    Claus, Rainer; Lucas, David M.; Ruppert, Amy S.; Williams, Katie E.; Weng, Daniel; Patterson, Kara; Zucknick, Manuela; Oakes, Christopher C.; Rassenti, Laura Z.; Greaves, Andrew W.; Geyer, Susan; Wierda, William G.; Brown, Jennifer R.; Gribben, John G.; Barrientos, Jacqueline C.; Rai, Kanti R.; Kay, Neil E.; Kipps, Thomas J.; Shields, Peter; Zhao, Weiqiang; Grever, Michael R.; Plass, Christoph

    2014-01-01

    ZAP-70 methylation 223 nucleotides downstream of transcription start (CpG+223) predicts outcome in chronic lymphocytic leukemia (CLL), but its impact relative to CD38 and ZAP-70 expression or immunoglobulin heavy chain variable region (IGHV) status is uncertain. Additionally, standardizing ZAP-70 expression analysis has been unsuccessful. CpG+223 methylation was quantitatively determined in 295 untreated CLL cases using MassARRAY. Impact on clinical outcome vs CD38 and ZAP-70 expression and IGHV status was evaluated. Cases with low methylation (<20%) had significantly shortened time to first treatment (TT) and overall survival (OS) (P < .0001). For TT, low methylation defined a large subset of ZAP-70 protein-negative cases with significantly shortened TT (median, 8.0 vs 3.9 years for high vs low methylation; hazard ratio [HR] = 0.43; 95% confidence interval [CI], 0.25-0.74). Conversely, 16 ZAP-70 protein-positive cases with high methylation had poor outcome (median, 1.1 vs 2.3 years for high vs low methylation; HR = 1.62; 95% CI, 0.87-3.03). For OS, ZAP-70 methylation was the strongest risk factor; CD38 and ZAP-70 expression or IGHV status did not significantly improve OS prediction. A pyrosequencing assay was established that reproduced the MassARRAY data (κ coefficient > 0.90). Thus, ZAP-70 CpG+223 methylation represents a superior biomarker for TT and OS that can be feasibly measured, supporting its use in risk-stratifying CLL. PMID:24868078

  19. Self-Reported Pigmentary Phenotypes and Race are Significant but Incomplete Predictors of Fitzpatrick Skin Phototype in an Ethnically Diverse Population

    PubMed Central

    He, Steven Y.; McCulloch, Charles E; Boscardin, W. John; Chren, Mary-Margaret; Linos, Eleni; Arron, Sarah T.

    2014-01-01

    Background Fitzpatrick skin phototype (FSPT) is the most common method used to assess sunburn risk and is an independent predictor of skin cancer risk. Due to a conventional assumption that FSPT is predictable based on pigmentary phenotypes, physicians frequently estimate FSPT based on patient appearance. Objective To determine the degree to which self-reported race and pigmentary phenotypes are predictive of FSPT in a large, ethnically diverse population. Methods A cross-sectional survey collected responses from 3386 individuals regarding self-reported FSPT, pigmentary phenotypes, race, age and sex. Univariate and multivariate logistic regression analyses were performed to determine variables that significantly predict FSPT. Results Race, sex, skin color, eye color and hair color are significant but weak independent predictors of FSPT (P<0.0001). A multivariate model constructed using all independent predictors of FSPT only accurately predicted FSPT to within one point on the Fitzpatrick scale with 92% accuracy (weighted kappa statistic=0.53). Limitations Our study enriched for responses from ethnic minorities and does not fully represent the demographics of the U.S. population. Conclusions Patient self-reported race and pigmentary phenotypes are inaccurate predictors of sun sensitivity as defined by Fitzpatrick skin phototype. There are limitations to using patient-reported race and appearance in predicting individual sunburn risk. PMID:24928709

  20. Predictors and Outcomes of Variability in Subjective Alcohol Intoxication among College Students: An Event-Level Analysis across Four Years

    PubMed Central

    Quinn, Patrick D.; Fromme, Kim

    2010-01-01

    Background Individual differences in subjective alcohol intoxication, as measured by laboratory-based alcohol challenge, have been identified as a phenotypic risk factor for alcohol use disorders. Further, recent evidence indicates that subjective alcohol response is also associated with event-level physiological consequences among college students, including blackouts and hangovers. Methods The current investigation tested predictors of and outcomes associated with subjective intoxication in the natural drinking environment. In a preliminary laboratory alcohol-challenge study (N = 53), we developed a brief measure of subjective alcohol intoxication for use in event level research. Participating students in the principal study (N = 1,867; 63% female; 54% Caucasian) completed 30 days of Web-based self-monitoring in each of the four college years. Results In the principal study, Generalized Estimating Equation analyses revealed that both lighter drinking and a family history of alcohol problems predicted greater subjective intoxication after accounting for estimated blood alcohol concentration (eBAC). Moreover, greater subjective intoxication during a given drinking episode was associated with negative alcohol-related consequences, illicit drug use, and unsafe sex, and at higher eBACs, was associated with aggression, sex, and property crime. Students who on average experienced greater subjective intoxication were also more likely to experience negative consequences and engage in illicit drug use, sex, unsafe sex, and aggression. Conclusions These findings suggest that both within-person variability and between-person individual differences in subjective intoxication may be risk factors for adverse drinking outcomes at the event level. Intervention efforts aimed at reducing problems associated with collegiate drinking may benefit from consideration both of who experiences greater subjective intoxication and of the situations in which they are more likely to do so

  1. Predicting the outcome of anomia therapy for people with aphasia post CVA: both language and cognitive status are key predictors.

    PubMed

    Lambon Ralph, Matthew A; Snell, Claerwen; Fillingham, Joanne K; Conroy, Paul; Sage, Karen

    2010-04-01

    The aim of this study was to determine whether it was possible to predict therapy gain from participants' performance on background tests of language and cognitive ability. To do this, we amalgamated the assessment and therapy results from 33 people with aphasia following cerebral vascular accident (CVA), all of whom had received the same anomia therapy (based on progressive phonemic and orthographic cueing). Previous studies with smaller numbers of participants had found a possible relationship between anomia therapy performance and some language and cognitive assessments. Because this study had access to a larger data set than previous studies, we were able to replicate the previous findings and also to verify two overarching factors which were predictive of therapy gain: a cognitive factor and a phonological factor. The status of these two domains was able to predict both immediate and longer-term therapy gain. Pre-treatment naming ability also predicted gain after the anomia therapy. When combined, both cognitive and language (naming or phonological) skills were found to be independent predictors of therapy outcome.

  2. Factors influencing the outcome of intrauterine insemination (IUI): age, clinical variables and significant thresholds.

    PubMed

    Speyer, B E; Abramov, B; Saab, W; Doshi, A; Sarna, U; Harper, J C; Serhal, P

    2013-10-01

    The aim was to investigate the influence of various biological factors upon the outcome of intrauterine insemination (IUI). The total IUI history (856 cycles) of 352 couples was studied. Live-birth showed a strong negative correlation with female age but no correlation with male age. Antimüllerian hormone (AMH) and antral follicle count (AFC) correlated negatively with female age, and follicle stimulating hormone (FSH) correlated positively. Significant thresholds were found for all three variables, and also for total motile count (TMC) in the prepared sperm. Calculating pregnancy losses per positive pregnancy showed a strong correlation with increasing female age. This was highly significant for biochemical losses but not for fetal heart miscarriages. Male age had no effect on rate of pregnancy loss. In conclusion, female age, FSH, AMH and TMC are good predictive factors for live-birth and therefore relate to essential in vivo steps in the reproductive process. PMID:24127958

  3. Predictors and long-term clinical outcomes of newly developed atrial fibrillation in patients with cardiac implantable electronic devices

    PubMed Central

    Kim, Bum Sung; Chun, Kwang Jin; Hwang, Jin kyung; Park, Seung-Jung; Park, Kyoung-Min; Kim, June Soo; On, Young Keun

    2016-01-01

    Abstract Objective: To evaluate predictors and long-term prognosis of atrial fibrillation (AF) following cardiac implantable electronic device (CIED) implantation in patients without history of AF. Methods: From May 1994 to April 2014, 1825 patients with CIED were enrolled in a retrospective, single-center registry. A total of 880 patients from the registry without prior documented AF history were included in the final analysis and were placed into either non-detected AF (NDAF) group or CIED-detected AF group according to development of AF over a follow-up period of 7 years. AF development was defined as any paroxysmal atrial tachyarrhythmia (atrial rate ≥ 180 beats/min) lasting at least 5 minutes according to CIED records. Results: Overall, 122 (13.8%) of the 880 patients experienced new development of AF during follow-up period. According to multivariate analysis, the independent predictors for development of AF were prior heart failure (hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.50–3.85; P < 0.001), prior sinus node dysfunction (HR, 2.33; 95% CI, 1.62–3.55; P < 0.001), and left atrium volume index of 38.5 mL/m2 or more (HR, 2.01; 95% CI, 1.23–3.30; P = 0.005). In CDAF group, the risk of heart failure readmission (adjusted HR, 3.79; 95% CI, 1.99–7.22; P < 0.001) and stroke readmission (adjusted HR, 5.33; 95% CI, 1.58–17.97; P = 0.007) was higher than in nondetected AF group. Conclusion: In patients with CIED, prior history of heart failure, sinus node dysfunction, and LA volume index ≥38.5 mL/m2 were independent predictors of new AF cases. Newly developed AF was significantly associated with increased risk of HF and stroke readmission, according to long-term follow up. PMID:27428213

  4. Pharmacogenetic predictors of outcome in patients with stage II and III colon cancer treated with oxaliplatin and fluoropyrimidine-based adjuvant chemotherapy.

    PubMed

    Custodio, Ana; Moreno-Rubio, Juan; Aparicio, Jorge; Gallego-Plazas, Javier; Yaya, Ricardo; Maurel, Joan; Rodríguez-Salas, Nuria; Burgos, Emilio; Ramos, David; Calatrava, Ana; Andrada, Encarna; Díaz-López, Esther; Sánchez, Antonio; Madero, Rosario; Cejas, Paloma; Feliu, Jaime

    2014-09-01

    Identifying molecular markers for tumor recurrence is critical in successfully selecting patients with colon cancer who are more likely to benefit from adjuvant chemotherapy. We investigated the effect of single-nucleotide polymorphisms (SNP) within genes involved in oxaliplatin and fluoropyrimidines metabolism, DNA repair mechanisms, drug transport, or angiogenesis pathways on outcome for patients with stage II and III colon cancer treated with adjuvant chemotherapy. Genomic DNA was extracted from formalin-fixed paraffin-embedded samples of 202 patients with stage II and III colon cancer receiving oxaliplatin-based adjuvant chemotherapy from January 2004 to December 2009. Genotyping was performed for 67 SNPs in 32 genes using the MassARRAY (SEQUENOM) technology. Our results were validated in an independent cohort of 177 patients treated with the same chemotherapy regimens. The combination of the selectin E (SELE) rs3917412 G>A G/G and the methylentetrahydrofolate reductase (MTHFR) rs1801133 T/T genotypes was associated with a significantly increased risk for recurrence in both the training [RR = 4.103; 95% confidence interval (CI), 1.803-9.334; P = 0.001] and the validation cohorts (RR = 3.567; 95% CI, 1.253-10.151; P = 0.017) in the multiple regression analysis considering the stage, lymphovascular invasion, and bowel perforation as covariates. The combined analysis of these polymorphisms was also significantly associated with overall survival in both cohorts (RR = 3.388; 95% CI, 0.988-11.623; P = 0.052, and RR = 3.929; 95% CI, 1.144-13.485; P = 0.020, respectively). Our findings suggest that the SELE rs3917412 and MTHFR rs1801133 SNPs could serve as pharmacogenetic predictors of tumor recurrence in patients with early-stage colon cancer treated with oxaliplatin-based adjuvant chemotherapy, thus allowing personalized selection of treatment to optimize clinical outcomes.

  5. Predictors of severity and outcome of global developmental delay without definitive etiologic yield: a prospective observational study

    PubMed Central

    2014-01-01

    Background Although several determinants of global developmental delay (GDD) have been recognized, a significant number of children remain without definitive etiologic diagnosis. The objective of this study was to assess the effect of various prenatal and perinatal factors on the severity and outcome of developmental delay without definitive etiologic yield. Methods From March 2008 to February 2010, 142 children with developmental quotient (DQ) <70 and without definitive etiologic diagnosis, were included. Prenatal and perinatal risk factors known to be associated with disordered neonatal brain function were identified. Participants underwent a thorough investigation, an individualized habilitation plan was recommended, and the children were followed-up regularly for a period of 2 < years. The effect of prenatal and perinatal risk factors on the severity and outcome of GDD was assessed by regression analysis. Results The mean age at enrolment was 31 ± 12 < months, and the mean DQ 52.2 ± 11.4. Prematurity and intrauterine growth restriction (IUGR) were found to be independently associated with lower DQ values. The mean DQ after the 2-year follow-up was 62.5 ± 12.7, and the DQ difference from the enrollment 10.4 ± 8.9 (median 10; range-10 to 42). DQ improvement (defined as a DQ difference?≥?median) was noted in 52.8% of the children. IUGR, low socio-economic status, and poor compliance to habilitation plan were found to be independently associated with poorer developmental outcomes. Conclusions Prematurity and IUGR were found to be significantly and independently related to the severity of GDD in cases without definitive etiologic yield. Poorer 2-year developmental outcome was associated with IUGR, low socioeconomic status and non compliance to habilitation plan. Prematurity was a significant determinant of the outcome only in association with the above mentioned factors. PMID:24521451

  6. Intelligence as a predictor of outcome in short- and long-term psychotherapy.

    PubMed

    Knekt, Paul; Saari, Taru; Lindfors, Olavi

    2014-12-30

    Intelligence has been suggested as a suitability factor for short-term therapy whereas its possible effect on short-term versus long-term therapy still is unknown. The aim of this study was to compare the prediction of intelligence on the level of psychiatric symptoms and psychosocial functioning in psychotherapies of different lengths. A total of 251 outpatients from the Helsinki Psychotherapy Study, aged 20–46 years, and suffering from mood or anxiety disorders were allocated to two long-term and two short-term therapies. Intelligence was assessed at baseline with the Wechsler Adult Intelligence Scale (WAIS-R). Psychiatric symptoms and psychosocial functioning were assessed 5–10 times during a 5-year follow-up using two primary symptom measures (HDRS and HARS) and one primary measure of psychosocial functioning (GAF). Short-term therapy was more effective than long-term therapy during the first year of follow-up. During the second to fourth follow-up year no differences between short- and long-term therapies or the intelligence groups were found. At the fifth follow-up year, however, long-term psychotherapy showed a statistically significantly larger change in all three primary measures compared to short-term therapy among those with higher intelligence. No differences between therapy groups were noted in those with lower intelligence. People with higher intelligence may benefit more from long-term than from short-term psychotherapy. These findings should be confirmed.

  7. Locus of Control, Self-Efficacy, and Task Value as Predictors of Learning Outcome in an Online University Context

    ERIC Educational Resources Information Center

    Joo, Young Ju; Lim, Kyu Yon; Kim, Jiyeon

    2013-01-01

    This study investigates the predictors of learner satisfaction, achievement and persistence in an online university located in South Korea. The specific predictors were learners' locus of control, self-efficacy, and task value, and the mediating effects of learner satisfaction and achievement were also tested. Structural equation modeling (SEM)…

  8. Anatomically Based Outcome Predictors of Treatment for Obstructive Sleep Apnea with Intraoral Splint Devices: A Systematic Review of Cephalometric Studies

    PubMed Central

    Guarda-Nardini, Luca; Manfredini, Daniele; Mion, Marta; Heir, Gary; Marchese-Ragona, Rosario

    2015-01-01

    Aims: The aim of this review is to summarize data from the literature on the predictive value of anatomy-based parameters, as identified by cephalometry, for the efficacy of mandibular advancement devices (MAD) for the treatment of obstructive sleep apnea (OSA). Methods: Articles were initially selected based on their titles or abstracts. Full articles were then retrieved and further scrutinized according to predetermined criteria. Reference lists of selected articles were searched for any missed publications. The selected articles were methodologically evaluated. Results: Of an initial 311 references, 13 were selected that assessed correlations between polysomnographic and cephalometric variables. The majority of studies demonstrated a correlation between treatment effectiveness and features as determined by cephalometric analysis, such as the mandibular plane angle, hyoid bone distance to mandible, antero-posterior diameter of the maxilla, tongue area, cranial base, and soft palate. Conclusions: The mandibular plane angle and the distance between hyoid bone and mandibular plane was found to have a predictive value for MAD effectiveness in OSA patients. However, the relative weak and somewhat inconsistent cephalometric data suggest that decisions based solely on these factors cannot be recommended, especially because an integrated analysis of other risk factors (e.g., age, sex, BMI) should also be taken into account. Citation: Guarda-Nardini L, Manfredini D, Mion M, Heir G, Marchese-Ragona R. Anatomically based outcome predictors of treatment for obstructive sleep apnea with intraoral splint devices: a systematic review of cephalometric studies. J Clin Sleep Med 2015;11(11):1327–1334. PMID:25979102

  9. An investigation of general predictors for cognitive–behavioural therapy outcome for anxiety disorders in a routine clinical setting

    PubMed Central

    Nielsen, Sara Kerstine Kaya; Vangkilde, Signe; Wolitzky-Taylor, Kate B; Daniel, Sarah Ingrid Franksdatter; Hageman, Ida

    2016-01-01

    Introduction Cognitive–behavioural therapy (CBT) is effective for treating anxiety disorders and is offered in most mental health services around the world. However, a relatively large number of patients with anxiety disorders do not benefit from CBT, experience relapses or drop out. Reliable predictors of treatment effects are lacking. The aim of this study is to investigate the predictive value of emotion regulation and attentional control for CBT outcome in a routine setting. Methods and analysis In this prospective and practice-based study, 112 patients with anxiety disorders referred for manual-based group CBT at two psychiatric outpatient clinics will be recruited. Emotion regulation, severity of anxiety and attentional control will be assessed with self-report measures and with an experimental computer-based attentional control task at baseline, post-treatment and at a 6-month follow-up. Emotion regulation will be measured with Difficulties in Emotion Regulation Questionnaire, severity of anxiety will be assessed with Beck Anxiety Inventory and attentional control will be measured with the self-report questionnaire, Attention Control Scale, and with an experimental computer-based attentional control task based on theory of visual attention. Data will be analysed using multilevel mixed-effects modelling. Ethics and dissemination The study is approved by the Danish National Ethical Board, the Department of Psychology Ethical Board, University of Copenhagen and by the Danish Data Protection Agency. Study findings will be disseminated through peer-reviewed journal publications and conference presentations. The Danish Committee System on Health Research Ethics has been notified about the project. Trial registration number NCT02638363. PMID:27016248

  10. The amplification of c-erb-B2 in cancer-free surgical margins is a predictor of poor outcome in oral squamous cell carcinoma.

    PubMed

    Jelovac, D B; Tepavčević, Z; Nikolić, N; Ilić, B; Eljabo, N; Popović, B; Čarkić, J; Konstantinović, V; Vukadinović, M; Miličić, B; Milašin, J

    2016-06-01

    The tumour subtype, TNM classification, and histopathological data are sometimes not sufficient for understanding and assessing the behaviour of oral cancers. In an attempt to find additional markers of tumour biology and behaviour, this study sought to determine the incidence and consequently the relevance of c-erb-B2, c-Myc, and H-ras gene alterations in tumour-free margins of oral squamous cell carcinoma (OSCC). Fifty samples of OSCC were analyzed for c-erb-B2 and c-Myc amplification by real-time polymerase chain reaction and for H-ras point mutations by sequencing. A relatively high incidence of genetic lesions was detected: 22% of cases had c-erb-B2 and 30% had c-Myc amplification, whilst only 12% harboured H-ras mutations. Kaplan-Meier analysis and the log-rank test showed statistically significant differences in 5-year survival rates and relapse between patients with tumour margins positive for c-erb-B2 amplification and those with margins that were negative (P=0.002). H-ras and c-Myc alterations could not be associated with tumour behaviour. Molecular analysis of margins, targeting cancer genes, could identify additional, independent predictors of risk and outcome in OSCC.

  11. The AGTR1 gene A1166C polymorphism as a risk factor and outcome predictor of primary intracerebral and aneurysmal subarachnoid hemorrhages.

    PubMed

    Adamski, Mateusz G; Golenia, Aleksandra; Turaj, Wojciech; Baird, Alison E; Moskala, Marek; Dziedzic, Tomasz; Szczudlik, Andrzej; Slowik, Agnieszka; Pera, Joanna

    2014-01-01

    Associations between the angiotensin II type 1 receptor (AGTR1) gene A1166C polymorphism and hypertension, aortic abdominal aneurysms (as a risk factor) as well as cardiovascular disorders (as a risk factor and an outcome predictor) have been demonstrated. We aimed to investigate the role of this polymorphism as risk factors and outcome predictors in primary intracerebral hemorrhage (PICH) and aneurysmal subarachnoid hemorrhage (aSAH). We have prospectively recruited 1078 Polish participants to the study: 261 PICH patients, 392 aSAH patients, and 425 unrelated control subjects. The A1166C AGTR1 gene polymorphism was studied using the tetra-primer ARMS-PCR method. Allele and genotype frequencies were compared with other ethnically different populations. The A1166C polymorphism was not associated with the risk of PICH or aSAH. Among the aSAH patients the AA genotype was associated with a good outcome, defined by a Glasgow Outcome Scale of 4 or 5 (p<0.02). The distribution of A1166C genotypes in our cohort did not differ from other white or other populations of European descent. In conclusion, we found an association between the A1166C AGTR1 polymorphism and outcome of aSAH patients, but not with the risk of PICH or aSAH. PMID:25168322

  12. Predictors of psychopathological outcome during peg-interferon and ribavirin therapy in patients with chronic HCV-correlated hepatitis.

    PubMed

    Dell'Osso, Bernardo; Prati, Gianmaria; Palazzo, M Carlotta; Rumi, Maria Grazia; Cavallaro, Flaminia; Aghemo, Alessio; Colombo, Massimo; Altamura, A Carlo

    2013-01-01

    Peg-interferon (Peg-IFN) and ribavirin (RBV) therapy is reported to induce psychiatric symptoms and syndromes in 20% of patients treated for Hepatitis C Virus (HCV) infection. Present study was aimed to quantify the phenomenon and assess the influence of psychiatric counseling over antiviral completion rate and the use of psychometric tools, in terms of prediction of psychopathological outcome. Ninety-six HCV patients were assessed, before antiviral treatment, by means of the Sheehan Disability Scale (SDS), Mood Disorder Questionnaire (MDQ), Symptom Checklist-90, and Internal State Scale (ISS). Sociodemographic and clinical variables and completion rate were collected. Binary logistic regression was performed to evaluate whether scores were predictive of psychiatric visit, development of psychiatric disorders, and need for treatment. Ninety-five patients (99%) completed antiviral treatment; 27 subjects (29%) needed psychiatric visit: among them, mood disorder was diagnosed in 15 (16%) and were pharmacologically treated. Baseline SDS and MDQ higher scores were found to be predictive of psychiatric visit [odds ratio (OR)=1.258, P<0.001 and OR=1.425, P=0.05, respectively]. Furthermore, higher MDQ score (P=0.017) and ISS hostility scores (OR=1.048, P=0.014) at baseline predicted the subsequent development of mood episodes, while ISS activation correlated negatively (OR=0.948, P=0.009). Finally, the need for treatment was predicted by higher scores at the MDQ and ISS activation items (OR=2.467, P=0.030; OR=0.970, P=0.038). Present findings suggest that psychiatric counseling may be needed in almost 30% of HCV patients on antiviral treatment, with positive influence over the completion rate. Baseline higher scores at psychometric questionnaires-MDQ-in particular, predictors of psychopathological outcome during Peg-IFN and RBV therapy in patients with chronic HCV-correlated hepatitis reflecting individual functioning before starting antiviral therapy and positive history

  13. Predictors of failure of awake regional anesthesia for neonatal hernia repair: data from the General Anesthesia compared to Spinal anesthesia (GAS) study: comparing apnoea and neurodevelopmental outcomes

    PubMed Central

    Frawley, Geoff; Bell, Graham; Disma, Nicola; Withington, Davinia E.; de Graaff, Jurgen C.; Morton, Neil S.; McCann, Mary Ellen; Arnup, Sarah J.; Bagshaw, Oliver; Wolfler, Andrea; Bellinger, David; Davidson, Andrew J.

    2015-01-01

    Background Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive outcomes. The General Anesthesia compared to Spinal anesthesia (GAS) study compares neurodevelopmental outcomes following awake RA or GA in otherwise healthy infants. Our aim was to describe success and failure rates of RA in this study and report factors associated with failure. Methods This was a nested cohort study within a prospective randomized, controlled, observer blind, equivalence trial. Seven hundred twenty two infants ≤ 60 weeks postmenstrual age, scheduled for herniorrhaphy under anesthesia were randomly assigned to receive RA (spinal, caudal epidural or combined spinal caudal anesthetic) or GA with sevoflurane. The data of 339 infants, where spinal or combined spinal caudal anesthetic was attempted, was analyzed. Possible predictors of failure were assessed including: patient factors, technique, experience of site and anesthetist and type of local anesthetic. Results RA was sufficient for the completion of surgery in 83.2% of patients. Spinal anesthesia was successful in 86.9% of cases and combined spinal caudal anesthetic in 76.1%. Thirty four patients required conversion to GA and an additional 23 (6.8%) required brief sedation. Bloody tap on the first attempt at lumbar puncture was the only risk factor significantly associated with block failure (OR = 2.46). Conclusions The failure rate of spinal anesthesia was low. Variability in application of combined spinal caudal anesthetic limited attempts to compare the success of this technique to spinal alone. PMID:26001028

  14. Peak cardiac power measured noninvasively with a bioreactance technique is a predictor of adverse outcomes in patients with advanced heart failure.

    PubMed

    Rosenblum, Hannah; Helmke, Stephen; Williams, Paula; Teruya, Sergio; Jones, Margaret; Burkhoff, Daniel; Mancini, Donna; Maurer, Mathew S

    2010-01-01

    Peak oxygen consumption (VO(2) ) during cardiopulmonary exercise testing (CPET) is a powerful predictor of survival, providing an indirect assessment of cardiac output (CO). Noninvasive indices of CO derived from bioreactance methodology would add significantly to peak VO(2) as a means of risk-stratifying patients with heart failure. In this study, 127 patients (53 ± 14 years of age, 66% male) with heart failure and an average ejection fraction of 31% ± 15% underwent symptom-limited CPET using a bicycle ergometer while measuring CO noninvasively by a bioreactance technique. Peak cardiac power was derived from the product of the peak mean arterial blood pressure and CO divided by 451. Follow-up averaged 404 ± 179 days (median, 366 days) to assess endpoints including death (n=3), heart transplant (n=10), or left ventricular assisted device implantation (n=2). Peak VO(2) and peak power had similar areas under the curve (0.77 and 0.76), which increased to 0.83 when combined. Kaplan-Meier cumulative survival curves demonstrated different outcomes in the subgroup with a VO(2) <14 mL/kg/min when stratified by a cardiac power above or below 1.5 W (92.2% vs 82.1% at 1 year and 81.6% vs 58.3% at last follow-up, P=.02 by log-rank test). Among patients with heart failure, peak cardiac power measured with bioreactance methodology and peak VO(2) had similar associations with adverse outcomes and peak power added independent prognostic information to peak VO(2) in those with advanced disease (eg, VO(2) <14 mL/kg/min).

  15. High birth weight in a suburban hospital in Cameroon: an analysis of the clinical cut-off, prevalence, predictors and adverse outcomes

    PubMed Central

    Choukem, Simeon-Pierre; Njim, Tsi; Atashili, Julius; Hamilton-Shield, Julian P; Mbu, Robinson

    2016-01-01

    Background and aims High birth weight (HBW) increases the risk of maternal and fetal morbidity and mortality. Its prevalence and adverse outcomes may be reduced if risk factors are identified and managed during pregnancy. The cut-off value for HBW remains debatable. The objectives of this study were to identify the optimal cut-off value and determine the prevalence, predictors and adverse outcomes of HBW in a suburban area of Cameroon. Design A 6-year retrospective register analysis and a 3-month prospective phase. Setting A secondary care level (regional) hospital in the city of Buea (southwest region of Cameroon). Participants Women who delivered in this hospital over a 6-year period (retrospective phase) and consenting pregnant mothers and their infants (singletons, born at >28 weeks gestation) (prospective phase). Outcome measures 90th centile of birth weights; prevalence of HBW defined as birth weight above the 90th centile; sociodemographic, maternal and obstetrical factors associated with HBW; maternal and neonatal adverse outcomes of HBW. Results Of the 4941 newborns reviewed in registers, the 90th centile of birth weights was 3850 g. Using this new cut-off, we obtained a prevalence of 14.0% for HBW in the 200 newborns included in the prospective phase. This was significantly higher than the prevalence (9.5%) yielded when the traditional cut-off of 4000 g was used (p=0.003). None of the factors assessed was independently associated with HBW. Newborns with HBW were more likely to have shoulder dystocia (p<0.01), and their mothers more likely to suffer from prolonged labour (p=0.01) and postpartum haemorrhage (p<0.01). Conclusions The results of this study suggest that the cut-off for HBW in this population should be 3850 g. Thus, 3 of every 10 babies born with HBW in this hospital are likely not receiving optimal postnatal care because 4000 g is currently used to qualify for additional support. PMID:27357199

  16. Natural killer cells phenotypic characterization as an outcome predictor of HCV-linked HCC after curative treatments.

    PubMed

    Cariani, Elisabetta; Pilli, Massimo; Barili, Valeria; Porro, Emanuela; Biasini, Elisabetta; Olivani, Andrea; Dalla Valle, Raffaele; Trenti, Tommaso; Ferrari, Carlo; Missale, Gabriele

    2016-08-01

    NK-cell number and function have been associated with cancer progression. A detailed analysis of phenotypic and functional characteristics of NK-cells in HCC is still lacking. NK-cell function is regulated by activating and inhibitory receptors determined by genetic factors and engagement with cognate ligands on transformed or infected cells. We evaluated phenotypic and functional characteristic of NK-cells in HCC patients undergoing curative treatment in relation to clinical outcome. NK-cells from 70 HCC patients undergoing resection or ablative treatment, 18 healthy volunteers and 12 cirrhotic patients with HCV-infection (controls) were phenotypically characterized. Unsupervised clustering based on the frequency of cells expressing different phenotypic NK-cell markers segregated HCC patients into different cohorts that were compared for outcome. NK-cell cytokine production and cytotoxicity were compared between cohorts with different overall survival (OS) and time to disease recurrence (TTR). By multivariate analysis, age, Child-Pugh class and NK-cell phenotypic clustering could independently identify patients with significantly different OS. NK-cells from patients with better outcome expressed higher levels of cytotoxic granules and CD3ζ and lower levels of natural cytotoxic receptors (NCRs) that were co-expressed with the inhibitory receptor NKG2A known to negatively regulate NCR function. Cytotoxic function and IFNγ production were significantly lower in the cohort of patients with worse outcome compared to controls (p < 0.05). Our results show a role for NK-cells in the control of HCC progression and survival providing the basis for the development of immunotherapeutic strategies to potentiate NK-cell response. PMID:27622055

  17. Natural killer cells phenotypic characterization as an outcome predictor of HCV-linked HCC after curative treatments.

    PubMed

    Cariani, Elisabetta; Pilli, Massimo; Barili, Valeria; Porro, Emanuela; Biasini, Elisabetta; Olivani, Andrea; Dalla Valle, Raffaele; Trenti, Tommaso; Ferrari, Carlo; Missale, Gabriele

    2016-08-01

    NK-cell number and function have been associated with cancer progression. A detailed analysis of phenotypic and functional characteristics of NK-cells in HCC is still lacking. NK-cell function is regulated by activating and inhibitory receptors determined by genetic factors and engagement with cognate ligands on transformed or infected cells. We evaluated phenotypic and functional characteristic of NK-cells in HCC patients undergoing curative treatment in relation to clinical outcome. NK-cells from 70 HCC patients undergoing resection or ablative treatment, 18 healthy volunteers and 12 cirrhotic patients with HCV-infection (controls) were phenotypically characterized. Unsupervised clustering based on the frequency of cells expressing different phenotypic NK-cell markers segregated HCC patients into different cohorts that were compared for outcome. NK-cell cytokine production and cytotoxicity were compared between cohorts with different overall survival (OS) and time to disease recurrence (TTR). By multivariate analysis, age, Child-Pugh class and NK-cell phenotypic clustering could independently identify patients with significantly different OS. NK-cells from patients with better outcome expressed higher levels of cytotoxic granules and CD3ζ and lower levels of natural cytotoxic receptors (NCRs) that were co-expressed with the inhibitory receptor NKG2A known to negatively regulate NCR function. Cytotoxic function and IFNγ production were significantly lower in the cohort of patients with worse outcome compared to controls (p < 0.05). Our results show a role for NK-cells in the control of HCC progression and survival providing the basis for the development of immunotherapeutic strategies to potentiate NK-cell response.

  18. Patient-reported outcomes 3 months after spine surgery: is it an accurate predictor of 12-month outcome in real-world registry platforms?

    PubMed

    Parker, Scott L; Asher, Anthony L; Godil, Saniya S; Devin, Clinton J; McGirt, Matthew J

    2015-12-01

    OBJECT The health care landscape is rapidly shifting to incentivize quality of care rather than quantity of care. Quality and outcomes registry platforms lie at the center of all emerging evidence-driven reform models and will be used to inform decision makers in health care delivery. Obtaining real-world registry outcomes data from patients 12 months after spine surgery remains a challenge. The authors set out to determine whether 3-month patient-reported outcomes accurately predict 12-month outcomes and, hence, whether 3-month measurement systems suffice to identify effective versus noneffective spine care. METHODS All patients undergoing lumbar spine surgery for degenerative disease at a single medical institution over a 2-year period were enrolled in a prospective longitudinal registry. Patient-reported outcome instruments (numeric rating scale [NRS], Oswestry Disability Index [ODI], 12-Item Short Form Health Survey [SF-12], EQ-5D, and the Zung Self-Rating Depression Scale) were recorded prospectively at baseline and at 3 months and 12 months after surgery. Linear regression was performed to determine the independent association of 3- and 12-month outcome. Receiver operating characteristic (ROC) curve analysis was performed to determine whether improvement in general health state (EQ-5D) and disability (ODI) at 3 months accurately predicted improvement and achievement of minimum clinical important difference (MCID) at 12 months. RESULTS A total of 593 patients undergoing elective lumbar surgery were included in the study. There was a significant correlation between 3-month and 12-month EQ-5D (r = 0.71; p < 0.0001) and ODI (r = 0.70; p < 0.0001); however, the authors observed a sizable discrepancy in achievement of a clinically significant improvement (MCID) threshold at 3 versus 12 months on an individual patient level. For postoperative disability (ODI), 11.5% of patients who achieved an MCID threshold at 3 months dropped below this threshold at 12 months; 10

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

    SciTech Connect

    Rades, Dirk; Setter, Cornelia; Dahl, Olav; Schild, Steven E.; Noack, Frank

    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, 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

  20. Overexpression of LMO4 induces mammary hyperplasia, promotes cell invasion, and is a predictor of poor outcome in breast cancer.

    PubMed

    Sum, Eleanor Y M; Segara, Davendra; Duscio, Belinda; Bath, Mary L; Field, Andrew S; Sutherland, Robert L; Lindeman, Geoffrey J; Visvader, Jane E

    2005-05-24

    The zinc finger protein LMO4 is overexpressed in a high proportion of breast carcinomas. Here, we report that overexpression of a mouse mammary tumor virus (MMTV)-Lmo4 transgene in the mouse mammary gland elicits hyperplasia and mammary intraepithelial neoplasia or adenosquamous carcinoma in two transgenic strains with a tumor latency of 13-18 months. To investigate cellular processes controlled by LMO4 and those that may be deregulated during oncogenesis, we used RNA interference. Down-regulation of LMO4 expression reduced proliferation of human breast cancer cells and increased differentiation of mouse mammary epithelial cells. Furthermore, small-interfering-RNA-transfected breast cancer cells (MDA-MB-231) had a reduced capacity to migrate and invade an extracellular matrix. Conversely, overexpression of LMO4 in noninvasive, immortalized human MCF10A cells promoted cell motility and invasion. Significantly, in a cohort of 159 primary breast cancers, high nuclear levels of LMO4 were an independent predictor of death from breast cancer. Together, these findings suggest that deregulation of LMO4 in breast epithelium contributes directly to breast neoplasia by altering the rate of cellular proliferation and promoting cell invasion.

  1. Correlating MDCT Liver Injury Grade and Clinical Outcome in Patients Without Significant Extra-hepatic Injury.

    PubMed

    Kumar, Ravi; Kumar, Atin; Baliyan, Vinit; Gamanagatti, Shivanand; Bhalla, Ashu Seith; Sharma, Raju; Gupta, Amit; Kumar, Subodh; Misra, M C

    2016-08-01

    The aim of the study was to correlate multi-detector computed tomography (MDCT) grading with clinical severity and outcome in liver trauma patients without significant extrahepatic injury. Over a period of 2 years (2011-2013), all patients showing evidence of liver injury on contrast-enhanced CT (CECT) abdomen and without significant extrahepatic trauma were prospectively included in the study. Correlation between the CT injury grade and outcome in terms of mortality, duration of ICU/hospital stay, fluid and blood requirements, need for intervention and complications were assessed. The significance of the difference in mortality, duration of ICU/hospital stay, fluid requirement and blood requirements among the patients with various injury grades was assessed by Kruskal-Wallis test. The significance of the difference in need for intervention and complications among the patients with various injury grades was assessed by Fisher's exact test. A total of 198 patients were found to have evidence of hepatic injury on CECT. Out of 198 patients, 117 had insignificant extrahepatic trauma. The overall mean age for these 117 patients was 25.74 ± 15.53 (age range 2-84 years). Death rates according to AAST grades were 0 % in grades II and III, 6.89 % in grade IV and 9.09 % in grade V (p = 0.053). The mean ICU and total hospital stay for grade II was 1.32 and 5.91 days, for grade III was 1.76 and 8.48, for grade IV was 2.86 and 10.31 days and for grade V was 6.54 and 12 days, respectively (p = 0.0001 for ICU, p = 0.0003 for total stay). Mean input and fluid deficit according to various grades were 8634/2607 ml for grade II, 9535/2555 ml for grade III, 15,549/6242 ml for grade IV and 19,958/8280 ml for grade V (p value input-0.0016, output-input (fluid deficit)-0.0001). Average unit of RBC and sum of the blood products transfused were 1.73 and 2.26 for grade II, 2.18 and 2.72 for grade III, 3.03 and 6.27 for grade IV, 6.85 and 38.12 for grade V

  2. Cerebrospinal Fluid Biomarkers and Reserve Variables as Predictors of Future “Non-Cognitive” Outcomes of Alzheimer’s Disease

    PubMed Central

    Ingber, Adam P.; Hassenstab, Jason; Fagan, Anne M.; Benzinger, Tammie L.S.; Grant, Elizabeth A.; Holtzman, David M.; Morris, John C.; Roe, Catherine M.

    2016-01-01

    Background The influence of reserve variables and Alzheimer’s disease (AD) biomarkers on cognitive test performance has been fairly well-characterized. However, less is known about the influence of these factors on “non-cognitive” outcomes, including functional abilities and mood. Objective We examined whether cognitive and brain reserve variables mediate how AD biomarker levels in cognitively normal persons predict future changes in function, mood, and neuropsychiatric behavior. Methods Non-cognitive outcomes were examined in 328 individuals 50 years and older enrolled in ongoing studies of aging and dementia at the Knight Alzheimer Disease Research Center (ADRC). All participants were cognitively normal at baseline (Clinical Dementia Rating [CDR] 0), completed cerebrospinal fluid (CSF) and structural neuroimaging studies within one year of baseline, and were followed for an average of 4.6 annual visits. Linear mixed effects models explored how cognitive reserve and brain reserve variables mediate the relationships between AD biomarker levels and changes in function, mood, and neuropsychiatric behavior in cognitively normal participants. Results Education levels did not have a significant effect on predicting non-cognitive decline. However, participants with smaller brain volumes exhibited the worst outcomes on measures of mood, functional abilities, and behavioral disturbance. This effect was most pronounced in individuals who also had abnormal CSF biomarkers. Conclusions The findings suggest that brain reserve plays a stronger, or earlier, role than cognitive reserve in protecting against non-cognitive impairment in AD. PMID:27104893

  3. A significant outcome of work life: occupational accidents in a developing country, Turkey.

    PubMed

    Ergör, O Alp; Demiral, Yücel; Piyal, Y Bülent

    2003-01-01

    Occupational accident rates are high in the developing world and they are among the crucial indicators of work life. The data on serious occupational accidents in three years from the Aegean Region of Turkey were analyzed in order to define the working life situation. The data for 1995-97 were obtained from The Social Insurance Institution. Variables were defined for workers, work environment and working conditions for descriptive analysis. The relationships between these variables and outcomes of the occupational accidents were analyzed. The fatality risk was 2.6 times higher for mining and construction than for the production sector (p<0.001), and 1.6 times higher for evening and night shifts than for day shifts (p<0.01). Mortality from being struck by something, falls, motor vehicle accidents and electrocutions were significantly higher than being cut or in, under or between objects (OR 3.5, 8.7, 23.1, 26.1 respectively and p<0.01). As a conclusion, it was suggested that within the globalization picture, occupational health problems in the developing world should be explored intensively in order to establish effective prevention programs.

  4. A significant outcome of work life: occupational accidents in a developing country, Turkey.

    PubMed

    Ergör, O Alp; Demiral, Yücel; Piyal, Y Bülent

    2003-01-01

    Occupational accident rates are high in the developing world and they are among the crucial indicators of work life. The data on serious occupational accidents in three years from the Aegean Region of Turkey were analyzed in order to define the working life situation. The data for 1995-97 were obtained from The Social Insurance Institution. Variables were defined for workers, work environment and working conditions for descriptive analysis. The relationships between these variables and outcomes of the occupational accidents were analyzed. The fatality risk was 2.6 times higher for mining and construction than for the production sector (p<0.001), and 1.6 times higher for evening and night shifts than for day shifts (p<0.01). Mortality from being struck by something, falls, motor vehicle accidents and electrocutions were significantly higher than being cut or in, under or between objects (OR 3.5, 8.7, 23.1, 26.1 respectively and p<0.01). As a conclusion, it was suggested that within the globalization picture, occupational health problems in the developing world should be explored intensively in order to establish effective prevention programs. PMID:14605434

  5. Predictors of short-term outcomes related to central subfield foveal thickness after intravitreal bevacizumab for macular edema due to central retinal vein occlusion

    PubMed Central

    Wang, Mei-Zi; Feng, Kang; Lu, Yao; Qian, Fang; Lu, Xin-Rong; Zang, Si-Wen; Zhao, Lin

    2016-01-01

    AIM To investigate the predictive factors for short-term effects of intravitreal bevacizumab injections on central subfield foveal thickness (CSFT) in patients with macular edema (ME) secondary to central retinal vein occlusion (CRVO). METHODS This was a retrospective study in 60 eyes treated with intravitreal bevacizumab injections for ME due to CRVO. Follow-up was three months. The Early Treatment Diabetic Retinopathy Study (ETDRS) score and CSFT measured by spectral-domain optical coherence tomography (SD-OCT) were used to observe the changes in best-corrected visual acuity (BCVA). Baseline BCVA, CSFT, age, CRVO duration and the presence of cystoid macular edema (CME) or subretinal fluid (SRF) were analyzed as potential predictive factors of the effects of intravitreal bevacizumab injections. RESULTS BCVA improved from 0.9 logMAR at baseline to 0.6 logMAR at 3mo, which was associated with a significant reduction in CSFT from 721 µm to 392 µm 3mo after injection. About 50% of CME cases and more than 90% of SRF cases responded to treatment with a complete resolution at 3mo. Age (P=0.036) and low baseline CSFT (P=0.037) were associated with a good 3-month prognosis. Patients >60 years old achieved better CME resolution (P=0.031) and lower CSFT at 3mo (305 µm vs 474 µm, P=0.003). CONCLUSION Intravitreal bevacizumab significantly improved visual acuity and CSFT in patients with CRVO after 3mo. Older age and lower baseline CSFT were good predictors of short-term CSFT outcomes. The retinal thickness response to bevacizumab might depend on the resolution of CME rather than SRF. PMID:26949616

  6. KRAS mutation is a weak, but valid predictor for poor prognosis and treatment outcomes in NSCLC: A meta-analysis of 41 studies

    PubMed Central

    Pan, Wei; Yang, Yan; Zhu, Hongcheng; Zhang, Youcheng; Zhou, Rongping; Sun, Xinchen

    2016-01-01

    Mutation of oncogene KRAS is common in non-small cell lung cancer (NSCLC), however, its clinical significance is still controversial. Independent studies evaluating its prognostic and predictive value usually drew inconsistent conclusions. Hence, We performed a meta-analysis with 41 relative publications, retrieved from multi-databases, to reconcile these controversial results and to give an overall impression of KRAS mutation in NSCLC. According to our findings, KRAS mutation was significantly associated with worse overall survival (OS) and disease-free survival (DFS) in early stage resected NSCLC (hazard ratio or HR=1.56 and 1.57, 95% CI 1.39-1.76 and 1.17-2.09 respectively), and with inferior outcomes of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) treatment and chemotherapy (relative risk or RR=0.21 and 0.66 for objective response rate or ORR, 95% CI 0.12-0.39 and 0.54-0.81 respectively; HR=1.46 and 1.30 for progression-free survival or PFS, 95%CI 1.23-1.74 and 1.14-1.50 respectively) in advanced NSCLC. When EGFR mutant patients were excluded, KRAS mutation was still significantly associated with worse OS and PFS of EGFR-TKIs (HR=1.40 and 1.35, 95 % CI 1.21-1.61 and 1.11-1.64). Although KRAS mutant patients presented worse DFS and PFS of chemotherapy (HR=1.33 and 1.11, 95% CI 0.97-1.84 and 0.95-1.30), and lower response rate to EGFR-TKIs or chemotherapy (RR=0.55 and 0.88, 95 % CI 0.27-1.11 and 0.76-1.02), statistical differences were not met. In conclusion, KRAS mutation is a weak, but valid predictor for poor prognosis and treatment outcomes in NSCLC. There's a need for developing target therapies for KRAS mutant lung cancer and other tumors. PMID:26840022

  7. Outcome Prediction after Mild and Complicated Mild Traumatic Brain Injury: External Validation of Existing Models and Identification of New Predictors Using the TRACK-TBI Pilot Study

    PubMed Central

    Lingsma, Hester F.; Yue, John K.; Maas, Andrew I.R.; Steyerberg, Ewout W.; Cooper, Shelly R.; Dams-O'Connor, Kristen; Gordon, Wayne A.; Menon, David K.; Mukherjee, Pratik; Okonkwo, David O.; Puccio, Ava M.; Schnyer, David M.; Valadka, Alex B.; Vassar, Mary J.; Yuh, Esther L.

    2015-01-01

    Abstract Although the majority of patients with mild traumatic brain injury (mTBI) recover completely, some still suffer from disabling ailments at 3 or 6 months. We validated existing prognostic models for mTBI and explored predictors of poor outcome after mTBI. We selected patients with mTBI from TRACK-TBI Pilot, an unselected observational cohort of TBI patients from three centers in the United States. We validated two prognostic models for the Glasgow Outcome Scale Extended (GOS-E) at 6 months after injury. One model was based on the CRASH study data and another from Nijmegen, The Netherlands. Possible predictors of 3- and 6-month GOS-E were analyzed with univariate and multi-variable proportional odds regression models. Of the 386 of 485 patients included in the study (median age, 44 years; interquartile range, 27–58), 75% (n=290) presented with a Glasgow Coma Score (GCS) of 15. In this mTBI population, both previously developed models had a poor performance (area under the receiver operating characteristic curve, 0.49–0.56). In multivariable analyses, the strongest predictors of lower 3- and 6-month GOS-E were older age, pre-existing psychiatric conditions, and lower education. Injury caused by assault, extracranial injuries, and lower GCS were also predictive of lower GOS-E. Existing models for mTBI performed unsatisfactorily. Our study shows that, for mTBI, different predictors are relevant as for moderate and severe TBI. These include age, pre-existing psychiatric conditions, and lower education. Development of a valid prediction model for mTBI patients requires further research efforts. PMID:25025611

  8. Understanding and Interpreting Regression Parameter Estimates in Given Contexts: A Monte Carlo Study of Characteristics of Regression and Structural Coefficients, Effect Size R Squared and Significance Level of Predictors.

    ERIC Educational Resources Information Center

    Jiang, Ying Hong; Smith, Philip L.

    This Monte Carlo study explored relationships among standard and unstandardized regression coefficients, structural coefficients, multiple R_ squared, and significance level of predictors for a variety of linear regression scenarios. Ten regression models with three predictors were included, and four conditions were varied that were expected to…

  9. Urinary Proteome and Systolic Blood Pressure as Predictors of 5-Year Cardiovascular and Cardiac Outcomes in a General Population.

    PubMed

    Zhang, Zhen-Yu; Thijs, Lutgarde; Petit, Thibault; Gu, Yu-Mei; Jacobs, Lotte; Yang, Wen-Yi; Liu, Yan-Ping; Koeck, Thomas; Zürbig, Petra; Jin, Yu; Verhamme, Peter; Voigt, Jens-Uwe; Kuznetsova, Tatiana; Mischak, Harald; Staessen, Jan A

    2015-07-01

    In a previous cross-sectional study, we identified a multidimensional urinary classifier (HF1), which was associated with left ventricular dysfunction. We investigated whether HF1 predicts cardiovascular end points over and beyond traditional risk factors. In 791 randomly recruited Flemish (mean age, 51.2 years; 50.6% women), we quantified HF1 by capillary electrophoresis coupled with mass spectrometry. In addition, we measured cardiovascular risk factors. HF1 averaged -0.97 U (range, -3.26 to 2.60). Over 6.1 years (median), 35 participants died and 63, 45, and 22 experienced fatal or nonfatal cardiovascular, cardiac, or coronary events, respectively. The incidence of fatal combined with nonfatal cardiovascular and cardiac end points, standardized for sex and age, increased across thirds of the HF1 distribution (P≤0.014), whereas trends for all-cause mortality and coronary events were nonsignificant (P≥0.10). The multivariable-adjusted hazard ratios (+1-SD) were 1.30 (95% confidence interval, 1.03-1.65; P=0.029) and 1.39 (1.06-1.84; P=0.018) for cardiovascular and cardiac events in relation to HF1. For systolic pressure, the corresponding estimates were 0.97 (0.74-1.28; P=0.85) and 0.93 (0.67-1.29; P=0.66), respectively. The HF1 upper thresholds optimized by maximizing Younden's index were -0.50 and -0.36 U for cardiovascular and cardiac end points, respectively. Prognostic accuracy significantly (P≤0.006) improved by adding HF1 to Cox models already including the other baseline predictors. Sensitivity analyses, from which we excluded 71 participants with previous cardiovascular disease, were confirmatory. In conclusion, over a 6-year period, the urinary proteome, but not systolic pressure, predicted cardiovascular and cardiac disease. PMID:26063667

  10. Surgeon perception is not a good predictor of peri-operative outcomes in robot-assisted radical prostatectomy.

    PubMed

    Stern, Joshua; Sharma, Saurabh; Mendoza, Pierre; Walicki, Mary; Hastings, Rachel; Monahan, Kelly; Sheikh, Baber; Wedmid, Alexei; Lee, David I

    2011-12-01

    Surgeons have always used their cognitive intuition for the execution of skilled tasks and real-time perception of intra-operative outcomes. We attempted to measure the overall accuracy of intra-operative surgeon perception on the functional outcome of early continence after robot-assisted radical prostatectomy (RARP). A single experienced surgeon (D.I.L.) used a scoring sheet to prospectively capture his subjective opinion of how well a particular portion of the RARP procedure was completed. Surgeon perception of factors affecting post-operative continence such as quality of bladder neck preservation, nerve sparing, urethral length, anastomosis, striated sphincter thickness, quality of Rocco repair and bladder neck plication suture (total 7 variables) were graded as "poor", "average" or "good". Urinary continence was graded as either total continence [0 pads per day (PPD) or social continence (security pad or one PPD)]. A total of 273 (39 patients × 7 variables) responses were recorded: 58.6% were rated as "good", 32.2% as "average" and 8.4% as "poor". A log-rank test for all perception variables showed no significant differences in subsequent achievement of continence (either 0 or 1 PPD) (P > 0.05) at both the 1- and 3-month time points. In the case of some perception variables, patients with "bad" scores gained continence a median of 3 weeks sooner than patients with "good" scores. Surgeon perception of intra-operative performance during RARP is a poor predictive indicator of subsequent functional outcome in terms of urinary continence. Inter-surgeon variability of perception may vary and needs further investigation. PMID:27628118

  11. Clinical Characteristics and Predictors of Adverse Outcome in Adult and Pediatric Patients With Healthcare-Associated Ventriculitis and Meningitis

    PubMed Central

    Srihawan, Chanunya; Castelblanco, Rodrigo Lopez; Salazar, Lucrecia; Wootton, Susan H.; Aguilera, Elizabeth; Ostrosky-Zeichner, Luis; Sandberg, David I.; Choi, HuiMahn A.; Lee, Kiwon; Kitigawa, Ryan; Tandon, Nitin; Hasbun, Rodrigo

    2016-01-01

    Background. Healthcare-associated meningitis or ventriculitis is a serious and life-threatening complication of invasive neurosurgical procedures or penetrating head trauma. Methods. We performed a retrospective study of adults and children with the diagnosis of healthcare-associated meningitis or ventriculitis, as defined by the 2015 Centers of Disease Control and Prevention case definition, at 2 large tertiary care hospitals in Houston, Texas from July 2003 to November 2014. Patients were identified by infection control practitioners and by screening cerebrospinal fluid samples sent to the central laboratory. We collected data on demographics, clinical presentations, laboratory results, imaging studies, treatments, and outcomes. Results. A total of 215 patients were included (166 adults and 49 children). A positive cerebrospinal fluid culture was seen in 106 (49%) patients, with the majority of the etiologies being Staphylococcus and Gram-negative rods. An adverse clinical outcome was seen in 167 patients (77.7%) and was defined as death in 20 patients (9.3%), persistent vegetative state in 31 patients (14.4%), severe disability in 77 patients (35.8%), or moderate disability in 39 patients (18.1%). On logistic regression analysis, age >45 years (adjusted odds ratio [OR], 6.47; 95% confidence interval [CI], 2.31–18.11; P ≤ .001), abnormal neurological exam (adjusted OR, 3.04; 95% CI, 1.27–7.29; P = .013), and mechanical ventilation (adjusted OR, 5.34; 95% CI, 1.51–18.92; P = .01) were associated with an adverse outcome. Conclusions. Healthcare-associated meningitis or ventriculitis is associated with significant morbidity and mortality. PMID:27419154

  12. Clinical Characteristics and Predictors of Adverse Outcome in Adult and Pediatric Patients With Healthcare-Associated Ventriculitis and Meningitis.

    PubMed

    Srihawan, Chanunya; Castelblanco, Rodrigo Lopez; Salazar, Lucrecia; Wootton, Susan H; Aguilera, Elizabeth; Ostrosky-Zeichner, Luis; Sandberg, David I; Choi, HuiMahn A; Lee, Kiwon; Kitigawa, Ryan; Tandon, Nitin; Hasbun, Rodrigo

    2016-04-01

    Background.  Healthcare-associated meningitis or ventriculitis is a serious and life-threatening complication of invasive neurosurgical procedures or penetrating head trauma. Methods.  We performed a retrospective study of adults and children with the diagnosis of healthcare-associated meningitis or ventriculitis, as defined by the 2015 Centers of Disease Control and Prevention case definition, at 2 large tertiary care hospitals in Houston, Texas from July 2003 to November 2014. Patients were identified by infection control practitioners and by screening cerebrospinal fluid samples sent to the central laboratory. We collected data on demographics, clinical presentations, laboratory results, imaging studies, treatments, and outcomes. Results.  A total of 215 patients were included (166 adults and 49 children). A positive cerebrospinal fluid culture was seen in 106 (49%) patients, with the majority of the etiologies being Staphylococcus and Gram-negative rods. An adverse clinical outcome was seen in 167 patients (77.7%) and was defined as death in 20 patients (9.3%), persistent vegetative state in 31 patients (14.4%), severe disability in 77 patients (35.8%), or moderate disability in 39 patients (18.1%). On logistic regression analysis, age >45 years (adjusted odds ratio [OR], 6.47; 95% confidence interval [CI], 2.31-18.11; P ≤ .001), abnormal neurological exam (adjusted OR, 3.04; 95% CI, 1.27-7.29; P = .013), and mechanical ventilation (adjusted OR, 5.34; 95% CI, 1.51-18.92; P = .01) were associated with an adverse outcome. Conclusions.  Healthcare-associated meningitis or ventriculitis is associated with significant morbidity and mortality. PMID:27419154

  13. Serum metabolomics identifies citrulline as a predictor of adverse outcomes in an equine model of gut-derived sepsis.

    PubMed

    Steelman, Samantha M; Johnson, Philip; Jackson, Amy; Schulze, James; Chowdhary, Bhanu P

    2014-05-15

    Acute laminitis is an inflammatory disease of the equine foot that often occurs secondarily to sepsis or systemic inflammation associated with gastrointestinal disease. It has been suggested that laminitis is similar to multiple organ dysfunction syndrome in humans, although in horses the weight-bearing laminar epithelium of the foot appears to be the tissue most sensitive to insult and the first "organ" to fail. Metabolomics performed on serum samples collected before (Con) and after (Lmn) experimental induction of gastrointestinal-associated sepsis in six horses detected 1,177 metabolites of both mammalian and bacterial origin in equine serum. Network and correlation analyses suggested a dysregulation of fatty acid metabolism in the Lmn group, as well as an accumulation of organic acids such as lactate. Furthermore, concentrations of the amino acid citrulline were decreased in Lmn samples from all study animals, suggesting that citrulline might be useful as a biomarker to identify critically ill animals that are at risk of developing laminitis. We therefore established normal ranges of plasma citrulline concentrations in a separate group of horses (n = 36) and tested the ability of citrulline to predict adverse outcomes (laminitis or death) in critically ill horses (n = 23). Plasma citrulline was significantly lower in critically ill horses that went on to experience adverse outcomes (n = 6). Further study is required to accurately determine a diagnostic cutoff, but the present data are suggestive of the predictive value of citrulline as a biomarker for laminar failure in equine sepsis. PMID:24619519

  14. Patterns, Predictors, and Outcomes of Falls Trajectories in Older Adults: The MOBILIZE Boston Study with 5 Years of Follow-Up

    PubMed Central

    Tchalla, Achille E.; Dufour, Alyssa B.; Travison, Thomas G.; Habtemariam, Daniel; Iloputaife, Ikechukwu; Manor, Brad; Lipsitz, Lewis A.

    2014-01-01

    Background Falls may occur as unpredictable events or in patterns indicative of potentially modifiable risks and predictive of adverse outcomes. Knowing the patterns, risks, and outcomes of falls trajectories may help clinicians plan appropriate preventive measures. We hypothesized that clinically distinct trajectories of falls progression, baseline predictors and their coincident clinical outcomes could be identified. Methods We studied 765 community-dwelling participants in the MOBILIZE Boston Study, who were aged 70 and older and followed prospectively for falls over 5 years. Baseline demographic and clinical data were collected by questionnaire and a comprehensive clinic examination. Falls, injuries, and hospitalizations were recorded prospectively on daily calendars. Group-Based Trajectory Modeling (GBTM) was used to identify trajectories. Results We identified 4 distinct trajectories: No Falls (30.1%), Cluster Falls (46.1%), Increasing Falls (5.8%) and Chronic Recurring Falls (18.0%). Predictors of Cluster Falls were faster gait speed (OR 1.69 (95CI, 1.50–2.56)) and fall in the past year (OR 3.52 (95CI, 2.16–6.34)). Predictors of Increasing Falls were Diabetes Mellitus (OR 4.3 (95CI, 1.4–13.3)) and Cognitive Impairment (OR 2.82 (95CI, 1.34–5.82)). Predictors of Chronic Recurring Falls were multi-morbidity (OR 2.24 (95CI, 1.60–3.16)) and fall in the past year (OR 3.82 (95CI, 2.34–6.23)). Symptoms of depression were predictive of all falls trajectories. In the Chronic Recurring Falls trajectory group the incidence rate of Hospital visits was 121 (95% CI 63–169) per 1,000 person-years; Injurious falls 172 (95% CI 111–237) per 1,000 person-years and Fractures 41 (95% CI 9–78) per 1,000 person-years. Conclusions Falls may occur in clusters over discrete intervals in time, or as chronically increasing or recurring events that have a relatively greater risk of adverse outcomes. Patients with multiple falls, multimorbidity, and depressive symptoms

  15. Predictors of Teacher Intervention in Indirect Bullying at School and Outcome of a Professional Development Presentation for Teachers

    ERIC Educational Resources Information Center

    Dedousis-Wallace, Anna; Shute, Rosalyn; Varlow, Megan; Murrihy, Rachael; Kidman, Tony

    2014-01-01

    This study with 326 girls-school teachers developed and tested a model of predictors of the likelihood that teachers will intervene in indirect bullying, and evaluated a professional development presentation. Teachers responded to bullying vignettes before and after a presentation on indirect bullying (Experimentals) or adolescent mental health…

  16. Heart rate variables in the Vascular Quality Initiative are not reliable predictors of adverse cardiac outcomes or mortality after major elective vascular surgery

    PubMed Central

    Scali, Salvatore; Bertges, Daniel; Neal, Daniel; Patel, Virendra; Eldrup-Jorgensen, Jens; Cronenwett, Jack; Beck, Adam

    2015-01-01

    associations disappeared in controlling for beta-blocker status. For AFB and open AAA repair patients, there was no significant association between AHR and MACE or 30-day mortality, irrespective or cardiac risk or beta-blocker status. DHR and extremes of highest intraoperative HR (>90 or 100 beats/min) were analyzed among all three operations, and no consistent associations with MACE or 30-day mortality were detected. Conclusions The VQI AHR and highest intraoperative HR variables are highly confounded by patient presentation, operative variables, and beta-blocker therapy. The discordance between cardiac risk and HR as well as the lack of consistent correlation to outcome makes them unreliable predictors. The VQI has elected to discontinue collecting AHR and highest intraoperative HR data, given insufficient evidence to suggest their importance as an outcome measure. PMID:26067200

  17. Stone heterogeneity index as the standard deviation of Hounsfield units: A novel predictor for shock-wave lithotripsy outcomes in ureter calculi.

    PubMed

    Lee, Joo Yong; Kim, Jae Heon; Kang, Dong Hyuk; Chung, Doo Yong; Lee, Dae Hun; Do Jung, Hae; Kwon, Jong Kyou; Cho, Kang Su

    2016-01-01

    We investigated whether stone heterogeneity index (SHI), which a proxy of such variations, was defined as the standard deviation of a Hounsfield unit (HU) on non-contrast computed tomography (NCCT), can be a novel predictor for shock-wave lithotripsy (SWL) outcomes in patients with ureteral stones. Medical records were obtained from the consecutive database of 1,519 patients who underwent the first session of SWL for urinary stones between 2005 and 2013. Ultimately, 604 patients with radiopaque ureteral stones were eligible for this study. Stone related variables including stone size, mean stone density (MSD), skin-to-stone distance, and SHI were obtained on NCCT. Patients were classified into the low and high SHI groups using mean SHI and compared. One-session success rate in the high SHI group was better than in the low SHI group (74.3% vs. 63.9%, P = 0.008). Multivariate logistic regression analyses revealed that smaller stone size (OR 0.889, 95% CI: 0.841-0.937, P < 0.001), lower MSD (OR 0.995, 95% CI: 0.994-0.996, P < 0.001), and higher SHI (OR 1.011, 95% CI: 1.008-1.014, P < 0.001) were independent predictors of one-session success. The radiologic heterogeneity of urinary stones or SHI was an independent predictor for SWL success in patients with ureteral calculi and a useful clinical parameter for stone fragility. PMID:27035621

  18. Abnormal Admission Chest X-Ray and MEWS as ICU Outcome Predictors in a Sub-Saharan Tertiary Hospital: A Prospective Observational Study

    PubMed Central

    Ssemmanda, Hannington; Lubulwa, Clare; Muyinda, Zeridah; Kwitonda, Pascal; Wanzira, Humphrey; Ejoku, Joseph

    2016-01-01

    Background. Critical care in Uganda is a neglected speciality and deemed costly with limited funding/prioritization. We studied admission X-ray and MEWS as mortality predictors of ICU patients requiring mechanical ventilation. Materials and Methods. We did a cross-sectional study in Mulago Hospital ICU and 87 patients for mechanical ventilation were recruited with mortality as the outcome of interest. Chest X-ray results were the main independent variable and MEWS was also gotten for all patients. Results. We recruited 87 patients; most were males (60.92%), aged between 16 and 45 years (59.77%), and most admissions for mechanical ventilation were from the Trauma Unit (30.77%). Forty-one (47.13%) of the 87 patients died and of these 34 (53.13%) had an abnormal CXR with an insignificant IRR = 1.75 (0.90–3.38) (p = 0.062). Patients with MEWS ≥ 5 (p values = 0.018) and/or having an abnormal superior mediastinum (p values = 0.013) showed a positive association with mortality while having a MEWS ≥ 5 had an incidence risk ratio = 3.29 (1.00–12.02) (p = 0.018). MEWS was a good predictor of mortality (predictive value = 0.6739). Conclusion. Trauma (31%) caused most ICU admissions, having an abnormal admission chest X-rays positively associated with mortality and a high MEWS was also a good predictor of mortality. PMID:27721991

  19. Predictors of Treatment Outcome for Retreatment Pulmonary Tuberculosis Cases among Tribal People of an Eastern India District: A Prospective Cohort Study

    PubMed Central

    2016-01-01

    Objective. The study was conducted to assess the treatment outcome of different category retreatment cases with the aim of finding out the important predictors of unfavorable outcomes. Methodology. This hospital based prospective cohort study was conducted in three tuberculosis units (TUs) of west Midnapore (a district of Eastern India), covering mostly the tribal populated areas. Patients who were registered for Category II antituberculosis treatment between 1st quarter of 2013 (Jan to Mar) and 4th quarter of 2013 (Oct to Dec) were considered as our study cohort and they were followed up till December 2014. The study was started with 177 patients but ultimately ended with 165 patients. Results. Unfavorable outcome was observed among 24.8% patients. Among them mostly 51.2% were defaulter, 22% were failure case, and 26.8% died during treatment. Patients, who were minority by religion, were found 4 times more vulnerable for unfavorable outcome. Unfavorable outcome was found 7 times more common among retreatment TB cases who remain sputum positive after completion of initiation phase of Category II treatment. Conclusion. Programmatic approach should be specified to address the minority by religion population and to reduce the load of sputum positive cases after completion of initiation phase treatment by tracking them. PMID:27656293

  20. Predictors of Treatment Outcome for Retreatment Pulmonary Tuberculosis Cases among Tribal People of an Eastern India District: A Prospective Cohort Study

    PubMed Central

    2016-01-01

    Objective. The study was conducted to assess the treatment outcome of different category retreatment cases with the aim of finding out the important predictors of unfavorable outcomes. Methodology. This hospital based prospective cohort study was conducted in three tuberculosis units (TUs) of west Midnapore (a district of Eastern India), covering mostly the tribal populated areas. Patients who were registered for Category II antituberculosis treatment between 1st quarter of 2013 (Jan to Mar) and 4th quarter of 2013 (Oct to Dec) were considered as our study cohort and they were followed up till December 2014. The study was started with 177 patients but ultimately ended with 165 patients. Results. Unfavorable outcome was observed among 24.8% patients. Among them mostly 51.2% were defaulter, 22% were failure case, and 26.8% died during treatment. Patients, who were minority by religion, were found 4 times more vulnerable for unfavorable outcome. Unfavorable outcome was found 7 times more common among retreatment TB cases who remain sputum positive after completion of initiation phase of Category II treatment. Conclusion. Programmatic approach should be specified to address the minority by religion population and to reduce the load of sputum positive cases after completion of initiation phase treatment by tracking them.

  1. Predictors of Treatment Outcome for Retreatment Pulmonary Tuberculosis Cases among Tribal People of an Eastern India District: A Prospective Cohort Study.

    PubMed

    Saha, Rajib

    2016-01-01

    Objective. The study was conducted to assess the treatment outcome of different category retreatment cases with the aim of finding out the important predictors of unfavorable outcomes. Methodology. This hospital based prospective cohort study was conducted in three tuberculosis units (TUs) of west Midnapore (a district of Eastern India), covering mostly the tribal populated areas. Patients who were registered for Category II antituberculosis treatment between 1st quarter of 2013 (Jan to Mar) and 4th quarter of 2013 (Oct to Dec) were considered as our study cohort and they were followed up till December 2014. The study was started with 177 patients but ultimately ended with 165 patients. Results. Unfavorable outcome was observed among 24.8% patients. Among them mostly 51.2% were defaulter, 22% were failure case, and 26.8% died during treatment. Patients, who were minority by religion, were found 4 times more vulnerable for unfavorable outcome. Unfavorable outcome was found 7 times more common among retreatment TB cases who remain sputum positive after completion of initiation phase of Category II treatment. Conclusion. Programmatic approach should be specified to address the minority by religion population and to reduce the load of sputum positive cases after completion of initiation phase treatment by tracking them. PMID:27656293

  2. Prenatal Diagnosis and Evaluation of Sonographic Predictors for Intervention and Adverse Outcome in Congenital Pulmonary Airway Malformation

    PubMed Central

    Hellmund, Astrid; Berg, Christoph; Geipel, Annegret; Bludau, Meike; Heydweiller, Andreas; Bachour, Haitham; Müller, Andreas; Müller, Annette; Gembruch, Ulrich

    2016-01-01

    Objective To describe antenatal findings and evaluate prenatal risk parameters for adverse outcome or need for intervention in fetuses with congenital pulmonary airway malformation (CPAM). Methods In our retrospective study all fetuses with a prenatal diagnosis of CPAM detected in our tertiary referral center between 2002 and 2013 were analyzed. Sonographic findings were noted and measurements of mass-to-thorax-ratio (MTR), congenital pulmonary airway malformation volume-ratio (CVR) and observed to expected lung-to head-ratio (o/e LHR) were conducted and correlated to fetal or neonatal morbidity and mortality and/or need for prenatal intervention. Results 67 fetuses with CPAM were included in the study. Hydropic fetuses were observed in 16.4% (11/67) of cases, prenatal intervention was undertaken in 9 cases; 7 pregnancies were terminated. The survival rate of non-hydropic fetuses with conservatively managed CPAM was 98.0% (50/51), the survival rate for hydropic fetuses with intention to treat was 42.9% (3/7). 10 (18.2%) children needed respiratory assistance. Fetuses with a CVR of <0.91 were significantly less likely to experience adverse outcome or need for prenatal intervention with sensitivity, specificity and positive/negative predictive value of 0.89, 0.71, 0.62 and 0.93, respectively. A MTR (mass-to-thorax-ratio) of < 0.51 had a positive predictive value of 0.54 and a negative predictive value of 0.96 of adverse events with a sensitivity of 0.95 and a specificity of 0.63. The negative predictive value for o/e LHR of 45% was 0.84 with sensitivity, specificity and positive predictive value of 0.73, 0.68 and 0.52, respectively. Conclusions The majority of cases with CPAM have a favorable outcome. MTR and CVR are able to identify fetuses at risk, the o/e LHR is less sensitive. PMID:26978067

  3. Preoperative quality of life and surgical outcomes in gynecologic oncology patients: A new predictor of operative risk?

    PubMed Central

    Doll, KM; Snavely, AC; Kalinowski, A; Irwin, DE; Bensen, JT; Bae-Jump, V; Boggess, JF; Soper, JT; Brewster, WR; Gehrig, PA

    2014-01-01

    Objective Quality of life (QoL) for women with gynecologic malignancies is predictive of chemotherapy related toxicity and overall survival but has not been studied in relation to surgical outcomes and hospital readmissions. Our goal was to evaluate the association between baseline, pre-operative QoL measures and 30-day post-operative morbidity and health resource utilization by gynecologic oncology patients. Methods We analyzed prospectively collected survey data from an institution-wide cohort study. Patients were enrolled from 8/2012 – 6/2013 and medical records data was abstracted (demographics, comorbid conditions, and operative outcomes). Responses from several validated health-related QoL instruments were collected. Bivariate tests and multivariable linear and logistic regression models were used to evaluate factors associated with QoL scores. Results Of 182 women with suspected gynecologic malignancies, 152 (84%) were surveyed pre-operatively and 148 (81%) underwent surgery. Uterine (94; 63.5%), ovarian (26; 17.5%), cervical (15; 10%), vulvar/vaginal (8; 5.4%), and other (5; 3.4%) cancers were represented. There were 37 (25%) cases of postoperative morbidity (PM), 18 (12%) unplanned ER visits, 9(6%) unplanned clinic visits, and 17 (11.5%) hospital readmissions(HR) within 30 days of surgery. On adjusted analysis, lower functional well-being scores resulted in increased odds of PM (OR 1.07, 95%CI 1.01-.1.21) and HR (OR 1.11, 95%CI 1.03-1.19). A subjective global assessment score was also strongly associated with HR (OR 1.89, 95%CI 1.14, 3.16). Conclusion Lower pre-operative QoL scores are significantly associated with post-operative morbidity and hospital readmission in gynecologic cancer patients. This relationship may be a novel indicator of operative risk. PMID:24726615

  4. Optimal Skin-to-Stone Distance Is a Positive Predictor for Successful Outcomes in Upper Ureter Calculi following Extracorporeal Shock Wave Lithotripsy: A Bayesian Model Averaging Approach

    PubMed Central

    Cho, Kang Su; Jung, Hae Do; Ham, Won Sik; Chung, Doo Yong; Kang, Yong Jin; Jang, Won Sik; Kwon, Jong Kyou; Choi, Young Deuk; Lee, Joo Yong

    2015-01-01

    Objectives To investigate whether skin-to-stone distance (SSD), which remains controversial in patients with ureter stones, can be a predicting factor for one session success following extracorporeal shock wave lithotripsy (ESWL) in patients with upper ureter stones. Patients and Methods We retrospectively reviewed the medical records of 1,519 patients who underwent their first ESWL between January 2005 and December 2013. Among these patients, 492 had upper ureter stones that measured 4–20 mm and were eligible for our analyses. Maximal stone length, mean stone density (HU), and SSD were determined on pretreatment non-contrast computed tomography (NCCT). For subgroup analyses, patients were divided into four groups. Group 1 consisted of patients with SSD<25th percentile, group 2 consisted of patients with SSD in the 25th to 50th percentile, group 3 patients had SSD in the 50th to 75th percentile, and group 4 patients had SSD≥75th percentile. Results In analyses of group 2 patients versus others, there were no statistical differences in mean age, stone length and density. However, the one session success rate in group 2 was higher than other groups (77.9% vs. 67.0%; P = 0.032). The multivariate logistic regression model revealed that shorter stone length, lower stone density, and the group 2 SSD were positive predictors for successful outcomes in ESWL. Using the Bayesian model-averaging approach, longer stone length, lower stone density, and group 2 SSD can be also positive predictors for successful outcomes following ESWL. Conclusions Our data indicate that a group 2 SSD of approximately 10 cm is a positive predictor for success following ESWL. PMID:26659086

  5. Psychological factors predict adherence to methotrexate in rheumatoid arthritis; findings from a systematic review of rates, predictors and associations with patient-reported and clinical outcomes

    PubMed Central

    Bluett, James; Barton, Anne; Hyrich, Kimme L; Cordingley, Lis; Verstappen, Suzanne M M

    2016-01-01

    Treatment response to methotrexate (MTX) for rheumatoid arthritis (RA) is not universal and non-adherence may partially explain this. The aims of this systematic review were to: (1) summarise existing rates of adherence to MTX, (2) identify predictors of adherence to MTX, and (3) assess the association between non-adherence and patient outcomes. The authors conducted a systematic search of papers published from January 1980 to February 2015 in PubMed, PsycINFO, EMBASE and CINAHL databases. Studies were eligible for inclusion if: (1) MTX was used as monotherapy or in combination with other therapies, (2) MTX was used in an RA or inflammatory polyarthritis population, (3) adherence was defined and measured as the extent to which patients followed their MTX regimen during the period of prescription, and (4) it was an original piece of research. In total, 10 studies met the inclusion criteria and 8 were evaluated as high quality. Rates of adherence ranged from 59% to 107%, and exposed differences in definitions of adherence, study methodologies and sample heterogeneity. A number of potential predictors of MTX adherence were identified; the strongest being related to beliefs in the necessity and efficacy of MTX, absence of low mood, mild disease and MTX monotherapy. Furthermore, 3 studies tested the association of adherence with disease activity as an outcome measure; all 3 found non-adherence associated with poor treatment response. This systematic review shows the importance of adherence to MTX treatment and summarises the associated modifiable factors. PMID:26848403

  6. Elevated Baseline C-Reactive Protein as a Predictor of Outcome After Aneurysmal Subarachnoid Hemorrhage: Data From the Simvastatin in Aneurysmal Subarachnoid Hemorrhage (STASH) Trial

    PubMed Central

    Budohoski, Karol; Smith, Christopher; Hutchinson, Peter J.; Kirkpatrick, Peter J.

    2015-01-01

    BACKGROUND: There remains a proportion of patients with unfavorable outcomes after aneurysmal subarachnoid hemorrhage, of particular relevance in those who present with a good clinical grade. A forewarning of those at risk provides an opportunity towards more intensive monitoring, investigation, and prophylactic treatment prior to the clinical manifestation of advancing cerebral injury. OBJECTIVE: To assess whether biochemical markers sampled in the first days after the initial hemorrhage can predict poor outcome. METHODS: All patients recruited to the multicenter Simvastatin in Aneurysmal Hemorrhage Trial (STASH) were included. Baseline biochemical profiles were taken between time of ictus and day 4 post ictus. The t-test compared outcomes, and a backwards stepwise binary logistic regression was used to determine the factors providing independent prediction of an unfavorable outcome. RESULTS: Baseline biochemical data were obtained in approximately 91% of cases from 803 patients. On admission, 73% of patients were good grade (World Federation of Neurological Surgeons grades 1 or 2); however, 84% had a Fisher grade 3 or 4 on computed tomographic scan. For patients presenting with good grade on admission, higher levels of C-reactive protein, glucose, and white blood cells and lower levels of hematocrit, albumin, and hemoglobin were associated with poor outcome at discharge. C-reactive protein was found to be an independent predictor of outcome for patients presenting in good grade. CONCLUSION: Early recording of C-reactive protein may prove useful in detecting those good grade patients who are at greater risk of clinical deterioration and poor outcome. ABBREVIATIONS: ALP, alkaline phosphatase ALT, alanine aminotransferase CK, creatine kinase CRP, C-reactive protein EVD, external ventricular drainage ICH GCP, International Conference on Harmonisation guidelines for good clinical practice mRS, modified Rankin Scale SAH, subarachnoid hemorrhage STASH, Simvastatin in

  7. The UKCAT-12 study: educational attainment, aptitude test performance, demographic and socio-economic contextual factors as predictors of first year outcome in a cross-sectional collaborative study of 12 UK medical schools

    PubMed Central

    2013-01-01

    Background Most UK medical schools use aptitude tests during student selection, but large-scale studies of predictive validity are rare. This study assesses the United Kingdom Clinical Aptitude Test (UKCAT), and its four sub-scales, along with measures of educational attainment, individual and contextual socio-economic background factors, as predictors of performance in the first year of medical school training. Methods A prospective study of 4,811 students in 12 UK medical schools taking the UKCAT from 2006 to 2008 as a part of the medical school application, for whom first year medical school examination results were available in 2008 to 2010. Results UKCAT scores and educational attainment measures (General Certificate of Education (GCE): A-levels, and so on; or Scottish Qualifications Authority (SQA): Scottish Highers, and so on) were significant predictors of outcome. UKCAT predicted outcome better in female students than male students, and better in mature than non-mature students. Incremental validity of UKCAT taking educational attainment into account was significant, but small. Medical school performance was also affected by sex (male students performing less well), ethnicity (non-White students performing less well), and a contextual measure of secondary schooling, students from secondary schools with greater average attainment at A-level (irrespective of public or private sector) performing less well. Multilevel modeling showed no differences between medical schools in predictive ability of the various measures. UKCAT sub-scales predicted similarly, except that Verbal Reasoning correlated positively with performance on Theory examinations, but negatively with Skills assessments. Conclusions This collaborative study in 12 medical schools shows the power of large-scale studies of medical education for answering previously unanswerable but important questions about medical student selection, education and training. UKCAT has predictive validity as a

  8. Reduction of Subjective Distress in CBT for Childhood OCD: Nature of Change, Predictors, and Relation to Treatment Outcome

    PubMed Central

    Kircanski, Katharina; Wu, Monica; Piacentini, John

    2013-01-01

    Little research has investigated changes in subjective distress during cognitive-behavioral therapy (CBT) for anxiety disorders in youth. In the current study, 40 youth diagnosed with primary obsessive-compulsive disorder (OCD; M age=11.9 years, 60% male, 80% Caucasian) and 36 parent informants completed separate weekly ratings of child distress for each OC symptom during a 12-session course of CBT. Between-session changes in distress were calculated at the start of, on average throughout, and at the end of treatment. On average throughout treatment, child- and parent-reported decreases in child distress were significant. Baseline OCD severity, functional impairment, and internalizing symptoms predicted degree of change in child distress. Additionally, greater decreases in child distress were predictive of more improved clinical outcomes. Findings advance our understanding of the strengths and limitations of this clinical tool. Future studies should examine youth distress change between and within CBT sessions across both subjective and psychophysiological levels of analysis. PMID:23774008

  9. Prognostic Significance of Neutrophil to Lymphocyte Ratio in Oncologic Outcomes of Cholangiocarcinoma: A Meta-analysis

    PubMed Central

    Tan, De-Wen; Fu, Yan; Su, Qi; Guan, Ming-Jun; Kong, Po; Wang, Sheng-Qiang; Wang, He-Ling

    2016-01-01

    Increasing evidence indicates that the neutrophil to lymphocyte ratio (NLR) is a useful biomarker of long-term outcomes in patients with cholangiocarcinoma. However, the prognostic role of NLR in patients with cholangiocarcinoma remains unclear. Thus, the current meta-analysis was undertaken to clarify the correlation between NLR and overall survival (OS) in cholangiocarcinoma, and a comprehensive literature research was conducted to understand the association of NLR and prognosis of cholangiocarcinoma. The hazard ratio (HR) with 95% confidence interval (CI) was used to assess OS. The synthesized HR of 1.449 (95% CI: 1.296–1.619, P < 0.001) indicated that a high NLR had an unfavourable effect on OS. Overall, this meta-analysis suggested that elevated preoperative NLR is associated with poorer rates of survival in cholangiocarcinoma patients. PMID:27694951

  10. FUNCTIONAL SIGNIFICANCE OF EARLY-LIFE IRON DEFICIENCY: OUTCOMES AT 25 YEARS

    PubMed Central

    Lozoff, Betsy; Smith, Julia B.; Kaciroti, Niko; Clark, Katy M.; Guevara, Silvia; Jimenez, Elias

    2013-01-01

    Objective To determine adulthood functioning following chronic iron deficiency in infancy. Study design At 25 years, we compared 33 participants with chronic iron deficiency in infancy to 89 who were iron-sufficient before and/or after iron therapy. Outcomes included education, employment, marital status, physical and mental health. Results Adjusting for sex and SES, a higher proportion of the chronic iron-deficient group did not complete secondary school (58.1% vs.19.8% in iron-sufficient group, Wald-value = 8.74, p = .003), were not pursuing further education/training (76.1% vs. 31.5%, Wald-value = 3.01, p = .08; suggestive trend), and were single (83.9% vs. 23.7%, Wald-value = 4.49, p = .03). They reported poorer emotional health and more negative emotions and feelings of dissociation/detachment. Results were similar in secondary analyses comparing the chronic iron-deficient group to participants in the iron-sufficient group who had been iron-deficient before treatment in infancy. Path analysis showed direct paths for chronic iron deficiency in infancy and being single and more detachment/dissociation at 25 years. There were indirect paths for chronic iron deficiency and not completing secondary school via poorer cognitive functioning in early adolescence and more negative emotions via behavior problems in adolescence, indicating a cascade of adverse outcomes. Conclusion The observational nature of the study limits causal inference, despite control for background factors. Nonetheless, the results indicate substantial loss of human potential. There may be broader societal implications, because many adults worldwide had chronic iron deficiency in infancy. Iron deficiency can be prevented or treated before it becomes chronic or severe. PMID:23827739

  11. Neurobiological factors as predictors of cognitive-behavioral therapy outcome in individuals with antisocial behavior: a review of the literature.

    PubMed

    Cornet, Liza J M; de Kogel, Catharina H; Nijman, Henk L I; Raine, Adrian; van der Laan, Peter H

    2014-11-01

    This review focuses on the predictive value of neurobiological factors in relation to cognitive-behavioral therapy outcome among individuals with antisocial behavior. Ten relevant studies were found. Although the literature on this topic is scarce and diverse, it appears that specific neurobiological characteristics, such as physiological arousal levels, can predict treatment outcome. The predictive value of neurobiological factors is important as it could give more insight into the causes of variability in treatment outcome among individuals with antisocial behavior. Furthermore, results can contribute to improvement in current treatment selection procedures and to the development of alternative treatment options.

  12. Biomarkers of treatment outcome in schizophrenia: Defining a benchmark for clinical significance.

    PubMed

    Levine, Stephen Z; Rabinowitz, Jonathan; Uher, Rudolf; Kapur, Shitij

    2015-10-01

    Emerging data from on imaging and genetic studies have generated interest in "clinically significant" biomarkers to predict response and prognosis. What constitutes "clinical significance" and how a biomarker would reach that threshold are unclear. To develop a benchmark we reviewed different approaches for defining "clinical significance" applied in schizophrenia research and identified that an improvement of 15 points on the PANSS Total is considered meaningful in clinical settings. Using this benchmark and we simulated thousands of schizophrenia trials, using characteristics derived from the NEWMEDS database with over 8000 patients with schizophrenia, to the kind of imaging, genetic, and other biomarkers that could attain clinical significance. We plotted the interaction between frequency-of-occurrence, the effect size of biomarkers and their relationship to the clinical significance threshold. Results show that categorical biomarkers are likely to attain clinical significance when they occur in 20-50% of the clinical population, and can predict at least a 8-10 point PANSS scale difference. Genetic markers are likely to have clinical significance when they occur in 20-50% of the population and can predict 7-9 points on the PANSS scale. A marker with a lower frequency or lesser effect size would find it hard to meet clinical significance thresholds for schizophrenia. The assumptions and limitations of this approach are discussed. Compared with standards in the rest of medicine, biomarkers that can attain this benchmark will be cost-effective and are likely to be adopted by clinical systems.

  13. Serum anti-Müllerian hormone levels as a predictor of the ovarian response and IVF outcomes

    PubMed Central

    Choi, Min Hye; Yoo, Ji Hee; Cha, Sun Hwa; Park, Chan Woo; Yang, Kwang Moon; Song, In Ok; Koong, Mi Kyoung; Kang, Inn Soo

    2011-01-01

    Objective The aim of this study was to investigate whether anti-Mullerian hormone (AMH) levels could be predict ovarian poor/hyper response and IVF cycle outcome. Methods Between May 2010 and January 2011, serum AMH levels were evaluated with retrospective analysis. Three hundred seventy infertile women undergoing 461 IVF cycles between the ages of 20 and 42 were studied. We defined the poor response as the number of oocytes retrieved was equal or less than 3, and the hyper response as more than 25 oocytes retrieved. Serum AMH was measured by commercial enzyme-linked immunoassay. Results The number of oocytes retrieved was more correlated with the serum AMH level (r=0.781, p<0.01) than serum FSH (r=-0.412, p<0.01). The cut-off value of serum AMH levels for poor response was 1.05 ng/mL (receiver operating characteristic [ROC] curves/area under the curve [AUC], ROCAUC=0.85, sensitivity 74%, specificity 87%). Hyper response cut-off value was 3.55 ng/mL (ROCAUC=0.91, sensitivity 94%, specificity 81%). When the study group was divided according to the serum AMH levels (low: <1.05 ng/mL, middle: 1.05 ng/mL - 3.55 ng/mL, high: >3.55 ng/mL), the groups showed no statistical differences in mature oocyte rates (71.6% vs. 76.5% vs. 74.8%) or fertilization rates (76.9% vs. 76.6% vs. 73.8%), but showed significant differences in clinical pregnancy rates (21.7% vs. 24.1% vs. 40.8%, p=0.017). Conclusion The serum AMH level can be used to predict the number of oocytes retrieved in patients, distinguishing poor and high responders. PMID:22384435

  14. Is Age a Determinant Factor in EVAR as a Predictor of Outcomes or in the Selection Procedure? Our Experience

    PubMed Central

    Machado, Rui; Teixeira, Gabriela; Oliveira, Pedro; Loureiro, Luís; Pereira, Carlos; Almeida, Rui

    2016-01-01

    Introduction Endovascular aneurysm repair (EVAR) is the therapy of choice in high risk patients with abdominal aortic aneurysm. The good results described are leading to the broadening of clinical indications to younger patients. However, reintervention rates seem higher and even with successful treatment sometimes there is growth of the aneurysm sac and rupture, meaning a failure of the therapeutic goal. This study proposes to analyse the impact of age in patients' selection and post-EVAR results. Methods The clinical records of consecutive patients undergoing endovascular aneurysm repair, between 2001 and 2013, were retrospectively reviewed. Patients were divided according to age groups (<70, 70-80 and >80 years). Gender, body mass index, aneurysm anatomic features, neck characteristics, iliac morphology, surgical indication, endograft type, anesthesic risk classification, length of stay, reinterventions and mortality were analysed and compared. Results The study included 171 patients, 161 (94.1%) men, and mean age 74.1±8.9 years. The age group under 70 had 32% of the patients. Only three characteristics were found different among age groups: 1) body mass index was higher in younger patients, with a considerable trend toward significance (P=0.06); 2) surgical indication, in the younger group, surgeon's and the patient's option were more proeminent (P<0.05); 3) erectile dysfunction was higher in elderly group (P<0.05). No other clinical and anatomical characteristics or final outcomes were found statisticaly different among age groups. Conclusion The absence of statistically differences in mortality and reinterventions among age groups suggests that age by itself is not a relevant factor in endovascular aneurysm repair. Indeed, the three characteristics different in younger (obesity, sexual function and patient's choice) favor endovascular aneurysm repair. PMID:27556312

  15. Trajectories of Intrusive Parenting During Infancy and Toddlerhood as Predictors of Rural, Low-Income African American Boys’ School-Related Outcomes

    PubMed Central

    Clincy, Amanda R.; Mills-Koonce, W. Roger

    2015-01-01

    Stability and change in maternal intrusiveness during early childhood is rarely explored, particularly within African American families. The current study examined the prediction of maternal intrusiveness during the first 3 years of life among mothers of rural, low-income African American boys and its relation to school-related outcomes. Observations of mothers (N=230) interacting with children at 6, 24, and 36 months were coded and analyzed. Predictors of the trajectories and child outcomes were assessed using questionnaires and various tasks. On average, mothers of African American boys increased in intrusiveness across the first 3 years of life. Cumulative sociodemographic risk was associated with initial levels of intrusiveness, and child fearfulness and maternal negative regard predicted increases in intrusiveness overtime. After controlling for sociodemographic risk, child temperament, and parental negativity, increases in intrusiveness over the first 3 years of life were associated with lower levels of expressive communication, inhibitory control, and intellectual functioning but not with attention focusing. Comprehensive parenting intervention efforts aimed toward improving children’s outcomes must take into consideration the broader socioeconomic and affective context in which parenting behaviors occur, as well as stability and change in parenting over time. PMID:23889012

  16. Haunted by ghosts: prevalence, predictors and outcomes of spirit possession experiences among former child soldiers and war-affected civilians in Northern Uganda.

    PubMed

    Neuner, Frank; Pfeiffer, Anett; Schauer-Kaiser, Elisabeth; Odenwald, Michael; Elbert, Thomas; Ertl, Verena

    2012-08-01

    Phenomena of spirit possession have been documented in many cultures. Some authors have argued that spirit possession is a type of psychopathology, and should be included as a category in diagnostic manuals of mental disorders. However, there are hardly any quantitative studies that report the prevalence of spirit possession on a population level and that provide evidence for its validity as a psychopathological entity. In an epidemiological study that was carried out in 2007 and 2008 with N = 1113 youths and young adults aged between 12 and 25 years in war-affected regions of Northern Uganda we examined the prevalence, predictors and outcomes of cen, a local variant of spirit possession. Randomly selected participants were interviewed using a scale of cen, measures of psychopathology (PTSD and depression) as well as indicators of functional outcome on different levels, including suicide risk, daily activities, perceived discrimination, physical complaints and aggression. We found that cen was more common among former child soldiers then among subjects without a history of abduction. Cen was related to extreme levels of traumatic events and uniquely predicted functional outcome even when the effects of PTSD and depression were controlled for. Our findings show that a long-lasting war that is accompanied by the proliferation of spiritual and magical beliefs and propaganda can lead to high levels of harmful spirit possession. In addition, we provide evidence for the incremental validity of spirit possession as a trauma-related psychological disorder in this context.

  17. Haunted by ghosts: prevalence, predictors and outcomes of spirit possession experiences among former child soldiers and war-affected civilians in Northern Uganda.

    PubMed

    Neuner, Frank; Pfeiffer, Anett; Schauer-Kaiser, Elisabeth; Odenwald, Michael; Elbert, Thomas; Ertl, Verena

    2012-08-01

    Phenomena of spirit possession have been documented in many cultures. Some authors have argued that spirit possession is a type of psychopathology, and should be included as a category in diagnostic manuals of mental disorders. However, there are hardly any quantitative studies that report the prevalence of spirit possession on a population level and that provide evidence for its validity as a psychopathological entity. In an epidemiological study that was carried out in 2007 and 2008 with N = 1113 youths and young adults aged between 12 and 25 years in war-affected regions of Northern Uganda we examined the prevalence, predictors and outcomes of cen, a local variant of spirit possession. Randomly selected participants were interviewed using a scale of cen, measures of psychopathology (PTSD and depression) as well as indicators of functional outcome on different levels, including suicide risk, daily activities, perceived discrimination, physical complaints and aggression. We found that cen was more common among former child soldiers then among subjects without a history of abduction. Cen was related to extreme levels of traumatic events and uniquely predicted functional outcome even when the effects of PTSD and depression were controlled for. Our findings show that a long-lasting war that is accompanied by the proliferation of spiritual and magical beliefs and propaganda can lead to high levels of harmful spirit possession. In addition, we provide evidence for the incremental validity of spirit possession as a trauma-related psychological disorder in this context. PMID:22580073

  18. Mental health outcomes and predictors of chronic disorders after the North Sea oil rig disaster: 27-year longitudinal follow-up study.

    PubMed

    Boe, Hans Jakob; Holgersen, Katrine H; Holen, Are

    2011-01-01

    The present study examined long-term mental health outcomes following a major disaster, including the relative risks (RR) of developing psychiatric disorders. Trauma exposure and predisaster vulnerability factors were examined as predictors of chronic psychopathology. Standardized questionnaires measuring psychological distress were completed 5½ months, 14 months, 5 years, and 27 years after the disaster. Twenty seven years after the disaster, 48 (79%) survivors and a matched comparison group of 62 (78%) nondisaster-exposed controls were assessed using the Structured Clinical Interview for DSM-IV, axis I Disorders. The prevalence of posttraumatic stress disorder among the survivors was 6.1%, and the risk of having a psychiatric disorder was more than 3 times higher than in the comparison group (RR = 3.44, 95% confidence interval = 1.6-7.6). Disaster exposure and general neurotic personality predicted chronic psychopathology, which was reported by 20.9% of the participants. Findings from this study suggest that increased risk of psychopathology persists 27 years after disaster. Both disaster exposure and vulnerable personality are important predictors of chronic psychopathology.

  19. Evidence of clinically significant change: the therapeutic alliance and the possibilities of outcomes-informed care.

    PubMed

    Manning, Walter H

    2010-11-01

    This article addresses the issue of clinically significant (or meaningful) change resulting from treatment for stuttering. Research in both medical and behavioral fields indicates that clients often have their own unique perspective of meaningful clinical change and that this perspective is often different from that of the professional administering the treatment. Among the variables that the client brings to the treatment session are their progression through stages of therapeutic change and the ways in which they believe they are capable of coping with their problem. Research has shown that how an individual interprets the meaning his or her therapeutic experience is central to clinically significant change. Procedures for obtaining feedback from clients concerning clinically significant change and the quality of the therapeutic alliance are described. PMID:21080293

  20. Predictors of 12-Month Outcome in Bulimia Nervosa and the Influence of Attitudes to Shape and Weight.

    ERIC Educational Resources Information Center

    Fairburn, Christopher G.; And Others

    1993-01-01

    Patients with bulimia nervosa were treated with either cognitive behavioral, behavioral, or a form of interpersonal psychotherapy for 19 sessions in an 18-week period. Assessments were made at pretreatment; posttreatment; and 4-, 8-, and 12-month follow-up. The nature of the relationship between attitudinal disturbance and outcome was complex and…

  1. Familism as a Predictor of Parent-Adolescent Relationships and Developmental Outcomes for Adolescents in Armenian American Immigrant Families

    ERIC Educational Resources Information Center

    Ghazarian, Sharon R.; Supple, Andrew J.; Plunkett, Scott W.

    2008-01-01

    We investigated associations between familism, parent-adolescent relationships, and developmental outcomes for a sample of 97 Armenian adolescents in immigrant families. Our results suggested that adolescents emphasizing family needs over their own were more likely to report conformity to parents' wishes, respect for parental authority, and…

  2. Unraveling the Differential Effects of Motivational and Skills, Social, and Self-Management Measures from Traditional Predictors of College Outcomes

    ERIC Educational Resources Information Center

    Robbins, Steven B.; Allen, Jeff; Casillas, Alex; Peterson, Christina Hamme; Le, Huy

    2006-01-01

    The authors report on a large-scale study examining the effects of self-reported psychosocial factors on 1st-year college outcomes. Using a sample of 14,464 students from 48 institutions, the authors constructed hierarchical regression models to measure the predictive validity of the Student Readiness Inventory, a measure of psychosocial factors.…

  3. Juxtaposing Math Self-Efficacy and Self-Concept as Predictors of Long-Term Achievement Outcomes

    ERIC Educational Resources Information Center

    Parker, Philip David; Marsh, Herbert W.; Ciarrochi, Joseph; Marshall, Sarah; Abduljabbar, Adel Salah

    2014-01-01

    In this study, we tested the hypothesis that self-efficacy and self-concept reflect different underlying processes and both are critical to understanding long-term achievement outcomes. Although both types of self-belief are well established in educational psychology, research comparing and contrasting their relationship with achievement has been…

  4. Dysfunctional Attitudes Scale Perfectionism: A Predictor and Partial Mediator of Acute Treatment Outcome among Clinically Depressed Adolescents

    ERIC Educational Resources Information Center

    Jacobs, Rachel H.; Silva, Susan G.; Reinecke, Mark A.; Curry, John F.; Ginsburg, Golda S.; Kratochvil, Christopher J.; March, John S.

    2009-01-01

    The effect of perfectionism on acute treatment outcomes was explored in a randomized controlled trial of 439 clinically depressed adolescents (12-17 years of age) enrolled in the Treatment for Adolescents with Depression Study (TADS) who received cognitive behavior therapy (CBT), fluoxetine, a combination of CBT and FLX, or pill placebo. Measures…

  5. Predictors of Employment Outcomes for People with Visual Impairment in Taiwan: The Contribution of Disability Employment Services

    ERIC Educational Resources Information Center

    Jang, Yuh; Wang, Yun-Tung; Lin, Meng-Hsiu; Shih, Kevin J.

    2013-01-01

    Introduction: We investigated the employment status and identified factors that may affect the employment outcomes of people with visual impairments in Taiwan. Methods: A retrospective, ex post facto design study was conducted. The sample included 313 visually impaired clients who commenced and "closed" (completed) disability employment…

  6. End-of-Life Communication and Adjustment: Pre-Loss Communication as a Predictor of Bereavement-Related Outcomes

    ERIC Educational Resources Information Center

    Metzger, Patricia L.; Gray, Matt J.

    2008-01-01

    Although bereavement-related emotional distress usually remits on its own over time, approximately 20% of bereaved individuals experience chronic emotional difficulties following the loss (Prigerson & Jacobs, 2001). Although several factors have been shown to be associated with poor outcomes post-loss, few studies have examined the relationship…

  7. Long-Term Outcome in Cognitive-Behavioral Treatment of Panic Disorder: Clinical Predictors and Alternative Strategies for Assessment.

    ERIC Educational Resources Information Center

    Brown, Timothy A.; Barlow, David H.

    1995-01-01

    Examines long-term outcome of cognitive-behavioral treatment in 63 patients with panic disorder. Many patients (27%) sought further treatment for panic during follow-up because of less-than-adequate response to treatment; nevertheless, additional treatment did not result in further clinical improvement. Pretreatment severity of disorder and the…

  8. Cognitive predictors and moderators of winter depression treatment outcomes in cognitive-behavioral therapy vs. light therapy.

    PubMed

    Sitnikov, Lilya; Rohan, Kelly J; Evans, Maggie; Mahon, Jennifer N; Nillni, Yael I

    2013-12-01

    There is no empirical basis for determining which seasonal affective disorder (SAD) patients are best suited for what type of treatment. Using data from a parent clinical trial comparing light therapy (LT), cognitive-behavioral therapy (CBT), and their combination (CBT + LT) for SAD, we constructed hierarchical linear regression models to explore baseline cognitive vulnerability constructs (i.e., dysfunctional attitudes, negative automatic thoughts, response styles) as prognostic and prescriptive factors of acute and next winter depression outcomes. Cognitive constructs did not predict or moderate acute treatment outcomes. Baseline dysfunctional attitudes and negative automatic thoughts were prescriptive of next winter treatment outcomes. Participants with higher baseline levels of dysfunctional attitudes and negative automatic thoughts had less severe depression the next winter if treated with CBT than if treated with LT. In addition, participants randomized to solo LT who scored at or above the sample mean on these cognitive measures at baseline had more severe depressive symptoms the next winter relative to those who scored below the mean. Baseline dysfunctional attitudes and negative automatic thoughts did not predict treatment outcomes in participants assigned to solo CBT or CBT + LT. Therefore, SAD patients with extremely rigid cognitions did not fare as well in the subsequent winter if treated initially with solo LT. Such patients may be better suited for initial treatment with CBT, which directly targets cognitive vulnerability processes.

  9. Paced QRS duration and myocardial scar amount: predictors of long-term outcome of right ventricular apical pacing.

    PubMed

    Lee, Seung-Ah; Cha, Myung-Jin; Cho, Youngjin; Oh, Il-Young; Choi, Eue-Keun; Oh, Seil

    2016-07-01

    Long-term right ventricular apical pacing (RVAP) is reportedly associated with heart failure (HF) development. However, the predictors of pacing-induced HF (PHF) remained unclear. We retrospectively enrolled 234 patients without structural heart disease who underwent a permanent pacemaker implantation with RVAP between 1982 and 2004. RVAP-induced HF was defined as left ventricular ejection fraction decrease >5 % with HF symptom without other HF development etiology. The QRS duration of a paced beat (pQRSd) and myocardial scar score were analyzed from each patient's 12-lead ECG. During a mean 15.6 years (range 3.3-30.0 years), 48 patients (20.5 %) patients developed RVAP-induced HF. The PHF group patients had a longer pQRSd (192.4 ± 13.5 vs. 175.7 ± 14.7 ms in non-PHF patients, p < 0.001) and a higher myocardial scar score (5.2 ± 1.9 vs. 2.7 ± 1.9, respectively p < 0.001). In multivariate Cox regression analysis, old age at implantation [Hazard ratio (HR) 1.62, 95 % confidential interval (CI) 1.22-2.16, p = 0.001], a longer pQRSd (HR 1.54, 95 % CI 1.15-2.05, p = 0.003), a higher myocardial scar score (HR 1.23, 95 % CI 1.03-1.49, p = 0.037), and a higher percentage of ventricular pacing (HR 1.31, 95 % CI 1.01-1.49, p = 0.010) were independent predictors of PHF. Based on the results of the receiver-operating characteristic (ROC) curve, the pQRSd cutoff was 185 ms (AUC 0.79, sensitivity 66.7 %, specificity 76.3 %) and myocardial scar score cutoff value was 4 (AUC 0.81, sensitivity 81.3 %, specificity 66.1 %). The pQRSd was positively correlated with scar score (r = 0.70, p < 0.001). pQRSd ≥185 ms and/or myocardial scar score ≥4 might be independent long-term prognostic markers of PHF.

  10. Significant Incidence of Extra-Articular Tibia Vara Affects Radiological Outcome of Total Knee Arthroplasty

    PubMed Central

    Saibaba, Balaji; Chouhan, Devendra K.; Kanojia, Rajendra K.; Prakash, Mahesh; Bachhal, Vikas

    2015-01-01

    Purpose To identify and quantify the presence of extra-articular tibia vara that might influence the mechanical axis alignment after total knee arthroplasty (TKA). Materials and Methods A total of 48 TKAs in 30 osteoarthritic Indian patients were prospectively evaluated. The hip-knee-ankle angle (HKA), joint line convergence angle, and varus angulation at the femur and tibia were measured from the preoperative and postoperative standing hip-to-ankle radiographs. Four different methods were used to measure the varus angulation at the tibia: metaphyseo-diaphyseal angle (MDA), the angle between the anatomical axis and mechanical axis of the tibia, the angle between the proximal third and distal third of tibia and the angle between the proximal half and distal half of tibia. Results Extra-articular tibia vara quantified using MDA had the most positive correlation with HKA. Receiver operating characteristic plotting showed that MDA of >4° predicts abnormal postoperative HKA. Twenty-eight out of 48 knees had MDA of >4°, and 78.6% of these had postoperative HKA under-correction and 21.4% had less than ideal tibial component position. Conclusions A significant inherent extra-articular varus angulation best measured using MDA exists in the proximal tibia in osteoarthritic Indian patients undergoing TKA. MDA of >4° is associated with abnormal postoperative HKA. Computer navigation may be useful for achieving ideal correction in such cases. PMID:26389071

  11. Mouse p53-Deficient Cancer Models as Platforms for Obtaining Genomic Predictors of Human Cancer Clinical Outcomes

    PubMed Central

    Dueñas, Marta; Santos, Mirentxu; Aranda, Juan F.; Bielza, Concha; Martínez-Cruz, Ana B.; Lorz, Corina; Taron, Miquel; Ciruelos, Eva M.; Rodríguez-Peralto, José L.; Martín, Miguel; Larrañaga, Pedro; Dahabreh, Jubrail; Stathopoulos, George P.; Rosell, Rafael; Paramio, Jesús M.; García-Escudero, Ramón

    2012-01-01

    Mutations in the TP53 gene are very common in human cancers, and are associated with poor clinical outcome. Transgenic mouse models lacking the Trp53 gene or that express mutant Trp53 transgenes produce tumours with malignant features in many organs. We previously showed the transcriptome of a p53-deficient mouse skin carcinoma model to be similar to those of human cancers with TP53 mutations and associated with poor clinical outcomes. This report shows that much of the 682-gene signature of this murine skin carcinoma transcriptome is also present in breast and lung cancer mouse models in which p53 is inhibited. Further, we report validated gene-expression-based tests for predicting the clinical outcome of human breast and lung adenocarcinoma. It was found that human patients with cancer could be stratified based on the similarity of their transcriptome with the mouse skin carcinoma 682-gene signature. The results also provide new targets for the treatment of p53-defective tumours. PMID:22880004

  12. Predictors of In Vitro Fertilization Outcomes in Women with Highest Follicle-Stimulating Hormone Levels ≥12 IU/L: A Prospective Cohort Study

    PubMed Central

    Huang, Lina N.; Jun, Sunny H.; Drubach, Nathalie; Dahan, Michael H.

    2015-01-01

    Objective The purpose of this study is to evaluate factors predictive of outcomes in women with highest follicle-stimulating hormone (FSH) levels ≥12 IU/L on basal testing, undergoing in vitro fertilization (IVF). Methods A prospective cohort study was conducted at Stanford University Hospital in the Reproductive Endocrinology and Infertility Center for 12 months. Women age 21 to 43 undergoing IVF with highest FSH levels on baseline testing were included. Donor/Recipient and frozen embryo cycles were excluded from this study. Prognostic factors evaluated in association with clinical pregnancy rates were type of infertility diagnosis and IVF stimulation parameters. Results The current study found that factors associated with clinical pregnancy were: increased number of mature follicles on the day of triggering, number of oocytes retrieved, number of Metaphase II oocytes if intracytoplasmic sperm injection was done, and number of embryos developed 24 hours after retrieval. Conclusions Our findings suggest that it would be beneficial for women with increased FSH levels to attempt a cycle of IVF. Results of ovarian stimulation, especially embryo quantity appear to be the best predictors of IVF outcomes and those can only be obtained from a cycle of IVF. Therefore, increased basal FSH levels should not discourage women from attempting a cycle of IVF. PMID:25867175

  13. Patient Outcomes in Association With Significant Other Responses to Chronic Fatigue Syndrome: A Systematic Review of the Literature

    PubMed Central

    Band, Rebecca; Wearden, Alison; Barrowclough, Christine

    2015-01-01

    Social processes have been suggested as important in the maintenance of chronic fatigue syndrome (also known as myalgic encephalomyelitis; CFS/ME), but the specific role of close interpersonal relationships remains unclear. We reviewed 14 articles investigating significant other responses to close others with CFS/ME and the relationships between these responses and patient outcomes. Significant other beliefs attributing patient responsibility for the onset and ongoing symptoms of CFS/ME were associated with increased patient distress. Increased symptom severity, disability, and distress were also associated with both solicitous and negative significant other responses. Specific aspects of dyadic relationship quality, including high Expressed Emotion, were identified as important. We propose extending current theoretical models of CFS/ME to include two potential perpetuating interpersonal processes; the evidence reviewed suggests that the development of significant other–focused interventions may also be beneficial. PMID:26617440

  14. Availability of Volunteer-Led Home-Based Care System and Baseline Factors as Predictors of Clinical Outcomes in HIV-Infected Patients in Rural Zambia

    PubMed Central

    Estopinal, Christopher B.; van Dijk, Janneke H.; Sitali, Stanley; Stewart, Hannah; Davidson, Mario A.; Spurrier, John; Vermund, Sten H.

    2012-01-01

    Background We assessed the impact of home-based care (HBC) for HIV+ patients, comparing outcomes between two groups of Zambians receiving antiretroviral therapy (ART) who lived in villages with and without HBC teams. Methods We conducted a retrospective cohort study using medical charts from Macha Mission Hospital, a hospital providing HIV care in Zambia's rural Southern Province. Date of birth, date of ART initiation, place of residence, sex, body mass index (BMI), CD4+ cell count, and hemoglobin (Hgb) were abstracted. Logistic regression was used to test our hypothesis that HBC was associated with treatment outcomes. Results Of 655 patients, 523 (80%) were eligible and included in the study. There were 428 patients (82%) with favorable outcomes (alive and on ART) and 95 patients (18%) with unfavorable outcomes (died, lost to follow-up, or stopped treatment). A minority of the 523 eligible patients (n = 84, 16%) lived in villages with HBC available. Living in a village with HBC was not significantly associated with treatment outcomes; 80% of patients in a village with HBC had favorable outcomes, compared to 82% of patients in a village without HBC (P = 0.6 by χ2). In bivariable analysis, lower BMI (P<0.001), low CD4+ cell count (P = 0.02), low Hgb concentration (P = 0.02), and older age at ART initiation (P = 0.047) were associated with unfavorable outcomes. In multivariable analysis, low BMI remained associated with unfavorable outcomes (P<0.001). Conclusions We did not find that living in a village with HBC available was associated with improved treatment outcomes. We speculate that the ART clinic's rigorous treatment preparation before ART initiation and continuous adherence counseling during ART create a motivated group of patients whose outcomes did not improve with additional HBC support. An alternative explanation is that the quality of the HBC program is suboptimal. PMID:23236351

  15. Cephalometric predictors of treatment outcome with mandibular advancement devices in adult patients with obstructive sleep apnea: a systematic review

    PubMed Central

    Ippolito, Daniela Rita; Bartolucci, Maria Lavinia; D'Antò, Vincenzo; Incerti-Parenti, Serena

    2015-01-01

    Objective The efficacy of mandibular advancement devices (MADs) in the treatment of obstructive sleep apnea (OSA) ranges between 42% and 65%. However, it is still unclear which predictive factors can be used to select suitable patients for MAD treatment. This study aimed to systematically review the literature on the predictive value of cephalometric analysis for MAD treatment outcomes in adult OSA patients. Methods The MEDLINE, Google Scholar, Scopus, and Cochrane Library databases were searched through December 2014. Reference lists from the retrieved publications were also examined. English language studies published in international peer-reviewed journals concerning the predictive value of cephalometric analysis for MAD treatment outcome were considered for inclusion. Two review authors independently assessed eligibility, extracted data, and ascertained the quality of the studies. Results Fifteen eligible studies were identified. Most of the skeletal, dental, and soft tissue cephalometric measurements examined were widely recognized as not prognostic for MAD treatment outcome; however, controversial and limited data were found on the predictive role of certain cephalometric measurements including cranial base angle, mandibular plane angle, hyoid to mandibular plane distance, posterior nasal spine to soft-palate tip distance, anterior nasal spine to epiglottis base distance, and tongue/oral cross sectional area ratio thus justifying additional studies on these parameters. Conclusions Currently available evidence is inadequate for identification of cephalometric parameters capable of reliably discriminating between poor and good responders to MAD treatment. To guide further research, methodological weaknesses of the currently available studies were highlighted and possible reasons for their discordant results were analyzed. PMID:26629477

  16. Language network dysfunction as a predictor of outcome in youth at clinical high-risk for psychosis

    PubMed Central

    Sabb, Fred W.; van Erp, Theo G.M.; Hardt, Molly E.; Dapretto, Mirella; Caplan, Rochelle; Cannon, Tyrone D.; Bearden, Carrie E.

    2009-01-01

    Objectives Language processing abnormalities are a hallmark feature of schizophrenia. Yet, no study to date has investigated underlying neural networks associated with discourse processing in adolescents at clinical high risk (CHR) for developing psychosis. Methods Forty CHR youth and 24 demographically comparable healthy controls underwent functional magnetic resonance imaging while performing a naturalistic discourse processing paradigm. We assessed differences in blood oxygenation level-dependent (BOLD) activity between task conditions (Topic Maintenance vs. Reasoning) and between groups. Furthermore, we examined the association of regional brain activity with symptom severity and social outcome at follow-up, 6 to 24 months after the scan. Results Relative to controls, CHR participants showed increased neural activity in a network of language-associated brain regions, including the medial prefrontal cortex bilaterally, left inferior frontal (LIFG; BA44/45, 47) and middle temporal gyri, and the anterior cingulate (BA24&32). Further, increased activity in the superior temporal gyrus (STG), caudate, and LIFG distinguished those who subsequently developed psychosis. Within the CHR sample, severity of positive formal thought disorder at follow-up was positively correlated with signal change in the LIFG, superior frontal gyrus, and inferior/middle temporal gyri, whereas social outcome was inversely correlated with signal change in the LIFG and anterior cingulate. Conclusions These findings are consistent with a neural inefficiency hypothesis in those at greatest risk for psychosis, and additionally suggest that baseline activation differences may predict symptomatic and functional outcome. These results highlight the need to further investigate the neural systems involved in conversion to psychosis, and how language disruption changes over time in at-risk adolescents. PMID:19861234

  17. Predictors of clinical outcome in a national hospitalised cohort across both waves of the influenza A/H1N1 pandemic 2009–2010 in the UK

    PubMed Central

    Myles, Puja R; Semple, Malcolm G; Lim, Wei Shen; Openshaw, Peter J M; Gadd, Elaine M; Read, Robert C; Taylor, Bruce L; Brett, Stephen J; McMenamin, James; Enstone, Joanne E; Armstrong, Colin; Bannister, Barbara; Nicholson, Karl G

    2012-01-01

    Background Although generally mild, the 2009–2010 influenza A/H1N1 pandemic caused two major surges in hospital admissions in the UK. The characteristics of patients admitted during successive waves are described. Methods Data were systematically obtained on 1520 patients admitted to 75 UK hospitals between May 2009 and January 2010. Multivariable analyses identified factors predictive of severe outcome. Results Patients aged 5–54 years were over-represented compared with winter seasonal admissions for acute respiratory infection, as were non-white ethnic groups (first wave only). In the second wave patients were less likely to be school age than in the first wave, but their condition was more likely to be severe on presentation to hospital and they were more likely to have delayed admission. Overall, 45% had comorbid conditions, 16.5% required high dependency (level 2) or critical (level 3) care and 5.3% died. As in 1918–1919, the likelihood of severe outcome by age followed a W-shaped distribution. Pre-admission antiviral drug use decreased from 13.3% to 10% between the first and second waves (p=0.048), while antibiotic prescribing increased from 13.6% to 21.6% (p<0.001). Independent predictors of severe outcome were age 55–64 years, chronic lung disease (non-asthma, non-chronic obstructive pulmonary disease), neurological disease, recorded obesity, delayed admission (≥5 days after illness onset), pneumonia, C-reactive protein ≥100 mg/litre, and the need for supplemental oxygen or intravenous fluid replacement on admission. Conclusions There were demographic, ethnic and clinical differences between patients admitted with pandemic H1N1 infection and those hospitalised during seasonal influenza activity. Despite national policies favouring use of antiviral drugs, few patients received these before admission and many were given antibiotics. PMID:22407890

  18. Going Tobacco-Free: Predictors of Clinician Reactions and Outcomes of the NY State OASAS Tobacco-Free Regulation

    PubMed Central

    de Tormes Eby, Lillian Turner; George, Kerrin; Brown, B. Lindsay

    2012-01-01

    In an effort to reduce patient tobacco dependence and create healthier work environments, New York State (NYS) mandated 100% tobacco-free addiction treatment programs for state funded or certified facilities in 2008. We present the results of a longitudinal study examining how local implementation features shape clinician reactions to the regulation and influence post-regulation clinician behavior and strain. A cohort of 147 clinicians associated with 13 treatment organizations throughout NYS completed a survey prior to the passage of the regulation and again approximately 1 year post-regulation. Findings reveal that local implementation features of clinician participation in the planning for change, the provision of change-related information, and perceived organizational support predicted perceptions of change management fairness, which in turn predicted clinical practice behaviors to support smoking cessation, as well as psychological and behavioral strain. In contrast, self-efficacy for change was neither related to local implementation or clinician outcomes. Practical implications are discussed. PMID:22959978

  19. Childhood to Early-Midlife Systolic Blood Pressure Trajectories: Early-Life Predictors, Effect Modifiers, and Adult Cardiovascular Outcomes.

    PubMed

    Theodore, Reremoana F; Broadbent, Jonathan; Nagin, Daniel; Ambler, Antony; Hogan, Sean; Ramrakha, Sandhya; Cutfield, Wayne; Williams, Michael J A; Harrington, HonaLee; Moffitt, Terrie E; Caspi, Avshalom; Milne, Barry; Poulton, Richie

    2015-12-01

    Previous studies examining blood pressure change over time have modeled an average population trajectory. Recent research among older adults suggests there may be subgroups with different blood pressure trajectories. Identifying subgroups at risk of developing adult hypertension early in life can inform effective risk reduction efforts. We sought to identify different systolic blood pressure trajectories from childhood, their correlated risk factors, and early-midlife cardiovascular outcomes. Blood pressure data at ages 7, 11, 18, 26, 32, and 38 years from a longitudinal, representative birth cohort study (n=975) were used to identify 4 distinct trajectory groups via group-based trajectory modeling: normal (21.8%), high-normal (43.3%), prehypertensive (31.6%), and hypertensive (4.2%). The categories refer to blood pressure beginning at the age of 7 years and most recently measured at the age of 38 years. Family history of high blood pressure (odds ratio [OR], 43.23; 95% confidence interval [CI], 5.27-354.65), male sex (OR, 109.48; 95% CI, 26.82-446.96), being first born (OR, 2.5; 95% CI, 1.00-8.69) and low birth weight (OR, 2.79; 95% CI, 2.49-3.09) were associated with hypertensive group membership (compared with the normal group). Higher body mass index and cigarette smoking resulted in increasing blood pressure across trajectories, particularly for the higher blood pressure groups. Prehypertensive and hypertensive trajectory groups had worse cardiovascular outcomes by early midlife. Harmful blood pressure trajectories are identifiable in childhood, associated with both antecedent and modifiable risk factors over time, and predict adult cardiovascular disease risk. Early detection and subsequent targeted prevention and intervention may reduce the lifecourse burden associated with higher blood pressure. PMID:26558818

  20. Childhood to Early-Midlife Systolic Blood Pressure Trajectories: Early-Life Predictors, Effect Modifiers, and Adult Cardiovascular Outcomes.

    PubMed

    Theodore, Reremoana F; Broadbent, Jonathan; Nagin, Daniel; Ambler, Antony; Hogan, Sean; Ramrakha, Sandhya; Cutfield, Wayne; Williams, Michael J A; Harrington, HonaLee; Moffitt, Terrie E; Caspi, Avshalom; Milne, Barry; Poulton, Richie

    2015-12-01

    Previous studies examining blood pressure change over time have modeled an average population trajectory. Recent research among older adults suggests there may be subgroups with different blood pressure trajectories. Identifying subgroups at risk of developing adult hypertension early in life can inform effective risk reduction efforts. We sought to identify different systolic blood pressure trajectories from childhood, their correlated risk factors, and early-midlife cardiovascular outcomes. Blood pressure data at ages 7, 11, 18, 26, 32, and 38 years from a longitudinal, representative birth cohort study (n=975) were used to identify 4 distinct trajectory groups via group-based trajectory modeling: normal (21.8%), high-normal (43.3%), prehypertensive (31.6%), and hypertensive (4.2%). The categories refer to blood pressure beginning at the age of 7 years and most recently measured at the age of 38 years. Family history of high blood pressure (odds ratio [OR], 43.23; 95% confidence interval [CI], 5.27-354.65), male sex (OR, 109.48; 95% CI, 26.82-446.96), being first born (OR, 2.5; 95% CI, 1.00-8.69) and low birth weight (OR, 2.79; 95% CI, 2.49-3.09) were associated with hypertensive group membership (compared with the normal group). Higher body mass index and cigarette smoking resulted in increasing blood pressure across trajectories, particularly for the higher blood pressure groups. Prehypertensive and hypertensive trajectory groups had worse cardiovascular outcomes by early midlife. Harmful blood pressure trajectories are identifiable in childhood, associated with both antecedent and modifiable risk factors over time, and predict adult cardiovascular disease risk. Early detection and subsequent targeted prevention and intervention may reduce the lifecourse burden associated with higher blood pressure.

  1. Clinical significance of interleukin-1 genotype in smoking patients as a predictor of peri-implantitis: A case-control study

    PubMed Central

    García-Delaney, Cristina; Sánchez-Garcés, Maria-Ángeles; Sánchez-Torres, Alba; Gay-Escoda, Cosme

    2015-01-01

    Background Interleukin-1 (IL-1) is a proinflammatory cytokine that plays an important role in the pathogenesis of periodontitis, and so it might be useful to detect high-risk cases of peri-implantitis. It has been reported that IL-1 polymorphisms and smoking habit have a synergic effect, increasing the incidence of peri-implantitis. The aim of the present study was to evaluate the relationship between IL-1 gene polymorphisms and peri-implantitis in smoking patients. Material and Methods A case-control study was performed in 27 patients with peri-implantitis and 27 patients with healthy implants. All patients included were smokers. IL-1A-C889T, IL-1B+C3953T and IL-1RN+T2018C were identified by polymerase chain reaction (PCR) amplification in order to establish a relation between these variables and the presence of peri-implantitis. A bivariate analysis was performed and odds-ratio (OR) were calculated. Results The incidence of peri-implantitis was significantly higher in patients with previous history of periodontitis (p=0.024; OR=10.9). Both groups were similar regarding IL-1A-C889T, IL-1B+C3953T and IL-1RN+T2018C genotypes. No increased risk in heavy smokers with IL-1 polymorphism was found. Conclusions IL-1 genotypes do not seem to be good predictors of peri-implantitis in the great majority of smoking patients. Furthermore, no synergic effect was found between IL-1 genotypes and heavy smokers. Patients with a previous history of periodontitis were more prone to peri-implantitis. Key words:Peri-implantitis, interleukin-1 genotype positive, case-control study, smoking. PMID:26449434

  2. Exposure to Agent Orange is a significant predictor of prostate-specific antigen (PSA)-based recurrence and a rapid PSA doubling time after radical prostatectomy

    PubMed Central

    Shah, Sagar R.; Freedland, Stephen J.; Aronson, William J.; Kane, Christopher J.; Presti, Joseph C.; Amling, Christopher L.; Terris, Martha K.

    2011-01-01

    OBJECTIVE To investigate and report the clinicopathological characteristics and outcomes after radical prostatectomy (RP) in patients with prostate cancer and previous exposure to Agent Orange (AO), particularly in relationship to race. PATIENTS AND METHODS In 1495 veterans who had undergone RP the clinicopathological characteristics, biochemical progression rates, and prostate-specific antigen (PSA) doubling time (DT) after recurrence between AO-exposed and unexposed men were compared using logistic and linear regression and Cox proportional hazards analyses, and stratified by race. RESULTS The 206 (14%) men with AO exposure were more likely to be black (P = 0.001), younger (P < 0.001), treated more recently (P < 0.001), have a higher body mass index (P = 0.001), have clinical stage T1 disease (P < 0.001), and have lower preoperative PSA levels (P = 0.001). After adjusting for several clinical characteristics, AO exposure was not significantly related to adverse pathological features but was significantly associated with biochemical progression risk (relative risk 1.55, 95% confidence interval 1.15–2.09, P = 0.004) and shorter PSADT (P < 0.001) after recurrence (8.2 vs 18.6 months). When stratified by race, these associations were present and similar in both races, with no significant interaction between race and AO exposure for predicting biochemical recurrence or mean adjusted PSADT (P interaction >0.20). CONCLUSIONS Patients with AO exposure and treated with RP were more likely to be black, present with lower risk features, have an increased risk of biochemical progression, and shorter PSADT after recurrence. When stratified by race, the association between AO exposure and poor outcomes was present in both races. These findings suggest that among selected men who choose RP, AO exposure might be associated with more aggressive prostate cancer. PMID:19298411

  3. Evidence for No Significant Impact of Müllerian Anomalies on Reproductive Outcomes of Twin Pregnancy in Korean Women.

    PubMed

    Shim, Sohyun; Hur, Yoon-Mi; Kim, Da Hee; Seong, Seok Ju; Kim, Mi-La; Shin, Joong Sik

    2016-04-01

    The present article aimed to evaluate the impact of congenital Müllerian anomalies (MA) on twin pregnancy after 24 gestational weeks in Korean women. All records of twin pregnancies in a large maternity hospital in Korea between January 2005 and July 2013 were analyzed. Patients with monochorionic monoamniotic (MCMA) twins, non-Korean patients, patients with twins delivered prior to 24 gestational weeks, and patients with miscarriage of one fetus or intrauterine fetal death (IUFD) before 24 gestational weeks were excluded from data analysis. In total, 1,422 women with twin pregnancy were eligible for data analysis, including 17 (1.2%) who had a known congenital MA (septate uterus, bicornuate uterus, arcuate uterus, and unicornuate uterus). Except for the mode of conception, baseline demographics were similar between women with MA and those without MA. No significant differences were found in pregnancy outcomes of gestational age at delivery (p = .86), birth weight of smaller and larger twins (p = .54 and p = .65), and number of twins with birth weight <5th percentile for gestational age (p = .43).The rates of obstetrical complications such as pre-eclampsia, gestational diabetes mellitus (GDM), placenta previa, cerclage, IUFD, and postpartum hemorrhage were not significantly different between the two groups either. We concluded that the presence of congenital MA may not increase obstetrical risks in outcomes of pregnancy of twins delivered after 24 gestational weeks.

  4. Predictors of outcome in ICU patients with septic shock caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae.

    PubMed

    Falcone, M; Russo, A; Iacovelli, A; Restuccia, G; Ceccarelli, G; Giordano, A; Farcomeni, A; Morelli, A; Venditti, M

    2016-05-01

    The aim of this study was to identify factors associated with mortality in intensive care unit patients with Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) septic shock. A retrospective analysis of intensive care unit patients with KPC-Kp infection and septic shock observed in a large teaching hospital from November 2010 to December 2014 was performed. A total of 111 patients were included in the study. The most frequent source of infection was unknown-focus bacteraemia in 53 patients (47.7%). The rate of resistance to colistin was 51.3%; 30-day mortality was reported for 44 patients (39.6%). Surviving patients were more frequently treated with an initial therapy (within 24 hours) including two or more antibiotics displaying in vitro activity against the isolated KPC-Kp strain (41.8 vs. 18.1%, p 0.01) and were also more likely to receive a definitive therapy including two or more in vitro active antibiotics (85.1 vs. 15.9%, p <0.001). Cox regression analysis revealed that a colistin-containing antibiotic regimen (hazard ratio (HR) 0.21, confidence interval (CI) 95% 0.05-0.72, p <0.001), use of two or more in vitro active antibiotics as definite therapy (HR 0.08, CI 95% 0.02-0.21, p <0.001) and control of removable source of infection (HR 0.14, CI 95% 0.04-0.25, p <0.001) were associated with favourable outcome; colistin resistance (HR 8.09, CI 95% 3.14-11.23, p 0.001) and intra-abdominal source of infection (HR 2.92, CI 95% 2.11-4.12, p 0.002) were associated with death. In conclusion, use of a definitive therapy with at least two antibiotics displaying in vitro activity against the KPC-Kp isolates was the most important determinant of favourable outcome, whilst isolation of colistin-resistant strains was associated with death in septic patients with KPC-Kp infection.

  5. Predictors of Adverse Pregnancy Outcomes in HIV infected Women in Latin America and the Caribbean: a Cohort Study

    PubMed Central

    Kreitchmann, Regis; Li, Su X.; Melo, Victor Hugo; Coelho, Debora Fernandes; Watts, D. Heather; Joao, Esau; Coutinho, Conrado Milani; Alarcon, Jorge O.; Siberry, George K.

    2014-01-01

    Objectives To examine maternal characteristics associated with adverse pregnancy outcomes (APOs) among HIV-infected women. Design Prospective cohort study Setting Multiple sites in Latin America and the Caribbean Population First on-study pregnancy among HIV-1-infected women enrolled in NISDI (Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) International Site Development Initiative) Perinatal (2002–2007) and LILAC (2008–2012) studies. Methods Frequencies of APOs assessed among pregnancies. Risk factors investigated by logistic regression analysis. Main Outcome measures APOs including preterm delivery (PT), low birth weight (LBW), small for gestational age (SGA), stillbirth (SB) and neonatal death. Results Among 1512 women, 1.9% (95% confidence interval [CI] 1.3–2.7%) of singleton pregnancies resulted in a stillbirth and 32.9% (30.6–35.4%) had at least one APO. Of 1483 singleton live births, 19.8% (17.8–21.9%) were PT, 14.2% (12.5–16.1%) were LBW, 12.6% (10.9–14.4%) were SGA, and 0.4% (0.2–0.9%) of infants died within 28 days after birth. Multivariable logistic regression modeling indicated that the following risk factors increased the probability of having one or more APOs: lower maternal body mass index (odds ratio [OR]=2.2; 95% CI: 1.4–3.5) at delivery, hospitalization during pregnancy (OR=3.3; 95% CI: 2.0–5.3), hypertension during pregnancy (OR=2.7; 95% CI: 1.5–4.8), antiretroviral use at conception (OR=1.4; 95% CI: 1.0–1.9) and tobacco use during pregnancy (OR=1.7; 95% CI: 1.3–2.2). Results of fitting multivariable logistic regression models for PT, LBW, SGA and SB are also reported. Conclusions HIV-infected women had relatively high occurrence of APOs and some maternal risk factors were associated with these APOs. Interventions targeting modifiable risk factors should be evaluated further. PMID:24602102

  6. A Selective Account of Effective Paradigms and Significant Outcomes in the Discovery of Inspirational Marine Natural Products⊥†

    PubMed Central

    Sashidhara, Koneni V.; White, Kimberly N.; Crews, Phillip

    2009-01-01

    Marine natural products continue to be a source of significant molecular structures that serve as a stimulus to seed further significant research. This account reviews some of the major advances in the study of marine biomolecules made at UC Santa Cruz over more than three decades. The continuing challenge of discovery and characterization of what we term “inspirational molecular structures”, will be presented in a comprehensive fashion. Examples of privileged molecular structures and their impact on biomedicinal research will be an important theme. The three major groups of organisms explored include: seaweeds, sponges, and marine derived fungi, and the study of their active principles has greatly benefited from synergistic collaborations with both academic and biopharmaceutical groups. The concluding sections of this chronicle will touch on prospects for future outcomes involving new sources and strategies. PMID:19209899

  7. Implementation of a Multidisciplinary Bleeding and Transfusion Protocol Significantly Decreases Perioperative Blood Product Utilization and Improves Some Bleeding Outcomes

    PubMed Central

    Timpa, Joseph G.; O’Meara, L. Carlisle; Goldberg, Kellen G.; Phillips, Jay P.; Crawford, Jack H.; Jackson, Kimberly W.; Alten, Jeffrey A.

    2016-01-01

    Abstract: Perioperative transfusion of blood products is associated with increased morbidity and mortality after pediatric cardiac surgery. We report the results of a quality improvement project aimed at decreasing perioperative blood product administration and bleeding after pediatric cardiopulmonary bypass (CPB) surgery. A multidisciplinary team evaluated baseline data from 99 consecutive CPB patients, focusing on the variability in transfusion management and bleeding outcomes, to create a standardized bleeding and transfusion management protocol. A total of 62 subsequent patients were evaluated after implementation of the protocol: 17 with single pass hemoconcentrated (SPHC) blood transfusion and 45 with modified ultrafiltration (MUF). Implementation of the protocol with SPHC blood led to significant decrease in transfusion of every blood product in the cardiovascular operating room and first 6 hours in cardiovascular intensive care unit ([CVICU] p < .05). Addition of MUF to the protocol led to further decrease in transfusion of all blood products compared to preprotocol. Patients <2 months old had 49% decrease in total blood product administration: 155 mL/kg preprotocol, 117 mL/kg protocol plus SPHC, and 79 mL/kg protocol plus MUF (p < .01). There were significant decreases in postoperative bleeding in the first hour after CVICU admission: 6 mL/kg preprotocol, 3.8 mL/kg protocol plus SPHC, and 2 mL/kg protocol plusMUF (p = .02). There was also significantly decreased incidence of severe postoperative bleeding (>10 mL/kg) in the first CVICU hour for protocol plus MUF patients (p < .01). Implementation of a multidisciplinary bleeding and transfusion protocol significantly decreases perioperative blood product transfusion and improves some bleeding outcomes. PMID:27134303

  8. Six-year outcomes in first admission adolescent inpatients: clinical and cognitive characteristics at admission as predictors.

    PubMed

    Pogge, David L; Insalaco, Brie; Bertisch, Hilary; Bilginer, Lale; Stokes, John; Cornblatt, Barbara A; Harvey, Philip D

    2008-07-15

    Persistent functional disability is common after even a single psychiatric admission in people with schizophrenia or bipolar disorder, but less is known about other conditions and about adolescent onset patients. This study examined clinical symptoms and cognitive performance at the time of the first admission for the prediction of 6-year outcomes. First admission adolescent patients with a variety of psychiatric diagnoses were assessed with comprehensive clinical ratings of psychopathology, a neuropsychological assessment, and received clinical diagnoses while experiencing their first psychiatric admission. They were contacted 6 years after discharge and examined with a structured assessment of psychiatric symptoms and functioning. Despite the low levels of overall impairment at follow-up, at least 20% of the variance in depression, psychosis, poor peer relationships and poor school attendance 6 years after the hospital admission were predicted by information collected during the hospitalization. Attentional deficits during admission predicted the presence of psychosis at follow-up more substantially than psychotic symptoms during admission, as well as predicting risk for relapse. Attentional deficits during a first psychiatric admission predicted risk for manifesting psychosis at 6-year follow-up to a more substantial degree than either a psychosis diagnosis or psychotic symptoms at admission. In contrast to psychosis, depression at follow-up was predicted by admission symptomatology, but not by cognitive deficits. PMID:18534688

  9. Predictors of longitudinal outcomes after unstable response to acute-phase cognitive therapy for major depressive disorder.

    PubMed

    Vittengl, Jeffrey R; Clark, Lee Anna; Thase, Michael E; Jarrett, Robin B

    2015-06-01

    After patients with major depressive disorder (MDD) respond to acute-phase cognitive therapy (CT), continuation-phase treatments may be applied to improve long-term outcomes. We clarified which CT responders experience remission, recovery, relapse, and recurrence by testing baseline demographic, clinical, and personality variables. The sample of CT responders at higher risk of relapse (N = 241) was randomized to 8 months of continuation-phase CT, double-blinded fluoxetine, or pill placebo, and followed 24 months (Jarrett & Thase, 2010). Patients with lower positive emotionality and behavioral activation at the end of acute-phase CT showed increased risk for relapse/recurrence of MDD. In addition, patients with lower positive emotionality and behavioral activation, as well as higher residual depression (including emotional, cognitive, and social facets), showed decreased probability of remission (≥6 continuous weeks of minimal or absent symptoms) after acute-phase CT. Finally, patients with greater residual depression, as well as younger age and earlier MDD onset, showed decreased probability of recovery (≥35 continuous weeks of minimal or absent symptoms) after acute-phase CT. Moderator analyses did not reveal differential prediction across the continuation phase treatment arms. These results may help clinicians gauge the prognoses and need for continuation treatment among MDD patients who respond to acute-phase CT.

  10. Exercise capacity and heart rate responses to exercise as predictors of short-term outcome among patients with stable coronary artery disease.

    PubMed

    Kiviniemi, Antti M; Lepojärvi, Samuli; Kenttä, Tuomas V; Junttila, M Juhani; Perkiömäki, Juha S; Piira, Olli-Pekka; Ukkola, Olavi; Hautala, Arto J; Tulppo, Mikko P; Huikuri, Heikki V

    2015-11-15

    Although exercise capacity (EC) and autonomic responses to exercise predict clinical outcomes in various populations, they are not routinely applied in patients with coronary artery disease (CAD). We hypothesized that the composite index of EC and exercise heart rate responses would be a powerful determinant of short-term risk in CAD. Patients with angiographically documented stable CAD and treated with β blockers (n = 1,531) underwent exercise testing to allow the calculation of age- and gender-adjusted EC, maximal chronotropic response index (CRI), and 2-minute postexercise heart rate recovery (HRR, percentage of maximal heart rate). Cardiovascular deaths and hospitalization due to heart failure, registered during a 2-year follow-up (n = 39, 2.5%), were defined as the composite primary end point. An exercise test risk score was calculated as the sum of hazard ratios related to abnormal (lowest tertile) EC, CRI, and HRR. Abnormal EC, CRI, and HRR predicted the primary end point, involving 4.5-, 2.2-, and 6.2-fold risk, respectively, independently of each other. The patients with intermediate and high exercise test risk score had 11.1-fold (95% confidence interval 2.4 to 51.1, p = 0.002) and 25.4-fold (95% confidence interval 5.5 to 116.8, p <0.001) adjusted risk for the primary end point in comparison with the low-risk group, respectively. The addition of this risk score to the established risk model enhanced discrimination by integrated discrimination index and reclassification by categorical and continuous net reclassification index (p <0.001 for all). In conclusion, the composite index of EC and heart rate responses to exercise and recovery is a powerful predictor of short-term outcome in patients with stable CAD.

  11. Alterations in the optic radiations of very preterm children-Perinatal predictors and relationships with visual outcomes.

    PubMed

    Thompson, Deanne K; Thai, Dolly; Kelly, Claire E; Leemans, Alexander; Tournier, Jacques-Donald; Kean, Michael J; Lee, Katherine J; Inder, Terrie E; Doyle, Lex W; Anderson, Peter J; Hunt, Rodney W

    2014-01-01

    Children born very preterm (VPT) are at risk for visual impairments, the main risk factors being retinopathy of prematurity and cerebral white matter injury, however these only partially account for visual impairments in VPT children. This study aimed to compare optic radiation microstructure and volume between VPT and term-born children, and to investigate associations between 1) perinatal variables and optic radiations; 2) optic radiations and visual function in VPT children. We hypothesized that optic radiation microstructure would be altered in VPT children, predicted by neonatal cerebral white matter abnormality and retinopathy of prematurity, and associated with visual impairments. 142 VPT children and 32 controls underwent diffusion-weighted magnetic resonance imaging at 7 years of age. Optic radiations were delineated using constrained spherical deconvolution tractography. Tract volume and average diffusion tensor values for the whole optic radiations and three sub-regions were compared between the VPT and control groups, and correlated with perinatal variables and 7-year visual outcome data. Total tract volumes and average diffusion values were similar between VPT and control groups. On regional analysis of the optic radiation, mean and radial diffusivity were higher within the middle sub-regions in VPT compared with control children. Neonatal white matter abnormalities and retinopathy of prematurity were associated with optic radiation diffusion values. Lower fractional anisotropy in the anterior sub-regions was associated with poor visual acuity and increased likelihood of other visual defects. This study presents evidence for microstructural alterations in the optic radiations of VPT children, which are largely predicted by white matter abnormality or severe retinopathy of prematurity, and may partially explain the higher rate of visual impairments in VPT children.

  12. Predictors of longitudinal outcome and recovery of pragmatic language and its relation to externalizing behaviour after pediatric traumatic brain injury.

    PubMed

    Ryan, Nicholas P; Catroppa, Cathy; Beare, Richard; Coleman, Lee; Ditchfield, Michael; Crossley, Louise; Beauchamp, Miriam H; Anderson, Vicki A

    2015-03-01

    The purpose of the present investigation was to evaluate the contribution of age-at-insult and brain pathology on longitudinal outcome and recovery of pragmatic language in a sample of children and adolescents with traumatic brain injury (TBI). Children and adolescents with mild to severe TBI (n=112) were categorized according to timing of brain insult: (i) Middle Childhood (5-9 years; n=41); (ii) Late Childhood (10-11 years; n=39); and (iii) Adolescence (12-15 years; n=32) and group-matched for age, gender and socio-economic status (SES) to a typically developing (TD) control group (n=43). Participants underwent magnetic resonance imaging (MRI) including a susceptibility weighted imaging (SWI) sequence 2-8 weeks after injury and were assessed on measures of pragmatic language and behavioural functioning at 6- and 24-months after injury. Children and adolescents with TBI of all severity levels demonstrated impairments in these domains at 6-months injury before returning to age-expected levels at 2-years post-TBI. However, while adolescent TBI was associated with post-acute disruption to skills that preceded recovery to age-expected levels by 2-years post injury, the middle childhood TBI group demonstrated impairments at 6-months post-injury that were maintained at 2-year follow up. Reduced pragmatic communication was associated with frontal, temporal and corpus callosum lesions, as well as more frequent externalizing behaviour at 24-months post injury. Findings show that persisting pragmatic language impairment after pediatric TBI is related to younger age at brain insult, as well as microhemorrhagic pathology in brain regions that contribute to the anatomically distributed social brain network. Relationships between reduced pragmatic communication and more frequent externalizing behavior underscore the need for context-sensitive rehabilitation programs that aim to increase interpersonal effectiveness and reduce risk for maladaptive behavior trajectories into the

  13. Outcome predictors in autism spectrum disorders preschoolers undergoing treatment as usual: insights from an observational study using artificial neural networks

    PubMed Central

    Narzisi, Antonio; Muratori, Filippo; Buscema, Massimo; Calderoni, Sara; Grossi, Enzo

    2015-01-01

    Background Treatment as usual (TAU) for autism spectrum disorders (ASDs) includes eclectic treatments usually available in the community and school inclusion with an individual support teacher. Artificial neural networks (ANNs) have never been used to study the effects of treatment in ASDs. The Auto Contractive Map (Auto-CM) is a kind of ANN able to discover trends and associations among variables creating a semantic connectivity map. The matrix of connections, visualized through a minimum spanning tree filter, takes into account nonlinear associations among variables and captures connection schemes among clusters. Our aim is to use Auto-CM to recognize variables to discriminate between responders versus no responders at TAU. Methods A total of 56 preschoolers with ASDs were recruited at different sites in Italy. They were evaluated at T0 and after 6 months of treatment (T1). The children were referred to community providers for usual treatments. Results At T1, the severity of autism measured through the Autism Diagnostic Observation Schedule decreased in 62% of involved children (Response), whereas it was the same or worse in 37% of the children (No Response). The application of the Semeion ANNs overcomes the 85% of global accuracy (Sine Net almost reaching 90%). Consequently, some of the tested algorithms were able to find a good correlation between some variables and TAU outcome. The semantic connectivity map obtained with the application of the Auto-CM system showed results that clearly indicated that “Response” cases can be visually separated from the “No Response” cases. It was possible to visualize a response area characterized by “Parents Involvement high”. The resultant No Response area strongly connected with “Parents Involvement low”. Conclusion The ANN model used in this study seems to be a promising tool for the identification of the variables involved in the positive response to TAU in autism. PMID:26170671

  14. Baseline psychophysiological and cortisol reactivity as a predictor of PTSD treatment outcome in virtual reality exposure therapy.

    PubMed

    Norrholm, Seth Davin; Jovanovic, Tanja; Gerardi, Maryrose; Breazeale, Kathryn G; Price, Matthew; Davis, Michael; Duncan, Erica; Ressler, Kerry J; Bradley, Bekh; Rizzo, Albert; Tuerk, Peter W; Rothbaum, Barbara O

    2016-07-01

    Baseline cue-dependent physiological reactivity may serve as an objective measure of posttraumatic stress disorder (PTSD) symptoms. Additionally, prior animal model and psychological studies would suggest that subjects with greatest symptoms at baseline may have the greatest violation of expectancy to danger when undergoing exposure based psychotherapy; thus treatment approaches which enhanced the learning under these conditions would be optimal for those with maximal baseline cue-dependent reactivity. However methods to study this hypothesis objectively are lacking. Virtual reality (VR) methodologies have been successfully employed as an enhanced form of imaginal prolonged exposure therapy for the treatment of PTSD. Our goal was to examine the predictive nature of initial psychophysiological (e.g., startle, skin conductance, heart rate) and stress hormone responses (e.g., cortisol) during presentation of VR-based combat-related stimuli on PTSD treatment outcome. Combat veterans with PTSD underwent 6 weeks of VR exposure therapy combined with either d-cycloserine (DCS), alprazolam (ALP), or placebo (PBO). In the DCS group, startle response to VR scenes prior to initiation of treatment accounted for 76% of the variance in CAPS change scores, p < 0.001, in that higher responses predicted greater changes in symptom severity over time. Additionally, baseline cortisol reactivity was inversely associated with treatment response in the ALP group, p = 0.04. We propose that baseline cue-activated physiological measures will be sensitive to predicting patients' level of response to exposure therapy, in particular in the presence of enhancement (e.g., DCS).

  15. Predictors of sustained reduction in energy and fat intake in the Diabetes Prevention Program Outcomes Study (DPPOS) Intensive Lifestyle Intervention

    PubMed Central

    Davis, Nichola J.; Ma, Yong; Delahanty, Linda M.; Hoffman, Heather J.; Mayer-Davis, Elizabeth; Franks, Paul W.; Saudek, Christopher; Brown-Friday, Janet; Isonaga, Mae; Kriska, Andrea M.; Venditti, Elizabeth M; Wylie-Rosett, Judith

    2014-01-01

    Background Few lifestyle intervention studies examine long-term sustainability of dietary changes. Objective To describe sustainability of dietary changes over 9 years in the Diabetes Prevention Program (DPP) and its Outcomes Study (DPPOS) among participants receiving the intensive lifestyle (ILS) intervention. Design 1079 participants were enrolled in the ILS arm of DPP; 910 continued participation in DPPOS. Fat and caloric intake derived from food frequency questionnaires (FFQ) at baseline and post-randomization years 1 and 9 were examined. Parsimonious models determined if baseline characteristics and ILS session participation predicted sustainability. Results Self-reported caloric intake was reduced from a median of 1876 kcal/d [inter-quartile range (IQR) 1452-2549] at baseline to 1520 kcal/d (IQR 1192 -1986) at year 1, and 1560 kcal/d (IQR 1223 -2026) at year 9. Dietary fat was reduced from a median of 70.4 grams (IQR 49.3-102.5) to 45 grams (IQR 32.2-63.8) at year 1 and increased to 61.0 grams (IQR 44.6-82.7) at year 9. Percent calories from fat was reduced from a median of 34.4% (IQR 29.6-38.5) to 27.1% (IQR 23.1-31.5) at year 1 but increased to 35.3% (IQR 29.7-40.2) at year 9. Lower baseline energy intake and year 1 dietary reduction predicted lower caloric and fat gram intake at year 9. Higher leisure physical activity predicted lower fat gram intake but not caloric intake. Conclusions Intensive lifestyle intervention can result in reductions in total energy intake for up to 9 years. Initial success in achieving reductions in fat and caloric intake and success in attaining activity goals appear to predict long-term success at maintaining changes. PMID:24144073

  16. Pre-miRNA variants as predictors of clinical outcome in patients with squamous cell carcinomas of the nonoropharynx

    PubMed Central

    Sturgis, Erich M.; Zheng, Hongliang; Wei, Qingyi; Li, Guojun

    2016-01-01

    Functional polymorphisms of miRNAs may affect the function and target expression of miRNAs, which can, in turn, affect the biological activity, etiology, and prognosis of cancer. We hypothesized that four common polymorphisms in pre-miRNAs (hsa-mir-146a rs2910164 G > C, hsa-mir-196a2 rs11614913 C > T, hsa-mir-149 rs2292832 G > T, and hsa-mir-499 rs3746444 A > G) are associated with survival in SCCNOP. We used univariate and multivariable Cox models to evaluate the associations between the four polymorphisms and survival. We found that hsa-mir-149 rs2292832 and hsa-mir-499 rs3746444 had statistically significant associations with survival, but hsa-mir-146a rs2910164 and hsa-mir-196a2 rs11614913 did not. Patients having the hsa-mir-149 CC and hsa-mir-499 TT wild-type genotypes had significantly better overall, disease-specific, and disease-free survival compared with those who had the corresponding variant CT/TT and CT/CC genotypes, respectively. Furthermore, these genotypes were significantly associated with reduced risk of overall death, death owing to disease, and recurrence after adjustment for important prognostic confounders, indicating that these pre-miRNA polymorphisms may be prognostic biomarkers for SCCNOP. Moreover, the stratified analyses based on smoking status and treatment indicated that the effects of hsa-mir-149 and hsa-mir-499 polymorphisms on survival were more pronounced in ever smokers and patients treated with chemoradiation. Our findings support that the hsa-mir-149 rs2292832 and hsa-mir-499 rs3746444 polymorphisms play a significant role in the prognosis of SCCNOP, especially in smokers and patients treated with chemoradiation. Prospective studies with larger sample sizes are needed to confirm these findings. PMID:27050146

  17. Illness perceptions in the context of differing work participation outcomes: exploring the influence of significant others in persistent back pain

    PubMed Central

    2013-01-01

    Background Previous research has demonstrated that the significant others of individuals with persistent back pain may have important influences on work participation outcomes. The aim of this study was to extend previous research by including individuals who have remained in work despite persistent back pain in addition to those who had become incapacitated for work, along with their significant others. The purpose of this research was to explore whether the illness beliefs of significant others differed depending on their relative’s working status, and to make some preliminary identification of how significant others may facilitate or hinder work participation for those with persistent back pain. Methods Interviews structured around the Illness Perception Questionnaire (chronic pain version) were conducted with back pain patients recruited from a hospital pain management clinic along with their significant others. Some patients had remained in work despite their back pain; others had ceased employment. Data were analysed using template analysis. Results There were clear differences between beliefs about, and reported responses to, back pain symptoms amongst the significant others of individuals who had remained in employment compared with the significant others of those who had ceased work. Three overarching themes emerged: perceived consequences of back pain, specific nature of employment and the impact of back pain on patient identity. Conclusions Significant others of employed individuals with back pain focused on the extent to which activity could still be undertaken despite back pain symptoms. Individuals out of work due to persistent back pain apparently self-limited their activity and were supported in their beliefs and behaviours by their significant others. To justify incapacity due to back pain, this group had seemingly become entrenched in a position whereby it was crucial that the individual with back pain was perceived as completely disabled. We

  18. HbA1c as a Predictor of Diabetes and as an Outcome in the Diabetes Prevention Program: A Randomized Clinical Trial

    PubMed Central

    2015-01-01

    OBJECTIVE Glycated hemoglobin (HbA1c), a standard measure of chronic glycemia for managing diabetes, has been proposed to diagnose diabetes and identify people at risk. The Diabetes Prevention Program (DPP) was a 3.2-year randomized clinical trial of preventing type 2 diabetes with a 10-year follow-up study, the DPP Outcomes Study (DPPOS). We evaluated baseline HbA1c as a predictor of diabetes and determined the effects of treatments on diabetes defined by an HbA1c ≥6.5% (48 mmol/mol). RESEARCH DESIGN AND METHODS We randomized 3,234 nondiabetic adults at high risk of diabetes to placebo, metformin, or intensive lifestyle intervention and followed them for the development of diabetes as diagnosed by fasting plasma glucose (FPG) and 2-h postload glucose (2hPG) concentrations (1997 American Diabetes Association [ADA] criteria). HbA1c was measured but not used for study eligibility or outcomes. We now evaluate treatment effects in the 2,765 participants who did not have diabetes at baseline according to FPG, 2hPG, or HbA1c (2010 ADA criteria). RESULTS Baseline HbA1c predicted incident diabetes in all treatment groups. Diabetes incidence defined by HbA1c ≥6.5% was reduced by 44% by metformin and 49% by lifestyle during the DPP and by 38% by metformin and 29% by lifestyle throughout follow-up. Unlike the primary DPP and DPPOS findings based on glucose criteria, metformin and lifestyle were similarly effective in preventing diabetes defined by HbA1c. CONCLUSIONS HbA1c predicted incident diabetes. In contrast to the superiority of the lifestyle intervention on glucose-defined diabetes, metformin and lifestyle interventions had similar effects in preventing HbA1c-defined diabetes. The long-term implications for other health outcomes remain to be determined. PMID:25336746

  19. Sonohysterographic Predictors of Successful Hysteroscopic Myomectomies

    PubMed Central

    Greene, Alexis D.; Morrissey, Mary Breda; Vega, Mario; Moshier, Erin

    2015-01-01

    Background and Objectives: The purpose of this study is to assess the rate of persistent submucosal myomas and intrauterine scarring after hysteroscopic myomectomy, as well as to evaluate the preoperative and intraoperative sonohysterographic findings that will predict persistence of myomas, scarring, and the need for repeat surgery. Methods: Charts from all hysteroscopic myomectomies performed by a single surgeon between 2003 and 2011 were reviewed for preoperative, intraoperative, and postoperative sonohysterographic findings. Predictors included myoma number, diameter and percent extension into the cavity of the largest fibroid, and percent surgically resected. These predictors were assessed with postoperative sonohysterography. Statistics included t test, logistic regression, χ2 test, and Fisher exact test. Results: Among the 79 cases with postoperative sonohysterograms, 17 (21.5%) had persistent submucosal myoma, and 9 (11.4%) had intrauterine scarring on postoperative sonohysterogram. Repeat hysteroscopic myomectomy was required in 11 (13.9%), but none required lysis of adhesions. The myoma number was not a significant predictor. A higher percentage of myoma within the cavity (63.35% vs 44.89%, P < .05) and smaller myoma size (2.22 cm vs 3.31 cm, P < .01) were significant predictors of a complete resection, a normal postoperative sonohysterogram, and avoidance of repeat surgery. On regression analysis, the percent of the myoma resected was the most significant outcome predictor (P < .001). Conclusion: Larger myomas with a lower percent found within the uterine cavity are less likely to be completely resected. Percent resection at the time of surgery is the most significant predictor of a normal postoperative sonohysterogram, as well as the best predictor of the need for repeat surgery. PMID:25848194

  20. Using the bootstrap to establish statistical significance for relative validity comparisons among patient-reported outcome measures

    PubMed Central

    2013-01-01

    Background Relative validity (RV), a ratio of ANOVA F-statistics, is often used to compare the validity of patient-reported outcome (PRO) measures. We used the bootstrap to establish the statistical significance of the RV and to identify key factors affecting its significance. Methods Based on responses from 453 chronic kidney disease (CKD) patients to 16 CKD-specific and generic PRO measures, RVs were computed to determine how well each measure discriminated across clinically-defined groups of patients compared to the most discriminating (reference) measure. Statistical significance of RV was quantified by the 95% bootstrap confidence interval. Simulations examined the effects of sample size, denominator F-statistic, correlation between comparator and reference measures, and number of bootstrap replicates. Results The statistical significance of the RV increased as the magnitude of denominator F-statistic increased or as the correlation between comparator and reference measures increased. A denominator F-statistic of 57 conveyed sufficient power (80%) to detect an RV of 0.6 for two measures correlated at r = 0.7. Larger denominator F-statistics or higher correlations provided greater power. Larger sample size with a fixed denominator F-statistic or more bootstrap replicates (beyond 500) had minimal impact. Conclusions The bootstrap is valuable for establishing the statistical significance of RV estimates. A reasonably large denominator F-statistic (F > 57) is required for adequate power when using the RV to compare the validity of measures with small or moderate correlations (r < 0.7). Substantially greater power can be achieved when comparing measures of a very high correlation (r > 0.9). PMID:23721463

  1. Pathophysiology, monitoring, outcome prediction, and therapy of shock states.

    PubMed

    Shoemaker, W C

    1987-04-01

    The time course of hemodynamic and oxygen transport patterns of survivors and nonsurvivors of high-risk critical illness patients was used to evaluate pathophysiologic mechanisms, develop outcome predictors, and propose therapeutic goals. The predictors and goals were tested prospectively and resulted in significantly reduced mortality and morbidity.

  2. Skeletal muscle radio-density is an independent predictor of response and outcomes in follicular lymphoma treated with chemoimmunotherapy.

    PubMed

    Chu, Michael P; Lieffers, Jessica; Ghosh, Sunita; Belch, Andrew R; Chua, Neil S; Fontaine, Amelie; Sangha, Randeep; Turner, A Robert; Baracos, Vickie E; Sawyer, Michael B

    2015-01-01

    Skeletal muscle radio-density (SMD) measures muscle radiation attenuation (in Hounsfield Units, HU) on computed tomography (CT) scans. Low SMD is prognostic of poor survival in melanoma, however its significance is unknown for hematologic malignancies. We performed a single institution, retrospective review of all follicular lymphoma (FL) patients who received chemoimmunotherapy from 2004-2009. Patient demographics, FL International Prognostic Index 1 (FLIPI-1), progression free (PFS) and overall survival (OS) were collected as primary endpoints. Objective response rates (ORR) were secondary. SMD was calculated using pre-treatment CT scans. In 145 patients reviewed, median values were age 59, FLIPI-1 of 2, stage III, and 8 chemoimmunotherapy cycles received. Median PFS for those with low SMD (<36.6 and <33.1 HU for patients with BMI ≤ 25 and > 25 kg/m2, respectively) compared to those with high SMD was profoundly worse, 69.6 vs. 106.7 months (hazard ratio [HR] 1.85; p = 0.01), respectively. Median OS was not reached in patients with high SMD vs. 92.7 months in low SMD patients (HR 4.02; p = 0.0002). Multivariate analysis supported lower SMD's OS detriment (HR = 3.40; p = 0.002) independent of FLIPI-1 (HR 1.46-2.76, p = 0.05) or gender. Low SMD predicted lower ORR, 83 vs. 96% (p = 0.01). SMD predicts survival independent of FLIPI-1 and potentially chemoimmunotherapy response. SMD is an inexpensive and powerful tool that can complement FLIPI-1. PMID:26030144

  3. Necrotizing Enterocolitis and Central line Associated Blood Stream Infection Are Predictors of Growth Outcomes in Infants with Short Bowel Syndrome

    PubMed Central

    Raphael, Bram P.; Mitchell, Paul D.; Finkton, Darryl; Jiang, Hongyu; Jaksic, Tom; Duggan, Christopher

    2016-01-01

    Objectives To describe the natural history of growth patterns and nutritional support in a cohort of infants with short bowel syndrome (SBS), and characterize risk factors for suboptimal growth. Study design Retrospective chart review of 51 infants with SBS followed by our intestinal rehabilitation program. Weight and length data were converted to age, sex and gestational age-standardized weight-for-age Z-scores (WAZ) and length-for-age Z-scores (LAZ). Results Median (25%ile, 75%iles) age at enrollment was 8.3 (0.9, 14.6) weeks, and follow-up duration was 10 (8, 13) months, including both inpatient and outpatient visits. Both WAZ and LAZ followed a U-shaped curve, with median for newborns (WAZ = −0.28 and LAZ = −0.41), a nadir at age 6 months (−2.38 and −2.18) and near recovery by age 1 year (−0.72 and −0.76). Using multivariable regression analysis, diagnosis of NEC was independently associated with significant decrements of WAZ (−0.76±0.32, P=0.02) and LAZ (−1.24±0.32, P=0.0001). ≥2 central line associated bloodstream infections (CLABSIs) was also independently associated with a decrease in WAZ (−0.95±0.33, P=0.004) and LAZ (−0.86±0.32, P=0.007). Conclusions In a cohort of infants with SBS, we observed a unique pattern of somatic growth, with concomitant deceleration of both WAZ and LAZ and near recovery by 1 year. Inflammatory conditions (NEC and CLABSIs) represent potentially modifiable risk factors for suboptimal somatic growth. PMID:25841540

  4. Mu opioid receptor (OPRM1) as a predictor of treatment outcome in opiate-dependent individuals of Arab descent

    PubMed Central

    AL-Eitan, Laith N; Jaradat, Saied A; Su, Steve YS; Tay, Guan K; Hulse, Gary K

    2012-01-01

    Background: A number of research studies on the genetics of opiate dependence have focused on the μ-opioid receptor (OPRM1), which is a primary target for opiates. This study aims to identify genetic polymorphisms within the OPRM1 gene involved in response to the biopsychosocial treatment in opiate-dependent individuals of Arab descent. Methods: Unrelated Jordanian Nationals of Arab descent (N = 183) with opiate dependence were selected for this study. These individuals, all males, met the DSM-IV criteria for opiate dependence and were undergoing a voluntary 8-week treatment program at a Jordanian Drug Rehabilitation Centre. All individuals were genotyped for 22 single nucleotide polymorphisms (SNPs) within the OPRM1 gene using the Sequenom MassARRAY® system (iPLEX GOLD). Statistical analyses were carried out using the R package. Results: Patients receiving biopsychosocial treatment showed that there was a significant difference in their OPRM1 SNPs’ genotyping distribution between good, moderate, and poor responders to the treatment at two sites (rs6912029 [G-172T], and rs12205732 [G-1510A], P < 0.05, Fisher’s exact test). Conclusion: This study is the first report of an association between the OPRM1 G-172T and G-1510A polymorphisms and treatment response for opiate dependence. Specifically, this study demonstrated that the OPRM1 GG-172 and GG-1510 genotypes were more frequent among patients who were nonresponders to the biopsychosocial treatment. However, further pharmacogenetic studies in a larger cohort of opiate-dependent patients of Arab descent are needed to confirm these findings and identify individuals with increased chance of relapse. PMID:23226066

  5. Ultrasensitive HCV RNA Quantification in Antiviral Triple Therapy: New Insight on Viral Clearance Dynamics and Treatment Outcome Predictors

    PubMed Central

    Garbuglia, Anna Rosa; Visco-Comandini, Ubaldo; Lionetti, Raffaella; Lapa, Daniele; Castiglione, Filippo; D’Offizi, Gianpiero; Taibi, Chiara; Montalbano, Marzia; Capobianchi, Maria Rosaria; Paci, Paola

    2016-01-01

    Objectives Identifying the predictive factors of Sustained Virological Response (SVR) represents an important challenge in new interferon-based DAA therapies. Here, we analyzed the kinetics of antiviral response associated with a triple drug regimen, and the association between negative residual viral load at different time points during treatment. Methods Twenty-three HCV genotype 1 (GT 1a n = 11; GT1b n = 12) infected patients were included in the study. Linear Discriminant Analysis (LDA) was used to establish possible association between HCV RNA values at days 1 and 4 from start of therapy and SVR. Principal component analysis (PCA) was applied to analyze the correlation between HCV RNA slope and SVR. A ultrasensitive (US) method was established to measure the residual HCV viral load in those samples which resulted “detected <12IU/ml” or undetectable with ABBOTT standard assay, and was retrospectively used on samples collected at different time points to establish its predictive power for SVR. Results According to LDA, there was no association between SVR and viral kinetics neither at time points earlier than 1 week (days 1 and 4) after therapy initiation nor later. The slopes were not relevant for classifying patients as SVR or no-SVR. No significant differences were observed in the median HCV RNA values at T0 among SVR and no-SVR patients. HCV RNA values with US protocol (LOD 1.2 IU/ml) after 1 month of therapy were considered; the area under the ROC curve was 0.70. Overall, PPV and NPV of undetectable HCV RNA with the US method for SVR was 100% and 46.7%, respectively; sensitivity and specificity were 38.4% and 100% respectively. Conclusion HCV RNA “not detected” by the US method after 1 month of treatment is predictive of SVR in first generation Protease inhibitor (PI)-based triple therapy. The US method could have clinical utility for advanced monitoring of virological response in new interferon based DAA combination regimens. PMID:27560794

  6. Prognostic Significance of Tumor Hypoxia Inducible Factor-1{alpha} Expression for Outcome After Radiotherapy in Oropharyngeal Cancer

    SciTech Connect

    Silva, Priyamal; Slevin, Nick J.; Sloan, Philip; Valentine, Helen; Cresswell, Jo; Ryder, David; Price, Patricia; Homer, Jarrod J.; West, Catharine

    2008-12-01

    Purpose: Head-and-neck squamous cell carcinoma (HNSCC) represents a heterogeneous group of patients in terms of subsite, treatment, and biology. Currently most management decisions are based on clinical parameters with little appreciation of patient differences in underlying tumor biology. We investigated the prognostic significance of clinicopathologic features and tumor hypoxia-inducible factor-1{alpha} (HIF-1{alpha}) expression in a homogeneous series of patients who underwent radiotherapy. Methods and Materials: An audit identified 133 consecutive patients with histologically proven squamous cell carcinoma of the tonsil or tongue base. All patients received primary radiotherapy between 1996 and 2001. Tumor HIF-1{alpha} expression was examined in 79 patients. Results: Features associated with poor locoregional control were low Hb level (p = 0.05) and advancing T (p = 0.008), N (p = 0.03), and disease (p = 0.008) stage. HIF-1{alpha} expression was a more significant adverse prognostic factor in the tonsil (hazard ratio [HR], 23.1; 95% confidence interval [CI]. 3.04-176.7) than the tongue-base tumor (HR, 2.86; 95% CI, 1.14-7.19) group (p = 0.03, test for interaction). High tumor HIF-1{alpha} expression was associated with low blood Hb levels (p = 0.03). In a multivariate analysis HIF-1{alpha} expression retained prognostic significance for locoregional control (HR, 7.10; 95% CI, 3.07-16.43) and cancer-specific survival (HR, 9.19; 95% CI, 3.90-21.6). Conclusions: There are significant differences in radiation therapy outcome within a homogeneous subsite of the oropharynx related to molecular marker expression. The work highlights the importance of studying homogeneous groups of patients in HNSCC, and the complex interrelationships between tumor biology and clinicopathologic factors. The establishment of tumor-type specific markers would represent a major advance in this area.

  7. Sustained Low Efficiency Dialysis in the Continuous Mode (C-SLED): Dialysis Efficacy, Clinical Outcomes, and Survival Predictors in Critically Ill Cancer Patients

    PubMed Central

    Kumar, Vikas; Madan, Niti; Xiao, Lianchun; Lahoti, Amit; Samuels, Joshua; Nates, Joseph; Price, Kristen

    2009-01-01

    Background and objectives: Oliguric, hypotensive patients who require large amounts of fluids may benefit from sustained low-efficiency dialysis performed continuously (C-SLED). C-SLED through higher clearance may improve survival, or through greater nutritional loss may worsen survival. No studies have assessed survival on C-SLED. The objective was to examine patient outcomes and survival predictors on C-SLED. Design, setting, participants, & measurements: The data of 199 consecutive cancer patients treated with C-SLED were analyzed. The median duration of C-SLED was 50 h. With 48 h of C-SLED, the blood urea nitrogen (BUN) and serum creatinine levels had decreased by 80% and 73%, respectively. The mean arterial pressure (MAP) was maintained despite higher ultrafiltration and reduced vasopressor use. The 30-d mortality rate was 65%. Despite excellent dialysis, the sequential organ failure assessment (SOFA) score remained predictive of mortality. In the univariate model, higher SOFA scores and lower values for MAP, blood pH, and serum albumin and creatinine levels were associated with higher mortality. Administration of total parenteral nutrition (TPN) was, however, associated with lower mortality. Results: In the multivariate model, the higher SOFA score and lower blood pH, MAP and C-SLED duration were associated with higher mortality. In a subset analysis of 129 patients who received C-SLED for at least 48 h, those with higher BUN levels, which were associated with higher TPN infusion, had a lower mortality risk. Conclusion: This first detailed report on C-SLED indicates that C-SLED can be effective and suggests a link between nutrition and survival. PMID:19628685

  8. Juvenile idiopathic arthritis in adulthood: fulfilment of classification criteria for adult rheumatic diseases, long-term outcomes and predictors of inactive disease, functional status and damage

    PubMed Central

    Oliveira-Ramos, Filipa; Eusébio, Mónica; M Martins, Fernando; Mourão, Ana Filipa; Furtado, Carolina; Campanilho-Marques, Raquel; Cordeiro, Inês; Ferreira, Joana; Cerqueira, Marcos; Figueira, Ricardo; Brito, Iva; Santos, Maria José; Melo-Gomes, José A; Fonseca, João Eurico

    2016-01-01

    Objectives To determine how adult juvenile idiopathic arthritis (JIA) patients fulfil classification criteria for adult rheumatic diseases, evaluate their outcomes and determine clinical predictors of inactive disease, functional status and damage. Methods Patients with JIA registered on the Rheumatic Diseases Portuguese Register (Reuma.pt) older than 18 years and with more than 5 years of disease duration were included. Data regarding sociodemographic features, fulfilment of adult classification criteria, Health Assessment Questionnaire, Juvenile Arthritis Damage Index—articular (JADI-A) and Juvenile Arthritis Damage Index—extra-articular (JADI-E) damage index and disease activity were analysed. Results 426 patients were included. Most of patients with systemic JIA fulfilled criteria for Adult Still's disease. 95.6% of the patients with rheumatoid factor (RF)-positive polyarthritis and 57.1% of the patients with RF-negative polyarthritis matched criteria for rheumatoid arthritis (RA). 38.9% of the patients with extended oligoarthritis were classified as RA while 34.8% of the patients with persistent oligoarthritis were classified as spondyloarthritis. Patients with enthesitis-related arthritis fulfilled criteria for spondyloarthritis in 94.7%. Patients with psoriatic arthritis maintained this classification. Patients with inactive disease had lower disease duration, lower diagnosis delay and corticosteroids exposure. Longer disease duration was associated with higher HAQ, JADI-A and JADI-E. Higher JADI-A was also associated with biological treatment and retirement due to JIA disability and higher JADI-E with corticosteroids exposure. Younger age at disease onset was predictive of higher HAQ, JADI-A and JADI-E and decreased the chance of inactive disease. Conclusions Most of the included patients fulfilled classification criteria for adult rheumatic diseases, maintain active disease and have functional impairment. Younger age at disease onset was predictive

  9. Effects of Multimedia Social Stories on Knowledge of Adult Outcomes and Opportunities among Transition-Aged Youth with Significant Cognitive Disabilities

    ERIC Educational Resources Information Center

    Richter, Sharon; Test, David

    2011-01-01

    Students with significant cognitive disabilities typically experience poor post-school outcomes as adults. Federal legislation and recent research reflect the importance of teaching self-determination skills as a strategy to improve post-school outcomes. However, the National Longitudinal Transition Study-2 (NLTS-2) reported that individuals with…

  10. Validation of DAB2IP methylation and its relative significance in predicting outcome in renal cell carcinoma

    PubMed Central

    Zhao, Liang-Yun; Kapur, Payal; Wu, Kai-Jie; Wang, Bin; Yu, Yan-Hong; Liao, Bing; He, Da-Lin; Chen, Wei; Margulis, Vitaly; Hsieh, Jer-Tsong; Luo, Jun-Hang

    2016-01-01

    We have recently reported tumor suppressive role of DAB2IP in RCC development. In this study, We identified one CpG methylation biomarker (DAB2IP CpG1) located UTSS of DAB2IP that was associated with poor overall survival in a cohort of 318 ccRCC patients from the Cancer Genome Atlas (TCGA). We further validated the prognostic accuracy of DAB2IP CpG methylation by pyrosequencing quantitative methylation assay in 224 ccRCC patients from multiple Chinese centers (MCHC set), and 239 patients from University of Texas Southwestern Medical Center at Dallas (UTSW set) by using FFPE samples. DAB2IP CpG1 can predict the overall survival of patients in TCGA, MCHC, and UTSW sets independent of patient age, Fuhrman grade and TNM stage (all p<0.05). DAB2IP CpG1 successfully categorized patients into high-risk and low-risk groups with significant differences of clinical outcome in respective clinical subsets, regardless of age, sex, grade, stage, or race (HR: 1.63-7.83; all p<0.05). The detection of DAB2IP CpG1 methylation was minimally affected by ITH in ccRCC. DAB2IP mRNA expression was regulated by DNA methylation in vitro. DAB2IP CpG1 methylation is a practical and repeatable biomarker for ccRCC, which can provide prognostic value that complements the current staging system. PMID:27129174

  11. Adult acclimation to combined temperature and pH stressors significantly enhances reproductive outcomes compared to short-term exposures.

    PubMed

    Suckling, Coleen C; Clark, Melody S; Richard, Joelle; Morley, Simon A; Thorne, Michael A S; Harper, Elizabeth M; Peck, Lloyd S

    2015-05-01

    This study examined the effects of long-term culture under altered conditions on the Antarctic sea urchin, Sterechinus neumayeri. Sterechinus neumayeri was cultured under the combined environmental stressors of lowered pH (-0.3 and -0.5 pH units) and increased temperature (+2 °C) for 2 years. This time-scale covered two full reproductive cycles in this species and analyses included studies on both adult metabolism and larval development. Adults took at least 6-8 months to acclimate to the altered conditions, but beyond this, there was no detectable effect of temperature or pH. Animals were spawned after 6 and 17 months exposure to altered conditions, with markedly different outcomes. At 6 months, the percentage hatching and larval survival rates were greatest in the animals kept at 0 °C under current pH conditions, whilst those under lowered pH and +2 °C performed significantly less well. After 17 months, performance was not significantly different across treatments, including controls. However, under the altered conditions urchins produced larger eggs compared with control animals. These data show that under long-term culture adult S. neumayeri appear to acclimate their metabolic and reproductive physiology to the combined stressors of altered pH and increased temperature, with relatively little measureable effect. They also emphasize the importance of long-term studies in evaluating effects of altered pH, particularly in slow developing marine species with long gonad maturation times, as the effects of altered conditions cannot be accurately evaluated unless gonads have fully matured under the new conditions. PMID:25491898

  12. Adult acclimation to combined temperature and pH stressors significantly enhances reproductive outcomes compared to short-term exposures.

    PubMed

    Suckling, Coleen C; Clark, Melody S; Richard, Joelle; Morley, Simon A; Thorne, Michael A S; Harper, Elizabeth M; Peck, Lloyd S

    2015-05-01

    This study examined the effects of long-term culture under altered conditions on the Antarctic sea urchin, Sterechinus neumayeri. Sterechinus neumayeri was cultured under the combined environmental stressors of lowered pH (-0.3 and -0.5 pH units) and increased temperature (+2 °C) for 2 years. This time-scale covered two full reproductive cycles in this species and analyses included studies on both adult metabolism and larval development. Adults took at least 6-8 months to acclimate to the altered conditions, but beyond this, there was no detectable effect of temperature or pH. Animals were spawned after 6 and 17 months exposure to altered conditions, with markedly different outcomes. At 6 months, the percentage hatching and larval survival rates were greatest in the animals kept at 0 °C under current pH conditions, whilst those under lowered pH and +2 °C performed significantly less well. After 17 months, performance was not significantly different across treatments, including controls. However, under the altered conditions urchins produced larger eggs compared with control animals. These data show that under long-term culture adult S. neumayeri appear to acclimate their metabolic and reproductive physiology to the combined stressors of altered pH and increased temperature, with relatively little measureable effect. They also emphasize the importance of long-term studies in evaluating effects of altered pH, particularly in slow developing marine species with long gonad maturation times, as the effects of altered conditions cannot be accurately evaluated unless gonads have fully matured under the new conditions.

  13. Predictors of outcome in reduced intensity allogeneic hematopoietic cell transplantation for chronic lymphocytic leukemia: summarizing the evidence and highlighting the limitations.

    PubMed

    Kharfan-Dabaja, Mohamed A

    2015-01-01

    Several studies have reported the prognostic significance of various clinical, genetic, biologic and molecular markers on postallogeneic hematopoietic cell transplantation outcomes such as nonrelapse mortality, relapse and survival. Notwithstanding limitations, existence of refractory/progressive disease at allografting yields worse nonrelapse mortality, more relapse and inferior overall survival. Advanced age results in higher nonrelapse mortality and increased relapse risk. Presence of poor-risk cytogenetics increases post-transplant relapse risk, but its impact on overall survival appears controversial. Developing prognostic models using large multicenter data could help better understand the effect of these and other variables on post-transplant outcomes. Newly discovered mutations as well as response (or not) to new potent therapies, such as ibrutinib or others, would likely be incorporated in such models.

  14. Septic acute kidney injury in critically ill patients - a single-center study on its incidence, clinical characteristics, and outcome predictors.

    PubMed

    Shum, Hoi-Ping; Kong, Harriet Hoi-Yan; Chan, King-Chung; Yan, Wing-Wa; Chan, Tak Mao

    2016-06-01

    Purpose The objective of this study is to examine the incidence, clinical characteristics, and outcome (90-day mortality) of critically ill Chinese patients with septic AKI. Methods Patients admitted to the ICU of a regional hospital from 1 January 2011 to 31 December 2013 were included, excluding those on chronic renal replacement therapy. AKI was defined using KDIGO criteria. Patients were followed till 90 days from ICU admission or death, whichever occurred earlier. Demographics, diagnosis, clinical characteristics, and outcome were analyzed. Results In total, 3687 patients were included and 54.7% patients developed AKI. Sepsis was the most common cause of AKI (49.2%). Compared to those without AKI, AKI patients had higher disease severity, more physiological and biochemical disturbance, and carried significant co-morbidities. Ninety-day mortality increased with severity of AKI (16.7, 27.5, and 48.3% for KDIGO stage 1, 2, and 3 AKI, p < 0.001). Full renal recovery was achieved in 71.6% of AKI patients. Compared with non-septic AKI, septic AKI was associated with higher disease severity and required more aggressive support. Non-recovery of renal function occurred in 2.5% of patients with septic AKI, compared with 6.4% in non-septic AKI (p < 0.001). Cox regression analysis showed that age, emergency ICU admission, post-operative cases, admission diagnosis, etiology of AKI, disease severity score, mechanical ventilation, vasopressor support, and blood parameters (like albumin, potassium and pH) independently predicted 90-day mortality. Conclusions AKI, especially septic AKI is common in critically ill Chinese patients and is associated with poor patient outcome. Etiology of AKI has a significant impact on 90-day mortality and may affect renal outcome. PMID:26981621

  15. Adult outcomes of preterm children.

    PubMed

    Hack, Maureen

    2009-10-01

    The survivors of the initial years of neonatal intensive care of preterm infants reached adulthood during the last decade. Reports of their adult outcomes examined have included neurodevelopmental, behavioral and health outcomes as well as social functioning and reproduction. Despite statistically significant differences between preterm young adults and controls in most outcomes studied, the majority of preterm survivors do well and live fairly normal lives. The two major predictors of adult outcomes are lower gestational age that reflect perinatal injury and family sociodemographic status which reflects both genetic and environmental effects.

  16. Delayed Administration of Bone Marrow Mesenchymal Stem Cell Conditioned Medium Significantly Improves Outcome After Retinal Ischemia in Rats

    PubMed Central

    Dreixler, John C.; Poston, Jacqueline N.; Balyasnikova, Irina; Shaikh, Afzhal R.; Tupper, Kelsey Y.; Conway, Sineadh; Boddapati, Venkat; Marcet, Marcus M.; Lesniak, Maciej S.; Roth, Steven

    2014-01-01

    Purpose. Delayed treatment after ischemia is often unsatisfactory. We hypothesized that injection of bone marrow stem cell (BMSC) conditioned medium after ischemia could rescue ischemic retina, and in this study we characterized the functional and histological outcomes and mechanisms of this neuroprotection. Methods. Retinal ischemia was produced in adult Wistar rats by increasing intraocular pressure for 55 minutes. Conditioned medium (CM) from rat BMSCs or unconditioned medium (uCM) was injected into the vitreous 24 hours after the end of ischemia. Recovery was assessed 7 days after ischemia using electroretinography, at which time we euthanized the animals and then prepared 4-μm-thick paraffin-embedded retinal sections. TUNEL and Western blot were used to identify apoptotic cells and apoptosis-related gene expression 24 hours after injections; that is, 48 hours after ischemia. Protein content in CM versus uCM was studied using tandem mass spectrometry, and bioinformatics methods were used to model protein interactions. Results. Intravitreal injection of CM 24 hours after ischemia significantly improved retinal function and attenuated cell loss in the retinal ganglion cell layer. CM attenuated postischemic apoptosis and apoptosis-related gene expression. By spectral counting, 19 proteins that met stringent identification criteria were increased in the CM compared to uCM; the majority were extracellular matrix proteins that mapped into an interactional network together with other proteins involved in cell growth and adhesion. Conclusions. By restoring retinal function, attenuating apoptosis, and preventing retinal cell loss after ischemia, CM is a robust means of delayed postischemic intervention. We identified some potential candidate proteins for this effect. PMID:24699381

  17. Tissue MicroRNAs as Predictors of Outcome in Patients with Metastatic Colorectal Cancer Treated with First Line Capecitabine and Oxaliplatin with or without Bevacizumab

    PubMed Central

    Boisen, Mogens K.; Dehlendorff, Christian; Linnemann, Dorte; Nielsen, Boye S.; Larsen, Jim S.; Østerlind, Kell; Nielsen, Svend E.; Tarpgaard, Line S.; Qvortrup, Camilla; Pfeiffer, Per; Holländer, Niels H.; Keldsen, Nina; Hansen, Torben F.; Jensen, Brita B.; Høgdall, Estrid V. S.; Jensen, Benny V.; Johansen, Julia S.

    2014-01-01

    Purpose We tested the hypothesis that expression of microRNAs (miRNAs) in cancer tissue can predict effectiveness of bevacizumab added to capecitabine and oxaliplatin (CAPEOX) in patients with metastatic colorectal cancer (mCRC). Experimental Design Patients with mCRC treated with first line CAPEOX and bevacizumab (CAPEOXBEV): screening (n = 212) and validation (n = 121) cohorts, or CAPEOX alone: control cohort (n = 127), were identified retrospectively and archival primary tumor samples were collected. Expression of 754 miRNAs was analyzed in the screening cohort using polymerase chain reaction (PCR) arrays and expression levels were related to time to disease progression (TTP) and overall survival (OS). Significant miRNAs from the screening study were analyzed in all three cohorts using custom PCR arrays. In situ hybridization (ISH) was done for selected miRNAs. Results In the screening study, 26 miRNAs were significantly correlated with outcome in multivariate analyses. Twenty-two miRNAs were selected for further study. Higher miR-664-3p expression and lower miR-455-5p expression were predictive of improved outcome in the CAPEOXBEV cohorts and showed a significant interaction with bevacizumab effectiveness. The effects were strongest for OS. Both miRNAs showed high expression in stromal cells. Higher expression of miR-196b-5p and miR-592 predicted improved outcome regardless of bevacizumab treatment, with similar effect estimates in all three cohorts. Conclusions We have identified potentially predictive miRNAs for bevacizumab effectiveness and additional miRNAs that could be related to chemotherapy effectiveness or prognosis in patients with mCRC. Our findings need further validation in large cohorts, preferably from completed randomized trials. PMID:25329796

  18. Readiness to quit as a predictor for outcomes of smoking-reduction programme with transdermal nicotine patch or bupropion in a sample of 308 patients with schizophrenia.

    PubMed

    Chou, Kuan-Ju; Chen, Hsing-Kang; Hung, Chih-Hung; Chen, Tzu-Ting; Chen, Chun-Ming; Wu, Bo-Jian

    2015-04-01

    Readiness to quit has been found to predict smoking-cessation outcomes in a general population. However, little is known about the relationship between the readiness to quit and smoking-reduction outcomes in patients with schizophrenia treated with pharmacological adjuvants. The aim of this study was to examine the association between readiness to quit and smoking-reduction outcomes in patients with schizophrenia. A total of 308 subjects using nicotine replacement therapy (NRT) (N = 242) or bupropion (N = 66) participated in an 8-week smoking-reduction programme. Participants were categorised into precontemplators (N = 127), contemplators (N = 76) and preparators (N = 105) to quit smoking based on the transtheoretical model. There was a significant difference in change in number of cigarettes (NOC) (p = 0.007) and Fagerstrom test for nicotine dependence (FTND) score (nicotine dependence level) (p = 0.029) across the stages of change. A linear regression model revealed trend of increasing reduction in NOC and FTND scores in different stages of change (NOC: B = -1.22, t = -2.81, p = 0.005; FTND: B = -0.43, t = -2.57, p = 0.011). However, the 7-day point prevalence of abstinence was 5.5% (18/308), but there was no significant association between stage of change and smoking cessation (p = 0.26), possibly due to a very small sample size of successful quitters. In summary, among a cohort of institutionalised chronic schizophrenia patients receiving 8-week NRT or bupropion, stage of change can predict smoking reduction and may serve as a useful indicator for patients' preparedness before a trial of smoking reduction.

  19. Long-Term Outcomes of Services for Two Persons with Significant Disabilities with Differing Educational Experiences: A Qualitative Consideration of the Impact of Educational Experiences

    ERIC Educational Resources Information Center

    Ryndak, Diane Lea; Ward, Terri; Alper, Sandra; Montgomery, Jennifer Wilson; Storch, Jill F.

    2010-01-01

    Though research exists related to effective services in inclusive general education settings for students with significant disabilities, there are no longitudinal investigations of adult outcomes for persons with significant disabilities who received services in inclusive general education settings. This study uses qualitative methods to describe…

  20. Long-Term Outcomes of Services in Inclusive and Self-Contained Settings for Siblings with Comparable Significant Disabilities

    ERIC Educational Resources Information Center

    Ryndak, Diane; Ward, Terri; Alper, Sandra; Storch, Jill F.; Montgomery, Jennifer Wilson

    2010-01-01

    A major goal of special education services is to prepare graduates for productive and rewarding lives as adults in the community. Follow-up studies, however, consistently have indicated very poor post-school outcomes for special education graduates. While there has been a wealth of research related to the effectiveness of services in inclusive…

  1. Psychosocial Interventions for the Acute Treatment of Late-life Major Depression: A Systematic Review of Evidence-based Treatments, Predictors of Treatment Outcomes and Moderators of Treatment Effects

    PubMed Central

    Kiosses, Dimitris N.; Leon, Andrew C.; Areán, Patricia A.

    2011-01-01

    The goal of this systematic review is to evaluate the efficacy of psychosocial interventions for the acute treatment of late-life depression and identify predictors of treatment outcomes and moderators of treatment effects. The results of the systematic review may help to advance the development of personalized psychosocial treatments for late-life major depression. Based on our criteria, Problem Solving Therapy (PST), Cognitive Behavioral Therapy (CBT), and Treatment Initiation and Participation Program (TIP) have supportive evidence of efficacy, pending replication. Even though the data on the predictors of treatment outcomes and moderators of treatment effects are still preliminary, it appears that baseline anxiety and stress level, personality pathology, endogenous depression, and reduced self-rated health are associated with worse depression outcomes. More research is also recommended to examine the moderating effects of baseline depression severity; for instance, our review indicates that Interpersonal Psychotherapy (IPT) may work better in participants with high baseline depression severity than in participants with low depression severity. Recommendations for future novel psychosocial interventions for the acute treatment of late-life major depression include application of these interventions in non-traditional settings, involvement of the caregivers in the treatment of cognitively and functionally impaired older adults with major depression, and expansion of research to include more racially and ethnically diverse populations as the samples of the examined studies is highly selective, i.e. overly healthy, cognitively intact, Caucasian, and highly educated. PMID:21536164

  2. [Clinical significance and functional outcomes of ligation of exterior carotid artery in surgical treatment of oropharyngeal cancer].

    PubMed

    Klochikhin, A L; Trofimov, E I; Gamilovskaia, Iu V; Chistiakov, A L

    2010-01-01

    This work was designed to analyse outcomes of the treatment of 65 patients with advanced oropharyngeal cancer who had received combined treatment including radical resection of the tumour. Thirty three patients underwent surgery without ligation of exterior carotid artery while the remaining 32 (control group) were operated after preceding ligation of this vessel. The influence of ligation of exterior carotid artery on cerebral circulation was evaluated by the following methods: estimation of the intraoperative blood loss from A.T. Staroverov's formula, ultrasound dopplerography of extracranial carotid segments, electroencephalography, measurement of the fields of vision using statistical quantitative perimetry, evaluation of the patients' neurologic status. It was shown that ligation of exterior carotid artery has no apparent effect on the intraoperative blood loss during radical surgery for the management of oropharyngeal cancer nor does it influence healing of the postoperative wound and oncological outcome of this treatment. PMID:20436415

  3. Mediators, Moderators, and Predictors of 1-Year Outcomes Among Children Treated for Early-Onset Conduct Problems: A Latent Growth Curve Analysis

    ERIC Educational Resources Information Center

    Beauchaine, Theodore P.; Webster-Stratton, Carolyn; Reid, M. Jamila

    2006-01-01

    Several child conduct problem interventions have been classified as either efficacious or well established. Nevertheless, much remains to be learned about predictors of treatment response and mechanisms of behavioral change. In this study, the authors combine data from 6 randomized clinical trials and 514 children, ages 3.0-8.5 years, to evaluate…

  4. An investigation of outcome expectancies as a predictor of treatment response for combat veterans with PTSD: Comparison of clinician, self-report, and biological measures

    PubMed Central

    Price, Matthew; Maples, Jessica L.; Jovanovic, Tanja; Norrholm, Seth D.; Heekin, Mary; Rothbaum, Barbara O.

    2015-01-01

    Background Outcome expectancy, or the degree to which a client believes that therapy will result in improvement, is related to improved treatment outcomes for multiple disorders. There is a paucity of research investigating this relation in regards to PTSD. Additionally, the bulk of the research on outcome expectancy and treatment outcomes has relied mostly on self-report outcome measures. Methods The relation between outcome expectancy on self-report measures, clinician-rated measures, and two biological indices (fear potentiated startle and cortisol reactivity) of PTSD symptoms was explored. The sample included combat veterans (N= 116) treated with virtual reality exposure therapy for PTSD. Results Results supported a negative association between outcome expectancy and both self-report and clinician-rated symptoms at the conclusion of treatment, but outcome expectancy was related to the magnitude of change during treatment for self-report measures only. Outcome expectancy was unrelated to biological measures of treatment response. Conclusions These findings suggest that outcome expectancy may be related to patient and clinician perceptions of outcomes but not biological indices of outcome for PTSD. PMID:25703611

  5. Prevalence and predictors of ischemia and outcomes in outpatients with diabetes mellitus referred for single-photon emission computed tomography myocardial perfusion imaging.

    PubMed

    Bourque, Jamieson M; Patel, Chetan A; Ali, Mohamed M; Perez, Margarita; Watson, Denny D; Beller, George A

    2013-05-01

    Background- The prevalence of ischemia and its prediction of events are unclear in outpatients with diabetes mellitus in the modern era of intensive medical management. We sought to identify the prevalence of ischemia, subsequent cardiac events, and impact of sex, stress type, and symptom status on these findings in a cohort of stable outpatients with diabetes mellitus referred for single-photon emission computed tomography myocardial perfusion imaging (MPI). Methods and Results- The study cohort included 575 consecutive outpatients with diabetes mellitus who underwent quantitative, gated single-photon emission computed tomography MPI. Clinical information, stress MPI variables, and cardiac events were prospectively collected and analyzed. The study population was at intermediate risk of coronary artery disease or had known coronary artery disease (40.3%); 29% of patients were asymptomatic at the time of stress testing. Scintigraphic ischemia and significant (≥10%) left ventricular ischemia were present in 126 patients (21.9%) and 29 patients (5.0%), respectively, and <1% of patients had early revascularization. The risk of ischemia was increased >2-fold by male sex (P<0.001), but was not impacted by pharmacological stress (P=0.15) or presence of symptoms (P=0.89). During a median 4.4 years follow-up, the rate of cardiac death/nonfatal myocardial infarction was moderate at 2.6%/y (cardiac death 0.8%/y) in the total cohort, but was 5.7%/y in those with ischemia (P<0.001). Pharmacological stress predicted a higher cardiac event rate (P<0.001) but symptoms did not (P=0.55). Conclusions- This cohort of stable outpatients with diabetes mellitus referred for single-photon emission computed tomography had low rates of significant ischemia and early revascularization; an initially low cardiac event rate increased after 2 years. Independent predictors of cardiac death/nonfatal myocardial infarction were known coronary artery disease, pharmacological stress, and MPI

  6. Handgrip strength is an independent predictor of functional outcome in hip-fracture women: a prospective study with 6-month follow-up.

    PubMed

    Di Monaco, Marco; Castiglioni, Carlotta; De Toma, Elena; Gardin, Luisa; Giordano, Silvia; Tappero, Rosa

    2015-02-01

    The objective of this study was to investigate the contribution of handgrip strength in predicting the functional outcome after hip fracture in women.We prospectively investigated white women (N = 193 of 207) who were consecutively admitted to a rehabilitation hospital after a hip fracture. We measured handgrip strength with a Jamar dynamometer (Lafayette Instrument Co, Lafayette, IN), on admission to rehabilitation. Ability to function in activities of daily living was assessed by the Barthel index both on discharge from rehabilitation and at a 6-month follow-up.We found significant correlations between handgrip strength measured before rehabilitation and Barthel index scores assessed both on discharge from rehabilitation (ρ = 0.52, P < 0.001) and after 6 months (ρ = 0.49, P < 0.001). Significant associations between handgrip strength and Barthel index scores persisted after adjustment for age, comorbidities, pressure ulcers, medications in use, concomitant infections, body mass index, hip-fracture type, and Barthel index scores assessed both preinjury and on admission to rehabilitation (P = 0.001). Further adjustments for both Barthel index scores and Timed Up-and-Go test assessed at rehabilitation ending did not erase the significant association between handgrip strength and the Barthel index scores at the 6-month evaluation (P = 0.007). To define successful rehabilitation, we categorized the Barthel index scores as either high (85 or higher) or low (<85). The adjusted odds ratio for 1 SD increase in grip strength was 1.73 (95% confidence interval [CI] 1.05-2.84, P = 0.032) for having a high Barthel index score at the end of inpatient rehabilitation and 2.24 (95% CI 1.06-5.18) for having a high Barthel index score at the 6-month follow-up.Handgrip strength assessed before rehabilitation independently predicted the functional outcome both after inpatient rehabilitation and at a 6-month follow-up in hip-fracture women.

  7. Measuring Treatment Outcome for Children with Serious Emotional Disturbances: Discriminant Validity and Clinical Significance of the Child and Adolescent Functioning Assessment Scale

    ERIC Educational Resources Information Center

    Roy, Kimberlee M.; Roberts, Michael C.; Vernberg, Eric M.; Randall, Camille J.

    2008-01-01

    We investigated the use of a popular measure, the Children and Adolescent Functional Assessment Scale (CAFAS), in treatment outcome research. The sample included 70 children who had been discharged from an elementary therapeutic classroom (Intensive Mental Health Program). Significant relationships were found between decreases in CAFAS scores and…

  8. Predictors of survival and favorable functional outcomes after an out-of-hospital cardiac arrest in patients systematically brought to a dedicated heart attack center (from the Harefield Cardiac Arrest Study).

    PubMed

    Iqbal, M Bilal; Al-Hussaini, Abtehale; Rosser, Gareth; Salehi, Saleem; Phylactou, Maria; Rajakulasingham, Ramyah; Patel, Jayna; Elliott, Katharine; Mohan, Poornima; Green, Rebecca; Whitbread, Mark; Smith, Robert; Ilsley, Charles

    2015-03-15

    Despite advances in cardiopulmonary resuscitation (CPR), survival remains low after out-of-hospital cardiac arrest (OOHCA). Acute coronary ischemia is the predominating precipitant, and prompt delivery of patients to dedicated facilities may improve outcomes. Since 2011, all patients experiencing OOHCA in London, where a cardiac etiology is suspected, are systematically brought to heart attack centers (HACs). We determined the predictors for survival and favorable functional outcomes in this setting. We analyzed 174 consecutive patients experiencing OOHCA from 2011 to 2013 brought to Harefield Hospital-a designated HAC in London. We analyzed (1) all-cause mortality and (2) functional status using a modified Rankin scale (mRS 0 to 6, where mRS0-3(+) = favorable functional status). The overall survival rates were 66.7% (30 days) and 62.1% (1 year); and 54.5% had mRS0-3(+) at discharge. Patients with mRS0-3(+) had reduced mortality compared to mRS0-3(-): 30 days (1.2% vs 72.2%, p <0.001) and 1 year (5.3% vs 77.2%, p <0.001). Multivariate analyses identified lower patient comorbidity, absence of cardiogenic shock, bystander CPR, ventricular tachycardia/ventricullar fibrillation as initial rhythm, shorter duration of resuscitation, prehospital advanced airway, absence of adrenaline and inotrope use, and intra-aortic balloon pump use as predictors of mRS0-3(+). Consistent predictors of increased mortality were the presence of cardiogenic shock, advanced airway use, increased duration of resuscitation, and absence of therapeutic hypothermia. A streamlined delivery of patients experiencing OOHCA to dedicated facilities is associated with improved functional status and survival. Our study supports the standardization of care for such patients with the widespread adoption of HACs.

  9. Molecular predictors of outcome with gefitinib and docetaxel in previously treated non-small-cell lung cancer: data from the randomized phase III INTEREST trial.

    PubMed

    Douillard, Jean-Yves; Shepherd, Frances A; Hirsh, Vera; Mok, Tony; Socinski, Mark A; Gervais, Radj; Liao, Mei-Lin; Bischoff, Helge; Reck, Martin; Sellers, Mark V; Watkins, Claire L; Speake, Georgina; Armour, Alison A; Kim, Edward S

    2010-02-10

    PURPOSE In the phase III INTEREST trial, 1,466 pretreated patients with advanced non-small cell lung cancer (NSCLC) were randomly assigned to receive gefitinib or docetaxel. As a preplanned analysis, we prospectively analyzed available tumor biopsies to investigate the relationship between biomarkers and clinical outcomes. METHODS Biomarkers included epidermal growth factor receptor (EGFR) copy number by fluorescent in situ hybridization (374 assessable samples), EGFR protein expression by immunohistochemistry (n = 380), and EGFR (n = 297) and KRAS (n = 275) mutations. Results For all biomarker subgroups analyzed, survival was similar for gefitinib and docetaxel, with no statistically significant differences between treatments and no significant treatment by biomarker status interaction tests. EGFR mutation-positive patients had longer progression-free survival (PFS; hazard ratio [HR], 0.16; 95% CI, 0.05 to 0.49; P = .001) and higher objective response rate (ORR; 42.1% v 21.1%; P = .04), and patients with high EGFR copy number had higher ORR (13.0% v 7.4%; P = .04) with gefitinib versus docetaxel. CONCLUSION These biomarkers do not appear to be predictive factors for differential survival between gefitinib and docetaxel in this setting of previously treated patients; however, subsequent treatments may have influenced the survival results. For secondary end points of PFS and ORR, some advantages for gefitinib over docetaxel were seen in EGFR mutation-positive and high EGFR copy number patients. There was no statistically significant difference between gefitinib and docetaxel in biomarker-negative patients. This suggests gefitinib can provide similar overall survival to docetaxel in patients across a broad range of clinical subgroups and that EGFR biomarkers such as mutation status may additionally identify which patients are likely to gain greatest PFS and ORR benefit from gefitinib.

  10. Prognostic Significance of Depressive Symptoms on Weight Loss and Psychosocial Outcomes Following Gastric Bypass Surgery: A Prospective 24-month Follow-up Study

    PubMed Central

    White, Marney A.; Kalarchian, Melissa A.; Levine, Michele D.; Masheb, Robin M.; Marcus, Marsha D.; Grilo, Carlos M.

    2015-01-01

    Objective This study examined the prognostic significance of depressive symptoms in bariatric surgery patients over 24 months of follow-ups. Method Three hundred fifty-seven patients completed a battery of assessments before and at 6, 12, and 24 months following gastric bypass surgery. In addition to weight loss and depressive symptoms, the assessments targeted eating disorder psychopathology and quality of life. Results Clinically significant depressive symptoms, defined as a score of 15 or greater on the Beck Depression Inventory, characterized 45% of patients prior to surgery, and 12% at 6-month follow-up, 13% at 12-month follow-up, and 18% at 24-month follow-up. Preoperative depressive symptoms did not predict postoperative weight outcomes. In contrast, post-surgery depressive symptoms were predictive of weight loss outcomes. Higher post-surgery depressive symptoms at each time point predicted a greater degree of concurrent and subsequent eating disorder psychopathology and lower quality of life. Conclusions The frequency of elevated depressive symptoms decreases substantially following gastric bypass surgery but increases gradually over 24-months. Postoperative depressive symptoms are significantly associated with poorer weight outcomes at 6-months and 12-months following surgery but does not predict longer-term weight outcomes at 24-months. Post-operative depressive symptoms prospectively predict greater eating disorder psychopathology and poorer quality of life through 24-months. Elevated depressive symptoms, readily assessed by self-report, may signal a need for clinical attention after surgery. PMID:25720515

  11. Gender and Single Nucleotide Polymorphisms in MTHFR, BHMT, SPTLC1, CRBP2, CETP, and SCARB1 Are Significant Predictors of Plasma Homocysteine Normalized by RBC Folate in Healthy Adults123

    PubMed Central

    Clifford, Andrew J.; Chen, Kehui; McWade, Laura; Rincon, Gonzalo; Kim, Seung-Hyun; Holstege, Dirk M.; Owens, Janel E.; Liu, Bitao; Müller, Hans-Georg; Medrano, Juan F.; Fadel, James G.; Moshfegh, Alanna J.; Baer, David J.; Novotny, Janet A.

    2012-01-01

    Using linear regression models, we studied the main and 2-way interaction effects of the predictor variables gender, age, BMI, and 64 folate/vitamin B-12/homocysteine (Hcy)/lipid/cholesterol-related single nucleotide polymorphisms (SNP) on log-transformed plasma Hcy normalized by RBC folate measurements (nHcy) in 373 healthy Caucasian adults (50% women). Variable selection was conducted by stepwise Akaike information criterion or least angle regression and both methods led to the same final model. Significant predictors (where P values were adjusted for false discovery rate) included type of blood sample [whole blood (WB) vs. plasma-depleted WB; P < 0.001] used for folate analysis, gender (P < 0.001), and SNP in genes SPTLC1 (rs11790991; P = 0.040), CRBP2 (rs2118981; P < 0.001), BHMT (rs3733890; P = 0.019), and CETP (rs5882; P = 0.017). Significant 2-way interaction effects included gender × MTHFR (rs1801131; P = 0.012), gender × CRBP2 (rs2118981; P = 0.011), and gender × SCARB1 (rs83882; P = 0.003). The relation of nHcy concentrations with the significant SNP (SPTLC1, BHMT, CETP, CRBP2, MTHFR, and SCARB1) is of interest, especially because we surveyed the main and interaction effects in healthy adults, but it is an important area for future study. As discussed, understanding Hcy and genetic regulation is important, because Hcy may be related to inflammation, obesity, cardiovascular disease, and diabetes mellitus. We conclude that gender and SNP significantly affect nHcy. PMID:22833659

  12. Gender and single nucleotide polymorphisms in MTHFR, BHMT, SPTLC1, CRBP2, CETP, and SCARB1 are significant predictors of plasma homocysteine normalized by RBC folate in healthy adults.

    PubMed

    Clifford, Andrew J; Chen, Kehui; McWade, Laura; Rincon, Gonzalo; Kim, Seung-Hyun; Holstege, Dirk M; Owens, Janel E; Liu, Bitao; Müller, Hans-Georg; Medrano, Juan F; Fadel, James G; Moshfegh, Alanna J; Baer, David J; Novotny, Janet A

    2012-09-01

    Using linear regression models, we studied the main and 2-way interaction effects of the predictor variables gender, age, BMI, and 64 folate/vitamin B-12/homocysteine (Hcy)/lipid/cholesterol-related single nucleotide polymorphisms (SNP) on log-transformed plasma Hcy normalized by RBC folate measurements (nHcy) in 373 healthy Caucasian adults (50% women). Variable selection was conducted by stepwise Akaike information criterion or least angle regression and both methods led to the same final model. Significant predictors (where P values were adjusted for false discovery rate) included type of blood sample [whole blood (WB) vs. plasma-depleted WB; P < 0.001] used for folate analysis, gender (P < 0.001), and SNP in genes SPTLC1 (rs11790991; P = 0.040), CRBP2 (rs2118981; P < 0.001), BHMT (rs3733890; P = 0.019), and CETP (rs5882; P = 0.017). Significant 2-way interaction effects included gender × MTHFR (rs1801131; P = 0.012), gender × CRBP2 (rs2118981; P = 0.011), and gender × SCARB1 (rs83882; P = 0.003). The relation of nHcy concentrations with the significant SNP (SPTLC1, BHMT, CETP, CRBP2, MTHFR, and SCARB1) is of interest, especially because we surveyed the main and interaction effects in healthy adults, but it is an important area for future study. As discussed, understanding Hcy and genetic regulation is important, because Hcy may be related to inflammation, obesity, cardiovascular disease, and diabetes mellitus. We conclude that gender and SNP significantly affect nHcy. PMID:22833659

  13. Parenting and Parental Anxiety and Depression as Predictors of Treatment Outcome for Childhood Anxiety Disorders: Has the Role of Fathers Been Underestimated?

    ERIC Educational Resources Information Center

    Liber, Juliette M.; van Widenfelt, Brigit M.; Goedhart, Arnold W.; Utens, Elisabeth M. W. J.; van der Leeden, Adelinde J. M.; Markus, Monica T.; Treffers, Philip D. A.

    2008-01-01

    A substantial percentage of children with anxiety disorders do not respond adequately to Cognitive Behavioral Therapy (CBT). Examination of parental factors related to treatment outcome could contribute to a further understanding of treatment outcome responses. This study investigated the predictive value of paternal and maternal emotional warmth,…

  14. The t(14;18) is associated with germinal center-derived diffuse large B-cell lymphoma and is a strong predictor of outcome.

    PubMed

    Barrans, Sharon L; Evans, Paul A S; O'Connor, Sheila J M; Kendall, S Jane; Owen, Roger G; Haynes, Andrew P; Morgan, Gareth J; Jack, Andrew S

    2003-06-01

    The t(14;18) is present in a significant proportion of diffuse large B-cell lymphomas (DLBCLs), however, the prognostic effect of the translocation and the relationship with transformed follicular lymphoma remains controversial. To clarify these uncertainties, interphase fluorescence in situ hybridization (FISH) was used to determine the incidence of the t(14;18) in nodal DLBCL, and this was correlated with BCL2 expression, germinal center (GC) immunophenotype, and patient outcome. FISH was performed on paraffin-extracted nuclei from 137 de novo nodal DLBCLs. Eighteen of 137 de novo DLBCLs were t(14;18) positive. The t(14;18) was most commonly associated with the subset of DLBCLs that expressed a GC phenotype, defined as CD10+, BCL6+ (GC-type DLBCL): positive in 14 of 47 (30%) cases, compared with 4 of 89 (5%) in the non-GC group (Pearson's chi(2) = 28.4; P < 0.0001). All cases with a translocation expressed BCL2 protein, however, 40 expressed BCL2 protein without a t(14;18). GC-type DLBCL patients with a t(14;18) had a significantly worse survival compared with GC-type DLBCL patients without the translocation (2-year survivals were 29 and 63%, respectively; P = 0.006). Of the cases without the translocation, BCL2 protein expression did not affect survival. In contrast, in the non-GC group of DLBCLs, BCL2 protein expression reduced the 2-year overall survival from 64% in the BCL2-negative group to 38%, with a median survival of 15.0 months (P = 0.02). In conclusion, the t(14;18) is common in DLBCLs, particularly in GC-type DLBCLs, where the presence of the translocation has a poor prognostic effect. BCL2 protein expression defines a group of non-GC DLBCL patients with a poor prognosis. PMID:12796378

  15. Multiple cores of high grade prostatic intraepithelial neoplasia and any core of atypia on first biopsy are significant predictor for cancer detection at a repeat biopsy

    PubMed Central

    Kim, Tae Sun; Ko, Kwang Jin; Shin, Seung Jea; Ryoo, Hyun Soo; Song, Wan; Sung, Hyun Hwan; Han, Deok Hyun; Jeong, Byong Chang; Seo, Seong Il; Jeon, Seong Soo; Lee, Kyu Sung; Lee, Sung Won; Lee, Hyun Moo; Choi, Han Yong

    2015-01-01

    Purpose To investigate the differences in the cancer detection rate and pathological findings on a second prostate biopsy according to benign diagnosis, high-grade prostatic intraepithelial neoplasia (HGPIN), and atypical small acinar proliferation (ASAP) on first biopsy. Materials and Methods We retrospectively reviewed the records of 1,323 patients who underwent a second prostate biopsy between March 1995 and November 2012. We divided the patients into three groups according to the pathologic findings on the first biopsy (benign diagnosis, HGPIN, and ASAP). We compared the cancer detection rate and Gleason scores on second biopsy and the unfavorable disease rate after radical prostatectomy among the three groups. Results A total of 214 patients (16.2%) were diagnosed with prostate cancer on a second biopsy. The rate of cancer detection was 14.6% in the benign diagnosis group, 22.1% in the HGPIN group, and 32.1% in the ASAP group, respectively (p<0.001). When patients were divided into subgroups according to the number of positive cores, the rate of cancer detection was 16.7%, 30.5%, 31.0%, and 36.4% in patients with a single core of HGPIN, more than one core of HGPIN, a single core of ASAP, and more than one core of ASAP, respectively. There were no significant differences in Gleason scores on second biopsy (p=0.324) or in the unfavorable disease rate after radical prostatectomy among the three groups (benign diagnosis vs. HGPIN, p=0.857, and benign diagnosis vs. ASAP, p=0.957, respectively). Conclusions Patients with multiple cores of HGPIN or any core number of ASAP on a first biopsy had a significantly higher cancer detection rate on a second biopsy. Repeat biopsy should be considered and not be delayed in those patients. PMID:26682019

  16. Use of Direct Instruction to Teach Reading to Students with Significant Cognitive Impairments: Student Outcomes and Teacher Perceptions

    ERIC Educational Resources Information Center

    Kanfush, Philip Michael, III.

    2010-01-01

    The purpose of this study was to determine whether students with significant cognitive impairments make measurable gains in reading skills as measured by the Woodcock Reading Mastery Tests--Revised when taught using Direct Instruction reading programs. Additionally, the study explored teacher perceptions of the effectiveness of Direct Instruction…

  17. Does the addition of writing into a pharmacy communication skills course significantly impact student communicative learning outcomes? A pilot study.

    PubMed

    Lonie, John M; Rahim, Hamid

    2010-12-01

    The objective of this study was to determine if the addition of a reflective writing component in a fourth year (P-2) pharmacy communication skills course would significantly affect 2 measures of learning: (1) objective multiple choice examination questions and (2) a patient counseling Objective Structured Clinical Examination (OSCE) score. Using a nonequivalent group quasi-experimental retrospective comparison design, 98 randomly selected final examination scores from students taking a non-writing intensive (NWI) communication skills course were compared with 112 randomly selected final examination scores from students that took a communication skills course in which students engaged in several reflective writing assignments. In addition, 91 randomly selected patient counseling OSCE scores from a NWI course were statistically compared with 112 scores from students that took the writing intensive (WI) course. There were statistically significant improvements in multiple choice examination scores in the group that took the reflective writing communication skills course. There was not a statistically significant difference in patient counseling OSCE scores after students completed the WI course. Studying the effects of using reflective writing assignments in communication skills courses may improve the retention and retrieval of information presented within the course.

  18. Clinical Significance of Repetitive Compound Muscle Action Potentials in Patients with Myasthenia Gravis: A Predictor for Cholinergic Side Effects of Acetylcholinesterase Inhibitors

    PubMed Central

    Lee, Hyo Eun; Kim, Yool-hee; Kim, Seung Min

    2016-01-01

    Background and Purpose Acetylcholinesterase inhibitors (AChEIs) are widely used to treat myasthenia gravis (MG). Although AChEIs are usually tolerated well, some MG patients suffer from side effects. Furthermore, a small proportion of MG patients show cholinergic hypersensitivity and cannot tolerate AChEIs. Because repetitive compound muscle action potentials (R-CMAPs) are an electrophysiologic feature of cholinergic neuromuscular hyperactivity, we investigated the clinical characteristics of MG patients with R-CMAPs to identify their clinical usefulness in therapeutic decision-making. Methods We retrospectively reviewed the clinical records and electrodiagnostic findings of MG patients who underwent electrodiagnostic studies and diagnostic neostigmine testing (NT). Results Among 71 MG patients, 9 could not tolerate oral pyridostigmine bromide (PB) and 17 experienced side effects of PB. R-CMAPs developed in 24 patients after NT. The highest daily dose of PB was lower in the patients with R-CMAPs (240 mg/day vs. 480 mg/day, p<0.001). The frequencies of PB intolerance and side effects were higher in the patients with R-CMAPs than in those without R-CMAPs [37.5% vs. 0% (p<0.001) and 45.8% vs. 12.8% (p=0.002), respectively]. The MG Foundation of America postintervention status did not differ significantly between MG patients with and without R-CMAPs, and the response to immunotherapy was also good in both groups. Conclusions Side effects of and intolerance to AChEIs are more common in MG patients with R-CMAPs than in those without R-CMAPs. AChEIs should be used carefully in MG patients with R-CMAPs. The presence of R-CMAPs after NT may be a good indicator of the risks of PB side effects and intolerance.

  19. Predictors of Cosmetic Outcome Following MammoSite Breast Brachytherapy: A Single-Institution Experience of 100 Patients With Two Years of Follow-Up

    SciTech Connect

    Dragun, Anthony E. . E-mail: dragun@radonc.musc.edu; Harper, Jennifer L.; Jenrette, Joseph M.; Sinha, Debajyoti; Cole, David J.

    2007-06-01

    Purpose: To identify the factors that predict for excellent cosmesis in patients who receive MammoSite breast brachytherapy (MBT). Methods and Materials: One hundred patients with Stage 0, I, or II adenocarcinoma of the breast underwent adjuvant therapy using MBT. A dose of 34 Gy, delivered in 10 fractions twice daily, was prescribed to 1-cm depth using {sup 192}Ir high-dose-rate brachytherapy. Patients were assessed for acute toxicity on the day of therapy completion, 4 weeks after therapy, and at least every 3 months by radiation, surgical, and/or medical oncologists. All available data were reviewed for documentation of cosmesis and rated using the Harvard Scale. All patients had a minimum follow-up of 6 months (median = 24 months). Results: Of 100 patients treated, 90 had adequate data and follow-up. Cosmesis was excellent in 62 (68.9%), good in 19 (21.1%), fair in 8 (8.9%), and poor in 1 (1.1%) patient. Using stepwise logistic regression, the factors that predicted for excellent cosmesis were as follows: the absence vs. presence of infection (p = 0.017), and the absence vs. presence of acute skin toxicity (p = 0.026). There was a statistically significant association between acute skin toxicity (present vs. absent) and balloon-to-skin distance (<8 vs. >8 mm, p = 0.001). Factors that did not predict for cosmesis were age, balloon placement technique, balloon volume, catheter days in situ, subcutaneous toxicity, and chemotherapy or hormonal therapy. Conclusions: The acute and late-term toxicity profiles of MBT have been acceptable. Cosmetic outcome is improved by proper patient selection and infection prevention.

  20. Ambulatory Hypertension Subtypes and 24-Hour Systolic and Diastolic Blood Pressure as Distinct Outcome Predictors in 8341 Untreated People Recruited From 12 Populations

    PubMed Central

    Li, Yan; Wei, Fang-Fei; Thijs, Lutgarde; Boggia, José; Asayama, Kei; Hansen, Tine W.; Kikuya, Masahiro; Björklund-Bodegård, Kristina; Ohkubo, Takayoshi; Jeppesen, Jørgen; Gu, Yu-Mei; Torp-Pedersen, Christian; Dolan, Eamon; Liu, Yan-Ping; Kuznetsova, Tatiana; Stolarz-Skrzypek, Katarzyna; Tikhonoff, Valérie; Malyutina, Sofia; Casiglia, Edoardo; Nikitin, Yuri; Lind, Lars; Sandoya, Edgardo; Kawecka-Jaszcz, Kalina; Mena, Luis; Maestre, Gladys E.; Filipovský, Jan; Imai, Yutaka; O’Brien, Eoin; Wang, Ji-Guang; Staessen, Jan A.

    2015-01-01

    Background Data on risk associated with 24-hour ambulatory diastolic (DBP24) versus systolic (SBP24) blood pressure are scarce. Methods and Results We recorded 24-hour blood pressure and health outcomes in 8341 untreated people (mean age, 50.8 years; 46.6% women) randomly recruited from 12 populations. We computed hazard ratios (HRs) using multivariable-adjusted Cox regression. Over 11.2 years (median), 927 (11.1%) participants died, 356 (4.3%) from cardiovascular causes, and 744 (8.9%) experienced a fatal or nonfatal cardiovascular event. Isolated diastolic hypertension (DBP24≥80 mm Hg) did not increase the risk of total mortality, cardiovascular mortality, or stroke (HRs≤1.54; P≥0.18), but was associated with a higher risk of fatal combined with nonfatal cardiovascular, cardiac, or coronary events (HRs≥1.75; P≤0.0054). Isolated systolic hypertension (SBP24≥130 mm Hg) and mixed diastolic plus systolic hypertension were associated with increased risks of all aforementioned end points (P≤0.0012). Below age 50, DBP24 was the main driver of risk, reaching significance for total (HR for 1-SD increase, 2.05; P=0.0039) and cardiovascular mortality (HR, 4.07; P=0.0032) and for all cardiovascular end points combined (HR, 1.74; P=0.039) with a nonsignificant contribution of SBP24 (HR≤0.92; P≥0.068); above age 50, SBP24 predicted all end points (HR≥1.19; P≤0.0002) with a nonsignificant contribution of DBP24 (0.96≤HR≤1.14; P≥0.10). The interactions of age with SBP24 and DBP24 were significant for all cardiovascular and coronary events (P≤0.043). Conclusions The risks conferred by DBP24 and SBP24 are age dependent. DBP24 and isolated diastolic hypertension drive coronary complications below age 50, whereas above age 50 SBP24 and isolated systolic and mixed hypertension are the predominant risk factors. PMID:24906822

  1. Predictors of Catastrophic Adverse Outcomes in Children with Pulmonary Hypertension Undergoing Cardiac Catheterization: A Multi-Institutional Analysis From The Pediatric Health Information Systems Database

    PubMed Central

    O’Byrne, Michael L.; Glatz, Andrew C.; Hanna, Brian D.; Shinohara, Russell T.; Gillespie, Matthew J.; Dori, Yoav; Rome, Jonathan J.; Kawut, Steven

    2015-01-01

    Background Cardiac catheterization is the standard of care procedure for diagnosis, choice of therapy, and longitudinal follow-up of children and adults with pulmonary hypertension (PH). However, the procedure is invasive and has risks associated with both the procedure and recovery period. Objectives Identify risk factors for catastrophic adverse outcome in children with PH undergoing cardiac catheterization. Methods We studied children and young adults 0-21 years of age with PH undergoing ≥1 cardiac catheterizations at centers participating in the Pediatric Health Information Systems (PHIS) database between 2007 and 2012. Using mixed effects multivariable regression, we assessed the association between pre-specified subject- and procedure-level covariates and the risk of the composite outcome of death and/or initiation of mechanical circulatory support within 1 day of cardiac catheterization after adjustment for patient- and procedure-level factors. Results 6,339 procedures performed on 4,401 patients with a diagnosis of PH from 38/43 centers contributing data to the PHIS database were included. The observed risk of composite outcome was 3.5%. In multivariate modeling, the adjusted risk of the composite outcome was 3.3%. Younger age at catheterization, cardiac operation in the same admission as the catheterization, pre-procedural systemic vasodilator infusion, and hemodialysis were independently associated with an increased risk of adverse outcomes. Pre-procedure use of pulmonary vasodilators was associated with reduced risk of composite outcome. Conclusions The risk of cardiac catheterization in children and young adults with PH is high relative to previously reported risk in other pediatric populations. The risk is influenced by patient-level factors. Further research is necessary to determine whether knowledge of these factors can be translated into practices that improve outcomes for children with PH. PMID:26361158

  2. Spectral Predictors

    SciTech Connect

    Ibarria, L; Lindstrom, P; Rossignac, J

    2006-11-17

    Many scientific, imaging, and geospatial applications produce large high-precision scalar fields sampled on a regular grid. Lossless compression of such data is commonly done using predictive coding, in which weighted combinations of previously coded samples known to both encoder and decoder are used to predict subsequent nearby samples. In hierarchical, incremental, or selective transmission, the spatial pattern of the known neighbors is often irregular and varies from one sample to the next, which precludes prediction based on a single stencil and fixed set of weights. To handle such situations and make the best use of available neighboring samples, we propose a local spectral predictor that offers optimal prediction by tailoring the weights to each configuration of known nearby samples. These weights may be precomputed and stored in a small lookup table. We show that predictive coding using our spectral predictor improves compression for various sources of high-precision data.

  3. Predicting Outcome in Acute Low-Back Pain

    PubMed Central

    Singer, Joel; Gilbert, J.R.; Hutton, Tim; Taylor, D.W.

    1987-01-01

    Patients presenting to their family physician with acute low-back pain were studied prospectively. Demographic factors and patient history at the initial visit were assessed to determine important predictors of selected clinical outcomes, including time to resumption of normal activities and time to relief from pain. While several predictors were significantly correlated with each of the outcomes assessed, the most consistent predictor of outcome proved to be the reported pain intensity at the initial visit. Baseline levels of pain intensity were related to expected time of recovery and probability of periodic pain in the future. Data collected in the initial history and physical examination of patients permit an assessment of factors that may be useful in establishing prognosis for relevant clinical outcomes. PMID:21263854

  4. Significance of myocardial tenascin‐C expression in left ventricular remodelling and long‐term outcome in patients with dilated cardiomyopathy

    PubMed Central

    Yokokawa, Tetsuro; Nakayama, Takafumi; Nagai, Toshiyuki; Matsuyama, Taka‐aki; Ohta‐Ogo, Keiko; Ikeda, Yoshihiko; Ishibashi‐Ueda, Hatsue; Nakatani, Takeshi; Yasuda, Satoshi; Takeishi, Yasuchika; Ogawa, Hisao; Anzai, Toshihisa

    2016-01-01

    Aim Dilated cardiomyopathy (DCM) has a variety of causes, and no useful approach to predict left ventricular (LV) remodelling and long‐term outcome has yet been established. Myocardial tenascin‐C (TNC) is known to appear under pathological conditions, possibly to regulate cardiac remodelling. The aim of this study was to clarify the significance of myocardial TNC expression in LV remodelling and the long‐term outcome in DCM. Methods and results One hundred and twenty‐three consecutive DCM patients who underwent endomyocardial biopsy for initial diagnosis were studied. Expression of TNC in biopsy sections was analysed immunohistochemically to quantify the ratio of the TNC‐positive area to the whole myocardial tissue area (TNC area). Clinical parameters associated with TNC area were investigated. The patients were divided into two groups based on receiver operating characteristic analysis of TNC area to predict death: high TNC group with TNC area ≥2.3% (22 patients) and low TNC group with TNC area <2.3% (101 patients). High TNC was associated with diabetes mellitus. Comparing echocardiographic findings between before and 9 months after endomyocardial biopsy, the low TNC group was associated with decreased LV end‐diastolic diameter and increased LV ejection fraction, whereas the high TNC group was not. Survival analysis revealed a worse outcome in the high TNC group than in the low TNC group (P < 0.001). Multivariable Cox regression analysis revealed that TNC area was independently associated with poor outcome (HR = 1.347, P = 0.032). Conclusions Increased myocardial TNC expression was associated with worse LV remodeling and long‐term outcome in DCM. PMID:26763891

  5. Eggshell thinning of osprey (Pandion haliaetus) breeding in Sweden and its significance for egg breakage and breeding outcome.

    PubMed

    Odsjö, Tjelvar; Sondell, Jan

    2014-02-01

    In the middle of the 1960s low reproductive rate was found in several osprey (Pandion haliaetus) nests in Sweden. Therefore a project was started to investigate the production and to collect unhatched eggs and shell fragments in different regions of Sweden during 1971-2008. Measurements of osprey eggs from museum collections from 1840 to 1970 were included to study long-term changes in shell thickness. In total, eggshell thickness of whole eggs from 666 clutches and of shell fragments from 693 nests was measured. The thinnest shell fragments were recorded in 1973 (mean for 71 clutches: 0.438 mm), minus 15.0% compared to thickness of unaffected eggs before 1946 (0.515 mm). After 1973, shell thickness increased to reach background levels in 2003 (0.515 mm). Thus, it took 30 years to reach full thickness again. From the start of the decrease it took more than 50 years to reach unaffected conditions. The number of whole eggs remaining intact in the nest throughout incubation was reduced when shell thickness decreased. Great loss of eggs due to breakage seems to occur when the mean shell thickness in the clutch was below 0.40 mm. In 1971-1973, when shell thinning was most pronounced, the average thickness of shell fragments was 0.366 mm in nests with 0 intact eggs (minus 29% compared to the pre-1946 background value); 0.393 mm (minus 24%) in nests with 1 intact egg; 0.431 mm (minus 16%) in nests with 2 intact eggs and 0.450 mm (minus 12%) in nests with 3 intact eggs. Differences in thickness were significant for 1 versus 2 intact eggs, 2 vs. 3 intact eggs and for 0+1 vs. 2+3 intact eggs. Actual data from the period 1971-73 shows a decline in the production of young (4-5 weeks) of some 15% (0.25 young per nest). PMID:24239823

  6. Postoperative Fluid Overload is a Useful Predictor of the Short-Term Outcome of Renal Replacement Therapy for Acute Kidney Injury After Cardiac Surgery.

    PubMed

    Xu, Jiarui; Shen, Bo; Fang, Yi; Liu, Zhonghua; Zou, Jianzhou; Liu, Lan; Wang, Chunsheng; Ding, Xiaoqiang; Teng, Jie

    2015-08-01

    To analyze the predictive value of postoperative percent fluid overload (PFO) of renal replacement therapy (RRT) for acute kidney injury (AKI) patients after cardiac surgery.Data from 280 cardiac surgery patients between 2005 January and 2012 April were collected for retrospective analyses. A receiver operating characteristic (ROC) curve was used to compare the predictive values of cumulative PFO at different times after surgery for 90-day mortality.The cumulative PFO before RRT initiation was 7.9% ± 7.1% and the median PFO 6.1%. The cumulative PFO before and after RRT initiation in intensive care unit (ICU) was higher in the death group than in the survival group (8.8% ± 7.6% vs 6.1% ± 5.6%, P = 0.001; -0.5[-5.6, 5.1]% vs 6.9[2.2, 14.6]%, P < 0.001). The cumulative PFO during the whole ICU stay was 14.3% ± 15.8% and the median PFO was 10.7%. The areas under the ROC curves to predict the 90-day mortality by PFO at 24 hours, cumulative PFO before and after RRT initiation, and PFO during the whole ICU stay postoperatively were 0.625, 0.627, 0.731, and 0.752. PFO during the whole ICU stay ≥7.2% was determined as the cut-off point for 90-day mortality prediction with a sensitivity of 77% and a specificity of 64%. Kaplan-Meier survival estimates showed a significant difference in survival among patients with cumulative PFO ≥ 7.2% and PFO < 7.2% after cardiac surgery (log-rank P < 0.001).Postoperative cumulative PFO during the whole ICU stay ≥7.2% would have an adverse effect on 90-day short-term outcome, which may provide a strategy for the volume control of AKI-RRT patients after cardiac surgery.

  7. Moderators and Non-Specific Predictors of Treatment Outcome for Anxiety Disorders : A Comparison of Cognitive Behavioral Therapy to Acceptance and Commitment Therapy

    ERIC Educational Resources Information Center

    Wolitzky-Taylor, Kate B.; Arch, Joanna J.; Rosenfield, David; Craske, Michelle G.

    2012-01-01

    Objective: Understanding for whom, and under what conditions, treatments exert their greatest effects is essential for developing personalized medicine. Research investigating moderators of outcome among evidence-based treatments for anxiety disorders is lacking. The current study examined several theory-driven and atheoretical putative moderators…

  8. Feelings and Performance in the First Year at University: Learning-Related Emotions as Predictors of Achievement Outcomes in Mathematics and Statistics

    ERIC Educational Resources Information Center

    Niculescu, Alexandra C.; Templelaar, Dirk; Leppink, Jimmie; Dailey-Hebert, Amber; Segers, Mien; Gijselaers, Wim

    2015-01-01

    Introduction: This study examined the predictive value of four learning-related emotions--Enjoyment, Anxiety, Boredom and Hopelessness for achievement outcomes in the first year of study at university. Method: We used a large sample (N = 2337) of first year university students enrolled over three consecutive academic years in a mathematics and…

  9. Family Rejection, Social Isolation, and Loneliness as Predictors of Negative Health Outcomes (Depression, Suicidal Ideation, and Sexual Risk Behavior) among Thai Male-to-Female Transgender Adolescents

    ERIC Educational Resources Information Center

    Yadegarfard, Mohammadrasool; Meinhold-Bergmann, Mallika E.; Ho, Robert

    2014-01-01

    This study examined the influence of family rejection, social isolation, and loneliness on negative health outcomes among Thai male-to-female transgender adolescents. The sample consisted of 260 male respondents, of whom 129 (49.6%) were self-identified as transgender and 131 (50.4%) were self-identified as cisgender (nontransgender). Initial…

  10. To What Extent is the Mayer and Salovey (1997) Model of Emotional Intelligence a Useful Predictor of Leadership Style and Perceived Leadership Outcomes in Australian Educational Institutions?

    ERIC Educational Resources Information Center

    Grunes, Paul; Gudmundsson, Amanda; Irmer, Bernd

    2014-01-01

    Researchers have found that transformational leadership is related to positive outcomes in educational institutions. Hence, it is important to explore constructs that may predict leadership style in order to identify potential transformational leaders in assessment and selection procedures. Several studies in non-educational settings have found…

  11. Maternal Jail Time, Conviction, and Arrest as Predictors of Children's 15-Year Antisocial Outcomes in the Context of a Nurse Home Visiting Program

    ERIC Educational Resources Information Center

    Shlafer, Rebecca J.; Poehlmann, Julie; Donelan-McCall, Nancy

    2012-01-01

    Data from the Nurse-Family Partnership intervention program were analyzed to compare the "selection" versus "unique" effects of maternal jail time on adolescent antisocial and health risk outcomes. Data from 320 women and their firstborn children were available from the prenatal, birth, and 15-year assessments. Consistent with a selection…

  12. Examining the Role of Culture-Specific Coping as a Predictor of Resilient Outcomes in African Americans from High-Risk Urban Communities

    ERIC Educational Resources Information Center

    Utsey, Shawn O.; Bolden, Mark A.; Lanier, Yzette; Williams, Otis, III

    2007-01-01

    This investigation examined the role of culture-specific coping in relation to resilient outcomes in African Americans from high-risk urban communities. Participants (N = 385) were administered a survey questionnaire packet containing measures of culture-specific coping, traditional resilience factors (cognitive ability, social support, and…

  13. Early Educational Intervention, Early Cumulative Risk, and the Early Home Environment as Predictors of Young Adult Outcomes within a High-Risk Sample

    ERIC Educational Resources Information Center

    Pungello, Elizabeth P.; Kainz, Kirsten; Burchinal, Margaret; Wasik, Barbara H.; Sparling, Joseph J.; Ramey, Craig T.; Campbell, Frances A.

    2010-01-01

    The extent to which early educational intervention, early cumulative risk, and the early home environment were associated with young adult outcomes was investigated in a sample of 139 young adults (age 21) from high-risk families enrolled in randomized trials of early intervention. Positive effects of treatment were found for education attainment,…

  14. Prevalence and Predictors of Poor Recovery from Mild Traumatic Brain Injury

    PubMed Central

    Li, Xiaoqi; McCauley, Stephen R.; Wilde, Elisabeth A.; Barnes, Amanda; Hanten, Gerri; Mendez, Donna; McCarthy, James J.; Levin, Harvey S.

    2015-01-01

    Abstract Although most patients with mild traumatic brain injury (mTBI) recover within 3 months, a subgroup of patients experience persistent symptoms. Yet, the prevalence and predictors of persistent dysfunction in patients with mTBI remain poorly understood. In a longitudinal study, we evaluated predictors of symptomatic and cognitive dysfunction in adolescents and young adults with mTBI, compared with two control groups—patients with orthopedic injuries and healthy uninjured individuals. Outcomes were assessed at 3 months post-injury. Poor symptomatic outcome was defined as exhibiting a symptom score higher than 90% of the orthopedic control (OC) group, and poor cognitive outcome was defined as exhibiting cognitive performance poorer than 90% of the OC group. At 3 months post-injury, more than half of the patients with mTBI (52%) exhibited persistently elevated symptoms, and more than a third (36.4%) exhibited poor cognitive outcome. The rate of high symptom report in mTBI was markedly greater than that of typically developing (13%) and OC (17%) groups; the proportion of those with poor cognitive performance in the mTBI group exceeded that of typically developing controls (15.8%), but was similar to that of the OC group (34.9%). Older age at injury, female sex, and acute symptom report were predictors of poor symptomatic outcome at 3 months. Socioeconomic status was the only significant predictor of poor cognitive outcome at 3 months. PMID:25970233

  15. Prevalence and Predictors of Poor Recovery from Mild Traumatic Brain Injury.

    PubMed

    Rabinowitz, Amanda R; Li, Xiaoqi; McCauley, Stephen R; Wilde, Elisabeth A; Barnes, Amanda; Hanten, Gerri; Mendez, Donna; McCarthy, James J; Levin, Harvey S

    2015-10-01

    Although most patients with mild traumatic brain injury (mTBI) recover within 3 months, a subgroup of patients experience persistent symptoms. Yet, the prevalence and predictors of persistent dysfunction in patients with mTBI remain poorly understood. In a longitudinal study, we evaluated predictors of symptomatic and cognitive dysfunction in adolescents and young adults with mTBI, compared with two control groups-patients with orthopedic injuries and healthy uninjured individuals. Outcomes were assessed at 3 months post-injury. Poor symptomatic outcome was defined as exhibiting a symptom score higher than 90% of the orthopedic control (OC) group, and poor cognitive outcome was defined as exhibiting cognitive performance poorer than 90% of the OC group. At 3 months post-injury, more than half of the patients with mTBI (52%) exhibited persistently elevated symptoms, and more than a third (36.4%) exhibited poor cognitive outcome. The rate of high symptom report in mTBI was markedly greater than that of typically developing (13%) and OC (17%) groups; the proportion of those with poor cognitive performance in the mTBI group exceeded that of typically developing controls (15.8%), but was similar to that of the OC group (34.9%). Older age at injury, female sex, and acute symptom report were predictors of poor symptomatic outcome at 3 months. Socioeconomic status was the only significant predictor of poor cognitive outcome at 3 months.

  16. Nurse work engagement impacts job outcome and nurse-assessed quality of care: model testing with nurse practice environment and nurse work characteristics as predictors

    PubMed Central

    Van Bogaert, Peter; van Heusden, Danny; Timmermans, Olaf; Franck, Erik

    2014-01-01

    Aim: To explore the mechanisms through which nurse practice environment dimensions, such as nurse–physician relationship, nurse management at the unit level and hospital management and organizational support, are associated with job outcomes and nurse-assessed quality of care. Mediating variables included nurse work characteristics of workload, social capital, decision latitude, as well as work engagement dimensions of vigor, dedication and absorption. Background: Understanding how to support and guide nurse practice communities in their daily effort to answer complex care most accurate, alongside with the demand of a stable and healthy nurse workforce, is challenging. Design: Cross-sectional survey. Method: Based on earlier empirical findings, a structural equation model, designed with valid measurement instruments, was tested. The study population included registered acute care hospital nurses (N = 1201) in eight hospitals across Belgium. Results: Nurse practice environment dimensions predicted nurses’ ratings of job outcome variables as well as quality of care. Features of nurses’ work characteristics, e.g., perceived workload, decision latitude, social capital, and the three dimension of work engagement, played mediating roles between nurse practice environment and outcomes. A revised model, using various fit measures, explained 60% of job outcomes and 47% of nurse-assessed quality of care. Conclusion: The findings in this study show that nurse work characteristics as workload, decision latitude, and social capital, alongside with nurse work engagement (e.g., vigor, dedication, and absorption) influence nurses’ perspective of their nurse practice environment, job outcomes, and quality of care. The results underline aspects to considerate for various stakeholders, such as executives, nurse managers, physicians, and staff nurses, in setting up and organizing health care services. PMID:25431563

  17. Parent Engagement With a Telehealth-Based Parent-Mediated Intervention Program for Children With Autism Spectrum Disorders: Predictors of Program Use and Parent Outcomes

    PubMed Central

    Berger, Natalie I

    2015-01-01

    Background There has been growing interest in using telehealth to increase access to parent-mediated interventions for children with ASD. However, little is known about how parents engage with such programs. Objective This paper presents program engagement data from a pilot study comparing self-directed and therapist-assisted versions of a novel telehealth-based parent-mediated intervention for young children with autism spectrum disorders (ASD). Methods Parents of young children with ASD were randomly assigned to receive a self-directed or therapist-assisted version of ImPACT Online. Parent engagement and satisfaction with the different components of the program website were examined using the program’s automated data collection and a post-treatment evaluation survey. We examined the relationship between program engagement and changes in parent knowledge and implementation and participant characteristics associated with program engagement. Results Of the 27 parent participants, the majority were female (26/27, 96%), married (22/27, 81%), with a college degree or higher (15/27, 56%), and less than half were not employed outside of the home (10/27, 37%). The mean chronological age of the child participants was 43.26 months, and the majority were male (19/27, 70%) and white (21/27, 78%). Most of the families (19/27, 70%) resided in a rural or medically underserved area. Parents logged into the website an average of 46.85 times, spent an average of 964.70 minutes on the site, and completed an average of 90.17% of the lesson learning activities. Participants in the therapist-assisted group were more likely to engage with the website than those in the self-directed group: F 2,24=17.65, P<.001. In total, 85% of participants completed the program, with a significantly greater completion rate in the therapist-assisted group (N=27): χ2 1=5.06, P=.03. Lesson learning activities were visited significantly more often than the supplemental activities (all Ps<.05). Multiple

  18. Predictors in Internet-delivered cognitive behavior therapy and behavioral stress management for severe health anxiety.

    PubMed

    Hedman, Erik; Andersson, Erik; Lekander, Mats; Ljótsson, Brjánn

    2015-01-01

    Severe health anxiety can be effectively treated with exposure-based Internet-delivered cognitive behavior therapy (ICBT), but information about which factors that predict outcome is scarce. Using data from a recently conducted RCT comparing ICBT (n = 79) with Internet-delivered behavioral stress management (IBSM) (n = 79) the presented study investigated predictors of treatment outcome. Analyses were conducted using a two-step linear regression approach and the dependent variable was operationalized both as end state health anxiety at post-treatment and as baseline-to post-treatment improvement. A hypothesis driven approach was used where predictors expected to influence outcome were based on a previous predictor study by our research group. As hypothesized, the results showed that baseline health anxiety and treatment adherence predicted both end state health anxiety and improvement. In addition, anxiety sensitivity, treatment credibility, and working alliance were significant predictors of health anxiety improvement. Demographic variables, i.e. age, gender, marital status, computer skills, educational level, and having children, had no significant predictive value. We conclude that it is possible to predict a substantial proportion of the outcome variance in ICBT and IBSM for severe health anxiety. The findings of the present study can be of high clinical value as they provide information about factors of importance for outcome in the treatment of severe health anxiety.

  19. KOOS Pain as a Marker for Significant Knee Pain Two and Six Years after Primary ACL Reconstruction: A Multicenter Orthopaedic Outcomes Network (MOON) Prospective Longitudinal Cohort Study

    PubMed Central

    Wasserstein, D; Huston, LJ; Nwosu, S; Spindler, KP

    2015-01-01

    Objective The prevalence of radiographic osteoarthritis (OA) after anterior cruciate ligament reconstruction (ACLR) approaches 50%, yet the prevalence of significant knee pain is unknown. We applied three different models of Knee injury and Osteoarthritis Outcome Score (KOOS) thresholds for significant knee pain to an ACLR cohort to identify prevalence and risk factors. Design Multicenter Orthopaedic Outcomes Network (MOON) prospective cohort patients with a unilateral primary ACLR and normal contralateral knee were assessed at 2 and 6 years. Independent variables included patient demographics, validated Patient Reported Outcomes (PRO; Marx activity score, KOOS), and surgical characteristics. Models included: (1) KOOS criteria for a painful knee = quality of life subscale <87.5 and ≥2 of: KOOSpain <86.1, KOOSsymptoms <85.7, KOOSADL <86.8, or KOOSsports/rec <85.0; (2) KOOSpain subscale score ≤72 (≥2 standard deviations below population mean); (3) 10-point KOOSpain drop from 2 to 6 years. Proportional odds models (alpha≤0.05) were used. Results 1,761 patients of median age 23 years, median BMI 24.8 kg/m2 and 56% male met inclusion, with 87% (1530/1761) and 86% (1506/1761) follow-up at 2 and 6 years, respectively. At 6 years, n=592 (39%), n=131 (9%) and n=169 (12%) met criteria for models #1 through #3, respectively. The most consistent and strongest independent risk factor at both time-points was subsequent ipsilateral knee surgery. Low 2-year Marx activity score increased the odds of a painful knee at 6 years. Conclusions Significant knee pain is prevalent after ACLR; with those who undergo subsequent ipsilateral surgery at greatest risk. The relationship between pain and structural OA warrants further study. PMID:26072385

  20. Does the severity of diabetic retinopathy predict pregnancy outcome?

    PubMed

    Klein, B E; Klein, R; Meuer, S M; Moss, S E; Dalton, D D

    1988-01-01

    The authors sought to determine whether the severity of diabetic retinopathy is a predictor of subsequent pregnancy outcome. One hundred and seventy-nine pregnant diabetic women were evaluated in their first trimester of pregnancy. Stereoscopic color photographs of the ocular fundus were taken and graded by the Fundus Photography Reading Center. Thirty-nine women had no retinopathy, while 28 had proliferative retinopathy in the worse eye. The women's history and hospital delivery room charts were reviewed with regard to pregnancy outcome. Thirty-three pregnancies terminated with an adverse outcome. A logistic regression analysis was used to evaluate significant predictors of pregnancy outcome. Of maternal age, duration of diabetes, glycosylated hemoglobin, proteinuria, cigarette smoking status, and severity of diabetic retinopathy, only the last variable significantly predicted an adverse outcome. These data suggest that the severity of retinopathy should be considered when counseling a pregnant diabetic woman.

  1. Predicting Meaningful Outcomes to Medication and Self-Help Treatments for Binge Eating Disorder in Primary Care: The Significance of Early Rapid Response

    PubMed Central

    Grilo, Carlos M.; White, Marney A.; Masheb, Robin M.; Gueorguieva, Ralitza

    2014-01-01

    Objective We examined rapid response among obese patients w