scholarly journals 48. Time Between Viral Loads for Suppressed and Non-Suppressed People with HIV During the COVID-19 Pandemic Compared to Pre-Pandemic

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S34-S35
Author(s):  
Walid El-Nahal ◽  
Nicola Shen ◽  
Catherine Lesko ◽  
Anthony Fojo ◽  
Bryan Lau ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Private Insurance ◽  
Patient Characteristics ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Heroin Use ◽  
Hazards Model ◽  
Measured Time ◽  
The Impact

Abstract Background During the COVID-19 pandemic, patients at the John G. Bartlett Specialty practice experienced disruptions in viral load (VL) monitoring due to 1) conversion to telemedicine visits and 2) closure of the onsite lab from March 16-July 13, 2021. We described the impact of the pandemic on VL monitoring. Methods We measured time from all index VLs collected during 3 periods: January 1, 2019 to March 15, 2020 (pre-pandemic); March 16 to July 12, 2020 (pandemic, closed onsite lab); and July 13 to December 31, 2020 (pandemic, open onsite lab) until a subsequent VL, 1 year after the index VL, or administrative censoring on December 31, 2020, whichever came first. We classified follow-up time according to these periods (treating period as a time-varying variable). We report hazard ratios (HRs) and 95% Confidence Intervals (CI) from a Cox proportional hazards model comparing the hazard of a VL during the pandemic periods to the pre-pandemic period, stratified by whether the index VL was suppressed (≤200 copies/mL). We tested for interactions between patient characteristics (age, sex at birth, race, ethnicity, and recent substance use) and period, to investigate differential effects of the pandemic on delayed VL. Results After 7,760 suppressed VL measurements, median times to subsequent VL during the pre-pandemic, pandemic (closed lab) and pandemic (open lab) periods, were 4.6 (HR=1.0), 8.9 (HR=0.34, CI:0.30, 0.37), and 5.8 (HR=0.73, CI:0.68,0.78) months respectively. After 1,025 non-suppressed VL measurements, median times to subsequent VL were 2.0 (HR=1.0), 3.9 (HR=0.57, CI:0.42,0.79), and 2.1 (HR=0.92, CI:0.76,1.10) months respectively. Time to subsequent VL after an index suppressed VL was less affected by the pandemic for patients who are white; had private insurance; or had no recent cocaine or heroin use. The effect of the pandemic on time to subsequent VL after a non-suppressed index VL did not significantly differ across patient characteristics. Conclusion Onsite lab closure disrupted VL collection for all groups. Once the onsite lab opened, the pandemic period was still associated with a delay among suppressed patients, but not non-suppressed patients. Further studies are needed to investigate if these delays are associated with lapses in viral suppression. Disclosures All Authors: No reported disclosures

Between National Polarization and Local Ideology: The Impact of Partisan Competition on State Medicaid Expansion Decisions

2019 ◽  
Vol 50 (2) ◽  
pp. 237-255 ◽  
Author(s):  
Joshua Meyer-Gutbrod
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Electoral Competition ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Party Competition ◽  
Medicaid Expansion ◽  
Hazards Model ◽  
Partisan Competition ◽  
The Impact

Abstract The U.S. Supreme Court’s decision to grant states the authority to reject Medicaid expansion under the Affordable Care Act without penalty threatened the implementation of this polarized health policy. While many Republican-controlled states followed their national allies and rejected Medicaid expansion, others engaged in bipartisan implementation. Why were some Republican states willing to reject the national partisan agenda and cooperate with Democrats in Washington? I focus on the role of electoral competition within states. I conclude that although electoral competition has been shown to encourage partisan polarization within the states, the combination of intergovernmental implementation and Medicaid expansion’s association with public welfare reverses this dynamic. I employ a Cox proportional-hazards model to examine the impact of state partisan ideology and competition on the likelihood of state Medicaid expansion. I find that strong inter-party competition mitigates the impact of more extreme partisan ideologies, encouraging potentially bipartisan negotiation with the federal administration.

scholarly journals Impact of Prior Cancer History on Outcomes in Thymoma

2020 ◽  
Author(s):  
Shilong Wu ◽  
Mengyang Liu ◽  
Weixue Cui ◽  
Guilin Peng ◽  
Jianxing He
Keyword(s):  
Overall Survival ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Cancer History ◽  
Treatment Methods ◽  
Hazards Model ◽  
Kaplan Meier ◽  
The Impact

Abstract Background Thymoma is an uncommon intrathoracic malignant tumor and has a long natural history. It is uncertain whether the survival of thymoma patient is affected by prior cancer history. Finding out the impact of a prior cancer history on thymoma survival has important implications for both decision making and research. Method The Surveillance, Epidemiology, and End Results (SEER) database was queried for thymoma patients diagnosed between 1975 and 2015. Kaplan-Meier methods and Cox proportional hazards model were used to analyze overall survival across a variety of stages, age, and treatment methods with a prior cancer history or not. Results A total of 3604 patients with thymoma were identified including 507 (14.1%) with a prior cancer history. The 10-year survival rate of patients with a prior cancer history (53.8%) was worse than those without a prior cancer history (40.32%, 95%CI 35.24-45.33, P < 0.0001). However, adjusted analyses showed that the impact of a prior cancer history was heterogenous across age and treatment methods. In subset analyses, prior cancer history was associated with worse survival among patients who were treated with chemoradiotherapy (HR: 2.80, 95% CI: 1.51-5.20, P = 0.001) and age ≤ 65 years (HR: 1.33, 95%CI: 1.02-1.73, P = 0.036). Conclusions Prior cancer history provides an inferior overall survival for patients with thymoma. But it does not worsen the survival in some subgroups and these thymoma patients should not be excluded from clinical trials.

Glucocorticoid receptor (GR) expression in circulating tumor cells (CTCs) to prognosticate overall survival (OS) for metastatic castration-resistant prostate cancer (mCRPC) patients (pts) treated with androgen receptor signaling inhibitors (ARSi).

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 194-194 ◽  
Author(s):  
David Wise ◽  
James Kelvin ◽  
Ryon Graf ◽  
Nicole A. Schreiber ◽  
Brigit McLaughlin ◽  
...  
Keyword(s):  
Protein Expression ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Predictive Biomarker ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Castration Resistant Prostate Cancer ◽  
Hazards Model ◽  
Kaplan Meier ◽  
The Impact

194 Background: Upregulation of GR protein expression in metastatic biopsies from pts with CRPC has previously been shown to correlate with resistance to enzalutamide and has been validated as a therapeutic target in pre-clinical studies. We sought to determine whether upregulated GR protein expression in CTCs from pts with progressing mCRPC predicted clinical outcomes following treatment with enzalutamide (E) or abiraterone (A). Methods: Pre-therapy blood samples from 54 pts with progressing mCRPC were subjected to CTC analysis using the Epic Sciences platform. Samples were examined to identify CK+ (CK+, CD45- cells, with intact nuclei, morph distinct) CTCs for GR protein expression. GR+ CTCs were defined as having expression greater than the 95th percentile of GR expression in the GR negative LNCAP cell line. Kaplan-Meier analysis was used to test the impact of GR+ CTCs on OS following treatment with A or E. A Cox proportional hazards model with CTC number and GR positivity was used in a multivariate analysis. Results: 37 out of 54 pts (69%) had detectable and viable CK+ CTCs. 28 out of 37 pts (76%) had CTCs with upregulated GR staining with a median of 6 GR+/CK+ cells/ml per patient (range 0.7 – 244 cells/ml). The OS of patients with GR+ CTCs treated with ARSi was significantly worse than that of patients without detectable GR+ CTCs (11.4 mo. vs NA, p < 0.01), an effect independent and additive to the presence of viable CTCs, a previously described prognostic biomarker (see Table). Conclusions: GR protein upregulation in CTCs can be detected in a significant percentage of pts with progressing mCRPC and the presence of GR+ CTCs predicts worse OS in response to ARSi. The data supports previously reported pre-clinical data proposing a pathogenic role for GR in mediating resistance to ARSi therapy. Detection of GR in patient CTCs may be a useful predictive biomarker to guide GR-directed therapies. [Table: see text]

scholarly journals Antibiotics modulate neoadjuvant therapy efficiency in patients with breast cancer: a pilot analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xi Zhang ◽  
Long Yu ◽  
Jiajie Shi ◽  
Sainan Li ◽  
Shiwei Yang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Therapy ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Antibiotic Administration ◽  
Hazards Model ◽  
Kaplan Meier ◽  
The Impact

AbstractMounting evidence suggests that microbiota dysbiosis caused by antibiotic administration is a risk factor for cancer, but few research reports focus on the relationships between antibiotics and chemotherapy efficiency. We evaluated the influence of antibiotic administration on neoadjuvant therapy efficacy in patients with breast cancer (BC) in the present study. BC patients were stratified into two groups: antibiotic-treated and control based on antibiotic administration within 30 days after neoadjuvant therapy initiation. Disease-free survival (DFS) and overall survival (OS) were assessed using the Kaplan–Meier method, and the Cox proportional hazards model was used for multivariate analyses. The pathologic complete response rate of the control group was significantly higher than that of the antibiotic-treated group (29.09% vs. 10.20%, p = 0.017). Further univariate analysis with Kaplan–Meier calculations demonstrated that antibiotic administration was strongly linked with both reduced DFS (p = 0.04) at significant statistical levels and OS (p = 0.088) at borderline statistical levels. Antibiotic administration was identified as a significant independent prognostic factor for DFS [hazard ratio (HR) 3.026, 95%, confidence interval (CI) 1.314–6.969, p = 0.009] and OS (HR 2.836, 95% CI 1.016–7.858, p = 0.047) by Cox proportional hazards model analysis. Antibiotics that initiated reduced efficiency of chemotherapy were more noticeable in the HER2-positive subgroup for both DFS (HR 5.51, 95% CI 1.77–17.2, p = 0.003) and OS (HR 7.0395% CI 1.94–25.53, p = 0.003), as well as in the T3-4 subgroup for both DFS (HR 20.36, 95% CI 2.41–172.07, p = 0.006) and OS (HR 13.45, 95% CI 1.39–130.08, p = 0.025) by stratified analysis. Antibiotic administration might be associated with reduced efficacy of neoadjuvant therapy and poor prognosis in BC patients. As a preliminary study, our research made preparations for further understanding and large-scale analyses of the impact of antibiotics on the efficacy of neoadjuvant therapy.

scholarly journals Cytoreductive nephrectomy in the modern era: Predictors of use, morbidity, and survival

2017 ◽  
Vol 11 (5) ◽  
pp. 184 ◽  
Author(s):  
Brian J. Minnillo ◽  
William Tabayoyong ◽  
John J. Francis ◽  
Matthew J. Maurice ◽  
Hui Zhu ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Private Insurance ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Cytoreductive Nephrectomy ◽  
Surgical Morbidity ◽  
Hazards Model ◽  
Modern Era

Introduction: To determine tumour, patient, and provider factors associated with cytoreductive nephrectomy (CN) use and to identify those factors that predicted short-term and long-term surgical outcomes.Methods: We performed a retrospective review (1998‒2011) of the National Cancer Database, a U.S. population-based oncology outcomes database. The review included 36 549 patients with metastatic renal cell carcinoma (mRCC). We assessed predictors of CN use, length of stay (LOS), 30-day readmission, and 30-day mortality using multivariable logistic regression. The Cox proportional hazards model assessed predictors of overall survival (OS).Results: Overall, 10 809 (29.6%) patients received CN, increasing from 15.2% to 36.1% over time. Private insurance (odds ratio [OR] 1.26; 95% confidence interval [CI] 1.16‒1.37) and academic facilities (OR 1.83; 95% CI 1.68‒1.99) were associated with receiving CN (p<0.0001). Charlson score ≥2 and older age group were less likely to undergo surgery (p<0.0001). Median LOS was five days (interquartile range [IQR] 3‒7), while 30-day readmission and 30-day mortality were 5.3% and 3.3%, respectively. Undergoing CN (hazard ratio [HR] 0.48; 95% CI 0.44‒0.52; p<0.0001) and treatment at academic centres (HR 0.88; 95% CI 0.81‒0.95; p=0.001) were independently associated with improved OS. Limitation includes retrospective design with possible selection bias.Conclusions: Increased CN use continues in the modern era, with relatively low surgical morbidity. Further study is required to determine if the finding of lower all-cause mortality in patients treated at academic centres is due to improved care or unmeasured confounders.

scholarly journals Exploring the Dynamics of Triglyceride With Stroke Onset in the Chinese Population Through Parameterized Joint Models

2021 ◽  
Author(s):  
Qian Mao ◽  
Wenfeng Gao ◽  
Liping Yang ◽  
Qian Zhao ◽  
Yujie Liu ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Stroke Onset ◽  
Shanxi Province ◽  
Joint Models ◽  
Dynamic Changes ◽  
Hazards Model ◽  
The Impact

Abstract Background: Stroke has become one of the diseases with the highest mortality and disability rates in the world, especially in low-income and developing countries. Our objective was to discuss the relationship between the longitudinal dynamic changes of TG and stroke onset in healthy population by constructing different parametric joint models.Methods: 298 participants aged 23 to 69 in Xijing hospital of Xi’an City in Shanxi Province from 2008 to 2015 were included. The Cox proportional hazards model was performed to analyze the correlation between TG and stroke incidence at baseline. Different parameterized joint models were used to analyze the impact of dynamic changes of TG on the incidence of stroke under longitudinal data.Results: Of the 298 participants, a total of 70 (23.49%) subjects developed stroke during the study period. Cox proportional hazards model showed that the risk of disease increased by 1.056 times (95%CI=0.920-0.975) for each 1 unit of baseline age decrease. Each 1 mmol/L increase in sqrt(TG) increased the risk by 1.816 times (95%CI=1.017-3.245). Joint model showed that the risk of sqrt (TG) increased by 4.869 times (95%CI=3.987-8.857) for each 1 mmol/L increase in longitudinal direction.The lagged effects (HR=5.284, 95%CI=4.397-9.680) and cumulative effects (HR=1.786, 95%CI=1.613-3.399) of sqrt (TG) dynamic trajectory were also statistically related to the incidence of stroke.Conclusions: Over time, the longitudinal growth of TG levels in individuals will increase the risk of stroke even more. People should pay more attention to the dynamic changes of individual TG value, as well as the lagged effect and cumulative effect, to reduce the incidence of stroke.

scholarly journals 466 PREVALENCE AND IMPACT OF FRAILTY IN PATIENTS HOSPITALISED WITH COVID-19. THE SALFORD EXPERIENCE IN WAVES 1 AND 2

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii14-ii18
Author(s):  
A Khan ◽  
F R Espinoza ◽  
T Kneen ◽  
A Dafnis ◽  
H Allafi ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Proportional Hazards ◽  
Hospital Admissions ◽  
Proportional Hazards Model ◽  
Patient Characteristics ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Clinical Frailty Scale ◽  
Patient Demographics ◽  
Hazards Model

Abstract Introduction The COVID-19 pandemic has had an extensive impact on the frail older population, with significant rates of COVID-related hospital admissions and deaths amongst this vulnerable group. There is little evidence comparing the prevalence and impact of frailty amongst patients hospitalised with COVID-19 in wave 1 vs wave 2 of the pandemic. Methods Prospective observational study of all consecutive patients admitted to Salford Royal NHS Foundation Trust (SRFT) between 27th February and 28th of April 2020 (wave 1), and 1st October to 10th November 2020 (wave 2) with a diagnosis of COVID-19. The primary endpoint was in-hospital mortality. Patient demographics, co-morbidities, biochemical parameters, and frailty (using the Clinical Frailty Scale, score 1–4 = not frail, score 5–9 = frail) were collected. A Cox proportional hazards model associating wave and frailty with mortality was used. A logistic regression model was used to associate patient characteristics with wave. Both models adjusted for patient characteristics. Results A total of 700 patients were included (N = 429, wave 1; N = 271, wave 2). In wave 1, 42% (N = 180) were female; median age was 72; 37% (N = 160) were non-survivors, 49% (N = 212) were frail (CFS 5–9). In wave 2, 38% (N = 104) were female; median age was 73; 30% (N = 80) were non-survivors, 39% (N = 106) were frail. There was a reduction in mortality in wave 2, aHR = 0.71 (95% CI 0.53–0.94). Frailty was associated with increased mortality, after adjustment for age, wave and other patient characteristics. Patients were more frail in wave 1, and the effect of frailty was more pronounced in wave 1 vs wave 2. Conclusion Frailty is highly prevalent amongst patients of all ages admitted to SRFT with COVID-19. Higher scores of frailty are associated with increased mortality.

scholarly journals A Longitudinal Analysis of Naturalization and International Migration in Switzerland, 2011–2017

2021 ◽  
Author(s):  
Juan Galeano ◽  
Aurélie Pont ◽  
Philippe Wanner
Keyword(s):  
International Migration ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
International Mobility ◽  
Mobility Factor ◽  
Hazards Model ◽  
Rich Data ◽  
The Impact

AbstractThe notion of residential settlement associated with the acquisition of new citizenship has been recently challenged by a number of studies highlighting its instrumentality as a subsequent mobility factor. The long and diverse history of Switzerland as a country of immigration and the availability of rich data on naturalization and international migration that allow individuals to be followed over time make this country a valuable case for investigating the impact of naturalization on international (return or onward) migration. Using longitudinal data, we follow 88,900 immigrants who entered the country between 1998 and 2000 over a period of 84 months between January 2011 and December 2017, documenting changes in naturalization status and in migratory movements and their direction. Using different implementations of a Cox proportional hazards model, we examine whether and under what conditions the international migration behaviour of naturalized persons differs from that of non-naturalized persons. Our results show that the population accessing naturalization tends to be less mobile, but also that among third-country nationals, naturalization can trigger further international mobility, in particular among those with poor economic performance and with no family ties in Switzerland.

scholarly journals Impact of Prior Cancer History on Outcomes in Thymoma

2020 ◽  
Author(s):  
Shilong Wu ◽  
Mengyang Liu ◽  
Weixue Cui ◽  
Guilin Peng ◽  
Jianxing He
Keyword(s):  
Overall Survival ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Cancer History ◽  
Treatment Methods ◽  
Hazards Model ◽  
Kaplan Meier ◽  
The Impact

Abstract Background: Thymoma is an uncommon intrathoracic malignant tumor and has a long natural history. It is uncertain whether the survival of thymoma patient is affected by prior cancer history. Finding out the impact of a prior cancer history on thymoma survival has important implications for both decision making and research.Method: The Surveillance, Epidemiology, and End Results (SEER) database was queried for thymoma patients diagnosed between 1975 and 2015. Kaplan-Meier methods and Cox proportional hazards model were used to analyze overall survival across a variety of stages, age, and treatment methods with a prior cancer history or not.Results: A total of 3604 patients with thymoma were identified including 507 (14.1%) with a prior cancer history. The 10-year survival rate of patients with a prior cancer history (53.8%) was worse than those without a prior cancer history (40.32%, 95%CI 35.24-45.33, P < 0.0001). However,adjusted analyses showed that the impact of a prior cancer history was heterogenous across age and treatment methods. In subset analyses, prior cancer history was associated with worse survival among patients who were treated with chemoradiotherapy (HR: 2.80, 95% CI: 1.51-5.20, P = 0.001) and age ≤ 65 years (HR: 1.33, 95%CI: 1.02-1.73, P = 0.036).Conclusions: Prior cancer history provides an inferior overall survival for patients with thymoma. But it does not worsen the survival in some subgroups and these thymoma patients should not be excluded from clinical trials.

scholarly journals Effect of multiple episodes of acute kidney injury on mortality: an observational study

2020 ◽  
Author(s):  
Heather Walker ◽  
Nicosha De Souza ◽  
Simona Hapca ◽  
Miles D Witham ◽  
Samira Bell
Keyword(s):  
Acute Kidney Injury ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Kidney Injury ◽  
Patient Characteristics ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Cox Proportional Hazards Model ◽  
Hazards Model ◽  
Increased Risk

Abstract Background Patients who survive an episode of acute kidney injury (AKI) are more likely to have further episodes of AKI. AKI is associated with increased mortality, with a further increase with recurrent episodes. It is not clear whether this is due to AKI or as a result of other patient characteristics. The aim of this study was to establish whether recurrence of AKI is an independent risk factor for mortality or if excess mortality is explained by other factors. Methods This observational cohort study included adult people from the Tayside region of Scotland, with an episode of AKI between 1 January 2009 and 31 December 2009. AKI was defined using the creatinine-based Kidney Disease: Improving Global Outcomes definition. Associations between recurrent AKI and mortality were examined using a Cox proportional hazards model. Results Survival was worse in the group identified to have recurrent AKI compared with those with a single episode of AKI [hazard ratio = 1.49, 95% confidence interval (CI) 1.37–1.63; P &lt; 0.001]. After adjustment for comorbidities, stage of reference AKI, sex, age, medicines that predispose to renal impairment or, in the 3 months prior to the reference AKI, deprivation and baseline estimated glomerular filtration rate (eGFR), recurrent AKI was independently associated with an increase in mortality (hazard ratio = 1.25, 95% CI 1.14–1.37; P &lt; 0.001). Increasing stage of reference AKI, age, deprivation, baseline eGFR, male sex, previous myocardial infarction, cerebrovascular disease and diuretic use were all associated with an increased risk of mortality in patients with recurrent AKI. Conclusions Recurrent AKI is associated with increased mortality. After adjusting for patient characteristics, the increase in mortality is independently associated with recurrent AKI and is not solely explained by other risk factors.

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