scholarly journals Antifibrillarin Antibodies Are Associated with Native North American Ethnicity and Poorer Survival in Systemic Sclerosis

2017 ◽  
Vol 44 (6) ◽  
pp. 799-805 ◽  
Author(s):  
Carolina Mejia Otero ◽  
Shervin Assassi ◽  
Marie Hudson ◽  
Maureen D. Mayes ◽  
Rosa Estrada-Y-Martin ◽  
...  
Keyword(s):  
Native American ◽  
Systemic Sclerosis ◽  
North American ◽  
Cox Regression ◽  
Bacterial Overgrowth ◽  
Demographic Factors ◽  
The United States ◽  
Cox Regression Analysis ◽  
Native North American ◽  
American Ethnicity

Objective.To examine the clinical correlates and survival in patients with antifibrillarin antibodies (AFA) in a large international study population consisting of well-characterized systemic sclerosis (SSc) cohorts from Canada, Australia, and the United States.Methods.Baseline clinical data from the prospective cohorts (Canadian Scleroderma Research Group, the Australian Scleroderma Cohort Study, and the American Genetics versus Environment in Scleroderma Outcome Study) were investigated. Clinical variables were harmonized and sera were tested for AFA using a commercially available SSc profile line immunoassay, regardless of the immunofluorescence staining pattern. Association of demographic and clinical features with AFA was investigated by logistic or linear regression. Further, a survival analysis was performed by Cox regression analysis.Results.A total of 1506 patients with SSc with complete serological profiles were included in the study. Fifty-two patients (3.5%) had antibodies detected against fibrillarin. Patients of African descent and Native North American ethnicity were more likely to be AFA-positive compared with other ethnicities. After adjustment for demographic factors, diffuse involvement, and intestinal bacterial overgrowth requiring antibiotics, gastrointestinal reflux disease showed a trend for association with AFA. Further, AFA positivity was associated with shorter survival independently of demographic factors and disease type (HR 1.76, 95% CI 1.11–2.79, p = 0.016).Conclusion.In this large multinational SSc cohort, AFA was associated with Native American ethnicity and was an independent predictor of mortality.

scholarly journals Analysis of treatment adherence and cost among patients with epilepsy: a four‐year retrospective cohort study in Pakistan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Muhammad Arif Asghar ◽  
Ahad Abdul Rehman ◽  
Muhammad Liaquat Raza ◽  
Yousra Shafiq ◽  
Muhammad Asif Asghar
Keyword(s):  
Associated Factors ◽  
Cox Regression ◽  
Tertiary Care ◽  
The United States ◽  
Initial Therapy ◽  
Study Cohort ◽  
Entire Study ◽  
Cox Regression Analysis ◽  
Recommended Treatment ◽  
Patients With Epilepsy

Abstract Background The adherence pattern of antiepileptic drugs (AEDs) among patients with epilepsy is relatively lower in the United States and different European countries. However, adherence and cost analysis of AEDs in Asian countries have not been thoroughly studied. Therefore, the present study aimed to analyze the cost and adherence of AEDs and its associated factors in patients followed in Pakistan. Methods Data from prescriptions collected from patients with epilepsy who have visited the Outpatient Department (OPD) of different tertiary care hospitals at the cosmopolitan city of Karachi, Pakistan from December 2015 to November 2019. The mean follow-up period for each participant was about 22 months. Pairwise comparisons from Cox regression/hazard ratios were used to assess the predictors of adherence. Direct costs of AEDs were calculated and presented as the annual cost of drugs. Results A total of 11,490 patients were included in this study, 51.2 % were male and 48.8 % were female with a mean age of 45.2 ± 15.8 y. Levetiracetam was found as the most prescribing AED in all study participants (32.9 %). Of them, 49.1 % of patients continued their initial recommended treatment. However, 31.3 % of patients have discontinued the therapy, while, 19.6 % were switched to other AED. Adherence with initial treatment was more profound in male (57.4 %) patients, compared to female with a mean age of 44.2 years. Lamotrigine users (60.6 %) showed a higher tendency to retain on initially prescribed drugs. The total cost of epilepsy treatment in the entire study cohort was 153280.5 PKR ($941.9). By applying the Cox regression analysis, it can be observed that the patients with increasing age (OR, 2.04), migraine (OR, 2.21), psychiatric disorders (OR, 4.28), other comorbidities (OR, 1.52) and users of other than top five prescribing AEDs (2.35) were at higher risk of treatment discontinuation. However, levetiracetam (OR, 0.69), valproic acid (OR, 0.52), carbamazepine (OR, 0.81), lamotrigine (OR, 0.80) or lacosamide (OR, 0.65) users have more chances to continue their initial therapy. Conclusions Similar to western countries, the majority of patients with epilepsy exhibited low adherence with AEDs. Various associated factors for improving adherence were identified in this study.

scholarly journals Frequent Cannabis Use and Cessation of Injection of Opioids, Vancouver, Canada, 2005–2018

2020 ◽  
Vol 110 (10) ◽  
pp. 1553-1560 ◽  
Author(s):  
Hudson Reddon ◽  
Kora DeBeck ◽  
M. Eugenia Socias ◽  
Stephanie Lake ◽  
Huiru Dong ◽  
...  
Keyword(s):  
Hazard Rate ◽  
People Who Inject Drugs ◽  
Cox Regression ◽  
The United States ◽  
Cannabis Use ◽  
Opioid Overdose ◽  
Cox Regression Analysis ◽  
Prospective Cohorts ◽  
Injection Cessation ◽  
The Impact

Objectives. To evaluate the impact of frequent cannabis use on injection cessation and injection relapse among people who inject drugs (PWID). Methods. Three prospective cohorts of PWID from Vancouver, Canada, provided the data for these analyses. We used extended Cox regression analysis with time-updated covariates to analyze the association between cannabis use and injection cessation and injection relapse. Results. Between 2005 and 2018, at-least-daily cannabis use was associated with swifter rates of injection cessation (adjusted hazard ratio [AHR] = 1.16; 95% confidence interval [CI] = 1.03, 1.30). A subanalysis revealed that this association was only significant for opioid injection cessation (AHR = 1.26; 95% CI = 1.12, 1.41). At-least-daily cannabis use was not significantly associated with injection relapse (AHR = 1.08; 95% CI = 0.95, 1.23). Conclusions. We observed that at-least-daily cannabis use was associated with a 16% increase in the hazard rate of injection cessation, and this effect was restricted to the cessation of injection opioids. This finding is encouraging given the uncertainty surrounding the impact of cannabis policies on PWID during the ongoing opioid overdose crisis in many settings in the United States and Canada.

Native American Ethnicity: a View from the British Museum1

2000 ◽  
Vol 73 (182) ◽  
pp. 221-238
Author(s):  
J. C. H. King
Keyword(s):  
United States ◽  
Native American ◽  
Native Americans ◽  
North America ◽  
American Indians ◽  
Historical Context ◽  
The United States ◽  
Native Identity ◽  
Native North America ◽  
American Ethnicity

Abstract Identity in Native North America is defined by legal, racial, linguistic and ethnic traits. This article looks at the nomenclature of both Indian, Eskimo and Native, and then places them in a historical context, in Canada and the United States. It is argued that ideas about Native Americans derive from medieval concepts, and that these ideas both constrain Native identity and ensure the survival of American Indians despite accelerating loss of language.

Evolution of clinical outcomes of metastatic pancreatic adenocarcinoma: A 10-year single-institution retrospective study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16760-e16760
Author(s):  
Moataz Ellithi ◽  
Mohamed A. Abdallah ◽  
Mahum Shahid ◽  
Isaak Ailts ◽  
Kate Waligoske ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Clinical Outcomes ◽  
Pancreatic Adenocarcinoma ◽  
Cox Regression ◽  
The United States ◽  
Wilcoxon Test ◽  
Cox Regression Analysis ◽  
Metastatic Pancreatic Adenocarcinoma ◽  
Significant Difference ◽  
Before And After

e16760 Background: Pancreatic adenocarcinoma represents the fourth leading cause of cancer-related death in the United States. A majority of patients have locally advanced or metastatic disease at the time of diagnosis. For many years, gemcitabine monotherapy was the standard of care for advanced disease, until recent studies demonstrated survival benefits for FOLFIRINOX (5-FU, leucovorin, irinotecan, and oxaliplatin) and Gem/nab-P (gemcitabine/nab-paclitaxel). In this study, we evaluated the clinical outcomes in patients with metastatic pancreatic adenocarcinoma in a single health system before and after the incorporation of these newer treatments into practice. Methods: A retrospective study of metastatic pancreatic adenocarcinoma patients diagnosed between January 2009 to December 2018 with follow up until December 2019. Overall survival (OS) and progression-free survival (PFS) were calculated using Kaplan-Meier survival analysis. Univariate and multivariable Cox regression analyses were used to explore predictors of survival. Results: 394 patients were diagnosed with metastatic pancreatic adenocarcinoma at Sanford Health hospitals during the study period. There was no statistically significant difference in OS between the cohort diagnosed between 2009-2013 compared to 2014-2018, with median OS of 4.7 and 3.6 months respectively; in those receiving at least one line of chemotherapy, the median OS was 6.7 and 7.3 months. While subgroup analysis of all study population based on the type of first-line chemotherapy showed improved survival with FOLFIRINOX and Gem/nabP as compared to gemcitabine monotherapy [10.7, 6.9, 4 months respectively] (Wilcoxon Test of Homogeneity of Survival Curves p = 0.0002). Univariate and multivariate Cox regression analysis of all study data revealed that at the time of the diagnosis, age (HR: 1.021, p = 0.0013), ECOG performance status > 1 (HR: 3.47, p = 0.0001), serum albumin (HR: 0.708, p = 0.0002), Neutrophil-to-Lymphocytes ratio (HR: 1.076, p≤0.0001) and platelets-to-lymphocyte ratio (HR: 0.998, p = 0.0031) were predictors of survival. Conclusions: Although newer treatments appear to offer improved survival for eligible patients, overall outcomes for metastatic pancreatic adenocarcinoma in this cohort were similar before and after the incorporation of newer treatment regimens. Further advances in the treatment and early detection of pancreatic cancer are needed to improve clinical outcomes.

Systemic therapy for advanced appendiceal adenocarcinoma: An analysis from the National Comprehensive Cancer Network (NCCN) database.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 562-562
Author(s):  
Mohamedtaki Abdulaziz Tejani ◽  
Anna ter Veer ◽  
Dana Milne ◽  
Rebecca Ottsesen ◽  
Tanios S. Bekaii-Saab ◽  
...  
Keyword(s):  
Systemic Therapy ◽  
Cox Regression ◽  
Single Agent ◽  
The United States ◽  
High Grade ◽  
Debulking Surgery ◽  
Cox Models ◽  
Cox Regression Analysis ◽  
Mucinous Histology ◽  
Appendiceal Adenocarcinoma

562 Background: Appendiceal neoplasms are rare and represent 1% of intestinal tumors in the United States. The role and efficacy of modern systemic therapy in advanced appendiceal adenocarcinoma has not been established. Methods: Patients with recurrent or metastatic appendiceal adenocarcinoma in the NCCN Colorectal Database (2005-2010) were analyzed. Study objectives were to describe and evaluate the efficacy of systemic therapy and investigate relationships with clinicopathologic features. Cox regression analysis was performed to identify predictors of PFS and OS. The hazard ratio and 95% CI from Cox models and median PFS and OS from Kaplan-Meier curves were reported. Results: Of 177 patients with advanced appendiceal carcinoma, 81 (46%) received systemic therapy for measurable disease and are the focus of this report (patients undergoing IP chemotherapy excluded). Patient/tumor characteristics: median age 50 (range 20-82), ECOG PS 0/1 (67%/22%), mucinous/non-mucinous (44 %/ 51%), 91% peritoneal and 15% liver metastases. 70% of patients had primary surgical debulking. Common chemotherapy regimens included FOLFOX with or without bevacizumab (n=30 and n=28), FOLFIRI (n=11), and single-agent fluoropyrimidine (n=7). Among 70 patients with a recorded best response, the response rate (RR) was 46% with 31% stable disease. Median PFS was 1.0 year (95% CI: 0.7-1.9) and OS was 2.1 years (95% CI: 1.7-2.6). Patients with non-mucinous histology, high grade tumors and non-debulking surgery had worse PFS and OS (Table). Conclusions: Treatment of advanced appendiceal adenocarcinoma at NCCN centers commonly incorporates agents utilized for colorectal cancer. RR, PFS and OS are comparable to those achieved in the treatment of metastatic CRC and support routine use of these regimens in clinical practice. Poor prognostic factors include non-mucinous histology, high grade and not undergoing debulking surgery. [Table: see text]

Natural history of T1N0M0 hepatocellular carcinoma: Large scale study in the United States.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 416-416
Author(s):  
Humaid Obaid Al-Shamsi ◽  
Reham Abdel-Wahab ◽  
Manal Hassan ◽  
Gehan Botrus ◽  
Ahmed S Shalaby ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Systemic Therapy ◽  
Cox Regression ◽  
Univariate Analysis ◽  
The United States ◽  
Categorical Variables ◽  
Cancer Center ◽  
Female Ratio ◽  
Cox Regression Analysis ◽  
Hepatic Reserve

416 Background: Prognostic modeling of hepatocellular carcinoma (HCC) is complex due to preexisting cirrhosis in most cases. Tumor features and factors related to functional hepatic reserve must be taken into account when considering treatment options or counseling patients about their survival. The key prognostic factors may vary at different stages of the disease especially for early stage. Methods: From 1992 to 2011 total of 397 HCC patients with T1N0M0 were referred to MD Anderson Cancer Center for treatment. Detailed clinical-pathologic information were retrieved from medical records. Univariate analysis was done using the c2or Fisher’s exact test for categorical variables. Kaplan-Meier used to estimate the median overall survival (OS). Multivariate cox regression analysis was performed to estimate the hazard ratio (HR) and 95% confidence interval (CI). Results: The male to female ratio was3:1. The mean age ± standard deviation was 65.04 ± 12.5, 57.2% were non-viral related, 59.7% had cirrhosis, and 9.3% had poorly differentiated tumor (PDT). Median OS (95% CI) was 28.5 months (23.6 – 33.4). First line therapy is summarized in table 1. Surgical intervention was similar to systemic therapy with 76% reduction in mortality compared to non-treated group. Restricted analysis among cirrhotic patients showed similar results. PDT was associated with significant poor prognosis compared to well-differentiated tumor, HR (95% CI) was 2.42 (1.36-4.28) after adjustment for demographic, epidemiological, and clinical factors. Conclusions: Our results indicate that T1N0M0 HCC patients have similar outcome with systemic therapy and surgery which could be beneficial for patients with underlying cirrhosis and high risk of postsurgical complications. [Table: see text]

Utilization of adjuvant chemotherapy in “ideal candidates” with stage III colon cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 4103-4103
Author(s):  
Mohsin Soleja ◽  
Suleyman Yasin Goksu ◽  
Nina Niu Sanford ◽  
Muhammad Shaalan Beg ◽  
Radhika Kainthla ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Socioeconomic Factors ◽  
Cox Regression ◽  
The United States ◽  
Stage Iii ◽  
Categorical Variables ◽  
Cox Regression Analysis ◽  
Factors Associated ◽  
Stage Iii Colon Cancer

4103 Background: Prior studies have observed under-utilization of adjuvant chemotherapy (ACT) in stage III colon cancer. Our aims were to observe the rate of utilization of ACT in very healthy or “ideal candidates”, identify reasons for omission and socioeconomic factors associated with ACT use, and observe patient outcomes. Methods: We queried patients from the National Cancer Database (NCDB) with stage III colon cancer, age<65, and Charlson-Deyo score of 0 who underwent resection in the United States between 2004-2015. Patients who received ACT were compared to patients who had surgery only (SO). We used chi-square test for categorical variables, Kaplan-Meier and Cox regression method for survival analyses. Results: Out of 243,388 stage III colon cancer patients during the study time, a total of 49,046 patients met the specific criteria of “ideal candidate”. Out of these, 88.5% received ACT and 11.5% underwent SO. The primary reason for chemotherapy omission was: no reason given (54.2%), patient/guardian refusal (26.7%), physician recommended against (9.3%), patient died (3%), unknown (6.7%). Patients who received ACT were more likely to be female, non-Hispanic white, have a higher level of education, travel shorter distance for cancer treatment, have private insurance or higher income as compared to counterpart ( all p<.001). Patients who received ACT had significantly better overall survival (5-year survival rate 74% vs. 54%, p<.001). This persisted after multivariable Cox regression analysis [HR:0.48 (CI:0.45-0.50), p<.001]. Conclusions: We observed a high rate of utilization (88.5%) of ACT in patients with stage III colon cancer who were under age 65 and without comorbidities. However, the omission of chemotherapy in this population remains a problem, partially due to patient refusal. Socioeconomic factors associated with lower utilization were primarily related to insurance status (private vs non-private). Patients who received ACT had significantly improved survival as compared to SO group. [Table: see text]

Abstract 18229: Heart Transplantation for Genetic Cardiomyopathies is Associated With Favorable Long-Term Survival and Graft Outcomes

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ziad Taimeh ◽  
Kairav Vakil ◽  
Cindy Martin ◽  
Renuka Jain ◽  
Monica Colvin
Keyword(s):  
Heart Transplantation ◽  
Graft Failure ◽  
Cox Regression ◽  
Survival Rates ◽  
The United States ◽  
Left Ventricular ◽  
Term Survival ◽  
Cox Regression Analysis ◽  
Transplant Survival ◽  
Post Transplant

Introduction and hypothesis: Genetic cardiomyopathies (GNCM) are a spectrum of myocardial disorders that can lead to heart failure, and frequently portend the need for heart transplantation. Post-transplant outcomes in this subgroup of patients have not been examined in a large, multicenter transplant cohort. Methods: Patients who underwent first-time heart transplantation in the United States between 1987 and 2012 were retrospectively identified from the United Network for Organ Sharing database. Patients with hypertrophic cardiomyopathy (HOCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), and left ventricular non-compaction (LVNC) constituted the GNCM group. Primary outcome was survival. Secondary outcomes included rejection, cardiac allograft vasculopathy (CAV), and graft failure. Results: Of the 49,417 transplant recipients identified, 997 recipients (mean age 36±20 years; 55% males; 79% Caucasian) had GNCM (HOCM n=836; ARVC n=83; LVNC n=78). Patients transplanted for GNCM had significantly higher 1, 5 and 10 year survival rates compared to those without GNCM (86%, 76%, 66% vs. 82%, 69%, 50%, respectively, log-rank p<0.001) (Figure 1A). After adjusting for age, sex, and race in multivariate Cox regression analysis; GNCM was associated with favorable post-transplant survival, with a hazard ratio of 0.70 (95% confidence interval 0.58-0.86; p=0.001). While the incidence of rejection was similar in GNCM compared to non-GNCM (43% vs. 40%, p=0.11), the incidences of CAV and graft failure were significantly lower compared to non-GNCM (24% vs 32%, p<0.001, and 9% vs 15%, p<0.001, respectively). The survival rates for HOCM, ARVC, and LVNC, were all similar to each other but significantly higher compared to non-GNCM (log-rank p<0.001) (Figure 1B). Conclusions: Patients with GNCM seem to have better post-transplant survival and graft outcomes than patients transplanted for other cardiomyopathies.

scholarly journals Cosmology and Native North American Mystical Traditions

Théologiques ◽  
2002 ◽  
Vol 9 (1) ◽  
pp. 113-142
Author(s):  
John A. Grim
Keyword(s):  
Native American ◽  
North America ◽  
Comparative Study ◽  
North American ◽  
Human Condition ◽  
Native Communities ◽  
Native North American ◽  
Indigenous Nations ◽  
First Peoples ◽  
Dynamic Performances

ABSTRACT Different indigenous nations in North America provide examples of mystical participation in the processes of creation. Some observers dismiss native communities as fragmented or romantically reimaged as "ecological Indians", yet, the tenacity of their religious insights deserve attention. Intellectually framed in images of interactions between specific peoples with particular geographical places, these images are also embedded in dynamic performances. This paper presents a comparative study of mystical paths among First Peoples in which personal and communal symbols fuse psychic, somatic, and social energies with local landscapes. Experienced as synesthetic intuitions, these images are made more conscious in rituals. These dynamic performances link words, actions, sounds, sights, and sensory observations. Ritualized expressions of native mystical life are themselves interpretive reflections back upon the personal, communal, spiritual, and ecological realms from which they emerge. Native American religious ways, thus, are lifeway complexes that address the limits and problems of the human condition, and foster mature mystical understanding.

Language Shift and Local Choice: On Practicing Linguistics in the 21st Century

1999 ◽  
Vol 21 (2) ◽  
pp. 23-27 ◽  
Author(s):  
Patricia Kwatchka
Keyword(s):  
Native American ◽  
21St Century ◽  
North American ◽  
Language Shift ◽  
Endangered Languages ◽  
Working Relationship ◽  
Native North American ◽  
Community Issues

Concern for endangered languages draws together two communities who have long been associated with each other, Native North American groups and linguists. The desire to maintain these languages, however, creates the need for a new working relationship between the two communities. This discussion formulates, first, some of the issues internal to Native American communities in their efforts to perpetuate their languages, and secondly, some of the steps that we, as linguists, can take to make our profession more responsive to these community issues.

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