Search results for: survival data analysis

Authors: Padma Chutoo, Elena Kulinskaya, Ilyas Bakbergenuly, Nicholas Steel, Dmitri Pchejetski

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Stroke is associated with a significant risk of morbidity and mortality. There is scarcity of research on the long-term survival after first-ever ischaemic stroke (IS) events in England with regards to effects of different medical therapies and comorbidities. The objective of this study was to model the all-cause mortality after an IS diagnosis in the adult population of England. Using a retrospective case-control design, we extracted the electronic medical records of patients born prior to or in year 1960 in England with a first-ever ischaemic stroke diagnosis from January 1986 to January 2017 within the Health and Improvement Network (THIN) database. Participants with a history of ischaemic stroke were matched to 3 controls by sex and age at diagnosis and general practice. The primary outcome was the all-cause mortality. The hazards of the all-cause mortality were estimated using a Weibull-Cox survival model which included both scale and shape effects and a shared random effect of general practice. The model included sex, birth cohort, socio-economic status, comorbidities and medical therapies. 20,250 patients with a history of IS (cases) and 55,519 controls were followed up to 30 years. From 2008 to 2015, the one-year all-cause mortality for the IS patients declined with an absolute change of -0.5%. Preventive treatments to cases increased considerably over time. These included prescriptions of statins and antihypertensives. However, prescriptions for antiplatelet drugs decreased in the routine general practice since 2010. The survival model revealed a survival benefit of antiplatelet treatment to stroke survivors with hazard ratio (HR) of 0.92 (0.90 – 0.94). IS diagnosis had significant interactions with gender and age at entry and hypertension diagnosis. IS diagnosis was associated with high risk of all-cause mortality with HR= 3.39 (3.05-3.72) for cases compared to controls. Hypertension was associated with poor survival with HR = 4.79 (4.49 - 5.09) for hypertensive cases relative to non-hypertensive controls, though the detrimental effect of hypertension has not reached significance for hypertensive controls, HR = 1.19(0.82-1.56). This study of English primary care data showed that between 2008 and 2015, the rates of prescriptions of stroke preventive treatments increased, and a short-term all-cause mortality after IS stroke declined. However, stroke resulted in poor long-term survival. Hypertension, a modifiable risk factor, was found to be associated with poor survival outcomes in IS patients. Antiplatelet drugs were found to be protective to survival. Better efforts are required to reduce the burden of stroke through health service development and primary prevention.

Keywords: general practice, hazard ratio, health improvement network (THIN), ischaemic stroke, multiple imputation, Weibull-Cox model.

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Authors: Danni Cheng

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Background: Preclinical and epidemiological studies have reported potential protective effects of low-density lipoprotein cholesterol (LDL-C) lowering drugs on head and neck squamous cell cancer (HNSCC) survival, but the causality was not consistent. Genetic variants associated with LDL-C lowering drug targets can predict the effects of their therapeutic inhibition on disease outcomes. Objective: We aimed to evaluate the causal association of genetically proxied cholesterol-lowering drug targets and circulating lipid traits with cancer survival in HNSCC patients stratified by human papillomavirus (HPV) status using two-sample Mendelian randomization (MR) analyses. Method: Single-nucleotide polymorphisms (SNPs) in gene region of LDL-C lowering drug targets (HMGCR, NPC1L1, CETP, PCSK9, and LDLR) associated with LDL-C levels in genome-wide association study (GWAS) from the Global Lipids Genetics Consortium (GLGC) were used to proxy LDL-C lowering drug action. SNPs proxy circulating lipids (LDL-C, HDL-C, total cholesterol, triglycerides, apoprotein A and apoprotein B) were also derived from the GLGC data. Genetic associations of these SNPs and cancer survivals were derived from 1,120 HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) and 2,570 non-HPV-driven HNSCC patients in VOYAGER program. We estimated the causal associations of LDL-C lowering drugs and circulating lipids with HNSCC survival using the inverse-variance weighted method. Results: Genetically proxied HMGCR inhibition was significantly associated with worse overall survival (OS) in non-HPV-drive HNSCC patients (inverse variance-weighted hazard ratio (HR IVW), 2.64[95%CI,1.28-5.43]; P = 0.01) but better OS in HPV-positive OPSCC patients (HR IVW,0.11[95%CI,0.02-0.56]; P = 0.01). Estimates for NPC1L1 were strongly associated with worse OS in both total HNSCC (HR IVW,4.17[95%CI,1.06-16.36]; P = 0.04) and non-HPV-driven HNSCC patients (HR IVW,7.33[95%CI,1.63-32.97]; P = 0.01). A similar result was found that genetically proxied PSCK9 inhibitors were significantly associated with poor OS in non-HPV-driven HNSCC (HR IVW,1.56[95%CI,1.02 to 2.39]). Conclusion: Genetically proxied long-term HMGCR inhibition was significantly associated with decreased OS in non-HPV-driven HNSCC and increased OS in HPV-positive OPSCC. While genetically proxied NPC1L1 and PCSK9 had associations with worse OS in total and non-HPV-driven HNSCC patients. Further research is needed to understand whether these drugs have consistent associations with head and neck tumor outcomes.

Keywords: Mendelian randomization analysis, head and neck cancer, cancer survival, cholesterol, statin

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Authors: Richard L. Summers

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The advanced computational analysis of biological systems is becoming increasingly dependent upon an understanding of the information-theoretic structure of the materials, energy and interactive processes that comprise those systems. The stability and survival of these living systems are fundamentally contingent upon their ability to acquire and process the meaning of information concerning the physical state of its biological continuum (biocontinuum). The drive for adaptive system reconciliation of a divergence from steady-state within this biocontinuum can be described by an information metric-based formulation of the process for actionable knowledge acquisition that incorporates the axiomatic inference of Kullback-Leibler information minimization driven by survival replicator dynamics. If the mathematical expression of this process is the Lagrangian integrand for any change within the biocontinuum then it can also be considered as an action functional for the living system. In the direct method of Lyapunov, such a summarizing mathematical formulation of global system behavior based on the driving forces of energy currents and constraints within the system can serve as a platform for the analysis of stability. As the system evolves in time in response to biocontinuum perturbations, the summarizing function then conveys information about its overall stability. This stability information portends survival and therefore has absolute existential meaning for the living system. The first derivative of the Lyapunov energy information function will have a negative trajectory toward a system's steady state if the driving force is dissipating. By contrast, system instability leading to system dissolution will have a positive trajectory. The direction and magnitude of the vector for the trajectory then serves as a quantifiable signature of the meaning associated with the living system’s stability information, homeostasis and survival potential.

Keywords: meaning, information, Lyapunov, living systems

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Authors: Felipa de Mello-Sampayo

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The aim of this study is to undertake, from patient’s perspective, the timing and probability of using teledermatology, comparing it with a conventional referral system. The dynamic stochastic model’s main value-added consists of the concrete application to patients waiting for dermatology surgical intervention. Patients with low health level uncertainty must use teledermatology treatment as soon as possible, which is precisely when the teledermatology is least valuable. The results of the model were then tested empirically with the teledermatology network covering the area served by the Hospital Garcia da Horta, Portugal, links the primary care centers of 24 health districts with the hospital’s dermatology department via the corporate intranet of the Portuguese healthcare system. Health level volatility can be understood as the hazard of developing skin cancer and the trend of health level as the bias of developing skin lesions. The results of the survival analysis suggest that the theoretical model can explain the use of teledermatology. It depends negatively on the volatility of patients' health, and positively on the trend of health, i.e., the lower the risk of developing skin cancer and the younger the patients, the more presurgical teledermatology one expects to occur. Presurgical teledermatology also depends positively on out-of-pocket expenses and negatively on the opportunity costs of teledermatology, i.e., the lower the benefit missed by using teledermatology, the more presurgical teledermatology one expects to occur.

Keywords: teledermatology, wait time, uncertainty, opportunity cost, survival analysis

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Authors: Tamirat Solomon, Aberash Yohannis, Efrem Gulfo

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The plantation of trees, which harmonizes the agroecology of the environment, has been implemented in Ethiopia with great concern for a noticeably degraded environment. This study was designed to evaluate the effectiveness of green legacy, species selection and, the rate of survival, and the management status in the study areas. A systematic sampling method was employed to collect the required data from 144 quadrants measuring a 15m radius with an interval of 40m apart. Additionally, 244 sample households were selected for the socioeconomic study in addition to secondary data collected from office recordings. The data collected was analyzed using multivariate analysis, considering exposure and outcome variables. The findings of this study indicated that four exotic tree species, namely; A. salgina, C. fistula, A. indica, and G. robusta, were commonly selected tree species for degraded land restoration in the study areas. Among the seedlings planted at the four study sites, a total of 79.9% survived, and A. salgina was the dominant and best performed species, A. indica was the least survived species in the entire study area. The age of the seedling before planting significantly (p = 0.05) affected the survival potential of most seedlings of species, and the majority (82%) of local communities expressed their positive attitudes and willingness to manage the restoration works in the study areas. It was recommended to consider the inclusion of native species in the restoration effort and evaluate the co-existence of native flora with exotic and its competition for nutrients, water, and light in addition to the invading potentials in the ecosystem. In general, before embarking on degraded land restoration, species selection, adequate preparation of seedlings, and species diversity composition that exactly fit the socioeconomic and ecological demands of the areas must get the attention for the success of the restoration.

Keywords: plantation forest, degraded land, forest restoration, plantation survival, species selection

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Authors: Yuchao Yao

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As two of the main characteristics of Chinese demographic trends, increasing divorce rates and decreasing fertility rates both shaped the population structure in the recent decade. Figuring out to what extent can be having a child make a difference in the divorce rate of a couple will not only draw a picture of Chinese families but also bring about a new perspective to evaluate the Chinese child-breeding policies. Based on China Family Panel Studies (CFPS) Data 2010-2018, this paper provides a systematic evaluation of how children influence a couple’s marital stability through a series of empirical models. Using survival analysis and propensity score matching (PSM) model, this paper finds that the number and age of children that a couple has mattered in consolidating marital relationship, and these effects vary little over time; during the last decade, newly having children can in fact decrease the possibility of divorce for Chinese couples; the such decreasing effect is largely due to the birth of a second child. As this is an inclusive attempt to study and compare not only the effects but also the causality of children on divorce risk in the last decade, the results of this research will do a good summary of the status quo of divorce in China. Furthermore, this paper provides implications for further reforming the current marriage and child-breeding policies.

Keywords: divorce risk, fertility, China, survival analysis, propensity score matching

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Authors: R. O. B. Bitencourt, F. S. Farias, M. C. Freitas, C. J. R. Balduino, E.S. Mesquita, A. R. C. Corval, P. S. Gôlo, E. G. Pontes, V. R. E. P. Bittencourt, I. C. Angelo

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Aedes aegypti larval survival rate was assessed after exposure to blastopores or conidia (mineral oil-in-water formulation or aqueous suspension) of Beauveria bassiana CG 479 propagules (blastospores or conidia). Here, mineral oil was used in the fungal formulation to control Aedes aegypti larvae. 1%, 0.5% or 0.1% mineral oil-in-water solutions were used to evaluate mineral oil toxicity for mosquito larvae. In the oil toxicity test, 0.1% mineral oil solution reduced only 4.5% larval survival; accordingly, this concentration was chosen for fungal oil-in-water formulations. Aqueous suspensions were prepared using 0.01% Tween 80^® in sterile dechlorinated water. A. aegypti larvae (L₂) were exposed in aqueous suspensions or mineral oil-in-water fungal formulations at 1×107 propagules mL^-1; the survival rate (assessed daily, for 7 days) and the median survival time (S₅₀) were calculated. Seven days after the treatment, mosquito larvae survival rates were 8.56%, 16.22%, 58%, and 42.56% after exposure to oil-in-water blastospores, oil-in-water conidia, blastospores aqueous suspension and conidia aqueous suspension (respectively). Larvae exposed to 0.01% Tween 80^® had 100% survival rate and the ones treated with 0.1% mineral oil-in-water had 95.11% survival rate. Larvae treated with conidia (regardless the presence of oil) or treated with blastospores formulation had survival median time (S₅₀) ranging from one to two days. S₅₀ was not determined (ND) when larvae were exposed to blastospores aqueous suspension, 0.01% Tween 80^® (aqueous control) or 0.1% mineral oil-in-water formulation (oil control). B. bassiana conidia and blastospores (mineral oil-in-water formulated or suspended in water) had potential to control A. aegypti mosquito larvae, despite mineral oil-in-water formulation yielded better results in comparison to aqueous suspensions. Here, B. bassiana CG 479 isolate is suggested as a potential biocontrol agent of A. aegypti mosquito larvae.

Keywords: blastospores, formulation, mosquitoes, conidia

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Authors: Vanessa Kummer, Maik Meusel

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Real estate demand estimates are typically derived from transaction data. However, in regions with excess demand, transactions are driven by supply and therefore do not indicate what people are actually looking for. To estimate the demand for housing in Switzerland, search subscriptions from all important Swiss real estate platforms are used. These data do, however, suffer from missing information—for example, many users do not specify how many rooms they would like or what price they would be willing to pay. In economic analyses, it is often the case that only complete data is used. Usually, however, the proportion of complete data is rather small which leads to most information being neglected. Also, the data might have a strong distortion if it is complete. In addition, the reason that data is missing might itself also contain information, which is however ignored with that approach. An interesting issue is, therefore, if for economic analyses such as the one at hand, there is an added value by using the whole data set with the imputed missing values compared to using the usually small percentage of complete data (baseline). Also, it is interesting to see how different algorithms affect that result. The imputation of the missing data is done using unsupervised learning. Out of the numerous unsupervised learning approaches, the most common ones, such as clustering, principal component analysis, or neural networks techniques are applied. By training the model iteratively on the imputed data and, thereby, including the information of all data into the model, the distortion of the first training set—the complete data—vanishes. In a next step, the performances of the algorithms are measured. This is done by randomly creating missing values in subsets of the data, estimating those values with the relevant algorithms and several parameter combinations, and comparing the estimates to the actual data. After having found the optimal parameter set for each algorithm, the missing values are being imputed. Using the resulting data sets, the next step is to estimate the willingness to pay for real estate. This is done by fitting price distributions for real estate properties with certain characteristics, such as the region or the number of rooms. Based on these distributions, survival functions are computed to obtain the functional relationship between characteristics and selling probabilities. Comparing the survival functions shows that estimates which are based on imputed data sets do not differ significantly from each other; however, the demand estimate that is derived from the baseline data does. This indicates that the baseline data set does not include all available information and is therefore not representative for the entire sample. Also, demand estimates derived from the whole data set are much more accurate than the baseline estimation. Thus, in order to obtain optimal results, it is important to make use of all available data, even though it involves additional procedures such as data imputation.

Keywords: demand estimate, missing-data imputation, real estate, unsupervised learning

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Authors: Di Luo, Maria Buchberger, Anja Pickhard

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Objectives: The purpose of this study was to assess and compare the diagnostic accuracy of four common morphological approaches, including sonography, computed tomography (CT), positron emission tomography/computed tomography (PET/CT), and magnetic resonance imaging (MRI) for the evaluation of cervical lymph node metastases in head and neck squamous cell carcinoma (HNSCC) patients. Material and Methods: Included in this retrospective study were 26 patients diagnosed with HNSCC between 2010 and 2011 who all underwent sonography, CT, PET/CT, and MRI imaging before neck dissection. Morphological data were compared to the corresponding histopathological results. Statistical analysis was performed with SPSS statistic software (version 26.0), calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for detection of cervical lymph node metastases. Results: The 5-year survival rate of the patient collective was 55.5%.Risk factors for survival included initial primary tumor stage, initial lymph node stage, initial metastasis status, and therapeutic approaches. Cox regression showed initial metastasis status(HR 8.671, 95%CI 1.316-57.123, p=0.025) and therapeutic approaches(HR 6.699, 95%CI 1.746-25.700, p=0.006)to be independent predictive risk factors for survival. Sensitivity was highest for MRI (96% compared to 85% for sonography and 89% for CT and PET/CT). Specificity was comparable with 95 % for CT and 98 % for sonography and PET/CT, but only 68% for MRI. While the MRI showed the least PPV (34%) compared to all other methods (85% for sonography,75% for CT, and 86% for PET/CT), the NPV was comparable in all methods(98-99%). The overall accuracy of cervical lymph node metastases detection was comparable for sonography, CT, and PET/CT with 96%,97%,94%, respectively, while MRI had only 72% accuracy. Conclusion: Since the initial status of metastasis is an independent predictive risk factor for patients’ survival, efficient detection is crucial to plan adequate therapeutic approaches. Sonography, CT, and PET/CT have better diagnostic accuracy than MRI for the evaluation of cervical lymph node metastases in HNSCC patients.

Keywords: cervical lymph node metastases, diagnostic accuracy, head and neck squamous carcinoma, risk factors, survival

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Authors: Osama Shakeel

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The objective of the paper is to study the clinic-pathological factors, survival analyses, recurrence rate, metastatic rate, risk factors and the management of cutaneous malignant melanoma at Shaukat Khanum Memorial Cancer Hospital and Research Center. Methodology: From 2014 to 2017, all patients with a diagnosis of cutaneous malignant melanoma (CMM) were included in the study. Demographic variables were collected. Short and long term oncological outcomes were recorded. All data were entered and analyzed in SPSS version 21. Results: A total of 28 patients were included in the study. Median age was 46.5 +/-15.9 years. There were 16 male and 12 female patients. The family history of melanoma was present in 7.1% (n=2) of the patients. All patients had a mean survival of 13.43+/- 9.09 months. Lower limb was the commonest site among all which constitutes 46.4%(n=13). On histopathological analyses, ulceration was seen in 53.6% (n=15) patients. Unclassified tumor type was present in 75%(n=21) of the patients followed by nodular 21.4% (n=6) and superficial spreading 3.5%(n=1). Clark level IV was the commonest presentation constituting 46.4%(n=13). Metastases were seen in 50%(n=14) of the patients. Local recurrence was observed in 60.7%(n=17). 64.3%(n=18) lived after one year of treatment. Conclusion: CMM is a fatal disease. Although its disease of fair skin individuals, however, the incidence of CMM is also rising in this part of the world. Management includes early diagnoses and prompt management. However, mortality associated with this disease is still not favorable.

Keywords: malignant cancer of skin, cutaneous malignant melanoma, skin cancer, survival analyses

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Authors: Adrita Banerjee, Ajeet Kumar Singh

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Antenatal care (ANC) from a skilled provider is important to monitor the pregnancy and reduce the risk of morbidity for mother and baby during pregnancy and delivery. The quality of antenatal care can be monitored through the content of services received and the kind of information mothers are given during their visit. Objective: The paper tries to examine the association between ANC check-ups and size/ birth weight. It also focuses on investigating the relationship between utilization of recommended prenatal care for mothers and its effect on infant survival in Nepal. Data and methods: This paper uses data from Nepal demographic Health Survey 2011. To understand the relationship bi-variate statistical analysis and logistic regressions has been done. Maternal health care utilization include ANC check-ups i.e. the type of ante-natal care providers, the number and timing of the visit. The various components of the check-ups include intake of iron tablets/syrups, intestinal parasitic drugs, etc. Results: The results show that women who had no antenatal care visits about 40% had small sized babies at the time of birth compared to women to had at least 3 ANC check up. Women who had at least 3 check-ups 17% of the babies have a small size. It has also been found that about 50 % of the women prefer ANC check-ups during pregnancies which have resulted in lowering the infant mortality by about 40% during 1996-2011. Conclusion: Ante natal care check is care and monitoring of the pregnant woman and her foetus throughout pregnancy. ANC checks have an effect on the infant health and child survival. A woman who had at least three check-ups the possibilities of adverse effect on infant health and infant survival was significantly lower. The findings argue for a more enhanced focus on ANC check-ups for improving the maternal and child health in Nepal.

Keywords: maternal, health, pregnancy, outcome

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Authors: Jaewoo Choi, Ki-Tae Hwang, Eunyoung Ko

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Backgrounds/Aims: Patients with breast cancer are currently classified according to TNM stage. Nevertheless, the actual volume would be mis-estimated, and it would bring on inappropriate diagnosis. Tridimensional volume-stage derived from the ellipsoid formula was presented as useful measure. Methods: The medical records of 480 consecutive breast cancer between January 2001 and March 2013 were retrospectively reviewed. All patients were divided into three groups according to tumor volume by receiver operating characteristic analysis, and the ranges of each volume-stage were that V1 was below 2.5 cc, V2 was exceeded 2.5 and below 10.9 cc, and V3 was exceeded 10.9 cc. We analyzed outcomes of volume-stage and compared disease-free survival (DFS) and overall survival (OS) between size-stage and volume-stage with variant intrinsic factor. Results: In the T2 stage, there were patients who had a smaller volume than 4.2 cc known as maximum value of T1. These findings presented that patients in T1c had poorer DFS than T2-lesser (mean of DFS 48.7 vs. 51.8, p = 0.011). Such is also the case in OS (mean of OS 51.1 vs. 55.3, p = 0.006). The cumulative survival curves for V1, V2 compared T1, T2 showed similarity in DFS (HR 1.9 vs. 1.9), and so did it for V3 compared T3 (HR 3.5 vs. 2.6) significantly. Conclusion: This study demonstrated that tumor volume had good feasibility on the prognosis of patients with breast cancer. We proposed that volume-stage should be considered for an additional stage indicator, particularly in early breast cancer.

Keywords: breast cancer, tridimensional volume of tumor, TNM stage, volume stage

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Authors: Sheikh Shams Azam, Manoj Raju, Venkatesh Pagidimarri, Vamsi Kasivajjala

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Over the past decade, there has been a steep rise in the data-driven analysis in major areas of medicine, such as clinical decision support system, survival analysis, patient similarity analysis, image analytics etc. Most of the data in the field are well-structured and available in numerical or categorical formats which can be used for experiments directly. But on the opposite end of the spectrum, there exists a wide expanse of data that is intractable for direct analysis owing to its unstructured nature which can be found in the form of discharge summaries, clinical notes, procedural notes which are in human written narrative format and neither have any relational model nor any standard grammatical structure. An important step in the utilization of these texts for such studies is to transform and process the data to retrieve structured information from the haystack of irrelevant data using information retrieval and data mining techniques. To address this problem, the authors present Q-Map in this paper, which is a simple yet robust system that can sift through massive datasets with unregulated formats to retrieve structured information aggressively and efficiently. It is backed by an effective mining technique which is based on a string matching algorithm that is indexed on curated knowledge sources, that is both fast and configurable. The authors also briefly examine its comparative performance with MetaMap, one of the most reputed tools for medical concepts retrieval and present the advantages the former displays over the latter.

Keywords: information retrieval, unified medical language system, syntax based analysis, natural language processing, medical informatics

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Authors: Kim Kennedy, Daren Gibson, Stephanie Flukes, Chandra Diwakarla, Lisa Spalding, Leanne Pilkington, Andrew Redfern

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Introduction: Head and neck cancer and treatments are known for their profound effect on nutrition and tube feeding is a common requirement to maintain nutrition. Aim: We aimed to evaluate the frequency of tube feeding in Aboriginal and non-Aboriginal patients, and to examine the relapse and survival outcomes in patients who require enteral tube feeding. Methods: We performed a retrospective cohort analysis of 320 head and neck cancer patients from a single centre in Western Australia, identifying 80 Aboriginal patients and 240 non-Aboriginal patients matched on a 1:3 ratio by site, histology, rurality, and age. Data collected included patient demographics, tumour features, treatment details, and cancer and survival outcomes. Results: Aboriginal and non-Aboriginal patients required feeding tubes at similar rates (42.5% vs 46.2% respectively), however Aboriginal patients were far more likely to fail to return to oral nutrition, with 26.3% requiring long-term tube feeding versus only 15% of non-Aboriginal patients. In the overall study population, 27.5% required short-term tube feeding, 17.8% required long-term enteral tube nutrition, and 45.3% of patients did not have a feeding tube at any point. Relapse was more common in patients who required tube feeding, with relapses in 42.1% of the patients requiring long-term tube feeding, 31.8% in those requiring a short-term tube, versus 18.9% in the ‘no tube’ group. Survival outcomes for patients who required a long-term tube were also significantly poorer when compared to patients who only required a short-term tube, or not at all. Long-term tube-requiring patients were half as likely to survive (29.8%) compared to patients requiring a short-term tube (62.5%) or no tube at all (63.5%). Patients requiring a long-term tube were twice as likely to die with active disease (59.6%) as patients with no tube (28%), or a short term tube (33%). This may suggest an increased relapse risk in patients who require long-term feeding, due to consequences of malnutrition on cancer and treatment outcomes, although may simply reflect that patients with recurrent disease were more likely to have longer-term swallowing dysfunction due to recurrent disease and salvage treatments. Interestingly long-term tube patients were also more likely to die with no active disease (10.5%) (compared with short-term tube requiring patients (4.6%), or patients with no tube (8%)), which is likely reflective of the increased mortality associated with long-term aspiration and malnutrition issues. Conclusions: Requirement for tube feeding was associated with a higher rate of cancer relapse, and in particular, long-term tube feeding was associated with a higher likelihood of dying from head and neck cancer, but also a higher risk of dying from other causes without cancer relapse. This data reflects the complex effect of head and neck cancer and its treatments on swallowing and nutrition, and ultimately, the effects of malnutrition, swallowing dysfunction, and aspiration on overall cancer and survival outcomes. Tube feeding was seen at similar rates in Aboriginal and non-Aboriginal patient, however failure to return to oral intake with a requirement for a long-term feeding tube was seen far more commonly in the Aboriginal population.

Keywords: head and neck cancer, enteral tube feeding, malnutrition, survival, relapse, aboriginal patients

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Authors: Chettou Souhaila, Soufi Omar, Roumia Mohammed Ammar

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Protecting the environment is to preserve the survival and future of humanity. Indeed, the environment is our source of food and drinking water, the air is our source of oxygen, the climate allows our survival and biodiversity are a potential drug reservoir. Preserving the environment is, therefore, a matter of survival. The objective of this project is to familiarize the general public with environmental problems not only with the theme of environmental protection, but also with the concept of biodiversity in different ecosystems. For it, the aim of our project was to create the Ecorium which is a place that preserves many species of plants of different ecosystems, schools, malls, buildings, offices, ecological transports, gardens, and many familial activities that participated in the ecosystems development, strategic biodiversity and sustainable development.

Keywords: ecological system, ecorium, environment, sustainable development

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Authors: Naser Shagerdi Esmaeli, Mohsen Hamidpour, Parisa Hasankhani Tehrani

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Background: The TP53 mutation is frequently detected in acute myeloid leukemia (AML) patients with complex karyotype (CK), but the stability of this mutation during the clinical course remains unclear. Material and Methods: In this study, TP53 mutations were identified in 7% of 500 patients with de novo AML and 58.8% of patients with CK in Tabriz, Iran. TP53 mutations were closely associated with older age, lower white blood cell (WBC) and platelet counts, FAB M6 subtype, unfavorable-risk cytogenetics, and CK, but negatively associated with NPM1 mutation, FLT3/ITD and DNMT3A mutation. Result: Multivariate analysis demonstrated that TP53 mutation was an independent poor prognostic factor for overall survival and disease-free survival among the total cohort and the subgroup of patients with CK. A scoring system incorporating TP53 mutation and nine other prognostic factors, including age, WBC counts, cytogenetics, and gene mutations, into survival analysis proved to be very useful to stratify AML patients. Sequential study of 420 samples showed that TP53 mutations were stable during AML evolution, whereas the mutation was acquired only in 1 of the 126 TP53 wild-type patients when therapy-related AML originated from different clone emerged. Conclusion: In conclusion, TP53 mutations are associated with distinct clinic-biological features and poor prognosis in de novo AML patients and are rather stable during disease progression.

Keywords: acute myloblastic leukemia, TP53, FLT3/ITD, Iran

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Authors: Ozan Kahraman, Hao Feng

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Several models such as Weibull, Modified Gompertz, Biphasic linear, and Log-logistic models have been proposed in order to describe non-linear inactivation kinetics and used to fit non-linear inactivation data of several microorganisms for inactivation by heat, high pressure processing or pulsed electric field. First-order kinetic parameters (D-values and z-values) have often been used in order to identify microbial inactivation by non-thermal processing methods such as ultrasound. Most ultrasonic inactivation studies employed first-order kinetic parameters (D-values and z-values) in order to describe the reduction on microbial survival count. This study was conducted to analyze the E. coli O157:H7 inactivation data by using five microbial survival models (First-order, Weibull, Modified Gompertz, Biphasic linear and Log-logistic). First-order, Weibull, Modified Gompertz, Biphasic linear and Log-logistic kinetic models were used for fitting inactivation curves of Escherichia coli O157:H7. The residual sum of squares and the total sum of squares criteria were used to evaluate the models. The statistical indices of the kinetic models were used to fit inactivation data for E. coli O157:H7 by MTS at three temperatures (40, 50, and 60 0C) and three pressures (100, 200, and 300 kPa). Based on the statistical indices and visual observations, the Weibull and Biphasic models were best fitting of the data for MTS treatment as shown by high R2 values. The non-linear kinetic models, including the Modified Gompertz, First-order, and Log-logistic models did not provide any better fit to data from MTS compared the Weibull and Biphasic models. It was observed that the data found in this study did not follow the first-order kinetics. It is possibly because of the cells which are sensitive to ultrasound treatment were inactivated first, resulting in a fast inactivation period, while those resistant to ultrasound were killed slowly. The Weibull and biphasic models were found as more flexible in order to determine the survival curves of E. coli O157:H7 treated by MTS on apple-carrot juice.

Keywords: Weibull, Biphasic, MTS, kinetic models, E.coli O157:H7

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Authors: Shi-xia Xu, Zai-wen Zhang, Ru-xue Chen, Shan Zhou, Xiang-feng Tang

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Objective: The clinical influence of HLA-DPB1 mismatches on clinical outcome of HSCT is less clear. This is the first meta-analysis to study the HLA-DPB1 matching statues on clinical outcomes after unrelated donor HSCT. Methods: We searched the CIBMTR, Cochrane Central Register of Controlled Trials (CENTRAL) and related databases (1995.01–2017.06) for all relevant articles. Comparative studies were used to investigate the HLA-DPB1 loci mismatches on clinical outcomes after unrelated donor HSCT, such as the disease-free survival (DFS), overall survival, GVHD, relapse, and transplant-related mortality (TRM). We performed meta-analysis using Review Manager 5.2 software and funnel plot to assess the bias. Results: At first, 1246 articles were retrieved, and 18 studies totaling 26368 patients analyzed. Pooled comparisons of studies found that the HLA-DPB1 mismatched group had a lower rate of DFS than the DPB1-matched group, and lower OS in non-T cell depleted transplantation. The DPB1 mismatched group has a higher incidence of aGVHD and more severe ( ≥ III degree) aGvHD, lower rate of relapse and higher TRM. Moreover, compared with 1-antigen mismatch, 2-antigen mismatched led to a higher risk of TRM and lower relapse rate. Conclusions: This meta-analysis indicated HLA-DPB1 has important influence on survival and transplant-related complications during unrelated donor HSCT and HLA-DPB1 donor selection strategies have been proposed based on a personalized algorithm.

Keywords: human leukocyte antigen, DPB1, transplant, meta-analysis, outcome

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Authors: Awf A. Al-Khan, Michael J. Day, Judith Nimmo, Mourad Tayebi, Stewart D. Ryan, Samantha J. Richardson, Janine A. Danks

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Osteosarcoma (OS) is the most common type of malignant primary bone tumour in dogs. In addition to their critical roles in bone formation and remodeling, parathyroid hormone-related protein (PTHrP) and its receptor (PTHR1) are involved in progression and metastasis of many types of tumours in humans. The aims of this study were to determine the localisation and expression levels of PTHrP and PTHR1 in canine OS tissues using immunohistochemistry and to investigate if this expression is correlated with survival time. Formalin-fixed, paraffin-embedded tissue samples from 44 dogs with known survival time that had been diagnosed with primary osteosarcoma were analysed for localisation of PTHrP and PTHR1. Findings showed that both PTHrP and PTHR1 were present in all OS samples. The dogs with high level of PTHR1 protein (16%) had decreased survival time (P<0.05) compared to dogs with less PTHR1 protein. PTHrP levels did not correlate with survival time (P>0.05). The results of this study indicate that the PTHR1 is expressed differently in canine OS tissues and this may be correlated with poor prognosis. This may mean that PTHR1 may be useful as a prognostic indicator in canine OS and could represent a good therapeutic target in OS.

Keywords: dog, expression, osteosarcoma, parathyroid hormone receptor 1 (PTHR1), parathyroid hormone-related protein (PTHrP), survival

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Authors: Michele Romanello

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COVID-19 has spread rapidly in Brazil since March 2020, making the country one of the most affected in the world by the pandemic. From an economic point of view, Brazil came from a pre-pandemic period characterized by low or negative growth, with a resulting increase in the number of unemployed and informal workers. This paper considers lockdown implementation in the situation of the large presence of informality in the economy. The objective of the paper is to analyze how the country has tried to help workers affected by economic crisis after the implementation of measures against COVID-19 and whether the emergency assistance from the government has been adequate to contain the increase of informal workers and unemployed. The methodology used in this paper is survival analysis. Through this methodology, the formality – informality, and informality – unemployment transitions are analyzed. This analysis draws data from the Continuous National Household Sample Survey (Continuous PNAD) and from the National Household Sample Survey COVID-19 (PNAD COVID-19) covering the period of January 2020 – July 2020. The results indicate that emergency aid has been not sufficient to reduce the transitions of workers from formal to informal jobs and from informal jobs to unemployment. Emergency aid has been not sufficient considering the previous situation of the country, with levels of poverty and inequality very high. In the next months, another fundamental determinant of the income trajectory in the context of the COVID-19 crisis will be the continuity of the emergency aid, especially considering the fiscal adjustment policy pursued by the government. Therefore, the current negative portrait may be even worse in the coming months.

Keywords: Brazil, COVID-19, informality, survival analysis

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Authors: Yemane Hailu Fissuh, Zhongzhan Zhang

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An estimating equation technique is an alternative method of the widely used maximum likelihood methods, which enables us to ease some complexity due to the complex characteristics of time-varying covariates. In the situations, when both the time-varying covariates and left-truncation are considered in the model, the maximum likelihood estimation procedures become much more burdensome and complex. To ease the complexity, in this study, the modified estimating equations those have been given high attention and considerations in many researchers under semiparametric transformation model was proposed. The purpose of this article was to develop the modified estimating equation under flexible and general class of semiparametric transformation models for left-truncated and right censored survival data with time-varying covariates. Besides the commonly applied Cox proportional hazards model, such kind of problems can be also analyzed with a general class of semiparametric transformation models to estimate the effect of treatment given possibly time-varying covariates on the survival time. The consistency and asymptotic properties of the estimators were intuitively derived via the expectation-maximization (EM) algorithm. The characteristics of the estimators in the finite sample performance for the proposed model were illustrated via simulation studies and Stanford heart transplant real data examples. To sum up the study, the bias for covariates has been adjusted by estimating density function for the truncation time variable. Then the effect of possibly time-varying covariates was evaluated in some special semiparametric transformation models.

Keywords: EM algorithm, estimating equation, semiparametric transformation models, time-to-event outcomes, time varying covariate

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Authors: Iñaki Aliende, Tom Webb, Lorenzo Escot

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There is a concern about the decrease in football referees globally. A study in Spain has analyzed the factors affecting a referee's career over the past 30 years through a survey of 758 referees. Results showed the impact of factors such as threats, education, initial vocation, and dependents on a referee's career. To improve the situation, the federation needs to provide better information, support young referees, monitor referees, and raise public awareness of violence toward referees. The study also formed a comprehensive model for federations to enhance their officiating policies by means of data-driven techniques that can serve other federations to improve referees' careers.

Keywords: data science, football referees, sport management, sport careers, survival analysis

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Authors: Li Minghui, Min Shaorong, Zhang Jun

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This paper aims for studying the operational efficiency of surface warship’s motorized evasion to acoustic homing torpedo. It orderly developed trajectory model, self-guide detection model, vessel evasion model, as well as anti-torpedo error model in three-dimensional space to make up for the deficiency of precious researches analyzing two-dimensionally confrontational models. Then, making use of the Monte Carlo method, it carried out the simulation for the confrontation process of evasion in the environment of MATLAB. At last, it quantitatively analyzed the main factors which determine vessel’s survival probability. The results show that evasion relative bearing and speed will affect vessel’s survival probability significantly. Thus, choosing appropriate evasion relative bearing and speed according to alarming range and alarming relative bearing for torpedo, improving alarming range and positioning accuracy and reducing the response time against torpedo will improve the vessel’s survival probability significantly.

Keywords: acoustic homing torpedo, vessel evasion, monte carlo method, torpedo defense, vessel's survival probability

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Authors: Khandoker Akib Mohammad

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While analyzing time-to-event data, it is possible that a certain fraction of subjects will never experience the event of interest, and they are said to be cured. When this feature of survival models is taken into account, the models are commonly referred to as cure models. In the presence of covariates, the conditional survival function of the population can be modelled by using the cure model, which depends on the probability of being uncured (incidence) and the conditional survival function of the uncured subjects (latency), and a combination of logistic regression and Cox proportional hazards (PH) regression is used to model the incidence and latency respectively. In this paper, we have shown the asymptotic normality of the profile likelihood estimator via asymptotic expansion of the profile likelihood and obtain the explicit form of the variance estimator with an implicit function in the profile likelihood. We have also shown the efficient score function based on projection theory and the profile likelihood score function are equal. Our contribution in this paper is that we have expressed the efficient information matrix as the variance of the profile likelihood score function. A simulation study suggests that the estimated standard errors from bootstrap samples (SMCURE package) and the profile likelihood score function (our approach) are providing similar and comparable results. The numerical result of our proposed method is also shown by using the melanoma data from SMCURE R-package, and we compare the results with the output obtained from the SMCURE package.

Keywords: Cox PH model, cure model, efficient score function, EM algorithm, implicit function, profile likelihood

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Authors: Jiahui Song, Ravindra Joshi

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High-intensity, nanosecond, pulsed electric fields have been shown to be useful non-thermal tools capable of producing a variety of specific cellular responses. While reversible and temporary changes are often desired based on electromanipulation, irreversible effects can also be important objectives. These include elimination of tumor cells and bacterial decontamination. A simple model-based rate-equation treatment of the various cellular biochemical processes was used to qualitatively predict the pulse number-dependent caspase activation and cell survival trends. The model incorporated the caspase-8 associated extrinsic pathway, the delay inherent in its activation, cytochrome c release, and the internal feedback mechanism between caspase-3 and Bid. Results were roughly in keeping with the experimental cell-survival data. A pulse-number threshold was predicted followed by a near-exponential fall-off. The intrinsic pathway was shown to be much weaker as compared to the extrinsic mechanism for electric pulse induced cell apoptosis. Also, delays of about an hour are predicted for detectable molecular concentration increases following electrical pulsing.

Keywords: apoptosis, cell survival, model, pathway

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Authors: Ankita Shukla

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The promotion and support of breastfeeding is a global priority with benefits for maternal and infant health, especially in low income and middle-income countries where the probability of child survival is still very low. In India too it has been well established that breastfeeding increases the survival of the child. However, the breastfeeding levels are quite low in the country. Examining the socio-economic inequality in breastfeeding pattern can help to the causal pathways responsible for early breastfeeding termination. This paper tries to understand the socio-economic differential in breastfeeding patterns among Indian women. Data is used from nationally representative National Family Health Survey-3. Using Cox regression modelling techniques, the analysis found that the likelihood of having small breastfeeding duration increased with increasing household wealth status similarly education also has negative effect on breastfeeding duration. The considerable gender difference is also visible in India, likelihood of stopping breastfeeding was significantly higher among female children compared with male children. To understand the cultural factors or norms responsible for the early termination of breastfeeding more in depth/qualitative studies are needed.

Keywords: breastfeeding, India, socio-economic inequality, women education

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Authors: Idrissa Kayijuka

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The logistic regression and Cox regression models (proportional hazard model) at present are being employed in the analysis of prospective epidemiologic research looking into risk factors in their application on chronic diseases. However, a theoretical relationship between the two models has been studied. By definition, Cox regression model also called Cox proportional hazard model is a procedure that is used in modeling data regarding time leading up to an event where censored cases exist. Whereas the Logistic regression model is mostly applicable in cases where the independent variables consist of numerical as well as nominal values while the resultant variable is binary (dichotomous). Arguments and findings of many researchers focused on the overview of Cox and Logistic regression models and their different applications in different areas. In this work, the analysis is done on secondary data whose source is SPSS exercise data on BREAST CANCER with a sample size of 1121 women where the main objective is to show the application difference between Cox regression model and logistic regression model based on factors that cause women to die due to breast cancer. Thus we did some analysis manually i.e. on lymph nodes status, and SPSS software helped to analyze the mentioned data. This study found out that there is an application difference between Cox and Logistic regression models which is Cox regression model is used if one wishes to analyze data which also include the follow-up time whereas Logistic regression model analyzes data without follow-up-time. Also, they have measurements of association which is different: hazard ratio and odds ratio for Cox and logistic regression models respectively. A similarity between the two models is that they are both applicable in the prediction of the upshot of a categorical variable i.e. a variable that can accommodate only a restricted number of categories. In conclusion, Cox regression model differs from logistic regression by assessing a rate instead of proportion. The two models can be applied in many other researches since they are suitable methods for analyzing data but the more recommended is the Cox, regression model.

Keywords: logistic regression model, Cox regression model, survival analysis, hazard ratio

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Authors: Daniel Nigusse Tollosa, Erica James, Alexis Hurre, Meredith Tavener

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Introduction: Lifestyle behaviours such as healthy diet, regular physical activity and maintaining a healthy weight are essential for cancer survivors to improve the quality of life and longevity. However, there is no study that synthesis cancer survivor’s adherence to healthy lifestyle recommendations. The purpose of this review was to collate existing data on the prevalence of adherence to healthy behaviours and produce the pooled estimate among adult cancer survivors. Method: Multiple databases (Embase, Medline, Scopus, Web of Science and Google Scholar) were searched for relevant articles published since 2007, reporting cancer survivors adherence to more than two lifestyle behaviours based on the WCRF/AICR recommendations. The pooled prevalence of adherence to single and multiple behaviours (operationalized as adherence to more than 75% (3/4) of health behaviours included in a particular study) was calculated using a random effects model. Subgroup analysis adherence to multiple behaviours was undertaken corresponding to the mean survival years and year of publication. Results: A total of 3322 articles were generated through our search strategies. Of these, 51 studies matched our inclusion criteria, which presenting data from 2,620,586 adult cancer survivors. The highest prevalence of adherence was observed for smoking (pooled estimate: 87%, 95% CI: 85%, 88%) and alcohol intake (pooled estimate 83%, 95% CI: 81%, 86%), and the lowest was for fiber intake (pooled estimate: 31%, 95% CI: 21%, 40%). Thirteen studies were reported the proportion of cancer survivors (all used a simple summative index method) to multiple healthy behaviours, whereby the prevalence of adherence was ranged from 7% to 40% (pooled estimate 23%, 95% CI: 17% to 30%). Subgroup analysis suggest that short-term survivors ( < 5 years survival time) had relatively a better adherence to multiple behaviours (pooled estimate: 31%, 95% CI: 27%, 35%) than long-term ( > 5 years survival time) cancer survivors (pooled estimate: 25%, 95% CI: 14%, 36%). Pooling of estimates according to the year of publication (since 2007) also suggests an increasing trend of adherence to multiple behaviours over time. Conclusion: Overall, the adherence to multiple lifestyle behaviors was poor (not satisfactory), and relatively, it is a major concern for long-term than the short-term cancer survivor. Cancer survivors need to obey with healthy lifestyle recommendations related to physical activity, fruit and vegetable, fiber, red/processed meat and sodium intake.

Keywords: adherence, lifestyle behaviours, cancer survivors, WCRF/AICR

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Authors: Michael Gidey Gebru

Abstract:

Most of Data Envelopment Analysis models operate in a static environment with input and output parameters that are chosen by deterministic data. However, due to ambiguity brought on shifting market conditions, input and output data are not always precisely gathered in real-world scenarios. Fuzzy numbers can be used to address this kind of ambiguity in input and output data. Therefore, this work aims to expand crisp Data Envelopment Analysis into Data Envelopment Analysis with fuzzy environment. In this study, the input and output data are regarded as fuzzy triangular numbers. Then, the Data Envelopment Analysis model with fuzzy environment is solved using a multi-objective method to gauge the Decision Making Units' efficiency. Finally, the developed Data Envelopment Analysis model is illustrated with an application on real data 50 educational institutions.

Keywords: efficiency, Data Envelopment Analysis, fuzzy, higher education, input, output

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Authors: Raymond Puijk, Rachid Rassir, Inger N. Sierevelt, Anneke Spekenbrink-Sporen, Bart G. C. W. Pijls, Rob G. H. H. Nelissen, Peter A. Nolte

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Background: Among uncemented total knee arthroplasty (TKA), a wide variety of metal surface structures (MSS) and coatings exist to enhance implants' biological properties (i.e., bone ingrowth). This study explores the variety of MSS-coating combinations and compares their mid-long-term survivorships with cemented TKAs, by using data from the Dutch Arthroplasty Register. Methods: A total of 235,500 cemented and 11,132 uncemented primary TKAs with a median follow-up of 5.1 years were included. MSS-coating combinations were (1) Porous-uncoated (n=8986), (2) Beaded-hydroxyapatite (HA)(n=1093), (3) Matte-uncoated (n=846), (4) Matte-Titanium-nitride (TiN) (n=207). Five- and 10-year revision-free survival for all-cause revisions, and aseptic loosening of the tibial component, were calculated and compared by using Kaplan-Meier, Log-rank tests, and multivariable Cox proportional hazard regression analyses. Results: Ten-year survival rates with all-cause revisions as an endpoint, were 94.2% for cement, and 94.7%, 96.3%, 92.1%, and 79.0% for porous-uncoated, beaded-HA, matte-uncoated, and Matte-TiN, respectively (p<0.01). Rates for aseptic loosening were 98.8% for cemented, and 98.7%, 99.8%, 97.2%, and 94.9% for the uncemented, respectively (p<0.01).The beaded-HA implants were half the risk for an all-cause revision compared to cemented implants (p<0.01). Matte-uncoated and matte-TiN implants were at more risk of an all-cause revision than cemented implants (p=0.01, p<0.01). Proportions of revisions for aseptic loosening were comparable among most groups. Conclusion: Based on Dutch registry data, four main MSS-coating combinations among uncemented TKAs were found. survivorships for all-cause revisions and aseptic release differed widely between groups. Beaded-HA and porous-uncoated implants had the best survival rates among the uncemented TKAs and were non-inferior to the cemented TKAs.

Keywords: total knee arthroplasty, cement, uncemented, cementless;, metal surface structure, coating

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