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Pérez de la Puente, Constanza, Federico Losco, Carolina Chacon, Juan Pablo Sade, Gonzalo H. Giornelli, Matias Chacon, and Reinaldo D. Chacon. "Intermediate-risk prostate cancer treated with external beam radiotherapy (EBRT): A risk group with heterogeneous behavior." Journal of Clinical Oncology 34, no. 2_suppl (January 10, 2016): 145. http://dx.doi.org/10.1200/jco.2016.34.2_suppl.145.
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145 Background: In men with intermediate-risk prostate cancer (IR-PC) treated with low dose EBRT, the addition of androgen deprivation therapy (ADT) prolongs overall survival. Zumsteg proposes a subdivision for de IR-PC group: favorable or unfavorable. Purpose: retrospective evaluation of EBRT efficacy according to IR-PC subgroups (favorable or unfavorable). Methods: From the institutional radiotherapy department database, from 2000 to 2011, 95 men with IR-PC were identified and subdivided as follows: Favorable Risk (FR) – Gleason 3+4 or less and positive prostate biopsies (ppb) not exceeding 50% and only one intermediate-risk factor excluding 4+3; Unfavorable risk (UR) – Gleason 4+3 or at least 2 intermediate-risk factors or at least one intermediate risk factor and ppb >50%. Results: 95 patients were included in the analysis, mean FUP 6.2 years. 32.6% (31) had >50% ppb, 14.7% (14) had Gleason 4+3, 38.9% (37) had 2 intermediate-risk factors. 42.1% (40) were FR and 57.9% (55) were UR. Median EBRT dose: 79.8Gy. Only 25% of FR patients received some hormonal therapy treatment. There were no differences in time to Prostatic Specific Androgen (PSA) nadir (FR 12 vs UR 13 months; p= .50), biochemical relapse free survival (RFS) (FR 60 vs US 58 months; p= .80), or doubling time PSA (FR 12 vs UR 11 months; p= .19). Biochemical relapse (BR) and local relapse (LR) rates were lower for FR (BR: FR 27.5 vs UR 38.2%, p= .17; LR: FR 5 vs UR 14.5%, p= .40). Local RFS (FR 13.6 vs UR 9.6 years; p= .11) and distant RFS (FR 13.1 vs UR 12.4 years; p= .65) were longer for FR patients. Conclusions: Short course ADT is the standard treatment in IR-PC patients when EBRT is indicated, especially if they have UR features. In our study IR-PC group had heterogeneous outcomes and, in spite the study limitations, FR patients had a trend for better prognosis even with a very low use of ADT. If Favorable IR-PC patients may avoid ADT morbidity should be answered by a randomized trial.
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Sweeting, P. J. "Modelling and Managing Risk." British Actuarial Journal 14, no. 1 (March 1, 2008): 111–25. http://dx.doi.org/10.1017/s1357321700001641.
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Alonzo, Todd A., Phoenix A. Ho, Robert B. Gerbing, Alan S. Gamis, Susana C. Raimondi, Betsy A. Hirsch, Todd Cooper, et al. "Conventional Cytogenetics, Molecular Profiling, and Flow Cytometric Response Data Allow the Creation of a Two-Tiered Risk-Group System for Risk-Based Therapy Allocation In Childhood AML- a Report From the Children's Oncology Group." Blood 116, no. 21 (November 19, 2010): 761. http://dx.doi.org/10.1182/blood.v116.21.761.761.
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Abstract Abstract 761 Conventional cytogenetics and morphologic response to induction chemotherapy have historically provided the tools for predicting outcome in patients with acute myeloid leukemia (AML). Several mutations are predictive of clinical outcome and have provided additional tools to help predict outcome in patients with AML without other risk features. Despite these recent advances, our ability to identify specific risk groups has been limited to a subset of patients, and nearly half of the patients with AML are regarded as having standard-risk (SR) disease. We inquired whether adding response by multidimensional flow cytometry (MDF) to data from conventional cytogenetics analysis and presence/absence of genomic alterations of FLT3 (FLT3-ITD), CEBPA, and NPM would provide a more robust risk-stratification system for risk-based therapy allocation. COG AML protocol AAML03P1 collected comprehensive cytogenetics characteristics, mutation profile (FLT3/ITD, CEBPA, and NPM mutation status), and MDF data on most of the 340 eligible patients enrolled on the study. Molecular and cytogenetic data were available for 275 of the 293 (94%) patients with responsive disease at the end of induction I. Disease-free survival (DFS) from the end of induction I was determined based on a combined molecular and cytogenetic risk profile. Risk status was defined based on the presence of t(8;21), inv(16), NPMc, and CEBPA mutations (favorable risk, FR) or the presence of monosomy 7, monosomy 5/del5q, and high allelic ratio FLT3-ITD (high risk, HR). On the basis of this allocation, 88 (32%) patients had FR AML, and 26 (10%) had HR AML. The remaining 161 (59%) patients without specific risk features were considered to have SR AML. DFS at 2 years from the end of induction I was 70%±12% for the FR cohort, 55% ±9% for the SR cohort, and 17%±20% for the HR cohort (p<0.001). The prevalence and prognostic significance of minimal residual disease (MRD) were assessed in the 103 patients with SR disease; 31 (30%) had evidence of MRD by MDF. DFS at 3 years from the end of induction I was significantly worse for those with MRD than for those without it (26%±21% vs. 67%±13%, p=0.01). Corresponding relapse risk in patients with or without MRD was 69%±21% and 30%±13%, respectively (p=0.011). We assessed the clinical impact of MRD in patients with HR or FR disease. Of the 18 patients with HR AML who had MRD data, 8 (44%) had MRD. DFS at 2 years for patients with HR disease with or without MRD was not significantly different (13%±23% vs. 36%±40%; p=0.127). Of the 73 patients with FR AML, MRD was detected in 12 (16%); MRD did not significantly influence DFS at 3 years from the end of induction I in those patients (45%±33% vs. 72%±17%, p=0.138). Thus, although the presence of MRD was significantly associated with worse outcome in patients with SR AML, similar significance could not be demonstrated in the FR or HR cohorts. Clinical outcomes of risk groups were reassessed after combining the MRD data with specific cytogenetic and molecular risk groups, i.e., patients with SR AML and MRD were added to the HR cohort, and those without MRD were added to the FR cohort. In the new risk-stratification system, 57 of 217 (26%) patients were in the HR cohort, and the remaining 160 (74%) patients were in the FR cohort. DFS at 3 years from induction I was 68%±9% for the FR cohort and 20%±16% (p<0.001) for the HR cohort. Cumulative incidence of relapse at 3 years from the end of induction I for those with FR or HR disease was 27%±9% and 71%±17%, respectively (p<0.001). Cytogenetics, molecular genotyping, and post-induction MDF analysis provide a robust means of stratifying all pediatric patients with AML into 2 risk groups with significantly different outcomes. This novel risk-allocation schema will be implemented in the upcoming COG Phase III AML trial. Disclosures: No relevant conflicts of interest to declare.
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Gudelytė, Laura, and Olga Navickienė. "Modelling of Systemic Risk of Banking Sector." Social Technologies 3, no. 2 (2013): 359–71. http://dx.doi.org/10.13165/st-13-3-2-09.
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Fernandes, B. M., S. Garcia, S. Ganhão, M. Rato, F. Pinheiro, M. Bernardes, and L. Costa. "SAT0449 SPONDYLOARTHRITIS AND FRACTURE RISK: DOES DXA REALLY HAVE AN IMPACT IN THE RISK OF FRACTURE ESTIMATED BY FRAX?" Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1181.1–1182. http://dx.doi.org/10.1136/annrheumdis-2020-eular.1570.
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Background:Low bone mineral density (BMD) is common in ankylosing spondylitis (AS). The fracture risk (FR) is increased and its reduction with pharmacologic therapy is not clearly defined in this population. However, early screening and bisphosphonates as first-line treatment are recommended.Objectives:To investigate the influence of dual-energy X-ray absorptiometry (DXA) in the ten-year risk of fracture assessed by FR Assessment Tool (FRAX) and to determine possible demographic or clinical factors associated with an increased FR in a spondyloarthritis (SpA) population.Methods:Retrospective study including all the over 40 years-old SpA patients (ASAS classification criteria) followed at our Rheumatology Department and registered in the national database. Demographic, clinical and laboratorial data were collected at the time of the last follow-up visit. Data from the last DXA (until 3 years prior to the last visit) were collected. Indication for pharmacological treatment by FRAX was assessed according to the national recommendations.Results:A total of 231 SpA patients were included: 126 males (54.5%), 53 (22.9%) smokers; 171 (74%) had AS, 23 (10%) had Inflammatory Bowel Disease Associated SpA and 37 (16%) had Undifferentiated SpA. At the last follow-up visit, the mean age was 52.9 years (±9.6) and the median disease duration was 21.9 years [1.0-55.5]. The mean ASDAS-CRP was 2.5 (±0.9) and the majority of patients had moderate (25.5%) or high (48.5%) disease activity (according to ASDAS). One hundred and thirty patients (56.3%) were taking NSAIDs, 45 (19.5%) were taking glucocorticoids, 85 (36.8%) were under csDMARDs and 170 (73.6%) under bDMARDs [157 (68%) under TNFi, 11 (4.8%) under secukinumab and 2 (0.9%) under ustekinumab].Eleven patients (4.8%) had previous fragility fractures, 118 (51.1%) had DXA in the last 3 years and 167 (72.3%) were taking calcium and/or vitamin D supplements.Sixteen patients (6.9%) had indication for treatment by FRAX without DXA and 9 of these (56.3%) were already under treatment. Similarly, 16 (6.9%) had indication for treatment by FRAX with DXA and 13 of these (81.3%) were already under treatment. Ten patients (4.3%) were reclassified in FRAX with DXA: 7 (3%) had no indication for treatment by FRAX without DXA but obtained it by FRAX with DXA and 3 (1.3%) had indication for treatment by FRAX without DXA but they lost it by FRAX with DXA. We found a moderate level of agreement in the indication for treatment between FRAX with and without DXA (kappa=0.595; p<0.001). The use of DXA in FRAX estimated a significant higher median FR, both for major osteoporotic fracture (2.4% [0.8-31.0] vs 1.8% [0.6-20.0]; p<0.001) and for hip fracture (0.5% [0.0-23.0] vs 0.2% [0.0-14.0]; p<0.001).We found significant correlations between FR and some disease-related variables (table 1).Table 1.Correlations between the risk of fracture estimated by FRAX and disease-related variables.Disease durationBASDAIASDAS-CRPBASMIBASFIEstimated fracture risk by FRAX:without DXAmajor osteoporotic fracturer=0.352p<0.001r=0.204p=0.002r=0.214p=0.001r=0.301p<0.001r=0.317p<0.001hip fracturer=0.389p<0.001r=0.142p=0.034r=0.170p=0.011r=0.305p<0.001r=0.275p<0.001with DXAmajor osteoporotic fracturer=0.227p=0.014r=0.314p=0.001r=0.356p<0.001r=0.293p=0.002r=0.379p<0.001hip fracturen.s.r=0.197p=0.036r=0.269p=0.004r=0.271p=0.004r=0.258p=0.006Conclusion:Our results showed that a similar number of patients had indication for pharmacological treatment by FRAX both with and without DXA. Although the inclusion of DXA resulted in a higher estimated FR by FRAX, the observed moderate level of agreement between FRAX with and without DXA suggests that the FR estimation by FRAX, even without DXA, may be a reasonable approach in SpA patients. In line with literature, we found significant associations between the estimated risk fracture by FRAX and some disease activity and function measures.Disclosure of Interests:Bruno Miguel Fernandes: None declared, Salomé Garcia: None declared, Sara Ganhão: None declared, Maria Rato: None declared, Filipe Pinheiro: None declared, Miguel Bernardes Speakers bureau: Abbvie, Amgen, Biogen, Eli-Lilly, Glaxo-Smith-Kline, Pfizer, Janssen, Novartis, Lúcia Costa: None declared
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Honda, Yohsuke, Shinsuke Mori, Tomoya Fukagawa, Toshihiko Kishida, Takahide Nakano, Shigemitsu Shirai, Masafumi Mizusawa, et al. "ULSOSEAL Technique: A Unique Technique to Achieve Hemostasis Using ExoSeal in High-Risk Patients after Common Femoral Artery Puncture." Journal of Interventional Cardiology 2021 (August 28, 2021): 1–7. http://dx.doi.org/10.1155/2021/2470333.
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This study aimed to assess the safety and feasibility of the ULtrasound-guided uSe Of exoSEAL technique (ULSOSEAL technique) in patients at a high risk of complications following the use of ExoSeal. ExoSeal is a novel, completely extravascular hemostatic device that can treat punctures of the common femoral artery; however, it is not preferable for use in cases that require hemostasis of complex puncture sites. From November 2019 to August 2020, the ULSOSEAL technique was performed in 35 patients with implanted stents (6 patients, 17%), severe calcification (32 patients, 91%), and plaque (7 patients, 20%) around the puncture site; the presence of these conditions is usually undesirable when using ExoSeal. The antegrade approach was used in 22 patients (71%). The size of the ExoSeal used was 5 Fr (13 patients, 37%), 6 Fr (21 patients, 60%), and 7 Fr (1 patient, 2%). Technical success was achieved in 34 patients (97%), while ExoSeal malfunction occurred in 1 patient. There was no incidence of vessel occlusion, pseudoaneurysm, arteriovenous fistula, infection, and secondary bleeding. One patient developed a hematoma (>5 cm in size); however, it occurred before the use of ExoSeal due to side leakage from the inserted sheath. The ULSOSEAL technique was safe and feasible for hemostasis in patients who were considered unsuitable for the ExoSeal device.
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Özçoban, Mehmet Şükrü, Muhammed Erdem Isenkul, Selçuk Sevgen, Seren Acarer, and Mertol Tüfekci. "Modelling the Effects of Nanomaterial Addition on the Permeability of the Compacted Clay Soil Using Machine Learning-Based Flow Resistance Analysis." Applied Sciences 12, no. 1 (December 24, 2021): 186. http://dx.doi.org/10.3390/app12010186.
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Impermeable base layers that are made of materials with low permeability, such as clay soil, are necessary to prevent leachate in landfills from harming the environment. However, over time, the permeability of the clay soil changes. Therefore, to reduce and minimize the risk, the permeability-related characteristics of the base layers must be improved. Thus, this study aims to serve this purpose by experimentally investigating the effects of nanomaterial addition (aluminum oxide, iron oxide) into kaolin samples. The obtained samples are prepared by applying standard compaction, and the permeability of the soil sample is experimentally investigated by passing leachate from the reactors, in which these samples are placed. Therefore, Flow Resistance (FR) analysis is conducted and the obtained results show that the Al additives are more successful than the Fe additive in reducing leachate permeability. Besides, the concentration values of some polluting parameters (Chemical Oxygen Demand (COD), Total Kjeldahl Nitrogen (TKN), and Total Phosphorus (TP)) at the inlet and outlet of the reactors are analyzed. Three different models (Artificial Neural Networks (ANN), Multiple Linear Regression (MLR), Support Vector Machine (SVM)) are applied to the data obtained from the experimental study. The results have shown that polluting parameters produce high FR regression similarity rates (>75%), TKN, TP, and COD features are highly correlated with the FR value (>60%) and the most successful method is found to be the SVM model.
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Nosari, Annamaria, Guido Nador, Andrea de Gasperi, Nichelatti Michele, Anghilieri Michela, Cozzi Paola, Mancini Valentina, et al. "Complications of Central Venous Catheters in Patients with Hematologic Malignancy: Analysis of Risk Factors." Blood 104, no. 11 (November 16, 2004): 4520. http://dx.doi.org/10.1182/blood.v104.11.4520.4520.
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Abstract CVC-related complications were retrospectively analysed for 373 CVCs inserted in 261 hematologic pts consecutively admitted to our Hematology Department between January 2002 and March 2004. Pts diagnosis comprised AML (96 pts, 36.8%), ALL (19 pts, 7.3%), lymphoproliferative disorders (74 pts, 28.3%), MM (51 pts, 19.5%), CML (13 pts, 5%), others (8 pts, 3.1%). The CVCs were polyurethane Plastimed three lumen 7 Fr (193 cases) for chemotherapy and polyurethane Arrow three lumen 12 Fr (173 cases) for chemotherapy and peripheral blood stem cell (PBSC) apheresis. CVCs were inserted, according to physician’s judgement, either at bedside (369 cases) or in the operating room (4 cases) and were used for drug infusion in 309 cases (82.8%), for total parenteral nutrition in 19 cases (5.1%), for blood transfusions in 226 cases (60.6%), for PBSC apheresis in 152 cases (40.7%). Fifty five CVCs were inserted in neutropenic pts ( N < 1 x 109/L); severe thrombocytopenia (Plts < 30 x 109/L) was present in 33/373 cases. Antithrombotic prophylaxis with low molecular weight heparin because of previous thrombosis was instituted in 33 cases (8.8%). At univariate and multivariate analysis the following risk factors for catheter-related bloodstream infections were considered: pt age, number of days/catheter, haematological disease, catheter lumen, administration of chemotherapy (standard- vs high-dose), presence of neutropenia. The median duration of CVCs after placement was 22.7 days (range 2–70) for the 7 Fr lumen, and 9 (range 1–39) for the 12 Fr. Major hemorrhagic complications related to the insertion procedure were observed in 4 cases of whom 2 were severely thrombocytopenic. CVC occlusion were observed in 24 cases (6.4%). Thrombotic complications developed in 7 cases (1.87% of inserted CVCs) and in 2/7 were complicated by pulmonary embolism; thrombophilia tests were negative in all 7 pts who developed thrombosis. Among febrile pts the frequency of bacteriemias was 19.6% (73/373 cases) of which 52/373 were CVC-related (13.9%). Approximately 6% of cases (23/373 CVCs) had CVC exit point infection with or without associated bacteriemia. Gram positive bacteria were isolated in 49 cases (67.1%), 38 of which were CVC-related (19 S. epidermidis, 4 S. pneumoniae, 3 S. aureus, 3 Enterococci species, 9 others). Gram negative bacteria were isolated in 23 cases, of which 13 were CVC-related (5 E.coli, 4 E. cloacae, 2 P. aeruginosa, 2 K pneumoniae). Candida was isolated in one case. Overall mortality in our patient population was 4.2% (11/261 pts); one patient only died of infection (P. aeruginosa sepsis) not CVC-related. At univariate and multivariate analysis significant risk factors for infection (p<0.0001) were only the number of days/catheters and duration of neutropenia. Among severely thrombocytopenic pts, haemorrhagic complications at CVC insertion were infrequent (6%). Although pts in our study population frequently displayed prolonged and severe neutropenia, frequency of CVC-related bacteremias was low (13.9%) compared to a general population reported frequency of 5–25%. Moreover, none of the pts died of CVC-related infection.
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Mamelak, Adam, Vivien Bonert, Ning-Ai Liu, Anat BenShlomo, Artak Labadzhyan, Risha Malik, Albert Shamouelian, and Odelia Cooper. "PMON47 Fluid restriction reduces hyponatremia and hospital readmission rates following pituitary surgery." Journal of the Endocrine Society 6, Supplement_1 (November 1, 2022): A553—A554. http://dx.doi.org/10.1210/jendso/bvac150.1150.
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Abstract Rationale: Hyponatremia occurs in approximately 20% of patients after transsphenoidal pituitary surgery (TSS). Symptomatic delayed hyponatremia from SIADH is a major cause of morbidity and hospital readmission. Prophylactic fluid restriction (FR) protocols starting 2-5 days after surgery may potentially reduce rates of symptomatic hyponatremia and readmissions. Methods Patients who underwent TSS for sellar and parasellar masses at a tertiary referral center were discharged with a one-liter fluid restriction protocol. Serum sodium levels were measured on post-operative day (POD) 7 with telephone follow-up care. Rates of hyponatremia and readmissions were compared to a cohort of 316 post-operative patients treated prior to the protocol. Numerical variables were summarized as mean ± SD and significance testing calculated by Chi-square and t-test. Results 105 patients were enrolled on the FR protocol upon discharge. Twelve patients were excluded as they had diabetes insipidus or prolonged hospitalization beyond POD 7. Ninety-three patients were included in the analysis, of whom 74.3% had pituitary adenomas, 5.4% Rathke's Cleft cysts, 8.6% meningiomas, 5.4% apoplexy, 2.2% craniopharyngiomas, and 4.3% other masses. Hyponatremia occurred in 13/93 (14%) patients. Mean POD 7 sodium was 137.9 mmol/L across the entire cohort. Two patients (2.1%) were readmitted for hyponatremia, while 3 were re-admitted for other causes. 88/93 (94.6%) of patients complied with the FR protocol. Of the 5 non-compliant patients, 2 developed hyponatremias (40%) compared to 3/88 (3.4%) in those who complied (p=0.008). Mean POD7 sodium was 138 (+/-4.5) mmol/L in those that complied and 135 (+/- 4.7) mmol/L in those who did not. Overall readmission rate for those with postoperative hyponatremia was 23% compared to 2.5% for those with normal sodium levels (p=0.0023). 15.4% of patients with hyponatremia were re-admitted for hyponatremia treatment, compared to 0/80 (0%) of those who did not develop post-operative hyponatremia (p=0.0004). Age and BMI did not impact hyponatremia rates. In 316 patients treated in 2012-2018 prior to the FR protocol, 78 (24.7%) developed delayed hyponatremia with 6% readmitted for hyponatremia. Thirty nine percent of patients with delayed hyponatremia were re-admitted, compared to 7.6% for those without hyponatremia. Compared to patients not on FR, patients on the FR protocol had 50% reduced risk of hyponatremia (OR=0.49 (95% CI 0.26-0.94, p=0.03), and a 3-fold reduced risk of overall readmissions (OR=0.31; 95% CI 0.12-0.81, p=0.0157) and readmission for hyponatremia (OR= 0.34;95% CI 0.08-1.5, p=0.16). A post-operative CSF leak or use of a lumbar drain were associated with an increased readmission rate in the historical cohort. Conclusion Instituting a one-liter daily FR protocol in patients after TSS results in significantly reduced rates of hyponatremia, overall readmissions, and readmission for symptomatic hyponatremia. A FR protocol should become routine practice in the post-operative care of patients undergoing pituitary surgery. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
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Saeed, Sahrai, Anastasia Vamvakidou, Spyridon Zidros, George Papasozomenos, Vegard Lysne, Rajdeep S. Khattar, and Roxy Senior. "Sex differences in transaortic flow rate and association with all-cause mortality in patients with severe aortic stenosis." European Heart Journal - Cardiovascular Imaging 22, no. 9 (March 18, 2021): 977–82. http://dx.doi.org/10.1093/ehjci/jeab045.
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Abstract Aims It is not known whether transaortic flow rate (FR) in aortic stenosis (AS) differs between men and women, and whether the commonly used cut-off of 200 mL/s is prognostic in females. We aimed to explore sex differences in the determinants of FR, and determine the best sex-specific cut-offs for prediction of all-cause mortality. Methods and results Between 2010 and 2017, a total of 1564 symptomatic patients (mean age 76 ± 13 years, 51% men) with severe AS were prospectively included. Mean follow-up was 35 ± 22 months. The prevalence of cardiovascular disease was significantly higher in men than women (63% vs. 42%, P < 0.001). Men had higher left ventricular mass and lower left ventricular ejection fraction compared to women (both P < 0.001). Men were more likely to undergo an aortic valve intervention (AVI) (54% vs. 45%, P = 0.001), while the death rates were similar (42.0% in men and 40.6% in women, P = 0.580). A total of 779 (49.8%) patients underwent an AVI in which 145 (18.6%) died. In a multivariate Cox regression analysis, each 10 mL/s decrease in FR was associated with a 7% increase in hazard ratio (HR) for all-cause mortality (HR 1.07; 95% CI 1.03–1.11, P < 0.001). The best cut-off value of FR for prediction of all-cause mortality was 179 mL/s in women and 209 mL/s in men. Conclusion Transaortic FR was lower in women than men. In the group undergoing AVI, lower FR was associated with increased risk of all-cause mortality, and the optimal cut-off for prediction of all-cause mortality was lower in women than men.
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Li, Bo. "GCT-24. RELAPSE PATTERN AND QUALITY OF LIFE IN PATIENTS WITH LOCALIZED GERMINOMA ORIGINATING FROM BASAL GANGLIA REGION." Neuro-Oncology 22, Supplement_3 (December 1, 2020): iii332—iii333. http://dx.doi.org/10.1093/neuonc/noaa222.244.
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Abstract BACKGROUND The optimal radiation field in localized basal ganglia (BG) germinoma was not well defined, mostly due to unknown relapse patterns. In our institute, both focal radiotherapy (FR) and craniospinal irradiation (CSI) plus boost were considered in this population until whole-brain radiotherapy (WBRT) plus boost became an option in 2008. Thus, a retrospective study was conducted to address the issue. Furthermore, the health-related quality of life (HRQOL) was also evaluated. METHODS Patients who were diagnosed as localized BG germinoma between 2000 and 2017 were studied. HRQOL was evaluated by PedsQL 4.0 (≤15 years) and SF-36 (>15 years) questionnaires based on the age at last follow-up. RESULTS Among 161 patients included, 35 patients received FR, 109 patients received WBRT plus boost, and 17 patients received CSI plus boost. After a median follow-up of 83 months (range, 13 to 214 months), 15 patients relapsed in FR group, 4 in WBRT group and 0 in CSI group. The 5-year DFS was 74.3%, 97.2%, and 100%, respectively (p<0.001). Among 15 patients who relapsed after FR, 14 had positive radiological findings, in which 6 (42.8%) had lesions documented at the periventricular area, and 7 (50.0%) in the frontal lobe. HRQOL data were available in 69 patients, which generally scored low. In 38 patients evaluated by SF-36, those receiving CSI had significantly lower mental component scores than those receiving WBRT (p=0.027) or FR (p=0.011). CONCLUSIONS Patients with localized BG germinoma present a unique relapse pattern. WBRT, which covers at-risk areas, showed both better disease control and HRQOL.
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Goddard, Jack, Jemma Castle, Emily Southworth, Anya Fletcher, Stephen Crosier, Idoia Martin-Guerrero, Miguel Garcia-Ariza, et al. "MEDB-71. Molecular characterisation of group 4 medulloblastoma improves risk-stratification and its biological understanding." Neuro-Oncology 24, Supplement_1 (June 1, 2022): i123. http://dx.doi.org/10.1093/neuonc/noac079.445.
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Abstract Group 4 (MBGrp4) accounts for ~40% of medulloblastoma and the majority of non-WNT/non-SHH cases, yet its underpinning biology is poorly understood, and survival outcomes are not sufficiently explained by established clinico-pathological risk factors. We investigated the clinical and molecular correlates of MBGrp4, including second-generation methylation non-WNT/non-SHH subtypes (I-VIII) and whole chromosome aberration (WCA) subtypes (defined by chromosome 7 gain, 8 loss, and 11 loss; WCA-favourable risk [WCA-FR] ≥2 features, WCA-high risk [WCA-HR] ≤1 feature). A clinically-annotated MBGrp4 discovery cohort (n=378) was assembled from UK CCLG institutions, collaborating centres and SIOP-UKCCSG-PNET3/HIT-SIOP-PNET4 clinical trials. Contemporary molecular profiling integrating methylation/WCA subtypes and next-generation sequencing was performed. Survival modelling was carried out with patients >3 years old who received craniospinal irradiation (n=336). Association analysis confirmed relationships between methylation and WCA subtypes. Subtypes VI and VII were enriched for WCA-FR (p<0.0001) and aneuploidy, whereas subtype VIII was defined solely by i17q (p<0.0001). Whilst we observed an overall low mutational burden, WCA-HR harboured recurrent mutations in genes involved in chromatin remodelling (p=0.007). No gene-specific events were associated with disease risk, however integration of both methylation subtype and WCA groups enabled improved risk-stratification survival models that outperformed current schemes. The optimal MBGrp4-specific model stratified patients into: favourable-risk (local disease, subtype VII or subtype VI with WCA-FR; 39/194 [20%], 97% 5-year PFS), very-high-risk (metastatic disease with WCA-HR; 71/194 [37%], 50% 5-year PFS) and high-risk (remaining patients; 84/194 [43%], 67% 5-year PFS). Findings were validated in independent cohorts. Comprehensive clinico-molecular assessment of MBGrp4 provides important understanding of its clinical and biological heterogeneity. Our novel MBGrp4 stratification scheme removes standard risk disease and identifies a favourable risk group (20% of MBGrp4) with potential for therapy de-escalation. Current therapeutic strategies are insufficient for the very-high risk group (encompassing 37% of MBGrp4), for whom novel therapies are urgently required.
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Lal, Punita, Vipul Nautiyal, Tamojit Chaudhuri, Mranalini Verma, Koilpillai Joseph Maria Das, and Shaleen Kumar. "Is aspiration as detected on pretreatment video fluorography, a harbinger of poor quality of life and early mortality in cancers of the upper aerodigestive tract treated with radiotherapy?" South Asian Journal of Cancer 03, no. 04 (October 2014): 209–12. http://dx.doi.org/10.4103/2278-330x.142968.
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Abstract Background: Patients with cancers of the upper aerodigestive tract (head and neck cancer (HNC)) tend to aspirate, either due to disease or treatment. The association of aspiration (documented on video fluorography (VFG)) with quality of life (QOL) and unexpected mortality was studied prospectively in patients treated with simultaneous integrated boost technique of intensity-modulated radiotherapy (SIB-IMRT). Materials and Methods: Moderately advanced (stage III/IV) HNC were treated by SIB-IMRT delivering 66 Gy/30 fr, 60 Gy/30 fr, and 54 Gy/30 fr to high, intermediate, and low risk volumes, respectively. They underwent serial VFG and QOL assessments (Quality of Life Questionnaire-Core 30 ( QLQ-C30) and head and neck-35 (HN35) European Organisation for Research and Treatment of Cancer (EORTC) tools) at 0, 3, and 6 months. Pharyngeal musculature (PM) was additionally delineated on planning computed tomography (CT) scans as potential organs at risk (OARs). Results: Between November 2009 and May 2011, 20 HNC were treated as per protocol. All patients were fit (Karnofsky performance status (KPS) ≥ 80). Based on VFG findings, seven patients (4/9 oropharynx and 3/11 laryngopharynx) were grouped as aspirators (A) and remaining 13 as non-aspirators (NA). The QOL study showed that pretreatment coughing and swallowing difficulties were greater in group A versus NA and remained persistently higher. In group A, deaths attributable to aspiration were seen in 3/7 patients, while none occurred in the NA group (Fisher′s exact P = 0.03). The mean PM dose was 60 Gy in both the groups and mean V60 was similar at 69 and 67% in A and NA groups, respectively. Conclusions: VFG helps identify patients who aspirate and are at risk of premature death due to its complications, alerting caregivers to direct attention appropriately.
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Fujita, Toshihiro, Shinichi Hashimoto, Shiroh Tanoue, Kengo Tsuneyoshi, Yoshitaka Nakamura, Makoto Hinokuchi, Hiromichi Iwaya, et al. "Factors Associated with the Technical Success of Bilateral Endoscopic Metallic Stenting with Partial Stent-In-Stent Placement in Patients with Malignant Hilar Biliary Obstruction." Gastroenterology Research and Practice 2019 (September 16, 2019): 1–7. http://dx.doi.org/10.1155/2019/5928040.
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Background. Bilateral biliary drainage decreases the risk of cholangitis, but bilateral endoscopic metallic stenting is technically challenging. Aim. We retrospectively evaluated the factors associated with successful bilateral self-expanding metal stent (SEMS) placement using the partial stent-in-stent (PSIS) method for malignant hilar biliary obstruction and also assessed the safety and efficacy of this technique. Methods. From April 2010 to February 2016, 47 consecutive patients (mean age, 73.0±8.6 years; 32 males and 15 females) underwent PSIS placement for malignant hilar biliary obstruction in our hospital. The technical success of PSIS, clinical response, and complications were investigated. Factors associated with the technical success of PSIS were assessed. Using a propensity score-matched analysis, we compared the procedure time, clinical response, complications, stent patency, and survival time in 17 matched patients treated with bilateral SEMS placement using a SEMS delivery system of <6.0 or ≥6.0 Fr. Results. The technical success rate was 77%. The clinical response rate was 91%, and the complication rate was 26%. Regarding complications, pancreatitis occurred in 5 patients (11%), cholangitis in 6 (13%), and cholecystitis in 1 (2%). A multiple logistic regression analysis identified the use of a SEMS with a delivery system<6.0 Fr as a factor associated with technical success (P=0.033; odds ratio, 10.769; 95% confidence interval, 1.205-96.212). In the 17 matched patients assigned according to the SEMS delivery system size, the procedure time was significantly shorter in those with a delivery system size<6.0 Fr than in those with ≥6.0 Fr (P<0.01). There were no significant differences in the clinical response, complication rate, stent patency, or survival time between the two groups. Conclusion. Using a delivery system<6.0 Fr in size helped improve the technical success and reduced the procedure time for the placement of a SEMS by the PSIS method.
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Arrighi, C., M. Brugioni, F. Castelli, S. Franceschini, and B. Mazzanti. "Urban micro-scale flood risk estimation with parsimonious hydraulic modelling and census data." Natural Hazards and Earth System Sciences 13, no. 5 (May 31, 2013): 1375–91. http://dx.doi.org/10.5194/nhess-13-1375-2013.
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Abstract. The adoption of 2007/60/EC Directive requires European countries to implement flood hazard and flood risk maps by the end of 2013. Flood risk is the product of flood hazard, vulnerability and exposure, all three to be estimated with comparable level of accuracy. The route to flood risk assessment is consequently much more than hydraulic modelling of inundation, that is hazard mapping. While hazard maps have already been implemented in many countries, quantitative damage and risk maps are still at a preliminary level. A parsimonious quasi-2-D hydraulic model is here adopted, having many advantages in terms of easy set-up. It is here evaluated as being accurate in flood depth estimation in urban areas with a high-resolution and up-to-date Digital Surface Model (DSM). The accuracy, estimated by comparison with marble-plate records of a historic flood in the city of Florence, is characterized in the downtown's most flooded area by a bias of a very few centimetres and a determination coefficient of 0.73. The average risk is found to be about 14 € m−2 yr−1, corresponding to about 8.3% of residents' income. The spatial distribution of estimated risk highlights a complex interaction between the flood pattern and the building characteristics. As a final example application, the estimated risk values have been used to compare different retrofitting measures. Proceeding through the risk estimation steps, a new micro-scale potential damage assessment method is proposed. This is based on the georeferenced census system as the optimal compromise between spatial detail and open availability of socio-economic data. The results of flood risk assessment at the census section scale resolve most of the risk spatial variability, and they can be easily aggregated to whatever upper scale is needed given that they are geographically defined as contiguous polygons. Damage is calculated through stage–damage curves, starting from census data on building type and function, for the main categories in the study area: structures, household contents and commercial contents. This method is tested in the area of the St. Croce district in Florence, one of the most seriously affected in the famous 1966 flood.
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Vogiatzi, Maria, Eric Macklin, Robert Schneider, Joseph Lane, Irina Chaikodinov, Nancy Olivieri, Melanie Kirby, et al. "Vertebral Abnormalities by Spine Morphometry in Thalassemia." Blood 108, no. 11 (November 16, 2006): 3829. http://dx.doi.org/10.1182/blood.v108.11.3829.3829.
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Abstract Background: The Thalassemia Clinical Research Network previously reported a high prevalence of low bone mass in thalassemia (thal) despite current treatment practices. Currently we report the association of vertebral compression fractures (frs) and vertebral (vert) growth disturbances with bone pain, bone mass, bone turnover and therapies in thal. Methods: Vert frs (T10-L4) were assessed by morphometry. Vert compression frs by quantitative assessment (Fr-qt) were defined as anterior or mid-vert hts at least 25% shorter than posterior hts or average vert ht at least 25% shorter than hts of adjacent vert. Frs by qualitative assessment (Fr-ql) and growth plate (GP) abnormalities were determined. Bone mineral density by DXA and bone turnover markers were measured. Results: 353 thal pts were studied 64% beta-thal major (beta-TM) 12% beta-thal Intermedia 11% E/beta-thal 11% HbH 1% alpha thal 1% stem cell transplant pts, mean age 23 (SD 12 yrs, range 6 – 75 yrs). General bone pain and back pain were self-reported for the 30 days prior to morphometry by 34% and 26% pts, respectively. Fr-qt occurred in 41 (12%) and Fr-ql in 9 (2.5%), while only 7 pts (2%) had a history of vertebral fr and prevalence did not differ by type of thal or gender. Fr-qt and Fr-ql prevalence increased with age (Fr-qt p < 0.1; Fr-ql p < 0.001). After controlling for age, lumbar DXA Z or T scores were negatively associated with frs (odds ratio for 1-SD increase: Fr-qt 0.670, 95% CI 0.488 to 0.921, p = 0.01; Fr-ql 0.303, 95% CI 0.125 to 0.730, p < 0.01). Hypertransfusion, yrs or onset of chelation, serum transferrin receptor or ferritin did not correlate with frs after controlling for age. Decreased ht Z score (p < 0.01) and growth hormone deficiency (GHD) (p = 0.01) were associated with higher risk for Fr-qt after correcting for age. Hypogonadism was also associated with Fr-qt but not after correction for age (odds ratio 1.916, 95% CI 0.927 to 3.959 p = 0.08). Presence of Fr-ql but not Fr-qt was correlated with generalized bone and back pain specifically (Fr-ql vs. back pain odds ratio 11.05, 95% CI 2.035 to 110.2, p = 0.001). GP abnormalities were present in 30 pts (9%), including 7 (2%) who also had Fr-qt. Prevalence of GP did not differ by gender but was more common in beta-TM pts (13%), E-beta thal (5%) and among all others (0%) (p=0.04). In beta-TM pts, lumbar DXA Z or T scores (p < 0.01), ht Z scores (p < 0.001) and age that chelation was started (p < 0.01) were all negatively associated with GP abnormalities after controlling for age. Hypogonadism (p = 0.001) and GHD (p = 0.04) were positively associated with GP abnormalities after controlling for age. Presence of GP was not correlated with either general bone pain or back pain specifically. Conclusions: Morphometry identified vert abnormalities in 18% of thal pts. These included moderate to severe vert wedging or GP disturbances. A subgroup of pts (2.5%) also had vert compression frs by radiologic assessment. Morphometry vert lesions were associated with low bone mass. Back pain was strongly correlated with radiologic frs but not with other lesions seen by morphometry.
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Schmidt, Thorsten, and Stefan Tappe. "Dynamic term structure modelling with default and mortality risk: new results on existence and monotonicity." Banach Center Publications 105 (2015): 211–38. http://dx.doi.org/10.4064/bc105-0-13.
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Scott, Ian C., Sophia Steer, Rachael Tan, Paola Forabosco, Ann W. Morgan, Anne Hinks, Wendy Thomson, et al. "Prediction model for rheumatoid arthritis: modelling 46 genetic risk variants with smoking." Lancet 381 (February 2013): S97. http://dx.doi.org/10.1016/s0140-6736(13)60537-1.
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Gualdi, Baptiste, Emma Binet-Stéphan, André Bahabi, Roxane Marchal, and David Moncoulon. "Modelling Fire Risk Exposure for France Using Machine Learning." Applied Sciences 12, no. 3 (February 4, 2022): 1635. http://dx.doi.org/10.3390/app12031635.
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Wildfires generating damage to assets are extremely rare in France. The peril is not covered by the French natural catastrophes insurance scheme (law of 13 July 1982). In the context of the changing climate, Caisse Centrale de Réassurance—the French state-owned reinsurance company involved in the Nat Cat insurance scheme—decided to develop its knowledge on the national exposure of France to wildfire risks. Current and future forest fires events have to be anticipated in case one of the events threatens buildings. The present work introduces the development of a catastrophe loss risk model (Cat model) for forest fires for the French metropolitan area. Cat models are the tools used by the (re)insurance sector to assess their portfolios’ exposure to natural disasters. The open-source national Promethée database focusing on the South of France for the period 1973–2019 was used as training data for the development of the hazard unit using machine learning-based methods. As a result, we observed an extension of the exposure to wildfire in northern areas, namely Landes, Pays-de-la-Loire, and Bretagne, under the RCP 4.5 scenario. The work highlighted the need to understand the multi-peril exposure of the French country and the related economic damage. This is the first study of this kind performed by a reinsurance company in collaboration with a scholarly institute, in this case EURIA Brest.
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Pitchaimuthu, Selladurai, Jitesh J. Thakkar, and P. R. C. Gopal. "Modelling of risk factors for defence aircraft industry using interpretive structural modelling, interpretive ranking process and system dynamics." Measuring Business Excellence 23, no. 3 (October 22, 2019): 217–39. http://dx.doi.org/10.1108/mbe-05-2018-0028.
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Purpose Risk management in defence aircraft industry has considerable interest among academics and practitioners. The purpose of this paper is to develop interactions among risk factors dimensions (RFDs) and inspect the importance relationship among the performance measures in Indian aircraft industry and, finally, understand the effect of involvements provided by the managerial team on risk reduction process. Design/methodology/approach An extensive literature review was carried out to identify 26 risk parameters and 13 performance measure indices relevant for an aircraft industry. Survey method was used to obtain the importance of these parameters and measures. Further, these factors are grouped into five risk dimensions based on the brain storming session by the project managers. Initially, Risk factors for defense aircraft industry (RFDs) analyzed by Interpretative structural model (ISM) to know the contextual relationship among the RFDs and then applied Interpretive ranking process (IRP) to inspect the pre-eminence relationship among them. Finally, SD is applied to understand the effect of involvements provided by the managerial team on risk reduction process. Findings Government policy and legal RFDs has emerged as the key driving RFDs. In IRP modelling, technology RFD has emerged as more influential RFD which is the more relevant factor with respect to performance measure indices and this result is supported by detailed sensitivity analysis of system dynamic model. Originality/value The outcomes of this research can help project management team to identify the high severity risk factors which need immediate risk reduction/mitigation action.
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Himes, Austin J., Eric C. Turnblom, Robert B. Harrison, Kimberly M. Littke, Warren D. Devine, Darlene Zabowski, and David G. Briggs. "Predicting Risk of Long-Term Nitrogen Depletion Under Whole-Tree Harvesting in the Coastal Pacific Northwest." Forest Science 60, no. 2 (April 22, 2014): 382–90. http://dx.doi.org/10.5849/forsci.13-009.
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Kusdian, R. Didin. "Simple macro aggregate transport demand modelling in river transport study." MATEC Web of Conferences 181 (2018): 12002. http://dx.doi.org/10.1051/matecconf/201818112002.
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Sustainability and development of river transport can reduce the burden of road transport, where the development of road transport requires clearing new land is increasingly expensive and development is quite expensive. To estimate the amount of potential movement of people and goods through river mode choice model can be derived based on a comparison of risk at each mode, whereby the greater the risk will be even smaller portion of the mode selected. From the results of the model calculation of the aggregate distribution modes, obtained through a portion of the potential movement of the Batang Hari river in Jambi, Sumatra Island, Indonesia is 13, 89% for the movement of people and 14.85% for goods.
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Hantson, Stijn, Almut Arneth, Sandy P. Harrison, Douglas I. Kelley, I. Colin Prentice, Sam S. Rabin, Sally Archibald, et al. "The status and challenge of global fire modelling." Biogeosciences 13, no. 11 (June 9, 2016): 3359–75. http://dx.doi.org/10.5194/bg-13-3359-2016.
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Abstract. Biomass burning impacts vegetation dynamics, biogeochemical cycling, atmospheric chemistry, and climate, with sometimes deleterious socio-economic impacts. Under future climate projections it is often expected that the risk of wildfires will increase. Our ability to predict the magnitude and geographic pattern of future fire impacts rests on our ability to model fire regimes, using either well-founded empirical relationships or process-based models with good predictive skill. While a large variety of models exist today, it is still unclear which type of model or degree of complexity is required to model fire adequately at regional to global scales. This is the central question underpinning the creation of the Fire Model Intercomparison Project (FireMIP), an international initiative to compare and evaluate existing global fire models against benchmark data sets for present-day and historical conditions. In this paper we review how fires have been represented in fire-enabled dynamic global vegetation models (DGVMs) and give an overview of the current state of the art in fire-regime modelling. We indicate which challenges still remain in global fire modelling and stress the need for a comprehensive model evaluation and outline what lessons may be learned from FireMIP.
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Liu, Junyang, Motoki Kaidu, Ryuta Sasamoto, Fumio Ayukawa, Nobuko Yamana, Hiraku Sato, Kensuke Tanaka, et al. "Two-fraction high-dose-rate brachytherapy within a single day combined with external beam radiotherapy for prostate cancer: single institution experience and outcomes." Journal of Radiation Research 57, no. 3 (June 1, 2016): 280–87. http://dx.doi.org/10.1093/jrr/rrw003.
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Abstract We investigated the outcomes of treatment for patients with localized prostate cancer (PCa) treated with 3D conformal radiation therapy (3D-CRT) followed by two-fraction high-dose-rate brachytherapy within a single day (2-fr.-HDR-BT/day) at a single institution. A total of 156 consecutive Asian males (median age, 67 years) were enrolled. To compare our findings with those of other studies, we analyzed our results using the D'Amico classification, assigning the patients to low- ( n = 5; 3.2%), intermediate- ( n = 36; 23.1%) and high-risk ( n = 115; 73.7%) groups (Stage T3 PCa patients were classified as high-risk). One patient in the D'Amico low-risk group (20%), 13 intermediate-risk patients (36.1%) and 99 high-risk patients (86.1%) underwent androgen deprivation therapy. We administered a prescription dose of 39 Gy in 13 fractions of 3D-CRT combined with 18 Gy of HDR-BT in two 9-Gy fractions delivered within a single day. We did not distinguish between risk groups in determining the prescription dose. The median follow-up period was 38 months. Of the 156 patients, one died from primary disease and five died from other diseases. The 3-year overall survival (OS) rates were 100%, 100% and 93.7%, and the 3-year ‘biochemical no evidence of disease (bNED)’ rates were 100%, 100% and 96.9% for the D'Amico low-, intermediate- and high-risk groups, respectively. No patient developed ≥ Grade 3 early toxicity. The Grade 3 late genitourinary toxicity rate was 2.6%, and no ≥ Grade 3 late gastrointestinal toxicity occurred. The efficacy and safety of this study were satisfactory, and longer-term follow-up is necessary.
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Holzmann, Hajo, and Matthias Eulert. "The role of the information set for forecasting—with applications to risk management." Annals of Applied Statistics 8, no. 1 (March 2014): 595–621. http://dx.doi.org/10.1214/13-aoas709.
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Forbes, Florence, Myriam Charras-Garrido, Lamiae Azizi, Senan Doyle, and David Abrial. "Spatial risk mapping for rare disease with hidden Markov fields and variational EM." Annals of Applied Statistics 7, no. 2 (June 2013): 1192–216. http://dx.doi.org/10.1214/13-aoas629.
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Popa, Mihnea Cristian, and Daniel Constantin Diaconu. "Flood and Flash Flood Hazard Mapping Using the Frequency Ratio, Multilayer Perceptron and Their Hybrid Ensemble." Proceedings 48, no. 1 (November 12, 2019): 6. http://dx.doi.org/10.3390/ecws-4-06429.
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The importance of identifying the areas vulnerable for both floods and flash-floods is an important component of risk management. The assessment of vulnerable areas is a major challenge in the scientific world. Adaptation and mitigation have generally been treated as two separate issues, both in public politics and in practice, in which mitigation is seen as the attenuation of the cause, and studies of adaption look into dealing with the consequences of climate change. Studies on the impact of climate change on flood risk are mostly conducted at the river basin or regional scale. Remote sensing and GIS technologies, together with the latest modelling techniques, can contribute to our ability to predict and manage floods. Various methods are commonly used to map flood sensitivity. Recent methods such as multicriteria evaluation, decision tree analysis (DT), fuzzy theory, weight of samples (WoE), artificial neural networks (ANN), frequency ratio (FR) and logistic regression (LR) approaches have been widely used by many researchers.
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González-Riancho, P., I. Aguirre-Ayerbe, I. Aniel-Quiroga, S. Abad, M. González, J. Larreynaga, F. Gavidia, O. Q. Gutiérrez, J. A. Álvarez-Gómez, and R. Medina. "Tsunami evacuation modelling as a tool for risk reduction: application to the coastal area of El Salvador." Natural Hazards and Earth System Sciences 13, no. 12 (December 13, 2013): 3249–70. http://dx.doi.org/10.5194/nhess-13-3249-2013.
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Abstract. Advances in the understanding and prediction of tsunami impacts allow the development of risk reduction strategies for tsunami-prone areas. This paper presents an integral framework for the formulation of tsunami evacuation plans based on tsunami vulnerability assessment and evacuation modelling. This framework considers (i) the hazard aspects (tsunami flooding characteristics and arrival time), (ii) the characteristics of the exposed area (people, shelters and road network), (iii) the current tsunami warning procedures and timing, (iv) the time needed to evacuate the population, and (v) the identification of measures to improve the evacuation process. The proposed methodological framework aims to bridge between risk assessment and risk management in terms of tsunami evacuation, as it allows for an estimation of the degree of evacuation success of specific management options, as well as for the classification and prioritization of the gathered information, in order to formulate an optimal evacuation plan. The framework has been applied to the El Salvador case study, demonstrating its applicability to site-specific response times and population characteristics.
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Corner, Robert J., Ashraf M. Dewan, and Masahiro Hashizume. "Modelling typhoid risk in Dhaka Metropolitan Area of Bangladesh: the role of socio-economic and environmental factors." International Journal of Health Geographics 12, no. 1 (2013): 13. http://dx.doi.org/10.1186/1476-072x-12-13.
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Alcântara, Amadeus C. S., Israel Assis, Daniel Prada, Konrad Mehle, Stefan Schwan, Lúcia Costa-Paiva, Munir S. Skaf, Luiz C. Wrobel, and Paulo Sollero. "Patient-Specific Bone Multiscale Modelling, Fracture Simulation and Risk Analysis—A Survey." Materials 13, no. 1 (December 24, 2019): 106. http://dx.doi.org/10.3390/ma13010106.
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This paper provides a starting point for researchers and practitioners from biology, medicine, physics and engineering who can benefit from an up-to-date literature survey on patient-specific bone fracture modelling, simulation and risk analysis. This survey hints at a framework for devising realistic patient-specific bone fracture simulations. This paper has 18 sections: Section 1 presents the main interested parties; Section 2 explains the organzation of the text; Section 3 motivates further work on patient-specific bone fracture simulation; Section 4 motivates this survey; Section 5 concerns the collection of bibliographical references; Section 6 motivates the physico-mathematical approach to bone fracture; Section 7 presents the modelling of bone as a continuum; Section 8 categorizes the surveyed literature into a continuum mechanics framework; Section 9 concerns the computational modelling of bone geometry; Section 10 concerns the estimation of bone mechanical properties; Section 11 concerns the selection of boundary conditions representative of bone trauma; Section 12 concerns bone fracture simulation; Section 13 presents the multiscale structure of bone; Section 14 concerns the multiscale mathematical modelling of bone; Section 15 concerns the experimental validation of bone fracture simulations; Section 16 concerns bone fracture risk assessment. Lastly, glossaries for symbols, acronyms, and physico-mathematical terms are provided.
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Naulin, Marie, Andreas Kortenhaus, and Hocine Oumeraci. "FAILURE PROBABILITY OF FLOOD DEFENCE STRUCTURES/ SYSTEMS IN RISK ANALYSIS FOR EXTREME STORM SURGES." Coastal Engineering Proceedings 1, no. 32 (February 2, 2011): 13. http://dx.doi.org/10.9753/icce.v32.management.13.
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Extreme storm surges can cause failures of flood defences resulting in severe flooding of the hinterland and catastrophic damages. In order to quantify the risk of flooding an integrated risk analysis is being performed wherein one task is the determination of failure probabilities of flood defences. In this paper the failure probability calculations of flood defence structures and systems under the loading of extreme storm surges are reported. Moreover, the analysis of the breach and breach development is briefly introduced. Preliminary results of the failure probabilities and the breach modelling are presented using the example of the estuarine urban area of Hamburg, Germany. These results are put in context of an integrated risk analysis approach for extreme storm surges which is applied within an ongoing German joint research project.
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Boytsov, S. A., A. D. Deev, and S. A. Shalnova. "Mortality and risk factors for non-communicable diseases in Russia: Specific features, trends, and prognosis." Terapevticheskii arkhiv 89, no. 1 (January 15, 2017): 5–13. http://dx.doi.org/10.17116/terarkh20178915-13.
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In the Russian Federation, the increase in all-cause and cardiovascular disease mortality began in the 1960s and lasted almost continuously until 2003. In our country, the characteristics of mortality are its substantially higher rates among men and a large regional variability, which is associated with economic, climatic, and geographic factors. Urbanization coupled with dietary changes and the higher prevalence of hypertension is the most likely initial impetus to the rise in mortality rates. The subsequent increase in mortality can be explained by the higher prevalence of behavioral and biological risk factors, alcoholism, and, since the 1990s, by heavy and protracted socioeconomic upheavals and lifestyle changes. The mortality decline since 2006 has been linked to the strengthening of the health system and to the reduction in the prevalence of smoking among men and hypertension in women. The slowing down of the pace of mortality decline may be due to the increase in the prevalence of hypertension and obesity among men. The modelling data show that by 2025, reductions in smoking prevalence rates by 23% among men and by 12% among women and increases in the efficiency of hypertension treatment by 17.2% in men and by 11.2% in women will reduce cardiovascular mortality rates by 15%.
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Doyen, Jerome, Eric Francois, Anne-Claire Frin, Karen Benezery, Fuxiang Zhou, Pascale Romestaing, Olivier Chapet, Nicolas N. Barbet, and Jean-Pierre Gerard. "Contact x-ray brachytherapy 50 kV (CXB) for organ preservation in T2 T3a-b rectal cancer: Lyon-Nice experience in 120 patients." Journal of Clinical Oncology 33, no. 3_suppl (January 20, 2015): 676. http://dx.doi.org/10.1200/jco.2015.33.3_suppl.676.
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676 Background: Organ preservation (avoiding TME surgery) for T2 T3 a-b rectal cancer is a field of active clinical research. Contact X Ray CXB combined with external beam radiotherapy (EBRT) ± concurrent chemotherapy (CRT) is an attractive method to achieve clinical complete response (cCR) and consequently rectal preservation. We report an overview of 120 patients treated with CXB+EBRT over a 25 year period in Lyon since 1986 and then in Nice until 2012. Methods: Between 1986 and 2012, 120 patients presenting rectal adenocarcinoma T2 T3a-b (distal rectum: 87; middle rectum: 33) were treated with CXB +EBRT with conservative intent. In Lyon (1986-2001), 80 patients median age: 73y; T2:52; T3:28) risk were treated using CXB (80-110 Gy/3-4 fr/4-6 weeks) followed by EBRT (39 Gy/13 fr/18 days) and 192 Iridium implant boost (20 Gy). When cCR was achieved, close surveillance was proposed. In Nice (2002-2012), 40 patients (median age 81y; T2:22; T3:18) received CXB same regimen as in Lyon (using new Papillon 50 machine since 2009) + EBRT (45-50 Gy/5weeks) with concurrent chemotherapy (5-FU or Capecitabine). When cCR was achieved close surveillance was proposed or local excision (13 pts). Results: Median follow-up time 58 months in both groups. Local relapse occurred mainly in the 2 first years. Isolated lymph node recurrence <5%. Bowel function good or excellent when rectum preserved. Main clinical outcomes in table (some improved results in Nice possibly due to better treatment approach and patient selection). Conclusions: CXB with EBRT and concurrent capecitabine achieve safely high rate of cCR with organ preservation. The OPERA randomized trial will reproduce Lyon R 96 trial (Gerard JP, JCO 2004;22:2404) and test the superiority of CXB boost for organ preservation. [Table: see text]
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Nicolet, P., L. Foresti, O. Caspar, and M. Jaboyedoff. "Shallow landslide's stochastic risk modelling based on the precipitation event of August 2005 in Switzerland: results and implications." Natural Hazards and Earth System Sciences 13, no. 12 (December 9, 2013): 3169–84. http://dx.doi.org/10.5194/nhess-13-3169-2013.
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Abstract. Due to their relatively unpredictable characteristics, shallow landslides represent a risk for human infrastructures. Multiple shallow landslides can be triggered by widespread intense precipitation events. The event of August 2005 in Switzerland is used in order to propose a risk model to predict the expected number of landslides based on the precipitation amounts and lithological units. The spatial distribution of rainfall is characterized by merging data coming from operational weather radars and a dense network of rain gauges with an artificial neural network. Lithologies are grouped into four main units, with similar characteristics. Then, from a landslide inventory containing more than 5000 landslides, a probabilistic relation linking the precipitation amount and the lithology to the number of landslides in a 1 km2 cell, is derived. In a next step, this relation is used to randomly redistribute the landslides using Monte Carlo simulations. The probability for a landslide to reach a building is assessed using stochastic geometry and the damage cost is assessed from the estimated mean damage cost using an exponential distribution to account for the variability. Although the model reproduces well the number of landslides, the number of affected buildings is underestimated. This seems to result from the human influence on landslide occurrence. Such a model might be useful to characterize the risk resulting from shallow landslides and its variability.
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Novera, R., W. P. Rahayu, H. D. Kusumaningrum, N. Indrotristanto, and E. Nikastri. "Prevalence of Salmonella contamination in processing chain of selected chicken based side dishes." Food Research 4, no. 3 (January 17, 2020): 690–96. http://dx.doi.org/10.26656/fr.2017.4(3).338.
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This study was aimed to determine the prevalence, the level and the main contributing factors to contamination of Salmonella spp. in four selected chicken-based side dishes prepared for the school canteens. One hundred and seven samples were collected from four different food processing chains, i.e. fried chicken with precooking, fried chicken without precooking, breaded fried chicken, and sauced chicken. Salmonella contamination was determined by the most probable number (MPN) and confirmed with polymerase chain reaction. Salmonella spp. were detected in 8 of 21 chicken cuts samples (360-920 MPN/g) and in 4 of 30 end products samples (0.61-3 MPN/g). The fact that Salmonella was still found at the end product indicated that cross-contamination and/or inadequate heating process likely occurred. Besides the chicken cuts, the contributing factors to the Salmonella contamination were water (4 of 17 samples) and seasonings (8 of 13 samples). To ensure the safety of chicken-based side dishes prepared for the school canteen, adequate cooking process must be performed by all food handlers. The results of this study might contribute to analysing the risk of salmonellosis in Indonesia.
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Hathurusingha, Priyantha I., and Kenneth R. Davey. "Chemical taste taint accumulation in RAS farmed fish – A Fr 13 risk assessment demonstrated with geosmin (GSM) and 2-methylisoborneol (MIB) in barramundi ( Lates calcarifer )." Food Control 60 (February 2016): 309–19. http://dx.doi.org/10.1016/j.foodcont.2015.08.014.
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Chandrakash, Saravanan, and Kenneth R. Davey. "Advancing the Fr 13 risk framework to an integrated three-step microbiological failure synthesis of pasteurization of raw milk containing Mycobacterium avium subsp. Paratuberculosis (MAP)." Chemical Engineering Science 171 (November 2017): 1–18. http://dx.doi.org/10.1016/j.ces.2017.05.020.
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Argawu, A. S. "Multilevel Modelling of Under-Five Time to Death, and Risk Factors." Statistics of Ukraine 91, no. 1 (March 1, 2021): 34–46. http://dx.doi.org/10.31767/su.1(92)2021.01.04.
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Under-five mortality is a leading indicator of child health and overall development of a country. Sub-Saharan Africa remains the region with the highest under-5 mortality rate in the world, with 1 child in 13 dying before his or her fifth birthday. Half of all under-five deaths in 2019 occurred in just five countries: Nigeria, India, Pakistan, the Democratic Republic of the Congo, and Ethiopia. In Ethiopia, as the 2016 Ethiopia Demographic and Health Survey (EDHS) report showed that the under-five mortality declined from 166 deaths per 1,000 live births in 2000 to 67 deaths per 1,000 live births in 2019 mini EDHS report (60% decreasing rate). However, there are regional disparities problems on under-five children mortality in Ethiopia. Thus, the major purpose of this study was to model the multilevel effects of U5 child time to death, and to determine the risk factors for child’s death based on the last full report (2016 EDHS). The data were analysed using descriptive statistics, stratified Cox proportional hazards regression and multilevel parametric survival models. In the study, 635 (6.1%) U5 deaths have observed from 10,331 children. And, the overall probability of survival was 0.93. Results obtained by fitting both stratified Cox proportional hazards regression and lognormal parametric fixed-effect models: sex of child, type of birth, birth order, size (weight) of child at birth, months of breastfeeding, number of U5 and five children, family size, wealth index, frequency of listening radio, place of delivery place of residence, and geographical region were found to be significant factors for U5 children death or estimated mean survival time. Furthermore a high risk death of U5 children was found to be associated with male children, twined children, ≤ 6 months breastfeeding children, few number of children in the home, children from small family size, children average weight below, children from poor families, private health sectors delivered children, children from mothers didn’t not listen radio, children from rural areas, children from Afar, Somali and Harari regional states. In the lognormal parametric random effects model, 1.7 and 0.9 estimated variations were observed among regional and household cluster levels on U5 children mean survival times. The researchers recommended that governments, and other concerned bodies should give special supports for mothers whose children are at high risk of death.
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Vanderveer, Elysha, Steven J. T. Huang, Helene Bruyere, Tanya Gillan, Charles H. Li, Khaled Ramadan, Diego Villa, et al. "Oral Fludarabine and Intravenous Rituximab (FR) for Chronic Lymphocytic Leukemia (CLL): Long Term Outcomes and Secondary Malignancies in 673 Patients Treated in British Columbia (BC)." Blood 134, Supplement_1 (November 13, 2019): 4300. http://dx.doi.org/10.1182/blood-2019-125189.
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Background: Oral fludarabine and intravenous rituximab (FR) was the standard first-line therapy for CLL or small lymphocytic lymphoma (SLL) patients (pts) in BC from 2003-2015. Ibrutinib for relapsed/refractory (R/R) CLL was introduced and publicly funded in 2015. Our aim was to review long term outcomes of all CLL/SLL pts treated with FR in BC, including the impact of 2nd line therapy with ibrutinib versus chemoimmunotherapy and to report the risk of secondary malignancies in this population based cohort. Methods: The BC Provincial CLL Database was used to identify all CLL/SLL pts who received first-line FR from 2003-2017. The BC Cancer Registry was used to identify secondary malignancies occurring after FR. Primary outcomes were overall survival (OS) and treatment free survival (TFS), defined as start of FR to next-line therapy or death/last follow-up. Variables examined for impact on OS/TFS included age at FR, gender, primary diagnosis (CLL vs SLL), B symptoms, advanced stage (Rai stage 3-4 CLL, Ann Arbor 1-2 SLL), baseline hemoglobin, lymphocyte count, platelets, LDH and FISH abnormalities. All variables significant on univariate analyses (P<.1) were included in multivariate Cox proportional hazard regression models to identify significant predictors of OS/TFS. Results: 673 pts were identified as receiving FR as first-line therapy for CLL (86%) or SLL (14%). Median time from CLL/SLL diagnosis to FR was 2.5 years (y) (range 0.1-27.3). Median age at FR was 67 y (range 26-91) with 73% ≥ 60 y and 39% ≥ 70 y. Most pts were male (66.1%), had early stage disease (84.2%) with no B symptoms (89.7%) and normal LDH (81.1%). Of 411 pts with pre-treatment FISH testing, prevalence of FISH abnormalities were: 48.5% del13q, 25.7% trisomy 12, 12.9% del11q, 8.0% del17p. Median number of FR cycles was 6 (range 1-10). Median follow-up of living pts from FR was 6.4 y (range 0.2-12.7). 2 y and 5 y OS were 89.4% (95% CI: 86.8-91.6) and 73% (95% CI: 69.0-76.6) respectively; median OS 11.6 y (95% CI: 4.6-13.7 y). 2 y and 5 y TFS were 72% (95% CI: 68-75%) and 37% (95% CI: 33 - 41) respectively, median TFS 3.8 y (95% CI: 1.78-7.09). Those with del17p had significantly worse OS and TFS compared to those without (median OS 5.7 vs 13.7 y, P<.001; median TFS 1.4 vs 3.9 y, P<.001), Fig. 1. Multivariate analysis identified only del17p (HR 4.35, 95%CI: 2.10-9.01, P<.001) and age at FR (HR 1.04, 95% CI: 1.01-1.07, P=.007) as significant predictors of OS, and del17p (HR 4.3, 95% CI: 2.5-7.5, P<.001) as a significant predictor of TFS. During the follow up period, 351 pts (52%) went on to 2nd-line therapy: ibrutinib 87 (including 2 with BR and 1+R), cyclophosphamide-based (CVP/CHOP) +/- R 102, repeat FR 71, FCR 6, F alone 21, bendamustine +/-R 13, chlorambucil+/-R 38, steroids 3, R alone 3, alemtuzumab 2, other chemotherapy 3 and allotransplant 2. Median follow-up after 2nd-line therapy was 2.8 y (range 0.1-10.8). Median OS and TFS from 2nd-line treatment (TFS2) for ibrutinib (n=87) vs. for other treatments (n=264) was: OS not reached vs 5.3 y, P<.001; TFS2 not reached vs 1.2 y, P<.001. These significant differences persisted when analyses were restricted to those who received ibrutinib vs. chemoimmunotherapy (n=169): median OS not reached vs. 6.3 y (P=.002); median TFS not reached vs. 1.7 y (P<.001), Fig. 2. 2 y OS and TFS2 after ibrutinib were 91% (95% CI: 80-96%) and 78% (95% CI: 65-87%), respectively. A total of 202 malignancies were recorded after initiation of FR in 166 pts (24.7%), Table 1. The median time from FR to 2nd malignancy was 2.3 y (range 0.1-13.5). Richter's transformation (RT) occurred in 36 pts (5.3%) at median 1.9 y (range 0.1-13.2) from FR. Most frequent 2nd malignancies were: non-melanoma skin cancer (11.7%), lung (2.5%), colon (2.1%), other heme (1.9%), and prostate (1.8%). There were 4 cases of acute myeloid leukemia (AML), 2 of which received alkylator therapy after FR prior to AML diagnosis. Conclusions: In this large, homogeneous cohort of CLL/SLL pts treated with first-line FR, including nearly 40% of pts ≥ age 70, we demonstrate a short median TFS of 3.8 y; however, a long OS of 11.6 y. Rates of 2nd malignancies are low after this non-alkylator based chemoimmunotherapy regimen. Ibrutinib for R/R CLL/SLL after FR resulted in significantly improved survival over alternate therapy, with excellent 2 yr OS 91% and TFS 78%. These data demonstrate the efficacy of FR and the benefit of ibrutinib over chemoimmunotherapy as second-line therapy for CLL/SLL in the real-world. Disclosures Bruyere: Jenssen: Other: Travel Grant; Celgene: Honoraria. Villa:Roche, Abbvie, Celgene, Seattle Genetics, Lundbeck, AstraZeneca, Nanostring, Janssen, Gilead: Consultancy, Honoraria. Scott:Celgene: Consultancy; Roche/Genentech: Research Funding; Janssen: Consultancy, Research Funding; NanoString: Patents & Royalties: Named inventor on a patent licensed to NanoSting [Institution], Research Funding. Savage:BMS, Merck, Novartis, Verastem, Abbvie, Servier, and Seattle Genetics: Consultancy, Honoraria; Seattle Genetics, Inc.: Consultancy, Honoraria, Research Funding. Connors:Takeda Pharmaceuticals: Honoraria; Seattle Genetics: Honoraria, Research Funding; Bristol-Myers Squibb: Consultancy. Sehn:TEVA Pharmaceuticals Industries: Consultancy, Honoraria; Acerta: Consultancy, Honoraria; Morphosys: Consultancy, Honoraria; F. Hoffmann-La Roche/Genentech: Consultancy, Honoraria, Research Funding; Seattle Genetics: Consultancy, Honoraria; Seattle Genetics: Consultancy, Honoraria; Astra Zeneca: Consultancy, Honoraria; F. Hoffmann-La Roche/Genentech: Consultancy, Honoraria, Research Funding; Kite Pharma: Consultancy, Honoraria; Kite Pharma: Consultancy, Honoraria; Morphosys: Consultancy, Honoraria; Abbvie: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; TEVA Pharmaceuticals Industries: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Acerta: Consultancy, Honoraria; Abbvie: Consultancy, Honoraria; Astra Zeneca: Consultancy, Honoraria. Gerrie:Lundbeck, Seattle Genetics: Consultancy, Honoraria.
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Carillo, Viviana, Tiziana Rancati, Cesare Cozzarini, Sergio Villa, Andrea Botti, Valeria Casanova Borca, Gabriella Cattari, et al. "Modeling acute urinary toxicity after radiotherapy for prostate cancer." Journal of Clinical Oncology 32, no. 4_suppl (February 1, 2014): 156. http://dx.doi.org/10.1200/jco.2014.32.4_suppl.156.
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156 Background: DUE-01 is a multi-centric observational study aimed at developing predictive models of genito-urinary toxicity and erectile dysfunction for prostate cancer patients treated with conventional (1.8-2Gy/fr, CONV) or moderate hypofractionation (2.5-2.7Gy/fr, HYPO). Current analysis focused on modelling the relationship between the risk of IPSS≥15 (IPSS15end) at the end of radiotherapy and clinincal/dosimetric risk factors. Methods: Planning data and relevant clinical factors were prospectively collected, including DVH/DSH referred to the whole treatment and to the weekly delivered dose (DVHw/DSHw). Best discriminating DVH/DSH parameters were selected by the differences between patients with/without IPSS15end=1 (t-test). Bootstrap variable selection techniques (300 resamples) in the framework of logistic backward feature selection was used to improve model building (El Naqa, IJROBP 2006). Graphical and quantitative analyses of the variable selection process applied to bootstrap data replicates was used to avoid underfitting/overfitting and to assess the final multivariable model. Results: 247 patients were available (CONV:116, HYPO:131). Seventy one out of 247 (28.7%) reported IPSS15end=1. The most predictive dosimetric tools were the absolute weekly delivered dose (DSHw and DVHw). DSHw and DVHw were alternatively inserted in the bootstrap variable selection flow, together with clinical risk factors. Due to the number of events, a logistic model containing six variables was accepted On the basis of observed frequency of variables in the top six positions, a model including basal IPSS (median OR=1.22, p=0.00001), use of anti-hypertensives (median OR=2.7, p=0.01), absolute bladder surface receiving more than 10.5 Gy/week (s10.5w, median OR=1.16, p=0.0001), and s12.5w (median OR=1.07, p=0.005), was choosen. AUC of this model was 0.80. Silmilar results were obtained when using DVHw. Conclusions: Basal IPSS, use of anti-hypertensive drugs, s10.5w/v10.5w and s12.5w/v12.5w are the main predictors of IPSS>=15 at the end of radiotherapy Bootstrap variable selection technique gives the modeler more insight into the importance and stability of the different variables selected and allows development of more robust models
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Cha, Byung Hyo, Min Jung Park, Joo Yeong Baeg, Sunpyo Lee, Eui Yong Jeon, Wafaa Salem Obaid Alsalami, Osama Mohamed Ibrahim Idris, and Young Joon Ahn. "How often should percutaneous gastrostomy feeding tubes be replaced? A single-institute retrospective study." BMJ Open Gastroenterology 9, no. 1 (April 2022): e000881. http://dx.doi.org/10.1136/bmjgast-2022-000881.
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ObjectivePercutaneous gastrostomy (PG) is a common procedure that enables long-term enteral nutrition. However, data on the durability of individual tube types are insufficient. We conducted this study to compare the longevities and features of different PG tube types.DesignWe performed a 5-year retrospective analysis of patients who underwent endoscopic and radiologic PG-related feeding tube procedures. The primary and secondary outcomes were tube exchange intervals and revenue costs, respectively. Demographic factors, underlying diseases, operator expertise, materials used, and complication profiles were assessed.ResultsA total of 599 PG-related procedures for inserting pull-type PG (PGP), balloon-type PG (PGB), PG jejunal MIC* (PGJM; gastrojejunostomy type), and PG jejunal Levin (PGJL) tubes were assessed. On univariate Kaplan-Meier analysis, PGP tubes showed longer median exchange intervals than PGB tubes (405 days (95% CI: 315 to 537) vs 210 days (95% CI: 188 to 238); p<0.001). Larger PGB tubes diameters were associated with longer durations than smaller counterparts (24 Fr: 262 days (95% CI: 201 to NA), 20 Fr: 216 days (95% CI: 189 to 239), and 18 Fr: 148 days (95% CI: 100 to 245)). The PGJL tubes lasted longer than PGJM counterparts (median durations: 168 days (95% CI: 72 to 372) vs 13 days (95% CI: 23 to 65); p<0.001). Multivariate Cox proportional regression analysis revealed that PGJL tubes had significantly lower failure rates than PGJM tubes (OR 2.97 (95% CI: 1.17 to 7.53); p=0.022). PGB tube insertion by general practitioners was the least costly, while PGP tube insertion by endoscopists was 2.9-fold more expensive; endoscopic PGJM tubes were the most expensive at two times the cost of PGJL tubes.ConclusionPGP tubes require replacement less often than PGB tubes, but the latter are more cost-effective. Moreover, PGJL tubes last longer than PGJM counterparts and, owing to lower failure rates, may be more suitable for high-risk patients.
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Bianchini, Solari, Soldato, Raspini, Montalti, Ciampalini, and Casagli. "Ground Subsidence Susceptibility (GSS) Mapping in Grosseto Plain (Tuscany, Italy) Based on Satellite InSAR Data Using Frequency Ratio and Fuzzy Logic." Remote Sensing 11, no. 17 (August 27, 2019): 2015. http://dx.doi.org/10.3390/rs11172015.
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This study aimed at evaluating and mapping Ground Subsidence Susceptibility (GSS) in the Grosseto plain (Tuscany Region, Italy) by exploiting multi-temporal satellite InSAR data and by applying two parallel approaches; a bivariate statistical analysis (Frequency Ratio) and a mathematical probabilistic model (Fuzzy Logic operator). The Grosseto plain experienced subsidence and sinkholes due to natural causes in the past and it is still suffering slow-moving ground lowering. Five conditioning subsidence-related factors were selected and managed in a GIS environment through an overlay pixel-by-pixel analysis. Firstly, multi-temporal ground subsidence inventory maps were prepared in the study area by starting from two inventories referred to distinct temporal intervals (2003–2009 and 2014–2019) derived from Persistent Scatterers Interferometry (PSI) data of ENVISAT and SENTINEL-1 satellites. Then, the susceptibility modelling was performed through the Frequency Ratio (FR) and Fuzzy Logic (FL) approaches. These analyses led to slightly different scenarios which were compared and discussed. Results show that flat areas on alluvial and colluvial deposits with thick sedimentary cover (higher than 20 m) on the bedrock in the central and eastern sectors of the plain are the most susceptible to land subsidence. The obtained FR- and FL-based GSS maps were finally validated with a ROC (Receiver Operating Characteristic) analysis, in order to estimate the overall performance of the models. The AUC (Area Under Curve) values of ROC analysis of the FR model were higher than the ones of FL model, suggesting that the former is a better and more appropriate predictor for subsidence susceptibility analysis in the study area. In conclusion, GSS maps provided a qualitative overview of the subsidence scenarios and may be helpful to predict and preliminarily identify high-risk areas for environmental local authorities and decision makers in charge of land use planning in the study area. Finally, the presented methodologies to derive GSS maps are easily reproducible and could also be applied and tested in other test sites worldwide, in order to check the modeling performance in different environmental settings.
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Fifer, Simon, Stephen Greaves, John Rose, and Richard Ellison. "A Combined GPS/Stated Choice Experiment to Estimate Values of Crash-Risk Reduction." Journal of Choice Modelling 4, no. 1 (2011): 44–61. http://dx.doi.org/10.1016/s1755-5345(13)70018-6.
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Brown, Jennifer R., Bethany Tesar, Lillian Werner, Evgeny Mikler, Hazel Reynolds, Christina Thompson, David C. Fisher, Naoko Takebe, Donna Neuberg, and Arnold S. Freedman. "Obatoclax in Combination with Fludarabine and Rituximab (FR) Is Well-Tolerated and Shows Promising Clinical Activity in Relapsed CLL/SLL." Blood 118, no. 21 (November 18, 2011): 2865. http://dx.doi.org/10.1182/blood.v118.21.2865.2865.
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Abstract Abstract 2865 Obatoclax is a small molecule mimetic of the BH3 domain of Bcl-2 family proteins. Obatoclax is broadly specific, with activity against Bcl-2, Bcl-X, Bcl-w and Mcl-1. CLL cells overexpress Bcl-2, Bcl-XL and Mcl-1 in particular, and obatoclax can induce apoptosis of CLL cells in vitro. A phase 1 study of single-agent obatoclax in heavily pretreated largely refractory CLL patients demonstrated that the dose-limiting toxicity was neurologic, including euphoria and ataxia, leading to a maximum tolerated dose of 28 mg/m2 given over 3 hours every 3 weeks. One PR was observed along with biologic activity demonstrated by reductions in lymphocyte counts and improvements in cytopenias. We therefore undertook this phase 1 study of the combination of obatoclax with FR in CLL patients relapsed after at least one prior therapy and in need of therapy again. Obatoclax was given as a three hour infusion on days 1 and 3 at three dose levels, 10, 14, and 20 mg/m2 per dose. Fludarabine was given at 25 mg/m2 days 1–5, and rituximab 375 mg/m2 day 1 following an option to split the dose in cycle 1. Thirteen patients were enrolled, seven men and six women, with median age 58. 5 (38%) had stage 3–4 disease. FISH showed one patient with del17p, one with complex karyotype, and five with del11q. Six of nine patients evaluable had high risk unmutated IGHV, and nine of ten patients evaluable were positive for ZAP-70. The median number of prior therapies was two, with 9 patients having had prior fludarabine-based combination chemotherapy, 10 patients having had prior rituximab, and 8 patients having had prior alkylator-based combination chemotherapy. The study therapy was well-tolerated, with a median of five cycles administered. One dose-limiting toxicity (DLT) was observed at the 20 mg/m2 obatoclax dose; this DLT was a greater than two week treatment delay for persistent grade 2–3 neutropenia in a patient who had had a similar event previously with FR alone. This DLT led to expansion of the third and highest cohort, which enrolled seven patients with no further DLTs observed. Other grade 3–4 toxicities have been limited and include neutropenia (n=5), thrombocytopenia (n=2), fever without neutropenia (n=2), increased ALT/AST (n=1), and dizziness (n=1). Neurologic side effects were easily managed and resembled alcohol intoxication, including grade 1–2 euphoria (n=6), ataxia (n=5), dizziness (n=6), anxiety (n=4), speech impairment (n=4) and confusion (n=3). The ORR by NCI-WG criteria was 85% (11/13; 90% CI 59–97%) with 15% CR (2/13; 90% CI 3–41%) and 38% nPRs (5/13; 90% CI 17–65%). With the addition of CT scan measurement of lymphadenopathy the ORR declined to 54% (7/13; 90% CI 29–78%) with no CRs. With a median follow-up of 26 months from the start of the study, three patients are in ongoing remission, six have relapsed with three receiving further therapy to date, two patients have gone on to stem cell transplantation, and two patients have died of disease. The median time to progression is 20 months (95% CI 9, 35 mos). We were able to demonstrate increased apoptosis compared to baseline in peripheral blood CLL lymphocytes during cycle 1 therapy in 9 of 13 patients, using Annexin V propidium iodide staining. We conclude that the FR-obatoclax regimen is well-tolerated and highly active in a relapsed CLL population. An extension of this study to increase the frequency of obatoclax dosing to days 1–3, and to change the chemotherapy backbone to FCR, is planned pending the availability of obatoclax. Disclosures: Brown: Calistoga: Consultancy, Research Funding; Celgene: Honoraria, Research Funding; Genzyme: Research Funding; GSK: Research Funding; Pharmacyclics: Consultancy.
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Molinari, D., F. Ballio, and S. Menoni. "Modelling the benefits of flood emergency management measures in reducing damages: a case study on Sondrio, Italy." Natural Hazards and Earth System Sciences 13, no. 8 (August 1, 2013): 1913–27. http://dx.doi.org/10.5194/nhess-13-1913-2013.
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Abstract. The European "Floods Directive" 2007/60/EU has produced an important shift from a traditional approach to flood risk management centred only on hazard analysis and forecast to a newer one which encompasses other aspects relevant to decision-making and which reflect recent research advances in both hydraulic engineering and social studies on disaster risk. This paper accordingly proposes a way of modelling the benefits of flood emergency management interventions calculating the possible damages by taking into account exposure, vulnerability, and expected damage reduction. The results of this model can be used to inform decisions and choices for the implementation of flood emergency management measures. A central role is played by expected damages, which are the direct and indirect consequence of the occurrence of floods in exposed and vulnerable urban systems. How damages should be defined and measured is a key question that this paper tries to address. The Floods Directive suggests that mitigation measures taken to reduce flood impact need to be evaluated also by means of a cost–benefit analysis. The paper presents a methodology for assessing the effectiveness of early warning for flash floods, considering its potential impact in reducing direct physical damage, and it assesses the general benefit in regard to other types of damages and losses compared with the emergency management costs. The methodology is applied to the case study area of the city of Sondrio in the northern Alpine region of Italy. A critical discussion follows the application. Its purpose is to highlight the strengths and weaknesses of available models for quantifying direct physical damage and of the general model proposed, given the current state of the art in damage and loss assessment.
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Ngnie-Teta, Ismael, Barthelemy Kuate-Defo, and Olivier Receveur. "Multilevel modelling of sociodemographic predictors of various levels of anaemia among women in Mali." Public Health Nutrition 12, no. 9 (September 2009): 1462–69. http://dx.doi.org/10.1017/s1368980008004400.
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AbstractObjectiveAnaemia currently affects 40–80 % of women in Africa. While risk factors for anaemia have been intensively studied, research has rarely compared risk factors between mild anaemia and moderate/severe anaemia. Also, the contribution of neighbourhood to the prevalence of anaemia has been rarely studied. The aim of the present study was to identify and compare individual and contextual factors associated with various levels of anaemia among women.DesignA multilevel analysis of data from the 2001 Mali Demographic and Health Survey (n3763) was carried out. Outcomes variables were mild anaemia, moderate-to-severe anaemia and any anaemia. Multilevel regression analyses were performed for each outcome.SettingMali, West Africa.SubjectsWomen (n3763) aged 15 to 49 years, including 512 pregnant women.ResultsAmong the eleven potential risk factors included in the models, two factors were associated with mild anaemia (BMI and education), three with any anaemia (pregnancy, BMI and education) and six with moderate-to-severe anaemia (pregnancy, BMI, education, wealth, childhood residency and region of residence). Clustering of anaemia within communities was 20 % for moderate-to-severe anaemia and 13 % for mild anaemia. Despite significant differences in the prevalence of anaemia across regions in Mali, no difference between regions in the risk of mild anaemia was found and only the region of Gao showed a significantly higher risk of moderate-to-severe anaemia.ConclusionsThe findings indicate that sociodemographic risk factors as well as clustering of anaemia varies with the severity of anaemia. Specific studies are needed to identify risk factors of mild anaemia as well as its consequences, as mild anaemia accounts for 20–40 % of total prevalence of anaemia in Africa.
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Hensher, David A., John M. Rose, Juan de Dios Ortúzar, and Luis I. Rizzi. "Estimating the Value of Risk Reduction for Pedestrians in the Road Environment: An Exploratory Analysis." Journal of Choice Modelling 4, no. 2 (2011): 70–94. http://dx.doi.org/10.1016/s1755-5345(13)70058-7.
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Yulian Safitri, Intan, Arsyad Ar, and Yosa Megasukma. "Analisis Kecelakaan Kerja Dengan Menggunakan Metode Statistik Dan Risk Assesment Pada Iup 206 & 329 Ha Batu Gamping Di PT. Semen Padang Sumatera Barat." COMSERVA Indonesian Jurnal of Community Services and Development 1, no. 8 (December 21, 2021): 392–412. http://dx.doi.org/10.36418/comserva.v1i8.52.
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Perusahaan Semen Padang merupakan perusahaan tambang batu gamping yang wilayah penambangannya terletak di Bukit Karang Putih, Kelurahan Indarung, Kecamatan Lubuk Kilangan, Sumatera Barat. Sistem penambangan yang diterapkan di perusahaan adalah quarry. Pelaksanaan kegiatan penambangan merupakan jenis pekerjaan yang memiliki potensi dan faktor bahaya dengan risiko yang tinggi dan rentan terhadap kecelakaan. Hal ini dapat disebabkan oleh tindakan tidak aman (unsafe act) maupun kondisi tidak aman (unsafe condition) sehingga menyebabkan terhentinya suatu kegiatan baik terhadap manusia maupun terhadap alat. Tujuan penelitian ini adalah untuk menilai kinerja K3 di PT. Semen Padang pada tahun 2019-2020 menggunakan analisis statistik kecelakaan dan analisis risk assessment. Pentingnya sebuah statistik dalam kecelakaan kerja yaitu untuk mengetahui apakah kecelakaan kerja dalam waktu tertentu mengalami kenaikan atau penurunan serta untuk menilai efektif atau tidaknya usaha pencegahan kecelakaan. Statistik kecelakaan kerja meliputi tingkat kekerapan kecelakaan (frequency rate), tingkat keparahan kecelakaan (severity rate), dan safe T-score (STS). Hasil penelitian menunjukkan bahwa terjadi 25 kejadian kecelakaan kerja pada tahun 2019 dan 13 kali kejadian kecelakaan kerja pada tahun 2020. Hasil perhitungan statistik kecelakaan kerja pada tahun 2019-2020 terhitung Frequency Rate (FR) yaitu nilainya berturut-turut adalah 11,51 ; 8,52, dan untuk Severity Rate (SR) yaitu nilainya berturut-turut adalah 416,10 ; 36,72. Berdasarkan perhitungan safe T-score menunjukkan bahwa membaiknya atau meningkatnya performance/kinerja K3 pada tahun 2020. Setelah mengetahui perbandingan efektifitas kinerja K3 pada perusahaan selanjutnya dilakukan analisis risk assessment, analisis ini dilakukan untuk menilai besarnya suatu risiko dari kecelakaan yang terjadi. Berdasarkan hasil penilaian risiko diketahui dari 13 kecelakaan terdapat 1 kecelakaan yang memiliki nilai ekstrim, 7 kecelakaan yang memiliki nilai “Risiko Tinggi”, 5 kecelakaan yang memiliki nilai “Risiko Sedang”. Penelitian ini menghasilkan rekomendasi penanggulangan atau perbaikan yang dapat dilakukan untuk potensi bahaya dengan tingkat risiko “Extrem” dan “High”.
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Saw, Seow Hoon, J. L. Mak, M. H. Tan, S. T. Teo, T. Y. Tan, M. Y. K. Cheow, C. A. Ong, et al. "Detection and quantification of Salmonella in fresh vegetables in Perak, Malaysia." Food Research 4, no. 2 (October 27, 2019): 441–48. http://dx.doi.org/10.26656/fr.2017.4(2).316.
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The eating of fresh and minimally processed vegetables is getting popular among Malaysians. This trend poses an increased risk of food poisoning associated with the consumption of fresh produce contaminated with pathogenic bacteria. Salmonellosis is a foodborne disease caused by several non-typhoidal Salmonella enterica serovars, predominantly serovars Enteritidis and Typhimurium. The present study aimed to determine the prevalence of Salmonella spp., S. enterica serovar Enteritidis and S. enterica serovar Typhimurium in fresh leafy vegetables such as cabbages (n = 40), lettuces (n = 20), and fruit vegetables such as tomatoes (n = 40), carrots (n = 40) and cucumbers (n = 40), which were sold by three different hypermarkets and a wet market in Kampar, Perak, Malaysia. The study was performed over a period of 13 months (January 2018 to January 2019). A combination of most probable number-multiplex polymerase chain reaction (MPN-mPCR) method was used to quantify the concentrations of Salmonella spp., S. enterica serovar Enteritidis and S. enterica serovar Typhimurium in the examined samples. The results of this study demonstrated that of the vegetables tested, tomatoes, carrots and lettuces were not contaminated by Salmonella spp., S. enterica serovar Enteritidis and S. enterica serovar Typhimurium. However, the presence of Salmonella spp. was detected in 3.3% of cabbages from the hypermarket, with estimated microbial loads ranging from <3.0 MPN/g to 15.0 MPN/g. On the other hand, S. enterica serovar Typhimurium was detected in 10.0% of the cucumbers from hypermarkets and 20% of them from the wet market. Their microbial loads were ranging from <3.0 MPN/g to >1,100 MPN/g. This indicated that cabbages and cucumbers could be the potential sources of salmonellosis. Therefore, the monitoring of food safety and hygienic practices should be strictly enforced by relevant government agencies to avoid potential poisoning by foodborne pathogens.
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