Tag: pubmed

Glomerular Dis. 2021 Aug;1(3):105-117. doi: 10.1159/000516832. Epub 2021 Jun 24.

ABSTRACT

INTRODUCTION: Disparities in health-related quality of life (HRQOL) have been inadequately studied in patients with glomerular disease. The aim of this study was to identify relationships between race/ethnicity, socioeconomic status, disease severity, and HRQOL in an ethnically and racially diverse cohort of patients with glomerular disease.

METHODS: Cure Glomerulonephropathy (CureGN) is a multinational cohort study of patients with biopsy-proven glomerular disease. Associations between race/ethnicity and HRQOL were determined by the following: 1. Missed school or work due to kidney disease; 2. Responses to Patient Reported Outcomes Measurement Information System (PROMIS) questionnaires. We adjusted for demographics, socioeconomic status, and disease characteristics using multivariable logistic and linear regression.

RESULTS: Black and Hispanic participants had worse socioeconomic status and more severe glomerular disease than White or Asian participants. Black adults missed work or school most frequently due to kidney disease (30% versus 16-23% in the other three groups, p=0.04), and had the worst self-reported global physical health (median score 44.1 versus 48.0-48.2, p<0.001) and fatigue (53.8 versus 48.5-51.1, p=0.002), compared to other racial/ethnic groups. However, these findings were not statistically significant with adjustment for socioeconomic status and disease severity, both of which were strongly associated with HRQOL in adults. Among children, disease severity but not race/ethnicity or socioeconomic status were associated with HRQOL.

CONCLUSIONS: Among patients with glomerular disease enrolled in CureGN, the worse HRQOL reported by Black adults was attributable to lower socioeconomic status and more severe glomerular disease. No racial/ethnic differences in HRQOL were observed in children.

PMID:34723246 | PMC:PMC8553235 | DOI:10.1159/000516832

JPGN Rep. 2021 May;2(2):e077. doi: 10.1097/PG9.0000000000000077.

ABSTRACT

OBJECTIVES: The relationship between vitamin D deficiency (VDD) and pediatric nonalcoholic fatty liver disease (NAFLD) remains uncertain due to conflicting results and few studies with histologic endpoints. We therefore used multiple imaging and histologic NAFLD endpoints to more comprehensively assess the association between VDD and NAFLD in a large pediatric population.

METHODS: Data were obtained from an ongoing pediatric NAFLD study in Bronx, NY. Briefly, overweight and obese children aged 2-18 years with alanine aminotransferase (ALT) levels ≥ 35 U/L were serially enrolled. Liver biopsy was obtained in accordance with clinical guidelines. All participants had liver imaging, namely, controlled attenuation parameter (CAP; Echosens, France) to assess steatosis and, to assess fibrosis, vibration controlled transient elastography (VCTE; FibroScan™, Echosens, France) and acoustic radiation force impulse (ARFI; Philips, Netherlands) imaging. Levels of 25-hydroxyvitamin D were measured serologically.

RESULTS: N=276 (88%) of 315 participants had 25-OH vitamin D results, of whom 241 (87%) were Hispanic, 199 (72%) were male, and 92 (33%) underwent liver biopsy. VDD was univariately associated with high waist circumference (p=0.004), high-density lipoprotein level (p=0.01), season (p=0.009), and CAP score (p=0.01). In multivariate analysis, only waist circumference (p=0.0002) and biopsy inflammation grade (p=0.03) were associated with VDD, though the latter had not approximated statistical significance in univariate analysis (p=0.56). There was no association between VDD and hepatic steatosis, ballooning, NAFLD Activity Score, ARFI or VCTE elasticity scores.

CONCLUSIONS: VDD was not associated with NAFLD defined by imaging and histologic endpoints, except for a possible relation with histologic inflammation grade.

PMID:34723254 | PMC:PMC8553135 | DOI:10.1097/PG9.0000000000000077

Eur Urol Open Sci. 2021 Sep 30;33:83-88. doi: 10.1016/j.euros.2021.09.005. eCollection 2021 Nov.

ABSTRACT

BACKGROUND: Retroperitoneal lymph node dissection (RPLND) is essential for the treatment of metastatic germ cell tumours of the testis. Recommendations on the referral and management of complex urological cancers in the UK includes centralisation of services to regional centres.

OBJECTIVE: To review contemporary PC-RPLND outcomes at a high-volume centre with a complex case-mix, and compare with national registry data.

DESIGN SETTING AND PARTICIPANTS: We retrospectively reviewed the medical records of PC-RPLNDs performed for germ cell tumours at our centre between July 2012 and September 2018.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Primary outcomes were Clavien 3+ complications, histology, rates of positive margin, relapse, in-field recurrences, and mortality. Secondary outcomes were blood loss, operation time, blood transfusion, adjuvant procedures, length of stay, and lymph node count. Surgical and histological outcomes of all RPLNDs for testicular cancers were compared with national RPLND registry data. For statistical difference, χ² testing was used.

RESULTS AND LIMITATIONS: A total of 178 procedures were performed, including 31 (17%) redo RPLNDs. Clavien 3+ complications occurred in 11 (7%). Histological findings in non-redo cases were the following: necrosis 24%, teratoma 62%, viable germ cell tumour 11%, and dedifferentiated cancers 3%. Rates of positive margin, relapse, and in-field recurrence were 11%, 17%, and 2%, respectively. Overall survival was 89% at a median of 36 mo. The median blood loss was 650 ml (350, 1250), with a transfusion rate of 8%. Nephrectomy, vascular reconstruction, and visceral resection was required in 12%, 6%, and 3% respectively. The median inpatient stay was 6 d (5, 8) and the median node count was 35 (20, 37). A comparison of all RPLNDs with national data showed no statistical difference in primary outcomes. Our blood transfusion rate was significantly lower (12% vs 21%, χ² [1, N = 322] = 4.296, p = 0.038).

CONCLUSIONS: Centralisation led to high quality of RPLND in UK. Within that, our series (the largest in the UK) demonstrates no significant difference in outcomes despite higher complexity cases. Our blood transfusion rates are in fact lower than national figures. Complex RPLNDs should be performed in high-volume centres where possible.

PATIENT SUMMARY: In the UK, retroperitoneal lymph node dissections (RPLND) are centralised to specialist centres and the quality of surgery is high, with low complications and good histological outcomes. When compared to national data, we found no significant difference in the majority of outcomes from our high-volume centre despite our complex case-mix.

PMID:34723218 | PMC:PMC8546923 | DOI:10.1016/j.euros.2021.09.005

Explor Res Clin Soc Pharm. 2021 Oct 26:100085. doi: 10.1016/j.rcsop.2021.100085. Online ahead of print.

ABSTRACT

OBJECTIVE: To describe the self-reported impact of the COVID-19 pandemic among final year student pharmacists enrolled in a Doctor of Pharmacy program in New York City during the first peak of the outbreak March through May 2020.

METHODS: A required senior seminar course for graduating student pharmacists served as a conduit for faculty led monitoring of the wellbeing of the cohort through three data sources: 1) polling data regarding stress factors during a COVID-19 informational session (March 2020), 2) survey data from a 12-item COVID-19 Impact Survey developed and administered electronically in May 2020 and 3) qualitative data from reflection papers mentioning COVID-19. Descriptive statistics, bivariate analysis and thematic analysis were used to summarize data.

RESULTS: In March, almost half of respondents (total = 185) reported high personal (47.6%) and school related stress (42.1%). Most students were participating in advanced pharmacy practice experiences (80%) and working in a pharmacy (80%). Survey data (n = 96) revealed the majority of participants perceived negative impact on their future career (69%) and reported concern for people close to them with suspected and confirmed COVID-19. One-third of participants reported knowing someone who died from COVID-19 and 8% were self-confirmed COVID-19 positive. Themes emerging from the reflection papers included: changed perspective, gained experience as a pharmacist during a pandemic, concern for loved ones, and positive outlook.

CONCLUSION: The COVID-19 pandemic had a significant impact on the wellbeing of a cohort of graduating student pharmacists in New York during the initial peaks of the spread in the United States. The results reinforce a need for student support during emergency situations, especially during the final year.

PMID:34723239 | PMC:PMC8547815 | DOI:10.1016/j.rcsop.2021.100085

Eur Urol Open Sci. 2021 Sep 22;33:11-18. doi: 10.1016/j.euros.2021.08.007. eCollection 2021 Nov.

ABSTRACT

BACKGROUND: Considering the relatively high 5-yr survival rate (76.9%) for bladder cancer (BC), its overall prevalence will probably continue to increase. Therefore, it is important to understand the effects of BC diagnosis and management, including psychological sequelae.

OBJECTIVE: To determine the prevalence of depression among elderly patients with BC and identify patient characteristics associated with depression.

DESIGN SETTING AND PARTICIPANTS: Survey responses from a population-based sample of 5787 patients older than 65 yr with a history of BC were retrieved from the Surveillance, Epidemiology and End Results-Medicare Health Outcomes Survey registry, spanning 1999-2014.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome measured is the prevalence of a positive depression screen. Cancer characteristics and demographic, socioeconomic, health-related, and activities of daily living (ADL)-related data were reviewed. Univariate analysis was conducted to identify correlation between a positive depression screen and patient characteristics. Multivariate analysis was performed to identify independent predictors of depression.

RESULTS AND LIMITATIONS: The prevalence of a positive depression screen was 14.0%. Poor general health (p < 0.001), impairment of ADL (p < 0.001), greater number of comorbidities (p < 0.001), and income <$30 000 (p < 0.001) were identified as correlates of depression. Univariate analysis found no association between a positive depression screen and time since the initial cancer diagnosis (p = 0.858) or cancer stage (p = 0.90). Multivariate analysis showed higher levels of education (p = 0.0097), increasing age (p = 0.0027), and marriage (p < 0.0001) were protective against the development of depression. Limitations include the lack of consideration of treatment outcomes and whether patients have active disease or only a history of cancer.

CONCLUSIONS: Depression affects a substantial percentage (14%) of elderly patients with BC. Poor general health and impaired ability to complete ADL were the greatest risk factors for depression. Acknowledgment of sociodemographic factors may improve awareness of depression in patients with BC and a potential need for psychosocial support.

PATIENT SUMMARY: Depression affects a significant proportion of patients with bladder cancer. Social and demographic factors influence a patient’s risk of depression. Acknowledgment of these factors may improve the detection of depression and a possible need for intervention.

PMID:34723216 | PMC:PMC8546926 | DOI:10.1016/j.euros.2021.08.007

Eur Urol Open Sci. 2021 Sep 27;33:48-55. doi: 10.1016/j.euros.2021.08.008. eCollection 2021 Nov.

ABSTRACT

BACKGROUND: Currently, metastatic hormone-sensitive prostate cancer (mHSPC) patients are often treated with docetaxel chemotherapy at the initiation of hormonal therapy. This treatment is based on the results of two pivotal trials. However, trial populations are not a representative of real-world patient populations.

OBJECTIVE: We aimed to analyze whether survival rates in our daily practice cohort is comparable with those in clinical trials and to characterize the tolerability of docetaxel chemotherapy in daily practice.

DESIGN SETTING AND PARTICIPANTS: In this retrospective cohort analysis, we studied 159 mHSPC patients treated with early docetaxel from April 2014 up to June 2020 in a top clinical hospital in The Netherlands. Patients were selected using hospital pharmacy records.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We compared the results of our cohort with the results of the cohorts of the two pivotal trials. We aimed to analyze the survival rates in our cohort and characterize the tolerability of docetaxel chemotherapy in daily practice.

RESULTS AND LIMITATIONS: Despite the relatively high number of comorbidities in our daily practice cohort, overall survival of our cohort showed great similarity with that of the two pivotal trials: 60.2 mo compared with 57.6 and 59.1 mo. Furthermore, early docetaxel was well tolerated in daily practice. Nearly 90% of the patients completed the full six cycles, and polyneuropathy led to relatively few dose reductions (6.9%).

CONCLUSIONS: Early docetaxel is well tolerated in daily practice. Our daily practice cohort showed great similarity in overall survival to the clinical trials. Our results might be of interest in the developing landscape of mHSPC treatment.

PATIENT SUMMARY: We studied docetaxel chemotherapy for metastatic prostate cancer in daily practice. These patients have the same survival as selected patients participating in clinical trials. Docetaxel was well tolerated in daily practice.

PMID:34723217 | PMC:PMC8546919 | DOI:10.1016/j.euros.2021.08.008

Eur Urol Open Sci. 2021 Sep 20;33:1-10. doi: 10.1016/j.euros.2021.08.005. eCollection 2021 Nov.

ABSTRACT

BACKGROUND: Radical cystectomy (RC) is associated with high morbidity.

OBJECTIVE: To evaluate healthcare and surgical factors associated with high-quality RC surgery.

DESIGN SETTING AND PARTICIPANTS: Patients within the prospective British Association of Urological Surgeons (BAUS) registry between 2014 and 2017 were included in this study.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: High-quality surgery was defined using pathological (absence of positive surgical margins and a minimum of a level I lymph node dissection template with a minimum yield of ten or more lymph nodes), recovery (length of stay ≤10 d), and technical (intraoperative blood loss <500 ml for open and <300 ml for minimally invasive RC) variables. A multilevel hierarchical mixed-effect logistic regression model was utilised to determine the factors associated with the receipt of high-quality surgery and index admission mortality.

RESULTS AND LIMITATIONS: A total of 4654 patients with a median age of 70.0 yr underwent RC by 152 surgeons at 78 UK hospitals. The median surgeon and hospital operating volumes were 23.0 and 47.0 cases, respectively. A total of 914 patients (19.6%) received high-quality surgery. The minimum annual surgeon volume and hospital volume of ≥20 RCs/surgeon/yr and ≥68 RCs/hospital/yr, respectively, were the thresholds determined to achieve better rates of high-quality RC. The mixed-effect logistic regression model found that recent surgery (odds ratio [OR]: 1.22, 95% confidence interval [CI]: 1.11-1.34, p < 0.001), laparoscopic/robotic RC (OR: 1.85, 95% CI: 1.45-2.37, p < 0.001), and higher annual surgeon operating volume (23.1-33.0 cases [OR: 1.54, 95% CI: 1.16-2.05, p = 0.003]; ≥33.1 cases [OR: 1.64, 95% CI: 1.18-2.29, p = 0.003]) were independently associated with high-quality surgery. High-quality surgery was an independent predictor of lower index admission mortality (OR: 0.38, 95% CI: 0.16-0.87, p = 0.021).

CONCLUSIONS: We report that annual surgeon operating volume and use of minimally invasive RC were predictors of high-quality surgery. Patients receiving high-quality surgery were independently associated with lower index admission mortality. Our results support the role of centralisation of complex oncology and implementation of a quality assurance programme to improve the delivery of care.

PATIENT SUMMARY: In this registry study of patients treated with surgical excision of the urinary bladder for bladder cancer, we report that patients treated by a surgeon with a higher annual operative volume and a minimally invasive approach were associated with the receipt of high-quality surgery. Patients treated with high-quality surgery were more likely to be discharged alive following surgery.

PMID:34723215 | PMC:PMC8546928 | DOI:10.1016/j.euros.2021.08.005

SN Soc Sci. 2021;1(10):257. doi: 10.1007/s43545-021-00264-w. Epub 2021 Oct 6.

ABSTRACT

Research in several Latin American countries points to violence, loss of traditional territories, and seeking education, health, and wage labor as key variables in triggering rural-urban migration among Indigenous people. This study presents an analysis of the migration patterns of Indigenous people in Brazil, compared to non-indigenous people, based on data from the most recent national census, conducted in 2010. Migration characteristics related to lifetime migration and recent migration were investigated by means of descriptive and multivariable logistic regression analyses. The findings pointed to complex mobility scenarios according to migrants’ Indigenous status and geographical regions of origin and destination. Indigenous people living in urban areas presented high levels of mobility (approximately 50% lived in different municipalities from those where they were born), which were more pronounced than those of non-Indigenous people. Indigenous people living in rural areas presented the lowest levels of migration (approximately 90% residing in their municipality of birth). Statistical modeling confirmed the patterns observed in descriptive analysis, highlighting the marked mobility of Indigenous subjects in urban areas. We emphasize the limitations of using census data for characterizing Indigenous mobility profiles, although no other nationally representative data are available. The finding that the Indigenous population living in urban areas presents rates of migration higher than their non-Indigenous counterparts is particularly important for the planning and implementation of a broad range of public policies aimed at ethnic minorities in the country, including health, education, and housing initiatives.

PMID:34723200 | PMC:PMC8549969 | DOI:10.1007/s43545-021-00264-w

SN Comput Sci. 2021;2(4):330. doi: 10.1007/s42979-021-00723-4. Epub 2021 Jun 7.

ABSTRACT

Machine translation is one of the applications of natural language processing which has been explored in different languages. Recently researchers started paying attention towards machine translation for resource-poor languages and closely related languages. A widespread and underlying problem for these machine translation systems is the linguistic difference and variation in orthographic conventions which causes many issues to traditional approaches. Two languages written in two different orthographies are not easily comparable but orthographic information can also be used to improve the machine translation system. This article offers a survey of research regarding orthography’s influence on machine translation of under-resourced languages. It introduces under-resourced languages in terms of machine translation and how orthographic information can be utilised to improve machine translation. We describe previous work in this area, discussing what underlying assumptions were made, and showing how orthographic knowledge improves the performance of machine translation of under-resourced languages. We discuss different types of machine translation and demonstrate a recent trend that seeks to link orthographic information with well-established machine translation methods. Considerable attention is given to current efforts using cognate information at different levels of machine translation and the lessons that can be drawn from this. Additionally, multilingual neural machine translation of closely related languages is given a particular focus in this survey. This article ends with a discussion of the way forward in machine translation with orthographic information, focusing on multilingual settings and bilingual lexicon induction.

PMID:34723204 | PMC:PMC8550410 | DOI:10.1007/s42979-021-00723-4

Front Artif Intell. 2021 Oct 15;4:757864. doi: 10.3389/frai.2021.757864. eCollection 2021.

ABSTRACT

This paper compares the predictive power of different models to forecast the real U.S. GDP. Using quarterly data from 1976 to 2020, we find that the machine learning K-Nearest Neighbour (KNN) model captures the self-predictive ability of the U.S. GDP and performs better than traditional time series analysis. We explore the inclusion of predictors such as the yield curve, its latent factors, and a set of macroeconomic variables in order to increase the level of forecasting accuracy. The predictions result to be improved only when considering long forecast horizons. The use of machine learning algorithm provides additional guidance for data-driven decision making.

PMID:34723174 | PMC:PMC8554645 | DOI:10.3389/frai.2021.757864