Objectives Comparative studies of survival between stereotactic body radiation therapy (SBRT) and surgery have been limited by lack of comparisons of recurrence patterns between matched cohorts in ...non−small cell lung cancer (NSCLC). Methods All patients undergoing treatment with surgery or SBRT for clinical stage I NSCLC between June 2004 and December 2010 were reviewed. Age, tumor characteristics, comorbidity score, pulmonary function, overall survival (OS), disease-free survival (DFS), and recurrence data were collected and propensity matching performed. Results The mean age for surgery (n = 458) was 65.8 ± 10.5 versus 74.4 ± 9.4 for SBRT (n = 151) ( P < .0001). For the entire surgical cohort, 3-year OS was 78% and DFS was 72%. For the entire SBRT cohort, 3-year OS was 47% and DFS was 42%. The overall local recurrence rate for surgery was 2.6%. The overall local recurrence rate for SBRT was 10.7%. A propensity-matched comparison based on age, tumor size, Adult Comorbidity Evaluation comorbidity score, forced expiratory volume in the first second of expiration, and tumor location resulted in 56 matched pairs. The 3-year OS was 52% versus 68% for SBRT and surgery ( P = .05); DFS was 47% versus 65% ( P = .01). At 3 years, local recurrence-free survival was 90% versus 92% for SBRT and surgery ( P = .07). Conclusions Although surgical resection seems to result in better OS and DFS versus SBRT, matching these disparate cohorts of patients remains challenging. Participation in clinical trials is essential to define the indications and relative efficacy of surgery and radiation therapy in a high-risk population with stage I NSCLC.
To describe the prevalence and 9-month incidence of depressive symptoms among a cohort of elderly primary care patients and to determine whether different patterns of depression are associated with ...different patterns of health services use.
Prospective study of depressive symptoms as measured by the Center for Epidemiologic Studies Depression (CES-D) scale and identification of patients' outpatient health services use through an electronic medical record system.
An academic primary care group practice at an urban ambulatory care clinic.
1711 patients aged 60 and older who completed the CES-D at baseline and 9 months later; 935 of these patients also completed the CES-D at 6 months.
The prevalence of significant symptoms of depression (CES-D > or = 16) was 17.1% at baseline and 18.8% at 9 months; 26.8% of patients exceeded the threshold on the CES-D either at baseline or 9 months, and the 9-month incidence was 11.7%. Among the patients re-interviewed at both 6 and 9 months, the 6-month incidence was 12%, and the incidence between the 6- and 9-month assessments was 10%. Of the 292 patients with depression at baseline, 140 (47.6%) remained depressed at the 9-month follow-up. Baseline and 6-month CES-D score, in addition to perceived health at 6 months, explained 45% of the variance in the 9-month CES-D score. Patients above the threshold on the CES-D at any time were more likely to rate their health as fair or poor (69.8% vs 43.7%) and more likely to have an emergency room visit (40.4% vs 29.4%). These patients also had 38% more outpatient visits (7.7 vs 5.6) and 61% higher total outpatient charges ($1209 vs $751) than patients who never exceeded the CES-D threshold over the 9-month window (all P values < 0.01).
Depressive symptoms were frequent and often persistent in this patient population. We identified patterns of oscillating severity of symptoms within individuals but relatively stable incidence and prevalence rates over a 9-month period. Patients who exceeded the threshold on the CES-D at any time during the study had significantly greater health services use and poorer perceived health.
This article reports on a prevalence study of dementia and Alzheimer's disease among two groups of subjects with the same ethnic background but widely differing environments.
The study was conducted ...among residents aged 65 years and older in two communities: Yorubas (N = 2,494) living in Ibadan, Nigeria, and African Americans (N = 2,212 in the community and N = 106 in nursing homes) living in Indianapolis, Indiana. The study design consisted of a screening stage followed by a clinical assessment stage for selected subjects on the basis of their performance on the screening tests.
The age-adjusted prevalence rates of dementia (2.29%) and Alzheimer's disease (1.41%) in the Ibadan sample were significantly lower than those in the Indianapolis sample, both in the community-dwelling subjects alone (4.82% and 3.69%, respectively) and in the combined nursing home and community samples (8.24% and 6.24%, respectively). The prevalence rates of dementia and Alzheimer's disease increased consistently with advancing age in both study groups.
To the authors' knowledge, this is the first study, using the same research method at the two sites, to report significant differences in rates of dementia and Alzheimer's disease in two different communities with similar ethnic origins.
The incidence rate of Alzheimer's disease (AD) was found to be 2 times lower in Yoruba than in African Americans. This study was aimed at identifying the factors associated with increased risk of ...incident AD in the two communities.
A two-stage design with initial screening using the CSI'D followed by neuropsychological test battery, relations' interview and physician assessment in a sub-sample.NINCDS-ADRDA criteria were met for AD. The risk factor variables assessed included demographic, lifestyle, medical and family history items.
In the Yoruba, AD was associated with age (OR = 1.07) and female gender (OR = 2.93). In African Americans, age (OR = 1.09) and rural living (OR = 2.08) were the significant risk factors, while alcohol was protective (OR = 0.49).
Age was a significant risk factor for AD at both sites. The higher risk of incident AD in the Yoruba female, and in African Americans who resided in rural areas in childhood were similar with the prevalence cases. Alcohol emerged a protective factor in African Americans. More studies are required, including biological measurements, to adequately explain the differences in rates.
BACKGROUND:Pediatric adherence to antiretroviral therapy (ART) is not well studied in resource-limited settings. Reported ART adherence may be influenced by contextual factors, such as orphan status.
...OBJECTIVES:The objectives of this study were to describe self- and proxy-reported pediatric ART adherence in a resource-limited population and to investigate associated contextual factors.
PATIENTS AND METHODS:This was a retrospective study involving pediatric, HIV-infected patients in Western Kenya. We included patients aged 0-14 years, who were on ART and had at least 1 adherence measurement (N = 1516). We performed logistic regression to assess the association between orphan status and odds of imperfect adherence, adjusting for sex, age, clinic site, number of adherence measures, and ART duration, stratified by age and ART duration.
RESULTS:Of the 1516 children, only 33% had both parents living when they started ART. Twenty-one percent had only father dead, 28% had only mother dead, and 18% had both parents dead. Twenty-nine percent reported imperfect ART adherence. The odds of ART nonadherence increase for children with both parents dead. Fifty-seven percent of children had imperfect clinic adherence. There was no significant association between orphan status and imperfect clinic adherence.
CONCLUSIONS:The majority of pediatric patients in this resource-limited setting maintained perfect ART adherence, though only half kept all scheduled clinic appointments. Understanding contextual factors, such as orphan status, will strengthen adherence interventions.
Mesh data has been a common form of data produced and searched in scientific simulations, and has been growing rapidly in the size thanks to the increasing computing power. Today, there are ...visualization tools that assist scientists to explore and examine the data, but their query capabilities are limited to a small set of fixed visualization operations, which is far too short to meet the needs of most users. Thus, it is imperative to provide ad hoc query tools for them.
In this paper, we propose an ad hoc query language MeshSQL, which has been extended from ANSI SQL99 to support the features unique to simulation mesh data, such as temporality, spatial regions, statistics, and similarity. After classifying MeshSQL queries based on three criteria related to efficient implementations of the queries, we present the syntax and semantics of MeshSQL, and support them with examples. We also discuss implementing MeshSQL queries in SQL99 in an object-relational database system that allows incorporating user-defined types and functions. To our knowledge, MeshSQL is the first and the only query language for simulation mesh data.
Predispositions to prescribe a pure analgesic, a cyclooxygenase inhibiting nonsteroidal antiinflammatory drug (NSAID) or a nonacetylated salicylate for a fictitious, uncomplicated case of ...osteoarthritis (OA) were surveyed in a sample of 152 community based primary care practitioners who had been characterized with respect to medical education and practice characteristics. Only 2 respondents (1%) prescribed a pure analgesic; 35% prescribed subantiinflammatory doses of cyclooxygenase inhibiting NSAID. The remainder (64%) recommended nonacetylated salicylates and cyclooxygenase inhibiting NSAID in doses large enough to achieve an antiinflammatory effect. Past participants in postgraduate rheumatology electives prescribed more costly regimens than those who had not participated (p = 0.05). When the case was altered to include a history of previous peptic ulcer, 44% chose cyclooxygenase inhibiting NSAID with adjunctive prophylaxis against NSAID induced gastropathy (e.g., misoprostol). When the complication was changed to renal insufficiency, recommendations for sulindac increased 3-fold over those for the uncomplicated case (34 vs 11%), and were most common among more recent medical school graduates and past participants in rheumatology electives (p less than 0.05 for both). The potential effects of educational and practice variables on the therapeutic strategies and costs of OA care in the community merit further systematic study.
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