Multidimensional Stratification Research Articles

Correlates of one-year mortality among patients living with HIV according to the stratification level of the pharmaceutical care model

ObjectivesThe patient living with HIV (PLWH) profile has changed and with it, the importance of patient-oriented pharmaceutical care (PC) has been highlighted, for which the stratification tool of the Capacity-Motivation-Opportunity (CMO) PC model helps us which adapts to the needs of each patient. To assess the true relevance, our main objective is to evaluate the differences of one-year mortality among PLWH stratified according to this model. MethodsA single-center observational analytical survival research study including adult PLWH on antiretroviral therapy (ART) from January-2021 to January-2022 treated at hospital pharmacy outpatient service according to CMO pharmaceutical care model. ResultsA total of 428 patients were included, a median age of 51 years (interquartile range 42–57 year). Overall, the number of patients stratified according to the CMO PC model was 86.2% at level 3, 9.8% at level 2, and 4.0% at level 1. Cox proportional hazard model that included the stratification level was associated with a higher mortality, whose level 1 patients had a 99.7% higher mortality (Hazard ratio=0.0003; 95%CI: 0.001–0.027). ConclusionsTo sum up, mortality of-one year differs when comparing the PC strata of level 1 and non-level 1, although being similar in age and other clinical conditions. This result suggests that the multidimensional stratification tool, included in the CMO PC model, could be used to modulate the patients intensity follow-up and design interventions more tailored to their needs.

Correlates of one-year mortality among patients living with HIV according to the stratification level of the pharmaceutical care model

ObjectivesThe patient living with HIV (PLWH) profile has changed and with it, the importance of patient-oriented pharmaceutical care (PC) has been highlighted, for which the stratification tool of the Capacity-Motivation-Opportunity (CMO) PC model helps us which adapts to the needs of each patient. To assess the true relevance, our main objective is to evaluate the differences of one-year mortality among PLWH stratified according to this model. MethodsA single-center observational analytical survival research study including adult PLWH on antiretroviral therapy (ART) from January-2021 to January-2022 treated at hospital pharmacy outpatient service according to CMO pharmaceutical care model. ResultsA total of 428 patients were included, a median age of 51 years (interquartile range 42–57 year). Overall, the number of patients stratified according to the CMO PC model was 86.2% at level 3, 9.8% at level 2, and 4.0% at level 1. Cox proportional hazard model that included the stratification level was associated with a higher mortality, whose level 1 patients had a 99.7% higher mortality (Hazard ratio=0.0003; 95%CI: 0.001–0.027). ConclusionsTo sum up, mortality of-one year differs when comparing the PC strata of level 1 and non-level 1, although being similar in age and other clinical conditions. This result suggests that the multidimensional stratification tool, included in the CMO PC model, could be used to modulate the patients intensity follow-up and design interventions more tailored to their needs.

DIGITAL TECHNOLOGIES: A FIELD OF NEW OPPORTUNITIES OR AN OBSTACLE FOR THE PERSONAL AND PROFESSIONAL REALIZATION OF PERSONS FROM THE ROMA COMMUNITY

In the modern global world, digital technologies are becoming more and more necessary and a mandatorycondition for successful personal and professional realization. We live in a world where digital change and the entryof new technologies into various social spheres have a significant impact on the way each one of us works, buys,communicates and communicates. A number of analyzes are available in the specialized literature, which take intoaccount the fact that through the ongoing digital change, an evolutionary change is taking place in society withsignificant socio-economic consequences, which bring risks and opportunities for profound changes in the socialstructure of society. In order to prevent polarization in society, action is needed to benefit vulnerable individuals andsocial groups. One such action is related to the achievement of equality of opportunity.Thus, not full equality is achieved, but "achieved inequality" (Parsons 2005) which replaces "assigned inequality" asa result of belonging to a certain class, ethnicity or gender by birth. If we have to paraphrase Ralph Dahrendorf'sthesis (RalfDahrendorf 1979), for the digital transition to happen, new technologies must increase the opportunitiesand improve the life chances of the different social groups in society. A research question of great practicalimportance is how new technologies, instead of deepening existing socio-economic inequalities, can create newopportunities for everyone, including vulnerable groups at risk, against whom statistical data show a lag in the use ofthe Internet for professional and personal fulfillment. The recovery and digital transition must be fair and include thedifferent social groups in society. Insufficiently researched in Bulgaria is what are the opportunities and risks thatdigital technologies hide for the representatives of the different ethnic communities.The present report follows the theoretical tradition of the multidimensional stratification approach, founded by MaxWeber, to determine divisions and positions in the social structure of society. On the basis of a series of in-depthinterviews conducted among representatives of the Roma community within the framework of a project on the topic:"Digital divide and social inequalities: levels, actors and interactions", funded by FNI at the Ministry of Educationand Science, an attempt will be made to answer the research question.

Databases on the problems of studying social stratification and mobility of urban elites and the middle strata of Tambov in the late 19th - early 20th centuries: sources, structure, technology of complex analysis

The article presents the structure of source-oriented electronic databases created on the basis of personified mass sources that contain information about the population of Tambov in 1896-1917. The features and possibilities of using mass primary sources for the study of social stratification and mobility of the propertied strata of the population of the provincial center in the late 19th - early 20th centuries are analyzed. Methods of complex processing of electronic databases on social stratification and mobility of the population of a Russian provincial city in the late 19th - early 20th centuries are characterized. The scientific novelty of the study consists of the use of information technologies to implement the method of social identification of the elite and middle layers of the provincial Russian city in the late 19th - early 20th centuries, the basis of which is the approaches and methods of theories of multidimensional stratification and social mobility. The information potential of the bases made it possible to conduct social ranking, analyze the social mobility of the elite and the middle strata of the provincial center in the late 19th - early 20th centuries. The presented methods and technologies for the creation and complex processing of source-oriented databases on the problems of social stratification and mobility of the elite and middle strata of Tambov in the late 19th - early 20th centuries can be used to study social processes in relation to other settlements, chronological periods, class-social and professional groups of the population.

Dissecting the clinical heterogeneity of adult-onset Still's disease: results from a multi-dimensional characterization and stratification.

To stratify adult-onset Still's disease (AOSD) patients in distinct clinical subsets to be differently managed, by using a multi-dimensional characterization. AOSD patients were evaluated by using a hierarchical unsupervised cluster analysis comprising age, laboratory markers systemic score and outcomes. The squared Euclidean distances between each pair of patients were calculated and put into a distance matrix, which served as the input clustering algorithm. Derived clusters were descriptively analysed for any possible difference. Four AOSD patients clusters were identified. Disease onset in cluster 1 was characterized by fever (100%), skin rash (92%) and arthritis (83%), with the highest ferritin levels [mean (S.D.) 14724 (6837) ng/ml]. In cluster 2, the onset was characterized by fever (100%), arthritis (100%) and liver involvement (90%), together with the highest CRP levels [288.10 (46.01) mg/l]. The patients in cluster 3 presented with fever (100%), myalgia (96%) and sore throat (92%). The highest systemic score values [8.88 (1.70)] and the highest mortality rate (54.2%) defined cluster 3. Fever (100%) and arthritis (90%) were the symptoms at the onset in cluster 4, which was characterized by the lowest ferritin and CRP levels [1457 (1298) ng/ml and 54.98 (48.67) mg/l, respectively]. Four distinct phenotypic subgroups in AOSD could be suggested, possibly associated with different genetic background and pathogenic mechanisms. Our results could provide the basis for a precision medicine approach in AOSD in an attempt to find a clinical and laboratory multidimensional stratification and characterization, which would drive a tailored therapeutic approach in these patients.

DNA methylation, transcriptome and genetic copy number signatures of diffuse cerebral WHO grade II/III gliomas resolve cancer heterogeneity and development

BackgroundDiffuse lower WHO grade II and III gliomas (LGG) are slowly progressing brain tumors, many of which eventually transform into a more aggressive type. LGG is characterized by widespread genetic and transcriptional heterogeneity, yet little is known about the heterogeneity of the DNA methylome, its function in tumor biology, coupling with the transcriptome and tumor microenvironment and its possible impact for tumor development.MethodsWe here present novel DNA methylation data of an LGG-cohort collected in the German Glioma Network containing about 85% isocitrate dehydrogenase (IDH) mutated tumors and performed a combined bioinformatics analysis using patient-matched genome and transcriptome data.ResultsStratification of LGG based on gene expression and DNA-methylation provided four consensus subtypes. We characterized them in terms of genetic alterations, functional context, cellular composition, tumor microenvironment and their possible impact for treatment resistance and prognosis. Glioma with astrocytoma-resembling phenotypes constitute the largest fraction of nearly 60%. They revealed largest diversity and were divided into four expression and three methylation groups which only partly match each other thus reflecting largely decoupled expression and methylation patterns. We identified a novel G-protein coupled receptor and a cancer-related ‘keratinization’ methylation signature in in addition to the glioma-CpG island methylator phenotype (G-CIMP) signature. These different signatures overlap and combine in various ways giving rise to diverse methylation and expression patterns that shape the glioma phenotypes. The decrease of global methylation in astrocytoma-like LGG associates with higher WHO grade, age at diagnosis and inferior prognosis. We found analogies between astrocytoma-like LGG with grade IV IDH-wild type tumors regarding possible worsening of treatment resistance along a proneural-to-mesenchymal axis. Using gene signature-based inference we elucidated the impact of cellular composition of the tumors including immune cell bystanders such as macrophages.ConclusionsGenomic, epigenomic and transcriptomic factors act in concert but partly also in a decoupled fashion what underpins the need for integrative, multidimensional stratification of LGG by combining these data on gene and cellular levels to delineate mechanisms of gene (de-)regulation and to enable better patient stratification and individualization of treatment.

КЛІНІКО–ЕПІДЕМІОЛОГІЧНІ ТРЕНДИ СУЧАСНОЇ ТОРАКОАБДОМІНАЛЬНОЇ ПОЛІТРАВМИ

Проведене концептуальне клініко–епідеміологічне дослідження поєднаної торакоабдомінальної травми (ПТАТ) на основі аналізу 2009 медичних карт. Клінічний діагноз та судово–медичні висновки трансформовані у коди шкали ВПХ(П)–МТ. Основним завданням було виділення клініко–епідеміологічних груп, що найкращим чином апроксимують процеси розподілу сучасної травми залежно від тяжкості ушкодження (ТУ). Для цього проведена багатовимірна стратифікація даних тяжкості травми шляхом кластеризації. Встановлено, що сучасна ПТАТ має чітку структуризацію на клініко–епідеміологічні групи, клінічний профіль яких визначається тяжкістю домінуючого ушкодження певної анатомо–функціональної ділянки (АФД). Травма грудей є найбільш частим домінуючим ушкодженням в структурі ПТАТ. Формальні ознаки політравми виявляють у 29,2% постраждалих, принциповим напрямком покращення результатів лікування слід вважати розробку методів лікування за принципами хірургічної тактики «damage control».

The Need for Multidimensional Stratification of Chronic Low Back Pain (LBP).

MiniThe authors wanted to determine which existing primary-care low back pain stratification schema is associated with distinct subpopulations. Initial stratification by DMPP identified potentially distinct epidemiological groups. DMPP stratification resulted in discrimination beyond that provided by disability or chronicity risk stratification alone.Study Design.A cross-sectional study of Canadian patients suffering from low back pain (LBP) seeking primary care.Objective.The aim of this study was to determine which existing primary care LBP stratification schema is associated with distinct subpopulations as characterized by easily identifiable primary epidemiological factors.Summary of Background Data.LBP is among the most frequent reasons for visits to primary care physicians and a leading cause of years lived with disability. In an effort to improve treatment response/outcomes in LBP primary care, different classification systems have been proposed in an effort to provide more tailored treatment with the intent of improving outcomes. Group-specific risk factors and underlying etiology might suggest a need for, or inform, changes to treatment approaches to optimize LBP outcomes.Methods.Stratification by dominant mechanical pain patterns; chronicity risk; disability severity. Multinomial logistic regression was used to identify the system showing greatest variability in associations with age, sex, obesity, and comorbidity. Once identified, the remaining schemas were incorporated into the model.Results.N = 970; mean age: 50 years (range: 18–93); 56% female. Stratification by pain pattern revealed greater variability. Adjusted analysis: Increasing age was associated with greater odds of intermittent, extension-based back- or leg-dominant pain [odds ratio (OR): 1.02 and 1.06; P < 0.01]; being male with leg-dominant pain (ORs > 2; P < 0.01). Overweight/obesity was associated with extension-based leg-dominant pain (OR = 2.6; P < 0.02) and increasing comorbidity with extension-based back-dominant pain (OR = 1.3; P < 0.01). Severe disability was associated only with constant leg pain (OR = 3.9; P < 0.01), and high chronicity risk with extension-based leg-dominant pain (OR = 0.4; P = 0.03).Conclusion.Dominant mechanical symptom stratification resulted in further discrimination of an epidemiologically distinct and a large subgroup of LBP patients not identified by disability or chronicity risk stratification alone. Findings suggest a need for primary care initiated multidimensional stratification in chronic LBP.Level of Evidence: 3

The Need for Multidimensional Stratification of Chronic Low Back Pain (LBP)

The Need for Multidimensional Stratification of Chronic Low Back Pain (LBP)

Inequality in Poverty

The paper analyzes the variety of discourses on social inequalities in postcommunist Bulgaria. The focus is on academic discourse, but political and everyday interpretations are presented as well. Politicians generally avoid talking about social differences and prefer instead the dichotomy of “elite” versus “the people,” whose interests the politicians vow to protect. In popular consciousness, the main division is between “the rich” (mafia, politicians, ex-nomenklatura) and “the honest poor.” In sociology, three main research trajectories have emerged: from class-based to status-based stratification; from one-dimensional to multidimensional stratification; and from a Marxist class model to a social network model. Perhaps the most important characteristic of Bulgarian society is its high level of poverty, according both to income indicators and self-perception. In this context of a pervasive sense of poverty, status differences lose their significance. This in turn prevents the establishment of group or class solidarity, as everyone feels she or he is competing with all others. Starting in 2013, a new trend can be observed: of social protests organized by those who say they feel powerless and manipulated by corrupt elites. As they try to initiate new types of economic negotiations with the government, sociologists have a responsibility both to study this new movement and to push the problems it raises into public debate.

Latin hypercube designs with controlled correlations and multi-dimensional stratification

Various methods have been proposed to construct Latin hypercube designs with small correlations. Orthogonal arrays have been used to construct Latin hypercube designs with multi-dimensional stratification. To integrate these two ideas, we propose a method to construct Latin hypercube designs with both controlled correlations and multi-dimensional stratification. For numerical integration, the constructed designs not only filter out lower-dimensional variance components as effectively as ordinary orthogonal array-based Latin hypercube designs, but also filter out bilinear terms more effectively. The proposed construction method entails no iterative searches. Sampling properties of the constructed designs are derived. Examples are given to illustrate the proposed construction method and the theoretical results.

Guidelines and standards: are they the same?

Although the natural relationship between cancer and thrombosis has been recognised since the middle of the 19th century, nearly 70% of patients with an increased risk of thrombosis do not receive appropriate antithrombotic prophylaxis. The blatant disregard for the basics of this acquired hypercoagulable state and guidelines on managing such an avoidable risk is obvious in the medical community. The primary stumbling blocks in this area are the concerns over the risk of bleeding, the absence of a systematic stratification of the thrombosis risk and structural and economic constraints. Different scales, with varying levels of complexity, have been proposed, however none of them have really been validated to determine this risk in its entirety, with its diverse range of clinical and therapeutic scenarios. The majority of medical societies have published their own guidelines, but these also appear to vary greatly. On the initiative of the Groupe Francophone Thrombose et Cancer (the French-speaking thrombosis and cancer group), a consensual document, based on the guidelines for the management of thrombosis in cancer patients from representatives of international learned societies will be published. In addition, within the framework of the Association Francophone pour les Soins Oncologiques de Support (Frenchspeaking association for supportive oncological care) and in light of current understanding and good clinical practices, a multidisciplinary group of experts have developed guidelines and recommendations in the form of simple and context-based algorithms to assist doctors in their antithrombotic strategic decision. The necessary harmonisation of guidelines and the enforcement of more systematic therapeutic education programmes for an individual besides multidimensional stratification of the vascular risk will result in the optimisation of this treatment of cancer patients and extended clinical practices.

Convergence or Divergence? Comparing Recent Social Trends in Industrial Societies.

Trends in fertility decline, intergenerational relations, religion and secularization, ecological movements, employment and labour-market changes, personal authority, and social conflict are examined. This analysis shows an unmistakable convergence of social trends except in the domain of religion. But when the interconnection of these trends within each national society is examined, unexpected divergences are revealed. There are parallel trends in demography, organization of production, national institutions, social practices, and life style, and divergent trends in social inequality, social movements, and local institutions. Barriers between social classes have eroded and something that might be called multidimensional stratification has emerged, the diminution of violence in social conflicts implies an increasing volume of negotiation, and all forms of personal authority have been weakened. The transformation of the family structure is no doubt one of the most important changes in western civilization. The cross-national analyses of recent social trends help us to assess both convergence and divergence and to identify emergent singularities. Does convergence of trends mean these societies face a common destiny? With respect to trends so strong that they act as exogenous variables, the answer is yes. However, with respect to the responses those trends elicit in the context of a particular society, the answer is no. Massive convergence of trends does not mean that societies face a uniform future.