Outcomes Of Different Types Research Articles

Outcomes of Surgical Correction of Atlantoaxial Instability in Patients with Down Syndrome: Systematic Review and Meta-Analysis

Atlantoaxial instability (AAI) is a common cause of neurologic dysfunction and pain in patients with Down syndrome (DS), frequently requiring instrumented fusion of the upper cervical spine. Despite this, optimal treatment strategy is controversial. A systematic review of the literature was performed according to the Preferred Reporting Items for Systemic Reviews and Meta-Analysis statement to identify patients with AAI and DS were treated with upper cervical spine fusion. Patient demographics, preoperative symptoms, fixation type, and outcome measures including complications, neurologic outcomes, and bony fusion status were gathered for patients in the included publications. Meta-analysis was performed to compare outcomes of different types of fixation constructs. Of the 1191 publications retrieved, 51 met inclusion criteria, yielding 137 patients. Six fixation strategies were identified: noninstrumented (n= 6), wiring (n= 77), wiring with rods (n= 14), screw fixation (n= 33), hook and rod fixation (n= 2), and screw and wire fixation (n= 5). Constructs with screws and rods had greater bony union (P= 0.003) and a lower rate of revision surgery (P= 0.047), loss of reduction or pseudoarthrosis (P= 0.009), halo utilization (P < 0.001), and early neurologic decline (P= 0.004) compared with wiring alone. Constructs with wires and rods had greater bony union (P= 0.036) than wiring alone. Numerous fixation strategies exist for AAI in patients with DS. Using a combination of screws, rods, and wiring in appropriately selected patients may help reduce the high rate of surgical complications in these patients.

Drug utilization research: a review

Data from drug utilization research is an invaluable resource for all stake holders involved in drug and health policies. Drug utilization is “marketing, distribution, prescription and use of drugs in a society, with special emphasis on the resulting medical, social and economic consequences”. Research on drug utilization includes factors related to prescribing, dispensing, administering and intake of medication and its associated events. The ultimate purpose of drug utilization research is to estimate the optimal quality of drug therapy by identifying, documenting, analysing problems in drug utilization and monitoring the consequences. It encourages the prescribers to prescribe correct drug at appropriate dose and affordable price. It contributes to the knowledge of rational use of drugs in the society; whether the drug is being prescribed appropriately, whether the drug is taken in correct dosage, whether the drug is available at affordable price or misused. It provides valuable feedback about the rationality of the prescription to the doctors. It also assesses whether an intervention affects the drug use in the population by examining the outcomes of different types of intervention given to improve rationality in drug use. Drug utilization research can be qualitative or quantitative and can be done by various methods. This review highlights the understanding of various aspects, different designs and WHO guidelines for conducting drug utilization research.

Clasificación de los desenlaces en los ensayos clínicos

A randomized controlled trial (RCT) is a planned and controlled experiment. It is also a prospective study in which one or more interventions are assigned to human participants in order to assess the effects on health outcomes, such as the efficacy and safety of treatments and interventions for different diseases. Different outcomes, whether clinical, patient-related or economic, can be measured in RCTs. An outcome is a clinical, medical, surgical or any other event that seeks to measure the effectiveness and safety of the treatment or intervention to be evaluated in an RCT. The choice of one or more outcomes depends on the nature of the study and the question to be answered. Likewise, the use of a wide range of outcomes tends to be more informative than the measure of one alone. Therefore, it is important to recognize each of these to define their correct implementation in the field of clinical research. This study aims to describe the different types of outcomes, which are classified into nine categories: 1. Efficacy and safety; 2. Primary, coprimary, secondary and tertiary; 3. Simple and compound; 4. Positive and negative; 5. Clinically significant and subrogated; 6. Objective and subjective; 7. Single, repeated measures and counts (events); 8. Dichotomous and continuous; and 9. Fixed time and calendar time.

Maternl and Neonatal Outcomes of Elective and Emergency Cesarean Sections

Cesarean section is safe surgical procedure, but increased cesarean section incidence leads to higher maternal and neonatal complications intraoperatively and postoperatively. This study aimed to assess the maternal and fetal outcomes of different types of cesarean sections in Kirkuk city. Hence, a prospective study was conducted in Obstetrics and Gynecology department of Azadi Teaching Hospital in Kirkuk city during 1st of October, 2013 to 31st of May, 2014, included 600 term pregnant women indicated for elective and emergency cesarean sections. It had been found that second stage Cesarean sections were significantly associated with womens’ obesity and irregular antenatal care (p<0.001). Extension of lower uterine incision, bladder injury and broad ligament hematoma were the reported introperative complication while, postoperative maternal complications were postpartum hemorrhage and secondary suturing of skin wound. Neonatal complications after first and second stage cesarean section were transient tachypnea, sepsis, admission to neonatal intensive care unit, hypoxic ischemic encephalopathy, birth asphyxia and low apgar score. In conclusion, the second stage cesarean section is obviously accompanied by many maternal and neonatal complications in comparison to elective and first stage cesarean sections.

Tutorial on Data Balancing: Application to Benchmarking Clinicians.

In this tutorial, we show how data balancing, in general, and stratified covariate balancing, in particular, can be used to benchmark clinicians. This tutorial aims to explain the concepts behind data balancing to readers who do not have a strong statistical background. Data balancing enables the analyst to compare the performance of clinicians with their peer groups on the same set of patients. The comparison is done in 3 steps. First, the patients are described in terms of their conditions/comorbidities. Each combination of comorbidities is treated as a separate type of patient. Second, the analyst measures the frequency of observing different types of patients. Third, expected outcomes are calculated for both the clinician and the peer group. The expected outcome for the clinician is calculated as the sum of product of 2 terms: probability of and the average outcome for different types of patients. The expected outcome for the peer group is calculated in the same way, with one difference: the distribution of peer group's patients is switched with the distribution of the clinician's patients. This allows us to simulate the performance of peer group on the clinician's patients. This switch in frequencies accomplishes the same goal as using propensity weights, or covariate balancing weights, but it avoids the cumbersome need to estimate the weights. In switching the distributions, a problem arises when the peer group does not see the same type of patients as the clinician. When the peer group's outcome for some patient types is missing, a synthetic case is organized. These synthetic cases are constructed from the peer group's experience with 2 complementary parts of the missing case. The reliance on synthetic cases allows one to have a match for every type of clinician's patients. Together, the synthetic case and the switch of distribution allow one to simulate the performance of the clinician and the peer group on same set of cases. The tutorial walks the reader through examples. The procedures described here can be applied to data in electronic health records. We present Standard Query Language for doing so.

Pretreatment Neutrophil-To-Lymphocyte Ratio (NLR) as a Prognostic Factor of Outcome for Patients with Oral Cavity Squamous Cell Carcinoma: A Single Institution Experience

Pretreatment Neutrophil-to-lymphocyte ratio (NLR) has been correlated with survival outcome in different types of cancers. In this study we evaluated the prognostic significance of pretreatment NLR in patients with oral squamous cell carcinoma (OSCC).

Ki-67 labeling index in glioblastoma; does it really matter?

Objective/BackgroundGlioblastoma (GB) is the most common primary malignant brain tumor in adults. Ki-67 is a nonhistone nuclear protein that is expressed by cells entering the mitotic cycle and is associated with the transcription of ribosomal RNA (rRNA). In gliomas, the extent of expression of Ki-67 is roughly proportional to the histologic grade. Over the years, association studies were conducted trying to link the poor outcome in different types of malignant tumors to the Ki-67 proliferative index. This study is designed to investigate the relationship between the proliferation marker, Ki-67, and the overall survival amongst glioblastoma patients diagnosed between 2006 and 2012 at a single institution in Riyadh, Saudi Arabia. MethodsThis is a retrospective cohort study which investigated the status of Ki-67 labeling index in glioblastoma patients diagnosed at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between 2006 and 2012. The Kaplan–Meier survival analysis was used to assess the overall survival (OS) and the Mantel–Cox log-rank test was used to compare the survival curves. Multivariate analysis using Cox proportional-hazards model was used to investigate other factors that might influence the overall survival. ResultsA total of 44 glioblastoma patients were included in the study. The median age at diagnosis was 56 (1–91) years. The 12-month survival rate for all glioblastoma patients was 48%. The median survival for patients with Ki-67 labeling index of ≤27%, and >27% was 11 months and 14 months, respectively. ConclusionThe difference between the survival curves of patients with Ki-67 labeling index of ≤27%, and Ki-67 of >27% was statistically insignificant (p = .130). Therefore, Ki-67 labeling index alone cannot predict survival in glioblastoma patients.

Main street plot scale in urban design for inclusive economies: Stockholm case studies

This paper explores evidence that entrepreneurial opportunities for migrants and other lower-income populations can be expanded in part through increasing the presence of fine-grained scales of plots and plates along main streets, as part of a systematic urban design strategy. It describes that systematic strategy herein. The paper encompasses the study of three main streets with varying plot sizes in the inner city of Stockholm, Sweden, and examines the outcomes for different types and scales of businesses. After presenting the findings, analysis and conclusions, larger questions of urban design for more inclusive economies are discussed.

Flexible Working, Work\u2013Life Balance, and Gender Equality: Introduction

This special brings together innovative and multidisciplinary research (sociology, economics, and social work) using data from across Europe and the US to examine the potential flexible working has on the gender division of labour and workers’ work–life balance. Despite numerous studies on the gendered outcomes of flexible working, it is limited in that the majority is based on qualitative studies based in the US. The papers of this special issue overcome some of the limitations by examining the importance of context, namely, family, organisational and country context, examining the intersection between gender and class, and finally examining the outcomes for different types of flexible working arrangements. The introduction to this special issue provides a review of the existing literature on the gendered outcomes of flexible working on work life balance and other work and family outcomes, before presenting the key findings of the articles of this special issue. The results of the studies show that gender matters in understanding the outcomes of flexible working, but also it matters differently in different contexts. The introduction further provides policy implications drawn from the conclusions of the studies and some thoughts for future studies to consider.

Sexual health interventions among early adolescents: an integrative review

Purpose Adolescent pregnancy and sexually transmitted infections including HIV are important public health issues in many countries around the world. The trend is escalating among adolescents of younger ages. Many programmes aim to prevent adolescent sexual risk behaviours associated with these health outcomes. The purpose of this paper is to describe and analyse methodological and substantive features of research on interventions to delay the initiation of sexual intercourse and prevent other sexual risk behaviours among early adolescents. Design/methodology/approach The review includes studies published between 2006 and 2017 that appear in Thai and international databases. Findings A total of 33 studies met specified review criteria. Of the studies reviewed, 14 used randomized control designs, 16 used quasi-experimental designs and three used a pre-test, post-test design. Sample sizes ranged from 64 to 4,776 subjects; nearly two-thirds of the studies (n = 22) included multiple follow-up surveys. The programmes evaluated in these studies can be grouped into three categories: abstinence-based sexuality education programmes (n = 12), comprehensive sexuality education programmes (n = 13) and youth development programmes designed for early adolescents (n = 10). In total, 22 programmes reviewed were effective in changing targeted adolescent psychosocial and/or behavioural outcomes. Research limitations/implications One of the limitations encountered in this study involved the search in library databases published only in Thai and English. Due to the limitation of searching library databases included in the review that reported the effects and differences among the included studies. Moreover, the search included publications consisted of heterogeneous designs and purpose with reports of different types of outcomes made it impossible to compare effect sizes. Practical implications The knowledge gained can be used to design and implement effective sexual health promotion programmes for early adolescents. Moreover, the findings can be applied as a guideline for health provider working in a schools, communities and adolescent health services. Recommendations for future studies are needed to consider methodological and substantive characteristics as well as the people who are involved in youth sexual health outcomes. Social implications It is necessary for government to develop a policy for encouraging parents to be aware and participate in solving the problems. Originality/value The review indicated that the positive effects of parental involvement and technology media as a programme material on the psychosocial and behavioural outcomes.

HDDA: DataSifter: statistical obfuscation of electronic health records and other sensitive datasets

ABSTRACTThere are no practical and effective mechanisms to share high-dimensional data including sensitive information in various fields like health financial intelligence or socioeconomics without compromising either the utility of the data or exposing private personal or secure organizational information. Excessive scrambling or encoding of the information makes it less useful for modelling or analytical processing. Insufficient preprocessing may compromise sensitive information and introduce a substantial risk for re-identification of individuals by various stratification techniques. To address this problem, we developed a novel statistical obfuscation method (DataSifter) for on-the-fly de-identification of structured and unstructured sensitive high-dimensional data such as clinical data from electronic health records (EHR). DataSifter provides complete administrative control over the balance between risk of data re-identification and preservation of the data information. Simulation results suggest that DataSifter can provide privacy protection while maintaining data utility for different types of outcomes of interest. The application of DataSifter on a large autism dataset provides a realistic demonstration of its promise practical applications.

Nonverbal synchrony: A new approach to better understand psychotherapeutic processes and drop-out.

Video-based measurement methods are new to psychotherapy research and provide new opportunities to investigate mechanisms of psychotherapeutic change related to nonverbal synchrony (movement coordination between patient and therapist). In this study, we validated the applied video-based procedures and evaluated nonverbal synchrony in association with the therapeutic relationship, therapy outcome, and drop-out. The naturalistic analysis sample consisted of 143 patients (136 videotaped sessions), who were treated with integrative cognitive–behavioral therapy at an out- patient clinic in southwest Germany. The videos were analyzed using Motion Energy Analysis (MEA), which provided a value for nonverbal synchrony. Patients routinely completed questionnaires assessing the therapeutic relationship and treatment success. We tested various confounding variables using multilevel modeling and investigated nonverbal synchrony in relation to measures of the therapeutic relationship. Further- more, we compared different types of outcomes with regard to nonverbal synchrony by means of multilevel modeling. The video-based procedures were shown to be highly valid. We found a link between the amount of nonverbal synchrony and therapeutic success; patients with nonimprovement and consensual termination showed the highest level, improved patients a medium level, and nonimproved patients with drop-out the lowest level of synchrony at the beginning of therapy, even when controlling for the therapeutic relationship. The study applied and evaluated a novel video-based approach in psychotherapy research and related it to common factors and the therapeutic process. Limitations of the automatic measurement methods and opportunities for the future routine prediction of drop-out are discussed.

Ex Vivo Expansion of Umbilical Cord Blood Hematopoietic Stem Cells on Collagen- Fibronectin Coated Electrospun Nano Scaffold

Surgical Outcome in Different Types of L4-L5 Degenerative Spondylolisthesis Based on CARDS Classification

Evaluation of complications and factors associated with multi-organ dysfunction in malaria: a cross sectional study

Background: Prevalence of complications in malaria continues to grow even with reducing number of malaria cases. Complications associated with malaria can involve multiple organs. There is paucity of literature on factors associated with multi organ dysfunction in different types of malaria.Methods: Our aim was to study the clinical profile of complications in different types of malaria with specific focus on multi-organ dysfunction (MODS). In this cross-sectional study confirmed cases of malaria were enrolled.Results: Plasmodium vivax malaria was the predominant type seen in 74.1% cases. The overall prevalence of thrombocytopenia was 61.5%, hepatic dysfunction 58%, cerebral malaria 16.1%, Hypoglycemia 7.5%, bleeding 34.5%, acute respiratory distress syndrome (ARDS) 5.7% and acute kidney injury (AKI) 49.4%. Hypoglycemia was significantly higher in mixed malaria (0.025, p = 0.025). Hepatic dysfunction and hyperbilirubinemia were significantly higher in mixed malaria (p=0.001). Mortality was seen in mixed malaria (p = 0.007). Only those with mixed malaria died (13%). Patients with MODS had higher prevalence of rashes (p &lt;0.0001) and cerebral malaria (p = 0.000). Serum levels of urea, creatinine, Bilirubin, Serum glutamic oxaloacetic transaminase (SGOT) and Serum glutamic pyruvic transaminase (SGPT) were significantly higher in patients with MODS (p&lt;0.0001 for all variables). On evaluating factors associated with multi-organ dysfunction presence of cerebral malaria [OR: 6.4 (95% CI): 2.4 to 17.4; p&lt;0.0001], type of malaria (Vivax or Falciparum or both) [1.77 (1.03 to 3.03); p=0.0038], and hypoglycemia [4.4 (1.08 to 17.8); p=0.038] were statistically significant on multivariate analysis.Conclusions: The present study demonstrates the factors associated with multi organ dysfunction and its impact on clinical outcome in different types of malaria.

Keratoprostheses in silicone oil-filled eyes: long-term outcomes.

To analyse the functional and anatomical outcomes of different types of keratoprostheses ineyes with retained silicone oil following vitreoretinal surgery. Retrospective chart review of patients operated with any type of permanent keratoprosthesis (Kpro) in silicone oil-filled eyes between March 2003 and June 2017 were analysed. 40 silicone oil-filled eyes underwent keratoprostheses, of which 22 were type 1 and 18 were type 2 Kpros (Lucia variant-nine, modified osteo odonto kerato prosthesis (MOOKP)-four, Boston type 2-three and osteoKpro-two) with a mean follow-up of 61.54 , 42.77, 45.25 , 25 and 37 months, respectively. Anatomic retention of the primary Kpro was noted in 33 eyes (82.5%). A best-corrected visual acuity of better than 20/200 and 20/400 was achieved in 26 (65%)+32 (80%) eyes. Retroprosthetic membrane (RPM) was the most common complication noted in 17 eyes (42.5%). Perioptic graft melt was noted in 4 of 22 eyes of the type 1 Kpro (2 (10.5%) without associated ocular surface disorder (OSD)) and in 1 eye each of Boston and Lucia type 2 Kpro. Laminar resorption occurred in one eye each of the MOOKP and OKP groups. Endophthalmitis and glaucoma did not occur in any eye. Appropriately chosen keratoprosthesis is a viable option for visual rehabilitation in eyes post vitreoretinal surgery with retained silicone oil-induced keratopathy not amenable to conventional penetrating keratoplasty. Kpro melt among type 1 Kpro did not occur in 89.5% eyes without associated OSD (19 of 22 eyes), despite the lack of aqueous humour and presence of RPM (4 eyes), two factors considered to play a significant role in the causation of sterile melts. Of interest to note was the absence of infection in any of these eyes. The possible protective role of oil from endophthalmitis is interesting, though yet to be ascertained.

Effect of CCL5 expression in the recruitment of immune cells in triple negative breast cancer

Triple negative breast cancer (TNBC) is the most aggressive form of breast cancer with limited options of targeted therapy. Recent findings suggest that the clinical course of TNBC may be modified by the presence of tumor-infiltrating lymphocytes (TILs) and chemokine’s expression, such as CCL5. Diverse studies have shown that CCL5 suppresses anti-tumor immunity and it has been related to poor outcome in different types of cancer while in other studies, this gene has been related with a better outcome. We sought to determine the association of CCL5 with the recruitment of TILs and other immune cells. With this aim we evaluated a retrospective cohort of 72 TNBC patients as well as publicly available datasets. TILs were correlated with residual tumor size after neoadjuvant chemotherapy (NAC) and CCL5 expression. In univariate analysis, TILs and CCL5 were both associated to the distant recurrence free survival; however, in a multivariate analysis, TILs was the only significant marker (HR = 0.336; 95%IC: 0.150–0.753; P = 0.008). CIBERSORT analysis suggested that a high CCL5 expression was associated with recruitment of CD8 T cells, CD4 activated T cells, NK activated cells and macrophages M1. The CD8A gene (encoding for CD8) was associated with an improved outcome in several public breast cancer datasets.

Do Changes to Family Structure Affect Child and Family Outcomes? A Systematic Review of the Instability Hypothesis

Many children experience multiple family transitions as their parents move into and out of romantic relationships. The instability hypothesis is a stress mediation model that suggests that family transitions cause stress and that this stress leads to worse developmental outcomes. We conducted a systematic review to evaluate the evidence base for this hypothesis. Thirty‐nine articles met the inclusion criteria. Most reports were secondary analyses of American longitudinal data sets. The support for the instability hypothesis was mixed, with many studies finding no evidence, or evidence only for certain groups, types of transitions, or outcomes. Protective factors and processes that prevent transitions from being stressful may explain some of the variability. Results suggest the need to empirically and theoretically differentiate relationship formation from dissolution, to examine effects of fathers' transitions, to include more and different types of outcomes, and to conduct this research within a broader variety of contexts.

Managerial Risk-Taking Incentives and Merger Decisions

We provide evidence concerning the effect of managerial risk-taking incentives on merger and acquisition (M&amp;A) decisions and outcomes for different types of mergers: vertical, horizontal, and diversifying. Using chief executive officer (CEO) relative inside leverage to proxy for the incentives of risk-averse managers, we find that CEOs with higher inside leverage are more likely to engage in vertical mergers, and those mergers generate lower announcement returns for shareholders. This effect of CEO relative inside leverage on returns for shareholders in vertical acquisitions is more pronounced when the acquirer has a higher degree of informational opacity, weak governance, and excess cash.

Clinical Features and Treatment Outcomes of Vitreoretinal Lymphoma according to Its Association with CNS Lymphoma

ABSTRACTPurpose: To compare the clinical features and treatment outcomes of different types of vitreoretinal lymphoma (VRL) that presents primarily, secondarily, or concurrently in association with CNS lymphoma.Methods: We retrospectively reviewed the medical records of 53 patients with VRL pathologically confirmed between 2000 and 2014 in two of the largest tertiary hospitals in Korea.Results: The proportions of primary, secondary, and concurrent VRL were 26%, 34%, and 40%, respectively. The primary VRL group had retinal infiltration most frequently (68%) among all groups and presented with the worst visual acuity at diagnosis (P = 0.035). The diagnostic delay was significantly shorter in patients with secondary VRL (1.4 months; P < 0.001). Median overall survival was 31 months in the entire cohort, and it was shortest in the concurrent VRL/CNS lymphoma group (18 months; P = 0.007).Conclusions: Ocular presentation and survival times may be different in VRL patients according to the association with CNS involvement.

T-lymphokine-activated killer cell-originated protein kinase (TOPK) as a prognostic factor and a potential therapeutic target in glioma.

TOPK is overexpressed in various types of cancer and associated with poor outcomes in different types of cancer. In this study, we first found that the expression of T-lymphokine-activated killer cell-originated protein kinase (TOPK) was significantly higher in Grade III or Grade IV than that in Grade II in glioma (P = 0.007 and P < 0.001, respectively). Expression of TOPK was positively correlated with Ki67 (P < 0.001). Knockdown of TOPK significantly inhibited cell growth, colony formation and increased sensitivities to temozolomide (TMZ) in U-87 MG or U-251 cells, while TOPK overexpression promoted cell growth and colony formation in Hs 683 or A-172 cells. Glioma patients expressing high levels of TOPK have poor survival compared with those expressing low levels of TOPK in high-grade or low-grade gliomas (hazard ratio = 0.2995; 95% CI, 0.1262 to 0.7108; P = 0.0063 and hazard ratio = 0.1509; 95% CI, 0.05928 to 0.3842; P < 0.0001, respectively). The level of TOPK was low in TMZ-sensitive patients compared with TMZ-resistant patients (P = 0.0056). In TMZ-resistant population, patients expressing high TOPK have two months’ shorter survival time than those expressing low TOPK. Our findings demonstrated that TOPK might represent as a promising prognostic and predictive factor and potential therapeutic target for glioma.