Strong Predictive Role Research Articles

MP23-19 PROSPECTIVE VALIDATION OF THE ROL SYSTEM IN SUBSTAGING PT1 HIGH-GRADE BLADDER CANCER: A CONFIRMATORY PROGRESSION RISK ANALYSIS TO EASE DECISION MAKING

You have accessJournal of UrologyCME1 May 2022MP23-19 PROSPECTIVE VALIDATION OF THE ROL SYSTEM IN SUBSTAGING PT1 HIGH-GRADE BLADDER CANCER: A CONFIRMATORY PROGRESSION RISK ANALYSIS TO EASE DECISION MAKING Marina Valeri, Roberto Contieri, Vittorio Fasulo, Miriam Cieri, Grazia M. Elefante, Massimo Lazzeri, Gianluigi Taverna, Luigi M. Terracciano, Rodolfo Hurle, and Piergiuseppe Colombo Marina ValeriMarina Valeri More articles by this author , Roberto ContieriRoberto Contieri More articles by this author , Vittorio FasuloVittorio Fasulo More articles by this author , Miriam CieriMiriam Cieri More articles by this author , Grazia M. ElefanteGrazia M. Elefante More articles by this author , Massimo LazzeriMassimo Lazzeri More articles by this author , Gianluigi TavernaGianluigi Taverna More articles by this author , Luigi M. TerraccianoLuigi M. Terracciano More articles by this author , Rodolfo HurleRodolfo Hurle More articles by this author , and Piergiuseppe ColomboPiergiuseppe Colombo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002562.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The management of T1 high-grade (HG) bladder cancer (BC) patients is still a challenging issue in urological practice. Depth and amount of lamina propria (LP) tumor invasion is a key prognostic variable. Compared to other substaging methods, the Rete Oncologica Lombarda (ROL) system - simply based on a 1-mm threshold- showed a high predictive value for tumor progression after transurethral resections of the bladder (TUR) in recent retrospective studies. Our aim was to validate ROL system on a large monoistitutional prospective series of primary urothelial carcinomas from TUR. METHODS: From 2013 to 2020, we prospectively maintained a database of pT1HG BC patients with available clinicopathologic data. Using ROL system for T1 substaging, we adopted a cut-off of 1 mm (diameter of a high-power field, HPF, objective 20x) to stratify tumors in ROL1 and ROL2, corresponding to invasive focus or multiple foci extending together for <1 HPF and for >1 HPF, respectively. Univariate and multivariate Cox proportional hazard models were employed to identify significant independent predictors of recurrence and progression after TUR. Kaplan-Meier (KM) survival estimates were used to investigate ROL’s predictive role on progression free survival (PFS) and recurrence free survival (RFS). RESULTS: A total of 229 confirmed T1HG BC entered the prospective study. Mean age was 73 yr and most patients were male (74.7%); 70 tumors were multifocal (30.57%), 33 cases had divergent differentiation (14.4%), associated carcinoma in situ (CIS) and lymphovascular invasion (LVI) occurred in 32 (14%) and 20 (9%) cases, respectively. ROL was feasible in all but one case (99.6%): 94 cases were ROL1 (41%) and 134 ROL2 (59%). All patients completed the BCG induction course and at least 1 or 2 maintenance courses. At a median follow up of 23 months (IQR 12.33-38.5), 59 patients had recurrence (25.76%) and 37 patients had progression (16%). ROL was a significant predictor of progression in univariate Cox regression analysis (OR= 3.58, 95% CI, 1.50-8.56; p=0.004), confirmed by the multivariate analysis (OR= 2.95, 95% CI, 1.11-7.87; p=0.03). In KM estimates for PFS and RFS, ROL showed a significant correlation with progression (p <0.01), while no significance was reached for recurrence (p >0.05). CONCLUSIONS: Our results confirmed the strong predictive role of ROL for progression on a large prospective series. We foster the application of ROL system for substaging T1HG BC, a simple and feasible method that might identify high risk patients and drive urological decision making. Source of Funding: No © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e391 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marina Valeri More articles by this author Roberto Contieri More articles by this author Vittorio Fasulo More articles by this author Miriam Cieri More articles by this author Grazia M. Elefante More articles by this author Massimo Lazzeri More articles by this author Gianluigi Taverna More articles by this author Luigi M. Terracciano More articles by this author Rodolfo Hurle More articles by this author Piergiuseppe Colombo More articles by this author Expand All Advertisement PDF DownloadLoading ...

Evaluation of Coronavirus Preventive Behaviors Among Women Referring to Comprehensive Health Service Centers in Isfahan Based on Protection Motivation Theory (Iran)

Background and Objectives: The coronavirus pandemic (COVID-19) has caused an extraordinary situation in the world since the end of 2019, which led to an unprecedented social, political and economic crisis. Currently, the most important way to deal with this pandemic is to fully comply with health protocols along with general vaccination, which is necessary to raise public awareness and change people's health and social behaviors. One of the models of health education and health promotion is the model of protection motivation, which in this study, based on this model, the preventive behaviors of women in Isfahan against coronavirus are evaluated. Methods: The present study was a cross-sectional-analytical study designed and conducted in 2021 The study population included all women covered by comprehensive health centers in Isfahan in 2021 and the sample size was 300 people. The data were collected using two questionnaires. The first questionnaire included demographic information of the participants and the second questionnaire included the constructs of protection motivation theory. Collected data were analyzed by SPSS v. 20 software using Pearson correlation coefficient, one-way analysis of variance and linear regression. Results: Based on the findings, the correlation between perceived (inconsistent) reward structure (P‌=‌0.000, r‌=‌-0.287) and perceived cost (barriers) (P‌‌=0.000, r‌=‌-0.466) with protection motivation (Intention) is negative, indicating that the motivation for protection decreases as the perceived reward and cost increase. Among the structures, self-efficacy had the highest correlation with protection motivation (P‌=‌0.000, r‌=‌0.664). Linear regression analysis showed that 58.4% of the variance of protection motivation can be predicted by other structures, The role of reward, cost, self-efficacy and fear constructs are significant and cost structure has a stronger predictive role. Conclusion: The findings of the present study showed that the constructs of the theory of Protection motivation can well predict the intention of individuals to observe the principles of prevention, Using this theory and its structures, effective interventions can be designed and implemented to control this epidemic. In the meantime, more attention should be paid to the cost structure. Also, based on these findings, it was found that the existing barriers to the observance of preventive principles have a significant impact on the intention of individuals to follow these principles.

The Role of Cumulative LDL Cholesterol in Cardiovascular Disease Development in Patients with Familial Hypercholesterolemia.

In patients with familial hypercholesterolemia (FH) the exposure of very high LDL-C concentration and cumulative LDL-C level (cum LDL-C) can play a significant role in the prognosis. Objective: to analyze the contribution of “cum LDL-C for all life” and the index “cum LDL-C/age” to the development of coronary heart disease (CHD), myocardial infarction (MI), and a combined end point: MI, stroke, unstable angina in FH patients. Methods: 188 patients (mean age 49.2 years, males 45.7%) with FH were examined (Dutch Lipid Clinic Criteria). We had evaluated cumulative LDL-C and index “cum DL-C/age” along with other classical risk factors. Cum LDL-C was calculated as LDL-Cmax × (age at initiating of hypolipidemic therapy) + LDL-C at inclusion age at initiation/correction therapy). Cumulative LDL-C and “cum LDL-C/age” were calculated as the ratio cum LDL-C to age. The follow-up period was 5.4 (from 3 to 10) years. Results: The index “cum LDL-C/age” was higher in patients with CHD 58.7 ± 10.4 mmol/L/years vs. 40.1 ± 11.7 mmol/L/years in patients without CHD (p < 0.001). According to our data based on the results of the logistic regression analysis in patients with FH, cumulative LDL-C and the cumulative index “cum LDL–C/age” played a strong predictive role in the development of CHD in FH patients; it was greater than the role of TC and LDL-C concentrations. We present ROC curves for CHD, MI and combined end point in FH patients, and a prognostic scale for CHD development, which is based on classical cardiovascular risk factors. Conclusion: cumulative LDL-C level plays an important role in the development of CHD in FH patients.

Role of LA strain assessed by speckle tracking echocardiography in predicting patients who develop POAF after a coronary artery bypass surgery

Abstract Objectives To evaluate the correlation between left atrial dysfunction assessed by speckle tracking echocardiography and development of postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass grafting. To determine the role of coronary risk factors in development of POAF. Method Patients undergoing CABG from January 2019 till June 2020 in Apollo institute, fulfilling the inclusion and exclusion criteria were included.Total of 200 patients were followed.They were subjected to LA strain and strain rate analysis by speckle tracking. Results The incidence of POAF in our study was 24% (n=48). The mean age of this study population was 59.13 years. The patients who developed POAF were older (68.5±9.048 vs 58.39±9.74 years, p value=0.05) than those with no POAF. POAF occurred in 2 phases. the highest proportion of POAF occurrence noticed on postoperative day 2. Among the total POAF cases 79.% occurred within the first 48 hours and 20.8% occurred later (p=0.001). Among the 48 patients who developed POAF, 5 of them developed recurrence during their hospital stay. They had reverted to sinus rhythm following anti-arrhythmic medication for a duration of &amp;gt;24 hours, but went on to develop recurrence of AF at a later. 4 among them reverted to sinus rhythm at discharge while 1 continued to remain in AF at discharge.The duration of hospital stay for patients with POAF group was 10.4 days compared with 10.04 days for those without POAF. Similarly the post-operative stay in the hospital was 7.4 days for the POAF group and 7.04 days for the NO POAF.There was no added economic impact secondary to AF.Comparing the values of left atrial volume index of both the groups it was derived that the mean LAVI value of the POAF group was 26.84+3.654 ml/m2 and that for the NO POAF group was 26.6+3.037ml/m2. Though the patients with POAF had larger LA volume, the chi square test analysis did not yield any clinically significant relationship between LAVI and POAF in our study (p=0.3). The mean LA global strain for the patients with POAF was 29.73+3.695%. And for the patients with no POAF was 36.3+4.854%. LA global strain was reduced in patients who developed POAF (P&amp;lt;0.001) which indicated a strong correlation between LA strain and POAF. Conclusion There is significant correlation between Global Left Atrial Strain and POAF in patients undergoing CABG (P&amp;lt;0.001).There is no significant correlation between patient factors like age, BMI, and the conventional coronary risk factors with POAFThere is no significant correlation between the conventional echocardiographic parameters like LA diameter, LAVI, LVDD, LVSD, LVEF and transmitral flow velocities with POAF. To conclude, preoperative speckle tracking assessment of LA has a strong predictive role in determining the occurrence of POAF in patients undergoing Coronary artery bypass grafting surgery. Funding Acknowledgement Type of funding sources: None.

Predictive value of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in advanced hepatocellular carcinoma patients treated with anti-PD-1 therapy.

BackgroundCurrently, there are no recognized or validated biomarkers to identify hepatocellular carcinoma patients (HCC) likely to benefit from anti–PD‐1 therapy. We evaluated the relationship between neutrophil‐lymphocyte ratio (NLR) and platelet‐lymphocyte ratio (PLR) and survival outcomes, pretreatment and after three doses (posttreatment) of nivolumab in HCC patients.MethodsMedical records of HCC patients treated with nivolumab between June 2016 and July 2018 were reviewed. Kaplan‐Meier analysis and the log‐rank test were used to calculate and compare overall survival between NLR < 5 Vs ≥ 5 and among PLR tertiles.ResultsA total of 103 patients were identified. Median age was 66 (29‐89) years. Median treatment duration was 26 (2‐149) weeks. Sixty‐four (62%) patients had Child‐Pugh class A (CP‐A) liver function. Barcelona Clinic Liver Cancer stage was B in 20 (19%) and C in 83 (81%) patients. CP‐A patients who achieved a partial or complete response had significantly lower posttreatment NLR and PLR (P < .001 for both) compared to patients who had stable disease or progression of disease. No relationship was observed between response and pretreatment NLR and PLR. NLR < 5 was associated with improved OS compared to NLR ≥ 5 both pretreatment (23 Vs10 months, P = .004) and posttreatment (35 Vs 9 months, P < .0001). Survival also differed significantly among PLR tertiles both pre‐ (P = .05) and posttreatment (P = .013). In a multivariable model, posttreatment NLR (HR = 1.10, P < .001) and PLR (HR = 1.002, P < .001) were strongly associated with survival. In a composite model of posttreatment NLR and PLR, a combination of high NLR and PLR was associated with an eightfold increased risk of death (HR = 8.3, P < .001).ConclusionsThis study suggests a strong predictive role of these inflammatory cell ratios in the posttreatment setting in HCC patients treated with anti anti–PD‐1 therapy and should be evaluated in a larger cohort.

Erectile Dysfunction as a Cardiovascular Risk Factor: Time to Step Up?

Erectile dysfunction (ED) is a major health problem that affects a significant proportion of the general population, and its prevalence is even higher in patients with CV risk factors and/or disease. ED and cardiovascular (CV) disease share several common pathophysiological mechanisms, and thus, the potential role of ED as a predictor of CV events has emerged as a significant research aspect. The purpose of this review is to present and critically discuss data assessing the relation between ED and CV disease and the potential predictive value of ED for CV events. A comprehensive review of the literature has been performed to identify studies evaluating the association between ED and CV disease. Several cross-sectional and prospective studies have examined the association between ED and CV disease and found an increased prevalence of ED in patients with CV disease. ED was shown to independently predict future CV events. Importantly, ED was found to precede the development of overt coronary artery disease (CAD) by 3 to 5 years, offering a "time window" to properly manage these patients before the clinical manifestation of CAD. Phosphodiesterase type 5 inhibitors are the first-line treatment option for ED and were shown to be safe in terms of CV events in patients with and without CV disease. Accumulating evidence supports a strong predictive role of ED for CV events. Early identification of ED could allow for the optimal management of these patients to reduce the risk for a CV event to occur.

Subjective Quality of Life, Religiousness, and Spiritual Experience in Greek Orthodox Christians: Data from Healthy Aging and Patients with Cardiovascular Disease.

The goal of this study is to examine subjective quality of life-life satisfaction, religiousness, and spiritual experience in healthy younger and older adults, as well as in older patients suffering from severe cardiovascular disease, while examining the role of marital status, employment and socioeconomic status, existence of social network, urbanicity, education, depression, and personal opinion about the country's current socioeconomic situation. Results revealed that there are no age differences and that the role of demographic variables as predictors of religiousness, spiritual experience, and quality of life-life satisfaction don't seem to be very strong. Marital status, employment, and religiousness moderately predict quality of life-life satisfaction. Quality of life-life satisfaction, religiousness, and spirituality are not strongly interconnected in this Greek Orthodox Christian sample. Future cross-cultural research should further investigate the role of other psychological and social parameters that may have a stronger predictive role in quality of life of older adults.

Weaning from tracheostomy in subjects undergoing pulmonary rehabilitation

Background: Weaning from tracheostomy has implications in management, quality of life, and costs of ventilated patients. Furthermore, endotracheal cannula removing needs further studies. Aim of this study was the validation of a protocol for weaning from tracheostomy and evaluation of predictor factors of decannulation.&#x0D; Methods: Medical records of 48 patients were retrospectively evaluated. Patients were decannulated in agreement with a decannulation protocol based on the evaluation of clinical stability, expiratory muscle strength, presence of tracheal stenosis/granulomas, deglutition function, partial pressure of CO2, and PaO2/FiO2 ratio. These variables, together with underlying disease, blood gas analysis parameters, time elapsed with cannula, comordibity, Barthel index, and the condition of ventilation, were evaluated in a logistic model as predictors of decannulation.&#x0D; Results: 63 % of patients were successfully decannulated in agreement with our protocol and no one needed to be re-cannulated. Three variables were significantly associated with the decannulation: no pulmonary underlying diseases (OR = 7.12; 95 % CI 1.2–42.2), no mechanical ventilation (OR = 9.55; 95 % CI 2.1–44.2) and period of tracheostomy ≤10 weeks (OR = 6.5; 95 % CI 1.6–27.5).&#x0D; Conclusions: The positive course of decannulated patients supports the suitability of the weaning protocol we propose here. The strong predictive role of three clinical variables gives premise for new studies testing simpler decannulation protocols.

Magnetic Resonance Spectroscopic Assessment of Isocitrate Dehydrogenase Status in Gliomas: The New Frontiers of Spectrobiopsy in Neurodiagnostics

In the era of integrated genomic-histologic analysis of brain tumors, new biomarkers have been introduced as diagnostic, prognostic, and therapeutic indicators. The analysis of the mutation in the isocitrate dehydrogenase (IDH) genes IDH1 and IDH2 has provided important diagnostic and prognostic information for patients affected by diffuse glioma (i.e., the presence of the mutation has been related to an increased survival rate). The reference standard of IDH mutation detection has been its assessment in surgical specimens, immunohistochemistry, and/or genetic sequencing. Knowing the IDH status information preoperatively would be of great importance, because it has been related to tumor progression and the response to treatment. The oncometabolite 2-hydroxyglutarate (2HG), accumulated in gliomas with IDH mutation status, can be detected invivo using magnetic resonance spectroscopy (MRS). The 2HG-MRS technique remains technically challenging. We have summarized the results of the first pilot study in Australia, which included 10 patients affected by glioma. The data recorded from May 2017 to November 2018 were analyzed. In our exploratory study, we reached a sensitivity and specificity of 100%, confirming the strong predictive role of 2HG, as detected using MRS, in the diagnosis of glioma. In the present study, we have focused on methodological tips and future perspectives of the technique in the neuroimaging and neuro-oncological scenario. We would advocate the integration of 2HG-MRS into standard clinical practice.

Post-psychotic depression: Paranoia and the damage done

To mitigate the often chronic course of schizophrenia and improve functional outcome, researchers are increasingly interested in prodromal states and psychological risk factors that may predict the outbreak of psychotic symptoms, but are also amenable to change. In recent years, depressive symptoms have been proposed as precursors of psychosis and some interventional studies indicate that the amelioration of depressive symptoms and depression-related thinking styles (e.g., worrying) improves positive symptoms, thereby “killing two birds with one stone”. Yet, in a prior study, we were unable to find a strong specific predictive role of depression on paranoia over three years, which may have been due to the use of a nonclinical sample with minimal/mild symptom fluctuations. To address this further, in the present study we adopted a similar methodological approach but assessed a large patient sample with a schizophrenia spectrum disorder at three assessment points; baseline (N = 250), 6 weeks later (n = 207, 82.8% retention) and 6 months after baseline (n = 185, 74% retention). Using cross-lagged modeling, we assessed paranoia with the respective items from the Positive and Negative Syndrome Scale (PANSS) and the Psychosis Rating Scales (PSYRATS) delusions subscale. Depression was measured using the Patient Health Questionnaire-9 (PHQ-9) and the Calgary Depression Scale for Schizophrenia (CDSS). We could identify a significant pathway from depression to paranoia from baseline to post (negative association) but not from post to follow-up. Paranoia significantly predicted depressive symptoms for both intervals. Our findings do not refute claims that depression may precede or even predict psychosis, but such a linkage does not seem to be ubiquitous.

Technical Resources in E-training Acceptance

Purpose: This paper examines the role of availability of resources in the acceptance of e-training in the Nigerian civil service. Perceived ease of use (PEOU) and Perceived usefulness (PU) of Technology Acceptance Model (TAM) was used as the base for consideration&#x0D; Design/methodology: Questionnaires were used to collect data from 450 heads of departments. The framework of the paper made up of technological infrastructure, internet facility, PEOU and PU was tested with SmartPLS 2.0 M3 software.&#x0D; Findings- This paper found both that PU and PEOU indicated strong predictive role in e-training acceptance. In addition, technological infrastructure was found significant. However, internet facility had in significant effect in e-training acceptance. &#x0D; Practical implications: This paper showed that availability of resources can help in the acceptance of e-training in the Nigerian civil service. This will help to improve the outlook and overall performance in the civil service. It will be beneficial to policy makers and government agencies in developing policies regarding e-training, create awareness of the benefits of accepting e-training in the public sector leading to better performance and efficiency.&#x0D; Originality: Relationships of technological infrastructure and internet facility which are necessary in the acceptance of e-training in the Nigerian civil service were examined in this paper

The combined utility of myeloperoxidase (MPO) and paraoxonase 1 (PON1) as two important HDL-associated enzymes in coronary artery disease: Which has a stronger predictive role?

Background and aimsSerum paraoxonase 1 (PON1) and myeloperoxidase (MPO) are HDL-associated enzymes that contribute significantly to the formation of dysfunctional HDL. The present study thus seeks to comparatively analyze the predictive role of PON1, MPO and the MPO/PON1 ratio and to also evaluate which one has a stronger predictive role in their combined utility as an MPO/PON1 ratio in coronary artery disease (CAD). MethodsPON1 activity and MPO concentrations were determined in patients with established CAD and those without significant CAD. Receiver operating characteristic (ROC) curves were drawn by plotting true positivity versus false positivity. ResultsThe ROC curve analyses showed that PON1 (AUC = 61%, p = 0.003) and MPO/PON1 (AUC = 60%, p = 0.01) have a better diagnostic performance than MPO (AUC = 50%, p = 0.42) in detecting patients with CAD. PON1 and MPO/PON1 were found to have a significantly stronger discriminatory power for the age range ≥52 and < 60 years (AUC = 69%, p = 0.008 for PON1; AUC = 66%, p = 0.022 for MPO/PON1). The multivariate analysis revealed PON1 as an independent variable that was significantly associated with the multi-vessel disease [odds ratio (OR) = 0.98; p = 0.017]. At the cutoff point of 30 μmol/mL/min for PON1 and 1.85 for MPO/PON1, specificities were 97% and 73% and sensitivities 30% and 54% for discriminating patients with single-vessel disease from non-CAD subjects. ConclusionsThe diagnostic performance of PON1 alone was comparable to that of the MPO/PON1 ratio for CAD risk assessment; however, MPO may increase the true positive rate. A larger number of blocked vessels seems to be associated with an increased predictive power for both PON1 and MPO/PON1. Recent data support the fact that PON1 and MPO may potentially be appropriate therapeutic targets for preventing CAD.

Predictors of craving and substance use among patients with alcohol, tobacco, cannabis or opiate addictions: Commonalities and specificities across substances

IntroductionCraving has been proposed as a major contributor to addiction relapse and the influence of mood on craving and substance use has been extensively documented. However, information is lacking concerning the extent to which the magnitude of these effects may vary according to different types of substances. The aim of the present study was to compare the prospective links between emotions, craving and substance use in four groups of patients beginning treatment for alcohol, tobacco, cannabis, or opiate addiction. MethodsEcological Momentary Assessment (EMA) was used over a two-week period. Data were analyzed using hierarchical linear modeling (HLM). Results159 participants were recruited (67.3% male; M = 36.7 years). The average response rate to the EMA assessments was 83.1%. The findings confirmed the strong predictive role of craving intensity on substance use reported at the next assessment of the day among the alcohol (γ = 0.224; p = .018), tobacco (γ = 0.133; p = .013) and cannabis groups (γ = 0.266; p = .019), but not for opiates (γ = 0.098; p = .142). Craving intensity was itself predicted by greater anxious mood (γ = 0.108; p = 0,029) and event negativity (γ = 0.107; p = .003) among tobacco patients, lower sad mood among cannabis patients (γ = −0.248; p = 0,002), and lower event negativity among opiate patients (γ = −0.201; p = .002). ConclusionWhile these results support the benefit of targeting craving in addiction treatment regardless of substance type, the substance-specific emotional risk factors for craving identified in this study may provide important insights for the development of personalized treatment strategies.

An examination of the factors affecting the adoption of E‐training in the Nigerian civil service sector

To examine the role that perceived support has in e‐training adoption in the Nigerian civil service, researchers developed a framework that addressed organizational, technical, and government support, as well as perceived usefulness and perceived ease of use. The results of a questionnaire administered to 450 department heads revealed that both perceived usefulness and perceived ease of use had a strong predictive role in e‐training adoption. Although organizational and government support were not shown to have a significant impact on the adoption of e‐training, technical support was found to play a role through its impact on perceived ease of use. By bolstering e‐training efforts with the proper support, public‐sector decision‐makers can facilitate the adoption of such programs in their quest to improve the performance of the government agencies they administer.

International stock return predictability: Is the role of U.S. time-varying?

This study investigates the predictability of 11 industrialized stock returns with emphasis on the role of U.S. returns. Using monthly data spanning 1980:2–2014:12, we show that there exist multiple structural breaks and nonlinearities in the data. Therefore, we employ methods that are capable of accounting for these and at the same time date stamping the periods of causal relationship between the U.S. returns and those of the other countries. First we implement a subsample analysis which relies on the set of models, data set and sample range as in Rapach et al. (J Finance LXVIII(4):1633–1662, 2013). Our results show that while the U.S. returns played a strong predictive role based on the OLS pairwise Granger causality predictive regression and news-diffusion models, its role based on the adaptive elastic net model is weak. Second, we implement our preferred model: a bootstrap rolling window approach using our newly updated data on stock returns for each countries, and find that U.S. stock return has significant predictive ability for all the countries at certain sub-periods. Given these results, it would be misleading to rely on results based on constant-parameter linear models that assume that the relationship between the U.S. returns and those of other industrialized countries are permanent, since the relationship is, in fact, time-varying, and holds only at specific periods.

Weaning from tracheostomy in subjects undergoing pulmonary rehabilitation.

BackgroundWeaning from tracheostomy has implications in management, quality of life, and costs of ventilated patients. Furthermore, endotracheal cannula removing needs further studies. Aim of this study was the validation of a protocol for weaning from tracheostomy and evaluation of predictor factors of decannulation.MethodsMedical records of 48 patients were retrospectively evaluated. Patients were decannulated in agreement with a decannulation protocol based on the evaluation of clinical stability, expiratory muscle strength, presence of tracheal stenosis/granulomas, deglutition function, partial pressure of CO2, and PaO2/FiO2 ratio. These variables, together with underlying disease, blood gas analysis parameters, time elapsed with cannula, comordibity, Barthel index, and the condition of ventilation, were evaluated in a logistic model as predictors of decannulation.Results63 % of patients were successfully decannulated in agreement with our protocol and no one needed to be re-cannulated. Three variables were significantly associated with the decannulation: no pulmonary underlying diseases (OR = 7.12; 95 % CI 1.2–42.2), no mechanical ventilation (OR = 9.55; 95 % CI 2.1–44.2) and period of tracheostomy ≤10 weeks (OR = 6.5; 95 % CI 1.6–27.5).ConclusionsThe positive course of decannulated patients supports the suitability of the weaning protocol we propose here. The strong predictive role of three clinical variables gives premise for new studies testing simpler decannulation protocols.

The small effects of non-hierarchical complexity variables on performance.

Even when the results show that most of the difficulty in solving problems is explained by the hierarchical complexity of the item, there are still variables that help in small ways in predicting how well items measure difficulty. One must understand what these variables are and take them into consideration when analyzing data from instruments designed to measure the impact of the order of hierarchical complexity of items. This study was designed to test the effect of small variables on task performance. The variables tested were hierarchical complexity, place in order, the number of calculations needs, the size of the numbers, and the causal variable position. Participants were asked to solve problems from task sequences from the logic/mathematics/physical science subdomains. The four instruments used were the algebra, balance beam, infinity and laundry instruments. These instruments were based on the model of hierarchical complexity (MHC). Participants were asked to first complete the laundry task sequence and move to the next task sequence. Items from each instrument were analyzed individually and as a group. A Rasch analysis was performed on all the items from all the instruments. The variables thought to have an effect were coded. The coded variables were then analyzed using stepwise regression. A stepwise regression was used and the small variables were tested with and without hierarchical complexity as a factor. The variables were regressed against the stage score of the items. For all four instruments stepwise regression with hierarchical complexity as one of the variable accounted for about 95% of the variance and the β was greater than 0.9. Stepwise regression with all the other variables except hierarchical complexity accounted for relatively lower variance and β. The results showed that order of hierarchical complexity has a very strong predictive role and accounts for most of the variance. The other variables only made very small contributions.

576P - Pharmacogenetic Profiling for Toxicity of Oxaliplatin and Fluoropyrimidines. Final Report from an Ancillary Protocol to the Tosca (Three or Six Colon Adjuvant) Trial

ABSTRACT Aim: A number of germline polymorphisms have shown promising predictive role for chemotherapy related toxicity in colorectal cancer patients. However, large-scale validation trials are necessary before pharmacogenetic findings are incorporated into clinical practice. We investigated 17 polymorphisms in 11 genes for their association with toxicity of fluoropyrimidines and oxaliplatin (TS, MTHFR, ERCC1, XRCC1, XRCC3, XPD, GSTT, GSTP, GSTM, ABCC1, ABCC2) in colorectal cancer patients enrolled in a prospective randomized trial of adjuvant chemotherapy. Methods: TOSCA is a non-profit, Italian, multicentre, randomized, non-inferiority phase III study conducted in high-risk stage II and stage III colorectal cancer patients treated with 6 or 3 months of either FOLFOX-4 or XELOX adjuvant chemoterapy. A planned sample of patients was accrued in the ancillary pharmacogenetic study. The primary endpoint was the evaluation of the relationship of genetic polymorphisms with occurrence of grade 3-4 CTCAE toxicity event (grade 2-4 for neurotoxicity). Results: From July 2007 to October 2011, 531 patients were enrolled from 26 experimental centres (194 patients in 6-month FOLFOX-4 arm, 194 patients in 3-month FOLFOX-4 arm, 74 patients in 6-month XELOX arm, 69 patients in 3-month XELOX arm). Grade ≥3 neutropenia and grade >2 neurotoxicity events occurred in 150 (29%) and in 132 patients (24.8%), respectively. Diarrhea grade > 3 events occurred in 34 (6.5%) patients. None of the studied polymorphisms showed clinically relevant association with toxicity. Conclusions: In the studied population, we ruled out a strong predictive role of known genetic variants for toxicity. Future investigations should address novel polymorphisms emerging from genome-wide association studies. Disclosure: All authors have declared no conflicts of interest.

Balance decrements are associated with age-related muscle property changes.

In this study, a comprehensive evaluation of static and dynamic balance abilities was performed in young and older adults and regression analysis was used to test whether age-related variations in individual ankle muscle mechanical properties could explain differences in balance performance. The mechanical properties included estimates of the maximal isometric force capability, force-length, force-velocity, and series elastic properties of the dorsiflexors and individual plantarflexor muscles (gastrocnemius and soleus). As expected, the older adults performed more poorly on most balance tasks. Muscular maximal isometric force, optimal fiber length, tendon slack length, and velocity-dependent force capabilities accounted for up to 60% of the age-related variation in performance on the static and dynamic balance tests. In general, the plantarflexors had a stronger predictive role than the dorsiflexors. Plantarflexor stiffness was strongly related to general balance performance, particularly in quiet stance; but this effect did not depend on age. Together, these results suggest that age-related differences in balance performance are explained in part by alterations in muscular mechanical properties.

Factors affecting treatment adherence for patients with hypertension by structural equation model

Objective To explore the factors of treatment adherence for patients with hypertension.Methods Data were collected among 520 patients with essential hypertension from 2009 to 2010.It investigated the factors of treatment adherence for patients with hypertension by self-report scales.Results Structural equation model analysis showed age,self-rated health,self-eificacy,quality of life,family function and health concept were all directly associated with treatment adherence,and these variables explained 52.0％ of the total variance.Self-efficacy and quality of life were regarded as mediators in predicting treatment adherence of hypertensive patients,other variables indirectly affected adherence behavior by two mediators.Age and self-efficacy showed a strong independent predictive role to adherence.Conclusions Healthcare providers should take effective measures to improve treatment adherence for patients with hypertension based on patients characteristic once they make reasons for adherence clear,which can enhance quality of life,control blood pressure and prevent complications. Key words: Hypertensive patients; Treatment adherence; Structural equation model