scholarly journals The Predicted Long-Term Benefits of Ensuring Timely Treatment and Medication Adherence in Early Schizophrenia

2019 ◽  
Vol 47 (3) ◽  
pp. 357-365
Author(s):  
Marcela Horvitz-Lennon ◽  
Zachary Predmore ◽  
Patrick Orr ◽  
Mark Hanson ◽  
Richard Hillestad ◽  
...  
Keyword(s):  
Early Stage ◽  
Competitive Employment ◽  
Independent Family ◽  
Treatment Entry ◽  
Adherence Intervention ◽  
Family Living ◽  
The Impact ◽  
Timely Treatment ◽  
Early Schizophrenia

AbstractThe impact of initiatives aimed at reducing time in untreated psychosis during early-stage schizophrenia will be unknown for many years. Thus, we simulate the effect of earlier treatment entry and better antipsychotic drug adherence on schizophrenia-related hospitalizations, receipt of disability benefits, competitive employment, and independent/family living over a ten-year horizon. We predict that earlier treatment entry reduces hospitalizations by 12.6–14.4% and benefit receipt by 7.0–8.5%, while increasing independent/family living by 41.5–46% and employment by 42–58%. We predict larger gains if a pro-adherence intervention is also used. Our findings suggest substantial benefits of timely and consistent early schizophrenia care.

scholarly journals The Long-Term Benefits of Ensuring Timely Treatment and Improved Medication Adherence in Early Schizophrenia: A Microsimulation Study

2018 ◽  
Vol 21 ◽  
pp. S188-S189
Author(s):  
M Horvitz-Lennon ◽  
Z Predmore ◽  
P Orr ◽  
M Hanson ◽  
R Hillestad ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Timely Treatment ◽  
Early Schizophrenia

scholarly journals The Real Impact of Bridging or Downstaging on Survival Outcomes after Liver Transplantation for Hepatocellular Carcinoma

Liver Cancer ◽  
2020 ◽  
Vol 9 (6) ◽  
pp. 721-733
Author(s):  
Sunyoung Lee ◽  
Kyoung Won Kim ◽  
Gi-Won Song ◽  
Jae Hyun Kwon ◽  
Shin Hwang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Early Stage ◽  
Organ Procurement ◽  
Survival Outcomes ◽  
Full Cohort ◽  
Donor Liver Transplantation ◽  
Positron Emission ◽  
The Impact

<b><i>Introduction:</i></b> There is no consensus regarding selection criteria on liver transplantation (LT) for hepatocellular carcinoma (HCC), especially for living donor liver transplantation, although emerging evidence has been found for the effectiveness of bridging or downstaging. <b><i>Objective:</i></b> We evaluated the long-term outcomes of patients who underwent LT with or without bridging or downstaging for HCC. <b><i>Methods:</i></b> This retrospective study included 896 LT recipients with HCC between June 2005 and May 2015. Recurrence-free survival (RFS), overall survival (OS), and their associated factors were evaluated. <b><i>Results:</i></b> The 5-year RFS in the full cohort of 896 patients was 82.4%, and the OS was 85.3%. In patients with initial Organ Procurement and Transplantation Network (OPTN) T1 and T2, the 5-year RFS and OS did not significantly differ between LT groups with and without bridging (all <i>p</i> ≥ 0.05). The 5-year RFS and OS of OPTN T3 patients with successful downstaging were not significantly different from those of patients with OPTN T2 with primary LT (<i>p</i> = 0.070 and <i>p</i> = 0.185), but were significantly higher than in patients with OPTN T3 with downstaging failure and initial OPTN T1 or T2 with progression (all <i>p</i> &#x3c; 0.001). In the multivariate analysis, last alpha-fetoprotein before LT ≥70 ng/mL (hazard ratio [HR]: 1.77, <i>p</i> = 0.001; HR: 1.72, <i>p</i> = 0.004), pretransplant HCC status exceeding the Milan criteria (HR: 5.12, <i>p</i> &#x3c; 0.001; HR: 3.31, <i>p</i> &#x3c; 0.001), and positron emission tomography positivity (HR: 2.57, <i>p</i> &#x3c; 0.001; HR: 2.57, <i>p</i> &#x3c; 0.001) were independent predictors for worse RFS and OS. <b><i>Conclusions:</i></b> The impact of bridging therapy on survival outcomes is limited in patients with early-stage HCC, whereas OPTN T1 or T2 with progression provides worse prognosis. OPTN T3 should undergo LT after successful downstaging, and OPTN T3 with successful downstaging allows for acceptable long-term posttransplant outcomes.

scholarly journals Adaptation to an amoeba host leads to Pseudomonas aeruginosa isolates with attenuated virulence

2022 ◽  
Author(s):  
Wai Leong ◽  
Wee Han Poh ◽  
Jonathan Williams ◽  
Carla Lutz ◽  
M. Mozammel Hoque ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Pseudomonas Aeruginosa ◽  
Late Stage ◽  
Early Stage ◽  
Opportunistic Pathogen ◽  
Phenotypic Traits ◽  
Nucleotide Polymorphisms ◽  
Chronic Infections ◽  
The Impact

The opportunistic pathogen Pseudomonas aeruginosa , is ubiquitous in the environment, and in humans is capable of causing acute or chronic infections. In the natural environment, predation by bacterivorous protozoa represents a primary threat to bacteria. Here, we determined the impact of long-term exposure of P. aeruginosa to predation pressure. P. aeruginosa persisted when co-incubated with the bacterivorous Acanthamoeba castellanii for extended periods and produced genetic and phenotypic variants. Sequencing of late-stage amoeba-adapted P. aeruginosa isolates demonstrated single nucleotide polymorphisms within genes that encode known virulence factors and this correlated with a reduction in expression of virulence traits. Virulence towards the nematode, Caenorhabditis elegans , was attenuated in late-stage amoeba-adapted P. aeruginosa compared to early-stage amoeba-adapted and non-adapted counterparts. Further, late-stage amoeba-adapted P. aeruginosa showed increased competitive fitness and enhanced survival in amoeba as well as in macrophage and neutrophils. Interestingly, our findings indicate that the selection imposed by amoeba resulted in P. aeruginosa isolates with reduced virulence and enhanced fitness, similar to those recovered from chronic cystic fibrosis infections. Thus, predation by protozoa and long-term colonization of the human host may represent similar environments that select for similar losses of gene function. Importance Pseudomonas aeruginosa is an opportunistic pathogen that causes both acute infections in plants and animals, including humans, and chronic infections in immunocompromised and cystic fibrosis patients. This bacterium is commonly found in soils and water where bacteria are constantly under threat of being consumed by bacterial predators, e.g. protozoa. To escape being killed, bacteria have evolved a suite of mechanisms that protect them from being consumed or digested. Here, we examine the effect of long-term predation on the genotypes and phenotypes expressed by P. aeruginosa . We show that long term co-incubation with protozoa resulted in mutations that resulted in P. aeruginosa becoming less pathogenic. This is particularly interesting as we see similar mutations arise in bacteria associated with chronic infections. Importantly, the genetic and phenotypic traits possessed by late-stage amoeba-adapted P. aeruginosa are similar to what is observed for isolates obtained from chronic cystic fibrosis infections. This notable overlap in adaptation to different host types suggests similar selection pressures amongst host cell types as well as similar adaptation strategies.

Short- and long-term outcomes of early stage non-small cell lung cancer (NSCLC) surgery.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 8544-8544
Author(s):  
Michael J. Kelley ◽  
David Harpole ◽  
Christina D. Williams
Keyword(s):  
Lung Cancer ◽  
Racial Differences ◽  
Squamous Cell ◽  
Causes Of Death ◽  
Early Stage ◽  
Large Cell ◽  
Stage I ◽  
Term Survival ◽  
The Impact

8544 Background: The goal of this study was to determine patient factors associated with short- vs long-term survival after surgery for stage I/II NSCLC and assess the distribution of causes of death over time. Methods: Using the VA Central Cancer Registry, we identified patients diagnosed 2001-2005 with stage I/II NSCLC who had surgery and survived 30 days after resection. We used multivariate logistic regression models to determine the impact of patient characteristics on 1 year (1Y), 5 year (5Y), and 10 year (10Y) mortality. We compared causes of death at 1Y versus 5Y after diagnosis. Results: The analysis included 4,693 patients. Among these patients, the 1Y, 5Y, and 10Y overall survival (OS) rates were 87%, 45%, and 22%, respectively. 50% of patients alive at 5 year survived to 10 years. For each survival time period, highest survival rates were among patients who were younger (≤65), had stage I disease, had lobectomy, and had fewer comorbidities (all p < 0.0001). Significant differences in 1Y and 10Y OS were noted for histology, with highest 1Y OS among adenocarcinoma (88%) and squamous cell (87%) and highest 10Y OS among large cell (28%) and adenocarcinoma (25%). Racial differences were only observed in 10Y OS (whites 22%, blacks 26%, p = 0.01). In multivariate analyses, age > 65, stage II disease, surgery other than lobectomy, and ≥3 comorbidities were associated with increased likelihood of 1Y, 5Y, and 10Y mortality. Large cell and other histology were the only additional significant predictors of 1Y mortality [OR: 1.94 (1.33-2.84) and OR:1.36 (1.05-1.77), respectively], and squamous cell histology was a significant predictor of 10Y mortality [OR: 1.19 (1.02-1.40)] relative to adenocarcinoma. Among patients who died within 1 year of diagnosis (n = 616), the primary causes of death were lung cancer (63%), cardiovascular disease (10%), other cancer (8%), respiratory disease (3%), and other causes (15). The contribution of these causes of 5Y mortality (n = 2602) were 60%, 11%, 10%, 4%, and 12%, respectively. Conclusions: Half of patients alive at 5Y after resection of stage I/II NSCLC were alive at 10Y. 10Y survival is associated with younger age, earlier stage, non-squamous histology, lobectomy, and fewer comorbidities, but not race.

Assessment of the impact of traffic volume on NO2 levels in Munich during the lock-down periods

2021 ◽  
Author(s):  
Sheng Ye ◽  
Ka Lok Chan ◽  
Tamara Brunner ◽  
Hanlin Zhang ◽  
Alexander Geiß ◽  
...  
Keyword(s):  
Meteorological Parameters ◽  
Early Stage ◽  
Measurement Techniques ◽  
Absolute Humidity ◽  
Ground Level ◽  
Traffic Volume ◽  
Impact Factors ◽  
Long Term Study ◽  
The Impact

&lt;p&gt;The global pandemic has many negative economic, social and health impacts, but the lock-downs also led to a reduction of traffic volume which resulted in lower NO&lt;sub&gt;2&lt;/sub&gt; levels in some areas. Our study made use of different air quality measurement techniques (in-situ, on-road, satellite remote sensing) to monitor long-term NO&lt;sub&gt;2&lt;/sub&gt; levels in Munich. While comparing NO&lt;sub&gt;2&lt;/sub&gt; levels associate with traffic volume before and after a lock-down, other influences based on meteorological parameters should be considered as well. In addition to traffic data we used records of wind, mixing layer height, temperature, humidity and other meteorological parameters to analyze the impact on measured pollution levels using a Generalized Additive Model (GAM) regression. Our long-term study using data between 2018 and 2021 shows that the dominating factor is wind speed, followed by traffic volume as the main factors for impacting NO&lt;sub&gt;2&lt;/sub&gt; levels, while absolute humidity and wind direction show less effects. We utilized those findings to find best suited time periods comparable to the lockdown time in terms of meteorological conditions. In order to focus on the traffic volume factor, we applied these findings to minimize other impact factors to evaluate the NO&lt;sub&gt;2&lt;/sub&gt; variability of different years comparing to the data from the lockdown periods. A significant reduction of the ground level NO&lt;sub&gt;2&lt;/sub&gt; concentrations in Munich during the early stage of the lockdown period in March 2020 could clearly be associated with a significant reduction of traffic volume.&lt;/p&gt;

Effects of long-term field experiments on early stage litter decomposition in Austria and Sweden

2020 ◽  
Author(s):  
Maria Regina Gmach ◽  
Martin A. Bolinder ◽  
Lorenzo Menichetti ◽  
Thomas Kätterer ◽  
Taru Sandén
Keyword(s):  
Litter Decomposition ◽  
Decomposition Rate ◽  
Field Experiments ◽  
Early Stage ◽  
Tillage Systems ◽  
K Value ◽  
Tea Bag Index ◽  
The Impact ◽  
Term Field

&lt;p&gt;Soil organic matter decomposition affects the local and global C cycles. Decomposition is mainly affected by soil type and climatic conditions, for a given quality of organic material. This study tested the effect of land use and management, litter type, and climate on the early stage decomposition rate in long-term field experiments (LTEs) in Austria and Sweden. Standardized litter (Rooibos and Green tea) were used according to the Tea Bag Index (TBI) protocol (Keuskamp et al. 2013) for comparison of litter decomposition rate (k) and stabilization factor (S) in 11 sites in Austria (2015 and 2016) and 9 sites in Sweden (2016). The tea bags were buried at 8 cm depth and collected after ~90 days. Austrian LTEs focused on mineral nitrogen fertilization, mineral potassium fertilization, organic fertilization, tillage systems, and crop residues management. The LTEs evaluated in Sweden focused mainly on annual and perennial crops, mineral fertilization, and tillage systems. The impact of environmental parameters (air temperature and precipitation) was modeled to normalize the variance due to climatic effects at each site. The preliminary results show that in Austria TBI decomposition differed more between sites than between treatments at the same LTE. Minimum tillage treatment had significantly higher decomposition rates compared to reduced and conventional tillage. In Sweden, decomposition rate differed more between treatments than between sites. Fertilized plots showed higher stabilization than unfertilized, and maximum N fertilization had the highest k, while unfertilized had the lowest k. The effect of different tillage systems on k and S were variable across sites and treatments, although ploughing tended to result in the lowest k. The northernmost site resulted in the highest k value. Results indicated higher stabilization in perennial forage crops compared to annual crops. We also considered time-series decomposition for some sites with measurements at different time points by the TBI approach (retrieving tea bags after 15, 30, 60, and 90 days), and the use of Random Forest regressions to evaluate the importance of pedo-climatic variables on early stage decomposition.&lt;/p&gt;

Effect of Static Aging on Mechanical Properties of an 18Cr-8Ni-W-Nb-V-N Stainless Steel

2012 ◽  
Vol 706-709 ◽  
pp. 2211-2216
Author(s):  
Ilya Nikulin ◽  
Rustam Kaibyshev
Keyword(s):  
Mechanical Properties ◽  
Stainless Steel ◽  
Austenitic Stainless Steel ◽  
Impact Toughness ◽  
Early Stage ◽  
Secondary Phase ◽  
Fracture Mechanisms ◽  
Aged Condition ◽  
The Impact

The interrelations between microstructure, precipitation and mechanical properties of the 18Cr-8Ni-W-Nb-V-N austenitic stainless steel were examined under long-term aging at 650°C. It was shown that aging leads to decreasing strength characteristics with increasing aging time despite the fact that hardness tends to increase. In none-aged condition the present steel exhibits superior impact toughness of about 255 J/cm-2. This values decreases gradually at the early stage of the aging. After 1000 hours exposure the impact toughness is 195 J/cm-2 and decreases sharply to 135 J/cm-2 at 3000 hours. However, an evidence for ductile fracture was found even after long-term aging. Degradation in impact toughness and mechanical properties with aging is discussed in relation to microstructure evolution, precipitations of the secondary phase and fracture mechanisms.

scholarly journals Developments in Drug Addiction During COVID-19—An Austrian Perspective Based on a Clinical Sample

2020 ◽  
Vol 11 ◽  
Author(s):  
Isabella Fuchs-Leitner ◽  
Kurosch Yazdi ◽  
Nikolas W. Gerstgrasser ◽  
Jan Rosenleitner
Keyword(s):  
Drug Use ◽  
Help Seeking ◽  
Early Stage ◽  
Clinical Sample ◽  
Original Data ◽  
Negative Consequences ◽  
Opioid Substitution Treatment ◽  
The Impact ◽  
Drug Use Disorder

Concerns about the negative consequences of the COVID-19 pandemic on people with substance use disorder (SUD) were raised by experts in the field around the world. Here we provide an Austrian perspective, discussing the impact of the pandemic on help-seeking patient with drug use disorder during the initial stage of the pandemic. Our perspectives are based on the situation as perceived at our clinical facility, and supported by original data collected from a small clinical sample of patients with drug use disorder (N = 32). The viewpoints and related descriptive data include the perceived individual impact of COVID-19, as well as various aspects of drug use behavior and the Austrian drug market before and after the onset of the pandemic. The consequences for a subgroup of patients in opioid substitution treatment (N = 24) are discussed. Surprisingly and in contrast to anticipated developments, we had the impression of a rather stable situation in Austria, at least at this early stage of the pandemic. The immediate impact of COVID-19 on these help-seeking patients with high levels of drug dependency seemed less severe than anticipated so far. Importantly, this observation might be a short-term effect for this already fragile group and careful monitoring of further developments as well as preparation of long-term strategies are advised. In general, problematic drug use is associated with many health risk factors and finding appropriate long-term health care strategies has to remain a top priority facing the pandemic. Our perspectives are restricted to observations from help-seeking patients at our clinic, and no conclusions for the general population can be directly drawn.

scholarly journals Surveillance as Determinant of Long-Term Survival in Non-Transplanted Hepatocellular Carcinoma Patients

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 897
Author(s):  
Filippo Pelizzaro ◽  
Alessandro Vitale ◽  
Anna Sartori ◽  
Andrea Vieno ◽  
Barbara Penzo ◽  
...  
Keyword(s):  
Lead Time ◽  
Early Stage ◽  
Multivariable Logistic Regression Analysis ◽  
Term Survival ◽  
Long Term Survival ◽  
Inverse Probability Weights ◽  
Surveillance Programs ◽  
Baseline Characteristics ◽  
The Impact

Purpose: We aimed at assessing the impact of surveillance on long-term survival in HCC patients. Methods: From the ITA.LI.CA database, we selected 1028 cases with long (≥5 years, LS group) and 2721 controls with short-term survival (<5 years, SS group). The association between surveillance and LS was adjusted for confounders by multivariable logistic regression analysis. Survival of surveilled patients was presented both as observed and corrected for the lead-time bias, and the comparison of survival between surveillance and no surveillance groups was also performed after balancing the baseline characteristics with inverse probability weights (IPW). Results: LS patients were more frequently diagnosed under surveillance (p < 0.0001), and had more favorable baseline characteristics. Surveillance was an independent predictor of LS (OR = 1.413, 95% CI 1.195–1.671; p < 0.0001). The observed and the lead-time corrected survival of surveilled patients were significantly longer compared to the survival of not surveilled patients (p < 0.0001 and p = 0.0008, respectively). In IPW adjusted populations, no survival differences were demonstrated between the two groups (p = 0.30). Conclusions: Surveillance, increasing early-stage diagnosis and applicability of curative treatments, is a fundamental determinant of long-term survival in HCC patients. A wide implementation of surveillance programs should be pursued in order to improve HCC patients’ prognosis.

LONG-TERM Risk of Late Effects After Treatment for EARLY-STAGE HODGKIN'S Lymphoma (HL).

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2732-2732
Author(s):  
Simonetta Viviani ◽  
Anna DI Russo ◽  
Valeria Bonfante ◽  
Pinuccia Valagussa ◽  
Gianni Bonadonna ◽  
...  
Keyword(s):  
Early Stage ◽  
Semen Analysis ◽  
Combined Modality Therapy ◽  
Cardiovascular Complications ◽  
Bulky Disease ◽  
Treatment Start ◽  
Survival Difference ◽  
The Impact

Abstract Abstract 2732 Background: Currently the vast majority of patients (pts) with early-stage HL can be cured. However they still face the lifetime risks of late secondary events, mainly secondary malignancies (SM) and cardiovascular complications (CV). To assess the impact of late events on Overall Survival (OS), we evaluated the incidence of SM and CV in pts with early-stage HL (I A, B, II A), enrolled in a prospective randomized trial comparing 4 cycles of ABVD followed by subtotal nodal irradiation (STNI, arm A) with 4 cycles of ABVD followed by involved field irradiation (IFRT, arm B). Material and Methods: From 1990 to 1995, pts with early stage, defined as stage I A and B and II A, ± bulky disease were randomized. After 4 cycles ABVD, RT was STNI (36 Gy on involved sites and 30 Gy on uninvolved sites) were delivered in arm A and IFRT (36 Gy) in arm B. As previously reported (Bonadonna G, J Clin Oncol 2004;15:2835), no significant survival difference was documented between the two arms. We extended follow-up to evaluate the incidence of late secondary events. Results: 140 pts were randomized, 68 to arm A and 72 to arm B. Median follow-up is 210 months (range:1–264). At 20 years, freedom from progression (FFP) is 95% for arm A and 90% for arm B (p=ns). Eight deaths occurred in arm A and 6 in arm B for a 20-yr OS of 84% for ABVD-STNI and 92% for ABVD-IFRT (p=ns).Cutaneous basal cell carcinoma excluded, a total of 13 SM were documented in arm A (1 MDS after 18 mos from treatment start, and 13 solid tumors after a median of 172 mos (range, 22–237): 7 breast, 2 prostate, 1 ovarian, 1 sigma, 1 cutaneous squamous cell) whereas only 3 SM (3 breast) occurred in arm B after a median fu of 170 mos (range, 160–198). The cumulative incidence of SM at 20 yr is 38% in arm A and 7% in arm B. Overall fatal myocardial infarction was documented in one pt in arm A and in two in arm B; fatal stroke occurred in 1 pt in arm A. Thirty-seven pregnancies occurred in 29 out of 70 premenopausal females (41%) after a mendian of 74 mos from treatment start; 35 males consented to have semen analysis: 63% were normospermic and 37% had some semen abnormality (oligo- ± astheno-± teratospermia) after a median of 42 mos; overall 10 pts fathered. Conclusions: These findings confirm that ABVD given for 4 cycles followed by reduced extent of irradiation (IFRT) resulted in excellent long-term OS and FFP with an important decrease in the incidence of malignant secondary event. This manageable treatment strategy can still be considered standard treatment for early-stage HL. Long-term follow-up of current combined modality therapy, where lower doses of RT and shorter courses of chemotherapy are applied in favorable presentations, and more intensive chemotherapy regimens like BEACOPP in unfavorable presentations, should lead to even less late secondary events and mortality. Disclosures: Gianni: Hoffman-La Roche: Consultancy, Honoraria.

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