Browsing by Subject "Risk"
- Results Per Page
- Sort Options
Item Open Access 3Rs for innovating novel antibiotics: sharing resources, risks, and rewards.(BMJ, 2012-04-03) So, Anthony D; Ruiz-Esparza, Quentin; Gupta, Neha; Cars, OttoItem Open Access A Climate Change Vulnerability and Risk Assessment for the City of Atlanta, Georgia(2010-04-28T18:23:36Z) Morsch, AmyThe Southeastern United States will experience several impacts from climate change over the coming decades, including average temperature increases of several degrees, more frequent droughts, and heavier rain and flood events. More intense weather will place stress on Atlanta’s infrastructure, affect planning decisions, and increase demands for already scarce natural and financial resources. The impacts will affect the health of Atlantans and test the strength of the local and regional economy. Understanding the future climate and preparing now will help ensure that the city remains an economically viable, healthy, and enjoyable place to live and work. Twenty-four planning areas in nine sectors that the city can influence were evaluated to determine their vulnerability and risk with regard to climate change. The assessments were designed using guidance from ICLEI’s Adaptation Guidebook and involved dozens of expert interviews, analysis of city reports, and a comprehensive literature review. The results show that air quality, water quality, and energy assurance are the most vulnerable, at-risk planning areas in the City of Atlanta. These areas are crucial to the health of citizens and the economic viability of the city. Increasing their resiliency will require significant coordination with all levels of government and the private sector. Failure to properly prepare these planning areas for climate change could result in substantial costs to the city. Several additional planning areas show significant vulnerability and risk. These include: electricity production and demand, affordable housing, disaster response, heat relief, stormwater management, urban forest management, road and bridge maintenance, and air transport. Analysis of vulnerability and risk by sector resulted in similar findings. The sectors of energy, water, and health will be most impacted by climate change over the coming decades. Improving the resiliency of these sectors may be most effectively achieved through measures that focus on strengthening sectors like ecology, transportation, and land use and development. This study identified recurring barriers that lower the city’s adaptive capacity. Lack of program funding and knowledge of climate change - and the impacts - were pervasive. Short planning horizons and planning efforts based on historical data (or future projections that ignore climate change) are also common and reduce Atlanta’s resiliency. Coordination between several planning areas is strong, but could be increased in others such as heat relief and urban planning. Narrow government mandates, like the flood plain ordinance, can also limit progress towards climate resiliency. In other cases, strict mandates like those stemming from the CSO Consent Decree have been instrumental to project success. The results of this project are intended to inform the next phase of adaptation planning. This involves setting high-level goals for climate resiliency and outlining the adaptation tactics to achieve them. It is recommended that a diverse, knowledgeable committee of local decision makers and stakeholders be tasked with this challenge. A robust adaptation strategy will place Atlanta in the company of other climate proactive cities that have already created comprehensive adaptation plans, like New York City and Chicago.Item Open Access A genome-wide association study of variants associated with acquisition of Staphylococcus aureus bacteremia in a healthcare setting.(BMC Infect Dis, 2014-02-13) Nelson, Charlotte L; Pelak, Kimberly; Podgoreanu, Mihai V; Ahn, Sun Hee; Scott, William K; Allen, Andrew S; Cowell, Lindsay G; Rude, Thomas H; Zhang, Yurong; Tong, Amy; Ruffin, Felicia; Sharma-Kuinkel, Batu K; Fowler, Vance GBACKGROUND: Humans vary in their susceptibility to acquiring Staphylococcus aureus infection, and research suggests that there is a genetic basis for this variability. Several recent genome-wide association studies (GWAS) have identified variants that may affect susceptibility to infectious diseases, demonstrating the potential value of GWAS in this arena. METHODS: We conducted a GWAS to identify common variants associated with acquisition of S. aureus bacteremia (SAB) resulting from healthcare contact. We performed a logistic regression analysis to compare patients with healthcare contact who developed SAB (361 cases) to patients with healthcare contact in the same hospital who did not develop SAB (699 controls), testing 542,410 SNPs and adjusting for age (by decade), sex, and 6 significant principal components from our EIGENSTRAT analysis. Additionally, we evaluated the joint effect of the host and pathogen genomes in association with severity of SAB infection via logistic regression, including an interaction of host SNP with bacterial genotype, and adjusting for age (by decade), sex, the 6 significant principal components, and dialysis status. Bonferroni corrections were applied in both analyses to control for multiple comparisons. RESULTS: Ours is the first study that has attempted to evaluate the entire human genome for variants potentially involved in the acquisition or severity of SAB. Although this study identified no common variant of large effect size to have genome-wide significance for association with either the risk of acquiring SAB or severity of SAB, the variant (rs2043436) most significantly associated with severity of infection is located in a biologically plausible candidate gene (CDON, a member of the immunoglobulin family) and may warrant further study. CONCLUSIONS: The genetic architecture underlying SAB is likely to be complex. Future investigations using larger samples, narrowed phenotypes, and advances in both genotyping and analytical methodologies will be important tools for identifying causative variants for this common and serious cause of healthcare-associated infection.Item Open Access A pri-miR-218 variant and risk of cervical carcinoma in Chinese women.(BMC cancer, 2013-01-15) Shi, Ting-Yan; Chen, Xiao-Jun; Zhu, Mei-Ling; Wang, Meng-Yun; He, Jing; Yu, Ke-Da; Shao, Zhi-Ming; Sun, Meng-Hong; Zhou, Xiao-Yan; Cheng, Xi; Wu, Xiaohua; Wei, QingyiBACKGROUND: MicroRNA (miRNA)-related single nucleotide polymorphisms (SNPs) may compromise miRNA binding affinity and modify mRNA expression levels of the target genes, thus leading to cancer susceptibility. However, few studies have investigated roles of miRNA-related SNPs in the etiology of cervical carcinoma. METHODS: In this case-control study of 1,584 cervical cancer cases and 1,394 cancer-free female controls, we investigated associations between two miR-218-related SNPs involved in the LAMB3-miR-218 pathway and the risk of cervical carcinoma in Eastern Chinese women. RESULTS: We found that the pri-miR-218 rs11134527 variant GG genotype was significantly associated with a decreased risk of cervical carcinoma compared with AA/AG genotypes (adjusted OR=0.77, 95% CI=0.63-0.95, P=0.015). However, this association was not observed for the miR-218 binding site SNP (rs2566) on LAMB3. Using the multifactor dimensionality reduction analysis, we observed some evidence of interactions of these two SNPs with other risk factors, especially age at primiparity and menopausal status, in the risk of cervical carcinoma. CONCLUSIONS: The pri-miR-218 rs11134527 SNP was significantly associated with the risk of cervical carcinoma in Eastern Chinese women. Larger, independent studies are warranted to validate our findings.Item Open Access Adherence to diabetes guidelines for screening, physical activity and medication and onset of complications and death.(J Diabetes Complications, 2015-11) Chen, Yiqun; Sloan, Frank A; Yashkin, Arseniy PAIMS: Analyze relationships between adherence to guidelines for diabetes care - regular screening; physical activity; and medication - and diabetes complications and mortality. METHODS: Outcomes were onset of congestive heart failure (CHF), stroke, renal failure, moderate complications of lower extremities, lower-limb amputation, proliferative diabetic retinopathy (PDR), and mortality during follow-up. Participants were persons aged 65+ in the Health and Retirement Study (HRS) 2003 Diabetes Study and had Medicare claims in follow-up period (2004-8). RESULTS: Adherence to screening recommendations decreased risks of developing CHF (odds ratio (OR)=0.83; 95% confidence interval (CI): 0.72-0.96), stroke (OR=0.80; 95% CI: 0.68-0.94); renal failure (OR=0. 82; 95% CI: 0.71-0.95); and death (OR=0.86; 95% CI: 0.74-0.99). Adherence to physical activity recommendation reduced risks of stroke (OR=0.64; 95% CI: 0.45-0.90), renal failure (OR=0.71; 95% CI: 0.52-0.97), moderate lower-extremity complications (OR=0.71; 95% CI: 0.51-0.99), having a lower limb amputation (OR=0.31, 95% CI: 0.11-0.85), and death (OR=0.56, 95% CI: 0.41-0.77). Medication adherence was associated with lower risks of PDR (OR=0.35, 95% CI: 0.13-0.93). CONCLUSIONS: Adherence to screening, physical activity and medication guidelines was associated with lower risks of diabetes complications and death. Relative importance of adherence differed among outcome measures.Item Open Access Adult Spinal Deformity Patients Recall Fewer Than 50% of the Risks Discussed in the Informed Consent Process Preoperatively and the Recall Rate Worsens Significantly in the Postoperative Period.(Spine, 2015-07) Saigal, Rajiv; Clark, Aaron J; Scheer, Justin K; Smith, Justin S; Bess, Shay; Mummaneni, Praveen V; McCarthy, Ian M; Hart, Robert A; Kebaish, Khaled M; Klineberg, Eric O; Deviren, Vedat; Schwab, Frank; Shaffrey, Christopher I; Ames, Christopher PStudy design
Recall of the informed consent process in patients undergoing adult spinal deformity surgery and their family members was investigated prospectively.Objective
To quantify the percentage recall of the most common complications discussed during the informed consent process in adult spinal deformity surgery, assess for differences between patients and family members, and correlate with mental status.Summary of background data
Given high rates of complications in adult spinal deformity surgery, it is critical to shared decision making that patients are adequately informed about risks and are able to recall preoperative discussion of possible complications to mitigate medical legal risk.Methods
Patients undergoing adult spinal deformity surgery underwent an augmented informed consent process involving both verbal and video explanations. Recall of the 11 most common complications was scored. Mental status was assessed with the mini-mental status examination-brief version. Patients subjectively scored the informed consent process and video. After surgery, the recall test and mini-mental status examination-brief version were readministered at 5 additional time points: hospital discharge, 6 to 8 weeks, 3 months, 6 months, and 1 year postoperatively. Family members were assessed at the first 3 time points for comparison.Results
Fifty-six patients enrolled. Despite ranking the consent process as important (median overall score: 10/10; video score: 9/10), median patient recall was only 45% immediately after discussion and video re-enforcement and subsequently declined to 18% at 6 to 8 weeks and 1 year postoperatively. Median family recall trended higher at 55% immediately and 36% at 6 to 8 weeks postoperatively. The perception of the severity of complications significantly differs between patient and surgeon. Mental status scores showed a transient, significant decrease from preoperation to discharge but were significantly higher at 1 year.Conclusion
Despite being well-informed in an optimized informed consent process, patients cannot recall most surgical risks discussed and recall declines over time. Significant progress remains to improve informed consent retention.Level of evidence
3.Item Open Access Analysis of Global Sea Level Rise Impact and Adaptation Risk Assessments(2011-04-28) Ward, MollyGlobal sea levels currently are rising and will continue to rise far into the future. This rise engenders significant risks to life and the environment, as it creates negative physical, economic, and societal impacts across the globe. The precise magnitude of the impacts depends on a diversity of variables, e.g., the amount the sea will rise, the magnitude of storm surges, and the types of adaptation and protection measures in place to mitigate the impacts. If the various geographic regions across the globe are to adequately prepare for the rising sea, it is necessary to conduct risk assessments to determine which specific impacts and the policy options that are necessary to mitigate those impacts. While many regions have conducted analyses and are planning adaptation measures, many have neither thoroughly assessed the impacts nor planned adequately for the risks. Additionally, some regions that have conducted analyses did not rigorously assess the impacts or a diversity of possible policy options. This may be due to lack of sufficient funding to conduct the assessment, lack of knowledge of the severity of the issue, or lack of expertise to conduct a thorough assessment. This paper examines a diversity of risk assessments conducted by regions worldwide. It includes a range of studies that assess regions with different economic capacities, types of terrain, location, and that implement a range of different methodologies. It examines and compares the impacts and policy options included in the analyses, as well as the variable inputs and evaluation criteria that were implemented to conduct the assessments. While some previous studies have analyzed a particular risk assessment methodology for sea level rise or compared adaptation measures, no previous study has been conducted to comparatively weigh the components and results of impact and adaptation risk assessments. Through a comparison of the components and results of a variety of risk analyses, this study provides valuable insights into the diverse impacts and possible policy options that may be selected for inclusion in future sea level rise studies. The goal of this study is to assist regions in tackling the problem of sea level rise by providing a foundation to streamline the process for future assessments. Based on the assessed reports, the results demonstrate that the most commonly analyzed impacts are those to a region’s economy and population. Additionally, the impacts to a region’s infrastructure, particularly transportation infrastructure, and total land surface appear to be of great importance. The variable inputs that appear to be most commonly applied to assess the impacts are storm surge and a range of sea level rise scenarios, as opposed to one specific future sea level rise quantity. The results of a comparison of reports that analyze policy options to sea level rise show that hard adaptation options (e.g., dikes, sea walls, breakwaters) are more commonly assessed than soft adaptation options (e.g., land use change, relocation). Of the hard and soft measure categories, natural barriers and resettle were included in the most reports. Additionally, it appears valuable to include the current protection activities and policies of a region in an assessment. The criteria most utilized for conducting the policy evaluations are the protection cost of a measure and its environmental impacts. While not all reports proposed an exact recommendation that the study area should pursue for mitigating sea level rise impacts, soft options were more frequently recommended at the conclusion of the reports. The majority of the studies were conducted with quantitative methods. However, it is recommended that future assessments also include a qualitative perspective. It may be valuable to discuss the impacts of sea level rise with residents of an area to determine which impacts are considered most important to mitigate and to determine the most appropriate adaptation options to pursue in preparation for mitigating those impacts. There is no correlation between a study region and the quantity of impacts analyzed or depth of the impacts assessed. Additionally, there is no correlation between a study region and the policy options pursued. Lastly, omissions of variables and criteria from the reports are explored. Future impact studies should include location-specific trends in sea level rise, as opposed to assessing the impacts based on the global average future sea level rise prediction. It is also important to incorporate the speed of the rise in a dynamic analysis, as well as any uncertainties in a report’s input variables. Future policy assessments should include a criterion that accounts for the human behavior and response to the sea level rise and the implemented policy measures.Item Open Access Analysis of Global Sea Level Rise Impact Risk Assessments(2011-04-28) Ward, MollyGlobal sea levels currently are rising and will continue to rise far into the future. This rise engenders significant risks to life and the environment, as it creates negative physical, economic, and societal impacts across the globe. If the various geographic regions across the globe are to adequately prepare for the rising sea, it is necessary to conduct risk assessments to determine which specific impacts to address. This paper examines a diversity of risk assessments conducted by regions worldwide. It includes a range of studies that assess regions with differing economic capacities, types of terrain, location, and that implement a range of methodologies. It examines and compares the impacts included in the analyses, as well as the variable inputs that were implemented to conduct the assessments. Through a comparison of the components and results of a variety of risk analyses, this study provides valuable insights into the diverse impacts that may be selected for inclusion in future sea level rise studies. The goal of this study is to assist regions in tackling the problem of sea level rise by providing a foundation to streamline the process for future assessments. Based on the assessed reports, the results demonstrate that the most commonly analyzed impacts are those to a region’s economy and population. Additionally, the impacts to a region’s infrastructure, particularly transportation infrastructure, and total land surface appear to be of great importance. The variable inputs that appear to be most commonly applied to assess the impacts are storm surge and a range of sea level rise scenarios, as opposed to one specific future sea level rise quantity. Overall, there is no correlation between a study region and the quantity of impacts analyzed or depth of the impacts assessed. The majority of the studies were conducted with quantitative methods. However, it is recommended that future assessments also include a qualitative perspective. Lastly, omissions of variables from the reports are explored. Future impact studies should include location-specific trends in sea level rise, as opposed to assessing the impacts based on the global average future sea level rise prediction. It is also important to incorporate the speed of the rise in a dynamic analysis, as well as any uncertainties in a report’s input variables.Item Embargo Anxious Care: Radioactive Uncertainty and the Politics of Life in Post-Nuclear Japan(2023) Cho, JieunSince the 2011 meltdown, the health of “Fukushima children” has become a problem for parents, politics, and future imaginaries in post-nuclear Japan. What are the ethical and political implications of making life around a child imperiled by radiation when (re)productivity of life must be remade in a compromised environment? This dissertation investigates (re)production of life in the wake of the Fukushima Daiichi nuclear disaster in Japan by studying the strivings of families who seek to raise healthy children amidst radiation as a condition of living: what I call “anxious care.” By foregrounding the family as a site for environmental struggles in an emerging politics of life, I examine the work of making children live against and within radiation, looking to consider the radical implications of caring for children in radioactive uncertainty. In particular, this project focuses on inner cities of Fukushima Prefecture that have been on the frontline of radiation debates for having been exposed to disaster-induced radiation while not designated for evacuation. Shifting focus to the edges of delimited disaster zones, I examine the multifaceted aftermath of the nuclear disaster, ranging from differentially altered forms of life conditioned by radioactive uncertainty, the unequal distribution of radiation risk through public/private organizations such as the family form, and the everyday impact of post-Fukushima radiation. Theorizing the stakes of living with nuclear risk as situated political ecologies which generates tensions and possibilities for new forms of life, this dissertation argues that notions of life are undergoing a moment of reconfiguration in post-nuclear Japan by both real-life families and the family form. In doing so, it contributes to critiquing and broadening the anthropological horizons of life amid environmental uncertainty in and beyond Japan.
Item Open Access Are Higher Global Alignment and Proportion Scores Associated With Increased Risks of Mechanical Complications After Adult Spinal Deformity Surgery? An External Validation.(Clinical orthopaedics and related research, 2021-02) Kwan, Kenny Yat Hong; Lenke, Lawrence G; Shaffrey, Christopher I; Carreon, Leah Y; Dahl, Benny T; Fehlings, Michael G; Ames, Christopher P; Boachie-Adjei, Oheneba; Dekutoski, Mark B; Kebaish, Khaled M; Lewis, Stephen J; Matsuyama, Yukihiro; Mehdian, Hossein; Qiu, Yong; Schwab, Frank J; Cheung, Kenneth Man Chee; AO Spine Knowledge Forum DeformityBackground
The Global Alignment and Proportion (GAP) score, based on pelvic incidence-based proportional parameters, was recently developed to predict mechanical complications after surgery for spinal deformities in adults. However, this score has not been validated in an independent external dataset.Questions/purposes
After adult spinal deformity surgery, is a higher GAP score associated with (1) an increased risk of mechanical complications, defined as rod fractures, implant-related complications, proximal or distal junctional kyphosis or failure; (2) a higher likelihood of undergoing revision surgery to treat a mechanical complication; and (3) is a lower (more proportioned) GAP score category associated with better validated outcomes scores using the Oswestry Disability Index (ODI), Scoliosis Research Society-22 (SRS-22) and the Short Form-36 questionnaires?Methods
A total of 272 patients who had undergone corrective surgeries for complex spinal deformities were enrolled in the Scoli-RISK-1 prospective trial. Patients were included in this secondary analysis if they fulfilled the original inclusion criteria by Yilgor et al. From the original 272 patients, 14% (39) did not satisfy the radiographic inclusion criteria, the GAP score could not be calculated in 14% (37), and 24% (64) did not have radiographic assessment at postoperative 2 years, leaving 59% (159) for analysis in this review of data from the original trial. A total of 159 patients were included in this study,with a mean age of 58 ± 14 years at the time of surgery. Most patients were female (72%, 115 of 159), the mean number of levels involved in surgery was 12 ± 4, and three-column osteotomy was performed in 76% (120 of 159) of patients. The GAP score was calculated using parameters from early postoperative radiographs (between 3 and 12 weeks) including pelvic incidence, sacral slope, lumbar lordosis, lower arc lordosis and global tilt, which were independently obtained from a computer software based on centralized patient radiographs. The GAP score was categorized as proportional (scores of 0 to 2), moderately disproportional (scores of 3 to 6), or severely disproportional (scores higher than 7 to 13). Receiver operating characteristic area under curve (AUC) was used to assess associations between GAP score and risk of mechanical complications and risk of revision surgery. An AUC of 0.5 to 0.7 was classified as "no or low associative power", 0.7 to 0.9 as "moderate" and greater than 0.9 as "high". We analyzed differences in validated outcome scores between the GAP categories using Wilcoxon rank sum test.Results
At a minimum of 2 years' follow-up, a higher GAP score was not associated with increased risks of mechanical complications (AUC = 0.60 [95% CI 0.50 to 0.70]). A higher GAP score was not associated with a higher likelihood of undergoing a revision surgery to treat a mechanical complication (AUC = 0.66 [95% 0.53 to 0.78]). However, a moderately disproportioned GAP score category was associated with better SF-36 physical component summary score (36 ± 10 versus 40 ± 11; p = 0.047), better SF-36 mental component summary score (46 ± 13 versus 51 ± 12; p = 0.01), better SRS-22 total score (3.4 ± 0.8 versus 3.7 ± 0.7, p = 0.02) and better ODI score (35 ± 21 versus 25 ± 20; p = 0.003) than severely disproportioned GAP score category.Conclusion
Based on the findings of this external validation study, we found that alignment targets based on the GAP score alone were not associated with increased risks of mechanical complications and mechanical revisions in patients with complex adult spinal disorders. Parameters not included in the original GAP score needed to be considered to reduce the likelihood of mechanical complications.Level of evidence
Level III, diagnostic study.Item Open Access Assessing risk of breast cancer in an ethnically South-East Asia population (results of a multiple ethnic groups study).(BMC cancer, 2012-11-19) Gao, Fei; Machin, David; Chow, Khuan-Yew; Sim, Yu-Fan; Duffy, Stephen W; Matchar, David B; Goh, Chien-Hui; Chia, Kee-SengBackground
Gail and others developed a model (GAIL) using age-at-menarche, age-at-birth of first live child, number of previous benign breast biopsy examinations, and number of first-degree-relatives with breast cancer as well as baseline age-specific breast cancer risks for predicting the 5-year risk of invasive breast cancer for Caucasian women. However, the validity of the model for projecting risk in South-East Asian women is uncertain. We evaluated GAIL and attempted to improve its performance for Singapore women of Chinese, Malay and Indian origins.Methods
Data from the Singapore Breast Screening Programme (SBSP) are used. Motivated by lower breast cancer incidence in many Asian countries, we utilised race-specific invasive breast cancer and other cause mortality rates for Singapore women to produce GAIL-SBSP. By using risk factor information from a nested case-control study within SBSP, alternative models incorporating fewer then additional risk factors were determined. Their accuracy was assessed by comparing the expected cases (E) with the observed (O) by the ratio (E/O) and 95% confidence interval (CI) and the respective concordance statistics estimated.Results
From 28,883 women, GAIL-SBSP predicted 241.83 cases during the 5-year follow-up while 241 were reported (E/O=1.00, CI=0.88 to 1.14). Except for women who had two or more first-degree-relatives with breast cancer, satisfactory prediction was present in almost all risk categories. This agreement was reflected in Chinese and Malay, but not in Indian women. We also found that a simplified model (S-GAIL-SBSP) including only age-at-menarche, age-at-birth of first live child and number of first-degree-relatives performed similarly with associated concordance statistics of 0.5997. Taking account of body mass index and parity did not improve the calibration of S-GAIL-SBSP.Conclusions
GAIL can be refined by using national race-specific invasive breast cancer rates and mortality rates for causes other than breast cancer. A revised model containing only three variables (S-GAIL-SBSP) provides a simpler approach for projecting absolute risk of invasive breast cancer in South-East Asia women. Nevertheless its role in counseling the individual women regarding their risk of breast cancer remains problematical and needs to be validated in independent data.Item Restricted Association between DNA damage response and repair genes and risk of invasive serous ovarian cancer.(PLoS One, 2010-04-08) Schildkraut, Joellen M; Iversen, Edwin S; Wilson, Melanie A; Clyde, Merlise A; Moorman, Patricia G; Palmieri, Rachel T; Whitaker, Regina; Bentley, Rex C; Marks, Jeffrey R; Berchuck, AndrewBACKGROUND: We analyzed the association between 53 genes related to DNA repair and p53-mediated damage response and serous ovarian cancer risk using case-control data from the North Carolina Ovarian Cancer Study (NCOCS), a population-based, case-control study. METHODS/PRINCIPAL FINDINGS: The analysis was restricted to 364 invasive serous ovarian cancer cases and 761 controls of white, non-Hispanic race. Statistical analysis was two staged: a screen using marginal Bayes factors (BFs) for 484 SNPs and a modeling stage in which we calculated multivariate adjusted posterior probabilities of association for 77 SNPs that passed the screen. These probabilities were conditional on subject age at diagnosis/interview, batch, a DNA quality metric and genotypes of other SNPs and allowed for uncertainty in the genetic parameterizations of the SNPs and number of associated SNPs. Six SNPs had Bayes factors greater than 10 in favor of an association with invasive serous ovarian cancer. These included rs5762746 (median OR(odds ratio)(per allele) = 0.66; 95% credible interval (CI) = 0.44-1.00) and rs6005835 (median OR(per allele) = 0.69; 95% CI = 0.53-0.91) in CHEK2, rs2078486 (median OR(per allele) = 1.65; 95% CI = 1.21-2.25) and rs12951053 (median OR(per allele) = 1.65; 95% CI = 1.20-2.26) in TP53, rs411697 (median OR (rare homozygote) = 0.53; 95% CI = 0.35 - 0.79) in BACH1 and rs10131 (median OR( rare homozygote) = not estimable) in LIG4. The six most highly associated SNPs are either predicted to be functionally significant or are in LD with such a variant. The variants in TP53 were confirmed to be associated in a large follow-up study. CONCLUSIONS/SIGNIFICANCE: Based on our findings, further follow-up of the DNA repair and response pathways in a larger dataset is warranted to confirm these results.Item Open Access Association between novel PLCE1 variants identified in published esophageal cancer genome-wide association studies and risk of squamous cell carcinoma of the head and neck.(BMC cancer, 2011-06-20) Ma, Hongxia; Wang, Li-E; Liu, Zhensheng; Sturgis, Erich M; Wei, QingyiPhospholipase C epsilon 1 (PLCE1) (an effector of Ras) belonging to the phospholipase family plays crucial roles in carcinogenesis and progression of several cancers, including squamous cell carcinoma of the head and neck (SCCHN). A single nucleotide polymorphism (SNP, rs2274223) in PLCE1 has been identified as a novel susceptibility locus in genome-wide association studies (GWAS) of esophageal squamous cell carcinoma (ESCC) and gastric cardia adenocarcinoma (GCA) that share similar risk factors with SCCHN. Therefore, we investigated the association between potentially functional SNPs in PLCE1 and susceptibility to SCCHN.We genotyped three potentially functional SNPs (rs2274223A/G, rs3203713A/G and rs11599672T/G) of PLCE1 in 1,098 SCCHN patients and 1,090 controls matched by age and sex in a non-Hispanic white population.Although none of three SNPs was alone significantly associated with overall risk of SCCHN, their combined effects of risk alleles (rs2274223G, rs3203713G and rs11599672G) were found to be associated with risk of SCCHN in a locus-dose effect manner (Ptrend=0.046), particularly for non-oropharyngeal tumors (Ptrend=0.017); specifically, rs2274223 was associated with a significantly increased risk (AG vs. AA: adjusted OR=1.29, 95% CI=1.01-1.64; AG/GG vs. AA: adjusted OR=1.30, 95% CI=1.03-1.64), while rs11599672 was associated with a significantly decreased risk (GG vs. TT: adjusted OR=0.54, 95% CI=0.34-0.86; TG/GG vs. TT: adjusted OR=0.76, 95% CI=0.61-0.95).Our findings suggest that PLCE1 variants may have an effect on risk of SCCHN associated with tobacco and alcohol exposure, particularly for those tumors arising at non-oropharyngeal sites. These findings, although need to be validated by larger studies, are consistent with those in esophageal and gastric cancers.Item Open Access Association between perceived life chaos and medication adherence in a postmyocardial infarction population.(Circulation. Cardiovascular quality and outcomes, 2013-11) Zullig, Leah L; Shaw, Ryan J; Crowley, Matthew J; Lindquist, Jennifer; Grambow, Steven C; Peterson, Eric; Shah, Bimal R; Bosworth, Hayden BBackground
The benefits of medication adherence to control cardiovascular disease (CVD) are well defined, yet multiple studies have identified poor adherence. The influence of life chaos on medication adherence is unknown. Because this is a novel application of an instrument, our preliminary objective was to understand patient factors associated with chaos. The main objective was to evaluate the extent to which an instrument designed to measure life chaos is associated with CVD-medication nonadherence.Methods and results
Using baseline data from an ongoing randomized trial to improve postmyocardial infarction (MI) management, multivariable logistic regression identified the association between life chaos and CVD-medication nonadherence. Patients had hypertension and a myocardial infarction in the past 3 years (n=406). Nearly 43% reported CVD-medication nonadherence in the past month. In simple linear regression, the following were associated with higher life chaos: medication nonadherence (β=1.86; 95% confidence interval [CI], 0.96-2.76), female sex (β=1.22; 95% CI [0.22-2.24]), minority race (β=1.72; 95% CI [0.78-2.66]), having less than high school education (β=2.05; 95% CI [0.71-3.39]), low health literacy (β=2.06; 95% CI [0.86-3.26]), and inadequate financial status (β=1.93; 95% CI [0.87-3.00]). Being married (β=-2.09, 95% CI [-3.03 to -1.15]) was associated with lower life chaos. As chaos quartile increased, patients exhibited more nonadherence. In logistic regression, adjusting for sex, race, marital status, employment, education, health literacy, and financial status, a 1-unit life chaos increase was associated with a 7% increase (odds ratio, 1.07; 95% CI [1.02-1.12]) in odds of reporting medication nonadherence.Conclusions
Our results suggest that life chaos may be an important determinant of medication adherence. Life chaos screenings could identify those at risk for nonadherence.Clinical trial registration
URL: http://www.clinicaltrials.gov. Unique identifier: NCT000901277.Item Open Access Association of Intracerebral Hemorrhage Among Patients Taking Non-Vitamin K Antagonist vs Vitamin K Antagonist Oral Anticoagulants With In-Hospital Mortality.(JAMA, 2018-02) Inohara, Taku; Xian, Ying; Liang, Li; Matsouaka, Roland A; Saver, Jeffrey L; Smith, Eric E; Schwamm, Lee H; Reeves, Mathew J; Hernandez, Adrian F; Bhatt, Deepak L; Peterson, Eric D; Fonarow, Gregg CAlthough non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly used to prevent thromboembolic disease, there are limited data on NOAC-related intracerebral hemorrhage (ICH).To assess the association between preceding oral anticoagulant use (warfarin, NOACs, and no oral anticoagulants [OACs]) and in-hospital mortality among patients with ICH.Retrospective cohort study of 141 311 patients with ICH admitted from October 2013 to December 2016 to 1662 Get With The Guidelines-Stroke hospitals.Anticoagulation therapy before ICH, defined as any use of OACs within 7 days prior to hospital arrival.In-hospital mortality.Among 141 311 patients with ICH (mean [SD] age, 68.3 [15.3] years; 48.1% women), 15 036 (10.6%) were taking warfarin and 4918 (3.5%) were taking NOACs preceding ICH, and 39 585 (28.0%) and 5783 (4.1%) were taking concomitant single and dual antiplatelet agents, respectively. Patients with prior use of warfarin or NOACs were older and had higher prevalence of atrial fibrillation and prior stroke. Acute ICH stroke severity (measured by the National Institutes of Health Stroke Scale) was not significantly different across the 3 groups (median, 9 [interquartile range, 2-21] for warfarin, 8 [2-20] for NOACs, and 8 [2-19] for no OACs). The unadjusted in-hospital mortality rates were 32.6% for warfarin, 26.5% for NOACs, and 22.5% for no OACs. Compared with patients without prior use of OACs, the risk of in-hospital mortality was higher among patients with prior use of warfarin (adjusted risk difference [ARD], 9.0% [97.5% CI, 7.9% to 10.1%]; adjusted odds ratio [AOR], 1.62 [97.5% CI, 1.53 to 1.71]) and higher among patients with prior use of NOACs (ARD, 3.3% [97.5% CI, 1.7% to 4.8%]; AOR, 1.21 [97.5% CI, 1.11-1.32]). Compared with patients with prior use of warfarin, patients with prior use of NOACs had a lower risk of in-hospital mortality (ARD, -5.7% [97.5% CI, -7.3% to -4.2%]; AOR, 0.75 [97.5% CI, 0.69 to 0.81]). The difference in mortality between NOAC-treated patients and warfarin-treated patients was numerically greater among patients with prior use of dual antiplatelet agents (32.7% vs 47.1%; ARD, -15.0% [95.5% CI, -26.3% to -3.8%]; AOR, 0.50 [97.5% CI, 0.29 to 0.86]) than among those taking these agents without prior antiplatelet therapy (26.4% vs 31.7%; ARD, -5.0% [97.5% CI, -6.8% to -3.2%]; AOR, 0.77 [97.5% CI, 0.70 to 0.85]), although the interaction P value (.07) was not statistically significant.Among patients with ICH, prior use of NOACs or warfarin was associated with higher in-hospital mortality compared with no OACs. Prior use of NOACs, compared with prior use of warfarin, was associated with lower risk of in-hospital mortality.Item Open Access Association of tumor necrosis factor-alpha promoter variants with risk of HPV-associated oral squamous cell carcinoma.(Molecular cancer, 2013-07-19) Jin, Lei; Sturgis, Erich M; Zhang, Yang; Huang, Zhigang; Song, Xicheng; Li, Chao; Wei, Qingyi; Li, GuojunTumor necrosis factor alpha (TNF-α) plays an important role in inflammation, immunity, and defense against infection and clearance of human papillomavirus (HPV). Thus, genetic variants may modulate individual susceptibility to HPV-associated oral squamous cell carcinoma (OSCC).In this study we genotyped four common single nucleotide polymorphisms (SNPs) in the TNF-α promoter [ -308G > A(rs1800629), -857C > T (rs1799724), -863C > A (rs1800630), and -1031T > C (rs1799964)] and determined HPV16 serology in 325 OSCC cases and 335 matched controls and tumor HPV status in 176 squamous cell carcinomas of the oropharynx (SCCOP) patients. Univariate and multivariable logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).We found that HPV16 seropositivity alone was associated with an increased risk of OSCC (OR, 3.1; 95% CI, 2.1-4.6), and such risk of HPV16-associated OSCC was modified by each SNP. Patients with both HPV16 seropositivity and variant genotypes for each SNP had the highest risk when using patients with HPV16 seronegativity and a wild-type genotype as a comparison group. Moreover, similar results were observed for the combined risk genotypes of four variants and all such significant associations were more pronounced in several subgroups, particularly in SCCOP patients and never smokers. Notably, the combined risk genotypes of four variants were also significantly associated with tumor HPV-positive SCCOP.Taken together, these results suggest that TNF-α SNPs may individually or, more likely, jointly affect individual susceptibility to HPV16-associated OSCC, particularly SCCOP and never smokers. Validation of our findings is warranted.Item Open Access Associations of PI3KR1 and mTOR polymorphisms with esophageal squamous cell carcinoma risk and gene-environment interactions in Eastern Chinese populations.(Scientific reports, 2015-01) Zhu, Jinhong; Wang, Mengyun; Zhu, Meiling; He, Jin; Wang, Jiu-Cun; Jin, Li; Wang, Xiao-Feng; Xiang, Jia-Qing; Wei, QingyiSingle nucleotide polymorphisms (SNPs) in the PI3K/PTEN/AKT/mTOR signaling pathway may contribute to carcinogenesis. We genotyped five potentially functional PIK3R1 and mTOR SNPs in 1116 esophageal squamous cell cancer (ESCC) patients and 1117 cancer-free controls to assess their associations with ESCC risk. We observed no association with ESCC risk for any of the selected SNPs. However, the combined analysis of these SNPs revealed that subjects with one-to-three risk genotypes had an increased ESCC risk. Stratified analysis by body mass index (BMI) found that ESCC risk was significantly associated with each of three mTOR SNPs among subjects with BMI < 25.0. Specifically, we found that subjects carrying ≥ 1 risk genotypes had significantly increased ESCC risk, particularly for males, ever-smokers, ever-drinkers, and those with age > 60, or BMI < 25.0. Moreover, three mTOR haplotypes were associated with an increase in ESCC risk. Our meta-analysis of mTOR rs2295080 and cancer risk provided further evidence that mTOR SNPs might modulate cancer susceptibility. In this population, such risk effects might be modified by other risk factors, highlighting the importance of gene-environment interaction in esophageal carcinogenesis. Additional, larger studies are warranted to validate our findings.Item Open Access A Risk‐Risk Trade‐off: Insecticide Use for Malaria Control(2011-04-29) Pfau, KristenMalaria is among the top causes of death in low-income countries. Because it is transmitted through a mosquito vector, programs to reduce or control these insects receive much attention. Recently, concerns have increased regarding possible chronic reproductive impairment following exposure to insecticides used in mosquito control. This project examines the human health benefits and potential human health consequences of indoor residual spraying (IRS), an increasingly popular method of insecticide use for malaria control. Meta-analysis was used to aggregate the results of published trials on efficacy of IRS in reducing malaria prevalence in a region. Statistical analysis incorporating results of all these studies led to general conclusions about the impact of any IRS program, and provided insight as to what variables resulted in greater effects in one community over another—for example, the type of insecticide used, the initial malaria prevalence in the community, and the time frame of the program. Next, the potential chronic human health consequences were assessed through a review of chemical, toxicological and epidemiological studies. Research focused on two chemicals, lambda-cyhalothrin and DDT. Screening of chemical properties and toxicological studies indicate a potential risk for negative human health outcomes from exposure to both chemicals. Identification and critique of several epidemiological studies that link exposure to IRS with negative reproductive health outcomes verify this risk for DDT. Finally, a series of interviews with malaria control experts in Tanzania provided insight on the cumulative perceptions of decision-makers regarding both the benefits and the consequences illustrated in the previous sections, as well as a variety of other facets of malaria prevention. While this project only presents a small portion of benefits and risks associated with using insecticides for malaria control, it is evident that the current risk assessment-risk management paradigm is not adequate for informing decisions on risk tradeoffs. The benefits and risks need to be considered holistically, not independently, in order to inform quality risk policies. Based on the case study of insecticide use for malaria control, a new framework is suggested in which risk tradeoffs are approached in an interdisciplinary, collaborative manner.Item Open Access Beta2-adrenergic receptor gene polymorphisms as systemic determinants of healthy aging in an evolutionary context.(Mech Ageing Dev, 2010-05) Kulminski, Alexander M; Culminskaya, Irina; Ukraintseva, Svetlana V; Arbeev, Konstantin G; Land, Kenneth C; Yashin, Anatoli IThe Gln(27)Glu polymorphism but not the Arg(16)Gly polymorphism of the beta2-adrenergic receptor (ADRB2) gene appears to be associated with a broad range of aging-associated phenotypes, including cancers at different sites, myocardial infarction (MI), intermittent claudication (IC), and overall/healthy longevity in the Framingham Heart Study Offspring cohort. The Gln(27)Gln genotype increases risks of cancer, MI and IC, whereas the Glu(27) allele or, equivalently, the Gly(16)Glu(27) haplotype tends to be protective against these diseases. Genetic associations with longevity are of opposite nature at young-old and oldest-old ages highlighting the phenomenon of antagonistic pleiotropy. The mechanism of antagonistic pleiotropy is associated with an evolutionary-driven advantage of carriers of a derived Gln(27) allele at younger ages and their survival disadvantage at older ages as a result of increased risks of cancer, MI and IC. The ADRB2 gene can play an important systemic role in healthy aging in evolutionary context that warrants exploration in other populations.Item Open Access Cancer and longevity--is there a trade-off? A study of cooccurrence in Danish twin pairs born 1900-1918.(J Gerontol A Biol Sci Med Sci, 2012-05) Christensen, Kaare; Pedersen, Jacob K; Hjelmborg, Jacob VB; Vaupel, James W; Stevnsner, Tinna; Holm, Niels V; Skytthe, AxelBACKGROUND: Animal models and a few human studies have suggested a complex interaction between cancer risk and longevity indicating a trade-off where low cancer risk is associated with accelerating aging phenotypes and, vice versa, that longevity potential comes with the cost of increased cancer risk. This hypothesis predicts that longevity in one twin is associated with increased cancer risk in the cotwin. METHODS: A total of 4,354 twin pairs born 1900-1918 in Denmark were followed for mortality in the Danish Civil Registration System through 2008 and for cancer incidence in the period 1943-2008 through the Danish Cancer Registry. RESULTS: The 8,139 twins who provided risk time for cancer occurrence entered the study between ages 24 and 43 (mean 33 years), and each participant was followed up to death, emigration, or at least 90 years of age. The total follow-up time was 353,410 person-years and, 2,524 cancers were diagnosed. A negative association between age at death of a twin and cancer incidence in the cotwin was found in the overall analyses as well as in the subanalysis stratified on sex, zygosity, and random selection of one twin from each twin pair. CONCLUSIONS: This study did not find evidence of a cancer-longevity trade-off in humans. On the contrary, it suggested that longevity in one twin is associated with lower cancer incidence in the cotwin, indicating familial factors associated with both low cancer occurrence and longevity.