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OBJECTIVES: This study developed a new model for risk assessment of immuno-glycolysis-related genes for lung adenocarcinoma (LUAD) patients to predict prognosis and immunotherapy efficacy. METHODS: LUAD samples and data obtained from the Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases are used as training and test columns, respectively. Twenty-two (22) immuno-glycolysis-related genes were screened, the patients diagnosed with LUAD were divided into two molecular subtypes by consensus clustering of these genes. The initial prognosis model was developed using the multiple regression analysis method and Receiver Operating characteristic (ROC) analysis was used to verify its predictive potential. Gene set enrichment analysis (GSEA) showed the immune activities and pathways in different risk populations, we calculated immune checkpoints, immune escape, immune phenomena (IPS), and tumor mutation burden (TMB) based on TCGA datasets. Finally, the relationship between the model and drug sensitivity was analyzed. RESULTS: Fifteen (15) key differentially expressed genes (DEGs) with prognostic value were screened and a new prognostic model was constructed. Four hundred and forty-three (443) samples were grouped into two different risk cohorts based on median model risk values. It was observed that survival rates in high-risk groups were significantly low. ROC curves were used to evaluate the model's accuracy in determining the survival time and clinical outcome of LUAD patients. Cox analysis of various clinical factors proved that the risk score has great potential as an independent prognostic factor. The results of immunological analysis can reveal the immune infiltration and the activity of related functions in different pathways in the two risk groups, and immunotherapy was more effective in low-risk patients. Most chemotherapeutic agents are more sensitive to low-risk patients, making them more likely to benefit. CONCLUSION: A novel prognostic model for LUAD patients was established based on IGRG, which could more accurately predict the prognosis and an effective immunotherapy approach for patients.
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Adenocarcinoma de Pulmão , Neoplasias Pulmonares , Humanos , Prognóstico , Adenocarcinoma de Pulmão/genética , Fatores de Risco , Análise por Conglomerados , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/terapiaRESUMO
Cyclists are vulnerable road users and face disproportionately high rates of road trauma, especially in low- and middle-income countries. Behaviour of road users is a system outcome, and thus studying cyclist behaviours can identify problems in the whole road transport system and assist in generating long-lasting, cost-effective solutions to promote cyclist safety. This study aims to investigate the similarities and disparities of cycling behaviour among countries with different income levels and cycling prevalence, and the relationships among cyclist demographic characteristics, behaviours and crash involvement. It applies the Cycling Behaviour Questionnaire (CBQ) to measure the behaviour of cyclists in three countries: Australia (high-income, emerging cycling country), China (mid-income, traditional cycling country) and Colombia (low-income, emerging cycling country). A total of 1094 cyclists (Australia 347, China 368, and Colombia 379) with a mean age of 31.8 years completed the online questionnaire. Confirmatory Factor Analysis was used to examine the factorial structure of the CBQ. The results showed that the three-factor CBQ (i.e., Traffic Violations, Errors and Positive Behaviours) had a stable and uniform factorial structure across all three countries. Cyclists reported more frequent positive behaviours than risky behaviours across all three countries. The Australian cyclists reported more positive behaviours and fewer violations than cyclists from the other countries, which is likely to reflect the road environment, policy and enforcement differences. Male cyclists tended to engage in more risky riding than females and reported more crash involvement. Older cyclists reported less risky riding and less involvement in crashes than younger cyclists. Cyclists who rode more often reported more frequent risky riding. The study helps understand the prevalence of risky/positive cyclist behaviours among countries and provides insights for developing systematic countermeasures to improve cycling environment and cyclist safety.
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Acidentes de Trânsito , Ciclismo , Adulto , Austrália , Colômbia , Feminino , Humanos , Masculino , Inquéritos e QuestionáriosRESUMO
SUMMARY: The microstructure of inner ear in Scincella tsinlingensis was observed by light microscopy and the expression of glial fibrillary acidic protein (GFAP) in membranous labyrinth among the juvenile age group, subadult age group and adult age group were also detected by methods of immunohistochemistry. The inner ear in S. tsinlingensis resembled those in other Scincid lizards in their anatomy and histology. Large and elongate cochlear duct was slightly bowed or arched laterally. There was no hint of limbic modifications and the limbic lip was absent in cochlear recess. The basilar papilla elongated anteroventrally possessed specialized tectorial sallets. GFAP staining was significantly distributed in supporting cells of the sensory epithelia of cochlear duct, while the utricular macula and canal ampullae showed immunopositive for the GFAP antibody, with weaker staining in the saccular macula. The membranous inner ear of three different age groups revealed the similar pattern of GFAP expression, which suggested that the distribution of supporting cells were independent of age in S. tsinlingensis.
RESUMEN: La microestructura del oído interno en Scincella tsinlingensis fue analizada mediante microscopía óptica y por otra parte, fue cuantificada la expresión de la proteína ácida fibrilar glial (GFAP) en el laberinto membranoso, entre los grupos de edad juvenil, subadulto y adulto, utilizándose métodos inmunohistoquímicos. El oído interno de S. tsinlingensis se asemejaba al de otros lagartos Scincid tanto en su anatomía como en su histología. El conducto coclear mayor estaba ligeramente arqueado o arqueado lateralmente. No había indicios de modificaciones límbicas y no se evidenció el labio en el receso coclear. La papila basilar alargada anteroventralmente poseía sallets tectoriales especializados. La tinción de GFAP se distribuyó significativamente en las células del epitelio sensorial del conducto coclear, mientras que la mácula utricular y la ampolla del canal mostraron inmunopositividad para el anticuerpo GFAP, con una tinción más débil en la mácula sacular. El oído interno membranoso de los tres grupos de edad diferentes reveló un patrón similar de expresión de GFAP, lo que sugiere que la distribución de las células de soporte son independiente de la edad en S. tsinlingensis.
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Animais , Proteína Glial Fibrilar Ácida/metabolismo , Orelha Interna/anatomia & histologia , Lagartos/anatomia & histologia , Imuno-Histoquímica , Proteína Glial Fibrilar Ácida/análise , Orelha Interna/química , MicroscopiaRESUMO
BACKGROUND: Medicare Shared Savings Program Accountable Care Organizations (ACOs) may focus more on primary care given ACO financial incentives. We examine variation in primary care treatment of 8 prevalent chronic conditions across ACOs and the factors affecting the variation, and compare the role of primary care in ACOs and non-ACOs. RESEARCH DESIGN: We conduct regression models at the ACO-level to identify factors predicting higher proportions of chronic condition visits delivered by primary care providers (PCPs) using 2013 Medicare claims and enrollment data. We compare the distribution of visits to PCPs, specialists and advanced practice providers between ACO-attributed and non-ACO-attributed beneficiaries. RESULTS: At the ACO-level, the proportion of patients who are white and of the local population who are college educated, the complexity of the patient population, and the supply of specialists were negatively associated with the proportion of chronic condition visits delivered by PCPs, whereas the percentage of contracted physicians within the ACO who were PCPs was positively associated. These results varied when subanalyses were conducted for each specific chronic condition. ACO care for chronic conditions was managed similar to that of care for non-ACO Medicare beneficiaries in 2013, but that some ACOs utilize PCPs to manage chronic conditions more than others. CONCLUSIONS: Many ACOs may underutilize PCPs, and thus could actively shift care to less expensive primary care for potential savings to payers. Barriers to that shift could include low numbers of PCPs contracted in the ACO, and existing referral patterns and patient relationships with specialists.
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Organizações de Assistência Responsáveis/economia , Redução de Custos/economia , Gastos em Saúde/estatística & dados numéricos , Medicare/economia , Atenção Primária à Saúde/economia , Doença Crônica/economia , Redução de Custos/métodos , Custos e Análise de Custo/economia , Humanos , Atenção Primária à Saúde/estatística & dados numéricos , Estados UnidosRESUMO
OBJECTIVE: To examine variations in premium and cost-sharing across marketplace plans available to eligible families. DATA SOURCES: 2011-2012 Medical Expenditure Panel Survey (MEPS), 2014 health plan data from healthcare.gov, and the 2011 Medicare Part D public formulary file. STUDY DESIGN: We identified a nationally representative cohort of individuals in the MEPS who would have been eligible for marketplace coverage. For each family, we simulated the total out-of-pocket payment (premium plus cost-sharing) under each available plan in their county of residence, assuming their premarketplace use. DATA COLLECTION/EXTRACTION METHODS: Confidential state and county of residence identifiers were merged onto MEPS public use files and used to match MEPS families to the plans available in their county as reported in the publicly available data from healthcare.gov. PRINCIPAL FINDINGS: We found substantial variation in total family health care spending, especially premium component, across marketplace plans. This is true even within a plan tier of the same minimum actuarial value, and for families eligible for subsidies. Variation among families with income below 250 percent of the FPL is larger than variation among families with higher income. CONCLUSIONS: Our simulations show substantial variations in net premium and out-of-pocket payments across marketplace plans, even within a plan tier.
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Custo Compartilhado de Seguro , Gastos em Saúde/estatística & dados numéricos , Trocas de Seguro de Saúde , Cobertura do Seguro/estatística & dados numéricos , Adolescente , Adulto , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Renda/estatística & dados numéricos , Masculino , Medicare , Pessoa de Meia-Idade , Patient Protection and Affordable Care Act , Estados Unidos , Adulto JovemRESUMO
BACKGROUND: In March 2014, the American Heart Association updated their guidelines for the management of oral anticoagulation (OAC) in atrial fibrillation, recommending OAC for all patients with CHA2DS2-VASc ≥2. Previously, only patients with CHADS2 ≥2 were recommended for anticoagulation. This study compared effectiveness and safety outcomes of OAC among patients who would receive OAC using the 2014 guidelines but not the 2011 guidelines. METHODS AND RESULTS: Using claims data from a 5% sample of 2013-2014 Medicare beneficiaries, we identified patients with initially diagnosed atrial fibrillation between 2013 and 2014 and selected those who would receive OAC under the 2014 guidelines but not the 2011 guidelines (those with CHA2DS2-VASc score ≥2 or CHADS2 score <2). Patients were categorized according to their use of OAC after first atrial fibrillation diagnosis (2937 users and 2914 nonusers). Primary outcomes included the composite of ischemic stroke, systemic embolism and death, and any bleeding event. Cox proportional hazard models were constructed to compare the risk of primary outcomes between the 2 groups, while controlling for patient demographic and clinical characteristics. There was no difference in the combined risk of stroke, systemic embolism, and death between the treatment groups (hazard ratio, 1.00; 95% confidence interval, 0.84-1.20). The risk of bleeding was higher for patients receiving OAC than for patients not receiving OAC (hazard ratio, 1.70, 95% confidence interval, 1.46-1.97). CONCLUSIONS: The benefit of OAC is not well defined in this patient population, and new studies that minimize residual confounding are needed to fully understand the risk/benefit of OAC in patients with atrial fibrillation and low to moderate stroke risk.
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Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Acidente Vascular Cerebral/prevenção & controle , Administração Oral , Demandas Administrativas em Assistência à Saúde , Idoso , Anticoagulantes/efeitos adversos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/mortalidade , Tomada de Decisão Clínica , Pesquisa Comparativa da Efetividade , Bases de Dados Factuais , Feminino , Fidelidade a Diretrizes/normas , Hemorragia/induzido quimicamente , Hemorragia/mortalidade , Humanos , Masculino , Medicare , Seleção de Pacientes , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
PURPOSE: The steps involved, the resources needed, and the challenges associated with applying predictive analytics in healthcare are described, with a review of successful applications of predictive analytics in implementing population health management interventions that target medication-related patient outcomes. SUMMARY: In healthcare, the term big data typically refers to large quantities of electronic health record, administrative claims, and clinical trial data as well as data collected from smartphone applications, wearable devices, social media, and personal genomics services; predictive analytics refers to innovative methods of analysis developed to overcome challenges associated with big data, including a variety of statistical techniques ranging from predictive modeling to machine learning to data mining. Predictive analytics using big data have been applied successfully in several areas of medication management, such as in the identification of complex patients or those at highest risk for medication noncompliance or adverse effects. Because predictive analytics can be used in predicting different outcomes, they can provide pharmacists with a better understanding of the risks for specific medication-related problems that each patient faces. This information will enable pharmacists to deliver interventions tailored to patients' needs. In order to take full advantage of these benefits, however, clinicians will have to understand the basics of big data and predictive analytics. CONCLUSION: Predictive analytics that leverage big data will become an indispensable tool for clinicians in mapping interventions and improving patient outcomes.