A proteomic surrogate for cardiovascular outcomes that is sensitive to multiple mechanisms of change in risk.

A reliable, individualized, and dynamic surrogate of cardiovascular risk, synoptic for key biologic mechanisms, could shorten the path for drug development, enhance drug cost-effectiveness and improve patient outcomes. We used highly multiplexed proteomics to address these objectives, measuring about 5000 proteins in each of 32,130 archived plasma samples from 22,849 participants in nine clinical studies. We used machine learning to derive a 27-protein model predicting 4-year likelihood of myocardial infarction, stroke, heart failure, or death.

Health impacts of a randomized biomass cookstove intervention in northern Ghana.

Background: Household air pollution (HAP) from cooking with solid fuels has adverse health effects. REACCTING (Research on Emissions, Air quality, Climate, and Cooking Technologies in Northern Ghana) was a randomized cookstove intervention study that aimed to determine the effects of two types of "improved" biomass cookstoves on health using self-reported health symptoms and biomarkers of systemic inflammation from dried blood spots for female adult cooks and children, and anthropometric growth measures for children only.

Methods: Two hundred rural households were randomized into four different cookstove groups.

Plasma protein patterns as comprehensive indicators of health.

Proteins are effector molecules that mediate the functions of genes and modulate comorbidities, behaviors and drug treatments. They represent an enormous potential resource for personalized, systemic and data-driven diagnosis, prevention, monitoring and treatment. However, the concept of using plasma proteins for individualized health assessment across many health conditions simultaneously has not been tested.

New Emission Factors and Efficiencies from in-Field Measurements of Traditional and Improved Cookstoves and Their Potential Implications.

Household cooking using solid biomass fuels is a major global health and environmental concern. As part of the Research on Emissions Air quality Climate and Cooking Technologies in Northern Ghana study, we conducted 75 in-field uncontrolled cooking tests designed to assess emissions and efficiency of the Gyapa woodstove, Philips HD4012, threestone fire and coalpot (local charcoal stove). Emission factors (EFs) were calculated for carbon monoxide (CO), carbon dioxide (CO), and particulate matter (PM).

Comparison of Models Analyzing a Small Number of Observed Meningitis Cases in Navrongo, Ghana.

The "meningitis belt" is a region in sub-Saharan Africa where annual outbreaks of meningitis occur, with epidemics observed cyclically. While we know that meningitis is heavily dependent on seasonal trends, the exact pathways for contracting the disease are not fully understood and warrant further investigation. Most previous approaches have used large sample inference to assess impacts of weather on meningitis rates.

Flexible modeling of the hazard rate and treatment effects in long-term survival studies.

The effects of predictors on time to failure may be difficult to assess in cancer studies with longer follow-up, as the commonly used assumption of proportionality of hazards holding over an extended period is often questionable. Motivated by a long-term prostate cancer clinical trial, we contrast and compare four powerful methods for estimation of the hazard rate. These four methods allow for varying degrees of smoothness as well as covariates with effects that vary over time.

Exposures to and origins of carbonaceous PM in a cookstove intervention in Northern Ghana.

REACCTING (Research on Emissions Air Quality, Climate, and Cooking Technologies in Northern Ghana) was a 200-home cookstove intervention study from 2013 to 2015. Study households were divided into four groups: a control group, a group given two locally made rocket stoves, a group given two Philips forced draft stoves, and a group given a locally made rocket stove and a Philips stove. In a subset of study households, 48-hour PM exposure samples were collected for adults and children, as well as in the primary cooking area.

A multivariate cure model for left-censored and right-censored data with application to colorectal cancer screening patterns.

We develop a multivariate cure survival model to estimate lifetime patterns of colorectal cancer screening. Screening data cover long periods of time, with sparse observations for each person. Some events may occur before the study begins or after the study ends, so the data are both left-censored and right-censored, and some individuals are never screened (the 'cured' population).

Research on Emissions, Air quality, Climate, and Cooking Technologies in Northern Ghana (REACCTING): study rationale and protocol.

Background: Cooking over open fires using solid fuels is both common practice throughout much of the world and widely recognized to contribute to human health, environmental, and social problems. The public health burden of household air pollution includes an estimated four million premature deaths each year. To be effective and generate useful insight into potential solutions, cookstove intervention studies must select cooking technologies that are appropriate for local socioeconomic conditions and cooking culture, and include interdisciplinary measurement strategies along a continuum of outcomes.

Survival Analysis with Electronic Health Record Data: Experiments with Chronic Kidney Disease.

This paper presents a detailed survival analysis for chronic kidney disease (CKD). The analysis is based on the EHR data comprising almost two decades of clinical observations collected at New York-Presbyterian, a large hospital in New York City with one of the oldest electronic health records in the United States. Our survival analysis approach centers around Bayesian multiresolution hazard modeling, with an objective to capture the changing hazard of CKD over time, adjusted for patient clinical covariates and kidney-related laboratory tests.

Shock index and early recognition of sepsis in the emergency department: pilot study.

Introduction: Screening for severe sepsis in adult emergency department (ED) patients may involve potential delays while waiting for laboratory testing, leading to postponed identification or over-utilization of resources. The systemic inflammatory response syndrome (SIRS) criteria are inaccurate at predicting clinical outcomes in sepsis. Shock index (SI), defined as heart rate / systolic blood pressure, has previously been shown to identify high risk septic patients.

Interfraction motion of the vaginal apex during postoperative intensity modulated radiation therapy: are we missing the target?

Objective: This study aimed to evaluate changes in vaginal cuff position and rectal distention during whole pelvic intensity modulated radiation therapy using daily image guidance for patients with gynecologic malignancies.

Materials And Methods: We reviewed 145 daily images from 5 patients treated with intensity modulated radiation therapy after total abdominal hysterectomy for endometrial or cervical cancer. A fiducial marker was placed in the vaginal cuff tissue before computed tomographic simulation.

Hyperlactatemia affects the association of hyperglycemia with mortality in nondiabetic adults with sepsis.

Background: Admission hyperglycemia has been reported as a mortality risk factor for septic nondiabetic patients; however, hyperglycemia's known association with hyperlactatemia was not addressed in these analyses.

Objectives: The objective was to determine whether the association of hyperglycemia with mortality remains significant when adjusted for concurrent hyperlactatemia.

Methods: This was a post hoc, nested analysis of a retrospective cohort study performed at a single center.

Impact of metformin use on the prognostic value of lactate in sepsis.

Objective: The objective of this study is to determine if metformin use affects the prevalence and prognostic value of hyperlactatemia to predict mortality in septic adult emergency department (ED) patients.

Methods: This is a single-center retrospective cohort study. Emergency department providers identified study subjects; data were collected from the medical record.

The prevalence, rate of progression, and treatment of elbow flexion contracture in children with brachial plexus birth palsy.

Background: Elbow flexion contracture is a well-known complication of brachial plexus birth palsy that adversely affects upper-extremity function. The prevalence, risk factors, and rate of progression of elbow flexion contracture associated with brachial plexus birth palsy have not been established, and the effectiveness of nonoperative treatment involving nighttime splinting or serial casting has not been well studied.

Methods: The medical records of 319 patients with brachial plexus birth palsy who had been seen at our institution between 1992 and 2009 were retrospectively reviewed to identify patients with an elbow flexion contracture (≥10°).

The natural history of cardiac and pulmonary function decline in patients with duchenne muscular dystrophy.

Study Design: Retrospective review of scoliosis progression, pulmonary and cardiac function in a series of patients with Duchenne Muscular Dystrophy (DMD).

Objective: To determine whether operative treatment of scoliosis decreases the rate of pulmonary function loss in patients with DMD.

Summary Of Background Data: It is generally accepted that surgical intervention should be undertaken in DMD scoliosis once curve sizes reach 35° to allow intervention before critical respiratory decline has occurred.

Differential maintenance of cortical and cancellous bone strength following discontinuation of bone-active agents.

Osteoporotic patients treated with antiresorptive or anabolic agents experience an increase in bone mass and a reduction in incident fractures. However, the effects of these medications on bone quality and strength after a prolonged discontinuation of treatment are not known. We evaluated these effects in an osteoporotic rat model.

Does donating blood for the first time during a national emergency create a better commitment to donating again?

Background And Objectives: Emergency situations often elicit a generous response from the public. This occurred after attacks on the US on September 11, 2001 when many new blood donors lined up to donate. This study was performed to compare return rates for first time donors (FTD) after September 11th, 2001 to FTD during a comparable period in 2000.

Longitudinal influences of partner depression on cognitive functioning in latino spousal pairs.

Background/aims: While social factors may influence the trajectories of cognitive aging, the influence of spousal characteristics (i.e. health or mental health) on cognitive decline has received little attention.

Immigration to the USA and risk for mood and anxiety disorders: variation by origin and age at immigration.

Background: Risk for mood and anxiety disorders associated with US-nativity may vary across immigrant groups.

Method: Using data from the National Epidemiological Study of Alcohol and Related Conditions (NESARC), we examined the association of lifetime risk for mood and anxiety disorders with US-nativity and age at immigration across seven subgroups of the US population defined by country or region of ancestral origin: Mexico, Puerto-Rico, Cuba, Central and South America, Western Europe, Eastern Europe, and Africa and the Caribbean. Discrete time survival models were used to compare lifetime risk between the US-born, immigrants who arrived in the USA prior to the age of 13 years and immigrants who arrived in the USA at the age of 13 years or older.