Browsing by Subject "Survival"
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Item Bayesian hierarchical parametric survival analysis for NBA career longevity(2012-05) Lakin, Richard Thomas; Scott, James (Statistician); Powers, DanielIn evaluating a prospective NBA player, one might consider past performance in the player’s previous years of competition. In doing so, a general manager may ask the following questions: Do certain characteristics of a player’s past statistics play a role in how long a player will last in the NBA? In this study, we examine the data from players who entered in the NBA in a five-‐year period (1997-‐1998 through 2001-‐2002 season) by looking at their attributes from their collegiate career to see if they have any effect on their career longevity. We will look at basic statistics take for each of these players, such as field goal percentage, points per game, rebounds per game and assists per game. We aim to use Bayesian survival methods to model these event times, while exploiting the hierarchical nature of the data. We will look at two types of models and perform model diagnostics to determine which of the two we prefer.Item Comorbidity measures to predict clinical and economic outcomes among elderly gynecologic cancer survivors(2016-05) Park, Chanhyun; Lawson, Kenneth Allen, 1952-; Barner, Jamie C.; Powers, Daniel A.; Rascati, Karen L.; Wilson, James P.The incidence of gynecologic cancers increases with age, and elderly cancer survivors are more likely to have additional comorbid conditions. However, little is known about the relationships between comorbidity and health outcomes among elderly gynecologic cancer survivors. The primary purpose of this study is to examine the relationships between comorbidity and health outcomes, and the secondary purpose is to compare the performance of commonly used comorbidity indices to predict health outcomes among elderly gynecologic cancer survivors. This retrospective data analysis study used the 2007-2010 SEER-Medicare data. The study population was elderly gynecologic cancer survivors in the US. The primary independent variable was each comorbidity index: diagnosis-based indices (Charlson Comorbidity Index (CCI), Elixhauser Index (EI), National Cancer Institute comorbidity (NCI) index) and medication-based indices (the Chronic Disease Score (CDS) and RxRisk). The dependent variables were: survival (overall survival time and one-year mortality), the numbers of healthcare utilization events (emergency room (ER)/inpatient visits, outpatient visits, and office-based practitioner visits), and healthcare costs (ER/inpatient visit, outpatient visit, office-based practitioner visit, pharmacy, and total healthcare). Cox models with time-dependent covariates, Poisson regressions, negative binomial regressions, and gamma regressions with a log link were used. A total of 4,063 survivors were included. Among them, 27.59% died within one year after diagnosis, and the mean (SD) of total healthcare costs was $40,605 ($34,014). The diagnosis-based indices were associated with a shorter overall survival time and an increased mortality and outperformed the medication-based indices in predicting them. Regarding healthcare utilization and costs, the CCI and CDS-1 scores were better predictors for ER/inpatient visit-related outcomes and total healthcare cost, while the CDS-2 and RxRisk scores were better predictors for office-based practitioner visit-related outcomes. None of the comorbidity indices were significant predictors for outpatient visit-related outcomes and prescription costs. Since the ability of the comorbidity indices varied depending on the outcome of interest, the outcome along with the purpose of the study should be considered in selecting an appropriate comorbidity index. This study provides evidence that clinicians can use in developing better treatment plans for specific conditions, that researchers can use in choosing the best comorbidity index, and that payers can use in their budgeting by identifying comorbid conditions with higher costs.Item Diacylglycerol, novel protein kinase C isozymes [eta] and [theta], and other diacylglycerol activated proteins promote neuroprotective plasmalemmal sealing in B104 neurons in vitro and rat sciatic nerve axons in vivo(2012-12) Zuzek, Aleksej; Bittner, George D.; Ben-Yakar, Adela; Dalby, Kevin N.; Thompson, Wesley J.; Zakon, HaroldTo survive, neurons and other eukaryotic cells must rapidly repair (seal) plasmalemmal damage. Such repair occurs by an accumulation of intracellular vesicles at or near the plasmalemmal disruption. Diacylglycerol (DAG)-dependent and cAMP-dependent proteins are involved in many vesicle trafficking pathways. Although recent studies have implicated the signaling molecule cAMP in sealing, no study has investigated how DAG and DAG-dependent proteins affect sealing and, whether pharmacological inhibition of such proteins could promote immediate repair of damaged mammalian axons. To this end, I investigated the role of DAG, protein kinase C (PKC) and other DAG-activated proteins in plasmalemmal sealing in B104 neurons in vitro and rat sciatic nerves in vivo. Using dye exclusion to assess Ca2+-dependent vesicle-mediated sealing of transected neurites of individually identifiable rat hippocampal B104 cells, I now report that, compared to non-treated controls, sealing probabilities and rates are increased by DAG and cAMP analogs that activate PKC and Munc13-1, and protein kinase A (PKA). Sealing is decreased by inhibiting DAG-activated novel protein kinase C isozymes η (nPKCη) and θ (nPKCθ) and, Munc13-1, the PKC effector myristoylated alanine rich PKC substrate (MARCKS) or phospholipase C (PLC). DAG-increased sealing is prevented by inhibiting MARCKS or PKA. Sealing probability is further decreased by simultaneously inhibiting nPKCη, nPKCθ and PKA. Extracellular Ca2+, DAG or cAMP analogs do not affect this decrease in sealing. I also report that applying inhibitors of nPKC and PKA to rat sciatic axons crush-severed in vivo under physiological calcium, do not promote immediate repair by polyethylene glycol (PEG), as assessed by compound action potential conduction and dye diffusion through crush sites. These and other data suggest that DAG increases sealing through MARCKS and that nPKCη, nPKCθ and PKA are all required to seal plasmalemmal damage in B104 neurons, and likely all eukaryotic cells.Item Fantastic worlds : Black feminist aesthetics in young adult fiction(2020-05-12) Taylor, Charlotte Terese; Perez, Domino Renee, 1967-; Pinto, SamanthaThis project examines how the young adult (YA) fantasy genre is used by Black female authors as both a response to the current sociopolitical climate and as a way to (re)imagine power and survival for Black girls. It looks toward three YA fantasy novels– L.L. McKinney’s A Blade So Black, Justina Ireland’s Dread Nation, and Tomi Adeyemi’s Children of Blood and Bone–all written by Black women and published in 2018 in order to examine how the protagonists of each mobilize resources as a way to gain power and survive. Each of the young Black female protagonists utilize resources that center undervalued sources of knowledge such as emotion, magic, myth, and the body. I refer to these sources as “Black feminist aesthetics.” This project examines how Black feminist aesthetics are integral to the protagonists attainment of power and their survival. It also examines how Black feminist aesthetics allow the protagonists to embrace alternative identities, roles, and relations than those typically offered young Black girls. A purpose of this project is to highlight that the stakes for Black girls seeing themselves in the literature they read are much higher than just representation. For young Black girls living in a world in which their bodies are vulnerable, and their lives are devalued, how Black girls show up in literature becomes important for how Black girls are treated in the world. Moreover, the existence of Black female characters who make and take power in imaginative ways while living within worlds that are violent toward them, offers readers the freedom to also imagine alternative, creative, and subversive ways to live within their own worlds. Afrofuturism and Black feminism provide the framework for such imaginings. The confluence of the two, Afrofuturist feminism, demonstrates how essential it is to center Black feminist thought in the imagining of transgressive, prosperous, and equitable Black futures.Item Impact of surveillance and early-stage versus late-stage hepatocellular carcinoma (HCC) detection on patient overall survival(2018-08) Bui, Cat Nguyen; Rascati, Karen L.; Gordon, Stuart; Lawson, Kenneth A; Wilson, JamesThis study investigated the impact of surveillance and early-stage versus late-stage hepatocellular carcinoma (HCC) detection on patients’ overall survival using a national US health plan database (1/1/2007 through 12/31/2012). Eligible Medicare patients were included in this two-phase study. Phase A assessed cirrhotic patients with surveillance versus no-surveillance from the cirrhosis diagnosis index date. Phase B assessed HCC patients with early-stage versus late-stage HCC detection from the HCC diagnosis index date. Phase A included 6,131 cirrhotic patients (surveillance N=3,376, no-surveillance N=2,755); 73% (N=4,443) decompensated and 27% (N=1,688) compensated patients; 145 (2.4%) with HCC; and 814 (13.3%) deaths. Among all cirrhotic patients, the surveillance cohort had a 28% higher risk of death compared to the no-surveillance cohort (adjusted hazard ratio [HR]=1.28; 95% CI=1.10-1.49; P<0.001); a non-statistically significant reduced risk among the subgroup of compensated-only patients (adjusted HR=0.68; 95% CI=0.46-1.02; P=0.06); a non-significant increased risk among cirrhotic patients with HCC (adjusted HR=1.18; 95% CI=0.70-1.98; P=0.54). The surveillance cohort had no significant difference in the odds of early-stage HCC detection compared to the no-surveillance cohort (adjusted odds ratio [OR]=1.77; 95% CI=0.80-3.91; P=0.16). Decompensated cirrhotic patients had higher odds of early-stage HCC detection compared to compensated patients (adjusted OR=5.12; 95% CI=1.12-23.35; P=0.03). Phase B (HCC) patients included 580 early-stage and 1,173 late-stage diagnoses; half (N=886) had cirrhosis pre-HCC index diagnosis (compensated: 13.0%, N=115; decompensated: 87.0%, N=771); 10% (N=181) received one regular surveillance a year pre-HCC index; 36 % (N=636) received HCC treatment (82.1%; N=522/636 received systemic chemotherapy); and 587 (33.5%) patients died. Patients with late-stage HCC diagnoses had a 60% higher risk of death compared to early-stage HCC diagnoses (adjusted HR=1.60; 95% CI=1.23-2.09; P=0.001). Patients with one regular surveillance a year pre-HCC diagnosis had a 29% lower risk of death compared to patients without regular surveillance (adjusted HR=0.71; 95% CI=0.51-0.97; P=0.03). This study found that surveillance had no survival benefit among all cirrhotic patients; however, surveillance reduced the risk of death among compensated cirrhotic patients, although non-significant. HCC patients with at least one regular surveillance a year pre-HCC diagnosis had a lower risk of death. Surveillance should be provided to patients before HCC diagnosis.Item Improved survival with initial MRSA therapy in high-risk community-onset pneumonia patients : application of a MRSA risk score(2014-08) Teshome, Besu Fekad; Frei, Christopher R.Community-onset (CO) methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is an evolving problem, and there is a great need for a reliable method to assess MRSA risk at hospital admission. A new MRSA prediction score classifies CO-pneumonia patients into low, medium, and high-risk groups based on objective criteria available at baseline. Our objective was to assess the effect of initial MRSA therapy on mortality in these three risk groups. We conducted a retrospective cohort study using data from the Veterans Health Administration. Patients were included if they were hospitalized with pneumonia and received antibiotics within the first 48 hours of admission. They were stratified into MRSA therapy and no MRSA therapy treatment arms based on antibiotics received in the first 48 hours. MRSA risk groups were analyzed separately. The primary outcome was 30-day patient mortality. Multivariable logistic regression was used to adjust for potential confounders. A total of 80,330 patients met inclusion criteria, of which 36% received MRSA therapy and 64% did not receive MRSA therapy. The majority of patients were classified as either low (51%) or medium (47%) risk, with only 2% classified as high-risk. In the high-risk group, unadjusted 30-day mortality was lower among patients who received initial MRSA therapy (40% versus 58%; p<0.0001). Likewise, multivariable logistic regression analysis also demonstrated that initial MRSA therapy was associated with a lower 30-day mortality in the high-risk group (adjusted odds ratio 0.57; 95% confidence interval 0.42-0.77). There was no benefit of initial MRSA therapy in the low or medium-risk groups. This study demonstrated improved survival with initial MRSA therapy in high-risk CO-pneumonia patients. The MRSA risk score should not replace clinical judgment, but it might be a useful tool to spare MRSA therapy for only those patients who are most likely to benefit.Item Management practices for sustainability of small, technology oriented businesses(2012-12) Quezada, Arturo; McCann, Robert Bruce, 1948-; Nichols, Steven Parks, 1950-The focal point for this research is a drilling automation small business. Questions regarding survival, growth, innovation, flexibility and professional management related to this technology business are seeded as the root for the research. Topics were selected based on the experience of the author as an attempt to provide answers to such questions. In a broader context, small businesses make an important contribution to the economy and job creation. Low survival rates raise questions about the factors that influence the success or failure of such businesses. Researches have attempted to identify such factors. However, there are limited theoretical models that were generated based on a small business setting. Many factors and their interactions among each other could determine the survival of a small business. However, there are techniques and philosophies that enhance the potential for success. Some of those techniques and philosophies proposed by authors researched are the Lean Startup methodology, analysis of roadblocks and speed bumps on the Product Development Process model, participative management, competencies alignment and outsourcing. Correlations between the small drilling automation business and research are made in order to generate the answers to the questions proposed initially. Ultimately, in regard to the company I work for, generation of intellectual property via outsourcing, deep knowledge of the potential market, financial flexibility obtained from capital and other resources by means of the relationships established helped the company to survive startup and grow. Founding expertise translated into good behavioral focus supported a sustained growth stage and competitiveness. There are applicable models and methodologies that serve to guide to faster innovation where associated risks are managed by having the multiple solutions available. The level of informality tolerated within the firm should be related to the level of performance, so for us there may be benefit to a more formal evaluation of the strategy, uncovering relationships and details not anticipated, that could lead to different decisions. Overcoming capital restraints to earn financial flexibility was particularly beneficial to our initial success. At current size and complexity level, it would be beneficial for our company to evaluate more formal tactical management.Item More than survival : literary representations of Indigenous women in 21st century México(2023-07-27) Sánchez Flores, Jessica L.; McDonough, Kelly S., 1970-; Cárcamo-Huechante, Luis E; Domínguez-Ruvalcaba, Héctor; Gutiérrez, Laura G.In this dissertation, I engage in an interdisciplinary and critical conversation on contemporary Indigenous cultural production, with particular emphasis on gendered violence, self-representation, and survivance. Gerald Vizenor (2008) coined the term survivance, and it centers Indigenous stories beyond victimhood (1). In my dissertation, I show how Indigenous people of México use literature to navigate and critique landscapes of violence and dispossession while simultaneously proposing a vision of survivance rather than perpetual victimhood. Various scholars have studied Indigenous women’s self-representation and their creative work in Latin America (Arias, 2013; McDonough 2014; Coon 2015; del Valle Escalante, 2015; Chacón, 2018). In my dissertation, I move these discussions forward by focusing on the various ways Indigenous women challenge expectations (Deloria 2004) both in their own communities and beyond. I analyze the works created by Indigenous individuals affiliated with the three most spoken Indigenous languages in México–Nahuatl, Zapotec, and Maya. In the first chapter, I focus on well-known Nahua playwright Ildefonso Maya Hernández's play Pitah Chacatzintla (1964; 1971) which presents us with a window into the life of a Nahua woman in the 1960s. In the second chapter I analyze Maya Yucatec author Sol Ceh Moo’s bilingual (Spanish and Maya Yucatec) novel Chen tumeen chu’úpen…/Sólo por ser mujer (2015) and the ways Honorina’s character challenges multiple violence(s). In the third chapter, I discuss Indigenous women and pleasure with Zapotec poet Irma Pineda’s erotic poetry book Naxiña’ Rului’ladxe’ / Rojo Deseo (2018). Moreover, I underline how the protagonists negotiate dominant-culture expectations and promote their own narratives and representations of indigeneity in México from the 1960s to the present day. As a move toward an anti-colonial methodology, cosas de mujeres (women’s things) helps me build a theoretical framework based on lived female experiences. I participated in actions such as sewing and cooking as generative, knowledge-producing activities that often occur in the kitchen to co-create knowledge(s) with them (Brooks 2006). In sum, this project sheds new light on contemporary Nahua, Zapotec, and Maya protagonists as weavers of their own stories, who are a part of, and significant contributors to Mexican society and the world at large.Item Neoadjuvant versus adjuvant chemotherapy for older adults with stage I–III breast cancer(2022-07-01) Zhang, Hanxi, M.S. in Pharmaceutical Sciences; Barner, Jamie C.; Moczygemba, Leticia R.; Rascati, Karen L; Kodali, Dhatri; Park, ChanhyunNeoadjuvant chemotherapy (NAC) has been increasingly used in breast cancer. Little is known about its use among older women and about the comparisons between NAC and adjuvant chemotherapy (AdC) within each breast cancer subtype. This study of older women with breast cancer aimed to: 1) assess the trends of and factors related to NAC receipt; 2) compare survival between NAC and AdC; and 3) compare health care utilization and costs between NAC and AdC. This study used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database and included older women (≥66 years) diagnosed with stage I–III breast cancer during 2010–2017 who received chemotherapy and surgery. Analyses were performed within each of six strata, defined based on the cancer subtype (hormone receptor [HR]-positive/human epidermal growth factor receptor 2 [HER2]-negative, HER2+, and triple-negative breast cancer [TNBC]) and stage (I–II and III). Trends of NAC receipt were tested with Cochran-Armitage tests. Overall and treated recurrence-free survival were compared between propensity score-matched NAC- and AdC-treated patients with Cox models. All-cause 1-year health care utilization and costs were compared between the matched patients with generalized linear models (GLMs). Among 8,495 patients included, 20.8% received NAC. NAC receipt increased significantly during 2010–2017, both overall and within each stratum (all p-values<.0001). Younger age groups, lower poverty, metropolitan residence, National Cancer Institute-designated cancer centers, later diagnosis years, lower comorbidity scores, and higher cancer stages were associated with NAC receipt in ≥1 stratum. No difference was found between NAC and AdC in survival after adjusting for multiple testing. Greater utilization was associated with NAC for institutional outpatient visits and physician office visits in most strata (adjusted p-values<.05), but a lower inpatient visit rate was associated with NAC in stage III TNBC (adjusted p<.05). Greater costs were associated with NAC for inpatient, institutional outpatient, physician service, and total costs in ≥1 stratum (adjusted p-values<.05). In conclusion, NAC use increased among older women in all subtypes and stages. Our observation of a trend toward an overall survival advantage of NAC in advanced HER2+ disease and toward an overall survival disadvantage of NAC in advanced TNBC warrants further research.Item Racial and ethnic inequality in adult survival in the United States(2013-08) Lariscy, Joseph Tyler, 1984-; Hummer, Robert A.While all racial/ethnic groups in the U.S. exhibited an increase in longevity during the twentieth century, inequalities in survival remain. Hispanics have the highest life expectancy at birth in the United States, non-Hispanic blacks have the lowest, and non-Hispanic whites exhibit life expectancy between the two minority groups. An overarching objective of Healthy People 2020 is to "achieve health equity, eliminate disparities, and improve the health of all groups." Yet, a similar objective based on the Healthy People 2010 campaign regarding reduction of health inequalities was clearly not met. As the population of the United States becomes increasingly diverse as a result of immigration, intermarriage, and evolving notions regarding race and ethnicity, health demographers must monitor adult survival outcomes and inequalities across racial and ethnic subpopulations. This dissertation examines current inequalities in survival among Hispanic, non-Hispanic black, and non-Hispanic white adults in the United States. Using the 1989-2006 National Health Interview Survey Linked Mortality Files and 2010 U.S. National Vital Statistics System, I contribute to the understanding of racial/ethnic survival disparities through three empirical studies: The first chapter affirms that Hispanic mortality rate and life expectancy estimates are favorable relative to blacks and whites, particularly for foreign-born Hispanics and from smoking-related causes. The second chapter shows that, in addition to their higher mean age at death, Hispanics exhibit less variability around that mean relative to non-Hispanic whites. Non-Hispanic blacks, on the other hand, have greater variability and lower life expectancy than the other two racial/ethnic groups. The lower variability among Hispanics relative to whites is largely attributable to lower incidence in cancer, suicide, and other external cause mortality, whereas the greater variability among blacks relative to whites is mainly due to greater dispersion in age at death from heart disease and the residual cause grouping. The third chapter finds that smoking initiation in childhood or adolescence contributes additional mortality risk for current heavy and light smokers relative to never smokers. Lower smoking prevalence and later initiation among foreign-born and U.S-born Hispanics account for much of their lower mortality risk relative to whites.Item Surviving total war in Kherson Region, Ukraine in 1941 - 1945(2013-05) Alexander, Vladyslav Christian; Wynn, Charters, 1953-; Bychkova Jordan, BellaWhile there are plenty of published materials concerning survival in Ukraine during World War II, most of those bypass the Kherson region and focus primarily on the German occupation. This thesis is an attempt to study the complex history of people's survival in Ukraine during a large portion of the twentieth century, through a micro-history of the city of Kherson and the neighboring villages, and towns of the region. The study analyzes the actions and the consequences for the various social, political and ethnic groups of changes in the ruling regimes, emphasizing the period of the return of the Red Army to the region in 1943-1944. This work attempts to provide an answer to the question of why the population of a provincial city, which endured no major combat, was reduced from about 100,000 residents in 1941 to less than a hundred on the day of return of the Soviets in 1944?Item The relationships between age, gender, and race and rate of immune recovery and life expectancy among patients living with HIV(2016-08) Nduaguba, Sabina Onyinye; Wilson, James P.; Ford, Kentya C.; Lawson, Kenneth ADespite medical advancement transforming HIV disease from a death sentence to a chronic illness, not all patients living with HIV (PLWH) experience the best health outcomes. The purpose of this study was to identify disparities (age, gender, and ethnicity) in health outcomes among patients living with HIV who reside in Texas. HIV surveillance data from the Texas Department of State Health Services was used to identify patients diagnosed with HIV between 1996 and 2013. This cohort was divided into 4 subcohorts according to year of HIV diagnosis; 1996-1997, 1998-2006, 2007-2010, and 2011-2013. The primary outcomes were rate of immune recovery, AIDS diagnosis, and death. Hierarchical linear models and survival analyses were used to assess the relationships between age, gender, and ethnicity and rate of immune recovery and AIDS diagnosis and death. A total of 70,996 patients were included in the study; 7,206, 36,286, 15,628, and 11,876 in the 1996-1997, 1998-2006, 2007-2010, and 2011-2013 subcohorts respectively. The results showed that age, gender, and ethnicity were not statistically associated with rate of immune recovery (p>0.01) but tended towards lower rate of immune recovery with increasing age and in males and Hispanics. Age was associated with clinical progression to AIDS and death (p<0.01) in all 4 subcohorts. Male gender was associated with clinical progression to AIDS in all subcohorts except the 2011-2013 subcohort but there was no relationship between gender and death in the 4 subcohorts. Compared to Hispanics, the risk of an AIDS diagnosis was lower in Blacks across all 4 subcohorts. After controlling for covariates, the relationship was lost in the 1996-1997 and 2011-2013 subcohorts. There was no clear difference in the risk of an AIDS diagnosis between Blacks and Whites. Compared to Whites and Hispanics, Blacks had higher risk of death in the 1996-1997 and 1998-2006 subcohorts. However, there was no relationship between ethnicity and death in the 2007-2010 and 2011-2013 subcohorts after controlling for covariates. In conclusion, the results of the survival analyses suggests some clinical relevance of differential rates of immune recovery, which presents an opportunity for early intervention before long-term outcomes like AIDS diagnosis and death occur.