393 research outputs found
Evaluating Case-Based Reasoning Systems
No full textEvaluation is an important issue for every scientific field and a necessity for an emerging soft-ware technology like case- based reasoning. This paper is a supplementation to the review of industrial case-based reasoning tools by K.-D. Althoff, E. Auriol, R. Barletta and M. Manago which describes the most detailed evaluation of commercial case-based reasoning tools currently available. The author focuses on some important aspects that correspond to the evaluation ofcase-based reasoning systems and gives links to ongoing research
Trends in Noninsulin Antidiabetic Medications in Patients with HIV and Type 2 Diabetes in North America, 2013 to 2021
No full textBackground: People living with HIV (PWH) have increased risks for type 2 diabetes (T2DM) and cardiovascular events (CVE). The use of novel noninsulin antidiabetic medications with cardiovascular benefits has been increasing over the past decade in general population. We described the utilization of noninsulin antidiabetic medications among PWH with T2DM using data extracted from electronic health records (EHR) from 2013 to 2021. To compare the methods measuring the utilization of medications, we reported the trends in prescriptions and applied assumptions to classify an individual’s regimen use.
Methods: Data of 19,565 eligible patients between April 1st, 2013 and December 31st, 2021 were derived from clinical cohorts in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). Noninsulin antidiabetic medication use was measured based on annual number of prescriptions. Noninsulin antidiabetic regimen use was measured applying assumptions of the length of use from a single prescription. We used descriptive statistics to estimate the medication- or regimen-specific numbers and proportions for each calendar year, and Poisson regression with robust variance with generalized estimating equations to analyze the annual trends within the study period.
Results: The prescriptions of biguanide and sulfonylurea decreased from 2013 (58% and 30% of total prescriptions) to 2021 (45% and 13% of total prescriptions; p-trend < 0.001 and p-trend < 0.01, respectively). The prescriptions of glucagon-like peptide 1 agonists (GLP-1 RA) and sodium-glucose transport protein 2 inhibitors (SGLT2i) increased from 2013 (1% and 0% of total prescriptions) to 2021 (19% and 12%; p-trend = 0.84 and p-trend = 0.93, respectively). Similar trends of regimen were seen with the application of different approaches for regimen classification. The difference in annual proportions of use between prescriptions and regimens was small (< 5 percentage point) except for sulfonylurea prescription and sulfonylurea monotherapy.
Conclusions: There was a rapid increase in the use of GLP-1 RA and SGLT2i among PHW with T2DM since the first approval of SGLT2i (2013) using prescription data from the EHR. Continued monitoring of the use of these medications and the impacts on CVE is needed
RISK FACTORS FOR MORTALITY FOLLOWING AN ANAL CANCER DIAGNOSIS AMONG PEOPLE WITH HIV FROM 2010-2020 IN NORTH AMERICA
No full textAbstract
Background
Although with advanced treatment for anal cancer, people with HIV (PWH) still have a higher risk for cancer. While investigating the risk factors associated with anal cancer mortality among PWH was limited. This study illustrated demographic and clinical factors of all-cause mortality after anal cancer diagnosis in North America.
Methods
The study population was selected based on the cohort of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), which included 580 PWH diagnosed with anal cancer from 2010 to 2020. Using Poisson regression models and sensitivity analysis, we assessed the association between anal cancer mortality and both demographic and clinical factors together.
Findings
Among the study population, 29% died, followed by an anal cancer diagnosis. Regional/distant stage of cancer stage was strongly associated with increased risk of mortality in both unadjusted (RR=5.48, 95% CI: 2.28-17.98) and adjusted models (RR=3.77, 95% CI: 1.44-9.88). At the same time, every 10-year increase in age was only significant in the adjusted model (RR=1.42, 95%CI: 1.05-1.92). HIV viral suppression was also associated with increased mortality risk in the adjusted model (RR=1.42, 95% CI: 1.05-1.92). Nadir CD4 counts, Sex, race and ethnicity were not significantly associated with the outcome
RISK FACTORS FOR MORTALITY FOLLOWING AN ANAL CANCER DIAGNOSIS AMONG PEOPLE WITH HIV FROM 2010-2020 IN NORTH AMERICA
No full textAbstract
Background
Although with advanced treatment for anal cancer, people with HIV (PWH) still have a higher risk for cancer. While investigating the risk factors associated with anal cancer mortality among PWH was limited. This study illustrated demographic and clinical factors of all-cause mortality after anal cancer diagnosis in North America.
Methods
The study population was selected based on the cohort of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), which included 580 PWH diagnosed with anal cancer from 2010 to 2020. Using Poisson regression models and sensitivity analysis, we assessed the association between anal cancer mortality and both demographic and clinical factors together.
Findings
Among the study population, 29% died, followed by an anal cancer diagnosis. Regional/distant stage of cancer stage was strongly associated with increased risk of mortality in both unadjusted (RR=5.48, 95% CI: 2.28-17.98) and adjusted models (RR=3.77, 95% CI: 1.44-9.88). At the same time, every 10-year increase in age was only significant in the adjusted model (RR=1.42, 95%CI: 1.05-1.92). HIV viral suppression was also associated with increased mortality risk in the adjusted model (RR=1.42, 95% CI: 1.05-1.92). Nadir CD4 counts, Sex, race and ethnicity were not significantly associated with the outcome
DIFFERENCES IN HEMOGLOBIN A1C 12 MONTHS AFTER DIRECT ACTING ANTIVIRALS TO TREAT HEPATITIS C VIRUS INFECTION IN ADULTS WITH HIV
No full textBackground: Previous studies suggested improved glycemic outcomes in hepatitis C virus
(HCV)-infected adults after direct-acting antivirals (DAAs) treatment. However, the impact of DAAs on glycated hemoglobin (HbA1c) levels in people with HIV/HCV coinfection is relatively unknown. This study aimed to determine the 12-month difference in HbA1c level between HIV/HCV coinfected adults on antiretroviral therapy (ART) who received a DAA prescription and those who did not receive a prescription in a large North American cohort of people living with
HIV.
Methods: The study was nested in the NA-ACCORD, a collaboration of observational HIV clinical cohort studies. Adults (>18 years old) with HIV/HCV coinfection who were on ART and prescribed DAAs between January 1, 2014, and December 31, 2022 ("case") were individually matched by year of observation, 10-year age group, sex, and race and ethnicity with one HIV/HCV coinfected participant who was under observation and not prescribed DAAs within one year of the DAA prescription date for the case (baseline). Multivariable linear regression models were used to evaluate the difference in HbA1c levels 12 months post-DAA prescription after
adjusting for baseline demographic and clinical characteristics, including baseline HbA1c.
Results: The 1,149 individuals with HIV/HCV coinfection and DAA prescription were matched to
1,100 similar individuals without DAA prescription (N= 2,249). The median HbA1c values in individuals with DAA prescription and those without DAA prescription at 12 months were 5.7% (interquartile range [IQR]: 5.3%-6.3%) and 5.6% (IQR: 5.2%-6.2%), respectively. There was no difference in the average HbA1c value at 12 months by DAA prescription (adjusted mean difference = 0.01%, 95% confidence interval: -0.09%, 0.08%) after adjusting for age, baseline
CD4 counts, baseline HbA1c, race and ethnicity, HIV risk groups, history of statin use, diabetes, chronic kidney disease > stage 3, and clinical cohorts; further controlling for sex did not change the results.
Conclusions: The study did not find a significant difference in HbA1c 12 months after DAA prescription in HIV/HCV coinfected adults on ART with DAA prescription compared to similar adults without DAA prescription. Studies investigating DAA's long-term (>12 months) effects on diabetes and cardiovascular risk factors are needed and may yield different findings
DIFFERENCES IN HEMOGLOBIN A1C 12 MONTHS AFTER DIRECT ACTING ANTIVIRALS TO TREAT HEPATITIS C VIRUS INFECTION IN ADULTS WITH HIV
No full textBackground: Previous studies suggested improved glycemic outcomes in hepatitis C virus
(HCV)-infected adults after direct-acting antivirals (DAAs) treatment. However, the impact of DAAs on glycated hemoglobin (HbA1c) levels in people with HIV/HCV coinfection is relatively unknown. This study aimed to determine the 12-month difference in HbA1c level between HIV/HCV coinfected adults on antiretroviral therapy (ART) who received a DAA prescription and those who did not receive a prescription in a large North American cohort of people living with
HIV.
Methods: The study was nested in the NA-ACCORD, a collaboration of observational HIV clinical cohort studies. Adults (>18 years old) with HIV/HCV coinfection who were on ART and prescribed DAAs between January 1, 2014, and December 31, 2022 ("case") were individually matched by year of observation, 10-year age group, sex, and race and ethnicity with one HIV/HCV coinfected participant who was under observation and not prescribed DAAs within one year of the DAA prescription date for the case (baseline). Multivariable linear regression models were used to evaluate the difference in HbA1c levels 12 months post-DAA prescription after
adjusting for baseline demographic and clinical characteristics, including baseline HbA1c.
Results: The 1,149 individuals with HIV/HCV coinfection and DAA prescription were matched to
1,100 similar individuals without DAA prescription (N= 2,249). The median HbA1c values in individuals with DAA prescription and those without DAA prescription at 12 months were 5.7% (interquartile range [IQR]: 5.3%-6.3%) and 5.6% (IQR: 5.2%-6.2%), respectively. There was no difference in the average HbA1c value at 12 months by DAA prescription (adjusted mean difference = 0.01%, 95% confidence interval: -0.09%, 0.08%) after adjusting for age, baseline
CD4 counts, baseline HbA1c, race and ethnicity, HIV risk groups, history of statin use, diabetes, chronic kidney disease > stage 3, and clinical cohorts; further controlling for sex did not change the results.
Conclusions: The study did not find a significant difference in HbA1c 12 months after DAA prescription in HIV/HCV coinfected adults on ART with DAA prescription compared to similar adults without DAA prescription. Studies investigating DAA's long-term (>12 months) effects on diabetes and cardiovascular risk factors are needed and may yield different findings
Trends in Noninsulin Antidiabetic Medications in Patients with HIV and Type 2 Diabetes in North America, 2013 to 2021
No full textBackground: People living with HIV (PWH) have increased risks for type 2 diabetes (T2DM) and cardiovascular events (CVE). The use of novel noninsulin antidiabetic medications with cardiovascular benefits has been increasing over the past decade in general population. We described the utilization of noninsulin antidiabetic medications among PWH with T2DM using data extracted from electronic health records (EHR) from 2013 to 2021. To compare the methods measuring the utilization of medications, we reported the trends in prescriptions and applied assumptions to classify an individual’s regimen use.
Methods: Data of 19,565 eligible patients between April 1st, 2013 and December 31st, 2021 were derived from clinical cohorts in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). Noninsulin antidiabetic medication use was measured based on annual number of prescriptions. Noninsulin antidiabetic regimen use was measured applying assumptions of the length of use from a single prescription. We used descriptive statistics to estimate the medication- or regimen-specific numbers and proportions for each calendar year, and Poisson regression with robust variance with generalized estimating equations to analyze the annual trends within the study period.
Results: The prescriptions of biguanide and sulfonylurea decreased from 2013 (58% and 30% of total prescriptions) to 2021 (45% and 13% of total prescriptions; p-trend < 0.001 and p-trend < 0.01, respectively). The prescriptions of glucagon-like peptide 1 agonists (GLP-1 RA) and sodium-glucose transport protein 2 inhibitors (SGLT2i) increased from 2013 (1% and 0% of total prescriptions) to 2021 (19% and 12%; p-trend = 0.84 and p-trend = 0.93, respectively). Similar trends of regimen were seen with the application of different approaches for regimen classification. The difference in annual proportions of use between prescriptions and regimens was small (< 5 percentage point) except for sulfonylurea prescription and sulfonylurea monotherapy.
Conclusions: There was a rapid increase in the use of GLP-1 RA and SGLT2i among PHW with T2DM since the first approval of SGLT2i (2013) using prescription data from the EHR. Continued monitoring of the use of these medications and the impacts on CVE is needed
THE ASSOCIATION BETWEEN FOOD ACCESS AND LIFE EXPECTANCY AT THE CENSUS TRACT-LEVEL IN MARYLAND, 2010-2015
No full textBackground
Life expectancy is an aggregated metric often used to indicate the overall health of a population. Low-quality food environments affect dietary decisions and in turn, may impact risk of chronic disease. The association between food access and life expectancy is not fully understood at the census tract-level. Additionally, differences in this association by urbanicity are not clear.
Methods
Using data from the U.S. Small-area Life Expectancy Estimates Project (USALEEP), and the USDA Food Access Research Atlas, we assessed the relationship between food access and other covariates with life expectancy at birth in urban and rural census tracts in Maryland. Low food access is defined as the percent of the population residing outside a 0.5-mile distance from supermarkets in urban areas or a 10-mile distance in rural areas. Crude and adjusted linear regression models were used to estimate the change in life expectancy [95% confidence interval] stratified by urban and rural census tracts.
Results
Census tract-level life expectancy at birth ranged from 62.6 years to 96.1 years, with a mean of 78.7 years. The crude and adjusted models for urban tracts (n=1,096) estimated an increase of 5 percentage points of the population with low food access was associated with a 0.147([0.107, 0.187] crude) and -0.011 ([-0.039, 0.016] adjusted) year change in life expectancy. Among rural census tracts (n=206), the crude and adjusted models estimated a -0.134 ([-0.372, 0.105] crude) and 0.265 ([0.022, 0.508] adjusted) year change in life expectancy was associated with an increase of percentage points of the population with low food access.
Conclusions
Our findings suggest that the association between low food access and life expectancy differs in urban and rural tracts in Maryland. These findings supply important information that must be considered by policy decision makers when assessing and implementing food access interventions in Maryland
Parent-Mediated Interventions With Children With Autism Spectrum Disorder: A Systematic Review
No full textAbstract
Date Presented 3/30/2017
A systematic review was conducted to evaluate the efficacy of parent-mediated interventions for children with autism in occupational performance areas. Findings support improvement in social communication and symptom severity, with emerging support for feeding, play, independence, and behavior.
Primary Author and Speaker: Caitlin Dammann
Additional Authors and Speakers: Colleen Althoff, Sarah Hope, Karla Ausderau</jats:p
THE ASSOCIATION BETWEEN FOOD ACCESS AND LIFE EXPECTANCY AT THE CENSUS TRACT-LEVEL IN MARYLAND, 2010-2015
No full textBackground
Life expectancy is an aggregated metric often used to indicate the overall health of a population. Low-quality food environments affect dietary decisions and in turn, may impact risk of chronic disease. The association between food access and life expectancy is not fully understood at the census tract-level. Additionally, differences in this association by urbanicity are not clear.
Methods
Using data from the U.S. Small-area Life Expectancy Estimates Project (USALEEP), and the USDA Food Access Research Atlas, we assessed the relationship between food access and other covariates with life expectancy at birth in urban and rural census tracts in Maryland. Low food access is defined as the percent of the population residing outside a 0.5-mile distance from supermarkets in urban areas or a 10-mile distance in rural areas. Crude and adjusted linear regression models were used to estimate the change in life expectancy [95% confidence interval] stratified by urban and rural census tracts.
Results
Census tract-level life expectancy at birth ranged from 62.6 years to 96.1 years, with a mean of 78.7 years. The crude and adjusted models for urban tracts (n=1,096) estimated an increase of 5 percentage points of the population with low food access was associated with a 0.147([0.107, 0.187] crude) and -0.011 ([-0.039, 0.016] adjusted) year change in life expectancy. Among rural census tracts (n=206), the crude and adjusted models estimated a -0.134 ([-0.372, 0.105] crude) and 0.265 ([0.022, 0.508] adjusted) year change in life expectancy was associated with an increase of percentage points of the population with low food access.
Conclusions
Our findings suggest that the association between low food access and life expectancy differs in urban and rural tracts in Maryland. These findings supply important information that must be considered by policy decision makers when assessing and implementing food access interventions in Maryland
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