In the analysis of competing risks data, some of covariates may not be fully observed for some subjects. In such cases, excluding subjects with missing covariate values from the analysis may result in biased estimates and loss of efficiency. In this paper, we studied multiple imputation and the augmented inverse probability weighting method for regression parameter estimation in the cause-specific proportional hazards model with missing covariates. The performance of estimators obtained from multiple imputation and the augmented inverse probability weighting method is evaluated by simulation studies, which show that those methods perform well. Multiple imputation and the augmented inverse probability weighting method were applied to investigate significant risk factors for the risk of death from breast cancer and from other causes for breast cancer data with missing values for tumor size obtained from the Prostate, Lung, Colorectal, and Ovarian Cancer Screen Trial Study. Under the cause-specific proportional hazards model, the methods show that race, marital status, stage, grade, and tumor size are significant risk factors for breast cancer mortality, and stage has the greatest effect on increasing the risk of breast cancer death. Age at diagnosis and tumor size have significant effects on increasing the risk of other-cause death.
Background: While the use of bioprosthetic valves for mitral valve replacement (MVR) is increasing, very few studies have compared bovine pericardial and porcine valves in the mitral position to help guide bioprosthetic selection. Methods: In the present study, patients who underwent MVR using bovine pericardial valves were compared with those who underwent MVR with porcine bioprostheses between January 1996 and July 2018. Those with prior MVR, infective endocarditis, congenital mitral valve disease, or ischemic mitral regurgitation were excluded. The primary outcomes were structural valve deterioration (SVD) and mitral valve reoperation from any cause, and death was regarded as a competing risk. Competing risk analysis and propensity score-matching were used for comparisons. Results: Among the 388 patients enrolled, pericardial and porcine bioprostheses were implanted in 217 (55.9%) and 171 (44.1%), respectively. Propensity score-matching yielded 122 pairs of patients that were well-balanced for all baseline covariates. No significant differences were observed between the groups in unadjusted (p=0.09) and adjusted overall survival (hazard ratio [HR], 1.13; 95% confidence interval [CI], 0.72-1.76; p=0.60). Competing risk analysis revealed no significant differences in the risks of mitral reoperation (HR, 1.07; 95% CI, 0.50-2.27; p=0.86) and development of SVD (HR, 1.57; 95% CI, 0.56-4.36; p=0.39) between the groups. Matched population analysis confirmed similar results regarding reoperation (HR, 0.99; 95% CI, 0.40-3.22; p=0.98) and SVD (HR, 1.39; 95% CI, 0.41-4.73; p=0.60). Conclusion: No significant differences in survival or valve durability were observed between bovine pericardial and porcine bioprosthetic MVR. These findings require further validation through studies with larger sample sizes.
Youngkwan Song;Ki Tae Kim;Soo Jin Park;Hong Rae Kim;Jae Suk Yoo;Pil Je Kang;Sung-Ho Jung;Cheol Hyun Chung;Joon Bum Kim;Ho Jin Kim
Journal of Chest Surgery
/
v.57
no.3
/
pp.242-251
/
2024
Background: This study compared the outcomes of surgical aortic valve replacement (AVR) in patients aged 50 to 70 years based on the type of prosthetic valve used. Methods: We compared patients who underwent mechanical AVR to those who underwent bioprosthetic AVR at our institution between January 2000 and March 2019. Competing risk analysis and the inverse probability of treatment weighting (IPTW) method based on propensity score were employed for comparisons. Results: A total of 1,580 patients (984 patients with mechanical AVR; 596 patients with bioprosthetic AVR) were enrolled. There was no significant difference in early mortality between the mechanical AVR and bioprosthetic AVR groups (0.9% vs. 1.7%, p=0.177). After IPTW adjustment, the risk of all-cause mortality was significantly higher in the bioprosthetic AVR group than in the mechanical AVR group (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.07-1.80; p=0.014). Competing risk analysis revealed lower risks of stroke (sub-distributional hazard ratio [sHR], 0.44; 95% CI, 0.28-0.67; p<0.001) and anticoagulation-related bleeding (sHR, 0.35; 95% CI, 0.23-0.53; p<0.001) in the bioprosthetic AVR group. Conversely, the risk of aortic valve (AV) reintervention was higher in the bioprosthetic AVR group (sHR, 6.14; 95% CI, 3.17-11.93; p<0.001). Conclusion: Among patients aged 50 to 70 years who underwent surgical AVR, those receiving mechanical valves showed better survival than those with bioprosthetic valves. The mechanical AVR group exhibited a higher risk of stroke and anticoagulation-related bleeding, while the bioprosthetic AVR group showed a higher risk of AV reintervention.
As the nature of triathlons is competition in three successive sports, triathletes experience elevated levels of stress on the body that are absent in single-sport athletic events, and consequently there are more potential medical problems to prepare for. Triathletes can also experience problems such as hypothermia, heat illness, excessive exposure to ultraviolet radiation, musculoskeletal injuries and trauma, immunosuppression, and haemolysis. Depending on the potentiality of such above-listed problems occurring in any given race, race organizers will prepare preventative measures and treatments accordingly. Olympic distance is not the only triathlon racing distance. Sprints, which are normally around half the Olympic distance, are common distances, as well as Long (2 km swim, 80 km bike, 20 km run), Ironman (3.8 km swim, 180 km bike, 42 km run), and ultra-distance events varying in length. Races of longer duration normally result in a higher percentage of athletes experiencing the above-mentioned medical problems, as well as inducing additional health risks such as hyponatraemia. Minimizing the occurrences of serious health issues is possible through the following means: carefully preparing for the probable race-day weather conditions; proper management and organization of the race; preparing an extensive water-safety and ground-course safety plan; distributing necessary nutrition along the course; and stressing the importance for athletes to have proper knowledge concerning race nutrition, biomechanical technique, physical preparation, and utilization of safe equipment. While risks of competing in triathlon are many, the instances of such medical problems are not excessive, and the triathlon has a reputation of being a reasonably safe sport as long as athletes with high risk take added precautions.
After the Cold War, obligations of nation are expanded to 'Comprehensive Security' that caring citizens' safety and welfare in addition to national defense. Major nations are competing to revolutionize their army to be prepared for various threats. Major nations, including United States and United Kingdom, are tend to adopting and using PMCs eagerly. The size of PMC market estimated around 70 billion euro and growing rapidly. Korea has to adopt PMCs for building military force and operating efficiency while driving 'Military Reform 2030'. Adopting PMCs in Korea can be considered as followings reflecting security situation. So, Korean army must consider implementing and adopting PMCs in order to building army force and attaining efficiency and preparing for the N orth Korean threat and various security risks.
Communications for Statistical Applications and Methods
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v.25
no.3
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pp.245-261
/
2018
Attempts have been made to define new classes of distributions that provide more flexibility for modelling skewed data in practice. In this work we define a new extension of the generalized gamma distribution (Stacy, The Annals of Mathematical Statistics, 33, 1187-1192, 1962) for Marshall-Olkin generalized gamma (MOGG) distribution, based on the generator pioneered by Marshall and Olkin (Biometrika, 84, 641-652, 1997). This new lifetime model is very flexible including twenty one special models. The main advantage of the new family relies on the fact that practitioners will have a quite flexible distribution to fit real data from several fields, such as engineering, hydrology and survival analysis. Further, we also define a MOGG mixture model, a modification of the MOGG distribution for analyzing lifetime data in presence of cure fraction. This proposed model can be seen as a model of competing causes, where the parameter associated with the Marshall-Olkin distribution controls the activation mechanism of the latent risks (Cooner et al., Statistical Methods in Medical Research, 15, 307-324, 2006). The asymptotic properties of the maximum likelihood estimation approach of the parameters of the model are evaluated by means of simulation studies. The proposed distribution is fitted to two real data sets, one arising from measuring the strength of fibers and the other on melanoma data.
Objective: The aim of our study was to determine the associations of heifer reproductive performance with survival up to the first calving, first-lactation milk yield, and the probability of being culled within 50 days after first calving. Methods: Data from 33 large Holstein-Friesian commercial dairy herds were gathered from the official milk recording database in Hungary. The data of heifers first inseminated between January 1, 2011 and December 31, 2014 were analyzed retrospectively, using Cox proportional hazards models, competing risks models, multivariate linear and logistic mixed-effects models. Results: Heifers (n = 35,128) with younger age at conception were more likely to remain in the herd until calving, and each additional month in age at conception increased culling risk by 5.1%. Season of birth was related to first-lactation milk yield (MY1; n = 19,931), with cows born in autumn having the highest milk production (p<0.001). The highest MY1 was achieved by heifers that first calved between 22.00 and 25.99 months of age. Heifers that calved in autumn had the highest MY1, whereas calving in summer was related to the lowest milk production (p<0.001). The risk of culling within 50 days in milk in first lactation (n = 21,225) increased along with first calving age, e.g. heifers that first calved after 30 months of age were 5.52-times more likely to be culled compared to heifers that calved before 22 months of age (p<0.001). Calving difficulty was related to higher culling risk in early lactation (p<0.001). Heifers that required caesarean section were 24.01-times more likely to leave the herd within 50 days after first calving compared to heifers that needed no assistance (p<0.001). Conclusion: Reproductive performance of replacement heifers is closely linked to longevity and milk production in dairy herds.
Proceedings of the Korean Institute Of Construction Engineering and Management
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2007.11a
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pp.652-655
/
2007
Due to stagnation of domestic market, increasing number of domestic construction companies started to make inroads into foreign market recently. Yet compared to domestic market, there are much more risks in the foreign market which companies may confront. So deliberate and rational decision making skills are required. Accordingly, there has been many researches which analyzed the risk of individual markets and also studies covering decision support models. In this study, we suggest a model concerning financial issues when branching out into a new market, specially in the construction companies' point of view. For this we used a real options game which shows real competition status of a new market and deduced a feature of that market, Upon these results, we also suggest a model which helps firms to decide whether investing in the expansion is smart action or not. The model developed in this study is made in specific circumstances of limited conditions. The future study makes more realistic models considering subjects like disproportion in information and generalization of competing companies.
This study is the research of enterprise security for raising the profitability and stability of Korean companies in global business environment and strategic cooperation of business. As the scientific technology gets complicated as day goes by and new competitors appear regardless the border in the modern business environment, the situation happens frequently which the huge company hands over their market to the new one armed with the innovative thinking overnight. To survive such new environment, the answer is the change of paradigm regarding business management method at the new point of view. With the low level of security risk management of Korean companies which stick to old habit, the security management which helps the companies secure profits is not affordable. The global village where the population of 7 billions live in 21st century is facing up to the rapid ecological adaptation. The rapid change of climatic environment creates the hundreds of thousands of sufferers in a moment, and we have been watching the millions of livestock are buried alive due to new contagious disease everyday. Such change encourages the humans in global village to change the basic way of living. The business ecosystem which is the basic root for economic life cannot be an exception. To survive the business environment of 21st century, the security risk management at management level is required and the reporting line of companies should be established newly for raising business competing power through security risk management. The companies should bear in mind that they can be disappeared into our old memories overnight if they are not sensitive to the changing environment. Out of new risks for the modern companies, the field especially Korean companies are dealing easily is the security risk. Not like past, the security risk which's size is much more massive and its propagation velocity is very fast is the one of important business risks which the management should take care. Out of security risks which influence on the modern companies significantly, the brand of companies, protection of their reputation, continuity of production and operation and keeping customer's trust are prior to the others. This study offered the suggestion regarding enterprise security and the strategic cooperation of business to deal with such security risk effectively.
Human history shows diverse strategies for survival and prosperity. This study introduces the concept of the expansion of wealth as a key to explain choice and behavior of political entities. American scholar, -Bruce Bueno de Mesquita-, offers theoretical grounds for this concept in that the cores of selectorate theory is settled. The political entity consists of two groups, -the winning coalition that has power to replace leader and non-winning coalition that has not. Leaders implement policies serving for the welfare of winning coalition in return for their loyalty. Both internal problems caused by demographic changes and external ones of climate changes, epidemic disease, or invasion compel leader and winning coalition to adopt policies of expansion that they believe may lead to the acquisition of wealth needed to counter those problems. The process starts by occupying one spot where other entities reside and then connecting it to its own. The line between spots functions as a foothold to form a new line to other spots. By repeating this process, a space is created in which new laws and orders are instated. In the early stage of expansion, war is hardly avoidable. Once finished successfully, the political circumstance tilts to encourage economic activities in order to generate national revenues to strengthen political power of winning coalition. However, as scale of economic activities grows, so does political power of civic classes in production and trade. To gain financial support required to run the political entity, delegation of power or bestowing autonomy to non-winning coalition is inevitable. Thus, expansion is not the ultimate solution, only to prolong the political survival if succeed. Maritime power came to attractive option when overland expansion had become obstructed. It offered much greater advantages in terms of political risks and financial burdens in exploring new regions of precious commodities than overland expansion. Each political entity around world have been, for the first time in human history, connected by maritime means since 15th century. It is worthy of noting that land conditions propelled people out to sea. Political and economic situations created opportunities to exploit geographical position in pursuit of wealth. In the 21st century, we witness the operation of international winning coalition that presides over the rules of expansion. Competing for market is synonymous to the expansion in this era, the cause and aim of it has not been changed though. Energy and dollars are key factors of expansion since the end of the 2nd world war. No matter what the forms and conditions change, naval power is still the most relevant means for expansion as it retains unique characters of maneuver, flexibility, continuity, display and projection of power. The strategy for using naval power should be in line with two different approaches for expansion: Approaches to the international winning coalition by making contribution to world order, and approaches to the non-international winning coalition by enhancing military diplomatic activities. The former will serve our share of winning coalition while the latter will open chances to acquire further prosperity.
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