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2.
Environ Int ; 185: 108416, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38394913

RESUMO

We evaluated the sensitivity of estimated PM2.5 and NO2 health impacts to varying key input parameters and assumptions including: 1) the spatial scale at which impacts are estimated, 2) using either a single concentration-response function (CRF) or using racial/ethnic group specific CRFs from the same epidemiologic study, 3) assigning exposure to residents based on home, instead of home and work locations for the state of Colorado. We found that the spatial scale of the analysis influences the magnitude of NO2, but not PM2.5, attributable deaths. Using county-level predictions instead of 1 km2 predictions of NO2 resulted in a lower estimate of mortality attributable to NO2 by âˆ¼ 50 % for all of Colorado for each year between 2000 and 2020. Using an all-population CRF instead of racial/ethnic group specific CRFs results in a 130 % higher estimate of annual mortality attributable for the white population and a 40 % and 80 % lower estimate of mortality attributable to PM2.5 for Black and Hispanic residents, respectively. Using racial/ethnic group specific CRFs did not result in a different estimation of NO2 attributable mortality for white residents, but led to âˆ¼ 50 % lower estimates of mortality for Black residents, and 290 % lower estimate for Hispanic residents. Using NO2 based on home instead of home and workplace locations results in a smaller estimate of annual mortality attributable to NO2 for all of Colorado by 2 % each year and 0.3 % for PM2.5. Our results should be interpreted as an exercise to make methodological recommendations for future health impact assessments of pollution.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Material Particulado/efeitos adversos , Material Particulado/análise , Colorado/epidemiologia , Dióxido de Nitrogênio/análise , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise
3.
J Med Virol ; 95(11): e29214, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37927108

RESUMO

Interleukin 7 receptor (IL7R) is vital in the adaptive immune response against human immunodeficiency viruses (HIV). We assessed IL7RA polymorphisms (SNPs) in antiretroviral therapy (ART)-naïve HIV patients for their association with spontaneous HIV infection control. We conducted a retrospective cohort study involving 667 ART-naïve patients categorized by HIV progression (ordinal variable): 150 rapid progressors, 334 moderate/typical progressors, 86 long-term nonprogressors elite controllers (LTNPs-EC), and 97 LTNPs-non-EC. We genotyped three IL7RA SNPs using Agena Bioscience's MassARRAY platform. The association between IL7RA SNPs and spontaneous HIV infection control was evaluated using ordinal logistic regression. Individuals carrying the rs10491434 G allele have a higher likelihood of spontaneous HIV infection control (adjusted odds ratio [aOR] = 1.33; p = 0.023). Moreover, the IL7RA GCT haplotype, consisting of three specific SNPs (rs6897932, rs987106, and rs10491434), demonstrated an association with the control of untreated HIV infection (aOR = 1.34; p = 0.050). Remarkably, the rs10491434 SNP and the IL7RA GCT haplotype exhibited similar aOR values, suggesting that rs10491434 may be primarily responsible for the observed effect of the haplotype. IL7RA rs10491434 G allele is associated with a higher likelihood of spontaneous HIV infection control, indicating its significant role in the pathogenesis of HIV, possibly influencing infection course and viral replication control.


Assuntos
Infecções por HIV , Subunidade alfa de Receptor de Interleucina-7 , Humanos , Progressão da Doença , Infecções por HIV/genética , Infecções por HIV/terapia , Controle de Infecções , Polimorfismo de Nucleotídeo Único , Estudos Retrospectivos , Subunidade alfa de Receptor de Interleucina-7/genética
4.
Environ Sci Technol ; 57(44): 17011-17021, 2023 11 07.
Artigo em Inglês | MEDLINE | ID: mdl-37874964

RESUMO

Biomass burning particulate matter (BBPM) affects regional air quality and global climate, with impacts expected to continue to grow over the coming years. We show that studies of North American fires have a systematic altitude dependence in measured BBPM normalized excess mixing ratio (NEMR; ΔPM/ΔCO), with airborne and high-altitude studies showing a factor of 2 higher NEMR than ground-based measurements. We report direct airborne measurements of BBPM volatility that partially explain the difference in the BBPM NEMR observed across platforms. We find that when heated to 40-45 °C in an airborne thermal denuder, 19% of lofted smoke PM1 evaporates. Thermal denuder measurements are consistent with evaporation observed when a single smoke plume was sampled across a range of temperatures as the plume descended from 4 to 2 km altitude. We also demonstrate that chemical aging of smoke and differences in PM emission factors can not fully explain the platform-dependent differences. When the measured PM volatility is applied to output from the High Resolution Rapid Refresh Smoke regional model, we predict a lower PM NEMR at the surface compared to the lofted smoke measured by aircraft. These results emphasize the significant role that gas-particle partitioning plays in determining the air quality impacts of wildfire smoke.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Incêndios , Fumaça/análise , Poluentes Atmosféricos/análise , Biomassa , Poluição do Ar/análise , Material Particulado/análise , Aerossóis/análise , Monitoramento Ambiental/métodos
5.
Environ Sci Technol ; 57(37): 13793-13807, 2023 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-37671787

RESUMO

The impact of aerosols on human health and climate is well-recognized, yet many studies have only focused on total PM2.5 or changes from anthropogenic activities. This study quantifies the health and climate effects of organic aerosols (OA) from anthropogenic, biomass burning, and biogenic sources. Using two atmospheric chemistry models, CAM-chem and GEOS-Chem, our findings reveal that anthropogenic primary OA (POA) has the highest efficiency for health effects but the lowest for direct radiative effects due to spatial and temporal variations associated with population and surface albedo. The treatment of POA as nonvolatile or semivolatile also influences these efficiencies through different chemical processes. Biogenic OA shows moderate efficiency for health effects and the highest for direct radiative effects but has the lowest efficiency for indirect effects due to the reduced high cloud, caused by stabilized temperature profiles from aerosol-radiation interactions in biogenic OA-rich regions. Biomass burning OA is important for cloud radiative effect changes in remote atmospheres due to its ability to be transported further than other OAs. This study highlights the importance of not only OA characteristics such as toxicity and refractive index but also atmospheric processes such as transport and chemistry in determining health and climate impact efficiencies.


Assuntos
Clima , Saúde Global , Humanos , Atmosfera , Temperatura , Aerossóis
6.
Environ Sci Technol Lett ; 10(8): 718, 2023 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-37577360

RESUMO

[This corrects the article DOI: 10.1021/acs.estlett.2c00599.].

7.
Artigo em Inglês | MEDLINE | ID: mdl-37569065

RESUMO

The field of mountain sports has its own characteristics, different from other sports modalities. Emotional intelligence and resilience not only refer to the adaptive capacity that can be developed after an adverse experience, but can also be factors that positively affect sporting performance in extreme conditions. In this study, 4818 athletes from the Spanish Federation of Mountain Sports and Climbing participated; 2696 were men (67.1%) and 1322 were women (32.9%), with a mean age of 49.42 years (±11.9). The Resilience Scale (RS-14), Wong Law Emotional Intelligence Scale (WLEIS-S) and Satisfaction with Life Scale (SWLS) were used. The aim was to provide evidence for the potential for resilience (personal competence and acceptance of self and life) among EI and life satisfaction in mountain and climbing athletes. The results showed that the coefficients of determination of personal competence [(Q2 = 0.286); (R2 = 0.578)], acceptance of self [(Q2 = 0.310); (R2 = 0.554)] and life satisfaction [(Q2 = 0.299); (R2 = 0.421)] for the estimation of the measurement model indicated a good model fit. In the future, it would be necessary to carry out specific studies discriminating by sport modality and methods for this area, with a large number of athletes and disciplines, as well as evaluating its possible applications for the improvement of emotional factors.


Assuntos
Esportes , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Esportes/psicologia , Inteligência Emocional , Atletas/psicologia , Emoções , Satisfação Pessoal
8.
Pathol Res Pract ; 248: 154648, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37399588

RESUMO

The origin of tumors has been under discussion over the years. Different theories have been suggested to explain this phenomenon. Among them, the Cancer-Stem Cells model, is one of the most outstanding. In this study, we reported a case of a 72-year-old man who presented two histologically different tumors with a 7-years gap, a Penile Squamous Cell Carcinoma and a Pleomorphic Undifferentiated Sarcoma, that share some molecular features. Phonotypical differences were showed and confirmed at histological and IHC levels. Molecular analysis showed an HPV infection in the carcinoma. Additionally, sequencing results revealed common (CDKN2A and TERT) and exclusive (FBXW7 and TP53) genetic alterations in both tumors (Table 1). The possible germline origin of common mutations was discarded after negative germline testing. Here we describe, for the first time a clinical case of a possible origin of two histologically different tumors from a common ancestor based on molecular data. Even if different hypothesis appear as possible, the Cancer Stem Cell-based model appears as the most suitable.

9.
ACS Earth Space Chem ; 7(6): 1235-1246, 2023 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-37342759

RESUMO

Atmospheric simulation chambers continue to be indispensable tools for research in the atmospheric sciences. Insights from chamber studies are integrated into atmospheric chemical transport models, which are used for science-informed policy decisions. However, a centralized data management and access infrastructure for their scientific products had not been available in the United States and many parts of the world. ICARUS (Integrated Chamber Atmospheric data Repository for Unified Science) is an open access, searchable, web-based infrastructure for storing, sharing, discovering, and utilizing atmospheric chamber data [https://icarus.ucdavis.edu]. ICARUS has two parts: a data intake portal and a search and discovery portal. Data in ICARUS are curated, uniform, interactive, indexed on popular search engines, mirrored by other repositories, version-tracked, vocabulary-controlled, and citable. ICARUS hosts both legacy data and new data in compliance with open access data mandates. Targeted data discovery is available based on key experimental parameters, including organic reactants and mixtures that are managed using the PubChem chemical database, oxidant information, nitrogen oxide (NOx) content, alkylperoxy radical (RO2) fate, seed particle information, environmental conditions, and reaction categories. A discipline-specific repository such as ICARUS with high amounts of metadata works to support the evaluation and revision of atmospheric model mechanisms, intercomparison of data and models, and the development of new model frameworks that can have more predictive power in the current and future atmosphere. The open accessibility and interactive nature of ICARUS data may also be useful for teaching, data mining, and training machine learning models.

10.
Biom J ; 65(7): e2200288, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37199700

RESUMO

Combination of several anticancer treatments has typically been presumed to have enhanced drug activity. Motivated by a real clinical trial, this paper considers phase I-II dose finding designs for dual-agent combinations, where one main objective is to characterize both the toxicity and efficacy profiles. We propose a two-stage Bayesian adaptive design that accommodates a change of patient population in-between. In stage I, we estimate a maximum tolerated dose combination using the escalation with overdose control (EWOC) principle. This is followed by a stage II, conducted in a new yet relevant patient population, to find the most efficacious dose combination. We implement a robust Bayesian hierarchical random-effects model to allow sharing of information on the efficacy across stages, assuming that the related parameters are either exchangeable or nonexchangeable. Under the assumption of exchangeability, a random-effects distribution is specified for the main effects parameters to capture uncertainty about the between-stage differences. The inclusion of nonexchangeability assumption further enables that the stage-specific efficacy parameters have their own priors. The proposed methodology is assessed with an extensive simulation study. Our results suggest a general improvement of the operating characteristics for the efficacy assessment, under a conservative assumption about the exchangeability of the parameters a priori.

11.
Environ Sci Technol ; 57(15): 6263-6272, 2023 04 18.
Artigo em Inglês | MEDLINE | ID: mdl-37011031

RESUMO

Urbanization and fires perturb the quantities and composition of fine organic aerosol in the central Amazon, with ramifications for radiative forcing and public health. These disturbances include not only direct emissions of particulates and secondary organic aerosol (SOA) precursors but also changes in the pathways through which biogenic precursors form SOA. The composition of ambient organic aerosol is complex and incompletely characterized, encompassing millions of potential structures relatively few of which have been synthesized and characterized. Through analysis of submicron aerosol samples from the Green Ocean Amazon (GoAmazon2014/5) field campaign by two-dimensional gas chromatography coupled with machine learning, ∼1300 unique compounds were traced and characterized over two seasons. Fires and urban emissions produced chemically and interseasonally distinct impacts on product signatures, with only ∼50% of compounds observed in both seasons. Seasonally unique populations point to the importance of aqueous processing in Amazonian aerosol aging, but further mechanistic insights are impeded by limited product identity knowledge. Less than 10% of compounds were identifiable at an isomer-specific level. Overall, the findings (i) provide compositional characterization of anthropogenic influence on submicron organic aerosol in the Amazon, (ii) identify key season-to-season differences in chemical signatures, and (iii) highlight high-priority knowledge gaps in current speciated knowledge.


Assuntos
Poluentes Atmosféricos , Poluentes Atmosféricos/análise , Material Particulado/análise , Estações do Ano , Aerossóis/análise , Poeira/análise
12.
Biom J ; 65(4): e2200126, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36732918

RESUMO

Delayed separation of survival curves is a common occurrence in confirmatory studies in immuno-oncology. Many novel statistical methods that aim to efficiently capture potential long-term survival improvements have been proposed in recent years. However, the vast majority do not consider stratification, which is a major limitation considering that most large confirmatory studies currently employ a stratified primary analysis. In this article, we combine recently proposed weighted log-rank tests that have been designed to work well under a delayed separation of survival curves, with stratification by a baseline variable. The aim is to increase the efficiency of the test when the stratifying variable is highly prognostic for survival. As there are many potential ways to combine the two techniques, we compare several possibilities in an extensive simulation study. We also apply the techniques retrospectively to two recent randomized clinical trials.


Assuntos
Neoplasias , Humanos , Estudos Retrospectivos , Simulação por Computador , Oncologia , Análise de Sobrevida , Modelos de Riscos Proporcionais
13.
Clin Infect Dis ; 76(10): 1854-1859, 2023 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-36763042

RESUMO

This is an account that should be heard of an important struggle: the struggle of a large group of experts who came together at the beginning of the COVID-19 pandemic to warn the world about the risk of airborne transmission and the consequences of ignoring it. We alerted the World Health Organization about the potential significance of the airborne transmission of SARS-CoV-2 and the urgent need to control it, but our concerns were dismissed. Here we describe how this happened and the consequences. We hope that by reporting this story we can raise awareness of the importance of interdisciplinary collaboration and the need to be open to new evidence, and to prevent it from happening again. Acknowledgement of an issue, and the emergence of new evidence related to it, is the first necessary step towards finding effective mitigation solutions.


Assuntos
COVID-19 , Humanos , SARS-CoV-2 , Pandemias/prevenção & controle , Organização Mundial da Saúde , Sociedades
14.
Environ Sci Technol ; 56(22): 15408-15416, 2022 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-36326040

RESUMO

Indoor gas-phase radical sources are poorly understood but expected to be much different from outdoors. Several potential radical sources were measured in a windowless, light-emitting diode (LED)-lit room in a college athletic facility over a 2 week period. Alternating measurements between the room air and the supply air of the heating, ventilation, and air-conditioning system allowed an assessment of sources. Use of a chlorine-based cleaner was a source of several photolabile reactive chlorine compounds, including ClNO2 and Cl2. During cleaning events, photolysis rates for these two compounds were up to 0.0023 pptv min-1, acting as a source of chlorine atoms even in this low-light indoor environment. Unrelated to cleaning events, elevated ClNO2 was often observed during daytime and lost to ventilation. The nitrate radical (NO3), which is rapidly photolyzed outdoors during daytime, may persist in low-light indoor environments. With negligible photolysis, loss rates of NO3 indoors were dominated by bimolecular reactions. At times with high NO2 and O3 ventilated from outdoors, N2O5 was observed. Elevated ClNO2 measured concurrently suggests the formation through heterogeneous reactions, acting as an additional source of reactive chlorine within the athletic facility and outdoors.


Assuntos
Poluentes Atmosféricos , Poluição do Ar em Ambientes Fechados , Esportes , Humanos , Cloro , Nitrogênio , Poluentes Atmosféricos/análise , Halogênios , Cloretos
15.
Nature ; 611(7935): 332-345, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36329272

RESUMO

Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic1,2. Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches1, while maintaining proven prevention measures using a vaccines-plus approach2 that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities3 in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end.


Assuntos
COVID-19 , Técnica Delfos , Cooperação Internacional , Saúde Pública , Humanos , COVID-19/economia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Governo , Pandemias/economia , Pandemias/prevenção & controle , Saúde Pública/economia , Saúde Pública/métodos , Organizações , Vacinas contra COVID-19 , Comunicação , Educação em Saúde , Política de Saúde , Opinião Pública
16.
J Phys Chem A ; 126(40): 7309-7330, 2022 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-36170568

RESUMO

Dark chamber experiments were conducted to study the SOA formed from the oxidation of α-pinene and Δ-carene under different peroxy radical (RO2) fate regimes: RO2 + NO3, RO2 + RO2, and RO2 + HO2. SOA mass yields from α-pinene oxidation were <1 to ∼25% and strongly dependent on available OA mass up to ∼100 µg m-3. The strong yield dependence of α-pinene oxidation is driven by absorptive partitioning to OA and not by available surface area for condensation. Yields from Δ-carene + NO3 were consistently higher, ranging from ∼10-50% with some dependence on OA for <25 µg m-3. Explicit kinetic modeling including vapor wall losses was conducted to enable comparisons across VOC precursors and RO2 fate regimes and to determine atmospherically relevant yields. Furthermore, SOA yields were similar for each monoterpene across the nominal RO2 + NO3, RO2 + RO2, or RO2 + HO2 regimes; thus, the volatility basis sets (VBS) constructed were independent of the chemical regime. Elemental O/C ratios of ∼0.4-0.6 and nitrate/organic mass ratios of ∼0.15 were observed in the particle phase for both monoterpenes in all regimes, using aerosol mass spectrometer (AMS) measurements. An empirical relationship for estimating particle density using AMS-derived elemental ratios, previously reported in the literature for non-nitrate containing OA, was successfully adapted to organic nitrate-rich SOA. Observations from an NO3- chemical ionization mass spectrometer (NO3-CIMS) suggest that Δ-carene more readily forms low-volatility gas-phase highly oxygenated molecules (HOMs) than α-pinene, which primarily forms volatile and semivolatile species, when reacted with NO3, regardless of RO2 regime. The similar Δ-carene SOA yields across regimes, high O/C ratios, and presence of HOMs, suggest that unimolecular and multistep processes such as alkoxy radical isomerization and decomposition may play a role in the formation of SOA from Δ-carene + NO3. The scarcity of peroxide functional groups (on average, 14% of C10 groups carried a peroxide functional group in one test experiment in the RO2 + RO2 regime) appears to rule out a major role for autoxidation and organic peroxide (ROOH, ROOR) formation. The consistently substantially lower SOA yields observed for α-pinene + NO3 suggest such pathways are less available for this precursor. The marked and robust regime-independent difference in SOA yield from two different precursor monoterpenes suggests that in order to accurately model SOA production in forested regions the chemical mechanism must feature some distinction among different monoterpenes.

17.
Indoor Air ; 32(8): e13070, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-36040283

RESUMO

The question of whether SARS-CoV-2 is mainly transmitted by droplets or aerosols has been highly controversial. We sought to explain this controversy through a historical analysis of transmission research in other diseases. For most of human history, the dominant paradigm was that many diseases were carried by the air, often over long distances and in a phantasmagorical way. This miasmatic paradigm was challenged in the mid to late 19th century with the rise of germ theory, and as diseases such as cholera, puerperal fever, and malaria were found to actually transmit in other ways. Motivated by his views on the importance of contact/droplet infection, and the resistance he encountered from the remaining influence of miasma theory, prominent public health official Charles Chapin in 1910 helped initiate a successful paradigm shift, deeming airborne transmission most unlikely. This new paradigm became dominant. However, the lack of understanding of aerosols led to systematic errors in the interpretation of research evidence on transmission pathways. For the next five decades, airborne transmission was considered of negligible or minor importance for all major respiratory diseases, until a demonstration of airborne transmission of tuberculosis (which had been mistakenly thought to be transmitted by droplets) in 1962. The contact/droplet paradigm remained dominant, and only a few diseases were widely accepted as airborne before COVID-19: those that were clearly transmitted to people not in the same room. The acceleration of interdisciplinary research inspired by the COVID-19 pandemic has shown that airborne transmission is a major mode of transmission for this disease, and is likely to be significant for many respiratory infectious diseases.


Assuntos
Poluição do Ar em Ambientes Fechados , COVID-19 , Humanos , Pandemias , Aerossóis e Gotículas Respiratórios , SARS-CoV-2
18.
J Adv Model Earth Syst ; 14(6): e2021MS002889, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35864945

RESUMO

A new configuration of the Community Earth System Model (CESM)/Community Atmosphere Model with full chemistry (CAM-chem) supporting the capability of horizontal mesh refinement through the use of the spectral element (SE) dynamical core is developed and called CESM/CAM-chem-SE. Horizontal mesh refinement in CESM/CAM-chem-SE is unique and novel in that pollutants such as ozone are accurately represented at human exposure relevant scales while also directly including global feedbacks. CESM/CAM-chem-SE with mesh refinement down to ∼14 km over the conterminous US (CONUS) is the beginning of the Multi-Scale Infrastructure for Chemistry and Aerosols (MUSICAv0). Here, MUSICAv0 is evaluated and used to better understand how horizontal resolution and chemical complexity impact ozone and ozone precursors over CONUS as compared to measurements from five aircraft campaigns, which occurred in 2013. This field campaign analysis demonstrates the importance of using finer horizontal resolution to accurately simulate ozone precursors such as nitrogen oxides and carbon monoxide. In general, the impact of using more complex chemistry on ozone and other oxidation products is more pronounced when using finer horizontal resolution where a larger number of chemical regimes are resolved. Large model biases for ozone near the surface remain in the Southeast US as compared to the aircraft observations even with updated chemistry and finer horizontal resolution. This suggests a need for adding the capability of replacing sections of global emission inventories with regional inventories, increasing the vertical resolution in the planetary boundary layer, and reducing model biases in meteorological variables such as temperature and clouds.

19.
J Appl Stat ; 49(2): 466-484, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35707213

RESUMO

Proportional hazards are a common assumption when designing confirmatory clinical trials in oncology. With the emergence of immunotherapy and novel targeted therapies, departure from the proportional hazard assumption is not rare in nowadays clinical research. Under non-proportional hazards, the hazard ratio does not have a straightforward clinical interpretation, and the log-rank test is no longer the most powerful statistical test even though it is still valid. Nevertheless, the log-rank test and the hazard ratio are still the primary analysis tools, and traditional approaches such as sample size increase are still proposed to account for the impact of non-proportional hazards. The weighed log-rank test and the test based on the restricted mean survival time (RMST) are receiving a lot of attention as a potential alternative to the log-rank test. We conduct a simulation study comparing the performance and operating characteristics of the log-rank test, the weighted log-rank test and the test based on the RMST, including a treatment effect estimation, under different non-proportional hazards patterns. Results show that, under non-proportional hazards, the hazard ratio and weighted hazard ratio have no straightforward clinical interpretation whereas the RMST ratio can be interpreted regardless of the proportional hazards assumption. In terms of power, the RMST achieves a similar performance when compared to the log-rank test.

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