Aortic events and relative survival in patients with moderately dilated proximal thoracic aorta

Objectives. This study describes growth, local and remote aortic events, and survival in patients with proximal (root, ascending) aortic diameters just below threshold for operation. Methods. Patients with proximal aortic diameter of 4.5 to 5.4 cm at baseline, were followed with serial computed tomography studies and data collected retrospectively. Aortic growth rate was estimated using mixed effects modelling. Clinical and radiological features associated with outcomes (all-cause death, aortic death, local or remote aortic events (dissection, rupture, intramural hematoma, or intervention)) were assessed with Cox analysis. Survival and freedom from events were estimated using Kaplan-Meier methods. Results. 80 patients underwent 274 CT scans during 265 patient-years. Median proximal aortic growth was 0.2 cm in 3 years. 32 events occurred in 28 patients (35%). Eleven events were local, all elective proximal aortic surgery. Nine events were remote: 5 type B aortic dissections, 3 descending aneurysms undergoing elective repair, and one infrarenal aortic rupture. Twelve patients died, half of type B aortic dissection. Relative survival compared to a matched normal population was 82% (95% confidence limits 55-98%) at 10 years. In Cox analysis, increased descending aortic diameter was an independent predictor of all-cause death (hazard ratio [HR], 1.39) and aortic death (HR 1.96). Conclusions. Descending, but not proximal, aortic growth was predictive of lethal events. The decreased relative survival, the substantial number of remote aortic events and aortic deaths strongly suggest continuous serial CT surveillance of the entire aorta. Other indicators than proximal aortic diameter appear needed to improve management of this patient group.

Utilizing a composite citation index for evaluating clinical ophthalmology research: insights into gender, nationality, and self-citation among top ophthalmology researchers

OBJECTIVES

To compare the performance of a composite citation score (c-score) and its six constituent citation indices, including H-index, in predicting winners of the Weisenfeld Award in ophthalmologic research. Secondary objectives were to explore career and demographic characteristics of the most highly cited researchers in ophthalmology.

METHODS

A publicly available database was accessed to compile a set of top researchers in the field of clinical ophthalmology and optometry based on Scopus data from 1996 to 2021. Each citation index was used to construct a multivariable model adjusted for author demographic characteristics. Using area under the receiver operating curve (AUC) analysis, each index's model was evaluated for its ability to predict winners of the Weisenfeld Award in Ophthalmology, a research distinction presented by the Association for Research in Vision and Ophthalmology (ARVO). Secondary analyses investigated authors' self-citation rates, career length, gender, and country affiliation over time.

RESULTS

Approximately one thousand unique authors publishing primarily in clinical ophthalmology/optometry were analyzed. The c-score outperformed all other citation indices at predicting Weisenfeld Awardees, with an AUC of 0.99 (95% CI: 0.97-1.0). The H-index had an AUC of 0.89 (95% CI: 0.83-0.96). Authors with higher c-scores tended to have longer career lengths and similar self-citation rates compared to other authors. Sixteen percent of authors in the database were identified as female, and 64% were affiliated with the United States of America.

CONCLUSION

The c-score is an effective metric for assessing research impact in ophthalmology, as seen through its ability to predict Weisenfeld Awardees.

The Ontology of Haag's Local Quantum Physics

The ontology of Local Quantum Physics, Rudolf Haag's framework for relativistic quantum theory, is reviewed and discussed. It is one of spatiotemporally localized events and unlocalized causal intermediaries, including the elementary particles, which come progressively into existence in accordance with a fundamental arrow of time. Haag's conception of quantum theory is distinguished from others in which events are also central, especially those of Niels Bohr and John Wheeler, with which it has been compared.

[Life events related to the German reunification and their associations with psychosocial health in a sample of northeast Germany]

Objectives: The aim of the present study was to investigate (1) the type and frequency of reported life events of the East German population related to the German reunification and (2) their associations with psychosocial health. Methods: Data of 2247 participants of the Study of Health in Pomerania was used.These qualitative responses were analysed using quantitative content analysis. Their associations with subjective physical and mental health, optimism, social support, depressive symptoms, and chronic stress were examined. Results: Eight life event categories were identified (education, employment-related changes, material changes, new opportunities, personal life events, politics, separations, reunifications). Especially, experiencing new opportunities was associated with a higher level of optimism as well as a lower level of depressive symptoms and chronic stress. Conclusions: In this study, events frequently described in the literature (e.g., employment-related and social changes) were confirmed and systematized.The observed associations of these events with psychosocial factors should be examined further in future studies.

Association Between Abnormal Metabolic Parameters and Receiving Subsequent Interventions in Children and Adolescents Initiating Second-Generation Antipsychotics

Objectives: This study aimed to examine the association between abnormal readings of metabolic parameters detected during second-generation antipsychotic (SGA) treatment and the likelihood of receiving subsequent adverse drug event interventions. Methods: This was a nested case-control study conducted on patients 1-17 years of age with at least two prescriptions of SGAs between January 2010 and January 2019 using TriNetX EMR data. Following an incident density sampling procedure, patients who received the SGA metabolic adverse event intervention (mAEI) (case) were matched with three nonrecipients (controls). The abnormal readings of metabolic parameters within 30 days before the initiation of mAIEs were further identified. These metabolic parameters include body mass index (BMI) and laboratory parameters such as cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, blood glucose, HbA1c, thyroid hormones, liver enzymes, and prolactin. The association of abnormal metabolic parameters with subsequent mAEIs was assessed using a conditional logistic regression model, after adjusting for demographic and other clinical risk factors. Results: One thousand eight hundred eighty-four children and adolescents met the inclusion criteria and were prescribed SGA mAEIs. The most common types of mAEIs prescribed were weight management pharmacotherapy (40.6%), switching from a high or medium metabolic risk profile SGA to a low-risk one (30.9%), nonpharmacological treatment (25.4%), and switching from SGA polytherapy to monotherapy (11.7%). The conditional logistic regression analysis on matched mAEI recipients and nonrecipients showed that patients with an abnormal BMI had 43% higher odds of receiving mAEI (odds ratio [95% confidence interval]: 1.43 [1.13-1.79]). However, the presence of an abnormal laboratory reading was not associated with the initiation of mAEIs. Conclusions: The prescribing of mAEIs were associated with the presence of obesity, but not with abnormal readings of other metabolic parameters, suggesting that additional data are needed to clarify the long-term implication of SGA metabolic adverse events other than weight gain and to inform the appropriate timing for interventions.

The international scandal of defective asparaginase: A blight on children with cancer

Acute lymphoblastic leukemia is the commonest form of cancer in children and adolescents worldwide, and asparaginase is an essential component of successful chemotherapy for this disease associated with long-term survival rates often exceeding 90% in high-income countries. Demonstrably defective preparations of asparaginase, distributed from China and India, increase the burden of morbidity and mortality, reducing attainable survival rates. This adverse outcome is enabled by inadequate regulation and oversight, especially in resource-poor settings in low- and middle-income countries where the great majority of children and adolescents with cancer live. The pediatric oncology community must rise to the challenge.

Events-Affect-Personality: A Daily Diary Investigation of the Mediating Effects of Affect on the Events-Personality Relationship

Our 10-day diary investigation anchored in dynamic personality theories, such as Whole Trait Theory examined (a) whether within-person variability in two broad personality traits Extraversion and Neuroticism is consistently predicted by daily events, (b) whether positive and negative affect, respectively partly mediate this relationship and (c) the lagged relationships between events, and next day variations in affect and personality. Results revealed that personality exhibited significant within-person variability, that positive and negative affect partly mediate the relationship between events and personality, affect accounting for up to 60% of the effects of events on personality. Additionally, we identified that event-affect congruency was accountable for larger effects compared to event-affect non-congruency.

International Microorganism Day: facilitating global outreach events using a decentralized model

On 17 September 1683, Antonie van Leeuwenhoek, a Dutch merchant who lacked formal education and fortune, wrote a letter to the Royal Society of London describing for the first time a single-celled organism. As a tribute to this revolutionary discovery, the Portuguese Society of Microbiology with the support of the Federation of European Microbiological Societies in 2017, designated this day as International Microorganism Day (IMD), a day aiming to raise awareness about the wonderful world of microbes. Six years after the establishment of IMD, the knowledge of microbiology outreach around this celebration has expanded greatly, with 5 years of in-person and 2 years of online events. The peak of these commemorations was in 2023, with 63 parallel outreach events and more than 5000 attendees, most of which were children, and young adults. While these in-person events were occurring in the month of September, the #InternationalMicroorganismDay hashtag reached nearly 2.3 million people online, reflecting the number of users who have seen a post containing this hashtag on social media. Using a decentralized model to facilitate 63 grass-roots teams to organize events locally, IMD achieved global representation both online and offline. This paper presents details behind the organization and data on the international impact of the IMD 2022 and 2023 events, outlines plans to expand reach to more countries and audiences, and encourages readers to participate with their own events in future IMD editions so that global impact can be expanded even further.

An Exploration of the Multiplicative Effect of "Other People" and Other Environmental Effects on Violence in the Night-Time Environment

BACKGROUND

The characteristics of night-time environments (NTEs) in which alcohol is consumed and that contribute to violence are poorly described. We explore competing explanations for violence in the NTE, with a particular focus on the number of patrons and its association with assault-related visits to a hospital emergency department. Other environmental features including the weather and notable events were also considered. The primary aim was to stimulate debate around the causal mechanisms responsible for violence.

METHODS

Assault-related ED visits occurring between 8 pm and 4 am were recorded at the University Hospital of Wales, the single Emergency Department (ED) serving Cardiff, Wales, United Kingdom. Footfall was derived from the total number of unique MAC addresses recorded per hour collected from ten wireless fidelity monitoring tools located in the city centre. A narrative review of the literature concerning alcohol and violence informed exploratory analyses into the association between night-time footfall, sporting events, the weather, and other potential predictors of assault-related visits to the ED. We developed analytic methods from formal accounts of queueing.

RESULTS

International rugby matches at home, the weather (temperature), national holidays, the day of the week, and number of patrons in the NTE predicted assault-related injury (R² = 0.70), with footfall yielding a positive non-linear exponential association consistent with predictions derived from mathematical models of queueing.

DISCUSSION

Assault-related visits to the ED have a non-linear association with the number of people socialising in the night-time environment and are further influenced by the weather and notable events. Opportunities for further research that might inform policy and interventions aimed at better managing NTEs are discussed.

Using music to probe how perception shapes imagination

Recent work using music highlights how past experiences and the immediate perceptual environment can shape imagination. Given that aspects of past experiences can be shared, depending on culture, as can the immediate perceptual environment, imaginings that might appear idiosyncratic or entirely subjective can in fact be broadly shared.

SARS-CoV-2 Risk Quantification Model and Validation Based on Large-Scale Dutch Test Events

In response to the outbreak of SARS-CoV-2, many governments decided in 2020 to impose lockdowns on societies. Although the package of measures that constitute such lockdowns differs between countries, it is a general rule that contact between people, especially in large groups of people, is avoided or prohibited. The main reasoning behind these measures is to prevent healthcare systems from becoming overloaded. As of 2021 vaccines against SARS-CoV-2 are available, but these do not guarantee 100% risk reduction and it will take a while for the world to reach a sufficient immune status. This raises the question of whether and under which conditions events like theater shows, conferences, professional sports events, concerts, and festivals can be organized. The current paper presents a COVID-19 risk quantification method for (large-scale) events. This method can be applied to events to define an alternative package of measures replacing generic social distancing.

The uneven distribution of futurity: Slow emergencies and the event of COVID‐19

The ongoing COVID‐19 pandemic strains conventional temporal imaginaries through which emergencies are typically understood and governed. Rather than a transparent and linear temporality, a smooth transition across the series event/disruption–response–post‐event recovery, the pandemic moves in fits and starts, blurring the boundary between normalcy and emergency. This distended temporality brings into sharp relief other slow emergencies such as racism, poverty, biodiversity loss, and climate change, which inflect how the pandemic is known and governed as an emergency. In this article, we reflect on COVID‐19 responses in two settler colonial societies—Australia and the United States—to consider how distinct styles of pandemic responses in each context resonate and dissonate across the racially uneven distribution of futurity that structures liberal order. In each case, the event of COVID‐19 has indeed opened a window that reveals multiple slow emergencies; yet in these and other responses this revelation is not leading to meaningful changes to address underlying forms of structural violence. In Australia and the United States, we see how specific slow emergencies—human‐induced climate change and anti‐Black violence in White supremacist societies, respectively—become intensified as liberal order recalibrates itself in response to the event of COVID‐19.

The ongoing COVID‐19 pandemic is revealing the limits of conventional temporal imaginaries through which emergencies are known and governed. Examples from Australia and the United States demonstrate how pandemic responses in settler colonial societies are reinforcing racially uneven claims on futurity. Rather than leading to meaningful change to address underlying structural violence, these distinct styles of emergency response are instead reinforcing racism, poverty, biodiversity loss, and climate change that conditioned the pandemic’s emergence and its uneven socio‐spatial impacts.

Incidence of liver- and non-liver-related outcomes in patients with HCV-cirrhosis after SVR

BACKGROUND & AIMS

As the long-term benefits of a sustained virological response (SVR) in HCV-related cirrhosis following direct-acting antiviral (DAA) treatment remain undefined, we assessed the incidence and predictors of liver-related events (LREs), non-liver-related events (NLREs) and mortality in DAA-treated patients with cirrhosis.

METHODS

Consecutive patients with cirrhosis and SVR were enrolled in a longitudinal, single-center study, and divided into 3 cohorts: Cohort A (Child-Pugh A without a previous LRE), Cohort B (Child-Pugh B or Child-Pugh A with prior non-hepatocellular carcinoma [HCC] LREs), Cohort C (previous HCC).

RESULTS

A total of 636 patients with cirrhosis (median 65 years-old, 58% males, 89% Child-Pugh A) were followed for 51 (8-68) months (Cohort A n = 480, Cohort B n = 89, Cohort C n = 67). The 5-year estimated cumulative incidences of LREs were 10.4% in Cohort A vs. 32.0% in Cohort B (HCC 7.7% vs. 19.7%; ascites 1.4% vs. 8.6%; variceal bleeding 1.3% vs. 7.8%; encephalopathy 0 vs. 2.5%) vs. 71% in Cohort C (HCC only) (p <0.0001). The corresponding figures for NLREs were 11.7% in Cohort A vs. 17.9% in Cohort B vs. 17.5% in Cohort C (p = 0.32). The 5-year estimated probabilities of liver-related vs. non-liver-related deaths were 0.5% vs. 4.5% in Cohort A, 16.2% vs. 8.8% in Cohort B and 12.1% vs. 7.7% in Cohort C. The all-cause mortality rate in Cohort A was similar to the rate expected for the general population stratified by age, sex and calendar year according to the Human Mortality Database, while it was significantly higher in Cohort B.

CONCLUSIONS

Patients with cirrhosis and an SVR on DAAs face risks of liver-related and non-liver-related events and mortality; however, their incidence is strongly influenced by pre-DAA patient history.

LAY SUMMARY

In this large single-center study enrolling patients with hepatitis C virus (HCV)-related cirrhosis cured by direct-acting antivirals, pre-treatment liver disease history strongly influenced long-term outcomes. In patients with HCV-related cirrhosis, hepatocellular carcinoma was the most frequent liver-related complication after viral cure. Due to improved long-term outcomes, patients with cirrhosis after HCV cure are exposed to a significant proportion of non-liver-related events.

Eye Movements during Dynamic Scene Viewing are Affected by Visual Attention Skills and Events of the Scene: Evidence from First-Person Shooter Gameplay Videos

The role of individual differences during dynamic scene viewing was explored. Participants (N=38) watched a gameplay video of a first-person shooter (FPS) videogame while their eye movements were recorded. In addition, the participants’ skills in three visual attention tasks (attentional blink, visual search, and multiple object tracking) were assessed. The results showed that individual differences in visual attention tasks were associated with eye movement patterns observed during viewing of the gameplay video. The differences were noted in four eye movement measures: number of fixations, fixation durations, saccade amplitudes and fixation distances from the center of the screen. The individual differences showed during specific events of the video as well as during the video as a whole. The results highlight that an unedited, fast-paced and cluttered dynamic scene can bring about individual differences in dynamic scene viewing.

"Pilot" spectator events in British horseracing during COVID-19: post-event SMS COVID-19 reporting

This study aimed to assess (i) COVID‐19 transmission prior to and following spectator events and (ii) methodological approaches to capturing event‐related transmission during the spectator return. Local authority population transmission rates were used to identify higher transmission areas, which were excluded from participant attendance following registration. Using observational online and SMS questionnaires, self‐reported COVID‐19 diagnoses (positive tests) and racing‐related NHS Test and Trace contacts within 14 days of spectating were reported for two British Horseracing events and three Point to Point (PTP) grassroots races. There were 1,477 registrations for the British Horseracing events, and 1,678 registrations for PTP races. Responses were received from 464 attendees of British Horseracing events (31.4% response rate). Two attendees reported a COVID‐19 diagnosis, and no attendees reported NHS Test and Trace contact. From PTP races, 862 attendees (51.3%) consented to receive the SMS survey, and responses were received from 495 attendees (57.4% response rate). Five attendees reported positive COVID‐19 diagnoses, and two attendees reported being contacted by NHS Test and Trace, of which one was following a non‐racing potential COVID‐19 exposure. There was limited evidence of COVID‐19 transmission at outdoor elite and grassroots level horseracing events during autumn 2020. A higher response rate was received with SMS surveys; however, there was a reluctancy to “opt in” to SMS methodology. This study describes different methodological approaches to monitoring COVID‐19 transmission risk at events, which may have relevance for other sporting and event contexts during the current pandemic, and sustained attendances during periods with circulating transmissible diseases.

Spontaneous Coronary Artery Dissection: Does Being Unemployed Matter? Insights from the GSCAD Registry

Background

Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome (ACS) and sudden cardiac death. Physical or emotional stressors are the most commonly reported triggers for SCAD. Unemployment has been identified as a source of emotional stress and is linked to poor mental and physical health.

Objective

To examine the association between employment status and in-hospital and follow-up adverse cardiovascular events in patients with SCAD.

Methods

We conducted a retrospective, multi-center, observational study of patients undergoing coronary angiography for ACS between January 2011 and December 2017. The total number of patients enrolled was 198,000. Patients were diagnosed with SCAD based on angiographic and intravascular imaging modalities whenever available. There were 83 patients identified with SCAD from 30 medical centers in 4 Arab gulf countries. In-hospital (myocardial infarction, percutaneous intervention, ventricular tachycardia/ventricular fibrillation, cardiogenic shock, death, internal cardioverter/defibrillator placement, dissection extension) and follow-up (myocardial infarction, de novo SCAD, death, spontaneous superior mesenteric artery dissection) cardiac events were compared among those who were employed and those who were not.

Results

The median age of patients in the study was 44 (37- 55) years. There were 42 (50.6%) female patients, and 41 (49.4) male patients. Of the cohort, 50 (60%) of the patients were employed and the remaining 33 (40%) were unemployed. 66% of all men were employed and 76% of all women were unemployed. After adjusting for gender unemployment was associated with worse in-hospital and follow-up cardiac events (adjusted OR 7.1, [1.3, 37.9]), p = 0.021.

Conclusion

Adverse cardiovascular events were significantly worse for patients with SCAD who were unemployed.

How happenings do (not) turn into events: A typology and an application to the case of 9/11 in the American and Dutch public spheres

Why do some happenings become incentives for cultural or political transformation (that is: turn into events), whereas others remain ordinary occurrences? The theoretical perspectives of cultural repertoires, cleavage structures, and discursive opportunities are prominent and fruitful approaches for explaining cultural or political behavior and attitudes, yet they do not have a satisfactory answer to this question. To fill in this gap, I introduce a typology that indicates how certain happenings merely reproduce existing trends, whereas other ones turn into motives to change them. This can be either because they are "focus events," which confirm dominant cultural or political patterns, or because they are "shock events," which form a break from them. I illustrate this typology by investigating the distinct meanings that 9/11 were accorded in the American and Dutch public spheres. This analysis shows that this happening became a "shock event" on the issue of safety in the American case, as it broke with the cultural repertoire of viewing the United States as a safe, militarily impenetrable nation. In contrast, 9/11 turned into a "focus event" concerning the issue of Islam in the Dutch case because it confirmed the discursive opportunities to problematize Muslims, which public actors in the Netherlands had already developed in the years leading up to 2001.

Ten years of weekly epidemiological teleconference (EpiLag) - an effective and time-efficient tool for infectious disease event information, Germany, 2009-2018

In 2009, the Robert Koch Institute (RKI) and the 16 German federal state public health authorities (PHAs) established a weekly epidemiological teleconference (EpiLag) to discuss infectious disease (ID) events and foster horizontal and vertical information exchange. We present the procedure, discussed ID topics and evaluation results of EpiLag after 10 years. We analysed attendance, duration of EpiLag and the frequency of reported events. Participants (RKI and state PHA) were surveyed regarding their satisfaction with logistics, contents and usefulness of EpiLag (Likert scales). Between 2009 and 2018, RKI hosted 484 EpiLag conferences with a mean duration of 25 min (range: 4–60) and high participation (range: 9–16; mean: 15 PHAs). Overall, 2975 ID events (39% international, 9% national and 52% subnational) were presented (mean: 6.1 per EpiLag), most frequently on measles (18%), salmonellosis (8%) and influenza (5%). All responding participants (14/16 PHAs and 9/9 at RKI) were satisfied with the EpiLag's organization and minutes and deemed EpiLag useful for an overview and information distribution on ID events relevant to Germany. EpiLag is time efficient, easily applicable and useful for a low-threshold event communication. It supports PHAs in crises and strengthens the network of surveillance stakeholders. We recommend its implementation to other countries or sectors.

The Language Network Is Recruited but Not Required for Nonverbal Event Semantics

The ability to combine individual concepts of objects, properties, and actions into complex representations of the world is often associated with language. Yet combinatorial event-level representations can also be constructed from nonverbal input, such as visual scenes. Here, we test whether the language network in the human brain is involved in and necessary for semantic processing of events presented nonverbally. In Experiment 1, we scanned participants with fMRI while they performed a semantic plausibility judgment task versus a difficult perceptual control task on sentences and line drawings that describe/depict simple agent-patient interactions. We found that the language network responded robustly during the semantic task performed on both sentences and pictures (although its response to sentences was stronger). Thus, language regions in healthy adults are engaged during a semantic task performed on pictorial depictions of events. But is this engagement necessary? In Experiment 2, we tested two individuals with global aphasia, who have sustained massive damage to perisylvian language areas and display severe language difficulties, against a group of age-matched control participants. Individuals with aphasia were severely impaired on the task of matching sentences to pictures. However, they performed close to controls in assessing the plausibility of pictorial depictions of agent-patient interactions. Overall, our results indicate that the left frontotemporal language network is recruited but not necessary for semantic processing of nonverbally presented events.

Bouncing back, if not beyond: Challenges for research on resilience

Setbacks are a fact of life for individuals and collectives—and resilience is a key concept in explaining why some entities positively adapt (i.e., bounce back) or even emerge stronger (i.e., bounce beyond), while others suffer from such events, sometimes permanently. In this short note, we briefly introduce the concept of resilience before moving to three key challenges for management research in this field. With this, we would like to encourage the international scholarly research community to view any phenomenon of their interest also from a resilience perspective, considering significant setbacks and processes of positive adaptation.

Supporting more affordable and equitable cancer care and research in Lower and Middle Income Countries: ecancer's commitment

Oncology professionals in Lower and Middle Income Countries (LMICs) are facing a challenging situation with rising cancer cases together with a lack of educational support and access to relevant research. This article outlines what ecancer are doing as an organisation to try to address these issues by providing high quality education in multiple formats for free and supporting authors and readers from LMICs to access and publish research.

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA-compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms "ablative laser" and "skin resurfacing" from March 2002 until July 2020. Studies included meta-analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self-resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.

Baseline characteristics predicting clinical outcomes and serious adverse events in middle-aged hypertensive women: a subanalysis of the SPRINT in women aged <65 years

Background/aim

The predictability of clinical outcomes in hypertension in specific patient groups, especially underrepresented populations is the key to rational treatment. This study aimed to investigate the impact of baseline characteristics of <65-year-old hypertensive women with an increased risk of cardiovascular events, managed with standard- or intensive-approach, on their clinical outcomes and serious adverse events (SAEs).

Materials and methods

Baseline characteristics of <65-year-old hypertensive women (n = 1247) in SPRINT, a multicenter randomized trial to compare standard and intensive antihypertensive treatment, were analyzed with Cox-regression method to determine potential predictors of the clinical outcomes and SAEs. The primary outcome was the composite of myocardial infarction (MI), non-MI acute coronary syndrome, stroke, heart failure, or cardiovascular death.

Results

The primary outcome occurred in 3.1% and SAEs in 27.6% of the population. The treatment groups were similar in terms of the primary outcome, SAEs, or their individual components. The primary outcome occurred significantly more in current smokers vs. nonsmokers (HR: 2.85, 95% CI: 1.34–6.09). The subjects who were on aspirin in the intensive-group were significantly more likely to develop the primary outcome (HR: 3.17, 95% CI: 1.23-8.19) and MI (HR: 10.15, 95% CI: 1.19-86.88) compared with those not using aspirin. The risk of overall SAEs was significantly higher in blacks vs. nonblacks (HR: 1.27, 95% CI: 1.01-1.58), in current-smokers vs. nonsmokers (HR: 1.59, 95% CI: 1.23-2.05), and those with vs. without chronic kidney disease (CKD), (HR: 1.38, 95% CI: 1.08-1.77). The likelihood of SAEs significantly increased with age (HR: 1.04, 95% CI: 1.01-1.07).

Conclusion

Smoking, aspirin, CKD, black race, and age seemed as important baseline characteristics in follow-up of <65-year-old hypertensive women, also depending on therapeutic strategy. Clinicians are expected to consider these critical parameters for effective antihypertensive management that promotes better outcomes in this middle-aged female population.

On the Overlap of Systemic Events: Covid-19, Climate, and Journalism

Covid-19 represents a systemic event-a state of emergency-that disrupts the routines of societies from the level of individuals to institutions, nations, and global interaction. Revealing the vulnerability of the intensively interconnected world suggests a juxtaposition with another systemic crisis: the climate emergency. Drawing on some key literature on the different aspects of "events"-as heightened political semiosis (Wagner-Pacifi), as (possible) transformation of social and symbolic structures (Sewell), and as moments where new horizons are opened (Arendt)-this essay suggests three intersecting themes where reactions to Covid-19 help to sharpen the crucial questions of future journalism: the role of "knowledge" and expertise, the power of national framing, and the challenge of covering the new imperatives and possibilities of everyday life.

Management of Immunotherapy Adverse Events in Oncological Patients: Anti-CTLA-4, Anti-PD-1/PD-L1

BACKGROUND

The widespread use of immunotherapy drugs in the oncological field has led to the spread of new toxicities compared to the more common chemotherapy treatments. This is because immunotherapy with anti-CTLA-4 (Cytotoxic T Lymphocytes-Associated Antigen 4), anti- PD-1 and anti-PD-L1 monoclonal antibodies has become the standard-of-care in a growing number of indications. Any organ or tissue can be involved, but more commonly, side effects are reported regarding skin, colon, endocrine glands, liver, lung and kidney. Other less frequent, but more serious, adverse events are neurological and myocarditis.

METHODS

We performed an electronic search on PUBMED of the literature concerning immunotherapy- related toxicities and their management in oncological patients from 2007 to 2020, with particular attention to the most recent publications.

AIM

To summarize the different types of immunotherapy-related toxicities, together with their incidence and diagnosis, and to simplify their management, especially in the emergency setting.

CONCLUSION

Usually, for grade I toxicities, it is not recommended to stop immunotherapy; for most of grade II toxicities, immunotherapy should be postponed to when toxicity will have regressed to grade I, considering the possibility of corticosteroid treatment for most toxicities. The majority of grade III and IV require administration of high-dose corticosteroid intravenous therapy and suspension of immunotherapy. Mortality related to immune checkpoint inhibitors' toxicity, occurring at a rate of 0.3-1.3%, is well below fatality rates due to other oncologic interventions and should not discourage the promising results so far reached by immunotherapy.

Events and Causal Mappings Modeled in Conceptual Spaces

The aim of the article is to present a model of causal relations that is based on what is known about human causal reasoning and that forms guidelines for implementations in robots. I argue for two theses concerning human cognition. The first is that human causal cognition, in contrast to that of other animals, is based on the understanding of the forces that are involved. The second thesis is that humans think about causality in terms of events. I present a two-vector model of events, developed by Gärdenfors and Warglien, which states that an event is represented in terms of two main components - the force of an action that drives the event, and the result of its application. Apart from the causal mapping, the event model contains representations of a patient, an agent, and possibly some other roles. Agents and patients are objects (animate or inanimate) that have different properties. Following my theory of conceptual spaces, they can be described as vectors of property values. At least two spaces are needed to describe an event, an action space and a result space. The result of an event is modeled as a vector representing the change of properties of the patient before and after the event. In robotics the focus has been on describing results. The proposed model also includes the causal part of events, typically described as an action. A central part of an event category is the mapping from actions to results. This mapping contains the central information about causal relations. In applications of the two-vector model, the central problem is how the event mapping can be learned in a way that is amenable to implementations in robots. Three processes are central for event cognition: causal thinking, control of action and learning by generalization. Although it is not yet clear which is the best way to model how the mappings can be learned, they should be constrained by three corresponding mathematical properties: monotonicity (related to qualitative causal thinking); continuity (plays a key role in activities of action control); and convexity (facilitates generalization and the categorization of events). I argue that Bayesian models are not suitable for these purposes, but some more geometrically oriented approach to event mappings should be used.

Viral fitness: history and relevance for viral pathogenesis and antiviral interventions

The quasispecies dynamics of viral populations (continuous generation of variant genomes and competition among them) has as one of its frequent consequences variations in overall multiplication capacity, a major component of viral fitness. This parameter has multiple implications for viral pathogenesis and viral disease control, some of them unveiled thanks to deep sequencing of viral populations. Darwinian fitness is an old concept whose quantification dates back to the early developments of population genetics. It was later applied to viruses (mainly to RNA viruses) to quantify relative multiplication capacities of individual mutant clones or complex populations. The present article reviews the fitness concept and its relevance for the understanding of the adaptive dynamics of viruses in constant and changing environments. Many studies have addressed the fitness cost of escape mutations (to antibodies, cytotoxic T cells or inhibitors) as an influence on the efficacy of antiviral interventions. Here, we summarize the evidence that the basal fitness level can be a determinant of inhibitor resistance.

Transformation of Event Representations along Middle Temporal Gyrus

When learning about events through visual experience, one must not only identify which events are visually similar but also retrieve those events' associates-which may be visually dissimilar-and recognize when different events have similar predictive relations. How are these demands balanced? To address this question, we taught participants the predictive structures among four events, which appeared in four different sequences, each cued by a distinct object. In each, one event ("cause") was predictably followed by another ("effect"). Sequences in the same relational category had similar predictive structure, while across categories, the effect and cause events were reversed. Using functional magnetic resonance imaging data, we measured "associative coding," indicated by correlated responses between effect and cause events; "perceptual coding," indicated by correlated responses to visually similar events; and "relational category coding," indicated by correlated responses to sequences in the same relational category. All three models characterized responses within the right middle temporal gyrus (MTG), but in different ways: Perceptual and associative coding diverged along the posterior to anterior axis, while relational categories emerged anteriorly in tandem with associative coding. Thus, along the posterior-anterior axis of MTG, the representation of the visual attributes of events is transformed to a representation of both specific and generalizable relational attributes.

The multifaceted abstract brain

concepts play a central role in human behaviour and constitute a critical component of the human conceptual system. Here, we investigate the neural basis of four types of abstract concepts, examining their similarities and differences through neuroimaging meta-analyses. We examine numerical and emotional concepts, and two higher-order abstract processes, morality judgements and theory of mind. Three main findings emerge. First, representation of abstract concepts is more widespread than is often assumed. Second, representations of different types of abstract concepts differ in important respects. Each of the domains examined here was associated with some unique areas. Third, some areas were commonly activated across domains and included inferior parietal, posterior cingulate and medial prefrontal cortex. We interpret these regions in terms of their role in episodic recall, event representation and social-emotional processing. We suggest that different types of abstract concepts can be represented and grounded through differing contributions from event-based, interoceptive, introspective and sensory-motor representations. The results underscore the richness and diversity of abstract concepts, argue against single-mechanism accounts for representation of all types of abstract concepts and suggest mechanisms for their direct and indirect grounding.This article is part of the theme issue 'Varieties of abstract concepts: development, use and representation in the brain'.

Ocular Adverse Events following Use of Immune Checkpoint Inhibitors for Metastatic Malignancies

PURPOSE

To report the clinical features, severity, and management of ocular immune-related adverse events (irAEs) in the setting of immune checkpoint inhibitor therapy for metastatic malignancies.

METHODS

Retrospective chart review at three tertiary ophthalmology clinics. Electronic medical records were reviewed between 2000 and 2017 for patients with new ocular symptoms while undergoing checkpoint inhibition therapy.

RESULTS

Eleven patients were identified. Ocular irAEs ranged from keratoconjunctivitis sicca to Vogt-Koyanagi-Harada-like findings. Average timing of irAEs from starting checkpoint inhibitor therapy was 15.7 weeks. Ocular inflammation was successfully controlled with corticosteroids in most cases, however three patients discontinue treatment as a result of ocular inflammation with decreased visual acuity, two discontinued due to progression of metastatic disease, and one discontinued due to severe systemic irAEs.

CONCLUSION

We found a wide spectrum of ocular irAEs associated with immune checkpoint inhibitors. In most cases, ocular AEs did not limit ongoing cancer treatment.

Transcending time in the brain: How event memories are constructed from experience

Our daily lives unfold continuously, yet when we reflect on the past, we remember those experiences as distinct and cohesive events. To understand this phenomenon, early investigations focused on how and when individuals perceive natural breakpoints, or boundaries, in ongoing experience. More recent research has examined how these boundaries modulate brain mechanisms that support long-term episodic memory. This work has revealed that a complex interplay between hippocampus and prefrontal cortex promotes the integration and separation of sequential information to help organize our experiences into mnemonic events. Here, we discuss how both temporal stability and change in one's thoughts, goals, and surroundings may provide scaffolding for these neural processes to link and separate memories across time. When learning novel or familiar sequences of information, dynamic hippocampal processes may work both independently from and in concert with other brain regions to bind sequential representations together in memory. The formation and storage of discrete episodic memories may occur both proactively as an experience unfolds. They may also occur retroactively, either during a context shift or when reactivation mechanisms bring the past into the present to allow integration. We also describe conditions and factors that shape the construction and integration of event memories across different timescales. Together these findings shed new light on how the brain transcends time to transform everyday experiences into meaningful memory representations.

Semantic detail in the developing verb lexicon: An extension of Naigles and Kako (1993)

Verbs are often uttered before the events they describe. By 2 years of age, toddlers can learn from such an encounter. Hearing a novel verb in transitive sentences (e.g. The boy lorped the cat), even with no visual referent present, they later map it to a causative meaning (e.g. feed) (e.g. Yuan & Fisher, ). How much semantic detail does their verb representation include on this first, underinformative, encounter? Is the representation sparse, including only information for which they have evidence, or do toddlers make more specific guesses about the verb's meaning? In two experiments (N = 76, mean age 27 months), we address this using an event type studied by Naigles and Kako (); they found that when toddlers hear a novel transitive verb while simultaneously viewing a non-causative referent-a contact event such as patting-they map the verb to the contact event. In Experiment 1 we replicated this basic result. Further, toddlers' representations persisted over a 5-minute delay, manifesting again during a retest. In Experiment 2, toddlers heard the verbs while watching two actors converse instead of while seeing contact events. At test, they showed no evidence of mapping the verbs to contact events, either initially or after a 5-minute delay, despite that in prior work they mapped verbs to causative events under identical circumstances. We infer that on hearing a novel verb in a transitive frame, absent a relevant visual scene, toddlers posit a more specific representation than the evidence requires-one that incorporates causative semantics. A video abstract of this article can be viewed at: https://youtu.be/aRCqSTbr6Bw.

[Cardiovascular protection of diabetic patient with chronic renal disease and particular case of end-stage renal disease in elderly patients]

Type 2 diabetes has an increasing prevalence. Life expectancy is dominated by cardiovascular risk, which is the leading cause of death in these patients. Up to one third of diabetic patients will develop diabetic nephropathy related to micro-angiopathy. Renal impairment further increases cardiovascular risk. Reducing cardiovascular morbidity and mortality is a major public health issue, as well as early preventing and managing chronic kidney disease (CKD). Good glycemic control prevents the micro-vascular complications of the disease (retinopathy, nephropathy, etc.) and, more recently recognized through prolonged monitoring of the VADT cohort, prevents cardiovascular complications. Control of blood pressure and dyslipidemia are essential in primary or secondary cardiovascular prevention. In addition, the blockers of the renin-angiotensin system slow down the progression of the MRC. Elderly patients with chronic kidney disease (CKD) form another growing group of the nephrologist daily patient pool. Especially for very elderly patients with comorbidities, the question of favoring conservative treatment rather than starting or pursuing dialysis may arise. Survival and quality of life are indeed not necessarily better in elderly patients undergoing dialysis, complications can occur eventually leading to discontinuation, and are occasionally associated with a feeling of stubbornness. Creation of prognostic score is a useful tool to help the decision-making process. However, dialogue with the patient and his/her family, as well as multidisciplinary collaboration remain fundamentals to determine the most suitable care.

From Actions to Effects: Three Constraints on Event Mappings

Events can be modeled through a geometric approach, representing event structures in terms of spaces and mappings between spaces. At least two spaces are needed to describe an event, an action space and a result space. In this article, we invoke general mathematical structures in order to develop this geometric perspective. We focus on three cognitive processes that are crucially involved in events: causal thinking, control of action and learning by generalization. These cognitive processes are supported by three corresponding mathematical properties: monotonicity (that we relate to qualitative causal thinking and allows extrapolation); continuity (that plays a key role in our activities of action control); and convexity (that facilitates generalization and the categorization of events, and enables interpolation). We define how such properties constrain events representations and relate them to thinking about events. We discuss the relevance of the three constraints for event segmentation and explore the implications of such constraints for semantics. We conclude by a discussion that relates our approach to other accounts of events.

Unified infusion rates for 10% intravenous immunoglobulin

Although manufacturers recommend varying infusion rates for differing intravenous immunoglobulin products (IVIg), there may be improved efficiency and reduced potential for error with the application of a single infusion policy for all IVIg products. During the transition from a 6% to a 10% IVIg, we prospectively evaluated patient reported adverse reactions to IVIg with the 10% product (Intragam 10) given at a rate faster than recommended by the manufacturer. While there was a significant increase in the rate of immediate infusion reactions when compared with the previous IVIg preparation (Intragam P), there was no increase in the rate of reactions post infusion. The rate of reactions was within previously reported expectations for other IVIg products. All reactions were minor, requiring no or minimal intervention and few impacted significantly on the quality of life. Despite an active haemovigilance program, minor adverse reactions were generally not reported. Our results suggest that a fast single rate of IVIg infusion is safe, and may minimise patient attendance and hospital resources with acceptable safety. In implementing a strategy to increase IVIg infusion rates an active process to monitor safety is preferred over standard haemovigiliance or pharmacovigilance processes.

Glomerular hyperfiltration is a predictor of adverse cardiovascular outcomes

The association between glomerular hyperfiltration and cardiovascular events is not well known. To investigate whether glomerular hyperfiltration is independently associated with risk of adverse outcome we analyzed 8794 participants, average age 52 years enrolled in 8 prospective studies. Of these, 89% had hypertension. Using the 5th and 95th percentiles of the age- and sex-specific quintiles of CKD-EPI-calculated estimated glomerular filtration rate (eGFR), we identified three participant groups with low, high and normal eGFR. The ambulatory pulse pressure interval was wider and nighttime blood pressure fall was smaller in both the low and high than in the normal eGFR participants. During a mean follow-up of 6.2 years, there were 722 cardiovascular events. Crude event rates were significantly higher for both high (1.8 per 100-person-year) and low eGFR groups (2.1 per 100 person-year) as compared with group with normal eGFR (1.2 per 100 person-year). In multivariable Cox models including age, sex, average 24-hour blood pressure, smoking, diabetes, and cholesterol, both high eGFR (hazard ratio 1.5 (95% confidence interval 1.2-2.1) and low eGFR (2.0 [1.5-2.6]) participants had a significantly higher risk of cardiovascular events as compared to those with normal eGFR. Addition of body mass index to the multivariable survival model did not change the magnitude of hazard estimates. Thus, glomerular hyperfiltration is a strong and independent predictor of cardiovascular events in a large multiethnic population of predominantly hypertensive individuals. Our findings support a U-shaped relationship between eGFR and adverse outcome.

The pros and cons of researching events ethnographically

Events (remarkable, disruptive happenings) are important subjects of study for understanding processes of change. In this essay, I reflect upon the issue of what the ethnographic method has to offer for the analysis of this social phenomenon. To do so, I review three recently published ethnographic studies of events. My conclusion is that it is indeed a very useful method for understanding the feelings and ideas of people who are experiencing eventful situations, for instance around protests or natural disasters. However, using this method also brings about practical difficulties, such as the 'luck' that an event occurs at the ethnographic fieldwork site. Next, as transformative responses to events are not bound by the place or time of the happening, other methods (interviews, discourse analysis, surveys) that make it easier to follow them in varying locations and periods might be more suitable for getting a comprehensive picture of their meaning-making dynamics.

Patients as Partners in Learning from Unexpected Events

IMPORTANCE

Patient safety experts believe that patients/family members should be involved in adverse event review. However, it is unclear how aware patients/family members are about the causes of adverse events they experienced.

OBJECTIVE

To determine whether patients/family members interviewed could identify at least one contributing factor for the event they experienced. Secondary objectives included understanding the way patients/family members became aware of adverse events, the types of contributing factors patients/family members identified for different types of adverse events, and recommendations provided by patients/family members to address the contributing factors.

DESIGN

We interviewed patients/family members using semistructured interviews to understand their perceptions about why these adverse events occurred. The adverse events occurred between 1991 and 2014.

SETTING

Participants described adverse events that occurred in various types of health care organizations (i.e., hospitals, ambulatory facilities/clinics, and dental clinics).

PARTICIPANTS

We interviewed 72 patients and family members who each described a unique adverse event. Eligibility requirements were that patients/family members spoke English or Spanish and were aware of an adverse event that happened to them or a loved one. INTERVENTION(S) FOR CLINICAL TRIALS OR EXPOSURE(S) FOR OBSERVATIONAL STUDIES: N/A.

MAIN OUTCOME(S) AND MEASURE(S)

The main outcome was determining whether patients/family members could identify at least one contributing factor they perceived as related to the adverse event they described.

RESULTS

Each participant identified at least one contributing factor and on average identified 3.67 contributing factors for their event. The most frequently mentioned contributing factors were Staff Qualifications/Knowledge (79 percent), Safety Policies/Procedures (74 percent), and Communication (64 percent). Participants knew about the contributing factors from personal observation only (32 percent), personal reasoning (11 percent), personal research (7 percent), record review (either their own medical records or reports they received in their own investigation; 6 percent), and being told by a physician (5 percent). Finally, patients/family members were able to provide recommendations that address each of the nine contributing factors we examined.

CONCLUSIONS AND RELEVANCE

Patients/family members identified contributing factors related to their adverse event. Given that these contributing factors might not be known to health care organizations because most participants stated that they were not involved in the analysis process, opportunities for organizational learning from patients are potentially being missed. Health care organizations should interview patients/family about the event that harmed them to help ensure a full understanding of the causes of the event.

Posttraumatic Stress Disorder and Stressful Life Events Among Rural Women With HIV Disease

Posttraumatic stress disorder (PTSD) and stressful life events are frequent and distressing problems for women living with HIV (WLWH). Studies have independently focused on the impact of these problems, but little work has examined the relationship between PTSD and stressful life events. Our cross-sectional study examined relationships between PTSD and recent stressful life events in WLWH. A sample of 60 women recruited through HIV community agencies in southeastern North Carolina completed the Stressful Life Events Questionnaire and the PTSD Checklist-Civilian Version (PCL-C). PTSD prevalence was high (43.2%). Two-thirds (66%) reported three or more recent life stressors. Women who experienced a higher number of recent life stressors scored higher on the PCL-C than those with fewer life stressors (p < .001). Recent stressful life events may accelerate PTSD symptoms. Findings underscore the importance of addressing mental health issues in HIV treatment settings. Implications for nursing practice are provided.

Critical incidents, including cardiac arrest, associated with pediatric anesthesia at a tertiary teaching children's hospital

BACKGROUND

Analysis of critical incidents provides valuable information to improve the quality and safety of patient care. This study identified and analyzed pediatric anesthesia-related critical incidents including cardiac arrests in a tertiary teaching children's hospital.

METHODS

All pediatric anesthesia-related critical incidents reported in a voluntary departmental reporting system between January 2008 and August 2013 were included in the analysis. A critical incident was defined as (i) any incident that altered patients' vital signs and affected the management of patients while they were under the care of an anesthesiologist, and (ii) human factor: where patient injury or accidents were as a result of human error. Changes in vital signs that recovered spontaneously were excluded.

RESULTS

During the 6-year study period, a total of 229 critical incidents were reported from 49,373 anesthetic procedures. The most frequently reported incidents were associated with the respiratory system (55%), with tracheal tube-related events accounting for 40.9% of respiratory incidents followed by laryngospasm (17.3% of respiratory incidents). Cardiac arrest occurred in 42 cases in this study (8.5 cases per 10,000 anesthetics). Cardiovascular problems were the major causes of cardiac arrest (66.7%), and incidents of cardiogenic shock and hemorrhage/hypotension contributed equally to the cardiac arrest induced by cardiovascular problems (each 16.7%). Human factor-related events accounted for 58.5% of all critical incidents of which 53.7% were respiratory events.

CONCLUSION

Despite recent improvements in safety of pediatric anesthesia, many preventable factors still remain that can lead to critical incidents.

Events and children's sense of time: a perspective on the origins of everyday time-keeping

In this article I discuss abstract or pure time versus the content of time, (i.e., events, activities, and other goings-on). Or, more specifically, the utility of these two sorts of time in time-keeping or temporal organization. It is often assumed that abstract, uniform, and objective time is a universal physical entity out there, which humans may perceive of. However, this sort of evenly flowing time was only recently introduced to the human community, together with the mechanical clock. Before the introduction of mechanical clock-time, there were only events available to denote the extent of time. Events defined time, unlike the way time may define events in our present day culture. It is therefore conceivable that our primeval or natural mode of time-keeping involves the perception, estimation, and coordination of events. I find it likely that events continues to subserve our sense of time and time-keeping efforts, especially for children who have not yet mastered the use of clock-time. Instead of seeing events as a distraction to our perception of time, I suggest that our experience and understanding of time emerges from our perception of events.

Investigating the prevalence and causes of events leading to falls among the elderly hospitalized in Bandar Abbas hospitals

BACKGROUND AND PURPOSE OF STUDY

Statistical indices show a growing increase in the elderly population around the world and our country. On the one hand, senior citizens are more exposed to tragic events than other age groups due to natural physiological changes. Falling down, accidents and scalds are among the most prevalent deadly events in this age group. Environmental security is vital in maintaining the elderly's health. Therefore, the present research was conducted seeking to determine the prevalence and causes of falls among the elderly hospitalized in Bandar Abbas hospitals.

METHODS AND MATERIALS

The present research is of a descriptive, cross-sectional type. Research population is comprised of all the elderly patients in Bandar Abbas hospitals. The sample included 300 individuals who were selected according to convenience sampling method till the sample was saturated. The instrument used was a questionnaire and the data were also gathered through interviews. The collected data were later analyzed by SPSS version 16. To analyze the data, descriptive statistics (frequency and percentage) were used along with the Chi-squared test. The significance level was set at P < 0.05.

RESULTS

From among the 300 subjects, 47.3% had experienced falls since the age of 60. In 22 of cases, it had led to injury and they were obliged to visit a doctor. The results of this research revealed that the causes of falls among the elderly were respectively: 43.33% of unbalance, 12.3% of poor eyesight, 11.66% of non-existing handles or fences, 12% of slippery ground, 2.66% of insufficient lightning, 8.66% of unbalance and poor eyesight and 9.33% of other reasons. As the results revealed, a correlation existed between falls and educational level (P < 0.025). Moreover, a significant correlation was found between sex and falls (P < 0.011). A similar significant correlation was also observed between the place of residence and falling down (P < 0.045).

CONCLUSION

According to the research results, planning to prevent events and traumas among the elderly and securing their residential environment is of an essential significance.

Splenic metabolic activity predicts risk of future cardiovascular events: demonstration of a cardiosplenic axis in humans

OBJECTIVES

This study sought to determine whether splenic activation after acute coronary syndrome (ACS) is linked to leukocyte proinflammatory remodeling and whether splenic activity independently predicts the risk of cardiovascular disease (CVD) events.

BACKGROUND

Pre-clinical data suggest the existence of a cardiosplenic axis, wherein activation of hematopoietic tissues (notably in the spleen) results in liberation of proinflammatory leukocytes and accelerated atherosclerotic inflammation. However, it is presently unknown whether a cardiosplenic axis exists in humans and whether splenic activation relates to CVD risk.

METHODS

(18)F-fluorodeoxyglucose ((18)FDG)-positron emission tomography (PET) imaging was performed in 508 individuals across 2 studies. In the first study, we performed FDG-PET imaging in 22 patients with recent ACS and 22 control subjects. FDG uptake was measured in spleen and arterial wall, whereas proinflammatory gene expression of circulating leukocytes was assessed by quantitative real-time polymerase chain reaction. In a second study, we examined the relationship between splenic tissue FDG uptake with subsequent CVD events during follow-up (median 4 years) in 464 patients who previously had undergone FDG-PET imaging.

RESULTS

Splenic activity increased after ACS and was significantly associated with multiple indices of inflammation: 1) up-regulated gene expression of proinflammatory leukocytes; 2) increased C-reactive protein; and 3) increased arterial wall inflammation (FDG uptake). Moreover, in the second study, splenic activity (greater than or equal to the median) was associated with an increased risk of CVD events (hazard ratio [HR]: 3.3; 95% confidence interval [CI]: 1.5 to 7.3; p = 0.003), which remained significant after adjustment for CVD risk factors (HR: 2.26; 95% CI: 1.01 to 5.06; p = 0.04) and for arterial FDG uptake (HR: 2.68; 95% CI: 1.5 to 7.4; p = 0.02).

CONCLUSIONS

Our findings demonstrate increased splenic metabolic activity after ACS and its association with proinflammatory remodeling of circulating leukocytes. Moreover, we observed that metabolic activity of the spleen independently predicted risk of subsequent CVD events. Collectively, these findings provide evidence of a cardiosplenic axis in humans similar to that shown in pre-clinical studies.

A Risk Score Derived from the Analysis of a Cluster of 27 Serum Inflammatory Cytokines to Predict Long Term Outcome in Patients with Acute Myocardial Infarction: a Pilot Study

BACKGROUND

The aim of our study was to evaluate the clinical utility and prognostic significance of a cluster of 27 serum cytokines for risk stratification after myocardial infarction.

MATERIALS AND METHODS

We enrolled 33 consecutive patients admitted to our institution for acute myocardial infarction and prospectively followed. We evaluated traditional cardiovascular risk factors and assayed, during the acute phase, 27 serum cytokines (IL-1, IL-1ra, IL-2, IL-4, IL-5, IL-6, IL -7, IL-8, IL-9, IL-10, IL-12, IL-13, IL-15, IL-17, EOTAXIN, FGF, G-CSF, GM-CSF, IFN-γ, IP-10, MCP-1, MIP-1α, MIP-1β, PDGF, RANTES, TNF-α, VEGF) potentially associated with cardiovascular risk. Patients were divided into two groups during follow-up according to the occurrence or absence of adverse cardiovascular events (recurrence of angina, re-infarction, death, need of new revascularization, occurrence of heart failure). We developed an additive risk score by assigning one point for each cytokine that had a value greater than the median value (range 0-27). Cytokines alone and the cytokines score were related to cardiovascular events.

RESULTS

Patients with and without major adverse cardiovascular events (MACEs) at follow up had a homogenous distribution of the main cardiovascular risk factors; differences were detected only for sex and age. Patients who experienced MACE had a significantly different distribution of I troponin (p=0.036), IL-8 (p=0.006), IL-13 (p=0.06), IL-10 (p=0.02), IL-17 (p=0.015), IP-10 (p=0.02), MIP-1β (p=0.05). At univariate analysis, IL -8 (p=0.046 OR 1.13), IL-10 (p=0.05 OR 1.14) and MIP-1β (p=0.016, OR 1.02) were significantly associated with the occurrence of MACE. This association was not confirmed at multivariate analysis. At the analysis of variance, a higher score was significantly associated with the occurrence of adverse events at follow up (F=5.07, p=0.03). At ROC curve analysis, a score greater than 13 better predicted the occurrence of adverse events at follow-up (AUC 0.72, p=0.03, sensibility 59.1%, specificity 81.8%).

CONCLUSIONS

In our study we did not identify a single inflammatory cytokine able to predict adverse events in a long term follow up, whereas the presence of more than 13 cytokines above the median value was useful for risk stratification.

Predictors of recording an event during prolonged inpatient video electroencephalogram monitoring in children

BACKGROUND

Distinguishing between seizures and nonepileptic events is a key challenge in pediatric neurology. The diagnostic gold standard is prolonged inpatient video electroencephalogram monitoring. However, little is known about preadmission characteristics that are predictive of recording an event during such monitoring.

METHODS

This is a retrospective chart review of children undergoing prolonged inpatient video electroencephalogram monitoring between 2009 and 2012 at a tertiary referral center for the purpose of distinguishing between seizures and nonepileptic events. Demographic information, medical history, event characteristics, and inpatient monitoring course were abstracted.

RESULTS

Two-hundred thirteen children were identified. The median recording duration was 25 hours (interquartile range 22.4-48.5), and median time to event of interest (among those with an event recorded) was 4.5 hours (interquartile range 1.4-18.8). An event of interest was recorded in 66% of patients. At the event level, 20% of recorded events were associated with an electroencephalogram correlate, which refers to a change in the pattern seen on the electroencephalogram during a seizure. At the patient level, 112 (79.4%) with events recorded had only nonepileptic events recorded, 25 (17.7%) had only seizures recorded, and 4 (2.8%) had both recorded. Recording an event was predicted by the presence of intellectual disability (P = 0.001), greater preadmission event frequency (P < 0.001), and shorter latency since most recent event (P < 0.001).

CONCLUSIONS

Prolonged inpatient electroencephalogram monitoring captured an event of interest in two-thirds of patients, with most of these events captured within less than four and a half hours of recording onset. Several factors predict a greater yield with prolonged inpatient video electroencephalogram monitoring--including event frequency, latency since the most recent event, and the presence of intellectual disability--and can be used to counsel patients regarding this study for the purpose of event capture in the context of shared decision making.

Cardiovascular disease risk reduction in rural China: a clustered randomized controlled trial in Zhejiang

BACKGROUND

Cardiovascular disease (CVD) is a major cause of death in China. Despite government efforts, the majority of hypertensive and diabetic patients in China do not receive proper treatment. Reducing CVD events requires long-term care that is proactive, patient-centred, community-based, and sustainable. We have designed a package of interventions for patients at high risk of CVD to be implemented by family doctors based in township hospitals (providers of primary care) in rural Zhejiang, China. This trial aims to determine whether the systematic CVD risk reduction package results in reduced CVD events among patients at risk of CVD compared with usual care, and whether the package is cost-effective and suitable for routine implementation and scale-up.

METHODS/DESIGN

This is a prospective, open-label, cluster randomized controlled trial (RCT) with blinded data analysis. The trial will randomize 67 township hospitals with 31,708 participants in three counties in Zhejiang Province. Participants will be identified from existing health records and will comprise adults aged 50 to 74 years, with a calculated 10-year CVD risk of 20% or higher, or diabetes. In the intervention arm, participants will receive a package of interventions including: 1) healthy lifestyle counseling (smoking cessation, and salt, oil, and alcohol reduction); 2) prescription of a combination of drugs (antihypertensives, aspirin, and statin); and 3) adherence support for drug compliance and healthy lifestyle change. In the control arm, participants will receive usual care for hypertension and diabetes management at individual clinicians' discretion. The primary outcome is the incidence of severe CVD events over 24 months of follow-up. All CVD events will be defined according to the World Health Organization (WHO) monitoring of trends and determinants in cardiovascular disease (MONICA) definitions, diagnosed at the county hospital or higher level, and reported by the Zhejiang surveillance system. Secondary outcomes include: mean systolic and diastolic blood pressure, blood glucose, serum total cholesterol (TC), and adherence to appointments, and drugs and lifestyle changes.

DISCUSSION

This trial focuses on risk reduction of CVD rather than specific diseases. It is not designed to compare therapeutic and healthy lifestyle interventions, but rather their combined effects in primary care settings. Through the trial, we intend to understand the effectiveness of the comprehensive CVD reduction package in routine practice. We also intend to understand the barriers and facilitators to implementing the package, and thus to advise on policy and practice change.

TRIAL REGISTRATION

Current Controlled Trials: ISRCTN58988083.

MOBBED: a computational data infrastructure for handling large collections of event-rich time series datasets in MATLAB

Experiments to monitor human brain activity during active behavior record a variety of modalities (e.g., EEG, eye tracking, motion capture, respiration monitoring) and capture a complex environmental context leading to large, event-rich time series datasets. The considerable variability of responses within and among subjects in more realistic behavioral scenarios requires experiments to assess many more subjects over longer periods of time. This explosion of data requires better computational infrastructure to more systematically explore and process these collections. MOBBED is a lightweight, easy-to-use, extensible toolkit that allows users to incorporate a computational database into their normal MATLAB workflow. Although capable of storing quite general types of annotated data, MOBBED is particularly oriented to multichannel time series such as EEG that have event streams overlaid with sensor data. MOBBED directly supports access to individual events, data frames, and time-stamped feature vectors, allowing users to ask questions such as what types of events or features co-occur under various experimental conditions. A database provides several advantages not available to users who process one dataset at a time from the local file system. In addition to archiving primary data in a central place to save space and avoid inconsistencies, such a database allows users to manage, search, and retrieve events across multiple datasets without reading the entire dataset. The database also provides infrastructure for handling more complex event patterns that include environmental and contextual conditions. The database can also be used as a cache for expensive intermediate results that are reused in such activities as cross-validation of machine learning algorithms. MOBBED is implemented over PostgreSQL, a widely used open source database, and is freely available under the GNU general public license at http://visual.cs.utsa.edu/mobbed. Source and issue reports for MOBBED are maintained at http://vislab.github.com/MobbedMatlab/