End Date Research Articles

Protocol publication rate and comparison between article, registry and protocol in RCTs.

Increasing transparency in clinical research is crucial to avoid misleading conclusions. Registering clinical trials prior to participant enrolment is mandatory, and the publication of trial protocols could further enhance transparency. However, the impact of protocol publication on primary outcomes (PO) and sample sizes (SS) remains unclear. This study aimed to determine the rates of trial protocol publication and registration for a sample of randomized controlled trials (RCTs) and to compare the consistency of published and registered PO and SS. A search was conducted in MEDLINE via PubMed® for RCT reports indexed in May and June 2023 across various medical specialties, focusing on general and high-impact factor journals. Data were extracted regarding trial registration, protocol publication, and comparisons were made between PO and SS in articles, registries, and published protocols. Out of 1119 references, 589 (52.6%) were RCTs. The corresponding protocol was published for 146 RCTs (24.8%) including 40 over 140 (28.6%) (6 without end date available) after the trial had ended. Sixty-two (42.4%) protocols were published before the trial conclusion, with no significant differences between PO and SS in published protocols and their corresponding articles. Five hundred and twenty-eight (89.6%) RCTs were registered, 225 over 510 (44%) were registered before the study start with no differences in PO and SS between article and registry. Articles published in generalist or high impact factor journals were associated with higher frequencies of published protocols and trial registration and a lower frequency of difference in PO and SS between articles, registries, and published protocols. While publishing trial protocols may enhance transparency in peer-review process, the initial registered protocol alone appears sufficient for ensuring consistency in primary outcomes and sample sizes. Protocol publication does not seem to provide additional significant benefits in terms of outcome reporting.

P-1884. Evaluation of Outpatient Parenteral Antimicrobial Therapy Practices within a Large Healthcare System

Abstract Background The practice of outpatient parenteral antimicrobial therapy (OPAT) has challenges such as reduced control and monitoring in the outpatient setting. Lack of availability of OPAT lab monitoring is associated with poorer outcomes. This study sought to describe the operations and practices of an OPAT program within a large health system to identify clinical and operational opportunities for workflow improvement. Laboratory monitoring completion over proportion of OPAT courses Methods This was a retrospective cohort study of patients receiving OPAT in a large healthcare system from January 1, 2022 to December 31, 2022. After excluding OPAT courses initiated in the outpatient setting and courses less than 7 days long, 200 OPAT courses for patients greater than 18 years of age were selected, using a random sample generator, from the Cleveland Clinic OPAT registry. Events were followed until the OPAT end date or 30 days, whichever occurred sooner. The relationship between lab monitoring completion within 24 hours of scheduled date and detection of clinically significant lab abnormalities (CSLAs) was examined using linear regression. Secondary outcomes included the rate of emergency department (ED) visits and readmissions. Cumulative incidence of ED visits by target lab monitoring level Results The mean age (SD) of included patients was 63 years (27) and 64% were male. Fewer than half the OPAT courses had 80% or higher lab monitoring completion (Figure 1). Detected CSLAs are shown in Table 1. In a linear regression model adjusted for high-risk medications, the number of CSLAs detected per OPAT course increased by 0.003 (95% C.I. 0.002 – 0.004) per unit increase in percentage lab monitoring completion (p < 0.001). ED visit within 30 days was 11% (Figure 2) and readmission within 30 days was 23% (Figure 3). Reasons for readmission included non-OPAT-related (53%, n=24 of 45), infection-related (40%, n=18 of 45), and adverse OPAT drug effects (9%, n=4 of 45). Cumulative incidence of readmissions by target lab monitoring level Conclusion This study showed a substantial gap in lab completion and a significant association between lab monitoring completion and detection of CSLAs, thereby demonstrating clinical and operational opportunity for OPAT workflow improvement with monitoring and follow-up actions. A multidisciplinary OPAT team with clearly defined roles may enhance safety, effectiveness, and efficiency within the program. Detection of Clinically Significant Lab Abnormalities Disclosures Andrea Pallotta, PharmD, Astra Zeneca: Advisor/Consultant|Viiv: Advisor/Consultant

Revocation nation: the rule of law and precarious legal status in Norway

ABSTRACT In response to increased numbers of refugee claimants in 2015, the Norwegian government introduced restrictive measures aimed, in part, at deterring future arrivals. These included the mandatory cessation of refugee status when conditions underpinning the grant of asylum have changed. Unlike in Denmark, however, group-based cessation practices have not remained a distinct priority for immigration authorities. Instead, protection reviews are entangled with efforts to combat fraud in the immigration system, and stricter conditions for settlement. The interaction of these measures prolongs temporary residence status and intensifies the possibility of deportation for previously secure immigrant groups. In this article I analyze how precarious status is consolidated through three mechanisms collectively referred to as ‘revocation’ in national law and practice: cessation assessments, the revocation of residence permits, and denaturalization. I then outline two dilemmas that revocation practice poses from a rule of law perspective. I conclude that legal certainty, a core rule of law value, can only be secured by introducing an ‘end date’ to uncertainty. This could be achieved by lifting the threat of cessation after a limited period of time and by introducing a statute of limitations for revocation based on fraud.

Investigation of the October effect in very low-frequency (VLF) signals

Abstract. Subionospheric very low-frequency (VLF) radio signals are reflected by free electrons in the ionospheric D-region at about 60–90 km altitude and can propagate over long distances, which makes them useful for monitoring the state of the D-region or perturbations due to solar flares. At the D-region height, the ionosphere is mainly ionized by solar Lyman-α radiation. The reflection characteristics of VLF signals depend on the state and dynamics of the D-region, which is highly influenced by Lyman-α radiation. Although the amplitude of the received terrestrial VLF signal changes as a function of solar zenith angle over the course of the year, the VLF amplitude shows a distinctive sharp decrease around October, which is hence called the “October effect”. This study investigates the occurrence of the October effect and its dependencies on latitude and longitude. We developed a method to detect the occurrence of the October effect in the long-term VLF data and derive key parameters characterizing (start and end date, intensity) the sudden decrease in the signal amplitude. This investigation using a network of VLF stations distributed over low-, middle-, and high-latitude regions shows that the occurrence of the October effect has a clear latitudinal dependency, occurring earlier in high-latitude regions than at midlatitudes. No low-latitude signature is found.

Clopidogrel combined with rivaroxaban in peripheral artery disease after revascularization.

To evaluate the efficacy and safety of clopidogrel-rivaroxaban combination compared to aspirin-rivaroxaban combination in patients with symptomatic peripheral artery disease (PAD). Consecutive patients with symptomatic PAD patients were analyzed from January, 2018 to June, 2022at Nanjing Drum Tower Hospital. Patients were divided into two groups based on the antithrombotic therapy. The primary efficacy outcome was a composite of major adverse cardiovascular events (MACE) and major adverse limb events (MALE), and the primary safety outcome was major bleeding. Patients were followed until the first occurrence of any outcomes or the study end date (30 June 2024). A total of 695 patients were enrolled into this study. The clopidogrel-rivaroxaban combination significantly reduced the risk of composite outcome (HR: 0.59, 95%CI: 0.41-0.83) without increasing the risk of major bleeding (HR: 0.68, 95%CI: 0.27-1.69). When analyzed separately, clopidogrel-rivaroxaban combination was associated with a reduced risk of MALE (HR: 0.61, 95%CI: 0.41-0.91), although no significant differences were observed in terms of MACE (HR: 0.64, 95%CI: 0.34-1.20) or all bleeding events (HR: 1.00, 95%CI: 0.52-1.93). In the subgroup analysis, there were no significant interactions between the treatment groups and the subgroups of age, diabetes, lesion sites, Rutherford classifications and renal function for composite outcome, MACE and MALE. The clopidogrel-rivaroxaban combination in PAD patients may offer enhanced cardiovascular protection without increasing the risk of bleeding complications. These findings suggested that clopidogrel could be a superior alternative to aspirin in dual antithrombotic therapy for PAD management.

Timing of Delivery of Low-Risk Persons and the Risk of Attention-Deficit Hyperactivity Disorder in Offspring: Sweden and British Columbia, Canada.

An evidence gap exists concerning the timing of delivery at 37-42 weeks and the risk of attention-deficit hyperactivity disorder (ADHD) in offspring. To determine the association between timing of delivery in low-risk pregnancies at term (37-42 weeks) gestations and ADHD in offspring. This population-based cohort study comprised 1,424,453 singletons in Sweden and 403,765 in British Columbia (BC), Canada, live-born at 37-42 completed weeks to low-risk pregnant women between 2000 and 2018. Children were followed up from age 1 until the date of death, emigration, their first diagnosis, or December 2020 (study's end date). The exposure was time of delivery assessed through gestational age, and the outcome was the diagnosis of ADHD. Cox regression models were used to examine the association between gestational age at delivery and ADHD. During the follow-up period, 59,989 children in Sweden were diagnosed with ADHD (4.5 per 1000 child-years). Correspondingly, in BC, during the same period, there were 27,445 children diagnosed with ADHD (7.4 per 1000 child-years). In Sweden, the adjusted hazard of ADHD was 10%, 6%, and 3% higher at 37, 38, and 39 weeks gestation compared with those born at ≥ 38, ≥ 39,and ≥ 40 weeks, respectively. In BC, the corresponding hazards were 9%, 6%, and 3%, respectively. Both regions showed no elevated ADHD risks for infants born at 40 weeks compared to those born at ≥ 41 weeks, with slightly lower rates at 40 weeks. In low-risk pregnancies, births at 37 and 38 weeks were associated with a higher ADHD risk, while births at 40 weeks showed no increased risk compared with those born at later gestations.

Niraparib as First-Line Maintenance Therapy in Patients with Stage III Ovarian Cancer and No Visible Residual Disease: AR1ZE Real-World Study.

Niraparib was approved for first-line (1L) maintenance (1LM) treatment of patients with advanced epithelial ovarian cancer (EOC) following the PRIMA/ENGOT-OV26/GOG-3012 (PRIMA) trial. PRIMA was restricted to patients at higher risk of progression (excluded stage III EOC with no visible residual disease [NVRD] after primary cytoreductive surgery [PCS]). This retrospective study evaluated the potential impact of excluding stage III EOC with NVRD from PRIMA by assessing real-world treatment outcomes following 1LM niraparib monotherapy in this patient population. Data from a US-nationwide electronic health record-derived deidentified database comprised adult patients diagnosed with stage III/IV EOC who received 1L platinum-based chemotherapy and initiated niraparib 1LM monotherapy (01Jan2017-28Feb2023). Patients were classified as PRIMA-like (EOC with higher-risk prognostic factors for disease progression) or stage III disease with NVRD after PCS. Real-world time to next treatment (rwTTNT) and progression-free survival (rwPFS), assessed from the end date of 1L platinum-based chemotherapy, were measured via Kaplan-Meier methods. Among 453 patients who received niraparib 1LM (PRIMA-like cohort, n = 390; stage III NVRD cohort, n = 63), median follow-up from index was 14.9 (interquartile range [IQR], 7.3-25.1) and 18.4 (IQR, 9.3-29.1) months in the PRIMA-like and stage III NVRD cohorts, respectively. Median rwTTNT was significantly longer in the stage III NVRD cohort (22.5 [95% confidence interval (CI), 17.3-not reached] months) than in the PRIMA-like cohort (11.7 [95% CI, 10.8-12.9] months; P < 0.001). Median rwPFS in the stage III NVRD cohort (25.2 [95% CI, 12.6-not reached] months) was more than double that in the PRIMA-like cohort (10.1 [95% CI, 9.1-11.9] months; P < 0.001). In the stage III NVRD cohort, rwTTNT and rwPFS were significantly longer than in the PRIMA-like cohort, consistent with clinical expectation. Results suggest niraparib clinical benefit may have been underestimated in PRIMA because of the exclusion of patients with stage III EOC with NVRD after PCS.

Systematic Review and Meta-analysis on Outcomes of the Advanta V12 or iCAST Bridging Stent Graft Used for Fenestrated and Branched Endovascular Aortic Repair.

Half of re-interventions after fenestrated and branched endovascular aortic repair (FB-EVAR) are target vessel related. Regarding bridging stent choice, existing data are controversial. This meta-analysis aimed to evaluate the performance of Advanta V12/iCAST as bridging stent in FB-EVAR. The English medical literature was searched through MEDLINE, Embase (via Ovid), and Cochrane databases (end date 15 April 2024). The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and PICO (Patient; Intervention; Comparison; Outcome) model were followed. A predefined protocol was registered to PROSPERO (CRD42024556603). Randomised controlled trials and observational studies (2010 - 2024) reporting on Advanta V12/iCAST related target vessel outcomes were eligible. Risk of bias was assessed using ROBINS-I, and evidence quality was assessed via Grading of Recommendations Assessment, Development and Evaluations (GRADE). Primary outcomes were freedom from instability, stenosis and or occlusion, endoleak type Ic and IIIc, and re-intervention of target vessels bridged with the Advanta V12/iCAST. Prevalence and regression meta-analysis were performed. From 1 439 articles, ten retrospective studies (7 525 target vessels; 3 890 target vessels bridged with Advanta V12/iCAST) were included. According to ROBINS-I, no study was of high quality. Mean follow up was 24.3 (95% confidence interval [CI] 23.9 - 24.7) months. Freedom from instability, stenosis and or occlusion, and endoleak type Ic and IIIc were 94% (95% CI 91 - 96%; p < .010; I2 = 91%; GRADE certainty, very low), 97% (95% CI 96 - 98%; p = .070, I2 = 44%; GRADE certainty, low), and 97% (95% CI 94 - 98%; p < .010; I2 = 81%; GRADE certainty, very low), respectively. Freedom from target vessel re-intervention was 95% (95% CI 92 - 97%; p < .010; I2 = 85%; GRADE certainty, very low). Four studies provided extractable data on Advanta V12/iCAST in fenestrations and four in branches. No difference was detected in freedom from instability (p = .47), stenosis and or occlusion (p = .36), and endoleak type Ic and IIIc (p = .90). Freedom from re-intervention was 93% (95% CI 87 - 96%; p < .010; I2 = 90%) in fenestrations and 95% (95% CI 91 - 97%; p = .060, I2 = 64%) in branches. Advanta V12/iCAST bridging stent showed high freedom from target vessel instability, stenosis and or occlusion, and endoleak. Freedom from re-intervention was 95%, being similarly high in fenestrations and branches.

Development of a database for managing social service students using MATLAB

This work presents the development and implementation of a database for managing social service students using MATLAB. The system is designed to optimize and automate the processes of data entry, updating, deletion, and generation of student reports. The database includes essential fields such as student ID, name, account number, initial and final service periods, start and end dates, project title, and completion status. Users interact with the system through a menu-based interface in MATLAB, allowing easy addition, deletion, and modification of records. The system exports the database to a PDF report using MATLAB as a LaTeX editor, executing automatically. This solution reduces administrative workload in the laboratory, improving the efficiency and reliability of managing social service students.

Extended Reality Gaming for Exercise and Mindfulness Throughout Pediatric Cancer Rehabilitation: Protocol for a Randomized Controlled Trial.

Pediatric patients with cancer have limited options to self-manage their health while they are undergoing treatments in the hospital and after they are discharged to their homes. Extended reality (ER) using head-mounted displays has emerged as an immersive method of improving pain and mental health and promoting health-enhancing physical activity among a variety of clinical groups, but there is currently no established protocol for improving both physical and mental health in pediatric cancer rehabilitation. This phase I, pilot, feasibility randomized controlled trial aims to investigate the potential effects of a 14-week ER program on physical activity participation and indicators of health among pediatric patients with cancer who undergo bone marrow transplantation. An ancillary aim is to evaluate the feasibility of the program through participant engagement. This study includes a 2-arm parallel group design with a 1-group crossover (the control group will start the intervention after a waiting period). Overall, 16 pediatric patients with cancer undergoing rehabilitation (aged ≥8 years) at a children's hospital will be randomly allocated into one of two groups: (1) an immediate start group that undergoes an ER program in the hospital until discharge and then for 8 weeks at home (total duration of approximately 14 weeks), and (2) a waitlist control group that undergoes usual care in the hospital and for 8 weeks at home, before receiving the 8-week home ER program. The program will include active video gaming with rhythmic music exercises as well as mindfulness-based practices using a high-quality app. Home-based programming will include behavioral coaching calls. Physical activity will be measured daily through step counts using a tri-axial accelerometer. Health outcomes will be measured across time and include global health, measured by the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Global Health Scale Short Form 7+2, and lung function, measured by a forced expiratory volume using a peak flow meter. Feasibility will be evaluated through participant engagement metrics, such as enrollment, dropout, adverse events, and attendance rates. Descriptive statistics will be obtained for all study variables. Outcomes will be modeled using mixed modeling procedures, and changes in means will be estimated with CIs. The study was funded in February 2024. Recruitment procedures started on June 27, 2024. All data are anticipated to be collected by February 2026. Full trial results are anticipated to be analyzed and submitted for publication by March 2026. The study's anticipated end date is March 31, 2026. This trial tests an accessible remote program for improving both physical and mental health among pediatric patients with cancer. The knowledge obtained from this study will inform the development of a larger trial. ClinicalTrials.gov NCT06298357; https://clinicaltrials.gov/study/NCT06298357. DERR1-10.2196/64879.

AI-assisted detection for chest X-rays (AID-CXR): a multi-reader multi-case study protocol

IntroductionA chest X-ray (CXR) is the most common imaging investigation performed worldwide. Advances in machine learning and computer vision technologies have led to the development of several artificial intelligence (AI)...

A new MIP RCCP model for tackling tactical project planning

This paper proposes a new continuous-time linear mixed model for rough cut capacity planning (RCCP) adapted to tackle various tactical project planning scenarios. RCCP models are typically designed for the early phases of projects to decide the work package's execution intensities for each project planning period. The goal is to solve large-scale, complex instances while ensuring both optimality and efficient resolution times. We propose modifications to the constraints of one of the best models in this field to improve its resolution. Recognizing that overlap between two consecutive periods adversely affects the performance of the MIP solver, we introduce minimal, fictitious boundaries between these periods. Additional strategies, derived from analyzing initial constraints and solver behaviour, ensure solution optimality. The objectives considered are: minimising the costs of using external resources by setting the project's end date (Time-driven) and minimising the makespan (Resource-driven). The bi-objective case is also addressed. The improved model reduces the average number of dual simplex iterations of CPLEX by 72%. Moreover, only 0.7% of large instances remained unresolved with the new model compared to nearly 30% of instances with the previous best model. The fast resolution of a single-objective problem opens up opportunities for multi-criteria approaches, making the model adaptable to more complex needs in practice.

The role of radiotherapy in intracranial hemangiopericytoma/solitary fibrous tumors : ATurkish Society for Radiation Oncology Central Nervous System Tumors Group Study (TROD 07-008).

Intracranial hemangiopericytomas (HPC) are rare tumors. Radiotherapy (RT) is frequently performed after surgery, depending on tumor size, location, and the type of resection. Moreover, RT is preferred as an effective treatment for local recurrence and metastasis. With this multicenter study, we aimed to investigate the effectiveness of postoperative RT in intracranial HPC patients using modern RT techniques. Patients aged 16years and older who underwent RT for histologically confirmed intracranial HPC were evaluated retrospectively. Forty-four patients from 17institutions were included. Demographic characteristics of the patients, pathological findings, and prognostic factors were documented. The Kaplan-Meier method was used for local control (LC), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS). The interval for survival analyses was calculated according to the end date of RT. Univariate and multivariate analysis methods were used for factors associated with survival and recurrence. Median age was 42years (16-71) and 70% of the patients were male. The most common initial symptoms were pain (47.7%) and vision problems (15.9%). Asupratentorial location was observed in 79.5% of patients. The median maximum tumor dimension was 4.7 (1.6-14) cm. Gross total (GTR) and subtotal resection (STR) were performed in 43.2% and 47.7% of patients, respectively. Adjuvant RT commenced amedian of 6 (2-16) weeks after surgery. Postoperative RT was administered using conventionally fractionated intensity-modulated radiotherapy (IMRT) or stereotactic radiosurgery (SRS). Atotal median dose of 60(38-66) Gy in amedian of 30(19-33) fractions was used for patients treated with IMRT and atotal median dose of 24(12-25) Gy in amedian of 3(1-5) fractions was used for patients treated with SRS. Local recurrence occurred in 9patients and locoregional recurrence in 2patients at amedian of 48months (range 26-143 months) after RT. Reoperation and reirradiation were applied to 5patients, reirradiation to 4patients, and reoperation to 2patients as salvage treatments. Reirradiation was administered at amedian dose of 35 (13.5-54) Gy using amedian of 5 (1-30) fractions. At amedian follow-up of 63 (6-262) months, 5‑year LC was 68.7%, DMFS 87.2%, PFS 60.8%, and OS 95.7%. The presence of residual macroscopic tumor before RT was associated with lower LC (p = 0.01) and shorter PFS (p = 0.04). In the presence of residual tumor before RT, 5‑year LC decreased from 92.9% to 46.7%, while 5‑year PFS decreased from 81.1% to 43.5% compared to patients with GTR. The presence of postoperative tumor was associated with alower LC rate in Cox regression analyzes (p = 0.02). The hazard ratio was 6.2 (1.2-30). However, the effect of residual disease before RT on OS was not statistically significant. Adjuvant radiotherapy is performed in the majority of patients with HPC, especially in cases where GTR cannot be performed. In our study, postoperative macroscopic residual tumor was found to be the only factor affecting LC and PFS in patients undergoing adjuvant RT, but its effect on OS was not shown. This may be due to the effectiveness of reoperation and/or reirradiation in the presence of recurrence after RT.

Impact of Face Mask-Wearing on Quality of Life in Post-Surgical Oral Cancer Patients: A Cross-Sectional Study.

Background: Treatments for oral squamous cell carcinomas (OSCCs) often result in significant aesthetic and functional issues, impacting patients' quality of life (QoL). The COVID-19 pandemic's mask mandates may have provided psychosocial benefits by concealing facial disfigurements, potentially reducing stigma. This study aimed to assess the impact of mask-wearing on the QoL of patients surgically treated for OSCC. Methods: This single-center, cross-sectional study, conducted from June 2022 to December 2023, included patients who had completed their treatment and returned home before or during the mask-wearing mandate. They answered a questionnaire using a four-point Likert scale to evaluate the mask-wearing's impact on QoL and the influence on it of physical appearance, tumor localization, radiotherapy, and treatment end date. Results: The questionnaire analysis found a high internal consistency among the questions (Cronbach's alpha = 0.931). Considering 41 patients (median age 69, 63% male), wearing a mask significantly improved QoL, with a mean score of 1.66 compared to a score of 2.00 for patients not wearing it (p < 0.001). This improvement was particularly notable for appearance concerns, fear of perception by family or others, and sociability apprehension. The QoL, with or without mask use, was not significantly modified when considering physical appearance, tumor localization, radiotherapy, or end date of the treatment, as demonstrated by two-way ANOVA tests and multiple linear regression. Conclusions: Mask-wearing positively impacted QoL in OSCC patients, providing psychological relief from disfigurement and social stigma. Masks offer a simple, accessible solution to enhance QoL while awaiting a definitive prosthetic treatment, suggesting that their continued use could be beneficial in supportive care strategies.

Frontal Pole Neuromodulation for Impulsivity and Suicidality in Veterans With Mild Traumatic Brain Injury and Common Co-Occurring Mental Health Conditions: Protocol for a Pilot Randomized Controlled Trial.

Suicide remains a leading cause of death among veterans in the United States, and mild traumatic brain injury (mTBI) increases the risk of suicidal ideation (SI) and suicide attempts (SAs). mTBI worsens impulsivity and contributes to poor social and occupational functioning, which further increases the risk of SI and SAs. Repetitive transcranial magnetic stimulation is a neuromodulatory treatment approach that induces neuroplasticity, potentially repairing neurodamage. Intermittent theta burst stimulation (iTBS) is a second-generation form of transcranial magnetic stimulation that is safe, shorter in duration, displays a minimal side effect profile and is a promising treatment approach for impulsivity in mTBI. Our novel proposed treatment protocol uses frontal pole iTBS to target the ventromedial prefrontal cortex, which may reduce impulsivity by strengthening functional connectivity between the limbic system and frontal cortex, allowing for improved top-down control of impulsive reactions, including SI and SAs. The objectives of this study are to (1) develop an iTBS intervention for veterans with mTBI, impulsivity, and SI; (2) assess the feasibility and tolerability of the intervention; and (3) gather preliminary clinical outcome data on SI, impulsivity, and functions that will guide future studies. This is a pilot, double-blinded, randomized controlled trial. In developing this protocol, we referenced the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) guidelines. We will enroll 56 participants (28 active iTBS and 28 sham iTBS). The iTBS intervention will be performed daily, 5 days a week, for 2 weeks. We will collect 10 validated, psychometric, quantitative outcome measures before, during, and after the intervention. Measures included will assess functioning, impulsivity, suicidality, posttraumatic stress disorder, and depressive symptoms. We will collect qualitative data through semistructured interviews to elicit feedback on the participants' experiences and symptoms. We will perform quantitative and qualitative analyses to (1) assess the feasibility, tolerability, and acceptability of the treatment; (2) gather advanced neuroimaging data to assess neural changes elicited by treatment; and (3) assess improvements in outcome measures of impulsivity and suicidality in veterans with mTBI. This study protocol was approved by the Edward Hines, Jr. VA Hospital Institutional Review Board (Hines IRB number 14-003). This novel treatment is a 5-year research project (April 1, 2023, to March 31, 2028) funded by the Veterans Administration Rehabilitation Research and Development service (CDA2 award IK2 RX002938). Study results will be disseminated at or before the project's end date in March 2028. We will provide preliminary evidence of the safety, feasibility, and acceptability of a novel frontal pole iTBS treatment for mTBI, impulsivity, SI and SAs, and functional deficits. ClinicalTrials.gov NCT05647044; https://clinicaltrials.gov/study/NCT05647044. PRR1-10.2196/58206.

Seasonal snow cover indicators in coastal Greenland from in situ observations, a climate model, and reanalysis

Abstract. Seasonal snow cover has important climatic and ecological implications for the ice-free regions of coastal Greenland. Here we present, for the first time, a dataset of quality-controlled snow depth measurements from nine locations in coastal Greenland with varying periods between 1997 and 2021. Using a simple modelling approach (Δsnow), we estimate snow water equivalent values solely based on the daily time series of snow depth. Snow pit measurements from two locations enable us to evaluate the Δsnow model. As there are very little in situ data available for Greenland, we then test the performance of the regional atmospheric climate model (RACMO2.3p2, 5.5 km spatial resolution) and reanalysis product (CARRA, 2.5 km spatial resolution) at the nine locations with snow observations. Using the combined information from all three data sources, we study spatio-temporal characteristics of the seasonal snow cover in coastal Greenland using the example of six ecologically relevant snow indicators (maximum snow water equivalent, melt onset, melt duration, snow cover duration, snow cover onset, and snow cover end date). In particular, we evaluate the ability of RACMO2.3p2 and CARRA to simulate these snow indicators at the nine different locations, perform a time series analysis of the indicators, and assess their spatial variability. The different locations have considerable spatial and temporal variability in snow cover characteristics, and seasonal maximum snow water equivalent (amount of liquid water stored in the snowpack) values range from less than 50 kg m−2 to greater than 600 kg m−2. The correlation coefficients between maximum snow water equivalent output from Δsnow and CARRA and RACMO are 0.73 and 0.48, respectively. Correlation coefficients are highest for maximum snow water equivalent and snow cover duration, and model and reanalysis output underestimate snow cover onset. We find little evidence of statistically significant (p&lt;0.05) trends at varied periods between 1997 and 2021 except for the earlier onset of snowmelt in Zackenberg (−8 d per decade, p=0.02, based upon RACMO output). While we stress the need for context-specific validation, this study suggests that in most cases snow depth or snow water equivalent output from CARRA can describe spatial and temporal characteristics of seasonal snow cover, particularly changes in melt onset and snow cover end date.

Public Leaderboard Feedback in Sampling Competition: An Experimental Investigation

Abstract We investigate the role of performance feedback, in the form of a public leaderboard, in a sequential-sampling contest with costly observations. We show theoretically that for contests with a fixed ending date (i.e., finite horizon), providing public performance feedback may result in fewer expected observations and a lower expected value of the winning observation. We conduct a controlled laboratory experiment to test the theoretical predictions and find that the experimental results largely support the theory. In addition, we investigate how individual characteristics affect competitive sequential-sampling activity.

P97 Drug survival rates and predictors of switching in psoriasis: a study of biologics and small molecules in the argentine population

Abstract Several real-world drug survival studies of biologics and small molecules (B&amp;SM) have been published, but not in Argentina. The objectives of this study were to estimate the proportion of patients requiring switching B&amp;SM, identify factors associated with switching, and evaluate the drug survival rate by class of the first B&amp;SM. A retrospective cohort study was conducted on patients with psoriasis disease who consecutively attended the psoriasis clinic from 1 March 2022, to 29 February 2024. Patients treated with B&amp;SM were selected. The start date of the first B&amp;SM was considered the index date, with the end date being the switching date, death, or last visit. Drug survival rates were analysed using a Kaplan–Meier graph and log-rank test. Switching associated factors were examined through a Cox proportional hazards model, adjusting for age, sex, psoriasis onset time, obesity, diabetes, joint involvement, and worst psoriasis area and severity index (PASI) score.A total of 893 patients were evaluated, with 18.9% (169) receiving B&amp;SM; 64% (108) were men, with a mean age of 55 [standard deviation (SD) 16.3]. 74.6% (126) had psoriasis that started before age 40, and the mean worst PASI score was 18.8 (SD 11.2). Joint involvement was present in 30.8% (52), and among them, 17.3% (9) were diagnosed with psoriatic arthritis after biologic treatment initiation. Anti-TNF agents were prescribed in 50.3% of cases and antiIL-17 in 22.5% as the first biologic. Anti-TNF agents had a higher survival rate when used as the first biological (P = 0.0016). Switching B&amp;SM was needed in 37.9% (64) of cases, with 39% of failures occurring within the initial treatment year. The most common reason for change was secondary failure, with inter-class change accounting for 86% (55) of cases. The Cox proportional hazard model showed that joint involvement was linked to an increased risk of switching B&amp;SM [hazard ratio (HR) 2.12, 95% confidence interval (CI) 1.14–3.97; P = 0.017]. Additionally, each unit increase in PASI score raised the HR of switching by 1.03 (95% CI 1.00–1.05; P = 0.034). Finally, diabetes was associated with a heightened risk of switching (HR 1.49, 95% CI 1.09–2.06; P = 0.012). In our setting, joint involvement, high PASI score, and diabetes are predictors of switching B&amp;SM.

Impermanence of the Visual Identity of Polish Local and Regional Governments

Abstract Research purpose. The literature on place branding lacks long-term and quantitative studies on the rebranding of territorial brands. Place branding consultants recommend that they should be reviewed and refreshed approximately every decade. However, it is emphasised that rebranding is demanding for the territorial organisation, and a place brand change should be undertaken in a methodical manner. Therefore, the objective of the study is to compare this process with the theoretical postulates summarised in the literature on the subject. Design / Methodology / Approach. The research method used was visual content analysis. The collected data were verified by individual interviews with representatives of local governments. The authors have been conducting a research project on Polish local and regional governments since 2011. Therefore, it is possible to summarise the changes, modifications, and rebranding of Polish territorial brands in the period 2011-2023. The queries were conducted regularly in the years 2011-2024 (the end date was the day of local government elections in Poland on April 7, 2024). Findings. More than 250 logos have been withdrawn or replaced, and approximately 100 have never been implemented. Research confirmed that the number of changes is large (more than 30% of logos have been replaced by new ones), but it is difficult to determine one or even the dominant cause of such serious organisational changes. Originality / Value / Practical implications. A review of the literature allows us to draw a conclusion about the lack of long-term research on the functioning and changes of the content of logos practised by places. Therefore, a 10-year study on the population of all local government units in Poland provides data that supports the development of territorial branding theory and allows analytical support for territorial rebranding processes. The research discussed is significant because it reveals, first, the frequency of changes and, second, the difficulty in defining the causes of these changes.

Analyzing the Diversity and Impacting Factors of Smoke-Free Legislation and Implementation in Mainland China: A Case Qualitative Research.

Since the ratification of the Framework Convention on Tobacco Control in 2005, mainland China has experienced notable delays in implementing the Framework Convention on Tobacco Control. This study aims to examine the legislation and implementation of smoke-free laws in different cities in mainland China, with a particular focus on identifying factors that contribute to these differences. Through a literature review and policy mapping, we gathered information on the variations in smoke-free laws' legislation and implementation across mainland China. To delve deeper into the local specifics of implementation and the factors contributing to these variations, qualitative interviews were conducted with 16 key stakeholders in two selected cities. This group included former policy makers, policy experts, enforcement officers, and public venue owners. Although the revision of Healthy Cities standards advocates for the enactment of smoking bans post-2021, less than half of these cities have implemented comprehensive smoke-free laws. This phenomenon can be partly attributed to the tobacco industry's significant influence in the legislative process and to policy makers' limited understanding of smoking rooms/areas being temporary measures without setting clear end dates for transition periods. We also identified inconsistent implementation across selected cities, attributed to inadequate coordination and workforce shortages. Our study reveals significant variations and delays in the adoption of smoke-free laws across different cities in mainland China. We identify key factors contributing to this disparity, underscoring the urgent need for targeted measures to address these challenges, such as setting up a coordinated department and promoting policy advocacy. This study reveals geographical disparities in the legislative progress and enforcement effectiveness of smoke-free laws in mainland China. Persistent interference from the tobacco industry has obstructed the establishment of comprehensive smoke-free laws. Additionally, policy makers' limited awareness of the harm caused by designated smoking areas, regional economic disparities, and inadequate interdepartmental coordination have impeded effective policy implementation. These findings underscore the urgent need to set enforcement goals aligned with local economic contexts and strengthen policy dialogue to empower policy makers and stakeholders to mitigate tobacco industry influence and achieve successful implementation.