High Proportion Of Events Research Articles

Comparison of cohort and nested case-control designs for estimating the effect of time-varying drug exposure on the risk of adverse event in the presence of ties.

Cohort and nested case-control (NCC) designs are frequently used in pharmacoepidemiology to assess the associations of drug exposure that can vary over time with the risk of an adverse event. Although it is typically expected that estimates from NCC analyses are similar to those from the full cohort analysis, with moderate loss of precision, only few studies have actually compared their respective performance for estimating the effects of time-varying exposures (TVE). We used simulations to compare the properties of the resulting estimators of these designs for both time-invariant exposure and TVE. We varied exposure prevalence, proportion of subjects experiencing the event, hazard ratio, and control-to-case ratio and considered matching on confounders. Using both designs, we also estimated the real-world associations of time-invariant ever use of menopausal hormone therapy (MHT) at baseline and updated, time-varying MHT use with breast cancer incidence. In all simulated scenarios, the cohort-based estimates had small relative bias and greater precision than the NCC design. NCC estimates displayed bias to the null that decreased with a greater number of controls per case. This bias markedly increased with higher proportion of events. Bias was seen with Breslow's and Efron's approximations for handling tied event times but was greatly reduced with the exact method or when NCC analyses were matched on confounders. When analyzing the MHT-breast cancer association, differences between the two designs were consistent with simulated data. Once ties were taken correctly into account, NCC estimates were very similar to those of the full cohort analysis.

Critical priority Multidrug-Resistant Organisms (MDROs) secondary infection among COVID-19 patients: hidden threat during a pandemic? A retrospective study

Background: The global Coronavirus Disease 2019 (COVID-19) pandemic is superimposed on the ongoing Multidrug-Resistant Organisms (MDROs) pandemic. Bacterial co-infection, particularly those caused by MDROs, is one of the risk factors linked to higher morbidity and mortality rates in COVID-19 patients. This study aims to compare critical priority MDROs profile causing bacteremia in COVID-19 and non-COVID-19 patients during a pandemic. Methods: A hospital-based retrospective cross-sectional study was conducted at Dr. Soetomo General Academic Hospital from April 2020 to December 2021. This study used a consecutive sampling technique, which included and analyzed all identified microorganism isolates from blood specimens that met the inclusion criteria. The Mann-Whitney test was used to compare MDRO profiles between COVID-19 and non-COVID-19 patients, which is significant if p < 0.05. Results: The total proportion of critical priority MDRO isolates in COVID-19 patients was 90/390 (23.08%), while in non-COVID-19 patients were 377/1446 (26.07%) isolates (p=0.228). Carbapenem-resistant Acinetobacter baumannii (CRAB) had a higher proportion of events in COVID-19 patients (12.05% vs. 7.05%, p < 0.001). In contrast, extended-spectrum β-lactamases (ESBL)-producing Klebsiella pneumoniae (ESBL-KP) had a higher proportion of events in non-COVID patients (7.54% vs. 2.82%, p < 0.001). Acinetobacter baumannii exhibited a high level of resistance, with 149/223 (66.82%) of the isolates being CRAB, with the COVID-19 group accounting for 47/59 (79.66%) and the non-COVID-19 group accounting for 102/164 (62.19%; z = 2.438; p = 0.015). Conclusion: The high proportion and resistance rate of critical priority MDROs, CRAB particularly, among COVID-19 patients, highlights the importance of effective AMR control practices and prevention strategies during the pandemic.

Target and non-target vessel related events at 10 years post percutaneous coronary intervention

AimsTo define the incidence of events related to the stented vessel (target vessel related events: TVRE) and events related to non-stented vessels (non-target vessel related events: NTVRE) through to 10-year follow-up in patients post-PCI with newer generation drug eluting stents (DES).Methods and resultsThe current study is a post-hoc analysis of patient level data from two randomised controlled trials in Germany. Patients older than 18 years with ischemic symptoms or evidence of myocardial ischemia in the presence of ≥ 50% de novo stenosis located in the native coronary vessels were considered eligible. The endpoints of interest were TVRE (a composite of first target vessel myocardial infarction or target vessel revascularization) and NTVRE (a composite of first non-target vessel MI or non-target vessel revascularization) through to 10 years post PCI.We included 4953 patients in this analysis. Through to 10-years post-PCI, TVRE occurred in 1238 of 4953 patients (cumulative incidence: 25.8%) and NTVRE occurred in 1442 of 4953 patients (cumulative incidence: 30.3%). The majority of TVRE and NTVRE were revascularization events. From 0 to 1 years, the cumulative incidence of TVRE was 15.9% and of NTVRE was 12.3%. From 1 to 10 years, the cumulative incidences of TVRE and NTVRE were 11.2% and 22.4%, respectively.ConclusionAt 10-year post-PCI with new generation drug eluting stents, events related to remote vessel disease progression account for a higher proportion of events than events related to the stented vessel.Trial registrationISAR TEST 4 ClinicalTrials.gov Identifier: NCT00598676. ISAR TEST 5 ClinicalTrials.gov Identifier: NCT00598533.Graphical abstract

An Analysis of Communication Strategies in Speaking

The scientific approach in the learning process. There are still some problems in applying the five main procedures of the Scientific Approach in learning activities. Activities must be by the stages of the Scientific Approach. This study aimed to analyze the type of communication between junior high school students during speaking class in junior high school who applied the 2013 curriculum. This study was qualitative using a qualitative design. Data collection is done through direct observation. In data collection, the study used a cellular recorder. In addition, observation sheets were also used to obtain data. Data were taken descriptively. The results of this study indicate that the teacher applies a 15-dimensional Communication Strategy, namely Literal Translation, Code Switching, Pantomime, Message Reduction, Message Substitution, Repetition, Use of Fillers, Verb Strategy Maker, Self Accuracy, Response, Asking Clarification, Asking for Confirmation, Asking for Help, Repetition Request, and Comprehension Comprehension. Of the 15 strategies applied, Response has the highest proportion of events around 23.72%. Meanwhile, students only use seven dimensions of Communication Strategy. Those are Self-Improvement, Self-Improvement, Pantomime, Code Switching, Use of Fillers, Expressing Disappointment, Explanation of Repetition, Pantomime has the highest occurrence. That is a 34.21% occurrence.

Adverse events in the paediatric emergency department: a prospective cohort study

BackgroundUnderstanding adverse events among children treated in the emergency department (ED) offers an opportunity to improve patient safety by providing evidence of where to focus efforts in a resource-restricted environment.ObjectiveTo...

Interaction between the Kansas City Cardiomyopathy Questionnaire and the Pocock's clinical score in predicting heart failure outcomes.

PurposeHeart failure (HF) is a complex syndrome. Its appropriate management should combine several health measurements. We assessed the relationship between the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Pocock’s clinical score.MethodsWe conducted a prospective registry of HF outpatients. The main outcome was occurrence of death or hospitalization during a 6-month follow-up. A multivariate logistic regression was performed, including the KCCQ overall summary score, the Pocock’s clinical score and their interaction in the model.ResultsFrom January 2008 to December 2010, 143 patients were involved. Mean age of patients was 68 years, and 74 % were men. KCCQ’s overall summary score and Pocock’s clinical score were inversely correlated (r = −0.24, p = 0.026). A total of 61 (42.7 %) events occurred. There was a high proportion of events (77.8 %) in patients with a Pocock’s clinical score >50 %, whatever the KCCQ score value. When the KCCQ score was ≤50 %, there was a low increase in risk as the Pocock’s clinical score increased (OR 2.0 [0.6; 6.6]). However, when the KCCQ score was between 50 and 75 or ≥75 %, there was a high increase in risk as the Pocock’s clinical score increased (OR 6.9 [1.2; 38.9] and OR 7.4 [0.8; 69.7], respectively).ConclusionsPatients with a high Pocock’s clinical score are at a high risk of death or hospitalization. For patients with a low Pocock’s clinical score, the KCCQ score can identify those at risk of these events.Electronic supplementary materialThe online version of this article (doi:10.1007/s11136-015-1154-9) contains supplementary material, which is available to authorized users.

Eye disorders reported with the use of mefloquine (Lariam(®)) chemoprophylaxis--A drug safety database analysis.

Between 80 and 90 million travellers visit malaria endemic areas annually and many require malaria chemoprophylaxis. The characterization of the risk and nature of eye disorders occurring during the use of malaria chemoprophylaxis is relevant for travel medicine advisors. We did a database analysis on eye disorder adverse events reported for mefloquine (as Lariam®) using the F. Hoffmann-La Roche global drug safety database for the time frame February 1984 to January 18th, 2011. These adverse event reports were reviewed by a trained ophthalmologist. The analysis focused on 3 categories of eye disorders--Category 1: visual acuity; Category 2: anatomical parts of the eye and Category 3: neuro-ophthalmic events. To put our analysis in context, an extensive literature search on "mefloquine" and "eye disorders" was conducted. A total of 591 cases with 695 events assigned to the "Eye disorder" SOC in individuals exposed to mefloquine chemoprophylaxis were reported. The highest proportion of events (n = 493, 70.9%) was in Category 1: visual acuity (mainly visual impairment and blurred vision), followed by Category 3: neuro-ophthalmic events (n = 124, 17.8%). The majority of visual adverse events were non-serious but 37.7% (n = 223) of cases were classified as serious. Nine events of maculopathy were reported and 48 cases with 53 events described symptoms of optic neuropathy. Mefloquine, like other anti-malarials, may be associated with eye disorders. Prescribers of anti-malarials should inform travellers regarding the risk of potential ocular side effects. Users of chemoprophylaxis who experience visual disorders should be referred to an ophthalmologist.

Flow cytometric determination of stem/progenitor content in epithelial tissues: an example from nonsmall lung cancer and normal lung.

Single cell analysis and cell sorting has enabled the study of development, growth, differentiation, repair and maintenance of "liquid" tissues and their cancers. The application of these methods to solid tissues is equally promising, but several unique technical challenges must be addressed. This report illustrates the application of multidimensional flow cytometry to the identification of candidate stem/progenitor populations in non-small cell lung cancer and paired normal lung tissue. Seventeen paired tumor/normal lung samples were collected at the time of surgical excision and processed immediately. Tissues were mechanically and enzymatically dissociated into single cell suspension and stained with a panel of antibodies used for negative gating (CD45, CD14, CD33, glycophorin A), identification of epithelial cells (intracellular cytokeratin), and detection of stem/progenitor markers (CD44, CD90, CD117, CD133). DAPI was added to measure DNA content. Formalin fixed paraffin embedded tissue samples were stained with key markers (cytokeratin, CD117, DAPI) for immunofluorescent tissue localization of populations detected by flow cytometry. Disaggregated tumor and lung preparations contained a high proportion of events that would interfere with analysis, were they not eliminated by logical gating. We demonstrate how inclusion of doublets, events with hypodiploid DNA, and cytokeratin+ events also staining for hematopoietic markers reduces the ability to quantify epithelial cells and their precursors. Using the lung cancer/normal lung data set, we present an approach to multidimensional data analysis that consists of artifact removal, identification of classes of cells to be studied further (classifiers) and the measurement of outcome variables on these cell classes. The results of bivariate analysis show a striking similarity between the expression of stem/progenitor markers on lung tumor and adjacent tumor-free lung.

Aspirin For Primary Prevention Of Cardiovascular Disease In Women

Cardiovascular disease (CVD) accounts for 34% of overall mortality in the United States or an average of 1 death every 38 seconds. While the majority of these events are related to coronary heart disease (CHD), stroke accounts for a sizeable burden of CVD among postmenopausal women. Before 75 years of age, a higher proportion of CVD events due to CHD occur in men than in women, as opposed to a higher proportion of events due to stroke occurring in women. Sex-based disparities in medical care are well documented, and under-treatment of women with aspirin for secondary prevention of CVD is a blatant example of the quality chasm described in the Institute of Medicine report "between the care we have and the care we could have". However, while aspirin appears to be of substantial net benefit in secondary prevention, the balance of its beneficial effects and bleeding hazards in primary prevention remains less certain, especially in women. The current review examines the evidence and provides recommendations for the use of aspirin for primary prevention of CVD in women.

Atendimentos de emergência por lesões decorrentes de causas externas: características das vítimas e local de ocorrência, Estado de São Paulo, Brasil, 2005

The objective of this study was to analyze the characteristics and place of occurrence of injuries treated in emergency departments. A total of 35,107 emergency department visits for injuries were analyzed, excluding traffic injuries, in São Paulo State, Brazil, 2005. The majority of victims were male (59.1%), and from 0 to 29 years of age (62.1%). Leading causes were falls (39.3%) and accidental blows (16.5%). Most injuries occurred in the home (64.7%), followed by public places (19.9%). Assaults were more frequent in public. Women were more likely to suffer injuries at home, as compared to men (OR = 0.51; 95% CI: 0.48-0.53). Men were 1.34 times more likely to be injured in public places, 3.22 times in bars, and 2.82 times in the workplace. A higher proportion of events among children aged 0 to 9 and individuals 60 years or older occurred at home. The results highlighted the home as an important place for the occurrence of injuries, which should be considered when planning injury prevention programs.

Morbidity and mortality from hazardous materials events in the personal services industry, 1993-2001: A follow-up report from the Hazardous Substances Emergency Events Surveillance (HSEES) system

An estimated 8% of acute hazardous materials (HazMat) events that occur annually in the United States involve victims. Little information is available in the literature pinpointing which industries are associated with these acute events. Data from the Agency for Toxic Substances and Disease Registry's Hazardous Substances Emergency Events Surveillance (HSEES) system were analyzed to determine which industry categories had the highest proportion of events with victims. These data were collected from 17 state health departments that participated in the HSEES system from 1993 through 2001. During 1993 through 2001, 53,142 HazMat events occurred, of which 51,989 involved actual releases. Of these events with actual releases, 4,324 (8.3%) involved victims. Of the 14 major industrial categories analyzed, personal services-with 1,311 total events, including 468 with victims-had the highest major industrial category proportion of events with victims (35.7%). This high proportion of events with victims was associated mainly with the following three personal services subcategories: private households; laundry, cleaning, and garment services; and hotels and motels. Most of the victims injured in personal services events involved members of the general public. The most frequently reported symptom was respiratory irritation. The causal factors leading to most releases were operator error, followed by deliberate/illegal damage. Targeting the personal services industries with appropriate prevention strategies may be an effective way to help begin reducing the high proportion of events with victims in this category.

INTERACTIONS BETWEEN CETACEANS AND THE TUNA FISHERY IN THE AZORES

AbstractWe studied the operational and ecological interactions between cetaceans and the tuna‐fishery in the Azores, based on reports of observers placed on board tuna fishing vessels from 1998 to 2000. Data were collected during 617 fishing trips (representing 43% of total fishing trips) and 6,554 fishing events. Cetaceans were present during <10% of the observed fishing events, with common dolphins (Delphinus delphis) accounting for 78% of the occurrences. The presence of cetaceans during fishing varied both spatially and temporally, depending on the distribution of fishing effort and on the pattern of occurrence of each cetacean species in the region. Overall, cetaceans interfered in 5% of the fishing events. This interference resulted in a higher proportion of events with no catches. In the three years, 49 dolphins were caught in the fishing lines but were released alive, although it is impossible to determine if they survived the interaction. Annual estimates of incidental capture of cetaceans by all the tuna fleet were calculated based on total tuna landings. An estimated 55 dolphins were captured in 1999, 38 in 1998, and 16 in 2000. Overall, our results suggest a low level of interaction between cetaceans and this fishery.

Effect of antihypertensive treatment in patients having already suffered from stroke. Gathering the evidence. The INDANA (INdividual Data ANalysis of Antihypertensive intervention trials) Project Collaborators.

Drug treatment of high blood pressure has been shown to reduce the associated cardiovascular risk. Stroke represents the type of event more strongly linked with high blood pressure, responsible for a high rate of death or invalidity, and with the highest proportion of events that can be avoided by treatment. Hypertensive patients with a history of cerebrovascular accident are at particularly high risk of recurrence. Specific trials of blood pressure lowering drugs in stroke survivors showed inconclusive results in the past. We performed a meta-analysis using all available randomized controlled clinical trials assessing the effect of blood pressure lowering drugs on clinical outcomes (recurrence of stroke, coronary events, cause-specific, and overall mortality) in patients with prior stroke or transient ischemic attack. We identified 9 trials, including a total of 6752 patients: 2 trials included 551 hypertensive stroke survivors; 6 trials of hypertensive patients included a small proportion of stroke survivors (536 patients); 1 trial included stroke survivors, whether hypertensive or not (5665 patients). The recurrence of stroke, fatal and nonfatal, was significantly reduced in active groups compared with control groups consistently across the different sources of data (relative risk of 0.72, 95% confidence interval: 0.61 to 0.85). There was no evidence that this intervention induced serious adverse effect. Blood pressure lowering drug interventions reduced the risk of stroke recurrence in stroke survivors. Available data did not allow to verify whether such benefit depends on initial blood pressure level. More data are needed before considering antihypertensive therapy in normotensive patients at high cerebrovascular risk.

Perceptual aspects of synthesized approximations to melody.

A procedure is described for synthesizing tone sequences that contain a high proportion of events that are likely to be found in melodies that occur in music. This is done by using a random-number generator with probability weightings that favor the selection of certain notes and intervals. The form of the probability weightings derives from constraints on the "semitone span" of the intervals, the "fifth span" of the intervals, and the occurrence of "scale" notes. The role of "redundancy" is also considered. In this way it is possible to obtain melodies that obey various combinations of the different constraints. Other melody variables are either fixed, randomized, or controlled. These experimental melodies were used in a test of the hypothesis that the more melodious tone sequences will be easier to organize perceptually and remember than less melodious sequences of equal redundancy. A psychophysical scaling procedure confirmed that the constraints generated tone sequences bearing degrees of perceptual similarity to "real" melodies. Melody discrimination was also measured. The "fifth span" and "scale" constraints increased the melodiousness of tone sequences. They also improved performance on tasks requiring the discrimination of unfamiliar, untransposed melodies, and the discrimination of transposed melodies after some familiarization. It is argued that general perceptual principles do not give a complete account of the perception of melody: A full description requires consideration of the listener's tacit musical "knowledge" and its interaction with perceptual processes.