Types Of Events Research Articles

Association Between Cardiovascular Event Type and Smoking Cessation Rates Among Outpatients With Atherosclerotic Cardiovascular Disease: Insights From the NCDR PINNACLE Registry.

It is unclear how the type of an atherosclerotic cardiovascular disease (ASCVD) event potentially influences patients' likelihood of smoking cessation. Using 2013 to 2018 data from the US based National Cardiovascular Data Registry Practice Innovation and Clinical Excellence outpatient cardiac registry, we identified patients who were current smokers at a clinic visit and followed them over time for a subsequent ASCVD event. Self-reported smoking status was assessed at each consecutive visit and used to determine smoking cessation after each interim ASCVD event (myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, stroke/transient ischemic attack, peripheral artery disease). We constructed separate multivariable Cox models with nonproportional hazards to examine the association of each interim ASCVD event with smoking cessation, compared with not having an interim ASCVD event. We estimated the relative association of ASCVD event type with smoking cessation using contrast tests. Analyses were stratified by presence versus absence of ASCVD at baseline. Across 530 cardiology practices, we identified 1 933 283 current smokers (mean age 62±15, male 54%, ASCVD at baseline 50%). Among the 322 743 patients who had an interim ASCVD event and were still smoking, 41 336 (12.8%) quit smoking by their first subsequent clinic visit, which was higher among those with baseline ASCVD (13.4%) as compared with those without baseline ASCVD (11.5%). Each type of ASCVD event was associated with an increased likelihood of smoking. Patients who had an myocardial infarction, underwent coronary artery bypass graft (hazard ratio, 1.60 [95% CI, 1.55-1.65]), or had a stroke or transient ischemic attack were more likely to quit smoking as compared with those who underwent elective percutaneous coronary intervention or had a new diagnosis of peripheral artery disease (hazard ratio, 1.20 [95% CI, 1.17-1.22]). Only 13% of patients reported smoking cessation after an ASCVD event, with the type of event being associated with the likelihood of smoking cessation, prompting the need for patient-centered interventions.

The UEMS experience in continuous medical education accreditation process: a ‘quo vadis’ analysis of our global database

Background: The authors systematically appraise a large database of continuous professional development (CPD) and continuous medical education (CME) events against the European Accreditation Council for Continuous Medical Education (EACCME) framework. Methods: The authors performed a retrospective observational study of all CPD or CME events within the European Union of Medical Specialists (UEMS) database between 2017 and 2019, including 91 countries and 6034 events. Assessment of event design, quality and outcomes was evaluated against a validated, expert-derived accreditation framework, using thematic analysis to extract distinct themes, and subsequent quantitative analysis. Results: The authors included 5649 live educational events (LEEs) and 385 e-learning materials (ELMs). Three thousand seven hundred sixty-two [3762 (62.3%)] of the events did not report clear justification in their needs assessment process. Most accreditation applications claimed covering a single educational need [1603/2277 (70.3%)]. Needs assessments were reported to be similar across conferences, courses and other types of events (P<0.01); 5642/6034 events (93.5%) had clearly documented expected learning outcomes; only 978/6034 (16.2%) reported a single expected learning outcome while the rest report 2–10 outcomes. Providers who declared more than one educational need also declared multiple learning outcomes (ρ=0.051, P<0.01). Conclusions: Despite EACCME providing a robust framework for the CPD/CME accreditation process, reporting quality can still be improved, as more than 1 in 2 events fail to provide a clear description of their needs assessment. To the authors’ knowledge, this is the largest educational LEE/ELM database, which can be a starting to revisit the CME/CPD accreditation process.

The relation between Rossby wave-breaking events and low-level weather systems

Abstract. Rossby wave-breaking events describe the last stage in the life cycle of baroclinic atmospheric disturbances. These breaking events can strongly influence large-scale circulation and are also related to weather extremes such as heat waves, blocking, and extreme precipitation events. Nonetheless, a complete understanding of the synoptic-scale dynamics involved with the breaking events is still absent. For example, it is not clear how well the theoretical life cycle experiments, which use a specified initial perturbation with a single zonal wavenumber and a prescribed simplified initial zonal jet, capture the life cycle of real-atmosphere weather systems. Here we combine a storm-tracking technique together with a wave-breaking detection algorithm to examine how upper-level wave breaking and surface weather systems are related in the North Atlantic during winter. These datasets allow us to examine whether upper-level wave breaking and low-level weather systems always occur simultaneously and if we can identify preferred relations between the surface weather system type (cyclone or anticyclone) and the type of the upper-level breaking event (cyclonic or anticyclonic wave breaking denoted CWB or AWB, respectively). We find that in the North Atlantic, most weather systems are associated with AWB and/or CWB at some point during their lifetime, while only few cyclones and anticyclones do not involve any upper-level wave breaking (roughly 11 % and 15 %, respectively). Our results imply that composites of cyclones and anticyclones involve a mixture of different types of life cycles, depending on whether they involve CWB or AWB, as well as their position relative to the Rossby wave-breaking (RWB) center. Moreover, the system characteristics (including actual and relative positions, intensities, and displacements) differ depending on the associated breaking type. We distinguish between “same-pairing” cases (i.e., cyclone with CWB and anticyclones with AWB) and “opposite-pairing” cases (i.e., cyclones with AWB and anticyclones with CWB). Compositing the cyclones and anticyclones based on this criterion, we find that in similar pairings the surface system is positioned so that its associated upper-level winds would enhance the breaking (the anomalous circulation is in the same direction as the background shear), but, for opposite pairings, the upper-level winds associated with the surface system do not act to enhance the breaking which occurs in the direction of the background shear. A better understanding of the different life cycles of real-atmosphere cyclones and anticyclones and the upper-level breaking they involve is important for exploring the relation between storm tracks and slowly varying weather regimes and how they are mediated by RWB events.

A 15-year longitudinal study of search-and-rescue dogs identifies the musculoskeletal, integumentary, and gastrointestinal systems as commonly affected.

A longitudinal study followed search-and-rescue (SAR) dogs for 15 years to determine the incidence of health events and whether factors of deployment during 9/11, breed, or sex altered the risk of specific events. 150 SAR dogs: 95 dogs deployed to the September 11 terrorist attack sites and 55 SAR dogs not deployed. Each year, a survey was sent to the handler to collect health information until the dog died or the handler withdrew from the study. The reported health events were then categorized according to the body system affected and etiology. Incidence risk rates, with 95% CIs, were calculated for the most common types of health events. Incidence rate ratios were calculated stratified by deployment status, sex, and breed and significance assessed. 1 or more health event was recorded in 96 of the 150 enrolled dogs. The most affected systems were the musculoskeletal (31%; CI, 24 to 39), integumentary (22%; CI, 15 to 29), and gastrointestinal (20%; CI, 14 to 26). The health events were most commonly reported as inflammatory (45%; CI, 37 to 53) and degenerative (28%; CI, 21 to 35) in nature. There were no significant differences in incidence of health events based on deployment status to the September 11, 2001, terrorist attacks. Additionally, there was no significant effect of breed or sex on incidence of health events. To improve the health and longevity of SAR dogs, disease prevention and management programs should focus on reducing the health problems involving the musculoskeletal system as well as the integumentary and gastrointestinal systems.

Measuring civilian moral injury: Adaptation and validation of the Moral Injury Events Scale (Civilian) and Expressions of Moral Injury Scale (Civilian).

Moral injury (MI) research has been expanded to populations beyond the military in recent years. A key barrier to further research into MI in civilian populations is the lack of valid, reliable measures of the construct appropriate for general civilian use. This article addresses this barrier by adapting two existing military measures and exploring their psychometrics in a general civilian sample: the Moral Injury Events Scale-Civilian (MIES-C) and Expressions of Moral Injury Scale-Military (EMIS-C). A sample of civilian women (n = 192) and men (n = 88) completed the above measures, and additional scales designed to capture theoretically supported primary and secondary markers of MI (guilt, shame, anger; depression, posttraumatic stress symptoms, anxiety). Confirmatory factor analyses found that the factor structure of the MIES-C and EMIS-C replicated well within our civilian sample. Discriminant validity was indicated through a significant negative correlation with well-being. Both measures correlated as predicted with each other and measures of MI markers at the total score level. Correlations of individual subscales with each of these measures were more varied. Results shed light on differential relationships between the type of MI event and clinical outcomes, suggesting some conceptual differences in how MI is experienced in general civilian populations. Results suggest that civilian populations are also susceptible to MI, but that existing measures may have problems capturing this effectively. While the MIES-C and EMIS-C are supported for civilian use, further scale construction efforts for this population are warranted. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

How Fault‐Normal and Shear‐Parallel Stiffness Influence Frictional Sliding Behavior

AbstractThe potential of faults to show earthquake‐generating slip instabilities depends not only on the intrinsic frictional properties of the fault zone, but also on the elasticity of the surrounding material. A velocity‐weakening fault is expected to show increasingly unstable frictional behavior with decreasing local elastic stiffness around the fault zone. Fault zone roughness can cause slip in the shear direction to be accompanied by fault‐normal movement, modulated by fault‐normal elastic properties, however these effects are poorly understood. Here, we systematically vary the stiffness surrounding the fault in both the shear‐parallel and fault‐normal directions, to investigate the origin of slip instabilities and changes in friction constitutive properties. We confirm the transition from stable sliding through slow slip to stick‐slip due to reduced fault‐parallel stiffness, and that the occurrence of different types of slip events can be explained by the ratio between shear and critical stiffness. In contrast, reducing the fault‐normal stiffness produces stick‐slip instabilities under conditions where the conventional critical stiffness criterion predicts stable sliding, and does not produce transitional slow slip events. Our data suggest that: (a) the stability criterion for frictional slip should be modified to incorporate fault‐normal stiffness, and (b) the unexpected slip instabilities may represent wrinkle‐like slip pulses, possibly due to a stiffness asymmetry introduced by lowering the fault normal stiffness on one side of the fault. This implies that earthquakes may occur when the fault‐normal stiffness, or bulk modulus for natural faults, is decreased and/or asymmetric across the fault zone, both of which may be common in nature.

Conversion to Brivaracetam Monotherapy in Clinical Practice: A Retrospective Study.

The study aimed to evaluate the effectiveness and safety of brivaracetam (BRV) as conversion monotherapy in adults with focal epilepsy treated in the context of real-world clinical practice. This was a retrospective, observational, non-interventional study in adults with focal epilepsy who converted to BRV monotherapy following the withdrawal of background antiseizure medications (ASMs). Primary effectiveness outcome was the retention rate of BRV as single ASM at 6 and 12months. Secondary outcomes included the 6- and 12-month rates of seizure freedom. Safety and tolerability outcomes included the frequency and type of adverse events (AEs) and the occurrence of treatment discontinuation due to AEs. A total of 44 participants with a median age of 63.5 (interquartile range 44-73.5) years were included; 17 subjects were seizure free at baseline, and 9 of them switched from levetiracetam because of lack of tolerability. The retention rate of BRV monotherapy was 88.6% (39/44) at 6months and 83.9% (26/31) at 12months. The rates of seizure freedom were 72.7% (32/44) in subjects with 6-month follow-up and 58.1% (18/31) in subjects with 12-month follow-up. The median maintenance dosage of BRV monotherapy was 150 (100-200) mg/day at 6months and 125 (100-200) mg/day in subjects with 12-month follow-up. Adverse events were recorded in 6/44 (13.6%) participants and led to BRV discontinuation in 2/44 (4.5%) cases. The reported AEs were somnolence (n = 3), fatigue (n = 2), and irritability (n = 1); no serious AEs were experienced. In 21/44 (47.7%) participants, BRV monotherapy resulted from the direct switch from levetiracetam. The rates of treatment retention and seizure freedom at 6 and 12months were higher among people who switched from levetiracetam to BRV monotherapy. Brivaracetam may be a valuable treatment of focal seizures in people who converted to monotherapy in a real-life setting.

Interpreting the Current Literature on Outcomes of Robotic-Assisted Versus Conventional Total Knee Arthroplasty Using Fragility Analysis: A Systematic Review and Cross-Sectional Study of Randomized Controlled Trials

BackgroundFragility analysis is a method of further characterizing outcomes in terms of the stability of statistical findings. This study assesses the statistical fragility of recent randomized controlled trials (RCTs) evaluating robotic-assisted versus conventional total knee arthroplasty (RA-TKA versus C-TKA). MethodsWe queried PubMed for RCTs comparing alignment, function, and outcomes between RA-TKA and C-TKA. Fragility index (FI) and reverse fragility index (RFI) (collectively, “FI”) were calculated for dichotomous outcomes as the number of outcome reversals needed to change statistical significance. Fragility quotient (FQ) was calculated by dividing the FI by the sample size for that outcome event. Median FI and FQ were calculated for all outcomes collectively as well as for each individual outcome. Subanalyses were performed to assess FI and FQ based on outcome event type and statistical significance, as well as study loss to follow-up and year of publication. ResultsThe overall median FI was 3.0 (interquartile range, [IQR] 1.0 to 6.3) and the median reverse fragility index was 3.0 (IQR 2.0 to 4.0). The overall median FQ was 0.027 (IQR 0.012 to 0.050). Loss to follow-up was greater than FI for 23 of the 38 outcomes assessed. ConclusionsA small number of alternative outcomes is often enough to reverse the statistical significance of findings in RCTs evaluating dichotomous outcomes in RA-TKA versus C-TKA. We recommend reporting FI and FQ alongside P values to improve the interpretability of RCT results.

Determination of correlations in multivariate count data with informative observation times.

We consider there are various types of recurrent events and the total number of occurrences are collected at the random observation times. It has concerned that the observation process may not be independent to the multivariate event processes, hence the total counts and observation times may be correlated and the dependence may exist among different types of the event processes as well. Many methods have developed nonparametric models to accommodate such unknown structures; however, it is difficult to assess and directly quantify their correlation relationships. A multivariate frailty model is proposed to this study, in which the event and observation processes are linked by frailty variables whose joint distribution can be implicitly specified through the multivariate normal distribution with some unknown covariance matrix. The Bayesian inference method is conducted to obtain the estimates of the regression coefficients and correlation parameters. We use a form of trigonometric functions to represent the covariance matrix, so that it meets the positive-definiteness condition efficiently during the estimation schemes. The simulation studies demonstrate the utility of the proposed models. We apply the model to a skin cancer prevention study, and aim to determine the covariate and association effects. We found treatment is significant in determining the duration of examination times; prior-counts, age and gender are significant variables on the occurrence rates of tumor counts. Using the covariance matrix to access the underlying dependent structure, the mutual correlations among them are all positive, and the basal cell counts are more related to the examination times.

Evaluation of a multi-component early warning system for pastoralist populations in Doolo zone, Ethiopia: mixed-methods study

BackgroundThis study evaluated an early warning, alert and response system for a crisis-affected population in Doolo zone, Somali Region, Ethiopia, in 2019–2021, with a history of epidemics of outbreak-prone diseases. To adequately cover an area populated by a semi-nomadic pastoralist, or livestock herding, population with sparse access to healthcare facilities, the surveillance system included four components: health facility indicator-based surveillance, community indicator- and event-based surveillance, and alerts from other actors in the area. This evaluation described the usefulness, acceptability, completeness, timeliness, positive predictive value, and representativeness of these components.MethodsWe carried out a mixed-methods study retrospectively analysing data from the surveillance system February 2019–January 2021 along with key informant interviews with system implementers, and focus group discussions with local communities. Transcripts were analyzed using a mixed deductive and inductive approach. Surveillance quality indicators assessed included completeness, timeliness, and positive predictive value, among others.Results1010 signals were analysed; these resulted in 168 verified events, 58 alerts, and 29 responses. Most of the alerts (46/58) and responses (22/29) were initiated through the community event-based branch of the surveillance system. In comparison, one alert and one response was initiated via the community indicator-based branch. Positive predictive value of signals received was about 6%. About 80% of signals were verified within 24 h of reports, and 40% were risk assessed within 48 h. System responses included new mobile clinic sites, measles vaccination catch-ups, and water and sanitation-related interventions. Focus group discussions emphasized that responses generated were an expected return by participant communities for their role in data collection and reporting. Participant communities found the system acceptable when it led to the responses they expected. Some event types, such as those around animal health, led to the community’s response expectations not being met.ConclusionsEvent-based surveillance can produce useful data for localized public health action for pastoralist populations. Improvements could include greater community involvement in the system design and potentially incorporating One Health approaches.

Proportional rates models for multivariate panel count data.

Multivariate panel count data arise when there are multiple types of recurrent events, and the observation for each study subject consists of the number of recurrent events of each type between two successive examinations. We formulate the effects of potentially time-dependent covariates on multiple types of recurrent events through proportional rates models, while leaving the dependence structures of the related recurrent events completely unspecified. We employ nonparametric maximum pseudo-likelihood estimation under the working assumptions that all types of events are independent and each type of event is a nonhomogeneous Poisson process, and we develop a simple and stable EM-type algorithm. We show that the resulting estimators of the regression parameters are consistent and asymptotically normal, with a covariance matrix that can be estimated consistently by a sandwich estimator. In addition, we develop a class of graphical and numerical methods for checking the adequacy of the fitted model. Finally, we evaluate the performance of the proposed methods through simulation studies and analysis of a skin cancer clinical trial.

Risk factors for posttraumatic stress disorder in trauma patients from bullfighting-related events in Spain

BackgroundUnintentional Trauma injuries are one of the leading causes of posttraumatic stress disorder development. However, screening for this condition is not typically included in routine medical care. Research on posttraumatic stress disorder after unintentional injuries sustained during entertainment activities involving risk, has been scarce. This study aimed to analyze the proportion of posttraumatic stress disorder and its risk factors in patients with trauma injuries sustained during bullfighting-related events in Spain. MethodsTwo hundred and seventy-four patients were evaluated to determine the presence of posttraumatic stress disorder at least one month after the injury. Data about sociodemographic variables, injury circumstances, characteristics of the injury, and treatments were collected by the surgery team on-site or collected during the follow-up assessment. Diagnosis of posttraumatic stress disorder was made by a trained clinician using a structured clinical interview based on DSM criteria. ResultsThe estimated proportion of was 25.18 % (95 % CI: 20.18 %, 30.18 %). Residing in areas with a bullfighting tradition, female gender, referral to a medical center, hospitalization, events involving fighting bulls, and having been injured by the crowd were significant predictors. LimitationsThe short-term follow-up and the inability to evaluate some predictors of interest, including the body site of the injury, the presence of disfigurement, and comorbid anxiety and depression, were noted. ConclusionPosttraumatic stress disorder could have a high prevalence in individuals injured in these types of events, especially in women, those who are not familiar with the situation, and those who require medical attention. These results highlight the need for routine screening for posttraumatic stress disorder in individuals with trauma injuries for early symptom management.

Acute Sport-Related Concussion Management and Return to Sport Time in High School Athletes

Background: The current evidence for acute management practices of sport-related concussion (SRC) is often limited to in-clinic visits, with limited studies identifying professionals in early SRC care and the association with prolonged recovery outcomes. Purpose: To describe acute SRC management practices (ie, the personnel in the initial evaluations, removal from activity) and test the association with prolonged return to sport (RTS) time. Study Design: Descriptive epidemiology study. Methods: We conducted a retrospective cohort study of 17,081 high school SRCs accrued between the 2015-2016 and 2020-2021 academic years. We reported acute management practices and RTS time as frequencies stratified by sex, sport, and event type and compared athletic trainer (AT) access in initial evaluation with chi-square tests (P < .05). Separate logistic regressions estimated odds ratios (ORs) and 95% CIs for removal from activity and prolonged RTS >21 days by acute management practices. Results: Most SRCs (n = 12,311 [72.1%]) had complete initial evaluation by an AT. Boys had an AT evaluation in 75.5% (n = 2860/3787) of practice-related and 74.8% (n = 5551/7423) of competition-related events. Girls had an AT evaluation in 61.3% (n = 1294/2110) of practice-related and 69.3% (n = 2606/3761) of competition-related events. In sex-comparable sports (n = 6501), there was no difference between boys (n = 1654/2455 [67.4%]) and girls (n = 2779/4046 [68.7%]) having an AT involved in the first evaluation (χ2 = 1.21; P = .27). Notably, 25.3% of girls’ SRCs were evaluated by a coach alone, and we observed differences in personnel in initial evaluations by sport. The odds of immediate removal were higher when an AT made the initial evaluation (OR, 2.8 [95% CI, 2.54-3.08]). The odds of prolonged RTS >21 days was lower for those with an AT in the initial evaluation (OR, 0.74 [95% CI, 0.65-0.84]) adjusting for significant factors from univariate analyses, boys relative to girls (OR, 0.85 [95% CI, 0.76-0.96]), specialty care relative to PCP (OR, 2.16 [95% CI, 1.90-2.46]), specialty care relative to urgent or ready care (OR, 0.99 [95% CI, 0.82-1.22]) concussion history (OR, 1.41 [95% CI, 1.22-1.63]), and removal from activity (OR, 0.90 [95% CI, 0.78-1.05]). Conclusion: This study found variability in personnel involved in initial SRC evaluations, with higher percentages of athletes with SRCs having ATs make the initial evaluation during competitive events. There was no association between sex and AT involvement in comparable sports. There was an association between prolonged RTS and AT involvement, sex, concussion history, and location of follow-up care.

How sudden- versus slow-onset environmental events affect self-identification as an environmental migrant: Evidence from Vietnamese and Kenyan survey data.

In response to changing climatic conditions, people are increasingly likely to migrate. However, individual-level survey data reveal that people mainly state economic, social, or political reasons as the main drivers for their relocation decision-not environmental motives or climate change specifically. To shed light on this discrepancy, we distinguish between sudden-onset (e.g., floods and storms) and slow-onset (e.g., droughts and salinity) climatic changes and argue that the salience of environmental conditions in individuals' migration decisions is shaped by the type of climate event experienced. Empirically, we combine individual-level surveys with geographic information on objective climatic changes in Vietnam and Kenya. The empirical evidence suggests that sudden-onset climate events make individuals more likely to link environmental conditions to their migration decision and, hence, to identify themselves as "environmental migrants." Regression analyses support these results and are consistent with the view that slow-onset events tend to be linked with migration decisions that are more economically motivated.

A Machine Learning Approach with Human-AI Collaboration for Automated Classification of Patient Safety Event Reports: Algorithm Development and Validation Study.

Adverse events refer to incidents with potential or actual harm to patients in hospitals. These events are typically documented through patient safety event (PSE) reports, which consist of detailed narratives providing contextual information on the occurrences. Accurate classification of PSE reports is crucial for patient safety monitoring. However, this process faces challenges due to inconsistencies in classifications and the sheer volume of reports. Recent advancements in text representation, particularly contextual text representation derived from transformer-based language models, offer a promising solution for more precise PSE report classification. Integrating the machine learning (ML) classifier necessitates a balance between human expertise and artificial intelligence (AI). Central to this integration is the concept of explainability, which is crucial for building trust and ensuring effective human-AI collaboration. This study aims to investigate the efficacy of ML classifiers trained using contextual text representation in automatically classifying PSE reports. Furthermore, the study presents an interface that integrates the ML classifier with the explainability technique to facilitate human-AI collaboration for PSE report classification. This study used a data set of 861 PSE reports from a large academic hospital's maternity units in the Southeastern United States. Various ML classifiers were trained with both static and contextual text representations of PSE reports. The trained ML classifiers were evaluated with multiclass classification metrics and the confusion matrix. The local interpretable model-agnostic explanations (LIME) technique was used to provide the rationale for the ML classifier's predictions. An interface that integrates the ML classifier with the LIME technique was designed for incident reporting systems. The top-performing classifier using contextual representation was able to obtain an accuracy of 75.4% (95/126) compared to an accuracy of 66.7% (84/126) by the top-performing classifier trained using static text representation. A PSE reporting interface has been designed to facilitate human-AI collaboration in PSE report classification. In this design, the ML classifier recommends the top 2 most probable event types, along with the explanations for the prediction, enabling PSE reporters and patient safety analysts to choose the most suitable one. The LIME technique showed that the classifier occasionally relies on arbitrary words for classification, emphasizing the necessity of human oversight. This study demonstrates that training ML classifiers with contextual text representations can significantly enhance the accuracy of PSE report classification. The interface designed in this study lays the foundation for human-AI collaboration in the classification of PSE reports. The insights gained from this research enhance the decision-making process in PSE report classification, enabling hospitals to more efficiently identify potential risks and hazards and enabling patient safety analysts to take timely actions to prevent patient harm.

P572 Evaluation of safety, pharmacokinetics and efficacy of oral treatment with OST-122 in patients with moderate to severe ulcerative colitis: A Phase Ib/IIa, randomized, double blind, placebo controlled clinical trial

Abstract Background OST-122 is an orally administered, GI-targeted and non-systemic JAK3/TYK2 inhibitor. In preclinical models and in healthy volunteers, OST-122 has demonstrated excellent safety and tolerability with minimal systemic exposure, thereby reducing the risk of causing serious systemic toxicities associated with current JAK inhibitors. The aim of this study was to evaluate the safety, tolerability, pharmacokinetics and preliminary efficacy of OST-122 in moderate to severe ulcerative colitis (UC) patients. Methods This randomized, double blind, placebo controlled, multicenter proof of concept trial enrolled patients aged 18 to 75 years with moderate to severe UC (Total Mayo score 5-10, Endoscopic score ≥2) and with inadequate/loss of response, or intolerance to conventional (steroids and immunomodulators) and/or advanced therapy (ie. anti-TNFα, anti-integrin, anti-interleukin 12/23) in a 3:1 ratio to receive oral OST-122 400 mg (n=28) or placebo (n=9) for 28 days. The main objective of this study was to evaluate the safety and tolerability of OST-122 in patients with moderate to severe UC over 28 days by assessing the number, severity and type of adverse events. The pharmacokinetic profile was determined to confirm the compound’s low exposure in plasma (Cmax, AUC) previously observed in healthy volunteers and preclinical model. Another objective was to explore preliminary efficacy by assessing clinical parameters including rectal bleeding score and clinical response. Results A total of thirty-seven patients, 59.5% males, mean age of 44.8 years were included. The patients in the OST-122 group (n=28) had a mean Total Mayo Score at baseline of 8.1 compared to TMS = 6.7 in the placebo group (n=9). Safety analysis revealed no significant differences in the number of reported adverse events between the two treatment groups, nor did serious adverse events occur (Table 1). There were no clinically relevant changes in vital signs, laboratory values or ECG parameters which raise any safety concerns. After 28 days of treatment, 63% of patients taking OST-122 showed an improvement in rectal bleeding (vs 33% in the placebo group), 44% achieved a clinical response (vs 11% on placebo) and 22% reached clinical remission (Figure 1). Statistical significance was not achieved due to the small study size and patient variability. Pharmacokinetic data indicated minimal plasma concentrations (Cmax,ave. Day28 0.92 ng/mL) and therapeutically relevant levels in colon tissue (Cave.,Day28 15.5 ug/g tissue). Conclusion GI-restricted OST-122 was well tolerated during the 4-week treatment. Its excellent safety profile, limited systemic absorption and promising trends of clinical activity may provide a safer therapeutic option for patients with moderate to severe UC.

Regression analysis of multivariate recurrent event data allowing time-varying dependence with application to stroke registry data.

In multivariate recurrent event data, each patient may repeatedly experience more than one type of event. Analysis of such data gets further complicated by the time-varying dependence structure among different types of recurrent events. The available literature regarding the joint modeling of multivariate recurrent events assumes a constant dependency over time, which is strict and often violated in practice. To close the knowledge gap, we propose a class of flexible shared random effects models for multivariate recurrent event data that allow for time-varying dependence to adequately capture complex correlation structures among different types of recurrent events. We developed an expectation-maximization algorithm for stable and efficient model fitting. Extensive simulation studies demonstrated that the estimators of the proposed approach have satisfactory finite sample performance. We applied the proposed model and the estimating method to data from a cohort of stroke patients identified in the University of Texas Houston Stroke Registry and evaluated the effects of risk factors and the dependence structure of different types of post-stroke readmission events.

Environmental sustainability in the event industry: a systematic review and a research agenda

Over the past few decades, the event industry has witnessed massive growth worldwide. This, however, has come with considerable environmental costs. Improper management of any type of event can indeed lead to significant environmental impacts, including increased carbon emissions, waste generation, and resource consumption. To establish a common knowledge base on the topic, we conducted a Systematic Literature Review and critically examined the current state of academic research regarding environmental sustainability in events. Our analysis reveals a fast-growing and interdisciplinary field, with 247 articles coming from multiple geographic locations and addressing multiple event types – from mega-events to small-scale festivals. We identify four thematic areas on which scholars have focused: (1) Events’ Environmental Impacts, namely the evaluation of the environmental impacts and legacy of events; (2) Green Event Management, the organization of environmentally friendly events across multiple perspectives (e.g., strategic, operational); (3) Environmental Policy & Guidelines, the contribution of policymakers and other industry stakeholders for a greener event sector; (4) Environmental Psychology of Event Stakeholders, the factors affecting perceptions and behaviours of event stakeholders in relation to environmental issues. We provide an in-depth review of these areas, identify gaps in our current understanding, and draft a comprehensive agenda to address them.

Multiple imputation strategies for missing event times in a multi-state model analysis.

In clinical studies, multi-state model (MSM) analysis is often used to describe the sequence of events that patients experience, enabling better understanding of disease progression. A complicating factor in many MSM studies is that the exact event times may not be known. Motivated by a real dataset of patients who received stem cell transplants, we considered the setting in which some event times were exactly observed and some were missing. In our setting, there was little information about the time intervals in which the missing event times occurred and missingness depended on the event type, given the analysis model covariates. These additional challenges limited the usefulness of some missing data methods (maximum likelihood, complete case analysis, and inverse probability weighting). We show that multiple imputation (MI) of event times can perform well in this setting. MI is a flexible method that can be used with any complete data analysis model. Through an extensive simulation study, we show that MI by predictive mean matching (PMM), in which sampling is from a set of observed times without reliance on a specific parametric distribution, has little bias when event times are missing at random, conditional on the observed data. Applying PMM separately for each sub-group of patients with a different pathway through the MSM tends to further reduce bias and improve precision. We recommend MI using PMM methods when performing MSM analysis with Markov models and partially observed event times.

Attachment avoidance predicts limited and selective sharing of personal events in close relationships

AbstractCommunicating personal experiences is crucial for fostering close relationships, but people can be reluctant to self‐disclose. The current research assessed the extent to which relationship‐specific (RS) and global attachment avoidance limit self‐disclosure of personal events in close relationships. Critically, we also identified the types of personal events that people will selectively share in relationships characterized by higher attachment avoidance. Participants (N = 609 in the aggregated sample) reported whether they shared up to four positive and four negative events that happened to them recently with up to eight close network‐members. We found that a one scale‐point increase in RS or global attachment avoidance (7‐point scales) predicted a 68% decrease or a 28% decrease in the odds of sharing, respectively. Nevertheless, people in more avoidant relationships did share personal events selectively: they uniquely prioritized sharing positive events, events that conveyed personal competence, and events that avoided vulnerability. Our findings shed light on the underlying factors contributing to the low likelihood of sharing personal experiences in more avoidant relationships and offer insights for future intervention work.