Treated exudative CNV: short-term and long-term real-life evolution

Abstract Background/Introduction The balloon expandable (BE) Edwards Sapien-S3/Ultra, and the self-expanding (SE) Medtronic Evolut-Pro represent the main volume of transcatheter aortic valve implantation (TAVI) procedures conducted worldwide. Purpose The present study represents the largest real-world comparison of periprocedural and short-term outcome between the aforementioned last generation devices. Methods Consecutive patients who had undergone TAVI with either the BE (S3/Ultra) or SE (Evolut-Pro/R-34mm if 34mm valve was required) device, in five centers were retrospectively studied. Periprocedural and short-term outcomes were recorded and compared. Results In total, 1341 patients (58.5% male) were treated with contemporary BE and SE valves (574 and 767pts with BE and SE respectively) and followed up for a median of 18.7 (IQR 30) months. Baseline demographics were similar between the two groups apart from severe left ventricle (LV) systolic impairment and extensive aorta calcification, being more prevalent amongst BE and SE groups respectively. Patients treated with the Evolut-Pro/R34mm device had significantly lower peak (16±9mmHg for SE vs 23.9±6mmHg for the BE valves, p=0.001) and mean (8.6±6mmHg SE vs 11.2±5.2mmHg BE, p=0.001) gradients at discharge. Conversely, the BE group demonstrated significantly lower rates of at least moderate residual aortic regurgitation (AR) post-operatively (0.7% vs 5.2% for BE and SE valves respectively, p<0.001). Interestingly, the rate of new permanent pacemaker (PPM) required after the implantation in initially pacemaker-free patients, was higher for the S3/Ultra cohort compared to the self-expanding valve group (14.4% vs 12.3% respectively, p=0.001). No statistical difference was recorded between valve groups regarding cerebrovascular events (3.4% vs. 2.7% for SE and BE respectively, p=0.466), major vascular complications (4.2% vs. 3.0% for SE and BE respectively, p=0.251) and death to hospital discharge (1.6% vs. 2.9% for SE and BE respectively, p=0.117). One-year Kaplan-Meier estimated survival was similar between the two groups (88.7% for BE vs. 91.4% for SE valves, plog-rank=0.093). When adjusting for age, extensive calcification of the aorta and baseline LV function all caused mortality hazard ratios were similar between patients treated with BE vs SE valves (HR 1.39; 95% CI 0.97 to 1.98, p=0.07). Conclusions Real life comparison of the last generation balloon expandable and self-expanding devices demonstrates superiority of the former in terms of residual PVL, at the expense of higher transvalvular gradients and higher need of new PPM implantation. The latter however may represent differences in center practices with regards to thresholds for permanent pacing. Long-term follow-up and future larger trials are required to establish any potential long-term difference in clinical outcomes and prognosis. FUNDunding Acknowledgement Type of funding sources: None.

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AB0641 MANAGING ANKYLOSING SPONDYLITIS (AS) WITH SHORT TERM BIOSIMILAR ADALIMUMAB REGIMEN IN A RESOURCE STRAPPED SETTING: A PROTOCOL DRIVEN COMMUNITY CLINIC ORIENTED STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3459 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1615.1-1615

Author(s):

A. Chopra ◽

N. Khadke ◽

M. Saluja ◽

T. Kianifard ◽

A. Venugopalan

Keyword(s):

Stress Reduction ◽

Symptomatic Relief ◽

Real Life ◽

Substantial Improvement ◽

First Year ◽

Short Term ◽

Mean Values ◽

One Year

Background:We were handicapped by the exorbitant cost of innovator anti-Tumour Necrosis Factor (TNF) drugs. Despite limited use, we sometimes observed long-term benefits following short term induction like use. Emboldened by advent of biosimilars, we carried out an investigational study.Objectives:To evaluate the effectiveness of a short regimen of biosimilar (Bs) Adalimumab in ASMethods:50 consenting patients (86% B27+) naïve for biologics and negative for latent TB screen were enrolled into an observational design study of one year; Baseline mean values for age, duration, ASDAS and CRP was 31 years, 98.8 months, 4.6 and 64 mg per dl respectively. During the first year, patients were begun with 40 mg Bs Adalimumab (Bs-ADL) (Exemptia™), injected fortnight, for 12-16 weeks. No patient received DMARD or steroid in the first year of study. Patients continued standard of care follow up program in the clinic. The ASAS (Assessment Spondyloarthritis International Society) improvement indices were used. Standard intention-to-treat analysis was performed; significant p <0.05.Results:Optimum ASAS 40 improvement was observed at week 12 (68%); substantial improvement lasted till week 36. At one year, the ASAS 40 was 38%; ASAS partial remission 22% patients. Pro-inflammatory cytokines (IL-6, TNF α and IL-17) showed conspicuous reduction; maximum drop in IL-6 at week 24 (See Figure). 11 patients withdrew in the first year. 30 patients completed two years and 22 patients completed 3 year follow up. Over time, there was substantial loss in the ASAS 20 and 40 responses but patients seemed satisfied with the on-going symptomatic relief and improved function. Admittedly, patients showed more adherences to advice on physical exercise and stress reduction. Flares were more frequent after 1 year requiring short term round the clock NSAID; only 5 patients could afford to repeat a short term Bs-ADL regimen and one patient underwent hip arthroplasty. None received steroids and 5 patients were begun on Sulfasalazine in the second year and monitored. We could not evaluate structural modification (AS). Selected outcomes over 2 and 3 years from the current study will be compared to matched control (derived from the clinic database). None developed TB or any serious drug related toxicity. 2 patients developed recurrent uveitis.Conclusion:This real life documented experience unravelled impressive long term benefits following a kick start short term induction regimen of Biosimilar Adalimumab in AS. Though contrary to standard practice, this seemed a practical solution in our setting. We speculate a psychological and motivational boost rather than a prolonged real time biological effect (Bs-ADL) for this phenomenon. Our study has important socioeconomic bearing and merits validation.Acknowledgement:This was essentially a non-commercial investigator-initiated study. Zydus Cedilla India provided a generous research grant with free of cost Bs_ADL to several patients and a large concession in the cost to the rest.Disclosure of Interests:Arvind Chopra Grant/research support from: Zydus Pharamceutical Ltd India, Nagnath Khadke: None declared, Manjit Saluja: None declared, Toktam Kianifard: None declared, Anuradha Venugopalan: None declared

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Biologics registries

10.1093/med/9780199642489.003.0034 ◽

2013 ◽

Author(s):

David Isenberg ◽

Angela Zink

Keyword(s):

Life Experience ◽

Real Life ◽

Controlled Trials ◽

Side Effect Profile ◽

Risk Of Infection ◽

Short Term ◽

Biologic Drugs ◽

Double Blind ◽

The Past

Double-blind controlled trials undertaken over the past two decades have established the short-term effectiveness and side-effect profile of biologic drugs for patients with rheumatoid arthritis and related diseases. However, the development of biologics registers to capture 'real-life experience' and explore long-term effectiveness and complications is equally important. In this chapter, we demonstrate how these registers have identified long-term joint benefits, a reduction in cardiovascular mortality, reassurance concerning fears about cancer development, and a balanced view of the risk of infection.

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Unpacking the Smart Mobility Concept in the Dutch Context Based on a Text Mining Approach

Sustainability ◽

10.3390/su11236583 ◽

2019 ◽

Vol 11 (23) ◽

pp. 6583 ◽

Cited By ~ 2

Author(s):

Manders ◽

Klaassen

Keyword(s):

Text Mining ◽

Qualitative Content Analysis ◽

Real Life ◽

Short Term ◽

The Status ◽

Mobility System ◽

Smart Mobility ◽

The One ◽

Sustainability Challenges

Existing mobility solutions are criticized for falling short of effectively addressing transport issues and sustainability challenges. In this light, smart mobility has received increasing attention. In the Netherlands, the smart mobility concept triggered various developments, leading to the uptake of initiatives for real-life experimentation, accompanied by an increase in media attention. While the concept is making its way through Dutch society, its meaning for practice remains unspecified. Therefore, this paper aims to unpack the meaning of the smart mobility concept, by analyzing Dutch news articles and initiatives’ websites using text mining and qualitative content analysis. The analyses reveal some ambiguous meanings for the smart mobility concept, demonstrating on the one hand a focus on incremental technological innovations that bring forward car-based solutions for short-term fixes, while on the other hand promising to address car-related issues and fundamentally change the mobility system by taking long-term challenges into account. In general, smart mobility seems to be about optimizations and maintaining the status quo rather than challenging it, although there are a few deviating and more critical voices. The smart mobility concept mobilizes actors and resources, but considering the ambiguities, these developments should be critically evaluated when proposed as solutions to transport issues and sustainability challenges.

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Time-dependent heterogeneity leads to transient suppression of COVID-19 epidemic, not herd immunity

10.1101/2020.07.26.20162420 ◽

2020 ◽

Author(s):

Alexei V. Tkachenko ◽

Sergei Maslov ◽

Ahmed Elbanna ◽

George N. Wong ◽

Zachary J. Weiner ◽

...

Keyword(s):

Empirical Data ◽

Social Activity ◽

Herd Immunity ◽

Real Life ◽

Short Term ◽

Susceptible Population ◽

Fragile State ◽

Face To Face ◽

Over Time

COVID-19 epidemic is characterized by the short-term overdispersion manifested in the phenomenon of super-spreading, whereby the majority of the transmission is driven by a minority of infected individuals. On the other hand, as demonstrated in this work, the eventual outcome of the epidemic is determined by the persistent heterogeneity of the population. While this long-term heterogeneity leads, e.g., to a reduction of the Herd Immunity Threshold (HIT), the overall progression of the epidemic is shaped by both persistent and short-term variations in individual susceptibilities and infectivities. We demonstrate how to incorporate persistent heterogeneity into a wide class of epidemiological models, and derive a non-linear dependence of the effective reproduction number Re on the susceptible population fraction S. This approach is further generalized to account for time variations in individual social activity. It is shown that the suppression of the early waves of the COVID-19 epidemic has been facilitated in some locations by Transient Collective Immunity (TCI). This is a fragile state that could be achieved below HIT, but would wane over time due to changing levels of individual social activity. Transient and long-term levels of heterogeneity are estimated by using empirical data from the COVID-19 epidemic as well as from real-life face-to-face contact networks. These results suggest that the hardest-hit areas, such as NYC, have achieved TCI following the first wave of the epidemic, but likely remain below the long-term HIT.Significance StatementBoth short-term overdispersion, associated, in particular, with superspreading events, and long-term persistent heterogeneity are shown to shape the spread of the COVID-19 pandemic. While the latter is expected to reduce the Herd Immunity Thresh-old (HIT), a suppression of the first wave of the epidemic could be facilitated by a combination of both long- and short-term variations of social activity across the population. By developing the epidemic theory which accounts for heterogeneity and temporal effects, we demonstrate that the state of Transient Collective Immunity (TCI) emerges well below the HIT during early, high-paced stages of the epidemic. However, this is a fragile state that would wane over time due to changing levels of social activity. Analysis of the empirical data suggests that by the end of the first wave of the COVID-19 epidemic, hardest-hit areas, such as NYC, have been close TCI, but likely below the long-term HIT.

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From single decisions to long-term choice patterns: Extending the dynamics of decision-making

10.31234/osf.io/kexj8 ◽

2019 ◽

Author(s):

Stefan Scherbaum ◽

Steven Lade ◽

Thilo Gross ◽

Stefan Siegmund ◽

Thomas Goschke ◽

...

Keyword(s):

Decision Making ◽

Sequential Sampling ◽

Real Life ◽

Decision Processes ◽

Neural Systems ◽

Short Term ◽

Sequential Sampling Models ◽

Attractor Model ◽

Trial Basis

Decision-making is usually studied on a trial by trial basis and each decision is assumed to represent an isolated choice process. These assumptions are also reflected in sequential sampling models which conceive of the decision-process as an accumulation of information about the attractiveness of the options at hand. Real-life decisions however are usually embedded in a rich context of previous choices at different time scales. A fundamental yet neglected question is therefore how the dynamics of choice processes unfold on a long-term time scale across several decisions. Here, we present a neural-inspired attractor model that integrates the short-term mechanism of accumulation models with the long-term dynamics of coupled neural systems. The model represents a class of models that incorporate inherent long-term dynamics. We use the model to predict long-term patterns, namely oscillatory switching, perseveration and dependence of perseveration on the delay between decisions. Furthermore, we predict RT effects for specific trials. We validate the predictions in two new studies and a reanalysis of existing data from a novel decision game in which participants have to perform delay discounting decisions. Applying the validated reasoning to a well-established choice questionnaire, we illustrate and discuss that taking long-term choice patterns into account may be necessary to accurately analyse and model decision processes.

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Comparison of Forecasting Techniques for Short-term and Long-term Real Life Problems

Dhaka University Journal of Science ◽

10.3329/dujs.v65i2.54523 ◽

2017 ◽

Vol 65 (2) ◽

pp. 139-144

Author(s):

Nandita Barman ◽

M Babul Hasan

Keyword(s):

Time Series ◽

Real Life ◽

Exponential Smoothing ◽

Short Term ◽

Life Problems ◽

Forecasting Method ◽

Out Of Sample ◽

Long Term Forecasting ◽

Exponential Smoothing Technique

In this paper, we analyze the most appropriate short-term and long term forecasting methods for our practical life where several methods of time series forecasting are available such as the Moving Averages method, Linear Regression with Time, Exponential Smoothing, Holt‘s Method, Holt-Winter‘s Method etc. This paper mainly concentrates on the Holt- Winters Exponential Smoothing technique as applied to time series that exhibit seasonality. The accuracy of the out-of-sample forecast is measured using MSE, MAPE, MAD. We will observe that the empirical results from the study indicate that the Holt-Winter‘s Multiplicative Forecasting Method processes as the most appropriate forecasting method for the sets of real life data that will be analyzed. Dhaka Univ. J. Sci. 65(2): 139-144, 2017 (July)

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Biologics registries

10.1093/med/9780199642489.003.0034_update_001 ◽

2015 ◽

Author(s):

David Isenberg ◽

Angela Zink

Keyword(s):

Life Experience ◽

Real Life ◽

Controlled Trials ◽

Side Effect Profile ◽

Risk Of Infection ◽

Short Term ◽

Biologic Drugs ◽

Double Blind ◽

The Past

Double-blind controlled trials undertaken over the past two decades have established the short-term effectiveness and side-effect profile of biologic drugs for patients with rheumatoid arthritis and related diseases. However, the development of biologics registers to capture ’real-life experience’ and explore long-term effectiveness and complications is equally important. In this chapter, we demonstrate how these registers have identified long-term joint benefits, a reduction in cardiovascular mortality, reassurance concerning fears about cancer development, and a balanced view of the risk of infection.

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A Case Study of Rock Type Prediction Using Random Forests: Erdenet Copper Mine, Mongolia

Minerals ◽

10.3390/min11101059 ◽

2021 ◽

Vol 11 (10) ◽

pp. 1059

Author(s):

Narmandakh Sarantsatsral ◽

Rajive Ganguli ◽

Rambabu Pothina ◽

Batmunkh Tumen-Ayush

Keyword(s):

Random Forests ◽

Rock Type ◽

Real Life ◽

Short Term ◽

Copper Mine ◽

Rock Types ◽

Simulated Performance ◽

Type Information

In a mine, knowledge of rock types is often desired as they are important indicators of grade, mineral processing complications, or geotechnical attributes. It is common to model the rock types with visual graphics tools using geologist-generated rock type information in exploration drillhole databases. Instead of this manual approach, this paper used random forest (RF), a machine learning (ML) algorithm, to model the rock type at Erdenet Copper Mine, Mongolia. Exploration drillhole data was used to develop the RF models and predict the rock type based on the coordinates of locations. Data selection and model evaluation methods were designed to ensure applicability for real life scenarios. In the scenario where rock type is predicted close to locations where information is available (such as in blocks being blasted), RF did very well with an overall success rate (OSR) of 89%. In the scenario where rock type was predicted for two future benches (i.e., 30 m below known locations), the best OSR was 86%. When an exploration program was simulated, performance was poor with a OSR of 59%. The results indicate that EMC can leverage RF models for short-term and long-term planning by predicting rock types within drilling blocks or future blocks quite accurately.

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A lasting sting: Examining the short-term and long-term effects of real-life group rejection

Group Processes & Intergroup Relations ◽

10.1177/1368430217695443 ◽

2017 ◽

Vol 21 (8) ◽

pp. 1109-1124 ◽

Cited By ~ 5

Author(s):

Julie L. Martin ◽

Laura Smart Richman ◽

Mark R. Leary

Keyword(s):

Social Status ◽

Satisfaction With Life ◽

Real Life ◽

Well Being ◽

Long Term Effects ◽

Short Term ◽

Long Term Changes ◽

Perceived Social Status ◽

The Impact

Although many studies have examined the short-term effects of rejection in laboratory settings, few have investigated the impact of rejection over time or in real-world contexts. The university sorority recruitment process offers a unique opportunity to address these shortcomings. Women participating in sorority recruitment were surveyed directly before recruitment, directly after recruitment, and 3 months later. Rejected women experienced decreases in all indicators of well-being directly after recruitment and did not return to baseline on depressive symptoms, positive mental health, satisfaction with life, perceived belonging, or perceived social status 3 months later. Accepted women showed no long-term changes in well-being, with the exception that happiness and perceived social status increased from baseline. A comparison group of women who did not participate in sorority recruitment showed no significant long-term changes in well-being. Perceived belonging, but not social status, significantly mediated the long-term emotional effects of rejection. These results document that rejection experiences can have long-lasting effects.

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