scholarly journals New Percutaneous Options for Tricuspid Intervention: How to Identify the Good Clinical Candidate

2020 ◽  
Vol 7 ◽  
Author(s):  
Alessandra Laricchia ◽  
Arif A. Khokhar ◽  
Francesco Giannini
Keyword(s):  
Management Strategy ◽  
Randomized Trials ◽  
Evidence Base ◽  
Severe Tricuspid Regurgitation ◽  
The Past ◽  
Stage Disease ◽  
Long Time ◽  
Risk Patients ◽  
High Operative Risk ◽  
Clinical Candidate

The tricuspid valve has been neglected for a long time and severe tricuspid regurgitation (TR) was largely undertreated in the past due to a high operative risk. In the last years we observed the development of different less invasive percutaneous options to treat TR. Currently, percutaneous treatments are reserved for high-risk patients presenting with advanced stage disease by which time they are likely to derive a partial benefit at best. There is a limited evidence base, including no randomized trials, to guide the management strategy for severe TR. In the interim we feel that choosing the best device for the most appropriate clinical candidate and with an adequate timing (most probably an “earlier” timing) will be the key combination to improve early and late outcomes of percutaneous treatments.

Cardiology

2016 ◽  
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Randomized Trials ◽  
Evidence Base ◽  
Evidence Based ◽  
Coronary Syndrome ◽  
The Past ◽  
Clinical Cardiology ◽  
Treatment Of Hypertension ◽  
St Elevation

To date, several thousand randomized trials of cardiac treatments have been published, and, over the past few decades, clinical cardiology has gradually evolved from an experience-based to an evidence-based specialty. This chapter focuses on familiarizing clinicians with some of the evidence underpinning contemporary cardiological practice and encourages interest in the future development of the cardiological evidence base. Using an eclectic selection and providing a balanced interpretation of trial results, it takes trials that have influenced cardiological practice, covering topics such as the optimal treatment of hypertension, non-ST elevation acute coronary syndrome, and heart failure.

1610: High-Risk Patients Undergoing Radical Prostatectomy Today are Less High-Risk than in the Past

2005 ◽  
Vol 173 (4S) ◽  
pp. 436-436
Author(s):  
Christopher J. Kane ◽  
Martha K. Terris ◽  
William J. Aronson ◽  
Joseph C. Presti ◽  
Christopher L. Amling ◽  
...  
Keyword(s):  
High Risk ◽  
Radical Prostatectomy ◽  
High Risk Patients ◽  
The Past ◽  
Risk Patients

scholarly journals Predicting Fraud Victimization Using Classical Machine Learning

Entropy ◽  
2021 ◽  
Vol 23 (3) ◽  
pp. 300
Author(s):  
Mark Lokanan ◽  
Susan Liu
Keyword(s):  
Machine Learning ◽  
Financial Literacy ◽  
Learning Algorithm ◽  
Demographic Characteristics ◽  
Financial Knowledge ◽  
The Past ◽  
Machine Learning Model ◽  
Long Time ◽  
Regulatory Organization ◽  
Investment Fraud

Protecting financial consumers from investment fraud has been a recurring problem in Canada. The purpose of this paper is to predict the demographic characteristics of investors who are likely to be victims of investment fraud. Data for this paper came from the Investment Industry Regulatory Organization of Canada’s (IIROC) database between January of 2009 and December of 2019. In total, 4575 investors were coded as victims of investment fraud. The study employed a machine-learning algorithm to predict the probability of fraud victimization. The machine learning model deployed in this paper predicted the typical demographic profile of fraud victims as investors who classify as female, have poor financial knowledge, know the advisor from the past, and are retired. Investors who are characterized as having limited financial literacy but a long-time relationship with their advisor have reduced probabilities of being victimized. However, male investors with low or moderate-level investment knowledge were more likely to be preyed upon by their investment advisors. While not statistically significant, older adults, in general, are at greater risk of being victimized. The findings from this paper can be used by Canadian self-regulatory organizations and securities commissions to inform their investors’ protection mandates.

Combination chemotherapy versus melphalan plus prednisone as treatment for multiple myeloma: an overview of 6,633 patients from 27 randomized trials. Myeloma Trialists' Collaborative Group.

1998 ◽  
Vol 16 (12) ◽  
pp. 3832-3842 ◽  
Keyword(s):  
Multiple Myeloma ◽  
Combination Chemotherapy ◽  
Randomized Trials ◽  
Outcome Measure ◽  
Individual Patient Data ◽  
Collaborative Group ◽  
Published Data ◽  
Recurrence Rates ◽  
Subgroup Analyses ◽  
Risk Patients

PURPOSE To compare combination chemotherapy (CCT) versus melphalan plus prednisone (MP) as treatment for multiple myeloma. PATIENTS AND METHODS In a collaborative worldwide overview of randomized trials of CCT versus MP, individual patient data on 4,930 patients from 20 trials were analyzed, with the addition of published data on a further 1,703 patients from seven trials. The main outcome measure was mortality, with response and recurrence rates being subsidiary end points. RESULTS Taking all of the trials together, response rates were significantly higher with CCT than with MP (60.0% v 53.2%; P < .00001, two-tailed). There was no evidence of any difference in mortality between CCT and MP, with a nonsignificant 1.5% reduction in death rate in favor of CCT (P = .6, two-tailed). There is heterogeneity of design between the trials, but subgroup analyses by type of CCT or by dose-intensities of CCT, of melphalan, or of prednisone did not identify any particular forms of therapy that were either clearly beneficial or clearly adverse. Similarly, analysis of the presentation features of the patients did not find any categories in which CCT differed significantly from MP in its effects on mortality; in particular, there was no evidence that poor-risk patients benefited more from CCT. CONCLUSION This overview found no difference, either overall or within any subgroup, in mortality between CCT and MP. In terms of survival, these therapeutic options, as tested in the trials considered, are approximately equivalent.

1993 Soichiro Honda Lecture: The Challenges of Change in the Auto Industry: Why Alternative Fuels?

1994 ◽  
Vol 116 (4) ◽  
pp. 727-732 ◽  
Author(s):  
R. J. Nichols
Keyword(s):  
Air Quality ◽  
Alternative Fuels ◽  
Combustion Engine ◽  
Auto Industry ◽  
Transportation Fuel ◽  
Alternative Fuel Vehicles ◽  
The Past ◽  
Entire Country ◽  
Long Time ◽  
Difficult Transition

Development of vehicles to operate on nonpetroleum fuels began in earnest in response to the energy shocks of the 1970s. While petroleum will remain the predominant transportation fuel for a long time, petroleum supplies are finite, so it is not too soon to begin the difficult transition to new sources of energy. In the past decade, composition of the fuel utilized in the internal combustion engine has gained recognition as a major factor in the control of emissions from the tailpipe of the automobile and the rate of formation of ozone in the atmosphere. Improvements in air quality can be realized by using vechicles that operate on natural gas, propane, methanol, ethanol, or electricity, but introduction of these alternative fuel vehicles presents major technical and economic challenges to the auto industry, as well as the entire country, as long as gasoline remains plentiful and inexpensive.

scholarly journals Through what mechanisms do protected areas affect environmental and social outcomes?

2015 ◽  
Vol 370 (1681) ◽  
pp. 20140267 ◽  
Author(s):  
Paul J. Ferraro ◽  
Merlin M. Hanauer
Keyword(s):  
Experimental Data ◽  
Protected Areas ◽  
Empirical Evidence ◽  
Strong Evidence ◽  
Protected Area ◽  
Evidence Base ◽  
Social Outcomes ◽  
Causal Effects ◽  
The Past ◽  
Made In

To develop effective protected area policies, scholars and practitioners must better understand the mechanisms through which protected areas affect social and environmental outcomes. With strong evidence about mechanisms, the key elements of success can be strengthened, and the key elements of failure can be eliminated or repaired. Unfortunately, empirical evidence about these mechanisms is limited, and little guidance for quantifying them exists. This essay assesses what mechanisms have been hypothesized, what empirical evidence exists for their relative contributions and what advances have been made in the past decade for estimating mechanism causal effects from non-experimental data. The essay concludes with a proposed agenda for building an evidence base about protected area mechanisms.

scholarly journals CYCLIC UNIVERSE AND INFINITE PAST

2007 ◽  
Vol 22 (34) ◽  
pp. 2587-2592 ◽  
Author(s):  
PAUL H. FRAMPTON
Keyword(s):  
Null Geodesic ◽  
Infinite Length ◽  
Infinite Time ◽  
Cyclic Universe ◽  
The Past ◽  
Long Time

We address two questions about the past for infinitely cyclic cosmology. The first is whether it can contain an infinite length null geodesic into the past in view of the Borde–Guth–Vilenkin (BGV) "no-go" theorem, The second is whether, given that a small fraction of spawned universes fail to cycle, there is an adequate probability for a successful universe after an infinite time. We give positive answers to both questions and then show that in infinite cyclicity the total number of universes has been infinite for an arbitrarily long time.

Small cell rectal cancer: a therapeutic challenge

2021 ◽  
Vol 14 (10) ◽  
pp. e244108
Author(s):  
Alex Fitzhugh ◽  
Alison Corr ◽  
Arshi Denton ◽  
Anthony Antoniou
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Hepatic Metastases ◽  
Disease Recurrence ◽  
Evidence Base ◽  
Small Cell ◽  
Bowel Habit ◽  
Small Cell Lung ◽  
Stage Disease

A generally well 71-year-old man presented to his general practitioner with altered bowel habit and haematochezia. Colonoscopy revealed a malignant-appearing rectal mass, with histological features of extrapulmonary small cell carcinoma (EPSCC) of the rectum. Imaging demonstrated limited stage disease with a threatened circumferential resection margin. He was treated with a modified platinum chemoradiotherapy regimen for small cell lung cancer with an excellent response. Unfortunately, his cardiac function precluded surgery at the time and the patient subsequently developed hepatic metastases with local disease recurrence, and died 15 months following his initial diagnosis. Rectal EPSCC is a rare diagnosis, and this case represented a challenge for the multidisciplinary team given the limited evidence base. Medical therapy reflects extrapolation of small cell lung cancer treatment and the role of surgery is less clearly defined given aggressive and refractory disease is common. Immunotherapy, however, represents an exciting development for metastatic disease.

Transcatheter aortic valve implantation is still inappropriate in low-risk, young patients: a UK perspective

2021 ◽  
pp. 1-4
Author(s):  
Suvitesh Luthra ◽  
Sunil K Ohri
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Young Patients ◽  
Evidence Base ◽  
Low Risk ◽  
Transcatheter Aortic Valve ◽  
Long Term Follow Up ◽  
Risk Patients ◽  
Aortic Valve Implantation ◽  
Valve Implantation

The PARTNER 3 and Evolut LRT trials have provided the evidence base for transcatheter aortic valve implantation in low-risk patients. However, there are still issues with durability, long-term follow up and complications before their widespread use can be considered appropriate in this group.

Long Time Coming: Prospects for Democracy in Iraq

2009 ◽  
Vol 33 (4) ◽  
pp. 115-148 ◽  
Author(s):  
Bruce E. Moon
Keyword(s):  
Nineteenth Century ◽  
The Other ◽  
Democratic Transitions ◽  
Quarter Century ◽  
The Past ◽  
Political Experience ◽  
Long Time ◽  
Time Required ◽  
Established Democracies

Prospects for democracy in Iraq should be assessed in light of the historical precedents of nations with comparable political experiences. Saddam Hussein's Iraq was an unusually extreme autocracy, which lasted an unusually long time. Since the end of the nineteenth century, only thirty nations have experienced an autocracy as extreme as Iraq's for a period exceeding two decades. The subsequent political experience of those nations offers a pessimistic forecast for Iraq and similar nations. Only seven of the thirty are now democratic, and only two of them have become established democracies; the democratic experiments in the other five are still in progress. Among the seven, the average time required to transit the path from extreme autocracy to coherent, albeit precarious, democracy has been fifty years, and only two have managed this transition in fewer than twenty-five years. Even this sober assessment is probably too optimistic, because Iraq lacks the structural conditions that theory and evidence indicate have been necessary for successful democratic transitions in the past. Thus, the odds of Iraq achieving democracy in the next quarter century are close to zero, at best about two in thirty, but probably far less.

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