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Introduction: In clinical trials, event adjudication is a process to review and confirm the accuracy of outcomes reported by site investigators. Despite efforts to automate the communication between a clinical-data-and-coordination center and an event adjudication committee, the review and confirmation of outcomes, as the core function of the process, still fully rely on human labor. To address this issue, we present an automated event adjudication system and its application in two randomized controlled trials., Methods: Centrally executed by a clinical-data-and-coordination center, the automated event adjudication system automatedly assessed and classified outcomes in a clinical data management system. By checking clinically predefined criteria, the automated event adjudication system either confirmed or unconfirmed an outcome and automatedly updated its status in the database. It also served as a management tool to assist staff to oversee the process of event adjudication. The system has been applied in: (1) the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial and (2) the New Approach riVaroxaban Inhibition of Factor Xa in a Global trial versus Aspirin to prevenT Embolism in Embolic Stroke of Undetermined Source (NAVIGATE ESUS) trial. The automated event adjudication system first screened outcomes reported on a case report form and confirmed those with data matched to preset definitions. For selected primary efficacy, secondary, and safety outcomes, the unconfirmed cases were referred to a human event adjudication committee for a final decision. In the New Approach riVaroxaban Inhibition of Factor Xa in a Global trial versus Aspirin to prevenT Embolism in Embolic Stroke of Undetermined Source (NAVIGATE ESUS) trial, human adjudicators were given priority to review cases, while the automated event adjudication system took the lead in the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial., Results: Outcomes that were adjudicated in a hybrid model are discussed here. The COMPASS automated event adjudication system adjudicated 3283 primary efficacy outcomes and confirmed 1652 (50.3%): 132 (21.1%) strokes, 522 (53%) myocardial infarctions, and 998 (59.7%) causes of deaths. The NAVIGATE ESUS one adjudicated 737 cases of selected outcomes and confirmed 383 (52%): 219 (51.5%) strokes, 34 (42.5%) myocardial infarctions, 73 (54.9%) causes of deaths, and 57 (57.6%) major bleedings. After one deducts the time needed for migrating the system to a new study, the automated event adjudication system helped to reduce the time required for human review from approximately 1303 to 716.5 h for the Cardiovascular Outcomes for People Using Anticoagulation Strategies trial and from 387 to 196 h for the New Approach riVaroxaban Inhibition of Factor Xa in a Global trial versus Aspirin to prevenT Embolism in Embolic Stroke of Undetermined Source trial., Conclusion: The automated event adjudication system in combination with human adjudicators provides a streamlined and efficient approach to event adjudication in clinical trials. To immediately apply automated event adjudication, one can first consider the automated event adjudication system and involve human assistance for cases unconfirmed by the former.

Men, relative to women, can benefit their total reproductive success by engaging in short-term pluralistic mating. Yet not all men enact such a mating strategy. It has previously been hypothesized that high mate value men should be most likely to adopt a short-term mating strategy, with this prediction being firmly grounded in some important mid-level evolutionary psychological theories. Yet evidence to support such a link has been mixed. This paper presents a comprehensive meta-analysis of 33 published and unpublished studies (N = 5928) in which we find that that self-reported mate value accounts for roughly 6% of variance in men's sociosexual orientation. The meta-analysis provides evidence that men's self-perceived mate value positively predicts their tendency to engage in short-term mating, but that the total effect size is small., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.)

In the first part of the series, it was demonstrated that very fast (<30 s) separations of therapeutic protein species are feasible using ultra-short (5 × 2.1 mm) columns. In the second part, our purpose was to find the appropriate column length; therefore, a systematic study was performed using various custom-made prototype reversed-phase liquid chromatography (RPLC) columns ranging from 2 to 50 mm lengths. It was found that on a low dispersion ultrahigh-pressure liquid chromatography instrument, columns between 10 and 20 mm were most effective when made with 2.1 mm i.d. tubing. However, with the same LC instrument, 3 mm i.d. columns as short as ∼5 to 10 mm could be effectively used. In both cases, it has been found to be best to keep injection volumes below 0.6 μL, which presents a potential limit to further decreasing column length, given the current capabilities of autosampler instrumentation. The additional volume of the column hardware outside of the packed bed (extra-bed volume) of very small columns is also a limiting factor to decrease the column length. For columns shorter than 10 mm, columns' extra-bed volume was seen to make considerable contributions to band broadening. However, the use of ultra-short columns seemed to be a very useful approach for RPLC of large proteins (>25 kDa) and could also work well for ∼12 kDa as the lowest limit of molecular mass. In summary, a renewed interest in the use of ultra-short columns is warranted, and additional method development will be to the benefit of the biopharmaceutical industry as there is an ever-increasing demand for faster, yet accurate assays ( e.g. , high-throughput screening) of proteins.

mTOR inhibitors exert a preventive effect on cytomegalovirus (CMV) disease in CMV seropositive (R+) kidney transplant recipients, but their impact during the curative treatment of CMV disease in high-risk kidney transplant recipients has not been investigated. We aimed to evaluate the efficacy and tolerance of mTOR inhibitors compared with mycophenolic acid in 63 consecutive kidney transplant recipients (80% of D+R-) suffering from CMV disease with a persistent or a recurrent CMV DNAemia. In this monocentric retrospective study, 16 had their treatment converted to mTOR inhibitors and 47 did not. The Kaplan-Meier curves did not show any significant differences in CMV DNAemia eradication (77% vs. 88% respectively; hazard ratio (HR), 1.648 [95% confidence interval (CI), 0.913-2.973]; log-rank test, P = .132), DNAemia recurrence (36% vs. 47%; HR, 1.517 [95% CI, 0.574-4.007]; log-rank test, P = .448) and CMV clinical recurrence (17% vs. 27%; HR, 1.375 [95% CI, 0.340-5.552]; log-rank test, P = .677) between patients who received mTOR inhibitors and those who did not. These results were confirmed in uni- and multivariate time-dependent Cox regressions. In summary, conversion from mycophenolic acid to mTOR inhibitors seems inadequate for improving CMV clearance or in better preventing CMV recurrences during severe or persistent CMV disease., (© 2020 The Societies and John Wiley & Sons Australia, Ltd.)

The chromatographic performance (speed, efficiency, and gradient peak capacity for the same analysis time) of conical columns are investigated from fundamental and experimental viewpoints. A stainless steel, conically shaped column (2.1 mm i.d/4.2 mm i.d. × 15 cm long, 0.4° opening angle) was prepared in-house and packed with 5 μm XBridge-C 18 fully porous particles. Its performance was compared to that of a conventional 3.0 mm × 15 cm cylindrical column packed with the same batch of particles. Both Giddings' theory of non-uniform columns and experiments agree and show that, irrespective of flow direction, the conical column is 15% less efficient than the conventional column. Remarkably, Blumberg's theory of band broadening in gradient elution mode predicts that conical columns may outperform conventional cylindrical columns if the ratio of their outlet i.d. to their inlet i.d. is 0.95 and 0.80 for small molecule and peptide mixtures, respectively. The maximum relative gain is marginal as it does not exceed a few percents. The theory reveals that the flow direction should be from the wide to the narrow end of the conical column in order to deliver the highest peak capacity. In agreement with the theory, the observed losses in absolute peak capacity for the same analysis time are 14.5% (narrow to wide end) and only 11.0% (wide to the narrow end) for small molecules (n-alkanophenones). They are 14.2% (narrow to wide end) and only 8.5% (wide to the narrow end) for peptide samples (bombesin). Additionally, conical columns reduce peak tailing with respect to standard columns. They are suitable column technology for ultra-fast gradient separations as they also minimize sample dispersion through the narrow i.d. outlet frit., (Copyright © 2019 Elsevier B.V. All rights reserved.)

The goal of this literature review is to provide the anesthesia practitioner with the skill set to detect and prepare for a difficult pediatric airway. The authors have reviewed and compiled information on some of the most common conditions that can predispose pediatric patients to a difficulty airway, such as macroglossia, mandibular hypoplasia, micrognathia, cervical instability, limited cervical movement, maxillary and midfacial hypoplasia, and cleft palate. This article provides an overview of preoperative assessment techniques, normal pediatric airway anatomy, and respiratory physiology. An emphasis is placed on some common syndromes and their related anatomical abnormalities that can compromise the airway, as well as anesthetic approaches recommended to successfully secure a potentially difficult airway.