To compare the safety and efficacy of rofecoxib* to naproxen for the treatment of juvenile rheumatoid arthritis (JRA).
This was a 12-week, multicenter, randomized, double-blind, double-dummy, active ...comparator-controlled, non-inferiority study with a prespecified 52-week open-label active comparator-controlled extension. Children (ages 2-11 yrs) and adolescents (ages 12-17 yrs) received lower-dose (LD)-rofecoxib 0.3 mg/kg/day up to 12.5 mg/day (base study only); or higher-dose (HD)-rofecoxib (0.6 mg/kg/day up to 25 mg/day) or naproxen 15 mg/kg/day as oral suspensions. Adolescents received daily rofecoxib (LD) 12.5 (base study only) or (HD) 25 mg, or naproxen 15 mg/kg/day (maximum 1,000 mg/day) as tablets. The primary endpoint was the time-weighted average proportion of patients meeting the American College of Rheumatology Pediatric-30 (ACR Pedi 30) response criteria. A prespecified bound for the 95% confidence interval for the ratio of the percentage of ACR Pedi 30 responders was used to assess non-inferiority of treatment response between groups. Safety was assessed throughout the study.
A total of 310 patients ages 2-17 years (181 (3/4) age 11) were randomized to receive LD-rofecoxib (N=109), HD-rofecoxib (N=100), or naproxen (N=101). The ACR Pedi 30 response rates following 12 weeks of treatment were 46.2%, 54.5%, and 55.1%, respectively. The relative rates of response compared to naproxen were 0.81 (95% CI 0.61, 1.07) and 0.98 (95% CI 0.76, 1.26) for LD- and HD-rofecoxib, respectively. Both rofecoxib doses were not inferior to naproxen. Patients (N=227) entering the extension received HD-rofecoxib or naproxen with efficacy maintained during the extension. All treatments were generally well tolerated throughout the study.
Daily treatment of JRA patients with rofecoxib up to 12.5 or 25 mg was well tolerated, providing sustained clinical effectiveness comparable to naproxen 15 mg/kg. *On September 30, 2004, Merck & Co., Inc. announced the voluntary worldwide withdrawal of rofecoxib from the market.
Promoting Diversity and Social Justice provides theories, perspectives, and strategies that are useful for working with adults from privileged groups—those who are in a more powerful position in any ...given type of oppression. The thoroughly revised edition of this accessible and practical guide offers tools that allow educators to be more reflective and intentional in their work—helping them to consider who they’re working with, what they’re doing, why they’re doing it and how to educate more effectively.
New features include:
A new chapter, "The Joy of Unlearning Privilege/Oppression," highlights specific ways people from privileged groups benefit from unlearning privilege/oppression and from creating greater equity.
A new chapter, "Allies and Action," gives focus and guidance on how people from privileged groups can constructively and appropriately be involved in social change efforts.
Updated Appendix of additional resources.
The theories and approaches discussed can be applied to a range of situations and audiences. This book is an excellent resource for professors, diversity trainers, teachers in classrooms and workshops, counselors, organizers, student affairs personnel, community educators, advocates, group facilitators, and any others involved with educating about diversity and equity.
Diane J. Goodman , Ed.D., is a trainer, college teacher, author, speaker, and consultant on diversity and social justice issues. For more information, see her website: http://www.dianegoodman.com.
"This new edition improves upon what was already an indispensable tool for educators, trainers, and activists. Written in an accessible and sympathetic voice, with concrete strategies and support, this is a text I find myself turning to again and again. If you are committed to dismantling privilege and oppression, you need this book!"
--Abby L. Ferber, Director of the Matrix Center for the Advancement of Social Equity and Inclusion, Professor of Sociology, and Women's and Ethnic Studies, University of Colorado at Colorado Springs
"Updating and extending her foundational work for a newly emerging social climate in a clear, personable, accessible, and yes, joyous style, Diane J. Goodman maintains a laser focus upon members of socially privileged groups. By so doing, she provides readers the tools they need to envision not only the concept, but most importantly, the reality of social justice."
--Warren J. Blumenfeld, Associate Professor, Department of Curriculum and Instruction, Iowa State University
IMPORTANCE: The rapid expansion of virtual health care has caused a surge in patient messages concomitant with more work and burnout among health care professionals. Artificial intelligence (AI) ...assistants could potentially aid in creating answers to patient questions by drafting responses that could be reviewed by clinicians. OBJECTIVE: To evaluate the ability of an AI chatbot assistant (ChatGPT), released in November 2022, to provide quality and empathetic responses to patient questions. DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, a public and nonidentifiable database of questions from a public social media forum (Reddit’s r/AskDocs) was used to randomly draw 195 exchanges from October 2022 where a verified physician responded to a public question. Chatbot responses were generated by entering the original question into a fresh session (without prior questions having been asked in the session) on December 22 and 23, 2022. The original question along with anonymized and randomly ordered physician and chatbot responses were evaluated in triplicate by a team of licensed health care professionals. Evaluators chose “which response was better” and judged both “the quality of information provided” (very poor, poor, acceptable, good, or very good) and “the empathy or bedside manner provided” (not empathetic, slightly empathetic, moderately empathetic, empathetic, and very empathetic). Mean outcomes were ordered on a 1 to 5 scale and compared between chatbot and physicians. RESULTS: Of the 195 questions and responses, evaluators preferred chatbot responses to physician responses in 78.6% (95% CI, 75.0%-81.8%) of the 585 evaluations. Mean (IQR) physician responses were significantly shorter than chatbot responses (52 17-62 words vs 211 168-245 words; t = 25.4; P < .001). Chatbot responses were rated of significantly higher quality than physician responses (t = 13.3; P < .001). The proportion of responses rated as good or very good quality (≥ 4), for instance, was higher for chatbot than physicians (chatbot: 78.5%, 95% CI, 72.3%-84.1%; physicians: 22.1%, 95% CI, 16.4%-28.2%;). This amounted to 3.6 times higher prevalence of good or very good quality responses for the chatbot. Chatbot responses were also rated significantly more empathetic than physician responses (t = 18.9; P < .001). The proportion of responses rated empathetic or very empathetic (≥4) was higher for chatbot than for physicians (physicians: 4.6%, 95% CI, 2.1%-7.7%; chatbot: 45.1%, 95% CI, 38.5%-51.8%; physicians: 4.6%, 95% CI, 2.1%-7.7%). This amounted to 9.8 times higher prevalence of empathetic or very empathetic responses for the chatbot. CONCLUSIONS: In this cross-sectional study, a chatbot generated quality and empathetic responses to patient questions posed in an online forum. Further exploration of this technology is warranted in clinical settings, such as using chatbot to draft responses that physicians could then edit. Randomized trials could assess further if using AI assistants might improve responses, lower clinician burnout, and improve patient outcomes.
This study examined cell localisation and plasmid maintenance of Vibrio sp. S141(p519ngfp) cells which grew in, and detached from, monoculture and mixed-species marine biofilms under continuous flow ...conditions. Over the 48 h time course of the experiments, the broad host range IncQ RSF1010 derivative plasmid, p519 ngfp , was maintained in S141(p519ngfp) cells detaching from the biofilms irrespective of selection for the plasmid, the presence of another bacterial species, or the order of substratum colonisation. S141(p519ngfp) cell localisation within mixed-species biofilms was affected by the order, and length of time, of colonisation. When S141(p519ngfp) was the initial coloniser of the biofilm, the localisation of the majority of the plasmid-bearing cells near the substratum surface was not affected. When S141(p519ngfp) cells colonised a pre-existing Psychrobacter sp. SW5HR biofilm, or the two species simultaneously colonised the substratum, non plasmid-bearing cells initially dominated the substratum surface; as the time of S141(p519ngfp) colonisation increased, the plasmid-bearing cells appeared to displace the SW5HR cells from the surface. Since the p519ngfp plasmid was stably maintained in the Vibrio sp. S141 host forming biofilms over a 48 h period, GFP-producing S141 cells were able to be localised in mixed-species biofilms and were found to dominate the substratum surface by 48 h.
The highly lipid-soluble opioids, fentanyl and sufentanil, frequently are used in combination with local anesthetic agents and/or epinephrine to provide postoperative epidural analgesia. The authors ...compared the incidence of side effects and patient satisfaction during prolonged epidural patient-controlled analgesia (PCA) infusions of these opioids in combination with bupivacaine and epinephrine.
Using a double-blind study design, 250 patients scheduled for elective cesarean delivery were, on arrival in the postanesthesia care unit, randomized into two epidural PCA infusion groups: group I (n = 125) received fentanyl 2 micrograms/ml with bupivacaine 0.01% and epinephrine 0.5 micrograms/ml and group II (n = 125) received sufentanil 0.8 micrograms/ml with bupivacaine 0.01% and epinephrine 0.5 microgram/ml. The initial infusion rate was 16 ml/h with self-administered 3-ml boluses every 15 min by PCA as desired. At intervals after discontinuation of the infusion, plasma samples were obtained to determine opioid concentrations.
The median overall satisfaction scores were 9.0 for group I and 10.0 for group II (difference not significant). Pain relief was satisfactory and comparable in both groups, and all patients could ambulate easily. The total number of times PCA requests were made was greater (P < 0.05, by Wilcoxon rank-sum test) for group I than for group II (106.7 +/- 312 vs. 70.8 +/- 138). There were no differences between the groups with respect to incidence of pruritus, sedation, and nausea; however, vomiting occurred more frequently with sufentanil than with fentanyl (12% vs. 4.8%, respectively; P < 0.05). At approximately 1-2 h after discontinuation of the infusion, 1 patient receiving fentanyl and 42 patients receiving sufentanil complained of lightheadedness and dizziness (P < 0.0001).
Epidural PCA in both groups had no serious side effects and achieved a high level of patient satisfaction. Those receiving sufentanil made fewer PCA requests but had a significantly greater incidence of vomiting during the infusion and dizziness after the termination of the infusion. Epidural sufentanil offered no advantages over epidural fentanyl.
Resilience to host inflammation and other perturbations is a fundamental property of gut microbial communities, yet the underlying mechanisms are not well understood. We have found that human gut ...microbes from all dominant phyla are resistant to high levels of inflammation-associated antimicrobial peptides (AMPs) and have identified a mechanism for lipopolysaccharide (LPS) modification in the phylum Bacteroidetes that increases AMP resistance by four orders of magnitude. Bacteroides thetaiotaomicron mutants that fail to remove a single phosphate group from their LPS were displaced from the microbiota during inflammation triggered by pathogen infection. These findings establish a mechanism that determines the stability of prominent members of a healthy microbiota during perturbation.
Evaluate safety and efficacy of mixed amphetamine salts extended release (MAS XR) in adults with attention-deficit/hyperactivity disorder (ADHD).
10-week interim analysis of the Quality of life, ...Effectiveness, Safety, and Tolerability (QU.E.S.T.) trial, an ongoing, 30-week, open-label, multicenter investigation of once-daily MAS XR (10-60 mg/day) in adults (>or=18 years of age) with ADHD in community practice settings.
With up to 10 weeks of open-label MAS XR 10 to 60 mg/day (final visit mean dose: 37.2 mg/day), 725 adults exhibited rapid, sustained improvement in ADHD symptoms. At end point, significant decreases from baseline were seen in ADHD Rating Scale IV total scores (-19.8+/-11.6; P<.0001), hyperactivity/impulsivity subscale (-8.1+/-6.1; P<.0001), and inattentive subscale (-11.6+/-6.7; P<.0001). Most subjects (74.4%) were rated as very much/much improved. Based on the 36-item Short Form Health Survey (version 2), significant improvements in quality of life were seen in the domains of general health, physical and mental health, vitality, and social, emotional and physical role functioning (P<.0001). Few subjects (6.9%) withdrew due to adverse events; the most common MAS XR-related adverse events were decreased appetite and dry mouth (19.2% each), insomnia (17.8%), and headache (16.8%).
In adults with ADHD, MAS XR treatment is generally safe and demonstrates significant improvement in ADHD symptoms and related quality of life.
A CLOSER LOOK AT THE ABI ON THE GOES-R SERIES Schmit, Timothy J.; Griffith, Paul; Gunshor, Mathew M. ...
Bulletin of the American Meteorological Society,
04/2017, Letnik:
98, Številka:
4
Journal Article
Recenzirano
Odprti dostop
The Advanced Baseline Imager (ABI) on board the Geostationary Operational Environmental Satellite-R (GOES-R) is America’s next-generation geostationary advanced imager. GOES-R launched on 19 November ...2016. The ABI is a state-of-the-art 16-band radiometer, with spectral bands covering the visible, near-infrared, and infrared portions of the electromagnetic spectrum. Many attributes of the ABI—such as spectral, spatial, and temporal resolution; radiometrics; and image navigation/registration—are much improved from the current series of GOES imagers. This paper highlights and discusses the expected improvements of each of these attributes. From ABI data many higher-level-derived products can be generated and used in a large number of environmental applications. The ABI’s design allows rapid-scan and contiguous U.S. imaging automatically interleaved with full-disk scanning. In this paper the expected instrument attributes are covered, as they relate to signal-to-noise ratio, image navigation and registration, the various ABI scan modes, and other parameters. There will be several methods for users to acquire GOES-R imagery and products depending on their needs. These include direct reception of the imagery via the satellite downlink and an online-accessible archive. The information from the ABI on the GOES-R series will be used for many applications related to severe weather, tropical cyclones and hurricanes, aviation, natural hazards, the atmosphere, the ocean, and the cryosphere.
The ABI on the GOES-R series is America’s next-generation geostationary advanced imager and will dramatically improve the monitoring of many phenomena at finer time and space scales.
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Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The air–sea exchange of heat and carbon in the Southern Ocean (SO) plays an important role in mediating the climate state. The dominant role the SO plays in storing anthropogenic heat and carbon is a ...direct consequence of the unique and complex ocean circulation that exists there. Previous generations of climate models have struggled to accurately represent key SO properties and processes that influence the large-scale ocean circulation. This has resulted in low confidence ascribed to twenty-first-century projections of the state of the SO from previous generations of models. This analysis provides a detailed assessment of the ability of models contributed to the sixth phase of the Coupled Model Intercomparison Project (CMIP6) to represent important observationally based SO properties. Additionally, a comprehensive overview of CMIP6 performance relative to CMIP3 and CMIP5 is presented. CMIP6 models show improved performance in the surface wind stress forcing, simulating stronger and less equatorward-biased wind fields, translating into an improved representation of the Ekman upwelling over the Drake Passage latitudes. An increased number of models simulate an Antarctic Circumpolar Current (ACC) transport within observational uncertainty relative to previous generations; however, several models exhibit extremely weak transports. Generally, the upper SO remains biased warm and fresh relative to observations, and Antarctic sea ice extent remains poorly represented. While generational improvement is found in many metrics, persistent systematic biases are highlighted that should be a priority during model development. These biases need to be considered when interpreting projected trends or biogeochemical properties in this region.
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Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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