Many studies have compared real-world clinical outcomes of immunotherapy in patients with metastatic non-small cell lung cancer (NSCLC) with reported outcomes data from pivotal trials. However, any ...differences observed could be only limitedly explored further for causation because of the unavailability of individual patient data (IPD) from trial participants. The present study aims to explore the additional benefit of comparison with IPD.
This study compares progression free survival (PFS) and overall survival (OS) of metastatic NSCLC patients treated with second line nivolumab in real-world clinical practice (n = 141) with IPD from participants in the Checkmate-057 clinical trial (n = 292). Univariate and multivariate Cox proportional hazards models were used to construct HRs for real-world practice versus clinical trial.
Real-world patients were older (64 vs. 61 years), had more often ECOG PS ≥ 2 (5 vs. 0%) and were less often treated with subsequent anti-cancer treatment (28.4 vs. 42.5%) compared to trial patients. The median PFS in real-world patients was longer (3.84 (95%CI: 3.19-5.49) vs 2.30 (2.20-3.50) months) and the OS shorter than in trial participants (8.25 (6.93-13.2) vs. 12.2 (9.90-15.1) months). Adjustment with available patient characteristics, led to a shift in the hazard ratio (HR) for OS, but not for PFS (HRs from 1.13 (0.88-1.44) to 1.07 (0.83-1.38), and from 0.82 (0.66-1.03) to 0.79 (0.63-1.00), respectively).
This study is an example how IPD from both real-world and trial patients can be applied to search for factors that could explain an efficacy-effectiveness gap. Making IPD from clinical trials available to the international research community allows this.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The aims of the study were to determine the prevalence of cardiometabolic risk factors and establish the proportion of people with psychosis meeting criteria for the metabolic syndrome (MetS). The ...study also aimed to identify the key lifestyle behaviours associated with increased risk of the MetS and to investigate whether the MetS is associated with illness severity and degree of functional impairment.
Baseline data were collected as part of a large randomized controlled trial (IMPaCT RCT). The study took place within community mental health teams in five Mental Health NHS Trusts in urban and rural locations across England. A total of 450 randomly selected out-patients, aged 18-65 years, with an established psychotic illness were recruited. We ascertained the prevalence rates of cardiometabolic risk factors, illness severity and functional impairment and calculated rates of the MetS, using International Diabetes Federation (IDF) and National Cholesterol Education Program Third Adult Treatment Panel criteria.
High rates of cardiometabolic risk factors were found. Nearly all women and most men had waist circumference exceeding the IDF threshold for central obesity. Half the sample was obese (body mass index ≥ 30 kg/m2) and a fifth met the criteria for type 2 diabetes mellitus. Females were more likely to be obese than males (61% v. 42%, p < 0.001). Of the 308 patients with complete laboratory measures, 57% (n = 175) met the IDF criteria for the MetS.
In the UK, the prevalence of cardiometabolic risk factors in individuals with psychotic illnesses is much higher than that observed in national general population studies as well as in most international studies of patients with psychosis.
Disordered eating is a serious and under‐recognized problem in people with diabetes. This narrative review summarizes the research contributions made by psychological science over the past 25 years ...to the study of disordered eating in people with type 1 or type 2 diabetes, and identifies gaps and future directions relevant to both healthcare professionals and researchers. Key focus areas of psychological research investigating disordered eating in people with diabetes have been: (1) defining and classifying types of disordered eating; (2) identifying demographic, diabetes‐specific and psychosocial correlates of disordered eating, and developing theoretical models of disordered eating in people with type 1 diabetes; (3) identifying the physical and psychosocial consequences of disordered eating; and (4) developing screening measures to identify disordered eating in people with type 1 diabetes. Psychological science has made significant contributions over the past 25 years to our understanding of the nature of this problem and the multiple factors which may interrelate with disordered eating in people with diabetes. Key areas for further attention include: (1) a better definition of disordered eating subtypes in people with type 1 diabetes; (2) characterizing disordered eating in people with type 2 diabetes; and (3) developing multidisciplinary, evidence‐based prevention and treatment interventions for comorbid disordered eating and diabetes.
What's new?
This review provides a recent critical summary of the literature exploring disordered eating in people with diabetes over the past 25 years.
We address key gaps; most notably, the absence of focus on people with type 2 diabetes and the urgent need for intervention strategies.
We review challenges for healthcare professionals involved in the clinical care of individuals with comorbid diabetes and disordered eating, and provide recommendations for the direction of care, emphasizing a tailored, multidisciplinary approach.
In this study, a frost formation model is presented based on a new two-dimensional approach for the growth rate. For modeling the frost formation over parallel cold plates, the basic transport ...equations of mass, energy and momentum have been discretized using the finite volume method in a two-dimensional domain in which air and frost are considered. A fixed grid formulation is used to deal with the air–frost moving boundary. An extended domain in the inlet boundary has been considered in order to study the frost formation in the leading edge of the plate. The numerical results have been validated against experimental data in which frost growth and temperature as a function of time are reported as local values. The model predictions of the frost thickness as a function of time agree with the experimental data within 10% of deviation for the case of intermediate plate temperature.
•A novel two-dimensional frost growth rate is detailed.•Two-dimensional frost growth rate can be leads to a more physically realistic frost growth in a future application in more complex geometry.•A new computation domain is required.
Sorbitol accumulation in the tissue is known to cause diabetic complications. Nanotechnology-enabled biosensor methods have high sensitivity, selectivity, and more rapid detection of an analytic for ...sorbitol which is used as a biomarker of diabetic complications. The biosensor used aldose reductase from serum blood to oxidize the NADPH by the enzymatic reaction and reduce glucose to sorbitol. Biosensors can be developed for diagnostic testing. Developing a simple, sensitive, and rapid method for sorbitol detection is significant for efficient monitoring of diabetic complications like neuropathy at the initial stages. This project synthesized quantum dots of copper sulfide (CuS QDs) to fabricate an Electrochemical sensor for the detection of sorbitol by the UV-irradiation technique. The crystal structure of CuS QDs was characterized using X-ray diffraction (XRD), which confirmed the synthesized sample’s hexagonal shape. The structure of the manufactured product was examined using energy-dispersive X-ray spectroscopy (EDX), and the result revealed just copper (Cu) and sulfide (S) elements, indicating that the synthetic material was pure. The morphology, optical properties, and particle size were investigated by scanning electron microscope (SEM), photoluminescence spectroscopy (PL), and transmission electron spectroscopy (TEM), respectively. The particle sizes of the CuS QDs were found to range between 5.4 to 9.1 nm. The CuS QDs will be dedicated to the conventional methods to synthesize the modified electrode functionalized with NADPH and covered with CuS QD (Ti-TiO2/CuS/NADPH) demonstrated switchable interfacial properties. The electrochemical process was characterized by cyclic voltammetry (CV). The developed sensor was successfully tested to detect sorbitol in human serum samples. The high catalytic activity and the redox behavior of CuS QD make it an efficient matrix for the realization of sorbitol. These results indicate that CuS QD is a suitable candidate material for developing enzyme-based sorbitol biosensors.
The fate of cadmium at the Muharram Aisha wastewater treatment plant in Karbala governorate, Iraq was studied using the TOXCHEM model. Cadmium, a known carcinogen, and is considered one of the most ...dangerous heavy metals and high concentrations, greater than permissible limits, were found in the treated wastewater. The plant operates using an activated sludge system and this was modeled via TOXCHEM with a sensitivity analysis carried out on the extended aeration system. Prior to analysis, the model was calibrated and validated for cadmium, with the adjustments leading to a mean square error (RMSE) and correlation coefficient (R) of 0.0001 and 0.81, respectively. The mass balance of cadmium in the Muharram Aisha treatment plant was found to be 4832.44 g/day (37.1726%) in the treated wastewater and 8164.52 g/day (62.804%) in the sludge, which indicated that the mix liquor suspended solid (MLSS) was the most sensitive factor. The sensitivity to cadmium was analyzed via MLSS in the extended aeration system and the results o indicated that the higher the MLSS concentration (mg/L), the greater the removal of cadmium in the treated wastewater. It was found that increasing the MLSS through a biological treatment method reduced the concentration of cadmium without the need for additional of any (potentially harmful) chemical treatments. The plant was subsequently operated for a period of 5 months with the MLSS increased from 1500 to 4500 mg/L, and this reduced the concentration of cadmium in the wastewater from 0.36 to 0.01 mg/L as a consequence. This research demonstrates how the novel application of TOXCHEM can be a useful tool in the reduction of heavy metal contamination in the environment.
Despite growing ideological diversity within the group, black Americans have maintained their overwhelmingly unified support for the Democratic Party. We argue that black Democratic partisanship is ...upheld, in part, through black Americans’ use of social sanctions (both positive and negative) to encourage compliance with a group norm of Democratic Party support. Leveraging the exogenous assignment of racial social context provided by the race of an interviewer in face-to-face American National Election Study survey interviews of black respondents, we demonstrate the racialized social imperative of black Democratic Party identification. We show that black respondents are more likely to identify as Democrats in the presence of other blacks, particularly those respondents whose conservative ideological placement provides a cross-pressuring incentive to otherwise make an alternative partisan choice. Our social explanation of black partisan homogeneity is a significant departure from previous accounts that have focused almost exclusively on attitudinal ascriptions to racial shared fate.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
48.
Managing perineal trauma after childbirth Webb, Sara; Sherburn, Margaret; Ismail, Khaled M K
BMJ (Online),
11/2014, Letnik:
349, Številka:
nov25 27
Journal Article, Book Review
Recenzirano
Every year millions of women worldwide sustain trauma to the perineum when giving birth. Around 6% of these women will have short term wound complications such as infection and dehiscence.1 Some are ...also at risk of long term problems such as dyspareunia, pain, urinary and faecal incontinence, pelvic organ prolapse, and psychosocial problems. Correct assessment and repair of this trauma is therefore essential to help reduce long term complications. In this review we focus on the management of childbirth related perineal trauma that does not involve injury to the anal sphincter complex (this has been dealt with previously2) - that is, first and second degree perineal trauma. We provide healthcare professionals caring for women during childbirth and the postnatal period with an overview of the current best evidence for the assessment, repair, and postnatal management of perineal trauma to reduce the incidence of complications in the short and long term.
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•Effect of urea on the behavior of sodium dioctylsulfosuccinate in water studied.•The urea effect is different below and above 1molkg−1 urea, cu.•The critical micelle concentration is ...dependent on urea concentration above cu only.•NaCl induces a shape change in sodium dioctylsulfosuccinate micelles below cu only.
Understanding the mechanism that controls the folding/unfolding of proteins in the presence of urea continues to be a subject of research, and since micelles mimic biological aggregates, equal importance has been given to the study of surfactants in the presence of urea. Despite several studies on the effect of urea on the behavior of reverse micelles and microemulsions based on sodium dioctylsulfosuccinate (AOT), the urea effect on AOT regular micelles has not been investigated and hence it is studied herein by using surface tension, steady-state fluorescence, and dynamic light scattering methods. The effect of urea on the behavior of AOT is found to be different below and above 1.0molkg−1 urea (cu). The critical micelle concentration (cmc) is almost independent of urea concentration below cu, whereas it increases with increasing urea amount above cu. In AOT+urea aqueous solution below cu, added NaCl at a particular critical concentration (c*) induces sudden increase in the values of (i) counterion binding constant, (ii) aggregation number, (iii) fluorescence intensity ratio of pyrene excimer to monomer, and (iv) hydrodynamic diameter of AOT aggregate, whereas such changes are suppressed by urea above cu. NaCl-induced shape change in AOT micelle takes place if urea concentration is below cu, but hindered above cu. The adsorption behavior of AOT at the air–solution interface as a function of NaCl is also found to be different below and above cu. The urea effect is explained in terms of increase in the polarity of the medium, better solvation of head groups and counterions, and weakening of head group–head group and head group–counterion interactions.
Aim
To explore the experiences of adults with newly diagnosed Type 1 diabetes in order to understand the adaptive processes that occur in the early phase of the condition.
Methods
We conducted ...longitudinal semi‐structured interviews with 30 adults newly diagnosed with Type 1 diabetes (age range 20–67 years; 16 men; median diabetes duration 23.5 months), recruited from hospitals in Denmark and the UK. The data were analysed using a narrative approach.
Results
The narratives could be grouped into three thematic areas: the diagnosis; learning about diabetes; and learning to live with diabetes. Diabetes was characterized as a major disruptor to the established and future life plans of participants, causing significant emotional distress. The narratives showed how early experiences triggered the development of ongoing psychological problems (fear of complications or hypoglycaemia) and diabetes distress, and that navigating different social scenarios (relationships and employment) could be challenging, leading to suboptimal self‐management behaviours. The narratives also showed that health professionals often did not attend effectively to participants’ emotional needs after diagnosis, and that the language used frequently triggered negative feelings, such as fear or a sense of failure.
Conclusions
Many of the common psychosocial problems associated with Type 1 diabetes seem to gestate in the early phase of life with the condition. There appear to be opportunities to enhance the support provided in this phase to minimize these problems.
What's new?
We currently know little about the early experiences of adults newly diagnosed with Type 1 diabetes or how they adapt to a life with diabetes.
This study shows that, after the diagnosis of diabetes, adults experience significant emotional distress and can quickly develop ongoing psychosocial problems that affect their self‐management behaviours.
After diagnosis, adults need much more support in adapting to the condition emotionally, psychologically and socially. Such support may reduce or prevent the development of negative psychosocial reactions that can impede self‐management behaviours and reduce well‐being.
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