The pharmacological treatment of depression consists of stages of trial and error, with less than 40% of patients achieving remission during first medication trial. However, in a large, ...randomized-controlled trial (RCT) in the U.S. ("GUIDED"), significant improvements in response and remission rates were observed in patients who received treatment guided by combinatorial pharmacogenomic testing, compared to treatment-as-usual (TAU). Here we present results from the Canadian "GAPP-MDD" RCT. This 52-week, 3-arm, multi-center, participant- and rater-blinded RCT evaluated clinical outcomes among patients with depression whose treatment was guided by combinatorial pharmacogenomic testing compared to TAU. The primary outcome was symptom improvement (change in 17-item Hamilton Depression Rating Scale, HAM-D17) at week 8. Secondary outcomes included response (≥50% decrease in HAM-D17) and remission (HAM-D17 ≤ 7) at week 8. Numerically, patients in the guided-care arm had greater symptom improvement (27.6% versus 22.7%), response (30.3% versus 22.7%), and remission rates (15.7% versus 8.3%) compared to TAU, although these differences were not statistically significant. Given that the GAPP-MDD trial was ultimately underpowered to detect statistically significant differences in patient outcomes, it was assessed in parallel with the larger GUIDED RCT. We observed that relative improvements in response and remission rates were consistent between the GAPP-MDD (33.0% response, 89.0% remission) and GUIDED (31.0% response, 51.0% remission) trials. Together with GUIDED, the results from the GAPP-MDD trial indicate that combinatorial pharmacogenomic testing can be an effective tool to help guide depression treatment in the context of the Canadian healthcare setting (ClinicalTrials.gov NCT02466477).
In this multicenter, placebo-controlled, randomized trial of intravenous magnesium sulfate in women at imminent risk for delivery between 24 and 31 weeks of gestation, magnesium sulfate did not ...significantly reduce the primary composite outcome of moderate or severe cerebral palsy or death. However, it did result in a reduced rate of cerebral palsy among survivors (a prespecified secondary outcome), which may suggest the possibility of benefit.
In women at imminent risk for delivery between 24 and 31 weeks of gestation, magnesium sulfate did not significantly reduce the primary composite outcome of moderate or severe cerebral palsy or death. However, it did result in a reduced rate of cerebral palsy among survivors.
Cerebral palsy is characterized by abnormal control of movement and posture that results in limitation of activity. It is caused by nonprogressive damage or dysfunction of the developing fetal or infant brain
1
and is a leading cause of chronic childhood disability, with profound medical, emotional, and economic consequences.
2
Preterm birth is a risk factor for cerebral palsy, and the magnitude of the risk is inversely correlated with gestational age at birth.
3
During the past 20 to 30 years, the survival of infants born markedly preterm has improved dramatically, and whereas some data suggest that the rate of cerebral palsy among . . .
Bull. Amer. Math. Soc. (N.S.) 32 (1995) 309-316 We describe an example of a $C^\infty$ diffeomorphism on a 7--manifold which
has a compact invariant set such that uncountably many of its connected
...components are pseudocircles. (Any 7--manifold will suffice.) Furthermore, any
diffeomorphism which is sufficiently close (in the $C^1$ metric) to the
constructed map has a similar invariant set, and the dynamics of the map on the
invariant set are chaotic.
Pharmacogenomics (PGx) studies the genetic influences on response to medications. Advances in PGx research have enabled preliminary success of commercialization to deliver PGx tests to several ...million patients globally. For example the US and Dutch governments reimburse PGx testing in a number of indications including those for psychiatric medications. However, PGx testing has yet to be adopted as a routine practice in clinical care. Thus policy regulating the commercialization and reimbursement of PGx testing is still at relatively early stages. Due to the rapid increase in clinical trial data and other types of validation, many current policy decisions in terms of reimbursement do not include recent evidence from randomized controlled trials, economic utility studies, and qualitative assessments of stakeholder opinions. The most cited barriers to adoption of PGx testing are 1) evidence for clinical utility, 2) evidence for economic effectiveness, and 3) stakeholder awareness. This presentation will consider these barriers regarding PGx testing and review the substantial new data published using relatively large datasets. We will examine these limitations to PGx testing and provide recommendations for further work to enhance knowledge and awareness of the significant value, and the critical considerations, of PGx testing in psychiatry.
Background The relevance of allergic sensitization, as judged by titers of serum IgE antibodies, to the risk of an asthma exacerbation caused by rhinovirus is unclear. Objective We sought to examine ...the prevalence of rhinovirus infections in relation to the atopic status of children treated for wheezing in Costa Rica, a country with an increased asthma burden. Methods The children enrolled (n = 287) were 7 through 12 years old. They included 96 with acute wheezing, 65 with stable asthma, and 126 nonasthmatic control subjects. PCR methods, including gene sequencing to identify rhinovirus strains, were used to identify viral pathogens in nasal washes. Results were examined in relation to wheezing, IgE, allergen-specific IgE antibody, and fraction of exhaled nitric oxide levels. Results Sixty-four percent of wheezing children compared with 13% of children with stable asthma and 13% of nonasthmatic control subjects had positive test results for rhinovirus ( P < .001 for both comparisons). Among wheezing subjects, 75% of the rhinoviruses detected were group C strains. High titers of IgE antibodies to dust mite allergen (especially Dermatophagoides species) were common and correlated significantly with total IgE and fraction of exhaled nitric oxide levels. The greatest risk for wheezing was observed among children with titers of IgE antibodies to dust mite of 17.5 IU/mL or greater who tested positive for rhinovirus (odds ratio for wheezing, 31.5; 95% CI, 8.3-108; P < .001). Conclusions High titers of IgE antibody to dust mite allergen were common and significantly increased the risk for acute wheezing provoked by rhinovirus among asthmatic children.
Kids, guns, and public policy Cook, Philip J
Law and contemporary problems,
01/1996, Letnik:
59, Številka:
1
Journal Article
Recenzirano
Policy interventions to address the increase in violence among teenagers and discourage violent youth from obtaining, carrying, and using guns; US; 9 articles. Section headings: The problem; ...Strategic analysis of gun markets; Mobilizing the police and the community.
Background:
An acute Achilles tendon rupture (AATR) is a common injury. The controversy that has surrounded the optimal treatment options for AATRs warrants an updated meta-analysis that is ...comprehensive, accounts for loss to follow-up, and utilizes the now greater number of available studies for data pooling.
Purpose:
To meta-analyze the rates of all complications after the treatment of AATRs with a “best-case scenario” and “worst-case scenario” analysis for rerupture rates that assumes that all patients lost to follow-up did not or did experience a rerupture, respectively.
Study Design:
Systematic review and meta-analysis; Level of evidence, 1.
Methods:
Two authors performed a systematic review of the PubMed and Embase databases according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines on February 17, 2020. The included studies were assessed in terms of the level of evidence, quality of evidence, and quality of the literature. A meta-analysis by fixed-effects models was performed if heterogeneity was low (I2 < 25%) and by random-effects models if heterogeneity was moderate to high (I2≥ 25%).
Results:
Surgical treatment was significantly favored over nonsurgical treatment for reruptures. Nonsurgical treatment was significantly favored over surgical treatment for complications other than reruptures, notably infections. Minimally invasive surgery was significantly favored over open repair for complications other than reruptures (no difference for reruptures), in particular for minor complications.
Conclusion:
This meta-analysis demonstrated that surgical treatment was superior to nonsurgical treatment in terms of reruptures. However, the number needed to treat analysis produced nonmeaningful values for all treatment options, except for surgical versus nonsurgical treatment and minimally invasive surgery versus open repair. No single treatment option was revealed to be profoundly favorable with respect to every complication. The results of this meta-analysis can guide clinicians and patients in their treatment decisions that should be made jointly and on a case-by-case basis.
Academic and policy interest in the determinants of subjective well-being continues to grow. To date, the role of temporal discounting—the extent to which people devalue future rewards—in people’s ...reports of their subjective well-being has remained unexplored. This paper is the first to provide evidence on the relationship between discount rates and evaluative and hedonic subjective well-being. Using data from a nationally representative sample of 2000 UK respondents in multiple regression analyses, the results suggest that people who devalue future rewards are less satisfied with life and less happy than those who place greater value on future outcomes. However, those who discount heavily are also more likely to expect that they will be happier in the future.
The benefit of social robots to support child learning in an educational context over an extended period of time is evaluated. Specifically, the effect of personalisation and adaptation of robot ...social behaviour is assessed. Two autonomous robots were embedded within two matched classrooms of a primary school for a continuous two week period without experimenter supervision to act as learning companions for the children for familiar and novel subjects. Results suggest that while children in both personalised and non-personalised conditions learned, there was increased child learning of a novel subject exhibited when interacting with a robot that personalised its behaviours, with indications that this benefit extended to other class-based performance. Additional evidence was obtained suggesting that there is increased acceptance of the personalised robot peer over a non-personalised version. These results provide the first evidence in support of peer-robot behavioural personalisation having a positive influence on learning when embedded in a learning environment for an extended period of time.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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