The main environmental problems associated with water body pollution are typically those caused by the discharge of untreated effluents released by various industries. Wastewater from the textile dye ...industry is itself a large contributor and contains a huge number of complex components, a wide spectrum of organic pollutants with high concentration of biochemical oxygen demand (BOD)/chemical oxygen demand (COD) and other toxic elements. One of several potential techniques to degrade such reactive dyes before being discharged to water bodies is photocatalysis, and bismuth-based photocatalysts are rapidly gaining popularity in this direction. Bismuth oxyhalides, BiOX (X=Cl, Br, I, F), as a group of ternary compound semiconductors (V-VI-VII), have been explored extensively for their photocatalytic activity due to their unique crystal lattice with special layered structure in pure as well as modified form. With suitable band gap and band edge positions, which are a required condition for efficient water breakup and high photon absorption, BiOCl scores over other oxyhalides. Photocatalytic activity depends on many factors such as synthesis method, morphology, size, illumination type, dye choice among others. This paper gives a critical review on bismuth oxyhalides as a family on various aspects of modifications such as doping (with unique and interesting metals as well), morphology and synthesis parameters, polymer and carbon assisted composites in order to further enhance the photocatalytic efficiency in UV/visible region of solar spectrum.
Randomized controlled trials are the principal means of establishing the efficacy of drugs. However pre-marketing trials are limited in size and duration and exclude high-risk populations. They have ...limited statistical power to detect rare but potentially serious adverse events in real-world patients. We summarize the principal methodological challenges in the reporting, analysis and interpretation of safety data in clinical trials using recent examples from systematic reviews. These challenges include the lack of an evidentiary gold standard, the limited statistical power of randomized controlled trials and resulting type 2 error, the lack of adequate ascertainment of adverse events and limited generalizability of trials that exclude high risk patients. We discuss potential solutions to these challenges. Evaluation of drug safety requires careful examination of data from heterogeneous sources. Meta-analyses of drug safety should include appropriate statistical methods and assess the optimal information size to avoid type 2 errors. They should evaluate outcome reporting biases and missing data to ensure reliable and accurate interpretation of findings. Regulatory and academic partnerships should be fostered to provide an independent and transparent evaluation of drug safety.
Myocarditis is a rare but severe adverse event associated with immune checkpoint inhibitors, its diagnosis depending on a high index of suspicion and appropriate investigations. Our objective was to ...systematically review the diagnostic approaches to myocarditis associated with immune checkpoint inhibitors.
The systematic review was conducted according to the PRISMA guidelines (PROSPERO Registration: CRD42018097247). We searched Medline and Embase for case reports, case series, and observational studies published in journal articles or presented as conference abstracts that describe patients who developed myocarditis after immune checkpoint inhibitor therapy.
After a review of 2326 citations, we included 88 cases (53 case reports/series published in journal articles and 35 cases in the observational study). Serum troponin was elevated in 98% of the case reports and 94% of participants in the observational study. ST changes including ST elevation were present in almost a third of case reports. Echocardiography revealed preserved left ventricular ejection fraction in 32% of case reports and 51% of cases in the observational study; however, preserved systolic function did not predict greater survival. Patients who suffered poorer prognosis tended to have major conduction defects or ventricular arrhythmias more frequently than patients who did not. Acute myocardial ischemia was ruled out in all cases (n = 31) when the diagnostic workup included coronary angiography.
Immune checkpoint inhibitor-associated myocarditis is characterized by elevation of cardiac troponin levels and non-specific electrocardiographic changes. Early coronary angiography may distinguish it from myocardial ischemia or myocardial infarction.
•Largest systematic review of immune checkpoint inhibitor-induced myocarditis cases•Cases show elevated cardiac biomarkers, nonspecific electrocardiographic changes.•Cases with poor prognosis reported conduction defects and arrhythmias.•High negative predictive value of coronary angiography may help in prompt diagnosis.
Network meta-analysis, in the context of a systematic review, is a meta-analysis in which multiple treatments (that is, three or more) are being compared using both direct comparisons of ...interventions within randomized controlled trials and indirect comparisons across trials based on a common comparator. To ensure validity of findings from network meta-analyses, the systematic review must be designed rigorously and conducted carefully. Aspects of designing and conducting a systematic review for network meta-analysis include defining the review question, specifying eligibility criteria, searching for and selecting studies, assessing risk of bias and quality of evidence, conducting a network meta-analysis, interpreting and reporting findings. This commentary summarizes the methodologic challenges and research opportunities for network meta-analysis relevant to each aspect of the systematic review process based on discussions at a network meta-analysis methodology meeting we hosted in May 2010 at the Johns Hopkins Bloomberg School of Public Health. Since this commentary reflects the discussion at that meeting, it is not intended to provide an overview of the field.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The association between sodium-glucose cotransporter 2 inhibitors (SGLT2i's) and lower extremity amputation is unclear.
To systematically review randomized control trials (RCTs) and observational ...studies quantifying risk of lower extremity amputations associated with SGLT2i use.
We searched PubMed, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials from January 2011 to February 2020 for RCTs and observational studies including lower extremity amputation outcomes for individuals with type 2 diabetes mellitus treated with SGLT2i's vs. alternative treatments or placebo.
Two reviewers independently extracted data.
Our primary outcome was risk of lower limb amputation. Secondary outcomes included peripheral arterial disease, peripheral vascular disease, venous ulcerations, and diabetic foot infections. We also evaluated the risk of bias. We conducted random and fixed effects relative risk meta-analysis of RCTs.
After screening 2,006 studies, 12 RCTs and 18 observational studies were included, of which 7 RCTs and 18 observational studies had at least one event. The random effects meta-analysis of 7 RCTs suggested the absence of a statistically significant association between SGLT2i exposure with evidence of substantial statistical heterogeneity (n = 424/23,716 vs n = 267/18,737 in controls; RR 1.28, CI's 0.93-1.76; I2 = 62.0%; p = 0.12) whereas fixed effects analysis showed an increased risk with statistical heterogeneity (RR 1.27, 1.09-1.48; I2 = 62%; p = 0.003). Subgroup analysis of canagliflozin vs placebo showed a statistically significantly increased risk in a fixed effects meta-analysis (n = 2 RCTs, RR 1.59, 1.26-2.01; I2 = 88%; p = 0.0001) whereas the meta-analysis of dapagliflozin or empagliflozin (n = 2 RCTs each) and a single RCT for ertugliflozin did not show a significantly increased risk. The findings from observational studies were too heterogeneous to be pooled in a meta-analysis and draw meaningful conclusions. Both randomized and observational studies were of generally good methodological quality.
Overall, there was no consistent evidence of SGLT2i exposure and increased risk of amputation. The increased risk of amputation seen in the large, long-term Canagliflozin Cardiovascular Assessment Study (CANVAS) trial for canagliflozin, and select observational studies, merits continued exploration.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Grassroots innovation is rapidly gaining research attention because of its crucial role in entrepreneurship development. Although entrepreneurial orientation holds the key for entrepreneurial ...success, research on how entrepreneurial orientation impacts the relationship between grassroots innovation (GRI) and entrepreneurial success is critical. This research is still in its infancy and has not adequately been addressed. This study endeavors to fill this gap while examining how the three factors of grassroots innovation such as new grassroots learning practices, local solution and networking capabilities influence entrepreneurial orientation enroute to affecting economic benefits and non-economic benefits from entrepreneurial activity. The study involved data from 400 grassroots innovators and a structural equation modeling approach was used to fit the data based on the aforementioned factors and components. The study reveals that entrepreneurial orientation is observed to fully mediate the relationship between the following three linear dependencies: new grassroots learning practices and economic benefits, networking capabilities and economic benefits, and local solution and non-economic benefits. This study also found that entrepreneurial orientation partially mediates the relationship in the following cases: new grassroots learning practices and non-economic benefits, networking capabilities and non-economic benefits, and local solution and economic benefits. The results provide empirical evidence to support that entrepreneurial orientation spurred by grassroots innovation significantly influence entrepreneurial success in the Indian context.
•This study examines how grassroots innovation affects entrepreneurial success.•Survey data from 400 grassroots innovators in India is collected.•Structural equation modeling is used.•This empirical research firstly explores entrepreneurial potential of grassroots innovation.•Entrepreneurial orientation mediates the grassroots innovation-entrepreneurial success relationship.
In this article, we explore and theorise how actors in the Sheffield City Region envision the development and orchestration of an innovation ecosystem in order to capture value from industry 4.0 ...technologies for manufacturing firms. This is theoretically motivated by the need to harmonise the knowledge combination and recombination practices that are required for the successful existence of innovation ecosystems at a regional level, in the applied context of industry 4.0 regional transformations. Drawing on data originating in semi‐structured interviews, a focus group and a real‐time Delphi with companies, companies associations, Higher Education Institutions, policy makers and Research and Technology Organisations, we examine specifically the role played by boundary organisations and how they respond by dynamically managing and articulating demands from within the network of partners. Our study deepens the theoretical and operational understanding of boundary organisations in the context of regional innovation systems and discusses how to sustain their role of bridging diverse epistemic communities.
Abstract Purpose We sought to evaluate whether exogenous testosterone therapy is associated with increased risk of serious cardiovascular events as compared to other treatments or placebo. Methods ...Study selection included randomized controlled trials (RCTs) and observational studies which enrolled men aged 18 years or older receiving exogenous testosterone for three or more days were included. The primary outcomes were death due to all causes, myocardial infarction and stroke. Secondary outcomes were other hard clinical outcomes such as heart failure, arrhythmia and cardiac procedures. Peto Odds ratio was used to pool data from RCTs. Risk of bias was assessed using Cochrane Collaboration tool and Newcastle and Ottawa scale respectively. The strength of evidence was evaluated using the Grades of Recommendation, Assessment, Development and Evaluation Working Group approach. Results A total of 39 RCTs and 10 observational studies were included. Meta-analysis was done using data from 30 RCTs. Compared to placebo, exogenous testosterone treatment did not show any significant increase in risk of myocardial infarction (OR 0.87, 95% CI 0.39-1.93, 16 RCTs), stroke (OR 2.17, CI 0.63-7.54, 9 RCTs) or mortality (OR 0.88, CI 0.55-1.41, 20 RCTs). Observational studies showed marked clinical and methodological heterogeneity. The evidence was rated as very low quality due to the high risk of bias, imprecision and inconsistency Conclusions We did not find any significant association between exogenous testosterone treatment and myocardial infarction, stroke or mortality in randomized controlled trials. The very low quality of the evidence precludes definitive conclusion on the cardiovascular effects of testosterone.
OBJECTIVE Type 2 diabetes is increasingly common and associated with substantial morbidity and mortality. This study examines trends in the patterns and costs of drug treatment of type 2 diabetes ...from 1997 to 2012. RESEARCH DESIGN AND METHODS We conducted descriptive analyses of cross-sectional data using the IMS Health National Disease and Therapeutic Index, a nationally representative audit of ambulatory physician practices in the U.S. We focused on visits for diabetes among patients 35 years of age or older. We used the IMS Health National Prescription Audit of pharmacy dispensing to derive information about drug expenditures. RESULTS Ambulatory diabetes visits increased from 23 million treatment visits in 1997 (95% CI 21-25) to 35 million (32-37) in 2007 and declined to 31 million visits by 2012 (27-31). Between 1997 and 2012 biguanide use increased, from 23% (20-26) to 53% (50-56) of treatment visits. Glitazone use grew from 6% (4-8) in 1997 (41% 39-43 of all visits in 2005), but declined to 16% (14-18) by 2012. Since 2005, dipeptidyl peptidase-4 (DPP-4) inhibitor use increased steadily, representing 21% (18-23) of treatment visits by 2012. Glucagon-like peptide 1 (GLP-1) agonists accounted for 4% of treatment visits in 2012. Visits where two or more drug compounds were used increased nearly 40% from 1997 to 2012. Between 2008 and 2012, drug expenditures increased 61%, driven primarily by use of insulin glargine and DPP-4 inhibitors. CONCLUSIONS Declining sulfonylurea and glitazone use has been offset by increases in DPP-4 inhibitor use and, to a lesser degree, use of GLP-1 agonists. Treatment of diabetes has grown in complexity while older treatments continue to be replaced or supplemented by newer therapies.
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